In Vitro Fertilisation and Intracytoplasmic Sperm Injection predictive factors: A review of the effect of female age, ovarian reserve, male age, and male factor on IVF/ICSI treatment outcomes.

The development of assisted reproductive technology has allowed offspring in infertile couples, and specifically, allowed infertile men to conceive through Intracytoplasmic Sperm Injection (ICSI). Despite the proven efficacy of In Vitro Fertilisation (IVF) and ICSI, many factors can influence its success. In this review we present an analysis on the effect of Female age, Ovarian Reserve, Male age and Male factor on the outcomes of IVF/ICSI, to determine if and which can be applied to the practical context. A literature search on PubMed, EMBASE and MEDLINE for relevant articles was elaborated until July 2021, leading to the selection of 234 articles based on their titles. After reading through the abstracts, those that evaluated IVF/ICSI predicting factors were selected. Finally, only those approaching female age, ovarian reserve, male age and male factor were considered in this review. Higher female age and baseline ovarian markers alterations such as lower anti-Müllerian hormone and antral follicular count, and higher basal follicle-stimulating hormone, were associated with poorer outcomes. The predictive value of Male age and Male factor presented varied results across literature. The multifactorial nature of male fertility makes evaluation difficult. Although the first assessment of male infertility is based on sperm concentration, motility and morphology, semen parameters have shown low prognostic value, whilst sperm DNA alterations gain importance. Nevertheless, results remain controversial. While some factors have proven to predict IVF/ICSI success, other need to be further studied to be applied to practical context to allow the best prognosis possible.

Enfermagem empreendedora: novos campos de atuação / Entrepreneurial nursing: new fields of action / Entrepreneurial nursing: new fields of action

Introdução: A enfermagem empreendedora é marcante pelo crescimento da profissão para com a tecnologia, ciência e inovação dentro dos vários campos de atuação que a saúde proporciona, alcançando assim, outros patamares para a evolução profissional dos enfermeiros. Objetivo: Identificar novos campos de atuação do enfermeiro empreendedor. Metodologia: Trata-se de um estudo descritivo, exploratório do tipo bola de neve com abordagem qualitativa por meio da aplicação de questionário do Google Forms on-line, realizado com enfermeiros empreendedores. Os dados foram analisados pela técnica de análise de conteúdo de Bardin. Resultados: Entre os entrevistados foi identificado que 88,2% eram do sexo feminino, com idade entre 24 e 49 anos, sendo a faixa etária de 26 anos predominante (23,5%), de diversos estados do Brasil, se destacando maior porcentagem no Maranhão (47,06%). As áreas de atuação que mais se destacaram entre os entrevistados foram: Pesquisa Científica: consultoria e assessoria, estomaterapia, enfermagem estética e a produção de conteúdo educativos e preparatórios pra concursos de enfermagem, sendo os principais desafios relatados como a falta de recursos financeiros para investir e a captação de clientes no início. Como características que o destaca e o diferencia dos outros profissionais, predominou-se boa comunicação, entender o que seu cliente necessita, ser persistente e ético. Os entrevistados também verbalizaram a importância de se empreender na enfermagem, visto que ela tem se destacado muito atualmente, gerando mais renda e satisfação profissional. Conclusão: as áreas de crescimento da enfermagem empreendedora são amplas e abrangem diferentes áreas de atuação, possibilitando mais oportunidades de emprego e sucesso na carreira.

Introduction: Entrepreneurial nursing is remarkable for the growth of the profession towards technology, science and innovation within the various fields of action that health provides, thus reaching other levels for the professional evolution of nurses. Objective: To identify new fields of action for entrepreneurial nurses. Methodology: This is a descriptive, exploratory snowball study with a qualitative approach through the ap- plication of an online Google Forms questionnaire, carried out with entrepreneurial nurses. Data were analyzed using Bardin's content analysis technique. Results: Among the interviewees, it was identified that 88.2% were female, aged between 24 and 49 years, with the predominant age group of 26 years (23.5%), from several states of Brazil, high- lighting the highest percentage in Maranhão (47.06%). The areas of activity that most stood out among the interviewees were: Scientific Research: consultancy and assistance, stomatherapy, aesthetic nursing and the production of educational and preparatory con- tent for nursing contests, with the main challenges reported as the lack of financial re- sources to invest and attracting customers early on. As characteristics that highlight and differentiate him from other professionals, good communication prevailed, understanding what his client needs, being persistent and ethical. The interviewees also verbalized the importance of undertaking nursing, as it has stood out a lot nowadays, generating more income and professional satisfaction. Conclusion: the growth areas of entrepreneurial nursing are wide and cover different areas of activity, providing more job opportunities and career success.

Introducción: La enfermería emprendedora se destaca por el crecimiento de la profesión hacia la tecnología, la ciencia y la innovación dentro de los diversos campos de acción que brinda la salud, alcanzando así otros niveles para la evolución profesional de las enfermeras. Objetivo: Identificar nuevos campos de acción para enfermeros em- prendedores. Metodología: Se trata de un estudio descriptivo, exploratorio tipo bola de nieve con abordaje cualitativo mediante la aplicación de un cuestionario en línea Google Forms, realizado con enfermeros emprendedores. Los datos se analizaron utilizando la técnica de análisis de contenido de Bardin. Resultados: Entre los entrevistados, se identi- ficó que el 88,2% eran del sexo femenino, con edad entre 24 y 49 años, con predominio de la franja etaria de 26 años (23,5%), de varios estados de Brasil, destacándose el mayor porcentaje en Maranhão (47,06% ). Las áreas de actividad que más se destacaron entre los entrevistados fueron: Investigación Científica: consultoría y asistencia, estomaterapia, enfermería estética y producción de contenidos educativos y preparatorios para concursos de enfermería, siendo los principales desafíos relatados la falta de recursos económicos para invertir y atraer clientes desde el principio. Como características que lo destacan y lo diferencian de otros profesionales, prevaleció la buena comunicación, entender lo que su cliente necesita, ser persistente y ético. Los entrevistados también verbalizaron la im- portancia de ejercer la enfermería, ya que se ha destacado mucho en la actualidad, gene- rando más ingresos y satisfacción profesional. Conclusión: las áreas de crecimiento de la enfermería emprendedora son amplias y abarcan diferentes áreas de actividad, proporci- onando más oportunidades de trabajo y éxito profesional.

Clinical outcomes of 77 TESE treatment cycles in non-mosaic Klinefelter syndrome patients.

OBJECTIVE: The current study aimed to present the clinical outcomes of 76 azoospermic patients with non-mosaic Klinefelter syndrome (KS), treated with testicular spermatozoa extraction (TESE) followed by intracytoplasmic sperm injection (ICSI) using either fresh or cryopreserved testicular spermatozoa. METHODS: We retrospectively evaluated 76 patients with non-mosaic KS belonging to a special group of cases that besides infertility did not present the classical signs and symptoms of testosterone deficiency. One of the patients repeated the TESE procedure (76 patients, 77 TESE cycles). Sixty of these 76 patients accepted to undergo TESE associated with ovarian stimulation, while 16 patients underwent TESE followed by testicular spermatozoa cryopreservation. Aneuploidy screening of the offspring was performed by Multiplex ligation-dependent probe amplification and by amniotic fluid karyotyping. Statistical analysis used the Chi-Squared Test, Fisher's Exact Test, 2-sided, for rates, and the Independent Samples T-test for equality of means, 2-sided. RESULTS: Testicular spermatozoa were recovered in 31 (40.3%) of the attempts. The patients underwent 47 ICSI cycles, 25 with fresh testicular spermatozoa and 22 with cryopreserved testicular spermatozoa. Fertilization (63.5% vs. 41.6%, p=0.000), implantation (37% vs. 13.2%, p=0.014), clinical pregnancy (60.9% vs. 19%, p=0.005) and live birth (65.2% vs. 23.8%, p=0.006) rates were higher with fresh testicular spermatozoa. Chromosome analysis of the 21 newborns was normal. CONCLUSIONS: The present data adds further information regarding the recovery rate of spermatozoa after TESE and the embryological and clinical outcomes with fresh and cryopreserved testicular spermatozoa, besides reassuring the safety concerning chromosomal transmission of KS from parents to their offspring.

A sketch-based system for modeling 3D objects: Applications to taxonomy.

We present a sketch-based system for modeling 3D objects with multiple contours as overlaid structures, allowing users to infer perceivable symmetries and occluded parts of the model prior to its automatic 3D reconstruction. Many approaches for sketch-based interfaces and modeling focus on the final drawing and 3D reconstruction of solid objects, exploring, as inputs, contours; however, when the subject consists of multiple drawings as overlaid structures, as usual in species descriptions, these approaches have to roughly infer or discard occluded parts. Unlike previous sketch-based techniques, we explore a set of 2D visual effects to enhance the visual perception of users while sketching multiple overlaid objects in single-view. The proposed system was applied to general simple zoological and botanical sketches as well as to published descriptions of species of Diptera, demonstrating its usefulness for taxonomy.

Twin pregnancies, crown-rump length and birthweight discordancy: the influence of chorionicity / Gestações gemelares, comprimento craniocaudal e discordância de peso ao nascimento: a influência da corionicidade

Abstract Objective The purpose of the present study was to analyze the influence of chorionicity in the biometric parameters crown-rump length (CRL), birthweight (BW), crown-rump length discordancy (CRLD) and birthweight discordancy (BWD), determine the correlation between these latter two in cases of intertwin discordancy, and to analyze the influence of chronicity in the presence of these discordancies with clinical relevance (> 10% and > 15%, respectively). Methods The present study was a retrospective study based on the twin pregnancy database of the Centro Hospitalar S. João (2010-2015), including 486 fetuses among 66 monochorionic (MC) and 177 dichorionic gestations (DC). The inclusion criteria were multiple pregnancies with 2 fetuses and healthy twin gestations. The exclusion criteria were trichorionic gestations and pregnancies with inconclusive chorionicity, multiple pregnancy with ≥ 3 fetuses and pathological twin gestations. Results No statistically significant difference was found in BW (p = 0.09) and in its discordancy (p = 0.06) nor in CRL (p = 0.48) and its discordancy (p = 0.74) between MCs and DCs. Crown-rump length discordancy and birthweight discordancy were correlated by the regression line "BWD = 0.8864 x CRLD + 0.0743," with r2 = 0.1599. Crown-rump length discordancy > 10% was found in 7.58% of monochorionic and in 13.56% of dichorionic twins. Birthweight discordancy > 15% was detected in 16.67% of monochorionic and in 31.64% of dichorionic twins. Conclusion No statistically significant influence of chorionicity was identified in both birthweight and birthweight discordancy, as in crown-rump length and crown-rump length discordancy. Birthweight discordancy was correlated to crown-rump length discordancy in 20% of cases.

Resumo Objetivo O objetivo do presente estudo foi analisar a influência da corionicidade nos parâmetros biométricos comprimento craniocaudal, peso ao nascimento, discordância de comprimento craniocaudal e discordância de peso ao nascimento, determinar a correlação entre estes dois últimos caso haja discordância intergemelar e analisar a influência da corionicidade na presença destas discordâncias com relevância clínica (> 10% e > 15%, respectivamente). Métodos O presente estudo foi um estudo retrospectivo baseado na base de dados de gestações gemelares do Centro Hospitalar S. João (2010-2015), incluindo 486 fetos de 66 gestações monocoriônicas e 177 dicoriônicas. Os critérios de inclusão foram gestações múltiplas de 2 fetos e gestações gemelares saudáveis. Os critérios de exclusão foram gestações tricoriônicas ou de corionicidade inconclusiva, gestações múltiplas com ≥ 3 fetos e gestações gemelares patológicas. Resultados Não se encontrou diferença estatisticamente significativa no peso ao nascimento (p =0,09) e sua discordância (p = 0,06) nem no comprimento craniocaudal (p = 0,48) e sua discordância (p = 0,74) entre gestações monocoriônicas e dicoriônicas. Considerando todas as gestações, as discordâncias de comprimento craniocaudal e peso ao nascimento foram correlacionadas pela reta de regressão "discordância de peso ao nascimento = 0.8864 x discordância de comprimento craniocaudal + 0.0743," com r2 = 0,1599. A discordância de comprimento craniocaudal > 10% descobriu-se em 7.58% das gestações monocoriônicas e em 13.56% das dicoriônicas. A discordância de peso ao nascimento > 15% detectou-se em 16.67% das gestações monocoriônicas e em 31.64% das dicoriônicas. Conclusão Não se identificou influência estatisticamente significativa no peso ao nascimento e sua discordância, bem como no comprimento craniocaudal e sua discordância. A discordância de peso ao nascimento correlacionou-se com a discordância de comprimento craniocaudal em 20% dos casos.

Twin Pregnancies, Crown-rump Length and Birthweight Discordancy: The Influence of Chorionicity.

OBJECTIVE: The purpose of the present study was to analyze the influence of chorionicity in the biometric parameters crown-rump length (CRL), birthweight (BW), crown-rump length discordancy (CRLD) and birthweight discordancy (BWD), determine the correlation between these latter two in cases of intertwin discordancy, and to analyze the influence of chronicity in the presence of these discordancies with clinical relevance (> 10% and > 15%, respectively). METHODS: The present study was a retrospective study based on the twin pregnancy database of the Centro Hospitalar S. João (2010-2015), including 486 fetuses among 66 monochorionic (MC) and 177 dichorionic gestations (DC). The inclusion criteria were multiple pregnancies with 2 fetuses and healthy twin gestations. The exclusion criteria were trichorionic gestations and pregnancies with inconclusive chorionicity, multiple pregnancy with ≥ 3 fetuses and pathological twin gestations. RESULTS: No statistically significant difference was found in BW (p = 0.09) and in its discordancy (p = 0.06) nor in CRL (p = 0.48) and its discordancy (p = 0.74) between MCs and DCs. Crown-rump length discordancy and birthweight discordancy were correlated by the regression line "BWD = 0.8864 x CRLD + 0.0743," with r2 = 0.1599. Crown-rump length discordancy > 10% was found in 7.58% of monochorionic and in 13.56% of dichorionic twins. Birthweight discordancy > 15% was detected in 16.67% of monochorionic and in 31.64% of dichorionic twins. CONCLUSION: No statistically significant influence of chorionicity was identified in both birthweight and birthweight discordancy, as in crown-rump length and crown-rump length discordancy. Birthweight discordancy was correlated to crown-rump length discordancy in 20% of cases.

OBJETIVO: O objetivo do presente estudo foi analisar a influência da corionicidade nos parâmetros biométricos comprimento craniocaudal, peso ao nascimento, discordância de comprimento craniocaudal e discordância de peso ao nascimento, determinar a correlação entre estes dois últimos caso haja discordância intergemelar e analisar a influência da corionicidade na presença destas discordâncias com relevância clínica (> 10% e > 15%, respectivamente). MéTODOS: O presente estudo foi um estudo retrospectivo baseado na base de dados de gestações gemelares do Centro Hospitalar S. João (2010­2015), incluindo 486 fetos de 66 gestações monocoriônicas e 177 dicoriônicas. Os critérios de inclusão foram gestações múltiplas de 2 fetos e gestações gemelares saudáveis. Os critérios de exclusão foram gestações tricoriônicas ou de corionicidade inconclusiva, gestações múltiplas com ≥ 3 fetos e gestações gemelares patológicas. RESULTADOS: Não se encontrou diferença estatisticamente significativa no peso ao nascimento (p = 0,09) e sua discordância (p = 0,06) nem no comprimento craniocaudal (p = 0,48) e sua discordância (p = 0,74) entre gestações monocoriônicas e dicoriônicas. Considerando todas as gestações, as discordâncias de comprimento craniocaudal e peso ao nascimento foram correlacionadas pela reta de regressão "discordância de peso ao nascimento = 0.8864 x discordância de comprimento craniocaudal + 0.0743," com r2 = 0,1599. A discordância de comprimento craniocaudal > 10% descobriu-se em 7.58% das gestações monocoriônicas e em 13.56% das dicoriônicas. A discordância de peso ao nascimento > 15% detectou-se em 16.67% das gestações monocoriônicas e em 31.64% das dicoriônicas. CONCLUSãO: Não se identificou influência estatisticamente significativa no peso ao nascimento e sua discordância, bem como no comprimento craniocaudal e sua discordância. A discordância de peso ao nascimento correlacionou-se com a discordância de comprimento craniocaudal em 20% dos casos.

Corino de Andrade disease: mechanisms and impact on reproduction.

Familial amyloid polyneuropathy was first described by Corino de Andrade in 1952 in Northern Portugal. It is a fatal autosomal dominant neurodegenerative disorder characterized by a progression of neurologic symptoms, beginning early in the reproductive life. The Transthyretin gene mutation originates a mutated protein that precipitates in the connective tissue as amyloid deposits. This disease is presently named Transthyretin-related hereditary amyloidosis. We performed an extensive review on this disease based on searches in Medical databases and in paper references. In this review, we briefly summarize the epidemiology and the mechanisms involved on amyloid deposition; we detailed how to evaluate the mechanisms implicated on the development of the major signs and symptoms associated with reproductive dysfunction; and we discuss the mechanisms involved in secondary sexual dysfunction after psychological treatments. Treatment of the disease is directed towards relieving specific symptoms in association with liver transplant, and molecular and genetic therapeutics. Although the current clinical trials indicate symptoms relief, no data on the reproductive function was reported. Thus, preimplantation genetic diagnosis is presently the only available technique that eradicates the disease as it avoids the birth of new patients.

Hábito parafuncional e disfunção temporomandibular, uma questão de gênero? / Oral parafunction and temporomandibular disorders, a matter of gender?

Introdução: as disfunções temporomandibulares (DTM) são caracterizadas por dor na região da articulação temporomandibular e região pré auricular, nos músculos mastigatórios, limitação da mobilidade articular e ruídos articulares. Fatores biomecânicos, neuromuscular, biopiscossocial e neurobiológico podem contribuir para esta disfunção. Objetivo: o propósito deste trabalho foi demonstrar a associação de hábitos parafuncionais entre os gêneros portadores da DTM. Método: realizou-se um estudo transversal com 150 sujeitos com questões estruturadas sobre hábitos parafuncionais e o Índice Anamnésico de Fonseca para classificação da DTM. Resultado e discussão: dos sujeitos tinham como pratica o habito parafuncional, 70% apresentavam algum grau de DTM sendo 82% destes do sexo feminino (p< 0,05); os hábitos orais mais prevalentes foram roer unha (34%) e mascar chicletes (30%). Considerações finais: as diferenças fisiológicas e de os papéis ocupados na sociedade deveexplicar associação do hábito parafuncional com o gênero feminino.

Introduction: Temporomandibular disorders (TMD) are characterized by pain in the region of the temporomandibular joint and pre-auricular region, in the masticatory muscles, limitation of joint mobility and articular noises. Biomechanical, neuromuscular, biopisco-social and neurobiological factors may contribute to this dysfunction. Objective: the purpose of this study was to demonstrate the association of oral parafunction among patients genres of Temporomandibular Disorders (TMD). Method: we conducted a cross-sectional study with 150 subjects with structured questions about parafunctional habits and the Fonseca Anamnesic Index for TMD classification. Results and Discussion: the subjects had to practice the parafunctional habit, 70% had some degree of TMD and 82% of females (p <0.05). The most prevalent oral habits were nailbiting (34%) and chewing gum (30%). Final remarks: physiologicaldifferences and the roles occupied in society should explain the association parafunctional habit with females.

Ingestive behavior and thermoregulatory responses of equine in grazing activities / Comportamento ingestivo e respostas termorregulatórias de equinos em atividades de pastejo

The objective of this article was to evaluate the main physiological responses, as well as the main patterns of ingestive behavior and physiological parameters of equines in activities grazing. Animal behavior is influenced by several factors, such as, climate, temperature, power supply, etc., thus becoming indispensable good management practices, for the animal can play to their best possible performance. The loss of heat in equines that give several ways (conduction, convection, radiation, evaporation), this occurs so that the animal can enter in their zone of thermal comfort (37.5ºC to 38.5ºC).

O objetivo deste artigo foi avaliar as principais respostas fisiológicas, bem como os principais padrões de comportamento ingestivo e parâmetros fisiológicos de equinos em atividades de pastejo. O comportamento animal recebe influência de diversos fatores, tais como, clima, temperatura, alimentação, etc., tornando-se assim indispensáveis boas práticas de manejo, para que o animal possa expressar o seu melhor desempenho possível. A perda de calor nos equinos se dar de várias maneiras (Condução, convecção, radiação, evaporação), isto ocorre para que o animal possa entrar na sua zona de conforto térmico (37,5°C a 38,5°C).

Ingestive behavior and thermoregulatory responses of equine in grazing activities / Comportamento ingestivo e respostas termorregulatórias de equinos em atividades de pastejo

The objective of this article was to evaluate the main physiological responses, as well as the main patterns of ingestive behavior and physiological parameters of equines in activities grazing. Animal behavior is influenced by several factors, such as, climate, temperature, power supply, etc., thus becoming indispensable good management practices, for the animal can play to their best possible performance. The loss of heat in equines that give several ways (conduction, convection, radiation, evaporation), this occurs so that the animal can enter in their zone of thermal comfort (37.5ºC to 38.5ºC).(AU)

O objetivo deste artigo foi avaliar as principais respostas fisiológicas, bem como os principais padrões de comportamento ingestivo e parâmetros fisiológicos de equinos em atividades de pastejo. O comportamento animal recebe influência de diversos fatores, tais como, clima, temperatura, alimentação, etc., tornando-se assim indispensáveis boas práticas de manejo, para que o animal possa expressar o seu melhor desempenho possível. A perda de calor nos equinos se dar de várias maneiras (Condução, convecção, radiação, evaporação), isto ocorre para que o animal possa entrar na sua zona de conforto térmico (37,5°C a 38,5°C).(AU)

Does BDNF genotype influence creative output in bipolar I manic patients?

INTRODUCTION: Creativity is a complex human ability influenced by affective and cognitive components but little is known about its underlying neurobiology. Bipolar Disorder (BD) is highly prevalent among creative individuals. Brain-derived neurotrophic factor (BDNF) is the most widely distributed neurotrophic factor, and has been implicated in the pathophysiology of BD. In contrast to the better functioning of the BDNF polymorphism (Val(66)Met) Val allele, the Met allele decreases BDNF transport and has been associated with worsened performance on several cognitive domains in euthymic BD subjects and controls. We hypothesized that the Val allele is associated with increased creativity in bipolar disorder. MATERIALS AND METHODS: Sixty-six subjects with BD (41 in manic and 25 in depressive episodes) and 78 healthy volunteers were genotyped for BDNF Val(66)Met and tested for creativity using the Barrow Welsh Art Scale (BWAS) and neuropsychological tests. RESULTS: Manic patients with the Val allele (Met-) had higher BWAS scores than Met+ carriers. This relationship was not observed among patients in depressive episodes or among control subjects. BDNF Met allele status showed no association with cognitive function in any of the groups. CONCLUSION: As postulated, these findings suggest that the better functioning allele of BDNF may selectively facilitate creative thinking in subjects with manic episodes, but not in controls or depressives. Further studies exploring the role of BDNF in the neurobiology of creativity in BD and in euthymic phases are warranted.

[Asphyxiation by suffocation and strangulation in children younger than 15 years of age]. / Asfixia por sofocación y estrangulación en menores de 15 años.

OBJECTIVE: Our aim was to describe non-intentional strangulation or suffocation suffered by children under 15 years of age. METHODS: Records from the Medical Examiner's Office showed child death by non-intentional strangulation or suffocation from January 1, 1991 to December 31, 2001. RESULTS: A total of 44 suffocations or non-intentional strangulations were registered. Overall mortality was 3.62/1,000,000 persons-year (27.57/1,000,000 in children < 1 year of age, 1.94/1,000,000 in older children); 63.6% were males. Most frequent mechanisms included neck entrapment between bars 18.2%, facial obstruction by bed clothes 15.9%, being covered by rubble, sand, or garbage 15.9%, strangulation by cord, chain, or strip 11.4%, and strangulation by dress or bed clothes 9.1%. CONCLUSIONS: Nearly all registered deaths could be prevented by education, supervision, or structural modifications. Strategies should also include obligatory standards for manufacturing and for warnings on labels.

Asfixia por sofocación y estrangulación en menores de 15 años / Asphyxiation by Suffocation and Strangulation in Children Younger than 15 Years of Age

Objetivo: describir características de eventos fatales asociados a estrangulación y sofocación no intencional en menores de 15 años. Material y métodos: registros del Servicio Médico Forense. Niños que fallecieron por estrangulación o sofocación no intencional de 01/01/1991 a 31/12/2001. Resultados: 44 sofocaciones o estrangulaciones no intencionales. Mortalidad de 3.62/1 '000,000 años-persona (27.57/1 '000,000 en menores de 1 año, 1.94/1 '000.000 en el resto), 63.6% hombres. Mecanismos más frecuentes: atrapamiento de cuello entre barrotes 18.2%, obstrucción facial por ropa de cama 15.9%, cubierto por escombro, arena o basura 15.9%, estrangulación por cordón, cadena o listón 11.4%, estrangulación por ropa de vestir o cama 9.1%. Conclusiones: casi todas las defunciones registradas podrían haberse prevenido mediante educación, supervisión o modificaciones estructurales del equipo. Las estrategias también deben incluir estándares obligatorios de manufactura y advertencias en eletiquetado de losproductos.

Objective: Our aim was to describe non-intentional strangulation or suffocation suffered by children under 15 years of age. Methods: Records from the Medical Examiner's Office showed child death by non-intentional strangulation or suffocation from January 1, 1991 to December 31, 2001. Results: A total of 44 suffocations or non-intentional strangulations were registered. Overall mortality was 3.62/ 1000,000 persons-year (27.57/1000,000 in children < 1 year of age, 1.94/1000.000 in older children); 63.6% were males. Most frequent mechanisms included neck entrapment between bars 18.2%, facial obstruction by bed clothes 15.9%, being covered by rubble, sand, or garbage 15.9%, strangulation by cord, chain, or strip 11.4%, and strangulation by dress or bed clothes 9.1%. Conclusions: Nearly all registered deaths could be prevented by education, supervision, or structural modifications. Strategies should also include obligatory standards for manufacturing and for warnings on labels.