Tesis Especializaciones (Ciencias Médicas)

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Browsing Tesis Especializaciones (Ciencias Médicas) by Author "Aguilar Gaibor, Carlos Iván"

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    Concordancia de la escala de Randhawa aplicada en adultos mayores en los hospitales José Carrasco Arteaga y Vicente Corral Moscoso, 2019 - 2020
    (Universidad de Cuenca, 2021-05-11) Martínez Gaona, Karla del Cisne; Aguilar Gaibor, Carlos Iván
    Background: 30% of laparoscopic cholecystectomies are performed in older adults, presenting difficulties due to the severity of the cholecystitis or the patient's comorbidities. The Randhawa scale developed in 2009 to predict a difficult laparoscopic cholecystectomy allowing a more adequate therapeutic projection according to the surgeon's criteria. Objective: to describe the concordance of the Randhawa scale applied to older adults in the José Carrasco Arteaga and Vicente Corral Moscoso hospitals, 2019-2020. Material and methods: a descriptive concordance study was carried out applying the Randhawa scale to patients who meet the inclusion criteria, in the emergency surgery service of the José Carrasco Arteaga and Vicente Corral Moscoso hospitals. Surgical time was taken as a gold test. The Kappa index was calculated using the SPSS version 15 software. A p ≤0.05 was accepted for statistical significance. Results: The level of concordance between the Randhawa scale and the surgical time of laparoscopic cholecystectomies was very weak with a Kappa index of 0.139 and p of 0.166, which is not statistically significant. The history of previous hospitalization is the only variable with good agreement with a Kappa index of 0.66 and p of 0.000. Conclusion: There is a very low concordance without statistical relevance of the Randhawa scale applied to the elderly at the José Carrasco Arteaga and Vicente Corral Moscoso hospitals.
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    Eficacia de la escala BISAP para predicción temprana de severidad en pancreatitis aguda biliar. Hospital Vicente Corral Moscoso. Cuenca, enero 2014 – julio 2015
    (2016) Aguilar Gaibor, Carlos Iván; Salamea Molina, Juan Carlos; Tenezaca Tacuri, Ángel Hipólito
    Introduction: the acute pancreatitis is a pathology in our environment, presents a high morbility and mortality according to the severity, hospital stay and complications. To detect early severity assessment scales as there BISAP, APACHE II and Ranson affects their aggressive initial management to prevent complications Objetive: to determine the effectiveness of the scale BISAP in early prediction of severity in pancreatitis acute biliary, Vicente Corral Moscoso Hospital. Cuenca, 2014 - 2015. Material and methods: we conducted a diagnostic test study, with a sample of 127 patients with acute pancreatitis calculated as EPIDAT 4.0, infinite poblation, proportion 30%, confidence level 95%, precition 8% which discharged with criteria of inclution and exclution. It was in used the consensus Atlanta 2012 for the diagnosis of Acute Pancreatitis was used and the three scales applied to predict severity. Data were analized in SPSS 15 Software. Results: the prevalence of severe pancreatitis was 14,2 % and the mortality rate of 3.9 %. The values for the scale APACHE-II of the sensitivity is 55.56 %, specificity 98.17 %, Value Predictive Positive 83.33 %, Value Predictive Negative 93.04 %. For BISAP the sensitivity is 61.11 %, a specificity of 96.33 %, Value Predictive Positive 73.33 %, Value Predictive Negative 93.75 %. The lowest are for Ranson. According to the area under the curve, the highest value was observed for the scale of BISAP with a value of 0.942, APACHE-II 0.937 and the scale Ranson whose value is 0,874. Conclusions: the best scale to predict the severity of acute pancreatitis is the BISAP for presente the value low of curve y sensibility higher than the other scales
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    Prevalencia de complicaciones mediatas y factores asociados en pacientes post apendicectomía laparoscópica, en el Hospital José Carrasco Arteaga. Cuenca; 2019
    (Universidad de Cuenca, 2019-05-13) Galarza Armijos, Mónica Eulalia; Aguilar Gaibor, Carlos Iván
    BACKGROUND: Acute appendicitis represents a surgical emergency and a public health problem, with a 10% prevalence of complications (1). According to the Ministry of Public Health, it represents the primary cause of morbidity in Ecuador (2). OBJECTIVE: To determine the prevalence and associated factors with mediate complications in post-laparoscopic appendectomy patients. José Carrasco Arteaga Hospital, Cuenca; 2019. METHOD: Analytical, cross-sectional, observational study, infinite universe, sample 215 (lowest prevalence 5.33%), unit of analysis: clinical history, using a form the information from the AS400 system was collected from randomized patients. The information was entered into Excel 2016 and SPSS 15.0. Frequency distributions and percentages were used to synthesize the data, and for the association OR, 95% CI, and for statistical significance the value of p<0.05. RESULTS: The prevalence of mediate complications was 13.5%, the most frequent being surgical site infection (6%). The associated factors include: delay in seeking medical attention> 24h (OR: 2.23, CI: 1.014 – 4.936), complicated acute appendicitis (OR: 2.3, CI: 1.045 – 5.087) and absence of prophylactic antibiotic treatment (OR: 4.15, CI: 1.401 – 12.289). These risk factors were statistically significant (p = 0.042, p = 0.035, p = 0.006 respectively). CONCLUSIONS: The prevalence of mediate complications in this study is similar to those reported in other neighboring countries, however, it is higher than that found in our city in another institution. Complications are associated with factors such as: delay in seeking medical attention> 24h, complicated acute appendicitis, and absence of prophylactic antibiotic therapy.
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    Prevalencia de infección de sitio quirúrgico y factores asociados. Hospital José Carrasco Arteaga, 2018
    (Universidad de Cuenca, 2020-06-01) Yunga Guamán, Milton Paul; Aguilar Gaibor, Carlos Iván
    Objective: to determine the prevalence of ISQ and the associated factors at the José Carrasco Arteaga Hospital, during the year 2018. Methodology: An analytical, cross-sectional study of prevalence in the area of surgery of the José Carrasco Arteaga Hospital was carried out in 2018. It was carried out with 233 medical records that met the inclusion criteria to establish the prevalence of SSI and factors. Associated as: age, preoperative stay, diabetes mellitus, drainage use, classification of the American Society Anesthesiologists (ASA), obesity, blood transfusion, antibiotic prophylaxis, open surgical approach, degree of wound contamination, surgical time, admission to intensive care. A bivariate and multivariate analysis was performed with the SPSS program, to establish the association between the SSI and the risk factors. The same ones that are specific in tables with their respective statistical analysis. Results: The prevalence of SSI was 16.30%, a statistically significant association was found with surgical time greater than 120 minutes, use of drains, open surgical approach, admission to intensive care unit, ASA III-IV, contaminated and dirty wound, preoperative stay greater than 24h (p ‹0.05). There was no statistical association with body mass index greater than 25, diabetes mellitus, age over 65 years or with blood transfusion. Conclusions: The SSI is within the reported ranges, the factors for SSI are duration of surgery 120 minutes and more, preoperative stay 24 hours and more, ASA III and IV, contaminated and dirty wound, blood transfusions, use of drains, admission to the intensive care unit, conventional approach and lack of administration of antibiotics before surgery. It was not found as a risk factor for overweight or obesity, diabetes mellitus, the age of 65 years and more; nor who receive blood transfusions.
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    Prevalencia de infección del sitio quirúrgico en pacientes apendicectomizados por técnica abierta y laparoscópica, en los hospitales Vicente Corral Moscoso y José Carrasco Arteaga. Cuenca, 2018
    (Universidad de Cuenca, 2020-03-04) Ávila Narváez, Juan Andrés; Aguilar Gaibor, Carlos Iván
    Background: The surgical site infection (SSI) is one of the main causes of infection and for their control is necessary to know the magnitude and associated factors. Objective: To establish the prevalence and factors associated with the surgical site infection in patients who underwent appendectomies based, in hospitals Vicente Corral Moscoso and José Carrasco Arteaga, during the period 2018. Method and materials: this is a cross-sectional study. The data is extracted from the database AS400 of the hospitals described, the clinical histories, and operational notes reports of anesthesia of 384 patients operated for acute appendicitis. To determine the factors associated statistical or was used (95%) and binary multivariate logistic regression analysis. Results: The prevalence of the surgical site infection was 12%. They found factors associated to the ISQ with statistical significance, the history of diabetes (OR 3.2; 95% CI 1.62 - 6.27; P 0.00), and the surgical time greater than 1 hour (OR 1.9; 95% CI 1.4 - 1.55; P 0.03). In contrast, there was an association, but not statistical significance between age greater than 29 years (OR 1.4; 95% CI 0.71 - 2.77; P 0.32), conventional surgical technique (OR 1.4; 95% CI 0.94 - 1.94; P 0.25). Obesity (OR 1.4; 95% CI 0.70 - 2.80; p value 0.33), male sex (OR 0.9, CI 95% 0.55 - 1.90, p 0.93) was not a factor associated with nor had statistical significance. The multivariate analysis explained that the history of diabetes was the factor most closely associated with the ISQ (p 0.000). Conclusions: The prevalence of surgical site infection in appendectomized patients was higher than that reported elsewhere in the literature, and is associated with the history of diabetes and the surgical time greater than 1 hour.