Pathways to paediatric urology subspecialisation: a study of casemix, incumbent attitudes and opinions.

OBJECTIVE: To identify any self-reported differences or attitudes towards certification, publication, or practice patterns between adult urology and paediatric general surgery-trained paediatric urology providers. There are no known published differences in clinical/operative/research outcomes in either group. METHODS: An 18-item cross-sectional survey was compiled through the EAU Young Academic Urologists (YAU) office and disseminated to a trans-Atlantic convenience sample of current practising paediatric urologists. This was created using a mini-Delphi method to provide current semi-quantitative data relating to current opinions and attitudes of this cohort. RESULTS: A total of 228 respondents completed the survey, with female respondents representing 37% and 34% for urology and paediatric general surgery, respectively. Nearly 90% overall respondents felt that a full 2-year paediatric fellowship program was very important and 94% endorsed a collaborative dedicated paediatric urology on call service, with 92% supporting the joint development of transitional care. Urology managed higher numbers of bedwetting (p = 0.04), bladder bowel dysfunction (p = 0.02), endourological procedures (p = 0.04), and robotics (p = 0.04). Paediatric general surgery managed higher numbers of laparoscopic reconstruction (p = 0.03), and posterior urethral valve ablation (p = 0.002). CONCLUSION: This study represents the first time that a cross-sectional cohort of paediatric urologists from different training backgrounds were compared to assess their productivity, practice patterns and attitudes. Paediatric urology is in a unique position to have two contributing specialities, with the ability to provide optimal transitional and lifelong care. We believe that there should be a strong emphasis on collaboration and to remove any historically-created barriers under policies of equity, diversity and inclusivity.

Neuropsychiatric Developmental Disorders in Children Are Associated With an Impaired Response to Treatment in Bladder Bowel Dysfunction: A Prospective Multi-Institutional European Observational Study.

PURPOSE: Bladder and bowel dysfunction is a common but underdiagnosed pediatric entity which may represent up to 47% of pediatric urology consults. The objectives of this observational study were to determine functional 1-year outcomes following standard treatment of bladder and bowel dysfunction in both control and neuropsychiatric developmental disorder groups using validated questionnaires, and to perform an initial cost analysis. MATERIALS AND METHODS: This was a prospective observational study conducted across a number of academic European centers (July 2020-November 2022) for new bladder and bowel dysfunction patients. Parents completed a sociodemographic survey, information pertaining to prior neuropsychiatric developmental disorder diagnoses, as well as a number of validated functional scores. RESULTS: A total of 240 patients were recruited. In the control bladder and bowel dysfunction group, the baseline Dysfunctional Voiding Scoring System and Childhood Bladder and Bowel Dysfunction Questionnaire scores were 20% and 17.% lower, respectively, after 1 year compared to the neuropsychiatric developmental disorder group. The change in improvement was diminished for the neuropsychiatric developmental disorder cohort in both Dysfunctional Voiding Scoring System and Childhood Bladder and Bowel Dysfunction Questionnaire scores. The odds ratio of full symptom resolution was 5.7 in the control cohort compared to the neuropsychiatric developmental disorder cohort. A cost analysis on prescribed medications at referral led to a total cost of €32,603.76 (US $35,381.00) in the control group and €37,625.36 (US $40,830.00) in the neuropsychiatric developmental disorder group. CONCLUSIONS: This study demonstrates that pediatric patients with a neuropsychiatric developmental disorder exhibit more severe bladder and bowel dysfunction at baseline and throughout treatment with a lower overall quality of life, as well as 15.4% higher medication costs at referral. It is also important that parents' and caregivers' expectations are managed regarding higher levels of treatment resistance for functional bladder and bowel issues.

A cross-sectional analysis of paediatric urologists' current practices, opinions and areas of perceived importance in the delivery of adolescent & transitional care.

INTRODUCTION: Complex urological anomalies often require continued care as patients reach adulthood. Adequate transition for adolescents with ongoing urological care needs is critical to allow for seamless care in adult hospitals. Studies have shown that this can lead to improved patient and parental satisfaction, and lower utilisation of unplanned inpatient beds and emergency department visits. There is currently no ESPU-EAU consensus on the adequate mechanism and very few individual papers examining the role of urological transition for these patients in a European setting. This study aimed to identify current practice patterns in paediatric urologists providing adolescent/transitional care, to assess their opinions towards formal transition and to look for variations in care. This has implications for long-term patient health and specialist care. METHODS: An 18-item cross-sectional survey was compiled and pre-approved through the EAU-EWPU and ESPU board offices prior to dissemination to all registered ordinary members affiliated with the ESPU. This was created using a mini-Delphi method through the EWPU research meetings to provide current semi-quantitative data relating to current opinions and attitudes of this cohort. RESULTS: A total of 172 respondents (55% paediatric general surgery; 45% urology) across 28 countries completed the survey. The majority of respondents were in practice >10 years and spent >80% time in paediatric urology. There was no formal transition process according to 50% respondents and over half of those that did have less than 1/month, with <10% using validated questionnaires. More than two-thirds respondents continued to provide care after transition, as >70% units had no designated corresponding adult service. Furthermore, 93% paediatric believe a formal transition service to be very important, using a multidisciplinary framework. A pareto chart demonstrated 10 specific conditions to be of most interest in transition to adulthood. CONCLUSION: This is the first study to assess the requirements of paediatric urologists for adequate transitional care, however due to the nature of the survey's distribution, this was a non-scientific poll based on a convenience sample of respondents. It is critical that dual-trained or adult-trained urologists with a specific interest in paediatric urology work with current paediatric urologists in a multidisciplinary fashion to facilitate early transition based on the adolescent's developmental and biopsychosocial requirements. National urological and paediatric surgical societies need to make transitional urology a priority. The ESPU and EAU should collaboratively consider developing transitional urology guidelines to allow a framework by which this can occur.

Biological Control Potential of Two Steinernematid Species Against the Date Fruit Stalk Borer (Oryctes elegans Prell, Coleoptera: Scarabaeidae).

The fruit stalk borer (Oryctes elegans) is an important pest of date palm (Phoenix dactylifera) trees in Saudi Arabia. This study was conducted to determine efficacy of using two species of entomopathogenic nematodes, Steinernema kushidai and Steinernema glaseri, against O. elegans under laboratory and field conditions. Under laboratory conditions, both species of nematodes showed a significant effect on the mortality of O. elegans larvae. Significant variations were observed when insects were exposed to nematodes for variable durations under laboratory conditions. They showed no differences in insect larval mortality when tested either in aqueous suspensions or in Galleria-infected cadavers. Insects exposed to nematode aqueous suspension for 4 d and those treated with Galleria-infected cadavers showed the same rates of mortality, which differed when insects were exposed to nematode-infected cadavers under field conditions. Mean percentages of corrected mortality varied between nematode species and number of infected cadavers. S. kushidai caused significantly higher mortality percentages ± SE (72.17 ± 5.57, 95.83 ± 4.17, 94.43 ± 5.57, and 100%) compared with S. glaseri when the fruit stalk borer, O. elegans, was treated for 6 wk with two, four, six, and eight infected cadavers, respectively.

Host-parasite interaction and impact of mite infection on mosquito population

ABSTRACT During the present study, the host-parasite relationship between mosquitoes and parasitic mites was investigated. The 8954 individuals of male and female mosquitoes belonging to 26 genera: seven each of Aedes and Culex, six of Anopheles and one each of Toxorhynchites, Coquillettidia and Uranotaenia were collected from 200 sites. The male and female mosquitoes were collected from the State of Uttar Pradesh, located at 26.8500° N, 80.9100° E in North India by deploying Carbon dioxide-baited and gravid traps. The intensity of mite's infection, type and number of mites attached to mosquitoes, mite's preference for body parts and host sexes were the parameters used to determine host-parasite relationship. Eight species of mites: Arrenurus acuminatus, Ar. gibberifrons, Ar. danbyensis, Ar. madaraszi, Ar. kenki, Parathyas barbigera, Leptus sp., and Anystis sp., parasitized mosquitoes. Parasitic mites preferred host's thorax for attachment as compared to the head, pre-abdomen or appendages. The present study suggests phoretic relationship between parasitic mites and mosquitoes. Wide occurrence, intensity of infection, parasitic load, and attachment preferences of the mites suggested their positive role in biological control of adult mosquitoes. The present study will set the path of future studies on host-parasite relationships of mites and mosquitoes and define the role of parasitic mites in the biological control of mosquitoes.

Effect of cerebrolysin on oxidative stress-induced apoptosis in an experimental rat model of myocardial ischemia.

Apoptosis plays a role in the process of tissue damage after myocardial infarction (MI). This study was designed to investigate the possible effect of cerebrolysin against apoptosis triggered by oxidative cell stress in myocardial ischemia induced by isoproterenol in rat. Rats were pretreated with cerebrolysin 5 mL/kg intraperitoneally for 7 days and intoxicated with isoproterenol (ISO, 85 mg/kg, sc) on the last 2 days. Hearts were excised and stained to detect the infarction size. Serum levels of cardiotoxicity indices as creatine kinase isoenzyme (CK-MB) and troponin I (cTnI) as well as the cardiac oxidative stress parameters as thiobarbituric acid reactive substances and superoxide dismutase were estimated. The expression of prodeath gene p53 and antideath gene Bcl-2 was also assessed from the excised heart tissues. Leakage of cardiac enzymes, elevated oxidative stress markers, and apoptotic indices confirmed the MI occurring as a consequence of isoproterenol-induced ischemia. Cerebrolysin pretreatment caused significant attenuation of the oxidative stress-induced apoptosis in the ischemic myocardial tissue. These findings provided an evidence that cerebrolysin could protect rat myocardium against ischemic insult that was attributed to its antioxidant as well as its anti-apoptotic properties.

Comparative susceptibilities of different life stages of the red palm weevil (Coleoptera: Curculionidae) treated by entomopathogenic nematodes.

The red palm weevil, Rhynocophorus ferrugineus (Olivier) (Coleoptera: Curculionidae) has become the most important pest of the date palm trees in the world. It has been reported in the kingdom of Saudi Arabia since 1987 and in Egypt since 1992. Studies were conducted to compare preferences among red palm weevil life stages for infection by 12 entomopathogenic nematodes (EPNs), under no choice and five stage choice experiments, and curative trials by some of EPNs isolates. All EPN isolates proved to be pathogenic for the first instars of red palm weevil larvae. Some of the test EPNs exhibited a preference for larvae over pupae, and a lesser degree of preference for adults. In contrast some strains showed no preference for any stage. The local Egyptian isolates of EPNs were most efficient nematodes against red palm weevil than foreign strains. Field assessments using trunk injection resulted in a substantial decline in the population of red palm weevil after two successive applications within 3 wk. Efficacies ranging 48-88% were achieved in the curative assay resulting in a significant increase in palm survival compared with the untreated control. In conclusion, there is a great potential for the use of EPNs, in particular the Steinernema sp. (EGG4), against the red palm weevil when injected in the date palm.

Interaction of the koinobiont parasitoid Microplitis rufiventris of the cotton leafworm, Spodoptera littoralis, with two entomopathogenic rhabditids, Heterorhabditis bacteriophora and Steinernema carpocapsae.

Entomopathogenic nematodes are generally considered beneficial organisms. However, they can affect beneficial insects such as parasitoids. The interaction between the entomopathogenic nematodes Heterorhabditis bacteriophora Poinar (Rhabditida: Heterorhabditidae) and Steinernema carpocapsae Weiser, and the parasitoid Microplitis rufiventris Kokujev (Hymenoptera: Braconidae) was investigated in the laboratory. In non-parasitized hosts, Spodoptera littoralis Boisduval (Lepidoptera: Noctuidae) larvae exposed to H. bacteriophora showed a higher percent mortality than those exposed to S. carpocapsae. Both nematodes were able to invade and propagate in non-parasitized S. littoralis larvae and those parasitized by M. rufiventris. Both nematode species reproduced in Microplitis-parasitized hosts, but there was a higher number of nematodes in non-parasitized larvae. S. carpocapsae yielded higher numbers of infective juveniles than H. bacteriophora. Generally, the number of nematodes harvested increased as their host's size increased. The interaction between the nematodes and parasitoid favored the nematodes when the nematodes were inoculated during the parasitoid egg stage or the young parasitoid larvae, thus giving the nematodes a better chance to grow and reproduce, resulting in the death of the parasitoid larvae. Conversely, when the nematodes were inoculated during the late larval instar of the parasitoid, the competition partially favored the wasp, thus giving approximately 50% of the wasps a better chance to develop, emerge, and reproduce, providing evidence that both nematodes and wasps could reproduce in the same host. Egg maturation of female wasps derived from nematode-infected hosts was not significantly different than those from control hosts. The combined application of nematodes and parasitoids may be beneficial if the detrimental effects of the nematodes on the parasitoid could be avoided by precisely timing the application strategies. It is clear that Microplitis larvae and the nematodes share the host larva and engage in a trophic interaction with each other. Intraguild predation is briefly discussed.

Suppression of leopard moth (Lepidoptera: Cossidae) populations in olive trees in Egypt through mating disruption.

The leopard moth, Zeuzera pyrina (L.) (Lepidoptera: Cossidae), is a damaging pest for many fruit trees (e.g., apple [Malus spp.], pear [Pyrus spp.] peach [Prunus spp.], and olive [Olea]). Recently, it caused serious yield losses in newly established olive orchards in Egypt, including the death of young trees. Chemical and biological control have shown limited efficiency against this pest. Field tests were conducted in 2005 and 2006 to evaluate mating disruption (MD) for the control of the leopard moth, on heavily infested, densely planted olive plots (336 trees per ha). The binary blend of the pheromone components (E,Z)-2,13-octadecenyl acetate and (E,Z)-3,13-octadecenyl acetate (95:5) was dispensed from polyethylene vials. Efficacy was measured considering reduction of catches in pheromone traps, reduction of active galleries of leopard moth per tree and fruit yield in the pheromone-treated plots (MD) compared with control plots (CO). Male captures in MD plots were reduced by 89.3% in 2005 and 82.9% in 2006, during a trapping period of 14 and 13 wk, respectively. Application of MD over two consecutive years progressively reduced the number of active galleries per tree in the third year where no sex pheromone was applied. In all years, larval galleries outnumbered moth captures. Fruit yield from trees where sex pheromone had been applied in 2005 and 2006 increased significantly in 2006 (98.8 +/- 2.9 kg per tree) and 2007 (23 +/- 1.3 kg per tree) compared with control ones (61.0 +/- 3.9 and 10.0 +/- 0.6 kg per tree, respectively). Mating disruption shows promising for suppressing leopard moth infestation in olives.