Medicina

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Actualización diagnóstica y tratamiento de celulitis periorbitaria en el paciente pediátrico
(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-11-06) Martínez Noriega, Ana Sofía; García Lozano, Ana María
Introduction: Periorbital cellulitis is a bacterial infection of the soft tissues surrounding the eye. In children, it is a common and potentially serious condition that can cause complications such as abscesses and meningitis. The aim of this study is to review the medical literature on periorbital cellulitis in pediatric patients, in order to describe its clinical features, the most common causes, methods of diagnosis and treatment, and associated complications. Methodology: A literature review was performed in medical databases such as Scielo, Pubmed, Scopus, Google Scholar using search terms such as "periorbital cellulitis", "children", "diagnosis" and "treatment". Studies published in the last ten years, in English and Spanish, were included. Results: Periorbital cellulitis is most common in children under 10 years of age, and the most common cause is the spread of upper respiratory tract infections. Symptoms include pain, redness and swelling around the affected eye, fever and general malaise. Diagnosis is made primarily by clinical examination and laboratory and imaging tests. Treatment includes antibiotics and, in some cases, surgical drainage of abscesses. Complications include loss of vision, intracranial abscesses and meningitis. Conclusions: Periorbital cellulitis is a potentially serious condition in pediatric patients, requiring early diagnosis and treatment to avoid complications.
Pie equinovaro congénito tratamiento y pronóstico actual
(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-10-04) Rueda Leguisamo, Kristell Kassandra; Aldaz Santamaria, Monica Patricia
Introduction: Congenital talipes equinovarus (CTEV), also known as clubfoot, is a complex orthopedic anomaly present at birth that affects the foot and ankle. This condition is characterized by heel inversion, forefoot adduction, and supination of the midfoot. As a result, CTEV can cause functional and aesthetic difficulties in the patient's life. Over the years, the treatment has undergone considerable evolution. In recent times, there has been an increasing focus on the Ponseti method. Objective: To describe current treatments and evaluate the most effective classification method for determining the prognosis of congenital talipes equinovarus. Methodology: This study involved a rigorous literature review focused on congenital talipes equinovarus. A comprehensive search of scientific literature was conducted in prominent databases such as PubMed, Scopus, Web of Science, and Google Scholar. Terms related to CTEV, such as "clubfoot," "talipes equinovarus," "congenital foot deformity," "Ponseti method," and "surgical treatment," were used for this purpose. Results: Based on the acquired findings, it has been deduced that the Ponseti method is the preferred and initial treatment for this disorder. This preference is based on its efficacy, safety, and long-term functional and aesthetic outcomes. The prognosis of these patients is strongly influenced by the severity of the deformity, the age at which treatment is initiated, and adherence to the treatment plan. Conclusions: Follow-up and early intervention in cases of recurrence or complications are essential to improve outcomes and ensure a functional and pain-free life for patients.
Actualización en el manejo del síndrome de Prune Belly
(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-10-04) Rodríguez Mariño, Josué Israel; Dávalos Barzola, Cindy Grace
Introduction: Prune Belly syndrome is a rare congenital disorder that is characterized by a triad that includes abdominal muscle deficiency, cryptorchidism and urinary tract abnormalities. The incidence of Prune Belly syndrome in the world is around 1 per 30,000 live births, in Latin America it is reported that its incidence is 3.8 cases per 100,000 male live births. On physical examination, the characteristic wrinkled appearance of the abdominal wall is the most notable physical finding. The management of patients with Prune Belly Syndrome requires a large multidisciplinary team approach to help these children thrive, gain weight, and be prepared for urological surgery if necessary. Objective: To prepare an easy-to-understand scientific article with updated and real information on the treatment of Prune Belly syndrome. Materials and Methods: A bibliographic review was carried out, using articles updated in the last 5 years, published in journals with an impact factor greater than 1 to ensure the quality of the information. The main databases used were: PubMed, Scopus, Medline, ProQuest, Dovepress, Clinical Practice Guidelines, ReciMundo (world scientific journal of research and knowledge). Results: A bibliographic review article was prepared with updated and highly interesting information in relation to the proposed topic, in addition, once all the information was reviewed, it was possible to reach the conclusion about the best treatment proposed by experts. Conclusion: Surgical treatment of children with Prune Belly syndrome can be divided into three steps: urinary tract reconstruction, abdominal wall reconstruction, and orchidopexy. Current recommendations indicate performing the Montfort technique in the pediatric age, taking advantage of the moment for urinary tract reconstruction if required, and for orchidopexy in a single surgical step, it is recommended to perform a second surgery with placement of a polypropylene mesh. through abdominoplasty with the Grazer technique, with the aim of providing an aesthetic improvement and support of the intra-abdominal organs.
Actualización de criterios diagnósticos y tratamiento en trombosis venosa profunda
(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-07-10) Fantoni Añazco, Isabel Cristina; Jurado Melo, Verónica Cristina
Introduction: Deep vein thrombosis (DVT) is a vascular disease characterized by the formation of blood clots in the deep veins, primarily in the lower extremities. DVT can lead to serious complications, such as pulmonary embolism. Early diagnosis and appropriate treatment are crucial for improving patient prognosis. Methodology: A comprehensive review of the updated scientific literature was conducted, including clinical trials, systematic reviews and meta -analyses, clinical practice guidelines, and expert consensus. Relevant studies were identified through searches in databases such as PubMed, Embase, and Cochrane Library. Objective: The aim of this study is to provide an update on diagnostic criteria and treatment of deep vein thrombosis, in order to improve identifi cation and management of this disease in clinical practice. Conclusion: Advances in diagnostic criteria were identified, such as the incorporation of risk stratification tools and the use of imaging tests such as Doppler ultrasound. In addition, changes in the therapeutic approach were found, including the use of directacting anticoagulants (DOACs) instead of conventional anticoagulation therapy. These updates aim to improve early detection of DVT, reduce complications, and optimize treatment.
Diagnóstico y tratamiento de la dermatomiositis: una revisión
(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-07-10) Mayorga Salazar, Jesús Alberto; Medina Medina, Doris Raquel
Introduction: Dermatomyositis (DM) is a rare chronic autoimmune disease with primary features of symmetrical proximal muscle weakness and skin involvement with differentiated skin lesions and a clinically heterogeneous constellation of systemic manifestations that may affect other organs mainly heart, lung and digestive system. In the absence of characteristic dermatologicalfindings or myopathy, DM can be difficult to diagnose; therefore, due to its low incidence and the complexity of its diagnosis, it is a topic of interest to motivate other colleagues in the healtharea to approach this pathology. Objective. To analyze the current scientific evidence of dermatomyositis and to elaborate a detailed review of the pathology. Methodology. The present work is a systematic review of the existing literature, of publications in scientific journals compiling information from the databases of Medline, Intra Med, PubMed, The Cochrane, SciELO and other journals with quality scientific evidence in which descriptors such as: Dermatomyositis, paraneoplastic syndrome, cancer are used. The records range between 30 and 50, after the combination of the different keywords with date restriction within the last five years, in Spanish and English. Results. Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of systemic acquired diseases characterized by chronic progressive muscle weakness and an inflammatory cellular infiltrate in skeletal muscle. In this group, polymyositis (PM), dermatomyositis (DM) and inclusion body myositis (IBM) are the most frequent diseases. Diagnosis is based on the cutaneous manifestations of the disease and the degree of muscle involvement, and when there is doubt in the diagnosis, electromyography or skin and muscle biopsy may be used. The goals of treatment of dermatomyositis include improving physical function and preventing the development of disability. Treatment should be instituted early and requires a team approach involving physical therapist, dermatologist and family physician. Involvement of other specialists may be necessary, depending on the particular manifestations of the disease. Conclusion. The diagnosis of dermatomyositis is given largely by the clinical manifestations of the disease, but in certain cases it represents a diagnostic challenge in patients who suffer from it in the absence of cutaneous manifestations, requiring complementary studies such as skin biopsy, electromyography and even muscle biopsy. Dermatomyositis is an autoimmune disease that generally appears as a paraneoplastic syndrome associated with an underlying malignant neoplasm in a subgroup of patients. Because of this, comprehensive management and timely diagnosis is necessary to prevent possible complications. The goals of dermatomyositis treatment include improving physical function and avoiding the development of disability. Among the therapeutic options that help to control this disease, we find pharmacological therapies such as the use of systemic corticosteroids, immunoglobulins, monoclonal antibodies and immunomodulators.
Leiomioma uterino: opciones terapéuticas actuales
(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-07-06) Peña Solis, Lizbeth Damaris; Mena Villarroel, Luis Byron
Uterine leiomyomas are the most common benign tumors in reproductive-age women. However, it is difficult to establish its incidence because only a minority of cases present symptoms, where compressive and hemorrhagic clinical pictures stand out that require timely management. Among the therapeutic alternatives drugs, minimally invasive techniques, myomectomy and hysterectomy are mentioned. Generally, the resolution capacity depends on the characteristics of the fibroid and the preferences of the patient regarding pregnancy. Objective: To analyze the current therapeutic alternatives used in uterine leiomyoma to improve the approach to this pathology in obstetric and gynecological patients. Method: Bibliographic review of the literature based on the selection of scientific articles from recent years based on the PRISMA method. Results: There are drugs capable of improving the clinical picture and stopping the growth of the fibroid, and at the same time, schemes that show insufficient or inconclusive results or serious adverse effects and, therefore, are not approved. On the other hand, the application of less invasive procedures depends on their availability, their resolving efficacy, the need for reintervention or the choice of subsequent surgery, which includes myomectomy and hysterectomy. Conclusion: Treatment of uterine leiomyoma should be individualized in all cases. Medical pharmacological schemes and myomectomy in its different modalities are the therapeutic pillar in women who wish to preserve fertility. Otherwise, you can opt for more aggressive methods; however, if possible, alternatives should be considered, leaving hysterectomy as the last option.
Revisión bibliográfica sobre nuevas alternativas en el manejo terapéutico y profiláctico para la migraña crónica
(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-07-04) Sampedro Garzón, Sofia Daniella; Recalde Navarrete, Ricardo Javier
Background: Migraine is a common chronic primary headache, which can be disabling if not properly treated. Numerous studies suggest that migraine remains underdiagnosed and undertreated. Methods: This study was carried out in January and February 2023 in an Andean city, through a survey answered by 43 doctors from the first and second level of health. The interview questions concerned knowledge of the diagnostic criteria and treatment methods of migraine. Results: On average, each physician consulted 3 migraine patients per mon th. More than half of the secondary care physicians (73%) listed partial diagnostic criteria for migraine without aura or mentioned aura in their responses. Only 15% of primary care physicians mentioned all diagnostic criteria for migraine without aura. Although 45% of them said they distinguished between episodic and chronic migraine, 18% provided an incorrect definition. The most prescribed drugs in prophylaxis were triptans (65%), followed by tricyclic antidepressants (42%), and in the therapeutic field, in the same way, tripatans, mostly followed AINES combination of antiemetics. Conclusions: Primary care physicians play a fundamental role in the diagnosis, treatment and follow-up of migraine; however, many of them have insufficient knowledge about its diagnosis and correct differentiation between chronic and episodic forms.
Varicocele: nuevos enfoques diagnósticos y terapéuticos
(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-07-04) Peña Criollo, Lizbeth Carolina; Parra Rosero, Andrea Catalina
Introduction: Varicocele is a pathological entity that presents with an abnormal and tortuous dilation of the pampiniform plexus. It affects approximately 15% of the general male population, being more common during adolescence. The left side is the most frequently affected (90%). In most cases, the varicocele is asymptomatic, however, on occasions it could present with a clinical picture of pain or heaviness in the scrotum. According to the European Association of Urology, the diagnosis of varicocele should be made initially on physical examination, and then confirmed by color Doppler ultrasound. Objective: To carry out an exhaustive bibliographic review on the new diagnostic and therapeutic approaches to varicocele. Methodology: A bibliographic search was carried out in which an extensive bibliography was collected whose main focus was focused on articles that discuss new diagnostic and therapeutic approaches to varicocele. Results: Ultrasound, being a non-invasive test and having an approximate accuracy of 90%, is considered the best tool for the diagnosis of varicocele. Another innovative technique is ultrasonic elastography, which can predict the improvement of abnormal semen parameters after undergoing varicocelectomy. Regarding therapeutic measures, the two main alternatives can be mentioned: percutaneous embolization and surgery.
Síndrome de vejiga dolorosa: fisiopatología y enfoques terapéuticos actuales
(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-07-03) Ortiz Perez, Cynthia Maribel; Guacho Guacho, Juan Sebastián
Introduction: Painful bladder syndrome or also called interstitial cystitis (IC/BPS) is a chronic pelvic pain disorder that is perceived as originating in the bladder and is accompanied by one or more symptoms of the lower urinary tract, without other identifiable caus e. Objective: Analyze the most current information regarding the pathophysiology and therapeutic approaches of Bladder Pain Syndrome. M aterials and method: A systematic review of the scientific literature on Bladder Pain Syndrome: Physiopathology and curre nt therapeutic approaches was carried out based on articles obtained from different databases such as: Pubmed, ScienceDirect, Medigraphic, Cochrane, Medline, ElSevier, etc.; publishing during the last five years and that contained up -todate and relevant information. Results: IC/BPS encompasses several clinical phenotypes with different pathophysiological mechanisms and, therefore, different therapeutic management. Two subtypes are currently recognized: IC/BPS with Hunner's lesions or interstitial cystitis (IC) and IC/BPS without Hunner's lesions or painful bladder syndrome (BPS). IC is an inflammatory disease associated with an immune response and infection, with various histopathological findings and treatment focused on restoring localized lesions in the bladder mucosa; while BPS is a non-inflammatory disorder associated with systemic hypersensitivity probably due to neurophysiological and/or endocrine alterations, with few or even no histological findings and with therapeutic strategies similar to those used in the management of other somatic syndromes. This classification into phenotypes is important because it facilitates the t reatment of the disease and favors future research, achieving a better understanding of the pathophysiology and, therefore, of the management of this syndrome. Conclusion: IC/BPS is a pathology of chronic pelvic pain, of still unknown etiology. Several pathophysiological mechanisms have been identified depending on the phenotype, which influence the histopathological findings. Likew ise, the clinical manifestations vary depending on the cystoscopy abnormalities. Finally, the therapeutic approach must be individualized and according to the type of this syndrome.
Nudo verdadero de cordón umbilical “revisión bibliográfica”
(Universidad Técnica de Ambato/ Facultad de Ciencias de Salud /Carrera de Medicina, 2023-07-03) Ortiz Amendariz, Denise Alexandra; Mena Villarroel, Luis Byron
The true knot of the umbilical cord is a potentially serious complication that can occur during pregnancy, it ranges between 0.3% and 2.1% of pregnancies, occurs because of a long or coiled umbilical cord, which by its length tends to intertwine completely at the ends on one or more occasions, in most cases tends to be asymptomatic and does not cause problems, It is important to mention that in spite of being an asymptomatic pathology in rare cases it can affect the flow of blood and fetal oxygen, which can cause growth problems, fetal hypoxia, heart failure and other serious complications such as fetal death. Treatment for a true umbilical cord knot depends on the severity of the situation. In some cases, a cesarean section may be recommended to ensure the safety of the fetus. In other cases, the fetus may be carefully monitored during delivery for any signsof problems and action taken as needed. True umbilical cord knots are rare and cannot be prevented. However, there are certain risk factors that may increase the likelihood of occurrence, such as having a long umbilical cord or having a fetus that makes accelerated movements intrauterine. If the presence of a true umbilical cord knot is suspected, it is important to receiveimmediate medical attention to minimize any risk to the fetus. In this research we will focus on reviewing the causes, risk factors, diagnosis and treatment of true umbilical cord knotting. Objective: Describe the main causes of the true umbilical cord knot, complications, risk factors, symptoms, diagnosis and treatment. Method: A descriptive and retrospective bibliographic review of documents published by scientific societies dedicated to collecting evidence on the treatment of overactive bladder syndrome, as well as research papers and scientific articles that describe the causes and treatment of OAB, was carried out. To locate the bibliographic documents, several documentary sources and guides published by different local and international professional associations of urology were reviewed. An exhaustive search was generated in repositories and scientific databases such as Pubmed, Scielo, Springer, MedLine, Redalyc, Dialnet, New England Journal of Medicine with the use ofdescriptors in both English and Spanish and the use of DeCs and MeSH (Urinary Bladder) thesauri.Overactive, Lower Urinary Tract Symptoms, Overactive Detrusor, Pelvic Floor). The final samples among all the reviewed databases were 30 articles in 30 Spanish and 20 articles in English. The inclusion standards for this review are as follows. Articles published from 2019 to this year and directly related to the research variables are articles belonging to the search engine selected for this review. In the same way, articles that did not correspond to the variable research, and that didnot belong to the selected sources, were excluded. Subsequently, an exhaustive reading of the names and the curriculum of each article is carried out to see which of them best adapt to thevariables of this review, thus receiving the number of articles with specific and useful information for the effective development of this study. Results: Fetal monitoring is important for the detection of this pathology, and if it occurs, fetuses should be subjected to continuous fetal surveillance to detect any signs of fetal distress. This may include tests of fetal well-being, such as electronic fetal monitoring or fetal heart rate tests. Childbirth planning is a helpful tool since control is maintained even before conception, since it includes a careful evaluation during all trimesters of pregnancy, allowing us to detect the presenceof this pathology early. In some cases, a cesarean delivery may be necessary to reduce the risk ofmaternal-fetal complications during vaginal delivery. Antenatal care is substantial and pregnant women should be advised to attend their antenatal care appointments on a regular basis to ensure that any problems, such as a true umbilical cord knot, are detected in time so that appropriatemeasures can be taken if they arrive. to present this pathology without endangering the life of the mother or the fetus. Tobacco and alcohol should be avoided during pregnancy because they increase the risk of complications during pregnancy, including the true knot of the umbilical cord. Insummary, the true umbilical cord knot is a potentially serious complication of pregnancy, but preventative measures can be taken to reduce the risk of complications and ensure a successful outcome for mother and fetus before, during, and after delivery. Conclusion: The diagnosis of a true umbilical cord knot is based on clinical evaluation and theuse of diagnostic techniques, such as prenatal ultrasound and fetal monitoring. If a true umbilical cord knot is suspected, it is important to seek medical attention immediately to avoidserious complications for the fetus. Treatment of a true umbilical cord knot will depend on theseverity of the complication and the health of the fetus. If a true umbilical cord knot is suspected, it is important to seek medical attention immediately to avoid serious complicationsfor the fetus. Some of the maternal and fetal risk factors for true umbilical cord knot include multiple pregnancy, polyhydramnios, fetal malformations, history of true umbilical cord knot, advanced maternal age, and fetal sex. If a pregnant woman has one or more of these risk factors, it is important to discuss the possibility of a true umbilical cord knot with her doctor and take the necessary precautions.

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