A study of neurologic symptoms on exposure to organophosphate pesticides in the children of agricultural workers

Pesticides are used extensively throughout the world in agriculture and in pest control as well as for community health purposes. Organophosphate (OP) pesticide self-poisoning is an important clinical problem in rural regions of the developing world that kills an estimated 200,000 people every year. Unintentional poisoning kills far fewer people but is an apparent problem in places where highly toxic OP pesticides are available. Neurologic dysfunction is the best documented health effect of pesticide exposure. High-level exposure has both acute and long-term neurologic signs and symptoms, and adverse effects have been reported in most type of pesticides, including organophosphate (OP), carbamate, organochlorine, and pyrethroid insecticides, herbicides, fungicides, and fumigants. Acute OP pesticide exposure can involve in wide range of both central and peripheral neurologic symptoms. Increased neurologic symptom prevalence may provide early evidence of neurologic dysfunctions, before clinically measurable signs are evident.

In this study, we analyzed the cross-sectional data on neurologic signs and symptoms from 225 rural children, both males (n = 132) and females (n = 93) who were occupationally and paraoccupationally exposed to methyl OPs (dichlorvos, fenthion, malathion, methyl parathion) and ethyl OPs (chlorpyrifos, diazinon, ethyl parathion) as they belonged to agricultural families handling, mixing, and spraying the OP pesticides. The children completed a specially designed questionnaire (Q16) on neurologic symptoms associated with pesticide exposure with their parental help. A suitable reference group consisting of rural children (n = 50) never involved in pesticide handling (neither outdoor nor indoor) belonging to similar socioeconomic strata included in the study to compare the prevalence of various neurologic symptoms between the two groups.

Among all the neurologic self-reported symptoms, headache, watering in eyes, and burning sensation in eye/face were the most important clinical manifestations attributed to OP pesticide exposure. These symptoms could probably be the consequence of chronic effects of most pesticides on the central nervous system. The muscarinic symptoms reported the maximum prevalence of salivation (18.22%), whereas lacrimation was observed in 17.33% cases, followed by diarrhea in 9.33% cases. The nicotinic clinical manifestations of acute OP poisoning revealed excessive sweating in 13.78% cases and tremors in 9.3% cases followed by mydriasis in 8.4% exposed children. The characteristic cholinergic symptoms, such as insomnia, headache, muscle cramps, weakness, and anorexia were also reported by both male and female exposed children. The high frequency of neurologic symptoms observed in the study may be due to parasympathetic hyperactivity due to the accumulated ACh resulting from AChE inhibition.

Comparison of RIPASA and Alvarado scores for the diagnosis of acute appendicitis

INTRODUCTION

The accuracy of the Alvarado score in diagnosing acute appendicitis in an Asian population has been disappointingly low. We prospectively compared the RIPASA score with the Alvarado score for the diagnosis of acute appendicitis.

METHODS

200 consecutive patients who presented to the Accident and Emergency Department with right iliac fossa pain were recruited in the study. Both the RIPASA and Alvarado scores were derived, but decisions for appendicectomy were based on clinical judgement. Receiver operating curve (ROC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for both scoring systems were calculated.

RESULTS

Only 192 out of the 200 patients who satisfied the inclusion and exclusion criteria were included in the analysis. At the optimal cut-off threshold score of 7.5 derived from the ROC, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of the RIPASA score were 98.0 percent, 81.3 percent, 85.3 percent, 97.4 percent and 91.8 percent, respectively. At the cut-off threshold score of 7.0 for the Alvarado score, the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 68.3 percent, 87.9 percent, 86.3 percent, 71.4 percent and 86.5 percent, respectively. The RIPASA score correctly classified 98 percent of all patients confirmed with histological acute appendicitis to the high-probability group (RIPASA score greater than 7.5) compared with 68.3 percent with the Alvarado score (Alvarado score greater than 7.0; p-value less than 0.0001).

CONCLUSION

The RIPASA score at a cut-off threshold total score of 7.5 is a better diagnostic scoring system than the Alvarado score for the diagnosis of acute appendicitis in our local setting.

Protective potential of Bacopa monniera (Brahmi) extract on aluminum induced cerebellar toxicity and associated neuromuscular status in aged rats

The present study attempts to assess the comparative effects of Bacopa monniera, (40 mg/kg body weight) and donepezil (2.5 mg/kg b. wt) on aluminum (100 mg / kg b. wt. of AlCl3) mediated oxidative damage in the cerebellum of aged rats (24 months) along with the associated dysfunctioning of neuromuscular coordination and motor activity. A significant decrease in the activities of antioxidant enzymes and increased total reacting oxygen species, lipid and protein peroxidation products observed in aluminum exposed rats. We observed that treatment with B. monniera extract restored the altered antioxidant enzyme activities more, when compared with donepezil. However, acetylcholinesterase showed similar effect both in donepezil and B. monniera treated groups. The content of aluminum was increased in all experimental groups, however, iron content was found increased in all groups except the B. monniera treated groups. Moreover, aluminum treated groups of rats exhibited significant changes in behavioral profiles but these changes were in both B. monniera and donepezil treated groups. The light microscopic and ultrastructural studies revealed damaged Purkinje's neurons and altered granular cell layer along with the increased accumulation of lipofuscin granules in aluminum treated animals. These changes were quite less pronounced in B. monniera group than that of donepezil and this may be due to the reduction of excess iron content by B. monniera. On the basis of our results it may be concluded that Al may be linked with cerebellar degeneration and neuromuscular disorders while Bacopa monniera extract helps in reversing these changes.

Emergence of amantadine-resistant avian influenza H5N1 virus in India

This study reports the genetic characterization of highly pathogenic avian influenza (HPAI) virus (subtype H5N1) isolated from poultry in West Bengal, India. We analyzed all the eight genome segments of two viruses isolated from chickens in January 2010 to understand their genetic relationship with other Indian H5N1 isolates and possible connection between different outbreaks. The hemagglutinin (HA) gene of the viruses showed multiple basic amino acids at the cleavage site, a marker for high virulence in chickens. Of greatest concern was that the viruses displayed amino acid substitution from serine-to-asparagine at position 31 of M2 ion channel protein suggesting emergence of amantadine-resistant mutants not previously reported in HPAI H5N1 outbreaks in India. Amino acid lysine at position 627 of the PB2 protein highlights the risk the viruses possess to mammals. In the phylogenetic trees, the viruses clustered within the lineage of avian isolates from India (2008-2009) and avian and human isolates from Bangladesh (2007-2009) in all the genes. Both these viruses were most closely related to the viruses from 2008 in West Bengal within the subclade 2.2.3 of H5N1 viruses.

Ethnographic mapping of alcohol use and risk behaviors in Delhi

This paper examines mapping and related data-gathering at geographical locations of vulnerable urban groups with regard to risky sexual behaviors and alcohol/drug use in the capital city of Delhi. The aim is to describe the situations of special geographic locations and sub-groups in relation to alcohol/drug use and risks of HIV/STI infections. The study was part of a community program for alcohol and drug users in slum communities in West and East Delhi carried out by the National Drug Dependence Treatment Centre (NDDTC) of the All India Institute of Medical Science (AIIMS), New Delhi, India. As part of a WHO multi-centered qualitative study among selected groups, mapping was done at different sites concerning alcohol use, social contexts, involvement in sexual risk behavior, availability of sex partners and related factors. Easy access to alcohol and drugs, accompanied by availability of sex workers appeared as compound risk factors in the study sites. Reported risky sexual behaviors included nonuse or irregular use of condoms, multiple sex partners, group sex, and anal sex with hijras (eunuchs).

Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis

INTRODUCTION

Acute appendicitis is one of the most common surgical emergencies. The Alvarado and modified Alvarado scores have been developed to aid diagnosis, but both scoring systems have poor sensitivity and specificity when applied in Middle Eastern and Asian populations. The aim of this study was to develop a new scoring system that is suitable for the local population.

METHODS

Clinical data from 312 patients who had undergone an emergency appendicectomy was retrospectively collected and used to generate 15 parameters. The probability was calculated and a score of 0.5, 1.0 or 2.0 was allocated to each parameter. The receiver operating curve (ROC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the new scoring system were derived using the StatsDirect statistical software.

RESULTS

The 15 parameters and the scores generated were age (less than 40 years is 1 point; greater than 40 years is 0.5 point), gender (male is 1 point; female is 0.5 point), right iliac fossa (RIF) pain (0.5 point), migration of pain to RIF (0.5 point), nausea and vomiting (1 point), anorexia (1 point), duration of symptoms (less than 48 hours is 1 point; more than 48 hours is 0.5 point), RIF tenderness (1 point), guarding (2 points), rebound tenderness (1 point), Rovsing's sign (2 points), fever (1 point), raised white cell count (1 point), negative urinalysis (1 point) and foreign national registration identity card (1 point). The optimal cut-off threshold score from the ROC was 7.5, with a sensitivity of 88 percent, a specificity of 67 percent, a PPV of 93 percent and an NPV of 53 percent. The negative appendicectomy rate decreased significantly from 16.3 percent to 6.9 percent, which was a 9.4 percent reduction (p is 0.0007).

CONCLUSION

The new appendicitis scoring system looked promising when applied to our settings, and had a better sensitivity and specificity than the Alvarado score when applied to Asian populations. A significant reduction in the negative appendicectomy rate was also predicted. A prospective evaluation of this new appendicitis scoring system, referred to as the RIPASA score, is ongoing.

Olanzapine-induced hepatopathy in albino rats: A newer model for screening putative hepatoprotective agents, namely silymarin

Backgrounds:

This study was conducted to establish olanzapine-induced hepatopathy in Wistar albino rats as a newer model to screen putative hepatoprotective agents namely silymarin.

Materials and Methods:

Albino rats were divided into three groups, namely vehicle control group (CG), olanzapine-treated group (OZ), and olanzapine plus silymarin (OZS) treated groups. Both the OZ and OZS groups were treated with the same dose of intraperitoneal olanzapine for 6 weeks and group OZS additionally received oral silymarin. Baseline and terminal hepatic enzymes (SGOT, SGPT, and ALP) were measured in all three groups.

Results:

Histopathological examination of livers of both OZ and OZS groups showed degenerative changes, whereas those of control group showed normal architecture. Liver enzyme levels showed statistically significant rise in comparison to the control group as well as the respective base line values in both the test groups, but the differences in the rise of liver enzymes between the two test groups were not statistically significant.

Conclusion:

Olanzapine-induced hepatopathy in rats can be used as a model for screening putative hepatoprotective agents and in our setting silymarin has failed to provide any hepatoprotection.

A study of clinico-haematological profiles of pancytopenia in children

We report on the clinico-haematological profile of pancytopenia in children from the Departments of Pediatrics and Pathology, Institute of Medical Sciences, Banaras Hindu University, India, over a period of 30 months. Pancytopenia was defined as: haemoglobin <10 g/dL, absolute neutrophil count 1.5 × 109/L and platelet count <100 × 109/L. A detailed history, clinical examination and haematological parameters were recorded. Bone marrow aspiration and trephine biopsy were carried out in all cases. One hundred and five cases aged 1.5–18 years, with a mean age of 8.6 years, were included in the study. Aplastic anaemia was the most common cause of pancytopenia (43%) followed by acute leukaemia (25%). Infections were the third most common cause of pancytopenia of which kala azar was the most common. Megaloblastic anaemia was seen in 6.7%.

Test of isospin symmetry via low-energy 1H(pi{-},pi{0})n charge exchange

We report measurements of the pi;{-}p-->pi;{0}n differential cross sections at six momenta (104-143 MeV/c) and four angles (0 degrees -40 degrees ) by detection of gamma-ray pairs from pi;{0}-->gammagamma decays using a photon-pair spectrometer at TRIUMF. This kinematic region exhibits a vanishing zero-degree cross section from destructive interference between s and p waves, thus yielding special sensitivity to pion-nucleon dynamics. Our data and previous data do not agree, with important implications for earlier claims of large isospin-violating effects.

Structural influence on the magnetic and electronic properties of annealed Fe/Al multilayers

Temperature dependent magnetic and electronic properties of electron beam evaporated Fe/Al multilayer samples (MLS) with an average composition of Fe0.70A1(0.30) (MLS-A) and Fe0.50Al0.50 (MLS-B) have been investigated. A ferromagnetic behaviour in MLS-A and nonmagnetic behaviour in MLS-B is obtained after annealing the multilayers at 400 degrees C. The different magnetic behaviours can be interpreted in terms of constant increase of Fe-3d and Al-3sp hybridization accompanied by an increased de-localization of the d-electrons participating in the strong bonding of Fe with Al leading to formation of different Fe-Al phases (Fe3Al in MLS-A) and (FeAl in MLS-B) as suggested from valence band photoemission and X-ray diffraction measurements.

Thickness dependent structural, electronic, and optical properties of Ge nanostructures

In the present paper, we have investigated structural, optical as well as electronic properties of electron beam evaporated Ge thin films having layer thicknesses ranging from ultra-thin (5 nm) to thick (200 nm). The Raman spectra show that all peaks are shifted towards lower wave number as compared to their bulk counterparts and are considered as a signature of nanostructure formation and quantum confinement effect. The Raman line exhibits transformation from nanocrystalline to microcrystalline phase with a reduction in blue shift of peak position with increase in Ge film thickness (>5 nm). Similarly, the optical absorption spectra corresponding to these films also show reduction in blue shift effect, although Ge 5 nm film shows the absorption behaviour quite different from higher thickness films. The corresponding band gap values obtained from absorption measurements are much larger than bulk Ge and are mainly attributed to the effect of quantum confinement as expected for small size particles calculated from GIXRD patterns. AFM data in each case are correlated and discussed with structural as well as optical results to support the effect of growth morphology on the above-mentioned observations. The results are further supported by photoelectron spectroscopy (PES), photoluminescence (PL) and resistivity measurements and are interpreted in terms of crystallinity and quantum confinement effect.