BACKGROUND: Acetylcholinesterase inhibitor insecticides (AChEIIs) were used extensively in the agrarian region of Anuradhapura for the past few decades. As a result, the region faced a heightened risk of toxicity. Carbaryl, carbofuran, chlorpyrifos, dimethoate, and fenthion were the five hazardous AChEIIs banned from Anuradhapura in 2014. Assessment of post-ban trends in acute poisoning will reveal the impact of the ban. Data on availability and sales of remaining AChEIIs will guide towards preventive measures against related toxicities. METHODS: Cross-sectional surveys were conducted at Anuradhapura district of Sri Lanka. Details related to acute AChEII poisoning were sorted from the Teaching Hospital Anuradhapura. Main insecticide vendors in Anuradhapura were surveyed to find information on availability and sales of AChEIIs. Chi-square for goodness of fit was performed for trends in acute poisoning and sales. RESULTS: Hospital admissions related to acute AChEII poisoning have declined from 554 in 2013 to 272 in 2017. Deaths related to acute AChEII poisoning have declined from 27 in 2013 to 13 in 2017. Sales of all five banned AChEIIs had reduced by 100%. Sales of the remaining AChEIIs were declining, except for acephate, phenthoate, and profenofos. However, one of the top selling, most frequently abused carbosulfan, had the highest risk of toxicity. Chi-square for goodness of fit showed a significance (P < 0.001) between the trends of hospital admissions for acute AChEII poisoning and the sales related to AChEIIs. CONCLUSIONS Hospital admissions related to acute poisoning was declining along with the overall sales of remaining AChEIIs, during the post-AChEII ban period. Nevertheless, future vigilance is needed on the remaining AChEIIs to predict and prevent related toxicities.
Agriculture ; legislation & jurisprudence ; Cholinesterase Inhibitors ; classification ; poisoning ; supply & distribution ; Commerce ; statistics & numerical data ; trends ; Cross-Sectional Studies ; Developing Countries ; Female ; Government Regulation ; Health Policy ; legislation & jurisprudence ; Hospitalization ; statistics & numerical data ; trends ; Humans ; Incidence ; Insecticides ; classification ; poisoning ; supply & distribution ; Male ; Poisoning ; epidemiology ; mortality ; prevention & control ; Risk Factors ; Sri Lanka ; epidemiology

PURPOSE: Carbamate insecticides are potent cholinesterase inhibitors capable of causing severe cholinergic toxicity. Use of carbamate rather than organophosphate insecticides has been increasing. Compared with organophosphate poisoning, relatively few studies have investigated carbamate-associated acute pancreatitis. We investigated general characteristics and pancreatitis of carbamate poisoning and the predictors, among those readily assessed in the emergency department. METHODS: We performed a retrospective review of consecutive patients, aged over 18 years, who were admitted between January 2008 and April 2012 to an emergency department (ED) of an academic tertiary care center for treatment of carbamate poisoning. Patients who exhibited poisoning by any other material, except alcohol, were excluded. After application of exclusion criteria, patients were divided according to carbamate-induced pancreatitis and non-pancreatitis groups. RESULTS: A total of 41 patients were included in this study. Among these 41 patients, the prevalence of acute pancreatitis was 36.6% (15 patients). Initial blood chemistry tests showed a statistically higher glucose level in the pancreatitis group, compared with the non-pancreatitis group (222, IQR 189-284 vs. 137, IQR 122-175 mg/dL, P<0.05). Regarding clinical courses and outcomes, a significantly higher proportion of patients developed pneumonia [10 (66.7%) vs. 6 (23.1%), P<0.05] and had a longer hospital stay (7 days, IQR 6-12 vs. 5 days, IQR 2-11, P<0.05), but no difference in mortality, in the pancreatitis group vs. the non-pancreatitis group. In multivariate analysis, the initial glucose was showing significant association with the presentation of carbamate-induced acute pancreatitis (odds ratio 1.018, 95% confidence interval 1.001-1.035, P<0.05). CONCLUSION: Carbamate-induced acute pancreatitis is common, but not fatal. Initial serum glucose level is associated with acute pancreatitis.
Blood Glucose ; Carbamates ; Chemistry ; Cholinesterase Inhibitors ; Emergency Service, Hospital ; Glucose ; Humans ; Insecticides ; Length of Stay ; Lipase ; Mortality ; Multivariate Analysis ; Organophosphate Poisoning ; Pancreatitis* ; Pneumonia ; Poisoning* ; Prevalence ; Retrospective Studies ; Tertiary Care Centers

On February 21, 2013, 6 elderly people collapsed abruptly after eating bean sprout bibimbab (boiled rice mixed with bean sprouts and seasoned with soybean sauce) at a countryside restaurant in the Chungbuk Province, Korea. Minutes after eating the meal, all of the patients lapsed into a state of stupor. Respiratory arrest developed in 2 patients; and one of two patients died of cardiac arrest. The autopsy identified methomyl and methanol in the deceased patient's gastric contents and in the remaining soybeanbean sauce seasoning. Five of the 6 patients ingested one spoonful of the soybeanbean sauce seasoning and survived, while one patient who died of cardiac arrest, ingested approximately two spoons. Symptoms of toxicity presented quickly in the subjects and progressed rapidly, including chest tightness, an unusual sensation in the pit of the stomach, dizziness, ataxia, and finally, collapse. Three patients who drank ethanol with the meal experienced only mild toxic symptoms. Our analysis of the clinical observations in these cases suggests that ingestion of methomyl pesticide and the additive toxicity of methanol may have been responsible for the intoxication.
Aged ; Cholinesterase Inhibitors/poisoning ; *Disease Outbreaks ; Ethanol ; Female ; Foodborne Diseases/*epidemiology ; Humans ; Insecticides/*poisoning ; Male ; Methanol/*poisoning ; Methomyl/*poisoning ; Republic of Korea/epidemiology

Acute Disease ; Adult ; Antidotes ; therapeutic use ; Antiparkinson Agents ; therapeutic use ; Benserazide ; Cholinesterase Inhibitors ; poisoning ; Humans ; Insecticides ; poisoning ; Levodopa ; therapeutic use ; Male ; Organophosphate Poisoning ; Parkinson Disease ; drug therapy ; pathology ; Pralidoxime Compounds ; therapeutic use ; Trihexyphenidyl ; therapeutic use

OBJECTIVETo investigate the therapeutic and prophylactic efficiency of HupA in mice with acute isocarbophos poisoning, and the protective effects of the HupA on AChE inhibited by isocarbophos.

METHODSMice were randomizedly divided into the non-treatment group, the atropine control group, the HupA treatment group and the atropine and HupA combined treatment group. Toxic signs and survival rates were observed and compared among these groups. The AChE activity was monitored in the whole blood, the red cells and brain tissue exposed to isocarbophos in the either treated with HupA or non-treated groups.

RESULTSIn HupA treatment group compared with the non-treatment group, toxic signs were significantly decreased and the survival rate was increased. The therapeutic efficiency in the atropine and HupA combined treatment group was better than other groups. After isocarbophos was administered, the AChE activity in the HupA treatment group and the non-treatment group was decreased. However, the AChE activity in the whole blood (1.096 +/- 0.111), (1.262 +/- 0.146), (1.181 +/- 0.353) U/ml, the red cells (0.798 +/- 0.063), (1.000 +/- 0.176), (0.837 +/- 0.331) and the brain tissue (13.739 +/- 2.970), (18.507 +/- 3.466), (10.764 +/- 2.212) U/g in HupA treatment group 0.5, 1 and 2 hours after isocarbophos was administered was significantly higher than those in the non-treatment group (P < 0.05 or P < 0.01).

CONCLUSIONHupA has therapeutic effect on mice with acute isocarbophos poisoning. The protective effect of HupA on blood and brain AChE inhibited by isocarbophos may be one of the mechanisms of the therapeutic effect of HupA in acute Isocarbophos poisoning.

Acetylcholinesterase ; blood ; metabolism ; Alkaloids ; Animals ; Brain ; enzymology ; Cholinesterase Inhibitors ; therapeutic use ; Insecticides ; poisoning ; Malathion ; poisoning ; Male ; Mice ; Mice, Inbred Strains ; Poisoning ; drug therapy ; Random Allocation ; Sesquiterpenes ; therapeutic use

OBJECTIVETo investigate whether acute dipterex poisoning (ADP) may cause oxidative stress and free radical damage in the bodies of acute dipterex poisoning patients (ADPPs), and to explore the mechanisms by which ADP may cause oxidative stress and free radical damage.

METHODSFifty ADPPs and fifty healthy adult volunteers (HAVs) whose ages, gender and others were matched with the ADPPs were enrolled in a randomized controlled study, in which concentrations of nitric oxide (NO), vitamin C (VC), vitamin E (VE) and beta-carotene (beta-CAR) in plasma as well as concentration of lipoperoxide (LPO), and activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPX) and acetylcholinesterase (AChE) in erythrocytes were determined by spectrophotometric analytical methods.

RESULTSCompared with the average values of experimental parameters in the HAVs group, the average values of plasma NO and erythrocyte LPO in the ADPPs group were significantly increased (P<0.0001), while those of plasma VC, VE and beta-CAR as well as erythrocyte SOD, CAT, GPX and AChE in the ADPPs group were significantly decreased (P<0.0001). Bivariate correlation analysis and partial correlation analysis suggested that when NO and LPO values were increased, and VC, VE, beta-CAR, SOD, CAT and GPX values were decreased in the ADPPs, AChE value was decreased gradually in the ADPPs (P<0.001-0.0001). Reliability analysis of experimental parameters reflecting oxidative stress and free radical damage in the ADPPs showed that the reliability coefficient (8 items) alpha=0.6909, and the standardized item alpha=0.8574.

CONCLUSIONThe findings in the present study suggest that ADP can cause oxidative stress and free radical damage, and inhibit markedly erythrocyte acetylcholinesterase activity in ADPPs.

Acetylcholinesterase ; blood ; Adolescent ; Adult ; Ascorbic Acid ; blood ; Case-Control Studies ; Catalase ; blood ; China ; Cholinesterase Inhibitors ; poisoning ; Erythrocytes ; drug effects ; enzymology ; Female ; Free Radicals ; Glutathione Peroxidase ; blood ; Humans ; Insecticides ; poisoning ; Lipid Peroxides ; blood ; Male ; Nitric Oxide ; blood ; Oxidative Stress ; Poisoning ; blood ; Random Allocation ; Superoxide Dismutase ; blood ; Trichlorfon ; poisoning ; Vitamin E ; blood ; beta Carotene ; blood

OBJECTIVETo study the effects of improving the neuromuscular transmission (NMT), "non-AChE-reactivating effects", by oximes in treating acute isocarbophos poisoning.

METHODSThe effect of pralidoxime chloride(PAM-Cl) on the neuromuscular transmission(NMT) in rats exposed to isocarbophos was studied by using the stimulation single fiber electromyography (SSFEMG) to determine the single fiber action potential.

RESULTSAfter the rats exposed to isocarbophos were treated by PAM-Cl, the mean consecutive difference(MCD) value [(25.99 +/- 5.84) microsecond] of single fiber action potential was significantly lower than that before PAM-Cl treatment [(33.21 +/- 4.09) microsecond, (P < 0.01)], but no AChE reactivation in blood and gastrocnemius was observed.

CONCLUSIONPAM-Cl has "non-AChE-reactivating effects", it could markedly improve isocarbophos-induced NMT block of gastrocnemius.

Acute Disease ; Animals ; Antidotes ; pharmacology ; Cholinesterase Inhibitors ; poisoning ; Insecticides ; poisoning ; Malathion ; poisoning ; Neuromuscular Junction ; drug effects ; physiology ; Pralidoxime Compounds ; pharmacology ; Rats ; Synaptic Transmission ; drug effects

OBJECTIVETo investigate the activity of ChE in rats poisoned by dimehypo and then treated with pralidoxime methylchloride or unithiol.

METHODRats were divided into control group (dimehypo); intervention groups [dimehypo plus pralidoxime methylchloride or dimehypo plus unithiol (sodium dimercaptopropanesulphonate)]. Rats were dosed with 4 different doses of dimehypo: 1/16, 1/8, 1/4 and 1/2 of LD50 respectively(the LD50 of dimehypo is 342 mg/kg). After being poisoned with dimehypo orally, rats were immediately injected intramuscularly with pralidoxime methylchloride or unithiol. The activity of ChE in blood was detected before and 1/2, 1, 2, 4 and 24 h after poisoning in dimehypo and intervention groups.

RESULTThe ChE activity of four dose subgroups at 1 h after poisoning were (1.04 +/- 0.21), (0.84 +/- 0.12), (0.71 +/- 0.12), (0.66 +/- 0.07) U/ml respectively; the ChE activity of pralidoxime methylchloride intervention groups were (1.01 +/- 0.18), (1.17 +/- 0.11), (1.01 +/- 0.04), (1.03 +/- 0.12) U/ml respectively; and the ChE activity of unithiol intervention groups were (1.15 +/- 0.15), (1.26 +/- 0.27), (1.08 +/- 0.08), (1.04 +/- 0.12) U/ml respectively. The inhibited ChE in blood was recovered by either treatment with pyraldoxime methylchloride or unithiol. These two drugs had similar effects of recovering the activity of ChE(P > 0.05), but at higher doses(1/4 and 1/2 of LD50) the effects of both were not so good.

CONCLUSIONPralidoxime methylchloride and unithiol could partly recover the activity of ChE inhibited by dimehypo.

Animals ; Antidotes ; pharmacology ; Cholinesterase Inhibitors ; poisoning ; Cholinesterases ; blood ; Dose-Response Relationship, Drug ; Insecticides ; poisoning ; Pralidoxime Compounds ; pharmacology ; Rats ; Unithiol ; pharmacology

OBJECTIVETo study the new method of monitoring and clearing organophosphate in blood during single or mixed organophosphate(OP) poisoning.

METHOD(1) Mixed equal volumes of blood of OP poisoned rat and healthy rat, then determine whole blood cholinesterase (ChE) activity. The descending range of ChE activity represents the level of residual OP in blood. (2) Poisoned rats by single or mixed OP pesticides were injected with 5% NaHCO3 15 ml/kg intraperitoneally, then the level of OP in blood was detected.

RESULTS(1) The monitoring results of blood residual OP by gas chromatography were similar to that by "Mixes blood method", which showed significant difference(P < 0.05) from that before OP administration. (2) NaHCO3 injection could not improve the toxic symptoms and whole blood or brain ChE inhibition in 10 CP poisoned rats, blood residual OP level was also not affected, but lung pathological changes by OP such as interstitial inflammation and oedema showed some relief.

CONCLUSIONThe monitoring of blood ChE by "mixed blood method" may reflect the general level of the blood residual OP within the range of exposure dose. The effect of NaHCO3 was not satisfactory, but it may improve OP-induced lung pathological changes.

Animals ; Cholinesterase Inhibitors ; poisoning ; Cholinesterases ; blood ; Chromatography, Gas ; Insecticides ; poisoning ; Lung ; pathology ; Organophosphate Poisoning ; Organophosphorus Compounds ; blood ; Rats ; Sodium Bicarbonate ; pharmacology

OBJECTIVETo study the neuromuscular function and its relation with the occurrence of myasthenia in rats poisoned by dimethoate (D), phoxim (P), methomyl (M), M + D and M + P respectively.

METHODSThe stimulation single fiber electromyography(SSFEMG) at different stimulus frequencies(5, 10 and 20 Hz) was used. The whole blood cholinesterase (ChE) activity was measured 1 h before and after poisoning.

RESULTS(1) Myasthenia occurred in 5 out of 9.5 out of 10.5 out of 5, and 8 rats poisoned by D, P, M + D, and M + P, respectively. (2) The average mean consecutive differences(MCD) at 5, 10, and 20 Hz in myasthenic rats were significantly higher than those of poisoned rats without myasthenia and the control ones. (3) SSFEMG changes at 5, 10 and 20 Hz were significantly consistent with the clinical manifestation of myasthenia, especially at 10 Hz and 20 Hz. (4) ChE activity was significantly lower in rats with P or D poisoning while ChE inhibition was of no difference in rats with M, M + D, and M + P poisoning. In the D poisoning and P poisoning groups, there was no significant difference in ChE inhibition between the rats with and without myasthenia.

CONCLUSIONMuscle weakness was associated with neuromuscular transmission dysfunction, but not well correlated with ChE inhibition. The SSFEMG with stimulus frequency at 10 Hz or 20 Hz could be used to detect the neuromuscular dysfunction during myasthenia induced by organophosphate insecticides and their mixtures poisoning.

Animals ; Cholinesterase Inhibitors ; poisoning ; Dimethoate ; poisoning ; Electromyography ; Insecticides ; poisoning ; Methomyl ; poisoning ; Muscle Weakness ; chemically induced ; Myasthenia Gravis ; chemically induced ; physiopathology ; Neuromuscular Junction ; drug effects ; physiology ; Organothiophosphorus Compounds ; poisoning ; Rats ; Synaptic Transmission ; drug effects