Trabajos de Titulación - Medicina
URI permanente para esta colecciónhttps://dspace.ucacue.edu.ec/handle/ucacue/23
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Item type: Ítem , Access status: Acceso Abierto , Embarazo ectópico bilateral. Reporte de caso(Universidad Católica de Cuenca., 2026) Calle Reinoso, Steve ManuelIntroduction: Bilateral ectopic pregnancy is the rarest form of extrauterine pregnancy and is extremely difficult to diagnose, occurring in 1% of pregnancies. The first publication of bilateral ectopic pregnancy was reported many years ago, reporting around 200 cases to date. Some of the countries that have reported these clinical cases are Chile, Mexico, and Colombia, among others. Furthermore, the diagnosis is based on clinical laboratory tests (human chorionic gonadotropin, progesterone, and others) and transvaginal ultrasound. Clinical case presentation: Female patient, 33 years old, AGO [Gynecology and Obstetrics Antecedents by its Spanish acronym]: G: 1, P: 1, C: 0, A: 0, referred clinical picture of 15 days of moderate transvaginal bleeding, accompanied by pain in the hypogastrium region with an intensity of 7/10 on the VAS scale, attended with ultrasound of ectopic pregnancy with amniotic sac, was evaluated and it was decided to admit her with surgical expectation. An exploratory laparotomy was performed, with findings of hemoperitoneum of approximately 300 ml, an injured right ectopic pregnancy, presenting an adnexal mass in the plastering phase +/- 8 cm, an uninjured left tubal ectopic pregnancy +/- 3cm, a macroscopically normal left ovary, hemorrhage of approximately 350 ml, diagnosing bilateral ectopic pregnancy resolved by right tubal adnexectomy plus partial left salpingectomy. Conclusions: Bilateral ectopic pregnancy is a rare pathology worldwide, and in our environment, the diagnosis is based on clinical symptoms, laboratory tests (human chorionic gonadotropin and progesterone), transvaginal ultrasound, and its treatment consists of surgeryItem type: Ítem , Access status: Acceso Abierto , Comparación diagnóstica de proteina Tau en saliva y en líquido cefalorraquídeo para la detección de enfermedad de Alzheimer. revisión sistemática(Universidad Católica de Cuenca., 2026) Guillén Gordillo, Pablo Sebastián; Noblecilla Vite, Ivanna NaomíIntroduction: Alzheimer's disease (AD) is a type of dementia characterized by a progressive neurocognitive disorder and the presence of proteins that trigger it, such as the P-tau protein. Objective: To compare the diagnostic efficacy of P-tau protein in saliva versus Cerebrospinal Fluid (CSF) for detecting Alzheimer's disease. Methodology: A systematic review was conducted following the PRISMA guidelines. Studies from the last five years were selected from databases such as PubMed and Web of Science in English and Spanish, according to inclusion and exclusion criteria. Bias was analyzed using the Robvis tool. Results: Of the 11 articles analyzed, three concluded that the use of saliva for the detection of p-tau protein might be beneficial for the diagnosis of Alzheimer's disease; however, no correlation was found with P-tau in cerebrospinal fluid. The remaining eight articles mention that it may become beneficial in the future; nevertheless, cerebrospinal fluid remains the gold standard. Discussion: The scientific evidence states that currently, the detection of P-tau protein in cerebrospinal fluid demonstrates greater efficacy compared to the detection in saliva, which has a lower efficacy. Conclusions: The diagnosis of AD by CSF will remain useful as an early and prognostic biomarker, while saliva is ideal for long-term monitoring.Item type: Ítem , Access status: Acceso Abierto , Granulomatosis con poliangeítis: reporte de caso(Universidad Católica de Cuenca., 2026) Amaya Yumbla , Maritza Del CisneIntroduction: Granulomatosis with Polyangiitis (GPA) is an autoimmune disease that belongs to the vasculitides associated with antineutrophil cytoplasmic antibodies (ANCA), which produce damage to the level of blood vessels. Its clinical presentation is complex and mainly affects the pulmonary and renal systems; its diagnosis is difficult; therefore, its management may be inadequate. The case of a 55-year-old female patient with GPA is reported, focusing on the clinical manifestations, diagnostic methods, and treatment regimen applied. Relevant findings: Presence of: sinusitis, cough with expectoration, dyspnea, pulmonary damage confirmed by computed axial tomography, and renal damage identified through laboratory tests and renal biopsy. Definitive diagnosis, therapeutic interventions, and results: The definitive diagnosis was reached through immunological tests, specifically ANCA testing, which reported high levels of anti-PR3 antibodies that are specific to GPA. For the management of the patient, an immunosuppressive regimen of cyclophosphamide and prednisone was initiated; however, due to observed adverse effects, it was decided to change the regimen to rituximab and mycophenolate mofetil, the doses were adjusted, taking into account the patient’s comorbidities. Conclusion: The importance of this case lies in the complex clinical presentation of the pathology, in addition to the diagnostic challenges and the importance of establishing an action plan according to the patient’s needs, identifying the severity of the multisystemic condition, and evaluating the underlying comorbidities.Item type: Ítem , Access status: Acceso Abierto , Detección de cáncer de páncreas mediante una red neuronal convolucional(Universidad Católica de Cuenca., 2026) Morquecho Solis, Veronica SamanthaIntroduction: Pancreatic cancer (PC) is a highly lethal malignant neoplasm worldwide, with an overall survival rate of less than five years after diagnosis, where risk factors may be hereditary or non-hereditary. Among exocrine malignant neoplasms, ductal adenocarcinoma is the most prevalent, accounting for approximately 90% of cases. Proper diagnosis and characterization of the tumor are strong predictors that help determine the type of treatment, the likelihood of metastasis, and survival. Literature Review: Convolutional Neural Networks (CNNs), when used to detect pancreatic cancer, achieve accuracy rates of over 95% in distinguishing cancerous from normal tissue. Furthermore, adequate training of CNNs on computed tomography (CT) scans enables the detection of tumors smaller than 2 centimeters with 87% sensitivity, while for tumors larger than 2 centimeters, accuracy increases to 95%, compared to 73% achieved in evaluat ions performed by medical personnel; however, such algorithms require detailed, high-qua lity information. Conclusion: Continuous advances in artificial intelligence have transformed research into the detection of pancreatic cancer using CNNs. This system offers accuracy rates of over 95%; therefore, properly training a CNN on computed tomography scans has surpassed the accuracy of conventional medical evaluation.Item type: Ítem , Access status: Acceso Abierto , Seguridad y tolerabilidad del nusinersen y onasemnogene como tratamientos para la atrofia muscular espinal: revisión sistemática(Universidad Católica de Cuenca., 2026) Fernandez Taday, Angela Fernanda; Suquinagua Ortiz, Jhon FernandoIntroduction: Spinal muscular atrophy (SMA) is an autosomal recessive disorder caused by a deletion in exon 7 of the SMN1 gene on chromosome 5q13. This alteration leads to a reduction in SMN protein, which is essential for the function of motor neurons. The most affected age group is children, who present clinical features such as asthenia, atrophy, paralysis, and, in severe cases, respiratory failure. For this reason, it is essential to analyze the safety and tolerability of therapies such as nusinersen and onasemnogene in treating this disease. Objective: To compare the safety and tolerability between nusinersen and onasemnogene as treatments for spinal muscular atrophy. Methodology: A systematic review was conducted through searches in databases such as Scopus, PubMed, and ProQuest, using inclusion and exclusion criteria, keywords based on health descriptors, and Boolean operators such as "AND" and "OR." The results will be presented in tables following the PRISMA method, and the methodological quality will be analyzed using the Newcastle-Ottawa Scale. Results: A total of 105 publications were found, of which 18 in English were selected, including clinical trials, systematic reviews, and retrospective observational studies. Conclusions: According to the collected data, nusinersen is safer than onasemnogene, with side effects managed according to each patient's symptomatology. Specifically, tolerability with onasemnogene is greater in patients (infants) with SMA type 1 and in patients with SMA type 2 and 3 (preschoolers and adults) treated with nusinersen.Item type: Ítem , Access status: Acceso Abierto , Conductas adictivas en la infancia y adolescencia: modelos teóricos, evaluación e intervención psicológica(Universidad Católica de Cuenca., 2026) Ochoa Vidal, Jhan PaulCurrently, children and adolescents are constantly at risk of developing various types of addictive behaviors; therefore, a literature review was conducted with the aim of identifying the conditions, theories, assessment methods, and intervention strategies related to these populations. This phenomenon requires an analysis of the underlying causes associated with family structure, social environment, and religious practices in order to identify modifiable risk factors. Addictive behaviors among young people are complex and influenced by various theoretical models, including critical pedagogy, self-efficacy theory, and ecological systems theory. Although internet use provides tools for development and socialization, it may also lead to addiction, particularly among individuals seeking to escape from personal problems. Internet addiction and other addictive behaviors are associated with psychosocial difficulties, social isolation, and mental health comorbidities. Prevention and treatment approaches should be multidisciplinary, incorporating psychological interventions, family-based strategies, and physical activities. The development of effective prevention policies and the need for rigorous clinical trials are essential to address these issues during adolescence.Item type: Ítem , Access status: Embargo , Síndrome de Stevens Johnson, asociado a la enfermedad por COVID-19: reporte de caso(Universidad Católica de Cuenca., 2026) Veloz Ayala , Edgar VinicioProyecto de Titulación embargado para publicación. Estará disponible a la fecha de publicación o de cierre de embargoItem type: Ítem , Access status: Embargo , Estrategias de intervención para la prevención y tratamiento de obesidad infantil en Latinoamérica(Universidad Católica de Cuenca., 2026) Paz Guerrero , Alex EdgarProyecto de Titulación embargado para publicación. Estará disponible a la fecha de publicación o de cierre de embargoItem type: Ítem , Access status: Acceso Abierto , Factores asociados a la conducta alimentaria en preescolares en centros de educación inicial, Cuenca-Ecuador, 2024(Universidad Católica de Cuenca., 2026) Vera Mena , Mayra Daniella; Vidal Carvallo , Diana DoménicaIntroduction: This study covers the factors associated with eating behavior in preschoolers, considering their importance in child development. A child's eating habits in early childhood are influenced by their environment, significantly impacting their long- and short-term health. It was also identified that there is a lack of information in these areas, especially in Latin America, demonstrating the relevance of this research. Objective: To determine the factors associated with eating behavior in preschoolers according to parental testimony in early childhood education centers in Cuenca, Ecuador, 2024. Methodology: The research was quantitative, correlational, and cross-sectional. A total of 196 preschoolers selected from municipal education centers in Cuenca participated. The Child Eating Behavior questionnaire (CEBQ) consisted of 35 questions classified into eight dimensions associated with eating behavior. Data were analyzed using SPSS, applying correlation and chi-square tests. Results: A group of 57.1% of participants were female, with an average age of 3 years. A high prevalence of emotional undereating (92.3%) and craving for alcohol (51%) was observed. No significant associations were found between eating behaviors and sociocultural and environmental factors. Conclusions: Eating behaviors in preschoolers were correlated, suggesting an interconnected pattern. Although no direct associations with environmental factors were found, family diet and caregiver practices are relevant for promoting healthy habits. These results have implications for public health and education to prevent developmental and growth disorders.Item type: Ítem , Access status: Acceso Abierto , Eficacia del anticuerpo Glofitamab como tratamiento de linfoma no Hodgkin. Revisión sistemática(Universidad Católica de Cuenca., 2026) Barreto Tenelanda , Byron Fernando; Atarihuana Valdez , Camila DomenicaIntroduction: Non-Hodgkin Lymphoma (NHL) is a hematological malignancy originating in B or T lymphocytes or natural killer cells. Current studies have evaluated therapy with glofitamab one of the most innovative bispecific monoclonal antibodies in the field of oncology. General objective: To determine the efficacy of the antibody glofitamab as a treatment for NHL. Methodology: A descriptive, systematic review was conducted. Articles from high-impact journals published within the last five years were retrieved from the following databases: PubMed, Scopus, and ProQuest. Search terms were based on DeCS and MeSH. Article selection followed the PRISMA guidelines. Results: Clinical trials demonstrated efficacy results for glofitamab, with an overall response rate of approximately 52% and a progression-free survival rate of 12 to 24 months. In refractory or regressing patients from prior therapies, glofitamab demonstrated favorable activity, with a durable complete response and a predictable, manageable safety profile. However, cytokine release syndrome was identified as the primary adverse effect.Item type: Ítem , Access status: Acceso Abierto , Accidente cerebrovascular hemorrágico secundario a dengue grave: Reporte de caso(Universidad Católica de Cuenca., 2026) Guambaña Vazquez , Bryan RubenIntroduction: Dengue is a viral disease trasmitted by Aedes aegypti, which continues to spread in Latin America and other subtropical and tropical regions, representing a major public health challenge. In its severe form, dengue may trigger rare neurological complications such as hemorrhagic cerebrovascular accident (CVA), possibly due to vascular damage and an exacerbated inflammatory response. This report presents a case that contributes to the medical literature by documenting the relationship between severe dengue and CVA. Clinical Findings: A 34-year-old male patient was admitted with a diagnosis of severe dengue and critical neurological deterioration. The initial evaluation revealed deep coma, anisocoria, and frontal intraparenchymal hemorrhage with midline shift, indicative of a secondary CVA. Diagnosis and Treatment: Following the definitive diagnosis of hemorrhagic CVA due to severe dengue, the patient was admitted to the Intensive Care Unit (ICU), where he received ventilatory support, treatment with hypertonic solution, and continuous monitoring for the management of cerebral edema and hemodynamic instability. Conclusion: The association between severe dengue and CVA poses a significant clinical challenge in endemic areas. This case highlights the importance of implementing preventive strategies in the management of patients with severe dengue, promoting early interventions that may improve prognosis in emergencies.Item type: Ítem , Access status: Acceso Abierto , Angiofibroma nasofaringeo juvenil: Reporte de un caso(Universidad Católica de Cuenca., 2026) Ortiz Atiencia , Katerin SamanthaIntroduction: Juvenile nasopharyngeal angiofibroma is a benign vascular neoplasm primarily affecting young males. It is a rare tumor, representing 0.05% of all head and neck tumors, with an incidence ranging from 1:5.000 to 1:60,000. As a rare neoplasm, conducting a case report on this pathology is important to increase medical knowledge on the subject and expand the information in the database. Case presentation: A 17-year-old male patient reported severe, persistent epistaxis of the left nostril for two days. He subsequently visited a specialist. A physical examination was performed, and after complementary tests, including a CT scan and angio-CT, a diagnosis of juvenile nasopharyngeal angiofibroma was made. The condition was treated with surgical resection. Conclusions: Juvenile nasopharyngeal angiofibroma is a benign but locally aggressive disease with epistaxis and nasal obstruction as its main clinical manifestations. It is diagnosed based on imaging studies. Treatment is complete surgical excision. The prognosis is favorable, although recurrence has been reported in 30% of cases.Item type: Ítem , Access status: Acceso Abierto , Tumor neuroendocrino y cáncer de próstata metacronico. Reporte de caso(Universidad Católica de Cuenca., 2026) Ulloa Delgado, Mateo SebastianIntroduction: This case report describes the coexistence of a neuroendocrine tumor and prostate cancer in a patient, diagnosed at different times (metachronous). Metachronous tumors, in which two types of cancer occur at different times, are rare, and the combination of a neuroendocrine tumor with prostate cancer is unusual. This study analyzes the clinical characteristics, diagnostic challenges, and therapeutic management of both types of cancer, providing valuable information for the treatment and follow-up of similar cases. This case report describes a 43-year-old male patient with a history of prostate cancer who visited a healthcare facility for a follow-up appointment, where a cluster of lymph nodes was identified in the left cervical region. Following diagnostic testing, the patient was diagnosed with: Large Cell Neuroendocrine Carcinoma of unknown primary origin with cervical, mediastinal, pulmonary, and retroperitoneal metastases. A prostatic origin was ruled out by immunohistochemistry. Conclusion: The diagnosis and treatment of these two types of metachronous primary cancers are complex and require a multidisciplinary approach to manage both prostate adenocarcinoma and the neuroendocrine carcinoma. This case highlights the importance of continuous surveillance to diagnose recurrence or a second primary tumor, thereby improving the patient's overall survival and quality of lifeItem type: Ítem , Access status: Acceso Abierto , Polimiositis secundaria a COVID-19: Reporte de Caso(Universidad Católica de Cuenca., 2026) Maldonado Cedillo, Juan SebastiánIntroduction: SARS-CoV-2 continues to be the subject of research in various areas; however, recent studies have shown its ability to trigger autoimmune diseases in genetically susceptible individuals. Polymyositis secondary to COVID-19 is rare and poorly documented in the scientific literature, with only two cases reported in the United States up to 2022. This report presents a case contributing to scientific knowledge about this rare association. Clinical case: A 44-year-old woman who developed symptoms of muscle weakness and myalgias after contracting COVID-19. In the myopathic panel, positive antibodies for Anti-Mi2-alpha and Anti-Jo-1 were identified. The patient was treated with prednisone, leading to complete symptom resolution. Despite medical recommendations, the patient refused to undergo a muscle biopsy or electromyography. The diagnosis of polymyositis secondary to COVID-19 was established based on clinical findings, elevated muscle enzymes, positivity for specific myositis antibodies (MSA), and an adequate response to corticosteroid treatment. Other differential diagnoses were ruled out through a thorough physical examination. Conclusions: This case provides evidence of a rare condition with a complex etiology, highlighting the association between COVID-19 and polymyositis. It contributes to scientific knowledge by providing reference data for future research. Continuous monitoring of patients with persistent muscle weakness following COVID-19 infection is essential, as it may facilitate early diagnosis and improve prognosis.Item type: Ítem , Access status: Acceso Abierto , Ameboma en anastomosis de bypass gástrico: Reporte de Caso(Universidad Católica de Cuenca., 2026) Troya Pérez , Andrea CelesteEntamoeba histolytica is a parasite that infects between 30 and 50 million people and is responsible for around 100,000 deaths annually, predominantly in developing countries where it is endemic. The infection may be asymptomatic; however, in a small percentage, it can cause serious complications, such as ameboma—an inflammatory mass in the colon that presents with symptoms such as fever and abdominal pain and sometimes simulates an intestinal obstruction. Diagnosis requires paraclinical examinations and imaging, followed by treatment with metronidazole. In gastric bypass patients, detection and treatment can be challenging due to underreporting and recurrence. A clinical case is described by a 36-year-old male patient with a history of hypertension, diabetes, obesity, and bariatric surgery, who developed a clinical picture similar to intestinal obstruction after gastric bypass. Studies, including computed tomography, revealed a thickening of the ascending colon caused by an ameboma, diagnosed by pathological analysis in a sample obtained during a right hemicolectomy. Management was surgical due to the incidental finding, supported by the use of antibiotics and nitroimidazoles, resulting in the patient's favorable recovery. This case describes the unusual manifestations of amebiasis in a postsurgical context, providing relevant data on infectious complications in surgical sites—phenomena rarely reported in the medical literature—which creates the need for the development of specific protocols for the management of infections with characteristics similar to the case.Item type: Ítem , Access status: Embargo , Evaluación de la normativa “Establecimientos de la salud Amigos de la Madre y del Niño” aplicada en el Hospital Provincial General Docente de Riobamba, 2024(Universidad Católica de Cuenca., 2026) Benalcázar Borja, Lisbeth Carolina; Jaramillo Leon, Jordan LeonardoProyecto de Titulación embargado para publicación. Estará disponible a la fecha de publicación o de cierre de embargoItem type: Ítem , Access status: Embargo , Rabdomiosarcoma embrionario en adulto joven: reporte de caso(Universidad Católica de Cuenca., 2026) Aray Coellar , Irma RosalíaProyecto de Titulación embargado para publicación. Estará disponible a la fecha de publicación o de cierre de embargoItem type: Ítem , Access status: Acceso Abierto , Necrólisis epidérmica tóxica: Reporte de caso(Universidad Católica de Cuenca., 2026) Sarmiento Amón , Santiago JosuéIntroduction: This case report describes a severe presentation of toxic epidermal necrolysis (TEN) in a 27-year-old female patient, triggered by the use of lamotrigine. TEN is a rare and potentially life-threatening immunological reaction that affects the skin and mucous membranes. This clinical case highlights the importance of recognizing early symptoms and prompt management to improve the prognosis. Clinical manifestations: The patient presented with erythematous lesions that evolved into painful blisters and extensive skin desquamation, as well as ocular involvement with a foreign-body sensation, oral and genital mucosal involvement, and respiratory symptoms requiring intensive care. Diagnosis: The diagnosis was confirmed based on medication history, clinical presentation, and evaluation with the SCORTEN scale, which estimated a mortality of 35.5%. Treatment: Discontinuation of the causative agent, management of complications, and administration of glucocorticoids and intravenous immunoglobulins were included, which progressively improved the skin lesions in conjunction with multidisciplinary management, achieving stabilization of respiratory and hemodynamic function. The patient was discharged after 9 days of hospitalization. This case highlights the need for timely diagnosis and management to prevent severe complications of TEN, emphasizing the effectiveness of the combination of glucocorticoids and immunoglobulins. Conclusion: Early identification of TEN and rapid initiation of immunomodulatory treatment can reduce complications and improve clinical outcomes in severe cases.Item type: Ítem , Access status: Embargo , Mieloma múltiple no secretor: Reporte de caso(Universidad Católica de Cuenca., 2026) Vásquez Astudillo, Renata FabiolaProyecto de Titulación embargado para publicación. Estará disponible a la fecha de publicación o de cierre de embargoItem type: Ítem , Access status: Acceso Abierto , Nefrocalcinosis renal por tuberculosis: Reporte de caso(Universidad Católica de Cuenca., 2026) Romero Pardo, Angie StefanyIntroduction: Nephrocalcinosis is considered rare in clinical practice, and even more so when associated with tuberculosis. It is characterized by the accumulation of calcium in the kidneys, particularly following hematogenous spread of the bacillus. It is usually detected incidentally on imaging studies due to nonspecific symptoms. Treatment must address both the tuberculosis infection and the renal calcifications to prevent complications such as kidney failure. Case Presentation: This is a 56-year-old male patient who presented with nonspecific urinary symptoms, such as pollakiuria, hematuria, and low back pain. The diagnosis was established through laboratory and imaging studies that revealed renal calcifications and lesions consistent with renal tuberculosis. Therapeutic intervention included an antituberculous consolidation-phase regimen and nutritional support, under comprehensive and multidisciplinary management. Conclusion: Through close follow-up and a favorable prognosis focused on controlling recurrences, the patient showed improvement. This case underscores the importance of early diagnosis of extrapulmonary tuberculosis and provides relevant evidence for considering renal tuberculosis in the differential diagnosis of nephrocalcinosis. To prevent serious complications such as kidney failure, early identification and treatment of the condition are essential.
