[Nicotine, pesticides, and tobacco, in Three Act Tragedy].

Since one of the main characters in Three Act Tragedy was an actor, the three murders described in the book have been likened to a curtain. The three seemingly unrelated murders were connected at the end of the story, a thrill unique to the author, Agatha Christie. Nicotine was used in all three murders in this book. Nicotine is highly toxic and was one of the main pesticides used until the mid-20th century. Although its use is currently prohibited, neonicotinoid pesticides, which have reduced toxicity, are still being used. Problems with nicotine intoxication include accidental ingestion by young children, green tobacco sickness, and suicide attempts. When nicotine enters the body, it binds to acetylcholine receptors and causes various symptoms.

Assessment of Cholinesterase inhibition activity of birds inhabiting pesticide exposed croplands and protected area in hot semi-arid region of Pakistan / Avaliação da atividade de inibição da colinesterase de pássaros que habitam áreas cultivadas e áreas protegidas expostas a pesticidas na região semiárida quente do Paquistão

Acetylcholinesterase (AChE) activity levels can be used as an indicator for AChE inhibition due to pesticide poisoning in bird species. We assessed the comparative brain cholinesterase (AChE) activity level of five bird species inhabiting pesticide exposed croplands and Protected Area i.e. Deva Vatala National Park (DVNP), Bhimber by using a spectrophotometric method. AChE activity levels ranged from 56.3 to 85.9 µmol/min/g of brain tissue of birds representing DVNP. However, AChE activity levels ranged from 27.6 to 79.9 µmol/min/g of brain tissue of birds representing croplands. AChE activity levels observed in Jungle babbler, Common babbler, and Red-vented bulbul showed significant differences (P 0.05). Maximum inhibition was recorded in Jungle babbler (53%) followed by Common babbler (35%), Red-vented bulbul (18%), White wagtail (15%), and Black drongo (7%). The brain cholinesterase inhibition levels under-protected ecosystems (DVNP, Bhimber) and agricultural landscape suggest insecticidal contamination and its impact on avifauna diversity. The study also emphasizes on the importance of pesticide-free zones to protect the biodiversity of birds.

Os níveis de atividade da acetilcolinesterase (AChE) podem ser usados como um indicador para a inibição da AChE devido ao envenenamento por pesticidas em espécies de aves. Avaliamos o nível de atividade comparativa da colinesterase cerebral (AChE) de cinco espécies de aves que habitam áreas cultivadas expostas a pesticidas e Área Protegida, ou seja, Deva Vatala National Park (DVNP), Bhimber, usando um método espectrofotométrico. Os níveis de atividade da AChE variaram de 56,3 a 85,9 µmol / min / g de tecido cerebral de aves representando DVNP. No entanto, os níveis de atividade da AChE variaram de 27,6 a 79,9 µmol / min / g de tecido cerebral de aves representando áreas de cultivo. Os níveis de atividade de AChE observados no tagarela da selva, tagarela comum e bulbul vermelho exalado mostraram diferenças significativas (P 0,05). A inibição máxima foi registrada no tagarela da selva (53%), seguido pelo tagarela comum (35%), bulbul vermelho (18%), alvéola branca (15%) e drongo preto (7%). Os níveis de inibição da colinesterase cerebral nos ecossistemas subprotegidos (DVNP, Bhimber) e na paisagem agrícola sugerem contaminação por inseticida e seu impacto na diversidade da avifauna. O estudo também enfatiza a importância das zonas livres de pesticidas para proteger a biodiversidade das aves.

Intoxicación por plaguicidas en autopsias medicolegales. Tegucigalpa 2014-2020 / Poisoning by pesticides in medicolegal autopsies. Tegucigalpa 2014- 2020

Justificación: Los plaguicidas han provocado un significativo problema de salud pública ya que han generado una importante carga a la mortalidad y a la morbilidad. Los suicidios con plaguicidas representan alrededor de un tercio de todos los suicidios en el mundo. Objetivo: Caracterizar las muertes relacionadas a plaguicidas, sometidas a autopsia médico legal en la Dirección de Medicina Forense de Tegucigalpa durante los años 2014- 2020. Metodología: Se consultó la base de datos digital la Dirección de Medicina Forense, encontrando 255 casos relacionados a muerte por plaguicidas de los que se seleccionaron 215 casos con expediente completo y disponible. Los cálculos estadísticos se realizaron con el programa PSPP. Resultados: Se encontraron 215 casos, el 58% eran hombres y el 42% mujeres, 54% eran solteros y 29% en unión libre. Sin escolaridad 11%, primaria incompleta 20%, primaria completa 15%, secundaria incompleta 12%, secundaria completa 10%. Respecto a la ocupación de los fallecidos, los oficios domésticos fue la más frecuente entre las mujeres y la agricultura entre los hombres. El 65% eran personas jóvenes menores de 40 años con una media de edad de 35 años (rango 8- 89a). La manera de muerte más frecuente fue suicida con el 71%. El plaguicida más utilizado como instrumento de muerte fue el fosfuro de aluminio (66%).Conclusión: La mayoría de las muertes por intoxicación con plaguicidas fueron suicidas; hombres jóvenes, menores de 40 años, solteros, con escolaridad que no sobrepasaba la secundaria; utilizaron las pastillas de fosfuro de aluminio como instrumento de autolesión. Se requiere estudiar más detalladamente el uso de tóxicos en general y de los plaguicidas en particular como instrumentos de autolesión y se evidencia la necesidad imperiosa de habilitar medidas de regulación para la comercialización y campañas de educación en la población para el uso y manejo adecuado...(AU)

Organochlorine pesticides, oxidative stress biomarkers, and leukemia: a case-control study.

Exposure to pesticides has been linked to an elevated risk of leukemia. The present research aimed to evaluate the relationship between organochlorine (OC) pesticides and biomarkers of oxidative stress in patients with leukemia. This work was conducted on 109 patients with leukemia and 109 healthy controls. The serum concentrations of seven derivatives of OCs including alpha-hexachlorocyclohexane (HCH), beta-HCH, gamma-HCH, 2,4-dichlorodiphenyltrichloroethane (DDT), 4,4-DDT, 2,4-dichlorodiphenyldichloroethylene (DDE), and 4,4-DDE along with acetylcholinesterase (AChE), glutathione peroxidase (GPx), superoxide dismutase (SOD), paraoxonase-1 (PON1), and catalase (CAT) activities as well as total antioxidant capacity (TAC), nitric oxide (NO), protein carbonyl (PC), and malondialdehyde (MDA) levels were measured in all the subjects. Levels of OCs were remarkably higher in patients with leukemia compared with the controls (p<0.05). In addition, levels of SOD, AChE, GPx, PON1, and TAC were remarkably lower in patients with leukemia compared with controls (p<0.05). In contrast, MDA, NO, and PC concentrations were higher in patients with leukemia than in the controls (p<0.05). Moreover, the serum level of 4,4-DDE was negatively associated with GPx activity (p=0.038). Our findings suggest that OCs may play a role in the development of leukemia by disrupting the oxidant/antioxidant balance.

Intoxicações exógenas por agrotóxicos no Espírito Santo, 2007-2016: distribuição espacial e tendências da taxa de incidência e letalidade dos casos notificados / Intoxicación por plaguicidas exógenos en el estado de Espírito Santo, Brasil, 2007-2016: distribución espacial y tendencia temporal de la tasa de incidencia y letalidad de los casos notificados / Exogenous pesticide poisoning in the state of Espírito Santo, Brazil, 2007-2016: spatial distribution and temporal trend in the incidence rate and case fatality ratio of notified cases

Objetivo: Descrever a distribuição espacial de casos de intoxicação por agrotóxicos e analisar a tendência temporal da taxa de incidência e letalidade por esse evento no estado do Espírito Santo, Brasil. Métodos: Estudo de série temporal dos casos confirmados de intoxicação por agrotóxicos reportados ao Sistema de Informação de Agravos de Notificação (Sinan) entre 2007 e 2016. As taxas de incidência foram apresentadas em mapas temáticos. Foram utilizados gráficos de dispersão, para apresentar a incidência e letalidade dos casos. Resultados: Houve taxa de incidência crescente de intoxicações no período, para o total dos casos, por sexo e faixa etária - exceto para maiores de 70 anos. A letalidade foi decrescente até 2012, com posterior aumento. Oito municípios apresentaram as maiores taxas de notificação (30 a 46 casos novos/100 mil habitantes). Conclusão: Houve aumento na incidência de notificações, no período. A letalidade mostrou-se decrescente até 2012, seguindo-se posterior crescimento.

Objetivo: Describir la distribución espacial de casos de intoxicación por plaguicidas y analizar su tendencia temporal de la tasa incidencia y letalidad en estado de Espírito Santo, Brasil. Métodos: Estudio de serie temporal de casos confirmados de intoxicación por plaguicidas notificados al Sistema de Información de Enfermedades de Notificación (Sinan) de 2007 a 2016. Las tasas de incidencia se basaron en mapas temáticos. Se utilizaron gráficos de dispersión para presentar la incidencia y la letalidad. Resultados: Incremento de la tase de incidencia de intoxicaciones en el período para el total de los casos, sexo y grupos de edad - excepto para mayores de 70 años. La letalidad fue disminuyendo hasta 2012, con un aumento posterior. Ocho asociaciones tuvieron las tasas de notificación más altas (30 a 46 nuevos casos/100.000 habitantes). Conclusión: Hubo un aumento en la incidencia de notificaciones en el período. La letalidad fue disminuyendo hasta 2012, seguida de un aumento posterior.

Objective: To describe the spatial distribution of pesticide poisoning cases and analyze the temporal trend in the incidence rate and case fatality ratio of this event in the state of Espírito Santo, Brazil. Methods: This was a time series study of confirmed cases of pesticide poisoning registered on the Notifiable Health Conditions Information System (SINAN) between 2007 and 2016. Incidence rates were presented in thematic maps. Scatter plots were used to show the incidence and case fatality ratio of cases. Results: There was an increasing incidence rate of poisoning in the period regarding the total number of cases, by sex and age group - except for those aged 70 years and over. There was a decreasing case fatality ratio until 2012, with a subsequent increase. Eight municipalities presented the highest notification rates (30 to 46 new cases/100,000 inhabitants). Conclusion: There was an increase in the incidence of notifications in the period. There was a decrease in case fatality ratio until 2012, subsequently followed by an increase.

[Clinical significance of combined sST2 and NT-proBNP detection for the short-term prognosis of acute organophosphorus pesticide poisoning].

Objective: To explore the value of soluble growth stimulation expression gene 2 protein (soluble suppression of tumorigenicity 2; sST2) and N terminal B type brain natriuretic peptide (N-terminal probrainnatriuretic peptide, NT-proBNP) in evaluating the short-term prognosis of acute organophosphorus pesticide poisoning. Methods: select 228 patients with acute organophosphorus pesticide poisoning in our hospital from October 2017 to March 2020. According to the grade of poisoning degree, it was divided into 82 cases in mild and moderate group and 146 cases in severe group. hs-cTnI、CK-MB、sST2、NT-proBNP、APACHE Ⅱ score and cholinesterase activity were detected 4 h、12 h、24 h after admission. ROC curve was used to evaluate sST2 and NT-proBNP to predict the prognosis of AOPP. Results: 4 hours after admission, there was no significant difference in the scores of hs-cTnI, APACHE Ⅱ, cholinesterase and CK-MB between the Severe Group and the mild and moderate Group (P<0.05) . At 12 and 24 hours after admission, the scores of hs-cTnI, CK-MB and APACHE Ⅱ in severe group were higher than those in mild and moderate group, and the changes of Cholinesterase were more significant than those in 12 hours after Admission (P<0.05) . 4 hours after admission, SST2 and NT-proBNP levels were significantly higher in severe group than those in mild and moderate Group (P<0.05) . The level of SST2 and NT-proBNP in the severe group was significantly higher than that in the mild and moderate group 12 and 24 hours after Admission (P<0.01) , and the level of SST2 and NT-proBNP was significantly higher than that in the mild group 12 hours after Admission (P<0.05) . Correlation analysis showed that 24 hours after admission, sST2, NT-proBNP were positively correlated with APACHE-Ⅱ scores (R=0.634, 0.723, P<0.01) . The area under sST2 combined with NT-proBNP was 0.891, higher than that under sST2 and NT-proBNP at 12 h after admission. The 24 h APACHE Ⅱ score after admission area under the curve was 0.838. Conclusion: sST2 and NT-proBNP combined detection can early predict the occurrence of recent complications in AOPP patients.

Pesticides Misused for Bed Bug Control: Comparing Professional and Nonprofessional Applications Reported to the National Pesticide Information Center, 2013-2017.

Objectives. To compare outcomes when pesticides are used to control bed bugs by professionals and nonprofessionals. Methods. All US National Pesticide Information Center inquiries from 2013 to 2017 were assessed to identify scenarios involving bed bugs and pesticide applications. Cases were evaluated with respect to types of applicators, misapplications, and human pesticide exposures. Results. Misapplications were more than twice as likely to be reported in cases involving nonprofessional applications (14%) as in cases involving professional applications (5%). Human exposures to pesticides were reported more often when pesticides were misapplied (70%) than when there were no apparent misapplications (31%). Conclusions. Both professionals and nonprofessionals may misuse pesticides to control bed bugs, which may increase the risks of exposure and adverse outcomes. Policy interventions may reduce pesticide incidents related to bed bug control by promoting professional involvement and adherence to product label instructions.

Case fatality of agricultural pesticides after self-poisoning in Sri Lanka: a prospective cohort study.

BACKGROUND: Pesticide poisoning is among the most common means of suicide globally, but can be prevented with regulation of the most hazardous agents. We aimed to compare the lethality of pesticides ingested by our cohort, seek evidence on variation between human and regulatory animal toxicity, and establish change over time in the case fatality of individual pesticides in Sri Lanka. METHODS: We examined the case fatality of agricultural pesticides in a prospective cohort in nine hospitals serving rural populations in Sri Lanka. We included all patients (>11 years) who had presented to a South Asian Clinical Toxicology Research Collaboration study hospital during the study period. Patients were enrolled by clinical research assistants and were regularly reviewed. Identification of the ingested pesticide was generally on the basis of history or positive identification of the container, supported by nested blood analysis. FINDINGS: From March 31, 2002, to Dec 31, 2019, 34 902 patients (median age 29 years [IQR 21-40]; 23 060 [66·1%] male) presented with a possible or known pesticide self-poisoning. We identified 23 139 specific pesticides that were ingested. Poisoning was fatal in 2299 (6·6%) patients. Case fatality varied greatly from 0·0% (several substances) to 41·8% (paraquat). The three most toxic agents (ie, paraquat, dimethoate, and fenthion) were banned between 2008 and 2011. Since 2013, the five agents causing the most deaths (ie, profenofos, propanil, fenobucarb, carbosulfan, and quinalphos) had a case fatality of 7·2-8·6%. A steady decline was seen in overall case fatality of pesticide poisoning (10·5% for 2002-06 to 3·7% for 2013-19), largely attributable to pesticide bans. A modest fall in case fatality for non-banned pesticides was also seen. INTERPRETATION: Declines seen in case fatalities of poisonings with non-banned pesticides suggest that medical management improved over time. The human data for acute toxicity of pesticides should drive hazard classifications and regulation. We believe that a global benchmark for registration of pesticides should include a less than 5% case fatality after self-poisoning, which could prevent many deaths and have a substantial effect on global suicide rates. FUNDING: The Wellcome Trust and the National Health and Medical Research Council of Australia. TRANSLATIONS: For the Sinhala and Tamil translations of the abstract see Supplementary Materials section.

Clinical utility of validated gas chromatography-ion trap mass spectrometry in patients with anticholinesterase pesticides poisoning.

Intentional or unintentional intake of anticholinesterase pesticides became common due to their extensive use in agricultural and domestic purposes, resulting in numerous poisoning cases. A simple, accurate, and sensitive gas chromatography-ion trap mass spectrometry-based method for the quantification of 12 anticholinesterase pesticides (monocrotophos, dimethoate, dichlorvos, azinphos-methyl, carbofuran, chlorpyrifos, dialifos, diazinon, malathion, parathion, methidathion, and terbufos) in serum was developed, and its utility in patients with alleged pesticides poisoning was assessed. The quantification was performed using liquid-liquid extraction by toluene/chloroform (4:1,v/v) with 500 µL of serum. On column limit of detection and limit of quantification were less than 50.00 µg/L. The recovery ranged from 97.54 to 103.23%. The calibration curves were linear (R2 > 0.9937). Accuracy was found to be between - 7.1 and 7.2%. Intra-day and inter-day reproducibility was less than 17% for the spiked quality control serum samples. The level of pesticide in serum quantified by the validated method correlated with clinical signs and symptoms, pseudo-cholinesterase activity, total atropine dose, length of hospital stay, and clinical outcome in 15 patients with alleged pesticide poisoning. The validated method may be used for monitoring and prognosis in patients with pesticide poisoning and diagnosis of poisoning in forensic toxicology.

Intoxicaciones agudas con pesticidas para fines suicidas en Costa Rica durante la década de 2010-2020 / SuicideSuicide attempts due to pesticide poisoning in Costa Rica during the 2010-2020 decade

Resumen Introducción: La intoxicación con plaguicidas es de los métodos más utilizados por los suicidas, especialmente en países agrícolas de ingreso medio-bajo. El objetivo de la investigación fue describir y analizar la situación epidemiológica de la intoxicación aguda por plaguicidas con fines suicidas en Costa Rica durante los años 2010-2020. Materiales y métodos: Se recopilaron datos del Centro Nacional para el Control de Intoxicaciones (CNCI) de las intoxicaciones agudas con plaguicidas para fines suicidas durante el 2010-octubre 2020 y datos del Instituto Nacional de Estadística y Censos (INEC) de las defunciones por suicidios con plaguicidas durante los años 2010-2019. Los datos se analizaron por sexo, edad, provincia, agente tóxico, ruta de absorción, severidad del cuadro clínico y mortalidad. Resultados: De las 3240 intoxicaciones agudas totales con plaguicidas para fines suicidas durante los años 2010-octubre 2020, el 64.7% eran hombres y 35.3% mujeres; 31.9% de las intoxicaciones ocurrieron en personas en edades entre los 20-29 años y 21% entre 30-39 años; 23.4% de los incidentes ocurrieron en la provincia de Alajuela y 19.7% en San José; el 75% de los plaguicidas utilizados eran de uso agrícola; en el 17.2% de las intoxicaciones utilizaron Glifosato y 15.9% Paraquat; en 98.3% de los casos la ruta de absorción fue por ingestión; 65.3% de los casos fueron reportados con sintomatología leve según el CNCI. Durante el 2010-2019, 432 personas murieron por suicidio utilizando plaguicidas, lo que significa una mortalidad anual promedio de 13.3% de las intoxicaciones agudas con plaguicidas para fines suicidas Conclusiones: La epidemiología de los intentos suicidas utilizando pesticidas en CR es muy similar a los patrones internacionales predominando hombres jóvenes en zonas agrícolas y que tienen acceso a los pesticidas. Es necesario fortalecer medidas e implementar políticas para la regulación, almacenaje y manejo adecuado de los plaguicidas.

Abstract Introduction: Pesticides self-poisoning is one of the most popular suicide methods especially in lower middle class income agricultural countries. The objective of this research is to describe and analyze the epidemiological situation of suicide attempts due to pesticide poisoning in Costa Rica during the last decade. Materials and methods: Data of pesticides self-poisoning goes all the way from 2010 until October 2020. That information was collected from the National Center for Poisoning Control (CNCI, stands for the initials in spanish) database and National Institute for Statistics and Census (INEC in spanish) data of pesticides self-poisoning deaths from 2010-2019. All data was analyzed by sex, age, province, toxic agent, route of absorption, clinical severity and mortality. Results: There were 3240 total cases of suicide attempts due to pesticides during 2010-october 2020; 64.7% of this poisoning were in men and 35.3% in women, 31.9% of the poisoning persons were in age with a range between 20-29 years and 21% between 30-39 years old; 23.4% of cases were reported in Alajuela and 19.7% in San José; 75% of the cases used agricultural pesticide; 17.2% of the poisonings occurred due to Glifosato and 15.9% due to Paraquat; ingestion was the route of absorption in 98.3% of the cases; and 65.3% reported mild clinical severity. During 2010-2019, 432 people died due to suicide using pesticides as a weapon, which means an average mortality of 13.3% of all the suicide attempts with pesticides in this period. Conclusions: Costa Rica´s epidemiology of suicide attempts using pesticides is very similar to international epidemiology, where most of the cases are young men that have access to pesticides and lived-in agricultural areas. It´s necessary to implement policies for the regulations, storage and proper management of pesticides in order to prevent suicide.

The cost-effectiveness of banning highly hazardous pesticides to prevent suicides due to pesticide self-ingestion across 14 countries: an economic modelling study.

BACKGROUND: Reducing suicides is a key Sustainable Development Goal target for improving global health. Highly hazardous pesticides are among the leading causes of death by suicide in low-income and middle-income countries. National bans of acutely toxic highly hazardous pesticides have led to substantial reductions in pesticide-attributable suicides across several countries. This study evaluated the cost-effectiveness of implementing national bans of highly hazardous pesticides to reduce the burden of pesticide suicides. METHODS: A Markov model was developed to examine the costs and health effects of implementing a national ban of highly hazardous pesticides to prevent suicides due to pesticide self-poisoning, compared with a null comparator. We used WHO cost-effectiveness and strategic planning (WHO-CHOICE) methods to estimate pesticide-attributable suicide rates for 100 years from 2017. Country-specific costs were obtained from the WHO-CHOICE database and denominated in 2017 international dollars (I$), discounted at a 3% annual rate, and health effects were measured in healthy life-years gained (HLYGs). We used a demographic projection model beginning with the country population in the baseline year (2017), split by 1-year age group and sex. Country-specific data on overall suicide rates were obtained for 2017 by age and sex from the Global Burden of Disease Study 2017 Data Resources. The analysis involved 14 countries spanning low-income to high-income settings, and cost-effectiveness ratios were analysed at the country-specific level and aggregated according to country income group and the proportion of suicides due to pesticides. FINDINGS: Banning highly hazardous pesticides across the 14 countries studied could result in about 28 000 (95% uncertainty interval [UI] 24 000-32 000) fewer suicide deaths each year at an annual cost of I$0·007 per capita (95% UI 0·006-0·008). In the population-standardised results for the base case analysis, national bans produced cost-effectiveness ratios of $94 per HLYG (95% UI 73-123) across low-income and lower-middle-income countries and $237 per HLYG (95% UI 191-303) across upper-middle-income and high-income countries. Bans were more cost-effective in countries where a high proportion of suicides are attributable to pesticide self-poisoning, reaching a cost-effectiveness ratio of $75 per HLYG (95% UI 58-99) in two countries with proportions of more than 30%. INTERPRETATION: National bans of highly hazardous pesticides are a potentially cost-effective and affordable intervention for reducing suicide deaths in countries with a high burden of suicides attributable to pesticides. However, our study findings are limited by imperfect data and assumptions that could be improved upon by future studies. FUNDING: WHO.

The prevalence of esophageal cancer after caustic and pesticide ingestion: A nationwide cohort study.

Habits such as smoking and alcohol drinking and existing esophageal malfunction are considered the main risk factors for esophageal carcinogenesis. Caustic ingestion of acidic or alkaline agents or strong irritants can induce severe esophageal corrosive injury and increase esophageal cancer risk. We studied the relationship between esophageal carcinoma and acute detergent or pesticide poisoning by using nationwide health insurance data. Methodology/Principle findings: We compared a pesticide/detergent intoxication cohort (N = 21,840) and an age- and gender-matched control cohort (N = 21,840) identified from the National Health Insurance Research Database between 2000 and 2011. We used the multivariable Cox proportional model to determine esophageal carcinoma risk. The overall incidence density of esophageal cancer was 1.66 per 10,000 person-years in the comparison cohort and 4.36 per 10,000 person-years in the pesticide/detergent intoxication cohort. The corresponding adjusted hazard ratio (HR) for esophageal cancer was 2.33 (95% confidence interval [CI] = 1.41-3.86) in the pesticide/detergent intoxication cohort compared with the control cohort. Patients with corrosive and detergent intoxication did not have a higher risk of esophageal cancer (adjusted HR = 0.98, 95% CI = 0.29-3.33) than those without pesticide/detergent intoxication. However, patients with pesticide intoxication had a significantly higher risk of esophageal cancer (adjusted HR = 2.52, 95% CI = 1.52-4.18) than those without pesticide/detergent intoxication. Conclusion: In the present study, after adjusting for conventional risk factors, we observed that pesticide intoxication could exert substantial effects through increased esophageal cancer risk. However, patients with detergent intoxication may not have an increased risk of esophageal cancer.

Occupational exposure to pesticides and health symptoms among family farmers in Brazil.

OBJECTIVE: To explore the association of occupational pesticide exposure with acute and mental health symptoms. METHODS: Cross-sectional survey carried out with 78 Brazilian family farmers, who were pesticide applicators and helpers conveniently selected. Symptoms and exposure data were collected by interviews, and mental health outcomes by the Self-Reporting Questionnaire. Blood samples were analyzed to assess cholinesterase levels. Exposure indicators and symptoms were compared between applicators and helpers, and Poisson regression was performed to estimate prevalence ratios. RESULTS: Farmers reported exposure to multiple pesticides from early ages; they worked without safety training, technical support, and full protective equipment, and they had a high prevalence of acute and mental health symptoms (e.g., headache, mucosal irritation, tachycardia, and depressive signs). Applicators had more cholinesterase changes than helpers, but less symptoms. Helpers used less personal protection and had significantly higher prevalence ratio of headache, dyspnea, wheezing, cough, poor digestion, tiredness, and feeling worthless, after adjustment. CONCLUSIONS: Acute and mental health symptoms were observed, both among farmers and helpers. Thus, surveillance actions must be reinforced in Brazil, technical support and safety training improved, focused on applicators and helpers, who are occupationally and environmentally exposed to pesticides. Agricultural practices of these groups with less pesticide use should receive incentive.

Suspected environmental poisoning by drugs, household products and pesticides in domestic animals.

Animal poisoning by chemicals (pesticides and household products) and drugs is a frequent occurrence and special attention should be paid to this phenomenon to improve prevention and treatment strategies and because of the fundamental role that animals may play as bioindicators. From January 2017 to March 2019 the Poison Control Centre of Milan (CAV) in collaboration with the University of Milan, collected and analyzed epidemiological data on animal poisoning. During this period, the CAV received a total of 442 enquiries on domestic animal poisoning episodes and, among these, 80.3 % were related to chemicals and drugs. Pesticides and drugs were the two major causes of poisoning (34.1 % and 33.5 %, respectively), followed by household products (29.3 %) and other causative agents (3.1 %, n = 11). In conclusion, these findings can provide useful information for the identification and monitoring of known and emerging toxicants, with positive repercussions on human, animal and environmental health.

Modified QuEChERS extraction method followed by simultaneous quantitation of nine multi-class pesticides in human blood and urine by using GC-MS.

Organophosphate, carbamate and pyrethroid pesticides are the most common insecticides used worldwide. They may cause chronic poisoning in farmers and acute poisoning in homicidal or suicidal cases. The determination of trace levels of these pesticides in human blood and urine is very challenging. This study focuses on a simultaneous quantitation method that was developed and validated for multi-class nine pesticides belonging to organophosphate, carbamate and pyrethroid classes in human blood and urine. Target pesticides were extracted from blood and urine using a modified QuEChERS (Quick, Easy, Cheap, Effective, Rugged and Safe) extraction method. Capillary column DB-35 ms (15 m × 0.25 mm, 0.25 µm) was used for chromatography with a 0.079 ml/min flow rate of carrier gas at constant pressure mode. Quantitation of sulfotep, phorate, carbofuran, chlorpyriphos, profenophos, triazophos, pyriproxyfen, lambda-cyhalothrin and permethrin was performed by mass spectrometer equipped with electron impact ionization source using selected ion monitoring (SIM) mode. The lower and upper limits of quantitation for all nine pesticides were 0.01 mg/L and 2.0 mg/dL respectively. The proposed method was proved to be simple, fast, sensitive, and robust. It has been applied to the analysis of 9 pesticides samples.

Successful treatment of aluminium phosphide poisoning by dihydroxyacetone: A two-case report study.

WHAT IS KNOWN AND OBJECTIVE: Aluminium phosphide (AlP) is an agricultural fumigant which produces phosphine gas in the presence of moisture. Phosphine inhibits oxidative phosphorylation and causes cell death by inhibiting cytochrome C oxidase. Clinical manifestations of AlP poisoning are refractory hypotension, tachycardia, low oxygen saturation and severe metabolic acidosis. CASE SUMMARY: Two cases received dihydroxyacetone (DHA) in addition to routine management of AlP poisoning. Administration of DHA (7 gr in 50 mL sodium bicarbonate, gavage) 2 times at a 1-hour interval improved the clinical signs. WHAT IS NEW AND CONCLUSION: This is the first case report to highlight the safe and successful treatment of AlP poisoning with DHA. However, more clinical studies are recommended to determine the precise mechanism of DHA action.

Software de gestión y análisis de los casos de intoxicaciones por plaguicidas - PlaguiTox / Management and analysis software for pesticide poisoning cases - PlaguiTox

Introducción: El Centro Nacional de Toxicología de Cuba, supervisa y controla la información de eventos atribuibles a la inmunización, vacunación e intoxicaciones con medicamentos y plaguicidas. Los casos que llegan al centro, se justifican mayormente por el uso de plaguicidas que tienen un alto nivel de toxicidad y riesgo de muerte. Los especialistas en toxicología, requieren facilidad para revisar las hojas de seguridad, el listado oficial de plaguicidas autorizados en Cuba y los casos anteriores. Esto permite analizar y emitir un diagnóstico, que salve la vida del afectado. Objetivo: Presentar un sistema para la gestión y el análisis de los casos intoxicados por plaguicidas. Métodos: El desarrollo se sustentó en la metodología de software Extreme Programming, modelado con la herramienta CASE Visual Paradigm 8.0 y lenguaje UML 2.0. Se utilizó Java con NetBeans 8.0.2 y como gestor de base de datos PostgreSQL 9.3. Resultados: Se desarrolló una herramienta de gestión de la información toxicológica, así como una base de casos de los síntomas, plaguicidas y diagnóstico por plaguicida. Los especialistas en toxicología cuentan con una herramienta de apoyo a la toma de decisiones, que reduce la ocurrencia de errores humanos(AU)

Introduction: The Cuban National Toxicology Center supervises and controls the information of events attributable to immunization, vaccination and poisonings with medications and pesticides. The cases that arrive at the center are mainly justified by the use of pesticides that have a high level of toxicity and risk of death. Specialists in toxicology require ease to review the safety sheets, the official list of authorized pesticides in Cuba and the above cases. This allows analyzing and issuing a diagnosis that saves the life of the affected person. Objective: To present a system for the management and analysis of cases poisoned by pesticides. Methods: The development was based on the Extreme Programming software methodology, modeled with the CASE Visual Paradigm 8.0 tool and the UML 2.0 language. Java was used with NetBeans 8.0.2 and as PostgreSQL 9.3 database manager. Results: A toxicological information management tool was developed, as well as a case database of symptoms, pesticides and pesticide diagnosis. Toxicology specialists have a decision support tool that reduces the occurrence of human errors(AU)

Occupational exposure to organophosphate pesticides and hematologic neoplasms: a systematic review. / Exposição ocupacional a agrotóxicos organofosforados e neoplasias hematológicas: uma revisão sistemática.

OBJECTIVE: To update findings of observational analytical studies on the association between occupational exposure to organophosphates and hematologic malignancies. METHODOLOGY: Systematic literature review, including cohort and case-control studies, without limitation of publication time, in Portuguese and English. The articles were traced from June 2017 to July 2019 in PubMed, MEDLINE, LILACS, Web of Science, and Scopus databases. The qualitative bias risk assessment was performed using the Newcastle-Ottawa Scale and the Downs and Black Checklist. Results were presented according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). RESULTS: Seventeen studies evaluated as good/high methodological quality were eligible. Exposure to diazinon (1 cohort), phonophos (1 cohort), dichlorvos, crotoxiphos and famphur (1 case control) was associated with leukemia, while exposure to organophosphate was associated to lymphomas (6 case control); the risk of non-Hodgkin's lymphoma was higher in those exposed to diazinon (1 control case) and malathion (3 control case) than non-exposed ones. Multiple myeloma occurred more commonly in organophosphate exposed than in non-exposed individuals (1 case-control). CONCLUSION: Occupational exposure to organophosphates increases the risk of hematologic malignancies, especially among individuals with longer exposure periods. Worker monitoring and exposure control measures are recommended.

Poisoning and associated factors to death from pesticides: case-control study, Brazil, 2017. / Intoxicações e fatores associados ao óbito por agrotóxicos: estudo caso controle, Brasil, 2017.

BACKGROUND: Pesticide poisoning causes high morbidity and mortality. Surveillance is required for post-marketing monitoring of these products. AIM: To assess poisonings and associated factors with lethality by pesticides. METHOD: This is a case-control study based on the cases of pesticide poisoning assisted in 2017 by Brazilian Poison Control Centers. Patients who died were the cases and the survivors, the control. The odds ratio (OR) of death and 95% confidence interval (CI) were calculated. From the regression model, a predictive model of death was developed, stratified by age, gender and occupational context to investigate the risk of agricultural workers poisoned by extremely hazardous agents. RESULTS: 3,826 patients poisoned by pesticides were identified, of which 146 died. Older people (OR = 4.94; 95%CI 2.49 - 9.80), males (OR = 1.68; 95%CI 1.15 - 2.46), agricultural workers (OR = 2.20; 95%CI 1.15 - 4.24), suicide attempts (OR = 13.27; 95%CI 6.48 - 27.19) and exposure to extremely hazardous products (OR = 2.77; 95%CI 1.84 - 4.16) odds of death from pesticide poisoning. CONCLUSION: Out of 100 pesticides poisoning, four died. Elderly, males, working in the agricultural sector, suicide attempts and extremely hazardous products had a higher risk of death.

Emerging pesticides responsible for suicide in rural Sri Lanka following the 2008-2014 pesticide bans.

BACKGROUND: Sri Lanka has reduced its overall suicide rate by 70% over the last two decades through means restriction, through a series of government regulations and bans removing highly hazardous pesticides from agriculture. We aimed to identify the key pesticide(s) now responsible for suicides in rural Sri Lanka to provide data for further pesticide regulation. METHODS: We performed a secondary analysis of data collected prospectively during a cluster randomized controlled trial in the Anuradhapura district of Sri Lanka from 2011 to 16. The identity of pesticides responsible for suicides were sought from medical or judicial medical notes, coroners' records, and the person's family. Trend analysis was done using a regression analysis with curve estimation to identify relative importance of key pesticides. RESULTS: We identified 337 suicidal deaths. Among them, the majority 193 (57.3%) were due to ingestion of pesticides while 82 (24.3%) were due to hanging. A specific pesticide was identified in 105 (54.4%) of the pesticide suicides. Ingestion of carbosulfan or profenofos was responsible for 59 (56.2%) of the suicides with a known pesticide and 17.5% of all suicides. The increasing trend of suicides due to carbosulfan and profenofos over time was statistically significant (R square 0.846, F 16.541, p 0.027). CONCLUSION: Ingestion of pesticides remains the most important means of suicides in rural Sri Lanka. The pesticides that were once responsible for most pesticide suicides have now been replaced by carbosulfan and profenofos. Their regulation and replacement in agriculture with less hazardous pesticides will further reduce the incidence of both pesticide and overall suicides in rural Sri Lanka.