Understanding Solid-Based Platelet-Rich Fibrin Matrices in Oral and Maxillofacial Surgery: An Integrative Review of the Critical Protocol Factors and Their Influence on the Final Product.

Platelet-rich fibrin (PRF) is a second-generation platelet concentrate whose use in clinical practice has been widely disseminated. This has led to the development of several commercial protocols, creating great confusion as to the terminology and implications of each of them. This integrative review aims to identify the critical factors of each of the phases of the solid-based PRF matrix protocol and their possible influence on their macro- and microscopic characteristics. An electronic search of the MEDLINE database (via PubMed), Web of Science, Scopus, LILACS, and OpenGrey was carried out. The search was temporarily restricted from 2001 to 2022. After searching, 43 studies were included that met the established criteria. There were numerous factors to consider in the PRF protocol, such as the material of the blood collection tubes, the duration of phlebotomy, the parameters related to blood centrifugation, the time from centrifugation to dehydration of the fibrin clots and their dehydration into membranes, as well as the time to clinical use. These factors influenced the macro- and microscopic characteristics of the PRF and its physical properties, so knowledge of these factors allows for the production of optimised PRF by combining the protocols and materials.

Mediación parental en el uso de tecnologías móviles en niños y niñas costarricenses: Una aproximación metodológica mixta / Parental mediation in children's use of mobile technology in Costa Rica: A mixed-methods approach

Resumen Las tecnologías digitales móviles son parte de la vida cotidiana de los niños. Sin embargo, poco se conoce sobre su contexto de uso en Latinoamérica. Esta investigación utilizó un diseño mixto para describir las características del uso de teléfonos móviles y tabletas en niños costarricenses entre 1 y 5 años de edad y sus cuidadores. El Estudio 1 analizó las interacciones familiares en áreas de comida de centros comerciales a través de observaciones no participantes. Los resultados indicaron que fueron los cuidadores quienes utilizaron los teléfonos durante la observación, ante lo cual los niños usualmente realizaron actividades que no implicaron interactuar con sus cuidadores. Frente a intentos de los niños por interactuar, los cuidadores raramente respondieron. A través de una metodología de encuesta dirigida a padres, el Estudio 2 exploró el uso de los dispositivos por parte de los niños y sus cuidadores en el hogar. Los resultados indicaron que los niños acceden principalmente a contenidos educativos al usar los dispositivos, y los cuidadores mencionaron usualmente acompañar a los niños durante su uso. También reportaron casi siempre utilizar las estrategias mediadoras de tipo restrictivo y de supervisión, y en menor medida la mediación instructiva y de uso conjunto. Además, los cuidadores consideraron que la actividad física y el sueño son los aspectos más negativamente afectados por el uso infantil de dispositivos, mientras que las habilidades matemáticas y lingüísticas tienden a verse más afectadas positivamente. Estos resultados caracterizan el uso temprano de dispositivos móviles en contextos de cuidado parental en Costa Rica.

Abstract Mobile technologies are part of children's everyday lives. However, little is known about their context of use in Latin America. The goal of this paper is to describe how Costa Rican caregivers and their children between the ages of 1 and 5 years old use smartphones and tablets. A mixed-methods approach was used, including two studies. Study 1 used non-participant observations to analyze family interactions related to smartphone use in food court areas in shopping malls. A total of 22 children were observed while interacting with their caregivers and their use of smartphones was registered (N = 269 events) and classified according to (a) the person who used the smartphone and (b) the actions that took place during its use. Results indicated smartphones were mostly used by caregivers (n = 226, 84.01 %), followed by a co-use to take pictures or make videos (n = 27, 10.03 %). Children's use was infrequent (n = 16, 5.94 %). During caregivers' use, children usually engaged in activities that did not involve their caretaker, such as silently eating, interacting with another adult not using a smartphone at the moment or looking around. When children attempted to interact with their caregivers while they were using their smartphones, caregivers rarely responded. No disruptive behaviors on children were observed after caregivers' lack of response. Using a survey methodology, Study 2 explored children's and caregivers' use of mobile devices at home. A total of 42.9 % of caregivers reported they sometimes facilitate a device to their children to be able to accomplish other domestic and work-related tasks, as well as to satisfy personal needs. Daily duration of caregivers' use of devices was longer on weekdays (M = 207 minutes, SD = 116.02) than weekends (M = 164.25 minutes, SD = 118.54). Caregivers' daily duration of use was related to children's daily duration of use during weekdays (r = .414) and weekends (r = .451), and during caregiving time on weekdays (r = .328) and weekends (r = .541). Using a Likert scale (1 = never, 5 = always), the children's consumed content was explored. Findings indicate that children mostly consumed content from YouTube (M = 3.60, SD = 1.14) and children's educational apps (M = 3.13, SD = 1.5). Use of educational videogames (M = 3.27, SD = 1.34), puzzle-like videogames (M = 2.36, SD = 1.26) and word games (M = 2.23, SD = 1.14) was more frequent than action (M= 1.48, SD = 1.02) and sports videogames (M= 1.55, SD = 0.93). Educational televised programs (M = 3.58, SD = 1.10) and musical cartoons (M = 3.27, SD = 1.11) were frequently consumed by children. A total of 47.2 % of caregivers also indicated that they always accompany their children while they use devices at home. Caregivers reported a higher use of technological restrictive mediation (M = 4.14, SD = 1.14) and supervision (M = 4.1, SD = 1.11), followed by instructive (M = 3.93, SD = 1.19) and co-use mediation (M= 3.62, SD = 1.14). On a scale of 1 (very negative) to 5 (very positive), caregivers indicated that physical activity (M = 1.72, SD = 1.07) and sleep (M = 2.09, SD = .96) were most negatively affected by children's device use, whereas mathematical (M = 3.36, SD = 1.04) and linguistic skills (M = 3.44, SD = 1.13) were the most positively affected. This study's results provide a preliminary understanding of the context of use of mobile technology during caregiving of young children.

Hyaluronic acid injection to restore the lost interproximal papilla: a systematic review.

OBJECTIVES: To assess the efficacy and safety of hyaluronic acid (HA) injections to restore the lost interproximal papilla. MATERIALS AND METHODS: A systematic literature search was conducted in PubMed/MEDLINE, Scopus and Cochrane electronic databases with no time restriction up to September 2021. Any clinical study evaluating HA injection into the interproximal papilla loss Class I and II according to Norland & Tarnow, were included based on the following PICO questions (1) Are HA injections effective for the reconstruction of the interproximal papilla loss? (2) What are the side/adverse effects of using HA for the reconstruction of interproximal papilla loss? The risk of bias assessment was performed using the Cochrane Collaboration's the Newcastle Ottawa and Joanna Briggs institute tools. RESULTS: A total of 1497 titles were retrieved. From these, eleven were included and underwent full data extraction. However, due to heterogeneity in the data among the included articles, a meta-analysis could not be performed. Three articles reported no-differences in term of papilla tip to contact point distance or the papilla fill reduction. Finally, five studies showed a reduction in the black triangle with a percentage range between 19 and 47%. CONCLUSION: The non-surgical use of HA injection seems to have a positive effect on the re-establishment of interproximal papilla lost. However post-operative complications might develop.

Patients' Attitudes and Sources of Information on Coronavirus Disease 2019 in Rural Michigan.

Background This study investigated patients' attitudes about severe acute respiratory syndrome coronavirus 2 in rural Michigan. Despite increasing cases in rural communities across America, surveys have revealed that residents may feel less threatened by the virus compared to their urban counterparts. This difference in attitude and information appraisal can negatively affect rural health by discouraging coronavirus disease (COVID-19) preventative behaviors. Understanding social influences that contribute to the formation of opinions about the pandemic can help public health officials and clinicians better address rural health. Methodology This cross-sectional study surveyed 299 participants from three primary care clinics in Shiawassee County of Michigan during a seven-week interval. Statistical analysis, primarily through SAS version 9.4 (SAS Institute Inc., Cary, NC, USA), included descriptive statistics, multiple linear regression models, paired t-tests, and correlation coefficients. A p-value less than or equal to 0.05 was considered significant. Results Patients believed the risk COVID-19 posed to their family was significantly higher than the risk it posed to themselves (p < 0.001). Patients who reported that they would follow their provider's advice for treatment of a non-COVID-19 medical illness were found to be more likely to follow a provider's advice on COVID-19 (p < 0.001). However, patients overall were more agreeable with following provider advice for non-COVID-19 medical illnesses than they were for COVID-19 (p < 0.001). Conclusions As patients were more agreeable with following medical advice on chronic conditions than COVID-19, there may be extrinsic factors influencing patient views of COVID-19. Polarization of COVID-19 in the media has heavily influenced attitudes toward the virus in America. Initiatives to provide reliable patient education is key to encouraging constructive discussions and a healthy rural community. In a strong patient-provider relationship, primary care providers can share and encourage appropriate healthy behaviors regarding COVID-19, which have a direct impact on community health.

Influence of incision on periodontal parameters after apical surgery: a meta-analysis.

INTRODUCTION: The aim of the present meta-analysis was to determine the effect of the different incision designs used in apical surgery on periodontal parameters. METHODS: An electronic search in Cochrane Library, Pubmed (MEDLINE), and Scopus was conducted on April 2020. Two independent investigators included clinical trials and prospective cohort studies comparing the influence of different incision designs used in apical surgery on gingival recession, periodontal probing depth, and clinical attachment level. A pairwise and network meta-analysis was performed in order to meta-analyze the direct and the indirect comparisons among the incision designs. RESULTS: Six articles were included for the qualitative and the quantitative syntheses, involving a total of 401 teeth (372 patients). The pairwise meta-analysis did not reveal statistically significant differences between the incision designs in any of the outcomes evaluated. However, to reduce the amount of buccal gingival recession, the papilla base incision presented the highest probabilities of being ranked the most effective incision (85.7%), followed by submarginal incision (50.0%) and intrasulcular incision (14.3%). CONCLUSION: Regardless of the incision design used, the periodontal parameters did not statistically differ after apical surgery. CLINICAL RELEVANCE: Periodontal parameters did not significantly change despite the incision used in apical surgery. However, based on the results of the present review, the papilla base incision seems to be the best option to reduce the amount of buccal gingival recession.

Prevalencia de bloqueo residual en la Unidad de Cuidados Postanestésicos del Hospital Metropolitano / Prevalence of residual blockade in the Postanesthetic Care Unit of the Hospital Metropolitano

RESUMEN El bloqueo residual se define como la debilidad muscular postoperatoria producida por un antagonismo incompleto de los relajantes neu-romusculares, siendo sus principales complicaciones las respiratorias. Actualmente, el mejor método de evaluación objetiva del bloqueo neuromuscular es el Tren de Cuatro (TOF). El objetivo de este estudio fue describir la prevalencia de bloqueo residual en la Unidad de Cuidados Postanestésicos (UCPA) en pacientes ASA I y ASA II sometidos a cirugía electiva y de emergencia bajo anestesia general en el Hospital Metropolitano. Se realizó un estudio observacional, descriptivo y prospectivo en 211 sujetos, donde mediante el TOF se deter-minó que la prevalencia de bloqueo residual en la UCPA fue del 8,5%, valor que se relacionó con la falta de monitorización de la función neuromuscular, determinando además que el empleo de fármacos que revierten el bloqueo neuromuscular no excluye la presencia de bloqueo residual. Se recomienda el uso rutinario de monitorización de la relajación neuromuscular para prevenir y diagnosticar el bloqueo residual, además de la administración de reversión farmacológica independientemente del tiempo quirúrgico.

ABSTRACT Residual blockade is defined as postoperative muscle weakness caused by incomplete antagonism of neuromuscular relaxants, its main complications being respiratory, currently the best method of objective evaluation of neuromuscular blockade is the Train of Four (TOF). The objective of this study was to describe the prevalence of residual block in the Post Anesthesia Care Unit (UCPA) in patients with ASA I and ASA II undergoing elective and emergency surgery under general anesthesia at the Metropolitan Hospital. An observational, descrip-tive and prospective study was conducted in 211 subjects, where it was determined that the prevalence of residual block in UCPA was 8.5% with TOF, a value that was related to the lack of monitoring of neuromuscular function, also determining that the use of drugs that reverse neuromuscular blockade does not exclude the presence of residual blockade. Routine use of neuromuscular relaxation monitoring is recommended to prevent and diagnose residual block, in addition to drug reversal administration regardless of surgical time.

Suicidio por confinamiento con bolsa plástica y gas helio: presentación de dos casos / Suicide with plastic bag and helium gas: two case report

Resumen El confinamiento al igual que el sepultamiento son parte de las sofocaciones por carencia de aire respirable. Su etiología principal es la accidental, como ocurre con los mineros o los niños que juegan con bolsas de plástico o quedan atrapados dentro de lugares sin ventilación. En la actualidad se ha visto el aumento a nivel mundial sobre todo en países desarrollados, del uso de una bolsa plástica en conjunto con algún gas noble (principalmente helio) como método suicida "per se" o como proceso final de eutanasia. En el presente artículo se hará revisión de dos casos en Costa Rica, con sus hallazgos en la necropsia, la carencia de hallazgos toxicológicos y la importancia del escenario de muerte para poder emitir un criterio desde el punto de vista médico legal.

Abstract The confinement as well as the burial are part of the suffocations due to lack of breathable air. Its main etiology is accidental, as it happens with miners or the children who play with plastic bags or get trapped inside unventilated places. At present, the increase in the world has been seen especially in developed countries of the use of a plastic bag in conjunction with some noble gas (mainly helium) as a suicidal method or as a final process of euthanasia.

Size effect of SnO2 nanoparticles on bacteria toxicity and their membrane damage.

Semiconductor SnO2 nanoparticles (NPs) are being exploited for various applications, including those in the environmental context. However, toxicity studies of SnO2 NPs are very limited. This study evaluated the toxic effect of two sizes of spherical SnO2 NPs (2 and 40 nm) and one size of flower-like SnO2 NPs (800 nm) towards the environmental bacteria E. coli and B. subtilis. SnO2 NPs were synthesized using a hydrothermal or calcination method and they were well characterized prior to toxicity assessment. To evaluate toxicity, cell viability and membrane damage were determined in cells (1 × 109 CFU mL-1) exposed to up to 1000 mg L-1 of NPs, using the plate counting method and confocal laser scanning microscopy. Spherical NPs of smaller primary size (E2) had the lowest hydrodynamic size (226 ± 96 nm) and highest negative charge (-30.3 ± 10.1 mV). Smaller spherical NPs also showed greatest effect on viability (IC50 > 500 mg L-1) and membrane damage of B. subtilis, whereas E. coli was unaffected. Scanning electron microscopy confirmed the membrane damage of exposed B. subtilis and also exhibited the attachment of E2 NPs to the cell surface, as well as the elongation of cells. It was also apparent that toxicity was caused solely by NPs, as released Sn4+ was not toxic to B. subtilis. Thus, surface charge interaction between negatively charged SnO2 NPs and positively charged molecules on the membrane of the Gram positive B. subtilis was indicated as the key mechanism related to toxicity of NPs.

Asymmetric Wnt Pathway Signaling Facilitates Stem Cell-Like Divisions via the Nonreceptor Tyrosine Kinase FRK-1 in Caenorhabditis elegans.

Asymmetric cell division is critical during development, as it influences processes such as cell fate specification and cell migration. We have characterized FRK-1, a homolog of the mammalian Fer nonreceptor tyrosine kinase, and found it to be required for differentiation and maintenance of epithelial cell types, including the stem cell-like seam cells of the hypodermis. A genomic knockout of frk-1, allele ok760, results in severely uncoordinated larvae that arrest at the L1 stage and have an excess number of lateral hypodermal cells that appear to have lost asymmetry in the stem cell-like divisions of the seam cell lineage. frk-1(ok760) mutants show that there are excess lateral hypodermal cells that are abnormally shaped and smaller in size compared to wild type, a defect that could be rescued only in a manner dependent on the kinase activity of FRK-1. Additionally, we observed a significant change in the expression of heterochronic regulators in frk-1(ok760) mutants. However, frk-1(ok760) mutants do not express late, nonseam hypodermal GFP markers, suggesting the seam cells do not precociously differentiate as adult-hyp7 cells. Finally, our data also demonstrate a clear role for FRK-1 in seam cell proliferation, as eliminating FRK-1 during the L3-L4 transition results in supernumerary seam cell nuclei that are dependent on asymmetric Wnt signaling. Specifically, we observe aberrant POP-1 and WRM-1 localization that is dependent on the presence of FRK-1 and APR-1. Overall, our data suggest a requirement for FRK-1 in maintaining the identity and proliferation of seam cells primarily through an interaction with the asymmetric Wnt pathway.

Radiculopatía cervical / Cervical radiculopathy

La patología cervical traumática y su relación con el quehacer de la medicina legal tiene gran importancia y vigencia, principalmente cuando se hace necesario realizar valoraciones a pacientes con alteraciones cervicales y se debe definir si estas están en relación a un trauma determinado o repetitivo en el tiempo como puede ocurrir en algunos casos de riesgo de trabajo. El médico forense debe estar muy bien preparado, conocer la anatomía cervical y de los miembros superiores, realizar un interrogatorio y un examen físico neurológico exhaustivo para orientar las posibilidades diagnósticas; es fundamental además el análisis de los estudios diagnósticos. En este caso en particular se realizar una revisión de la radiculpatía cervical, su fisiopatología, mecanismos de producción y las implicaciones médico legales al realizar la valoración en pacientes con cervicobraquialgia...

Incesto: enfoque médico legal / Incest: forensic approach

El incesto se refiere a la actividad sexual realizada entre personas de una misma familia, por lo que legalmente no pueden casarse. En nuestra sociedad y cultura se le considera al mismo un tabú y se contemplan las diferentes variantes del mismo en el código penal bajo los delitos de violación. El incesto, por tanto es un tipo de abuso sexual, es una actividad repetitiva y gradual, que va de meses a años antes de la revelación del secreto, ocurre en todas las clases sociales y raciales y se ha establecido que los agresores son predominantemente del sexo masculino y las víctimas corresponden al sexo femenino. La valoración médico legal en casos de incesto es la misma que se realiza en los casos de delitos sexuales, mediante una entrevista abierta y no dirigida, un examen físico completo, contando con el total consentimiento de las y los involucrados, con exámenes de laboratorio y principalmente evitando la revictimización de las víctimas...

Cáncer cervical: Citología en base líquida, convencional y otras pruebas de tamizaje / Cervical cancer: Liquid-based, conventional cytology and other screening tests

La citología cervicovaginal como herramienta diagnóstica se inició en el siglo XIX con el médico griego George Papanicolaou y se implementó en los programas de tamizaje de cáncer a mediados de 1960, logrando una reducción de la mortalidad (80%) a nivel mundial. Como limitación está la baja sensibilidad que oscila entre 30 y 87%, con promedio de 53%. La mortalidad por cáncer cervical mundial es de 86% y 88% en países en vía de desarrollo. En Colombia la tasa de mortalidad ajustada por edad es de 18,2 por 100.000. Esto se debe al control de calidad inadecuado y la pobre actualización permanente de los citohistotecnólogos, sumada al alto número de lecturas realizadas en la jornada laboral, llevando a un sobrediagnóstico de atipia de células escamosas de significado indeterminado (ASCUS). Además influyen factores como la no toma de la citología por el bajo nivel socioeconómico y la falta de afiliación al régimen de seguridad social. La citología en base líquida (CBL) resuelve cinco problemas: 1) falta de captura de la totalidad de la muestra, 2) fijación deficiente, 3) distribución aleatoria de células anómalas, 4) existencia de elementos perturbadores y 5) mala calidad del frotis. Esta técnica incrementa la sensibilidad de lesiones intraepiteliales de alto grado y carcinomas, sin variación en la especificidad. Otras pruebas de tamización son la detección y tipificación del virus del papiloma humano (VPH) incluida en el plan obligatorio de salud (POS) 2012, la prueba de reacción en cadena de la polimerasa (PCR), oncogenes RNA E6 Y E7 y la inspección visual con ácido acético y lugol (vía vili) cuya filosofía es ver y tratar.

Cervico-vaginal cytology has been used as a diagnostic tool since the early 19th century started by the Greek physician George Papanicolaou and was implemented for cancer screening programs since the mid 1960s achieving an 80% reduction in mortality rate worldwide. A low sensibility between 30 and 87%, average 53%, is a drawback. Global mortality rate due to cervical cancer is 86% and 88% in developing countries. The age-related mortality rate in Colombia is 18.2 per 100.000 patients. The latter is due to inadequate quality control and lack of update training for cytohispathology technicians, in addition to the high number of readings performed during their work day leading to overdiagnosis of Atypical Squamous Cells of Undetermined Significance (ASCUS). Other factors such as not performing a cervical smear due to low socioeconomic status and lack of affiliation to the social security system are also important. The use of liquid-based cytology (LBC) resolves five problems: 1) failure to capture the complete sample, 2) poor fixation, 3) random distribution of anomalous cells, 4) existence of perturbing elements, and 5) poor quality of the smear. This technique increases the sensibility of high-grade intraepithelial lesions and cancer lesions with no specificity variation. Other screening tests are: human papillomavirus (HPV) detection and typing tests included in the 2012 Health Obligatory Plan (POS) and the polymerase chain reaction tests (PCR), RNA oncogenes E6 and E7 and visual inspection with acetic acid and lugol´s iodine (VIA/VILI) in a “see and treat” cervical prevention strategy.

Actualización: sífilis en medicina legal / Updated: syphilis in forensics

La sífilis es una enfermedad compleja de origen bacteriano, caracterizada por una amplia variedad de presentaciones clínicas, que le han hecho merecedora del nombre de la imitadora o la gran impostora, que a pesar del desarrollo tecnológico y terapéutico actual, esta enfermedad de transmisión sexual se mantiene presente en nuestra sociedad como en los tiempos antiguos, siendo que pese a los esfuerzos por disminuir su prevalencia, esta se mantiene elevada. El papel del médico forense en la valoración de los delitos sexuales contempla el descarte de enfermedades de transmisión sexual y debido a las implicaciones médico legales que conlleva este tipo de transmisión y las correlaciones médicas que con la presencia o no de estas enfermedades se pueda realizar, es que se considera esencial el pleno conocimiento de las mismas, y siendo la sífilis una de las más complejas, se considera necesaria una revisión de esta patología...

Inoculo de hongos de micorrizasarbuscular en pasturas de Brachiaria decumbens(Poaceae) en zonas de loma y vega / Inoculum of Arbuscular Mycorrhizal Fungi on Brachiaria decumbens (Poaceae) Pastures in Valley and Hilly Terrain

Los factores que influyen en la distribución del inóculo de hongos micorrícicos arbusculares (micelio externo y esporas) son diversos. Entre ellos pueden mencionarse la especie vegetal predominante, el pH, la humedad del suelo, la conductividad, el contenido de fósforo, nutrientes y de metales pesados. Muchos de los reportes de la literatura son contradictorios y basados en estudios realizados en zonas templadas; en condiciones tropicales es difícil determinar los factores edáficos y ambientales que estimulan la producción de inóculo y la forma en que lo hacen. Brachiaria decumbens, como especie de pasto predominante en paisajes de loma y vega en el piedemonte amazónico colombiano, ha sido poco estudiada en su relación micorrícica. En este estudio se realizó la determinación de la densidad de esporas y micelio externo en 26 zonas cubiertas con B. decumbens, correspondientes a paisajes de loma y vega. Simultáneamente se valoraron el contenido de fósforo disponible (ppm), pH y humedad relativa del suelo (por ciento). Mediante correlaciones de Spearman (rangos) y análisis de varianza (ANDEVA) de una vía por KruscallWallis, se encontró que el inóculo se distribuye de forma diferente en loma y vega, siendo mayor la densidad de esporas en loma que en vega y más homogéneo en contenido de micelio externo en vega que en loma. No se encontró efecto del fósforo disponible, el pH y la humedad del suelo sobre la densidad de inóculo de HMA.

Inversión uterina puerperal crónica: presentación de un caso y revisión de la literatura / Chronic uterine inversion: a case report and review of the literature

Se presenta un caso de diagnóstico tardío de inversión uterina poco frecuente en la literatura médica. El cuadro clínico de la paciente incluía sangrado genital moderado persistente y dispareunia de 14 meses de evolución. La técnica de reposicionamiento uterino se realizó por vía vaginal con revisión posterior por vía laparoscópica y evolución satisfactoria. Se hace una revisión de la literatura.

Dolor abdominal en el servicio de urgencias pediátricas / Abdominal pain in the pediatric emergency department

Antecedentes: el dolor abdominal es una causa frecuente de consulta en los servicios de urgencias pediátricas. El objeto del estudio fue encontrar si existe un perfil clínico y paraclínico de los pacientes con dolor abdominal que sugiera si su patología requiere tratamiento quirúrgico o médico. Métodos: se realizó un trabajo observacional, prospectivo, de los pacientes que ingresaban al servicio de urgencias pediátricas con diagnóstico del dolor abdominal. Se comparon las variables clínicas, de laboratorio y gabinete de las alteraciones quirúrgicas y médicas mediante la prueba de la ji cuadrada, considerando a p significativa <0.005. Resultados: el 15 por ciento de 188 pacientes ingresaron por dolor abdominal. De ellos, 102 tenían alteración médica y 86 quirúrgica. Los diagnósticos más frecuentes fueron: apendicitis, dolor abdominal inespecífico, infección de vías urinarias y constipasión. En apoyo de la alteración quirúrgica fueron estadísticamente significativos (p<0.005) el signo de rebote, hiperestesia, resistencia muscular, leucocitosis con neutrofilia y borramiento del psoas. Para alteración médica lo fueron la constipación y los síntomas urinarios. Conclusiones: los pacientes con rebote, hiperestesia, resistencia muscular, leucocitosis con neutrofilia y borramiento del psoas, probablemente presentan alteración abdominal "quirúrgica". Como estos datos no existen en todos los enfermos, si existe duda en el diagnóstico, conviene la vigilancia constante