Prevalence and associations of Trypanosoma spp. and Sodalis glossinidius with intrinsic factors of tsetse flies

Trypanosomiasis has been identified as a neglected tropical disease in both humans and animals in many regions of sub-Saharan Africa. Whilst assessments of the biology of trypanosomes, vectors, vertebrate hosts and the environment have provided useful information about life cycles, transmission, and pathogenesis of the parasites that could be used for treatment and control, less information is available about the effects of interactions among multiple intrinsic factors on trypanosome presence in tsetse flies from different sites. It is known that multiple species of tsetse flies can transmit trypanosomes but differences in their vector competence has normally been studied in relation to individual factors in isolation, such as: intrinsic factors of the flies (e.g. age, sex); habitat characteristics; presence of endosymbionts (e.g. Wigglesworthia glossinidia, Sodalis glossinidius); feeding pattern; host communities that the flies feed on; and which species of trypanosomes are transmitted. The purpose of this study was to take a more integrated approach to investigate trypanosome prevalence in tsetse flies. In chapter 2, techniques were optimised for using the Polymerase Chain Reaction (PCR) to identify species of trypanosomes (Trypanosoma vivax, T. congolense, T. brucei, T. simiae, and T. godfreyi) present in four species of tsetse flies (Glossina austeni, G. brevipalpis, G. longipennis and G. pallidipes) from two regions of eastern Kenya (the Shimba Hills and Nguruman). Based on universal primers targeting the internal transcribed spacer 1 region (ITS-1), T. vivax was the predominant pathogenic species detected in flies, both singly and in combination with other species of trypanosomes. Using Generalised Linear Models (GLMs) and likelihood ratio tests to choose the best-fitting models, presence of T. vivax was significantly associated with an interaction between subpopulation (a combination between collection sites and species of Glossina) and sex of the flies (X2 = 7.52, df = 21, P-value = 0.0061); prevalence in females overall was higher than in males but this was not consistent across subpopulations. Similarly, T. congolense was significantly associated only with subpopulation (X2 = 18.77, df = 1, P-value = 0.0046); prevalence was higher overall in the Shimba Hills than in Nguruman but this pattern varied by species of tsetse fly. When associations were analysed in individual species of tsetse flies, there were no consistent associations between trypanosome prevalence and any single factor (site, sex, age) and different combinations of interactions were found to be significant for each. The results thus demonstrated complex interactions between vectors and trypanosome prevalence related to both the distribution and intrinsic factors of tsetse flies. The potential influence of the presence of S. glossinidius on trypanosome presence in tsetse flies was studied in chapter 3. A high number of Sodalis positive flies was found in the Shimba Hills, while there were only two positive flies from Nguruman. Presence or absence of Sodalis was significantly associated with subpopulation while trypanosome presence showed a significant association with age (X2 = 4.65, df = 14, P-value = 0.0310) and an interaction between subpopulation and sex (X2 = 18.94, df = 10, P-value = 0.0043). However, the specific associations that were significant varied across species of trypanosomes, with T. congolense and T. brucei but not T. vivax showing significant interactions involving Sodalis. Although it has previously been concluded that presence of Sodalis increases susceptibility to trypanosomes, the results presented here suggest a more complicated relationship, which may be biased by differences in the distribution and intrinsic factors of tsetse flies, as well as which trypanosome species are considered. In chapter 4 trypanosome status was studied in relation to blood meal sources, feeding status and feeding patterns of G. pallidipes (which was the predominant fly species collected for this study) as determined by sequencing the mitochondrial cytochrome B gene using DNA extracted from abdomen samples. African buffalo and African elephants were the main sources of blood meals but antelopes, warthogs, humans, giraffes and hyenas were also identified. Feeding on multiple hosts was common in flies sampled from the Shimba Hills but most flies from Nguruman had fed on single host species. Based on Multiple Correspondence Analysis (MCA), host-feeding patterns showed a correlation with site of sample collection and Sodalis status, while trypanosome status was correlated with sex and age of the flies, suggesting that recent host-feeding patterns from blood meal analysis cannot predict trypanosome status. In conclusion, the complexity of interactions found suggests that strategies of tsetse fly control should be specific to particular epidemic areas. Future studies should include laboratory experiments that use local colonies of tsetse flies, local strains of trypanosomes and local S. glossinidius under controlled environmental conditions to tease out the factors that affect vector competence and the relative influence of external environmental factors on the dynamics of these interactions.

Principales causas de morbilidad y mortalidad secundario a trauma craneoencefálico severo, en niños menores de 12 años en el Hospital Nacional de Niños “Benjamin Bloom”,ingresados en el periodo de Enero a Diciembre de 2012

El trauma craneoencefálico constituye actualmente la primera causa de muerte en niños por encima de un año de edad y en los casos graves o severos representa una mortalidad elevada para unos y para otros, los sobrevivientes, secuelas incapacitantes permanentes. Nuestro país al momento no cuenta con datos amparados en estudios serios para la población general, mucho menos para la edad pediátrica, infiriendo tener un perfil epidemiológico similar al de otros países más desarrollados; por lo cual el presente trabajo pretende mediante una investigación tipo descriptiva, transversal y retrospectiva, identificar algunas características epidemiológicas, y las principales causas de morbilidad y mortalidad asociadas al trauma craneoencefálico severo en pacientes pediátricos menores de doce años que ingresaron al Hospital Nacional de Niños Benjamín Bloom durante el año 2012. Para dicho cometido se hizo uso de un método de investigación relativamente sencillo, realizando la recolección de datos primarios directamente de los expedientes de la totalidad de los pacientes en cuestión durante dicho año, aplicando un cuestionario en base a objetivos. Los datos así obtenidos se procesaron mediante una base de datos usando el software EpiInfo 3.5.1. Posteriormente se analizaron utilizando medidas de estadística descriptiva, mediante lo que se concluyó, que en el Hospital Nacional de Niños Benjamín Bloom, se atienden pacientes con trauma craneoencefálico severo procedentes de toda la geografía del país, teniendo como principales causas las caídas por accidentes en el hogar y sitios públicos, seguidos por los accidentes de tránsito y los golpes o traumas contusos; predominantemente hay una mayor incidencia en la edad escolar y el sexo masculino. Más del 50% de los pacientes atendidos por esta causa presenta lesiones concomitantes asociadas principalmente en tórax y abdomen.

Resultado perinatal de embarazos a término con oligohidramnios de moderado a severo que consultan en el Hospital Nacional de Maternidad “Dr. Raúl Arguello Escolán” entre el período de Enero a Diciembre de 2013

La disminución del líquido amniótico se asocia con un incremento de la morbimortalidad del recién nacido. La principal consecuencia descrita por la literatura es una mayor compresión sobre el abdomen fetal, lo que conlleva a una disminución en el movimiento del diafragma fetal, que puede desencadenar una limitación en el desarrollo del tejido funcional pulmonar conllevando problemas en la transición respiratoria en la vida extrauterina del infante. El oligohidramnios como condición que complica el embarazo se observa en el 3 al 5 % del total de los embarazos. El líquido amniótico es esencial para el crecimiento y desarrollo del feto. El líquido protege al feto de infecciones, traumatismos, compresión del cordón umbilical y facilita los movimientos fetales. El volúmen de líquido amniótico es un indicador importante utilizado frecuentemente en el control prenatal debido a que ciertas alteraciones de líquido amniótico se asocian con un pobre pronóstico del embarazo, ya que pueden mostrarnos defectos anatómicos en el riñón fetal que pueden conllevar múltiples malformaciones. En la actualidad, en la mayoría de centros perinatales de América se utiliza el índice de líquido amniótico como parte de una de las pruebas de bienestar fetal. En el Hospital de Maternidad el oligohidramnios es una patología muy frecuente de causa de consulta en unidad de emergencia y consulta externa, así como de ingreso hospitalario. Con el presente trabajo se dio a conocer el resultado perinatal de las pacientes que presentaron oligohidramnios durante el embarazo que consultaron el Hospital Nacional de Maternidad, así como también se describe la presencia de factores de riesgo socioeconómicos como la edad, escolaridad y estado civil que puedan presentarse en ésta patología. También se describe cual ha sido la vía de evacuación más frecuente en éstos casos, así como también el resultado perinatal de los recién nacidos con ésta patología la cual se presentó durante el embarazo.

Lower limb and associated injuries in frontal-impact road traffic collisions.

Objectives: To study the relationship between severity of injury of the lower limb and severity of injury of the head, thoracic, and abdominal regions in frontal-impact road traffic collisions. Methods: Consecutive hospitalised trauma patients who were involved in a frontal road traffic collision were prospectively studied over 18 months. Patients with at least one Abbreviated Injury Scale (AIS) ≥3 or AIS 2 injuries within two AIS body regions were included. Patients were divided into two groups depending on the severity of injury to the head, chest or abdomen. Low severity group had an AIS < 2 and high severity group had an AIS ≥ 2. Backward likelihood logistic regression models were used to define significant factors affecting the severity of head, chest or abdominal injuries. Results: Eighty-five patients were studied. The backward likelihood logistic regression model defining independent factors affecting severity of head injuries was highly significant (p=0.01, nagelkerke r square = 0.1) severity of lower limb injuries was the only significant factor (p=0.013) having a negative correlation with head injury (Odds ratio of 0.64 (95% CI: 0.45-0.91). Conclusion: Occupants who sustain a greater severity of injury to the lower limb in a frontal-impact collision are likely to be spared from a greater severity of head injury.

Polissacarídeos sulfatados de interesse farmacológico no camarão litopenaeus schimitti

Sulfated Polysaccharides with unique chemical structures and important biological activities has been found in a diversity of sea invertebrates. For that, to exist a huger interest on the biotechnology field in the research theses sulfated compounds isolated from sea organisms. Despite the privileged brazilian position for these compounds attainment, there are still a few scientific informations about the isolated substances and their biological activities. A head the displayed, the present work has for objectives, to evaluate the pharmacological properties of the glycosaminoglycans isolated from the sea shrimp Litopenaeus schimitti on homeostasis, blood coagulation, leukocytes migration and platelet/leukocyte adhesion. For this, yhe glycosaminoglycans were extracted from crustacean tissues by proteolysis, fractionation with acetone and later submitted to pharmacological assays. The crustacean tissues showed compounds heparin-like, with anticoagulant activity of 45 IU/mg and 90 IU/mg, respectively. These molecules showed low residual hemorrhagic effects in the tested concentration (100 µg/mL), when compared to unfractionated commercial heparin (UFH). Another dermatan sulfate-like compound, predominately constituted for disulfated disaccharides, was isolated from crustacean abdomen. This compound showed an efficient effect on leukocytes migration inhibition, in the concentration of 15 µg/mL, reducing the cellular infiltration in 65% when compared to the controlled animals. In this same concentration, the DS reduced in 60% the protein concentration of the peritoneal exudates. In the concentration, this compound of 0.5 mg/mL, it was capable to reduce in 40% platelet/leukocytes adhesion. Our data demonstrate that these sulfated polysaccharides isolated from the shrimp L. schimitti will can be used as bioactive compounds, appearing as active principles for pharmacological development, anticoagulants and inflammatory response regulators

Estudo do genoma do vírus causador da mionecrose infecciosa em camarões e desenvolvimento de métodos para detecção de polimorfismos

Shrimp farming is one of the activities that contribute most to the growth of global aquaculture. However, this business has undergone significant economic losses due to the onset of viral diseases such as Infectious Myonecrosis (IMN). The IMN is already widespread throughout Northeastern Brazil and affects other countries such as Indonesia, Thailand and China. The main symptom of disease is myonecrosis, which consists of necrosis of striated muscles of the abdomen and cephalothorax of shrimp. The IMN is caused by infectious myonecrosis virus (IMNV), a non-enveloped virus which has protrusions along its capsid. The viral genome consists of a single molecule of double-stranded RNA and has two Open Reading Frames (ORFs). The ORF1 encodes the major capsid protein (MCP) and a potential RNA binding protein (RBP). ORF2 encodes a probable RNA-dependent RNA polymerase (RdRp) and classifies IMNV in Totiviridae family. Thus, the objective of this research was study the IMNV complete genome and encoded proteins in order to develop a system differentiate virus isolates based on polymorphisms presence. The phylogenetic relationship among some totivirus was investigated and showed a new group to IMNV within Totiviridae family. Two new genomes were sequenced, analyzed and compared to two other genomes already deposited in GenBank. The new genomes were more similar to each other than those already described. Conserved and variable regions of the genome were identified through similarity graphs and alignments using the four IMNV sequences. This analyze allowed mapping of polymorphic sites and revealed that the most variable region of the genome is in the first half of ORF1, which coincides with the regions that possibly encode the viral protrusion, while the most stable regions of the genome were found in conserved domains of proteins that interact with RNA. Moreover, secondary structures were predicted for all proteins using various softwares and protein structural models were calculated using threading and ab initio modeling approaches. From these analyses was possible to observe that the IMNV proteins have motifs and shapes similar to proteins of other totiviruses and new possible protein functions have been proposed. The genome and proteins study was essential for development of a PCR-based detection system able to discriminate the four IMNV isolates based on the presence of polymorphic sites

Primary squamous cell carcinoma of the stomach presenting as a huge retroperitoneal tumor: a case report

A man complained of upper abdominal pain and early satiety for one month. An upper gastrointestinal endoscopy showed nothing special. A CT scan of the abdomen was performed, which demonstrated a huge heterogeneous retroperitoneal mass close to the dorsal wall of the stomach and surrounding the abdominal aortic and celiac trunk. The resected specimen suggested that an irregular tumor invaded the dorsal wall of the stomach. Postoperative histological examination confirmed that it was a gastric squamous cell carcinoma.

Opisthorchiasis in infant remains from the medieval Zeleniy Yar burial ground of XII-XIII centuries AD

We present a paleoparasitological analysis of the medieval Zeleniy Yar burial ground of the XII-XII centuries AD located in the northern part of Western Siberia. Parasite eggs, identified as eggs of Opisthorchis felineus, were found in the samples from the pelvic area of a one year old infant buried at the site. Presence of these eggs in the soil samples from the infant’s abdomen suggests that he/she was infected with opisthorchiasis and imply consumption of undercooked fish. Ethnographic records collected among the population of the northern part of Western Siberia reveal numerous cases of feeding raw fish to their children. Zeleniy Yar case of opisthorchiasis suggests that this dietary custom has persisted from at least medieval times.

Adenocarcinoma pleomórfico de células giganates de vías biliares(osteoclastoma like)

Las células gigante tipo osteoclásticas (CGTO) del páncreas son una entidad poco frecuente descrito originalmente por Rosaien 1968, caracterizado por osteoclastos, que son células gigantes mononucleares idénticas a las células del estroma observadas en tumores óseos. Desde entonces, hay pocos informes de los tumores que contienen células gigantes en otras localizaciones anatómicas. Las CGTO se pueden distinguir de las células gigantes tipo pleomórficas (CGTP), debido a la falta de un marcado pleomorfismo nuclear asociado. A menudo, un carcinoma de páncreas histológicamente reconocibles acompaña CGTO, dando lugar a un mal resultado. Formas puras de CGTO presentan un mejor pronóstico porque se necesita mucho tiempo para desarrollar metástasis, pero esta forma es muy raros, con pocos casos reportados en la literatura Inglésa. La mayoría de veces se discute el diagnóstico de benignidad de estos tumores basados en la evaluación de inmunohistoquímica. El presente caso se trata de una paciente de sexo femenino de 56 años de edad con cuadro caracterizado por dolor tipo cólico que mejora con antiespasmódicos, de varios meses de evolución, con periodos de remisión y exacerbación. A examen físico presenta: en piel y mucosas ligero tinte subictérico, a nivel abdominal: abdomen doloroso de forma difusa sin viseromegalias o masas palpables

Criterios predictivos de colecistectomía laparoscópica difícil: clínicos, de laboratorio y ecográficos. Hospitales Vicente Corral M. y José Carrasco A. Cuenca 2006

Los objetivos del estudio fueron: determinar si los criterios clínicos: Murphy positivo, fiebre y cirugías previas del abdomen superior, tamaño de cálculo, pared de fondo vesicular más de 3 mm de grosor, distensión vesicular, líquido perivesicular, Murphy ecográfico, cálculo impactado en el cuello vesicular y barro biliar, están asociados significativamente con colecistectomía laparoscópica difícil. Resultados: De los 140 pacientes de ambos sexos realizados colecistectomía laparoscópica: 26 fueron del HVCM Y 114 del hospital José Carrasco (IESS).

Study of new physiological characteristics as protein receptors (RP55) of light, color, heat, motion, smell, electric, vibration and position located in head, body and abdominal, found in mosquito larvae.

The main objective of the research is to demonstrate new physiological characteristics receptors in the presence of mosquito larvae. 100 larvae of different species were collected and studied for a week in periods of 8-24 hrs. Larvae stages I, II, III and IV have photo-thermo receptors of light and heat housed in the body is divided into head, thorax and abdomen, perceive hot or cold environments, and have fibers in chest or hairs lining your body or abdomen, and a pair of antennae on the head. Stages II and III are more developed than the initial stages. They are attracted by the dark green at the bottom, a pair of eyes that perceive light and color. Have receptors proteins (RP55) that capture motion at a speed the slightest movement of waves in the water. Its nose is not well developed but have chemoreceptors. They adapt to changes in pH in alkaline media, are sensitive to chemical, thermal and mechanical changes nociceptors have electroreceptors or galvanoreceptores sensitive to electrical stimuli, have mechanoreceptors that are sensitive to touch, pain, pressure, gravity, sound. They have a GPS position that seems the guides. It is precisely in the fibers, mushrooms or bristles are recipients along with the micro villi in head, thorax and abdomen.
RESUMEN El objetivo principal de la investigación es demostrar nuevas características fisiológicas como la presencia de receptores en las larvas de mosquitos. Se recolectaron 100 larvas de diferentes especies y se estudiaron por una semana en periodos de 8 a 24 hrs. Las larvas de los estadios I,II,III y IV tienen foto-termo receptores de luz y calor alojados en el cuerpo que se divide en cabeza, tórax y abdomen, perciben ambientes fríos o calientes, así como tienen fibras en tórax o pelos que recubren su cuerpo, y un par de antenas en la cabeza. Los estadios II y III son más desarrollados que las etapas iniciales. Tienen receptores proteicos RP55. Les atrae el color verde oscuro en el fondo, un par de ojos que perciben la luz y color con fotoreceptores. Tienen receptores RP55 de movimiento que captan a una velocidad el más mínimo movimiento de ondas en el agua. Su olfato no está muy desarrollado pero tienen quimioreceptores. Se adaptan a cambios de pH en medios alcalinos, tienen nociceptores sensibles a cambios químicos, térmicos y mecánicos, tienen galvanoreceptores o electroreceptores sensibles a estímulos eléctricos, tienen mecanoreceptores que son sensibles al tacto, dolor, presión gravedad, sonido. Tienen un GPS de posición que pareciera las orienta.

Analgesia con el uso de fentanilo en la anestesia raquídea

El estudio se realiza en 80 pacientes quirúrgicos del Hospital Vicente Corral Moscoso a los cuales se les aplicó un tratamiento alternativo del dolor postoperatorio, que consistió en la asociación de Fentanilo a la anestesia raquídea. Por la misma vía. Las cirugías fueron principalmente de abdomen inferior y de las extremidades inferiores. Los pacientes seleccionados fueron de ambos sexos, en las edades comprendidas entre los 18 y 80 años, sin riesgos operatorios, esto es, sin trastornos de la conciencia, que no presenten cardiopatías, diabetes, descompensaciones, ni patologías; tiroidea, vascular y/o respiratoria; o que requieran sondaje vesical por más de 48 horas. A los 80 pacientes se les dividió en dos grupos denominados

Kinematics and Local Motion Planning for Quasi-static Whole-body Mobile Manipulation

This thesis studies mobile robotic manipulators, where one or more robot manipulator arms are integrated with a mobile robotic base. The base could be a wheeled or tracked vehicle, or it might be a multi-limbed locomotor. As robots are increasingly deployed in complex and unstructured environments, the need for mobile manipulation increases. Mobile robotic assistants have the potential to revolutionize human lives in a large variety of settings including home, industrial and outdoor environments.

Mobile Manipulation is the use or study of such mobile robots as they interact with physical objects in their environment. As compared to fixed base manipulators, mobile manipulators can take advantage of the base mechanism’s added degrees of freedom in the task planning and execution process. But their use also poses new problems in the analysis and control of base system stability, and the planning of coordinated base and arm motions. For mobile manipulators to be successfully and efficiently used, a thorough understanding of their kinematics, stability, and capabilities is required. Moreover, because mobile manipulators typically possess a large number of actuators, new and efficient methods to coordinate their large numbers of degrees of freedom are needed to make them practically deployable. This thesis develops new kinematic and stability analyses of mobile manipulation, and new algorithms to efficiently plan their motions.

I first develop detailed and novel descriptions of the kinematics governing the operation of multi- limbed legged robots working in the presence of gravity, and whose limbs may also be simultaneously used for manipulation. The fundamental stance constraint that arises from simple assumptions about friction and the ground contact and feasible motions is derived. Thereafter, a local relationship between joint motions and motions of the robot abdomen and reaching limbs is developed. Baseeon these relationships, one can define and analyze local kinematic qualities including limberness, wrench resistance and local dexterity. While previous researchers have noted the similarity between multi- fingered grasping and quasi-static manipulation, this thesis makes explicit connections between these two problems.

The kinematic expressions form the basis for a local motion planning problem that that determines the joint motions to achieve several simultaneous objectives while maintaining stance stability in the presence of gravity. This problem is translated into a convex quadratic program entitled the balanced priority solution, whose existence and uniqueness properties are developed. This problem is related in spirit to the classical redundancy resoxlution and task-priority approaches. With some simple modifications, this local planning and optimization problem can be extended to handle a large variety of goals and constraints that arise in mobile-manipulation. This local planning problem applies readily to other mobile bases including wheeled and articulated bases. This thesis describes the use of the local planning techniques to generate global plans, as well as for use within a feedback loop. The work in this thesis is motivated in part by many practical tasks involving the Surrogate and RoboSimian robots at NASA/JPL, and a large number of examples involving the two robots, both real and simulated, are provided.

Finally, this thesis provides an analysis of simultaneous force and motion control for multi- limbed legged robots. Starting with a classical linear stiffness relationship, an analysis of this problem for multiple point contacts is described. The local velocity planning problem is extended to include generation of forces, as well as to maintain stability using force-feedback. This thesis also provides a concise, novel definition of static stability, and proves some conditions under which it is satisfied.

Efectividad de la terapia manual en pacientes con dismenorrea primaria

La dismenorrea primaria (DP) debe considerarse como el desorden ginecológico crónico más doloroso en mujeres en edad reproductiva y debe ser considerado como un desorden multifactorial, se puede describir como un síndrome doloroso, sin causa orgánica objetiva, generalmente de tipo cólico en la parte inferior del abdomen que puede irradiar a la zona lumbar y a la pelvis y se pueden asociar síntomas como náuseas, diarrea, mareos, dolor de cabeza y vómitos; el dolor suele aparecer el primer día de la menstruación con una intensidad muy elevada y su duración es de 48 a 72 horas. La DP habitualmente empieza durante la adolescencia, de 6 a 12 meses tras la menarquia, cuando la ovulación se regulariza y si no se toma ninguna medida farmacológica, el dolor se cronifica durante toda la etapa fértil de la mujer. Como factores de riesgo de la DP encontramos los antecedentes familiares de dismenorrea con probable predisposición genética y la menarquia antes de los 13 años. Según la literatura mundial, la prevalencia de DP oscila del 16% al 91% en mujeres en edad reproductiva y de ese porcentaje del 2% al 29% muestran un dolor severo; si la edad de inicio es sobre los 12, 13 años y la de desaparición sobre los 45 a 50, las mujeres pueden llegar a presentar dolor en 20-30 años de su vida; la DP es la primera causa de absentismo escolar y laboral en adolescentes y jóvenes. En España hay un 50% de adolescentes que sufren dolor y de ellas en el 10 % de los casos les incapacita durante 1 a 3 días para realizar una vida normal, el impacto en la calidad de vida y a nivel psicosocial es muy importante...

FAST-E en Pacientes con Trauma Abdominal Cerrado Estable, en un Departamento de Urgencias en Colombia

El impacto que ha generado el trauma en Colombia a lo largo de la historia, nos ha obligado a mejorar y adaptar diferentes tipos de sistemas de atención en trauma, basados en los lineamientos internacionales, los cuales buscan evitar el significativo aumento en las tasas de mortalidad y discapacidad que se obtienen de este, especialmente en los servicios de Emergencias en los cuales se reciben el 100% de estos pacientes con traumatismo múltiple o politraumatismo. Dentro de este grupo de pacientes hay un subgrupo que son las pacientes con trauma de abdomen que cursan con estabilidad hemodinámica y además son clasificados de bajo riesgo, ya sea por índices de trauma o por otros métodos como la medición sérica de lactato, los cuales tienen un papel poco despreciable al momento de ver mortalidad y discapacidad por trauma, ya sea penetrante o cerrado; en este trabajo específicamente nos centramos en las personas que consultan al servicio de Emergencias con trauma cerrado de abdomen los cuales son considerados de bajo riesgo, siendo este subgrupo de pacientes uno de los más difíciles de abordar y enfocar al momento de la valoración inicial, ya que se debe tener la seguridad de que no hay lesiones que comprometen la vida y por consiguiente estos pacientes puedan ser dados de alta.