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 , Inhibidores Janus Cinasa (inhibidores JAK) como terapia de primera línea en pacientes con enfermedad inflamatoria intestinal vs terapia médica convencional. Revisión sistemática(Universidad Católica de Cuenca., 2026) Méndez Bravo, Omar Alexander; Muñoz Ganazhapa, Mario EnriqueTitle: Janus Kinase Inhibitors as First-line Therapy in Patients with Inflammatory Bowel Disease Versus Conventional Medical Therapy: A Systematic Review. Objective: To analyze the efficacy and safety of Janus kinase inhibitors as first-line treatment compared with conventional medical therapy in patients with inflammatory bowel disease. Methodology: A systematic review was conducted in accordance with the PRISMA 2020 statement, using the following eligibility criteria: clinical trials and observational studies published in the last 5 years in English and Spanish were included, involving patients over 18 years of age diagnosed with IBD. Databases such as PubMed and Cochrane were searched between November 2024 and April 2025. The risk of bias was assessed using the Rob2 tool for clinical trials and the JBI tool for observational studies. Results: Eleven articles were included, showing that JAK inhibitors (filgotinib and upadacitinib) demonstrated notable superiority in terms of clinical remission, symptom reduction, and improvement in quality of life compared to conventional therapy, which was associated with a higher incidence of adverse effects. Discussion: The studies indicated that JAK inhibitors offered sustainable efficacy and a favorable safety profile; however, most studies had a high risk of bias and small sample sizes. Conclusion: JAK inhibitors presented an effective and safe alternative to conventional therapy, highlighting their significant impact as a first-line treatment for IBD.Item type: Ítem , Access status: Acceso Abierto , Comparación del uso de vonoprazan y esomeprazol en el manejo de pacientes con enfermedad por reflujo gastroesofágico erosivo: revisión sistemática(Universidad Católica de Cuenca., 2026) Castillo Condoy , María Stefany; Gonzaga Tejada , Jean DiegoProyecto de Titulación embargado para publicación. Estará disponible a la fecha de publicación o de cierre de embargoItem type: Ítem , Access status: Acceso Abierto , Eficacia y seguridad del Trastuzumab Deruxtecan versus Trastuzumab Pertuzumab en pacientes con cáncer de mama HER2 positivo. Revisión sistemática(Universidad Católica de Cuenca., 2026) Merchán Arica, Joseph Alexander; Padilla Balarezo, Jean PierreIntroduction: HER2 breast cancer represents a rather aggressive form of neoplasms, which has prompted the development of targeted therapies to improve the prognosis of patients. Among these options are Trastuzumab Deruxtecan (T-DXd) and the combined scheme of Trastuzumab with Pertuzumab (T+P), both of which are widely used in different clinical scenarios. Objective: To evaluate the efficacy and safety of Trastuzumab Deruxtecan versus Trastuzumab Pertuzumab in patients with HER2-positive breast cancer. Methodology: A systematic review was conducted following PRISMA 2020 guidelines. Thirteen studies belonging to a period equal to or less than five years, at the date of the present study, selected after a search in PubMed and Scopus, were included. Clinical trials and observational studies were analyzed, and the risk of bias was assessed with validated tools (RoB 2 and Newcastle-Ottawa). Results: The findings demonstrate that T-DXd exhibits a higher efficacy in terms of progression-free survival (10 - 17 months) and objective response rates (up to 62%). However, it presents a higher risk of pulmonary adverse effects, such as interstitial lung disease. In comparison, T+P showed moderate efficacy, but with a more manageable safety profile. Conclusion: Trastuzumab Deruxtecan represents an emerging alternative, particularly in patients with advanced or refractory disease, although its use requires careful risk assessment. The therapeutic decision should be individualized according to the characteristics and needs of each patient.Item type: Ítem , Access status: Acceso Abierto , Eficacia del plasma rico en plaquetas en múltiples dosis versus monodosis en el tratamiento de la gonartrosis: Revisión sistemática(Universidad Católica de Cuenca., 2026) Amaguaya Amaguaya, Ingrid Dalay; Duchitanga Torres , Sebastián AlejandroTitle: Efficacy of Multiple-Dose Versus Single-Dose Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis. A Systematic Review. Objectives: To evaluate the efficacy of platelet-rich plasma (PRP) administered in multiple doses versus a single dose in reducing pain, improving joint function, and enhancing quality of life in patients with knee osteoarthritis. Methodology: We included randomized clinical trials and observational studies (2019–2024) in English involving patients with knee osteoarthritis (Kellgren-Lawrence grades I–IV) that compared single-dose or multiple-dose PRP with other intra-articular interventions or with each other. We excluded systematic reviews, animal studies, and studies with incomplete data. Studies were retrieved from PubMed, Scopus, and Taylor & Francis, with searches conducted through February 15, 2025. Risk of bias was assessed using GRADEpro, classifying studies as high, moderate, or low risk. Results were summarized in descriptive tables, comparing changes in VAS and WOMAC scores at 6 weeks and 3, 6, and 12 months. Results: Six articles (4 randomized clinical trials, 2 prospective studies) involving 392 patients were included. Multiple doses of PRP significantly reduced pain (VAS) and improved function (WOMAC) at 12 months compared with a single dose, particularly in patients with mild-to-moderate knee osteoarthritis. Discussion: Limitations included heterogeneity in PRP preparation and bias among patients. Multiple doses yielded better results in the early stages. Conclusion: Multiple doses of PRP are more effective at reducing pain, improving function, and enhancing quality of life in patients with knee osteoarthritis. A regimen of three injections is recommended.Item type: Ítem , Access status: Acceso Abierto , Terapia electroconvulsiva en comparación con la Estimulación Magnética Transcraneal en episodios depresivos post COVID-19. Revisión sistemática(Universidad Católica de Cuenca., 2026) Andrade Chimbo, Diana Kasandra; Calero Ortiz , Steeven AnthonyIntroduction: COVID-19 left numerous sequelae, significantly affecting people's quality of life. Among these consequences, depression is of particular concern, with uncertainty regarding its neurobiological impact. Therefore, therapies such as Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS) have emerged as potentially viable treatment options. General Objective: To evaluate the efficacy of Electroconvulsive Therapy and Transcranial Magnetic Stimulation in the treatment of post-COVID-19 depressive episodes. Methodology: A systematic review was conducted based on the criteria established by the PRISMA 2020 statement, including articles published in Spanish and English, with free access, and involving individuals aged ≥18 years. Reviews, meta-analyses, and gray literature that did not address ECT and/or TMS for post-COVID-19 depression were excluded. Searches were conducted in the PubMed, Taylor & Francis, and Scopus databases from November 2024 to March 2025, using the JBI tool. Results: Case reports and cross-sectional studies highlighted the efficacy of TMS, associated with high tolerability, in moderate cases, whereas ECT showed greater efficacy in severe cases. Good adherence to the procedures was identified, with minor adverse effects. Discussion: The results supported the use of these therapies on an individualized basis; however, limitations such as methodological heterogeneity and small sample sizes increased the risk of bias. Conclusions: TMS is recommended for moderate cases and ECT for severe cases; however, further controlled studies are needed to strengthen the evidence supporting this practice.Item type: Ítem , Access status: Acceso Abierto , Asociación entre el uso de etinilestradiol y el riesgo de candidiasis vulvovaginal en mujeres en edad reproductiva: revisión sistemática(Universidad Católica de Cuenca., 2026) Pacheco Peláez , Melany Tatiana; Espín Vélez , Doménica NahomiAssociation between ethinylestradiol use and the risk of vulvovaginal candidiasis in women of reproductive age: a systematic review Introduction: Vulvovaginal candidiasis (VVC) is a common infection of the lower genital tract in women of reproductive age. Factors such as vaginal microbiome imbalance and the use of hormonal contraceptives, especially ethinylestradiol, can promote Candida albicans. Objectives: To analyze the association between ethinylestradiol use and the risk of vulvovaginal candidiasis in women of reproductive age. Methodology: Eligibility criteria: Original studies in English, Spanish, Portuguese, and French, published between 2019 and 2024, were included. Reviews, studies with incomplete data, and animal studies were excluded. Information Sources: PubMed, Scopus, Taylor & Francis, Cochrane, ProQuest. Risk of bias: Assessed using the GRADEpro tool. Synthesis of results: Contingency tables were grouped according to specific objectives. Results: Eleven studies (cross-sectional, cohort, and experimental) were included, involving approximately 5086 women. Most showed a positive association between ethinylestradiol use and the risk of VVC, especially with combined oral contraceptives. Only one study demonstrated a possible protective effect. Discussion: Studies with very low certainty, methodological limitations, and bias predominated, which reduces the strength of the conclusions. However, a possible relationship between ethinylestradiol and VVC is evident. Conclusions: There is a possible association between ethinylestradiol use and an increased risk of VVC. It is recommended to consider individual factors, select appropriate contraceptive methods, and perform antifungal tests in recurrent cases.Item type: Ítem , Access status: Embargo , Efectividad del omega 3 vs ibuprofeno en el tratamiento de la dismenorrea primaria: una revisión sistemática(Universidad Católica de Cuenca., 2026) Reyes Guartán, Gloria Stefanny; Quito Chávez , Yordy ManuelProyecto de Titulación embargado para publicación. Estará disponible a la fecha de publicación o de cierre de embargoItem type: Ítem , Access status: Acceso Abierto , Seguridad del uso de la buprenorfina-naloxona en comparación con la metadona en pacientes con síndrome de abstinencia para el tratamiento del dolor agudo. Revisión sistemática(Universidad Católica de Cuenca., 2026) Campoverde Peláez , María Salomé; Velecela Cordero , Jennifer CristinaTitle: Safety of Buprenorphine-Naloxone Compared to Methadone in Patients with Withdrawal Syndrome for the Treatment of Acute Pain: A Systematic Review. Objectives: To assess the safety of buprenorphine-naloxone compared to methadone in patients with withdrawal syndromes to treat acute pain. Methodology: Articles published within the last decade in English or Spanish were included. Eligible studies comprised clinical trials, observational studies, or narrative reviews involving human participants over 18 years of age. Systematic reviews and meta-analyses were excluded. The databases consulted were PubMed, Taylor & Francis, Scopus, Springer, Web of Science, and Google Scholar. The risk of bias was assessed with RoB 2 and JBI tools, depending on the study design. Results were analyzed narratively and classified into safety, efficacy, and adverse effects. Results: Buprenorphine-naloxone (BUP/NX) showed lower risk of abuse, overdose, adverse effects, as well as reduction in drug craving. Methadone presented higher risks due to its pharmacokinetic profile. Discussion: BUP/NX is considered a safer alternative than methadone for the treatment of acute pain in patients with opioid withdrawal syndrome, as it is associated with a lower risk of abuse and serious adverse effects. Broader use of BUP/NX and further comparative studies are recommended. Conclusions: BUP/NX offers a superior safety profile compared to methadone in managing acute pain in patients with withdrawal syndrome, with a lower risk of severe adverse effects.Item type: Ítem , Access status: Acceso Abierto , Eficacia de la gastroplastía endoscópica en comparación con la manga gástrica en la reducción de peso en pacientes con obesidad: Revisión sistemática(Universidad Católica de Cuenca., 2026) Cabezas Aquino , Gilbert Eduardo; Carpio Zúñiga , Daniel MateoIntroduction: Obesity is a chronic disease with high prevalence in Latin America and serious public health implications. In light of the failure of conventional measures, sleeve gastrectomy and endoscopic gastroplasty (ESG) have emerged as effective treatments. Objective: To determine the efficacy of endoscopic gastroplasty versus sleeve gastrectomy in terms of weight reduction, comorbidity remission, and complications in patients with obesity. Methodology: The study included human studies in English or Spanish, published within the last five years, involving patients over 18 years of age. Searches were conducted in PubMed and Scopus between November 2024 and April 2025. The risk of bias was assessed using the RoB 2 and JBI tools. Results were narratively synthesized based on the type of intervention and outcome. Results: Sleeve gastrectomy showed greater long-term weight loss (up to 73.5% EWL) compared to ESG (15–20% at 12 months). Both techniques resulted in comorbidity remission; however, ESG had fewer complications. Discussion: The main difference between the two procedures lies in the fact that sleeve gastrectomy offers greater efficacy in weight loss and comorbidity remission, while endoscopic gastroplasty stands out for its lower invasiveness and complication rate. Conclusions: Sleeve gastrectomy is more effective for weight loss, while endoscopic gastroplasty presents fewer complications. The choice of procedure should be adapted to the patient's clinical profile.Item type: Ítem , Access status: Acceso Abierto , Efectividad del aceite de onagra en comparación con la vitamina E como coadyuvante en el tratamiento de la mastalgia: revisión sistemática(Universidad Católica de Cuenca., 2026) Vasquez Campoverde, María Del Cisne; Saquicela Durán , Anthony EstuardoIntroduction: Mastalgia, a common breast pain that affects women's quality of life, leads to the search for effective natural alternatives as a complementary treatment. Objective: To evaluate the effectiveness of vitamin E versus evening primrose oil as an adjuvant treatment for reducing mastalgia. Methodology: A systematic review was conducted following the PRISMA 2020 statement guidelines. Open-access articles published within the last 10 years were considered. Searches were performed in the PubMed and Taylor & Francis databases. Twelve studies were included, comprising clinical trials and observational studies. The risk of bias was assessed using the RoB-2 tool for clinical trials and the JBI for observational studies. Results: Both treatments reduced pain. Evening primrose oil alleviated cyclical mastalgia after months of use, while vitamin E also decreased breast pain. In most studies, efficacy was similar, with good tolerance and mild adverse effects. Discussion: Results varied due to methodological differences between studies. Both evening primrose oil and vitamin E showed moderate effectiveness in treating mastalgia and were safe, although they did not consistently outperform placebo. Evening primrose oil requires prolonged use (4-6 months) to achieve better results. Conclusions: Both vitamin E and evening primrose oil are considered safe and effective therapies for moderately reducing breast pain, with vitamin E being slightly more notable in effectiveness. Further studies are recommended to strengthen the findings.Item type: Ítem , Access status: Acceso Abierto , Correlación del índice glucosa-triglicéridos en la etnia Shuar de Morona Santiago 2018-2019(Universidad Católica de Cuenca., 2026) García Aguirre, Juan Diego; Sandoval Rosales, María JoséIntroduction: The triglyceride-glucose index (TyG) has gained relevance as an accessible indicator for detecting insulin resistance, a central factor in the development of metabolic diseases. This study aimed to determine the correlation between the TyG index and the risk of such diseases in the Shuar population of Morona Santiago, during the years 2018-2019. Methodology: An observational, cross-sectional, analytical, descriptive, and mixed-method study was conducted. A database of 300 individuals aged 18 to 65 years with a previous diagnosis of metabolic diseases was used. Variables such as age, sex, educational level, fasting glucose, and triglyceride levels were considered. The TyG index was calculated using the formula: In(glucose x triglycerides)/2. Results: The study showed a high prevalence of dysglycemia, with 48.33% of participants presenting prediabetes and 12.33% type 2 diabetes mellitus (T2DM). The TyG index showed a significant association in both disorders: for each increase in the index, the probability of prediabetes increased by 159 times (p<0.001), and in T2DM by 111 times (p<0.001). In addition, women showed a higher prevalence of metabolic disorders. Conclusions: It was concluded that the TyG index is a reliable and useful marker for the early detection of metabolic diseases in vulnerable populations. Its incorporation into public health programs can facilitate early diagnosis and guide preventive interventions in resource-limited communities.Item type: Ítem , Access status: Acceso Abierto , Sertralina versus trimebutina en el tratamiento del Síndrome de intestino irritable: una revisión sistemática(Universidad Católica de Cuenca., 2026) Cumbicus Castillo, Roxana Carolina; Pineda Morocho , Micaela Angely“SERTRALINE VERSUS TRIMEBUTINE IN THE TREATMENT OF IRRITABLE BOWEL SYNDROME: A SYSTEMATIC REVIEW” Objective: This systematic review aimed to compare the efficacy of sertraline versus trimebutine in the treatment of irritable bowel syndrome (IBS), considering both digestive symptoms and the presence of emotional comorbidities. Methodology: Open-access articles published in Spanish or English within the last decade, that included an adult population aged 18 years or older, were selected. Clinical trials and observational studies were considered, excluding reviews and case reports. The databases Scopus, PubMed, Taylor & Francis, Cochrane, ProQuest, Web of Science, and Springer Nature were used in a search period from November 2024 to April 2025. The risk of bias was assessed using the RoB 2 tool for clinical studies and the JBI Critical Appraisal Tools for observational studies and narrative reviews. The results were synthesized descriptively using tables and figures. Results: Nine articles were analyzed. Trimebutine demonstrated moderate efficacy in alleviating digestive symptoms, particularly when combined with other treatments. In contrast, sertraline offered better results in patients with IBS associated with anxiety or depression, although a possible increased risk of microscopic colitis was observed. Discussion: The identified limitations include methodological heterogeneity and limited access to certain studies. Conclusions: Trimebutine is adequate in mild cases of IBS, while sertraline is preferable when there is emotional involvement. The importance of personalizing treatments and promoting higher-quality research is emphasized.Item type: Ítem , Access status: Acceso Abierto , Utilidad de leuprolide en comparación con implantes de histrelina en el tratamiento de la pubertad precoz central: Revisión sistemática(Universidad Católica de Cuenca., 2026) Tanguila Morales , Alan Jhosue; Torres Espinoza , Mayerly JuliethIntroduction: Central precocious puberty (CPP) is an early activation of the hypothalamic-pituitary-gonadal axis, manifesting before the age of 8 years in girls and 9 years in boys. It is classified as idiopathic or organic, and treatment is based on GnRH analogues such as leuprolide and histrelin implants, whose effectiveness and safety profile are compared in this review. Objective: To evaluate the clinical efficacy of leuprolide versus histrelin implants in the treatment of CPP, considering adherence, tolerability, and adverse events. Methodology: Articles and comparative studies in English or Spanish published within the last 5 years, which were performed on humans over 18 years of age, were selected. Cases, reviews, and studies lacking methodological rigor were excluded. The sources of information were PubMed and Taylor & Francis. The risk of bias was evaluated using the RoB 2 (clinical trials) and JBI (observational) tools. The results, including adverse events and adherence, were tabulated, along with a narrative on efficacy. Results: Nineteen studies were included: 2 clinical trials, 5 cross-sectional, and 12 cohort studies. Both treatments showed effective suppression of the gonadotropic axis. Histrelin showed a longer duration of action and fewer adverse effects. Leuprolide showed good adherence, although it requires frequent administration. Discussion: Limitations include the risk of bias in some studies and heterogeneity in populations and therapeutic regimens; however, both treatments demonstrated high efficacy and safety. Conclusions: Both leuprolide and histrelin are valid options for CPP; the choice should be based on the patient's profile, access, and family preferences.Item type: Ítem , Access status: Acceso Abierto , Alteraciones metabólicas en etnia Shuar 2018-2019(Universidad Católica de Cuenca., 2026) Noboa Rodas , Samantha Anais; Serrano Andrade , Alfredo MatiasIntroduction: Metabolic syndrome (MS) is a highly prevalent pathology that encompasses metabolic disorders such as central obesity, hypertension, dyslipidemia, and insulin resistance, all of which increase the risk of cardiovascular and metabolic diseases. What is striking is the presence of this condition in ethnic groups such as the Shuar population. Methodology: A cross-sectional, descriptive, observational approach was used to evaluate 300 Shuar individuals in Morona Santiago, Ecuador. Data were collected through sociodemographic questionnaires, anthropometric measurements, and biochemical tests, ensuring strict compliance with ethical and privacy principles. Results: A total of 10.67% of the participants were diagnosed with MS, with a higher prevalence found in women and individuals over 55 years of age. The results indicate high rates of fasting glucose, reduced HDL, and prevalence of abdominal obesity, indicating an increased risk of cardiometabolic complications. Conclusions: Research reveals that dietary changes and an increase in sedentary lifestyles may be deteriorating the health of the Shuar community. It is imperative to develop and implement public health policies that recognize the cultural and social needs of indigenous communities in order to reduce the impact of MS.Item type: Ítem , Access status: Acceso Abierto , Comparación de polimorfismos genéticos e interferón tipo 1 en la predicción de susceptibilidad del lupus eritematoso sistémico: Revisión sistemática(Universidad Católica de Cuenca., 2026) Astudillo Rodríguez , María Eduarda; Rodas Arias , María AuxiliadoraIntroduction: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease with multiple clinical manifestations, which makes early diagnosis difficult. These delays can adversely affect patients' quality of life and pose an additional problem for the healthcare system. Currently, the roles of genetic polymorphisms and type I interferon are being investigated as possible biomarkers to assess predisposition to systemic lupus erythematosus and facilitate earlier and more personalized diagnoses. Objective: To compare the utility of genetic polymorphisms and type I interferon levels as predictors of susceptibility to systemic lupus erythematosus, based on available scientific evidence. Methodology: A systematic review will be carried out using databases such as PubMed, Scopus, Cochrane, and Taylor & Francis. Original studies, performed in humans, published in English or Spanish between 2019 and 2024, will be considered. Narrative reviews, letters to the editor, and analyses with significant methodological limitations or small samples will be excluded. Results: Genetic polymorphisms and variations in type I interferon levels are expected to be important markers for the early detection of SLE and may be useful in personalized healthcare settings. Discussion: Variations such as rs2205960 (TNFSF4), as well as changes in genes such as FOXP3 and IFIH1, have been linked to an increased risk of SLE. However, genetic diversity among populations highlights the need to validate these findings in different population contexts.Item type: Ítem , Access status: Acceso Abierto , Dihidroartemisinina/Piperaquina versus Artemisinina como tratamiento de malaria por Plasmodium Falciparum resistente a la cloroquina: una revisión sistemática(Universidad Católica de Cuenca., 2026) Picón Nivelo, Dorian Paul; Mendoza Zambrano , MelissaDihydroartemisinin/piperaquine versus artemisinin as treatment for malaria by Plasmodium falciparum resistant to chloroquine: a systematic review. Objective: Evaluate the efficacy of dihydroartemisinin/piperaquine compared to monotherapy with artemisinin in the treatment of malaria caused by Plasmodium falciparum resistant to chloroquine. Methodology: Studies published in the last decade, in English or Spanish, with complete text available, were included. They were considered clinical trials, observational studies, and case series. Systematic reviews, meta-analyses, studies in animals, and incomplete or duplicated articles were excluded. Systematic searches were carried out in the databases of Scopus and PubMed, finishing in 2024. The tool GradePro was applied to value the level of confidence in the evidence and the possibility of bias. The data were organized through descriptive tables, analyzing efficacy, prevalence of resistance, and time of parasitic elimination. Results: A total of 18 articles were selected, including more than 10,000 patients. In the majority, DHA/PPQ (Dihydroartemisinin/Piperaquine) showed rates of cure superior to 95%, a faster elimination of the parasite (less than 48 hours), and a minor recurrence compared to artemisinin alone. Discussion: The limitations included risk of bias in some observational studies and imprecision in specific molecular data. Without embargo, the global evidence supports the superiority of DHA/PPQ in efficacy and control of resistance. Conclusion: It is more effective than monotherapy and must be prioritized in zones with resistance to chloroquine. Its use, sustained together with the molecular vigilance, is key to preserving the antimalarial efficacy.Item type: Ítem , Access status: Acceso Abierto , Comparación de Luspatercept Y Eritropoyetina en el tratamiento de pacientes con síndrome mielodisplásico de bajo riesgo: revisión sistemática(Universidad Católica de Cuenca., 2026) Betancourth Sanmartín, Kevin Eduardo; Méndez Mendoza , Karla NicoleObjective: To synthesize the available scientific evidence on the efficacy of luspatercept versus erythropoietin in the treatment of low-risk MDS. Methodology: A systematic review was conducted following the PRISMA 2020 guidelines. The databases PubMed, Taylor & Francis, and Scopus were searched for studies published between 2020 and 2025. Randomized clinical trials and observational studies evaluating erythroid response, transfusion independence, and adverse effects were included. The risk of bias was assessed using the RoB 2 and JBI tools. Results: Sixteen studies were included. Luspatercept showed greater efficacy than erythropoietin, with erythroid response rates of up to 74.5% and transfusion independence in patients refractory to ESAs. Adverse events were mild to moderate, with no significant increase in progression to acute myeloid leukemia. Discussion: Despite methodological variability and a moderate risk of bias, results were consistent. Luspatercept demonstrated clinical superiority over erythropoietin in refractory settings. Conclusion: Luspatercept represents an effective alternative to erythropoietin in the treatment of low-risk MDS, with an acceptable safety profile, particularly benefiting patients who are refractory or carry mutations such as SF3B1.Item type: Ítem , Access status: Acceso Abierto , Eficacia de la epinefrina racémica en comparación con la presión positiva continua en la vía aérea (CPAP) en el tratamiento de niños con bronquiolitis aguda: revisión sistemática(Universidad Católica de Cuenca., 2026) Mejia Guanoquiza , Paul Santiago; Pesantez Heras, Adriana BelenTitle: Efficacy of Racemic Epinephrine Compared to Continuous Positive Airway Pressure (CPAP) in the Treatment of Children with Acute Bronchiolitis: A Systematic Review. Objective: To determine the efficacy of racemic epinephrine compared to continuous positive airway pressure (CPAP) in treating children with acute bronchiolitis, with the aim of identifying which procedure provides greater clinical benefits. Methodology: The study followed PRISMA 2020 guidelines. It included clinical trials in Spanish and English published between 2010 and 2025, excluding incomplete studies, systematic reviews, among others. Searches were conducted in databases such as PubMed, Scopus, and ProQuest. The risk of bias was assessed using the Cochrane RoB-2 tool, and the data were presented in tables. Results: Thirteen clinical trials involving over 1,000 pediatric patients were analyzed. CPAP showed effective management in moderate to severe cases within the intensive care units (ICU), improving respiratory parameters. Epinephrine demonstrated great utility in mild cases or as a supplement to reduce hospitalizations. Discussion: CPAP demonstrates greater efficacy in severe cases; however, its use may be limited by available resources or infrastructure. In contrast, epinephrine is an accessible and safe alternative in less complex contexts. Limitations identified include methodological heterogeneity and variability in the evaluated outcomes. Conclusion: CPAP is the most effective option for moderate to severe bronchiolitis. Epinephrine is useful and safe for mild cases where non-invasive ventilatory support is unavailable.Item type: Ítem , Access status: Acceso Abierto , Fitoestrogenos versus desvenlafaxina en el tratamiento de los sintomas vasomotores en la menopausia: revision sistematica(Universidad Católica de Cuenca., 2026) Calderon Tituana , William Fabian; Vivanco Ordoñez, Kania PauletteTitle: Phytoestrogens versus Desvenlafaxine in the Treatment of Vasomotor Symptoms in Menopause. Objective: To compare the use of phytoestrogens versus desvenlafaxine in the management of vasomotor symptoms in menopausal women. Methodology: The study design is a systematic literature review that employed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology to compare the use of phytoestrogens versus desvenlafaxine in the management of vasomotor symptoms in menopausal women. Results: Vasomotor symptoms (VMS), such as hot flashes and night sweats, are common manifestations in women transitioning to menopause and postmenopausal women, significantly impacting their quality of life. Hormone therapy has been the standard treatment, but its use is limited by associated risks, especially in women with a family history of cancer, thromboembolic disease, or cardiovascular contraindications. Therefore, research into non-hormonal treatments, such as phytoestrogens and desvenlafaxine, has been promoted. Discussion: It is important to note that the safety of both approaches is favorable, although careful individualization of treatment is required. Furthermore, the need to standardize phytoestrogen formulations to optimize their clinical efficacy is highlighted. Promoting additional controlled and comparative studies between both strategies will be key to strengthening current recommendations and offering safe and effective alternatives to women during this period of life. Conclusion: Desvenlafaxine has established itself as an effective and well-tolerated therapeutic option, with consistent effects in reducing both the frequency and intensity of hot flashes, being especially useful in women for whom hormone therapy is contraindicated. Regarding phytoestrogens, although their efficacy may vary, they constitute a natural and safe alternative, appreciated mainly for their favorable safety profile and high acceptance among patients.Item type: Ítem , Access status: Acceso Abierto , Comparación entre oxitocina y carbetocina en la prevención de hemorragia postparto. Revisión sistemática(Universidad Católica de Cuenca., 2026) Enriquez Morocho, María José; Verdugo Calle, Lizbeth FernandaTitle: Comparison of Oxytocin and Carbetocin in the Prevention of Postpartum Hemorrhage: A Systematic Review. Background: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality globally, especially in low- and middle-income countries. Oxytocin and carbetocin are uterotonics widely used for their prevention; however, the need to compare their efficacy and safety remains. Methodology: Review conducted following PRISMA 2020 guidelines, registered in PROSPERO CRD420251070606. The search was performed in PubMed and Taylor & Francis databases (2020-2025). Eligibility criteria included clinical/comparative studies in humans, excluding reviews and case reports. Bias assessment was performed using RoB 2 and JBI tools. A meta-analysis was not conducted due to heterogeneity; the results were synthesized narratively. Results: Eleven studies were included (nine clinical trials, one cross-sectional, one cohort; n > 2,000 patients). Carbetocin showed greater efficacy than oxytocin, reducing the need for additional uterotonics (5.9% vs. 15.2%) and presenting fewer adverse effects (hypotension: 30% with oxytocin vs. minimal cases with carbetocin). Its prolonged action was key in elective cesarean sections and high-risk patients. Conclusion: Carbetocin outperformed oxytocin in efficacy and safety, making it ideal for elective cesarean sections and high-risk patients.
