Resumen Antecedentes: El daño cerebral adquirido es un trastorno neurológico común. Objetivo: Determinar las intersecciones probabilísticas de variables relacionadas con daño cerebral adquirido a partir de la determinación de probabilidades a priori y a posteriori. Método: Estudio retrospectivo analítico. Se realizó análisis descriptivo y se calcularon intervalos de confianza para la media y para la proporción con α = 0.05 considerando la edad del paciente y el diagnóstico. Se realizó análisis de intersección probabilística, probabilidad a priori y a posteriori considerando el diagnóstico, el sexo y la década de edad; por último, se utilizó la prueba χ2. Resultados: Se analizaron 736 pacientes. El diagnóstico más frecuente fue el trastorno del lenguaje. Los pacientes diagnosticados con trastorno de memoria fueron los más jóvenes y los diagnosticados con trastorno cognitivo degenerativo los más longevos. La probabilidad de que llegue al hospital, al servicio de patología de lenguaje, un paciente con secuelas por daño cerebral adquirido, sea diagnosticado con trastorno del lenguaje y sea hombre es del 29.06%. Conclusiones: La alta prevalencia de discapacidad a corto y largo plazo generada por el daño cerebral adquirido indica la importancia de la detección y el diagnóstico temprano y oportuno que favorezcan una pronta y eficiente atención especializada.

Abstract Background: The acquired brain damage is a common neurological disorder. Objective: Determine the probabilistic intersections of variables related to acquired brain damage from the determination of a priori and a posteriori probabilities. Method: Analytical retrospective study. A descriptive analysis was carried out, confidence intervals were calculated to obtain the mean and the proportion with α = 0.05 considering the age of the patient and the diagnosis. An analysis of probabilistic intersection, a priori and a posteriori probability was performed considering diagnosis, sex and age decade; finally, chi squared was calculated. Results: 736 patients were analyzed. The most frequent diagnosis was language disorder. The patients diagnosed with memory disorder were the youngest and those diagnosed with degenerative cognitive disorder the oldest. The probability that a patient with sequelae due to acquired brain damage arrives at the hospital, at the language pathology service, to be diagnosed with a language disorder and that this patient is also a man is 29.06%. Conclusions: The high prevalence of short and long-term disability generated by acquired brain damage highlights the importance of an early and timely detection and diagnosis so that it favors prompt and efficient specialized care.

Abstract Objective: The objective of this study was to investigate the prevalence, clinical features, and factors related to personal protective-associated headaches. Methods: We conducted a cross-sectional study among healthcare workers using an online questionnaire. Results: We surveyed 305 participants. The N95 face-mask was the most used device by 93%. Of 305 respondents, 206 experienced headaches while wearing protective equipment; 36.06% suffered from a headache disorder before the pandemic. The prevalence of de novo headache was 39.01%. Gender, age, or exposure to coronavirus disease were not determining factors to develop headache. Headache intensity was higher in front-line healthcare workers and was correlated (r = 0.728) with the time wearing protective equipment. The more days per month the participants wore personal protective equipment the shorter the time to headache onset after donning equipment. Conclusion: Our study confirms the relationship between frequent and prolonged use of protection devices with headaches and reaffirms the implication of external pressure as a primary mechanism.

Resumen Objetivo: Investigar la prevalencia, las características clínicas y los factores relacionados con las cefaleas asociadas al equipo de protección personal. Métodos: Realizamos un estudio transversal entre trabajadores de la salud por medio de un cuestionario en línea. Resultados: Encuestamos a 305 participantes. La mascarilla N95 fue el dispositivo más utilizado opor 93%. Del total de encuestados, 206 experimentaron cefalea mientras usaban el equipo de protección; el 36.06% padecía algun trastorno cefalálgico antes del inicio de la pandemia. La prevalencia de cefalea de novo fue del 39.01%. El género, la edad o la exposición a la enfermedad por coronavirus no fueron factores determinantes para desarrollar cefalea. La cefalea fue de mayor intensidad en los trabajadores de primera línea y se correlacionó (r = 0.728) con el tiempo que se uso el equipo de protección personal. Mientras más días por mes los participantes usaron el equipo de protección personal menor fue el tiempo de inicio de la cefalea tras la colocación del equipo cada vez. Conclusiones: Nuestro estudio confirma la asociación del uso frecuente y prolongado de dispositivos de protección con el desarrollo de cefalea y reafirma la implicación de la compresión externa como mecanismo primario.

Resumen Objetivo: Describir los efectos económicos en la homeostasis biopsicosocial a partir de un análisis tridimensional de la interacción conjunta de la comorbilidad biológica, psicológica y económico-social, con la finalidad de conocer las probabilidades de ocurrencia a partir de estas condiciones de forma simultánea. Método: Estudio transversal y muestreo aleatorio por cuotas. Participaron 353 hombres y mujeres mayores de 20 años que contestaron un cuestionario con 27 preguntas (biopsicosociales-económicas). Se analizaron los datos tridimensionalmente con la finalidad de conocer la probabilidad de ocurrencia de las variables estudiadas y su posible localización en el cubo unitario probabilístico. Resultados: Con base en la propuesta del cubo unitario se obtiene que, en las personas con ingresos de 2200 a 6600 pesos, en los hombres existe una probabilidad de 12.9 por cada 1000 habitantes de presentar deudas, sobrepeso y depresión grave; en las mujeres, la probabilidad es de 2.08 por cada 1000 habitantes. Conclusiones: Existe un eje prioritario que determina el cambio de las variables restantes, en este caso el eje económico que determina las condiciones biológicas y psicológicas.

Abstract Objective: Describes the economic effects on bio-psychosocial homeostasis from a three-dimensional analysis of the joint interaction of biological, psychological and economic-social comorbidities, in order to know the probabilities of occurrence of these conditions simultaneously. Method: It is a cross-sectional study and random quota sampling. 353 men and women over 20 years of age participated, and answered a 27 questions application (bio-psycho-economic-social), the data was analyzed three-dimensionally in order to know the probability of occurrence of the variables studied and their possible location in the probabilistic unit cube. Results: Based on the unit cube proposal, it can be observed that in the block of people with incomes from 2200 to 6600 pesos in the group of men there is a probability of 12.9 per 1000 inhabitants of presenting debt problems, overweight and severe depression, while in the case of women, the probability is 2.08 per 1000 inhabitants. Conclusions: There is a priority axis that determines the change of the remaining variables, in this case it is the economic axis the one that determines the biological and psychological conditions.

Abstract Objective: To describe and analyze clinical and sociodemographic aspects of a cohort of patients with language, speech and learning disorder. Method: Descriptive retrospective study. Patient records (2011 to 2015) were selected, making up a total of 4632. Averages, standard deviations, percentages and frequencies were calculated; in order to assess whether there was a significant difference between variables, chi squared test and a conditional probability analysis was performed between the variables to obtain a priori and a posteriori probability. Results: Disorders of language, speech and learning occurred more frequently in males, 3358 patients (72.5%). The most frequent diagnosis was language development disorder, diagnosed in 2924 patients (63.1%). A higher incidence and prevalence of language delay were found for the male sex (p < 0.05). Conclusions: Of all the variables studied, only the incidence of delay in language development with respect to the male sex was significant; three out of four patients were male and 1 female.

Resumen Objetivo: Describir y analizar aspectos clínicos y sociodemográficos de una cohorte de pacientes con trastornos del lenguaje, del habla y del aprendizaje. Método: Estudio retrospectivo descriptivo. Se seleccionaron expedientes de 4632 pacientes (años 2011 a 2015). Se calcularon medias, desviaciones estándar, porcentajes y frecuencias, Con la finalidad de evaluar si existía diferencia significativa entre variables se utilizó la prueba de ji al cuadrado y se realizó un análisis de probabilidad condicional entre las variables para obtener la probabilidad a priori y a posteriori. Resultados: Los trastornos del lenguaje, del habla y del aprendizaje se presentaron con mayor frecuencia en el sexo masculino, con 3358 pacientes (72.5%). El diagnóstico más frecuente fue el trastorno del lenguaje, diagnosticado en 2924 pacientes (63.1%). Se encontraron mayores incidencia y prevalencia de retraso del lenguaje en el sexo masculino (p < 0.05). Conclusiones: De todas las variables estudiadas, solo la incidencia de retraso en el desarrollo del lenguaje con respecto al sexo masculino fue significativa; de cada cuatro pacientes, tres eran de sexo masculino y uno de sexo femenino.

Abstract Objective: To describe the productivity of the research works presented in the Interuniversity and resident doctors Competition of the Mexican Academy of Surgery since its origin in 2010. Method: Observational cross-sectional descriptive study in which the variables are considered: category of participation (university/resident) type of work (research, clinical case, etc.), university and institution of origin, type of presentation [poster/oral]) Descriptive statistics was used. Results: Since 2010, 9 interuniversity competitions and 8 resident doctors have been developed. A total of 974 papers were presented, predominantly residents (65.29%), oral presentations (54.51%) and original works (58.11%). 8.9% of the published works. Conclusions: The Contest is a good forum to disseminate research in the new generations of doctors.

Resumen Objetivo: Describir los primeros 10 años del Concurso Interuniversitario y de Médicos Residentes de la Academia Mexicana de Cirugía. Método: Estudio observacional de tipo transversal descriptivo en el que se consideran las variables categoría de participación (universitario/residente), tipo de trabajo (investigación, caso clínico, etc.), universidad e institución de procedencia, y tipo de presentación (cartel/oral). Se empleó estadística descriptiva. Resultados: Desde 2010 se han desarrollado nueve concursos interuniversitarios y ocho de médicos residentes. En total se han presentado 974 trabajos, predominando los de residentes (65.29%), las presentaciones orales (54.51%) y los trabajos originales (58.11%). El 8.9% de los trabajos han sido publicados. Conclusiones: El Concurso es un buen foro para difundir la investigación de las nuevas generaciones de médicos.

Abstract Objective: Propose a system of multivariate multiple regression equations in order to establish a mathematical association that allows estimating the current units needed during the adjustment phase with respect to age and time that were used the implants. Method: Descriptive cross-sectional study. A total of 41 pediatric patients with a unilateral cochlear implant participated. Three groups were formed and multivariable multiple regression equations were constructed. Results: For Group 1, in electrode Groups 3 and 4, there is a lower standard deviation and a similar index of asymmetry of the current units; in Group 2, the groups of electrodes with similar index of asymmetry were 2 and 4, while group of electrodes 3 presented average of 21.54 and dispersion smaller (16.25); in Group 3, groups of electrodes 3 and 4 presented similar standard deviation and average and smaller standard deviation. With respect to the standard estimation error, the lowest variability of current units was obtained in Group 2 for electrode Group 3. Conclusion: The proposed equations could be used in the clinical area by knowing the units current needed with respect to age and time of use the implant.

Resumen Objetivo: Proponer un sistema de ecuaciones de regresión múltiple multivariable para establecer una asociación matemática que permita estimar las unidades de corriente necesarias durante la fase de ajuste con respecto a la edad y el tiempo de uso del implante coclear. Método: Estudio transversal descriptivo. Participaron 41 pacientes pediátricos con implante coclear unilateral. Se conformaron tres grupos y se construyeron ecuaciones de regresión múltiple multivariable. Resultados: Para el grupo 1 se observa en los grupos de electrodos 3 y 4 menor desviación estándar y similar índice de asimetría de las unidades de corriente; en el grupo 2, los grupos de electrodos con similar índice de asimetría fueron el 2 y el 4, y el grupo de electrodos 3 presentó un promedio de 21.54 y una dispersión más pequeña (16,25); en el grupo 3, los grupos de electrodos 3 y 4 presentaron similar desviación estándar y promedio y desviación estándar más pequeños. Con respecto al error estándar de estimación, se obtuvo una menor variabilidad de unidades de corriente en el grupo 2 para el grupo de electrodos 3. Conclusión: Las ecuaciones propuestas son de utilidad clínica al conocer las unidades de corriente necesarias considerando la edad y el tiempo de uso del implante coclear.

Abstract Objective: To compare the amplitude of potentials by acoustic stimulation at 500 Hz versus 1000 Hz in healthy subjects. Methods: 25 subjects; potentials were performed with acoustic stimuli burst-type at 500 and 1000 Hz with a stimulation rate of 5.1 at 100 dB in both ears. Descriptive statistics tests were performed, confidence intervals were calculated for the mean with 95% reliability, standard error graphs and t-test for related samples. Results: The values obtained in amplitude when performing an acoustic stimulus at 1000 Hz show a faster response compared to that obtained in the frequency of 500 Hz. The t-test showed a significant difference in the amplitude in the 1000 Hz frequency between ears with a significance value of p < 0.025. Conclusions: It is strengthened the hypothesis that in the amplitude of potentials by aerial acoustic stimulation in the frequency of 1000 Hz a greater amplitude is generated in relation to the one generated in the frequency of 500 Hz.

Resumen Objetivo: Comparar la amplitud de los potenciales miogénicos vestibulooculares por estimulación acústica a 500 y 1000 Hz en sujetos sanos. Método: Se estudiaron 25 sujetos y se realizaron potenciales con estímulos acústicos tipo burst a 500 y 1000 Hz con una tasa de estimulación de 5.1 a 100 dB en ambos oídos. Se realizaron pruebas de estadística descriptiva y se calcularon los intervalos de confianza para la media con un 95% de confiabilidad, las gráficas de error estándar y la prueba t para muestras relacionadas. Resultados: Los valores obtenidos en amplitud al realizar estímulo acústico a 1000 Hz muestran una respuesta más rápida en comparación con la obtenida en la frecuencia de 500 Hz. La prueba t mostró una diferencia significativa en la amplitud en la frecuencia 1000 Hz entre oídos, con un valor de significancia p < 0.025. Conclusiones: Se fortalece la hipótesis de que en los potenciales por estimulación acústica aérea en la frecuencia de 1000 Hz se genera una mayor amplitud en relación con la generada en la frecuencia de 500 Hz.

Resumo: Os instrumentos de avaliação da gravidade do paciente grave fornecem informações objetivas intra e interobservadores relacionadas à gravidade da doença, sua evolução em relação ao tempo, estratificação de risco são fundamentais para tomada de decisão. O objetivo deste trabalho é apresentar uma nova proposta para a avaliação do APACHE II baseada em um modelo matemático de mudança de tempo/velocidade, velocidade instantânea e aceleração.

Abstract: The illness severity scoring systems provide objetive measures for inter and intra comparisons with time, provide useful information for comparing the severity of illness are an essencial part of the improvment in clinical decisions and in stratifying patients. Appropiated application of these models helps in decision making at the right time. The aim of this paper is to submit a proposal for the evaluation of the APACHE II score based on a vectorial mathematical model of chance in time/velocity, instant velocity and aceleration.

Resumen: Las herramientas de evaluación de la gravedad en el enfermo grave proporcionan información objetiva intra e interobservador relacionada con la gravedad de la enfermedad, su evolución en relación al tiempo y la estratificación de riesgo son parte fundamental en la toma de decisiones. El objetivo de este trabajo es presentar una nueva propuesta de la evaluación del APACHE II basada en un modelo matemático de cambio en el tiempo/velocidad, velocidad instantánea y aceleración.

Resumo: Objetivo: Comprovar a capacidade prognóstica como preditor de mortalidade da Child Pugh lactato na população de pacientes cirróticos admitidos na terapia intensiva da Fundação Clínica Médica Sur. Material e métodos: Estudo de investigação clínica, coorte não concorrente, onde os dados foram coletados no período de 1 de Janeiro de 2012 a 31 Dezembro de 2014. Resultados: 28 casos admitidos na unidade de terapia intensiva da Fundação Clínica Médica Sur, diagnosticados com cirrose hepática, dos quais faleceram um total de 16 pacientes (57.1%) nos primeiros 40 dias após a admissão e sobreviveram 12 (42.9%). Calculou-se a existência de uma correlação entre a defunção e a Classificação Child Pugh lactato maior de 14 pontos, encontrando um r = 0.708. A pontuação CPL maior a 14 pontos está associado à mortalidade em 87.5% e inferior a 14 foi associado a sobrevida à 40 dias em um 83.33%. Conclusões: A Clasificação Child Pugh lactato maior a 14 pontos tem uma forte correlação com a mortalidade.

Abstract: Objective: This study aimed to establish if the Child-Pugh+lactate score is a reliable prognostic scoring tool as mortality predictor in cirrhotic patients admitted to the Médica Sur Clinic Foundation Intensive Care Unit. Material and methods: This was a 3-year, single-centered retrospective cohort study performed in a general ICU. Results: Twenty-eight cases were collected in the period from January 1, 2012 to December 31, 2014, of which a total of 16 patients (57.1%) died within the first 40 days after admission and 12 survived (42.9%). It was assessed if there was a correlation between death and a Child-Pugh lactate score greater than 14, finding an r = 0.708. Conclusions: A Child-Pugh+lactate score with a numerical value above 14 points has a direct relation with mortality in cirrhotic patients admitted to the ICU.

Resumen: Objetivo: Comprobar la capacidad pronóstica como predictor de mortalidad de la clasificación de Child-Pugh lactato en la población de pacientes cirróticos que ingresan en la Unidad de Cuidados Intensivos de la Fundación Clínica Médica Sur. Material y métodos: Estudio de investigación clínica, cohorte no concurrente, donde se obtuvieron datos en el periodo comprendido del 1 de enero de 2012 al 31 de diciembre de 2014. Resultados: Ingresaron 28 casos a la Unidad de Terapia Intensiva de la Fundación Clínica Médica Sur con diagnóstico de cirrosis hepática; de ellos, fallecieron un total de 16 (57.1%) sujetos dentro de los primeros 40 días posteriores a su ingreso y sobrevivieron 12 (42.9%). Se calculó si existía correlación entre la defunción y el puntaje de la clasificación Child-Pugh lactato mayor de 14, y se encontró una r = 0.708. El puntaje mayor a 14 puntos se asoció a mortalidad en 87.5%, así como el puntaje menor a 14 se vinculó a supervivencia a 40 días en 83.33%. Conclusiones: La clasificación de Child-Pugh más lactato mayor de 14 puntos tiene una fuerte correlación con la mortalidad.

We describe the carotid-cerebral arterial vasculature of the domestic rooster (Gallus gallus Linnaeus). Ten cocks race Rhode Island of 2.5 kg of weight were used, which were subjected to vascular replesion conservation technique. It was concluded that anastomosis intercarotidea, the formation of the basilar artery and the absence of the vertebral arteries are the most significant components of the cephalic vasculature. It is proposed to standardize the nomenclature of the arteries of the brain-stem carotid arterial because of the confusing terminology used by various authors.

Se describe la vasculatura arterial carotídea-cerebral del gallo doméstico (Gallus gallus Linnaeus). Se utilizaron 10 gallos de 2.5 kg de peso, estirpe Rhode Island, los cuales fueron sometidos a la técnica de conservación replesión vascular. Se concluyó que la anastomosis intercarotídea, la formación de la arteria basilar y la ausencia de las arterias vertebrales son los componentes más sobresalientes de la vasculatura cefálica. Se propone estandarizar la nomenclatura de las diversas estructuras anatómicas y vasculares ligadas a la vasculatura arterial carotídea-cerebral ya que son confusas en las diversas publicaciones.

Abstract: Infant crying is a complex phenomenon that implies several functions: breathing, action of laryngeal and supralaryngeal muscles under the control of the neurovegetative systems of the brainstem, and the limbic system, and the association of cortical areas and the cerebellum. Although it is a communication system different to babbling and language, it is related with the future development of phonation. Cry analysis provides information about the neuro-physiologic and psychological states of newborns and the identification of perinatal abnormalities. It is necessary to discuss the subject extensively because there are new data on situations such as laringomalacia, congenital hypothyroidism, deafness and sleep apnea that seem to be associated to infantile crying behaviors. Infant cries can be analyzed as behavioral conditions (hunger, anger and pain cries) allows knowing of mother-child relationship or the effect under diverse cultural conditions, such as stress, emo-tional deprivation or illness. A spectrographic analysis of the cries may identify several characteristics: threshold, latency, duration of phonation, maximum and minimum of the fundamental frequency (F0), occurrence and maximum pitch of shift, gliding, melody, biphonation, bifurcation, noise concentration, quality of the voice, double harmonic break, glottal plosives, vibratos, melody types, F0 stability and inspiratory stridor. To date, it has not been possible to establish alteration patterns. The best studied variables are F0, its harmonics and the duration of each emission; it is accepted that F0 varies between 400 and 600 Hz, during 1.4 ± 0.6s. Under such approaches, diverse alterations and risk factors have been studied: congenital alterations, malnutrition, sudden death, maternal exposition to drugs, prematurely born babies or perinatal asphyxia and disturbances of the central nervous system. Authors have reported F0 equal or less than 300 Hz in cases of sudden death or with high frequencies, near the 1000 Hz in the Cri du chat syndrome, perinatal asphyxia and other cases who died suddenly. During the cry, there is an increase of intra-abdominal pressure, heart rate and blood pressure, reduction of oxygen saturation, increase of the intra cranial-pressure, beginning of stress reactions, depletion of the energy anf oxygen reserves, such as the found in the Valsalva's maneuver. Every event of prolonged cries implies alteration of the breathing control like a Hering-Breuer reflex. Considering that some authors have proposed early vocalizations are a good predictor of deafness, in a previous paper we reported the characteristics of the cry of 20 deaf neonates. However, we were not able to demonstrate differences when comparing them with normal hearing neonates and infants, using only parametric methods. Still, we decided to go further and investgate the quality of infant cries of deaf neonates and infants. Material and methods. Twenty zero-to two-year old cases were studied; they were deaf children of both sexes; all cases were included in a follow-up program on the Human Communication Department of the National Institute of Perinatology of Mexico and were compared with 20 normal hearing children. We re-corded Brain Stem Evoked Auditory Responses (BEAR) and cry recording using a digital Sony recorder during the physical exploration. We analyzed the frequency (Hz) and duration of the espiratory cries, the duration of inspiration between two cry emissions and the characteristics of the spectrogram. Quantitative analysis. The usual estimates of means and standard variation were obtained and they were compared with one way analysis of variance. We organized typologies of frequency by means of cluster techniques (Ward method). The distribution of the duration of the periods of crying and silence was explored with a contingency tables. Qualitative analysis. Two standardized observers visually analyzed all the cries to determine any variation of F0 and of harmonic frequencies. Whenever a variation of F0 was observed, we obtained maximum and minimum frequencies, as well as average duration of each cry emission. The procedure was validated by means of the graphic comparison with a Fouries analysis. Results. Mean duration of cries in the deaf group was 0.5845 ± 0.6150 s (range 0.08-5.2 s), while in the group of normal hearing cases was 0.5387 ± 0.2631 (range 0.06-1.75 s). From the deaf group, five cases had very prolonged duration of cries, without statistical significance. The mean duration of the inspiration was 0.3962 ± 0.2326, with a range of 0.06 to 1.75 in the deaf group and of 0.4083 ± 0.1854, with a range of 0.21 at 0.96, in the controls, without difference among groups. There was no correlation between the time of espiratory cry and that of the inspiration. Three cry topologies were organized: one of shorter duration (mean 0.30 s), with 111 spectrograms, an intermediate one (mean 0.73) with 85 spectrograms and one of prolonged duration (mean 4.5 s) with spectrograms of three cases. Three topologies of the inspiratory period were obtained: one of short periods (mean 0.33 s), with 171 spectrograms, one of intermediate duration (mean 0.80 s) with 18 spectrograms and one of prolonged duration (mean 1.60 s) with three cases. There were no statistical differences of tipologies between the deaf groups and normal hearing cases. On the qualitative analysis of cries, we came across several variations which are interpreted as abnormalities: vibratos, poor melodic control, loss of fundamental frequencies, harmonic limited production, plosives, gliding, bi phonation, and a loss of intensity at end of cry emissions. These changes were also observed on the control cases, but only in a very limited number. Discussion. Cry spectrogram analysis are non invasive indicators of the neonate's neurophysiologic organization. Although cry duration varies in healthy newborns, the accepted variation for a normal range is 1.1 to 2.8 s, with standard deviations around 0.6 s. Consistent differences have not been demonstrated between risk and control groups. However, abnormal cases such as Down syndrome or severe asphyxia have very short cries, whereas on the Cri du chat syndrome the duration of cries is prolonged. Extended cries imply cardiac and respiratory risks which have been associated with later outcomes as development retardation and sudden death. There are also some questions to solve, such as the regulation and control of cry, starting from breathing mechanisms or from a sensorial afferent, mediated by hearing. The deaf infants are constituted in a study model, considering that the auditory afference is suppressed and the control of the cry is restricted to the breathing environment. In the studied spectrograms, the duration of the cry was within reported normal limits by other authors, inasmuch in the normal hearing control cases as in the deaf, except the dissident cases, but without these reaching statistical significance. Further research of brainstem function is needed for the abnormal cases with prolonged cry periods, since such cries are interpreted as an alteration of the breathing reflexes of Hering-Breuer, which might have a pathological meaning in the sense of the sob's spasm or even more severe risk factors as sleep apnea and even sudden death. The qualitative analysis in the deaf individuals demonstrated a poor quality and unstable character of melodic control, with a smaller number of harmonics. The deaf cases lost the relationship between the fundamental frequencies and their harmonics, mainly because of the participation of supraglottic structures that modulate pitch and due to the poorness of melodic control, either for monotony or due to the impossibility of returning to a normal pattern, following variations such as vibrato, plosives or noise concentration. In the cases of prolonged cries, starting from the third second, the sound intensity tends to diminish and the harmonics are lost, perhaps due to a decrease of the subglottal pressure of phonation. This finding supports the auditory control of crying related to breathing mechanisms. Conclusions. In preliminary terms, by means of the melodic analysis of the spectrograms, differences are demonstrated be-tween the cries of the deaf and of the normal hearing cases. The increase of the complexity of the melody of the cry, or their poverty, are indicative of the neuromuscular function and they may support the evaluation of phonation before language development. The study of the spectrograms of deaf individuals does not constitute an element for the detection or for diagnosis since, to date, estimators of sensibility or of specificity have not been established, but they constitute a support for its integral evaluation, with the possibility of evaluating and of improving therapeutic rehabilitation.

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