Paraquat intoxication in subjects who attempt suicide: why they chose paraquat

Exploring Metabolic and Gut Microbiome Responses to Paraquat Administration in Male Wistar Rats: Implications for Oxidative Stress

In this study, we examined the metabolic and gut microbiome responses to paraquat (PQ) in male Wistar rats, focusing on oxidative stress effects. Rats received a single intraperitoneal injection of PQ at 15 and 30 mg/kg, and various oxidative stress parameters (i.e., MDA, SOD, ROS, 8-isoprostanes) were assessed after three days. To explore the omic profile, GC-qTOF and UHPLC-qTOF were performed to assess the plasma metabolome; 1H-NMR was used to assess the urine metabolome; and shotgun metagenomics sequencing was performed to study the gut microbiome. Our results revealed reductions in body weight and tissue changes, particularly in the liver, were observed, suggesting a systemic effect of PQ. Elevated lipid peroxidation and reactive oxygen species levels in the liver and plasma indicated the induction of oxidative stress. Metabolic profiling revealed changes in the tricarboxylic acid cycle, accumulation of ketone body, and altered levels of key metabolites, such as 3-hydroxybutyric acid and serine, suggesting intricate links between energy metabolism and redox reactions. Plasma metabolomic analysis revealed alterations in mitochondrial metabolism, nicotinamide metabolism, and tryptophan degradation. The gut microbiome showed shifts, with higher PQ doses influencing microbial populations (e.g., Escherichia coli and Akkermansia muciniphila) and metagenomic functions (pyruvate metabolism, fermentation, nucleotide and amino acid biosynthesis). Overall, this study provides comprehensive insights into the complex interplay between PQ exposure, metabolic responses, and gut microbiome dynamics. These findings enhance our understanding of the mechanisms behind oxidative stress-induced metabolic alterations and underscore the connections between xenobiotic exposure, gut microbiota, and host metabolism.

Ferulic acid grafted into β-cyclodextrin nanosponges ameliorates Paraquat-induced human MRC-5 fibroblast injury

Paraquat (PQ) is a commercially important and effective herbicide in the world. Nevertheless, it has higher toxicity causing acute organ damage and different complications, mainly in the lungs and kidneys. Ferulic acid (FA), 4-hydroxy-3-methoxycinnamic acid imposes multiple pharmacological impacts. No protective effect of FA on PQ poisoning-caused human embryonic lung fibroblast damage has not been reported. Despite their many beneficial effects, FA is characterized by poor water solubility, low bioavailability, and phytochemical instability. To solve the problem, β-cyclodextrin nanosponge (β-CD NSs) was utilized to increase the solubility of FA so that it was grafted into β-CD NSs to establish β-CD@FA NSs. The purpose of this work was to examine for the first time the protective effect of β-CD@FA NS on MRC-5 human lung cells damages induced by PQ poisoning. MTS assay was performed to investigate the viability of MRC-5 cells at different concentrations of FA/β-CD@FA NSs when cells were co-cultured with 0.2 μg/mL PQ. The flow cytometry study was carried out to determine apoptosis. Malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT) levels were detected using appropriate biochemistry kits. Compared with the PQ group, the cell activity, CAT, and SOD levels were significantly increased in the FA and chiefly in β-CD@FA NSs intervention groups, whereas apoptosis and MDA levels were markedly decreased. The inflammatory factors tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), and interleukin 22 (IL-22) were detected. The results demonstrate that β-CD@FA NSs can inhibit PQ-induced cell damage by enhancing antioxidant stress capacity and regulation of inflammatory responses.

Protective effects of natural compounds against paraquat-induced pulmonary toxicity: the role of the Nrf2/ARE signaling pathway

Paraquat (PQ) is a toxic herbicide to humans. Once absorbed, it accumulates in the lungs. PQ has been well documented that the generation of reactive oxygen species (ROS) is the main mechanism of its toxicity. Oxidative damage of PQ in lungs is represented as generation of cytotoxic and fibrotic mediators, interruption of epithelial and endothelial barriers, and inflammatory cell infiltration. No effective treatment for PQ toxicity is currently available. Several studies have shown that natural compounds (NCs) have the potential to alleviate PQ-induced pulmonary toxicity, due to their antioxidant and anti-inflammatory effects. NCs function as protective agents through stimulation of nuclear factor erythroid 2-related factor 2 (Nrf2)/antioxidant response element (ARE) signaling pathways. Elevation of Nrf2 levels leads to the expression of its downstream enzymes such as SOD, CAT, and HO-1. The hypothesized role of the Nrf2/ARE signaling pathway as the protective mechanism of NCs against PQ-induced pulmonary toxicity is reviewed.

Sciadopitysin mitigates spermatological and testicular damage instigated by paraquat administration in male albino rats

Paraquat (PQ) is a herbicide that has ability to induce testicular toxicity by producing reactive oxygen species (ROS). Sciadopitysin (SPS) is a promising flavonoid that displays multiple pharmacological properties i.e., anti-inflammatory, anti-oxidant and anti-apoptotic. Therefore, the present study was designed to evaluate the mitigative role of SPS against PQ induced testicular toxicity in male rats. The experiment was performed on male albino rats (n = 48) that were divided into 4 groups. The group-1 was control group. Group-2 was administrated orally with PQ (5 mg/kg). Group-3 was administrated orally with PQ (5 mg/kg) and SPS (2 mg/kg). Group-4 was supplemented with SPS (2 mg/kg) through oral gavage. The experiment was conducted for 56 days. The exposure to PQ significantly lowered the activities of catalase (CAT), glutathione reductase (GSR), superoxide dismutase (SOD) as well as glutathione peroxidase (GPx). Whereas, a substantial increase was observed in dead sperms number, abnormalities in the tail, head as well as midpiece of sperms in PQ intoxicated rats. Moreover, a significant increase in the level of ROS and malondialdehyde (MDA) was noticed in PQ administrated group. Furthermore, steroidogenic enzymes expression was significantly decreased in PQ-intoxicated group, whereas the level of inflammatory markers was increased in PQ administrated rats. Besides, the expression of apoptotic markers was significantly escalated in PQ exposed rats, whereas the expression of anti-apoptotic markers was considerably reduced. A significant reduction in hormonal level was also noticed in the rats that were administrated with PQ. Moreover, the histopathological examination revealed that PQ significantly damaged the testicles. However, the supplementation of SPS with PQ significantly reduced the adverse effects of PQ in the testes of albino rats. Therefore, the current investigation demonstrated that SPS possesses a significant potential to avert PQ-induced testicular dysfunction due to its anti-apoptotic, androgenic, anti-oxidant and anti-inflammatory nature.

Gene deletion of long-chain acyl-CoA synthetase 4 attenuates xenobiotic chemical-induced lung injury via the suppression of lipid peroxidation

Long-chain acyl-CoA synthetase (ACSL) 4 converts polyunsaturated fatty acids (PUFAs) into their acyl-CoAs and plays an important role in maintaining PUFA-containing membrane phospholipids. Here we demonstrated decreases in various kinds of PUFA-containing phospholipid species in ACSL4-deficient murine lung. We then examined the effects of ACSL4 gene deletion on lung injury by treating mice with two pulmonary toxic chemicals: paraquat (PQ) and methotrexate (MTX). The results showed that ACSL4 deficiency attenuated PQ-induced acute lung lesion and decreased mortality. PQ-induced lung inflammation and neutrophil migration were also suppressed in ACSL4-deficient mice. PQ administration increased the levels of phospholipid hydroperoxides in the lung, but ACSL4 gene deletion suppressed their increment. We further found that ACSL4 deficiency attenuated MTX-induced pulmonary fibrosis. These results suggested that ACSL4 gene deletion might confer protection against pulmonary toxic chemical-induced lung injury by reducing PUFA-containing membrane phospholipids, leading to the suppression of lipid peroxidation. Inhibition of ACSL4 may be promising for the prevention and treatment of chemical-induced lung injury.

Inhibition of soluble epoxide hydrolase reduces paraquat neurotoxicity in rodents

Given the paucity of research surrounding the effect of chronic paraquat on striatal neurotoxicity, there is a need for further investigation into the neurotoxic effects of paraquat in mouse striatum. Furthermore, while previous studies have shown that inhibiting soluble epoxide hydrolase mitigates MPTP-mediated endoplasmic reticulum stress in mouse striatum, its effect on paraquat toxicity is still unknown. Thus, this study attempts to observe changes in inflammatory and endoplasmic reticulum stress markers in mouse striatum following chronic paraquat administration to determine whether inhibiting soluble epoxide hydrolase mitigates paraquat-induced neurotoxicity and whether it can reduce TLR4-mediated inflammation in primary astrocytes and microglia. Our results show that while the pro-inflammatory effect of chronic paraquat is small, there is a significant induction of inflammatory and cellular stress markers, such as COX2 and CHOP, that can be mitigated through a prophylactic administration of a soluble epoxide hydrolase inhibitor.

β-Cyclodextrin/Azobenzene Microspheres Loaded with Paraquat Are Safe and Effective

Although paraquat is a widely used herbicide, it is toxic to humans if ingested or absorbed through an open wound. To improve the safety of paraquat, a new formulation of paraquat based on photoresponsive polymers was exploited. Photoresponsive β-cyclodextrin polymer microspheres (AZO-CD) were synthesized via a host-guest interaction between β-cyclodextrin and azobenzene. AZO-CD were characterized by Fourier transform infrared spectrometry, circular dichroism, ultraviolet (UV) spectrophotometry, and thermogravimetric analysis, and their photoresponsiveness was also evaluated. AZO-CD were used to load paraquat, which yielded photoresponsive paraquat-loaded microspheres. For the paraquat-loaded microspheres, irradiation with UV light or sunlight induced the isomerization of azobenzene into the cis form. Then, the cis-azobenzene was liberated from the cavities of the β-cyclodextrin. The paraquat-loaded microspheres released paraquat continuously over time. Furthermore, under UV light, the herbicidal capacity of the paraquat-loaded microspheres against barnyard grass was comparable to that of free paraquat at the same dose. Our findings show that loading paraquat into AZO-CD provides a safe and environmentally friendly herbicide formulation.

Characteristics and psychopathology of 1,086 patients who self-poisoned using pesticides in Taiwan (2012-2019): A comparison across pesticide groups

Background Previous studies, mainly from low- and middle-income settings, showed that pesticide self-poisonings were mostly impulsive with low levels of psychopathology. We aimed to investigate whether pesticide self-poisoning in a high-income country showed similar profiles, and whether those with certain characteristics and psychopathology were more likely to use specific pesticides. Methods Data were extracted from hospital records of pesticide self-poisoning patients treated at eight major hospitals in Taiwan between 2012 and 2019. Multinomial logistic regression was used to investigate the association of interpersonal conflicts, triggers of self-poisoning, and psychopathology with the groups of pesticides ingested. Results A total of 1,086 patients who self-poisoned using pesticides were identified; 67.0% were male and 39.8% aged 65+ years. Approximately three quarters (75.7%) of patients who received psychiatric assessment had at least one psychiatric diagnosis, and the prevalence was 48.3% in all patients. No association was found between the pesticide groups ingested and interpersonal conflicts, most of the triggers, past psychiatric service use, or having psychiatric diagnoses. Limitations Data were collected from hospital records retrospectively. Only 60.3% of the patients received a psychiatric assessment. Conclusions The majority of patients who self-poisoned using pesticides and received psychiatric assessment in Taiwan had psychiatric illness. Patients who ingested different groups of pesticides were similar in their characteristics. The choice of pesticides used in self-poisoning more likely relates to availability rather than intentional selection. Psychiatric assessment and treatment are important in patients who self-poisoned using pesticides, while restricting access to highly hazardous pesticides is likely to prevent many deaths from pesticide self-poisoning.

Silymarin protects the rats against paraquat-induced acute kidney injury via Nrf2

BACKGROUND

Paraquat (PQ) poisoning induces severe acute kidney injury and causes extremely high rate of death. In this study, we aimed to investigate the protective effects of silymarin on PQ-induced acute kidney injury and explore the underlying mechanisms.

METHODS

A rat model was established through intraperitoneal injection of PQ. Rats were administrated with saline or silymarin for 3 days. Then, survival rate, physiological parameters, and renal injury score were evaluated. The apoptosis and oxidative stress in kidney tissues were determined through hematoxylin and eosin staining, quantitative reverse transcription polymerase chain reaction, Western blot, and enzyme-linked immunosorbent assays.

RESULTS

Silymarin administration could significantly increase the survival rate of PQ-poisoned rats. It was found that silymarin treatment improved renal function, decreased injury score in kidney tissues, and inhibited the apoptosis and oxidative stress in PQ-induced acute kidney injury through the activating the signaling pathway of Nrf2 and promoting its nuclear translocation.

CONCLUSION

Silymarin exhibited a protective effect against PQ-induced kidney injury, suggesting that treatment with this flavonoid could be a potential therapeutic agent for the treatment of acute kidney injury.

In vitro removal of paraquat and diquat from aqueous media using raw and calcined basil seed

Raw and calcined basil seeds (BS and BS1000, respectively) were evaluated for their ability to remove herbicides such as paraquat and diquat. The physicochemical properties of BS and BS1000 were determined and the effects of contact time and initial concentration on paraquat and diquat adsorption were assessed. After calcination treatment, the number of pores in BS increased, and the specific surface area was increased from 0.265 to 86.902 m² g^-1. The quantity of herbicides adsorbed using BS1000 was greater than that using either BS or medicinal-grade carbon. Additionally, the adsorption quantity increased with the increase in contact time and initial concentration of herbicide. Therefore, BS1000 is a potential resource for the removal of herbicides. Moreover, BS and BS1000 exhibited the capacity for herbicide adsorption in simulated intestinal fluid.

Reasons for under-reporting of paraquat poisoning in India

Background Paraquat is an inexpensive herbicide used in agriculture because it is easily available and the cost of labour for manual clearance of weeds is prohibitive. Paraquat is toxic to human beings and is also used for committing suicide. We studied the reasons for under-reporting of paraquat poisoning including those related to the training of doctors. Methods In this mixed-methods study, we describe a series of patients with paraquat poisoning. We recorded their demographic data, clinical features, treatment and outcome with an intention to explore the reason for an initial misdiagnosis. We also explored whether deficiencies in curricula contributed to the misdiagnosis. Results The patients of paraquat poisoning (n=28) were mostly young illiterate men driven by impulsive behaviour rather than chronic depression. Paraquat was consumed by patients from non-agricultural background as well, implying easy access to the poison. Many patients could not name the agent and so initial treatment was directed at organophosphorus poisoning. The diagnostic signs included paraquat tongue, renal failure and jaundice. Most of the casualty medical officers and residents were unfamiliar with the symptoms and signs of paraquat poisoning as was evident by their answers to the questionnaire. Knowledge of medical students about paraquat poisoning was not assessed in the theory examinations and viva. Conclusion Factors contributing to the limitation in establishing the diagnosis are illiteracy and ignorance of the patients, lack of specific signs and lack of training of medical officers in treating patients with paraquat poisoning.

Hemodynamic and electromechanical effects of paraquat in rat heart

Paraquat (PQ) is a highly lethal herbicide. Ingestion of large quantities of PQ usually results in cardiovascular collapse and eventual mortality. Recent pieces of evidence indicate possible involvement of oxidative stress- and inflammation-related factors in PQ-induced cardiac toxicity. However, little information exists on the relationship between hemodynamic and cardiac electromechanical effects involved in acute PQ poisoning. The present study investigated the effects of acute PQ exposure on hemodynamics and electrocardiogram (ECG) in vivo, left ventricular (LV) pressure in isolated hearts, as well as contractile and intracellular Ca2+ properties and ionic currents in ventricular myocytes in a rat model. In anesthetized rats, intravenous PQ administration (100 or 180 mg/kg) induced dose-dependent decreases in heart rate, blood pressure, and cardiac contractility (LV +dP/dtmax). Furthermore, PQ administration prolonged the PR, QRS, QT, and rate-corrected QT (QTc) intervals. In Langendorff-perfused isolated hearts, PQ (33 or 60 μM) decreased LV pressure and contractility (LV +dP/dtmax). PQ (10-60 μM) reduced the amplitudes of Ca2+ transients and fractional cell shortening in a concentration-dependent manner in isolated ventricular myocytes. Moreover, whole-cell patch-clamp experiments demonstrated that PQ decreased the current amplitude and availability of the transient outward K+ channel (Ito) and altered its gating kinetics. These results suggest that PQ-induced cardiotoxicity results mainly from diminished Ca2+ transients and inhibited K+ channels in cardiomyocytes, which lead to LV contractile force suppression and QTc interval prolongation. These findings should provide novel cues to understand PQ-induced cardiac suppression and electrical disturbances and may aid in the development of new treatment modalities.

Gallic acid exerts anti-inflammatory, anti-oxidative stress, and nephroprotective effects against paraquat-induced renal injury in male rats

Paraquat (PRQ) is a toxic chemical compound that is very noxious to animals and humans. Gallic acid is a phenolic compound that has antioxidant properties. In this study, we evaluated the ameliorative effect of gallic acid against PRQ-induced renal injury and oxidative stress. In this research, the rats were segregated into six groups. Group 1 is the control group; group 2 received paraquat only; group 3 received gallic acid only; and groups 4, 5, and 6 received paraquat plus gallic acid at doses of 25, 50, and 100 mg/kg bw respectively. Findings of this work displayed that the renal contents of the vitamin C, superoxide dismutase (SOD), and catalase (CAT) significantly reduced and the levels of the serum protein carbonyl, creatinine, serum glutamate pyruvate transaminase (sGPT), urea, serum glutamate oxaloacetate transaminase (sGOT), uric acid, MDA, serum IL-1β, and the kidney IL-1β gene expression were remarkably increased in the group receiving PRQ only compared with that in the control group. On the other hand, treatment with gallic acid after exposure to PRQ led to a significant elevation in renal vitamin C, SOD, and CAT levels plus a remarkable decrease in the serum protein carbonyl, creatinine, sGPT, urea, sGOT, uric acid, MDA, IL-1β, and renal gene expression of IL-1β in comparison with the PRQ-only-treated rats. Histological changes were also ameliorated by gallic acid administration. The data approve that gallic acid diminished the deleterious effects of PRQ exposure. In this regard, our results indicated that the administration of gallic acid could alleviate the noxious effects of PRQ on the antioxidant defense system and renal tissue.

Cellular injury leading to oxidative stress in acute poisoning with potassium permanganate/oxalic acid, paraquat, and glyphosate surfactant herbicide

Previous studies on human acute kidney injury (AKI) following poisoning with potassium permanganate/oxalic acid (KMnO4/H2C2O4), paraquat, and glyphosate surfactant herbicide (GPSH) have shown rapid and large increases in serum creatinine (sCr) that cannot be entirely explained by direct nephrotoxicity. One plausible mechanism for a rapid increase in sCr is oxidative stress. Thus, we aimed to explore biomarkers of oxidative stress, cellular injury, and their relationship with sCr, after acute KMnO4/H2C2O4, paraquat, and GPSH poisonings. Serum biomarkers [sCr, creatine (sCn), cystatin C (sCysC)] and urinary biomarkers [cytochrome C (CytoC), 8-isoprostane (8-IsoPs)] were evaluated in 105 patients [H2C2O4/KMnO4 (N = 57), paraquat, (N = 21), GPSH (N = 27)] recruited to a multicenter cohort study. We used area under the receiver operating characteristics curve (AUC-ROC) to quantify the extent of prediction of moderate to severe AKI (acute kidney injury network stage 2/3 (AKIN2/3)). Patients with AKIN2/3 showed increased levels of CytoC. Early high CytoC predicted AKIN2/3 in poisoning with KMnO4/H2C2O4 (AUC-ROC4-8h: 0.81), paraquat (AUC-ROC4-8h: 1.00), and GPSH (AUC-ROC4-8h: 0.91). 8-Isoprostane levels were not significantly elevated. Reduced sCn and increased sCr/sCn ratios were observed for 48 h post KMnO4/H2C2O4 ingestion. Paraquat exhibited a similar pattern (N = 11), however only 3 were included in our study. Increased CytoC suggests there is mitochondrial injury coupled with energy depletion. The increased sCr within 24 h could be due to increased conversion of cellular creatine to creatinine during the process of adenosine triphosphate (ATP) generation and then efflux from cells. Later increases of sCr are more likely to represent a true decrease in kidney function.

Effects of quercetin loaded nanostructured lipid carriers on the paraquat-induced toxicity in human lymphocytes

Paraquat (PQ) as a herbicide and an environmental pollutant with increasing importance due to its toxicity to humans and animals. This study aimed to evaluate the protective and antioxidant activity of quercetin loaded Nanostructured Lipid Carriers (QNLC) against toxicity induced by PQ. Blood lymphocytes were prepared using Ficoll polysaccharide and subsequently by gradient centrifugation. The QNLC was prepared using an ultra-sonication method, which was characterized by dynamic light scattering (DLS) and transmission electron microscopy (TEM). The viability, reactive oxygen species (ROS), lipid peroxidation (LPO), mitochondrial membrane potential (MMP), lysosome membrane integrity, Bax and Bcl2 gene expression were evaluated in human isolated lymphocytes. The results showed spherical QNLCs with nano-size range (52.7 nm) and high drug encapsulation efficiency (98.5% -96%). The results also indicated that PQ induced cell death, as well as ROS production, decreased by QNLC in human lymphocytes. Also, QNLC meaningfully restored MMP reduction, lysosomal membrane destabilization, and lipid peroxidation and were capable of preventing PQ-treated change in Bax and Bcl2 gene expression. We report that QNLC, have a significantly higher capacity to prevent PQ-induced toxicity than Q itself. It is suggested that the QNLC is a promising antioxidant for drug delivery to be used as a therapeutic and prophylactic agent for PQ poisoning.

Small molecule proteomics quantifies differences between normal and fibrotic pulmonary extracellular matrices

BACKGROUND

Pulmonary fibrosis is a respiratory disease caused by the proliferation of fibroblasts and accumulation of the extracellular matrix (ECM). It is known that the lung ECM is mainly composed of a three-dimensional fiber mesh filled with various high-molecular-weight proteins. However, the small-molecular-weight proteins in the lung ECM and their differences between normal and fibrotic lung ECM are largely unknown.

METHODS

Healthy adult male Sprague-Dawley rats (Rattus norvegicus) weighing about 150 to 200 g were randomly divided into three groups using random number table: A, B, and C and each group contained five rats. The rats in Group A were administered a single intragastric (i.g.) dose of 500 μL of saline as control, and those in Groups B and C were administered a single i.g. dose of paraquat (PQ) dissolved in 500 μL of saline (20 mg/kg). After 2 weeks, the lungs of rats in Group B were harvested for histological observation, preparation of de-cellularized lung scaffolds, and proteomic analysis for small-molecular-weight proteins, and similar procedures were performed on Group C and A after 4 weeks. The differentially expressed small-molecular-weight proteins (DESMPs) between different groups and the subcellular locations were analyzed.

RESULTS

Of the 1626 small-molecular-weight proteins identified, 1047 were quantifiable. There were 97 up-regulated and 45 down-regulated proteins in B vs. A, 274 up-regulated and 31 down-regulated proteins in C vs. A, and 237 up-regulated and 28 down-regulated proteins identified in C vs. B. Both the up-regulated and down-regulated proteins in the three comparisons were mainly distributed in single-organism processes and cellular processes within biological process, cell and organelle within cellular component, and binding within molecular function. Further, more up-regulated than down-regulated proteins were identified in most sub-cellular locations. The interactions of DESMPs identified in extracellular location in all comparisons showed that serum albumin (Alb) harbored the highest degree of node (25), followed by prolyl 4-hydroxylase beta polypeptide (12), integrin β1 (10), apolipoprotein A1 (9), and fibrinogen gamma chain (9).

CONCLUSIONS

Numerous PQ-induced DESMPs were identified in de-cellularized lungs of rats by high throughput proteomics analysis. The DESMPs between the control and treatment groups showed diversity in molecular functions, biological processes, and pathways. In addition, the interactions of extracellular DESMPs suggested that the extracellular proteins Alb, Itgb1, Apoa1, P4hb, and Fgg in ECM could be potentially used as biomarker candidates for pulmonary fibrosis. These results provided useful information and new insights regarding pulmonary fibrosis.

A metal-catex composite electrode for determination of paraquat in various samples by Ad-differential pulse cathodic stripping voltammetry

In this work, a novel kind of metal-catex composite electrode for determination of paraquat (PQ) by adsorptive differential pulse voltammetry is introduced. The metal-catex composite electrode was fabricated by cathodic electropolymerization of p-nitrophenol and p-nitrobenzoic acid in the presence of tin (II) chloride as a scaffold for composite structure on prepared glassy carbon electrode. Electropolymerization was carried out in sodium acetate medium. The surface of the fabricated electrode was characterized with field emission scanning electron microscope and energy-dispersive X-ray spectrometry. The obtained results show that there are Sn nanoparticles in the structure of the catex-composite. Chemical structure of metal-catex composite electrode was investigated using FTIR (ATR), ¹³C NMR, H NMR and a suitable mechanism for electropolymerization has been proposed. This metal-catex composite electrode was applied for determinations of PQ using sodium acetate buffer solutions at pH = 6.5 as an electrolyte solution. All parameters influencing the performance of the fabricated electrode were studied and optimized. The proposed electrode exhibits good linearity versus PQ concentration in the range of 3.8 × 10^-8 to 7.7 × 10^-7 mol L^-1 and shows a manifold increase in sensitivity (more than 30 times) as compared to the glassy carbon electrode. The LOQ of this electrode was 7.78 × 10^-9 mol L^-1, which is comparable with that of other electrochemical methods. The mean, standard deviation and relative standard deviation for seven repetitive determinations of paraquat (7.78 × 10^-8 mol L^-1) were measured to be 7.75 × 10^-8 mol L^-1, ±0.29 × 10^-8 mol L^-1, and 3.75% respectively. This electrode was applied for the determination of paraquat in natural water, natural juice, potatoes and onions. The introduced electrode shows good stability with repeated use and over long periods (about 20 days). There is a good agreement between the results for water analysis by this method and the standard method.

Application, monitoring and adverse effects in pesticide use: The importance of reinforcement of Good Agricultural Practices (GAPs)

This review intends to integrate the relevant information that is related to pesticide applications in food commodities and will cover three main sections. The first section encompasses some of the guidelines that have been implemented on management of pesticide application worldwide, such as the establishment of a value called Maximum Residue Level (MRL) through the application of Good Agricultural Practices (GAPs) into daily agricultural activities. A brief overview of the methods adopted in quantification of these trace residues in different food samples will also be covered. Briefly, pesticide analysis is usually performed in two stages: sample preparation and analytical instrumentation. Some of the preparation methods such as QuEChERs still remain as the technique of choice for most of the analytical scientists. In terms of the instrumentation such as the gas chromatography-mass spectrophotometry (GC-MS) and high performance-liquid chromatography (HPLC), these are still widely used, in spite of new inventions that are more sustainable and efficient such as the capillary electrophoresis (CE). Finally, the third section emphasizes on how pesticides can affect our health significantly whereby different types of pesticides result in different adverse health implications, despite its application benefits in agriculture in controlling pests. To date, there are limited reviews on pesticide usage in many agricultural-based nations; for the purpose of this review, Malaysia is selected to better illustrate pesticide regulations and implementation of policies. Finally, the review aims to provide an insight on how implementation of GAP and food safety assurance are inter-related and with this established correlation, to identify further measures for improvement to enable reinforcement of optimised agricultural practices specifically in these countries.

A Storable Mediatorless Electrochemical Biosensor for Herbicide Detection

A novel mediatorless photo-bioelectrochemical sensor operated with a biofilm of the cyanobacterium Synechocystis PCC6803 wt. for herbicide detection with long term stability (>20 days) was successfully developed and tested. Photoanodic current generation was obtained in the absence of artificial mediators. The inhibitory effect on photocurrent of three commonly used herbicides (i.e., atrazine, diuron, and paraquat) was used as a means of measuring their concentrations in aqueous solution. The injection of atrazine and diuron into the algal medium caused an immediate photocurrent drop due to the inhibition of photosynthetic electron transport. The detected concentrations were suitable for environmental analysis, as revealed by a comparison with the freshwater quality benchmarks set by the Environmental Protection Agency of the United States (US EPA). In contrast, paraquat caused an initial increase (~2 h) of the photocurrent effect of about 200%, as this compound can act as a redox mediator between the cells and the anode. A relatively long-term stability of the biosensor was demonstrated, by keeping anodes colonized with cyanobacterial biofilm in the dark at 4 °C. After 22 days of storage, the performance in terms of the photocurrent was comparable with the freshly prepared biosensor. This result was confirmed by the measurement of chlorophyll content, which demonstrated preservation of the cyanobacterial biofilm. The capacity of this biosensor to recover after a cold season or other prolonged environmental stresses could be a key advantage in field applications, such as in water bodies and agriculture. This study is a step forward in the biotechnological development and implementation of storable mediatorless electrochemical biosensors for herbicide detection.

Radiomics Nomogram Analyses for Differentiating Pneumonia and Acute Paraquat Lung Injury

Paraquat poisoning has become a serious public health problem in some Asian countries because of misuse or suicide. We sought to develop and validate a radiomics nomogram incorporating radiomics signature and laboratory bio-markers, for differentiating bacterial pneumonia and acute paraquat lung injury. 180 patients with pneumonia and acute paraquat who underwent CT examinations between December 2014 and October 2017 were retrospectively evaluated for testing and validation. Clinical information including demographic data, clinical symptoms and laboratory test were also recorded. A prediction model was built by using backward logistic regression and presented on a nomogram. The radiomics-based features yielded areas under the receiver operating characteristic curve of 0.870 (95% CI 0.757–0.894), sensitivity of 0.857, specificity of 0.804, positive predictive value of 83.3%, negative predictive value of 0.818 in the primary cohort, while in the validation cohort the model showed similar results (0.865 (95% CI 0.686–0.907), 0.833, 0.792, 81.5%, respectively). The individualized nomogram included radiomics signature, body temperature, nausea and vomiting, and aspartate transaminase. We have developed a radiomics nomogram that combination of the radiomics features and clinical risk factors to differentiate paraquat lung injury and pneumonia for patients with an unclear medical history of exposure to paraquat poisoning, providing appropriate therapy decision support.

Trends in pesticide suicide in South Korea, 1983-2014

AIMS

Self-poisoning using pesticides is among the major methods of suicide worldwide, and accounts for one-fifth of suicides in 2006-2010 in South Korea. We investigated long-term trends in pesticide suicide rates in South Korea and factors related to these trends.

METHODS

We calculated age-standardised rates of pesticide suicide in South Korea (1983-2014) using registered death data. We used graphical approach and joinpoint regression analysis to examine secular trends in pesticide suicide by sex, age and area, and a time-series analysis to investigate association of pesticide suicide rate with socioeconomic and agriculture-related factors. Age, period and cohort effects were examined using the intrinsic estimator method.

RESULTS

Age-standardised rate of pesticide suicide fluctuated between 1983 and 2000 before it markedly increased in 2000-2003 (annual percent change 29.7%), followed by a gradual fall (annual percent change -6.3%) in 2003-2011. Following the paraquat ban (2011-2012), there was a marked reduction (annual percent change -28.2%) in 2011-2014. Trend in pesticide suicide was associated with divorce rate but not with other factors studied. Declines in pesticide suicide in 2003-2011 were most noticeable in younger groups and metropolises; by contrast, elderly adults aged 70+ living in rural areas showed an upward trend until after the 2011-2012 paraquat ban, when it turned downward. In the age-period-cohort modelling, having been born between 1938 and 1947 was associated with higher pesticide suicide rates.

CONCLUSIONS

Pesticide suicide trend changed substantially in South Korea over the last three decades. Effective prevention should include close monitoring of trends and strong regulations of toxic pesticides.

Nrf2 overexpression protects against paraquat-induced A549 cell injury primarily by upregulating P-glycoprotein and reducing intracellular paraquat accumulation

Paraquat (PQ) intoxication causes thousands of mortalities every year, worldwide. Its pulmonary-targeted accumulation and the acute lung injury it subsequently causes, remain a challenge for detoxification treatment. A previous study has demonstrated that the upregulation of nuclear factor erythroid-2 related factor 2 (Nrf2) prevents PQ toxicity in cell line and murine models. As Nrf2 target genes include a group of membrane transporters, the current study assessed the protective mechanism exerted by Nrf2 against PQ toxicity and intracellular PQ accumulation via its effects on P-glycoprotein (P-gp), a downstream transporter of Nrf2. Adenovirus vectors containing the Nrf2 gene were transfected into A549 cells. Cell proliferation was assessed by Cell Counting Kit-8. The levels of LDH, MDA, SOD, TNF-α, IL-6 levels were detected using their respective ELISA kits. In addition, the levels of Nrf2 and P-gp protein expression were detected by western blot analysis. The concentration of PQ was measured by HPLC. The results revealed that overexpressed Nrf2 significantly increased P-gp protein levels, decreased the intracellular accumulation of PQ and attenuated PQ-induced toxicity. However, the protective effects of Nrf2 overexpression on PQ-challenged A549 cells were abrogated following cyclosporine A treatment, a competitive inhibitor of P-gp, which also increased intracellular PQ levels. These data indicated that Nrf2 gene overexpression prevented PQ toxicity in A549 cells, potentially via the upregulation of P-gp activity and the inhibition of intracellular PQ accumulation. Thus, Nrf2 and P-gp may serve as potential therapeutic targets for the treatment of PQ-induced injury.

Rapid Simultaneous Determination of Paraquat and Creatinine in Human Serum Using a Piece of Paper

Paraquat intoxication is characterized by acute kidney injury and multi-organ failure, causing substantial mortality and morbidity. This study aims to develop a 2-in-1 paper-based analytical device to detect the concentrations of paraquat and creatinine in human serum, which can help clinicians diagnose patients with paraquat poisoning in a more rapid and geographically unrestricted manner. The procedure involves fabrication of a paper-based analytical device, i.e., printing of design on a filter paper, heating of wax-printed micro zone plates so as molten wax diffusing into and completely through the paper to the other side, forming hydrophobic boundaries that could act as detection zones for the paraquat colorimetric assay, and finally analysis using ImageJ software. The paper employed a colorimetric sodium dithionite assay to indicate the paraquat level in a buffer or human serum system in less than 10 min. In this study, colorimetric changes into blue color could be observed by the naked eye. By curve fitting models of sodium dithionite in normal human serum, we evaluated the serum paraquat levels for five paraquat patients. In the sodium dithionate assay, the measured serum paraquat concentrations in patients 1⁻5 were 22.59, 5.99, 26.52, 35.19 and 25.00 ppm, respectively. On the other hand, by curve fitting models of the creatinine assay in normal human serum, the measured serum creatinine concentrations were 16.10, 12.92, 13.82, 13.58 and 12.20 ppm, respectively. We found that the analytical performance of this device can compete with the standard of Clinical Laboratory of Chang Gung Memorial Hospital, with a less complicated sample preparation process and more rapid results. In conclusion, this 2-in-1 paper-based analytical device has the advantage of being simple and cheap, enabling rapid detection of paraquat intoxication as well as assessment of renal prognosis.

Arterial lactate in predicting mortality after paraquat poisoning: A meta-analysis

OBJECTIVE

This study aimed to explore the effects of arterial lactate as a predictor of mortality in patients with paraquat (PQ) poisoning.

METHODS

The databases PubMed, EMBase, Web of Science, ScienceDirect, Cochrane library, and studies published until 31 February 2018 were searched. The data were extracted to perform pooled analysis, heterogeneity testing, sensitivity analysis, publication bias analysis, and Fagan plot analysis.

RESULTS

Pooled analysis showed that a high arterial lactate was significantly correlated with poor mortality (pooled odds ratio = 16.94, 95% confidence interval [CI]: 7.96-36.08, P < .001). The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 77% (95% CI: 0.69-0.84), 84% (95% CI: 0.74-0.90), 4.7 (95% CI: 2.9-7.8), 0.28 (95% CI: 0.20-0.39), and 17 (8-36), respectively. An area under the curve of 0.87 (95% CI: 0.83-0.89) means a high ability for prognostic detection.

CONCLUSION

Our findings show that arterial lactate is an effective predictor of mortality in patients with PQ poisoning.

Increased plasma prothrombin time is associated with poor prognosis in patients with paraquat poisoning

BACKGROUND

Paraquat can cause severe injury to vascular endothelial cells and lead to coagulation dysfunction when it is taken into the blood by oral ingestion. In this study, we aim to find a routine coagulation index to serve as an indicator of outcome in patients with acute paraquat poisoning.

METHODS

Between January 2012 and December 2016, 209 patients who attempted suicide by oral ingestion of paraquat were admitted to the emergency room. Routine coagulation indices, including plasma prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fbg), thrombin time (TT), and D-dimer were measured to analyze the trend of changes and their relationship with prognosis.

RESULTS

The results showed that the PT and APTT values in the ≥30 mL group were significantly greater than those in the <30 mL group (both P < .01). Within 1 week of admission, PT and APTT values gradually decreased, while Fbg levels gradually increased. Univariate and multivariate Cox regression analysis indicated that sex, ingestion volume, and PT were independent predictors of mortality within 40 days. The cumulative survival rates differed significantly (P = .001) between patients with PT <12 seconds and PT ≥12 seconds.

CONCLUSIONS

Coagulation status in patients with PQ poisoning was closely related to prognosis. Routine monitoring of coagulation function, particularly PT in plasma, is helpful for analysis of the condition and prognosis of patients with PQ poisoning.

Point-of-care testing in the early diagnosis of acute pesticide intoxication: The example of paraquat

Acute pesticide intoxication is a common method of suicide globally. This article reviews current diagnostic methods and makes suggestions for future development. In the case of paraquat intoxication, it is characterized by multi-organ failure, causing substantial mortality and morbidity. Early diagnosis may save the life of a paraquat intoxication patient. Conventional paraquat intoxication diagnostic methods, such as symptom review and urine sodium dithionite assay, are time-consuming and impractical in resource-scarce areas where most intoxication cases occur. Several experimental and clinical studies have shown the potential of portable Surface Enhanced Raman Scattering (SERS), paper-based devices, and machine learning for paraquat intoxication diagnosis. Portable SERS and new SERS substrates maintain the sensitivity of SERS while being less costly and more convenient than conventional SERS. Paper-based devices provide the advantages of price and portability. Machine learning algorithms can be implemented as a mobile phone application and facilitate diagnosis in resource-limited areas. Although these methods have not yet met all features of an ideal diagnostic method, the combination and development of these methods offer much promise.

Effect of prohibiting the use of Paraquat on pesticide-associated mortality

Background

Paraquat is associated with a high rate of fatalities in acute poisoning. This study aimed to examine the association between the national public health policy that banned the use of paraquat and the incidence of pesticide-associated mortality.

Methods

All external causes of death from 2009 to 2013 of Korea were analyzed. The intervention was a national public health policy that annulled the authorized use (2011) and banned the purchase of paraquat (2012). Two periods were compared as follows: before (2009-2010) and after (2012-2013) the intervention period. The main outcome was pesticide-associated death coded on the death certificate. Multivariable logistic regression analysis adjustment for gender, age, season and weekday of death, province, education level, marital status, and occupation was performed to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for pesticide-associated mortality. The effect sizes of the intervention across all intents (Accident, Suicide, Homicide, and Undetermined) were compared by adding an interaction term (intervention*intent group) to the above model.

Results

A total of 127,866 deaths from for all external causes were analyzed, including 65,538 from 2009 to 2010 and 62,373 from 2012 to 2013. Pesticide-associated mortality decreased from 9.7% (2009-2010) to 6.5% (2012-2013) (p < 0.001). The AOR (95% CI) of the intervention on pesticide-associated mortality was 0.59 (0.56-0.62). The AORs of the intervention according to intent were 0.72 (0.55-0.96) in the Accident group, 0.61 (0.58-0.64) in the Suicide group, 1.29 (0.43-3.87) in the Homicide group, and 0.44 (0.38-0.50) in the Undetermined group.

Conclusion

The national public health policy that banned paraquat resulted in a significant decrease in pesticide-associated mortality.

Paraquat use among farmers in Korea after the ban

The purpose of this study was to examine the proportion of paraquat use among farmers and to describe their epidemiologic characteristics after the paraquat ban in 2012. We interviewed 249 farmers in Korea in 2014. Approximately 20% of the farmers reported using paraquat in 2014. Farmers with longer farming experience, longer pesticide application years, and upland farming reported an increased risk of paraquat use although the trend was not statistically significant. The majority of the farmers used preexisting paraquat (85.7%), but some farmers purchased it illegally (14.3%). Farmers who used paraquat perceived paraquat as a dangerous chemical; however, they disagreed with the necessity of the paraquat ban.

Effects of Paraquat Ban on Herbicide Poisoning-Related Mortality

PURPOSE

In Korea, registration of paraquat-containing herbicides was canceled in November 2011, and sales thereof were completely banned in November 2012. We evaluated the effect of the paraquat ban on the epidemiology and mortality of herbicide-induced poisoning.

MATERIALS AND METHODS

This retrospective study analyzed patients treated for herbicide poisoning at 17 emergency departments in South Korea between January 2010 and December 2014. The overall and paraquat mortality rates were compared pre- and post-ban. Factors associated with herbicide mortality were evaluated using logistic analysis. To determine if there were any changes in the mortality rates before and after the paraquat sales ban and the time point of any such significant changes in mortality, R software, version 3.0.3 (package, bcp) was used to perform a Bayesian change point analysis.

RESULTS

We enrolled 2257 patients treated for herbicide poisoning (paraquat=46.8%). The overall and paraquat poisoning mortality rates were 40.6% and 73.0%, respectively. The decreased paraquat poisoning mortality rate (before, 75% vs. after, 67%, p=0.014) might be associated with increased intentionality. The multivariable logistic analysis revealed the paraquat ban as an independent predictor that decreased herbicide poisoning mortality (p=0.035). There were two major change points in herbicide mortality rates, approximately 3 months after the initial paraquat ban and 1 year after complete sales ban.

CONCLUSION

This study suggests that the paraquat ban decreased intentional herbicide ingestion and contributed to lowering herbicide poisoning-associated mortality. The change point analysis suggests a certain timeframe was required for the manifestation of regulatory measures outcomes.

Time-dependent haemoperfusion after acute paraquat poisoning

Early haemoperfusion (HP) therapy has been found to be very effective in acute paraquat (PQ) poisoning, but the effective rescue window is still uncertain. Demographic data and the type of therapies administered of 621 patients were included as confounding factors in this retrospective study. After receiver operating characteristic curve analysis and intra-group/subgroup analysis, the initiation of glucocorticoid therapy within 3 hrs of exposure with a second treatment given <21 hrs after exposure, HP initiated within 4 hrs of exposure with a second treatment given <20 hrs after exposure, the appearance of pulmonary lesions ≤8 days after exposure and six other variables were used in a multiple analysis. The strength of positivity of the PQ urine test on admission, HP initiated within 4 hrs of exposure with a second treatment given <20 hrs after exposure, the appearance of pulmonary lesions ≤8 days after exposure, and stage III AKI on admission were independent factors of survival probability. HP therapy for acute PQ poisoning was the main therapeutic intervention investigated in this study. Outcomes were time dependent, and the crucial factor was the initiation of therapy within 4 hrs of PQ poisoning followed by a second treatment within 20 hrs.

Effectiveness of the sequential organ failure assessment, acute physiology and chronic health evaluation II, and simplified acute physiology score II prognostic scoring systems in paraquat-poisoned patients in the intensive care unit

OBJECTIVE

This study was conducted to assess the ability of the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) II scoring systems, as well as the simplified acute physiology score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with paraquat. This will assist physicians with risk stratification.

MATERIAL AND METHODS

The medical records of 244 paraquat-poisoned patients admitted to the ICU from January 2010 to April 2015 were examined retrospectively. The SOFA, APACHE II, and SAPS II scores were calculated based on initial laboratory data in the emergency department and during the first 24 h of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II. The ability of the SOFA score, APACHE II score, and SAPS II method to predict group mortality was assessed using a receiver operating characteristic (ROC) curve and calibration analyses.

RESULTS

A total of 219 patients (mean age, 63 years) were enrolled. Sensitivities, specificities, and accuracies were 58.5%, 86.1%, and 64.0% for the SOFA, respectively; 75.1%, 86.1%, and 77.6% for the APACHE II scoring systems, respectively; and 76.1%, 79.1%, and 76.7% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.716, 0.850, and 0.835, respectively.

CONCLUSION

The SOFA, APACHE II, and SAPS II had different capabilities to discriminate and estimate early in-hospital mortality of paraquat-poisoned patients. Our results show that although the SOFA and SAPS II are easier and more quickly calculated than APACHE II, the APACHE II is superior for predicting mortality. We recommend use of the APACHE II for outcome predictions and risk stratification in paraquat-poisoned patients in the ICU.

Protective Effects of Arachidonic Acid Against Paraquat-Induced Pulmonary Injury

In this study, we aimed to study the effects of arachidonic acid (AA) on acute lung injury (ALI) caused by paraquat (PQ) in mice. Male Kunming mice were randomly divided into three groups: control group, PQ group, and PQ + AA group (n = 24). The mice in the PQ and PQ + AA groups received a single oral dose of 20 mg/kg bodyweight PQ, and the mice of the PQ + AA group were challenged by 500 mg/kg bodyweight AA posttreatment 2 h after PQ administration. The results indicated that the administration of AA significantly increased the activity of superoxide dismutase (SOD), decreased the activity of myeloperoxidase (MPO), the content of malondialdehyde (MDA), and the level of lactate dehydrogenase (LDH). Pathological examination also revealed that AA effectively alleviated PQ-induced histological damage. Furthermore, AA significantly reduced PQ-induced upregulations of inflammatory mediators such as tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, and IL-8. These results demonstrated that AA had effective protection against PQ-induced ALI.

Unfractionated bone marrow cells attenuate paraquat-induced glomerular injury and acute renal failure by modulating the inflammatory response

The aim of this study was to evaluate the efficacy of unfractionated bone marrow cells (BMCs) in attenuating acute kidney injury (AKI) induced by paraquat (PQ) in a mouse model. PQ (55 mg/kg BW) was intraperitoneally injected into C57BL/6 female mice to induce AKI, including renal function failure, glomerular damage and renal tubule injury. Glomerular podocytes were the first target damaged by PQ, which led to glomerular injury. Upon immunofluorescence staining, podocytes depletion was validated and accompanied by increased urinary podocin levels, measured on days 1 and 6. A total of 5.4 × 10(6) BMCs obtained from the same strain of male mice were injected into AKI mice through the tail vein at 3, 24, and 48 hours after PQ administration. As a result, renal function increased, tubular and glomerular injury were ameliorated, podocytes loss improved, and recipient mortality decreased. In addition, BMCs co-treatment decreased the extent of neutrophil infiltration and modulated the inflammatory response by shifting from pro-inflammatory Th1 to an anti-inflammatory Th2 profile, where IL-1β, TNF-α, IL-6 and IFN-γ levels declined and IL-10 and IL-4 levels increased. The present study provides a platform to investigate PQ-induced AKI and repeated BMCs injection represents an efficient therapeutic strategy.

Impact of paraquat regulation on suicide in South Korea

BACKGROUND

Ingestion of pesticides (mainly paraquat) accounted for one-fifth of suicides in South Korea in 2006-10. We investigated the effect on suicide mortality of regulatory action, culminating in a ban on paraquat in South Korea in 2011-12.

METHODS

We calculated age-standardized method-specific suicide mortality rates among people aged ≥15 in South Korea (1983-2013) using registered death data. Negative binomial regression was used to estimate changes in the rate and number of pesticide suicides in 2013, compared with those expected based on previous trends (2003-11).

RESULTS

Pesticide suicide mortality halved from 5.26 to 2.67 per 100 000 population between 2011 and 2013. Compared with the number expected based on previous trends, the regulations were followed by an estimated 847 [95% confidence interval (CI) -1180 to -533] fewer pesticide suicides, a 37% reduction in rates (rate ratio = 0.63, 95% CI 0.55 to 0.73) in 2013. The decline in pesticide suicides after the regulations was seen in all age/sex/geographical groups. The absolute reduction in the number of suicides was greatest among men, the elderly and in rural areas. The reduction in pesticide suicides contributed to 56% of the decline in overall suicides that occurred between 2011 and 2013. There was no impact of the regulations on crop yield.

CONCLUSIONS

The regulation of paraquat in South Korea in 2011-12 was associated with a reduction in pesticide suicide. Further legislative interventions to prevent the easy availability of highly lethal suicide methods are recommended for reducing the number of suicides worldwide.

Effect of acute paraquat poisoning on CYP450 isoforms activity in rats by cocktail method

Paraquat is a highly effective contact herbicide that is marketed worldwide as a fantastical, non-selective compound for broadleaf weed control. As compared to most pesticides, paraquat is extremely toxic to humans and the lack of strategies to manage paraquat poisoning has resulted in high fatality rates. The rats were randomly divided into acute paraquat poisoning group and control group. The paraquat group rats were given 36 mg/kg paraquat by intragastric administration. The influence of acute paraquat poisoning on the activities of CYP450 isoforms CYP2B6, CYP1A2, CYP2C9, CYP2D6, CYP3A4 and CYP2C19 were evaluated by cocktail method, they were responded by the changes of pharmacokinetic parameters of bupropion, phenacetin, tolbutamide, metoprolol, midazolam and omeprazole. The six probe drugs were given to rats through intragastric administration, and the plasma concentrations were determined by UPLC-MS/MS. In the results of paraquat group compared to control group, there was statistical pharmacokinetic difference for bupropion, tolbutamide, metoprolol, midazolam and omeprazole. Acute paraquat poisoning may induce the activities of CYP2C19, and inhibit of CYP2B6, CYP2C9, CYP2D6 and CYP3A4 in rats. This may give advising for reasonable drug use after acute paraquat poisoning.

Common Pesticides Used in Suicide Attempts Following the 2012 Paraquat Ban in Korea

To determine the change in pesticides used during suicide attempts after the 2012 paraquat (PQ) ban, we evaluated the annual number of suicide attempts by pesticide ingestion between 2011 and 2014. We extracted demographic, clinical outcome, and pesticide class data from the medical records of 1,331 patients that attempted suicide by pesticide ingestion. Pesticides were sorted into 5 groups: herbicides, insecticides, fungicides, other pesticides, and combined pesticides. Each group was subdivided into various classes based on publications by the respective Resistance Action Committees. The chi-square test for trends was used to compare the annual incidence of categorical variables. The total number of suicide attempts decreased each year, from 399 in 2011 to 245 in 2014. Simultaneously, PQ ingestion decreased from 253 patients in 2011 to 60 in 2014. The proportion of PQ to pesticides also decreased from 63.4% in 2011 to 24.5% in 2014. Furthermore, the rate of decrease in the proportion of PQ to all herbicide categories increased by calendar year. In conclusion, there is a significant trend in increased annual number of suicides and proportion of suicides using glyphosates and glufosinates versus total herbicides. However, the number of suicide attempts using glyphosate and glufosinate is lower than that using PQ. The ratio of persons completing suicide to those attempting suicide after pesticide ingestion has decreased every year after the PQ ban.

Paraquat prohibition and change in the suicide rate and methods in South Korea

The annual suicide rate in South Korea is the highest among the developed countries. Paraquat is a highly lethal herbicide, commonly used in South Korea as a means for suicide. We have studied the effect of the 2011 paraquat prohibition on the national suicide rate and method of suicide in South Korea. We obtained the monthly suicide rate from 2005 to 2013 in South Korea. In our analyses, we adjusted for the effects of celebrity suicides, and economic, meteorological, and seasonal factors on suicide rate. We employed change point analysis to determine the effect of paraquat prohibition on suicide rate over time, and the results were verified by structural change analysis, an alternative statistical method. After the paraquat prohibition period in South Korea, there was a significant reduction in the total suicide rate and suicide rate by poisoning with herbicides or fungicides in all age groups and in both genders. The estimated suicide rates during this period decreased by 10.0% and 46.1% for total suicides and suicides by poisoning of herbicides or fungicides, respectively. In addition, method substitution effect of paraquat prohibition was found in suicide by poisoning by carbon monoxide, which did not exceed the reduction in the suicide rate of poisoning with herbicides or fungicides. In South Korea, paraquat prohibition led to a lower rate of suicide by paraquat poisoning, as well as a reduction in the overall suicide rate. Paraquat prohibition should be considered as a national suicide prevention strategy in developing and developed countries alongside careful observation for method substitution effects.

The mechanism of rapamycin in the intervention of paraquat-induced acute lung injury in rats

1. Paraquat (PQ) is an organic nitrogen heterocyclic herbicide that is widely used in agriculture throughout the world. Numerous studies have reported PQ intoxication on humans. 2. In this study, we established a rat lung injury model induced by PQ and evaluated the intervention effect of rapamycin on the model, exploring the pathogenesis of PQ on lung injury as well as therapeutic effects of rapamycin on PQ-induced lung injury. 3. A rat lung injury model was established by gavage of PQ, and rapamycin was used to treat the model animals with PQ-induced lung injury. Different physiological indices were measured through Western blot and real-time polymerase chain reaction to evaluate the effect of rapamycin on the PQ-induced lung injury. 4. The analyses showed that application of rapamycin could significantly reduce the lung injury damage caused by PQ, with lung tissue wet-dry weight ratio, pathological features, compositions in serum, protein in bronchoalveolar lavage fluid and other indices being significantly improved after the injection of rapamycin. 5. It was inferred that the use of rapamycin could improve the PQ-induced lung injury through inhibiting the activity of mTOR. And we expected the use of rapamycin to be a potential treatment method for the PQ intoxication in future.

Early haemoperfusion with continuous venovenous haemofiltration improves survival of acute paraquat-poisoned patients

Objective

To determine whether haemoperfusion (HP) with continuous venovenous haemofiltration (CVVH) improves the survival of patients with acute paraquat poisoning, compared with those treated using HP alone.

Methods

Medical records of patients with acute paraquat poisoning were analysed. Patients were randomised to undergo HP or HP + CVVH within 24 h of paraquat ingestion. Mortality rate, survival duration and cause of death were recorded.

Results

There were no significant differences in mortality rate between the HP group ( n = 458) and the HP + CVVH group ( n = 226) (57.4% and 58.4%, respectively). The mean survival duration was significantly longer in the HP + CVVH group than the HP group (8.6 ± 3.1 and 5.1 ± 2.3 days, respectively). Early circulatory collapse was a major cause of death in the HP group. The major cause of death in the HP + CVVH group was late respiratory failure.

Conclusion

Combined therapy with HP and CVVH can prevent early death and prolong survival duration following acute paraquat poisoning, providing the opportunity for further treatment.

Psychiatric comorbidity and its impact on mortality in patients who attempted suicide by paraquat poisoning during 2000-2010

BACKGROUND

Paraquat poisoning is a lethal method of suicide used around the world. Although restricting its accessibility had been widely discussed, the underlying psychopathological mechanism of paraquat self-poisoning and its association with mortality have not yet been explicitly evaluated.

METHODS

We included all patients admitted to a tertiary general hospital in Taiwan between 2000 and 2010 following a suicide attempt by paraquat self-administration. Diagnoses were made upon psychiatric consultation based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The risk of mortality was calculated by logistic regression with various psychiatric or medical covariates.

RESULTS

The consultation-liaison psychiatry team assessed 157 patients who attempted suicide by paraquat poisoning. Mood disorders (54.0%), including dysthymic (26.7%) and major depressive disorders (24.7%), were the most common psychiatric diagnoses among the self-poisoning patients. Among those who attempted suicide, 87 patients (58.0%) died and dysthymic disorder (OR = 5.58, 95% CI: 1.13-27.69; p < 0.05) significantly increased the mortality risk after adjustment for relevant medical variables, including age, gender, severity index of paraquat poisoning (SIPP), and risk for respiratory failure.

CONCLUSIONS

Awareness of comorbid psychiatric illnesses, especially dysthymic disorder, is vital in the prevention and treatment of suicide by paraquat poisoning.

Diagnostic and therapeutic approach for acute paraquat intoxication

Paraquat (PQ) has known negative human health effects, but continues to be commonly used worldwide as a herbicide. Our clinical data shows that the main prognostic factor is the time required to achieve a negative urine dithionite test. Patient survival is a 100% when the area affected by ground glass opacity is <20% of the total lung volume on high-resolution computed tomography imaging 7 days post-PQ ingestion. The incidence of acute kidney injury is approximately 50%. The average serum creatinine level reaches its peak around 5 days post-ingestion, and usually normalizes within 3 weeks. We obtain two connecting lines from the highest PQ level for the survivors and the lowest PQ level among the non-survivors at a given time. Patients with a PQ level between these two lines are considered treatable. The following treatment modalities are recommended to preserve kidney function: 1) extracorporeal elimination, 2) intravenous antioxidant administration, 3) diuresis with a fluid, and 4) cytotoxic drugs. In conclusion, this review provides a general overview on the diagnostic procedure and treatment modality of acute PQ intoxication, while focusing on our clinical experience.

QTc prolongation as a useful prognostic factor in acute paraquat poisoning

BACKGROUND

Acute paraquat poisoning has a high mortality rate. Several prognostic factors have been proposed to predict the mortality risk of paraquat-poisoned patients. However, these prognostic factors are complex and some require a laboratory. Corrected QT (QTc) has been used as a prognostic factor in several clinical conditions, such as acute organophosphate poisoning. In addition, the measurement can be obtained in a reasonable amount of time.

STUDY OBJECTIVES

This study's objective was to investigate whether QTc can predict mortality in paraquat-poisoned patients.

METHODS

This was a retrospective study. Potential prognostic factors such as QTc, vital signs at admission, and certain biochemistry variables were analyzed with Cox regression analyses for their ability to predict a patient's survival from paraquat poisoning.

RESULTS

Sixty acute paraquat-poisoned patients were admitted to the emergency department during the study period. The QTc of the survival group ranged from 0.35 to 0.48 s, whereas the nonsurvivor group ranged from 0.32 to 0.63 s. The nonsurvivor group contained a higher percentage of patients with QTc prolongation (≥0.45 s) compared with the survivor group (p = 0.04). The hazard ratio of QTc prolongation for a patient's death was found to be 2.47 (95% confidence interval [CI] 1.68-5.67) in patients with a lower potassium level (<3.2 mEq/L) and 3.71 (95% CI 1.53-8.97) in patients with a higher potassium level (≥3.2 mEq/L). In addition, hyperdynamic circulation was observed upon admission of these poisoned patients.

CONCLUSION

QTc prolongation is a useful prognostic factor for predicting death in acute paraquat-poisoned patients. Cardiovascular collapse may occur in some paraquat-poisoned patients. Physicians can use QTc as an indicator of a patient's severity of poisoning and mortality risk.

Protective effects of exogenous β-hydroxybutyrate on paraquat toxicity in rat kidney

In this study, we demonstrated the protective effects of β-hydroxybutyrate (β-HB) against paraquat (PQ)-induced kidney injury and elucidated the underlying molecular mechanisms. By histological examination and renal dysfunction specific markers (serum BUN and creatinine) assay, β-HB could protect the PQ-induced kidney injury in rat. PQ-induced kidney injury is associated with oxidative stress, which was measured by increased lipid peroxidation (MDA) and decreased intracellular anti-oxidative abilities (SOD, CAT and GSH). β-HB pretreatment significantly attenuated that. Caspase-mediated apoptosis pathway contributed importantly to PQ toxicity, as revealed by the activation of caspase-9/-3, cleavage of PARP, and regulation of Bcl-2 and Bax, which were also effectively blocked by β-HB. Moreover, treatment of PQ strongly decreased the nuclear Nrf2 levels. However, pre-treatment with β-HB effectively suppressed this action of PQ. This may imply the important role of β-HB on Nrf2 pathway. Taken together, this study provides a novel finding that β-HB has a renoprotective ability against paraquat-induced kidney injury.

Incidence, etiology, and outcomes of rhabdomyolysis in a single tertiary referral center

We have encountered numerous cases of rhabdomyolysis associated with acute pesticide intoxication; however, the cause, incidence, and treatment outcomes of rhabdomyolysis have not been studied. The current study involved 2,125 patients hospitalized with acute chemical poisoning. Based on clinical and laboratory parameters and treatment outcomes, we found that overall incidence of rhabdomyolysis in our hospital was 0.06% (93 of 143,830 patients admitted), but the incidence associated with acute pesticide intoxication was 1.8% (33 of 1,793 cases). The incidence of rhabdomyolysis after pesticide intoxication was significantly higher in men than in women (P = 0.010). The amount of pesticide ingested was significantly higher in rhabdomyolysis patients than that in those who did not develop rhabdomyolysis (mean ± SD, 114.1 ± 79.5 mL vs 74.1 ± 94.2 mL, P = 0.010). Our results show that pesticide intoxication is a frequent cause of rhabdomyolysis and is more common among men than women. The volume of pesticide ingested, and not the degree of human toxicity, is the main factor influencing the incidence of rhabdomyolysis.

New formulation of paraquat with lysine acetylsalicylate with low mammalian toxicity and effective herbicidal activity

BACKGROUND

Currently, the commercial formulations of the herbicide paraquat are highly toxic to humans, and no effective antidote is available for paraquat poisoning. The aim of the present study was to develop a safe formulation, combining paraquat and the known antidote lysine acetylsalicylate. The toxicity of a mixture of Gramoxone® (20% paraquat) and lysine acetylsalicylate in adult Wistar male rats and the herbicidal efficacy against grass lawn (50% of Poa pratensis and 50% of Festuca arundinacea) were evaluated. This new formulation was administered to Wistar rats by gavage at 125 mg kg(-1) of paraquat ion and lysine acetylsalicylate at 79, 158 or 316 mg kg(-1) body weight, and the survival rate was observed for 30 days.

RESULTS

The survival rate of the paraquat group was only 40%, while lysine acetylsalicylate provided effective protection, with full survival observed in the groups that received 125 mg kg(-1) of paraquat ion and 316 mg kg(-1) of lysine acetylsalicylate. Both formulations of paraquat, either in the absence or in the presence of lysine acetylsalicylate, provided the same herbicidal activity against the tested herbal species.

CONCLUSIONS

The present formulation of paraquat containing lysine acetylsalicylate, significantly decreases mammalian toxicity while maintaining effective herbicidal activity.

Pesticide poisonings in South Korea: findings from the National Hospital Discharge Survey 2004-2006

OBJECTIVES

Pesticide poisoning stands as a major public health issue worldwide. The objective of this study was to examine the epidemiologic characteristics of pesticide-related hospitalizations in South Korea.

METHODS

Data from the Korea National Hospital Discharge Survey were analyzed to describe the epidemiologic characteristics of pesticide poisoning among hospitalized patients from 2004 through 2006. Pesticide-related hospitalizations were identified using the International Classification of Diseases, Tenth Revision codes. National estimates of pesticide-related hospitalizations were calculated using sampling weights for number of hospitalizations.

RESULTS

A total of 25,982 pesticide-related hospitalizations were estimated during the years 2004-2006, yielding an average annual pesticide-related hospitalization rate of 17.8 per 100,000 population in South Korea. Age-specific rates for pesticide-related hospitalization increased with age, with the highest rate noted among those aged 70 or above. The majority of pesticide-related hospitalization was cases of intentional poisoning in rural areas. Seasonal variation in the rate was observed, with summer being the highest among both men and women.

CONCLUSIONS

Pesticide-related hospitalization is prevalent and demonstrates demographic and seasonal and regional variations. More effective strategies to reduce pesticide-related hospitalizations are required in South Korea.