The effect of anastrozole therapy on final height and sex hormone levels in pubertal boys receiving growth hormone therapy

ABSTRACT Objective: This research aimed to evaluate retrospectively the effect of anastrozole on height gain and sex hormone levels in pubertal boys receiving growth hormone (GH). Materials and methods: Pubertal boys who received both GH and anastrozole (GH+A) were one-to-one matched with boys who received only GH (GH-Only) for chronological and bone age, pubertal stage and height before the GH initiation, treatment duration and midparental height. Anthropometric measurements throughout treatment and adult heights were compared between the groups. Sex hormone levels were evaluated longitudinally in the GH+A group. Results: Forty-eight cases (24 in each group) were included. There was no statistical difference in adult height between the GH+A and GH-Only (p = 0.071). However, when the analysis was limited to those receiving anastrozole for at least 2 years, mean adult height was higher in the GH+A than in the GH-Only group (173.1 ± 6.2/169.8 ± 5.6 cm, p = 0.044). Despite similar growth rates between the two groups, bone age advancement was slower in the GH+A than in the GH-Only in a mean anastrozole treatment period of 1.59 years (1.37 ± 0.80/1.81 ± 0.98 years, p = 0.001). The greatest increase for FSH, LH, total and free testosterone and decrease for estradiol levels were observed in the third month after anastrozole was started, albeit remaining within the normal ranges according to the actual pubertal stages. Conclusions: Using anastrozole with GH for at least 2 years decelerates the bone age advancement resulting in adult height gain with no abnormality in sex hormone levels. These results suggest anastrozole can be used as an additional treatment to GH for further height gain in pubertal boys.

Investigación narrativa con niños y niñas: una reflexión teórico-metodológica

(analítico) Se presenta una reflexión teórico-metodológica derivada de una investigación sobre experiencias de participación y subjetividades en niños y niñas, ubicados en contextos institucionales y comunitarios de tres países de la región. En oposición a los enfoques que asumen a estas personas como sujetos receptores per se, la metodología de este estudio adoptó la investigación narrativa, dada su potencialidad para que los participantes logren narrarse, conocerse y transformarse. De esta manera, en la primera parte, se propone un acercamiento ontológico, epistémico y metodológico a la investigación narrativa con niños y niñas. Luego, basados en el trabajo de campo del estudio, se abordan técnicas de investigación que favorecen la interacción horizontal para la generación de conocimiento con estas personas, desde lo dialógico y lo estético. Al final, se presentan las conclusiones.

(analytical) The article presents a theoretical-methodological reflection derived from research on experiences of participation and subjectivities in boys and girls, located in institutional and community contexts in three countries of the region. In opposition to the approaches that assume these people as receiving subjects per se, methodology of this study adopted narrative research, given its potential for the participants to narrate themselves, to know themselves and to transform themselves. Thus, in the first part, an ontological, epistemic and methodological approach to narrative research with children is proposed. Then, based on the field work of the study, research techniques that favor horizontal interaction for the generation of knowledge with these people are addressed, through the dialogic and the aesthetic. Finally, the conclusions are presented.

(analítico) O artigo apresenta uma reflexão teórico-metodológica derivada de pesquisas sobre experiências de participação e subjetividades em meninos e meninas, localizadas em contextos institucionais e comunitários em três países da região. Em oposição às abordagens que assumem essas pessoas como sujeitos receptores per se, a metodologia deste estudo adotou a pesquisa narrativa, dada a sua potencialidade de os participantes narrarem, conhecerem e se transformarem. Assim, na primeira parte, propõe-se uma abordagem ontológica, epistêmica e metodológica da pesquisa narrativa com crianças. Em seguida, com base no trabalho de campo do estudo, são abordadas técnicas de pesquisa que favorecem a interação horizontal para a geração de conhecimento com essas pessoas, a partir da dialógica e da estética. Ao final, são apresentadas as conclusões.

Analysis on related influencing factors and psychological behavior of boys with overactive bladder / 中华实用儿科临床杂志

Objective:To investigate the prevalence of overactive bladder (OAB) in Chinese boys and risk factors, and to evaluate the psychological and behavioral status of OAB patients.Methods:Cross-sectional study.From October 2020 to July 2021, 2 800 boys aged 6-15 years from 6 primary and secondary schools in a county of Henan Province were selected by stratified random cluster sampling method.An anonymous questionnaire was used to investigate the epidemiological situation of OAB, including the basic information, lower urinary tract symptoms, Overactive Bladder Score Scale (OABSS) scores, pediatric sleep questionnaire (PSQ) and strengths and difficulties questionnaire (SDQ). In addition, the correlation between OAB and residence, body mass index (BMI), nocturnal enuresis (NE), overuse of diapers, history of urinary tract infection, abnormal stool, phimosis, redundant prepuce, and concealed penis by Chi- square test, Logistic multivariate regression analysis, and t-test. Results:A total of 2 333 valid questionnaires were collected.The overall prevalence of OAB in boys was 6.0%(141/2 333 cases). NE, history of urinary tract infection, abnormal stool, overuse of diapers, phimosis, redundant prepuce, concealed penis were risk factors for OAB in boys ( OR>1, P<0.05), while BMI was not a risk factor for OAB in boys ( OR<1, P>0.05). The emotional symptoms[ (7.64±2.03) scores vs.(6.51±2.53) scores], conduct problems [(8.14±1.62) scores vs.(7.31±1.88) scores], hyperactivity[(5.64±2.27) scores vs.(4.98±2.03) scores], peer communication problems [(7.16±1.63) scores vs.(6.59±1.60) scores], difficulty scores[(30.26±6.48) scores vs.(27.69±6.44) scores] and PSQ scores [(5.36±3.00) scores vs.(3.94±2.53) scores] in OAB group were significantly higher than those of non-OAB group ( t=-5.117, -5.005, -3.310, -4.056, -4.553, -5.006, respectively, all P<0.05). Conclusions:OAB in boys is common and affects mental health and sleep quality.Meanwhile, NE, history of urinary tract infection, abnormal stool, overuse of diapers, phimosis, redundant prepuce, or concealed penis are the risk factors for OAB in boys.

Reconstrucción del ligamento patelofemoral medial con tendón del aductor mayor en pacientes pediátricos con inestabilidad de rótula / Reconstruction of the Medial PatellofemoralLigament with Adductor Magnus Tendon in Pediatric Patients with Patella Instability

Introducción: El ligamento patelofemoral medial se considera el principal estabilizador medial de la rótula. La reconstrucción está indicada en pacientes con luxación recidivante, cuando el tratamiento conservador ha fallado. Objetivo: Describir y evaluar una técnica de reconstrucción del ligamento patelofemoral medial con el tendón del aductor mayor en pacientes con esqueleto inmaduro. Métodos: Estudio anatómico y descriptivo de pacientes en los que se empleó el tendón del aductor mayor para reconstruir el ligamento patelofemoral medial. Después de la cirugía se evaluó reluxación, inestabilidad y satisfacción, con escala de Kujala. Resultados: Se disecaron 5 piezas de cadáveres frescos. El tendón del aductor mayor fue de 8 a 9 cm de longitud. Se realizaron ocho cirugías en siete pacientes entre 8-17 años, uno de ellos con síndrome de Down. El seguimiento mínimo fue 12 meses. No hubo reluxación, el paciente con síndrome de Down presentó subluxación rotuliana. La flexión y extensión de rodillas fue completa. Conclusiones: En pacientes con esqueleto inmaduro con placa de crecimiento del fémur distal presente y cercana al punto isométrico del ligamento, acarrea dificultades para la reconstrucción del ligamento patelofemoral medial. La técnica descrita por Avikainen permite reconstrucción no anatómica del ligamento sin realizar túneles femorales que pongan en riesgo la físis. Este trabajo describe la técnica con aductor mayor. De las ocho rodillas operadas, en solo una se presentó subluxación, en las otras se obtuvo buen resultado, sin luxación, y los pacientes quedaron satisfechos con el resultado(AU)

Introduction: The medial patellofemoral ligament is considered the main medial stabilizer of the patella. Reconstruction is indicated in patients with recurrent dislocation, when conservative treatment has failed. Objective: To describe and evaluate a reconstruction technique of the medial patellofemoral ligament with the adductor magnus tendon in patients with an immature skeleton. Methods: Anatomical and descriptive study of patients in which the adductor magnus tendon was used to reconstruct the medial patellofemoral ligament. After surgery, reluxation, instability and satisfaction were evaluated with Kujala scale. Results: Five pieces of fresh corpses were dissected. The adductor magnus tendon was 8 to 9 cm long. Eight surgeries were performed in seven patients between 8-17 years old, one of them with Down syndrome. The minimum followup period was 12 months. There was no relaxation. The patient with Down syndrome had patellar subluxation. The flexion and extension of the knees was complete. Conclusions: The reconstruction of the medial patellofemoral ligament causes difficulties in patients with immature skeleton, plate growth of the distal femur close to the isometric point of the ligament. The technique described by Avikainen allows non-anatomical reconstruction of the ligament without performing femoral tunnels that put the physis at risk. This paper describes the adductor magnus technique. Only one knee, out of the eight operated, had subluxation. The rest had good result, with no dislocation, and the patients were satisfied with the result(AU)

Trastornos del sueño en un escolar posterior al aislamiento social por la COVID-19 / Sleeping disorders in a school boy after social isolation due to the COVID-19

Se describe caso clínico de un escolar de 6 años y 3 meses de edad, quien a partir del aislamiento social por la COVID-19 presentó pesadillas asociadas a irritabilidad, desinterés por las clases y necesidad de la presencia de los padres a la hora de dormir. Se efectuó evaluación y se descartaron clínicamente enfermedades orgánicas, así como trastornos mentales. Se realizaron recomendaciones psicológicas y se indicó la terapia floral de Bach. El paciente tuvo una evolución favorable.

The case report of a 6 year and three months school boy is described; he had nightmares associated with irritability, lack of interest for the classes and necessity of his parents presence at bed time, due to social isolation for the COVID 19. An evaluation was carried out and organic diseases were clinically ruled out, as well as mental disorders. Psychological recommendations were carried out and Bach's floral therapy was indicated. The patient had a favorable clinical course.

Estandarización del análisis multi-locus de número variable de repeticiones en tándem automatizado para tipificación de Staphylococcus aureus Resistentes a Meticilina causantes de infecciones invasivas en población pediátrica paraguaya / Standardization of automated multi-locus variable number tandem repeats analysis for Methicillin-resistant Staphylococcus aureus typing isolated from invasive infections in paraguayan pediatric population

Introducción: Staphylococcus aureus es considerado uno de los patógenos humanos más importantes a nivel mundial y sus niveles de resistencia a meticilina han aumentado incluso en cepas aisladas de personas sin factores de riesgo nosocomial, por lo que la tipificación genética de los clones circulantes es fundamental para comprender los patrones de diseminación. Objetivo: Obtener la tipificación de SARM que causaron infecciones invasivas a niños mediante el empleo de la técnica de análisis multi-locus de número variable de repeticiones en tándem (MLVA) automatizada. Materiales y Métodos: Estudio observacional, descriptivo de corte transverso. Resultados: Se analizaron 25 cepas SARM que representan más de 700 aislamientos de S. aureus colectados en los años 2010, 2012 y 2013 de 4 hospitales de referencia nacional. La automatización de la técnica MLVA incluyó la tipificación del 88% (22/25) de los aislamientos en estudio, resultando 3 perfiles diferentes, cada uno asociado a un "spa tipo" distinto, siendo el perfil 1-t019 el predominante (86%), seguido por el perfil 3-t002 (9%), arrojando 100% de concordancia con el método MLVA manual, así como una alta concordancia con el método estándar de oro, PFGE. Conclusiones: La inclusión de un método de análisis de fragmentos automatizado permitió llevar a cabo la caracterización de aislamientos mejorando el tiempo de respuesta y manteniendo una alta sensibilidad en comparación con el método manual.

Introduction: Staphylococcus aureusis considered one of the most critical human pathogens worldwide, and its levels of methicillin resistance have increased even in strains isolated from people without nosocomial risk factors. Therefore the genetic typing of circulating clones is essential to understand dissemination patterns. Objective: Obtain the MRSA typing that caused invasive infections in children by using the automated multi-locus variable number of tandem repeats (MLVA) analysis technique. Materials and methods: Observational, descriptive, cross-sectional. Results: 25 strains MRSA representing more than 700S. aureusisolates collected in 2010, 2012, and 2013 from 4 national reference hospitals were analyzed. The MLVA automation included the typing of 88% (22/25) isolates, resulting in 3 different profiles, each one associated with a different spa type, being the 1-t019 the predominant (86%), followed by the 3-t002 profile (9%), yielding 100% concordance with the MLVA manual, as well as high concordance with the standard gold method, PFGE. Conclusions: The inclusion of an automated fragment analysis method led to the characterization of isolates, improving response time, and maintaining high sensitivity compared to the manual process.

Pleomorphic Adenoma of the Upper Lip: A Rare Presentation in a Young Boy and Differential Diagnosis

@#A healthy 4-year-old boy presented with a painless lump on his upper lip for three years duration with no significant changes in size. Clinical examination revealed the presence of firm and mobile lump on the labial mucosa measuring approximately 15 mm × 10 mm, slightly pale yellowish compared to the surrounding tissues. The covering mucosa was intact and was non-tender upon palpation. Excisional biopsy was performed under general anaesthesia and the histopathological results revealed the presence of a partially encapsulated pleomorphic adenoma with variable epithelial and stromal components.

Fotoprotección y fotodaño en la niñez y la adolescencia / Photoprotection and photodamage in the childhood and adolescence

Durante las últimas décadas se ha incrementado la incidencia del cáncer de piel, debido fundamentalmente a la exposición a las radiaciones solares, por lo cual es importante la protección desde las edades tempranas. Teniendo en cuenta lo anterior, se realizó una revisión bibliográfica con el objetivo de describir los efectos que estas ocasionan en los seres humanos y las formas de protección adecuadas. Se concluyó que el conocimiento y la implementación de las recomendaciones para la fotoprotección, son necesarias para prevenir los efectos causados por dichas radiaciones.

During the last decades the incidence of the skin cancer has been increased, due fundamentally to the exposure to the sun radiations, reason why it is important the protection since early ages. Keeping this in mind, a literature review was carried out with the objective of describing the effects that they cause in the human beings and the appropriate protection forms. It was concluded that the knowledge and the implementation of the recommendations for photoprotection, are necessary to prevent the effects caused by these radiations.

Conocimientos sobre violencia familiar en padres o cuidadores de escolares de un colegio de educación básica / Knowledge about family violence in student's parents or caregivers of a basic education school

Objetivo: Determinar los conocimientos sobre violencia familiar en padres o cuidadores de niños en etapa escolar en una institución educativa nacional del distrito de Ate Vitarte (Lima, Perú). Métodos: Enfoque cuantitativo, tipo descriptivo de corte transversal. Se trabajó con una muestra de 73 padres o cuidadores de escolares de un colegio estatal de Lima. La técnica utilizada fue la encuesta y como instrumento se utilizó un cuestionario que constó de dos partes: la primera sobre datos sociodemográficos de los sujetos de estudio y una segunda parte donde se indaga sobre los conocimientos de violencia familiar en veinte preguntas relativas a violencia física, psicológica, sexual y por negligencia. Resultados: El 62 % de los encuestados obtuvo un nivel de conocimiento bajo en violencia física por negligencia; el 52 %, en violencia sexual, y el 34 %, en violencia psicológica. Por otro lado, se consideró el puntaje global sobre conocimiento de violencia de los cuales el 45 % obtuvo un nivel bajo. Conclusión: Los padres o cuidadores tienen un conocimiento deficiente de los conceptos de violencia y sus tipos.

Objective: To determine the knowledge about family violence parents or caregivers of children in school stage have in a state educational institution in Ate Vitarte (Lima, Peru). Methods: Quantitative Approach, descriptive cross- sectional type. The sample was comprised of 73 parents or caregivers of schoolchildren in a state school in Lima. The technique used was surveying and the instrument was a questionnaire which consisted of two parts: the first on socio-demographic data from the Study subjects and a second section was related to the knowledge of family violence in twenty questions on physical, psychological, sexual violence and negligence. Results: 62% of the respondents got a low score related to knowledge about physical violence by negligence; 52% in sexual violence, and 34% in psychological violence. On the other hand, the other score that was taken into account was the overall score on knowledge of violence from which 45% obtained a low level. Conclusion: Parents or caregivers have poor knowledge of the concepts of violence and their types.

Pigmentações extrínsecas negras do esmalte em Odontopediatria / Pigmentos negros extrínsecos del esmalte en Odontopediatría / Extrinsic dark-pigmentation of the tooth enamel in pediatric dentistry

As pigmentações negras do esmalte se devem à coloração extrínseca e estão associadas com problemas estéticos. O objetivo é apresentar dois casos clínicos de crianças com pigmentações extrínsecas negras do esmalte dentário, com ênfase no tipo de tratamento e no acompanhamento. Trata-se de um paciente de 5 anos de idade que utilizava constantemente sulfato ferroso para tratamento de anemia por deficiência de ferro; e outro paciente de 12 anos de idade com diabetes mellitus tipo 1 e dermatomiosite. No primeiro caso observou-se a presença de pigmentações negras extrínsecas nos dentes decíduos e nos primeiros molares permanentes, principalmente nas superfícies lingual e vestibular na região cervical e terço médio, além de lesões de cárie incipientes nas superfícies oclusais dos molares e manchas brancas ativas nos primeiros molares permanentes. No segundo caso, havia pigmentações negras extrínsecas na região cervical das superfícies lisas dos dentes decíduos e permanentes. No primeiro caso, foi realizado tratamento para remoção das pigmentações negras e polimento dos dentes por meio de profilaxia profissional com creme dental abrasivo que contém pedra pomes microgranulada. Houve uma melhora no aspecto clínico a partir da segunda sessão e finalizado na quinta sessão. Para o caso 2, observou-se dificuldade na remoção de manchas pigmentadas na região cervical e risco de sangramento gengival. Uma vez que a criança necessitava de antibiótico profilático, optamos pelo controle diário de biofilme e não remoção pela profilaxia profissional, uma vez que o paciente não se queixava do impacto estético. Conclui-se que as pigmentações negras extrínsecas podem ser observadas facilmente em crianças, e ainda que haja um comprometimento estético, não traz danos à manutenção da saúde bucal. Cabe ressaltar que não está claro como sua presença na superfície dentária reduz a suscetibilidade à cárie. Além disso, a escolha do tratamento sempre deverá ser baseada no risco-benefício para o paciente(AU)

Dark enamel pigments are due to extrinsic staining and associated with aesthetic problems. The objective is to present two cases of children with black extrinsic pigmentation in the tooth enamel, with emphasis on the type of treatment and monitoring. This is a 5-year-old patient of who constantly used ferrous sulfate to treat anemia by iron deficiency, and another 12-year-old patient with type 1 diabetes and dermatomyositis. In the first case, we observed the presence of black extrinsic pigments in the primary teeth and the first permanent molars, especially in the lingual and vestibular part in the cervical region and middle third, together with incipient caries lesions on the occlusal surfaces of molars and active white spots on the first permanent molars. In the second case, there were strange black pigmentation in the cervical region of the smooth surfaces of the primary and permanent teeth. In the first case, the treatment performed was to remove black pigments and polishing the teeth by means of professional prophylaxis and using an abrasive toothpaste containing micro-granules of pumice. There was an improvement in the clinical aspect from the second session and the treatment ended at the fifth session. For the second case, we observed difficulty to remove the pigmented spots in the cervical region, together with the risk of bleeding gums. When the child needed prophylactic antibiotics, we opted for the daily control of the biofilm and it was not removed by professional cleaning, because the patient did not complain about the aesthetic impact. As conclusions, the extrinsic black pigments can be easily observed in children, and despite its aesthetic effect, it does damage oral health. It should be noted that it is unclear how their presence on the tooth surface reduces susceptibility to caries or tooth decay. In addition, the choice of treatment should always be based on the relation risk-benefit for the patient(AU)

Los pigmentos de esmalte negro se deben a la tinción extrínseca y están asociados con problemas estéticos. El objetivo es presentar dos casos clínicos de niños con pigmentaciones extrínsecas negras del esmalte dental, con énfasis en el tipo de tratamiento y el seguimiento. Se trata de un paciente de 5 años de edad, que utilizaba constantemente sulfato ferroso para el tratamiento de la anemia por deficiencia de hierro, y otro paciente de 12 años de edad con diabetes mellitus tipo 1 y dermatomiositis. En el primer caso se observó la presencia de pigmentos extrínsecos negros en los dientes primarios y los primeros molares permanentes, principalmente en la parte lingual y vestibular en la región cervical y tercio medio; además de lesiones de caries incipientes en las superficies oclusales de los molares y manchas blancas activas en los primeros molares permanentes. En el segundo caso, había pigmentaciones negras extrañas en la región cervical de las superficies lisas de los dientes primarios y permanentes. En el caso 1, se realizó el tratamiento para eliminar los pigmentos negros y el pulido de los dientes por medio de una profilaxis profesional con crema dental abrasiva que contiene microgránulos de piedra pómez. Hubo una mejora en el aspecto clínico a partir de la segunda sesión y se finalizó en la quinta sesión. Para el caso 2, se observó dificultad en la eliminación de manchas pigmentadas en la región cervical y el riesgo de sangrado de las encías. Una vez que el niño necesitaba antibióticos profilácticos, optamos por el control diario de la biopelícula y no se eliminó por la limpieza profesional, ya que el paciente no se quejaba del impacto estético. Se concluye que los pigmentos negros extrínsecos pueden observarse fácilmente en los niños, y aunque haya un efecto estético, no hace daños al mantenimiento de la salud bucal. Cabe señalar que no está claro cómo su presencia en la superficie del diente reduce susceptibilidad a la caries. Además, la elección del tratamiento siempre se debe basar en el beneficio-riesgo para el paciente(AU)

Hernia diafragmática congénita en un niño de 12 años. Reporte de caso / Congenital diaphragmatic hernia in a boy of 12 years-old. Case report

Fundamento: La hernia diafragmática congénita con debut tardío es una anomalía congénita rara, la cual se diagnostica ante una amplia gama y grados diversos de presentación sintomática, o como hallazgos radiológicos, lo que puede llevar a errores diagnósticos y fracasos terapéuticos. Objetivo: Mostrar un caso de presentación tardía de hernia diafragmática congénita dada la importancia de tenerla presente para los posibles diagnósticos a esa edad. Presentación de caso: Niño de 12 años de edad que llegó al cuerpo de guardia con disfagia y disnea progresiva de tres días de evolución. Se realizó rayos X donde se le diagnosticó la enfermedad, se operó y tuvo una evolución satisfactoria. Conclusiones: La identificación oportuna de la afección permitió el éxito del tratamiento y la recuperación.

Background: The Congenital diaphragmatic hernia with late premiere is a strange congenital anomaly, which is diagnosed before a wide range and diverse grades of symptomatic presentation, or as radiological discoveries, what can take to diagnostic errors and therapeutic failures. Objective: To show a case of late presentation of congenital diaphragmatic hernia given the importance of having it present for the possible diagnoses to that age. Case presentation: A 12 years-old boy that arrived to guard's body with dysphagia and progressive dyspnea of three days of evolution. He was carried out X rays where he was diagnosed the illness, he was operated and he had a satisfactory evolution. Conclusions: The opportune identification of the affection allowed the success of the treatment and the recovery.

Evaluación de riesgo genotóxico por exposición laboral al betún en lustracalzados. La Paz-Bolivia / Evaluation of genotoxic risk due to shoe polish exposurein shoeshine boys. La Paz-Bolivia

OBJETIVO: Evaluar el riesgo genotóxico en los lustracalzados expuestos laboralmente al betún y sus componentes. MATERIAL Y MÉTODOS: Estudio de casos-controles y autocontroles. Se estudiaron 53 lustracalzados y 24 controles. Se determinó el daño genotóxico mediante la técnica de micronúcleos y otras alteraciones metanucleadas en mucosa bucal. RESULTADOS: Las edades promedio del grupo de expuestos y controles fue de 35.0±8.8 y 27.8±1.5 respectivamente. El grupo de expuestos estuvo conformado varones (83%) y mujeres (17%), con un promedio de años de trabajo de 13.4±7.6, de los cuales la mayoría no usa medidas de protección laboral (73.6%). No se observó diferencias significativas en la frecuencia de alteraciones metanucleadas entre el grupo de expuesto y controles: binucleadas (BN) (p=0.273), broken egg (BE) (p=0.635), carriorexis (CR) (p=0.677), cariolisis (CL) (p=0.770), índice de reparación celular (p=0.201). El análisis de asociación entre exposición y genotoxicidad demostró que el uso del betún no es un factor de riesgo. La evaluación pre y post exposición al betún del grupo de lustracalzados no obtuvo diferencias significativas luego del periodo ventana para BN (p=0.804), BE (p=1.274), CR (p=0.503), CL (p= 1.000) e IR (p=0.424). CONCLUSIÓN: El uso del betún en la población estudiada, no es un factor de riesgo genotóxico. Sin embargo, es necesario continuar estudios de cohorte con una población más numerosa.

OBJECTIVE: To asses the genotoxic risk in shoeshine boys who are constantly exposed to shoe polish and its components. MATERIAL AND METHODS: The study was cross-sectional (exposed and controls) and of cross over trials. It was studied 53 shoe shiners (exposed group) and 24 controls. The buccal cytome technique was applied on children for determining genotoxic damage. RESULTS: The average age of the exposed group and controls was 35.0 ± 8.8 and 27.8 ± 1.5 respectively. The exposed group consisted males (83%) and women (17%), with an average of 13.4 years of work ± 7.6, most of which do not use labor protection measures (73.6%). No significant differences were observed in frequency of metanucleadas alterations from the group of exposed and controls: binucleate (BN) (p = 0.273), broken egg (BE) (p = 0.635), karyorrhexis (KR) (p = 0.677), karyolysis (KL) (p = 0.770), cellular repair rate (RR) (p = 0.201). The analysis of association between exposure and genotoxicity showed that the use of shoe polish and its components is not a risk factor. The assessment pre and post-exposure to shoe polish in the exposed group showed no significant differences after the window period for BN (p = 0.804), BE (p = 1.274), CR (p = 0.503), CL (p = 1.000) and RR (p = 0.424). CONCLUSION: The use of shoe polish by shoeshine boy population is not a genotoxic risk factor. However it is necessary to continue cohort studies with a larger population.

Interferencias oclusales en niños con dentición temporal y mixta temprana / Occlusal interferences in children with temporary and early mixed dentition

Se realizó una investigación descriptiva y de prevalencia en 80 niños de 5-6 años de edad, que asistieron al Círculo Infantil "Ana de Quesada" de Santiago de Cuba desde octubre de 2010 hasta septiembre de 2011, para precisar la influencia de algunos factores de riesgo en la aparición de interferencias dentarias en escolares con dentición temporal y mixta temprana. La prevalencia de interferencias dentarias fue elevada en la serie objeto de estudio, en cuyos integrantes se determinaron como factores predisponentes para la aparición de alteraciones morfológicas y funcionales de la oclusión: lactancia y dieta no adecuada, hábitos deformantes como ingerir la leche en biberón, hábito postural sobre la cara y disfunción lingual. De todo ello se infiere que la detección precoz de las interferencias oclusales permite interceptar las maloclusiones dentarias, así como prevenir anomalías dentomaxilofaciales y trastornos de la articulación temporomandibular.

A descriptive and prevalence investigation was carried out in 80 children between 5-6 years who attended "Ana de Quesada" day care center in Santiago de Cuba from October, 2010 to September, 2011, to specify the influence of some risk factors in the emergence of tooth interferences in school children with early temporary and mixed dentition. The prevalence of tooth interferences was high in the studied series, in whom predisposing factors for the emergence of morphological and functional changes of the occlusion: nursing and non appropriate diet, deforming habits such as to ingest milk in baby bottle, postural habit on the face and lingual dysfunction were determined. It is inferred from this that the early detection of the occlusal interferences allows to intercept the teeth malocclusions, as well as to prevent dentomaxillofacial anomalies and dysfunctions of the temporomandibular articulation.

Status survey of sexual development of boys aged 6 to 13 years old from Zhengzhou area / 医学研究生学报

Objective Boy sexual development is affected not only by age, but also by environment factors .The present study was to survey and evaluate the status of sexual development in boys from Zhengzhou area and to explore their influencing factors. Methods The height, weight, waist circumference, hip circumference, penis and testicles in 3779 boys aged from 6 to 13 years old in Zhengzhou were measured .The penis length and testicular volume of different ages and their influencing factors were compared, and the beginning age and sexual development characteristics were explored .The development of genitalia and pubes were evaluated by Tanner staging criteria and standards, which were divided into five stages. Results There were 3779 boys, including 395 overweight cases (10.45%) and 208 obesity cases (5.50%).The testicular volume and penis length increased by age, which increased slowly at the age of 6 to 11, followed by a rapid increase after the age of 11 year old.Testicular volume increased more rapidly than that of penis length. The medians quartile of testicular volume in overweight group ,obese group and normal group were 2.50 mL, 2.50 mL, 2.00 mL, 2.00 mL,2.00 mL,1.00 mL respectively .The testicular volume in overweight group and obese group were significantly greater than that in nor -mal group (P<0.01) and there were no difference between overweight group and obese group .The penis length in overweight group and obese group were significantly less than that in normal group (P<0.01), and there was no difference between overweight group and obese group.Testicular volume and penis length were positively correlated with age, height, weight, body mass index, waist circumference and hip circumference; the correlation between testicular volume and height, penis length and age were the strongest. The age of development of testicle (average 12.02 years) in urban area was later by 2.73 years than that in the rural area (average 9.9 years), the difference was statistically significant (P<0.001).The age of pubic development (P2) and maturity (P5) was (12.34 ±0.83) years and (12.39 ±1.24 ) years.The incidence of precocity in boys was 0.40%. Conclusion The sexual development of boys from Zheng-zhou area is similar to the results of large scale survey from China .Attention should be paid to the effect of obesity on sexual develop-ment, and early intervention should be given, the occurrence of adverse events of sexual development can be avoided .

Quiste tímico cervical en un niño / Cervical thymic cyst in a child

Se presenta el caso clínico de un paciente de 7 años de edad con antecedentes de buena salud, quien fue ingresado a los 5 años en el Hospital Infantil Sur de Santiago de Cuba por presentar aumento de volumen en la región lateral izquierda del cuello, doloroso, sobre todo al ingerir alimentos, y fiebre de 38 °C. Luego del tratamiento indicado egresó a los 10 días, pero con seguimiento por consulta externa. Al cabo de los 2 años y medio acudió a la consulta de Cirugía con aumento de volumen en la región lateral derecha del cuello. Se realizó la exéresis del tumor y los resultados del estudio anatomopatológico confirmaron que se trataba de un quiste tímico cervical.

The case report of a 7 years patient is presented with a history of good health who was admitted when he was 5 years in the Southern Pediatric Hospital from Santiago de Cuba for presenting increase of volume mainly in the left lateral region of the painful neck, when ingesting foods, and fever 38 °C. After the prescribed treatment he was discharged 10 days later, but with follow up through out-patient department. After 2 and a half years he came to the Surgery Department with an increase of volume in the right lateral region of the neck. The exeresis of the tumor was carried out and the results of the pathological study confirmed that it was a thymic cervical cyst.

Mortalidad por neumonía en menores de 5 años / Mortality due to pneumonia in children under 5 years

Se llevó a cabo un estudio observacional, descriptivo y transversal de 18 niños menores de 5 años de edad, fallecidos por neumonía adquirida en la comunidad (como causa básica de muerte) en el Hospital Docente Pediátrico Sur durante el período de enero de 1997 a diciembre de 2011, con vistas a caracterizarles y determinar las tasas de mortalidad por dicha causa. Las variables clínicas, epidemiológicas y paraclínicas se obtuvieron de los registros de defunciones y morbilidad del Departamento de Estadística de la institución, así como de las historias clínicas de los pacientes. En la investigación se observó que el mayor número de fallecidos correspondiera al sexo masculino (67,7 %) y al grupo etario de 1-4 años (58,8 %); además primaron el cuadro clínico muy grave al momento del ingreso (44,4 %), la anemia (82,3 %), los ingresos previos (100,0 %), el hacinamiento (77,7 %), el asma bronquial como enfermedad crónica (61,1%), la linfocitosis (61,1 %), el recuento de leucocitos normal (50,0 %) y las imágenes de condensación inflamatoria bilateral en las radiografías (61,1 %). Las tasas de mortalidad específica y mortalidad proporcional por neumonía mostraron tendencias evolutivas descendentes, en tanto la de mortalidad bruta reveló menor cuantía.

An observational, descriptive and cross sectional study of 18 children under 5 years of age, who died due to community acquired pneumonia (as the basic cause of death) was carried out in the Teaching Pediatric Southern Hospital during the period of January, 1997 to December, 2011, with the objective of characterizing them and to determine the mortality rates for this cause. The clinical, epidemiological and paraclinical variables were obtained from the death and morbidity records of the Statistic Department in the institution, as well as from the medical records of the patients. In the investigation it was observed that the highest number of deads corresponded to the male sex (67.7%) and to the age group 1-4 years (58.8%); very severe clinical pattern at admission (44.4%), anemia (82.3%), previous admissions (100,0%), stacking (77.7%), bronchial asthma as chronic disease (61.1%), lymphocytosis (61.1%), the normal leukocytes count (50.0%) and the images of bilateral inflammatory condensation in the x-rays (61.1%) also prevailed. The specific and proportional death rates for pneumonia showed descending evolutionary tendencies, as long as that of gross mortality revealed lower values.

La infancia contemporánea / Contemporary childhood

Exponemos el resultado analítico de una consulta de un “corpus” documental representativo en la investigación social sobre el estado actual de los estudios sobre la infancia. Los criterios para elaborar el análisis y exposición de los resultados son: la variedad de concepciones sociales; el origen histórico y la perspectiva sociológica; la experiencia social de la infancia; las imágenes o representaciones que la sociedad tiene de ella; los desarrollos conflictivos de los derechos de la infancia en términos de educación y castigo jurídico; y el porvenir de la infancia moderna como sujeto de medios de comunicación. Historiadores e historiadoras, antropólogos y antropólogas, pedagogos y pedagogas, juristas y sociólogos y sociólogas, analizan los diversos sistemas de representación de la infancia constituidos en el tiempo y en el espacio.

We present the analytical results of the consultation of a representative documentary "corpus" from the social research about the current status of the studies on childhood. The criteria to undertake the analysis and presentation of the results are: variety of social conceptions; historical origin and sociological perspective; the social experience of childhood; images or representations that society has thereof; the conflicting developments of children's rights in terms of education and legal punishment; and the future of modern childhood as subject of the media. Historians, anthropologists, teachers, jurists and sociologists analyze the different systems of childhood representations constituted in time and space.

Las adopciones de un niño / The adoption of a child

El trabajo tiene como fin articular un caso clínico de un niño de 9 años, con algunos conceptos y nociones psicoanalíticas fundamentalmente, a partir de los aportes del psicoanalista inglés Donald W. Winnicott. Las singularidades del caso clínico están marcadas por haberse constituido en un espacio institucional dispuesto a los fines de una posible adopción legal del niño, quien en el tiempo de los encuentros estaba atravesando una situación que llamaremos “devolución”. El abordaje clínico del espacio con el niño se realizó en el marco de un proyecto perteneciente a la Universidad de Buenos Aires. Dicho proyecto se dedicaba a la temática de Adopciones articulando dicha especificidad con institución pública del Estado Nacional. Ello le ha aportado a la dirección del espacio terapéutico una impronta diferente a la clínica de consultorio y por lo tanto ha requerido del abordaje del psicoanalista una apuesta a poder repensar conceptos y estrategias clínicas, incluso bordear ciertos saberes, establecer nuevas fronteras, en función de los requerimientos y demandas que fundaron el encuentro. Por último, el caso se dispone a pensar conceptualmente las posibilidades de un niño de adoptar su deseo y a partir de dicha apropiación reescribir su historia, refundar sus lazos sociales y fundamentalmente restablecer su porvenir en torno a la responsabilidad de nuevos referentes parentales.

The aim of this work is to articulate a clinical case of a 9 year old boy,with some psychoanalytic concepts and notions from the contributions ofan English psychoanalyst Donald W. Winnicott. The singularities of the caseare determined by having become an institutional space provided for thepurpose of a possible legal adoption of the child who, at the time of thesessions, was going through a state, known as “feedback”.The clinical approach to the child was performed in the framework of aproject that belongs to the University of Buenos Aires. This project wasdevoted to the subject of adoptions articulating this theme with a publicinstitution belonging to the National Government. This has brought to thedirection of the therapy device a distinctive mark on the clinical approach.Therefore, the psychoanalyst’s approach has been required to reconsiderclinical concepts and strategies, and also to reach around certainknowledge to establish new boundaries, according to the requirements anddemands that the meeting founded. Finally, the case invites to think aboutthe possibilities of a child to own his desire and to rewrite his story, refoundhis social bonds and restore his future around the responsibility of the newparents relatives.

Palavra, ritmo e jogo: fios que dançam no processo de simbolização / Palabra, ritmo y juego: hilos que danzan en el proceso de simbolización / Word, rhythm and game: dancing wires in the process of symbolization

No presente artigo, o autor desenvolve o tema do processo de simbolização no processo de subjetivação da criança, tomando como ponto de referência e análise o papel do polo da presença do outro em sua função simbolizante. Isso implica em conceituar a simbolização a partir de uma perspectiva intersubjetiva. Para isso, também é tentado um diálogo com as contribuições da arte a partir de escritores como J. L. Borges e S. Hustvedt e seu conceito de ritmo e entreidade. Toma-se como um dos pontos fundamentais desenvolver o tema do ritmo a partir de diferentes perspectivas e afirma-se a hipótese do papel da lei materna como princípio organizador do vínculo, em consonância com o papel da lei paterna. Faz-se uma análise mais detalhada do jogo do fort-da e do papel da atenção do terceiro no jogo elaborativo. Também é analisado o caso do menino dos cordões, de Winnicott, para abrir um espaço de reflexão sobre o papel estruturante do jogo e do terceiro na constituição psíquica

In this paper, the author develops the theme of the symbolization process regarding the child subjectivity process, using as a point of reference and analysis, the role of the other’s presence pole in his symbolizing function. This, implies on conceptualizing symbolization from an intersubjective perspective. To do so, it is proposed a dialogue with art contributions from writers such as J. L. Borges and S. Hustvedt and their concept of rhythm and betweenness. One of the key points is to develop the theme of rhythm from different perspectives and to assert a hypothesis of the role of maternal law as the organizing principle of the bond, in consonance with the role of paternal law. A detailed analysis of the fort-da game and of the attention role of the third in the elaborative game will be done. It is also analysed Winnicott’s case of a boy and his strings, in order to open a space for reflection on the role (structural or defective) of the game and of the third in the psychic constitution

En el presente artículo el autor desarrolla el tema del proceso de simbolización en el proceso de subjetivación del niño, tomando como punto de referencia y análisis, el papel del polo de la presencia del otro en su función simbolizante. Esto implica conceptualizar la simbolización desde una perspectiva intersubjetiva, para ello también se intenta un dialogo con los aportes del arte,a partir de escritores como J. L. Borges y S. Hustvedt y su concepto de ritmo y entreidad. Se toman como uno de los puntos fundamentales desarrollar el tema del ritmo desde diferentes perspectivas y se hace hincapié en la hipótesis del papel de la ley materna como principio organizador del vínculo, en consonancia con el papel de la ley paterna. Se realiza un análisis más detallado del juego del fort-da y del papel de la atención del tercero en el juego elaborativo. Y del caso del niño del cordel de Winnicott, para abrir un espacio de reflexión sobre el papel estructurante del juego y del tercero en la constitución psíquica

Uma investigação do ser-aí do menino selvagem à luz do pensamento heideggeriano / An investigation of the Dasein of the wild boy through Heidegger's thought / Una investigación del ser-ahí del niño salvaje a luz del pensamiento heideggeriano

Este trabalho busca, na história de Victor de Aveyron, elementos para discutir o modo pelo qual a existência humana se constitui. Por não ter convivido em ambiente humano, Victor foi motivo de intensas discussões no meio científico, especialmente entre os empiristas e os racionalistas. Nesta pesquisa assumimos uma postura fenomenológica, trazendo a história do menino selvagem à discussão por meio da fenomenologia hermenêutica de Heidegger, apontando, assim, para o caráter de indeterminação, o "ter de ser", e de singularidade da existência, sempre em jogo na constituição do modo de ser do homem.

This work aims to find, in the story of Victor of Aveyron, elements to discuss the way in which human existence is constituted. For not having lived in the human environment, Victor was the subject of intense discussions within the scientific community, especially among empiricists and rationalists. In this research we take a phenomenological approach, bringing the story of the wild boy into the discussion through the Heidegger's phenomenology hermeneutic, pointing to the character of indeterminacy, mineness; and the singularity of the existence, always presented in the constitution of man's way of being.

Este trabajo busca en la historia de Víctor de Aveyron elementos para discutir el modo por el cual la existencia humana se constituye. Por no haber convivido en ambiente humano, Víctor ha sido motivo de intensas discusiones en el medio científico, especialmente entre los empiristas y los racionalistas. En esta investigación asumimos una postura fenomenológica, trayendo la historia do menino salvaje a discusión por medio de la fenomenología hermenéutica de Heidegger, apuntando, así, para el carácter de indeterminación, o "tener de ser", e de singularidad de la existencia, siempre en juego en la constitución del modo de ser del hombre.