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BACKGROUND: Recently, hoarseness affecting the supraglottic structure has been reported in Kawasaki Disease. The objective of this study was to characterize the frequency of hoarseness in acute KD patients in Latin America. METHODS: We used prospective data from the multinational REKAMLATINA Network (Red de Enfermedad de Kawasaki en America Latina) a total of 865 patients from 20 countries were enrolled during the 3-year study period. Data on hoarseness was available in 858 (99.2%) patients. The clinical and laboratory characteristics between hoarse and non-hoarse KD were compared. RESULTS: Hoarseness was documented in 100 (11.6%) patients. Hoarse patients were younger compared to KD without hoarseness (median age 18 vs. 26 months; p=0.002) and presented with a lower hemoglobin (10.7g/dL vs 11.3g/dL; p= 0.040) and hematocrit levels (32% vs 33%, p=0.048) . CONCLUSIONS: Hoarseness was found to be prevalent as a presenting sign of acute KD in younger children. Anemia may indicate the presence of active inflammation.

El presente artículo tiene como propósito realizar una reflexión sobre los desafíos que tiene la educación para continuar con el proceso de enseñanza- aprendizaje, ante la nueva situación epidemiológica que se enfrenta a nivel mundial. Se realiza un análisis del inicio de la Covid como pandemia y los retos que tienen que enfrentar las instituciones de la educación superior.

Introduction: Chikungunya, an infectious disease trans-mitted by the bite of an Aedes mosquito, tends to be an asymptomatic and benign course. However, atypical and severe clinical manifestations have been observed in children during Chikungunya infection. Objective: To present a case of epidermolysis by Chikun-gunya in a 24-day-old newborn during the 2014 epidemic in the Dominican Republic. Case report: Case of 24-day-old newborn presenting with an initial bullous thorax lesion that later spread diffusely developing into an epidermolysis. After mana-gement, good evolution was observed. However, residual hyper and hypochromic skin lesions remained.

El trabajo preventivo de la familia desde su labor educativa con los hijos es uno de los grandes retos a los que se enfrenta la institución educativa, la que requiere de vías, métodos y alternativas que sean efectivas para lograr alcanzar un desarrollo integral de los niños y adolescentes. De ahí que la preparación recíproca de ambas instituciones sea una prioridad en la educación cubana. En el presente artículo se exponen algunos fundamentos teóricos que sustentan los principios formativos de nuestro sistema educativo como eje esencial desde la propia actividad del educador, el que debe contemplar la atención a la familia desde la diversidad y el contexto en que se desarrollan estos niños y adolescentes. PALABRAS CLAVE: trabajo preventivo; familia; labor educativa; institución educativa. PREVENTIVE WORK OF THE FAMILY IN INTERACTION WITH THE INSTITUTION ABSTRACT The preventive work of the family from its educational work with the children is one from the big challenges to those that faces the educational institution, the one that requires of roads, methods and alternative that are effective to be able to reach an integral development of the children and adolescents. With the result that the reciprocal preparation of both institutions is a priority in the Cuban education. Presently article some theoretical foundations are exposed that sustain the formative principles of our educational system as essential axis from the educator's own activity, the one that should contemplate the attention to the family from the diversity and the context in that these children and adolescents are developed. KEYWORDS: work; preventive; family; educational work; educational institution.

Introducción: el síndrome de Nicolau, embolia cutis o dermatitis livedoide, es una reacción adversa poco frecuente a la administración de inyección intramuscular, subcutánea o intraarticular de medicamentos, inicia con dolor intenso y eritema que evoluciona a lesión livedoide que se torna hemorrágica, progresa a necrosis isquémica de piel y tejidos más profundos. Caso clínico: niño de 7 meses de edad, luego de inyección intramuscular de metamizol sódico presenta llanto continuo, seguido de lesión purpúrica afectando espalda, glúteo, muslo y pierna derechos, evolucionando hasta cicatrización total en 18 semanas. Conclusión: el síndrome de Nicolau, condición iatrogénica por inyección de múltiples medicamentos, produce lesión necrótica en área de irrigación de vasos afectados. El conocimiento de este síndrome facilitaría su prevención, al igual que su diagnóstico y manejo tempranos.

Background: RSV is the main cause of bronchiolitis and interstitial pneumonia in the first 2 years of life and is associated with bacterial complications and increased hospitalizations for respiratory infections.The cases usually occur in autumn and winter. In the Dominican Republic the clinical and epidemiological compartments of the ARF caused by RSV are unknown.Objectives:To determine the clinical and epidemiological characteristics of cases of ARI for RSV in children under 2 years old during the study period.Methods:Prospective, descriptive and observational study in which all children from 0 to 24 months admitted with a diagnosis of bronchiolitis during the study period and chest X-rays reported as bronchiolitis or alveolar-interstitial pneumonia were studied and confirmed by the Binax Now®VRS test.Results:Of 114 children between 0-24 months of age and of both sexes, who were admitted with a diagnosis of bronchiolitis in the HIRRC during the study period, 54 cases (48%) confirmed the RSV through the Binax Now® test. VRS, 62 percent corresponded to males, 76 percent to children under 4 months; cough and respiratory distress were the most frequent clinical manifestations with 52 cases (94.5%), followed by wheezing (46) (83.6%) and subcostal retraction (41) (74.5%), chest radiography reported bronchiolitis in 36 cases (66.7%) pneumonia alveolus -interstitial in 16 cases (29.6%), pneumonia plus pneumothorax and bronchiolitis plus atelectasis in 1 case (1.8%) respectively. In 76.3% the stay was less than 4 days. All cases were presented in the months of October (19 cases), November (22 cases), December (12 cases) and January (1 case), and 87% presented anemia, a finding not reported in other studies.Conclusion:RSV has seasonal behavior, is responsible for the majority (48%) of cases of bronchiolitis and interstitial pneumonia in younger infants, cough and respiratory distress were the most frequent clinical manifestations, anemia was present in 87% of cases.Background: RSV is the main cause of bronchiolitis and interstitial pneumonia in the first 2 years of life and is associated with bacterial complications and increased hospitalizations for respiratory infections.The cases usually occur in autumn and winter. In the Dominican Republic the clinical and epidemiological compartments of the ARF caused by RSV are unknown. Objectives: To determine the clinical and epidemiological characteristics of cases of ARI for RSV in children under 2 years old during the study period.Methods:Prospective, descriptive and observational study in which all children from 0 to 24 months admitted with a diagnosis of bronchiolitis during the study period and chest X-rays reported as bronchiolitis or alveolar-interstitial pneumonia were studied and confirmed by the Binax Now®VRS test. Results:Of 114 children between 0-24 months of age and of both sexes, who were admitted with a diagnosis of bronchiolitis in the HIRRC during the study period, 54 cases (48%) confirmed the RSV through the Binax Now® test. VRS, 62 percent corresponded to males, 76 percent to children under 4 months; cough and respiratory distress were the most frequent clinical manifestations with 52 cases (94.5%), followed by wheezing (46) (83.6%) and subcostal retraction (41) (74.5%), chest radiography reported bronchiolitis in 36 cases (66.7%) pneumonia alveolus -interstitial in 16 cases (29.6%), pneumonia plus pneumothorax and bronchiolitis plus atelectasis in 1 case (1.8%) respectively. In 76.3% the stay was less than 4 days. All cases were presented in the months of October (19 cases), November (22 cases), December (12 cases) and January (1 case), and 87% presented anemia, a finding not reported in other studies.Conclusion: RSV has seasonal behavior, is responsible for the majority (48%) of cases of bronchiolitis and interstitial pneumonia in younger infants, cough and respiratory distress were the most frequent clinical manifestations, anemia was present in 87% of cases.

La sociedad ha puesto empeño en la difícil tarea de prevenir, minimizar o impedir las manifestaciones de intento suicida, fenómeno que posee un nexo inseparable con los procesos sociales, de ahí que la preparación integral desde la formación inicial del maestro primario para el desarrollo de este trabajo en sus diferentes contextos de actuación, son retos que el sector educacional deberá enfrentar para eliminar los obstáculos que interfieren en la prevención desde el proceso educativo de cualquier manifestación con un desenlace fatal. PALABRAS CLAVE: prevención; intento suicida; formación inicial. A PEDAGOGICAL LOOK AT THE PREVENTION OF SUICIDAL ATTEMPTS ABSTRACT The society has endeavored to the difficult task of preventing, minimizing or preventing the manifestations of suicide attempt, which is a phenomenon that has an inseparable link with social processes. That is why the comprehensive training from initial training of primary teacher for the development of this work in different contexts of action, are challenges that the education sector will face to remove barriers that interfere with prevention from the educational process of any manifestation with a fatal outcome. KEYWORDS: prevention, suicide attempt; initial training.

Contaminated sharps, such as needles, lancets, scalpels, broken glass, specimen tubes, and other instruments, can transmit bloodborne pathogens such as HIV, hepatitis B (HBV), and hepatitis C viruses (HCV).Observation of facilities and injections and questionnaire-guided interviews were conducted in 2005 among health care workers (HCWs) in 2 public hospitals in Santo Domingo and 136 public immunization clinics (IC) in the Dominican Republic. Injection practices and sharps injuries (SIs) in health care facilities in the Dominican Republic were assessed in cross-sectional surveys to identify areas in which preventive efforts might be directed to make injection practices safer.Of the 304 hospital HCWs and 136 ICs HCWs interviewed, 98 (22.3%) reportedor =1 SIs during the previous 12 months. ICs had a lower incidence (13 per 100 per person-years [p-y]) of SIs than hospitals (65 per 100 p-y) (P.0001). Unsafe needle recapping was observed in 98% of all injections observed at hospitals but in only 12% of injections at ICs (P.0001). Sharps were observed improperly disposed in regular waste containers in 24 (92%) of 26 areas at which injections are prepared at the hospitals but in only 11 (8%) of 136 ICs (P.0001). Training in injection safety was received by 4% of HCWs in hospitals but by 77% in ICs (P.001). Of 425 HCWs, 247 (58%) were fully immunized against hepatitis B. There was a higher risk of SIs among staff dentists (adjusted relative risks [aRR], 5.9; 95% confidence interval [CI]: 2.8-12.6), resident physicians (aRR, 3.5; 95% CI: 1.8-6.9), and those who gaveor =11 therapeutic injections per day (aRR, 1.6; 95% CI: 1.1-2.4).Injection practices at ICs were safer than those found at public hospitals. Preventive strategies to lower SIs in public hospitals should include regular training of hospital staff to minimize needle recapping and improper disposal, among other interventions to reduce the dangers of needles.