Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Urinary tract infections are caused by a variety of uropathogenic bacteria, and this pathology is one of the frequent reasons for emergency consultation. A study with a quantitative, descriptive, cross-sectional, observational, non-experimental approach was carried out in the Emergency Service of the Puyo General Hospital during the period from January to December 2021, with the objective of determining the most used empirical drug, agent prevalent bacteria and their resistance. This through the collection of information from medical records, the Varanus system and laboratory results with a total of 858 patients, excluding a total of 320. A higher prevalence of UTI was identified in the female sex, with a percentage of 98%, the antibiotic prescribed with most frequent is ciprofloxacin in 40.2%. E.coli is the most frequent pathogen with a drug resistance to ampicillin/sulbactam of 56.6%.

Introduction: Among the problems of impact on population health are tooth decay and malnutrition. Objective: To determine the prevalence of caries and its relationship with the body mass index, in students from 8 to 12 years old of an educational unit of the caregiver of Ambato-Ecuador. Methods: Cross-sectional and descriptive study. 138 students participated with prior informed consent. A survey was applied to obtain data on their physical activity weight, height, gender and school year. The body mass index (BMI) was rated according to the criteria of the World Health Organization. The ICDAS system (International Caries Detection and Assessment System) was used for caries detection. Descriptive analysis was performed through frequencies and percentages. Measures of central tendency were obtained in the analysis of the ICDAS based on each of the intervening variables. The relationship of the variables age, gender, BMI and physical activity with caries was carried out through generalized linear models using Poisson regression. Results: Underweight students had 2.6 times more risk of presenting ICDAS A, those with normal weight 1.6 times higher risk and those who were overweight 2.7 times higher likely. The ICDAS had an increasing behavior in function of a greater physical activity, the ICDAS by the ICDAS C decreased in relation to a major activity carried out. Conclusions: The prevalence of caries is directly related to a higher body mass index, while physical activity shows an inverse relationship with the appearance of moderate and severe carious lesions.

Introduction: Postpartum hemorrhage (PPH), defined as blood loss of 500ml in vaginal delivery or 1000ml in cesarean delivery, is associated with alterations in uterine tone (atony), uteroplacental tissue retention, trauma or coagulation disorders, with uterine atony being the main cause. Conventionally, the administration of uterotonic agents during labor was established to prevent hemorrhage; however, nowadays, the dosage of ATX, an antifibrinolytic, is proposed for the prevention of PPH by cesarean section. Objective: To analyze and establish the effectiveness of ATX for the prevention of PPH by cesarean section by means of a systematic review. Methodology: A systematic review with retrospective descriptive design was performed based on literature in English and Spanish obtained from Pubmed, Google academic, The New England Journal of Medicine, Redalyc, ScienceDirect databases applying as exclusion criteria the last 5 years, from 2017 to 2022, low evidence and high bias. In addition, the administration of ATX exclusively for prevention of PPH by cesarean section was emphasized. Results: The information gathered describes basic concepts of cesarean section and postpartum hemorrhage as well as the pharmacodynamics of ATX, allowing us to determine the efficacy of this antifibrinolytic in the prevention of PPH after cesarean section. In addition to the above, it allows us to determine the adverse effects and benefits of ATX administration. Conclusions: Based on the information obtained, it was concluded that the administration of ATX (1 g or 10 mg/kg) is recommended for PPH prophylaxis after cesarean section, since it showed a reduction in preoperative and postoperative blood loss. It also reduced the need for blood transfusion, the decrease in the hemoglobin (Hb) and hematocrit (Hct) curves, the need for additional doses of additional uterotonic agents and the incidence of PPH in high-risk patients.

 The development of the COVID-19 pandemic has generated a health crisis in the world from which Ecuador has not been able to recover, the lack of organization, the poor distribution of health resources, have generated a breach of several bioethical principles during the medical practice, in this context the present research work aims to determine the application of bioethical principles in medical practice during the health emergency by COVID 19, through a documentary narrative bibliographic review of the last 5 years in databases such as Pubmed, Elsevier, academic Google, Scielo, using Health Sciences descriptors such as: coronavirus disease, bioethical principles, bioethics, public health, humanization of care. The inclusion criteria were complete articles in English and Spanish between the years 2017-2022. The review of 30 articles that met the eligibility criteria was added. In the results we address bioethical principles, ethical dilemmas that are derived from fear and mental health; the lack of individual protection equipment; lack of resources and equipment and the doctor-patient relationship.

Introduction: Medical simulation is one of the tools that projects the medical student in training, modernization, and specialization, in scenarios where they can face situations based on clinical problems or trauma in a phantom of low, medium and high complexity that it approaches a scenario very similar to those that would be faced by subjects in their professional medical practice, reducing the risks of iatrogenic events. Objectives: Describe the benefits of medical simulation and the hybrid patient approach in health education. Methodology: A documentary design investigation was carried out, of a descriptive and exploratory nature. Through the search of complete scientific articles, in databases such as SciElo, Pubmed, Google Scholar and LATINDEX, using the descriptors: simulation, health, medicine, learning. Results: Initially, forty-three writings in English and Spanish were identified on aspects to be investigated, of which, once their summaries were selected and analyzed, they were adapted to 32 articles. Conclusions: It is concluded that, depending on the complexity of the medical practice, there are phantoms of high or medium complexity that help training and adaptation to the real clinical scenario, but it depends a lot on the commitment of the apprentice and the tutor for the cognitive learning of a skill.

The Constitution of the Republic of Ecuador, in article 32, provides that: Health is a right guaranteed by the State, whose realization is linked to the exercise of other rights, including the right to water, food, education, physical culture , work, social security, healthy environments and others that support good living. The provision of health services will be governed by the principles of equity, universality, solidarity, interculturality, quality, efficiency, effectiveness, precaution and bioethics with a gender and generational approach.

Introduction: Abdominal ectopic pregnancy represents 1% of extrauterine pregnancies; its incidence ranges between 1:10,000 and 1:30,000 pregnancies, has the highest mortality rate, being this 7.7 times higher, than in other ectopic pregnancies. Objectives: To present a clinical case of an abdominal ectopic accident, its diagnosis and timely treatment. Materials and methods: a descriptive and retrospective study was performed, presenting a clinical case. Authorization was obtained from the teaching and research department for access to medical records and publication of images. Clinical case:  21-year-old female patient, pregnancies 1, deliveries: 1, intergenetic period 5 years, presents symptomatology of 2 days of evolution, characterized by : moderate to high intensity pain in right iliac fossa, which is irradiated to hypogastrium. The physical examination draws attention to the depressive soft abdomen, painful in the right iliac fossa to the superficial and deep palpation, the vaginal exam closed cervix, painful to mobilization, does not present transvaginal losses. Ultrasound examination confirmed the presence of an ectopic miscarried pregnancy, so exploratory laparotomy was performed showing hemoperitoneum 1000 CC approximately, aspiration was performed, cavity was examined and uterus was observed, annexes within normal limits, unscathed , ectopic pregnancy is observed located in epiplón on the right side, in addition to satisfied maternity, partial bilateral salpinguectomy is performed. Discussion: Abdominal ectopic pregnancy represents a diagnostic and therapeutic challenge and can be located at the bottom of the pelvic sac, wide ligament, intestine or lateral pelvic wall, is a rare type of pregnancy and is often misdiagnosed, passing a long time , evolving into hemoperitoneum, abortion, embolism or, rarely, in diagnosed cases, live birth by cesarean section. In the case presented, the pregnancy was located at the level of epiplón. Conclusion: In our country, there is not yet a study that exposes the current reality of this condition at the national level, being abdominal ectopic pregnancy, a pathology with a mortality 7 times higher than other ectopic pregnancies, for its atypical clinical presentation and its difficult ultrasound location. It is concluded that in the presence of abdominal pain and positive serum HGC test in a young woman in reproductive stage with or without the use of contraceptive methods, the presence of an extrauterine pregnancy should be suspected and its treatment will depend on its hemodynamic state, whereas, if you arrive in hypovolemic shock your treatment will be imminent surgical, because it is a life-threatening accident ectopic pregnancy, as happened in the case presented, whose diagnosis was intraoperative at the time of the examination of the abdominal cavity; which can be performed , laparoscopically or by exploratory laparotomy, giving resolution and control of hemodynamics. In other cases conservative medical treatment with metrotexate may be given as long as it meets criteria.

Context: Over the years, several scales have been developed to support the diagnosis and predict the severity of cases with a framework suggestive of acute appendicitis. In this investigation, these scales are compared. Objective: To determine the degree of diagnostic certainty of the Alvarado and RIPASA scales as diagnostic support for Acute Appendicitis, at Hospital General Puyo, from 2021 to December 2021. Methodology: Analytical, comparative, retrospective research, with diagnostic accuracy. Population and sample: Clinical histories of 105 adult patients admitted with a diagnosis of acute appendicitis during the study period. The SPSS v25.0 program was used, sensitivity (S), specificity (E), predictive values (PPV and NPV), likelihood ratios (LR+ and LR-), diagnostic OR (ORD), 95% CI and Receiver Operating Characteristic (ROC) curves. As reference questions, the criterion of the surgeon and the histopathological examination were taken. To compare both curves, the Hanley and McNeil statistics were used. Results: Diagnostic accuracy: Alvarado: Sensitivity: 49.0% (35.9%-62.3%), Specificity: 50.0% (37.1%-62.9%); Positive Predictive Value: 48.1% (34.2%-62.2%); Negative Predictive Value: 50.9% (37.0-64.7%), Positive Likelihood Ratio: 0.9 (0.7-1.4), Negative Likelihood Ratio: 1.0 (0.7 -1.5); Odds diagnostic ratio: 0.9 (0.4-2.1), Area under the curve: 51.8% (40.6%-63.0%). RIPASA: Sensitivity: 76.5% (62.2%-86.7%), Specificity: 12.9% (5.8%-25.5%), Positive Predictive Value: 45.3% (34.7 %-56.4%), Negative Predictive Value: 36.8% (17.2%-61.4%), Positive Likelihood Ratio: 0.88 (0.73-1.06), Negative Likelihood Ratio: 1.82 (0.78-4.25), Odds diagnostic ratio: 0.48 (0.17-1.35), Area under the curve: 60.8% (49.7%-71.9%). Conclusions: There were no significant differences between the RIPASA and Alvarado scales in relation to the diagnostic accuracy of acute appendicitis at the Hospital General de Puyo. In both cases, the performance was “discrete”; but, due to the characteristics of the show, this finding should not be generalized

Introduction: traumatic brain injury (TBI) and associated traumatic injuries continue to stand out as one of the main causes of morbidity and mortality. Pre-hospital management, as well as the time of arrival and admission to the emergency area, the period to enter the operating room, postoperative management and in the intensive care unit are vital. Objectives: the general objective is to present a series of 3 clinical cases of young patients with head trauma who suffered motorcycle accidents on the coast of Ecuador and who were treated in Guayaquil, to emphasize the prevention of complications, in addition to describing the diagnosis. and neurocritical treatment performed. Materials and methods: clinical cases are presented; authorization is obtained from the teaching and research department for access and review of medical records and images. Clinical cases: all the cases corresponded to young, male patients who presented a motorcycle traffic accident without a helmet, the first case presented diffuse axonal injury, and required several months in the intensive care unit, the second case was a patient with a fracture. sunken right parietal artery, which was diagnosed and treated opportunely receiving surgical treatment with good results, the third case presented epidural hematoma, which underwent a hemispheric decompressive craniectomy on the right side and drainage of the epidural hematoma, obtaining satisfactory results. Discussion: in this population, a lack of safety measures was observed, such as the use of a helmet, which resulted in patients presenting: diffuse axonal injury, fractures with collapse, and bruises. Nuclear magnetic resonance and computerized axial tomography of the brain were important in the evaluation of the lesions, since they allowed making a timely decision and choosing the type of treatment, as well as knowing the prognosis in each case. Conclusions: Head trauma is an emergency that requires immediate resolution, it is a growing problem and the main cause of mortality and morbidity in young adults, with a high burden on health care, causing disability in previously healthy patients, the hospital transfer system and time influence its prognosis, interrelated with diagnosis and timely treatment. The cases presented were promptly resolved with a good response. The patient who presented diffuse axonal injury had severe neurological sequelae. It is important to highlight that the three cases presented were due to a motorbike traffic accident, without the use of a helmet, a situation that must be prevented.

Introduction: According to global statistics, cervical cancer ranks third among the most common neoplasms affecting women, is considered a public health problem, whose most important risk factor is human papillomavirus (HPV) infection. Objective: The objective of this work is to conduct a review of the literature on Cervical Cancer and human papillomavirus, diagnosis and prevention. Materials and methods: a descriptive, retrospective study, review of scientific medical articles, MedLine databases were consulted , Willey online library, Epistemonikos , PUBMED, ELSEVIER, articles mostly from 2018 onwards, in English and Spanish. Results: The World Health Organization (WHO) has employed strategies to increase HPV vaccination, approved by the US Food and Drug Administration; for all 9- to 45-year-olds, in the prevention of genital, cervical, anal, oropharyngeal, and genital cancers, the American Academy of Pediatrics also recommends vaccinating children before sexual activity between the ages of 11 and 12, having a great collective impact the vaccination of men and women. Currently, cervical diagnosis of HPV is performed with the molecular HPV DNA screening test by PCR, which is the only one approved by the FDA (Food and Drug Administration) of the United States of America, despite the Pap test, despite being a great screening tool for the detection of precancerous and cancerous lesions, it does not detect the HPV virus, but the cytological changes produced by the infection. Conclusion: Human papillomavirus infection is the main cause of cervical cancer. The importance of this research lies in the need to raise awareness for the early screening of the aforementioned virus, in addition to prevention through vaccination, which reduces the incidence of cancer, so that strategies should be implemented, to increase the availability of vaccines, at lower cost, and to inform the population about the benefit of their use, by conducting global awareness campaigns. Keywords: Cervical Dysplasia, Cervical Intraepithelial Neoplasia, Squamous Cervical Intraepithelial Lesions, HPV-16, HPV-18