Medicina
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Item 100 AÑOS DESPUÉS DE LA BCG, VACUNAS VIVAS ATENUADAS FRENTE A LA TUBERCULOSIS(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2024-09-24) Freire-Bravo, Milena Thais; Echeverría Valencia, Gabriela FernandaBackground: For more than a century, the BCG vaccine, derived from an attenuated strain of Mycobacterium bovis known as bacillus Calmette-Guérin, has been used to prevent tuberculosis (TB). Despite its widespread use, the effectiveness of the BCG vaccine is variable, and its protection is transitory. Objective: To compile information on the feasibility and effectiveness of new live attenuated vaccines as alternatives to the BCG vaccine in the prevention of tuberculosis. Methods: A bibliographic review of descriptive scope was carried out, using articles specialized in medical, nursing and epidemiology topics from the last two years (2022-2023), the search was carried out autonomously in various databases. Results: In clinical trials and preclinical studies, various live attenuated, inactivated and subunit/adjuvant vaccines have shown potential to improve immunogenicity and protection against tuberculosis. Vaccines such as MTBVAC and RUTI are in different phases of clinical development, while others, such as M72/AS01E and H56, are in advanced phases of testing. Conclusions: The invasion of M. tuberculosis can culminate in bacillary dissemination to other vital organs; it is crucial to develop more effective vaccines for adults and optimize vaccine combinations, addressing the genetic variability of the strains and immunological differences between populations. Currently, research into vaccines against tuberculosis reflects notable progress and an increasingly deep understanding of immunological interactions.Item “Abdomen agudo obstructivo secundario a íleo biliar”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-05-01) Jiménez Espín, Galo Paúl; Pozo Mayorga, Fernando PatricioDr. Esp.Gallstone ileus is a serious condition due to not being diagnosed opportunely caused by the migration of a stone to the intestinal lumen through a biliary fistula being a rare cause of acute obstructive abdomen representing 1% to 4% of cases. Mortality rates of between 12 to 27% and morbidity of up to 50% have been described due to the critical state in which most of these patients are found (3). A 72-year-old male patient presents with generalized abdominal pain of great intensity without apparent cause of 5 days of evolution and nausea that reaches content vomiting. In pharmacy they prescribe paracetamol and hyoscine bromide without improvement. Physical examination: BP: 110/60 CF: 84X', BF: 20X', ° T: 36.5 °, O2: 84% Weight: 56kg. Patient awake, obeys verbal orders, semi-humid oral mucous membranes. Cardiovascular: rhythmic, normofonetic heart sounds, no murmurs are heard. Respiratory: decreased vesicular murmur, presence of rales in both lung bases. Abdomen: distended, painful to superficial and deep palpation Blumberg (+), increased tympanic percussion and decreased hydro-aerial sounds with metallic tone. Laboratory and imaging tests were requested: leukocytes13600, hemoglobin 21.4g / dL, hematocrit 75%, platelets 358000, neutrophils 88.3%, lymphocytes 6.6%. Urine: bacteria +++, pyocytes 15-18xc, red blood cells 1-2xc. Abdominal ultrasound: Gallbladder inside it is observed multiple lithiasic images, in addition to important dilation of bowel loops with fluid and peristalsis of fight. Abdominal x-ray: intestinal dilation and presence of hydro-aerial levels. Hydration, antibiotic, and laparotomy are started by finding the jejunum and ileum dilated with a +/- 5cm long by 3cm diameter, before which we decided to extract more primary raft of the ileum. He remains hospitalized for 7 days and evolves without complications.Item Abdomen Agudo Obstructivo Secundario A Tumor de la cola del Páncreas(2016-09-01) Valle Proaño, Christian Andrés; Yépez Yerovi, Fabián Eduardo Dr. Esp.The following case is a male patient 67 years old, mestizo, catholic religion, born and living in Ambato (Pishilata), painter occupation, incomplete higher education; Family history Pathological father died with pancreatic cancer; Personal history Pathological Parkinson's disease 11 years ago; Pathological history Surgical Prostatectomy 5 years. Go to present about 72 hours ago epigastric pain, cramping of mild to moderate intensity that radiates to the right flank and left shaped belt accompanied with widespread decay, so go to Mobile Hospital where he administered antibiotic therapy not specified, probable diagnosis of acute diarrheal disease without showing clinical improvement, 24 hours before admission, the patient persists with abdominal pain of great intensity accompanied postprandial vomiting on three occasions in moderate amount of food and bilious content as well alteration of intestinal habit prone to constipation, so go back to Mobile Hospital who you refer to Provincial Teaching Hospital Ambato (HPDA). In the emergency service received HPDA patient with TA 100/60 mmHg FC: 108 lpm FR: 35 rpm, 96% O2 Sat, aware, no fever, dry oral mucosa, preserved cardiopulmonary, tense abdomen distended and painful epigastric mesogastrio, with increased bowel sounds, no signs of peritonitis, no limbs edema, tremor in the upper extremities, distal pulses present at the entrance to the surgery department with presumptive diagnosis of obstructive acute abdomen is decided. Having assessed the patient decides to perform a Laparotomy Exploratory meeting free fluid inflammatory abdominal cavity, erythematous bowel loops and dilated from the first jejunal loops to the angle of Treitz and duodenum, is also a tumor in the tail of the pancreas was found irregular edges, well vascularized, enlarged spleen, performing pancreatectomy Distal and splenectomy hard consistency, remaining hospitalized in the Department of Surgery at later presented a pancreatic fistula low spending the same which was controlled and had an evolution favorably so within 30 days of hospitalization is decided hospital in good general conditions for outpatient control. The histopathologic result was a lymphangioma tail of the pancreas.Item Abdomen Agudo por Absceso Tubárico Secundario A Enfermedad Inflamatoria Pélvica más Apendicitis Aguda(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-11-01) Guamancuri Silva, Jorge Gabriel; Pozo Mayorga, Fernando Patricio Dr. Esp.At the Hospital Provincial Docente Ambato (HPDA), the acute abdominal pain is the most frequent cause of query. In the Hospital Provincial Docente Ambato (HPDA), acute abdominal pain is the most frequent cause of consultation. By the other hand, the Gíneco-obstetric pain constitutes the second cause of hospitalization, being in this way the Emergency Service the first contact with the patient. For this reason, is really vital to know about the different pathologies which causes the acute abdomen, and so confront them in the better way. Likewise, it is crucial to determine the first instance if it’s about of a quirurgic acute abdomen and if it needs immediate hospitalization. The most important factor in this situation, because of our environment, is discard a pregnancy at the beggining of the evaluation in a female patient. Considering the possibility of a broken ectopic pregnancy that could turn it in a death or life event, becomes essential. The opportune pelvic acute ache diagnosis is vital, at the first instance, because the delay in the diagnosis increases in a devastating proportion the mortality, and consequently, the recovery time for the patient, the inherent economic spending, and even, in these time too hostile with the medicine career, because of the legal demands.Item Abdomen Agudo Quirúrgico Secundario a Rotura Uterina por Legrado Inducido(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Chango Silva, Margarita Fernanda; Pancho Zela Dr., Marlon MauricioIntroduction. Abdominal pain is a complex, sometimes difficult to diagnose and one of the most frequent causes of consultation in emergency services entity, and it is for all medical meet its features to quickly determine the conduct to be followed, since its timely decision may depend on the outcome of the patient. The clinical signs and symptoms are varied and depend on the etiology. In our case report the cause of acute abdomen was the same uterine perforation that may be iatrogenic or spontaneous. Iatrogenic causes include procedures such as dilation and curettage. Spontaneous causes are less commonly responsible for uterine perforation. Given the severity of the disease it is very important to study the female population to prevent irremediable complications in the patient. Objective. Evaluate the clinical management of patients with acute abdomen secondary to surgical uterine perforation. Development. This case is a female patient 26 years of age diagnosed incomplete abortion from 10 weeks pregnancy about concerns that perform curettage twice a week after you have perforativo peritoneal syndrome so go to hospital IESS Riobamba, there perform additional biochemical and imaging test, so is diagnosed with acute abdomen possible uterine rupture, and perform emergency surgery. He later transferred to Hospital IESS Ambato where he is transferred to Ambato IESS Hospital where he is admitted to the intensive therapy during hospitalization is relaparotomy, develop favorably. Conclusions. The acute abdomen secondary to uterine perforation, is a box that requires a proper diagnosis and an immediate resolution because it is at risk the life of the patient. In our case report the clinical management was not entirely appropriate.Item Abdomen Obstructivo Secundario a Herniación Inguinal(2016-12-01) Medina Aguilar, Mireya Andrea; Pozo Mayorga, Fernando Patricio Fernando Patricio Dr.The following case raised in the Provincial General Hospital of Latacunga. It relates about a 78 years old male patient, in which it shows continuum pain at an inguinal level with an evolution of 24 hours approximately. The frame is accompanied with the inability of ambulation, for this reason the patient attends the physician. The initial physical examination shows pain when performing the palpation at an inguinal region level, besides it can be palpated non reducible mass in the same place with solid consistency. The laboratory examinations are performed with normal results, however the image examinations are altered and show a gaseous pattern that suggest an acute abdomen of obstructive kind. The patient is urgently taken to the operations room, determining a peritonitis which requires a Bogota bag to be constructed. 48 hours later, a cavity washing is performed including its closure. Yet, the patient presents a lousy evolution which requires him to be taken once again to the operations room where it can be evidenced a perforation of the small intestine bail which does resection and ileostomy, later, it is complicated by the respiratory system with a frame of dry cough. In the image examination it can be seen the presence of infiltrators at a base level which are added to the nosocomial pneumonia pathology. The patient is transferred to tertiary level attention for its treatmentItem ABLACIÓN ENDOMETRIAL POR RADIOFRECUENCIA PARA EL TRATAMIENTO DE SANGRADO UTERINO ANORMAL REVISIÓN BIBLIOGRÁFICA(2025-06-13) Guanin Choco, Maria de los Angeles; Salgado Oviedo, Gabriela Socorro; Universidad Técnica de Ambato / Facultad de Ciencias de Salud / Carrera de MedicinaThis systematic review aims to evaluate the effectiveness, safety, and acceptability of radiofrequency endometrial ablation (RFA) for the treatment of abnormal uterine bleeding (AUB). The study focuses on the comparison of RFA with other techniques and includes a search in databases such as PubMed and Scopus, as well as Google Scholar. The inclusion criteria were articles that addressed RFA for AUB, presented or synthesized scientific evidence on its efficacy, safety, or patient satisfaction, and did not limit themselves to technical aspects of the procedure. The results showed that RFA is an effective and safe treatment for AUB, with a rapid recovery and reduced need for additional surgery. However, it is associated with side effects such as pelvic pain, infection, and uterine perforation. The study also highlights the importance of considering patient preferences and clinical variability when choosing the best treatment for AUB.Item Abordaje del paciente con abdomen abierto. Revisión de la literatura(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-10-04) Villagomez Mayorga, María Paula; Cadena Baquero, Juan CarlosIntroduction: The catastrophic abdomen is a situation in which the abdominal cavity is open, the edges are retracted and compressed into a single set of fibrous tissue that prevents its adequate dissection with the presence of fragile loops of small intestines adhered to each other, often complicated with enterocutaneous or enteroatmospheric fistulas that are associated with a high degree of morbidity and mortality close to 40%, thus conditioning the quality of life of the patient. Management represents a challenge for the surgeon since it requires a multidisciplinary approach, especially in the ICU, and, in most patients, it is necessary to combine complex therapies. Treatment usually begins with a conservative approach that avoids the risks of major surgery. Objective: To critically analyze the updated scientific evidence on the open abdomen as a surgical technique. Material and methods: The theoretical support of this work is obtained by research and analysis of specialized consultation documents such as scientific articles, magazines, books, and additional physical and virtual documents through search engines and medical bibliography databases. Conclusions: The clinical approach focuses on hemodynamic stabilization of the patient, avoiding malnutrition and rational use of antibiotic therapy; while the surgical approach seeks adequate closure of the abdominal wall, for which several temporary and definitive closure techniques have been developed; however, neither is the gold standard for treatment, and the lack of definitive data makes it necessary to individualize its use in each patient.Item “Absceso Perirrenal”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2015-11-01) Vargas Pérez, Noemi Guadalupe; Gallegos Ponce, Carlos Elias Dr.Se realizó el análisis de un caso clínico, de una paciente femenina de 60 años de edad, sin antecedentes clínicos, alérgicos y quirúrgicos de importancia, que desde hace 1 año presenta dolor constante localizado en la región lumbar de moderada intensidad, el mismo que se intensifica hace 1mes, con irradiación hacia flanco izquierdo e hipogastrio, se acompaña con polaquiuria y tenesmo vesical, por lo que acude a casa de salud de atención primaria, donde es manejada con Nitrofurantoina 100mg QD por 15 días, hace 24 horas acude al servicio de Emergencias del Hospital Regional Docente Ambato, con dolor intenso a nivel lumbar. Al examen físico T/A 130/70mmhg, FC82 lpm, FR 20 rpm, álgica, abdomen suave muy doloroso el flanco izquierdo e hipogastrio, puntos ureterales superior, medio y puño percusión izquierda positiva. Exámenes complementarios: leucocitosis de 12810 segmentados 91.8%, EMO no infeccioso, ECO renal litiasis renal izquierda + presencia de masa renal. Paciente es hospitalizada y valorada por especialidad quien indica manejo clínico quirúrgico, siendo tratada con Ciprofloxacino 200mg IV c/12h. Se completa estudio con TAC simple y contrastada que es sugerible de absceso perirrenal izquierdo + masa suprarrenal izquierda. 22 días posteriores paciente es intervenida quirúrgicamente, dentro de los hallazgos encontrados se describe riñón izquierdo con presencia de líquido supurativo el cual es drenado y se procede a la colocación de drenaje, a nivel suprarrenal se evidencia masa + hematoma el mismo que es enucleado. Postquirúrgico: Ceftriaxona 1g IV c12h, Acido Tranexamico 1 ampolla c/6 h, Ácido ascórbico 500 mg IV c12h, Tramadol 100 mg IV c/8h. Reporte diario de cuantificación de drenaje es mínimo, paciente asintomática es dada de alta médica con Ciprofloxacina 500 mg VO c/12h con el debido seguimiento clínico.Item Absceso Esofágico Secundario a Ingesta de Cuerpo Extraño en Paciente Adulto Mayor(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Silva Rodríguez, Luis Ramón; Vilaña Icaza, Juan Carlos Dr. Esp.The ingestion of foreign bodies is very common in everyday medical practice, constituting the second indication of emergency upper gastrointestinal endoscopy after gastrointestinal bleeding. In children is more frequent intake of inorganic foreign bodies and these round and blunt (coins, buttons, batteries, parts of toys), rather than sharp; however, in adults organic foreign bodies are the most common (poorly chewed food bowls, bones, fish bones). One of the complications of foreign body ingestion (Fishtail) can be INTRAMURAL esophageal abscess is a rare disorder characterized by a large laceration between mucosal and submucosal layer of the esophageal wall without drilling. They are also responsible for 7 to 14% of all esophageal perforations, which can lead to serious injuries such as neck deep abscesses, mediastinitis among others. This case is a female patient 75 years old with a history of diabetes mellitus type two. Refers back to the accidental ingestion of Fishbone, 48 hours, presents dysphagia and neck pain of moderate intensity, go to sub-health center where it is valued, and they decide to transfer to conducting imaging study. It is valued in emergency, irritable patient, algica, physical examination presence of clots level oropharynx is evident, further examination which report a high glycemia, leukocytes with deviation to the left, elementary and microscopic examination of urine, infection is performed. In cervical spine x-ray foreign body in esophagus projected level 6. cervical vertebra seen its entry into service of Internal Medicine is decided, by apparent box esophageal abscess, esophageal perforation and decompensation of their underlying disease and to complement other tests. reporting chest tomography us morphology of the esophagus is distended in almost all their passage predominantly performed above level - carinal, study suggests supplementing with upper endoscopy, the same as reported ESOPHAGEAL Abscess.Item Absceso Esofágico Secundario a Ingesta de Cuerpo Extraño en Paciente Adulto Mayor(2016-10-01) Silva Rodríguez, Luis Ramón; Vilaña Icaza, Juan Carlos Dr. Esp.The ingestion of foreign bodies is very common in everyday medical practice, constituting the second indication of emergency upper gastrointestinal endoscopy after gastrointestinal bleeding. In children is more frequent intake of inorganic foreign bodies and these round and blunt (coins, buttons, batteries, parts of toys), rather than sharp; however, in adults organic foreign bodies are the most common (poorly chewed food bowls, bones, fish bones). One of the complications of foreign body ingestion (Fishtail) can be INTRAMURAL esophageal abscess is a rare disorder characterized by a large laceration between mucosal and submucosal layer of the esophageal wall without drilling. They are also responsible for 7 to 14% of all esophageal perforations, which can lead to serious injuries such as neck deep abscesses, mediastinitis among others. This case is a female patient 75 years old with a history of diabetes mellitus type two. Refers back to the accidental ingestion of Fishbone, 48 hours, presents dysphagia and neck pain of moderate intensity, go to sub-health center where it is valued, and they decide to transfer to conducting imaging study. It is valued in emergency, irritable patient, algica, physical examination presence of clots level oropharynx is evident, further examination which report a high glycemia, leukocytes with deviation to the left, elementary and microscopic examination of urine, infection is performed. In cervical spine x-ray foreign body in esophagus projected level 6. cervical vertebra seen its entry into service of Internal Medicine is decided, by apparent box esophageal abscess, esophageal perforation and decompensation of their underlying disease and to complement other tests. reporting chest tomography us morphology of the esophagus is distended in almost all their passage predominantly performed above level - carinal, study suggests supplementing with upper endoscopy, the same as reported ESOPHAGEAL Abscess.Item ABSCESO HEPÁTICO COMO PRECURSOR DEL CÁNCER COLORRECTAL(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2024-06-07) Amores Alvarez, Lissette Aracely; Cevallos Teneda, Andrea CarolinaPyogenic cryptogenic liver abscesses (HA) have been called precursors of colorectal cancer (CRC). The importance of the relationship between these pathologies resides in the diagnosis and early treatment of cancer, so the investigation of the underlying causes of the development of cryptogenic liver abscesses is required. The objective of this review was to expose the studies that show the prevalence of AH as a preceding sign of CRC, from which a range of 1.9 to 13.9% was identified, according to studies of Asian populations. The location, number, and symptoms of AH did not show a specific relationship with the intestinal pathology, while diabetes mellitus and the presence of klebsiella pneumoniae were the incident factors in most CRC cases. One of the mechanisms identified was bacterial translocation from the altered intestinal wall, the pathogenesis of the microorganisms involved, and immunocompromised states. Together, these factors determine the development of liver abscesses as precursors of colonic neoplastic processes.Item “Absceso Hepático por Cándida”(2015-11-01) Sotalín Tonato, María Belén; Mejía Ortiz, Ruth Aurelia Dra.Se realizó el análisis del caso clínico con el objetivo de identificar los factores predisponentes del absceso hepático por Cándida en un niño que acude al Hospital IESS Ambato por presentar dolor abdominal de 9 días de evolución localizado en hipocondrio derecho, nausea que llega al vómito por 3 ocasiones, y alza térmica no cuantificada. Al examen físico paciente en regulares condiciones generales, taquicardico, abdomen suave, depresible, doloroso a la palpación en hipocondrio derecho, Murphy positivo, hepatomegalia 2 cm por debajo del reborde costal. Paraclínica al ingreso muestra: Biometría Hemática (leucocitos 12.2 x 103/uL, neutrófilos 73%), PCR 48 mg/L, Coproparasitario (PMN 12-15 x campo), ECO reporta absceso hepático en lóbulo izquierdo de aproximadamente 54 cc de volumen. Se ingresa al paciente con diagnóstico de absceso hepático, tratado con Ceftriaxona 1.5 gr IV C12h + Metronidazol 350 mg IV C8h, se realiza drenaje de absceso, cultivo y antibiograma de secreción que reporta positivo para Cándida Albicans, razón por la cual se añade antifúngico (fluconazol 210 mg IV QD) se solicitó cuantificación de CD3 CD4 CD8 e índice CD3, CD8 encontrándose en valores normales. Y cuantificación de inmunoglobulinas, reportando IgA e IgG disminuidos que evidencian una alteración de la inmunidad humoral, probablemente una inmunodeficiencia transitoria. Se decide el alta al décimo día de tratamiento y octavo día postdrenaje para completar esquema de tratamiento ambulatorio. A los 30 días del alta se realiza nuevo eco de control que reporta absceso en etapa de resolución favorable.Item “Absceso hepático y esplénico secundario a apendicitis aguda”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-05-01) Reinoso Torres, Lizeth Carolina; Guanuchi Quito, Franklin Hernan Dr. EspWe present the case of a male patient of 15 years of age, with a surgical history of grade II appendicitis resolved 1 month ago on the day of admission, go to the emergency service, presenting abdominal pain of 7 days of evolution, add boost non-quantifiable thermal, cough that does not mobilize secretions, chills, went to a private doctor 4 days ago who prescribes antipyretic treatment and discharge with medication, improvement picture however 2 days ago it presents thermal rise not quantified, yellow skin, upper abdominal pain so they go to this health house. Physical examination at admission: TA: 91/49; FC: 120; FR: 28; SO2: 92%, temperature 36.8 ° C; General Appearance: Algico, jaundiced, conscious, oriented patient, Glasgow scale15 / 15. Mouth: dry oral mucosa; skin: icteric dye; heart: hyperphonic noises, no murmurs; lungs: diminished vesicular murmur in right lung base; abdomen: soft, depressible, painful on palpation, positive blumberg, liver palpation 2 cm under the costal margin; lower extremities: multiple petechiae, patient is operated on the following day approaching an exploratory laparotomy evidencing yellow inflammatory fluid approximately 600cc in suprahepatic and perihepatic space and 300 cc in perisplenic space, placing drainages; due to the septic and hemodynamic condition, patient enters the Intensive Care Unit, 17 days after admission, hepatic abscess is seen in segment VI on Computed Tomography, performing percutaneous drainage; on the second day after drainage, new abscess is evidenced in segment VII of 14cc , total of 6 percutaneous drainages, plus abscess culture reports Pseudomonas aeruginosa, presents complications of a subconjunctival hemorrhage, hypoacusis due to possible drug ototoxicity, patient is transferred to the surgery service where it ends with antibiotic scheme, presenting favorable clinical evolution is discharged to the month 4 days and control with treating doctor in outpatient clinic.Item “Absceso pancreático secundario a pancreatitis aguda”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-10-01) Chamorro Barona, David Enrique; Guanuchi Quito, Franklin Dr. Esp.Pancreatic abscess is a circumscribed collection of pus, with little or no necrotic content. It is usually a complication of severe pancreatitis, four weeks after the onset of symptomatology, product of necrosis with subsequent liquefaction of tissue and secondary infection, constituting the abscess, and located in the vicinity of the affected organ. The symptomatology is non-specific, so the finding of gas is the only specific radiological sign, and percutaneous bacteriology is the only method to confirm the diagnosis in the preoperative period. Translated with www.DeepL.com/TranslatorWe present the case of a male patient of 27 years old, who was treated in the emergency service of the Ambato General Teaching Hospital for abdominal pain, which was catalogued as surgical problem, an exploratory laparotomy was performed, finding steate necrosis on the epiplon, and purulent collections on the pancreas’s tail and body, as well as purulent fluid on retroperitoneum. The abscess was drained and 3 drainages were put, 2 of the, on epigastrium and the last one on the left parietal-colic slide, the patient was also treated with broad spectrum antibiotics. The present work pretends to identify the critical points of the attention, proposing a therapeutic and diagnostic strategy for the management of severe pancreatitis and complications.Item Absceso Pulmonar por Klebsiella Pneumoniae(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Valverde Tixilema, Jairo Marcelo; Sunta Ruiz, Mario Leopoldo Dr.Lung abscess caused by Klebsiella pneumoniae usually due to aspiration of infected material from the upper respiratory tract, in immunosuppressed patients often complicated with abscess formation. They are usually caused by anaerobic bacteria and is often associated with periodontal diseases, sometimes multiple germs acting synergistically involved. This case concerns a 48-year-old born and lives in Simiatug Province of Bolivar, female, married, indigenous, farmer, illiterate, Catholic, unknown blood type. With a history of pulmonary tuberculosis diagnosed BK + 9 years apparently completed treatment. Patient comes for a cough and hemoptysis. Family of patient complains that makes it about a month has dry cough of great intensity and frequency which evolves into coughing that mobilizes secretions yellowish, fetid with traces of blood very difficult elimination which produces dyspnea on moderate effort to clinical accompanied, chills, hyporexia, hike ends unquantified and asthenia. Presenting clinical picture is exacerbated dyspnea with minimal effort the same as the passage of time evolves orthopnoea whereby the patient in a bad condition decides to go to a nursing home. In reviewing devices and systems it has a weight loss of approximately 15 kg in a month because of reduced food intake. Physical examination shows: Blood Pressure: 90/60 mmHg, heart rate: 80 beats per minute, respiratory rate 24 per minute, axillary temperature: 370C, Sat O2: 70%. conscious, oriented, hemihydrate, afebrile patients cachectic dependent oxygen by nasal cannula, dry skin, normal color hypoelastic, Glasgow 15/15, average overall. Head: normocephalic, hair normal implantation, Eyes: isochoric pupils normorreactivas light Nose: nasal septum no deviations, normal implantation Ears: normal implantation, External Auditory Canal: permeable, Mouth: no injuries, wet and pink oral mucosa, teeth in poor condition, remains sputum yellowing of fetid odor, oropharynx observed: no failure, Neck: symmetrical, thyroid OA, Thorax: domed in left hemithorax, mobility and expandability decreased, not nodal chains are palpated, decreased adipose tissue, Heart: rhythmic heart sounds no murmurs Lungs: abolished based vesicular murmur and middle third pulmonary right field, increased vocal vibration in right lung field, Abdomen: no lesions are seen, soft painless pitting on palpation, noises hydroaerial: present, Tips: symmetrical, preserved tone and strength, presence of edema ++ / +++ which leaves fovea.Item “Absceso retroperitoneal como complicación de apendicitis aguda”(Medicina, 2018-10-01) Chaglla Alomoto, Alexandra Pamela; Viteri Llerena, Wilian Geovanni.Dr. Esp.Acute appendicitis is the most frequent cause of acute abdomen and represents one of the most common emergencies that a surgeon faces. It occurs, generally, in patients between the second and third decades of life, being less frequent in the extremes of life. The estimated risk to present this pathology is between 7 and 8%. According to the INEC, in 2017, 38,533 cases5 of acute appendicitis were recorded in Ecuador, representing a rate of 22.97 cases5 per 10,000 inhabitants, thus being the first cause of morbidity in the country. Currently the treatment of choice is surgical, there is a high risk of perforation and peritonitis especially in cases of delay in diagnosis and appropriate treatment; there is controversy about the correct treatment for an acute appendicitis that develops abscess or phlegmon. The following, a male patient of 51 years of age, presented with abdominal pain, 8 days prior to admission of moderate intensity, 7/10 on the visual analog scale, that start in the epigastrium accompanied by nausea, fever, does not decrease with the intake of food, vomiting, deposition, urination and decubitus, self-medicated scopolamine butylbromide, without decreased the syntomatology on the third day goes to a private doctor,administring intravenous ceftriaxone 1g (IV), gentamicin 160 mg IV, single dose, ciprofloxacin 750 mg BID; until the day of admission without yielding pain. Until the day of admission present a pain that is located in the right iliac fossa, so he goes to this health house where he performs ecosonography (09/26/2017) which reports: biliary mud in a small amount, suggestive of appendicular plastron, TAC simple and contrasted abdomen and pelvis (09/26/2017) that reports: intraperitoneal abscess located in the right iliac fossa with extension to the flank and hypochondrium on the same side, volume approximately 300, with an increase in the density of mesentery fatty tissue suggestive picture of perforated appendix. Pathology that was resolved with three surgical interventionsItem “Accidente cerebrovascular isquémico: infarto de tallo cerebral”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-05-01) Carrillo Bayas, Andrés Daniel; Córdova Peñaloza, OpilioDr. Esp.The Ischemic Stroke represents the third cause of death, the first cause of physical disability and the second cause of dementia in adults. Annually an estimated 15 million people in the world suffer a stroke, of these, five million die and another five suffer a permanent disability, which has a very significant impact on families and society. Ischemic stroke is the clinical syndrome that is characterized by symptoms and / or focal signs that develop rapidly, sometimes with global loss of brain function, lasting more than 24 hours, with no apparent cause other than a vascular origin due to obstruction or occlusion arterial. The probable reasons for this deterioration include the extension of the thrombus, the failure of the substitution of collateral circulation, and the progression towards arterial occlusion. The presence of hypotension due to cardiac compromise, or the increase in blood viscosity due to dehydration, can aggravate ischemic stroke and increase patient deterioration. The adequate initial care of these patients allows reducing the morbidity and mortality and sequelae associated with this pathology. Two clear phases are distinguished: 1) Prehospital and 2) Hospitable during the first hour. The knowledge of Controllable or treatable Risk Factors and the non-treatable ones; This starts from the daily practice in hospitals and primary care centers, as well as patients with neurological sequelae due to a Stroke caused by the lack of adequate control. xii The present Clinical Case Analysis was developed through a descriptive investigation based on Epidemiology and Public Health, reviewing the Clinical History of a patient with Ischemic Stroke: Cerebral Stem Infarction of the General Ambato Teaching Hospital of the Intensive Care Unit.Item Acción inmunomoduladora de los micronutrientes en pacientes adultos con enfermedades infecciosas(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-07-04) Tapia Chaguamate, Erika Alexandra; Zabala Haro, Alicia MonserrathThe present narrative review aims to describe the role of micronutrients and their relationship with the immune response in the adult individual to characterize their site of action, function and impact on their effectiveness. Micronutrients are considered elements with a minimum proportionality in the daily nutritional requirements, however, their significance goes beyond their numerical value since it plays a leading role as metabolic, biochemical and immune mediator. The maintenance and performance of natural and cellular immune function have been correlated with elements such as vitamin C with antioxidant action, vitamin D cell migration and neutrophilic, Zinc lymphocyte receptor expression for an effective cellular response, sulforaphane proinflammatory action, quercetin induction of phase II antioxidant enzymes,antiviral agent by inhibition of lipid peroxidation and platelet aggregation. It is pertinent to provide optimal levels of trace elements through a balanced and diverse diet and avoid falling into deficiency states that diminish the immune system's effectiveness.Item ACETATO DE ULIPRISTAL EN EL MANEJO DE LA MIOMATOSIS UTERINA SINTOMÁTICA. UNA REVISIÓN BIBLIOGRÁFICA(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2024-06-07) Aleaga Gavilánez, Jorge David; Belalcázar Sánchez, Yajaira MonserrathObjective. To perform a literature review on the use of ulipristal acetate (UPA) in the management of symptomatic uterine myomatosis. To evaluate the efficacy and safety of the drug, in order to avoid serious adverse effects such as liver failure. Methods. We collected scientific articles performed in symptomatic women with uterine myomatosis undergoing management with UPA. The search was carried out in high impact databases such as PubMed, Taylor&Francis, Springer, Elsevier, etc. At the conclusion of the search and based on the eligibility criteria, only 39 articles met the inclusion criteria and were selected. Results. According to the studies analyzed, the 14 articles present favorable results in relation to the improvement of symptoms and quality of life of the patients, since it was possible to control uterine bleeding, raise hemoglobin levels, reduce the size and volume of the fibroids, without presenting any serious effect that would lead to the interruption of the treatment. Only one study identified nine cases of severe liver damage, of which five cases ended in liver transplantation and the others reported resolution of the liver injury after discontinuation of treatment. Conclusion. The use of UPA is considered an effective treatment in this pathology. The serious adverse effects shown in the studies proved to be inconclusive because the presence of liver injury or elevation of transaminases prior to treatment was demonstrated. However, new recommendations for the use of the drug were published.