Tesis Especializaciones (Ciencias Médicas)

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Browsing Tesis Especializaciones (Ciencias Médicas) by Author "Abad Vázquez, Jaime Patricio"

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    Comparación de drenajes tubulares y cierre primario de heridas sucias en pacientes quirúrgicos. Hospitales Vicente Corral Moscoso y José Carrasco Arteaga. 2013
    (2014) Carrión Zambrano, Juan Mauricio; Abad Vázquez, Jaime Patricio; Tenezaca Tacuri, Ángel Hipólito
    The presence of a surgical infection should be considered a complication of great importance from the biological and economic, causes of morbidity and mortality, and these important issues to consider in health institutions. (1) Objective: to determine the benefit of using more tubular drains primary closure in contaminated wounds compared with that using a local management of the wound with saline plus tertiary wound closure. Materials and method: experimental study, we considered a sample of 114 with surgically dirty wound, half were placed a drain tube and primary closure (group 1), and the other half pressure washing performed with saline and tertiary closure (group 2). Results: the most affected age group was 36-45 years in both groups. The surgical time of >2 hours was 64,91% in the study group 1, group 2 of 56,14%. Surgical site infection occurred in 5,26 % of patients in group 1 and in group 2 was 36,84% of patients. Hospital stay in group 1 had predominantly in the range of 5-6 days with a 59,65% while in group 2 the predominant range was increased to 7 days with a 50, 88%. In group 1, the relative risk (RR) with presence of surgical site infection was 0, 14(IC95% 0.05-0.45), the absolute risk reduction (ARR) of 0, 316 and in relation to bacterial load > 105 was 0, 16(IC95% 0.05-0.50), the ARR de 0,281. The number needed to treat (NNT) is 3,558. Discussion: the null hypothesis is rejected, the alternative hypothesis is accepted Conclusion: the use of tubular drainage and primary closure in dirty wounds is a safe and effective method to reduce the risk of surgical site infection. KEYWORDS: WOUND INFECTION, TECHNICAL WOUND CLOSURE, THERAPY NEGATIVE PRESSURE WOUND
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    Comparación del valor pronóstico de la escala revisada de trauma y apache II con la sobrevida de pacientes traumatizados graves. Hospital Vicente Corral Moscoso, 2013
    (2014) Vidal Carpio, Jenny Marcela; Abad Vázquez, Jaime Patricio; Tenezaca Tacuri, Ángel Hipólito
    History: severe trauma is a real public health problem worldwide, being violence and traffic accidents the most common cause of this problem. To predict the survival of these patients, scales are used, which contribute to this end. Objective: to determine that the revised scale of trauma is a better predictor of survival than the APACHE II, compared with survival to 30 days of severe trauma patients admitted to Hospital Vicente Corral Moscoso. Materials, methods and types of study: a descriptive study of 91 medical records of patients diagnosed with severe trauma and admitted to Hospital Vicente Corral Moscoso was performed from december 2012 to may 2013. The results were: male-predominant with a percentage of 80.22% and a percentage of 19.78% were female; the most common group ages were between 16 and 44 years. Traffic accidents had a percentage of 30%, followed by stab wounds with a percentage of 21%. The RTS predicted that a percentage of 96.70% will live and a percentage of 3.30% will die. APACHE II predicted that a percentage of 93.3% will live and a percentage of 6.59% will die; while 30 days after the trauma occurred, the following result was obtained: a percentage of 79.12% lived and a percentage of 20.88% died. Conclusion: APACHE II is a better predictor of survival than the RTS scale. Keywords: SEVERE TRAUMA, RTS, APACHE II, SURVIVAL.
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    Profilaxis de infección del sitio quirúrgico en apendicectomía mediante infiltración local aleatroria de metronidazol, Hospital Vicente Corral Moscoso. Cuenca. 2012
    (2014) Cedillo Villamagua, Andrea Gabriela; Abad Vázquez, Jaime Patricio; Tenezaca Tacuri, Ángel Hipólito
    The surgical wound infection postoperatively is a problem for the patient and surgeon worldwide. It has tried to reduce this infection considering several alternatives, one of them, the use of metronidazole infiltrated into the incision. Objective: to determine effectiveness of the prophylaxis of the surgical site infection (SSI) in uncomplicated appendectomy with local metronidazole, Vicente Corral Moscoso Hospital, Cuenca 2012. Methods: Is a clinical controlled trial, randomized, simple blind, with monitoring for 30 days. 220 patients with appendicitis uncomplicated were included in this study, were divided randomly 110 in the experimental group and 110 in the control group. Both groups underwent open appendectomy, were placed systemic prophylaxis. In the experimental group was joined by local prophylaxis with metronidazole placed intraoperative, the general data were collected to analyze with RR, RRR, RRA, NNT and Chi square. Results: study groups presented, socio-demographic, percentage similarities. The surgical site infection (SSI) was present in 8.6% of the experimental group and 10.5% of the control group. Clinically heat, pain and blush were presents in 100% of the cases; the most frequent SSI was the superficial one. The NNT determines if metronidazole infiltrates 52 patients, surgical site infection be avoided in one. Conclusions: the use of local prophylaxis with metronidazole, is not better to reduce the frequency of SSI in postsurgical patients with uncomplicated appendicitis.