Aldicarb poisoning

Aldicarb, 2-methyl-2 (methylthio) propanal o-[(methylamino)-carbonyl] oxime is a pesticide manufactured since 1965. This carbamate ester is sold under the tradename Temik and is used as an insecticide and nematicide. The Environmental Protection Agency has classified aldicarb in the highest toxicity category and has defined a strict control for its delivery and use. In Brazil and the Caribbean island of Guadeloupe, aldicarb is illegally used as a household rodenticide with a widespread risk of poisoning. Our study presents the first review of aldicarb poisoning with clinical and analytical findings and oxime treatment is discussed. Eighteen patients with cholinergic symptoms admitted to the Emergency Unit and two with a history of aldicarb poisoning who died were included in the study. As agricultural workers, only two of them could legally use Temik. Seventy percent of the patients were managed by the Emergency Mobile Unit. Serum cholinesterase activity was always < 30 percent of the normal range and aldicarb was identified by ultraviolet spectra and retention time after liquid chromatography separation. The most common muscarinic effect was diarrhoea (98 percent), the main nicotinic sign was fasciculation (78 percent) and 44 percent of the poisoned patients had central nervous system depression (Glasgow Coma Score < 8). Four patients had serious abnormalities and two of them died. These results suggest that aldicarb intoxication is always severe. Oxime treatment did not produce side effects and should be recommended whenever the pesticide involved is unknown. Effective measures should be implemented to stamp out the illicit use of aldicarb.(Au)

Aldicarb poisoning.

Aldicarb (2-methyl-2(methylthio) propanal o-[(methylamino)-carbonyl] oxime) is a pesticide manufactured since 1965. This carbamate ester is sold under the tradename, Temik, and is used as insecticide and nematicide. The Environmental Protection Agency has classified aldicarb in the highest toxicity category and has defined a strict control for its delivery and use. In Brazil and the Caribbean island, aldicarb is illegally used as a household rodenticide with a widespread risk of poisoning. Our study presents the first review of aldicarb poisoning circumstances associated with clinical and analytical findings. Moreover, the oxime treatment is discussed. Eighteen patients with cholinergic symptoms admitted to the Emergency Unit and two deceased with a history of aldicarb poisoning were included in the study. As agricultural workers, only two of them could legally use Temik. Seventy percent of the patients was managed by the Emergency Mobil Unit. Serum cholinesterase activity was always lower than 30% of the normal range and aldicarb was identified by UV spectra and retention time after liquid chromatography separation. The most common muscarinic effect was diarrhea, the main nicotinic sign fasciculation and almost half of the poisoned patients had central nervous system (CNS) depression (Glasgow Coma Score lower than 8). Four patients had serious conduction abnormalities and two of them died. These results suggest that aldicarb intoxication is always severe. Oxime treatment did not produce side effects and should be recommended whenever the pesticide involved is unknown. Effective measures should be implemented to stamp out the illicit use of aldicarb.

Modified EMIT Dau Immunossay to allow cocaine metabolites determination in urine of crack cocaine smokers - abstract

Alkaloidal cocaine (COPC) is widely sold in the West Indies in a form suitable for smoking. These little rocks called "crack", addictive in high doses (typically 120 mg), produce a rapid, intense, high and a very compelling type of COC dependence. The bioavailability and the metabolism of the smoked form (half-life of 56 min versus 78 and 80 min, respectively, after IV and IN COC administration) conduce to low levels of metabolites in serum and in urine. Clinical and forensic toxicology laboratories are more and more solicited for testing major cocaine metabolite: benzoylecgonine (BZE). The Enzyme Multiplied Immunossay Technique (EMIT) is a fast, simple and reliable technology. However, the assay cut off concentration for BZE of the commercially available kit: (EMIT dau Cocaine Metabolite Immunoassay) is too high (300ng/ml) for serum or urine detectable levels of BZE in cocaine smokers. We proposed a modified EMIT assay to make this technique suitable for level of detection. The immunoassay was applied to ROCHE COBAS MIRA Plus analyser. The increase of the sample volume up to 25 ul and the use of calibration standards 0 to 300 ng/ml conduce to a lower detection limit of 50ng/ml. The within run precision of the assay was less than 10 percent. The results were confirmed by gas chromatography mass spectrometry. The increase of sensitivity was near 30 percent. No false positive results were observed. The presented modification demonstrates the application of currently available EMIT Immunoassay to rapid and reliable testing for BZE in cocaine smokers. (AU)

Survival after paraquat poisoning in a HIV positive patient.

From 1987 to 1994, 31 cases of acute paraquat poisoning were managed in the CHRU of Pointe à Pitre (FWI). Eighteen patients died, 13 survived. Biological indexes accurately predicted patient's outcome in all cases out of one. In the last case biological parameters were misleading: the corresponding patient survived despite consistent clinical and biological prognosis of death. The unexpected survivor was West Indian, male, agricultural worker of 26 years who alleged drunk about 300 ml of gramoxone (20% v/v paraquat) in a suicide attempt. The patient was HIV-infected (Elisa+, Western-Blot+) and presented an AIDS syndrome (CD4 count inferior to 200 cells/mm2) established since 10 months and treated by AZT. We could not identify any other distinguishing features among the unexpected survivor and the rest of the patients. This observation suggests that the immunological status of the patient could explain this protection from paraquat toxicity.

A biological index to predict patient outcome in paraquat poisoning.

1. In humans, the accidental or voluntary ingestion of paraquat, a non selective contact herbicide, is often lethal. Paraquat induces renal failure amongst other effects. 2. In this study we test the value of an index of the rate of increase in plasma creatinine over a 5 h period (dCreat/dt) to predict the outcome in intoxicated patients. These results are compared to previously published indices of severity of the paraquat poisoning. The proposed index is reliable, within the capability of any laboratory and will indicate the prognosis for poisoned patients within 6 h of admission to hospital.

Plasma fibronectin kinetics during uncomplicated acute myocardial infarction.

Plasma fibronectin (Fbn) was assessed daily in 9 men admitted to the cardiology care unit for uncomplicated acute myocardial infarction (AMI). In a control group of twenty healthy men, plasma Fbn was 0.290 +/- 0.0417 g/l-1 (mean +/- SD). In 6 hypertensive AMI patients, Fbn levels were increased to a maximum of 0.461 +/- 0.0294 g/l-1 at day five (5.5 +/- 0.84 days) and returned to the range of the control group values 56 +/- 32.8 hours afterwards. Three normotensive patients had higher Fbn results without returning to the control group range at the end of the hospitalization (0.734 +/- 0.0209 gl-1). Plasma Fbn could in part be implicated in the repair process and/or in the limitation of the cardiac necrosis extension. Moreover, it seems that a link exists between plasma Fbn kinetics and hypertension and/or normotension during uncomplicated AMI.

Plasma fibronectin kinetics during uncomplicated acute myocardial infarction

Plasma fibronectin (Fbn) was assessed daily in 9 men admitted to the cardiology care unit for uncomplicated acute myocardial infarction (AMI). In a control group of twenty healthy men, plasma Fbn was 0.290ñ 0.0417g/l-1 (meanñSD). In 6 hypertensive AMI patients, Fbn levels were increased to a maximum of 0.461ñ0.0294 g/l-1 at day five (5.5 ñ 0.84 days) and returned to the range of the control group values 56 ñ 32.8 afterwards. Three normotensive patients had higher Fbn results without returning to the control group range at the end of the hospitalization (0.734 ñ 0.209 gl-1). Plasma Fbn could in part be implicated in the repair process and/or in the limitation of the cardiac necrosis extension. Moreover, it seems that a link exists between plasma Fbn kinetics and hypertension and/or normotension during uncomplicated AMI. (AU)

Plasma fibronectin kinetics during uncomplicated acute myocardial infarction

Plasma fibronectin (Fbn) was assessed daily in 9 men admitted to the cardiology care unit for uncomplicated acute myocardial infarction (AMI). In a control group of twenty healthy men, plasma Fbn was 0.290ñ 0.0417g/l-1 (meanñSD). In 6 hypertensive AMI patients, Fbn levels were increased to a maximum of 0.461ñ0.0294 g/l-1 at day five (5.5 ñ 0.84 days) and returned to the range of the control group values 56 ñ 32.8 afterwards. Three normotensive patients had higher Fbn results without returning to the control group range at the end of the hospitalization (0.734 ñ 0.209 gl-1). Plasma Fbn could in part be implicated in the repair process and/or in the limitation of the cardiac necrosis extension. Moreover, it seems that a link exists between plasma Fbn kinetics and hypertension and/or normotension during uncomplicated AMI.

A biological index to predict patient outcome in paraquat poisoning - abstract

Paraquat (1,1 dimethyl 4,4-bipyridilium dichloride) is a non-selective contact herbicide. Paraquat intoxication is related to redox cycling with uncontrolled generatioan of oxygen centred free radicals. This acute intoxication is most often lethal since proposed treatments have not improved the survival rate. In an effort to develop a reliable method to predict patients' outcome, the rate of blood creatinine increase (RCI: dcreatinine/dt) was investigated since prognosis depends largely on the renal function of the intoxicated patient. Eighteen patients were enrolled in the present study (6 survivors, 12 non-survivors). All biochemical parameters were quantified on CHEM I analyzer (TECHNICON, Domont, France). Blood creatinine over time in patients who died was strictly linear as assessed by the corresponding regression analysis - deceased (n=6):y=8.3x86.9 (r=0.76; p<0.0001) (zero order kinetics). The average RCI for survivors (n=6) was 0.45 æmol/L/H/ (SD ñ 0.27 æmol/L/H) and for dead patients (n=12) was 14.3 æmol/L/H (SD ñ 12.0 æmol/L/H). The calculated RCI uupper limit lower for survivors was equal to 1.26 æmol/L/H and the observed lower limit of RCI for dead patients was about 3 æmol/L/H. The two groups clearly separated and no overlap of values was observed. To avoid an artificial increase due to analytical variations a minimum delay of 5 hours between two consecutive assays was observed. In conclusion, the proposed index is inexpensive and does not require any specialized materials. The mathematical expression is not time dependent (zero order kinetics), and the statistical analysis shows its accuracy and reliability to predict patient outcome after a paraquat acute intoxication (AU)

Urology in Guadeloupe: benign and malignant prostatic pathology - abstract

This study reports on the surgical experience for prostatic pathology in the urological department of the Centre Hospitalier Universitaire (CHU) of Guadeloupe for the period August 1, 1992 to June 30, 1993. There were 202 surgical interventions comprising 95 (48 percent) benign prostatic hypertrophies, 104 (52 percent) adenocarcinomas and 3 (1.5 percent) doubtful. The diagnostic efficiency of Prostatic Specific Antigen (PSA) was studied in terms of specificity and sensitivity to discriminate between benign and malignant diseases and the usefulness of scintigraphy. From the 104 adenocarcinomas, only 7 radical prostatectomies were performed. Other patients were either too old for surgery or presented bone metastasis. These results give evidence of a dramatically high percentage of adenocarcinomas in Guadeloupe (AU)

Fibronectin and the prognosis of adverse foetal outcome in maternal hypertension: a study from a West Indian population - abstract

A single assay of maternal fibronectin level is not specific enough to predict adverse foetal outcome, but daily measurement of maternal fibronectin level and a time-relate analysis allow a good prediction of the disease. In predicting adverse foetal outcome, these measurements complement the information provided by the physical methods of evaluation of the foetal status such as Doppler, ehcography or cardiotocography. The daily profile of plasma fibronectin level during hypertensive pregnancies shows a bi-phasic pattern: an early increase in fibronectin is followed by a decrease or at least a plateau preceding delivery. This last observation is consistent with a protective role of fibronectin as emphasised by Frolich and Bathia (AU)

Does alcoholism protect against acute paraquat poisoning in black patients? - abstract

Between 1987 and 1991, 27 cases of acute paraquat poisoning were treated in the CHRU, Guadeloupe, French West Indies. In 22/27 patients indices developed by Yamaguchi et al, Pileire and Ragoucy-Sengler and Proudfoot-Sherman (SIPP curves of paraquat concentration/time survival limits) were used to try and predict outcome. Thirteen patients died and 9 survived. Indices were misleading in 3 patients who survived although clinical course and biological parameters were predictive of a fatal outcome. Each of the unexpected survivors was an Antillean male agricultural worker who had drunk > 20 ml of gramozone (20 percent v/v paraquat) in a suicide attempt. The 3 patients were heavy, chronic rum drinkers who consumed in excess of 80 g ethanol per day. No other distinguishing features between the 3 survivors and the rest of the patients could be identified. This observation suggests that alcohol consumption of sufficient magnitude can protect against paraquat toxicity (AU)

Frequency of occurrence of immunoglobulin changes in monoclonal gammopathies in Guadeloupe (FWI): comparison with published data - abstract

The distribution of 213 monoclonal gammopathies according to sex, age and heavy and light chains was determined over a 5-year period at the Centre Hospitalier Regional et Universitaire, Pointe-a-Pitre, Guadeloupe.(Results are included in a table). There was no sex difference in any of the parameters tested. The mean age of males was 38.5 SD 10.6 yrs and of females 69.2 SD 11.9 years. The relative frequency of individual immunoglobulin classes involved in monoclonal gammopathies was different from that of non-West Indian populations but similar to that of Guadeloupe, another West Indian Island. Results were obtained that confirmed Osterland's (7) hypothesis that the relative frequency of occurrence of immunoglobulin classes involved in monoclonal gammopathies correlates fairly well with relative frequency of immunoglobulin classes in normal sera (AU)

Comparison of questionnaire and biochemical markers to detect alcohol abuse in a West Indian population.

This study bears upon the respective validity of biochemical markers and questionnaires to detect alcohol abuse in a population with a high rate of alcohol-linked neurological complications. GammaGT and apoprotein AII were the most powerful of eight studied biochemical markers in detecting two-thirds of excessive drinkers. The CAGE questionnaire identified 74% of moderate drinkers and 94% of excessive drinkers with a life style and patterns of alcohol consumption different from previously tested target populations. The joint association of the CAGE questionnaire and apoprotein AII detected more than 9 out of 10 moderate or excessive drinkers defined on the basis of a quantity-frequency grid.