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Os defeitos de esmalte são alterações qualitativas ou quantitativas na estrutura dentária, que originam-se de fatores sistêmicos, locais ou genéticos. A hipoplasia de Turner é um defeito na espessura do esmalte localizado cuja etiologia decorre de um traumatismo ou infecção periapical presente no dente decíduo predecessor, afetando o desenvolvimento do dente permanente. O objetivo do presente estudo foi apresentar um caso clínico de paciente infantil com dente hipoplásico de Turner em pré-molar, que tornou-se não vital sem que houvesse lesão de cárie ou trauma adicional. Em razão das características clínicas e radiográficas do dente afetado, bem como do risco de cárie e do comportamento cooperador da paciente, optou-se pela reabilitação do elemento afetado por meio de tratamento endodôntico e de restauração semidireta em resina composta. Torna-se de fundamental importância o conhecimento da etiologia e a realização de um exame clínico e radiográfico minucioso visando ao diagnóstico precoce e à elaboração de um plano de tratamento adequado para todos os defeitos de desenvolvimento do esmalte, incluindo-se a hipoplasia de Turner, cujo tratamento dependerá da severidade da alteração, do comportamento do paciente e do risco de cárie. Sugere-se a realização de estudos que associem a microestrutura do esmalte hipoplásico com a ausência de vitalidade pulpar.

Enamel defects are qualitative or quantitative changes in the tooth structure originating from systemic, local, or genetic factors. Turner's hypoplasia is a defect in the thickness of the localized enamel whose etiology arises from trauma or periapical infection in the predecessor deciduous tooth, affecting the permanent tooth's development. The objective of the present study was to present a clinical case of a child patient with a hypoplastic Turner premolar tooth, which became non-vital without the occurrence of caries, or additional trauma. Due to the affected tooth's clinical and radiographic characteristics, the risk of cavities, and the patient's cooperative behavior, it was decided to rehabilitate the affected element through endodontic treatment and semidirect restoration in composite resin. It is of fundamental importance to know the etiology and carry out a thorough clinical and radiographic examination aiming at early diagnosis and the development of an adequate treatment plan for all enamel developmental defects, including Turner's hypoplasia, whose treatment will depend on the severity of the change, the patient's behavior and the risk of caries. Studies are suggested to be carried out that associate the microstructure of hypoplastic enamel with the absence of pulp vitality.

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Background/Objectives: Sleep and cognitive alterations are common symptoms associated with child Post-traumatic stress disorder (PTSD) and depression (DEP). This study aims to investigate the relationship between sleep disturbances and cognitive alterations in PTSD and DEP. Methods: Using a quantitative, cross-sectional exploratory design, we examined 130 students (106 girls and 24 boys) aged 11 to 16 years (mean age = 12.9, SD = 1.35) from 6th to 8th grade. Twenty-eight participants met the criteria for PTSD, 15 met the criteria for DEP, 43 met the criteria for both PTSD+/DEP+, and 44 served as the control group. Comparative analyses were conducted using the MANOVA and multiple one-way ANOVA tests. Results: The MANOVA test indicated an interaction between cognitive and sleep alterations. Post hoc analysis revealed that sleep patterns were significantly altered among the groups with PTSD, DEP, and PTSD+/DEP+ (F(3, 126) = 16.98, p = 0.001). In contrast, cognitive alterations were most pronounced in PTSD and PTSD+/DEP+ (F(3, 126) = 63.97, p < 0.001). Conclusions: These findings emphasize the impact of PTSD and DEP on cognition and sleep. Potential clinical implications suggest the need for interventions targeting sleep and cognitive alterations. This study underscores the complex relationship among traumatic experiences, depression, and cognitive/sleep alterations.

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Intensifying storms and inter-annual El Niño events may increase psychological stress and worsen mental health. This study examines the relationship between flood exposure and long-term mental health symptoms among adolescents and young people in Peru, the world's most affected country by El Niño. We analyzed community and self-reported survey data from the Young Lives Study to contrast mental health in 2016 among youth who lived in communities that experienced or did not experience flooding between 2013 and 2016. We pre-processed data on 1344 individuals in 93 communities, using optimal full matching on Mahalanobis distance with a propensity score caliper, and estimated relative risks to mental health scores in the general population of young people and among gender-stratified groups via quasi-Poisson regression. Exposure to floods did not yield conclusive differences in mental health scores in this sample. Further evidence is needed on mental health patterns over time, the influence of exposure severity, and the impact of disaster relief on symptomology in mounting an effective global health response.

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Objective: To evaluate the effects of rapid maxillary expansion (RME) on nasal patency and nasomaxillary dimensions in children and adolescents with mouth-breathing through 8 years of clinical follow-up. Methods: RME was performed using a Hyrax orthodontic appliance in 28 mouth-breathers (6-13 years old). During follow-up, objective tests of nasal respiratory function were conducted, such as acoustic rhinometry, which provided the minimum cross-sectional areas of the nasal cavity, and active anterior computed rhinomanometry, which measured inspiratory nasal resistance. The tomographic widths of the coronal sections of the nose and maxilla were also measured. Fisher's exact test and the Mann-Whitney U test were used to compare categorical and numerical variables, respectively, in mouth-breathers with and without allergic rhinitis. Temporal evolution was assessed using generalized estimating equation models. Statistical significance was set at P < 0.05. Results: There was a reduction in inspiratory resistance after RME with a stable improvement in nasal patency during the 8-year follow-up period (P = 0.0179). All nasal and maxillary tomographic widths showed statistically significant increases in the short-term (P < 0.0001), and most of them showed significant increases in the long-term when compared with the pre-expansion period. Tomographic measurements were not influenced by allergic rhinitis. Conclusions: Our study showed that RME promoted and maintained the widening of the posterior maxillary structure in children and adolescents with mouth-breathing, with a decrease in inspiratory nasal resistance during the 8-year follow-up period. These findings highlight the importance of RME in mouth-breathers with maxillary atresia.

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BACKGROUND AND AIMS: The first years of life are fundamental for the establishment of the gut microbiota, with diet being one of the main early exposures. During this period, the beneficial effect of breastfeeding on modulating the gut microbiota is well known; however, there are important gaps in the literature on the effects of ultra-processed food (UPF) consumption, particularly in longitudinal and large sample designs. Through a prospective birth cohort study, we investigated the effects of UPF consumption on the gut microbiota of children during the first year of life. METHODS: This study included children from the MINA-Brazil birth cohort with gut microbiota data (16S rRNA) available at the 1-year follow-up (n = 728). Data on breastfeeding practices were collected after childbirth and during follow-up visits. Complementary feeding was measured using a semi-structured questionnaire, referring to the day before the interview at the 1-year follow-up. A combined variable was generated according to breastfeeding practices and UPF consumption and was used as an independent variable in the adjusted median regression models, with alpha diversity parameters as the dependent variable. Beta diversity was analyzed using PERMANOVA according to Bray-Curtis dissimilarity and Distance-based Redundancy Analysis (db-RDA) adjusted for covariates. Relative abundance was analyzed using ANCOM-BC (corrected by FDR) and MaAsLin2 adjusted for covariates. RESULTS: Weaned children who consumed UPF showed a significant increase in alpha diversity for all parameters in the median regression models (Observed ASVs: p = 0.005; Shannon index: p = 0.036; Chao index: p = 0.026; Simpson index: p = 0.012) and in beta diversity (PERMANOVA: p = 0.006; db-RDA: p < 0.001) compared to breastfed children who did not consume UPF. Breastfed children who did not consume UPF had a higher relative abundance of Bifidobacterium than weaned children who consumed UPF (both p < 0.001 for ANCOM-BC and MaAsLin2) and a lower relative abundance of Firmicutes (p < 0.001 for MaAsLin2), Blautia (both p < 0.001 for ANCOM-BC and MaAsLin2), Sellimonas (p = 0.008 for ANCOM-BC) and Finegoldia (p = 0.045 for MaAsLin2) than weaned children who consumed UPF. CONCLUSION: These findings suggest that UPF consumption may negatively impact the diversity and abundance of the gut microbiota, with a more pronounced effect in children who have already been weaned.

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Objective: Orthopedic trauma is significant in modern society due to its incidence and its impact on healthcare and social interactions. Concerns include the risk of permanent sequelae affecting individual development and causing social stigma. Fractures, while not the most lethal lesion, may result in physical variable disability; publications show that about 30% of children experience fractures by skeletal maturity, primarily from low-energy trauma. This study aims to identify the fracture patterns in the immature skeleton at a tertiary-level public hospital. Methods: Individuals with skeletally immature fractures of the locomotor system, treated at a tertiary-level emergency unit from January 2016 to January 2020, were included. Data collected included social characteristics, trauma origin, fracture descriptors, and treatment modality. Age groups: infant, preschool, school-age, adolescent. Trauma energy is classified as low, moderate, or high. Results: A total of 926 cases were recorded in 505 patients, with a predominance of males. The most affected bones were the radius (29.5%), humerus (24.2%), and ulna (15.8%). The metaphysis was the most common location (46.7%), followed by the diaphysis (33.2%). Falls accounted for the largest portion, at 64.7%, with the majority (364) being low-energy trauma. High-energy trauma, such as pedestrian accidents and car accidents, represented 13.7%, and of these, 54.2% were polytraumatized. Conclusion: Fractures of the forearm persist as the most common, particularly at the distal third of the radius, with males being more exposed. Climatic seasonality and cultural traits such as soccer practice have little impact on the epidemiology of fractures. The results obtained in this investigation resemble those obtained by international literature. Level of Evidence III; Retrospective Cohort Study.

Objetivo: O trauma ortopédico é relevante na sociedade moderna devido à incidência e ao seu impacto na saúde e nas interações sociais. As preocupações incluem o risco de sequelas permanentes afetando o desenvolvimento individual e causando estigma social. Fraturas, embora não sejam as lesões mais letais, podem resultar em incapacidade física variável, alguns estudos mostram que cerca de 30% das crianças experimentam fraturas até a maturidade esquelética, principalmente devido a traumas de baixa energia. Esse estudo tem como objetivo identificar o padrão de fraturas do esqueleto imaturo de um hospital público de nível terciário. Métodos: Foram analisados indivíduos com fraturas do sistema locomotor, imaturos esqueleticamente, tratados em uma unidade de emergência de nível terciário entre janeiro de 2016 a janeiro de 2020. Os dados coletados incluíram características sociais, do evento traumático e da fratura; grupos etários infantil, pré-escolar, escolar, adolescente; energia do trauma classificada como baixa, moderada ou alta. Resultados: 926 casos foram registrados em 505 pacientes, com predominância de homens. Os ossos mais afetados foram o rádio (29,5%), úmero (24,2%) e ulna (15,8%). A metáfise foi o local mais comum (46,7%), seguido pela diáfise (33,2%). Quedas representaram a maior parte (64,7%), sendo a maioria consideradas traumas de baixa energia. Trauma de alta energia, como acidentes com pedestres e acidentes de carro, representaram 13,7%, e destes, 54,2% foram politraumatizados. Conclusão: As fraturas do antebraço persistem como as mais comuns, particularmente no terço distal do rádio, com os homens estando mais expostos. Consideramos que a sazonalidade climática e os traços culturais, como a prática de futebol, têm pouco impacto na epidemiologia das fraturas. Os resultados obtidos nesta investigação se assemelham aos obtidos pela literatura internacional. Nível de Evidência III; Estudo de Coorte Retrospectivo.

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Introduction: Specialized public services for attending children and adolescents with complaints of scholar difficulties are scarce in Brazil. It is important to recognize this target population and understand its demands, so these facilities may be able to meet their needs and offer qualified and effective services. The main objective of this study was to characterize the profile of neuropediatric patients cared for in a reference outpatient facility in Brazil. Method: Data were extracted from children's and adolescent's records, corresponding to assessments carried out between March 2017 to March 2023. Results: From 220 selected records, 70% had complaints related to learning difficulties and 79.1% to attention disorders. The most frequent diagnoses were attention-deficit/hyperactivity disorder (30%), intellectual deficiency (19.1%), and learning-specific disorder (17.7%). A significant association with scholarship was found between motor agitation [χ2(9) = 29.8; p < 0.001], behavioral complaints [χ2(9) = 16.2; p = 0.050], and language difficulties [χ2(9) = 17.0; p = 0.043]. Results have indicated significant differences relating to diagnosis and gender: boys had a higher prevalence for dyslexia [χ2(1) = 4.44; p = 0.035], intellectual deficiency [χ2(1) = 8.38; p = 0.004], and autism spectrum disorder [χ2(1) = 9.29; p = 0.002], when compared to girls. Conclusion: These results corroborate international findings over complaints regarding learning difficulties and correlated disturbances, in addition to the existing comorbidities between different diagnoses related to neurodevelopment and scholar acquisitions.

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(1) Background: Obesity and overweight are defined as an abnormal or excessive accumulation of fat that can be harmful to health. These are conditions that can lead to a lifetime of diseases, including cancer, diabetes, and heart disease. The diagnosis of overweight and obesity in children and adolescents depends on the international reference used. (2) Objectives: In this study aimed to determine the level of concordance of the prevalence of underweight, normal weight, overweight, and obesity were estimated with three international references in Mexican children and adolescents between 2 and 18 years of age. (3) Methods: We used specific the body mass index (BMI) cut-off points of the ENSANUT Continua 2022 database. The weight category was measured using the World Health Organization (WHO) criteria (<-2 standard deviation (SD), underweight; -2 and +0.99 SD, normal weight; +1 and +1.99 SD, overweight; and ≥+2 SD, obesity); Centers for Disease Control and Prevention (CDC) criteria (

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BACKGROUND: The early consumption of ultra-processed foods (UPFs) and added sugars (AS) has been linked to adverse outcomes in infancy. The objective of this study was to determine the effectiveness of a dietary counselling strategy to prevent the consumption of UPFs and AS in the first year of life. METHODOLOGY: A multicentre randomised controlled trial was conducted with 516 mother-child pairs in three state capitals of Brazil. Mothers were randomly assigned to the control group (CG) or intervention group (IG) after childbirth. The IG received orientation based on UNICEF dietary guidelines and five monthly telephone calls to reinforce the intervention. Dietary intake was measured using food introduction questionnaires and 24-h recalls during home visits at 6 and 12 months. Between-group differences were analysed by generalised estimating equations and presented as mean difference (95% CI). RESULTS: Children in the IG had lower UPF intake at 6 and 12 months of age (-20.69 g/day; 95% CI: -37.87 to -3.50; p = 0.018 and -32.51 g/day; 95% CI: -61.03 to -3.99; p = 0.025) and lower AS intake at 12 months of age (-4.92 g/day; 95% CI: -9.43 to -0.41; p = 0.033). The intervention also had a positive impact on the period of exclusive breastfeeding, reducing the offer of infant formula, cow's milk, and toddler milk in the first year of life. PRINCIPAL CONCLUSIONS: The dietary counselling strategy was effective at preventing the early consumption of UPFs and AS in the first year of life. Future research should focus on social and cultural barriers to improve adherence to infant feeding interventions.

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AIM: The aim was to investigate the salivary amino acid profile in children with protein-energy undernutrition (PEU) and its association with caries experience in the presence of other risk factors. METHODS: The study had a cross-sectional design and was carried out with 122 children (12-71 months old), classified according to their level of undernutrition (mild-GI, n = 22; moderate-GII, n = 53) or healthy controls (GC, n = 47). The children were categorized based on the presence of caries into caries-experienced groups (ceos > 0, 22 CG, 12 GI and 18 GII) and caries-free groups (ceos = 0, 25 CG, 10 GI and 36 GII). Total unstimulated and stimulated saliva were collected to determine amino acids and Streptococcus mutans, respectively. RESULTS: Eighteen amino acids were associated with PEU. Undernutrition and caries experience influenced the presence of the following amino acids: L-anserine, asparagine, ethanolamine, gamma-aminobutyric acid, and norleucine. Asparagine was a significant predictor of a lower probability of caries experience in a logistic regression model. CONCLUSIONS: Salivary amino acids are associated with undernutrition in children, and the presence of asparagine in saliva relates to a lower caries risk.

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INTRODUCTION: Children who suffer from severe caries in childhood may have negative impacts on the growth, development, nutritional problems and quality-of-life problems related to the oral health of the child and their family. There are no studies that have compared rehabilitative techniques of primary anterior teeth regarding patient-centred outcomes and even longevity of the restoration. Thus, this project aims to evaluate the effectiveness of restorative treatment of anterior primary teeth with monochromatic composite resin in single insertion through polyvinyl crowns, after selective removal of carious tissue compared with the effectiveness of conventional restoration. METHODS AND ANALYSIS: This study proposes to conduct a randomised clinical trial, composed of a sample of 194 deciduous central and lateral incisors with active cavitated lesions, simplified International Caries Detection and Assessment System (ICDAS) C+ score (active and extensive stage caries: ICDAS 5 and 6), with involvement of more than two surfaces. This sample will be divided into two experimental groups, both with selective removal of carious tissue: a group in which conventional restoration will be performed using opaque resins, and another group with monochrome resin with chameleon effect and polyvinyl crowns. The explanatory variables-gender, age, toothbrushing, use of fluoridated toothpaste and dental floss, and socioeconomic status-will be collected through a questionnaire with open questions. The progression of caries lesions after 24 months of follow-up will be considered as the primary outcome. Secondary outcomes will include tooth survival, longevity of restoration, quality of life, perception and satisfaction of the participants' parents/guardians. ETHICS AND DISSEMINATION: This protocol has been approved by the Human Research Ethics Committee of Universidade Metropolitana de Santos (protocol number: 6.019.297. Approved 24 April 2023). Results will be submitted to international peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER: NCT05875064.

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BACKGROUND: Amputations in children represent significant events. Few studies analyse amputations in this specific population, and most of them are old, regionalised and with small sample sizes. Besides, there are no large studies in low-income and middle-income countries. This study aims to analyse a large sample of amputations (19 439 procedures performed in the Brazilian public health system) in children aged 0-14 over 14 years. METHODS: Retrospective cross-sectional population-based analysis of all lower limb amputations performed in the Brazilian public health system between 2008 and 2021 in children up to 14. Using a public database, all types of amputations were selected, defining the number of procedures, their main aetiologies, trends over the years, patient demographics and regional distribution. RESULTS: 19 439 lower limb amputations were performed in the Brazilian public health system between 2008 and 2021, mainly at the toe level (85%). Amputations occurred predominantly in males (64%) and children aged 0-4 (47%). The global trend is a non-significant decrease in the total number of amputations over the period (p=0.427), but we observe a significant decrease (p<0.001) in amputations in older children (aged 10-14). Amputations are more concentrated in the most populated regions, while the highest mortality is found in the least densely populated areas. Trauma is the main aetiology associated with lower limb amputations in Brazilian children (60%). CONCLUSION: The epidemiology of amputations in Brazil differs from the rest of the world. Trauma is the main aetiology.

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BACKGROUND: Sexual exploitation of children and adolescents (SECA) is a mostly invisible phenomenon, having negative impacts on adolescents' health and well-being. There is increasing awarenessof preventative strategies to reduce sexual exploitation of children and adolescents, but limited evidence on their effectiveness and mechanisms. This project addresses this gap through the impact and process evaluation of 'Growing Up Without Violence' (GWV), the largest intervention in Brazil tackling SECA. METHODS: We will conduct a two-arm cluster randomised trial (CRT) with parallel assignment in the municipalities of Cabo de Santo Agostinho and Jaboatão dos Guararapes, in Brazil. We will randomly allocate 30 schools to intervention and 30 to wait-list control arms. In each of these schools, we will randomly select independent samples of fifty students (aged 12 to 17) to participate in baseline and endline surveys. We will invite students to self-complete pre-programmed questionnaires in a private school space, under the supervision of trained researchers. Our main analysis is a cross-sectional comparison between control and intervention schools of students' levels of basic knowledge for identifying appropriate and inappropriate sexual advances and acts (primary outcome). Secondary outcomes include knowledge of risks of online sexual exploitation, willingness to report incidents of sexual abuse and exploitation, and recall of exposure SECA preventive training content. DISCUSSION: To our knowledge, this is the first large-scale rigorous evaluation of an intervention to prevent SECA in Brazil. Findings will inform our strategies and future interventions to prevent SECA.

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INTRODUCTION: Sickle cell anemia has a genetic origin characterized by an autosomal recessive inheritance pattern. The nervous system may be subject to vaso-occlusion and, consequently, affect the proper functioning of the central portion of hearing. OBJECTIVE: To assess central auditory skills and analyze short- and long-latency auditory evoked potentials in children with sickle cell disease. METHODS: Cross-sectional study. All children had normal hearing thresholds, and their central auditory processing underwent behavioral assessment with a battery of tests involving dichotic and monotic listening, binaural interaction, and temporal processing. The electrophysiological assessment used short- and long-latency auditory evoked potentials. Descriptive statistics were performed. RESULTS: Of the 28 subjects evaluated (mean age of 9.46 years), 18 were females and 10 were males. Central auditory processing disorder was identified in 85.7% of the children. The auditory skills of figure-ground for verbal sounds, binaural interaction, and complex temporal ordering were the most affected. An increase in the absolute latencies of Waves III and V was observed in the short-latency potential. CONCLUSION: Individuals with sickle cell disease have central auditory processing disorder, identified primarily by behavioral assessment.

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BACKGROUND: Cirrhotic patients face heightened energy demands, leading to rapid glycogen depletion, protein degradation, oxidative stress, and inflammation, which drive disease progression and complications. These disruptions cause cellular damage and parenchymal changes, resulting in vascular alterations, portal hypertension, and liver dysfunction, significantly affecting patient prognosis. AIM: To analyze the association between Child-Turcotte-Pugh (CTP) scores and different nutritional indicators with survival in a 15-year follow-up cohort. METHODS: This was a retrospective cohort study with 129 cirrhotic patients of both sexes aged > 18 years. Diagnosis of cirrhosis was made by liver biopsy. The first year of data collection was 2007, and data regarding outcomes were collected in 2023. Data were gathered from medical records, and grouped by different methods, including CTP, handgrip strength, and triceps skinfold cutoffs. The prognostic values for mortality were assessed using Kaplan-Meier curves and multivariate binary logistic regression models. RESULTS: The coefficient for CTP was the only statistically significant variable (Wald = 5.193, P = 0.023). This suggests that with a negative change in CTP classification score, the odds of survival decrease 52.6%. The other evaluated variables did not significantly predict survival outcomes in the model. Kaplan-Meier survival curves also indicated that CTP classification was the only significant predictor. CONCLUSION: Although different classifications showed specific differences in stratification, only CTP showed significant predictive potential. CTP score remains a simple and effective predictive tool for cirrhotic patients even after longer follow-up.

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OBJECTIVE: To apply the Toronto Childhood Cancer Staging Guidelines (TG) and Estimate the Observed Survival Probabilities for Pediatric Patients with Leukemia and Lymphoma. METHODS: Staging at diagnosis was conducted according to tier 2 of the TG. The study cohort included patients aged 0 -19 years from the Population-Based Cancer Registry (PBCR) of Mato Grosso, diagnosed with leukemia and lymphoma between 2008 and 2017, with follow-up until December 31, 2022. Observed 60-month survivals were calculated using the Kaplan-Meier method. RESULTS: Staging was assigned in 67.3% of cases (n=239), while in 32.7% (n=116), staging could not be applied due to incomplete data. Among the cases of acute lymphoblastic leukemia (ALL), 70.7% (n=133) were staged as CNS1, with an observed survival probability of 75.0%. For acute myeloid leukemia (AML), 42.2% (n=21) were staged as CNS-, with an estimated survival of 60.0%. Most Hodgkin lymphoma (HL) cases were staged as IIA/B (37.7%, n=23) and IIIA/B (21.3%, n=13), with survival probabilities of 91.3% and 91.7%, respectively. Among non-Hodgkin lymphoma (NHL) cases, 32.1% (n=18) were staged as stage III, with a survival probability of 70.6%. CONCLUSION: The application of TG in the PBCR in Mato Grosso proved feasible, allowing for comparability of survival estimates across different stages. However, collecting tier 2 staging information will be a challenge for the PBCR due to incomplete information in medical records.

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Introduction. Echocardiographic measurement of inferior vena cava diameters and collapsibility index (IVCCI) can estimate right heart chamber function and intravascular volume status. Few reports of reference values for diameters and IVCCI in the pediatric population exist. This exploratory study aimed to understand the behavior of diameters and IVCCI as a function of body surface area (BSA) in healthy children to establish possible reference values in the future. Population and methods. Ninety-nine Mexican children aged 12 to 204 months were included. Anthropometry and transthoracic M-mode echocardiography were performed to assess the maximum expiratory diameter (MAXDE) and the minimum inspiratory diameter (MINDI). IVCCI was calculated with the formula (MAXDE - MINDI) / MAXDE × 100. Results. A linear regression model was performed to calculate the predicted values (mean ± 2 standard deviations of MAXDE and MINDI expressed per BSA). The predicted value of the IVCCI for each representative BSA value was calculated from the MAXDE and MINDI values predicted by the model. Conclusions. Variations were found in the values of diameters and IVCCI concerning studies performed in other pediatric groups. This indicates the importance of having specific reference values for each population and opens the door to generating more research in healthy children and even those with cardiac disorders.

Introducción. La medición ecocardiográfica de los diámetros e índice de colapsabilidad de la vena cava inferior (ICVCI) puede estimar la función de las cavidades cardíacas derechas y el estado del volumen intravascular. Existen pocos reportes de valores de referencia para los diámetros y el ICVCI en población pediátrica. El objetivo de este estudio exploratorio fue conocer el comportamiento de los diámetros y el ICVCI en función de la superficie corporal (SC) en niños sanos, para que en el futuro se puedan establecer posibles valores de referencia. Población y métodos. Se incluyeron 99 niños mexicanos de 12 a 204 meses de edad. Se realizó antropometría y ecocardiografía transtorácica en modo M para evaluar el diámetro máximo en espiración (MAXDE) y el diámetro mínimo en inspiración (MINDI). El ICVCI se calculó con la fórmula (MAXDE - MINDI) / MAXDE × 100. Resultados. Se realizó un modelo de regresión lineal para calcular los valores predichos (media ± 2 desviaciones estándar del MAXDE y del MINDI expresados por SC). El valor predicho del ICVCI para cada valor representativo de la SC se calculó a partir de los valores del MAXDE y del MINDI predichos por el modelo. Conclusiones. Se encontraron variaciones en los valores de los diámetros y ICVCI con respecto a los estudios realizados en otros grupos pediátricos. Esto indica la importancia de tener valores de referencia específicos para cada población y abre la puerta a generar más investigaciones en niños sanos e incluso con trastornos cardíacos.

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Failure to thrive is a general term describing infants who do not reach weight, length, or body mass index expected for their age. It can be related often to malnutrition due to inadequate caloric and protein intake, but also to excessive loss of nutrients, inadequate metabolism, inadequate absorption, or excessive caloric and energy expenditure. It may be either organic or inorganic in origin, and in most cases, does not require investigation through complementary examinations. It is associated with social and health detrimental outcomes. Most cases of failure to thrive are of non-organic etiology, thus clinical history evaluation and physical examination are of utmost importance in the management of these patients. Therapeutics includes behavioral or nutritional interventions, as well as treatment of possible underlying diseases. The treatment approach is more effective in improving clinical outcomes if applied as early as possible.

El retardo de crecimiento es un término general que describe a los niños que no alcanzan el peso, la estatura o el índice de masa corporal esperados para su edad. Esto puede estar relacionado, con frecuencia, con desnutrición por inadecuada ingesta calórica y proteica, pero también por excesiva pérdida de nutrientes, metabolismo anormal, mala absorción o excesiva pérdida calórica. La causa puede ser orgánica o inorgánica y, en la mayoría de los casos, no requiere estudios complementarios. Se asocia con resultados sociales y de salud desfavorables. La mayoría de los casos son de etiología no-orgánica por lo que la evaluación de la historia clínica y el examen físico son de extrema importancia en el manejo de estos pacientes. El tratamiento incluye intervenciones conductuales o nutricionales, así como el tratamiento de posibles enfermedades subyacentes. El enfoque terapéutico es más efectivo para lograr la mejoría si se aplica tan temprano como sea posible.

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Secondhand smoke affects nearly 40% of children worldwide, leading to serious health and behavioral problems. Being neurotoxic, it poses potential risks for child health and learning. In Cuba, there is limited research on the association of secondhand smoke with children's brain health, especially in vulnerable populations like young children at home. The overall purpose of this study is two-fold. First, we determined the relationship between household smoke exposure and risks to brain health in Cuban children. Second, we analyzed the role of family environment factors, such as socio-economic status, in our estimates. Although this research represents the first investigation of its kind in Cuba, we expect to find evidence of neurotoxic associations with household smoke. We collected data between 2015 and 2018 using the medical records of 627 Cuban preschool children to explore the link between brain health indicators and exposure to tobacco smoke at home. We assessed archival reports on parental smoking, duration and frequency of exposure, and several indicators of brain health, including executive function, language development, sleep quality, and fluid intelligence. The findings indicate that exposure to tobacco smoke at home has a negative association with children's brain health, affecting both the cognitive (executive and linguistic functions) and non-cognitive aspects (sleep quality) of child development. Continuous exposure (five to seven times per week) and transient exposure (two to three times per week) were found to be more negatively related to sleep quality than in cognitive functions, particularly in children of middle socio-economic status. This highlights the need to implement parental information campaigns in Cuba.

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INTRODUCTION: Joint hypermobility (JH) is mobility beyond the normal range of motion. JH can be an isolated finding or a characteristic of a syndrome. Characteristics related to the sitting position with atypical body positions, such as sitting in splits (S), with the foot on the head (F), in W (W), in a concave shape (C), episodes of dislocations, and subluxations, suggest impacts on body mechanics since childhood, with damage to the conformation of the joints. OBJECTIVES: Identify preclinical signs of JH, in addition to Beighton Score (BS), through signs that are easily recognized early by pediatricians and family members to avoid possible joint deformities in the future. METHODS: The medical records of 124 children (59.7% girls) between one and nine years old were analyzed. JH was assessed using the BS, a history of luxations/subluxations, and the concave (C), "W", "splits" (S), and foot (F) on head sitting positions. RESULTS: The concave sitting position was the most common, followed by W, F, and S in decreasing order. A total of 52.4% of the children had BS > 6, with a higher prevalence among girls (60.8%) compared to boys (40.0%); a difference statistically significant (p = 0.024, Fisher's exact test). Thirty-two patients (27.4%) had luxations/subluxations with the higher scores. CONCLUSIONS: Sitting in S, F, W, and C positions are preclinical phenotypic characteristics of JH, easily identified by pediatricians and family members to prevent possible joint deformities. BS ≥ 6 is more frequently observed in all positions. The majority of the total sample has BS > 6, with a significant female gender influence. Among those with a history of occasional joint dislocations and subluxations, half of them have the highest BS scores.