Trabajos de Titulación - Medicina
URI permanente para esta colecciónhttps://dspace.ucacue.edu.ec/handle/ucacue/23
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Item type: Ítem , Access status: Acceso Abierto , Seguridad y tolerabilidad del nusinersen y onasemnogene como tratamientos para la atrofia muscular espinal: revisión sistemática(Universidad Católica de Cuenca., 2026) Fernandez Taday, Angela Fernanda; Suquinagua Ortiz, Jhon FernandoIntroduction: Spinal muscular atrophy (SMA) is an autosomal recessive disorder caused by a deletion in exon 7 of the SMN1 gene on chromosome 5q13. This alteration leads to a reduction in SMN protein, which is essential for the function of motor neurons. The most affected age group is children, who present clinical features such as asthenia, atrophy, paralysis, and, in severe cases, respiratory failure. For this reason, it is essential to analyze the safety and tolerability of therapies such as nusinersen and onasemnogene in treating this disease. Objective: To compare the safety and tolerability between nusinersen and onasemnogene as treatments for spinal muscular atrophy. Methodology: A systematic review was conducted through searches in databases such as Scopus, PubMed, and ProQuest, using inclusion and exclusion criteria, keywords based on health descriptors, and Boolean operators such as "AND" and "OR." The results will be presented in tables following the PRISMA method, and the methodological quality will be analyzed using the Newcastle-Ottawa Scale. Results: A total of 105 publications were found, of which 18 in English were selected, including clinical trials, systematic reviews, and retrospective observational studies. Conclusions: According to the collected data, nusinersen is safer than onasemnogene, with side effects managed according to each patient's symptomatology. Specifically, tolerability with onasemnogene is greater in patients (infants) with SMA type 1 and in patients with SMA type 2 and 3 (preschoolers and adults) treated with nusinersen.Item type: Ítem , Access status: Acceso Abierto , Conductas adictivas en la infancia y adolescencia: modelos teóricos, evaluación e intervención psicológica(Universidad Católica de Cuenca., 2026) Ochoa Vidal, Jhan PaulCurrently, children and adolescents are constantly at risk of developing various types of addictive behaviors; therefore, a literature review was conducted with the aim of identifying the conditions, theories, assessment methods, and intervention strategies related to these populations. This phenomenon requires an analysis of the underlying causes associated with family structure, social environment, and religious practices in order to identify modifiable risk factors. Addictive behaviors among young people are complex and influenced by various theoretical models, including critical pedagogy, self-efficacy theory, and ecological systems theory. Although internet use provides tools for development and socialization, it may also lead to addiction, particularly among individuals seeking to escape from personal problems. Internet addiction and other addictive behaviors are associated with psychosocial difficulties, social isolation, and mental health comorbidities. Prevention and treatment approaches should be multidisciplinary, incorporating psychological interventions, family-based strategies, and physical activities. The development of effective prevention policies and the need for rigorous clinical trials are essential to address these issues during adolescence.Item type: Ítem , Access status: Embargo , Síndrome de Stevens Johnson, asociado a la enfermedad por COVID-19: reporte de caso(Universidad Católica de Cuenca., 2026) Veloz Ayala , Edgar VinicioProyecto de Titulación embargado para publicación. Estará disponible a la fecha de publicación o de cierre de embargoItem type: Ítem , Access status: Embargo , Estrategias de intervención para la prevención y tratamiento de obesidad infantil en Latinoamérica(Universidad Católica de Cuenca., 2026) Paz Guerrero , Alex EdgarProyecto de Titulación embargado para publicación. Estará disponible a la fecha de publicación o de cierre de embargoItem type: Ítem , Access status: Acceso Abierto , Factores asociados a la conducta alimentaria en preescolares en centros de educación inicial, Cuenca-Ecuador, 2024(Universidad Católica de Cuenca., 2026) Vera Mena , Mayra Daniella; Vidal Carvallo , Diana DoménicaIntroduction: This study covers the factors associated with eating behavior in preschoolers, considering their importance in child development. A child's eating habits in early childhood are influenced by their environment, significantly impacting their long- and short-term health. It was also identified that there is a lack of information in these areas, especially in Latin America, demonstrating the relevance of this research. Objective: To determine the factors associated with eating behavior in preschoolers according to parental testimony in early childhood education centers in Cuenca, Ecuador, 2024. Methodology: The research was quantitative, correlational, and cross-sectional. A total of 196 preschoolers selected from municipal education centers in Cuenca participated. The Child Eating Behavior questionnaire (CEBQ) consisted of 35 questions classified into eight dimensions associated with eating behavior. Data were analyzed using SPSS, applying correlation and chi-square tests. Results: A group of 57.1% of participants were female, with an average age of 3 years. A high prevalence of emotional undereating (92.3%) and craving for alcohol (51%) was observed. No significant associations were found between eating behaviors and sociocultural and environmental factors. Conclusions: Eating behaviors in preschoolers were correlated, suggesting an interconnected pattern. Although no direct associations with environmental factors were found, family diet and caregiver practices are relevant for promoting healthy habits. These results have implications for public health and education to prevent developmental and growth disorders.Item type: Ítem , Access status: Acceso Abierto , Eficacia del anticuerpo Glofitamab como tratamiento de linfoma no Hodgkin. Revisión sistemática(Universidad Católica de Cuenca., 2026) Barreto Tenelanda , Byron Fernando; Atarihuana Valdez , Camila DomenicaIntroduction: Non-Hodgkin Lymphoma (NHL) is a hematological malignancy originating in B or T lymphocytes or natural killer cells. Current studies have evaluated therapy with glofitamab one of the most innovative bispecific monoclonal antibodies in the field of oncology. General objective: To determine the efficacy of the antibody glofitamab as a treatment for NHL. Methodology: A descriptive, systematic review was conducted. Articles from high-impact journals published within the last five years were retrieved from the following databases: PubMed, Scopus, and ProQuest. Search terms were based on DeCS and MeSH. Article selection followed the PRISMA guidelines. Results: Clinical trials demonstrated efficacy results for glofitamab, with an overall response rate of approximately 52% and a progression-free survival rate of 12 to 24 months. In refractory or regressing patients from prior therapies, glofitamab demonstrated favorable activity, with a durable complete response and a predictable, manageable safety profile. However, cytokine release syndrome was identified as the primary adverse effect.Item type: Ítem , Access status: Acceso Abierto , Accidente cerebrovascular hemorrágico secundario a dengue grave: Reporte de caso(Universidad Católica de Cuenca., 2026) Guambaña Vazquez , Bryan RubenIntroduction: Dengue is a viral disease trasmitted by Aedes aegypti, which continues to spread in Latin America and other subtropical and tropical regions, representing a major public health challenge. In its severe form, dengue may trigger rare neurological complications such as hemorrhagic cerebrovascular accident (CVA), possibly due to vascular damage and an exacerbated inflammatory response. This report presents a case that contributes to the medical literature by documenting the relationship between severe dengue and CVA. Clinical Findings: A 34-year-old male patient was admitted with a diagnosis of severe dengue and critical neurological deterioration. The initial evaluation revealed deep coma, anisocoria, and frontal intraparenchymal hemorrhage with midline shift, indicative of a secondary CVA. Diagnosis and Treatment: Following the definitive diagnosis of hemorrhagic CVA due to severe dengue, the patient was admitted to the Intensive Care Unit (ICU), where he received ventilatory support, treatment with hypertonic solution, and continuous monitoring for the management of cerebral edema and hemodynamic instability. Conclusion: The association between severe dengue and CVA poses a significant clinical challenge in endemic areas. This case highlights the importance of implementing preventive strategies in the management of patients with severe dengue, promoting early interventions that may improve prognosis in emergencies.Item type: Ítem , Access status: Acceso Abierto , Angiofibroma nasofaringeo juvenil: Reporte de un caso(Universidad Católica de Cuenca., 2026) Ortiz Atiencia , Katerin SamanthaIntroduction: Juvenile nasopharyngeal angiofibroma is a benign vascular neoplasm primarily affecting young males. It is a rare tumor, representing 0.05% of all head and neck tumors, with an incidence ranging from 1:5.000 to 1:60,000. As a rare neoplasm, conducting a case report on this pathology is important to increase medical knowledge on the subject and expand the information in the database. Case presentation: A 17-year-old male patient reported severe, persistent epistaxis of the left nostril for two days. He subsequently visited a specialist. A physical examination was performed, and after complementary tests, including a CT scan and angio-CT, a diagnosis of juvenile nasopharyngeal angiofibroma was made. The condition was treated with surgical resection. Conclusions: Juvenile nasopharyngeal angiofibroma is a benign but locally aggressive disease with epistaxis and nasal obstruction as its main clinical manifestations. It is diagnosed based on imaging studies. Treatment is complete surgical excision. The prognosis is favorable, although recurrence has been reported in 30% of cases.Item type: Ítem , Access status: Acceso Abierto , Tumor neuroendocrino y cáncer de próstata metacronico. Reporte de caso(Universidad Católica de Cuenca., 2026) Ulloa Delgado, Mateo SebastianIntroduction: This case report describes the coexistence of a neuroendocrine tumor and prostate cancer in a patient, diagnosed at different times (metachronous). Metachronous tumors, in which two types of cancer occur at different times, are rare, and the combination of a neuroendocrine tumor with prostate cancer is unusual. This study analyzes the clinical characteristics, diagnostic challenges, and therapeutic management of both types of cancer, providing valuable information for the treatment and follow-up of similar cases. This case report describes a 43-year-old male patient with a history of prostate cancer who visited a healthcare facility for a follow-up appointment, where a cluster of lymph nodes was identified in the left cervical region. Following diagnostic testing, the patient was diagnosed with: Large Cell Neuroendocrine Carcinoma of unknown primary origin with cervical, mediastinal, pulmonary, and retroperitoneal metastases. A prostatic origin was ruled out by immunohistochemistry. Conclusion: The diagnosis and treatment of these two types of metachronous primary cancers are complex and require a multidisciplinary approach to manage both prostate adenocarcinoma and the neuroendocrine carcinoma. This case highlights the importance of continuous surveillance to diagnose recurrence or a second primary tumor, thereby improving the patient's overall survival and quality of lifeItem type: Ítem , Access status: Acceso Abierto , Polimiositis secundaria a COVID-19: Reporte de Caso(Universidad Católica de Cuenca., 2026) Maldonado Cedillo, Juan SebastiánIntroduction: SARS-CoV-2 continues to be the subject of research in various areas; however, recent studies have shown its ability to trigger autoimmune diseases in genetically susceptible individuals. Polymyositis secondary to COVID-19 is rare and poorly documented in the scientific literature, with only two cases reported in the United States up to 2022. This report presents a case contributing to scientific knowledge about this rare association. Clinical case: A 44-year-old woman who developed symptoms of muscle weakness and myalgias after contracting COVID-19. In the myopathic panel, positive antibodies for Anti-Mi2-alpha and Anti-Jo-1 were identified. The patient was treated with prednisone, leading to complete symptom resolution. Despite medical recommendations, the patient refused to undergo a muscle biopsy or electromyography. The diagnosis of polymyositis secondary to COVID-19 was established based on clinical findings, elevated muscle enzymes, positivity for specific myositis antibodies (MSA), and an adequate response to corticosteroid treatment. Other differential diagnoses were ruled out through a thorough physical examination. Conclusions: This case provides evidence of a rare condition with a complex etiology, highlighting the association between COVID-19 and polymyositis. It contributes to scientific knowledge by providing reference data for future research. Continuous monitoring of patients with persistent muscle weakness following COVID-19 infection is essential, as it may facilitate early diagnosis and improve prognosis.Item type: Ítem , Access status: Acceso Abierto , Ameboma en anastomosis de bypass gástrico: Reporte de Caso(Universidad Católica de Cuenca., 2026) Troya Pérez , Andrea CelesteEntamoeba histolytica is a parasite that infects between 30 and 50 million people and is responsible for around 100,000 deaths annually, predominantly in developing countries where it is endemic. The infection may be asymptomatic; however, in a small percentage, it can cause serious complications, such as ameboma—an inflammatory mass in the colon that presents with symptoms such as fever and abdominal pain and sometimes simulates an intestinal obstruction. Diagnosis requires paraclinical examinations and imaging, followed by treatment with metronidazole. In gastric bypass patients, detection and treatment can be challenging due to underreporting and recurrence. A clinical case is described by a 36-year-old male patient with a history of hypertension, diabetes, obesity, and bariatric surgery, who developed a clinical picture similar to intestinal obstruction after gastric bypass. Studies, including computed tomography, revealed a thickening of the ascending colon caused by an ameboma, diagnosed by pathological analysis in a sample obtained during a right hemicolectomy. Management was surgical due to the incidental finding, supported by the use of antibiotics and nitroimidazoles, resulting in the patient's favorable recovery. This case describes the unusual manifestations of amebiasis in a postsurgical context, providing relevant data on infectious complications in surgical sites—phenomena rarely reported in the medical literature—which creates the need for the development of specific protocols for the management of infections with characteristics similar to the case.Item type: Ítem , Access status: Embargo , Evaluación de la normativa “Establecimientos de la salud Amigos de la Madre y del Niño” aplicada en el Hospital Provincial General Docente de Riobamba, 2024(Universidad Católica de Cuenca., 2026) Benalcázar Borja, Lisbeth Carolina; Jaramillo Leon, Jordan LeonardoProyecto de Titulación embargado para publicación. Estará disponible a la fecha de publicación o de cierre de embargoItem type: Ítem , Access status: Embargo , Rabdomiosarcoma embrionario en adulto joven: reporte de caso(Universidad Católica de Cuenca., 2026) Aray Coellar , Irma RosalíaProyecto de Titulación embargado para publicación. Estará disponible a la fecha de publicación o de cierre de embargoItem type: Ítem , Access status: Acceso Abierto , Necrólisis epidérmica tóxica: Reporte de caso(Universidad Católica de Cuenca., 2026) Sarmiento Amón , Santiago JosuéIntroduction: This case report describes a severe presentation of toxic epidermal necrolysis (TEN) in a 27-year-old female patient, triggered by the use of lamotrigine. TEN is a rare and potentially life-threatening immunological reaction that affects the skin and mucous membranes. This clinical case highlights the importance of recognizing early symptoms and prompt management to improve the prognosis. Clinical manifestations: The patient presented with erythematous lesions that evolved into painful blisters and extensive skin desquamation, as well as ocular involvement with a foreign-body sensation, oral and genital mucosal involvement, and respiratory symptoms requiring intensive care. Diagnosis: The diagnosis was confirmed based on medication history, clinical presentation, and evaluation with the SCORTEN scale, which estimated a mortality of 35.5%. Treatment: Discontinuation of the causative agent, management of complications, and administration of glucocorticoids and intravenous immunoglobulins were included, which progressively improved the skin lesions in conjunction with multidisciplinary management, achieving stabilization of respiratory and hemodynamic function. The patient was discharged after 9 days of hospitalization. This case highlights the need for timely diagnosis and management to prevent severe complications of TEN, emphasizing the effectiveness of the combination of glucocorticoids and immunoglobulins. Conclusion: Early identification of TEN and rapid initiation of immunomodulatory treatment can reduce complications and improve clinical outcomes in severe cases.Item type: Ítem , Access status: Embargo , Mieloma múltiple no secretor: Reporte de caso(Universidad Católica de Cuenca., 2026) Vásquez Astudillo, Renata FabiolaProyecto de Titulación embargado para publicación. Estará disponible a la fecha de publicación o de cierre de embargoItem type: Ítem , Access status: Acceso Abierto , Nefrocalcinosis renal por tuberculosis: Reporte de caso(Universidad Católica de Cuenca., 2026) Romero Pardo, Angie StefanyIntroduction: Nephrocalcinosis is considered rare in clinical practice, and even more so when associated with tuberculosis. It is characterized by the accumulation of calcium in the kidneys, particularly following hematogenous spread of the bacillus. It is usually detected incidentally on imaging studies due to nonspecific symptoms. Treatment must address both the tuberculosis infection and the renal calcifications to prevent complications such as kidney failure. Case Presentation: This is a 56-year-old male patient who presented with nonspecific urinary symptoms, such as pollakiuria, hematuria, and low back pain. The diagnosis was established through laboratory and imaging studies that revealed renal calcifications and lesions consistent with renal tuberculosis. Therapeutic intervention included an antituberculous consolidation-phase regimen and nutritional support, under comprehensive and multidisciplinary management. Conclusion: Through close follow-up and a favorable prognosis focused on controlling recurrences, the patient showed improvement. This case underscores the importance of early diagnosis of extrapulmonary tuberculosis and provides relevant evidence for considering renal tuberculosis in the differential diagnosis of nephrocalcinosis. To prevent serious complications such as kidney failure, early identification and treatment of the condition are essential.Item type: Ítem , Access status: Acceso Abierto , Enfermedad de Erdheim-Chester desafío diagnóstico e implicaciones terapéuticas(Universidad Católica de Cuenca., 2026) Siguencia Lema, Christian GabrielIntroduction: Erdheim–Chester disease (ECD) is a rare disorder of unknown etiology that typically presents between the second and seventh decades of life, with a mean age of onset of 46 years. It is characterized by the abnormal proliferation and infiltration of non-Langerhans cell histiocytes. It can be asymptomatic or present with localized symptoms ―with bone involvement as the main clinical sign―, or lead to systemic complications. Diagnosis is based on clinical, imaging, and histopathological findings that confirm the disease. Currently, treatment for ECD includes FDA-approved BRAF inhibitors. The prognosis for ECD is currently favorable, in part due to the introduction of BRAF inhibitors to the market in 2016. General Objective: To describe the diagnostic methods, various treatment modalities, and prognosis of the Erdheim–Chester disease. Methodology: This is a descriptive, non-experimental literature review. Data were collected through the Elsevier, ScienceDirect, SciELO, and PubMed databases. Inclusion and exclusion criteria were applied, employing keywords such as: Edrheim–Chester disease, diagnostic, treatment, and histiocytes. Finally, Boolean operators, including AND, OR, and NOT, were employed. Results: The literature review revealed that current therapeutic regimens include interferon alpha as the first-line treatment. Likewise, IL-6 receptor antagonists and anti-TNF-α inhibitors are available for treatment. ECD represents a challenge for physicians; however, its identification is essential; therefore, it is crucial to consider three main aspects, including clinicopathological findings, complemented by nonspecific radiological findings.Item type: Ítem , Access status: Acceso Abierto , Enfermedad de Fabry con compromiso renal: reporte de caso(Universidad Católica de Cuenca., 2026) Molina Arizaga, Ana FrancyIntroduction: Fabry disease is a lysosomal genetic disorder characterized by the accumulation of globotriaosylceramide (GL-3) due to a deficiency of the enzyme alpha-galactosidase A, primarily in organs such as the kidneys, heart, and nervous system. It offers a valuable perspective on a rare pathology and underscores the relevance of accurate and early diagnoses. Clinical Manifestations: This article presents the case of a 24-year-old woman with lower extremity edema, elevated proteinuria, and impaired renal function, typical symptoms of Fabry nephropathy. A definitive diagnosis was established through renal biopsy and electron microscopy, which revealed lysosomal inclusions and characteristic zebra bodies of Fabry disease. Initially, treatment with prednisone and losartan was prescribed, achieving a reduction in proteinuria levels and normalization of creatinine, reflecting a positive response to supportive renal treatment. Conclusions: The importance of a comprehensive clinical evaluation, supported by histopathology analysis—especially electron microscopy—is highlighted for detecting characteristic signs of lysosomal accumulation and progressive renal damage. When combined with enzymatic tests, genetic testing, and renal biopsies, this approach enables a more accurate and earlier diagnosis, which is essential to anticipate progression toward chronic kidney disease.Item type: Ítem , Access status: Acceso Abierto , Relación de la obesidad con la hiperplasia endometrial(Universidad Católica de Cuenca., 2026) Garzón Garcia , Mauricio JoséIntroduction: Endometrial hyperplasia is a condition characterized by excessive proliferation of the endometrial lining due to an imbalance between estrogen and progesterone. Similarly, obesity has been identified as a risk factor for endometrial hyperplasia and cancer, as it increases estrogen exposure. Understanding the relationship between these two conditions is crucial for developing effective prevention and treatment strategies. Methodology: A literature review was conducted using bibliographic databases including PubMed, Scopus, and Web of Science, focusing on publications from the past 10 years. Primary studies, systematic reviews, and meta-analyses addressing the relationship between obesity and endometrial hyperplasia were included. Results: The risk of endometrial hyperplasia and the progression of endometrial cancer are closely associated with obesity. Obese women exhibit higher levels of unopposed estrogen due to the aromatization of androgens in adipose tissue. Weight loss interventions can significantly improve clinical outcomes in the early stages of the disease. Conclusions: Obesity is a significant risk factor for the development and progression of endometrial hyperplasia and endometrial cancer. The WHO classification system facilitates clinical management by distinguishing between types with different risks of progression. Studies conducted in Latin America reveal a growing association between obesity and endometrial hyperplasia, underscoring the need to address obesity as part of disease management strategies.Item type: Ítem , Access status: Acceso Abierto , Pustulosis exantemática generalizada aguda inducida por antiinflamatorios no esteroideos: Reporte de caso(Universidad Católica de Cuenca., 2026) Leon Montero , Brigitte AracelyIntroduction: Acute Generalized Pustular Psoriasis is a rare skin disease characterized by the sudden appearance of tiny, sterile, non-follicular pustules on an erythematous and edematous base. It primarily affects women, with most reported cases having been attributed to antibiotics use; however, in this case, non-steroidal anti-inflammatory drugs triggered it. Pathogenesis involves CD4 and CD8 T lymphocytes, which contribute to the formation of vesicles and pustules. Symptoms include itching, fever, leukocytosis, and biochemical abnormalities. Diagnosis is based on clinical history, physical examination, and biopsy. The main treatment consists of eliminating the causal agent and supportive measures, with spontaneous resolution occurring within 1 to 2 weeks. Case presentation: A case of Acute Generalized Pustular Psoriasis is presented in a 50-year-old female patient who developed generalized erythematous pustules after receiving intramuscular diclofenac, with a biopsy confirming the diagnosis, and treatment initiated with the biological drugs (infliximab). Conclusions: This work demonstrates how drug-induced skin reactions can occur with unusual medications, such as non-steroidal anti-inflammatory drugs. Additionally, it highlights how treatment with biological drugs achieved better results compared to conventional treatment.
