Medicina
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Item ENFOQUE DIAGNOSTICO DEL SÍNDROME DE EMBOLIA GRASA, UNA REVISIÓN BIBLIOGRÁFICA(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2024-06-10) Suárez Villacís, Bryan Eduardo; López Moya, Andrea GabrielaIntroduction: Fat embolism syndrome (SEG) is an ill-defined clinical condition attributed to the entry of fat emboli into the circulation. SEG occurs mainly because of orthopedic trauma, and less frequently to other non-traumati c conditions (pancreatitis, sickle cell anemia, osteomyelitis, diabetes m ellitus, fatty liver disease) or after an iatrogenic intervention (longterm corticosteroid therapy, liposuction). Objective: The objective of this work is to learn about fat embolism (GE) and FES, and to present a narrative review focused on its diagnosis, covering its definitions, causes, presentation and treatment. Materials and methods: Review and selection of scientific articles from different databases (PUBMED, Scopus and MedLine), in English. 26 articles (types) were included. Discussion: Despite the growing body of literature describing the occurrence of SEG, significant clinical uncertainty remains regarding its diagnosis, prevention, and treatment. Conclusions: A more detailed understanding of the pathogenesi s of this rare syndrome will facilitate specific strategies for prevention and treatment. More high-quality prospective clinical trials are needed to clarify the role of pharmacological treatment in SEG.Item “Síndrome de intestino corto como complicación de perforación intestinal y hernia inguinal”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-05-01) Herrera Lescano, Roger Vinicio; Navarrete Álvarez, Luis Edmundo Dr. Esp.We present the case of a female patient, adult, subjected to left inguinal herniorrhaphy that triggers short bowel syndrome. The short bowel syndrome used to refer to malabsorption, resulting from previous resections of the intestine (acquired), or its absence due to malformations (congenital). Objectives: To describe the clinical picture, risk factors, diagnostic and therapeutic procedures, and identify the critical points of the short bowel syndrome. Research method: Bibliographic review in scientific texts and articles; review of clinical history and direct interview with the patient. Conclusion: The short bowel syndrome is caused by a decrease in the functional surface of the small intestine causing clinical, metabolic and nutritional alterations. This abnormality responds to various etiologies, being its main complication states of malnutrition. The management is focused on achieving a nutritional balance that compensates the basic requirements. Recommendations: • Carry out an exhaustive control of electrolyte values. • It is recommended to start enteral nutrition early, in the phase of adaptation of the SIC, where the absorptive capacity is increased.Item Miocardiopatía Hipertrófica Apical que Simula un Síndrome Coronario Agudo(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Arce Pérez, Yanael Marcelo; Mora Brito, Edgar Vicente Dr. Esp.Hypertrophic cardiomyopathy is a myocardial disease that is caused by genetic alterations in genes encoding different sarcomeric proteins, is presented as a thickening of the ventricular wall variable location, and has a wide clinical spectrum of expression ranging from asymptomatic carriers to those which they present sudden death as the first manifestation of the disease. Apical hypertrophic cardiomyopathy is a rare variant, with circumscribed hypertrophy to ventricular apex. It has well-established electrocardiographic characteristics; but it can mimic other diseases. Starting from this premise, the analysis of this case report is to establish guidelines therapeutic diagnosis, and mention of the major complications for the proper management of apical hypertrophic cardiomyopathy. The case of a male patient, 49 years old, diabetic, with a family history of sudden death. Go to the emergency with severe pain in the left lower limb, after physical exertion and referred occasional palpitations, he has never presented dyspnea, angina or syncope. Examination revealed: rhythmic heart sounds of low intensity, and positive signs Lasègue Bragard. The electrocardiogram reveals deep negative T waves in precordial leads V3-V6. Suspecting acute coronary syndrome admitted with antithrombotic therapy. The obtained negative cardiac enzymes, and once passed the lower limb painful picture because ciatalgia the patient undergoes a stress test without registering electrocardiographic changes. Having no conclusive diagnosis, magnetic resonance imaging, which identifies severe hypertrophy in the ventricular apex is requested. Antithrombotic drugs are suspended and beta blockers start. The final diagnosis was apical hypertrophic cardiomyopathy and sciatica. Patient evolved properly.Item Crisis Convulsivas por Hiponatremia secundaria a Síndrome de Sheehan(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) López Mayorga, Oscar Ricardo; Dr. Guarnizo Briceño, José AbdónThis study analyzes the clinical case of a patient with seizures per secondary hyponatremia syndrome Sheehan, one of the pathologies associated with patients with postpartum bleeding is one of the rare complications of these diseases but with early treatment and shall not exceed their proper conditions. A case of a patient with gynecological history not to have menstrual cycles after his only feat 8 years is presented, comes because of vomiting in copious amounts of food content then proceed to be hematological parameters, which is accompanied by tonic-clonic seizures , impaired level of consciousness and disorientation, so is brought to this house health. The patient is referred to the internal medicine department where it is valued, additional tests are performed and Sheehan Syndrome, after which it is treated side effects and the disease is diagnosed.Item Crisis Convulsivas Asociadas a Síndrome Poliglandular Autoinmune(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Bermeo Chango, Silvia Tatiana; Arguello Navarro, Hugo Enrique Dr.Polyglandular autoimmune syndrome (SPA) is a rare disorder characterized by the coexistence of at least two glandular insufficiencies mediated immune mechanisms, together with other diseases not endocrinological it. The objective of this research is to describe the clinical presentation and the flaws in the health system that impede the timely treatment of these patients, this case is a teenage female patient 17 years old with a history of primary adrenal insufficiency and hypothyroidism primary diagnosed since age 7, which required several hospitalizations due to decompensation of the underlying pathology; as family history has consanguinity of parents (first cousins), maternal grandmother with diabetes; twin sister diagnosed with adrenal insufficiency and epilepsy, who dies at age 7 by their condition; gynecological history menarche at age 11 with irregular menstrual cycles every 3-5 months, amenorrhea over 16 years. As usual medication consume prednisone 5 mg QD, levothyroxine 100 ug QD, income family relates my having tingling in the arms, lower limb pain and seizure generalized 24 hours earlier, involuntary movements of upper and lower limbs is observed deviation glance the right, relaxation of sphincters, recover spontaneously, and left with paresthesias in upper limbs, lower limbs muscle pain with spasmodic muscular contraction that prevents full extension; hospitalization tonic clonic seizure new box about 5 minutes, without relaxation of sphincters with spontaneous recovery is observed. In addition to the physical examination Chevostek positive sign, upper limbs, Trossseau positive sign, lower limb muscle strength IV / V, negative Babinsky was found; with these symptoms the patient goes emergency service to Internal Medicine Hospital IESS of Latacunga, where several complementary tests showing change in values electrolyte is conducted, several imagenlógicos studies performed after which the group of diseases presenting is cataloged from childhood to today as autoimmune polyglandular syndrome type I, restoring itself compensator treatment of their endocrinological disorders.Item Hematuria como Debut de Hipernefroma(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Poma Macías, Jairo José; Guacho Guacho, Juan Sebastián. Dr. Esp.The Hypernephroma also called renal tubular cell carcinoma, tumor Internist, gray tumor cells, renal cell carcinoma, clear cell tumor or tumor Grawitz, is the most common adult renal tumor. It represents 2.3% of all malignant tumors and is more common in men than in women 3: 1 and between 50 and 70 years. (17). There are symptoms for neoplastic within which we name: fever, weight loss, anemia. (18) (19) (20) As for what the risk factors for both development refers has been linked with diets high in fat and cholesterol, as well as environmental carcinogens and snuff without the availability of clear evidence of the existence of an etiologic factor clearly demonstrated. They described genetic alterations 97% of patients showed allelic loss suppressor gene family and the Von Hippel-Lindau disease that is given by: renal carcinoma, retinal hemangioma, hemangioblastomas spinal cord and cerebellum, and pheochromocytomas. The treatment of kidney cancer can divide it into surgical and conservative: Nephrectomy is used in the tumor located having two partial nephrectomy and radical nephrectomy pathways which in turn can be performed by laparoscopic or open surgery. Conservative treatment and surveillance masses reserves that are less than 4cm, as they usually have a relatively low mortality using cytokines and cytoreductive nephrectomy prior systemic therapy has been shown to provide a survival benefit in patients with good prognosis. With regard to targeted therapies cytoreductive nephrectomy is no evidence retrospective can be beneficial in patients with intermediate or risk for patients with symptomatic primary lesion, although prospective trials are ongoing. Hematuria affects about 16% of the adult population and this may serve as a marker of infection, cancer and others. (1). The origin of it can be: kidneys, ureters, bladder, prostate and ureters, must be distinguished from bleeding of these places and relate with urination, which we call urethral bleeding, and whose origin would be located somewhere below the external sphincter the urethra (2), including the risk factors of microscopic hematuria most cases is benign (1) it is why we must take into account the characteristics of the same in the study of this as a symptom of Hypernephroma with two other features are: abdominal mass and flank pain which make up the triad of this disease.Item Isquemia Miocárdica por vaso Espasmo Alérgico Secundario a Aines(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Lozada Martínez, Gabriela Del Carmen; Mora Brito, Edgar Vicente Dr.This present clinical case has as aim to analyze the kounis syndrome (KS) (ischemia, myocardium allergic vessel spasm) a masculine patient of 47 years old, mestizo, with atopic dermatitis since childhood and fixed drug erythema by sulfas for ten years. Three months before his entry, he presented an upper respiratory case, that’s why the doctor gave him primary care and the doctor prescribed ibuprofen, debuting with pruritis or itchy in elbows and knees with periods of exacerbation and spontaneous remission 48 hours before his entry he referred holocraneana headache he self – medicated ibuprofen and after that a precordial pain appears from moderated to intensive, similar to oppressive. But He didn’t get better with the resting, that’s why he arrived to emergency services. Electrocardiogram showed alterations with ischemia, normal cardiac enzymes, and established treatment protocol for acute coronary syndromes, without a segment elevations (NSTEACS) During his hospitalization he presented irritated injuries erythematous and desquamatives that coalesce in Scales, a cutaneous biopsy was done and reported a superficial peri vascular dermatitis and acute with eosinophilic infiltration compatible with a medication reaction. Due to the presence of NSTEACS associated with an allergically process, concluding in SK as type 1. During the analysis of this case, the opportunities were emphasized and health system access that the patient had, besides an update and exhaustive checking of the features related with this syndrome.Item Síndrome de Embolia Grasa Secundaria a Fractura de Fémur(2016-10-01) Moreira Granda, Edison Javier; Guerrero Sierra, Alfonso Bolívar Dr. Esp.For those who manage major trauma victims, the topic of fat embolism weighs heavily on the mind. The incidence of this problem can approach 90% in patients who have sustained major injuries. If it progresses to the rare clinical entity known as fat embolism syndrome (FES), a systemic inflammatory cascade affecting multiple organ systems, morbidity and mortality are high. Accordingly, swift diagnosis and treatment of fat embolism are paramount for ensuring the survival of this patient population. (1) Here, we present a case of a 25-year-old previously healthy who was admitted to our hospital after suffering a traffic accident with front right latero impaction against a trailer to go as copilot. The patient's injuries include a fractured right femur subtrochanteric fracture and contusions. The patient went on to develop fat embolism syndrome twelve hours after the accident. Its symptoms include poor respiratory mechanics with desaturation, tachycardia, tachypnea, irritability disorientation. Based on the clinical presentation and imaging support, the patient was transferred to the intensive care unit for hospital management. During the development of this clinical case we specify in detail the clinical, diagnostic methods, treatment and evolution that had the patient during their hospital stay.Item Síndrome Antifosfolipídico en adulto joven(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-08-01) Palate Amaguaña, Elsa Priscila; Mora Brito, Edgar VicenteDr.Male patient 39 years old. He born in Mother Earth in the province of Pastaza and resident in the Jatari community, mestizo, cohabiting marital status, complete secondary education, occupation agriculture, personal medical history of deep vein thrombosis 4 years ago. Patient comes upon referral Health Center to present about 24 hours ago abdominal pain, continuous type, 6/10, located in epigastric left upper quadrant radiating to further relates that fail nausea vomiting. Physical examination: blood pressure 105 / 78mmHg, heart rate 74 beats per minute, respiratory rate 22 breaths per minute, temperature 36.8ºC, BMI 26.6 m / kg. Abdomen presence of collateral venous network, tenderness epigastric and left upper quadrant, hepatomegaly two traverses palpated below the costal margin. Tips presence of violet plate 10 x 4 cm located in the left wing. According to the clinical and laboratory results, is suspected antiphospholipid syndrome, so tests that are processed through social work, they performed in a private laboratory, confirming the diagnosis so it is processed are prompted for an interconsultation to hematology in a third level institution also hepatosplenomegaly thought of the presence of portal vein thrombosis and Boud Chiari syndrome, which are discarded, continuing his study is studied. The patient is assessed by hematology treatment (enoxaparin 60 subcutaneous milligrams every 12 hours, warfarin 5 mg via daily oral), which evolves satisfactorily, therefore is discharged and continuous controls outpatient service is established, interconsultation also requested to hepatology.Item Encefalopatía Epiléptica, Síndrome de West(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-05-01) López Poveda, Lucía Maribel; Lana Saavedra, Héctor Enrique Dr. Esp.West syndrome is a pediatric epileptic encephalopathy age-dependent characterized by the classic triad: epileptic spasms, hypsarrhythmic pattern and psychomotor retardation. It starts in the majority during the 1st year of life, with an incidence between 3 and 12 months old. The objective of this research is to describe the clinical presentation and the flaws in the health system that impede the timely treatment of these patients, this case is a male patient infant under 6 months of age, presents sudden movements of upper limbs and chest flexed forward, squinting up, followed by loud crying until sleep of 10 minutes, by several times a day, go to the health center where they are slow to make reference, go to HPDA emergency where it is not treated and finally go to the outpatient clinic where it is valued and your income is decided. He is hospitalized, seeing the seriousness of the symptoms you decide to start treatment with Valproic Acid at a dose of 15 mg / kg / dose. TAC then performed additional tests: frontal cortical atrophy; EEG slowing and disorganization of brain electrical activity (hypsarrhythmia) determining a diagnosis of West syndrome