Infectivity of Entomopathogenic Fungal Isolates Against Tarnished Plant Bug Lygus lineolaris (Hemiptera: Miridae).

Twelve isolates of entomopathogenic fungi belonging to Metarhizium robertsii, M. pinghaense, M. brunneum, Beauveria bassiana, and Isaria fumosorosea were screened against tarnished plant bug. All isolates were pathogenic, causing mortality from 28.8 ± 3.4 to 96.3 ± 2.7%. The LT50 values ranged from 2.7 to 6.0 d while the LT90 values varied between 6.6 and 15.0 d. Metarhizium robertsii isolate CPD6 (will be under the trade name NoVil) was among the isolates that caused high mortality within shorter times and was selected for study on developmental stages and greenhouse trial. The third-, fourth-, and fifth-instar nymphs, and adults were inoculated with 106, 107, and 108 conidia per ml of NoVil. All the stages were susceptible to fungal infection. However, third and fourth instars were the most susceptible with no significant differences in mortality across the three concentrations. On the other hand, mortality was dose-dependent with fifth-instar nymph and adult stages. The LT50 and LT90 values were also dose-dependent, with higher concentrations having shorter lethal-time values as compared to the lower concentrations. In the greenhouse, pepper plants were sprayed with NoVil and chemical insecticide Flonicamid (as industrial standard), before releasing adult tarnished plant bug. Mortality of 37.3, 75.5, and 76.3% was recorded in the control, NoVil, and Flonicamid, respectively. This study has identified NoVil as a potential mycoinsecticide candidate for the control of tarnished plant bug under greenhouse conditions. Further field testing on juvenile and adults is needed to evaluate the potential for in-field control.

Evaluation of massive transfusion protocol practices by type of trauma at a level I trauma center.

PURPOSE: To evaluate massive transfusion protocol practices by trauma type at a level I trauma center. METHODS: A retrospective analysis was performed on a sample of 76 trauma patients with MTP activation between March 2010 and January 2015 at a regional trauma center. Patient demographics, transfusion practices, and clinical outcomes were compared by type of trauma sustained. RESULTS: Penetrating trauma patients who required MTP activation were significantly younger, had lower injury severity score (ISS), higher probability of survival (POS), decreased mortality, and higher Glasgow Coma scale (GCS) compared to blunt trauma patients. Overall, the mortality rate was 38.16%. The most common injury sustained among blunt trauma patients was head injury (36.21%), whereas the majority of the penetrating trauma patients sustained abdominal injuries (55.56%). Although the admission coagulation parameters and timing of coagulopathy were not significantly different between the two groups of patients, a significantly higher proportion of penetrating trauma patients received high plasma content therapy relative to blunt trauma patients (p < 0.01). CONCLUSION: Despite the use of the same MTP for all injured patients requiring massive transfusion, significant differences existed between blunt trauma patients and penetrating trauma patients. These differences in transfusion characteristics and outcomes following MTP activation underscore the complexity of implementing MTPs and warrant vigilant transfusion practices to improve outcomes in trauma patients.

Case series supporting heme detoxification via therapeutic plasma exchange in acute multiorgan failure syndrome resistant to red blood cell exchange in sickle cell disease.

BACKGROUND: Depletion of haptoglobin (Hp) and hemopexin (Hx) with increase in free hemoglobin and heme are important etiologies of vaso-occlusive complications in sickle cell disease (SCD). This study is the first to show an association between clinical improvement in SCD and repletion of Hp and Hx by therapeutic plasma exchange (TPE) using plasma replacement. STUDY DESIGN AND METHODS: Thirteen fresh-frozen plasma (FFP) units derived from consecutive whole blood donations were thawed at 37°C after 10 months of storage; Hp and Hx concentrations immediately postthaw and after 5 days of refrigerated storage were analyzed by enzyme-linked immunosorbent assay (ELISA). All SCD patients presenting to a single institution over a 2-year period with acute multiorgan failure syndrome resistant to red blood cell exchange (RCE) were treated with TPE with FFP replacement; concentrations of Hp, Hx, and heme were evaluated before and after TPE by ELISA. RESULTS: Plasma concentrations of Hp and Hx decreased approximately 20% (p ≤ 0.002) after 5 days of refrigerated storage. Significant mean fold increases after TPE of 10 for Hp (p < 0.005) and seven for Hx (p < 0.003) and a 30% mean decrease in heme concentrations (p = 0.07) were noted in association with clinical improvement (three patients), whereas minimal increases in Hp and Hx were associated with continued clinical deterioration in one patient. CONCLUSION: Fresh-frozen plasma rather than thawed plasma is optimal for Hp and Hx replacement. Patient data are consistent with Hp and Hx increases via TPE limiting clinical toxicity of worsened hemolysis associated with severe vaso-occlusive complications refractory to RCE in SCD.

Blood pressure percentiles by age and height for children and adolescents in Tehran, Iran.

To construct reference percentiles for blood pressure (BP) by sex, age and height for the first time in Iran, we used data on 16 972 healthy children, aged 1 month to 18 years, collected during 2000-2010 in Tehran. BP in this population rose steadily with age and height following a very similar trend in both genders up to the age of 14. Systolic BP (SBP) rise was more prominent in younger ages, and after puberty (15-18 years) was greater in boys compared with girls, while the rise in diastolic BP (DBP) was slightly higher in girls. Iranian norms, compared with 'Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents' (US-4th-Report) and the 'German BP Percentiles by Age and Height for Children and Adolescents' (KiGGS), showed a similar pattern of differences for both genders. For example, for Tehrani boys up to 6 years old whose heights were equal to 50th percentile of stature-for-age as well as length-for-age growth charts, the differences in 95th percentile for SBPs compared with the US-4th-report varied from 2-21 mm Hg while compared with KiGGS, maximum of differences was 9 mm Hg. For boys 7-15 years of age, ours were slightly higher than both. For ages of 16 and 17 years, we yielded figures lower than US-4th-report (2 mm Hg) but higher than KiGGS (3 mm Hg). Iranian 95th percentile for DBPs was lower than US-4th-report and KiGGS (1-11 mm Hg). Considering the differences with US-4th-report and KiGSS standards, the references presented in this study should rather be applied in Iranian population.

Medullary carcinoma of the breast: ten year clinical experience of the Kuwait cancer control centre.

BACKGROUND: Medullary carcinomas of the breast account for fewer than 7% of all invasive breast cancers. Some investigators include medullary carcinomas in the favourable histologic subtype, despite its aggressive histologic appearance. However, others fail to confirm its favourable prognosis. METHODS: This was a retrospective analysis of sixty-one (61) cases of breast cancer cases diagnosed with Medullary Carcinoma, presenting to the Kuwait Cancer Control Center between 1995 and 2005. RESULTS: Median survival time was 122 months and the seven-year disease free survival was 82%. Overall survival rate was not assessed as no cases died during the study period. No cases were metastatic from the start and only eight cases developed metastases, local recurrence or contralateral breast primary. 68.8% of the cases were Stage I or IIA (i.e. no lymph node affection). CONCLUSION: There is no overt favourable prognosis of medullary carcinoma when compared to invasive ductal carcinoma. Prognosis is more related to stage than histologic subtyping. The majority of cases were negative estrogen and progesterone receptor status and node negative.

Reliability of the Kuwait Cancer Registry: a comparison between breast cancer data collected by clinical oncologists and registry staff.

AIM: The quality of cancer registration is of great importance and the present study was conducted to assess the reliability of Kuwait Cancer Registry data on breast cancer. METHODS: Data from the clinical records extracted by a group of clinical oncologists for another study on 1,235 breast cancer cases diagnosed between 1999 and 2004 were used to audit the data held on these individuals by the Kuwait Cancer Registry (KCR). Only 902 cases met the eligibility criteria. Main measures were sex, nationality, laterality, morphology, stage of disease at time of admission to the center, type of treatment and status at last follow up (alive or dead). RESULTS: Full or high agreement between registry data and clinical oncologists collected data was recorded for sex, nationality and laterality. The rate of agreement for treatment with chemotherapy and status at last follow up was near perfect. Substantial agreement was also noted for morphology, tumor grade, TNM staging, surgical, radiotherapy and hormonal treatment. The majority of minor differences in morphology disagreements occurred when a more specific description was stated by registry staff, while major disagreement occurred due to difference in the codes used. CONCLUSIONS: The accuracy of the KCR data seems to be comparable to that found in reviews of other cancer registries. Stage was the hardest variable for the registry to collect accurate information on. KCR data could be improved by improving the quality of information provided to the registry.

Small bowel obstruction caused by intraluminal migration of retained percutaneous endoscopic gastrostomy internal bumper.

INTRODUCTION: Early complications associated with percutaneous endoscopic gastrostomy are well documented. Late complications associated with retained gastrostomy flange are rare. It is unclear why some patients with retained gastrostomy flange (internal bumper) develop mechanical obstruction and others do not. We report a case of mechanical obstruction with perforation occurring 6 months after the tube was cut. PATIENT AND METHODS: A 76-year-old hemiplegic patient with no swallowing reflex and who previously was on long-term percutaneous gastrostomy feeding tube underwent removal of the feeding tube but the internal bumper was left in situ due to encrustation. RESULTS: Due to migration of the retained flange, the patient developed small bowel obstruction. CONCLUSIONS: Retained internal bumper is potentially dangerous and we recommend endoscopic retrieval of such flange.

Primary gastrointestinal lymphoma in Kuwait. An 11-yr retrospective analysis of 108 cases.

One hundred and eight cases of primary gastrointestinal lymphoma from the files of Kuwait Cancer Control Center over a period of 11 yr were analysed retrospectively. The occurrence was 47 in the proximal small intestine, 38 in the stomach, 18 in the distal ileum and five in the colon and rectum. The majority of the patients were in stage III. Using a modified Rappaport's classification, lymphocytic lymphoma was the commonest histologic type (60%) as compared to histiocytic lymphoma (19%). Four patients had early IPSID (immunoproliferative small intestinal disease). The 'Western' type of lymphoma occurred in the fourth decade while the 'Mediterranean' type occurred in the third decade of life. The latter occurred more commonly among people of low socioeconomic background. Chemotherapy was the single most effective mode of treatment. Addition of surgery, radiotherapy or both did not improve the 2-yr survival but did improve the 5-yr survival.