Trabajos de Titulación - Sede Azogues - Medicina
URI permanente para esta colecciónhttps://dspace.ucacue.edu.ec/handle/ucacue/89
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Ítem Acceso Abierto Efectividad del crosslinking corneal en el manejo de la progresión del queratocono. Revisión sistemática(Universidad Católica de Cuenca., 2024) Chuva Palacios, Yadira Fabiana; Calle Luna, Liliana Francisca; 0105968325Background: Keratoconus is a corneal ectasia characterized by thinning and conical deformation, which leads to reduced visual acuity. Corneal cross-linking , a technique that strengthens and stabilizes the cornea by creating cross-links between collagen fibers, is employed to halt its progression. Objective: To determine the effectiveness of corneal cross-linking compared to conventional treatments in managing the progression of keratoconus in diagnosed patients. Methods: A systematic review was conducted on the topic "Effectiveness of Corneal Cross-Linking in Managing the Progression of Keratoconus. A Systematic Review" within the field of ophthalmology. Information was sourced from PubMed, Web of Science, Embase, ProQuest, Taylor & Francis, Scopus, and SciELO databases in English and Spanish, published in the last five years. Observational studies and clinical trials were included, and the quality of evidence was assessed using the GRADE system. Results: A total of 289 records were included, and 2,915 participants were evaluated after screening. Most studies demonstrated that corneal cross-linking is effective in halting the progression of keratoconus, especially in its early stages, compared to conventional treatments. Additionally, a 20% improvement in visual acuity was observed. Predictive factors for success, such as age, disease severity, and associated conditions, were identified. Corneal cross-linking is a beneficial treatment option, as it halts disease progression and improves visual acuity. Keywords: Keratoconus, corneal cross-linking, management, visual acuityÍtem Acceso Abierto Eficacia de la tercer ventriculostomía endoscópica en pacientes con hidrocefalia no comunicante. Revisión Sistemática(Universidad Católica de Cuenca., 2024) Torres Ormaza, Julio Cesar; Paula Castro, Paola Elizabeth; 1206334045Background: Non-communicating hydrocephalus is a condition caused by an obstruction in the cerebrospinal fluid circulation system. Due to the nature of this disease, treatment involves surgical intervention. Historically, shunt systems have been the standard treatment; however, endoscopic techniques, such as endoscopic third ventriculostomy (ETV), are gaining prominence due to their minimally invasive nature and reduced risk of long-term complications. Objective: To analyze the efficacy of endoscopic third ventriculostomy in patients with non-communicating hydrocephalus. Methodology: A literature search was conducted in English and Spanish on Scopus, PubMed, ProQuest, and Web of Science databases. Reviews were performed following the PRISMA flow diagram. Results: This systematic review assessed the effectiveness of ETV for non-communicating hydrocephalus. The data indicate that ETV has an overall efficacy rate of 82.14% and a complication rate of 12.91%. These findings suggest that, while not free of risks, ETV is a viable and effective alternative for managing non-communicating hydrocephalus. Predictive tools such as measuring the optic nerve sheath diameter, detecting the "buckling sign," and assessing the thickness of retinal nerve fibers contribute to predicting surgical success. Conclusions: ETV is a safe and effective option for treating non-communicating hydrocephalus. Improved patient selection and future comparative studies are needed to optimize its use and long-term outcomes in clinical practice. Keywords: efficacy, obstructive hydrocephalus, ventriculostomy, third ventricle, cerebrospinal fluidÍtem Acceso Abierto Manejo del hipotiroidismo subclínico en adultos jóvenes. Revisión sistemática(Universidad Católica de Cuenca., 2024) Leal Guerrero, Jacobo Israel; Calle Gutiérrez , María Silvana; 0302361357Introduction: Subclinical hypothyroidism is an endocrine disorder characterized by elevated levels of thyroid-stimulating hormone while maintaining average concentrations of free thyroxine in the blood, suggesting altered thyroid gland function. The treatment for this condition typically involves levothyroxine; however, certain factors must be considered to guide a more appropriate management approach. Objective: To describe the management of subclinical hypothyroidism in young adults through a systematic review. Methodology: A systematic review was conducted following PRISMA guidelines, employing a descriptive and retrospective study based on articles and scientific journals from major databases such as PubMed, Google Scholar, World Health Organization, and Pan American Health Organization. Open-access articles categorized within SCImago quartiles Q1 and Q2, related to the management of subclinical hypothyroidism in young adults, were included in the review. Conclusion: The findings reveal a higher prevalence of subclinical hypothyroidism among young adults aged 27 to 29 years. Therefore, it is essential to consider management criteria for subclinical hypothyroidism, as treatment is entirely individualized for each patient. Keywords: thyroid dysfunction, subclinical hypothyroidism, levothyroxine, thyroxine, triiodothyronineÍtem Acceso Abierto Efectividad de la facoemulsificación versus la femtofacoemulsificación como tratamiento de la catarata senil en adultos mayores. Revisión sistemática(Universidad Católica de Cuenca., 2024) Bermeo Chimborazo, Mayra Alexandra; Calle Luna, Liliana Francisca; 0350155255Objective: To evaluate phacoemulsification's (PHACO) effectiveness versus femto-phacoemulsification (FLACS) as a surgical technique for managing senile cataracts in older adults. Methodology: A retrospective, descriptive, and qualitative systematic review was conducted. It was structured according to the PRISMA 2020 guidelines. Inclusion criteria: Publications from 2014 to 2024 in English or Spanish from indexed journals accessible via free full-text databases. The databases used were SciELO, PubMed, Scopus, Science Direct, Springer Link, Google Scholar, and Web of Science. Bias risk was evaluated using the Cochrane Review Manager 5.4.1 tool. Results: The findings were synthesized in a summary table featuring author, title, country, year, results, and objectives. Twenty-four 24 Randomized Controlled Trials (RCTs) with 5,943 participants were included. Each trial compared aspects of cataract surgery with PHACO versus FLACS, such as safety, efficacy, cost-effectiveness, endothelial cell loss, visual outcomes, and complications. Conclusions: Both PHACO and FLACS are viable surgical techniques for managing senile cataracts, with notable differences favoring FLACS in endothelial cell preservation and reduced ultrasonic energy use. However, PHACO remains more cost-effective and reveals comparable outcomes regarding complications and visual results, making it the preferred technique for most cases. Keywords: cataracts, surgery, phacoemulsification, femtosecond laserÍtem Acceso Abierto Tratamiento rehabilitador de la parálisis cerebral infantil. Revisión Sistemática(Universidad Católica de Cuenca., 2024) Guaman Yansaguano, Jonnathan Patricio; Capote Llanares, Miguel Ángel; 0302514328Background: This systematic review analyzes the problems of rehabilitative treatment in children with infantile cerebral palsy (ICP). Objective: To evaluate the effectiveness of rehabilitation treatment in children with ICP, analyzing its impact on motor function, autonomy, and quality of life of patients through a systematic review of updated and relevant scientific literature. Methods: This review was based on PRISMA 2020 guidelines; observational studies and randomized clinical trials (RCTs) were employed. Results: A remarkable variability could be appreciated in the effectiveness of the assessment scales, specifically the Bobath Foundation Scale and the Gross Motor Function Scale (GMFM). The Bobath Scale indicated greater consistency in evaluating motor and functional development, while the GMFM effectively measured specific changes in gross motor function over time. The positive predictive value of the Bobath Scale ranged from 70% to 95%, depending on clinical context and type of Intracerebral hemorrhage (ICH), whereas the GMFM ranged from 60% to 90%. Regarding the negative predictive value, the GMFM had a more consistent performance, approximately 75%-98%, compared to the Bobath Scale at 50%-85%. Furthermore, likelihood ratios indicated that the GMFM might be more effective in identifying significant functional improvements in children with ICP. Keywords: motor function, cerebral palsy, rehabilitation treatmentÍtem Acceso Abierto Crononutrición y salud metabólica en adolescentes y adultos. Revisión sistemática(Universidad Católica de Cuenca., 2024) Pastuizaca Paucar, Jhoana Elizabeth; Faicán Rocano, Pedro Fernando; 0302877816Chrononutrition is an emerging field that investigates the relationship between diet and circadian biological rhythms, highlighting the importance of regular sleep and eating schedules based on individual chronotypes, as this study aims to understand the metabolic issues caused by such imbalances. Objective: To describe the relationship between chrononutrition and metabolic health in adolescents and adults. Methodology: A systematic review followed PRISMA guidelines, including clinical trials, cross-sectional, observational, and cohort studies published in the last five years. A search equation was created using scientific databases such as Scopus, PubMed, Web of Science, Taylor & Francis, and Science Direct. Bias was analyzed using RAYYAN and NHLBI, and results were synthesized in a contingency table. Results: Fifteen articles met the eligibility criteria, including 11 controlled trials and four observational studies (cross-sectional and longitudinal), with a sample of 3,760 participants. The findings suggest that chrononutrition influences the development of metabolic or cardiac diseases associated with weight gain according to eating patterns and sleep duration. Conclusions: It was determined that chrononutrition directly impacts cardiometabolic health in adolescents and adults, as the biological clock is affected by sleep or eating schedules, which can lead to physiological imbalances. Further studies are needed to substantiate these findings. Keywords: adolescent, adult, chrononutrition, metabolismÍtem Acceso Abierto Factores de riesgo de la somnolencia diurna excesiva en estudiantes de educación secundaria y superior. Revisión sistemática(Universidad Católica de Cuenca., 2024) Carrión Aguilar, Melissa Gissel; Medina Arias, Anita Lorena; 0750407967Title: Risk Factors for Excessive Daytime Sleepiness in Secondary and Higher Education Students. A Systematic Review Objective: To identify risk factors associated with excessive daytime sleepiness in high school and higher education students. Methodology: This systematic review included peer-reviewed studies on the topic published in the last five years in English or Spanish. Exclusion criteria included studies that did not specifically address the topic, non-peer-reviewed publications, and studies with populations other than students. Databases used for this review included Springer Link, Taylor & Francis, Elsevier, SciELO, Wiley Online Library, PubMed, and Google Scholar, focusing on studies from the past five years. The risk of bias was assessed using the NHLBI tool for observational studies, emphasizing the clarity of the research question. Results were synthesized quantitatively using odds ratios and correlation coefficients. Results: Excessive daytime sleepiness was significantly associated with poor sleep quality, electronic device use before sleep, academic stress, and substance use, negatively impacting academic performance and emotional well-being. Discussion: Evidence from multiple studies indicates that daytime sleepiness in students is linked to factors such as poor sleep quality, electronic device use, academic stress, and substance use. Conclusions and Relevance: Daytime sleepiness in students is influenced by multiple factors that affect their academic performance and well-being. Health and education professionals are encouraged to implement interventions that improve sleep quality and manage academic stress. Keywords: sleep quality, students, associated factors, systematic review, daytime sleepinessÍtem Acceso Abierto Nuevos Antirretrovirales para el tratamiento del VIH. Revisión sistemática(Universidad Católica de Cuenca., 2024) Rivas Ordóñez, Adriana Lizeth; Pérez Ramírez, Jacinto Eugenio; 1900458751Background: The introduction of new antiretrovirals (ARVs) has transformed Human Immunodeficiency Virus (HIV) treatment, improving efficacy and tolerability. Evaluating these new regimens is essential to understand their impact in different clinical settings. Objective: This systematic review aims to analyze the effectiveness and safety of new ARVs regimens approved for HIV-1 treatment, comparing their performance with treatments. Methodology: A comprehensive search was conducted in databases such as PubMed, Cochrane Library, and Embase, including studies published in 2019. Studies were evaluated according to PRISMA guidelines, and the Cochrane Risk of Bias tool was used to assess their quality. Results: The new ARVs demonstrated greater efficacy in viral suppression and a superior safety profile, with fewer serious side effects than traditional treatments. In addition, the reduced pill burden favored greater adherence to treatment. These regimens were effective in diverse populations, including those with drug resistance or previous treatment failures. Conclusion: The new ARV regimens improve viral suppression and tolerability and simplify treatment, facilitating adherence and adapting to different patient profiles. It suggests that they could become the first choice in HIV-1 treatment. Keywords: HIV, antiretrovirals, compliance and adherence to treatment, side effects, systematic reviewÍtem Acceso Abierto Efectividad del febuxostat en pacientes hiperuricémicos. Revisión sistemática(Universidad Católica de Cuenca., 2024) Calle Crespo, Víctor Manuel; Calle Gutiérrez, María Silvana; 0303097224Hyperuricemia is a chronic, treatable condition caused by the deposition of monosodium urate crystals in joints and periarticular tissues due to elevated serum uric acid levels. This disorder is associated with various comorbidities and an increased risk of cardiovascular disease. Pharmacological management of hyperuricemia includes xanthine oxidase enzyme inhibitors, with febuxostat demonstrating beneficial effects in this pathology. Objective: To determine the effectiveness of febuxostat in hyperuricemic patients. Methods: A systematic review was conducted using the PRISMA 2020 methodology. This descriptive study was based on scientific literature from databases such as PubMed and Taylor & Francis, utilizing freely accessible articles indexed in SCImago Q1 and Q2 quartiles regarding febuxostat's effectiveness in hyperuricemic patients. Results: Twenty scientific documents were identified following a search that applied eligibility criteria and a meticulous analysis of each article's abstracts, results, and conclusions. These included 17 randomized controlled clinical trials, two prospective cohort studies, and one retrospective cohort study. Conclusions: Febuxostat's effectiveness was observed compared to allopurinol, topiroxostat, and placebo. The study demonstrated that febuxostat improves glomerular filtration and provides vascular protection by reducing serum uric acid levels. Keywords: effectiveness, febuxostat, inhibitor, xanthine oxidase, hyperuricemiaÍtem Acceso Abierto Terapia con ondas de choque en enfermedades osteomioarticulares. Revisión Sistemática(Universidad Católica de Cuenca., 2024) Pérez Cáceres, Jessica Silvana; Capote Llenares, Miguel Ángel; 0105304745Extracorporeal shock wave therapy involves high-energy pressure waves directed at tissues, which helps treat musculoskeletal conditions such as nonunion fractures, plantar fasciitis, tendinopathies, and tendon calcifications. Objective: To examine the effectiveness of shock wave therapy in osteomyomuscular conditions. Methodology: A retrospective, descriptive, and qualitative systematic review was conducted based on PRISMA guidelines. Inclusion criteria: Scientific studies published between 2019 and 2024 in English or Spanish, indexed in databases; Exclusion criteria: Articles published before 2019, other treatments for osteomyomuscular diseases, paid or unavailable articles, and articles in languages other than English or Spanish. Results synthesis: Presented through title, author, country, year, study type, results, and associated factors. Results: Ten randomized clinical trials with 570 participants were included. Shock wave therapy showed statistically significant results in reducing pain and improving stability, functionality, and electrophysiological parameters in various osteomyomuscular conditions; all randomized controlled trials (RCTs) reported statistically significant p-values (p<0.05). Conclusions: Shock wave therapy has proven effective in reducing pain and increasing functionality in various musculoskeletal conditions; however, further research is needed to establish consistent treatment protocols and better understand long-term effects. Keywords: joint, disease, osteomyomuscular, shock wavesÍtem Acceso Abierto Factores de riesgo y diagnóstico de epilepsia en adolescentes. Revisión sistemática(Universidad Católica de Cuenca., 2024) Loaiza Orozco, Pedro Cirio; Crespo Domínguez, Juan Sebastián; 0707052577Epilepsy is a disorder caused by abnormal discharges in neurons; it is associated with risk factors such as a family history of epilepsy, cranioencephalic trauma, electrolyte imbalance, preeclampsia, and birth asphyxia. Worldwide prevalence affects 0.5-1% of the population, with a higher incidence in males. Data reveal that approximately 30% of this prevalence falls within the 10 to 25 years age range, with 75% of cases presenting before age 20. In Ecuador, epilepsy prevalence is 7 to 12 cases per 1,000 inhabitants, with concerns about its rising incidence. Objective: To analyze the risk factors and updated diagnostic methods for adolescent epilepsy. Methodology: A systemic, descriptive review using a qualitative and quantitative approach was conducted in SciELO, PudMed, Medigraphic, the Spanish Society of Neurology (SEN by its Spanish acronym), and Scopus databases it selected 25 scientific articles published in the last 5 years, according to the eligibility criteria using the PRISMA 2020 guide. Results: The most frequent risk factors were premature birth at 64.28%, asphyxia at birth at 50%, heredofamilial history of epilepsy at 42.85%, and neonatal hypoglycemia at 42.85%, among others; on the other hand, new diagnostic methods include genetic studies, stereotactic electroencephalography, and voxel-based magnetic resonance imaging. Conclusions: Epilepsy has become a significant health issue, with neonatal risk factors being crucial to its development; new efficient diagnostic methods facilitate identifying and treating this pathology. Keywords: adolescents, epilepsy, risk factors, diagnosisÍtem Acceso Abierto Tratamiento antimicrobiano en shock séptico. Revisión sistemática.(Universidad Católica de Cuenca., 2024) Padilla Padilla, Angélica Estefanía; Pérez Ramírez, Jacinto Eugenio; 0150700623Introduction: Sepsis is a dysregulated body response to an infection, resulting in a systemic immune response that can progress to septic shock if not managed promptly and appropriately. Bacteria are the main causal agents, with Staphylococcus aureus being the most common pathogen in 77% of cases, followed by Streptococcus pneumoniae in 45%. The severity level depends on the setting in which the individual was infected, increasing the importance of hospital emergency departments in recent years for timely detection and the application of new clinical practice guidelines. These guidelines assess the level of compromise and mortality risk and the need for early and adequate treatment. Objective: To identify the antimicrobials currently used in septic shock. Methodology: A systematic review of septic shock and the antimicrobials used was conducted through a literature search of scientific articles, following the PRISMA 2020 guidelines, using databases such as Taylor& Francis, Redalyc, SciELO, Scopus, PubMed, Web of Science, and Science Direct. Conclusions: Diagnostic methods are crucial for timely and appropriate treatment based on each patient’s severity. According to current guidelines, the most commonly used antimicrobials are cephalosporins and carbapenems, administered as monotherapy or in combination therapy. Early empirical treatment in suspected septic shock cases significantly reduces mortality rates. Keywords: shock, sepsis, multi-organ, antimicrobialÍtem Acceso Abierto Sensibilidad y especificidad de las escalas de predicción de RACE y CPSS. Revisión sistemática(Universidad Católica de Cuenca., 2024) Cajas Yascaribay, Cristopher Damian; Torres Criollo, Larry Miguel; 0301952651This study addresses the challenges of diagnosing ischemic stroke (AIS) in resource-limited clinical settings, where the Rapid Arterial Occlusion Evaluation (RACE) and Cincinnati Prehospital Stroke Scale (CPSS) scales serve as essential tools. It aimed to compare the sensitivity and specificity of these two scales through a systematic review of recent studies. The methodology followed the PRISMA model, including clinical trials and observational studies published in English or Spanish. Results revealed notable variability: CPSS demonstrated greater consistency in sensitivity, while RACE excelled in specificity. The positive predictive value of CPSS ranged from 22% to 98%, while RACE's was between 28% and 93%. Regarding negative predictive value, RACE performed more uniformly (60%- 100%) than CPSS (23%- 96%). Likelihood ratios (LR) indicated that RACE might be more effective in excluding AIS in negative cases. In conclusion, while both scales have advantages, CPSS is more suitable for early detection due to its higher sensitivity. In contrast, RACE is more helpful in confirming suspected cases due to its specificity. Additional studies are recommended to standardize their use and assess their impact on clinical practice and long-term outcomes. Keywords: CPSS, RACE, sensitivity, specificity, predictive valueÍtem Acceso Abierto Infecciones oportunistas que afectan a pacientes con trasplante de órganos. Revisión sistemática(Universidad Católica de Cuenca., 2024) Romero Ávila, Luis Fernando; Pérez Ramírez, Jacinto Eugenio; 0301863569Background: Opportunistic infections are conditions that cause complications in transplant patients, potentially leading to organ rejection or death. This systematic review aimed to analyze the infections most frequently affecting transplant patients and their treatment and prophylaxis. Method: A retrospective cross-sectional descriptive systematic review with a non-experimental design was focused on medical documents in English and Spanish from 2017 to 2024 in scientific databases such as PubMed, Taylor & Francis, Dialnet, Elsevier, Medline, and Scopus. Literature reviews and scientific articles not corresponding to the years mentioned, those not in English or Spanish, and those on topics of no significant relevance were excluded. The information was organized using the Zotero reference manager and an Excel table. Results: The initial search resulted in 4,331 records in PubMed, 3,038 in Taylor & Francis, 2,194 in Web of Science, and 1,637 in SCOPUS, totaling 11,200 documents. After applying filters, 28 relevant articles were selected, ranging from Q1 to Q2, and rated as excellent according to the Pedro scale. Discussion: Based on the 28 reviewed articles, 26 authors discussed the primary transplants affected: liver, lung, heart, kidney, pancreas, and intestine, and all of them agreed on the microorganisms impacting each organ and the treatment and prophylaxis methods. Keywords: opportunistic infections, transplant, post-transplant, treatment, prophylaxisÍtem Acceso Abierto Tratamiento conservador versus tratamiento quirúrgico de la fractura de Colles. Revisión Sistemática.(Universidad Católica de Cuenca., 2024) Ludizaca Quito, Jonnathan Josue; Capote Llenares, Miguel Ángel; 0302124805Background: A Colles' fracture occurs at the distal end of the radius with dorsal comminution, dorsal angulation, dorsal displacement, radial shortening, and an associated fracture of the ulnar styloid process. Diagnosis is primarily based on clinical signs, especially the characteristic "dinner fork" deformity. The most common complications include compartment syndrome, median nerve injury, and vascular injuries. Therefore, this systematic review compares the effectiveness of conservative and surgical treatments for Colles' fracture. Methods: A literature search was conducted at the Catholic University of Cuenca's virtual library about clinical and randomized controlled trials, as well as original articles from databases such as Scopus, Web of Science, and PubMed. The search focused on relevant studies of conservative and surgical treatments for Colles' fracture. Additionally, literature search matrix was created in Excel, and the EndNote reference manager was used to organize the references. Results: Among the included studies, comparisons between casting and immobilization with volar flexion and ulnar deviation (VFUDC) indicated that the surgical group had better outcomes. Conclusions: From the reviewed articles, it was concluded that functional cast immobilization was more effective than VFUDC immobilization; regarding postoperative pain relief; ibuprofen demonstrated that it was more effective. Long-term comparative studies are needed to assess the functional outcomes of conservative and surgical treatments. Keywords: Colles' fracture, conservative treatment, surgical treatment, complicationsÍtem Acceso Abierto Complicaciones relacionadas a la nutrición parenteral en pacientes pediátricos. Revisión sistemática.(Universidad Católica de Cuenca., 2024) González Merchán , Viviana Elizabeth; Pérez Ramírez, Jacinto Eugenio; 1718376799Introduction: Parenteral nutrition refers to a type of feeding that supplies the body with a concentrated mixture through a venous line, either peripheral or central. The complications associated with parenteral nutrition in children are generally alarming when using central lines due to the risks of sepsis and mechanical and metabolic disturbances caused by factors such as long-duration catheters and the type and number of lumens. Objective: To identify the main complications associated with parenteral nutrition in pediatric patients. Methodology: A qualitative, descriptive systematic review was conducted following the PRISMA 2020 guidelines. The data collected comes from publications over the last five years from SciELO, PubMed, Google Scholar, Semantic Scholar, and SpringerLink. Each publication was assessed for quality and individual bias risks. Results: Approximately 519,750 publications were found before applying filters. After filtering, 18 scientifically relevant studies were selected, from which two were obtained from Google Scholar, three from PubMed, four from SciELO, eight from Semantic Scholar, and one from SpringerLink. After analyzing and comparing these studies, it was identified that the most common complications in parenteral nutrition for pediatric patients were infectious and mechanical. Discussion: Following a thorough analysis and comparison of the results with the available literature, it is established that this systematic review aims to address the stated objectives. Keywords: complications, parenteral nutrition, pediatrics, cathetersÍtem Acceso Abierto Complicaciones en fracturas expuestas de extremidades inferiores. revisión sistemática(Universidad Católica de Cuenca., 2024) Encalada Castillo, Kevin Andrés; Capote Llanares, Miguel Ángel; 0302538624Open fractures represent a global health issue due to their unfavorable prognosis. In the United States, 11.5 individuals per 100,000 experience these fractures each year, with 40% occurring in the lower limbs. Objective: To analyze data on the most common complications of open fractures in the lower limbs. Methodology: A systematic review was developed on complications associated with open fractures in the lower extremities. The scientific articles were searched in databases such as SciELO, PubMed, and Google Scholar, including publications from 2018 to 2022. The selected studies were evaluated using the PRISMA 2020 method and the GRADE scale to classify the quality of information. The PICO strategy was applied to structure the research. Data were organized and presented in tables. Results: An initial pool of 5,134 records was identified, of which eight studies were included in the qualitative synthesis. These studies revealed a high prevalence of infectious complications, with infection rates ranging from 19% to 40.4%. Other identified complications included pseudarthrosis, suture dehiscence, amputations, osteomyelitis, shortening, compartment syndrome, and fatigue of osteosynthesis materials. According to Gustilo-Anderson, grade III fractures exhibited the highest complication rates. Conclusions: Open fractures in the lower limbs are expected, with tibial fractures being the most prevalent and showing a high incidence of Grade III fractures. Infections are the most frequent complication, followed by nonunion and compartment syndrome. Keywords: open fracture, complications, lower limbs, infectionsÍtem Acceso Abierto Factores de riesgo asociados al consumo de sustancias ilícitas en estudiantes universitarios. Revisión Sistemática.(Universidad Católica de Cuenca., 2024) Domo Andrade, Gabriela Carolina; Velásquez Troconis, Alberto Ramón; 0705946432Illicit substance consumption among university students has a multifactorial origin due to the influence of various risk factors, including environmental, genetic, and individual aspects. In young university students, it leads to significant personal, familial, and academic consequences. Illicit substance consumption is influenced by a lack of prevention and psychoeducational focus and by fostering values, attitudes, and healthy emotions initially at home, in schools, universities, and at the state level. Objective: To determine the risk factors associated with illicit substance consumption among university students. Methodology: A systematic review with a qualitative, descriptive approach was conducted. It involved searching for original articles in scientifically accredited virtual libraries and databases using the PRISMA 2020 guidelines. Data from documents were sourced from online databases such as SciELO, Redalyc, Taylor & Francis, and Web of Science. Each study was evaluated for quality and bias. Results: The studies used in this review were of excellent quality, with a low risk of bias. Results revealed that risk factors leading to illicit substance consumption include demographic factors (gender, age, occupation, socioeconomic status, educational level, and religion); social factors (parties, family relationships, and recreational activities); psychological factors (primarily anxiety, depression, stress, personality traits, and self-esteem); work-related factors (employment and workplace conflicts); and academic factors (course preferences, part-time studies, failed semesters, peer groups, academic performance, lack of understanding and concentration). Other factors with a lesser association include bullying and quality of life. Keywords: illicit substances, university students, risk factors, drug consumption, preventionÍtem Acceso Abierto Efectividad diagnóstica y seguridad de la Elastografía en pacientes con Fibrosis Hepática. Revisión Sistemática(Universidad Católica de Cuenca., 2024) Aguaiza Rivera , Estefanía De Rocío; Idrovo Vázquez, Víctor Aníbal; 0302078126Introduction: Hepatic fibrosis results from a chronic inflammatory process of liver tissue, leading to the development of pathological scar tissue. Diagnosis is usually clinical, using scales like the hepatic steatosis index (HSI), fatty liver index (FLI), and NAFLD fibrosis score (NFS). However, due to their low effectiveness, several studies have supported using elastography. Objective: To determine the diagnostic effectiveness of transient elastography compared to the HSI, FLI, and NFS scales for diagnosing hepatic fibrosis in Non-alcoholic fatty liver disease (NAFLD) through a systematic review. Methodology: This systematic review was conducted according to PRISMA 2020 guidelines. Data was collected through an updated search of medical databases such as PubMed, Elsevier, SciELO, and Cochrane, with information selected based on inclusion and exclusion criteria. The OXFORD standard was used to categorize the references. Results: Forty-one bibliographic references were collected, 14 were used in the discussion, and 6 provided relevant data on the sensitivity and specificity of the scales. At the same time, the remaining eight references study the safety and diagnostic or prognostic effectiveness of transient elastography or FibroScan in NAFLD. Conclusion: Transient elastography, as an early marker of liver damage, is more effective in patients under 35 years of age with a low Body Mass Index (BMI) and no congestive diseases. Its sensitivity is 96%, and specificity is 98%, higher than the NFS, FLI, and index for Liver Fibrosis (FIB) scales. Keywords: elastography, hepatic fibrosis, steatosis, ultrasoundÍtem Acceso Abierto Factores de riesgo de cáncer de mama. Revisión Sistemática(Universidad Católica de Cuenca., 2024) Vizhñay Ramón, Paola Estefania; Espinoza Díaz, Cristobal Ignacio; 1400980288Breast cancer is considered a disease with a high mortality rate. Modifiable risk factors, such as hormone use, obesity, physical activity, alcohol consumption, and smoking, contribute to breast cancer risk. Additionally, breast cancer risk has been described in women with a family history of the disease, BReast CAncer gene 1/2 (BRCA1/2) mutations, or familial cancer syndromes. Methodology: Based on the PRISMA 2020 statement, a qualitative systematic review was conducted using electronic databases such as PubMed, Scopus, and Web of Science. Study quality was assessed using the U.S. National Institutes of Health scale. Results: Twenty-five eligible articles were included. Most studies highlighted that in women with a family history of breast cancer, modifiable risk factors showed no association with breast cancer. In contrast, some studies reported a decrease in risk (physical activity) or an increase (hormonal contraception/menopausal hormone therapy, smoking, alcohol consumption). Conclusions: This review identified and evaluated various limitations in the included studies, which affect the interpretation of the results. The risk of bias was mainly observed in the inconsistency of exposure and outcome measurements and variability in the definitions of modifiable risk factors. This heterogeneity in measurement, ranging from retrospective to current data across different life stages, underscores the need for standardization in the definitions and methodologies used in future research. Keywords: BRCA1, BRCA2, cancer, luminal A, luminal B, breast, triple-negative
