Characterization of bound phenthoate residues in citrus

The metabolism and fate of phenyl ring-labeled¹⁴C-phenthoate {O,O- dimethylS-[-(carboethoxy)benzyl] phosphorodithioate} was examined in the Valencia orange fruit with emphasis on the characterization of bound phenthoate residues in the fruit peel. The products recovered from the citrus fruit wash were unchanged phenthoate, phenthoate oxon, demethyl phenthoate, phenthoate acid, ethyl mandelate, and mandelic acid. The same products, with the exception of phenthoate oxon, were found in the acetone extract of the fruit peel. Enzymatic hydrolysis of the bound residue in the peel with-glucosidase, followed by acidic and basic hydrolysis gave ethyl mandelate as the major product, followed by mandelic acid, demethyl phenthoate and phenthoate acid. Phenthoate was metabolized and conjugated in citrus fruits into detoxication products.     

Penetrating injury of the cornea by a barbed fish hook and its surgical management by “Cut-it out technique”

Fishing is a worldwide pastime enjoyed by millions of people. Ocular fishing injuries though uncommon may cause potentially devastating ocular trauma. We report a rare case of penetrating injury of the cornea by a barbed fish hook and its successful surgical management by “cut-it out technique”. We are discussing the various techniques available for removal of fish hooks. The hook can be successfully removed with minimal trauma to ocular structures by understanding the structure of the fish hook and by employing the appropriate method of extraction.     

Malathion carboxylesterase activity in human liver and its inactivation by isomalathion.

Malathion carboxylesterase activity was assayed in 16 samples of human liver obtained at autopsy. In general, this survey did not suggest correlations between malathion carboxylesterase activity and age, sex, or cause of death. However, the lowest levels of carboxylesterase activity were found in two severely steatotic livers and one cholestatic liver, indicating a possible relationship between liver pathology and its capacity to detoxify malathion. A soluble stable and partially purified preparation of human liver malathion carboxylesterase was obtained by detergent extraction and fraction of whole liver homogenate. The activity of this fraction was susceptible to concentration-dependent inactivation by isomalathion but was resistant to three other impurities isolated from technical malathion. The potency of isomalathion as a malthion carboxyl-esterase inactivator supports the possibility that this compound may have contributed to the recently reported epidemic of malathion poisonings in Pakistan.     

Malathion carboxylesterase titer and its relationship to malathion toxicity

The titer of malathion carboxylesterase in liver and sera of rats, three strains of mice, and five groups of pretreated mice was correlated with the malathion LD50 values measured in these groups. The equation of a regression line relating enzyme titer to toxicity was used to predict the median lethal dosage of purified malathion to humans. The mean value, 3655 mg/kg, was compared with dosages ingested in actual cases of human malathion poisonings. A discrepancy was noted between the LD50 value predicted in this study and the life-threatening doses of commercial malathion reported in the clinical literature. The unexpectedly high toxicity of commercial malathion may be related to its content of esterase-inactivating impurities.     

A rare case of superior vena cava syndrome in a patient on VV-ECMO

Superior vena cava (SVC) syndrome is caused by either extrinsic compression of SVC or intrinsic lesions within SVC leading to obstruction of SVC and consequently swelling of the face, neck, and upper extremeities. Iatrogenic incidence is on the rise due to the use of long-term indwelling catheters. SVC syndrome in extracorporeal membrane oxygenation (ECMO) has been defined in neonatal and paediatric ECMO cases. Only one case of SVC syndrome in adult has been defined while using a double-lumen ECMO cannula. Our case describes a case of SVC syndrome in a case on veno-venous ECMO (VV-ECMO) with an internal jugular vein (IJV) return cannula which is unheard of. A high index of suspicion is required to diagnose SVC syndrome.     

Inactivation of esterases by impurities isolated from technical malathion.

Compounds previously identified as contaminants of technical malathion were found to diminish the activity of serum malathion carboxylesterase, liver malathion carboxylesterase, and serum cholinesterase in vitro and in vivo. The compounds tested were, in increasing order of potency, O,O,S-trimethyl phosphorodithioate, O,O,S-trimethyl phosphorothioate, O,S,S-trimethyl phosphorodithioate, and O,S-dimethyl S-(1,2-dicarboethoxy)ethyl phosphorodithioate. In vivo, the diminutions of serum esterase activity caused by these compounds were transient, with the exception of the diminutions caused by O,O,S-trimethyl phosphorothioate, which persisted for at least 54 hr. The most potent of these esterase inactivators, also known as isomalathion, is of particular interest as a possible contributor to an epidemic of malathion poisonings among malaria workers in Pakistan.     

Sonographic and CT features of splenogonadal fusion

Splenogonadal fusion is a rare congenital anomaly characterized by fusion of splenic tissue to the gonad. Although more than 150 cases have been described in the literature, there are only anecdotal reports of the diagnosis of this entity before surgery. Preoperative recognition of this anomaly permits avoidance of radical surgical procedures such as orchiectomy. The radiological literature regarding this condition is scant. We report the imaging findings in a child with splenogonadal fusion, where sonography and contrast-enhanced spiral CT permitted characterization of the lesion and delineation of the vascular supply to the aberrant splenic tissue and the testis.     

Incidence of re-surgery after manual small-incision cataract surgery at a tertiary eye-care center in South India

Purpose:To study the incidence of re-surgery after manual small-incision cataract surgery (MSICS) at a tertiary eye-care center in South India and to compare the re-surgery rate between trainees and experts.Methods:A retrospective study was conducted at a tertiary eye-care center in Andhra Pradesh state of South India, which included 19,515 patients who underwent MSICS between 2012 and 2022 with 369 eyes of 369 patients who underwent re-surgery within 1 week of primary surgery. Factors included demographic data, type of re-surgery, that is, wound re-suturing, IOL repositioning, cortical wash, as well as anterior chamber (AC) wash.Results:19,515 eyes from the year 2012–2022 were analyzed. Most of the patients undergoing re-surgery belonged to the age group of 61–70 years (40.3%). Wound re-suturing was the more frequently performed re-surgery (47.6%). Wound re-suturing rates were comparable between the trainees and experts, whereas IOL repositioning, cortical wash, and AC wash were higher in the cases performed by trainees though statistically not significant.Conclusion:Careful pre-operative assessment, training under supervision, and other measures can be taken to reduce the re-surgery rates. Timely diagnosis and early treatment can give better outcomes and prevent devastating complications like endophthalmitis.     

Delirium in Ventilated Patients: Is ABCDEF Bundle the Solution?

How to cite this article: Rangappa R. Delirium in Ventilated Patients: Is ABCDEF Bundle the Solution? Indian J Crit Care Med 2021;25(7):743–744.     

Scarless Cholecystectomy: Laparoscopic Cholecystectomy with Abdominoplasty

Three patients presented to our hospital with abdominal wall laxity and symptomatic cholelithiasis. All of them wanted to undergo a cosmetic procedure (abdominoplasty) to reduce the abdominal wall laxity. They were also diagnosed to have cholelithiasis and had intermittent episodes of pain in the right upper quadrant of the abdomen. The ports for laparoscopic cholecystectomy were made in such a way that all the ports sites were removed in the skin flap that was excised during abdominoplasty, and there was no scar in the upper abdomen. The procedure was completed without leaving any telltale signs of laparoscopic cholecystectomy, and this led to a better cosmetic result from the patients’ point of view.