RESUMO Objetivo: Reconhecer e abordar a síndrome de Patau, apesar de sua raridade e da baixa expectativa de vida associada, por meio da apresentação de um estudo de caso de uma paciente de dois anos que recebe cuidados em casa por intermédio de serviços de home care. Descrição do caso: Apresentamos uma paciente do sexo feminino que desafiou as probabilidades, com sobrevivência prolongada devida, possivelmente, ao home care. Ela nasceu por cesariana, com 31 semanas + 4 dias, em razão da restrição do crescimento uterino. A mãe, de 36 anos, recebeu cuidados pré-natais adequados e gozava de boa saúde. O diagnóstico da síndrome de Patau foi confirmado por meio de cariótipo após o nascimento. Apesar da gravidade clínica do caso, a paciente, hoje com dois anos, recebe atendimento domiciliar especializado, apoiado por traqueostomia e gastrostomia. Um técnico de enfermagem dedicado 24 horas garante acompanhamento contínuo, e a paciente beneficia-se de check-ups médicos regulares, fisioterapia cinco vezes por semana, sessões semanais de fonoaudiologia, consultas mensais com nutricionista e apoio psicológico contínuo aos familiares. Comentários: Esta abordagem multidisciplinar resultou em melhora motora discreta, destacando o impacto positivo do cuidado integral no seu bem-estar geral. A existência de uma rede robusta de apoio às famílias que enfrentam desafios semelhantes é crucial, e um cuidado multidisciplinar pode prevenir eficazmente as complicações associadas a esta impactante síndrome. Objetivo associada care probabilidades devida possivelmente cesariana 3 dias uterino mãe prénatais pré natais saúde nascimento especializado gastrostomia 2 beneficiase beneficia se checkups check ups regulares semana fonoaudiologia familiares Comentários discreta bemestar bem estar geral crucial

ABSTRACT Objective: To recognize and address Patau’s syndrome, despite its rarity and associated low life expectancy, through the presentation of a case study of a 2-year-old patient receiving Home Care services. Case description: We present a female patient who defied the odds with a prolonged survival, possible due to Home Care. She was delivered via cesarean section at 31 weeks + 4 days due to restricted uterine growth. The mother, aged 36, had received proper prenatal care and was in good health. The diagnosis of Patau’s syndrome was confirmed through karyotyping after birth. Despite the severe clinical nature of the case, the patient, now with two years old, receives specialized home-based care, supported by a tracheostomy and gastrostomy. A dedicated 24-hour nursing technician ensures continuous monitoring, and the patient benefits from regular medical check-ups, physiotherapy five times a week, weekly speech therapy sessions, monthly consultations with a nutritionist, and ongoing psychological support for her family members. Comments: This multidisciplinary approach has resulted in a slight motor response, highlighting the positive impact of comprehensive care on her overall well-being. The existence of a robust support network for families facing similar challenges is crucial, and a multidisciplinary care can effectively prevent complications associated with this impactful syndrome. Objective Pataus Patau s expectancy 2yearold yearold 2 year old services description survival 3 growth mother 36 health birth homebased home based gastrostomy 24hour hour 24 monitoring checkups, checkups check ups, ups check-ups week sessions nutritionist members Comments response wellbeing. wellbeing well being. being well-being crucial

ABSTRACT Introduction: sexual satisfaction and safety are key elements for male well-being, integrating physical and emotional aspects of intimacy. These concepts encompass the full enjoyment of sexual relationships, along with comfort and confidence in the protective practices used. Objective: determine sexual happiness and satisfaction with sexual safety in men from Asunción and Central during 2023. Methodology: a cross-sectional study was carried out in Asunción and Central during the months of September to November 2023. The study population consisted of eligible men who were over 18 years of age, who were assigned the sex male at birth, residents of the selected cities. The study variables were demographics, mental health (anxiety, depression and suicidal ideation). Results: the study included 143 participants. Of these, 55.24 % (79) were between 18 and 29 years old, 69.23 % (99) identified as gay, and 12.59 % (18) as bisexual. Men who have sex with men showed a higher probability of reporting satisfaction, with an age-adjusted odds ratio of 2.82 (95 % CI: 1.41-3.57, p=0.001) compared to heterosexuals. Having three or more stable partners and eleven or more non-stable partners was strongly associated with being MSM (p=0.003 and p=0.001, respectively). Conclusion: men who have sex with men reported higher levels of sexual satisfaction, suggesting a positive experience in their intimate relationships. However, this group also showed a tendency to have a higher number of sexual partners, both stable and non-stable. These differences in sexual behaviors may indicate distinct social norms or personal preferences among the studied groups.

RESUMEN Introducción: la satisfacción y seguridad sexual son elementos clave para el bienestar masculino, integrando aspectos físicos y emocionales de la intimidad; estos conceptos engloban el disfrute pleno de las relaciones sexuales, junto con la comodidad y confianza en las prácticas de protección utilizadas. Objetivo: determinar la felicidad sexual y satisfacción con la seguridad sexual en hombres de Asunción y Central durante el 2023. Metodología: se realizó un estudio observacional, descriptivo de corte transversal en Asunción, y Central durante los meses de setiembre a noviembre del 2023. La población de estudio lo constituyeron los hombres elegibles que tenían mayor de 18 años, a quienes se les asignó el sexo masculino al nacer, residentes de las ciudades seleccionadas. Las variables del estudio fueron las demográficas, salud mental (ansiedad, depresión e ideación suicida). Resultados: el estudio incluyó 143 participantes. De estos, el 55,24 % (79) tenía entre 18 y 29 años, el 69,23 % (99) se identificó como gay, y el 12,59 % (18) como bisexual. Los Hombres que tienen sexo con hombres mostraron una mayor probabilidad de reportar satisfacción, con una odds ratio ajustada por edad de 2,82 (IC 95 %: 1,41-3,57, p=0,001) en comparación con los heterosexuales, tener tres o más parejas estables y once o más parejas no estables se asoció fuertemente con ser HSH (p=0,003 y p=0,001, respectivamente). Conclusión: los hombres que tienen sexo con hombres reportaron niveles más altos de satisfacción sexual, lo que sugiere una experiencia positiva en sus relaciones íntimas. Sin embargo, este grupo también mostró una tendencia a tener un mayor número de parejas sexuales, tanto estables como no estables. Estas diferencias en comportamientos sexuales pueden indicar distintas normas sociales o preferencias personales entre los grupos estudiados.

Abstract It is known that neuronal maturation after birth lasts approximately twenty years and requires a large amount of energy. If a pregnancy occurs before maturation, the energy must be distributed between the mother and the offspring, having an effect on the anatomical and functional processes of the brain. Therefore, the electrical activity of the frontal cortex was compared, as well as the performance of its functions and maternal care in adolescents and young people (less than six months after giving birth). The NEUROPSI test (attention and coding) and a maternal care instrument were applied to primiparous adolescents and young people; electroencephalographic recordings were performed on a sample of this population. Significant differences are observed in the coding and attention processes (F= 4.5, α= 0.03*; F= 79.7, α= 0.00**), and a significant correlation between attention and maternal care (health and affection categories) as well as health care coding. The electrical activity of the frontal lobe was slower in primiparous adolescents as well as maternal care behaviors. The above is related to delay in the neuronal maturation of adolescent mothers.

Resumen Se sabe que la maduración neuronal tras el nacimiento dura aproximadamente veinte años y necesita gran cantidad de energía. Si ocurre un embarazo antes de la maduración, la energía debe repartirse entre la madre y la cría, teniendo efecto en los procesos anatómicos y funcionales del cerebro. Por ello, se comparó la actividad eléctrica de la corteza frontal, así como el desempeño de sus funciones y cuidados maternales en adolescentes y jóvenes (con menos de seis meses posteriores al parto). Se aplicó el test NEUROPSI (atención y codificación) y un instrumento de cuidados maternales a primíparas adolescentes y jóvenes; a una muestra de esta población se les realizó registros electroencefalográficos. Se observan diferencias significativas en los procesos de codificación y atención (F= 4.5, α= 0.03*; F=79.7, α= 0.00**), y una correlación significativa entre la atención y el cuidado maternal (categorías de salud y cariño), así como de la codificación sobre el cuidado de la salud. La actividad eléctrica del lóbulo frontal fue más lenta en las adolescentes primíparas, así como las conductas de cuidado maternal. Lo anterior se relaciona con una menor maduración neuronal de madres adolescentes.

Abstract The birth of the liberal system of education in the Roman Empire and its expansion, after the French revolution through pedagogical naturalism along the paths of Western education, its diversification through the new school movement means the installation from the conjunctural to the structural of a soft pedagogy that, with the emergence of emotional intelligences, infantilises education from the devaluation of discipline, effort and study as an arduous and slow process. To this, after the pandemic, online education intensifies and algorithms appear as agile solutions to accelerate and simplify the teaching-learning processes. The desire to make education profitable means the viralisation and hegemony of neoliberal budgets at all levels of education systems, progressively transforming higher education into theme parks at the service of transnationals where gamification replaces pedagogy and didactics replaces epistemologies, emptying universities of knowledge to turn them into higher institutions of entertainment. Re-reading memory not in order to commune with the past, but to analyse the intentions that founded universities as institutions that hosted slow pedagogies, based on study and discipline to dissolve the discourses ascribed to power and to be sources of contextualised and problematic truths, capable of disputing authoritarianisms' status quo through a dialogue of knowledge necessary for the construction of the imaginary of the community.

Resumen El nacimiento del sistema liberal de enseñanza en el imperio romano y su expansión, tras la revolución francesa, a través del naturalismo pedagógico, por las sendas de la educación occidental, su diversificación mediante el movimiento de la escuela nueva, significa la instalación desde lo coyuntural a lo estructural de una pedagogía blanda que, con la emergencia de las inteligencias emocionales, infantiliza la educación desde la devaluación de la disciplina, el esfuerzo y el estudio como un proceso arduo y lento. A ello, tras la pandemia, se intensifica la educación online y aparecen los algoritmos como soluciones ágiles para acelerar y simplificar los procesos de enseñanza-aprendizaje (la educación se vuelve sólo aprendizaje). Los deseos de rentabilizar la educación significan la viralización y hegemonía de los presupuestos neoliberales en todos los niveles de los sistemas educativos, transformando las instituciones de educación superior, progresivamente, en parques temáticos al servicio de las transnacionales donde la gamificación sustituye a la pedagogía y las didácticas a las epistemologías, vaciando las universidades de saberes para convertirlas en instituciones de entretenimiento. Releer el pasado, no para comulgar con él, sino para recuperar las intenciones que fundaron las universidades como instituciones que hospedaron unas pedagogías lentas, basadas en el estudio y la disciplina, capaces de educar sujetos capaces de disolver los discursos adscritos al poder y, ser fuentes de verdades contextualizadas y problemáticas; capaces, en suma, de disputar a los autoritarismos su estatus quo mediante un diálogo de saberes necesario para la construcción del imaginario de lo comunitario.

Resumen La seguridad de los psicofármacos durante el embarazo es un tema crucial en la práctica clínica. En esta revisión, se hace un breve recorrido sobre los cambios en el embarazo que impactan en la farmacodinamia de los medicamentos, además, se analizan los principales grupos farmacológicos en psiquiatría y sus efectos durante el embarazo. Se identifican tres períodos críticos durante el embarazo. El período de las primeras dos semanas se asocia con un mayor riesgo de aborto espontáneo. El período de la segunda a la décima semana es el más riesgoso, ya que pueden ocurrir alteraciones teratogénicas que afectan el desarrollo fetal. El período posterior a la décima semana se caracteriza por alteraciones en el crecimiento y desarrollo funcional del feto, pero suelen ser menos graves. Los antidepresivos, especialmente los inhibidores selectivos de la receptación de serotonina (ISRS) y los antipsicóticos de segunda generación se consideran los más seguros, pero estos últimos pueden estar asociados con síndrome metabólico, cardiopatías congénitas y trastornos del neurodesarrollo. El litio se ha asociado con efectos teratogénicos y malformaciones cardíacas, mientras que el valproato está relacionado con defectos congénitos importantes. Las benzodiacepinas pueden tener efectos tóxicos y causar síndrome de abstinencia en el recién nacido. La seguridad de los psicofármacos durante el embarazo requiere una evaluación individualizada de los beneficios y riesgos. Aunque algunos grupos de psicofármacos se consideran relativamente seguros, es necesario tener precaución y considerar las posibles complicaciones asociadas con su uso durante el embarazo.

Abstract: The safety of psychoactive drugs during pregnancy is a crucial issue in clinical practice. In this review, a brief overview of the changes in pregnancy that impact the pharmacodynamics of drugs is made; in addition, the main pharmacological groups in psychiatry and their effects during pregnancy are analyzed. Three critical periods during pregnancy are identified. The period of the first two weeks is associated with an increased risk of miscarriage. The period from the second to the tenth week is the most at risk , since teratogenic effects that affect fetal development can take place. The period after the tenth week is characterized by alterations in fetal growth and functional development , however ,less severe defects. Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), and second-generation antipsychotics are considered the safest, but the latter may be associated with metabolic syndrome, congenital heart disease, and neurodevelopmental disorders. Lithium has been associated with teratogenic effects and cardiac malformations, while valproate is associated with major birth defects. Benzodiazepines can have toxic effects and cause Neonatal Withdrawal Syndrome . The safety of psychotropic drugs during pregnancy requires an individualized assesment of the benefits and risks. Although some groups of psychiatric drugs are considered relatively safe, caution is needed when considering the potential complications associated with their use during pregnancy.

Resumo Introdução: A deficiência de crescimento na doença renal crônica está relacionada à elevada morbidade e mortalidade. O retardo do crescimento nessa doença é multifatorial. É fundamental conhecer os fatores modificáveis e estabelecer estratégias para melhorar o atendimento às crianças afetadas. Objetivos: Descrever padrões de crescimento em crianças com DRC e fatores de risco associados à baixa estatura. Métodos: Analisamos retrospectivamente dados antropométricos e epidemiológicos, peso ao nascer, prematuridade e níveis de bicarbonato, hemoglobina, cálcio, fosfato, fosfatase alcalina e paratormônio de crianças com DRC estágios 3–5, não submetidas a diálise, acompanhadas por pelo menos um ano. Resultados: Incluímos 43 crianças, a maioria meninos (65%). O escore z médio de altura/comprimento/idade das crianças no início e no acompanhamento foi de –1,89 ± 1,84 e –2,4 ± 1,67, respectivamente (p = 0,011). Cinquenta e um por cento das crianças apresentaram baixa estatura, e essas crianças eram mais jovens que aquelas com estatura adequada (p = 0,027). Níveis de PTH no início do acompanhamento correlacionados com escore z de altura/comprimento/idade. Uma subanálise com crianças menores de cinco anos (n = 17) mostrou que 10 (58,8%) delas apresentaram déficit de desenvolvimento e escore z de peso/idade mais baixo (0,031) e escore z de IMC/idade mais baixo (p = 0,047). Conclusão: Crianças, especialmente mais jovens, com DRC, que não estavam em diálise, apresentaram elevada prevalência de baixa estatura. Níveis de PTH foram correlacionados com escore z de altura, e deficiência de crescimento foi associada a pior estado nutricional. Portanto, é essencial monitorar o crescimento dessas crianças, controlar o hiperparatireoidismo e fornecer suporte nutricional. Introdução mortalidade multifatorial afetadas Objetivos Métodos epidemiológicos nascer bicarbonato hemoglobina cálcio fosfato 35 3 5 3–5 diálise ano Resultados 4 65%. 65 65% . (65%) alturacomprimentoidade altura comprimento idade 189 1 89 –1,8 184 84 1,8 24 2 –2, 167 67 1,67 p 0,011. 0011 0,011 0 011 0,011) 0,027. 0027 0,027 027 0,027) n 17 58,8% 588 58 8 (58,8% pesoidade 0,031 0031 031 (0,031 IMCidade IMC 0,047. 0047 0,047 047 0,047) Conclusão Crianças nutricional Portanto 3– 6 (65% 18 –1, 1, –2 16 1,6 001 0,01 01 002 0,02 02 58,8 (58,8 0,03 003 03 (0,03 004 0,04 04 (65 –1 – 00 0,0 58, (58, (0,0 (6 0, (58 (0, ( (5 (0

Abstract Introduction: Growth failure in chronic kidney disease is related to high morbidity and mortality. Growth retardation in this disease is multifactorial. Knowing the modifiable factors and establishing strategies to improve care for affected children is paramount. Objectives: To describe growth patterns in children with chronic kidney disease and the risk factors associated with short stature. Methods: We retrospectively analyzed anthropometric and epidemiological data, birth weight, prematurity, and bicarbonate, hemoglobin, calcium, phosphate, alkaline phosphatase, and parathormone levels of children with stages 3–5 CKD not on dialysis, followed for at least one year. Results: We included 43 children, the majority of which were boys (65%). The mean height/length /age z-score of the children at the beginning and follow-up was –1.89 ± 1.84 and –2.4 ± 1.67, respectively (p = 0.011). Fifty-one percent of the children had short stature, and these children were younger than those with adequate stature (p = 0.027). PTH levels at the beginning of the follow-up correlated with height/length/age z-score. A sub-analysis with children under five (n = 17) showed that 10 (58.8%) of them failed to thrive and had a lower weight/age z-score (0.031) and lower BMI/age z-score (p = 0.047). Conclusion: Children, particularly younger ones, with chronic kidney disease who were not on dialysis had a high prevalence of short stature. PTH levels were correlated with height z-score, and growth failure was associated with worse nutritional status. Therefore, it is essential to monitor the growth of these children, control hyperparathyroidism, and provide nutritional support. Introduction mortality multifactorial paramount Objectives Methods data weight prematurity bicarbonate hemoglobin calcium phosphate phosphatase 35 3 5 3– year Results 4 65%. 65 65% . (65%) heightlength length age zscore z score followup follow up 189 1 89 –1.8 184 84 1.8 24 2 –2. 167 67 1.67 p 0.011. 0011 0.011 0 011 0.011) Fiftyone Fifty 0.027. 0027 0.027 027 0.027) heightlengthage zscore. score. subanalysis sub analysis n 17 58.8% 588 58 8 (58.8% weightage 0.031 0031 031 (0.031 BMIage BMI 0.047. 0047 0.047 047 0.047) Conclusion Children ones zscore, score, status Therefore hyperparathyroidism support 6 (65% 18 –1. 1. –2 16 1.6 001 0.01 01 002 0.02 02 58.8 (58.8 0.03 003 03 (0.03 004 0.04 04 (65 –1 – 00 0.0 58. (58. (0.0 (6 0. (58 (0. ( (5 (0

Abstract Introduction: Adverse or favourable rearing conditions early in life affect emotional response during adolescence. To study the effect of early rearing on emotional response, animal models such as maternal separation (MS) and social enrichment (SE) by community nesting have been useful. However, the comparison of the effect of MS and SE on anxiety-related behaviours in adolescent rats is unknown. Objective: This study aimed to assess the effects of MS and SE on the emotional response of adolescent rats exposed to the elevated plus-maze test (EPM). Method: Pregnant Wistar rats were randomly distributed into three groups according to the rearing condition. In the MS group, pups were separated daily from their dams for 180 minutes, from postnatal day (P) 2 to 14. In the SE group, two females that gave birth synchronously were housed in a cage with a litter of eight pups. Females from control standard housing (SH) were individually housed and kept with their offspring until weaning (P23). On P32, anxiety-related measures were evaluated using an EPM. Results: MS and SE increase anxiety-related behaviours and locomotion in rats exposed to the EPM. SE had sex-dependent effects on anxiety-related measures, increasing vertical activity in females and horizontal activity in males. MS but not SE increased body weight gain in female rats. Conclusion: Adverse or favourable rearing conditions early in life may result in an increased anxiety phenotype in the EPM during adolescence. It is likely that the favourable effect of SE depends on the number of dams per communal nest.

Resumen Introducción: Las condiciones de crianza adversas o favorables en etapas tempranas de la vida afectan la respuesta emocional durante la adolescencia. Para estudiar el efecto de la crianza temprana sobre la respuesta emocional, han sido útiles modelos animales como la separación materna (SM) y el enriquecimiento social (ES) mediante anidamiento comunitario. Sin embargo, se desconoce la comparación del efecto de la SM y el ES sobre las conductas relacionadas con la ansiedad en ratas adolescentes. Objetivo: Este estudio pretende evaluar los efectos de la SM y el ES sobre la respuesta emocional de ratas adolescentes expuestas al test del laberinto en cruz elevado (EPM). Método: Las ratas Wistar preñadas se distribuyeron aleatoriamente en tres grupos según la condición de crianza. En el grupo SM, las crías fueron separadas diariamente de sus madres durante 180 minutos, desde el día postnatal (P) 2 hasta el 14. En el grupo ES, dos hembras que parieron de forma sincronizada se alojaron en una caja con una camada de ocho crías. Las hembras del alojamiento estándar de control (SH) se alojaron individualmente y se mantuvieron con sus crías hasta el destete (P23). En P32, se evaluaron las medidas relacionadas con la ansiedad mediante un EPM. Resultados: La SM y el ES aumentan las conductas relacionadas con la ansiedad y la locomoción en las ratas expuestas al EPM. El ES tuvo efectos dependientes del sexo en las medidas relacionadas con ansiedad, aumentando la actividad vertical en las hembras y la actividad horizontal en los machos. La SM, pero no el ES, incrementó la ganancia de peso corporal en las ratas hembra. Conclusiones: Condiciones de crianza adversas o favorables en etapas tempranas de la vida pueden dar lugar a un fenotipo de ansiedad aumentado en el EPM durante la adolescencia. Es probable que el efecto favorable del ES dependa del número de hembras por nido comunitario.

We investigated the timely initiation of antenatal care among Brazilian adolescents to support the national discussion on the gestational age limit for legal abortion. Using data from the Live Births Information System (SINASC) from 2020 to 2022, we correlated timely prenatal care (in the first trimester of pregnancy) with the adolescent's age, region, race/color, and education level. Considering the estimated age at conception, we estimate that 11,607 annual births result from vulnerable rape. Timely initiation increased with age, being 70.2% for all adolescents (<20 years), but only 55.6% for those under 13; 14.1% of adolescents started antenatal care at 22 weeks or more of gestation (28.3% among those <13 years). Timely initiation was lower in the North Region, among Indigenous girls, and among those with low educational attainment. The results challenge the recent legislative proposal to limit legal abortion for victims of vulnerable rape to up to 22 weeks of gestational age. Delays in recognizing pregnancy and communicating with the family contribute to the late initiation of antenatal care and the decision to abort. The proposed deadline for legal abortions will primarily affect the most socioeconomically and racially vulnerable adolescents.

Investigamos o início oportuno do pré-natal em adolescentes brasileiras para subsidiar a discussão nacional sobre o limite de idade gestacional para o aborto legal. Com dados do Sistema de Informação sobre Nascidos Vivos (SINASC) 2020-2022 correlacionamos o início oportuno do pré-natal (primeiro trimestre da gestação) com a idade da adolescente, região, raça/cor e escolaridade. Considerando a idade estimada na concepção, estimamos que 11.607 partos anuais resultam de estupro de vulnerável. O início oportuno aumentou com a idade, sendo de 70,2% para todas as adolescentes (<20 anos), mas de apenas 55,6% para aquelas abaixo de 13 anos; 14,1% das adolescentes iniciaram o pré-natal com 22 semanas ou mais de gestação (28,3% entre <13 anos). O início oportuno foi menor na Região Norte, entre meninas indígenas e entre aquelas com baixa escolaridade. Os resultados questionam o recente projeto de lei de limitar o aborto legal para vítimas de estupro de vulnerável até 22 de semanas de idade gestacional. Demoras no reconhecimento da gestação e na comunicação para a família contribuem para o início tardio do pré-natal e para a decisão de abortar. A proposta de limite do prazo para abortos legais irá atingir principalmente as adolescentes mais vulneráveis em termos socioeconômicos e raciais.

SUMMARY: Drinking alcohol while pregnant can cause several diseases, belonging to an umbrella of disorders known as Fetal Alcohol spectrum disorders. Alcohol exposure during pregnancy is linked to reduced birth weights, shorter bones, delayed bone growth, decreased bone resilience, and delayed ossification of the bones. However, the specific effects on the craniofacial bones, particularly the mandible, remain less explored. This study aims to fill this gap by examining the impact of gestational alcohol consumption on mandibular structure. Time-mated pregnant Sprague Dawley dams were divided into an ethanol group (n=6) and a saline control group (n=6). The ethanol group was given 0.015ml/g of 25.2% ethanol, while the control group received 0.9% saline for the first 19 days of gestation. The presence of a vaginal plug indicated the first day of gestation. After birth, the pups were euthanized at three weeks of age, and their mandibles were harvested and analyzed using a 3D-mCT scanner to assess bone ratio, trabecular thickness, number, and spacing. Osteometric measurements for mandibular length and height were also taken. The study found no significant differences in trabecular morphometric parameters between the groups. However, one parameter for mandibular length (Cd-Bi) and two parameters for mandibular height (Cd-Ag and Cr-Ag) were significantly smaller in the ethanol group than in the controls. The study reveals that gestational alcohol consumption can significantly affect the development of the mandible, with potential implications for understanding the mechanisms behind alcohol-induced teratogenicity. The findings highlight the need for further research to explore the intricate interactions between embryological, biological, genetic, and epigenetic factors that contribute to the varied effects of alcohol exposure during pregnancy on different skeletal systems.

RESUMEN: Beber alcohol durante el embarazo puede causar varias enfermedades, pertenecientes a un conjunto de trastornos conocidos como trastornos del espectro alcohólico fetal. La exposición al alcohol durante el embarazo está relacionada con un peso reducido al nacer, huesos más cortos, retraso en el crecimiento óseo, disminución de la resistencia ósea y retraso en la osificación de los huesos. Sin embargo, los efectos específicos sobre los huesos craneofaciales, particularmente la mandíbula, siguen siendo menos analizados. Este estudio tiene como objetivo llenar este vacío examinando el impacto del consumo de alcohol gestacional en la estructura mandibular. Las madres preñadas Sprague Dawley apareadas en el tiempo, se dividieron en un grupo de etanol (n=6) y un grupo control de solución salina (n=6). El grupo de etanol recibió 0,015 ml/g de etanol al 25,2 %, mientras que el grupo control recibió solución salina al 0,9 % durante los primeros 19 días de gestación. La presencia de un tapón vaginal indicó el primer día de gestación. Después del nacimiento, las crías fueron sacrificadas a las tres semanas de edad, y sus mandíbulas fueron extraídas y analizadas utilizando un escáner 3D-mCT para evaluar la proporción ósea, el grosor trabecular, el número y el espaciado. También se tomaron medidas osteométricas de longitud y altura mandibular. El estudio no encontró diferencias significativas en los parámetros morfométricos trabeculares entre los grupos. Sin embargo, un parámetro para la longitud mandibular (Cd-Bi) y dos parámetros para la altura mandibular (Cd-Ag y Cr-Ag) fueron significativamente menores en el grupo de etanol que en los controles. El estudio revela que el consumo de alcohol gestacional puede afectar significativamente el desarrollo de la mandíbula, con implicaciones potenciales para comprender los mecanismos detrás de la teratogenicidad inducida por el alcohol. Los hallazgos resaltan la necesidad de realizar más investigaciones para explorar las intrincadas interacciones entre factores embriológicos, biológicos, genéticos y epigenéticos que contribuyen a los diversos efectos de la exposición al alcohol durante el embarazo en diferentes sistemas esqueléticos.

Abstract Objective To evaluate the growth trajectory of head circumference and neurodevelopment, and to correlate head circumference with cognitive, language, and motor outcomes during the first two years. Method Prospective cohort study in a tertiary hospital including 95 newborns under 32 weeks or 1500 g. Neonates who developed major neonatal morbidities were excluded. The head circumference was measured at birth, at discharge, and at term-equivalent age, 1, 3, 5, 12, 18, and 24 months of corrected age, and the Bayley Scales (Bayley-III) were applied at 12, 18 and 24 months of corrected age to assess cognitive, language and, motor domains. Scores below 85 were classified as mild/moderate deficits and scores below 70 as severe deficits. The association between head circumference Z score and Bayley scores was assessed using Pearson's correlation. The study considered a significance level of 0.05. Results There was a decrease of -0.18 in the head circumference Z score between birth and discharge and the catch-up occurred between discharge and 1 month (an increase of 0.81 in the Z score). There was a positive correlation between head circumference and Bayley scores at 18 months. There was also a positive correlation between head circumference at discharge and at 5 months with the three domains of the Bayley. Conclusion Serial measurements of head circumference provide knowledge of the trajectory of growth, with early catch-up between discharge and 1 month, as well as its association with neurodevelopment. Head circumference is therefore a valuable clinical marker for neurodevelopment, especially in very preterm newborns. neurodevelopment cognitive years 9 3 150 g excluded termequivalent term equivalent 12 2 BayleyIII III (Bayley-III 8 mildmoderate mild moderate 7 Pearsons Pearson s 005 0 05 0.05 0.18 018 -0.1 catchup catch up an 081 81 0.8 score. . score) 15 00 0.0 0.1 01 -0. 08 0. -0 -

Abstract Objective To compare the phase angle (PhA) through bioelectrical impedance (BIA) of children with intestinal failure (IF) using prolonged parenteral nutrition (PN) followed by an Intestinal Rehabilitation Program, with a control group. Methods Children under 10 years of age with IF using prolonged PN for >60 days (study group) were included. The control group consisted of healthy children without chronic pathologies, matched by sex and age. Anthropometric parameters evaluated were: weight, height, weight/age z-score (W/A), height/age z-score (H/A), BMI, BMI/A z-score, arm circumference, triceps skinfold, subscapular skinfold, mid-arm muscle circumference. BIA parameters were resistance (R), reactance (Xc), and phase angle (PhA). Results Twenty-eight children were included in the study group, median (IQR) age was 11 (8-27) months, 53.6 % were male. In the control group, 28 children were included, median (IQR) age was 12.5 (8-24.7) months, 50 % were male. Children from the study group had W/A z-scores and H/A z-scores significantly lower than controls. There was no significant difference between PhA in the study group and controls, [median (IQR) 4.3° (3.8;4.6) vs 4.0° (3.8;5.4) respectively, p = 0.980]. Prematurity was significantly higher in the study group than in the controls, but there was no significant correlation between gestational age at birth and PhA of the children from the study group. Conclusion Children with IF using prolonged PN showed lower W/A and H/A compared to the control group, but without significant difference between the PhA of children with IF compared to controls. (PhA (BIA (IF (PN Program 1 60 >6 pathologies weight height weightage zscore z score W/A, WA , W A (W/A) heightage H/A, HA H (H/A) BMI BMIA zscore, score, circumference skinfold midarm mid R, R (R) Xc, Xc (Xc) PhA. . Twentyeight Twenty eight IQR (IQR 827 8 27 (8-27 months 536 53 6 53. male 2 125 12 5 12. 824.7 8247 24.7 24 7 (8-24.7 zscores scores controls 43 4 3 4.3 3.84.6 3846 3.8 4.6 (3.8;4.6 40 0 4.0 3.85.4 3854 5.4 (3.8;5.4 respectively 0.980. 0980 0.980 980 0.980] > (W/A (H/A (R (Xc 82 (8-2 824 824. 247 24. (8-24. 4. 84 3.84. 384 38 3. 46 (3.8;4. 85 3.85. 385 54 5. (3.8;5. 098 0.98 98 (8- (8-24 3.84 (3.8;4 3.85 (3.8;5 09 0.9 9 (8 (3.8; 0. ( (3.8 (3. (3

Abstract Introduction: Monochorionic monoamniotic (MCMA) pregnancy accounts for 1% of multiple pregnancies, with two fetuses sharing a placenta and amniotic cavity, representing a high obstetric risk pregnancy. Objective: To describe characteristics and perinatal outcomes of MCMA pregnancies, monitored, managed, and resolved according to the ultrasound follow-up protocol. Method: Observational, longitudinal, retrospective study, including all patients with MCMA pregnancies, from August 2010 to April 2022, monitored and evaluated at public hospital. Results: A total of 475 twin pregnancies; 1.3% MCMA pregnancies. Average maternal age 31.1 years (24-40), 50% primiparas. One case presented late miscarriage at 19 weeks, the remaining cases all delivered by cesarean section at 32.2 weeks (31-34). Average birth weight of 1,774 grams (1,150-2,050). Of the total pregnancies, 50% had two live twins at one year of age, 66.6% had two live twins at birth. Of the total fetuses: 17% late miscarriages, 8.3% stillbirths, and 8.3% neonatal deaths. Newborns hospitalized in neonatology had an average of 26 days (3-60). Conclusion: The management and follow-up of MCMA pregnancies is a significant challenge due to their high morbidity and mortality and potential complications. A multidisciplinary approach, applying standardized protocols, would be essential to ensure proper management.

Resumen Introducción: El embarazo monocorial monoamniótico (MCMA) corresponde al 1% de embarazos múltiples, dos fetos que comparten placenta y cavidad amniótica, lo que representa un embarazo de alto riesgo obstétrico. Objetivo: Describir características y resultados perinatales de gestaciones MCMA, controladas, manejadas y resueltas según protocolo de seguimiento ultrasonográfico. Método: Estudio observacional, longitudinal, retrospectivo, que incluyó a todas las pacientes con embarazos MCMA, de agosto de 2010 hasta abril de 2022, controladas y evaluadas en un hospital público. Resultados: Total de 475 gestaciones gemelares; 1,3% embarazos MCMA. Edad materna promedio 31,1 años (24-40), el 50% primigestas. Un caso presentó aborto tardío de 19 semanas, los restantes casos, todos partos vía cesárea a las 32,2 semanas (31-34). Promedio de peso al nacer de 1.774 gramos (1.150-2.050). Del total de embarazos, el 50% tenía dos gemelos vivos al año de vida, el 66,6% tenía dos gemelos vivos al parto. Del total de fetos: 17% abortos tardíos, 8,3% mortinatos y 8,3% mortineonatos. Recién nacidos hospitalizados en neonatología, promedio 26 días (3-60). Conclusión: El manejo y seguimiento del embarazo MCMA es un gran desafío, debido a su elevada morbimortalidad y complicaciones potenciales. Un enfoque multidisciplinario, aplicando protocolos estandarizados, sería esencial para garantizar un adecuado manejo.

Abstract Introduction: External cephalic version (ECV) allows to reduce the rate of cesarean sections due to breech presentation, with a variable success rate and without increasing obstetric complications, although it has been described that after successful ECV there could be a higher rate of intrapartum cesarean sec3ons as well as instrumental deliveries. Objective: To analyse results and factors associated with vaginal delivery after ECV, compared to delivery in patients with a spontaneously cephalic fetus. Method: Retrospective case-control study in patients with ECV performed in the same clinic. Each case was matched to a control. Demographic and clinical variables were analysed to determine maternal and neonatal outcomes as well as predictors of mode of delivery in successful ECV patients. Results: Four hundred fifty-eight ECV patients proposed were included, of which 276 (60.3%) were successful. Success was associated with multiparity, uterine relaxation and female fetal sex. Two hundred twenty-seven patients had a birth in our centre, who were matched with 229 controls. The ECV group had a higher rate of cesarean sections (23.3 vs. 15.3%; p = 0.03). Dystocia was the most frequent indication in both groups. Conclusions: ECV is a safe technique with a high success rate and good results, but once a successful version is achieved, the patient has a higher cesarean section rate attributable to any indication. Other obstetric were similar to patients with a spontaneously cephalic presentation fetus.

Resumen Introducción: La versión cefálica externa (VCE) permite disminuir la tasa de cesáreas por presentación de nalgas, con tasa de éxito variable y sin aumentar las complicaciones obstétricas, aunque se ha descrito que tras VCE exitosa podría haber mayor tasa de cesáreas intraparto así como de partos instrumentales. Objetivo: Analizar resultados y factores relacionados con el parto vaginal tras VCE exitosa comparándolos con el parto en pacientes con feto espontáneamente en cefálica. Método: Estudio retrospectivo de casos y controles en pacientes con VCE realizada en un único centro. Se analizaron variables demográficas y clínicas para determinar resultados maternos, neonatales y predictores de tipo de parto en las pacientes de VCE exitosa. Resultados: Se incluyeron 458 pacientes con VCE, de las cuales 276 (60,3%) fueron exitosas. El éxito se asoció a multiparidad, relajación uterina y sexo fetal femenino. Tuvieron un parto en nuestro centro 227 pacientes. Se emparejaron con 229 controles. El grupo VCE tuvo mayor tasa de cesáreas (23,3 vs. 15,3%; p = 0,03). La distocia fue la indicación más frecuente en ambos grupos. Conclusiones: La VCE es una técnica segura con alta tasa de éxito y buenos resultados. Una vez se consigue una versión exitosa la paciente tiene mayor tasa de cesárea atribuible a cualquier indicación, siendo los demás resultados obstétricos similares a las pacientes con un feto espontáneamente en presentación cefálica.

Abstract Introduction: Ectopic pregnancy presents in 2% of all pregnancies worldwide, of which approximately 1.3% occur abdominally. This article presents a case of advanced abdominal pregnancy diagnosed at week 18, which progressed adequately until week 33, obtaining a live birth. Case presentation: A search of the literature was carried out in two databases, both in English. Results: Sixty-five articles were found related to the topic review, including 30 cases of advanced abdominal pregnancy reports in the last 10 years. Conclusions: An analysis of the diagnosis, management, and possible complications of cases such as the one reports in this article is carried out.

Resumen Introducción: El embarazo ectópico se desarrolla en el 2% de todas las gestaciones a nivel mundial, de las cuales aproximadamente el 1,3% ocurre de forma abdominal. El presente artículo expone un caso de embarazo abdominal avanzado diagnosticado en la semana 18, el cual progresó de forma adecuada hasta su finalización en semana 33, obteniéndose un nacido vivo. Presentación de caso: Se realizó una búsqueda de la literatura en dos bases de datos diferentes, ambas en inglés. Resultados: Se obtuvieron 65 artículos relacionados con la revisión de tema, encontrándose 30 casos de embarazo abdominal avanzado reportados en los últimos 10 años. Conclusiones: Se realiza un análisis del diagnóstico, manejo y posibles complicaciones de casos como el reportado en este artículo.

Abstract Introduction: The physical, neuroendocrine, social, and psychological changes in the postpartum period favor postpartum depression, a condition that impacts the mother-child relationship, including breastfeeding. Objective: To determine probable postpartum depression as a factor associated with the suspension of exclusive breastfeeding. Method: Analytical cross-sectional design in postpartum women; two groups were integrated, women with probable depression and women without postpartum depression as determined by the Edinburgh Postpartum Depression Scale. The sample size was 63 women with depression and 153 without depression. Exclusive breastfeeding was defined as maternal feeding, without any other solid or liquid supplements such as water, for at least one month of the newborn’s life. The statistical analysis plan included chi square test, odds ratio and confidence interval for odds ratio. Results: For every 5.10 (95% CI; 2.71-9.52) mothers with probable postpartum depression who do not exclusively breastfeed there is one mother without postpartum depression who also does not exclusively breastfeed. In the first group the prevalence of non-breastfeeding is 65.1% and in the second group 26.8% (p = 0.013). Conclusion: It can be affirmed that probable postpartum depression is a factor associated with the suspension of exclusive breastfeeding in the first month after birth.

Resumen Introducción: Los cambios físicos, neuroendocrinos, sociales y psicológicos en el puerperio favorecen la depresión posparto, condición que impacta en la relación madre e hijo, incluyendo la lactancia materna. Objetivo: Determinar la probable depresión posparto como factor asociado al abandono de la lactancia materna exclusiva. Método: Diseño transversal analítico en mujeres puérperas; se integraron dos grupos, mujeres con probable depresión posparto y sin probable depresión posparto, determinado por la Escala de depresión posparto de Edimburgo. El tamaño de la muestra fue de 63 mujeres con depresión y 153 sin depresión. La lactancia materna exclusiva se definió como la alimentación de la madre, sin ningún otro suplemento sólido o líquido como el agua, al menos durante un mes de vida del recién nacido. El plan de análisis estadístico incluyó prueba de chi cuadrada, razón de momios e intervalo de confianza para razón de momios. Resultados: Por cada 5,10 (IC95%: 2,71-9,52) madres con probable depresión posparto que no tienen lactancia materna exclusiva existe una madre sin probable depresión posparto que tampoco tiene lactancia materna exclusiva. En el primer grupo la prevalencia de no lactancia es del 65,1% y en el segundo grupo del 26,8% (p = 0,013). Conclusión: Se puede afirmar que la probable depresión posparto es un factor asociado a la suspensión de la lactancia materna exclusiva en el primer mes posterior al nacimiento.