Resumen Introducción: Los camioneros de la empresa “Nortev Spa” se exponen diariamente a situaciones de alto riesgo, debido a que se encuentran manejando, corren el riesgo de afectar su salud, ya que pueden verse involucrados en accidentes de tránsito, poniendo en riesgo sus vidas y las de otras personas en la carretera generando lesiones y/o la muerte de ellas. Indirectamente su salud se ve afectada de otras maneras. Objetivo: Determinar patologías prevalentes que afectan la salud de camioneros pertenecientes a una empresa chilena. Método: estudio descriptivo de corte transversal, con muestra de 29 camioneros. Para la recogida de datos se aplicó la encuesta que tiene por nombre “Patologías prevalentes que afectan el desempeño laboral de los transportistas”, validada en Argentina 2016. Resultados: Entre los resultados se destaca que el 48,3% (14 trabajadores) de los camioneros sufren de dolor de espalda, seguido de estrés con un 34,5% (10 trabajadores) siendo más frecuente en hombres 96,6% (28 trabajadores). Conclusiones: Se puede concluir que debido a las extensas jornadas de trabajo la salud de la mayoría de los camioneros se ve afectada de manera directa, presentando molestias musculoesqueléticas lo que podría estar relacionado con la edad y los hábitos de vida que tienen.

Abstract Introduction: The truckers of the company “Nortev Spa” are exposed daily to high-risk situations, because they are driving, they run the risk of affecting their health, since they may be involved in traffic accidents, putting their lives and lives at risk. of other people on the road causing injury and/or death to them. Indirectly your health is affected in other ways. Objective: To determine prevalent pathologies affecting the health of truck drivers belonging to a Chilean company. Method: descriptive cross-sectional study, with a sample of 29 truck drivers. For data collection, the survey called “Prevalent pathologies that affect the work performance of carriers” was applied, validated in Argentina 2016. Results: Among the results, it is highlighted that 48.3% (14 workers) of the truck drivers suffer from back pain, followed by stress with 34.5% (10 workers) being more frequent in men 96.6% (28 wokers). Conclusions: It can be concluded that due to the long working hours, the health of most truckers is directly affected, presenting musculoskeletal discomfort, which could be related to their age and lifestyle habits.

Background: Postmenopausal women have higher severity of coronary heart disease (CHD) than premenopausal women and type 2 diabetes mellitus (T2DM) is an independent risk factor. Aim: To assess the severity of CHD in pre and postmenopausal patients undergoing coronary angiography and the impact of T2DM in both groups. Material and Methods: A coronary angiography was performed to 707 women due to suspected CHD during 2013 and 2014. Of these, 579 were older than 55 years and were considered as postmenopausal. Factors such as hypertension, obesity, smoking, creatinine and T2DM were registered. The severity of CHD in coronary angiography was evaluated according to the number of vessels with more than 50% stenosis. Results: Compared to their postmenopausal counterparts, premenopausal women had less frequency of T2DM (31% and 42% p < 0.033), hypertension (52 and 78%, p < 0.001) and alteration of renal function (11 vs. 39%, p < 0.001). Absence of coronary lesions was found in 44 and 32% of premenopausal and postmenopausal women, respectively (p < 0.01). Premenopausal women with T2DM had a higher frequency of multi-vessel disease than those without the disease (25 and 4.5%, p < 0.001). The frequency of multi-vessel disease was higher in postmenopausal than premenopausal women (24 and 11%, p < 0.01). Hypertension, T2DM and renal involvement were associated with a higher frequency multiple vessel disease. Conclusions: The severity of CHD is higher in postmenopausal women and T2DM is associated with the disease.

Abstract It proposes to adopt an exterior active policy that allows to restate the position of Mexico, to check its international participation in the international area in questions as the combat to the climate change, the prohibition of nuclear weapons and the multilateral management of the cross-border currents of migration and refuge flows. To articulate a strategy in the bilateral relations of Mexico with regard to the change of approach of The United States, to cultivate global diplomatic relations, but concentrate its resources on strategic issues.

Resumen Se propone adoptar una política exterior activa que permita replantear la posición de México, revisar su participación en el ámbito internacional en cuestiones como el combate al cambio climático, la prohibición de las armas nucleares y el manejo multilateral de las corrientes transfronterizas de migración y refugio. Articular una estrategia en las relaciones bilaterales de México con respecto al cambio de enfoque de Estados Unidos, para cultivar relaciones diplomáticas globales, pero concentrar sus recursos en cuestiones estratégicas.

Abstract In the light of the results of the last Congress of the ChineseCommunist Party (CCP), it highlighted the direction of thenation towards the cusp of national economies in the thirddecade of the century under the leadership of Xi Jinping to thenext five years. The article puts economic and social evolutionof China’s policy in the new global context; the same updatesand develops their approaches and their position and globalinfluen- ce to cover the gaps and exercise the leadership thatUnited States loses.

Resumen A la luz de los resultados del pasado congreso del Partido Comunista Chino (PCCh), se delineo el rumbo de la nación hacia la cúspide de las economías nacionales en el tercer decenio del siglo bajo el liderazgo de Xi Jinping para el próximo lustro. El artículo sitúa la evolución económica y social de la política de China en el nuevo contexto global; así mismo actualiza y desarrolla sus planteamientos y su posición e influencia global para cubrir los vacíos y ejercer el liderazgo que Estados Unidos pierde.

Abstract: Orofacial granulomatosis is a nonspecific term that contains a wide variety of granulomatous entities, which share a clinical and histopathological presentation. It manifests as persistent or recurrent orofacial swelling, amongst other findings. Idiopathic orofacial granulomatosis, characterized by an absence of systemic granulomatous disease, is a diagnosis of exclusion. The main differential diagnosis is Crohn's disease. Its pathogenesis is unknown, however, it seems to be immune-mediated. Patch-test sensitivity to multiple allergens is well documented. Currently, therapeutic options consider restrictive diets, topical, intralesional, and systemic agents. First-line therapy is currently a matter of debate. We present a review of the value of diet therapy in this syndrome, along with two illustrative cases.

Resumen: Introducción: la cirugía micrográfica de Mohs es una técnica para la exéresis de cánceres de piel con el examen histológico del 100% de los márgenes quirúrgicos, logrando la tasa de curación más alta con máxima preservación de tejido sano. Objetivo: realizar una descripción clínico-epidemiológica de nuestras primeras 130 cirugías en el Hospital de Clínicas. Método: análisis descriptivo de todos los pacientes operados por un único cirujano de Mohs en nuestra Unidad de Cirugía Dermatológica desde noviembre de 2013 hasta junio de 2016. Se registraron datos clínicos, tumorales y quirúrgicos. Resultados: se estudiaron 130 cirugías en 90 pacientes; 62,3% fueron realizadas en hombres y 37,7% en mujeres. La edad media fue de 68 años (rango: 33-90 años). El 67,7% provenía de Montevideo y el 32,3% del interior del país. El 68% correspondía a carcinoma basocelular y 32% a carcinoma espinocelular. El 91,5% eran tumores primarios y el 8,5% recurrentes. El 75,3% se encontraba en cabeza y cuello. El tipo más frecuente de cierre fueron los colgajos en 43% (56). Hasta el momento, 70 pacientes han completado seguimiento de al menos un año, donde se vio recidiva tumoral en un solo caso (1/70; 1,43%). Conclusiones: la cirugía de Mohs es un procedimiento seguro y eficaz, y nuestros resultados coinciden con lo descrito en centros de referencia internacional. Este es el primer centro de Uruguay que cuenta con un cirujano de Mohs y presentamos el primer estudio en pacientes uruguayos.

Abstract: Introduction: Mohs micrographic surgery is a technique for the excision of skin cancer with histologic analysis of 100% of the surgical margins, achieving the highest cure rate, while allowing maximum preservation of surrounding healthy tissue. Objective: to perform a clinical-epidemiologic description of our first 130 surgeries at the Hospital de Clínicas. Method: descriptive analysis of all patients operated by a single Mohs surgeon in our Dermatologic Surgery Unit between November 2013 and June 2016. Clinical, tumoral and surgical data was registered. Results: 130 surgeries performed in 90 patients were studied. 62.3% were male patients and 37.7% female. Mean age was 68 years (range: 33 - 90 years). 67.7% resided in Montevideo and 32.3% from other parts of the country. 68% corresponded to basal cell carcinoma, and 32% to squamous cell carcinoma. 91.5% were primary tumors, and 8.5% were recurrent. 75.3% were located on the head and neck region. The most frequently used method of closure were flaps in 43% (56). Up to this moment, 70 patients have undergone follow-up for at least twelve months, and so far, only one case showed recurrence (1/70; 1.43%). Conclusions: Mohs surgery is safe and effective, and our results agree with reports of international reference centers. This is the first center in Uruguay with a Mohs Surgeon, and we present the first study in Uruguayan patients.

Resumo: Introdução: a cirurgia micrográfica de Mohs é uma técnica para a exéreses de cânceres de pele com o exame histológico de 100% das margens cirúrgicas, conseguindo a taxa de cura mais alta com máxima preservação de tecido saudável. Objetivo: realizar uma descrição clínico-epidemiológica das primeiras 130 cirurgias realizadas no Hospital de Clínicas de Uruguai. Método: análise descritiva de todos os pacientes operados por um único cirurgião de Mohs na Unidade de Cirurgia Dermatológica no período novembro 2013 - junho 2016. Foram registrados dados clínicos, tumorais e cirúrgicos. Resultados: foram analisadas 130 cirurgias realizadas em 90 pacientes sendo. 62.3% em homens e 37.7% em mulheres. A média de idade média foi 68 anos (intervalo: 33 - 90 anos). 67.7% eram originários de Montevidéu e os restantes 32.3% do interior. 68% correspondiam a carcinoma basocelular e 32% a carcinoma de células escamosas. 91.5% eram tumores primários e 8.5% recorrentes. 75.3% estavam localizados em cabeça e pescoço. O tipo mais frequente de fechamento foi por retalhos em 43% (56). Até o momento, 70 pacientes completaram um seguimento mínimo de 1 ano, no qual se observou recidiva tumoral em somente 1 caso (1/70; 1.43%). Conclusões: a cirurgia de Mohs é um procedimento seguro e eficaz, e nossos resultados coincidem com os descritos por centros de referência internacional. Este é o primeiro centro no Uruguai que conta com um cirurgião de Mohs e que apresenta o primeiro estudo em pacientes uruguaios.

Abstract: The controversial election and bumpy start of the Trump administration point towards a major change of direction for the American economic policy with consequences at global scale. Despite being close to full employment, a range of measures, which taken together are equivalent to a stimulus package, were offered. Fiscal expansion with both corporate and personal tax reductions and huge increases in infraestrcture, defense and other investment expenditures, as well as across the board deregulation for extractive and financial firms and protection measures to respond to competitive conditions deemed unfair. The decleared aims were to double the rate of growth and increase employment, particularly in manufactures. This paper review some initial reactions and the multilateral financial institutions approach, to underline the fragility of some of the proposals and evaluate the reach of their repercussions.

Resumen: Con el controvertido arribo de Donald Trump a la presidencia de Estados Unidos se vislumbra una reorientación de la política económica que no dejará de influir en la perspectiva global. Aunque el país está próximo al pleno empleo, se ofrecieron diversas medidas aisladas, cuyo conjunto se asemeja a un amplio paquete de estímulo: expansión fiscal integrada por cuantiosas reducciones de impuestos y un aumento considerable del gasto, en especial en defensa e infraestructura; desregulación agresiva a favor de las empresas extractivas y financieras, disposición a proteger en forma activa a las empresas frente a la injusta competencia externa. El objetivo declarado es duplicar la tasa de crecimiento y multiplicar el empleo, en especial en las manufacturas. Este artículo revisa algunas de las primeras reacciones y el enfoque de las instituciones multilaterales, para enfatizar la fragilidad de algunas de las propuestas y ponderar el alcance de sus repercusiones.

Laugier-Hunziker syndrome is a rare benign idiopathic condition characterized by acquired macular pigmentation of lips and buccal mucosa, often accompanied with melanonychia. The main concern with this condition is to rule out other differential diagnosis with systemic repercussions and similar hyperpigmentation patterns, such as Peutz-Jeghers syndrome, adrenal insufficiency and melanoma. We report a 58-year-old female with a 20-year history of Sjögren’s syndrome, presenting with melanonychia and hyperpigmentation in the buccal mucosa. She had no relevant medication history and is a non-smoker. The patient denied any other symptoms. The histopathology confirmed the diagnosis of Laugier-Hunziker syndrome.

Abstract The Mexican energy system is analysed looking at its links with the long-term growth, stability and development of the country's economy. The political, economic and financial factors behind the 2013 Constitutional amendment on energy are also examined. Looks at the impact of the oil market opening on Pemex and the implications of sharing with private actors the rights and obligations of the State in the exploitation and utilization of hydrocarbons property of the Nation. Among the main conclusions, underlines the following: the reform worsens the growing structural dysfunction of Mexican energy sector, aggravating its extreme concentration on fossil fuels; prioritize the primary activities and marginalizes those related to industrial hydrocarbon processing; it reinforces already existing bias as exporter of crude oil and importer of petroleum products; it increases the fiscal burden and the latent financial bankruptcy of Pemex, and leaves to the market the pace and modalities of inclusion of the national energy system into the global energy transition.

Resumen Analiza el funcionamiento estructural del sistema energético mexicano y sus vínculos con el crecimiento, la estabilidad y el desarrollo, así como las motivaciones que dieron lugar a la reforma constitucional de 2013. Se examina el impacto de la reforma en Pemex y las repercusiones de distribuir con actores privados que sobrelleva la apertura mercantil, derechos y obligaciones del Estado en la explotación y aprovechamiento de los hidrocarburos propiedad de la Nación. Se advierte que la reforma agrava la creciente disfuncionalidad estructural, pues no ofrece salida a la concentración extrema del sistema energético; prioriza las actividades primarias y margina las de transformación industrial; refuerza el sesgo exportador de crudo e importador de derivados del petróleo; agrava la carga fiscal y la quiebra financiera latente de Pemex; y cede al mercado la inserción del sistema energético nacional en la transición energética global.

Abstract Inequality has been perhaps the most visited subject in social sciences, especially economics, debates of the past decades, along with the explosion of its multiple faces: mainly income and wealth. Its extension and reach, summarized in impressive figures, are already well known. However, till the end of the last decade, its consequences for the economic growth haven't been fully identified. Nowadays, there is full recognition of the fact that inequality affects growth and increased inequalitymaims growth gravely. However, there has been not a similar advancement in the design and implementation of policies to face it and annul this obstacle to the restoration of global economic dynamics. Actions related with the fight against inequality are the seed of systemic change to answer the crash of the combination of unregulated market economies and formal democratic regimes, that sort of global paradigm in place at least since the beginning of the 90's, but certainly since long before.

Resumen La desigualdad ha sido el tópico más debatido en las ciencias sociales, en especial la economía, en los últimos decenios, que han presenciado la explosión de sus principales dimensiones: ingreso y riqueza entre ellas. Se ha avanzado mucho en el estudio de sus dimensiones, alcances y extensión, que se han resumido en impresionantes indicadores. Hasta comienzos del decenio, sin embargo, no se habían identificado sus costos en términos de efectos negativos sobre el crecimiento económico. Ahora es generalizado el reconocimiento de que la desigualdad disminuye el crecimiento y la desigualdad creciente lo afecta de manera multiplicada. Empero, no ha sido equivalente el avance en la definición e instrumentación de políticas para hacerle frente de manera efectiva y retirar este enorme obstáculo a la recuperación del dinamismo económico global. Los desarrollos asociados al combate a la desigualdad constituyen el germen de un cambio sistémico ante la bancarrota del binomio economías de mercado desreguladas y democracias electorales formales, esa suerte de paradigma global vigente al menos desde inicios de los años noventa, pero en realidad desde mucho antes.

The energy reform constitutes a paradigmatic change. It means nearly unrestricted legal access to private investments and turns back both the exclusivity of the State in energy activities and the scope of Nation's sovereignty over hydrocarbons. The reform proponents believe as a matter of fact that private investors will react on the way they want to. A naive similar assumption was adopted regarding the convergence of both investors and Nation interests. Without demonstration, based on doctrinarian perception of the market laws, it is assumed that maximization of hydrocarbons exploitation, increased income for the government and the reversal of the present declining trend of the country's oil surplus will be in order. As a consequence of the protracted stagnation of the country's oil processing capacity (refining and petrochemicals) the reform will accentuate the crude oil exporting bias of the past three decades. The new paradigm represents a century long retrogression: a new exporting colonial enclave justified by the assumption that the presence of foreign investment will automatically translate into a widened hydrocarbons horizon for the country.

La reforma energética significa un cambio de paradigma. Su esencia es la apertura jurídica e institucional, casi irrestricta, a la inversión privada, el repliegue en las funciones de exclusividad del Estado y la reducción del ámbito de soberanía de la Nación sobre los hidrocarburos. Sus impulsores dan por hecho una reacción favorable de la inversión privada, especialmente la extranjera, convergente además con el interés nacional. Asumen, sin demostración o evidencia, salvo recurrir a argumentos doctrinarios de mercado, que será posible maximizar la explotación de hidrocarburos, generar mayores ingresos del gobierno y revertir la tendencia decreciente del excedente petrolero. Ante la atonía crónica de la capacidad instalada de refinación y de petroquímica, se acentúa el sesgo exportador de petróleo crudo, característico del sector energético mexicano durante las últimas tres décadas. El nuevo paradigma petrolero así forjado constituye un retorno al prevaleciente hace un siglo, no muy diferente al de un enclave colonial primario exportador, soportado por la expectativa de que la inversión extranjera directa permitirá fortalecer el horizonte de explotación de los hidrocarburos.