Trabajos de Titulación - Medicina
URI permanente para esta colecciónhttps://dspace.ucacue.edu.ec/handle/ucacue/23
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Envíos recientes
Ítem Acceso Abierto Terapia ANTI-TNF versus NO ANTI-TNF en el manejo de la enfermedad de Crohn perianal fistulizante(Universidad Católica de Cuenca., 2025) Alvarez Sarmiento, Josseline Elizabeth; Ascaribay Mora , Andrés Fernando; Aldás Erazo , Manuel Rafael; 0106092380; 0106627565Title: Anti-TNF Therapy versus Non-Anti-TNF Therapy in Perianal Fistulizing Crohn's Disease Objective: To determine the effectiveness of Anti-TNF Therapy versus Non-Anti-TNF therapy in managing fistulizing perianal Crohn's disease. Methodology: The PRISMA declaration was used through databases such as PubMed, Cochrane, SciELO, ProQuest, and ScienceDirect, using search algorithms based on keywords. In addition, eligibility and inclusion criteria were applied, including articles published within the last five years, a list of biologics as therapy for CD (Crohn’s Disease) perianal fistulizing, original articles in Spanish and English; and exclusion criteria such as those that are not scientific and do not support the research question. Additionally, to determine the risk of bias in the studies, the Newcastle-Ottawa scale was applied, and finally, to synthesize the results, the Excel tool was used in which the interventions of the participants in each article were initially described, whether with the use of one or another biological. Results: In this review, a total of 31 articles, including both descriptive studies and clinical trials, were used, involving a total of 6803 participants with fistulizing perianal CD. On average, the included articles demonstrated a clinical remission rate of 37.82% and a response rate of 59.21% non-anti-TNF therapy patients. However, those patients with anti-TNF therapy achieved a remission rate of 50.67% and a response rate of 67.77%. In addition, adverse effects were found in both therapeutic profiles, such as skin erythema, recurrent infections, and worsening of perianal CD, among others. Conclusions: Although both therapies are feasible, TNF inhibitors stand out in response and clinical remission in maintenance. However, they present more significant adverse effects.Ítem Acceso Abierto Clip endoscópico para la prevención del sangrado después de la resección de pólipos colorrectales(Universidad Católica de Cuenca., 2025) Bustamante Correa, Karla Elizabeth; Calle Rodas, Daniel Alejandro; 0107559445Colorectal polyps are lesions that protrude from the surface of the mucosa into the lumen of the colorectum. They are treated surgically, and bleeding is the most common complication during the procedure. However, 10% of patients may bleed for up to 3 days after resection, which is usually managed by endoscopic hemostasis using coagulation forceps, adrenaline injections, and thermal coagulation methods. Currently, endoscopic clips have gained popularity as a new hemostatic technique. Despite their good results, they have limitations depending on patient-specific factors and the technique applied by the endoscopist. This literature review aims to describe the efficacy of endoscopic clips as a preventive measure for bleeding after colorectal polyp resection. Considering the benefits and limitations of the technique, several authors justify that clipping is appropriate according to clinical criteria and the individual characteristics of the patient. However, others contrast this with evidence suggesting the lack of efficacy of routinely use of clips to close resection sites, especially in polyps smaller than 20 mm. The effectiveness of clips for prophylactic purposes in bleeding remains controversial due to the significant gap in the standardization of data collected across different studies. The size of the polyps, resection technique, number of clips used to close the lesion, and endoscopist training are the main factors that affect the resultsÍtem Acceso Abierto Hipotiroidismo congénito(Universidad Católica de Cuenca., 2025) Montaño Loja , Angie Tamara; Vanegas Cobeña , Nancy Esperanza; 0107171365Congenital hypothyroidism (CH) is a medical condition in which a newborn has a defect in the production of thyroid hormones. An absent, underdeveloped, or malformed thyroid gland can cause this. Discussion of CH is extremely important due to its profound implications for the health and development of newborns. Neonatal screening plays a fundamental role in the early detection and effective management of this condition. This practice allows affected newborns to be identified before they show clinical symptoms, facilitating early initiation of treatment with levothyroxine. Early detection and timely treatment are crucial to prevent delays in physical and mental development, as well as to reduce the risk of long-term complications associated with CH. In conclusion, a comprehensive understanding of congenital hypothyroidism requires a multidisciplinary approach that includes early detection, appropriate treatment, and continuous monitoring of the patient.Ítem Acceso Abierto Complicaciones pulmonares causadas por la utilización del cigarrillo electrónico(Universidad Católica de Cuenca., 2025) Porras Carrillo , Gabriela Katherine; Maldonado Valverde, Andrés; 0706210556The use of electronic cigarettes has raised concerns due to potential lung complications. Although they have been promoted as a less risky alternative to traditional smoking, studies show they are not without risks to lung health. One of the main complications is acute lung injury, such as bronchiolitis obliterans, a serious disease that can lead to permanent lung dysfunction and, in extreme cases, death. However, there has been an increase in cases of lung diseases, especially among young people who use e-cigarettes with liquids containing nicotine and other additives. Another significant complication is the development of lipid pneumonia, a lung condition in which tissues become inflamed due to the inhalation of oils and other components present in the liquids used in e-cigarettes. This condition can cause symptoms such as breathing difficulties, coughing, chest pain, and other serious respiratory symptoms. Furthermore, electronic cigarettes can aggravate pre-existing respiratory conditions, such as asthma and chronic obstructive pulmonary disease (COPD). Exposure to the chemical components and fine particles in e-cigarette aerosol can irritate the airways and worsen symptoms in people who already have these diseases. In summary, even though that e-cigarettes have been promoted as a better and safer option than conventional smoking, their use carries significant risks to lung health. Both patients and healthcare personnel need to be aware of these complications and take measures to prevent their occurrenceÍtem Acceso Abierto Vitamina D y cáncer de mama(Universidad Católica de Cuenca., 2025) Lopez Vallejo, Maria Eduarda; Ochoa Bravo , Andrea Catalina; 1316160504Introduction: The relationship between vitamin D and breast cancer has been a subject of growing interest in medical research, as numerous studies suggest an association between adequate vitamin D levels and a significant reduction in the risk of developing neoplasms of the mammary gland. Sun-derived vitamin D, primarily known for its role in bone health, has emerged as a potentially crucial factor in the prevention and progression of various types of neoplasms, including breast cancer. Clinical and experimental studies support its role in tumor inhibition, improved prognosis, and lower incidence in populations with adequate sun exposure. Consequently, this literature review aims to highlight the relationship between breast cancer pathology and vitamin D. Objective: To conduct a narrative literature review on the relationship between vitamin D and breast cancer. Methodology: A scientific literature search was conducted using databases such as PubMed, Scopus, SciELO, and Web of Science, covering 10 years up to the present, and focusing on studies related to vitamin D and cancer. Conclusion: Vitamin D deficiency plays a significant role as a major risk factor for the development of breast neoplasia. Maintaining adequate vitamin D levels helps combat the growth and spread of this carcinoma.Ítem Acceso Abierto Anticuerpos monoclonales como tratamiento para la esclerosis múltiple: efectividad, seguridad y perspectivas futuras(Universidad Católica de Cuenca., 2025) Ramón Once , Jheymi Marcela; Jaramillo Alvarez , Christian Andrés; 1400859425TITLE: Monoclonal Antibodies as a Treatment for Multiple Sclerosis: Efficacy, Safety, and Future Prospects. The treatment of multiple sclerosis may include lifestyle changes and/or the administration of drugs, depending on the severity and clinical manifestations presented by the patient. OBJECTIVE: To analyze the efficacy and safety associated with the use of monoclonal antibodies as a treatment for multiple sclerosis. METHODOLOGY: This research consists of a descriptive literature review with a qualitative approach, supported by 55 publications obtained from scientific databases such as Scopus, Lilacs, Redalyc, PubMed, Web of Science, and SciELO. CONCLUSION: Multiple sclerosis has no cure, but the emergence of monoclonal antibodies represents a reliable alternative to reduce the severity of symptoms, control the progression of disability, prevent new relapses, and improve the quality of life of patients.Ítem Acceso Abierto Efectos de los inhibidores del cotransportador sodio-glucosa tipo 2 en la anemia(Universidad Católica de Cuenca., 2025) Reinoso Astudillo , Evelyn Marcela; Reiban Espinoza, Esteban Adrian; 0107488108Introduction: The relevance of this review lies in the growing evidence that sodium-glucose cotransporter 2 inhibitors (SGLT2i) go beyond their traditional use in managing type 2 diabetes, showing potential benefits for treating anemia associated with chronic diseases such as chronic kidney disease and heart failure. This review examines the impact of SGLT2i on erythropoiesis, thereby enhancing life expectancy and quality of life. Literature Review: Recent studies indicate that SGLT2i improve tissue hypoxia and anemia by inhibiting glucose reabsorption in the renal tubules, reducing oxygen consumption, and improving renal tissue oxygenation. This results in an elevation of erythropoietin production, an increase in hematocrit and hemoglobin levels, and an improvement in survival, as well as a reduction in renal and cardiovascular events. The underlying mechanisms include reducing inflammation and modulating hypoxia signaling and ferrokinetics. Conclusions: SGLT2i have an extended therapeutic effect that goes beyond glycemic control, also including the regulation of anemia in patients with chronic diseases. These findings suggest a paradigm shift in the therapeutic approach, offering a more comprehensive treatment for these comorbidities.Ítem Acceso Abierto El papel del macrófago en la migración de las células troncohematopoyéticas a la médula ósea(Universidad Católica de Cuenca., 2025) Cabrera Donoso, Arianna Camila; Puente Mosquera , Karola Adriana; 0107463655The hematopoietic system, which encompasses the production of blood cells, is profoundly influenced by the presence and function of macrophages. These cells play a key role in regulating erythropoiesis, the immune response, and tissue repair. Their involvement ranges from the creation of specialized niches for red blood cell production to the modulation of the hematopoietic microenvironment and the inflammatory response. A thorough understanding of macrophage biology and function can significantly impact the diagnosis, treatment, and development of therapies for hematological disorders, such as leukemia and anemia. Their functional plasticity and diversity offer promising opportunities for more targeted and effective therapeutic interventions. However, further research is still needed to fully unravel the role of macrophages in hematological health and pathology, highlighting the importance of continuing research in this field in the search for new therapeutic strategies.Ítem Acceso Abierto Relación entre el Parkinson y la depresión: causas y tratamiento(Universidad Católica de Cuenca., 2025) Oliveros Ramón, Lizbeth Estefanía; Jaramillo Loaiza, Walter Viterio; 0106340003Introduction: Patients with Parkinson's disease present a higher incidence of depressive symptoms compared to the general population. This association is attributed to neurobiological, psychological, and psychosocial factors. Treatment is of vital importance due to the multiple implications depression may have on disease progression and patients’ quality of life, since effective treatment of depression can contribute to an improvement in the emotional, social, and functional well-being of the patient with Parkinson's disease. This paper aims to describe the relationship between Parkinson's disease and depression, with reference to its causes and treatment. Literature Review: A narrative-type investigation was conducted, including 15 articles in Spanish and English from the last 5 years. The current literature highlights dopaminergic neuronal degeneration in the central nervous system as the main cause of Parkinson's disease. Regarding treatment, the efficacy of antidepressants already used in clinical practice has been demonstrated, as well as alternative therapies. These findings underscore the importance of a comprehensive approach to treating depression in patients with Parkinson's disease. Conclusions: The relationship between Parkinson's disease and depression is complex, as it involves neurobiological, psychological, and social causes. The psychological impact of a chronic illness and the loss of independence lead to social isolation, which can exacerbate depressive episodes. Conventional antidepressant treatments are effective; however, alternative therapies have also demonstrated their value and effectiveness in improving motor and non-motor symptoms associated with Parkinson's disease.Ítem Acceso Abierto Complicaciones de la Trombosis Venosa Esplácnica(Universidad Católica de Cuenca., 2025) Silva Tene, Katherine Mabel; Puente Mosquera, Karola Adriana; 0803076694Introduction: Splanchnic Venous Thrombosis (STV) is an infrequent but serious condition, involving the formation of a blood clot in the splanchnic venous system, transporting blood through several digestive organs such as the spleen, liver, small intestine, and colon. In some cases, STV may be asymptomatic; which makes its complications potentially life-threatening. This literature review aims to describe the complications of STV to improve its diagnosis and treatment. Theoretical Framework: Among the main complications identified from this review are portal hypertension, caused by obstruction of portal blood flow; splenic infarction, triggered by necrosis of splenic tissue due to insufficient blood supply; mesenteric thrombosis, resulting from thrombosis of the mesenteric veins, leading to intestinal ischemia; and pulmonary thromboembolism, which occurs when a blood clot detaches and moves to the lung. Conclusions: Splanchnic venous thrombosis is a disease with the potential to trigger life-threatening complications. Therefore, it should be diagnosed in time and, in turn, provided with adequate treatment to prevent these complications. In addition, as it is a rare disease, further studies are needed to understand and improve the underlying mechanisms of STV and to develop more effective preventive and therapeutic strategies.Ítem Acceso Abierto Efectividad de las estrategias de telemedicina en el seguimiento de pacientes con enfermedades cardiacas crónicas(Universidad Católica de Cuenca., 2025) Mora Sacaquirin, Juan Carlos; Chunchi Ayala , Luis Mario; 0705433613Introduction Telemedicine, defined as medical practice supported by mobile devices and wireless technology, has experienced rapid growth in response to healthcare challenges, particularly in the management of chronic diseases such as heart failure. Key Findings of the Review Telemedicine has proven to be an effective tool that contributes to reducing mortality and hospitalizations in patients with chronic heart disease. Remote cardiac monitoring enables early detection of decompensation, improving clinical outcomes. The combination of telemonitoring and pharmacological support reduces both mortality and hospitalizations. It is also effective and cost-effective in cardiovascular risk prevention, cardiac rehabilitation, and chronic diseases management. Technological advances and data management will further optimize these strategies. Conclusions Medicine 4.0 is transforming the care of chronic heart disease through advanced technologies such as telemonitoring and mobile health systems, improving the efficiency and quality of care without replacing the physician. However, it faces challenges such as data security and initial implementation costs, especially in areas with limited resources.Ítem Acceso Abierto Infiltrado de adipocitos en médula ósea y su relación con la progresión del mieloma múltiple(Universidad Católica de Cuenca., 2025) Romero Vintimilla, José Rodrigo; Castillo Mosquera, Paulette Geovanna; Puente Mosquera , Adriana; 0706967155; 1719717850TITLE: Adipocyte Infiltration in Bone Marrow and Its Relationship with the Progression of Multiple Myeloma OBJECTIVE: This research aims to determine the relationship between adipocyte infiltration in bone marrow and its relationship with the progression of multiple myeloma. METHODOLOGY: A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement in the PubMed, Scopus, and WoS databases, searching for clinical trials on adipocyte infiltration in bone marrow and its relationship with disease progression. RESULTS: Ten clinical trial-type research articles that met the eligibility criteria were included. The selected articles determined that bone marrow adipose tissue increased disease progression through the inhibition of adiponectin, the increase of proto-oncogenes, and the decrease of tumor suppressor genes and chemoresistance. A combination of three drugs was effective in 75% of cases in co-cultured cells with normal adipocytes. However, only 46% of the cells inhibited myeloma cell growth in those with increased adipocytes. DISCUSSION: Several studies found that adipose tissue infiltration in the bone marrow was associated with progression from monoclonal gammopathy of undetermined significance (MGUS) to symptomatic multiple myeloma phase or chemoresistance in certain patients, although some mechanisms remain unclear. CONCLUSION: Based on the research, adipocyte infiltration in the bone marrow of patients with multiple myeloma is related to disease progression. This is due to the action of adiponectin at the cellular microenvironment level through various signaling pathways, inhibiting cell apoptosis and increasing clonal proliferation.Ítem Acceso Abierto Consumo de cafeína y anomalías congénitas: Revisión sistemática(Universidad Católica de Cuenca., 2025) Urgiles Rolland, Jorge Thomas; Ríos Romero, Kimberly Aniana; Muñoz Cajilima, Juan Pablo; 3040090023; 1719559484Introduction: Caffeine consumption produces effects on the fetus during pregnancy; however, the relationship between these changes and the appearance of congenital malformations is not entirely clear. Therefore, early detection of caffeine consumption in all pregnant women and women of childbearing age is encouraged to limit its consumption and prevent malformations. Objective: To determine the association between caffeine consumption during pregnancy and congenital anomalies. Methodology: A systematic review was conducted using the PRISMA 2020 statement. For this purpose, the search was performed in PubMed, Web of Science, and Scopus databases. The articles were selected using eligibility criteria, and the risk of bias was assessed using the ROBINS-I tool. Results: The results indicate that coffee consumption is associated with oral and craniofacial malformations, although some studies did not find this relationship. Adverse effects of caffeine on fetal blood flow, metabolism, increased amniotic fluid volume, cardiac and genital abnormalities, and low birth weight were also identified; however, other studies did not observe adverse effects with low doses of caffeine. Furthermore, coffee consumption has been associated with decreased fetal bone density and neurological alterations. Finally, although the evidence is limited, some studies suggest possible genetic alterations associated with caffeine consumption. Discussion: Pregnancy is a dynamic process influenced by internal and external factors, including diet. Some studies suggest that caffeine consumption is associated with oral and craniofacial malformations, cardiac, fetal growth, neurological, and genetic alterations. However, other studies do not find these relationships, and several present a high risk of bias. These limitations highlight the need for more rigorous and well- designed research to clarify the effects of caffeine on embryonic development. Conclusion: The systematic review reveals that coffee consumption is associated with oral and craniofacial malformations, cardiac, vascular, and neurological alterations in fetuses, low birth weight, and decreased bone density. Although some studies found that there is no relationship with certain anomalies and that low doses of caffeine seem not to have negative effects, the general evidence suggests possible risks for embryonic development.Ítem Acceso Abierto Amiloidosis cutánea: reporte de caso(Universidad Católica de Cuenca., 2025) López Guerrero, Ángela Patricia; Carlos Rolando; 0104987482Primary cutaneous amyloidosis is a rare pathology, particularly in its primary form, which may be associated with systemic diseases. It generally goes unnoticed and has a higher prevalence in women, with a ratio of 9:1. In Ecuador, it is more common in the coastal region and typically occurs in countries situated along the equatorial line. Its symptomatology is nonspecific, making diagnosis difficult. To date, there is no gold standard treatment; however, its management is symptomatic and yields non-curative results, a topic that remains controversial among healthcare professionals. A 30-year-old female patient presents with a case of a scaly and pruritic dermatosis in the form of macules on the upper back, neck, and hands since adolescence. Previously, she underwent treatments with corticosteroids and moisturizers, resulting in periods of remission and exacerbation. Upon physical examination, macroglossia and desquamative eruptions were noted, leading to a biopsy that confirmed the diagnosis of primary cutaneous amyloidosis. For treatment, the patient has adopted hygienic-dietary measures, moisturizers, topical corticosteroids, and antihistamines. Therefore, primary cutaneous amyloidosis is considered rare, challenging to diagnose, and subject to controversial treatment.Ítem Acceso Abierto Enfermedad de Rosai Dorfman: Reporte de caso(Universidad Católica de Cuenca., 2025) Durán Heras , Lisbeth Karola; Puente Mosquera , Karola Adriana; 1401145378Rosai-Dorfman disease (RDD) is a pathology that has not been extensively studied due to the low incidence of cases and its infrequent presentation, particularly in our country, Ecuador, where only one case has been reported. Therefore, presenting a detailed investigation encompassing the most relevant data on the process the patient underwent ―from the onset of symptoms, diagnosis, treatment, prognosis, to their current status― represents a valuable contribution to the scientific community, as it will provide guidelines for the management of patients presenting with the same condition. In that vein, the case of a 23-year-old male patient with a classic presentation of RDD is presented. The patient noticed the presence of a mass located in the left cervico-lateral area approximately 5 years ago, which evolved, showing relevant symptoms such as increased size (adenomegaly), pain, erythema, and inflammation. This prompted him to seek private medical consultation where basic and serological examinations were performed, all of which were within their normal range. Subsequently, a lymphadenectomy was decided upon, since the adenopathy met the criteria for performing an excisional biopsy in order to rule out cellular malignancy; the definitive diagnosis based on the analysis of the laboratory results was the presence of RDD. This report allows for a better understanding of one of the different clinical forms of the disease, the sequence of decisions that were made in accordance with the progress of the case, and a brief comparison between the existing literature and the findings of this investigation.Ítem Acceso Abierto Síndrome de Holt Oram en el recién nacido: reporte de caso(Universidad Católica de Cuenca., 2025) López Llivicura , Jonnathan Lisandro; Merchán Bustos , Fabián Andrés; 0105124143Holt Oram syndrome or atriodigital dysplasia, is caused by a rare autosomal dominant disorder given by a mutation in the long arm of chromosome 12 of the TBX5 gene, this disorder produces cardiac disorders such as interatrial and interventricular septal defects, and failures in the heart conduction system, in addition we can evidence skeletal abnormalities. The case presented is about a girl newborn who has prenatal history of diabetic mother without adherence to treatment and presents atrial and ventricular septal defect associated to overriding aorta showed by echocardiogram in addition to defects in the left upper limb and right lower limb.Ítem Acceso Abierto Trombocitopenia hereditaria: manejo perioperatorio en pacientes en cirugía cardíaca(Universidad Católica de Cuenca., 2025) Moran Palomeque , Antonela Estefania; Puente Mosquera , Karola Adriana; 0106398159Hereditary thrombocytopenia (HT) presents a significant challenge in the perioperative management of patients undergoing cardiac surgery due to the increased risk of hemorrhagic complications. This paper aims to analyze current strategies for the perioperative management of HT in cardiac surgery patients. A comprehensive literature review was conducted across various databases, and 43 high-quality studies were selected. The results highlight the importance of a thorough preoperative evaluation, including a detailed clinical history, physical examination, specific platelet function tests, and close follow-up with hematology. Therefore, it is important to emphasize that optimal perioperative management requires a multidisciplinary approach, with individualized strategies for each patient. Key measures primarily include optimizing the platelet count through transfusional support, the use of hemostatic agents, and drugs that improve platelet function, along with meticulous surgical techniques. Furthermore, close monitoring of hemostasis is essential throughout the procedure and in the immediate postoperative period. In conclusion, the perioperative management of HT in cardiac surgery demands a comprehensive and coordinated approach tailored to individual needs. Only through methodical planning, multidisciplinary teamwork, and continuous vigilance can outcomes be optimized and the risks associated with this complex hematological condition be minimized.Ítem Embargo Accidente ofídico en mujer gestante: reporte de caso(Universidad Católica de Cuenca., 2025) Guartán Pando, Janneth Verónica; González Pineda, Julio César; 0106346745Proyecto de Titulación embargado para publicación. Estará disponible a la fecha de publicación o de cierre de embargoÍtem Acceso Abierto Síndrome de Wiskott-Aldrich: reporte de caso(Universidad Católica de Cuenca., 2025) Guzmán Ochoa , Adriana Katherine; Espinoza Cardenas, Carlos Rolando; 0105472641Wiskott-Aldrich Syndrome is a primary immunodeficiency linked to the X chromosome; its rare incidence is 1 - 4 cases per million male live births. The classic phenotype can lead to the development of autoimmunity, with hemolytic anemia being the most common, followed by vasculitis, and, in a lower percentage, inflammatory bowel disease and kidney diseases. This case reports on a one-year-and-three-month-old male patient diagnosed with Wiskott-Aldrich Syndrome of classic phenotype who experienced health problems since birth, including recurrent pneumonia, anemia, thrombocytopenia, and bleeding episodes. He presented to the hospital due to emesis and yellowish liquid stools with mucus, but no blood. During the physical examination, marked decompensation was observed, manifested by pallor, tachycardia, and asthenia. Paraclinical tests confirmed the presence of hemolytic anemia and thrombocytosis. Radiology studies revealed the presence of an extensive splenic infarction, adding further complications to the patient's clinical picture. Although autoimmunity and hemolytic anemia are common complications in this syndrome, its hallmark is thrombocytopenia. Therefore, it is significant that the patient presented thrombocytosis, which was a relevant factor in the development of an extensive splenic infarction that required a splenectomy for resolution.Ítem Embargo Trastorno por déficit de atención e hiperactividad y su relación con el microbiota intestinal(Universidad Católica de Cuenca., 2025) Gordillo Espinoza , María Fernanda; Chalco Calle , Diego Fernando; 0705961464Proyecto de Titulación embargado para publicación. Estará disponible a la fecha de publicación o de cierre de embargo
