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3 << 2 9 < < A :9. ; 9 9 < C < < ; " C <6< ); 9 " " L <=< " D : < < 6< < 9 : 9 " " 6<6< 9 2> / 9 9 ) " 2 6<=< 2: / 9 9 ) " " 3 6<?< 9 0 / 9 /)A " " 4 6< < 0 / 9 9 ) " D 6<8< /) " 2J 6<B< / 9 9 ) " 22 6<C< D 0 0 / 9 9 ) " " 23 6<E< 9 9 D 9 5< "" 24 6< 7< / 9 " 2B :9. >9 < < 2C =< < 9 F 9 2. " 2C =<6< ) 0 " 2C =<=< 9 " 2L =<?< ) 9 " 2L =< < 9> " " 2D =<8< 9> " " 2D :9. 9 < 3

4 ?< < " 3?<6< ) / 09 " " AA : < AD < < 0 9 " " AD <6< " B2 <=< " B2 ) ) 2 : < B3 D < C

5 DEDICATORIA Dedico esta Tesis a mi querida esposa Dora Alicia, a mis hijos Gabriela, Lorena, Herman y Gonzalo y a mis nietos Augusto Gabriel, Herman Alonso e Ignacio por su comprensión y apoyo que me han permitido culminar este trabajo.

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7 El autor desea expresar su más sincero agradecimiento: A Dios Padre Todopoderoso por haberme dado vida y salud que me permitieron realizar este trabajo. A mis amados Padres que desde el cielo siguieron velando por mi y dándome la fuerza para no desmayar nunca. Al Dr. Víctor Bazul Nicho por su apoyo y sugerencias como asesor de esta Tesis. Al Dr. Alejandro Colichón Y. y Laboratorios Med-Lab por su apoyo laboratorial. A las licenciadas María Elena Flores y Elizabeth Ramos, y a la sra. Gaby Atencio por su apoyo en el trabajo de campo. A las srtas. Susana Flores y Ruth Almanza, por su invalorable apoyo secretarial. A los Drs. Juan Torres O. y Emma Cambillo M., por su apoyo en los aspectos estadísticos. A las gestantes adolescentes que colaboraron generosa y voluntariamente para realizar esta investigación. A todas las personas de la Facultad de Medicina de San Fernando que me ayudaron incondicionalmente. 3

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

11 :9. ; 9 9 :9. ; 9 9 < < ; / + * + / / * </ / ( / ) + F<5 / + / 0 +0 / = 0/ 9 /< / /+ </ 0/ =. + (/ 9 0/ * / / (G 0. + /9 += + /. + % ) +G/ / 0/ 9 / ;0 = + ;0 + * + + /+ / / / / + += /.. +" + * / / 0 / + + / + + / += / + + G + ;0 + (/ 9 / ) / 8 + F + = / / +=. = * ) ( + G += ;0 / 0 * / / / +( / ( + + /9 +" / DDL = + 0F + + / * / AJ=3K * </ / /0 + G+? / + 90 BB / F + / A ) D > + ) / DDD + + < ;0 3K 0F + / A ) D > + + / + + :/ ( + / 5 E" / +< +. / / / / + C

12 ! " #$ % %&$ ' ( ' # # % ) $% & '$% & %# # % $ % # %! *+ $ ', % % - % > + +0*+ (0 / += + / ;0 0 + / 0/ / / 0 / = ;0 + (/ 9 ;0 * </ + / + 0/ + ( / /0 / 0) / /0 + * </ ;0 0/ + * + / ;0 / 5 0/ ) * / /+ 0 / +( /9 </. + %= + ;0 /5 + ( + + * ;0 / 5 / / / 90+ </ /9 / + * </ F 5 /" = + / ;0 + 0F % / / 0/ * * /+ /9 </ / / = ;0 0 / / / /9 </ / / / 0/ * * ;0 /E. + DJK 5 0 / </ + /9 + /. + </ = + + ) /. 0 " + DLB / + / 0/ 5 0/ + (0 ) /. + %= 5 / </ ;0 / 0) / / 5 0+" / 8 + / < / DDB / + 0 = 5 0/ </ / > + J > / + : + 5 / /9 </? + + (/ 9 ;0 + / > + ;0. / / J :+ > + /. / + * / 9 + / + 5 / 5 ) / + :/ / +( / /9 </" # ( = :+ + / + + / 8 + F +=. / + / 9 += + ;0 / / + /9 / = :+ / + + * * + / / ;0 +. * + / / * * + /+ /9 </ ) + + </ + # % + / + * + 0F + = ;0 / 0 +( F + / + 0/ 9 +( 0F = / / / / 5 * / + / 8 + F + / + + / 9 / + F += ;0 /9 + / G 0/ > / 5 0/ </ + / > + ) / > + / J > + = / / / 0 / ;0 + + / 5 / 0. + / > + / 9 / + + G+" + + E / + /+ + ; : / / F0+ 9 " <6< ); 9 < G, # $ 2 / + 5 / ) ( /9 </ % / + ( 0 + ( + / + + / + /+ 0 / / " 0 / + :+ F + + ) 0 / / + + F +" )< G, # $ %' H $% " / 5 / /9 </ # % ) + * 9 / + / </ / / + ( + / + + / + 2" / ( + + /9 </ %= 9 / + </ / + * </" 3" / + 5 / + %+ ( / ( + / + / / - % L

13 :9. ; 9 9 ( + 5 += 9 / / 0/ ( 5 0/ </ / + / / * + +" 4" / +( /9 </. + % ( + / + / / </ / 0 F ( + / " <=< E </ + / / < (0/ + / + / : F / / / / / / + / /+ 0 </ / + E< + 0 = + * / + + / + ( + / += ;0 * (< * F / 0/ ;0 + + * < / 4K? / / 5 / /9 </ % / + ( 0 * / = / /9 </ 5 = 0/;0 0/ + 0 / ( + / + / * / 3K= / 0G ( + / > +" / + / += * (< * F / 0/ 0 + * + / ( / ;0 / < / * / + /5 + ( </= ;0 + / * ( / + 9 < 0/ /0 0 ( + / /9 </ # % ) ( + / + / + + F + + D

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15 : : /9 </ / % 6# %7 + /+ 0/ * + 0 8* 0/ " ( / E </ 0/ 0.0* / 0 / + / + + /9 </ / > 2JJJ" > / 0/ </ + / + 0 / 0+ + </ / # % ) G/ + </ </ 5 = + + ) /. : <( + / 5 + G+ + / 5 / 0/ /( 5 / / 0 + / / ( / 6 / - % 7 ;0 5 / J"BK= /. 2"4K / 8* / / 6 N #:+;0 E- G/ E= 7 647" / /0 + G+ * / + / 0 / / + /( + 5 / /9 </ / / ( </ ( ( :9 = 0 / ( 5 / + 0) + + *+ 5 / + 5 E</ 6A=B=A=B7" 6< < 9 : 9 # % / 9 / 5 " 0 ( / /+ + 0/ * / 0 / " + : / / 0/ /8 + = / ( / = ;0 + : 0/ / / ( / " 5 </ + / G 0 / " / </ + G/ + )

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21 : T / / + / + / + ) + * F + + / +" 8/ 0 + / + + ( 0 * / + ;0 + :/ / ) +( / /9 </= + / 0 /+ + </ 5 + / + +=. ) G / /+ + </ / + / += 0 + F<5 / + ) 0 + ) += + / 0 / </ + / 8 + F + + 6B27" / + G+ + ( + * F / = /9 </ / / > + / + ;0 / > + + / 5 / * F +? + / * ( * ;0 / + ( 0 /9 </ / / + / : ) / / ( / <( = + /9 </ + + ;0 9 F / B7" 5 / /9 </ + / / > + = 0 ) 0 / </ 5 0/ </ 0/ 5 + /9 / + ) + / + / + ;0 + / / = / ;0 + :/ / ) +( /9 </" / CJK /0 5 + /9 / + # % 0 / / + / + ) 0 + F<5 / + / + + A ) 3D > + 6B37" / </ / 8 + F + += 9 +( :+ / " +G 0 9 6B47 < 0/ 5 / + %+ ( / / + 0F + 0/ G/ /9 + 5 / +" / * ( = + 0F +. + / + + F + + / / + (/ 9 5 / + * * + / / - %+ ;0 + 0F + / / /(0/ + F + 6 UJ=J7" E 0/ ++ 6BA7 / 0/ < / 0 / 90+ </ /9 </ # % / 9 < 0/ + (/ 9 + 6C=DK 5+" C=3K7 %+ ( / - %+= /. * + ) 0F +. + ;0 + / G / / 0/ G/ /9 + 5 / += / 0/ ( 0 / / + / / + + /( " + +< * < ( / 0 / + + / E< = ) / " / (+ 6BB7 < / 0/ ( 0 2CJ / / + / + 0/ + ) 62=2K7 + %+ ( ;0 A=JJJ / / + + /( 6J=4K7" 5 /( 0 6BC7 5 0< 5 / %+ ( / 2D ;0 90 / + / 3CD 0F + ( 0 / ;0 /G / 0/ ) /< + / / + 6 7" +. E( + 90 / 4=4K /G / %+ ( =4K ( 0 /? + 9 / / 90 + G+ / + (/ 9 5 ;0 E:+ ;0 / + G+ / 9. ;0 + E< + 0 6DC47 5 / /9? + / * ( 0 / + + < * + ( 0 + / - %+= / 0 0 / # %= / + (/ 9 5 / 6 UJ=JJ7 + * * + / / 0 ( 0 / 6AB=CK 5+" 24=AK7" / + 0 ) + ) 6BL7 E / / ( 0 / / ;0 + / / < / F + * + 5 / %+ ( 6=CK 5+" J=LK? VJ=3JA7 0/;0 0 / + +0 / %+ (= / - %+ / / + (/ 9 5 / + + / ( ;0 / ( 0 / 6BC=JK 5+" JK? UJ=JJJ7? / + + = 0/ /: < ;0 + 0 </ ) /8 > + </ / + (/ 9 5 / + + / C

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

23 : C4-CB7= 0/ 0 / + / / / / * F + ;0 / + /( 6C4=CA7" / * ( 0 /9 </ + 5 / + 0) 9 / ) G / + /( 0 ;0 (0/ / / C4=CC7 /9 </ / # %. + /+ / + / + / + 5 %+ ( ;0 90 / * 0 :/ / 5 ( / 6CL7" + / + + / 90 / /( 0 ) 90 / / + 0/ %+ (= ;0 / * / % ( + 5 " / </ # %. + / ;0 + / / + /. + (0 % 6CD7 ). 0 /+ + </ # % /+ / </ 9 / + / 0/ / / ;0 %+ ( ) % ( LJ7" 0 9 0E + 5 / ;0 + / / + / /9 </ # % / 0/ +( /9 </ + 0/ " + F * + / + /. + (0 % +( G/ /9 </ +0*+ (0 / = + / /( 2J-2CK 6AL= BJ=CJ=C7" +. / / + </ G 0 + /+ + </ 5 /. += 0/;0 / /+ + </ / / # % / / > + 6C=C2=L=L27= / / > + ) C27 ) / + / / + 6BJ=CJ=C= L37 / / / ;0 </ 5 ( / / + + / " 6< < 0 / 9 9 ) :+ 8/ / ( + </ 6L47" 0 + ) G = %= ) 7 / + ( + </ 6 LA=LB7 +0 /9 </ # % / + ( + / + / 9 + ;0 + 5 / / 0F + / ( + / 0/ + / / 0 " 6LC7" / + 0F + ;0 ) + / + </ +. + %= 0 / + + * E /= /9 / LL7" +( /+ + </ % 9 + / # % / = 9 F + 0+ / G( /. + % 6 % (7 ) +0 / 0 6 / - % 7 6LD7" +( /+ + </ / # % + JK / + % ( / ( 5 ) / % + 5 ) DJK / ;0 + / % ( + 5 6LA=LD7" +( /9 </ </ # % / 0/ / / ;0 / * / 0/ + ) 5 0/ </. + % + 4JK" 6LD7". ) 5 / +09 / / 0 = ;0 ) 0+ +: = 0 /+ + </ 5 # % 6C=LC7= / 0/ E </ 5 5 / /+ + </ / 0 / # % 6LC7" / ( % ;0 / ( + </= 5 / /9 </ / / / / ;0 0 /9 </ 0 / ( + </"6DJ7" /9 </ / / # % + + /9 </ / D

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

29 : G+" / / 0 / / / E </= 0 * / E </= ) + 0F 0 </= 5 E ) /+ </ 0F / 0 5 = +G 0/ + </ + + / + /9 0 / / + / = 0* = 8+ = + </ + ( += + ;0. /.. ;0 + 0E / * + / 5 += / + ) / 0 + / + + / 62A7" / + 0 * Z / ) 2JJ 62B7= 9 / < / + / / = + / ; F<5 / + 3 2J > ) )0 / + = + / + ( 0 3 B > += DK * F ) JK + 0 ) * F? * / + / + / = /9 0 / ;0 0 / + * / 0 + ( 0 =.. ;0 4CK + F<5 / = / / / * / + 8* + ) / = + / E</ / ABK 5 + </ ) E / + +" + 0( + + ;0 +0 / F<5 / + / +0 * + / + / BK7 ( K7" / + C 2J > + * / + 8/ CK7" / / </ / / / 0/ </ = / = + / / (0/ )S <( + 62A7" + / + 0/ 5 / + F<5 / + / 0/ * E / + = 0 / + /. / = / +. / /( /< + / + 0 / + 5 / F + + ) + ;0 /. / + / 9G+ / / / / + /+ * / " DDL 62C7= / / ;0 C=BK 0F + + / / / / + J ) 4 > += 34=DK / + A ) C > + ) 24K / + L ) D > +" / +0 ;0 BC"K 0F += F += 05 / +0 </ / + / ) * * / /+ 0 / 05 / 0/ * = 0/. F / - + / F / 0/ /9 /+ + </ " / 0 + / / ;0 + 0F / / +0 5 :+ / ;0 + 0F + 0 * / + ) + / / / + 0F = / A=AK 05 / +0 </ / + J ) 4 > += AA=LK / + A ) C > += L=4K / + L ) D > + ) / + J=3K J > + " / + 0 ) / / / + + / + + / / = 0/;0 / / + / + ;0 / + 5 "6 / J ) 4 > += 3=CK ) C=DK + 5 / 7" / / = B=2K 05 / +0 </ / J ) 4 > += 2L=C / A ) C > + ) 24=LK / L ) D > + = + ;0 AD=CK + 0F + / / +0 </ / + / / 5 * 0) / ;0 / </ / / + ( 0 </= + (8/ + < = + / + / 9 * + ) + ;0 / / +< + ;0 / / + / / =4K / J ) 4 > + 7? ;0 + / L=AK + / 9 * + / / / + / 2A

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

31 :9. >9 :9. >9 =< < 9 F / = /+5 + = / G = / " =<6< ) 0 * </ + 0 / < 0F + + / + / 4 ) D > += ( + / + / / + / + / 0 ;0 ( + </= ;0 0 / /+ 0 / / +0 / / + / / * / / * ;0 + / 5 0/ / / + / / ( + 2JJ3 * 2JJ4" 0 E / + + (0 / + +! # $% %!. " + / + + / + / + / + / 4 ) D > +" 2" + / / + / + 6 G/ / 7" 2C

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

34 ! " #$ % %&$ ' ( ' # # % ) $% & '$% & %# # % $ % # %! *+ $ ', % % - % E + /: + + / 0/ + ( + G+ \( ;0 + + / E / + (0 / +;0 " G, # $% K#$ $ %# H%# $ "- / + 5 / /9 </ # % / + ( + / + + / + 6 / - ( 7 / + </ G+ + / ) / / + / /9 </ # % + </ </ </ 0 * / / /. - 0 ) = /: </ / * + / /( / ) 0 / 9 / + </ / + + * ( / + / /9 </" 2"- / ( </ /: /9 </ # %= + / / 8 += ;0 9 / + </ / + / E / * </"" + </ 8 ) / [-5 * + / + 0 :/ 9 / * / 0/ + ( + / + + / + / ( + + </ ( + </ ++ / = / /9 </ + % + 0/ / ( /9 ; / /. + % ) </ F 7 + * * ;0 / / + + / / 0/ / 5 0 = / ;0 G / / 5 / " 3" - / + 5 / + </ </ %+ ( / ( + / + + / + / /9 </ 5 / 3J

35 :9. 9 :9. 9?< < /8 + / + ( + / + ; / / +0 + / / JL4= ) / 3B E / + / 4 > += 5 0 / /+09 / /( = 9 (0/ G/ - <(. * * 5 0/ / -. + %= ;0 / + /: + + J4L ( + / + / + / 4 ) D > + ) / 0/ B"A > + / + G+ + :+ / / / ;0 3"3K / B > + / + ) BL"CK ) B > +? +G + = CJ"3K / < / ) 2D"CK 90? / + + B"K / (8/ / + 5 ) 23"BK / / / (0/ + B / +? 3J"K + / N0 / 0 ( /. = AD"4K / F = L4"JK / 0 </ + 0/ = ( / ) G 6 LA"4K7 + + ; * ) (0 ) 27" 9) L< < 9 :

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37 :9. 9 "# $! 9 /. + ) *+ + + / + + * 05 / + + (0 / ! 24K / ;0 / + + > + = BD"3K </ / A ) B > += ) / B"JK / > += BB"4K 05 / + 0/ = BA"CK 05 / +. F 5 5 = 0/ 3"4K / + 0/ * ) 0/ 3K 0/ * / 0 = C"4K 90 5 *0+ 5 = ) 2"AK / 9 + < ;0 * E *0+ ) D"LK 9. * / / + + / + / = 0/ 4"3K. * / 2 F + ) + + F + 4"3K? + / * ( = 0 / + / (< + * /8 / + + B"4K F 2 ) A"4K F. * / 3 < :+ / +" / </ + (0 = B"AK 9 ;0 +0 F /0/ 0+ / </= 2C"DK 0+ / = D"BK / * _" 2 ) (0 + 3 ) 47" 9) L 6< 9 : 9 ) 9>9 33

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

39 :9. 9 G % # &$ H % 2 %# # % $ #, 0/ * B4A J B"3K =JK %# $!&! '# $!&! / * 3 + /+ (/ / / + * / / + /9. : / ( + / +0 F = +G ( /9 </ %? / + + / DL"2K= DL"AK= DD"DK= DD"DK 9 < /. * / = %? +G + = CD"AK F ;0 +0 F 0 /. /. +? 0/ 2J"4K / + *? / + = 9 ;0 AC"JK /. / = 0/ 42"LK / + *? / + / 0/ / + / </ / / F + / +. / / 3A

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42 ! " #$ % %&$ ' ( ' # # % ) $% & '$% & %# # % $ % # %! *+ $ ', % % - % G % # &$ H % 2 %# # % $ #, / </ / + / ;0 / 5 5 /. / /. +. E / / F * +S/ +S/ * +S/ 2JB L3L 4 JJ D=CK LJ=JK J=4K DB=4K 2C J4B 2=BK =JK DD=LK J=K J=K DCA 2C 4B D3=JK 2=BK 4=4K (# ) * +,! -. + / 3L

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47 :9. 9 G % # &$ H % # 4 $ 'M $ G & # $ $% # $ + + / + 0( / / + / + 5 /+ 0 </ /+ 0 </ / / /< / </ * /( + /+0 B > + / + :+ B > / / / + / / / / F / /+ 0 </ 0/ 0 0/ / / / = BC=D 2L=B C=4 BL=2 3=L B=2 L3=L AD=A 4J=A 3C=L B2=2 J=JB. J=J. J=J. 4J=3 AD=C J=2 3=L L3=D 2= 3=L L3=D B 4L=B A=4 3=32 +. J=223. J=223. /" " /" " < F < * + * F / ) F ) 9 + < +0 + (0/ / </ * U G/ ^ G/ 32 B= 2=C A=D 34=A 4 3=3 LB= 3=D 2J=4 CD=B 2D=C J=L J=L J=L 2=B A=4 A=4 C3 2C 2C C3 J=J2B. J=32B. 2=B CL=4 2=B CL=4 A=4 43

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51 :9. 9 # H%# % # &$ H % 'M $ G $ & # $ $% # $ + / </ 5 + :+ 0/ :+ 0/ 5 E C=D B2=B 3C=4 L= 4L=B A=4 J=JLA. 9) B< < 9 : 9 9 D ) 9 9 4C

52 ! " #$ % %&$ ' ( ' # # % ) $% & '$% & %# # % $ % # %! *+ $ ', % % - % G % / ; / + # &$ H % O & %# # % # M $ $ % # % $% # $ / (0 / 2 ) 3 ) 3 / + /(0/ / + /(0/ 8 * + / + /(0/ 8. F / + /(0/ * + / 0 + / + / + /(0/ " "" / (0 4 / A ) B ) B *0+ 5 0:/ + 5 += + 05 *0+ / + /(0/ * E 0 0 *0+ "" / + / 8 F + + :+ + / 0)" F + 0 4L E N 2A2 ` 5 / K L 3"C J"CA G G /9" 0 " J"34 "BB A4B 23 4"2 "CB J"C2 4"2B 2AJ BDB B 2"4J 2C 3"LL "3C J"BC 2"CD 3A2 A J 2"L4 B"BC "D J"2L 3"JB J33 4J 3B 3"4L C A"JJ "A J"BL 3"3L DJL BLL 3J 3"3J 2C 3"D2 "4 J"BD 2"LD 3BJ 3 J 2"CL 3 D"BL 2"LD J"D4 L"D2 JC 22C 34 3"34 B 2"B4 J"L3 J"33 2"JA AB2 L 3"2J J"B4 J"32 "2L 2AD CL 3 A"J2 2 2"AB J"C J"C 2"DJ DCJ CL 3A 3"B 2 2"AB J"C J"C 2"DJ DCJ 2B 3A 3"B J J"JJ J"JJ J22 2JL 3C 3"B2 J 4"L "AJ J"C4 3"J4 L4J 4A 2C 3"2 2 4"44 J"C4 J"C 3"3

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65 : / / / + </ / /(0/ + 5 * + ( 0 / 0 ( + / / + :+ F + / + += *0+ 5 = 0+ / : + + (0 0+ / </= / +( /9 </ # %" (0 / = + 5 * *+ /8 * E + * += / + / + </ + G+ / + (/ 9 5 " / / E * + / + / / + /9. :. * / 6 UJ=J27 ) :+ / + / </ / +( /9 </ ). * 5 5 / UJ=JJ7" / + * / / / / + += / / / /F + 6A= B= A= B= J27? (0 / + + * < 0/ </ + (/ 9 5 / / /. + 6 UJ=JC47= 0/;0 + + </ / / / 0/ + / G9 = + / + * * ;0 ;0 / 9 / /. + =. ) + /. + %= ) ;0 / /0 + G+= / / G/ +. (/<+ + <( = 0. :+ 0 / + / > += : / </ ; / > + + /? * / / + ( 0 5 * + + / E< +( 5 + E</ 5 / ) + + < ;0 + +( + * / / " / 0/ / < + + * F ;0 / 0 F + 0/ 9 +( ) ;0 E:+ :+ / / + ( 0 = * ) / + (0 = / E + / 5 0 / + 9 / + 5 * + / + / 0 ( / ) F * ( + / + /? / / + 0/ + </ / + 5 * + 0F ( = / F =. + / : =. + = ( </ ) 9 0 / + 0 +" 0 + * + ;0 0 / + /G + : ( + /+ * +( ) + / /G / /(0/ * F +( = +( / + + * G / + / 0/ + 9 +" * / + 5 / / + ( 0 + +( 90 B"2K 9 / * F +( ;0 /E< 2"ALK= 0 / + / * F +(. *G 0/ +( 5 2"3CK ; (/ 9 5 = /+ (0 / / + F / / / +( / /9 </" +. E( = /9 + / 0/ ( / = ) G 5 E 0 / ( F G + 0/ 9 / / + 0 ( + /? + ;0 ;0 +( /9 </ + / / / / + / + / * / + :+ F += + / ;0 + /9 </ + G 0 / 0/ + F ;0 + /+ +( " +. E( + / G + /5 + ( </ / / (G + /9 / + + / + ) 0 + F<5 / + ) ;0 / G = /+ / + * ;0 + 9 ;0 / 0 F05 / 0 = + / / 9 / : + (0 ) + /0 </ / + <@ += + 5 / </ 5? + = 5 0/ </ * ( + + B

66 ! " #$ % %&$ ' ( ' # # % ) $% & '$% & %# # % $ % # %! *+ $ ', % % - % / > + / + 0 J > += /+ / ;0 + / (0/ + ( / + /0 + G+ + / 5 = + * / / > / " <6< " /9 </ % / /+ 0 / / 0/ / / / + ( + / + + / + CB"3K / 5 / + %+ ( ) L=4AK / 5 / /9 </ / / / + C > + / +" 2" LB=J K + ( + / + /G / 0 </ + 0/ +0 = ;0 / / ;0 + 0/ G 0 </ / + ( + /0 + G+ + (0 0 + / + BK F + + ( + / + /. / 0+ / </" 3" (0/ ( / + /9 </ # %=. * 5 5 / + 5 = / / + ) / / +. + / F = 90 / * + / + / /5 + ( </" 4" *+ 5< + 0/ </ + 5 / / / /9 </. + % ) /8 F + )S / + += 0/;0 + / 90 + (/ / G+ " (# / / + ( + +( = / + :+ 9 += 0/ ) +( /9 </. + / + ;0 / / / / /(8/ 9 +( " <=< "- / + + ( + / + + / + * / + + / + / /9 </ % / ) 9 / ( + </" 2"- * / 9 E 0 </ / + ( > = / / / 0 / ;0 / / / + / / " 3"- + * : * / 0 + F<5 / += 0/ + (0 ) 0/ 0 </ :+ / / + <@ +=. / 0/ > 5 / </ / </7 /. + % / + + J > + " B2

67 ) ) 2 : ) ) 2 : Zuckerman JN, Zuckerman AJ (999) The epidemiology of hepatitis b. Clin Liver Dis;3:79-87 Favero MS. Gerba CP Summary of Workshop 2. Environmental aspects of viral hepatitis transmission. In: Szmuness W, Alter HJ, Maynard JF, editors, Viral hepatitis, International Symposium, 98 Philadelphia: Franklin Institute Press, 982: Favero MS., Maynard JF, Leger RT, Graham DR, Dixon RE( 979)Guidelines for the care of patients hospitalized with viral hepatitis. Ann Intern Med ; 9: Fiaccadori F, Bertoletti A, Penna A, Ferrari C.(992) The immunopathogenesis of hepatits B. Ann Ital Med Int ; 7: Vildósola H, Farfán G, Colán E, y col. (990). Prevalencia del antígeno de superficie del virus de la hepatitis B en población de la costa, sierra y selva del Perú. Reporte Preliminar. Rev. Gastroent. Perú 0: Méndez M, Arce M, Krüger H y col. (989). Prevalencia de marcadores de hepatitis viral en diversos grupos de población del Perú. Bol Of Sanit Panam 06: Jenison SA, Lemon SM, Baker LN, et al. Quantitative analysis of hepatis B virus in saliva and semen of chronically infected homosexual men. J Infect Dis 987; 56: Darani M, Gerber M Hepatitis B antigen in vaginal secretions. Lancet 974; 2:008. Franklyn N. Judson, MD Epidemiology of Sexually Transmitted Hepatitis B Infections in B3

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