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 Síndrome de Heyde asociado al factor de Von Willebrand(Universidad Católica de Cuenca., 2024) Cárdenas Andrade, Gabriel Joseph; Reibán Espinoza, Esteban Adrián; 0107130379Introduction: Heyde's syndrome is a disorder that was described for the first time in 1958. This disorder can cause high mortality and morbidity rates if the correct diagnosis is not made. Objectives: Bring up an approach of Heyde Syndrome to focus the attention of different researchers and provide a compilation of updated information for a better understanding of the topic. Methods: Articles such as Meta-Analysis, Bibliographic Reviews, Systematic Reviews and clinical tests were taken in consideration for this article, leaving behind articles that did not meet the inclusion criteria mentioned before. MeSH terms such as: "Aortic stenosis AND Gastrointestinal AND Hemorrhage AND Syndrome AND Von Willebrand” were used for the search. Results: Heyde's syndrome usually occurs at advanced ages, there are not enough studies, therefore there is no data for this disorder, making it difficult to diagnose. Aortic stenosis in Heyde's syndrome is a key finding when it is accompanied by gastrointestinal bleeding. Demonstrating that aortic stenosis is related to metalloprotease activity producing a Von Willebrand proteolysis. Conclusion: Heyde's syndrome is a complicated pathology, with characteristic signs and symptoms such as aortic stenosis, gastrointestinal bleeding and anemia. Surgically placed or transcatheter prostheses can improve the severity of this pathology, especially in patients with advanced aortic stenosis.Ítem Acceso Abierto Beneficios del pinzamiento tardío del cordón umbilical en el recién nacido(Universidad Católica de Cuenca., 2024) Salinas Cano, Briggette Anahi; Herrera Jaramillo, María Isabel; 1105070161Introduction: Delayed clamping of the umbilical cord has been discussed since the last century, especially when clinical practices began this procedure between two and three minutes after delivery or until the cord pulsations ceased, sometimes extending the delay up to twenty seconds after delivery. Scientific evidence shows that this practice increases hemoglobin concentrations in neonates, helping to prevent certain pathologies. Therefore, although the benefits of this practice are outlined, there is no scientific reference on the definitive time at which cord clamping should be performed. Objective: To determine the benefits of delayed clamping of the umbilical cord in newborns Methodology: A documentary research technique was used to collect articles from indexed journals and publications with scientific endorsement. In addition, a content analysis was conducted on the selected articles to identify information exclusively related to delayed umbilical cord clamping. Result: It is determined that the ideal timing to perform delayed clamping is three minutes after birth. Conclusions: This procedure's main benefit is reducing anemia in newborns. It also promotes direct placental transfusion, increases iron levels, prevents intraventricular hemorrhage, and reduces necrotizing enterocolitis or late sepsis.Ítem Acceso Abierto Reporte de caso: carcinoma metaplásico de mama con componente epitelial escamoso puro y mutación de PIK3CA(Universidad Católica de Cuenca., 2024) León Crespo, Karen Vanessa; Coronel Montero, Jorge Sebastián; 0107146995Introduction. Metaplastic breast carcinoma with a pure squamous epithelial component is a rare breast tumour with a prevalence between 0.06% and 0.2%. There are a limited number of case reports on this disease, its molecular features are poorly defined and the underlying basis for the histologic heterogeneity remains unclear. Objective. Describe the case of a 67-year-old female patient diagnosed with metaplastic breast carcinoma with pure squamous epithelial component and mutation of the PIK3CA gene, to analyze the clinical characteristics, histological patterns and to explore the treatment in this neoplasm. Methodology. The methodology used was a case report; the information collected was through the analysis of the patient's clinical history with prior authorization by means of informed consent. Results. A 67-year-old female patient detects a palpable mass in the right breast during self-exploration. She underwent complementary examinations for evaluation, and it was determined that she had metaplastic breast carcinoma with a pure squamous epithelial component with alteration of the PIK3CA gene. Currently, the patient has concluded her adjuvant therapy and is under follow-up imaging studies. Conclusion. Metaplastic breast carcinoma with pure squamous epithelial component represents a rare and aggressive entity that requires an accurate diagnosis and appropriate treatment. Knowing the genetic alterations can help treatment and treatment response.Ítem Acceso Abierto Relación entre la restricción de crecimiento intrauterino y la deficiencia de vitamina D(Universidad Católica de Cuenca., 2023) Calva Sanchez, Lessly Paola; Durán Vega, Oswaldo Jair; 0150635712The high prevalence of vitamin D deficiency (VDD) in pregnancy and the studies that have reported fetal growth restriction (IUGR) in pregnant women with low vitamin D concentrations or improvement of the restriction after supplementation with the same guide to the existence of a relationship between the two problems. Articles were searched and analyzed in the PubMed, Science, and Taylor & Francis databases, entering the terms: fetal growth restriction, vitamin D deficiency, pregnancy complications, and maternal nutrition. The physiological anti-inflammatory, pro-angiogenic, and proliferation-regulating effects of vitamin D and its receptor in the fetal-placental unit are impaired in mothers with low serum 1α,25-hydroxyvitamin D levels. Deficient maternal vitamin D concentrations interfere in the evolution of pregnancy and can contribute to the development of IUGR by causing placental insufficiency.Ítem Acceso Abierto Ampuloma bien diferenciado: reporte de caso(Universidad Católica de Cuenca., 2023) Sarmiento Sarmiento, Chrisy Esthephanye; Orellana Bernal, Paola Verónica; 0107407009Vater papilla adenomas are neoplasms with high potential for malignant transformation, so regardless of their degree, they require resection to prevent their progression. Endoscopic ampulectomy is considered a minimally invasive alternative with a lower morbidity rate compared to duodenopancreatectomy. The present case report is of a 45-year-old female patient who goes to an external consultation for pruritus located in the arms for about 1 month in treatment with loratadina without improvement of her picture. Three days ago, she showed evidence of skin and icteric sclerosis, so laboratory examinations revealed an alteration of the liver profile. He was arrested on suspicion of obstructive icteric syndrome. Handling ampulomas by endoscopic ampulectomy is an effective and less invasive technique; however, it is recommended in patients in whom there is no intraductal invasion and a pattern of adenocarcinoma. This case is transcendental since, being a rare disease in our environment, it awakens great medical interest, both theoretical and clinical.Ítem Acceso Abierto Valoración de los factores de riesgo y manejo clínico de la litiasis renal en adultos(Universidad Católica de Cuenca., 2024) Santos Balvoa, Rosa Alegría; Bueno Castro, Andrés Santiago; 0302626221Background: Kidney stones, or nephrolithiasis, are the third most common urological disease. They are characterized by various types of mineral salts embedded in an organic matrix, which develop in the kidneys or the upper urinary tract. Globally, the prevalence ranges from 4 to 17 cases per thousand inhabitants, with a mortality rate of 5% and a recurrence rate of 50 to 60%. Objective: To identify the risk factors and clinical management of kidney stones in adults. Methodology: This document presents a literature review conducted by searching recognized databases such as PubMed, SciELO, Elsevier, and NIH MedlinePlus for studies from the last five years. Results: Risk factors are associated with modifiable and non-modifiable elements. Among the former are sociodemographic data such as age, sex, and body mass index, as well as the consumption of certain foods that increase the risk of kidney stones due to excessive intake of lithogenic substances. Clinical management is closely related to the type of calculus. Conclusions: The management of kidney stones depends on their type and the patient's comorbidities. Therefore, hygienic-dietary measures and pharmacological treatments are recommended, including analgesics, alpha-blockers, calcium channel blockers, corticosteroids, and phosphodiesterase-5 inhibitors.Ítem Acceso Abierto Denervación simpática renal en la hipertensión arterial refractaria(Universidad Católica de Cuenca., 2024) Yanzaguano Molina, Diana Marisol; Clavijo Rosales, Claudia Gabriela; 0106141336Arterial hypertension is considered a worldwide disease, and its classification includes refractory arterial hypertension; its importance lies in the fact that, despite pharmacological and non-pharmacological treatments, blood pressure values remain high. Therefore, the scientific community has innovated in different methods to improve the patient's life, opting for therapies that, although invasive, are excellent options, as is the case of renal sympathetic denervation; the role of new devices in the therapy for resistant arterial hypertension was evidenced. The main result demonstrated that radiofrequency was the most used technique in the renal denervation procedure; it was shown that the techniques used for each process did not present serious complications. However, it was considered a treatment with great benefits for the population studied, through the prognosis, since a considerable decrease in systolic blood pressure of - 10 mmHg was obtained. It was confirmed that renal sympathetic denervation becomes safe and effective.Ítem Acceso Abierto Funduplicatura de Nissen en enfermedad por reflujo gastroesofágico con metaplasia de Barrett refractaria al tratamiento: reporte de caso(Universidad Católica de Cuenca., 2023) Ochoa Quinteros, Kevin Marcelo; Aldás Erazo, Manuel Rafael; 0105217434Introduction: Gastroesophageal reflux disease occurs due to the involvement of the cardia and the esophagus as a result of gastric content regurgitation. Its global prevalence ranges from 10% to 30% of the population. Within this group, approximately 30-40% show resistance to proton pump inhibitors treatment, while other pharmacological measures have proven ineffective. However, fundoplication, regardless of the surgical technique used, has been shown to be effective in the long term, reversing the damage and resolving symptoms. Methodology: Descriptive retrospective case presentation. Objective: To describe a clinical case of a patient with treatment-resistant GERD with Barrett's metaplasia, treated surgically with Nissen fundoplication. Results: A 48-year-old female patient with a history of hiatal hernia presented with symptoms of epigastralgia, progressive dysphagia, and postprandial heartburn. Upper gastrointestinal endoscopy was performed, and upon macroscopic presence of metaplasia, a biopsy was performed, diagnosing Gastroesophageal reflux disease with Barrett's metaplasia. Treatment with proton pump inhibitors was initiated; however, no improvement in the epithelium was observed in the follow-up endoscopy, leading to the decision to perform surgical intervention using Nissen fundoplication as a definitive treatment. After one month, the patient showed positive progress, with a total improvement in her symptoms. Conclusion: Nissen fundoplication is established as a long-term therapeutic alternative with lower recurrence rates and complications compared to conventional medical treatment. However, further studies are still required to determine the optimal timing of this treatment. It is crucial to emphasize the importance of early intervention to prevent complications associated with GERD.Ítem Acceso Abierto Esclerosis Múltiple: el rol de los agentes neuroprotectores en la progresión y nuevos estudios sobre remielinización(Universidad Católica de Cuenca., 2023) Berrezueta Sigüenza, Steven José; Ochoa Bravo, Andrea Catalina; 0105464515Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system characterized by demyelination and neurodegeneration, and despite significant therapeutic advances, it remains a major cause of disability in young adults. The aim of this review is to describe existing information on the role of neuroprotective agents in the progression of multiple sclerosis and new research on remyelination. We note that neuroprotective agents, such as ocrelizumab, natalizumab, and fingolimod, offer potential to limit neurodegeneration and possibly influence disease progression, while remyelination therapies aimed at repairing damaged myelin, including anti-LINGO-1 antibody, clemastine, and high-dose biotin, are showing promising results in preclinical and clinical trials. Progress in this field is encouraging. Indeed, in the future, combination therapies incorporating immunomodulatory, neuroprotective, and remyelinating agents may become a standard approach to the treatment of MS.Ítem Acceso Abierto Fotoprotección sistémica como complemento a la fotoprotección tópica frente a la radiación solar(Universidad Católica de Cuenca., 2024) Peña Avecillas, Ana Belén; Espinoza Cárdenas, Rolando; 0605694975Solar radiation can have significant health benefits; however, constant exposure to solar radiation can generate alterations in the skin and the functioning of the organism. The adverse effects of prolonged and continuous exposure to sunlight constitute a public health problem, especially for vulnerable children and adolescents. It is estimated that ultraviolet radiation accounts for 40% to 50% of cumulative exposure between the ages of 18 and 20 years and is a major risk factor for skin cancer. In this regard, in recent years, several studies have been proposed suggesting the use of oral sunscreens as a complement to topical sun protection. The aim of this work is to demonstrate how oral photoprotection complements topical photoprotection against solar radiation. In this literature review, a total of 32 articles were selected from databases such as PubMed, Google Scholar, and SciELO. Several studies have shown that the antioxidant, anti-inflammatory, and immunomodulatory effects of oral photo protectors can contribute to preventing the chronic adverse effects of solar radiation, such as immunosuppression and skin cancer. Although oral photoprotection does not replace topical photoprotection, when used together, they have a synergistic effect against the adverse effects of solar radiation.Ítem Embargo Trastornos del estado de ánimo con ideación suicida y su rendimiento académico en estudiantes universitarios(Universidad Católica de Cuenca., 2024) Benítez González, Darío Xavier; Vintimilla Espinosa, María José; 1104320435Ítem Acceso Abierto Causas de suicidio en adolescentes de América Latina: el antes y durante la pandemia(Universidad Católica de Cuenca., 2024) Fajardo Valarezo, Rina Marcela; Solorzano Bernita, Rosa Elizabeth; 0707000170Introduction: Suicide is a deliberate act of taking one's own life, which begins with suicidal ideation and ends with suicide itself. General Objective: To describe the causes of suicide in Latin American adolescents before and during the COVID-19 pandemic. Methodology: The study design is a narrative literature review, encompassing studies with infant-youth populations (10-19 years) at risk for suicide, suicidal ideation, suicide attempt, and suicide. Articles from the year 2017 to the year 2022. Bibliographies in English and Spanish include all types of articles with a clear methodology and information related to the causes of suicide in Latin America. Expected: In infant-juveniles with ages between 10-19 years, where the male sex predominated in ages 15-19 years; where the percentage of suicides in 2017 was in Uruguay with 19.1%, in 2018 Uruguay with 16.6%, in 2019 Ecuador 15.5%, in 2020 Peru with 2.01%, in 2021 Peru with 2.15%. As the main causes of suicide we have the two main ones which are depression and anxiety; counting with a higher rate of depression in the year 2017 in Paraguay with 1245.49, in the year 2018 it was in Paraguay with 1234.15, in the year 2019 it was in Brazil with 1214.76, taking into account that in the year 2020 this Mexico with a percentage of 60.4% and in the year 2021 Mexico with 48.3%; the average rate was in Brazil in the year 2017,2018,2019 with 1180.61- 1181.4 -1180.5; thus observing in 2020 and 2021 the average in Ecuador was 22.22%- 50% in anxiety.Ítem Acceso Abierto Factores de riesgo y tratamiento profiláctico en pacientes pediátricos por infección de citomegalovirus post trasplante renal(Universidad Católica de Cuenca., 2023) Ramírez Jaramillo, Daniela Carolina; Herrera Jaramillo, María Isabel; 0706657939Introduction: Cytomegalovirus (CMV) is one of the main agents responsible for morbidity and mortality in the pediatric population after having undergone kidney transplantation. Cytomegalovirus infection represents one of the most frequent complications in these patients and its severity arose from the immune status against the virus between the donor and the recipient; Children generally present immunosuppression after receiving a kidney transplant, so adequate preventive treatment can be very helpful to stabilize the health of these patients and thus avoid sequelae or long-term complications. Objective: To describe the main risk factors and the appropriate prophylactic treatment in pediatric patients due to cytomegalovirus infection after a kidney transplant. Methodology: The present investigation has as a study design a narrative bibliographic review through the compilation of scientific articles obtained from databases in a time interval between 2018 - 2023, through the corresponding inclusion and exclusion criteria. Results: Impermeable status, recipient and donor serology, and recipient age were among the various risk factors found. On the other hand, the drugs valganciclovir and ganciclovir were the prophylactic treatment of choice for post-transplant children, demonstrating a relative significance to avoid longterm sequelae and thus avoid morbidity and mortality in the pediatric population.Ítem Acceso Abierto Terapia biológica mediante el uso de linfocitos T con receptores de antígenos quiméricos (CAR-T CELLS) para la leucemia linfoide aguda refractaria: Revisión sistemática(Universidad Católica de Cuenca., 2024) Matute Farfán, Dayana Lorena; Reiban Espinoza, Adrián Esteban; 0106746233; Adrián EstebanIntroduction: Acute Lymphoid Leukemia Refractory is a type of hematological cancer with an overproduction of B or T lymphocytes despite first-line treatment. Patients often do not survive relapse; modern treatments have been investigated for new targets, including Biological Therapy using chimeric antigen receptor T-lymphocytes. Objective: To analyze the efficacy and describe the adverse effects of using chimeric antigen receptor T-cell biologic therapy for treating refractory acute lymphoid leukemia. Methodology: A systematic review was performed in English, in databases such as Scopus, PubMed, Web of Science, and Cochrane, of clinical trials published in the last five years involving patients with refractory acute lymphoid leukemia. The search strategy used MeSH terms through the equation "Biological therapy" AND "T-Lymphocytes" AND "Receptors Chimeric antigen" AND "Refractory" NOT "Multiple myeloma" NOT "Lymphoma" and the quality of the information was evaluated with the New-Castle Ottawa Scale tool. Results: Six clinical trials were included, totaling 127 patients studied. Of the six studies performed, three were negative for minimal residual disease, while in the remaining studies, patients were found to be in complete remission with incomplete hematologic recovery. The most common adverse effect was cytokine release syndrome in 55-100%, followed by immune effector cell-associated neurotoxicity syndrome in 4.3-40%. Conclusions: The complete remission of this disease averaged more than 80% biological therapy with CAR-T cells. However, the side effects caused by CAR-T cells can be life-threatening. Research of CAR-T cells for patients with refractory T-cell acute lymphoid leukemia is needed, as the databases have not provided information on this subject.Ítem Acceso Abierto Escalas diagnósticas en apendicitis aguda(Universidad Católica de Cuenca., 2024) Mora Flores, Jeimi Adriana; Vera Pulla, Raúl David; 1400889273The prompt, rapid and accurate diagnosis of this condition is based mainly on the clinical evaluation of the patient, the results of laboratory tests and imaging. However, a difficulty arises since not all patients present the typical symptomatology. In order to avoid future complications that can lead to death due to late diagnosis or lack of complementary tests, two methods have had to be included to help in these cases. These two systems that have been included are a quasi-quantitative evaluation, they are called modified Alvarado scale and RIPASA that score the patients and according to this will evaluate them through parameters indicating the probability of having appendicitis according to the number of signs and symptoms that are present. For the search of this information the main databases such as Scielo, Pubmed, Elsevier, Scopus and Web of Science have been used, where the most recent articles on the investigated topic have been deeply searched. It is expected to find results that provide us with information on which scale is superior to make an accurate diagnosis of AA. Conclusion: The RIPASA scoring system has been shown to be superior to the so-called modified Alvarado scale in diagnosing AA.Ítem Acceso Abierto Factores de riesgo asociados al síndrome visual informático en estudiantes de Medicina: una revisión sistemática(Universidad Católica de Cuenca., 2023) Naranjo Torres, John Steeven; Mendieta Ortíz, Veronica Lizbetn; Cervantes Anaya, Luis Alberto; 0106574320; 0106089550The text discusses the increasing use of smart mobile devices and associated health problems, focusing on computer visual syndrome (CVS) induced by excessive screen viewing. Objective: To identify risk factors associated with computer visual syndrome in medical students. Methodology: A systematic review of medical-scientific literature was performed using the PRISMA 2020 guidelines. Searches were conducted in various databases such as Medline/PubMed, OVID, Web Of Science; Scopus; SpringerLink and Taylor & Francis Online, selecting and reviewing a total of 163 scientific articles published between April 2019 and April 2023. Results: A total of 8 articles were selected to be evaluated, all were cross-sectional studies, whose total sample is about 7611 participants. The quality of the articles was evaluated using the Q1 to Q4 journal ranking. It was shown that ocular fatigue syndrome is very common in university students, with a prevalence ranging from 82.5% to 95%. In addition, risk factors associated with prolonged use of electronic devices, such as extended screen time on computers and smartphones, were found. Conclusion: It is highlighted that this syndrome occurs frequently in people who constantly use screens and electronic devices due to their work or study. Among the risk factors identified is the gender difference.Ítem Acceso Abierto Estrategias diagnósticas de la coartación de aorta en el periodo prenatal(Universidad Católica de Cuenca., 2023) Barros Ramírez, Dayana Gabriela; Alarcón, Maria José; 0706200615Coarctation of the aorta accounts for 5 to 10% of all congenital heart diseases, with a prevalence of approximately 4 per 10 000 neonates, ranking seventh among all congenital heart diseases. It is characterized by the presence of narrowing of the caliber of the aorta artery, usually at the site of insertion of the ductus arteriosus, resulting in obstruction of blood flow. The difficulty of diagnosing CoAo in the prenatal period is related to an increase in the false positive rate, since it is generally based on a suspected diagnosis that corresponds to indirect and nonspecific signs, dependent on the gestational age of onset. Therefore, a delay in its diagnosis leads to long-term consequences favoring the presence of refractory hypertension, stroke, aortic dissection and heart failure, therefore the importance of diagnosing coarctation of the aorta in the prenatal period lies in the fact that the mortality and morbidity figures related to this disease are high when its prenatal detection is ignored. Despite being a congenital heart disease that is difficult to diagnose, strategies such as the combination of 2D and Doppler have been implemented since they allow to observe abnormal signs and the hemodynamics of the heart, also determining that the best stage for the diagnosis of CoA is in the second trimester of pregnancy.Ítem Acceso Abierto Abordaje diagnóstico en pacientes adultos con Mastocitosis Sistémica(Universidad Católica de Cuenca., 2024) Auquilla Rubio , Karol Estefania; Córdova Serrano, Rosana Daniela; 0107338105Systemic mastocytosis is a heterogeneous group of diseases characterized by the proliferation and activation of clonal mast cells in various cutaneous and extracutaneous organs, ranging from indolent to rare, aggressive forms. It is classified as a rare disease due to its low prevalence; it is considered underdiagnosed because the symptoms may be nonspecific and even involve various organs, so the approach should be multidisciplinary to prevent severe forms of this disease. A narrative literature review was carried out, and the sources of information were obtained through scientific search engines such as ScienceDirect and PubMed. The review was thorough in order to obtain relevant and updated information on the subject. The present review aims to identify the diagnostic approach in adult patients with systemic mastocytosis.Ítem Embargo Correlación de índice triglicéridos glucosa con parámetros cardiometabólicos en adultos(Universidad Católica de Cuenca., 2023) Carpio Carpio, Carmen Karina; Vinueza Zarumeño, Adriana Michelle; Peña Cordero, Susana Janeth; 0104991047; 0107193229Ítem Acceso Abierto Asociación entre el biomarcador tumoral antígeno carbohidrato 125 y la insuficiencia cardíaca(Universidad Católica de Cuenca., 2024) Suárez Vargas, Angie Nicole; Clavijo Rosales, Claudia Gabriela; 0706429008In the world, approximately 20 million people have heart failure (HF). Therefore, a biomarker indicating a state of congestion, treatment, and mortality prognosis is essential. For this purpose, the carbohydrate antigen 125 (CA125) can be used in clinical practice because a decrease in CA125 values <35 U/ml reduces mortality from any other factor within a year. The tumor biomarker, carbohydrate antigen 125, was associated with heart failure (HF) as an independent prognostic factor for all-cause mortality at one year (Hazard Ratio [HR]: 3.05, p= 0.002) when the CA125 value was ≥47.6 U/ml. Additionally, it was established as a congestion marker in HF patients with a CA125 value >35 U/ml. It will allow for the assessment of the risk of decompensation in the future and provide timely treatment, starting with depletion therapy, the use of diuretics, and potentially indicating palliative care.
