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Ragab HE, El-Banna A, Elshaer NS, Azzaz O. L-carnitine: A novel approach in management of acute cholinesterase inhibitor insecticide poisoning. Toxicol Res (Camb) 2024; 13:tfae104. [PMID: 38993484 PMCID: PMC11234197 DOI: 10.1093/toxres/tfae104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/17/2024] [Accepted: 07/02/2024] [Indexed: 07/13/2024] Open
Abstract
Cholinesterase inhibitors (ChEIs) insecticide poisoning is a serious global health concern that results in hundreds of thousands of fatalities each year. Although inhibition of the cholinesterase enzyme is the main mechanism of ChEI poisoning, oxidative stress is considered the mechanism underlying the related complications. The study aimed to assess the oxidative status of the patients with ChEI insecticide poisoning and the role of L-carnitine as adjuvant therapy in their management. Human studies on the efficacy and safety of L-carnitine in treating insecticide poisoning are limited despite its growing research interest as a safe antioxidant. This prospective study was conducted on eighty patients with acute ChEIs insecticide poisoning admitted to Alexandria Poison Center, Alexandria Main University Hospital, Egypt. Patients were allocated into two equal groups randomly. The L-carnitine (LC) group received the conventional treatment (atropine & toxogonin) and LC and the standard treatment (ST) group received the standard treatment only. Outcome measures were fatality rate, the total administered dose of atropine & toxogonin, length of hospital stay, and the requirement for ICU admission or mechanical ventilation. The study results revealed that malondialdehyde (MDA) significantly decreased in the LC group. Cholinesterase enzyme levels increased significantly after treatment in the LC group than in the ST group. The LC group needed lower dosages of atropine and toxogonin than the ST group. Also, the LC group showed no need for ICU admission or mechanical ventilation. The study concluded that LC can be considered a promising adjuvant antioxidant treatment in acute ChEIs pesticide poisoning.
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Affiliation(s)
- Hisham Elsayed Ragab
- Professor of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University Champollion street, Al Mesallah Sharq, Qesm Al Attarin, Alexandria 21521, Egypt
| | - Asmaa El-Banna
- Professor of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University Champollion street, Al Mesallah Sharq, Qesm Al Attarin, Alexandria 21521, Egypt
| | - Noha Selim Elshaer
- Assistant Professor of Industrial Medicine and Occupational Health, Department of Community Medicine, Faculty of Medicine, Alexandria University Champollion street, Al Mesallah Sharq, Qesm Al Attarin, Alexandria 21521, Egypt
| | - Omnia Azzaz
- Assistant Lecturer in Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Alexandria University Champollion street, Al Mesallah Sharq, Qesm Al Attarin, Alexandria 21521, Egypt
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Eizadi-Mood N, Mahvari R, Akafzadeh Savari M, Mohammadbeigi E, Feizi A, Mirmoghtadaei P, Sami R, Meamar R. Acute pesticide poisoning in the central part of Iran: A 4-year cross-sectional study. SAGE Open Med 2023; 11:20503121221147352. [PMID: 36778200 PMCID: PMC9909076 DOI: 10.1177/20503121221147352] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/07/2022] [Indexed: 02/10/2023] Open
Abstract
Objectives Intoxication with pesticides is a well-known public health problem. We aimed to describe the demographic and toxico-clinical characteristics and outcomes of patients with pesticide poisoning. Methods This retrospective cross-sectional study was performed in Khorshid Hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. All patients with pesticide poisoning (insecticides, herbicides, fungicides, rodenticides, and acaricides) were evaluated. The patients' demographic, toxicological, clinical, and laboratory findings from March 2016 until March 2021 were collected and analyzed. Results During the study period, 25,659 patients with acute poisoning were admitted, of which, 1567 (6.1% of the total poisoning) with pesticide poisoning were included. The mean ± SD age of the patients was 31.34 ± 13.7 years and 55.3% were men (male/female ratio = 1.23). In approximately 75% of the patients, poisoning occurred by suicidal attempts, while in 14.3% (n = 224), it was accidental. Insecticides caused about 51.30% of the poisonings. However, rodenticides were most commonly used in completed suicide attempts (79.9%). The frequency of previously attempted suicide, and self-harming was different among the patients with respect to the type of pesticide poisoning (p < 0.05). Previous suicidal attempts (35.3%) and self-harming (17.3%) were reported more in patients poisoned with the combination of pesticides. Half of the patients were employed. Nausea and vomiting (56.7%, n = 889) were the most common clinical manifestations; 8.3% (n = 130) of the patients died, 64 of whom had rodenticide poisoning. Conclusion The prevalence of pesticide poisoning was relatively low; most were insecticide poisoning. Poisoning occurred most through attempted suicide. Rodenticides and herbicides had higher mortality rates than other pesticides. Patients with previously attempted suicide and self-harming behavior may use a combination of pesticides.
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Affiliation(s)
- Nastaran Eizadi-Mood
- Department of Clinical Toxicology, School of Medicine, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Razieh Mahvari
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Akafzadeh Savari
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ehsan Mohammadbeigi
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Ramin Sami
- Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rokhsareh Meamar
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,Rokhsareh Meamar, Isfahan Clinical Toxicology Research Center, Khorshid Hospital, Ostandari Street, Hasht Behest Avenue, Isfahan 8618774571, Iran.
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Joubert BR, Mantooth SN, McAllister KA. Environmental Health Research in Africa: Important Progress and Promising Opportunities. Front Genet 2020; 10:1166. [PMID: 32010175 PMCID: PMC6977412 DOI: 10.3389/fgene.2019.01166] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 10/23/2019] [Indexed: 12/16/2022] Open
Abstract
The World Health Organization in 2016 estimated that over 20% of the global disease burden and deaths were attributed to modifiable environmental factors. However, data clearly characterizing the impact of environmental exposures and health endpoints in African populations is limited. To describe recent progress and identify important research gaps, we reviewed literature on environmental health research in African populations over the last decade, as well as research incorporating both genomic and environmental factors. We queried PubMed for peer-reviewed research articles, reviews, or books examining environmental exposures and health outcomes in human populations in Africa. Searches utilized medical subheading (MeSH) terms for environmental exposure categories listed in the March 2018 US National Report on Human Exposure to Environmental Chemicals, which includes chemicals with worldwide distributions. Our search strategy retrieved 540 relevant publications, with studies evaluating health impacts of ambient air pollution (n=105), indoor air pollution (n = 166), heavy metals (n = 130), pesticides (n = 95), dietary mold (n = 61), indoor mold (n = 9), per- and polyfluoroalkyl substances (PFASs, n = 0), electronic waste (n = 9), environmental phenols (n = 4), flame retardants (n = 8), and phthalates (n = 3), where publications could belong to more than one exposure category. Only 23 publications characterized both environmental and genomic risk factors. Cardiovascular and respiratory health endpoints impacted by air pollution were comparable to observations in other countries. Air pollution exposures unique to Africa and some other resource limited settings were dust and specific occupational exposures. Literature describing harmful health effects of metals, pesticides, and dietary mold represented a context unique to Africa. Studies of exposures to phthalates, PFASs, phenols, and flame retardants were very limited. These results underscore the need for further focus on current and emerging environmental and chemical health risks as well as better integration of genomic and environmental factors in African research studies. Environmental exposures with distinct routes of exposure, unique co-exposures and co-morbidities, combined with the extensive genomic diversity in Africa may lead to the identification of novel mechanisms underlying complex disease and promising potential for translation to global public health.
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Affiliation(s)
- Bonnie R Joubert
- National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, United States
| | | | - Kimberly A McAllister
- National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, United States
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Ssemugabo C, Nalinya S, Halage AA, Neebye RM, Musoke D, Jørs E. Doctors experiences on the quality of care for pesticide poisoning patients in hospitals in Kampala, Uganda: a qualitative exploration using donabedian's model. BMC Health Serv Res 2020; 20:30. [PMID: 31918695 PMCID: PMC6953287 DOI: 10.1186/s12913-020-4891-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/06/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pesticides are responsible for a significant percentage of deaths globally with majority occurring in sub-Saharan Africa. Deaths due to pesticide poisoning can be reduced if poisoning cases are managed optimally. However, the quality of care given to pesticide poisoning patients is still insufficient especially in sub-Saharan Africa. This study was aimed at exploring doctors' experiences on quality of care for pesticide poisoning cases in hospitals in Kampala, Uganda. METHODS Fifteen (15) in-depth interviews were conducted with doctors who were directly involved in management of pesticide poisoning patients in the accident and emergency, Medicine, Pediatrics and Intensive Care Unit wards in 5 hospitals in Kampala, Uganda. All interviews were transcribed and subjected to directed content analysis with the guidance of the Donabedian model of quality of care which emphasizes structure, process and outcome measures as pertinent to ensuring quality of care. RESULTS Doctors reported structural, process and outcome facets that support diagnosis and treatment of pesticide poisoning cases that improved the quality of care they provided. Among the structures includes hospital units such as Intensive Care Unit (ICU), pediatrics and internal medicine; equipment and clinical guidelines such as airway, breathing and consciousness (ABC) protocol; and doctors' knowledge and experiences. Doctors relied on history, and signs and symptoms to establish the cause and severity of pesticide poisoning. However, some patients and caretakers provided inaccurate pesticide poisoning history. Due to its availability in hospitals, doctors largely relied on atropine to manage pesticide poisoning cases whether or not relevant to treat the actual pesticide active ingredient responsible for the poisoning. Although majority of the cases treated recovered, those due to suicide were further referred to the hospital psychiatrist. Sharing experiences of managing pesticide poisoning patients among health workers and engaging in sensitization outreaches against pesticide poisoning were reported as potential activities to improve quality of care for pesticide poisoning patients. CONCLUSION Doctors reflected on the structure, process and outcome measures of quality of care given to pesticide poisoning patients. The implications of hospital structures and clinical process to the quality of the outcomes of care demonstrates their importance in improving management of pesticide poisoning cases in hospitals in Kampala, Uganda.
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Affiliation(s)
- Charles Ssemugabo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Sarah Nalinya
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Abdullah Ali Halage
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Ruth Mubeezi Neebye
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Erik Jørs
- Department of Occupational and Environmental Medicine, Odense University Hospital, Sdr, Boulevard 29, DK-5000 Odense C, Denmark
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de la Fuente J, Contreras M, Kasaija PD, Gortazar C, Ruiz-Fons JF, Mateo R, Kabi F. Towards a Multidisciplinary Approach to Improve Cattle Health and Production in Uganda. Vaccines (Basel) 2019; 7:vaccines7040165. [PMID: 31683596 PMCID: PMC6963272 DOI: 10.3390/vaccines7040165] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 10/25/2019] [Accepted: 10/30/2019] [Indexed: 12/13/2022] Open
Abstract
A meeting and course supported by the Vice-Presidency for International Affairs of the Spanish National Research Council (CSIC) and the National Agricultural Research Organization of Uganda (NARO) were held at the National Livestock Resources Research Institute (NaLIRRI) in Nakyesasa, Wakiso, Uganda on September 2–9, 2019. The activities were conducted within the collaboration program between the Institute of Game and Wildlife Research (IREC, CSIC-UCLM-JCCM, Spain) and NARO for the development of vaccines and other interventions for the control of cattle ticks in Uganda.
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Affiliation(s)
- José de la Fuente
- SaBio, Instituto de Investigación en Recursos Cinegéticos (IREC), Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Castilla-La Mancha (UCLM)-Junta de Comunidades de Castilla-La Mancha (JCCM), Ronda de Toledo s/n, 13005 Ciudad Real, Spain.
- Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK 74078, USA.
| | - Marinela Contreras
- SaBio, Instituto de Investigación en Recursos Cinegéticos (IREC), Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Castilla-La Mancha (UCLM)-Junta de Comunidades de Castilla-La Mancha (JCCM), Ronda de Toledo s/n, 13005 Ciudad Real, Spain.
| | - Paul D Kasaija
- SaBio, Instituto de Investigación en Recursos Cinegéticos (IREC), Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Castilla-La Mancha (UCLM)-Junta de Comunidades de Castilla-La Mancha (JCCM), Ronda de Toledo s/n, 13005 Ciudad Real, Spain.
- National Livestock Resources Research Institute (NaLIRRI/NARO), Kampala 5704, Uganda.
| | - Christian Gortazar
- SaBio, Instituto de Investigación en Recursos Cinegéticos (IREC), Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Castilla-La Mancha (UCLM)-Junta de Comunidades de Castilla-La Mancha (JCCM), Ronda de Toledo s/n, 13005 Ciudad Real, Spain.
| | - Jose F Ruiz-Fons
- SaBio, Instituto de Investigación en Recursos Cinegéticos (IREC), Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Castilla-La Mancha (UCLM)-Junta de Comunidades de Castilla-La Mancha (JCCM), Ronda de Toledo s/n, 13005 Ciudad Real, Spain.
| | - Rafael Mateo
- SaBio, Instituto de Investigación en Recursos Cinegéticos (IREC), Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Castilla-La Mancha (UCLM)-Junta de Comunidades de Castilla-La Mancha (JCCM), Ronda de Toledo s/n, 13005 Ciudad Real, Spain.
| | - Fredrick Kabi
- National Livestock Resources Research Institute (NaLIRRI/NARO), Kampala 5704, Uganda.
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Kwesiga B, Ario AR, Bulage L, Harris J, Zhu BP. Fatal cases associated with eating chapatti contaminated with organophosphate in Tororo District, Eastern Uganda, 2015: case series. BMC Public Health 2019; 19:767. [PMID: 31208431 PMCID: PMC6580625 DOI: 10.1186/s12889-019-7143-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few cases of organophosphate poisoning in developing countries have been investigated using clinical and epidemiological methods. On 30 October 2015, 3 students at Mukuju School, Tororo District, Uganda, died soon after eating chapatti (locally-made flat bread) from the same food stand. Ministry of Health investigated to identify the cause and recommend prevention measures. METHODS We defined a case as onset during 30-31 October 2015 in a resident of Mukuju Town of ≥1 of the following symptoms: excessive saliva, profuse sweating, dizziness, low blood pressure, constricted pupils or loss of consciousness. We reviewed medical/police records and interviewed survivors, healthcare workers, and police officers. We collected samples of implicated food for toxicological analysis. Autopsies were performed on decedents to identify the cause of death. RESULTS We identified 7 cases with 3 deaths (case-fatality ratio = 43%). Clinical manifestations included acute onset of confusion (100%), constricted pupils (43%), excessive saliva (43%), and low blood pressure (43%). All 7 cases had onset from 16:00-18:00 h on 30 October, with a point-source exposure pattern. Of the 7 cases, 86% (6/7) were men; the mean age was 24 (range: 20-32) years. The 3 decedents each ate a whole chapatti while the other 4 cases ate half or less. Autopsy findings of the 3 decedents indicated organophosphate poisoning. Toxicological analysis found high levels of malathion in leftover foods (266 mg/L in dough and 258 mg/L in chapatti) and malaoxon (a highly toxic malathion derivative) in decedents' postmortem specimens (mean levels of 19 mg/L in the blood and 22 mg/L in the gastric contents). There was a delay of 4 h before the patients received appropriate treatment. Police investigations revealed that flour used to make the chapatti was intentionally contaminated with an organophosphate pesticide. CONCLUSION This fatal outbreak of organophosphate poisoning was associated with consumption of roadside-vended chapatti made of flour contaminated with pesticide. Clinicians should be aware of symptoms of organophosphate poisoning and prepared to treat it quickly. Street vendors should carefully consider the source of their ingredients. An in-depth surveillance review of such poisonings in Uganda would guide policymakers in reducing access by criminals and accidental exposures for the public.
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Affiliation(s)
- Benon Kwesiga
- Uganda Public Health Fellowship Program, Ministry of Health, P.O. Box 7272, Kampala, Uganda.
| | - Alex R Ario
- Uganda Public Health Fellowship Program, Ministry of Health, P.O. Box 7272, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Ministry of Health, P.O. Box 7272, Kampala, Uganda
| | - Julie Harris
- Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bao-Ping Zhu
- United States Centres for Disease Control and Prevention, Kampala, Uganda.,Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
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Palkhade R, Yadav S, Mishra S, Muhamed J. Acute oral toxicity of pesticide combination (acephate 50% and imidacloprid 1.8% as active ingredients) in Sprague-Dawley rats. Vet World 2018; 11:1291-1297. [PMID: 30410236 PMCID: PMC6200575 DOI: 10.14202/vetworld.2018.1291-1297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/01/2018] [Indexed: 12/21/2022] Open
Abstract
Aim The aim of this study was to assess the acute toxic interaction and lethal dose (LD50) of pesticide combination product (acephate 50% and imidacloprid 1.8% as active ingredients) available in the market in Sprague-Dawley female rats by oral route. Materials and Methods A total of 10 Sprague-Dawley female rats were divided into two groups, comprising five rats in each dose group. Both groups were identified as control and test groups, respectively. Control group received sterile water as vehicle and test group received pesticide combination (acephate 50% and imidacloprid 1.8% as active ingredients) at a dose of 0 and 2000 mg/kg body weight. As per the Organization for Economic Cooperation and Development Guideline 420, initially one animal each from both the control and test groups were dosed with 0 and 2000 mg/kg, respectively, as sighting study. Based on the results of sighting study, additionally, four animals each from both groups were dosed with the same dose to make a total of five animals in each group. Dose volume was constant as 10 mL/kg. All animals were observed daily twice for clinical signs and mortality. Body weight was recorded on day 0 and weekly thereafter during 14 days' observation period; last body weight (fasted) was recorded on day 15. All the rats of both the groups were humanely sacrificed on day 15 for gross pathology, collection of organs for histopathology, organ weighing, and morphometry. Organ weights were taken as absolute values, and relative organ weights to last fasted body weights were calculated. Results Pesticide combination (acephate 50% and imidacloprid 1.8% as active ingredients) treated rats showed cholinergic signs with one mortality in the test group. No significant difference was observed in body weight, relative organ weights, and organ morphometry between pesticide combination exposed and non-exposed groups. Gross pathology of the treated rats was also comparable with respect to control group. Histopathological changes in the liver, kidneys, heart, lung, adrenaline, spleen, and ovaries of test group rats were found to be comparable with control group rats. Conclusion The present study demonstrated the LD50 of one of the combination products available in the market having acephate 50% and imidacloprid 1.8% as active ingredients in Sprague-Dawley female rats which is >2000 mg/kg body weight. Furthermore, gross, histopathology and histoarchitectural alterations of all the vital organs of the test group were comparable to the control.
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Affiliation(s)
- Rajendra Palkhade
- Laboratory Animal Facility, ICMR-National Institute of Occupational Health, Ahmedabad, Gujarat, India
| | - Suresh Yadav
- Toxicology Division, ICMR-National Institute of Occupational Health, Ahmedabad, Gujarat, India
| | - SukhDev Mishra
- Biostatistics and Data Management Division, ICMR-National Institute of Occupational Health, Ahmedabad, Gujarat, India
| | - Jaseer Muhamed
- Poison Information Center, ICMR-National Institute of Occupational, Ahmedabad, Gujarat, India
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