Abstract: Introduction: The last two decades have seen an exponential growth in the distribution and availability of child pornographic material on the Internet and social networks. The medical community is involved in assisting the investigating authorities in relation to estimating the age and sexual maturity of the alleged victims. Objective: To determine the efficacy of using Tanner stages as a method for esti mating chronological age in alleged child pornography cases based on published evidence. Material and Method: Systematic review study in PubMed and Scopus databases following PRISMA guideli nes. Articles describing the outcome of using Tanner stages to estimate chronological age in alleged child pornography cases were identified. For screening, those written in English or Spanish published from January 1, 2000, to April 30, 2020, were considered. The following data were extracted from the articles included: type of study; material and methods used; Tanner items examined; evaluators’ characteristics; results; estimated chronological age versus real age; observer-dependent variations (bias); and conclusions. Results: Seven studies were included. Three were literature reviews and four were case studies with expert testimony and observer bias. This method is ineffective when the alleged victim, in both sexes, shows sexual maturation in Tanner stages 3-5. In stages 1-2, it may be useful to state that the victim is under 18 years old, but not to determine their chronological age. Conclusion: Scientific evidence discourages the use of Tanner stages to estimate the chronological age of the vic tim from images in alleged child pornography cases. Pediatricians, and other medical professionals, should avoid making a testimony that is not scientifically based.

Resumen: Introducción: En las dos últimas décadas se ha producido un crecimiento exponencial de la distribución y disponi bilidad de material pornográfico infantil en Internet y las redes sociales. La comunidad médica está involucrada con la asistencia a las autoridades investigadoras en relación con la estimación de la edad y la madurez sexual de las presuntas víctimas. Objetivo: Determinar la eficacia del uso de las etapas de Tanner como método para estimar la edad cronológica en presuntos casos de pornografía infantil basada en la evidencia publicada. Material y Método: Estudio de revisión sistemática en las bases de datos PubMed y Scopus siguiendo directrices PRISMA. Se identificaron los artículos que describen el resultado del uso de las etapas de Tanner para estimar la edad cronológica en presuntos casos de pornografía infantil. Para el cribado se consideraron los escritos en inglés o español publicados desde el 1 de enero de 2000 hasta el 30 de abril de 2020. De los artículos finalmente incluidos se extrajeron los siguientes datos: tipo de estudio; material y métodos utilizados; ítems de Tanner examinados; ca racterísticas de los evaluadores; resultados; edad cronológica estimada versus la edad real; variaciones dependientes del observador (sesgo); conclusiones. Resultados: Se incluyeron siete estudios. Tres eran revisiones de la literatura y cuatro estudios de casos con testimonio de expertos y sesgo de los observadores. Este método es ineficaz cuando la presunta víctima, para ambos sexos, muestra una maduración sexual en las etapas 3-5 de Tanner. En las etapas 1-2 puede ser útil para testificar que la víctima es menor de 18 años, pero no para determinar su edad cronológica. Conclusión: La evidencia científica desaconseja el uso de las etapas de Tanner para estimar la edad cronológica de la víctima a partir de imágenes en supuestos casos de pornografía infantil. Los pediatras, y otros profesionales de la medicina, deben evitar emitir un testimonio que no tenga una base científica.

ABSTRACT Congenital clubfoot treatment has evolved throughout history. Serial manipulations and immobilizations were used from antiquity to the end of the Middle Ages. From the Renaissance to the 17th century the first orthotics were created. In the 18th century, the use of plaster casts began and complex orthotics and footwear developed. The period from 19th century until the third decade of the 20th century was characterized by the practice of tenotomies, with surgery being the main therapeutic approach. In the 20th century, Joseph Kite and Ignacio Ponseti described their effective non-surgical method, which led to the return to serial manipulations and immobilizations in the face of aggressive surgery. When reviewing the history of clubfoot treatment, it is surprising to see that the treating doctors made the same mistakes over and over again because they constantly ignored what they had already learned from their predecessors and, instead, were often confused by the new ones information or trends. In the 21st century, advances in cell biology, molecular genetics, diagnostic imaging, biomechanics and biomaterials suggest that personalized treatments can be designed for patients with clubfoot.

Resumen El tratamiento del pie zambo congénito ha evolucionado a lo largo de la historia. Desde la Antigüedad hasta finales de la Edad Media se utilizaron las manipulaciones e inmovilizaciones seriadas. Del Renacimiento al siglo XVII se crearon las primeras ortesis. En el siglo XVIII comenzó el uso de moldes de yeso y se desarrollaron ortesis y calzados complejos. El período del siglo XIX hasta la tercera década del XX, se caracterizó por la práctica de las tenotomías, siendo la cirugía el principal enfoque terapéutico. En el siglo XX, Joseph Kite e Ignacio Ponseti describieron su eficaz método no quirúrgico, lo que produjo el regreso a las manipulaciones e inmovilizaciones seriadas frente a la cirugía agresiva. Cuando se revisa la historia del tratamiento del pie zambo, sorprende ver que los médicos tratantes cometían los mismos errores una y otra vez, porque ignoraban constantemente lo que ya habían aprendido de sus antecesores y, en su lugar, a menudo se veían confundidos por las nuevas informaciones o tendencias. En el siglo XXI, los avances en biología celular, genética molecular, diagnóstico por la imagen, biomecánica y biomateriales hacen prever que se puedan diseñar tratamientos personalizados para los pacientes con pie zambo.

Introduction: the objective of the study was to review the oral and dental manifestations of child abuse. Material and methods: we performed a systematic review study following the PRISMA guidelines. We performed 2 searches using MeSH terms in the Medline/PubMed database for the period ranging from 1/1/2000 to 12/31/2019. Results: the review included 26 articles, of which 65.4% were published in dental journals and 16% in paediatric journals. All oral and dental injuries caused by physical abuse raise suspicion, but none are pathognomonic. They must be distinguished from unintentional injuries, which are common in the paediatric population. To do so, the presence of physical signs considered strong warning signs must be assessed. All oral and dental diseases resulting from neglect are suggestive but not confirmatory of neglect. Therefore, it is necessary to assess whether there are factors considered necessary to diagnose dental neglect, such as other health problems arising from chronic neglect or other indicators of physical and/or sexual abuse. Oral infections by Neisseria gonorrhoeae or Treponema pallidum are pathognomonic for sexual abuse. All other oral injuries and diseases are considered suspicious or suggestive. Conclusions: injuries and diseases resulting from child abuse or neglect frequently manifest the oral and intraoral regions. It is essential that paediatricians and dentists be aware of the problem, trained in its detection, and knowledgeable of when and how to document and notify suspected cases. These efforts, as well as the overall work of these professionals, will increase our ability to prevent and detect child maltreatment and to protect and care for children.

Introducción: el objetivo de este estudio es revisar las manifestaciones orales y dentales del maltrato infantil. Material y métodos: estudio de revisión sistemática siguiendo directrices PRISMA. Se realizaron dos estrategias de búsqueda con términos MeSH en la base de datos Medline/PubMed desde el 1/1/2000 hasta el 31/12/2019. Resultados: 26 artículos fueron incluidos. El 65,4% se publicaron en revistas de Odontología y el 16% en las de Pediatría. Todas las lesiones orales y dentales por abuso físico son sospechosas, pero ninguna patognomónica. Deben distinguirse de las accidentales, comunes en la edad pediátrica. Para ello, es necesario observar la existencia de indicadores físicos de especial sospecha. Todas las enfermedades orales y dentales por negligencia son sugerentes, pero ninguna patognomónica. Por ello, es necesario observar si existen factores considerados como necesarios para establecer el diagnóstico de negligencia dental, problemas de salud derivados de una negligencia crónica, y otros indicadores de abuso físico o sexual. Las infecciones orales por Neisseria gonorrhoeae y Treponema pallidum son patognomónicas de abuso sexual. Todas las demás lesiones y enfermedades orales son sospechosas o sugerentes. Conclusiones: las lesiones y enfermedades por abusos y negligencia infantil se manifiestan con frecuencia en la región oral e intraoral. Es fundamental que los pediatras y los odontólogos tengan conciencia del problema, estén formados en su detección, y conozcan cuándo y cómo documentar y notificar. Tales esfuerzos, así como el trabajo en común de dichos profesionales, fortalecerán la capacidad de prevenir y detectar el maltrato infantil y mejorar la capacidad de cuidar y proteger a los niños.

Abstract Introduction: Oral and dental (OD) disorders in children with Rubinstein-Taybi syndrome (RTS) are frequent but not well-known by dentists and pediatricians due to the syndrome being extremely rare. Objective: To describe the OD findings observed in a 5-year-old girl with RTS and to update the literature. Clinical case: The patient presented the following OD manifestations: prominent lower lip, narrow mouth opening, narrow and arched palate, history of angular cheilitis, micrognathia, poor lingual motility, plaque and tartar, bleeding from gingival areas due to poor dental prophylaxis, and malocclusion in the form of an anterior open bite. These OD manifestations are seen in more than 40-60% of patients with RTS. Conclusions: Professionals who treat children with RTS should become aware of the advisability of referring them to the pediatric dentist from 1 year of age and performing check-ups every 6 months. Dental management is often difficult so collaboration with anesthesiologists is recommended in order to carry out a safe and effective treatment.

Abstract Central precocious puberty (CPP) is a rare disease. The mean annual incidence in girls is 0.8-1.1/100,000 and in boys 0-0.1/100,000. Intracranial arachnoid cysts (ICACs) are usually congenital and represent 1% of intracranial masses in newborns. Intraventricular location is rare. The objective of this work is to carry out a literature updated review of the coexistence of CPP and intraventricular arachnoid cyst (IVAC). ICACs are usually asymptomatic but can present with CPP in 10-40% of patients. IVACs represents only 0.3-1.4% of ICACs, and most seemed originate from the velum interpositum cistern. CPP in girls is usually idiopathic, while in 30-70% of boys are due to an intracranial lesion. Therefore, the coexistence of PPC and IVAC is very rare in boys and exceptional in girls. The exact mechanism of a cyst´s influence on the hypothalamic-pituitary axis is not completely understood. Theories include increased ventricular volume, associated mass effect on the hypothalamus, and direct compression of portions of the hypothalamic-pituitary axis. Analysis of LH peaks after GnRH testing is the gold standard for the diagnosis of CPP. Brain MRI should be part of the assessment in boys and also in girls since clinical features, including age and sex, are not helpful in predicting those with underlying brain pathology. In cases of CPP with IVAC, surgery does not have any effect on the course of pubertal development. The indication for surgery is the onset of neurological symptoms. The medical treatment selected, safe and effective, is GnRH analog depot preparations. In conclusion, there seems to be a consensus for the diagnosis and management of the coexistence of CPP and IVAC, but the etiopathogenesis is not yet well recognized.

Abstract Introduction and objective: The study aimed to investigate the prevalence of untreated dental caries in Latin American immigrant children who enter into the child protection system in Aragon, Spain. We analyze if these are related to demographic factors, body mass index, or vulnerability circumstances. Methods: Cross-sectional observational study. We analyze the social and health records of every child between the age of 6 and 17 that required residential care in the period between 2000 and 2019. The Social Services Institute of Aragon who compiled their records and directed the protection measures assessed their vulnerability conditions. A standard anthropometric and oral evaluation by healthcare professionals, together with the recollection of their demographic data, was carried out as these children accessed the welfare system. Results: Two hundred and thirty-one children (55.8% female) with an average age (SD) of 13.6 (3.8) years were evaluated. The prevalence of untreated dental caries was 16.5%. These were associated to the age group 6-13 years-old (p<0.001), the second-generation (p=0.004) and the temporary or permanent parental inability to provide child welfare (p=0.009) due to death, incarceration, physical illness, mental illness, drug addiction, or causes of a similar nature, together with the absence of relatives taking care of the child. The prevalence of overweight and obesity was 32% and do not exhibited association with the presence of untreated dental caries. Conclusion: We observe either that, besides cariogenic dietary habits acquired in their native community or their foster one, socio-family vulnerability and deprivation play an essential role in the high prevalence of untreated dental caries.

Abstract Introduction: few studies conducted in Spain have analysed the influence of ethnicity in the prevalence of overweight and obesity in adolescents. Our aim was to assess the prevalence of overweight and obesity in first-generation immigrant adolescents in Aragon, compared our results to those of the HBSC-2014 study for Spain, and discuss potential aetiological factors. Materials and methods: cross-sectional study in 274 immigrant adolescents (11-17 years) from Latin America (n = 160) and Eastern Europe (n = 114). To assess overweight and obesity, we calculated the body mass index an applied the cut-off points proposed by the International Obesity Task Force. We used two-tailed z- and t-tests for comparisons, defining statistical significance as a p-value of less than 0.05. Results: we found overweight or obesity in 27.5% of immigrant adolescents from Latin America (18.8% and 8.7%, respectively) and 14.9% of those from Eastern Europe (12.3% and 2.6%, respectively). In Latin American adolescents, the prevalence of obesity was significantly higher (P = .03846), as was the prevalence of overweight and obesity combined (P = .01352), mostly on account of male adolescents (P = .04036). The comparison with the HBSC-2014 study in Spain showed a higher prevalence of obesity in Latin American immigrant adolescents that was statistically significant (P = .00228). Conclusions: the prevalence of overweight and obesity in first-generation immigrant adolescents from Latin America was significantly higher than that observed in autochthonous Spanish adolescents and Caucasian first-generation immigrant adolescents. We believe that genetic, socio-economic, cultural and behavioural factors are involved in the aetiology of obesity and overweight. This population is at high risk of developing metabolic syndrome and cardiovascular disease in adulthood.

Resumen Introducción: en España son escasos los estudios que analizan la influencia étnica en la prevalencia de sobrepeso y obesidad en la adolescencia. El objetivo es investigar la prevalencia de sobrepeso y obesidad en adolescentes inmigrantes de primera generación en Aragón, comparar los resultados con los del Estudio HBSC-2014 España, y emitir consideraciones etiológicas. Material y métodos: estudio transversal sobre 274 adolescentes (11-17 años) inmigrantes de Latinoamérica (n = 160) y Europa del Este (n = 114). Para definir el sobrepeso y la obesidad se calculó el índice de masa corporal y se utilizaron los puntos de corte propuestos por la International Obesity Task Force. Para el estudio comparativo se utilizaron la prueba Z y la prueba T-test, de dos colas, con un nivel de significación de p < 0,05. Resultados: presentaron sobrepeso y obesidad el 27,5% de los adolescentes inmigrantes latinoamericanos (el 18,8 y el 8,7%, respectivamente) y el 14,9% de los de Europa del Este (el 12,3 y el 2,6%, respectivamente). Los adolescentes latinoamericanos mostraron una prevalencia superior y estadísticamente significativa de obesidad (p = 0,03846) y de sobrepeso y obesidad (p = 0,01352), a expensas principalmente de los varones (p = 0,04036). La comparación con el Estudio HBSC-2014 España mostró una prevalencia superior y estadísticamente significativa de obesidad (p = 0,00228) en los latinoamericanos. Conclusiones: la prevalencia de sobrepeso y obesidad en los adolescentes inmigrantes de primera generación de Latinoamérica es significativamente superior que la observada en adolescentes autóctonos e inmigrantes de primera generación de origen caucásico. Consideramos que en su etiología intervienen factores genéticos, socioeconómicos, culturales y comportamentales. Esta población tiene un alto riesgo de desarrollar un síndrome metabólico y enfermedades cardiovasculares en la edad adulta.

Objectives: To determine whether there are differences between Spanish gypsy and foreign immigrant children admitted to protection centers in the characteristics of the maltreatment, social and familial factors linked to maltreatment, and health status. Methods: The social and health reports of 83 Spanish gypsy and 105 foreign immigrant children admitted to protection centers of the Aragonese Institute for Social Services (Instituto Aragonés de Servicios Sociales [IASS]) because of maltreatment from January 1994 to December 2003 were reviewed. Maltreatment, its types, and warning signs were defined and assessed according to the guidelines drawn up by the IASS. The social and familial risk factors associated with maltreatment were determined according to national studies. Health status was assessed following protocols used by the IASS. A descriptive and comparative statistical study was performed. Results: The Spanish gypsy children were mostly in the age group of 0-5 years, while foreign immigrants were mostly in the age group of 12-17 years. Spanish gypsy children showed a greater frequency of physical and emotional neglect and/or abandonment (p < 0.001) and were more likely to have families with problems of crime (odds ratio [OR] = 16.5; 95% confidence interval [95%CI], 6.7-40.7), drug/alcohol abuse (OR = 8.8; 95%CI, 3.7-21) and families with more than one social and health risk factor (OR = 9.3; 95%CI, 3.8-22.8). Spanish gypsy children showed a greater frequency of neurological disorders, disabling diseases, absent or incomplete immunizations, and dermatologic diseases. Foreign immigrant children showed a greater frequency of physical and psychological and/or sexual abuse (p < 0.001) and were more likely to live in a single parent family (OR = 7.9; 95%CI, 2.2-27.7). Conclusions: Identifying the differences between these two groups of maltreated children could be useful for professionals working in the community social services in charge of developing intervention strategies for the prevention and early detection of maltreatment, as well as for professionals in charge of the health of these children during their stay in a protection center.

Objetivos: Analizar las diferencias entre niños españoles de etnia gitana e inmigrantes extranjeros ingresados en centros de protección, respecto a las características del maltrato, los factores familiares y el estado de salud. Métodos: Se revisaron los expedientes sociosanitarios de 83 niños gitanos españoles y 105 niños inmigrantes que ingresaron desde enero de 1994 hasta diciembre de 2003 por maltratos en centros de protección del Instituto Aragonés de Servicios Sociales (IASS). El maltrato, sus tipos e indicadores se definieron y evaluaron según guías elaboradas por el IASS. Los factores familiares de riesgo sociosanitario asociados con el maltrato se determinaron según estudios nacionales. El estado de salud se evaluó según los protocolos elaborados por el IASS. Se realizó un estudio estadístico descriptivo y comparativo. Resultados: En los niños gitanos españoles predomina el grupo de edad de 0-5 años, mientras que en los inmigrantes es más frecuente el grupo de 12-17 años. En los niños gitanos españoles es también más frecuente la situación de negligencia física, emocional y/o abandono (p < 0,001) y la pertenencia a familias con problemas de delincuencia (odds ratio [OR] = 16,5; intervalo de confianza [IC] del 95%, 6,7-40,7), toxicomanía o alcoholismo (OR = 8,8; IC del 95%, 3,7-21,0) y multiproblemáticas (OR = 9,3; IC del 95%, 3,8-22,8). En los niños gitanos es más frecuente también la presencia de trastornos neurológicos, enfermedades discapacitantes, inmunizaciones ausentes o incompletas y enfermedades dermatológicas. Por su parte, los niños inmigrantes presentaron una frecuencia superior de maltrato físico, psicológico y/o sexual (p < 0,001), así como una procedencia de familias monoparentales (OR = 7,9; IC del 95%, 2,2-27,7). Conclusiones: Conocer las diferencias entre estos 2 grupos de niños maltratados puede ser de utilidad para los profesionales de los servicios sociales comunitarios responsables de desarrollar estrategias de intervención para la prevención y la detección precoz del maltrato, y para los responsables de la salud de estos menores mientras permanecen en un centro de protección.

Objectives: To determine whether there are differences between Spanish gypsy and foreign immigrant children admitted to protection centers in the characteristics of the maltreatment, social and familial factors linked to maltreatment, and health status. Methods: The social and health reports of 83 Spanish gypsy and 105 foreign immigrant children admitted to protection centers of the Aragonese Institute for Social Services (Instituto Aragonés de Servicios Sociales [IASS]) because of maltreatment from January 1994 to December 2003 were reviewed. Maltreatment, its types, and warning signs were defined and assessed according to the guidelines drawn up by the IASS. The social and familial risk factors associated with maltreatment were determined according to national studies. Health status was assessed following protocols used by the IASS. A descriptive and comparative statistical study was performed. Results: The Spanish gypsy children were mostly in the age group of 0-5 years, while foreign immigrants were mostly in the age group of 12-17 years. Spanish gypsy children showed a greater frequency of physical and emotional neglect and/or abandonment (p < 0.001) and were more likely to have families with problems of crime (odds ratio [OR] = 16.5; 95% confidence interval [95%CI], 6.7-40.7), drug/alcohol abuse (OR = 8.8; 95%CI, 3.7-21) and families with more than one social and health risk factor (OR = 9.3; 95%CI, 3.8-22.8). Spanish gypsy children showed a greater frequency of neurological disorders, disabling diseases, absent or incomplete immunizations, and dermatologic diseases. Foreign immigrant children showed a greater frequency of physical and psychological and/or sexual abuse (p < 0.001) and were more likely to live in a single parent family (OR = 7.9; 95%CI, 2.2-27.7). Conclusions: Identifying the differences between these two groups of maltreated children could be useful for professionals working in the community social services in charge of developing intervention strategies for the prevention and early detection of maltreatment, as well as for professionals in charge of the health of these children during their stay in a protection center.

Objetivos: Analizar las diferencias entre niños españoles de etnia gitana e inmigrantes extranjeros ingresados en centros de protección, respecto a las características del maltrato, los factores familiares y el estado de salud. Métodos: Se revisaron los expedientes sociosanitarios de 83 niños gitanos españoles y 105 niños inmigrantes que ingresaron desde enero de 1994 hasta diciembre de 2003 por maltratos en centros de protección del Instituto Aragonés de Servicios Sociales (IASS). El maltrato, sus tipos e indicadores se definieron y evaluaron según guías elaboradas por el IASS. Los factores familiares de riesgo sociosanitario asociados con el maltrato se determinaron según estudios nacionales. El estado de salud se evaluó según los protocolos elaborados por el IASS. Se realizó un estudio estadístico descriptivo y comparativo. Resultados: En los niños gitanos españoles predomina el grupo de edad de 0-5 años, mientras que en los inmigrantes es más frecuente el grupo de 12-17 años. En los niños gitanos españoles es también más frecuente la situación de negligencia física, emocional y/o abandono (p < 0,001) y la pertenencia a familias con problemas de delincuencia (odds ratio [OR] = 16,5; intervalo de confianza [IC] del 95%, 6,7-40,7), toxicomanía o alcoholismo (OR = 8,8; IC del 95%, 3,7-21,0) y multiproblemáticas (OR = 9,3; IC del 95%, 3,8-22,8). En los niños gitanos es más frecuente también la presencia de trastornos neurológicos, enfermedades discapacitantes, inmunizaciones ausentes o incompletas y enfermedades dermatológicas. Por su parte, los niños inmigrantes presentaron una frecuencia superior de maltrato físico, psicológico y/o sexual (p < 0,001), así como una procedencia de familias monoparentales (OR = 7,9; IC del 95%, 2,2-27,7). Conclusiones: Conocer las diferencias entre estos 2 grupos de niños maltratados puede ser de utilidad para los profesionales de los servicios sociales comunitarios responsables de desarrollar estrategias de intervención para la prevención y la detección precoz del maltrato, y para los responsables de la salud de estos menores mientras permanecen en un centro de protección.