Simultaneous monitoring and dietary risk assessment of 386 pesticides in market samples of black tea.

Black tea samples (390) collected from local markets situated in different locations of India were monitored for the residues of 386 pesticides using QuEChERS (Quick, Easy, Cheap, Effective, Rugged, and Safe) based extraction and analysis by gas and liquid chromatography tandem mass spectrometry (GC-MS/MS and LC-MS/MS). Residues of seventeen pesticides were detected, of which propargite, cypermethrin, and novaluron showed the highest % positive detections. A comparison of the concentrations of the detected pesticide residues with the available national and international maximum residue limits (MRLs) showed that seven samples exceeded the Indian MRLs while no sample was found to exceed the CODEX MRLs. The risk due to the detected pesticide levels evaluated in terms of hazard quotient (HQ) and hazard index (HI) was found to be very low (<1), suggesting that the pesticide residues in the tea were safe for consumption by Indian adults and children.

Lumbar Spinal Epidural Capillary Hemangioma: A Case Report and Literature Review.

BACKGROUND Capillary hemangiomas are often seen on the skin of young individuals and are rarely found in the spine. These vascular lesions can arise from any spinal compartment, although they are more commonly found in the intradural extramedullary (IDEM) than the epidural location. We present a unique case of a woman with a histologically proven spinal epidural capillary hemangioma (SECH). The imaging and histopathological characteristics, as well as the treatment strategy of this vascular lesion, are highlighted along with a comprehensive review of the literature. CASE REPORT A 38-year-old woman presented with progressively worsening low back pain that radiated to both legs. Neurological examination revealed a weakness of the left leg without sensory loss. Magnetic resonance imaging (MRI) demonstrated an epidural tumor at L1-L2 level, making an obtuse angle with the cerebrospinal fluid (CSF) on sagittal T2-weighted images. The patient underwent a complete tumor resection without complications or recurrence. The histology revealed a capillary hemangioma. CONCLUSIONS SECH is exceedingly rare, with only 22 cases in the reported literature. Females are more commonly affected than males, and the thoracic spine is more commonly involved than the lumbar spine. SECH often mimics other epidural and IDEM lesions, leading to misdiagnosis. MRI is useful to differentiate SECH from lesions in the various spinal compartments; additionally, MRI is essential for preoperative planning and patient surveillance. Preoperative embolization is an option given the high vascularity of SECH. Surgery is the mainstay treatment, with a good prognosis, in most cases without recurrence.

Candida auris on Apples: Diversity and Clinical Significance.

Candida auris is a multidrug-resistant nosocomial fungal pathogen. While the marine environment was recently identified as a natural niche for C. auris, the environment(s) that might have contributed to the development and spread of antifungal resistance in C. auris remains a mystery. Because stored fruits are often treated with fungicides to prevent postharvest spoilage, we hypothesized that stored fruits could serve as a possible selective force for and a transmission reservoir of antifungal-resistant isolates of pathogenic yeasts, including C. auris. To test this hypothesis, we screened fruits to study the diversity of pathogenic yeasts and their antifungal susceptibility profiles. Among the 62 screened apples, the surfaces of 8 were positive for C. auris, and all were stored apples. Whole-genome sequencing (WGS) showed that C. auris strains from apples were genetically diverse and exhibited broad phylogenetic distribution among the subclades within clade I. Interestingly, strains from apples had closely related strains from other sources in India, including from patients, hospitals, and marine environments, and from clinical strains from other parts of the world. A broad range of fungicides, including dimethyl inhibitors (DMIs), were detected in stored apples, and all C. auris isolates exhibited reduced sensitivity to DMIs. Interestingly, C. auris was not isolated from freshly picked apples. Together, the results suggest a potentially complex ecology for C. auris with agriculture fungicide application on stored fruits as a significant selective force for drug resistance in clinics. IMPORTANCE In 2019, the U.S. Centers for Disease Control and Prevention classified the multidrug-resistant Candida auris as one of five pathogens posing the most urgent threats to public health. At present, the environment(s) that might have contributed to the development and spread of antifungal resistance in C. auris is unknown. Here, we tested whether fruits could be a source of multidrug-resistant C. auris. We identified genetically diverse C. auris strains with reduced sensitivity to major triazole dimethyl inhibitors fungicides on the surfaces of stored apples. The successful isolation of C. auris from apples here calls for additional investigations into plants as a reservoir of C. auris. Our findings suggest that C. auris in the natural ecosystem may come in contact with agriculture fungicides and that stored fruits could be a significant niche for the selection of azole resistance in C. auris and other human fungal pathogens.

Persistence evaluation of fluopyram + tebuconazole residues on mango and pomegranate and their risk assessment.

The persistence of combination formulation of fluopyram 200 + tebuconazole 200-400 SC was evaluated across different agro-climates in India for the management of fungal diseases in two commercially important fruit crops, mango and pomegranate. The residues were extracted using quick easy cheap effective rugged and safe (QuEChERS) method and quantification was done on liquid chromatography-tandem mass spectrometry (LC-MS/MS). The fungicide degradation followed 1st-order kinetics and the half-lives were 2.9-6.4 days for mango, and 3.5-7.4 days for pomegranate for both the fungicides. On the basis of Organisation for Economic Co-operation and Development (OECD) maximum residue limit (MRL) calculation, 1.0 mg kg-1 MRL was obtained for fluopyram while for tebuconazole, it was 0.5 mg kg-1 on mango, at the pre-harvest interval (PHI) of 5 days. For pomegranate, the respective MRLs were 1.0 mg kg-1 and 0.7 mg kg-1 at PHI of 7 days. The dietary risk assessment study indicated that % acceptable daily intake (% ADI) and % acute reference dose (% ARfD) were much lower than 100; thus, the application of fluopyram and tebuconazole on mango and pomegranate is unlikely to present public health concern.

Long-term monitoring of 155 multi-class pesticide residues in Indian vegetables and their risk assessment for consumer safety.

A systematic long-term study was conducted to monitor the pesticide residues in commercially important vegetables that are produced, consumed, and exported from India. Residues of 155 commonly used pesticides were determined in 966 samples of cabbage, green chilli, and okra grown in North and North-Western part of India. The residues were extracted using modified Quick, Easy, Cheap, Effective, Rugged, and Safe (QuEChERS) method and quantified by gas chromatography-mass spectrometry and liquid chromatography tandem-mass spectrometry. Acetamiprid, cypermethrin, imidacloprid, metalaxyl, and profenofos were the most frequently detected pesticides. No pesticide was detected in 94.4% cabbage, 34.5% green chilli, and 61% okra samples. The chronic risk assessment due to the dietary exposure of the pesticides was evaluated for Indian adult and child. The results suggested that the detected residue levels in vegetables were within safe limits and their consumption will not pose any dietary risk to the consumers.

Cerebellar Stroke in a COVID-19 Infected Patient. a Case Report.

BACKGROUND: Recent studies have reported that COVID-19 infected patients with stroke, who were often in the older age group, had a higher incidence of vascular risk factors, and more severe infection related respiratory symptoms. These observations provided little evidence to suggest that COVID-19 infection is a potential causative factor for stroke. This report describes a young patient with a cerebellar stroke secondary to COVID-19 infection. CASE PRESENTATION: A 45-year old male presented at a hospital, reporting a two-day history of headache, vertigo, persistent vomiting, and unsteady gait. Physical examination revealed gaze-evoked nystagmus on extraocular movement testing, left-sided dysmetria and dysdiadochokinesia. He was diagnosed with a left cerebellar stroke. An external ventricular drain was inserted, and sub-occipital craniectomy was performed to manage the effects of elevated intracranial pressure due to the extent of oedema secondary to the infarct. He also underwent screening for the COVID-19 infection, which was positive on SARS-COV-2 polymerase chain reaction testing of his endotracheal aspirate. Blood and cerebrospinal fluid samples were negative. After the surgery, the patient developed atrial fibrillation and had prolonged vomiting symptoms, but these resolved eventually with symptomatic treatment. He was started on aspirin and statin therapy, but anticoagulation was withheld due to bleeding concerns. The external ventricular drain was removed nine days after the surgery. He continued with active rehabilitation. CONCLUSIONS: Young patients with COVID-19 infection may be more susceptible to stroke, even in the absence of risk factors. Standard treatment with aspirin and statins remains essential in the management of COVID-19 related stroke. Anticoagulation for secondary prevention in those with atrial fibrillation should not be routine and has to be carefully evaluated for its benefits compared to the potential harms of increased bleeding associated with COVID-19 infection.

A study comparing depression, anxiety, and coping styles between high school students attending and not attending coaching class for medical entrance examination.

BACKGROUND: Various kinds of stressors and psychological problems have been reported in the adolescent student population. This study assessed and compared depression, anxiety, and various coping styles among high school students attending coaching classes for medical entrance examination (MEE) and those not. MATERIALS AND METHODS: Systemic random sampling technique was used to recruit 400 high school students with equal number of those attending (Group 1) and those not attending any coaching class for MEE (Group 2). They underwent screening for depression and anxiety through Patient Health Questionnaire-9 and Generalized Anxiety Disorder 7-item. Coping styles were assessed through brief COPE inventory. Screening positive subjects were assessed in detail by a psychiatrist using ICD-10 (International Classification of Diseases 10th Revision), Diagnostic Criteria for Research (DCR). The severity of depression and anxiety was measured through HAM-D and HAM-A, respectively. RESULTS: Depression and anxiety were reported by higher proportion of Group 1 (36%) than Group 2 (22%), χ 2(1) = 9.52; P = 0.002. In both the groups, depressive disorder was the most common, followed by generalised anxiety-disorder and mixed anxiety-depression. The severity of depression (HAM-D score) and anxiety (HAM-A Score) was significantly more Group 1. "Active coping" (χ 2= 4.79 P = 0.02) and "Humor" (χ 2= 30.90, P ≤ 0.01) were more commonly used by healthy students, while "Religious coping" (χ 2= 37.92 P ≤ 0.01) were the most common among those diagnosed with depression/anxiety disorder. CONCLUSION: Higher prevalence of the psychological problems in adolescent school students preparing for MEE highlights the importance of aptitude assessment, career counseling, and school mental health program before their exposure to the competitive academic atmosphere.

Dissipation kinetics and risk assessment of iprovalicarb + propineb fungicide in tomato under different agroclimates.

Multi-location supervised field trials in India were conducted with a combination pesticide formulation (iprovalicarb 5.5% + propineb 61.25%, 66.75% WP) in tomato to study dissipation behavior at single (iprovalicarb 137.5 g a.i. ha-1 + propineb 1531.25 g a.i. ha-1) and double (iprovalicarb 275 g a.i. ha-1 + propineb 3062.5 g a.i. ha-1) dose. The samples were processed using a modified QuEChERS method for iprovalicarb and acid hydrolysis followed by carbon disulfide estimation for propineb and confirmation of their respective residues by LC-MS/MS and GC-MS. Both the fungicides in tomato fruits obey first-order kinetics irrespective of location and doses. Half-life (t1/2) values at all the four locations ranged from 1.08 to 4.67 days for iprovalicarb and 3.36 to 11.41 days for propineb in tomato. The Food Safety and Standards Authority of India (FSSAI) has set MRL of 1 mg kg-1 for propineb, but no MRL is yet fixed for iprovalicarb. Using OECD MRL calculator, the calculated MRL for iprovalicarb and propineb was found to be 2 and 4 mg kg-1, respectively. The hazard quotient (HQ) < 1, theoretical maximum daily intake (TMDI) < acceptable daily intake (ADI), TMDI < maximum permissible intake (MPI), percent acute hazard index (% aHI) ≤ 1, and percent chronic hazard index (% cHI) < 1 for both the fungicides indicated that the combination formulation will not pose any dietary risk and thus considered safe for human health.

Dissipation kinetics and consumer risk assessment of novaluron + lambda-cyhalothrin co-formulation in cabbage.

Cabbage, one of the most popular vegetables in the world is infested by several insect-pests and diseases. Novaluron, a chitin synthesis inhibitor and lambda-cyhalothrin, a synthetic pyrethroid group insecticide are used to manage insect-pests on cabbage. The dissipation kinetics and risk assessment of combination formulation (novaluron 9.45% + lambda-cyhalothrin 1.9%) with different modes of action has not yet been investigated in cabbage. Multi-location supervised field trials were therefore, conducted in different agro-climatic regions of India for safety evaluation of the combination product. The co-formulation at the recommended (novaluron 750 g a.i. ha-1 + lambda-cyhalothrin 750 g a.i. ha-1) and double the recommended (novaluron 1500 g a.i. ha-1 + lambda-cyhalothrin 1500 g a.i. ha-1) dose was sprayed on the cabbage crop. The samples were extracted and cleaned up using a modified QuEChERS method, and the residues analyzed by GC-ECD and GC-MS. The half-life (t1/2) varied between 1.77 and 2.51 and 2.00-3.38 days for novaluron and 1.36-2.24 and 1.69-3.82 days for lambda-cyhalothrin in cabbage at respective doses. The Food Safety and Standards Authority of India (FSSAI) has set the MRL of 0.7 mg kg-1 for novaluron at PHI of 5 days, and no MRL is set for lambda-cyhalothrin in cabbage. On the basis of OECD MRL calculator, the MRLs of 0.6 and 1.5 mg kg-1 for novaluron and lambda-cyhalothrin, respectively were calculated at the respective doses at PHI of 3 days. Hazard quotient (HQ) <1, theoretical maximum daily intake (TMDI) < acceptable daily intake (ADI) and < maximum permissible intake (MPI), percent acute hazard index (% aHI) <1, and percent chronic hazard index (% cHI) <1 for both novaluron and lambda-cyhalothrin suggested that the combination formulation is safe and will not pose any dietary risk to the consumers. The study will be helpful to conduct risk assessment of other pesticides/combination pesticides on food crops on which their MRLs have not yet been fixed.

Persistence, dissipation, and risk assessment of a combination formulation of trifloxystrobin and tebuconazole fungicides in/on tomato.

Multi-locational supervised field trials were conducted in different agro-climatic regions in India to study dissipation of trifloxystrobin and tebuconazole in tomato after spraying a combination formulation (trifloxystrobin 25% + tebuconazole 50%, 75WG) at recommended doses: (i) single (trifloxystrobin 87.5 g a.i. ha-1 + tebuconazole 175 g a.i. ha-1) and (ii) double (trifloxystrobin 175 g a.i. ha-1 + tebuconazole 350 g a.i. ha-1). Fruit samples were extracted with ethyl acetate using a modified QuEChERS method. The residues (parent fungicides + metabolite) were analyzed and confirmed by GC-ECD and GC-MS, respectively. The half-life (t1/2) of trifloxystrobin and tebuconazole in tomato varied from 1.08 to 1.72 and 1.13 -to 1.64 days at single; and 1.27 to 2.13 and 1.24 to 1.96 days at double dose, respectively. Since maximum residue limit (MRL) at pre-harvest interval (PHI) of 5 days is impractical, as tomato is usually harvested and consumed almost everyday after the last spray, the risk assessment was performed at minimum PHI of 1 day. Accordingly, on the basis of supervised field trial data and using OECD MRL calculator, MRL of 0.5 and 1.5 mg kg-1 at single dose were proposed for trifloxystrobin and tebuconazole in/on tomato, respectively.

Development, validation of QuEChERS-based method for simultaneous determination of multiclass pesticide residue in milk, and evaluation of the matrix effect.

Extraction and quantification of pesticide residue from the milk matrix at or below the established maximum residue limit (MRL) is a challenging task for both analytical chemists and the regulatory institutions to take corrective actions for the human health and safety. The main aim of the study is to develop a simple rapid and less expensive QuEChERS extraction and cleanup method for simultaneous analysis of 41 multiclass pesticide residue in milk by gas chromatography-electron capture detector (GC-ECD), followed by confirmation of the residues with gas chromatography-mass spectrometer (GC-MS). Effect of sorbent type, temperature, spiking concentration, matrix effect (ME), measurement uncertainty (MU), inter- and intra-assay repeatability, reproducibility of recovery, and trueness of the results were investigated to validate the effectiveness of the method. Limit of determination (LOD) and limit of quantitation (LOQ) for all the analytes ranged within 0.001-0.02 and 0.002-0.05 µg mL-1, respectively. The % recovery of all the pesticides ranged between 91.38 and 117.56% with relative standard deviation (RSD) below 2.79%. The MU for all the analytes was ≤29% of respective LOQs, and except for few pesticides, the ME was largely negative. The method fulfilled all the SANTE guidelines and thus can be extended for routine analysis of multiclass pesticide residue in milk.

Attitude of undergraduate medical students toward psychiatry: A cross-sectional comparative study.

CONTEXT: Both psychiatry as a specialty and mental illnesses carry a lot of stigmatizing attitudes. Even medical professionals are not immune to prevailing stigma. Psychiatrists are perceived to have less scientific attitude, earn less money, to be less respected, and to have less prestige. AIMS: The present study was designed to know the attitude of medical students with different years of exposure to medical education, toward psychiatry as a specialty. SETTINGS AND DESIGN: The study was conducted at JLN medical College, Ajmer. The participants were divided into two groups, undergraduate and interns, respectively. It was a cross-sectional descriptive study. MATERIALS AND METHODS: Self-administered sociodemographic and Attitude Toward Psychiatry-30 items questionnaires were given to the second-year and medical intern and the scores were analyzed using appropriate statistical tools. STATISTICAL ANALYSIS USED: Student's t-test and Chi-square test using SPSS version 21. RESULTS: Nearly 84% of second-year medical students and 52% of interns had positive attitude toward psychiatry (P = 0.001). Only five second-year (5%) and two intern (1.8%) students affirmatively indicated to choose psychiatry as a career choice, while 73% denied choosing psychiatry as a specialty. CONCLUSIONS: Second-year medical students showed more positive attitude than the intern group. Increasing negative attitude in higher classes might be due to poor teaching of psychiatry in under graduate training, ridiculous stereotypic comments and remarks by medical teachers and practitioners belonging to other specialty branches.

Lead: Tiny but Mighty Poison.

The documentation of lead toxicity (plumbism) dates back to the times when man learnt its various applications. This versatile heavy metal is non-degradable and its ability to get accumulated in the body that goes undiagnosed, makes it a serious environmental health hazard. Lead is now known to affect almost every organ/tissue of the human body. With irreversible effects on neurobiological development of young children and foetus, its toxicity has lasting implications on the human life. Outlining the symptoms, diagnosis and treatment therapy for lead poisoning, the present review elaborates the pathophysiological effects of lead on various organs. This will be of immense help to the health professionals so as to inculcate a better understanding of the lead poisoning which otherwise is asymptomatic. With chelation therapy being the classic path of treatment, new strategies are being explored as additive/adjunct therapy. It is now understood that lead toxicity is completely preventable. In this regard significant efforts are in place in the developed countries whereas much needs to be done in the developing countries. Spreading the awareness amongst the masses by educating them and reducing the usage of lead following stricter industry norms appears to be the only roadmap to prevent lead poisoning. Efforts being undertaken by the Government of India and other organisations are also mentioned.

Pediatric Percutaneous Nephrolithotomy-Experience of a Tertiary Care Center.

OBJECTIVE: To present the experience of pediatric percutaneous nephrolithotomy (PCNL) of our center. MATERIALS AND METHODS: This study was conducted from 1995 to 2015, on patients <15 years of age having renal and upper ureteral stones who underwent PCNL. Stones were classified as per Guy's stone score (GSS). Standard bull's eye technique was used for subcostal puncture. To avoid supracostal puncture, puncture was done in full inspiration or by oblique tract. If these maneuvers failed, then supracostal puncture was done. Tract was dilated to 24F. RESULTS: Six hundred sixty PCNLs were performed on 639 patients. Puncture was subcostal in 87.6% cases with tract dilated as much as 24F. Pelvicaliceal system was most commonly accessed through middle calix (73.94%). Upper caliceal puncture (23.78%) was more frequently used in complete (82.35%) and partial staghorn (51%) stones. Two tracts were made in 16 (2.42%) cases, because of large stone burden. Average operative time was significantly longer in complex (45.43 minutes) compared to simple stones (29.39 minutes). Overall success rate was 94.39%, but it was significantly lower in partial (91.37%) and complete staghorn stones (82.35%). Complications were present in 21.66% cases and were classified according to Clavien grading. Majority of patients (97.9%) had minor complications (Clavien grade 1 & 2). On multivariate analysis, GSS ≥2, stone size >200 mm2, and multiple caliceal, partial, and complete staghorn stones were predictors of failure and complications. CONCLUSION: PCNL is a minimally invasive surgical technique for removal of renal and upper ureteral stones, which have low morbidity rate, high success rate, and short hospital stay. Although the uses of smaller instruments are on the rise, procedure can still be safely performed in children using adult instruments. Supracostal approach if done cautiously does not increase morbidity rate.

Aphid-repellent pheromone E-ß-farnesene is generated in transgenic Arabidopsis thaliana over-expressing farnesyl diphosphate synthase2.

BACKGROUND AND AIMS: Plant-synthesized sesquiterpenes play a pivotal role in chemotactic interactions with insects. Biosynthesis of functionally diverse sesquiterpenes is dependent on the availability of a pool of the precursor farnesyldiphosphate (FDP). In Arabidopsis thaliana, FPS2, encoding cytosolic farnesyldiphosphate synthase, is implicated in the synthesis of cytosolic FDP, but it is not known whether enhanced levels of FDP have a commensurate effect on sesquiterpene-mediated defence responses. This study examined transgenic arabidopsis plants generated to over-express FPS2 in order to determine if any effects could be observed in the response of aphids, Myzus persicae. METHODS: Transgenic arabidopsis plants were generated to over-express FPS2 to produce FPS2 in either the cytosol or the chloroplasts. Morphochemical analyses of the transgenic plants were carried out to detremine growth responses of roots and shoots, and for GC-MS profiling of sesquiterpenes. Aphid response to hyrdo-distillate extracts and head-space volatiles from transgenic plants was assessed using a bioassay. KEY RESULTS: Either over-expression of FPS2 in the cytosol or targetting of its translated product to chlorplasts resulted in stimulatory growth responses of transgenic arabidopsis at early and late developmental stages. GC-MS analysis of hydro-distillate extracts from aerial parts of the plants revealed biosynthesis of several novel sesquiterpenes, including E-ß-farnesene, an alarm pheromone of aphids. Both entrapped volatiles and hydro-distillate extracts of the transgenic leaves triggered agitation in aphids, which was related to both time and dose of exposure. CONCLUSIONS: Over-expression of FPS2 in the cytosol and targeting of its translated product to chloroplasts in arabidopsis led to synthesis of several novel sesquiterpenes, including E-ß-farnesene, and induced alarm responses in M. persicae. The results suggest a potential for engineering aphid-resistant strains of arabidopsis.

Chemoprotective role of triphala against 1,2-dimethylhydrazine dihydrochloride induced carcinogenic damage to mouse liver.

The present study was carried out to investigate the protective role of Triphala (a combination in equal proportions by weight of fruit powder of Terminalia belerica, Terminalia chebula and Emblica officinalis) against 1,2-dimethylhydrazinedihydrochloride (DMH) induced Endoplasmic reticulum stress (ER stress) in mouse liver. An oral dose of 3 mg/kg body wt in drinking water for 5 weeks significantly (P < 0.001) increased the levels of serum glutamate oxaloacetate transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), serum Alkaline phosphatase (ALP) and total bilirubin thus suggesting damage to mouse liver and biliary dysfunction. The DMH administration invariably led to increase in the liver microsomal proteins of molecular weight of about 29 (ERp29) and 53 kDa (ERp53) and decrease in the protein of molecular weight of 36 kDa (ERp36) thereby suggesting the interference of DMH and its metabolites with normal protein biosynthesis and folding, in the reticular membranes of the liver cells thus developing ER stress. Histological studies show necrosis, large sized hepatocytes with increased N:C ratio, aberrant mitotic figures and prominent nucleoli in the liver of DMH treated mice. In animals fed 5% Triphala in diet (w/w) during DMH administration, there was significant decrease in the above changes in the liver suggesting the suppression of DMH induced ER stress in liver. Triphala significantly (P < 0.05) decreased lipid peroxidation and also the activity of lactate dehydrogenase (LDH) in mouse liver. It simultaneously increased the level of reduced glutathione (GSH) and the activity of glutathione-S-transferase (GST) thereby suggesting that it prevents peroxidative damage and also diverts the active metabolites (electrophiles) of DMH from their interactions with critical cellular bio-molecules which could be responsible for its protective action against DMH.