Clinical Practice: Should we Radically Alter our Sedation of Critical Care Patients, Especially Given the COVID-19 Pandemics?

The high number of patients infected with the SARS-CoV-2 virus requiring care for ARDS puts sedation in the critical care unit (CCU) to the edge. Depth of sedation has evolved over the last 40 years (no-sedation, deep sedation, daily emergence, minimal sedation, etc.). Most guidelines now recommend determining the depth of sedation and minimizing the use of benzodiazepines and opioids. The broader use of alpha-2 adrenergic agonists ('alpha-2 agonists') led to sedation regimens beginning at admission to the CCU that contrast with hypnotics+opioids ("conventional" sedation), with major consequences for cognition, ventilation and circulatory performance. The same doses of alpha-2 agonists used for 'cooperative' sedation (ataraxia, analgognosia) elicit no respiratory depression but modify the autonomic nervous system (cardiac parasympathetic activation, attenuation of excessive cardiac and vasomotor sympathetic activity). Alpha-2 agonists should be selected only in patients who benefit from their effects ('personalized' indications, as opposed to a 'one size fits all' approach). Then, titration to effect is required, especially in the setting of systemic hypotension and/or hypovolemia. Since no general guidelines exist for the use of alpha-2 agonists for CCU sedation, our clinical experience is summarized for the benefit of physicians in clinical situations in which a recommendation might never exist (refractory delirium tremens; unstable, hypovolemic, hypotensive patients, etc.). Because the physiology of alpha-2 receptors and the pharmacology of alpha-2 agonists lead to personalized indications, some details are offered. Since interactions between conventional sedatives and alpha-2 agonists have received little attention, these interactions are addressed. Within the existing guidelines for CCU sedation, this article could facilitate the use of alpha-2 agonists as effective and safe sedation while awaiting large, multicentre trials and more evidence-based medicine.

Pharmacokinetics of Sulfadoxine and Pyrimethamine for Intermittent Preventive Treatment of Malaria During Pregnancy and After Delivery

Sulfadoxine/pyrimethamine is recommended for intermittent preventative treatment of malaria during pregnancy. Data from 98 women during pregnancy and 77 after delivery in four African countries were analyzed using nonlinear mixed‐effects modeling to characterize the effects of pregnancy, postpartum duration, and other covariates such as body weight and hematocrit on sulfadoxine/pyrimethamine pharmacokinetic properties. During pregnancy, clearance increased 3‐fold for sulfadoxine but decreased by 18% for pyrimethamine. Postpartum sulfadoxine clearance decreased gradually over 13 weeks. This finding, together with hematocrit‐based scaling of plasma to whole‐blood concentrations and allometric scaling of pharmacokinetics parameters with body weight, enabled site‐specific differences in the pharmacokinetic profiles to be reduced significantly but not eliminated. Further research is necessary to explain residual site‐specific differences and elucidate whether dose‐optimization, to address the 3‐fold increase in clearance of sulfadoxine in pregnant women, is necessary, viable, and safe with the current fixed dose combination of sulfadoxine/pyrimethamine.

Why should the anesthesiologist evaluate nutritional status?

BACKGROUND

The anesthesiologist's involvement in perioperative medicine has significantly changed. In order to identify patients at risks of perioperative complications, the anesthesiologist has to consider, amongst others, screening and management of undernutrition. For this purpose knowledge of prevalence and risk factors, along with screening tools and guidelines for an adapted nutritional management and outcomes of renutrition are mandatory. The present review intends to provide these tools to the Anesthesiologists.

METHOD

We conduct a literature review in Pubmed, Direct Science and Cochrane Library without limit of time related to undernutrition in the perioperative period.

RESULTS

Undernutrition is common in surgical patients. Undernutrition is associated with an increase of morbidity, mortality, length of hospital stay and costs. Undernutrition could probably be detected during the anesthetic consultation with simple and rapid tests, such as SNAQ, MST, MUST and NRS-2002. Nevertheless, further studies are needed to validate such tests in surgical patients. Waiting for these results, we prefer MUST. The implementation of nutritional support recommendations would reduce postoperative complications.

CONCLUSION

The anesthesiologist could play an important role in undernutrition screening and its management in order to reduce perioperative morbidity.

Single nucleotide polymorphisms in toll-like receptor 6 are associated with altered lipopeptide- and mycobacteria-induced interleukin-6 secretion

Toll-like receptors (TLRs) are critical mediators of the immune response to pathogens. The influence of human TLR6 polymorphisms on susceptibility to infection is only partially understood. Most microbes contain lipopeptides recognized by TLR2/1 or TLR2/6 heterodimers. Our aim was to determine whether single nucleotide polymorphisms (SNPs) in TLR6 are associated with altered immune responses to lipopeptides and whole mycobacteria.

We sequenced the TLR6 coding region in 100 healthy South African adults to assess genetic variation and determined associations between polymorphisms and lipopeptide- and mycobacteria-induced IL-6 production in whole blood. We found 2 polymorphisms, C745T and G1083C that were associated with altered IL-6 secretion. G1083C was associated with altered IL-6 levels in response to lipopeptides, Mycobacterium tuberculosis lysate (Mtb, P = 0.018) and BCG (P = 0.039). The 745T allele was also associated with lower NF-κB signaling in response to di-acylated lipopeptide, PAM2 (P = 0.019) or Mtb (P = 0.026) in a HEK293 cell line reconstitution assay, compared with the 745C allele.

We conclude that TLR6 polymorphisms may be associated with altered lipopeptide-induced cytokine responses and recognition of Mtb. These studies provide new insight into the role of TLR6 variation and the innate immune response to human infection.

Differentiation of Mycobacterium tuberculosis complex by PCR amplification of genomic regions of difference

Differentiation of members of the Mycobacterium tuberculosis complex by conventional mycobacteriological methods is time consuming, making surveillance of species-specific disease difficult. A two-step, multiplex polymerase chain reaction (PCR) method based on genomic regions of difference (RD1, RD1(mic), RD2(seal), RD4, RD9 and RD12) was developed for the differentiation of M. canettii, M. tuberculosis, M. africanum, M. microti, M. pinnipedii, M. caprae, M. bovis and M. bovis BCG. The size of the respective multiplex PCR amplification products corresponded to the presence of the different M. tuberculosis complex members. This method allows for rapid differentiation, making it suitable for routine laboratories and surveillance purposes.

Endometrial function in vervet monkeys (Cercopithecus aethiops): morphology, beta3 integrin and insulin-like growth factor binding protein-1 expression during the menstrual cycle and pregnancy in the normal and disrupted endometrium

The expression of endometrial beta3 integrin and insulin-like growth factor binding protein-1 (IGFBP-1) was studied in cycling and pregnant vervet monkeys. There were clear changes of beta3 integrin expression during the menstrual cycle, with the strongest immunostaining observed on day 26. Moderate to strong expression was observed during pregnancy. The expression of IGFBP-1 during the menstrual cycle was weak but upregulated during pregnancy with moderate to strong staining. The administration of a single dose of onapristone at 10 mg/kg on days 17, 21 and 22 of the menstrual cycle, followed by a biopsy on days 22, 22 and 26, respectively, and during pregnancy (34-44 days menstrual age) 24 h before the biopsy, disrupted and desynchronized the endometrium. However, no effect on beta3 integrin expression could be observed and staining reflected the untreated patterns. The same applied to IGFBP-1 except that during pregnancy the expression of this protein was reduced or abolished. The results suggest that beta3 integrin is associated with endometrial receptivity in vervet monkeys and that IGFBP-1 plays an important role during pregnancy in this species. The administration of onapristone appeared to only influence IGFBP-1 expression. To our knowledge, this is the first time that these endometrial proteins have been investigated in vervet monkeys. This study should therefore contribute to improving our understanding of the reproductive function of this species.

The GSB total knee arthroplasty. A medium- and long-term follow-up and survival analysis

From 1981 to 1987, 77 GSB-II total knee arthroplasties were implanted in 65 patients. There were 23 men and 42 women aged on average 60 years old (range 30-85 years). The diagnosis was osteoarthritis (OA) in 21 knees, rheumatoid arthritis (RA) in 44 knees, and other in 12 knees. A clinical and radiological follow-up was performed in two stages after a mean of 6.7 years (61 knees) and 14.8 years (22 knees) to assess the medium- and long-term results and to determine if deterioration had occurred after mid-term follow-up. A survival analysis was done with two endpoints: (1) revision, and (2) revision, moderate or severe pain and lost to follow-up (worst-case scenario). At the last follow-up 36 patients (44 knees) had died, 2 patients (2 knees) refused examination, and 3 patients (3 knees) were lost to follow-up. Six knees had been revised for malposition (1.3%), septic (3.9%) and aseptic (2.6%) loosening. The mean Knee Society score after 6.7 and 14.8 years was 85 points (OA 82 points, RA 87 points). Lateralisation, subluxation or dislocation of the patella was present in 8 of 17 knees at the last follow-up. The 6- and 15-year survival rates with revision as the endpoint were 95% (CI 89%-100%) and 87% (CI 65%-100%), respectively. For the worst-case scenario, the 6- and 15-year survival rates were 95% (CI 89%-100%) and 56% (CI 0%-100%), respectively. The medium- and long-term results of the GSB-II total knee arthroplasty were good, and a decline in the knee score did not occur beyond the mid-term follow-up. Patella complications were abundant, and a marked decrease in implant survival was noted when moderate or severe pain and lost to follow-up were included as endpoints.

The detection and monitoring of early pregnancy in the vervet monkey (Cercopithecus aethiops) with the use of ultrasound and correlation with reproductive steroid hormones

Twenty early pregnancies were diagnosed and monitored in vervet monkeys by ultrasonography. Non-gravid uteri became increasingly echogenic from cycle days 7 to 26. The first definite sign of pregnancy was a gestational cavity of 2 mm (+/- 0.80) at 33.0 (+/- 1.48) days menstrual age, which was also used to date all subsequent features. Earlier signs, such as an endometrial line swelling or endometrial 'pregnancy' ring, as reported for other non-human primate species, could not be reliably and consistently used to diagnose pregnancy in vervet monkeys. A rapid increase of the gestational cavity size from days 37 to 49 corresponded closely to a rapid increase in plasma progesterone concentration from day 39 to 49. The first yolk sac was recognizable at 38.0 days (+/- 3.10) and measured 3.3 mm (+/- 0.40) in diameter. A heart beat could be detected at 45.5 (+/- 1.73) days and the size of the first measurable embryo at 35 days was 2 mm. The dating of most features was within the range reported for other non-human primate species.

Fumonisin B1 influenced the effects of arachidonic acid, prostaglandins E2 and A2 on cell cycle progression, apoptosis induction, tyrosine- and CDC2-kinase activity in oesophageal cancer cells

In a previous study, we showed that, of a group of lipids including arachidonic acid (AA), prostaglandins E2 (PGE2) and A2 (PGA2), PGA2 had the most marked effect on the inhibition of cell growth, activation of tyrosine kinase activity, lowering of the number of G1-phase cells, and induction of p53 levels in oesophageal carcinoma (WHCO3) cells. No significant effects by the three lipids were seen in normal monkey kidney cells. In the present study, the effects of the inhibitor of ceramide synthesis, fumonisin B1 (FB1), a metabolite of Fusarium verticillioides (= F. moniliforme) which is implicated in the high incidence of oesophageal cancer, were determined on AA, PGE2 and PGA2 WHCO3 treated cells. In the presence of FB1, the lipid-enhanced tyrosine kinase activity was lowered. Flow cytometric and morphological studies showed that FB1 lowered the marked apoptosis induced by especially PGA2. FB1, however, in combination with AA, PGE2 or PGA2 increased the number of G2/M cells. AA>PGE2>PGA2 alone decreased CDC2-kinase activity, but, in the presence of FB1, CDC2-kinase activity was significantly increased. The PGA2- and AA-induced p53 levels were lowered in the presence of FB1. We concluded that FB1 diminished the cytotoxic effects of the lipids on oesophageal tumour cells.

Effects of gamma-linolenic acid and arachidonic acid on cell cycle progression and apoptosis induction in normal and transformed cells

The effects of arachidonic acid (AA) and gamma-linolenic acid (GLA) on cell cycle progression and apoptosis induction, using flow cytometry, were compared on normal human skin fibroblasts, strain HSF43 with wild type (wt) p53, large T antigen transformed HSF43 cells (line E8T4) with non functional p53, and on two lymphoblast cell lines, TK6 with wt p53 and WTK1 with mutant p53. AA and GLA caused similar dose (50, 75 and 100 microg/ml AA and GLA) and time dependent (24 and 48 h) induction of apoptosis in each cell line. The degrees of the response of the four cell lines were, however, different. The normal HSF43 cells were most resistant against apoptosis induction and the WTK1 cells most susceptible. The apoptosis induction appeared to be independent of functional p53. Cell cycle progression was also similarly affected by AA and GLA in the two cell types. In the fibroblast type cells (HSF43 and E8T4) S- and G2/M-phase arrests were evident after 48 h exposure to AA and GLA, and in the lymphoblast cell lines (TK6 and WTK1) the cells were arrested in the G1-phase.

17beta-Estradiol metabolites affect some regulators of the MCF-7 cell cycle

The activity of p34(cdc2) plays a key role in the regulation of the eukaryotic cell cycle. Another cell cycle associated molecule is PCNA. We investigated the effects of 2-hydroxy-17beta-estradiol, a cell proliferator, and 2-methoxy-17beta-estradiol, a potent inhibitor of cell growth, on the levels and activity of p34(cdc2) and on the levels of PCNA, as well as on protein phosphorylation in MCF-7 cells. 2-Hydroxyestradiol increased p34(cdc2) activity at G1/S and elevated PCNA levels during S-phase. 2-Methoxyestradiol caused unscheduled activation of p34(cdc2) in S-phase and decreased levels of p34(cdc2) and PCNA during G2/M. We conclude that 2-hydroxy- and 2-methoxyestradiol have definite, though different regulatory functions during the cell cycle.

The induction of apoptosis in human cervical carcinoma (HeLa) cells by gamma-linolenic acid

A high concentration (50 micrograms/ml) of gamma-linolenic acid (GLA) induced morphological lesions typical of apoptosis, as well as DNA fragmentation, in HeLa cells. A lower concentration of GLA (20 micrograms/ml), caused an increased proliferating cell nuclear antigen (PCNA) labelling, with 92.7% cells positive, compared to 27.7% at a concentration of 50 micrograms/ml GLA. In correlation with these results, the number of cells with degraded DNA below the G0/G1 peak increased significantly in the 50 micrograms/ml GLA-treated cells, but increased only slightly in cells exposed to the lower level of GLA. The high levels of PCNA induced by 20 micrograms/ml GLA, in both G1 and S phases, may indicate a state of DNA repair synthesis, whilst at the higher concentration of GLA, most of the cells became apoptotic. Since apoptosis is associated with the deregulation of c-Myc expression, and as the Raf-1-MAP kinase cascade activates the expression of c-Myc and c-Jun, we investigated the effects of 20 and 50 micrograms/ml GLA on the Raf-1, c-Myc and c-Jun levels, and on the activity of MAP kinase. The results showed that 50 micrograms/ml GLA lowered the activity of MAP kinase. As expected with the decreased MAP kinase activity in the cells exposed to the higher level GLA, the c-Jun levels were also lowered. The levels of c-Myc, however, were increased. It is therefore possible that the deregulated expression of c-Myc in the HeLa cells exposed to the high level of GLA (50 micrograms/ml) may contribute to the induction of apoptosis in HeLa cells.

Wildlife, people and development: veterinary contributions to wildlife health and resource management in Africa

Human population pressures, habitat loss, environmental degradation and illegal hunting in Africa have resulted in the loss of biodiversity and near extinction of certain wildlife species. The dilemma for Africa is the balancing of conservation and development. If wildlife is not to become a relic of the past then it must have more than just aesthetic value. It must contribute materially to the well being of people who live close to the resource. In fact, appropriate management of biodiversity would lay the foundations for a more positive future for the rural people of Africa, with the key being the adoption of an active adaptive management philosophy. This paper reviews the issue of sustainable use of wildlife resources and how the Veterinary profession contributes positively to wildlife health management in Africa. These contributions have been through increasing veterinary inputs into wildlife management and research, disease surveillance and prevention, training and education. Wildlife and ecosystems are increasingly having to be managed in order to save and maintain biological diversity. Veterinarians have a crucial role to play towards the maintenance of wildlife health as part of a multi-disciplinary wildlife management team.

Plasma cortisol as an indicator of stress due to capture and translocation in wildlife species

Plasma cortisol concentrations were determined by radioimmunoassay in 712 individual animals of 18 wildlife species after either physical or chemical restraint, tranquillisation or trauma, in order to define baseline values and to assess the possibility of using cortisol as an indicator of stress. The cortisol levels appeared to rise after capture in all the species examined except the Cape buffalo. On the basis of the plasma cortisol levels, chemical capture was less stressful than physical restraint. Animals which were tranquillised had lower than 'normal' cortisol levels, whereas animals that had suffered trauma or which died after they were captured had higher than normal cortisol levels.

Desertification of subtropical thicket in the Eastern Cape, South Africa: Are there alternatives?

The Eastern Cape Subtropical Thicket (ECST) froms the transition between forest, semiarid karroid shrublands, and grassland in the Eastern Cape, South Africa. Undegraded ECST forms an impenetrable, spiny thicket up to 3 m high consisting of a wealth of growth forms, including evergreen plants, succulent and deciduous shrubs, lianas, grasses, and geophytes. The thicket dynamics are not well understood, but elephants may have been important browsers and patch disturbance agents. These semiarid thickets have been subjected to intensive grazing by domestic ungulates, which have largely replaced indigenous herbivores over the last 2 centuries. Overgrazing has extensively degraded vegetation, resulting in the loss of phytomass and plant species and the replacement of perennials by annuals. Coupled with these changes are alterations of soil structure and secondary productivity. This rangeland degradation has largely been attributed to pastoralism with domestic herbivores. The impact of indigenous herbivores differs in scale, intensity, and nature from that of domestic ungulates. Further degradation of the ECST may be limited by alternative management strategies, including the use of wildlife for meat production and ecotourism. Producing meat from wildlife earns less income than from domestic herbivores but is ecologically sustainable. The financial benefits of game use can be improved by developing expertise, technology, and marketing. Ecotourism is not well developed in the Eastern Cape although the Addo Elephant National Park is a financial success and provides considerable employment benefits within an ecologically sustainable system. The density of black rhinoceros and elephant in these thickets is among the highest in Africa, with high population growth and the lowest poaching risk. The financial and ecological viability of ecotourism and the conservation status of these two species warrant expanding ecotourism in the Eastern Cape, thereby reducing the probability of further degradation of ECST.

A comparative study of ochratoxin A-induced apoptosis in hamster kidney and HeLa cells

Ochratoxin A (OA), produced by strains of Aspergillus and Penicillium, at a dose of 20 micrograms/ml caused nuclear and nucleolar changes characteristic of apoptosis in hamster kidney (HaK) and HeLa cells. However, the morphological and biochemical lesions were not identical in the two cell types. In HaK cells micronuclei formation in prophase and interphase cells predominated but in HeLa cells apoptotic body formation was more prevalent. Indirect immunofluorescence indicated that nucleolar morphology was affected in both cell types with segregation of the fibrillar and granular components of the nucleolus present after 24 hr exposure. [35S]Methionine incorporation into SDS-PAGE-separated proteins was decreased after continuous exposure for 24 hr, but after only 3 hr exposure, the synthesis of three proteins was markedly increased in HaK (approximately 39, 90, and 180 kDa) and HeLa (approximately 40, 92, and 150 kDa) cells. Enhanced early synthesis of proteins was more pronounced in HaK cells in the G1-phase and in HeLa cells in the S-phase. Internucleosomal DNA breaks, characteristic of apoptosis, were present in G1 and S-phase HaK cells exposed to OA. In contrast, DNA of very high molecular weight was seen in synchronized HeLa cells. The results indicate that OA may activate different cellular processes involved in the degradation of DNA in HaK and HeLa cells.

Differential cytotoxic effects of gamma-linolenic acid on MG-63 and HeLa cells

Gamma-linolenic acid (GLA) inhibited cell proliferation in MG-63 and HeLa cells. Different morphological lesions were present in dividing cells; abnormal spindle formation in MG-63 cells and chromosome hypercondensation in HeLa cells. Different types of cell death were also present in interphase cells, no apoptosis but only 6% pycnosis in MG-63 cells and 90% apoptosis in HeLa cells. In MG-63 cells immunofluorescence showed segregation of nucleoli components, abnormal spindle formation and decreased labelling of microtubuli during interphase. In HeLa interphase cells prominently labelled abnormally arranged microtubuli were observed. The effects of GLA on protein synthesis in synchronized cells were determined with [35S]-methionine incorporation and SDS-PAGE. Decreased protein synthesis in both G1- and S-phase MG-63 cells was present. In S-phase HeLa cells, proteins of approximately 40, 92 and 150 kD were markedly expressed. Signalling mechanisms involved in cell proliferation and cell death may be differently affected in MG-63 and HeLa cells.

Flaccid trunk paralysis in free-ranging elephants (Loxodonta africana) in Zimbabwe

An epizootic of flaccid trunk paralysis began in free-ranging Zimbabwean elephants (Loxodonta africana) on the southern shore of Lake Kariba in 1989. It involved a selective neuropathy of peripheral nerves supplying the trunk, with axon and myelin degeneration, muscle atrophy, compensatory hypertrophy, and fine endomyseal fibrosis, without inflammatory changes.

Hemostasis in children undergoing liver transplantation

We reviewed the records of 200 children who underwent 238 orthotopic liver transplantations in order to determine which preoperative factors could predict intraoperative blood loss. A coagulation abnormality score (CAS) was calculated by allowing one point for each abnormality in six preoperative coagulation tests. The mean CAS values were significantly greater in children suffering from fulminant hepatic failure (Fulm) or post-necrotic cirrhosis (PNC) and those having retransplantation (ReTx) than in those with disease of other etiologies. No correlation was found between the CAS and the mean blood requirements in the different etiology groups. According to the amount of blood transfused, children could be divided in two groups. Group 1 were those with biliary atresia and ReTx, who received more than 200 ml/kg. Group 2 included those with PNC, Fulm, metabolic diseases, and Alagille syndrome and Byler disease, who received less than 140 ml/kg. The mean CAS was significantly lower and the PT significantly better in Group 1. We conclude that preoperative coagulation tests were weak predictors of intraoperative bleeding. The etiology of the underlying liver disease and previous abdominal surgery play an important role in the occurrence of severe bleeding. Intraoperatively, children presented the same hemostatic changes as adults.

Effects of gamma-linolenic acid on mitosis and nuclear morphology in osteogenic sarcoma cells

In this study it is shown that gamma-linolenic acid (GLA) at concentrations of 10, 20 and 50 micrograms/ml has a dose-responsive inhibitory effect on mitosis in osteogenic sarcoma cells after exposure for 24, 48 and 72 hours, respectively. GLA also has marked effects on the morphology of the nucleus and nucleolus of these cells. Decreased silver staining of nuclear phosphoproteins was also evident in GLA-supplemented cells.

Comparative blood characteristics of ranched and free-ranging American bison (Bison bison)

Blood samples were obtained from 20 bison (Bison bison) from a ranch in northern lower Michigan, as well as from 20 free-ranging bison of the same sex and similar age from the Badlands National Park in South Dakota. Hematologic and serum biochemical values were determined. The values were comparable in both groups, except for those for BUN, aspartate transaminase, and phosphorus, which were significantly (P less than 0.001) higher in the ranched bison than in the free-ranging bison. These differences were attributed to nutritional effects. Impact of age on blood characteristics was assessed in the ranched bison only by comparing values from calves weighing less than 185 kg with those from bison weighing more than 185 kg. Calves had significantly (P less than 0.001) higher values for phosphorus and RBC counts and lower total protein values than adults. Adult bison had higher eosinophil and neutrophil counts with lower numbers of lymphocytes, suggestive of a stress leukogram, whereas calves had the typical bovine neutrophil:lymphocyte ratio.

Thermal injury in pregnancy--the neglected tragedy

Thermal injury sustained during pregnancy presents special management problems for the gravid woman and her unborn child. Because of the reported high morbidity and mortality and lack of available data in South Africa, a multicentre retrospective review was undertaken by five burn centres. Thirty-three patients (average age 25,7 years) with mean 30% (range 1-80%) total body surface area burn were assessed. A review of the clinical material led to the following observations and conclusions. Pregnancy does not influence maternal outcome after thermal injury and maternal survival is usually accompanied by fetal survival in the absence of significant maternal complications. Maternal survival is less likely if the burn wound exceeds 50% total body surface area. Thermal injury does increase the risk of spontaneous abortion and premature labour, and fetal survival depends on fetal maturity. Early obstetric intervention is only indicated in the gravely ill patient where complications (hypoxia, hypotension, sepsis) jeopardize the life of a viable fetus. The mode of delivery should be determined by obstetric considerations.

Overwinter survival of carfentanil-immobilized male bison

A problem with studies that examine immobilization-related drug effects on large mammals is that no true control group exists because untreated (non-captured) animals in the same population have not been examined. We present data to show that overwinter survival in male bison (Bison bison) immobilized with carfentanil was the same as untreated bison. This unique experimental design allows us to conclude that the drug had no long-term effect on male bison overwinter survival.

Effects of capture on biological parameters in free-ranging bighorn sheep (Ovis canadensis): evaluation of normal, stressed and mortality outcomes and documentation of postcapture survival

Blood samples and physiological data were collected from 634 bighorn sheep (Ovis canadensis) captured by four different methods between 1980 and 1986 in the western United States. These parameters were evaluated for selected physiological, biochemical and hematological values. Postcapture biological parameters were compared among bighorn sheep according to four different outcomes; normal, stressed or compromised, capture myopathy (CM) mortality, and accidental mortality. Significant differences (P less than 0.05) were noted between outcome groups relative to certain parameters: temperature, respiration, creatinine phosphokinase (CPK), lactic dehydrogenase (LDH), serum glutamic oxaloacetic transaminase (SGOT), blood urea nitrogen (BUN), glucose, white blood cell count (WBC) and plasma pH. Such differences between groups may help in evaluating the clinical status of bighorn sheep at capture, enabling one to predict those animals that might develop CM at a later date, indicate candidates for preventive medical treatment prior to release, and/or which should be followed closely to determine long-term survival. Evaluation of follow-up data (n = 77) related to outcome status and long-term survival of bighorn sheep indicated that less than 4% (3 of 77) were dead within 1 mo of capture (one of these had been classified as normal and two as stressed or compromised at capture); less than 3% (3 of 77) were dead greater than 1 mo, and less than 6 mo after capture two were classified in the stressed outcome and one as diseased. Eighty-eight percent (68 of 77) were alive from 1 mo to 5 yr after capture (53 were classified as normal, 12 as stressed or compromised and 3 as diseased), and 2% (1 of 77) had chronic CM but was still alive (this animal had been classified as normal). Of 77 sheep in the follow-up group, less than 3% (2 of 77) were not observed following capture (one was classified as normal and one as stressed and diseased). Of the fatalities, less than 3% (2 of 40) had been captured by the net-gun and less than 4% (1 of 27) by drive-net. Those two unobserved in the follow-up group also had been caught with the net-gun, 5% (2 of 40). The single surviving CM case had been captured by the net-gun. Although the net-gun appears to be one of the safest methods of capturing individual bighorn sheep, based on evaluation of capture data and biological parameters, it may not be associated with the best long-term survival in some bighorn sheep.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects of capture on biological parameters in free-ranging bighorn sheep (Ovis canadensis): evaluation of drop-net, drive-net, chemical immobilization and the net-gun

Blood samples and physiological data were collected from 634 bighorn sheep captured between 1980 and 1986 in the western United States. Bighorn sheep were evaluated for physiological parameters (temperature, pulse and respiration), selected biochemical parameters (cortisol, creatine phosphokinase (CPK), serum glutamic oxaloacetic transaminase (SGOT), lactic dehydrogenase (LDH), alkaline phosphotase (AP), potassium, sodium, chloride, creatinine, blood urea nitrogen (BUN), selenium, glucose, total protein, plasma pH and plasma PCO2), and selected hematological parameters (packed cell volume (PCV), hemoglobin (HB), red blood cell count (RBC), and white blood cell count (WBC]. These parameters were compared among bighorn sheep captured by four different methods: drop-net (n = 158), drive-net (n = 249), chemical immobilization (n = 90) and the net-gun (n = 137). Biological parameters affected by stress, including temperature, respiration, cortisol, CPK, SGOT, potassium, glucose and WBC revealed significant differences among capture methods (P less than 0.05). Some blood parameter differences, including temperature, respiration, cortisol, glucose and WBC could be explained partially by the distribution of age and sex within capture method groups. Drop-net and net-gun methods of capture appeared to produce the least amount of alteration to biological parameters related to capture stress or compromise and capture mortality. Drive-net was similar to the former methods while chemical immobilization caused the greatest changes in the above physiological, biochemical and hematological parameters.

Chemical immobilization of free-ranging North American bison (Bison bison) in Badlands National Park, South Dakota

Twenty-six free-ranging North American bison (Bison bison) (22 adult bulls, one yearling male and three adult females) were immobilized using a combination of carfentanil and xylazine. For carfentanil the dose range (mean +/- SD) was 1.8-5.0 micrograms/kg (2.4 +/- 0.7 micrograms/kg) and for xylazine 0.004-0.125 mg/kg (0.07 +/- 0.03 mg/kg). Induction time (mean +/- SE) was 14.2 +/- 2.9 min (median 8 min), while the total mean reversal time after administration of a narcotic antagonist was 9.0 +/- 1.4 min (median 8 min). Only one animal that received the highest initial dose of carfentanil (2.5 mg) showed evidence of becoming "re-narcotized." Five animals required two or more doses of carfentanil before becoming immobilized. Overall, small volumes of drug used (mean = 0.62 ml for carfentanil, 0.53 ml for xylazine) enabled the use of 1 to 2 ml darts, increasing both accuracy and impact safety. Darting success approached 100%.

Capture methods in five subspecies of free-ranging bighorn sheep: an evaluation of drop-net, drive-net, chemical immobilization and the net-gun

Six hundred thirty-four bighorn sheep (Ovis canadensis) were captured in the western United States between 1980 and 1986, using four different methods: drop-net (n = 158), drive-net (n = 249), chemical immobilization (n = 90) and net-gun (n = 137). The net-gun was found to have considerable advantages over the use of ground nets and chemical immobilization methods for capturing bighorn sheep. Evaluation of specific outcome categories for individual sheep, including normal, compromised (stress-induced), mortality from capture myopathy (CM), and accidental mortality, revealed significant differences in these rates between capture groups (P less than 0.05). The use of the net-gun resulted in the lowest proportion of compromised sheep at 11% (15/137), had no CM mortality, and resulted in a 2% (2/137) accidental mortality. The use of drop-nets resulted in 15% compromised sheep (24/158), a CM mortality rate of 2% (3/158), and an accidental mortality rate of 1% (2/158). A similar proportion of sheep were compromised with the drive-nets (16%, 39/249). This method also had the highest CM mortality rate at 3% (7/249), and an accidental mortality rate of less than 1% (2/249). Chemical immobilization resulted in the most compromised sheep at 19% (17/90), had a CM mortality rate of 2% (2/90), and caused the most accidental deaths at 6% (5/90). Drop-nets and drive-nets were comparable when combining total mortality with rates for compromised bighorn sheep, 18% and 19%, respectively (29/158 and 48/249). Chemical immobilization had the highest combined measure of risk at 27% (24/90) and net-gun lowest at 12% (17/137).(ABSTRACT TRUNCATED AT 250 WORDS)

Oral hyperalimentation and the prevention of severe weight loss in burned patients

It is well known that the marked hypermetabolic response of the human body to thermal injury requires aggressive nutritional support. In order to minimize catabolic conditions resulting in severe weight loss, an oral hyperalimentation regimen has been successfully implemented in the burns unit of Tygerberg Hospital, Cape Town. Ninety-eight patients with deep burns, varying from 20 per cent to more than 60 per cent of body surface area, were included in this study. The results indicated a general increase in the percentage of patients who gained weight from week to week after week 2 post-burn in all burns categories. An exception was the 60 per cent and more burns category in which an increasing number of patients lost weight until week 4 post-burn. The results of this study and the apparent discrepancy in the above 60 per cent category are presented.

Oral hyperalimentation and the prevention of severe weight loss in burned patients

It is well known that the marked hypermetabolic response of the human body to thermal injury requires aggressive nutritional support. In order to minimize catabolic conditions resulting in severe weight loss, an oral hyperalimentation regimen has been successfully implemented in the burns unit of Tygerberg Hospital, Cape Town. Ninety-eight patients with deep burns, varying from 20 per cent to more than 60 per cent of body surface area, were included in this study. The results indicated a general increase in the percentage of patients who gained weight from week to week after week 2 post-burn in all burns categories. An exception was the 60 per cent and more burns category in which an increasing number of patients lost weight until week 4 post-burn. The results of this study and the apparent discrepancy in the above 60 per cent category are presented.

A study to assess the effects of a new Betadine cream formulation compared to a standard topical treatment regimen for burns

This study has shown that Betadine cream with or without Aserbine is as easy to apply and remove as Betadine ointment plus Aserbine. With Betadine cream there is as good as and in some instances better healing than with Betadine ointment/Aserbine in the topical treatment of burns. However, the addition of a necrolytic cream to Betadine cream does have favourable effects on wound healing and bacterial counts. More importantly, this study suggests that Betadine cream can penetrate the wound more effectively than the Betadine ointment/Aserbine combination but that the addition of a necrolytic cream is still advantageous.

Scanning electron microscopy of Bunostomum phlebotomum (Railliet, 1900)

Live specimens of Bunostomum phlebotomum were collected from the small intestine of a calf and processed for scanning electron microscopy using standard methods. This paper describes the surface morphology of adult worms. All these hookworms showed a dorsally bent anterior end with its buccal capsule, which opens antero-dorsally with a pair of chitinous cutting plates on the ventral margin. Prominent cervical papillae and a well developed male bursa with a dorsal and 2 lateral lobes, were observed. The female tail is slender and pointed with the anal opening close to the tip. Further studies are necessary to demonstrate morphological differences from other hookworms and to obtain more detail of the male bursa and female tail.

A new povidone-iodine cream for the treatment of burns. Comparison with a standard topical regimen

A remarkable improvement in the rate of burn healing has been achieved with a mixture of povidone-iodine ointment (Betadine) and malic, benzoic and salicylic acids (MBS) (Aserbine). A study was undertaken to compare the effects of a new povidone-iodine formulation (Betadine cream) with and without MBS with povidone-iodine ointment plus MBS. All preparations were easy to apply and were readily removed, causing only mild discomfort on application in the majority of cases. A significant difference in healing times was observed between povidone-iodine cream and povidone-iodine cream plus MBS. There was also a significant difference in the decrease in the number of positive bacterial cultures between these two treatments. This applied to both superficial and deep burns. No skin sensitivity reactions were reported with any of the preparations. The addition of MBS to povidone-iodine cream did not produce as significant an improvement in results as its addition to povidone-iodine ointment.

Survey of desert bighorn sheep in California for exposure to selected infectious diseases

From February 1983 to June 1985, 188 desert bighorn sheep (Ovis canadensis nelsoni, = 161 and Oc cremnobates, = 27) from 18 herds in 17 mountain ranges and one captive herd were caught, marked, and had blood, fecal, and nasal mucus samples collected. Nasal swab specimens were cultured bacteriologically and virologically specifically for parainfluenza-3 (PI-3) virus. Bacterial flora differed from herd to herd. Pathogenic pneumophilic bacteria (eg, Pasteurella sp) seldom were found. Parainfluenza-3 virus was isolated from 6 bighorn sheep in 3 herds. Fecal specimens were examined for parasite ova and low numbers of lungworm (Protostrongylus sp) larvae were found in feces from 2 herds. Sera were evaluated for antibodies against respiratory syncytial virus, ovine progressive pneumonia, infectious bovine rhinotracheitis, PI-3, bovine viral diarrhea, brucellosis, leptospirosis, contagious ecthyma, bluetongue, and epizootic hemorrhagic disease. Blood clots were cultured virologically for bluetongue and epizootic hemorrhagic disease. Serologic evidence of bluetongue and/or epizootic hemorrhagic disease was found in 9 herds, and bluetongue virus (serotypes 10,11,13 and 17) was isolated from 3 herds. Antibody titers against PI-3 and respiratory syncytial virus were found in 9 and 13 herds, respectively. Evidence of bovine viral diarrhea infection was found in 6 herds, whereas infectious bovine rhinotracheitis was found in only 1 herd. Antibody titers against contagious ecthyma were found in 9 of 18 herds in California, and active lesions were seen occasionally. Evidence of ovine progressive pneumonia, leptospirosis, or brucellosis was not found.

Topical burn therapy comparing povidone-iodine ointment or cream plus aserbine, and povidone-iodine cream

A trial comparing three topical agents was carried out in patients with burns. The substances investigated were 10% povidone-iodine (PVP-I) ointment mixed with a proteolytic agent, 5% PVP-I cream alone and in combination with the same proteolytic agent. Differences were observed in healing times and bacteriological cultures. Shorter healing times were observed in burns treated with PVP-I cream. The addition of a proteolytic agent to the cream made no difference to the results. Fewer positive cultures for Staphylococcus aureus and Pseudomonas aeruginosa were obtained in the groups treated with the cream. It was concluded that 5% PVP-I cream is a safe and effective topical agent in burns.