[Installed Capacity Perception Survey for the Training of Residents Program in Orthopedics and Care Needs in Acute and Chronic Musculoskeletal Pathology in Mexico]. / Encuesta de Percepción en Capacidad Instalada para la Formación de Médicos Residentes en Ortopedia (Traumatología) y Necesidades de la Atención en Patología Musculoesquelética Aguda y Crónica en México. Primera Parte.

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.

Study of enzymatic digestion of cellulose by small angle neutron scattering.

Small angle neutron scattering (SANS) was used to study the structure of Avicel (FD100) microcrystalline cellulose during enzymatic digestion. Digestions were performed in either of two modes: a static, quiescent mode or a dynamic mode using a stirred suspension recycled through a flow cell. The scattering pattern for as-received Avicel in D(2)O buffer is comprised of a low Q power law region resulting from the surface fractal character of the microcrystalline fibers and a high Q roll-off due to scattering from water-filled nanopores with radii approximately 20 A. For digestions in the dynamic mode the high Q roll-off decreased in magnitude within approximately 1 h after addition of enzymes, whereas in the static digestions no change was observed in the high Q roll-off, even after 60 h. These results indicate that only with significant agitation does enzyme digestion affect the structure of the nanopores.

[Agreement between pneumotachograph and PiKo-1 measurements of PEF and FEV1]. / Estudio de la concordancia de 2 aparatos para la medida del PEF y FEV1: neumotacógrafo y PiKo-1.

OBJECTIVE: To assess how well values for peak expiratory flow (PEF) and forced expiratory volume in 1 second (FEV1) agree when measured with the PiKo-1 device and with a conventional pneumotachograph. PATIENTS AND METHODS: This randomized, single-blind study included 40 patients who attended the clinic for lung function testing. The 2 measurement devices were the Masterlab pneumotachograph and the PiKo-1. A correction factor estimated by the manufacturer was applied to the measurements taken with the PiKo-1. RESULTS: The values obtained with the 2 devices differed by a mean of 5.8218 L/min for PEF (95% confidence interval [CI], -9.4809 to 21.1387) and 0.001 L for FEV1 (95% CI, -0.0616 to 0.0636). The intraclass correlation coefficient was 0.9652 (95% CI, 0.9336-0.9819) for PEF and 0.9876 (95% CI, 0.9761-0.9936) for FEV1. CONCLUSIONS: The PiKo-1 is a simple and easy-to-use device that can be very useful for monitoring and assessing the severity of obstructive pulmonary diseases. The results must be corrected for altitude and the estimated correction factor should be applied.

Fibromyalgia syndrome: overnight falls in arterial oxygen saturation.

PURPOSE: Sleep alterations and muscular changes suggesting hypoxia have been reported in fibromyalgia syndrome (FS) pathophysiology. We tested the hypothesis that patients with FS show falls in the oxygen saturation of hemoglobin in arterial blood (SaO2%) during sleep. PATIENTS AND METHODS: Overnight SaO2% was measured by digital pulse oximetry in 28 randomly selected women who met 1990 American College of Rheumatology criteria for the diagnosis of FS and 15 similar controls. Considering the results of pulse oximetry and in order to evaluate the possible presence of a sleep apnea syndrome (SAS) as the reason for the nocturnal desaturations, the Epworth Sleepiness Scale (ESS) was mailed to the patients and controls. Patients and controls who had a score higher than 10 on the ESS underwent a polysomnographic study. RESULTS: Patients with FS showed lower overnight minimum SaO2% (86.8 +/- 1.3 versus 90.7 +/- 0.9 in controls, P < 0.05), greater number of desaturations (8.3 +/- 1.8 versus 2.7 +/- 0.8 in controls, P < 0.05) and more desaturations/hour (1.3 +/- versus 0.4 +/- 0.1 in controls, P < 0.05), more night minutes in SaO2% < 92% (56.3 +/- 12.9 versus 9.1 +/- 3.8 in controls, P < 0.01) and more minutes in SaO2% < 90% (14.7 +/- 3.7 versus 2.4 +/- 1.0 in controls, P < 0.05). There were no differences between patients with FS and controls in ESS scores. Five patients (19.2%) in the FS group and 2 (15.4%) in the control group had ESS scores higher than 10. One patient had 1 control subject showed on apnea-plus-hypopnea index higher than 5 (13 and 9, respectively) in polysomnographic study. CONCLUSIONS: Patients with FS showed small overnight falls in SaO2% and spent more time during the night in SaO2% below 92% and 90% than did the control group. These alterations that, as a whole, are not due to the presence of an associated SAS could be important in FS musculoskeletal pathophysiology.

[Smoking in schools. A cross-sectional epidemiologic study of a population of 4,281 school children]. / Tabaquismo escolar. Estudio epidemiológico transversal en una población de 4.281 escolares.

Smokers begin to acquire their habit early. The objective of this study was therefore to determine real smoking habits among young people in Spain and create a profile of the adolescent smoker. A questionnaire was administered to a cross-section of the population. The results obtained coincide with reports by other authors in the Spanish and international literature. We found that the prevalence of smoking among young people between 9 and 19 years of age is approximately 25% and tobacco use increases with age. Young smokers participate less in sports and have a greater tendency to approve tobacco advertising. Young smokers' reasons for starting to smoke are diverse and the notion of "being grown-up" did not appear to apply to our cohort. We discuss, in the light of recent findings, the role of parents and social context in encouraging young people to smoke. The age of 14 is a key moment for taking up and establishing the habit of smoking.

[Pulmonary carcinoma associated with bullous emphysema]. / Carcinoma pulmonar asociado a enfisema bulloso.

Malignant complication of pulmonary bullous disease is rare but not negligible. Its importance lies in the young age when it appears. Eighty-nine cases in the literature, including four of our own cases, are included in this review. Etiopathogenic theories are discussed along with clinical, radiological, pathological, diagnostic, prognostic, and treatment characteristics. Smoking is a primary factor in this process, and quitting is key in terms of prevention. Surgical methods are usually necessary to perform the diagnosis, but that does not exclude the use of other techniques-particularly, fine-needle aspiration biopsy under radiological control-whose role should be validated. The prognosis is bad if there is no commitment to prevention. Even though the value of serial radiological controls is unknown, such controls may help in the early detection of neoplastic degeneration in bullous disease. The nature of the problem in handling these cases therapeutically is determined by the severity of bullous dystrophy: therefore, surgery should be considered on an individual basis.

[Sleep apnea syndrome. Clinical manifestations and treatment with continuous positive airway pressure in 40 patients]. / Síndrome de apnea del sueño. Manifestaciones clínicas y tratamiento con presión positiva continua sobre la vía aérea (cPAP) en 40 pacientes.

Sleep obstructive apnea syndrome (SOAS) is defined by the existence of recurrent respiratory pauses during sleep, in general accompanied by arterial hypoxemia. In the present study the clinical characteristics of 40 patients diagnosed of SOAS are defined, highlighting amongst them de time sleepiness (85%), unavoidable sleep (85%) and tendency to snore (100%). Incidence is greater in males, in the fourth or fifth decades of lives in obese subjects (82%) and with associated hypertension (38%). Treatment with continuous positive pressure on respiratory tract (cPAP) achieves a significant decrease (p less than 0.001) in the mean duration of apnea and in the apnea-hypopnea/hour index, and it also manages to significantly increase arterial oxygen saturation. Similarly, a good adaptation to treatment, with a drop out rate of 7.5% and the absence of serious complications are observed.

[Bagassosis. Allergic pneumonitis in an industrial employer (author's transl)]. / Bagazosis. Enfermedad pulmonar en un trabajador industrial.

A clinical observation of bagassosis in an industrial employer is reported. The disease had an acute initial onset with severe respiratory distress and roentgenographic image of pulmonary diffuse nodular infiltrates. Clinical manifestations and radiographic pattern disappeared after 4 months of corticosteroid therapy. Bagassosis is an allergic pneumonitis of hypersensitivity; other cases published up to the present time are reviewed as well as clinical symptoms, roentgenologic pattern, pathological findings and immunological origin corresponding to this condition. Bagassosis was first reported in 1937, it is an uncommon disease and its different forms of clinical presentation may lead to misdiagnosis. Cessation of exposure usually results in complete recovery.