Introduction. Subclinical hypothyroidism in older adults becomes difficult to diagnose, because thyroid stimulating hormone increases in value as age advances, maintaining normal thyroxine values, which is why the setting and circumstances of the patient will influence the diagnosis and treatment. General objective. To describe the diagnosis and treatment of subclinical hypothyroidism in older adults. Methodology. A non-experimental narrative literature review study was conducted. The initial search yielded 163 articles of which, after reviewing the title, abstract and elimination of duplicates, we worked with 12 articles, according to the type of research. Results. The diagnosis of subclinical hypothyroidism is demonstrated by high thyroid stimulating hormone and normal thyroxine values. In those over 60 years of age thyroid stimulating hormone >10 mIU\L is present. Most physicians administer low doses of levothyroxine or decide to monitor the patient for 3 – 6 before administering levothyroxine. Conclusions. For the diagnosis of subclinical hypothyroidism in older adults, symptomatology, age, their comorbidities and the setting should be assessed, Thyroid hormone replacement therapy can be beneficial or detrimental, so proper assessment of the patient will determine whether medication is required or just watch and wait to avoid overtreatment. 

Introduction: The most frequently diagnosed malignancy worldwide is breast cancer. There are new minimally invasive therapeutic alternatives thanks to technological innovations, such as cryoablation, radiofrequency ablation and microwave ablation, which have given satisfactory results. Objective: Describe ablation techniques as treatment in patients with breast cancer. Methodology: A non-experimental narrative study was conducted, with a bibliographic review. Articles in English and Spanish from the last five years were used. Results: The ablation techniques were described; in what type of patients, they were used and what was the efficacy of the ablation techniques as a treatment in patients with breast cancer in a clearer way and with more updated bibliography. Conclusions: Ablation techniques have a high efficacy as a treatment in patients with early-stage breast cancer, especially in young women and women of childbearing age. These satisfactory results were better observed in tumors less than or equal to 2 cm, in tumors greater than 2 cm the results take time to appear.

Introduction. The horticultural products of the Ecuadorian Amazon, the technological changes, the current transformations, and the demands of the national and international market, are attributed to a productive dynamic to the CODEX STAN 237-2003 regulations. And it focuses on mathematical modeling to solve the problems of industrial use that lead to commerce. Objective. Develop the mathematical modeling based on parameters of volume, density, weight of its main components of the whole exotic fruit with its categorization of the Hylocereus undatus (Haworth) D.R. Game (pitahaya). Methodology was implemented in the two cantons Pastaza and Province, Canton Palora of the province of Morona Santiago, considering its productive potential and the Codex Alimentarius and Colombian I CONTEC Standards. The application was according to the categorization, for the integral calculation with balances of masses, volume and density through statistical analysis obtained. Results. The mathematical model was based on its extra, first, second and residue categories of volume and mass, obtaining the means and the coefficient of variation of 6.05% and with a reliability margin of 99% and with an adjusted R2 of 98%. Achieving the obtaining of nine mathematical formulas with all their constants (25 – 35), and with a high reliability of 99%, for its industrial use of this raw material, by producers, merchants, industrialists, and students interested in this Research developed in the Ecuadorian Amazon.

Introduction the planetary age is among us globalization is not a living room but an emergency room that requires key circumstantial changes for its understanding, inclusiveness and regional, international, national and local integration, being clear about university problems is the conclave of the mercantile development, which governs the cognitive and metacognitive application of higher education, transversalized in current student and professional academic adaptations, unprecedented brain machinery in digital and hybrid today with problematic resonance in weak cultural realities to the transformation of paradigmatic thought traditional with resistance to change of logical and flexible perspective in the teaching and learning process for the benefit of the student body. The objective of this research was to determine the cultural aspects through the application of the hermeneutic method to analyze the degree of post-pandemic academic adaptation in students and professors of the Espoch. Methodology This work shares the analysis of the hermeneutic-phenomenological method, carried out in the confinement and post-pandemic period with the higher education community in its cultural behaviors and academic adaptations, in response to the alternative of periodic adaptive flexibility. Conclusion in the participation of teachers and students in this new academic scenario only evidenced the transfer of limited, subjective and dishonest knowledge of desperate realities to retake the autonomy of knowledge, behavior and diaphragmatic of real and critical content.

Introduction. This study is because Ecuador, from the Constitution of 2008 and the Organic Law of Higher Education of 2010, has gone through profound changes in higher education; since the access, financing and quality management, policies have continuously varied, bringing unflattering results in university management. Goal. Identify, summarize, and analyze the best available conceptions on public policies for access, budget allocation and quality management in higher education in Ecuador. Methodology. To meet the stated objective, some databases were consulted, such as LATINDEX, SCOPUS and others; identifying, selecting, analyzing, and characterizing various works relevant to the subject, as the main source of the study; Results. Regarding access, from 2008 to 2011, there was a positive effect; however, when combined with the measures of merit and quality, the potential of gratuity was diluted. Regarding financing, the current formula used by the State to calculate the allocation of the budget shows a bias towards those Higher Education Institutions (IES) that have historically been privileged. Regarding the Quality of HEIs, the need to implement new dynamic, open, normative management models that combine the quality of processes with external factors is evident. Conclusions. The access that is currently managed is based on elitist policies, with unfair entry requirements. The budget allocation has a formula that does not consider the special characteristics that HEIs may have, favoring the university elites; and the quality policies do not consider the strategic vision and the internal processes of continuous improvement of the HEIs.

Introduction. Migraine is one of the leading causes of disability with a higher prevalence in women. The use of botulinum toxin has shown great efficacy in chronic treatment, reducing symptoms such as headache days. Objective. Describe the usefulness of botulinum toxin in the treatment of chronic migraine. Methodology. A non-experimental study of the bibliographic review type was developed on the usefulness of botulinum toxin in the treatment of chronic migraine in which scientific articles that were investigated in databases such as Pubmed and Scopus were used. The period of the articles included was the last 5 years. Results. it was possible to demonstrate the different benefits of onabotulinumtoxinA, adverse effects, and benefits compared to other first-line treatments. Conclusion. It is concluded that onabotulinumtoxinA has shown to be especially useful in the treatment of chronic migraine, decreasing the frequency of headaches days-months, reducing the severity of headaches, and increasing the quality of life.

Both vehicular and pedestrian traffic is a problem that developing cities are currently experiencing, with the growth of the population and the number of vehicles, the spaces of mobilization are experiencing congestion, affecting the sustainability of the city. To achieve an early analysis of this problem, indicators have been created to describe a phenomenon qualitatively or quantitatively, but their extensive study has generated an extensive list of these, where regions with limited resources and without a culture of data collection, are inapplicable and unreliable. Therefore, the objective of this study is to evaluate a framework of sustainable indicators that describe the phenomenon of vehicular and pedestrian traffic for a specific area, and to obtain a list of applicable and relevant indicators. The methodology begins with the identification of bibliographic sources and the selection of indicators already evaluated to obtain an initial list, as a second step, this list of indicators was zoned based on expert opinion, fulfilling the criteria imposed, and finally it was verified that these indicators are applicable. In this study, a list of verified, measurable and applicable indicators was obtained for any zone of the city of Cuenca and a methodology of analysis that presents a wide potential for the zoning of sustainable indicators, this selection is absolutely based on the opinion of expert judgment.

Introduction: This article restates the extended reasoning between ordinary justice and indigenous justice, which, from historical times to the present, shows that there has been conflict of competences between the two jurisdictions, since the ordinary one has guaranteed the due process, while the indigenous jurisdiction has the ancestral as its foundation. Therefore, the need to implement an infra-constitutional regulation in the indigenous justice system is a priority, at least an exercise of ruling out which matters cannot be incorporated into the scope of internal conflict even though it has occurred in the community, to guarantee due process and legal security. Methodology: Methodology of inductive, deductive, and historical character, by virtue of the fact that different regulations, articles and laws were analyzed that allowed from a comparative study of law to infer in its application and use in the Ecuadorian legislation, in addition, from the analysis of cases and sentences it was possible to identify the existing gaps in our Magna Carta with reference to indigenous justice. Results: The indigenous justice in Ecuador, part of the human groups that preserve their traditional cultures, customs, decision of most people resisting the application of ordinary justice, in reference to the behavior of a conduct that has committed the illicit that is drastically punished in the communities, peoples and nationalities. Conclusion: It should be indicated that, for the cited authors and sentences of the Constitutional Court, it is notorious that there is a conflict of competences between the ordinary jurisdiction and the indigenous jurisdiction, since there is no supplementary norm in the indigenous justice that allows guaranteeing a due process and legal security.

Introduction. In 2020, COVID-19-associated multisystem inflammatory syndrome in children was first reported, which can have a severe course and may require supportive care. Objective. To review the scientific literature on symptomatology, diagnosis and treatment of multisystemic inflammatory syndrome in children with COVID-19. Methodology. A systematic review of publications indexed in the following browsers was performed: PubMed, Scopus, Web of Science, since 2017, those that had some relation with the subject to be treated were chosen, in a complementary way this search was performed using the keywords. Results. A total of 26 articles related to the topic were found, reflecting that multisystemic inflammatory syndrome is present in a large percentage of children who suffered COVID-19, MIS is characterized by fever, gastrointestinal manifestations, changes in the oral mucosa and skin rash. Laboratory and imaging tests are used to diagnose this pathology. Treatment consists of applying IV immunoglobulin. Conclusion.  Being a pathology of recent appearance in children it is important to study it and define the different components for an adequate diagnosis and treatment.

Introduction: Complications of prematurity are the main causes of suffering some type of disability until death, this presents with a high health risk at the neurological level in the long term. General objective: To analyze the impact on the associated complications on neurodevelopment in preterm infants until reaching the equivalent of term. Methodology: As for the process, it will be carried out following the recommendations established in the PRISMA declaration, it will also work with Scopus, PubMed and Web of Science databases, the period of the publications will be from 2016 to 2021, obtaining 13 articles for their respective analysis. Main results: In short, this methodology will allow us to obtain an idea about the impact in relation to complications in prematurity at the neurodevelopmental level, however, the challenge of this article is to obtain recent findings related to neurological changes associated with prematurity and its impact on possible disabilities. Conclusion: It is clear that this is an area that deserves a stronger research approach to identify the modifiable factors that shape the development of these very vulnerable preterm infants.

Introduction: Chronic subdural hematoma is a disease characterized by a collection of blood in the subdural space (dura mater and arachnoid), it is one of the most frequent types of subarachnoid hemorrhage and if the correct treatment is given to patients with this pathology, they have a favorable diagnosis. Objective: to determine the management of chronic subdural hematoma in a 62-year-old patient at the San José Hospital in the City of Azogues. Clinical case description: 62-year-old male patient, married, from Tulcán, resident in Cuenca-Ecuador, with primary education, bricklayer occupation, mestizo race, Jehovah's Witness religion, ORH+ blood type. With a diagnosis of chronic subdural hematoma, with no pathological history. Evolution: After the surgical procedure, the patient goes to the recovery room with post-surgery and then goes to the respective room with anti-cerebral edema measures, 0.9% saline solution, anticonvulsant, antibiotic, analgesics, as well as corticosteroids, after a day of patient recovery, he is discharged. in good condition, conscious, alert, and oriented in time, space and person with a Glasgow scale of 15/15, photoreactive pupils, isochoric, and the drain is removed under asepsis and antisepsis standards and is sutured, and the patient is sent home with outpatient pharmacological treatment. Conclusion: Such was the exposed clinical case, thus ensuring the physical, mental, and social well-being of the individual.