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Escherichia coli y coliformes totales en carne molida comercializada en el mercado 12 de abril Cuenca-Ecu= ador

 

Escherichia coli and total coliforms in ground beef sold in the 12 d= e abril market in Cuenca-Ecuador<= /p>

 

1=

Kelly Belén Quizhpi Quito

=

https://orcid.org/0009-0007-96= 99-890X

 

 

Facultad de Bioquímica y Farmacia – Universidad Católica de Cuenc= a. Cuenca- Ecuador

belen.quizhpi@est.ucacue.edu.ec

2=

David Israel Bravo Crespo

=

https://orcid.org/= 0000-0001-5131-4120

 

 

 Facultad de Bioquímica y Farmacia- Unidad Académica de Salud y Bienestar- Universidad Cat&o= acute;lica de Cuenca. Cuenca-Ecuador.

dbravoc@ucacue.edu.ec

3=

José Antonio Baculima Suarez

=

https://orcid.org/= 0000-0002-6695-665X

 

 

Facultad de Bioquímica y Farmacia- Unidad Académica de Salud y Bienesta= r- Universidad Católica de Cuenca. Cuenca-Ecuador.<= /p>

jbaculima@ucacue.edu.ec

 

 

Artículo de Investigación Científica y Tecnológica=

Envi= ado: 17/06/2023

Revi= sado: 12/07/2023

Acep= tado: 01/08/2023

Publ= icado: 30/08/2023

DOI:&n= bsp; <= span lang=3DEN-US style=3D'font-size:10.0pt;font-family:"Times New Roman",seri= f; mso-fareast-font-family:"Times New Roman";mso-ansi-language:EN-US'>https:= //doi.org/10.33262/anatomiadigital.v6i3.2.2673 <= /o:p>

 

&= nbsp;

Cítese:

 

Quizhpi Quito , K. B., Bravo Cresp= o , D. I., & Baculima Suarez , J. A. (2023). Escherichia coli y coli= formes totales en carne molida comercializada en el mercado 12 de abril Cuenca-Ecuador. Anatomía Digital, 6(3.2), 41-56. https://doi.org/10.33262/anatomiadigital.v6i3.2.2673

 

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3D"Interfaz

 

Esta revista está prote= gida bajo una licencia Creative Commons Attribution Non Commercial No Derivati= ves 4.0 International. Copia de la licencia: http://creativecommons.org/licenses/by-n= c-nd/4.0/

 

 

Palabr= as clave:

Escherichia= coli, Coliformes totales, Contaminación, Carne molida, Enfermedades transmitidas por alimentos, ETAS, Higiene Alimentaria.<= /p>

 

&n= bsp;

Resume= n

Introducción: La carne de res molida es una fuente de alimento por su contenido de proteína, sin embargo, al ser manipulada de forma incorrecta, existe la posibilidad de contaminación por microorgani= smos perjudiciales para la salud como el caso de Escherichia coli. Ob= jetivo: Determinar la presencia de Escherichia co= li y Coliformes Totales en carne molida comercializada en el mercado 12 de abr= il de la ciudad de Cuenca- Ecuador. Metodología:

Diseño transversal no experimental, de tipo descriptivo y observacional. Se realizó un muestreo de tipo no probabilístico por conveniencia para la obtención de 120 muestras de carne de res mol= ida. Resultados: De las 120 muestras recolectadas se determinó una frecuencia de Escherichia c= oli en el 75% y un 16,67% de Coliformes totales, en la carne de res molida. Conclusión: Se evidenció la presencia de Escherichia coli y Coliformes Totales en= las muestras obtenidas de carne de res molida, expendidas en el mercado 12 de abril de la ciudad de Cuenca, esto puede deberse a la falta de higiene y = una mala manipulación del producto por parte de sus expendedores. &= Aacute;rea de estudio general: medicina, Área de estudio específica: microbiología, Tipo de estudio: revisión bibliográfica.

Keywords:

Escherichia coli, Total coliforms, Contamination, Ground beef, Foodborne diseases, ETS, Food hygiene.

 

 

Abstract

Introduction: Ground beef is a food source because of its protein content, however, when handl= ed improperly, there is the possibility of contamination by microorganisms harmful to health such as Escherichia coli. Objective: To determine the presence of Escherichia coli and total coliforms in ground beef sold in the 12 de Abril market in the city= of Cuenca, Ecuador. Methodology: Experimental, descriptive, and observational cross-sectional design. A non-probabilistic convenience sampling was carried out to obtain 120 samples of ground beef= . Results: Of the 120 samples collected, a frequency of Escherichia coli was determined in 75% and 16.6= 7% of total coliforms in ground beef. Conclusion: The presence of Escherichia coli and total coliforms was evidenced in the samples obtained from ground beef sold in the 12 de Abril market in the c= ity of Cuenca, this may be due to the lack of hygiene and poor handling of the product by the vendors.

Introducción

Las ETAs (enfermedad= es de transmisión alimentaria) son producidas por la ingestión de alimentos o bebidas que han sido contaminadas con microorganismos patógenos que afectan a la salud del consumidor. Las ETAs abarcan un espectro de dolencias sumamente amplio y constituyen un problema de salud pública a nivel mundial. Aquellos alimentos que frecuentemente son involucrados en casos de ETA son los de origen animal, entre ellos tenemos = la carne bovina, porcina, huevos, mariscos, carne de aves y productos lá= ;cteos (1–3).             

Las infecciones pued= en ser ocasionadas por diferente microorganismo como bacterias parásita= s, virus o sustancias químicas, que pueden llegar a contaminar los alimentos y así desarrollar enfermedades que serán transmitid= as por los mismos. La carne molida al ser manipulada de forma directa proporci= ona las condiciones adecuadas para el desarrollo de los microorganismos (4̵= 1;6).        &= nbsp;   

La OMS reporta que l= as causas más frecuentes de ETA son producidas por agentes causantes de enfermedades diarreicas especialmente: norovirus, Campylobacter spp, Salmonella entéricas, Salmonella typhi, Taenia solium, Staphylococcus aureus, Clostridium perfringens, Escherichia = Coli O157:H7, Shigella sp, Listeria monocytogenes y el virus del Hepatitis A, los antes mencionados son los responsables de una alta mortalidad (7,8).

Uno de los principal= es reservorios en donde se encuentran los patógenos causantes de ETAs, = es la especie bovina, la misma constituye una fuente principal de carne y leche para el consumo humano. El patógeno que más se destaca es E. coli productor de la toxina shi= ga (9,10).

Escherichia coli&nbs= p;

E. coli es un bacilo gramnegativo que pertenece a la familia enterobacteriaceae. Es una bacteria anaeróbica facultativa, quimiorganotrofica. Es fácilmente cultivable en medios de laboratori= o. Todas las especies fermentan glucosa, además reducen los nitratos a nitritos. Son oxidasa negativos y catalasa positivos. Habitan en el intesti= no de seres de sangre caliente, como el hombre y los animales. Los tipos de E. coli pueden causar enfermedades= que se propagan a través del agua o de los alimentos contaminados (11,12= ).

E. coli es la productora de la toxina shiga, que es la causante de enfermedades alimentarias, que se destacan por producir cólicos y diarrea. Esta toxina puede crecer a temperaturas que oscilan entre los 7 y = 50 grados centígrados. Se destruye a una temperatura de 70 grados centígrados o más. El serotipo con más importancia en = la salud pública es E. coli O157:H7(13).

En Tandil la carne d= ebe cumplir con requisitos microbiológicos, es así como en el año 2021 la municipalidad realizó una inspección bromatológica en los diferentes locales en donde se expende este tip= o de carne y sus derivados. El estudio de M. Ruiz., determinó la presenci= a de E. coli en 30 muestras analizad= as; deduciendo que tanto las condiciones sanitarias de los locales como las mal= as técnicas de manipulación por parte de los comerciantes, dan l= ugar a una contaminación cruzada (14).

 En Argentina, = las enfermedades producidas por E. coli= , están asociadas con la carne molida contaminada. El estudio de Ruiz = et al., concluye que los principales reservorios de E. coli lo conforma la carne bovina, por lo tanto, la ún= ica manera de obtener carne de calidad es mejorando las condiciones de higiene y sanidad en los puntos de abasto, entre ellas se resalta la transmisió= ;n que se da a través de las manos de los expendedores de producto (14,= 15).

En un mercado de Guayaquil en el año 2020, mediante un estudio realizado por Alarcón et al, indicó que las condiciones higiénicas y= el ambiente en el que se expende el producto a los diferentes consumidores, ju= ega un papel importante, en cuanto a la proliferación bacteriana en la carne. Se evidencio que la mayor parte de locales de expendio presenta condiciones higiénicas buenas de acuerdo con la FAO (16,17).<= span style=3D'font-size:12.0pt;line-height:150%;font-family:"Times New Roman",se= rif; mso-fareast-font-family:"Times New Roman"'>

En el 2021 el MSP (ministerio de salud pública) del Ecuador mediante un estudio indicó que se registran alrededor de 6.728 casos de intoxicaci&oacut= e;n alimentaria. En dónde 159 casos pertenecen a la provincia del Azuay = (18). 

En la actualidad los datos que presenta el ministerio de salud pública son muy escasos, p= or ello es necesario realizar una investigación de análisis microbiológico, para evaluar la calidad de la carne molida que es consumida en la ciudad de Cuenca, debido a que este producto es parte de una dieta balanceada para el ser humano (19).

En relación c= on todo lo anteriormente mencionado se ha visto en la necesidad de desarrollar este trabajo investigativo cuyo propósito es establecer la presencia= de Escherichia coli y Coliformes Totales en carne molida comercializada en el = mercado 12 de abril de la ciudad de Cuenca- Ecuador y así comprobar si el producto cumple con los requisitos establecidos en la normativa INEN 1338.<= span style=3D'mso-tab-count:1'>

Metodología

Esta investigación se realizó mediante un diseño transversal experimental, de tipo descriptivo y observacional. El estudio se elabor&oac= ute; a partir de muestras obtenidas del mercado 12 de abril de Cuenca-Azuay, Ecuador.

Las variables cuantitativas de UFC para E. Coli y Coliformes Totales no son paramétricas (Kolmogorov-Smirnov p=3D0,000) <= /p>

Toma de muestra 

Se seleccionaron los= 15 locales que se dedican al comercio de carne de res molida en el mercado 12 = de abril, con el fin de obtener muestras que representen a toda la población. Las muestras de carne fueron recolectadas dos veces por semana. En cada día se tomaron cuatro muestras, dos superficiales y = dos internas al momento de la apertura de los puestos y cuatro muestras m&aacut= e;s cuatro horas después de que se abrieron los mismos.

El primer día= se tomaron muestras de los seis primeros puestos y el segundo de los nueve restantes. Se tomaron en dos días diferentes para observar si existe= una variación, en los resultados, en comparación de los dí= as de feria, en donde hay una mayor aglomeración de consumidores y los com= unes en los cuales existe menos cantidad de personas. Así, se obtuvieron = un total de 120 muestras para analizar. 

La carne fue manipul= ada por el vendedor y depositada en una bolsa plástica de manejo comerci= al de cada uno de los locales. Posteriormente las muestras se introdujeron en = una bolsa hermética cerrada para evitar contaminaciones cruzadas, en don= de se rótulo la fecha, la hora, el número de puesto, códi= go de la muestra, superficie de donde fue tomada la muestra y fueron colocadas= en un depósito frío para ser correctamente trasladadas al laboratorio de microbiología alimentos de la Universidad Cató= lica de Cuenca y se procesaron en un plazo no mayor a 3 horas.=

Preparación d= e la muestra; el método de referencia fue la NTE-INEN 1529-2.<= /span>

Se utilizó únicamente la dilución primaria (1/10), se tomaron 90 ml de a= gua peptona y 10 gr de muestra de carne, se depositaron en un frasco de vidrio previamente esterilizado, se homogeneizó mediante la trituraci&oacut= e;n en una licuadora por un minuto. Se dejó reposar la muestra por 5 min= y se procedió a sembrar.

Una vez realizada la dilución, se colocó 1000ul en las placas Compact Dry EC y se procedió a rotular cada placa que contenía la dilución, con el código asignado con el fin de identificar la presencia o no de Escherichia Coli. 

Identificació= n de Escherichia coli mediante Compact Dry EC

La identificaci&oacu= te;n de E. coli se desarrolló mediante la siembra de 1 ml de la dilución anteriormente menciona= da en las mini placas Compact Dry EC y se incubó a 37 grados centígrados por 24 horas. Se realizó la cuantificación= de las colonias de E. coli y Colif= ormes Totales, basándose en el color de las colonias, azules si hay presen= cia de         E. coli y lilas si exist= en Coliformes Totales ().

El rechazo y aceptación de cada una de las muestras se realizó conforme a = la normativa INEN 1338 en donde establece requisitos necesarios para que un producto cárnico crudo se considere seguro y de calidad. en donde el rango de aceptación es 1,0 x 102 y el de rechazo 1,0 x 10= 3

Resultados

De un total de 15 puestos de venta de productos cárnicos se obtuvieron 8 muestras de c= arne molida por cada uno de los puestos, de las cuales 4 muestras (2 internas y 2 superficiales) fueron tomadas a las 08:00 y las otras 4 muestras (2 interna= s y 2 superficiales) a las 13:00. La obtención de estas se realizó = en 2 días diferentes, 48 muestras el jueves y 72 el domingo, esto nos da = un total de 120 muestras para el análisis.

Los resultados analizados indican que el 90% de las muestras se encuentran en un ambiente expuesto y en una bandeja metálica, mientras que tan solo el 10%, está en refrigeración. El 6,7% de las muestras utilizan un contenedor plástico y el 3,3% se encuentra en una funda plást= ica como lo indica la tabla 1.

 

Tabla 1. Caracterización de la muestra 

Ambiente

 

Frecuenci= a

Porcentaj= e

Porcentaje válido

Porcentaj= e acumulado

Válido

Expuesto

108<= /o:p>

90,0=

90,0=

90,0=

Refrigeración

12

10,0=

10,0=

100,0

Total

120<= /o:p>

100,0

100,0

 

Contenedor<= /p>

 

Frecuenci= a

Porcentaj= e

Porcentaje válido

Porcentaje acumulado

Válido

Bandeja metálica

108<= /o:p>

90,0=

90,0=

90,0=

Bandeja de plástico

8

6,7<= /o:p>

6,7<= /o:p>

96,7=

Funda plástica<= /span>

4

3,3<= /o:p>

3,3<= /o:p>

100,0

Total

120<= /o:p>

100,0

100,0

 

Los resultados analizados de las 120 muestras indican que los datos estadísticos para    E. coli son (MED 661,75 DE 582,509= ) y para Coliformes Totales (MED 44,47 DE 94,894) esto nos indica que los datos= de E. coli están menos dispers= os en comparación a Coliformes Totales. El punto máximo de UFC encontradas para E. coli es 3000 mientras que para Coliformes totales 440 UFC. En contraste lo mínimo= de UFC encontradas tanto para E. coli<= /i> como para Coliformes totales fue 0, tal y como lo muestra la tabla 2.<= /o:p>

Tabla 2.  Datos estadísticos 

Estadísticos

&nbs= p;

E. coli (= UFC)

Coliformes Totales (UFC)

N

Válido

120<= /o:p>

120<= /o:p>

Perdidos

0

0

Media

661,75

44,47

Mediana

675,00

0,00=

Moda

0

0

Desviación estándar=

582,509

94,894

Rango

3000=

440<= /o:p>

Mínimo

0

0

Máximo

3000=

440<= /o:p>

De un total de 120 muestras de carne molida recolectada en el mercado 12 de abril, el 75% esta= ban contaminadas por E. coli, se identificaron mediante las placas Compact Dry EC. El restante 25% no estaba contaminado. En contraste el 16,67% tienen una contaminación por Coliformes Totales y en el 83,33% no se encontró contaminació= n, como lo muestra la figura 1.

Figura 1. Porcentaje de muest= ras contaminadas y no contaminadas de Escherichia coli y Coliformes Totales, en= el mercado 12 de abril Cuenca-Ecuador

En 90 muestras de carne molida se encontró la presencia de E. coli, y en los 30 restantes no se presentó contaminación por parte del microorganismo antes mencionado. En cuanto a la presencia de Coliformes totales fue menor en com= paración con E. coli, debido a que solo 34 muestras de las 120 resultaron contaminad= as, esto nos indica que en 86 muestras de carne no se identificó este microorganismo. El grado de contaminación de las muestras, est&aacut= e; basado en la normativa INEN 1338, la cual nos indica las UFC que se aceptan= y las que se rechazan.

La contaminaci&oacut= e;n que se da por E. coli si depend= e del ambiente, es decir en un ambiente expuesto existe mayor porcentaje de contaminación de las muestras esto nos indica que el 86,75 se encuen= tra contaminado. La contaminación que se da por Coliformes totales también depende del ambiente en el que se encuentra la mayor parte de las muestras contaminadas se encontraban expuestas.

En cuanto al área de la muestra, es decir tanto la parte superficial como interna presentó contaminación por E. coli y Coliformes totales, esto nos indica que no depende del área de toma = de muestra para que se observe la presencia de estos microorganismos. Por otro lado, el contenedor de la muestra no resulta ser una variable significativa debido a que la contaminación no depende del material del contenedor= , en los 3 contenedores diferentes se observó que existía la prese= ncia tanto de E. coli como de Colifo= rmes Totales.

El día de tom= a de muestra, nos indica que, si es una variable dependiente, en cuanto a la presencia tanto de E. coli como= de Coliformes totales, en donde se puede observar que el domingo presenta una mayor contaminación de las muestras en comparación con el jue= ves para E. coli. Esto nos demuestra que en los días en donde existe may= or aglomeración de personas, se presenta una contaminación mucho más alta a diferencia de aquellos días en los que, menor cant= idad de personas visitan el mercado. Sin embargo, la presencia de Coliformes tot= ales es mucho más alta el jueves, esto puede darse por la higiene deficie= nte de los manipuladores del producto.

Se observa una mayor contaminación de E. coli= y Coliformes totales en las muestras, tomadas a las 8 de la mañana, es= to nos permite, denominar una variable dependiente a la hora de toma de muestr= a, en donde se observa un mayor porcentaje de contaminación en horas de= la mañana.

Discusión

La carne de res moli= da a granel, es consumida con frecuencia en la ciudad de cuenca, pues es expendi= da en los diversos mercados,  siendo esto un posible riesgo para la salud= de sus consumidores, ya que la manipulación de la carne es directa y es aquí donde este estudio reveló que existen microorganismo patógenos que se asocian a las enfermedades producidas por alimentos (ETAs), esto concuerda con Fernández S. et al., en su estudio mencio= nan que aquellos microorganismos asociados con la generación de ETA, hab= itan en los alimentos crudos entre ellos tenemos a E.coli, Salmonella, S. = aureus(1,20).

Escherichia coli = es un microorganismo= que se encuentra en el intestino del ser humano, y que utiliza las manos y el a= gua sin tratar como medio de transporte para la contaminación de aliment= os, por ende las personas que manipulan productos alimenticios  deben tener una adecuada higiene y condición sanitaria para la distribució= ;n de los diferentes productos  cárnicos, debido a que pueden prov= ocar una intoxicación alimentaria si esta no se cumple, esto coincide con Ruiz M. et al ., ya que en su estudio menciona que las condiciones sanitari= as de los productos como las malas técnicas de manipulación son = las causantes de una contaminación cruzada(9,14,17).

Los resultados investigativos evidenciaron que, de las 20 muestras de carne de res molida analizadas, 90 (75%) resultaron positivas para E. coli mientras que 30 fueron negativas, en cuanto a Coliformes totales 34 (28,3%) positivas y las 86 restantes negativas, estos resultados concuerdan con Alarcón M. et al., pues en su estudio en donde se analizaron 200 muestras, E. coli fue la especie predominante en la carne mo= lida de res con un 46,5% (16).

El ambiente de las muestras, resultó ser una variable importante en cuanto a este análisis, en donde se evidencio que en un ambiente expuesto, existe mayor contaminación por parte de este microorganismo (86,7%),  = en comparación con aquellas muestras que se encontraban refrigeradas, en donde se evidenció que existe una menor contaminación por E.coli (13.3%), estos datos se par= ecen con los analizados por Alarcon M. et al., en donde concluyen que el producto cárnico al estar expuesto al ambiente aligera la proliferació= n de bacterias(16,21).

En este estudio no se realizó la identificación de serotipos de Escherichia coli, sin embargo, es importante destacar la importancia de estas, sobre todo de E. Coli O157:H7, pues afecta a la salud de las personas, siendo considerad= a un problema de salud pública a nivel mundial por su alto grado de toxicidad, como lo menciona Usera. M. et al., en su investigación en donde menciona que es la causante de un síndrome urémico hemolítico, que tiene una tasa de mortalidad entre el 5 y el 10% (22= –24).

El reducido tiempo p= ara analizar las muestras limita la extrapolación de los resultados. A p= esar de ello, el presente estudio tiene la intención de presentar la importancia de la vigilancia en el control de calidad en los vendedores de = productos cárnicos, en los mercados.

Conclusiones

Se pudo evidenciar u= na frecuencia elevada de Escherichia coli en las muestras obtenidas de carne de res molid= a, expedida por los diferentes vendedores de productos cárnicos del mer= cado 12 de abril, esto puede deberse a una higiene inadecuada y un mal procedimi= ento al momento de manipular este alimento. La presencia de este microorganismo = hace que el consumo de carne se convierta en un riesgo para la salud de sus consumidores y puede estar asociado con enfermedades transmitidas por alimentos.

Se establece que la mayor parte de muestras analizadas no cumplen con los requisitos que sostie= ne la normativa INEN 1338, que corresponde a productos cárnicos crudos = no procesados, en donde establece condiciones específicas para que un p= roducto sea considerado seguro y de calidad para los consumidores.

Se concluye, conform= e a los estudios revisados sobre E. col= i y microorganismos en los alimentos, realizados en diferentes países = que para, disminuir el riesgo de contaminación alimentaria, se debe mejo= rar el nivel de higiene y condiciones ambientales, para la distribución = de esta, además tener en cuenta el estado en el que se encuentra el animal, debido a que representa una parte fundamental en las ETAs ya que es conside= rado como el mayor reservorio de microorganismos.=

Conflicto de intereses

Los autores afirman no tener conflicto de intereses.

Declaración de contribución de los autore= s

Los autores = Kelly Belén Quizhpi Quito, David Israel Bravo = Crespo & José Antonio Baculima Suarez han contribuido de manera significativa al desarrollo de la investigació= n y la elaboración del manuscrito. Todos los autores contribuyeron activamente en la concepción de la idea, la revisión crítica del contenido y la aprobación final de la versi&oacut= e;n a ser publicada.

Referencias Bibliográficas=

1.      =           Fernandez Sergio, Marcia Jhunior, Buu Jes= sy, Baca Yanina, Chavez Vilma, Montoya Hector, et al. Enfermedades transmitidas= por Alimentos (Etas); Una Alerta para el Consumidor. Ciencia Latina Revista Científica Multidisciplinar [Internet]. 2021 May [cited 2023 Aug 3];5(2):2284–98. Available from: https://ciencialatina.org/index.php/cienciala/article/view/433

2.      =           Barad Alexa, Rivero Daniela, Dahl Wendy. Dietas populares: Alimentos crudos. In: Cold Spring Harbor Symposia on Quantitative Biology [Internet]. 2020 [cited 2023 Aug 3]. p. 427–34. Available from: https://journals.flvc.org/edis/ar= ticle/view/125085

 

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20.      Rodriguez D= iego, Erazo Juan, Narvaez Cecilia. Tecnicas cuantitativas de investigacion de mercados aplicadas al consumo de carne en la generacion millenial de la ciu= dad de Cuenca (Ecuador). Revista Espacios [Internet]. 2019 [cited 2023 Aug 3]; Available from: https://www.revistaespacios.com/a= 19v40n32/19403220.html

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22.      Usera MA. <= span class=3DSpellE>Escherichia coli O157 pro= ductor de verotoxina: un resumen práctico [Inte= rnet]. Madrid; 2015 [cited 2023 Aug = 3]. Available from: https://s= eimc.org/contenidos/ccs/revisionestematicas/bacteriologia/o157.pdf

23.  &nb= sp;   MSD. Manual MSD. 2022 [cited 2023 Aug 3]. Infección por Escherichia coli O157:H7 = y otras E. coli enterohemorrágicas (EHEC). Available from: https://w= ww.msdmanuals.com/es-ec/professional/enfermedades-infecciosas/bacilos-gramn= egativos/infecci%C3%B3n-por-o157-h7-y-otras-enterohemorr%C3%A1gicas-ehec

24.      Margal Nuri= a, Dominguez Angela, Prats Guillen, Salleras Lluis. Escherichia coli enterohemorr= ágica [Internet]. Barcelona; 1997 Oct [cited 2023 Aug 3]. Available from: = https://s= cielo.isciii.es/scielo.php?script=3Dsci_arttext&pid=3DS1135-57271997000= 500002

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El artículo que se publica es de exclusiva responsabilidad de los autor= es y no necesariamente reflejan el pensamiento de la Revista Anatomía Digital.

 

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El artículo queda en propiedad de la revist= a y, por tanto, su publicación parcial y/o total en otro medio tiene que = ser autorizado por el director de la Revista Anatomía Digital.

 

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