المؤلفون: Stephanie Veronica Yagua Velasquez, Luis Diego Solano Vega

المصدر: Ciencia & Salud, Vol 5, Iss 3 (2021)

مصطلحات موضوعية: Asma, Bromuro de tiotropio, Tiotropio, Antagonistas receptores muscarinicos, Broncodilatador, Medicine (General), R5-920

الوصف: Asthma is a chronic disease with a significant disease burden and many patients fail to control the disease despite recommended medical therapy.19 The long-term goals of asthma management include achieving good control of symptoms, minimizing risk asthma exacerbations, reduce hospitalizations, use of rescue medication, airflow limitation and side effects, as well as allow normal levels of activity.29 According to the Global Initiative for Asthma (GINA) guidelines , asthma management is based on a cornerstone of inhaled corticosteroid therapy (ICS), supplemented with complementary therapies for those with poor or deteriorating disease control.1 Tiotropium, a long-acting anticholinergic bronchodilator that is administered once a day, it is indicated for the treatment of chronic obstructive pulmonary disease (COPD) for more than a decade and has recently been approved in several countries for the treatment of asthma.18 In this review, we summarized the significant effect of tiotropium for the treatment of moderate-to-severe asthma, mainly in increasing morning PEF, evening PEF, peak FEV and trough FEV based on high-quality RCTs. Nevertheless, no significant difference in peak FVC, trough FVC, AE and serious AE was found between the 2 groups. A close comparison of the 2 groups revealed that more high-quality larger-sample RCTs are needed to gather more strong evidence on the therapeutic efficacy and safety of tiotropium for clinical practice.

وصف الملف: electronic resource

العلاقة: http://revistacienciaysalud.ac.cr/ojs/index.php/cienciaysalud/article/view/281Test; https://doaj.org/toc/2215-4949Test

الوصول الحر: https://doaj.org/article/6be5d9791be44fe393c9cca020812da9Test

المؤلفون: Yagua Velasquez, Stephanie Veronica, Solano Vega, Luis Diego

المصدر: Revista Ciencia y Salud; Vol. 5 No. 3 (2021); Pág. 42-51 ; Revista Ciencia y Salud Integrando Conocimientos; Vol. 5 Núm. 3 (2021); Pág. 42-51 ; 2215-4949

مصطلحات موضوعية: Asma, Bromuro de tiotropio, Tiotropio, Antagonistas receptores muscarinicos, Broncodilatador, Asthma, Tiotropium bromide, Tiotropium, Muscarinic receptor antagonists, Bronchodilator

الوصف: Asthma is a chronic disease with a significant disease burden and many patients fail to control the disease despite recommended medical therapy.19 The long-term goals of asthma management include achieving good control of symptoms, minimizing risk asthma exacerbations, reduce hospitalizations, use of rescue medication, airflow limitation and side effects, as well as allow normal levels of activity.29 According to the Global Initiative for Asthma (GINA) guidelines , asthma management is based on a cornerstone of inhaled corticosteroid therapy (ICS), supplemented with complementary therapies for those with poor or deteriorating disease control.1 Tiotropium, a long-acting anticholinergic bronchodilator that is administered once a day, it is indicated for the treatment of chronic obstructive pulmonary disease (COPD) for more than a decade and has recently been approved in several countries for the treatment of asthma.18 ; Asthma is a chronic disease with a significant disease burden and many patients fail to control the disease despite recommended medical therapy.19 The long-term goals of asthma management include achieving good control of symptoms, minimizing risk asthma exacerbations, reduce hospitalizations, use of rescue medication, airflow limitation and side effects, as well as allow normal levels of activity.29 According to the Global Initiative for Asthma (GINA) guidelines , asthma management is based on a cornerstone of inhaled corticosteroid therapy (ICS), supplemented with complementary therapies for those with poor or deteriorating disease control.1 Tiotropium, a long-acting anticholinergic bronchodilator that is administered once a day, it is indicated for the treatment of chronic obstructive pulmonary disease (COPD) for more than a decade and has recently been approved in several countries for the treatment of asthma.18 In this review, we summarized the significant effect of tiotropium for the treatment of moderate-to-severe asthma, mainly in increasing morning PEF, evening PEF, peak FEV and trough FEV ...

وصف الملف: application/pdf; text/html

العلاقة: http://revistacienciaysalud.ac.cr/ojs/index.php/cienciaysalud/article/view/281/398Test; http://revistacienciaysalud.ac.cr/ojs/index.php/cienciaysalud/article/view/281/408Test; http://revistacienciaysalud.ac.cr/ojs/index.php/cienciaysalud/article/view/281Test

الإتاحة: http://revistacienciaysalud.ac.cr/ojs/index.php/cienciaysalud/article/view/281Test

المؤلفون: Quint, Jennifer K., Montonen, Jukka, Esposito, Daina B., He, Xintong, Koerner, Leslie, Wallace, Laura, Miravitlles Fernández, Marc

المساهمون: Institut Català de la Salut, Quint JK National Heart and Lung Institute, Imperial College London, London, UK. Montonen J, Wallace L Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany. Esposito DB, He X, Koerner L Department of Safety and Epidemiology, HealthCore, Inc, Watertown, MA, USA. Miravitlles M Servei de Pneumologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus

المصدر: Scientia

مصطلحات موضوعية: Pulmons - Malalties obstructives - Tractament, Avaluació de resultats (Assistència sanitària), Farmacologia respiratòria, DISEASES::Respiratory Tract Diseases::Lung Diseases::Lung Diseases, Obstructive::Pulmonary Disease, Chronic Obstructive, Other subheadings::Other subheadings::Other subheadings::/drug therapy, ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Prognosis::Treatment Outcome, CHEMICALS AND DRUGS::Organic Chemicals::Aza Compounds::Azabicyclo Compounds::Tropanes::Scopolamine Derivatives::Tiotropium Bromide, ENFERMEDADES::enfermedades respiratorias::enfermedades pulmonares::enfermedades pulmonares obstructivas::enfermedad pulmonar obstructiva crónica, Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia, TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::pronóstico::resultado del tratamiento, COMPUESTOS QUÍMICOS Y DROGAS::compuestos orgánicos::compuestos aza::compuestos azabicíclicos::tropanos::derivados de escopolamina::bromuro de tiotropio

الوصف: Malaltia pulmonar obstructiva crònica; Corticosteroides; Olodaterol ; Enfermedad pulmonar obstructiva crónica; Corticosteroides; Olodaterol ; Chronic obstructive pulmonary disease; Corticosteroids; Olodaterol ; Introduction In patients with chronic obstructive pulmonary disease (COPD), treatment with long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) combination therapy significantly improves lung function versus LABA/inhaled corticosteroid (ICS). To investigate whether LAMA/LABA could provide better clinical outcomes than LABA/ICS, this non-interventional database study assessed the risk of COPD exacerbations, pneumonia, and escalation to triple therapy in patients with COPD initiating maintenance therapy with tiotropium/olodaterol versus any LABA/ICS combination. Methods Administrative healthcare claims and laboratory results data from the US HealthCore Integrated Research DatabaseSM were evaluated for patients with COPD initiating tiotropium/olodaterol versus LABA/ICS treatment (January 2013–March 2019). Patients were aged at least 40 years with a diagnosis of COPD (but not asthma) at cohort entry. A Cox proportional hazard regression model was used (as-treated analysis) to assess risk of COPD exacerbation, community-acquired pneumonia, and escalation to triple therapy, both individually and as a combined risk of any one of these events. Potential imbalance of confounding factors between cohorts was handled using fine stratification, reweighting, and trimming by exposure propensity score (high-dimensional); subgroup analyses were conducted on the basis of blood eosinophil levels and exacerbation history. Results The total population consisted of 61,985 patients (tiotropium/olodaterol n = 2684; LABA/ICS n = 59,301); after reweighting, the total was 42,953 patients (tiotropium/olodaterol n = 2600; LABA/ICS n = 40,353; mean age 65 years; female 54.5%). Patients treated with tiotropium/olodaterol versus LABA/ICS experienced a reduction in the risk of COPD exacerbations (adjusted hazard ratio ...

وصف الملف: application/pdf

العلاقة: Advances in Therapy;38; https://doi.org/10.1007/s12325-021-01646-5Test; Quint JK, Montonen J, Esposito DB, He X, Koerner L, Wallace L, et al. Effectiveness and Safety of COPD Maintenance Therapy with Tiotropium/Olodaterol versus LABA/ICS in a US Claims Database. Adv Ther. 2021 May;38:2249–2270.; https://hdl.handle.net/11351/7133Test; 000629189600001

الإتاحة: https://doi.org/10.1007/s12325-021-01646-5Test
https://hdl.handle.net/11351/7133Test

المؤلفون: Renata Szpak, Beatriz Boger, Giovanna Chipon Strapasson, Leticia Mara Marca, Eliane Carneiro Gomes, Yanna Dantas Rattmann

المصدر: Revista de Saúde Pública do Paraná, Vol 4, Iss 3, Pp 105-114 (2021)

مصطلحات موضوعية: decisões judiciais, sistema único de saúde, brometo de tiotrópio, Public aspects of medicine, RA1-1270

الوصف: O estudo objetivou caracterizar as ações de demanda judicial impetradas no estado do Paraná para obtenção do medicamento Brometo de Tiotrópio, destinado ao tratamento de pessoas diagnosticadas com a Doença Pulmonar Obstrutiva Crônica (DPOC). Foram consideradas as ações do período de 2013 a 2016. As variáveis de interesse foram sexo, idade e ocupação dos pacientes, histórico de tabagismo, estágio da DPOC, tratamento e justificativa médica. Nas ações individuais (n=98) predominaram idosos de ambos os sexos (50%), tabagistas ou ex-tabagistas (54%), aposentados (63,3%), com a DPOC grave e muito grave (93,9%). A demanda se justificava pela necessidade de melhorar a resposta clínica (66,3%). O Brometo de Tiotrópio foi recentemente reavaliado e recomendado para incorporação pelo Sistema Único de Saúde (SUS), em razão das novas evidências sobre a sua efetividade e segurança. A disponibilização deste medicamento pelo SUS traz a perspectiva de maior facilidade no acesso e benefícios terapêuticos para os usuários com DPOC.

العلاقة: http://revista.escoladesaude.pr.gov.br/index.php/rspp/article/view/541Test; https://doaj.org/toc/2595-4474Test; https://doaj.org/toc/2595-4482Test; https://doaj.org/article/051e765b7ca64082bb0fe8d0ab621fffTest

الإتاحة: https://doi.org/10.32811/25954482-2021v4n3p105Test
https://doaj.org/article/051e765b7ca64082bb0fe8d0ab621fffTest

المؤلفون: Xintong He, Leslie Koerner, Daina B. Esposito, Laura Wallace, Marc Miravitlles, Jennifer K Quint, Jukka Montonen, Alberto de la Hoz

المساهمون: Institut Català de la Salut, [Quint JK] National Heart and Lung Institute, Imperial College London, London, UK. [Montonen J, Wallace L] Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany. [Esposito DB, He X, Koerner L] Department of Safety and Epidemiology, HealthCore, Inc, Watertown, MA, USA. [Miravitlles M] Servei de Pneumologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus

المصدر: Scientia
Advances in Therapy

مصطلحات موضوعية: 030213 general clinical medicine, Exacerbation, Organic Chemicals::Aza Compounds::Azabicyclo Compounds::Tropanes::Scopolamine Derivatives::Tiotropium Bromide [CHEMICALS AND DRUGS], Pulmons - Malalties obstructives - Tractament, Other subheadings::Other subheadings::/drug therapy [Other subheadings], Pulmonary Disease, Chronic Obstructive, chemistry.chemical_compound, 0302 clinical medicine, Maintenance therapy, Adrenal Cortex Hormones, Pharmacology (medical), Farmacologia respiratòria, Original Research, COPD, Chronic obstructive pulmonary disease, Olodaterol, Hazard ratio, General Medicine, Bronchodilator Agents, enfermedades respiratorias::enfermedades pulmonares::enfermedades pulmonares obstructivas::enfermedad pulmonar obstructiva crónica [ENFERMEDADES], Treatment Outcome, 030220 oncology & carcinogenesis, Drug Therapy, Combination, Female, hormones, hormone substitutes, and hormone antagonists, medicine.medical_specialty, Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores], Muscarinic Antagonists, Lower risk, Database, 03 medical and health sciences, Internal medicine, Administration, Inhalation, medicine, Humans, Corticosteroids, Tiotropium Bromide, Adrenergic beta-2 Receptor Agonists, compuestos orgánicos::compuestos aza::compuestos azabicíclicos::tropanos::derivados de escopolamina::bromuro de tiotropio [COMPUESTOS QUÍMICOS Y DROGAS], Aged, Asthma, Respiratory Tract Diseases::Lung Diseases::Lung Diseases, Obstructive::Pulmonary Disease, Chronic Obstructive [DISEASES], business.industry, Tiotropium, diagnóstico::pronóstico::resultado del tratamiento [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Diagnosis::Prognosis::Treatment Outcome [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], medicine.disease, Confidence interval, Benzoxazines, respiratory tract diseases, chemistry, Avaluació de resultats (Assistència sanitària), business

الوصف: Malaltia pulmonar obstructiva crònica; Corticosteroides; Olodaterol Enfermedad pulmonar obstructiva crónica; Corticosteroides; Olodaterol Chronic obstructive pulmonary disease; Corticosteroids; Olodaterol Introduction In patients with chronic obstructive pulmonary disease (COPD), treatment with long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) combination therapy significantly improves lung function versus LABA/inhaled corticosteroid (ICS). To investigate whether LAMA/LABA could provide better clinical outcomes than LABA/ICS, this non-interventional database study assessed the risk of COPD exacerbations, pneumonia, and escalation to triple therapy in patients with COPD initiating maintenance therapy with tiotropium/olodaterol versus any LABA/ICS combination. Methods Administrative healthcare claims and laboratory results data from the US HealthCore Integrated Research DatabaseSM were evaluated for patients with COPD initiating tiotropium/olodaterol versus LABA/ICS treatment (January 2013–March 2019). Patients were aged at least 40 years with a diagnosis of COPD (but not asthma) at cohort entry. A Cox proportional hazard regression model was used (as-treated analysis) to assess risk of COPD exacerbation, community-acquired pneumonia, and escalation to triple therapy, both individually and as a combined risk of any one of these events. Potential imbalance of confounding factors between cohorts was handled using fine stratification, reweighting, and trimming by exposure propensity score (high-dimensional); subgroup analyses were conducted on the basis of blood eosinophil levels and exacerbation history. Results The total population consisted of 61,985 patients (tiotropium/olodaterol n = 2684; LABA/ICS n = 59,301); after reweighting, the total was 42,953 patients (tiotropium/olodaterol n = 2600; LABA/ICS n = 40,353; mean age 65 years; female 54.5%). Patients treated with tiotropium/olodaterol versus LABA/ICS experienced a reduction in the risk of COPD exacerbations (adjusted hazard ratio 0.76 [95% confidence interval 0.68, 0.85]), pneumonia (0.74 [0.57, 0.97]), escalation to triple therapy (0.22 [0.19, 0.26]), and any one of these events (0.45 [0.41, 0.49]); the combined risk was similar irrespective of baseline eosinophils and exacerbation history. Conclusions In patients with COPD, tiotropium/olodaterol was associated with a lower risk of COPD exacerbations, pneumonia, and escalation to triple therapy versus LABA/ICS, both individually and in combination; the combined risk was reduced irrespective of baseline eosinophils or exacerbation history. Support for this project and the journal’s Open Access Fee were funded by Boehringer Ingelheim International GmbH. No Rapid Service Fee was received by the journal for the publication of this article.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a3446c3ad53e6c49a71f8449ed192704Test
https://doi.org/10.1007/s12325-021-01646-5Test

المؤلفون: Unfried Hernández, Sebastián

المساهمون: Betancourt Flores, Eddy

المصدر: Universidad de Costa Rica, San José, Costa Rica
Kérwá
Universidad de Costa Rica
instacron:UCR

مصطلحات موضوعية: FEV1, Bromuro de Tiotropio, Tiotropio, EPOC, Exacerbación, Exacerbaciones, respiratory tract diseases

الوصف: RESUMEN Antecedentes: La frecuencia de exacerbaciones están relacionado con la progresión de la enfermedad pulmonar obstructiva crónica. Las medidas destinadas a prevenir exacerbaciones y retrasar la progresión de la enfermedad, pueden ayudar a disminuir la morbimortalidad de los pacientes con este padecimiento. El bromuro de tiotropio es un tratamiento de primera elección para los pacientes sintomáticos y con riesgo de exacerbación. Métodos: Se trata de una revisión bibliográfica, se realizó la busqueda de información en PubMed, OvidSP, EMBASE y Cochrane, utilizando las siguientes palabras clave: COPD, EPOC, tiotropium bromide, tiotropium, COPD exacerbations, antimuscarinic effect, spiriva y lung function. Se indentificaron inicalmente 1,473 artículos, para este trabajo se consideraron revisiones sistemáticas, meta-análisis, estudios clínicos y guias internacionales, tanto en inglés como en español. Se realizó revisión manual de los títulos y se excluyeron aquellos que por su contenido no concordaban con la temática abordada, de manera que tras aplicar dichos criterios, se incluyeron 63 documentos para la revisión respectiva Conclusiones: El bromuro de tiotropio ha demostrado disminuir la tasa de exacerbaciones en pacientes EPOC, además que disminuye el tiempo de la siguiente exacerbación. Asimismo, se ha documentado que el inicio de este tratamiento reduce la caída de FEV1, mejora la caminata de 6 minutos y mMRC. ABSTRACT Background: The frequency of exacerbations is related to the progression of chronic obstructive pulmonary disease. Measures aimed at preventing exacerbations and delaying the progression of the disease can help reduce the morbidity and mortality of patients with this condition. Tiotropium bromide is a first-line treatment for symptomatic patients and those at risk of exacerbation. Methods: This is a bibliographic review, information was searched in PubMed, OvidSP, EMBASE and Cochrane, using the following keywords: COPD, EPOC, tiotropium bromide, tiotropium, COPD exacerbations, antimuscarinic effect, spiriva and lung function. 1,473 articles were initially identified; for this work, systematic reviews, meta-analyzes, clinical studies and international guidelines were considered, both in English and Spanish. A manual review of the titles was carried out and those that did not correspond with the subject matter due to their content were excluded, so that after applying these criteria, 63 documents were included for the respective review. Conclusions: Tiotropium bromide has been shown to reduce the rate of exacerbations in COPD patients, in addition to decreasing the time to the next exacerbation. Additionally, it has been documented that the initiation of this treatment reduces the fall in VEF1, improves the 6-minute walk and mMRC. UCR::Vicerrectoría de Investigación::Sistema de Estudios de Posgrado::Salud::Especialidad en Neumología

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=dedup_wf_001::5608a7afac207b084108793372e64dd2Test

المؤلفون: Navarro Reynoso,Francisco

المصدر: Revista del Instituto Nacional de Enfermedades Respiratorias v.19 n.2 2006

مصطلحات موضوعية: Costo-efectividad, EPOC, hospitalización, ipratropio, salbutamol, teofilina, tiotropio

الوصف: La enfermedad pulmonar obstructiva crónica (EPOC) afecta, aproximadamente, a 600 millones de personas; anualmente mueren 2.7 millones; es la cuarta causa de muerte en el mundo y es una enfermedad prevenible. El costo anual aproximado es de 1,876 a 2,000 US dólares y los gastos en que incurre durante una exacerbación pueden representar un gasto catastrófico para cualquier familia y para la sociedad, por lo que el manejo ambulatorio de los pacientes con EPOC es de suma importancia. Broncodilatadores como el salbutamol, teofilina, ipratropio y tiotropio, y sus combinaciones, se utilizan para el manejo ambulatorio de estos pacientes. El objetivo del presente trabajo es determinar los costos de las diferentes combinaciones de broncodilatadores y analizar las conveniencias de cada uno de ellos, en un estudio prospectivo, longitudinal, observacional y descriptivo de pacientes con EPOC que se siguieron durante un año y se dividieron en tres grupos: grupo I, 32 enfermos, se utilizó sulfato de salbutamol + bromuro de ipratropio inhalados; grupo II, 33 enfermos, se trató con sulfato de salbutamol + bromuro de tiotropio inhalados; el grupo III, 15 enfermos, con teofilina oral. Dentro de los resultados del análisis de costos se observó que el costo total de la atención anual en el grupo II, es menor que en los otros dos.

وصف الملف: text/html

الإتاحة: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0187-75852006000200006Test

المؤلفون: Gil-Aldea, I. (I.), Azanza, J.R. (José Ramón), Palacios, E. (E.), Solchaga, S. (S.)

مصطلحات موضوعية: Tiotropio, Broncodilatador

وصف الملف: application/pdf

العلاقة: https://hdl.handle.net/10171/35463Test

الإتاحة: https://hdl.handle.net/10171/35463Test

المؤلفون: Perú. Ministerio de salud, Dirección General de Medicamentos, Insumos y Drogas

المصدر: Dirección General de Medicamentos, Insumos y Drogas
Repositorio institucional DIGEMID
DIGEMID-Institucional
Dirección General de Medicamentos, Insumos y Drogas (Digemid) – Ministerio de Salud
instacron:DIGEMID

مصطلحات موضوعية: olodaterol, enfermedad pulmonar, tiotropio, EPOC, purl.org/pe-repo/ocde/ford#3.01.05 [http], obstructiva crónica

الوصف: En la revisión de la solicitud presentada respecto al medicamento bromuro de tiotropio 2.5mcg + olodaterol 2.5mcg solución para inhalación, se observa que el expediente señala que existe un vacío terapéutico, y debido a que en el Petitorio Nacional Único de Medicamentos Esenciales (PNUME) se cuenta con medicamentos para el tratamiento de la indicación solicitada; por este motivo el Equipo Técnico acuerda desestimar la solicitud.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=od______3056::b15cb30629f910bc446194886c4d6b5bTest
http://repositorio.digemid.minsa.gob.pe/handle/DIGEMID/129Test

المؤلفون: Perú. Ministerio de salud, Dirección General de Medicamentos, Insumos y Drogas

المصدر: Dirección General de Medicamentos, Insumos y Drogas
Repositorio institucional DIGEMID
DIGEMID-Institucional
Dirección General de Medicamentos, Insumos y Drogas (Digemid) – Ministerio de Salud
instacron:DIGEMID

مصطلحات موضوعية: enfermedad pulmonar, tiotropio, EPOC, purl.org/pe-repo/ocde/ford#3.01.05 [http], obstructiva crónica

الوصف: En la revisión de las solicitudes presentadas respecto al medicamento bromuro de tiotropio 2.5mcg/dosis solución para inhalación y 5mcg/dosis solución para inhalación, se observa que los expedientes señalan que existe un vacío terapéutico, y debido a que en el Petitorio Nacional Único de Medicamentos Esenciales (PNUME) se cuenta con medicamentos para el tratamiento de la indicación solicitada; por este motivo el Equipo Técnico acuerda desestimar la solicitud.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=od______3056::6ab60489e54af9d6b626591935e2cb18Test
http://repositorio.digemid.minsa.gob.pe/handle/DIGEMID/128Test