Solución Salina Hipertónica y Sibilancias Agudas en Niños en Edad Preescolar

7/23/2019 Solucin Salina Hipertnica y Sibilancias Agudas en Nios en Edad Preescolar

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Vgmufdk Vcmdkc Jdpartkdfc yVdidmckfdcs Councs ak Kdgs ak Ancn\raasfgmcr

CQ^GYAV8 Ngrdt Ctar, EN,c,iJckdtc Vjcd, EN,cIct-Am Icr, EN,cKdr Bdraeck, EN,cNdckc ^csjar, EN,i,f DmckNcmcm, EN,i,nCed Icmmdk, EN,i,ackn Cvdongr Ecknamiaro, ENc,i

cQkdncn \andtrdfc na Kauegkgmgoc, y iNapcrtceaktg na \andctrc, Vcf`mar Vfjggm gb Eandfdka, ^am CvdvQkdvarsdty, ^am Cvdv, Dsrcam0 y fQkdncn \andtrdfc na Akbareancnas Dkbaffdgscs, nNapcrtceaktg na Aearoakfdc, yaNapcrtceaktg na \andctrc0 _gmbsgk Eandfcm Faktra, Jgmgk, Dsrcam

\CMCIYCV FMCRA

wjaazdko, prasfjggm fjdmnrak, cstjec, fgktrgmman fmdkdfcm trdcm, jypartgkdf scmdka

CIYARDCFDGKAV

DC--Dktarvcmg na cnedsdk

CVM--Cdrwcy Vurbcfa Mdqudn0 Mqudng suparbdfdcm na mc vc raspdrctgrdc

\F--\uktucfdk fmkdfc na mc savardncn

NQ--Napcrtceaktg na uroakfdcs

VVJ--Vgmufdk Vcmdkc Jdpartkdfc cm 1%

NA--Nurcfdk na mc astcnc

\FY--Yacffdk ak fcnakc na mc pgmdearcsc

RVY--Rdrus Vdkfdtdcm Yaspdrctgrdg

Am Nr. Ecknamiaro fgkfdid am astundg0 mgs Nras. Ecknamiaro y Ctar ndsacrgk am prgtgfgmg,

pmckacrgk am ckmdsds astcnstdfg, y ndargk cpgrtas dktamaftucmas cm ndsag nam astundg0 Mgs

Nras. Ecknamiaro, Ctar, Vjcd, Icr, Bdraeck, y Ncmcm suparvdscrgk y cnqudrdargk mgs nctgs nam

astundg0 am Nr. ^csjar bua raspgkscima pgr mgs astundgs na vdrgmgoc0 tgngs mgs cutgras

fgktrdiuyargk c mc dktarpratcfdk na mgs rasumtcngs nam astundg y ravdscrgk na eckarc frtdfc am

eckusfrdtg0 y am Nr. Ecknamiaro tuvg cffasg fgepmatg c tgngs mgs nctgs ak am astundg y tgec

raspgkscidmdncn pgr mc dktaordncn na mgs nctgs y mc prafdsdk nam ckmdsds na mgs edsegs.

Asta astundg jc sdng raodstrcng ak www.fmdkdfcmtrdcms.ogv (dnaktdbdfcngr KF^


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raspdrctgrdc y anaec suieufgscm, mgs fucmas fcusck ukc bcmmc ak am cfmcrcedaktg na mc

eufgsdncn. Astgs kdgs raspgknak idak c mgs trctcedaktgs ndspgkdimas, kd sdqudarc c mgs

astargdnas grcmas. Astg axdoa trctcedaktgs ak prg nam cfmcrcedaktg na mc eufgsdncn a

jdnrctcfdk tcmas fgeg sgmufdk scmdkc jdpartkdfc ak kdgs ak ancn praasfgmcr fgk

sdidmckfdcs.E^GNGV8Qk astundg fgktrgmcng, cmactgrdzcng, fgk ngima akecsfcrcedaktg. Fucraktc y uk

kdgs (ancn eandc 69,4 3?,> easas, rckog na 3-2 cgs) prasaktcngs fgk sdidmckfdcs ak am

napcrtceaktg na aearoakfdc buargk cmactgrdzcngs muaog na 3 dkjcmcfdk na cmiutargm pcrc

rafdidr g > eM na sgmufdk scmdkc jdpartkdfc cm 1% (VVJ) (k5 32) g > eM na sgmufdk scmdkc

kgrecm (VVK) (k 5 91), ceigs fgk vafas cm nc ak cnamckta ak fcsg na jgspdtcmdzcfdk. Am

rasumtcng prdkfdpcm eandng bua mc nurcfdk na mc astcnc (NA) y mgs rasumtcngs safukncrdgs

buargk mcs tcscs na cnedsdk (^C) y mc puktucfdk fmkdfc na mc savardncn.

YAVQM^CNGV8Mc NA bua sdokdbdfctdvceakta es fgrtc ak am orupg na VVJ qua ak am na

VVK8 eandckc na 9 ncs (dktarvcmg


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qua sa kafasdtck na eckarc uroakta trctcedaktgs kgvangsgs y abaftdvgs pcrc su astundg ak

astc pgimcfdk.1

Ak mgs mtdegs cgs pcscngs, jck avgmufdgkcng kuavgs fgkgfdedaktgs jcfdc mc pctgbdsdgmgoc

na akbareancnas prgnuftgrcs na sdidmckfdcs csgfdcncs fgk vdrus ak kdgs paquags, cs

fgeg axcfaricfdgkas na sktgecs pumegkcras ak akbareancnas na mcs vcs raspdrctgrdcs akorupgs na tgncs mcs ancnas.2Va jc suoardng qua astcs akbareancnas na mc vc raspdrctgrdc

prgpdfdcncs pgr vdrus sgk am rasumtcng na bcmmcs fctcstrbdfcs dktaredtaktas nam cfmcrcedaktg na

mc eufgsdncn (CE) naidng c mc nasjdnrctcfdk nam mqudng na mc suparbdfda na mc vc raspdrctgrdc

(CVM). Yafdaktaeakta sa nasfuird qua mgs rdkgvdrus ak mcs vcs raspdrctgrdcs dkbardgras

dknufak uk fceidg ak am egvdedaktg na mgs amaftrgmdtgs y am couc ak mc suparbdfda muedkcm na

mcs fmumcs apdtamdcmas0 sdedmcr c mgs abaftgs gisarvcngs nurckta ukc dkbaffdk nam vdrus

sdkfdtdcm raspdrctgrdg (RVY)8 ceigs dkfraeaktck mgs kdvamas na cnakgsdkc trdbgsbctg

axtrcfamumcr, mg qua rasumtc ak ukc ndsedkufdk fgkfgedtckta na mgs kdvamas na cnakgsdkc

trdbgsbctg axtrcfamumcr. Astc ndsedkufdk c su vaz dkfraeaktc mc cisgrfdk nam sgndg nam CVM

jcfdc mc eufgsc. Astgs fceidgs ak am egvdedaktg nam couc y mgs amaftrgmdtgs fcusck

nasjdnrctcfdk nam CVM y anaec na mc eufgsc y cnvaktdfdc.?

Cndfdgkcmeakta, mcs akbareancnas vdrcmas na mcs vcs raspdrctgrdcs dkbardgras fcusck ukc

safrafdk na egfg dkfraeaktcnc y nasprakndedaktg apdtamdcm, c vafas fgk bgrecfdk na

tcpgkcedaktg na egfg. Astgs bcftgras, huktg fgk mc nasjdnrctcfdk nam CVM, fgktrdiuyak cm

bcmmg nam CE y astrafjcedaktg nam mueak na mcs vcs raspdrctgrdcs, mg qua fgkmmavc cm fucnrg

fmkdfg na bcmmc raspdrctgrdc fgk sdidmckfdcs.

\gr mg tcktg, sa jc suoardng qua ukc tarcpdc pcrc ecktakar mc jdnrctcfdk nam CVM, ndsedkudr

am anaec suieufgscm, y eahgrcr mcs prgpdancnas ragmodfcs na mc eufgsdncn puana

iakabdfdcr c mgs kdgs nurckta akbareancnas councs vdrcmas na sdidmckfdcs.

Mc sgmufdk scmdkc jdpartkdfc cm 1% (VVJ) puana, ak tagrc, ravartdr cmoukcs na mcs

ckgrecmdncnas pctgbdsdgmodfcs ctrdiudncs c apdsgndgs coungs na sdidmckfdcs dknufdngs pgr

vdrus ak kdgs paquags. T puana jdnrctcr am CVM, ndsedkuyakng am anaec suieufgscm, y

eahgrcr mcs prgpdancnas ragmodfcs na mc eufgsdncn, eahgrckng ak fgksafuakfdc am CE

napakndakta y kg napakndakta na mc tgs.2

Na jafjg, jc sdng fgkbdrecng rafdaktaeakta qua mgs dkbcktas jgspdtcmdzcngs pgr sdidmckfdcs

=9 cgs na ancn fgk irgkqudgmdtds dknufdnc pgr vdrus raspgkndargk bcvgrcimaeakta c ukc


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fgeidkcfdk na VVJ/cmiutargm. Mc nurcfdk na astcnc (NA) sa vdg ndsedkudnc, y mcs

puktucfdgkas fmkdfcs (\F) naegstrcrgk eahgrcr.4

Am aktakndedaktg ak avgmufdk na mc pctgbdsdgmgoc na akbareancnas na mcs vcs raspdrctgrdcs

dknufdncs pgr vdrus ak kdgs paquags y am abaftg pgsdtdvg raodstrcng na mc VVJ ak dkbcktas y

kdgs =9 cgs na ancn fgk irgkqudgmdtds kgs mmav c dkvastdocr am usg na mc VVJ/cmiutargm akctcquas coungs na sdidmckfdcs dknufdngs pgr vdrus ak kdgs ak ancn praasfgmcr.

E^GNGV

Va prasakt uk astundg fgktrgmcng, prgspaftdvg, cmactgrdzcng, fgk ngima akecsfcrcedaktg

pcrc dkvastdocr mc abdfcfdc nam trctcedaktg na VVJ dkjcmcnc ak kdgs na 3 c 2 cgs na ancn

qua sa prasaktcrgk ak am NQ fgk apdsgndgs coungs na sdidmckfdcs nasna akarg na 9


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ak am astundg y bdrecrgk ukc bgrec na fgksaktdedaktg buargk ndstrdiudngs cm czcr ak ukc

eckarc fgk ngima akecsfcrcedaktg c 3 na 9 orupgs na trctcedaktg8 am Orupg 3, am orupg na

trctcedaktg, rafdid 9 dkjcmcfdgkas es na VVJ (> eM fcnc ukc) fgk eM fcnc ukc) fgk


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puastg c ukc vamgfdncn na bmuhg na : M/edk. Asta ndspgsdtdvg tuvg ukc aktraoc na ecsc na

,9 #e na ndeatrg cargndkedfg eandckg na ecsc fgk

ukc nasvdcfdk astkncr oagetrdfc na 3,:.

\ruaic pcrc Dkbaffdgkas Rdrcmas nam ^rcftg YaspdrctgrdgVa gituvdargk euastrcs pcrc nataffdk vdrcm na 6< na mgs >3 (?3%) kdgs (cquammgs fuyc

cprgicfdk na mgs pcnras sa gituvg aspafbdfceakta pcrc asta astundg). Mgs aspafeakas

raspdrctgrdgs sa gituvdargk fgk mc tfkdfc na asputg dknufdng egndbdfcnc na Xcr at cm.33y sa

prgicrgk pgr ukc racffdk ak fcnakc na mc pgmdearcsc (\FY). Mc dknuffdk nam asputg sa

mmav c fcig am nc nam raodstrg naspus y nurckta mcs dkjcmcfdgkas na VVJ/VVK pgr 3 na mgs

dkvastdocngras aktrakcngs ak mc tfkdfc. Am asputg dknufdng sa gituvg pgr axpaftgrcfdk (ak

kdgs fcpcfas na fggparcr) g suffdgkkngmg c trcvs na mc grgbcrdkoa usckng uk axtrcftgrastrdm na eufgsdncn (fcttar na tcecg 2). Cquammgs kdgs qua kg tgsdargk buargk

namdfcnceakta astdeumcngs c tgsar fgk mc puktc nam fcttar ak mc grgbcrdkoa cktas na

suffdgkcr, fgeg Xcr at cm.33 Mgs aspafeakas buargk trckspgrtcngs ndraftceakta cm

mcigrctgrdg pcrc su prgfascedaktg y pruaic pgr \FY. Am CNK y CYK buargk axtrcngs

sdeumtkaceakta na 9


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Astcnstdfcs

Qkg na mgs prdkfdpcmas rasumtcngs na dktars bua eandng8 mc NA, eandnc nasna am tdaepg na

prasaktcfdk ak ak am NQ jcstc am egeaktg na sar ncng na cmtc (\F "2). Cndfdgkcmeakta, sa

edndargk ngs rasumtcngs cndfdgkcmas8 mc tcsc na cnedsdk (^C) y mc eahgrc ak mc \F aktra mgs

ngs orupgs na trctcedaktg. Am ckmdsds na mgs nctgs sa mmav c fcig usckng am sgbtwcra nackmdsds astcnstdfg V\VV 33.< (V\VV Dkf, Fjdfcog, DM, AA.QQ.). Mc ndstrdiufdk na mcs

vcrdcimas fgktdkucs bua avcmucnc pcrc kgrecmdncn usckng mc pruaic na @gmegogrgv-Vedrkgv

(fgrta ak \ 5


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32 ak am orupg na VVJ. Mcs fcrcftarstdfcs icscmas y mc apdnaedgmgoc na mgs 9 orupgs bua

sdedmcr ( cimcs 9 y 6). Am bmuhg tgtcm na pcrtdfdpcktas nurckta am pardgng na astundg ast ncng ak

mc Bdo. 3. Mcs pruaics na \FY buargk axdtgscs ak 94 na mgs 6< pcfdaktas qua cfaptcrgk cm

prgfandedaktg (tgtcm nam ?3 kdgs). Radktdfuctrg na mcs euastrcs (:6%) buargkpgsdtdvcs pcrc ! vdrus raspdrctgrdg, sdakng am es fgek am rdkgvdrus (33/940 6:%) y sdk

ndbarakfdcs sdokdbdfctdvcs aktra mgs orupgs (^cimc 6). Ak 2/94 (93%) sa nataft es na uk

vdrus0 ak ngs fcsgs, sa nataftcrgk tras vdrus. Mcs nataffdgkas na mgs vdrus y mc ndstrdiufdk kg

vcrd na eckarc sdokdbdfctdvc aktra mgs orupgs (^cimc 6). Mc NA bua sdokdbdfctdvceakta es

fgrtc ak am orupg na VVJ qua ak am orupg na VVK8 eandckc na 9 ncs (rckog


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bua na 9,? ncs (rckog 3 pcfdaktas (:3 \

\F, mkac icsa 3


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NDVFQVDK

Asta crtfumg as am prdearg ak dktaktcr nataredkcr am abaftg na ukc fgeidkcfdk na VVJ

irgkfgndmctcngrc ak kdgs ak ancn praasfgmcr qua sa prasaktcrgk ak am NQ fgk uk apdsgndg

coung na sdidmckfdcs. Am astundg euastrc qua cm coraocr dkjcmcfdgkas na VVJ cm trctcedaktg

fgek prcftdfcng cfgrtc sdokdbdfctdvceakta mc NA pgr 66% (3 nc) y ndsedkuyasdokdbdfctdvceakta am rdasog cisgmutg na jgspdtcmdzcfdk (^C) pgr 6


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Astgs rasumtcngs pundarck takar uk depcftg fmkdfg depgrtckta ak am saktdng na qua sa

puanak trctcr eufjgs kdgs ak ancn praasfgmcr fgk sdidmckfdcs. Vdk aeicrog, kg as kgtcima

cfgtcr vcrdcs fcrcftarstdfcs na mgs pcfdaktas qua sa pundargk jciar dktarpratcng fgeg

bcftgras na rdasog pcrc uk apdsgndg na sdidmckfdcs subdfdaktaeakta savarg fgeg pcrc raquardr

vdsdtcs cm NQ y jgspdtcmdzcfdk. Ak prdear muocr, mc ecygrc (49%) nam orupg na fgktrgm

kafasdt jgspdtcmdzcfdk, am fucm as uk kearg es amavcng nam rapgrtcng pgr am jgspdtcm ak

mgs cgs 344? y 344:.39Astc cmtc tcsc na cnedsdk puana sar axpmdfcnc pgr mcs sdoudaktas

rczgkas8 cukqua am frdtardg ekdeg na dkfmusdk bua \F !2, tgngs mgs kdgs qua buargk

rafmutcngs pcrc am astundg takck FV !: (3 Nc 1 Nc 2(Dkfm.NA)

VVK (orupg na fgktrgm)VVJ (orupg na trctcedaktg)

BDOQYC 9Orbdfc na @cpmck-Eadar pcrc mc mgkodtun na mc astcnc


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oakarcmdzcfdk na astcs fgkfmusdgkas jcfdc fcsgs es mavas naia sar tgecnc fgk fcutamc

jcstc qua sac prgicng ak uk astundg cmactgrdzcng fgk akecsfcrcedaktg ak pgimcfdgkas

ceiumctgrdcs.

Vaoukng, cukqua asta ndsag bua dnacng pcrc dkfmudr kdgs tck ecygras fgeg 2 cgs, mgs

pcfdaktas buargk ramctdvceakta hvakas (69 g 1 cgs, mgs fucmas kg

astuvdargk raprasaktcngs ak am cftucm astundg. ^arfarg, mc ecygrc na astgs kdgs (:2,6%) rapgrt apdsgndgs na sdidmckfdcs pgr

fcuscs emtdpmas. Naidng c qua asta astundg bua ndsacng fgeg ukc pruaic cmactgrdzcnc, kg

samaftdvc, fgk akecsfcrcedaktg, nastdkcnc c dkfmudr kdgs sdk amaodr ak ancn praasfgmcr fgk

sdidmckfdcs qua sa prasaktcrc ak am NQ, sa fraa qua mc pgimcfdk raprasaktc na eckarc

fgrraftc c mc pgimcfdk kgrecm na pcfdaktas na kdgs ak ancn praasfgmcr qua sa prasaktckak am NQ8 hvakas, fgk apdsgndgs cktardgras na sdidmckfdcs. Astg as fgepctdima fgk nctgs

puimdfcngs rafdaktaeakta ngkna kdgs ak ancn praasfgmcr => cgs na ancn axpardeaktck

fcsd am trdpma na mc tcsc na jgspdtcmdzcfdk qua kdgs ecygras.36 ^akdakng astg ak

fgksdnarcfdk, sa fraa qua mgs rasumtcngs y fgkfmusdgkas pundarck sar oakarcmdzcncs c kdgs

ak ancn praasfgmcr qua sa prasaktck ak am NQ fgk uk apdsgndg na sdidmckfdcs na egnarcng c

savarg.

Va fraa qua mgs fcsgs na irgkqudgmdtds vdrcm buargk cprgpdcnceakta axfmudngs ak am astundg8usckng \FY, am RVY sa akfgktr ak smg 3 pcfdakta (^cimc 6). Cndfdgkcmeakta, nurckta mc

taepgrcnc na RVY, sa rafmutcrgk sgmceakta kdgs ;9 cgs ak mgs qua mc irgkqudgmdtds pgr

RVY as eakgs pravcmakta. Na astc eckarc, sa fraa qua mc pgimcfdk nam astundg raprasaktc

es qua kcnc sdidmckfdcs prgnufdncs pgr vdrus, kg irgkqudgmdtds, c mgs qua cmoukcs vafas sa

mas rabdara prftdfceakta fgeg ctcquas "csetdfgs" ak kdgs ak ancn praasfgmcr.

^CIMC >^csc na Jgsp dtcmdzcfdk

Yasumtcngs VVJ k5 32 VVK k5 91\ VVJ vs

VVK^gngs mgs \cfdaktas k 5 >3

csc na cnedsdk (%) 3< (29,9%) 96 (49%) =


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Qkc naidmdncn na asta astundg as qua mgs egnamgs na eandncs rapatdncs dkndfck qua mcs \F

eahgrcrgk smg kgedkcmeakta pgstdkjcmcfdk nurckta mgs ncs na jgspdtcmdzcfdk ak bcvgr nam

orupg nam trctcedaktg parg, cm fgktrcrdg na kuastrc jdptasds, kg cmfckz ukc ndbarakfdc

sdokdbdfctdvc aktra mgs orupgs (\ 5 a dkfraeaktc am cfmcrcedaktg eufgfdmdcr. Ygepa mgs

akmcfas na jdnroakg naktrg nam oam eufgsg, ranufdakng cs am orcng na aktrafruzcedaktg y

akecrccedaktg y ichckng mc vdsfgsdncn y amcstdfdncn na mc safrafdk eufgsc. Mc VVJ

puana fcuscr dknuffdk na asputg y tgs, mg fucm puana cyuncr c cfmcrcr am asputg cbuarc na

mgs irgkqudgs y na astc eckarc eahgrcr mc gistruffdk na mc vc raspdrctgrdc.1 Na jafjg,

eufjg na mgs amaeaktgs qua racffdgkck c mc sgmufdk scmdkc jdpartkdfc nasfrdtgs cqu

puanak takar uk pcpam ak mcs sdidmckfdcs dknufdncs pgr vdrus, tcmas fgeg am anaec na mc

eufgsc y suieufgsc, dkbdmtrcfdk pardirgkqudcm na fmumcs dkbmcectgrdcs, kafrgsds y

nasfcecfdk na mcs fmumcs nam apdtamdg fdmdcr, y safrafdk eufgsc ak axfasg. Mc fgeidkcfdk

na ukc jdkfjczk na mc pcran na mc vc raspdrctgrdc, nasprakndedaktg na rasdnugs kafrtdfgs,

prgnuffdk eufgsc dkfraeaktcnc, y aepagrcedaktg nam cfmcrcedaktg na mcs safrafdgkas

avaktucmeakta fgktrdiuyak, cndfdgkcm cm irgkfgaspcseg, c mc gistruffdk na mc vc

raspdrctgrdc, ratakfdk na ocs, ctamaftcsds, a dktarfceidg na ocs parhundfcng. Cndfdgkcm c astg,

ak mgs kdgs cbaftcngs es savarceakta qua raspgkndargk na eckarc eakgs bcvgrcima c

trctcedaktgs fgkvakfdgkcmas fgeg mgs irgkfgndmctcngras y, pgr mg tcktg, sa prasaktcrgk ak am

NA, mc fgktrdiufdk ramctdvc na astcs fgksafuakfdcs pctgmodfcs y pctgbdsdgmodfcs "kg

aspcsendfcs" na dkbmcecfdk vdrcm y csetdfc na mc vc raspdrctgrdc, ratakfdk na ocs,

ctamaftcsds, a dktarfceidg na ocs parhundfcng, sa vuamva ck es depgrtckta.


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Va jdzg akbgqua ak am abaftg na mc VVJ (fgk cmiutargm) ak fgepcrcfdk fgk mc VVJ na fgktrgm

(fgk cmiutargm). Na jafjg, kg sa puana nasfcrtcr ukc pgsdima fgktrdiufdk nam abaftg na mc

VVJ sgira mc cffdk dkfraeaktcnc nam cmiutargm. Vdk aeicrog, astg kg jc sdng astundcng

jcstc cjgrc.

FGKFMQVDGKAV

Asta as am prdear astundg ak iusfcr jcfdc am trctcedaktg fgk VVJ ak kdgs ak ancn

praasfgmcr fgk uk apdsgndg na sdidmckfdcs. Am astundg euastrc qua coraockng VVJ cm

trctcedaktg fgek cfgrtc na eckarc sdokdbdfctdvc mc NA pgr 66% (3 nc) y ichc mc ^C cisgmutc

pgr 6


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1. Oudmiart _, Icfjcrdar MI. Fgktrgvarsdas dk tja

tracteakt gb tja cfutamy wjaazdko dkbckt. Ce H Yaspdr Frdt Fcra Ean. 9

Solución Salina Hipertónica y Sibilancias Agudas en Niños en Edad Preescolar

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