Germinal matrix hemorrhage: can be detected effectively

The germinal matrix hemorrhage corresponds to a cerebrovascular event originated in its blood vessels, it is prevalent in premature babies and is the first cause of infant mortality in Ecuador; Its inadequate diagnosis has an important impact on the neurodevelopment of premature infants and can generate serious sequelae that may be greater depending on the degree of prematurity, especially in premature infants weighing 500 to 750 g at birth. One of the main tools to diagnose womb bleeding is transfontanelar ultrasound, which is fundamental in the detection and early management of the situation. It should be considered that it requires an experienced radiologist to identify and interpret the findings. Some associated risk factors are: gestational age, low birth weight, low Apgar score, acidosis, and neonatal asphyxia. The factors that are involved in bleeding can be: intravascular, vascular and extravascular. The degrees can range from Grade I (hyperechogenic mass due to the presence of clots, the choroid plexus looks thickened in the trigone region), Grade II (in which the hemorrhage extends to the cisterna magna, which increases the risk of hydrocephalus) , Grade III in which the clot will become more anechoic over time, the presence of blood in the CSF can cause chemical ventriculitis) and Grade IV (with paraventricular hypercogenecity with involvement of the frontal and parietal lobes). Transfontanelar ultrasound can detect various brain lesions in the premature newborn, including bleeding from the germ matrix and periventricular leukomalacia. The main cause of leukomalacia is hypoxic-ischemic events, so that the lesions predominate in the periventricular white matter. The use of this technique is recommended for the timely diagnosis of bleeding in newborns with risk factors.

Juan C. Jara Santamaría, Luis E. Torres Morán, Cecilia Trujillo Jácome, Patricio Yánez Moretta, Guido F. Cumbicus Naranjo, Shirley G. Mantilla Naranjo

26-43

Trauma of the brain skull with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). About a case

Hyponatremia is the most frequent hydro-electrolyte disorder, it is caused by the inability to excrete water normally. The anamnesis and the physical examination constitute useful tools now of the diagnostic confrontation. The problem is that reaching a definitive diagnosis, although he has a history of head trauma and the general practitioners do not know how to distinguish between a trauma that loses Sal (SPC) and a Syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Give specific guidelines for differentiation between two pathologies that appear after traumatic brain injury to general practitioners for their prompt treatment and to avoid future complications. Methodology. Research was the compilation of information retrospectively from a medical history in a private clinic in Guayaquil, follow its in-hospital evolution and see its definitive treatment. Outcome. The following is a case of a 19-year-old patient who, after suffering traumatic brain injury and with a simple brain tomography without brain alterations, presented hyponatremia with alteration of consciousness and that when giving specific treatment for SIADH improves adequately. Hyponatremia is the most frequent electrolyte disorder in the neurocritical patient, being a major cause of morbidity and mortality if adequate therapeutic measures are not instituted immediately. SIADH and CPS have been described as the 2 syndromes that most frequently explain the presence of hyponatremia associated with increased natriuresis in the neurocritical patient. In them, the evaluation of blood volume allows establishing the differential diagnosis between the two entities, although this is often a real diagnostic challenge. Conceptually, the diagnosis of "brain lacking salt" seems to be more appropriate to define hyponatremia in the neurocritical patient, since regardless of its cause, the mainstay of therapy is always the same.

Juan Carlos Salazar Flores, Edwin Javier Correa Vivanco, Katherine Elizabeth Gonzaga Aguilar, Magna Mercedes Valdez Vallejo

44-55

Multiparidad como factor de riesgo para enfermedad trofoblástica gestacional en el Hospital Maternidad Matilde Hidalgo de Procel. Análisis de un caso.

Introduction: Gestational trophoblastic disease is a rare complication of pregnancy characterized by abnormal proliferation of the trophoblast (tissues derived from the human placenta). Its classification is based on the histological characteristics provided by its trophoblastic origin and the biological properties of its Tissues that have the ability to secrete human chorionic gonadotropin (hCG), the latter being of clinical utility, its value becomes a tumor marker that allows early identification of the process and even for the adoption of treatments without histological verification being essential. Objective: To determine the importance of diagnosis based on the quantification of chorionic gonadotropin hormone and early ultrasound. Methodology: The research design was carried out through descriptive research through a clinical case. Conclusion: Maternal age (extremes of reproductive life) and multiparity are a risk factor in pregnancy, childbirth, or the puerperium, related to maternal morbidity and mortality and other complications during pregnancy. Confirmation of the diagnosis is based on quantification of the chorionic gonadotropin hormone and early ultrasound. Treatment of hydatidiform mole consists of uterine evacuation, if pregnancy is not desired; hysterectomy is preferable in women aged 40 years or older, since at least a third of these women will develop persistent gestational trophoblastic neoplasia.

Roxana Mercedes Ochoa Reinoso, Ingrid Verónica Ostaiza Veliz, Fabian Paris Larrea Acevedo

56-70

Handling of semiautomatic external defibrillators by internal nursing students. Guayaquil University. 2019-2020

Introduction: Ventricular fibrillation and pulseless ventricular tachycardia are the arrhythmias that most frequently appear in sudden cardiac arrest in adults (more than 85%), the correct treatment is early electrical defibrillation. Objective: To determine the management of semi-automatic external defibrillators in nursing students. Guayaquil University. 2029-2020. Methodology: A descriptive, quantitative methodology was used, the sampling was non-probabilistic, by means of volunteer subjects, being made up of 146 students, using as an instrument a questionnaire made up of closed and open questions that were analyzed with the SPSS statistical package. Results: Only 28% recognize the paddle placement zone, 68.4% rarely check if the patient is urinated or wet and 57.5% rarely recognize that the paddles should not be placed on top of the pacemaker, 100% know that it is necessary to voice the alarm before performing the electric shock, among the main factors are 100% frequently the lack of DSA simulators in laboratories, followed by 71.9% who respond that they rarely handle the equipment during hospital practices and the lack of motivating methodologies representing 67.8%, strategies, with 100% enabling laboratories with adequate simulators, 97.9% improving the coverage for handling equipment during hospital practices, 93.8% using motivating methodologies. Conclusions: There are difficulties in handling defibrillators, mainly influenced by the lack of defibrillators in laboratories and the possibility of handling the equipment during hospital practice, together with the lack of motivational methodologies on the part of the teacher.

Héctor Mariño Cano, Youdesley Avila Peña

71-81