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PURPOSE: Abnormally invasive placenta is an important cause of maternal morbidity, and its primary complication is massive bleeding. Strategies for preventing bleeding include arterial endovascular occlusion. One concern with the use of intra-arterial occlusion balloons is radiation exposure to the fetus, which occurs while determining balloon position. In this study, we sought to determine the radiation absorbed dose by the fetus during intra-aortic occlusion balloon placement in patients with abnormally invasive placenta. MATERIALS AND METHODS: We estimated the fetal absorbed dose and the entrance skin dose in the vaginal fundus and lumbar skin, respectively, using thermoluminescent dosimeter crystals, during intra-aortic balloon positioning using the mobile X-ray image intensifier system (C-arm) in digital radiography mode, directly in surgery room, without transfer to angiographic suite. We also performed a mannequin-based simulation to validate the entrance skin dose measurement technique. RESULTS: Ten women undergoing surgical management of an abnormally invasive placenta, in whom the location of the intra-aortic occlusion balloon was verified using plain radiography with C-arm in the surgery room, were included in the study. Following maternal and fetal radiation exposure, the entrance skin dose and radiation absorbed dose by the fetus were 1.31 ± 0.96 mGy and 0.27 ± 0.28 mGy, respectively, with radiation exposure durations of <1 s. CONCLUSIONS: There were no complications with the use of REBOA, the radiation absorbed dose by the fetus, entrance skin dose, and duration of radiation exposure during intra-aortic occlusion balloon placement were lower than those reported for other vascular occlusion techniques, being this a safe procedure.

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Ivan IV "The Terrible" was the first Tsar of all Russias and was crowned in 1547. He extended Russian territories and opened the route to Siberia in successful campaigns against Tartars. He increased his personal power to the point of generating an autocracy that isolated him progressively from the council of Boyars. He had a complex personality and his acts were impregnated by a profound religiousness, episodes of rage, mood changes and a sense of "personal fate". All these traits configure the controversial "temporal lobe personality". The possible association between these personality traits and the eventual epilepsy that Ivan IV could suffer, is discussed. This association is called "temporal lobe syndrome". Considering the mood changes, with severe irritability and episodes of control loss alternated with feelings of guilt, sadness and isolation, another possibility is that the Tsar had an affective bipolar disorder or, less probably, a personality disorder.

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Ivan IV "The Terrible" was the first Tsar of all Russias and was crowned in 1547. He extended Russian territories and opened the route to Siberia in successful campaigns against Tartars. He increased his personal power to the point of generating an autocracy that isolated him progressively from the council of Boyars. He had a complex personality and his acts were impregnated by a profound religiousness, episodes of rage, mood changes and a sense of "personal fate". All these traits configure the controversial "temporal lobe personality". The possible association between these personality traits and the eventual epilepsy that Ivan IV could suffer, is discussed. This association is called "temporal lobe syndrome". Considering the mood changes, with severe irritability and episodes of control loss alternated with feelings of guilt, sadness and isolation, another possibility is that the Tsar had an affective bipolar disorder or, less probably, a personality disorder.

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BACKGROUND: Pseudomonas aeruginosa is a common cause of nosocomial infections, particularly in intensive care units (ICUs). The aim of this study was to characterize P. aeruginosa clinical isolates by comparing antimicrobial susceptibility patterns with the presence of plasmids and to establish the clonal relatedness by pulsed-field gel electrophoresis (PFGE) typing. METHODS: The patients included those with isolation of P. aeruginosa hospitalized for more than 48 h in the ICU from April to May 1998. Environmental and staff cultures were obtained simultaneously. Minimal inhibitory concentrations, plasmid DNA profiles, and PFGE genomic patterns of enzyme restriction chromosomal DNA were compared. RESULTS: Sixty P. aeruginosa isolates were obtained from 197 clinical specimens, 178 environmental samples, and 47 hand cultures of personnel. Antimicrobial resistance was as follows: tobramycin 100%; ticarcillin, cefotaxime, ceftriaxone, ceftazidime, and gentamicin 80%; cefepime 60%; amikacin, ticarcillin/clavulanate, imipenem, and meropenem 40%; piperacillin and norfloxacin 20%; carbenicillin 12%, and ciprofloxacin 0%. Plasmids were detected in 11 isolates (18%). PFGE typing showed that 23 isolates belonged to a common clone (pattern A), identified from five patients, two nurses, and 10 environmental samples. Ten isolates were grouped in four clusters and 27 isolates had unrelated genomic patterns. There was no relationship among DNA genomic patterns, plasmid profiles, and susceptibility patterns. CONCLUSIONS: PFGE demonstrated the existence of a common clone in a critical care area. Reinforcement of infection control measures is needed to avoid horizontal transmission and severe infections.

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Numerous investigations have pointed out the importance that the fatty acids have in the process health-illness, and that the marine resources are excellent sources of the series omega 3 and omega 6. In Mexico, the sardine is a product of marine origin of wide consumption due to its high readiness and low cost. The objective of the present study was to determine the fatty acids profile (FA) in sardine canned in tomato sauce coming from different fishing areas (A) of the Mexican Pacific. There were randomly obtained 8 commercial mark (5 cans of each mark) of sardine canned in tomato sauce; they were classified in sardine of South Baja California Sur (A1), Sonora (A2) and Sinaloa (A3). The samples without draining were liquified and thereafter were obtained the methyl esters of fatty acids that were analyzed by gas chromatography with a flame ionization detector. In all the areas they were identified and quantified as 3 FA omega 3 (linolenic, EPA and DHA) and 2 AG omega 6 (linoleic and arachidonic); this source is rich in FA monounsaturated and also presents a considerable quantity of trans FA (18:1n9t and 18:2n6t). The DHA was the most abundant AG in all the areas (3064-4704 mg/100 g); finally, the relationships omega 3/omega 6 were from 3.5 (A1) up to 8.9 (A3). In conclusion, sardine canned in tomato sauce of the mexican Pacific is a rich food in omega-3 and omega-6 FA, independently of the processing area.

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A direct relationship exists between the state of health and the diet, and inside this some components, such as the fatty acids (FA), influence mostly in the prevention of certain illnesses (coronary heart disease, hypertension, rheumatoid arthritis, inflammatory answer, and arterial pressure). One of the main sources of essential FA are the marine products; the tuna is a marine food of wide consumption in Mexico due its readiness and low cost. The objective of this work was to determine the profile of fatty acids (FA) in tuna canned in oil and in water coming from three fishing areas of the Mexican Pacific. There were randomly obtained 7 oil-tuna commercial marks (AA) and 5 water- tuna (AW) coming from the next fishery areas: Baja California Sur (L1), Colima (L2) and Mazatlán (L3). The samples without draining were liquefied and thereafter it was obtained the methyl esters of fatty acids that were analyzed by gas chromatography with a flame ionization detector. In all the areas were identified 20 FA (mg/100 g); three AG omega 3 (EPA, DHA and linolenic) and two omega 6 (linoleic and arachidonic). In the AA of the three areas the most abundant saturated FA were estearric and palmitic acids, the most abundant monounsaturated fatty acid was the cis-vaccenic, followed by the oleic acid. The behavior of those omega 3 in the AA of the three areas were similar: with the less quantity was the linolenic acid (447-755), continued by the EPA (979-1323) and finally high concentrations of DHA (1862-3327). In the AW the DHA was the most abundant fatty acid in all the areas (1086-4456), the most abundant monounsaturated fatty acid was the palmitic (640-3809). It was observed the presence of trans fatty acids in high quantities in AW: linolelaidic (1394-1495) and elaidic (377-1234). The relationship omega 3/omega 6 in the AA was similar in L1 and L2, and lower in L3; in AW was higher in L2 and L3. In conclusion, evident variation exists in the content of FA among areas; it could be considered that the AA of L3 and AW of L2 as the richest in omega-3 and omega-6 FA. In general, the tuna in water is a richer food in FA omega 3 and omega 6 that the tuna in oil, independently of the fishery area.

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Resistance of Mycobacterium tuberculosis to antimycobacterial agents is a worldwide problem. The proposite of this study was to analyze the current resistance patterns of patients with initial episodes, as well as relapses, due to M. tuberculosis in western Mexico. From January 1993 to February 1999 a total of 237 strains of M. tuberculosis (120 from initial cases and 117 from relapse cases) were analyzed. Two hundred and four (86%) strains were isolated from the lower respiratory tract, and 33 strains (14%) from extrapulmonary sites. Twenty-three percent of M. tuberculosis isolated from patients with initial episodes were resistant to both isoniazid and rifampin, and 52% of M. tuberculosis isolated from relapse cases were also resistant to both isoniazid and rifampin.

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BACKGROUND: Bacteriuria > or = 10(5) CFU/ml is evidence of urinary tract infection in the absence of associated signs or symptoms. The presence of pyuria with asymptomatic bacteriuria established the response of elderly women against microorganisms capable of causing invasiveness or tissue injury of the urinary tract. METHODS: The association between bacteriuria and pyuria was determined in 178 elderly, ambulatory women without symptoms of urinary tract infection in seven nursing homes. Urine culture results were subsequently analyzed in conjunction with absolute leukocyte count in urine. In this cross-sectional study, asymptomatic bacteriuria in elderly women was classified with and without pyuria. RESULTS: The prevalence of asymptomatic bacteriuria was found in 44 (24.7%) elderly women. The presence of pyuria had a sensitivity of 63.6% for bacteriuria and a specificity of 91%. The positive predictive value for the presence of pyuria predicting those with bacteriuria was 70%, and the negative predictive value for the absence of pyuria predicting those without bacteriuria was 88.4%. Escherichia coli was the most common organism isolated in 81.8% of the women. CONCLUSIONS: Bacteriuria > or 10(5) CFU/ml associated with pyuria was detected in 77% of elderly women with asymptomatic urinary tract infections. Bacteriuria of < 10(5) CFU/ml with pyuria proves less sensitive as an indicator of urinary tract infection. Elderly women with pyuria but without bacteriuria should be studied for other causes of urinary tract inflammation.

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Sardine is a sea food widely consumed in Mexico due to it's abundance and very low price. Its content in vitamins, minerals and chemical composition were evaluated in its canned presentation in tomato sauce. Samples proceeded from 3 fishery areas of the Mexican Pacific: (L1) Baja California Sur, (L2) Sonora and (L3) Sinaloa. The proximal chemical analysis was carried out by the AOAC methods; mineral content (Ca, Mg, Na, K, Fe, Zn, Cu, Cd, Cr, Pb) was determined by atomic absorption spectrophotometry and vitamins A, B1, B2 and niacin were quantified by HPLC. Results showed a high moisture content from 69 to 82%, ether extract ranged between 7.8% (L2) and 10.2% (L3) and crude protein content between 10.6% (L3) and 14.6% (L1). Vitamin A (IU/100 g) was similar for all samples: L1 (63-66); thiamin (mg/100 g) was high in L1 (0.13) and low in L3 (0.09); riboflavin was high in L1 (0.15) and showed values of 0.13 for both L2 and L3; niacin content was high in all samples: L1 (2.24), L2 (1.48) and L3 (1.75). Minerals were abundant (mg/100 g) in Na, K, and P; L1 showed a great variation for Na (363-636) compared with L2 and L3 (250); K was very variable among the samples: L1 (597), L2 (100) and L3 (57). Phosphorous and magnesium had small variations: P (229, 243 and 212) and Mg (28, 23 and 23) for L1, L2 and L3. Iron was more abundant in L1 (5.5) and L3 (4.3); Zn was higher in L2 (3.4) and similar in L1 (2.5) and L3 (2.2). Copper showed a great variation in L2 (0.21-0.48) but the averages were similar (0.37, 0.35, 0.33, for L1, L2 and L3 respectively). Finally, heavy metal content was lower than 0.002 mg/100 g. In conclusion, there are some variation in Ca, Na, K, thiamin and niacin content in canned sardine with tomato sauce, depending upon the fishing area.

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