Dimensión transversal maxilar en adultos clase I esqueletal en tomografía de cráneo completo

Objective: To determine the average measurement of DTM in an Ecuadorian population, with the aim of obtaining a standard applicable to Andean patients. Method: The study had a quantitative, descriptive, observational, cross-sectional approach in which a sample of 120 CT scans was analyzed. It was determined that the DTM is 53.89mm and 55.93mm respectively with a standard deviation of 2.94mm in men and 3.46mm in women. Results: It was determined that the DTM could be standardized to populations that share similar characteristics; the measurements found show significant differences to the references of measurements in previous studies and also differences not considered with respect to gender.Objetivo: Determinar el promedio de la medida de la DTM en una población ecuatoriana, con la finalidad de obtener una norma aplicable a pacientes andinos. Método: El estudio tuvo enfoque cuantitativo, descriptivo, observacional, transversal en el que se analizó una muestra de 120 tomografías. Se determinó que la DTM es de 53.89mm y 55.93mm respectivamente con una desviación estándar de 2.94mm en hombres y 3.46mm en mujeres. Resultados: Determinar que la DTM podría ser estandarizada a poblaciones que compartan características similares; las medidas encontradas evidencian diferencias significativas a las referencias de mediciones en estudios previos y además diferencias no consideradas con respecto al género

Morbi-mortalidad en el departamento de clínica del Hospital Vicente Corral Moscoso de la ciudad de Cuenca durante el período 2000-2002

Tomando en consideración los cambios sociales y culturales que pueden modificar los perfiles epidemiológicos, hemos considerado importante determinar la morbilidad y mortalidad a través de un estudio descriptivo donde podamos presentar lo que sucede en el área de Clínica del Hospital Vicente Corral Moscoso, más aún por la carencia de información que existe en nuestro medio sobre este tema y la cual ayudaría a mejorar la atención prestada tradicionalmente. En el área de Clínica, de 3207 pacientes hospitalizados durante el período 2000-2002 se encontró que la principal causa de morbilidad es la Neumonía seguida de las enfermedades cerebrovasculares, el intento de suicidio, tuberculosis y causas relacionadas con la diabetes mellitas entre las principales. En lo referente a la mortalidad la principal causa encontrada es aquella relacionada con las enfermedades del hígado, sepsis y diabetes mellitus que están ubicadas entre las primeras. Es importante destacar que en lo que concierne al género existe hasta cierto punto un equilibrio dentro de los grupos de morbimortalidad pues alcanzan porcentajes muy cercanos, además llama la atención que los grupos erarios que se encuentran en los límites de nuestro estudio son aquellos que representan mayor número de casos (entre 16 y 25 años y mayores de 75 años)For the tabulation of data, preparation of charts and graphs used the MS Excel program. The results obtained with the statistics of the country and Uruguay finding several similarities and differences in the incidence of diseases and their trends are compared. It was concluded that the 10 leading causes of mortality in the area of ​​Pediatrics during 2000-2002 were: pneumonia; hemolytic disease of the fetus and newborn; intracranial trauma; other disorders originating in the perinatal period; diarrhea and gastroenteritis of presumed infectious origin; transient disorders carbohydrate metabolism specific to fetus and newborn; burns and corrosion; Other injuries of specified regions; Regions unspecified and multiple body regions; Other conditions originating in the perinatal period; infections of the skin and subcutaneous tissue. We recommend taking into account the need to strengthen actions to prevent morbidity and mortality from preventable diseases and coordinating the services of care at different levels of careDoctor en Medicina y CirugíaCuenc

Barriers and Advantages of Self-Sampling Tests, for HPV Diagnosis: A Qualitative Field Experience Before Implementation in a Rural Community in Ecuador

Introduction: Cervical cancer screening has demonstrated high efficacy in reducing cervical cancer mortality worldwide. However, clinician sampling is often perceived as an uncomfortable procedure that could reduce screening uptake. Self-sampling methods for HPV diagnosis have shown high sensitivity, which could increase acceptance and screening rates among women. Purpose: This study aims to identify the perceived barriers and advantages of self-sampling methods versus clinician sampling for cervical cancer screening in a rural setting in Ecuador. Patients and Methods: A qualitative study was conducted. Seven focus group discussions took place in the rural Parish of El Valle in Azuay Province, Cuenca, Ecuador. Women native to this rural area were included in the study. FGDs were recorded and transcribed, and content analysis was performed to categorize and analyze the data. Results: A total of 45 women participated in the study. Clinician sampling was perceived as a painful and intrusive method. However, participants believed that it is more reliable compared to self-sampling methods, attributing this to the direct visualization of the cervix, which facilitates the detection of cervical pathologies. The perceived advantages of self-sampling included increased comfort, pain reduction, time savings, the ability to perform the test at home, and the potential for widespread availability through pharmacies or local traditional healers. Nevertheless, doubts about the test’s reliability as well as the user’s proficiency in self-testing posed barriers to the adoption of this technique. Conclusion: Self-sampling methods offer several advantages over clinician sampling, such as enhanced privacy, comfort, and accessibility to cancer screening. Barriers primarily revolved around users’ proficiency in performing the test and the reliability of the results. Providing training for using self-sampling tests could address these barriers. Keywords: cervical cancer, self-sampling, acceptance, barriers and facilitatorsIntroduction: Cervical cancer screening has demonstrated high efficacy in reducing cervical cancer mortality worldwide. However, clinician sampling is often perceived as an uncomfortable procedure that could reduce screening uptake. Self-sampling methods for HPV diagnosis have shown high sensitivity, which could increase acceptance and screening rates among women. Purpose: This study aims to identify the perceived barriers and advantages of self-sampling methods versus clinician sampling for cervical cancer screening in a rural setting in Ecuador. Patients and Methods: A qualitative study was conducted. Seven focus group discussions took place in the rural Parish of El Valle in Azuay Province, Cuenca, Ecuador. Women native to this rural area were included in the study. FGDs were recorded and transcribed, and content analysis was performed to categorize and analyze the data. Results: A total of 45 women participated in the study. Clinician sampling was perceived as a painful and intrusive method. However, participants believed that it is more reliable compared to self-sampling methods, attributing this to the direct visualization of the cervix, which facilitates the detection of cervical pathologies. The perceived advantages of self-sampling included increased comfort, pain reduction, time savings, the ability to perform the test at home, and the potential for widespread availability through pharmacies or local traditional healers. Nevertheless, doubts about the test’s reliability as well as the user’s proficiency in self-testing posed barriers to the adoption of this technique. Conclusion: Self-sampling methods offer several advantages over clinician sampling, such as enhanced privacy, comfort, and accessibility to cancer screening. Barriers primarily revolved around users’ proficiency in performing the test and the reliability of the results. Providing training for using self-sampling tests could address these barriers. Keywords: cervical cancer, self-sampling, acceptance, barriers and facilitator

Cytology Versus Molecular Diagnosis of HPV for Cervical Cancer Screening. Comparison of the Diagnostic Properties of Four Tests in a Rural Community of Cuenca Ecuador

El cáncer de cuello uterino (CC) es considerado una amenaza para la vida de las mujeres, por esta razón la OMS lanzó la estrategia 90-70-90, que busca erradicar el CC hasta el 2030. Parte de la estrategia implica el tamizajecon pruebas de biología molecular de alta sensibilidad para el diagnóstico de VPH, que sustituyan a la citología cervical. El objetivo de esta investigación, fue comparar la sensibilidad y especificidad de las pruebas de biología molecular, incluyendo la auto toma para el diagnóstico del VPH con la citología tradicional. Metodología: Se realizó un estudio de pruebas diagnósticas, en una parroquia rural de Cuenca, Ecuador. Un total de 120 mujeres participaron. Cada participante recolectó por sí misma una muestra vaginal y otra de orina y luego un profesional de salud realizó una toma cervical estándar para el diagnóstico molecular de VPH y citología. Esta última prueba fue considerada como el estándar de oro. Las tres muestras fueron procesadas con el mismo protocolo de amplificación e hibridación genómica para de detección del VPH (Hybribio) siguiendo las instrucciones del fabricante. La citología fue procesada siguiendo la técnica estándar. Resultados: La sensibilidad de la auto toma vaginal para el diagnóstico del VPH AR alcanzó el 100 % (IC 75.7, 100.0), y la especificidad 94.4% (IC 88.4, 97,43). El auto muestreo de orina tuvo una sensibilidad de 91,6 % (IC 64.61, 98.51), y una especificidad de 96,435 (IC 91.18, 98.6). La citología cervical alcanzó una sensibilidad 41,67% (IC 19.33, 68.5) y una especificidad de 85,19% (IC 77.28, 90.67) Conclusiones: Este estudio demuestra que los métodos de auto muestreo vaginal y auto muestreo en orina tienen una sensibilidad y especificidad similar a la comparada con la muestra tomada por el profesional de salud para el diagnóstico molecular del VPH. La sensibilidad de la citología (Papanicolaou) es inferior en relación a las pruebas de biología molecular para el tamizaje primario del CC.Cervical cancer (CC) is considered a threat to women’s lives, which is why the WHO launched the 90-70-90 strategy, seeking to eradicate CC by 2030. Part of the strategy involves screening with highly sensitive molecular biology tests for HPV diagnosis to replace cervical cytology. The objective of this research was to compare the sensitivity and specificity of molecular biology tests, including self-testing for HPV diagnosis with traditional cytology. Methodology: A study of diagnostic tests was conducted in a rural parish of Cuenca, Ecuador. A total of 120 women participated. Each participant self-collected a vaginal and a urine sample and then a health professional performed a standard cervical smear for HPV molecular diagnosis and cytology. The latter test was considered the gold standard. All three samples were processed with the same amplification and genomic hybridization protocol for HPV detection (Hybribio) following the manufacturer’s instructions. Cytology was processed following the standard technique. Results: The sensitivity of vaginal self-sampling for the diagnosis of HR HPV reached 100% (CI 75.7, 100.0), and specificity 94.4% (CI 88.4, 97.43). Urine self-sampling had a sensitivity of 91.6% (CI 64.61, 98.51), and a specificity of 96.435 (CI 91.18, 98.6). Cervical cytology achieved a sensitivity of 41.67% (CI 19.33, 68.5) and a specificity of 85.19% (CI 77.28, 90.67) Conclusions: This study demonstrates that vaginal self-sampling and urine self-sampling methods have similar sensitivity and specificity compared to the sample taken by the health professional for molecular diagnosis of HPV. The sensitivity of cytology (Papanicolaou) was lower in relation to molecular biology tests for primary screening of CC.Riobamb

La empatía y estudiantes de medicina en la Universidad de Azuay, Ecuador

  Objetivo. Identificar el nivel de empatía en los estudiantes de medicina de la Universidad del Azuay. Materiales y métodos. Se realizó un estudio transversal. Los niveles de empatía de los estudiantes se midieron a través  de la Escala de Empatía Médica de Jefferson, versión S (EEMJ) en español, adaptada culturalmente en el contexto  Ecuador. La comparación de los datos se realizó mediante análisis de varianza bifactorial modelo III. Resultados. Se pudo observar que las mujeres tienen un promedio mayor de los niveles de empatía que los hombres en casi todos los cursos, excepto en el sexto. Existieron diferencias estadísticamente significativas cuando se analizaron por separado las puntuaciones por género y curso; estas diferencias no fueron significativas cuando se analizó la interacción entre las dos variables señaladas. Conclusiones. Los resultados de este estudio son consistentes con otros trabajos, especialmente con los realizados en Latinoamérica, los que muestran variabilidad de la respuesta empática en estudiantes de medicina

Role of self-sampling for the diagnosis of human papillomavirus in rural areas from Cuenca Ecuador: Acceptance, sensitivity and specificity among urine sampling, self-sampling and clinician sampling

Background/Objectives: Background: During 2020, 1534 new cases of cervical cancer were reported in Ecuador and 813 women died from this cause. Pap smear has decreased mortality of (CC), however in Ecuador 41.6% of women in their reproductive age have been never screened. Different barriers for CC screening have been identified, among them: long waiting times, pain, embarrassment, lack of risk perceptions are related with this low coverage. High sensitivity tests for primary screening of HPV are useful for an early detection of cervical pathology. Self-sampling techniques could overcome barriers and increase participation in screening and participation. Objectives 1.- To compare the sensitivity and specificity of urine and vaginal self-sampling test versus clinician sampling test, for HPV diagnosis. 2.- To compare the acceptability of urine and vaginal self-sampling methods versus clinician sampling among rural women Methods: A diagnostic test study was conducted in a rural parish of Cuenca, Ecuador. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for HPV testing. The latter was considered as the golden standard. All three samples were processed with the same amplification and hybridization protocol for HPV detection (Hybribio) following the manufacturer's instructions. After sample collection a questionnaire to qualify device and technique and individual acceptability was applied and additional overall preference of three sample tests was evaluated Results: A total of 120 women participated main chracteristicas are: median age 35 years; 40.8% married; 46.7% had a primary level of education; median age of sexual onset, 17.6 years Sensitivity The prevalence of any type of HPV with clinician sampling was 15.0%, 17.5% with urine sampling and 18.3% with vaginal self-sampling. Self-sampling sensitivity reached 94.4% (IC 74.2-99.9), and specificity 92.1% (IC 85.2-95.9). Urine sampling had a sensitivity of 88.8% (IC 67.2, 96.9), and specificity 94.1% (IC 67.2-96.9). The negative predictive value was 98.9% (IC 94.2-99.8) for vaginal self-sampling and 97.6% (IC 92.6-99.4) for urine sampling. Conclusions: This study shows that vaginal and urine self-sampling methods have similar sensitivity and specificity compared with clinician sampling for the diagnosis of HPV. The correlation between HPV genotypes among the three tests is satisfactory. Acceptability Compared with clinician sampling, both vaginal self-sampling OR 20.12 (7.67-52.8) and urine sampling OR16.63 (6.79-40.72), were more comfortable, granted more privacy: vaginal self-sampling OR 8.07 (3.44-18.93); urine sampling OR 19.5 (5.83-65.21, were less painful: vaginal self-sampling OR 0.07 (0.03-0.16); urine sampling OR 0.01 (0-0.06) and less difficult to apply: vaginal self-sampling OR 0.16 (0.07-0.34) urine sampling OR 0.05 (0.01-0.17). Overall preference has shown an advantage for vaginal self-sampling 4.97 (2.71-9.12). No statistically significant preference was demonstrated with urine self-sampling versus clinician sampling. Conclusions: This study shows that vaginal and urine self-sampling methods have similar sensitivity and specificity compared with clinician sampling for the diagnosis of HPV. The correlation between HPV genotypes among the three tests is satisfactory. Self sampling methods have a high acceptance in rural communities. Doubts on the reliability of self-sampling often appears to be a limitation on the acceptabilityBilba

La empatía y los estudiantes de medicina en la Universidad de Azuay, Ecuador

Objetivo: Identificar el nivel de empatía en los estudiantes de medicina de la Universidad del Azuay. Materiales y métodos: Se realizó un estudio transversal. Los niveles de empatía de los estudiantes se midieron a través de la Escala de Empatía Médica de Jefferson, versión S (EEMJ) en español, adaptada culturalmente en el contexto de Ecuador. La comparación de los datos se realizó mediante análisis de varianza bifactorial modelo III. Resultados: Se pudo observar que las mujeres tienen un promedio mayor en los niveles de empatía que los hombres en casi todos los cursos, excepto en el sexto. Existieron diferencias estadísticamente significativas cuando se analizaron por separado las puntuaciones por género y curso; estas diferencias no fueron significativas cuando se analizó la interacción entre las dos variables señaladas. Conclusiones: Los resultados de este estudio son consistentes con otros trabajos, espe- cialmente con los realizados en Latinoamérica, que muestran variabilidad de la respuesta empática en estudiantes de medicina

Knowledge and practices of cervical cancer prevention among women with histopathological lesions. Cuenca, Ecuador 2021

Los conocimientos y las prácticas son esenciales para promover la salud, prevenir enfermedades, mantener la salud y hacer frente a las enfermedades en general y en particular al cáncer cérvico-uterino. El objetivo del presente estudio fue describir las características sociodemográficas y prácticas de prevención en mujeres con lesiones histopatológicas de cuello uterino, para lo cual se entrevistó a 174 mujeres de entre 30 a 89 años de edad, atendidas en los hospitales de SOLCA y Vicente Corral de la ciudad de Cuenca. Los resultados muestran que las participantes en su mayoría residentes en zonas urbana y urbano-marginal, casadas, con educación primaria y secundaria, con dificultades económicas y auto identificación mestiza, presentaron con mayor frecuencia lesiones histopatológicas tipo LIEAG, LIEBG y Cáncer. Si bien poseen información sobre el VPH, muy pocas conocen que es la principal causa del CCU, que se transmite sexualmente, que existen vacunas y pruebas de detección temprana. Entre los factores facilitadores para la realización del examen de Papanicolaou(PAP)están: la visita de seguimiento, recomendación médica, iniciativa propia y recomendación de una amiga o familiar; en tanto que los factores personales, problemas en el servicio de salud, dificultades económicas y familiares, constituyeron las principales barreras.Palabrasclave: Conocimiento y prácticas de prevención, cáncer de cuello uterino, virus del papiloma humano.Knowledge and practices are essential to promote health, prevent disease, maintain health, and cope with diseases in general and cervical cancer in particular. The objective of this study was to describe the sociodemographic characteristicsand prevention practices in women with histopathological lesions of the cervix, for which 174 female patients,between 30 and 89 years of age,were interviewed at the SOLCA and Vicente Corral hospitals in the city of Cuenca. The results show that the participants, mostlyliving in urban and marginal urban areas, married, with primary and secondary education, with economic difficulties and mestizo self-identification, more frequently presented histopathological lesions of the LIEAG, LIEBG and Cancer type. Although they have information about HPV, very few know that it is the main cause of CCU, that it is transmitted sexually, that there are vaccines and early detection tests. Among the facilitating factorsto carry out the Pap smearare:the follow-up visit, medical recommendation, own initiative and recommendation of a friend or relative; while personal factors, problems in the health service, economicand familydifficulties, constitute the main barriers

Evaluation of urine and vaginal self-sampling versus clinician-based sampling for cervical cancer screening: a field comparison of the acceptability of three sampling tests in a rural community of Cuenca, Ecuador

Self-sampling methods for HPV testing have been demonstrated to be highly sensitive and specific. The implementation of these methods in settings with a lack of infrastructure or medical attention has been shown to increase the coverage of cervical cancer screening and detect cervical abnormalities in the early stages. The aim of this study is to compare the acceptability of urine and vaginal self-sampling methods versus clinician sampling among rural women. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for Pap smear and HPV testing. After the sample collection, a questionnaire to qualify the device, technique, and individual acceptability was applied, and the additional overall preference of three sample tests was evaluated. Results: The characteristics of the participants were as follows: median age of 35 years; 40.8% were married; 46.7% had a primary level of education; median age of sexual onset of 17.6 years. Compared with clinician sampling, both vaginal self-sampling, OR 20.12 (7.67–52.8), and urine sampling, OR 16.63 (6.79–40.72), were more comfortable; granted more privacy: vaginal self-sampling, OR 8.07 (3.44–18.93), and urine sampling, OR 19.5 (5.83–65.21); were less painful: vaginal self-sampling, OR 0.07 (0.03–0.16), and urine sampling, OR 0.01 (0–0.06); were less difficult to apply: vaginal self-sampling, OR 0.16 (0.07–0.34), and urine sampling, OR 0.05 (0.01–0.17). The overall preference has shown an advantage for vaginal self-sampling, OR 4.97 (2.71–9.12). No statistically significant preference was demonstrated with urine self-sampling versus clinician sampling. Conclusions: Self-sampling methods have a high acceptance in rural communities. Doubts on the reliability of self-sampling often appear to be a limitation on its acceptability. However, the training and education of the community could increase the uptake of these methods

Barriers and facilitators to cervical cancer screening among under-screened women in Cuenca, Ecuador: the perspectives of women and health professionals

Background: Cervical cancer screening is a cost-effective method responsible for reducing cervical cancer-related mortality by 70% in countries that have achieved high coverage through nationwide screening strategies. However, there are disparities in access to screening. In Ecuador, although cervical cancer is the second most common cancer in women, only 58.4% of women of reproductive age have ever been screened for cervical cancer. Methodology: A qualitative study was performed to understand the current barriers to screening and to identify strategies that could increase uptake in Azuay province, Ecuador. Seven focus group discussions (FGDs) were conducted with under-screened women and health professionals (HPs). The FGDs were recorded and transcribed. Content analysis was done using the socio-ecological framework to categorize and analyse the data. Results: Overall, 28 women and 27 HPs participated in the study. The two groups perceived different barriers to cervical cancer screening. The HPs considered barriers to be mainly at the policy level (lack of a structured screening plan; lack of health promotion) and the individual level (lack of risk perception; personal beliefs). The women identified barriers mainly at organizational level, such as long waiting times, lack of access to health centres, and inadequate patient–physician communication. Both groups mentioned facilitators at policy level, such as national campaigns promoting cervical cancer screening, and at community and individual level, including health literacy and women’s empowerment. Conclusions: The women considered access to health services the main barrier to screening, while the HPs identified a lack of investment in screening programmes and cultural patterns at the community level as major obstacles. To take an integrated approach to cervical cancer prevention, the perspectives of both groups should be taken into account. Additionally, new strategies and technologies, such as self-administered human papillomavirus (HPV) testing and community participation, should be implemented to increase access to cervical cancer screenin