Abstract Introduction and objective: This work describes the importance of adopting effective methods of sampling reprocessed endoscopes for the detection of microorganisms adhered to the internal walls of these devices. The objective of this work is to compare the rate of bacterial contamination of the channels of reprocessed endoscopes, through irrigation water culture and that obtained after brushing the channels. A secondary objective was to determine the antimicrobial susceptibility of the pathogens isolated in both methods. Method: A total of 26 endoscopes (duodenoscopes, gastroscopes, colonoscopes, bronchoscopes and echoendoscopes) were subjected to automatic cleaning and reprocessing before use in patients at Hospital Juárez de México. Cleaned and reprocessed endoscopes were simultaneously subjected to two bacteriological test methods based on no brushing (method A) and brushing (method B) of the channels. Bacterial strains isolated after carcass culture were identified to genus and species level and subjected to antimicrobial resistance testing. Results: Method A revealed zero rate of residual bacterial contamination in both channels (suction and working). The microbiological results obtained by method B revealed bacterial contamination rates of 30.7%. Bacterial strains belonging to the families Enterobacteriaceae, Bacillaceae, Pseudomonadaceae, Micrococcaceae and Staphylococcaceae were identified. High rates of antimicrobial resistance were detected against 12 tested antibiotics from eight different families. Conclusion: Implementation of microbiological surveillance of endoscope reprocessing with modified sampling methods is necessary to prevent healthcare-associated infections from endoscopic procedures.

Resumen Introducción y objetivo: Este trabajo describe la importancia de adoptar métodos efectivos de muestreo de endoscopios reprocesados para la detección de microorganismos adheridos a las paredes internas de estos dispositivos. El objetivo de este trabajo es comparar la tasa de contaminación bacteriana de los canales de endoscopios reprocesados, mediante cultivo del agua de irrigación y la obtenida posterior a un cepillado de los canales. Un objetivo secundario fue determinar la sensibilidad antimicrobiana de los patógenos aislados en ambos métodos. Método: Un total de 26 endoscopios (duodenoscopios, gastroscopios, colonoscopios, broncoscopios y ecoendoscopios) fueron sometidos a limpieza y reprocesamiento automático antes de su uso en pacientes del Hospital Juárez de México. Los endoscopios limpios y reprocesados se sometieron simultáneamente a dos métodos de prueba bacteriológica basados en ausencia de cepillado (método A) y cepillado (método B) de los canales. Las cepas bacterianas aisladas después del cultivo de canales se identificaron a nivel de género y especie y se sometieron a pruebas de resistencia antimicrobiana. Resultados: El método A reveló cero tasa de contaminación bacteriana residual en ambos canales (succión y trabajo). Los resultados microbiológicos obtenidos por el método B revelaron tasas de contaminación bacteriana del 30.7%. Se identificaron cepas bacterianas pertenecientes a las familias Enterobacteriaceae, Bacillaceae, Pseudomonadaceae, Micrococcaceae y Staphylococcaceae. Se detectaron altas tasas de resistencia antimicrobiana contra 12 antibióticos probados de ocho familias diferentes. Conclusión: La implementación de la vigilancia microbiológica del reprocesamiento de endoscopios con métodos modificados de muestreo es necesaria para prevenir infecciones asociadas a la atención de la salud por procedimientos endoscópicos.

Abstract Following the argument that the likelihood of observing expansive fiscal policy increases under left-wing governments whereas right-wing ones tend to enforce restrictive fiscal policies, this article examines the relationship between ideological positions in Latin American parliamentary elites and fiscal policy, concentrating on the Left-Right continuum. The multiple correspondence analysis of 99 legislatures and 18 countries between 1994 and 2019 shows that Left-Right semantics do not determine stances on fiscal policy. Our findings confirm that regardless of ideological orientation, controlling tax evasion is considered a fiscal reform priority.

Resumen Bajo el argumento de que la probabilidad de observar políticas fiscales expansivas es mayor con los gobiernos de izquierda, mientras que los gobiernos de derecha tienen más probabilidades de llevar a cabo una política fiscal restrictiva, este artículo examina la relación entre los posicionamientos ideológicos de las élites parlamentarias latinoamericanas y la fiscalidad, centrándose en el continuo izquierda-derecha. El análisis de correspondencias múltiples de la base de datos de 99 legislaturas y 18 países durante el periodo 1994-2019, revela que la semántica izquierda-derecha no determina los posicionamientos en política fiscal. Nuestros hallazgos confirman que, independientemente de la orientación ideológica, el control a la evasión se considera una medida prioritaria de reforma fiscal.

Background: A significant proportion of the clinical record is in free text format, making it difficult to extract key information and make secondary use of patient data. Automatic detection of information within narratives initially requires humans, following specific protocols and rules, to identify medical entities of interest. Aim: To build a linguistic resource of annotated medical entities on texts produced in Chilean hospitals. Material and Methods: A clinical corpus was constructed using 150 referrals in public hospitals. Three annotators identified six medical entities: clinical findings, diagnoses, body parts, medications, abbreviations, and family members. An annotation scheme was designed, and an iterative approach to train the annotators was applied. The F1-Score metric was used to assess the progress of the annotator's agreement during their training. Results: An average F1-Score of 0.73 was observed at the beginning of the project. After the training period, it increased to 0.87. Annotation of clinical findings and body parts showed significant discrepancy, while abbreviations, medications, and family members showed high agreement. Conclusions: A linguistic resource with annotated medical entities on texts produced in Chilean hospitals was built and made available, working with annotators related to medicine. The iterative annotation approach allowed us to improve performance metrics. The corpus and annotation protocols will be released to the research community.

Introduction: Esophageal perforation is a possible complication after anterior cervical fusion. However, these complications usually appear intraoperatively or in the early postoperative course. Case report: A 35-years-old females, who underwent a C3-C5 anterior cervical fusion 3 years ago, after suffering a mild cervical trauma, she complained of dysphagia. A retroesophageal abscess was observed, caused by esophageal perforation, secondary to plaque rupture and screw extrusion.

Resumen Introducción: La perforación esofágica es una posible complicación de la artrodesis cervical anterior. Sin embargo, estas suelen ocurrir intraoperatoriamente o en el posoperatorio precoz. Caso clínico: Mujer de 35 años sometida, 3 años antes, a artrodesis de C3-C5, que tras sufrir un traumatismo leve con latigazo cervical, comienza con disfagia. Se objetiva un absceso retroesofágico por perforación esofágica, causado por rotura de la placa protésica y extrusión de un tornillo.

Introduction and objective: BMI can be misleading for certain body constitutions, for this reason other parameters have been proposed as predictors of cardiovascular risk, among them the adiposity (calculated through CUNBAE formula) the Framingham Index and the Atherogenic Index (TC-r/HDL-c.) We propose to compare these factors as markers of success after sleeve gastrectomy as bariatric surgery procedure for obese patients. Material and methods: We performed a prospective observational study of patients undergoing to a sleeve gastrectomy and with a minimum follow-up period of 1 year. We analyze the evolution of BMI, adiposity, the Framingham Index & the Atherogenic Index. Results: We analyzed 140 patients. Preoperative BMI was 49.1 kg/m², with a 54.8% for adiposity. The Framingham value was 7.54% and Atherogenic Index: 4.2. At 12 months BMI was 28.4 kg/m² and adiposity percentage 39.4%. At the same time, the Framingham was 3.7% and Atherogenic Index: 1.64. Analyzing these data, after 12 months from surgery, the mean of BMI is in range of overweight, the adiposity is classified as obesity (> 25% in men and > 35% in women), the Framingham range describes a low cardiovascular risk (< 5%) and the Atherogenic Index is located in the normal range (< 3). Correlating these parameters we observed that BMI is correlated with adiposity at preoperative values (Pearson 0.486; p = 0.004), postoperative (Pearson 0.957; p < 0.001), and the difference between them (Pearson 0.606; p = 0.017). This is logical, because the BMI is included in the formula for calculating the adiposity (by CUNBAE formula.) In the postoperative values correlated the adiposity with Framingham value (Pearson 0.814, p = 0.036) and with the atherogenic risk (p = 0.049, 0.517 Pearson.) In preoperative values, these correlations are not objectified. BMI was not correlated with adiposity. Conclusion: The adiposity correlates better with cardiovascular risk indices, such as the Framingham Index or the Atherogenic Index, but only in the postoperative values. These elements represent useful tools for assessing the decreased risk of cardiovascular disease after bariatric surgery.

Introducción y objetivo: el IMC puede resultar engañoso para ciertas complexiones corporales, por lo que se han propuesto otros parámetros como la adiposidad (calculada a través de fórmula CUN-BAE, el índice de Framingham de riesgo cardiovascular (IF) y el índice aterogénico (IA) (rCT/HDL-c) como predictores de riesgo cardiovascular. Se propone comparar estos factores como marcadores de éxito terapéutico tras cirugía en pacientes obesos sometidos a gastrectomía vertical laparoscópica (GVL) como procedimiento de cirugía bariátrica. Material y métodos: realizamos un estudio observacional prospectivo de pacientes sometidos a GVL y con un periodo de seguimiento mínimo de 1 año. Analizamos la evolución de IMC, adiposidad, IF e IA. Resultados: analizamos 140 pacientes. El IMC preoperatorio fue de 49,1 kg/m², con una adiposidad del 54,8%, un IF 7,54% y un IA de 4,2. A los 12 meses el IMC era de 28,4 kg/m², con una adiposidad del 39,4%, un IF del 3,7% y un IA de 1,64. En función de estos resultados, a los 12 meses el IMC medio está en rango de sobrepeso, la adiposidad en niveles de obesidad (obesidad: > 25% en hombres y > 35% en mujeres), el IF en rango de riesgo cardiovascular bajo (< 5%) y el IA dentro del rango de normalidad (< 3). Correlacionando estos parámetros observamos que el IMC se correlaciona con la adiposidad tanto en valores preoperatorios (Pearson 0,486; p = 0,004), posoperatorios (Pearson 0,957; p < 0,001), como en la diferencia entre ambos (Pearson 0,606; p = 0,017), lo cual es lógico, porque el IMC se incluye en la fórmula CUN-BAE para el cálculo de la adiposidad. En los valores posoperatorios se objetiva una correlación de la adiposidad con el IF (Pearson 0,814, p = 0,036) y con el IA (Pearson 0,517; p = 0,049). En los valores preoperatorios no se objetivan dichas correlaciones. El IMC no se correlacionó con la adiposidad. Conclusión: la adiposidad se correlaciona con índices de riesgo cardiovascular, como el índice de Framingham o el índice aterogénico, pero solo en las determinaciones posoperatorias. Estos elementos suponen herramientas útiles para valorar la disminución del riesgo de enfermedad cardiovascular después de cirugía bariátrica.

PURPOSE: To evaluate the performance of a 'one-stop' clinic in terms of proportion of discharges or inclusion in surgical waiting lists. MATERIALS AND METHODS: All patients were referred from primary care facilities (population 220.646) and from different departments in the hospital. Eight senior urologists, two registered nurses and two nurse attendants participated in the experience. Prior to the start of the project, referral protocols had been agreed with the primary care physicians involved. Compliance with the protocols was periodically tested. Eventually 5537 first visits (January-December 2009) where evaluable. RESULTS: Overall, the 'one-stop' format proved feasible in 74.2% of the patients (4108/5537). Patients, who successfully used the 'one-stop' format, were significantly younger than those who required additional consultations (43 vs 50 years old, respectively, Student's t test < 0.001). For obvious reasons the 'one-stop' format was universally possible in male sterilization and penile phimosis patients. Similarly, the 'one-stop' policy was applied in most consultations due to male sexual dysfunction (75%) and urinary tract infection (73%). Other health problems, such as haematuria (62%) and renal colic (46%), required more than one visit so that care of the patient reverted to the traditional, outpatient care model. CONCLUSION: A 'one-stop' philosophy is feasible for a number of procedures in a urological outpatient clinic. The costs to implement such an approach would be limited to managerial expenditure.

Objective: To determine the prevalence of cardiovascular disease at diagnosis of type 2 diabetes mellitus. Methods: Retrospective observational study in an urban primary health care centre between 1991 and 2000. Review of clinical patient characteristics, cardiovascular disease and risk factors, in the year of diabetes diagnosis. Patients without any glycaemia recorded before diagnostic were excluded. Logistic regression was done to identify the variables associated to cardiovascular events. Results: From 598 cases of diabetes diagnosed, 487 with previous glycaemia were included for the analysis (mean age [SD], 60.4 [10.9]; 53% women). The prevalence of cardiovascular risk factors was: obesity 61.1%, hypertension 71.9%, hypercholesterolemia 52%, hypertriglyceridemia 35.3% and present or previous smoking habit (24 and 16,6%). 96.9% of them presented at least one of the studied cardiovascular risk factors and 53.4% three or more. 78 patients (16%; CI95%: 12.8-19.3) had cardiovascular disease before or during the first year of diagnosis (men 21.4% and women 11.2%). The prevalence of cardiovascular disease increased progressively with the number of cardiovascular risk factors. The significant predictive variables of cardiovascular disease (logistic regression) were: age >55 years (OR=2.91; CI95%: 1.46-5.80), smoking habit (OR=2.28; CI95%: 1.15-4.51) and HbA1c >7% (OR=1.8; CI95%: 1.1-3.1). Conclusions: A high prevalence of cardiovascular disease and cardiovascular risk factors at diabetes diagnosis was observed. Age, smoking habit and elevated glycated haemoglobin were the variables related to cardiovascular disease.

Objetivo: Conocer la prevalencia de la enfermedad cardiovascular en el momento del diagnóstico de la diabetes mellitus tipo 2. Métodos: Estudio observacional retrospectivo realizado en un centro de atención primaria urbano entre 1991 y 2000. Revisión de las características clínicas, factores de riesgo y enfermedad cardiovascular el año del diagnóstico de diabetes. Se excluyeron los pacientes sin glucemias previas al diagnóstico. Se realizó un análisis de regresión logística para identificar las variables asociadas a la presencia de eventos cardiovasculares. Resultados: De los 598 nuevos casos de diabetes diagnosticados se analizaron los 487 que tenían valores previos de glucemia (media de edad [desviación estándar]: 60,4 [10,9] años; un 53% eran mujeres). La prevalencia de factores de riesgo cardiovascular fue: obesidad 61,1%, hipertensión arterial 71,9%, hipercolesterolemia 52%, hipertrigliceridemia 35,3% y tabaquismo actual 24% o previo 16,6%. El 96,9% tenía algún factor de riesgo cardiovascular y el 53,4% tres o más. Un total de 78 pacientes presentaron enfermedad cardiovascular anterior o detectada durante el primer año de diagnóstico (16%; intervalo de confianza del 95%[IC95%]: 12,8-19,3; varones 21,4% y mujeres 11,2%). La prevalencia de enfermedad cardiovascular aumentó con el número de factores de riesgo cardiovascular. El análisis de regresión logística mostró una asociación de la enfermedad cardiovascular y la edad >55 años (odds ratio [OR]=2,91; IC95%: 1,46-5,80), el tabaquismo (OR=2,28; IC95%: 1,15-4,51) y los valores de hemoglobina glucosilada (HbA1c) >7% (OR=1,85; IC95%: 1,10-3,1). Conclusiones: Se observa una elevada prevalencia de factores de riesgo y enfermedad cardiovascular en el momento del diagnóstico de la diabetes; la edad, el tabaquismo y la HbA1c son las variables relacionadas con la enfermedad cardiovascular.

Objective: To determine the prevalence of cardiovascular disease at diagnosis of type 2 diabetes mellitus. Methods: Retrospective observational study in an urban primary health care centre between 1991 and 2000. Review of clinical patient characteristics, cardiovascular disease and risk factors, in the year of diabetes diagnosis. Patients without any glycaemia recorded before diagnostic were excluded. Logistic regression was done to identify the variables associated to cardiovascular events. Results: From 598 cases of diabetes diagnosed, 487 with previous glycaemia were included for the analysis (mean age [SD], 60.4 [10.9]; 53% women). The prevalence of cardiovascular risk factors was: obesity 61.1%, hypertension 71.9%, hypercholesterolemia 52%, hypertriglyceridemia 35.3% and present or previous smoking habit (24 and 16,6%). 96.9% of them presented at least one of the studied cardiovascular risk factors and 53.4% three or more. 78 patients (16%; CI95%: 12.8-19.3) had cardiovascular disease before or during the first year of diagnosis (men 21.4% and women 11.2%). The prevalence of cardiovascular disease increased progressively with the number of cardiovascular risk factors. The significant predictive variables of cardiovascular disease (logistic regression) were: age >55 years (OR=2.91; CI95%: 1.46-5.80), smoking habit (OR=2.28; CI95%: 1.15-4.51) and HbA1c >7% (OR=1.8; CI95%: 1.1-3.1). Conclusions: A high prevalence of cardiovascular disease and cardiovascular risk factors at diabetes diagnosis was observed. Age, smoking habit and elevated glycated haemoglobin were the variables related to cardiovascular disease.

Objetivo: Conocer la prevalencia de la enfermedad cardiovascular en el momento del diagnóstico de la diabetes mellitus tipo 2. Métodos: Estudio observacional retrospectivo realizado en un centro de atención primaria urbano entre 1991 y 2000. Revisión de las características clínicas, factores de riesgo y enfermedad cardiovascular el año del diagnóstico de diabetes. Se excluyeron los pacientes sin glucemias previas al diagnóstico. Se realizó un análisis de regresión logística para identificar las variables asociadas a la presencia de eventos cardiovasculares. Resultados: De los 598 nuevos casos de diabetes diagnosticados se analizaron los 487 que tenían valores previos de glucemia (media de edad [desviación estándar]: 60,4 [10,9] años; un 53% eran mujeres). La prevalencia de factores de riesgo cardiovascular fue: obesidad 61,1%, hipertensión arterial 71,9%, hipercolesterolemia 52%, hipertrigliceridemia 35,3% y tabaquismo actual 24% o previo 16,6%. El 96,9% tenía algún factor de riesgo cardiovascular y el 53,4% tres o más. Un total de 78 pacientes presentaron enfermedad cardiovascular anterior o detectada durante el primer año de diagnóstico (16%; intervalo de confianza del 95%[IC95%]: 12,8-19,3; varones 21,4% y mujeres 11,2%). La prevalencia de enfermedad cardiovascular aumentó con el número de factores de riesgo cardiovascular. El análisis de regresión logística mostró una asociación de la enfermedad cardiovascular y la edad >55 años (odds ratio [OR]=2,91; IC95%: 1,46-5,80), el tabaquismo (OR=2,28; IC95%: 1,15-4,51) y los valores de hemoglobina glucosilada (HbA1c) >7% (OR=1,85; IC95%: 1,10-3,1). Conclusiones: Se observa una elevada prevalencia de factores de riesgo y enfermedad cardiovascular en el momento del diagnóstico de la diabetes; la edad, el tabaquismo y la HbA1c son las variables relacionadas con la enfermedad cardiovascular.