Pesticides in the environment: Degradation routes, pesticide transformation products and ecotoxicological considerations.

Among rising environmental concerns, emerging contaminants constitute a variety of different chemicals and biological agents. The composition, residence time in environmental media, chemical interactions, and toxicity of emerging contaminants are not fully known, and hence, their regulation becomes problematic. Some of the important groups of emerging contaminants are pesticides and pesticide transformation products (PTPs), which present a considerable obstacle to maintaining and preserving ecosystem health. This review article aims to thoroughly comprehend the occurrence, fate, and ecotoxicological importance of pesticide transformation products (PTPs). The paper provides an overview of pesticides and PTPs as contaminants of emerging concern and discusses the modes of degradation of pesticides, their properties and associated risks. The degradation of pesticides, however, does not lead to complete destruction but can instead lead to the generation of PTPs. The review discusses the properties and toxicity of PTPs and presents the methods available for their detection. Moreover, the present study examines the existing regulatory framework and suggests the need for the development of new technologies for easy, routine detection of PTPs to regulate them effectively in the environment.

Magnetic resonance imaging in paediatric ocular and orbital lesions: A pictorial review.

Paediatric orbital lesions encompass a wide spectrum of benign and malignant entities that can arise from different components of the orbit. Clinical symptoms and signs are often nonspecific, and imaging plays a crucial role in the diagnosis and management. Ultrasonography has a limited role and radiation is a major concern with CT especially in the paediatric population. MRI is the modality of choice that avoids the radiation hazard and provides superior soft tissue contrast. The lesions can be localized using the 'compartment' approach which helps to narrow the list of differentials. MRI also provides critical information for management such as presence of perineural spread and intracranial extension. This article depicts the spectrum of Magnetic Resonance imaging findings encountered in paediatric ocular and orbital lesions.

Lipid Profile and Small Dense Low-Density Lipoprotein in Acute Coronary Syndrome Patients: Relationships to Demographic, Clinical, Angiographic, and Therapeutic Variables.

Background: Several lines of evidence have supported small dense low-density lipoproteins (sd-LDL) as a marker of cardiovascular disease. The present study assessed the relationship between lipid profile and sd-LDL levels with demographic, clinical, angiographic, and therapeutic variables in acute coronary syndrome (ACS) patients. Methods: This was a single-centre, prospective, cross-sectional study conducted from September 2014 to September 2015. Patients with a diagnosis of ACS were included in this study. High-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were determined by direct homogenous assay and sd-LDL levels were calculated using an earlier described equation by Srisawadi et al. Results: A total of 200 patients with a diagnosis of ACS were studied. Males constituted 78% of the population cohort and almost 45% of participants were aged <45 years. Patients aged ≤45 years displayed higher mean sd-LDL levels of 30.40 ± 14.18 mg/dL versus patients aged >45 years with mean sd-LDL levels of 28.01 ± 11.58 mg/dL, but the difference was not statistically significant (p = 0.19). Females also displayed higher mean sd-LDL levels, but the difference also failed to achieve statistical significance (30.95 ± 13.44 mg/dL and 28.54 ± 12.64, respectively; p = 0.185). Diabetics had higher mean sd-LDL levels (33.64 ± 13.01 mg/dL and 28.07 ± 12.60 mg/dL; p = 0.273) whilst smokers had lower mean levels (27.21 ± 12.12 mg/dL and 30.51 ± 13.21 mg/dL, respectively; p = 0.071). However, the ratio of sd-LDL/lb-LDL (large buoyant LDL) was significantly higher in diabetics (0.48 vs. 0.39; p = 0.023). In the angiography cohort (n = 88), single-vessel disease was the most predominant overall while among patients aged >45 years, triple-vessel disease was significantly higher (p = 0.005). Similarly, the sd-LDL levels were 33.12 ± 11.13 mg/dL, 27.68 ± 9.80 mg/dL, and 31.65 ± 15.26 mg/dL among patients with single, double, and triple-vessel disease and did not differ significantly (p = 0.262). Prior statin users had significantly lower mean sd-LDL levels of 24.79 ± 12.23 mg/dL compared to statin-naïve patients with a mean sd-LDL of 30.01 ± 12.79 mg/dL (p = 0.027). Non-HDL levels were also significantly lower in prior statin users (112.83 mg/dL vs. 128.9 mg/dL; p = 0.017). Conclusion: In this cohort of ACS patients, age, sex, diabetes, smoking, and the angiographic severity of coronary artery disease had no significant impact on sd-LDL levels, while prior statin usage led to significantly lower sd-LDL levels. Diabetic patients, however, did have significantly higher sd-LDL/lb-LDL ratios.

A cross sectional study on psychological impact of covid19 on post graduate doctors and Compulsory Rotatory Residential interns in COVID isolation ward of a tertiary care centre, Madurai.

BACKGROUND: COVID-19 pandemic causes major impact on economic, physical, mental well-being of people all over the world. Doctors are working in stressful, unprepared, limited resource setting, and they are under the continuous threat of getting infection. Managing mental health of these warriors is great importance. Hence the present study to estimate the psychological impact of COVID-19* and factors associated with it among doctors in tertiary care hospital, Madurai. METHODS: A Cross-sectional study was conducted during October-November 2020 using a pre-designed semi structured questionnaire and DASS-21 scale which were sent through Google form to doctors who were in their quarantine period after the COVID duty. Totally 292 responses were received. Descriptive statistics done to find frequencies and percentages. Correlation for continuous variables; Univariate and multivariate regression for categorical variables were used to predict the factors influencing the psychological impact. RESULTS: In our study, 42.1% doctors were depressed, 43.8% were stressed and 50.7% had anxiety. Depression*, anxiety*, stress* scores were positively correlated with number of COVID duties(r2 0.163,0.138,0.133), number of elderly persons(r2 0.188,0.169,0.188) in their family and negatively correlated with sleep duration(r 2-0.219,-0.281,-0.239), attitude of study participants(r2-0.319,-0.274,-0.291). Multiple logistic regression showed that disturbed sleep(odd'sratio = 3.931,2.734,3.420) and poor quality of sleep which affect the next day function(odd'sratio = 3.470,2.968,3.122) were significant predictors for all three psychological impacts. CONCLUSION: High prevalence of psychological impact estimated, ensures the requirement of early screening with timely psychological intervention and establishment of guideline policies to support mental health of healthcare workers* for maintaining the functionality of healthcare system.

Of "Cotton Balls" and "Owl's eyes".

Report of a 3-month old girl child who died due to multi-systemic infection of cytomegalovirus (CMV) involving the lungs, liver and kidneys along with pneumocystis jiroveci pneumonia (PJP). The mother of the child tested positive for CMV IgG and HIV with a very low CD4 count (160/ µl). Co-infection of cytomegalovirus and pneumocystis jiroveci always occurs in the setting of immunocompromise. Congenital CMV infection is transmitted through the placenta, especially during the first trimester and causes severe multi-systemic disease whereas perinatal infection is acquired during childbirth/ breastfeeding where the babies have maternal protective antibodies leading to much milder or asymptomatic infection. PJP is more common in infancy and presents as hypoxic pneumonia. CMV causes cyto-nucleomegaly and classic "owl's eye" inclusions on histology while PJP presents with characteristic fluffy "cotton ball" alveolar exudates.

Utility of cytomorphology in distinguishing solid pseudopapillary neoplasm of pancreas from pancreatic neuroendocrine tumor with emphasis on nuclear folds and nuclear grooves.

BACKGROUND: Pancreatic solid pseudopapillary tumor (SPN) and pancreatic neuroendocrine tumors (Pan-NET) have close resemblance on imaging and cytomorphology, though they differ in their prognosis and treatment strategy. SPNs are low-grade indolent tumors while Pan-NETs harbor malignant potential with propensity to metastasize. We aim to differentiate SPN from Pan-NET based on cyto-morphology; to classify nuclear membrane (NM) irregularities or nuclear folds into four grades and see whether they bear any difference with respect to the two entities. METHODS: Eighteen and ten confirmed cases of SPN and Pan-NET were included in the study. Smears were assessed for architecture, background changes, cellular, and nuclear features, which were compared between the two study groups. Nuclear folds were classified into four grades. Nuclear folds and nuclear grooves were also compared between the two groups. RESULTS: All SPN patients were females; mean age of 28 years. Pan-NET patients had equal male to female ratio; mean age of 46 years. Both SPN (78%) and Pan-NET (71%) showed predilection for pancreatic head. Mean size of lesion was 4.8 cm and 3.1 cm in SPN and Pan-NET groups. Papillary pattern, branching capillaries, degenerative background were significantly more prominent in SPN; sudden anisonucleosis and cytoplasmic granularity in Pan-NET. Metachromatic matrix, hyaline globules, and nuclear grooves were noted exclusively in SPNs. Nuclear fold grades 2 and 3 were more characteristic of SPN than Pan-NET (P = 0.041 and 0.002, respectively). CONCLUSIONS: Cytomorphology is vital in differentiating SPN from Pan-NET with nuclear folds being an important nuclear feature.

Assessment of validity of the 'Culprit Score' for predicting the culprit lesion in patients with acute inferior wall myocardial infarction.

INTRODUCTION: Many electrocardiographic criteria have been developed to determine the infarct-related artery in acute inferior wall myocardial infarction. The aim of this study was to test the commonly used criteria and devise a simplified score to further improve the diagnostic accuracy. MATERIALS AND METHODS: From 2011 to 2013, 100 patients with acute inferior wall myocardial infarction were recruited for electrocardiographic and angiographic analyses. RESULTS: The mean age of the patients was 65±12 years with 74% of patients being male. In our study population, significantly more ST-segment depression was seen in lead aVL and ST elevation in lead III in those with right coronary artery (RCA) occlusions. In left circumflex artery (LCX) occlusions, significantly more ST depression was seen in leads V1-3 (most significantly in lead V2) and ST elevation in lead II. In addition, more prominent ST depression was seen in lead aVL and ST elevation in V1 in proximal RCA occlusions. Based on the findings, we devised a score named Culprit Score, which was defined as [II-V2/III+V1-aVL]. The sensitivity and specificity of Culprit Score ≤0.5 to predict proximal RCA occlusions; 0.5 to ≤1.5 to predict distal RCA occlusions; and score >1.5 to predict LCX occlusions were 85% and 85%; 80% and 86%; and 80% and 94%, respectively. Similarly, the negative predictive value was more than 80%. CONCLUSION: The Culprit Score was found to have high specificity and negative predictive value to identify the infarct-related artery in inferior wall myocardial infarction.

Efficacy of multi-detector coronary computed tomography angiography in comparison with exercise electrocardiogram in the triage of patients of low risk acute chest pain.

OBJECTIVES: To compare the safety and diagnostic efficacy of coronary computed tomography angiography (CTA) with exercise electrocardiography (XECG) in triaging patients of low risk acute chest pain. BACKGROUND: Noninvasive assessment of coronary stenosis by CTA may improve early and accurate triage of patients presenting with acute chest pain to the emergency department (ED). METHODS: Low risk patients of possible acute coronary syndrome (ACS) were included in the study. The patients in CTA arm with significant stenosis (≥ 50%) underwent catheterization, while those with no or intermediate stenosis (<50%) were discharged from ED and followed up periodically for six months for major adverse cardiovascular events (MACE). The same protocol was applied for XECG arm. Outcomes included: safety and diagnostic efficacy. RESULTS: A total of 81 (41 CTA and 40 XECG) patients were enrolled. In this study CTA was observed to be 100% sensitive and 95.7% specific in diagnosing MACE in low risk patients of chest pain presenting to the ED, with a PPV of 94.7% and an NPV of 100%.The overall diagnostic efficacy was 97.6%. XECG was observed to be 72.7% sensitive and 96.6% specific in diagnosing MACE with a PPV of 88.9% and NPV of 90.3% in low risk chest pain patients presenting to the ED. The overall diagnostic accuracy was 90%. CONCLUSION: CTA is an excellent diagnostic tool in ED patients with low risk of ACS, with minimum time delay as compared to XECG, and also is safe for triaging such patients.

Foramen of civinini: a new anatomical guide for maxillofacial surgeons.

INTRODUCTION: Study on Morphometric and radiological aspect on existence of foramen of civinini. Sphenoid bone comprises of some rare ossified ligaments, may encounter difficulty in surgical procedures. Incidence of Pterygospinous bars various with different racial groups and they are genetically controlled. Complete ossification of pterygospinous ligament form foramen of civinini. Entrapments of vessels or nerves may occur due to existence of pterygospinous bar. The bar may locate medially or inferiorly to formen ovale as seen in Hawaiian and lemurs. Co - existence of bar with the wide lateral pterygoid plate exhibits development of the bar from herbivore, carnivore and old world monkeys. Comparatively absence or small spine of civinini noted in new world monkeys, rodents and platyrrhines. Pterygospinousbar represents the phylogenetic remnant of Human beings. MATERIAL AND METHODS: By using digital vernier caliper, the measurements of length, width of the pterygospinous bar and area of foramen of civinini including the length and breadth of lateral pterygoid plate were measured. Using X rays the radiological view was determined. RESULTS: In this study from 160 cases of skull and sphenoid bones revealed that complete and incomplete foramen of civinini in 1.25% and 7.5% of cases respectively. Peculiarly accessory foramen of civinini noticed in 1.25% of cases. Maximum area of foramen of civinini was 94.2mm(2). The maximum width of lateral pterygoid was noted as 19.6mm respectively. Mentocoronal view of skiagram clearly shows the bar. CONCLUSION: During Anaesthesia for trigeminal neuralgia may encounter difficult to pass the needle. The bar compress the mandibular nerve branches can cause lingual numbness, pain and speech impairment. Conductive anaesthesia on the mandibular nerve through the lateral subzygomatic route may be difficult to approach. Exploring the anatomical and clinical updates of pterygospinous bar may guide the surgeons and radiologists to overcome any difficulties in infratemporal and para or retropharyngeal regions.

Comparative assessment of platelet GpIIb/IIIa receptor occupancy ratio with Eptifibatide/Tirofiban in patients presenting with ACS and undergoing PCI.

BACKGROUND: The level of platelet inhibition by a Glycoprotein IIb/IIIa (GpIIb/IIIa) antagonist therapy necessary to minimize thrombotic complications in patients undergoing percutaneous coronary intervention (PCI) is a subject of debate. The degree of platelet inhibition obtained 10 min after start of GpIIb/IIIa antagonist therapy predicts adverse events after PCI. The aim of this study was to look at platelet inhibition and to compare platelet GpIIb/IIIa receptors occupancy ratio (GpRO) with Eptifibatide and Tirofiban using various dose regimens and correlate with 30-day clinical outcomes in patients presenting with high-risk acute coronary syndromes (ACS) and undergoing PCI. METHODS: The patients were divided into four sub groups: (1) Eptifibatide two intracoronary bolus (180 µg/kg) alone (E(B)); or (2) two intravenous bolus (180 µg/kg) followed by infusion at 2 µg/kg/min for 24 h (E(B + Inf)); and (3) Tirofiban standard bolus dose (0.4 µg/kg) over 30 min followed by infusion at 0.1 µg/kg/min (T(Std)); or (4) at ADVANCE dose bolus (25 µg/kg) over 3 min, followed by infusion at 0.1 µg/kg/min (T(Adv)). Number of GpIIb/IIIa receptors was assessed by flow cytometry at baseline and 10 min after the bolus and percentage of free receptors was determined to calculate the GpRO. Patients were followed for 30 days for any major adverse cardiac events (MACE). RESULTS: 200 consecutive patients (including 74% with ST-elevation ACS) were enrolled. GpRO in groups E(B) (n = 48) and E(B + Inf) (n = 44) were 62.7% ± 27.2% and 61.4% ± 6.1% respectively while in the groups T(Std) (n = 96) and T(Adv) (n = 12) groups were 35.1% ± 17.74% and 68.8% ± 27.3% respectively. The GpRO was similar in E(B), E(B + Inf) and T(Adv) groups and was significantly higher than T(Std) group (p < 0.0001). The 30-day MACE rates in E(B) (4.2%), E(B + Inf) (4.5%) and T(Adv) (4.2%) were significantly lower than T(Std) group (12.5%) (p < 0.01). CONCLUSIONS: Standard dose Tirofiban results in significantly lower rates of GpIIb/IIIa receptor occupancy ratio and this correlated with higher incidence of 30-day MACE in high-risk ACS patients undergoing PCI.

Depression and the heart.

Cardio Vascular disease (CVD) as well as depression are both highly prevalent disorders and both of them cause a significant decrease in quality of life and increase the economic burden for the patient. Depressed individuals are more likely to develop angina, fatal or non-fatal myocardial infarction, than those who are not depressed. Over the past decade, evidence has accumulated to suggest that depression may be a risk factor for cardiac mortality in patients with established coronary artery disease (CAD). The 'vicious cycle' linking CVD to major depression and depression to CVD, deserves greater attention from both cardio-vascular and psychiatric investigators.(1).

Patterns and determinants of dyslipidaemia in 'Young' versus 'Not so Young' patients of coronary artery disease: a multicentric, randomised observational study in northern India.

AIMS: The aims of the study were to ascertain difference in lipid levels of 'Young' onset of coronary artery disease (CAD) (≤ 45 years) vs. 'Not so Young' onset of CAD (≥ 55 years) among north Indians and also to investigate determinants of 'dyslipidaemia' in CAD patients. METHODS: This was a prospective, multicentric, randomised, observational study carried in eight centres of UP, India. All blood investigations were performed employing a central laboratory. RESULTS: Out of a total 435 patients studied, 218 were in the 'young group' (YG) and 235 were in the 'Not so Young Group' (NSYG). Dyslipidaemia was more common in YG as evident by significantly higher levels of total cholesterol, triglycerides, low- and very low-density lipoprotein cholesterol as compared to NSYG. Diabetes, hypertension, urban lifestyle, and family history of CAD were found to be important determinants of dyslipidaemia in YG. CONCLUSION: We conclude that lipid levels among north Indians are significantly higher in younger patients with CAD when compared with elderly.

Giant coronary artery aneurysm following implantation of Endeavour stent presenting with fever.

Coronary artery aneurysms are a known but uncommon complication of percutaneous coronary intervention (PCI) probably related to effects of vessel wall trauma and possibly a combination of hypersensitivity and incomplete endothelisation associated with drug-eluting stents (DES). We present here a case of giant coronary artery aneurysm 3 months following implantation of a zotarolimus eluting endeavour stent presenting with fever.

Giant right atrial aneurysm presenting as right heart failure.

Idiopathic aneurysmal dilatations of the right atrium are rare anomalies. We report one such case of a young man presenting with fatigue, abdominal distension, pedal oedema, unremarkable cardiac examination except for raised jugular venous pressure, an electrocardiogram showing normal sinus rhythm with right bundle-branch block, and an radiograph of the chest showing cardiomegaly. The echocardiographic examination revealed a giant right atrium with low pressure tricuspid regurgitation. The computed tomography confirmed the findings of two-dimensional echocardiography. He was put on medical treatment and remained symptomatically controlled on follow-up.

Lateral intraventricular epidermoid in a child with hydrocephalus.

Lateral intraventricular tumors are uncommon. They grow linearly rather than exponentially and hence are slow-growing lesions without causing mass effects and hydrocephalus. We report a rare case of large bulky right intraventricular epidermoid tumor in a child. This tumor was associated with mass effect on the surrounding structures and hydrocephalus.