Browsing by Author "Cevallos Agurto, Cecibel Yadira"

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    Abdominal and thoracic wall closure: damage control surgery's cinderella
    (2021) Ordoñez, Carlos A.
    Damage control surgery principles allow delayed management of traumatic lesions and early metabolic resuscitation by performing abbreviated procedures and prompt resuscitation maneuvers in severely injured trauma patients. However, the initial physiological response to trauma and surgery, along with the hemostatic resuscitation efforts, causes important side effects on intracavitary organs such as tissue edema, increased cavity pressure, and hemodynamic collapse. Consequently, different techniques have been developed over the years for a delayed cavity closure. Nonetheless, the optimal management of abdominal and thoracic surgical closure remains controversial. This article aims to describe the indications and surgical techniques for delayed abdominal or thoracic closure following damage control surgery in severely injured trauma patients, based on the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia. We recommend negative pressure dressing as the gold standard technique for delayed cavity closure, associated with higher wall closure success rates and lower complication and mortality rates
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    Is the whole greater than the sum of its parts? the implementation and outcomes of a whole blood program in Ecuador
    (2021) Himmler, Amber Nicole; Galarza Armijos, Monica Eulalia; Reinoso Naranjo, Jeovanni Homero; Peña Patiño, Sandra Gioconda; Sarmiento Altamirano, Doris; Flores Lazo, Nube Lucia; Pino Andrade, Raul Haldo; Sacoto Aguilar, Hernán; Fernández de Córdova, Lenin; Cevallos Agurto, Cecibel Yadira; Raykar, Nakul; Puyana, Juan Carlos
    Background Hemorrhagic shock is a major cause of mortality in low-income and middle-income countries (LMICs). Many institutions in LMICs lack the resources to adequately prescribe balanced resuscitation. This study aims to describe the implementation of a whole blood (WB) program in Latin America and to discuss the outcomes of the patients who received WB. Methods We conducted a retrospective review of patients resuscitated with WB from 2013 to 2019. Five units of O+ WB were made available on a consistent basis for patients presenting in hemorrhagic shock. Variables collected included gender, age, service treating the patient, units of WB administered, units of components administered, admission vital signs, admission hemoglobin, shock index, Revised Trauma Score in trauma patients, intraoperative crystalloid (lactated Ringer's or normal saline) and colloid (5% human albumin) administration, symptoms of transfusion reaction, length of stay, and in-hospital mortality. Results The sample includes a total of 101 patients, 57 of which were trauma and acute care surgery patients and 44 of which were obstetrics and gynecology patients. No patients developed symptoms consistent with a transfusion reaction. The average shock index was 1.16 (±0.55). On average, patients received 1.66 (±0.80) units of WB. Overall mortality was 13.86% (14 of 101) in the first 24 hours and 5.94% (6 of 101) after 24 hours. Discussion Implementing a WB protocol is achievable in LMICs. WB allows for more efficient delivery of hemostatic resuscitation and is ideal for resource-restrained settings. To our knowledge, this is the first description of a WB program implemented in a civilian hospital in Latin America. Level of evidence Level IV.
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    Prevalencia y factores asociados de complicaciones posoperatorias en cirugía general del paciente adulto mayor, según la escala de Clavien-Dindo. Hospital Vicente Corral Moscoso. Cuenca 2019 – 2021
    (Universidad de Cuenca, 2022-02-04) Abril Orellana, Gabriela Alexandra; Cevallos Agurto, Cecibel Yadira
    Background: The elderly have a higher rate of postoperative complications, being considered a high-risk age group for morbidity and mortality, increased hospital stay, reinterventions, additional treatments and increased costs. Objective: To determine the prevalence and associated factors of postoperative complications in General Surgery of the elderly, according to the Clavien-Dindo classification. Vicente Corral Moscoso Hospital. Cuenca 2019-2021. Methodology: A cross-sectional analytical observational study was carried out to study postoperative complications according to Clavien-Dindo in 180 elderly who underwent surgery at the Vicente Corral Moscoso Hospital. The data were analyzed with the SPSS 25.0 program. The characterization of the population was carried out using descriptive statistics, for the association the OR was used, with its 95% IC and p value <0.05. Results: The most frequent age was 65 to 84 years (86.10%), 55.60% female. 67% present associated comorbidity: cardiovascular (43.30%), endocrine metabolic (33.90%) and pulmonary (16.10%). 52.20% were overweight and 15.60% had grade I obesity. 42% developed some type of postoperative complication in a period of 30 days after the intervention, the most common being mortality (32%), Clavien-Dindo grade II 25, 33%, grade I 20%, grade III B 6.67%, grade IV A 4% and grade IV B 12%. Endocrine-metabolic comorbidity OR 2.65 (IC 95% 1.41-5.03), hypoalbuminemia OR 7.91(IC 95% 4.01-15.6) and prolonged surgical time OR 6.85 (IC 95% 3.37-13.95), these association was statistically significant. Conclusions: Postoperative complications in the elderly are related to endocrine-metabolic comorbidity, hypoalbuminemia and prolonged surgical time.
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    Sensibilidad y especificidad del ultrasonido en apendicitis aguda en mujeres en el Hospital Vicente Corral Moscoso, 2013
    (2014) Cevallos Agurto, Cecibel Yadira; Salamea Molina, Juan Carlos; Tenezaca Tacuri, Ángel Hipólito
    Objective: To validate the effectiveness of abdominal ultrasound in women with clinical suspicion of acute appendicitis. Methodology: Descriptive study of diagnostic test, 323 patients with clinically suspected acute appendicitis who presented to the emergency area Vicente Corral Moscoso hospital between February and July 2013 were included. An abdominal ultrasound was performed to confirm the diagnosis and sensitivity, specificity, positive and negative predictive values in both women and men was measured and a general evaluation of the results was performed. Result: 323 abdominal ultrasounds were performed to assess the probable diagnosis of acute appendicitis determined by the patient's clinical, obtaining globally sensitivity 78.52% (73.29%-83.74%), specificity 78.52% (73.29%-83.74%), positive predictive value 84.81% (80.03%-89.59%) and negative predictive value of 36.05% (25.32%-46.78%). Correspond to 170 women and 153 men, in women there was sensitivity 76.38% (68.6%-84.16%), specificity 41.86% (25.95%-57.77%), positive predictive value 79.51% (71.94%-87.08%) and negative predictive value of 37.5% (22.76%-52.24%). In men found sensitivity of 80.62%, specificity 54.17%, positive predictive value 90.43% and negative predictive value of 34.21%. Conclusions: The diagnosis of acute appendicitis remains a clinical but abdominal ultrasound has an overall performance in our acceptable medium, due to its accessibility and low cost is the ideal test when faced with borderline cases especially women adnexal pathology and its use in men is restricted to cases greater diagnostic doubt. My results validated the sensitivity of the test with low level of specifity. Keywords: ACUTE APPENDICITIS, ACUTE ABDOMEN, ABDOMINAL ULTRASOUND.