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 Sensibilidad y especificidad de la hemoglobina glicosilada como prueba diagnóstica de diabetes y prediabetes: revisión sistemática.(Universidad Católica de Cuenca., 2025) García González, Carlos Rafael; Rivera Juca, Christian Mauricio; Torres González, Álvaro Alexandrs; 0302303094; 0105767297Introduction: Type 2 diabetes mellitus (T2DM) and prediabetes are highly prevalent public health problems in Latin America. Early detection is essential to prevent complications. Glycated hemoglobin (HbA1c) has been proposed as a diagnostic alternative to fasting plasma (FPG) and oral tolerance test (OGTT), although doubts remain about its sensitivity and specificity. Objective: To determine the sensitivity and specificity of HbA1c as a diagnostic test for diabetes and prediabetes in adults compared with traditional methods. Methodology: Systematic review in accordance with PRISMA 2020. Eligibility: observational, cohort, cross-sectional studies, and systematic reviews published from 2015 to 2025 in adolescents and adults (≥12 years). Children under 12 years of age, pregnant women, and patients with conditions that alter HbA1c were excluded. Risk of bias: assessed using QUADAS-2 and the NHLBI scale. Synthesis of results: comparative narrative analysis of sensitivity, specificity, LR+, and LR−. Results: Fifteen studies were included. The sensitivity of HbA1c ranged from 39% to 97.6% and specificity from 52% to 99%. The cutoff point ≥6.5% showed high specificity but low sensitivity; values between 5.9% and 6.3% improved sensitivity without significant loss of specificity. Discussion and Limitations: HbA1c is practical and specific, but its low sensitivity limits its use in isolation. Publication and language biases and methodological heterogeneity were identified. Conclusions: Adjusting cut-off points or combining HbA1c with FPG or OGTT improves detection in different clinical settings. Keywords: glycated hemoglobin, sensitivity, specificity, diabetes, prediabetesÍtem Acceso Abierto Factores de riesgo y manifestaciones clínicas de la Dermatitis atópica en lactantes. Revisión Sistemática.(Universidad Católica de Cuenca., 2025) Chamba Supliguicha, Andrea Estefanía; Peláez Vélez, Luzmila Carolina; 0105569735Background: Atopic dermatitis is a chronic, multifactorial, inflammatory skin disease associated with genetic, immune, and environmental factors. The primary clinical manifestations in infants are erythematous and edematous papules or plaques, often accompanied by erosion, exudation, and crusts. This review aims to analyze the risk factors and clinical manifestations of atopic dermatitis in infants. Methods: Inclusion criteria were applied, including the time frame from 2019 to 2024, the age group (infants), and open-access articles in Spanish and English that covered the topics established in the objectives. All articles that fell outside these criteria were excluded. The databases used were Ovid, Scopus, PubMed, and ScienceDirect. A flowchart and a table with the parameters involved were used to synthesize the results. Results: After screening and analyzing the studies found, thirty studies were included based on the inclusion and exclusion criteria, using a comprehensive analysis and a review matrix of articles to present data on risk factors and clinical manifestations associated with atopic dermatitis in infants. Discussion: Studies highlight that, in infants, atopic dermatitis begins on the face, spreads to extensor areas, and progresses to skin folds with persistent pruritus and xerosis. Its risk/progression reflects the interaction between barrier/genetic vulnerability and early prenatal and postnatal exposures (pollution, microbiota, protective farm exposure, antibiotics, Lower Respiratory Tract Infection (LRTI), and cesarean delivery with heterogeneous effect). Keywords: atopic dermatitis, infant, risk factors, clinical manifestationsÍtem Acceso Abierto Prevalencia de Enteroparasitosis y factores asociados en niños de las instituciones educativas Oriente Ecuatoriano y República del Ecuador. Guapán - Ecuador. 2024(Universidad Católica de Cuenca., 2025) Lojano Munzón, Esteban German; Samaniego Jara, Gerald Alexander; Espinoza Díaz, Cristobal Ignacio; 0302499868; 1400720882Introduction: Intestinal parasitoses are prevalent diseases among children due to poor sanitation and inadequate hygiene conditions, causing significant morbidity worldwide. It is estimated that 1.5 million children are infected, presenting symptoms such as abdominal pain, diarrhea, nausea, and vomiting. Objective: To determine the prevalence and factors associated with enteroparasitosis in children aged 5-10 years in the educational institutions Oriente Ecuatoriano and República del Ecuador in May 2024. Methodology: A total of 134 children were included, encompassing all students enrolled from the first to the seventh year of basic education. Coproparasitic tests were performed to detect the presence of parasites in fecal samples. The data were analyzed using SPSS, applying frequency tables and chi-square tests with a significance level of p<0.05. Results: Enteroparasitosis was found in 95.7% of the children, with 70.9% of cases being monoparasitosis and 29.1% polyparasitosis. Factors such as not washing hands before meals (32.5% prevalence) and after using the bathroom (42.3% prevalence), not boiling water before drinking it (35.8% prevalence), and living in homes with dirt floors (57.1%) or ceramic floors (46.4%) and adobe walls (50.0%) were significantly associated with the presence of parasites (p<0.05). Conclusions: The need to improve hygiene practices and housing conditions in rural communities to reduce the high burden of enteroparasitosis among children is highlighted. Keywords: intestinal parasitosis, protozoa, diarrhea, foodÍtem Acceso Abierto Relación entre conocimiento sobre métodos anticonceptivos y embarazo adolescente en estudiantes de secundaria de la Unidad Educativa Fiscal Los Vergeles, Guayaquil - Ecuador, 2024(Universidad Católica de Cuenca., 2025) Armijos Alcívar, Ana María; Vera Moncada, Ana Belén; Rodas Torres, Américo Gerardo; 0303135180; 0953166485Introduction: Adolescence is a period characterized by sexual curiosity, frequently explored irresponsibly due to a lack of knowledge or use of contraceptives, which leads to consequences such as adolescent pregnancy. In 2021, global statistics revealed that adolescent pregnancy is a seriousmajor problem in countries such as Ecuador, where the National Institute of Statistics and Census (INEC, by its acronym in Spanish) reported that 56.7% of pregnancies occurred among high school students. Objective: To determine the relationship between knowledge of contraceptive methods and adolescent pregnancy among high school students at Unidad Educativa Fiscal Los Vergeles, Guayaquil – Ecuador, 2024. Methods: An observational, analytical, cross-sectional study with a qualitative and quantitative approach was conducted. The SexContraKnow-Instrument survey, validated in Spanish in 2019, was administered to 175 female high school students. Results: Of the 296 students, 59.1% were female and 40.9% male. A total of 86.8% were single, 12.8% cohabiting, and 0.3% were married. Twenty-seven-point four percent (27.4%) reported having initiated sexual activity at age 14. Chi-square analysis revealed no statistically significant association between knowledge of contraceptive methods and adolescent pregnancy (χ² (1) = 0.867, p = 0.352), with an odds ratio (OR) of 0.541. Conclusions: No statistically significant association was identified between the level of contraceptive knowledge and adolescent pregnancy. Although most participants demonstrated good knowledge, a considerable proportion lacked adequate information, underscoring the need to strengthen sexual education programs. Further studies are suggested to corroborate these findings. Keywords: adolescent, contraceptives, knowledge, pregnancyÍtem Acceso Abierto Conocimientos, actitudes y hábitos de fotoprotección en estudiantes de la Universidad Católica de Cuenca, Azogues – Ecuador. 2024(Universidad Católica de Cuenca., 2025) Peña Carrión, Nataly Cristina; Toalongo Sucuzhañay, Deysi Maribel; Peláez Vélez, Luzmila Carolina; 1150297396; 0302892534Background: At the Catholic University of Cuenca, Azogues campus, there are no previous studies on knowledge, attitudes, and habits regarding sun protection, despite the high exposure to UV radiation in the region, which highlights the need for research to promote effective prevention of sun damage. Objective: To determine the knowledge, attitudes, and habits related to sun protection among students at the Catholic University of Cuenca, Azogues, Ecuador, 2024. Methodology: An observational, prospective, and cross-sectional study with a quantitative approach was conducted at the Azogues campus between March and August, 2024. A total of 345 students were selected through stratified random sampling according to age, sex, and academic program. Participants completed an adapted and validated version of the “CHACES Questionnaire.” Data were analyzed using SPSS version 2.0. Results: The sample included 345 students with an average age of 20.7 years, mostly women (58%). Of the participants, 59.42% demonstrated an intermediate level of knowledge about sun protection, while only 1.45% had a high level, with no significant differences by gender. Also, 52.5% rejected tanning, and 39.7% showed high awareness of sunscreen use. Among the other aspects, 48.7% reported regular sunscreen use, although other measures such as appropriate clothing and eye protection were less common. Conclusions: A high percentage of students have intermediate knowledge about sun protection. Although sunscreen use was common, other preventive measures such as appropriate clothing and eye protection were less frequently practiced. The relevance of this study lies in identifying gaps in knowledge and practices related to sun protection and in the need to implement effective preventive strategies in this population. Keywords: knowledge, attitudes and practices, university students, sun protection, UV radiationÍtem Acceso Abierto Enfermedades neurológicas relacionadas a la eutanasia y suicidio asistido. Revisión Sistemática(Universidad Católica de Cuenca., 2025) Benavides Ortega, Flor Nayely; Crespo Domíguez, Juan Sebastián; 0302743182Background: Euthanasia and assisted suicide are terms that emerged in the Roman Empire as practices intended to provide a dignified death to patients experiencing unbearable suffering. In neurology, various conditions such as Parkinson’s disease, multiple sclerosis, amyotrophic lateral sclerosis, and Friedreich’s ataxia are relevant causes for requesting euthanasia or assisted suicide. Objective: To describe the main neurological diseases for which euthanasia and assisted suicide are requested in countries where they are legally practiced, addressing the following research question: What are the main neurological diseases for which euthanasia and assisted suicide are requested? Methods: The review included case-control articles, meta-analyses, randomized controlled trials, case series, and undergraduate and graduate theses. Data were collected from databases, including PubMed, Cochrane, Scopus, WoS, Taylor & Francis, and Redalyc. Results: Applying the PRISMA methodology yielded 37,638 results, of which, after applying inclusion and exclusion criteria, 16 articles were selected. Of these, five address legislation in different countries, six present cases of neurological diseases for which medical assistance to die was requested, and four report relevant statistics on euthanasia and assisted suicide. Conclusions: Euthanasia and assisted suicide, legalized in 12 countries, are based on terminal illnesses and intolerable physical and emotional suffering. The main neurodegenerative diseases involved are Parkinson's, dementia, amyotrophic lateral sclerosis, and Friedrich's ataxia. The rates of requests for these procedures are on the rise. Keywords: euthanasia, assisted suicide, legal framework, neurological diseasesÍtem Acceso Abierto Screening del Síndrome del Túnel Carpiano en el personal operativo de la CB Cooperativa en las provincias Azuay y Cañar. Ecuador. 2024(Universidad Católica de Cuenca., 2025) Arévalo Sarmiento, Anabel Maritza; Galarza Alvarez , Sandra Maritza; Peñafiel Encalada, Alicia; 0302263892; 0107370108Background: Continuous and excessive repetition of manual activities negatively impacts the hands and wrists, a situation most commonly observed in the workplace, and predominantly affects women. Objective: To determine the prevalence of Carpal Tunnel Syndrome (CTS) among the operational staff of the Small Business Savings and Credit Cooperative Biblián LTDA in the provinces of Azuay and Cañar during 2024. Methodology: A qualitative-quantitative approach was adopted with a non-experimental, observational, cross-sectional, and descriptive design. In the quantitative component, two instruments were applied: a sociodemographic data survey and the Boston Questionnaire, aimed at assessing the severity of symptoms and functional status. The population consisted of 207 male and female employees from the CB Cooperative in Azuay and Cañar, and a census was used to collect the entire sample. Data were gathered through Google Forms and processed using SPSS software, version 24. Results: The analysis reveals that, among the 200 participants, 32% presented a low risk of CTS, 54% a moderate risk, and 14% a high risk. Higher prevalence and severity of symptoms were observed among women and in the 31-40 age group. Conclusions: The study concludes that the operational staff of the CB Cooperative in Azuay and Cañar present a high prevalence of CTS symptoms, with higher incidence and severity of symptoms in women and older workers. Keywords: Median nerve, Carpal Tunnel Syndrome, Boston Questionnaire, Paresthesia, Joint painÍtem Acceso Abierto Efectividad del esomeprazol versus lansoprazol para la prevención de úlceras gástricas: revisión sistemática(Universidad Católica de Cuenca., 2025) Idrovo León , Cayetano Francisco; Palomeque Campoverde, Wilson Xavier; Faicán Rocano, Pedro; 0104588306; 0302640479The systematic review indicates that both esomeprazole and lansoprazole are effective in preventing nonsteroidal anti-inflammatory drug (NSAID)-induced gastric ulcers; however, esomeprazole proves to be superior. This drug has better bioavailability, more stable acid control, and lower variability in clinical response. Studies highlight that it achieves a greater reduction in the incidence of ulcers, bleeding, and relapses, with success rates exceeding 85%. Lansoprazole, while effective, shows slightly lower outcomes and greater variability in efficacy. Both drugs present similar safety profiles, with mild and infrequent adverse effects. Overall, the evidence concludes that esomeprazole provides clear clinical advantages in high-risk patients and in the long-term use of NSAIDs. Methodology: This research consists of a descriptive systematic review with a qualitative approach, conducted using databases such as PubMed, Scopus, and ScienceDirect. The inclusion criteria include clinical trials and comparative observational studies published in the last five years. Results: According to the review of various articles, esomeprazole was identified as the drug offering greater protection against gastric ulcers and lower complication rates, providing clear evidence for optimizing clinical decision-making. Conclusions: Esomeprazole offers a slight advantage over lansoprazole in terms of efficacy and lower relapse rates, making it the preferred preventive option, especially in patients with a history of recurrent ulcers or in cases where reducing the risk of new long-term lesions is essential. Keywords: gastric ulcers, NSAIDs, esomeprazole, lansoprazole, proton pump inhibitorsÍtem Acceso Abierto Proyecto de Titulación embargado para publicación. Estará disponible a la fecha de publicación o de cierre de embargo(Universidad Católica de Cuenca., 2025) Benavides Reinoso, Dennis Raúl; Espinoza Díaz, Cristobal Ignacio; 0302942172Ítem Acceso Abierto Eficacia del plasma rico en plaquetas versus corticoides para el tratamiento de la epicondilitis lateral. Revisión sistemática(Universidad Católica de Cuenca., 2025-09-17) Matute Jimenez, Walter Vinicio; Tenecela, Miguel Angel; 0105789697; Tenecela, MelissaABSTRACT Introduction: Lateral epicondylitis, commonly known as tennis elbow, is a prevalent musculoskeletal condition that affects the tendon insertion of the forearm extensors. Its etiology is associated with repetitive microtrauma leading to tendon degeneration. Conventional treatment includes physical therapy, analgesics, and corticosteroid injections. However, the recurrence of symptoms and limited long-term efficacy have encouraged the search for alternative therapies such as platelet-rich plasma (PRP), which has emerged as an option based on the regenerative potential of platelet growth factors. Objective: To evaluate the efficacy of platelet-rich plasma (PRP) injections compared to corticosteroids in the treatment of lateral epicondylitis. Methodology: A systematic review was conducted in accordance with the PRISMA 2020 guidelines, searching for scientific articles in indexed databases, including PubMed and Scopus. Studies published between 2010 and 2025 on the effectiveness of PRP versus corticosteroids in patients with lateral epicondylitis were selected, and methodological quality was assessed using the RoB 2 tool. Results: The studies analyzed showed that platelet-rich plasma (PRP) provides sustained efficacy with functional improvement and pain reduction between 3 and 24 months, surpassing corticosteroids, whose effect is immediate but transient and associated with a high relapse rate, as well as potential degenerative effects on the tendon. Keywords: corticosteroid, lateral epicondylitis, platelet-rich plasma, treatment.Ítem Acceso Abierto Mortalidad por enfermedad de Alzheimer y otras demencias en Ecuador del 2012 al 2022.(Universidad Católica de Cuenca., 2025-09-17) Salinas Huerta, María Caridad; Tenecela, Melissa; 0350190112; Espinoza, CristóbalABSTRACT Background: Alzheimer’s disease is a primary global concern, and in Ecuador, increased life expectancy has led to a higher prevalence of age-related diseases, including dementias. Objective: To analyze mortality due to Alzheimer’s disease and other dementias in Ecuador between 2012 and 2022, considering cause, diagnosis, sex, age, region, and area of residence. Methodology: Observational, analytical, cross-sectional study at the national level, based on death records from the National Institute of Statistics and Censuses (INEC, by its Spanish acronym). A total of 855,122 deaths were included for the period 2012–2022, within a historical total of 1,709,425 (1997–2022). Cases in which Alzheimer’s disease or other dementias were listed as the main or contributing cause were selected. Results: A total of 8,060 deaths from Alzheimer’s disease and other dementias were recorded, with an increase to 6,153 in the most recent period. Seventy-nine percent (79%) occurred in urban areas. Alzheimer’s disease accounted for 60% of deaths, with a predominance among women (62%) compared to men (38%). Ninety-eight percent (98%) were individuals aged ≥65 years. Regionally, the Sierra region accounted for 59% of Alzheimer’s deaths and 70% of deaths from other dementias, showing a 2.0617 times higher probability of mortality compared to other regions (χ²=27.494; p<0.00001). In urban areas, individuals who died from Alzheimer’s had a 1.1730 times higher probability of death compared to those who died from other causes (χ²=4.458; p<0.0001). Conclusions: Mortality from dementias in Ecuador increased significantly between 2012 and 2022, with a higher burden among women and older adults, and predominance in the Sierra region. Public health strategies adapted to these determinants are required. Keywords: Alzheimer’s disease, dementias, mortality, Ecuador, altitude, public healthÍtem Acceso Abierto Uso excesivo de pantallas como factor de riesgo para el deterioro de la salud psicológica en niños y adolescentes: revisión sistemática(Universidad Católica de Cuenca., 2025) Ruilova Saquicilí, Kathyna Salomé; Manzano Lituma, Felipe Emmanuel; 0302284088Introduction: Devices with screens, such as phones, tablets, and televisions, have increasingly and consistently become part of families’ daily routines. This study is relevant because it examines how excessive screen use can increase the risk of anxiety and depression by affecting behavioral control, especially among young people, revealing a bidirectional relationship between screen exposure and emotional and behavioral symptoms. Objective: To determine the relationship between excessive screen use in children and adolescents and the risk of presenting psychological health issues. Methodology: A systematic review was conducted following the PRISMA 2020 guidelines, including nine open-access observational studies and one quasi-experimental study published between 2020 and 2025, available in English or Spanish, in databases such as PubMed, Scopus, and SciELO. Results: A total of 20 studies were analyzed, with a combined sample of 423,599 children and adolescents. Most studies reported statistically significant associations between excessive screen use (≥2 to ≥6 hours/day) and the presence of anxiety, depression, or ADHD. Social media showed the most consistent effects, while educational screen use had a lesser impact. Conclusion: Prolonged screen use is associated with psychological alterations in minors, which calls for evidence-based preventive interventions. Keywords: Screen time, mental deterioration, mental health, children, adolescentsÍtem Acceso Abierto Eficacia de los anticuerpos monoclonales anti-beta amiloide para el deterioro cognitivo en pacientes con Alzheimer: revisión sistemática(Universidad Católica de Cuenca., 2025) Medina Sarango, Fredy Alexander; Bravo Salinas, Sara Elizabeth; 1106207572Background: Alzheimer’s Disease (AD) is the leading cause of dementia worldwide and affects more than 44 million people. Its incidence increases with age. AD generates significant economic and social burdens, and traditional treatments have limited efficacy. Objective: To compare the efficacy of anti-beta amyloid monoclonal antibodies for cognitive impairment in patients with Alzheimer’s disease. Methods: Systematic review of descriptive, comparative, and qualitative designs based on PRISMA 2020 guidelines. The databases used were PubMed, Scopus, ScienceDirect, and Springer Link. Results: Fourteen randomized clinical trials involving 13,905 patients were included. Conclusions: Monoclonal antibodies are indicated in the early stages of Alzheimer’s disease and are not considered first-line treatment. Their benefit is to slow cognitive decline by reducing cerebral amyloid burden; however, the risks of developing amyloid-related imaging abnormalities (ARIA) are very high. Lecanemab and donanemab demonstrated better performance in reducing amyloid burden and decelerating cognitive decline compared to aducanumab, gantenerumab, and solanezumab, as evidenced by the ADAS-COG, CDR-SB, and ADCOMS scales, which assess cognitive decline. Keywords: Alzheimer’s disease, anti-beta amyloid (Aβ), monoclonal antibodyÍtem Acceso Abierto Medidas de autocuidado de los pies en pacientes diabéticos del Centro de Rehabilitación Integral Especializado de Azogues - Ecuador. 2024(Universidad Católica de Cuenca., 2025) Quevedo Vera, Flor María; Devia Solis, Nury Lissie; 0302285234Background: Foot self-care in diabetic patients is essential to prevent severe complications such as ulcers and amputations, which represent a public health challenge due to their high prevalence and clinical consequences. This research is relevant as it contributes to improving patients' quality of life and optimizing prevention strategies in primary care in the city of Azogues. Objective: To assess the level of knowledge regarding foot care among diabetic patients at the Centro de Rehabilitación Integral Especializado de Azogues (CRIE, by its Spanish acronym), using the Nottingham Assessment of Functional Footcare survey (NAFF-r). Methods: This was a quantitative, descriptive, non-experimental, and cross-sectional study. The NAFF-r survey was administered to a representative sample of 186 patients, whose responses were recorded and processed in Excel. Results: The mean age was 58.6 years; 50.5% were male. It was determined that 64.5% of the respondents had adequate knowledge of foot self-care measures (95% CI: 57.6% – 71.4%). A significant association was found between the gender variable (p = 0.003) and the level of knowledge, with relevance to the parameters of injury prevention. Conclusions: Most patients showed an adequate level of knowledge. Gender was established as a significant sociodemographic variable, and injury prevention parameters were identified as key determinants. These findings suggest the need for reinforcing education for diabetic patients. It is recommended to conduct this research in rural areas before drawing general conclusions. Keywords: self-care, Type 2 Diabetes Mellitus, diabetic footÍtem Acceso Abierto Eficacia de los programas de cribado para la displasia congénita de cadera en recién nacidos: revisión sistemática.(Universidad Católica de Cuenca., 2025) Contreras Peralta, Joseline Estefanía; Samaniego Juela, Linda Gessell; Capote LLaneres, Miguel Ángel; 1401255896; 0704774025Background: Congenital hip dysplasia is a developmental anomaly of the hip joint that can lead to long-term complications, making newborn screening programs essential for reducing its incidence through various clinical and imaging strategies. Objective: To determine the efficacy of screening programs and tests used in the diagnosis of hip dysplasia in newborns. Methods: This systematic review was conducted following the PRISMA 2020 guidelines, including randomized controlled trials (RCTs) and cohort studies, assigned through a comprehensive search strategy. The quality of each study was assessed using the NIH scale, which helped to ensure clinical decisions. Additionally, the RoB-2 tool was used to quantify bias, enabling more informed decisions regarding the evidence used. Results: A combined approach, integrating universal ultrasound screening with neonatal physical examination, which improves sensitivity without replacing clinical screening, was observed in regions such as Oceania, Asia, and much of Europe. Countries such as Italy, Slovenia, North Macedonia, and Ireland have implemented universal screening, whereas others, including the United States and Egypt, maintain a selective model based on risk factors. Some systems, such as Sweden's, have opted for continuous clinical surveillance up to 12 months of age without routine use of ultrasound, but with positive results in their context. This model may be particularly beneficial in countries with limited resources, as it strikes a balance between diagnostic efficacy and the sustainability of the healthcare system. Keywords: congenital hip dysplasia, ultrasound, screening efficacyÍtem Acceso Abierto Eficacia de Infliximab versus Rituximab en el tratamiento de la artritis reumatoide: revisión sistemática(Universidad Católica de Cuenca., 2025) Minchala Castro, Mayra Isabbel; Buenaño Rodriguez, Christian Eduardo; 0302216791Optimal dosing of biologics for rheumatoid arthritis (RA) remains undefined, contributing to clinical variability. The objective was to evaluate the efficacy of Infliximab and Rituximab (bDMARDs) to identify dosing regimens that maximize outcomes and safety. A PRISMA 2020 systematic review was conducted in PubMed, Scopus, Web of Science, and Springer, focusing on studies from the last 10 years that met the ACR 20/50/70 criteria. Reviews, meta-analyses, and gray literature were excluded. The risk of bias was assessed using the RoB 2 tool. Infliximab 10 mg/kg every 8 weeks demonstrated the highest clinical response; 6 mg/kg provided a balance between efficacy and safety. Rituximab at 2 × 1000 mg reduced activity more than 2 × 500 mg, although the advantage was modest. Both therapies were administered with methotrexate to enhance the response. However, unrepresentative populations make broad extrapolation difficult. In conclusion, both drugs are viable therapies; infliximab is faster-acting, while rituximab is useful after prior treatment failures. The choice should be individualized, considering impact, cost, and tolerance to optimize quality of life. Keywords: Infliximab, Rituximab, dosing, effectivenessÍtem Acceso Abierto Pie diabético y su abordaje terapéutico. Revisión Sistémica(Universidad Católica de Cuenca., 2025) Latacela Bravo, María Cristina; Izquierdo Coronel, Diana Carolina; 0302394275Background: Diabetic foot represents a long-term complication of diabetes, characterized by tissue damage in the lower extremities, accompanied by neurological dysfunction and peripheral vascular problems. It is a frequent reason for hospital admission in patients with diabetes and is the primary cause of non-traumatic amputations. The main pathological processes underlying this condition derive from diabetic neuropathy and peripheral artery disease, which contribute to foot deformities and increase susceptibility to injury following trauma. Objective: To investigate the therapeutic approach applied to the diabetic foot. Methods: A systematic review was conducted according to the PRISMA 2020 guidelines, to determine the current therapeutic measures used in diabetic foot. Data collection required the use of high-impact databases, through the combined use of keywords and Boolean connectors to select the most relevant research articles. Results: The studies analyzed on the therapeutic algorithm focus on the pathogenic triggering mechanisms and their multidisciplinary care to achieve the best prognosis. Conclusions: Current evidence enabled the compilation of various therapeutic techniques for the management of diabetic foot, with the purpose of providing optimal lesion treatment.Ítem Acceso Abierto Eficacia del sutimlimab y rituximab en el tratamiento de la anemia hemolítica autoinmune: revisión sistemática(Universidad Católica de Cuenca., 2025) Calderón Sisalima, Jefferson Alejandro; Buenaño Rodriguez, Jefferson Alejandro; 1150934949Autoimmune hemolytic anemia (AIHA) is a hematologic disorder caused by the activation of autoantibodies that lead to the lysis of red blood cells. It is classified according to the antibody involved (IgG, IgM), its activation temperature (cold, warm), and its origin (primary, secondary). AIHA caused by warm autoantibodies accounts for approximately 80% of cases worldwide. Currently, monoclonal antibodies such as sutimlimab and rituximab offer a promising alternative for the treatment of the disease. General Objective: To determine the efficacy of sutimlimab and rituximab in the treatment of autoimmune hemolytic anemia. Specific Objectives: To establish an updated bibliographic basis on autoimmune hemolytic anemia and the efficacy of sutimlimab and rituximab in its treatment, in order to update knowledge on the management of AIHA. Methods: A systematic review was conducted following the PRISMA methodology, focused on obtaining, organizing, and describing updated information on the efficacy of rituximab and sutimlimab in the treatment of AIHA. Bias: The RoB 2 tool was used. Level of Evidence: Evaluated using the Oxford and NHLBI tools. Results: Sutimlimab and rituximab (as monotherapy or in combination) achieved hemoglobin increases of 2.6 to 4 g/dL, reductions in lactate dehydrogenase (LDH) of up to 60%, and a significant decrease in transfusion requirements (up to 100%). Response rates ranged from 54% to 93%, with sustained clinical improvements and response times ranging from 3 to 6 weeks. Controlled trials, such as CADENZA, CARDINAL, RAIHA, and Waldenström provided stronger evidence, while open-label studies confirmed efficacy results, although with methodological limitations. Keywords: autoimmune hemolytic anemia, immunoglobulins, monoclonal antibody sutimlimab, rituximabÍtem Acceso Abierto Inmunoterapia como tratamiento actual para Cáncer colorrectal. Revisión Sistemática(Universidad Católica de Cuenca., 2025) Aguilar Mora, Elian Alberto; Buenaño Rodriguez, Christian Eduardo; 0705621126Immunotherapy for colorectal cancer (CRC) has increased its development at an accelerated rate in the last 10 years. Several high-quality clinical trials have been conducted in the last decade to examine the application of programmed death receptor (1DPD-1) / programmed death ligand (PD-L1) inhibitors in patients with metastatic colorectal cancer (mCRC). However, the clinical benefits, including the effectiveness and safety of these anti-CCRCC managements, remain controversial. Objective: To analyze the efficacy of Pembrolizumab as immunotherapy in patients with colorectal cancer, using a systematic review. Methodology: In this study, a systematic review was conducted to determine the efficacy of immunotherapy as a modern treatment for CRC. Detailed searches were performed in several bibliographic databases, including PubMed, Taylor & Francis, Scopus, and ProQuest, among others, published until 2023. The search terms used were “metastatic colorectal cancer,” “immunotherapy,” “PD-1,” “PD-L1,” and study subjects at different stages of pathology were included. Relevant articles that met the established inclusion criteria were selected and analyzed. Results: Anti-PDL- 1/PD-1 (Pembrolizumab) therapy in advanced dMMR/MSI-H CRC was associated with improved survival. Anti PD-1/PD-L1 combined with anti-angiogenic drugs, targeted agents, or chemotherapy could be effective in MSS mCRC. Conclusions: Immunotherapy was effective for BRAF and KRAS/NRAS (RAS/RASRAS) mutated CRC. The high incidence of grade II and III adverse reactions at 85% reveals the importance of multidisciplinary work and further research and updates on this topic. Keywords: immunotherapy, metastatic colorectal cancer, PD-1, PD-L1, PembrolizumabÍtem Acceso Abierto Eficacia del Tofacitinib y Baricitinib en el tratamiento de artritis reumatoide: revisión sistemática(Universidad Católica de Cuenca., 2025) Díaz Carrera, Mizhell Tatiana; Buenaño Rodríguez, Christian Eduardo; 0302633664Introduction: Rheumatoid arthritis is a chronic condition that significantly impacts patients’ quality of life. The development of Janus kinase inhibitors, such as tofacitinib and baricitinib, represents an effective therapeutic alternative. However, it is necessary to analyze the available evidence to determine their efficacy and safety. Methods: A systematic literature review was conducted from January 2010 to June 2024, following PRISMA guidelines. The search was performed in PubMed, Scopus, Cochrane Library, and ClinicalTrials.gov, using MeSH terms related to tofacitinib, baricitinib, and rheumatoid arthritis. Randomized clinical trials, comparative studies, and systematic reviews that evaluated clinical efficacy, as expressed by remission, DAS28, and ACR responses, were included. Quality assessment was performed using NHLBI criteria, and risk of bias was assessed using the RoB 2 tool. Results: A total of 45 studies were identified, of which 34 were selected after applying eligibility criteria. Finally, 17 studies published between 2010 and 2024 met the specific objectives, highlighting adequate methodological quality and a low risk of bias in key domains such as random sequence generation and intervention blinding. Relevant outcomes included significant clinical response rates (ACR20) and sustained improvements in the DAS28 scores; however, limitations remain regarding the clarity of adverse event reporting and loss to follow-up. Conclusion: Both tofacitinib and baricitinib are effective therapeutic alternatives for the management of rheumatoid arthritis, with consistent evidence of clinical improvement in standardized parameters.
