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Jha A, Hazra D, Yadav B, Zachariah A, Alex R. Prognostication and Prediction of Outcomes in Patients with Organophosphorus and Carbamate Poisoning: A Prospective Cohort Study. Indian J Crit Care Med 2024; 28:141-147. [PMID: 38323266 PMCID: PMC10839923 DOI: 10.5005/jp-journals-10071-24617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/18/2023] [Indexed: 02/08/2024] Open
Abstract
Background Organophosphorus (OP) and carbamate poisoning are significant concerns in developing nations. This study evaluates the effectiveness of the ChE check mobile, a cholinesterase-rapid bedside diagnostic test, in the diagnosis and management of OP and carbamate poisoning. Materials and methods We conducted this prospective observational study, involving patients with OP and carbamate poisoning over 1 year (June 2016 to June 2017) at a single tertiary care center. Levels of RBC cholinesterase (E-AChE), butyl cholinesterase (BChE), and various other determinants were systematically coded and analyzed. Results The study population (n = 60) consisted primarily of males (n = 43; 71.7%), with a mean age of 30.6 (SD: 13.7) years. Monocrotophos (n = 10; 20.4%) and carbofuran (n = 4; 8.1%) were the commonest OP and carbamate compounds, respectively. The median initial atropinization dose was 10 (IQR: 0, 61.5) mg, with a median total administered atropine dose of 116 (IQR: 32, 320) mg. A significant negative correlation was found between E-AChE levels and both the initial atropinization dose (ρ: -0.653, p-value < 0.001) and total atropine requirement (ρ: -0.659, p-value < 0.001) during admission. An E-AChE cut-off of 4 units/g hemoglobin provided an area under the curve of 0.73 (sensitivity: 80.0%, specificity: 68.6%, p-value < 0.001) for predicting moderate to severe peradeniya organophosphorus poisoning. Conclusion The check mobile device can be a valuable tool for prognosticating patients. There was a significant correlation between low E-AChE levels and the atropine requirement and severity. How to cite this article Jha A, Hazra D, Yadav B, Zachariah A, Alex R. Prognostication and Prediction of Outcomes in Patients with Organophosphorus and Carbamate Poisoning: A Prospective Cohort Study. Indian J Crit Care Med 2024;28(2):141-147.
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Affiliation(s)
- Avanish Jha
- Department of General Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Darpanarayan Hazra
- Department of Emergency Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Bijesh Yadav
- Department of Biostatistics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Anand Zachariah
- Department of General Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Reginald Alex
- Department of Emergency Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Dassanayake TL, Weerasinghe VS, Gawarammana IB, Buckley NA. Changes of attention-related brain activity over 6 months after acute organophosphate pesticide poisoning: a prospective follow-up study. Clin Toxicol (Phila) 2021; 60:576-584. [PMID: 34904500 DOI: 10.1080/15563650.2021.2010742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
CONTEXT Ingestion of organophosphate (OP) pesticides is a common method of self-harm in developing countries. Apart from acute cholinergic effects, limited evidence implicates OP poisoning in long-term neurocognitive deficits. However, prospective neurophysiological evidence of long-term deficits is scarce in humans. We aimed to determine long-term cognitive changes of acute OP pesticide self-poisoning in a prospective follow-up study, using event-related potentials (ERPs), an electroencephalographic index of cognitive functioning. METHODS We recruited 203 patients (147 men) hospitalised with OP pesticide ingestion (OP group; all had significant erythrocyte cholinesterase inhibition) and 50 patients (23 men) with paracetamol overdose (control group) as a means of self-harm. We recorded their ERPs and behavioural performance in a selective attention task at three post-exposure time points: on discharge from hospital (around 14 days post-ingestion), 6 weeks and 6 months post-ingestion. We compared the reaction time and ERP components of the two groups at each time point, adjusting for sex, age, education and comorbid depression in multiple regression models. RESULTS OP group had significantly slower reaction times than the control group on discharge and at 6 weeks, but not at 6 months. On discharge, the OP group also showed significantly prolonged latency of the parietal P3b component, signifying delayed attentional processing. P3b amplitudes were also significantly smaller in the OP group on discharge and at 6 months. Within the OP group, greater clinical severity of poisoning was associated with smaller P3b amplitudes. Early pre-attentive cortical processing (as indexed by N1 ERP component) showed no significant intergroup differences. CONCLUSIONS Acute OP pesticide poisoning was associated with impaired behavioural and neurophysiological indices of selective attention. These deficits outlast the cholinergic phase of intoxication. The neurobehavioral impairment disappears over months, but neurophysiological deficits seem to last even after 6 months. This impairment could potentially compromise the performance and safety of patients for months following clinical recovery.
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Affiliation(s)
- Tharaka L Dassanayake
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,School of Psychological Sciences, The University of Newcastle, Callaghan, Australia
| | - Vajira S Weerasinghe
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Indika B Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nicholas A Buckley
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Discipline of Pharmacology, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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Reddy BS, Skaria TG, Polepalli S, Vidyasagar S, Rao M, Kunhikatta V, Nair S, Thunga G. Factors associated with outcomes in organophosphate and carbamate poisoning: a retrospective study. Toxicol Res 2020; 36:257-266. [PMID: 32685430 PMCID: PMC7351927 DOI: 10.1007/s43188-019-00029-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/18/2019] [Accepted: 11/27/2019] [Indexed: 10/24/2022] Open
Abstract
Organophosphate and carbamate (OPC) poisoning is a major global health hazard requiring immediate medical intervention. Atropine (ATR) is an essential antidote in organophosphate and carbamate poisoning, with the inclusion of cholinesterase reactivators and other anticholinergics, namely pralidoxime (PAM) and glycopyrrolate (GPR). This study aimed to compare the efficacy of various treatment regimens and identify the factors affecting mortality. The data of patients presented at the emergency unit with the consumption of OPC compounds between the years 2013 and 2017 were retrospectively reviewed. The study population was then categorized into four treatment patterns (1) ATR alone, (2) ATR and PAM, (3) ATR and GPR, (4) ATR, PAM and GPR. The outcome of the patients was assessed in terms of survival, intubation, ICU days, and days of ventilation and hospitalization. Univariate and multivariate analyses were performed to investigate the risk factors associated with mortality and odds ratio (OR). A total of 441 patients were included in the study, of which 69.16% were males, and 375 patients survived. Consumption of poison with a suicidal intention was reported in 98.19% of the patients, and the treatment with ATR and PAM (42.86%) was observed to have lower days of ventilation in comparison to the treatment with ATR and GPR (p = 0.003). Patients requiring intubation were also lowest in the group treated with ATR and PAM (27.51%). The age group of > 50 years (OR 4.275 [CI 2.179-8.387]), male gender (OR 2.608 [CI 1.258-5.406]), and the treatment pattern with ATR, PAM and GPR (OR 2.233 [CI 1.002-4.040]) were independently associated with mortality. In summary, male gender, elderly population, and treatment patterns followed adversely affected the outcome in patients with OPC poisoning.
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Affiliation(s)
- B. Shrikar Reddy
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Teny Grace Skaria
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Sravani Polepalli
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Sudha Vidyasagar
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mahadev Rao
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Vijayanarayana Kunhikatta
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Sreedharan Nair
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Girish Thunga
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
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Dassanayake TL, Weerasinghe VS, Gawarammana I, Buckley NA. Subacute and chronic neuropsychological sequalae of acute organophosphate pesticide self-poisoning: a prospective cohort study from Sri Lanka. Clin Toxicol (Phila) 2020; 59:118-130. [PMID: 32567959 DOI: 10.1080/15563650.2020.1778719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CONTEXT Some epidemiological evidence implicates acute organophosphate (OP) pesticide poisoning in long-term neurocognitive deficits. However, no study has prospectively followed up poisoned patients long-term from the time of intoxication. We aimed to determine whether clinically significant acute OP self-poisoning leads to subacute and chronic neurocognitive deficits, in a prospective follow up study. METHODS Employing Mini Mental State Examination, Digit Span and Cambridge Neuropsychological Test Automated Battery (CANTAB), we compared multiple cognitive functions in 222 patients hospitalized with acute OP pesticide self-poisoning with a control group of 52 patients hospitalized with paracetamol overdose, at three time points: on discharge following clinical recovery, 6 weeks and 6 months post-ingestion. Intergroup comparisons at each time point were done in multiple regression models, adjusting for sex, age, education and psychiatric comorbidities. OP within-group analysis was done to determine a dose-response relationship. RESULTS After adjusting for covariates, the OP poisoned group had significantly poorer working memory (Digit Span) and episodic memory (CANTAB Paired Associates Learning); impaired spatial planning (CANTAB Stocking of Cambridge); and slower response speed in the sustained attention task (CANTAB Rapid Visual Information Processing), in the post-discharge assessment. Only working memory and episodic memory measures were impaired in the OP group at 6 weeks, whereas no significant intergroup differences were observed at 6 months. The OP subgroup who had complete red cell acetylcholinesterase inhibition on admission had poorer episodic memory when tested post-discharge than those who had partial inhibition, but no significant subgroup differences were observed at 6 weeks or 6 months. DISCUSSION Acute OP pesticide poisoning may cause neuropsychological impairment that outlasts the cholinergic phase on a subacute time scale; but does not cause measurable chronic neuropsychological deficits.
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Affiliation(s)
- Tharaka L Dassanayake
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,School of Psychology, The University of Newcastle, Callaghan, Australia
| | - Vajira S Weerasinghe
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Indika Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nicholas A Buckley
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,School of Pharmacology, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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5
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Dahanayake P, Dassanayake TL, Pathirage M, Colombage A, Gawarammana IB, Senanayake S, Sedgwick M, Weerasinghe VS. Dysfunction in macula, retinal pigment epithelium and post retinal pathway in acute organophosphorus poisoning. Clin Toxicol (Phila) 2020; 59:111-117. [PMID: 32530332 DOI: 10.1080/15563650.2020.1771359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
CONTEXT Organophosphorus (OP) insecticide poisoning is a significant health problem in South Asian countries. Although cholinergic receptors are present at the junction between photoreceptors and the retinal pigment epithelium (RPE), human studies of the effects of OP poisoning on the visual pathways are very few. This study aims to demonstrate the pattern of changes in retina and post retinal pathways in patients with acute OP poisoning using visual electrophysiological tests. METHODS This is an observational, cross-sectional study conducted at the Neurophysiology Unit, Teaching Hospital, Peradeniya, Sri Lanka. We tested 16 patients recovered from cholinergic phase, at least 24 h after deatropinization and within 8 weeks of OP ingestion. We assessed the functional integrity of the photoreceptors and ganglion cells of the macula by pattern electroretinography (PERG); RPE by electro-oculography (EOG); and post retinal pathways by pattern reversal visual evoked potentials (PR-VEP). Latencies and amplitudes of PR-VEP and PERG, light peak (LP), dark trough (DT) and Arden ratio of EOG were determined in patients and compared with 16 controls using the Mann-Whitney U test. RESULTS Of the 16 OP-poisoned patients (median age of 37 ± IQR 20 years), six (37.5%) had reduced Arden ratio with reference to the International Society of Clinical Electrophysiology of Vision cut-off value of 1.7. The median Arden ratio in patients (1.69 ± IQR 0.36) was significantly lower compared to controls (1.90 ± IQR 0.4). The median latencies and amplitudes of PR-VEP or PERG were not significantly different between patients and controls. However, three patients had prolonged P100 latencies in PR-VEP and one had prolonged P50 latency in PERG. CONCLUSIONS Acute OP poisoning seems to affect the functions of the RPE and the visual electrophysiological changes outlast the cholinergic phase. Limited evidence suggests that photoreceptors of the macula region and post retinal pathway might be affected in some patients.
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Affiliation(s)
- Padmini Dahanayake
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Teaching Hospital, Peradeniya, Sri Lanka
| | - Tharaka L Dassanayake
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Teaching Hospital, Peradeniya, Sri Lanka.,School of Psychology, The University of Newcastle, Callaghan, Australia.,South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Manoji Pathirage
- Teaching Hospital, Peradeniya, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Indika B Gawarammana
- Teaching Hospital, Peradeniya, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Michael Sedgwick
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Vajira S Weerasinghe
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Teaching Hospital, Peradeniya, Sri Lanka
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6
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Amend N, Niessen KV, Seeger T, Wille T, Worek F, Thiermann H. Diagnostics and treatment of nerve agent poisoning—current status and future developments. Ann N Y Acad Sci 2020; 1479:13-28. [DOI: 10.1111/nyas.14336] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/25/2020] [Accepted: 03/05/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Niko Amend
- Bundeswehr Institute of Pharmacology and Toxicology Munich Germany
| | - Karin V. Niessen
- Bundeswehr Institute of Pharmacology and Toxicology Munich Germany
| | - Thomas Seeger
- Bundeswehr Institute of Pharmacology and Toxicology Munich Germany
| | - Timo Wille
- Bundeswehr Institute of Pharmacology and Toxicology Munich Germany
| | - Franz Worek
- Bundeswehr Institute of Pharmacology and Toxicology Munich Germany
| | - Horst Thiermann
- Bundeswehr Institute of Pharmacology and Toxicology Munich Germany
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7
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Alahakoon C, Dassanayake TL, Gawarammana IB, Weerasinghe VS, Buckley NA. Differences between organophosphates in respiratory failure and lethality with poisoning post the 2011 bans in Sri Lanka. Clin Toxicol (Phila) 2019; 58:466-470. [PMID: 31496307 DOI: 10.1080/15563650.2019.1660782] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Self-poisoning with organophosphorus pesticides (OPs) has high morbidity and mortality. The most toxic OP formulations have been progressively banned in Sri Lanka over the past three decades. However, respiratory failure (RF) requiring ventilation remains a major contributor to fatalities. Therefore, this study was conducted to examine the frequency of RF and death after poisoning with the currently available OPs to determine if further bans might be warranted to reduce the burden of OP poisoning in Sri Lanka.Methods: Five hundred and forty patients with confirmed OP self-poisoning were prospectively observed throughout their hospital stay following admission to Peradeniya hospital in the Central Province of Sri Lanka. Clinical data including the time and duration of intubation were documented prospectively in structured datasheets.Results: One hundred and forty-nine patients required ventilation (27%), and 34 (23%) of those died. Males with alcohol co-ingestion were more likely to develop RF. Compared to other OPs, profenofos (Odds Ratio [OR] = 2.5, 95% CI: 1.5-3.9), and quinalphos (OR = 4.5, 95% CI: 1.6-12.6) were more likely to, and chlorpyrifos (OR = 0.2, 95% CI: 0.1-0.4) less likely to lead to RF than other OPs. Profenofos was also associated with higher mortality (OR = 2.3, 95% CI: 1.1-4.6) than other OPs. The median time to intubation was longer for profenofos, but the duration of intubation was similar for all OP formulations.Conclusion: RF and deaths following OP ingestion continue to be a major problem in Sri Lanka, with profenofos being the major current agent of concern. Strategies to replace profenofos and quinalphos use with less toxic insecticides should be explored. Doctors should be alert to the high probability of delayed and prolonged RF after profenofos poisoning.
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Affiliation(s)
- Chanika Alahakoon
- Department of Physiology, University of Peradeniya, Peradeniya, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Tharaka L Dassanayake
- Department of Physiology, University of Peradeniya, Peradeniya, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka.,School of Psychology, The University of Newcastle, Callaghan, Australia
| | - Indika B Gawarammana
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Vajira S Weerasinghe
- Department of Physiology, University of Peradeniya, Peradeniya, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nicholas A Buckley
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka.,The Discipline of Pharmacology, School of Medical Sciences, University of Sydney, Sydney, Australia
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8
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Erickson TB, Brooks J, Nilles EJ, Pham PN, Vinck P. Environmental health effects attributed to toxic and infectious agents following hurricanes, cyclones, flash floods and major hydrometeorological events. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2019; 22:157-171. [PMID: 31437111 DOI: 10.1080/10937404.2019.1654422] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Extreme hydrometeorological events such as hurricanes and cyclones are increasing in frequency and intensity due to climate change and often associated with flash floods in coastal, urbanized and industrial areas. Preparedness and response measures need to concentrate on toxicological and infectious hazards, the potential impact on environmental health, and threat to human lives. The recognition of the danger of flood water after hurricanes is critical. Effective health management needs to consider the likelihood and specific risks of toxic agents present in waters contaminated by chemical spills, bio-toxins, waste, sewage, and water-borne pathogens. Despite significant progress in the ability to rapidly detect and test water for a wide range of chemicals and pathogens, there has been a lack of implementation to adapt toxicity measurements in the context of flash and hurricane-induced flooding. The aim of this review was to highlight the need to collect and analyze data on toxicity of flood waters to understand the risks and prepare vulnerable communities and first responders. It is proposed that new and routinely used technologies be employed during disaster response to rapidly assess toxicity and infectious disease threats, and subsequently take necessary remedial actions.
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Affiliation(s)
- Timothy B Erickson
- Department of Emergency Medicine, Brigham & Women's Hospital, Harvard Medical School, Harvard Humanitarian Initiative , Boston , MA , USA
| | - Julia Brooks
- Department of Emergency Medicine, Brigham & Women's Hospital, Harvard Medical School, Harvard Humanitarian Initiative , Boston , MA , USA
| | - Eric J Nilles
- Department of Emergency Medicine, Brigham & Women's Hospital, Harvard Medical School, Harvard Humanitarian Initiative , Boston , MA , USA
| | - Phuong N Pham
- Department of Emergency Medicine, Brigham & Women's Hospital, Harvard Medical School, Harvard Humanitarian Initiative , Boston , MA , USA
| | - Patrick Vinck
- Department of Emergency Medicine, Brigham & Women's Hospital, Harvard Medical School, Harvard Humanitarian Initiative , Boston , MA , USA
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9
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Trueblood AB, Ross JA, Shipp EM, McDonald TJ. Feasibility of Portable Fingerstick Cholinesterase Testing in Adolescents in South Texas. J Prim Care Community Health 2019; 10:2150132719838716. [PMID: 30929548 PMCID: PMC6444767 DOI: 10.1177/2150132719838716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Adolescents are particularly vulnerable to the impacts of pesticide exposures,
which can be assessed using surveys, environmental measurements, and
biomonitoring. Biomonitoring of blood cholinesterase can be used to determine if
an individual has been exposed to pesticides. A limitation of blood
cholinesterase testing can be the use of a laboratory as well as time to receive
results. In addition to laboratory tests, there are fingerstick cholinesterase
(ChE) tests, which can eliminate the need for laboratory testing. Some
populations, such as farmworkers, would benefit through fingerstick ChE tests.
The objective of this pilot study is to determine the feasibility (eg, can the
testing be used to assess ChE levels) of using fingerstick ChE testing in
adolescent populations living along the Texas-Mexico border where adolescents
who often engage in farm work live. A sub-objective was to explore differences
in ChE levels by sex. The Model 400 Test-Mate ChE kit by EQM Research Inc
(Cincinnati, OH) was used to assess for ChE inhibition in the participants,
specifically acetylcholinesterase (AChE), which is 1 of the 2 ChE enzymes.
During the postassessment, males had a mean AChE value of 3.75 U/mL (95% CI
3.51-3.98); whereas females had a mean AChE value of 2.86 U/mL (95% CI
2.64-3.08), which was statistically significant. Overall, the study supports the
use of field ChE testing in adolescent populations with a small percentage
(6.90%) refusing to complete ChE testing.
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Affiliation(s)
| | | | - Eva M Shipp
- 1 Texas A&M Transportation Institute, College Station, TX, USA
| | - Thomas J McDonald
- 3 Texas A&M University School of Public Health, College Station, TX, USA
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10
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Serrano-Medina A, Ugalde-Lizárraga A, Bojorquez-Cuevas MS, Garnica-Ruiz J, González-Corral MA, García-Ledezma A, Pineda-García G, Cornejo-Bravo JM. Neuropsychiatric Disorders in Farmers Associated with Organophosphorus Pesticide Exposure in a Rural Village of Northwest México. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E689. [PMID: 30813607 PMCID: PMC6427808 DOI: 10.3390/ijerph16050689] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/12/2019] [Accepted: 02/18/2019] [Indexed: 12/22/2022]
Abstract
This study aims to determine the degree of acetylcholinesterase inhibition and neurological symptoms for each of the psychiatric disorders diagnosed in the farm workers of a rural population in the state of Baja California, Mexico. We conducted a cross-sectional study on 140 agricultural workers (exposed participants). The study was run using the Mini International Neuropsychiatric Interview Diagnostic Test (MINI), a pre-established questionnaire to diagnose the mental state of each agricultural worker. Analysis of enzymatic activity was carried out using the modified Ellman method. The results showed that, among agricultural workers with slightly inhibited enzymatic activity, 25% met the criteria for the diagnosis of major depression with suicidal attitudes, 23.9% with inhibited enzymatic activity showed generalized anxiety, 23.5% showed combined depression⁻anxiety, and 22% met the criteria for major depression and no psychiatric diagnosis disorder. These results suggest the need for the development of effective public-health strategies to inform farm workers about integrated pesticide management in order to prevent serious health complications.
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Affiliation(s)
- Aracely Serrano-Medina
- Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Calzada Universidad 14418, Parque Industrial Internacional, Tijuana 22300, Mexico.
| | - Angel Ugalde-Lizárraga
- Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Calzada Universidad 14418, Parque Industrial Internacional, Tijuana 22300, Mexico.
| | - Michelle Stephanie Bojorquez-Cuevas
- Facultad de Ciencias Químicas e Ingeniería, Universidad Autónoma de Baja California, Calzada Universidad 14418, Parque Industrial Internacional, Tijuana 22300, Mexico.
| | - Jatniel Garnica-Ruiz
- Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Calzada Universidad 14418, Parque Industrial Internacional, Tijuana 22300, Mexico.
| | - Martín Alexis González-Corral
- Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Calzada Universidad 14418, Parque Industrial Internacional, Tijuana 22300, Mexico.
| | - Arnold García-Ledezma
- Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Calzada Universidad 14418, Parque Industrial Internacional, Tijuana 22300, Mexico.
| | - Gisela Pineda-García
- Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Calzada Universidad 14418, Parque Industrial Internacional, Tijuana 22300, Mexico.
| | - José Manuel Cornejo-Bravo
- Facultad de Ciencias Químicas e Ingeniería, Universidad Autónoma de Baja California, Calzada Universidad 14418, Parque Industrial Internacional, Tijuana 22300, Mexico.
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11
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Rapid quantification of two chemical nerve agent metabolites in serum. Biosens Bioelectron 2019; 131:119-127. [PMID: 30826646 DOI: 10.1016/j.bios.2019.01.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 02/07/2023]
Abstract
Organophosphorus compounds (OPs) continue to represent a significant chemical threat to humans due to exposures from their use as weapons, their potential storage hazards, and from their continued use agriculturally. Existing methods for detection include ELISA and mass spectrometry. The new approach presented here provides an innovative first step toward a portable OP quantification method that surmounts conventional limitations involving sensitivity, selectivity, complexity, and portability. DNA affinity probes, or aptamers, represent an emerging technology that, when combined with a mix-and-read, free-solution assay (FSA) and a compensated interferometer (CI) can provide a novel alternative to existing OP nerve agent (OPNA) quantification methods. Here it is shown that FSA can be used to rapidly screen prospective aptamers in the biological matrix of interest, allowing the identification of a 'best-in-class' probe. It is also shown that combining aptamers with FSA-CI enables quantification of the OPNA metabolites, Sarin (NATO designation "G-series, B", or GB) and Venomous Agent X (VX) acids, rapidly with high selectivity at detection limits of sub-10 pg/mL in 25% serum (by volume in PBS). These results suggest there is potential to directly impact diagnostic specificity and sensitivity of emergency response testing methods by both simplifying sample preparation procedures and making a benchtop reader available for OPNA metabolite quantification.
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Chang YC, Ge X, Wang LJ, Lee SS, Paulsen MH, Khan QM, Khalid ZM, Bhalli JA, Waheed U, Simpson CD, Du D, Li L, Lin Y. An ultra low-cost smartphone device for in-situ monitoring of acute organophosphorus poisoning for agricultural workers. SENSORS AND ACTUATORS. B, CHEMICAL 2018; 275:300-305. [PMID: 37576435 PMCID: PMC10422983 DOI: 10.1016/j.snb.2018.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
In this work, we present an ultra-low-cost smartphone device for in situ quantification of OP poisoning severity. The performance of the lens-less smartphone spectrum apparatus (LeSSA) is evaluated using standard human Interleukin-6 (IL-6) immunoassay kits. Upon dose-response curve fitting, LeSSA demonstrates an accuracy of 99.5%. The limit of detection (LOD) of LeSSA was evaluated through comparison of 6.4 pg/ml with standard laboratory grade UV-vis spectrophotometer at 5.5 pg/ml. Evaluating the capacity of LeSSA in spike solution by combining plasma cholinesterase (PChE) and human plasma shows consistency at agreement of 97.6% between LeSSA and the laboratory instrument. For application demonstration, the activity of PChE for 24 agricultural workers' plasma samples was measured with LeSSA, showing exceptional agreement (r2 = 0.92) with the laboratory instrument reference. In addition to near laboratory grade accuracy, the total manufacturing cost of LeSSA is only $20 USD highlighting it's affordability. With LeSSA, clinicians can evaluate OP poisoning severity without the need to transport patient samples to facilities at far distances. Utilizing LeSSA, immediate results can be used for administration of appropriate treatment.
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Affiliation(s)
- Yu-Chung Chang
- School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, USA
| | - Xiaoxiao Ge
- School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, USA
| | - Li-Ju Wang
- School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, USA
| | - Stephen Sauchi Lee
- Department of Statistical Science, University of Idaho, Moscow, ID 83844, USA
| | - Michael H. Paulsen
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA
| | - Qaiser M. Khan
- National Institute for Biotechnology and Genetic Engineering, P.O. Box 577, Jhang Road, Faisalabad, Pakistan
| | - Zafar M. Khalid
- National Institute for Biotechnology and Genetic Engineering, P.O. Box 577, Jhang Road, Faisalabad, Pakistan
| | - Javed A. Bhalli
- National Institute for Biotechnology and Genetic Engineering, P.O. Box 577, Jhang Road, Faisalabad, Pakistan
| | - Usman Waheed
- National Institute for Biotechnology and Genetic Engineering, P.O. Box 577, Jhang Road, Faisalabad, Pakistan
| | - Christopher D. Simpson
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA
| | - Dan Du
- School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, USA
| | - Lei Li
- School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, USA
| | - Yuehe Lin
- School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, USA
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Shihana F, Worek F, Dassanayake GA, Rathgamage SH, Dhanarisi J, Buckley NA. Evaluation of the accuracy of “ChE check mobile” in measurement of acetylcholinesterase in pesticide poisoning. Clin Toxicol (Phila) 2018; 57:411-414. [DOI: 10.1080/15563650.2018.1530778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Fathima Shihana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Discipline of Pharmacology, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Franz Worek
- Department of Toxicological Enzymology, Bundeswehr Institute of Pharmacology and Toxicology, Munich, Germany
| | - Gihani A. Dassanayake
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Surangi H. Rathgamage
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Jeevan Dhanarisi
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nicholas A. Buckley
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Discipline of Pharmacology, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
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Alahakoon C, Dassanayake TL, Gawarammana IB, Sedgwick EM, Weerasinghe VS, Abdalla A, Roberts MS, Buckley NA. Prediction of organophosphorus insecticide-induced intermediate syndrome with stimulated concentric needle single fibre electromyography. PLoS One 2018; 13:e0203596. [PMID: 30261032 PMCID: PMC6159867 DOI: 10.1371/journal.pone.0203596] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 08/23/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Deliberate self-poisoning (DSP) using organophosphorus (OP) insecticides are a common clinical problem in Asia. OPs inhibit acetylcholine esterase (AChE), leading to over-activity of muscarinic and nicotinic cholinergic circuits. Intermediate syndrome (IMS) is mediated via prolonged nicotinic receptor stimulation at the neuromuscular junction and its onset is between 24-96 hours post ingestion. The aims of the present study were 1) to investigate whether neuromuscular junction dysfunction within the first 24 hours following exposure, quantified by jitter in single fibre electromyography (SfEMG), can predict IMS, and 2) to compare the changes in SfEMG jitter over the course of the illness among patients who developed IMS (IMS+) and those who did not (IMS-). METHODS AND FINDINGS We conducted a prospective cohort study in a tertiary care hospital in Sri Lanka on 120 patients admitted between September 2014 and August 2016 following DSP by OP insecticides viz., profenofos 53, phenthoate 17, diazinon 13, chlorpyrifos 5, others 12, unknown 20. SfEMG was performed every second day during hospitalization. Exposure was confirmed based on the history and red blood cell AChE assays. IMS was diagnosed in patients who demonstrated at least three out of four of the standard IMS criteria: proximal muscle weakness, bulbar muscle weakness, neck muscle weakness, respiratory paralysis between 24-96 hours post ingestion. Respiratory failure requiring intubation occurred in 73 out of 120 patients; 64 of these were clinically diagnosed with IMS. Of the 120 patients, 96 had repeated SfEMG testing, 67 of them being tested within the first 24 hours. Prolonged jitter (>33.4μs) within the first 24 hours was associated with greatly increased risk of IMS (odds ratio = 8.9, 95% confidence intervals = 2.4-29.6, p = 0.0003; sensitivity 86%, specificity 58%). The differences in jitter between IMS+ and IMS- patients remained significant for 72 hours and increased jitter was observed in some patients for up to 216 hours. For intubated patients, the median time for jitter to normalize and median time to extubate were similar, and the two variables had a moderate positive correlation (r = 0.49, P = 0.001). CONCLUSIONS Prolonged jitter recorded with SfEMG <24 hours of ingestion of an OP strongly correlates with subsequent occurrence of IMS. The time course of electrophysiological recovery of the NMJ was similar to the time course of respiratory recovery in IMS patients.
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Affiliation(s)
- Chanika Alahakoon
- Department of Physiology, University of Peradeniya, Peradeniya, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- * E-mail:
| | - Tharaka L. Dassanayake
- Department of Physiology, University of Peradeniya, Peradeniya, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- School of Psychology, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Indika B. Gawarammana
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - E. Michael Sedgwick
- Department of Physiology, University of Peradeniya, Peradeniya, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Vajira S. Weerasinghe
- Department of Physiology, University of Peradeniya, Peradeniya, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ahmed Abdalla
- Basil Hetzel Institute for Translational Health Research, School of Pharmacy & Medical Sciences, University of South Australia, Adelaide, Australia
- Pharmaceutical Chemistry Department, Helwan University, Cairo, Egypt
| | - Michael S. Roberts
- Basil Hetzel Institute for Translational Health Research, School of Pharmacy & Medical Sciences, University of South Australia, Adelaide, Australia
- Therapeutics Research Centre, Diamantina Institute, University of Queensland, Queensland, Australia
- Translation Research Institute, Brisbane, Queensland, Australia
| | - Nicholas A. Buckley
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- The Discipline of Pharmacology, School of Medical Sciences, University of Sydney, Sydney, Australia
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Dhanarisi HKJ, Gawarammana IB, Mohamed F, Eddleston M. Relationship between alcohol co-ingestion and outcome in profenofos self-poisoning - A prospective case series. PLoS One 2018; 13:e0200133. [PMID: 29975747 PMCID: PMC6033444 DOI: 10.1371/journal.pone.0200133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 06/20/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The importance of alcohol co-ingestion for outcome in organophosphorus (OP) insecticide self-poisoning has only been studied for the relatively hydrophilic dimethyl insecticide, dimethoate. We aimed to assess the effect of alcohol in acute poisoning with the lipophilic S-alkyl OP insecticide, profenofos. METHODOLOGY Demographic and clinical data, including an alcohol history, were prospectively collected from all cases of acute poisoning with agricultural profenofos EC50 presenting to two Sri Lankan hospitals over seven years. RESULTS Of 1859 patients with acute OP insecticide self-poisoning, 243 (13.1%) reported ingestion of profenofos (male 182/243, 74.9%). Alcohol co-ingestion was reported by 64/243 (26.3%). All patients reporting alcohol co-ingestion were male (64/64 [100%] vs 118/179 [65.9%] not reporting alcohol ingestion, p<0.001). More patients reporting alcohol co-ingestion died (10/64 [15.6%] vs 10/179 [5.6%]; p = 0.013) and required intubation (13/64 [20.3%] vs 16/179 [8.9%], p = 0.016) compared to those who did not co-ingest alcohol. Using multi-logistic regression, controlling for the estimated dose ingested, age (OR 11.1 [2.5 to 48.9] for age > 35 years vs ≤35 years) and alcohol co-ingestion (OR 3.1 [1.2 to 7.9]) were independently associated with increased risk of death. Increased risk of intubation was independently associated with age (OR 3.2 [1.6 to 6.6] for age > 35 years vs ≤35 years) and alcohol co-ingestion (OR 3.2 [1.6 to 6.4]). CONCLUSION A history of alcohol co-ingestion, as well as older age, is independently associated with worse outcome in patients' self-poisoned with profenofos.
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Affiliation(s)
- H. K. Jeevan Dhanarisi
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- * E-mail:
| | - Indika B. Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Pharmacology, School of Medical Sciences, Sydney, Australia
- Department of Pharmacy, Faculty of Allied Helath Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Pharmacology, Toxicology, & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
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Kofod DH, Jørs E, Varma A, Bhatta S, Thomsen JF. The use of self-reported symptoms as a proxy for acute organophosphate poisoning after exposure to chlorpyrifos 50% plus cypermethrin 5% among Nepali farmers: a randomized, double-blind, placebo-controlled, crossover study. Environ Health 2016; 15:122. [PMID: 27964728 PMCID: PMC5154153 DOI: 10.1186/s12940-016-0205-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 12/03/2016] [Indexed: 05/30/2023]
Abstract
BACKGROUND Previous studies stating a high prevalence of occupational acute pesticide poisoning in developing countries have mainly relied on measurements of the rather non-specific self-reported acute pesticide poisoning symptoms. Only a few studies have measured the biomarker plasma cholinesterase (PchE) activity, in addition to the symptoms, when assessing occupational acute pesticide poisoning. This study evaluated self-reported symptoms as a proxy for acute organophosphate poisoning among Nepali farmers by examining self-reported acute organophosphate poisoning symptoms and PchE activity in response to occupational acute organophosphate exposure. METHODS We performed a randomized, double-blind, placebo-controlled, crossover trial among 42 Nepali commercial vegetable farmers. The farmers were randomly assigned (ratio 1:1) to a 2-h organophosphate (chlorpyrifos 50% plus cypermethrin 5%: moderately hazardous) spray session or a 2-h placebo spray session, and after 7 days' washout, the farmers were assigned to the other spray session. Before and after each spray session farmers were interviewed about acute organophosphate poisoning symptoms and PchE activity was measured. Analyses were conducted with a Two Sample T-test and Mann Whitney U-test. RESULTS We found no difference in the symptom sum or PchE activity from baseline to follow up among farmers spraying with organophosphate (symptom sum difference -1, p = 0.737; PchE mean difference 0.02 U/mL, p = 0.220), placebo (symptom sum difference 9, p = 0.394; PchE mean difference 0.02 U/mL, p = 0.133), or when comparing organophosphate to placebo (symptom p = 0.378; PchE p = 0.775). However, a high percentage of the farmers reported having one or more symptoms both at baseline and at follow up in the organophosphate spray session (baseline 47.6%, follow up 45.2%) and placebo spray session (baseline 35.7%, follow up 50.0%), and 14.3% of the farmers reported three or more symptoms after the organophosphate spray session as well as after the placebo spray session. CONCLUSION We found a general presence of acute organophosphate symptoms among the farmers regardless of organophosphate exposure or poisoning. Thus, self-reported acute organophosphate symptoms seem to be a poor proxy for acute organophosphate poisoning as the occurrence of these symptoms is not necessarily associated with acute organophosphate poisoning. TRIAL REGISTRATION ClinicalTrials.gov, NCT02838303 . Registered 19 July 2016. Retrospectively registered.
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Affiliation(s)
- Dea Haagensen Kofod
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, Entrance 20F, 2400 Copenhagen NV, Denmark
- Department of Occupational and Environmental Medicine, Odense Hospital, University of Southern Denmark, Odense, Denmark
| | - Erik Jørs
- Department of Occupational and Environmental Medicine, Odense Hospital, University of Southern Denmark, Odense, Denmark
- International Centre for Occupational, Environmental and Public Health (ICOEPH), Odense Hospital, University of Southern Denmark, Odense, Denmark
- Dialogos, Noerrebrogade 52C, Copenhagen N, Denmark
| | - Anshu Varma
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, Entrance 20F, 2400 Copenhagen NV, Denmark
- International Centre for Occupational, Environmental and Public Health (ICOEPH), Odense Hospital, University of Southern Denmark, Odense, Denmark
- Dialogos, Noerrebrogade 52C, Copenhagen N, Denmark
| | - Shankuk Bhatta
- Institute of Medicine, Tribhuvan University of Nepal, Kathmandu, Nepal
| | - Jane Frølund Thomsen
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, Entrance 20F, 2400 Copenhagen NV, Denmark
- International Centre for Occupational, Environmental and Public Health (ICOEPH), Odense Hospital, University of Southern Denmark, Odense, Denmark
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Jamal F, Haque QS, Singh S, Rastogi SK. RETRACTED: The influence of organophosphate and carbamate on sperm chromatin and reproductive hormones among pesticide sprayers. Toxicol Ind Health 2015; 32:1527-1536. [DOI: 10.1177/0748233714568175] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Farrukh Jamal
- Department of Biochemistry, Dr. Ram Manohar Lohia Avadh University, Faizabad, Uttar Pradesh, India
| | - Quazi S Haque
- Department of Biochemistry, Dr. Ram Manohar Lohia Avadh University, Faizabad, Uttar Pradesh, India
| | - Sangram Singh
- Department of Biochemistry, Dr. Ram Manohar Lohia Avadh University, Faizabad, Uttar Pradesh, India
| | - SK Rastogi
- Council of Scientific & Industrial Research, Indian Institute of Toxicological Research, Lucknow, Uttar Pradesh, India
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Chowdhary S, Bhattacharyya R, Banerjee D. Acute organophosphorus poisoning. Clin Chim Acta 2014; 431:66-76. [DOI: 10.1016/j.cca.2014.01.024] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 01/15/2014] [Accepted: 01/18/2014] [Indexed: 11/25/2022]
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Rajapakse BN, Neeman T, Buckley NA. Effect of acetylcholinesterase (AChE) point-of-care testing in OP poisoning on knowledge, attitudes and practices of treating physicians in Sri Lanka. BMC Health Serv Res 2014; 14:104. [PMID: 24589276 PMCID: PMC4015291 DOI: 10.1186/1472-6963-14-104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 01/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Toxicology and Emergency medicine textbooks recommend measurement of acetylcholinesterase (AChE) in all symptomatic cases of organophosphorus (OP) poisoning but laboratory facilities are limited in rural Asia. The accuracy of point-of-care (POC) acetylcholinesterase testing has been demonstrated but it remains to be shown whether results would be valued by clinicians. This study aims to assess the effect of seeing AChE POC test results on the knowledge, attitudes and practices of doctors who frequently manage OP poisoning. METHODS We surveyed 23 clinicians, who had different levels of exposure to seeing AChE levels in OP poisoned patients, on a) knowledge of OP poisoning and biomarker interpretation, b) attitudes towards AChE in guiding poison management, oxime therapy and discharge decisions, and c) practices of ordering AChE in poisoning scenarios. RESULTS An overall high proportion of doctors valued the test (68-89%). However, we paradoxically found that doctors who were more experienced in seeing AChE results valued the test less. Lower proportions valued the test in guidance of acute poisoning management (50%, p = 0.015) and guidance of oxime therapy (25%, p = 0.008), and it was apparent it would not generally be used to facilitate early discharge. The highest proportion of respondents valued it on admission (p < 0.001). A lack of correlation of test results with the clinical picture, and a perception that the test was a waste of money when compared to clinical observation alone were also comments raised by some of the respondents.Greater experience with seeing AChE test results was associated with increased knowledge (p = 0.034). However, a disproportionate lack of knowledge on interpretation of biomarkers and the pharmacology of oxime therapy (12-50%) was noted, when compared with knowledge on the mechanism of OP poisoning and management (78-90%). CONCLUSIONS Our findings suggest an AChE POC test may not be valued by rural doctors. The practical use of AChE in OP poisoning management is complex, and a poor understanding of how to interpret test results may have affected its perceived utility. Future research should evaluate the impact of providing both AChE and training in interpretation on clinicians' attitudes and practice.
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Affiliation(s)
- Bishan N Rajapakse
- College of Medicine, Biology and Environment, Australian National University, Canberra, Australia.
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Use of OpdA, an organophosphorus (OP) hydrolase, prevents lethality in an African green monkey model of acute OP poisoning. Toxicology 2014; 317:1-5. [PMID: 24447378 DOI: 10.1016/j.tox.2014.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 12/05/2013] [Accepted: 01/03/2014] [Indexed: 11/21/2022]
Abstract
Organophosphorus (OP) pesticides are a diverse class of acetylcholinesterase (AChE) inhibitors that are responsible for tremendous morbidity and mortality worldwide, killing approximately 300,000 people annually. Enzymatic hydrolysis of OPs is a potential therapy for acute poisoning. OpdA, an OP hydrolase isolated from Agrobacterium radiobacter, has been shown to decrease lethality in rodent models of OP poisoning. This study investigated the effects of OpdA on AChE activity, plasma concentrations of OP, and signs of toxicity after administration of dichlorvos to nonhuman primates. A dose of 75 mg/kg dichlorvos given orally caused apnea within 10 min with a progressive decrease in heart rate. Blood AChE activity decreased to zero within 10 min. Respirations and AChE activity did not recover. The mean dichlorvos concentration rose to a peak of 0.66 μg/ml. Treated monkeys received 1.2mg/kg OpdA iv immediately after poisoning with dichlorvos. In Opda-treated animals, heart and respiratory rates were unchanged from baseline over a 240-minute observation period. AChE activity slowly declined, but remained above 25% of baseline for the entire duration. Dichlorvos concentrations reached a mean peak of 0.19 μg/ml at 40 min after poisoning and decreased to a mean of 0.05 μg/ml at 240 min. These results show that OpdA hydrolyzes dichlorvos in an African green monkey model of lethal poisoning, delays AChE inhibition, and prevents lethality.
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Malla G, Basnet B, Vohra R, Lohani SP, Yadav A, Dhungana V. Parenteral organophosphorus poisoning in a rural emergency department: a case report. BMC Res Notes 2013; 6:524. [PMID: 24321121 PMCID: PMC4029564 DOI: 10.1186/1756-0500-6-524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 12/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poisoning is a common presentation in the emergency department. Oral exposures to organophosphorus compounds are especially frequent in rural and agricultural regions of South Asia and throughout the developing world. CASE PRESENTATION Here we report a case of deliberate self-harm with an organophosphorus pesticide via the relatively uncommon parenteral route. A young woman injected herself with chlorpyriphos. Although the cholinergic effects were mild, cellulitis and abscess development were noted as a result. CONCLUSION Resource limited agricultural countries like Nepal present health care workers with numerous challenges in poisoning management. This case represents a rare but potentially morbid method of agrochemical poison exposure.
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Affiliation(s)
| | - Bibhusan Basnet
- Department of General practice and Emergency Medicine, B, P, Koirala Institute of Health Sciences, Dharan, Nepal.
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Jalady AM, Dorandeu F. [Interest of the cholinesterase assay during organophosphate poisonings]. ACTA ACUST UNITED AC 2013; 32:856-62. [PMID: 24209986 DOI: 10.1016/j.annfar.2013.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
Cholinesterases are the main targets of organophosphorus compounds. The two enzymes present in the blood (butyrylcholinesterase, BChE; acetylcholinesterase, AChE) are biomarkers of their systemic toxicity. Activity of the plasma BChE is very often determined as it allows a rapid diagnostic of poisoning and is a marker of the persistence of the toxicant in the blood. The activity of the red blood cell AChE gives a better picture of the synaptic inhibition in the nervous system but the assay is less commonly available in routine laboratories. Better biomarker of the exposure, it allows a diagnosis of the severity of the poisoning and helps to assess the efficacy of oxime therapy. Besides the practical aspects of blood collection and sample processing, and the interpretation of the assays, this review stresses the complementarity of both enzyme assays and recalls their crucial interest for the confirmation of poisoning with an organophosphorus in a situation of war or terrorist attack and for the monitoring of occupational exposures.
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Affiliation(s)
- A-M Jalady
- Antenne médicale des armées (AMA) de Vert-Le-Petit, centre médical des armées (CMA) de Montlhéry, site de DGA Maîtrise NRBC-Lieu dit « Le Bouchet », 5, rue Lavoisier, BP n(o) 3, 91710 Vert-Le-Petit, France.
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Thiermann H, Worek F, Kehe K. Limitations and challenges in treatment of acute chemical warfare agent poisoning. Chem Biol Interact 2013; 206:435-43. [PMID: 24091052 DOI: 10.1016/j.cbi.2013.09.015] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 09/18/2013] [Accepted: 09/20/2013] [Indexed: 02/02/2023]
Abstract
Recent news from Syria on a possible use of chemical warfare agents made the headlines. Furthermore, the motivation of terrorists to cause maximal harm shifts these agents into the public focus. For incidents with mass casualties appropriate medical countermeasures must be available. At present, the most important threats arise from nerve agents and sulfur mustard. At first, self-protection and protection of medical units from contamination is of utmost importance. Volatile nerve agent exposure, e.g. sarin, results in fast development of cholinergic crisis. Immediate clinical diagnosis can be confirmed on-site by assessment of acetylcholinesterase activity. Treatment with autoinjectors that are filled with 2mg atropine and an oxime (at present obidoxime, pralidoxime, TMB-4 or HI-6) are not effective against all nerve agents. A more aggressive atropinisation has to be considered and more effective oximes (if possible with a broad spectrum or a combination of different oximes) as well as alternative strategies to cope with high acetylcholine levels at synaptic sites should be developed. A further gap exists for the treatment of patients with sustained cholinergic crisis that has to be expected after exposure to persistent nerve agents, e.g. VX. The requirement for long-lasting artificial ventilation can be reduced with an oxime therapy that is optimized by using the cholinesterase status for guidance or by measures (e.g. scavengers) that are able to reduce the poison load substantially in the patients. For sulfur mustard poisoning no specific antidote is available until now. Symptomatic measures as used for treatment of burns are recommended together with surgical or laser debridement. Thus, huge amounts of resources are expected to be consumed as wound healing is impaired. Possible depots of sulfur mustard in tissues may aggravate the situation. More basic knowledge is necessary to improve substantially therapeutic options. The use of stem cells may provide a new and promising option.
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Affiliation(s)
- Horst Thiermann
- Bundeswehr Institute of Pharmacology and Toxicology, Munich, Germany.
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Miranda-Contreras L, Gómez-Pérez R, Rojas G, Cruz I, Berrueta L, Salmen S, Colmenares M, Barreto S, Balza A, Zavala L, Morales Y, Molina Y, Valeri L, Contreras CA, Osuna JA. Occupational exposure to organophosphate and carbamate pesticides affects sperm chromatin integrity and reproductive hormone levels among Venezuelan farm workers. J Occup Health 2013; 55:195-203. [PMID: 23445617 DOI: 10.1539/joh.12-0144-fs] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Several reports suggest that chronic pesticide exposure may affect semen quality and male fertility in humans. The objective of this study was to evaluate the association between occupational exposure to organophosphate (OP) and carbamate (CB) pesticides and semen quality, as well as levels of reproductive and thyroid hormones of Venezuelan farm workers. METHODS Thirty-five healthy men (unexposed group) and 64 male agricultural workers (exposed group) were recruited for clinical evaluation of fertility status. Fresh semen samples were evaluated for sperm quality and analyzed for DNA fragmentation index (DFI) by flow cytometry. Pesticide exposure was assessed by measuring erythrocyte acetylcholinesterase (AChE) and plasma butyrylcholinesterase (BuChE) with a Test-mate ChE field kit. Serum levels of total testosterone (Tt), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), thyroid stimulating hormone (TSH) and free thyroxine (FT4) were analyzed using enzyme immunoassay kits. RESULTS Evidence of pesticide exposure was found in 87.5% of farmers based on AChE and BuChE inhibition. Significant increments were observed in sperm DFI with significant decreases in some semen parameters. DFI was negatively correlated with BuChE, sperm concentration, morphology and vitality in these workers. The levels of Tt, PRL, FT4 and TSH appeared to be normal; however, there was a tendency for increased LH and FSH levels in exposed workers. CONCLUSIONS Our results confirm the potential impact of chronic occupational exposure to OP/CB pesticides on male reproductive function, which may cause damage to sperm chromatin, decrease semen quality and produce alterations in reproductive hormones, leading to adverse reproductive health outcomes.
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Holas O, Musilek K, Pohanka M, Kuca K. The progress in the cholinesterase quantification methods. Expert Opin Drug Discov 2012; 7:1207-23. [DOI: 10.1517/17460441.2012.729037] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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