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IntroductionPediatric organophosphate insecticide poisonings are rare in the United States, and life-threatening toxicity is rarely seen. We report 2 accidental ingestions of the organophosphate insecticide coumaphos that resulted in life-threatening symptoms.Case reportsA 7-year-old boy and 10-year-old girl both presented from home after accidental ingestion of 1 "spoonful" of coumaphos 20% liquid (Asuntol; Bayer de Mexico, S.A. de C.V., Mexico D.F., Mexico). There were no other known ingestions. Both became rapidly symptomatic, with the boy developing dyspnea, vomiting, and depressed mental status and the girl developing headache and nausea. Soon afterward, the boy had witnessed cardiopulmonary arrest and the girl developed altered mental status and flaccid paralysis. Both were treated initially with atropine, but required no additional doses. On arrival to the pediatric intensive care unit (ICU), both patients received pralidoxime with subsequent plasma exchange and continuous venovenous hemodiafiltration (CVVHDF). Transient anemia, coagulopathy, transaminitis, and hyperglycemia developed in both patients. The girl was extubated on hospital day 6 and the boy on hospital day 11. The girl's course was complicated by aspiration pneumonia and an isolated seizure. The boy's course was complicated mainly by anoxic brain injury, associated seizures, neuroagitation, spasticity, and autonomic instability. The girl was discharged on hospital day 16 and remains asymptomatic 32 days after ingestion. As of 90 days after ingestion, the boy remains admitted to inpatient rehabilitation.DiscussionThe clinical benefit of pralidoxime, plasma exchange, and CVVHDF is uncertain in these cases. The optimal treatment regimen for organophosphate insecticide toxicity remains poorly defined.

In this study, the effects of two different biodegradable plastic additives on the thermal and mechanical properties of isotactic polypropylene were investigated, analyzed, and presented. Biosphere biodegradable plastic additive and another oxidative biodegradable plastic additive, D2W, were used in 0.25, 0.5, 1.0, 1.5, and 2.0 wt% to prepare two sets of isotactic polypropylene composites. Differential scanning calorimeter and optical polarized light microscope were used to analyze the obtained composites thermally while the mechanical properties of these composites were studied by conducting tensile and impact testing. The morphological results reveal that only monoclinic α spherulites were obtained when the polypropylene crystallizes isothermally from the melt, it was found that both biodegradable plastic additives used decreases the size of the spherulites and increases their densities per unit volume. The incorporation of the Biosphere within the polypropylene matrix raises the crystallization temperature while the existence of D2W within the matrix delays the crystallization process. The addition of 2 wt% of Biosphere allows polypropylene to crystallize at about 13°C higher than neat polypropylene. It has been found that the addition of the biosphere increases Young's modulus, while decreases the yield strength, the elongation at break, and the impact strength. On the other hand, D2W as an oxidative biodegradable plastic additive increases the elongation at break and the impact strength while decreases the yield strength and Young's modulus. [ABSTRACT FROM AUTHOR]

The effect of microcrystalline cellulose (MCC) on the thermal properties (melting and crystallization temperatures and percentage crystallinity) and degradation of low density polyethylene (LDPE)–MCC blends were investigated. Weight percentages of MCC were varied at 0, 0.5, 1, 2.5, 5, 10, 20, and 30 wt%. The thermal properties of the composites were studied using differential scanning calorimetry while the degradation test was carried out using soil burial method; the weight loss of LDPE/MCC composites was measured and analyzed over a period of 120 days. It has been found that the addition of MCC to LDPE increased the crystallization temperature from 99°C to 103.5°C and decreased the melting temperature from 117°C to 113.6°C. A rule of a nucleating agent has been given as an interpretation to this increase in the crystallization temperature and intensity of crystals by the increase of MCC content. The dramatic reduction was in the percentage crystallinity where the value reduced from 58% for neat LDPE to about 11% for LDPE/30 wt% MCC. On the other hand, the addition of MCC has a little effect on degradation of LDPE; the weight loss did not exceed 1.5% over a period of 120 days. It seems that even at high MCC concentration, LDPE long carbon chains restrict and increase the resistance to microorganism attack and hence, reduce the hydrolysis and degradability. [ABSTRACT FROM AUTHOR]

This work was intended to provide an understanding of the effect of microcrystalline cellulose (MCC) on the mechanical properties of low-density polyethylene (LDPE). The impact resistance and the tensile properties of low-density LDPE/MCC composites were investigated. The weight fraction of MCC was varied at (0, 0.5, 1, 2.5, 5, 10, 20, and 30 wt%). The obtained blends were then used to prepare the required tensile and impact testing samples by hot compression molding technique. It has been found that MCC has a strong influence on the mechanical properties of LDPE. At a low MCC weight fraction, there was a little improvement in the ultimate strength, fracture stress, and elongation at break, but at a high MCC weight fraction, the tensile properties were deteriorated and reduced significantly. The addition of 1 wt% MCC to LDPE enhanced the mentioned properties by 10, 25, and 6%, respectively. While at 30 wt% MCC, these properties were lowered by 36, 25, and 96%. The elastic modulus of LDPE composites was improved on all MCC weight fractions used in the study, at 20 wt% MCC, an increase in the elastic modulus by 12 folds was achieved. On the other hand and compared with the impact strength of pure LDPE, the addition of MCC particles enhanced the impact strength, the highest value obtained was for LDPE composites filled with 10 wt% MCC where the impact strength enhanced by two folds. [ABSTRACT FROM AUTHOR]

B Learning Objectives: b Endotracheal intubation and mechanical ventilation are lifesaving interventions. A cuff leak test (CLT) is a screening test for LE performed prior to extubation. The use of systemic steroid in patients who failed CLT was highly variable, 38.1% use steroids routinely or most of the time, 46.5% rarely or never use steroids. [Extracted from the article]

Background: Delirium in critically ill patients is independently associated with poor clinical outcomes. There is a scarcity of published data on the prevalence of delirium among critically ill patients in Saudi Arabia. Therefore, we sought to determine, in a multicenter fashion, the prevalence of delirium in critically ill patients in Saudi Arabia and explore associated risk factors., Methods: A cross-sectional point prevalence study was conducted on January 28, 2020, at 14 intensive care units (ICUs) across 3 universities and 11 other tertiary care hospitals in Saudi Arabia. Delirium was screened once using the Intensive Care Delirium Screening Checklist. We excluded patients who were unable to participate in a valid delirium assessment, patients admitted with traumatic brain injury, and patients with documented dementia in their medical charts., Results: Of the 407 screened ICU patients, 233 patients were enrolled and 45.9% were diagnosed with delirium. The prevalence was higher in mechanically ventilated patients compared to patients not mechanically ventilated (57.5% vs. 33.6%; P < 0.001). In a multivariate model, risk factors independently associated with delirium included age (adjusted odds ratio [AOR], 1.021; 95% confidence interval [CI], 1.01-1.04; P = 0.008), mechanical ventilation (AOR, 2.39; 95% CI, 1.34-4.28; P = 0.003), and higher severity of illness (AOR, 1.01; 95% CI, 1.001-1.021; P = 0.026)., Conclusion: In our study, delirium remains a prevalent complication, with distinct risk factors. Further studies are necessary to investigate long-term outcomes of delirium in critically ill patients in Saudi Arabia., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 International Journal of Critical Illness and Injury Science.)