Trabajos de Titulación - Medicina
URI permanente para esta colecciónhttps://dspace.ucacue.edu.ec/handle/ucacue/23
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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 embargoÍtem Acceso Abierto Espondilitis Anquilosante: Reporte de caso(Universidad Católica de Cuenca., 2025) Orellana Cuesta , Ana Carolina; Salamea Sarmiento, Cecibel Johanna; 0105106603Introduction: A case is reported at the “José Carrasco Arteaga” Hospital, which is particularly significant due to its early onset at 14 years of age, being unusual since the disease generally presents at around 30 years of age, with a peak at 25 years old. This report contributes to the scientific literature by providing detailed documentation of the evolution of Ankylosing Spondylitis (AS) in a young patient, highlighting the diagnostic and therapeutic challenges in this age group. Clinical Manifestations: The patient presented with primary symptoms of chronic low back pain, morning stiffness, and fatigue, along with a family history of rheumatic diseases. These findings, together with clinical and imaging examinations, allowed the identification of typical features of AS, including bilateral sacroiliitis and signs of inflammation in the joints. Diagnosis: It was established through a combination of symptom and image findings, confirming the presence of Ankylosing Spondylitis. Therapeutic interventions included using non-steroidal anti-inflammatory drugs (NSAIDs) and intensive physical therapy, resulting in significant improvement for the patient. Conclusion: The main lesson learned from this case is the importance of considering AS as a differential diagnosis in young patients with chronic low back pain and relevant family history, even when the age of onset is unusually early. This case highlights the need for an early and comprehensive evaluation to implement timely therapeutic interventions and improve long-term outcomes in young patients with AS.Ítem Acceso Abierto Enfermedad Renal Crónica Terminal secundaria mutación MYH9RD: reporte de caso(Universidad Católica de Cuenca., 2025) Medina Quizhpi, Karen Nicole; Bueno Castro , Andrés Santiago; 0104799242The condition characterized by the irreversible and progressive loss of kidney function is defined as End-Stage Renal Disease (ESRD). Such loss eventually requires that the patient initiate a renal replacement therapeutic plan such as peritoneal dialysis, hemodialysis, or a kidney transplant. There is a prevalence of at least 1 in 20,000 – 25,000 regarding diseases related to the MYH9RD mutation; the inheritance pattern is autosomal dominant. This case report concerns a 12-year-old male patient. The clinical features include generalized pallor, ecchymosis spread throughout the body, and fine tremors in the upper and lower extremities. He is diagnosed with end-stage renal failure resulting from the MYH9RD mutation. Therapy is initiated with the placement of a Tenckhoff catheter for peritoneal dialysis. In conclusion, the mutation in the MYH9RD gene tends to have significant physical repercussions in several areas, such as the kidney, in which the therapy negatively impacts the patient's living conditions, resulting in a significant emotional effect.Ítem Acceso Abierto Puericultura: estrategias de prevención en el recién nacido y lactante(Universidad Católica de Cuenca., 2025) Neira Neira , Franklin Xavier; Quizhpi ParedeS, Diana Elizabeth; 0302654066Puericulture focuses on ensuring the comprehensive development of children in their early years through scientific knowledge and practices. It goes beyond continuous care and includes techniques to safeguard health and promote proper growth. It is considered a preventive branch of pediatrics and is fundamental to ensure proper care during early childhood. Implementing preventive strategies for infant care is crucial, including providing adequate family planning, ensuring an adequate parenting environment, and promoting exclusive breastfeeding. Additionally, teaching healthy eating techniques, including the progressive implementation of nutritious foods, is essential, as it can reduce infant morbidity and mortality and promote healthy growth. In conclusion, childcare plays a fundamental role in children’s physical and emotional care, focusing on guaranteeing their integral well-being from birth to adolescence. It is not limited only to medical care and supervision of physical development, but also encompasses emotional and psychological aspects. By providing guidance to parents on healthy child-rearing practices, childcare promotes strong emotional relationships between parents and children, contributing to the social and the emotional development of children.Ítem Acceso Abierto Tofacitinib versus Etanercept como tratamiento de artritis reumatoide en adultos entre 45-55 años(Universidad Católica de Cuenca., 2025) Cevallos Diaz , Dianela Carolina; Cuenca Alvarado , Erika Karina; Salamea Sarmiento , Cecibel Johanna; 0705465243; 0105640734Title: Tofacitinib versus Etanercept as a Treatment for Rheumatoid Arthritis in 44-45 Year-Old Adults Objective: This research aims to determine the adverse effects of tofacitinib and etanercept in the treatment of rheumatoid arthritis in 44-45 year-old adults. Methodology: A systematic literature review was conducted, considering clinical trials and case reports. The search was carried out in PubMed, Scopus, and Web of Science databases, and 11 studies were chosen. The risk of bias was assessed using the Cochrane Systematic Reviews tool. Results: Eleven studies were considered according to the eligibility criteria, and they determined that the most common adverse effects were skin infections, with the highest percentage of 28%. In addition, the risk of developing cancer was notably lower in the group of patients using Tumor Necrosis Factor (TNF) inhibitors compared to those using non-biological disease-modifying antirheumatic drugs as treatment, both before and after administration of the drugs. Discussion: Various studies determined that, among dermatological and subcutaneous alterations, pruritus was mentioned as the most frequent; in infections and infestations, nasopharyngitis was the most frequent, followed by cystitis and pneumonia. Conclusion: The study indicates that TNF inhibitors significantly reduce the risk of patients developing cancer compared to tofacitinib. However, it is associated with a higher rate of pulmonary thrombosis. Common adverse reactions include pruritus, pain at the injection site, and several infections, with some severe complications such as sepsis.Ítem Acceso Abierto Impacto de la telemedicina en la precisión del diagnóstico médico(Universidad Católica de Cuenca., 2025) Merchán Morocho, Jennifer Karina; Serrano Paredes , Karina De Lourdes; 0105570758Telemedicine and telediagnosis have emerged in chronic diseases, completely transforming how they are treated. These technological advances have managed to reduce delays and overcome obstacles in the public health field, allowing medical interventions to be delivered more efficiently. Fortunately, advances in telecommunication have opened the doors to a horizon of possibilities. It is now possible to provide various health services to more people affected by chronic diseases, such as diabetes, respiratory or heart disease, and their associated complications, which would otherwise represent an expensive burden on the public health system. Revealing data on the positive impact of the inclusion of Information and Communication Technologies (ICTs) in the diagnosis and treatment of chronic diseases was discovered through extensive research. Implementing these tools has significantly reduced the number of patients requiring hospitalization due to exacerbations or complications of their primary disease. Additionally, there has been a marked improvement in the overall well-being of patients and a decrease in the mortality rate. However, despite the progress made, these virtual tools still face obstacles to their adoption globally. Technological and educational limitations present significant challenges, hindering widespread implementation and equitable access. However, as we overcome these barriers, it is clear that telemedicine and telediagnosis have the potential to change the healthcare panorama for chronic diseases radically.Ítem Acceso Abierto Complicaciones Endocrinológicas posterior a Trasplante de Células Progenitoras Hematopoyéticas(Universidad Católica de Cuenca., 2025) Cedillo Morán , Lina Briggitte; Puente Mosquera, Karola Adriana; 0705459931Introduction: Hematopoietic stem cell engraftment, also known as bone marrow transplantation or hematopoietic progenitor cell transplantation, is a therapeutic procedure that involves the infusion of autologous or allogeneic hematopoietic stem cells into a patient aiming at restoring normal hematopoietic function. Main Findings from the Review: Patients who undergo hematopoietic progenitor cell transplantation tend to experience an extended period of dysfunction, which is caused by the administration of the conditioning regime and the infusion of hematopoietic progenitor cells. Additionally, the type of transplantation is described based on the origin of the progenitor cells, whether autologous, allogeneic, or syngeneic. Understanding post-transplant endocrinological complications is crucial for early decompensation detection, thereby improving outcomes. Conclusions: It is important to note that hematopoietic progenitor cell transplantation is a medical procedure that involves the transfer of hematopoietic stem cells, which are immature cells capable of differentiating into various types of blood cells, including white blood cells, red blood cells, and platelets. This treatment is used to manage various diseases, including leukemia, lymphoma, multiple myeloma, and other conditions associated with the immune system.Ítem Acceso Abierto Reporte de caso: leucemia mieloide crónica BCR-ABL negativo(Universidad Católica de Cuenca., 2025) Soria Pangol , Paúl Esteban; Córdova Serrano, Rosana Daniela; 0105944367The study of BCR/AB- negative chronic myeloid leukemia is of great medical importance because it is a disease that is still unknown, of low prevalence, and highly aggressive and difficult to treat. Therefore, staying up to date on this disease is crucial to improving diagnostic and therapeutic methods. Currently, only a few cases have been reported and published for study; thus, this report will provide additional information on this pathology. The case of a 64-year-old mixed-race female patient, presenting with symptoms of generalized jaundice and ecchymosis, is reported. She was hospitalized for possible leukemia. Various complementary examinations were performed, including a complete blood count, bone marrow aspiration and biopsy, and genetic and cytogenetic tests, leading to a diagnosis of atypical myeloid leukemia. Hydroxyurea was started as initial treatment from admission until voluntary discharge. This case report aims to provide useful information on the clinical findings, diagnostic results, responses to treatment, and the patient’s evolution. This is fundamental for advancing the reader's medical knowledge.Ítem Acceso Abierto Utilización de probióticos en la microbiota intestinal en la población pediátrica(Universidad Católica de Cuenca., 2025) Sarmiento Uguña, Paola Carolina; Herrera Jaramillo, María Isabel; 0106060015The intestinal flora or microbiota is the group of bacteria that reside throughout the intestinal tract, permanently interacting with the aim of mutually benefiting each other. Objective: To analyze the benefits that come with the use of probiotics in the intestinal microbiota of the pediatric population Methodology: The present study is a bibliographic review approached under a descriptive design, considering the following sources of information: PubMed, Scopus, Lilacs, Redalyc, SciELO and Web of Science. Results: Probiotics help maintain intestinal flora; stimulate the immune system of the pediatric patient and contribute to their state of health. Conclusions: The use of probiotics is an alternative to prevent a number of digestive, intestinal and liver conditions. The most commonly used probiotics areEnterococcus faecium, Lactobacillus salivaris, subtilis, rhamnosus GG, Bifidobacterium Bifidum, Boulardii, Streptococcus thermophilus and Bifidobacteria. The use of these supplements modifies the toxins derived from pathogens, promotes the growth and proliferation of beneficial agents, stimulates resistance to the colonization of harmful bacteria, reduces the pH of the digestive tract and provides artificial nutritional support. Its administration does not have significant complications, but it can lead to adverse effects such as gas, bloating and stomach pain, general body discomfort, skin rashes and metabolicproblems. The selection criteria are: to be duly validated, to be gastro-resistant and to be able to adhere to the intestinal mucosa.Ítem Acceso Abierto Relación entre el nivel de riesgo del consumo de alcohol y la dinámica familiar en adultos de 18-60 años en la parroquia Sinincay, Cuenca-Ecuador. 2024(Universidad Católica de Cuenca., 2024) Narváez Puma, Blanca Alicia; Quintuña Quichimbo , Adriana Jaqueline; Vintimilla Espinoza , María José; 0106060015; 0105841860Introduction: Alcoholism, as a public health challenge, constitutes a factor that, depending on the level of consumption, will have consequences in the family environment, causing dysfunction. Objective: To determine the relationship between alcohol risk consumption and family dynamics in 18-60-year-old adults from Sinincay parish, Cuenca – Ecuador, 2024. Methodology: A quantitative approach of correlational-analytical and cross-sectional scope was applied. A sample of 376 individuals was taken, and the data analysis was elaborated with SPSS using Chi-square and Odds ratio. The Alcohol Use Disorders Identification Test (AUDIT) was used to evaluate the risk of alcoholism, and the Family Functionality (FF-SIL) test for family dysfunction. Results: Most participants were men (60%) aged 28-37 years of a medium socioeconomic level (70%). It was observed that 43% of the group had some level of problematic alcohol consumption: 25% with risk consumption, 11% with harmful consumption, and 7% with dependence. Regarding family functioning, 33.5% of the families were functional, 36.7% moderately functional, 25% dysfunctional, and 4.8% severely dysfunctional. Analysis of variance indicated a significant relationship between the variables, showing that higher levels of alcohol consumption were associated with more significant family dysfunction. Conclusion: The results suggest that the level of risk of alcohol consumption is related to family dysfunction. This underlines the need for interventions to address alcohol consumption in the family context. Further studies are recommended to validate these findings and explore effective preventive and therapeutic interventions in community environments.Ítem Acceso Abierto Nuevas estrategias de diagnóstico y tratamiento en la enfermedad de Perthes(Universidad Católica de Cuenca., 2025) Gómez Ávila , Dalila Lizbeth; Flores Flores , Pedro Martin; 0107065526Perthes disease is an avascular osteonecrosis of the femoral head that primarily affects children. It is a condition with long-term risks. The incidence is higher in males with different regional variations. This review focuses on recent innovations in diagnosis and treatment for more timely treatment. Diagnosistically, non-contrast magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) sequences has been implemented, allowing for early detection of changes in the femoral epiphysis. In addition, perfusion MRI (pMRI) and quantitative T2 and T1ρ mapping provide valuable information on blood perfusion and epiphyseal cartilage quality. Furthermore, biomarkers such as CD31+/CD42b-EMPs and IL-6 are useful for assessing vascular health and inflammation. Based on various articles, proposed treatment techniques include surgical interventions. Triple osteotomy, proximal femoral osteotomy, and containment osteotomy have been shown to improve joint congruency in the affected hip. Moreover, biological therapies using growth factors and stem cells, along with immunomodulators, offer promising prospects for bone tissue regeneration and modulation of the inflammatory response. The main conclusion is that combining new diagnostic methods with advanced therapies can significantly improve the short- and long-term outcomes in Perthes disease, optimizing clinical management and patients' quality of life.Ítem Acceso Abierto Eficacia del Ulipristal como tratamiento en la reducción del tamaño de los miomas(Universidad Católica de Cuenca., 2025) Coyago Molina, Domenica Elizabeth; Muñoz Cajilima, Juan Pablo; 0105418214Uterine fibroids, also known as leiomyomas, are benign neoplasms arising from smooth muscle cells in the myometrium, affecting approximately 40% of women of reproductive age. Their growth is stimulated mainly by estrogens and progesterone. Ulipristal acetate (UPA), a selective progesterone receptor modulator (SPRM), has shown efficacy in reducing the size of fibroids and improving symptoms such as menstrual bleeding and pelvic pain. The literature review reveals that, although UPA is presented as a promising alternative to surgical treatment of uterine fibroids, close monitoring of liver function is essential to ensure patient safety. Evidence suggests the importance of estrogens and progesterone in the pathophysiology of fibroids, making SPRMs an effective therapeutic option. However, the recent discontinuation of UPA highlights the need for further research to evaluate its hepatic safety. Thus, UPA remains a viable and effective option for patients with symptomatic uterine fibroids, provided that adequate surveillance is performed and each case is considered on an individual basis.Ítem Embargo Eficacia del Ocrelizumab como tratamiento de primera línea para pacientes adultos jóvenes con esclerosis múltiple(Universidad Católica de Cuenca., 2025) Samaniego Cando , William Fernando; Idrovo Jiménez , Humberto Eduardo; Jaramillo Alvarez, Christian Andres; 0107388308; 0604763144Proyecto de Titulación embargado para publicación. Estará disponible a la fecha de publicación o de cierre de embargoÍtem Acceso Abierto Biofeedback y coherencia cardiaca en el manejo y prevención del estrés(Universidad Católica de Cuenca., 2025) Cárdenas Coronel , Ivonne Salomé; Tapia Pinguil , Álvaro Paul; 0150349132Introduction: Stress affects physical and mental health worldwide. Studies show that stress is the cause of about 90% of pathologies. Moreover, it is also one of the most frequent reasons for consultation, which is why techniques have been develop to manage and prevent stress. These techniques allow people to visualize and consciously control the psychological processes and physiological functions, such as heart rate. These techniques aim to achieve cardiac coherence, synchronizing the heart’s activity with emotions and the brain. Literature Review: Evidence shows that the heart is taken as the main organ to regulate stress due to its significant capacity to maintain the body's harmony, known as cardiac coherence. Studies on stress management and prevention have shown that applying feedback techniques significantly improves performance and emotional self-control during stressful situations. Conclusion: Finally, research shows positive results when subjects self-regulate their cardiac coherence, especially when associated with positive emotions or thoughts. Furthermore, it seems that the rhythmic pattern of the heart rate can be synchronized even between people in proximity. Although studies on cardiac coherence have been conducted, more research is nowadays needed to incorporate these techniques into clinical treatments.
