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Pirmoghni A, Shahmoradi B, Taymoori P, Bagheri A, Nasrollahi P, Karimi Z, Mohammadian F, Emami N, Choi H. Application of the theory of planned behavior to model the intention and behavior of tomato growers in pesticide exposure. Heliyon 2024; 10:e35794. [PMID: 39170219 PMCID: PMC11337015 DOI: 10.1016/j.heliyon.2024.e35794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 07/27/2024] [Accepted: 08/02/2024] [Indexed: 08/23/2024] Open
Abstract
Widespread and indiscriminate use of pesticides has become one of the most important environmental and public health problems around the world. This study was conducted with the aim of applying the theory of planned behavior model to investigate the knowledge, attitude, and behavior of tomato growers in the face of pesticides in agricultural lands located in Kurdistan province, western Iran. We included 300 tomato growers in this study and they filled up a standard TPB questionnaire containing questions about basic information, knowledge, attitude and behavior about pesticides and their actions for disposing of the residual spray solution, washing place of pesticide sprayer, and the disposal of water from washing the equipment. Most of the respondents, 86.7 %, had not participated in promotional classes on how to dispose of the residual solution. Approximately 46.15, 38.46, and 15.39 % of pesticides contained moderately toxic, slightly toxic and practically non-toxic compounds, respectively. More than two-thirds (89 %) of the tomato growers stated that they leave the water from washing the equipment in the field. In addition, among the three variables of TPB, attitudes had the highest score (3.38), which indicated the positive to relatively neutral attitude of farmers towards the safe use of pesticides. These findings can be useful for planners and environmental organizations to make effective interventions to reduce environmental pollution caused by pesticides. Since the incorrect use of pesticides is one of the important environmental and health factors, education and awareness programs can help farmers to consider the correct use of pesticides and environmental protection more.
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Affiliation(s)
- Amin Pirmoghni
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - B. Shahmoradi
- Department of Environmental Health Engineering, Faculty of Health, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - P. Taymoori
- Department of Health Promotion, Faculty of Health, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Asghar Bagheri
- Department of Agricultural Management and Water Engineering, Faculty of Agricultural Sciences and Natural Resources, University of Mohaghegh Ardabili, Iran
| | - Parisa Nasrollahi
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Zhino Karimi
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Farough Mohammadian
- Department of Occupational Health Engineering, Faculty of Health, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Naier Emami
- Department of Agricultural Extension and Education, Faculty of Agriculture, Abu-Ali Sina University, Hamedan, Iran
| | - H.J. Choi
- Department of Biomedical Science, Catholic Kwandong University, Republic of Korea
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Jain R, Singh MK, Ali N, Khan MR, Bajaj A, Mudiam MKR. Innovative disposable in-tip cellulose paper (DICP) device for facile determination of pesticides in postmortem blood samples: A proof-of-concept study. J Chromatogr B Analyt Technol Biomed Life Sci 2024; 1245:124268. [PMID: 39126993 DOI: 10.1016/j.jchromb.2024.124268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 08/01/2024] [Accepted: 08/04/2024] [Indexed: 08/12/2024]
Abstract
Accurately identifying and quantifying toxicants is crucial for medico-legal investigations in forensic toxicology; however, low analyte concentrations and the complex samples matrix make this work difficult. Therefore, a simplified sample preparation procedure is crucial to streamline the analysis to minimize sample handling errors, reduce cost and improve the overall efficiency of analysis of toxicants. To address these challenges, an innovative disposable in-tip cellulose paper (DICP) device has been developed for the extraction of three pesticides viz. Chlorpyrifos, Quinalphos and Carbofuran from postmortem blood samples. The DICP device leverages cellulose paper strips housed within a pipette tip to streamline the extraction process, significantly reducing solvent usage, time, and labor while maintaining high analytical accuracy. The extraction of pesticides from postmortem blood using the DICP device involves a streamlined process characterized by adsorption and desorption. The diluted blood samples were processed through the DICP device via repeated aspirating and dispensing calyces to adsorb the pesticides onto the cellulose paper. The adsorbed pesticides are then eluted using acetone, which is collected for GC-MS analysis. The method was meticulously optimized, achieving a limit of quantification in the range of 0.009-0.01 µg mL-1. The intra-day and inter-day precisions were consistently less than 5 % and 10 %, respectively, with accuracy ranging from 94-106 %. Relative recoveries for the analytes were observed to be between 60 % and 93.3 %, and matrix effects were determined to be less than 10 %. The method's sustainability was validated with a whiteness score of 98.8, an AGREE score of 0.64, a BAGI score of 70 and ComplexMoGAPI score of 77. Applicability was demonstrated through successful analysis of real postmortem blood samples and proficiency testing samples, highlighting its potential utility in forensic toxicology.
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Affiliation(s)
- Rajeev Jain
- Central Forensic Science Laboratory, Directorate of Forensic Science Services, Ministry of Home Affairs, Govt. of India, Dakshin Marg, Sector - 36A, Chandigarh 160036, India.
| | - Mukesh Kumar Singh
- Institute of Pesticide Formulation Technology (IPFT), Sector-20, Udyog Vihar, Gurugram 122016, Haryana, India
| | - Nemat Ali
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Mohammad Rashid Khan
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Atul Bajaj
- Central Forensic Science Laboratory, Directorate of Forensic Science Services, Ministry of Home Affairs, Govt. of India, Dakshin Marg, Sector - 36A, Chandigarh 160036, India
| | - Mohana Krishna Reddy Mudiam
- Institute of Pesticide Formulation Technology (IPFT), Sector-20, Udyog Vihar, Gurugram 122016, Haryana, India; Analytical & Structural Chemistry Department, CSIR-Indian Institute of Chemical Technology, Tarnaka, Uppal Road, Hyderabad 500007, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
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Noghrehchi F, Dawson AH, Raubenheimer J, Mohamed F, Gawarammana IB, Eddleston M, Buckley NA. Restrictions on Pesticides and Deliberate Self-Poisoning in Sri Lanka. JAMA Netw Open 2024; 7:e2426209. [PMID: 39106063 PMCID: PMC11304112 DOI: 10.1001/jamanetworkopen.2024.26209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/08/2024] [Indexed: 08/07/2024] Open
Abstract
Importance Deliberate self-poisoning using pesticides as a means of suicide is an important public health problem in low- and middle-income countries. Three highly toxic pesticides-dimethoate, fenthion, and paraquat-were removed from the market in Sri Lanka between 2008 and 2011. In 2015, less toxic pesticides (chlorpyrifos, glyphosate, carbofuran, and carbaryl) were restricted. Subsequent outcomes have not been well described. Objective To explore the association of pesticide bans with pesticide self-poisonings and in-hospital deaths. Design, Setting, and Participants In this cross-sectional study with an interrupted time series design, data were prospectively collected on all patients with deliberate self-poisonings presenting to 10 Sri Lankan hospitals between March 31, 2002, and December 31, 2019, and analyzed by aggregated types of poisoning. The correlates of pesticide bans were estimated within the pesticide group and on self-poisonings within other substance groups. The data analysis was performed between April 1, 2002, and December 31, 2019. Exposures Implementation of 2 sets of pesticide bans. Main Outcomes and Measures The main outcomes were changes in hospital presentations and in-hospital deaths related to pesticide self-poisoning as measured using segmented Poisson regression. Results A total of 79 780 patients (median [IQR] age, 24 [18-34] years; 50.1% male) with self-poisoning from all causes were admitted to the study hospitals, with 29 389 poisonings (36.8%) due to pesticides. A total of 2859 patients died, 2084 (72.9%) of whom had ingested a pesticide. The first restrictions that targeted acutely toxic, highly hazardous pesticides were associated with an abrupt and sustained decline of the proportion of poisonings with pesticides (rate ratio [RR], 0.85; 95% CI, 0.78-0.92) over the study period and increases in poisonings with medications (RR, 1.11; 95% CI, 1.02-1.21) and household and industrial chemicals (RR, 1.20; 95% CI, 1.05-1.36). The overall case fatality of pesticides significantly decreased (RR, 0.33; 95% CI, 0.26-0.42) following the implementation of the 2008 to 2011 restrictions of highly hazardous pesticides. Following the 2015 restrictions of low-toxicity pesticides, hospitalizations were unchanged, and the number of deaths increased (RR, 1.98; 95% CI, 1.39-2.83). Conclusions and Relevance These findings support the restriction of acutely toxic pesticides in resource-poor countries to help reduce hospitalization for and deaths from deliberate self-poisonings and caution against arbitrary bans of less toxic pesticides while more toxic pesticides remain available.
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Affiliation(s)
- Firouzeh Noghrehchi
- Translational Australian Clinical Toxicology, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Andrew H. Dawson
- Translational Australian Clinical Toxicology, Faculty of Medicine and Health, The University of Sydney, Australia
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - Jacques Raubenheimer
- Translational Australian Clinical Toxicology, Faculty of Medicine and Health, The University of Sydney, Australia
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - Fahim Mohamed
- Translational Australian Clinical Toxicology, Faculty of Medicine and Health, The University of Sydney, Australia
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - Indika B. Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka
- Centre for Pesticide Suicide Prevention and Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Nicholas A. Buckley
- Translational Australian Clinical Toxicology, Faculty of Medicine and Health, The University of Sydney, Australia
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka
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Nasrabadi M, Nazarian M, Darroudi M, Marouzi S, Harifi-Mood MS, Samarghandian S, Farkhondeh T. Carbamate compounds induced toxic effects by affecting Nrf2 signaling pathways. Toxicol Rep 2024; 12:148-157. [PMID: 38304697 PMCID: PMC10831123 DOI: 10.1016/j.toxrep.2023.12.004] [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: 06/06/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 02/03/2024] Open
Abstract
Carbamate (CBs) is a class of insecticides which is being known as an important cause of intentional or accidental poisoning. CBs, cause carbamylation of acetylcholinesterase at neuronal synapses and neuromuscular junction. Exposure to CBs through skin contact, inhalation, or ingestion can result in significant cholinergic toxicity. This is due to the elevation of acetylcholine levels at ganglionic synapses found in both the sympathetic and parasympathetic nervous systems, as well as muscarinic receptors located in target organs of the parasympathetic nervous system, nicotinic receptors situated in skeletal muscle tissue, and the central nervous system. The association between human illnesses and environmental exposures to CBs have been extensively studied in several studies. Although CBs-triggered toxicity leads to overproduction of reactive oxygen species (ROS), the detailed association between the toxicity under CBs exposure and NFE2-related factor 2 (Nrf2) signaling pathways has not been completely clarified. In this review we aimed to summarize the latest findings on the functional interrelationship between carbamates compounds and Nrf2 signaling.
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Affiliation(s)
| | - Maryam Nazarian
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Majid Darroudi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Basic Sciences, Neyshabur University of Medical Sciences, Neyshabur 9318614139, Iran
| | - Somayeh Marouzi
- Department of Basic Sciences, Neyshabur University of Medical Sciences, Neyshabur 9318614139, Iran
- Department of Medical Biotechnology and Nanotechnology, Faculty of Medicine, Mashhad, Iran
| | | | - Saeed Samarghandian
- Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur 9318614139, Iran
| | - Tahereh Farkhondeh
- Department of Toxicology and Pharmacology, School of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran
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Tilley D, Christopher LD, Farrar T, Naidoo N. Emergency Medical Service responses as latent social capital toward Deliberate Self-Harm, Suicidality and Suicide. PSYCHOL HEALTH MED 2024; 29:743-753. [PMID: 37200110 DOI: 10.1080/13548506.2023.2214867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 05/11/2023] [Indexed: 05/20/2023]
Abstract
Escalation in Deliberate Self-Harm (DSH) is indicative of a rise in poor mental health and/or a failure of social and health services. The phenomenon of DSH exacerbates mental illness sequela, while being an essential indicator of suicide risk. Globally, about 800 000 people commit suicide yearly, averaging almost one suicide every 40 s. Based on a Retrospective Cross-Sectional Study, the aim sought to establish the scope of the DSH, suicidality and suicide case-load from a Western Cape Emergency Medical Services (EMS) prehospital perspective. A census of 3 years of EMS Incident Management Records (IMR) from a large rural district with seven local municipalities was undertaken using a novel data collection instrument. The 2976 (N) mental health-related incidents that met the inclusion criteria (from 413 712 cases) suggest a presentation rate of 7 per 1000 EMS calls. Sixty percent (n = 1776) were regarded to have deliberately self-harmed, attempted suicide or committed suicide. Overdose/deliberate self-poisoning accounted for 52% (n = 1550) of all the DSH caseload of the study. Attempted suicide accounted for 2.7% (n = 83) and Suicide for 3.4% (n = 102) of the suicidality case-load from the study, respectively. Suicide averaged 2.8. suicides per month in the Garden Route District over the 3-year period. Men were five times more likely to commit suicide than women, commonly using strangulation, while women mostly ingested household detergents and poison, and overdosed on chronic medication. Understandably, the EMS needs to assess its own capability to respond, treat, and transport health-care users with DSH and suicidality. This study demonstrates the EMS 'everyday' exposure to DSH, suicidality and suicide case-load. It represents a critical first step in the problem-space definition upon which a determination of the need for EMS responses can be based, to interrupt suicidality by removing methods of harm and strengthening the mental health economy through social capital investment.
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Affiliation(s)
- Daniel Tilley
- Department of Emergency Medical Science, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Lloyd Denzil Christopher
- Department of Emergency Medical Science, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Thomas Farrar
- Department of Mathematics and Physics, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Navindhra Naidoo
- Paramedicine, School of Health Sciences, Western Sydney University, Sydney, Australia
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Kachiko G, Weisheit A, Ajayi CO, Tolo CU, Tusiimire J. Immuno-Kachiks formula immunomodulates and ameliorates hepatic damage induced by monosodium glutamate in rats. Heliyon 2024; 10:e27076. [PMID: 38463849 PMCID: PMC10920360 DOI: 10.1016/j.heliyon.2024.e27076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/12/2024] Open
Abstract
The immune system plays a vital role in controlling liver fibrosis and enhancing the pathogenesis of liver inflammation. Monosodium glutamate is a common flavor-enhancement food additive. This study evaluated the immunomodulatory and hepato-curative effects of the Immuno-Kachiks polyherbal formulation against monosodium glutamate-induced immune suppression and hepatic damage in rats. Monosodium glutamate was given orally at a 2000 mg/kg dose to male Wistar rats for three months to induce liver damage and immune suppression. After three months of successful induction, three groups were separately administered orally with Immuno-Kachiks formula at 400, 800, and 1500 mg/kg/day for 28 days. At the end of the treatment period, liver and blood samples were collected for histological and biochemical analysis. The lymphocyte count remained significantly low while the neutrophil count and the neutrophil-to-lymphocyte ratio increased significantly, despite the cessation of monosodium glutamate ingestion for 28 days. The Immuno-Kachiks formula (IKF) significantly increased the lymphocyte count, reduced the neutrophil-to-lymphocyte ratio, and normalized the neutrophil count. Neither monosodium glutamate nor the IKF significantly caused alpha-fetoprotein levels to rise or fall below normal. High doses (800 and 1500 mg/kg) of the Immuno-Kachiks formula significantly raised serum levels of aspartate aminotransferase, alkaline phosphatase, and total bilirubin. 1500 mg/kg of the IKF caused mild liver inflammation. The IKF restored the liver morphologic alterations observed in monosodium glutamate-induced liver damage in rats. The results suggest that the Immuno-Kachiks herbal formulation is a potential curative agent for early-stage liver damage and could restore suppressed adaptive immunity.
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Affiliation(s)
- Geoffrey Kachiko
- Pharm-BioTechnology and Traditional Medicine Center of Excellence (PHARMBIOTRAC), Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
- Department of Pharmacy, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Anke Weisheit
- Pharm-BioTechnology and Traditional Medicine Center of Excellence (PHARMBIOTRAC), Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Clement Olusoji Ajayi
- Pharm-BioTechnology and Traditional Medicine Center of Excellence (PHARMBIOTRAC), Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Casim Umba Tolo
- Pharm-BioTechnology and Traditional Medicine Center of Excellence (PHARMBIOTRAC), Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Jonans Tusiimire
- Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
- Department of Pharmacy, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
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Mazuryk J, Klepacka K, Kutner W, Sharma PS. Glyphosate: Impact on the microbiota-gut-brain axis and the immune-nervous system, and clinical cases of multiorgan toxicity. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 271:115965. [PMID: 38244513 DOI: 10.1016/j.ecoenv.2024.115965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/25/2023] [Accepted: 01/06/2024] [Indexed: 01/22/2024]
Abstract
Glyphosate (GLP) and GLP-based herbicides (GBHs), such as polyethoxylated tallow amine-based GLP surfactants (GLP-SH), developed in the late 70', have become the most popular and controversial agrochemicals ever produced. Nowadays, GBHs have reached 350 million hectares of crops in over 140 countries, with an annual turnover of 5 billion and 11 billion USD in the U.S.A. and worldwide, respectively. Because of the highly efficient inhibitory activity of GLP targeted to the 5-enolpyruvylshikimate-3-phosphate synthase pathway, present in plants and several bacterial strains, the GLP-resistant crop-based genetic agricultural revolution has decreased famine and improved the costs and quality of living in developing countries. However, this progress has come at the cost of the 50-year GBH overuse, leading to environmental pollution, animal intoxication, bacterial resistance, and sustained occupational exposure of the herbicide farm and companies' workers. According to preclinical and clinical studies covered in the present review, poisoning with GLP, GLP-SH, and GBHs devastatingly affects gut microbiota and the microbiota-gut-brain (MGB) axis, leading to dysbiosis and gastrointestinal (GI) ailments, as well as immunosuppression and inappropriate immunostimulation, cholinergic neurotransmission dysregulation, neuroendocrinal system disarray, and neurodevelopmental and neurobehavioral alterations. Herein, we mainly focus on the contribution of gut microbiota (GM) to neurological impairments, e.g., stroke and neurodegenerative and neuropsychiatric disorders. The current review provides a comprehensive introduction to GLP's microbiological and neurochemical activities, including deviation of the intestinal Firmicutes-to-Bacteroidetes ratio, acetylcholinesterase inhibition, excitotoxicity, and mind-altering processes. Besides, it summarizes and critically discusses recent preclinical studies and clinical case reports concerning the harmful impacts of GBHs on the GI tract, MGB axis, and nervous system. Finally, an insightful comparison of toxic effects caused by GLP, GBH-SH, and GBHs is presented. To this end, we propose a first-to-date survey of clinical case reports on intoxications with these herbicides.
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Affiliation(s)
- Jarosław Mazuryk
- Department of Electrode Processes, Institute of Physical Chemistry, Polish Academy of Sciences, 01-224 Warsaw, Poland; Bio & Soft Matter, Institute of Condensed Matter and Nanosciences, Université catholique de Louvain, 1 Place Louis Pasteur, 1348 Louvain-la-Neuve, Belgium.
| | - Katarzyna Klepacka
- Functional Polymers Research Team, Institute of Physical Chemistry, Polish Academy of Sciences, 01-224 Warsaw, Poland; ENSEMBLE(3) sp. z o. o., 01-919 Warsaw, Poland
| | - Włodzimierz Kutner
- Department of Electrode Processes, Institute of Physical Chemistry, Polish Academy of Sciences, 01-224 Warsaw, Poland; Faculty of Mathematics and Natural Sciences. School of Sciences, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland
| | - Piyush Sindhu Sharma
- Functional Polymers Research Team, Institute of Physical Chemistry, Polish Academy of Sciences, 01-224 Warsaw, Poland
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Weerasinghe M, Jobe L, Konradsen F, Eddleston M, Pearson M, Jayamanne S, Hawton K, Gunnell D, Agampodi S. Differences in the characteristics of people who purchase pesticides from shops for self-harm versus those who use pesticides available in the domestic environment in Sri Lanka. Trop Med Int Health 2023; 28:901-911. [PMID: 37871998 DOI: 10.1111/tmi.13941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
OBJECTIVE Data from South Asia indicate that for 15%-20% of suicide attempts, pesticides are purchased from shops; otherwise, pesticides are obtained from an individual's house or nearby environment. We aimed to investigate the difference between individuals who directly purchase pesticides from shops for suicide attempts and suicide deaths versus those related to accessing the pesticides from an individual's house or nearby environment. METHODS We conducted two comparative studies in rural Sri Lanka: (1) non-fatal shop cases (n = 50) were survivors of self-poisoning with pesticides who ingested the pesticides after purchasing them from a shop; non-fatal domestic cases (n = 192) were survivors who accessed pesticides from their house or nearby environment. (2) fatal shop cases (n = 50) were individuals who died after ingesting pesticides they purchased for the act; fatal domestic cases (n = 102) were patients who died after ingesting pesticides they accessed at house or nearby environment. Logistic regression analysis was used to assess the characteristics which distinguished between the shop and domestic cases. RESULTS Data indicate that 20.7% and 32.9% of individuals who used pesticides for suicide attempts and suicide deaths had purchased them from shops, respectively. Being a non-farmer was the main distinguishing characteristic of shop cases: adjusted odds ratios (AOR) 8.9, 95% confidence intervals (CI) 3.2-24.4 for non-fatal shop cases, and AOR 4.0, 95% CI 1.5-10.6 for fatal shop cases. Non-fatal shop cases also had higher suicide intent (AOR 3.0, CI 1.0-8.9), and ingesting an insecticide (AOR 4.8, CI 1.8-1.0-8.9) than non-fatal domestic cases. CONCLUSION A high suicide intent of individuals who purchase pesticides for the event explains the high proportion of such fatal cases. Such high suicide intent makes the prevention implications difficult to spell out for those individuals who purchase pesticides for self-poisoning. However, our findings are valuable for clinicians to assess pesticide poisoning cases in hospitals.
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Affiliation(s)
- Manjula Weerasinghe
- Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Lei Jobe
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Konradsen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Melissa Pearson
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Shaluka Jayamanne
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - David Gunnell
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Suneth Agampodi
- International Vaccine Institute, Seoul, South Korea
- Center for Public Health, Anuradhapura, Sri Lanka
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Schölin L, Knipe D, Bandara P, Eddleston M, Sethi A. Banning highly hazardous pesticides saves the lives of young people, particularly females, in low- and middle-income countries. BMC Public Health 2023; 23:2249. [PMID: 37968702 PMCID: PMC10647157 DOI: 10.1186/s12889-023-17071-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/26/2023] [Indexed: 11/17/2023] Open
Abstract
Pesticide self-poisoning is a public health problem mostly affecting low- and middle-income countries. In Sri Lanka, India and China suicide rates have reduced among young people, particularly females, following highly hazardous pesticides (HHP) bans. This success story requires attention to encourage more research on differential effects of HHP bans.
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Affiliation(s)
- Lisa Schölin
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK.
| | - Duleeka Knipe
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Piumee Bandara
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Aastha Sethi
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
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Kaur S, Chowdhary S, Kumar D, Bhattacharyya R, Banerjee D. Organophosphorus and carbamate pesticides: Molecular toxicology and laboratory testing. Clin Chim Acta 2023; 551:117584. [PMID: 37805177 DOI: 10.1016/j.cca.2023.117584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/09/2023]
Abstract
Population and food requirements are increasing daily throughout the world. To fulfil these requirements application of pesticides is also increasing. Organophosphorous (OP) and Organocarbamate (OC) compounds are widely used pesticides. These pesticides are used for suicidal purposes too. Both inhibit Acetylcholinesterase (AChE) and cholinergic symptoms are mainly used for the diagnosis of pesticide poisoning. Although the symptoms of the intoxication of OP and OC are similar, recent research has described different targets for OP and OC pesticides. Researchers believe the distinction of OP/OC poisoning will be beneficial for the management of pesticide exposure. OP compounds produce adducts with several proteins. There is a new generation of OP compounds like glyphosate that do not inhibit AChE. Therefore, it's high time to develop biomarkers that can distinguish OP poisoning from OC poisoning.
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Affiliation(s)
- Sumanpreet Kaur
- Department of Experimental Medicine and Biotechnology, PGIMER, Chandigarh 160012, India
| | - Sheemona Chowdhary
- Department of Experimental Medicine and Biotechnology, PGIMER, Chandigarh 160012, India
| | - Deepak Kumar
- Department of Experimental Medicine and Biotechnology, PGIMER, Chandigarh 160012, India.
| | - Rajasri Bhattacharyya
- Department of Experimental Medicine and Biotechnology, PGIMER, Chandigarh 160012, India.
| | - Dibyajyoti Banerjee
- Department of Experimental Medicine and Biotechnology, PGIMER, Chandigarh 160012, India.
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Stephenson L, Van Den Heuvel C, Humphries M, Nash C, Byard RW. Features of fatal pesticide ingestion in South Australia. MEDICINE, SCIENCE, AND THE LAW 2023:258024231197914. [PMID: 37661826 DOI: 10.1177/00258024231197914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Pesticides are used to kill, repel or control any animal or plant species which are considered pests, but have also been associated with intentional and unintentional human fatalities. A rapid increase in pesticide suicides was observed during 'The Green Revolution' after pesticides were introduced into low- and middle-income rural households without appropriate guidelines for safe use and storage. While national pesticide bans have contributed to a significant decrease in pesticide-related suicides, such cases still comprise a large proportion of all suicides around the world. The aim of the current study was to provide a profile of pesticide suicides in a high-income country as a point of comparison against studies from low- and middle-income countries. Statistical analyses were performed using R (version 4.2.3). Over the 20-year study period, there were a low, yet consistent number of pesticide suicides which were most common among males over the age of 40. Paraquat and methomyl pesticides collectively contributed to almost half (48.8%) of all fatalities. Consistent with the literature, such cases often occurred with little premeditation in response to an acute emotional crisis. While interpretation of autopsy findings was mostly limited, there were some pesticides that demonstrated findings consisted with previously reported characteristics (e.g., gastroesophageal erosions with paraquat). Given the high proportion of cases where paraquat and methomyl pesticides were implicated, it may be appropriate to review the availability and accessibility of such compounds to reduce the occurrence of pesticide suicides in South Australia and potentially the wider Australian population.
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Affiliation(s)
- Lilli Stephenson
- School of Biomedicine, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Melissa Humphries
- School of Mathematical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Christine Nash
- Toxicology Group, Forensic Science SA (FSSA), Adelaide, South Australia, Australia
| | - Roger W Byard
- Pathology Group, Forensic Science SA (FSSA), Adelaide, South Australia, Australia
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Yan Y, Jiang Y, Liu R, Eddleston M, Tao C, Page A, Wang L, Feng G, Liu S. Impact of pesticide regulations on mortality from suicide by pesticide in China: an interrupted time series analysis. Front Psychiatry 2023; 14:1189923. [PMID: 37732083 PMCID: PMC10507350 DOI: 10.3389/fpsyt.2023.1189923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/08/2023] [Indexed: 09/22/2023] Open
Abstract
Background Pesticide bans and regulatory restrictions have been shown to be effective strategies for preventing suicide in several countries. Suicide and suicide by pesticides have decreased significantly in China over the past two decades. However, whether the reduction was associated with pesticide regulation is unknown. Methods The monthly data on suicide and suicide by pesticide from 2006 to 2018 were obtained from China's Disease Surveillance Point (DSP) system. Information on China's pesticide regulations since 1970 was obtained from Pesticide Action Network International (PAN International), Joint Meeting on Pesticide Management Highly Hazardous Pesticides (JMPM HHP) lists, the website of the Ministry of Agriculture of China, Pesticide Information Network of China, and the Wan Fang database. Change point detection and policy analysis were combined to identify the time of any trend change breakpoint of suicide and suicide by pesticide. Interrupted time series analysis was used to investigate the pre- and post-breakpoint trends of monthly standardized rates in suicide and suicide by pesticide. Results The standardized pesticide suicide rate decreased by 60.5% from 6.50 in 2006 to 2.56 per 100,000 in 2018. Larger declines were evident among people in urban areas (67.3%), female individuals (63.5%), and people aged 15-44 years (68.1%). The effect of policies banning highly hazardous organophosphorus pesticides (HHOP) [rate ratio (RR) = 0.993, 95% CIs (0.991-0.994)] in December 2008 and stopping domestic sales and use of paraquat aqueous solution (RR = 0.992, 95% CIs: 0.990-0.994) in July 2016 were more pronounced than regulating the paraquat-related products (RR = 1.003, 95% CIs: 1.002-1.004) in April 2012. Conclusion Declines in suicide by pesticide in China occurred contemporaneously with regulatory bans and restrictions implemented on several pesticides, particularly in urban areas, among female individuals, and the relatively low age profile. These findings indicate the potential influence of these bans on trends of suicide by pesticides.
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Affiliation(s)
- Yongfu Yan
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yingying Jiang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Rong Liu
- The George Institute for Global Health, Faculty of Medicine, The University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, United Kingdom
| | - Chuanjiang Tao
- Institute for the Control of Agrochemicals, Ministry of Agriculture and Rural Affairs, Beijing, China
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guoshuang Feng
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shiwei Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
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Eddleston M. Banning toxic pesticides is effective at preventing suicides in South Asia. BMJ 2023; 382:1838. [PMID: 37586726 DOI: 10.1136/bmj.p1838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Michael Eddleston
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh EH16 4TJ, UK
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Schölin L, Sørensen JB, Eddleston M. A lethal cocktail - shining a light on the relationship between alcohol use and pesticide self-poisoning. Clin Toxicol (Phila) 2023; 61:581-583. [PMID: 37815248 DOI: 10.1080/15563650.2023.2259599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Alcohol and pesticides are toxic substances that each cause acute and chronic harm to humans. Alcohol plays an important and complex role in pesticide self-poisoning, involving toxicological, public health, and social aspects important for research, prevention, and interventions. ALCOHOL USE DISORDER AND SOCIAL HARMS While the evidence on alcohol co-ingestion in the context of pesticide self-poisoning is limited, it appears that alcohol use increases complications. Even fewer studies address alcohol use disorder and dependence among pesticide self-poisoning patients. The harmful use of alcohol also impacts social life, families, and communities in several ways, including pesticide self-poisoning among individuals around the alcohol user. This, however, is vastly understudied. OUTSIDE INFLUENCES Agrochemicals and alcohol are produced by industries with financial interests, and the outcome of individual acts of pesticide self-poisoning depends on the lethality of the pesticide purchased and ingested. The promotion of acutely toxic pesticides by companies must be acknowledged within this issue. CONCLUSION The relationship between alcohol and pesticide self-poisoning is increasingly clear, but more studies are needed to guide management. We cannot ignore that pesticide self-poisoning and harmful use of alcohol occur within the context of wider, often structural, stressors and are influenced by commercial entities.
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Affiliation(s)
- Lisa Schölin
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
| | | | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
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15
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Zhang J, Yao T, Gong W, Gao Y, Zhao G. Additive screening and formula optimization of microbial inhibitor having disease prevention and growth promotion effects on Avena sativa. Front Microbiol 2023; 14:1208591. [PMID: 37547695 PMCID: PMC10397394 DOI: 10.3389/fmicb.2023.1208591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
In order to develop environment friendly microbial inhibitor that can also control disease and promote oat (Avena sativa) growth, the growth rate method and response surface methodology were used to screen wetting agents, preservatives and protective agents at optimal concentrations in this study. Antagonistic activity of the tested bacterium and cell-free fermentation liquid against pathogenic fungi was evaluated on potato dextrose agar (PDA) substratum plates by dual culture technique. Oxford cup method was used to measure antagonistic reaction between screened bacteria. According to each screened bacteria with 50 mL were mixed and cultured in Luria-bertani (LB) substratum. Additives of Wetting agents, UV-protectors, and preservatives were screened by single factor test on the growth concentration of screened mixed bacteria. Afterwards, the optimal additives and concentrations were screened by Box-Behnken method. The microbial inhibitor was detected according to national standards GB20287-2006 and tested on oat in a pot experiment. The results showed that: (1) Functional bacteria which including Bacillus velezensis and Brevundimonas faecalis had control effects of 50.00% to 83.29% on three pathogenic fungi, and their cell free-fermentation liquid could inhibit the growth of pathogenic fungi from 23.51% to 39.90%; (2) Tween-80 was most suitable as wetting agents for Mix biocontrol bacteria (MBB) with 1.00% mass fraction; Sorbitol was selected as UV protective agents for MBB with 0.50% mass fraction. And methyl paraben was used as a preservative for MBB, with 0.50% mass fraction; (3) The most effective adjuvant contained 14.96 mL/L Tween-80, 5.12 g/L methylparaben and 5.6 g/L sorbitol; and (4) The microbial inhibitor controlled 45.57% of oat root rot and increased plant height, root length and seedling biomass. This study provides a suitable environment for the protection of mixed biocontrol bacteria, and lays a foundation for the prevention and control of oat diseases, the promotion of growth and the improvement of quality.
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Affiliation(s)
- Jiangui Zhang
- College of Grassland Science, Gansu Agricultural University, Lanzhou, Gansu, China
- Key Laboratory of Grassland Ecosystem of Ministry of Education, Lanzhou, Gansu, China
| | - Tuo Yao
- College of Grassland Science, Gansu Agricultural University, Lanzhou, Gansu, China
- Key Laboratory of Grassland Ecosystem of Ministry of Education, Lanzhou, Gansu, China
| | - Wenlong Gong
- College of Grassland Science, Gansu Agricultural University, Lanzhou, Gansu, China
| | - Yamin Gao
- College of Grassland Science, Gansu Agricultural University, Lanzhou, Gansu, China
| | - Guiqin Zhao
- College of Grassland Science, Gansu Agricultural University, Lanzhou, Gansu, China
- Key Laboratory of Grassland Ecosystem of Ministry of Education, Lanzhou, Gansu, China
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16
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Niquet J, Nguyen D, de Araujo Furtado M, Lumley L. Treatment of cholinergic-induced status epilepticus with polytherapy targeting GABA and glutamate receptors. Epilepsia Open 2023; 8 Suppl 1:S117-S140. [PMID: 36807554 PMCID: PMC10173853 DOI: 10.1002/epi4.12713] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/15/2023] [Indexed: 02/23/2023] Open
Abstract
Despite new antiseizure medications, the development of cholinergic-induced refractory status epilepticus (RSE) continues to be a therapeutic challenge as pharmacoresistance to benzodiazepines and other antiseizure medications quickly develops. Studies conducted by Epilepsia. 2005;46:142 demonstrated that the initiation and maintenance of cholinergic-induced RSE are associated with trafficking and inactivation of gamma-aminobutyric acid A receptors (GABAA R) thought to contribute to the development of benzodiazepine pharmacoresistance. In addition, Dr. Wasterlain's laboratory reported that increased N-methyl-d-aspartate receptors (NMDAR) and alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPAR) contribute to enhanced glutamatergic excitation (Neurobiol Dis. 2013;54:225; Epilepsia. 2013;54:78). Thus, Dr. Wasterlain postulated that targeting both maladaptive responses of reduced inhibition and increased excitation that is associated with cholinergic-induced RSE should improve therapeutic outcome. We currently review studies in several animal models of cholinergic-induced RSE that demonstrate that benzodiazepine monotherapy has reduced efficacy when treatment is delayed and that polytherapy with drugs that include a benzodiazepine (eg midazolam and diazepam) to counter loss of inhibition, concurrent with an NMDA antagonist (eg ketamine) to reduce excitation provide improved efficacy. Improved efficacy with polytherapy against cholinergic-induced seizure is demonstrated by reduction in (1) seizure severity, (2) epileptogenesis, and (3) neurodegeneration compared with monotherapy. Animal models reviewed include pilocarpine-induced seizure in rats, organophosphorus nerve agent (OPNA)-induced seizure in rats, and OPNA-induced seizure in two mouse models: (1) carboxylesterase knockout (Es1-/- ) mice which, similarly to humans, lack plasma carboxylesterase and (2) human acetylcholinesterase knock-in carboxylesterase knockout (KIKO) mice. We also review studies showing that supplementing midazolam and ketamine with a third antiseizure medication (valproate or phenobarbital) that targets a nonbenzodiazepine site rapidly terminates RSE and provides further protection against cholinergic-induced SE. Finally, we review studies on the benefits of simultaneous compared with sequential drug treatments and the clinical implications that lead us to predict improved efficacy of early combination drug therapies. The data generated from seminal rodent studies of efficacious treatment of cholinergic-induced RSE conducted under Dr. Wasterlain's guidance suggest that future clinical trials should treat the inadequate inhibition and temper the excess excitation that characterize RSE and that early combination therapies may provide improved outcome over benzodiazepine monotherapy.
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Affiliation(s)
- Jerome Niquet
- Department of NeurologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
- Epilepsy Research LaboratoryVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
| | - Donna Nguyen
- Neuroscience DepartmentU.S. Army Medical Research Institute of Chemical Defense (USAMRICD)Aberdeen Proving GroundMarylandUSA
| | | | - Lucille Lumley
- Neuroscience DepartmentU.S. Army Medical Research Institute of Chemical Defense (USAMRICD)Aberdeen Proving GroundMarylandUSA
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Setia S, Chiwhane A. Intermediate Syndrome Due to Organophosphate Poisoning: A Case Report. Cureus 2023; 15:e39368. [PMID: 37362485 PMCID: PMC10285569 DOI: 10.7759/cureus.39368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Organophosphates, also known as phosphate esters, are a category of pesticide compounds that function by indirectly inhibiting the activity of an enzyme called acetylcholinesterase (AChE). AChE is responsible for breaking down acetylcholine (ACh) at the neuromuscular junction into acetic acid and choline. These compounds cause various clinical presentations upon acute toxicity, among which intermediate syndrome (IMS) exhibits an unpredictable course. This report describes the case of a farmer who ingested monocrotophos and ethanol in a suicide attempt, leading to a prolonged stay in the hospital and invasive ventilation, along with complications including ventilator-associated pneumonia. The patient received a total of 9000 mg of atropine over his 14-day hospitalization period.
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Affiliation(s)
- Shubhangi Setia
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anjalee Chiwhane
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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18
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Sarkar S. Despite historic bans, south Asia still struggles with pesticide suicides. BMJ 2023; 381:678. [PMID: 37041012 DOI: 10.1136/bmj.p678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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Mitra JK, Hansda U, Bandyopadhyay D, Sarkar S, Sahoo J. The role of a combination of N-acetylcysteine and magnesium sulfate as adjuvants to standard therapy in acute organophosphate poisoning: A randomized controlled trial. Heliyon 2023; 9:e15376. [PMID: 37123961 PMCID: PMC10133766 DOI: 10.1016/j.heliyon.2023.e15376] [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: 06/26/2022] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023] Open
Abstract
Background Mortality in acute organophosphate (OP) poisoning remains high despite current standard therapy with atropine and oximes. Due to dose-limiting side effects of atropine, novel therapies are targeting other putative mechanisms of injury, including oxidative damage, to reduce atropine dosage. Objectives N-acetylcysteine (NAC) and magnesium sulfate (MgSO4) have different mechanisms of actions and should act synergistically in OP poisoning. In this study, we wanted to evaluate whether this novel combination, used as an adjuvant to standard care, could improve clinical outcomes. Methods The study was conducted in the Emergency Department and ICU of AIIMS Bhubaneswar (a tertiary care center and government teaching institute) between July 2019 and July 2021. Eighty-eight adult patients with history and clinical features of acute OP poisoning were randomly allocated (1:1) into two groups. The Study group received 600 mg NAC via nasogastric tube thrice daily for 3 days plus a single dose of 4 g Inj. MgSO4 IV on first day and the Control group received suitably matched placebo (double-blinding) - in addition to standard care in both the groups. The primary outcome measure was to compare the total dose of Inj. Atropine required (cumulative over the entire treatment duration) between the control group and the study group receiving NAC and MgSO4. The secondary outcome measures were lengths of ICU and hospital stays, need and duration of mechanical ventilation, the differences in BuChE activity, oxidative stress biomarkers - MDA and GSH levels, the incidences of adverse effects including delayed sequalae like intermediate syndrome and OPIDN, and comparison of mortality between the two groups. Results Data from 43 patients in Control and 42 patients in Study group was finally analyzed. The baseline parameters were comparable. Total atropine requirements were lower in the Study group [175.33 ± 81.25 mg (150.01-200.65)] compared to the Control [210.63 ± 102.29 mg (179.15-242.11)] [Mean ± SD (95% CI)], but was not statistically significant. No significant differences in any of the other clinical or biochemical parameters were noted. Conclusion The N-acetylcysteine and MgSO4 combination as adjuvants failed to significantly reduce atropine requirements, ICU/hospital stay, mechanical ventilatory requirements, mortality and did not offer protection against oxidative damage.
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Affiliation(s)
- Jayanta Kumar Mitra
- Department of Anesthesiology & Critical Care, AIIMS Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
- Corresponding author.
| | - Upendra Hansda
- Department of Trauma & Emergency, AIIMS Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Debapriya Bandyopadhyay
- Department of Biochemistry, AIIMS Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Satyaki Sarkar
- Department of Anesthesiology & Critical Care, AIIMS Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Joshna Sahoo
- Department of Anesthesiology & Critical Care, AIIMS Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
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Morales-Cruz MJ, Scheveck B, Diaz VI, McNally KS, Elfman J, Ganti L. Organophosphate Toxicity Presenting as a Stroke Alert. Cureus 2023; 15:e36882. [PMID: 37128516 PMCID: PMC10147558 DOI: 10.7759/cureus.36882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 03/31/2023] Open
Abstract
Altered mental status is a common emergency department presentation. It has a broad differential and can be particularly challenging when the patient is unable to give a history and collateral information is not immediately available. The authors present a case of altered mental status initially brought in as a stroke alert but later discovered to be intentional organophosphate ingestion. Although organophosphate poisoning is relatively rare in the United States, it should be considered in patients with altered mental status with miosis who are unresponsive to naloxone, especially in the setting of bradycardia or copious secretions.
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Stuart AM, Merfield CN, Horgan FG, Willis S, Watts MA, Ramírez-Muñoz F, U JS, Utyasheva L, Eddleston M, Davis ML, Neumeister L, Sanou MR, Williamson S. Agriculture without paraquat is feasible without loss of productivity-lessons learned from phasing out a highly hazardous herbicide. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:16984-17008. [PMID: 36622585 PMCID: PMC9928820 DOI: 10.1007/s11356-022-24951-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
A small proportion of the thousands of pesticides on the market today are associated with a disproportionately high incidence of severe acute pesticide poisoning and suicide. Paraquat stands out as one of the most lethal pesticides in common use, frequently involved in fatal incidents due to suicides or accidental exposure. Even though paraquat has been banned in over 67 countries, it is still widely used in many others, particularly in Asia and Latin America. Based on a literature review and consultations, this paper identifies options for replacing paraquat and distils practical lessons from numerous successes around the world. Our aim is to support regulators, policymakers, agronomists and the supply chain sector with practical information related to phasing out paraquat. Production data consistently failed to show any negative effects of banning paraquat on agricultural productivity. A wide range of alternative approaches to weed management and crop defoliation are available, many of which do not rely on herbicides. Over 1.25 million farmers in low- and middle-income countries (LMICs) successfully produce a range of crops for private voluntary standards (PVS) in food and fiber supply chains which prohibit paraquat use. We conclude from the findings of this study that eliminating paraquat will save lives without reducing agricultural productivity. Less hazardous and more sustainable alternatives exist. To enhance successful adoption and uptake of these methods on a wide scale, farmers require training and support within an enabling policy environment.
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Affiliation(s)
| | | | - Finbarr G Horgan
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
- Facultat de Ciencias Agrarias Y Forestales, Escuela de Agronomía, Universidad Católica del Maule, Casilla 7-D, 3349001, Curico, Chile
- EcoLaVerna Integral Restoration Ecology, Bridestown, Kildinan, T56 P 499, Cork, Ireland
| | - Sheila Willis
- Pesticide Action Network UK, Brighthelm Centre, Brighton, UK
| | | | - Fernando Ramírez-Muñoz
- Central American Institute for Studies On Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | | | - Leah Utyasheva
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
| | - Mark L Davis
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
| | | | - Manoé R Sanou
- Department of Plant Protection and Packaging, Ministry of Agriculture, Ouagadougou, Burkina Faso
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Yaseen T, Hajjar MJ, Baogen G. High hazzard pesticides (HHPs) in Near East and North Africa (NENA), constrains and recommendations to mitigate the risk of HHPs. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:1133-1151. [PMID: 35915308 DOI: 10.1007/s11356-022-22023-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
This study presents an overview of the current situation of highly hazardous pesticides (HHPs) in North Africa and Near East countries (NENA). This work reviews the registered pesticides in the region and identify HHPs being used according to the criteria 1-8 for HHPs of FAO/WHO Guidelines on HHPs. In addition, to identify the weakness and the need of the region to mitigate the risk from the use of HHPs, the report ended with recommendations needed in the region to improve the pesticide managements and registration, such as improving the agricultural practices by adopting the integrated pest management IPM and including replacing HHPs with ecosystem-friendly alternatives if available. The total number of pesticides registered and used in NENA region is 642 active ingredients (IA). Eighty-nine HHPs are still in use in NENA region and 50% of them are evaluated under 1-7 criteria of GHS HHPs. This evaluation shows that 50% of HHPs are insecticides, 22% fungicides, 10% herbicides, 8% nematocides, and 10% rodenticides. The rest of 38 HHPs are identified under criteria 8. This high number of HHPs still in use in some NENA countries urges the need of technical assistance to reduce the use of HHPs. The type of assistant varies from country to other; to identify the priority of technical and legal assistant needed, a country-based assessments must be carried out at the near future.
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Affiliation(s)
- Thaer Yaseen
- FAO, Regional Office for the Near East and North Africa Region, 11 Al Eslah El Zerai St., Dokki, Cairo, Egypt.
| | | | - Gu Baogen
- FAO, Pest and Pesticide Management, Rome, Italy
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23
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Fu XL, Qian Y, Jin XH, Yu HR, Wu H, Du L, Chen HL, Shi YQ. Suicide rates among people with serious mental illness: a systematic review and meta-analysis. Psychol Med 2023; 53:351-361. [PMID: 33952359 DOI: 10.1017/s0033291721001549] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND People with serious mental illness are at great risk of suicide, but little is known about the suicide rates among this population. We aimed to quantify the suicide rates among people with serious mental illness (bipolar disorder, major depression, or schizophrenia). METHODS PubMed and Web of Science were searched to identify studies published from 1 January 1975 to 10 December 2020. We assessed English-language studies for the suicide rates among people with serious mental illness. Random-effects meta-analysis was used. Changes in follow-up time and the suicide rates were presented by a locally weighted scatter-plot smoothing (LOESS) curve. Suicide rate ratio was estimated for assessments of difference in suicide rate by sex. RESULTS Of 5014 identified studies, 41 were included in this analysis. The pooled suicide rate was 312.8 per 100 000 person-years (95% CI 230.3-406.8). Europe was reported to have the highest pooled suicide rate of 335.2 per 100 000 person-years (95% CI 261.5-417.6). Major depression had the highest suicide rate of 534.3 per 100 000 person-years (95% CI 30.4-1448.7). There is a downward trend in suicide rate estimates over follow-up time. Excess risk of suicide in males was found [1.90 (95% CI 1.60-2.25)]. The most common suicide method was poisoning [21.9 per 100 000 person-years (95% CI 3.7-50.4)]. CONCLUSIONS The suicide rates among people with serious mental illness were high, highlighting the requirements for increasing psychological assessment and monitoring. Further study should focus on region and age differences in suicide among this population.
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Affiliation(s)
- Xue-Lei Fu
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001 PR China
| | - Yan Qian
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001 PR China
| | - Xiao-Hong Jin
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001 PR China
| | - Hai-Rong Yu
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001 PR China
| | - Hua Wu
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001 PR China
| | - Lin Du
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001 PR China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu, 226019 PR China
| | - Ya-Qin Shi
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001 PR China
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Fu G, Duan Y, Yi W, Zhang S, Liang W, Li H, Yan H, Wu B, Fu S, Zhang J, Zhang G, Wang G, Liu Y, Xu S. A rapid and reliable immunochromatographic strip for detecting paraquat poinsoning in domestic water and real human samples. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 315:120324. [PMID: 36191800 DOI: 10.1016/j.envpol.2022.120324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/14/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Paraquat (PQ) is one of the most commonly used herbicides, but it has polluted the environment and threatened human health through extensive and improper usage. Here, a new naked-eye PQ immunochromatographic strip was developed to recognize PQ in domestic water and real human samples within 10 min based on a novel custom-designed anti-PQ antibody. The PQ test strip could recognize PQ at a concentration as low as 10 ng/ml, reaching the high-efficiency time-of-flight mass spectrometry detection level and identifying trace amounts of PQ in samples treated with a diquat (DQ) and PQ mixture. Notably, both the performance evaluation and clinical trial of the proposed PQ strips were validated in multiple hospitals and public health agencies. Taken together, our study firstly provide the clinical PQ-targeted colloidal gold immunochromatographic test strip designed both for environment water and human sample detection with multiple advantages, which are ready for environmental monitoring and clinical practice.
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Affiliation(s)
- Guanyan Fu
- Chongqing Key Laboratory of Prevention and Treatment for Occupational Diseases and Poisoning, Chongqing, 400060, China; National Emergency Response Team for Sudden Poisoning, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College Chongqing 400060, China
| | - Yu Duan
- Chongqing Key Laboratory of Prevention and Treatment for Occupational Diseases and Poisoning, Chongqing, 400060, China; National Emergency Response Team for Sudden Poisoning, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College Chongqing 400060, China
| | | | - Shun Zhang
- Chongqing Key Laboratory of Prevention and Treatment for Occupational Diseases and Poisoning, Chongqing, 400060, China; Zybio Inc, Chongqing, 400016, China
| | - Wenbin Liang
- Key Laboratory of Luminescence Analysis and Molecular Sensing (Southwest University), Ministry of Education, College of Chemistry and Chemical Engineering, Southwest University, Chongqing, 400715, China
| | - Huiling Li
- Department of Occupational Medicine and Clinical Toxicology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, PR China
| | - Huifang Yan
- Key Laboratory of Chemical Safety and Health, National Institute for Occupational Health and Poison Control, Beijing, 100050, China
| | - Banghua Wu
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, 510300, China
| | - Sheng Fu
- Hunan Prevention and Treatment Institute for Occupational Diseases, Hunan Province, 410007, China
| | - Jing Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Gen Zhang
- Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, 430010, China
| | - Guixue Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Yongsheng Liu
- Chongqing Key Laboratory of Prevention and Treatment for Occupational Diseases and Poisoning, Chongqing, 400060, China; National Emergency Response Team for Sudden Poisoning, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College Chongqing 400060, China
| | - Shangcheng Xu
- Chongqing Key Laboratory of Prevention and Treatment for Occupational Diseases and Poisoning, Chongqing, 400060, China; National Emergency Response Team for Sudden Poisoning, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College Chongqing 400060, China.
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Hao Y, Fan T, Sun G, Li F, Zhang N, Zhao L, Zhong R. Environmental toxicity risk evaluation of nitroaromatic compounds: Machine learning driven binary/multiple classification and design of safe alternatives. Food Chem Toxicol 2022; 170:113461. [PMID: 36243219 DOI: 10.1016/j.fct.2022.113461] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/11/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
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Wang X, Chi Y, Li F. Exploring China stepping into the dawn of chemical pesticide-free agriculture in 2050. FRONTIERS IN PLANT SCIENCE 2022; 13:942117. [PMID: 36161034 PMCID: PMC9504061 DOI: 10.3389/fpls.2022.942117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
China has implemented a series of policies to reduce the usage of chemical pesticides to maintain food production safety and to reduce water and soil pollution. However, there is still a huge gap in developing biological pesticides to replace chemical agents or managing pests to prevent crop production loss. It is necessary to predict the future use of chemical pesticides and to exploit the potential ways to control pests and crop diseases. Pesticide usage is affected by seasonal changes and analyzed by using a seasonal autoregressive integrated moving average (ARIMA) model (a statistical model that predicts future trends using time-series data). The future development of biopesticides in China was predicted using the compound annual growth rate (CAGR), which is calculated via the equation [(Final value/Starting value)1/years - 1] according to the annual growth rate of target products over time. According to the reducing trend of pesticide and biological pesticide usage annually, China is predicted possibly step into the era of pesticide-free agriculture in 2050 based on the analysis of the ARIMA model. With CAGR calculation, China will produce from 500 thousand to one million tons of biopesticides in 2050, which can meet the need to replace chemical pesticides in agriculture to prevent the present crop production loss. To achieve the goal, China still has the greatest challenges to develop biopesticides and use various strategies to control pest and crop diseases. China may step into the dawn of chemical pesticide-free agriculture in 2050 if biopesticides can be developed smoothly and pests can be controlled well using various strategies.
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Affiliation(s)
- Xuejiang Wang
- Wuzhoufeng Agricultural Science & Technology Co., Ltd., Yantai, China
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27
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Bhusal S, Bhandari R, Dahal S, Niroula A, Basnet K, Chaudhary A, Pant S. Organophosphorus Poisoning among Patients Admitted to the Intensive Care Unit of the Department of Internal Medicine in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:766-769. [PMID: 36705124 PMCID: PMC9794948 DOI: 10.31729/jnma.7823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/21/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Organophosphates are potent cholinesterase inhibitors that when ingested in excessive amounts can be fatal. Organophosphorus poisoning has become an important clinical problem with increased mortality in the country from accidental or intentional ingestion of, or exposure to the pesticide. This study aimed to find out the prevalence of organophosphorus poisoning among patients admitted to the Intensive Care Unit of the Department of Internal Medicine in a tertiary care centre. METHODS A descriptive cross-sectional study was conducted among patients admitted to the Intensive Care Unit of the Department of Internal Medicine of a tertiary care centre after receiving ethical approval from the Institutional Review Committee (Reference number: 2003202205). The study was conducted between 1 February 2021 and 1 February 2022 using hospital records. Convenience sampling was done among the patients who met the eligibility criteria. The diagnosis of organophosphorus poisoning was made based on the patient's history, clinical examination and the measurement of serum acetylcholinesterase levels. Point estimate and 95% Confidence Interval were calculated. RESULTS Among 1108 patients admitted, organophosphorus poisoning was seen in 50 (4.15%) (3.29-5.73, 95% Confidence Interval). CONCLUSIONS Our study found that the prevalence of organophosphorus poisoning was lower when compared to similar studies done in similar settings.
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Affiliation(s)
- Suzit Bhusal
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal,Correspondence: Dr Suzit Bhusal, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal. , Phone: +977-9861487985
| | - Rupa Bhandari
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | | | - Aliska Niroula
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Krity Basnet
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | | | - Subash Pant
- Department of Internal Medicine, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
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Nendick E, Mohamed F, Raubenheimer J, Gawarammana I, Buckley NA, Eddleston M. Acute fungicide self-poisoning - a prospective case series. Clin Toxicol (Phila) 2022; 60:1106-1112. [PMID: 35950874 DOI: 10.1080/15563650.2022.2105710] [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: 11/03/2022]
Abstract
BACKGROUND Pesticide self-poisoning is a global clinical and public health problem. While self-poisoning with insecticides and herbicides has been extensively studied, there is minimal literature on acute fungicide self-poisoning. We aimed to study the clinical course and outcome of fungicide self-poisoned patients recruited to a prospective cohort in Sri Lanka. METHODS We conducted a prospective study of patients presenting with fungicide self-poisoning to nine hospitals in Sri Lanka between 2002 and 2020. Patients were enrolled by clinical research assistants, with clinical outcomes being recorded at regular review for each patient. RESULTS We identified 337 cases of self-poisoning with fungicides (alcohol as only co-ingestant), including 28 different fungicides across 5 different fungicide classes. Median time from ingestion to examination was 3.1 (1.8-5.7) h. Nearly all presented to hospital fully conscious (GCS 15, 15-15)- only 27 patients (8.0%) presented with reduced GCS (<15) and only 2 (0.6%) had GCS 3/15. Most patients (333/337, 98.8%) made a full recovery, of whom only eight (2.37%) required intubation and ventilation. Four patients died (case fatality rate: 1.2%; 95% CI 0.0-23.4) after ingestion of edifenphos (n = 2), propamocarb and pyraclostrobin. CONCLUSION Fungicide self-poisoning appears to be less hazardous than insecticide or herbicide self-poisoning, with a substantially lower case fatality in the same cohort. Edifenphos is an exception to this 'less toxic' rule; as a WHO Class Ib highly hazardous pesticide, we recommend its withdrawal from, and replacement in, global agricultural practice. Propamocarb should be listed in the WHO hazard classification as propamocarb hydrochloride to reflect the higher toxicity of the common agricultural formulation. Pyraclostrobin currently has no WHO classification; one is urgently required now that its ingestion has now been linked the death of a patient. Additional prospective clinical data on fungicide self-poisoning is required to expand knowledge on the effects of these diverse compounds.
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Affiliation(s)
- Edward Nendick
- Academic Unit of Medical Education, University of Sheffield, Sheffield, UK
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Jacques Raubenheimer
- Pharmacology, Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Indika Gawarammana
- Faculty of Allied Health Sciences, Department of Pharmacy, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nick A Buckley
- National Poison Centre, Universiti Sains Malaysia, Penang, Malaysia
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Utyasheva L, Robertson G, Sharma JR. Perception of the criminality of attempted suicide in Nepal and its impact on suicide reporting. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2022; 83:101796. [PMID: 35594745 DOI: 10.1016/j.ijlp.2022.101796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/22/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
In 2018-2019, according to the official statistics, 5754 people died as a result of suicide in Nepal. This is a high number for a country with a population of 29 million people. Experts believe that the actual rate is considerably higher and that many suicides are not reported. This underreporting of suicide is frequently blamed on the stigma and the criminality of attempted suicide. Yet, there has never been a criminal liability for attempted suicide in Nepal. This article discusses the reasons for the perception of the criminality of attempted suicide in the country, its consequences, and the ways of addressing them. We found that the involvement of the police at the initial stages of suicide investigation confirms public perceptions that attempted suicide is a punishable offense and this may reinforce the stigma of suicide. Recent criminalization of the abetment of suicide has contributed to this perception as the public may not be clear about the distinction between abetment of suicide and attempted suicide. Criminalization of suicide not in the laws but in minds discourages reporting and help-seeking behaviour and victimizes people who need support and services. We argue that decriminalization is more than removing the outdated legal clauses from the legal statutes, but also public awareness raising about the reasons for police investigation of suspicious deaths, sensitivity training, and education of government officials, policymakers, and police about suicide and its prevention. These are needed to dispel the myth of criminalization of attempted suicide in Nepal. Our findings could be of wider interest to scholars working on reducing the stigma of suicide and decriminalization of suicide attempts.
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Affiliation(s)
- Leah Utyasheva
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, PTT, QMRI E3.22a, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.
| | - Gael Robertson
- Centre for Pesticide Suicide Prevention, University of Edinburgh, 47 Little France Cres, Edinburgh EH16 4TJ, UK.
| | - Jeevan R Sharma
- Chrysal Macmillan Building, School of Social and Political Science, University of Edinburgh, EH8 9LD, UK.
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Nguyen NTT, Nguyen LM, Nguyen TTT, Liew RK, Nguyen DTC, Tran TV. Recent advances on botanical biosynthesis of nanoparticles for catalytic, water treatment and agricultural applications: A review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 827:154160. [PMID: 35231528 DOI: 10.1016/j.scitotenv.2022.154160] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
Green synthesis of nanoparticles using plant extracts minimizes the usage of toxic chemicals or energy. Here, we concentrate on the green synthesis of nanoparticles using natural compounds from plant extracts and their applications in catalysis, water treatment and agriculture. Polyphenols, flavonoid, rutin, quercetin, myricetin, kaempferol, coumarin, and gallic acid in the plant extracts engage in the reduction and stabilization of green nanoparticles. Ten types of nanoparticles involving Ag, Au, Cu, Pt, CuO, ZnO, MgO, TiO2, Fe3O4, and ZrO2 with emphasis on their formation mechanism are illuminated. We find that green nanoparticles serve as excellent, and recyclable catalysts for reduction of nitrophenols and synthesis of organic compounds with high yields of 83-100% and at least 5 recycles. Many emerging pollutants such as synthetic dyes, antibiotics, heavy metal and oils are effectively mitigated (90-100%) using green nanoparticles. In agriculture, green nanoparticles efficiently immobilize toxic compounds in soil. They are also sufficient nanopesticides to kill harmful larvae, and nanoinsecticides against dangerous vectors of pathogens. As potential nanofertilizers and nanoagrochemicals, green nanoparticles will open a revolution in green agriculture for sustainable development.
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Affiliation(s)
- Ngoan Thi Thao Nguyen
- Institute of Environmental Technology and Sustainable Development, Nguyen Tat Thanh University, 298-300A Nguyen Tat Thanh, District 4, Ho Chi Minh City 755414, Viet Nam; Department of Chemical Engineering and Processing, Nong Lam University, Thu Duc District, Ho Chi Minh City 700000, Viet Nam
| | - Luan Minh Nguyen
- Institute of Environmental Technology and Sustainable Development, Nguyen Tat Thanh University, 298-300A Nguyen Tat Thanh, District 4, Ho Chi Minh City 755414, Viet Nam; Department of Chemical Engineering and Processing, Nong Lam University, Thu Duc District, Ho Chi Minh City 700000, Viet Nam
| | - Thuy Thi Thanh Nguyen
- Faculty of Science, Nong Lam University, Thu Duc District, Ho Chi Minh City 700000, Viet Nam
| | - Rock Keey Liew
- Pyrolysis Technology Research Group, Institute of Tropical Aquaculture and Fisheries (AKUATROP), Universiti Malaysia Terengganu, 21030 Kuala Nerus, Terengganu, Malaysia; NV WESTERN PLT, No. 208B, Jalan Macalister, Georgetown 10400, Pulau Pinang, Malaysia
| | - Duyen Thi Cam Nguyen
- Institute of Environmental Technology and Sustainable Development, Nguyen Tat Thanh University, 298-300A Nguyen Tat Thanh, District 4, Ho Chi Minh City 755414, Viet Nam; NTT Hi-Tech Institute, Nguyen Tat Thanh University, 298-300A Nguyen Tat Thanh, District 4, Ho Chi Minh City 755414, Viet Nam.
| | - Thuan Van Tran
- Institute of Environmental Technology and Sustainable Development, Nguyen Tat Thanh University, 298-300A Nguyen Tat Thanh, District 4, Ho Chi Minh City 755414, Viet Nam; NTT Hi-Tech Institute, Nguyen Tat Thanh University, 298-300A Nguyen Tat Thanh, District 4, Ho Chi Minh City 755414, Viet Nam.
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Hulse EJ, Clutton RE, Drummond G, Thompson AP, van Beek EJR, Smith SH, Eddleston M. Lung injury caused by aspiration of organophosphorus insecticide and gastric contents in pigs. Clin Toxicol (Phila) 2022; 60:725-736. [PMID: 35147477 PMCID: PMC9162497 DOI: 10.1080/15563650.2022.2028803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/21/2021] [Accepted: 01/09/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Patients who require mechanical ventilation after self-poisoning with ingested organophosphorus (OP) insecticides often die. Aspiration of stomach contents may contribute to lung injury and lethality. This study was designed to assess the severity of direct and indirect pulmonary injury created by pulmonary instillation of mixtures of OP insecticide, solvent (Solv) and porcine gastric juice (GJ) compared to controls. METHODS Terminally anaesthetised minipigs (groups n = 5) were exposed to sham bronchoscopy or given mixtures (0.5 mL/kg) of: saline, GJ, OP insecticide and GJ (OP + GJ), or Solv and GJ (Solv + GJ), placed into the right lung, and monitored for 48 h. Lung injury was assessed through analysis of bronchoalveolar lavage fluid (BALF), computed tomography and histopathology. RESULTS OP + GJ created a direct lung injury consisting of neutrophil infiltration, oedema and haemorrhage, as well as indirect injury to the other lung. OP + GJ directly-injured lung parenchyma had increased concentrations of BALF protein, albumin, IL-6, IL-8 and C-reactive protein (CRP) at 24 h (p < 0.05), and BALF protein, albumin and CRP at 48 h (p < 0.05), when compared with controls. Aspiration of GJ produced similar direct effects to OP + GJ but less indirect lung injury. Lung injury was less severe after Solv + GJ, for combined lung histopathology scores (vs. OP + GJ, p < 0.05) and for the proportion of directly-injured lung that was poorly/non-aerated at 48 h. CONCLUSION Pulmonary instillation of OP + GJ created more lung damage than controls or Solv + GJ. In patients with severe OP insecticide poisoning and reduced consciousness, early airway protection is likely to reduce pulmonary damage.
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Affiliation(s)
- Elspeth J. Hulse
- Pharmacology, Toxicology, and Therapeutics Department, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Richard E. Clutton
- Wellcome Trust Critical Care Laboratory for Large Animals, University of Edinburgh, Edinburgh, UK
| | - Gordon Drummond
- Anaesthesia, Critical Care and Pain Medicine department, Division of Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Adrian P. Thompson
- Pharmacology, Toxicology, and Therapeutics Department, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Edwin J. R. van Beek
- Edinburgh Imaging, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Sionagh H. Smith
- Easter Bush Pathology, Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Michael Eddleston
- Pharmacology, Toxicology, and Therapeutics Department, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Eddleston M, Nagami H, Lin CY, Davis ML, Chang SS. Pesticide use, agricultural outputs, and pesticide poisoning deaths in Japan. Clin Toxicol (Phila) 2022; 60:933-941. [PMID: 35475715 DOI: 10.1080/15563650.2022.2064868] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Although pesticide poisonings occur worldwide, most high-income countries have not been severely affected. Japan is a key exception, with pesticide suicides becoming a major public health concern in the 1980s. We here report the epidemiology of lethal pesticide poisoning in Japan in relation to its pesticide regulation and agricultural output. METHODS We obtained data on pesticide registration and sales from the Japan Plant Protection Association's annual Pesticide Handbook, National Food and Agricultural Materials Inspection Center, and Food and Agriculture Organization of the United Nations. Data on deaths due to pesticide poisoning and population were obtained from Vital Statistics of Japan. We reviewed the registration status and hazard classification of pesticides in Japan and analysed the relationships between the use/sales, pesticides fatalities, and agricultural output. RESULTS Five hundred and twenty-nine pesticide active ingredients are currently registered in Japan, including four WHO hazard class IB organophosphorus and carbamate insecticides. Paraquat was registered in 1962 as a liquid SL20 formulation. In 1986, restrictions were imposed on its sale/use and a 4.3% paraquat ion/4.1% diquat ion combination product registered by ICI. There were 221 pesticide poisoning fatalities in 2019, down from 2648 in 1986, a 92% reduction over 33 years. Self-poisoning was responsible for most pesticide deaths in both 1985 (2013/2476, 81.3%) and 2019 (146/221, 66.1%). Pesticide poisoning made up 8.6% of all suicides in 1985, down to 0.7% in 2019. Unintentional pesticide poisoning deaths also all fell by 83.8%, from 463 to 75. These reductions were associated with reduced sales of both OP/carbamate insecticides and paraquat/diquat but no apparent change in agricultural output across a broad range of crops. CONCLUSIONS Reduced use of highly hazardous pesticides and lowered concentration formulations in Japan were associated with major decreases in all deaths from pesticide poisoning and the proportion of all suicides due to pesticide ingestion.
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Affiliation(s)
- Michael Eddleston
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Hiroshi Nagami
- Institute for Prevention of Pesticide Adverse Effects on Human, Yamatokohriyama, Japan
| | - Chien-Yu Lin
- Institute of Health Behaviors and Community Sciences, and Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Mark L Davis
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, and Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan.,Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Jaacks LM, Serupally R, Dabholkar S, Venkateshmurthy NS, Mohan S, Roy A, Prabhakaran P, Smith B, Gathorne-Hardy A, Veluguri D, Eddleston M. Impact of large-scale, government legislated and funded organic farming training on pesticide use in Andhra Pradesh, India: a cross-sectional study. Lancet Planet Health 2022; 6:e310-e319. [PMID: 35397219 DOI: 10.1016/s2542-5196(22)00062-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 02/10/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The use of pesticides in agriculture has been associated with the destruction of biodiversity and damage to human health. A marked reduction in pesticide use is urgently required globally, but whether this can be achieved rapidly and at scale is unclear. We aimed to assess whether government-legislated and funded organic farming training in Andhra Pradesh, India, reduced pesticide use by farmers and sales of pesticides by pesticide retailers. METHODS We did a cross-sectional survey between Aug 11 and Nov 26, 2020, among farmers and pesticide retailers in Kurnool District of Andhra Pradesh (India). We assessed the impact of the Andhra Pradesh Community Managed Natural Farming (APCNF) programme, which aims to transition 100% of the agricultural land of Andhra Pradesh (population approximately 49 million, 6 million of whom are farmers) to organic farming practices by 2030. We did cross-sectional phone interview surveys of farmers and face-to-face surveys of pesticide retailers. We used multivariable Poisson regression models to estimate relative risks (RRs) and logistic regression models to estimate odds ratios (ORs). FINDINGS 962 farmers were invited to participate, of whom 894 (93%) consented (709 conventional farmers and 149 APCNF farmers). 47 pesticide retailers were invited to participate, of whom 38 (81%) consented. APCNF farmers had practised APCNF for a median of 2 years (IQR 1-3). APCNF farmers were less likely to use pesticides than conventional farmers (adjusted RR 0·65 [95% CI 0·57-0·75]), although pesticide use remained high among both APCNF and conventional farmers (73 [49%] of 148 APCNF farmers vs 695 [99%] of 700 conventional farmers; p<0·0001). APCNF farmers had lower pesticide expenditures than conventional farmers (median US$0 [IQR 0-170] for APCNF farmers vs $175 [91-281] for conventional farmers; p=0·0001). Increased frequency of meeting with agricultural extension workers was associated with reduced pesticide use among ACPNF farmers. Seven (18%) of 38 retailers reported a decrease in sales of pesticides in the past 4 years; no difference in the odds of reporting a decrease in pesticide sales in the past 4 years was identified between APCNF retailers and conventional retailers (OR 0·95 [95% CI 0·58-1·57]). INTERPRETATION Despite a major government drive for organic agriculture, about half of APCNF farmers continued to use pesticides and no impact on pesticide sales at local retailers was observed. A combination of policy instruments (eg, bans on highly hazardous pesticides), not solely training for farmers, might be needed to eliminate pesticide use in agriculture. FUNDING Scottish Funding Council and UK Research and Innovation.
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Affiliation(s)
- Lindsay M Jaacks
- Global Academy of Agriculture and Food Security, University of Edinburgh, Edinburgh, UK; Public Health Foundation of India, New Delhi, India; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | | | - Shweta Dabholkar
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
| | - Nikhil Srinivasapura Venkateshmurthy
- Public Health Foundation of India, New Delhi, India; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA; Centre for Chronic Disease Control, New Delhi, India
| | - Sailesh Mohan
- Public Health Foundation of India, New Delhi, India; Centre for Chronic Disease Control, New Delhi, India
| | - Aditi Roy
- Public Health Foundation of India, New Delhi, India
| | - Poornima Prabhakaran
- Public Health Foundation of India, New Delhi, India; Centre for Chronic Disease Control, New Delhi, India
| | - Barbara Smith
- Centre for Agroecology, Water and Resilience, Coventry University, Coventry, UK
| | - Alfred Gathorne-Hardy
- Global Academy of Agriculture and Food Security, University of Edinburgh, Edinburgh, UK
| | - Divya Veluguri
- Global Academy of Agriculture and Food Security, University of Edinburgh, Edinburgh, UK
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
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Moreau G, Ramal AF, Letana SD, Horgan FG. Death in the paddy field: Carcass decomposition and associated arthropods in subunits of a rice field landscape. Forensic Sci Int 2022; 335:111288. [PMID: 35397359 DOI: 10.1016/j.forsciint.2022.111288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 11/15/2022]
Abstract
Although rice production landscapes are often the scene of homicides, vertebrate decomposition and associated arthropods have never been described from rice paddies. Tropical rice landscapes are typically composed of irrigated/non-irrigated rice fields, fallow land (i.e., uncultivated fields), and low earthen levees (bunds) used as access pathways. The specific microclimatic and environmental conditions associated with each subunit of rice field landscapes are likely to impact carcass decomposition as well as the arthropod species associated with carrion. Here, we tested the hypothesis that the combined effects of constraints on arthropod colonization and survival, scarcity of necromass, limited habitat architecture, and recurrent disturbance limit the ability of carrion-related arthropods to colonize corpses and large carcasses in tropical rice-fields. Our results from monitoring pig carcasses in Philippine rice fields indicated that vertebrate decomposition in irrigated fields was slower and incomplete when compared to non-irrigated fields and bunds. Carcasses were colonized by a small complex of carrion-related arthropods that differed in composition and relative species abundance between dry bunds and relatively humid rice paddies. Fire ants (Solenopsis germinata) were observed frequently on carcasses exposed on bunds, rarely in non-irrigated fields, and almost never in irrigated fields. The presence of fire ants was associated with reduced blow fly (Chrysomya megacephala) abundance. Taken together, this indicates that the arthropod fauna associated with carcasses in tropical rice fields is relatively simple in contrast to the generally high arthropod diversity reported for other ecosystems at tropical latitudes. The limited richness of the community also means that an understanding of the development of one abundant calliphorid blow fly, C. megacephala, may be sufficient to investigate deaths and homicides under conditions similar to the ones described in this study.
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Affiliation(s)
- Gaétan Moreau
- Département de Biologie, Université de Moncton, Moncton, NB E1A 3E9, Canada.
| | - Angelee Fame Ramal
- Food and Agriculture Organization of the United Nations, Manila 1554, Philippines.
| | - Socrates D Letana
- Bohart Museum of Entomology, University of California, Davis 95616, USA; Natural History Museum of Denmark, University of Copenhagen, København DK-1350, Denmark.
| | - Finbarr G Horgan
- EcoLaVerna Integral Restoration Ecology, Bridestown, Kildinan, Co. Cork, Ireland; Universidad Católica del Maule, Facultad de Ciencias Agrarias y Forestales, Escuela de Agronomía, Casilla 7-D, Curicó, Chile.
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Taşaltın N, Karakuş S, Taşaltın C, Baytemir G. Highly sensitive and selective rGO based Non-Enzymatic electrochemical sensor for propamocarb fungicide pesticide detection. Food Chem 2022; 372:131267. [PMID: 34638065 DOI: 10.1016/j.foodchem.2021.131267] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/05/2021] [Accepted: 09/28/2021] [Indexed: 01/28/2023]
Abstract
In this study, reduced graphene oxide (rGO) was prepared using a green ultrasonic microwave assisted method and investigated rGO based non-enzymatic electrochemical sensor for detecting a synthetic fungicide as a propamocarb (PM) pesticide. The rGO-based sensor exhibited rapid response within 1 min, low detection limit of 0.6 μM and wide linear range of (1-5) μM with a high sensitivity of 101.1 μAμM-1 cm-2 for PM. Besides this, the sensor detected the propamocarb pesticide on the real cucumber sample with high sensitivity in the concentration range of (1-5) μM within a 1-minute cycle. The sensor is highly selective against propamocarb pesticide. The prepared non-enzymatic electrochemical sensor exhibited high sensitivity, high selectivity, reproducibility, and rapid response.
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Affiliation(s)
- Nevin Taşaltın
- Maltepe University, Dept. of Electrical & Electronics Engineering, Istanbul, Turkey; CONSENS, Maltepe University Research Center, Istanbul, Turkey.
| | - Selcan Karakuş
- Istanbul University-Cerrahpasa, Dept. of Chemistry, Istanbul, Turkey
| | - Cihat Taşaltın
- TUBİTAK Marmara Research Center, Materials Institute, Gebze, Kocaeli, Turkey
| | - Gülsen Baytemir
- Maltepe University, Dept. of Electrical & Electronics Engineering, Istanbul, Turkey
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Eddleston M. CON: Oximes should be used routinely in organophosphorus insecticide poisoning. Br J Clin Pharmacol 2022; 88:5070-5073. [PMID: 34989015 DOI: 10.1111/bcp.15217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 11/30/2022] Open
Abstract
Organophosphorus (OP) insecticide poisoning causes respiratory failure due to acetylcholinesterase (AChE) inhibition. The AChE reactivating antidote pralidoxime was developed in the 1950s and soon noted to benefit patients occupationally poisoned with the highly potent OP insecticide parathion. Routine use of pralidoxime and other oximes such as obidoxime then became widely recommended. However, nearly all severe cases of OP poisoning now result from self-poisoning with large volumes of less potent (WHO hazard class Ib and II) insecticides and co-formulated solvents. Unfortunately, oxime clinical trials have never shown benefit from their use for these patients, and some have shown that pralidoxime may be associated with harm, including increased mortality. Oximes should not be used routinely for the care of OP insecticide poisoned patients until translational and clinical studies have identified a safe and effective oxime regimen and identified the patients who benefit.
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Affiliation(s)
- Michael Eddleston
- Pharmacology, Therapeutics & Toxicology, Centre for Cardiovascular Science, and Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
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Wang B, Zhang M, Zhang W, Zhao S, Tian X, Fu G. Hemoperfusion in combination with hemofiltration for acute severe organophosphorus pesticide poisoning: A systematic review and meta-analysis. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2022; 27:33. [PMID: 35548179 PMCID: PMC9081518 DOI: 10.4103/jrms.jrms_822_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/31/2021] [Accepted: 03/08/2022] [Indexed: 11/12/2022]
Abstract
Background: Acute severe organophosphorus pesticide poisoning (ASOPP) is one of the major diseases that endanger human life and health. However, the effects of conventional therapy including gastric lavages, mechanical ventilation, muscarinic antagonist drugs, and cholinesterase reactivators were uncertain. This meta-analysis aims to investigate the safety and efficacy of hemoperfusion combined with hemofiltration besides routine therapy for ASOPP. Materials and Methods: A comprehensive search for candidate publications was performed through PubMed, Medline, Cochrane Library, WanFang, Chinese Biomedical Literature, and China National Knowledge Infrastructure from database inception to May 12, 2020. The retrieved studies were screened by the predefined inclusion and exclusion criteria. The data of important end points were extracted. The risk ratio (RR) and weighted mean difference (WMD) were pooled for categorical variables and continuous variables, respectively. Meta-analyses and publication bias were conducted by using STATA software version 15.1. Results: A total of 11 randomized controlled trials with 811 patients were included. Compared to conventional therapy group, patients in the hemoperfusion plus hemofiltration group were significantly superior with regard to mortality (RR 0.38, 95% confidence interval [CI] [0.25, 0.57], P < 0.001), total atropine dosing (WMD −147.34 mg, 95% CI [−199.49, −95.18], P < 0.001), duration of mechanical ventilation (WMD −2.34 days, 95% CI [−3.77, −0.92], P < 0.001), cholinesterase recovery time (WMD −2.49 days, 95% CI [−3.14, −1.83], P < 0.001), and length of stay (WMD −4.52 days, 95% CI [−5.31, −3.73], P < 0.001). Conclusion: Combined hemoperfusion and hemofiltration was a very safe and effective treatment protocol for ASOPP, not only resulting in significantly decreased mortality but also resulting in reduced total atropine dosing, duration of mechanical ventilation, cholinesterase recovery time, and length of stay.
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Dissanayake KN, Margetiny F, Whitmore CL, Chou RCC, Roesl C, Patel V, McArdle JJ, Webster R, Beeson D, Tattersall JEH, Wyllie DJA, Eddleston M, Ribchester RR. Antagonistic postsynaptic and presynaptic actions of cyclohexanol on neuromuscular synaptic transmission and function. J Physiol 2021; 599:5417-5449. [PMID: 34748643 DOI: 10.1113/jp281921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/01/2021] [Indexed: 01/20/2023] Open
Abstract
Intentional ingestion of agricultural organophosphorus insecticides is a significant public health issue in rural Asia, causing thousands of deaths annually. Some survivors develop a severe, acute or delayed myasthenic syndrome. In animal models, similar myasthenia has been associated with increasing plasma concentration of one insecticide solvent metabolite, cyclohexanol. We investigated possible mechanisms using voltage and current recordings from mouse neuromuscular junctions (NMJs) and transfected human cell lines. Cyclohexanol (10-25 mM) reduced endplate potential (EPP) amplitudes by 10-40% and enhanced depression during repetitive (2-20 Hz) stimulation by up to 60%. EPP decay was prolonged more than twofold. Miniature EPPs were attenuated by more than 50%. Cyclohexanol inhibited whole-cell currents recorded from CN21 cells expressing human postjunctional acetylcholine receptors (hnAChR) with an IC50 of 3.74 mM. Cyclohexanol (10-20 mM) also caused prolonged episodes of reduced-current, multi-channel bursting in outside-out patch recordings from hnAChRs expressed in transfected HEK293T cells, reducing charge transfer by more than 50%. Molecular modelling indicated cyclohexanol binding (-6 kcal/mol) to a previously identified alcohol binding site on nicotinic AChR α-subunits. Cyclohexanol also increased quantal content of evoked transmitter release by ∼50%. In perineurial recordings, cyclohexanol selectively inhibited presynaptic K+ currents. Modelling indicated cyclohexanol binding (-3.8 kcal/mol) to voltage-sensitive K+ channels at the same site as tetraethylammonium (TEA). TEA (10 mM) blocked K+ channels more effectively than cyclohexanol but EPPs were more prolonged in 20 mM cyclohexanol. The results explain the pattern of neuromuscular dysfunction following ingestion of organophosphorus insecticides containing cyclohexanol precursors and suggest that cyclohexanol may facilitate investigation of mechanisms regulating synaptic strength at NMJs. KEY POINTS: Intentional ingestion of agricultural organophosphorus insecticides is a significant public health issue in rural Asia, causing thousands of deaths annually. Survivors may develop a severe myasthenic syndrome or paralysis, associated with increased plasma levels of cyclohexanol, an insecticide solvent metabolite. Analysis of synaptic transmission at neuromuscular junctions in isolated mouse skeletal muscle, using isometric tension recording and microelectrode recording of endplate voltages and currents, showed that cyclohexanol reduced postsynaptic sensitivity to acetylcholine neurotransmitter (reduced quantal size) while simultaneously enhancing evoked transmitter release (increased quantal content). Patch recording from transfected cell lines, together with molecular modelling, indicated that cyclohexanol causes selective, allosteric antagonism of postsynaptic nicotinic acetylcholine receptors and block of presynaptic K+ -channel function. The data provide insight into the cellular and molecular mechanisms of neuromuscular weakness following intentional ingestion of agricultural organophosphorus insecticides. Our findings also extend understanding of the effects of alcohols on synaptic transmission and homeostatic synaptic function.
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Affiliation(s)
- Kosala N Dissanayake
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, UK.,Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Filip Margetiny
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Robert C-C Chou
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Cornelia Roesl
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Vishwendra Patel
- Department of Pharmacology, Physiology and Neuroscience, Rutgers, State University of New Jersey, Newark, NJ, USA
| | - Joseph J McArdle
- Department of Pharmacology, Physiology and Neuroscience, Rutgers, State University of New Jersey, Newark, NJ, USA
| | - Richard Webster
- Weatherall Institute for Molecular Medicine, Radcliffe Infirmary, Oxford, UK
| | - David Beeson
- Weatherall Institute for Molecular Medicine, Radcliffe Infirmary, Oxford, UK
| | | | - David J A Wyllie
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, UK.,Centre for Brain Development and Repair, Institute for Stem Cell Biology and Regenerative Medicine, Bangalore, India
| | - Michael Eddleston
- Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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Karbelkar A, Reynolds EE, Ahlmark R, Furst AL. A Microbial Electrochemical Technology to Detect and Degrade Organophosphate Pesticides. ACS CENTRAL SCIENCE 2021; 7:1718-1727. [PMID: 34729415 PMCID: PMC8554842 DOI: 10.1021/acscentsci.1c00931] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Indexed: 06/13/2023]
Abstract
Organophosphate (OP) pesticides cause hundreds of illnesses and deaths annually. Unfortunately, exposures are often detected by monitoring degradation products in blood and urine, with few effective methods for detection and remediation at the point of dispersal. We have developed an innovative strategy to remediate these compounds: an engineered microbial technology for the targeted detection and destruction of OP pesticides. This system is based upon microbial electrochemistry using two engineered strains. The strains are combined such that the first microbe (E. coli) degrades the pesticide, while the second (S. oneidensis) generates current in response to the degradation product without requiring external electrochemical stimulus or labels. This cellular technology is unique in that the E. coli serves only as an inert scaffold for enzymes to degrade OPs, circumventing a fundamental requirement of coculture design: maintaining the viability of two microbial strains simultaneously. With this platform, we can detect OP degradation products at submicromolar levels, outperforming reported colorimetric and fluorescence sensors. Importantly, this approach affords a modular, adaptable strategy that can be expanded to additional environmental contaminants.
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Affiliation(s)
- Amruta
A. Karbelkar
- Department
of Chemical Engineering, Massachusetts Institute
of Technology, Cambridge, Massachusetts 02139, United States
| | - Erin E. Reynolds
- Department
of Chemical Engineering, Massachusetts Institute
of Technology, Cambridge, Massachusetts 02139, United States
| | - Rachel Ahlmark
- Department
of Chemical Engineering, Massachusetts Institute
of Technology, Cambridge, Massachusetts 02139, United States
| | - Ariel L. Furst
- Department
of Chemical Engineering, Massachusetts Institute
of Technology, Cambridge, Massachusetts 02139, United States
- Center
for Environmental Health Sciences, Massachusetts
Institute of Technology, Cambridge, Massachusetts 02139, United States
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40
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Chen J, Su Y, Lin F, Iqbal M, Mehmood K, Zhang H, Shi D. Effect of paraquat on cytotoxicity involved in oxidative stress and inflammatory reaction: A review of mechanisms and ecological implications. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 224:112711. [PMID: 34455184 DOI: 10.1016/j.ecoenv.2021.112711] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/07/2021] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
Paraquat (PQ) is a cheap and an effective herbicide, which is widely being used worldwide to remove weeds in cultivated crop fields. However, it can cause soil and water pollution, and pose serious harm to the environment and organisms. Several countries have started to limit or prohibit the use of PQ because of the increasing number of human deaths. Its toxicity can damage the organisms with a multi-target mechanism, which has not been fully understood yet. That is why it is hard to treat as well. The current research on PQ focuses on its targeted organ, the lungs, in which PQ mostly trigger pulmonary fibrosis. While there is a lack of systematic research, there are few studies published discussing its toxic effects at systematic level. This review summarizes the major damages caused by PQ in different organisms and partial mechanisms by which it causes these damages. For this purpose, we consulted several research articles that studied the toxicity of PQ in various tissues. We also listed some drugs that can be used to alleviate the toxicity of PQ. However, at present, the effectiveness of these drugs is still being explored in animal experiments and the study of their mechanism will also help in understanding the poisoning mechanism of PQ, which will ultimately lead to effective treatment in future.
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Affiliation(s)
- Jiaxin Chen
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China
| | - Yalin Su
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China
| | - Fei Lin
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China
| | - Mujahid Iqbal
- Department of Pathology, Cholistan University of Veterinary and Animal Sciences (CUVAS), Bahawalpur 63100, Pakistan
| | - Khalid Mehmood
- Department of Clinical Medicine and Surgery, Faculty of Veterinary and Animal Sciences, The Islamia University of Bahawalpur, 63100, Pakistan
| | - Hui Zhang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China.
| | - Dayou Shi
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China.
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Karunarathne A, Bhalla A, Sethi A, Perera U, Eddleston M. Importance of pesticides for lethal poisoning in India during 1999 to 2018: a systematic review. BMC Public Health 2021; 21:1441. [PMID: 34294076 PMCID: PMC8296580 DOI: 10.1186/s12889-021-11156-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 05/27/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Poisoning is a major problem in India. However, there is little systematic information on the key poisons responsible for most deaths by geographical area and over time. We aimed to review the literature to identify the poison classes causing the greatest number of deaths in India over the last 20 years. METHODS We performed a systematic literature review in Medline, Embase and Google Scholar (1999-2018), and Indian online medical journals, to find papers that reported deaths from all forms of poisoning in India, with last search 20 April 2020. We included epidemiological studies, observational studies, randomised trials, interventional studies, and case series published from 1999 to 2018 that showed the number of deaths and autopsy studies indicating the specific poisons or poison classes. Studies providing the case fatality for specific poisons or classes, which enabled calculation of the number of deaths, were also included. We excluded deaths due to animal bites and stings, ethanol or methanol poisoning, and gas inhalation as well as papers reporting a single death (case study of single patient). We grouped the papers into 5-year intervals and identified the two most common poison classes in each paper. We used descriptive statistics to summarise the findings over time based on the causative poison and the location of the study. RESULTS We identified 186 papers reporting 16,659 poisoning deaths between 1999 and 2018. The number of publications per 5-year interval showed no clear trend over the period (48, 38, 67, and 36 for consecutive periods). Half of the deaths (n = 8338, 50.0%) were reported during the first 5 years of the study (1999-2003), the number of deaths declining thereafter (to n = 1714 in 2014-2018). Deaths due to pesticide poisoning (94.5%) were dominant across the study period compared to other classes of poison [hair dye paraphenylenediamine poisoning (2.6%), medicine overdose (1.4%) or plant poisoning (1.0%)]. Among the pesticides, aluminium phosphide was the most important lethal poison during the first 10 years before declining markedly; organophosphorus insecticides were important throughout the period, becoming dominant in the last decade as aluminium phosphide cases declined. Unfortunately, few papers identified the specific organophosphorus insecticide responsible for deaths. CONCLUSION Use of the published literature to better understand the epidemiology of lethal poisoning in India has clear limitations, including secular variation in publishing practices and interest in poisoning. Unfortunately, there are no long-term detailed, combination hospital and community studies from India to provide this information. In their absence, our review indicates that pesticides are the most important poison in India, with organophosphorus insecticides replacing aluminium phosphide as the key lethal poison after government regulatory changes in 2001 reduced the latter's lethality. Plant and hair dye poisoning and medicines overdose caused few deaths. Aluminium phosphide deaths mostly occurred in northern Indian states, whereas deaths from organophosphorus insecticide poisoning occurred throughout India. Paraquat poisoning has become a clinical problem in the last 10 years. Lethal pesticide poisoning remains alarmingly common, emphasising the need for additional regulatory interventions to curtail the burden of pesticide poisoning deaths in India. More detailed reporting about the specific pesticide involved in lethal poisoning will be helpful to guide regulatory decisions.
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Affiliation(s)
- Ayanthi Karunarathne
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Ashish Bhalla
- Department of Internal Medicine, Nehru Hospital, Institute of Medical Education and Research, Chandigarh, India
| | - Aastha Sethi
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Government of Maharashtra, Mumbai, Maharashtra, India
| | - Uditha Perera
- Usher Institute for Population Health Sciences & Informatics, University of Edinburgh, Edinburgh, UK
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
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Nakamura H, Hirayama I, Hiruma T, Doi K. Subcutaneous injection of organophosphate (Fenitrothion)-Management of preventing the appearance of toxic symptoms: A case report. Clin Case Rep 2021; 9:e04424. [PMID: 34267910 PMCID: PMC8271260 DOI: 10.1002/ccr3.4424] [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: 12/30/2020] [Revised: 04/23/2021] [Accepted: 05/11/2021] [Indexed: 12/04/2022] Open
Abstract
There is a risk of unnecessary extensive incision because of swelling after the subcutaneous injection; however, removing completely the injected organophosphate by making a skin incision before the appearance of toxic symptoms could reduce sequelae.
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Affiliation(s)
- Hitomi Nakamura
- Department of Emergency and Critical Care MedicineThe University of TokyoTokyoJapan
| | - Ichiro Hirayama
- Department of Emergency and Critical Care MedicineThe University of TokyoTokyoJapan
| | - Takahiro Hiruma
- Department of Emergency and Critical Care MedicineThe University of TokyoTokyoJapan
| | - Kent Doi
- Department of Emergency and Critical Care MedicineThe University of TokyoTokyoJapan
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Li LR, Chaudhary B, You C, Dennis JA, Wakeford H. Glucocorticoid with cyclophosphamide for oral paraquat poisoning. Cochrane Database Syst Rev 2021; 6:CD008084. [PMID: 34190331 PMCID: PMC8243635 DOI: 10.1002/14651858.cd008084.pub5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND This an update of a Cochrane Review. Paraquat is a widely used herbicide, but is also a lethal poison. In some low- and middle-income countries (LMICs) paraquat is commonly available and inexpensive, making poisoning prevention difficult. Most of the people poisoned by paraquat have taken it as a means of self-poisoning. Standard treatment for paraquat poisoning prevents further absorption and reduces the load of paraquat in the blood through haemoperfusion or haemodialysis. The effectiveness of standard treatments is extremely limited. The immune system plays an important role in exacerbating paraquat-induced lung fibrosis. Immunosuppressive treatment using glucocorticoid and cyclophosphamide in combination has been developed and studied as an intervention for paraquat poisoning. OBJECTIVES To assess the effects of glucocorticoid with cyclophosphamide for moderate to severe oral paraquat poisoning. SEARCH METHODS The most recent searches were run in September 2020. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Injuries Trials Register), Ovid MEDLINE(R), Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily and Ovid OLDMEDLINE, Embase Classic + Embase (Ovid), ISI WOS (SCI-EXPANDED, SSCI, CPCI-S, and CPSI-SSH), and trials registries. We also searched the following three resources: China National Knowledge Infrastructure database (CNKI ); Wanfang Data (); and VIP () on 12 November 2020. We examined the reference lists of included studies and review papers. SELECTION CRITERIA We included randomised controlled trials (RCTs). For this update, in accordance with Cochrane Injuries' Group policy (2015), we included only prospectively registered RCTs for trials published after 2010. We included trials which assessed the effects of glucocorticoid with cyclophosphamide delivered in combination. Eligible comparators were standard care (with or without a placebo), or any other therapy in addition to standard care. Outcomes of interest included mortality and infections. DATA COLLECTION AND ANALYSIS We calculated the mortality risk ratio (RR) and 95% confidence interval (CI). Where possible, we summarised data for all-cause mortality at relevant time periods (from hospital discharge to three months after discharge) in meta-analysis, using a fixed-effect model. We conducted sensitivity analyses based on factors including whether participants were assessed at baseline for plasma paraquat levels. We also reported data on infections within one week after initiation of treatment. MAIN RESULTS We included four trials with a total of 463 participants. The included studies were conducted in Taiwan (Republic of China), Iran, and Sri Lanka. Most participants were male. The mean age of participants was 28 years. We judged two of the four included studies, including the largest and most recently conducted study (n = 299), to be at low risk of bias for key domains including sequence generation. We assessed one study to be at high risk of selection bias and another at unclear risk, since allocation concealment was either not mentioned in the trial report or explicitly not undertaken. We assessed three of the four studies to be at unclear risk of selective reporting, as no protocols could be identified. An important source of heterogeneity amongst the included studies was the method of assessment of participants' baseline severity using analysis of plasma levels (two studies employed this method, whilst the other two did not). No studies assessed the outcome of mortality at 30 days following ingestion of paraquat. Low-certainty evidence from two studies indicates that glucocorticoids with cyclophosphamide in addition to standard care may slightly reduce the risk of death in hospital compared to standard care alone ((RR 0.82, 95% CI 0.68 to 0.99; participants = 322); results come from sensitivity analysis excluding studies not assessing plasma at baseline). However, we have limited confidence in this finding as heterogeneity was high (I2 = 77%) and studies varied in terms of size and comparators. A single large study provided data showing that there may be little or no effect of treatment at three months post discharge from hospital (RR 0.98, 95% CI 0.85 to 1.13; 1 study, 293 participants; low-certainty evidence); however, analysis of long-term results amongst participants whose injuries arose from self-poisoning must be interpreted with caution. We remain uncertain of the effect of glucocorticoids with cyclophosphamide on infection within one week after initiation of the treatment; this outcome was assessed by two small studies only (31 participants, very low-certainty evidence) that considered leukopenia as a proxy or risk factor for infection. Neither study reported infections in any participants. AUTHORS' CONCLUSIONS Low-certainly evidence suggests that glucocorticoids with cyclophosphamide in addition to standard care may slightly reduce mortality in hospitalised people with oral paraquat poisoning. However, we have limited confidence in this finding because of substantial heterogeneity and concerns about imprecision. Glucocorticoids with cyclophosphamide in addition to standard care may have little or no effect on mortality at three months after hospital discharge. We are uncertain whether glucocorticoid with cyclophosphamide puts patients at an increased risk of infection due to the limited evidence available for this outcome. Future research should be prospectively registered and CONSORT-compliant. Investigators should attempt to ensure an adequate sample size, screen participants for inclusion rigorously, and seek long-term follow-up of participants. Investigators may wish to research the effects of glucocorticoid in combination with other treatments.
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Affiliation(s)
- Luying Ryan Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | | | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jane A Dennis
- Cochrane Injuries Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Wakeford
- Cochrane Injuries Group, London School of Hygiene & Tropical Medicine, London, UK
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Serlin Y, Minuk J, Schondorf R. Neurological Impairments in a Patient Returning From Cuba. JAMA Neurol 2021; 77:1570-1571. [PMID: 32897306 DOI: 10.1001/jamaneurol.2020.3193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Yonatan Serlin
- Neurology Residency Training Program, McGill University, Montreal, Quebec, Canada
| | - Jeffrey Minuk
- Department of Neurology and Neurosurgery, McGill University, Jewish General Hospital, Montreal, Quebec, Canada
| | - Ronald Schondorf
- Department of Neurology and Neurosurgery, McGill University, Jewish General Hospital, Montreal, Quebec, Canada
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Utyasheva L, Sharma D, Ghimire R, Karunarathne A, Robertson G, Eddleston M. Suicide by pesticide ingestion in Nepal and the impact of pesticide regulation. BMC Public Health 2021; 21:1136. [PMID: 34120596 PMCID: PMC8201746 DOI: 10.1186/s12889-021-11155-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nepal recorded 5754 suicides in 2018-19 - a high number for a relatively small country. Over 24% of these suicides were by poisoning, most by ingestion of highly concentrated agricultural pesticides. Nepal has actively regulated pesticides to reduce their health impacts since 2001. We aimed to analyse Nepal's history of pesticide regulation, pesticides responsible for poisonings, and relate them to national suicide rates. METHODS Information on pesticide regulation was collected from the Plant Quarantine and Pesticide Management Centre of the Ministry of Agriculture and Livestock Development. National data on suicides from 1980 to 2019 were obtained from the National Statistical Bureau and Nepal Police. Data on the pesticides responsible for self-poisoning and pesticide suicides over time were obtained from a systematic literature review. RESULTS As of June 2020, 171 pesticides were registered for use in Nepal, of which one was extremely hazardous (WHO Class Ia), one other highly hazardous (WHO Class Ib), and 71 moderately hazardous (WHO Class II). Twenty-four pesticides have been banned since 2001, with eight (including five WHO Class I compounds) banned in 2019. Although the suicide rate has increased more than twelve-fold since 1980, particularly for hanging (15-fold increase from 1980 to 2018), fatal pesticide self-poisoning has increased by 13-fold. Methyl-parathion is reported to be the key pesticide responsible for pesticide self-poisoning in Nepal, despite being banned in 2006. CONCLUSION The full effect of the recent pesticide policy reform in Nepal remains to be seen. Our analysis shows a continuing increase in suicide numbers, despite bans of the most important pesticide in 2006. This may indicate smuggling across the border and the use of the brand name (Metacid) for pesticides in general making it difficult to identify the responsible pesticide. More information is required from forensic toxicology labs that identify the individual compounds found. The effect of recent bans of common suicide pesticides needs to be monitored over the coming years. Evidence from other Asian countries suggests that HHPs bans will lead to a marked reduction in suicides, as well as fewer cases of occupational poisoning.
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Affiliation(s)
- Leah Utyasheva
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Dilli Sharma
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Rakesh Ghimire
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Ayanthi Karunarathne
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Gael Robertson
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK. .,Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
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Rivera-Urbalejo AP, Vázquez D, Fernández Vázquez JL, Rosete Enríquez M, Cesa-Luna C, Morales-García YE, Muñoz Rojas J, Quintero Hernández V. APORTES Y DIFICULTADES DE LA METAGENÓMICA DE SUELOS Y SU IMPACTO EN LA AGRICULTURA. ACTA BIOLÓGICA COLOMBIANA 2021. [DOI: 10.15446/abc.v26n3.85760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Los microorganismos son de gran interés porque colonizan todo tipo de ambiente, sin embargo, uno de los problemas al que nos enfrentamos para conocer su diversidad biológica es que no todos los microorganismos son cultivables. El desarrollo de nuevas tecnologías como la generación de vectores de clonación aunado al desarrollo de técnicas de secuenciación de alto rendimiento ha favorecido el surgimiento de una nueva herramienta llamada metagenómica, la cual nos permite estudiar genomas de comunidades enteras de microorganismos. Debido a que ningún ambiente es idéntico a otro, es importante mencionar que dependiendo del tipo de muestra a analizar será el tipo de reto al cual nos enfrentaremos al trabajar con metagenómica, en el caso específico del suelo existen diversas variantes como la contaminación del suelo con metales pesados o diversos compuestos químicos que podrían limitar los estudios. Sin embargo, pese a las limitaciones que el mismo ambiente presenta, la metagenómica ha permitido tanto el descubrimiento de nuevos genes como la caracterización de las comunidades microbianas que influyen positivamente en el desarrollo de plantas, lo cual en un futuro podría generar un gran impacto en la agricultura. En este artículo se realizó una revisión de diversas investigaciones que han empleado metagenómica, reportadas en las bases de datos de PudMed y Google Schoolar, con el objetivo de examinar los beneficios y limitaciones de las diversas metodologías empleadas en el tratamiento del ADN metagenómico de suelo y el impacto de la metagenómica en la agricultura.
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Chen J, Zhang Y, Chai Y, Meng Z, Zhang Y, Chen L, Quan D, Wang Y, Meng Q, Li C. Synergistic enhancement of the emergency treatment effect of organophosphate poisoning by a supramolecular strategy. Chem Sci 2021; 12:5202-5208. [PMID: 34163757 PMCID: PMC8179580 DOI: 10.1039/d1sc00426c] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/24/2021] [Indexed: 01/19/2023] Open
Abstract
Poisoning by organophosphorus agents (OPs) is a serious public health issue across the world. These compounds irreversibly inhibit acetylcholinesterase (AChE), resulting in the accumulation of acetylcholine (ACh) and overstimulation of ACh receptors. A supramolecular detoxification system (SDS) has been designed with a view to deliver pyridine-2-aldoxime methochloride (PAM) with a synergistic inhibition effect on the ACh-induced hyperstimulation through host-guest encapsulation. NMR and fluorescence titration served to confirm the complexation between carboxylatopillar[6]arene (CP6A) and PAM as well as ACh with robust affinities. Patch-clamp studies proved that CP6A could exert an inhibition effect on the ACh-induced hyperstimulation of ACh receptors. Support for the feasibility of this strategy came from fluorescence imaging results. In vivo studies revealed that complexation by CP6A serves to increase the AChE reactivation efficiency of PAM. The formation of the PAM/CP6A complex contributed to enhance in a statistically significant way the ability of PAM not only to relieve symptoms of seizures but also to improve the survival ratio in paraoxon-poisoned model rats. These favorable findings are attributed to synergistic effects that PAM reactivates AChE to hydrolyze ACh and excess ACh is encapsulated in the cavity of CP6A to relieve cholinergic crisis symptoms.
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Affiliation(s)
- Junyi Chen
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology Beijing 100850 P. R. China
- College of Environmental and Chemical Engineering, Shanghai University Shanghai 200444 P. R. China
| | - Yadan Zhang
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology Beijing 100850 P. R. China
| | - Yao Chai
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology Beijing 100850 P. R. China
| | - Zhao Meng
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology Beijing 100850 P. R. China
| | - Yahan Zhang
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology Beijing 100850 P. R. China
| | - Longming Chen
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology Beijing 100850 P. R. China
| | - Dongqin Quan
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology Beijing 100850 P. R. China
| | - Yongan Wang
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology Beijing 100850 P. R. China
| | - Qingbin Meng
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology Beijing 100850 P. R. China
| | - Chunju Li
- College of Environmental and Chemical Engineering, Shanghai University Shanghai 200444 P. R. China
- Key Laboratory of Inorganic-Organic Hybrid Functional Material Chemistry, Ministry of Education, Tianjin Key Laboratory of Structure and Performance for Functional Molecules, College of Chemistry, Tianjin Normal University Tianjin 300387 P. R. China
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Lee YY, Chisholm D, Eddleston M, Gunnell D, Fleischmann A, Konradsen F, Bertram MY, Mihalopoulos C, Brown R, Santomauro DF, Schess J, van Ommeren M. The cost-effectiveness of banning highly hazardous pesticides to prevent suicides due to pesticide self-ingestion across 14 countries: an economic modelling study. Lancet Glob Health 2021; 9:e291-e300. [PMID: 33341152 PMCID: PMC7886657 DOI: 10.1016/s2214-109x(20)30493-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Reducing suicides is a key Sustainable Development Goal target for improving global health. Highly hazardous pesticides are among the leading causes of death by suicide in low-income and middle-income countries. National bans of acutely toxic highly hazardous pesticides have led to substantial reductions in pesticide-attributable suicides across several countries. This study evaluated the cost-effectiveness of implementing national bans of highly hazardous pesticides to reduce the burden of pesticide suicides. METHODS A Markov model was developed to examine the costs and health effects of implementing a national ban of highly hazardous pesticides to prevent suicides due to pesticide self-poisoning, compared with a null comparator. We used WHO cost-effectiveness and strategic planning (WHO-CHOICE) methods to estimate pesticide-attributable suicide rates for 100 years from 2017. Country-specific costs were obtained from the WHO-CHOICE database and denominated in 2017 international dollars (I$), discounted at a 3% annual rate, and health effects were measured in healthy life-years gained (HLYGs). We used a demographic projection model beginning with the country population in the baseline year (2017), split by 1-year age group and sex. Country-specific data on overall suicide rates were obtained for 2017 by age and sex from the Global Burden of Disease Study 2017 Data Resources. The analysis involved 14 countries spanning low-income to high-income settings, and cost-effectiveness ratios were analysed at the country-specific level and aggregated according to country income group and the proportion of suicides due to pesticides. FINDINGS Banning highly hazardous pesticides across the 14 countries studied could result in about 28 000 (95% uncertainty interval [UI] 24 000-32 000) fewer suicide deaths each year at an annual cost of I$0·007 per capita (95% UI 0·006-0·008). In the population-standardised results for the base case analysis, national bans produced cost-effectiveness ratios of $94 per HLYG (95% UI 73-123) across low-income and lower-middle-income countries and $237 per HLYG (95% UI 191-303) across upper-middle-income and high-income countries. Bans were more cost-effective in countries where a high proportion of suicides are attributable to pesticide self-poisoning, reaching a cost-effectiveness ratio of $75 per HLYG (95% UI 58-99) in two countries with proportions of more than 30%. INTERPRETATION National bans of highly hazardous pesticides are a potentially cost-effective and affordable intervention for reducing suicide deaths in countries with a high burden of suicides attributable to pesticides. However, our study findings are limited by imperfect data and assumptions that could be improved upon by future studies. FUNDING WHO.
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Affiliation(s)
- Y Y Lee
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, VIC, Australia; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia.
| | - D Chisholm
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - M Eddleston
- Pharmacology, Toxicology and Therapeutics, University and British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
| | - D Gunnell
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK; Population Health Sciences Institute, Bristol Medical School, Bristol, UK; National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, UK
| | - A Fleischmann
- Department of Mental Health and Substance Use, WHO, Geneva, Switzerland
| | - F Konradsen
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK; Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M Y Bertram
- Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - C Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - R Brown
- Department of Environment, Climate Change and Health, WHO, Geneva, Switzerland
| | - D F Santomauro
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - J Schess
- Generation Mental Health Association, New York, NY, USA; Ross School of Business, University of Michigan, Ann Arbor, MI, USA
| | - M van Ommeren
- Department of Mental Health and Substance Use, WHO, Geneva, Switzerland
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Chronic Exposure to Organophosphates Pesticides and Risk of Metabolic Disorder in Cohort from Pakistan and Cameroon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052310. [PMID: 33652791 PMCID: PMC7967685 DOI: 10.3390/ijerph18052310] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/12/2021] [Accepted: 02/19/2021] [Indexed: 12/23/2022]
Abstract
(1) Background: Organophosphorus pesticides (OPPs) are major chemicals used in agriculture for eradication of insecticides/pesticides. Unfortunately, the longtime exposure of human beings to OPPs could lead to metabolic disorder such as high blood pressure, hyperglycemia, overweight or dyslipidemia. The aim of this research is to evaluate the possible metabolic dysregulations as a consequence of chronic OPPs exposure to individuals in Cameroon and Pakistan. (2) Methods: Blood samples were collected from 300 participants in each country, into ethylenediaminetetraacetic acid (EDTA) tubes. The samples were extracted with solid phase extraction (methanol/water) for analysis of OPPs with gas chromatography mass spectrometry. The spectrophotometry and Enzyme Linked ImmunoSorbent Assay (ELISA) were used to measure the hepatic, renal, pancreatic and cardiovascular functions. The atherogenic index (AI) was also determined in OPPs exposed and nonexposed cohorts. (3) Results: The results showed the presence of malathion, parathion and chlorpyrifos OPPs residues in Cameroonians, and malathion and chlorpyrifos in Pakistani samples, respectively. Elevated Body Mass Index (BMI), insulin, blood glucose, dyslipidemia and hypertension were noted in OPPs chronic exposed groups. In addition, dysregulated liver and kidney function profiles were observed in all participants regardless of gender and age groups. (4) Conclusions: The study concludes that both the study cohorts showed several metabolic dysregulations attributable to chronic exposure to a mixture of OPPs which may provide precursors for establishment of metabolic syndrome and other chronic diseases. Further different extended population-based studies are suggested to understand the differential metabolic dysfunctions caused by structurally different OPPs mixtures exposure.
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Weerasinghe M, Konradsen F, Eddleston M, Pearson M, Jayamanne S, Knipe D, Hawton K, Gunnell D, Agampodi S. Factors associated with purchasing pesticide from shops for intentional self-poisoning in Sri Lanka. Trop Med Int Health 2021; 25:1198-1204. [PMID: 33463883 DOI: 10.1111/tmi.13469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE In South Asia, up to one in five individuals who ingest pesticides for self-poisoning and survive purchased them from a shop immediately prior to the event. Thus far, no research has taken place to determine whether interventions implemented through the pesticide sellers might be acceptable or effective, despite the hundreds of thousands of such risk purchases each year. We aimed to investigate factors associated with purchasing pesticides for self-poisoning in Sri Lanka. METHODS We used a case-control study. Cases (n = 50) were individuals who ingested pesticides after purchasing them for the act, and controls (n = 200) were customers who bought pesticides but did not use them for self-harm. Logistic regression analysis was used to assess socio-demographic and purchase-specific risk factors. RESULTS Alcohol intoxication (adjusted odds ratios [AOR] 36.5, 95% confidence intervals [CI] 1.7-783.4) and being a non-farmer AOR 13.3, 95% CI 1.8-99.6 were the main distinguishing factors when purchasing pesticides for self-poisoning. The positive predictive values were 93.3% (95% CI 68.0-99.8%) and 88.2% (95% CI 72.5-96.7%), respectively. One and/or other of these factors characterised 72.0% of cases but only 2.5% controls. CONCLUSION While results need to be interpreted cautiously, sales restrictions to prevent alcohol-intoxicated persons and non-farmers purchasing pesticides for self-poisoning may be effective.
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Affiliation(s)
- Manjula Weerasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Flemming Konradsen
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Melissa Pearson
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Shaluka Jayamanne
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Duleeka Knipe
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - David Gunnell
- Population Health Sciences, University of Bristol, Bristol, UK.,National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
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