A single bout of resistance exercise triggers mitophagy, potentially involving the ejection of mitochondria in human skeletal muscle.

AIM: The present study aimed to investigate the effects of a single bout of resistance exercise on mitophagy in human skeletal muscle (SkM). METHODS: Eight healthy men were recruited to complete an acute bout of one-leg resistance exercise. SkM biopsies were obtained one hour after exercise in the resting leg (Rest-leg) and the contracting leg (Ex-leg). Mitophagy was assessed using protein-related abundance, transmission electron microscopy (TEM), and fluorescence microscopy. RESULTS: Our results show that acute resistance exercise increased pro-fission protein phosphorylation (DRP1Ser616) and decreased mitophagy markers such as PARKIN and BNIP3L/NIX protein abundance in the Ex-leg. Additionally, mitochondrial complex IV decreased in the Ex-leg when compared to the Rest-leg. In the Ex-leg, TEM and immunofluorescence images showed mitochondrial cristae abnormalities, a mitochondrial fission phenotype, and increased mitophagosome-like structures in both subsarcolemmal and intermyofibrillar mitochondria. We also observed increased mitophagosome-like structures on the subsarcolemmal cleft and mitochondria in the extracellular space of SkM in the Ex-leg. We stimulated human primary myotubes with CCCP, which mimics mitophagy induction in the Ex-leg, and found that BNIP3L/NIX protein abundance decreased independently of lysosomal degradation. Finally, in another human cohort, we found a negative association between BNIP3L/NIX protein abundance with both mitophagosome-like structures and mitochondrial cristae density in the SkM. CONCLUSION: The findings suggest that a single bout of resistance exercise can initiate mitophagy, potentially involving mitochondrial ejection, in human skeletal muscle. BNIP3L/NIX is proposed as a sensitive marker for assessing mitophagy flux in SkM.

Mitofusin-2 induced by exercise modifies lipid droplet-mitochondria communication, promoting fatty acid oxidation in male mice with NAFLD.

BACKGROUND AND AIM: The excessive accumulation of lipid droplets (LDs) is a defining characteristic of nonalcoholic fatty liver disease (NAFLD). The interaction between LDs and mitochondria is functionally important for lipid metabolism homeostasis. Exercise improves NAFLD, but it is not known if it has an effect on hepatic LD-mitochondria interactions. Here, we investigated the influence of exercise on LD-mitochondria interactions and its significance in the context of NAFLD. APPROACH AND RESULTS: Mice were fed high-fat diet (HFD) or HFD-0.1 % methionine and choline-deficient diet (MCD) to emulate simple hepatic steatosis or non-alcoholic steatohepatitis, respectively. In both models, aerobic exercise decreased the size of LDs bound to mitochondria and the number of LD-mitochondria contacts. Analysis showed that the effects of exercise on HOMA-IR and liver triglyceride levels were independent of changes in body weight, and a positive correlation was observed between the number of LD-mitochondria contacts and NAFLD severity and with the lipid droplet size bound to mitochondria. Cellular fractionation studies revealed that ATP-coupled respiration and fatty acid oxidation (FAO) were greater in hepatic peridroplet mitochondria (PDM) from HFD-fed exercised mice than from equivalent sedentary mice. Finally, exercise increased FAO and mitofusin-2 abundance exclusively in PDM through a mechanism involving the curvature of mitochondrial membranes and the abundance of saturated lipids. Accordingly, hepatic mitofusin-2 ablation prevented exercise-induced FAO in PDM. CONCLUSIONS: This study demonstrates that aerobic exercise has beneficial effects in murine NAFLD models by lessening the interactions between hepatic LDs and mitochondria, and by decreasing LD size, correlating with a reduced severity of NAFLD. Additionally, aerobic exercise increases FAO in PDM and this process is reliant on Mfn-2 enrichment, which modifies LD-mitochondria communication.

Plasma insulin-like growth factor-II (IGF-II) and IGF-II/IGF-I ratio in a chilean case of Doege-Potter Syndrome

Introduction: Doege-Potter syndrome is a rare clinical entity characterized by recurrent hypoglycemic events caused by non-pancreatic tumors secreting an incompletely processed high-molecular-weight form of Insulin-like Growth factor-II (IGF-II). Aim: To report IGF-II and IGF-I circulating levels in a Chilean case of Doege-Potter syndrome and control individuals, and to identify the high-molecular-weight form of IGF-II. Methods: We measured IGF-II and IGF-I plasma levels using enzyme-linked immunoassays (ELISA) in the patient and ten controls. We identified the high-molecular-weight form of IGF-II performed by Western blot. Results: The plasma concentration of IGF-II in the patient was 868.9 ng/mL, which is only slightly > 80th percentile of controls (681,4 ± 212,8 ng/mL; mean ± standard deviation). In contrast, IGF-I plasma concentration in the patient was 17.6 ng/mL, which is notoriously lower than the corresponding levels in controls (109.1 ± 19.1 ng/mL). The IGF-II/IGF-I ratio in the patient was 49.4 (normal value < 10), which is 7.8 times higher compared to the average ratio of controls (6.3 ± 1.5). The high-molecular form of IGF-II presence in samples was confirmed through Western blot. Conclusions: The plasma IGF-II/IGF-I ratio better indicates the Doege-Potter syndrome's metabolic impairment than isolated measurements of circulating IGF-II or IGF-I levels.

Introducción: El síndrome de Doege-Potter es una rara entidad clínica caracterizada por eventos hipoglicémicos recurrentes causados por tumores no-pancreáticos que secretan una forma incompletamente procesada con alto peso molecular del factor de crecimiento similar a la insulina-II (IGF-II). Objetivo: Reportar los niveles circulantes de IGF-II e IGF-I en un caso chileno de síndrome de Doege-Potter y en controles, así como identificar la forma de alto peso molecular de IGF-II. Métodos: Los niveles plasmáticos de IGF-II e IGF-I se determinaron mediante inmunoensayos de tipo ELISA en el caso índice y en 10 controles. La forma de alto peso molecular de IGF-II se identificó mediante western-blot. Resultados: La concentración plasmática de IGF-II en el paciente fue de 868,9 ng/mL, que es sólo ligeramente superior al percentil 80 del grupo control (681,4 ± 212,8 ng/mL; media ± desviación estándar). Sin embargo, la concentración plasmática de IGF-I en el paciente fue de 17,6 ng/ mL, que es notoriamente inferior a la de los controles (109,1 ± 19,1 ng/mL). La razón IGF-II/IGF-I en el paciente fue de 49,4 (valor normal < 10), que es 7,8 veces superior a la media de los controles (6,3 ± 1,5). La presencia de la forma de alto peso molecular de IGF-II se confirmó mediante western-blot. Conclusiones: La razón IGF-II/IGF-I en plasma es un mejor indicador de las alteraciones metabólicas del síndrome de Doege-Potter que las mediciones aisladas de IGF-II o IGF-I circulantes.

Spheroids derived from the stromal vascular fraction of adipose tissue self-organize in complex adipose organoids and secrete leptin.

BACKGROUND: Adipose tissue-derived stromal vascular fraction (SVF) harbors multipotent cells with potential therapeutic relevance. We developed a method to form adipose spheroids (AS) from the SVF with complex organoid structure and enhanced leptin secretion upon insulin stimulation. METHODS: SVF was generated from the interscapular brown adipose tissue of newborn mice. Immunophenotype and stemness of cultured SVF were determined by flow cytometry and in vitro differentiation, respectively. Spheroids were generated in hanging drops and non-adherent plates and compared by morphometric methods. The adipogenic potential was compared between preadipocyte monolayers and spheroids. Extracellular leptin was quantified by immunoassay. Lipolysis was stimulated with isoprenaline and quantified by colorimetric methods. AS viability and ultrastructure were determined by confocal and transmission electron microscopy analyses. RESULTS: Cultured SVF contained Sca1 + CD29 + CD44 + CD11b- CD45- CD90- cells with adipogenic and chondrogenic but no osteogenic potential. Culture on non-adherent plates yielded the highest quantity and biggest size of spheroids. Differentiation of AS for 15 days in a culture medium supplemented with insulin and rosiglitazone resulted in greater Pparg, Plin1, and Lep expression compared to differentiated adipocytes monolayers. AS were viable and maintained leptin secretion even in the absence of adipogenic stimulation. Glycerol release after isoprenaline stimulation was higher in AS compared to adipocytes in monolayers. AS were composed of outer layers of unilocular mature adipocytes and an inner structure composed of preadipocytes, immature adipocytes and an abundant loose extracellular matrix. CONCLUSION: Newborn mice adipose SVF can be efficiently differentiated into leptin-secreting AS. Prolonged stimulation with insulin and rosiglitazone allows the formation of structurally complex adipose organoids able to respond to adrenergic lipolytic stimulation.

Differentiation and Imaging of Brown Adipocytes from the Stromal Vascular Fraction of Interscapular Adipose Tissue from Newborn Mice.

Brown adipose tissue (BAT) is only present in mammals and has a thermogenic function. Brown adipocytes are characterized by a multilocular cytoplasm with multiple lipid droplets, a central nucleus, a high mitochondrial content, and the expression of uncoupling protein 1 (UCP1). BAT has been proposed as a potential therapeutic target for obesity and its associated metabolic disorders due to its ability to dissipate metabolic energy as heat. To investigate BAT function and regulation, brown adipocyte culturing is indispensable. The present protocol optimizes tissue processing and cell differentiation for culturing brown adipocytes from newborn mice. Additionally, procedures for the imaging of differentiated adipocytes with both confocal immunofluorescence and transmission electron microscopy are shown. In the brown adipocytes differentiated with the techniques described herein, the major defining features of classical BAT are preserved, including high UCP1 levels, increased mitochondrial mass, and very close physical contact between the lipid droplets and mitochondria, making this method a valuable tool for BAT studies.

Plasma insulin-like growth factor-II (IGF-II) and IGF-II/IGF-I ratio in a chilean case of Doege-Potter Syndrome.

INTRODUCTION: Doege-Potter syndrome is a rare clinical entity characterized by recurrent hypoglycemic events caused by non-pancreatic tumors secreting an incompletely processed high-molecular-weight form of Insulin-like Growth factor-II (IGF-II). AIM: To report IGF-II and IGF-I circulating levels in a Chilean case of Doege-Potter syndrome and control individuals, and to identify the high-molecular-weight form of IGF-II. METHODS: We measured IGF-II and IGF-I plasma levels using enzyme-linked immunoassays (ELISA) in the patient and ten controls. We identified the high-molecular-weight form of IGF-II performed by Western blot. RESULTS: The plasma concentration of IGF-II in the patient was 868.9 ng/mL, which is only slightly > 80th percentile of controls (681,4 ± 212,8 ng/mL; mean ± standard deviation). In contrast, IGF-I plasma concentration in the patient was 17.6 ng/mL, which is notoriously lower than the corresponding levels in controls (109.1 ± 19.1 ng/mL). The IGF-II/IGF-I ratio in the patient was 49.4 (normal value < 10), which is 7.8 times higher compared to the average ratio of controls (6.3 ± 1.5). The high-molecular form of IGF-II presence in samples was confirmed through Western blot. CONCLUSIONS: The plasma IGF-II/IGF-I ratio better indicates the Doege-Potter syndrome's metabolic impairment than isolated measurements of circulating IGF-II or IGF-I levels.

Representaciones de estándares de belleza en profesionales sanitarias que atienden mujeres chilenas diagnosticadas con Trastornos de la Conducta Alimentaria / Representations of beauty standards in health care professionals who attend chilean women diagnosed with Eating Disorder

Resumen Los Estándares de Belleza (EB) cumplen un rol importante como fenómeno sociocultural cuya difusión en el mundo contemporáneo influyen en la manifestación de Trastornos de la Conducta Alimentaria (TCA), mayoritariamente en mujeres. Es así como a pesar de su formación, las Profesionales Sanitarias (PS) que intervienen en TCA no están exentas de la influencia de los EB. Es por ello que el objetivo de este estudio es describir las representaciones de los EB de las PS que atienden población chilena adulta joven diagnosticada con TCA. Se empleó una metodología cualitativa, a través de entrevistas en profundidad a nueve PS. Los resultados principales muestran que las profesionales coinciden en que el sistema sociocultural ha influido históricamente en la construcción de EB, dotando de mandatos y prototipos, llevando a las mujeres a caer en dietas perjudiciales para la salud o en TCA, con la finalidad de alcanzar el cuerpo esperado socialmente y sentir pertenencia. Siendo en la actualidad las redes sociales, familia, amigos, ámbito educativo y laboral mantenedores de estos EB. Es así como las profesionales han empleado distintas estrategias (p. ej., estilo de vida saludable, aceptación de la propia imagen corporal), para que estos EB no interfieran en su ejercicio profesional.

Abstract Beauty Standards (BS) have an outstanding role in our society, as a sociocultural phenomenon is easily spread in the contemporary world as they influence in people's Eating Disorders (ED) mostly in women. Thus, despite their studies, Health Professionals (HP) who work with eating disorders could be influenced by BS. For this reason, the aim of this study is to describe the representations of BE of the HP who attend young adult chilean population diagnosed with eating disorders. A qualitative methodology was used, through in-depth interviews. The main results show that professionals agree that the sociocultural system has historically influenced the construction of BS, providing mandates and prototypes, leading women to fall into harmful diets or TCA in order to reach the body that is accepted and developed a belonging feeling. Currently social networks, family, friends, educational and work environment maintain these BS. In consequence health professionals have used different strategies (i.e. healthy lifestyle, acceptance of their own body image), so that these BS do not interfere in their professional practice.

Decreased caveolae in AGPAT2 lacking adipocytes is independent of changes in cholesterol or sphingolipid levels: A whole cell and plasma membrane lipidomic analysis of adipogenesis.

BACKGROUND: Adipocytes from lipodystrophic Agpat2-/- mice have impaired adipogenesis and fewer caveolae. Herein, we examined whether these defects are associated with changes in lipid composition or abnormal levels of caveolae-associated proteins. Lipidome changes were quantified in differentiated Agpat2-/- adipocytes to identify lipids with potential adipogenic roles. METHODS: Agpat2-/- and wild type brown preadipocytes were differentiated in vitro. Plasma membrane was purified by ultracentrifugation. Number of caveolae and caveolae-associated proteins, as well as sterol, sphingolipid, and phospholipid lipidome were determined across differentiation. RESULTS: Differentiated Agpat2-/- adipocytes had decreased caveolae number but conserved insulin signaling. Caveolin-1 and cavin-1 levels were equivalent between Agpat2-/- and wild type adipocytes. No differences in PM cholesterol and sphingolipids abundance were detected between genotypes. Levels of phosphatidylserine at day 10 of differentiation were increased in Agpat2-/- adipocytes. Wild type adipocytes had increased whole cell triglyceride, diacylglycerol, phosphatidylglycerol, phosphatidic acid, lysophosphatidylcholine, lysophosphatidylethanolamine, and trihexosyl ceramide, and decreased 24,25-dihydrolanosterol and sitosterol, as a result of adipogenic differentiation. By contrast, adipogenesis did not modify whole cell neutral lipids but increased lysophosphatidylcholine, sphingomyelin, and trihexosyl ceramide levels in Agpat2-/- adipocytes. Unexpectedly, adipogenesis decreased PM levels of main phospholipids in both genotypes. CONCLUSION: In Agpat2-/- adipocytes, decreased caveolae is not associated with changes in PM cholesterol nor sphingolipid levels; however, increased PM phosphatidylserine content may be implicated. Abnormal lipid composition is associated with the adipogenic abnormalities of Agpat2 -/- adipocytes but does not prevent insulin signaling.

Absence of AGPAT2 impairs brown adipogenesis, increases IFN stimulated gene expression and alters mitochondrial morphology.

BACKGROUND: Biallelic loss of function variants in AGPAT2, encoding 1-acylglycerol-3-phosphate O-acyltransferase 2, cause congenital generalized lipodystrophy type 1, a disease characterized by near total loss of white adipose tissue and metabolic complications. Agpat2 deficient (Agpat2-/-) mice completely lacks both white and interscapular brown adipose tissue (iBAT). The objective of the present study was to characterize the effects of AGPAT2 deficiency in brown adipocyte differentiation. METHODS: Preadipocytes obtained from newborn (P0.5) Agpat2-/- and wild type mice iBAT were differentiated into brown adipocytes, compared by RNA microarray, RT-qPCR, High-Content Screening (HCS), western blotting and electron microscopy. RESULTS: 1) Differentiated Agpat2-/- brown adipocytes have fewer lipid-laden cells and lower abundance of Pparγ, Pparα, C/ebpα and Pgc1α, both at the mRNA and protein levels, compared those to wild type cells. Prmd16 levels were equivalent in both, Agpat2-/- and wild type, while Ucp1 was only induced in wild type cells, 2) These differences were not due to lower abundance of preadipocytes, 3) Differentiated Agpat2-/- brown adipocytes are enriched in the mRNA abundance of genes participating in interferon (IFN) type I response, whereas genes involved in mitochondrial homeostasis were decreased, 4) Mitochondria in differentiated Agpat2-/- brown adipocytes had altered morphology and lower mass and contacting sites with lipid droplets concomitant with lower levels of Mitofusin 2 and Perlipin 5. CONCLUSION: AGPAT2 is necessary for normal brown adipose differentiation. Its absence results in a lower proportion of lipid-laden cells, increased expression of interferon-stimulated genes (ISGs) and alterations in mitochondrial morphology, mass and fewer mitochondria to lipid droplets contacting sites in differentiated brown adipocytes.

Acuerdo entre tres evaluadores y un experto en la detección de riesgo relacional en el posparto entre la madre y su recién nacido, Temuco, IX región, Chile, 2010 / Agreement among three examiners and one expert in the detection of mother-infant attachment risk during the post-partum period, Temuco, IX región, Chile, 2010

Introducción: después del nacimiento es recomendable evaluar el vínculo entre la madre y el recién nacido para detectar riesgo de alteraciones en esta interacción y planificar intervenciones precoces para favorecer el apego seguro. El evaluador debe realizar observaciones confiables para el diagnóstico, para lo cual requiere capacitación, entrenamiento y experiencia.Objetivo: describir la concordancia interobservador entre tres evaluadores y un experto en la detección de riesgo relacional entre la madre y su recién nacido, aplicando la pauta de evaluación relacional de Kimelman.Materiales y métodos: estudio de corte transversal. Se evaluaron diadas madre-hijo durante su estadía en el Hospital Hernán Henríquez Aravena de Temuco, centro de referencia de la región de la Araucanía, sur de Chile. Se excluyeron las madres de recién nacidos hospitalizados. Muestra no probabilística por conveniencia. La concordancia interobservador fue medida en el diagnóstico del riesgo de mala interacción y en las variables de la pauta relacional de Kimelman. Para el análisis se utilizó la estadística kappa, se consideraron aceptables las observaciones interobservador con valor kappa mayor a 0,5.Resultados: se evaluaron 71 díadas madre-recién nacido (M-RN) en el periodo comprendido entre el 1 y 30 de marzo de 2010. La concordancia en los ítems que evalúan la interacción entre la madre y el recién nacido se encuentra entre 0 y 1. En los ítems que evalúan el grado de aceptación la concordancia está entre 0,59 y 0,86. La calificación de la armonía de la interacción está sobre 0,57; la tonalidad afectiva entre 0,42 y 0,83; el diagnóstico, tanto del alto riesgo como del bajo riesgo relacional, fluctúa entre 0,43 y 0,91.Conclusión: se enfatiza la importancia de la capacitación con base en la teoría del apego, las características de la interacción diádica y el desarrollo de competencias para entrevistar y observar sistemáticamente, a fin de obtener certeza de las conductas observadas.

Introduction: It is advisable to assess the bonding between the mother and the newborn in order to identify abnormalities in this interaction and plan for early interventions to facilitate attachment. The examiner must make reliable observations for diagnosis and this requires training and experience.Objective: To describe inter-observer agreement among three examiners and one expert in the detection of mother-infant attachment risk between, applying the Kimelman attachment assessment guide.Materials and methods: Cross-sectional study. Mother-infant pairs were assessed during their stay at Hospital Hernán Henríquez Aravena in Temuco, a referral centre for the Araucanía region in southern Chile. Mothers of hospitalized infants were excluded. A non-probabilistic sample was used for convenience. Inter-observer agreement was measured in relation to the diagnosis of the risk of poor interaction and the variables of the Kimelman attachment guide. Kappa statistics was used for the analysis and inter-observer observations were considered acceptable when the kappa value was greater than 0.5.Results: Overall, 71 mother-infant (M-I) pairs were assessed during the period between March 1st and March 30th, 2010. Agreement regarding the items that assess the interaction between the mother and the newborn is in the range of 0 to 1. Items that assess the degree of acceptance are between 0.59 and 0.86. The rating for interaction harmony is above 0.57; affective tone is between 0.42 and 0.83; the diagnosis of high as well as low relational risk ranges between 0.43 and 0.91.Conclusion: We emphasize the importance of training based on the theory of attachment, the characteristics of the dyadic interaction, and the development of interviewing and systematic observation competencies in order to be certain about observed behaviours.

Violencia de pareja en estudiantes universitarios del sur de Chile / Intimate partner violence in south Chilean college students

El presente estudio tuvo como objetivo estimar la magnitud de la violencia de pareja en estudiantes universitarios en la Región sur de Chile, describir las formas en que se manifiesta; los factores de riesgo asociados, las consecuencias y las estrategias utilizadas para enfrentarla. Método: Se utilizó un diseño cuantitativo descriptivo. La muestra estuvo constituida por 447 estudiantes universitarios balanceados por sexo, a los cuales se les administró un cuestionario que indagaba acerca de conducta violenta en las relaciones de pareja. Resultados: 57% reporta haber vivido alguna vez en su vida violencia psicológica y 26% violencia física. Los factores asociados a recibir violencia física fueron: sexo, violencia psicológica recibida, actitudes favorables hacia la violencia, y baja participación religiosa, las variables asociadas a la violencia psicológica fueron: sexo, violencia física recibida, actitudes favorables hacia la violencia, y mayor tiempo de relación de pareja. Los resultados indican que la violencia de pareja es un problema significativo en los universitarios y sus características facilitan su invisibilización, dificultando un abordaje oportuno.

The present study sought to estimate the magnitude of intimate partner violence (IPV) in university students in southern Chile; to describe its manifestations, its associated factors, consequences and coping strategies. Method: A descriptive quantitative design was used, the sample was constituted by 447 university students randomly selected balanced by sex. Participants were asked about violent behaviour conduct through a questionnaire. Results: 57% of those questioned reported having experienced some psychological abuse, 26% reported physical violence at least once in their lifetime. Associated factors to receive physical violence were: sex, suffering psychological violence, favourable attitudes towards violence, and low religious participation. Associated factor to receive psychological violence was: sex, physical violence received, favourable attitudes towards the violence, and the length of the relationship. Discussion: Typical features of intimate partner violence in college life settings seem to favor its invisibility, thus turning it into a difficult phenomenon to approach and to prevent.

Programa de prevención de abuso sexual infantil para menores preescolares y escolares de educación básica del sector de Pedro de Valdivia de la ciudad de Temuco / Program of prevention of infantile sexual abuse for prescholastic and scholastic of basic education of the sector of Pedro de Valdivia of the city of Temuco

El presente estudio es la ejecución y evaluación de un Programa de Prevención de Abuso Sexual Infantil a partir de una práctica en red como estrategia para implementar proyectos que permitan movilizar recursos profesionales e institucionales para abordar temáticas tan complejas como el abuso sexual y su prevención. El proyecto consistió en diseñar un programa a partir de un video interactivo de prevención en el tema señalado. Se aplico en 10 instituciones integrantes de la Rede Abordaje Integral del Maltrato Infantil Creciendo Juntos la cual funciona desde el año 1996 en un sector urbano-popular de la ciudad de Temuco en Chile. A través de esta estrategia se capacitaron 250 niños de edad escolar y preescolar en el desarrollo de habilidades de autocuidado. A partir del registro cualitativo se identificaron las representaciones sociales de la muestra respecto a limites corporales, relación con los extraños, confianza con padres y educadores, y conciencia de riesgo de abuso sexual y maltrato infantil. El componente lúdico y participativo es un elemento que favorece el desarrollo de este tipo de proyectos

Ejercicios fisicos terapeuticos para pacientes artrosicos

Esta investigacion se realizo con una muestra de 29 personas que padecian de artrosis y asistian a un area terapeutica perteneciente al municipio Plaza de la Revolucion. La muestra fue objeto de la aplicacion de mediciones goniometricas y de una encuesta mediante la que se compararon los resultados obtenidos en dichas mediciones, asi como la determinacion del consumo personal de medicamentos y el gasto monetario, por parte de las personas incluidas en el estudio. Los resultados demostraron que los ejercicios terapeuticos habian aumentado la movilidad de las articulaciones estudiadas, especialmente la del hombro. Tambien se observo una reduccion en el consumo diario de medicamentos en tabletas, ya que de las 105 que se consumian antes de comenzar el tratamiento con ejercicios, en la actualidad solo se consumen 55,5 lo cual representa un ahorro de 2,79 pesos. (AU)