Volúmen 34 No . 3 (2016)
Permanent URI for this collectionhttps://dspace-test.ucuenca.edu.ec/handle/123456789/26486
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Item Síndrome antifosfolipídico catastrófico(Universidad de Cuenca. Facultad de Ciencias Médicas, 2016-12) Rodríguez- Pintó, Ignasi; Cervera, RicardThe term anti-phospholipid syndrome (APS) “catastrophic” was introduced to define a serious and rapidly progressive form of APS which leads to multi-organ failure. Patients with catastrophic APS have in common: a) a clinical evidence of multiple organ involvement (3 or more organs); b) pathological evidence of occlusion of multiple small vessels (although some patients have also thrombosis of large vessels) and c) confirmation of the presence of anti-phospholipid antibodies (APAs), usually at high titers. Although they represent less than 1% of all patients with APS, they usually found in an urgent medical situation that requires a thorough clinical monitoring and an early and vigorous treatmentItem Sindrome de Coffin-Siris(Universidad de Cuenca. Facultad de Ciencias Médicas, 2016-12) Tacuri Ordóñez, Mayra Pricila; Jaramillo Oyervide, Julio AlfredoThis study describes a case of a 6-years and 9-months- old child, who was attended at the Child Development Center of the University of Cuenca (CEDIUC), with the characteristics of the Coffin-Syndrome. The karyotype 46xy, inv9 (p12q13), determined by clinical features the diagnosis of Coffin-Syndrome. Child product of the fourth pregnancy, prenatal history: threatened abortion; natal history: he born at 38.4 weeks of gestation with a diagnosis of respiratory distress, for this reason he was hospitalized for 15 days in the Intensive Care unit of the Humanitarian clinic; post-natal history: he presented global developmental delay, in addition to other affections such as congenital heart disease and ventricular septal defect. He receives treatment in several centers. The Coffin-Siris syndrome is a rare genetic disease, with a low incidence and for this reason it is not studied enough, it is characterized by mental retardation, delayed psychomotor development, coarse facies, thinning hair and hypoplasia of the fifth finger nail. A comprehensive bibliographic review was performed, and Coffin-Siris syndrome is a rare genetic disease with about 10 cases published in Latin America; the etiology is still controversial, its chromosomal location has not been defined, but some authors have raised a possible autosomal recessive inheritanceItem Características del primer hemograma, al momento del diagnóstico de leucemia linfoblástica aguda, en los niños del Instituto del Cáncer SOLCA-Cuenca(Universidad de Cuenca. Facultad de Ciencias Médicas, 2016-12) Guerrero Quiroz, Enmanuel Isidoro; Peñafiel Martinez, Eulalia Cumandá; Sempértegui Cárdenas, Pablo XavierBACKGROUND: The acute lymphoblastic leukemia (ALL) is the most common type of childhood cancer that affects the blood and bone marrow as a result of abnormal clonal proliferation of a cell group, and contrary to what is popularly believed, it not always debuts with leukocytosis (white blood cells> 10,000). METHODS: it is a descriptive study in which they were evaluated the blood counts from a total of 110 patients with ALL, from 1 to 18 years, treated at the Society for Fight against Cancer (SOLCA) Cuenca, between January 2009 and April 2014. Their demographic characteristics (age, sex, origin) and its number of white blood cells (WBCs), hemoglobin (Hb), platelet, levels of lactate dehydrogenase (LDH), risk group, presence of Philadelphia chromosome and immunophenotype (T or B) were analyzed. RESULTS: The 53% of the patients were children. The average age was 7.9 years. Most served children belonged to the Azuay province. The 50% of patients had leukocytosis at the moment of diagnosis, the 42% Hb less than 8g / dL and 80% lower than 150 000 platelets / L. All children (100%) had a LDH above the normal value (234 U / L). The range was between 600 and 556000 GB/ L with an average of 48 000 GB / L. The 95% presented an immunophenotype B and 5% of patients were positive for Philadelphia chromosome. CONCLUSIONS: After the analysis it was concluded that half of the patients had leukocytosis. Most presented thrombocytopenia and anemia. This information should be considered when reviewing a child’s blood count, because as has been shown and unlike what was thought, leukocytosis is not always present in leukemia. Keywords: Acute Lymphoblastic Leukemia, hyperleukocytosis, blood countItem Validación de la puntuación de apendicitis pediátrica (pas) frente a la escala de Alvarado, para el diagnóstico de apendicitis en niños de 4 a 15 años de edad(Universidad de Cuenca. Facultad de Ciencias Médicas, 2016-12) Tipán Barros, Jonathan Maximiliano; Morocho Malla, Manuel Ismael; Córdova Neira, Fernando Marcelo; Tipán Barros, Tatiana MaribelBackground: The appendicitis is the most common surgical pathology in childhood. It is necessary an agile and accurate method to avoid excessive paraclinical examinations, diagnostic errors and unnecessary appendectomies. The systematic scores are the best processes for ordering clinical manifestations and reach the diagnosis. Objective: To validate simultaneously the pediatric appendicitis score (PAS) and Alvarado scales for the diagnosis of acute appendicitis in children aged from 4 to 15 years old with acute abdomen in pediatric emergencies of a third level hospital in the national health system. Materials and methods: A total of 161 patients aged from 4 to 15 years old were treated at the Vicente Corral Moscoso Hospital in the pediatric emergency service with clinical suspicion of acute appendicitis. They were applied the two scores before the surgery. The diagnosis was confirmed with histology. We compared the diagnostic capacity of PAS and Alvarado, and the proportion of agreement between tests with respect to the gold standard. Results: The sample had a predominance of males. The median age was 12 years, weight 37.5 ± 12.2 kg, height 138.5 ± 15.4 cm and 42% of malnutrition among those that were: emaciation, overweight and obesity. The sensitivity of PAS was higher (97.1 vs 79.8) although with lower specificity (50 vs 59). The negative predictive value of PAS was higher (73.1 vs 31.7). The agreements between histology and tests were higher for PAS (90.7% vs 74.5%). The 99% of phlegmonous appendicitis belonged to PAS and the 84% to Alvarado. More false negatives were produced with the Alvarado score (P <0.001). Conclusion: The PAS score is a reliable and easy diagnostic tool to use for deciding on acute appendicitis surgery suspected in children. Until the conclusive evidence is available, the use of both scores should be considered as a good clinical practiceItem La Psicología de la salud como enfoque de intervención comunitaria(Universidad de Cuenca. Facultad de Ciencias Médicas, 2016-12) Arias Rivera, Shirley JeannetThis work of Participatory Action-Research, systematizes the experience developed in fifteen urban-marginal communities of Guayaquil city and in close cantons during the second half of 2014 and 2015. Objective: To carry out a diagnostic-community intervention since the health psychology approach to the promotion of healthy behaviors. Materials and Method: It was divided into three stages. In the first one, the information was collected to describe the community. In the second, the community intervention was designed and implemented. In the third stage its evaluation was done. The instruments used were: observation records, an interview guide, a diagnostic matrix and a community intervention guide. Conclusions: An integral health, safety and community organization are the basic aspects of the community proposal to improve the quality of life. Keywords: Behavioral Medicine, Consumer Participation, Quality of Life, Social GroupItem Neurodesarrollo en el hipotiroidismo congénito y sus particularidades electroencefalográficas(Universidad de Cuenca. Facultad de Ciencias Médicas, 2016-12) Calle Ulloa, Boris Eduardo; Calle Saquipay, Ángel Domingo; Hurtado Matute, Johanna Alexandra; Cobos Castro, Johanna Elizabeth; Pinos Brito, María CarmenCongenital hypothyroidism (CH) is a result of a deficiency of thyroid hormone (TH) by altering thyroid (primary hypothyroidism), or pituitary causes (secondary hypothyroidism) or hypothalamic (tertiary hypothyroidism). Thyroid hormone at the tissue level, is involved in the maturation and functional differentiation of various organs such as the development of the central nervous system (CNS), in which an insufficient supply of HT in time and place, resulting in permanent abnormalities, history highlighting the irreversible intellectual deficit. In the world’s population it has been estimated a frequency of 1: 300 to 1: 4000 newborns. The treatment is oral supplementation with thyroxin. OBJECTIVE: To describe the neurodevelopmental congenital hypothyroidism and electroencephalographic characteristics. MATERIALS AND METHOD: It is an observational, descriptive and cross-sectional study in preschool children diagnosed with HC, who were administered the Denver II scale, a comprehensive neurological evaluation and a digital electroencephalogram. RESULTS: A total of 12 patients, 7 (58%) female and 5 (42%) males were evaluated. All patients were evaluated by the scale of Denver II, 4 (33%) were delayed in their psychomotor development, predominantly in the language area. Regarding the neuro-pediatric assessment was found that 5 patients had neurological manifestations and perform digital electroencephalogram 7 (59%) had electroencephalographic changes, 5 (71%) showed immaturity and 2 (29%) dysfunction. CONCLUSIONS: Afer the analysis made throughout this investigation, the conclusions are: The results of this study show a heterogeneous pattern, however target the possible association between clinical manifestations and electroencephalographic findings. Patients with congenital hypothyroidism present a condition in the area of language which was determined by applying the scale Denver II. The abnormal clinical manifestations are mainly in the verbal area, but they are also presented as subtle manifestations or unspecific as inattention, irritability and behavioral disorders. Keywords: Congenital Hypothyroidism, Neurodevelopmental Disorders, Neurologic Manifestations, electroencephalographyItem Valor diagnóstico de la técnica del bloque celular frente a la citología convencional en fluidos corporales Solca-Cuenca 2007- 2008(Universidad de Cuenca. Facultad de Ciencias Médicas, 2016-12) Palta González, Miroslava Araceli; Murillo Bacilio, Rocio Magdali; Correa Martínez, Fabián GerardoAnatomy-pathological diagnosis of neoplastic diseases is performed through the morphological study, either by cytological or histopathological methods, which were supplemented in necessary cases by other procedures or additional techniques. The cytological differentiation between benign and malignant cells in serous fluids and in fine needle aspiration biopsies is often difficult in daily practice. The technique of the cell block is important to be able to reveal tumor cells in samples that have been reported as negative for malignancy by conventional cytological methods, since it is a methodology that allows the use of immunohistochemistry. Objective: Analyze the diagnostic value of the cell block technique in pathological body fluids and fine needle aspiration biopsies in the Department of Pathology of the SOLCA-Cuenca Cancer Institute. Period June 2007 - March 2008. Methods: It is a descriptive correlational study between conventional cytology and cell block. A total of 56 cases from peritoneal lavage fluids were included; ascites fluid, pleural, intratumoral, biliary, BAAF of mammary gland, thyroid, ganglion, vaginal duct, pancreatic tumor and physiological samples such as urine; who were cyto-centrifuged in the Cytospin team and cell block technique. Results: With the Cytospin technique there were inconclusive cases for diagnosis, while with the cell block technique (CB) they were not present. The cell block technique was found in 28.5% of malignant neoplastic cases and with 10.7% in conventional cytology. The 30.5% were asked for immunohistochemical techniques to define the neoplastic origin, being the majority from the gastrointestinal and pulmonary tract. Conclusions: The cell block technique should be a routine procedure in the cytology section. The usefulness of the cell blocks is due to its simplicity, and on the other hand it contributes specificity, since it allows evaluating aspects such as the architecture of the sample, and performs techniques of cytochemistry and immunohistochemistry presenting an optimal quality for its interpretationItem Mitomicina C: una nueva alternativa para la estenosis de cuello vesical(Universidad de Cuenca. Facultad de Ciencias Médicas, 2016-12) Olmedo, Tomas; Hidalgo, Juan; Reyes, Diego; Marchant, Fernando; Ledezma, Rodrigo; Aliaga, Alfredo; Fleck, Daniela; Castro, Iñaki; Barahona, Jaime; Abad Vázquez, Jaime PatricioIntroduction: The mitomycin C is a chemotherapeutic agent by virtue of its antiproliferative and antibiotic activity. We evaluated the outcome of endoscopic radial cervicotomy combined with intralesional mitomycin C injection for the treatment of severe bladder neck stenosis after traditional treatment failure. Materials and methods: It was a retrospective review of patients with severe bladder neck stenosis who had a surgery between July 2013 and August 2015 with mitomycin C. The 54.5% of patients had failed at least 1 time with internal cervicotomy and/or endoscopic resection of the bladder neck. In our intervention, three or four endoscopic incisions were performed with a cold cut in the neck of the bladder, followed by intralesional injection of 0.3 to 0.4 mg / ml of the mitomycin C at each incision site. Results: A total of 11 patients were treated with endoscopic incision with a cold cut in the neck of the bladder combined with mitomycin C injection. Before the surgery 4 patients (36%) were cystostomy users. At a mean follow-up of 9 months (range 1-20), 9 patients (82%) had spontaneous urine after 1 procedure, while 2 patients (18%) achieved this goal after 2 procedures using mitomycin C. Conclusions: The treatment for bladder neck stenosis with endoscopic radial cervicotomy with cold cut combined with intralesional mitomycin C injection resulted in bladder neck permeability in 82% of patients after 1 procedure and 100% after 2 procedures. Although the first results are promising, some prospective and randomized studies with long-term monitoring are required to validate these findingsItem Situación de salud de los médicos especialistas graduados en la Universidad de Cuenca, años 2004 - 2013(Universidad de Cuenca. Facultad de Ciencias Médicas, 2016-12) Ortiz Segarra, José Ignacio; Ortiz Mejía, José StalinOBJECTIVE: To describe the health situation of graduates and medical specialists who graduated in the Faculty of Medical Sciences of the University of Cuenca during the years 2004 to 2013 and their relationship with working conditions. METHODS: A cross-sectional study was carried out using a validated self-administered form by 102 medical specialists after informed consent; also conducted interviews with key informants and review of documentary sources were done. The descriptive statistical analysis was performed using frequencies and percentages, and for the calculation of the probability of association between self-perception of health and working conditions, the Multivariable Logistic Regression was used through the SPSS v-20 program. RESULTS: The health status of medical specialists was characterized by a self-perception of the health between regular and bad in 22% with risk to suffer any health mental problem (13%), very little physical activity (33%) people who practice any sport less than one time per week or nothing (64%), inadequate food (47%), presence of pain (72%), diseases provoked or aggravated by work (25%), occupational accidents (7%), consumption of analgesics (40%). A good and very good self-perception of health are associated in a statistically significant way with family economic support (OR 3.20, 95% CI 1.18 - 8.70), live with relatives (OR 4.58, 95% CI 1.49 - 13.99), and decision on when to rest (OR 5.37; 95% CI 2.19 to 13.17). The health mental risk is significantly associated with changes in wages (OR 5.12, 95% CI 1.46 - 17.93). CONCLUSIONS: The self-perception of good health depends on family support and rest, and the health mental risk is associated with changes in wages