Introduction: It is defined as the condition that affects the lung parenchyma because the tissues become thick and hard, hindering its elasticity and the passage of oxygen to the blood vessels. Objective. - Conduct a bibliographic review about the diagnostic and therapeutic approach to pulmonary fibrosis. Materials and methods: In the present review, an exhaustive search was conducted for information on pulmonary fibrosis in databases such as UpToDate, Springer, Google Scholar, PUBMED, Journals and official pages of world information on Covid 19. Conclusion: The main imaging tests to detect the presence of fibrosis were identified, as well as treatments to improve the quality of life of patients after hospital discharge.

Introduction: The World Health Organization defines quality health care as that which recognizes the needs of users; When evaluating the quality of care, the probability of achieving satisfactory results is increased, it depends on the patient's perspective, for this reason it is important to exceed expectations when meeting her needs. Objective: To evaluate the quality of care during prenatal care at the Vicentina health unit. Methodology: Quantitative, non-experimental, cross-sectional research, the data obtained were based on the satisfaction scale with Health Services-S5/22 adapted to the SERVQUAL model, the information was synthesized through the data matrix, taking 100 pregnant women as a sample. Results: A statistically significant relationship was found between the quality of care provided and the perception by pregnant women, with a satisfactory perception for reliability of 51.2%, security with 60.5%, empathy with 52.6%. and tangible aspects in 65.5%; In terms of responsiveness, 58.5% dissatisfaction was obtained. Conclusions: The quality of prenatal care was good, with an average of 52.26% satisfactory perception, on the other hand, several dimensions were identified that should be reassessed, in which a lower level of satisfaction was recorded.

Introduction: Painful bladder syndrome or also called interstitial cystitis (IC/BPS) is a chronic pelvic pain disorder that is perceived as originating in the bladder and is accompanied by one or more symptoms of the lower urinary tract, without other identifiable cause. Objective: Analyze the most current information regarding the pathophysiology and therapeutic approaches of Bladder Pain Syndrome. Methodology: A systematic review of the scientific literature on Bladder Pain Syndrome: Physiopathology and current therapeutic approaches was conducted based on articles obtained from different databases such as: Pubmed, ScienceDirect, Medigraphic, Cochrane, Medline, ElSevier, etc.; publishing during the last five years and that contained up-to-date and relevant information. Results: IC/BPS encompasses several clinical phenotypes with different pathophysiological mechanisms and, therefore, different therapeutic management. Two subtypes are currently recognized: IC/BPS with Hunner's lesions or interstitial cystitis (IC) and IC/BPS without Hunner's lesions or painful bladder syndrome (BPS). IC is an inflammatory disease associated with an immune response and infection, with various histopathological findings and treatment focused on restoring localized lesions in the bladder mucosa; while BPS is a non-inflammatory disorder associated with systemic hypersensitivity probably due to neurophysiological and/or endocrine alterations, with few or even no histological findings and with therapeutic strategies similar to those used in the management of other somatic syndromes. This classification into phenotypes is important because it facilitates the treatment of the disease and favors future research, achieving a better understanding of the pathophysiology and, therefore, of the management of this syndrome. Conclusion: IC/BPS is a pathology of chronic pelvic pain, of still unknown etiology. Several pathophysiological mechanisms have been identified depending on the phenotype, which influence the histopathological findings. Likewise, the clinical manifestations vary depending on the cystoscopy abnormalities. Finally, the therapeutic approach must be individualized and according to the type of this syndrome. 

Introduction: Currently, the pandemic caused by SARS-CoV-2 has created a new concern in the health system, due to long-term systemic manifestations in patients who have been with this disease, defining it as a post-COVID-19 syndrome in 2020, given the persistence of symptoms requiring management that includes various specialties that give relief to the different discomforts manifested by the patient.  Objective: This article is conducted to know and describe about the post-COVID-19 syndrome with updated and useful information for the knowledge of health personnel who face this pathology. Methodology: A search was conducted in databases such as: MEDLINE/Pubmed, Google scholar, Springer, where information on this topic is found. Results: It is a pathology that presents a wide repertoire of symptoms that involves different organs which will depend on certain risk factors and the complications it had during the pathological process. There are biomarkers that in the future may become the gold standard for the diagnosis of post-COVID-19 syndrome, which will allow to verify the functioning of the organs that have been affected. Current studies propose beneficial therapies such as respiratory rehabilitation whose objective is to improve lung function. Discussion: At present it is not yet fully known the pathophysiological process by which persistent symptoms occur, however, studies show the probable causes and clinical picture that predispose to this disease, the same that will be attended at the first level of care and provide symptomatic treatment. Conclusion: The revolution in the health system caused by SARS-CoV-2 again evaluates the capacity of health professionals, so research describes this phenomenon as a post-COVID-19 syndrome.

Goal. The objective of this research was to determine the efficacy of magnesium sulfate as an adjunct to analgesia in bitches undergoing abdominal cavity surgery. Materials and methods. In the present investigation, thirty female dogs underwent elective OVH through the midline, which were randomly distributed and single-blinded into two groups. Group 1: 15 patients were medicated in the postoperative period with magnesium sulfate (25 mg/Kg), cephalexin (25 mg/Kg) and meloxican (0.2 mg/Kg). In group 2, magnesium sulfate was replaced by 0.9% saline solution at a dose of 0.25 ml/Kg. Once the surgical act was over, the patients were transferred to the recovery room, where the estimation of the pain using the Melbourne scale, at 2-, 4-, 6- and 8-hours post-surgery. Results. The maximum pain score level for both groups occurred in the immediate postoperative period, group 1 presented a mild pain level, group 2, moderate pain, finding significant statistical differences in both groups, the pain decreased as the treatment progressed. weather. Heart rate values ​​in group 1 remained within range values, while group 2 showed an increase of 26% in the first two hours. Conclusions. With the results obtained in the present investigative work, it was possible to establish that the addition of magnesium sulfate significantly reduces the level of pain in bitches subjected to elective OVH.

Objective: To compare the results of the application of the growth curves of the World Health Organization and those adapted for Ecuadorians, in children from 7 to 10 years of age in the province of Manabí. Methodology: Observational, analytical, cross-sectional study. The population is made up of Manabi children between 7 and 10 years old, a sample of 148 subjects. Inclusion criteria: 7 to 10 years old, Ecuadorian nationality, enrollment in an educational institution, informed consent by parents, attend during the measurement dates. Those who did not attend or resisted were excluded. The variables studied are age, sex, height and weight, BMI. The data were analyzed using the IBM – SPSS 25 statistical package. Cohen's Kappa index was used to compare the concordance between both instruments. Results: The WHO growth curves allowed us to categorize 87.2% of the subjects with normal height, 1.4% tall height, 11.5% short stature; 47.3% normal weight, 40.5% overweight, 8.8% obesity, 3.4% underweight; Regarding BMI, 42.6% normal weight, 29.1% overweight, 18.2% obesity and 10.1% underweight. While the curves adapted for the Ecuadorian population categorized 65.5% normal height, 34.5% tall height, without short stature subjects; 67.6% normal weight, 16.2% overweight, 16.2% obesity, without underweight subjects; Regarding BMI, 54.1% normal weight, 25% overweight, 12.8% obesity and 8.1% underweight. Conclusion: There is moderate concordance between the growth curves for subjects between 5 and 19 years of the WHO and those adapted for the Ecuadorian population by Monnier et al, with a predominance of the assessment of height and weight, and with better concordance for the body mass index.

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.

Introducción: El aneurisma aórtico es una protrusión o dilatación anormal que se produce a nivel de la pared vascular debido a un debilitamiento de las capas de la aorta, en su mayoría de la íntima y de la media generando la retención de un coágulo perivascular en la adventicia del vaso; que puede generar su disección. Objetivo: Describir un caso clínico de aneurisma aórtico ascendente más insuficiencia aórtica grave, diagnosticado de forma casual y resuelto por la técnica de Bentall – Bono. Metodología: Estudio descriptivo y retrospectivo, presentación de caso clínico. Resultados: Se presenta el caso de un paciente masculino de 50 años con dolor precordial intenso de tipo opresivo, acompañado de disnea y palpitaciones. Al examen físico paciente hipotenso, alteraciones del pulso. A la ausculta cardiaca soplo diastólico en foco aórtico, horquilla esternal. Presencia de signos de Quincke, Traube, Musset, Hill. Al estudio de Electrocardiograma taquicardia sinusal con signos de sobrecarga de ventrículo izquierdo. Ecocardiograma transtorácico que reveló aneurisma importante de la raíz y aorta ascendente, con compromiso del ventrículo izquierdo, reflujo aórtico severo y una dilatación del ventrículo izquierdo. Tomografía de tórax confirma aneurisma, se decidió transferencia a una unidad de tercer nivel donde le realizaron cirugía cardiaca con la técnica de Bentall – Bono. Conclusione: El aneurisma de la aorta ascendente tiene una baja frecuencia, pero serias complicaciones que condicionan su elevada mortalidad y tiene indicación de cirugía urgente. Entre las técnicas más seguras de realizar, se encuentra la técnica de Bentall - Bono modificada.

Foundations: The elastics for medical-dental use that have been placed in the mouth are subjected to different substances present in food and beverages, such as lactic acid, citric acid, heptane, alcohol/water, erythrosine, which determine slight changes in them, so they must be replaced according to the needs required by the treatment and these will be indicated by the professional specialist. Objective: Comparison of plastic and elastic deformation between elastomeric modules of three commercial brands in neutral medium: in vitro study materials. Methods: It was conducted with a quantitative approach, longitudinal temporality with projective level and quasi-experimental design; In addition, the study population was considered by the most representative commercial factors in the region: American Orthodontics, Orthometric and Dentaurum in a neutral artificial saliva medium. Results: The deformation of the external and internal diameter of the elastomeric modules of the American Orthodontics trademark demonstrated greater plastic and elastic deformation of hasta by 32.67% ± 5.54 being the highest percentage of deformation obtained. On the other hand, the thickness of the Dentaurum elastomeric modules demonstrated a plastic and elastic deformation of up to 27.82% ± 7.51 being the highest percentage of deformation obtained. Conclusions: The greater deformation of the external and internal diameter and thickness is evident and occurs at intervals of 7 days of control, in addition, it is recommended to follow the recommendations of the factory so that the results are optimal in each event or moment of mechanics in orthodontics.

Foundations: There are diagnostic methods to determine the mandibular transverse width in orthodontics, which is performed in postero-anterior radiographs, in study models and in cone beam computed tomography, the latter being the most indicated method due to its greater precision. The correct diagnosis allows us to develop and plan a treatment according to the needs of the patient, today the use of Cone Beam Computed Tomography (CBCT) is a tool that helps us approach the patient in the three planes of space, and specifically in the cross-sectional analysis of the jams, we determine their adequate width or their discrepancies, which provides us clear data for a correct treatment plan. Objective: To determine the average mandibular transverse distance in an adult Andean population evaluated by Cone Beam Computed Tomography. Methods: The study was conducted in 120 tomography’s of adult patients (67 women, 53 men) in which the measurements were obtained to determine the total mandibular transverse distance of the study population and the mandibular transverse distance by male and female sex. By means of CBCT specifically in the axial view, where the internal cortices of the vestibular tables were in the lower first permanent molars at the level of the furcation, using the create line tool and the transverse distance of the internal cortical of a side to inner cortex of the other side. Results: It was determined that the total average mandibular transverse distance in men was 53.73 mm, the total mandibular transverse distance in women was 44,39 mm and the total mandibular transverse distance was 52,54 mm. Conclusions: The mandibular transverse distance in the skeletal Class I population is greater than the currently existing reference measurements, with higher values for males than females.

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.

Foundations: For Orthodontics the quantitative contribution that can give the inclinations of the teeth at the end of the treatment has relevance, for example, with age, the vestibulum-palatine inclinations of the molars vary in relation to the width of the intermolar arch, where studies indicate that the maxillary and mandibular molars are more vertical while there is an increase in the widths in the intermolar arches. According to the literature, there is little information on the inclination values of the first molars in adult patients. Objective: The purpose of this study was to investigate by means of complete skull tomography the degree of vestibulum-palatine inclination of the first maxillary permanent molars in individuals with class I skeletal. Methods: We analyzed 120 ct scans of the complete skull (64 belonging to women and 56 to men) chosen by a sample at convenience by selection criteria. CBCTs (cone beam computed tomography) were obtained using a Newton Tomography GI-EVO Multislice CT scan (Cone Beam). Results:  The average of the inclinations in both male and female gender was for the first right upper molar of 94.03° ± 6.64, for the first left upper molar the average was 95.26° ± 5.40. And the overall average vestibulum-palatine inclination of the first right and left upper molar was 94.65° ± 6.02. Therefore, values above 100.67° indicated an oral or vestibular inclination of the upper first molar and values below 88.63° indicated a palatal inclination.  Conclusions: The vestibule-palatine inclination of the first maxillary molars was 94.65° with standard deviation ± 6.02, as a reliable measure by the horizontal reference (Frankfurt plane) that indicates the adequate and stable angulation that should have for the completion of an optimal orthodontic treatment.

Foundations: The study of transverse malocclusions has evidenced important and necessary knowledge for the care of the population with these dental alterations and has also provided useful and necessary information for the implementation of what has been evidenced in the development of dental practice. Objective:  The objective was to describe the quality of the report of the studies related to the early approach of transverse malocclusions: diagnosis and treatment. Methods: Type of descriptive, retrospective, cross-sectional study. The sample consisted of 21 reference articles from the early approach study of transverse malocclusions published by Padilla et al. 2009, which were evaluated using the STROBE Declaration guide, considering its recommended indicators. Descriptive statistics were applied calculating absolute and relative frequencies. Results: When evaluating the presentation in terms of methods, it was observed that there are important limitations and weaknesses related to all sections, with greater depth in the study design and statistical methods because 100% do not comply with the recommendations, not a single study explains how key elements of the study design were presented, how missing data were addressed, nor does it describe analytical methods that take into account the sampling strategy where appropriate, nor does it describe sensitivity analyzes where appropriate. Likewise, in the methods section, a minority of them partially complied with the STROBE recommendations in this aspect, ranging from 30.7% to 38.4% of the total articles. Conclusions: It is concluded that the publications studied show low compliance with the recommendations of the STROBE and CONSORT declarations.

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.

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,

Hypertensive disorders of pregnancy (THE) are of excellent value worldwide, this is due to the significant effect on maternal and fetal morbidity and mortality, the (THE) are quite common, affecting between 5% and 10% of all pregnancies. General objective: to determine the prevalence of hypertensive disorders in pregnancy through a systematic review of the literature. Methodology: A systematic literature review on the prevalence of hypertensive disorders in pregnancy was developed using PRISMA statements. Results: in Norway, the study sample was women who gave birth during the years 1999 to 2014, the prevalence of preeclampsia was 3.7%. Conclusion: the prevalence of eclampsia, preeclampsia in Norway was 3.7 %, Nepal 1.77%, African region is 2.9%, Southeast Asian region 1.1%, India 3.8 ± 0.6%, Ecuador 3.6%, Iran 6.5%, Argentina 2.9%, Colombia 3.5%. Prevalence of Hellp syndrome: Chile 13.6%, Iran 0.8%, Asia 0.69%, Argentina 5.51%, China was 0.5% to 0.9%, Peru 9.7%, France 0.2%, Mexico 4.5%.

Introduction. Multidrug-resistant tuberculosis is a threat to public health; despite the existence of treatment, it continues to be the infectious disease that causes the most deaths worldwide. Objective. To determine factors associated with multidrug-resistant tuberculosis through a clinical case from the El Paraíso Health Center in the city of Machala. Methodology. This is a 43-year-old male patient, mestizo race, no occupation, with a history of type II diabetes mellitus for 17 years, currently under regular treatment with intermediate-acting insulin 20 IU AM and 10 IU PMI, with poor control and not adhering to treatment, alcohol consumption 4 times per week, tobacco 2 packs per day, cocaine consumption 5 years ago for 6 months, presenting a clinical picture characterized by cough with mucopurulent expectoration, accompanied by weight loss, nocturnal thermal rise, asthenia and anorexia for approximately 1 month. He was diagnosed with treatment-resistant tuberculosis and started a second-line treatment regimen. Results. Patient with rifampicin-resistant tuberculosis with associated risk factors: drug addiction, alcoholism, chronic smoker, insulin-dependent type 2 diabetes, and high psychosocial risk.

El termino aneurisma de fistula arteriovenosa se utiliza en medicina para definir que es una dilatación vascular localizada, donde participa toda la pared del vaso incrementando el diámetro vascular en un 50% o más.  Objetivo general: Revisar en la evidencia científica sobre determinar los factores de riesgo y prevalencias del aneurisma de fístula arteriovenosa en pacientes de hemodiálisis. Metodología: Se trabajó con un método de enfoque descriptivo en lo que se refiere a las estrategias de búsqueda se utilizó las bases de datos científicas como, PubMed, Scopus, Web off Science, mediante la combinación de palabras clave lo que permitió seleccionar artículos en idioma español e inglés entre los años de publicación 2015 al 2021, se escogerán aquellos que tuvieran alguna relación con la temática a tratar. Resultados principales: El método empleado en la investigación será hipotético deductivo, utilizará un diseño no experimental de nivel descriptivo, que recogerá la información en un período de los 5 últimos años, cuyos resultados serán visualizados en gráfica y textualmente. Conclusión: La evidencia significativa para afirmar los factores observados si están asociados significativamente a la formación de aneurismas en fístula arteriovenosa, con una p-valor < 0.05, afirmando o anulando la hipótesis planteada para dichos factores.

Introduction: Leptospirosis as a zoonotic disease in recent years has been of great concern in the world being a disease of declaration to the WHO as the years go by in certain areas preferably those linked to tropical and subtropical climates it has been established that its presence has an increase especially in rainy seasons,  this bacterium causes disease in several patients, whether animal or human, and for that reason it is important to know its distribution and spread.  Objectives: The main objective of this research is to have an updated document on leptospirosis, its potential zoonoses and the current state in the country Ecuador. To determine leptospirosis as a zoonotic disease of epidemiological importance at the national level. To know the distribution of leptospirosis in terms of their research at the national level. Methodology: Bibliographic for leptospirosis as a disease of zoonotic importance to elaborate a document with an update of this important, 23 publications were found, but 13 were considered to know the current and real situation of leptospirosis in Ecuador. Results: This investigation showed that the positive cases for leptospirosis using any diagnostic technique obtained various results which on average was de 58.04% of prevalence being the coastal region the one that presents most of the cases. Conclusions: Leptospirosis is a disease that affects several species including humans worldwide, but in our country, it is under consideration, it can be concluded that in all the investigations that are reported there is a high prevalence, and the most studied region is the coast.