Introduction: Minimal change hepatic encephalopathy is the mildest presentation characterized by nonspecific subclinical alterations not evident through physical examination. It is attributed to the liver's inability to eliminate toxins originating in the intestine, with ammonia being the primary toxin. Probiotics are currently considered a significant advancement in the management of this condition, as they act to reduce the quantity of pathogenic microorganisms, thus mitigating excess ammonia in the brain. Objective: To describe the efficacy of probiotics as secondary prophylaxis in patients with minimal change hepatic encephalopathy. Methodology: This is a narrative literature review, involving a comprehensive examination of the literature on the effectiveness of probiotics in patients with minimal change hepatic encephalopathy, sourced from scientific databases such as PubMed, Scielo, Cochrane Library, and Science Direct, using the PRISMA strategy. Results: A total of fifty-one studies were reviewed, gathering key recommendations regarding the significance of diagnosing streptococcus B hemolyticus during pregnancy from scientific databases, including PubMed, Scielo, Cochrane Library, and Science Direct, employing the PRISMA strategy. Conclusion: The use of probiotics has demonstrated positive effects in the management and prevention of minimal change hepatic encephalopathy, especially when employed in various combinations of bacterial strains and other adjunctive medications. Additionally, it should be noted that probiotics are cost-effective and readily accessible. The studies presented highlight their efficacy in treating various hepatopathies and preventing cirrhosis-related complications, due to their ability to modulate intestinal flora, intestinal permeability, and immune response. General Study Area: Medicine. Specific Study Area: General Medicine.

Introduction. Insulinization is a treatment for patients with diabetes mellitus (DM). Especially in early ages and patients with type 1 DM. However, its use has also been tested in patients with type 2 DM, in any age group including older adults. Objective. To detail insulinization in older adults with type 2 diabetes mellitus. Methodology. A literature review was carried out based on the use of scientific articles as bibliographic sources. The search for these articles was carried out in digital platforms and databases exclusively of health areas: Springer, Elsevier, PubmedCentral, among others. To refine the searches, keywords were used as descriptors in both English and Spanish. To improve the results, the search was supported with Boolean operators such as AND and OR. The PRISMA model was used for screening articles. Results.  A total of 80 articles were reviewed within which 15 were useful for the results and discussion chapters. The main indications to start insulinization in older adults is failure to treat with oral antidiabetics, cardiovascular disease, kidney or liver disease, and in those hospitalized patients under medical supervision. Conclusion. The advantages of insulinization have to do with the ease of self-administration, even in advanced ages. Complications were more related to weight gain and hypoglycemia, as more important aspects. In general, the literature showed a tendency towards complications over the advantages of insulinization

Introduction. In Latin America, it is reported that gallstone disease affects between 8.9% and 27.7% of individuals during adulthood. Regarding Ecuador, the prevalence of cholelithiasis is estimated at 10%, being more common in women and individuals over 50 years old. Objective. To define difficult laparoscopic cholecystectomy. Methodology. This research was conducted through a literature review, also known as a narrative review, allowing the collection and analysis of quality information from various high-impact databases. Results. Difficult laparoscopic cholecystectomy faces challenges arising from anatomical and pathological conditions, such as adhesions, anomalous biliary anatomy, and large stones. Risks include obesity, previous surgeries, and acute gallbladder inflammation. Surgical strategies encompass alternative approaches, cholecystolithotomy, and specialized tools. Evaluation of studies indicates variability in efficacy and safety. Technological advances, like robotic surgery and advanced imaging techniques, are influencing practice. Identifying risks, adapting approaches, and considering technology hold promise to enhance planning and outcomes in this complex surgery. Conclusion.  Difficult laparoscopic cholecystectomy confronts challenges rooted in specific anatomical and pathological conditions. Reviewing surgical strategies and techniques, coupled with assessing their efficacy and safety, provides a solid foundation for informed decision-making in clinical practice. Recognizing recent technological and surgical advancements underscores the need for ongoing adaptation to medical and surgical evolution. Ultimately, these conclusions support the necessity for an individualized, evidence-based approach in difficult laparoscopic cholecystectomy, aiming to optimize outcomes and ensure patient safety.

Introduction: Coma mixedematoso represents the extreme manifestation of uncontrolled hypothyroidism, which can occur in patients who are experiencing a systemic illness such as SARS-COV-2, leading to increased patient mortality due to the fatal interaction between these two conditions when they coexist. Objective: To provide an updated overview of the diagnosis and management of coma mixedematoso in patients with SARS-COV-2. Methodology: A conceptual literature review on coma mixedematoso in SARS-COV-2 patients was conducted, extracting information from various scientific databases such as PubMed, Scielo, Science Direct, among others, using the PRISMA strategy. Results: In patients with SARS-COV-2 and coma mixedematoso, notable vital signs include bradycardia, hypotension, eutermia, and low oxygen saturation. This may result from the interaction between both conditions. Coma mixedematoso can be directly or indirectly triggered by the infection, especially in intensive care patients with respiratory distress syndrome. Therefore, evaluating thyroid function in SARS-COV-2 patients, particularly in severe cases, is crucial. Conclusion: Thyroid profile assessment should be considered in SARS-COV-2-infected patients due to the possibility of developing coma mixedematoso. This diagnosis should be considered in cases of altered consciousness with normal or low body temperature, even during an infection. In these patients, the prevalence of coma mixedematoso is higher in women (90% in analyzed cases), and the relationship between respiratory rate and oxygen saturation is not always inversely proportional. Hypotension is common (72.73%) and is often associated with a decrease in pulse pressure due to negative inotropic and chronotropic effects and vasoconstriction. General Study Area: Medicine Specific Study Area: General Medicine

Introduction. Membranous glomerulonephritis (MGN) is a chronic renal pathology that affects the glomeruli, which are the structures responsible for filtering the blood in the kidneys. Timely treatment and proper management of membranous nephropathy in adult patients are essential to improve the quality of life of patients. Objective. To describe the most effective therapeutic approaches and the factors that can influence the response to treatment for early diagnosis and management of membranous glomerulonephritis. Methodology. A descriptive narrative study was conducted through systematic data collection, in which a representative sample of scientific research relevant to the treatment and management of the disease was selected during the period 2019-2023. Results.  Treatment of membranous glomerulonephritis in low-risk patients is based on the use of ARA II or IECA to control blood pressure and reduce proteinuria, with the aim of reducing by 20% the rate of recurrence of the disease. If there is not a response to therapy, more aggressive options are available, such as the immunosuppressive treatment itself, which increases total remission by 73% and reduces the risk of developing terminal kidney disease by 22%. Conclusion.  The effectiveness of therapy for membranous glomerulonephritis is based on the combination of steroid-based immunosuppressive therapy with chlorambucil or cyclophosphamide to prevent poor treatment tolerance by the nephrotic patient and decrease the relapses of membrane nephropathy.

Introduction.  Begging is a social problem that is directly linked to inequality and poverty. It becomes a factor of social inequality when it is considered that it arises based on the lack of socioeconomic resources within a family. The situation of begging among children and adolescents is based on problems such as: human mobility and scarce labor opportunities. The objective of this research is to identify the social factors that cause begging among children and adolescents in the Fundación Ciudadanos en Acción in the city of Cuenca. Methodology.  A descriptive quantitative methodology was used to meet the objective and its design was non-experimental. Results. The results obtained show that social factors, especially the scarce job opportunities, have a significant impact on the family structure, thus generating begging activities. Conclusion. The conclusions indicate that both human mobility and employment opportunities constitute causes of child begging, since children and adolescents feel the need to support their families by using this means to obtain money and food. It is therefore recommended that comprehensive strategies be developed to promote decent employment, access to education and social protection, providing children and their parents with an opportunity for a more secure and prosperous future.

Introduction. Educational Management for Children's Recreation refers to a program that focuses on the delivery and management of childcare services, preparing individuals to plan, design and manage childcare. It cannot be overstated, as it provides children with a safe and enriching environment where they can participate in activities that promote their physical, social, and emotional development. The benefits of educational child leisure management are numerous and far-reaching, as children participate in physical activities that promote their overall well-being. Providing children with opportunities to learn, grow and thrive in a safe and nurturing environment. Objective. Identify the contributions of educational management and children's recreation to children. Methodology.  The methodology has an approach taken to collect and analyze data, as well as the specific research questions or hypotheses being investigated. For educational management of children's recreation, the methodology might involve conducting surveys or interviews with parents, teachers, and students to better understand their perspectives on the role of recreation in education. To ensure the validity and reliability of the research, it is important to carefully consider the population under study. Results.  From the literature review, several results were obtained since educational management is a key factor for adequate school recreation, of which the following are highlighted: 1. Planning of educational management of children's recreation. 2. Implementation of the educational management for children's recreation. 3. Evaluation of educational management for children's recreation. 4. Collaboration with parents and the community. 5. Personnel management for the educational management of children's recreation. 6. Budgeting and resource management for educational management of children's recreation. 7. Legal and ethical considerations for the educational management of children's recreation. Conclusion.  The educational management of children's recreation is a crucial aspect of providing quality recreational activities for schoolchildren. It involves several axes such as: planning, implementation, evaluation, collaboration with parents and the community, staff management, budgeting, and resource management, as well as legal and ethical considerations, are essential components of effective educational management. It is a vital aspect of after-school care, providing children with a range of engaging learning and leisure experiences. It is crucial that the educational management of children's recreation continues to evolve and innovate. A call to action is needed for further improvement and investment in afterschool programs, including increased funding and resources for program development and research. General area of study: Education. Specific area of study: Educational management.

Introduction. Student conflicts in the classroom can be defined as disagreements, arguments or disputes between students that disrupt the learning environment. By implementing strategies for preventing student-to-student conflict, teachers can create a more positive and productive learning environment for all students. There are several strategies teachers can use to prevent student-student conflict in the classroom. It involves creating a classroom culture that values respect, empathy, and open communication, as well as setting clear expectations for behavior and the consequences for non-compliance. When conflicts arise, it is essential to address them promptly and effectively. Teachers can help them develop the skills and attitudes necessary to resolve conflicts effectively and respectfully. Objective. Conceptualize strategies for the prevention of conflicts between students in the classroom. Methodology. The proposed methodology contains ten steps: 1. Research design. Type of research. 3. Level of research. 4. Research modality. Methods, procedures and techniques of investigation, contemplating. 6. Population or study group. 7. Inclusion criteria. Exclusion criteria. 9. Elimination criteria. 10. Aspects. Results. The results obtained are detailed below: Establish clear expectations and standards. Fostering positive relationships. Using effective classroom management techniques. Encourage open communication. Teach conflict resolution techniques. Address bullying and harassment. Provide opportunities for collaboration. Consider the individual needs of each student. Evaluate and adjust strategies. Conclusion. Conflict among students in the classroom can be prevented through a variety of strategies. These strategies include establishing clear expectations and rules, promoting positive relationships, and others considering the promotion of opportunities for collaboration and consideration of individual student needs. Continuous improvement of conflict prevention strategies is the last key strategy for preventing student conflict in the classroom. This involves a commitment to ongoing professional development, seeking added resources and information, and staying current with the latest research and best practices in this field. General area of study: Education. Specific Area of Study: Classroom Conflict Prevention.

Introduction Moodle is an online learning platform that seeks to promote interaction and collaboration between peers and research into content for online courses, streamline learning processes, capture and manage competencies, skills and values ​​for the use of educational resources, creating communities of students who need to learn effectively, which shortens their time and allows them to review the content in the time and space they decide. Objective: Use the Moodle platform to conduct the virtual minor surgery course to optimize the teaching and learning process. Methodology. The deductive and analytical method was applied, with a qualitative approach, through the survey technique and the questionnaire instrument, with ten questions, of a descriptive, non-experimental nature, the variables were not manipulated, it was transversal, the data were collected at the same time and place. Results. The results indicated that the Moodle platform is positive for education, it allows the use of different tools to carry out tasks, upload research, it even serves to carry out the evaluation, 45.2% indicated that it allows applying tests, workshops, participation in forums, questionnaires that can be applied in the course of minor surgery. The advantages of personalizing educational environments are highlighted. Conclusion. It is concluded that it is flexible, the contents can be reviewed at any time and from any place, benefiting continuous training, it encourages independent study, the investigative nature, it is self-directed, effective, and efficient learning around ​​minor surgery.