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 Manejo terapéutico actualizado del labio y paladar hendido. Revisión Sistemática(Universidad Católica de Cuenca., 2025) Alcívar Zambrano, Marcela Lissette; Durán Palacios , María Teresa; 1312613324Background: Cleft lip and palate is the most common craniofacial anomaly. Its origin is multifactorial and includes disruptions during embryological development, genetic susceptibility, and exposure to harmful environmental factors. Objective: To determine the current approach to the management of cleft lip and palate through a systematic review of the scientific literature. Methodology: A qualitative research study with a non-experimental, descriptive-analytical design was conducted to analyze the management of patients with cleft lip and palate. The structure of the study followed the PRISMA 2020 guidelines. Results: Contemporary management of cleft lip and palate includes procedures such as cheiloplasty, palatoplasty, nasoalveolar fistula closure, bone grafting, and orthognathic surgery. Surgical interventions require adequate development and balance in the child’s nutritional and hemodynamic status to withstand these procedures; therefore, they are typically performed from 12 months of age. Conclusions: Current management of cleft lip and palate involves a multidisciplinary approach, with contributions from several specialties during the prenatal and postnatal periods. Treatment focuses on reconstructing the lip and palate during the early years of life through the use of orthopedic devices and surgical interventions. This is followed by physiotherapy to support proper hearing and speech development, along with corrective measures to restore normal growth, function, and facial appearance. Keywords: cleft lip and palate, congenital anomaly, risk factor, treatment, multidisciplinary managementÍtem Acceso Abierto Efectividad de la embolización y cirugía en el manejo del trauma hepático en adultos: revisión sistemática(Universidad Católica de Cuenca., 2025) Fajardo Cardenas, Mayra Michelle; Saquicela Espinoza, Luis Alberto; 0105803464Effectiveness of Embolization and Surgery in the Management of Liver Trauma in Adults: A Systematic Review Abstract It is estimated that at least 75% of all abdominal traumas involve damage specifically to the liver. The most common immediate intervention has always been surgery; however, in recent years, embolization has gained prominence. Objectives: To describe the effectiveness of embolization and surgery in the management of hepatic trauma in adults. Methods: A systematic literature review was conducted, reviewing different medical databases such as Elsevier, PubMed, ScienceDirect, and others. Searches were performed in English and Spanish using medical subject headings and Boolean operators such as AND and OR to optimize results. The screening was based on the PRISMA 2020 model. The quality of the articles was also assessed using the NIH tool, and bias was evaluated with the ROBINS-I tool. Results: Management with embolization showed better effectiveness records than surgeries. However, the use of each procedure depended on the severity of the injury. Mortality ranged from 12% to 15%, while complications occurred in approximately 50% of cases. Surgeries showed a higher rate of complications. Conclusions: The investigations analyzed showed high levels of study quality as well as a low risk of bias. The effectiveness of the procedures depended on the hemodynamic stability of the patient and the degree of severity of the trauma. Embolization is used in the mildest degrees. At higher severity, management has almost always been surgical. The main complications were biloma, hepatic ischemia, and pseudoaneurysm. Keywords: surgical procedures, abdominal injuries, hepatic trauma, trauma management, endovascular techniquesÍtem Acceso Abierto Eficacia del lecanamab versus donanemab en el tratamiento de la enfermedad de Alzheimer: revisión sistemática(Universidad Católica de Cuenca., 2025) Vera Siguenza, Juan Sebastián; Crespo Domínguez, Juan Sebastián; 0105458970Background: Alzheimer's disease is a progressive neuropathology that affects memory and cognitive abilities. This condition is considered the most common type of dementia, and among the drugs under study are lecanemab and donanemab. Objective: This study aimed to identify the efficacy of Lecanemab versus Donanemab in the treatment of Alzheimer's disease. Methodology: A systematic review included articles published in medical databases such as SpringerLink, PubMed, Scopus, and Elsevier. Keywords were used as search descriptors, and Boolean operators were applied to optimize search results. A screening of the articles was conducted. The PRISMA 2020 statement was followed, and a quality assessment of the studies and risk of bias analysis was performed. Results: A total of seven clinical trials meeting the predefined objectives of this research were included. All studies provided high-quality information. Donanemab showed a 36% disease-slowing rate, with adverse effects occurring in 15% to 20% of cases. Meanwhile, lecanemab demonstrated a 32.5% disease-slowing rate, with adverse effects reported in 15% to 27% of cases. Conclusions: The efficacy of both drugs showed advantages in slowing disease and reducing amyloid plaque, using lecanemab and donanemab. The most notable adverse effects included dizziness, falls, microhemorrhages, and very low fatality rates. Keywords: amyloid, donanemab, Alzheimer's disease, lecanemab, mental disordersÍtem Acceso Abierto Eficacia de levetiracetam y valproato en epilepsia generalizada infantil: revisión sistemática.(Universidad Católica de Cuenca., 2025) Gonzaga Jaya, Amanda Mireya; Quevedo Crespo, María José; 0106726854Generalized epilepsy is a chronic, recurrent clinical syndrome of paroxysmal origin with various etiological causes, affecting both cerebral hemispheres and primarily targeting neurons in the brain's central region. It is classified into three subtypes: convulsive, absence, and myoclonic seizures. Several treatments are available for generalized epilepsy, with levetiracetam and valproate being among the most commonly used. Objective: To determine the efficacy of levetiracetam and valproate in pediatric generalized epilepsy. Methods: A systematic review was conducted following the PRISMA 2020 guidelines. This descriptive study is based on scientific studies published in major databases, including PubMed and Taylor & Francis, focusing on the effectiveness of levetiracetam and valproate in pediatric patients with generalized epilepsy. Results: Twelve scientific documents were identified, including eight from PubMed and four from Taylor & Francis. After applying eligibility criteria and analyzing each article's abstracts, results, and conclusions, ten were randomized controlled clinical trials, one was a prospective cohort study, and one was a retrospective cohort study. Conclusions: In individuals with generalized tonic-clonic seizures (with or without other types of epileptic seizures), first-line treatment with sodium valproate has the best profile compared to other treatments. However, lamotrigine and levetiracetam may be considered first-line alternative treatments, particularly for individuals for whom sodium valproate is not a viable treatment option. Keywords: efficacy, levetiracetam, generalized epilepsyÍtem Acceso Abierto Eficacia de la vacuna recombinante contra el herpes zóster: revisión sistemática(Universidad Católica de Cuenca., 2025) Ortega Vásquez, María José; Pérez Ramírez, Jacinto Eugenio; 1726768482Background: Herpes zoster (HZ) is a condition caused by the reactivation of the varicella-zoster virus (VZV). In Europe, the annual incidence of HZ in the general population ranges from 2 to 4.6 cases per 1,000 people yearly, with a notable increase as age advances. This disease is associated with various conditions that affect cellular immunity, such as autoimmune diseases, cancer, immunosuppressive treatments, and certain chronic diseases. Objective: To examine the latest published evidence on the effectiveness of the herpes zoster vaccine, categorized according to its efficacy, efficiency, effectiveness, and safety. Drug interactions will also be addressed. Additionally, current vaccination recommendations will be included. Methodology: A systematic analysis will be conducted using available information from literary databases such as PubMed, Science Direct, SciELO, Elsevier, Cochrane, and Google Scholar, from January 1st, 2020, to August 31st 2024. Updated literature references from Q1 to Q4 quartiles will be included. The review will follow the guidelines of the PRISMA 2020 statement, and the selection of articles will be based on their methodological quality, using the criteria defined in the Oxford scale. Results: The aim is to create a high-quality database on the effectiveness of the herpes zoster vaccine through a review and selection of scientific literature addressing its efficacy, efficiency, effectiveness, and safety. Keywords: adjuvant, efficacy, herpes zoster vaccine, recombinant vaccine, virusÍtem Acceso Abierto Eficacia de los alambres retrógrados laterales versus los alambres retrógrados cruzados en el manejo de las fracturas supracondíleas del codo en niños: revisión sistemática(Universidad Católica de Cuenca., 2025) Garcia Padilla, Jonathan Leonidas; Capote Llanares, Miguel Ángel; 0302429014Background: Supracondylar elbow fractures are among the most common bone injuries in children, accounting for 70% of all elbow fractures. They are classified using the Gartland Classification System and require appropriate treatment to prevent complications such as loss of mobility or angular deformities. Thus, the choice of fixation method, whether lateral or crossed retrograde wires, can significantly influence clinical outcomes. Objective: To evaluate the efficacy of lateral retrograde wires versus crossed retrograde wires in the management of supracondylar elbow fractures in children, in terms of bone healing, functionality, and postoperative complications. Methods: A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statements, utilizing Medical Subject Headings (MeSH) terms to facilitate information retrieval from various databases. Additionally, the ROB-1 tool for randomized clinical trials and the Review Manager (RevMan) software were used. Results: The findings indicate that both methods have advantages and disadvantages in terms of efficacy and safety. The studies analyzed revealed that lateral retrograde wires tend to provide greater fixation stability, resulting in a lower rate of postoperative complications. On the other hand, crossed retrograde wires are preferred in certain cases due to their ease of use and shorter surgical time. However, the variability of the results suggests that the choice of method should be individualized based on the specific characteristics of each fracture and patient. Keywords: retrograde wires, consolidation, supracondylar fracturesÍtem Acceso Abierto La hipoglucemia como factor de riesgo para el desarrollo de demencia en pacientes diabéticos: revisión sistemática(Universidad Católica de Cuenca., 2025) Pesántez Coronel, Mayra Alejandra; Izquierdo Coronel, Diana; 0350004651Recurrent hypoglycemia has been identified as a significant risk factor for the development of dementia in patients with diabetes mellitus, both Type 1 and Type 2. Several studies suggest that hypoglycemic episodes, especially severe ones, can trigger structural alterations in the brain, such as brain volume loss and cortical atrophy, which contribute to cognitive decline. Hypoglycemia can induce direct neuronal damage, affecting key brain areas such as the hippocampus, and can also lead to cerebral hypoperfusion. Objective: This study aims to evaluate the relationship between hypoglycemic episodes and the development of dementia in diabetic patients through a systematic review of the available scientific literature. Methodology: A descriptive systematic literature review was conducted following the PRISMA guidelines. Results: The results indicate that in patients with Type 1 diabetes, repeated exposure to hypoglycemic episodes can double the risk of developing dementia in old age. In Type 2 diabetes, the incidence of dementia increases by 25.4% in those with a history of hypoglycemia. The frequency and severity of hypoglycemic episodes are directly related to an increased risk of cognitive impairment, particularly in older adults. These findings highlight the importance of adequate glucose management in diabetic patients to minimize hypoglycemic episodes and, consequently, prevent the development of dementia, especially in individuals with comorbidities or early signs of cognitive decline. Keywords: hypoglycemia, dementia, cognitive risk, diabetes mellitusÍtem Acceso Abierto Sensibilidad y especificidad diagnóstica: histeroscopia versus ecografía transvaginal en el sangrado uterino anormal. Revisión sistemática(Universidad Católica de Cuenca., 2025) Narvaéz Carangui, Carla Maricela; Gallegos Vintimilla, Santiago Homero; 0302616644Diagnosing abnormal uterine bleeding (AUB) requires precise techniques to clarify its cause. This systematic review compares transvaginal ultrasound and hysteroscopy methods in terms of sensitivity and specificity for the overall diagnosis of abnormal uterine bleeding of structural origin. The methodology followed the PRISMA model, including randomized clinical trials and observational studies published in English or Spanish. Results: The studies revealed that hysteroscopy had a notable sensitivity of 82.35% but limited specificity (47.06%). In contrast, ultrasound demonstrated higher specificity at 83.3% but lower sensitivity (42.67%). Regarding positive predictive value, transvaginal ultrasound was superior with 71.23% compared to hysteroscopy with 60.87%, while the opposite was observed for the negative predictive value. Likelihood ratios (LR) indicated favorable values for hysteroscopy. Conclusion: Although both methods have advantages, hysteroscopy is more suitable for diagnosing AUB. The choice of technique depends on clinical factors, available resources, and patient-specific characteristics. Keywords: hysteroscopy, transvaginal ultrasound, sensitivity, specificity, predictive valueÍtem Acceso Abierto Eficacia de la terapia dual con amoxicilina y vonoprazan versus la terapia cuádruple con bismuto para la erradicación de helicobacter pylori: una revisión sistemática(Universidad Católica de Cuenca., 2025) Lapo Torres, Bryan Steeven; Blandin Lituma, Paula Eliana; 0706664950Objective: To determine the efficacy and safety of dual therapy with amoxicillin and vonoprazan versus bismuth-based quadruple therapy to eradicate Helicobacter pylori. Methodology: A systematic literature review was conducted using significant databases such as (Medline, Embase, MDPI, Cochrane, LILACS) and keywords (Helicobacter pylori, vonoprazan, amoxicillin, and bismuth, among others). Eleven studies meeting eligibility criteria were selected (inclusion: studies with dual therapy using amoxicillin and vonoprazan in one treatment arm and bismuth-based quadruple therapy in the other; exclusion: abstracts, conference presentations, other article types, and quadruple therapy including vonoprazan). Efficacy, safety, and quality were assessed using the NIH risk of bias tool for clinical studies. Results: Eleven articles were included, all randomized non-inferiority clinical trials with 100 to 600 participants suffering from untreated H. pylori gastric infection. The eradication efficacy of H. pylori with dual therapy using vonoprazan and amoxicillin ranged from 59.3% to 98.5%. H. pylori eradication rates were similar between the two therapies (OR 1.27, 95% CI 0.72–2.22, p=0.41), as most included studies were non-inferiority trials. Reported adverse events were gastrointestinal, with dual therapy showing a lower incidence (OR 0.28, 95% CI 0.23–0.35, p=<0.00001) than bismuth-based quadruple therapy. Both groups demonstrated high adherence rates of over 80%. Keywords: vonoprazan, eradication, Helicobacter pylori, amoxicillin, bismuthÍtem Acceso Abierto Eficacia y seguridad de los inhibidores del cotransportador de sodio glucosa-2 versus los agonistas del receptor del péptido similar al glucagón-1, en personas con diabetes tipo 2 y enfermedad renal crónica: revisión sistemática(Universidad Católica de Cuenca., 2025) Chuqui Coronel, Segundo Miguel; Redrovan Coraizaca, Andres Leonardo; Idrovo Vázquez, Víctor Aníbal; 0302503388; 0302627807Background: Diabetes is a serious global health problem, with an estimated prevalence of 425 million in 2017, which is projected to decline to nearly 360 million by 2045, according to the International Diabetes Federation (IDF). A significant complication is chronic kidney disease, which develops in nearly half of individuals previously diagnosed with type 2 diabetes mellitus. Therefore, there is an urgent need for more effective and safer approaches. Objective: To evaluate the efficacy and safety of Sodium-glucose cotransporter type 2 (SGLT2) inhibitors compared to Glucagon-Like Peptide-1 (GLP-1) agonists in the treatment of adult patients with type 2 diabetes mellitus and chronic kidney disease. Methods: This systematic review will follow the PRISMA 2020 methodology, which will enhance the quality of this review. Additionally, various health determinants will be used to conduct a comprehensive search for information. Results: SGLT-2 inhibitors indicated a significant reduction in HbA1c levels with a value of -0.8%, representing an effect estimate of the presented variables, along with a 95% confidence interval. On the other hand, GLP-1 agonists showed a reduction of -0.7%, with 95% confidence interval, indicating no significant differences between both variables, especially in terms of safety. SGLT-2 inhibitors were associated with a higher risk of urogenital infections, while GLP-1 agonists indicated an increased incidence of nausea and vomiting. Therefore, both types of medications are effective, but present patterns of adverse events that should be considered in clinical practice. Keywords: GLP-1 agonists, diabetes mellitus, SGLT-2 inhibitorsÍtem Acceso Abierto Sensibilidad y especificidad de cervicometría versus fibronectina fetal en la predicción de parto prematuro: revisión sistemática(Universidad Católica de Cuenca., 2025) González Álvarez, Jennifer Patricia; Pesantez Siguencia, Katherine Graciela; Rodas Torres, Américo Gerardo; 0105837009; 0302738737Background: Preterm birth is one of the leading causes of neonatal morbidity and mortality, making the early identification of women at risk crucial. This systematic review analyzes and compares the sensitivity and specificity of two widely used diagnostic methods: cervical length measurement and fetal fibronectin test. Cervical length measurement, which evaluates cervical length via ultrasound, and fetal fibronectin detection, a protein indicative of extracellular matrix breakdown during pregnancy, have shown effectiveness in predicting preterm birth. However, their performance varies depending on factors such as test timing and population characteristics. Method: This study was conducted following the PRISMA framework by systematically reviewing scientific articles from databases such as Scopus, PubMed, and Cochrane Library, including articles that evaluated and compared these two methods regarding sensitivity and specificity. The information will be organized using the Rayyan platform, and the quality of the studies will be assessed using Joanna Briggs Institute forms. Expected Results: This study aims to determine which diagnostic method offers greater sensitivity and specificity in predicting preterm birth. Conclusions: This systematic review seeks to provide a better understanding of diagnostic methods for preventing preterm birth. Keywords: cervical length measurement, fetal fibronectin, preterm birthÍtem Acceso Abierto Eficacia de los tratamientos derivados del extracto de melaleuca versus otros tratamientos para la blefaritis por demodex: revisión sistemática(Universidad Católica de Cuenca., 2025) Arostegui Gutiérrez, César Iván; Guamán Ávila; Arias Peláez, María Cristina; 1400645162; 0302846316Background: Demodex blepharitis is a chronic ophthalmological condition characterized by inflammation of the eyelid margins. Although many people with Demodex mites are asymptomatic, conventional treatments include pharmacological and hygiene measures. Objective: To determine the efficacy of melaleuca extract treatment compared with other treatments for Demodex blepharitis. Methods: This review used the PRISMA 2020 methodology, including IT B, randomized controlled trials (RCTs) to ensure reliable results, and 1.0 (RoB 1) tool to assess the risk of bias. Results: Melaleuca extract used in Demodex blepharitis has been shown to reduce clinical manifestations. However, it is not considered a replacement for conventional antibiotics, as these are still essential in cases requiring timely and rapid intervention to prevent bacterial proliferation. This oil, complemented with antibiotics, offers an alternative to reduce inflammation and combat various microorganisms. It is crucial to assess patients on an individual basis. Conclusion: Melaleuca extract demonstrated efficacy in reducing symptoms of Demodex blepharitis, such as itching, burning, and dry eyes, enhancing traditional therapies. Compared to treatments like ivermectin and metronidazole, it is more competitive even though, in some cases, it shows higher eradication rates. Its favorable safety profile and minor side effects make it ideal for patients seeking lower-risk therapeutic options. In addition to alleviating symptoms, it improves emotional well-being and functionality, making it a practical option for managing this condition. Keywords: visual acuity, corneal crosslinking, keratoconusÍtem Acceso Abierto Antibioticoterapia versus apendicectomía en apendicitis aguda no complicada en adultos y niños: revisión sistemática(Universidad Católica de Cuenca., 2025) Idrovo Calle, Wilson Rolando; Rodas Andrade, Jorge Roberto; 0301961363Traditionally, acute appendicitis has been treated through open surgery; however, laparoscopic surgery has become the most widely used method today. Additionally, the use of antibiotics is being evaluated, specifically in uncomplicated cases. Objective: To evaluate the comparative effectiveness of antibiotic therapy versus appendectomy in the treatment of uncomplicated acute appendicitis in adults and children. Methodology: Twenty studies comparing the use of antibiotics and appendectomy for the treatment of uncomplicated acute appendicitis in children and adults were analyzed using search engines and electronic databases such as Scopus, Taylor & Francis, Web of Science, UpToDate, DynaMed Plus, and PubMed. Results were synthesized into tables, and bias was assessed using various scales. Results: The quality of life in adults was significantly improved with broad-spectrum antibiotics like metronidazole, with scores above 0.86 points. Only one study reported elevated scores in children. Recurrence rates of acute appendicitis ranged from 11% to 33.5% in adults and from 3% to 45.8% in children. Conclusions: The combination of ciprofloxacin and metronidazole was the most commonly used antibiotic regimen, with success rates ranging from 64% to 98.46%. Hospital stays for antibiotic treatment ranged from 28.9 hours to 6.8 days, while stays for the surgical group ranged from 1 to 4 days, with a maximum period of 3 days in children. Keywords: appendicitis, adult, child, antibiotics, quality of lifeÍtem Acceso Abierto Eficacia del ácido tranexámico ante medicamentos útero tónicos para el control de la hemorragia posparto primaria. Revisión sistemática(Universidad Católica de Cuenca., 2025) Loja Patiño, Johanna Elizabeth; Blandín Lituma, Paula Eliana; 0302411806Postpartum hemorrhage is defined by the World Health Organization (WHO) as blood loss of 500 ml or more within the first 24 hours after vaginal delivery and 1,000 ml or more after cesarean delivery, causing hemodynamic alterations in the patient. Common causes include uterine tone abnormalities, trauma, retained tissue, or coagulopathies. Objective: To determine the efficacy of tranexamic acid compared to the use of uterotonic drugs for the control of primary postpartum hemorrhage. Methodology: A systematic literature review was conducted, with searches performed in databases such as PubMed, SpringerLink, Elsevier, and Frontiers. Keywords were combined using Boolean operators like AND to optimize results. The review included studies in English and Spanish published after 2020, all available in open access. Literature references were managed with Zotero, articles were analyzed using the NIH tool, and the risk of bias was evaluated with ROB-2. Results: Thirteen articles meeting the specific objectives were included. Seven analyzed tranexamic acid, and six focused on oxytocin and carbetocin, the leading uterotonic drugs. All the drugs achieved the primary outcomes specified in the articles. However, oxytocin was more likely to cause maternal adverse effects. Conclusions: All analyzed drugs demonstrated high efficacy in achieving the primary objective of reducing bleeding levels. Treatment lasted up to 10 minutes, with varying dosages based on population characteristics. Oxytocin presented the highest incidence of adverse effects, notably tremors. Keywords: tranexamic acid, hemorrhage, postpartum hemorrhage, oxytocinÍtem Acceso Abierto Eficacia de la enoxaparina versus el rivaroxabán en la prevención del tromboembolismo venoso en trauma ortopédico: revisión sistemática(Universidad Católica de Cuenca., 2025) Nivelo Alvarez, Paula Renata; Capote Llanares, Miguel Ángel; 0954297040Venous thromboembolism (VTE) is a condition that leads to the formation of a blood clot in a blood vessel, which can travel and eventually block blood flow, endangering the patient’s life. Objective: To analyze the efficacy of enoxaparin versus rivaroxaban in preventing venous thromboembolism in orthopedic trauma. Methodology: A systematic review with a descriptive design and mixed approach was conducted following the PRISMA method parameters, analyzing 22 articles from scientific sources such as PubMed, Scopus, Lilacs, Redalyc, SciELO, and Web of Science. Results: Obesity, smoking, hypertension, diabetes, a history of venous thrombosis, and hospitalization were the predominant risk factors. Additionally, women over 60 years old were prevalent in both groups. The administered dose of enoxaparin was 40 mg/day for durations of 10, 14, 30, 35, and 90 days, while the daily dose of rivaroxaban was 10 mg for 7, 14, 35, 42, and 90 days. Enoxaparin reduced the risk of deep vein thrombosis (DVT) to 2.11% and pulmonary embolism (PE) to 0.57%. Rivaroxaban reduced DVT to 2.30% and PE to 0.13%. Both medications were well-tolerated by patients, though they presented common adverse effects such as bleeding at a low incidence. Conclusions: Both drugs effectively prevent VTE, but rivaroxaban revealed greater efficacy in preventing PE and did not present mortality cases. Keywords: venous thromboembolism, adverse effects, prevention, enoxaparin, rivaroxabanÍtem Acceso Abierto Eficacia de la hidralazina versus nifedipino en el tratamiento de la preeclampsia: revisión sistemática(Universidad Católica de Cuenca., 2025) Benalcázar Urgiles, Patricia Jacqueline; Naula Morocho, Johanna Veronica; Gallegos Vintimilla, Santiago Homero; 0107130221; 0106182850Background: Among the most commonly used drugs in pregnant women diagnosed with preeclampsia are hydralazine and nifedipine. Their efficacy, as well as their onset of action, has been demonstrated to reach optimal levels. Their use is widespread, though not without concerns about adverse maternal and perinatal effects. Objective: To characterize the efficacy of hydralazine versus nifedipine in treating preeclampsia. Methodology: A systematic literature review was conducted involving searches in health databases, primarily PubMed, Elsevier, and SpringerLink, using predefined descriptors supported by Boolean operators such as AND and OR to optimize the searches. The PRISMA methodology was employed for screening and selection processes. All articles included were published after 2020 in English or Spanish as essential inclusion criteria. Sixty-four references met the established requirements, and 57 were included in the final bibliography. Results: Twelve articles met the screening and suitability processes according to the designed objectives. The onset of action of both medications varied depending on the doses. Hydralazine demonstrated a slightly faster onset compared to nifedipine. Regarding efficacy levels, both drugs showed optimal results. However, nifedipine was associated with a higher incidence of adverse effects. Conclusions: Hydralazine proved to be faster in its action. Both drugs achieved appropriate levels of efficacy, although nifedipine revealed a more significant number of adverse effects. Keywords: antihypertensives, hydralazine, hypertension, nifedipine, preeclampsiaÍtem Acceso Abierto Secuelas en pacientes con neumonía por COVID-19(Universidad Católica de Cuenca., 2022) Armijos González, Ana Lucía; Idrovo Vásquez, Víctor Aníbal; 1900536390Millions have been infected by a new virus that appeared in 2019 and spread rapidly around the world, causing mild to fatal conditions. The current and future concern is “The consequences in patients with pneumonia by COVID-19” that, according to the evidence, there is a multi-organ involvement. Objective: To know the sequelae in patients with pneumonia caused by Covid 19. Material and method: a systematic review of studies, cases, and articles that met the selection criteria. Results: in hospitalized patients: pulmonary fibrosis in 37% (intubated), myocarditis 3.9%, tracheal stenosis with 50.8% of symptomatic patients and of wich 3.1% is associated with trachea-esophageal fistula and tracheomalacia; and in outpatients: pulmonary fibrosis in 12% (not intubated), pericarditis in 21.7%, myocarditis 13.7%, PE 17%, ischemic stroke in 1.6%, predisposition to kidney injury in 100% of older adults, depression, and anxiety in 30%, sleep disorders in 85%, and initial symptoms of intection such as dyspnea, anosmia, myalgia, headache, etc., that persist for more than a month or more than 12 months, in about half or all of the patients. Conclusions: the evidence shows a real compromise in vital organs such as the lung, heart, and kidney in a large percentage of patients, for which the opening of health centers for pulmonary rehabilitation and psychological care should be considered; in addition, it established follow-up guidelines for early detection of sequelae and treatment. Keywords: sequelae, SARS CoV 2, Covid 19, Post Covid Syndrome, prolonged CovidÍtem Acceso Abierto Infuciciencia cardiaca aguda y furosemida a altas dosis(Universidad Católica de Cuenca., 2022) Argudo Cabrera, Pablo Andrés; Idrovo Vásquez, Víctor Aníbal; 0105874929Introduction: An imbalance in the contractile capacity of the heart causes acute heart failure. It is currently considered that there is no wholly established therapeutic management. So more than 80% of patients are treated with loop diuretics, mainly furosemide, which is the mainstay of treatment. Objective: To determine the benefit of high-dose furosemide in treating acute heart failure. Materials and methods: A literature review was performed based on the PRISMA guide of articles mentioning furosemide as a first-line drug in databases such as PubMed and Cochrane, that study acute heart failure and its therapeutic management. The studies reviewed are written in English and Spanish and published in the last five years. A total of 28 articles were analyzed. Results: According to articles, furosemide continues to be considered a therapeutic pillar. The evidence also mentions whether this drug is administered at high doses in continuous doses or boluses; it continues to be accepted. Conclusions: Considering the studies conducted, furosemide has not been shown to reduce mortality. However, it is still the therapeutic pillar of initial management, especially at high doses. Based on the research carried out in trials and comparative studies, there is currently no established management scheme. Keywords: acute heart failure, loop diuretics, high dosesÍtem Acceso Abierto Manejo de la insuficiencia Renal Aguda con Furosemida a Dosis Altas(Universidad Católica de Cuenca., 2022) Andrade Ortiz, Jefferson Fernando; Idrovo Vásquez, Víctor Aníbal; 0302946611Introduction: Acute renal failure (ARF), considered a condition characterized by a sudden decrease in renal function, is associated with high rates of morbidity and mortality in critically ill patients. In this sense, the initial therapeutic management is important, which should focus on optimizing the patient’s internal hemodynamics. To do this, a series of diuretic drugs are used in patients with a tendency to retain fluids. In this regard, furosemide is the most widely used diuretic, however, the therapeutic value of high-dose administration is not fully known. Objective: To present current scientific evidence on the management of ARF with furosemide in high doses. Materials and Methods: A methodological design of the descriptive non-experimental type was used, with the review of nine articles of the current scientific literature of the digital databases SciELO, PubMed, Cochrane, among others, to compile relevant information and achieve a better understanding of the topic. Results: Previous studies do not recommend the application of this treatment; however, four current studies show that furosemide at high doses in continuous infusion increases diuresis, the restoration of renal function, and the decrease in deaths. Conclusions: The evidence is controversial, the therapeutic strategy should be aimed at patients with ARF without severe symptoms, preferably in continuous infusion since it is beneficial, although in-depth studies are required to adequately validate the results and define the clinical applications. Keywords: AKI, high doses, furosemide, acute renal failure, oliguriaÍtem Acceso Abierto Síndrome de distrés respiratorio en el recién nacido(Universidad Católica de Cuenca., 2022) Alvarez Montero, Manuel Felipe; Alomía Castro, Paul Esteban; 0302498381Background: Respiratory distress syndrome, hyaline membrane disease (HMD), or respiratory distress syndrome in the newborn (RDSN) is the most frequent pathological entity in patients with gestational age < 37 weeks; it is caused by surfactant deficit conditioning the oxygenation of the newborn. Objective: To describe with updated information the respiratory distress syndrome in newborns. Methodology: A scientific literature review was conducted, programmed, and focused on the last five years to present a quality project to strengthen the knowledge of the disease; after a complete reading, the literary selection was performed utilizing the Mendeley program. Results: The main factors were prematurity (93.9%) and male sex (59.2%). Pulmonary ultrasound and ductus arteriosus velocity is sound in prenatal diagnosis, presenting sensitivity (83%) and specificity (93%). After birth, thoracic radiography has a sensitivity (85%) and predictive value (86%). Betamethasone was adequate in the preventive treatment for RDSN in 727 patients who received two doses (57.5%) and 436 with one dose (34.5%), reducing it by (60%) and (21%) respectively. Natural surfactant improved ventilation by (96%), decreasing bronchopulmonary dysplasia and postpartum death. CPAP and IMV were effective in reducing lung damage and neonatal mortality. Conclusions: Male premature infants are a risk factor, currently, innovative methods in diagnosis and treatment allow fetal well-being. Keywords: respiratory distress syndrome, hyaline membrane disease, newborn, surfactant.
