Medicina
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Item Impacto de los factores ambientales en la aparición de preeclampsia grave (Revisión de la literatura)(Universidad Técnica de Ambato/Facultad de Ciencias de la Salud/Carrera de Medicina, 2022-09-01) Martínez Quinteros, Andrea Soledad; Belalcázar Sánchez, Yajaira Monserrath, DraPreeclampsia is a vascular placental pathology that affects around 5% of all pregnant women worldwide, characterized by the presence of high blood pressure and proteinuria from the 20th week of gestation. It represents the fourth cause of perinatal morbidity and mortality and, in turn, is one of the main causes of induced prematurity and intrauterine fetal growth restriction. Currently, climate change is a fact that must be taken into account within the risk factors in the development of various pathologies, which allows health professionals to develop skills and attitudes in the field of climate change. Seasonal and climatic factors seem to be involved in the development of this pathology, however, there are insufficient studies that examine all individual, socioeconomic and environmental factors, including the meteorological or climatic variant, as influential factors in the development of severe preeclampsia. The seasonality of preeclampsia has been observed at the time of delivery by different studies carried out in regions with different climatic and economic conditions. The present work will consist of a systematic review of the available bibliography in scientific journal publications with a good level of evidence of publications made in the last 10 years, in Spanish, English and French languages. Information will be collected from databases such as Medline, Intra Med, PubMed, The Cochrane, SciELO, Hyper Article en Ligne (HAL), BASE, Scinapse, Semantic Scholar, among others. In addition, bibliographic data and citations of scientific articles and degree works available in the virtual library of the Technical University of Ambato and in universities at an international level will be included, taking the line of research belonging to Human Health itself that corresponds to the Domain of Food Systems, Nutrition and Health of the Faculty of Health Sciences of the Technical University of Ambato.Item Pileflebitis, complicación extraña de apendicitis aguda en paciente gestante, reporte de un caso(Universidad Técnica de Ambato/Facultad de Ciencias de la Salud/Carrera de Medicina, 2020-10-01) Moya Romero, Katherine Solange; Guanuchi Quito, Franklin Hernán Dr. Esp.Objective: To characterize a pregnant patient who presents with pileflebitis as a strange complication of acute appendicitis. Discussion: A case of a pregnant 18-year-old female patient is reported, who reports diffuse abdominal pain of moderate to great intensity, accompanied by vomiting and diarrheal stools, as well as jaundice in the chest and legs. Hepatitis was diagnosed clinically without specifying the results of examinations and treatment that was not referred started, as she did not show improvement, she was transferred to the Ambato General Teaching Hospital. The previous clinical picture is ruled out with an in-depth physical examination and complementary examinations, confirming the presence of sepsis of abdominal origin due to acute perforated appendicitis, generalized peritonitis complicated by pilephlebitis; surgical intervention and resolution of the clinical picture is performed. Materials and methods: A retrospective descriptive study based on clinical case analysis is carried out. Conclusions: After reviewing the clinical case and the bibliography, it is concluded that pilephlebitis is septic thrombosis of the portal system due to acute abdominal inflammatory conditions; It presents with variable clinical manifestations depending on the cause of origin and by affected portal branch. The diagnosis includes normal or slightly altered liver function with leukocytosis, positive blood cultures, Doppler ultrasound or computed tomography corroborating the pathology. For therapeutic measures, control of the septic focus, liver abscesses and pylephlebitis is considered.Item “Síndrome de hellp completo, secundario a preeclampsia grave”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-05-01) Salazar Lizano, Darío Israel; Dr. Córdova Peñaloza, OpilioThis case is about a 22-year-old female patient with no relevant pathological history who is taking her first pregnancy (34 weeks), is treated in Emergency on 06/02/2017 for presenting approximately 24 hours before her admission Holocranial headache of moderate intensity accompanied by scotomas, espigastralgia and about 12 hours ago decrease her fetal movements, so go to a private doctor who recommends going to Provincial Ambato Hospital. Is evaluated in Emergency who decide her hospitalization to Gynecology and Obstetrics service with a diagnosis of Tonsillitis + Pregnancy of 33.5 weeks + Fetal Bradycardia Upon admission to Obstetrics and Gynecology, a patient is received with SCORE MAMA 4 without a strip, Arterial Blood Pressure: 100/60, Heart Rate: 74 bpm, Respiratory Rate: 22 rpm, Saturation: 94%, ultrasound scan, finding a single fetus, transverse , cephalic pole to the right, upper back, posterior fundic placenta Grade III, absence of heartbeat, for which they decide termination of pregnancy by high route, procedure that is performed under spinal anesthesia at one and a half hours after admission to obstetrics gynecology. During the procedure, a bladder catheter is placed to assess diuresis, which is not produced, cataloging it in this way with Acute Renal Insufficiency, for this reason Obstetrics Specialists request an assessment by the Intensive Care Unit (ICU), who value the patient and decide on treatment based on hydration and antibiotic therapy. In a new assessment by obstetrics gynecologist the patient is found with hepatic transaminase values and elevated LDH as well as coagulation times, and with alterations in abdominal ultrasound, and for this reason the specialists decided to initiate the protocol of hypertensive disease of pregnancy, Anuria is evidenced and a new assessment is requested by ICU who decide to enter the Intensive Care Unit for management of incomplete HELLP syndrome + renal failure and possible complications (07/02/2017). In intensive care room stayed controlled until 09/02/2017 where it is found that the patient has an increase in the production of each of their drains which were placed during the procedure of cesarean section. TAC Tóraco - Abdominal is performed where the presence of ascitic fluid + bilateral pleural effusion is evidenced, laboratory tests blood count, blood chemistry and EMO were altered and so a medical consensus is made among surgeons, gynecologists and intensivists who decide compensation of dyscrasia blood + anemia + expectant management due to the need for an eventual laparotomy. On 02/12/2017, the patient presented generalized tonic clonic movements, whereby phenobarbital 240 IV STAT was administered, maintaining arterial pressures between 160/100 - 120/70. However, there was an improvement in terms of urine production, as well as examinations of laboratory with slight improvement Patient evolves favorably and after 11 days of hospitalization in the ICU on 02/18/2017, it is decided to discharge and later be treated in the obstetric gynecology ward, presenting the following diagnoses: 1) late puerperium for fetal death, 2) complete HELLP, 3) Severe preeclampsia, 4) Acute hemorrhagic anemia, 5) Coagulopathy, 6) Eclampsia 7) Hepatic failure. In the Gynecology floor, the patient is managed according to the diagnoses given by the ICU by specialist doctors and on 04/03/2017 after 31 days of hospitalization and having been treated until all of her pathologies are resolved she is dischargedItem “Hipertiroidismo en embarazo complicado por placenta previa”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-05-01) Vinueza Sánchez, Diego Ismael; Guarnizo Briceño, José Abdón Dr. Esp.Thyroid pathology is common in pregnancy and is associated with the risk of miscarriage, preterm delivery, neonatal morbidity, and obstetric complications such as eclampsia, preeclampsia, and premature delivery. Timely diagnosis and adequate treatment of thyroid disease in pregnancy are very important to avoid maternal-fetal complications. The causes of hyperthyroidism are diverse, of which Graves' disease has the highest incidence, others such as toxic multinodular goiter, toxic solitary adenoma, subacute thyroiditis (de Quervain), are exceptional. There are a variety of symptoms in this clinical entity that stand out are: tachycardia, heat intolerance, tremor, anxiety, nervousness and diaphoresis, orbitopathy, pretibial myxedema and have found the loss or inadequate gain of weight. The documented maternal complications of hyperthyroidism without treatment are hypertension, preeclampsia, placental abruption, congestive heart failure and even abortions. To reach the diagnosis of gestational hyperthyroidism, there must be low TSH levels (less than 0.1 mUI / l) or undetectable (less than 0.01 mIU / l) and high levels of free T4. If free T4 is normal, hyperthyroidism is subclinical. On the other hand placenta previa is a condition in which the placenta is implanted in the lower uterine segment, very close to the internal cervical os (OCI) or covering it either totally or partially. The classification used for placenta previa is based on 2 variants: placenta previa proper mind (OCI is covered by placental tissue totally or partially) and marginal placenta previa (the placental edge is less than 2cm from the OCI but does not cover it). Placenta previa occurs with painless active bleeding without uterine activity in the 2nd trimester or during the 3rd trimester. For the diagnosis, transvaginal ultrasound allows the measurement of the placental edge to the OCI. The distance between the placental border and the OCI determined by the transvaginal ultrasound after the week. Normally, a distance of 2cm or less from the OIC is indicative of cesarean section to prevent obstetric hemorrhage.Item “Conocimientos, actitudes y prácticas sobre salud sexual y reproductiva relacionadas al embarazo en adolescentes de 14 a 19 años que acuden al centro de salud n.2 de la ciudad de Ambato durante el período marzo - agosto 2014.”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2014-11-01) Herrera Lozada, Alexandra Elizabeth; Estenoz Álvarez, Maggy Dra.Objective: To determine the knowledge, attitudes and practices on sexual and reproductive health related to pregnancy in adolescents aged 14 to 19 who come to the health center N.2 Ambato city during the period March - August 2014. Design: Descriptive study, transversal. Method and material: A sample from a universe of 480 adolescent mothers between 14 and 19 who attended the outpatient gynecology and pediatrics at the Health Center N.2 Ambato city from March to August 2014 was determined based on the confidence level or 95% confidence (1.96 ) , accuracy = 3% , expected ratio = 5 % ( 0.05) that maximizes the sample size , which allowed us to know how many teenagers must study , the result was 240 teenage mothers were randomly selected without ethnic distinction to which they were surveyed through a questionnaire. Results: Adolescents Before Starting sexual life were reported Contraceptive Methods in 37% of cases and where they obtained information were in educational institutions in 70%, family 18%, internet 6%, health center 0 % the average age of first sexual intercourse was at 15.9 years due to curiosity, more in love , and in some cases are forced by the couple (try love) 5% did not use protection in 73% in its first sexual experience. 78 % know STIs, the most known and used condoms MAC is followed by the PAE. The main cause of teenage pregnancy is by not using contraceptives at 60%, followed by the lack of communication between partners 13 %, the failure of the methods 8%, 5% of family problems. The reaction of adolescent mothers from pregnancy was Rejected at 61%, 4% was Desire. The attitude of the family against pregnancy was negative 36 %, the attitude of the baby's parents recognized pregnancy and were responsible for 83 %, 11% experienced discrimination by their pregnant friends found her. Conclusions: The vast majority of teenage mothers has no knowledge of MAC and STIs and if reported claim that knowledge of contraception, and STIs are weak, cold , are not comprehensive , are not adapted to their needs , culture and therefore not are helping teens make good choices as protection during sex , nor have they contributed to the formation of responsible attitudes to sexual and reproductive health. The best-known method is the adolescent condom and PAE but not all young people use it correctly.Item “Pancreatitis aguda durante el embarazo”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2017-02-01) Villacís Recalde, Richard Guillermo; Salazar Faz, Fernando AbelDr. Esp.Item Embarazo Ectópico Abdominal y Shock Hipovolémico(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-11-01) Aucapiña Rodríguez, Luz Cecilia; Gavilanes Sáenz, Víctor Patricio Dr.The abdominal ectopic pregnancy is an exceptional anomaly that represents 1% of ectopic pregnancies; it is associated with high morbidity and mortality, maternal and fetal. The risk of maternal mortality is 7 to 8 times greater than a tubal pregnancy and it is 90 ectopic times greater than an intrauterine pregnancy. This is a pathology of difficult diagnosis that, in many cases, belatedly established and it is considered an obstetric emergency. Female patient of 23 years old who presents an abdominal pain of 2 months evolution and amenorrhea of approximately 17 weeks, she is admitted to Hospital General Puyo by abdominal pain in study and hypovolemic shock, βHCG is performed with positive result and eco FAST showing free liquid in abdominal cavity and an appearance of embryo outside the uterine cavity with movement, so it is considered a probable accident ectopic pregnancy. On physical examination is hypotensive, tachycardic with generalized pallor, Algic facies, oral mucosal semihumid. An Emergency exploratory laparotomy with identification of abdominal ectopic pregnancy, salpingectomy, right oophorectomy, partial omentectomy is performed. Also, compensation with blood products for trans-surgical cardiovascular instability is indicated. The patient is transferred to intensive therapy to control and manage cardiovascular. Presenting a satisfactory evolution and at 17 hours of admission she is discharged to continue handling by gynecology and obstetrics where she remains hospitalized 2 days and sent homeItem Embarazo Ectópico Accidentado mas Shock Hipovolémico(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Hidalgo Noroña, Tránsito Maricela; González Guevara, Laura Catalina Dra.Ectopic pregnancy is defined as the implantation of the fertilized egg outside the uterine cavity. In Ecuador, according to data released by the INEC in 2014, ectopic pregnancy is the fourth leading cause of maternal death with a result of 6.02%. The most common location of ectopic pregnancy is in the fallopian tube. There are multiple factors related to ectopic pregnancy and the prevalence of such factors is increasing, it correlates with a history of sexually transmitted diseases, ectopic pregnancy, tubal surgery, adult women and snuff disease. It is one of the most important causes of acute abdomen in obstetrics and despite progress in diagnostic and therapeutic methods, ectopic pregnancy continues to represent worldwide problem of maternal morbidity and mortality in the first trimester of pregnancy. This case describes a female patient of 29 years old with no medical history of importance, date of last menstruation know, go to the emergency room because of abdominal pain for about 2 hours, accompanied by tachycardia, hypotension and generalized pallor. Laboratory tests which report leukocytosis, decreased hemoglobin, hematocrit and positive BHCG are made. In addition to reporting abdominal ultrasound performed rugged ectopic pregnancy. Patient is assessed by emergency obstetric resulting test income is decided to surgical center for emergency laparotomy for ectopic pregnancy injured more hypovolemic shock finding free bleeding cavity more clots approximately 3000 milliliters, is administered crystalloid and packed red blood cells plus thereby controls the patient hemodynamically. Approximately 24 hours after the patient has difficulty breathing and chest x-ray desaturation is valued by internal medicine and cardiology who diagnostic acute pulmonary edema, treatment is established it is done. Patient course and is discharged 5 days later. Despite scientific advances in diagnosis, prevention and treatment of this disease is still left unnoticed patients of this kind, either suspicion at the time of care, delay in referral to areas of higher resolution, or perhaps for lack diagnostic tools that enable us to reach a concrete analysis quick and timely manner, it is important to consider the relevance of the investigation of this case report that aims to create a clear and precise understanding of the diagnosis and management of ectopic pregnancy for early intervention, for the benefit of the patient.Item Polihidramnios en Embarazo de 33 Semanas más Hipermadurez Placentaria(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Borja Caiza, Catherine Elizabeth; Mera Ramos, Gerardo Vinicio Dr. Esp.Polyhydramnios is the excessive increase of amniotic fluid 1500-2000 ml or better define distwice normal for gestational age. This is a rare condition less than 0.5%, althoughit is more common in twin, diabetic pregnancy or fetal malformations. Can occur in two way sacute presented in a rough manner between 20 and 24 weeks and chronic which is established progressive from week 24 to above 28.As the week because of complications such as premature rupture of membranes, preterm labor or postpartum hemorrhage by the large uterine distention. Determining the volume of amniotic fluid can be performed using ultrasound is the main tooldue to good penetration of ultrasound with minimal absorption. Because of its interposition in to the uterine cavity, between uterineti estructures, placental, and fetal cableways, allows a good display. Since the assessment of the placenta is essential because itallowsustomeet the growingfetus and itslast ten weeks are crucial in determining the maturity and placental development and assess early treatment Polyhydramnios. The following case is a patient female 17 years of age with gynecological and obstetric history of menarche at age 11, irregular menstrual cycles 1time / month for 5 days IVSA 15 years, CS # 3 diseases not sexually transmitted, paptes , current gestas 1 abortions 0, with the date of the last menstrual period 20-02- 2015 according toreliable patient taking a pregnancy Patient comes accompanied by hermotherto the emergency room of the Provincial Teaching Hospital Ambato referring abdominal pain more or less two hours contraction type located in lower abdomen and lumbar region radiating to more moderate removal of mucous splug and decreased fetal movements. Beingassessedbyphysicalexaminationfindingobstetricianbellypregnantuterus, cephalic single fetus, movingleft back, with a FCF of 136-140, decreased fetal movements and sporadic uterine activity, lower limb edema +. Genital region transvaginal no loss of fluid sise videnced touch 4 cm dilation and effacement of 70% with intact membranes ginecoide pelvis. Results ecosonography obstetric Doppler flow metry + PBF + 32.4 weeks of pregnancy not consistent with LMP, amniotic fluid index of 27.2, posterior placenta fundic 3.9cm thick, with grade III signs of maturity.Item Hernia Diafragmática Congénita de Bochdalek(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-05-01) López Arboleda, Jaime David; Salazar Faz, Fernando Abel Dr.Congenital Diaphragmatic Hernia is a severe malformation with bad neonatal prognosis is often associated with abnormalities in various organs3. It is defined as the abdominal viscera entry into the chest cavity through a normal or pathological diaphragm orifice. The compression exerted on the herniated viscera the lungs causes pulmonary hypoplasia which is the leading cause of neonatal death7-8. Management options available today include the termination of pregnancy, expectant prenatal with postnatal treatment and therapy fetal.1 This clinical case is a female patient of 30 years old, married with background pathological personal gastritis chronic gynecological and obstetric history: beginning of sexual life at age 20, menarche at age 14, regular menstrual cycles every 28 days, dysmenorrhea no, sexually any transmission, pregnancies 2, births 0, caesarean sections 1, abortions 0, controls 3 echoes 2 complete vaccines, folic acid yes vitamins yes paptest 6 months normal, threatened abortion ago at 5 weeks of gestation due to release of gestational sac, enter asymptomatic studying of 24.6 weeks referred to private health pregnancy with transvaginal ultrasound reporting: 24.4 weeks of pregnancy, fetal diaphragmatic hernia and pulmonary hypoplasia, physical exams: stress pressure: 110/70, heart rate 86 x', saturation 92%, temperature: 37.3 °, conscious patient, afebrile, hydrated, abdomen: fundal height according to gestational age, fetal monitoring: fetal heart rate 145, fetal these movements, inguinal region: small yellowish discharge is evident without bad odor, patient assessment of fetal viability and the possibility of terminating pregnancy is reported, it is recommended that an nuclear magnetic resonance full abdomen confirming the diagnosis of diaphragmatic hernia congenital transfer is decided at a higher level hospital.