Morphological and mitochondrial DNA characters for identification and phylogenetic analysis of the myiasis-causing flesh fly Wohlfahrtia magnifica and its relatives, with a description of Wohlfahrtia monegrosensis sp. n. Wyatt & Hall.

Wohlfahrtia magnifica (Schiner) (Diptera: Sarcophagidae) is a major cause of traumatic myiasis in livestock in Central and Eastern Europe and in countries bordering the Mediterranean. The present study explored the utility of external body characters, genitalia characters and mitochondrial DNA characters for identification of this and related species in the subfamily Paramacronychiinae. Sequence analyses of the 3' terminal 273 bp of the mitochondrial cytochrome b gene revealed two lineages of W. magnifica, one from Spain and France and the other from the rest of Eurasia, differing by only two base pairs. Phylogenetic analysis of cytochrome b showed that W. magnifica and Wohlfahrtia vigil Walker were sister species; this conclusion was not contradicted by a phylogenetic analysis of the morphological characters. Based on cytochrome b, the genetic distance between specimens of W. vigil from Europe and North America was sufficiently large to justify the recognition of more than one species. A new species, Wohlfahrtia monegrosensis, from northern Spain, was described, based on morphology and cytochrome b. A unique combination of external body characters of males or females were diagnostic for W. magnifica, the W. vigil group and Wohlfahrtia bella, but only the genitalia characters were diagnostic for all nine species studied.

Response of bobwhite quail and gray-tailed voles to granular and flowable diazinon applications.

We used gray-tailed voles (Microtus canicaudus) and northern bobwhite quail (Colinus virginianus) as experimental model species to field test whether small mammals and birds respond differently to equivalent concentrations of a pesticide applied in granular and flowable formulations. In mid-May 1998, we placed voles into 15, 0.2-ha enclosures planted with a mixture of pasture grasses. In mid-July, we placed quail into the same enclosures with the voles. In late July, we applied the organophosphorus insecticide diazinon in five treatments; a control (all habitats sprayed with water), liquid formulation of diazinon at 0.55 kg/ha, liquid formulation of diazinon at 1.11 kg/ha, broadcast of granular diazinon at 1.11 kg/ha, and broadcast of granular diazinon at 2.22 kg/ha. The diazinon treatment in liquid and granular formulations did not depress population size or growth rate, or survival rate of voles. We found a significant difference in the survival rate of the quail between the controls and treatments; granular diazinon caused a measurable decline of quail survival, whereas the liquid application at an equivalent rate did not significantly affect quail survival. Analysis of our results suggests that ground-feeding birds are more susceptible to granular insecticides than flowable applications, but voles were not susceptible to either formulation at the rate we used.

Old World screwworm fly, Chrysomya bezziana, occurs as two geographical races.

A morphological and molecular analysis was undertaken with the objective of identifying markers for geographical populations of Old World screwworm flies, Chrysomya bezziana Villeneuve (Diptera: Calliphoridae). The morphological analysis involved 192 adult flies from 14 countries, and the molecular analysis involved 45 larvae or adults from 14 populations in 11 countries. Principal components and cluster analysis of 10 morphological characters indicated that flies from Papua New Guinea (PNG) were a distinct group and most similar to flies from nearby Asian islands (Java, Sabah). There was poor resolution of other geographical regions, but some support for clustering of flies from Africa or India. Cladistic analysis of mitochondrial DNA sequences gave strong support for recognizing two races of Old World screwworm, one from sub-Saharan Africa and the other from the Gulf region and Asia. This latter race could be further divided into two lineages, i.e. one from mainland Asia (from Iraq to the Malay Peninsula) and the other from two islands of PNG.

A field test of the quotient method for predicting risk to Microtus canicaudus in grasslands.

We used gray-tailed voles, Microtus canicaudus, as an experimental model species to field test a prediction of the Quotient Method (QM) for risk to small mammals of an insecticide in grasslands. In May 1997, we placed voles into 12 0.2-ha enclosures planted with a mixture of pasture grasses. In late July, we applied 1.55 kg/ha of the insecticide Guthion(R) 2S (azinphos-methyl) in three treatments: a control (all habitat sprayed with water), full spray (all of the habitat sprayed with Guthion 2S), and half-spray (one-half of the habitat sprayed with Guthion 2S and one half with water). Five replicates were used for the half-spray and control, and two replicates for the full-spray. The Guthion 2S treatment did not depress population size, growth rate, or survival of voles in half-spray or full-spray enclosures. Our results were inconsistent with the QM prediction for use of Guthion 2S in grass habitats. These results also differed from our previous studies in alfalfa habitats in which measurable responses were detected at the same application rate. The differences probably are due to the different types of vegetation between current and previous studies. The grass habitat in our enclosures was an average of 60 cm high and was very thick from ground level to about 40 cm. Much of the residue likely accumulated in the upper strata of vegetation and did not reach ground level at this application rate. Under the conditions of this study, voles were less affected in grassland habitat than they were in alfalfa habitat.

Pediatric mortality probability estimated from pre-ICU severity of illness.

OBJECTIVE: The Pediatric Risk of Mortality (PRISM) score is a measure of illness severity based on abnormalities observed in the bedside examination and laboratory assessment. PRISM scores obtained after pediatric intensive care unit (PICU) admission predict mortality probability, but no previous efforts to evaluate mortality risk before PICU admission have been reported. Our study was performed on patients admitted to PICUs at four pediatric tertiary care centers to derive a quantitative estimate of hospital mortality probability as a function of PRISM scores obtained at referring hospitals before PICU transfer. Performance of the model was tested by evaluating accuracy of mortality predictions obtained from pre-ICU PRISM scores in a separate validation set of patients. METHODS: Patients were randomized to the derivation or validation sets. Data were recorded prospectively from observations made at hospitals referring to the study PICUs. Patients included 780 infants and children with medical and surgical emergencies and trauma. Electively admitted patients were excluded from analysis. RESULTS: The relationship between mortality probability (P) and the pre-ICU PRISM score is expressed by the equation: P = er/(1 + er). In this equation, r is an empirical function of the pre-ICU PRISM score: r = .197 x PRISM - 4.705. The mortality probability rises from near 0 at low scores, approaching 1 (certainty) above a PRISM score of 40. Mortality probability exceeds 10% at a score of 13 and exceeds 50% at a score of 24. Performance of predictions in the validation set of patients was evaluated for five categories of mortality probability. The observed number of deaths corresponded to predicted mortality across the range of illness severity. When compared for each tertiary institution, observed mortality rates were similar to predictions for three of four institutions. For data obtained at institution D, the observed mortality of 17% significantly exceeded the 7% predicted rate. In infants younger than 1 year, as well as children 1 year and older, observed mortality rates were similar to predicted. CONCLUSIONS: The pre-ICU PRISM score as a measure of illness severity provides an estimate of hospital mortality probability. Further investigation is required to determine the use of pre-ICU mortality estimates in making clinical decisions.

Reduction of morbidity in interhospital transport by specialized pediatric staff.

OBJECTIVE: We prospectively compared the occurrence of morbidity during high-risk interhospital transport in two types of transport systems: specialized tertiary center-based vs. nonspecialized, referring hospital-based. DESIGN: Concurrent, prospective comparison of morbidity at two pediatric centers that use different types of transport team. SETTING: Two tertiary care pediatric intensive care units (ICU). The specialized team consisted of a pediatric resident, pediatric intensive care nurse, and a pediatric respiratory therapist. Comparison was made with referring institution transports by nonspecialized personnel to a second center. The two centers were similar in size and patient mix, with referral areas of similar population and rural/urban ratio. PATIENTS: One hundred forty-one patients transported to two tertiary pediatric ICUs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two types of events were assessed: vital signs and other observable clinical events were described as "physiologic deteriorations." Events such as loss of intravenous access, endotracheal tube mishaps, and exhaustion of oxygen supply were described as "intensive care-related adverse events." Pretransport severity of illness and therapy were described by Pediatric Risk of Mortality (PRISM) and Therapeutic Intervention Scoring System (TISS) scores. Only high-risk patients with PRISM scores of > or = 10 were analyzed. Intensive care-related adverse events occurred in one (2%) of 49 transports by the specialized team and 18 (20%) of 92 transports by nonspecialized personnel. The difference is statistically significant (p < .05). Physiologic deterioration was similar in the two groups occurring in five (11%) of 47 specialized team transports and 11 (12%) of 92 transports by the nonspecialized team. CONCLUSION: We conclude that specialized pediatric teams can reduce transport morbidity. This is the first published study to compare two models of pediatric transport using identical definitions of severity and morbidity.

A pediatric trauma center without a pediatric surgeon: a four-year outcome analysis.

Approximately 25% of all injury victims are in the pediatric age group, and one in four injured children will require a pediatric trauma center. According to the American College of Surgeons as well as many state guidelines, a level I pediatric trauma team should be directed by a pediatric surgeon. In 1986, the pediatric surgeon left our pediatric trauma center, but the center remained open under a cooperative effort by the adult trauma surgeons and pediatric intensivists. We have retrospectively reviewed the charts of all pediatric trauma patients (age less than or equal to 15 years) for the subsequent 4 years to determine the outcome of treatment without a pediatric surgeon. During this period, we treated 303 pediatric patients with multiple or serious single-system injuries. The mean age was 6.9 +/- 0.3 (SEM) years and 66% were boys. Falls were the cause of injury in 31% of the patients, with pedestrian/bicycle, motor vehicle crashes, and penetrating injuries resulting in 26%, 19%, and 3% of the injuries, respectively. The mean ISS was 15.6 +/- 0.8, and 73% of the patients had at least one AIS greater than or equal to 3. Surgical procedures were required in 48% of the patients. There were 27 deaths in this group, most commonly related to head injury (89%). The mean Pediatric Trauma Score of the patients who died was 1.6 +/- 0.8 and no patient with a Pediatric Trauma Score greater than 7 died.(ABSTRACT TRUNCATED AT 250 WORDS)

Obstructive aortic and renal thrombosis in the newborn--spontaneous recovery.

A 13-day-old infant presented with acute renal failure secondary to a large thrombus formation involving the umbilical aorta and both renal arteries. The initial clinical manifestations were hematuria, followed by anuria, severe dehydration, grunting respirations, and cyanosis of her feet. She was treated with intravenous fluids and peritoneal dialysis. At the onset, there was no blood flow into the abdominal aorta or into the kidneys. Heparinization and fibrinolytic therapies were unsuccessful in dissolving the clot. However, the aortic clot recanalized spontaneously a few weeks later, but the renal arteries remained permanently occluded. Despite this, her kidneys showed blood flow bilaterally and she recovered her renal function, probably by reperfusing her kidneys through collateral circulation. Malignant hypertension ensued after improvement of renal function, but it could be controlled by appropriate antihypertensive therapy.

Haemodynamic actions of clonidine in tetraplegia--effects at rest and during urinary bladder stimulation.

We studied the haemodynamic effects of clonidine (2 micrograms/kg/iv) in 7 tetraplegics and 7 normal subjects. Measurements of blood pressure, stroke volume, cardiac output and digital (finger) skin blood flow were made before and after clonidine for 60 minutes. Blood pressure, stroke volume and cardiac output did not fall in tetraplegics, unlike normals. Resting digital skin blood flow was higher in tetraplegics and fell after clonidine. In normal subjects however, an increase in digital skin blood flow occurred after clonidine. The pressor and digital vasoconstrictor responses to bladder stimulation were attenuated after clonidine. The inability of clonidine to induce a fall in blood pressure, stroke volume, cardiac output and cause peripheral vasodilation in tetraplegics is consistent with its central sympatholytic effects. Attenuation of the responses to bladder stimulation suggest an effect on spinal sympathetic neurones.

Chondro-calcinosis and difficult intubation in acromegaly.

Difficulties encountered in carrying out tracheal intubation in acromegalic patients have been well documented. This paper reports the difficulty encountered in a patient with acromegaly complicated by extensive calcification of the larynx.

Analgesic effects of sublingual buprenorphine.

The analgesic effects of sublingually administered buprenorphine 0.4 mg have been compared with morphine 10 mg given intramuscularly in patients following operation. The results indicate a slower onset of action for buprenorphine but of much longer duration than morphine. There were no serious side effects or difference in their incidence between the two drugs.

Late-onset intestinal obstruction in cystic fibrosis--meconium ileus equivalent.

Four patients who suffered from cystic fibrosis and late-onset bowel obstruction (meconium ileus equivalent), and who were treated by surgery, are discussed. The importance of early correct diagnosis is stressed, since surgery may be prevented if bowel washouts and oral medications are given before the condition becomes complicated.

Ketamine and paediatric radiotherapy.

Two hundred and seventy-two ketamine anesthetics have been given to sixteen children undergoing radiotherapy. Satisfactory conditions were provided in every case and the incidence of complications was low. At the present time ketamine would appear to be the most satisfactory agent in thos children who require sedation in order to undergo radiotherapy.