Introduction: This paper presents the design of a protocol for the referral of patients with clinical findings of visual disturbances that require vision therapy through the design of algorithms based on decision trees for their clinical management and visual rehabilitation supported by clinical evidence; the absence of standardization of processes makes it impossible to make a referral decision, which can generate uncertainty in making timely and correct provisions. Objective: Design a protocol to refer to vision therapy from the optometric consultation. Methodology: This research is qualitative, quantitative descriptive, because results were obtained based on the experience of 162 professionals surveyed; This research was conducted in the province of Manabí, although a national survey was applied to visual health professionals; Based on the data obtained, the protocol for referral to vision therapy was designed. Results: the action protocol was designed with five algorithms: amblyopia, remote PPC, strabismus in distant and near vision, and oculomotor dysfunction, accommodation, and decreased stereopsis dysfunctions. Conclusions: The basic tests identified that should be performed based on visual function are visual acuity, refraction, contrast vision and color vision; for visual efficiency: ocular motility, accommodation, and stereopsis; the structure of the protocol for referral to the visual therapy area was established through easy-to-interpret flowcharts. The standardization and management of equality of procedures is a useful tool for conducting research and multicenter studies where there must be equality.

Cardiovascular diseases are very common in canines, despite a thorough clinical examination and diagnostic tests such as radiography, electrocardiogram, echocardiography and blood pressure measurement, it is still difficult to estimate the severity and evolution of these pathologies. However, we must also point out that the heart generally shows certain substances called biomarkers, which help to determine its condition and its location, which is why this research was developed, with the sole objective of determining some cardiac biomarkers in canines. As predictors of cardiac involvement, in the present study three cardiac biomarkers were evaluated in thirty canines divided into three age groups grouped between 7 to 9 years (Group A); 9 to 12 years (Group B) and more than 12 years (Group C) respectively; resulting in group C presenting the highest proportion of positivity for the markers under study followed by groups A and B that match positive cases, likewise the Tnl biomarker was the most sensitive (26.6%), followed by TnC (20%). ) and BnP shows less sensitivity (16.6%). It is clear that, although cardiac biomarkers are considered an important aid in cardiological diagnosis, they cannot replace the information provided by a meticulous clinical examination and imaging aids such as echocardiography and radiography.

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.

Introduction: Varicocele is a dilatation of the pampiniform plexuses caused by the presence of retrograde flow, the incidence of varicocele in the male population classically has been described close to 16%, being 35-45% among men with infertility. Objective: To analyze the effect of varicocele treatment on fertility outcomes in infertile men. Methodology: A search was conducted in English and Spanish in the databases Sciencedirect, PubMed, Redalyc and Scielo, with the descriptors, Varicocele, Male Infertility, Treatment, Results using the Boolean AND finding sixty-four publications and selecting twenty-eight. Results: The most used treatment was laparoscopic surgery in patients with infertility and conservative treatment in cases without infertility and without pain. Conclusions: Surgical treatment was shown to improve infertility by 80% within 12 months.

Background: Ethical values play a significant role in the training of medical students. The COVID-19 Pandemic has impacted all actors in health systems worldwide. Objective: To demonstrate the influence of the COVID-19 Pandemic on the perception of ethical values by rotating interns of the medical career after ten months of work in the Pandemic. Method: A modified VIA-IS (Value in Action Inventory Strength) Likert survey of values was applied at the Technical University of Manabí to rotating interns before starting work in the pandemic and after 10 months of work in the pandemic. Results: There was a change in the category scores of the values by the housemen. 89.50% of the medicine interns considered that the COVID 19 Pandemic changed their perception of values. The number of values categorized as High Score was significantly higher after working during the pandemic for a CI95, an error of 0.05% and p<0.05. Conclusions. Exposure to the COVID-19 pandemic as workers in the “hot zone” first line produced changes in the appreciation of ethical values in the rotating interns of the Medicine career at the Technical University of Manabí.

Introduction: The spectrum of cardiometabolic diseases constitute a serious global health problem. The global prevalence of diabetes, since 1980, has gone from 4.7% to 8.5% in 2010 for the adult population. According to the International Diabetes Federation, in 2019 an estimated 463 million people had diabetes. It is estimated that this figure will increase to 578 million by the year 2030, and 700 million in 2045, behaving like a true pandemic. Gastrointestinal (GI) complications of diabetes are the product of various changes in physiological mechanisms, such as disturbances in the motility of the digestive tract and alterations in the process of absorbing water and electrolytes. Objective: Synthesize the generalities of the gastrointestinal complications of diabetes. Methodology:  Literature review; ScienDirect, Redalyc, SciElo, Lilacs databases were consulted, the scientific production was discriminated based on seniority, giving priority to articles less than 5 years old, presenting a description of the gastrointestinal complications of diabetes and be found in Spanish and English. Conclusions: Gastrointestinal complications associated with diabetes are pathologies that should be the subject of extensive study and knowledge by health personnel, doctors, nurses, and nutritionists, who are at the first level of care to identify and refer to the patients. Work on the prevention of diabetes and promotion of good cardiometabolic control constitutes the cornerstone in terms of complications of this chronic pathology.

Introduction: HELLP syndrome affects up to 20% of pregnant women with preeclampsia and is associated with high rates of maternal and fetal mortality. Spontaneous liver rupture is a life-threatening complication of HELLP syndrome, affecting 1 in 45,000 - 260,000 pregnancies, multiparous; in the age of forty; after 32 weeks of gestation. Objective: To conduct a narrative review of the current literature on spontaneous liver rupture associated with HELLP syndrome. Methodology:  A bibliographic review was conducted in the electronic databases of Pubmed, Redalyc, ScienceDirect, SciELO of scientific publications related to the objective of the review. Results: Hepatic rupture is the rupture of a compressive hepatic subcapsular hematoma, these hematomas usually occur in five out of seven women with severe preeclampsia or HELLP syndrome. Pathophysiologically fibrin deposits and vasospasm in pregnancy lead to increased liver pressure and necrosis, causing liver rupture. Clinical manifestations include right upper quadrant pain, epigastric pain, vomiting, and hemodynamic shock. It is usually diagnosed from the surgical finding associated with injury and maternal and / or fetal risk. Therapeutic approaches range from conservative management to liver transplantation. Conclusions: Spontaneous hepatic rupture of a subcapsular hepatic hematoma caused by HELLP syndrome is a rare but life-threatening complication, which usually occurs between weeks 28 and 36 of gestation. Clinical manifestations include epigastric pain, sudden right quadrant pain, and hemodynamic shock. If rupture is suspected, complementary examinations include ultrasound. Treatment can range from conservative management, emergency laparotomy, arterial embolization to liver transplantation.

Introduction. Worldwide, a culture of safety focused on increasing the quality of care of its services is being implemented in the occupational health team. Objective. Propose the implementation of a seminar on Patient Safety and Care Quality for students of the Obstetrics Career of a University of Ecuador. Methodology. Academic variables of the Obstetrics Career of a university institution in Ecuador were analyzed and subsequently the application of a practical theoretical seminar was configured, complementary to academic training, related to the culture of patient safety and quality of care, which is immersed in health care. Some didactic resources are planned for the development of competences, stories such as theoretical learning, problem posing and problem solving. The evaluation was defined based on indicators. Results. A curricular design without reference content to patient safety in the Obstetrics Career was identified, based on which, pedagogical strategies were proposed to increase knowledge of these issues and contribute to the reduction of the risk that the patient has. health personnel, to cause adverse events of diverse types. Conclusion. It is important that these topics are taught from the undergraduate educational curriculum, that is, in university classrooms, so that future professionals are sensitized and achieve a culture of patient safety.

Introduction. Childhood is a stage of life characterized by observation, curiosity, and discovery, through experimentation and play, children get to know themselves and their environment. In the stage of sexual development, children become aware of the sex to which they belong imitating roles of people of their gender, which marks their behavior and being able to adapt to their environment. Objective. To determine the emotional and behavioral factors involved in child sexual development, and discerning normative and pathological behavior. Method. A systematic review was carried out based on 19 investigations of the last 10 years and considering the scientific databases such as Scopus, Web of Science, PubMed, Taylor & Francis, Google Scholar. Results. The studies reviewed showed that child sexual development is a natural part of the human being. There are two types of sexual behavior, the normative, based on self-exploration, imitation, the expression of affection towards oneself and the others and the pathological, in which the behaviors and emotions of the normative are expressed more explicitly and as a frequent pattern as it relates to sexual abuse. Conclusions. It was concluded that emotional factors such as affectivity, self-esteem and behavioral factors such as curiosity and self-exploration represent normative behavior, while pathological behaviors such as depression and distress, and violent behaviors influence emotions such as depression and distress, and violent behaviors and excessive manipulation of private parts. For healthy child sexual development, it is essential for children to have guidance and receive age-appropriate information to build security and trust in them.

Introduction: blood is a body fluid with a very important function in various biological and metabolic processes. Type A and B antigens determined by genetic inheritance are those found on the outside of erythrocytes, they vary in different populations, so they are the subject of important studies in various branches of medicine, in the area of ​​gynecology and obstetrics , it is important to identify a blood incompatibility early or preventively to favor the reduction of neonatal morbidity and mortality rates, since it can lead to hemolytic disease of the newborn or other complications. Objective: To collect the most important and up-to-date information on ABO incompatibility. Methodology: Systematic review of documents and research in English and Spanish obtained from scientific platforms such as Elsevier, ScIELO, PubMed and from national and international university repositories since 2017, with descriptors such as the ABO System, blood, maternal-fetal incompatibility, complications, among others. Results: Of a total of 112 documents initially, 62 were used to read their summaries, excluding the others due to lack of relevance to the research topic or duplication of information. Conclusions: ABO blood incompatibility is a complication that generates an antigen-antibody reaction and can be fatal. Therefore, all medical branches; or at least the vast majority, initially consider performing blood typing tests to apply the corresponding treatments or determine the etiological cause of an associated pathology, knowing that there are natural processes in gynecology in which ABO incompatibility can generate important complications in the newborn such as hemolytic disease of the newborn, anemia, or severe hyperbilirubinemia, which increase morbidity and mortality rates.