Trabajos de Titulación - Sede Azogues - Medicina
URI permanente para esta colecciónhttps://dspace.ucacue.edu.ec/handle/ucacue/89
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Ítem Acceso Abierto Eficacia de la monoterapia versus la terapia combinada para el tratamiento de la enfermedad de Chagas: revisión sistemática.(Universidad Católica de Cuenca., 2024) León Criollo, Karen Andrea; Espinoza Díaz, Cristóbal Ignacio; 1723086862Introduction: A systematic review of the effectiveness of monotherapy and combination therapy for Chagas disease. Objective: To evaluate the effectiveness of monotherapy versus combined therapy in treating Chagas disease, focusing on its impact on parasitemia reduction, clinical outcomes, and adverse effects. Methodology: Randomized clinical trials (2012–2024) involving patients diagnosed in acute or chronic phases were included. Reviews, theses, and non-randomized studies were excluded. Information sources included databases such as Scopus, PubMed, EMBASE, and ClinicalTrials.gov, with the last search conducted in November 2024. The Cochrane Collaboration assessed the risk of bias using the ROB-2 tool. The results were synthesized through qualitative and quantitative analyses of the included studies. Results: Twenty studies (randomized clinical trials and case-control studies) involving 2,841 patients were analyzed. Monotherapy with benznidazole showed an average efficacy of 80%-89% in achieving negative seroconversion in parasitological counts but was associated with adverse effects (rash, neuropathies). Combination therapy with benznidazole and posaconazole or nifurtimox increased efficacy to 86%-96%, albeit with a higher incidence of severe side effects. Alternatives such as fexinidazole demonstrated better tolerance but lower comparative efficacy. Conclusions: Benznidazole remains the reference treatment for Chagas disease, especially in acute phases. Combination therapy offers higher parasite elimination rates but is limited by increased adverse effects, restricting its use in vulnerable populations. Findings support a personalized approach that considers the clinical status and patient tolerance to optimize outcomes. Keywords: Chagas, monotherapy, combined therapy, pharmacological treatment, therapeutic efficacyÍtem Acceso Abierto Efectividad de la técnica de Lichtenstein modificada versus la técnica de Bassini en el tratamiento de hernias inguinales: revisión sistemática(Universidad Católica de Cuenca., 2024) Zumba Ríos, Lucy Paulette; Rodas Andrade, Jorge Roberto; 0706293040Background: Inguinal hernias are a surgical condition characterized by the protrusion of abdominal contents through the abdominal wall, significantly affecting patients' daily well-being. Surgical treatment aims to restore normal anatomy, utilizing either the modified Lichtenstein technique, which employs a tension-free approach with a synthetic mesh, or the Bassini technique, which focuses on anatomical reconstruction without mesh, for managing inguinal hernias. Objective: To determine the effectiveness of the Lichtenstein technique compared to the Bassini technique in the surgical treatment of patients with inguinal hernias. Methods: This systematic review was conducted according to the PRISMA 2020 guidelines. The NIH and RoB-1 tools were used to assess methodological quality and risk of bias in randomized controlled trials (RCTs). Results: Significant variations in clinical outcomes were revealed, with the Lichtenstein technique demonstrating a lower recurrence rate (1-5%) compared to the Bassini technique (>10%). The Lichtenstein technique's mesh reinforces the hernia defect, reduces tissue tension, minimizes postoperative complications, decreases pain associated with the condition, and shortens surgical stay durations. These findings suggest that the modified Lichtenstein technique is more effective than the Bassini technique for managing inguinal hernias. Keywords: inguinal hernias, Bassini technique, Lichtenstein techniqueÍtem Acceso Abierto Alteraciones de la coagulación en pacientes con COVID19. Revisión Sistemática(Universidad Católica de Cuenca., 2024) González Baque, Gianni Aaron; Pauta Castro, Paola Elizabeth; 1350581409Coagulopathies, or disorders in blood clotting processes, have been associated with an increased risk of bleeding and thrombosis. Infection with SARS-CoV-2, the virus causing COVID-19, has proven to be a significant contributing factor to various pathophysiological alterations, including coagulopathies. These disorders are particularly relevant in severe patients, as they can lead to thromboembolic complications and increased mortality. Objective: To conduct a comprehensive review of coagulopathies in patients diagnosed with COVID-19. Methodology: A systematic review was conducted following the PRISMA 2022 guidelines, with a review of 885 articles in the Taylor & Francis, Web of Science, PubMed, and Scopus databases. Studies were screened and selected based on inclusion and exclusion criteria, resulting in 11 articles. The review focused on identifying alterations of coagulation factors, the mechanisms causing the alterations, and the most appropriate pharmacological management to counteract the effects of the virus on the circulatory system. Results: The analysis revealed that in 45% of the cases, D-dimer was the most affected factor among the patients studied. Conclusion: The information obtained from the analysis of the different studies compared with what is stated in different literature agrees with the alteration caused by the pathophysiological mechanisms triggered by the virus that caused COVID-19. Keywords: coagulopathies, COVID-19, D-dimerÍtem Acceso Abierto Eficacia de la terapia física convencional frente a la terapia de estimulación eléctrica transcutánea (TENS) en pacientes con neuropatía diabética. Revisión sistemática(Universidad Católica de Cuenca., 2024) González Peñafiel, Deysi Magaly; Intriago Acosta, Ariel Patricio; Faicán Rocano, Pedro Fernando; 0302984620; 1315638443Background: Diabetic neuropathy is a condition characterized by peripheral nerve damage, leading to pain, weakness, and reduced sensitivity, significantly impacting quality of life. Managing neuropathic pain is challenging, as it typically does not respond to conventional analgesics. Thus, physical therapy, which includes therapeutic exercises and manual techniques, is beneficial in improving this condition. At the same time, transcutaneous electrical nerve stimulation (TENS) is a non-invasive treatment using electrical impulses to also alleviate this condition. Objective: To determine the efficacy of conventional physical therapy versus TENS therapy in patients with diabetic neuropathy. Methods: A systematic review was conducted following the PRISMA 2020 guidelines, utilizing the ROB-1 tool to assess the risk of bias. Results were analyzed and visualized using the REVMAN software. Results: TENS therapy provides immediate relief from neuropathic pain caused by peripheral nerve damage due to hyperglycemia. In contrast, conventional physical therapy offers a more comprehensive approach, addressing pain, improving mobility, and enhancing long-term quality of life. Consequently, a combined approach integrating both therapeutic measures is ideal for treating diabetic neuropathy. Keywords: neuropathic pain, transcutaneous electrical stimulation, physical therapyÍtem Acceso Abierto Factores de riesgo asociados a preeclampsia en gestantes adolescentes. Revisión sistemática.(Universidad Católica de Cuenca., 2024) Rojas Reyes, Karol Jelithza; Lema Guamán, Rosa Oliva; 1105156259Preeclampsia (PE), classified as a hypertensive disorder of pregnancy, occurs after the 20th week of gestation and is a significant cause of maternal and fetal morbidity and mortality, most frequently affecting the adolescent population. Objective: To identify the risk factors associated with preeclampsia in pregnant adolescents. Method: This systematic review was conducted by analyzing case-control studies, cohort studies, and universal literature reviews addressing this issue. The studies were selected based on inclusion and exclusion criteria, limited to publications from the last five years, and sourced from databases such as PubMed, Scopus, Web of Science, and the digital repository of the Catholic University of Cuenca. Results: The literature reviewed revealed consistent findings. The studies included in this review showed excellent evidence quality and a low risk of bias. The risk factors associated with preeclampsia in pregnant adolescents were identified as age, nulliparity, obesity, type 1 diabetes mellitus, a family history of preeclampsia, and polycystic ovary syndrome. Keywords: preeclampsia, risk factors, preeclampsia in adolescentsÍtem Acceso Abierto Consecuencias en la salud mental tras el impacto del COVID 19. Revisión sistemática(Universidad Católica de Cuenca., 2024) Alvarez Alvarez, Carlos Alberto; González Zumba, Fabián Orlando; 0302874243Introduction: During the COVID-19 pandemic, healthcare workers experienced psychological changes for various reasons, leading to anxiety, depression, and stress. Objective: To determine the mental health consequences for healthcare staff after the COVID-19 pandemic. Methodology: A systematic review was conducted using the PRISMA model, ensuring the quality and transparency of the study types. Major biomedical databases, such as PubMed and ScienceDirect, were searched to gather relevant studies. The review focused on 15 epidemiological studies, building a solid foundation to address the research question and topic. The results and data from these studies were used to develop sound and reliable conclusions, placing this review at a high level of scientific evidence hierarchy. Results and Conclusions: After analyzing the 15 articles, it was concluded that the COVID-19 pandemic had an adverse impact on the mental health of healthcare staff. Those directly exposed to the virus for its containment and treatment experienced the most significant effects. Numerous psychological disorders, such as stress, anxiety, and depression, were identified. The most affected were doctors and nurses, particularly in Asian countries where the outbreak began and spread. In conclusion, frontline healthcare workers in hospitals and medical care facilities are severely impacted during pandemics, exhibiting high levels of depression, stress, and anxiety, along with other aggravating factors. Keywords: mental health, COVID-19, pandemic, healthcare professional, anxietyÍtem Acceso Abierto Terapia anti-VEGF versus Fototerapia dinámica en pacientes con degeneración macular húmeda relacionada a la edad. Revisión sistemática(Universidad Católica de Cuenca., 2024) Arroyave Pico, Jean Luis; Cabeza García, Ana María; 1312098047Age-related wet macular degeneration (AMD) is a leading cause of blindness in older adults. This study compares the efficacy and safety of anti-vascular endothelial growth factor (anti-VEGF) therapies and photodynamic therapy (PDT), both individually and in combination, assessing their impact on visual acuity, disease progression, and patient quality of life. Methodology: A systematic review of recent studies on anti-VEGF and PDT therapies in patients with wet AMD was conducted, focusing on controlled trials that assessed improvements in visual acuity and reductions in central macular thickness (CMT). Data were analyzed using Forest Plots and random-effects models to compare the treatment efficacy. Results: The findings indicate that monotherapy with anti-VEGF treatments effectively reduces CMT and improves visual acuity, significantly outperforming PDT. However, combined therapies (anti-VEGF + PDT) were proven particularly beneficial for patients with advanced or refractory AMD, achieving greater visual stability and reducing the frequency of required injections. The combination of PDT with anti-VEGF did not significantly increase the incidence of adverse events. Conclusions: Anti-VEGF therapies are the most effective in improving vision and reducing retinal thickness, highlighting their combined efficacy with PDT in advanced or resistant cases. Individualized treatment is essential to optimize outcomes and improve the quality of life for these patients. Keywords: wet age-related macular degeneration, anti-VEGF therapies, photodynamic therapy, visual acuity, bevacizumabÍtem Acceso Abierto Eficiencia del citrato de potasio versus Phyllanthus niruri en el tratamiento de la litiasis renal. Revisión sistemática(Universidad Católica de Cuenca., 2024) Vite Macias, Franklin Junior; Sanango Reinoso, Wilmer Stalin; 1315589901Introduction: Kidney stones, characterized by the formation of calculi, can be managed using potassium citrate, known for its urine-alkalinizing properties and its ability to prevent stone formation, and Phyllanthus niruri, a plant with demonstrated litholytic and diuretic properties. Both treatments have shown promising results. Objective: To compare the efficiency of potassium citrate versus Phyllanthus niruri in treating kidney stones through a systematic review. Methodology: A systematic review was conducted following the PRISMA 2020 model for study screening. Bias was analyzed using the ROB 2 tool, and study quality was assessed using the NHLBI criteria. Results: A total of 53 studies were analyzed, of which 19 met the selection criteria. Both treatments proved effective in managing kidney stones, albeit through different mechanisms of action, and were more effective in younger patients. Adverse effects included nausea, diarrhea, and stomach discomfort. Rarely, potassium citrate could cause hyperkalemia, particularly in patients with renal insufficiency. Conclusion: Assessing the efficacy of both treatments for kidney stones indicates that potassium citrate and Phyllanthus niruri are effective for prevention and treatment. However, the evidence base is more robust and consistent for potassium citrate due to more well-designed clinical trials supporting its use. Phyllanthus niruri, as a natural alternative, demonstrates a favorable safety profile. Keywords: Phyllanthus niruri, renal lithiasis, potassium citrate, herbal medicineÍtem Acceso Abierto Detección temprana de cáncer gástrico utilizando nuevas técnicas endoscópicas. Revisión sistemática(Universidad Católica de Cuenca., 2024) Jimbo González, Wendy Dayana; Buenaño Rodríguez, Christian Eduardo; 0302678719Gastric cancer (GC)is one of the most common cancers with high mortality rates worldwide, so early detection is crucial to improve survival rates, which can reach 70% if the cancer is detected when it is still limited to the superficial layers of the stomach. Endoscopy plays a vital role in the early identification of gastric lesions, enabling direct visualization of the stomach lining and detecting abnormalities before the cancer progresses. This tool has effectively reduced mortality risk by enabling timely, less invasive interventions. This systematic review evaluates advances in endoscopic techniques, focusing on innovations that enhance early GC detection and improve patient outcomes. Studies published between 2019 and 2024 that reported new endoscopic techniques for early GC detection were included for analysis using the PubMed and Scopus databases. Forty-seven studies met the eligibility criteria and were analyzed in full text. This systematic review describes the most recent advances in white light endoscopy, chromoendoscopy, endoscopic ultrasound, confocal endomicroscopy, and serological biomarkers. In conclusion, these innovative techniques, together with advanced technologies, improve the quality of the results and, when combined with artificial intelligence, facilitate real-time histopathological analysis, obtaining a more accurate characterization of early-stage GC tumors. Keywords: Gastric cancer, endoscopy, diagnostics, innovationÍtem Acceso Abierto Proyecto de titulación embargado para publicación. Estará disponible a la fecha de publicación o cierre de embargo.(Universidad Católica de Cuenca., 2024) Medina Idrovo, Victora Jazmín; Chango Criollo, Esteban Ismael; 0928546159Ítem Acceso Abierto Complicaciones cerebrovasculares en pacientes hipertensos. Revisión Sistemática(Universidad Católica de Cuenca., 2024) Gualán Vásquez, Juan Pablo; Garcés Ortega, Juan Pablo; 1105119687Introduction: Hypertension (HTN) is one of the most significant risk factors for cerebrovascular disease (CVD), including ischemic and hemorrhagic strokes. Given the high global prevalence of hypertension and its strong association with CDV, it is crucial to understand the relationship between HTN and various types of cerebrovascular complications, the magnitude of this risk, and the factors that may mitigate it. Objective: To identify the primary cerebrovascular diseases in hypertensive patients through a systematic review. Methodology: A methodical analysis was conducted, focusing on observational studies and clinical trials retrieved from prestigious databases such as PubMed, the Cochrane Library, and Scopus. Strict eligibility criteria were applied to ensure the inclusion of studies with high methodological quality and statistically significant data. Results: Twelve studies were included, comprising approximately 52,150 hypertensive patients across diverse geographic regions, primarily aged between 55 and 75 years. Of the participants, 58% were men and 42% were women. The reviewed studies identified several subtypes of CVD in hypertensive patients: thromboembolic cerebral infarction, lacunar infarction, intracerebral hemorrhage, subarachnoid hemorrhage, and transient ischemic attack. Conclusions: In hypertensive patients, identifying and managing additional risk factors such as age, obesity, obstructive sleep apnea, diabetes, and unhealthy lifestyles are essential to reducing the risk of CVD. Keywords: hypertension, cerebrovascular complications, cerebrovascular diseaseÍtem Acceso Abierto Alteraciones cognitivas en pacientes con esquizofrenia. Revisión Sistemática(Universidad Católica de Cuenca., 2024) Pullaguari Idrovo, Jeanine del Rocío; Herrera Lema, Ángel Oswaldo; 0302873286Schizophrenia is a mental disorder characterized by a wide range of symptoms, including significant cognitive impairments that affect executive functions, attention, and memory, profoundly impacting individuals' daily lives. Objective: To synthesize existing scientific evidence on cognitive deficits associated with schizophrenia, identify the main cognitive impairments, and determine the efficacy of different interventions to improve cognitive functions in these patients. Methodology: A systematic search was conducted in PubMed, PsycINFO, and Scopus, following PRISMA guidelines. A total of 990 documents were identified, from which ten relevant studies published within the last five years were selected. Data were extracted regarding study design, sample size, cognitive evaluation methods, and main findings. Results: The analyzed studies reported p-values < 0.05, indicating high statistical significance in identifying essential cognitive impairments in patients with schizophrenia. Interventions such as cognitive-behavioral therapies and antipsychotic medications demonstrated a 30% effectiveness in improving cognitive functions. Conclusions: These results highlight the need for targeted interventions addressing cognitive deficits to enhance patients' quality of life. The review recognizes certain limitations, such as the heterogeneity of methodologies among the included studies. Keywords: schizophrenia, cognition, attention, memory, executive functionsÍtem Acceso Abierto Eficacia de la tercer ventriculostomía endoscópica en pacientes con hidrocefalia no comunicante. Revisión Sistemática(Universidad Católica de Cuenca., 2024) Castillo Avila, Anthony Javier; Torres Criollo, Larry Miguel; 0705608594Background: Non-communicating hydrocephalus is a condition caused by an obstruction in the cerebrospinal fluid circulation system. Due to the nature of this disease, treatment involves surgical intervention. Historically, shunt systems have been the standard treatment; however, endoscopic techniques, such as endoscopic third ventriculostomy (ETV), are gaining prominence due to their minimally invasive nature and reduced risk of long-term complications. Objective: To analyze the efficacy of endoscopic third ventriculostomy in patients with non-communicating hydrocephalus. Methodology: A literature search was conducted in English and Spanish on Scopus, PubMed, ProQuest, and Web of Science databases. Reviews were performed following the PRISMA flow diagram. Results: This systematic review assessed the effectiveness of ETV for non-communicating hydrocephalus. The data indicate that ETV has an overall efficacy rate of 82.14% and a complication rate of 12.91%. These findings suggest that, while not free of risks, ETV is a viable and effective alternative for managing non-communicating hydrocephalus. Predictive tools such as measuring the optic nerve sheath diameter, detecting the "buckling sign," and assessing the thickness of retinal nerve fibers contribute to predicting surgical success. Conclusions: ETV is a safe and effective option for treating non-communicating hydrocephalus. Improved patient selection and future comparative studies are needed to optimize its use and long-term outcomes in clinical practice. Keywords: efficacy, obstructive hydrocephalus, ventriculostomy, third ventricle, cerebrospinal fluidÍtem Acceso Abierto Efectividad y complicaciones del implante de válvula aórtica transcatéter. Revisión sistemática(Universidad Católica de Cuenca., 2024) Tenezaca Pillaga, Marcia Alexandra; Idrovo Vásquez, Víctor Aníbal; 0301904140Title: Effectiveness and Complications of Transcatheter Aortic Valve Implantation: A Systematic Review. Objective: To analyze the effectiveness and complications associated with Transcatheter Aortic Valve Implantation (TAVI) in patients with severe aortic stenosis. Methodology: Following PRISMA guidelines, studies were included comparing patients with aortic stenosis who underwent TAVI within the last 10 years. The search was conducted on PubMed, Elsevier, Springer Link, and SciELO databases. The Cochrane RoB 2.0 tool was used to evaluate the risk of bias, and the GRADE approach was applied to estimate the quality of evidence. Results: Twenty-five 25 articles representing 37,825 patients were considered. The findings indicated that TAVI demonstrated significant effectiveness comparable to Surgical Aortic Valve Replacement (SAVR) regarding short- and long-term mortality. However, TAVI was associated with a higher risk of vascular complications and an increased need for permanent pacemakers. Conversely, TAVI revealed lower rates of stroke and respiratory complications, highlighting its favorable safety profile compared to SAVR. Discussion: The evidence's limitations include risks of bias in observational studies and heterogeneity among the studied populations. Further research is required to corroborate these findings and provide more specific clinical recommendations. Conclusions and Relevance: TAVI is a viable alternative to SAVR, with favorable outcomes in effectiveness and safety, albeit with certain complications. Keywords: aortic stenosis, transcatheter valve replacementÍtem Acceso Abierto Efectividad del crosslinking corneal en el manejo de la progresión del queratocono. Revisión sistemática(Universidad Católica de Cuenca., 2024) Chuva Palacios, Yadira Fabiana; Calle Luna, Liliana Francisca; 0105968325Background: Keratoconus is a corneal ectasia characterized by thinning and conical deformation, which leads to reduced visual acuity. Corneal cross-linking , a technique that strengthens and stabilizes the cornea by creating cross-links between collagen fibers, is employed to halt its progression. Objective: To determine the effectiveness of corneal cross-linking compared to conventional treatments in managing the progression of keratoconus in diagnosed patients. Methods: A systematic review was conducted on the topic "Effectiveness of Corneal Cross-Linking in Managing the Progression of Keratoconus. A Systematic Review" within the field of ophthalmology. Information was sourced from PubMed, Web of Science, Embase, ProQuest, Taylor & Francis, Scopus, and SciELO databases in English and Spanish, published in the last five years. Observational studies and clinical trials were included, and the quality of evidence was assessed using the GRADE system. Results: A total of 289 records were included, and 2,915 participants were evaluated after screening. Most studies demonstrated that corneal cross-linking is effective in halting the progression of keratoconus, especially in its early stages, compared to conventional treatments. Additionally, a 20% improvement in visual acuity was observed. Predictive factors for success, such as age, disease severity, and associated conditions, were identified. Corneal cross-linking is a beneficial treatment option, as it halts disease progression and improves visual acuity. Keywords: Keratoconus, corneal cross-linking, management, visual acuityÍtem Acceso Abierto Diagnóstico y tratamiento de la fibrilación auricular. Revisión Sistemática(Universidad Católica de Cuenca., 2024) Torres Ormaza, Julio Cesar; Paula Castro, Paola Elizabeth; 1206334045Introduction: Atrial fibrillation (AF) is a tachyarrhythmia in which the atria beat uncoordinatedly at elevated rates, making timely diagnosis and effective treatment essential. Objective: To identify the most effective diagnostic methods and treatments for atrial fibrillation through a systematic review. Methodology: A qualitative and descriptive study was conducted by reviewing articles from scientific databases, following the PRISMA guidelines. Results: The electrocardiogram is the most effective diagnostic method, with a sensitivity of 94–98% and a specificity of 76–95%. Regarding treatment, anticoagulants play a crucial role in managing hemorrhagic risk. Vitamin K antagonists (VKAs) are recommended for patients with structural heart disease, while direct oral anticoagulants (DOACs) are preferred for those without such conditions. Factors including symptomatology, hemodynamics, and recurrence are considered for cardioversion. Pharmacological cardioversion is effective for episodes lasting <48 hours in patients with stable hemodynamics, while electrical cardioversion is recommended for the opposite scenario. Ablation provides more significant benefits in patients with AF and heart failure. Comorbidities are associated with increased morbidity and mortality. Conclusions: The electrocardiogram is the most valuable diagnostic tool, but cardiac Holter monitoring offers more significant benefits for paroxysmal episodes. VKAs are superior to DOACs; however, for non-valvular AF, DOACs have proven equally effective. Flecainide and propafenone show the highest success rates in restoring rhythm, while beta-blockers outperform calcium channel blockers and glycosides in maintaining heart rate. Regarding comorbidities, they increase the risk of AF episodes.Ítem Acceso Abierto Manejo del hipotiroidismo subclínico en adultos jóvenes. Revisión sistemática(Universidad Católica de Cuenca., 2024) Leal Guerrero, Jacobo Israel; Calle Gutiérrez , María Silvana; 0302361357Introduction: Subclinical hypothyroidism is an endocrine disorder characterized by elevated levels of thyroid-stimulating hormone while maintaining average concentrations of free thyroxine in the blood, suggesting altered thyroid gland function. The treatment for this condition typically involves levothyroxine; however, certain factors must be considered to guide a more appropriate management approach. Objective: To describe the management of subclinical hypothyroidism in young adults through a systematic review. Methodology: A systematic review was conducted following PRISMA guidelines, employing a descriptive and retrospective study based on articles and scientific journals from major databases such as PubMed, Google Scholar, World Health Organization, and Pan American Health Organization. Open-access articles categorized within SCImago quartiles Q1 and Q2, related to the management of subclinical hypothyroidism in young adults, were included in the review. Conclusion: The findings reveal a higher prevalence of subclinical hypothyroidism among young adults aged 27 to 29 years. Therefore, it is essential to consider management criteria for subclinical hypothyroidism, as treatment is entirely individualized for each patient. Keywords: thyroid dysfunction, subclinical hypothyroidism, levothyroxine, thyroxine, triiodothyronineÍtem Acceso Abierto Efectividad de la facoemulsificación versus la femtofacoemulsificación como tratamiento de la catarata senil en adultos mayores. Revisión sistemática(Universidad Católica de Cuenca., 2024) Bermeo Chimborazo, Mayra Alexandra; Calle Luna, Liliana Francisca; 0350155255Objective: To evaluate phacoemulsification's (PHACO) effectiveness versus femto-phacoemulsification (FLACS) as a surgical technique for managing senile cataracts in older adults. Methodology: A retrospective, descriptive, and qualitative systematic review was conducted. It was structured according to the PRISMA 2020 guidelines. Inclusion criteria: Publications from 2014 to 2024 in English or Spanish from indexed journals accessible via free full-text databases. The databases used were SciELO, PubMed, Scopus, Science Direct, Springer Link, Google Scholar, and Web of Science. Bias risk was evaluated using the Cochrane Review Manager 5.4.1 tool. Results: The findings were synthesized in a summary table featuring author, title, country, year, results, and objectives. Twenty-four 24 Randomized Controlled Trials (RCTs) with 5,943 participants were included. Each trial compared aspects of cataract surgery with PHACO versus FLACS, such as safety, efficacy, cost-effectiveness, endothelial cell loss, visual outcomes, and complications. Conclusions: Both PHACO and FLACS are viable surgical techniques for managing senile cataracts, with notable differences favoring FLACS in endothelial cell preservation and reduced ultrasonic energy use. However, PHACO remains more cost-effective and reveals comparable outcomes regarding complications and visual results, making it the preferred technique for most cases. Keywords: cataracts, surgery, phacoemulsification, femtosecond laserÍtem Acceso Abierto Tratamiento rehabilitador de la parálisis cerebral infantil. Revisión Sistemática(Universidad Católica de Cuenca., 2024) Guaman Yansaguano, Jonnathan Patricio; Capote Llanares, Miguel Ángel; 0302514328Background: This systematic review analyzes the problems of rehabilitative treatment in children with infantile cerebral palsy (ICP). Objective: To evaluate the effectiveness of rehabilitation treatment in children with ICP, analyzing its impact on motor function, autonomy, and quality of life of patients through a systematic review of updated and relevant scientific literature. Methods: This review was based on PRISMA 2020 guidelines; observational studies and randomized clinical trials (RCTs) were employed. Results: A remarkable variability could be appreciated in the effectiveness of the assessment scales, specifically the Bobath Foundation Scale and the Gross Motor Function Scale (GMFM). The Bobath Scale indicated greater consistency in evaluating motor and functional development, while the GMFM effectively measured specific changes in gross motor function over time. The positive predictive value of the Bobath Scale ranged from 70% to 95%, depending on clinical context and type of Intracerebral hemorrhage (ICH), whereas the GMFM ranged from 60% to 90%. Regarding the negative predictive value, the GMFM had a more consistent performance, approximately 75%-98%, compared to the Bobath Scale at 50%-85%. Furthermore, likelihood ratios indicated that the GMFM might be more effective in identifying significant functional improvements in children with ICP. Keywords: motor function, cerebral palsy, rehabilitation treatmentÍtem Acceso Abierto Crononutrición y salud metabólica en adolescentes y adultos. Revisión sistemática(Universidad Católica de Cuenca., 2024) Pastuizaca Paucar, Jhoana Elizabeth; Faicán Rocano, Pedro Fernando; 0302877816Chrononutrition is an emerging field that investigates the relationship between diet and circadian biological rhythms, highlighting the importance of regular sleep and eating schedules based on individual chronotypes, as this study aims to understand the metabolic issues caused by such imbalances. Objective: To describe the relationship between chrononutrition and metabolic health in adolescents and adults. Methodology: A systematic review followed PRISMA guidelines, including clinical trials, cross-sectional, observational, and cohort studies published in the last five years. A search equation was created using scientific databases such as Scopus, PubMed, Web of Science, Taylor & Francis, and Science Direct. Bias was analyzed using RAYYAN and NHLBI, and results were synthesized in a contingency table. Results: Fifteen articles met the eligibility criteria, including 11 controlled trials and four observational studies (cross-sectional and longitudinal), with a sample of 3,760 participants. The findings suggest that chrononutrition influences the development of metabolic or cardiac diseases associated with weight gain according to eating patterns and sleep duration. Conclusions: It was determined that chrononutrition directly impacts cardiometabolic health in adolescents and adults, as the biological clock is affected by sleep or eating schedules, which can lead to physiological imbalances. Further studies are needed to substantiate these findings. Keywords: adolescent, adult, chrononutrition, metabolism
