A Scientific Review of Pesticides: Classification, Toxicity, Health Effects, Sustainability, and Environmental Impact.

Over the years, the use of pesticides has risen significantly, primarily to combat undesirable organisms that threaten crucial crops. A variety of pesticides are available, each designed to protect crops from specific threats like fungi, bacteria, and other pests. Other than crop protection, pesticides are also used in controlling insect vector-borne diseases like malaria and Lyme disease in humans. However, the application of these pesticides must be carefully measured and managed to prevent adverse effects on humans, non-target animals, and the environment. This review delves into the detailed classification of pesticides, exploring their mechanisms of action, applications, benefits, and potential side effects. Understanding the different categories of pesticides, such as herbicides, insecticides, fungicides, rodenticides, and biopesticides, helps us comprehend how each function to control pests. Additionally, we discuss the advantages of pesticide use, including increased crop yields and the prevention of crop diseases, which contribute to food security and agricultural productivity. This review also addresses the significant concerns related to pesticide usage, such as the development of pest resistance, health risks to humans through exposure and residues in food, as well as the impact on biodiversity and ecosystems. The review emphasizes the importance of using pesticides responsibly and implementing integrated pest management strategies to mitigate this risk of exposure. By providing a comprehensive overview of pesticide classification, mechanisms of action, and implications, this review aims to inform and guide us to the safe and effective use of pesticides for daily agricultural practices.

The Enigma of Delayed Neurotoxicity in Organophosphate Poisoning: A Case Report of Clinical Presentation With Normal MRI Findings.

Organophosphates (OP) are the most widely used pesticides globally and are misused for suicides because of their easy availability. It leads to functional impairment of distal segments of sensory and motor axons of peripheral nerves, as well as impacting the ascending and descending spinal tracts. It progresses through latent, progressive, static, and improvement phases. In the improvement phase, peripheral nerve regeneration occurs, revealing the spinal cord lesion with myelopathic features. The acute symptoms and treatments of OP poisoning have been extensively documented in the literature. Delayed neurotoxicity is a rare but debilitating condition that can manifest weeks after initial exposure. A high index of suspicion for OP-induced delayed neurotoxicity should be maintained in patients presenting with delayed neurological symptoms post-OP exposure, even with normal MRI findings. OP linked to delayed neuropathy include triorthocresyl phosphate, chlorpyriphos, malathion, fipronil, mipafox, matriphonate, and parathion. Among these, the most hazardous OP ester is tri-o-cresyl phosphate. We report a case of a 28-year-old male who developed neurotoxicity five weeks following OP poisoning with chlorpyrifos. Early diagnosis and symptomatic management are important for improving patient outcomes.

Albuterol as an adjuvant in acute anticholinesterase pesticide poisoning: a randomized, placebo-controlled clinical trial.

Acute anticholinesterase pesticide poisoning is a serious clinical problem, particularly in developing countries. Atropine is the most acceptable treatment for acute anticholinesterase poisoning. However, it only stops fluid production. Albuterol is a beta-2 receptor agonist that can increase fluid removal and speed the return of effective oxygen exchange. This study aims to evaluate the safety and efficacy of nebulized albuterol as an adjuvant therapy in patients with acute anticholinesterase poisoning. This stratified block randomized, single-blinded, placebo-controlled, parallel-group clinical trial was conducted between November 2020 and October 2021. It enrolled 80 patients with acute anticholinesterase pesticide poisoning who were admitted to Tanta University Poison Control Center. Patients were allocated into two groups (40 patients each). The strata were based on the severity of poisoning (moderate and severe). Patients in group I received 10 mg of nebulized albuterol. Group II received an equivalent volume of nebulized normal saline. Additionally, standard treatment was provided to both groups. Outcomes included oxygenation, mortality, need for endotracheal intubation and mechanical ventilation, hospital stay duration, time to atropinization, and total doses of atropine and oxime. We found insignificant differences in sociodemographics, exposure characteristics, clinical manifestations, or routine laboratory tests between the studied groups. The median values of oxygen saturation by pulse oximetry were 99% in the albuterol moderate toxicity group and 98% in the control moderate toxicity group. Albuterol significantly improved oxygen saturation in moderate intoxicated patients (P = 0.039). Therefore, nebulized albuterol is a safe drug. Moreover, it may improve oxygenation in acute anticholinesterase pesticide poisoning.

Clinical Profile and Predictors of Intensive Care Admission in Neonicotinoid Poisoning in a Tertiary Care Hospital in South India.

Background and objectives: Neonicotinoids are a newer class of pesticides that are believed to cause predominantly mild toxicity in humans. This study aimed to describe the clinical features of neonicotinoid poisoning and identify predictors of severe toxicity. Materials and methods: This retrospective study included all patients with neonicotinoid poisoning admitted to a Tertiary Care Center in India over an 18-year period. Clinical and laboratory features were compared against outcomes to identify predictors of the need for intensive care admission. Results: Twenty-eight patients were included in the study of which 28.6% had severe disease requiring ICU admission. A higher respiratory rate, blood lactate level, SOFA, and qSOFA scores as well as a lower Glasgow coma score at presentation predicted ICU admission. First-generation compounds and imidacloprid consumption were associated with longer ICU stays and a longer duration of invasive ventilation. Conclusion: Neonicotinoid compounds can cause significant toxicity with oral ingestion. Imidacloprid and other first-generation compounds were associated with more severe toxicity requiring intensive care. Simple clinical parameters assessed at presentation can be used to predict severe disease and the need for ICU care. Larger, prospective studies are required to confirm these findings. How to cite this article: Sanga L, Jacob A, Jayakaran JAJ, Iyadurai R. Clinical Profile and Predictors of Intensive Care Admission in Neonicotinoid Poisoning in a Tertiary Care Hospital in South India. Indian J Crit Care Med 2024;28(1):66-69.

Inadequate Personal Protective Equipment Factors and Odds Related to Acute Pesticide Poisoning: A Meta-Analysis Report.

INTRODUCTION: Acute pesticide poisoning (APP) continues to affect farm workers, especially in low- and middle-income countries (LMIC). The dose-response relationship between exposure and APP is well-researched, but pesticide exposure assessment in a practical environment is difficult to perform, considering various work practices and protections in place. It is well known that inadequate personal protective equipment (PPE) use is a risk factor of APP. However, it is unknown which types of inadequate PPE use, such as face or other types of general protection, are most harmful. METHODS: This study aimed to identify if inadequate PPE use is an indicator of APP risk following established specifications for meta-analysis of epidemiological studies. Included studies reported an odds ratio (OR) between PPE use to APP in agricultural workers. Data extracted from selected articles included authors, publication year, country of origin, farm type, population size, method of data collection and time frame of reported symptoms, job task, type of PPE and pesticides used, adjustments made in analysis, OR for APP, and 95% confidence intervals (CI). Meta-analysis was performed using a random effects model, where ORs were pooled to assess an overall estimate for poisoning odds. RESULTS: Our findings suggested that inadequate PPE use was associated with increased odds (OR = 1.57, 95% CI = 1.16-2.12) of having APP. Failure to use general protection and inadequate face protection increased odds of APP by 1.29 times (95% CI = 0.88-1.90) and 1.92 times (95% CI = 1.23-3.00), respectively. CONCLUSIONS: The meta-analysis results indicate that improper facial protection and general protection are not differently associated with APP odds. Our study concludes that more robust protection against inhalation and dermal contact are critical because any gaps in comprehensive full-body PPE would put workers and exposed populations at APP risk.

An elderly patient with depression and a suicide attempt during the COVID-19 pandemic: a case report.

Objective: Elderly individuals are among the age groups with the highest risk of suicide. The coronavirus (COVID-19) pandemic forced isolation and resulted in an increased risk of depression, hopelessness, and perceived burdensomeness among the elderly, thereby increasing the risk of suicide. Methods: This is a case report of an elderly single retired school principal with obsessive-compulsive personality traits who developed depression with psychotic symptoms after being isolated following the movement control order (MCO) during the COVID-19 pandemic. The social isolation led to feelings of loneliness and hopelessness. The patient's depressive symptoms worsened after he developed physical illnesses, such as eye floaters, that affected his daily activities. This caused him to have suicidal ideation to the extent that he attempted suicide by ingesting 90 mL of pesticide. Two weeks prior to the attempt, he updated his will and asked his friend to keep it. After the suicide attempt, he vomited and had diarrhea and epigastric pain. He called his friend, who brought him to the hospital emergency room (ER). He was resuscitated and subsequently admitted to the intensive care unit (ICU). After being medically stabilized, he was transferred to the psychiatric ward, where further treatment was administered for his depression. His depressive symptoms and suicidal ideation improved after he was administered antidepressants and psychotherapy. Results: The impact of the COVID pandemic has led to a surge in mental health issues such as anxiety and depression. The elderly are among the highest-risk groups of individuals to contract or die of COVID-19 infection, and they are also the most likely to develop mental health issues related to the pandemic. Furthermore, the risk of death by suicide is highest in this age group due to physical illness, social isolation, and the lack of a support system. This case also highlights the need for awareness of suicidal ideation screening among non-medical healthcare professionals and religious organizations to avoid the treatment gap. Conclusion: It is essential to enhance suicide risk assessment and management among the elderly after the COVID-19 pandemic.

ß-glucuronidase as a biomarker for assessing the exposure to anticholinergic pesticides: A meta-analysis.

INTRODUCTION: The human exposure to anticholinergic pesticides has been associated with the development of various diseases. Therefore, several biomarkers have been proposed for biomonitoring human exposure to anticholinergic pesticides. OBJECTIVE: This work evaluated the effect of human exposure to anticholinergic pesticides on ß-glucuronidase (GUSB) levels. METHODS: A systematic review was performed using PubMed, Web of Science, Scopus, and EBSCO databases up to December 2021. The statistical analysis employed standardized mean differences and meta-regression. And the trial sequential analysis was performed. RESULTS: Nine studies were included. A monotonic relationship was observed between poisoning severity and GUSB. Furthermore, BuChE levels were correlated with GUSB levels. CONCLUSIONS: The results indicated that GUSB levels could be used as a possible diagnosis biomarker in poisoning related to anticholinergic pesticide exposure. However, the use of GUSB to assess the chronic exposure to anticholinergic pesticides could be only performed in recent exposure (≈ 7 days after last exposure).

Diagnostic Dilemma in Fatal Paraquat Poisoning: An Autopsy Case Report.

Paraquat is a highly toxic agent used as an herbicide worldwide. Despite its easy and widespread availability, data regarding cases of paraquat poisoning in India is limited. Diagnosis often becomes difficult without a clear history, owing to its rather nonspecific and varying presentation. In the present case, a 22-year-old man was brought with a history of high-grade fever, sore throat, and oral ulcers for around a week. He was symptomatically treated at multiple hospitals and was worked up for suspected diagnoses like diphtheria and influenza (H1N1). Later during treatment, it was revealed that "Paraxzone" was procured online by the patient himself two weeks before the onset of his symptoms. Thence, the treatment regimen was modified following suspicion of paraquat poisoning. However, the delay in diagnosis led to the worsening his condition, and the patient succumbed to death due to pulmonary and renal complications after 16 days of survival. The postmortem examination, supplemented with histopathological evaluation, supported the diagnosis of paraquat poisoning. Paraquat poisoning can mimic a myriad of clinical conditions. Thorough history taking, a high degree of suspicion, and collaborative work with the investigating agency are of paramount importance while dealing with cases of suspected paraquat poisoning in hospital settings.

Surveillance of pesticide poisoning in an East and a West Malaysian hospital: characteristics of pesticide poisoning and the early impact of a national Paraquat ban.

BACKGROUND: Previous studies have shown that pesticide bans were associated with reduced fatal pesticide self-poisoning cases in high, and low-and-middle-income countries. We aimed to investigate the characteristics of pesticide poisoning patients admitted to two Malaysian hospitals and the early impact of the national paraquat ban implemented on 1st January 2020 in a culturally heterogenous South-East-Asian upper-middle-income setting. METHODS: Data were collected from an East (Bintulu) and a West (Ipoh) Malaysian hospital medical records in 2015-2021 and 2018-2021, respectively. Logistic regression analyses were conducted to investigate the association of aspects such as socio-demographic and clinical characteristics, paraquat ban with the types of pesticides involved (paraquat versus non-paraquat versus unknown) ,and the outcomes (fatal versus non-fatal). RESULTS: From the study sample of 212 pesticide poisoning patients aged 15 years or above, the majority were self-poisoning cases (75.5%) with a disproportionate over-representation of Indian ethnic minority (44.8%). Most pesticide poisoning cases had socio-environmental stressors (62.30%). The commonest stressors were domestic interpersonal conflicts (61.36%). 42.15% of pesticide poisoning survivors had a psychiatric diagnosis. Paraquat poisoning accounted for 31.6% of all patients and 66.7% of fatalities. Case fatality was positively associated with male gender, current suicidal intent, and paraquat poisoning. After the paraquat ban, the proportion of pesticide poisoning cases using paraquat decreased from 35.8 to 24.0%, and the overall case-fatality dropped slightly from 21.2 to 17.3%. CONCLUSIONS: Socio-environmental stressors in specific domestic interpersonal conflicts, seemed more prominent in pesticide poisoning compared to psychiatric diagnosis. Paraquat accounted for the majority of pesticide-associated deaths occurring in hospitals in the study areas. There was preliminary evidence that the 2020 paraquat ban led to a fall in case fatality from pesticide poisoning.

Intermediate Syndrome Due to Organophosphate Poisoning: A Case Report.

Organophosphates, also known as phosphate esters, are a category of pesticide compounds that function by indirectly inhibiting the activity of an enzyme called acetylcholinesterase (AChE). AChE is responsible for breaking down acetylcholine (ACh) at the neuromuscular junction into acetic acid and choline. These compounds cause various clinical presentations upon acute toxicity, among which intermediate syndrome (IMS) exhibits an unpredictable course. This report describes the case of a farmer who ingested monocrotophos and ethanol in a suicide attempt, leading to a prolonged stay in the hospital and invasive ventilation, along with complications including ventilator-associated pneumonia. The patient received a total of 9000 mg of atropine over his 14-day hospitalization period.

Organophosphate Toxicity Presenting as a Stroke Alert.

Altered mental status is a common emergency department presentation. It has a broad differential and can be particularly challenging when the patient is unable to give a history and collateral information is not immediately available. The authors present a case of altered mental status initially brought in as a stroke alert but later discovered to be intentional organophosphate ingestion. Although organophosphate poisoning is relatively rare in the United States, it should be considered in patients with altered mental status with miosis who are unresponsive to naloxone, especially in the setting of bradycardia or copious secretions.

The advantages of penehyclidine hydrochloride over atropine in acute organophosphorus pesticide poisoning: A meta-analysis.

Background: Penehyclidine hydrochloride (PHC) has been used for many years as an anticholinergic drug for the treatment of acute organophosphorus pesticide poisoning (AOPP). The purpose of this meta-analysis was to explore whether PHC has advantages over atropine in the use of anticholinergic drugs in AOPP. Methods: We searched Scopus, Embase, Cochrane, PubMed, ProQuest, Ovid, Web of Science, China Science and Technology Journal Database (VIP), Duxiu, Chinese Biomedical literature (CBM), WanFang, and Chinese National Knowledge Infrastructure (CNKI), from inception to March 2022. After all qualified randomized controlled trials (RCTs) were included, we conducted quality evaluation, data extraction, and statistical analysis. Statistics using risk ratios (RR), weighted mean difference (WMD), and standard mean difference (SMD). Results: Our meta-analysis included 20,797 subjects from 240 studies across 242 different hospitals in China. Compared with the atropine group, the PHC group showed decreased mortality rate (RR=0.20, 95% confidence intervals [CI]: 0.16-0.25, P <0.001), hospitalization time (WMD=-3.89, 95% CI: -4.37 to -3.41, P <0.001), overall incidence rate of complications (RR=0.35, 95% CI: 0.28-0.43, P <0.001), overall incidence of adverse reactions (RR=0.19, 95% CI: 0.17-0.22, P <0.001), total symptom disappearance time (SMD=-2.13, 95% CI: -2.35 to -1.90, P <0.001), time for cholinesterase activity to return to normal value 50-60% (SMD=-1.87, 95% CI: -2.03 to -1.70, P <0.001), coma time (WMD=-5.57, 95% CI: -7.20 to -3.95, P <0.001), and mechanical ventilation time (WMD=-2.16, 95% CI: -2.79 to -1.53, P <0.001). Conclusion: PHC has several advantages over atropine as an anticholinergic drug in AOPP.

Current situation and influencing factors for suicidal intent in patients with intentional acute pesticide poisoning.

Introduction: Since pesticides have been widely used in agricultural production, acute pesticide poisoning (APP) has gradually become a worldwide public health problem. Recently, the number of APP cases has been high in China, and the intentional self-administration of pesticides is the main cause of APP. However, there is a lack of relevant studies on the factors influencing suicidal intent in patients with intentional APP. This study aimed to explore the current situation and influencing factors for suicidal intent among patients with intentional APP. Methods: In this cross-sectional study, we enrolled a total of 225 patients with intentional APP admitted to the emergency department of our Grade A comprehensive hospital in Shandong Province between June 2019 and January 2021. Patients were investigated using a health status interview questionnaire, Beck Suicidal Intent Scale, Duke Social Support Index, psychological stress scale, Dickman Impulsivity Inventory, Trait Anxiety Inventory, Center for Epidemiologic Studies Depression Scale, and Beck Hopelessness Scale. Descriptive statistics, single-factor analysis, and multiple linear regression were used for data analysis. Results: Suicidal intent scores were collected and averaged (14.23 ± 6.22). Multiple linear regression analysis revealed that marital status, residential area, impulsivity, hopelessness, depression, psychological strain, and social support impact suicidal intent. Conclusion: Patients with intentional APP have high suicidal intent. Therefore, different interventions should be tailored to different patients.

Child and adolescent mortality associated with pesticide toxicity in Cape Town, South Africa, 2010-2019: a retrospective case review.

BACKGROUND: Poisoning of children after exposure to pesticides is a major public health concern, particularly in countries with poorer urban populations, such as South Africa. This may stem from the illegal distribution and domestic use of street pesticides, which are highly hazardous agricultural pesticides. The aim of this study was to profile paediatric deaths due to acute pesticide poisoning in the west-metropole of Cape Town, South Africa; to identify whether the active ingredients were highly hazardous pesticides according to the FAO and WHO; and to inform policy and public health interventions to prevent future exposures and mortality. METHODS: A retrospective and descriptive analysis of forensic post-mortem records (2010 to 2019) was conducted to identify cases of paediatric deaths (< 18 years old) in the west metropole of Cape Town, involving pesticide poisoning admitted to the Salt River mortuary (one out of 16 mortuaries in the Western Cape province). Demographic, circumstantial, autopsy, and toxicological information was captured. Descriptive statistics, together with chi-square tests, Fisher's probability tests, and Mann-Whitney U tests were used to analyse the data. RESULTS: In total, 54 paediatric pesticide deaths were identified, including 22 (40.7%) males and 32 (59.3%) females, out of 5,181 paediatric unnatural deaths admitted over the 10-year period. The median age of the decedents was 8.3 years (range: 1 day to 17.9 years), with the majority under five years (42.6%) or between 15 and 18 years old (40.7%). All incidents occurred in peri-urban areas of Cape Town, with most individuals being admitted to hospital (88.9%) for a median survival time of 4.8 h. Toxicological analysis was requested in 50 cases (92.6%) with the organophosphate pesticides terbufos (n = 29), methamidophos (n = 2) and diazinon (n = 2) detected most frequently. Adolescent (15-18 years) suicides (29.6%) and accidental child deaths (< 4 years) (18.5%) were common. CONCLUSIONS: Terbufos and methamidophos are highly hazardous pesticide (HHP) active ingredients registered in South Africa for agricultural uses, yet commonly sold as street pesticides for domestic use in lower socioeconomic areas. Reducing access and availability of toxic pesticides, especially through the illegal selling of street pesticides, and providing low toxic alternatives to poorer communities, may support mortality reduction initiatives. Mortality and toxicology data provide important, often overlooked, surveillance tools for informing policy and public health interventions to reduce toxic pesticide harm in local communities.

A Rare Presentation of Imidacloprid Poisoning.

Acute poisoning with pesticides and insecticides can sometimes result in unexpected clinical manifestations. Awareness regarding all possible signs and symptoms of poisoning with these compounds can help in timely diagnosis and treatment. Deliberate ingestion of imidacloprid, a neonicotinoid insecticide, despite being minimally lethal to humans, proved to be life-threatening to a 14-year-old boy. A prompt diagnosis of methemoglobinemia followed by the administration of methylene blue led to successful recovery.

Agriculture without paraquat is feasible without loss of productivity-lessons learned from phasing out a highly hazardous herbicide.

A small proportion of the thousands of pesticides on the market today are associated with a disproportionately high incidence of severe acute pesticide poisoning and suicide. Paraquat stands out as one of the most lethal pesticides in common use, frequently involved in fatal incidents due to suicides or accidental exposure. Even though paraquat has been banned in over 67 countries, it is still widely used in many others, particularly in Asia and Latin America. Based on a literature review and consultations, this paper identifies options for replacing paraquat and distils practical lessons from numerous successes around the world. Our aim is to support regulators, policymakers, agronomists and the supply chain sector with practical information related to phasing out paraquat. Production data consistently failed to show any negative effects of banning paraquat on agricultural productivity. A wide range of alternative approaches to weed management and crop defoliation are available, many of which do not rely on herbicides. Over 1.25 million farmers in low- and middle-income countries (LMICs) successfully produce a range of crops for private voluntary standards (PVS) in food and fiber supply chains which prohibit paraquat use. We conclude from the findings of this study that eliminating paraquat will save lives without reducing agricultural productivity. Less hazardous and more sustainable alternatives exist. To enhance successful adoption and uptake of these methods on a wide scale, farmers require training and support within an enabling policy environment.

Analysis of clinical characteristics of 294 acute poisoning patients with gastric lavage / 中华急诊医学杂志

Objective:To describe the current situation of gastric lavage operation and put forward measures for improvement by analyzing the clinical characteristics of 294 patients with gastric lavage in Poisoning Treatment Center of The First Affiliated Hospital of Nanjing Medical University.Methods:The clinical data of 294 patients with acute poisoning and gastric lavage from 2019 to 2021 were collected and analyzed retrospectively, and the related parameters (poison type, gastric lavage volume, poisoning to gastric lavage time, etc.) of each year were compared.Results:A total of 653 poisoning patients underwent gastric lavage from 2019 to 2021, with an average age of (44.2 ±20.1) years, and 134 (45.6%) were male. The main causes of gastric lavage were pesticide poisoning (52.72%) and drug poisoning (42.86%). The volume of gastric lavage was less than 10 L for 43.8% of patients and 10-20 L for 32.7% of patients. Patients with gastric lavage within 60 min after ingestion of poison accounted for 45.3%, followed by 25.8% within 61-120 min. The in-hospital mortality rate was 17.7%. The common complications of gastric lavage were: the incidence of gastrointestinal bleeding (55/121, 45.5%), the incidence of aspiration pneumonia (54/140, 38.6%), and the incidences of electrolyte disorder (21% of low potassium, 29% low calcium, and 10.0% low sodium). Compared with the groups in different years, the proportion of gastric lavage in poisoning was 58.85% vs. 46.60% vs. 32.41%, which decreased year by year, with statistical difference ( P <0.05). And there was no difference in the period from ingestion to gastric lavage and gastric lavage fluid volume. There was an increasing trend in poison types between diquat and other insecticides, but there was no statistical difference. Conclusions:From 2019 to 2021, the most common causes of acute gastric lavage were pesticide poisoning and drug poisoning, and the proportion of diquat and other pesticides showed an overall upward trend. A majority of the patients (71.1%) had gastric lavage within 2 h, and 76.5% of the patients had less than 20 L gastric lavage fluid. In the future, we will further control the amount of gastric lavage fluid and pay attention to the gastric lavage operation of new insecticide poisoning.

Time trend of pesticide poisoning in Jiaxing from 2008 to 2020 / 环境与职业医学

Background Pesticide poisoning is not only a common acute poisoning, but also an indispensable public health problem. It is important to describe and analyze the epidemic characteristics and trends of pesticide poisoning for its prevention and control. Objective To understand the epidemiological characteristics and trends of pesticide poisoning in Jiaxing from 2008 to 2020, and provide a basis for making effective intervention measures. Methods The relevant information of pesticide poisoning cases in Jiaxing from 2008 to 2020 was collected through the Occupational Disease and Occupational Health Information Monitoring System of the China Disease Prevention and Control Information System, and the demographic information was obtained from the statistical yearbook of Jiaxing. Joinpoint regression models were used to analyze trends in overall, gender, age, season, type of poisoning, and type of pesticide among poisoned individuals. Results A total of 3109 cases of pesticide poisoning were reported in Jiaxing City from 2008 to 2020. The overall pesticide poisoning incidence trended downward from 2008 to 2014, with an annual percent change (APC) of −9.0% (95%CI: −16.6%-−0.7%). The female pesticide poisoning incidence trended downward from 2008 to 2015, with an APC of −8.6% (95%CI: −13.9%-−2.9%). The 18-34 age group showed a decreasing trend of pesticide poisoning incidence from 2008 to 2015, with an APC of −11.0% (95%Cl: −17.4%-4.3%), and an increasing trend from 2015 to 2020, with an APC of 18.5% (95%Cl: 4.7%-34.0%). The >60 age group showed a decreasing trend of pesticide poisoning incidence from 2008 to 2014, with an APC of -12.9% (95%Cl: −20.4%-−4.7%). The second quarter showed an increasing trend of pesticide poisoning incidence from 2010 to 2020, with an APC of 4.4% (95%CI: 0.3%-8.5%); the third quarter showed a decreasing trend, with an APC of −4.9% (95%CI: −8.6%-−1.1%); the fourth quarter showed an increasing trend from 2015 to 2020, with an APC of 17.8% (95%CI: 4.4%-33.0%). Productive poisoning showed a decreasing trend, with an APC of −11.1% (95%CI: −16.2%-−5.7%); self-poisoning showed a decreasing trend from 2008 to 2014, with an APC of -9.5% (95%CI: −17.4%-−0.7%), and an increasing trend from 2014 to 2020, with an APC of 10.2% (95%CI: 0.5%-20.8%). The incidences of poisoning by herbicides, fungicides, and mixed formulations all showed an increasing trend from 2008 through 2020, with an APC of 8.6% (95%CI: 5.8%-11.5%), 9.1% (95%CI: 0.3%-18.7%), and 193.3% (95%CI: 11.6%-671.0%), respectively; the incidence of poisoning by other types of pesticides showed a decreasing trend from 2008 to 2020, with an APC of −14.1% (95%CI: −23.7%-−3.2%). Conclusion The overall reported pesticide poisoning incidents in Jiaxing City present a decline then a rise in 2008 to 2020. Relevant departments should take timely measures to prevent and reduce the occurrence of pesticide poisoning according to the changing characteristics and occurrence trends of local pesticide poisonings.

Clinical characteristics of patients with cardiac arrest induced by pesticide poisoning: Analysis of 15 cases

Introduction and objective: Pesticide poisoning induced cardiac arrest (PPICA) has rarely been reported before, and can easily be overlooked by physicians. The aim of the study was to investigate the clinical characteristics of PPICA patients.MethodsThis was a single-center, retrospective analysis in the emergency intensive care unit (EICU) at tertiary medical facility, from January 2015 to December 2018.ResultsA total of 15 patients with PPICA in EICU were included, of which nine were females, where suicide was the only cause of poisoning. Thirteen were in-hospital cases and only three cases showed an initial shockable rhythm. On admission, patients’ median acute physiology and chronic health evaluation II score was 20 (12, 21) and median sequential organ failure assessment score was 7 (4, 10). All cases required invasive mechanical ventilation and vasopressors therapy. Seven patients received blood purification therapy. The primary toxic agent was organophosphorus pesticide (OP) and all OP cases (8/15) received pralidoxime and atropine therapy. Thirteen patients received gastric decontamination. The primary complications were cardiogenic shock (10/15) and acute kidney injury (3/15). Seven patients survived at discharge. Of these, three made a full recovery without neurological sequelae.ConclusionsCardiac arrest has rarely been reported in pesticide poisoning before, and can easily be overlooked. Physicians therefore should pay attention to specific therapy and best supportive treatment, which could be critical to improve the disease outcomes. (AU)

Introducción y objetivo: El paro cardíaco inducido por envenenamiento por pesticidas (PPICA) rara vez se ha informado antes, y los médicos pueden pasarlo por alto fácilmente. El objetivo del estudio fue investigar las características clínicas de los pacientes con PPICA.MétodosEste fue un análisis retrospectivo de un solo centro en la unidad de cuidados intensivos de emergencia (EICU) en un centro médico terciario, desde enero de 2015 hasta diciembre de 2018.ResultadosSe incluyeron un total de 15 pacientes con PPICA en la UCIN, de los cuales 9 eran mujeres jóvenes, donde el suicidio fue la única causa de intoxicación. Trece fueron casos intrahospitalarios y solo 3 casos mostraron un ritmo inicial desfibrilable. Al ingreso, la mediana de la puntuación de la evaluación II de la fisiología aguda y la salud crónica de los pacientes fue de 20 (12–21) y la mediana de la puntuación de la evaluación de la insuficiencia orgánica secuencial fue de 7 (4–10). Todos los casos requirieron ventilación mecánica invasiva y terapia vasopresora. Siete pacientes recibieron terapia de purificación de sangre. El principal agente tóxico fue el plaguicida organofosforado (OP) y todos los casos de OP (8/15) recibieron tratamiento con pralidoxima y atropina. Trece pacientes recibieron descontaminación gástrica. Las principales complicaciones fueron shock cardiogénico (10/15) y lesión renal aguda (3/15). Siete pacientes sobrevivieron al alta. De estos, 3 se recuperaron por completo sin secuelas neurológicas.ConclusionesEl paro cardíaco rara vez se ha informado antes en la intoxicación por pesticidas y puede pasarse por alto fácilmente. Por lo tanto, los médicos deben prestar atención a la terapia específica y al mejor tratamiento de apoyo, que podría ser fundamental para mejorar los resultados de la enfermedad. (AU)

Streamlining referral decisions for childhood poisoning: a cross-sectional study from a tertiary children's hospital in Cape Town, South Africa.

Introduction: The study objectives were to report on current paediatric poisoning figures from South Africa, and to better understand this patient population to contribute suggestions for streamlining local triage and referral criteria. Methods: A retrospective review of children presenting to Red Cross War Memorial Children's Hospital (RCWMCH) with poisoning between January 2009 and December 2019 was performed. Data were extracted from the Poisons Information Centre's Clinical Poisonings Database. Results: There were 3699 incidents, involving 3662 patients; 3011 (81%) patients were under 5 years (median 29 months, IQR 19 to 49 months). There was a slight decline in numbers over the 11-year period.Most patients were referred (n = 2542, 69%), which included a greater proportion that were symptomatic (p < 0.001). There were 8 deaths (case fatality rate 0.2%).Medications were the most common single toxin group (n = 1270, 38%), followed by handyman and industrial (HI) products (n = 889, 27%), household products (n = 451, 14%), and pesticides (n = 445, 13%). There was a significant relationship between toxin type and referral patterns (p < 0.001) as well as clinical severity (p < 0.001): pesticides and HI products (paraffin, n = 486/568, 86%) had a greater proportion of referrals, and pesticides more moderate to fatal poisonings (n = 132/445, 30%), all due to cholinergic (organophosphates and carbamates) and formamidine pesticides.The medication subgroups anticonvulsants (n = 21/78, 27%), anti-infectives (n = 4/34, 12%), multi-vitamin/mineral (MVM) supplements (n = 17/84, 20%), neuropsychiatric medications (n = 50/350, 14%) and substances of abuse (n = 13/47, 28%) had larger proportions of moderate to severe poisonings (p < 0.001), as did the small group of biological toxins (n = 17/55, 31%; p < 0.001). Conclusion: Certain medication, pesticide, and biological toxin subgroups, should be flagged for early referral. The goal is to improve patient outcomes as well as optimize the use of limited resources.