Low mercury, cadmium and lead concentrations in tuna products from the eastern Pacific.

Tuna species: Skipjack (Katsuwonus pelamis), yellowfin (Thunnus albacares) and bigeye (Thunnus obesus) are mainly processed into canned products (loins, solid pack, flakes) either in water or oil, and pre-cooked frozen loins. The National Institute of Fisheries of Ecuador (ISO/IEC 17025 certified), which is the official control laboratory, samples and analyses production batches of companies exporting to the European Union in order to ensure the quality control of Ecuadorean tuna product. From 2009 to 2016, 2572 samples have been analysed (by standard methods) for mercury, cadmium, and lead. The averages were 0.24 ± 0.14; 0.03 ± 0.03 and 0.05 ± 0.05 mg kg-1 (wet weight) respectively; which are well below the norms; i.e., total mercury: 1 mg kg-1; Lead: 0.3 mg kg-1 and Cadmium: 0.1 mg kg-1 according to the EU maximum limits. Over time mercury levels in the sample seemed to decrease but for cadmium and lead no clear pattern was observed. Additionally; samples of tuna can products taken at random from local vendor stores gave concentrations of: Mercury: 0.043 ± 0.004 mg kg-1; Cadmium: 0.012 ± 0.002 mg kg-1; Lead: below detection limit (0.01 mg kg-1). There were a few cases (15 out of 2572: 0.58%) of samples with readings near or just over-limit concentrations; of these, 12 corresponded to Cd, two to Pb and one to Hg. Some of them can be considered statistical outliers as well as cross contamination during analytical procedures. Raw tuna samples have given similar or lower concentrations. No significant statistical correlation was found between Hg, Cd and Pb values, this would suggest that the bioaccumulation of each metal is independent of each other. Literature reports that surface dissolved Hg, Cd, and Pb in the eastern Pacific are in the range of 2-18 ng kg-1. Assuming suggested bioaccumulation of 2-6 times, the end concentration in the tuna would be 0.012-0.042; 0.036-0.108 and 0.010-0.027 µg kg-1 of Hg, Cd, and Pb respectively, that would be one order (or more) below the safe consumption limit. Most, if not all the tuna processed in Ecuador is captured in the eastern Pacific and within its EEZ. Ecuadorian canned tuna complies with stringent standards for presence of these metals; therefore, it can be considered safe to be consumed from the point of view of these metal concentrations. However, further studies should assess metal concentrations exclusively from Ecuadorian tuna captured close to coastal and insular areas.

Cuban Experience with Lung Ultrasound to Diagnose and Classify Pleural Effusion in Critically Ill Patients.

Pleural effusion is a common condition in critically ill patients (both clinical and surgical). Its diagnosis and classification are important for followup of patients with cardiorespiratory difficulty. Lung ultrasound is used for this purpose, but no reports have been published on its use in Cuba with critically ill patients in intensive care units. We performed lung ultrasound on 144 such patients with cardiorespiratory illnesses, average age 54 years, predominantly men (66%; 95/144), with average APACHE II score 13.6, and 22.1% mortality risk. Patients were divided into two groups: clinical (bronchopneumonia and cardiac insufficiency) and surgical (postoperative liver and kidney transplant or vascular and cardiovascular surgery) to diagnose and classify pleural effusion according to locus (right, left and bilateral) and structural pattern (I, II A, II B, III and IV). Pleural effusions were diagnosed in 81.2% (117/144) of patients (clinical 44.4%, 52/117; surgical 55.6%, 65/117). Bilateral location was the most common (68.4%, 80/117), followed by right (23.9%, 28/117) and then left (7.7%, 9/117). Structural pattern I (anechoic appearance) was observed in 61.5% of cases (72/117); 21.4% (25/117) were II A, 12.8% (15/117) II B, 3.4% (4/117) III, and 0.9% (1/117) were IV. We found no association between pleural effusion localization and ultrasound structural pattern in clinical patients (Fisher exact test 4.2 p = 0.9). In surgical patients, however, complex ultrasound patterns (II A, II B and III) were significantly more common in bilateral forms (Fisher exact test 14.1; p = 0.009). Further studies of this type in Cuba will help provide useful data for prompt treatment and followup of these patients.

High clustering rates of multidrug-resistant Mycobacterium tuberculosis genotypes in Panama.

BACKGROUND: Tuberculosis continues to be one of the leading causes of death worldwide and in the American region. Although multidrug-resistant tuberculosis (MDR-TB) remains a threat to TB control in Panama, few studies have focused in typing MDR-TB strains. The aim of our study was to characterize MDR Mycobacterium tuberculosis clinical isolates using PCR-based genetic markers. METHODS: From 2002 to 2004, a total of 231 Mycobacterium tuberculosis isolates from TB cases country-wide were screened for antibiotic resistance, and MDR-TB isolates were further genotyped by double repetitive element PCR (DRE-PCR), (GTG)5-PCR and spoligotyping. RESULTS: A total of 37 isolates (0.85%) were resistant to both isoniazid (INH) and rifampicin (RIF). Among these 37 isolates, only two (5.4%) were resistant to all five drugs tested. Dual genotyping using DRE-PCR and (GTG)5-PCR of MDR Mycobacterium tuberculosis isolates revealed eight clusters comprising 82.9% of the MDR-TB strain collection, and six isolates (17.1%) showed unique fingerprints. The spoligotyping of MDR-TB clinical isolates identified 68% as members of the 42 (LAM9) family genotype. CONCLUSION: Our findings suggest that MDR Mycobacterium tuberculosis is highly clustered in Panama's metropolitan area corresponding to Panama City and Colon City, and our study reveals the genotype distribution across the country.

Fetoscopia operatoria: fotocoagulación láser selectiva en el síndrome de transfusión intergemelar / Operatory fetuses: selective laser photocoagulation of the inter-twi transfusion syndrome

El síndrome de transfusión intergemelar severo sin tratamiento presenta una mortalidad virtual de 100 por ciento en ambos fetos. Se han descrito múltiples opciones terapéuticas para esta entidad. La fotocoagulación láser de las anastomosis placentarias intergemelares es la única terapia capaz de revertir el síndrome preservando la vida de los fetos. Presentamos un caso de síndrome de transfusión intergemelar estadio III con severas complicaciones maternas en el cual se realizó fotocoagulación láser selectiva de los vasos comunicantes: Discutimos la utilidad de ésta y otras alternativas terapéuticas.