Two are better than one: the combinations of Beauveria bassiana, diatomaceous earth, and indoxacarb as effective wheat protectants.

The current study evaluates the efficacy of the entomopathogenic fungus Beauveria bassiana (Balsamo-Crivelli) Vuillemin (Hypocreales: Cordycipitaceae), diatomaceous earth (DE) (Protect-It), and the oxadiazine indoxacarb, at single or combined applications on wheat kernels, for the management of the rusty grain beetle, Cryptolestes ferrugineus (Stephens) (Coleoptera: Laemophloeidae), the red flour beetle, Tribolium castaneum (Herbst) (Coleoptera: Tenebrionidae), the khapra beetle, Trogoderma granarium Everts (Coleoptera: Dermestidae), and the lesser grain borer, Rhyzopertha dominica (F.) (Coleoptera: Bostrychidae). The study was conducted between November 2020 and August 2021 in Faisalabad under a complete randomized block design. The combination of DE + indoxacarb was the most efficient as it caused higher overall mortalities ranging between 59.34 and 100%, and lower overall progeny production ranging between 8.35 and 33.70 individuals per vial, than all other treatments. Beauveria bassiana alone exhibited the lowest mortality rates ranging between 22.33 and 47.76%, and the highest offspring emergence, ranging between 51.33 and 78.55 individuals per vial. Similar pattern was observed when persistence bioassays were conducted. For a period of 120 days, the DE + indoxacarb was the most powerful combination against all tested species, providing overall mortality rates between 17.06 and 63.80%. The overall progeny production was lower for the insect individuals exposed on wheat treated with the DE + indoxacarb combination, ranging between 13.66 and 52.23 individuals per vial, and higher for those exposed to B. bassiana alone, ranging between 44.03 and 107.67 individuals per vial, for the entire duration of storage. However, the efficacy of all treatments decreased gradually during the course of storage. The findings of the current study indicate that the combinations of entomopathogenic fungi, DE, and indoxacarb can be used for the prolonged protection of stored wheat from the tested noxious insect species of stored products. Further research, which will include other inert dusts in combination with entomopathogenic fungi and indoxacarb, may provide additional knowledge towards an effective management of noxious species occurring in storages.

Combinations of Beauveria bassiana and spinetoram for the management of four important stored-product pests: laboratory and field trials.

The current study examines the efficacy of the semi-synthetic insecticide spinetoram and entomopathogenic fungi Beauveria bassiana (Balsamo-Crivelli) Vuillemin (Hypocreales: Cordycipitaceae) as wheat protectants against the lesser grain borer, Rhyzopertha dominica (F.) (Coleoptera: Bostrychidae), the red flour beetle, Tribolium castaneum (Herbst) (Coleoptera: Tenebrionidae), the granary weevil, Sitophilus granarius (L.) (Coleoptera: Curculionidae), and the khapra beetle, Trogoderma granarium Everts (Coleoptera: Dermestidae), under laboratory and field trials. One dose of B. bassiana, i.e., 1 × 107 conidia/kg wheat, two doses of spinetoram, i.e., spine1: 0.05 ppm (mg/kg wheat), spine2: 0.1 ppm, and their combinations (Bb + spine1, Bb + spine2) were evaluated at 20, 25, and 30 °C. All treatments provided significantly higher mortality at 30 °C compared with the other two temperatures. Maximum mortality levels were observed in the treatments where B. bassiana was combined with the higher dose of spinetoram (0.1 ppm). All treatments reduced progeny production in comparison with the control groups. Maximum progeny reduction was observed at 30 °C, on wheat treated with the Bb + spine2 combination. The combination Bb + spine2 also provided elevated mortality rates in both laboratory and field persistence trials, but at 180 days caused moderate mortality to all tested insect species. Concerning progeny, at laboratory persistence trials, the combination Bb + spine2 exhibited the lowest offspring emergence to all tested species compared to the other treatments and control. Overall, our study showed that R. dominica was the most susceptible species followed by S. granarius, T. castaneum, and T. granarium. Our findings revealed that the combination of B. bassiana and spinetoram may be a useful tool for efficient and advanced integrated pest management strategies for long storage periods under multiple temperatures.

Natural Warriors against Stored-Grain Pests: The Joint Action of Beauveria bassiana and Steinernema carpocapsae.

Tribolium castaneum, Trogoderma granarium, Oryzaephilus surinamensis, Sitophilus oryzae, Rhyzopertha dominica, and Cryptolestes ferrugineus are all major pests of stored grains. In this study, the efficiency of single and joint applications of the entomopathogenic nematode (EPN) Steinernema carpocapsae at two different doses (50 and 100 IJs cm-2) and the entomopathogenic fungus (EPF) Beauveria bassiana for the management of the aforementioned pests was estimated. At single treatments, both doses of S. carpocapsae caused higher mortality rates to all six pest species compared to B. bassiana. The combined treatment of EPF and EPN resulted in higher mortality compared to single treatments. Mortality was strongly influenced by the exposure interval and the application dose of the EPN at both single and combined treatments. Maximum mortality was observed for the application of the combined treatment at the high dose of S. carpocapsae and B. bassiana. Among the different insect species tested, the maximum mortality rate was observed for R. dominica (96.62%), followed by S. oryzae (90.48%), T. castaneum (87.23%), C. ferrugineus (76.05%), O. surinamensis (70.74%), and T. granarium (57.71%). The outcomes of this study demonstrate the potential of utilizing specific combinations of EPF and EPN as effective natural enemies against stored-grain pests.

Evaluating the Compatibility of Spinosad and Alpha-Cypermethrin for Controlling Six Insect Pests Infesting Stored Wheat.

The deterioration of stored wheat due to pest infestations is a significant concern, with pests like Rhyzopertha dominica, Tribolium castaneum, Cryptolestes ferrugineus, Sitophilus oryzae, Oryzaephilus surinamensis, and Trogoderma granarium being major contributors. This study examined the efficacy of spinosad and alpha-cypermethrin, individually and in combination, against these pests under laboratory conditions. Spinosad was tested at two concentrations (0.05 and 0.1 mg/kg), while alpha-cypermethrin was applied at 0.05 mg/kg. The combined application of both insecticides led to significantly higher pest mortality compared to single treatments. Importantly, all treatments caused substantial pest mortality and exhibited the ability to suppress pest progeny production over time, as observed in both laboratory and persistence trials. Among the various treatment combinations, the joint application of 0.1 mg/kg spinosad and 0.05 mg/kg alpha-cypermethrin emerged as the most effective, resulting in elevated mortality and a marked reduction in pest progeny. Rhyzopertha dominica exhibited the highest susceptibility among the pests, followed by S. oryzae, T. castaneum, C. ferrugineus, O. surinamensis, and T. granarium. The remarkable performance of the joint action of alpha-cypermethrin and spinosad at low doses highlights this combination as an efficacious approach for safeguarding stored grain against these destructive insect pests, warranting further exploration.

Role of Endoscopic Ultrasound in Predicting Solid Pancreatic Lesions Using Strain Ratio and Elastography.

Background: Despite advancement in imaging techniques, the diagnosis of solid pancreatic lesions (SPLs) remains challenging. The latest advancement in elastography permits the quantitative measurements of the average elasticity of a lesion. Therefore, our main aim of this study was to determine the utility of endoscopic ultrasound-guided elastography (EUS-EG) and strain ratio (EUS-SR) in predicting SPLs. Materials and methods: This cross-sectional study was performed at the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation. All patients with radiological diagnosis of SPLs underwent EUS-EG, followed by strain ratio (SR) measurement and targeted pancreatic fine needle lesion biopsy (FNB). Area under the receiver operating curve (AUROC) was obtained for SR and combined elastography and SR and at an optimal cutoff, diagnostic accuracy was obtained in predicting the nature of SPLs. Results: A total of 52 patients were included in this study. Out of them, 32 (61.5%) patients were males while 20 (38.5%) were females. The mean age was 50.8 ± 12.5 years. Twenty-four (46.2%) patients had malignant pancreatic lesions. Among malignant lesions, the most common etiology was pancreatic adenocarcinoma seen in 18 (34.6%) patients. Out of 28 (53.8%) patients with benign lesions, 14 (26.9%) patients had inflammatory disease. Area under the receiver operating curve was obtained for both SR alone and SR combined with elastography score in differentiating benign from malignant SPLs which was 0.832 (p-value < 0.001) for SR alone and a slightly higher for combined SR with elastography (AUROC-0.839)(p-value < 0.001). At an optimal cutoff of SR of >17, the sensitivity was 94.8% and the diagnostic accuracy was 74% in predicting SPLs. While, when SR and elastography were combined together, the sensitivity increased to 96% with a diagnostic accuracy of 75%. Conclusion: Combined EUS-EG and SR were accurate in diagnosing malignant pancreatic lesions with a diagnostic accuracy of 75% providing additional diagnostics information before biopsy. However, multicentric studies with larger sample sizes are required for the validation of our results to determine the utility and diagnostic accuracy of EUS-SR in defining the characteristic of pancreatic lesions. How to cite this article: Bajaj K, Yaseen T, Tasneem AA, et al. Role of Endoscopic Ultrasound in Predicting Solid Pancreatic Lesions Using Strain Ratio and Elastography. Euroasian J Hepato-Gastroenterol 2023;13(1):1-4.

A Tertiary Care Center's Experience with Clinicopathological Characteristics of Gallbladder Carcinoma in Our Population.

Introduction: Gallbladder cancer (GBC) is the most common malignant biliary tract tumor with the shortest survival from the time of diagnosis. This poor prognosis is due to the destructive biologic behavior of GBC, lack of sensitive screening tests for early detection, and vague nature of first presentation. Here in this study, we will evaluate the baseline characteristics of the patients presenting with gallbladder carcinoma in our population. Materials and methods: This retrospective study was conducted in the Department of Gastroenterology at Sindh Institute of Urology and Transplantation (SIUT), Karachi. Patient data were compiled and composed from the in-patient health records, radiology, and operational records. Those patients with suspicion of GBC, but negative at histology, or patients having inconclusive radiologic findings, were excluded. Baseline characteristics were recorded. Results were presented as means ± SD for quantitative data or as numbers with percentages for qualitative data. Continuous variables were analyzed using the Student's t-test, while categorical variables were analyzed using the Chi-square test. A p-value of <0.05 was considered statistically significant. Results: A total of 162 patients were included in our study. Among them, 101 (62.3%) were females. Hypertension was the most common comorbid illness noted in 29 (17.9%) patients while 91 (56.2%) patients had no concurrent comorbidities. Most common risk factor for carcinoma of gallbladder was gallstones seen in 106 (65.1%) patients. The most common presenting complaint was combination of obstructive jaundice, weight loss with right hypochondrial pain seen in 66 (40.7%) patients. On CT abdomen, direct liver infiltration without lymphovascular invasion was noted in 77 (47.5%) patients followed by liver infiltration along with lymphovascular invasion in 26 (16%) patients and distant metastasis in 24 (14.8%) patients. On gallbladder (GB) mass biopsy, 58 (35.8%) patients had well-differentiated, 46 (28.4%) had moderately differentiated, while 33 (20.4%) had poorly differentiated adenocarcinoma. Of 162 patients, 103 (63.6%) patients underwent endoscopic retrograde cholangiopancreatography (ERCP). The most common finding on ERCP was proximal common bile duct (CBD) stricture with intrahepatic biliary system dilatation which was noted in 95 (58.6%) patients. Percutaneous transhepatic cholangiography (PTC) was performed only in 9 (5.6%) patients. Seventeen (10.5%) patients were managed by simple cholecystectomy, 39 (24.1%) patients underwent extended cholecystectomy, 14 (8.6%) patients underwent chemotherapy, while 102 (56.8%) patients were given palliative management. When followed for 1 year, 101 (62.3%) patients died within 6 months. Conclusion: The baseline characteristics, biopsy findings, modes of treatment, and rates of 1 year mortality were studied in patients with gallbladder carcinoma in our population. Advanced age, high white blood cell counts, and serum bilirubin at presentation with low lymphocyte count and presence of comorbid illnesses were the factors independently associated with increased mortality in patients with gallbladder carcinoma. However, further studies with large sample size and stratification with respect to age, gender, and different variables can be done in terms of mortality in patients with gallbladder carcinoma. How to cite this article: Akbar N, Yaseen T, Muhammad A, et al. A Tertiary Care Center's Experience with Clinicopathological Characteristics of Gallbladder Carcinoma in Our Population. Euroasian J Hepato-Gastroenterol 2022;12(1):35-39.

CABG in a patient recovering from dengue fever.

Dengue fever (DF) is the most common and widespread arbovirus infection worldwide. It is endemic in the tropical and sub-tropical areas of the world especially in Southeast Asia, the Pacific, East and West Africa, the Caribbean and South America with cyclical epidemics. Major epidemics of DF have occurred in India and Southeast Asia in the last two decades. We have outlined the anaesthetic management of a 64-year-old man with DF who needed urgent Coronary artery Bypass graft surgery.

Clinical characteristics and outcome of ICU admitted MERS corona virus infected patients.

Middle East Respiratory Syndrome (MERS) is a novel respiratory illness firstly reported in Saudi Arabia in 2012. It is caused by a new corona virus, called MERS corona virus (MERS-CoV). Most people who have MERS-CoV infection developed severe acute respiratory illness. AIM OF THE WORK: This work is done to determine the clinical characteristics and the outcome of intensive care unit (ICU) admitted patients with confirmed MERS-CoV infection. PATIENTS AND METHODS: This study included 32 laboratory confirmed MERS corona virus infected patients who were admitted into ICU. It included 20 (62.50%) males and 12 (37.50%) females. The mean age was 43.99 ± 13.03 years. Diagnosis was done by real-time reverse transcription polymerase chain reaction (rRT-PCR) test for corona virus on throat swab, sputum, tracheal aspirate, or bronchoalveolar lavage specimens. Clinical characteristics, co-morbidities and outcome were reported for all subjects. RESULTS: The main symptoms among the included patients were: fever (96.87%), cough (93.75%), dyspnea (90.62%), sore throat (75%), runny nose (75%), sputum (50%), headache (43.75%), myalgia (40.62%), chest pain (37.50%), hemoptysis (37.50%), nausea and vomiting (34.37%), abdominal pain (21.87%) and diarrhea (15.62%). The presence of abdominal symptoms is significantly (P < 0.05) associated with bad prognosis. Out of the included 32 patients, 18 patients (56.25%) survived and 14 patients (43.75%) expired. There was a statistically significant difference in the duration of symptoms before hospitalization, mechanical ventilation and ICU and total hospital stay between the expired group and survivors (P < 0.01). Current smoking and smoking severity were statistically significantly (P < 0.01) higher in the expired group compared to survivors. Also, there was a statistically (P < 0.05) significant positive correlation between mortality and smoking severity (r = 0.640). Most of the expired patients presented with bilateral pulmonary infiltrates or unilateral infiltrates, but most of the survivors presented with normal radiology or increased bronchovascular markings, and this difference in the results was statistically highly significant (P < 0.01). There were statistically highly significant (P < 0.01) differences in the mean values of APACHE II score (21.11 ± 3.70 vs 24.21 ± 3.82), SOFA score (5.83 ± 2.64 vs 8.85 ± 2.17) and CPIS (7.55 ± 1.14 vs 8.64 ± 1.39) between the expired group and survivors respectively. Also, there was a statistically significant decrease in PH, PaO2, O2 saturation and HCO3 (P < 0.05) among the expired group in comparison with the survivors, but no statistical difference regarding PaCO2 (P > 0.05). There was a statistically significant positive correlation between mortality and old age (r = 0.633), obesity (r = 0.712), diabetes mellitus (r = 0.685), renal failure (r = 0.705), chronic heart diseases (0.591), COPD (r = 0.523), malignancy (r = 0.692), kidney transplantation (r = 0.644) and liver cirrhosis (r = 0.525) (P < 0.05). There was a statistically (P < 0.05) positive correlation between the number of associated co-morbidities and mortality (r = 0.735). CONCLUSIONS: Most MERS corona patients present with fever, cough, dyspnea, sore throat, runny nose and sputum. The presence of abdominal symptoms may indicate bad prognosis. Prolonged duration of symptoms before patients' hospitalization, prolonged duration of mechanical ventilation and hospital stay, bilateral radiological pulmonary infiltrates, and hypoxemic respiratory failure were found to be strong predictors of mortality in such patients. Also, old age, current smoking, smoking severity, presence of associated co-morbidities like obesity, diabetes mellitus, chronic heart diseases, COPD, malignancy, renal failure, renal transplantation and liver cirrhosis are associated with a poor outcome of ICU admitted MERS corona virus infected patients.