Exploratory Systematic Review Research Articles

Use of Disinfectants and Cleaning Products Associated with Respiratory Disease: A Scoping Review

Introduction: there is extensive evidence on the harmful respiratory effects of exposure to disinfectants and cleaning products. Methodology: an exploratory systematic review was carried out in five databases: LILACS, PubMed, MEDLINE and BIREME. Twenty articles from 2013 to 2024 were selected for the present review. Results: chemical compounds present in some disinfectants and cleaning products such as Polyhexamethylene guanidine (PHMG) and Chloromethylisothiazolinone/Methylisothiazolinone (CMIT/MIT) influence the development of Humidifier Respiratory Distress Syndrome (HDRS) and increased incidence of asthma and Chronic Obstructive Pulmonary Disease (COPD) in adults. Conclusions: There is a relationship between exposure to chemical compounds in certain disinfectants and lung health impairment. It is imperative to increase the general population’s awareness of the effects of these substances will lead to improved self-care in those who are in daily contact with these elements.

Forging a green future: Synergizing industry 4.0 technologies and circular economy tactics to achieve net-zero in sustainable supply chains

Industry 4.0 (I4.0) and Circular Economy (CE) are emerging in academic, managerial, and policy debates, leading to integrating sustainable supply chain and net zero paradigms as an important phenomenon for maintaining competitive advantages in business. Although CE and I4.0 have significant benefits, their integration is largely untapped, representing a significant opportunity to integrate technological advancements with sustainable practices. Hence, this study investigates how CE and I4.0 can be integrated to achieve net zero in a knowledge-based sustainable supply chain. As part of this objective, the paper conducts an exploratory systematic review of selected articles published in peer-reviewed journals. Three main categories are identified from the selected articles: (i) CE principles and I4.0 technologies integration, (ii) the role of CE-I4.0 nexus in a sustainable supply chain (iii) leveraging CE-4.0 integration for net zero sustainable supply chains. We propose a multi-perspective framework to analyze the net zero sustainable supply chain implementation level using I4.0, CE, and stakeholders’ perspectives. A recommendation from this study suggests increased attention from sustainable supply chain stakeholders on developing infrastructure, including knowledge-building development and training processes focused on net zero. By utilizing our improved knowledge of I4.0 and CE, the results of the study will help researchers, businesses, and policymakers to develop an effective and integrated strategic approach to foster a net zero sustainable supply chain.

Detection of diabetic retinopathy using artificial intelligence: an exploratory systematic review

Diabetic retinopathy is a disease that can lead to vision loss and blindness in people with diabetes, so its early detection is important to prevent ocular complications. The aim of this study was to analyze the usefulness of artificial intelligence in the detection of diabetic retinopathy. For this purpose, an exploratory systematic review was performed, collecting 77 empirical articles from the Scopus, IEEE, ACM, SciELO and NIH databases. The results indicate that the most commonly used factors for the detection of diabetic retinopathy include changes in retinal vascularization, macular edema and microaneurysms. Among the most commonly applied algorithms for early detection are ResNet 101, CNN and IDx-DR. In addition, some artificial intelligence models are reported to have an accuracy ranging from 90% to 95%, although models with accuracies below 80% have also been identified. It is concluded that artificial intelligence, and in particular deep learning, has been shown to be effective in the early detection of diabetic retinopathy, facilitating timely treatment and improving clinical outcomes. However, ethical and legal concerns arise, such as privacy and security of patient data, liability in case of diagnostic errors, algorithmic bias, informed consent, and transparency in the use of artificial intelligence.

Use of artificial intelligence in the detection of coffee rust: An exploratory systematic review

Coffee rust, caused by the fungus Hemileia vastatrix, is a fungal disease that affects coffee production and quality, so its early detection is crucial to prevent massive outbreaks and protect production. This article analyzes the most effective factors, the algorithms used, the accuracy of the models, and the challenges in the detection of coffee rust, through an exploratory systematic review of 35 empirical articles obtained from Scopus, IEEE Xplore and SciELO. The review identifies that the most determinant factors for detection include humidity, temperature and the presence of shade. The most commonly used algorithms are Convolutional Neural Networks (CNN), Support Vector Machines (SVM) and Random Forest, highlighting CNN for its ability to process and analyze images with an accuracy of 99.57%, followed by Artificial Neural Networks (ANN) with 98% and SVM with 96%. However, it is concluded that challenges remain such as the need for high quality labeled datasets, variability in environmental conditions and implementation costs. This study provides a comprehensive overview of recent advances and areas for improvement in coffee rust detection, providing information for researchers, practitioners and decision makers in the agricultural sector.

Resorbable Osteosynthesis in Mandibular Fractures. An Exploratory Systematic Review

Mandibular fractures have a high prevalence in the maxillofacial region, often requiring surgical intervention. The gold standard for treatment involves open reduction with osteosynthesis using titanium plates. New biocompatible materials have been applied to address the complications and disadvantages of titanium plates, leading to the emergence of absorbable osteosynthesis plates. Understanding the effectiveness of titanium plates and absorbable osteosynthesis plates in the treatment of mandibular fractures helps determine the need to invest in new techniques with predictable outcomes. To describe the effectiveness of using titanium plates and absorbable osteosynthesis plates in the treatment of mandibular fractures. In August 2023, an exploratory systematic review of the available literature since 2018 on the use of absorbable osteosynthesis plates in mandibular fractures was conducted. PubMed, Scopus, and WOS were searched, including studies in English or Spanish. A total of 227 articles were obtained. After reviewing titles and abstracts, 29 articles were included for full-text reading. Nine duplicates were discarded, and 10 were excluded based on predefined criteria, resulting in a total of 10 articles for this study. Authors report that titanium plates exhibit less displacement of the contact surface in fractured segments due to a larger surface area, rigidity, and load-bearing capacity. Absorbable osteosynthesis plates are more flexible but are susceptible to greater deformation under significant masticatory forces, potentially leading to fracture opening and displacement of bone segments. Postoperative complications were analyzed, and no statistically significant differences were found. Titanium and absorbable devices did not differ in terms of biomechanical behavior and postoperative complications in the treatment of mandibular fractures. Further studies comparing both types of plates in mandibular fractures are needed.

Presence of integrons and their correlation with multidrug resistance in Salmonella enterica serovar Typhimurium: Exploratory systematic review

In Salmonella enterica serovar Typhimurium (Typhimurium), multidrug resistance is associated with integrons carrying resistance genes dispersed by mobile genetic elements. This exploratory systematic review sought to identify integron types and their resistance genes in multidrug resistance Typhimurium isolates. We used Medline, PubMed, SciELO, ScienceDirect, Redalyc, and Google Scholar as motor searchers for articles in Spanish or English published between 2012 and 2020, including the keywords “integrons”, “antibiotic resistance”, and “Salmonella Typhimurium”. We included 38 articles reporting multidrug resistance up to five antibiotic families. Class 1 integrons with aadA2 and blaPSE-1 gene cassettes were predominant, some probably related to the Salmonella genomic island 1. We did not find studies detailing class 1 and 2 integrons in the same isolate, nor class 3 integrons reported. The presence of integrons largely explains the resistance profiles found in isolates from different sources in 15 countries.

Analysis of innovation drivers with a mapping innovation approach

Objective of the study: This study aims to identify and analyze the drivers of innovation in Ecuador. Methodology/Approach: The significance of innovation drivers was investigated through an exploratory systematic review using a mapping innovation approach. Statistical methods were used to apply an empirical analysis based on the Ecuadorian survey on Science, Technology, and Innovation Activities (released 2017). Originality/Relevance: As far as we are aware, this is the first study to investigate the drivers of innovation from a comprehensive approach of mapping innovation in Ecuador. Main results: The management of innovation drivers in Ecuador often presents issues for 98% of non-innovative companies. The most relevant innovation driver in Ecuadorian companies is cooperation with external sources where partner geolocations worldwide play a significant role. Theoretical/ Methodological Contribution: This study extends the framework of innovation drivers. The strengths and limitations of Ecuadorian innovation were identified from four perspectives of innovation drivers: internal innovation drivers, external innovation drivers, knowledge for innovation development, and investment in innovation. Social/Management Contribution: This study contributes to the understanding of innovation drivers in developing countries.

The role of smart technologies in managing supply chain post pandemic: an exploratory scientific procedures and rationales for systematic literature review

Purpose The COVID-19 pandemic has brought unprecedented disruptions to global supply chains, compelling organizations to reevaluate their strategies for resilience and adaptability. In response, smart technologies (ST) have emerged as integral tools in post-pandemic supply chain management (SCM). This study aims to conduct an exploratory systematic literature review to comprehensively examine the evolving landscape of smart technology adoption in the context of SCM post-pandemic. Design/methodology/approach A systematic literature review has been conducted to examine the potential research contribution or directions in the field of ST and SCM. In total, 240 articles were shortlisted from the SCOPUS database in the chosen field of research. Bibliometric analysis was conducted by using VOSviewer to investigate the research trends in the area of SCM. Findings The review identifies key themes and trends, including supply chain resilience, digital transformation, enhanced visibility, predictive analytics and sustainability considerations. It explores the role of ST in fostering agility, transparency and risk mitigation within supply chains. Furthermore, eight clusters were identified to generate several thematic topics of ST in SCM. The results have evidenced a strong gap related to Industry 5.0 approaches for the supply chain field. A total of 240 publications, including journal articles, have been found in the literature. A total of 37 words, which were grouped in 8 clusters, have been identified in the data analysis. Research limitations/implications By synthesizing the current state of literature, this study provides valuable insights for practitioners, policymakers and researchers seeking to navigate the complexities of post-pandemic SCM in an increasingly digitized and interconnected world. The findings highlight the transformative potential of ST and offer a roadmap for further exploration in this critical domain. Originality/value In this paper, the development path of the field of ST in SCM during the pandemic and the research constructs are presented and potential research directions are based on the bibliometric method.

Physiological and Performance Adaptations to Interval Training in Endurance-Trained Cyclists: An Exploratory Systematic Review and Meta-Analysis

Background: In endurance cycling, both high-intensity interval training (HIIT) and sprint interval training (SIT) have become popular training modalities due to their ability to elicit improvements in performance. Studies have attempted to ascertain which form of interval training might be more beneficial for maximising cycling performance as well as a range of physiological parameters, but an amalgamation of results which explores the influence of different interval training programming variables in trained cyclists has not yet been conducted.
 Objective: The aims of this study were to: (1) systematically investigate training interventions to determine which training modality, HIIT, SIT or low- to moderate-intensity continuous training (LIT/MICT), leads to greater physiological and performance adaptations in trained cyclists; and (2) determine the moderating effects of interval work-bout duration and intervention length on the overall HIIT/SIT programme.
 Data Sources: Electronic database searches were conducted using SPORTDiscus and PubMed.
 Study Selection: Inclusion criteria were: (1) at least recreationally-trained cyclists aged 18–49 years (maximum/peak oxygen uptake [V̇O2max/V̇O2peak] ≥45 mL·kg-1·min-1); (2) training interventions that included a HIIT or SIT group and a control group (or two interval training groups for direct comparisons); (3) minimum intervention length of 2 weeks; (4) interventions that consisted of 2–3 weekly interval training sessions­.
 Results: Interval training leads to small improvements in all outcome measures combined (overall main effects model, SMD: 0.33 [95%CI = 0.06 to 0.60]) when compared to LIT/MICT in trained cyclists. At the individual level, point estimates favouring HIIT/SIT were negligible (Wingate model: 0.01 [95%CI = -3.56 to 3.57]), trivial (relative V̇O2max/V̇O2peak: 0.10 [95%CI = -0.34 to 0.54]), small (absolute V̇O2max/V̇O2peak: 0.28 [95%CI = 0.15 to 0.40], absolute maximum aerobic power/peak power output: 0.38 [95%CI = 0.15 to 0.61], relative absolute maximum aerobic power/peak power output: 0.43 [95%CI = -0.09 to 0.95], physiological thresholds: 0.46 [95%CI = -0.24 to 1.17]), and large (time-trial/time-to-exhaustion: 0.96 [95%CI = -0.81 to 2.73]) improvements in physiological/performance variables compared to controls, with very imprecise interval estimates for most outcomes. In addition, intervention length did not contribute significantly to the improvements in outcome measures in this population, as the effect estimate was only trivial (βDuration: 0.04 [ 95%CI = -0.07 to 0.15]). Finally, the network meta-analysis did not reveal a clear superior effect of any HIIT/SIT types when directly comparing interval training differing in interval work-bout duration.
 Conclusion: The results of the meta-analysis indicate that both HIIT and SIT are effective training modalities to elicit physiological adaptations and performance improvements in trained cyclists. Our analyses highlight that the optimisation of interval training prescription in trained cyclists cannot be solely explained by interval type or interval work-bout duration and an individualised approach that takes into account the training/competitive needs of the athlete is warranted.

Stigma and fear of getting sick in the care of people living with HIV: an exploratory systematic review.

The aim of the present study was to explore the stigma and fear of getting sick in health professionals who treat people living with HIV. An exploratory systematic review was conducted. The search was limited to the presence of stigma and fear of getting sick on the part of healthcare workers who treat people living with HIV, documented by the health workers or patients themselves. No language restriction was made and systematic reviews, comments or communications were excluded. The sources of information were Scopus, PubMed/MEDLINE, Science Direct, and the CENTRAL Registry, from the last 5 years. The quality of the evidence was assessed with an adapted tool and the synthesis of the results was carried out using a narrative synthesis approach. Twenty-three articles were included, which related structural stigma, stigma by health professionals and fear of getting sick. Among the findings, data stood out such as that more than 50% of patients reported having experienced discrimination due to HIV and even accumulated stigma for other additional causes. Stigma enacted in healthcare settings was related to suboptimal adherence to treatment (OR 1.38; 95% CI: 1.03-1.84; p=0.028). Stigma is a structural barrier in the care of people living with HIV and generates a psychological, physical, and social health impact for these people. Some limitations of the present study are that, despite searching the major databases, important manuscripts may have been left out. Additionally, there are regions that are not represented in this review because no manuscripts from those areas were found.

Health conditions in land transport workers and climate change. Exploratory systematic review.

A systematic exploratory review was carried out to describe the influence of climate change on the health conditions of land transport drivers, both physical and mental. Additionally, actions for the prevention of these complications are described. For the review, several databases, such as Science Direct, MEDLINE, Springer, PubMed, Redalyc, EBSCO, SciELO, and Scopus, were examined. There was the need to extend the search timeframe from 5 years to 10 years. The studies found consisted mainly of review articles, showing an emphasis on public health and a high frequency of possible physical effects on the cardiovascular and respiratory systems. At the mental level, the presence of cases of anxiety, depression and stress were mentioned. As for alternatives for the prevention of these effects, the importance of creating public policies for health promotion and disease prevention was highlighted. It is important to increase scientific production in the field of occupational safety and health and applied studies.

Asociación entre hiperglucemia y complicaciones post-exodoncia en pacientes con Diabetes Mellitus tipo II: Scoping Review

Introduction: Diabetes mellitus (DM) is a prevalent chronic metabolic disorder worldwide, with Type II DM (T2DM) emerging as the most widespread variant. In Chile, approximately 11% of adults aged 20 to 79 suffer from this condition. Given its high prevalence, dental surgeons should be trained to evaluate risk factors, particularly the potential complications linked to tooth extraction in individuals with T2DM. Objetive: To describe the available scientific evidence on post-exodontia complications associated with hyperglycemia in patients with Type II diabetes mellitus. Materials and Methods: An exploratory systematic review was conducted following the PRISMA-ScR extension protocols using the databases PubMed, EBSCO, Scopus and the Cochrane Library. The search employed the following algorithms: ((“Diabetic patient complications” AND “Dental extractions”)), ((“Diabetes” AND “tooth extraction”)), ((“Glycemia” AND “Tooth extraction complications”), ((“Blood glucose” AND “Tooth extractions”), ((“Dental extraction sockets” AND “Diabetics”). Results: Out of a total of 973 articles, 25 were included for this review. Six relevance criteria were considered, revealing safety parameters for conducting extractions in patients with T2DM, with capillary blood glucose levels not exceeding 200 mg/dL for elective extractions and 240 mg/dL for emergency extractions. Conclusions: There is limited evidence correlating threshold values of hyperglycemia with post-extraction complications in patients with T2DM. Most authors agree that the primary concern is not T2DM itself, but hyperglycemia. Furthermore, there is minimal consistency in the recommended care protocols for these patients.

Didactic strategies to enhance meaningful learning in higher education

Currently, the majority of teachers strive to innovate various teaching-learning techniques in order to provide better learning opportunities to their students. For this reason, teachers must refine these skills so that students "learn how to learn." Teachers must adapt to different learning styles to meet the needs of students, generating meaningful learning and improving academic performance. With this in mind, the objective of the study was to analyze the didactic strategies that promote meaningful learning in higher education. To achieve this, an exploratory systematic review was conducted using the PRISMA methodology, utilizing Google Scholar, ScienceDirect, and Epistemonikos as sources of information for works published from 2019 to 2023. From this analysis, a connection was found between communication and information technologies in didactic strategies used to promote and/or generate meaningful learning, and sets of strategies focused on individualizing teaching. It is concluded that didactic strategies contribute to the development of activities in higher education, as they foster and improve learning through student experience via didactics focused on individualized teaching, which assist in group teaching centered on information presentation and collaborative work through schemes, concept maps, summaries, questions, analogies, feedback, glossaries, semantic networks, etc

Software quality models: Exploratory review

INTRODUCTION: The emerging industrialization of software promotes the continuous development of new evaluation models that adapt to the product's characteristics and the organizations' needs. OBJECTIVES: This article aims to identify the software quality models proposed between 2016 and 2020. METHODS: We conducted an exploratory systematic review in the SciELO, IEEE Xplore, and Scopus databases, resulting in 14 research papers proposing new models for assessing software quality. RESULTS: 79% of the research papers were extracted from IEEE Xplore, and 50% of them were authored by individuals affiliated with European institutions. We presented various software quality models focused on assessing both product quality and usability for specific purposes. Additionally, we reported that the proposed models are based on common software quality metrics standards such as CMMI, ISO/IEC 9126, and others. CONCLUSION: The review serves to update the state of the art regarding the software quality models proposed in recent years, which will be valuable for researchers and software developers when seeking evaluation models that align with their specific needs.

A systematic review and meta-analysis of the SIRT1 response to exercise

Sirtuin 1 (SIRT1) is a key physiological regulator of metabolism and a target of therapeutic interventions for cardiometabolic and ageing-related disorders. Determining the factors and possible mechanisms of acute and adaptive SIRT1 response to exercise is essential for optimising exercise interventions aligned to the prevention and onset of disease. Exercise-induced SIRT1 upregulation has been reported in animals, but, to date, data in humans have been inconsistent. This exploratory systematic review and meta-analysis aims to assess various exercise interventions measuring SIRT1 in healthy participants. A total of 34 studies were included in the meta-analysis (13 single bout exercise, 21 training interventions). Studies were grouped according to tissue sample type (blood, muscle), biomarkers (gene expression, protein content, enzyme level, enzyme activity), and exercise protocols. A single bout of high-intensity or fasted exercise per se increases skeletal muscle SIRT1 gene expression as measured by qPCR or RT-PCR, while repeated resistance training alone increases blood SIRT1 levels measured by ELISA. A limited number of studies also show a propensity for an increase in muscle SIRT1 activity as measured by fluorometric or sirtuin activity assay. In conclusion, exercise acutely upregulates muscle SIRT1 gene expression and chronically increases SIRT1 blood enzyme levels.

Reported prevalence of dental caries in Mexican children and teenagers

Dental caries is a serious multifactorial oral disease that causes demineralization of the tooth's hard tissues and affects more than half of the world's population. The objective of this exploratory systematic review was to determine the prevalence of dental caries in Mexican children and adolescents, as well as related factors such as sex, nutritional status, type of dentition, education, living conditions, socioeconomic level, and the type of demographic area. The eligibility criteria to be considered were observational studies whose sample included Mexicans 0-15 years of age in which the prevalence or an index of dental caries had been evaluated. Eligible studies were identified through the search carried out in 6 databases and manual search, without publication time restriction. Fifty-four studies were found that met the eligibility criteria. In these included studies it was observed that, in the last decades, the prevalence of caries in Mexican children and adolescents exhibits a tendency to decrease this disease. In the 1980s, caries prevalences of up to 92.8% were reported; between 1990-1999, the highest reported prevalence was 97%; from 2000-2009, the highest reported prevalence was 95%; from 2010 to 2019 the highest prevalence was 94.6%; and from 2020 and 2021, prevalences of up to 88.5% were reported. Although there has been a decrease in the prevalence of caries in Mexican children, this disease continues to be linked to biological, behavioral and socioeconomic determinants.

Exploratory systematic review and meta-analysis on period poverty

Exploratory systematic review and meta-analysis on period poverty

THE USE OF INERTIAL DEVICES IN WHEELCHAIR BASKETBALL: EXPLORATORY SYSTEMATIC REVIEW

The aim of the study was to conduct an exploratory systematic review related to Wheelchair Basketball, and the use of inertial devices as a novel tool to quantify internal and external load during training sessions and matches. For the search of scientific manuscripts, the following keywords were used, in English: “Basketball”, “Wheelchair” and “Inertial device”; and, in Spanish: “Baloncesto”, “Silla de ruedas” and “Dispositivo inercial”. The databases used were Web of Science and Google Scholar. Also, to limit the search, a series of document inclusion and exclusion criteria were established, to collect the most appropriate manuscripts for the subject under study. Twelve scientific papers were selected, which were classified according to the variables predetermined by the researchers. The largest number of publications related to the subject is produced in 2019, and they are mainly Quantitative empirical studies. Therefore, it is interesting to increase scientific knowledge in the WB.

A systematic literature review of the longitudinal risk factors associated with juvenile cyber-deviance

Cyber-deviance has been studied extensively over the past two decades, though owing to the elusive nature of cyberspace and the anonymity it affords its users, research has yet to paint a clear picture of the risk factors that predict online deviance. Early identification of these factors is critical to the development of effective crime prevention strategies. To date, a comprehensive review of the longitudinal risk factors associated with juvenile cyber-deviance, in all its forms, has yet to be examined. This study aims to address this research gap by conducting an exploratory systematic literature review appraising current knowledge on the risk factors associated with juvenile cyber-deviance. Various databases were systematically searched for relevant English-language journal articles comprising longitudinal studies on young people aged 12–17 years. Eligible studies included an outcome measure of any distinct form of deviance perpetrated using digital devices and/or the Internet, potential risk and/or protective factors, and quantitative analyses. This search yielded 26,926 studies, of which 38 met the inclusion criteria. Most of the studies found examined the longitudinal risk factors associated with cyberbullying, followed by studies on sexting, cyber dating abuse, and general cyber-delinquency. Results indicated several longitudinal factors were consistently associated with cyber-deviance (e.g., gender, physical bullying, low self-control, child-rearing, parental attachment, and deviant peers). Physical bullying had the most consistent and pronounced association with cyber-deviance. Most studies had a relatively sound methodological quality; however, the small number of studies and their concentration on cyberbullying requires that the findings be interpreted with caution. Additional high-quality research is needed examining the longitudinal risk factors associated with all types of cyber-deviance to identify vulnerable young people and prioritise them for intervention prospectively.

Chronic heavy metal intoxication in survivors of improvised explosive devices with embedded fragments and its neoplastic potential. Exploratory systematic review

Introducción: Los artefactos explosivos improvisados son armas no convencionales que pueden provocar múltiples lesiones y dejar esquirlas a modo de cuerpos extraños que pueden contener metales tóxicos, con potencial afectación a la salud de las víctimas según reportes datados desde 1977, los cuales mencionan alta mortalidad por cáncer y otros síntomas compatibles con toxicidad crónica Objetivo: Describir los resultados de investigación que informen sobre la toxicidad crónica producida por metales en personas víctimas de artefactos explosivos improvisados con esquirlas internalizadas, y sus posibles relaciones con cáncer. Metodología: Revisión sistemática exploratoria de literatura publicada y gris que se realizó entre los meses de marzo a mayo de 2021 en diferentes repositorios de tesis y bases de datos (Scielo, Pubmed, Academic Search Complete, JSTOR, Biblioteca Virtual en Salud, Freepdf, Google Académico, Open Grey); sin límite temporal o geográfico. Se incluyeron artículos originales de revistas indexadas o informes finales no publicados, correspondientes a investigaciones científicas con texto completo, en inglés, español y portugués. Resultados: De 56 documentos evaluados, solamente tres cumplieron criterios de inclusión. Todos estaban escritos en idioma inglés. Solo un estudio iraquí abordó población civil y los otros trabajos aludían a veteranos norteamericanos. Los niveles elevados de metales tóxicos, asociados con alteraciones tisulares circunscritas, fueron hallazgos recurrentes. No hubo reportes de patologías instauradas o manejos clínicos. Conclusión: Fue escasa la evidencia científica recabada; sin embargo, sí se han reportado cambios tisulares circundantes a esas esquirlas. Se considera necesario realizar más estudios relacionados con el tema, incluyendo seguimientos a largo plazo de las afectaciones tisulares detectadas.