Ciencias de la Salud
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Item Hepatoesplenomegalia Secundario a Síndrome Antifosfolipídico(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Lascano Laica, Gabriela Del Cisne; Mullo Guaminga, Guido Edgar Dr.Also called antiphospholipid syndrome antiphospholipid syndrome, anticardiolipin syndrome, antiphospholipid syndrome cofactor, Hughes syndrome; and in France known as Soulier-Boffe syndrome it is an autoimmune hypercoagulable state caused by antibodies directed against phospholipids of cell membranes, causing increased susceptibility to the formation of intravascular clots (thrombosis) in both arteries and veins, also complications related to pregnancy such as spontaneous abortions, fetal death, preterm delivery, or severe preeclampsia. The etiology and pathogenesis of these antibodies are not elucidated, the wide range of clinical manifestations could be explained by multiple mechanisms, it is said that this syndrome occurs due to an autoimmune disorder that leads to the production of autoantibodies directed against components of cell membranes called phospholipids (antiphospholipid antibodies or aPL). Thrombosis is a major disease mechanisms, primarily caused by the activation of endothelial cells, monocytes and platelets. Now it considered as one of the most frequently acquired and cerebrovascular accident (CVA) in under 50 causes of thrombophilia. More than 50% of lupus patients with aPL eventually develop SAF. The term "primary antiphospholipid syndrome" is used when the SAF occurs in the absence of other autoimmune diseases, while the term "secondary antiphospholipid syndrome" is used when the SAF occurs in the context of other autoimmune diseases such as systemic lupus erythematosus (SLE). In some rare cases, an EFF may lead to multisystem failure (multiple organ failure), sudden due to widespread thrombosis; in this case usually use the term catastrophic antiphospholipid syndrome, and presents a high risk of death. The evaluation is carried out mainly in a thorough medical history, physical examination and laboratory tests for antibodies phospholipid cardiolipin antibodies (aCL), anti beta2 glycoprotein I antibodies, lupus anticoagulant. For the diagnosis of antiphospholipid syndrome should be present at least one clinical and one laboratory finding. The goal of prophylactic treatment is to keep the patient INR between 2.0 and 3.0, however it is not often done with patients without any kind of thrombotic symptoms; During pregnancy, they heparins and low molecular weight low-dose aspirin instead of warfarin are used, due to the teratogenicity of warfarin. Women who have experienced recurrent spontaneous abortions are given prophylactic treatment with aspirin and initiate treatment with low molecular weight heparin disappears just recognize that their menstrual cycle. In refractory cases it can be used plasmapheresis.Item Calidad de la atención al Paciente con Vih en el Nivel Primario de Salud(2016-10-01) Morales Stacey, Evelin Tamara; Mullo Guaminga, Guido Edgar Dr. Esp.HIV / AIDS is the set of immunologic and virologic phenomena that develop from the time a person becomes infected until viremia and count in peripheral blood CD4 stabilize. The set of signs and symptoms that may occur during the primary infection (PI) is known as acute retroviral syndrome (SRA), cousin symptomatic infection or acute HIV infection / AIDS. The primary infection is followed by a long period usually clinically silent, known as asymptomatic phase. The most common symptoms are fever, maculopapular rash, mouth ulcers, lymphadenopathy, arthralgia, pharyngitis, malaise, anorexia, weight loss, and myalgias lymphocytic meningitis. The greater or lesser severity of this process has implications with unfavorable prognosis, so that patients with more intense and longer clinical symptoms progression of HIV / AIDS tends to be faster. Male patient 32 years of age, black race, security guard occupation, marital status cohabiting, born in Quito and resident Puyo - Pastaza 10 years ago, go to the health center for a year and a half presenting unquantified fever, coughing color greenish diarrhea accompanied by several times about 8 days ago evolution. Physical examination: oral mucous oropharynx semihumid, congestive, purulent, so Tonsillopharyngitis prescribing doctor diagnosed as antibiotic therapy and sends perform additional tests, among them VDRL and HIV / AIDS (rapid test). Following this patient comes to health center at 3 days, where reported results of reactive VDRL and HIV / AIDS (rapid test) positive, for which physician indicates that send reference to Hospital General Puyo and must first end their treatment for diagnostic Tonsillopharyngitis. Patient comes to health center within 15 days, indicating that goes by reference to the hospital in question, where they indicate that the attending physician days ago no longer works in that health unit, because there was change of rural doctor established by the Ministry Public Health, so agendan turn with new doctor; patient reports in consultation persisting with diarrheal symptoms without apparent cause more weight loss and mentioned that he was going to make reference to the Hospital General Puyo for diagnosis of HIV / AIDS (rapid test), this health area is treated with antibiotic therapy more antiparasitic. Physical examination: Blood pressure: 106/60 mm / Hg, heart rate: 70 beats per minute, Respiration Rate: 20 breaths per minute, Weight 63 kg Height: 1.63 meters, BMI 23.7 kg / m2, skin: normal, oropharynx: no oral mucosal congestive semihumid, heart rhythm, no murmurs, lungs breath sounds preserved, not superadded noise, abdomen soft, depressible, painless to superficial or deep palpation, lymph nodes: BTE lymphadenopathy. Therefore reference is made by the clinic antecedent diagnosis of HIV / AIDS (rapid test) positive at the General Hospital Puyo; where it is consulted, adequate assessment of the background especially sex life finding risk factors is done to sexually transmitted infections, so rapid test is performed (chromatography) on two occasions for HIV / AIDS positive result. Following this request to the Confirmatory test (WESTERN BLOT), where positive research reports antibody against HIV / AIDS. Operation is initiated to determine treatment and when the treatment antirrretroviral patient.