Complicaciones del uso de la Máscara Laríngea en Pacientes Pediátricos. Estudio Multicéntrico / Complications of the use laryngeal mask in Pediatric Patients. Multicenter Study

Introducción: La máscara laríngea es el equipamiento con el objetivo de aumentar la calidad, seguridad, cuidado, sin embargo, a pesar de tener uso universal y alta eficacia para la ventilación no está exenta de complicaciones. El objetivo de la presente Investigación fue identificar la frecuencia de complicaciones con el uso de mascara laríngea en los hospitales públicos Vicente Corral Moscoso y José Carrasco en la ciudad de Cuenca. Métodos: Es un estudio observacional, descriptivo, prospectivo, en 220 pacientes pediátricos, ASA I , II y III intervenidos en cirugías electivas y emergentes bajo anestesia general en un intervalo de tiempo de 30 a 240 minutos, de todas las especialidades médicas quirúrgicas del año 2018 ,se utilizaron los diferentes tipos de máscara. La muestra se obtuvo aplicando la fórmula para población desconocida (n = (Z2 x p x q)/ e2), nivel de confianza (Z): 95%. (1.96) Margen de error (e): 5% Probabilidad de ocurrencia del evento (p): 15% Probabilidad de no ocurrencia del evento (q): 85%. Resultados: 220 casos ingresados al estudio. El índice de complicaciones laríngeas es 5.9% , frecuentemente la tos y secreción sanguinolenta, asociándose factores como mascara clásica, edad (2-5 años), tiempo mayor de 60 minutos, mayor número de intentos, ASA> I, estado nutricional sobrepeso, e insertar en formación. Conclusión: La máscara laríngea es validada como dispositivo en anestesia pediátrica por aprendizaje rápido, baja tasa de fracaso, menores complicaciones y utilidad en vías aéreas difíciles, Es insuficiente la evidencia para respaldar el uso de un determinado dispositivo por encima de otro

Introduction: The laryngeal mask is the equipment with the aim of increasing quality, safety, care, however, despite having universal use and high efficacy for ventilation, it is not without complications. The objective of this research was to identify the frequency of complications with the use of a laryngeal mask in the Vicente Corral Moscoso and José Carrasco public hospitals in the city of Cuenca. Methods: It is an observational, descriptive, prospective study in 220 pediatric patients, ASA I, II and III who underwent elective and emergent surgeries under general anesthesia in a time interval of 30 to 240 minutes, of all surgical medical specialties of the year 2018, the different types of mask were used. The sample was obtained by applying the formula for unknown population (n = (Z2 x p x q) / e2), confidence level (Z): 95%. (1.96) Margin of error (e): 5% Probability of occurrence of the event (p): 15% Probability of non-occurrence of the event (q): 85%. Results: 220 cases entered the study. The rate of laryngeal complications is 5.9%, frequently cough and bloody discharge, associating factors such as classic mask, age (2-5 years), time greater than 60 minutes, greater number of attempts, ASA> I, nutritional status, overweight, and insert in formation. Conclusion: The laryngeal mask is validated as a device in pediatric anesthesia due to rapid learning, low failure rate, fewer complications and usefulness in difficult airways. The evidence is insufficient to support the use of a certain device over another.

Estudio de Cohortes: Angioplastia Primaria con Trombectomía versus Angioplastia Primaria Convencional en Pacientes con Infarto Agudo de Miocardio con Elevación del Segmento S-T. Hospital de Especialidades José Carrasco Arteaga, 2009 ­ 2016 / Cohort Study: Primary Angioplasty with Thrombectomy versus Conventional Primary Angioplas-ty in Patients with ST - segment Elevation Myocardial Infarction. José Carrasco Arteaga Hospital, 2009 ­ 2016

INTRODUCCIÓN: Durante la angioplastia primaria (AP) en pacientes con infarto agudo de miocar-dio con elevación del segmento ST; los trombos intracoronarios pueden embolizar a la microcircu-lación y aumentar el tamaño del infarto. Este fenómeno podría ser reducido mediante la trombec-tomía; no obstante, estudios recientes no han demostrado mejoría en la reperfusión coronaria o en la presentación de eventos clínicos mayores, razón por la que su uso rutinario es controvertido. MÉTODOS:Se realizó un estudio de cohortes retrospectivo. El universo incluyó a 206 pacientes con IAMEST del Instituto Ecuatoriano de Seguridad Social, fueron divididos en dos grupos; grupo 1: AP con trombectomía (107 pacientes), y grupo 2: AP convencional (99 pacientes). El objetivo fue com-parar reperfusión coronaria (resolución del segmento ST, flujo TIMI final 3, no reflujo, y recuperación de la fracción de eyección del ventrículo izquierdo) y eventos clínicos mayores a los 30 días (muerte cardiaca, muerte por otra causa, perforación, trombosis del stent, ictus, sangrado mayor, reinfarto, shock cardiogénico, revascularización de emergencia, falla cardiaca NYHA IV). Para el análisis se uti-lizaron medidas de asociación, riesgo relativo e intervalo de confianza; para un nivel de significancia p= <0.05. RESULTADOS: En relación a la reperfusión coronaria, la resolución del segmento ST en el grupo de trombectomía versus el grupo convencional fue del 29.9% y 43.3% respectivamente (RR 0.68, IC 95%: 0.47­0.99, p= 0.04). Considerando los eventos clínicos mayores, la muerte de causa cardíaca ocurrió en el 4.7% de pacientes del grupo de trombectomía versus un 13.1% en el grupo conven-cional (RR 0.35, IC 95%: 0.13­0.96, p= 0.032). Los demás parámetros de reperfusión y los eventos clínicos mayores no presentaron diferencia estadísticamente significativa. CONCLUSIÓN: La AP con trombectomía no se relacionó con mejoría en la reperfusión coronaria, pero si con disminución de muerte por causa cardíaca(AU)

BACKGROUND: During primary angioplasty in patients with ST-segment elevation myocardial Infarc-tion (STEMI); intracoronary thrombi can embolize in the microcirculation and increase the size of the infarct. This phenomenon could be reduced by thrombectomy; however, recent studies have shown no improvement in coronary reperfusion or in the presentation of major clinical events, which is why its routine use remains controversial. METHODS: A retrospective cohort study was conducted. The universe included 206 patients with STEMI from the Ecuadorian Social Security Institute, two groups were made; group 1: PA with thrombectomy (107 patients), and group 2: conventional PA (99 patients). The aim was to compare coronary reper-fusion outcomes (ST segment resolution, TIMI 3 final flow, no reflow, and recovery of left ventricular ejection fraction) and major clinical events in 30 days (cardiac death, death from another cause, perfo-ration, stent thrombosis, stroke, major bleeding, re infarction, cardiogenic shock, emergency revascu-larization, NYHA IV heart failure). For the analysis of the information, measures of association, relative risk and confidence interval were used; for a level of significance p= <0.05. RESULTS: In relation to coronary reperfusion outcomes, resolution of ST segment in the thrombectomy group versus conventional group was 29.9% and 43.3% respectively (RR 0.68, 95% CI: 0.47 - 0.99, p=0.04). Considering the major clinical events, cardiac death occurred in 4.7% of patients in the throm-bectomy group versus 13.1% in the conventional group (RR 0.35, 95% CI: 0.13 - 0.96, p= 0.032). Other re-perfusion parameters and major clinical end points did not present a statistically significant difference. CONCLUSION: Thrombectomy was not associated with improvement in coronary reperfusion however it was associated with a decrease in cardiac death.(AU)

Nivel de Producción y Características de la Investigación Científica en Salud en la Facultad de Ciencias Médicas de la Universidad de Cuenca, 2009 - 2014 / Level of Production and Characteristics of Scientific Research in Health in the Faculty of Medical Sciences of the University of Cuenca, 2009 - 2014

OBJETIVO: Determinar el nivel y características de la producción científica de la Facultad de Ciencias Mé-dicas de la Universidad de Cuenca, en el período 2009 ­ 2014. MÉTODOS: Se realizó una investigación analítica de cor-te transversal. La muestra, aleatoria y representativa, estuvo constituida por 460 trabajos de investigación, 272 de grado, 98 de posgrado y 100 de la Revista de la Facultad de Ciencias Médicas. Los datos se obtuvieron de los archivos digitales de la Biblioteca. Se estudiaron las características en los niveles académicos de grado, posgrado y docente. Las diferencias significativas se establecieron mediante el estadístico chi cuadrado y un valor de p<0.005.RESULTADOS: Se produjeron 996 trabajos de investigación a razón de 166 trabajos por año, predominó la investigación biomédica (74.6%), clínica (73%), observacional (88.5%), cuantitativa (89.3%), descriptiva (65.7%), aplicada (96.7%) y se realizó más a nivel hospitalario (42.4%); en el grado y en la Revista hay más coautoría, en posgrado la autoría es individual; la producción de la Revista, en la que la mayor parte publican profesores de la Facultad, es baja en comparación con la magni-tud del grado y posgrado; la tendencia es a incrementar el número de trabajos de investigación; existiendo baja colaboración internacional (4.1%) e interinstitucional (8.5%).CONCLUSIONES: La investigación es limitada en su magnitud, aunque con tendencia al incremento, es predominantemente observacional, cuantitativa, descriptiva, biomédica, clínica, que se realiza con muy poca colaboración internacional e interinstitucional.

OBJECTIVE: To determine the level and characteristics of the scientific production in the Medical Sciences Facul-ty of the University of Cuenca, in the period 2009-2014.METHODS: A cross-sectional analytical research was conducted. The sample, which was, random and repre-sentative, was consisted by 460 research papers, 272 graduate, 98 post graduate and 100 of the Faculty of Medical Sciences Magazine. The data were obtained from the digital files of the Library. The characteristics were studied in academic levels of graduate, postgra-duate and teacher. Significant differences were establi-shed using the chi square and a value of p <0.005.RESULTS: A total of 996 research papers were produ-ced at a rate of 166 jobs per year, predominated the biomedical research (74.6%), clinical (73%), observa-tional (88.5%), quantitative (89.3%), descriptive (65.7%) applied (96.7%) and it was performed more in hospitals (42.4%); in the graduate and in the magazine there is more co-authored, in the postgraduate the authorship is individual; according to the production of the maga-zine, which published most professors of the Faculty, is low compared to the magnitude of graduate and post-graduate; the tendency is to increase the number of research papers; existing a low international (4.1%) and inter-institutional (8.5%) collaboration.CONCLUSIONS: The research is limited, but with a ten-dency to increase, it is mainly observational, quantitati-ve, descriptive, biomedical, and clinical, which is done with very little international and inter-institutional collaboration.

Características de la investigación en el posgrado: avances y limitaciones. Facultad de Ciencias Médicas. Universidad de Cuenca. 2009 ­ 2014 / Characteristics of postgraduate research: advances and limitations. Faculty of Medical Sciences. University of Cuenca. 2009-2014

Objective: To determine the characteristics of the postgraduate research in order to generate research policies.Methods: A cross-sectional analytical re-search was conducted to determine the characteristics of research in the various postgraduate levels. A stratified random sample of the database of postgraduate research contained in the website of the University of Cuenca was used. Chi2 sta-tistic was used, and a level of significance was accepted p <0.05 in hypothesis tes-ting. The sample consisted of 98 research papers.Results: The model for biomedical research is predominant (79.6%) in the Masters is the social (65.5%). (p: 0.000). Most are clinics (78.6%) investigations. Research with so-cial components developed in the masters (72.4%). (p: 0.000). The number of resear-chers males (50.0%) is similar to that of wo-men (50.0%). The investigations are made by an author. Investigations are applied (100.0%) and quantitative (94.9%). Only the Masters there are qualitative (6.9%), mixed (6.9%) and other (3.4%) investigations. (p = 0.051). Dominated by observational stu-dies (78.6%); the intervention constitute 21.4% (p = 0.889). The descriptive research (36.7%), analytical (39.8%) have greater weight than those of intervention (23.5%), p: 0.321). In the analytical cross-sectional research predominate (89.7%), and the ex-perimental intervention (78.3%). There is no international cooperation and inter is mini-mal (7.1%) referred to the Masters. There is good correspondence with the lines of ins-titutional research (57.1%) in most research and the use of international bibliographic standards is high (99.6%).Conclusions: The fundamental characte-ristics of research at the graduate has not changed substantially. The predominant biomedical research remains, quantitati-ve, clinical, observational, there has been progress in reducing the descriptive inves-tigations and have increased (transverse) and experimental analytics. The master has developed more social health research. Research has failed to overcome the aca-demic and personal interest level, no inter-national collaboration and inter is scarce. It has improved the technical component, is majority use international bibliographic standards.