Ciencias de la Salud
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Item “Valores séricos de anticuerpos (igg) antitetánicos y su relación con el desarrollo de preeclampsia en mujeres embarazadas que cursan el tercer trimestre de gestación”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Laboratorio Clínico, 2019-08-01) Carrera Quizhpe, Darío Xavier; Arráiz de Fernández, Carolina Dra. Esp.The study of serum anti-tetanus IgG values is a new, innovative and very important research for the country because there are no previous studies on this subject. This project was carried out between the Ambato General Teaching Hospital, the Technical University of Ambato and the San Francisco University of Quito, whose main objective was to analyze the serum values of anti-tetanus IgG antibodies and establish whether the preeclamptic patients are fully immunized according to the scheme of the Ministry of Public Health of Ecuador. The type of research was exploratory because there are not enough previous studies in the country, it is also cross-sectional descriptive because the data of the demographic variables collected in a given period of time were analyzed on a predefined population or sample, since the objective was to verify the hypothesis proposed and to verify if there are protective titers of antitetanic IgG in pregnant women with preeclampsia. The study population was 73 preeclamptic patients who were in the third trimester of pregnancy, this sample was calculated by applying the sample size formula to obtain a proportion in a finite or known population. The results obtained in the present investigation through the ELISA test in the laboratory and Pearson's Chi-square Frequency Descriptive and Chi-square statistical estimators allowed us to know the most representative demographic variables in which preeclampsia and equals are more frequent. To corroborate that the titers of the antitetanic IgG are directly proportional to the time of placement of the last dose of the dT vaccine. It was concluded that the preeclamptic patients studied have anti-tetanus IgG titers in high concentrations with a mean of 86.31 IU, this being a high value and in turn protective against the infectious agent producing tetanus and confirming that patients are immunized..Item “Niveles séricos de anticuerpos anti-peroxidasa tiroidea (anti-tpo) en sujetos pediátricos con los trastornos del espectro autista (tea) y su correlación con los niveles séricos maternos”,(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Laboratorio Clínico, 2018-09-01) Poaquiza Gallegos, Lucía Elizabeth; Arraiz de Fernandez, Carolina Md. Esp.This research project was to determine and to correlate serum levels of anti-TPO antibodies in mothers of pediatric subjects with ASD and their children compared with controls which were mothers and their children with typical development. We analyzed serum levels of anti-TPO antibodies to check if there were a direct association with the development of ASD. Methodologically, it was used a descriptive cross-sectional and correlational analysis; doing the research in field and laboratory. We worked with 88 patients, of which 30 were pediatric subjects aged between 3 - 17 years of age with Autism Spectrum Disorders, their mothers, and 14 children with neurotypical development and their mothers, who underwent the quantitative analysis of serum levels of anti-TPO. The quantification of serum levels of anti-TPO was carried out using the test method of enzyme-linked immunosorbent assay (ELISA). For the correlation of serum levels of anti-TPO of ASD children and their mothers we use statistical methods of Odds Ratio (OR), and Pearson. The analysis determined that 100% of the pediatric subjects with ASD presented normal serum (values of less than 40IU/ml): 3.3% of the mothers of the pediatric subjects with ASD presented high serum levels of anti-TPO antibodies (greater than 40IU/ml). On the other hand the 7.1% of the mothers of children with typical development presented high serum levels of anti-TPO antibodies. The analysis of correlation (r) of anti-TPO antibodies serum levels in pediatric subjects with ASD and their mothers presented a Pearson´s correlation of 0.207. The correlation of anti-TPO antibodies serum levels in pediatric subjects with typical development and their mothers presented a negative very low Pearson´s correlation of –0.01. Concluding that the serum levels of anti-TPO antibodies of mothers has no correlation with the development of ASD.Item “Vasculitis de pequeños vasos con afectación renal”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2017-05-01) Escalante Amancha, María Fernanda; Guacho Guacho, Juan Sebastián Dr. Esp.Vasculitis is a group of systemic diseases characterized by inflammation of the blood vessels, thus determining the deterioration or obstruction of normal blood flow and damage to the integrity of the vascular wall. They can affect any type of vessel of the organism and the compromise can be of one or several organs or systems. The caliber of the blood vessel that can compromise, goes from great arteries (aorta and its main branches, temporal arteries); Medium vessels (muscular arteries); and small vessels (arterioles, capillaries and venules). Vasculitis associated with antibodies to neutrophil cytoplasm (ANCA) causes renal dysfunction predominantly due to severe inflammation with the presence of cellular growths in the glomeruli. The clinical manifestation of these diseases is due to the expression of ischemia in the tissues of the involved vessels, in addition to presenting fever, weight loss and general compromise of the state that frequently accompany systemic inflammation. The diagnosis is based on clinical manifestations, immunological studies and renal biopsy. The vast majority of patients with ANCA-associated vasculitis reach the control of the disease with immunosuppressive therapy, being important to perform an early onset in order to better the evolution and avoid complications. We present the case of an elderly male patient, with no significant pathological history. It is present for a three-month course of evolution due to anesthesia, anorexia, nausea that does not reach vomit and headache, a hospital center where it is attended to and shows microscopic hematuria plus leukocyturia, is interpreted as a urinary infection and starts treatment Antibiotic, As they have not improved the performance of laboratory tests in which they observe high azoles, and cataloging as a chronic kidney disease, so they decide to make a referral to a level II hospital, to the external consultation area of Nephrology. Patient due to its systemic manifestations, active urinary sediment in the absence of urinary infection and renal dysfunction of unaffiliated cause is suspected in an immunological disease with renal involvement, indicating immunological studies of antineutrophil cytoplasmic antibodies (ANCA) with a perinuclear pattern ANCA-P) positive, orienting towards vasculitis of small ANCA positive vessels.Item “Ictus en paciente jóven secundario a una valvulopatía mitral”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2017-04-01) López Ortega, Ana Gabriela; De La Cruz Puebla, Myriam Gricelda Dra. Esp.Stroke is defined as cerebral involvement (permanent or transient) secondary to ischemia or bleeding from damage to the blood vessels in the brain. The incidence of stroke is estimated at around 6-20 cases per 100,000 inhabitants per year. There are no epidemiological studies in Ecuador. In the young adult patient (15-45 years) is a rare but not exceptional entity being the first cause of disability and the second cause of dementia and death worldwide. In younger patients the disease causes a longer period of disability and condition in the quality of life. The prognosis is favorable, requiring an extensive and individualized study, assessing the presence of data that can guide and determine the etiology. Its importance is that when knowing the mechanism that causes this disease, it will be possible to carry out an adequate treatment and an effective secondary prevention. We report the case of a 30-year-old female patient with no personal history, a family history of a father with type 2 diabetes mellitus, a history of gynecological obstetrics 2, childbirth 1, and abortion 1, who presented with clinical manifestations of altered consciousness followed by neurological defficit of 7 hours of evolution. Physical examination revealed motor aphasia, right larval hemiparesis. A simple nuclear magnetic resonance imaging (MRI) scan was performed in which hypointense images were observed in the left parietal level and in the right thalamus where it was evident congruent with areas of acute infarction. During admission to the hospital, ANA, ANCA and LE cells were tested: negative; Serological for lues and human immunodeficiency virus (HIV): negative; Blood chemistry and blood count: normal; Coagulation times: normal; Blood gases: Normal, BHCG: negative; normal EKG, echocardiogram with a result of Severe mitral stenosis of possible rheumatic origin. We did not perform the cerebral vascular imaging test (Angiotac), toxicological that were not managed. Antiepileptic treatment with phenytoin 100mg 1 tablet VO QD was evaluated in the first week, showing relative remission. In the second week it starts with antiplatelet ASA 100mg VO QD until its egress. After analyzing the data obtained in the medical history, physical examination and complementary studies we conclude that we are in the presence of a stroke in a young patient and the cause is a highly embolic cardiomyopathy (severe mitral stenosis of rheumatic origin), which unfortunately was not detected early until it produced the neurological complication previously manifested.Item Insuficiencia Renal Asociada Poliangeítis Microscópica(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Velasco Chávez, Lenin Israel; Guacho Guacho, Juan Sebastián Dr. Esp.Microscopic polyangiitis (PAM) is a rare idiopathic autoimmune disease that by not granulomatous small or medium vessels, necrotizing systemic vasculitis associated with the presence of antineutrophil cytoplasmic antibodies (Anti-Neutrophil Cytoplasmic Antibodies, ANCA) is characterized with both pulmonary and renal involvement. (1) Cause renal dysfunction predominantly by severe glomerular inflammation and kidney failure. The diagnosis is based on clinical manifestations, the result of biopsies of lesions, the positivity of ANCA and justifying if a patient with systemic vasculitis of small vessels pauci-immune no evidence of necrotizing granulomatous inflammation or asthma. The vast majority of patients with ANCA-associated vasculitis reach the temporary control of the disease with immunosuppressive therapy currently available. (4) The case of a female patient aged 61 presented with a history of chronic renal failure of unknown cause in substitute treatment of renal function 6 months ago. With box frank hemoptysis accompanied by hemodynamic compromise associated with the presence of polyarthralgia several months of evolution, fatigue and weight loss. Physical examination lung auscultation highlights the presence of bilateral crackles disseminated. additional tests where severe anemia, increased bilirubin at the expense of indirect, in peripheral blood smear fragmentocitosis in lung CT scan showed alveolar hemorrhage is observed is performed. Given the history of renal failure of unknown cause associated with more anemia respiratory disorders hemolytic suspected in an immunological disease with both renal disease such as pulmonary, immunological studies antineutrophil cytoplasmic antibodies (ANCA) indicated these being positive with perinuclear pattern (ANCA P), moving towards small vessel vasculitis ANCA positive, manejándose as a microscopic poliangeítitis.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.Item Miastenia Gravis de Predominio Ocular(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Sánchez Sánchez, Joselyn Gabriela; Pérez Padilla, Carlos Alberto Dr.Myasthenia gravis is a neuromuscular disorder, autoimmune mediated by antibodies (Ac) decreasing the number of acetylcholine receptors at neuromuscular junctions leading cause regarded as disturbances thymus. Globally the annual incidence is 1-5 / 10,000 inhabitants, is predominant in women 21-39 and men aged 50 – 69. In Ecuador Are null epidemiological studies. It is characterized by progressive muscle weakness and fatigue that starts in eye muscles and if in 3 years is not associated with extraocular symptoms, 90% were not widespread. Its main classification is ocular and generalized MG triggers that can reach a myasthenic crisis with 4.4% mortality. The treatment begins with anticholinesterase short term, it continues with long-term corticosteroid (best alternative) and in a few cases are associated immunomodulators; while in severe forms plasmapheresis and IV Ig is used, in MG with thymoma is used thymectomy. The current forecast is promising. The case of a male patient of 20 years with no history who goes by more left eyelid ptosis and double vision, general weakness of 48 hours of evolution is presented. Physical examination is ptosis, bilateral horizontal nystagmus and paresis of cranial nerves IV and VI. We use neostigmine test: positive, mediastinal TAC without disturbances thymus, Ac ANA, ANCA and LE cells: negative. It is not used the repetitive stimulation test or single fiber electromyography due to lack of adequate equipment nor the AChR antibodies that were not managed are not made. It starts corticosteroid therapy with prednisone 20mg c / 8 hours evaluated at 2 weeks noticing relative remission. At 3 months comes back and inadvertently reduces the dose to 40mg / day for 1 month, further beneficial effect is maintained and no involvement of other muscle groups. It is concluded that the characteristic symptoms of ocular MG comprises ptosis, diplopia and nystagmus and established with specified clinical tests, and pharmacological, serological and electrophysiological analysis according to their sensitivity contribute to the diagnosis of ocular MG predominantly available in our environment and finally similar tables should be well differentiated.Item Determinación de Perfil Tiroideo y su relación con el Anticuerpo Antiperoxidasa Tiroidea en pacientes con Vitíligo(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Laboratorio Clínico, 2016-09-01) Viteri Haro, Gabriela Cristina; Cárdenas Ponce, Jorge Luis Dr.The determination of peroxidase antibodies and thyroid profile has been suggested in patients with Vitiligo knowing that there are other factors that can affect the levels of the hormones of the thyroid profile as well as, those of peroxidase in blood antibodies. The relationship that exists between these parameters and the Vitiligo is still dispute the few studies that exist in the Ecuador. For the study included 40 patients men/women aged 6 to 78 who were diagnosed with Vitiligo, the mean age of men was 42 years old, while in women it was 35-year-old. The samples entered the clinical laboratory, they were analyzed using the technique of Electroquioluminicencia TSH: sandwich, T3: competition, T4: competition and the results analyzed by ANOVA system. The age and gender did not differ significantly in the results of the samples analyzed. Mean ± standard deviation of serum TSH concentrations were 6.61 ± 5.04 UI and anti-TPO Autoantibodies were 139,05 ± 238,59 UI. The correlation between the two (TSH / Pearson = 17.17 TPO) was statistically significant (p = 0.0001), 19 patients (90.5%) of the positive anti-TPO had hypothyroidism. In the same way, only two (9.5%) were eutiroideos.