Other Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons^™

Blunt Cerebrovascular Injury (Bcvi): Universal Cta Neck Screening At Level 2 Trauma Center, Tamine Gogel

Doctor of Nursing Practice Projects

Blunt Cerebrovascular Injury (BCVI) refers to injuries to the vessels supplying blood to the brain, primarily carotid and vertebral arteries, and can result from trauma, resulting in stroke by vessel dissection, thrombus formation, embolization, and hemorrhage. Timely identification is crucial for effective intervention and improved outcomes. This doctoral project proposes the implementation of universal screening using Computed Tomography Angiography (CTA) of the neck during initial workup for blunt force trauma at a Level II ACS-verified trauma center. The primary objective is to mitigate potential delays in diagnosing and treating BCVI, thereby reducing the likelihood of complications. Patients ≥ 15 years …

Patient-Centered Preimplant Education Session And Bi-Weekly Text Message Adherence Reminders In Patients With A Newly Implanted Cardiomems® Device: A Quality Improvement Study, Elizabeth M. Miller, Alicia Abboud, Audrey Cooper

Doctor of Nursing Practice Projects: College of Nursing

Rationale

Heart failure is a deadly disease, affecting over 6.2 million individuals and costing the United States an estimated 30.7 billion dollars (Virani et al., 2020). By 2023, heart failure costs in the United States are estimated to grow to 70 billion dollars with 75-80% of these costs attributed to inpatient hospitalizations (Heidereich et al., 2022). The CardioMEMs® is a small device placed in the patient’s pulmonary artery via a minimally invasive procedure by an interventional cardiologist. The use of remote patient data from the CardioMEMs® device has been shown to reduce hospital re-admissions, facilitate tailored medication management, detect increased …

Morel Lavallee Lesion: A Shear Fascia-Nating Soft Tissue Injury, Isaac F. Su, James A. Espinosa, Alan A. Lucerna

Rowan-Virtua Research Day

Morel-Lavallée lesions (MLLs), first described by their namesake, French physician Victor-Auguste-François Morel-Lavallée, in 1863, represent a distinct category of soft-tissue degloving injuries. These injuries occur when a shearing force disrupts the connection between subcutaneous tissue and fascia, severing lymphatic vessels and capillaries, and leading to an encapsulated collection of lymph, blood, and necrotic fat. Because this space is deep and enclosed, the fluid accumulation cannot easily drain or resolve spontaneously and often an inflammatory capsule develops, further inhibiting resorption. Undiagnosed, patients go on to develop chronic pain, infection, skin necrosis, progressive neurovascular deficits, and, in severe cases, potential loss of …

A Rare Presentation: Intracranial Hemorrhage As A Symptom Of Acute Leukemic Transformation In A 23-Year Old Male, Kelsey M. Murray, Kishan Patel

Rowan-Virtua Research Day

This case highlights the urgency of considering acute leukemic transformation in young patients presenting with neurological deficits, emphasizing the importance of prompt evaluation and management to optimize patient outcomes. The case depicted is a tragic complication of Chronic Myeloid Leukemia (CML) and its acute blast crisis. Remarkably, the patient exhibited none of the typical constitutional symptoms associated with CML.

A Literature Review Of Current Treatments For The Hypermobility Subtype Of Ehlers-Danlos Syndrome, John Gericke, Mary Zsolway, Chelsea Reyes, Pooja Patel, Saad Ahmed, Julia Hwang, Venkateswar Venkataraman

Rowan-Virtua Research Day

Purpose: The purpose of this study is to compare pharmacologic intervention, neurocognitive therapy, physical therapy, and orthotics in treating the hypermobility subtype of Ehlers-Danlos Syndrome (hEDS) and determine which has the most positive effect on symptoms.

Introduction: Ehlers-Danlos Syndrome is an inheritable connective tissue disorder which results from a genetic mutation that alters the body’s ability to produce collagen. The most common subtype of Ehlers-Danlos Syndrome is hEDS, which leads to hypermobility and hyperextensibility and can cause frequent joint dislocations.

Methods: A review of literature was performed to compare each treatment based on reported results. The types of studies reviewed …

The Benefits And Risks Of Pudendal Nerve Block And Dorsal Root Ganglion Stimulation In Pudendal Neuralgia, Pooja A. Patel

Rowan-Virtua Research Day

Context: Pudendal neuralgia is a chronic neuropathic pain syndrome worsening throughout daily activities. Although temporarily relieved when standing or lying down, it is often misdiagnosed, improperly treated, and/or refractory to treatment leading to a negative impact on quality of life. The lack of research in proper diagnosis and interventional management (such as dorsal root ganglion stimulation (DRGS) and pudendal nerve block) further contributes to the delay in relief from the chronic pain. Objective: The goal of this scoping review is to assess if research exists on benefits and risks of pudendal nerve block and dorsal root ganglion and …

National Inpatient Sample Analysis: Examining Clinical Outcomes In Cardiac Ablation Patients With Hyperlipidemia, Tony Elias, Mena Elmalh, Kyrillos Girgis, Taha Syed, Rafail Beshai

Rowan-Virtua Research Day

Background Cardiac ablation, utilizing radiofrequency or cryoablation, is a therapeutic approach for correcting abnormal heart rhythms by disrupting specific electrical pathways within the heart. Despite the growing utilization of cardiac ablation, limited research exists on the impact of hyperlipidemia, a prevalent cardiovascular risk factor, on outcomes in patients undergoing this procedure. Previous studies underscore the importance of understanding how comorbid conditions, such as hyperlipidemia, influence the efficacy and safety of cardiac ablation.1,2 Consequently, this study aimed to leverage the national inpatient sample database to investigate in-hospital outcomes among cardiac ablation patients with hyperlipidemia.

Methods Data from the National Inpatient Sample …

Sex Differences In Outcomes Among Patients Who Underwent Cardiac Ablation: A Retrospective Cohort Study, Tony Elias, Mena Elmalh, Kyrillos Girgis, Taha Syed, Rafail Beshai

Rowan-Virtua Research Day

Background Cardiac ablation, encompassing radiofrequency and cryoablation modalities, is a therapeutic intervention targeting abnormal heart rhythms by disrupting electrical pathways within the heart. Despite its widespread use, research focusing on sex-specific outcomes among patients undergoing cardiac ablation remains limited. Understanding potential sex differences in treatment response and outcomes is crucial for optimizing patient care and outcomes.1,2 Therefore, this retrospective cohort study aimed to analyze the national inpatient sample database to assess in-hospital outcomes among patients undergoing cardiac ablation, specifically focusing on sex disparities.

Methods Data from the National Inpatient Sample (NIS) Database for the years 2019 and 2020 were utilized …

Cost-Effectiveness And Outcomes Of Utilizing Tisagenlecleucel Therapy (Car T-Cell) In Pediatric Acute Lymphoblastic Leukemia In Comparison To Standard Of Care (Soc) Therapies: A Scoping Review, Andrew Atschinow, Evangeline Attota, Warren Chan, Pooja Kasarapu, Priyal Shah, Karina Vizzoni

Rowan-Virtua Research Day

Aims

This review aims to assess the correlations between outcomes and cost of treatment methods for pediatric acute lymphoblastic leukemia patients, specifically comparing CAR T-cell therapy and Standard-of-Care (SoC) therapy. The socioeconomic background of patients will also be taken into consideration to see if there are differences in their outcomes.

Methods

Peer-reviewed publications were collected from PubMed and Web of Science. The keyword strings used were “acute lymphoblastic leukemia,” “pediatric acute lymphoblastic leukemia,” “pediatric,” “CAR T-cell therapy,” and “cost-effectiveness.” 27 citations were obtained. Titles were screened by 6 authors. Articles met the inclusion criteria including potential Quality-Adjusted Life Year (QALY) …

Effects Of Obesity On Patients Undergoing Cardiomems Procedure: Retrospective Cohort Study, Tony Elias, Mena Elmalh, Priya Brahmbhatt, Kyrillos Girgis, Taha Syed, Michael Valderrama, Rafail Beshai

Rowan-Virtua Research Day

★ Remote hemodynamic monitoring (CardioMEMs) is becoming increasingly important for management of chronic heart failure patients.

★ There is limited data looking specifically for obese patients who undergo CardioMEMs implantation.

★ We sought to examine the national inpatient sample database to describe in-hospital outcomes for this demographic

Clinical Outcomes For Impella Patients Associated With Hyperlipidemia: An Analysis Of The National Inpatient Sample, Tony Elias, Sonika Vatsa, Kyrillos Gamal, Taha Syed, Rafail Beshai

Rowan-Virtua Research Day

The Impella, a ventricular assist device, is crucial for managing severe heart failure and cardiogenic shock. Despite its widespread use, there's scant information on how hyperlipidemia affects Impella patients. To address this gap, we delved into the National Inpatient Sample Database from 2019 and 2020. Our aim was to scrutinize in-hospital outcomes among these patients. We identified 8233 Impella patients, among whom 1012 (12.3%) had hyperlipidemia. Those with hyperlipidemia displayed higher rates of hypertension, diabetes mellitus, and chronic kidney disease compared to their counterparts without hyperlipidemia. Shockingly, in-hospital mortality was notably elevated in the hyperlipidemia group, emphasizing its clinical significance. …

Clinical Outcomes For Impella Procedure In Octogenarians, Nonagenarians, And Centenarians: A Retrospective Cohort Study, Tony Elias, Sonika Vatsa, Kyrillos Girgis, Michael Valderrama, Rafail Beshai

Rowan-Virtua Research Day

The Impella, a vital ventricular assist device, has seen extensive use in managing severe heart failure and cardiogenic shock. However, the impact of this procedure on older individuals remains poorly understood. To address this gap, we scrutinized the National Inpatient Sample Database from 2019 to 2020 to elucidate in-hospital outcomes among older patients who underwent the Impella procedure. Among the 8233 patients who underwent Impella insertion, 1389 (16.8%) were in the older population, aged 80 years or older. This subgroup exhibited a higher prevalence of comorbidities such as hypertension, diabetes mellitus, and chronic kidney disease compared to younger patients. Alarmingly, …

Transcranial Electrical Stimulation As A Treatment For Aging-Related Cognitive Disorders: Review Of Published Evidence, Srujan Dadi, Kyle Jackson, Don Shamilov

Rowan-Virtua Research Day

Alzheimer's disease (AD) and MCI are a major concern in modern neuropsychiatric care, chiefly for their difficult management. This strategic literature review categorizes MCI via the Jak-Bondi criteria and relates it to tES treatment paradigms. Commonly used outcome measures and regional brain mapping data synergizes associations between MCI pathology and potential tES treatment targets. Effect sizes were calculated and attributed to outcome measures based on primary articles evaluating the efficacy of tES. These were then corresponded to a desired Jack-Bondi classification. A better understanding of the efficacy of tES on specific brain regions in synergy with diagnostic criteria will allow …

Ultrasound Versus Radiography For Evaluating Surgical Necrotizing Enterocolitis, Sayed H. Aftab, Santiago Martinez-Correa, Minh-Huy Huynh, Wondwossen T. Lerebo, Jorge Delgado, Rebecca Denis, Misun Hwang

Rowan-Virtua Research Day

Purpose:

Necrotizing enterocolitis (NEC) is an abdominal inflammatory condition that is common in premature neonates. Although abdominal radiograph (AR) remains the imaging standard for NEC, it may miss up to 50% of early signs of NEC and has been described to have a sensitivity as low as 15.4% for detecting pneumoperitoneum. Abdominal ultrasound (US) is portable, non-invasive, and allows real-time bowel integrity, movement, and perfusion assessment. We aim to evaluate the concordance between US and AR in detecting NEC features and the diagnostic performance of both modalities in detecting pneumoperitoneum.

Methods and materials:

We conducted an IRB-approved retrospective, cross-sectional, single-center …

The Case For Using Composition Tomography To Evaluate Perirectal Necrotizing Fasciitis: Is It Really Necessary?, Tyler Bayliss, David Denning

Marshall Journal of Medicine

Clinical reviews of Fournier’s Gangrene state that diagnostic protocol includes interpreting CT, MRI, or Ultrasound imaging along with clinical symptoms and lab findings. We think that the use of imaging techniques as a diagnostic tool is no longer needed as Fournier’s Gangrene is specific enough of a disease that clinicians can diagnose using labs and physical examination alone.

Cases of perirectal necrotizing soft tissue infection recorded at St. Marys Medical Center were reviewed. Results of physical exams and imaging were compared along with measurements of severity upon admittance and length of stay. Due to the COVID-19 pandemic, we investigated if …

Effects Of Core Stabilization Exercises In Patients With Non-Specific Low Back Pain: Huber Motion Lab Versus Conventional, Ebru Koyuncu, Nur Tunali, Seda Saka, Ertuğrul Ural, Melek Güneş Yavuzer

Baltic Journal of Health and Physical Activity

Introduction: This study aimed to determine the effects of core stabilization exercises with Huber® Motion Lab on pain, depression, and activity levels in patients with non-specific low back pain (LBP).

Materials and methods: In this study, 30 patients with non-specific LBP were allocated either to an experimental or to a control group. Both groups received a conventional physiotherapy program for 15 sessions. In addition, the control group performed 30 minutes of core stabilization exercises on the floor, whereas the experimental group used the Huber® Motion Lab device. The main outcome measures were pain severity (Visual Analogue Scale VAS), depression (Beck …

Evaluation Of Novel Therapeutic Agents For The Treatment Of Chronic Dry Eyes, Lilian Huynh, Evonie Villarete, Surajit Dey

Annual Research Symposium

Dry eye disease (DED) is a multifactorial ocular condition, where disrupted tear film stability and ocular surface inflammation affected between 5% to 34% of the worldwide population in 2015 and posed a challenge to conventional ophthalmic treatments. Recent advances have led to potential novel therapeutics aiming to alleviate symptoms and improve patient outcomes.

Classification Of Colorectal Cancer Using Resnet And Efficientnet Models, Abhishek Ranjan, Priyanshu Srivastva, B Prabadevi, R Sivakumar, Rahul Soangra, Shamala K. Subramaniam

Physical Therapy Faculty Articles and Research

Introduction:

Cancer is one of the most prevalent diseases from children to elderly adults. This will be deadly if not detected at an earlier stage of the cancerous cell formation, thereby increasing the mortality rate. One such cancer is colorectal cancer, caused due to abnormal growth in the rectum or colon. Early screening of colorectal cancer helps to identify these abnormal growth and can exterminate them before they turn into cancerous cells.

Aim:

Therefore, this study aims to develop a robust and efficient classification system for colorectal cancer through Convolutional Neural Networks (CNNs) on histological images.

Methods:

Despite challenges in …

Glaucoma Neovascular, Una De Las Consecuencias De La Oclusión De La Vena Central De La Retina, Nicol Daniela Jiménez Rojas

Ciencia y Tecnología para la Salud Visual y Ocular

Objetivo. Estudiar y describir la relación entre la oclusión de la vena central de la retina y el glaucoma neovascular, su etiología, epidemiología, fisiopatología, factores de riesgo, presentación clínica y tratamientos. Metodología. Revisión de la literatura acerca del glaucoma neovascular secundario a oclusión de la vena central de la retina, tomando artículos comprendidos entre 2014 y 2022, con criterios de exclusión artículos de series de casos. Resultados. El glaucoma neovascular (GNV) es una afectación patológica ocular, secundaria a una afección ocular y/o sistémica hipóxica que conduce a isquemia retiniana, dentro de las etiologías más comunes (33 %) se encuentra la …

Impacto De La Pandemia Por Covid-19 En La Decisión De Los Pacientes Sometidos A Cirugía Refractiva En Una Institución Privada En Bogotá, Colombia, Juliana Palacio Varona, Brian Pérez Riaño, María Paula Castro Mora, María Andrea Estevez Florez, Luis Guillermo Isaza Gómez, Diana V. Rey-Rodríguez

Ciencia y Tecnología para la Salud Visual y Ocular

En el 2020, durante la pandemia por covid-19, disminuyeron los procedimientos en los centros de cirugía refractiva, pero resurgieron para octubre de ese mismo año, ya que aumentaron un 4 % en comparación con el 2019. Existe una información limitada sobre el impacto de la pandemia en la realización de cirugías y la razón que obedece a dicho aumento. Objetivo: identificar el efecto de la pandemia por covid-19 en la cirugía refractiva mediante la delimitación de las principales motivaciones para la realización del procedimiento. Métodos: estudio descriptivo observacional de corte transversal, por medio de la respuesta de un cuestionario sobre …

Prevalencia De Astenopia En Niños Escolares De 6 A 17 Años, Por El Uso De Pantallas Digitales Durante La Pandemia Por Covid-19 (2020-2022): Revisión Sistemática, Jenny Paola Acosta Castellanos, Nancy Piedad Molina-Montoya

Ciencia y Tecnología para la Salud Visual y Ocular

Introducción: El uso de dispositivos electrónicos es primordial en la vida cotidiana a nivel mundial y gracias a la emergencia sanitaria por COVID-19 se incrementó, obligando a los estudiantes a tomar clases virtuales, y esto aumento la prevalencia de astenopia. Objetivo General: Determinar la prevalencia de astenopia reportada por la literatura en niños escolares de 6 a 17 años, por el uso de pantallas digitales durante la pandemia por COVID-19. Método de Investigación: Se realizo una revisión sistemática cualitativa mediante la pregunta PECO; la búsqueda bibliográfica de realizo en bases las bases de datos, con ecuaciones construidas con palabras clave …

Using Digital Assessment Technology To Detect Neuropsychological Problems In Primary Care Settings, David J Libon, Emily Frances Matusz, Stephanie Cosentino, Catherine C Price, Rod Swenson, Meagan Vermeulen, Terrie Beth Ginsberg, Adaora Obiageli Okoli-Umeweni, Leonard Powell, Robert Nagele, Sean Tobyne, Joyce Rios Gomes-Osman, Alvaro Pascual-Leone

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

INTRODUCTION: Screening for neurocognitive impairment and psychological distress in ambulatory primary and specialty care medical settings is an increasing necessity. The Core Cognitive Evaluation™ (CCE) is administered/scored using an iPad, requires approximately 8 min, assesses 3- word free recall and clock drawing to command and copy, asks questions about lifestyle and health, and queries for psychological distress. This information is linked with patients' self- reported concerns about memory and their cardiovascular risks.

METHODS: A total of 199 ambulatory patients were screened with the CCE as part of their routine medical care. The CCE provides several summary indices, and scores on …

Using Cartesian Coordinate Systems To Create, Classify, And Retrieve Biomedical Time-Series: Applications To 24-Hour Ambulatory Blood Pressure Monitoring, Antonio Garcia, Gladys E. Maestre, John Blangero, Jesus D. Melgarejo, Julio Facelli

Research Symposium

Background: Ambulatory Blood Pressure Measurement (ABPM) allows physicians to monitor blood pressure variability under everyday living conditions and predicts clinical outcomes better than conventional blood-pressure measurement. ABPM can demonstrate mean arterial pressure (MAP) behavior over 24 hours relevant to clinical practice, such as nocturnal hypertension or increased blood pressure variability. We hypothesized that individuals with the same cardiovascular health status would have the same MAP signal (MAPs) waveform.

Methods: This study reutilizes a data subset from the IDACO Consortium to create 24-hour MAPs. We assigned all the MAPs to data matrix X, performed principal components analysis (PCA) to X, and …

Correlación Entre La Sintomatología Ocular Asociada Al Síndrome Visual Informático E Insuficiencia De Convergencia, César Luis Ruiz Sanabria, Erika Yuliana Niño Vega, Sandra Patricia Jurado

Ciencia y Tecnología para la Salud Visual y Ocular

El incremento en la demanda de uso de dispositivos electrónicos y pantallas digitales ha provocado la aparición de trastornos músculo esqueléticos, psicosociales y visuales; dentro de estos últimos se encuentra el trastorno denominado síndrome visual informático (svi), que se ha reportado desde hace más de veinte años; su tasa en la población oscila entre el 37 % y el 70 % (1). La alta recurrencia de alteraciones visuales dentro del svi permite relacionarlo con disfunciones de la visión binocular como la insuficiencia de convergencia (ic). Objetivo general: identificar la correlación existente entre la sintomatología ocular asociada al síndrome visual informático …

The Noloco Strategy For Essential Hypertension, F. Matthew Mihelic Md

Faculty Publications

Ninety-nine percent of all “essential” hypertension can be controlled by using the NoLoCo strategy, without causing any significant side-effects and without an increase in insulin resistance. NoLoCo stands for Norvasc (amlodipine), Lozol (indapamide), and Cozaar (losartan), but the medicines are considered and used in reverse order.

Calidad De Vida Y Productividad En Trabajadores Présbitas No Corregidos: Revisión Sistemática, Laura Natalia León Maldonado, Natalia Andrea Carrasco Romero, Karoll Lindhey Núñez Carranza, Nancy Piedad Molina-Montoya

Ciencia y Tecnología para la Salud Visual y Ocular

La presbicia es un proceso degenerativo normal asociado a la edad, que afecta al sistema visual dificultando enfocar con nitidez las imágenes en visión próxima, aspecto que puede generar la disminución de la productividad de los trabajadores que precisan realizar tareas de cerca y consecuentemente afectar su calidad de vida. La presente investigación tiene por objetivo sintetizar la evidencia científica sobre cómo la presbicia no corregida disminuye la productividad y la calidad de vida del trabajador mayor de 40 años. La metodología utilizada se basó en una búsqueda bibliográfica y el reporte se realizó cumpliendo los criterios de la declaración …

Caracterización Socioeconómica, Demográfica, Laboral Y Académica De Los Graduados De Optometría De La Universidad El Bosque En Bogotá, Colombia, Diana García-Lozada, José Rudas-Valero, Reinaldo Acosta-Martínez, Jenny Maritza Sánchez-Espinosa, Alejandra Mendivelso-Suárez, Lady Johana Morales-Solano

Ciencia y Tecnología para la Salud Visual y Ocular

Objetivo: conocer las características socioeconómicas, demográficas, laborales y académicas de los graduados del Programa de Optometría de la Universidad El Bosque, entre el 2013 y el 2022. Métodos: estudio observacional de corte transversal analítico, en el que se envió una encuesta electrónica a 365 graduados del Programa de Optometría. El instrumento incluyó 54 preguntas sobre variables demográficas, socioeconómicas, laborales y de formación académica posgradual. Resultados: de 190 graduados que respondieron la encuesta el 79,7 % eran de sexo femenino y el 90,6 % tenían entre 21 y 30 años. El 76,3 % permanecían solteros, el 76,8 % no tenían personas …

Yoga Ocular, Una Práctica Que Podría Reducir La Sintomatología Y Mejorar Algunos Aspectos De La Función Binocular En Pacientes Jóvenes, Nancy Piedad Molina-Montoya

Ciencia y Tecnología para la Salud Visual y Ocular

No abstract provided.

Discromatopsias Y Su Relación Con El Desempeño Biopsicosocial Cotidiano, Myrna Miriam Valera-Mota, Mitzi Rubi Valencia-Estrada, Javier Alonso-Trujillo, Abraham Alonso-Ricardez, Luz Elena Maya-López, Ma. Consepcion Rodríguez-Salgado, Paola Guadalupe García-Guízar, Marco Antonio Reynoso-Castro

Ciencia y Tecnología para la Salud Visual y Ocular

Objetivo. Conocer cómo influye la visión de los pacientes discrómatas, particularmente de tipo congénito (deuteranómalos, protanómalos, deuteranopes y protanopes), en su vida cotidiana escolar, laboral o profesional y las principales dificultades enfrentadas, de acuerdo con el modelo biopsicosocial. Método. Se diseñó un instrumento de calidad de vida del paciente discrómata en el que se incluyeron diferentes categorías de la vida cotidiana, con un total de veintitrés reactivos que fueron aplicados a todos los pacientes diagnosticados con alguna discromatopsia en el gabinete de color de la Clínica de Optometría de la Facultad de Estudios Superiores Iztacala, de la Universidad Nacional Autónoma …

Percepción De Los Deportistas Sobre La Importancia Del Sistema Visual En El Rugby Paralímpico, Ana María Parra Arroyo, Sandra Patricia Jurado Medina, Sandra Milena Medrano, Nancy Piedad Molina-Montoya

Ciencia y Tecnología para la Salud Visual y Ocular

En las últimas décadas, se ha incrementado la atención sobre la relación de las habilidades visuales y el deporte. No obstante, son pocas las investigaciones realizadas sobre este tema en deportes paralímpicos y, en particular, aquellas que indaguen sobre la percepción de la influencia del sistema visual en el desempeño deportivo de los atletas. El objetivo de este estudio fue determinar la percepción de los jugadores de rugby en silla de ruedas sobre la influencia del sistema visual en el deporte. Se incluyeron quince deportistas pertenecientes a la selección paralímpica de rugby de Bogotá y Cundinamarca, a quienes se les …