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Aims Given the high levels of absenteeism due to musculoskeletal disorders of the upper limbs, there is a need for preventive strategies to protect workers exposed to high risk levels. The purpose of this study was to determine the effect of a workplace-based muscle resistance training exercise program in the presence of pain and musculoskeletal dysfunction of the upper extremities in manufacturing workers exposed to repetitive movements and excessive effort in the workplace. Method Randomized controlled trial in manufacturing workers. A sample of 120 healthy workers was allocated at random to an experimental group, which received a resistance-based exercise program, and a control group, which performed stretching exercises. Results The muscle resistance training exercise had a protective effect on the intensity of pain perceived by workers in their upper limbs (RR: 0.62 95% CI 0.44-0.87) compared with the group of workers who performed stretching exercises. Conclusion A workplace-based muscle resistance training exercise program is an effective preventive strategy in factory workers exposed to risk; however, it is necessary for companies initially to adopt mechanisms to minimize exposure as a prevention strategy.

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Abstract: Introduction: It is essential that orthopaedic resident physicians be highly proficient in all aspects, considering the balance between supply, demand, need and context. Fundamental to identify the capacity and quality installed for their training in Mexico. Material and methods: Observational Study, transverse, non-probabilistic sampling-conglomerates, in two phases. The instrument has 8 domains, 57 variables and 4,867 items. 60 graduate professors of 20 states, 50 hospital sites, 22 university programs. Results: 1,038 years of experience (collective intelligence), 17 years of experience/teacher (01 to 50 years). Identified: acute pathology 30 (2 to 90%), chronic pathology 30 (5 to 96%), patients ˂ 15 years, 10 (3 to 30%), patients between 15 and 65 years, 47 (2 to 78%), patients ˃ 65 years, 20 (2 to 60%), number of beds/seat 20 (2 to 510), number of clinics 3 (1 to 48), number of surgical procedures/headquarters per year at the national level, was 960 (50 to 24,650). The national average per resident doctor is 362 surgeries/year with 1,450 surgical times/year. Conclusions: The needs and resources for the training of physicians specializing in orthopedics/traumatology are highly heterogeneous, so it should be adapted to the epidemiological needs of the region of influence, in an area of epidemiological transition. 62.2% expressed not having or have bad academic and scientific infrastructure at its headquarters, more than 50% without rotation overseas and ˃ 90% without regular scientific production.

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INTRODUCTION: It is essential that orthopaedic resident physicians be highly proficient in all aspects, considering the balance between supply, demand, need and context. Fundamental to identify the capacity and quality installed for their training in Mexico. MATERIAL AND METHODS: Observational Study, transverse, non-probabilistic sampling-conglomerates, in two phases. The instrument has 8 domains, 57 variables and 4,867 items. 60 graduate professors of 20 states, 50 hospital sites, 22 university programs. RESULTS: 1,038 years of experience (collective intelligence), 17 years of experience/teacher (01 to 50 years). Identified: acute pathology 30 (2 to 90%), chronic pathology 30 (5 to 96%), patients 15 years, 10 (3 to 30%), patients between 15 and 65 years, 47 (2 to 78%), patients 65 years, 20 (2 to 60%), number of beds/seat 20 (2 to 510), number of clinics 3 (1 to 48), number of surgical procedures/headquarters per year at the national level, was 960 (50 to 24,650). The national average per resident doctor is 362 surgeries/year with 1,450 surgical times/year. CONCLUSIONS: The needs and resources for the training of physicians specializing in orthopedics/traumatology are highly heterogeneous, so it should be adapted to the epidemiological needs of the region of influence, in an area of epidemiological transition. 62.2% expressed not having or have bad academic and scientific infrastructure at its headquarters, more than 50% without rotation overseas and 90% without regular scientific production.

INTRODUCCIÓN: Es fundamental que los médicos residentes de ortopedia (traumatología) sean altamente competentes en todos los aspectos, considerando el equilibrio entre la oferta, demanda, necesidad y contexto. Es primordial identificar la capacidad y calidad instalada para su formación en México. MATERIAL Y MÉTODOS: Estudio observacional, transversal, muestreo no probabilístico-conglomerados, en dos fases. El instrumento tiene ocho dominios, 57 variables y 4,867 ítems. Sesenta profesores de postgrado de 20 estados, 50 sedes hospitalarias, 22 programas universitarios. RESULTADOS: 1,038 años de experiencia (inteligencia colectiva), 17 años de experiencia/profesor (01 a 50 años). Se identificó: patología aguda 30 (2 a 90%), patología crónica 30 (5 a 96%), pacientes 15 años, 10 (3 a 30%), pacientes entre 15 y 65 años, 47 (2 a 78%), pacientes 65 años, 20 (2 a 60%), número de camas/sede 20 (2 a 510), número de consultorios 3 (1 a 48), el número de procedimientos quirúrgicos/sede al año a nivel nacional fue de 960 (50 a 24,650). La media nacional por médico residente es de 362 cirugías/año con 1,450 momentos quirúrgicos/año. CONCLUSIONES: Las necesidades y recursos para la formación de médicos especialistas en ortopedia/traumatología son en alto grado heterogéneos, por lo cual se debería adaptar a las necesidades epidemiológicas de la región de influencia, en un ámbito de transición epidemiológica. Sesenta y dos punto dos por ciento expresó no tener o tener deficiente infraestructura académica y científica en su sede, más de 50% sin rotación al extranjero y 90% sin producción científica regular.

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The two main classes of secondary metabolites, alkaloids and quinovic acid glycosides, of Uncaria tomentosa (Willd.) DC. (Rubiaceae), a Peruvian plant commonly known as 'uña de gato', have been analysed. Separation of the alkaloidal fraction was achieved using a solid phase extraction method based on cationic exchange, and an analytical method employing HPLC-ES/MS has been developed. Quantitative data for commercial wild bark, cultivated bark and leaves are reported. The analysis of quinovic acid glycosides was performed directly on the crude extract using both a fast analytical method based on flow injection ES/MS, and a more complete analytical technique using HPLC-MS.

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BACKGROUND: The diagnosis of patients with short segments of intestinal metaplasia in the distal esophagus, has increased in recent years. AIM: To assess the clinical, pathological and functional features of patients with esophageal intestinal metaplasia. PATIENTS AND METHODS: A prospective study was performed in 95 control subjects, 115 patients with cardial intestinal metaplasia and 89 patients with short Barret esophagus with intestinal metaplasia. All had clinical and endoscopic assessments, esophageal manometry and determination of 24 h esophageal exposure to acid and duodenal content. RESULTS: Control patients were younger and, in this group, the pathological findings in the mucosa distal to the squamous-columnar change, showed a preponderance of fundic over cardial mucosa. In patients with intestinal metaplasia and short Barret esophagus, there was only cardial mucosa, that is the place where intestinal metaplasia implants. Low grade dysplasia was only seen in the presence of intestinal metaplasia. Gastroesophageal sphincter pressure decreased and gastric and duodenal reflux increased along with increases in the extension of intestinal metaplasia. CONCLUSIONS: These findings confirm the need to obtain multiple biopsies from the squamous-columnar mucosal junction in all patients with gastroesophageal reflux symptoms, for the detection of early pathological changes of Barret esophagus and eventual dysplasia.

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BACKGROUND: There is a relationship between stressful situations and the susceptibility towards certain diseases, probably mediated by immune system modifications. AIM: To study T lymphocyte proliferation in medical students during periods of differing academic stress. SUBJECTS AND METHODS: Blood samples were obtained from 42 medical students during a period of moderate academic stress, immediately before a final examination and after their summer vacations. T lymphocyte proliferation in response to 5, 10 and 20 mg/ml phytohemagglutinin was measured by the incorporation of 3H-thymidine, and plasma cortisol was measured by RIA. RESULTS: T lymphocyte stimulation index in response to all phytohemagglutinin concentrations was significatively lower in the period before examination than in the other two periods. There were no differences in the index between the period of moderate stress and after summer vacations. Plasma cortisol levels were 15.6 +/- 4.3, 18.6 +/- 5.8 and 16.7 +/- 5.1 mg/dl during the periods of moderate stress, before the examination and after vacations, respectively (p < 0.05 for the difference between examination and the other two periods). CONCLUSIONS: There is a decrease in lymphocyte proliferation and an increase in cortisol levels during a period of acute academic stress in medical students, suggesting that, the exposure of the healthy subjects to common stressful stimuli, may affect their immunocompetance.

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Enamel resistance to acid dissolution is a factor which has an influence upon dental caries susceptibility. The objectives of this study were to determine enamel resistance to acid dissolution by applying the RM technique, and to correlate data obtained to the prevalence of dental caries. Two hundred and seventy one children between seven and nine years of age were chosen by non probabilistic sampling in two city districts, (six public schools in Mexico City). These children's central permanent incisives had already erupted. The DMF-T and dmf-t indexes were recorded, and the RM enamel resistance test was performed on them. A total of 56.4% of the subjects in the sample had very resistant enamel and 27.3%, less resistant enamel. A proportion of 57.9% was free of dental caries on the permanent dentition and 10% in the temporary dentition. The average obtained for the DMF-T index was 0.93 +/- 1.34 and that for dmf-t was 4.7 +/- 3.1. Data suggest that enamel resistance distribution is not homogeneous and this increases proportionally in relation to the eruption third (p < 0.05.) Spearman's correlation coefficient was found to be negative and statistically significant at p < 0.05. The RM technique showed the presence of individuals with different enamel resistance to acid dissolution.

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The clinical record of 5 patients are studied. They were hospitalized in Santo Tomás Hospital with history of chronic and massive intoxication with inhaled and ingested cocaine. They all had cardiomegaly: in one, of grade I; in three, of grade III. The echocardiography mode B showed global cardiomegaly with dilatation of cavities and ejection fraction of 20% or below.

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The clinical record of 5 patients are studied. They were hospitalized in Santo Tomás Hospital with history of chronic and massive intoxication with inhaled and ingested cocaine. They all had cardiomegaly: in one, of grade I; in three, of grade III. The echocardiography mode B showed global cardiomegaly with dilatation of cavities and ejection fraction of 20% or below

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Un potente calcio antagonista del tipo de los dihidropiridinas el isradipino, fue evaluado en 132 pacientes ambulatorios (66.7 por ciento del sexo femenino y 33.3 por ciento del sexo masculino) con el diagnóstico clínico de hipertensión arterial leve a moderada, mediante un estudio multicéntrico abierto no comparativo, en diversos Hospitales de Lima-Perú. El protocolo de estudio incluyó un período inicial de 2 semanas de "lavado" o confirmación diagnóstica, según el caso, seguido por 12 semanas de tratamiento con Isradipino 2.5 mg dos veces al día. La edad promedio del grupo fue de 56.7 años (+/- 6.3), peso promedio 66.9 Kgs.(+/- 11.0) y talla 1.60 cms.(+/- 9.0). El 30.3 por ciento de los pacientes tenían diversas enfermedades asociadas, 86.4 por ciento habían sido tratados previamente por hipertensión arterial y 85.8 por ciento tenían hipertensión arterial diagnosticada hacia más de un año. Luego de noventa días de tratamiento con Isradipino se encontró una disminución promedio de 28.8 mmHg en la presión arterial sistólica, la que decreció de 168.5 (+/- 16.7) a 140.0 (+/- 11.4) mmHg (p<0000). En cuanto a la presión diastólica, la diferencia también fue estadísticamente significativa (p<0000) ya que disminuyó de 102.3 (+/- 5.11) a 84.6 (+/- 5.9) mmHg, con una reducción promedio de 17.4 mmHg. No se observaron variaciones clínicamente significativas en la frecuencia cardíaca. Isradipino fue bien tolerado. Los efectos secundarios mas frecuentes fueron: bochornos y cefalea, todos ellos pasajeros y que fueron disminuyendo en el curso del tratamiento, necesitando suspender la droga solo en el 5.3 por ciento de pacientes. Los parámetros de laboratorio clínico estudiados, así como el electro cardiograma y el fondo de ojo, no presentaron modificaciones. Se concluye que el Isradipino es un nuevo fármaco de muy buena eficacia antihipertensiva, bien tolerado y seguro en el tratamiento de la hipertensión arterial leve a moderada

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