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Introduction: The axis Growth hormone-growth hormone-growth hormone-insulin growth factor type 1 (GHRH-GH-IGF1) demonstrates an extraordinary level of biological complexity. When there is a molecular defect in the growth hormone receptor, it triggers an inability to synthesize the growth factor IGF-1 in the liver, which is what we know as growth hormone insensitivity syndrome (GHID). Within this picture is the well-known Laron syndrome, a disease of autosomal recessive inheritance characterized by a primary resistance to GH, in Ecuador there is a large population with this syndrome and in it several mechanisms of insensitivity to GH have been studied as well as the metabolic and cellular effects of IGF-1 deficiency. We present a systematic review of the existing literature, collecting information from the databases of Medline, Intra Med, PubMed, The Cochrane, SciELO and other journals with quality scientific evidence, which analyzes the evidence found in recent years that suggests the existence of a correlation between GHID and the minimal risk of diabetes mellitus and all types of cancer. The primary insensitivity to GH possessed by patients with SL would thus represent a favorable condition in relation to the risk of diabetes mellitus and cancer. Among the suggested protective mechanisms of GHID are an increase in insulin sensitivity and decreased IGF-1 leading to less cell progression to cancer.

Foundations: The interaction of the cranio-cervical posture with the position of the hyoid bone causes movements between the head, spine, and jaw; these, if not adequate, could cause modifications in the dimension of the pharyngeal airway, dentofacial morphology, among others, including the TMJ (Temporomandibular Joint). Objective: The purpose of this study was determinate the tomographic relationship of facial biotype with hyoid bone. Methods: The present study had a quantitative, descriptive-relational approach of transversal temporality; whose sample was made up of 150 head and neck tomography in individuals aged 13 to 75 years that met the selection criteria established by the researchers and that were taken during the year 2021; subsequently, the tomography was analyzed through the use of 3D Slicer software that allowed the measurement of the hyoid triangle (H'- Rgn- C3), Frankfort plane, subsequently the facial biotype was analyzed by anterior facial height and facial height, as well as to obtain the cephalometric analysis of Jarabak. Results: In the correlation analysis between the position of the hyoid bone with the biofacial in general, a correlation coefficient of 0.030531854 was found with an R2 of 0.0009 where a very low positive statistical correlation could be established   with positive linear adjustment of the evaluated variables. Conclusions: The correlation present between the facial biotype and the hyoid bone is very low positive with an evident positive linear adjustment of the variables evaluated; that is, it is possible to mention and predict that the position of the hyoid bone will be altered according to the facial biotype.

Introducción: La violencia de tipo sexual puede afectar a todo ser humano sin importar edad, sexo, etnias, condición social o laboral; un punto importante a recalcar es que afecta a la libertad de decisión y de consentimiento expreso del goce de los derechos e integridad sexual de quien se está formando y no tiene la capacidad de decidir sobre actividades sexuales de manera libre. Según el Instituto Nacional de Estadísticas y Censos (2011) el 25,7% de mujeres ecuatorianas han sido víctimas de violencia sexual. Dentro de la exploración física de la víctima es importante detectar lesiones a nivel extragenital, paragenital y/o genital; para ayudar en el proceso se han creado escalas de aplicación durante el examen sexológico forense, una de estas es la Escala de Gravedad de Lesiones Genitales (GISS: Genital Injury Severity Scale) desarrollada por Kelly D. et al. en el año 2013, para valorar y dar una gradación a las lesiones en el área genital de las víctimas femeninas. Objetivo: Aplicar la Escala de Gravedad de Lesiones Genitales (GISS) y relacionarla con la observación directa durante el examen sexológico forense. Metodología: El diseño del estudio fue observacional, transversal y analítico, en mujeres víctimas de presunta agresión sexual que se les realizó el examen sexológico forense. Resultados: Se demostró que existe relación entre la escala de gravedad de lesiones genitales (GISS) y la observación directa (OD) (Índice de Kappa: 0,66; IC95%: 0,52-0,79) para establecer lesiones genitales en mujeres víctimas de presunta agresión sexual. Conclusiones:La Escala de gravedad de lesiones genitales (GISS) no presenta ventajas de identificación de lesiones con respecto a la observación directa.

Definimos como violencia a la conducta agresiva, cuya intención es la de causar daño sobre aquel que la ejerce, partiendo de este breve concepto podemos citar que la violencia intrafamiliar es el tipo de conducta agresiva que ocurre entre miembros de una familia, o también el caso de personas emparentadas ya sea por consanguinidad o por afinidad. El presente caso se trata de una persona de sexo femenino, adulta, víctima de agresión verbal, por parte de su pareja sentimental teniendo como resultado final de la agresión, amplias lesiones físicas. Como conclusión tenemos un caso de violencia intrafamiliar  cuyo  victimario fue la  pareja sentimental de la paciente, si bien las lesiones no fueron proporcionadas directamente por el agresor, pero las amenazas de muerte fueron las que desencadenaron la reacción de supervivencia en la víctima y le ocasionó indirectamente las amplias lesiones físicas.

Introduction: fine needle aspiration has played an essential role in the evaluation of the patient with thyroid nodule, being a fast, minimally invasive method and the patient will quickly be reintegrated into his activities. Objective: to determine the validity of the Fine Needle Aspiration Puncture (FNAP) guided by ultrasound in the diagnosis of thyroid cancer in patients of the José Carrasco Arteaga Hospital in 2017. Methodology: validation study of diagnostic tests that compared fine needle aspiration puncture guided by ultrasound with histopathology (gold standard); 236 patients accomplished inclusion criteria. For the analysis, frequencies and percentages, standard deviation and mean were applied, according to quantitative and qualitative variables respectively; for the validation of the FNAP, tests of sensitivity, specificity, positive and negative predictive value were performed. The respective bioethical processes were applied. Results: 73.78% of patients were over 48 years old (mean of 56.52, SD +/- 13.51). According to the Bethesda classification, most patients presented atypia with 27.1%, followed by 26.3% of follicular neoplasia. By histopathology, 53.8% were benign with 43.2% of papillary carcinomas. The sensitivity was 73.39%; specificity 57.48%, validity index 64.83%; positive predictive value 59.7%; negative predictive value 71.57%; positive likelihood ratio 1.73, negative likelihood ratio 0.46; Youden index 0.31, Cohen's Kappa index 0.31. Conclusions:  The FNAP had a greater sensitivity than specificity; however, it could nCot be decisive at the time of diagnosis and decision-making.

El catéter venoso periférico (PVC) a menudo es una aplicación común que   utilizamos para el cuidado   de pacientes a nivel mundial para la administración de líquido intravenoso (IV). Objetivo: examinar en la literatura científica sobre la flebitis asociada a la colocación de catéter venoso periférico a través de la revisión sistemática.  Metodología: es una revisión bibliográfica para la realización de este proceso, se seguirán las recomendaciones del método PRISMA. Resultados principales:   la prevalencia a nivel mundial de flebitis fue Australia 12%, Portugal 11,5%, Alemania 7,6%, España 5,6 %, Portugal 36,7%. Los factores de riesgo edad, sitio de venopunción, calibre de catéter venoso, intentos fallidos y medicamentos del VIH, pacientes diabéticos, fármacos inmunosupresores, sitio de venopunción, catlón número 18. Los factores de riesgo de flebitis: edad, sexo, sitio de venopunción, catéteres venosos de gran tamaño, intentos fallidos, líquidos hipertónicos antibióticos. Conclusión: el personal deberá conocer los síntomas de flebitis, monitorear el sitio en el que se colocó la vía venosa periférica, la parte anatómica debe centrarse al calibre del catéter venoso, la atención debe ser cómoda y segura logrando aumentar la calidad de esta, así se lograra evitar complicaciones como por ejemplo inflamación,

In the health care setting, the nursing staff stands out as the major support network maintaining a direct relationship with patients with chronic kidney disease facing hemodialysis treatments. The main objective was to examine in the scientific literature on nursing care based on self-care in patients with hemodialysis treatment. The research was conducted through systematic review based on PRISMA. A search for updated scientific articles from fifteen years ago was carried out using keywords in databases such as: Scopus, Redalyc and Scielo. Results: The 20 selected articles showed how nursing care is provided to patients undergoing hemodialysis treatment. The following article is expected to inform health personnel about nursing care based on self-care in patients with hemodialysis treatment in order to achieve an intervention according to the requirements of each of these patients. Conclusion: It is concluded that nursing care is the fundamental basis for renal patients with hemodialysis treatment to have a good quality of life with respect to their self-care.

Antimicrobial resistance caused by extended-spectrum β-lactamase (ESBL)-producing members of the Enterobacteriaceae family is a global public health problem. ESBLs are enzymes that confer resistance to first, second, third and fourth generation penicillins and cephalosporins, which are expressed in greater proportion in gram-negative bacteria. Objective: To characterize ESBL-producing Enterobacteriaceae in blood cultures of patients treated in different areas of the Isidro Ayora General Hospital in Loja, period 2019-2020. Materials and methods: Quantitative, descriptive, cross-sectional documentary study. The sample consisted of 114 isolates. Results: The most frequent variables of the study were female sex (54.4%), adult age group (39.5%) with a mean age of 45 years. The prevalent bacterial species were Klebsiella spp., (43.9%) and Escherichia. coli (39.5%), followed by Enterobacter spp., (6.1%), Salmonella spp., (3.5%), Citrobacter freundii (2.6%), Proteus mirabilis (1.8%), Morganella morganii (1.8%) and Serratia marcescens (0.9%). According to antimicrobial susceptibility, there was high resistance to all tested beta-lactams, while sensitivity to aminoglycosides, fluoroquinolones and carbapenems was present. The predominant species were Klebsiella spp., in Hospitalization and Escherichia coli in Emergency. Of all the species Klebsiella spp., and Escherichia coli are ESBL (32.5%). Conclusions: Antimicrobial resistance caused by ESBL-producing Enterobacteriaceae is considered a serious health problem. Therefore, it is important to evaluate and establish ESBL prevention, control, and dissemination measures to reduce drug resistance and provide effective treatment.

Introduction: LADA type diabetes was originally identified in 1977 by Irvine WJ et al. However, it was not until 1993 that Toumi et al introduced the term for the first time. Currently there is no consensus to define exactly LADA, thus, LADA diabetes is a form of type 1 diabetes of slow progression that is characterized by presenting manifestations classically associated with type 2 diabetes, plus evidence of antibodies against b-cells. pancreatic, particularly autoantibodies against glutamic acid decarboxylase. Objective: Synthesize the main considerations of LADA type diabetes from the perspective of primary care. Methodology: bibliographic review of articles and books published in the PubMed, ScienceDirect and ScieElo databases. In the non-systematic search, the LADA terms and descriptors were used; Latent autoimmune diabetes in adults; and Latent autoimmune diabetes in adults; The inclusion criteria were used: seniority no more than 5 years, Spanish or English language, including the topics pathophysiology, epidemiology, pathogenesis, etiology, clinical characteristics, diagnosis, comorbidities, treatment and approach from the first level - prevention; and be available for free. After applying the inclusion criteria, the search was reduced to 531 papers; of which thirty-five were selected from the quick reading. Results: a review of the literature was constructed that synthesizes the main aspects regarding LADA diabetes and guides elementary considerations for its suspicion and approach at the first level of health. Conclusion: LADA type diabetes is an underdiagnosed form of type 1 diabetes with a higher incidence than classic type 1 diabetes; suspecting it and managing it at the first level of care is a competence of primary care professionals, given its incidence, however, the diagnosis must be made by a specialist in the area.