1. Pestic Biochem Physiol. 2020 Mar;164:122-129. doi: 10.1016/j.pestbp.2020.01.001.
Epub 2020 Jan 7.
Protective effect of caffeic acid phenethyl ester against imidacloprid-induced
hepatotoxicity by attenuating oxidative stress, endoplasmic reticulum stress,
inflammation and apoptosis.
Shao B(1), Wang M(2), Chen A(3), Zhang C(4), Lin L(4), Zhang Z(4), Chen A(4).
Author information:
(1)Department of Public Health, Jining Medical University, Jining, Shandong
272067, PR China; State Key Laboratory of Environmental Chemistry and
Ecotoxicology, Research Center for Eco-Environmental Sciences and University of
Chinese Academy of Sciences, The Chinese Academy of Sciences, Beijing 100085, PR
China. Electronic address: shaobo2016@sina.com.
(2)Department of pharmacy, Affiliated Hospital of Jining Medical University,
Jining Medical University, Jining, Shandong 272067, PR China.
(3)Department of Mental Health, Jining Medical University, Jining, Shandong
272067, PR China.
(4)Department of Public Health, Jining Medical University, Jining, Shandong
272067, PR China.
Imidacloprid (IMI) is a widely used neonicotinoid pesticide in the world, its
environmental and human health risk has particularly attracted the attention of
researchers. Caffeic acid phenethyl ester (CAPE), an active polyphenol of
propolis, has many pharmacological activities including free radical scavenger,
anti-inflammatory, and anti-oxidant. In this study, protective effect of CAPE
against IMI induced liver injury in mice was performed. Administration of 1 and
2.5 mg/kg CAPE markedly prevented serum AST and ALT increase in 5 mg/kg
IMI-induced mice. CAPE significantly downregulated liver NO generation and lipid
peroxidation, and upregulated glutathione, catalase, superoxide dismutase and
glutathione peroxidase in a dose-dependent manner in liver of IMI-induced mice.
Endoplasmic reticulum stress represented by the swelling of endoplasmic reticulum
was observed by transmission electron microscope in IMI group. Pretreatment of
2.5 mg/kg CAPE significantly attenuated the endoplasmic reticulum stress induced
by IMI in liver. Western blot analysis illustrated that pretreatment of CAPE
downregulated the upregulation of TNF-α and IFN-γ induced by IMI in liver of
mice. Moreover, the increase of positive apoptotic hepatocytes further suggested
apoptosis might be involved in IMI-induced hepatotoxicity. Pretreatment of 1 and
2.5 mg/kg CAPE significantly decreased positive apoptotic hepatocytes, suggested
that CAPE prevented apoptosis in liver of IMI-induced mice. In conclusion, CAPE
prevented liver injury in IMI-induced mice via attenuation of oxidative stress,
endoplasmic reticulum stress, inflammation and apoptosis. Our findings may have
broad biological and environmental implications for future research on the
therapeutic strategy to prevent liver injury induced by pesticides.
Copyright © 2020 Elsevier Inc. All rights reserved.
DOI: 10.1016/j.pestbp.2020.01.001
PMID: 32284117 [Indexed for MEDLINE]
Conflict of interest statement: Declaration of Competing Interest None.
2. Pediatr Ann. 2020 Mar 1;49(3):e124-e131. doi: 10.3928/19382359-20200214-01.
Infestations, Bites, and Insect Repellents.
Kamath S, Kenner-Bell B.
Infestations and arthropod bite reactions in children are common reasons for
presentation to pediatric health care providers. Infestations in children include
head lice, scabies, and other mites. Fleas and bed bugs are common causes of bite
reactions in children, and papular urticaria is a chronic, recurrent eruption
resulting from delayed hypersensitivity to a variety of insect bites. Both
infestations and bite reactions may result in severe pruritus with associated
sleep disturbance and can be a source of significant distress for patients and
families. In this review, we discuss infestations and bite reactions affecting
pediatric patients, along with the approach to treatment and prevention of these
conditions. [Pediatr Ann. 2020;49(3):e124-e131.].
Copyright 2020, SLACK Incorporated.
DOI: 10.3928/19382359-20200214-01
PMID: 32155278 [Indexed for MEDLINE]
3. Toxicol Lett. 2020 Jun 15;326:31-51. doi: 10.1016/j.toxlet.2020.03.005. Epub 2020
Mar 4.
Pesticides, cognitive functions and dementia: A review.
Aloizou AM(1), Siokas V(1), Vogiatzi C(1), Peristeri E(1), Docea AO(2), Petrakis
D(3), Provatas A(1), Folia V(1), Chalkia C(1), Vinceti M(4), Wilks M(5), Izotov
BN(6), Tsatsakis A(7), Bogdanos DP(8), Dardiotis E(9).
Author information:
(1)Department of Neurology, Laboratory of Neurogenetics, University Hospital of
Larissa, Greece; Faculty of Medicine, School of Health Sciences, University of
Thessaly, Larissa, Greece.
(2)Department of Toxicology, University of Medicine and Pharmacy of Craiova,
200349, Craiova, Romania.
(3)Laboratory of Toxicology, Medical School, University of Crete, Voutes, 71409,
Heraklion, Crete, Greece.
(4)Department of Biomedical, Metabolic, and Neural Sciences, University of Modena
and Reggio Emilia, Modena, Italy; Department of Epidemiology, Boston University
School of Public Health, Boston, USA.
(5)Swiss Centre for Applied Human Toxicology, University of Basel, CH‑4055,
Basel, Switzerland.
(6)Department of Analytical and Forensic Medical Toxicology, Sechenov University,
119048, Moscow, Russian Federation.
(7)Department of Analytical and Forensic Medical Toxicology, Sechenov University,
119048, Moscow, Russian Federation; Center of Toxicology Science & Research,
Medical School, University of Crete, 71003, Heraklion, Crete, Greece.
(8)Department of Rheumatology and Clinical Immunology, University General
Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University
of Thessaly, Viopolis, 40500, Larissa, Greece.
(9)Department of Neurology, Laboratory of Neurogenetics, University Hospital of
Larissa, Greece; Faculty of Medicine, School of Health Sciences, University of
Thessaly, Larissa, Greece. Electronic address: edar@med.uth.gr.
Pesticides are widely-used chemicals commonly applied in agriculture for the
protection of crops from pests. Depending on the class of pesticides, the
specific substances may have a specific set of adverse effects on humans,
especially in cases of acute poisoning. In past years, evidence regarding
sequelae of chronic, low-level exposure has been accumulating. Cognitive
impairment and dementia heavily affect a person's quality of life and scientific
data has been hinting towards an association between them and antecedent chronic
pesticide exposure. Here, we reviewed animal and human studies exploring the
association between pesticide exposure, cognition and dementia. Additionally, we
present potential mechanisms through which pesticides may act neurotoxically and
lead to neurodegeneration. Study designs rarely presented homogeneity and the
estimation of the exposure to pesticides has been most frequently performed
without measuring the synergic effects and the possible interactions between the
toxicants within mixtures, and also overlooking low exposures to environmental
toxicants. It is possible that a Real-Life Risk Simulation approach would
represent a robust alternative for future studies, so that the safe exposure
limits and the net risk that pesticides confer to impaired cognitive function can
be examined. Previous studies that evaluated the effect of low dose chronic
exposure to mixtures of pesticides and other chemicals intending to simulate real
life exposure scenarios showed that hormetic neurobehavioral effects can appear
after mixture exposure at doses considered safe for individual compounds and
these effects can be exacerbated by a coexistence with specific conditions such
as vitamin deficiency. However, there is an overall indication, derived from both
epidemiologic and laboratory evidence, supporting an association between exposure
to neurotoxic pesticides and cognitive dysfunction, dementia and Alzheimer's
disease.
Copyright © 2020 Elsevier B.V. All rights reserved.
DOI: 10.1016/j.toxlet.2020.03.005
PMID: 32145396 [Indexed for MEDLINE]
Conflict of interest statement: Declaration of Competing Interest The authors
declare that they have no conflict of interest.
4. Medicine (Baltimore). 2020 Feb;99(6):e19063. doi: 10.1097/MD.0000000000019063.
Comparison of severity index and plasma paraquat concentration for predicting
survival after paraquat poisoning: A meta-analysis.
Cao ZX(1), Zhao Y, Gao J, Feng SY, Wu CP, Zhai YZ, Zhang M, Nie S, Li Y.
Author information:
(1)Emergency Department, Cangzhou Central Hospital, No. 16 Xinhua Road, Yunhe Qu,
Cangzhou 061000, China.
BACKGROUND: Severity index and plasma paraquat (PQ) concentration can predict the
prognosis of patients with PQ poisoning. However, the better parameter is yet to
be systematically investigated and determined. Thus, we conduct this systematic
review and meta-analysis to investigate the prognostic value of severity index
and plasma PQ concentration in patients with PQ poisoning.
METHODS: We searched PubMed, Embase, Web of Science, ScienceDirect, and Cochrane
Library to identify all relevant papers that were published up to March 2019. All
diagnostic studies that compared severity index and plasma PQ concentration to
predict mortality in patients with PQ poisoning were enrolled in this
meta-analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) for
individual trials were pooled using a random-effect model. We also aggregated
heterogeneity testing, sensitivity analysis, and publication bias analysis.
RESULTS: Ultimately, seven studies involving 821 patients were included. The
pooled OR with a 95% CI of severity index was 24.12 (95% CI: 9.34-62.34,
P < .001), with an area under the curve of 0.88 (95% CI: 0.85-0.90), sensitivity
of 0.84 (95% CI: 0.74-0.91), and specificity of 0.81 (95% CI: 0.75-0.87).
Meanwhile, the pooled OR with 95% CI of plasma PQ concentration was 34.39 (95%
CI: 14.69-80.56, P < .001), with an area under the curve of 0.94 (95% CI:
0.91-0.96), sensitivity of 0.86 (95% CI: 0.75-0.93), and specificity of 0.89 (95%
CI: 0.76-0.95). Sensitivity analysis demonstrated the stability of the results of
our meta-analysis. No significant publication bias was observed in this
meta-analysis.
CONCLUSION: Overall, this study indicated that severity index and plasma PQ
concentration have relatively high-prognostic value in patients with PQ
poisoning, and that the sensitivity and specificity of plasma PQ concentration
are superior to those of severity index.
DOI: 10.1097/MD.0000000000019063
PMCID: PMC7015625
PMID: 32028427 [Indexed for MEDLINE]
5. Toxicol Lett. 2020 May 1;323:10-18. doi: 10.1016/j.toxlet.2020.01.022. Epub 2020
Jan 23.
Chloropicrin-induced toxicity in the respiratory system.
Pesonen M(1), Vähäkangas K(2).
Author information:
(1)Faculty of Health Science, School of Pharmacy/Toxicology, University of
Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland. Electronic address:
Maija.Pesonen@uef.fi.
(2)Faculty of Health Science, School of Pharmacy/Toxicology, University of
Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland.
Chloropicrin is a volatile and reactive chemical that has been utilized as a
warfare agent and a pesticide to fumigate soil against insects, fungi and
nematodes. It poses a health risk to humans and animals if inhaled. The main
source of chloropicrin exposure is occupational and occurs during its
manufacture, transport and fumigation. Chloropicrin is toxic via all routes of
exposure but the main route of systemic exposure is inhalation of the ambient
air. Thus, the toxicity mainly affects the respiratory system. After a low level
exposure, the first sign is irritation of the upper respiratory tract and eyes.
Irritation is mediated by the sensory nerve fibers, which coordinate further
activation of various protective reflexes. Chloropicrin-induced irritation is
generally reversible but can alter airway responsiveness to other inhalation
toxicants. Severe exposures cause injuries in the respiratory tract,
inflammation, and even life-threatening edema. Much of the chloropicrin-caused
symptoms and toxicity in the respiratory system displays similarities with those
evoked by chlorine, which is also a breakdown product of chloropicrin. This
review summarizes the latest information on chloropicrin with emphasis on the
toxicity in the respiratory system. The data indicates that oxidative stress,
modification of macromolecules, mutations, dysfunctions of cell organelles and
cell death are involved in acute chloropicrin-induced toxicity in the respiratory
system.
Copyright © 2020. Published by Elsevier B.V.
DOI: 10.1016/j.toxlet.2020.01.022
PMID: 31982502 [Indexed for MEDLINE]
Conflict of interest statement: Declaration of Competing Interest The authors
declare that there are no conflicts of interest.
6. Toxicol Lett. 2020 Jun 1;325:51-61. doi: 10.1016/j.toxlet.2020.01.017. Epub 2020
Jan 22.
Differences in biological activities between recombinant human paraoxonase 1
(rhPON1) subtype isozemys R/Q as antidotes against organophosphorus poisonings.
Cui Y(1), Zhao M(2), Han L(3).
Author information:
(1)Department of Emergency Medicine, Shengjing Hospital of China Medical
University, No. 36 Sanhao Street, Shenyang, 110004, China. Electronic address:
cuiyue_soaring@sina.com.
(2)Department of Emergency Medicine, Shengjing Hospital of China Medical
University, No. 36 Sanhao Street, Shenyang, 110004, China. Electronic address:
zhaom@sj-hospital.com.
(3)Specialist Clinics, Shengjing Hospital of China Medical University, No. 39
Huaxiang Road, Shenyang, 110022, China. Electronic address: Hanl@sj-hospital.org.
Paraoxonase 1 (PON1) is a type of aromatic esterase widely existing in mammals.
It can hydrolyze various kinds of compounds effectively in vivo and in vitro.
Previous studies have confirmed that PON1 can be used as antidote against
organophosphorus poisonings (OPs). In this study, we obtained two subtype
isozymes (i.e. rhPON1R192 and rhPON1Q192) by gene recombination and compared
their detoxification effects against different OPs in rats. The rhPON1R192
demonstrated better detoxification effect against chlorpyrifos poisoning than the
rhPON1Q192, whose detoxification effect against diazinon poisoning was prior to
the former. Both of them showed poor detoxification effect against trithion.
Therefore, we concluded that, to different OPs, better detoxification effect may
be achieved by selecting the PON1 subtype isozyme with higher specific hydrolytic
activity.
Copyright © 2020. Published by Elsevier B.V.
DOI: 10.1016/j.toxlet.2020.01.017
PMID: 31981688 [Indexed for MEDLINE]
Conflict of interest statement: Declaration of Competing Interest The author
declares that they have no conflict of interests.
7. Rev Saude Publica. 2020 Jan 20;54:09. doi: 10.11606/s1518-8787.2020054001455.
eCollection 2020.
Assessment of Primary Health Care for rural workers exposed to pesticides.
[Article in English, Portuguese]
Silvério ACP(1), Martins I(2), Nogueira DA(3), Mello MAS(4), Loyola EAC(4),
Graciano MMC(5).
Author information:
(1)Universidade José do Rosário Vellano. Curso de Medicina. Alfenas - MG, Brasil.
(2)Universidade Federal de Alfenas. Faculdade de Farmácia. Curso de pós-graduação
em Ciências Farmacêuticas. Alfenas - MG, Brasil.
(3)Universidade Federal de Alfenas. Instituto de Ciências Exatas. Programa de
pós-graduação em Estatística Aplicada e Biometria. Alfenas - MG, Brasil.
(4)Universidade José do Rosário Vellano. Faculdade de Medicina. Alfenas - MG,
Brasil.
(5)Universidade Federal de Lavras. Departamento de Ciências da Saúde. Alfenas-MG,
Brasil.
OBJECTIVE: To evaluate the attributes of Primary Health Care (PHC) for rural
workers; to analyze sociodemographic conditions, history of poisoning and
hospitalizations for pesticides and use of personal protective equipment; and to
verify exposure to pesticides by determining bioindicators.
METHODS: Cross-sectional, descriptive-analytical study with a sample of 1,027
rural workers living in municipalities belonging to a regional health department
in Southern Minas Gerais, whose PHC is governed by the Family Health Strategy
model. We used the adult version of the Primary Care Assessment Tool (PCATool
Brazil) and a structured questionnaire to collect socioeconomic data, history of
poisoning and hospitalization for pesticides and use of personal protective
equipment. Blood samples were collected to measure biomarkers of pesticide
exposure and signs of renal and hepatic sequelae.
RESULTS: Low education was prevalent, as well as the intense contact of workers
with pesticides. Frequent use of personal protective equipment was higher among
men, as was the history of poisoning and hospitalizations for pesticides. Rates
of 20% poisoning, 15% liver disease and 2% nephropathy were detected. Signs of
hepatotoxicity were more frequent in men. Gender differences were all
statistically significant. Regarding PHC, only the attribute "degree of
affiliation" had a high score. None of the poisoning cases detected in the study
were previously diagnosed.
CONCLUSIONS: Despite the high coverage of the Family Health Strategy,
occupational risk and its consequences have not been detected by health services,
which do not seem oriented to primary care, even lacking their essential
attributes. There is a need for immediate and effective adaptation of public
policies regarding the health of rural workers, with adequate training of teams
and review of the portfolio of PHC services offered.
DOI: 10.11606/s1518-8787.2020054001455
PMCID: PMC6961967
PMID: 31967278 [Indexed for MEDLINE]
8. Life Sci. 2020 Feb 15;243:117290. doi: 10.1016/j.lfs.2020.117290. Epub 2020 Jan
8.
Human amniotic mesenchymal stem cells alleviate paraquat-induced pulmonary
fibrosis in rats by inhibiting the inflammatory response.
He F(1), Wang Y(2), Li Y(3), Yu L(4).
Author information:
(1)Key Laboratory of Cell Engineering in Guizhou Province, The Affiliated
Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, PR China; Biological
Treatment Talent Base of Guizhou Province, The Affiliated Hospital of Zunyi
Medical University, Zunyi, Guizhou 563003, PR China; Zunyi Stem Cell and
Regenerative Medicine Engineering Research Center, The Affiliated Hospital of
Zunyi Medical University, Zunyi, Guizhou 563003, PR China. Electronic address:
hfwyyx@yeah.net.
(2)Key Laboratory of Cell Engineering in Guizhou Province, The Affiliated
Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, PR China; Biological
Treatment Talent Base of Guizhou Province, The Affiliated Hospital of Zunyi
Medical University, Zunyi, Guizhou 563003, PR China; Zunyi Stem Cell and
Regenerative Medicine Engineering Research Center, The Affiliated Hospital of
Zunyi Medical University, Zunyi, Guizhou 563003, PR China. Electronic address:
wangyuyingangle@163.com.
(3)Key Laboratory of Cell Engineering in Guizhou Province, The Affiliated
Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, PR China; Biological
Treatment Talent Base of Guizhou Province, The Affiliated Hospital of Zunyi
Medical University, Zunyi, Guizhou 563003, PR China; Zunyi Stem Cell and
Regenerative Medicine Engineering Research Center, The Affiliated Hospital of
Zunyi Medical University, Zunyi, Guizhou 563003, PR China. Electronic address:
814326940@qq.com.
(4)Key Laboratory of Cell Engineering in Guizhou Province, The Affiliated
Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, PR China; Biological
Treatment Talent Base of Guizhou Province, The Affiliated Hospital of Zunyi
Medical University, Zunyi, Guizhou 563003, PR China; Zunyi Stem Cell and
Regenerative Medicine Engineering Research Center, The Affiliated Hospital of
Zunyi Medical University, Zunyi, Guizhou 563003, PR China. Electronic address:
ylm720@yeah.net.
AIMS: To investigate the therapeutic effects of human amniotic mesenchymal stem
cells (hAMSCs) on paraquat (PQ)-induced pulmonary fibrosis in rats and
investigate the inflammatory mechanisms.
MAIN METHODS: hAMSCs were identified by morphological, flow cytometry and
immunocytochemistry. A pulmonary fibrosis model was induced by administering PQ
to rats. The hAMSCs group was treated with hAMSCs after 6 h of PQ poisoning. At
21 days after hAMSCs transplantation, lungs were harvested for H&E, Masson and
immunohistochemical staining to evaluate pulmonary histopathology, collagen
deposition, CD3+ cell infiltration and hAMSCs colonization. Arterial blood was
used for lactic acid analysis and venous blood was used to detect TNF-α, IL-6,
and TGF-β1 by ELISA method.
KEY FINDINGS: hAMSCs can improve the lung structure and decrease collagen
deposition induced by PQ. The membranes of CD3+ T cell in the PQ group were round
and complete, while that in the hAMSCs group rats exhibited punctate or diffuse
staining. In addition, the CD3+ cell was decreased by hAMSCs administration, and
MAB1281-positive cells were detected in lung of hAMSCs group rats. The survival
rate of the hAMSCs group was significantly higher than that of the PQ group at
21 days after injection. TNF-α, IL-6, TGF-β1 and lactic acid were significantly
decreased by hAMSCs administration.
SIGNIFICANCE: hAMSCs have a significant therapeutic effect on pulmonary fibrosis
induced by acute PQ poisoning and can improve survival rate in rats. Furthermore,
hAMSCs administration can improve lung histopathology and reduce collagen
deposition by reducing inflammatory CD3+ T cell infiltration, inflammatory
cytokine expression and lactic acid levels.
Copyright © 2020 Elsevier Inc. All rights reserved.
DOI: 10.1016/j.lfs.2020.117290
PMID: 31923420 [Indexed for MEDLINE]
Conflict of interest statement: Declaration of competing interest The authors
declare that there are no conflicts of interest.
9. PLoS One. 2020 Jan 10;15(1):e0209306. doi: 10.1371/journal.pone.0209306.
eCollection 2020.
ETAPOD: A forecast model for prediction of black pod disease outbreak in Nigeria.
Etaware PM(1), Adedeji AR(2), Osowole OI(3), Odebode AC(1).
Author information:
(1)Department of Botany, Faculty of Science, University of Ibadan, Ibadan, Oyo
State, Nigeria.
(2)Cocoa Research Institute of Nigeria (CRIN), Idi-Ayunre, Ibadan, Oyo State,
Nigeria.
(3)Department of Statistics, Faculty of Science, University of Ibadan, Ibadan,
Oyo State, Nigeria.
Food poisoning and environmental pollution are products of excessive chemical
usage in Agriculture. In Nigeria, cocoa farmers apply fungicides frequently to
control black pod disease (BPD), this practice is life threatening and lethal to
the environment. The development of a warning system to detect BPD outbreak can
help minimize excessive usage of fungicide by farmers. 8 models (MRM1-MRM8) were
developed and 5 (MRM1-MRM5) selected for optimization and performance check. MRM5
(ETAPOD) performed better than the other forecast models. ETAPOD had 100%
performance rating for BPD prediction in Ekiti (2009, 2010, 2011 and 2015) with
model efficiency of 95-100%. The performance of the model was rated 80% in 2010
and 2015 (Ondo) with model efficiency of 85-90%, 70% in 2011 (Osun) with model
efficiency of 81-84%, 60% in 2010 (Ondo and Osun) and 2015 (Osun) with model
efficiency of 75-80%, 40% in 2009 (Osun) with model efficiency of 65-69% and 0%
1n 2011 (Ondo) with model efficiency between 0 and 49%. ETAPOD is a simplified
BPD detection device for the past, present and future.
DOI: 10.1371/journal.pone.0209306
PMCID: PMC6953891
PMID: 31923186 [Indexed for MEDLINE]
Conflict of interest statement: The authors have declared that no competing
interests exist.
10. BMC Health Serv Res. 2020 Jan 9;20(1):30. doi: 10.1186/s12913-020-4891-6.
Doctors experiences on the quality of care for pesticide poisoning patients in
hospitals in Kampala, Uganda: a qualitative exploration using donabedian's model.
Ssemugabo C(1), Nalinya S(2), Halage AA(2), Neebye RM(2), Musoke D(2), Jørs E(3).
Author information:
(1)Department of Disease Control and Environmental Health, School of Public
Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala,
Uganda. cssemugabo@musph.ac.ug.
(2)Department of Disease Control and Environmental Health, School of Public
Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala,
Uganda.
(3)Department of Occupational and Environmental Medicine, Odense University
Hospital, Sdr, Boulevard 29, DK-5000, Odense C, Denmark.
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.
DOI: 10.1186/s12913-020-4891-6
PMCID: PMC6953287
PMID: 31918695 [Indexed for MEDLINE]
11. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Nov;31(11):1416-1422. doi:
10.3760/cma.j.issn.2095-4352.2019.11.020.
[Xuebijing improves clinical prognosis and reduces mortality in patients with
acute paraquat poisoning: a Meta-analysis included 1 429 patients].
[Article in Chinese]
Qian H(1), Liu B(2), Shen F(2), Wu Y(2), Yang H(1), Cheng Y(2), Yang G(1), Li
X(1), Zheng X(1), Qin J(1), Li S(1), He T(1).
Author information:
(1)Guizhou Medical University, Guiyang 550004, Guizhou, China.
(2)Department of Critical Care Medicine, the Affiliated Hospital of Guizhou
Medical University, Guiyang 550004, Guizhou, China. Corresponding author: Shen
Feng, Email: doctorshenfeng@163.com.
OBJECTIVE: To explore the therapeutic effect of Xuebijing on patients with acute
paraquat poisoning (APP) by using systematic evaluation method.
METHODS: PubMed, Cochrane Library, Embase, Wanfang database, China National
Knowledge Infrastructure (CNKI), VIP database (VIP) and China Biology Medicine
(CBM) were searched using the computers to find the literatures published about
the Xuebijing injection for the treatment of APP. Randomized controlled trials
(RCT) were retrieved from the establishment of the database to August 2019.
Patients in experimental group were treated with Xuebijing injection combined
with conventional treatment, while the patients in control group were only given
conventional treatment. The patients' outcome included the 14-day mortality,
arterial oxygen saturation (SaO2) and incidence of pulmonary fibrosis. In
addition, the 6-month survival rate, alanine aminotransferase (ALT), serum
creatinine (SCr), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α),
malondialdehyde (MDA) and superoxide dismutase (SOD) between the two groups were
compared. The literature data were extracted by two researchers independently,
and the quality of the literatures was evaluated according to the Cochrane 5.1
handbook. The Meta-analysis was performed by using RevMan 5.3 software. The
results stability of Meta-analysis was tested by sensitivity analysis. The
publication bias was analyzed through drawing of funnel diagram.
RESULTS: Twenty-seven RCT studies in total were enrolled, of which 26 were in
Chinese and 1 was in English. A total of 1 429 patients were enrolled, among whom
726 were in experimental group and another 703 were in control group.
Meta-analysis showed that compared with the control group, the 14-day mortality
[relative risk (RR) = 0.62, 95% confidence interval (95%CI) was 0.54 to 0.72, P <
0.000 01] and incidence of pulmonary fibrosis (RR = 0.67, 95%CI was 0.53 to 0.85,
P = 0.000 9) of patients in the experimental group were significantly lowered,
while SaO2 at 7 days and 14 days were significantly increased [7 days: mean
difference (MD) = 16.86, 95%CI was 9.89 to 23.83, P < 0.000 01; 14 days: MD =
16.51, 95%CI was 10.22 to 22.80, P < 0.000 01]. Compared with the control group,
the survival rate within 6 months (RR = 1.55, 95%CI was 1.41 to 1.71, P < 0.000
01) and SOD (MD = 13.88, 95%CI was 7.43 to 20.33, P < 0.000 1) of patients in the
experimental group were significantly increased, ALT at 14 days (MD = -78.35,
95%CI was -127.35 to -29.34, P = 0.000 5), SCr at 7 days and 14 days (7 days: MD
= -135.13, 95%CI was -219.09 to -51.17, P = 0.002; 14 days: MD = -206.05, 95%CI =
-290.13 to -121.96, P < 0.000 01), CRP (MD = -11.55, 95%CI was -17.77 to -5.33, P
= 0.000 3), TNF-α (MD = -9.27, 95%CI was -15.48 to -3.96, P = 0.000 9) and MDA
(MD = -1.27, 95%CI was -1.57 to -0.96, P < 0.000 01) were significantly lowered.
The overall effect value of the parameters with high heterogeneity was not
significantly changed after further Meta-analysis excluding any one of the
studies, suggesting that the result was relatively stable. Funnel chart analysis
was used to analyze the parameters from more than 10 articles enrolled, and it
showed that there was publication bias.
CONCLUSIONS: Xuebijing injection can reduce the mortality of patients with APP,
which may because that it can improve liver and kidney function, reduce
inflammation and oxidative stress damage, inhibit pulmonary fibrosis and increase
oxygenation level.
DOI: 10.3760/cma.j.issn.2095-4352.2019.11.020
PMID: 31898576 [Indexed for MEDLINE]
12. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Nov;31(11):1411-1415. doi:
10.3760/cma.j.issn.2095-4352.2019.11.019.
[Using of pre-hospital emergency resources by acute alcoholism patients in a
hospital in Guangzhou: a data survey from 2009 to 2018].
[Article in Chinese]
Zhu Y(1), Lu H(1), Han J(1), Jiang H(1), Li S(2), Chen X(1), Lin P(1).
Author information:
(1)Department of Emergency, the Second Affiliated Hospital of Guangzhou Medical
University, Guangzhou 510260, Guangdong, China.
(2)Guangzhou Emergency Command Center, Guangzhou 510260, Guangdong, China.
Corresponding author: Lin Peiyi, Email: linpeiyi@163.com.
OBJECTIVE: To analyze the using of pre-hospital emergency resources and treatment
characteristics of acute alcoholism patients in Guangzhou.
METHODS: The pre-hospital emergency data of the emergency department of the
Second Affiliated Hospital of Guangzhou Medical University from January 1st in
2009 to December 31st in 2018 were obtained from the database of the Guangzhou
Emergency Medical Command Center. The related data of patients with acute
alcoholism were collected, including gender, age, poisoning severity, treatment
results, caller type, number of empty vehicles (empty vehicle was defined as the
empty vehicle return caused by the ambulance who did not receive or refused to
come to the hospital after the ambulance leaved), departure time (from the
ambulance to the completion time), on-site time (from the ambulance to the
patient boarding time) and the distribution of pre-hospital emergency time in 24
hours on weekdays and weekends. The relationship between acute alcoholism
patients and the peak of in-hospital emergency treatment was analyzed.
RESULTS: A total of 2 408 acute alcoholism patients were recorded, among whom 2
109 patients (87.58%) with acute alcoholism,126 (5.23%) with drug poisoning, 67
(2.78%) with chemical poisoning, 3 (0.13%) with pesticide poisoning, and 103
(4.28%) with other poisoning. Acute alcoholism patients were mainly male, with a
total of 1 862 cases (88.29%), and the ratio between males and females was
7.54:1. In 2 109 patients with acute alcoholism, 93.41% were in the age range of
18-59 years old. The number of mild patients was 1 717 (81.41%), 1 178 (55.86%)
needed further treatment, and no patient died. For the occupation of pre-hospital
emergency resources, 43.24% (912/2 109) of acute alcoholism called 120 through
110 with empty vehicles of 36.79% (776/2 109), which were significantly higher
than the acute cerebrovascular disease [3.83% (362/9 461), 5.80% (549/9 461),
both P < 0.01], acute trauma [24.29% (1 708/7 033), 7.96% (560/7 033), both P <
0.01], acute circulation system disease [2.44% (90/3 694), 2.87% (106/3 694),
both P < 0.01], and acute respiratory system disease [0.86% (31/3 606), 1.58%
(57/3 606), both P < 0.01]. Furthermore, empty vehicles were more likely to
happen through 110 with empty vehicles rate of 51.75% (472/912), which was
significantly higher than that through the witness [40.82% (60/147), P < 0.01]
and relatives and friends [23.24% (244/1 050), P < 0.01]. The driving time and
on-site time of acute alcoholism were significantly shorter than those of acute
cerebrovascular disease, acute circulation system disease, and acute respiratory
system disease [driving time (minutes): 26 (20, 34) vs. 34 (26, 45), 38 (29, 49),
38 (29, 50); on-site time (minutes): 6 (4, 10) vs. 10 (7, 14), 10 (7, 15), 10 (8,
15), all P < 0.01], but there was no statistical difference as compared with
acute trauma [driving time (minutes): 26 (20, 34) vs. 29 (20, 42), on-site time
(minutes): 6 (4, 10) vs. 7 (4, 11), both P > 0.05]. The regularity of variation
in number of critically acute alcoholism patients was distinctive, which peaked
in the period of 21:00-00:00 and bottomed out in the period of 09:00-13:00, which
overlapped with the peak flow in the hospital emergency department (17:00-22:00).
CONCLUSIONS: Acute alcoholism patients occupy excessive pre-hospital emergency
resources, and overlap with the hospital emergency treatment peak. It is
necessary to strengthen the public propaganda and education on the rational usage
of 120 emergency resources and reduce waste.
DOI: 10.3760/cma.j.issn.2095-4352.2019.11.019
PMID: 31898575 [Indexed for MEDLINE]
13. Medicine (Baltimore). 2020 Jan;99(1):e18136. doi: 10.1097/MD.0000000000018136.
Fetal outcomes after intentional ingestion of paraquat: A case report.
Chen J(1)(2), Jian X(1), Yu G(1), Si M(1), Kan B(1).
Author information:
(1)Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong
University, Jinan, Shandong.
(2)Department of Intensive Care Unite, The Second Affiliated Hospital and Yuying
Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China.
RATIONALE: Despite the fact that treatment of paraquat poisoning in pregnant
women and their fetuses is challenging and raises ethical issues, it is rarely
reported in the literature. We report the case of a pregnant woman who took
paraquat intentionally.
PATIENT CONCERNS: A 36-year-old woman at 38 weeks gestational age, in an apparent
suicide attempt, drank 1 mouthful (about 20 ml) of paraquat solution. Ten hours
later, her urine dithionate test showed light blue color with a plasma paraquat
concentration of 0.547 μg/ml. Six hours after admission, a male infant, whose
plasma paraquat concentration was 0.761 μg/ml, together with 0.673 μg/ml in the
amniotic fluid measured by high-performance liquid chromatography, was delivered
but the woman's lung, liver, and kidney function declined rapidly.
DIAGNOSIS: INTERVENTIONS:: Because of placenta previa and multiple organ failure,
emergency cesarean section, and panhysterectomy were performed for the pregnant
woman. Intravenous injection of antibiotic to prevent infection and dexamethasone
30 mg once a day were administered. Mechanical ventilation was performed for the
infant and meropenem and penicillin injection was administered.
OUTCOMES: The infant died 33 hours after birth while the mother died on the 3rd
day after ingestion.
LESSONS: Paraquat can enter the fetus through the placenta and the amniotic fluid
via fluid exchange. The pathological changes of fetal organs may relate to
gestational age, and the prognosis was very poor in both the mother and the
fetus.
DOI: 10.1097/MD.0000000000018136
PMCID: PMC6946536
PMID: 31895766 [Indexed for MEDLINE]
14. Lancet Psychiatry. 2020 Jan;7(1):9-11. doi: 10.1016/S2215-0366(19)30478-X.
Preventing suicide through pesticide regulation.
Eddleston M(1), Gunnell D(2).
Author information:
(1)Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh
EH16 4TJ, UK. Electronic address: m.eddleston@ed.ac.uk.
(2)Population Health Sciences, Bristol Medical School, University of Bristol,
Bristol, UK.
DOI: 10.1016/S2215-0366(19)30478-X
PMID: 31860459 [Indexed for MEDLINE]
15. Soud Lek. 2019 Fall;64(4):42-43.
Medicolegal implication of an autopsy case of methidathion ingestion.
Naoko T, Hiroshi K, Mitsuru K, Mostofa J, Asuka I, Kunihiko T, Shoji K, Kiyoshi
A.
We present an autopsy case involving ingestion of methidathion, an
organothiophosphate pesticide. A headspace gas chromatography mass spectrometry
system was used for screening of volatile compounds. Subsequent toxicological
analysis was performed using liquid chromatography tandem mass spectrometry.
Xylene and ethylbenzene were detected in stomach contents. We also identified
methidathion at concentrations of 3.07 and 2240 µg/ml in femoral venous blood and
stomach contents, respectively. We concluded that the victim ingested
methidathion insecticide, with an estimated dose of at least 9.2 g.
PMID: 31842549 [Indexed for MEDLINE]
16. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2019 Nov 20;37(11):877-880. doi:
10.3760/cma.j.issn.1001-9391.2019.11.021.
[Progress in treatment of acute aluminum phosphide poisoning].
[Article in Chinese; Abstract available in Chinese from the publisher]
Lu MF(1), Nie SN(2).
Author information:
(1)Department of Emergency Medicine, General Hospital of Eastern Theater Command,
Nanjing 210002, China; Department of Emergency Medicine, Northern Jiangsu
People's Hospital Affiliated to Yangzhou University, Yangzhou 225000, China.
(2)Department of Emergency Medicine, General Hospital of Eastern Theater Command,
Nanjing 210002, China.
Aluminum phosphide (ALP) is frequently used for grain conservation despite its
high toxicity. In some developing countries increased utilization of ALP has
resulted in increment of ALP-attributed poisoning numbers. The mortality of ALP
poisoning is extremely high and no effective antidote is available so far.
However, the astute survey of potential misconceptions in the course of acute
toxicity has led some scientists to introduce novel therapeutic approaches.
Meanwhile, some new antioxidants were discovered and expected to be used in the
management of ALP poisoning. In addition, the progress in intensive care has
promoted technologies such as CRRT, IABP and ECMO for the treatment of ALP
poisoning with reported success in alleviating severe toxicity. Recent studies on
the therapy of ALP poisoning are reviewed in this article.
Publisher: 磷化铝（aluminum
phosphide，ALP）是一种具有高毒性的谷物熏蒸剂。在一些发展中国家，ALP的频繁使用导致中毒的患者数量增加。ALP中毒的死亡率极高且目前尚无特效的解毒剂。
对急性毒性过程探讨的不断深入引入了新的治疗手段。某些新的可能有效的抗氧化剂有望应用于治疗ALP中毒。此外，重症监护医学的发展促进了持续肾脏替代治疗（CRRT）、主
动脉内球囊反搏（IABP）和体外膜肺氧合（ECMO）等技术的临床应用，已有部分成功的AlP中毒救治案例报道。我们对近年来急性磷化铝中毒治疗的研究进展进行综述。.
DOI: 10.3760/cma.j.issn.1001-9391.2019.11.021
PMID: 31838827 [Indexed for MEDLINE]
17. J Chromatogr B Analyt Technol Biomed Life Sci. 2020 Jan 1;1136:121880. doi:
10.1016/j.jchromb.2019.121880. Epub 2019 Nov 23.
Fabrication of benzenesulfonic acid groups modified magnetic microspheres as an
MSPE adsorbent for fast determination of paraquat and diquat in human urine
combined with UPLC-HRMS.
Pan S(1), Zhang J(2), He Q(3), Chen X(4), Jin M(4).
Author information:
(1)Zhejiang Provincial Key Laboratory of Health Risk Appraisal for Trace Toxic
Chemicals, Ningbo Municipal Center for Disease Control and Prevention, Ningbo,
Zhejiang 315010, China. Electronic address: panshengdong0714@163.com.
(2)Enriching Biotechnology (Shanghai) Co. Ltd, 1688 North Guoquan Road, Shanghai
200438, China.
(3)National Institute of Occupational Health and Poison Control, Chinese Center
for Disease Control and Prevention, Beijing 100050, China.
(4)Zhejiang Provincial Key Laboratory of Health Risk Appraisal for Trace Toxic
Chemicals, Ningbo Municipal Center for Disease Control and Prevention, Ningbo,
Zhejiang 315010, China.
In this study, novel benzenesulfonic acid groups modified magnetic microspheres
(Fe3O4@SiO2@poly(4-VB)) were synthesized and characterized by scanning electron
microscopy (SEM), transmission electron microscopy (TEM), Fourier-transform
infrared spectrometry (FTIR), and vibrating sample magnetometer (VSM). The
as-prepared Fe3O4@SiO2@poly(4-VB) was employed as a magnetic-phase extraction
(MSPE) adsorbent for rapid determination of paraquat (PQ) and diquat (DQ) in
human urine samples coupled with ultra-high performance liquid
chromatography-high resolution mass spectrometry (UPLC-HRMS). Moreover, this
paper had expounded systematically the mass spectrum cracking mechanisms of PQ
and DQ. And a zwitterionic functionalized SIELC Obelisc R column was employed for
separation and retention of the above two polar herbicides using 50 mmol/L
ammonium formate (pH = 3.7)-acetonitrile as the mobile phase. Besides, the
adsorption and desorption conditions of Fe3O4@SiO2@poly(4-VB) toward PQ and DQ
were optimized in spiking urine samples to obtain the best adsorption and
desorption efficiencies. And the adsorption mechanisms of Fe3O4@SiO2@poly(4-VB)
toward PQ and DQ referred to synergetic effect of electrostatic attraction and
π-π interaction. Under the optimal conditions, the inter-day and intra-day
spiking recoveries of the proposed method were in the range of 86.7-109.9% with
RSDs less than 10%. The limits of detection (LODs) were obtained by spiking in
blank urine samples at a series of low concentrations and were found to be
0.12 μg/L and 0.14 μg/L for PQ and DQ, respectively, which were lower than the
comparing literatures. The developed analytical method was proven to be simple,
rapid, sensitive, and accurate for clinical poisoning analysis.
Copyright © 2019 Elsevier B.V. All rights reserved.
DOI: 10.1016/j.jchromb.2019.121880
PMID: 31805401 [Indexed for MEDLINE]
18. Biomed Res Int. 2019 Oct 30;2019:7901760. doi: 10.1155/2019/7901760. eCollection
2019.
Validity and Reliability of an Assessment Tool for the Screening of Neurotoxic
Effects in Agricultural Workers in Chile.
Lucero B(1), Ceballos PA(2), Muñoz-Quezada MT(1), Reynaldos C(1), Saracini C(1),
Baumert BO(3).
Author information:
(1)The Neuropsychology and Cognitive Neurosciences Research Center (CINPSI
Neurocog), Faculty of Health Sciences, Universidad Católica del Maule, Talca
3460000, Chile.
(2)Department of Nursery, Faculty of Health Sciences, Universidad Católica del
Maule, Talca 3460000, Chile.
(3)Department of Environmental Health, Rollins School of Public Health, Emory
University, Atlanta, GA 30322, USA.
There is a substantial use of pesticides within the agricultural industry of
Chile, with neurotoxic effects through mechanisms of acetylcholinesterase
inhibition. These pesticides result in deterioration in health, increasing the
risk of diseases such as Parkinson's and Alzheimer's in highly exposed
occupational population. To date, there are no brief assessment tools to monitor
cognitive impairment in agricultural workers chronically exposed to these
pesticides. Method. 234 agricultural workers and 305 nonagricultural workers were
assessed two times (test-retest) through a brief tool which comprised three tests
(clock-drawing test (CDT); frontal assessment battery (FAB); trail making tests
(TMT) A and B). The full scale of WAIS-IV was administered as a gold standard to
18% of the sample of agricultural workers. Factor analysis was used to evaluate
the factor structure, and validity and test-retest reliability were assessed
concurrently. Results. Cronbach's alpha values were satisfactory or above
(>0.60). Test-retest correlations were all significantly correlated (p < 0.001).
All the tests had a significant correlation with the full scale IQ score of
WAIS-IV (p < 0.05). The Kaiser-Meyer-Olkin (KMO) measure was 0.74, and the
Bartell sphericity test = p < 0.001. Three factors explaining 61.62% of the
variance were extracted. Two items of the FAB test were dropped of the final
factor solution. Normative data transformed into percentile scores and stratified
by age and educational level were obtained for Chilean agricultural workers.
Conclusion. The brief assessment tool has adequate metric properties as a
screening instrument. This allows for a simple administration test (10 to 15
minutes) that can potentially be used for the rapid monitoring of cognitive
deterioration in the face of occupational exposure to pesticides in agricultural
workers.
Copyright © 2019 Boris Lucero et al.
DOI: 10.1155/2019/7901760
PMCID: PMC6875037
PMID: 31781643 [Indexed for MEDLINE]
Conflict of interest statement: The authors declare that there are no conflicts
of interest regarding the publication of this paper.
19. Glob Health Action. 2019;12(1):1692616. doi: 10.1080/16549716.2019.1692616.
Estimating the government health-care costs of treating pesticide poisoned and
pesticide self-poisoned patients in Sri Lanka.
Ahrensberg H(1), Madsen LB(1), Pearson M(2)(3), Weerasinghe M(2)(4), Eddleston
M(2)(3), Jayamanne S(2)(5), Hansen KS(6), Ariyarathna V(2), Rajapaksha S(2),
Konradsen F(1)(2).
Author information:
(1)Section of Global Health, Department of Public Health, University of
Copenhagen, Copenhagen, Denmark.
(2)South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of
Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
(3)Pharmacology, Toxicology & Therapeutics, University/BHF Centre for
Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
(4)Department of Community Medicine, Faculty of Medicine & Allied Sciences,
Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.
(5)Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.
(6)Department of Health Services Research, Department of Public Health,
University of Copenhagen, Copenhagen, Denmark.
Background: Pesticide self-poisoning as a method of suicide is a major global
health problem.Objectives: To estimate the cost and per patient cost of treating
pesticide self-poisoning at different hospital levels in a Sri Lankan district,
and to examine the distribution of cost components. Another objective was to
investigate changes in total cost of treatment of pesticide poisoning for all
causes at different administrative levels in Sri Lanka in 2005 and 2015.Methods:
The economic framework was a costing analysis, adopting a government perspective.
Cost data were collected prospectively over a 4-month period in 2016 for patients
admitted for pesticide self-poisoning to six hospitals in the Anuradhapura
District. Assumption-based scenario analyses were run to determine changes in
total pesticide poisoning treatment costs.Results: We included 67 self-poisoned
patients in the study. The total cost of treatment was US$ 5,714 at an average
treatment cost of US$ 85.3 (9.7-286.6) per patient (across all hospital levels).
Hospital costs constituted 67% of the total cost for treating self-poisoning
cases and patient-specific costs accounted for 29%. Direct cost of patient
hospital transfer constituted the smallest share of costs (4%) but accounted for
almost half of the total costs at primary level. The estimated total cost of
treating all causes of pesticide poisoning in Sri Lanka was US$ 2.5 million or
0.19% of the total government health expenditure (GHE) in 2015.Conclusion: Our
findings indicate that the average per patient cost of pesticide self-poisoning
treatment has increased while the total cost of pesticide poisoning treatment as
a percentage of the total GHE in Sri Lanka has declined over the past decade. A
continuous focus on banning the most hazardous pesticides available would likely
further drive down the cost of pesticide self-poisoning and pesticide poisoning
to the government.
DOI: 10.1080/16549716.2019.1692616
PMCID: PMC6896413
PMID: 31775583 [Indexed for MEDLINE]
20. Food Chem. 2020 May 1;311:125897. doi: 10.1016/j.foodchem.2019.125897. Epub 2019
Nov 16.
Preparing monoclonal antibodies and developing immunochromatographic strips for
paraquat determination in water.
Li Y(1), Liu L(1), Kuang H(1), Xu C(2).
Author information:
(1)State Key Laboratory of Food Science and Technology, Jiangnan University,
Wuxi, People's Republic of China; International Joint Research Laboratory for
Biointerface and Biodetection, and School of Food Science and Technology,
Jiangnan University, Wuxi, People's Republic of China.
(2)State Key Laboratory of Food Science and Technology, Jiangnan University,
Wuxi, People's Republic of China; International Joint Research Laboratory for
Biointerface and Biodetection, and School of Food Science and Technology,
Jiangnan University, Wuxi, People's Republic of China. Electronic address:
xcl@jiangnan.edu.cn.
Paraquat (PQ) poisoning is a serious threat to human health that leads to
pulmonary toxicity, neurotoxicity, and inflammation. Protecting humans from PQ
exposure requires the development of rapid analytical methods for on-site
detection. Here, two monoclonal antibodies against PQ were generated and an
immunochromatographic assay (ICA) was exploited to determine PQ concentrations in
water samples. The results showed that the monoclonal antibody 1D6 exhibited
higher affinity and sensitivity, with an affinity constant of 5.4 × 108 mol/L and
a limit of detection as low as 0.02 ng/mL. Without sample pretreatment, the
developed ICA method provided visible limits of detection ranging from 0.25 to
1 ng/mL, and cut-off limits ranging from 1 to 5 ng/mL, where average recoveries
were between 83.15% ± 1.9% and 94.49% ± 2.45% with a coefficient of variation
ranging from 1.40% to 7.37%. Importantly, these observations were consistent with
liquid chromatography tandem mass spectrometry. These data and results suggested
that the ICA method was a reliable, portable, and high-throughput method for
determining PQ residues in water samples.
Copyright © 2019 Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.foodchem.2019.125897
PMID: 31771914 [Indexed for MEDLINE]
21. BMJ Case Rep. 2019 Nov 24;12(11). pii: e230044. doi: 10.1136/bcr-2019-230044.
Unusual presentation of haemoptysis following accidental inhalation of the
'superwarfarin' rodenticide brodifacoum.
Love RL(1), Sharma N(2), Chong K(3).
Author information:
(1)Department of Respiratory Medicine, East and North Hertfordshire NHS Trust,
Stevenage, UK ryan.love@nhs.net.
(2)Department of Radiology, East and North Hertfordshire NHS Trust, Stevenage,
UK.
(3)Department of Respiratory Medicine, East and North Hertfordshire NHS Trust,
Stevenage, UK.
Haemoptysis is a worrying symptom for patients and can represent a diagnostic
challenge for clinicians. We present the case of a 56-year-old woman who
presented to the emergency department with acute haemoptysis and associated
sudden-onset dyspnoea. The patient remained haemodynamically stable and there was
no demonstrable drop in haemoglobin concentration. Following rigorous
investigations, on further questioning, the patient recalled inadvertent
inhalation of the rodenticide brodifacoum. This exposure was deemed to represent
the cause of their acute haemoptysis, which subsequently fully resolved without
intervention.
© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and
permissions. Published by BMJ.
DOI: 10.1136/bcr-2019-230044
PMID: 31767603 [Indexed for MEDLINE]
Conflict of interest statement: Competing interests: None declared.
22. Medicine (Baltimore). 2019 Nov;98(47):e18086. doi: 10.1097/MD.0000000000018086.
Extracorporeal treatment in children with acute severe poisoning.
Sun X(1)(2), Chen X(1)(2), Lu J(1)(2), Tao Y(1)(2), Zhang L(1)(2), Dong L(1)(2).
Author information:
(1)Department of Pediatrics.
(2)Key Laboratory of Birth Defects and Related Diseases of Women and Children,
Ministry of Education, West China Second University Hospital, Sichuan University,
Chengdu, Sichuan, China.
Acute poisoning in children is a clinical emergency. Prompt and effective
treatment is critical for life-threatening poisoning. Extracorporeal treatment
(ECTR) is a practical option for enhancing the elimination of poisons.We
conducted a retrospective observational study on 338 children with severe acute
poisoning who received ECTR during hospitalization from January 2010 to December
2017. The poisonous substances, utilization of ECTR, adverse reactions to ECTR,
and outcomes were recorded.The top 3 poisoning categories, in order of frequency,
were found to be pesticides (57.99%), biotoxins (25.15%), and pharmaceuticals
(14.20%). Paraquat (35.21%), an organic heterocyclic herbicide with high toxicity
to humans, was the most common toxic substance. The main modalities of ECTR use
were hemoperfusion (50.59%) and therapeutic plasma exchange (42.60%), followed by
continuous renal replacement therapy (4.44%) and hemodialysis (1.18%). There were
also 4 patients (1.18%) with a combination of ECTR performed. Adverse events of
ECTR included errhysis and hematomas around the catheter exit site, oral cavity
bleeding, allergic reactions, hypothermia, hypotension, and blood coagulation.
The adverse reactions were mostly mild to moderate and were manageable. During
the study period, there were 295 patients (87.28%) who were cured, 9 (2.66%) who
experienced some improvement, and 34 (10.06%) who died.ECTR modalities were found
to be clinically effective approaches to the treatment of poisoning by
pesticides, biotoxins, and pharmaceuticals, indicating they are important
modalities in toxicology and treatment, and are well tolerated by children.
DOI: 10.1097/MD.0000000000018086
PMCID: PMC6882618
PMID: 31764843 [Indexed for MEDLINE]
23. BMJ Case Rep. 2019 Nov 21;12(11). pii: e230966. doi: 10.1136/bcr-2019-230966.
Clinical effects from household insecticide: pyrethroid or organophosphate
toxicity?
Basrai Z(1), Koh C(2), Celedon M(2), Warren J(3).
Author information:
(1)Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles,
California, USA zahir.basrai@va.gov.
(2)Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles,
California, USA.
(3)David Geffen School of Medicine, Los Angeles, California, USA.
A 54-year-old man with a history of schizophrenia presented to the emergency room
for weakness with associated lacrimosis, drooling, nausea, emesis, diarrhoea,
diplopia and burning sensation on his skin that began 6 hours after spraying five
cans of Raid on his carpet. He was noted to have miotic pupils and hyperactive
bowel sounds. Given the clinical presentation, the patient was diagnosed with
organophosphate (OP) toxicity. After being admitted, he developed symptoms
associated with his OP toxicity and was successfully treated with atropine and
pralidoxime. Most Raid products contain pyrethroids; however, both OPs and
pyrethroids are available in commercial pesticides and patients may misidentify
ingestions. There are limited data reporting the toxicity of pyrethroid overdose
in humans and to guide its subsequent treatment. It is crucial to keep a low
threshold for diagnosing and treating patients with acute onset of symptoms
suspicious for an OP or pyrethroid toxidrome.
© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and
permissions. Published by BMJ.
DOI: 10.1136/bcr-2019-230966
PMID: 31753823 [Indexed for MEDLINE]
Conflict of interest statement: Competing interests: None declared.
24. J Environ Sci Health B. 2020;55(3):273-282. doi: 10.1080/03601234.2019.1690342.
Epub 2019 Nov 20.
An LC-MS/MS method for creatine and creatinine analysis in paraquat-intoxicated
patients.
Sukhang M(1), Junkuy A(1), Buckley N(2)(3), Mohamed F(2)(3)(4), Wunnapuk K(1).
Author information:
(1)Toxicology Unit, Department of Forensic Medicine, Faculty of Medicine, Chiang
Mai University, Chiang Mai, Thailand.
(2)South Asian Clinical Toxicology Research Collaboration, University of
Peradeniya, Peradeniya, Sri Lanka.
(3)Clinical Pharmacology and Toxicology Research Group, Discipline of
Pharmacology, Faculty of Medicine and Health, The University of Sydney, Sydney,
New South Wales, Australia.
(4)Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri
Lanka.
A sudden increase in serum creatinine after paraquat intoxication has been
reported in several clinical studies. However, this dramatic change of creatinine
may be possibly due to an interconversion of creatine-creatinine in relation to
paraquat toxicity. In order to investigate the creatine-creatinine relationship,
a liquid chromatography tandem mass spectrometry in combination with electrospray
ionization was developed and validated for simultaneous determination of creatine
and creatinine in the serum. The chromatographic separation was achieved on a
Gemini® C6-Phenyl column with a gradient elution consisting of 0.1% formic acid
in ultrapure water and methanol as the mobile phase. The method yielded suitable
levels of specificity and selectivity, and calibration curves of creatine and
creatinine in serum were linear over the concentration range of 0.5-200 µg mL-1.
The limit of quantification of both compounds was 0.5 µg mL-1, and the method was
accurate within the recovery range of 96.23-102.75%, indicating the robustness of
the method. The method was successfully applied to toxicological samples from
paraquat-intoxicated patients, and the concentrations of creatine and creatinine
were quantified. High creatine concentrations in serum samples were observed
which may lead to high serum creatinine despite normal kidney function as
creatine is converted to creatinine in proportion to its concentration.
DOI: 10.1080/03601234.2019.1690342
PMID: 31744381 [Indexed for MEDLINE]
25. PLoS One. 2019 Nov 19;14(11):e0225416. doi: 10.1371/journal.pone.0225416.
eCollection 2019.
Multimorbidity and complex multimorbidity in Brazilian rural workers.
Petarli GB(1), Cattafesta M(1), Sant'Anna MM(2), Bezerra OMPA(3), Zandonade E(1),
Salaroli LB(4).
Author information:
(1)Postgraduate Program in Collective Health, Health Sciences Center, Federal
University of Espírito Santo, Vitória, Espírito Santo, Brazil.
(2)Center for Health Sciences, Federal University of Espírito Santo, Vitória,
Brazil.
(3)Department of Family Medicine, Mental and Collective Health, Medical school,
Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil.
(4)Postgraduate program in Nutrition and Health, and Graduate Program in
Collective Health, Center for Health Sciences, Federal University of Espírito
Santo, Vitória, Espírito Santo, Brazil.
OBJECTIVE: To estimate the prevalence of multimorbidity and complex
multimorbidity in rural workers and their association with sociodemographic
characteristics, occupational contact with pesticides, lifestyle and clinical
condition.
METHODS: This is a cross-sectional epidemiological study with 806 farmers from
the main agricultural municipality of the state of Espírito Santo/Brazil,
conducted from December 2016 to April 2017. Multimorbidity was defined as the
presence of two or more chronic diseases in the same individual, while complex
multimorbidity was classified as the occurrence of three or more chronic
conditions affecting three or more body systems. Socio-demographic data,
occupational contact with pesticides, lifestyle data and clinical condition data
were collected through a structured questionnaire. Binary logistic regression was
conducted to identify risk factors for multimorbidity.
RESULTS: The prevalence of multimorbidity among farmers was 41.5% (n = 328), and
complex multimorbidity was 16.7% (n = 132). More than 77% of farmers had at least
one chronic illness. Hypertension, dyslipidemia and depression were the most
prevalent morbidities. Being 40 years or older (OR 3.33, 95% CI 2.06-5.39),
previous medical diagnosis of pesticide poisoning (OR 1.89, 95% CI 1.03-3.44),
high waist circumference (OR 2.82, CI 95% 1.98-4.02) and worse health
self-assessment (OR 2.10, 95% CI 1.52-2.91) significantly increased the chances
of multimorbidity. The same associations were found for the diagnosis of complex
multimorbidity.
CONCLUSION: We identified a high prevalence of multimorbidity and complex
multimorbidity among the evaluated farmers. These results were associated with
increased age, abdominal fat, pesticide poisoning, and poor or fair health
self-assessment. Public policies are necessary to prevent, control and treat this
condition in this population.
DOI: 10.1371/journal.pone.0225416
PMCID: PMC6863555
PMID: 31743369 [Indexed for MEDLINE]
Conflict of interest statement: The authors have declared that no competing
interests exist.
26. Braz J Infect Dis. 2019 Nov - Dec;23(6):410-418. doi: 10.1016/j.bjid.2019.10.003.
Epub 2019 Nov 4.
Infectivity of Simulium damnosum s.l. and therapeutic coverage of ivermectin
distribution 10 years post treatment around Owena Dam, Ondo state, Nigeria.
Akinsanya B(1), Adewale B(2), Adenusi A(3), Lawal A(1), Rahman O(2).
Author information:
(1)University of Lagos, Faculty of Science, Department of Zoology, Parasitology
Unit, Nigeria.
(2)Nigerian Institute of Medical Research, Public Health and Epidemiology
Department, Lagos, Nigeria.
(3)University of Lagos, Lagos, Department of Medical microbiology and
Parasitology, Nigeria.
BACKGROUND: Studies related to infectivity status of insect vectors are seen as
necessities in understanding the epidemiology of vector-borne diseases and
planning effective control measures. This study assessed the infectivity
ofSimulium damnosum s.l. around Owena River as well as evaluated therapeutic
coverage of Ivermectin distribution in the area.
METHOD: Human landing sampling method was used to collect adult flies on human
attractants from 07:00 to 18:00 for two consecutive days a month for three months
(July 2016 - September 2016). Parity assessment was conducted to determine the
age of fly populations. Parous flies were further dissected to detect the
presence or absence ofOnchocerca larvae. Biting rates and transmission potentials
were calculated using standard methods. A quantitative survey was carried out to
determine the therapeutic coverage and compliance to ivermectin treatment for the
control of Onchocerciasis in the study area using standard household coverage
questionnaires.
RESULTS: A total of 914 adult female flies were collected during the study
period. The daily biting rate (DBR) varied from 146 fly per man day (FMD) in July
to 162.5 FMD in August. The monthly biting rate (MBR) was lowest in September
(2170 bites per man per month) but highest in August (3358.3 bites per man per
month). MBD ranged from 13.23 fly per man hour (FMH) in July to 14.77 FMH in
August. The results indicated that the majority of the flies collected at the
sampling points were nulliparous [685 (74.95%)] while others were parous [229
(25.05%)]. The biting activity of the flies showed a marked decrease in
population in August compared to July which later increased in September.
Infection rates varied from 2 (0.7%) in July to 7 (2.2%) in August while the
infectivity rate during the study ranged from zero (July and September) to 3
(1.0%) in August.
CONCLUSION: Despite the years of treatment of onchocerciasis in Owena community,
there were still some infective flies capable of transmitting O. volvolus. This
could be due to the low rate of therapeutic coverage as a result of
non-compliance in the community for various reasons earlier stated.
Copyright © 2019 Sociedade Brasileira de Infectologia. Published by Elsevier
España, S.L.U. All rights reserved.
DOI: 10.1016/j.bjid.2019.10.003
PMID: 31697923 [Indexed for MEDLINE]
27. J Med Case Rep. 2019 Nov 5;13(1):327. doi: 10.1186/s13256-019-2234-1.
Heroin overdose masquerades as methomyl poisoning: a case report.
Amornlertwatana Y(1), Narongchai P(2), Narongchai S(1).
Author information:
(1)Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University,
Chiang Mai, 50200, Thailand.
(2)Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University,
Chiang Mai, 50200, Thailand. paitoon.narongchai@cmu.ac.th.
BACKGROUND: Methomyl is the most common cause of suicidal death but heroin is the
most common cause of accidental death. The problem is to determine the exact
cause and manner of death between methomyl or heroin toxicity. The evidence from
autopsy includes crime scene investigation, toxicological analysis by liquid
chromatography with mass spectrometry, and knowledge of methomyl and heroin
intoxication.
CASE PRESENTATION: A 35-year-old Thai man and a 30-year-old Thai woman were found
showing evidence of cyanosis, with a fine froth around the nose and mouth.
Postmortem interval time was 24 hours. According to the police's and hotel
owner's records, the couple stayed together for 1 day before being found dead in
bed, naked, with a foul and a fine froth around the nose and mouth. A methomyl
insecticide sachet and a plastic box containing white powder form of heroin were
found at the scene. Laboratory tests of the male corpse identified the presence
of methomyl in the blood of the stomach and morphine, codeine, methadone, and
tramadol in the systemic blood. Blood cholinesterase enzyme activity and morphine
concentration was 3416 U/L or 53% (normal 6400 U/L) and 0.058 μg/ml respectively.
Laboratory test of the female corpse identified the presence of methomyl in the
stomach and blood, and cholinesterase enzyme activity was 1965 U/L or 30.7%.
CONCLUSIONS: Cause of death of the male corpse was deemed to be due to heroin
intoxication as the blood concentration of morphine was more than the lethal
concentration with a morphine/codeine ratio of more than 1:1. Methomyl
intoxication of the male corpse was unlikely to be the cause of death because
methomyl systemic blood concentration was found to be very low, < 2.5 μg/ml, and
cholinesterase enzyme levels did not indicate lethal activity (< 10-15% of
normal). The main problem regarding an insurance claim is that the policy will
not pay out in the case of heroin-associated deaths, as it is an addictive drug.
The policy would pay out on death by suicide with methomyl insecticide, which was
not prohibited by the insurance company after 1 year of insurance. So, it is not
clear whether or not the family will receive money from the insurance company.
DOI: 10.1186/s13256-019-2234-1
PMCID: PMC6829933
PMID: 31690350 [Indexed for MEDLINE]
28. BMC Public Health. 2019 Oct 22;19(1):1344. doi: 10.1186/s12889-019-7613-4.
Protective practices against tick bites in Denmark, Norway and Sweden: a
questionnaire-based study.
Jepsen MT(1)(2), Jokelainen P(3), Jore S(4), Boman A(5), Slunge D(6), Krogfelt
KA(7)(8)(9).
Author information:
(1)Department of Bacteria, Parasites and Fungi, Statens Serum Institut,
Copenhagen, Denmark. martintjepsen@gmail.com.
(2)Department of Virus and Microbiology Special Diagnostics, Statens Serum
Institut, Copenhagen, Denmark. martintjepsen@gmail.com.
(3)Department of Bacteria, Parasites and Fungi, Statens Serum Institut,
Copenhagen, Denmark.
(4)Norwegian Institute of Public Health, Oslo, Norway.
(5)Department of Economics, University of Gothenburg, Gothenburg, Sweden.
(6)Gothenburg Centre for Sustainable Development, GMV, University of Gothenburg,
Gothenburg, Sweden.
(7)Department of Bacteria, Parasites and Fungi, Statens Serum Institut,
Copenhagen, Denmark. kak@ssi.dk.
(8)Department of Virus and Microbiology Special Diagnostics, Statens Serum
Institut, Copenhagen, Denmark. kak@ssi.dk.
(9)Department of Science and Environment, Roskilde University, Roskilde, Denmark.
kak@ssi.dk.
BACKGROUND: Tick-borne infections are of emerging and increasing concern in the
Scandinavian countries Denmark, Norway and Sweden. Only few studies have
investigated protective practices against tick bites in the general population.
The aim of this multi-country study was to assess the use of protective practices
and the perception of the efficacy of them.
METHODS: We surveyed the extent of using protective practices against tick bites,
using the same questionnaire in three local languages. In addition, we surveyed
perceptions of how good a protection the different practices provide. Altogether
783 individuals from Denmark, 789 from Norway and 1096 from Sweden participated
in the study by completing an extensive online questionnaire in October 2016.
RESULTS: Altogether 1011 respondents (37.9%) reported using at least three
different protective practices either often or always when in areas where there
are ticks, while 522 (19.6%) reported using none. Female gender was among the
factors identified as positively associated with using several of the specific
practices often or always when in areas where there are ticks. The
gender-difference in extent of using protective practices against tick bites was
particularly pronounced in Sweden. Based on a multivariable logistic regression
model, being female, being from Sweden, and having experienced one or more tick
bites were positively associated with using at least three different protective
practices against tick bites either often or always when in areas where there are
ticks (odds ratios 1.90, 1.87 and 1.88, respectively).
CONCLUSIONS: The results of our study, especially the observed differences by
country and by gender, can be useful in targeting future information to the
public. In particular, our results suggest that men across all ages should be
considered a specific target group for this information.
DOI: 10.1186/s12889-019-7613-4
PMCID: PMC6805683
PMID: 31640665 [Indexed for MEDLINE]
29. J Ethnopharmacol. 2020 Jan 30;247:112299. doi: 10.1016/j.jep.2019.112299. Epub
2019 Oct 10.
Protective role of cinnabar and realgar in Hua-Feng-Dan against LPS plus
rotenone-induced neurotoxicity and disturbance of gut microbiota in rats.
Chen C(1), Zhang BB(1), Hu AL(1), Li H(1), Liu J(2), Zhang F(3).
Author information:
(1)Key Laboratory of Basic Pharmacology of Ministry of Education and Joint
International Research Laboratory of Ethnomedicine of Ministry of Education,
Zunyi Medical University, Zunyi, Guizhou, China.
(2)Key Laboratory of Basic Pharmacology of Ministry of Education and Joint
International Research Laboratory of Ethnomedicine of Ministry of Education,
Zunyi Medical University, Zunyi, Guizhou, China. Electronic address:
Jie@liuonline.com.
(3)Key Laboratory of Basic Pharmacology of Ministry of Education and Joint
International Research Laboratory of Ethnomedicine of Ministry of Education,
Zunyi Medical University, Zunyi, Guizhou, China. Electronic address:
zhangfengzmc@163.com.
ETHNOPHARMACOLOGICAL RELEVANCE: Hua-Feng-Dan (HFD) is a traditional Chinese
medicine used for neurological disorders. HFD contains cinnabar (HgS) and realgar
(As4S4). The ethnopharmacological basis of cinnabar and realgar in HFD is not
known.
AIM OF THE STUDY: To address the role of cinnabar and realgar in HFD-produced
neuroprotection against neurodegenerative diseases and disturbance of gut
microbiota.
MATERIALS AND METHODS: Lipopolysaccharide (LPS) plus rotenone (ROT)-elicited rat
dopaminergic (DA) neuronal damage loss was performed as a Parkinson's disease
animal model. Rats were given a single injection of LPS. Four months later, rats
were challenged with the threshold dose of ROT. The clinical dose of HFD was
administered via feed, starting from ROT administration for 46 days. Behavioral
dysfunction was detected by rotarod and Y-maze tests. DA neuron loss and
microglial activation were assessed via immunohistochemical staining and western
bolt analysis. The colon content was collected to extract bacterial DNA followed
by real-time PCR analysis with 16S rRNA primers.
RESULTS: LPS plus ROT induced neurotoxicity, as evidenced by DA neuron loss in
substantia nigra, impaired behavioral functions and increased microglial
activation. HFD-original (containing 10% cinnabar and 10% realgar) rescued loss
of DA neurons, improved behavioral dysfunction and attenuated microglial
activation. Compared with HFD-original, HFD-reduced (3% cinnabar and 3% realgar)
was also effective, but to be a less extent, while HFD-removed (without cinnabar
and realgar) was ineffective. In analysis of gut microbiome, the increased
Verrucomicrobiaceae and Lactobacteriaceae, and the decreased Enterobacteeriaceae
by LPS plus ROT were ameliorated by HFD-original, and to be the less extent by
HFD-reduced.
CONCLUSION: Cinnabar and realgar are active ingredients in HFD to exert
beneficial effects in a neurodegenerative model and gut microbiota.
Copyright © 2019. Published by Elsevier B.V.
DOI: 10.1016/j.jep.2019.112299
PMID: 31606537 [Indexed for MEDLINE]
30. Biomedica. 2019 Sep 1;39(3):478-490. doi: 10.7705/biomedica.4255.
Knowledge, attitudes, and practices about dengue among pupils from rural schools
in an endemic area in Colombia
[Article in English, Spanish; Abstract available in Spanish from the publisher]
Sarmiento-Senior D(1), Matiz MI, Jaramillo-Gómez JF, Olano VA, Vargas SL,
Alexander N, Lenhart A, Stenström TA, Overgaard HJ.
Author information:
(1)Instituto de Salud y Ambiente, Universidad El Bosque, Bogotá, D.C., Colombia.
sarmientodiana@unbosque.edu.co.
INTRODUCTION: Dengue is a public health problem in tropical and subtropical
regions of the world. Studies on dengue in rural areas are scarce since the
disease is considered mainly urban.
OBJECTIVE: To determine the knowledge (K), attitudes (A) and practices (P) of
dengue in an endemic area in Colombia.
MATERIALS AND METHODS: We conducted a cross-sectional study with 515 pupils (7-16
years old) in 34 rural schools in Anapoima and La Mesa municipalities during
2011. Each KAP category was evaluated independently by a scoring system and then
categorized into high, medium or low.
RESULTS: Pupils recognized knowledge variables such as the symptoms (fever, bone
pain), transmission route (mosquito bites), and mosquito breeding sites
(uncovered water tanks, solid waste). Average scores on attitude were high in
both municipalities indicating a well-developed perception of disease severity.
Seeking treatment in medical centers and self-medication for fever management and
the use of mosquito net and space-spraying of insecticides were the most
frequently identified practices.
DISCUSSION: This is the first KAP dengue study performed in a rural area in
Colombia and as such it contributes to the understanding of dengue perceptions by
the inhabitants of these areas. It showed a medium level of knowledge about
dengue and a lower level of preventive practices in pupils from rural schools. It
also showed that pupils considered space-spraying as crucial for vector control.
The presence of the vector in rural areas of the country underlines the need to
improve surveillance and education to more effectively control the vector and
promote prevention methods including community participation.
Publisher: Introducción. El dengue es un problema de salud pública en las
regiones tropicales y subtropicales del mundo. Los estudios sobre la enfermedad
en áreas rurales son escasos debido a que se presenta principalmente en los
núcleos urbanos. Objetivo. Determinar los conocimientos, las actitudes y las
prácticas sobre el dengue en un área rural endémica en Colombia. Materiales y
métodos. Se hizo un estudio transversal con 515 estudiantes, entre los 7 y los 16
años de edad en 34 escuelas rurales de los municipios de Anapoima y La Mesa en el
2011. Cada categoría se evaluó por separado con un puntaje clasificado como alto,
medio o bajo. Resultados. Los estudiantes reconocieron los síntomas (fiebre,
dolor de huesos), la ruta de transmisión (picadura de mosquitos) y los criaderos
(depósitos de agua destapados, residuos sólidos). El promedio de los puntajes de
actitudes fue alto en ambos municipios, lo que indica que percibían la gravedad
del dengue. Las prácticas más frecuentes de tratamiento de la fiebre fueron la
consulta médica y la automedicación, en tanto que los métodos de control más
frecuentes fueron el uso de mosquiteros y el rociamiento con insecticidas.
Discusión. Este es el primer estudio de conocimientos, actitudes y prácticas
sobre el dengue en un área rural de Colombia. Los resultados contribuyen a
entender las percepciones de la enfermedad en sus habitantes y evidenciaron
niveles medios de conocimiento y puntuaciones bajas en cuanto a las prácticas
entre los estudiantes de las escuelas rurales. Los estudiantes consideraron que
la fumigación es importante para el control del vector. La presencia del mosquito
en áreas rurales del país resalta la necesidad de mejorar la vigilancia y la
educación para lograr un control efectivo del vector y promover métodos de
prevención que incluyan la participación comunitaria.
DOI: 10.7705/biomedica.4255
PMID: 31584762 [Indexed for MEDLINE]
31. PLoS One. 2019 Oct 2;14(10):e0222617. doi: 10.1371/journal.pone.0222617.
eCollection 2019.
Transgenic cotton and farmers' health in Pakistan.
Kouser S(1), Spielman DJ(2), Qaim M(3).
Author information:
(1)Department of Economics, COMSATS University Islamabad, Islamabad, Pakistan.
(2)Environment and Production Technology Division, International Food Policy
Research Institute, Washington, DC, United States of America.
(3)Department of Agricultural Economics and Rural Development, University of
Goettingen, Germany.
Despite substantial research on the economic effects of transgenic
insect-resistant Bacillus thuringiensis (Bt) cotton, there is still limited work
on this technology's impacts on human health. Due to the inbuilt insect
resistance, Bt cotton requires fewer pesticide sprays than conventional cotton,
which is not only advantageous from economic and environmental perspectives, but
may also result in health benefits for farmers. Using socioeconomic and
biophysical data from Pakistan, we provide the first evidence of a direct
association between Bt gene expression in the plant and health benefits. A key
feature of this study is that Bt cotton cultivation in Pakistan occurs in a
poorly regulated market: farmers are often mistaken in their beliefs about
whether they have planted Bt cotton or conventional cotton, which may affect
their pesticide-use strategies and thus their pesticide exposure. We employ a
cost-of-illness approach and variations in the measurement of Bt adoption to
estimate the relationship between Bt cotton and farmers' health. Bt adoption
based on farmers' beliefs does not reduce the pesticide-induced cost of illness.
However, adoption based on measuring Bt gene expression is associated with
significant health cost savings. Extrapolating the estimates for true Bt seeds to
Pakistan's entire Bt cotton area results in annual health cost savings of around
US$ 7 million. These findings have important implications for the regulation of
seed markets in Pakistan and beyond: improved regulations that ensure claimed
crop traits are really expressed can increase the benefits for farmers and
society at large.
DOI: 10.1371/journal.pone.0222617
PMCID: PMC6774528
PMID: 31577819 [Indexed for MEDLINE]
Conflict of interest statement: The authors have declared that no competing
interests exist.
32. Am J Public Health. 2019 Nov;109(11):1548-1556. doi: 10.2105/AJPH.2019.305260.
Conceptual Frameworks in Scientific Inquiry and the Centers for Disease Control
and Prevention's Approach to Pesticide Toxicity (1948-1968).
Washburn R(1).
Author information:
(1)Rachel Washburn is with the Department of Sociology at Loyola Marymount
University, Los Angeles, CA.
Comment in
Am J Public Health. 2019 Nov;109(11):1487-1488.
This article examines the rise of the Centers for Disease Control and
Prevention's (CDC's) small but influential program on the human toxicology of
synthetic pesticides after World War II. For nearly 20 years, scientists working
in the CDC's Toxicology Section conducted a range of laboratory, field, and
clinical studies to assess whether pesticides, such as
dichlorodiphenyltrichloroethane (DDT), caused harm to humans. Applying an
industrial hygiene approach to study pesticide toxicity, the team used the
symptoms of poisoning as their criteria for harm and consistently found that,
when used as intended, pesticides were generally safe for humans. In the
post-Silent Spring era, these findings were increasingly challenged as the field
of toxicology developed and different ways of understanding pesticide toxicity
gained greater acceptance. While it is easy to dismiss the CDC's findings as
excessively narrow, examining how the team arrived at their conclusions provides
an instructive lesson about the powerful ways conceptual frameworks shape
scientific inquiry and the unexpected ways data can be reinterpreted in different
problem contexts. (Am J Public Health. 2019;109:1548-1556. doi:
10.2105/AJPH.2019.305260).
DOI: 10.2105/AJPH.2019.305260
PMID: 31577488 [Indexed for MEDLINE]
33. J Clin Pharm Ther. 2019 Dec;44(6):958-962. doi: 10.1111/jcpt.13005. Epub 2019 Sep
26.
Bromadiolone poisoning leading to subarachnoid haemorrhage: A case report and
review of the literature.
Zuo W(1), Zhang X(2), Chang JB(2), Ma WB(2), Wei JJ(2).
Author information:
(1)Department of Pharmacy, Peking Union Medical College Hospital, Peking Union
Medical College, Chinese Academy of Medical Sciences, Beijing, China.
(2)Department of Neurosurgery, Peking Union Medical College Hospital, Peking
Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
WHAT IS KNOWN AND OBJECTIVE: Many cases of rodenticide poisoning have been
reported. Bromadiolone, often called a super-warfarin, is a second-generation
dicoumarin rodenticide with long half-life. The main clinical manifestations of
bromadiolone poisoning are excessive or inappropriate bleeding of skin mucosa,
digestive tract and urinary tract. However, the phenomenon of central nervous
system (CNS) toxicity is an uncommon medical emergency. We present a case of SAH
and intracerebral haematoma mediated by bromadiolone intoxication, revealing that
bromadiolone poisoning might cause intracerebral haematoma.
CASE DESCRIPTION: A 44-year-old woman presented with skin mucosa haemorrhage and
haematuresis initially. The patient developed lethargy, headache, nausea and
vomiting. The toxicology test result revealed that the presence of bromadiolone
in her blood. Coagulation test results showed a longer prothrombin time (PT),
activated partial thromboplastin time (APTT) and a high international normalized
ratio (INR). SAH, frontal lobe haematoma, midline shift and brain oedema were
discovered by skull CT examination. The coagulation disorders were addressed
after the treatment of vitamin K and fresh frozen plasma. The intracranial
symptoms were relieved after surgery and the treatment with mannitol.
WHAT IS NEW AND CONCLUSION: This case suggests that bromadiolone poisoning should
be diagnosed and treated as early as possible. Bromadiolone poisoning might cause
SAH and intracerebral haematoma, which is rare but potentially lethal. It is
important to strengthen the diagnosis and post-treatment monitoring.
© 2019 John Wiley & Sons Ltd.
DOI: 10.1111/jcpt.13005
PMID: 31556967 [Indexed for MEDLINE]
34. Chemosphere. 2020 Jan;238:124753. doi: 10.1016/j.chemosphere.2019.124753. Epub
2019 Sep 4.
Characterization of boscalid-induced oxidative stress and neurodevelopmental
toxicity in zebrafish embryos.
Wang H(1), Meng Z(1), Liu F(1), Zhou L(1), Su M(1), Meng Y(1), Zhang S(2), Liao
X(1), Cao Z(1), Lu H(3).
Author information:
(1)Jiangxi Engineering Laboratory of Zebrafish Modeling and Drug Screening for
Human Diseases, Jiangxi Key Laboratory of Developmental Biology of Organs, Ji'an,
Jiangxi, China; Center for Developmental Biology of Jinggangshan University,
College of Life Sciences, Jinggangshan University, Ji'an, Jiangxi, China.
(2)Department of General Surgery, Jiangxi Provincial Children's Hospital,
Nanchang, 330006, PR China.
(3)Jiangxi Engineering Laboratory of Zebrafish Modeling and Drug Screening for
Human Diseases, Jiangxi Key Laboratory of Developmental Biology of Organs, Ji'an,
Jiangxi, China; Center for Developmental Biology of Jinggangshan University,
College of Life Sciences, Jinggangshan University, Ji'an, Jiangxi, China.
Electronic address: luhq2@126.com.
Boscalid is a widely used fungicide in agriculture and has been frequently
detected in both environments and agricultural products. However, evidence on the
neurotoxic effect of boscalid is scarce. In this study, zebrafish served as an
animal model to investigate the toxic effects and mechanisms of boscalid on
aquatic vertebrates or higher animals. And we unravelled that boscalid induced
developmental defects associated with oxidative stress. Developmental defects,
including head deformity, hypopigmentation, decreased number of newborn neurons,
structural defects around the ventricle, enlarged intercellular space in the
brain, and nuclear concentration, were observed in zebrafish embryos after
boscalid exposure at 48 hpf. Interestingly, we found that boscalid might directly
induce oxidative stress and alter the activity of ATPase, which in turn disrupted
the expression of genes involved in neurodevelopment and transmitter-transmitting
signalings and melanocyte differentiation and melanin synthesis signalings.
Ultimately, the differentiation of nerve cells and melanocytes were both impacted
and the synthesis of melanin was inhibited, leading to morphological
abnormalities. Additionally, exposure to boscalid led to less and imbalance
motion and altered tendency of locomotor in larval fish. Collectively, our
results provide new evidences for a comprehensive assessment of its toxicity and
a warning for its residues in environment and agricultural products.
Copyright © 2019 Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.chemosphere.2019.124753
PMID: 31545217 [Indexed for MEDLINE]
35. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Aug;31(8):1043-1044. doi:
10.3760/cma.j.issn.2095-4352.2019.08.027.
[Experience of continuous fluid therapy in successfully rescuing a patient with
acute severe paraquat poisoning].
[Article in Chinese]
Feng E(1), Cheng Y, Tan Z, Wang H.
Author information:
(1)Department of Critical Care Medicine, Shouguang People's Hospital Affiliated
to Weifang Medical College, Shouguang 262700, Shandong, China. Corresponding
author: Cheng Youlin, Email: sdicu@126.com.
OBJECTIVE: Paraquat (PQ) poisoning has become one of the common pesticide
poisoning in China. PQ is extremely toxic to human beings. The fatality rate of
oral PQ poisoning is more than 90%. So far, there is no specific antidote. Seek
effective treatment measures for PQ poisoning has become the focus of clinical
medical research. In November 2017, a patient with acute severe PQ poisoning was
treated in the intensive care unit (ICU) of Shouguang People's Hospital
Affiliated to Weifang Medical College. The patient refused blood purification
therapy and was rescued successfully only by continuous fluid therapy, diuresis,
catharsis and routine treatment. By reviewing the treatment process of this case,
new treatment ideas for the clinical treatment of PQ poisoning in primary
hospitals were provided. Patients with acute PQ poisoning should be rescued by
immediate administration of emetic, gastric lavage, catharsis and oral
montmorillonite powder. For those without dysfunction of heart, lung and and
kidney, a large amount of fluid treatment and diuresis should be given
immediately to promote the excretion of poison. The key to improve the success
rate of rescue of acute PQ poisoning is to eliminate PQ from the body as soon as
possible.
DOI: 10.3760/cma.j.issn.2095-4352.2019.08.027
PMID: 31537237 [Indexed for MEDLINE]
36. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Aug;31(8):1013-1017. doi:
10.3760/cma.j.issn.2095-4352.2019.08.020.
[Early white blood cell count in predicting mortality after acute paraquat
poisoning: a Meta-analysis].
[Article in Chinese]
Li Y(1), Zhang H(2), Zhang G(1).
Author information:
(1)Department of Emergency, the First Affiliated Hospital of Henan University of
Science and Technology, Luoyang 471003, Henan, China.
(2)Department of Emergency, the Second Affiliated Hospital of Henan University of
Science and Technology, Luoyang 471003, Henan, China. Corresponding author: Zhang
Guoxiu, Email: znjkxzhh@163.com.
OBJECTIVE: To evaluate the prognostic value of early white blood cell count (WBC)
in patient of acute paraquat poisoning.
METHODS: The literatures about the studies on early WBC and prognosis after
paraquat poisoning published in journals at home and abroad were searched. The
Chinese literature database contained CNKI, VIP, Wanfang Database, and China
Biomedicine Database (CBM), and the journals were limited to the core journals.
The foreign language database included PubMed, Embase and Cochrane library
clinical controlled trial database. The retrieval date was from the initial
publication to April 22nd in 2019, without the limitation of languages. Two
researchers independently extracted literature information, and the
Newcastle-Ottawa Scale (NOS) was used to evaluate literature quality. The odds
ratio (OR), sensitivity, specificity, positive likelihood ratio (PLR), negative
likelihood ratio (NLR), diagnostic odds ratio (DOR) and the area under the
summary receiver operating characteristic (SROC) were combined and analyzed
through the Stata 15.0 software to evaluate the predictive value of early WBC
after acute paraquat poisoning. Publication bias was analyzed by Deeks funnel
graph.
RESULTS: There were 7 retrospective studies and 1 prospective study in a total of
980 paraquat poisoning patients, 5 of them were English literatures, the others
were Chinese literatures. There was no heterogeneity among the studies (I2 =
43.5%, P > 0.05). The OR and its 95% confidence interval (95%CI) of the
literature was combined through the fixed effect model. The Meta-analysis results
were statistically significant (OR = 18.63, 95%CI = 13.63-25.48, P < 0.001),
suggesting that the WBC was significantly correlated with the mortality of
patients. The combined sensitivity, specificity, PLR, NLR and DOR were 0.75
(95%CI = 0.66-0.82), 0.85 (95%CI = 0.80-0.90), 5.14 (95%CI = 3.86-6.86), 0.29
(95%CI = 0.22-0.39), 17.53 (95%CI = 12.23-25.13) respectively, and the area under
the SROC of the WBC was 0.88 (95%CI = 0.85-0.91). Deeks funnel plot was
symmetrical (P = 0.21), and there was no obvious publication bias.
CONCLUSIONS: The early WBC has a certain predictive value for the prognosis of
acute paraquat poisoning patients.
DOI: 10.3760/cma.j.issn.2095-4352.2019.08.020
PMID: 31537230 [Indexed for MEDLINE]
37. Malar J. 2019 Sep 18;18(1):314. doi: 10.1186/s12936-019-2958-9.
Eave ribbons treated with transfluthrin can protect both users and non-users
against malaria vectors.
Mwanga EP(1), Mmbando AS(2), Mrosso PC(2), Stica C(2), Mapua SA(2), Finda
MF(2)(3), Kifungo K(2), Kafwenji A(2), Monroe AC(2)(4)(5)(6), Ogoma SB(2), Ngowo
HS(2)(3), Okumu FO(2)(3)(7).
Author information:
(1)Environmental Health and Ecological Sciences Department, Ifakara Health
Institute, Morogoro, Tanzania. emwanga@ihi.or.tz.
(2)Environmental Health and Ecological Sciences Department, Ifakara Health
Institute, Morogoro, Tanzania.
(3)Institute of Biodiversity, Animal Health and Comparative Medicine, University
of Glasgow, Glasgow, G12 8QQ, UK.
(4)Johns Hopkins Center for Communication Programs, Baltimore, MD, USA.
(5)University of Basel, Basel, Switzerland.
(6)Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.
(7)School of Public Health, University of Witwatersrand, Johannesburg, South
Africa.
BACKGROUND: Eave ribbons treated with spatial repellents effectively prevent
human exposure to outdoor-biting and indoor-biting malaria mosquitoes, and could
constitute a scalable and low-cost supplement to current interventions, such as
insecticide-treated nets (ITNs). This study measured protection afforded by
transfluthrin-treated eave ribbons to users (personal and communal protection)
and non-users (only communal protection), and whether introducing mosquito traps
as additional intervention influenced these benefits.
METHODS: Five experimental huts were constructed inside a 110 m long, screened
tunnel, in which 1000 Anopheles arabiensis were released nightly. Eave ribbons
treated with 0.25 g/m2 transfluthrin were fitted to 0, 1, 2, 3, 4 or 5 huts,
achieving 0, 20, 40, 60, 80 and 100% coverage, respectively. Volunteers sat near
each hut and collected mosquitoes attempting to bite them from 6 to 10 p.m.
(outdoor-biting), then went indoors to sleep under untreated bed nets, beside
which CDC-light traps collected mosquitoes from 10 p.m. to 6 a.m.
(indoor-biting). Caged mosquitoes kept inside the huts were monitored for
24 h-mortality. Separately, eave ribbons, UV-LED mosquito traps (Mosclean) or
both the ribbons and traps were fitted, each time leaving the central hut
unfitted to represent non-user households and assess communal protection. Biting
risk was measured concurrently in all huts, before and after introducing
interventions.
RESULTS: Transfluthrin-treated eave ribbons provided 83% and 62% protection
indoors and outdoors respectively to users, plus 57% and 48% protection indoors
and outdoors to the non-user. Protection for users remained constant, but
protection for non-users increased with eave ribbons coverage, peaking once 80%
of huts were fitted. Mortality of mosquitoes caged inside huts with eave ribbons
was 100%. The UV-LED traps increased indoor exposure to users and non-users, but
marginally reduced outdoor-biting. Combining the traps and eave ribbons did not
improve user protection relative to eave ribbons alone.
CONCLUSION: Transfluthrin-treated eave ribbons protect both users and non-users
against malaria mosquitoes indoors and outdoors. The mosquito-killing property of
transfluthrin can magnify the communal benefits by limiting unwanted diversion to
non-users, but should be validated in field trials against pyrethroid-resistant
vectors. Benefits of the UV-LED traps as an intervention alone or alongside eave
ribbons were however undetectable in this study. These findings extend the
evidence that transfluthrin-treated eave ribbons could complement ITNs.
DOI: 10.1186/s12936-019-2958-9
PMCID: PMC6751741
PMID: 31533739 [Indexed for MEDLINE]
38. Environ Sci Pollut Res Int. 2019 Nov;26(32):33135-33145. doi:
10.1007/s11356-019-06457-4. Epub 2019 Sep 13.
A study of the predictive factors of mortality in acute poisoning with aluminum
phosphide with special reference to echocardiography and SOFA score.
Sheta AA(1), El-Banna AS(2), Elmeguid RA(1), Mohamed HE(3), Gad NH(1).
Author information:
(1)Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine,
Alexandria University, Alexandria, Egypt.
(2)Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine,
Alexandria University, Alexandria, Egypt. elbanna.asmaa@yahoo.com.
(3)Department of Critical Care Medicine, Faculty of Medicine, Alexandria
University, Alexandria, Egypt.
Aluminum phosphide (AlP) is considered now one of the most common causes of
poisoning among agricultural pesticides. Poisoning with AlP is extremely toxic to
humans with high mortality rate. The aim of this work was to evaluate the
prognostic factors and outcome of acute aluminum phosphide poisoning in
Alexandria Main University Hospital during a period of 6 months from 1 November
2017 until the end of April 2018, highlighting the role of SOFA score and
echocardiography in predicting the mortality. The prospective study was conducted
on all patients admitted with acute AlP poisoning to Alexandria Main University
Hospital for those 6 months. Patients' data were collected in a special sheet and
included biosocial data, medical history, poisoning history, complete medical
examination, investigations, duration of hospital stay, and the outcome. All
patients were assessed according to SOFA score on admission. Thirty patients were
admitted during the period of the current study. Females outnumbered males in all
age groups with a sex ratio of 2.75:1. The mean age of patients was 22.77 ± 12.79
years. 96.6% of patients came from rural areas. 93.3% of the cases were exposed
to poisoning at home, where suicidal poisoning accounted for (86.7%) of cases.
43.3% of patients died (n = 13), and the median value of SOFA score among
non-survivors was 10, versus 1 among survivors. The median value of ejection
fraction among non-survivors (25%) was half its value in survivors (50%).
Although there were many predictors of severity of AlP poisoning, SOFA score was
the most predictive factor of mortality detected by multivariate analysis.
DOI: 10.1007/s11356-019-06457-4
PMID: 31520378 [Indexed for MEDLINE]
39. Medicine (Baltimore). 2019 Sep;98(37):e17199. doi: 10.1097/MD.0000000000017199.
Neutrophil-lymphocyte ratio as an early predictor for patients with acute
paraquat poisoning: A retrospective analysis.
Cao ZX(1), Song YQ, Bai WJ, Wang WJ, Zhao Y, Zhang SL, Feng SY.
Author information:
(1)Emergency Department, Cangzhou Central Hospital, Yunhe Qu, Cangzhou City,
China.
This retrospective study aimed to investigate whether the neutrophil-lymphocyte
ratio (NLR) can be used as an early predictor of 90-day survival in patients with
acute paraquat (PQ) poisoning.This study enrolled 105 patients with acute PQ
poisoning admitted from May 2012 to May 2018. Kaplan-Meier curve, receiver
operating characteristic curve, and Cox proportional hazards regression analyses
were used to investigate the predictive value of NLR for 90-day survival of
patients with acute PQ poisoning.The 90-day survival rate was 40.95% (43/105).
Survivors had lower NLR (P <.001), which was an independent predictor of 90-day
survival according to the Cox proportional hazard regression analyses. The area
under the NLR curve was 0.842 (95% CI: 0.767-0.917, P <.001) in predicting 90-day
survival.Our findings showed that low NLR was a valuable early predictor of
90-day survival in patients with acute PQ poisoning.
DOI: 10.1097/MD.0000000000017199
PMCID: PMC6750259
PMID: 31517877 [Indexed for MEDLINE]
40. Arch Toxicol. 2019 Oct;93(10):3037-3038. doi: 10.1007/s00204-019-02555-x. Epub
2019 Sep 10.
Highlight report: hepatotoxicity of triazole fungicides.
Albrecht W(1).
Author information:
(1)Leibniz Research Centre for Working Environment and Human Factors, Ardeystr.
67, 44139, Dortmund, Germany. albrecht@ifado.de.
Comment on
Arch Toxicol. 2019 May;93(5):1311-1322.
DOI: 10.1007/s00204-019-02555-x
PMID: 31506785 [Indexed for MEDLINE]
41. Medicine (Baltimore). 2019 Sep;98(36):e17015. doi: 10.1097/MD.0000000000017015.
Synthetic cannabinoid-associated coagulopathy secondary to long-acting
anticoagulant rodenticides: Observational case series and management
recommendations.
Bahouth MN(1), Kraus P(2), Dane K(2), Plazas Montana M(3), Tsao W(4), Tabaac
B(1), Jasem J(3), Schmidlin H(2), Einstein E(5), Streiff MB(3), Shanbhag S(3).
Author information:
(1)Cerebrovascular Division, Department of Neurology.
(2)Department of Pharmacy.
(3)Department of Hematology, Johns Hopkins Hospital.
(4)Department of Neurology, Johns Hopkins School of Medicine.
(5)Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview
Medical Center, Baltimore, Maryland.
Synthetic cannabinoids have become increasingly popular drugs of abuse due to low
cost and inability to detect these substances on routine drug screenings. In the
United States, incidence of synthetic cannabinoid contamination with long-acting
anticoagulant rodenticides (LAARs) resulting in coagulopathy and bleeding
complications has been described.We sought to describe the natural history,
management approach, and outcomes of bleeding secondary to synthetic
cannabinoid-associated LAAR toxicity in an observational case series of patients
evaluated at an urban academic medical system.We conducted an observational study
of patients with suspected exposure to LAAR-contaminated synthetic cannabinoids
and associated bleeding treated within the Johns Hopkins Health System.In this 16
subject cohort, hematuria was the most common bleeding symptom at presentation.
The majority of the cohort (75%) had international normalized ratio (INR) > 9.6
at presentation. Of the 13 patients with brodifacoum testing, 12/13 (92%) were
positive. Twelve patients (75%) had at least 1 INR value below 2 within 24 hours
of the first INR measurement. Of this cohort, 1/16 (6%) died in hospital. The
median length of hospital stay was 4 days, (interquartile range = 3-6). The
average cost of pharmacological treatment for coagulopathy during inpatient
hospitalization was $5300 (range, $2241-$8086).In patients presenting with
unexplained coagulopathy it is important for emergency department providers to
consider LAAR intoxication and consider formal testing for brodifacoum to assist
with treatment planning. Use of a standardized management algorithm including
intravenous/oral vitamin K, judicious use of blood products and close laboratory
monitoring is essential to optimizing outcomes.
DOI: 10.1097/MD.0000000000017015
PMCID: PMC6739027
PMID: 31490385 [Indexed for MEDLINE]
42. Daru. 2019 Dec;27(2):885-888. doi: 10.1007/s40199-019-00298-9. Epub 2019 Sep 5.
Accidental paraquat induced hypersalivation: a case report.
Anusha J(1)(2), Moudgil K(3)(4).
Author information:
(1)Department of Pharmacy Practice, JSS College of Pharmacy, Ooty, India.
(2)JSS Academy of Higher Education and Research, Mysuru, India.
(3)Department of Pharmacy Practice, JSS College of Pharmacy, Ooty, India.
khayatimoudgil@jssuni.edu.in.
(4)JSS Academy of Higher Education and Research, Mysuru, India.
khayatimoudgil@jssuni.edu.in.
Paraquat is one of the most commonly used lethal herbicide. Even the small amount
of paraquat is hazardous to human beings. Poisoning by paraquat is most commonly
happening in agricultural based economical country. This poison is a threat to
public health and its high mortality rate is responsible for a significant number
of death. We hereby report a case of 38-year-old male with a history of
accidental paraquat ingestion. He works as a gardener which contributes to the
ease in availability of the poison. He had the post accidental paraquat
consumption complaints of lip sores, swallowing difficulty and hypersalivation in
more amount. The patient was admitted in the Casualty and underwent the
supportive treatment. Laboratory investigations were found to be normal except
WBC count which was elevated. Early diagnosis and proper management can reduce
the mortality rate and even small amount of paraquat can lead to some major fatal
outcomes. At present there is no specific antidote available so there is a need
to focus more on the prevention and management of paraquat poisoning.
DOI: 10.1007/s40199-019-00298-9
PMCID: PMC6895330 [Available on 2020-09-05]
PMID: 31489576 [Indexed for MEDLINE]
43. Malar J. 2019 Sep 2;18(1):301. doi: 10.1186/s12936-019-2937-1.
A qualitative study on the use of long-lasting insecticidal nets (LLINs) for the
prevention of malaria in the Peruvian Amazon.
Iyer M(1), Skelton J(2), de Wildt G(2), Meza G(3).
Author information:
(1)Department of Population and Health Science, University of Birmingham,
Birmingham, UK. MiaIyer0@gmail.com.
(2)Department of Population and Health Science, University of Birmingham,
Birmingham, UK.
(3)Facultad de Medicina Humana, Universidad Nacional de la Amazonia Peruana,
Iquitos, Peru.
BACKGROUND: Malaria is a huge global health burden due to its mortality,
morbidity and cost to economies. It is necessary to eliminate the disease in all
countries where possible to achieve the World Health Organization target of > 90%
reduction by 2030. Successful previous campaigns suggest elimination is feasible
in Peru. However, the incidence has recently been rising, focalized to the region
of Loreto. Currently, the distribution of long-lasting insecticide-treated nets
(LLINs) is a major part of Peru's malaria control strategy, however these may be
having a limited effect in Loreto, because of the recent behavioural adaption of
the mosquito vector, Anopheles darlingi, to earlier biting times, as well as
local perceptions and practices towards LLINs. It was, therefore, necessary to
investigate how perceptions, practices and lifestyle factors affect the efficacy
of LLINs in Loreto.
METHODS: Qualitative research was carried out in 5 rural communities along the
Iquitos-Nauta Road in Loreto, which have increased exposure and have received
nets in a distribution scheme prior to the study. Twenty semi-structured
interviews as well as observations of the bed nets were conducted in
participants' homes, using a topic guide. Thematic content analysis was used to
produce the findings.
RESULTS: All participants viewed malaria prevention as a high priority, and the
use of bed nets was deeply embedded in the culture. They expressed preference for
LLINs over traditional-type nets. However there were too few LLINs distributed,
participants did not maintain the nets correctly, washed them too frequently and
did not repair holes. The earlier mosquito biting times were also problematic.
Additionally, poor housing construction and proximity to mosquito breeding sites
further increased transmission.
CONCLUSION: The positive findings in attitudes of the respondents can be used to
improve malaria control in these communities. Interventions providing education
on effective LLIN use should be implemented. A change in strategy away from
vector control methods is also necessary, as these do not provide long-term
protection due to the adaptability of An. darlingi. Interventions focusing on
parasite control are recommended, and socio-economic factors which increase
malaria risk should be addressed.
DOI: 10.1186/s12936-019-2937-1
PMCID: PMC6721337
PMID: 31477112 [Indexed for MEDLINE]
44. Nature. 2019 Aug;572(7771):S8-S9. doi: 10.1038/d41586-019-02526-3.
Can cannabis go green?
Madhusoodanan J.
DOI: 10.1038/d41586-019-02526-3
PMID: 31462788 [Indexed for MEDLINE]
45. Environ Toxicol Pharmacol. 2019 Nov;72:103241. doi: 10.1016/j.etap.2019.103241.
Epub 2019 Aug 12.
DNA damage and adverse neurological outcomes among garlic farmers exposed to
organophosphate pesticides.
Sapbamrer R(1), Hongsibsong S(2), Sittitoon N(3), Amput P(4).
Author information:
(1)Department of Community Medicine, Faculty of Medicine, Chiang Mai University,
110 Inthavaroros Road, Sri Phum Subdistrict, Maung District, Chiang Mai, 50200,
Thailand. Electronic address: lekratana56@yahoo.com.
(2)Environment and Health Research Unit, Research Institute for Health Sciences,
Chiang Mai University, 110 Intavaroros Road, Sriphum Subdistrict, Muang District,
Chiang Mai, 50200, Thailand. Electronic address: s_hongsibsong@hotmail.com.
(3)Institute of Public Health, Suranaree University of Technology, 111 University
Avenue, Muang District, Nakhon Ratchasima, 30000, Thailand. Electronic address:
pinnalin@sut.ac.th.
(4)School of Allied Health Sciences, University of Phayao, 19 Moo 2, Mae Ka
Subdistrict, Muang District, Phayao Province, 56000, Thailand. Electronic
address: pummy_pt@hotmail.com.
Garlic farmers used organophosphate pesticides to control insects, resulting in
an increased risk for adverse health outcomes. Thus, we investigated exposure to
organophosphate pesticides, DNA damage, nerve conduction, and neurological
symptoms among 134 garlic farmers. They were interviewed, measured nerve
conduction, and collected blood and urine for determining DNA damage and
dialkylphosphate metabolites. Total dialkylphosphate levels of farmers who began
cultivating garlic in October were significantly higher than those of non-farmers
and the farmers who began cultivating in November and December. Farmers showed
significantly longer comet tail lengths and tail moments than non-farmers.
However, their mean compound motor and sensory nerve action potential amplitudes
of the median, ulnar, and common peroneal nerves were within normal ranges.
Measurement of DNA damage is useful as a biomarker of long-term and low-level
exposure to organophosphate pesticides; however, electromyography might be not
sufficiently sensitive to detect nerve conduction effects in farmers exposed to
pesticides.
Copyright © 2019 Elsevier B.V. All rights reserved.
DOI: 10.1016/j.etap.2019.103241
PMID: 31437569 [Indexed for MEDLINE]
46. Biomed Res Int. 2019 Jul 15;2019:6360459. doi: 10.1155/2019/6360459. eCollection
2019.
Monocytes as an Early Predictor for Patients with Acute Paraquat Poisoning: A
Retrospective Analysis.
Zhao Y(1), Song YQ(1), Gao J(1), Feng SY(1), Li Y(1).
Author information:
(1)Emergency Department, Cangzhou Central Hospital, No. 16 Xinhua Road, Yunhe Qu,
Cangzhou City 061000, China.
Background: The predictive values of monocytes in the prognosis of patients with
acute paraquat (PQ) poisoning are unclear. This retrospective study investigated
the predictive values of monocytes in the prognosis of patients with acute PQ
poisoning.
Methods: Adult patients who suffered from acute PQ poisoning in the emergency
care unit of Cangzhou Central Hospital from May 2012 to December 2018 were
enrolled. The patients were divided into groups, namely, survival and
nonsurvival, according to a 90-day prognosis. Moreover, correlation, logistic
regression, receiver-operator characteristic (ROC), and Kaplan-Meier curve
analyses were applied to evaluate the monocyte values used to predict the
prognosis of patients with acute PQ poisoning.
Result: Among the 109 patients, 45 survived within 90 days after the poisoning,
resulting in a 41.28% survival rate. The monocyte count of the nonsurvivors was
significantly higher than that of the survivors (P< 0.001). Correlation analysis
showed that monocyte count positively correlated with plasma PQ concentration (r=
0.413; P< 0.001) and negatively correlated with survival time (r= 0.512; P<
0.001) and 90-day survival (r= 0.503; P< 0.001). Logistic regression analysis
showed that elevated monocytes were the independent risk factors for the 90-day
survival. The area under the ROC curve of the monocyte count used to predict the
90-day survival was 0.826 (95% CI: 0.751-0.904), the optimal cut-off was
0.51×109/L, sensitivity was 73.4%, and specificity was 86.7%.
Conclusion: This study demonstrated that elevated monocyte count is a useful
early predictor of 90-day survival in patients with acute PQ poisoning. However,
further studies are warranted to draw firm conclusions.
DOI: 10.1155/2019/6360459
PMCID: PMC6679898
PMID: 31428640 [Indexed for MEDLINE]
Conflict of interest statement: The authors have no conflicts of interest.
47. J Forensic Leg Med. 2019 Oct;67:28-36. doi: 10.1016/j.jflm.2019.07.010. Epub 2019
Aug 3.
Forensic entomotoxicology: Current concepts, trends and challenges.
Chophi R(1), Sharma S(2), Sharma S(3), Singh R(4).
Author information:
(1)Department of Forensic Science, Punjabi University, Patiala, Punjab, 147002,
India. Electronic address: ritochophi@gmail.com.
(2)Department of Forensic Science, Punjabi University, Patiala, Punjab, 147002,
India. Electronic address: sprihasharma90@gmail.com.
(3)Department of Forensic Science, Punjabi University, Patiala, Punjab, 147002,
India. Electronic address: sahilforensics289@gmail.com.
(4)Department of Forensic Science, Punjabi University, Patiala, Punjab, 147002,
India. Electronic address: rajchandel@gmail.com.
The application of forensic entomotoxicology in investigations of death by
poisoning has gained popularity as insects serves as an alternative specimen
(evidence) when conventional toxicological samples have degraded or are no longer
available. Successful detection, identification, and quantification of drugs and
toxic substances from insects have been demonstrated through various research
experiments. In the present review paper, role of insects as toxicological
sample, its collection and preservation, analysis using various instrumental
techniques, and trends in the use of analytical techniques have been discussed.
Limitations hindering the growth of this field and the way forward for future
studies have been highlighted. In addition, the effect of poisons on insects used
for postmortem interval estimation has been described.
Copyright © 2019 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All
rights reserved.
DOI: 10.1016/j.jflm.2019.07.010
PMID: 31398663 [Indexed for MEDLINE]
48. Przegl Epidemiol. 2019;73(2):269-280.
Repellents as a major element in the context of prevention of tick-borne diseases
Przygodzka M(1), Mikulak E(1), Chmielewski T(1), Gliniewicz A(1)(2).
Author information:
(1)National Institute of Public Health - National Institute of Hygiene,
Department of Parasitology and Vector-borne Diseases,
(2)National Institute of Public Health - National Institute of Hygiene,
Department of Health Promotion and Prevention of Chronic Diseases
In Poland, out of the 21 species of ticks described, two species have the
greatest epidemiological significance: Ixodes ricinus and Dermacentor
reticulatus. Their participation in the transmission of etiologic agents of
vector diseases such as Lyme disease, tick-borne encephalitis, human granulocytic
anaplasmosis, babesiosis, rickettsiosis and many others is widely known. Due to
the often severe and sometimes fatal course of diseases transmitted by ticks, a
great deal of emphasis is placed on prophylactic activities, minimizing the
possibility of biting and transfering pathogens along with the arachnid saliva.
In addition to means of personal protection, including appropriate clothing,
protective vaccinations, avoiding tick habitats or body checking after returning
from this type of places, one of the most important elements of anti-tick
prevention is the use of effective repellents. The key role of using the
repellent is to discourage the arthropod from attacking and to prevent it from
taking food, as a result of which there is no phenomenon of transmission of
pathogens from the hematophage to the host organism. The most commonly used
substances with arthropod repellent properties are: N-N-diethylm-toluamide
(DEET), 3-(N-acetyl-N-butyl) aminopropionic acid ethyl ester (IR3535), icaridine,
permethrin and essential oils. However, it should be remembered that no repellent
ever protects 100% all the time after application - its use should be considered
as one of many elements of personal protection in the prevention of tick bites.
DOI: 10.32394/pe.73.25
PMID: 31385684 [Indexed for MEDLINE]
49. Ann Saudi Med. 2019 Jul-Aug;39(4):229-235. doi: 10.5144/0256-4947.2019.229. Epub
2019 Aug 5.
An epidemiological snapshot of toxicological exposure in children 12 years of age
and younger in Riyadh.
Alruwaili ND(1), Halimeh B(1), Al-Omar M(1), Alhatali B(2), Sabie II(3), Alsaqoub
M(4).
Author information:
(1)From the Department of Emergency Medicine, King Faisal Specialist Hospital and
Research Centre, Riyadh, Saudi Arabia.
(2)From the Department of Environmental and Occupational Health, Ministry of
Health, Muscat, Oman.
(3)From the Department of Pediatric Emergency, King Saud Medical City, Riyadh,
Saudi Arabia.
(4)From the Department of Pediatrics, King Saud Medical City, Riyadh, Saudi
Arabia.
BACKGROUND: Poisoning among the pediatric population is an important public
health concern that is responsible for frequent pediatric emergency department
visits and hospital admissions. Surveillance of poisoning cases is essential for
designing and implementing effective preventive strategies.
OBJECTIVE: Describe the characteristics of acute poison exposure and related
therapeutic interventions in children aged 12 years and younger.
DESIGN: Prospective, descriptive cross-sectional study.
SETTING: Two pediatric emergency departments in Riyadh.
PATIENTS AND METHODS: We prospectively reviewed pediatric poisonings that
presented to emergency departments over a period of two years.
MAIN OUTCOME MEASURES: Epidemiological aspects of pediatric poisoning Riyadh.
SAMPLE SIZE: 1035 patients.
RESULTS: The median (IQR) age at the time of exposure was 27 (23-42) months. The
most frequently involved substance class was toxic household products in children
younger than 6 years and pesticides in children 6 years or older. A frequently
involved single agent was paracetamol in younger and older children. The majority
of patients (78.7%) were completely asymptomatic at the time of presentation and
during the observation period. Almost half of the exposure incidents (47.8%)
needed no intervention. Most exposure incidents (95%) did not require any
pharmacological support and most (87%) did not require nonpharmacological
intervention. Eight (0.7%) patients required intubation and mechanical
ventilation. Activated charcoal was administered for 27% of cases. Gastric
lavage, whole bowel irrigation, and ipecac were used in a few cases (1%, 0.3%,
and 0.1%, respectively). Enhanced elimination interventions were performed for
only 0.5% of exposure cases. Only two patients died.
CONCLUSIONS: Household products were the commonest reason for pediatric
poisonings in Saudi Arabia and most of them were asymptomatic. Our results
suggest a need for strategic plans for prevention and care.
LIMITATIONS: May not be representative of the experiences and practices of
smaller hospitals in remote regions of the country.
CONFLICT OF INTEREST: None.
DOI: 10.5144/0256-4947.2019.229
PMCID: PMC6838645
PMID: 31381368 [Indexed for MEDLINE]
50. Mayo Clin Proc. 2019 Aug;94(8):1646-1647. doi: 10.1016/j.mayocp.2019.05.007.
Pregnancy in Women With Life-Threatening Poisoning With Long-Acting Anticoagulant
Rodenticides.
Yaqoob M(1), Feinstein DL(1), Rubinstein I(1).
Author information:
(1)Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department
of Medicine, and Department of Anesthesiology, University of Illinois at Chicago
Jesse Brown Veterans Affair Medical Center, Chicago, IL.
DOI: 10.1016/j.mayocp.2019.05.007
PMID: 31378241 [Indexed for MEDLINE]