Medical-Scientific Journal CAMbios HECAM
The CAMbios HCAM Medical-Scientific Journal evidences the investigative work of health professionals, oriented to improve and increase scientific production, as well as building a critical citizenry that knows that the structural change of society is in human talent and trusts the quality professionals who work with scientific rigor in this hospital and combine their professional practice with studies and research, for the advancement of science.
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Enfermedad Inflamatoria Intestinal: Nuevos desafíos
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Citizen Perceptions on Public Health Communication Management in the fightagainst chronic childhood malnutrition in Ecuador
Chronic childhood malnutrition affected 27% of children under 5 years of age in Ecuador, posing a significant obstacle to the country’s well-being and social and economic development. Public health communication proved essential in addressing this problem, enabling education, building trust, and mobilizing the community. However, structural and cultural barriers hindered its effectiveness. The study’s objective was to analyze community perceptions of the communication strategies implemented to combat chronic childhood malnutrition, assessing their strengths and areas for improvement. To this end, a systematic review was conducted using the PRISMA methodology, searching various databases, including PubMed, Scopus, and SciELO, as well as reports from institutions such as the Ecuadorian Ministry of Public Health, the WHO, and UNICEF, with publications published between 2018 and 2024. Three key dimensions were identified: accessibility of messages, cultural adaptation, and trust in institutions. Although the clarity of the messages and the use of digital media were highlighted, cultural and linguistic barriers, especially in rural and indigenous communities, limited the impact. A lack of trust in institutions and insufficient adaptation to local contexts also hampered the strategies’ effectiveness. Upon completion of the work, it was recommended that interventions be improved with an inclusive and culturally appropriate approach that fosters collaboration with community leaders and intersectoral policies.
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CALIDAD DE VIDA DE LOS RESIDENTES DEL HOSPITAL CARLOS ANDRADE MARÍN
The work performed by medical residents is characterized by long working hours after stressful conditions, and in many occasions, few sleeping hours. In the last few years there has been increasing concern to evalúate whether the quality of care provided to patients and the residents’ medical training are affected under these conditions. There are increasing worries about long working and teaching hours residents have to endure. In this study we performed a description of the quality of life of the medical residents in clinical, surgical and critical areas in Carlos Andrade Marin Hospital, using a validated questionnaire. These findings could lead to implementing benefits to júnior doctors and improving the quality of care patients receive.
COMPLICACIONES EN SALA DE OPERACIONES DEL HOSPITAL CARLOS ANDRADE MARÍN. DE DICIEMBRE 2011 A NOVIEMBRE 2012
The Anesthesiology is a strong medical - surgical specialty. It views the patient from the perioperative standpoint, integrating the anesthesiologist in preoperative evaluation and preparation. The likelihood of complications in the operating room is directly related to the pathology and the clinical condition of the patient for surgery. According to OMS, we intervene surgically to 4% of the world’s population (234 million). Seven million of these surgeries have complications or adverse outcomes, and one million of them die during or immediately after surgery. A descriptive study was conducted at Hospital Carlos Andrade Marín (HCAM) to report the num ber of complications in the operating room during one year. The num ber of surgical procedures performed in the operating room HCAM in the period December 2011 to November 2012 was 18,246. 14,113 were scheduled surgical procedures and 5950 were emergencies procedures. There were 25 cases, (0.13%) or complications related to incidents, 15 (0.1%) cases occurred within scheduled surgeries and 10 (0.16%) cases in emergency surgeries. Mortality was 28% (7 deaths), of which 3 cases were related to anesthetic management, namely aspiration in patients with intestinal obstruction and in poor condition (1,16:10.000 cases) who died in days of surgery, the remaining cases have been linked to other causes not necessarily related to anesthesia (2,19:10.000 cases). It can be concluded that there is not a culture of reporting complications, either for fear of criticism or simply careless, skewing the data and information provided.
Hospital de Especialidades Carlos Andrade Marín
Procedimientos Quirúrgicos Operativos/efectos adversos
Assessment of the pediatric assessment triangle (TEP), emergency area, Carlos Andrade Marín Hospital (HECAM), Quito Ecuador
Introduction: Timely and adequate triage in pediatric patients is a challenge faced by health professionals. The pediatric population is vulnerable to critical conditions that lead to collapse when not appropriately intervened. Objective: To evaluate the pediatric triangle as a predictor of severity in patients treated in the pediatric emergency area of the Carlos Andrade Marín Specialty Hospital, in the period from June to November 2021. Materials and methods: An observational study of diagnostic test evaluation was carried out. The ROC curve of the pediatric assessment triangle assessments and the level of severity according to Lq-SOFA was constructed. The relationship between clinical and demographic characteristics and the classes defined for PE was sought. Results: 182 patients were included, of which it was found that more than half were female and only 11 were referred to the Intensive Care Unit or died. The AUC-ROC of the pediatric assessment triangle to predict severity in pediatric patients was 0.848. The sensitivity was 71% and the specificity was 96%. There was a relationship between age, sex, comorbidities and the outcome of admission with the PET assessment. Conclusion: PET could be a predictor of severity; however, more studies are needed to contrast the results of this investigation.
Survival analysis of acute promyelocytic leukemia in a third-level hospital in Ecuador.
INTRODUCTION. There is an important number of reports in Latin America, but there is a lack of data on acute promyelocytic leukemia (APL) in Ecuador., this is the main reason to carry out this study in the country, a disease that in recent decades has shown a significant improvement in survival. OBJECTIVES. To evaluate the overall survival (OS) and event-free survival (EFS), and also the demography, and the most relevant clinical and laboratorial findings. METHODS. We retrospectively reviewed the medical records of 48 patients with APL, diagnosed between January 2012 and December 2019. We collected the most relevant demographic, clinical and laboratorial characteristics, as well as data related to 30-day mortality, and 5 year–OS (overall survival) and EFS (event-free survival). RESULTS. Among the forty-eight (48) patients with acute promyelocytic leukemia, 44 patients received treatment, the mean number of days for the start of all trans retinoic acid (ATRA) and/or arsenic trioxide (ATO) was of 2.5 days from the moment of the diagnosis. 60.4% of patients were classified as low risk and 39.5% as high risk, according to the national comprehensive cancer network (NCCN). The early death rate was 31.2%, the main cause of which was sepsis, multidrug resistant (MDR) bacterias were isolated in 83% of the patients who took blood cultures and died of early sepsis. after a median follow-up of 35 months only one patient relapsed. the five-year OS and EFS was 51.2%; In the multivariate analysis, only age was identified as an adverse prognostic factor. DISCUSSION. Compared to prospective trials with ATRA-based regimens, we found an inferior OS, mainly because of a high-rate early death. if we compare our findings with other real-world reports, we will also show inferior results probably explained by the high rate of early death due to infection by MDR batteries, in addition to the early deaths caused by hemorrhages. CONCLUSION. The low rate of OS shown in this study, could be improved based on changes to optimize the access of the patients to an early diagnosis and treatment and the reduction of the unacceptably high rates of multidrug resistance bacterial infections in our setting.
Disseminated cryptococcosis in HIV/AIDS: a call for clinical suspicion
Cryptococcosis is a fungal disease with global distribution. The cause is generally the reactivation of a latent infection in immunosuppressed patients, months or years after the initial exposure. Cryptococcemia is the clearest manifestation of disseminated disease and is associated with a high percentage of cryptococcal meningitis. The case of a 25-year-old woman with a recent diagnosis of HIV infection is presented, whose predominant symptoms were chronic diarrhea with significant weight loss and fever, with few neurological manifestations. Due to persistence of fever, blood cultures were performed with the isolation of Cryptococcus and subsequently a lumbar puncture with the same microbiological growth in cerebrospinal fluid. For this reason, a case of disseminated cryptococcosis in an immunosuppressed patient was considered.
Invasive Fungal Infections;Acquired Inmunodeficiency Syndrome
Acute abdomen secondary to peritoneal and intestinal tuberculosis. Clinical case report.
INTRODUCTION. In Ecuador, 6,094 new cases of tuberculosis were diagnosed in 2018. Most of these occurred in the coastal region. Extrapulmonary presentations cover a minority of cases and abdominal tuberculosis (intestinal and peritoneal) only represents 2.5%, however, this prevalence is increasing due to the increased survival of immunosuppressed patients. The clinical manifestations of this are non-specific and can present as ulcerative or stenosing forms (intestinal tuberculosis) and ascites or adhesion (peritoneal tuberculosis) and may be like Crohn’s disease and peritoneal carcinomatosis, respectively. The management of uncomplicated abdominal tuberculosis is carried out with an antifimic scheme like that used in pulmonary tuberculosis, reserving surgery for cases of intestinal perforation or obstruction, fistulas, abscesses, or hemorrhage. CLINICAL CASE. A 28-year-old male patient with a history of lymphoproliferative disease under study presented symptoms of acute abdomen secondary to intestinal perforation, identifying during the surgical period multiple irregular lymphadenopathies with production of caseous secretion, with histopathological results of peritoneal and intestinal tuberculosis, requiring multiple surgical interventions for formation of intestinal fistulas. DISCUSSION. Abdominal tuberculosis occurs predominantly in young adults, generally affecting the ileocecal region, with acute abdomen being a rare presentation, so there are no recommendations for the surgical management of these complications. We recommend that general characteristics be taken into consideration for the management of fistulas from other inflammatory/infectious causes, being essential the time in which the surgical resolution is planned. CONCLUSION. Tuberculosis is a public health problem that can affect different organs and systems, implying that its symptoms will be diverse and non-specific, requiring high clinical and epidemiological suspicion to make a timely diagnosis and treatment that improves the patient’s prognosis and quality of life.
Attitude of Health Staff towards the administration of the vaccine against coronavirus disease 2019
INTRODUCTION: Administration of the vaccine against coronavirus disease 2019-nCoV and its possible effects on its acceptance in health workers. OBJECTIVE: To evaluate the attitude of health personnel at the Goyeneche III Hospital Arequipa Peru in relation to the vaccine against coronavirus disease 2019-nCoV and identify them to reinforce favorable beliefs about the vaccine. MATERIALS AND METHODS: Cross-sectional descriptive correlational observational study, with a population of 916 health professionals from which 120 health professionals were selected, 100% of the respondents (n:120) were vaccinated against coronavirus disease 2019- nCoV at Hospital III Goyeneche. The attitude of health personnel towards the vaccine was evaluated using physical surveys distributed over 2 weeks through simple random sampling. The data were analyzed using SPSS. RESULTS: Doctors represented 39.2% of the study, the majority of workers vaccinated with 4 doses represented 45.8%. There was a good acceptance of the vaccine against coronavirus disease 2019-nCoV in terms of agreeing in the behavioral, cognitive, as well as affective dimension of the attitude.: CONCLUSION: Workers at the institution have shown a positive acceptance of the 2019-nCoV coronavirus disease vaccine, encouraging healthcare staff to get vaccinated themselves. During the pandemic, government authorities had to implement measures to enhance vaccine acceptance using official channels.
Kidney graft survival in patients with renal transplant with active rejection
ABSTRACT Rejection is defined as an increase in serum creatinine level after exclusion of other causes of injectable dysfunction, associated with specific pathological changes in the injectable and may occur at any time after transplantation. OBJECTIVE: Determine the survival time of the kidney graft in kidney transplant patients with Active Rejection. MATERIALS AND METHODS: Observational, descriptive, cross-sectional study was carried out at the Carlos Andrade Marín Specialty Hospital in the period 2013-2022, the universe was made up of an anonymized database of 460 transplant patients, of which 92 patients (20 %) presented a diagnosis of active rejection. The SPSS v26® statistical program was used. RESULTS: 60.8% were male patients, with a mean age of 43.7 years, allograft survival in patients with rejection was 85% at 5 years of follow-up, and of those who did not have rejection it was 97.1% at 5 years with one (p =0.001). Rejection mediated by T cells presented a greater survival rate of the kidney graft of 97% and the lowest survival rate was evident in rejection mediated by antibodies. DISCUSSION. The incidence of kidney graft rejection globally is estimated at 5% to 10%, although it can be higher, up to 35%, in the high immunological risk group, with increasing prevalence. Allograft survival worsens with each episode of rejection compared to patients who do not experience graft rejection. CONCLUSION: The highest survival rate was evident in patients without rejection during 5 years of follow-up, corroborating what was found in the state of the art in this study, the survival of rejection mediated by T cells was superior in relation to rejection mediated by antibodies.
Graft Rejection; Immunosuppressive Agents;Kidney Transplantation;Graft Survival
Guayas y Guayaquil: el epicentro de la pandemia por COVID-19 en el año 2020 en Sudamérica. Un análisis del exceso de mortalidad.
Entre marzo y abril del año 2020 la ciudad de Guayaquil fue un epicentro mundial a causa de la pandemia por el COVID-19, esto produjo un exceso de defunciones y saturación de los servicios de salud que el país nunca antes había enfrentado.
Manejo de hiperglicemia inducida por corticoides en pacientes hospitalizados y ambulatorios
Corticosteroid-induced hyperglycemia is an abnormal increase in blood glucose due to the use of glucocorticoids (GCs). Its incidence varies depending on the dose, the method of administration, and individual factors such as age, BMI, and family history of diabetes. According to the ADA, 10 to 15% of hospitalized patients receive corticosteroids, and 56 to 86% of them may develop corticosteroid-induced hyperglycemia, even without prior diabetes. Glucocorticoids affect carbohydrate metabolism by decreasing glucose absorption due to insulin resistance in the liver, muscle, and other peripheral tissues. The effects vary depending on the type and dose of glucocorticoids; intermediate-acting ones (prednisone) mainly cause postprandial hyperglycemia, while long-acting ones (dexamethasone) generate persistent hyperglycemia beyond 24 hours. Regarding treatment, the objectives must be individualized according to comorbidities, life expectancy, adherence to treatment and risk of hypoglycemia. A target glucose range of 140 to 180 mg/dL is recommended for most hospitalized patients, with adjustments based on the patient's clinical condition, type of glucocorticoid, and dose received. In mild cases, oral hypoglycemic agents such as metformin, sulfonylureas, DPP-4 inhibitors, or GLP-1 receptor agonists may be used. In more significant hyperglycemia, insulin is the treatment of choice. In conclusion, identifying patients at risk, adequately monitoring glucose levels, and adjusting treatment is important to minimize complications and improve clinical outcomes.
Sensitivity and Specificity of the Neutrophil Lymphocyte Index in Early Neonatal Sepsis. Carlos Andrade Marin Hospital. 2017 - 2021.
INTRODUCTION: Early neonatal sepsis is a public health challenge in Ecuador, with high morbidity and mortality rates. Early diagnosis is crucial, but current methods have limitations. The neutrophil-lymphocyte ratio, emerges as a promising biomarker for the detection and management of early neonatal sepsis. This study aims to establish its cutoff point and evaluate its efficacy at the Carlos Andrade Marín Specialty Hospital. MATERIALS AND METHODS: A retrospective and descriptive study was conducted at this hospital, collecting neonatal clinical data from January 2017 to December 2021. Records of patients with suspected early neonatal sepsis born from week 26 were included, excluding incomplete medical records or those with late-onset sepsis. Variables such as age, sex, and biomarkers were analyzed using SPSS version 27 software. The study was approved by the hospital's ethics committee. RESULTS: A total of 102 medical records of newborns with neonatal sepsis over 5 years were analyzed. Most were very premature and born by cesarean section. A cutoff point of 0.86 for the neutrophil-lymphocyte ratio was determined, with a sensitivity of 98.1% and a specificity of 85.4%. DISCUSSION: No significant relationship was found between sex and sepsis. Although the neutrophil-lymphocyte ratio showed high sensitivity and specificity, its low area under the curve indicates that it is not a reliable marker for diagnosing neonatal sepsis. CONCLUSION: Additional studies with larger samples and other biological markers are needed to improve the diagnostic capacity for neonatal sepsis.
Factors associated with breastfeeding in Ecuadorian women, secondary analysis of the ENSANUT-2018 survey
INTRODUCTION: According to the WHO and UNICEF, Breastfeeding is considered the first right that every human being acquires at the moment of birth. This food is recommended exclusively during the first 6 months of life and can be maintained until the 2 years old. Objective: To know the prevalence of breastfeeding during the first hour of life and on free demand and to describe the associated factors in Ecuadorian women. Materials and methods: Analytical, observational, retrospective study, with a secondary database from the ENSANUT-2018 survey, this analysis was carried out on women of age (10-49 years) considering sociodemographic variables such as area of residence, ethnicity, level of education, age, region, marital status, in addition to the questions from the ENSANUT form 2, section III (questions 302, 304, 309, 310,312,316,317,318,324). A univariate analysis was performed for sociodemographic variables, analysis using the Chi2 test and a logistic regression to determine the factors associated with breastfeeding using the STATA-64 program. Results: The sample included a total of 11,293 observations, with a prevalence of breastfeeding of 94.80%, finding an association between breastfeeding during the first hour of life with the variables area of residence (p=0.000), ethnicity (p= 0.000), educational level (p=0.000), age of the person surveyed (p=0.015), region (p=0.000); while breastfeeding on demand had an association with the variables area of residence (p=0.000), level of education (p=0.049), age of last child (p=0.009), age of the person surveyed (p=0.048). and marital status (p=0.051). Conclusions: This study allowed us to know the prevalence of breastfeeding and the factors that are associated in the population of Ecuadorian women, which will guide the competent authorities to establish appropriate measures and public policies that ensure the protection of Breastfeeding.
CORRELACIÓN CLÍNICA, POR ULTRASONIDO E HISTOPATOLOGÍA DEL ENGROSAMIENTO ENDOMETRIAL EN PACIENTES PRE Y POST MENOPÁUSICAS HOSPITAL “CARLOS ANDRADE MARÍN”: 2011 - 2012
From January 2011 to December 2012, we conducted a retrospective descriptive study in postmenopausal women not receiving hormone replacement therapy, taken in the outpatient and / or emergency Carlos Andrade Marín Hospital and who had endometrial thickening detected by ultrasound transvaginal (> 4 mm in postmenopause and> 16 mm in the pre menopause). Endometrial biopsy was performed for histopathological study. A total of 360 patients were studied: 180 postmenopausal and 180 premenopausal. The age limits were 22 and 90 years. The average endometrial thickness was 14.7 ± 10.5 mm. Hyperplasia correspond to the largest percentage in all groups, with the highest prevalence of simple hyperplasia without atypia (> percentage perimenopausal), followed by complex hyperplasia with atypia, complex hyperplasia without atypia and finally simple hyperplasia with atypia. In the perimenopausal, endometrial thickness was between 14 to 49 mm with an average. of 19.3 ± 5.4. The percentage malignancy has a twice higher in postmenopausal (15.6% vs. 5%) and in the perimenopausal corresponded to 8.5%. The nulliparous had higher malignancy (18.8%), as hyperplasia (37.6%). We conclude that the mean endometrial thickness by ultrasound TV reproductive age was 16 and 20 mm and in the menopausal between 10 and 14 mm. The main cause of endometrial thickening postmenopausal atrophy was then malignancy and simple hyperplasia without atypia, in patients of reproductive age were proliferative and secretory endometrium with abnormal growth pattern followed by a simple endometrial hyperplasia without atypia and endometrial polyp. The percentage of perimenopausal simple hyperplasia without atypia, complex with atypia was higher. The malignancy is higher in postmenopausal (15.6%) in the perimenopausal (8.5%). It is important to consider the results in our own population in the presence of postmenopausal bleeding and bleeding in the peri menopausal patients should not be underestimated
QUERATOPLASTIA PENETRANTE EN CLÍNICA DE OJOS FINLANDIA DE QUITO ECUADOR DESDE EL A Ñ O 2010 AL 2012
It is a descriptive study of 72 cases of penetrating keratoplasty, conducted from March 2010 to March 2012 and its respective followed for six months. We analyzed the following variables: age of the recipient and the donor, most common gender, etiology, complications and changes in visual acuity, Keratoconus was the most common cause of penetrating keratoplasty, followed by postoperative bullous keratopathy and infectious keratopathies.
AGRADECIMIENTO AL HOSPITAL CARLOS ANDRADE MARIN
La medicina tiene como objetivo principal “el alivio del sufrimiento humano”. La tarea más noble del médico transcurre en planos simultáneos y complejos y nos enfrenta cotidianam ente con nuestros semejantes en los momentos difíciles de enfermedad, vulnerabilidad y duelo
EPIDEMIOLOGÍA CLÍNICA POR MORDEDURAS DE SERPIENTES EN PACIENTES DEL SERVICIO DE EMERGENCIAS DEL HOSPITAL “DR. GUSTAVO DOMINGUEZ Z." PERIODO DE ENERO A DICIEMBRE DEL 2012
It is difficult to know the actual number of bites by poisonous snakes in the world; the fact is that snakebites by frequency of occurrence and morbidity causing represent a serious public health problem in tropical countries. The World Health Organization estimates that worldwide annually are five million of snakebites, with 125 000 deaths a year half of them die poisonings. In South America, Brazil is the country with the highest number of accidents of this type, has nearly 20 000 cases per year, followed by Perú (4500), Venezuela (2 500-3 000), Colombia (2675), Ecuador (1 200-1 600) and Argentina (1150-1250) .In Brazil, the regions most at risk are the central, west and north. The genus Bothrops is responsible for 90% of accidents caused by poisonous snakes in Brazil. Proper Identification of the type of snake involved in the accident is crucial in determining the most appropriate treatment to follow. The aim of this study was to evalúate the epidemiológica!, clinical accidents snakebites in children and adults hospitalized in the Emergency Hospital Dr. Gustavo Dominguez Z in the period January 2012 to November 2012.
Guillain Barré syndrome. Atypical case report.
INTRODUCTION. Guillain-Barré syndrome is an acute inflammatory autoimmune neuritis whose most common type is acute inflammatory demyelinating polyneuropathy, with a mean age of onset of 40 years, with a predominance in men of all ages, races and nationalities. It is characterized by symmetrical ascending muscle weakness predominantly distal, generating a decrease or absence of deep tendon reflexes and which can compromise the cranial nerves, especially the seventh. CLINICAL CASE. A 23-year-old mixed-race male patient with a diagnosis of Guillain Barré who presented hyperreflexia in the lower extremities, without albumin-cytological dissociation. DISCUSSION. The phenomenon of hyperreflexia has been described in 13% of cases with Guillain Barré Syndrome, and the majority of cases occur in patients with acute motor axonal form. When reviewing the literature, cases of hyperreflexia commonly present as a late phenomenon towards the second week of evolution. Albumino-cytological dissociation can occur in approximately 35% of cases. CONCLUSIONS. It is important to report variations in the usual clinical manifestations of Guillain Barré in order to establish the diagnosis quickly and initiate treatment early and thus reduce possible sequelae.
Pathological Conditions, Signs and Symptoms
GIGANTOMASTIA: MÁS QUE UN PROBLEMA ESTÉTICO
The Gigantomastia is a condition that affects women in their puberty stage which causes excessive growth of the glands becoming a serious cosmetic problem, but not only carries this difficulty but can cause major structural defects such as deformation of the box thoracic hyperlordosis deformity clavicles with back pain and poor posture can affect the normal functioning of women in their daily routine, the psychological impact should also be taken into account as many women are isolated by their physical and aesthetic problem. There gigantomastia other forms such as those occurring during pregnancy and in the late stage near menopause, the present review is to focus that kind of treatment techniques currently exist and as follow-ups should be channeled towards improved esteem and correct anatomical defects mentioned.
PROFILAXIS DE LAS ÚLCERAS DE ESTRÉS EN EL PACIENTE CRÍTICO: RECOMENDACIONES
Syndrome mucosal damage related to stress (SDMRE) is the term used to describe the phenomenon that causes damage at the lining of the stomach and duodenum, in conditions of physiological stress. Through a observational analysis recognizes that the use of prophylaxis is broad añd is present in all patients in both the ICU and beyond, so we present a review on stress ulcer prophylaxis and what patients who benefit from its use in the intensive care setting, based on current evidence.
BIOÉTICA CLÍNICA: CASO DE LIMITACIÓN DE ESFUERZO TERAPÉUTICO
Clinical bioethics cases are rarely presented or published mainly because they are subjects that should be treated based on bioethical principies. The treatment of bioethical dilemmas has been done from different points of view, each of one proposing their own scheme. For this occasion, the Integrated System for Bioethical Cases Treatment has been adopted. We present a case that frequently should be addressed by medical staff : Limitation of therapeutic effort and Palliative care. This case took place at a Hospital in Quito and was treated without respecting basic bioethical principies. The case is presented to make health professionals aware of the importance of making the right decisión at the right time.
PROTOCOLO PARA LA PREVENCIÓN Y MANEJO DE LA NÁUSEA Y VÓMITO POSTOPERATORIOS
The incidence of perioperative nausea and vomiting (PONV) in the general population has been estimated in 20 to 30% reaching 80% in high risk population. It is associated with complications and low levels of satisfaction in the postoperative period. Evidence shows better results when preventing the problem than handling it once it becomes established. We performed a comprehensive review of the current evidence in order to elabórate the guidelines to prevent and treat PONV for the Anesthesiology department. Main recommendations according with this guidelines to treat and prevent NVPO are: 1) risk for PONV should be assessed in all patients undergoing surgery, with the amended Apfel scale in adults or the amended Eberhart scale in children, 2) measures to reduce baseline risk should be used in adults at modérate or high risk and all children, 3) pharmacologic prophylaxis with one drug for patients at modérate risk or low risk undergoing high risk surgery, prophylaxis with two drugs in patients at high risk or modérate risk undergoing high risk surgery and prophylaxis with three drugs in patients al high risk undergoing high risk surgery. Effective drugs to address and prevent PONV are ondasentron, granisetrón, palonosetron, droperidol and dexamethasone. Among these ondasentron is the election drug as rescue therapy.
DISTROFIA SIMPÁTICO REFLEJA: A PROPÓSITO DE UN CASO
We present the case of a young male presenting with intense burning pain in the left leg after a hip replacement surgery. The patient's leg was hypotrophic with distal cyanosis, skin trophic changes and low amplitude pulses. Ultrasound doppler study showed normal arterial flow in both legs. He was diagnosed with a Complex Regional Pain Syndrome. Nonsteoidal anti-inflammatory drugs and neuromodulator drugs were started complemented by physical therapy with partial symptomatic relief. A lumbar sympathectomy was performed reaching complete symptoms remission. Complex Regional Pain Syndrome is characterized by intense and disproportionate local pain associated with vasomotor and trophic phenomena. An excessive sympathetic response is part of it's physiopathology mechanisms. Diagnostic criteria inelude the presence of neuropathic pain, vasomotor and trophic changes and no other disease explaining the symptoms. A multidisciplinary management is needed. Physical, psychological andpharmacological therapies are the first line of treatment. Sympathectomy has shown excellent results with long lasting pain relief.
SINDROME DE DESEQUILIBRIO POSTDIALISIS: UNA ENTIDAD OLVIDADA
The post-dialysis disequilibrium syndrome is a clinical phenomenon of acute neurological signs and symptoms attributed to the development of cerebral edema, which occurs during or after treatment with hemodialysis. This syndrome is rare but once it happens is a serious complication of dialysis. The disequilibrium syndrome was a major problem for two or more decades, when patients with acute uremia were subjected to prolonged dialysis. The treatment of this syndrome once that has been established is unsuccessful, henee the measures to prevent its development are crucial. In the following case review we will describe the pathophysiology of the same and also discuss the measures and factors that allow us to prevent their development.
PREVALENCIA DE LOS DIFERENTES TIPOS DE CANCER EN EL SERVICIO DE ONCOLOGÍA DEL HOSPITAL CARLOS ANDRADE MARÍN EN EL PERÍODO DEL 2000 AL 2011
Cáncer is the leading cause of death in developed countries and the second leading cause in developing countries, as is the case in Ecuador
SIMPATECTOMÍA TORÁCICA POR VIDEOTORACOSCOPÍA EN HIPERHIDROSIS, EPIDEMIOLOGÍA Y SEGUIMIENTO A UN AÑO
This is an transversal retrospective descriptive study, we analyze the prequirurgic epidemiologic characteristics and a year satisfaction of patients with hiperhydrosis hat have been operated of thoracoscopic bilateral sympatectomy. It took into account 41 patients operated in 2011, is predominantly female with 58.5%, men seeking help 2.8 years later than women and in 78% the hyperhidrosis committed armpits, thoracoscopy proceeded to supine with mean operative time of 78 minutes, in less than 5% was reported intraoperative complications, similar to other data centers. Adverse effects in the postoperative period occurred less frequently than expected according to other series, almost 25% less in some cases. All patients reported satisfaction. This makes the procedure efficient, safe and fast at the time being the treatment of choice for severe hyperhidrosis
BIOPSIA CORE (PERCUTÁNEA) GUIADA POR ECOGRAFIA EN PACIENTES CON LESIONES MAMARIAS SOSPECHOSAS DE MALIGNIDAD (BIRADS 3 ,4 y 5) Y SU CORRELACION HISTOPATÓLOGICA. SERVICIO DE RADIOLOGÍA - HOSPITAL “CARLOS ANDADE MARÍN” Enero 2008 a Julio 2012
Ultrasonographically (US) guided core needle orpercutaneus biopsy is currently recognized as a reliable alternative to surgical biopsy for the histopathologic , giving to each patient an optimal managment. The advances in biopsy devices and techniques for sampling the breast lesión make less number of falsenegative results, additionally the operator experience makes ffom this technique the choice to breast lesions diagnostic. To support the effectiveness of this method is important have a radiologic-histologyc correlation y after that the postoperative confirmation. The improve of this technique to obtain better results is essential to avoid errors during the sampling and give an acuracy diagnosis giving to each patient the best treatment as possible. The breast lesión ultrasound visualization is the most important requirement, otherwise we should choose another method to make the biopsy, the better choice always if is possible will be the ultrasound because has many advantages as no radiation use, real time technique visualization, low cost, accessibility and many kind of devices availability to perform the procedure.
ESTUDIO DE TIEMPO DE PROGRESIÓN Y SOBREVIDA GLOBAL EN PACIENTES CON CÁNCER RENAL DE CÉLULAS CLARAS METASTÁSICO TRATADOS CON SUNITINIB EN EL SERVICIO DE ONCOLOGIA DEL HOSPITAL CARLOS ANDRADE MARÍN EN EL PERIODO COMPRENDIDO ENTRE ENERO DEL AÑO 2010 A
The clear cell renal cell carcinoma (CRCC) is the most common cáncer of the kidney, at the time of diagnosis 30% of patients have metastases and 40% are in disease recurrence. It is highly resistant to chemotherapy and poor responses were evidenced with the interleukins and interferón before use, so that the current target therapy with tyrosine kinase inhibitors were used.
LARINGOESPASMO POSEXTUBACIÓN: COMPARACIÓN DE LA EFICACIA DE LA ADMINISTRACIÓN DE LIDOCAÍNA AL 2% SIN EPINEFRINA (S/E) ANTES DE LA EXTUBACIÓN Y DURANTE LA INDUCCIÓN ANESTÉSICA EN LA PREVENCIÓN DEL LARINGOESPASMO EN NIÑOS SOMETIDOS A CIRUGÍA ORA
Laringospasm is one of the most dreaded complications for a pediatric anesthesiologist and it is considered one of the most frequent causes of cardiac arrest in children: its incidence is greater in children who breastfeed. A double blind experiment was carried out where the efficacy of intravenous Lidocaine 2% WO/E administered before extubation (control group) was compared to the administration of the same substance in the induction process as a means of preventing laringospasm. The study included 49 patients older than 6 months and younger than 10 years, males and females and all for oral surgery. Children with high respiratory infections, whose surgery was not oral, patients with two or more intubation attempts and patients, who would require mechanic ventilation after surgery, were excluded from the study. The study group was randomly selected into two groups, Control with 24 patients who were administered Lidocaine 2% WO/E (substance A) before extubation, and the Experimental Group with 25 patients who were administered Lidocaine 2% WO/E (Substance B) during induction. Results: Three cases of laringospasm are linked to the administration of Lidocaine 2% WO/E at induction (p 0.5, RR 1.4) and two cases of laringospasm were linked to the administration of Lidocaine 2% WO/E before extubation (p0.5,RR 0.69). Conclusión: there is no sufficient significant data that indicates that the use of Lidocaine 2% WO/E during induction prevenís laringospasm, nevertheless the study confirms that it does prevent laringospasm when used before extubation.