Tesis Especializaciones (Ciencias Médicas)

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Caso clínico 1: hernia diafragmática postraumática, Caso clínico 2: hernioplastia insicional lumbar
(Universidad de Cuenca, 2023-06-15) Castro Palaguachi, Verónica Graciela; Quichimbo Sangurima, Fausto Marcelo
Introduction: Diaphragmatic hernias are defined as the passage of abdominal organs into the thoracic cavity through a defect in the diaphragm, sometimes resulting from severe trauma, constituting a surgical challenge. Thoracoabdominal incisions are commonly used for various thoracic and vascular cases, although they are rarely used for diaphragmatic hernias, which are usually repaired by laparotomy, thoracotomy or minimally invasive approaches. Case report: We present the clinical case of a 25-year-old patient with a history of penetrating stab wound trauma 4 years ago, who came to the emergency room with diffuse abdominal pain diagnosed on admission as acute partial subocclusive abdomen treated surgically by exploratory laparotomy with surgical findings of non-diseased appendix and ileus, with torpid evolution 5 days later he presented respiratory difficulty, chest x-ray was performed showing left pleural effusion, treated with pleural drainage obtaining fecaloid liquid of approximately 1500ml volume, so it was decided to perform an urgent thoracotomy finding perforated diaphragmatic hernia + pleural empyema + necrosis of the splenic angle of the colon, diaphragmatic herniorraphy + pleural cavity lavage + decortication + pleural drainage + laparotomy + resection of the splenic angle of the colon + end-to-end anastomosis + peritoneal peritoneal cavity lavage + peritoneal cavity lavage + pleural drainage + peritoneal anastomosis + peritoneal anastomosis terminal anastomosis + peritoneal cavity lavage + Jackson Pratt drain placement Results: Patient remained hospitalized for 43 days, presented as a complication pachyepleuritis left empyema reintervened by left lateral thoracotomy, evolving favorably after receiving treatment with intravenous is discharged home in good condition. Introduction: Lumbar hernia is the rarest of all abdominal wall hernias and represents only 0.2% of all hernias. About 20% are congenital, mainly secondary to embryonic development defects, while 80% are acquired.1,2 The most recent literature recommends the laparotomy approach with the use of prosthetic materials as the most appropriate, so the procedure is fast, easy, and safe.2,3 Clinical case: A 46-year-old patient with a history of left radical nephrectomy by lumbotomy approach in 2021, who presents moderate intensity pain and sensation of mass protrusion in the left lumbar region. The physical examination showed a wall defect of approximately 10 cm diameter throughout abdominal content protruded at repose and before Valsalva maneuvers, but it was also reducible by external compression. Simple and contrast-enhanced computerized axial tomography (CAT) of the abdomen and pelvis reported a hernial defect at the left lumbar level with omental content of approximately 8x7cm without compromise of vascularization. A lumbar insicional hernioplasty was performed with a double mesh technique, “sandwich” type, one of them placed intraperitoneal and the second retromuscular. Conclusion: Surgical repair by open approach of hernial defects at the lateral level, using double mesh (intraperitoneal and inframuscular) “sandwich” type, is a safe technique and with satisfactory results in those patients with a defect greater than 5 cm with a bad quality aponeurosis.
Determinación preanestésica del volumen gástrico por ecografía en apendicectomías. Hospital José Carrasco Arteaga. Cuenca, 2020 – 2021
(Universidad de Cuenca, 2022-03-14) Benavides Calle, Daniela Fernanda; Palacios Reinoso, Carlos Santiago
Background: Breathing of gastric contents into the airways is a serious complication that can occur during local anesthesia; especially in emergency surgeries, such as appendectomies, where preoperative fasting is not always reliable and it is considerade full stomach. Ultrasound is a useful tool to measure gastric volume, predicting the risk of breathing into the airways, and to choose accurate anesthetic management. Objective: To determine the preanesthetic gastric volume by ultrasound in patients who are going to undergo appendectomy at the José Carrasco Arteaga Hospital. Methods: A descriptive observational study. The population consisted of adult patients undergoing appendectomy at the José Carrasco Hospital. The sample was calculated according to an unknown universe, obtaining 174 participants. The results were processed in SPSS V27, and expressed in measures of frequency, central tendency and dispersion according to the type of variable. A histogram was used for a general visualization of the behavior of the gastric volume. Results: the majority of patients were men, between 30 and 39 years old, overweight and ASA 1. The mean gastric volume was 41.88 ± 23.92 ml The average fasting time was 9.5 hours, 42.5% took clear liquids for the last time. 21.3% are considered to have “at risk stomach” condition and 1.7% have high risk of breathing into the airways. There was a change in anesthetic induction in 4.6%. Conclusions: the gastric volume measured by ultrasound was highly variable, the majority of patients had a low risk of aspiration and no association was found with any pharmacological or pathological factors that alter gastric emptying.
Embarazo en adolescentes y factores asociados individuales, familiares y sociales: una revisión sistemática
(Universidad de Cuenca, 2022-02-09) Ramón Granda, César Fernando; Mogrovejo Guzmán, Marilupe Josefina
Background: worldwide, adolescent pregnancy rates are on the rise, especially in developing countries, leading to negative effects on the biopsychosocial sphere of adolescents and their family environment. Objective: to determine the association between adolescent pregnancy and individual, family and social factors. Methodology: a systematic review was conducted, the search was performed in five electronic databases: Pubmed, Sciencie Direct, Scielo, Redalyc and Latindex, and the MeSH (Medical Subject Headings) terms "Teen pregnancy" or "pregnant teen" and the Health Sciences Descriptors (DeCS) "teen pregnancy" or "pregnant teen" were used. Nineteen studies were included, published from 2015 to 2020, with quartiles of the (Scimago Journal & Country Ranking) from 1 to 4, in English, Spanish and Portuguese. Results: It was found that risk factors such as family dysfunction and household poverty were statistically significantly associated with adolescent pregnancy. Other factors that were associated were early initiation of sexual relations, lack of knowledge of contraceptive methods, low level of education, being a resident of rural areas, and low level of education of the parents. Conclusion: This review emphasizes that individual, family and social factors are associated with adolescent pregnancy. Limitations: most of the publications required subscription and prior payment, so we opted for other databases, such as Pub Med and Scielo.
Determinación de los niveles basales de Co2 espirado mediante capnografía, en pacientes quirúrgicos. Hospital Vicente Corral Moscoso. Cuenca, 2019-2020
(Universidad de Cuenca, 2021-07-09) Tigre Cuenca, Daniela Soledad; Cevallos Sacoto, Francisco Antonio; Morales Sanmartín, Jaime Rodrigo
Introduction: In anesthesiology and in critically ill patients, it is necessary to maintain the levels of carbon dioxide (CO2) in normal parameters, whose alteration influences morbidity and mortality. The pressure values of CO2 and Exhaled CO2 (ETCO2) have been shown to vary depending on atmospheric pressure. In the city of Cuenca at 2560 meters above sea level (masl), there is still no study that establishes normal values. Objective: To determine the basal levels of expired CO2 in surgical patients at the Vicente Corral Moscoso Hospital. Methodology: An observational, descriptive study with 534 patients without comorbidities, who underwent surgery at the Vicente Corral Moscoso Hospital in Cuenca Ecuador. To collect data, a thermometer, barometer, humidity sensor, vital signs monitor and capnograph were used; they were recorded in a form, they were analyzed in the IBM SPSS version 22 software with descriptive statistics. Results: The mean expired ETCO2 was 28.36 ± 1.81 mmHg, 95% CI (28.277 - 28.434). Alveolar pressure was 68,116 ± 3,897 95% CI (28,277 - 28,435). There was a significant difference (p <0.05) in the CO2 means according to respiratory rate, mean arterial pressure and whether it was elective or emergency surgery. Conclusions: There is agreement with other studies that indicate that the higher the ETCO2 levels are lower, the range obtained could be taken into account as a reference for the adequate management of ETCO2 in the inhabitants of this geographical area.
Evaluación de la Escala de Alvarado versus Score de respuesta inflamatoria de la apendicitis, Hospital José Carrasco Arteaga 2018
(Universidad de Cuenca, 2020-02-20) Rodas Andrade, Jorge Roberto; Ordóñez Cumbe, Julio César
Background: acute appendicitis is a common disease in the environment, characterized by abdominal pain, but which often occurs with atypical clinical tables that delay its surgical treatment or discard it; so, it is necessary to have an easy and useful tool that allows the timely resolution of this pathology. Objetive: assess the usefulness of the Alvarado Scale versus the Inflammatory Response of Appendicitis (AIRs) in the diagnosis of Acute Appendicitis Method and Materials: a diagnostic test validation study was conducted to compare the AIR and Alvarado scales, considering the results of pathological anatomy as a gold test. 292 patients were included at the José Carrasco Arteaga hospital during 2018. For statistical analysis, sensitivity, specificity, positive predictive value, negative predictive value, ROC curve and likelihood Ratio were obtained. Results: 49.7% of the participants are in the age group of young adults, with male predominance (62.7%), married marital status 63%, mixed ethnicity 91.4%, secondary education 58.6%. The Alvarado scale had a sensitivity of 88.5%, specificity of 29.6%, positive predictive value of 81% and negative of 42%, an LR + of 1.23 and a LR – of 0.38; that were lower than those recorded by AIR of 94.7% (sensitivity), 76.5% (specificity), positive predictive value 93%, negative predictive value of 80%, LR + 4.02 and one LR – 0.07. The area under the ROC curve of the AIRS was 0.897, higher than that of Alvarado of 0.611; conferring on the first scale greater diagnostic accuracy. Conclusion: the AIR Score has a higher specificity, positive predictive value and negative predictive value, in addition showed better diagnostic effectiveness than Alvarado's score in diagnosing acute appendicitis.
Hiperuricemia asociada a complicaciones materno-fetales en pacientes con preeclampsia, Hospital Vicente Corral Moscoso, Cuenca, 2017
(2019) Martínez Espinoza, Bárbara Belén; Sarmiento Tapia, Nimrod Ludim; Vintimilla Maldonado, Jaime Rosendo
Objective: To determine the association between hyperuricemia and maternal and fetal complications in women from 28 weeks of gestation, diagnosed of preeclampsia and hospitalized in the Department of Obstetrics of the Hospital Vicente Corral Moscoso, during the year 2017. Materials and Methods: A cross-sectional study was carried out in a sample of 185 preeclamptic patients. The sample size was calculated with 95% confidence, 14% prevalence of HELLP syndrome, 5% inference error; the patients entered the study sequentially. The data were taken directly and analyzed with the SPSS software, version 15. The magnitude of the risk was performed with the prevalence ratio and its 95% confidence interval, and the significance with the Fisher exact test, correction of Yachts and the Chi square. Results: Age fluctuated between 15 and 45 years, 42% lived in free union, 51% resided in urban areas; the number of gestas varied between 1 and 11; the termination of pregnancy was between 28 and 41 weeks, with cesarean section being the main route. The prevalence of hyperuricemia was 36.8% (95% CI: 29.9-43.5). A significant association of hyperuricemia with eclampsia (RP 2.83, 95% CI: 2.32-3.44 and corrected p-value 0.017), low weight (RP 2.28, 95% CI: 1.57-3.31 and p-value 0.000) and prematurity (RP 1.73, 95% CI: 1.17-2.57 and p-value 0.017). Conclusions: The prevalence of hyperuricemia is lower than that found in other studies. High values of uric acid can predict the development of complications such as eclampsia, low birth weight and prematurity.
Enfermedad diverticular diagnosticada por tomografía computarizada multidetector y factores asociados. Hospital José Carrasco Arteaga. Cuenca, 2018
(2019) Rendón Ortiz, María Amada; Sanclemente Villavicencio, Jessica Patricia
Background: diverticular disease is defined as the presence of herniations through the muscular layer of the colon, as well as the inflammation of the same. The multidetector computed tomography study is the best imaging test to assess the presence or absence of diverticular disease, diverticulosis, diverticulitis and its complications. Objective:to determine the prevalence of diverticular disease diagnosed by multidetector tomography and associated factors in the Hospital of José Carrasco Arteaga, in the city of Cuenca during the year 2018. Materials and methods: Analyticalcross-sectional study, the study was conducted in 224 patients, prior the signing of the informed consent, the data were obtained from the clinical history, by interview and the result of pelvic abdominal tomography in patients with abdominal pain under study, subsequently they were entered in a collectionf orm and analyzed with the SPSS software. Results: The ages were in the range of 18 to 92 years with a mean of 55.26 (± 18.584), being the female sex the predominant one (64.70%). The prevalence of the disease diagnosed by tomography was 55.80%, of which only 6.70% corresponded to diverticulitis. Conclusions: The prevalence of the disease diagnosed by tomography was 55.80%. The most frequent location of diverticulosis was the sigmoid colon, followed by the descending colon. Diverticulitis was located in both the sigmoid and descending colon in the same percentage. The factors associated with constipation, obesity, sedentary lifestyle and family history were statistically significant for the presence of the disease.
Quistes renales simples diagnosticados con tomografía multidetector y factores asociados. Hospital José Carrasco Arteaga. Cuenca, 2017
(2019) Revelo Villacrés, Alex David; Castillo López, Jorge Luis; Beltrán Carreño, José Patricio
Background: Simple renal cysts are closed sacs that have a thin and smooth wall, contain liquid, which is homogeneous, with a density similar to water, whose clinical significance is still uncertain. Objectives: To determine the prevalence of simple renal cysts diagnosed with 64-channel multidetector tomography and associated factors in the José Carrasco Arteaga Hospital. Methodology: An analytical cross-sectional study will be carried out, with the patients that go to the area of Imaging for the performance of a tomographic study of simple abdomen, in a simple random sample of 416 patients, during the period January-December 2017. The exam was carried out with a 64-slice Multidetector Tomography. Results: The prevalence of simple renal cysts was 22.11%, with a mean age of 51.3 ± 16.2 years, of which the male sex represented the highest proportion (58,73%). The simple renal cyst was more frequently unilateral (77,17%), and predominantly localized to the right side and peripherally (86,95%). The majority had a size smaller than 20mm (64,13%), in addition the average diameter of the largest cyst was 19,18 ± 14,75 mm, with a range of 3 to 66 mm. We found a significant association of simple renal cysts with type 2 diabetes mellitus (p = 0.020), arterial hypertension (p = 0.000) and decreased renal function (p = 0.000). Renal lithiasis did not present statistical significance (p = 0.120).
El machismo en la conducta sexual y reproductiva de los adolescentes varones escolarizados de la parroquia de Nulti-Azuay 2015
(Universidad de Cuenca, 2017-11-11) Zhañay Condo, Wilson Esteban; Vega Crespo, Bernardo José
Background: Machismo or sexist attitudes in adolescence can be precursors of behavior of superiority or violence against women in adult life, so its identification becomes important in the adolescence. Objective: To determine factors associated with machismo in the sexual behavior of adolescent students in Nulti Parish. Azuay 2015 Methods and materials: We conducted a quantitative, cross-sectional and analytical study in 160 male students in the parish of Nulti, Azuay 2015. The EMS-Sexism-12 instrument was applied to determine the machismo scale. Quantitative variables with normal distribution were expressed as mean and standard deviation, while those with non-normal distribution were expressed as medians and interquartile range. Quantitative ones were represented as absolute and relative frequencies, bivariate analysis was performed to determine risk factors for high machismo. Results: The average machismo scale was 25, 48±6, 68 points. We found a greater scale of machismo in adolescents with relationships, and a greater number of them in those who referred the use of condoms. In the same way it is associated the person with whom their first sexual intercourse took place, and the familiar functionality with a machismo level. According to the evaluated factors, the presence of a relationship, and the presence of a non-functional family were the factors that showed a significant risk for high machismo. Conclusions: The presence of relationships is a factor related to a higher machismo in male adolescents. The presence of a relationship, the person with whom their first sexual intercourse took place, and the belief that condoms prevent sexually transmitted diseases, were associated
Relación entre los factores biopsicosociales, funcionalidad familiar y la prevalencia de sobrepeso y obesidad en niños escolarizados de 5ª 9 años de la parroquia de Machángara, durante 2015-2016
(Universidad de Cuenca, 2017-11-11) Gómez Arias, Ana Cecilia; Palacios Espinoza, Elvira del Carmen
Objective. To determine the relationship between biopsychosocial factors, family functionality, overweight, and obesity in schoolchildren aged 5 to 9 years of the Machángara parish 2015-2016. Methods and materials. A mixed study was conducted: the BMI with WHO / MSP tables, the questionnaire and the FF-SIL family function test were used in the quantitative part to describe the characteristics of the population and the relation with the associated factors. In the qualitative part, we described the parents' perceptions regarding family, overweight and obesity food practices and their relationship. Results. The prevalence was 17.6% of overweight and 12.4% of obesity, and a statistically significant positive association was found when the number of siblings was 2 or less (RP 1.7 CI 95% 1.089-2.936). There was no statistically significant association, but overweight in children was more frequent, when there was a history of obesity in the parents, in those who did little physical activity and in those who used new generation technologies more than 2 hours a day, in the type of obesity. Nuclear family, and functional families. The parents' perception of overweight and obesity was related to family feeding practices and knowledge of obesity. Conclusions. Overweight and obesity were associated with the number of siblings with a risk of 1.7 times higher if the family had up to 2 children
Densidad óptica en embarazadas normales y madurez pulmonar fetal. Estudio en el líquido amniótico. Hospital Vicente Corral Moscoso. Cuenca -Ecuador 1999
(Universidad de Cuenca, 1999-11-11) Ortega Cueva, Fausto Germán; Ulloa Maurat, Jaime Patricio; Cárdenas Herrera, Oswaldo José; Quito Riera, Lauro Bolívar
Colecistectomía temprana versus diferida posterior a pancreatitis aguda biliar leve en el “Hospital Vicente Corral Moscoso” enero 2014 - junio 2015
(2015) Andrade Gómez, Jorge Andrés; Salamea Molina, Juan Carlos; Tenezaca Tacuri, Ángel Hipólito
Introduction: Acute pancreatitis is the third common cause of acute gastrointestinal hospitalization. It has 5% of mortality rate. In most Western countries approximately 30-55% of cases are caused by gallstones or biliary sludge called gallstone pancreatitis. Cholecystectomy has been established as definitive treatment of biliary pancreatitis but the optimal timing is still in debate. Objective: To determine the benefits and complications of early cholecystectomy versus delayed cholecystectomy to subsequent biliary mild acute pancreatitis in the HVCM Surgery department during January 2014 to June 2015. Materials and methods: Prospective descriptive comparative research. Universe of 79 patients from 18 to 75 years that evaluated advantages and disadvantages of early cholecystectomy versus delayed after mild acute biliary pancreatitis. Descriptive analysis was conducted of statistical variables in SPSS version 21. Results: 49 corresponded to early cholecystectomy group 30 to delayed group. The female was most affected in 21 to 50 years group. Hospital stay was lower in the first group (mean 3.8 days, p <0.000). Surgery time was less than 60 minutes in early cholecystectomy. Inflammatory adhesions were presented in both groups. Timing of cholecystectomy does not affect the number or type of intraoperative complications. Conclusions: Early cholecystectomy (<72h admission) in the management of patients with mild gallstone pancreatitis has led to a significant reduction in hospital stay without increasing complications
Eficacia y seguridad del sulfato de magnesio como coadyuvante en la analgesia postoperatoria de histerectomía abdominal, bajo anestesia general balanceada. Hospitales Vicente Corral Moscoso y José Carrasco Arteaga. Cuenca. 2013
(2016) Ilbay Gómez, Ana del Rocío; Viteri León, Octavio Enrique; Morocho Malla, Manuel Ismael
Background: this becomes a pressing problem in Ecuador, where there are still inconclusive aspects to be considered. Objective: to determine the effectiveness and safety of intravenous magnesium sulfate as an coadyuvant to postoperative analgesia for abdominal hysterectomy under general anesthetics. Vicente Corral Moscoso Hospital and Hospital José Carrasco Arteaga Cuenca, 2013. Material and Methods: a clinical, randomized, single-blind study was performed; it was formed by two equal groups of 78 patients that were scheduled for abdominal hysterectomy. Group "A" was administered 50mg / kg Magnesium sulphate, and 15 minutes of balanced general anesthesia. In addition, analgesics such as tramadol 2 mg / kg at the time of aponeurotic closure; after that 1 mg / kg was first given every 6 hours during postoperative care and after that ketorolac 30 mg trans-surgical.; while "Group B" was given balanced general anesthesia using the before mentioned parameters with the exception of administering magnesium sulfate. Pain intensity was measured by visual analog scales. Results: group A showed mild pain average 3.76 + 1.22 compared to the group B which recorded moderate pain average 5.05 + 1.42; this difference is statistically significant up to 4 hours postoperatively with p = 0.000. No group reported cases of anaphylactic reaction, hypotension; nausea, vomiting or respiratory depression: bradycardia occurs in the two groups, having no significant statistical difference. Conclusions: magnesium sulphate proved effective as adjunctive analgesia until 4 hours postoperatively, its administration is safe
Prevalencia de depresión y factores asociados en los estudiantes de medicina de la Universidad Católica de Cuenca. 2014
(Universidad de Cuenca, 2015-11-11) Solórzano Bernita, Rosa Elizabeth; Pacurucu Castillo, Saúl Francisco; Mosquera Vallejo, Lorena Elizabeth
MAIN OBJECTIVE: To determine the prevalence of depression and associated factors in students of the Faculty of Medicine, Catholic University of Cuenca 2014. MATERIALS AND METHODS: We performed a cross-sectional study. The universe was 1373 students enrolled in the Faculty of Medicine, Catholic University of Cuenca. The sample consisted of 195 students was obtained by simple random sampling and calculation based on the 95 % confidence. Test of Hamilton and socio demographic form was used for data collection. The information collected was analyzed in the program SPSS statistical measures as frequencies, percentages, OR, 95% CI and p value < 0.05 was used. RESULTS: A total of 195 students were included in this review, mean age 21 ± 3 years; Women were 59%, and 41% men. In types / levels of depression mild depression predominance with a percentage 33.8% (CI 95% 0,27- 040). The association between depression and sex provided a OR 0.378, 95% CI 0,209- 0.684 and p = 0.001, with the other factors was no statistical significance. CONCLUSION: The prevalence of depression was 47.7% (95% CI 0.41- 0.55) found a significant association with sex.
Prevalencia de enfermedad arterial periférica y factores asociados en clubes de pacientes con diabetes mellitus tipo 2, Cuenca 2014
(Universidad de Cuenca, 2015-11-11) Palacios Quezada, Marco Vinicio; León Astudillo, Edgar José; Morocho Malla, Manuel Ismael
Objective: To determine the peripheral arterial disease prevalence and its related factors in type 2 diabetes people from the primary care diabetic patients clubs from Ministry of Public Health in the urban area from Cuenca city, 2014. Methods: Cross-sectional study in a calculated sample with an infinite universe, based on the 95% confidence inference with an error of 4.5% and lower expected prevalence of 10%. Diagnosis established by determining the ankle brachial index with a bidirectional vascular doppler examination with an 8 MHz probe EZ8 or VP5HS 5 MHz probe for edematous extremities, with the technique from American Heart Association 2012. Results: 254 patients were included with a mean age of 63.6 ± 11.4 years, predominantly female (70.3 %). The prevalence of peripheral arterial disease was estimated to be 47.2; 95% CI 41.1 - 53. 3 with significant association for a diabetes mellitus evolution of ≥ 5 years (OR 2.06; 95% CI 1.15 - 3.68, p = 0.015). 58.6 % of the population had a concomitant diagnosis of hypertension. The lipid profile values were close to the recommended ranges, the Glycosylated Hemoglobin A1c average value was 9.2 ± 2.7 %. Conclusions: The estimated prevalence of peripheral arterial disease is similar to that reported Studies with the ankle brachial index as a diagnostic criteria and was associated statistically with a diabetes duration for 5 years or more.
Evaluación de la calidad de atención de salud que reciben los pacientes geriátricos en el Hospital José Carrasco Arteaga IESS Cuenca 2006-2007
(2007) Ballesteros Guillén, Mercy del Pilar; Rosales Avila, Glenda Graciela; Cabrera Cárdenas, Carmen Lucía; Merchán, María Gerardina
Valoración del Test de Alvarado en el diagnóstico dudoso de la apendicitis aguda. Hospital Vicente Corral Moscoso y José Carrasco Arteaga. Cuenca, octubre del 2002 a abril 2003
(2003) Delgado Pauta, Jorge Antonio; Zaldúa Reyes, Jorgito Antonio; Figueroa Morales, Francisco Efraín; Maldonado Sánchez, Luis Rogelio
Antibiótico profilaxia perioperatoria en colecistitis aguda
(1990) Clavijo Campos, Hidalgo Leoman; Moscoso Abad, Teodoro Enrique; Cañizares Aguilar, Aurelio Ernesto
Tratamiento de la incontinencia urinaria de esfuerzo con ejercicios de Kegel: hospitales Vicente Corral Moscoso y José Carrasco Arteaga, Cuenca 2003
(2004) Andrade Cedillo, Janeth del Cisne; Molina Novillo, Javier Alonso; Morales Sanmartín, Jaime Rodrigo
Dosis vs volumen de 75 mb de L-bupivacaina + 100 mcg de fentanil en anestesia epidural para cesárea. Hospitales José Carrasco y Vicente Corral, Cuenca 2009
(2010) Morocho Malla, Rosa Balbina; Vega Crespo, Bernardo José; Orellana Cabrera, Iván Eladio

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