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Symptoms of sugarcane orange rust were observed on July 17, 2008 on sugarcane cvs. Mex 57-1285, Mex 61-230, and Co 301 (a clone received in Mexico in 1953) at the Centro de Investigación y Desarrollo de la Caña de Azúcar en Tuxtla Chico, Chiapas, Mexico. In El Salvador, from August 2008 through January 2009, rust symptoms were observed on cv. CP 72-2086 (previously resistant to brown rust caused by Puccinia melanocephala Syd. & P. Syd.) in 117 dispersed sugarcane-production fields in various localities of El Salvador. Likewise, rust symptoms were first observed on sugarcane cv. SP 74-8355 (more than 25% severity and considered resistant to brown rust) at Natá, Coclé Province in Panama from January to February 2008. Dried herbarium leaf samples of sugarcane rust-infected leaves collected in El Salvador and Mexico were sent to the ARS, USDA Systematic Mycology and Microbiology Laboratory in Beltsville MD for identification. Panamanian samples were collected similarly and analyzed at the CALESA Biotechnology Laboratory. Morphological features of uredinial lesions and urediniospores were distinct from those of P. melanocephala and consistent with P. kuehnii E. J. Butler observed previously on specimens from Florida, Guatemala, Costa Rica, and Nicaragua (1-3). Analysis of the ITS1, 5.8S, and ITS2 and 28S large subunit rDNA sequences of the rust on infected cvs. Mex 57-1285, Mex 61-230, and Co 301 (BPI 878930, 879139, and 879140; GenBank Accession Nos. GO283006, GO283004, and GO283005, respectively) from Mexico and cv. CP 72-2086 from three locations in El Salvador (BPI 879135, 879136, and 879137; GenBank Accession Nos. GO283009, GO283007, and GO283008, respectively) all confirmed the identification of P. kuehnii. Similar analysis of the ITS1, 5.8S, and ITS2 rDNA sequence for the rust infecting cv. SP 74-8355 (GenBank Accession No. GO281584) confirmed the identification of P. kuehnii in Panama. To our knowledge, this is the first report of P. kuehnii causing orange rust disease of sugarcane in El Salvador, Mexico, and Panama. These findings also confirm the wider distribution of orange rust in the Western Hemisphere. References: (1) E. Chavarria et al. Plant Dis. 93:425, 2009. (2) J. C. Comstock et al. Plant Dis. 92:175, 2008. (3) W. Ovalle et al. Plant Dis. 92:973, 2008.

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OBJECTIVE: To examine the effect of intravenous nicardipine in the treatment of children with severe hypertension. METHODS: The medical records of 29 children (mean age 94 months) treated with intravenous nicardipine were retrospectively reviewed. The mean duration of severe hypertension before nicardipine use was 12.5 hours. Most (74%) patients were receiving other antihypertensive agents before nicardipine. RESULTS: The initial nicardipine dose was 0.8 +/- 0.3 microg/kg/min (mean +/- SD). The mean effective dose was 1.8 +/- 1.0 microg/kg/min (range, 0.3 to 4.0). Blood pressure control was achieved within 2.7 +/- 2.1 hours after nicardipine was started. Nicardipine treatment produced a 16% reduction in systolic blood pressure, a 23% reduction in diastolic blood pressure, and a 7% increase in heart rate. Nicardipine was effective as a single agent on 26 (84%) of 31 occasions. Adverse effects included tachycardia, flushing, palpitations, and hypotension. CONCLUSIONS: When administered in the intensive care unit setting with close patient monitoring, intravenous nicardipine effectively lowered blood pressure in children with severe hypertension. Larger prospective studies should be conducted to confirm these findings.

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In 1994 the government of Puerto Rico adopted a capitated managed health care system for the medically indigent. The new law has been implemented in most municipalities. A survey of children with special health care needs treated at a tertiary pediatric center under the capitated managed care system and the prior non-capitated system was analyzed using the Consumer Assessments of Health Plan Survey (CHAPS) instrument. One third of the patients who were under the new capitated managed care system were not satisfied with the medial care they were receiving. The parents of children with multidisciplinary conditions found it much more difficult to access care at the tertiary center. It took parents two years to learn to navigate within the capitated managed care system. Studies to measure outcome and health quality of children with special health care needs in capitated managed health care programs must be developed to learn how the potential benefits of managed care can be maximized and the potential harms minimized. The purpose of this study was to analyze the accessibility and satisfaction of caretakers of children with special health care needs under a capitated managed health care system.

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OBJECTIVE: The purpose of this study is to determine the seroprevalence of blood borne transmissible diseases of the orthopaedic trauma surgical patients who deny or did not have knowledge of having disease or risk factors, but are positive for either human immunodeficiency virus, hepatitis B virus, and hepatitis C virus. BACKGROUND: Orthopaedic surgeons practicing in areas with a high prevalence of HIV infection may expect that up to 7% of their patients who undergo emergency procedures and 1% to 3% of those who undergo elective surgery will be HIV-positive. METHOD: All conscious adult patients consecutively admitted for surgical management by the orthopaedic service were evaluated. A detailed questionnaire was completed asking the patient of knowledge of having a transmissible disease and documenting certain risk factors. Blood samples were taken to test for HIV, HBV and HCV and all positive patients were sent to a follow up clinic. RESULTS: Out of 100 patients the following results were found: 7% were positive for HIV, 12% positive for HBV, 12% positive for HCV, 19% were positive to at least one test, and 9% were positive in more than one test. Of the one hundred patients, 6% had a positive test in spite of denying having a disease or any risk factors. None of the patients with HBV and/or HCV knew they were positive and three (43%) of the seven with HIV were also unaware of their condition. CONCLUSIONS: This study suggests that a worrisome number of patients are seropositive for a blood borne transmissible disease, even though they had no knowledge of such disease and claimed they had no risk factors. In order to protect orthopaedic surgeons from the unreliability of some patients' histories, all trauma orthopaedic surgical patients should be managed with universal precautions.

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Data regarding orthopaedic work-force is presented. Data is based on information obtained from the Puerto Rico Board of Medical Examiners, the Puerto Rico Department of Health and orthopaedic surgeon's practice. The purpose of this study is to compare the local orthopaedic manpower with the American Academy of Orthopaedic Surgeons most recent national manpower survey and to provide a database of the local orthopaedic work-force.

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The purpose of this study is to evaluate the use of Intraoperative Autotransfusion (IAT) as a second stage in the use of autologous blood to reduce the need of allogeneic transfusions. We reviewed the medical records of 41 pediatric patients who underwent spinal fusion procedures from September 1991, to August 1993. Our experience with IAT started in August 1992. The group of patients was divided into those who only received preoperative donation autologous blood (53.6%) and those who received preoperative donation autologous blood and IAT (46.4%). The use of preoperative autologous blood donation in combination with IAT has proven to be a safe method of operative blood loss replacement in pediatric age patients. Exclusive use of autologous blood can reduce or eliminate transfusion reactions and exposure to transfusion transmitted agents and helps to increase the blood reserve at blood banks.

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Partly because of their poor fossil record, the relationships of neotropical platyrrhine monkeys to other groups of primates and to each other remain perhaps the most poorly known for any major primate clade. Here we report the discovery of a complete platyrrhine skull from the Andes of central Chile, by far the best preserved Tertiary primate cranium from South America. This find, coupled with recent phylogenetic analyses of higher groups of anthropoid primates, has the potential to revise substantially our understanding of platyrrhine interrelationships, indicating, among other points, significant modification to reconstruction of the ancestral platyrrhine morphotype and a likely African origin for New World monkeys. A 40Ar/39Ar radioisotopic date directly associated with the skull indicates an Early Miocene age, marking the first report of South American mammals of this age from outside Argentine Patagonia. Finally, this discovery demonstrates the enormous potential of vastly distributed, but virtually untapped, Andean volcaniclastic deposits to yield further insights into the origin and diversification of South American primates.

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The usefulness of a digoxigenin-labeled genomic DNA probe for the detection of subgingival Bacteroides forsythus was examined. In addition, the arbitrarily primed polymerase chain reaction (AP-PCR) was used to delineate the genetic diversity of B. forsythus periodontal isolates. The DNA probe detected 10(3) B. forsythus cells and yielded a strong signal at 10(4) cells. It reacted with B. forsythus ATCC 43037T and 44 clinical isolates and showed no detectable reactivity with 75 strains of 24 other oral microbial species. In comparison to culture, the DNA probe in a dot-blot method demonstrated a sensitivity of 88.8% and a specificity of 38.4% (accuracy, 72.5%). By colony-blotting on primary plates, a sensitivity of 98.1% and a specificity of 53.8% (accuracy, 82.5%) were obtained. B. forsythus was detected in 449 (73.1%) of 614 periodontitis patients. The occurrence of the organism was closely associated with Porphyromonas gingivalis, both species being present in 54.8% and absent in 22.2% of 270 study samples. AP-PCR identified 24 B. forsythus genotypes among 27 test strains. This study demonstrated the utility of a non-radioactive genomic probe for direct detection of B. forsythus in subgingival specimens. The species showed a considerable degree of genetic diversity. DNA analysis may help to determine the role of B. forsythus in periodontal disease and its mode of transmission among exposed individuals.

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The usefulness of a digoxigenin-labeled genomic DNA probe for the detection of subgingival Bacteroides Forsythus was examined. In addition, the arbitrarily primed polymerase chain reaction (AP-PCR) was used to delineate the genetic diversity of B. Forsythus periodontal isolates. The DNA probe detected 10(3) B. Forsythus cells and yielded a strong signal at 10 (4) cells. It reacted with B. Forsythus ATCC 43037T and 44 clanical isolates and showed no detectable reactivity with 75 strains of 24 other oral microbial species. In comparison to culture, the DNA probe in a dot-blot method demonstrated a sensitivity of 88.8 percent and a specificity of 38.4 percent (accuracy, 72.5 percent). By colony-blotting on primary plates, a sensitivity of 98.1 percent and a specificity of 53.8 percent (accuracy, 82.5 percent) were obtained. B. Forsythus was detected in 449 (73.1 percent) of 614 periodontitis patients. The occurrence of the organism was closely associated with Porphyromonas gingivalis, both species being present in 54.8 percent and absent in 22.2 percent of 270 study samples. AP-PCR identified 24 B. Forsythus genotypes among 27 test straing. This study demonstrated the utility of a non-radioactive genomic probe for direct detection of B. Forsythus in subgingival specimens. The species showed a considerable degree of genetic diversity. DNA analysis may help to determine the role of B. Forsythus in periodontal disease and its mode of transmission among exposed individuals

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This study reviews the medical records of 29 patients that were submitted to 29 spinal fusion procedures with the purpose to evaluates the efficacy of using predeposited autologous blood transfusions to replace operative blood loss. The patients age ranged from 8 to 25 years. Each patient was started on oral iron supplement as soon as surgery was scheduled. The phlebotomies were performed at the American Red Cross Blood Services Puerto Rico Chapter. Blood was drawn 1 unit every 6 days if the hematocrit was above 34%. The last phlebotomy was performed at least 7 days before surgery. The average amount of blood donated was 3.17 units (1,427 ml). The whole blood was stored using the adenine saline solution (ADSOL) as preservative for as long as 35 days. The average preoperative hematocrit value was 35%. In 89% of the cases only autologous blood was transfused. In the rest of the cases family donated homologous blood was required. The use of pre deposited autologous blood for replacement of operative blood loss has proven to be a safe, easy and well accepted method for the pediatric age patients. It also reduced the need for homologous blood and helps to increase the blood reserve at banks.

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A review of the literature and four additional cases of surgical excision of anterior cervical osteophytes causing dysphagia is presented. Surgical excision of the osteophytes is recommended only after a complete evaluation to rule out other causes of dysphagia and after an adequate period of conservative therapy. The patients must be advised that frequently symptoms will recur to some extent as time progresses. In patients who have findings consistent with diffuse idiopathic skeletal hyperostosis (DISH Syndrome) recurrence of the osteophyte appears to be more common.

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