Browsing by Author "Sarmiento Altamirano, Doris Adriana"

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Correlación entre el psa y el hallazgo histopatológico, en pacientes sometidos a biopsia transrectal de próstata guiada por ultrasonido en el diagnóstico de adenocarcinoma de próstata, Hospital José Carrasco Arteaga, Cuenca, Ecuador, 2017-2018
(2019) Terán Govea, Faberth Miguel; Tigsi Ganzhi, Luis Manuel; Sarmiento Altamirano, Doris Adriana
Background: prostate cancer (PCa) is the most common malignancy in men, with high incidence and mortality rates. With the prostate-specific antigen (PSA) test, the detection and diagnosis of PAC increased, the place of detection of the pathology in the initial stages, and the improvement of prostate biopsy techniques, among other aspects. Objective: to determine the correlation of PSA and the histopathological finding in patients undergoing transrectal ultrasound-guided prostate biopsy and diagnosis of prostate adenocarcinoma, José Carrasco Arteaga Hospital, Cuenca, Ecuador, 2017-2018. Methodology: the sample size was 219 patients; the data were obtained from the medical records. A correlation study was carried out that compared the values of PSA with the histopathological finding of the patients who underwent a prostate biopsy guided by ultrasound in the period between January 2017 and July 2018, through statistical analysis Kappa de Cohen. Results: 66.7% of the patients were over 65 years of age, with an average age of 67.7 years. The prevalence of prostate cancer was 36.1%. The median PSA (15.40) between patients with and without cancer was statistically significant, with Mann Whitney U of 3330 and p-value: 0.000 (significance). The agreement was 0.24 with a p of 0.000 and this is acceptable. Conclusion: the PSA test in the diagnosis of prostate cancer was useful, being the transrectal biopsy of the prostate guided by ultrasound a support for its diagnosis
Determinación de factores de riesgo para apendicitis aguda complicada en el Hospital Vicente Corral Moscoso. 2018
(Universidad de Cuenca, 2020-02-27) Ayala Yunga, Jonathan Alfredo; Sarmiento Altamirano, Doris Adriana
Background: complicated acute appendicitis (CAA) is defined as a stage of infection that may suffer a delay in the presentation, diagnosis or treatment of the pathology, the resolution of the picture is like a common procedure and basic knowledge in the area of General Surgery. Objective: to determine the risk factors for complicated acute appendicitis in the Vicente Corral Moscoso hospital during the period January to December 2018. Material and methods: A cross-sectional study was carried out to identify the prevalence of CAA and risk factors. The variables analyzed were: age, sex, time of evolution, ethnic identification, self-medication, comorbidities, family history, fever, leukocytosis. Data were collected using a form and were tabulated with the SPSS v 22. program. Qualitative variables will be analyzed with frequency and percentage and quantitative variables with average, standard deviation, minimum and maximum values; The factors associated with the CAA are analyzed with OR, 95% CI, Chi2 and binary logistic regression. Results: 280 records of patients who met the inclusion criteria were analyzed, the majority were women (51.8%), the mean age was 32.46 years SD ± 13.74. Among the factors associated with CAA with statistical significance are: self-medication (OR 6.85; 95% CI 2.82-16.63. P <0.05), thermal increase (OR 21.24; 95% CI 6.26 -72.02. P <0.05) and evolution time greater than 24 hours (OR 330.55; 95% CI 44.43-2458.76. P <0.05). Conclusions: the prevalence of complicated acute appendicitis is high in our environment and is associated with factors such as the time of evolution greater than 24 hours, self-medication and thermal rise
Factores asociados a apéndice blanca en pacientes apendicectomizados Hospitales Vicente Corral Moscoso y José Carrasco Arteaga. 2018
(Universidad de Cuenca, 2020-02-20) Ortiz Tobar, Juan Pablo; Sarmiento Altamirano, Doris Adriana
Background: the appendectomy is the most frequent surgery in the emergency services, currently there are no specific data, signs or symptoms that prevent the surgeon from falling into the error of removing a normal appendix. Objective: to determine the frequency and factors associated with white appendix patients older than 16 years undergoing appendectomy at the José Carrasco and Vicente Corral Moscoso Hospitals in the city of Cuenca. Methods and Techniques: A cross-sectional analytical study was conducted, with 432 patients who met the inclusion criteria. The data were collected using a form, its tabulation was performed using SPSS 20 software. Quantitative variables were analyzed with average and standard deviation, qualitative variables with frequency and percentage; In addition, for the associated factors, a bivariate analysis was performed using Odds Ratio with 95% CI and multivariate logistic regression with a value of p <0.05. Results: the frequency of white appendectomy was 9.3%, predominantly in women between 25 and 39 years old; the factors associated with statistical significance were, not presenting a Mac Burney sign 8.79% (OR 10.26; 95% CI 1.40–74.93; p 0.04), being female (OR 2.19; 95% CI 1.11-4.31; p 0.016), absence of hypersensitivity (OR 13.65; 95% CI 3.96-47.08; p 0.00) and living in rural areas (OR 2.816; 95% CI 1.54 - 25,208; p 0,021). Conclusions: the frequency of white appendectomy was similar to that reported in the literature, the associated factors were, being female, absence of hypersensitivity, showing no sign of Mac Burney and residing in rural areas.
Factores relacionados con el consumo de alcohol en los estudiantes de la Universidad de Cuenca durante el año lectivo 2005-2006
(2007) Sánchez Saquicela, Joanna Fernanda; Saquisilí González, Johanna del Rocío; Sarmiento Altamirano, Doris Adriana; Serrano Arias, María Gabriela; Cañizares Aguilar, Aurelio Ernesto; Mosquera Vallejo, Lorena Elizabeth
It is a descriptive quantitative. The study population consisted of a proactive, stratified sample, collected at random, made up 10% of each of the faculties. They were taken into account as frequency cariables old gender, origin, religion, age of onset, faculty, peiodicidad, with whom does the consumption of drink type, intensity of use, predisposing factors and consequences of the use
Índice de trauma abdominal PATI modificado como factor predictivo de complicaciones postoperatorias en pacientes con trauma abdominal ingresados en el servicio de cirugía del Hospital Vicente Corral Moscoso, año 2019
(Universidad de Cuenca, 2021-05-14) Chica Alvarracín, Pablo Adrián; Sarmiento Altamirano, Doris Adriana
Introduction: The PATI Index (Penetrating Abdominal Trauma Index) establishes the classification of abdominal organ injury severity as a standard. PATI ́s usefulness lies in defining intraoperative behaviors and predicting complications, also as a common language that facilitates the investigation of morbidity and mortality associated to trauma. Objective: To determine the concordance index between the standard PATI and modified PATI scales of postoperative complications in patients with abdominal trauma admitted to the service of at Vicente Corral Moscoso Hospital in 2019. Methods and materials: Descriptive study of agreement was carried out using the kappa index between the two scales PATI standard and PATI MODIFIED, it was worked with the universe of 52 patients. Sociodemographic and clinical variables were analyzed and morbidity and mortality were determined as a result variable. Results: 52 patients with abdominal trauma, 86% men, the mean age 34.8 years. 67% were rural, 33.5% needed more than 7 days of hospitalization. 62% of traumas were closed and 38% penetrating, of this late, 17 by knife and 3 by firearm. The causes: 42.3% physical assaults and 21.2% traffic accidents. The PATI ≥ 25 points 7 (13.5%) and modified PATI mean 14.6 SD ± 10.9 with a result ± 25 points 13 (25%). 16% were complicated, 5.75% died. The kappa index was 0.51, giving a moderate degree of agreement between scales. Conclusions: The modified PATI scale has moderate concordance with the standard PATI scale for predicting complications and mortality in patients with abdominal trauma.
Infección del sitio quirúrgico y relación con factores asociados en cirugía abdominal. Hospital Vicente Corral Moscoso, 2016
(2016) Sarmiento Altamirano, Doris Adriana; Salamea Molina, Juan Carlos; Morocho Malla, Manuel Ismael
Objective: to determine the prevalence of surgical site infection, and its relationship with associated factors in patients with abdominal surgery that were assisted by the trauma and emergency service at Vicente Corral Moscoso Hospital in 2016. Methods and Materials: we carried out a cross-sectional study with 206 patients that met the inclusion criteria, and signed the consent. They were observed since they were admitted until they developed an infection, or thirty days after the surgery. Variables such as age, gender, wound contamination, overweight, obesity, cigarette smoking, preoperative stay, comorbidities, surgical time, steroids or immunosuppressive, hyperglycemia, transfusions, using drainage, ICU stay, antibiotic prophylaxis, prior antibiotic, antibiotic treatment were studied. The data was entered in a database to then carry out a bivariate and multivariate analysis. Results: the prevalence was of 17.48 %, finding significant statistic relevance in age (above 65 years of age), length of the surgery (longer than 120 minutes), preoperative stay (longer than 24 hours), hyperglycemia (above 180 mg/dL) ASA III and IV, contaminated and dirty wound, transfusions, using drainage, ICU stay, the non-use of antibiotic prophylaxis, open approach, using prior antibiotic and BMI over 35. Statistic relevance was not found on the following variables: cigarette smoking, taking immunosuppressants, antibiotic prophylaxis longer than 60 minutes and use of antibiotic treatment. Conclusion: surgical site infection is higher to those reported, and is related to various risk factors that correspond to both, the patient, and the surgery itself
Prevalencia de rigidez articular y factores asociados en los adultos mayores de la ciudad de Cuenca. Estudio multicéntrico. 2018
(2019-04-03) Suri Ochoa, Rosmy Anahí; Vaca Morocho, Andrea Jackeline; Quizhpe Merchán, Carmita Victoria; Sarmiento Altamirano, Doris Adriana
BACKGROUND: in Ecuador the percentage of older adults in the year 2017 was 6.5%, by 2050 it will represent 18% of the total population, with an average life expectancy of approximately 76 years. The lack of flexibility affects the daily activities of older adults, decreases their quality of life and their relationship with the social environment. GENERAL OBJECTIVE: to determine the prevalence of joint stiffness and associated factors in the elderly of the city of Cuenca, 2018. METHODOLOGY: a prospective cross-sectional analytical study was carried out, with 160 elderly people from the geriatric centers of the city of Cuenca. A flexibility test was applied, including the battery for the senior fitness test (SFT), to assess the degree of joint stiffness. The statistical analysis was performed with SPSS version 15. Frequency, dispersion, bivariate analysis (OR, IC, P-value and multivariate) and binary logistic regression (multivariate analysis) were taken. RESULTS: Women (74.4%) and subjects 65 to 79 years (60.6%) predominated in the study. The most common pathological antecedent was Arthrosis, followed by Arthritis, Diabetes mellitus and some level of Depression. As for physical activity, assets are only less than one fifth. Independent people predominated for their daily activities. CONCLUSIONS: The prevalence of stiffness was 40.6% in lower limbs and 70.6% in lower limbs. Osteoarthritis in the upper limbs and low physical activity were the most important risk factors for stiffness.
Prevalencia y factores asociados a la colangitis aguda en el Hospital José Carrasco Arteaga. Cuenca 2019
(Universidad de Cuenca, 2021-05-14) Pacurucu Merchán, Abdon Xavier; Sarmiento Altamirano, Doris Adriana; Morocho Malla, Manuel Ismael
Introduction: Acute cholangitis remains a fatal disease in the absence of timely treatment and its diagnosis remains a challenge. Therefore, it is necessary to reveal the prevalence and the factors associated to the cholangitis development, in order to provide an early and effective resolution. Objective: To determine the prevalence and associated factors of acute cholangitis in the "Hospital José Carrasco Arteaga", Cuenca - Azuay, period 2019. Materials and methods: Observational, analytical - cross-sectional study. 507 patients with a diagnosis of choledocholithiasis were studied, 263 presented cholangitis. The data were analyzed with the SPSS 18.0 program. For the descriptive analysis, the statistics of dispersion and central tendencies, frequency and percentages were used, the associated factors will be established with PR> 1, with its 95% CI. The accepted statistical significance was p <0.05 of 2. Results: 507 patients were studied, 263 (51.90%) had cholangitis; the average age was of 64.5 years (± 19.92). The sex with the highest frequency was female (52.90%) with 268 patients. The predominant age group was the elderly (55.02%) with a number of 279 patients. Mild cholangitis was more common and age 60 years or older is considered a risk factor for developing cholangitis. Conclusion: Acute cholangitis is statistically related to advanced age and not to other factors such as: sex, ERCP, diabetes, HBP, etc.
Recomendaciones generales para la atención de la patología quirúrgica urgente en el contexto de la pandemia por COVID-19
(Universidad del Azuay, 2020) Cevallos Agurto, Cecibel Yadira
The successful implementation of a trauma and acute care surgery model in Ecuador
(2020) Sarmiento Altamirano, Doris Adriana; Himmler, Amber Nicole; Chango Siguenza, Oscar Miguel; Pino Andrade, Raul Haldo; Flores Lazo, Nube Lucia; Reinoso Naranjo, Jeovanni Homero; Sacoto Aguilar, Hernan Patricio; Fernandez de cordova Rubio, German Lenin; Rodas, Edgar B.; Puyana, Juan Carlos; Salamea Molina, Juan Carlos
For years, surgical emergencies in Ecuador were managed on a case-by-case basis without significant standardization. To address these issues, the Regional Hospital Vicente Corral Moscoso adapted and implemented a model of “trauma and acute care surgery” (TACS) to the reality of Cuenca, Ecuador. A cohort study was carried out, comparing patients exposed to the traditional model and patients exposed to the TACS model. Variables assessed included number of surgical patients attended to in the emergency department, number of surgical interventions, number of surgeries performed per surgeon, surgical wait time, length of stay and in-hospital mortality.
Validación del clearance de lactato como predictor de mortalidad en pacientes con trauma moderado y severo. Hospital Vicente Corral Moscoso. Cuenca, 2017
(2019) Mantilla Sarmiento, Gabriela Alejandra; Sarmiento Altamirano, Doris Adriana; Alvarez Serrano, Marlene Elizabeth
Introduction: The prevalence of mortality in patients with trauma can reach high figures, in Ecuador, the main cause of mortality from injuries are traffic accidents, for this reason, there is great interest to improve the early detection of critically ill patients, for provide intensive and adequate management. Objective: To determine the validity of lactate clearance as a predictor of mortality in patients with moderate and severe trauma. Hospital Vicente Corral Moscoso, Cuenca 2017. Method and materials: A validation study of diagnostic tests was performed in patients with moderate to severe trauma, a blood sample was taken for serum lactate at the time of admission and at 6 hours to quantify the lactate clearance and compared with the REMS scale(Rapid Emergency Medicine Score) (pattern of gold), the outcome variable was mortality. Results: 149 patients who met the inclusion criteria were studied, a mortality prevalence of 22.1% was found. The mean age was found to be 39.91 SD ± 18.92; a sensitivity and specificity was found for the lactate of admission of 84.85% and 56.9%; a sensitivity and specificity for lactate at 6 hours of 87.88% and 73.28%; the area under the lactate curve both at admission and at 6 hours was greater than 0.8. The clearance of lactate showed a sensitivity of 72.73%, and specificity of 75.86%. A cut-off point of 2.5 was determined for the lactate of admission and of 1.93 for the lactate of 6 hours. Conclusions: the 6-hour lactate presents a better predictor for mortality in patients with trauma, while the lactate clearance achieved high sensitivity and specificity for surveillance of resuscitation.
Validación del índice de impedancia venosa renal en la valoración de Uropatía obstructiva aguda. Hospital Vicente Corral Moscoso. 2017-2018
(2019) Pico Poveda, Mildred Valeria; Llivisaca Tacuri, José Enrique; Sarmiento Altamirano, Doris Adriana
Background. Acute obstructive uropathy represents a cause very frequent of abdominal pain in the emergency rooms of Ecuador. Given the clinical suspicion of acute obstructive uropathy, the first diagnostic tool is grayscale ultrasound, however, because it only detects anatomical changes, its sensitivity and specificity is poor. Doppler ultrasound by measuring the arterial resistance index have been used to get more functional information, nevertheless the conclusions have not been satisfactory; recent studies have been focused on the venous site of the vascular tree for the diagnosis of acute obstruction. Objective. To determine the validity of the renal venous impedance index by Doppler ultrasound for the assessment of acute obstructive uropathy. Material and methods. A diagnostic test validation study was made in 163 patients who attended the Radiology Department of Vicente Corral Moscoso Hospital in the city of Cuenca from January 2017 to January 2018. The sample was calculated on the basis of prevalence of renal colic in a study conducted in the city of Cuenca of 61.3%, expected sensitivity of 94%, expected specificity of 99%, accuracy of 5%, confidence level of 95%, and took into account of 15% of the losses that might occur. Patients were selected with clinical suspicious of renal colic. All individuals underwent intravenous venous Doppler ultrasound in both kidneys and Urography by computed Tomography (UroTC) as a gold test. Results: The sensitivity and specificity of the venous impedance index by Doppler ultrasound in the diagnosis of acute obstructive uropathy is high. The sensitivity and specificity was 81% and 93% respectively. The area under the ROC curve was 0.891 which determines that the diagnostic test was an excellent test for the diagnosis of acute obstructive uropathy. A cutoff value of 0.30 has a sensitivity of 90% and a specificity of 18%. Therefore, this technique could be used routinely in the diagnosis of hydronephrosis due to acute obstructive uropathy.
Validez de la radiografía en el diagnóstico de la enfermedad degenerativa articular de rodilla. Hospital José Carrasco Arteaga, Cuenca, Ecuador, 2017-2018
(2019) Machuca Rivera, Magaly Yelena; Tigsi Ganzhi, Luis Manuel; Sarmiento Altamirano, Doris Adriana
Background: Osteoarthritis is the most common form of arthritis and the main cause of disability in the elderly population. Osteoarthritis has been evaluated with an X-ray, which shows bone characteristics, which include marginal osteophytes, sclerosis and narrowing of the joint space, is also valued with magnetic resonance, being a less accessible, high cost, not available in all hospitals in the country. Objective: To determine the validity of the X-ray in the diagnosis of knee joint degenerative disease. Methodology: diagnostic test validation study with 202 patients who attended the radiology department of the José Carrasco Arteaga Hospital in the city of Cuenca from February 2017 to January 2018, it was included to patients who required a knee radiography and later to this one nuclear magnetic resonance (gold test). Patients will be taken as a positive result for degenerative degeneration due to radiography, those that meet the radiographic criteria. The information was processed in SPSS software obtaining sensitivity, specificity, positive and negative predictive value, reason of positive and negative likelihood. Results: 92.11% of sensitivity and 72% of specificity were obtained, VPP of 90.01%, VPN 75%, negative probability ratio of 3.29. Prevalence of degenerative knee disease of 75.25%. Conclusions: The radiography is useful for the diagnosis of knee degenerative disease
Validez de la relación del diámetro transverso del cerebelo y la circunferencia abdominal para el diagnóstico de restricción de crecimiento intrauterino en gestaciones mayores de 20 semanas. Hospital José Carrasco Arteaga.
(2018) Reinoso Jaramillo, María Eugenia; Faicán Benenaula, José Francisco; Sarmiento Altamirano, Doris Adriana
Background: Intrauterine growth restriction (IUGR) is a disorder in which the fetus is abnormally small for gestational age, and it constitutes one of the main causes of perinatal and intrauterine morbidity and mortality. Within ultrasound parameters the most valid is the relationship of estimated fetal weight with gestational age. However, without a reliable gestational age this parameter loses its usefulness so a parameter of equal or better efficacy, independent of age is required. Objective: To determine the validity of the relation of the transverse diameter of the cerebellum and the abdominal circumference (DTC / AC) for the diagnosis of intrauterine growth restriction in gestations older than 20 weeks in the José Carrasco Arteaga Hospital. Methodology: Diagnostic test validity study in pregnant women older than 20 weeks. The estimated fetal weight and the reliable gestational age that was determined according to the ultrasound under 20 weeks were used as a gold test. Indicators of diagnostic validity were obtained. Results: The prevalence of intrauterine growth restriction was 14.7%. The mean age was 29.38. The sensitivity of the DTC / AC ratio was 80% and the specificity was 95%, VVP was 72.92%, VVN was 96.43%, with a cutoff of 15.9 (90% sensitivity and 6% false positives). Conclusion: The diagnostic test presented high sensitivity and specificity for the diagnosis of intrauterine growth restriction, being a useful parameter in the independent diagnosis of gestational age.
Validez de la tomografía multicorte en la invasión local (t) del adenocarcinoma gástrico en pacientes atendidos en el Instituto del Cáncer SOLCA - Cuenca 2010 - 2017
(2018) Parra Segovia, Carolyn Viviana; Ordoñez Anzoátegui, Pedro Fabián; Sarmiento Altamirano, Doris Adriana
Objectives: to determine the validity of multislice tomography in the local invasion (T) of gastric adenocarcinoma in patients treated at the Institute of Cancer Society "SOLCA" center of Cuenca, in the period July 2010 - July 2017. Method and materials: a diagnostic test validation study was conducted with 129 patients, taking histopathology as a gold test. It were reviewed the clinical histories of each patient with a confirmed diagnosis of gastric adenocarcinoma. The variables studied were age, sex, histological type, tumor report, nodule, tomographic metastasis (TNM) given before surgery and / or sample taking for biopsy as well as the degree of invasion reported by histopathology by tumor, nodule, metastasis (pTNM). The data was entered into a database. Information was obtained on sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood indexes. Results: The distribution of gastric adenocarcinoma was similar in both men and women, presenting more frequently in older adults, the intestinal variant was more prevalent. The highest prevalence of T (Tumor) by tomography was in T3 and T4. The highest prevalence for pTNM (pathology) was for pT4. The highest sensitivity of multislice tomography was for T3 and the highest specificity corresponded to T1. The test proved invalid in sensitivity for T2. Conclusion: Multislice tomography is especially useful for diagnosis in stage T3, similar to that reported in published studies
Validez de las escalas predictoras de mortalidad en sepsis abdominal. Hospital Vicente Corral Moscoso. Cuenca- Ecuador 2019
(Universidad de Cuenca, 2021-05-12) Herrera Guerrero, Jorge Estuardo; Sarmiento Altamirano, Doris Adriana
Objective: to determine the validity of the predictive mortality scales in abdominal sepsis in patients in the ICU area of the Vicente Corral Moscoso Hospital. Cuenca - Ecuador, period 2019. Materials and methods: this is a diagnostic test evaluation study, where various scales were applied such as SOFA (Sequential Organ Failure Assessment); GCS (Glasgow coma scale); SAPS (Simplified Acute Physiology Score), MODS (Multiple Organ Dysfunction Score), LODS (Logistic Organ Dysfunction Score); MPM (Mortality Probability Model). The APACHE II (Acute Physiology And Cronic Health Evaluation) scale was taken as the gold test, the population corresponded to 155 patients diagnosed with abdominal-type sepsis. To determine the validity of the tests, the ROC curve, Sensitivity, Specificity and positive, negative, positive LR, negative LR predictive values were used. Expected results: the average age was 60 years, (SD ± 19 years). The most predominant group were the elderly female (51%). The comorbidities were: arterial hypertension (34.20%) and diabetes mellitus (20.60%). The most frequent postoperative complication was pneumonia (25.80%). The most frequent cause of sepsis was cholangitis (26.50%). The LODS scale obtained an area under the curve of 0.96 with S = 96% and E = 82%; SOFA was the one with the lowest S = 78% and E = 71%. Conclusion: the LODS scale was the one with the highest validity in predicting mortality from abdominal sepsis, when compared with SOFA, GCS, SAPS, MODS, MPM.