Ciencias de la Salud
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Item “La neuroartropatía de charcot en el pie diabético”(Carrera de Medicina, 2019-06-01) Santo Cepeda, Kristopher Alexander; Guarnizo Briceño, José Abdón. Dr. Esp.Male patient of 58 years of age, married, resident in Pastocalle, with a history of Diabetes Mellitus type 2 diagnosed 15 years ago in insulin treatment with familiar family history: paternal grandfather with type 2 diabetes mellitus. Patient comes due to difficulty walking 3 months of evolution that is accompanied by edema, heat, flushing and deformation, at the level of the inner border of the left foot is observed ulceration of 3 centimeters in diameter with irregular edges, so go to the center of health of Alaquez where they do not perform any procedure, for which he performs cures of his ulcer with hot water and medicinal herbs, as there is no improvement go to this house of health and decides to enter vascular surgery At physical examination patient conscious, oriented, with stable vital signs, symmetrical thorax with preserved expandability; heart rhythmic heart sounds, lungs conserved vesicular murmur, abdomen soft, depressible, not painful to superficial and deep palpation, RHA present. Pulse pedions present. Decreased sensitivity and absent tendon reflexes. X-ray of the left foot is made in which slight arterial calcifications are observed, with multiple osteolytic lesions in the tarsal area and proximal parts of the first and second metatarsals. An echo Doppler is requested, which shows a clear decrease in the speeds in anterior tibial arteries and later. In laboratory tests shows leukocytosis, but neutrophilia plus thrombocytosis with elevated CRP, in blood chemistry: fasting glucose: 235 mg / dl, cholesterol: 256 mg / dl and triglycerides: 180 mg / dl. The first therapeutic behaviors used in this case were: empirical antibiotic therapy, a medication for primary hypercholesterolemia, general care, glycemia control, wound culture and cures twice a day of the ulcer plus immobilization of the left foot.Item “Proteinuria como causa de nefropatía”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2017-07-01) Peñafiel Ortiz, Magaly Consuelo; Guacho Guacho, Juan SebastiánDr. Esp.Glomerulopathy is designated a set of diseases that are characterized by a loss of normal functions of the renal glomerulus. They are characterized by the appearance of form elements or proteins in the urine, with varying degrees of renal failure. From the clinical point of view, they present with several alterations, denominated nefrítico syndrome, nefrótico syndrome, alterations of the urinary sediment, acute renal failure, fast progressive and chronic. However, these clinical designations are insufficient to accurately characterize these processes, so it has been fundamental to introduce anatomopathological criteria in their classification. Certain NG occur in the context of systemic (secondary) diseases, while in others renal lesions develop in isolation (primary). The following case is about a female patient, who attends to present edema in lower limbs, is admitted for a study of etiology and chronicity of renal disease with diagnosis of nephrotic - nephrotic syndrome currently in renal function replacement therapy.Item Embarazo Ectópico Accidentado mas Shock Hipovolémico(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Hidalgo Noroña, Tránsito Maricela; González Guevara, Laura Catalina Dra.Ectopic pregnancy is defined as the implantation of the fertilized egg outside the uterine cavity. In Ecuador, according to data released by the INEC in 2014, ectopic pregnancy is the fourth leading cause of maternal death with a result of 6.02%. The most common location of ectopic pregnancy is in the fallopian tube. There are multiple factors related to ectopic pregnancy and the prevalence of such factors is increasing, it correlates with a history of sexually transmitted diseases, ectopic pregnancy, tubal surgery, adult women and snuff disease. It is one of the most important causes of acute abdomen in obstetrics and despite progress in diagnostic and therapeutic methods, ectopic pregnancy continues to represent worldwide problem of maternal morbidity and mortality in the first trimester of pregnancy. This case describes a female patient of 29 years old with no medical history of importance, date of last menstruation know, go to the emergency room because of abdominal pain for about 2 hours, accompanied by tachycardia, hypotension and generalized pallor. Laboratory tests which report leukocytosis, decreased hemoglobin, hematocrit and positive BHCG are made. In addition to reporting abdominal ultrasound performed rugged ectopic pregnancy. Patient is assessed by emergency obstetric resulting test income is decided to surgical center for emergency laparotomy for ectopic pregnancy injured more hypovolemic shock finding free bleeding cavity more clots approximately 3000 milliliters, is administered crystalloid and packed red blood cells plus thereby controls the patient hemodynamically. Approximately 24 hours after the patient has difficulty breathing and chest x-ray desaturation is valued by internal medicine and cardiology who diagnostic acute pulmonary edema, treatment is established it is done. Patient course and is discharged 5 days later. Despite scientific advances in diagnosis, prevention and treatment of this disease is still left unnoticed patients of this kind, either suspicion at the time of care, delay in referral to areas of higher resolution, or perhaps for lack diagnostic tools that enable us to reach a concrete analysis quick and timely manner, it is important to consider the relevance of the investigation of this case report that aims to create a clear and precise understanding of the diagnosis and management of ectopic pregnancy for early intervention, for the benefit of the patient.