Self-poisoning by pesticide and other substances in a general hospital

Self-poisoning by pesticides is a major public health problem, especially in agricultural communities. The purpose of this study is to investigate the pattern of poisoning of all patients admitted to an emergency care at a general hospital in Trinidad for the period 2003-2004. In a two-year retrospective study, data on self-poisoning from hospital archives were analyzed for demographic and other patterns. A total of 765 cases of self poisoning were identified. The most common source of poisoning was ingestion of pesticides (n=275, 35.9% of all cases). Differences in age and gender were found; patients with pesticide ingestion were younger (mean age 25.8 years) and more frequently female. The majority of patients with pesticide poisoning were admitted to wards and one death reported. Poisoning by pesticides is prevalent in South Trinidad. The high incidence indicates an urgent need for implementing public health strategies for prevention in keeping with the recommendations of the World Health Organization.

Effect of concomitant atropine and glycopyrrolate infusion in organophosphorus poisoning

AIM : To study the effectiveness of concomitant atropine and glycopyrrolate infusion over atropine infusion in organophosphorus (OP) poisoning. METHODS : A prospective randomized study was carried out among 60 OP poisoned patients admitted to an emergency department of tertiary care hospital in south India. All patients admitted with acute OP poisoning were enrolled in the study. They were randomized into test group and control group of 30 patients each. Patients who received only atropine alone were randomized as control group and patients who received concomitant glycopyrrolate were enrolled in the test group. All patients were provided 1g pralidoxime every eighth hourly treatment. The severity was assessed using GCS, APACHE II, and PSS scores at admission. The outcomes were accessed in terms of intermediate syndrome, ventilation period, total dose and duration of atropine, atropine toxicity, incidence of pneumonia,hospitalization period and mortality.

Pesticide regulation, utilization, and retailers' selling practices in Trinidad and Tobago, West Indies: current situation and needed changes.

OBJECTIVE: To explore pesticide regulation in Trinidad and Tobago, and to ascertain pesticide utilization and retailers' selling practices on Trinidad, which is the larger of twin islands that constitute the republic of Trinidad and Tobago. METHODS: Between February and June 2005, agrochemical retailers in Trinidad were surveyed about the most frequently sold pesticides and their knowledge and practices of pesticide sale. The Poisons and Toxic Chemicals Control Board of the Ministry of Health informed on legislature. RESULTS: Of 107 actively trading licensed pesticide outlets, 97 participated (91 per cent response rate) in the survey. Currently only 2.9 per cent (21) of 720 registered products from four chemical classes are frequently utilized. Paraquat, methomyl, and alpha-cypermethrin (respective trade names are Gramoxone, Lannate, and Fastac) from World Health Organization (WHO) Hazard Classes I and II, and glyphosate isopropylamine (Swiper, Class U) are the most frequently purchased pesticides. Pet shops constitute 39.2 per cent (38) of retail shops selling pesticides. No regulations guide pesticide sale to agriculturists, and children may purchase them. Inadequate human and technical resources render legislative controls ineffective and disciplinary action against offenders is weak. Extensive governmental resources are employed in legislative procedures and product approval for the very low, 2.9 per cent utilization rate, negatively impacting on monitoring pesticide sales. The Poisons Information Centre (PIC) does not liaise with the Poisons and Toxic Chemicals Control Board or provide educational interventions for the community. As a result of this survey, it was possible to develop the first database to include the chemical, brand, and colloquial names of pesticides used in Trinidad and Tobago;...

Paralytic shellfish poisoning toxins in green mussels (Perna viridis) from the Gulf of Paria, Trinidad

Paralytic shellfish poisoning (PSP) toxins were determined in green mussels (Perna viridis) collected from one collection site in the Gulf of Paria in Trinidad in 1999 and 2000. Aqueous extracts of PSP were purified by passage through C-18 SPE cartridges, oxidized with peroxide and periodate, respectively, then analyzed by HPLC with fluorescence detection. This procedure provided rapid and highly sensitive screening of samples for PSP toxins. Further purification of PSP-containing extracts using COOH SPE cartridges resulted in the separation and identification of individual PSP toxins. The method of analysis was validated by spike and recovery experiments, with 85-103% recoveries of mixed toxins. PSP toxins determined in our samples in both years were GTX2,3, dcGTX2,3, STX, and dcSTX, while GTX1,4 and NeoSTX were only identified in 1999 and 2000, respectively. In 1999, GTX1,4, GTX2,3 and dcGTX2,3 predominated, as compared to NeoSTX, GTX2,3 and dcGTX2,3 in 2000. However, mussel samples in 2000 contained higher total concentrations of detected PSP toxins than those of 1999. These results represent the first identification of specific PSP toxins in local shellfish and provide a basis for effective monitoring and control of these toxins in Trinidad.

The spectrum of accidental childhood poisoning in the Caribbean

Objective. To assess accidental poisoning in children in the Caribbean country of Antigua and Barbuda, including the incidence, the types of substances ingested, the age of the children involved, and the clinical outcomes. The results from Antigua and Barbuda were compared with results of other reports from the English-speaking Caribbean and from the United States of America. Design and Methods. We performed a retrospective review of the charts of all patients less than 13 years old admitted to the Children's Ward at Holbertson Hospital in Antigua for accidental poisoning between March 1989 and March 1999. Those data were compared with data from earlier reports from Barbados, Guyana, Jamaica, and the United States of America. Results. In Antigua and Barbuda there were 255 hospital admissions for accidental poisoning among children below 13 years old over that 10-year period. Of the 255 ingestions, 115 of them (45 percent) were in 1-year-old children, 69 (27 percent) were in 2-year-old children, and 26 (10 percent) were in 3-year-old children. These proportions in Antigua and Barbuda are similiar to the age patterns seen in the other countries with which we made comparisons. In Antigua and Barbuda there was an annual average of 26 hospital admissions for poisoning for the roughly 20, 000 children below 13 years of age, for a rate of 1.3 per 1,000. In comparing the patterns of childhood poisoning in all the countries we studied, we found that, as economic levels rose, there was a shift in the substances ingested, with hydrocarbon and plant ingestions decreasing and chemical and medication ingestions increasing. Conclusions. There is an increasing variety and complexity of poisonous substances ingested as economic conditions improve. This trend would make the establishment of a poison control center for the English-speaking Caribbean a logical step (AU)

Poisonous plants of Jamaica

This book is the first of its kind and will provide much needed information about the toxins that are present in fifty of the most poisonous plants here, with data on their effects on the body and very importantly, the antidotes that are needed

Evidence for PSP in mussels in Trinidad

Herein we present the first evidence for the presence of Paralytic Shellfish Poison (PSP) in Trinidadian waters. The toxin was found in a meat extract of the mussel, Perna viridis. PSP has not previously been demonstrated in the shellfish of Caribbean islands. The presence of PSP in Trinidad is therefore significant in that it presents an opportunity to better understand the dynamics of PSP and algal blooms in both a region and island environment not normally associated with PSP.P. viridis is not native to Trinidad, but rather originates from eastern Asia. It presented itself only recently in Trinidadian waters. Interestingly, shellfish consumption and algal blooms have had a long history of coexistence in Trinidad without any record of human intoxications. In this context, potential Public Health implications of finding PSP in a non-native shellfish species are briefly discussed.

The changing spectrum of childhood poisoning in the Caribbean - Poster abstract

OBJECTIVE: To determine the incidence of accidental poisoning in children, types of ingested substances, age of victims and outcome and compare data from Antigua with those from the United States and other Caribbean countries. DESIGN AND METHODS: A retrospective review of the records of all patients admitted to Children's Ward, Holberton Hospital, Antigua from March 1989 to March 1999 was performed. Data were compared with previous reports form Jamaica (1977), Barbados (1978), Guyana (1988) and the United States (1990). RESULTS: In Antigua there were 255 ingestions in children less than 13 years, with 45 percent in 1-year old, 27 percent in 2 year old and 10 percent in 3 year old children; 57 percent boys, similar in all countries. Two percent (2 percent) of poisonings in Jamaica were fatal and 0.3 percent in Antigua (kerosene). Fatality rate was 6 per 100,000 in Antigua, 0.5 per 100,000 in USA. Per capita GDP was US$995 in Guyana, US$2,079 in Jamaica, US$3,700 in Barbados, US$5,377 in Antigua and US$18,448 in United States. CONCLUSIONS: A comparison of poisonings seen in the Caribbean suggest that, with economic advance, ingestates change from hydrocarbon to medications and households products.(AU)

Ethnicity and excess mortality

The study examines and assesses the excess mortality from cerebrovascular disease, ischaemic heart disease, diabetes, hypertensive disease, injury and poisonings in City and Hackney descendents by country of birth used as proxy of ethnicity. The five year specific death rates for descendents aged 35 to 84 yars for England and Wales during the period 1986-90 was used as the standard to celebrate standardised proportional mortality ratios for these diseases. Mortality odds ratios were computed using the United Kingdom born descendents as the comparison group and all causes of death except genitourinary neoplasms, cirrhosis of the liver and the causes of interest as the auxillary (controls) cause of death. African Caribbean groups contribute 95 percent of the excess mortality from hypertensive disease. Caribbean and Indian groups account for over half the excess deaths from diabetes. All three groups contribute the excess deaths from cerebrovascular disease. Indian females appear to have twice the mortality risk of the England and Wales women, but this excess is hidden by the deficits of the Caribbean, British and younger Indian male groups who show deficit deaths from this cause. Mortality differentials are demonstrable by ethnic group at district level and may be greater than other available sources indicate. Standardised mortality odds ratios may be valuable tool for examining data sets lacking denominator data.(AU)

Paraquat induced suicide in Southern Trinidad

The rate of suicide in Trinidad and Tobago is much greater than in most of its Caribbean neighbours and self poisoning is the most common form of suicidal gesture. Paraquat poisoning in particular has been identified as one of the main agents of completed suicide. We therefore reviewed the deaths due to suicide in 1996 in South Trinidad, which is the area of Trinidad with the greatest agricultural activity, in an attempt to characterize paraquat induced suicide in terms of demographic and aetiological features. Case notes and clinical interviews were reviewed in all deaths due to deliberate self harm for the year 1996 at the General Hospital, San Fernando, Trinidad. There were 48 cases of completed suicide for the year and 39 (81 percent) of these were due to paraquat poisoning, giving an incidence of 8 per 100,000 population. Among the males, 48 percent were in the 25-34 year age group (p<0.001) and among the females 50 percent were in the 15-24 year age group (p<0.05). Family of origin disputes and marital problems were the most cited precipitants (p<0.003). Individuals of East Indian descent accounted for 89 percent of the cases (p<0.001). Psychiatric diagnoses were made in 20 percent of the cases with depression being the most frequently identified condition. While the ingestion of paraquat was often accompanied by heavy alcohol dependence. These findings confirm that paraquat poisoning continues to be a very significant problem and that young East Indian individuals seem particularly likely to attempt suicide by this means.(AU)

Ten-year retrospective study of the epidemiological and economic aspects of corrosive substance ingestion in children admitted to the BHC and UHWI (1986-1995)

The public health impact of corrosive substance ingestion in children is significant. The study examined secondary data on corrosive ingestion in children admitted to the Bustamante Hospital for Children (BHC) and the University Hospital of the West Indies (UHWI)during the period 1986-1995. The aim of the study was to compare the epidemiological variables and trends in children with corrosive substance ingestion and to estimate the cost burden to the health sector. During the period 1986-1995 a total of 308 children with corrosive ingestion were admitted to the BHC and UHWI with an average of 31 children per annum. There was a significant decline in the incidence of corrosive ingestion in children over the ten-year period. Age was identified as a major risk factor. Ninety-six percent of children studied fell into the 0-5 years age group with children in the 12-23 months age group being especially vulnerable. Alkalis were the most prevalent substances ingested, accounting for 91 percent of cases. Liquid bleach was the most commonly used household alkali ingested 99.6 percent of ingestions were determined to be accidental. These findings suggested that lack of awareness as to the proper storage of chemicals and poor supervision of children in the home may be contributary factors. Only one child developed oesophageal stricture as a consequence of having ingested causitc soda. The average lenght of stay in hospital was 3 days. Majority of the cases were from the Kingston and St. Andrew metropolitan region, with a significant proportion arising in the lower soci-economic areas. The average cost of hospitalization to patients was $129.60. Patients admitted to the public hospital pay a minimal fee as the cost of treatment is subsidized by government. Corrosive ingestion in children is preventable. Intervention strategies if implemented will ensure that the declining incidence trend continues (AU)

Self poisoning in the adolescent and adult population at the Georgetown Hospital, Guyana - abstract

The admissions registers of the Emergency Unit at the Public Hospital, Georgetown were reviewed for patients >10 years of age admitted for self poisoning between the 1 Jan. 1992 and 31 Dec. 1992. The ethnicity, gender, age group, prevalence and substance type was documented. There were 114 East Indians, 53 Africans and 1 Chinese admitted to the medical wards for self poisoning. All cases were parasucidal with rates of 55/10 (to the fifth power) and 57/10 (to the fifth power) for adults and adolescents, respectively. The ratio of East Indian:African attempters was 2:1 with a 1.5:1 ratio of East Indians:Africans in the population. There were 79 males and 89 females. In the 10-19 year age group 52 cases of self poisoning were admitted. In the 20-29 age group there were 61 cases. In the 30-39 age group 28 cases and in the 40-59 year age group 13 cases were admitted. The youngest was 12 yrs and the oldest 90 yrs of age. The majority of cases (141/168 or 84 percent) wer in the 10-39 year age group. An average of 14 cases was admitted per month. The commonest known substances ingested were organophosphates (58 cases), household substances (40), medicinal tablets (26), kerosene oil(25) and grammoxone (10). Preventive measures, including education, should be targetted to farmers and youths and young adults in the 10-29 year age group in whom self-poisoning is most common.(AU)

Poisoning in children at Georgetown Hospital, Guyana: a two year review

Between January 1992 and December 1993 a total of 109 children ó 10 years of age were admitted to the paediatric medical wards of the Georgetown Public Hospital for poisonous substance ingestion. Poisoning was most frequently seen in the 1-year-age-group (46 cases) followed by the 2-year-age-group (31) and the 3-year-age-group (15). There were no admissions of children aged 6, 7, 9 and 10 years. The youngest was 3-weeks-of-age and the oldest 8-years. The most common known substances ingested in order of frequency were kerosene (66 cases), bleach (11) and caustic soda (6 cases). There were 15 cases involving ingestion of known and 8 cases of unknown, medicinal substances (AU)

Accidental childhood injuries and trauma - abstract

Paediatric (<15 years of age) admissions for accidental injuries at the Queen Elizabeth Hospital, Barbados, were studied retrospectively for the period 1982-1991. Notes were retrieved according to the International Classification of Diseases. The objectives of the study were to evaluate the spectrum, incidence and trends of injury occurring during the period. There was a declining trend of admissions, with the most significant decrease in the 1-2-year-olds. The 5-12-year-old group had the most admissions (45 percent), followed by the 1-4-year-olds (37 percent), 13-14 years (13 percent) and <1 year (5 percent). Falls were the most prevalent cause for admission (36 percent), followed by motor vehicle accidents (MVA) (19 percent) and poisoning (14 percent). Poisoning, burns and foreign bodies were the most common in the 1-4-year-old age group. Falls, MVAs, being stuck with an object and machinery-related injuries were the most common in the 5-12-year-old age group. There was an overall decreasing trend in falls, being stuck with objects and poisonings, but there was an increasing trend in burns until 1986, but declining thereafter. There was an initial downward trend in the machinery-related injuries until 1985, but an increase thereafter. Despite the general declining trend in admissions for trauma, preventable trauma from machinery in the 5-12-year-old age group and burns in the 1-4-year-old age group showed no appreciable decrease in incidence (AU)

Demographic and clinical features of adolescent parasuicides

The demographic, ethnic and clinical characteristics of 102 adolescents admitted to the Port-of-Spain General Hospital over a 10-month period because of parasuicide were studied. The estimated rate of attempted suicide among adolescents was 94 per 100,000 of the hospital catchment population. Ninety per cent of the sample were females. Fifteen per cent had previously attempted suicide. Twenty-five per cent were clinically depressed, 22 percent had adjustment reactions, and in 49 percent no mental illness was detected. In 50 percent of cases, no further treatment was necessary after the first psychiatric interview. Intra-family conflicts were the most frequent reasons given for the attempted suicides. Girls of East Indian origin attempted suicide more frequently than those of African origin. Adolescents of mixed racial backgrounds attempted suicide less frequently than those of either African or East Indian origins. The findings of the study suggest a need for the adolescent psychiatric services to be upgraded, and for a review of the hospital policy of admitting all parasuicides of whatever degree as this is resulting in unnecessary and costly utilization of hospital beds (AU)

Arsenic: the forgotten poison?

Chronic arsenic poisoning is an uncommon cause of peripheral neuropathy in Jamaica. A patient with this disorder is described. The insidious nature of chronic arsenic poisoning, with its disabling complications, is emphasised. (AU)

Factors associated with the ingestion of harmful substances by children registered at the Bustamante Hospital for Children and at the University Hospital of the West Indies in 1990

Accidental ingestion of harmful substances in children continues to be a problem. This problem can significantly increase the rate of morbidity among this young population. This study was aimed at examining the factors relating to the ingestion of harmful substances. The study addressed issues such as the socio-economic status of the child, and the environment in which the child finds himself. The study included children who were registered at the Bustamante hospital for Children in 1990, aged 0 - 5 years whose primary diagnosis was related to the ingestion of harmful substances. The findings revealed that kerosene oil was the substance most often ingested, and children in the 1 - 2 age group were the most frequently affected. Improper handling and storage of the potentially harmful substance contributed to the ingestion of these substances. (AU)

Suicide by poisoning

An epidemiological evaluation was conducted on 270 patients who died at the General Hospital, Port-of-Spain after presenting with deliberate self-poisoning between January, 1986 and June, 1990. The cause of death was confirmed by autopsy and toxicological analysis. Epidemiological variables of age, sex, race, precipitating factors and types of poison used were assessed. It was found that the male to female ratio was 2.7:1. East Indians accounted for 54.4percent , Africans 42.0 percent, people of mixed ethnic origin 3 percent and Caucasians 0.6 percent. The majority of cases (52.6 percent) were seen in the age group 11-34 years. "Lovers' quarrels" (35.4 percent of cases), psychiatric illness (27.8 percent of cases) and family disputes (27 percent of cases) were reported as the most frequent precipitating events in suicide. East Indians predominated in those suicides precipitated by "lovers' quarrels" and family disputes, accounting for 63.2 percent and 58.9 percent of these cases, respectively; while for those suicides in which psychiatric illnesses were the main precipitating event, Africans were represented by 53.3 percent and East Indians 45.3 percent. Depression was the most common psychiatric illness diagnosed. Paraquat was the most popular poison used in 63.7 percent of the suicidal cases, and other agrochemicals were used in 20 percent of the cases. (AU)