Medicina
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Item Neumatosis intestinal ¿un problema de mal diagnóstico?(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-11-06) Gaguancela Sabando, María del Cisne; Dávalos Barzola, Cindy GraceIntroduction: Intestinal pneumatosis, pathology in the intestinal wall associated with different underlying clinical conditions, due to the accumulation of gases that generate inflammatory diseases, frequently related to the patient's state of emergency, requiring rapid diagnosis. Objective: Disseminate as much information as possible about the relevant aspects of Intestinal Pneumatosis as a problem derived from a bad diagnosis, in order to reduce the morbidity and mortality rate in patients with acute pathology. Methods: Bibliographic review article, supported by documentary methodology, by compiling information in digital databases: Pubmed, SciELO, Science Direct and Google Scholar, using descriptors in Health Sciences (DeCS), with article inclusion criteria. published between the years 2017-2022, in English and Spanish. Results: They point towards the manifestation of the pathogenesis, still to be determined exactly, given the multiple causes and related pathologies that can complicate the finding in time, becoming a daily medical challenge with even asymptomatic patients. Likewise, carrying out invasive assessments can compromise intraperitoneal exploration in certain cases, making it necessary to complement it with other methods to obtain a better diagnosis. Conclusions: Imaging is considered ideal to verify a diagnosis of IP, specifically computed tomography, since they can demonstrate internal details in the intestinal wall, being able to show three patterns of pneumatosis, which are reviewed by the literature through through cystoid bubbles, linear and circular patterns, being binding for proper diagnosis in time to help reduce comorbidities and avoid current morbidity and mortality rates.Item Actualización en el diagnóstico, tratamiento y pronóstico de osteosíntesis imperfecta(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-10-04) Tusa Tubon, Bryan Fabricio; Montiel Fleire, Sainly del CarmenIntroduction: The "brittle bone disease," scientifically known as Osteogenesis Imperfecta, is a genetic disorder that affects the production of collagen in bones, leading to significant susceptibility to fractures and bone weakness. Despite advances in understanding the disease, the diversity in its clinical and genetic manifestations remains a challenge in medicine. Objective: This review aims to provide a more comprehensive and contemporary analysis of the diagnosis, management alternatives, and long-term expectations for affected individuals. Methodology: A bibliographic review was conducted, involving literature searches in medical databases. Results: It was evident that the use of genetic sequencing allows for more accurate diagnosis. Additionally, treatment has evolved towards a multidisciplinary approach, including physiotherapy, orthopedic surgery, and pharmacological therapy with bisphosphonates to increase bone density. The prognosis of these patients has improved, although the quality of life may be affected, especially in severe cases. Recent advances in genetic diagnosis and molecular therapies have completely changed the treatment landscape, offering new hope to patients. Conclusions: Despite these advances, there remains an urgent need to research and develop new, safer, and more effective therapies to enhance the well-being and survival rates of these patientsItem Pie equinovaro congénito tratamiento y pronóstico actual(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-10-04) Rueda Leguisamo, Kristell Kassandra; Aldaz Santamaria, Monica PatriciaIntroduction: Congenital talipes equinovarus (CTEV), also known as clubfoot, is a complex orthopedic anomaly present at birth that affects the foot and ankle. This condition is characterized by heel inversion, forefoot adduction, and supination of the midfoot. As a result, CTEV can cause functional and aesthetic difficulties in the patient's life. Over the years, the treatment has undergone considerable evolution. In recent times, there has been an increasing focus on the Ponseti method. Objective: To describe current treatments and evaluate the most effective classification method for determining the prognosis of congenital talipes equinovarus. Methodology: This study involved a rigorous literature review focused on congenital talipes equinovarus. A comprehensive search of scientific literature was conducted in prominent databases such as PubMed, Scopus, Web of Science, and Google Scholar. Terms related to CTEV, such as "clubfoot," "talipes equinovarus," "congenital foot deformity," "Ponseti method," and "surgical treatment," were used for this purpose. Results: Based on the acquired findings, it has been deduced that the Ponseti method is the preferred and initial treatment for this disorder. This preference is based on its efficacy, safety, and long-term functional and aesthetic outcomes. The prognosis of these patients is strongly influenced by the severity of the deformity, the age at which treatment is initiated, and adherence to the treatment plan. Conclusions: Follow-up and early intervention in cases of recurrence or complications are essential to improve outcomes and ensure a functional and pain-free life for patients.Item Diagnóstico temprano y tratamiento de hipotiroidismo congénito(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-10-04) Cayambe Quilligana, Jennifer Marisol; Mejía Ortiz, Ruth AureliaCongenital hypothyroidism is the most frequent endocrine pathology occurring in the perinatal period that can cause mental retardation due to a deficit of thyroid hormones. According to the location it can be primary, secondary or central. The objective of this update is to describe the importance of early diagnosis and treatment of congenital hypothyroidism that will allow a normal neurodevelopment in the pediatric patient. Only 5 to 10% of newborns present clinical manifestations at birth, so the realization of an adequate clinical history, identification of risk factors such as familial hypothyroidism and neonatal screening is very important for its evaluation. In our country since 2011, this program has been implemented allowing a timely diagnosis and early initiation of treatment with levothyroxine to avoid irreversible damage caused by this pathology, achieving an excellent prognosis. Follow-up should be carried out subsequently until the patient reaches adulthood.Item Diagnóstico y tratamiento del hematoma subdural crónico(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-07-10) Lucio Parra, Lisseth Jackeline; Romo López, Ángel GeovannyChronic subdural hematoma is considered a neurosurgical pathology frequently found in elderly patients over 65 years of age, although it can also develop in children and young adults. This pathology is a condition secondary to cranioencephalic trauma that is accompanied by symptoms such as headache, cognitive impairment, gait disturbance, or motor weakness. OBJECTIVE: To conduct a literature search on the clinical characteristics, and pathophysiology that causes the symptoms and treatment of chronic subdural hematoma. METHODOLOGY: This is a retrospective, descriptive, bibliographic review article, in which an exhaustive classic and contemporary search (from the last 5 years published) of scientific articles, books, and doctoral theses available in different academic databases in medicine will be carried out on chronic subdural hematoma, to describe the origin, causes, clinical characteristics, methods of diagnosis and therapeutic management of this pathology. RESULTS: The characteristics of chronic subdural hematoma vary according to the severity and location of the hematoma, it can be caused by advanced age, anticoagulant medications, brain diseases, alcohol abuse, etc. CONCLUSIONS: Seek specialized medical attention in the case of presenting any symptoms because early diagnosis can prevent serious complications to the health of patients.Item Diagnóstico y tratamiento de la dermatomiositis: una revisión(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-07-10) Mayorga Salazar, Jesús Alberto; Medina Medina, Doris RaquelIntroduction: Dermatomyositis (DM) is a rare chronic autoimmune disease with primary features of symmetrical proximal muscle weakness and skin involvement with differentiated skin lesions and a clinically heterogeneous constellation of systemic manifestations that may affect other organs mainly heart, lung and digestive system. In the absence of characteristic dermatologicalfindings or myopathy, DM can be difficult to diagnose; therefore, due to its low incidence and the complexity of its diagnosis, it is a topic of interest to motivate other colleagues in the healtharea to approach this pathology. Objective. To analyze the current scientific evidence of dermatomyositis and to elaborate a detailed review of the pathology. Methodology. The present work is a systematic review of the existing literature, of publications in scientific journals compiling information from the databases of Medline, Intra Med, PubMed, The Cochrane, SciELO and other journals with quality scientific evidence in which descriptors such as: Dermatomyositis, paraneoplastic syndrome, cancer are used. The records range between 30 and 50, after the combination of the different keywords with date restriction within the last five years, in Spanish and English. Results. Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of systemic acquired diseases characterized by chronic progressive muscle weakness and an inflammatory cellular infiltrate in skeletal muscle. In this group, polymyositis (PM), dermatomyositis (DM) and inclusion body myositis (IBM) are the most frequent diseases. Diagnosis is based on the cutaneous manifestations of the disease and the degree of muscle involvement, and when there is doubt in the diagnosis, electromyography or skin and muscle biopsy may be used. The goals of treatment of dermatomyositis include improving physical function and preventing the development of disability. Treatment should be instituted early and requires a team approach involving physical therapist, dermatologist and family physician. Involvement of other specialists may be necessary, depending on the particular manifestations of the disease. Conclusion. The diagnosis of dermatomyositis is given largely by the clinical manifestations of the disease, but in certain cases it represents a diagnostic challenge in patients who suffer from it in the absence of cutaneous manifestations, requiring complementary studies such as skin biopsy, electromyography and even muscle biopsy. Dermatomyositis is an autoimmune disease that generally appears as a paraneoplastic syndrome associated with an underlying malignant neoplasm in a subgroup of patients. Because of this, comprehensive management and timely diagnosis is necessary to prevent possible complications. The goals of dermatomyositis treatment include improving physical function and avoiding the development of disability. Among the therapeutic options that help to control this disease, we find pharmacological therapies such as the use of systemic corticosteroids, immunoglobulins, monoclonal antibodies and immunomodulators.Item Revisión bibliográfica sobre nuevas alternativas en el manejo terapéutico y profiláctico para la migraña crónica(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-07-04) Sampedro Garzón, Sofia Daniella; Recalde Navarrete, Ricardo JavierBackground: Migraine is a common chronic primary headache, which can be disabling if not properly treated. Numerous studies suggest that migraine remains underdiagnosed and undertreated. Methods: This study was carried out in January and February 2023 in an Andean city, through a survey answered by 43 doctors from the first and second level of health. The interview questions concerned knowledge of the diagnostic criteria and treatment methods of migraine. Results: On average, each physician consulted 3 migraine patients per mon th. More than half of the secondary care physicians (73%) listed partial diagnostic criteria for migraine without aura or mentioned aura in their responses. Only 15% of primary care physicians mentioned all diagnostic criteria for migraine without aura. Although 45% of them said they distinguished between episodic and chronic migraine, 18% provided an incorrect definition. The most prescribed drugs in prophylaxis were triptans (65%), followed by tricyclic antidepressants (42%), and in the therapeutic field, in the same way, tripatans, mostly followed AINES combination of antiemetics. Conclusions: Primary care physicians play a fundamental role in the diagnosis, treatment and follow-up of migraine; however, many of them have insufficient knowledge about its diagnosis and correct differentiation between chronic and episodic forms.Item Nudo verdadero de cordón umbilical “revisión bibliográfica”(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-07-03) Ortiz Amendariz, Denise Alexandra; Mena Villarroel, Luis ByronThe true knot of the umbilical cord is a potentially serious complication that can occur during pregnancy, it ranges between 0.3% and 2.1% of pregnancies, occurs because of a long or coiled umbilical cord, which by its length tends to intertwine completely at the ends on one or more occasions, in most cases tends to be asymptomatic and does not cause problems, It is important to mention that in spite of being an asymptomatic pathology in rare cases it can affect the flow of blood and fetal oxygen, which can cause growth problems, fetal hypoxia, heart failure and other serious complications such as fetal death. Treatment for a true umbilical cord knot depends on the severity of the situation. In some cases, a cesarean section may be recommended to ensure the safety of the fetus. In other cases, the fetus may be carefully monitored during delivery for any signsof problems and action taken as needed. True umbilical cord knots are rare and cannot be prevented. However, there are certain risk factors that may increase the likelihood of occurrence, such as having a long umbilical cord or having a fetus that makes accelerated movements intrauterine. If the presence of a true umbilical cord knot is suspected, it is important to receiveimmediate medical attention to minimize any risk to the fetus. In this research we will focus on reviewing the causes, risk factors, diagnosis and treatment of true umbilical cord knotting. Objective: Describe the main causes of the true umbilical cord knot, complications, risk factors, symptoms, diagnosis and treatment. Method: A descriptive and retrospective bibliographic review of documents published by scientific societies dedicated to collecting evidence on the treatment of overactive bladder syndrome, as well as research papers and scientific articles that describe the causes and treatment of OAB, was carried out. To locate the bibliographic documents, several documentary sources and guides published by different local and international professional associations of urology were reviewed. An exhaustive search was generated in repositories and scientific databases such as Pubmed, Scielo, Springer, MedLine, Redalyc, Dialnet, New England Journal of Medicine with the use ofdescriptors in both English and Spanish and the use of DeCs and MeSH (Urinary Bladder) thesauri.Overactive, Lower Urinary Tract Symptoms, Overactive Detrusor, Pelvic Floor). The final samples among all the reviewed databases were 30 articles in 30 Spanish and 20 articles in English. The inclusion standards for this review are as follows. Articles published from 2019 to this year and directly related to the research variables are articles belonging to the search engine selected for this review. In the same way, articles that did not correspond to the variable research, and that didnot belong to the selected sources, were excluded. Subsequently, an exhaustive reading of the names and the curriculum of each article is carried out to see which of them best adapt to thevariables of this review, thus receiving the number of articles with specific and useful information for the effective development of this study. Results: Fetal monitoring is important for the detection of this pathology, and if it occurs, fetuses should be subjected to continuous fetal surveillance to detect any signs of fetal distress. This may include tests of fetal well-being, such as electronic fetal monitoring or fetal heart rate tests. Childbirth planning is a helpful tool since control is maintained even before conception, since it includes a careful evaluation during all trimesters of pregnancy, allowing us to detect the presenceof this pathology early. In some cases, a cesarean delivery may be necessary to reduce the risk ofmaternal-fetal complications during vaginal delivery. Antenatal care is substantial and pregnant women should be advised to attend their antenatal care appointments on a regular basis to ensure that any problems, such as a true umbilical cord knot, are detected in time so that appropriatemeasures can be taken if they arrive. to present this pathology without endangering the life of the mother or the fetus. Tobacco and alcohol should be avoided during pregnancy because they increase the risk of complications during pregnancy, including the true knot of the umbilical cord. Insummary, the true umbilical cord knot is a potentially serious complication of pregnancy, but preventative measures can be taken to reduce the risk of complications and ensure a successful outcome for mother and fetus before, during, and after delivery. Conclusion: The diagnosis of a true umbilical cord knot is based on clinical evaluation and theuse of diagnostic techniques, such as prenatal ultrasound and fetal monitoring. If a true umbilical cord knot is suspected, it is important to seek medical attention immediately to avoidserious complications for the fetus. Treatment of a true umbilical cord knot will depend on theseverity of the complication and the health of the fetus. If a true umbilical cord knot is suspected, it is important to seek medical attention immediately to avoid serious complicationsfor the fetus. Some of the maternal and fetal risk factors for true umbilical cord knot include multiple pregnancy, polyhydramnios, fetal malformations, history of true umbilical cord knot, advanced maternal age, and fetal sex. If a pregnant woman has one or more of these risk factors, it is important to discuss the possibility of a true umbilical cord knot with her doctor and take the necessary precautions.Item Actualización del manejo integral del hipotiroidismo subclínico(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-07-03) Nuñez Silva, David Sebastian; Cevallos Teneda, Andrea CarolinaHypothyroidism is a pathology characterized by high levels of the stimulating hormone called thyrotropin (TSH), on several occasions it manifests itself with mild symptoms, it precedes the subclinical term since, unlike the underlying disease, the hormonal levels of tetraiodothyronine and triiodothyronine are They are normal. Currently the decision of the correct management of the disease is a subject of debate, since an inadequate management of it can lead the patient to develop primary hypothyroidism, the frequency of thyroid diseases at present are causes of morbidity, mortality and disability at the worldwide, taking into consideration that hypothyroidism is the twenty-third most common diagnosis evaluated in medical consultation. Objective: To analyze the updated available literature on subclinical hypothyroidism, clinical manifestations, identification and comprehensive management. Method: Systematized Bibliographic Review of literature based on the selection of scientific articles from recent years based on the PRISMA method. Results: There is evidence of a clear clinical improvement in patients with T4 hormonal treatment, as long as the patient presents clear symptoms of the pathology, the benefit during pregnancy and in patients with comorbidities is significantly favourable, otherwise the analysis of the risks of the therapy is still in controversy. Conclusions: The treatment of subclinical hypothyroidism is totally individualized, pharmacological intake by hormone replacement with levothyroxine has shown significant benefits in symptomatic patients, the riskbenefit ratio will depend on the causes of said pathology according to the characteristics of the patient such as; race, sex and age.Item Actualización del embarazo ectópico para atención primaria de salud(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-06-09) Estrella López, Pamela Estefanía; Bustillos Solórzano, Marcos EdissonIntroduction: Ectopic pregnancy (EE) comes from the Greek "Ektopos" meaning offsite, and therefore all pregnancies whose implantation of the fertilized egg occurs outside the uterine cavity in women of childbearing age are considered the most frequent site of implantation, and it is generally at the level of the uterine tubes. Its symptoms are not so specific and it is characterized by abdominal pain accompanied on occasions by vaginal bleeding or amenorrhea, so the clinical picture is not sufficient for early diagnosis, requiring the implementation of complementary tests to corroborate the suspicion. Objectives: Analyze and collect updated information on ectopic pregnancy for primary health care. Materials and methods: A literature review in English and Spanish available in the PubMed, Scopus, Cochrane, Scielo, Latindex and Google Academy databases was carried out with a filter of the last 5 years, from 2016 to 2021, focusing on ectopic pregnancy. Results and discussion: The most recent literature review describes the risk factors, epidemiology, and location, as well as the clinical diagnosis, laboratory, and ultrasound criteria that help us determine the location of the ectopic pregnancy. In addition,it allows us to orient ourselves in the current management of it through expectant management or surgical treatment depending on the patient's condition. Conclusions: Clinical diagnostic methods, ultrasound findings are essential in confirming the diagnosis. It also provides a guide to establish the appropriate treatment that can be conservative by the administration of metrotexate (MTX) as first-line therapy or by referral to a center of greater specialty to carry out procedures such as laparotomy or laparoscopy depending on the hemodynamic status of the patient.