Reproductive dormancy in boll-weevil from populations of the midwest of Brazil.

The boll weevil (Anthonomus grandis Boheman) (Coleoptera: Curculionidae) is an introduced pest in Brazil, which in 30 yr has successfully expanded to various eco-regions and became the most important pest of cotton (Gossypium hirsutum, Malvaceae). Given the limited knowledge about the adaptive mechanisms that allowed successful establishment of the pest population in a tropical region, in this work we studied the potential of the Midwest population of boll weevils to enter a reproductive dormancy and identified the importance of the feeding source for induction of dormancy. We investigated morphological and physiological characters as indicators of the dormancy. We also investigated the occurrence of reproductive dormancy in boll weevils populations from cotton farms of the Midwestern region of Brazil during the cotton and noncotton seasons of 2009 and 2010. The studies revealed that boll weevils entered facultative reproductive dormancy; however, unlike what has been observed for boll weevils from temperate and subtropical regions, the hypertrophy of fat body and hexamerin levels did not straightly correlated to reproductive dormancy. The food source and field conditions during early adult development were decisive factor for the induction of reproductive dormancy. The incidence of reproductive dormancy increased progressively as the phenology of cotton plant advanced, reaching approximately 90% at the end of the crop season. During the noncotton season, the boll weevil was predominantly found in reproductive dormancy, especially females; however, there is evidence of use of multiple adaptive strategies to colonize the next harvest.

Evidence of bacterial biofilms in nasal polyposis.

INTRODUCTION: The pathogeny of chronic rhinosinusitis with nasal polyposis (CRS/NP) has not been elucidated. Bacterial exotoxins have been implicated in many inflammatory chronic diseases, such as chronic otitis, chronic tonsillitis, cholesteatomas, and more recently CRS/NP. We propose that the bacteria in CRS/NP are not only present in a planktonic state, but also occur in microbial communities as biofilms. OBJECTIVE: To determine and characterize the presence of biofilms in CRS/NP. METHODS: We performed a prospective study in 12 patients undergoing endoscopic sinus surgery for nasal polyposis. Ten patients without CRS/NP who underwent septoplasty were included as a control group. Tissue samples were obtained from the inferior turbinate mucosae. The bacteria were isolated and typified and the material was examined in vitro using a spectrophotometer, and in vivo using optical microscopy and confocal scanning laser microscopy. RESULTS: Moderate to high in vitro biofilm-forming capacity was detected in 9 out of 12 patients with CRS/NP (mean [SD] optical density values of between 0.284 [0.017] and 3.337 [0.029]). The microorganisms isolated were Staphylococcus (5 patients), Streptococcus viridans, Pseudomonas aeruginosa, Enterococcus faecalis and Streptococcus viridans/Corynebacterium. Biofilms were demonstrated in vivo in 2 patients and no biofilm structures were evident in any of the controls. CONCLUSION: This study demonstrates the presence of bacterial biofilms in patients with CRS/NP. This chronic inflammatory factor might contribute to nasal mucosa damage, increased inflammatory cells in tissue, and the subsequent hyperplasic process.

Cognitive function assessment in elderly patients with overactive bladder treated with transdermal oxybutynin. / Evaluación de la función cognitiva en pacientes de edad avanzada con vejiga hiperactiva tratados con oxibutinina transdémica.

INTRODUCTION AND OBJECTIVES: Older patients with overactive bladder under antimuscarinic treatment are especially susceptible to cognitive impairment. The aim was to assess short term changes in cognitive function in elderly patients with overactive bladder treated with transdermal oxybutynin. MATERIALS AND METHODS: Observational, retrospective, multicentre study in patients with overactive bladder aged 65-80 years undergoing treatment with transdermal oxybutynin. Before and after one month of treatment, cognitive function using the Memory Alteration Test and Clock-Drawing Test, changes in symptoms with validated questionnaires, patient perception of treatment response using Treatment Benefit Scale and treatment adherence with the modified Morisky-Green test, were assessed. RESULTS: From 85 eligible patients, 70 completed the assessment (mean age: 71.4±4.5; BMI: 28.7±3.1kg/m2). No cognitive impairment was observed after one month with transdermal oxybutynin: Memory Alteration Test (+1 point; 95%CI: 0.0-1.5), Clock-Drawing Test (0 points; 95%CI: 0.0-0.0). A statistically significant improvement (P<.001) was observed in all urinary storage symptoms, except stress urinary incontinence. There was an improvement in the Bladder Control Self-Assessment Questionnaire (symptom score: -2.27; 95%CI: -2.8, -1.7; P<.001; bother score: -2.73; 95%CI: -3.3, -2.1; P<.001). 70% of patients reported either a stable or improved bladder condition according to the Patient Perception of Bladder Condition questionnaire. 72.8% of patients reported that their urinary problems had improved or greatly improved with an 84.3% treatment adherence. CONCLUSIONS: No cognitive impairment was observed in elderly patients after one month of treatment with transdermal oxybutynin; urinary urgency symptoms improved and there was adequate treatment adherence.

[Importance of nocturia and its impact on quality of sleep and quality of life in patient with benign prostatic hyperplasia]. / Importancia de la nocturia y su impacto en la calidad del sueño y en la calidad de vida en el paciente con hiperplasia benigna de próstata.

INTRODUCTION: Nocturia is the main cause of insomnia or sleep interruption in adult men, which has a negative impact on daily activities, quality of life (QoL) and quality of sleep (QoS). The assessment of nocturia and its impact on QoL and QoS in patients suffering from benign prostatic hyperplasia (BPH) has been poor in terms of clinical research, moreover there is a lack of specific methods to assess this impact. OBJECTIVES: The objectives of BPH treatment should include the improvement of patient's QoL by controlling both diurnal and nocturnal symptoms. In order to assess how nocturia affects QoL and also QoS, some specific tools, such as N-QoL questionnaire or the number of Hours of Undisturbed Sleep (HUS), have been recently developed. Therefore, it would be interesting to assess how nocturia reduction due to LUTS/BPH treatment can impact on some objective parameters such as HUS and also how nocturia reduction improves QoS and QoL. This assessment should be developed during the application of pharmacological treatments in clinical practice by means of these specific tools. With the aim of tackling nocturia as an urologic problem in patients with LUTS/BPH, as well as knowing the physiology of sleep and the effect of nocturia on the sleep and QoL, a meeting of expert urologists, that gathered about fifty specialists of all around Spain, was held in Madrid. This article presents the main ideas and concepts exposed in this meeting. CONCLUSIONS: Nocturia is a symptom with a high prevalence in older patients with STUI/BPH. The PreNoc study has showed a Nocturia prevalence in Spain of 83% in patients > or =60 years old diagnosed of BPH. Nocturia is the most bothersome symptom in patients with STUI/BPH.

Quality-of-life assessment in patients with benign prostatic hyperplasia: effects of various interventions.

A literature search was conducted to review quality-of-life (QOL) measurement in patients with benign prostatic hypertrophy (BPH). The different QOL instruments are discussed in relation to their correlation with symptom evaluation in studies of treatment options for BPH. Symptom evaluation of BPH has been standardised internationally with the International Prostatic Symptom Score (IPSS), but there is neither agreement nor data to decide which QOL instrument is preferable. The most widely used QOL instrument is the disease-specific QOL single question added to the IPSS. Other QOL instruments have been used, but none has gained unanimous approval. The results of QOL assessments obtained from comparative clinical studies of treatment options for BPH are discussed. These studies compare treatment options such as watchful waiting, drug treatment and surgery. Disease-specific QOL domains (interference with daily activities) tend to improve more with treatment interventions than general health measures (i.e. general well-being). The use of QOL instruments to evaluate patients with BPH, and their many treatment options, is still open to debate with regard to which instruments are preferred and their importance to the clinical evaluation of the patient. The challenge remains to find an acceptable disease-specific QOL instrument that adds information to currently used disease measures of BPH.

Relationship between systemic joint laxity, TMJ hypertranslation, and intra-articular disorders.

The aim of this study was to evaluate the correlation between general joint hypermobility, temporomandibular joint (TMJ) hypertranslation and signs and symptoms of TMJ intra-articular disorders. One hundred twenty individuals constituted the sample, divided into two groups: Group I (symptomatic) included 60 patients with complaints of joint noises, pain, or jaw locking, and Group II (nonsymptomatic) included 60 people with no TMD complaints. The Beighton's hypermobility score addressed the systemic laxity while lateral x-rays taken in both closed and full open mouth positions measured TMJ mobility (condyle hypertranslation). No association was found between intra-articular disorders and systemic hypermobility (p > 0.05). A significant negative correlation (p < 0.05) was found between age and systemic hypermobility, while no correlation was detected between systemic and TMJ hypermobility (condyle hypertranslation).

[Percutaneous urethral suspension with bone anchorage (Vesica) in the treatment of stress urinary incontinence. Results after a year of follow-up]. / Suspensión uretral percutánea con anclaje óseo (vesica) en el tratamiento de la incontinencia urinaria de esfuerzo. Resultados tras un año de seguimiento.

OBJECTIVES: Evaluation of efficacy of percutaneous bladder neck suspension with bone anchors in women with stress incontinence with no previous treatment. PATIENTS AND METHODS: Fourteen women (mean age 48, range 37-74) were operated. All had a stable bladder and objective leakage, either by pad test of by physical examination. Ten were evaluated by a incontinence questionnaire. Mean incontinence time before the procedure was 3.9 years. All needed pads (mean 3.3 pads/day). The surgical technique is described. RESULTS: Mean surgical time was 80 minutes. In three patients there was bladder perforation during the procedure, that was solved by delaying the catheter withdraw. Mean postoperative stay was 4.2 days, with good tolerance, and one patient was discharged with a cystostomy. After a minimum follow-up of one year (mean 17.5 months), eleven patients have improved their continence (6 dry, 5 socially acceptable incontinence < pads/day) and 3 have recurrence. Postoperative pad test was < or = 10 g in patients without improvement and over 20 g in patients who failed. Mean postoperative total score in the questionnaire decreased from 10.1 to 2.5 in patients who improved and didn't change in patients who failed. CONCLUSION: Percutaneous bladder neck suspension is a useful alternative to open interventions, due to its low morbidity and lower postoperative stay.

[Drug-induced fever caused by prophylactic isoniazid in bladder instillations with BCG]. / Fiebre farmacológica por isoniacida profiláctica en instilaciones vesicales con BCG.

We present of one patient with isolated pharmacological fever probably caused by Isoniazid given prophylactically 24 hours prior to each vesical instillation with BCG as maintenance therapy for in situ vesical carcinoma. The fever appeared in two occasions before the instillation and did not returned once the drug was discontinued. We Review this adverse effect which may lead to diagnostic error.

[Quantification of urine leaks: standardized one-hour pad test]. / Cuantificación del escape de orina: prueba del pañal estandarizada de una hora ("pad test").

OBJECTIVE: To assess the feasibility and diagnostic performance of the one hour pad test proposed by ICS. PATIENTS AND METHODS: The pad test was performed in 20 women referred for incontinence. Five were included in a surgical protocol and 15 had inconsistent medical history. Their mean age was 52.5 years, the mean time of incontinence was 3.4 years and they used a mean of 3.5 pads/day. Six showed leakage on physical examination (PE) and 2 during previous cystometry. RESULTS: The test is well tolerated and lasts one hour and 15 minutes. The test was positive in 17 (mean leakage = 168 g). Leakage was not related to duration of incontinence, number of pads or cystometric capacity. A weak negative correlation (r = -0.52) was found between leakage and voided volume on uroflowmetry performed after the test. All patients who leaked on PE had a positive test and a significantly higher leakage compared to patients who didn't leak on PE. CONCLUSION: The pad test is a feasible outpatient procedure in the context of a Urodynamics Unit, providing objective information on leakage in most patients.

[Complete urodynamic office evaluation; a method for the delivery of health care]. / Visita completa de urodinamia; una modalidad asistencial.

INTRODUCTION: The goal of the study was to evaluate the usefulness of the complete urodynamic office evaluation. This assistance modality consists on the realisation in the same moment of the clinical chart, physical examination, urodynamic study, report, therapeutic indications, program of other complementary studies, hospitalisation or discharge from the outpatient office. PATIENTS AND METHODS: During 1 year complete urodynamic office evaluation was performed to 100 patients (87 female, 13 male) All patients were directed to our department to perform a urodynamic test, most of them due to incontinence. Different kinds of urodynamic tests were performed in 91 patients, with a medium of 2 studies per test. Abnormalities were detected in 59 cases. RESULTS: After the complete urodynamic office evaluation, 16 patients were programmed for surgery, 26 were discharged from outpatient office, 37 were directed to follow up in the outpatient setting, 2 were hospitalised, and 19 were lost of follow up. CONCLUSIONS: The complete urodynamic office evaluation allowed us to get the diagnostic and therapeutic approach in 98% of patients, employing a standard of 90 minutes. Twenty six percent of patients could be discharged from our center. Sixteen patients were operated on following this unique visit, that means an important reduction in the usual assistance delay.

[Bacteremia caused by Clostridium perfringens as a complication of ureterosigmoidostomy]. / Bacteriemia por clostridium perfringens como complicación de una ureterosigmoidostomía.

A 63 year old male underwent cystectomy and ureterosigmoidostomy after diffuse carcinoma "in situ" of the bladder was discovered, and thereafter, various episodes of pyelonephritis and metabolic imbalance, in one of them, a left pneumo-ureter and a positive blood culture for Clostridium Perfringens and enterococci was detected. Empiric therapy with Aztreonam was started, and changed after to high-dose intravenous amoxicillin. Two months later the ureterosigmoidostomy was converted to an ileal conduit. The patient has remained asymptomatic on subsequent controls.

[The use of the IPSS questionnaire in surgical patients. International Prostatic Symptom Score]. / Uso del cuestionario IPSS en pacientes operados.

Some feasibility problems were detected during the evaluation of the IPSS questionnaire in Spanish that might limit its application. Our initial experience with the IPSS in patients undergoing surgery had 3 aims: 1) assess if changes in format and wording will improve feasibility; 2) evaluate symptoms before and after surgery according to the patients' point of view and 3) determine possible predictive factors of bad outcome in patients undergoing surgery for BPH. 50 patients were included and 35 completed symptom and urolow evaluation before and after the intervention. First objective: a modified format improved feasibility up to 92% (from 49% with the original format). Second objective: 7 patients had a poor symptomatic outcome (either worsened or had an unsignificant improvement), but only one of them had a low postoperative Qmax. Third objective: patients with preoperative urinary retention had a worse urodynamic outcome, but most improved in their symptoms. Worse symptomatic results occurred in: a) patients with a IPSS score smaller than 13 and b) patients undergoing transurethral incision of the prostate. The results are presented both in global (comparison of mean values) and in an individualized manner to call upon the pitfalls in their interpretation.

[The IPPS questionnaire in patients and controls. Psychometric validation]. / Cuestionario IPSS en pacientes y controles. Validación psicométrica.

The translation into Spanish of the AUA/International Prostatic Symptom (AUA/IPS) Score hadn't been validated in spanish. METHODS. AUA/IPS questionnaire was self administered by 103 consecutive patients and by 24 healthy volunteers. An alternative formulation to question 4 (ALT-4) was added. RESULTS. 51 patients (49%) and 17 controls (79%) completed al questions (Feasibility). Reliability was measured by: a) Crohnbach's alpha (0.68 and 0.70 with ALT-4) b) Kendall's coefficient of concordance (0.097, significance < 0.001) and c) retesting 17 patients within 2 months. The relation of the AUA/IPS scores with quality of life (Construct validity) showed a Spearman's correlation coefficient of 0.57 (confidence = 0.0001), and 0.52/0.0004 with ALT-4. The relation with uroflowmetry (Concurrent empirical validity) was poor as shown in ROC curves. CONCLUSIONS. The Spanish version of the AUA/IPS questionnaire given in an easy format improves feasibility without alteration of reliability or validity. The relation of the AUA/IPS score with uroflowmetry is poor, although the questionnaire can be considered valid and reliable.

Assessment of the psychometric properties of the Spanish language version of questionnaire ICIQ-Male Lower Urinary Tract Symptoms (ICIQ-MLUTS).

OBJECTIVES: To evaluate the psychometric properties of the Spanish version of the ICIQ-Male Lower Urinary Tract Symptoms Questionnaire (ICIQ-MLUTS): Feasibility (% of completion and ceiling/ground effects), reliability (Test-retest), convergent validity (vs Bladder Control Self-Assessment Questionnaire [BSAQ] and vs International Prostate Symptom Score [I-PSS]) and criterion validity (according to presence or absence of symptoms). MATERIAL AND METHODS: This was an observational, non-interventionist and multicenter study. 223 male patients with lower urinary tract symptoms (LUTS), predominantly storage symptoms and aged 18-65, took part in the study. Patients completed the ICIQ-MLUTS (test), I-PSS and BSAQ questionnaires and referred their urinary symptoms in a single visit, with the exception of a subgroup composed by 49 patients that completed the questionnaire again 15 days after initial visit to evaluate test-retest reliability. The questionnaire includes 13 items divided in 2 sub-scales: Voiding symptoms (V) from 0-20 and Incontinence symptoms (I) from 0-24. RESULTS: Percentage of patients that completed all items: 98.84%. Ground effect is 0 and ceiling effect was under 6% in both sub-scales. Test-retest reliability: Intraclass correlation coefficient (ICC) ranged from 0.68 to 0.88, except on Delay. Kappa shows a good agreement, between 0.60 and 0.81, except for Nocturia. Convergent validity: Correlation (Spearman) between the questionnaire sub-scales scores and the rest of measures is statistically significant (P < .01 and P < .05). Criterion validity: Statistically significant differences (P < .05) between scores on ICIQ-MLUTS, from patients that refer experiencing symptoms and those who do not. CONCLUSION: The Spanish version of the ICIQ-MLUTS questionnaire shows adequate feasibility, reliability and validity.

Evaluation of the Boll Weevil Anthonomus grandis Boheman (Coleoptera: Curculionidae) suppression program in the state of Goiás, Brazil.

The boll weevil Anthonomus grandis Boheman (Coleoptera: Curculionidae) is the most important cotton pest in Brazil. A large-scale field-testing of a Boll Weevil Suppression Program (BWSP) was implemented to assess its technical and operational feasibility for boll weevil suppression in the state of Goiás, Brazil. The pilot plan focused on 3,608 ha of cotton during the 2006/2007 and 6,011 ha in the 2007/2008 growing seasons; the areas were divided into four inner zones with an outer buffer zone. We analyzed data on boll weevil captures using pheromone traps installed in the BWSP fields, on the detection of the first insect and the first damaged floral bud, greatest damage, and number of insecticide applications. The nonparametric Mann-Whitney U test was used to evaluate the differences between presuppression and suppression years. Fourteen pheromone-baited trapping evaluations were used to compare the weevil populations from 2006/2007 and 2007/2008 growing seasons. The BWSP regime reduced in-season boll weevil captures from 15- to 500-fold compared to presuppression levels in the preceding year. The low capture rates were related to delays in infestation and damage by weevils. The smaller population size measured by trapping and field monitoring reduced the number of required insecticide treatments. The BWSP strategy was efficient in suppressing populations of this pest and is a viable program for cotton production in subtropical and tropical regions, with long-term economic and environmental benefits.