Excimer Light Treatment for Idiopathic Guttate Hypomelanosis: A Pilot Study.

BACKGROUND: Idiopathic guttate hypomelanosis (IGH) is a commonly acquired benign leukoderma characterized by multiple discrete, hypo- or depigmented macules often on extremities that can be aesthetically undesirable for patients. This is the first study using excimer laser for treatment. OBJECTIVE: To determine the effectiveness of excimer laser for repigmentation of idiopathic guttate hypomelanosis. METHODS AND MATERIALS: In this longitudinal, split-body controlled, single-blinded pilot study, 6 patients were treated with excimer laser for 12 weeks using the vitiligo protocol. Effectiveness was graded by the blinded observer scale through photographic comparisons at the end of the study. Participants also graded their progress at intervals during the study. A descriptive trend analysis and an ANOVA model were used to determine outcomes. RESULTS: Lesions that received the excimer treatment had significantly higher repigmentation by the end of the study compared with baseline and untreated lesions. CONCLUSION: Excimer laser treatments are already considered to be a safe modality for a variety of skin conditions. This study suggests that excimer is an effective treatment option with acceptable cosmetic outcomes for IGH.

Update on pediatric hyperhidrosis.

Hyperhidrosis is a common and under-recognized disease in the pediatric population that has a significant impact on quality of life. Focal and generalized forms of hyperhidrosis exist, which can be idiopathic or secondary to underlying medical conditions or medications. Treatment is tailored to the specific patient needs, characteristics and goals. These include topical preparations, iontophoresis, botulinum toxin and anticholinergic medications.

Clearance of nasal Staphylococcus aureus colonization with triple antibiotic ointment.

BACKGROUND: The prevalence of Staphylococcus aureus colonization of healthcare workers is reported at 30%, with colonization rates for methicillin-resistant S aureus (MRSA) reported between 2.0% and 8.5% among industrialized nations. The anterior nares are the most frequent colonization site. Mupirocin is the standard of care for nasal S aureus decolonization, with decolonization rates as high as 90%. Staphyloccocal resistance to mupirocin has been described, requiring additional management strategies. In certain situations, triple antibiotic ointment (TAO) may be a suitable alternative for elimination of nasal S aureus colonization. OBSERVATIONS: Adult healthcare workers within an academic-centered hospital (n=216) were screened via nasal swab with culture for S aureus colonization. Forty-!ve subjects (20.8%) screened positive for S aureus; of these subjects, 3 (1.4%) were positive for MRSA. Of the 45 subjects with positive cultures, 30 completed 5 days of twice-daily intranasal TAO application. One week after treatment, all 30 subjects were reswabbed; 16 (53.3%) showed evidence of decolonization on repeat culture. CONCLUSIONS: The rate of S aureus colonization of healthcare workers in our study is lower than published rates in industrialized nations. Intranasal application of TAO may be a viable option for eradication of nasal colonization by methicillin-susceptible S aureus in environments where mupirocin-resistant bacterial strains become more prevalent.

Association of esterases with insecticide resistance in Culex quinquefasciatus (Diptera: Culicidae).

The southern house mosquito, Culex quinquefasciatus Say, is a competent vector of human disease and an important target of mosquito abatement programs. However, these management programs have been compromised by development of insecticide resistance. In the current study, susceptibilities to naled and resmethrin, two adulticides used in mosquito abatement, were monitored using a topical and contact bioassay, respectively, in five field- collected populations of C. quinquefasciatus (MARC, HOOD1, HOOD2, MINLOVE, and THIB). Frequencies of resistance, measured as survival after treatment with discriminating concentrations (i.e., sufficient to kill > 90% of a reference susceptible strain) were high (88.0-96.8%) in all field collections treated with naled, but were variable (3.3-94.2%) with resmethrin. In addition, esterase activities in mosquitoes from these collections were quantified using alpha-naphthyl acetate and ranged from 1.08 to 3.39 micromol alpha-naphthol produced min(-1) mg prot(-1). Heightened activities were associated with decreased insecticide susceptibility in HOOD1, THIB, and MINLOVE but not HOOD2. Esterases were visualized using native polyacrylamide gel electrophoresis, and intra- and interstrain differences in banding patterns were detected. In addition, esterases from MINLOVE mosquitoes were more numerous and intensely staining when compared with those from a laboratory-susceptible strain. Finally, naled synergized the toxicity of resmethrin in populations with decreased insecticide susceptibility and increased esterase activity by 2.5-(MINLOVE) to three-fold (THIB). Results from this study will allow management strategies for populations of C. quinquefasciatus to be optimized, and provide a foundation for further studies exploring use of esterase inhibitors as synergists of pyrethroid toxicity.

Riding the Wave: Reactive Vector-Borne Disease Policy Renders the United States Vulnerable to Outbreaks and Insecticide Resistance.

Funding for vector-borne disease surveillance, management, and research is cyclical and reactive in the United States. The subsequent effects have yielded gross inequities nationally that unintentionally support recurrent outbreaks. This policy forum is comprised of four primary subsections that collectively identify specific areas for improvement and offer innovative solutions to address national inadequacies in vector borne disease policy and infrastructure.

Needs Assessment of Southeastern United States Vector Control Agencies: Capacity Improvement Is Greatly Needed to Prevent the Next Vector-Borne Disease Outbreak.

A national 2017 vector control capacity survey was conducted to assess the United States' (U.S.'s) ability to prevent emerging vector-borne disease. Since that survey, the southeastern U.S. has experienced continued autochthonous exotic vector-borne disease transmission and establishment of invasive vector species. To understand the current gaps in control programs and establish a baseline to evaluate future vector control efforts for this vulnerable region, a focused needs assessment survey was conducted in early 2020. The southeastern U.S. region was targeted, as this region has a high probability of novel vector-borne disease introduction. Paper copies delivered in handwritten envelopes and electronic copies of the survey were delivered to 386 unique contacts, and 150 returned surveys were received, corresponding to a 39% response rate. Overall, the survey found vector control programs serving areas with over 100,000 residents and those affiliated with public health departments had more core capabilities compared to smaller programs and those not affiliated with public health departments. Furthermore, the majority of vector control programs in this region do not routinely monitor for pesticide resistance. Taken as a whole, these results suggest that the majority of the southeastern U.S. is vulnerable to vector-borne disease outbreaks. Results from this survey raise attention to the critical need of providing increased resources to bring all vector control programs to a competent level, ensuring that public health is protected from the threat of vector-borne disease.

Superficially invasive transitional cell carcinoma of the bladder associated with distant cutaneous metastases.

Cutaneous metastases from transitional cell carcinoma of the bladder are rare and most often associated with a deeply invasive primary tumor. This case report describes a 69-year-old male with previously resected superficially invasive primary transitional cell carcinoma of the bladder who presented with distant cutaneous and central nervous system metastases associated with recurrent bladder cancer. In addition, this case highlights the differential diagnosis of metastatic carcinomas that display a CK7/CK20 positive immunophenotype including transitional cell carcinoma, pancreatic carcinoma, cholangiocarcinoma and rare gastric carcinomas.

Failure to recognize newly identified aortic dilations in a health care system with an advanced electronic medical record.

BACKGROUND: Concern is growing about missed test results, but data assessing their effect on patient safety are limited. OBJECTIVE: To examine the frequency with which computed tomography (CT)-documented dilations of the abdominal aorta are accompanied by evidence in the electronic medical record (EMR) that a clinician recognized the abnormality. DESIGN: Retrospective cohort study. SETTING: 2 hospitals in the Veterans Affairs Health Care System. PATIENTS: Patients with new dilations of the abdominal aorta detected on CT performed in 2003. MEASUREMENTS: Radiology report and EMR evidence that the radiologist notified the clinical service, aneurysm size, and interval between CT and EMR recognition. RESULTS: Computed tomography scans of 4112 patients were reviewed and 440 (11%) aortic dilations were identified, of which 91 were new findings. Radiologists directly notified clinical teams about 5 (5%) new dilations. Clinical teams did not record in the EMR recognition of 53 of 91 (58%) dilations within 3 months of the CT, and 9% of these dilations were 5.5 cm or larger. The median time to recognition of aneurysm in the EMR was 237 days, and no EMR documentation existed for 16 abnormalities (29% of surviving patients) during a mean follow-up of 3.2 years. No evidence indicated that any of the aneurysms ruptured or that patient deaths resulted from the delayed follow-up. LIMITATION: Clinicians may have recognized some aneurysms but did not document them in the EMR. CONCLUSION: Clinicians neglect to note a substantial proportion of new aortic dilations in the EMR. The findings highlight the need for better strategies to ensure documentation of follow-up of tests.

Urban Entomology Highlights From 2019 Help Create Integrated Pest Management Plans.

Urban insect pests such as ants, termites, cockroaches, and bed bugs are more than just nuisances; they often negatively impact structures, landscapes, animal health, commercial food production, food safety, and public health (mental, physical, and financial). Due to the tremendous burden these insects can inflict, researchers, manufacturers, and pest management professionals work to create solutions that effectively manage urban and structural pests. One solution that has proven useful in agriculture is the development of an integrated pest management (IPM) plan; i.e., a science-based approach to pest control that utilizes multiple tactics such as preventative tools, chemical control (sprays, fumigation, and baits), biological control, and exclusion. There are many permutations of urban IPM plans, but in general they consist of five components: 1) identifying the pest, 2) monitoring the pest, 3) developing an intervention plan (including prevention and control techniques), 4) implementing the program, and 5) recording and evaluating the results. The objectives of the current publication were to 1) highlight urban entomology research published in 2019 and 2) show how the results from these publications help pest management professionals create and implement IPM plans.

Impact of sublethal exposure to a pyrethroid-neonicotinoid insecticide on mating, fecundity and development in the bed bug Cimex lectularius L. (Hemiptera: Cimicidae).

Sublethal exposure to an insecticide may alter insect feeding, mating, oviposition, fecundity, development, and many other life history parameters. Such effects may have population-level consequences that are not apparent in traditional dose-mortality evaluations. Earlier, we found that a routinely used combination insecticide that includes a pyrethroid and a neonicotinoid (Temprid® SC) had deleterious effects on multiple bed bug (Cimex lectularius, L.) behaviors. Here, we demonstrate that sublethal exposure impacts physiology and reproduction as well. We report that sublethal exposure to Temprid SC has variable aberrant effects on bed bugs depending on the strain, including: a reduction in male mating success and delayed oviposition by females. However, after sublethal exposure, egg hatch rate consistently declined in every strain tested, anywhere from 34%-73%. Conversely, impact on fifth instar eclosion time was not significant. While the strains that we tested varied in their respective magnitude of sublethal effects, taken together, these effects could reduce bed bug population growth. These changes in bed bug behavior and fecundity could lead to improved efficacy of Temprid SC in the field, but recovery of impacted bugs must be considered in future studies. Sublethal effects should not be overlooked when evaluating insecticide efficacy, as it is likely that other products may also have indirect effects on population dynamics that could either aid or inhibit successful management of pest populations.

Behavioral effects of sublethal exposure to a combination of ß-cyfluthrin and imidacloprid in the bed bug, Cimex lectularius L.

BACKGROUND: Bed bugs (Cimex lectularius) are blood-feeding insect pests with public health relevance. Their rapid evolution of resistance to pyrethroids has prompted a shift to combination products that include both a pyrethroid and neonicotinoid insecticide. Insecticides have both a direct impact on mortality and an indirect effect on behavior. Thus, we assessed the sublethal effects of a widely used combination product containing ß-cyfluthrin (a pyrethroid) and imidacloprid (a neonicotinoid), as unexpected behavioral changes after exposure have been known to affect efficacy of insecticides. RESULTS: We found that bed bugs exposed to sublethal doses of a combination product containing ß-cyfluthrin and imidacloprid did not feed as effectively as untreated bugs. Their locomotion behavior was also reduced. However, aggregation in response to the presence of conspecific harborages was not affected by sublethal exposure. CONCLUSION: Bed bugs exhibit behavioral changes after sublethal exposure to a combination product that could affect pest management choices and outcomes. A reduction in host-finding efficiency and feeding could complement the lethal effects of the insecticide. Alternatively, reduced locomotion following exposure could limit ongoing contact with insecticide deposits. However, an overall reduction in movement indicates that treatments are unlikely to cause dispersal of bugs to adjacent dwellings. © 2016 Society of Chemical Industry.

Insecticide resistance in the bed bug comes with a cost.

Adaptation to new environmental stress is often associated with an alteration of one or more life history parameters. Insecticide resistant populations of insects often have reduced fitness relative to susceptible populations in insecticide free environments. Our previous work showed that three populations of bed bugs, Cimex lectularius L., evolved significantly increased levels of resistance to one product containing both ß-cyfluthrin and imidacloprid insecticides with only one generation of selection, which gave us an opportunity to explore potential tradeoffs between life history parameters and resistance using susceptible and resistant strains of the same populations. Life history tables were compiled by collecting weekly data on mortality and fecundity of bugs from each strain and treatment throughout their lives. Selection led to a male-biased sex ratio, shortened oviposition period, and decreased life-time reproductive rate. Generation time was shortened by selection, a change that represents a benefit rather than a cost. Using these life history characteristics we calculated that there would be a 90% return to pre-selection levels of susceptibility within 2- 6.5 generations depending on strain. The significant fitness costs associated with resistance suggest that insecticide rotation or utilization of non-insecticidal control tactics could be part of an effective resistance management strategy.

Population variation in and selection for resistance to pyrethroid-neonicotinoid insecticides in the bed bug.

Pyrethroid resistance in bed bugs, Cimex lectularius, has prompted a change to combination products that include a pyrethroid and a neonicotinoid. Ten populations of bed bugs were challenged with two combination products (Temprid SC and Transport GHP). Susceptibility of these populations varied, with the correlated response of the two products indicating cross resistance. We imposed selection on three populations using label rate Temprid, and then reared progeny from unselected and selected strains. All selected strains were significantly less susceptible to Temprid SC than unselected strains. Temprid selected strains were also less susceptible to Transport. The pyrethroid component of Temprid showed a significantly higher LD50 in selected strains, but susceptibility to the neonicotinoid remained unchanged. Taken together these results indicate resistance to combination insecticides is present in field populations at levels that should be of concern, and that short-term selection affecting existing variance in susceptibility can quickly increase resistance.

Bed bugs evolved unique adaptive strategy to resist pyrethroid insecticides.

Recent advances in genomic and post-genomic technologies have facilitated a genome-wide analysis of the insecticide resistance-associated genes in insects. Through bed bug, Cimex lectularius transcriptome analysis, we identified 14 molecular markers associated with pyrethroid resistance. Our studies revealed that most of the resistance-associated genes functioning in diverse mechanisms are expressed in the epidermal layer of the integument, which could prevent or slow down the toxin from reaching the target sites on nerve cells, where an additional layer of resistance (kdr) is possible. This strategy evolved in bed bugs is based on their unique morphological, physiological and behavioral characteristics and has not been reported in any other insect species. RNA interference-aided knockdown of resistance associated genes showed the relative contribution of each mechanism towards overall resistance development. Understanding the complexity of adaptive strategies employed by bed bugs will help in designing the most effective and sustainable bed bug control methods.

Effectiveness of acupressure on pruritus and lichenification associated with atopic dermatitis: a pilot trial.

BACKGROUND: Pruritus is a debilitating aspect of atopic dermatitis (AD). Acupuncture has been reported to diminish pruritus, but self-administered acupressure has not been previously evaluated. OBJECTIVES: To evaluate the effectiveness of acupressure on the severity of eczema in a pilot trial. METHODS: Adult patients with AD were randomised to an intervention group (acupressure with standard of care) or a control group (standard of care alone). Subjects in the intervention group performed acupressure using a 1.2 mm acupellet at the LI11 point, applying pressure for 3 min three times per week for 4 weeks. The severity of itching and AD at baseline and at 4 weeks were measured on a visual analogue scale (VAS), the Investigator's Global Assessment (IGA) and the Eczema Area and Severity Index (EASI). RESULTS: Fifteen subjects were enrolled, 12 of whom completed the study between November 2009 and May 2011. There was no significant change between baseline and follow-up survey scores within the control group. In the investigation group there was a decrease in the VAS score (p=0.05) and EASI lichenification (p=0.03), although without significant change in the overall EASI score. Comparison of the scores between groups showed a greater decrease in VAS in the experimental group than in the control group (p=0.04), and a decrease in the IGA (p=0.03) and EASI lichenification score (p=0.03). The overall EASI scores were unchanged. CONCLUSION: Subjects using acupressure at LI11 for 4 weeks had improvement in pruritus and lichenification. Acupressure may prove to be an easily administered alternative treatment, but larger-scale studies are needed to confirm these preliminary findings.