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 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.Ítem Acceso Abierto Eficacia de acetónido de triamcinolona intralesional versus 5-fluorouracilo intralesional para el tratamiento de cicatrices hipertróficas y queloides: revisión sistemática(Universidad Católica de Cuenca., 2025) Guamán Rodríguez, Karol Dennisse; Heras Cisneros, Jonnathan Miguel; Peláez Vélez, Luzmila Carolina; 1724501885; 0105960058Background: Hypertrophic scars and keloids are fibroproliferative disorders resulting from an abnormal skin healing response, causing aesthetic, functional, and psychological impairment. Among the therapeutic options, intralesional injections of triamcinolone acetonide (TAC) and 5-fluorouracil (5-FU) have shown efficacy. However, controversy persists regarding which provides better outcomes in terms of volume reduction, symptomatic improvement, and adverse effects. Objective: To determine the efficacy of intralesional triamcinolone acetonide compared to intralesional 5-fluorouracil in the treatment of hypertrophic scars and keloids. Methods: A systematic review was conducted following the PRISMA 2020 guidelines, including randomized controlled trials (RCTs) studies that guarantee robustness of the results. The risk of bias was assessed using the ROB-2 tool. Results: The reviewed studies indicate that intralesional 5-fluorouracil is more effective in reducing the volume of keloid and hypertrophic scars compared to triamcinolone acetonide. Moreover, 5-FU has a more favorable safety profile, with fewer adverse effects such as skin atrophy and hypopigmentation. However, TAC remains superior in managing inflammatory symptoms such as pruritus and pain, suggesting that treatment choice should be based on the individual characteristics of each lesion and the patient’s therapeutic priorities. Discussion: Intralesional 5-FU appears to be preferable for reducing scar size, whereas TAC is useful in cases with prominent inflammation. Therefore, combining both agents may optimize clinical outcomes. Treatment decisions should be individualized based on symptoms and tolerance. Keywords: triamcinolone acetonide, hypertrophic scar, 5-fluorouracil, keloidsÍtem Acceso Abierto Prevalencia de Vaginosis bacteriana en pacientes del Centro de salud Nº 1 de la ciudad de Loja de enero 2022- diciembre 2023(Universidad Católica de Cuenca., 2025) Acevedo Balcázar, Ariana Salomé; Arias Peláez, María Cristina; 1150357422Bacterial vaginosis (BV) is a common gynecological infection that has been associated with various obstetric complications and an increased risk of acquiring sexually transmitted infections. In 2015, a study conducted at Health Center No. 2 in Loja reported a prevalence of 23%, highlighting the need for updated data to provide a current epidemiological overview. Objective: To determine the prevalence of bacterial vaginosis at Health Center No. 1 in the city of Loja from January 2022 to December 2023. Methods: This was an observational, descriptive, cross-sectional, and retrospective study based on vaginal secretion test results recorded in an anonymized database from the statistics department of Health Center No. 1 in the city of Loja from January 2022 to December 2023. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 27, which determined descriptive statistical tests. Results: The prevalence of bacterial vaginosis at Health Center No. 1 was 7.83% in 2022 and 9.23% in 2023, with an overall prevalence of 8.5%. The most prevalent age group was between 24 and 26 years, and the most frequent microorganism was Gardnerella vaginalis, with 83.5%. Conclusions: A higher prevalence of bacterial vaginosis was recorded in 2023 compared to 2022, highlighting the need to strengthen preventive measures and guide future research. Keywords: prevalence, bacterial vaginosis, vaginal infection, reproductive ageÍtem Acceso Abierto Eficacia y seguridad del Pitolisant en el tratamiento de la narcolepsia: revisión sistemática(Universidad Católica de Cuenca., 2025) Orbe Orbe, Willian Isael; Galán Avecillas, Yadira Alexandra; 03028005783Title: Efficacy and Safety of Pitolisant in the Treatment of Narcolepsy: A Systematic Review. Objective: To determine the efficacy and safety of pitolisant in the treatment of narcolepsy. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines, using the databases Scopus, PubMed, ScienceDirect, SciELO, and Cochrane Library. Scientific studies published between 2020 and 2025 were included randomized clinical trials, meta-analyses, and full-text articles in Spanish or English on patients diagnosed with narcolepsy. The search incorporated Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH), combined with Boolean operators AND and OR. Results: Fifteen studies were included after applying tools such as the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), Grading of Recommendations Assessment, Development and Evaluation (GRADE), and OXFORD. A total of 100 studies were excluded because they did not meet the methodological criteria, and 181 were excluded based on the selection criteria. Discussion: Pitolisant is presented as an effective and safe therapeutic option for narcolepsy, reducing excessive daytime sleepiness (EDS) and cataplexy, improving quality of life. Its safety profile is favorable, with mild and transient adverse effects. Limitations: The review identified publication and citation biases, difficulties with duplicate studies, exclusion of languages other than English and Spanish, and a lack of data on long-term effects. Conclusions: Pitolisant is an effective and safe therapeutic option for narcolepsy, demonstrating low abuse potential and a favorable adverse effect profile. Keywords: Efficacy, narcolepsy, pitolisant, safetyÍtem Acceso Abierto Eficacia y seguridad de inhibidores del cotransportador sodio glucosa tipo 2 versus biguanidas en el tratamiento de la diabetes mellitus Tipo 2 en adultos mayores: revisión sistemática(Universidad Católica de Cuenca., 2025) Mogrovejo Pinos, Lizbeth Augusta; Rojas Caldas, Lissbeth Juliana; Sanango Reinoso, Wilmer Stalin; 0302471552; 0350012985Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and biguanides are commonly prescribed pharmacological agents in the treatment of Type 2 Diabetes Mellitus (T2DM). Both aim to regulate blood glucose levels through different mechanisms of action. Objective: To evaluate the efficacy and safety of SGLT2 inhibitors compared to biguanides in the treatment of T2DM in the elderly population. Methods: A systematic review was conducted using databases such as PubMed, SpringerLink, and Elsevier. Medical subject headings and Boolean operators (AND/OR) were used to optimize the search. Open-access articles published in English or Spanish since 2020 were included. The selection process followed the PRISMA 2020 guidelines. The risk of bias was assessed using the RoB-2 tool, and methodological quality was evaluated with the National Institute of Health (NIH) assessment tool. Results: Dapagliflozin was the SGLT2 inhibitor that demonstrated the greatest efficacy, reflected in a greater reduction in glycated hemoglobin (HbA1c), and was associated with fewer adverse effects compared to other drugs. However, the studies did not show statistically significant differences between treatments, and the patient’s age influenced the results. Conclusions: Dapagliflozin emerged as the most effective and safest option among the evaluated medications. Nevertheless, further targeted research in the older adult population is necessary to validate these findings. Keywords: Type 2 diabetes mellitus, biguanides, adverse effects, metformin, glycated hemoglobinÍtem Acceso Abierto Tratamiento quirúrgico para Parkinson: actualización bibliográfica.(Universidad Católica de Cuenca., 2025) Herrera Brito, José Armando; Crespo Argudo, Karla Marcela; 1104571540Introduction: Parkinson’s disease is a chronic condition characterized by the progressive loss of dopaminergic neurons, leading to disabling motor symptoms. In the initial stages, pharmacological treatments are employed; nonetheless, in cases of insufficient response or advanced disease phases, surgical interventions such as deep brain stimulation (DBS), thalamotomy, and pallidotomy are considered. Objective: To identify the current surgical techniques used in the treatment of Parkinson's disease. Method: A systematic review following PRISMA 2020 guidelines was conducted, utilizing information from the last 5 years and databases including PubMed, Scopus, and Springer. Results: Eighty percent of the included studies focused on Deep Brain Stimulation. It produced sustained motor improvements in 75–80% of patients in the long term. Pallidotomy and thalamotomy improved motor symptoms in 65% of cases. These ablative procedures are irreversible and carry risks (hemorrhages, infections). Furthermore, benefits in non-motor symptoms were observed in approximately 70% of patients treated with DBS. Conclusions: DBS is the surgical technique of choice for advanced Parkinson's disease due to its high efficacy (80% motor improvement) and adjustable nature. Pallidotomy and thalamotomy are options for selected cases, providing significant improvements (65%) but with irreversible risk. Collectively, these surgical procedures improve long-term symptomatic control and reduce medication dependency. The selection of the technique should be individualized based on clinical criteria. Keywords: Parkinson’s, functional surgery, Deep Brain Stimulation, pallidotomy, thalamotomyÍtem Acceso Abierto Polímeros biocompatibles basados en hidroxiapatita y colágeno quitosano aplicados al campo de la medicina regenerativa: revisión sistemática(Universidad Católica de Cuenca., 2025) Cabrera Ortega, Alexander Sebastián; Gutiérrez Ortega, Fausto Horacio; 0302849880Regenerative medicine has continuously evolved, integrating increasingly advanced technologies based on synthetic biological materials. These materials are designed in various sizes and shapes to facilitate the adhesion and proliferation of different types of cellular structures, enabling tissue growth and regeneration. Objective: To analyze the use of biocompatible polymers based on hydroxyapatite and collagen-chitosan in regenerative medicine. Methodology: A systematic review was conducted using the following databases: Scopus, PubMed, ScienceDirect, SciELO, and the Cochrane Library, covering the period from January 2019 to December 2024. Health descriptors (DeCS and MeSH) were used to identify keywords, and Boolean connectors AND and OR. Results: Selection criteria were applied, and 41 articles published within the specified time frame were included. Nine hundred thirty records were excluded for not meeting the methodological criteria relevant to the research topic. Additionally, 83 articles were excluded for failing to meet inclusion criteria, which required experimental studies involving support structures in their application in regenerative medicine, both in vivo and in vitro. A data matrix was used to validate each document during the data curation process. Conclusions: Advances in medicine have enabled the implementation of new technologies involving biopolymers in the development of cellular structures, improving their properties for the regeneration of specific tissues and thereby enhancing patients' quality of life. Keywords: biopolymers, regenerative medicine, tissue engineering, collagen-chitosan, hydroxyapatiteÍtem Acceso Abierto Eficacia de la monoterapia versus terapia combinada para el tratamiento de la hiperplasia endometrial: revisión sistemática.(Universidad Católica de Cuenca., 2025) Mejía Rodríguez, Ana Graciela; Mejía Rodríguez, Jessica Raquel; Vélez Vintimilla, Ana Paula; 0302737457; 0302737465Background: Endometrial hyperplasia is an abnormal proliferation of the endometrium that, if left untreated, can progress to endometrial carcinoma. Therapeutic management includes monotherapy with progestins and combination therapy with other agents, such as metformin. However, the most effective strategy to reduce histologic progression, recurrence rates, and adverse effects is still under debate. Objective: To evaluate the efficacy of combination therapy with progestins plus metformin compared to progestin monotherapy for the treatment of endometrial hyperplasia through a systematic review of scientific literature. Methods: A systematic review was conducted following PRISMA guidelines. Studies were retrieved from databases including PubMed, Scopus, Cochrane Library, and LILACS. Clinical trials and observational studies comparing monotherapy and combination therapy in patients with endometrial hyperplasia without atypia or with atypia were included. Results: Endometrial hyperplasia is a premalignant lesion with a high incidence and a significant risk of progression to endometrial cancer. This systematic review compared the efficacy of the levonorgestrel-releasing intrauterine device (LNG-IUD) versus combination therapy with megestrol and metformin, revealing a higher regression rate with the LNG-IUD (91.15% vs. 81.74%). The therapeutic response was more favorable in cases of hyperplasia without atypia, and no significant differences were found based on patient age. Keywords: endometrial hyperplasia, megestrol, levonorgestrel, metformin, treatment outcomeÍtem Acceso Abierto Síndrome de superposición Asma-EPOC. Revisión Sistemática(Universidad Católica de Cuenca., 2025) Lopez Torres, Mercy Alejandra; Galán Avecillas, Estefanía Pamela; 1401239338Background: Asthma-COPD (Chronic Obstructive Pulmonary Disease) Overlap Syndrome (ACOS) is the existence of both asthma and COPD pathologies in a single patient. Currently, this syndrome has been of special interest due to an increase in respiratory symptoms, a higher degree of exacerbations and a deteriorated lifestyle. General objective: To describe the update of the Asthma-COPD overlap syndrome. Specific objectives: To define COPD. To identify the new methods used for the diagnosis of COPD. To indicate the updated treatment for COPD. The research question is: What are the updates of the asthma-EPOC overlap syndrome? Methods: A search was made in PubMed, Scopus, and SciELO databases. We Open access, in full, or incomplete articles published in the last five years, in Portuguese, English, and Spanish were selected. The samples included young people, adults, older adults, and BALB/c rodents. Irrelevant or non-scientific articles were excluded. Conclusions: ACOS reveals the coexistence of asthma and COPD, associated with pollutants and a negative impact on lung function and quality of life. The importance of updated diagnostic methods and personalized treatments is highlighted. Keywords: asthma-COPD overlap syndrome, dyspnea, lung function, forced spirometry, mixed lung disorderÍtem Acceso Abierto Complicaciones perinatales en neonatos de madres con diabetes gestacional. Revisión Sistemática(Universidad Católica de Cuenca., 2025) Matute Ortiz, Doménica Monserrathe; Barzallo Ochoa, Tania Pamela; 0350093696Background: Gestational diabetes mellitus is a metabolic disorder characterized by increased glucose levels detected in the early stages of gestation. It leads to various complications in the neonate, thereby increasing the risk of neonatal mortality. Objective: To determine the perinatal complications in neonates born to mothers with gestational diabetes. Methods: An exploratory, observational, retrospective, and cross-sectional approach was utilized based on the PRISMA 2020 guidelines. It includes studies published within the last five years and scientific journals from digital repositories such as SCOPUS, SCIENCE-DIRECT, MEDLINE, and COCHRANE. Results: A total of 735 studies were obtained after applying the search criteria. Subsequently, this research applied selection parameters, yielding a total of 25 articles that were analyzed individually. Among these, the main perinatal complications identified were respiratory distress syndrome, large for gestational age neonate, macrosomia, and neonatal jaundice. However, these complications were associated with an increase rate of hospitalization in neonatal intensive care units. Additional reported complications included neonatal hypoglycemia, hyperbilirubinemia, and birth trauma. Conclusion: The main perinatal complications in neonates born to mothers with gestational diabetes were anthropometric and metabolic, comparable to those mentioned in the broader literature. Keywords: neonates, gestational diabetes, pregnancy complicationsÍtem Acceso Abierto Implicaciones clínicas de la obesidad en adultos. Revisión Sistemática.(Universidad Católica de Cuenca., 2025) Suscal Guillén , Kimberly Paulette; Guerra Ortega, Diana Laura; 0301987194Background: The growing silent pandemic of obesity in the last decades and the increase of comorbidities have increased the morbid mortality rate; therefore, obesity has come to be positioned as a potent risk factor for the development of different clinical implications. Objective: To understand the clinical implications of obesity in adulthood through a systematic review using reliable scientific information sources. Methodology: A systematic review of the PRISMA 2020 model, through analysis of clinical trials, meta-analysis studies, and articles in Spanish and/or English collected from scientific databases such as ResearchGate, Scopus, and PubMed, including information from the last five years was conducted. Results: Thirty articles were collected showing that obesity acts as the main precursor of other clinical conditions due to the inflammatory mediators generated by the accumulation of adipose tissue, which alter the physiology of the organs and trigger the appearance of implications mainly at the hepatic, cardiorespiratory, and endocrine-metabolic levels. Discussion: The time at which the development of clinical implications begins in individuals with obesity has not been estimated, but it is mentioned that weight control helps to prevent disease progression. However, a subgroup of patients with obesity is metabolically healthy, indicating that adequate weight control could decrease the rate of comorbidities triggered by this factor. Keywords: adults, BMI, obesity, metabolic disordersÍtem Acceso Abierto Modulación de la microbiota intestinal en el tratamiento de la obesidad. Revisión Sistemática(Universidad Católica de Cuenca., 2025) Urgiles Calderón, Sabrina Lizbeth; Cordero Cordero, Gabriela del Rosario; 0350091617Research on the relationship between gut microbiota and obesity has significantly increased in recent decades. The first connection was established through studies in mice; researchers have identified a relationship between dietary interventions and microbiota composition. These studies have demonstrated that modulation of the gut microbiota can increase the population of beneficial microorganisms and lead to changes in body weight, providing a potential therapeutic approach for obesity, a metabolic disorder that has become a public health crisis. Since 1975, the prevalence of obesity has tripled and continues to rise significantly. Therefore, this study aims to explore gut microbiota modulation as a treatment for obesity. A qualitative systematic review was conducted following PRISMA guidelines, involving the selection of original scientific articles published within the last five years, in Spanish or English, from various academic databases. Data were extracted and analyzed from multiple studies focusing on the type of intervention applied and its effects on patients, particularly with anthropometric and biochemical parameters, as well as its impact on gut microbiota composition. The findings suggest that different diets, as well as the intake of prebiotics and probiotics, can alter the composition of the gut microbiota, which in turn may be used as a treatment strategy for obesity by improving and regulating anthropometric measures and biochemical markers, such as glucose levels and lipid profiles. Keywords: gut microbiota, obesity, diet, probiotics, prebiotics
