Ciencias de la Salud
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Item TRATAMIENTO ANTICOAGULANTE EN PACIENTES CON FIBRILACIÓN AURICULAR Y ENFERMEDAD RENAL CRÓNICA(2025-06-16) Oñate Gutiérrez, Alan Daniel; Sánchez Salazar, Nelly Alexandra; Universidad Técnica de Ambato / Facultad de Ciencias de Salud / Carrera de MedicinaIntroduction. Atrial fibrillation is the most common arrhythmia characterized by premature atrial beats, causing ineffective atrial contraction and promoting thrombus formation. It is associated with chronic kidney disease, where a prothrombotic and prohemorrhagic state coexists, further increasing thromboembolic risk. Treatment with oral anticoagulants is key to preventing thromboembolic events. Objective. To analyze the clinical benefit of oral anticoagulant therapy in patients with non-valvular AF and advanced CKD. Methodology. A bibliographic review was conducted in the MEDLINE/PubMed, Scopus, and ScienceDirect databases. The review included articles published in the last 5 years, open access, and in English or Spanish. Results. The reviewed studies indicate the need to properly stratify thromboembolic and hemorrhagic risk. DOACs are the anticoagulant therapy of choice over warfarin, except in moderate to severe mitral stenoses and in patients with mechanical prosthetic valves. The recommendations and evidence for advanced CKD and dialysis are unclear, especially when CrCl <15 ml/min. Furthermore, factors that could influence therapy, such as the presence of polypharmacy and the assessment of renal function, should be considered. Conclusion. The evidence does not suggest a benefit of oral anticoagulant therapy in preventing thromboembolism in patients with advanced CKD, and alternative non-pharmacological therapies could be chosen.Item EFECTOS DEL EJERCICIO INTRADIALÍTICO SOBRE LA FUERZA MUSCULAR Y CAPACIDAD FÍSICA EN PACIENTES CON ENFERMEDAD RENAL CRÓNICA QUE RECIBEN HEMODIÁLISIS(2025-06-16) Armas Ingavélez, Melanie Samantha; Morales Solis, Jorge Marcelo; Universidad Técnica de Ambato / Facultad de Ciencias de Salud / Carrera de MedicinaIntroduction: patients with advanced stages of chronic kidney disease present a hypercatabolic state characterized by loss of body proteins, which has a negative impact on physical capacity and muscle strength, particularly in patients undergoing hemodialysis, leading to reduced quality of life and increased mortality. Exercise has been shown to improve muscle function in this population but remains underutilized due to safety concerns and lack of evidence. Methodology: we conducted a descriptive systematic review of cohort studies and randomized clinical trials published in the last 5 years in English or Spanish whose main intervention is intradialytic physical exercise was conducted. Results: thirteen studies were analyzed that described an improvement in physical and functional capacity of patients who were included in the intradialytic exercise groups, although changes regarding body composition were not significant. Conclusions: the implementation of structured and supervised exercise programs during hemodialysis can mitigate the adverse effects of prolonged inactivity, improve physical function, and ultimately improve the quality of life of CKD patients.Item Musicoterapia y ansiedad en pacientes en hemodiálisis.(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Centro de Posgrados, 2023-11-01) Avilés Peña, Daniel Armando Psicól; Vásquez de la Bandera Cabezas, Fabricio MScItem “Ülceras cutáneas en insuficiencia venosa en pacientes con falla renal crónica”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-06-01) Monge Riofrio, Christian Paul; Dr. Esp. Toapanta Yugcha, Iván GuillermoMale patient of 75 years of age, married, driver, born and resident of Coca, with a personal history of chronic renal insufficiency without treatment, venous insufficiency without treatment, arterial hypertension, without family, surgical or allergies. Patient is admitted to the surgery service from an outpatient clinic in the Coca hospital, since from 4 months he has pain in the lower limbs with a predominance of the right leg, of moderate intensity, as an apparent cause of having been in water at rest, as well as polyuria and nocturia from 3 months ago, it was accompanied by pruritus that ended up causing excoriations until reaching ulceration 3 months ago. To the patient physical examination consents, oriented, hydrated, FC 80, FR 20, systolic BP 120/80 diastolic mmHg, SO2 92% ambient air, T 37,6 C Skin and phantoms slightly pale, moist oral mucosal. Expandable, normal cardiopulmonary Thorax without added noises.Abdomen: Soft depressable painful to palpation in hypogastrium.Lower limbs: hyperpigmented skin Rots 2/5. Edema (++ / ++++) depression of up to 4mm and disappearance in 15 seconds that leaves no fovea with flushing and local heat, presence of ulcers in right leg in anterolateral side of lukewarm with purulent exudate of delimited edges excavated from granulomatous background. Exams: Ecodoppler of lower limbs reports chronic venous insufficiency. Blood chemistry reports creatinine of 3.36 mg / dl, urea of 81 mg / dl. Kidney echo and urinary tract: Kidney Right size and normal position of regular edges, homogeneous texture with increased echogenicity, several cystic images are visualized inside, small images of lithiasis are visualized towards its lower calyx of 0.60 cm not dilatation of the excretory duct. Left Kidney: retains its normal position, irregular contours increased its normal echogenicity, presence of renal cyst to its lower pole measuring 2.94 x 3.72cm, no dilation of its excretory system.Item “Embarazo en una paciente con enfermedad renal crónica en hemodialisis”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-05-01) Chango Tituaña, María de los Angeles; Guacho Guacho, Juan Sebastián Dr.Chronic kidney disease is seen in approximately 4% of women in the reproductive stage, and includes both primary renal diseases and secondary to a systemic disorder. However, the association of advanced chronic kidney disease (ACKD) in stage 5D and gestation is an infrequent event, with a variable incidence. (1) We present the case of a 26-year-old female patient with a personal history of untreated hypertension (HTA) and primary glomerulopathy, which led to renal failure in stage 5D diagnosed one year ago in three-week treatment with hemodialysis. Within her gynecological-obstetric history: family planning method, her menstrual cycles were irregular; previous deeds: two, masculine, live births, without complications; gesta 3: current unknown date of last menstruation (FUM). Patient goes to nephrology control with obstetric echo that reports pregnancy of 15.1 weeks. Change of hemodialysis therapy is indicated to 5 times per week and it is immediately referred to the gynecology and obstetrics service where it carries out pregnancy uptake and subsequently goes to 2 more controls. At 31.1 weeks of gestation, she went to prenatal control, referring to headache and edema at the level of the lower limbs. She is admitted to the Obstetrics-Gynecology service where she stays hospitalized for 26 hours and receives antihypertensive treatment, pulmonary maturation and later is transferred from emergency to third level with a diagnosis of: Pregnancy of 31.2 weeks by Extrapolated Echo + Chronic Hypertension + Preeclampsia Sobreañadida + HELLP syndrome. In the third level, pregnancy is terminated by means of an emergency caesarean section, obtaining a live male product, which remains for 27 days in the neonatal care unit after which it passes away due to sepsis of early origin due to Streptococcus pneumoniae