An agromedicine initiative for first-year medical students, 1998-2004: biochemistry seminar proves feasible.

This report describes a 20 class-hour, 10-session seminar on agromedicine-oriented topics, delivered as part of a basic science course for medical students (biochemistry) at the Medical University of South Carolina. The course was initiated in 1998 and continued through 2004. The preceptors are family medicine and agricultural research professors. Concepts from primary care, epidemiology, entomology, toxicology, and food science appeal strongly to the first-year medical student group (limited to 10 students). The agromedicine/environmental medicine seminar series is one of 16 research seminars available for in-depth study. As part of the course in biochemistry, this seminar has earned positive evaluations from medical students who expect to widen their perspective on global health and the environment. Seminar topics include food safety, farm trauma, nutraceuticals, crop protection, insect-borne disease, occupational health and safety, diet and cancer, birth defects, and bioengineering. Seventy medical students have participated in the interdisciplinary seminar. They perceive environmental science as affecting the health of their patients and as an essential part of their preparation for curative and preventive medicine. Readers may find medical school curriculum committees more receptive to accepting and continuing an agromedicine offering if it can be incorporated in a basic science course such as biochemistry or pharmacology.

Fire ant anaphylaxis: two critical cases in South Carolina.

Two clinical cases illustrate near-fatal reactions to fire ant venom encountered by an infant playing in the backyard, and by a pharmacist working indoors in a hospital setting under a ceiling ventilation duct.

Recognition and management of acute pesticide poisoning.

Most poisonings from pesticides do not have a specific antidote, making decontamination the most important intervention. For maximal benefit to the patient, skin, eye, and gastric decontamination should be undertaken while specifics of the poisoning are being determined. As in most illnesses and injuries, the history of the poisoning is of great importance and will determine specific needs for decontamination and therapy, if any exist. Protection of health care workers during the decontamination process is important and frequently overlooked. Skin decontamination is primarily accomplished with large volumes of water, soap, and shampoo. Gastric decontamination by lavage is indicated if ingestion of the poisoning has occurred within 60 minutes of patient presentation. Activated charcoal, combined with a cathartic, is also indicated in most poisonings presenting within 60 minutes of ingestion. With large volume ingestion poisonings, activated charcoal may be used after 60 minutes, but little data exist to support this practice. Syrup of ipecac is no longer recommended for routine use. The cholinergic syndrome "all faucets on" characterizes poisoning by organophosphates and carbamates. Organochlorine insecticides (lindane and other treatments for scabies and lice) can produce seizures with excessive use or use on large areas of nonintact skin. Non-dipyridyl herbicides, biocides (including pyrethrins, pyrethroids, and Bacillus thuringiensis) rarely produce anything other than mild skin, eye, and/or gastrointestinal irritation on topical exposure or ingestion.