Is there a relationship between the WHO hazard classification of organophosphate pesticide and outcomes in suicidal human poisoning with commercial organophosphate formulations?

Titanium dioxide based nanocomposites - Current trends and emerging strategies for the photocatalytic degradation of ruinous environmental pollutants

Many ruinous pollutants are omnipresent in the environment and among them; pesticides are xenobiotic and pose to be a bio-recalcitrance. Their detrimental ecological and environmental impacts attract attention of environmental excerpts and the surge of stringent regulations have endows the need of a technically feasible treatment. This critical review emphasizes about the occurrence, abundance and fate of structurally distinct pesticides in different environment. The practiced remedial strategies and in particular, the advanced oxidation processes (AOPs) those utilize the photo-catalytic properties of nano-composites for the degradation of pollutants are critically discussed. Photo-catalytic degradation utilizes many composite materials at nano-scale level, wherein synthesis of nano-composites with appropriate precursors and other adjoining functional moieties are of prime importance. Therefore, suitable starter materials along with the reaction conditions are prerequisite for effectively tailoring the nano-composites. The aforementioned aspects and their customized applications are critically discussed. The associated challenges, opportunities and process economics of degradation using photo-catalytic AOP techniques are highlighted and in addition, the review tries to explain how best the photo-degradation can be a stand-alone tool with a societal importance. Conclusively, the future prospects for undertaking new researches in photo-catalytic breakdown of pollutants that can be judiciously sustainable.

Acute phenthoate self-poisoning: a prospective case series

BACKGROUND

The clinical characteristics following self-poisoning with organophosphorus (OP) insecticides differs according to the insecticide ingested. Phenthoate is a dimethoxy WHO Hazard Class II OP pesticide with limited literature on its clinical characteristics and outcome. We aimed to better understand its clinical characteristics by studying patients with phenthoate self-poisoning in Sri Lanka.

METHODS

We conducted a prospective cohort study of patients presenting with phenthoate self-poisoning to eight hospitals in Sri Lanka between 2002 and 2018. Clinical outcomes were recorded for each patient. Blood samples for measuring plasma phenthoate concentration, cholinesterase activity, and response to oximes were available for a very small number of patients recruited to a clinical trial.

RESULTS

Two hundred and ninety-two patients who ingested agricultural phenthoate formulations were included in the study. Median time to admission was 3.9 (IQR 2.4 - 6.8) h. Forty-two (14.4%) patients were intubated, mostly (30/37, 81%) within 24 h of ingestion (median time to intubation 7.2 [IQR 2.6-20.9] h). Median duration of intubation was 74.8 (IQR 26.8-232.5) h; the longest duration in a survivor was 592 h. Nineteen died (case fatality 6.5%, 95% CI 4.0-10.0); median time to death was 37 (IQR 16 - 101.7) h. Median plasma phenthoate concentration in patients with samples (n = 81) was 135 (IQR 62.7-356.5) ng/mL (0.42 µmol/mL [0.2 to 1.1 µmol/mL]). Five of six patients receiving pralidoxime chloride 2 g showed an initial increase in AChE and BuChE activity that was not sustained despite an infusion of pralidoxime.

CONCLUSION

Phenthoate self-poisoning has a 6.5% case fatality rate. Most patients who experience respiratory failure undergo early intubation; most deaths occurred among those patients who were intubated less than 24 h after ingestion. There was a non-sustained increase in cholinesterase activity with pralidoxime, but further studies are required to analyse the extent to which oximes are clinically effective in phenthoate self-poisoning.

Determination of quinalphos in human whole blood samples by high-performance thin-layer chromatography for forensic applications

A simple and rapid procedure for the determination of quinalphos in human whole blood using liquid-liquid extraction and high-performance thin-layer chromatography was developed and validated. Seven different organic solvents were tested for optimum extraction of quinalphos from spiked blood samples. The effect of pH on the extraction yield of quinalphos was also examined. An average recovery of 93.61% was achieved from diethyl ether solvent at pH 3. Chromatographic separation was performed on silica gel 60F₂₅₄ plates using mobile phase n-hexane-acetone in the ration 9:1 (v/v). Densitometric detection was carried out at 325 nm in absorbance mode. The interference of other organophosphorus pesticides of forensic relevance was not observed. The linear regression analysis in spiked whole blood samples resulted in linear calibration plot in the range 1 to 100 μg mL^-1 with r² = 0.9981. Sensitivity was represented by LLOQ at 1 μg mL^-1. The within-day precision and between-day precision ranged from 0.18 to 1.04%, and 0.14 to 0.79% with an overall average recovery of 91.06% at three concentrations 1, 10, and 50 μg mL^-1. No significant decrease in the concentration of quinalphos was observed for samples under different storage conditions. Finally, the developed procedure was applied to postmortem blood samples obtained in three fatal cases of poisoning by quinalphos.

Dichlorvos alters morphology and behavior in zebrafish (Danio rerio) larvae

Dichlorvos (2,2-dichlorovinyl-dimethylphosphate), an organophosphorus pesticide used for indoor insect and livestock parasite control, is among the most common commercially available pesticides. However, there are significant concerns over its toxicity, especially due to its relative stability in water, soil, and air. Zebrafish, an important developmental model, has been used for studying the effects of toxic compounds. The aim of this study was to evaluate the exposure to dichlorvos at early life stages (1 h postfertilization - 7 days postfertilization) in the zebrafish and its toxicological effects during the development, through morphological (7 days postfertilization), locomotor and social behavior analysis (7, 14, 30, 70, and 120 days postfertilization). Dichlorvos (1, 5, and 10 mg/L) exposure reduced the body length and heartbeat rate at 7 days postfertilization (dpf), as well as the surface area of the eyes (5 and 10 mg/L). The avoidance behavior test showed a significant decrease in escape responses at 7 (1, 5, and 10 mg/L) and 14 (5 and 10 mg/L) dpf zebrafish. The evaluation of larval exploratory behavior showed a reduction in distance traveled, mean speed (1, 5, and 10 mg/L) and time mobile (10 mg/L) between control and dichlorvos groups. In addition, the analysis performed on adult animals showed that the changes in distance traveled and mean speed remained reduced in 30 (1, 5, and 10 mg/L) and 70 dpf (5 and 10 mg/L), recovering values similar to the control at 120 dpf. The social behavior of zebrafish was not altered by exposure to dichlorvos in the early stages of development. Thus, the exposure to organophosphorus compounds at early stages of development induces an increased susceptibility to behavioral and neuronal changes that could be associated with several neurodegenerative diseases.

Can we predict intermediate syndrome? A review

INTRODUCTION

Ingestion of organophosphorus insecticides (OPI) is a common method of deliberate self harm in the developing world. Deaths mainly follow as a result of the respiratory failure associated with both cholinergic crisis and the intermediate syndrome. Even though death can be prevented by early mechanical ventilation of these patients, limited studies are available regarding the prediction of intermediate syndrome and subsequent respiratory failure.

OBJECTIVE

To systematically review articles that are published with regard to possible prediction of intermediate syndrome using clinical, biochemical and electrophysiological parameters.

METHODS

A systematic review on literature published in English language was done in the PubMed database without a date limitation. Two sets of search terms were used. The first set consisted of MeSH Terms "organophosphates", "organophosphate poisoning", "op poisoning" "organophosphate insecticide poisoning" and "organophosphorus". The second set included the MeSH Terms "Intermediate syndrome", "proximal muscle weakness", "cranial nerve palsies", "respiratory depression" and "neck muscle weakness". Articles containing at least one word from each set were reviewed.

RESULTS

At least one MeSH term from each set was incorporated in 179 articles. Of these, 69 were rejected as they were not related to organophosphate poisoning or intermediate syndrome.

PREDICTION OF IMS

Clinical prediction is mostly based on ICU scoring systems. Biochemical markers such as reduced levels of serum and erythrocyte acetylcholine esterase have been studied many times. Both clinical and biochemical markers show a modest relationship in predicting IMS. Single fibre electromyography show promising results as it directly assesses neuromuscular junction.

CONCLUSION

The intermediate syndrome which follows organophosphate poisoning still remains a significant problem with its high morbidity. Clinical and biochemical markers show modest results in predicting IMS. Neurophysiological markers such as single fibre EMG should be studied further as they measure activity of affected nicotinic receptors directly.

Fatal poisoning by terbufos following occupational exposure

CONTEXT

Terbufos (TBF) is a class Ia (extremely hazardous) organophosphate pesticide (OP) and its distribution in industrialized countries has been severely restricted. Thus, acute occupational poisoning is rather uncommon. However, it still occurs in rural areas of some developing countries, where the sale of TBF is not controlled and its use is thus not properly regulated. We report a case of a 43-year-old female farmer who died after applying TBF granules.

CASE

The patient died within 3 h after applying 20 bags of 5% TBF granules (900 g per bag). Investigation showed that her personal protective equipment (PPE) did not provide effective protection against dermal and inhalational exposure. Postmortem analysis revealed extremely low red blood cell acetylcholinesterase activity. Toxicological analysis of TBF showed 1.45 × 10^-2 μg/ml in the heart blood and 0.17 μg/g in the liver.

DISCUSSIONS

This patient died as a result of toxicity from dermal and inhalational exposure to TBF. Over-application, improper equipment, inadequate and defective PPE, and lack of hygienic precautions were all contributing factors.

CONCLUSIONS

TBF is a highly toxic OP. Inadequate regulatory control, improper environmental application, and ineffective PPE resulted in a fatal human exposure.

Scenario of organophosphate pollution and toxicity in India: A review

The present study on organophosphate deals with the reports on pollution and toxicity cases throughout India. The use of pesticides was introduced in India during the 1960s which are now being used on a large scale and represents the common feature of Indian agriculture. Use of organophosphates as a pesticide came as an alternative to chlorinated hydrocarbons due to their easy degradability. Although these xenobiotics degrade under natural condition, their residues have been detected in soil, sediments, and water due to their non-regulated usage practice. The over-reliance on pesticides has not only threatened our environment but contaminations of organophosphate residues have been also detected in certain agricultural products like tea, sugars, vegetables, and fruits throughout India. This paper highlights many of the cases where different organophosphates have been detected exceeding their respective MRL values. Some organophosphates detected are so hazardous that even WHO has listed them in class 1a and class 1b hazardous group. Presence of their residues in blood, milk, honey, and tissues of human and animals revealed their excessive use and bioaccumulating capabilities. Their intentional or unintentional uptake is causing thousands of deaths and severity each year. Most of the toxicity cases presented here are due to their uptake during a suicidal attempt. This shows how easily these harmful substances are available in the market.

New onset refractory status epilepticus as an unusual presentation of a suspected organophosphate poisoning

New onset refractory status epilepticus (NORSE) is a new entity in medical literature. It has different infectious and noninfectious etiologies showing a devastating impact onto the clinical outcome of patients. Therapy with anaesthetic and antiepileptic agents often fails to improve the condition, unless the primary cause is rectified. Here is presented the case of a young female with a history of depression who after a recent bereavement came to the Emergency Department of Aga Khan University Hospital with complaints of drowsiness that lasted for few hours. Though she had no history of organophosphate poisoning, her physical examination and further investigations were suggestive of the diagnosis. During her hospital stay, she developed refractory status epilepticus. Her seizures did not respond to standard antiepileptic and intravenous anesthetic agents and subsided only after intravenous infusion of atropine for a few days. Organophosphate poisoning is a very common presentation in the developing world and the associated status epilepticus poses a devastating problem for emergency physicians. In patients with suspected organophosphate poisoning with favoring clinical exam findings, the continuation of atropine intravenous infusion can be a safe option to abate seizures.

Clinical features of organophosphate poisoning: A review of different classification systems and approaches

PURPOSE

The typical toxidrome in organophosphate (OP) poisoning comprises of the Salivation, Lacrimation, Urination, Defecation, Gastric cramps, Emesis (SLUDGE) symptoms. However, several other manifestations are described. We review the spectrum of symptoms and signs in OP poisoning as well as the different approaches to clinical features in these patients.

MATERIALS AND METHODS

Articles were obtained by electronic search of PubMed(®) between 1966 and April 2014 using the search terms organophosphorus compounds or phosphoric acid esters AND poison or poisoning AND manifestations.

RESULTS

Of the 5026 articles on OP poisoning, 2584 articles pertained to human poisoning; 452 articles focusing on clinical manifestations in human OP poisoning were retrieved for detailed evaluation. In addition to the traditional approach of symptoms and signs of OP poisoning as peripheral (muscarinic, nicotinic) and central nervous system receptor stimulation, symptoms were alternatively approached using a time-based classification. In this, symptom onset was categorized as acute (within 24-h), delayed (24-h to 2-week) or late (beyond 2-week). Although most symptoms occur with minutes or hours following acute exposure, delayed onset symptoms occurring after a period of minimal or mild symptoms, may impact treatment and timing of the discharge following acute exposure. Symptoms and signs were also viewed as an organ specific as cardiovascular, respiratory or neurological manifestations. An organ specific approach enables focused management of individual organ dysfunction that may vary with different OP compounds.

CONCLUSIONS

Different approaches to the symptoms and signs in OP poisoning may better our understanding of the underlying mechanism that in turn may assist with the management of acutely poisoned patients.

Performance of clinical scoring systems in acute organophosphate poisoning

INTRODUCTION

Clinical scoring systems are used to predict mortality rate in hospitalized patients. Their utility in organophosphate (OP) poisoning has not been well studied.

METHODS

In this retrospective study of 396 patients, we evaluated the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the Simplified Acute Physiology Score (SAPS) II, Mortality Prediction Model (MPM) II, and the Poisoning Severity Score (PSS). Demographic, laboratory, and survival data were recorded. Receiver operating characteristic (ROC) curves were generated, and the area under the curve (AUC) was calculated to study the relationship between individual scores and mortality rate.

RESULTS

The mean (standard deviation) age of the patients was 31.4 (12.7) years, and at admission, their pseudocholinesterase (median, interquartile) level was 317 (222-635) U/L. Mechanical ventilation was required in 65.7% of the patients and the overall mortality rate was 13.1%. The mean (95% confidence interval) scores were as follows: APACHE-II score, 16.4 (15.5-17.3); SAPS-II, 34.4 (32.5-36.2); MPM-II score, 28.6 (25.7-31.5); and PSS, 2.4 (2.3-2.5). Overall, the AUC for mortality was significantly higher for APACHE-II (0.77) and SAPS-II (0.77) than the PSS (0.67). When patients were categorized, the AUCs were better for WHO Class II (0.71-0.82) than that for Class I compounds (0.60-0.66). For individual compounds, the AUC for APACHE-II was highest in quinalphos (0.93, n = 46) and chlorpyrifos (0.86, n = 38) and lowest in monocrotophos (0.60, n = 63). AUCs for SAPS-II and MPM-II were marginally but not significantly lower than those for APACHE-II. The PSS was generally a poorer discriminator compared to the other scoring systems across all categories.

CONCLUSIONS

In acute OP poisoning, the generic scoring systems APACHE-II and SAPS-II outperform the PSS. These tools may be used to predict the mortality rate in OP poisoning.

Acute toxicity of veterinary and agricultural formulations of organophosphates dichlorvos and diazinon in chicks

Formulation components of organophosphate insecticidal preparations might affect their toxic action in animals. The objective of this study was to examine and compare the acute toxicity and cholinesterase inhibition in seven to 14-day-old chicks dosed orally with dichlorvos and diazinon in standard veterinary and agricultural formulations. The acute (24 h) oral median lethal doses (LD50) of the formulations were determined using the up-and-down method. Respective LD50 of dichlorvos of the veterinary and agricultural formulations in chicks were 11.1 mg kg(-1) and 6.51 mg kg(-1) and those of diazinon 6.4 mg kg(-1) and 6.7 mg kg(-1). Plasma and brain cholinesterase activities were measured by electrometry after in vivo and in vitro exposure to organophosphates. The chicks showed signs of cholinergic toxicosis within one hour of dosing. Dichlorvos (8 mg kg(-1)) and diazinon (4 mg kg(-1)) in the veterinary and agricultural formulation significantly reduced both plasma and brain cholinesterase activities in the chicks. The veterinary formulation of dichlorvos reduced plasma ChE by 60% and agricultural by 40% and brain ChE by 93% and 87%, respectively. In contrast, ChE inhibition by diazinon in the agricultural formulation of diazinon was stronger than by the veterinary formulation; 72% vs. 64% in plasma and 97% vs. 80% in the brain, respectively. The highest in vitro inhibitions were observed with dichlorvos in the agricultural formulation (50%) in the brain samples and with diazinon in the agricultural formulation (52%) in the plasma samples. While they exist, differences between formulations cannot be taken as a rule and further investigations should inventory the toxicity of standard veterinary and agricultural organophosphate formulations in addition to the known data for pure forms.

Mortality rate and pattern following carbamate methomyl poisoning. Comparison with organophosphate poisoning of comparable toxicity

CONTEXT

Methomyl is a widely used carbamate insecticide. It is known that mortality rate is generally low in carbamate poisoning, but fatalities from methomyl poisoning have been reported. Nevertheless, there is no reported comparative outcome of methomyl and organophosphate poisoning of comparable toxicity concerning mortality rate and mortality pattern.

OBJECTIVE

This study aims to compare the mortality rate and pattern following methomyl poisoning with those after organophosphate poisoning of comparable toxicity.

MATERIAL AND METHODS

A retrospective study was conducted on patients with cholinesterase inhibitor poisoning admitted to our institution. Among a diverse group of cholinesterase inhibitors, we included patients who presented after ingesting methomyl or World Health Organisation hazard Class I organophosphate compounds. Patients were divided into two groups; the methomyl group and the Class I organophosphate group.

RESULTS

The methomyl group consisted of 17 patients, and the Class I organophosphate group consisted of 42 patients. Seven patients (41.2%) in the methomyl group presented with cardiac arrest, while none presented with cardiac arrest in the Class I organophosphate group (p < 0.001). In the methomyl group, patients who had not experienced cardiac arrest at presentation survived to discharge from hospital. Among the seven patients who presented with cardiac arrest, three died from multiple organ dysfunction syndrome after resuscitation from cardiac arrest. In the Class I organophosphate group, four patients died from pneumonia and complicating acute respiratory distress syndrome. Therefore, the mortality rate was 17.6% in the methomyl group and 9.5% in the Class I organophosphate group (p = 0.399).

CONCLUSION

The mortality rate of methomyl poisoning was comparable to that of World Health Organisation Class I organophosphate poisoning. All died patients in the methomyl group experienced cardiac arrest, and died from multiple organ dysfunction syndrome after resuscitation from cardiac arrest.