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Chen J, Cao Y, Yuan Q, Wang R, Chai J, Chen C, Fang J. Acetamiprid and pyridaben poisoning: A case report. Toxicol Rep 2023; 11:212-215. [PMID: 37727219 PMCID: PMC10505946 DOI: 10.1016/j.toxrep.2023.09.007] [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: 08/07/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023] Open
Abstract
Background The agricultural industry has experienced beneficial outcomes by implementing contemporary synthetic pesticides, specifically, the mixture of acetamiprid and pyridaben. However, concerns regarding public health have arisen due to the increased number of suicides caused by insecticide poisoning. Nevertheless, limited reports of human exposure to these pesticides have reported various adverse clinical effects. In this study, we present the case of an individual who consumed the acetamiprid and pyridaben mixture for suicidal purposes, and subsequently developed central nervous system depression, hyperlactacidemia, and metabolic acid poisoning, which thus required clinical management. Case report A 74-year-old woman was transported to our hospital after ingesting a combination of 30 mL of acetamiprid 5 % and pyridaben 5 %. The patient displayed nausea and vomiting symptoms, followed by confusion. An arterial blood gas analysis revealed metabolic acidosis and hyperlactacidemia. The patient was carefully monitored for vital signs and treated with gastric lavage, purgation, and proton pump inhibitors to reduce gastric acid, blood volume, and electrolyte resuscitation. In addition, the patient received 24 h of hemoperfusion (HP) and continuous renal replacement therapy (CRRT). As a result of these interventions, the patient had a speedy recovery and was discharged 10 days later. Conclusion This case report provided the details of a rare instance of acute poisoning in humans resulting from exposure to newer synthetic pesticides, specifically acetamiprid and pyridaben. The report described the clinical manifestations and effective supportive therapy management. Future clinicians may find the results of this report valuable for identifying clinical symptoms and treating acute poisoning caused by newer synthetic pesticides.
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Affiliation(s)
- Juan Chen
- Department of Critical Care Medicine, The Affiliated Xiangshan Hospital of Wenzhou Medical University, 291 Donggu Road, Dandong Street, Xiangshan, Ningbo, Zhejiang 315700, China
| | - Yang Cao
- Department of Critical Care Medicine, The Affiliated Xiangshan Hospital of Wenzhou Medical University, 291 Donggu Road, Dandong Street, Xiangshan, Ningbo, Zhejiang 315700, China
| | - Qionghui Yuan
- Department of Critical Care Medicine, The Affiliated Xiangshan Hospital of Wenzhou Medical University, 291 Donggu Road, Dandong Street, Xiangshan, Ningbo, Zhejiang 315700, China
| | - Ren Wang
- Department of Critical Care Medicine, The Affiliated Xiangshan Hospital of Wenzhou Medical University, 291 Donggu Road, Dandong Street, Xiangshan, Ningbo, Zhejiang 315700, China
| | - JiangJie Chai
- Department of Critical Care Medicine, The Affiliated Xiangshan Hospital of Wenzhou Medical University, 291 Donggu Road, Dandong Street, Xiangshan, Ningbo, Zhejiang 315700, China
| | - Chensong Chen
- Department of Critical Care Medicine, The Affiliated Xiangshan Hospital of Wenzhou Medical University, 291 Donggu Road, Dandong Street, Xiangshan, Ningbo, Zhejiang 315700, China
| | - Junjie Fang
- Department of Critical Care Medicine, The Affiliated Xiangshan Hospital of Wenzhou Medical University, 291 Donggu Road, Dandong Street, Xiangshan, Ningbo, Zhejiang 315700, China
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Wu YJ, Chang SS, Chen HY, Tsai KF, Lee WC, Wang IK, Lee CH, Chen CY, Liu SH, Weng CH, Huang WH, Hsu CW, Yen TH. Human Poisoning with Chlorpyrifos and Cypermethrin Pesticide Mixture: Assessment of Clinical Outcome of Cases Admitted in a Tertiary Care Hospital in Taiwan. Int J Gen Med 2023; 16:4795-4804. [PMID: 37908758 PMCID: PMC10614644 DOI: 10.2147/ijgm.s432861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023] Open
Abstract
Background and Purpose There is an overall paucity of data regarding the human toxicity of chlorpyrifos and cypermethrin pesticide mixture. Both organophosphate and pyrethroid insecticides are metabolized by carboxylesterases. Thus, its pesticide combination, organophosphates may boost the toxicity of pyrethroids via inhibited its detoxification by carboxylesterases. This study examined the clinical course, laboratory tests, and outcomes of patients with chlorpyrifos, cypermethrin or their pesticide mixture poisoning, and to determine what association, if any, might exist between these findings. Patients and Methods Between 2000 and 2021, 121 patients poisoned with chlorpyrifos, cypermethrin, or their pesticide mixture were treated at Chang Gung Memorial Hospital. Patients were categorized as chlorpyrifos (n=82), cypermethrin (n=27) or chlorpyrifos and cypermethrin (n=12) groups. Demographic, clinical, laboratory and mortality data were collected for analysis. Results The patients experienced a broad range of clinical symptoms, including aspiration pneumonia (44.6%), salivation (42.5%), acute respiratory failure (41.3%), acute kidney injury (13.9%), seizures (7.5%), hypotension (2.6%), etc. Leukocytosis (12,700±6600 /uL) and elevated serum C-reactive protein level (36.8±50.4 mg/L) were common. The acute respiratory failure rate was 41.3%, comprising 48.8% in chlorpyrifos, 11.1% in cypermethrin as well as 58.3% in chlorpyrifos and cypermethrin poisoning. Patients with chlorpyrifos and cypermethrin pesticide mixture poisoning suffered higher rates of acute respiratory failure (P=0.001) and salivation (P=0.001), but lower Glasgow Coma Scale score (P=0.011) and serum cholinesterase level (P<0.001) than other groups. A total of 17 (14.0%) patients expired. The mortality rate was 14.0%, including 17.1% in chlorpyrifos, 3.7% in cypermethrin as well as 16.7% in chlorpyrifos and cypermethrin poisoning. No significant differences in mortality rate were noted (P=0.214). Conclusion Chlorpyrifos pesticide accounted for the major toxicity of the pesticide mixture. While the data show a higher rate of respiratory failure in the chlorpyrifos and cypermethrin pesticide mixture group than others, other measures of toxicity such as mortality and length of stay were not increased.
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Affiliation(s)
- Yi-Jan Wu
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, Department of Public Health, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Hsien-Yi Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
| | - Kai-Fan Tsai
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Branch, Kaohsiung City, Taiwan
| | - Wen-Chin Lee
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Branch, Kaohsiung City, Taiwan
| | - I-Kuan Wang
- Department of Nephrology, China Medical University Hospital, Taichung City, Taiwan
- College of Medicine, China Medical University, Taichung City, Taiwan
| | - Chern-Horng Lee
- Division of General Internal Medicine and Geriatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
| | - Chao-Yu Chen
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Shou-Hsuan Liu
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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Khonje V, Hart J, Venter J, Deonarain S, Grossberg S. Acute organophosphorus toxicity in a regional hospital in Johannesburg, South Africa: A retrospective chart review. Afr J Emerg Med 2023; 13:104-108. [PMID: 37152660 PMCID: PMC10160343 DOI: 10.1016/j.afjem.2023.04.002] [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: 12/14/2022] [Revised: 02/23/2023] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Intentional and accidental organophosphorus exposures pose a significant healthcare-related burden on South African communities. This study will review the demographics, characteristics and clinical course of patients presenting with features of acute organophosphorus toxicity to a regional Emergency Centre in Johannesburg, South Africa. Methods This was a retrospective chart review of all patients treated for possible acute organophosphorus toxicity from January 2020 to August 2021. Results A total of 205 patients were identified of which 134 patients were included in the study. The median age was 26 years with a male predominance (male= 56%, female=44%). 109 patients (81.3%) survived, 18 patients (13.4%) demised and the outcome of 7 patients (5.2%) was unknown. The median hospital length of stay was 8 days, (IQR= 5-13 days), and the longest hospital stay was 37 days in ICU. Atropinisation dose was significantly higher for intubated patients (median=140.0mg; IQR=90mg-219.5mg) compared to patients who were not intubated (median=60mg; IQR=20.5mg-120mg, p < 0.05). The length of stay was significantly higher for intubated patients (median=11 days; IQR=7-15 days) compared to patients who were not intubated (median=5 days; IQR=3-8 days, p < 0.00). There was a moderate positive correlation between atropinisation dose and length of stay (Correlation coefficient = 0.37, p < 0.00). There was a moderate negative correlation between atropinisation dose and cholinesterase level (Correlation coefficient= - 0.39, p < 0.00). Of those reported to have adverse effects 78.6%, were related to atropine toxicity. Conclusion Our study shows a high mortality rate secondary to organophosphorus toxicity. Significant exposures and thus higher doses of atropine were associated with increased length of stay and need for intubation. We found a high incidence of atropine-related adverse effects. More studies are needed to further establish the balance between the therapeutic and adverse effects of high-dose atropine as a treatment modality for organophosphorus toxicity.
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Affiliation(s)
- Vanessa Khonje
- Emergency Department, Thelle Mogoerane Regional Hospital, Vosloorus, Gauteng, South Africa
- Corresponding author:
| | - Jedd Hart
- Emergency Department, Thelle Mogoerane Regional Hospital, Vosloorus, Gauteng, South Africa
- Division of Emergency Medicine, Faculty of Health Sciences, University of Witwatersrand, Gauteng, South Africa
| | - Jakus Venter
- Emergency Department, Thelle Mogoerane Regional Hospital, Vosloorus, Gauteng, South Africa
- Division of Emergency Medicine, Faculty of Health Sciences, University of Witwatersrand, Gauteng, South Africa
| | - Saisha Deonarain
- Emergency Department, Thelle Mogoerane Regional Hospital, Vosloorus, Gauteng, South Africa
| | - Saul Grossberg
- Emergency Department, Thelle Mogoerane Regional Hospital, Vosloorus, Gauteng, South Africa
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Al-Rosyid LM, Santoso IB, Titah HS, Mangkoedihardjo S, Trihadiningrum Y, Hidayati D. Correlation between BOD/COD Ratio and Octanol/Water Partition Coefficient for Mixture Organic Compounds. Toxicol Int 2022. [DOI: 10.18311/ti/2022/v29i3/29141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Correlation between the BOD/COD ratio and Partition coefficient of octanol/ water (Pow) on a single organic substance shows that the Pow value is directly proportional to the toxicity level and inversely proportional to BOD/COD ratio. This research examined the correlation to a mixture of organic substances. The objective is to obtain a varied range of substances, as well as determining the quality of wastewater discharging to fresh waters. Need for analysis of organic substances used as antiseptics during the Covid-19 pandemic. In addition, organic substances from the organophosphate pesticide class, diazinon, were used. BOD5, COD, Pow, and LC50-96h toxicity tests using Daphnia magna were used. Six types of the mixture of organic substances included diazinon-formaldehyde-isopropyl alcohol, ethanol-oxalic acid-formaldehyde, isopropyl alcohol-glycerol-lactose, acetic acid-isopropyl alcohol-formaldehyde, sucrose-glycerol-acetic acid, and oxalic acid-formaldehyde-diazinon, with 3 different concentrations of 10, 100, and 1000 mg/L, three repetitions. The lowest BOD/COD ratio (<0.2) and the highest Pow value (>4) are found in diazinon-formaldehyde-IPA. Its toxicity in D. magna also showed the lowest LC-50 (11.82 mg/L). Whereas, sucrose-glycerol-acetic acid had the highest BOD/COD ratio (>0.7) and lowest Pow (<0.7) with the highest LC- 50 (567.88 mg/L). Other organic substances mixtures have characteristics in the range of these mixtures. Pow variability and the BOD/COD ratio have a negative correlation. A mixture of organic matter is more biodegradable making it has a higher tendency to dissolve in water.
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Prediction of chemical warfare agents based on cholinergic array type meta-predictors. Sci Rep 2022; 12:16709. [PMID: 36203081 PMCID: PMC9537167 DOI: 10.1038/s41598-022-21150-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/23/2022] [Indexed: 11/08/2022] Open
Abstract
Molecular insights into chemical safety are very important for sustainable development as well as risk assessment. This study considers how to manage future upcoming harmful agents, especially potentially cholinergic chemical warfare agents (CWAs). For this purpose, the structures of known cholinergic agents were encoded by molecular descriptors. And then each drug target interaction (DTI) was learned from the encoded structures and their cholinergic activities to build DTI classification models for five cholinergic targets with reliable statistical validation (ensemble-AUC: up to 0.790, MCC: up to 0.991, accuracy: up to 0.995). The collected classifiers were transformed into 2D or 3D array type meta-predictors for multi-task: (1) cholinergic prediction and (2) CWA detection. The detection ability of the array classifiers was verified under the imbalanced dataset between CWAs and none CWAs (area under the precision-recall curve: up to 0.997, MCC: up to 0.638, F1-score of none CWAs: up to 0.991, F1-score of CWAs: up to 0.585).
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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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Mechanisms and treatment strategies of organophosphate pesticide induced neurotoxicity in humans: A critical appraisal. Toxicology 2022; 472:153181. [DOI: 10.1016/j.tox.2022.153181] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/20/2022] [Accepted: 04/11/2022] [Indexed: 12/31/2022]
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Chen YC, Lin CH, Wu SL. Neurological Sequela of Acute Pesticide Poisoning Among Adults in Central Taiwan. Front Neurol 2021; 12:745265. [PMID: 34956044 PMCID: PMC8708347 DOI: 10.3389/fneur.2021.745265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Cases of acute pesticide poisoning account for significant morbidity and mortality in developing countries; however, its burden in Taiwan remains unknown. The study examined acute pesticide poisoning (APP) involving adults in the central region of Taiwan, which is a mainly agricultural sub-urban area. Methods: The retrospective study evaluated the outcome and neurological sequelae of patients with APP in a Taiwanese cohort between April 2002 and February 2019. The pesticides were classified according to the Insecticide Resistance Action Committee Mode of Action (MoA) classification. The clinical characteristics, duration of hospitalization (days), follow-up duration (years), in-hospital mortality, neurological sequela, and imaging findings were recorded. Furthermore, multivariate logistic regression analyses were performed. Results: We identified 299 patients with APP comprising 206 (68.9%) adult men with a mean exposure age of 56.4 ± 16.8 years. Paraquat, organophosphates, pyrethroids, carmabates, and phosphinic acid were the most commonly known reported poisoning agents. The mortality rate was highest in users with paraquat (77.1%), followed by phosphinic acid (22.2%), carbamates (16.7%), and organophosphates (15.8%). After a mean follows up of 3.69 ± 2.26 years, the most common neurological sequela was a cognitive decline (56 among 225 survivors, 24.89%), peripheral neuropathy (11 among 225 survivors, 4.89%), tremor (10 among 225 survivors, 4.44%), ataxia (3/225, 1.33%), and parkinsonism feature (2/225, 0.89%). Brain imaging studies revealed basal ganglion lesions on CT or hyperintensity on T2-weighted MRI images in 26 among 46 patients (56.5%). The basal ganglion lesions on brain imaging had a positive correlation with neurological sequelae. Conclusion: Acute pesticide poisoning (APP)-related mortality is high especially paraquat intoxication, and cognitive decline, as well as peripheral neuropathy, were the most common neurological sequelae among survivors, which is highly correlated with basal ganglia lesions on brain imaging.
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Affiliation(s)
- Yen-Chung Chen
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Chin-Hsien Lin
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shey-Lin Wu
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
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Buckley NA, Fahim M, Raubenheimer J, Gawarammana IB, Eddleston M, Roberts MS, Dawson AH. Case fatality of agricultural pesticides after self-poisoning in Sri Lanka: a prospective cohort study. Lancet Glob Health 2021; 9:e854-e862. [PMID: 33901424 PMCID: PMC8131203 DOI: 10.1016/s2214-109x(21)00086-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 02/01/2021] [Accepted: 02/16/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pesticide poisoning is among the most common means of suicide globally, but can be prevented with regulation of the most hazardous agents. We aimed to compare the lethality of pesticides ingested by our cohort, seek evidence on variation between human and regulatory animal toxicity, and establish change over time in the case fatality of individual pesticides in Sri Lanka. METHODS We examined the case fatality of agricultural pesticides in a prospective cohort in nine hospitals serving rural populations in Sri Lanka. We included all patients (>11 years) who had presented to a South Asian Clinical Toxicology Research Collaboration study hospital during the study period. Patients were enrolled by clinical research assistants and were regularly reviewed. Identification of the ingested pesticide was generally on the basis of history or positive identification of the container, supported by nested blood analysis. FINDINGS From March 31, 2002, to Dec 31, 2019, 34 902 patients (median age 29 years [IQR 21-40]; 23 060 [66·1%] male) presented with a possible or known pesticide self-poisoning. We identified 23 139 specific pesticides that were ingested. Poisoning was fatal in 2299 (6·6%) patients. Case fatality varied greatly from 0·0% (several substances) to 41·8% (paraquat). The three most toxic agents (ie, paraquat, dimethoate, and fenthion) were banned between 2008 and 2011. Since 2013, the five agents causing the most deaths (ie, profenofos, propanil, fenobucarb, carbosulfan, and quinalphos) had a case fatality of 7·2-8·6%. A steady decline was seen in overall case fatality of pesticide poisoning (10·5% for 2002-06 to 3·7% for 2013-19), largely attributable to pesticide bans. A modest fall in case fatality for non-banned pesticides was also seen. INTERPRETATION Declines seen in case fatalities of poisonings with non-banned pesticides suggest that medical management improved over time. The human data for acute toxicity of pesticides should drive hazard classifications and regulation. We believe that a global benchmark for registration of pesticides should include a less than 5% case fatality after self-poisoning, which could prevent many deaths and have a substantial effect on global suicide rates. FUNDING The Wellcome Trust and the National Health and Medical Research Council of Australia. TRANSLATIONS For the Sinhala and Tamil translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Nicholas A Buckley
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka; Pharmacology, Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Mohamed Fahim
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka; Faculty of Allied Health Sciences, Department of Pharmacy, University of Peradeniya, Kandy, Sri Lanka; Pharmacology, Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jacques Raubenheimer
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka; Pharmacology, Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Indika B Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka; Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Michael S Roberts
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka; Basil Hetzel Institute for Translational Health Research, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia; Diamantina Institute, University of Queensland, Brisbane, QLD, Australia
| | - Andrew H Dawson
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka; Pharmacology, Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Omar S, Bahemia IA, Toerien L, San Pedro KM, Khan AB. A retrospective comparison of the burden of organophosphate poisoning to an Intensive Care Unit in Soweto over two separate periods. Afr J Emerg Med 2021; 11:118-122. [PMID: 33680732 PMCID: PMC7910160 DOI: 10.1016/j.afjem.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/31/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Organophosphate poisoning (OPP) is a major health-care burden in South Africa. Recently, we have observed that patients admitted to our Intensive Care Unit (ICU) with OPP have followed a more complicated course in comparison to previous years. Objectives To describe the differences in the clinical course and costs of patients with OPP between two time periods, namely 2012 and 2017. Methods Retrospective comparison of patients admitted to the Intensive Care Unit (ICU) of Chris Hani Baragwanath Academic Hospital between January 2012 to December 2012 and January 2017 to December 2017. Results Forty-one patients were found in the database. Patients from our 2017 cohort showed a significantly longer total median (IQR) length of stay 8 (4–17) days vs. 2 (2–3) days, p = 0.000, duration of antidote therapy 5 (3−10) days vs. 2 (2–3) days, p = 0.004 and duration of ventilation 4 (2−11) days vs 1 (1–2) day, p = 0.003. Patients presenting in 2017 were more likely to be admitted to ICU, odds ratio 5.6 (CI 1.2–26). There was a 31- fold increase in ICU costs between 2012 and 2017. Conclusion Based on our experience, the clinical course of OPP requiring ICU admission has evolved into a condition with a longer length of stay, duration of antidote therapy, ventilatory support, increased risk of complications and additional costs.
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Kamath S, Gautam V. Study of organophosphorus compound poisoning in a tertiary care hospital and the role of Peradeniya Organophosphorus Poisoning scale as a prognostic marker of the outcome. J Family Med Prim Care 2021; 10:4160-4167. [PMID: 35136783 PMCID: PMC8797078 DOI: 10.4103/jfmpc.jfmpc_518_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction: Organophosphate compounds (OPC) cause most self-poisoning deaths in India due to their easy availability and lack of stringent laws. Aim: To evaluate the clinical profile and outcome of the patients presenting with OPC poisoning and to study the prognostic value of Peradeniya Organophosphorus Poisoning Scale (POPS) in predicting the clinical outcomes. Methods and Materials: This was a prospective study involving 100 patients of OPC poisoning admitted to Tata Main Hospital from June 2018 to May 2020 based on the inclusion criteria. Demographic profile, clinical features, treatment details, and need for ventilatory support were noted. POPS was applied on admission, and the patients were followed up for the outcome in terms of morbidity and mortality. Observations: Of the 100 patients, most patients were between 20 and 29 years with male to female ratio being 1.2:1. Vomiting (94%), followed by excessive secretions (84%) were the most common symptoms. Overall mortality was 22%. On grading of severity as per the POP scale, 27% of the patients had mild poisoning, 37% patients had moderate, whereas 36% had severe poisoning. Only 11.11% of the patients with POPS 0–3 required ventilator support, whereas 16.2% of the patients with POPS 4–7, and 100% of patients with POPS 8–11 required ventilator assistance (P < 0.0001). Similarly, the total dose of atropine required (P < 0.0001), length of intensive care unit (ICU) stay, complications, and mortality (P < 0.0001) were significantly associated with higher POPS. Conclusion: POPS at admission, correlated well with the need for ventilator support, the total dose of atropine required, length of stay in the ICU, complications, and mortality. It can thus be used for prognostication and risk stratification of patients with OPC poisoning.
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Tsai CY, Wu CJ, Wu JCC, Fang C, Huang YH, Dai KY. Redox-active DJ-1 sustains brainstem cardiovascular regulation via maintenance of mitochondrial function during mevinphos intoxication. Neurochem Int 2020; 139:104791. [PMID: 32650030 DOI: 10.1016/j.neuint.2020.104791] [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] [Received: 03/18/2020] [Revised: 05/18/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023]
Abstract
DJ-1 (also known as PARK7) is a redox-active protein that protects against oxidative stress. This study evaluated the hypothesis that DJ-1 sustains brainstem cardiovascular regulation via maintaining mitochondrial function in the rostral ventrolateral medulla (RVLM), a brainstem site known to maintain blood pressure and sympathetic vasomotor tone, during cardiovascular depression elicited by the organophosphate insecticide mevinphos. In Sprague-Dawley rats, intravenous administration of mevinphos (640 μg kg-1) resulted in progressive hypotension, accompanied by an increase (Phase I) followed by a decrease (Phase II) of an experimental index for spontaneous baroreflex-mediated sympathetic vasomotor tone, alongside elevation in mitochondrial superoxide levels in the RVLM. There was concurrent activation of DJ-1 induced by oxidative stress in the RVLM, which was causally and temporally related to translocation of DJ-1 to mitochondria, reduction in mitochondrial membrane potential, increase in cytosolic apoptosis-inducing factor level, and apoptotic cell death in this brainstem site. Loss-of-function by immunoneutralization of DJ-1 in the RVLM significantly exacerbated those biochemical and cellular events, enhanced the progressive hypotension, diminished the increased and augmented the decreased spontaneous baroreflex-mediated sympathetic vasomotor tone respectively during Phases I and II, and heightened lethality during mevinphos intoxication. We conclude that DJ-1 in the RVLM sustains brainstem cardiovascular regulation induced by mevinphos via maintaining mitochondrial function.
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Affiliation(s)
- Ching-Yi Tsai
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC.
| | - Chiung-Ju Wu
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC
| | - Jacqueline C C Wu
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC
| | - Chi Fang
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC
| | - Ya-Hui Huang
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC
| | - Kuang-Yu Dai
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC
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Liu HF, Ku CH, Chang SS, Chang CM, Wang IK, Yang HY, Weng CH, Huang WH, Hsu CW, Yen TH. Outcome of patients with chlorpyrifos intoxication. Hum Exp Toxicol 2020; 39:1291-1300. [PMID: 32336155 DOI: 10.1177/0960327120920911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION There is a paucity of literature analyzing outcome of chlorpyrifos intoxication. METHODS A total of 40 patients with chlorpyrifos intoxication were seen at Chang Gung Memorial Hospital between 2008 and 2017. Patients were stratified into two subgroups according to their prognosis, as good (n = 12) or poor (n = 28). Good prognosis group were defined as patients who survived without serious complications, and poor prognosis group included patients who died and survived after development of severe complications. Demographic, clinical, laboratory, and mortality data were obtained for analysis. RESULTS Patients aged 53.8 ± 16.3 years and most were male (80.0%). All patients (100.0%) developed acute cholinergic crisis such as emesis (45.0%), respiratory failure (42.5%), tachycardia (30.0%), kidney injury (22.5%), and seizure (7.5%). Intermediate syndrome developed in 12.5% of patients, but none had delayed neuropathy (0%). The poor prognosis group suffered higher incidences of respiratory failure (p = 0.011), kidney injury (p = 0.026), and prolonged corrected QT interval (p = 0.000), and they had higher blood urea nitrogen level (p = 0.041), lower Glasgow coma scale score (p = 0.011), and lower monocyte count (p = 0.023) than good prognosis group. All patients were treated with atropine and pralidoxime therapy, but six patients (15.0%) still died of intoxication. In a multivariate logistic regression model, blood urea nitrogen was a significant risk factor for poor prognosis (odds ratio: 1.375, 95% confidence interval: 1.001-1.889, p = 0.049). Nevertheless, no mortality risk factor could be identified. CONCLUSION The mortality rate of patients with chlorpyrifos intoxication was 15.0%. Furthermore, acute cholinergic crisis, intermediate syndrome, and delayed neuropathy developed in 100.0%, 12.5%, and 0% of patients, respectively.
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Affiliation(s)
- H-F Liu
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou
| | - C-H Ku
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou
| | - S-S Chang
- Institute of Health Behaviors and Community Sciences, Department of Public Health, College of Public Health, National Taiwan University, Taipei
| | - C-M Chang
- Division of Rehabilitation and Community Psychiatry, Department of Psychiatry, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou
| | - I-K Wang
- Department of Nephrology, China Medical University Hospital and College of Medicine, China Medical University, Taichung
| | - H-Y Yang
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou
| | - C-H Weng
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou
| | - W-H Huang
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou
| | - C-W Hsu
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou
| | - T-H Yen
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou
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Huang WC, Yen TH, Lin L, Lin C, Juang YY, Wang BH, Lee SH. Clinical Characteristics of Pesticide Self-Harm as Associated with Suicide Attempt Repetition Status. Neuropsychiatr Dis Treat 2020; 16:1717-1726. [PMID: 32764947 PMCID: PMC7371433 DOI: 10.2147/ndt.s258475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/28/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Previous suicide behavior predicts future suicide risk. Studies of suicide repetition are important for suicide prevention. This study examined the clinical characteristics and psychiatric comorbidities of pesticide self-harm as associated with suicide attempt repetition status. PATIENTS AND METHODS This retrospective, observational study included patients admitted to a medical center in northern Taiwan between 2000 and 2015 following suicide attempts by pesticide. Diagnoses were made by a consultation-liaison psychiatry team based on the DSM IV-TR criteria. Independent samples t-test was used to analyze the quantitative variables and Pearson's Chi-squared test with a Bonferroni adjustment for categorical variables. Univariate binary logistic regression analysis was conducted to determine the predictors for repeated suicide attempt and multivariate binary logistic regression analysis to identify significant associated factors. RESULTS Among 151 patients, organophosphate pesticides were the most used (80.8%). The average age was 52.9±17.2 years. Most patients were married males from rural areas, with depressive disorder most often diagnosed (40.4%). Nearly one-third of them were suicide repeaters (n=43, 28.5%); these patients were less likely to be married (53.5%, p=0.001), had previously used psychiatric services (72.1%, p<0.001) and chose complex suicide (46.5%, p=0.014) more often compared to nonrepeaters. No significant differences were found between repeaters and nonrepeaters regarding psychiatric comorbidities. Multivariate logistic regression analysis revealed that marital status (odds ratio: 2.916, 95% confidence interval: 1.234-6.891, p=0.015) and previous psychiatric services usage (odds ratio: 6.897, 95% confidence interval: 3.012-15.625, p<0.001) were significant risk factors associated with suicide repetition. CONCLUSION Pesticide suicide repeaters were characterized by less likely to be married and more likely to use psychiatric services before suicide attempts. These features help ensuring that the needs of people who have made a suicide attempt are addressed, and it reduces the likelihood of repetition.
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Affiliation(s)
- Wei-Chen Huang
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Long Lin
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chemin Lin
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yeong-Yuh Juang
- Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Bi-Hwa Wang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shwu-Hua Lee
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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15
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Tangiisuran B, Jiva M, Ariff AM, Abdul Rani NA, Misnan A, Rashid SM, Majid MIA, Dawson AH. Evaluation of types of poisoning exposure calls managed by the Malaysia National Poison Centre (2006-2015): A retrospective review. BMJ Open 2018; 8:e024162. [PMID: 30598487 PMCID: PMC6318535 DOI: 10.1136/bmjopen-2018-024162] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Accidental or intentional poisoning is a public health concern requiring intervention. The current study designs to evaluate the types of poisoning exposure calls received by the Malaysia National Poison Centre (NPC) over a 10-year period. SETTINGS AND DATA SOURCES The poisoning enquiries database (2006-2015) from the Malaysia NPC was used for the analysis. PARTICIPANTS The NPC records all telephone calls that it manages using a validated and standardised form. Demographics and types of the poisoning exposure calls were extracted and descriptive analysis was applied. PRIMARY AND SECONDARY OUTCOMES The primary outcome of this study is to evaluate NPC data for trends in the poisoning exposure calls based on the types and modes of poisoning over a 10-year period. The secondary outcome is to evaluate the characteristics of human exposure cases based on the calls received by the NPC. RESULTS There was a notable increase in the number of poisoning exposure calls noticed during the 10-year period but dropped significantly in 2012. The highest number of poisoning exposure calls came from Selangor (21.0%), Perak (18.0%) and Negeri Sembilan (9.8%). More than half of the exposure was intentional (53.8%) involving more women (50.3%) as compared with men (41.9%), and in the 20-29 years age group category (33.5%). Exposure mostly occurred at home (96%) through the ingestion route (94.1%). Pharmaceutical products (40.5%), pesticides (31.7%) and household products (20.1%) were the common agents implicated for intentional exposure. CONCLUSIONS There is an increasing trend in enquiries on poisoning exposure calls made to the NPC. Most of the intentional poisoning exposures occurred among younger women and involved pharmaceuticals, pesticides or household products. Poisoning safety education and other interventions are needed to curb poisoning incidents.
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Affiliation(s)
- Balamurugan Tangiisuran
- National Poison Centre, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - Maryam Jiva
- Institute of Pharmaceutical Sciences, Kings College London, London, UK
| | | | | | - Asdariah Misnan
- National Poison Centre, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - Sazaroni Md Rashid
- National Poison Centre, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | | | - Andrew H Dawson
- Royal Prince Alfred Hospital and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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16
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Chuang MC, Chang CH, Lee CS, Li SH, Hsiao CC, Fang YF, Hsieh MJ. One-year mortality among hospital survivors of cholinesterase inhibitor poisoning based on Taiwan National Health Insurance Research Database from 2003 to 2012. BMC Pharmacol Toxicol 2018; 19:72. [PMID: 30424813 PMCID: PMC6234557 DOI: 10.1186/s40360-018-0263-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 10/26/2018] [Indexed: 12/27/2022] Open
Abstract
Background Acute cholinesterase inhibitor (CI) poisoning, including organophosphate and carbamate poisoning, is a crucial problem in developing countries. Acute intoxication results in a cholinergic crisis, neurological symptoms, or respiratory failure. However, the short-term and long-term outcomes of CI poisoning are seldom reported. Methods Data from the National Health Insurance Research Database were used to investigate the outcomes after organophosphate and carbamate poisoning. Patients who were hospitalized for a first episode of acute CI poisoning between 2003 and 2012 were enrolled in this study. Outcomes of acute CI poisoning with or without mechanical ventilation were analyzed. Results Among 6832 patients with CI poisoning, 2010 developed respiratory failure requiring mechanical ventilation, and the other 4822 patients did not require mechanical ventilation. The hospital mortality rate was higher in patients requiring mechanical ventilation than in those not requiring mechanical ventilation (33.3% versus 4.7%, p < 0.0001). In patients with respiratory failure with mechanical ventilation, the patients without pneumonia had higher mortality rate than those with pneumonia. (36.0% versus 19.9%, p < 0.0001). The 1-year mortality rate the survivors of CI poisoning was 6.7%. Among 5932 survivors after cholinesterase inhibitor poisoning, the one-year mortality rate in patients with mechanical ventilation during hospitalization was higher than those without mechanical ventilation during hospitalization (11.4% versus 5.4% respectively, p < 0.0001). Conclusions The one-year mortality rate of survivors after CI poisoning was 6.7%. Meanwhile, age, pneumonia, and mechanical ventilation may be predictive factors for the one-year mortality among the survivors after CI poisoning. Diabetes mellitus was not a risk factor for hospital mortality in patients with CI poisoning.
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Affiliation(s)
- Min-Chun Chuang
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, No. 6, Sec. West, Chia-Pu Road, Pu-Tz City, Chiayi, 613, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chih-Hao Chang
- Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung medical foundation, Taoyuan City, Taiwan.,Division of Pulmonary and Critical Care, Department of Internal Medicine, Saint Paul's Hospital, Taoyuan City, Taiwan.,Chang-Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chung Shu Lee
- Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung medical foundation, Taoyuan City, Taiwan.,Division of Pulmonary and Critical Care, Department of Internal Medicine, Saint Paul's Hospital, Taoyuan City, Taiwan.,Chang-Gung University College of Medicine, Taoyuan City, Taiwan
| | - Shih-Hong Li
- Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung medical foundation, Taoyuan City, Taiwan.,Chang-Gung University College of Medicine, Taoyuan City, Taiwan
| | - Ching-Chung Hsiao
- Chang-Gung University College of Medicine, Taoyuan City, Taiwan.,Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Yueh-Fu Fang
- Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung medical foundation, Taoyuan City, Taiwan.,Division of Pulmonary and Critical Care, Department of Internal Medicine, Saint Paul's Hospital, Taoyuan City, Taiwan.,Chang-Gung University College of Medicine, Taoyuan City, Taiwan
| | - Meng-Jer Hsieh
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, No. 6, Sec. West, Chia-Pu Road, Pu-Tz City, Chiayi, 613, Taiwan. .,Department of Respiratory Care, Chang-Gung University, Taoyuan City, Taiwan.
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17
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Tsai CY, Dai KY, Fang C, Wu JCC, Chan SHH. PTEN/FLJ10540/PI3K/Akt cascade in experimental brain stem death: A newfound role for a classical tumorigenic signaling pathway. Biochem Pharmacol 2018; 155:207-212. [PMID: 30008438 DOI: 10.1016/j.bcp.2018.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/01/2018] [Indexed: 12/28/2022]
Abstract
Despite great advances in contemporary medicine, brain death still remains enigmatic and its cellular and molecular mechanisms unsettled. This review summarizes recent findings that substantiate the notion that PTEN/FLJ10540/PI3K/Akt cascade, the classical tumorigenic signaling pathway, is actively engaged in experimental brain stem death. These results were based on a clinically relevant animal model that employs the pesticide mevinphos as the experimental insult in Sprague-Dawley rats to mimic brain stem death in patients died of organophosphate poisoning. The neural substrate investigated is the rostral ventrolateral medulla (RVLM), a brain stem site classically known to maintain arterial pressure (AP) and is established to be the origin of a "life-and-death" signal detected from AP, which reflects brain stem cardiovascular dysregulation that precedes death. Activation of PI3K/Akt signaling pathway in the RVLM upregulates the nuclear factor-κB/nitric oxide synthase II/peroxynitrite cascade, resulting in impairment of brain stem cardiovascular regulation that leads to the loss of the "life-and-death" signal in experimental brain stem death. This process is reinforced by FLJ10540, a PI3K-association protein; and is counteracted by PTEN, a negative regulator of PI3K/Akt signaling. The concept that a classical signaling pathway in tumorigenesis is also an active player in cardiovascular dysregulation in brain stem death provides new ramifications for translational medicine. It promulgates the concept that rather than focusing on a particular disease condition, a new vista for future therapeutic strategy against both fatal eventualities should target at this common cellular cascade.
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Affiliation(s)
- Ching-Yi Tsai
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan, Republic of China.
| | - Kuang-Yu Dai
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan, Republic of China
| | - Chi Fang
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan, Republic of China
| | - Jacqueline C C Wu
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan, Republic of China
| | - Samuel H H Chan
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan, Republic of China.
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18
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Lekei E, Ngowi AV, London L. Acute Pesticide Poisoning in Children: Hospital Review in Selected Hospitals of Tanzania. J Toxicol 2017; 2017:4208405. [PMID: 29441090 PMCID: PMC5758850 DOI: 10.1155/2017/4208405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/20/2017] [Accepted: 12/03/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Acute pesticide poisoning (APP) is a serious problem worldwide. Because the burden of childhood APP is unknown in Tanzania, this study describes the distribution, circumstances, and patterns of APP involving children under 18 years in Tanzania. METHODOLOGY A 12-month prospective study was conducted in 10 Tanzanian healthcare facilities in 2006 using a data collection tool for surveillance. RESULTS Of 53 childhood poisoning cases identified, 56.6% were female. The most common poisoning circumstances were accidents (49.1%) and suicide (30.2%). The most vulnerable children were 16-17 years old (30.2%). Suicide was significantly more common in females (PRR females/males = 1.66; 95% CI = 1.03-2.68) and accidental cases were more common in children aged 10 years or younger. Suicide was concentrated in children over 10 years, comprising 53% of cases in this age group. Organophosphates (OPs), zinc phosphide, and endosulfan were common amongst reported poisoning agents. The annual APP incidence rate was 1.61/100,000. CONCLUSION APP is common among children in this region of Tanzania. Prevention of suicide in older children should address mental health issues and control access to toxic pesticides. Prevention of accidents in younger children requires safer storage and hygiene measures. Diverse interventions are needed to reduce pesticide poisoning among children in Tanzania.
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Affiliation(s)
- Elikana Lekei
- Tropical Pesticides Research Institute, P.O. Box 3024, Arusha, Tanzania
| | - Aiwerasia V. Ngowi
- School of Public Health and Social Sciences, Department of Environmental and Occupational Health, Muhimbili University of Health and Allied Sciences (MUHAS), P.O. Box 65015, Dar es Salaam, Tanzania
| | - Leslie London
- School of Public Health & Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, South Africa
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PTEN, a negative regulator of PI3K/Akt signaling, sustains brain stem cardiovascular regulation during mevinphos intoxication. Neuropharmacology 2017; 123:175-185. [DOI: 10.1016/j.neuropharm.2017.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/03/2017] [Accepted: 06/06/2017] [Indexed: 01/06/2023]
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20
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Huang HS, Lee KW, Ho CH, Hsu CC, Su SB, Wang JJ, Lin HJ, Huang CC. Increased risk for hypothyroidism after anticholinesterase pesticide poisoning: a nationwide population-based study. Endocrine 2017; 57:436-444. [PMID: 28756521 DOI: 10.1007/s12020-017-1373-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/05/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE Previous animal studies have reported that acute anticholinesterase pesticide (organophosphate and carbamate) poisoning may affect thyroid hormones. However, there is no human study investigating the association between hypothyroidism and anticholinesterase pesticide poisoning, and therefore, we conducted a retrospective nationwide population-based cohort study to delineate this issue. METHODS We identified 10,372 anticholinesterase pesticide poisoning subjects and matched 31,116 non-anticholinesterase pesticide poisoning subjects between 2003 and 2012 from the Nationwide Poisoning Database and the Longitudinal Health Insurance Database 2000, respectively, in a 1:3 ratio by index date, age, and sex for this study. We compared the cumulative incidence of hypothyroidism between the two cohorts by following up until 2013. Independent predictors for hypothyroidism were also investigated. RESULTS In total, 75 (0.72%) anticholinesterase pesticide poisoning subjects and 184 (0.59%) non-anticholinesterase pesticide poisoning subjects were diagnosed with hypothyroidism during the follow-up. Cox proportional hazard regression analysis showed that anticholinesterase pesticide poisoning subjects had higher risk for hypothyroidism than did non-anticholinesterase pesticide poisoning subjects (adjusted hazard ratio: 1.47, 95% confidence interval: 1.11-1.95) after adjusting for age, sex, hypertension, malignancy, liver disease, renal disease, atrial fibrillation or flutter, thyroiditis, goiter, other endocrine disorders, and mental disorder. Stratified analysis showed that anticholinesterase pesticide poisoning subjects had higher risk for hypothyroidism than did non-anticholinesterase pesticide poisoning subjects in terms of the age subgroup of 40-64 years, female sex, past history of goiter, follow-up of <1 month, and anticholinesterase pesticide poisoning subjects without atropine treatment (incidence rate ratio [IRR]: 1.66, 95% confidence interval: 1.20-2.30). Female sex, malignancy, renal disease, thyroiditis, goiter, mental disorder, and anticholinesterase pesticide poisoning without atropine treatment were independent predictors for hypothyroidism. CONCLUSIONS Anticholinesterase pesticide poisoning is associated with increased risk for hypothyroidism. Early evaluation of thyroid function in anticholinesterase pesticide poisoning subjects is suggested, especially in subjects without atropine treatment, aged 40-64 years, female sex, and past history of goiter.
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Affiliation(s)
- Hung-Sheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Keng-Wei Lee
- Division of Cardiovascular Diseases, Department of Internal Medicine, Chi-Mei Medical Center, Chiali, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Shih-Bin Su
- Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Leisure, Recreation, and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Department of Medical Research, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
- Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
- Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
- Bachelor Program of Senior Service, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan.
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Razwiedani LL, Rautenbach P. Epidemiology of Organophosphate Poisoning in the Tshwane District of South Africa. ENVIRONMENTAL HEALTH INSIGHTS 2017; 11:1178630217694149. [PMID: 28469445 PMCID: PMC5345965 DOI: 10.1177/1178630217694149] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/24/2017] [Indexed: 05/24/2023]
Abstract
BACKGROUND Organophosphate poisoning is a major public health problem in South Africa. Individuals get exposed to organophosphate in both the domestic and industrial spheres. METHOD A cross-sectional study was conducted using retrospective, secondary data of organophosphate poisoning cases over a 3-year period, reported at the Tshwane District surveillance office. Data were analysed using Microsoft Excel, and Epi Info version 7 was used for descriptive statistics. RESULTS A total of 207 cases were reported with ages ranging from 10 months to 59 years. Most of the cases were men (58.9%). Intentional poisoning accounted for 51% of cases. Unintentional poisoning accounted for 21.7% of cases, and 26.5% of cases had unknown circumstances of poisoning. A significant number (50.2%) of intentional poisonings were suicide related. Nonsuicidal cases accounted for 47.4% of cases, and deliberate unlawful poisoning accounted for 2.4% of cases. The mortality rate for the whole group was 3.4%. CONCLUSIONS Improvement in data collection on organophosphate poisoning is essential to properly measure the burden of the problem. More effective regulatory controls for pesticide use are needed in South Africa.
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Affiliation(s)
- L L Razwiedani
- Department of Community Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Pgd Rautenbach
- Department of Community Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Shadboorestan A, Vardanjani HM, Abdollahi M, Goharbari MH, Khanjani N. A systematic review on human exposure to organophosphorus pesticides in Iran. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, ENVIRONMENTAL CARCINOGENESIS & ECOTOXICOLOGY REVIEWS 2016; 34:187-203. [PMID: 27333452 DOI: 10.1080/10590501.2016.1202756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Human exposure to organophosphorus (OP) pesticides is a serious health challenge. We conducted a systematic review by searching international and national databases for published literature on any human exposure to OPs in Iran from 1990 to March 2015. Qualified papers were in two categories including studies in which biomarkers of exposure were assessed (n = 13; total no. of subjects = 759) and studies that had reported prevalence of OPs-induced poisoning (OPP) and mortality (n = 26; total no. of subjects = 5428). The mean level of activity of acetyl-cholinesterase and butyryl-cholinesterase were 68.65% and 74.2%, respectively. Overall proportion (%) of OPP was estimated (16; 95% CI, 14 to 19).
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Affiliation(s)
- Amir Shadboorestan
- a Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Hossein Molavi Vardanjani
- b Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences , Kerman , Iran
| | - Mohammad Abdollahi
- a Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Mohammad Hadi Goharbari
- a Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Narges Khanjani
- c Environmental Health Engineering Research Center, Kerman University of Medical Sciences , Kerman , Iran
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Reprint of 'Evaluating organophosphate poisoning in human serum with paper'. Talanta 2015; 145:66-72. [PMID: 26459445 DOI: 10.1016/j.talanta.2015.09.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/14/2015] [Accepted: 05/22/2015] [Indexed: 11/21/2022]
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Huang HS, Hsu CC, Weng SF, Lin HJ, Wang JJ, Su SB, Huang CC, Guo HR. Acute Anticholinesterase Pesticide Poisoning Caused a Long-Term Mortality Increase: A Nationwide Population-Based Cohort Study. Medicine (Baltimore) 2015; 94:e1222. [PMID: 26222853 PMCID: PMC4554117 DOI: 10.1097/md.0000000000001222] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Acute anticholinesterase pesticide (organophosphate and carbamate) poisoning (ACPP) often produces severe complications, and sometimes death. We investigated the long-term mortality of patients with ACPP because it is not sufficiently understood. In this retrospective nationwide population-based cohort study, 818 patients with ACPP and 16,360 healthy comparisons from 1999 to 2010 were selected from Taiwan's National Health Insurance Research Database. They were followed until 2011. Ninety-four (11.5%) ACPP patients and 793 (4.9%) comparisons died (P < 0.01) during follow-up. The incidence rate ratios (IRRs) of death were 2.5 times higher in ACPP patients than in comparisons (P < 0.01). The risk of death was particularly high in the first month after ACPP (IRR: 92.7; 95% confidence interval [CI]: 45.0-191.0) and still high for ~6 months (IRR: 3.8; 95% CI: 1.9-7.4). After adjusting for age, gender, selected comorbidities, geographic area, and monthly income, the hazard ratio of death for ACPP patients was still 2.4 times higher than for comparisons. Older age (≥35 years), male gender, diabetes mellitus, coronary artery disease, hypertension, stroke, mental disorder, and lower monthly income also predicted death. ACPP significantly increased long-term mortality. In addition to early follow-up after acute treatment, comorbidity control and socioeconomic assistance are needed for patients with ACPP.
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Affiliation(s)
- Hung-Sheng Huang
- From the Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan (H-SH, C-C Hsu, H-JL, C-C Huang); Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan (H-SH, S-BS, C-C Huang); Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan (C-C Hsu, H-JL); Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan (S-FW, J-JW); Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan (S-FW); Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan (H-JL); Department of Leisure, Recreation, and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan (S-BS); Department of Medical Research, Chi Mei Medical Center, Liouying, Tainan, Taiwan (S-BS); Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C-C Huang, H-RG); Department of Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan (C-C Huang); Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan (C-C Huang); Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan (H-RG)
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Jose A, Selvakumar R, Peter JV, Karthik G, Fleming DH, Fleming JJ. Estimation of Monocrotophos renal elimination half-life in humans. Clin Toxicol (Phila) 2015; 53:629-32. [DOI: 10.3109/15563650.2015.1054500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yen TH, Chen KH, Hsu MY, Fan ST, Huang YF, Chang CL, Wang YP, Cheng CM. Evaluating organophosphate poisoning in human serum with paper. Talanta 2015; 144:189-95. [PMID: 26452809 DOI: 10.1016/j.talanta.2015.05.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/14/2015] [Accepted: 05/22/2015] [Indexed: 11/30/2022]
Abstract
This manuscript describes the development and clinical testing of a paper-based, metabolic assay designed for rapid, semi-quantitative measurement of organophosphate poisoning. Paper-based platforms, including point-of-care devices and 96-well plates, provided semi-quantitative information regarding the concentration of AchE (a biomarker for organophosphate poisoning). The paper-based 96-well-plate developed and implemented in this study was used to measure the level of organophosphate poisoning in three different clinical patients. Results were comparable to those obtained using conventional hospital methods currently considered the "gold standard". This diagnostic device offers several advantages over conventional methods, including short operating time (twice as fast as conventional methods), procedure simplicity, and reduced fabrication cost. With further commercialization efforts, the methods described in this manuscript could be applied to a wide range of potential diagnostic applications in the field.
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Affiliation(s)
- Tzung-Hai Yen
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University and School of Medicine, Taipei, Taiwan
| | - Kuan-Hung Chen
- Institute of Nanoengineering and Microsystems, National Tsing Hua University, Hsinchu, Taiwan
| | - Min-Yen Hsu
- Institute of Nanoengineering and Microsystems, National Tsing Hua University, Hsinchu, Taiwan; Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shu-Ting Fan
- Institute of Nanoengineering and Microsystems, National Tsing Hua University, Hsinchu, Taiwan
| | - Yu-Fen Huang
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Chia-Ling Chang
- Department of Nephrology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Yu-Ping Wang
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chao-Min Cheng
- Institute of Nanoengineering and Microsystems, National Tsing Hua University, Hsinchu, Taiwan.
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Gazzi EN, Sorodoc V, Jaba IM, Lionte C, Bologa C, Lupusoru CE, Lupusoru R, Sorodoc L, Petris O. Profile of adult acute cholinesterase inhibitors substances poisoning - a 30 years analysis. Open Med (Wars) 2015; 10:278-284. [PMID: 28352706 PMCID: PMC5152987 DOI: 10.1515/med-2015-0041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 03/31/2015] [Indexed: 12/02/2022] Open
Abstract
Objectives The objective of this study was to assess the pattern and outcome of acute cholinesterase inhibitors substances (CIS) poisoning cases, in a cohort from a regional tertiary care hospital. Methods cases admitted in the Toxicology Clinic of “Sf. Spiridon” Emergency Clinic Hospital Iasi, Romania between 1983 and 2013 were studied. Results a total number of 606 patients were included. The reason for exposures was intentional in 70% of cases and the commonest route of poisoning was oral in 92.2%. The highest percent of cases was females (56.4), the age group 20–29 (25.4%) and the majority (66.7%) coming from rural areas, 28.2% being agricultural workers. 36.6% of cases were severe clinical forms. Overall mortality rates were 3.8%, more than half of the death patients (65.2%) had concomitant alcohol intake. It was a significant statistical association between decrease level of serum cholinesterase on admittance and severe forms (p 0.000) and between survival and deaths groups (p 0.000). The pattern of poisoning described by our retrospective study suggests that CIS poisoning are mainly preventable. The main effective goals for prevention are restriction in free accessibility to toxic pesticides, together with sustained efforts in education concerning the life-threatening danger of pesticide poisoning.
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Affiliation(s)
- Eugen N Gazzi
- "Sf. Spiridon" Emergency Clinic Hospital, Internal Medicine and Toxicology Department, School of Medicine "Gr. T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Victorita Sorodoc
- "Sf. Spiridon" Emergency Clinic Hospital, Internal Medicine and Toxicology Department, School of Medicine "Gr. T. Popa" University of Medicine and Pharmacy, Iasi, Romania, Tel: +40728040582
| | - Irina M Jaba
- Pharmacology - Toxicology Department, Faculty of Medicine, "Gr. T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Catalina Lionte
- "Sf. Spiridon" Emergency Clinic Hospital, Internal Medicine and Toxicology Department, School of Medicine "Gr. T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Cristina Bologa
- "Sf. Spiridon" Emergency Clinic Hospital, Internal Medicine and Toxicology Department, School of Medicine "Gr. T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Catalina E Lupusoru
- Pharmacology - Toxicology Department, Faculty of Medicine, "Gr. T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Raoul Lupusoru
- Physiopathology Department, Faculty of Medicine, "Gr. T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Laurentiu Sorodoc
- "Sf. Spiridon" Emergency Clinic Hospital, Internal Medicine and Toxicology Department, School of Medicine "Gr. T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Ovidiu Petris
- "Sf. Spiridon" Emergency Clinic Hospital, Internal Medicine and Toxicology Department, School of Medicine "Gr. T. Popa" University of Medicine and Pharmacy, Iasi, Romania
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Tsai CY, Chen CH, Chang AYW, Chan JYH, Chan SHH. Upregulation of FLJ10540, a PI3K-association protein, in rostral ventrolateral medulla impairs brain stem cardiovascular regulation during mevinphos intoxication. Biochem Pharmacol 2014; 93:34-41. [PMID: 25449601 DOI: 10.1016/j.bcp.2014.10.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 10/29/2014] [Indexed: 12/15/2022]
Abstract
FLJ10540, originally identified as a microtubule-associated protein, induces cell proliferation and migration during tumorigenesis via the formation of FLJ10540-PI3K complex and enhancement of PI3K kinase activity. Interestingly, activation of PI3K/Akt cascade, leading to upregulation of nitric oxide synthase II (NOS II)/peroxynitrite signaling in the rostral ventrolateral medulla (RVLM), the brain stem site that maintains blood pressure and sympathetic vasomotor tone, mediates the impairment of brain stem cardiovascular regulation induced by the pesticide mevinphos. We evaluated the hypothesis that upregulation of FLJ10540 in the RVLM is upstream to this repertoire of signaling cascade that underpins mevinphos-induced circulatory depression. Microinjection bilaterally of mevinphos (10nmol) into the RVLM of anesthetized Sprague-Dawley rats induced a progressive hypotension that was accompanied by an increase (Phase I), followed by a decrease (Phase II) of an experimental index for baroreflex-mediated sympathetic vasomotor tone. There was augmentation in FLJ10540 mRNA in the RVLM or FLJ10540 protein in RVLM neurons, both of which were causally and temporally related to an augmentation of binding between the catalytic subunit (p110) and regulatory subunit (p85) of PI3K, phosphorylation of Akt at Thr308 site, and NOS II, superoxide or peroxynitrite level in the RVLM. Immunoneutralization of FJL10540 in the RVLM significantly antagonized those biochemical changes, and blunted the progressive hypotension and the reduced baroreflex-mediated sympathetic vasomotor tone during mevinphos intoxication. We conclude that upregulation of FLJ10540 in the RVLM elicits impairment of brain stem cardiovascular regulation that underpins circulatory depression during mevinphos intoxication via activation of PI3K/Akt/NOS II/peroxynitrite signaling cascade in the RVLM.
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Affiliation(s)
- Ching-Yi Tsai
- Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan, Republic of China
| | - Chang-Han Chen
- Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan, Republic of China
| | - Alice Y W Chang
- Institute of Physiology, National Cheng Kung University, Tainan, Taiwan, Republic of China
| | - Julie Y H Chan
- Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan, Republic of China
| | - Samuel H H Chan
- Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan, Republic of China.
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Peshin SS, Srivastava A, Halder N, Gupta YK. Pesticide poisoning trend analysis of 13 years: a retrospective study based on telephone calls at the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi. J Forensic Leg Med 2013; 22:57-61. [PMID: 24485423 DOI: 10.1016/j.jflm.2013.12.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/11/2013] [Accepted: 12/07/2013] [Indexed: 11/26/2022]
Abstract
The study was designed to analyze the incidence and pattern of pesticide poisoning calls reported to the National Poisons Information Centre (NPIC), AIIMS, New Delhi and highlight the common classes of pesticides involved in poisoning. The telephone calls received by the Centre during the thirteen year period (1999-2012) were entered into a preset proforma and then into a retrievable database. A total of 4929 calls of pesticide poisoning were recorded. The data was analyzed with respect to age, gender, mode and type of poisoning. The age ranged from 1 to 65 years with the preponderance of males (M = 62.19%, F = 37.80%). The age group mainly involved in poisoning was 18-35 years. While 59.38% calls pertained to household pesticides, 40.61% calls related to agricultural pesticides. The common mode of poisoning was intentional (64.60%) followed by accidental (34.40%) and unknown (1%). Amongst the household pesticides, the highest number of calls were due to pyrethroids (26.23%) followed by rodenticides (17.06%), organophosphates (6.26%), carbamates (4.95%) and others (4.86%). In agricultural pesticides group, the organophosphates (9.79%) ranked the first followed by, aluminium phosphide (9.65%), organochlorines (9.31%), pyrethroids (3.87%), herbicides, weedicides and fungicides (3.20%), ethylene dibromide (2.82%), and others (1.70%). The data analysis shows a high incidence of poisoning due to household pesticides as compared to agricultural pesticides, clearly emphasizing the need for creating awareness and education about proper use and implementation of prevention programmes.
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Affiliation(s)
- Sharda Shah Peshin
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India.
| | - Amita Srivastava
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Nabanita Halder
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Yogendra Kumar Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India.
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Peter JV, Thomas L, Graham PL, Moran JL, Abhilash KPP, Jasmine S, Iyyadurai R. Performance of clinical scoring systems in acute organophosphate poisoning. Clin Toxicol (Phila) 2013; 51:850-4. [PMID: 24066733 DOI: 10.3109/15563650.2013.841181] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Clinical scoring systems are used to predict mortality rate in hospitalized patients. Their utility in organophosphate (OP) poisoning has not been well studied. METHODS In this retrospective study of 396 patients, we evaluated the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the Simplified Acute Physiology Score (SAPS) II, Mortality Prediction Model (MPM) II, and the Poisoning Severity Score (PSS). Demographic, laboratory, and survival data were recorded. Receiver operating characteristic (ROC) curves were generated, and the area under the curve (AUC) was calculated to study the relationship between individual scores and mortality rate. RESULTS The mean (standard deviation) age of the patients was 31.4 (12.7) years, and at admission, their pseudocholinesterase (median, interquartile) level was 317 (222-635) U/L. Mechanical ventilation was required in 65.7% of the patients and the overall mortality rate was 13.1%. The mean (95% confidence interval) scores were as follows: APACHE-II score, 16.4 (15.5-17.3); SAPS-II, 34.4 (32.5-36.2); MPM-II score, 28.6 (25.7-31.5); and PSS, 2.4 (2.3-2.5). Overall, the AUC for mortality was significantly higher for APACHE-II (0.77) and SAPS-II (0.77) than the PSS (0.67). When patients were categorized, the AUCs were better for WHO Class II (0.71-0.82) than that for Class I compounds (0.60-0.66). For individual compounds, the AUC for APACHE-II was highest in quinalphos (0.93, n = 46) and chlorpyrifos (0.86, n = 38) and lowest in monocrotophos (0.60, n = 63). AUCs for SAPS-II and MPM-II were marginally but not significantly lower than those for APACHE-II. The PSS was generally a poorer discriminator compared to the other scoring systems across all categories. CONCLUSIONS In acute OP poisoning, the generic scoring systems APACHE-II and SAPS-II outperform the PSS. These tools may be used to predict the mortality rate in OP poisoning.
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Affiliation(s)
- J V Peter
- Medical Intensive Care Unit, Christian Medical College and Hospital , Vellore, TN , India
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Occupational neurotoxic diseases in taiwan. Saf Health Work 2012; 3:257-67. [PMID: 23251841 PMCID: PMC3521924 DOI: 10.5491/shaw.2012.3.4.257] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 09/24/2012] [Accepted: 09/24/2012] [Indexed: 11/26/2022] Open
Abstract
Occupational neurotoxic diseases have become increasingly common in Taiwan due to industrialization. Over the past 40 years, Taiwan has transformed from an agricultural society to an industrial society. The most common neurotoxic diseases also changed from organophosphate poisoning to heavy metal intoxication, and then to organic solvent and semiconductor agent poisoning. The nervous system is particularly vulnerable to toxic agents because of its high metabolic rate. Neurological manifestations may be transient or permanent, and may range from cognitive dysfunction, cerebellar ataxia, Parkinsonism, sensorimotor neuropathy and autonomic dysfunction to neuromuscular junction disorders. This study attempts to provide a review of the major outbreaks of occupational neurotoxins from 1968 to 2012. A total of 16 occupational neurotoxins, including organophosphates, toxic gases, heavy metals, organic solvents, and other toxic chemicals, were reviewed. Peer-reviewed articles related to the electrophysiology, neuroimaging, treatment and long-term follow up of these neurotoxic diseases were also obtained. The heavy metals involved consisted of lead, manganese, organic tin, mercury, arsenic, and thallium. The organic solvents included n-hexane, toluene, mixed solvents and carbon disulfide. Toxic gases such as carbon monoxide, and hydrogen sulfide were also included, along with toxic chemicals including polychlorinated biphenyls, tetramethylammonium hydroxide, organophosphates, and dimethylamine borane. In addition we attempted to correlate these events to the timeline of industrial development in Taiwan. By researching this topic, the hope is that it may help other developing countries to improve industrial hygiene and promote occupational safety and health care during the process of industrialization.
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Nagase S, Kohguchi K, Tohyama K, Watanabe M, Iwatani Y. Interference by pralidoxime (PAM) salts in clinical laboratory tests. Clin Chim Acta 2012. [PMID: 23195028 DOI: 10.1016/j.cca.2012.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Drugs sometimes alter the results of clinical laboratory tests. We examined the effects of pralidoxime (PAM) salts, a medicine used to treat organophosphorus poisoning, on clinical laboratory test results for the first time. METHODS The effects of PAM salts on glucose (GLU) measurements were examined using a point-of-care testing (POCT) meter, four self-monitoring of blood glucose (SMBG) meters, and two biochemical autoanalyzers. The effects of PAM salts on other clinical tests were also evaluated. RESULTS The addition of PAM iodide or potassium iodide, but not of PAM chloride or potassium chloride, to blood samples increased the GLU values measured by one POCT meter and 4 SMBG meters using the enzyme electrode (hydrogen peroxidase or oxygen electrode) method. On the other hand, PAM iodide or PAM chloride, but not KI or KCl, affected the values measured at 340 nm by an autoanalyzer using absorption spectrophotometry in 8 of 14 clinical laboratory tests. The absorption spectrum of PAM changed from 294 to 338 nm due to the reaction between PAM and the alkaline buffer, a component of the measuring reagents. CONCLUSIONS PAM iodide increases the GLU values measured by the enzyme electrode method, and PAM salts affected the values measured at 340 nm by absorption spectrophotometry in many other clinical test items.
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Affiliation(s)
- Sumika Nagase
- Department of Biomedical Informatics, Division of Health Sciences, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
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Chien WC, Chung CH, Jaakkola JJK, Chu CM, Kao S, Su SL, Lai CH. Risk and prognostic factors of inpatient mortality associated with unintentional insecticide and herbicide poisonings: a retrospective cohort study. PLoS One 2012; 7:e45627. [PMID: 23029146 PMCID: PMC3448651 DOI: 10.1371/journal.pone.0045627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 08/21/2012] [Indexed: 11/28/2022] Open
Abstract
Introduction Pesticide poisoning is an important public health problem worldwide. The study aimed to determine the risk of all-cause and cause-specific inpatient mortality and to identify prognostic factors for inpatient mortality associated with unintentional insecticide and herbicide pesticide poisonings. Methods We performed a retrospective cohort study of 3,986 inpatients recruited at hospitalization between 1999 and 2008 in Taiwan. We used the International Classification of Disease, 9th ed., Clinical Modification external causes of injury codes to classify poisoning agents into accidental poisoning by insecticides and herbicides. Comparisons in mortality rates were made between insecticide poisoning patients and herbicide poisoning patients by using the Cox proportional hazards models to estimate multivariable-adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs). Results There were 168 deaths during 21,583 person-days of follow-up evaluation (7.8 per 1,000 person-days). The major causes of mortality for insecticide poisonings were the toxic effect of organophosphate and coma, and the major causes of mortality for herbicide poisonings were the toxic effect of other pesticides and the toxic effect of organophosphate. The mortality for herbicide exposure was fourfold higher than that for insecticide exposure. The factors associated with inpatient mortality were herbicide poisonings (HR = 4.58, 95% CI 3.29 to 6.37) and receiving mechanical ventilation treatment (HR = 3.85, 95% CI 2.73 to 5.42). Conclusions We demonstrated that herbicides stand out as the dominant agent for poisoning-related fatalities. The control of and limiting access to herbicide agents and developing appropriate therapeutic regimens, including emergency care, should be priorities.
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Affiliation(s)
- Wu-Chien Chien
- Department of Public Health, National Defense Medical Center, No. 161, Section 6, Neihu District, Taipei City, Taiwan, Republic of China
| | - Chi-Hsiang Chung
- Graduate Institute of Life Sciences, National Defense Medical Center, No. 161, Section 6, Neihu District, Taipei City, Taiwan, Republic of China
| | - Jouni J. K. Jaakkola
- Center for Environmental and Respiratory Health Research, Institute of Health Sciences, University of Oulu, Oulu, Finland
| | - Chi-Ming Chu
- Department of Public Health, National Defense Medical Center, No. 161, Section 6, Neihu District, Taipei City, Taiwan, Republic of China
| | - Senyeong Kao
- Department of Public Health, National Defense Medical Center, No. 161, Section 6, Neihu District, Taipei City, Taiwan, Republic of China
| | - Sui-Lung Su
- Department of Public Health, National Defense Medical Center, No. 161, Section 6, Neihu District, Taipei City, Taiwan, Republic of China
| | - Ching-Huang Lai
- Department of Public Health, National Defense Medical Center, No. 161, Section 6, Neihu District, Taipei City, Taiwan, Republic of China
- * E-mail:
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Heart rate-corrected QT interval helps predict mortality after intentional organophosphate poisoning. PLoS One 2012; 7:e36576. [PMID: 22574184 PMCID: PMC3344908 DOI: 10.1371/journal.pone.0036576] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 04/10/2012] [Indexed: 01/17/2023] Open
Abstract
Introduction In this study, we investigated the outcomes for patients with intentional organophosphate poisoning. Previous reports indicate that in contrast to normal heart rate-corrected QT intervals (QTc), QTc prolongation might be indicative of a poor prognosis for patients exposed to organophosphates. Methods We analyzed the records of 118 patients who were referred to Chang Gung Memorial Hospital for management of organophosphate poisoning between 2000 and 2011. Patients were grouped according to their initial QTc interval, i.e., normal (<0.44 s) or prolonged (>0.44 s). Demographic, clinical, laboratory, and mortality data were obtained for analysis. Results The incidence of hypotension in patients with prolonged QTc intervals was higher than that in the patients with normal QTc intervals (P = 0.019). By the end of the study, 18 of 118 (15.2%) patients had died, including 3 of 75 (4.0%) patients with normal QTc intervals and 15 of 43 (34.9%) patients with prolonged QTc intervals. Using multivariate-Cox-regression analysis, we found that hypotension (OR = 10.930, 95% CI = 2.961–40.345, P = 0.000), respiratory failure (OR = 4.867, 95% CI = 1.062–22.301, P = 0.042), coma (OR = 3.482, 95% CI = 1.184–10.238, P = 0.023), and QTc prolongation (OR = 7.459, 95% CI = 2.053–27.099, P = 0.002) were significant risk factors for mortality. Furthermore, it was revealed that non-survivors not only had longer QTc interval (503.00±41.56 versus 432.71±51.21 ms, P = 0.002), but also suffered higher incidences of hypotension (83.3 versus 12.0%, P = 0.000), shortness of breath (64 versus 94.4%, P = 0.010), bronchorrhea (55 versus 94.4%, P = 0.002), bronchospasm (50.0 versus 94.4%, P = 0.000), respiratory failure (94.4 versus 43.0%, P = 0.000) and coma (66.7 versus 11.0%, P = 0.000) than survivors. Finally, Kaplan-Meier analysis demonstrated that cumulative mortality was higher among patients with prolonged QTc intervals than among those with normal QTc intervals (Log-rank test, Chi-square test = 20.36, P<0.001). Conclusions QTc interval helps predict mortality after intentional organophosphate poisoning.
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Abd El-bar M, Sawaby R. A preliminary investigation of insect colonization and succession on remains of rabbits treated with an organophosphate insecticide in El-Qalyubiya Governorate of Egypt. Forensic Sci Int 2011; 208:e26-30. [DOI: 10.1016/j.forsciint.2010.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 09/18/2010] [Accepted: 10/06/2010] [Indexed: 12/01/2022]
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Peter JV, Jerobin J, Nair A, Bennett A, Samuel P, Chrispal A, Abraham OC, Mathews KP, Fleming JJ, Oommen A. Clinical profile and outcome of patients hospitalized with dimethyl and diethyl organophosphate poisoning. Clin Toxicol (Phila) 2010; 48:916-23. [DOI: 10.3109/15563650.2010.528425] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Dawson AH, Eddleston M, Senarathna L, Mohamed F, Gawarammana I, Bowe SJ, Manuweera G, Buckley NA. Acute human lethal toxicity of agricultural pesticides: a prospective cohort study. PLoS Med 2010; 7:e1000357. [PMID: 21048990 PMCID: PMC2964340 DOI: 10.1371/journal.pmed.1000357] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 09/15/2010] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND agricultural pesticide poisoning is a major public health problem in the developing world, killing at least 250,000-370,000 people each year. Targeted pesticide restrictions in Sri Lanka over the last 20 years have reduced pesticide deaths by 50% without decreasing agricultural output. However, regulatory decisions have thus far not been based on the human toxicity of formulated agricultural pesticides but on the surrogate of rat toxicity using pure unformulated pesticides. We aimed to determine the relative human toxicity of formulated agricultural pesticides to improve the effectiveness of regulatory policy. METHODS AND FINDINGS we examined the case fatality of different agricultural pesticides in a prospective cohort of patients presenting with pesticide self-poisoning to two clinical trial centers from April 2002 to November 2008. Identification of the pesticide ingested was based on history or positive identification of the container. A single pesticide was ingested by 9,302 patients. A specific pesticide was identified in 7,461 patients; 1,841 ingested an unknown pesticide. In a subset of 808 patients, the history of ingestion was confirmed by laboratory analysis in 95% of patients. There was a large variation in case fatality between pesticides-from 0% to 42%. This marked variation in lethality was observed for compounds within the same chemical and/or WHO toxicity classification of pesticides and for those used for similar agricultural indications. CONCLUSION the human data provided toxicity rankings for some pesticides that contrasted strongly with the WHO toxicity classification based on rat toxicity. Basing regulation on human toxicity will make pesticide poisoning less hazardous, preventing hundreds of thousands of deaths globally without compromising agricultural needs. Ongoing monitoring of patterns of use and clinical toxicity for new pesticides is needed to identify highly toxic pesticides in a timely manner.
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Affiliation(s)
- Andrew H Dawson
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
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Akdur O, Durukan P, Ozkan S, Avsarogullari L, Vardar A, Kavalci C, Ikizceli I. Poisoning severity score, Glasgow coma scale, corrected QT interval in acute organophosphate poisoning. Hum Exp Toxicol 2010; 29:419-25. [PMID: 20203133 DOI: 10.1177/0960327110364640] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate effectiveness of the poisoning severity score (PSS), Glasgow coma scale (GCS), and corrected QT (QTc) interval in predicting outcomes in acute organophosphates (OP) poisoning. Over a period of 2 years, 62 patients with OP poisoning were admitted to emergency department (ED) of Erciyes University Medical School Hospital. The age, sex, cause of contact, compound involved, time elapsed between exposure and admission to the ED, duration of hospital stay, and cardiac manifestations at the time of presentation were recorded. GCS and poisoning severity score (PSS) was calculated for each patient. Electrocardiogram (ECG) analysis included the rate, rhythm, ST-T abnormalities, conduction defects, and measurement of PR and QT intervals. Sixty-two patients with OP poisoning presented to our ED from January 2007 to December 2008 from which 54 patients were included in the study. The mean age was 34.1 +/- 14.8 years. Of the cases, 53.7% were female. Twenty-six patients had a prolonged QTc interval. Mean PSS of men and women was 1.8 +/- 1.0. No statistically significant correlation was found between the PSS and QTc intervals of the cases. A significant correlation was determined between the GCS and PSS of grade 3 and grade 4 cases. GCS is a parameter that helps clinician to identify advanced grade OP poisoning patients in the initial assessment in the ED. However, ECG findings, such as prolonged QTc interval, are not effective in determination of short-term prognosis and show no relationship with PSS.
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Affiliation(s)
- Okhan Akdur
- Canakkale Onsekiz Mart University Faculty of Medicine, Department of Emergency Medicine, Canakkale, Turkey.
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Eddleston M, Worek F, Eyer P, Thiermann H, Von Meyer L, Jeganathan K, Sheriff MHR, Dawson AH, Buckley NA. Poisoning with the S-Alkyl organophosphorus insecticides profenofos and prothiofos. QJM 2009; 102:785-92. [PMID: 19737786 PMCID: PMC2766103 DOI: 10.1093/qjmed/hcp119] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many organophosphorus (OP) insecticides have either two O-methyl or two O-ethyl groups attached to the phosphorus atom. This chemical structure affects their responsiveness to oxime-induced acetylcholinesterase (AChE) reactivation after poisoning. However, several OP insecticides are atypical and do not have these structures. AIM We aimed to describe the clinical course and responsiveness to therapy of people poisoned with two S-alkyl OP insecticides-profenofos and prothiofos. DESIGN We set up a prospective cohort of patients with acute profenofos or prothiofos self-poisoning admitted to acute medical wards in two Sri Lankan district hospitals. Clinical observation was carried out throughout their inpatient stay; blood samples were taken in a subgroup for assay of cholinesterases and insecticide. RESULTS Ninety-five patients poisoned with profenofos and 12 with prothiofos were recruited over 5 years. Median time to admission was 4 (IQR 3-7) h. Eleven patients poisoned with profenofos died (11/95; 11.6%, 95% CI 5.9-20); one prothiofos patient died (1/12; 8.3%, 95% CI 0.2-38). Thirteen patients poisoned with profenofos required intubation for respiratory failure (13/95; 13.7%, 95% CI 7.5-22); two prothiofos-poisoned patients required intubation. Both intubations and death occurred late compared with other OP insecticides. Prolonged ventilation was needed in those who survived-a median of 310 (IQR 154-349) h. Unexpectedly, red cell AChE activity on admission did not correlate with clinical severity-all patients had severe AChE inhibition (about 1% of normal) but most had only mild cholinergic features, were conscious, and did not require ventilatory support. CONCLUSION Compared with other commonly used OP insecticides, profenofos and prothiofos are of moderately severe toxicity, causing relatively delayed respiratory failure and death. There was no apparent response to oxime therapy. The lack of correlation between red cell AChE activity and clinical features suggests that this parameter may not always be a useful marker of synaptic AChE activity and severity after OP pesticide poisoning.
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Affiliation(s)
- M Eddleston
- National Poisons Information Service, Royal Infirmary of Edinburgh, Edinburgh, UK.
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