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 terapia dual con amoxicilina y vonoprazan versus la terapia cuádruple con bismuto para la erradicación de helicobacter pylori: una revisión sistemática(Universidad Católica de Cuenca., 2025) Lapo Torres, Bryan Steeven; Blandin Lituma, Paula Eliana; 0706664950Objective: To determine the efficacy and safety of dual therapy with amoxicillin and vonoprazan versus bismuth-based quadruple therapy to eradicate Helicobacter pylori. Methodology: A systematic literature review was conducted using significant databases such as (Medline, Embase, MDPI, Cochrane, LILACS) and keywords (Helicobacter pylori, vonoprazan, amoxicillin, and bismuth, among others). Eleven studies meeting eligibility criteria were selected (inclusion: studies with dual therapy using amoxicillin and vonoprazan in one treatment arm and bismuth-based quadruple therapy in the other; exclusion: abstracts, conference presentations, other article types, and quadruple therapy including vonoprazan). Efficacy, safety, and quality were assessed using the NIH risk of bias tool for clinical studies. Results: Eleven articles were included, all randomized non-inferiority clinical trials with 100 to 600 participants suffering from untreated H. pylori gastric infection. The eradication efficacy of H. pylori with dual therapy using vonoprazan and amoxicillin ranged from 59.3% to 98.5%. H. pylori eradication rates were similar between the two therapies (OR 1.27, 95% CI 0.72–2.22, p=0.41), as most included studies were non-inferiority trials. Reported adverse events were gastrointestinal, with dual therapy showing a lower incidence (OR 0.28, 95% CI 0.23–0.35, p=<0.00001) than bismuth-based quadruple therapy. Both groups demonstrated high adherence rates of over 80%. Keywords: vonoprazan, eradication, Helicobacter pylori, amoxicillin, bismuthÍtem Acceso Abierto Eficacia y seguridad de los inhibidores del cotransportador de sodio glucosa-2 versus los agonistas del receptor del péptido similar al glucagón-1, en personas con diabetes tipo 2 y enfermedad renal crónica: revisión sistemática(Universidad Católica de Cuenca., 2025) Chuqui Coronel, Segundo Miguel; Redrovan Coraizaca, Andres Leonardo; Idrovo Vázquez, Víctor Aníbal; 0302503388; 0302627807Background: Diabetes is a serious global health problem, with an estimated prevalence of 425 million in 2017, which is projected to decline to nearly 360 million by 2045, according to the International Diabetes Federation (IDF). A significant complication is chronic kidney disease, which develops in nearly half of individuals previously diagnosed with type 2 diabetes mellitus. Therefore, there is an urgent need for more effective and safer approaches. Objective: To evaluate the efficacy and safety of Sodium-glucose cotransporter type 2 (SGLT2) inhibitors compared to Glucagon-Like Peptide-1 (GLP-1) agonists in the treatment of adult patients with type 2 diabetes mellitus and chronic kidney disease. Methods: This systematic review will follow the PRISMA 2020 methodology, which will enhance the quality of this review. Additionally, various health determinants will be used to conduct a comprehensive search for information. Results: SGLT-2 inhibitors indicated a significant reduction in HbA1c levels with a value of -0.8%, representing an effect estimate of the presented variables, along with a 95% confidence interval. On the other hand, GLP-1 agonists showed a reduction of -0.7%, with 95% confidence interval, indicating no significant differences between both variables, especially in terms of safety. SGLT-2 inhibitors were associated with a higher risk of urogenital infections, while GLP-1 agonists indicated an increased incidence of nausea and vomiting. Therefore, both types of medications are effective, but present patterns of adverse events that should be considered in clinical practice. Keywords: GLP-1 agonists, diabetes mellitus, SGLT-2 inhibitorsÍtem Acceso Abierto Sensibilidad y especificidad de cervicometría versus fibronectina fetal en la predicción de parto prematuro: revisión sistemática(Universidad Católica de Cuenca., 2025) González Álvarez, Jennifer Patricia; Pesantez Siguencia, Katherine Graciela; Rodas Torres, Américo Gerardo; 0105837009; 0302738737Background: Preterm birth is one of the leading causes of neonatal morbidity and mortality, making the early identification of women at risk crucial. This systematic review analyzes and compares the sensitivity and specificity of two widely used diagnostic methods: cervical length measurement and fetal fibronectin test. Cervical length measurement, which evaluates cervical length via ultrasound, and fetal fibronectin detection, a protein indicative of extracellular matrix breakdown during pregnancy, have shown effectiveness in predicting preterm birth. However, their performance varies depending on factors such as test timing and population characteristics. Method: This study was conducted following the PRISMA framework by systematically reviewing scientific articles from databases such as Scopus, PubMed, and Cochrane Library, including articles that evaluated and compared these two methods regarding sensitivity and specificity. The information will be organized using the Rayyan platform, and the quality of the studies will be assessed using Joanna Briggs Institute forms. Expected Results: This study aims to determine which diagnostic method offers greater sensitivity and specificity in predicting preterm birth. Conclusions: This systematic review seeks to provide a better understanding of diagnostic methods for preventing preterm birth. Keywords: cervical length measurement, fetal fibronectin, preterm birthÍtem Acceso Abierto Eficacia de los tratamientos derivados del extracto de melaleuca versus otros tratamientos para la blefaritis por demodex: revisión sistemática(Universidad Católica de Cuenca., 2025) Arostegui Gutiérrez, César Iván; Guamán Ávila; Arias Peláez, María Cristina; 1400645162; 0302846316Background: Demodex blepharitis is a chronic ophthalmological condition characterized by inflammation of the eyelid margins. Although many people with Demodex mites are asymptomatic, conventional treatments include pharmacological and hygiene measures. Objective: To determine the efficacy of melaleuca extract treatment compared with other treatments for Demodex blepharitis. Methods: This review used the PRISMA 2020 methodology, including IT B, randomized controlled trials (RCTs) to ensure reliable results, and 1.0 (RoB 1) tool to assess the risk of bias. Results: Melaleuca extract used in Demodex blepharitis has been shown to reduce clinical manifestations. However, it is not considered a replacement for conventional antibiotics, as these are still essential in cases requiring timely and rapid intervention to prevent bacterial proliferation. This oil, complemented with antibiotics, offers an alternative to reduce inflammation and combat various microorganisms. It is crucial to assess patients on an individual basis. Conclusion: Melaleuca extract demonstrated efficacy in reducing symptoms of Demodex blepharitis, such as itching, burning, and dry eyes, enhancing traditional therapies. Compared to treatments like ivermectin and metronidazole, it is more competitive even though, in some cases, it shows higher eradication rates. Its favorable safety profile and minor side effects make it ideal for patients seeking lower-risk therapeutic options. In addition to alleviating symptoms, it improves emotional well-being and functionality, making it a practical option for managing this condition. Keywords: visual acuity, corneal crosslinking, keratoconusÍtem Acceso Abierto Antibioticoterapia versus apendicectomía en apendicitis aguda no complicada en adultos y niños: revisión sistemática(Universidad Católica de Cuenca., 2025) Idrovo Calle, Wilson Rolando; Rodas Andrade, Jorge Roberto; 0301961363Traditionally, acute appendicitis has been treated through open surgery; however, laparoscopic surgery has become the most widely used method today. Additionally, the use of antibiotics is being evaluated, specifically in uncomplicated cases. Objective: To evaluate the comparative effectiveness of antibiotic therapy versus appendectomy in the treatment of uncomplicated acute appendicitis in adults and children. Methodology: Twenty studies comparing the use of antibiotics and appendectomy for the treatment of uncomplicated acute appendicitis in children and adults were analyzed using search engines and electronic databases such as Scopus, Taylor & Francis, Web of Science, UpToDate, DynaMed Plus, and PubMed. Results were synthesized into tables, and bias was assessed using various scales. Results: The quality of life in adults was significantly improved with broad-spectrum antibiotics like metronidazole, with scores above 0.86 points. Only one study reported elevated scores in children. Recurrence rates of acute appendicitis ranged from 11% to 33.5% in adults and from 3% to 45.8% in children. Conclusions: The combination of ciprofloxacin and metronidazole was the most commonly used antibiotic regimen, with success rates ranging from 64% to 98.46%. Hospital stays for antibiotic treatment ranged from 28.9 hours to 6.8 days, while stays for the surgical group ranged from 1 to 4 days, with a maximum period of 3 days in children. Keywords: appendicitis, adult, child, antibiotics, quality of lifeÍtem Acceso Abierto Eficacia del ácido tranexámico ante medicamentos útero tónicos para el control de la hemorragia posparto primaria. Revisión sistemática(Universidad Católica de Cuenca., 2025) Loja Patiño, Johanna Elizabeth; Blandín Lituma, Paula Eliana; 0302411806Postpartum hemorrhage is defined by the World Health Organization (WHO) as blood loss of 500 ml or more within the first 24 hours after vaginal delivery and 1,000 ml or more after cesarean delivery, causing hemodynamic alterations in the patient. Common causes include uterine tone abnormalities, trauma, retained tissue, or coagulopathies. Objective: To determine the efficacy of tranexamic acid compared to the use of uterotonic drugs for the control of primary postpartum hemorrhage. Methodology: A systematic literature review was conducted, with searches performed in databases such as PubMed, SpringerLink, Elsevier, and Frontiers. Keywords were combined using Boolean operators like AND to optimize results. The review included studies in English and Spanish published after 2020, all available in open access. Literature references were managed with Zotero, articles were analyzed using the NIH tool, and the risk of bias was evaluated with ROB-2. Results: Thirteen articles meeting the specific objectives were included. Seven analyzed tranexamic acid, and six focused on oxytocin and carbetocin, the leading uterotonic drugs. All the drugs achieved the primary outcomes specified in the articles. However, oxytocin was more likely to cause maternal adverse effects. Conclusions: All analyzed drugs demonstrated high efficacy in achieving the primary objective of reducing bleeding levels. Treatment lasted up to 10 minutes, with varying dosages based on population characteristics. Oxytocin presented the highest incidence of adverse effects, notably tremors. Keywords: tranexamic acid, hemorrhage, postpartum hemorrhage, oxytocinÍtem Acceso Abierto Eficacia de la enoxaparina versus el rivaroxabán en la prevención del tromboembolismo venoso en trauma ortopédico: revisión sistemática(Universidad Católica de Cuenca., 2025) Nivelo Alvarez, Paula Renata; Capote Llanares, Miguel Ángel; 0954297040Venous thromboembolism (VTE) is a condition that leads to the formation of a blood clot in a blood vessel, which can travel and eventually block blood flow, endangering the patient’s life. Objective: To analyze the efficacy of enoxaparin versus rivaroxaban in preventing venous thromboembolism in orthopedic trauma. Methodology: A systematic review with a descriptive design and mixed approach was conducted following the PRISMA method parameters, analyzing 22 articles from scientific sources such as PubMed, Scopus, Lilacs, Redalyc, SciELO, and Web of Science. Results: Obesity, smoking, hypertension, diabetes, a history of venous thrombosis, and hospitalization were the predominant risk factors. Additionally, women over 60 years old were prevalent in both groups. The administered dose of enoxaparin was 40 mg/day for durations of 10, 14, 30, 35, and 90 days, while the daily dose of rivaroxaban was 10 mg for 7, 14, 35, 42, and 90 days. Enoxaparin reduced the risk of deep vein thrombosis (DVT) to 2.11% and pulmonary embolism (PE) to 0.57%. Rivaroxaban reduced DVT to 2.30% and PE to 0.13%. Both medications were well-tolerated by patients, though they presented common adverse effects such as bleeding at a low incidence. Conclusions: Both drugs effectively prevent VTE, but rivaroxaban revealed greater efficacy in preventing PE and did not present mortality cases. Keywords: venous thromboembolism, adverse effects, prevention, enoxaparin, rivaroxabanÍtem Acceso Abierto Eficacia de la hidralazina versus nifedipino en el tratamiento de la preeclampsia: revisión sistemática(Universidad Católica de Cuenca., 2025) Benalcázar Urgiles, Patricia Jacqueline; Naula Morocho, Johanna Veronica; Gallegos Vintimilla, Santiago Homero; 0107130221; 0106182850Background: Among the most commonly used drugs in pregnant women diagnosed with preeclampsia are hydralazine and nifedipine. Their efficacy, as well as their onset of action, has been demonstrated to reach optimal levels. Their use is widespread, though not without concerns about adverse maternal and perinatal effects. Objective: To characterize the efficacy of hydralazine versus nifedipine in treating preeclampsia. Methodology: A systematic literature review was conducted involving searches in health databases, primarily PubMed, Elsevier, and SpringerLink, using predefined descriptors supported by Boolean operators such as AND and OR to optimize the searches. The PRISMA methodology was employed for screening and selection processes. All articles included were published after 2020 in English or Spanish as essential inclusion criteria. Sixty-four references met the established requirements, and 57 were included in the final bibliography. Results: Twelve articles met the screening and suitability processes according to the designed objectives. The onset of action of both medications varied depending on the doses. Hydralazine demonstrated a slightly faster onset compared to nifedipine. Regarding efficacy levels, both drugs showed optimal results. However, nifedipine was associated with a higher incidence of adverse effects. Conclusions: Hydralazine proved to be faster in its action. Both drugs achieved appropriate levels of efficacy, although nifedipine revealed a more significant number of adverse effects. Keywords: antihypertensives, hydralazine, hypertension, nifedipine, preeclampsiaÍtem Acceso Abierto Secuelas en pacientes con neumonía por COVID-19(Universidad Católica de Cuenca., 2022) Armijos González, Ana Lucía; Idrovo Vásquez, Víctor Aníbal; 1900536390Millions have been infected by a new virus that appeared in 2019 and spread rapidly around the world, causing mild to fatal conditions. The current and future concern is “The consequences in patients with pneumonia by COVID-19” that, according to the evidence, there is a multi-organ involvement. Objective: To know the sequelae in patients with pneumonia caused by Covid 19. Material and method: a systematic review of studies, cases, and articles that met the selection criteria. Results: in hospitalized patients: pulmonary fibrosis in 37% (intubated), myocarditis 3.9%, tracheal stenosis with 50.8% of symptomatic patients and of wich 3.1% is associated with trachea-esophageal fistula and tracheomalacia; and in outpatients: pulmonary fibrosis in 12% (not intubated), pericarditis in 21.7%, myocarditis 13.7%, PE 17%, ischemic stroke in 1.6%, predisposition to kidney injury in 100% of older adults, depression, and anxiety in 30%, sleep disorders in 85%, and initial symptoms of intection such as dyspnea, anosmia, myalgia, headache, etc., that persist for more than a month or more than 12 months, in about half or all of the patients. Conclusions: the evidence shows a real compromise in vital organs such as the lung, heart, and kidney in a large percentage of patients, for which the opening of health centers for pulmonary rehabilitation and psychological care should be considered; in addition, it established follow-up guidelines for early detection of sequelae and treatment. Keywords: sequelae, SARS CoV 2, Covid 19, Post Covid Syndrome, prolonged CovidÍtem Acceso Abierto Infuciciencia cardiaca aguda y furosemida a altas dosis(Universidad Católica de Cuenca., 2022) Argudo Cabrera, Pablo Andrés; Idrovo Vásquez, Víctor Aníbal; 0105874929Introduction: An imbalance in the contractile capacity of the heart causes acute heart failure. It is currently considered that there is no wholly established therapeutic management. So more than 80% of patients are treated with loop diuretics, mainly furosemide, which is the mainstay of treatment. Objective: To determine the benefit of high-dose furosemide in treating acute heart failure. Materials and methods: A literature review was performed based on the PRISMA guide of articles mentioning furosemide as a first-line drug in databases such as PubMed and Cochrane, that study acute heart failure and its therapeutic management. The studies reviewed are written in English and Spanish and published in the last five years. A total of 28 articles were analyzed. Results: According to articles, furosemide continues to be considered a therapeutic pillar. The evidence also mentions whether this drug is administered at high doses in continuous doses or boluses; it continues to be accepted. Conclusions: Considering the studies conducted, furosemide has not been shown to reduce mortality. However, it is still the therapeutic pillar of initial management, especially at high doses. Based on the research carried out in trials and comparative studies, there is currently no established management scheme. Keywords: acute heart failure, loop diuretics, high dosesÍtem Acceso Abierto Manejo de la insuficiencia Renal Aguda con Furosemida a Dosis Altas(Universidad Católica de Cuenca., 2022) Andrade Ortiz, Jefferson Fernando; Idrovo Vásquez, Víctor Aníbal; 0302946611Introduction: Acute renal failure (ARF), considered a condition characterized by a sudden decrease in renal function, is associated with high rates of morbidity and mortality in critically ill patients. In this sense, the initial therapeutic management is important, which should focus on optimizing the patient’s internal hemodynamics. To do this, a series of diuretic drugs are used in patients with a tendency to retain fluids. In this regard, furosemide is the most widely used diuretic, however, the therapeutic value of high-dose administration is not fully known. Objective: To present current scientific evidence on the management of ARF with furosemide in high doses. Materials and Methods: A methodological design of the descriptive non-experimental type was used, with the review of nine articles of the current scientific literature of the digital databases SciELO, PubMed, Cochrane, among others, to compile relevant information and achieve a better understanding of the topic. Results: Previous studies do not recommend the application of this treatment; however, four current studies show that furosemide at high doses in continuous infusion increases diuresis, the restoration of renal function, and the decrease in deaths. Conclusions: The evidence is controversial, the therapeutic strategy should be aimed at patients with ARF without severe symptoms, preferably in continuous infusion since it is beneficial, although in-depth studies are required to adequately validate the results and define the clinical applications. Keywords: AKI, high doses, furosemide, acute renal failure, oliguriaÍtem Acceso Abierto Síndrome de distrés respiratorio en el recién nacido(Universidad Católica de Cuenca., 2022) Alvarez Montero, Manuel Felipe; Alomía Castro, Paul Esteban; 0302498381Background: Respiratory distress syndrome, hyaline membrane disease (HMD), or respiratory distress syndrome in the newborn (RDSN) is the most frequent pathological entity in patients with gestational age < 37 weeks; it is caused by surfactant deficit conditioning the oxygenation of the newborn. Objective: To describe with updated information the respiratory distress syndrome in newborns. Methodology: A scientific literature review was conducted, programmed, and focused on the last five years to present a quality project to strengthen the knowledge of the disease; after a complete reading, the literary selection was performed utilizing the Mendeley program. Results: The main factors were prematurity (93.9%) and male sex (59.2%). Pulmonary ultrasound and ductus arteriosus velocity is sound in prenatal diagnosis, presenting sensitivity (83%) and specificity (93%). After birth, thoracic radiography has a sensitivity (85%) and predictive value (86%). Betamethasone was adequate in the preventive treatment for RDSN in 727 patients who received two doses (57.5%) and 436 with one dose (34.5%), reducing it by (60%) and (21%) respectively. Natural surfactant improved ventilation by (96%), decreasing bronchopulmonary dysplasia and postpartum death. CPAP and IMV were effective in reducing lung damage and neonatal mortality. Conclusions: Male premature infants are a risk factor, currently, innovative methods in diagnosis and treatment allow fetal well-being. Keywords: respiratory distress syndrome, hyaline membrane disease, newborn, surfactant.Ítem Acceso Abierto Complicaciones cardiovasculares más frecuentes en pacientes con COVID-19(Universidad Católica de Cuenca., 2022) Alvacora Lema, Magdalena Abigail; Garcés, Juan Pablo; 0302412085Background: During the COVID-19 pandemic, there was evidence of a 12% increase in deaths due to cardiovascular pathologies. Some theories relate the COVID-19 virus to the appearance of these pathologies. Objective: To analyze the most frequent cardiovascular complications in patients with COVID-19. Methodology: Literature review type research. It was performed following inclusion and exclusion criteria, analyzing 56 articles published from January 1, 2020, to November 31, 2022, using BIREME DeCS/MeSH terms in the databases PubMed, Springerlink, Doaj, and SciELO, in Spanish and English. Expected results: It is expected to describe the most frequent cardiovascular complications in patients with COVID-19, the mechanisms that relate SarCoV-2 infection to the appearance of these complications, the incidence of prevalent problems associated with SarCoV-2 and mortality, and the most commonly used treatments. Keywords: cardiovascular complications, coronavirus, cardiovascular disease, sars-cov-2, sars-cov-2Ítem Acceso Abierto Exacerbación de las convulsiones consecuentes al período menstrual. Epilepsia Catamenial(Universidad Católica de Cuenca., 2022) Álvarez Abad, Wilson Oswaldo; Torres Criollo, Larry Miguel; 0302707930Introduction: Catamenial epilepsy is a neurological disease characterized by increased frequency of seizure presentation during the menstrual cycle, pathophysiologically due to estrogen elevation and progesterone depletion. Diagnosis is mainly clinical, although laboratory criteria are also assessed. Therapeutic management is based on the use of anticonvulsivants and hormonal therapy. Objective: To determine the relantioship between increased seizure frequency and the menstrual cycle. Methodology: This research was perfomed based on PRISMA 2020 systematic verification by searching DeCs and MeSH keywords, Boolean type connections, y u o, and y or in the following databases: PubMed, Medline, ResearchGate, World of Science, Scielo, Elsevier, Redalyc, UptoDate, DocPlayer, BioMed, World Scientific Publishing, ILAE, national to international university repositories. Results: By applying inclusion and exclusion criteria, it included retrospective and descriptive studies, case reports, bibliographic reviews, manuals, and practical guides, in a total of 33 bibliographic references of moderate and high quality. Discussion; When comparing studies, there is no variability in concept, pathophysiology, and diagnosis. However, the lack of research studies, such as current clinical trials regarding therapeutic management, is notable. Conclusions: Catamenial epilepsy is poorly diagnosed due to the lack of knowledge of the relationship between hormonal changes during menstruation and seizure exacerbations. Therefore, the diagnosis is nonspecific and untimely, and the treatmen is currently obsolete. Keywords: seizures, catamenial epilepsy, neuroactive, proconvulsant, neuroprotectiveÍtem Acceso Abierto Efectividad de la carbetocina versus oxitocina en el tratamiento de la hemorragia postparto: revisión sistemática(Universidad Católica de Cuenca., 2024) Terreros Vintimilla, Dennise Anabella; Ulloa Cazar, Valeria Stefany; Ulloa Cazar, Valeria Stefany; 0107408890; 0107421745Background: Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality, particularly in low- and middle-income countries. Oxytocin and carbetocin are the primary recommended treatments; however, uncertainty remains about which is more effective in reducing maternal mortality and blood loss. Objective: To compare the effectiveness of carbetocin versus oxytocin in treating PPH through a systematic review of observational studies, analyzing various risk factors and reducing blood loss. Methods: A systematic review will be conducted following PRISMA guidelines. Studies will be searched in databases such as PubMed, SciELO, ScienceDirect, and Cochrane, focusing on direct comparisons between carbetocin and oxytocin in women with PPH. Study selection will be performed using the Rayyan platform, and quality assessment will be conducted using the ROB 1 and ROB 2 tools. Expected Results: This study aims to determine whether carbetocin is more effective than oxytocin in reducing maternal mortality and blood loss. Conclusion: This systematic review will provide evidence-based insights into the comparative efficacy of these treatments, offering a better perspective on clinical practices for managing PPH, especially in resource-limited settings. Keywords: carbetocin, postpartum hemorrhage, oxytocinÍtem Acceso Abierto Asociación entre la infección por Helicobacter pylori y el desarrollo de los linfomas MALT gástricos. Revisión sistemática(Universidad Católica de Cuenca., 2024) López Amaya , Jenny Karina; Yuxi Bustos, Jessica Roxana; 0105802490Background: There is a risk of Helicobacter pylori infection ranging from 40% to 60% in highly developed countries. However, in developing countries, especially in Latin America, it can be as high as 90%, according to research published in Cuba. According to the Ministry of Public Health in Ecuador, the prevalence of Helicobacter pylori infections is 45% in rural areas and 47% in urban areas, with 23% of cases in asymptomatic patients. Primary gastric lymphomas account for more than 10% of lymphomas and more than 5% of gastric neoplasms. At the time of diagnosis, it presents as a low-grade tumor in 70-85% of cases. Objectives: To determine the relationship between Helicobacter pylori infection and the subsequent development of gastric mucosa-associated lymphoid tissue (MALT) lymphoma through a systematic review. Methods: This study conducted a systematic review of the descriptive and explanatory literature, using the PRISMA statement to carry out this procedure. Expected results: The results obtained from this study aimed to identify the relationship between the development of gastric MALT lymphomas in patients infected with Helicobacter pylori and the role of eradicating this bacterium in suppressing the lymphoma mentioned above. Keywords: infection, Helicobacter pylori, gastric MALT lymphoma, mucosa-associated lymphoid tissue, bacterium.Ítem Acceso Abierto Eficacia del fibrinógeno versus complejos de concentrados protrombóticos en el tratamiento de hemorragia aguda en pacientes politraumatizados. Revisión sistemática(Universidad Católica de Cuenca., 2024) Saca Gualán, Sara Ñusta; Idrovo Vásquez, Víctor Anibal; 1104326747Acute hemorrhage is a heterogeneous condition associated with significant mortality in young adults. Viscoelastic tests demonstrate high sensitivity and specificity in detecting hypofibrinogenemia and guiding massive transfusion protocols. The first-line pharmacological tool is tranexamic acid; however, the current paradigm emphasizes administering hemostatic agents, such as fibrinogen concentrate and prothrombin complexes, to effectively manage massive bleeding and coagulation abnormalities. In Ecuador, hemostatic agents are limited to tertiary-level hospitals due to their cost. Nonetheless, the health system employs fibryga (recombinant fibrinogen complex) and octaplex (prothrombin complex). Objective: To compare the efficacy of fibrinogen versus prothrombin complex concentrates in managing acute hemorrhage in polytraumatized patients. Methodology: This retrospective and descriptive study follows PRISMA guidelines. Bias assessment was conducted using Cochrane Review Manager and NHLBI tools. Fourteen articles were analyzed and retrieved from scientific databases such as Cochrane, Scopus, PubMed, Taylor & Francis, and UpToDate. Results: Prothrombin complexes demonstrated hemostatic efficacy in 85.8% of patients with life-threatening hemorrhage, including cerebral and gastrointestinal bleeding and anticoagulant reversal, at doses of 1 ml/kg (25 IU/kg). In contrast, fibrinogen concentrate was effective in pure hypofibrinogenemia states at doses of 1 to 4 grams in adults, adjusted based on serum fibrinogen levels (greater than 200 mg/dL).Ítem Acceso Abierto Sensibilidad y especificidad de los marcadores antiangiogénicos versus ecografía doppler de arterias uterinas para el diagnóstico de preeclampsia. Revisión sistemática(Universidad Católica de Cuenca., 2024) Aguirre Barreto, Ariana Milena; Rodas Torres, Américo Gerardo; 0706437019Objectives: To evaluate the sensitivity and specificity of antiangiogenic markers in the early detection of preeclampsia compared to uterine artery Doppler ultrasound through a systematic review analysis. Methodology: A descriptive, qualitative, and retrospective systematic review was conducted. The inclusion criteria encompassed articles in English, Spanish, or Portuguese published from 2014 to 2024 focusing on angiogenic factors and Doppler ultrasound, linked to indexed journals, freely accessible, and available in full text. Exclusion criteria included articles published before 2014, studies involving other biomarkers, paid articles, or those not published in the languages mentioned above. Information sources included online search engines, the physical and virtual library of the Catholic University of Cuenca, and e-books. The Cochrane Review Manager 5.4.1 tool was used to assess the risk of bias for case-control and cohort studies. Results: Twelve articles were included from the following databases: PubMed (2), Scopus (3), Web of Science (2), Springer Link (2), and Science Direct (3). A total of 13,234 patients were analyzed. The studies explored preeclampsia from various perspectives, such as prediction in different trimesters, angiogenic factors, and maternal-fetal risks. Conclusions: The analysis of antiangiogenic markers, specifically the sFlt-1/PIGF ratio, has proven to be an effective tool in predicting preeclampsia, improving sensitivity and specificity compared to traditional methods. Combining these markers with uterine artery Doppler ultrasound enhanced diagnostic accuracy. Keywords: Doppler ultrasound, antiangiogenic factors, prediction, preeclampsia, sFlT- 1/PlGF ratioÍtem 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 technique
