Design and Integration of a Texting Tool to Keep Patients' Family Members Updated During Hospitalization: Clinicians' Perspectives.

An important gap in the literature is how clinicians feel about patient-centered technologies and how clinicians experience patient-centered technologies in their workflows. Our goal was to identify clinician users' perspectives on facilitators (pros) and barriers (cons) to using 1 digital texting innovation to promote family centered care during patients' hospitalizations. This qualitative study was conducted at a tertiary care center in Houston, consisting of 7 hospitals (1 academic hospital and 6 community hospitals), involving analyzation of 3 focus groups of 18 physicians, 5 advanced practice providers, and 10 nurse directors and managers, as well as a content analysis of 156 real-time alerts signaling family dissatisfaction on the nursing unit/floor. Thematic analysis methods were used. We selected these participants by attending their regularly scheduled service-line meetings. Clinician feedback from focus groups resulted in 3 themes as facilitators: (a) texting platforms must be integrated within the electronic medical record; (b) texting reduces outgoing phone calls; (c) texting reduces incoming family phone calls. Clinician feedback resulted in 3 themes as barriers: (a) best practice alerts can be disruptive; (b) real-time alerts can create hopelessness; and (c) scale-up is challenging. The analyzation of facilitators (pros) and barriers (cons) pertains only to the clinician's feedback. We also analyzed real-time alerts signaling family dissatisfaction (defined as "service recovery escalation" throughout this manuscript). The most common selection for the source of family dissatisfaction, as reflected through the real-time alerts was, "I haven't heard from physicians enough," appearing in 52 out of 156 alerts (33%). The second most common selection for the source of dissatisfaction was "perceived inconsistent or incomplete information provided by team members," which was selected in 48 cases (31%). Our findings indicate that clinicians value inpatient texting, not only for its ability to quickly relay updates to multiple family members with 1 click, but also because, when used intentionally and meaningfully, texting decreases family phone calls.

Wound characteristics and infiltration with immune globulin for rabies postexposure prophylaxis in the emergency department.

OBJECTIVE: This study described characteristics of wounds caused by animal exposures and evaluated patient factors and wound factors associated with wound infiltration of human rabies immune globulin (HRIG). MATERIALS AND METHODS: This retrospective cohort study evaluated wound characteristics among patients who had visible wounds and received HRIG or rabies vaccine for rabies postexposure prophylaxis (PEP) at 15 emergency departments from May 2016 to June 2018. RESULTS: Of 110 included patients (9 children, 82 adults, and 19 older adults), 21% (n = 23) had ≥2 wounds, and 10% (n = 11) had infected wounds. Twenty-eight (25%) patients had severe wounds, defined as receiving sutures (n = 20) or reaching subcutaneous tissue or bone (n = 20). Wounds were present on upper extremities for 42% (n = 46) of patients, lower extremities for 35% (n = 38), head/face for 3% (n = 3), and in multiple locations for 21% (n = 23). Wounds were < 3 cm in length for 64% (n = 70) of patients. Puncture wounds were present in 60% (n = 66) of patients, abrasions in 45% (n = 49), and lacerations in 38% (n = 42). Among 108 wounds from 82 patients with documented HRIG administration sites, 57% (n = 62) of wounds received HRIG infiltration. Infiltration occurred less frequently for wounds on the face/head/torso (adjusted odds ratio [aOR] = 0.07, 95% confidence interval [CI] = 0.01 to 0.49), wounds on hands/fingers (aOR = 0.20, 95% CI = 0.06 to 0.65), and abrasion-only wounds (aOR = 0.26, 95% CI = 0.08 to 0.80) after adjusting for age. CONCLUSIONS: Upon presentation for rabies PEP, most patients did not have severe wounds and did not require emergency services or complex wound management. Wounds on the face, head, torso, hands, or fingers and abrasions were less likely to receive HRIG infiltration.

Implementation of Clinical Decision Support on Emergency Department Delivery of Human Rabies Immune Globulin.

Importance: Fatal human rabies infections can be prevented through appropriate rabies postexposure prophylaxis (PEP). Errors in patient selection and administration of human rabies immune globulin in the emergency department (ED) setting were identified in a previous study of rabies PEP administration. Objective: To test the a priori hypothesis that implementation of a rabies PEP bundle in the ED would improve full adherence to 6 human rabies immune globulin quality indicators compared with preimplementation controls. Design, Setting, and Participants: This quality improvement study was conducted in 15 EDs in a US multihospital health system. Patients who received human rabies immune globulin or rabies vaccine in the ED from January 2015 to June 2018 were included in the preimplementation control group and from December 2019 to November 2020 were included in the postimplementation intervention group. Data were analyzed in January 2021. Exposure: The PEP bundle was implemented in December 2019 and consisted of electronic health record enhancements, including clinical decision support, ED staff education, and patient education. Main Outcomes and Measures: Full adherence to 6 human rabies immune globulin quality indicators: patient selection, dose, timing, infiltration into wounds, administration distant from rabies vaccine site, and administration that avoids the buttock. Results: The study included 324 patients; 254 patients were in preimplementation group (mean [SD] age, 39 [21] years; 135 [53%] women) and 70 in the postimplementation group (mean [SD] age, 38 [19] years; 33 [47%] women). Most patients presented to EDs embedded in a community hospital (231 patients [71%]). Full adherence increased from 37% in the preimplementation group to 61% postimplementation (absolute increase, 24%; 95% CI, 11% to 37%; P < .001). Adherence improved for quality indicators for infiltration into wounds (137 of 254 patients [54%] to 50 of 70 patients [71%]; P = .009), administration distant from rabies vaccine site (180 of 254 [71%] to 58 of 70 [83%]; P = .04), and administration that avoids the buttock (168 of 254 [66%] to 58 of 70 [83%]; P = .007). No instances of sciatic nerve injury or compartment syndrome were observed. Conclusions and Relevance: In this quality improvement study, implementation of a rabies PEP bundle was associated with improved patient selection and delivery of human rabies immune globulin in EDs across a multihospital health system. Although the bundle included ED staff education and patient discharge education, the observed improvement was likely driven by clinical decision support from the rabies PEP ED order set. Future research should evaluate implementation of this clinical decision support at other health systems.

Avoidable emergency department visits for rabies vaccination.

BACKGROUND: Administering subsequent doses of rabies vaccine is not a medical emergency and does not require access to emergency department (ED) services. This study reviewed ED visits for rabies postexposure prophylaxis (PEP) to identify avoidable ED visits for subsequent rabies vaccination. METHODS: This retrospective study included patients who received human rabies immune globulin (HRIG) or rabies vaccine at 15 EDs of a multi-hospital health system from 2016 to 2018. All ED visits were classified as initial or non-initial healthcare visits after animal exposure. Emergency department visits for non-initial healthcare were classified as necessary (HRIG administration, worsening symptoms, other emergent conditions, or vaccination during a natural disaster) or avoidable (rabies vaccination only). RESULTS: This study included 145 patients with 203 ED visits (113 initial and 90 non-initial healthcare visits). Avoidable ED visits were identified for 19% (28 of 145) of patients and 66% (59 of 90) of ED visits for non-initial healthcare. Contributing factors for avoidable ED visits were suboptimal ED discharge instructions to return to the ED for vaccination (n = 20 visits) and patients' inability to coordinate outpatient follow-up (n = 17 visits). Patients with previous avoidable ED visits had a 73% probability for unnecessarily returning to the ED for vaccination. The average number of avoidable ED visits observed per patient was 0.41 (95% CI = 0.25 to 0.56). Since the Centers for Disease Control and Prevention reports that 30,000 to 60,000 Americans initiates rabies PEP each year, we estimate that 7500 to 33,600 avoidable ED visits occur for rabies vaccination in the US each year. CONCLUSIONS: One of 5 patients who received rabies PEP in the ED had avoidable ED visits for subsequent rabies vaccination. This study highlights systemic lack of coordination following ED discharge and barriers to accessing rabies vaccine.

Factors associated with quality of care in inflammatory bowel diseases: a view from patient's side using the IQCARO quality of care decalogue.

BACKGROUND: Quality of care (QoC) is a highly important topic in inflammatory bowel disease (IBD). We recently elaborated a decalogue of QoC indicators (IQCARO-QoC) developed by IBD patients. The aim of the present study was to assess the factors associated with patients' evaluation of QoC in Spain using the IQCARO-QoC Decalogue recently developed by IBD patients. METHODS: A survey including patients' socio-demographic and clinical characteristics, and the IQCARO-QoC Decalogue, was completed by IBD patients. We described patients' assessment of QoC across Spanish patients. A univariable and multivariable analysis was performed to explore the associations between patients' characteristics and QoC. RESULTS: Questionnaires from 788 participant patients were analysed. Participants' mean age was 43.4 years, 63% were females and 58% had Crohn's disease. The mean QoC score was 8.1 (± 2.4 SD) points out of a maximum of 10. Items with the lowest score were related to the provision of information and the implication of the medical team throughout the entire patient care. Factors associated with better QoC scores included: being employed better disease control, fewer numbers of unscheduled visits, and being followed by a gastroenterologist specialized in IBD. CONCLUSIONS: Spanish patients' reported QoC seems to be globally good although there is room for improvement, especially in providing adequate information to patients. Care provided by specialized IBD gastroenterologists seems to be related with higher QoC scores.

Biological parameters of the triatomine, Meccus phyllosomus pallidipennis, fed on two bloodmeal sources under laboratory conditions.

Chagas disease is one of the most important vector-borne diseases in Latin America, including Mexico. Meccus phyllosomus pallidipennis (Stål), 1872 (Hemiptera: Reduviidae) is a Mexican triatomine vector that is commonly associated with hens and rabbits. The biological parameters of two cohorts fed on hens (H) and on rabbits (R) were evaluated. The median lifecycles of the two cohorts were 198 days (H) and 180 days (R). Moreover, mortality was around 30% in both cohorts. Time lapse for beginning of feeding was 0.5-1.9 (H) and 1.1-2.4 min (R). Feeding times of each instar in both cohorts were over 10 min. Most specimens fed on hens defecated immediately after feeding, whereas those that fed on rabbits defecated within 1-5 min post-feeding. Similar numbers of males and females (50%) were obtained in both cohorts. An average of 2.1-2.3 eggs per female per day was noted in both cohorts, with eclosion rates of 95.4 (H) and 88.8% (R). Thus, it can be concluded that M. phyllosomus pallidipennis may take advantage of feeding in hens, as in rabbits, which could imply a higher risk of Trypanosoma cruzi transmission to humans and animals in its distribution area.

Prospective multicentre study on barbed reposition pharyngoplasty standing alone or as a part of multilevel surgery for sleep apnoea.

OBJECTIVES: The aim of this study was to demonstrate in a prospective multicentre study that Barbed Reposition Pharyngoplasty (BRP) procedure is safe and effective in management of obstructive sleep apnoea/hypopnea syndrome (OSAHS) patients. DESIGN: Prospective study. SETTING: Multicentre study. PARTICIPANTS: Patients suffering from obstructive sleep apnoea. MAIN OUTCOMES MEASURES: Values of postoperative apnoea-hypopnea index (AHI), oxygen desaturation index (ODI), epworth sleepiness scale (ESS). RESULTS: 111 Barbed Reposition Pharyngoplasty procedures standing alone or as a part of multilevel surgery for OSAHS, performed between January and September 2016, were analysed in 15 different centres. The average hospitalisation period was 2.5 ± 0.5 days. The mean patient age was 46.3 ± 10.5 years. The average body mass index at the time of the procedure was 27.9 ± 3.2, and the majority of the patients were men (83%). The mean preoperative and postoperative apnoea/hypopnea index was 33.4 ± 19.5 and 13.5 ± 10.3, respectively (P < .001). The mean preoperative and postoperative ESS score was 10.2 ± 4.5 and 6.1 ± 3.6, respectively (P < .001). The mean preoperative and postoperative ODI were 29.6 ± 20.7 and 12.7 ± 10.8, respectively (P < .001). CONCLUSIONS: Patients undergoing BRP standing alone or as part of a multilevel approach for the treatment of OSAHS have a reasonable expectation for success with minimal morbidity.

Biological parameters of interbreeding subspecies of Meccus phyllosomus (Hemiptera: Reduviidae: Triatominae) in western Mexico.

Understanding the biological parameters of some triatomine subspecies of Meccus phyllosomus (Burmeister) is a crucial first step in estimating the epidemiological importance of this group. Biological parameters related to egg eclosion, egg-to-adult development time, number of blood meals to moult, percentage of females at the end of the cycle, number of laid eggs, and the accumulative mortality for each instar of three M. phyllosomus subspecies [Meccus phyllosomus pallidipennis (Stål), Meccus phyllosomus longipennis (Usinger), and Meccus phyllosomus picturatus (Usinger)] as well as their laboratory hybrids were evaluated and compared. No significant differences (P > 0.05) were recorded among the experimental hybrids (M. p. longipennis × M. p. pallidipennis, M. p. longipennis × M. p. picturatus, M. p. pallidipennis × M. p. picturatus) and reciprocal cohorts. In five of the six studied parameters (egg eclosion, egg-to-adult development time, number of blood meals to moult, number of laid eggs and accumulative mortality), with the exception of the non-significant percentage of females obtained among all the studied cohorts, at least one of the parental cohorts in each set of crosses exhibited better fitness results than by those of their hybrid descendants. The lack of hybrid fitness in our study indicates the maintenance of reproductive isolation of parental genotypes. Moreover, the results lead us to propose that an incipient speciation process by distance is currently developing among the three studied subspecies, increasing the differences between them that modify the transmission efficiency of Trypanosoma cruzi to human beings in Mexico.

Biological characteristics of geographically isolated populations of Meccus mazzottii (Hemiptera: Reduviidae) in southern Mexico.

Chagas disease, caused by Trypanosoma cruzi Chagas, is one of the most epidemiologically important vector-borne zoonoses in Mexico. Among the 32 reported triatomine species from Mexico, Meccus mazzottii (Usinger) (Hemiptera: Reduviidae) is one of the most important vectors of T. cruzi in the southern part of the country. Variability among populations of triatomines has been recorded for several species (Meccus longipennis (Usinger) and Meccus pallidipennis (Stal)) that are closely related to M. mazzottii, showing an apparent influence of local environmental conditions on the biology of each population, which could modify the impact of vector control measurements. Therefore, this study sought to compare the biological features of populations of M. mazzottii from two geographically far apart areas that have similar environmental characteristics and to compare populations from close geographical areas that have different environmental characteristics. The mean longevity, percentages of mortality of nymphs, the total mean number of bloodmeals to molt (considered instar by instar), the mean number of eggs laid by females, and the percentage of hatched eggs were similar between the two localities that are geographically far apart but have similar environmental characteristics. On the other hand, important differences were noticed when a comparison was carried out on the two localities with similar environmental conditions with respect to that locality with different conditions, independent of geographic distance. Most of the studied parameters led us to conclude that the three studied populations are very highly influenced by local environmental conditions. The results of this study indicate the importance of studying the biological characteristics of local populations of triatomines to carry out specific control measurements, instead of using standard ones that could fail if they are not adapted to the target population.

Newly diagnosed adult AML and MPAL patients frequently show clonal residual hematopoiesis.

Adult acute myeloid leukemia (AML) is a highly heterogeneous stem cell malignancy characterized by the clonal expansion of immature myeloid precursors. AML may emerge de novo, following other hematopoietic malignancies or after cytotoxic therapy for other disorders. Here, we investigated the clonal vs reactive nature of residual maturing bone marrow cells in 59 newly diagnosed adult AML and mixed phenotype acute leukemia (MPAL) patients as assessed by interphase fluorescence in situ hybridization analysis of AML and myelodysplastic syndrome-associated cytogenetic alterations and/or the pattern of chromosome X inactivation, in females. In addition, we investigated the potential association between the degree of molecular/genetic involvement of hematopoiesis and coexistence of altered immunophenotypes by flow cytometry. Our results indicate that residual maturing neutrophils, monocytes and nucleated red cell precursors from the great majority of newly diagnosed AML and MPAL cases show a clonal pattern of involvement of residual maturing hematopoietic cells, in association with a greater number of altered immunophenotypes. These findings are consistent with the replacement of normal/reactive hematopoiesis by clonal myelopoiesis and/or erythropoiesis in most newly diagnosed AML and MPAL cases, supporting the notion that in most adults presenting with de novo AML, accumulation of blast cells could occur over a pre-existing clonal hematopoiesis.

Efficacy and uptake of soil-applied imidacloprid in the control of Asian citrus psyllid and a citrus leafminer, two foliar-feeding citrus pests.

The systemic neonicotinoid insecticide imidacloprid, Admire Pro, was applied to 3- and 4-yr-old nonbearing 'Rio Red' grapefruit, Citrus x paradisi Macfad., trees in 2006 and 2007, respectively, to determine its effects in the control of two major citrus pests, the Asian citrus psyllid, Diaphorina citri Kuwayama (Hemiptera: Psyllidae), and a citrus leafminer Phyllocnistis citrella Stainton (Lepidoptera: Gracillariidae). Young flush shoots were randomly collected weekly for 13 and 11 wk in 2006 and 2007, respectively, to determine the infestation levels and densities of immature stages of both Asian citrus psyllid and P. citrella. Additional flush shoot samples were collected in 2007 and titers of imidacloprid in leaf tissue were determined using an enzyme-linked immunosorbent assay. Soil application of imidacloprid significantly reduced the infestation levels and densities of both pests on flush shoots, starting from the second week post application. The effects of the neonicotinoid insecticide were similar in both years. Analysis of imidacloprid concentration in leaf tissue showed a gradual increase during the first 3 wk, and titers remained well above 200 ppb for 11 wk postapplication. Significant positive correlations were obtained between imidacloprid titers in leaf tissue and the percentage of control levels achieved for both pests. A high level of suppression of both P. citrella and Asian citrus psyllid populations on citrus trees was associated with imidacloprid titer in leaf tissue >200 ppb, which was reached 2 wk after soil treatment. Although soil application of imidacloprid did not provide rapid knockdown of Asian citrus psyllid and P. citrella populations, it resulted in chronic residues in leaf tissue and long-term suppression of both pests.

Frequency of adverse events and mortality in patients with pleural empyema in a public referral hospital in Mexico City.

SETTING: Adverse events (AEs) that occur during medical treatment are a public health problem. OBJECTIVE: 1) To measure the prevalence of AEs, 2) to characterize those that occur in patients diagnosed with empyema and 3) to analyze the mortality rate associated with the presence of empyema. DESIGN: Retrospective case series based on a review of files of patient diagnosed with empyema. RESULTS: A total of 347 files were assessed, reporting 96.6% of the total number of patients diagnosed with empyema in that period. There were 176 AEs reported for 150 of the patients. The frequency of at least one AE was 43%, with prolonged hospitalization being the most frequent condition. In these cases, 97% of the AEs were considered preventable. Intrahospital mortality was 4.8%, with age (HR for every 5 years 1.21, 95%CI 1.08-1.35, P < 0.001) and the presence of diabetes mellitus (HR 2.26, 95%CI 1.0-5.0, P = 0.04) being significant associated factors. CONCLUSION: There was a high frequency of AEs in patients with empyema, but most were considered preventable, especially the length of hospitalization, which could be reduced through timely surgery.

[Seropositivity to Helicobacter pylori among university students and their families. A comparative cross-sectional study]. / Seropositividad a Helicobacter pylori entre estudiantes universitarios y sus familias. Estudio comparativo.

OBJECTIVE: To associate serologic response to Helicobacter pylori (Hp) among seropositive university students and their families in western Mexico. METHODS: We conducted a comparative transversal study, and randomized 30 nuclear families of 14 Hp-seropositive university students and 14 Hp-seronegative university students. We carried out seropositivity measurements (IgG) to Hp using the ELISA method. An analysis was performed utilizing the chi-squared and Mann-Whitney U tests, with the aid of EPI INFO 2000 and SIGMA STAT 3.2 software. RESULTS: Global seropositivity in the families of infected students was 57 vs. 13% of the relatives of non-infected students (p = 0.000002). In families of Hp-positive students we found the following frequencies: parental (father and mother) 70%; mother 71%, and siblings 42%, while for seronegative individuals incidences were: parental 17% (p = 0.00005), mother 12% (p = 0.001), and siblings 10% (p = 0.0076). CONCLUSIONS: There is a greater prevalence of antibodies against Hp in the relatives of seropositive students.

Seropositividad a Helicobacter pylori entre estudiantes universitarios y sus familias. Estudio comparativo / No disponible

Objetivo: asociar la respuesta serológica a Helicobacter pylori(Hp) entre estudiantes universitarios seropositivos y sus familiasen el occidente de México.Métodos: estudio transversal comparativo aleatorizado de30 núcleos familiares de 14 estudiantes universitarios seropositivospara Hp, y 16 negativos. Se realizó determinación de seropositividad(IgG) a Hp por método de ELISA. El análisis se hizo utilizandochi cuadrado y U de Mann Whitney, con la ayuda de losprogramas EPI INFO 2000 y SIGMA STAT 3.1Resultados: la seropositividad global del núcleo familiar delos estudiantes infectados fue del 57 vs. el 13% de los familiaresde los estudiantes no infectados (p = 0,000002). En las familiasde los estudiantes positivos a Hp se encontró una frecuencia de:binomio paterno (padre y madre) 70%, madres 71%, hermanos42%, mientras que en los seronegativos fue: binomio paterno17% (p = 0,00005), madres 12% (p = 0,001), hermanos 10% (p= 0,0076).Conclusiones: existió mayor prevalencia de anticuerpos aHp en los familiares de los alumnos seropositivos

Objective: to associate serologic response to Helicobacterpylori (Hp) among seropositive university students and their familiesin western Mexico.Methods: we conducted a comparative transversal study, andrandomized 30 nuclear families of 14 Hp-seropositive universitystudents and 14 Hp-seronegative university students. We carriedout seropositivity measurements (IgG) to Hp using the ELISA method.An analysis was performed utilizing the chi-squared andMann-Whitney U tests, with the aid of EPI INFO 2000 and SIGMASTAT 3.2 software.Results: global seropositivity in the families of infected studentswas 57 vs. 13% of the relatives of non-infected students(p = 0.000002). In families of Hp-positive students we found thefollowing frequencies: parental (father and mother) 70%; mother71%, and siblings 42%, while for seronegative individuals incidenceswere: parental 17% (p = 0.00005), mother 12% (p = 0.001),and siblings 10% (p = 0.0076).Conclusions: there is a greater prevalence of antibodiesagainst Hp in the relatives of seropositive students

Importance of species of Triatominae (Heteroptera: Reduviidae) in risk of transmission of Trypanosoma cruzi in western Mexico.

The epidemiological risk of infection by Trypanosoma cruzi Chagas in human populations of western Mexico is still under study. Although most vectors in this region and their vector capability are already known, new studies estimating the risk and the importance of individual Triatominae species (Hemiptera: Reduviidae) for T. cruzi transmission are necessary. For 1 yr, every month, > 400 human dwellings and their surroundings in eight communities of two western Mexico states were searched for triatomines. More than 1,000 specimens representing four species were collected and checked for T. cruzi infection. Based on the usual entomological indices, only the inhabitants of Gavilán El Progreso-La Villita are at serious risk of vectorial infection by T. cruzi. A population of Meccus longipennis (Usinger) was found living in peridomestic rock pile boundary walls after an insecticide spraying. It was confirmed the major role of peridomestic habitats as shelter areas for triatomines, particularly in rock pile boundary walls and chicken roosts. Triatominae presence also was verified in certain sylvatic habitats, including primarily heaps of stones. The important role of M. longipennis in the potential transmission of T. cruzi in the region and the secondary role of M. picturatus (Usinger) and Triatoma barberi Usinger also were confirmed. Null colonization of houses by T. barberi, which was collected primarily in peridomestic habitats, differs from its common intradomiciliary collection in other studies. Meccus pallidipennis (Stål) most probably does not exist in Nayarit. Meccus mazzottii (Usinger) and Meccus phyllosomus (Burmeister) are no longer found in Nayarit and Jalisco. Additional studies are necessary to determine the current epidemiological situation in other areas of western Mexico.

Characterization of manures from fish cage farming in Chile.

This study aims to characterize salmonid manures and to determine their potential use in agricultural soils. Sampling was carried out below salmon and trout cages in farms located in lakes and in the sea in the South of Chile during 2002-2003. Manure was analyzed for macronutrients, micronutrients and heavy metals. Results showed a high variability between samples and differences between sea and lake manure. Dry matter contents were low averaging c. 12-15%. Manures showed low OM contents with values

Epidemiological and clinical characteristics of scorpionism in Colima, Mexico (2000-2001).

We analyzed 13,223 clinical records of patients treated for scorpion sting in hospitals of the Mexican Institute of Public Health and the Ministry of Health in the state of Colima, Mexico, during the years 2000-2001. A database containing demographic, epidemiological and clinical information was constructed and analyzed retrospectively. Patients were classified in the categories as mild (49.2%), moderate (33.8%) and severe (17.0%) according to commonly accepted standards. Most common symptoms recorded were local pain (94.7%), local paresthesia (67.2%), pruritus/itching (54.3%), sensation of a lump or hair in the throat (47.3%), and sialorrhoea (27.7%). The median time from sting to admission to the emergency room (patient delay) was 33min (interquartile range: 12-60). We found that older and clinically severe patients were significantly associated with longer times of admission to the emergency room. Age was significantly associated with clinical severity: the age group 0-10 years included a higher proportion of severe cases than the group 11 years and older. In four cases, patients died. An educational campaign to inform the population about the importance of receiving prompt attention following a scorpion sting has potential value in reducing complications in the emergency room.

First Report of Iris yellow spot virus on Onion (Allium cepa) in Texas.

Iris yellow spot virus (IYSV; family Bunyaviridae, genus Tospovirus) has emerged as a potentially devastating and widespread virus of onion. IYSV was first reported in the United States from Idaho in 1993 and has since spread to many of the onion-producing areas (1). In South America, the most recent reports of the virus on onion were from Peru and Chile (2,4). In 2005, onion plants in Uvalde County, Texas exhibited necrotic lesions on leaves typical of IYSV and disease incidence approached 100% in some fields with yield loss and quality problems. Five of six plants tested were positive for IYSV with double antibody sandwich-enzyme linked immunosorbent assay (DAS-ELISA; Agdia Inc., Elkhart, IN). In 2006, similar lesions were observed on onion plants in Uvalde County and approximately 400 km south in Hidalgo and Cameron counties. Infection points generally started as a single plant near the edge of fields and spread to plants in a 3- to 4-m area after 1 to 2 weeks. Early-season disease incidence was low in onions grown for bulbs and transplants, <10% in 2006. Disease incidence increased in some fields until the crop was harvested. Leaves of symptomatic plants were tested for IYSV and Tomato spotted wilt virus (TSWV) using DAS-ELISA, and 18 of 23 samples from the Hidalgo County area and 12 of 21 samples from the Uvalde County area were positive for IYSV. All samples tested for TSWV from these counties were negative. Virus infection in some ELISA-positive plants was verified by reverse transcription-polymerase chain reaction (RT-PCR) using primers derived from the small RNA of IYSV. The primers flanked the IYSV nucleocapsid (N) gene (5'-TAA AAC AAA CAT TCA AAC AA-3' and 5'-CTC TTA AAC ACA TTT AAC AAG CAC-3' (3). RT-PCR gave a PCR product of expected size (approximately 1.2 kb). The DNA amplicon was cloned and sequenced (GenBank Accession No. DQ658242). Nucleotide sequence analysis confirmed the identity of the amplicon as that of IYSV N gene and sequence comparisons with known IYSV N gene sequences showed 95 to 98% sequence identity. The primary vector of IYSV, onion thrips (Thrips tabaci), is a widespread and destructive pest of onion in south Texas. The year-to-year incidence of IYSV and the severity of the disease will probably depend on the onion thrips population levels. Bulb yield reduction could be severe during years with high thrips populations. More research is needed to determine the impact of IYSV on bulb yield in Texas, the relationship between IYSV incidence and T. tabaci population levels, and oversummering hosts. To our knowledge, this is the first known report of IYSV in Texas. References: (1) D. H. Gent et al. Plant Dis. 88:446, 2004, (2) S. W. Mullis et al. Plant Dis. 90:377, 2006, (3) H. Pappu et al. Arch. Virol. 151:1015, 2006. (4) M. Rosales et al. Plant Dis. 89:1245, 2005.

First Report of Rust Caused by Phakopsora pachyrhizi on Soybean and Kudzu in Texas.

The Asian soybean rust fungus, Phakopsora pachyrhizi H. Sydow & Sydow, was found on a 0.4-ha patch of kudzu (Pueraria lobata) near Dayton (Liberty County) in East Texas on November 2, 2005. Nearly 100% of the 300 leaflets examined were diseased with severity ranging from 5 to >100 lesions per leaflet. Eleven soybean fields as much as 20 km away were scouted and no infected plants were found. Asian soybean rust was also found on a 0.4-ha field of soybean (Glycine max cv. Vernal) on February 14, 2006 at the Texas A&M Agricultural Experiment Station in Weslaco (Hidalgo County) in the Lower Rio Grande Valley (LRGV) of Texas. Disease incidence was 100% (severity ranging from 5 to >100 lesions per leaflet) on 50 younger plants with green leaves along the edges of the field, whereas most of the plants in this field had senesced. These plants were not symptomatic and were at the R6 stage (full seed) when this field was previously scouted on December 19, 2005. Lesions on leaflets of kudzu and soybean were small and angular with erumpent uredinia typical of P. pachyrhizi. Urediniospores were ovoid or globose, hyaline, and measured 25 to 30 × 14 to 21 µm. Leaf samples with pustules were positive for P. pachyrhizi using enzyme-linked immunosorbent assay (ELISA) (Envirologix, Portland, ME). Morphological and polymerase chain reaction (PCR) identification of P. pachyrhizi from kudzu and soybean samples were confirmed by the USDA-APHIS-PPQ NIS and CPHST laboratories in Beltsville, MD as previously described (2). The kudzu in East Texas is not likely to support overwintering of the pathogen because it usually dies back during the winter. Leaves at this site were dead by January 17, 2006. This is the southernmost infestation of kudzu in Texas known to us. In contrast, the LRGV has a subtropical climate that would favor year-round survival of the fungus (3). This area, where 120 to 160 ha of soybeans are grown, may be a source of inoculum for soybean rust epidemics in the Midwest. Spore movement would follow the same pattern as seen with cereal rusts (1). However, soybeans are typically absent from the LRGV between late December and early March, so survival of the fungus during this interval would require other hosts. Regardless of whether the fungus overwinters here, or moves in from elsewhere, the LRGV spring crop could serve as an early indicator of a potential rust epidemic. References: (1) M. G. Eversmeyer and C. L. Kramer. Annu. Rev. Phytopathol. 38:491, 2000. (2) J. M. Mullen et al. Plant Dis. 90:112, 2006. (3) S. Pivonia et al. Plant Dis. 89:678, 2005.

Cistatina C como marcador de filtración glomerular y su utilidad en pacientes diabéticos / Cystatin C as a marker of glomerular filtration rate and its utility in diabetic patients

En el presente trabajo estudiamos la cistatina C como marcador de filtración glomerular frente a la creatinina sérica y el aclaramiento de creatinina en una población de pacientes ambulantes diabéticos y no diabéticos para ver su posible utilización como prueba de screening en la detección de una disminución de la función renal. Se determinó en 72 pacientes diabéticos y en 70 pacientes no diabéticos la creatinina sérica [Jaffé cinético en Hitachi 747, Roche], cistatina C [inmunonefelometría, BN II Dada—Behring] y el aclaramiento de creatinina corregido por la superficie corporal; y además la microalbuminuria en orina de 24 horas en los pacientes diabéticos [inmunonefelometría, BN II Dade-Behring]. Los resultados obtenidos muestran en todos los grupos estudiados una mejor correlación para cistatina frente al aclaramiento de creatinina, sobre todo en el grupo de no diabéticos [r = 0.783].También las curvas de rendimiento diagnóstico presentan mejor comportamiento para cistatina C en el grupo de no diabéticos, donde con una especificidad del 80 % encontramos sensibilidades del 93 %. En conclusión, la cistatina C puede ser utilizada como prueba de screening para valorar el grado de filtración glomerular. En los pacientes diabéticos sigue siendo necesario realizar el aclaramiento de creatinina para detectar una disminución en la función renal (AU)

We evaluated the performance of serum cystatin C es a glomerular filtration rate marker and compared it with the performance of serum creatinine and creatinine clearance in a population of diabetic and no diabetic patients. Seventy-two diabetic patients and seventy no diabetic patients were studied. The serum creatinine was measured with a Jaffé kinetic method in an Hitachi 747 [Roche] and the cystatin C by a particle-enhanced nefelometry immunoassay in a BN II (Dade-Behring). The creatinine clearance was corrected for body size, ln diabetic patients we determinated the microalbuminuria in twenty-four urine samples too. The results obtained showed a better correlation coefficient for cystatin C to creatinine cleareance in the no diabetic group [r = 0783]. The non parametric ROC curvas provided the best results for cystatin C in no diabetic group with en 80% of specificity and 93 % of sensitivity. In conclusion, the cystatin C can be used as a screening test to evaluate the filtration glomerular rate. However, in diabetic patients it is necessary to perform the creatinine clearance to detect renal impairment (AU)