Body composition assessment with ultrasound muscle measurement: optimization through the use of semi-automated tools in colorectal cancer.

Colorectal cancer (CRC) is a disease with a high prevalence and major impact on global health. Body composition (BC) data are of great importance in the assessment of nutritional status. Ultrasound (US) is an emerging, accessible and non-invasive technique that could be an alternative when it is not feasible to perform computed tomography (CT). The aim of this study is to evaluate the correlation between CT, as a reference technique, and US of the rectus femoris (RF) as a "proof of concept," in a cohort of patients with CRC and assess the optimisation of results obtained by US when performed by our new semi-automated tool. A single-centre cross-sectional study including 174 patients diagnosed with CRC and undergoing surgery was carried out at the Vall d'Hebron Hospital. We found a strong correlation between CT and US of the RF area (r = 0.67; p < 0.005). The latter, is able to discriminate patients with worse prognosis in terms of length of hospital stay and discharge destination (AUC-ROC = 0.64, p 0.015). These results improve when they are carried out with the automatic tool (area AUC-ROC = 0.73, p 0.023), especially when normalised by height and eliminating patients who associate overflow. According to our results, the US could be considered as a valuable alternative for the quantitative assessment of muscle mass when CT is not feasible. These measurements are improved when measuring software is applied, such as "Bat" software.

Comparison of computed tomography and dual-energy X-ray absorptiometry in the evaluation of body composition in patients with obesity.

Objective: a) To evaluate the accuracy of the pre-existing equations (based on cm2 provided by CT images), to estimate in kilograms (Kg) the body composition (BC) in patients with obesity (PwO), by comparison with Dual-energy X-ray absorptiometry (DXA). b) To evaluate the accuracy of a new approach (based on both cm2 and Hounsfield Unit parameters provided by CT images), using an automatic software and artificial intelligence to estimate the BC in PwO, by comparison with DXA. Methods: Single-centre cross-sectional study including consecutive PwO, matched by gender with subjects with normal BMI. All the subjects underwent BC assessment by Dual-energy X-ray absorptiometry (DXA) and skeletal-CT at L3 vertebrae. CT images were processed using FocusedON-BC software. Three different models were tested. Model 1 and 2, based on the already existing equations, estimate the BC in Kg based on the tissue area (cm2) in the CT images. Model 3, developed in this study, includes as additional variables, the tissue percentage and its average Hounsfield unit. Results: 70 subjects (46 PwO and 24 with normal BMI) were recruited. Significant correlations for BC were obtained between the three models and DXA. Model 3 showed the strongest correlation with DXA (r= 0.926, CI95% [0.835-0.968], p<0.001) as well as the best agreement based on Bland - Altman plots. Conclusion: This is the first study showing that the BC assessment based on skeletal CT images analyzed by automatic software coupled with artificial intelligence, is accurate in PwO, by comparison with DXA. Furthermore, we propose a new equation that estimates both the tissue quantity and quality, that showed higher accuracy compared with those currently used, both in PwO and subjects with normal BMI.

Laboratory Hyperspectral Image Acquisition System Setup and Validation.

Hyperspectral Imaging (HSI) techniques have demonstrated potential to provide useful information in a broad set of applications in different domains, from precision agriculture to environmental science. A first step in the preparation of the algorithms to be employed outdoors starts at a laboratory level, capturing a high amount of samples to be analysed and processed in order to extract the necessary information about the spectral characteristics of the studied samples in the most precise way. In this article, a custom-made scanning system for hyperspectral image acquisition is described. Commercially available components have been carefully selected in order to be integrated into a flexible infrastructure able to obtain data from any Generic Interface for Cameras (GenICam) compliant devices using the gigabyte Ethernet interface. The entire setup has been tested using the Specim FX hyperspectral series (FX10 and FX17) and a Graphical User Interface (GUI) has been developed in order to control the individual components and visualise data. Morphological analysis, spectral response and optical aberration of these pushbroom-type hyperspectral cameras have been evaluated prior to the validation of the whole system with different plastic samples for which spectral signatures are extracted and compared with well-known spectral libraries.

High parathyroid hormone predicts exacerbations in COPD patients with hypovitaminosis D.

BACKGROUND: Hypovitaminosis D has been linked to deterioration in clinical parameters and lung function in COPD. As a response to low levels of vitamin D serum Parathyroid Hormone (iPTH) is increased in some, but not all, patients. The aim of this study was to determine whether COPD patients with elevated PTH levels are at higher risk of COPD exacerbations and hospitalizations. METHODS: 166 COPD outpatients were randomly preselected. Clinical and analytical characteristics were assessed at baseline. After excluding patients with other conditions known to disturb calcium metabolism 141 patients were identified. Except one, all patients were prospectively followed for 12 months after obtaining the blood samples. Hypovitaminosis D was considered when serum 25(OH)D < 30 ng/mL. Secondary hyperparathyroidism was considered when serum iPTH was higher than normal (50 pg/mL) in patients with hypovitaminosis D. COPD exacerbations and hospital admissions were recorded during the follow-up. RESULTS: Prevalence of hypovitaminosis D in COPD patients was 89.3%, prevalence of secondary hyperparathyroidism associated with hypovitaminosis D was 22,9%. Cox proportional risk analysis showed that patients belonging to the high iPTH-low 25(OH)D group were at a higher risk of moderate COPD exacerbations (HR 1.81 (CI95% 1.043-3.127), p = 0.035) and hospital admissions (HR 5.45 (CI95% 2.018-14.720), p = 0.002) as compared with those with normal iPTH-low 25(OH)D levels. CONCLUSIONS: COPD patients with hypovitaminosis D and elevated iPTH have higher risk of moderate exacerbations and hospitalizations than those with hypovitaminosis D and normal iPTH.

A Multispectral Camera Development: From the Prototype Assembly until Its Use in a UAV System.

Multispectral imaging (MI) techniques are being used very often to identify different properties of nature in several domains, going from precision agriculture to environmental studies, not to mention quality inspection of pharmaceutical production, art restoration, biochemistry, forensic sciences or geology, just to name some. Different implementations are commercially available from the industry and yet there is quite an interest from the scientific community to spread its use to the majority of society by means of cost effectiveness and ease of use for solutions. These devices make the most sense when combined with unmanned aerial vehicles (UAVs), going a step further and alleviating repetitive routines which could be strenuous if traditional methods were adopted. In this work, a low cost and modular solution for a multispectral camera is presented, based on the use of a single panchromatic complementary metal oxide semiconductor (CMOS) sensor combined with a rotating wheel of interchangeable band pass optic filters. The system is compatible with open source hardware permitting one to capture, process, store and/or transmit data if needed. In addition, a calibration and characterization methodology has been developed for the camera, allowing not only for quantifying its performance, but also able to characterize other CMOS sensors in the market in order to select the one that best suits the budget and application. The process was experimentally validated by mounting the camera in a Dji Matrice 600 UAV to uncover vegetation indices in a reduced area of palm trees plantation. Results are presented for the normalized difference vegetation index (NDVI) showing a generated colored map with the captured information.

Hyperspectral imaging and deep learning for the detection of breast cancer cells in digitized histological images.

In recent years, hyperspectral imaging (HSI) has been shown as a promising imaging modality to assist pathologists in the diagnosis of histological samples. In this work, we present the use of HSI for discriminating between normal and tumor breast cancer cells. Our customized HSI system includes a hyperspectral (HS) push-broom camera, which is attached to a standard microscope, and home-made software system for the control of image acquisition. Our HS microscopic system works in the visible and near-infrared (VNIR) spectral range (400 - 1000 nm). Using this system, 112 HS images were captured from histologic samples of human patients using 20× magnification. Cell-level annotations were made by an expert pathologist in digitized slides and were then registered with the HS images. A deep learning neural network was developed for the HS image classification, which consists of nine 2D convolutional layers. Different experiments were designed to split the data into training, validation and testing sets. In all experiments, the training and the testing set correspond to independent patients. The results show an area under the curve (AUCs) of more than 0.89 for all the experiments. The combination of HSI and deep learning techniques can provide a useful tool to aid pathologists in the automatic detection of cancer cells on digitized pathologic images.

Genome Sequence of Bacillus halotolerans Strain MS50-18A with Antifungal Activity against Phytopathogens, Isolated from Saline Soil in San Luís Potosí, Mexico.

Bacillus halotolerans strain MS50-18A, isolated from saline soil, possesses antifungal activity toward root rot causal phytopathogens and has friendly interactions with the chili pepper plant. The draft genome sequence is 4.06 Mb in length and contains 4,215 genes. Genes related to glycine/betaine uptake and bacilysin biosynthesis are present, supporting its saline stress tolerance and antifungal activity.

[Fusarium species associated with basal rot of garlic in North Central Mexico and its pathogenicity]. / Patogenicidad de especies de Fusarium asociadas a la pudrición basal del ajo en el centro norte de México.

Garlic in Mexico is one of the most profitable vegetable crops, grown in almost 5,451ha; out of which more than 83% are located in Zacatecas, Guanajuato, Sonora, Puebla, Baja California and Aguascalientes. Blossom-end rot caused by Fusarium spp is widely distributed worldwide and has been a limiting factor in onion and garlic production regions, not only in Mexico but also in other countries. The presence of Fusarium oxysporum has been reported in Guanajuato and Aguascalientes. Fusarium culmorum has been reported in onion cultivars of Morelos; and Fusarium proliferatum, Fusarium verticillioides, Fusarium solani and Fusarium acuminatum have been previously reported in Aguascalientes. The goal of this work was identifying the Fusarium species found in Zacatecas, Guanajuato and Aguascalientes, to assess their pathogenicity. Plants with disease symptoms were collected from hereinabove mentioned States. The samples resulted in the identification of: F. oxysporum, F. proliferatum, F. verticillioides, F. solani and F. acuminatum species; out of which Aguascalientes AGS1A (F. oxysporum), AGS1B (F. oxysporum) and AGSY-10 (F. acuminatum) strains showed higher severity under greenhouse conditions.

Patogenicidad de especies de Fusarium asociadas a la pudrición basal del ajo en el centro norte de México / Fusarium species associated with basal rot of garlic in North Central Mexico and its pathogenicity

El ajo en México es uno de los cultivos de hortalizas más rentables, más del 83% de esta superficie es aportada por los estados de Zacatecas, Guanajuato, Sonora, Puebla, Baja California y Aguascalientes. La pudrición basal ocasionada por Fusarium spp. se encuentra ampliamente distribuida a nivel mundial; esta enfermedad se ha convertido en una limitante en zonas productoras de cebolla y ajo, no solo en México, sino también en otros países, En México, se ha informado la presencia de Fusarium oxysporum en plantas en Guanajuato y en semillas de ajo en Aguascalientes. En el estado de Morelos se ha reportado la presencia de Fusarium culmorum en cultivares de cebolla. Asimismo, en Aguascalientes se tienen antecedentes de otras especies como Fusarium proliferatum, Fusarium verticillioides, Fusarium solani y Fusarium acuminatum. Para este trabajo se planteó como objetivo identificar las especies de Fusarium encontradas en los estados de Zacatecas, Guanajuato y Aguascalientes, y evaluar su patogenicidad. Se realizaron recolectas de plantas con síntomas de la enfermedad en los estados antes mencionados. De los muestreos realizados se identificaron las especies F. oxysporum, F. proliferatum, F. verticillioides, F. solani y F. acuminatum; las cepas de Aguascalientes identificadas como AGS1A (F. oxysporum), AGS1B (F. oxysporum) y AGSY-10 (F. acuminatum) fueron las que presentaron bajo condiciones de invernadero un mayor índice de severidad.

Garlic in Mexico is one of the most profitable vegetable crops, grown in almost 5,451 ha; out of which more than 83% are located in Zacatecas, Guanajuato, Sonora, Puebla, Baja California and Aguascalientes. Blossom-end rot caused by Fusarium spp is widely distributed worldwide and has been a limiting factor in onion and garlic production regions, not only in Mexico but also in other countries. The presence of Fusarium oxysporum has been reported in Guanajuato and Aguascalientes. Fusarium culmorum has been reported in onion cultivars of Morelos; and Fusarium proliferatum, Fusarium verticillioides, Fusarium solani and Fusarium acuminatum have been previously reported in Aguascalientes. The goal of this work was identifying the Fusarium species found in Zacatecas, Guanajuato and Aguascalientes, to assess their pathogenicity. Plants with disease symptoms were collected from hereinabove mentioned States. The samples resulted in the identification of: F. oxysporum, F. proliferatum, F. verticillioides, F. solani and F. acuminatum species; out of which Aguascalientes AGS1A (F. oxysporum), AGS1B (F. oxysporum) and AGSY-10 (F. acuminatum) strains showed higher severity under greenhouse conditions.

Trastorno disociativo: a propósito de un caso / Dissociative disorders: a case report

Se presenta el caso clínico de una adolecente con trastorno de identidad disociativo a consecuencia de haber sufrido abuso sexual intrafamiliar y se aprovecha el caso para hacer una revisión del tema.

We present the clinical case of a teenager suffering from dissociative identity disorder as a result of having been the victim of intrafamily sexual abuse. We take the opportunity to revise the subject.

Articulos originales: displasia del desarrollo de la cadera, en un centro de atención primaria / Original articles: developmental dysplasia of the hip, in a primary care center

Identificar antecedentes, cuadro clínico y radiológico de un grupo de niños con displasia del desarrollo de cadera (DDC).

Comunicación especial: sindrome de alienación parental: otra presentación de maltrato infantil / Comunicaciçon special parental alienation syndrome: another presentation of child abuse

En los últimos años los modelos tradicionales de familia han sufrido cambios que muestran un gran aumento de separaciones y divorcios. Si este hecho ocurre es importante garantizar la relación adecuada de los hijos tanto con el padre como con la madre porque constituye un derecho fundamental de los niños expresados hace muchos años en el articulo 9 de la Convención de los Derechos del Niño.

Development of a molecular genetic linkage map for Colletotrichum lindemuthianum and segregation analysis of two avirulence genes.

A framework genetic map was developed for the fungal pathogen Colletotrichum lindemuthianum, the causal agent of anthracnose of common bean (Phaseolus vulgaris L.). This is the first genetic map for any species within the family Melanconiaceae and the genus Colletotrichum and provides the first estimate of genome length for C. lindemuthianum. The map was generated using 106 haploid F1 progeny derived from crossing two Mexican C. lindemuthianum isolates differing in two avirulence genes (AvrclMex and AvrclTO). The map comprises 165 AFLP markers covering 1,897 cM with an average spacing of 11.49 cM. The markers are distributed over 19 major linkage groups containing between 5 and 25 markers each and the genome length was estimated to be approximately 3,241 cM. The avirulence genes AvrclMex and AvrclTO segregate in a 1:1 ratio supporting the gene for gene hypothesis for the incompatible reaction between C. lindemuthianum and P. vulgaris, but could not be incorporated into the genetic map. This initial outline map forms the basis for the development of a more detailed C. lindemuthianum linkage map, which would include other types of molecular markers and allow the location of genes previously isolated and characterized in this species.

Características clínicas de la tuberculosis pulmonar bacilífera. Hospital Regional de Loreto enero 1998 - diciembre 2002 / Clinical characteristics of the pulmonary tuberculosis bacilífera. Loreto's Regional hospital January, 1998 - December, 2002

Objetivo: Determinar las características clínicas del paciente con tuberculosis (TBC) pulmonar bacilífera, del Hospital Regional de Loreto (HRL) de enero de 1998 a diciembre del 2002. Materiales y Métodos: Es un trabajo descriptivo, retrospectivo, transversal. Se revisó la ficha clínica de 271 pacientes con tuberculosis pulmonar bacilífera que ingresaron al programa de control de tuberculosis del HRL durante 5 a±os. Resultados: De los 271 pacientes el tiempo de enfermedad mßs frecuente fue mayor que 1 mes a 6 meses (44.7 por ciento), de inicio insidioso (93 por ciento), los signos y síntomas predominantes fueron tos (96.7 por ciento), baja de peso (86 por ciento), expectoración (83 por ciento) y pérdida del apetito (72.3 por ciento); al examen pulmonar predominaron respiración ruda(29.2 por ciento), subcrépitos (28.8 por ciento); las radiografías patológicas mostraron compromiso pulmonar bilateral (43.3 por ciento), 38 por ciento fueron BK(+) y 31 por ciento BK(+++), la baciloscopía de esputo fue positiva en la primera muestra en 64.2 por ciento y solo 18.1 por ciento presentaron enfermedad asociada, principalmenteanemia y diabetes mellitus. Conclusiones: Los pacientes con TBC pulmonar bacilífera presentaron un tiempo de enfermedad 1-6 meses, inicio insidioso, con tos, baja de peso, expectoración y pérdida del apetito; con respiración ruda y subcrépitos al examen, compromiso pulmonar bilateral en la radiografía; BK(+) y baciloscopía positiva en la primera muestra de esputo.

Cloning and sequence analysis of ornithine decarboxylase gene fragments from the Ascomycota.

Ornithine decarboxylase (ODC; EC 4.1.1.17) catalyzes the initial step in the biosynthesis of polyamines, the conversion of ornithine to putrescine. Based on the most conserved regions of fungal ODCs, we designed and synthesized oligonucleotides to amplify homologous fragments of three important plant pathogenic Pyrenomycete fungi (Ascomycota), Magnaporthe grisea, Colletotrichum lindemuthianum and Fusarium solani, and one insect pathogenic fungus Metarhizium anisopliae. Cloning and sequencing of the amplified fragments revealed homologies of between 37 to 88% with other fungal ODCs. The predicted peptide sequences were compared by Clustal analysis and conserved sequences corresponding to the substrate and cofactor binding sites were identified. Comparative analyses of the ODC fragments isolated in this study, revealed high homology between them (68.3-81.1%) and also with other Pyrenomycetes such as Neurospora crassa (order Sordariales; 68.6-72.9%) and Fusarium graminearum (order Hypocreales; 70.8-88.1%). Data obtained in this work revealed that these fungi constitute a compact group separated from other eukaryotic ODCs.

Heterothallic mating observed between Mexican isolates of Glomerella lindemuthiana.

Although several reports have described the occurrence of the teleomorphic state of Glomerella lindemuthiana (anamorph, Colletotrichum lindemuthianum), there has been a lack of continuity in this research. To identify G. lindemuthiana isolates capable of developing the teleomorphic state, 19 Mexican isolates were analyzed. Three types of response were observed: (i) negative, where only mycelial growth with or without acervuli was observed; (ii) potential, where in addition to the above, spherical perithecia-like structures were observed; (iii) positive, where perithecia containing asci and ascospores were observed. All strains were self-sterile and only one combination of strains produced fertile perithecia. From this fertile combination 168 individual ascospore cultures were isolated, including five from a single ascus. Forty-four monoascospore cultures were characterized with AFLP, confirming that these individuals were progeny from a sexual cross between the original two G. lindemuthiana isolates and that sexual reproduction in G. lindemuthiana is heterothallic in nature. Analysis of the parental strains with degenerate PCR primers indicated that sequences homologous to the HMG box of the MAT1-2 idiomorph are present in both parental isolates. This supports previous observations in other Glomerella species where the standard ascomycete configuration of distinct idiomorphs at the MAT locus does not hold true. The significance of these results is discussed.

Analysis of Pathotypes of Colletotrichum lindemuthianum Found in the Central Region of Mexico and Resistance in Elite Germ Plasm of Phaseolus vulgaris.

The pathotypes of 17 isolates of Colletotrichum lindemuthianum from the central region of Mexico were characterized to determine the genetic relationship among isolates from this region and other regions of Mexico, and to evaluate the resistance present in the elite germ plasm collection of Phaseolus vulgaris at INIFAP. Eight pathotypes were identified, including pathotype 292, which is reported for the first time in Mexico. The lack of isolates infecting cultivar TU carrying the Co-5 resistance gene suggests that this cultivar is a useful source of resistance. Six pathotypes produced susceptible reactions on only differential cultivars of Middle American origin, one pathotype on a single cultivar of Andean origin, and one pathotype on cultivars of both Middle American and Andean origin. Comparison of amplified fragment length polymorphism (AFLP) genotypes of 21 isolates confirmed suggestions that populations of C. lindemuthianum are comprised of asexually reproducing clonal lineages. Analysis of five different pathotypes of C. lindemuthianum on 21 elite genotypes of P. vulgaris identified four genotypes from different races of P. vulgaris resistant to all five pathotypes. This information will allow breeders and farmers to select the resistant genotypes most suited to their needs.

Características clínico-patológicas de los meningiomas del niño: experiencia de 30 años (1970-1999) en el Hospital Infantil de México Federico Gómez / Clinico-pathological characteristics of meningiomas in children: a 30 years experience of the Hospital Infantil de Mexico Federico Gomez

Introducción. Las neoplasias más comunes en la infancia son leucemias y linfomas seguidas por los tumores intracraneanos. De este grupo los meningiomas tienen una incidencia de 0.4 a 4.6 por ciento. En los adultos la incidencia es entre 13 y 27 por ciento. El tratamiento de elección es la resección quirúrgica con sobrevida, en las series recientes, de 100 por ciento para las variedades histológicas de bajo grado de malignidad (de acuerdo a la clasificación de la Organización Mundial de la Salud) y sobrevida de 1.5 años en promedio para las variantes de alto grado de malignidad. Material y métodos. Se analizaron 20 casos, con un método observacional y retrospectivo. Se revisaron los archivos clínicos y de patología de 1970 a 1999 del Hospital Infantil de México Federico Gómez, seleccionándose los casos con diagnóstico histopatológico de meningioma. Se hizo análisis estadístico descriptivo. Resultados. Se operaron 21 meningiomas en 20 pacientes. Once fueron del sexo masculino, 9 del femenino. El promedio de edad fue 8.6 años (10 meses-17 años). La sintomatología más frecuente fue cefalea y vómito. En relación a su localización 3 se encontraban en la convexidad, 3 en la base , 3 intraventriculares, 3 falciales, 3 intraparenquimatosos, 1 del valle silviano, 1 frontoparietal derecho y 1 múltiple, además de 3 casos raquídeos. Se observó predominio de la variedad transicional (7 casos); otros casos fueron meningoteliales(5), fibroblásticos (3), psamomatosos (3), papilar (1) y angioblástico (1). El grado de resección se calificó de acuerdo a la clasificación de Simpson. Nueve pacientes se encuentran en control, 5 fallecieron y 6 no tuvieron seguimiento suficiente. Conclusiones. El diagnóstico clínico, de imagen e histopatológico acertado llevará a la curación en 100 por ciento de los casos de meningiomas benignos y al tratamiento de elección en las variantes malignas. La serie que se presenta es la primera en niños mexicanos por lo que se considera de gran interés su difusión.

Abuso sexual en niñas y niños: consideraciones clínicas / Sexual abuse in children: clinical considerations

Objetivo. Identificar antecedentes, cuadro clínico, conductas de riesgo individuales y familiares en un grupo de niños víctimas de abuso sexual. Población. Niños que denunciaron ser víctimas de agresión sexual en el Organismo Nacional de la Mujer y Familia (ONAMFA) de la ciudad de El Alto, entre marzo de 1995 a marzo de 1996. Material e Métodos. Diseño prospectivo y descriptivo (serie de casos). Método de muestreo no probabilístico. A todos los niños que cumplieron con los criterios de inclusión se les aplicó un cuestionario que permitió indagar: datos generales, antecedentes familiares, antecedentes de la agresión , repercusiones individuales y familiares del abuso sexual. El examen físico se orientó a la evaluación de las lesiones físicas, obtención de muestras forenses del área genital, búsqueda de enfermedades de transmisión sexual y detección de embarazo. Resultados. De 140 denuncias de agresión sexual, sólo 86 cumplieron con los criterios de inclusión. Las edades de la víctimas variaron de 3 a 18 años (promedio de 10,3). Predominó el sexo femenino (95 por ciento) afectando principalmente el grupo de preadolescentes. La mayoria pertencían a familias dsifuncionales y la agresión sexual ocurrió en su domicilio (54,6 por ciento). El tío fue el principal agresor intrafamiliar, vecinos y extraños en el extrafamiliar. El examen físico fue normal en 51 por ciento y anormal en 49 por ciento de las víctimas. Se encontraron lesiones genitales(44,2 po ciento), lesiones anales (4,7 por ciento) embarazos (11,7 por ciento) y enfermedades de transmisión sexual (9,3 por ciento). Las lesiones genitales fueron: ausencia de himen (15 por ciento), laceraciones por desgarros (18,6 por ciento), himen atenuado (3,5 por ciento) y cicatriz en himen (7 por ciento). Las lesiones anales fueron: equimosis (1,2 por ciento), fisuras (2,4 por ciento) y cicatriz (1,2 por ciento). En la piel se encontraron lesiones físicas asociadas a la agresión sexual en el 23,3 por ciento (sugilaciones, equimosis por mordeduras, fracturas óseas y alopecia por arrancamiento). La madre y tía fueron los principales familaires denunciantes. Conclusión. Es importante desarrollar estrategias, mecanismos de prevención y tratamientos de los casos de abuso sexual