Browsing by Autor "Ismael Vargas Gallego"

Now showing 1 - 4 of 4

Artificial Intelligence in the Intensive Care Unit: Present and Future
(2025) Jhossmar Cristians Auza-Santiváñez; Ariel Sosa Remón; Freddy Ednildon Bautista-Vanegas; Ingrid Neysa Cabezas-Soliz; Ismael Vargas Gallego; Blas Apaza-Huanca; Jorge Márquez-Molina; Daniel Ramiro Elías Vallejos-Rejas
Introduction: Artificial intelligence (AI) is significantly transforming critical medicine and intensive care. Its ability to process large volumes of data and generate accurate predictions has improved medical decision-making, optimizing diagnosis, treatment, and reducing the workload of healthcare personnel. Methodology: A literature review was conducted between November 2024 and February 2025, consulting databases such as SciELO, LILACS, Scopus, PubMed-MedLine, Google Scholar, and ClinicalKeys. Original articles, case reports, and open-access systematic reviews from the last 5 years were selected, using descriptors in Health Sciences (DeCS) and Boolean operators for the search. Development: Current applications of AI in the ICU include: Monitoring and early detection of adverse events using sensors and machine learning algorithms; diagnosis and prognosis through deep neural networks for medical image interpretation; treatment optimization, including adjustments in mechanical ventilation and pharmacogenomics; efficient management of hospital resources. The future of AI in critical care is oriented towards more explanatory and transparent systems, personalized precision medicine, integration with emerging technologies and automation of clinical processes. Conclusions: Artificial intelligence (AI) is redefining care in intensive care units, improving diagnostic accuracy, optimizing treatments, improving clinical decision-making and thus allowing more efficient hospital management. However, as advanced as it is, it will never replace the empathy and clinical judgment of healthcare professionals. By integrating AI responsibly, we not only save more lives, but we also humanize critical patient care, always remembering that, at the heart of intensive medicine, there is compassion and commitment to each patient.
Relevance of ultrasound detection and assessment of vascular calcifications in chronic kidney disease
(2024) Jhossmar Cristians Auza-Santiváñez; Blas Apaza-Huanca; Jose Luis Diaz-Guerrero; Daniel Ramiro Elías Vallejos-Rejas; Yenifer Zelaya-Espinoza; Ismael Vargas Gallego; Ariel Sosa Remón
Introduction: Chronic kidney disease (CKD) affects approximately 10% of the Spanish population and constitutes an independent cardiovascular risk factor. Vascular calcifications, especially in the abdominal aorta, are significantly associated with increased cardiovascular mortality in patients with CKD. This systematic review evaluates the evidence on the usefulness of ultrasound to detect and assess vascular calcifications in patients with CKD, and its relevance as a cardiovascular risk factor.Methods: A systematic search of multiple electronic databases was conducted until July 2024. Original studies published between 2000 and 2024 evaluating the use of ultrasound to detect vascular calcifications in adult patients with CKD at any stage were included. Reviews, letters, editorials, animal studies and those not published in English or Spanish were excluded. Methodological quality was assessed using the Newcastle-Ottawa scale for observational studies and the Cochrane tool for clinical trials.Results: Twenty-eight studies were included with a total of 50 to 3,000 participants per study. Most were observational studies, with 3 randomised clinical trials. Ultrasound showed good correlation with computed tomography (r=0.65-0.82) to quantify aortic and femoral calcifications. The presence of aortic calcifications was associated with increased risk of cardiovascular mortality (HR 1.8-3.2) in patients with advanced CKD and on haemodialysis. Iliac/femoral calcifications were associated with increased risk of cardiovascular events (RR 1.6-2.4) in patients with stage 3-5 CKD. Incorporation of ultrasound assessment of calcifications into CKD-specific risk algorithms significantly improved their predictive performance.Discussion: Ultrasonography emerges as a valuable tool for the detection of vascular calcifications due to its non-invasive nature, low cost and ability to perform repeated assessments. However, limitations such as heterogeneity in assessment methods, variable sample sizes and lack of long-term follow-up in some studies were identified. Further research is needed to standardise protocols and assess the long-term impact of interventions based on ultrasound detection of calcifications.Conclusions: Ultrasonography is an effective and accessible tool for detecting and assessing vascular calcifications in patients with CKD, providing relevant prognostic information for cardiovascular risk stratification. Its consideration as a first-line tool in nephrological practice is recommended. However, large-scale prospective studies are needed to definitively validate its prognostic value in different stages of CKD and to evaluate the efficacy of early interventions based on these findings.
Usefulness of ultrasound in the diagnosis of lumbricoid ascaris. Case Report and Literature Review
(2024) Ismael Vargas Gallego; Jhossmar Cristians Auza-Santiváñez; Ariel Sosa Remón; Eloy Paycho Anagua; Marco Antonio Gumucio Villarroel; R. Sarmiento; Mildred Ericka Kubatz La Madrid
Introduction. The World Health Organization (WHO) points out that more than a third of the world's population is infected by one or more parasites. Ascariasis is the most prevalent parasitic disease in the world, with approximately 664 million people infested. Clinical case. A 22-year-old female patient enters the emergency department with general malaise, with worsening symptoms in recent days, intense abdominal pain, associated with nausea and uncontrollable vomiting. She also reports non-elimination of gas and absence of bowel movements. . An emergency ultrasound is requested, it reports the stomach with the presence of a linear, tubular echogenic image that moves in different directions. Discussion. The widespread use of ultrasound in Emergency Departments for the diagnosis of acute abdomen, as well as in the laboratory, allowed us to reach the presumptive diagnosis of temporary biliary obstruction due to A. lumbricoides, in addition, the presence of jaundice, direct hyperbilirubinemia and discrete elevation gamma-glutamyltransferase (GGT); findings that could direct the exploration of the bile duct during the surgical procedure. Conclusions. The importance of the clinical case lies in the use of abdominal ultrasound as a diagnostic method for Ascaris Lumbricoides. The use of ultrasound in emergency services is essential in the presence of an acute abdomen, and in any patient who presents acute biliary symptoms, always think about this pathology
Wünderlich syndrome. Report of two cases with different presentation modalities
(2025) Jorge Luis Santana Pérez; Dulvis Lianet Acosta Herrería; Jorge Luis Santana León; Ariel Sosa Remón; Jhossmar Cristians Auza-Santiváñez; Ismael Vargas Gallego; Jorge Márquez-Molina; Giovanni Callizaya Macedo
Case reports: Case 1 is a male patient who presented with left lumbar pain and wanders to the emergency department. Case 2: a female patient is brought to the emergency department in hypovolemic shock. In both cases, it was decided to perform urgent surgical treatment to correct the hemorrhage due to the progressive deterioration of hemodynamics, the subsequent evolution was favorable.Relevance: Wünderlich syndrome is characterized by retropritoneal hemorrhage localized at the renal or perirenal level, which occurs sudden onset. Implications: The available evidence on this pathology is scarce because it is a little suspected medical emergency.Conclusion: Wünderlich syndrome presents relatively frequently in emergency departments and represents a diagnostic-therapeutic challenge.