Acute renal failure and hepatopathy consequent upon ingestion of cooked gallbladder of Indian carp: A case report.

Among freshwater fishes, the Indian Carp (Labeo rohita, "ROHU") is one of the most chosen species for Indian diets, but reports of toxicity are rare. This report is of a middle-aged healthy female who developed pain in the abdomen, vomiting, and diarrhea within hours of ingestion of a cooked portion of Indian carp's intestines and gallbladder. There was an inadvertent delay in diagnosis over 1 week due to the rarity of incidence and non-availability of a definite diagnostic indicator coupled with the lack of awareness and high index of suspicion. However, the patient could finally be diagnosed and treated appropriately after roving around many hospitals and then had life-threatening complications such as acute renal failure and hepatopathy, requiring repeated hemodialysis and supportive treatment before being fit for discharge. In this report, a detailed discussion of the clinical course and toxicological aspects are enumerated with a cautious note to spread awareness to facilitate prompt diagnosis.

External challenges for specialists dealing with forensic autopsies.

BACKGROUND: In addition to poor infrastructure, and human resource constraints, forensic medicine specialists in developing countries face many external challenges. OBJECTIVES: We aimed to investigate the prevalence, type, and source of external challenges confronting them including sex, age, religion, deceased's place of residence and the number of accompanying relatives. MATERIALS AND METHODS: This cross-sectional, observational study was conducted between August 2020 and July 2022 at the Mortuary of AIIMS, Bhubaneswar with the approval of the ethical committee. RESULTS: Of note, forensic medicine specialists faced external challenges in about one in five cases (20.5%). Most demands were to either minimise the autopsy procedure (n = 65) or to conduct the autopsy at inappropriate times (n = 58). The demands to minimise the autopsy procedure were significantly associated with the deceased's age (p = 0.046), religion (p = 0.010), socioeconomic class (p = 0.020) and manner of death (p = 0.019). CONCLUSIONS: Our study found that forensic medicine specialists in India face significant external challenges. Avoiding unnecessary complete autopsies, implementing night autopsies, and embracing minimally invasive autopsies are recommended to mitigate these challenges.

Outcome prediction using sequential organ failure assessment (SOFA) score and serum lactate levels in organophosphate poisoning.

Background: Organophosphorus compounds are widely used as pesticides in agriculture practicing countries like India. Since it is readily available and accessible, it is one of the most commonly used agents for suicidal poisoning. The current study was undertaken to evaluate the performance of the SOFA score (scoring system) and the serum lactate level (laboratory parameter) as a mortality predictor in organophosphorus poisoning. Material and Methods: This prospective observational study was conducted at AIIMS, Bhubaneswar, for 17 months. The study population included all patients with an alleged history of ingestion of organophosphorus (OP) compounds reporting to the casualty. The receiver operating characteristic (ROC) curve and the logistic regression analysis were used for the analysis. Results: In our study, 75 patients with OP poisoning were studied after satisfying the inclusion criteria. OP poisoning was commonly seen in married males aged 21-40 years. Twelve (16%) patients died during the process of treatment. There was a statistically significant difference in the mean SOFA score, serum lactate level, pH value, and mean duration of hospital stay between the discharged and the deceased patients. In the current study, the ROC curve analysis used to assess the predictor of the outcome of OP poisoning showed that the area under the curve for SOFA score and serum lactate level were 0.794 (95% CI 0.641-0.948) and 0.659 (95% CI 0.472-0.847), respectively. Conclusion: Sequential Organ Failure Assessment (SOFA) score is significantly associated with the outcome of organophosphate poisoning and can be utilized to predict mortality.

Ectopic pancreas, gastric, duodenal and colonic tissue in a case of persistent umbilical discharge: Report of two patients with review of literature.

One of the typical complaints in the pediatric population is umbilical discharge. Among the congenital causes, remnants of omphalomesenteric duct or patent urachus are often detected. On a few occasions, multiple types of ectopic tissue are present. We describe histopathologic findings of two cases reported recently at our center as pediatric umbilical lesions with associated ectopic tissue. Histopathology of the excised mass confirmed the patent omphalomesenteric duct with ectopic gastric, duodenal, and colonic mucosa and pancreatic tissue in two patients with the clinical presentation of umbilical discharge. There were no associated congenital anomalies in these patients. The presence of multiple ectopic gastrointestinal mucosa and pancreas in the umbilical mass is unusual. Herein, we report these cases because of its rarity, multiple ectopic tissues, and reviewing the literature of the reported cases of multiple ectopic tissues.

Lethal Neurotoxicity in Lambda-Cyhalothrin Poisoning: A Rare Case Report.

ABSTRACT: Agricultural poisons (insecticides and pesticides) are the most common types of poison implicated in the morbidity and mortality associated with acute poisoning. Suicidal ingestion is more frequent than accidental or homicidal poisonings. Pyrethroids are considered relatively safer than other insecticides. Lambda-cyhalothrin (LCH) belongs to the fourth-generation, type II synthetic pyrethroid. To the best of our knowledge, fatalities after LCH exposure have not yet been reported in the literature. Here, we describe a case of LCH poisoning in a 54-year-old male farmer after an accidental pipe burst in a sprayer while spraying in the field. The patient died 10 days after poisoning due to severe neurotoxicity resulting in bilateral parieto-occipital and brainstem infarcts. The histopathological features of the brain associated with LCH poisoning have been discussed in this report.

Use of Fogarty catheter as bronchial blocker for lung isolation in children undergoing thoracic surgery: A single centre experience of 15 cases.

Background and Aim: Various devices such as single lumen tubes, balloon-tipped bronchial blockers, and double-lumen tubes can be used for lung isolation in children, but no particular device is ideal. As such, there is a wide variation in lung isolation techniques employed by anaesthesiologists in this cohort of patients. This study aims to describe our experience with Fogarty catheters for lung isolation in children. Methods: This was a single centre, retrospective review of 15 children, below the age of 8 years, undergoing thoracic surgeries and requiring lung isolation. Demographic details, clinical parameters, complications during Fogarty catheter placement, number of attempts for placement, time taken for satisfactory lung isolation, and intraoperative complications were collected. Results: Successful lung isolation was achieved in all 15 children with Fogarty catheters of various sizes with the help of flexible bronchoscopy. Desaturation and bradycardia were the commonest complications seen during placement of the catheters but resolved with bag-mask ventilation. On average, 2 attempts were required for successful Fogarty placement. The mean time for successful lung isolation was 6.9 ± 1.3 minutes. The commonest intraoperative complication noted was desaturation, which resolved with an increase in FiO2 and positive end expiratory pressure. 2 children had migration of the device proximally to the trachea causing airway obstruction. The devices were successfully repositioned in both cases. Conclusion: Fogarty catheters can be used for successful lung isolation in children less than 8 years of age, undergoing thoracic surgery.

Large Spinal Abscess in a Neonate.

Spontaneous spinal epidural abscess is rare entity in neonates. These are surgical emergency in which early diagnosis and prompt decompression is necessary to avoid permanent cord damage. The diagnosis is based on clinical findings of paraplegia supported by radiological findings on an MRI. We found a large extra spinal abscess in an infant that on further evaluation showed a communicating epidural component, yet the baby was neurologically intact. The abscess was drained in emergency with clearance of epidural component and appropriate antibiotics instituted for Streptococcus pyogenes as per sensitivity. The patient is doing well at 6 months follow up.

Bioelectrochemical treatment of acid mine drainage (AMD) from an abandoned coal mine under aerobic condition.

In this study, a bioelectrochemical system (BES) was used to treat acid mine drainage (AMD) from an abandoned coal mine in the cathode chamber under aerobic condition. Activated sludge from a local wastewater treatment plant was used in the anode chamber of the BES to supply electrons to the treatment. After 7days, the pH of the cathode solution enhanced from 2.5 to 7.3. More than 99% of Al, Fe and Pb were removed, and removal rates of 93%, 91%, 89% and 69% were achieved for Cd, Zn, Mn and Co respectively with biocathode. Energy-dispersive X-ray spectroscopy (EDS) study revealed the deposition of the various types of metals on the cathode surface, and some metals were detected in the precipitates of the cathode chamber. The bacteria for AMD treatment was identified to be Serratia spp. using 16s rRNA gene amplification and sequencing. Scanning electron microscopy showed attached growth of the bacteria on the cathode. The bioelectrochemical treatment of the AMD was also compared with the biological treatment in a continuously stirred batch reactor (CSBR).

Sudden death as a complication of choriocarcinoma.

We report the case of a young man with a history of sudden death. On autopsy, a large retroperitoneal mass was found along with secondaries in the liver and lungs. No testicular abnormality was detected on palpation. Based on histopathological examination, it was diagnosed to be a case of choriocarcinoma. Unfortunately, it was not definitively determined whether the retroperitoneal mass represents the primary tumor or secondary involvement with testes being the primary source. It is important that forensic pathologists are aware of this disease as a potential cause of sudden death. The main focus of the paper is the approach of a forensic pathologist to a case of a sudden death when an unexpected and undiagnosed tumor is found in the retroperitoneum and not much information is available about the clinical history of the deceased.

Fatal Cleistanthus collinus toxicity: a case report and review of literature.

Cleistanthus collinus is an extremely toxic plant poison. We report a case of suicidal ingestion of boiled water decoction of C. collinus where the patient presented with abdominal pain and giddiness. There was persistent metabolic acidosis and fluctuation in the level of serum potassium. The ECG changes indicated a probable myocardial injury with conduction abnormality. At autopsy, the viscera were found to be congested. The toxins were detected in the viscera and blood by TLC and HPLC. Cleistanthin A and B, collinusin, and diphyllin are the principal toxic constituents of the plant. Consumption of a boiled decoction of leaves is highly toxic and, medical management of patients is mainly supportive because the molecular mechanisms of toxin action are unknown. In the recent years, C. collinus has created a considerable amount of interest because of its complex metabolites and their cytotoxic activities. Through this study, the authors have tried to highlight different properties pertaining to C. collinus.

Scale for assessment of lethality of suicide attempt.

BACKGROUND: Lethality of suicidal attempt provides useful information regarding the behavior. There is a perceived need for a clinically useful scale that can be easily adapted to various methods and circumstances of attempt. AIMS: The study intended to develop and test utility of a scale for measuring lethality that can reflect overall clinical observation taking into account various indicators of lethality and which can be used across clinical scenarios involving different methods. SETTINGS AND DESIGN: Cross-sectional study in a hospital. MATERIALS AND METHODS: The scale for assessment of lethality of suicide attempt (SALSA) has two components: The first component has four items indicating seriousness of the attempt and its likely consequences and the second component is the global impression of lethality. All the items are scored from 1 to 5, higher scores suggestive of increased lethality. SALSA was used to evaluate lethality of 82 consecutive suicide attempters; and it was compared with lethality of suicide attempt rating scale (LSARS) and risk-rescue rating scale. STATISTICAL ANALYSIS: Chi-square, t-test, analysis of variance, Cronbach's alpha, binary logistic regression. RESULT: There was significant correlation of SALSA score with that of LSARS (r: 0.89) and risk score of risk-rescue rating (r: 0.93, P < 0.001); and negative correlation with rescue score (r: -0.569; P < 0.001). Internal consistency reliability of SALSA was high (Cronbach's alpha: 0.94). Lethality scores of SALSA differentiated known groups with different lethality, e.g. deceased and survived; attempters with different levels of medical intervention: In-patient only, intensive care, ventilator support. SALSA score significantly predicted the lethal outcome (odds ratio: 3.2, confidence interval: 1.12-8.98). CONCLUSION: SALSA is a useful instrument for assessment of lethality of suicidal behaviors during clinical evaluations considering the ease of administration, its ability to differentiate clinical groups with known variations of lethality and clinical outcomes.