Diccionario Medico de Bolsillo

www.siempre-medicina.com

Siempre-medicina.com

'LFFLRQDULR0pGLFR

&RQFLVR\GH%ROVLOOR

8QD'LYLVLyQ(GLWRULDOGH-D\SHH%URWKHUV0HGLFDO3XEOLVKHUV3/WG

1XHYD'HOKL‡&LXGDGGH3DQDPi‡/RQGUHV‡)LODGHOÀD((88

5HFRSLODGR\(GLWDGRSRU

813DQGD0'

0pGLFR-HIH

1XHYD'HOKL,QGLD

'LFFLRQDULR0pGLFR

&RQFLVR\GH%ROVLOOR

6HJXQGD(GLFLyQ

8QD'LYLVLyQ(GLWRULDOGH-D\SHH%URWKHUV0HGLFDO3XEOLVKHUV3/WG 1XHYD'HOKL‡&LXGDGGH3DQDPi‡/RQGUHV‡)LODGHOÀD((88

www.siempre-medicina.com

8QD'LYLVLyQ(GLWRULDOGH-D\SHH%URWKHUV0HGLFDO3XEOLVKHUV3/WG 352'8&&,21 (GLWRUHQ-HIH'U6DPXHO%R\G 'LUHFWRUDGH3URGXFFLyQ.D\UD0HMtD &RPSRVLFLyQ'LJLWDO/DXUD'XUiQ 'LUHFWRUGH$UWH(GXDUGR&KDQGHFN &RPXQLFDFLRQHV,QWHUQDFLRQDOHV-R\FH2UWHJD 7UDGXFFLyQ\(GLFLyQDO(VSDxRO'UD$QDLND&RQFHSFLyQ3DQDPi5HSGH3DQDPi 0(5&$'(2 'LUHFWRUGH0HUFDGHR\9HQWDVSDUD$PpULFD/DWLQD6ULQLYDV&KDXEH\ *HUHQWHGH6HUYLFLRDO&OLHQWH0LURVODYD%RQLOOD *HUHQWHGH9HQWDV7RPiV0DUWtQH] (GLFLyQSDUD0p[LFRGLVWULEXLGDH[FOXVLYDPHQWHSRU&XpOODU$\DOD (GLFLyQSDUDHOUHVWRGH$PpULFD/DWLQDGLVWULEXLGDSRU -D\SHH+LJKOLJKWV0HGLFDO3XEOLVKHUV,QF ‹'HUHFKRVGH$XWRU(GLFLyQHQ(VSDxROSRU-D\SHH+LJKOLJKWV0HGLFDO3XEOLVKHUV,QF 7RGRVORVGHUHFKRVVRQUHVHUYDGRV\SURWHJLGRVSRUHOGHUHFKRGHDXWRU1LQJXQDVHFFLyQGH HVWHOLEURSRGUiVHUUHSURGXFLGDDOPDFHQDGDHQXQVLVWHPDGHUHFXSHUDFLyQRWUDQVPLWLGDHQ QLQJXQDIRUPDRPHGLRIRWRFRSLDVPHFiQLFRJUDEDFLyQXRWURQLVXVLOXVWUDFLRQHVFRSLDGDV PRGLÀFDGDVRXWLOL]DGDVSDUDVXSUR\HFFLyQVLQHOFRQVHQWLPLHQWRSRUHVFULWRGHOSURGXFWRU       &RPR HVWH OLEUR OOHJDUi D PpGLFRV \ SHUVRQDO PpGLFR GH GLIHUHQWHV SDtVHV FRQ GLIHUHQWH HQWUHQDPLHQWR FXOWXUD \ DQWHFHGHQWHV ORV SURFHGLPLHQWRV \ SUiFWLFDV GHVFULWDV HQ HVWH OLEUR GHEHQ VHU LPSOHPHQWDGDV HQ FXPSOLPLHQWR GH ORV GLIHUHQWHV HVWiQGDUHV TXH GHWHUPLQHQ ODV FLUFXQVWDQFLDVGHFDGDVLWXDFLyQHVSHFtÀFD6HKDQUHDOL]DGRJUDQGHVHVIXHU]RVSDUDFRQÀUPDU ODLQIRUPDFLyQSUHVHQWDGD\SDUDUHODFLRQDUODFRQODVSUiFWLFDVGHDFHSWDFLyQJHQHUDO(ODXWRUHO GLUHFWRU\HOSURGXFWRUQRSXHGHQDFHSWDUODUHVSRQVDELOLGDGSRUORVHUURUHVRH[FOXVLRQHVRSRU HOUHVXOWDGRGHODDSOLFDFLyQGHOPDWHULDODTXtSUHVHQWDGR1RH[LVWHQLQJXQDJDUDQWtDH[SUHVDR LPSOtFLWDGHHVWHOLEURRGHODLQIRUPDFLyQSRUpOLPSDUWLGD &XDOTXLHUUHVHxDRPHQFLyQGHFRPSDxtDVRSURGXFWRVHVSHFtÀFRVQRSUHWHQGHVHUXQ UHVSDOGRSRUSDUWHGHODXWRURGHOSURGXFWRU 'LFFLRQDULR0pGLFR&RQFLVR\GH%ROVLOOR 813DQGD0'        ,6%1 3XEOLFDGRSRU -D\SHH+LJKOLJKWV0HGLFDO3XEOLVKHUV,QF 7HO)D[ &LXGDGGHO6DEHU (PDLOFVHUYLFH#MSKPHGLFDOFRP 7HFQRSDUTXH,QGXVWULDO(GLI ZZZMSKPHGLFDOFRP *DLOODUG+LJKZD\&OD\WRQ 3DQDPi5HSGH3DQDPi

www.siempre-medicina.com

$

PLHVSRVD

H

KLMRV

3UHIDFLR

(VWD HGLFLyQ GHO 'LFFLRQDULR 0pGLFR &RQFLVR \ GH

%ROVLOORHQHVSDxROVHSXEOLFDDVROLFLWXGGHPXFKRV

H[SHUWRV TXH GHVSXpV GH PLQXFLRVD UHYLVLyQ  OR

UHFRPLHQGDQ FRPR XQ OLEUR FRPSOHWR SUiFWLFR

GLQiPLFR\IiFLOGHOHHU



&RPRHVXQOLEURGHUiSLGDHYROXFLyQKHPRVWUDEDMDGR

SULPHUDPHQWH FRQ ORV WpUPLQRV \ SDODEUDV GH XVR

PiV IUHFXHQWH (O  WH[WR GH FDGD FDStWXOR SUHVHQWD XQ

FRPSHQGLRGHUHIHUHQFLDVDODVSDODEUDVPiVHPSOHDGDV

HQODUDPDPpGLFDGHIRUPDFODUD\SUHFLVD



1LQJ~Q  HVIXHU]R  VH  KD  OLPLWDGR HQ OD SURGXFFLyQ

GLVHxRLOXVWUDFLRQHV\FDOLGDGGHSDSHOGHO'LFFLRQDULR

0pGLFR(VXQOLEURSUiFWLFRFX\DYLJHQFLDVHFRQVHUYDUi

D WUDYpV GH ORV DxRV PHMRUDQGR OD FRPXQLFDFLyQ \

D\XGDHQHOGHVDUUROORGHOYRFDEXODULRPpGLFR

'UD0DUtD&HOLQD3UHFLDGR/LPDV

&DUGLyORJD

-HIDGHO'HSDUWDPHQWRGH&DUGLRORJtD

8QLYHUVLGDG$XWyQRPDGH*XDGDODMDUD

-DOLVFR0p[LFR

www.siempre-medicina.com

3UyORJRGHOD6HJXQGD(GLFLyQ

(VWD QXHYD HGLFLyQ GHO 'LFFLRQDULR 0pGLFR &RQFLVR \ GH

%ROVLOOR KD H[SHULPHQWDGR XQ SURFHVR GH UHYLVLyQ

FXLGDGRVR,QFOX\HKHUPRVDVLOXVWUDFLRQHV\GLDJUDPDV

DXWRH[SOLFDWLYRVDWRGRFRORU6HKDQDxDGLGRPiVGH

QXHYDVÀJXUDV\QXPHURVDVDQRWDFLRQHV



6LQFHUDPHQWH VH HVSHUD TXH HO 'LFFLRQDULR 0pGLFR

&RQFLVR\GH%ROVLOORSUXHEHVHUXQDIXHQWHGHUHIHUHQFLD

IiFLOPHQWH GLVSRQLEOH HQ EHQHILFLR GH HVWXGLDQWHV

SURIHVRUHV SUDFWLFDQWHV GH PHGLFLQD DVt FRPR

WDPELpQ GH ORV SURIHVLRQDOHV LQYROXFUDGRV HQ HO

FXLGDGR GH OD VDOXG (VWH GLFFLRQDULR LQFRUSRUD

HO YRFDEXODULR \ SDODEUDV PiV FRPXQHV XWLOL]DGDV HQ

OD PD\RUtD GH ODV HVSHFLDOLGDGHV PpGLFDV LQFOX\HQGR

PHGLFLQD FLUXJtD REVWHWULFLD \ JLQHFRORJtD RWRUULQR

ODULQJRORJtD RIWDOPRORJtD HWF (O VLJQLÀFDGR GH FDGD

WHUPLQRORJtD VX H[SOLFDFLyQ \ ORV HMHPSORV KDQ VLGR

GHVFULWRVHQXQIRUPDWRIiFLOGHHQWHQGHU\FRPSUHQVLEOH



/DVFUtWLFDVFRQVWUXFWLYDV\HODSR\RFRQWLQXRGHORV

OHFWRUHVQRVDQLPDQJUDQGHPHQWH

813DQGD

0'

3UyORJRGHOD3ULPHUD(GLFLyQ

(Q HO PHUFDGR H[LVWH XQ FUHFLPLHQWR GH GLFFLRQDULRV

PpGLFRV TXH SUROLIHUD UiSLGDPHQWH $OJXQRV VRQ WDQ

JUDQGHVTXHVRODPHQWHVLUYHQFRPROLEURVGHUHIHUHQFLD

PLHQWUDV TXH RWURV VRQ PX\ SHTXHxRV H LQFRPSOHWRV

SDUD GHSHQGHU VROR GH HOORV /D PD\RUtD GH

ORV GLFFLRQDULRV QR LQFRUSRUDQ SUHSDUDFLRQHV

IDUPDFpXWLFDV 3RU OR WDQWR ORV HVWXGLDQWHV WLHQHQ OD

VHQVDFLyQ GH KDEHUVH TXHGDGR DWUiV FXDQGR EXVFDQ

D\XGDHQXQGLFFLRQDULRPpGLFR



(VWDDPSOLDGLIHUHQFLDPHDQLPyDUHFRSLODU\SUHVHQWDU

D QXHVWURV HVWLPDGRV OHFWRUHV XQ GLFFLRQDULR PpGLFR

FRPSDFWR\FRPSOHWROODPDGR'LFFLRQDULR0pGLFR&RQFLVR

\ GH %ROVLOOR  $XQTXH FRQFLVR LQFRUSRUD ODV SDODEUDV

PiV FRPXQHV \ HO YRFDEXODULR XWLOL]DGR SRU FXDOTXLHU

GLFFLRQDULRGHUHSXWDFLyQ(OVLJQLÀFDGRGHXQDSDODEUD

VX H[SOLFDFLyQ \ HMHPSORV VH GHVFULEHQ GH XQD IRUPD

VLPSOH \ FRPSUHQVLEOH /D PD\RUtD GH ORV SURGXFWRV

IDUPDFpXWLFRVGLVSRQLEOHVHQHOPHUFDGRHQFRQWUDURQVX

OHJtWLPROXJDUHQHVWHGLFFLRQDULRGRQGHVHHYLWDURQODV

H[SOLFDFLRQHV\HMHPSORVLQQHFHVDULRV(VWHOLEURVHUiGH

XWLOLGDGSDUDHVWXGLDQWHV\SUDFWLFDQWHVGHPHGLFLQDDVt

FRPRSDUDSURIHVRUHV\SURIHVLRQDOHVLQYROXFUDGRVHQHO

FXLGDGRGHODVDOXG



&RQHODSR\RFRQWLQXRGHORVOHFWRUHVHVWR\FRQÀDGR

GHPHMRUDUHOOLEURHQORVDxRVVLJXLHQWHV

813DQGD

0'

www.siempre-medicina.com

$FURPHJDO\

$UDFQRGDFWLOLD

$UWHULD%DVLODU

3ODFD

$UWHULD9HUWHEUDO

3ODFD

$UWHULD5DGLDO$UWHULD3XOPRQDU

(VWUXFWXUDVGHO2tGR

3ODFD

6HJPHQWRV3XOPRQDUHV

3ODFD

9tVFHUDV7RUiFLFDV\$EGRPLQDOHV

3ODFD

(VWUXFWXUDVGHO&RUD]yQ

3ODFD

9HQDVGHOD([WUHPLGDG6XSHULRU

3ODFD

9HQDVGHOD([WUHPLGDG,QIHULRU

3ODFD

9HQDVGHOD&DEH]D\&XHOOR

3ODFD

$UWHULDVGHOD([WUHPLGDG6XSHULRU

3ODFD

$UWHULDVGHOD([WUHPLGDG,QIHULRU

3ODFD

$UWHULDVGH&DEH]D\&XHOOR

3ODFD

$UWHULDVGHO$EGRPHQ\3HOYLV

3ODFD

$UWHULDVGHO$EGRPHQ\3HOYLV

3ODFD

1HUYLRVGHODV([WUHPLGDGHV

3ODFD

1HUYLRV6XSHUÀFLDOHVGH&DEH]D\&XHOOR

3ODFD

0~VFXORVGHO7URQFR9LVWD3RVWHULRU

3ODFD

0~VFXORVGHO7URQFR9LVWD$QWHULRU

3ODFD

0~VFXORVGH&DEH]D\&XHOOR

3ODFD

+RP~QFXORPRWRVHQVRULDO

3ODFD

$

$FHWLOSLULGLQD0HWDEROLWRGHOD QLFRWHQDPLGDSURYRFDVtQWRPDV GH GHÀFLHQFLD GH QLFRWHQDPLGD FXDQGR VH GD FRPR DOLPHQWR D UDWRQHV $WpUPLQR  (Q REVWHWULFLD QLxR QDFLGRHQWUHODV²VHPDQDV GHJHVWDFLyQ $EDGLHVLJQRGH6LJQRHQWDEHV GRUVDO HQ HO FXDO KD\ SpUGLGD GHO GRORU SRU RSUHVLyQ VREUH HO WHQGyQFDOFiQHR(VSDVPRGHO P~VFXOR HOHYDGRU GH SiUSDGR VXSHULRU TXH RFXUUH GH IRUPD IUHFXHQWHHQODWLURWR[LFRVLVSHUR WDPELpQ VH SXHGH YHU GH IRUPD QRUPDOFRQWHQVLyQ\IDWLJD $EDSLFDO /HMRV GH X RSXHVWR DO

iSLFH

$EiSWLVWRV7UpSDQR FyQLFR GLVH xDGRGHIRUPDTXHQRVHGHVOL]D DWUDYpVGHODDEHUWXUDyVHD\QR OHVLRQD OD GXUDPDGUH R FHUHEUR VXE\DFHQWH

$EDURJQRVLD   3pUGLGD R IDOWD GH KDELOLGDG SDUD HVWLPDU HO SHVR EUDJQRVLD $EDUWLFXODFLyQ    $UWLFXODFLyQ GLDUWURGLDO'LVORFDFLyQGHXQD DUWLFXODFLyQ $EDUWLFXODU1RFRQHFWDGRFRQR VLWXDGRFHUFDDXQDDUWLFXODFLyQ $EDVLD,QFDSDFLGDGSDUDFDPLQDU GHELGRDLQFRRUGLQDFLyQPRWRUD FRPSDUHFRQDVWDVLD

$EDWLU   'LVPLQXLU HQ IXHU]D R LQWHQVLGDGPRGHUDURUHPLWLU $EDWWDJHDEDWDJH0DWDQ]DGH

DQLPDOHV HVSHFtILFDPHQWH GH

DQLPDOHVHQIHUPRVSDUDSUHYHQLU OD LQIHFFLyQ GH RWURV   (O DUWH GH VHOHFFLyQ GH XQ DQLPDO HQ SUHSDUDFLyQSDUDXQDRSHUDFLyQ $EDWWRLU   &DVD GH PDWDQ]D R XQ

HVWDEOHFLPLHQWR SDUD PDWDU \ SUHSDUDUDQLPDOHV

$ED[LDO4XHQRHVWiVLWXDGRHQOD OtQHDD[LDOGHODHVWUXFWXUD $EGHUKDOGHQ UHDFFLyQ R SUXHED

GH  'HWHFFLyQ GH XQD HQ]LPD SURWHROtWLFDDFWLYDDQRUPDOFRQWUD XQD SURWHtQD H[WUDxD HODERUDGD HQ HO FXUVR GH XQ HPEDUD]R FiQFHU HVTXL]RIUHQLD \ YDULDV LQIHFFLRQHV $EGRPHQDEVWLSXP'HIRUPLGDG DEGRPLQDOTXHHVHOUHVXOWDGRGH ORVP~VFXORVUHFWRVDEGRPLQDOHV FRQJpQLWDPHQWHFRUWRV $EGRPLQDO DQJLQD   $WDTXH DJXGR GH GRORU DEGRPLQDO VHYHUR TXH FRP~QPHQWH RFXUUH GHVSXpVGHFRPHU\DPHQXGRVH DVRFLD FRQ SpUGLGD GH SHVR QiXVHDVYyPLWRV\GLDUUHD(VWR HV FDXVDGR SRU HVWUHFKDPLHQWR X REVWUXFFLyQ GH ODV DUWHULDV PHVHQWpULFDV SULQFLSDOPHQWH GH RULJHQDWHURHVFOHUyWLFR $EGRPLQDODSRQHXURVLV$PSOLD H[WHQVLyQ WHQGLQRVD D WUDYpV GH ODFXDOVHLQVHUWDQORVP~VFXORV REOLFXRH[WHUQRREOLFXRLQWHUQR \WUDQVYHUVR $EGRPLQDODSRSOHMtD , Q I D U W R G H  X Q  y UJ D Q R  D E G R P L Q D O  XVXDOPHQWHHOLQWHVWLQRGHOJDGR FRPR UHVXOWDGR GH HVWHQRVLV X

www.siempre-medicina.com



RFOXVLyQYDVFXODU

$EGRPLQDOFRVWLOODV  &RVWLOODV IORWDQWHV  2VLILFDFLyQ GH ODV LQWHUVHFFLRQHVWHQGLQRVDV $EGRPLQDOHSLOHSVLD (TXLYDOHQ

WHGHFRQYXOVLyQHQODFXDOORV VtQWRPDV PiV SURPLQHQWHV VRQ HO GRORU DEGRPLQDO VHQVDFLyQ GHQiXVHDV\DPHQXGRGRORUGH FDEH]D

$EGRPLQDOKLGURSHVtD$VFLWLV $EGRPLQDOLQIOXHQ]D *DVWURHQ

WHULWLVYLUDO

$EGRPLQDO PLJUDxD  'RORU DE GRPLQDO QiXVHDV YyPLWRV R GLDUUHD DVRFLDGRV FRQ PLJUDxD 9HUWDPELpQHTXLYDOHQWHGHFRQ YXOVLRQHV

$EGRPLQDOSWRVLV9LVFHURSWRVLV $EGRPLQDOUHÁHMR&RQWUDFFLyQ

GH ORV P~VFXORV DEGRPLQDOHV LQGXFLGD SRU HO URFH GH OD SLHO VXSUD\DFHQWH UHÁHMR FXWiQHR R VXSHUÀFLDO

$EGRPLQDOUHJLRQHV /DV QXHYH UHJLRQHVGHODEGRPHQVHGHOLQHDQ DUWLILFLDOPHQWH SRU GRV OtQHDV KRUL]RQWDOHV \ GRV SDUDVDJLWD OHV /DV OtQHDV KRUL]RQWDOHV VRQ WDQJHQWHVDORVFDUWtODJRVGHODV QRYHQDV FRVWLOODV \ ODV FUHVWDV LOtDFDV UHVSHFWLYDPHQWH \ ODV OtQHDV SDUDVDJLWDOHV VH GLEXMDQ YHUWLFDOPHQWH HQ FDGD ODGR PH GLDOHVDOOLJDPHQWRLQJXLQDO/DV UHJLRQHVIRUPDGDVVRQ$UULED KLSRFRQGULRGHUHFKRHSLJDVWULR HKLSRFRQGULRL]TXLHUGR(QHO PHGLRODWHUDOROXPEDUGHUHFKD L]TXLHUGDXPELOLFDO\$EDMR² LQJXLQDORLOtDFDGHUHFKDS~ELFD RKLSRJDVWULRHLQJXLQDORLOtDFD L]TXLHUGD 7DPELpQ VH OHV OODPD UHJLRQHVDEGRPLQLV

$EGRPLQDO UHVSLUDFLyQ  7LSR GH UHVSLUDFLyQ SURYRFDGD SRU OD FRQWUDFFLyQ GHO GLDIUDJPD \ OD H[SDQVLyQHOiVWLFD\UHWUDFFLyQGH ODVSDUHGHVDEGRPLQDOHV $EGRPLQRSRVWHULRU (QREVWHWUL FLDHVODSRVLFLyQIHWDOHQODFXDO HODEGRPHQHVWiKDFLDDGHODQWH $EGRPLQRYHVLFDO VDFR 6DFR IRU

PDGR SRU OD UHIOH[LyQ GHO SH ULWRQHR GH OD SDUHG DEGRPLQDO DQWHULRU VREUH OD YHMLJD XULQDULD GLVWHQGLGDHVWHFRQWLHQHODIRVD LQJXLQDOODWHUDO\PHGLDO $EGXFFLyQ0RYLPLHQWRGRQGH

XQDSDUWHVHPXHYHKDFLDDIXHUD GHO HMH GHO FXHUSR R GH XQD H[ WUHPLGDG  (Q RIWDOPRORJtD HV HOPRYLPLHQWRGHORVRMRVKDFLD DIXHUDPiVDOOiGHOSDUDOHOLVPR $EGRPLQDOFRVWLOODV $EGXFFLyQ 5HJLRQHVGHO$EGRPHQ

www.siempre-medicina.com

 $EGXFLU0RYHUVHKDFLDDIXHUDGH ODOtQHDPHGLD $EGXFWRU  0~VFXOR TXH HQ FRQWUDFFLyQVHPXHYHOHMRVGHOHMH GHOFXHUSRRGHXQDH[WUHPLGDG 0~VFXORTXHVHHQFXHQWUDHQ DQLPDOHVFRQFROD\FRUUHVSRQGH DOP~VFXORFRFFtJHRHQHOKRPEUH $EGXFWRU GLJLWLPLQLPL 0~VFXOR DEGXFWRU GHO GHGR PHxLTXH R GHGR PiV SHTXHxR GHO SLH 7DPELpQ VH OH OODPD P~VFXOR DEGXFWRUGLJLWLPLQLPL

$EGXFWRU KDOOXFLV  0~VFXOR GHO ODGR PHGLDO GHO SLH TXH VH LQVHUWD VREUH OD EDVH GHO SULPHU PHWDWDUVLDQR 7DPELpQ OODPDGR P~VFXORDEGXFWRUKDOOXFLV $ E G X F W R U  K D O O X F L V  O R Q J X V 0~VFXORGHODUHJLyQDQWHULRUGH ODSLHUQDTXHVHLQVHUWDHQODEDVH GHOSULPHUPHWDWDUVLDQR $EGXFWRULQGLFLV3ULPHUP~VFXOR LQWHUyVHRGRUVDOGHODPDQR $ E G X F W R U  R V V L V  P H W D W D U V L

TXLQWL 9DULDQWH GHO DEGXFWRU GLJLWLPLQLPL TXH VH LQVHUWD HQ OD WXEHURVLGDG GHO FXDUWR PHWDWDUVLDQR

$EGXFWRUSROOLFLVEUHYLV0~VFXOR DEGXFWRU FRUWR GHO SXOJDU 7DPELpQ OODPDGR P~VFXOR DEGXFWRUSROOLFLV

$EGXFWRUSROOLFLVORQJXV0~VFXOR DEGXFWRU ODUJR GHO SXOJDU 7DPELpQ OODPDGR P~VFXOR DEGXFWRUSROOLFLVORQJXV $EGXFWRU QHUYLR   6H[WR QHUYLR

FUDQHDO FX\DV ÀEUDV VXUJHQ GHO

Q~FOHR ORFDOL]DGR HQ OD SRUFLyQ GRUVDO GHO SXHQWH FHUFD GH OD URGLOOD LQWHUQD GHO QHUYLR IDFLDO \DORODUJRGHVXFXUVRLQHUYD DO P~VFXOR UHFWR ODWHUDO HO FXDO PXHYH DO JORER RFXODU KDFLD DIXHUD WDPELpQ OODPDGR QHUYLR DEGXFHQVRPRWRURFXODUH[WHUQR $EGXFWRUQ~FOHR1~FOHRTXHHVWi

SRU GHEDMR GHO SLVR GHO FXDUWR YHQWUtFXORHQODXQLyQGHOSXHQWH \ OD PpGXOD HO FXDO RULJLQD DO QHUYLRDEGXFWRU

$EGXFWRU SDUiOLVLV GHO 3DUiOLVLV GH OD DEGXFFLyQ HVSHFLDOPHQWH GHO P~VFXOR FULFRDULWHQRLGHR SRVWHULRU\SRUFRQVLJXLHQWHGH ODVFXHUGDVYRFDOHV $EGXFWRUDFXELHUWD $SOLFDFLyQ RUWRSpGLFDGHORQDRFXHURSDUD PDQWHQHUODDEGXFFLyQHQFDVRGH EXUVLWLVGHOGHOWRLGHV

$EHUUDFLyQ  'HVYLDFLyQ GH OR QRUPDO R XVXDO  5HIUDFFLyQ GHVLJXDO R IRFDOL]DFLyQ GHO FULVWDOLQR $EHUUDFLyQ FURPiWLFD UHIUDFFLyQ GHVLJXDO GH ORV UD\RV GHOX]GHGLIHUHQWHVORQJLWXGHVGH RQGD SURGXFLHQGR XQD LPDJHQ ERUURVD FRQ ERUGHV GH FRORUHV

$EHUUDFLyQ FURPRVyPLFD SpUGLGD

JDQDQFLDRLQWHUFDPELRGHPDWHULDO JHQpWLFR HQ ORV FURPRVRPDV GH XQD FpOXOD TXH UHVXOWD HQ GHOHFFLyQ GXSOLFDFLyQ LQYHUVLyQ RWUDQVORFDFLyQGHJHQHV $EHUUDQWH9DULDQWH R GHVYLDFLyQ

GHORQRUPDOHQIRUPDHVWUXFWXUD RFXUVR

$EGXFLU $EHUUDQWH

 $EHWDOLSRSURWHLQHPLD (QIHUPH GDGGHELGDDODDXVHQFLDFDVLWRWDO GH`OLSRSURWHtQDVFDUDFWHUL]DGD SRUODSUHVHQFLDSUHGRPLQDQWHHQ VDQJUHGHDFDQWRFLWRVKLSRFROHV WHUROHPLDVtQGURPHFHOtDFRHQOD LQIDQFLDWHPSUDQD\DWD[LDWDUGtD QHXURSDWtD SHULIpULFD UHWLQLWLV SLJPHQWRVD IUHFXHQWH \ DWURÀD PXVFXODU UDVJR KHUHGLWDULR DX WRVyPLFR

$ELRJpQHVLV 7HRUtD GH TXH ORV RUJDQLVPRVYLYLHQWHVVHSXHGHQ RULJLQDUGHODPDWHULDQRYLYLHQWH JHQHUDFLyQHVSRQWiQHD $ELRQDUFLD/HWDUJLDGHELGRDXQ SDGHFLPLHQWR $ELRTXtPLFD4XtPLFDLQRUJiQLFD $ELRVLV$XVHQFLDGHYLGD1R YLDELOLGDG

$ELRWURÀD 3pUGLGD SURJUHVLYD GH OD YLWDOLGDG GH FLHUWRV WHMLGRV X yUJDQRV TXH OOHYDQ D GHVyUGH QHV R SpUGLGD GH OD IXQFLyQ OR FXDO JHQHUDOPHQWH VH DSOLFD D HQIHUPHGDGHV GHJHQHUDWLYDV KHUHGLWDULDV GH LQLFLR WDUGtR HM &RUHDGH+XQWLQJWRQ $ELUULWDQWH$JHQWHWDOFRPRXQD FUHPDRSROYRTXHDOLYLDODLUUL WDFLyQ

$EODFLyQ 5HPRFLyQ GH SDUWH GH XQWXPRUSRUDPSXWDFLyQH[FL VLyQXRWURPHFDQLVPR $EODQGDGRU  3UHSDUDFLRQHV TXH FRQWLHQHQHQ]LPDVSURWHROtWLFDV FRPRODSDSDtQDSDUDKDFHUPiV WLHUQDREODQGDODFDUQH $EODVWLQD $QWLFXHUSR VLPLODU D

XQD VXVWDQFLD TXH DSDUHFH HQ ODVDQJUHGHODVUDWDVLQIHFWDGDV SRUWULSDQRVRPDVODFXDOLQKLEH ODUHSURGXFFLyQGHHVWRVRUJDQLV PRV $EODWLRSODFHQWDH$EUXSWLRSOD FHQWDHRSODFHQWDSUHYLD $EOHIDULD 'HIHFWRFRQJpQLWRPDU

FDGR SRU OD DXVHQFLD SDUFLDO R WRWDOGHORVSiUSDGRV $EOHSVLD 3pUGLGD R DXVHQFLD GH YLVLyQ $EOXHQWH 'HWHUJHQWHOLPSLDGRU $%2 JUXSR VDQJXtQHR   6LVWHPD GHJUXSRVDQJXtQHRGHWHUPLQDGR JHQpWLFDPHQWH  HVWi GHILQLGR SRU OD UHDFFLyQ GH DJOXWLQDFLyQ GH ORV HULWURFLWRV H[SXHVWRV D ORV DQWLFXHUSRV DQWL$ \ DQWL% TXH RFXUUHQ QDWXUDOPHQWH \ D DQWLVXHURVVLPLODUHV(OVXHURGH ORVLQGLYLGXRVQRUPDOHVFRQWLHQH LVRDQWLFXHUSRVFRQWUDORVDQWtJH QRV TXH IDOWDQ HQ ORV HULWURFLWRV GDQGR HO VLJXLHQWH DUUHJOR GH DQWtJHQRV LVRDJOXWLQyJHQRV \ DQWLFXHUSRV *UXSR$QWtJHQR$QWLFXHUSR /DQG(ULWURFLWDULR6pULFR 6WHLQHU$JOXWLQyJHQR$JOXWLQLQD $\%DXVHQWH $QWL$    $QWL% $$  $QWL% %%  $QWL$ $%$% QLQJXQR  6HKDQUHFRQRFLGRVXEJUXSRVGH $\VHKDQGHVLJQDGRFRQVXEtQ GLFHFRPR$$HWF $EHWDOLSRSURWHLQHPLD $%2JUXSRVDQJXtQHR

www.siempre-medicina.com



$ERUGDMH   3URFHGLPLHQWR TXLU~UJLFR SDUD OD H[SRVLFLyQ GH FXDOTXLHU yUJDQR R WHMLGR $FHUFDUVH

$ERUWDGDVtVWROH6tVWROHFDUGtDFD SUHPDWXUDHQODFXDOQRVHSUR GXFH RQGD GH SXOVR SHULIpULFR GHELGR D OOHQDGR YHQWULFXODU PtQLPRHQODFRUWDGLiVWROHTXH ODSUHFHGH

$ERUWDPLHQWR  )LOWUDGR GH FDOGR GHDERUWRGH%UXFHOODXVDGRSDUD HYRFDU XQD UHDFFLyQ HQ ORV SD FLHQWHVFRQEUXFHORVLVDFWLYDRHQ DTXHOORVTXHVHKDQUHFXSHUDGR GHXQDLQIHFFLyQ

$ERUWDU  &DXVDU XQ DERUWR OOHYDUDGHODQWHXQIHWRQRYLDEOH  7HUPLQDU SUHPDWXUDPHQWH R GHWHQHU HQ HWDSDV WHPSUDQDV WDOHV FRPR HO FXUVR GH XQD HQ IHUPHGDG  &RQWHQHU  R  QR OOHJDUDOFUHFLPLHQWR\GHVDUUROOR Pi[LPR $ERUWLFLGD$VHVLQDWRGHXQIHWR QRQDFLGR$JHQWHTXHGHVWUX \HXQIHWR\SURGXFHXQDERUWR $ERUWLYD SROLRPLHOLWLV  )RUPD

WHPSUDQD  GH SROLRPLHOLWLV FD UDFWHUL]DGD FOtQLFDPHQWH SRU VtQWRPDVUHODWLYDPHQWHOHYHVGH LQIHFFLyQ GHO WUDFWR UHVSLUDWRULR VXSHULRU FHIDOHD DOWHUDFLRQHV JDVWURLQWHVWLQDOHV QiXVHDV \ YyPLWRV SHUR TXH HQ VX  SUR JUHVLyQQRLQYROXFUDDOVLVWHPD QHUYLRVR FHQWUDO /DV SUXHEDV GHGLDJQyVWLFRGHÀQLWLYRVRQHO DLVODPLHQWRGHOYLUXV\ODVUHDF FLRQHVVHUROyJLFDV $ERUWLYR   'URJD R DJHQWH TXH LQGXFHODH[SXOVLyQGHOIHWR $ERUWR'DUDOX]DXQHPEULyQR IHWRSUHYLRDODHWDSDGHYLDELOLGDG HMVHPDQDVGHJHVWDFLyQHOIHWR SHVD PHQRV GH  JUDPRV 6H GHEH GLVWLQJXLU HQWUH  DERUWR \  QDFLPLHQWR SUHPDWXUR /RV LQIDQWHV SUHPDWXURV VRQ DTXHOORV TXH QDFHQ GHVSXpV TXH  VH KD DOFDQ]DGR OD HWDSD GH YLDELOLGDG  SHUR DQWHV GHO WpUPLQRFRPSOHWR(OSURGXFWR GHXQQDFLPLHQWRQRYLDEOH/D GHWHQFLyQ GH FXDOTXLHU DFFLyQ R SURFHVR DQWHV GH VX WHUPLQDFLyQ QRUPDO

$ERUWRDFFLGHQWDO'HELGRDIDOOD

JROSHXRWUDOHVLyQ

$ERUWR FRPSOHWR  $TXHO HQ HO

FXDO HO HPEULyQ LQFOX\HQGR ODV PHPEUDQDV VRQ FRPSOHWD PHQWHH[SXOVDGDVHLGHQWLÀFDGDV

$ERUWR FULPLQDO  7HUPLQDFLyQ

LQGXFLGDGHOHPEDUD]RVLQMXVWL ÀFDFLyQPpGLFDROHJDO

$ERUWR  IDOOLGR $TXHO HQ HO FXDO HO IHWR PXHUH LQ ~WHUR SHUR HO SURGXFWR GH OD FRQFHSFLyQ HV UHWHQLGR HQ HO ~WHUR SRU GRV PHVHVRPiV

$ERUWR  KDELWXDO   &RQGLFLyQ HQ ODFXDOXQDPXMHUKDWHQLGRWUHV yPiVDERUWRVHVSRQWiQHRVFRQ VHFXWLYRV

$ERUWR  LQFLSLHQWH $PHQD]D GH

DERUWR R DERUWR LQPLQHQWH HQ HO FXDO KD\ VDQJUDGR YDJLQDO FRSLRVR FRQWUDFFLRQHV XWHULQDV \GLODWDFLyQFHUYLFDO

$ERUGDMH  $ERUWRLQFLSLHQWH



$ERUWRLQFRPSOHWR(QHOFXDOSDU

WHGHOSURGXFWRGHODFRQFHSFLyQ VH H[SXOVD SHUR SDUWH XVXDO PHQWH OD SODFHQWD SHUPDQHFH HQHO~WHUR

$ERUWR  LQHYLWDEOH   $TXHO TXH

VH DGYLHUWH SRU OD UXSWXUD GH ODV PHPEUDQDV HQ  SUHVHQFLD GH GLODWDFLyQ FHUYLFDO TXH KD DYDQ]DGR PiV DOOi VLQ OD HVSHUDQ]DGHSUHYHQLUXQDERUWR FRPSOHWR $EUDTXLD 0XWLODFLyQ $EUDTXLR,QGLYLGXRVLQXQEUD]R $EUDTXLRFHIDOLD$XVHQFLDFRQJp QLWDGHODFDEH]D\EUD]RV $EUDVLyQ  ÉUHD GHQXGDGD GH SLHOPHPEUDQDPXFRVDRHSLWHOLR VXSHUÀFLDOSRUIULFFLyQRUDVSDGR WDOHV FRPR OD DEUDVLyQ FRUQHDO HVFRULDFLyQ  'HVJDVWH PHFi QLFR GH XQ GLHQWH D SDUWLU GHO FHSLOODGR LQFRUUHFWR DSDUDWRV R EUX[LVPR&RPSDUHFRQDWULFLyQ HURVLyQ

$EULNRVRYR$EULNRVR;WXPRUGH 0LREODVWRPD GH FpOXODV JUDQX ODUHV

$EURVLD $EVWLQHQFLD GH FRPLGD D\XQR

$EUXSWLR $EUXSFLyQGHVJDUUDQ GR

$EUXSWLR SODFHQWDH 6HSDUDFLyQ SUHPDWXUDGHODSODFHQWDSUHYLD DOQDFLPLHQWRGHOLQIDQWH $EVFHVR  &ROHFFLyQ FLUFXQVFULWD

GHSXV

$EVFHVRDPHELDQR$EVFHVRHQHO

KtJDGR TXH FRQWLHQH DPHEDV \ SXHGHVHUVHJXLGRSRUGLVHQWHUtD

DPHELDQD eVWH WDPELpQ  SXHGH RFXUULU LQGHSHQGLHQWHPHQWH VLQ LQIHFFLyQLQWHVWLQDO

$EVFHVR  DQRUHFWDO   $TXHO TXH

RFXUUH HQ HO WHMLGR FRQHFWLYR DOUHGHGRUGHODQR

$EVFHVR  FDQDOLFXODU $EVFHVR GH

PDPDTXHVHGHVFDUJDGHQWURGH ORVGXFWRVGHOHFKH

$EVFHVR  FDVHRVR    $TXHO HQ HO FXDOODSXVWLHQHXQDFRQVLVWHQFLD SDUHFLGDDTXHVRVXDYH

$EVFHVR GH  %URGLH   ,QÁDPDFLyQ

FUyQLFD DOJXQDV YHFHV WXEpUFX ORVGHODFDEH]DGHXQKXHVRHQ HVSHFLDOGHODWLELD

$EVFHVR GH  'HOSHFK $EVFHVR

TXH DSDUHFH V~ELWDPHQWH SHUR FRQ VtQWRPDV GH LQIODPDFLyQ OHYHVDFRPSDxDGRVGHDGLQDPLD PDUFDGD $ERUWRLQFRPSOHWR   $EVFHVRGH'HOSHFK $EVFHVR

www.siempre-medicina.com



$EVFHVR GH  0XQUR  &ROHFFLyQ

PLFURVFySLFD GH OHXFRFLWRV HQ FRQWUDGRVHQODFDSDJUDQXODUGHO HVWUDWRFyUQHRHQODSVRULDVLV $EVFHVRGH3RWW$EVFHVRIUtRR WXEHUFXORVR $EVFHVRGH%H]ROG$EVFHVRSUR IXQGRHQHOFXHOORDVRFLDGRFRQ VXSXUDFLyQ GHO RtGR PHGLR \ WURPERVLVSXUXOHQWDGHOVHQR $EVFHVRGH'RXJODV6XSXUDFLyQ HQHOVDFRGH'RXJODV

$EVFHVR GH 'XERLV   4XLVWH GHO

WLPR FDXVDGR SRU  FUHFLPLHQWR GH WHMLGR WtPLFR GHQWUR GH ORV FRUS~VFXORVGH+DVVDOO

$EVFHVR GH 3DXWULHU   /HVLyQ PL

FURVFySLFD HQ OD HSLGHUPLV TXH VH YH HQ PLFRVLV I~QJLFD  eVWH HVWi FRPSXHVWR GH FpOXODV GHO PLVPRWLSRGHODVTXHIRUPDQORV LQÀOWUDGRVHQHOFRULRQ

$EVFHVR GHQWRDOYHRODU $EVFHVR

FRQÀQDGRDOSURFHVRDOYHRODUTXH LQYROXFUDODVUDtFHVGHORVGLHQWHV $EVFHVRGLYDJDQWH$EVFHVRTXH RFXUUHDGLVWDQFLDGHOIRFRSULPD ULRGHLQIHFFLyQSXVTXHVHSUR IXQGL]DDORODUJRGHORVSODQRV IDVFLDOHV\RWUDVHVWUXFWXUDV $EVFHVRHSLSORLFR$EVFHVRHQR URGHDQGRHORPHQWXPPDMXV $EVFHVRÁDWXRVXV$EVFHVRWLPSiQLFR $EVFHVR  ÁHPRQRVR   6XSXUDFLyQ FLUFXQVFULWD DVRFLDGD FRQ  LQÁD PDFLyQDJXGDGHOWHMLGRFRQHFWL YRVXEFXWiQHR

$EVFHVR  IUtR  $EVFHVR VLQ FDORU XRWURVVLJQRVORFDOHVGHLQÁDPD FLyQFRP~QPHQWHWXEHUFXORVR $EVFHVRJODQGXODU$EVFHVRGHQWUR GHFXDOTXLHUJOiQGXODHQHVSHFLDO HQ R DOUHGHGRU GH XQ QyGXOR OLQIiWLFR $EVFHVR  JRPRVR $TXHO TXH VH GHEHDDEODQGDPLHQWRRUXSWXUD GHXQDJRPDHVSHFLDOPHQWHHQHO KXHVRRHOWLPRGHORVQLxRVFRQ VtÀOLVFRQJpQLWDHM'XERLVD $EVFHVRLVTXLRUHFWDO$TXHOTXH

LQYROXFUD ORV WHMLGRV GH OD IRVD LVTXLRUHFWDO

$EVFHVRODFXQDU$TXHOTXHLQYR

OXFUDODODFXQDXUHWUDO

$EVFHVROHFKRVR$EVFHVRPDPDULR

TXHRFXUUHGXUDQWHODODFWDQFLD

$EVFHVR  RPHQWDO $EVFHVR HQ R

TXHURGHDDORPHQWXPPDMXV $EVFHVR  RVLÁXHQWH   8VXDOPHQWH XQDEVFHVRIUtRGLYDJDQWHTXHVH RULJLQDGHXQIRFRGHHQIHUPHGDG HQXQKXHVR $EVFHVRSDUDPpWULFR $TXHOTXH

HVWi HQ HO WHMLGR FRQHFWLYR GHO OLJDPHQWRDQFKRGHO~WHUR $EVFHVRSHUGHFRWLEXP    $EVFHVR GLYDJDQWH $EVFHVRSHULFRURQDO,QIHFFLyQFRQ FROHFFLyQGHSXVDOUHGHGRUGHOD FRURQDGHXQGLHQWHSDUFLDOPHQWH EURWDGRXVXDOPHQWHHQHOWHUFHU PRODUVXSHULRUHLQIHULRU/DSXV VHFROHFFLRQDHQXQEROVLOOR\DVHD GLVWDOGLVWREXFDO\RGLVWROLQJXDO DODFRURQDGHOGLHQWH $EVFLVD    /D KRUL]RQWDO GH GRV FRRUGHQDGDV XVDGDV DO WUD]DU OD LQWHUUHODFLyQ GH GRV JUXSRV GH GDWRV/DOtQHDYHUWLFDOHVOODPDGD ODRUGHQDGD(QySWLFDHOSXQWR

$EVFHVRGH0XQUR $EVFLVD



GRQGHORVUD\RVGHOX]FUX]DQHO HMHRD[LVSULQFLSDO

$EVROXWDWHPSHUDWXUD 7HPSHUD WXUD FDOFXODGD DO  FHUR DEVROXWR HVWLPDGR DSUR[LPDGDPHQWH D ƒ&yƒ)

$EVROXWR FHUR   7HPSHUDWXUD GH DSUR[LPDGDPHQWH ƒ& y ƒ) OD FRPSOHWD DXVHQFLD GHFDORU

$EVROXWRHVFRWRPD(VFRWRPDFRQ SHUFHSFLyQ GH OX] HQWHUDPHQWH DXVHQWH

$EVROXWR SHUtRGR UHIUDFWDULR  (O SHUtRGR UHIUDFWDULR HQ HO FXDO QR KD\ HVWtPXOR VLQ HPEDUJR HV  IXHUWH SDUD H[FLWDU XQD UHV SXHVWD

$EVROXWR XPEUDO   /D PHQRU LQWHQVLGDG PHGLGD EDMR FRQGL FLRQHV H[SHULPHQWDOHV ySWLPDV $ODFXDOHOHVWtPXORHVHIHFWLYR RSHUFLELGR

$EVRUEDQFLD   (Q HVSHFWURVFRStD DSOLFDGD HO ORJDULWPR QHJDWLYR DODEDVHGHODWUDQVPLFLyQ(O WpUPLQRGHQVLGDGySWLFDKDVLGR XVDGRSDUDH[SUHVDUODDEVRUEHQ FLDGHODVVROXFLRQHV $EVRUEHIDFLHQWH&XDOTXLHUDJHQWH TXHSURPXHYHODDEVRUFLyQ $EVRUEHQWH  &XDOTXLHU FRVD FDSD]GHDEVRUEHURDVSLUDUORV ÁXLGRVKHFHVXRQGDVGHOX] /DDSOLFDFLyQGHXQDGURJDRDSy VLWR TXH SURPXHYD OD DEVRUFLyQ GHOWHMLGRHQIHUPR

$EVRUEHU (QÀVLRORJtDDVSLUDU WRPDU HPEHEHU ORV OtTXLGRV R JDVHV D WUDYpV GH RVPRVLV \

FDSLODULGDG,QÀOWUDUHQODSLHO FRPR ORV UD\RV XOWUDYLROHWDV ,QFRUSRUDUGHQWURGHOFXHUSRD WUDYpVGHODVDQJUHROLQID3DUD UHFLELUHQHUJtDUDGLDQWH\FRQYHU WLUODHQRWUDIRUPDDPHQXGRFRQ DXPHQWRGHODWHPSHUDWXUD $EVRUELEOH OLJDGXUD   /LJDGXUD

FRPSXHVWDGHWHMLGRDQLPDOFRPR HOFDWJXWHOFXDOSXHGHVHUDEVRU ELGRSRUORVWHMLGRV $EVRUELGDGRVLV(QUDGLRORJtDHV ODFDQWLGDGGHHQHUJtDLPSDUWLGD SRU SDUWtFXODV LRQL]DQWHV D XQD XQLGDGGHPDVDGHPDWHULDOLUUD GLDGRHQXQVLWLRGHLQWHUpV $EVRUFLyPHWUR    ,QVWUXPHQWR TXHGHWHUPLQDODVROXELOLGDGGH XQ JDV R OD FDQWLGDG DEVRUELGD $SDUDWRTXHPLGHHOJURVRUGH XQDFDSDGHÁXLGRHQWUHGRVKRMDV SDUDOHODVGHSODFDVGHYLGULRVHQ DSDUHQWHDSRVLFLyQ $EVRUFLyQ(QÀVLRORJtD\IDUPDFR ORJtDHOSDVRGHXQRRPiVSURFHVRV GHYDULRVFRQVWLWX\HQWHVGHOFXHUSR RGHDJHQWHVPHGLFLQDOHVDWUDYpV GHODVPHPEUDQDVGHOFXHUSRGH XQFRPSDUWLPLHQWRWLVXODUDRWUR HMSURGXFWRVGHODGLJHVWLyQDWUD YpVGHODPXFRVDJDVWURLQWHVWLQDO RGURJDVDWUDYpVGHODSLHO(Q ItVLFD \ TXtPLFD OD DGTXLVLFLyQ SRUXQRyPiVSURFHVRVItVLFRVR TXtPLFRVGHXQJDVSRUXQVyOLGR ROtTXLGRRGHXQOtTXLGRSRUXQ VyOLGR(QItVLFDUDGLRORJtD\HV SHFWURIRWRPHWUtDHOSURFHVRGRQGH ODLQWHQVLGDGGHOUD\RGHFXDOTXLHU UDGLDFLyQ HOHFWURPDJQpWLFD HV $EVROXWDWHPSHUDWXUD $EVRUFLyQ

www.siempre-medicina.com



DWHQXDGD DO  SDVDU D WUDYpV GH FXDOTXLHUPDWHULDOSRUFRQYHUVLyQ GH OD HQHUJtD GH UDGLDFLyQ D XQ HTXLYDOHQWHGHFDQWLGDGGHHQHUJtD ODFXDODSDUHFHGHQWURGHOPHGLR ODHQHUJtDUDGLDQWHHVFRQYHUWLGD D FDORU R DOJXQD RWUD IRUPD GH HQHUJtDPROHFXODU(QSVLFRORJtD LQDWHQFLyQDWRGRSHURDXQVyOR SHQVDPLHQWRRDFWLYLGDG $EVRUFLyQDWHOHFWDVLDSRU$WHOHF

WDVLDREVWUXFWLYD

$EVRUFLyQEDQGDGH 5HJLyQ GHO HVSHFWURGHDEVRUFLyQHQODFXDO ODDEVRUEHQFLDSDVDDWUDYpVGHO Pi[LPRRLQÁH[LyQ $EVRUFLyQFRHÀFLHQWHGH&RQV WDQWHHQODOH\GHDEVRUFLyQSDUD ODVUDGLDFLRQHVKRPRJpQHDV $EVRUFLyQFXUYDGH(QUDGLRELR

ORJtD FXUYD TXH PXHVWUD YDULD FLyQHQODDEVRUFLyQGHUDGLDFLyQ FRPRXQDIXQFLyQGHODORQJLWXG GHRQGD $EVRUFLyQHVSHFWURGH(VSHFWUR GHUDGLDFLyQHOFXDOKDSDVDGRD WUDYpVGHDOJXQDVVXVWDQFLDVVH OHFWLYDPHQWHDEVRUELEOHVFRPROD OX]EODQFDGHVSXpVTXHKDSDVDGR DWUDYpVGHOYDSRU $EVRUSWLYR$EVRUEHQWH $EVWHUJHQWH4XHWLHQHSURSLH GDGHVGHOLPSLH]DRSXUJDWLYDV 8QDORFLyQGHOLPSLH]D8Q SXUJDWLYR $EVWLQHQFLD$EQHJDFLyQYROXQWD ULDRDEVWHQFLyQGHLQGXOJHQFLD GH DSHWLWRV HVSHFLDOPHQWH GH FRPLGDV EHELGDV DOFRKyOLFDV R UHODFLRQHVVH[XDOHV

$EVWLQHQFLD GHOLULR GH  'HOLULR TXH RFXUUH FRQ OD VXVSHQVLyQ GHO DOFRKRO R DOJXQD GURJD HQ SHUVRQDDGLFWDDHVWRV $EVWLQHQFLDVtQGURPHGH7DTXL FDUGLD LQVRPQLR KLSRWHQVLyQ HWFGHELGRDDEVWLQHQFLDDEUXSWD GHODOFRKRO\RSLiFHRVHQSHUVR QDVDGLFWDV $EXOLD3pUGLGDRGHIHFWRHQODKD ELOLGDGSDUDWRPDUGHFLVLRQHV $EXORPDQtD   'HVRUGHQ PHQWDO

FDUDFWHUL]DGRSRUIDOWDGHIXHU]D GHFRQYLFFLyQHLQGHFLVLyQ $FDODVLD )DOOD HQ UHODMDUVH UHIL

ULpQGRVH HVSHFLDOPHQWH D ODV DEHUWXUDVYLVFHUDOHVFRPRVRQHO FDUGLDVRFXDOTXLHURWURP~VFXOR HVItQWHU $EVRUFLyQDWHOHFWDVLDSRU $FDOFHURVLV $FDODVLD&DUGLD $FDOFHURVLV'HÀFLHQFLDGHFDOFLR HQODGLHWDRHOFXHUSRFRPRUHVXO WDGRGHODSpUGLGDGHPLQHUDOHV HQHOH[FUHPHQWR

www.siempre-medicina.com



$FDOFXOLD   3pUGLGD GHO SRGHU SDUD WUDEDMDU FXDOTXLHU SUREOH PD PDWHPiWLFR LQFOXVR ORV PiV VHQFLOORV $FDPSVLD5LJLGH]GHXQDDUWLFX ODFLyQDQTXLORVLV $FDQDODU6XUFRHQXQKXHVR $FDQWHVWHVLD)RUPDGHSDUHVWHVLDV HQODFXDOKD\VHQVDFLyQFRPRGH XQSLQFKD]R $FDQWKRFKHLORQHPD SHUVWDQV  /D ´ÀODULDSHUVLVWHQWHµHVSUHYDOHQWH HQÉIULFDWURSLFDO\ODSDUWHQRUWH GH 6XU $PpULFD FDUDFWHUL]DGD SRU IRUPDV DGXOWDV TXH YLYHQ HQ ODV FDYLGDGHV SHULWRQHDO \ SHULFiUGLFD \ SRU PLFURILODULDV TXH QR HVWiQ HQYDLQDGDV  \ QR PDQLÀHVWDQ SHULRGLFLGDG HQ OD VDQJUHFLUFXODQWHWUDVPLWLGRSRU HVSHFLHV FXOLRLGHV SLFDGXUDV GH PRVTXLWRV 8VXDOPHQWH VH FRQVLGHUDD$SHUVWDQVFRPRXQ SDUiVLWRQRGDxLQRSHURDOJXQRV REVHUYDGRUHV SLHQVDQ TXH pVWH SXHGHFDXVDUHGHPD\XQDFRQGL FLyQTXHVLPXODWULSDQRVRPLDVLV $QWHULRUPHQWH OODPDGR )LODULD

VDQJXLQLV $FDQWKRFKHLORQHPD VWUHSWRFHUFD (VSHFLH GH ORPEUL] ILODULD TXH VRODPHQWHVHHQFXHQWUDGHIRUPD UDUDHQQDWLYRVGHÉIULFDWURSLFDO FDUDFWHUL]DGDSRUIRUPDVDGXOWDV TXHYLYHQHQODGHUPLV\WHMLGRV VXEFXWiQHRV \ SRUTXH OD PL FURÀODULD QR HVWiQ HQYDLQDGD \ PDQLÀHVWD ELSHULRGLFLGDG HQ OD VDQJUH FLUFXODQWH SXHGH FDXVDU HMHPSORV GH HGHPD FUyQLFR GH

OD SLHO$QWHULRUPHQWH OODPDGR

0LFURÀODULDVWUHSWRFHUFD $FDQWLyQ /D SXQWD GH OD HVSLQD QDVDODQWHULRU $FDQWRFHIDOLDVLV,QIHVWDFLyQFRQ XQDVHVSHFLHVGHDFDQWRFHIDOLDV $FDQWRFLWR(ULWURFLWR HVSLQRVR R SHFXOLDUPHQWHHVSLQRVRFDUDFWHUL ]DGRSRUP~OWLSOHVSUR\HFFLRQHV FLWRSOiVPLFDVHVSLQRVDV $FDOFXOLD $FDQWRFLWRVLV $FDQWRFLWRVHQ $EHWDOLSRSURWHLQHPLD $FDQWRFLWRVLV   5DUD FRQGLFLyQ HQ OD FXDO FDVL HO  DO  SRU FLHQWRGHORVFpOXODVVDQJXtQHDV URMDVVRQDFDQWRFLWRV´HULWURFLWRV HVSLQRVRVµHMHVIHURFLWRVSHFX OLDUHVFRQSVHXGRSRGLDDQFKDVR JUXHVDVFRORFDGDVLUUHJXODUPHQWH FRPR SUR\HFFLRQHV ODV FpOXODV DQRUPDOHVPDQLÀHVWDQDXPHQWR HQ OD IUDJLOLGDG PHFiQLFD \ HQ HO FRQWHQLGR GH OLSROHFLWLQD $ VH SLHQVD TXH UHVXOWD GHO DOHOR PXWDQWHUHFHVLYRGHXQJHQTXH FRQWURODODHVWUXFWXUDQRUPDOGH ODVFpOXODVVDQJXtQHDVURMDV



$FDQWRLGH (Q IRUPD GH HVSLQD HVSLQRVR

$FDQWROLVLV  7pUPLQR XVDGR HQ SDWRORJtD GpUPLFD SDUD GHQRWDU OD GLVROXFLyQ GH ODV FDSDV GH OD HSLGHUPLV6HYHHQDTXHOODVFRQ GLFLRQHVFRPRHOSpQÀJRYXOJDULV \TXHUDWRVLVIROOLFXODULV $FDQWRPD &DUFLQRPD GH FpOXODV

HVFDPRVDV R HSLGpUPLFDV TXH UDWLQL]DGDV FRUQLILFDGDV ELHQ GLIHUHQFLDGDV DOJXQDV YHFHV HO WpUPLQR VH XVD FRQ UHIHUHQFLD D DTXHOORV QHRSODVPDV  HQ OD SLHO FRQSRFRRQLQJXQDHYLGHQFLDGH LQYDVLyQ&RQVLGHUDGRSRUDOJX QRV H[SHUWRV FRPR QHRSODVPDV EHQLJQRV $FDQWRPD DFDQWRVLV  $XPHQWR GHOJURVRUGHODFDSDGHFpOXODV HVSLQRVDVGHODHSLGHUPLV3XHGH VHUGHELGRDDXPHQWRGHOWDPDxR GHODVFpOXODV $FDQWRPD DGHQRLGHVF\VWLFXP(Q IHUPHGDG FXWiQHD TXH FRQVLVWH HQ P~OWLSOHV QyGXORV SHTXHxRV GH FpOXODV EHQLJQDV  HSLWHOLDOHV QHRSOiVLFDVDPPGHFRORU DPDULOOR SHUODGR R FDUQRVR TXH GHULYDQ  GH FpOXODV EDVDOHV GH OD HSLGHUPLV R FpOXODV VLPLODUHV HQ ORV IROtFXORV SLORVRV TXH VH HQFXHQWUDQ  SULQFLSDOPHQWH HQ OD FDUD UDt] GH OD QDUL] VLHQ SiUSDGRVPHMLOODVIUHQWH\EDU ELOOD 7DPELpQ FRQRFLGR FRPR HSLWHOLRPDGHDGHQRLGHVFLVWLFXP R HSLWHOLRPD TXtVWLFR EHQLJQR P~OWLSOHDOJXQDVYHFHVDVRFLDGR FRQVLULQJRPDRFLOLQGURPD $FDQWRPDQLJULFDQV(UXSFLyQGH

FUHFLPLHQWR YHUUXJRVR H KLSHU SLJPHQWDFLRQ TXH RFXUUH HQ OD SLHOGHODD[LODHLQJOH(QDGXOWRV HVLQGLFDWLYRGHPDOLJQLGDGDE GRPLQDO8QWLSREHQLJQRRFXUUH HQORVQLxRV(QHOWLSREHQLJQR R MXYHQLO ORV VXMHWRV VRQ REHVRV \ODFRQGLFLyQGHODSLHOHVDXWR OLPLWDGD

$FDQWRTXHLORQHPD  *pQHUR GH ORPEULFHV SDUDVLWDULDV ILODULDV HQ HO KRPEUH VH FDUDFWHUL]DQ SRU IRUPDV DGXOWDV TXH YLYHQ SULQFLSDOPHQWHHQODVFDYLGDGHV GHO FXHUSR R HQ OD SLHO \ WHMLGR VXEFXWiQHR $FDQWRTXHUDWRGHUPLD +LSHUTXH UDWRVLV $FDUELD5HGXFFLyQPDUFDGDHQHO ELFDUERQDWRGHODVDQJUH $FDUGLD $XVHQFLD FRQJpQLWD GHO

FRUD]yQ XQD FRQGLFLyQ D YHFHV SUHVHQWH HQ ORV PLHPEURV SDUD VtWLFRVGHJHPHORVXQLGRV $FDUGLDFXV*HPHORXQLGRSDUDVtWL

FRGHVXFRPSDxHURRTXHXWLOL]D OD FLUFXODFLyQ SODFHQWDULD GH VX FRPSDxHUR\QRWLHQHFRUD]yQ $FDULDVLV  &XDOTXLHU HQIHUPHGDG

FDXVDGDSRUXQDFiULGR $FDULFLGD$JHQWHSDUDPDWDUiFDURV $FiULGR 8Q PLHPEUR GHO RUGHQ

$FDULQDXQDJDUUDSDWD ÉFDUR&XDOTXLHUDGHYDULRVDUiF

QLGRVGLPLQXWRVTXHVRQDPH QXGRSDUDVtWLFRVHQORVKRPEUHV \ DQLPDOHV SXHGHQ LQIHVWDU D ORV DOLPHQWRV \ SURSDJDU HQIHU PHGDGHV

$FDQWRLGH ÉFDUR

 $FDURIRELD  0LHGR D SHTXHxRV SDUiVLWRVRSHTXHxDVSDUWtFXODV $FDURLGH     4XH VLPXOD XQD JDUUDSDWD8QiFDURRJDUUDSDWD $FDWDIDVLD 3pUGLGDGHOSRGHUSDUD IRUPXODUFRUUHFWDPHQWHXQDDVH YHUDFLyQ $FDWDOHSVLD FDWDOHSVLD    'H ILFLHQFLD PHQWDO FDUDFWHUL]DGD SRU IDOWD GH HQWHQGLPLHQWR  ,QFHUWLGXPEUHHQHOGLDJQyVWLFR RSURQyVWLFR

$FDWDOpSWLFR'HÀFLHQWHHQFRP SUHQVLyQ,QFHUWLGXPEUH $FDWDSRVLV'LÀFXOWDG SDUD WUDJDU

OtTXLGRVHVWULFWDPHQWHLQFDSDFL GDGSDUDKDFHUOR

$FDWH[LD  3pUGLGD DQRUPDO GH VHFUHFLRQHV

$FDWH[LV  'HVRUGHQ PHQWDO HQ HO FXDO FLHUWRV REMHWRV R LGHDV IUD FDVDQSDUDHYRFDUXQDUHVSXHVWD HPRFLRQDOHQHOLQGLYLGXR $FDWLVLD $JLWDFLyQPRWRUD $FFLGHQWH (YHQWR R OHVLyQ V~EL

WDPHQWH LQHVSHUDGR TXH RFXUUH VLQSUHVDJLRRDGYHUWHQFLDRTXH VHGHVDUUROODHQHOFXUVRGHXQD HQIHUPHGDG

$FFRXFKHXU2EVWHWUD

$FFUHWLR FRUGLV$GKHVLRQHV GHO SHULFDUGLR D ODV HVWUXFWXUDV  H[ WUDFDUGtDFDVDG\DFHQWHV $FHEXWRORO$JHQWH EORTXHDGRU EHWDDGUHQpUJLFRXVDGRHQKLSHU WHQVLyQ $FHFDLQLGD 0HWDEROLWR GH SURFDL QDPLGD $FHFOLGLQD&RPSXHVWR VLQWpWLFR TXHVLPXODODDFHWLOFROLQDXVDGD HQJODXFRPDDOSRUFLHQWR $FHIDORJDVWULD$XVHQFLDGHFDEH ]DWyUD[\DEGRPHQFRPRVHYH HQJHPHORVSDUDVtWLFRVFRQSHOYLV \SLHVVRODPHQWH $FHIDORSRGLD$XVHQFLDFRQJpQLWD GHFDEH]D\SLHV $FHIDOySRGR)HWRPDOIRUPDGRVLQ FDEH]DRSLHV $FHIDORTXLULD$XVHQFLDGHFDEH]D \PDQRV $FHIDOyVWRPR )HWR PDOIRUPDGR TXHQRWLHQHSUiFWLFDPHQWHFDEH ]DSHURHQVXUHJLyQPiVVXSH ULRUXQDERFDFRPRDEHUWXUD $FHQHVWHVLD$XVHQFLDGHODVHQ VDFLyQQRUPDOGHH[LVWHQFLDItVLFD R GH OD FRQVFLHQFLD GH IXQFLyQ YLVFHUDO $FHQRFRXPDURO11'(IHFWLYRDQ WLFRDJXODQWHVLQWpWLFRRUDOGHOWLSR GHFXPDULQD\FRQDFFLyQVLPLODU $FpUYXOR  *UDQLWRV GH FDUERQDWR

\ IRVIDWR GH FDOFLR HQ HO SOH[R FRURLGH\JOiQGXODSLQHDO $FHUYXORPD  7XPRU LQWUDFUDQHDO

TXH FRQWLHQH DFpUYXORV R DUHQD FHUHEUDOSVDPPRPD $FHVFHQFLD /LJHURJUDGRGHDFL GH](OSURFHVRGHKDFHUVHDJULR $FHVFHQWH /LJHUDPHQWHiFLGR $FHVWRPD*UDQXODFLyQH[XEHUDQWH TXHHVWiIRUPDQGRXQDFLFDWUL] $FHWDO/tTXLGRFODURKHFKRSRUOD R[LGDFLyQLPSHUIHFWDGHODOFRKRO +DVLGRXVDGRFRPRKLSQyWLFR $FHWDOGHKtGR$OGHKtGRDFpWLFR

 (WDQRO HWDOGHKtGR &+&+2 OtTXLGR LQFRORUR GH RORU LUULWDQ WH VH SROLPHUL]D D SDUDOGHKtGR

$FDURIRELD $FHWDOGHKtGR



HQ SUHVHQFLD GH iFLGR VXOI~ULFR eVWH HV XQ LQWHUPHGLDULR HQ OD IHUPHQWDFLyQGHOHYDGXUDGHFDU ERKLGUDWRV \ HQ HO PHWDEROLVPR GHODOFRKROHQHOKRPEUH $FHWDPLGD$PLGDGHiFLGRDFpWLFR IRUPDGDSRUODDFFLyQGHODFHWDWR GHHWLORVREUHDPRQtDFRVXUJHHQ FULVWDOHVGHOLFXHVFHQWHVLQFRORURV GHRORUUDWRQHVFR $FHWDPLQRIpQ 1DFHWLOSDPLQR IHQRO3DFHWDPLGRIHQROXQSRO YR EODQFR LQRGRUR FULVWDOLQR \ OLJHUDPHQWHDPDUJRXVDGRFRPR DQWLSLUpWLFR\DQDOJpVLFR $FHWDQLOLGD+HFKDGHDQLOLQDSRU ODDFFLyQVREUHpVWDGHODFHWLOFOR UXUR2FXUUHHQODIRUPDGHHVFD PDEODQFDRSROYRFULVWDOLQRPX\ OLJHUDPHQWHVROXEOHHQDJXDSHUR VROXEOH HQ  SDUWHV GH DOFRKRO XVDGRFRPRXQDQDOJpVLFR\DQ WLSLUpWLFRWR[LFRVXXVRFRQWLQXR FDXVDFLDQRVLV

$FHWDUVRQD ÉFLGR DFHWDUVRO %3 DFHWLO DPLQR KLGUR[L IHQLO DUVp QLFR iFLGR 1 DFHWLOKLGUR[L 0DUVDQLOLFR HVWRUYDVRO XVDGR HQODDPHELDVLV\FRPRDSOLFDFLyQ ORFDOHQODDQJLQDGH9LFHQW\HQ WULFRPRQDYDJLQDOLV $FHWDWR6DOGHiFLGRDFpWLFR $FHWD]RODPLGD  'LDPR[ VXOIR QDPLGD KHWHURFtFOLFD $FHWLOD PLQR WLDGL]ROH VXOIRQD PLGDeVWHLQKLEHODDFFLyQGHOD DQKLGUDVD FDUEyQLFD HQ HO ULxyQ FDXVDQGRXQDXPHQWRHQODH[ FUHFLyQXULQDULDGHVRGLRSRWDVLR \ELFDUERQDWRH[FUHFLyQUHGXFLGD GH DPRQtDFR XQD HOHYDFLyQ GHO S+GHODRULQD\FDtGDGHOS+GH ODVDQJUH+DVLGRXVDGRHQDFL GRVLVUHVSLUDWRULDSDUDGLXUHVLV\ FRQWUROGHODUHWHQFLyQGHÁXLGRV HQHSLOHSVLD\HQJODXFRPD $FpWLFR  5HODFLRQDGR DO YLQDJUH

DJULR

$FHWLOFLVWHtQD0XFRP\VWDJHQWH PXFROtWLFRTXHUHGXFHODYLVFRVL GDGGHODVVHFUHFLRQHVPXFRVDV $FHWLOFRHQ]LPD  3URGXFWR GH OD

FRQGHQVDFLyQ GH OD FRHQ]LPD$ \ iFLGR DFpWLFR XQ LQWHUPHGLD ULR HQ OD WUDQVIHUHQFLD GH GRV IUDJPHQWRV GH FDUERQR HQ  VX LQJUHVR KDFLD HO FLFOR GHO iFLGR WULFDUER[tOLFR $FHWLOFROLQDeVWHUGHiFLGRDFpWLFR GHFROLQDDLVODGRGHOFRUQH]XHOR GHFHQWHQR7DPELpQHVOLEHUDGR GHODVWHUPLQDFLRQHVSUHJDQJOLy QLFDV \ SRVWJDQJOLyQLFDV GH ODV ILEUDV SDUDVLPSiWLFDV \ GH ODV WHUPLQDFLRQHV  SUHJDQJOLyQLFDV GH ODV ÀEUDV  VLPSiWLFDV &DXVD LQKLELFLyQ FDUGtDFD YDVRGLODWD FLyQ SHULVWDOVLV JDVWURLQWHVWLQDO \ RWURV HIHFWRV SDUDVLPSiWLFRV eVWDVHKLGUROL]DHQFROLQD\iFLGR DFpWLFRSRUODHQ]LPDFROLQHVWHUD VDTXHHVWiSUHVHQWHHQODVDQJUH \RWURVWHMLGRV

$FHWLOFROLQHVWHUDVD&ROLQHVWHUDVD TXH GHJUDGD OD DFHWLOFROLQD HQ FROLQD\iFLGRDFpWLFR $FHWLOGLJLWR[LQD$F\ODQLGPLVPD DFFLyQ \ XVRV TXH OD GLJLWR[LQD SHURGHLQLFLRPiVUiSLGR\GXUD FLyQGHDFFLyQPiVFRUWD $FHWDPLGD $FHWLOGLJLWR[LQD

www.siempre-medicina.com



$FHWLOHQR *DV LQFRORUR GH RORU GHVDJUDGDEOHTXHDUGHFRQXQD LQWHQVDÁDPDEODQFD6HSUHSDUD FRPHUFLDOPHQWHSRUODDFFLyQGHO DJXDVREUHHOFDUEXURGHFDOFLR $FHWLOIHQLOWLGUD]LQD 3ROYR FULV

WDOLQR REWHQLGR DO WUDWDU OD IHQL KLGUD]LQDFRQDQKtGULGRDFpWLFR DQWLSLUpWLFR SRGHURVR SHUR GHV WUXFWLYRGHODVFpOXODVVDQJXtQHDV URMDV 8VDGD HQ OD SROLFLWHPLD YHUD WDPELpQ H[WHUQDPHQWH HQ HQIHUPHGDGHV SDUDVtWLFDV GH OD SLHO FRPR XQJHQWR DO  SRU FLHQWR

$FHWLOIRVIDWR)RVIDWRGHDOWDHQHU JtDTXHMXHJDODSDUWHGHO´DFHWDWR DFWLYRµ HQ HO PHWDEROLVPR GH YDULDVEDFWHULDV $FHWLOSDPLQRIHQLOVDOLFLODWReV WHUGHiFLGRVDOLFtOLFRRDFHWLOS DPLQRIHQROXVDGRFRPRXQDQDO JpVLFRDQWLSLUpWLFR\DQWLVpSWLFR LQWHVWLQDO $FHWLOVDOLFtOLFRiFLGR 3ROYR LQR GRUREODQFRFULVWDOLQRVROXEOHHQ SDUWHVGHDJXDRDOFRKRODO SRUFLHQWRIiFLOPHQWHDEVRUELGR SRU ODV PHPEUDQDV PXFRVDV \ H[FUHWDGR HQ OD RULQD GHQWUR GH ODVKRUDVDPSOLDPHQWHXVDGR FRPR DJHQWH  DQDOJpVLFR DQWL LQÁDPDWRULR\HQWUDWDPLHQWRGH UHXPDWLVPR $FHWREDFWHU*pQHURGHODIDPLOLD 3VHXGRPRQDGDFHDHFRQWLHQHRUJD QLVPRV HQ IRUPD GH EDVWyQ TXH IUHFXHQWHPHQWH VH HQFXHQWUDQ HQ IRUPD HORQJDGDV UDPLILFD GDV R HGHPDWL]DGD SRODUPHQWH

ÁDJHODGRV FXDQGR VRQ PyYLOHV OD HQHUJtD HV DVHJXUDGD SRU OD R[LGDFLyQGHODOFRKROHQVLGUDGH YLQRRFHUYH]DDiFLGRDFpWLFR $FHWRIHQD]LQD PDOHDWR GH  0D

OHDWR GH  WLQGDO GLPDOHDWR GH IHQRWLD]LQD XQ DJHQWH WUDQTXL OL]DQWH FRQ DFFLyQ DQWLHPpWLFD KLSRWHQVRUD HVSDVPROtWLFD \ DQWLKLVWDPtQLFD

$FHWRIHQHWLGLQD 6XUJH FRPR FULV WDOHVLQFRORURVUHOXFLHQWHVXVXDO PHQWHHVFDPRVRRFRPRXQÀQR SROYR EODQFR UHOXFLHQWH DQWL SLUpWLFR

$FHWRIHQRQD'HULYDGRGHEUHDGH FDUEyQ IHQLOHWLO FHWRQD OtTXLGR LQFRORURTXHVHFULVWDOL]DHQDJX MDVEODQFDVDEDMDVWHPSHUDWXUDV FRQ RORU GH DOPHQGUD DPDUJD +DVLGRXVDGRFRPRKLSQyWLFRR GHSUHVLYROHYH $FHWRKH[DPLGD   6XOIRQLOXUHD XVDGDHQGLDEHWHV $FHWROiFWLFRiFLGR,QWHUPHGLDULR HQHOFDWDEROLVPRGHOiFLGRSLU~ YLFRDOHYDGXUD $FHWRODVD (Q]LPD TXH FDWDOL]D OD R[LGDFLyQ GH DOFRKRO D iFLGR DFpWLFR

$FHWRPHQDIWRQD8VDGRHQHOWUD WDPLHQWRSUHSDUDWRULRGHLFWHULFLD REVWUXFWLYD HQ OD HQIHUPHGDG KHPRUUiJLFDGHOUHFLpQQDFLGR\ SURÀOiFWLFDPHQWH SDUD SUHYHQLU ODKHPRUUDJLDQHRQDWDO $FHWRPHURFWRO $JHQWH PHUFXULDO RUJiQLFRDQWLEDFWHULDQR $FHWRPRUÀQD+HURtQDYHDGLDFH WLOPRUÀQD $FHWLOHQR $FHWRPRUÀQD

www.siempre-medicina.com

 $FHWRQD'LPHWLOFHWRQDOtTXLGDLQ FRORUDYROiWLOHLQÁDPDEOH&DQWL GDGHVH[WUHPDGDPHQWHSHTXHxDV VHHQFXHQWUDQHQODRULQDQRUPDO SHUR HQ JUDQGHV FDQWLGDGHV HQ OD RULQD \ VDQJUH GH SHUVRQDV GLDEpWLFDVRFDVLRQDOPHQWHGDXQ RORUHWpUHRDODRULQD\DOLHQWRGH ORVGLDEpWLFRV

$FHWRQDIWRQD1DIWLOPHWLOFHWRQDTXH VXUJHFRPRDJXMDVDPDULOODV $FHWRQXULD ([FUHFLyQ HQ OD RULQD

GH JUDQGHV FDQWLGDGHV GH DFH WRQD FRPR LQGLFDFLyQ GH XQD R[LGDFLyQLQFRPSOHWDGHJUDQGHV FDQWLGDGHVGHJUDVDFRP~QPHQ WHRFXUUHHQDFLGRVLVGLDEpWLFD $FHWRTXLQDVD(Q]LPDHQFRQWUDGD HQOD(VFKHULFKLDFROLFDWDOL]DQGR OD IRUPDFLyQ GH DFHWLOIRVWDWR D SDUWLU GH DFHWDWR HQ SUHVHQFLD GH$73

$FHWUL]RDWR  &RPSXHVWR UDGLR RSDFR XVDGR HQ XURJUDItD VH LQ\HFWDLQWUDYHQRVDPHQWH $FHWUL]yLFR iFLGR  0HGLR UDGLR

RSDFR $FKRULRQ *pQHURGHKRQJRSDUD VtWLFRHOQRPEUHDSURSLDGRDKRUD HV7ULFRSK\WRQ $FLFORYLU $JHQWHDQWLYLUDOXVDGR HQHOKHUSHV $FLGDPLQXULD(OSDVRGHOH[FHVR GHDPLQRiFLGRVHQODRULQD $FLGHPLD $XPHQWRHQODFRQFHQ WUDFLyQGHLRQHV+HQODVDQJUH XQDFDtGDSRUGHEDMRGHORQRUPDO GHOS+TXHQRUHVLVWHDOWHUDFLRQHV HQHOFRQWHQLGRGHELFDUERQDWR $FLGLVPR (QYHQHQDPLHQWR SRU

iFLGRV LQWURGXFLGRV VLQ SRGHU GLVWLQJXLUORGHODDFLGRVLVRHQYH QHQDPLHQWRSRUiFLGRVIRUPDGRV HQHOPHWDEROLVPR

ÉFLGR DFHWRDFpWLFR  ÉFLGR GLDFp WLFR &+&2&+&22+  XQR GH ORV FXHUSRV FHWyQLFRV IRUPD GRV HQ H[FHVR \ TXH DSDUHFHQ HQ OD RULQD GXUDQWH HO D\XQR R GLDEHWHV

ÉFLGR FtWULFR FLFOR GHO   FLFOR GH .UHEV(O FLFOR LQYROXFUD HO PH WDEROLVPR R[LGDWLYR GHO iFLGR SLU~YLFRD&2\+2OLEHUDQGR HQHUJtD$73

ÉFLGR  &RPSXHVWR GH XQ HOH PHQWR HOHFWURQHJDWLYR R UDGLFDO FRQ KLGUyJHQR pVWH IRUPD VDOHV SRUHOUHHPSOD]RGHWRGDRSDUWH GHO KLGUyJHQR FRQ HOHPHQWRV HOHFWURSRVLWLYRV R UDGLFDOHV 8Q iFLGR TXH FRQWLHQH XQ iWRPR GH KLGUyJHQR GHVSOD]DEOH HQ OD PROpFXODVHOODPDPRQREiVLFRHO TXHFRQWLHQHGRVGHHVWRViWRPRV HVGLEiVLFR\HOTXHFRQWLHQHPiV GHGRVHVSROLEiVLFR(QOHQJXD MH SRSXODU FXDOTXLHU FRPSXHV WR TXtPLFR TXH WLHQH XQ VDERU iFLGR ÉFLGRDFpWLFR  ÉFLGR GLDFpWLFR &+&22+XQSURGXFWRGHOD R[LGDFLyQGHODOFRKRO\GHOGHV WUXFWLYRGHVWLODGRGHODPDGHUD HOiFLGRRÀFLDOHVXQOtTXLGRTXH FRQWLHQH HO  SRU FLHQWR %3  SRU FLHQWR GH iFLGR DFpWLFR DEVROXWR DFHWDWR GH KLGUyJH QR8VDGRORFDOPHQWHFRPRXQ FRQWUDLUULWDQWH\RFDVLRQDOPHQWH $FHWRQD ÉFLGRDFpWLFR

www.siempre-medicina.com

 LQWHUQDPHQWH 8VDGR WDPELpQ FRPRUHDFWLYR ÉFLGRUiSLGR7pUPLQRTXHGHQRWD EDFWHULDVTXHQRVHGHFRORUDQSRU ORViFLGRVPLQHUDOHVGHVSXpVGH KDEHUVLGRWHxLGRVFRQWLQWHVGH DQLOLQD OD OHSUD WXEHUFXORVLV \ FXDOTXLHUEDFLORVRQHMHPSORV $FLGRVLV 2[\VLV FRQGLFLyQ GH GLVPLQXFLyQHQODUHVHUYDGHiOFDOL ELFDUERQDWRGHODVDQJUH\RWURV OtTXLGRVFRUSRUDOHVFRQRVLQXQD GLVPLQXFLyQH[LVWHQWHGHOS+ $FLGRVLVFRPSHQVDGD 5HGXFFLyQ HQODUHVHUYDGHiOFDOLHQODFXDO ORVPHFDQLVPRVFRPSHQVDWRULRV PDQWLHQHQHOS+GHORVOtTXLGRV FRUSRUDOHV HQ YDORUHV QRUPDOHV HQ DFLGRVLV FRPSHQVDGD HO &2_ \ HO ELFDUERQDWR XVXDOPHQWH DXPHQWDQDXQTXHHOS+SHUPD QH]FDGHQWURGHUDQJRVQRUPDOHV

$FLGRVLV SRU GLy[LGR GH FDUER QR  $FLGRVLV TXH UHVXOWD GH OD UHWHQFLyQ GH &2 pVWD HV XQD

H[FHSFLyQ GH OD GHÀQLFLyQ HQ HO HQFDEH]DGR SULQFLSDO GHELGR D TXH HO ELFDUERQDWR GH ORV OtTXL GRV FRUSRUDOHV HVWi XVXDOPHQWH DXPHQWDGR $FLGRVLVUHVSLUDWRULD 5HGXFFLyQ HQODUHVHUYDGHiOFDOLGHORVOtTXL GRVFRUSRUDOHVFRQXQDFDtGDHQHO S+TXHHVUHVXOWDGRGHODIDOODHQ ORVPHFDQLVPRVFRPSHQVDWRULRV DGHFXDGRVHOELFDUERQDWRSXHGH HVWDUGHQWURGHUDQJRVQRUPDOHV HQ DFLGRVLV QR FRPSHQVDGD SRU UHWHQFLyQGH&2 $FLGRVLVUHQDOWXEXODU ,QFDSDFL GDGSDUDH[FUHWDUODRULQDiFLGD FRQ KLSHUFORUHPLD GHELGR D GH IHFWR FRQJpQLWR GH OD DQKLGUDVD FDUEyQLFD FDXVDQGR IRUPDFLyQ GHÀFLHQWHGHELFDUERQDWR $FLHVLV(VWHULOLGDGHQODPXMHU  /D FRQGLFLyQ GH  QR HPED UD]DGD ÉFLJRV  4XH RFXUUH VyOR QR HQ SDUHV ÉFLJRVYHQD&RQWLQXDFLyQWRUiFL FDGHODYHQDOXPEDUDVFHQGHQWH D WUDYpV GHO KLDWR DyUWLFR HQ HO GLDIUDJPD HQWUDQGR D OD YHQD FDYD VXSHULRU D QLYHO GH OD YHU WHEUD7

ÉFLQR8QDGHODVGLPLQXWDVSRU FLRQHVVHFUHWRUDVVLPLODUDXQVDFR GHXQDJOiQGXODDFLQRVD$OJXQDV DXWRULGDGHV XVDQ HO WpUPLQR iFLQR \ DOYpROR GH IRUPD LQWHU FDPELDEOH FRQ UHIHUHQFLD D ODV JOiQGXODVPLHQWUDVRWUDVORGLIH UHQFLDQSRUODVDEHUWXUDVDQJRV WDV GHO iFLQR GHQWUR GHO GXFWR H[FUHWRU(OWHUULWRULRSXOPRQDU DEDVWHFLGR SRU XQ EURQTXLROR WHUPLQDOXQXVRDEVROXWR $FLYLFLQD $QiORJRGHSLULPLGLQD

TXH EORTXHD OD FRQYHUVLyQ GH 873D/73 $FODVLD  7HMLGR SDWROyJLFR TXH VH RULJLQD \ HV FRQWLQXR GHO WHMLGR QRUPDOSRUFRQVLJXLHQWHSURYHH FRQWLQXLGDG GH OD HVWUXFWXUD FRPRHQODFRQGURGLVWURÀD $FORUKLGULD$XVHQFLDGHiFLGRKL GURFORUKtGULFRGHOMXJRJiVWULFR ÉFLGRUiSLGR $FORUKLGULD

www.siempre-medicina.com



$FOXRIRELD0LHGRDODRVFXULGDG $FOXVLyQ )DOWDGHFRQWDFWRHQWUH

ODV VXSHUILFLHV RSXHVWDV GH ORV PRODUHV \ GLHQWHV ELF~VSLGHV FXDQGRODPDQGtEXODHVWiFHUUD GD $FPp3HUtRGRGHPD\RULQWHQVL GDGGHFXDOTXLHUVtQWRPDVLJQR RSURFHVR $FQp(UXSFLyQSDSXODURSXVWXODU GHELGRDLQÁDPDFLyQFRQDFXPX ODFLyQGHVHFUHFLRQHVTXHLQYROX FUDQODVJOiQGXODVVHEiFHDV $FQpDJPLQDWD$FQLWLVXQDHUXS FLyQGHSHTXHxDVSiSXODVURML]DV RVFXUDV HQ OD FDUD TXH VH KDFHQ SXVWXODUHV VHJXLGD FRQ FLFDWUL] OLJHUD

$FQp  DUWLÀFLDOLV  3URGXFLGR SRU

LUULWDQWHV H[WHUQRV FRPR OD EUHD R GURJDV DGPLQLVWUDGDV LQWHU QDPHQWH FRPR HO \RGXUR  $ PHQXGRDXWRLQÁLJLGD $FQpDWUyÀFD9XOJDULVHQODFXDO ODVOHVLRQHVGHMDQXQDOLJHUDFDQ WLGDGGHFLFDWUL] $FQpFLOLDULV3iSXODVIROLFXODUHV \S~VWXODVHQORVERUGHVOLEUHVGH ORVSiUSDGRV $FQp  GHFDOYDQV    5DUR WLSR GH

IROLFXOLWLV IROLFXODU GHO FXHUR FDEHOOXGRTXHSURGXFHFLFDWUL]\ OXHJRDORSHFLD $FQpNHUDWRVD(UXSFLyQGHSiSX ODVTXHFRQVLVWHHQWDSRQHVGXURV TXHVHSUR\HFWDQGHORVIROtFXORV GH FDEHOOR DFRPSDxDGRV GH LQ ÁDPDFLyQ $FQpQHRQDWRUXP5DUDFRQGLFLyQ HQORVLQIDQWHVFDUDFWHUL]DGDSRU SiSXODV\FRPHGRQHVHQODIUHQWH \PHMLOODV $FQpSDSXORVD&RQGLFLyQTXHVH DVHPHMDDOFORUDFQpHQODFXDOORV FRPHGRQHVFHQWUDOHVQHJURVHVWiQ SUHVHQWHVHQWRGDVODVOHVLRQHV $FQp  URViFHD$FQp HULWHPDWRVR

URViFHD GH ODV PHMLOODV \ QDUL] DVRFLDGR FRQ SiSXODV S~VWXODV YDVRVVDQJXtQHRVGLODWDGRVHQODV SOLHJXHVQDVRODELDOHV\IROtFXORV GLODWDGRV $FQpVLÀOtWLFD6LItOLGHVSXVWXODU XQUDURWLSRGHVtÀOLVVHFXQGDULD $FQp  WHODQJLHFWRGHV  (UXSFLyQ WHODQJLHFWRLGHV DVRFLDGD FRQ WXEHUFXORVLV $FQpXUWLFDWD(UXSFLyQTXHHP SLH]D FRPR SHTXHxDV URQFKDV XUWLFDULDOHV\FRQWLQ~DQFRQFLFD WUL]DFLyQOLJHUD $FOXRIRELD $FQpXUWLFDULD $FQpURViFHD

www.siempre-medicina.com

 $FQp  YXOJDULV  $FQp VLPSOH[ DFQp GLVVHPLQDWD DFQp VLPSOH QR FRPSOLFDGR HUXSFLyQ GH SiSXODV \ S~VWXODV FRQ XQD EDVHLQÁDPDWRULDFRQGLFLyQTXH RFXUUHSULPDULDPHQWHGXUDQWHOD SXEHUWDG\DGROHVFHQFLDGHELGRD XQDSDUDWRVHEiFHRKLSHUUHDFWLYR SUREDEOHPHQWH DIHFWDGR SRU OD DFWLYLGDGKRUPRQDO $FQHJpQLFR3HUWHQHFLHQWHDVXVWDQ FLDVTXHVHSLHQVDQVRQUHVSRQVD EOHVGHFDXVDUDFQpYXOJDULV $FQHPLD$WURÀDGHORVP~VFX ORVGHODSDQWRUULOOD$XVHQFLD FRQJpQLWDGHODVSLHUQDV $FRJQRVLDDFRJQRVLV  (O FRQRFL PLHQWRGHORVUHPHGLRV $FROLD 6HFUHFLyQ GH ELOLV VXSUL

PLGD

$FyOLFR6LQELOLV $FRORJtD7HUDSpXWLFD

$FROXULD$XVHQFLDGHSLJPHQWRV ELOLDUHV GH OD RULQD HQ FLHUWRV FDVRVGHLFWHULFLD $FRO~ULFR 6LQELOLVHQODRULQD $FRPDQtD 6XPLVLyQVHUYLODDTXH OORVFRQDXWRULGDGPLHQWUDVVHHV VREUHGRPLQDQWHHQHOKRJDU $FRPLD$ORSHFLDFDOYLFLH $FRPRGDFLyQ  $MXVWH GHO RMR D YDULDVGLVWDQFLDVHVSHFtÀFDPHQWH DOWHUDFLyQ HQ OD FRQYH[LGDG GHO FULVWDOLQR SDUD SRGHU OOHYDU ORV UD\RVGHOX]GHXQREMHWRH[WHUQR DOIRFRHQODUHWLQD

$FRQDWLYR 6LQHOGHVHRRYROXQWDG GHDFWXDU

$FRQGURSODVLD  &RQGURGLVWURÀD DFODVLD GLDÀVLDULD DQRUPDOLGDG HQ OD FRQYHUVLyQ GHO FDUWtODJR D KXHVR UHVXOWDQGR HQ XQ HQDQR DVLPpWULFR

$FRQGURSODVWLD&RQGURGLVWURÀD $FyQLWR/DUDt]VHFDGHO$FRQLWXV

QDSHOOXV DQWLSLUpWLFR GLXUpWLFR

GLDIRUpWLFR DQRGLQR GHSUHVRU FDUGtDFR \ UHVSLUDWRULR DQDOJp VLFRH[WHUQR

$FRSODU  8QLUVH WHQHU XQD XQLyQ VH[XDO

$FRSURVLV  $XVHQFLD R JUDQ HV FDVH] GH PDWHULD IHFDO HQ ORV LQWHVWLQRV

$FQpYXOJDULV $FRSURVLV

$FQp9XOJDULV $FQp9XOJDULV

 $FRUHD$XVHQFLDFRQJpQLWDGHOD SXSLODGHORMR $FRULD$XVHQFLDGHODVHQVDFLyQGH VDFLHGDGGHVSXpVGHFRPHU $FUDQLD)DOWDGHFUiQHR $FUHFLyQ $XPHQWRSRUDGLFLyQ HQODSHULIHULDGHPDWHULDOGHOD PLVPDQDWXUDOH]DTXHODTXH\D HVWDED SUHVHQWH HM OD IRUPD GH FUHFLPLHQWRGHORVFULVWDOHV(Q RGRQWRORJtDPDWHULDOH[WUDxRTXH VHFROHFFLRQDHQODVXSHUÀFLHGHO GLHQWH R HQ XQD FDYLGDG  8Q FUHFLPLHQWRHQFRQMXQWR $FUHPRQLRVLV&RQGLFLyQPDUFDGD SRUÀHEUH\ODDSDULFLyQGHJRPD FRPRWXPHIDFFLyQFDXVDGDSRUHO KRQJR$FUHPRQLXPSRWURQLL $FULIODYLQD7L Q W H  G H  D F U L G L Q D  XQD PH]FOD GH FORUXUR GH   GLDPLQRPHWLODFDULGLQLXP \  GLDPLQDFULGLQD 3ROYR URMR FKRFRODWRVR LQRGRUR VROXEOH HQ DJXD $QWLVpSWLFR SRWHQWH

$FULÁDYLQDKLGURFORUXURGHÉFL

GRGHDFULÁDYLQDWULSDÁDYLQDiFL GDXVDGDFRPRXQDQWLVpSWLFRGH ODV KHULGDV 6H KD DGPLQLVWUDGR LQWUDYHQRVDPHQWHHQEUXFHORVLV WXODUHPLDEODVWRPLFRVLV\WULSD QRVRPLDVLV $FRUHD $FULÁDYLQDKLGURFORUXURGH $FRQGURSODVLD

www.siempre-medicina.com



$FULPRQLD/D FDOLGDG GH VHU LQ WHQVDPHQWHLUULWDQWHFRUURVLYRR SXQJHQWH

$FULVRUFLQD  $JHQWH DQWLI~QJLFR GLVSRQLEOH FRPR FUHPD DO  SRUFLHQWR

$FULWRFURPDFLD  &HJXHUD D ORV FRORUHV

$FURDFLWRVLV   /D RFXUUHQFLD GH XQ JUDQ Q~PHUR GH OLQIRFLWRV HQ OD FLUFXODFLyQ SHULIpULFD OLQ IRFLWRVLV $FURDJQRVLV$XVHQFLDGHODVHQVL ELOLGDGGHODVH[WUHPLGDGHV $FUREUDTXLFHIDOLD&RQGLFLyQHQ ODFXDOHOGLiPHWURDQWHURSRVWH ULRUGHOFUiQHRHVDQRUPDOPHQWH FRUWD $FURFHIDOLD0DOIRUPDFLyQGHODFD EH]DTXHFRQVLVWHHQXQDEyYHGD FUDQHDODOWDRSXQWLDJXGDGHELGR DFLHUUHSUHPDWXURGHODVVXWXUDV VDJLWDOFRURQDO\ODPERLGHV $FURFLDQRVLV  'HVRUGHQ FLUFXOD

WRULRHQHOFXDOODVPDQRV\PH QRV FRP~QPHQWH ORV SLHV HVWiQ SHUVLVWHQWHPHQWH IUtRV D]XOHV \ VXGRURVRV/DVIRUPDVOHYHVHVWiQ PX\DVRFLDGDVDVDEDxRQHV $FURGLQLD 1HXULWLV SHULIpULFD

GHODVGHGRVGHPDQRVRGHGRV GH ORV SLHV  8QD FRQGLFLyQ FDXVDGDHQUDWDVSRUGHÀFLHQFLD GH SLULGR[LQD % FDUDFWHUL]DGD SRU HQURMHFLPLHQWR \ HGHPD GH ODSXQWDGHODVRUHMDV\QDUL]OOH YDQGRDQHFURVLVGHHVWDVSDUWHV $FURGROLFRPHOLD7DPDxRJUDQGH \FUHFLPLHQWRGHVSURSRUFLRQDGR GHODVPDQRV\SLHV $FURHVWHVLD*UDGRVH[WUHPRVGH KLSHUHVWHVLD  +LSHUHVWHVLD GH XQDRPiVH[WUHPLGDGHV $FURIRELD 7HPRU PyUELGR D ORV

OXJDUHVHOHYDGRV

$FURJHULD (QYHMHFLPLHQWR SUH PDWXURGHODSLHOGHODVPDQRV\ SLHV

$FURPDVLD3DOLGH] FDTXpFWLFD SDOLGH] DVRFLDGD FRQ OD IDFLHV KLSRFUiWLFD GH HQIHUPHGDG H[ WUHPDGDPHQWH VHYHUD R FUyQLFD DPHQXGRSUHOXGLDQGRHOHVWDGR PRULEXQGR $XVHQFLD GH XQD UHDFFLyQGHWLQFLyQRUGLQDULDHQOD FpOXODRWHMLGR$FURPDWRSVLD $FURPiWLFR,QFRORUR4XHQR GHVFRPSRQHODOX]EODQFD4XH QRVHWLxHUiSLGDPHQWH $FURPDWR  3HUVRQD WRWDOPHQWH

FLHJDDOFRORU

$FURPDWyÀOR   4XH QR VH FROR UHD FRQ OD WLQFLyQ KLVWROyJLFD R EDFWHULROyJLFD&pOXODRWHMLGR TXHQRSXHGHWHxLUVHHQODIRUPD XVXDO

$FURPDWROLVLV3ODVPyOLVLVSURWR SODVPROLVLV FDULRSODVPROLVLV GLVROXFLyQGHODFURPDWLQDGHXQD FpOXODRVXQ~FOHR

$FURPDWRSVLD  &HJXHUD WRWDO DO FRORU

$FURPDWRVLV $XVHQFLD GH OD SLJ PHQWDFLyQ QDWXUDO FRPR HQ HO DOELQLVPR

$FURPDWXULD3DVRGHRULQDLQFROR UDRPX\SiOLGD

$FURPHJDOLD (QIHUPHGDG GH 0D ULH GHVRUGHQ WUyILFR PDUFDGR SRUHODODUJDPLHQWRSURJUHVLYRGH

$FULPRQLD $FURPHJDOLD

 ODFDEH]D\FDUDPDQRVSLHV\ WyUD[GHELGRDVHFUHFLyQH[FHVLYD GHODKRUPRQDGHFUHFLPLHQWRSRU HOOyEXORDQWHULRUGHODJOiQGXOD SLWXLWDULD

$FURPHODOJLD  8QD QHXURVLV YD VRPRWRUD PDUFDGD SRU HQURMH FLPLHQWR GRORU \ HGHPD GH ORV GHGRVGHPDQRV\SLHVFHIDOHD\ YyPLWRV SUREDEOHPHQWH OR PLV PRTXHHQODHULWURPHODOJLD $FURPLR 3URFHVR DFURPLDO OD

WHUPLQDFLyQH[WHUQDGHODHVSLQD

GH OD HVFiSXOD OD FXDO VH SUR \HFWD FRPR XQ SURFHVR DQFKR \ DSODVWDGRSRUHQFLPDGHODIRVD JOHQRLGHDpVWHVHDUWLFXODFRQOD FODYtFXOD\GDDGKHVLyQDOP~V FXORGHOWRLGHV\DOJXQDVÀEUDVGH P~VFXORWUDSHFLR

$FURSDTXLD  2VWHRDUWURSDWtD SXO PRQDUKLSHUWUyÀFD

$FURSDWtD $FKDWDPLHQWR KHUHGL WDULR VLPSOH GH ORV GtJLWRV VLQ HQIHUPHGDG SXOPRQDU DVRFLDGD X RWUD HQIHUPHGDG SURJUHVLYD D PHQXGR PiV VHYHUD HQ KRP EUHV KHUHQFLD DXWRVyPLFD GR PLQDQWH

$FURVD$]~FDUREWHQLGDSRUODDF FLyQGHODVROXFLyQGpELODOFDOLQD GHIRUPDOGHKLGR

$FURVRPD (OFXHUSR\X[WDQXFOHDU HQ OD H[WUHPLGDG DQWHULRU GH OD HVSHUPiWLGHGHULYDGDGHODSDUDWR GH*ROJL

$FURWLVPR $XVHQFLDRLPSHUFHSWL ELOLGDGGHOSXOVRVLQSXOVR $FWLQD  8QR GH ORV FRPSXHVWRV

GH SURWHtQD HQ OD FXDO OD DFWL QRPLRVLQD SXHGH VHU GLYLGLGD 3XHGHH[LVWLUHQODIRUPDÀEURVD IDFWLQDRJOREXODU*DFWLQD $FWLQREDFLOR*pQHURGHODIDPLOLD %ULFHOODFHD*UDPQHJDWLYRLQPy YLOSHTXHxRHQIRUPDGHEDVWyQ R FRFRLGH FDUDFWHUL]DGR SRU OD WHQGHQFLDDIRUPDUDJUHJDGRVHQ ORVWHMLGRVRFXOWLYRVORVFXDOHV VLPXODQDORVJUiQXORVGHD]XIUH GHDFWLQRPLFRVLV3DWyJHQRSDUD ORV DQLPDOHV DOJXQDV HVSHFLHV DWDFDQDOKRPEUH

$FURPHODOJLD $FWLQREDFLOR

$FURPHJDOLD

$FURPLyQ



$FWLQyIRUR 0H]FOD GH WUHV SDUWHV GHy[LGRGHFHULR\XQDSDUWHGH GLy[LGRGHWRULRXVDGDHQHOGLDJ QyVWLFRFRQUD\RVGHURHQWJHQ $FWLQRPLFHV  +RQJR GH UD\R DVt

OODPDGR GHELGR D TXH VXUJH GH OD DJUHJDFLyQ  GH EDVWRQHV UD GLDQWHVHQIRUPDGHJDUURWHXQ JpQHURGHODIDPLOLD$FWLQRP\FH

WDFHDH TXH FRQWLHQH RUJDQLVPRV

ÀODPHQWRVRV UDPLÀFDGRV LQPy YLOHV TXH IRUPDQ XQ PLFHOLR \ VH IUDJPHQWDQ HQ HOHPHQWRV GH WDPDxR LUUHJXODU  /D PD\RUtD VRQ DQDHUyELFRV SHUR DOJXQRV VRQPLFURDHURItOLFRV8QDVSRFDV GH ODV HVSHFLHV VRQ SDWyJHQDV SDUDORVKRPEUHVYDULDVFDXVDQ FRVWUDV\RWUDVHQIHUPHGDGHVGH ODVSDSDVSHURHOPD\RUQ~PHUR GHpVWRVVRQRUJDQLVPRVGHOVXHOR QRSDWyJHQRV $FWLQRPLFLQD6XVWDQFLDFULVWDOLQD DQWLEDFWHULDO DLVODGD GHO $FWLQR

PLFHV HVWUHSWRPLFHV DQWLELRWLFXV

$FWLYD FRQWUD EDFWHULDV *UDP SRVLWLYDV HM %DFLOOXV VXEWLOLV OL JHUDPHQWHDFWLYRFRQWUDEDFWHULDV *UDPQHJDWLYDV(VWHWDPELpQHV IXQJLFLGD \ Wy[LFR D ORV WHMLGRV DQLPDOHV +D\ WUHV FRPSXHVWRV PX\ VLPLODUHV OODPDGRV $ % \&

$FWLQRPLFRVLV  (QIHUPHGDG GHO JDQDGR \ FHUGRV DOJXQDV YHFHV WUDQVPLWLGD DO KRPEUH FDXVDGD SRUHOKRQJRGHUD\R$FWLQRPLFHV

1RFDUGLD eVWH DIHFWD PiV FR

P~QPHQWHODPDQGtEXODPDQGt EXODJUXPRVDSHURSXHGHLQYD

GLUHOFHUHEURSXOPRQHVRWUDFWR JDVWURLQWHVWLQDO 6H FDUDFWHUL]D SRUODIRUPDFLyQGHJUDQXORPDV GH FUHFLPLHQWR OHQWR ORV FXDOHV HYHQWXDOPHQWHVHGHVFRPSRQHQ \HPLWHQSXVYLVFRVDTXHFRQWLHQH GLPLQXWRVJUiQXORVDPDULOOHQWRV ORVVtQWRPDVFRQVWLWXFLRQDOHVVRQ GHFDUiFWHUVpSWLFR

$FWLRIDJR 9LUXV GHVWUXFWRU GHO

DFWLQRP\FHWHV $FWLWXG&RQGXFWDKDFLDXQDSHU VRQDFRVDRVLWXDFLyQ3RVLFLyQ R SRVWXUD FRUSRUDO DVXPLGD HM SRVWXUDFDWDWyQLFD $FWLYDFLyQ   (VWDGR GH DOHUWD ([FLWDFLyQVH[XDO $FWLYDFLyQ(ODFWRGHYROYHUVH DFWLYR $XPHQWR HQ HO FRQWH QLGR GH HQHUJtD GH XQ iWRPR R PROpFXODDWUDYpVGHODHOHYDFLyQ GHODDEVRUFLyQGHODWHPSHUDWXUD RIRWRQHVGHOX]HWFORFXDOKDFH TXHHOiWRPRRPROpFXODVHDPiV UHDFWLYR7pFQLFDVGHDOWHUDFLyQ GHO PHGLR DPELHQWH ÀVLROyJLFR GHO FHUHEUR DO HVWLPXODUOR FRQ OX]VRQLGRRHOHFWULFLGDGDÀQGH SURGXFLUXQDDFWLYLGDGDQRUPDO RFXOWD R ODWHQWH HQ HO HOHFWURHQ FHIDORJUDPD(VWLPXODFLyQGH ODGLYLVLyQFHOXODUHQXQyYXORD WUDYpV GH IHUWLOL]DFLyQ R PHGLRV DUWLÀFLDOHV $FWLYDGRU   6XVWDQFLD TXH VH FRQYLHUWH HQ RWUD VXVWDQFLD WD OHV FRPR XQD HQ]LPD DFWLYD 6HFUHFLyQLQWHUQDGHOSiQFUHDV $SDUDWR SDUD LPSUHJQDU FRQ DJXDGHQWURGHXQUDGLRGHHPD

$FWLQyIRUR $FWLYDGRU

 QDFLyQ&DWDOL]DGRURDFHOHUDGRU GHODSROLPHUL]DFLyQGHUHVLQDV $FWLYR(IHFWRGHSURGXFFLyQQR SDVLYR0iVTXHORXVXDOSUR EDEOHPHQWHH[SHULPHQWDDOJXQD UHDFFLyQTXtPLFD

$FWLYR  WUDQVSRUWH   (O QRPEUH

GDGRDOSDVRGHLRQHVRPROpFXODV DWUDYpVGHODPHPEUDQDFHOXODU GLIHUHQWH D OD GLIXVLyQ SDVLYD SHURSRUXQSURFHVRTXHFRQVXPH HQHUJtD/DGLIXVLyQDFWLYDSXHGH WHQHU OXJDU FRQWUD XQ JUDGLHQWH GHFRQFHQWUDFLyQ

$FWRPLRVLQD  &RPSOHMR GH SUR WHtQDV  FRPSXHVWR GH JOREXOLQD PLRVLQD \ DFWLQD HQ OD PLFHOOD GH OD ÀEUD PXVFXODU (VWD HV OD VXVWDQFLD HVHQFLDO FRQWUiFWLO GHO P~VFXOR

$FWRQLD+RQJRTXHFDXVDSDUFKHV DPDULOOHQWRV HQ OD PHPEUDQD PXFRVDIDUtQJHDHOFXDOSXHGHVHU FRQIXQGLGRFRQGLIWHULDSHUWHQH FHDORUGHQ(QGRP\FHWDWHV $FXDIRELD0LHGRPyUELGRDODJXD $FXDQDXWD3HUVRQDV TXH WUDEDMDQ EDMRHODJXDSDUDUHDOL]DULQYHV WLJDFLRQHV $FXDSXQWXUD ,Q\HFFLRQHV VXEFX WiQHDV GH DJXD SDUD SURGXFLU FRQWUDLUULWDFLyQ

$FXHGXFWR&DQDORFRQGXFWR

$FXHGXFWR  FHUHEUDO  &DQDO HQ HO FHUHEURPHGLRTXHXQHHOWHUFHU \FXDUWRYHQWUtFXOR $FXHGXFWRFRFOHDU&DQDOTXHFR QHFWDHOHVSDFLRVXEDUDFQRLGHR\ HOHVSDFLRFRFOHDUSHULOLQIiWLFR $FXHGXFWRYHVWLEXODU   3DVR GHO

YHVWtEXOR D OD SDUWH SHWURVD GHO KXHVRWHPSRUDO

$FXRVR$JXRVR

$FXRVRKXPRU/tTXLGRWUDQVSD UHQWH SURGXFLGR SRU HO SURFHVR FLOLDU\OOHQDODFiPDUDDQWHULRU\ SRVWHULRUGHORMR\ÀQDOPHQWHHV DEVRUELGRSRUHOFDQDOGH6FKOH PPKDFLDHOVLVWHPDYHQRVR $FXSXQWXUD   3XQFLRQHV UHDOL ]DGDV FRQ ILQDV DJXMDV ODUJDV SDUD SURSyVLWRV GLDJQyVWLFRV R WHUDSpXWLFRV $FXVPD $OXFLQDFLyQ DXGLWLYD HQODFXDOORVVRQLGRVLQGHÀQLGRV FRPR FDPSDQHR R VLOELGRV VRQ HVFXFKDGRV $F~VWLFD &LHQFLDGHORVVRQLGRV \VXSHUFHSFLyQ $F~VWLFR5HODFLRQDGRDODDXGL FLyQRSHUFHSFLyQGHVRQLGR $FXVWLFRIRELD   0LHGR D ORV VR QLGRV $GDPDQWLQD     (Q H[WUHPR GXUR HVSHFtILFDPHQWH UHODFLRQDGR DO HVPDOWHGHORVGLHQWHV

$GDPDQWLQRPD7XPRUGHODPDQ GtEXOD TXH VXUJH GH ODV FpOXODV GHO HVPDOWH 3XHGH VHU EHQLJQR R GH EDMR JUDGR GH PDOLJQLGDG 6,1DPHOREODVWRPD

$GDPV6WRNHVVtQGURPHGH3pU GLGD GH OD FRQVFLHQFLD GHELGR D FDtGD V~ELWD HQ OD FLUFXODFLyQ FHUHEUDO FRP~QPHQWH GHVSXpV GHXQEORTXHRFDUGtDFR $GGLVLQD )DFWRUHQHOWHMLGRJiV WULFR\PXFRVDJiVWULFDTXHDFW~D $FWLYR $GGLVLQD

www.siempre-medicina.com



VREUH HO IDFWRU H[WUtQVHFR SDUD SURGXFLUHOSULQFLSLRKHPDWtQLFR GHOKtJDGR $GHQDVD 8QD HQ]LPD GHVDPL QDQWH HQ HO KtJDGR SiQFUHDV \ ED]RTXHFRQYLHUWDODDGHQRVLQD HQKLSR[DQWLQD $GHQLODWR FLFODVD   (Q]LPD TXH VLQWHWL]DF$03 $GHQLQD 8QD GH GRV SXULQDV HQFRQWUDGDV WDQWR HQ HO iFLGR ULERQXFOHLFR\GHVR[LUULERQXFOHL FRWDPELpQHQFRQWUDGDHQYDULRV QXFOHyWLGRV GH LPSRUWDQFLD HQ HO FXHUSR HM iFLGR DGHQtOLFR DGHQRVLQDWULIRVIDWR$73FRHQ ]LPDV,\,,4QLWUyJHQR $GHQLWLV,QÁDPDFLyQGHXQQyGX ORRJOiQGXODOLQIiWLFD $GHQRDFDQWRPD1HRSODVLDPDOLJ QD TXH FRQVLVWH SULQFLSDOPHQWH GH HSLWHOLR JODQGXODU DGHQR FDUFLQRPD XVXDOPHQWH ELHQ GLIHUHQFLDGRFRQIRFRVGHFpOXODV QHRSOiVLFDVGHPHWDSODVLDDHVFD PRVDVRHSLGHUPRLGHV $GHQREODVWR  &pOXOD HPEULyQLFD

GHVWLQDGDDSUROLIHUDUHQFpOXODV TXH HQWUDQ HQ OD IRUPDFLyQ GH XQDJOiQGXOD

$GHQRFDUFLQRPD  1HRSODVLD PD OLJQD GH FpOXODV HSLWHOLDOHV HQ XQSDWUyQJODQGXODURVLPLODUD JODQGXODU IUHFXHQWHPHQWH FRQ LQÀOWUDFLyQGHOWHMLGRDG\DFHQWH PHWiVWDVLV\UHFXUUHQFLDGHVSXpV GHVXUHPRFLyQHWFXQDGHQRPD PDOLJQR $GHQRFLVWRPD$GHQRPDHQODFXDO HO HSLWHOLR JODQGXODU QHRSOiVLFR

IRUPDTXLVWHVRHVWUXFWXUDVVLPL ODUHVDTXLVWHV

$GHQRKLSyÀVLV  /yEXOR DQWHULRU SDUVDQWHULRURSDUVJODQGXODULV GHODJOiQGXODSLWXLWDULD $GHQDVD $GHQROHLRPLRÀEURPD $GHQRKLSyÀVLV $GHQRLGH 6LPLODUDJOiQGXODDGH QLIRUPHOLQIRLGHLQGLFDXQDIRUPD GH WHMLGR FRQHFWLYR  HQFRQWUDGR HQ ORV QyGXORV OLQIiWLFRV ED]R DPtJGDODV QyGXORV VROLWDULRV \ DJUHJDGRV GHO LQWHVWLQR PpGXOD yVHD URMD  \  HQ DOJ~Q RWUR VLWLR HVWH FRQVLVWH HQ XQ HQWUDPDGR R UHWtFXOR GH WHMLGR FRQHFWLYR TXH FRQWLHQHPDVDVGHFpOXODVUHGRQ GDVOLQIRFLWRVHQVXLQWHUVWLFLR $GHQRLGLVPR  6tQWRPDV \ VLJQRV DVRFLDGRV FRQ DGHQRLGHV DJUDQ GDGDV $GHQROHLRPLRÀEURPD1HRSODVLD EHQLJQDGHRULJHQPHVRGpUPLFR TXH FRQVLVWH SULQFLSDOPHQWH GH ÀEUREODVWRV\WHMLGRFRQHFWLYRFRQ FpOXODVPXVFXODUHVOLVDVQHRSOi VLFDV HOHPHQWRV JODQGXODUHV R DGHQRPDWRVRVRV

www.siempre-medicina.com

 $GHQRPD 1HRSODVLD GH HSLWHOLR JODQGXODU $GHQRPDFURPyIRER  7XPRU GH ODVFpOXODVFURPyIREDVGHOFXHUSR SLWXLWDULR DQWHULRU DVRFLDGR FRQ KLSRSLWXLWDULVPR ODV FpOXODV QR VHWLxHQELHQFRQWLQWHViFLGRVR EiVLFRV $GHQRPDGHJHWVRZD 8Q DGHQR FDUFLQRPDGHODJOiQGXODWLURLGHV DQWLJXDPHQWHVHSHQVDEDTXHHO RULJHQHVWDEDHQHOiQJXORODWHUDO SHUR SUREDEOHPHQWH UHSUHVHQWD XQDPHWiVWDVLVGHXQDQHRSODVLD SULPDULD HQ OD JOiQGXOD PLVPD WDPELpQ OODPDGD VWUXPD SRVW EUDQTXLDOLV $GHQRPDHRVLQRItOLFR7XPRUGH FpOXODVFURPyÀODVHRVLQRItOLFDVGH ODSLWXLWDULDDQWHULRUDVRFLDGRFRQ JLJDQWLVPR\DFURPHJDOLD $GHQRPDPDOLJQR$OJXQDVYHFHV XVDGR SDUD DGHQRFDUFLQRPD HQ HVSHFLDO FXDQGR VH SLHQVD TXH XQDSRUFLyQGHODGHQRPDSXHGH VHUKLVWROyJLFDPHQWHPDOLJQRRVH UHFRQRFHXQDQHRSODVLDPHWDVWi VLFDGHWLSRVLPLODU $GHQRPD  UDFLPRVR   1HRSODVLD EHQLJQD FRPSXHVWD GH WHMLGR HSLWHOLDO TXH VH DVHPHMD D XQD JOiQGXODUDFLPRVD $GHQRPDVHEiFHR1HRSODVLDTXH RFXUUHHQODFDUDFRPSXHVWDGH XQDPDVDGHJOiQGXODVVHEiFHDV \DSDUHFHFRPRXQDDFXPXODFLyQ GH SiSXODV URMRDPDULOOHQWDV \ DPDULOODV DOJXQDV YHFHV ORV SDFLHQWHVVRQPHQWDOPHQWHUHWDU GDGRVFRQFRQYXOVLRQHV $GHQRPDGHLVORWHVGHFpOXODV1HRSOD VLDEHQLJQDGHOSiQFUHDVFRPSXHVWD GHWHMLGRVLPLODUHQHVWUXFWXUDDODGH ORVLVORWHVGH/DQJHUKDQVeVWHSXHGH FRQWHQHUFpOXODVEHWDIXQFLRQDQWHV \ SXHGH FDXVDU KLSRJOXFHPLD DOJXQDVYHFHVOODPDGRLQVXOLQRPD R/DQJHUKDQVLDQD $GHQRPLRVLV  2FXUUHQFLD HFWy SLFD R LPSODQWDFLyQ GLIXVD GH WHMLGRDGHQRPDWRVRHQHOP~VFXOR XVXDOPHQWHP~VFXOROLVRFRPR HQODLQYDVLyQEHQLJQDGHOPLR PHWULRSRUWHMLGRHQGRPHWULDO $GHQRPL[RPD1HRSODVLDEHQLJQD FRQFDUDFWHUtVWLFDVKLVWROyJLFDVGH DGHQRPD\PL[RPD $GHQRTXLVWH7XPRUTXtVWLFRTXH VHGHVDUUROODGHOHSLWHOLRJODQGX ODUDGHQRFLVWRPD $GHQRVDUFRPD1HRSODVLDPDOLJQD GH WHMLGR PHVRGpUPLFR FRQ HOH PHQWRVDGHQRPDWRLGHVDOJXQDV YHFHVDSOLFDGRDOVDUFRPDTXHVH RULJLQDHQHOWHMLGRFRQHFWLYRGH XQDJOiQGXOD $GHQRVLQD3URGXFWRGHODFRQGHQ VDFLyQGHODDGHQLQD\'ULERVD XQ QXFOHyVLGR HO FXDO SXHGH HQFRQWUDUVH HQWUH ORV SURGXFWRV GHODKLGUyOLVLVGHWRGRVORViFLGRV QXFOHLFRV\GHYDULRVQXFOHyWLGRV GHDGHQLQD $GHQRVLQDGLIRVIDWRGH3URGXFWR GHODFRQGHQVDFLyQGHDGHQRVLQD FRQ iFLGR SLURIRVIyULFR $'3 IRUPDGRGHOWULIRVIDWRGHDGHQR VLQD $73 SRU OD KLGUyOLVLV GHO JUXSRIRVIDWRWHUPLQDOGHO~OWLPR FRPSXHVWR

$GHQRPD $GHQRVLQDGLIRVIDWRGH