Medicina
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Item "Facomatosis tipo neurofibromatosis 1 o enfermedad de von recklinghausen en paciente pediátrico asintomático(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2019-10-01) Valle Ocando, Ana Karina; Paredes Lascano, Patricia Dra. Esp.Introducción: el término Neurofibromatosis (NF) abarca a un conjunto de enfermedades hereditarias incluidas en el grupo de facomatosis o patologías neurocutáneas, consideradas raras o huérfanas en nuestro país, que se identifican por la tendencia al desarrollo de neoplasias benignas a partir de estructuras derivadas del ectodermo. Tiene tres variantes, siendo la NF1, caracterizada principalmente por lesiones cutáneas y neurofibromas (tumores de origen nervioso), la más frecuente; la NF2, rara, con predominio de manifestaciones tumorales del sistema nervioso central y periférico sin lesiones cutáneas, y la NF3, la forma menos frecuente, que se distingue de los otros tipos por la presencia de tumores provenientes de las vainas nerviosas que se denominan schwannomas. Objetivo: Analizar el caso clínico de un paciente pediátrico asintomático con Facomatosis tipo Neurofibromatosis 1 o Enfermedad de Von Recklinghausen, en lo que concierne a su presentación clínica, diagnóstico, tratamiento y seguimiento, reportando las oportunidades de mejora para la identificación de Enfermedades raras o huérfanas en la Atención Primaria de Salud. Materiales y métodos: Caso clínico, análisis descriptivo y retrospectivo. Resultados: Paciente masculino de 9 años de edad, quien consultó para evaluación rutinaria como control de niño sano en el Hospital General Ambato–IESS. Durante su valoración se identificaron numerosas lesiones cutáneas generalizadas tipo máculas “café con leche”, así como efélides en región axilar, estableciéndose el diagnóstico de NF1 por presentar criterios clínicos de esta patología. Se le realizó estudios complementarios sin alteraciones hematológicas, mientras que en la resonancia magnética computarizada se evidenció lesión tipo neurofibroma localizado en bulbo raquídeo, confirmándose el diagnóstico. En la actualidad el paciente mantiene seguimiento por el servicio de pediatría y neurología. Conclusiones: La NF1 es una patología de presentación rara con una evolución benigna que por lo general no amerita tratamiento. No obstante, debido a las posibles implicaciones en la estética y funcionalidad del paciente se debe realizar diagnóstico precoz para hacer seguimiento adecuado tanto en Atención Primaria y hospitalaria como en especialidades. En consecuencia, posterior a establecer los puntos críticos en relación con el acceso a la atención médica, se caracterizaron las oportunidades de mejora en beneficio de futuros pacientes con sospecha o diagnóstico confirmado de NF1.Item “Angiomiolipoma renal con áreas epitelioides a propósito de un caso”(2019-10-01) Manotoa Santana, Erika Leonor; Guanuchi Quito, Franklin HernánDr. Esp.Introduction: The kidney tumors include various histological entities, from harmless cysts until very aggressive cancers. The kidney angiomyolipomas are uncommon entities that represent a challenge for diagnosis and management, classically the kidney angiomyolipomas hey have been considered as harmless neoplasms, however, two histological variants have been described, one of benign classic behavior and another epithelioid of aggressive behavior with difficult histological characterization and poor prognosis, which in 2004 was classified by the World Health Organization as potentially malignant neoplasms, which should be better studied. 1,2 Case Description: A 30-year-old woman, from the city of Ambato -Ecuador, , without a significant pathological history who presents with moderate abdominal pain and a note of increased volume in epigastrium and mesogastrium, imaging tests show the presence of mass in the left flank and hypochondrium shows fat density, The woman is admitted to the Surgery Service of the Regional Hospital of Teaching Ambato for a scheduled mass excision surgery and during the transoperative period it becomes a tumor excision + left nephrectomy. Histopathological study was received that reports lipomatous angiomyolipoma with epithelioid areas, patient is being monitored by external consultation of the entity, in stable condition, without the appearance of new lesions.Item “Quiste hepático gigante a propósito de un caso”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2019-10-01) Quelal Zurita, Alex Dario; Guanuchi Quito Dr. Esp., Franklin HernánTECHNICAL UNIVERSITY OF AMBATO FACULTY OF HEALTH SCIENCES MEDICAL CAREER “GIANT LIVER CYST” - Author: Quelal Zurita, Alex Dario. TUTOR: Dr. Esp. Guanuchi Quito Franklin Hernán Date: october 2019. SUMMARY Objective: To characterize the patients who present giant liver cysts and identify the possible complications that these present. Materials and methods: Retrospective descriptive study of clinical case analysis. Discussion: A case of a 41-year-old male patient with a very intense abdominal pain picture of a few days of evolution, located in the right hypochondrium, is reported. It is diagnosed as pancreatitis of biliary origin but after that, with pertinent studies the diagnosis of the presence of liver cyst that includes segments IV, V and VIII is reached, so drainage is done to remove it. Conclusions: The problems related to the present clinical case, as well as the literature review, are analyzed in this way, patients with giant liver cysts are characterized, as well as their management and possible complications.Item “Implicación del desarrollo de patologías metabólicas asociadas a obesidad grado III en una gestante”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2019-10-01) Vallejo Pasquel, Edison Patricio; Naranjo Naranjo, Doris Maricela Dra. Esp.A 38-year-old female patient with a history of multiparity, super-morbid obesity, 16-year-old intergenésic, ORh-cephalovaginal delivery prior to term. Upon admission, I accused of feeling of loss of vaginal fluid from a single pregnancy of 34 SDG, with ultrasound control that reports a decreased ILA and a single fetus, with an 8/10 biophysical profile, with weight over 99 percentile. Its initial management by APP and vaginosis is performed by antibiotic therapy and DMG is diagnosed. Re-enter the 38.2 SDG for contraction-type pain, when performing fetal monitoring, resuscitation-resistant fetal tachycardia is found, so termination of pregnancy is performed due to fetal well-being commitment. During his hospital stay he is assessed by intensive therapy due to tachycardia and desaturations, which are subsequently filmed to wound infection, cataloging as soft tissue sepsis performing several surgical cleanings achieving improvement of the picture. The patient is sometimes several procedures for wound dehiscence. The final endocrinological treatment is done with insulin at low doses without requiring an increase in new hospitalizations. In subsequent controls, it does not maintain adequate glycemic values despite the introduction of pharmacological and dietary measures to correct it.Item "Malformaciones congénitas en neonatos relacionadas con contaminación ambiental"(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2019-10-01) Rubio Ruiz, Sebastián Patricio; Zavala Calahorrano, Alicia MarifernandaEnvironmental pollution is defined as the chemical, chemical or biological components present in the environment that cause damage to living beings such as humans, being the main producer of this humanity, through its activity and work: factories, mining, oil , activity in which the air, water and earth are affected, which in the short, medium and long term is harmful to health, affected by physical and chemical imbalances, resulting in malformations, which affects since the embryonic implantation accompanied by alteration genetic and cellular until phenotypic alterations. Descriptive - observational study, which analyzes the relationship between environmental pollution and congenital malformations in newborns at the General Teaching Hospital Riobamba - Ecuador in a population of 253 infants, chosen by inclusion and exclusion criteria. Consult the PRAS 2018 database for review and analysis of the information. The documentary research has a legal and ethical basis for its respective execution, which facilitates access to the records of the care performed between February and November 2018, medical records, from the results with the team it was equated with the most complications important cases and their proximity to regions with poverty or environmental pollution (mining). A concentration of more numerous cases of Polydactyly and Low Weight at birth in the Parish of San Juan is evidenced with 38% and 89% respectively. In addition, it is the parish with the highest concentration of mining Total: 19 (nineteen). Consequently, environmental pollution in Columbe with 91% of cases of Fissure of the Palate would be associated with the presence of 8 mining companies in the sector. In conclusion, the positive relationship between the presence of congenital malformations due to environmental contamination can be affirmed. The recommendations that emerge from this research work would be associated with the priority attention of this problem correctly; establishing prevention strategies in order to avoid and reduce risks through the timely detection of places that could have special environmental characteristics in affected areas, promoting early intervention before treating pregnancies and ruling out fetal abnormalitiesItem "Manejo de síndrome antifosfolípido en el embarazo y prevención de complicaciones materno-fetales”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2019-06-01) Vaca Plazarte, Jose Luis; Belalcázar Sánchez, Yajaira Monserrath Dra. Esp.A 37-year-old female patient with a personal pathological history of antiphospholipid syndrome diagnosed 7 years ago by immunological tests and abortion history on two occasions, without treatment and obesity. Surgical history of a previous caesarean section 7 years ago. Family history of older sister with antiphospholipid syndrome; gynecological-obstetric history: menarche at age 11, beginning of sexual life at 19 years of age, gestations, 4 abortions, 3 deliveries, caesarean section, 1 live births, and PAP test 2 years ago with normal results. CURRENT PREGNANCY: FUM: 05/18/2018 FPP: 02/25/2019 gestational age 37 weeks. Controls 7. Echoes 5. Unplanned pregnancy. Receives calcium 1 gram, acetylsalicylic acid 100 milligrams per day and enoxaparin 40 milligrams subcutaneous day from week 19 of gestation. Patient captured by referral from the first level of health care at 22.5 weeks. At the moment asymptomatic without reporting discomfort. Abdomen: pregnant womb uterine height of 25 centimeters, single live fetus, cephalic, right back, fetal heart rate of 146 bpm, negative uterine activity. Inguinogenital region: there is no evidence of leucorrhoea or genital bleeding. Acetylsalicylic acid 100 mg orally is maintained every day with calcium 2 grams orally every day, enoxaparin 60 mg subcutaneous daily and ferrous sulfate 100 milligrams day; Follow-up is continued by external consultation without complications, she comes to consultation at 37.2 weeks of pregnancy, referring abdominal pain of moderate intensity, her admission is decided for the end of pregnancy, which is carried out without complications by caesarean section obtaining a live newborn without complications , after completing 48 hours of post-surgical observation, patient withdraws in good conditions with newborn and indicated with enoxaparin 60 milligrams subcutaneous daily for 5 days and control by external consultation.Item Las inmunodeficiencias primarias humorales, en este contexto la Inmunodeficiencia Selectiva de IgG, es de vital importancia más aun cuando se asocia a patologías como el Síndrome de Stevens – Jonhson y alergias respiratorias, debido a la poca frecuencia con que se manifiesta en pacientes pediátricos, y por la morbilidad y mortalidad que ocasiona cuando no es diagnosticada precozmente debido a su clínica muy variada. Se reporta el caso de un paciente masculino que desde los 3años 11 meses de edad, se le ha dado seguimiento por la especialidad de Inmunología y Alergología en consulta externa por antecedentes de infecciones del tracto respiratorio superior a repetición, y alergias a componentes medio-ambientales, en varias consultas se denota la disminución selectiva de la IgG, el cual a la edad de 5 años 8 meses debuta con lesiones dermatológicas mucocutaneas caracterizadas por placas eritematosas con ampolla central, además de síntomas y signos de afección pulmonar. La biopsia confirma el diagnóstico para Síndrome de Stevens – Jonhson, y la cuantificación de inmunoglobulinas ratifica la Inmunodeficiencia Selectiva de IgG. El objetivo del presente reporte de caso es determinar la importancia del diagnóstico y tratamiento oportuno en pacientes con inmunodeficiencia, para prevenir, a la vez correlacionar la predisposición y susceptibilidad que conlleva este tipo de patología(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2019-06-01) Carranza Sánchez, Luis Alfonso; Acosta Acosta, Josué Dr. Esp.The humoral primary immunodeficiencies, in this context, the Selective Immunodeficiency of IgG, is of vital importance even more when it is associated to pathologies such as Stevens - Johnson syndrome and respiratory allergies, due to the infrequent manifestation in pediatric patients, and due to the morbidity and mortality that it causes when it is not diagnosed early due to its very varied clinic. We report the case of a male patient who, since 3 years 11 months of age, has been followed up by the specialty of Immunology and Allergology in outpatient clinic due to a history of upper respiratory tract infections, and allergies to environmental components. , several consultations denote the selective decrease of IgG, which at the age of 5 years 8 months debuts with mucocutaneous dermatological lesions characterized by erythematous plaques with central bleb, in addition to symptoms and signs of pulmonary disease. The biopsy confirms the diagnosis for Stevens - Johnson syndrome, and the quantification of immunoglobulins confirms the Selective Immunodeficiency of IgG. The objective of this case report is to determine the importance of diagnosis and timely treatment in patients with immunodeficiency, to prevent, at the same time correlate the predisposition and susceptibility that this type of pathology entails.Item “Síndrome de hellp como complicación de preeclampsia”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2019-06-01) Fernández Velasco, Diego Rodrigo; Tapia Ávila, Marco Vinicio Dr. Esp.Our current case is about a 21-year-old patient with no significant personal history, taking her first pregnancy with 37 weeks of gestation on admission and verbally referring at least 6 prenatal controls not confirmed due to loss of prenatal care card, the pregnant woman go to your local health house referring to headache and abdominal pain type contraction, place where to take vital signs blood pressure of 160/100 mmhg, and a new shot at 2 hours reporting the same figures, no changes are reported cervical, was diagnosed as a hypertensive disorder of pregnancy type severe preeclampsia with signs of severity more threat of preterm delivery, where they refer was established impregnation with magnesium sulfate with first dose of fetal lung maturation and is referred to health home of greater complexity level. It was evaluated in the emergency service of the General Hospital Latacunga where blood pressure of 125/77 mmHg was found without accompanying symptomatology to the obstetric examination was detected unique cephalic alive product with present movements with fetal heart rate of 140 bpm and uterine activity of 1/10 / 20 ", to the genital touch: posterior cervix with 1cm dilatation and 10% effacement. It was decided to enter the Gynecology and Obstetrics service with pregnancy diagnoses of 37 weeks for FUM + preeclampsia without signs of severity + early labor with a spontaneous evolution plan. At 48 hours after admission, he presented with severe headache, which was associated with pain in the epigastrium, presenting high arterial tension (155/98 mmHg) with regular uterine activity and pelvis not suitable for touch, in addition to laboratory tests that report, PLATELETS: 97 10 ^ 3 / Ul, TGO: 157.20 U / L, TGP: 97.00 U / L, LDH: 865 U / L; with which are added the diagnoses of: cephalopelvic disproportion maternal factor and Hellp syndrome type II secondary to preeclampsia with signs of severity, reasons why it is decided to terminate the pregnancy by caesarean section, due to risk of compromise of well-being fetal, with posterior fundic placenta with a 4x2 cm pediculated subserous myoma on the anterior uterine surface. After three days, responding favorably and improving the clinical picture, the discharge was decided with a medical appointment scheduling for control and monitoring of the case.Item “Síndrome del niño maltratado por negligencia como causa de desnutrición crónica severa en madre adolescente”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2019-06-01) Salazar Flores, Diana Estefanía; García Lozano Dra. Esp., Ana MaríaThe following case is about a female patient of 4 years 6 months, preschool, born and resident in Montalvo-Tungurahua, product of first pregnancy, pregnancy of adolescent mother, poorly controlled, well tolerated, home delivery, immediate crying, feeding with milk Exclusive maternal up to one year of age, complete immunizations for age through home visits, adequate height growth until 11 months as reported by mother, apparently hospitalized at 11 months of age by EDA + dehydration, after which girl presents progressive and chronic weight loss whose control and follow-up is carried out in Montalvo Health Center. He comes referred for the first time from the Health Center for Severe Malnutrition, to the patient physical examination with syndromic aspect, corporal cephalogram disproportion, senile appearance, cachectic, thorax with protruding medial deformation, muscular hypotrophy, diminished adipose panniculus universal respecting Bichat bag, dental caries , psychomotor delay, patient remains hospitalized for 10 days receiving medical attention and nursing staff, nutritional education to the mother and grandmother, valued by the services of Dentistry, Psychology, Social Work is discharged for follow-up by stable External Consultation and with weight gain.Item “Aplicación de la posición prono en síndrome de distrés respiratorio agudo”(2019-06-01) Torres Granja, Andrea Gianella; Córdova Peñaloza, Opilio Dr. Esp.Currently for Acute Respiratory Distress Syndrome (ARDS) the use of mechanical ventilation with low circulating volumes is recommended, together with positive end- expiratory pressure (PEEP). However, there are patients who persist hypoxemic and therefore should be used therapeutic to improve arterial oxygenation, where prone decubitus has been shown to be a safe technique capable of improving arterial oxygenation in ARDS, to date has not been generalized its use in intensive care units. The present clinical case investigation details the great utility of the prone position in ARDS