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.

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.
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.
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.
Patients with intentional APP have high suicidal intent. Therefore, different interventions should be tailored to different patients.

UNASSIGNED: Although the global suicide deaths due to intentional pesticide poisoning disproportionately occur in low income countries (LIC) and lower to middle income Countries (LMIC), there is a scarcity of reports on emergency centre (EC) mortality and its predictors in these settings. Our goal was to determine the case fatality rate of Acute Pesticide Poisoning (APP) presenting to Mbarara Regional Referral Hospital (MRRH) EC and find out whether initial triage category predicted mortality in these patients.
UNASSIGNED: This was a prospective observational longitudinal study. Patients presenting with APP were enrolled using data collection forms. Data collected included initial triage category, vital signs, demographics, initial assessment, and management. They were followed up for 1 week.
UNASSIGNED: Out of 66 patients admitted with suspected pesticide poisoning, 61 had complete follow up during the study period. However, only 58 patients had the pesticide ingested confirmed. These were predominantly males 48 (73%) and farmers 28(42%) with a median age of 23 years (IQR 18-31). Majority of patients 58 (88%) were suicide attempts and had ingested mostly organophosphates 23 (35%), amitraz 11(17%), zinc phosphide 7(10%), and aluminium phosphide 4(6%). The median time from ingestion to presentation was 4hours (IQR 2.5-8). More than half 41(62%) of the patients were in the red triage category (ESI-1). The overall case fatality rate of APP was 18%. Majority of patients who died were in the red triage category but the initial triage category was not significantly associated with mortality (p=0.381). Male gender (p=0.018), time of admission (p= 0.037), and triage vitals including hypothermia (p=0.020), hypoxia (p= 0.004), hypotension (p= 0.031), and tachypnea (p= 0.031) were significantly associated with mortality.
UNASSIGNED: Although initial triage category was a poor predictor, triage vital signs, gender, and time of admission were significantly associated with mortality in patients with APP.

Background and Purpose: Cases of acute pesticide poisoning account for significant morbidity and mortality in developing countries; however, its burden in Taiwan remains unknown. The study examined acute pesticide poisoning (APP) involving adults in the central region of Taiwan, which is a mainly agricultural sub-urban area. Methods: The retrospective study evaluated the outcome and neurological sequelae of patients with APP in a Taiwanese cohort between April 2002 and February 2019. The pesticides were classified according to the Insecticide Resistance Action Committee Mode of Action (MoA) classification. The clinical characteristics, duration of hospitalization (days), follow-up duration (years), in-hospital mortality, neurological sequela, and imaging findings were recorded. Furthermore, multivariate logistic regression analyses were performed. Results: We identified 299 patients with APP comprising 206 (68.9%) adult men with a mean exposure age of 56.4 ± 16.8 years. Paraquat, organophosphates, pyrethroids, carmabates, and phosphinic acid were the most commonly known reported poisoning agents. The mortality rate was highest in users with paraquat (77.1%), followed by phosphinic acid (22.2%), carbamates (16.7%), and organophosphates (15.8%). After a mean follows up of 3.69 ± 2.26 years, the most common neurological sequela was a cognitive decline (56 among 225 survivors, 24.89%), peripheral neuropathy (11 among 225 survivors, 4.89%), tremor (10 among 225 survivors, 4.44%), ataxia (3/225, 1.33%), and parkinsonism feature (2/225, 0.89%). Brain imaging studies revealed basal ganglion lesions on CT or hyperintensity on T2-weighted MRI images in 26 among 46 patients (56.5%). The basal ganglion lesions on brain imaging had a positive correlation with neurological sequelae. Conclusion: Acute pesticide poisoning (APP)-related mortality is high especially paraquat intoxication, and cognitive decline, as well as peripheral neuropathy, were the most common neurological sequelae among survivors, which is highly correlated with basal ganglia lesions on brain imaging.

UNASSIGNED: Pesticide poisoning is a burning occupational health issue across the world. The pesticide use in the cardamom plantations of Idukki district, Kerala, India is one of the world\'s highest. However, limited studies addressed its ill effects on the health of pesticide applicators.
UNASSIGNED: To assess the magnitude of acute pesticide poisoning (APP) among pesticide applicators and understand the nature of severity based on their occupational characteristics.
UNASSIGNED: A descriptive cross-sectional study was conducted in 2018. A total of 300 pesticide applicators with minimum 1-year experience (79.3% males) were selected from 30 randomly selected cardamom plantations in Udumbanchola Taluk.
UNASSIGNED: WHO Field Surveys of Exposure to Pesticides Standard Protocol and Murphy\'s method of Farmer Self-Surveillance system of pesticide poisoning were used for assessing pesticide exposure and APP, respectively. Statistical analysis used: Descriptive (frequencies) and exploratory statistical analyses (Pearson\'s Chi-square test) were done using IBM SPSS 23.0.
UNASSIGNED: The prevalence of APP in this study was 100% as all the pesticide applicators reported at least one sign and/or symptom of APP. The mild APP was more prevalent (80.7%), followed by moderate (18.7) and severe (0.60). Decrease in duration and frequency of spraying, use of motor pump sprayer, safe storage and disposal of pesticides, and proper personal hygiene were found to reduce the severity of APP.
UNASSIGNED: All the pesticide applicators in cardamom plantations of Idukki are at risk of APP. It is important to train them about the measures to prevent the same.

BACKGROUND: Acute pesticide poisoning (APP) is reported to affect community health worldwide but its burden in Tanzania is unknown particularly in women. This study examines APP involving adult females and adolescent girls 10 to 19 years in 3 regions of Tanzania which are famous for coffee and vegetable production.
METHODS: Over the period of 12 months, health facility-based surveillance for cases of APP was implemented in 10 Tanzanian healthcare facilities in 2006.
RESULTS: The study identified 108 APP cases of whom 31 (28.7%) occurred amongst adolescent girls. Suicide was the leading poisoning circumstances (60.2%) and the most vulnerable women were 20-29 years old who comprised 38.4% of all cases with suicide as circumstance. Organophosphates (OPs), zinc phosphide, paraquat and endosulfan were common amongst known reported poisoning agents. The annual APP incidence, mortality and Case Fatality Rate for women were 5.1/100,000, 0.2/100,000 and 3.7/100, respectively.
CONCLUSIONS: APP amongst women in Tanzania is common and this call for diverse preventive interventions to reduce poisoning incidents.

Mobile health is a fast-developing field. The use of mobile health applications by healthcare professionals (HCPs) globally has increased considerably. While several studies in high income countries have investigated the use of mobile applications by HCPs in clinical practice, few have been conducted in low- and middle-income countries. The University of Cape Town developed a pesticide notification guideline which has been adapted and embedded into a South African Essential Medical Guidance mobile application. This study evaluated the usefulness of the guideline within a mobile application for improving the ability of HCPs to diagnose and notify on acute pesticide poisonings (APPs).
A descriptive online questionnaire, with 15 open- and 20 closed-ended questions, was completed by 50 South African emergency medicine physicians and registrars (i.e. medical doctors training as specialists) between December 2015 to February 2016. Descriptive statistics were used to calculate response frequencies and percentages using SPSS version 23. Texts from the open-ended questions were thematically analysed. Fisher\'s exact test was applied to determine associations.
A significant association was found between participants\' knowledge that APP is a notifiable condition, and ever reporting the poisoning to the National Department of Health (p = 0.005). Thirty four percent of the participants were aware of the guideline within the Essential Medical Guidance application despite only seven participants having used it. Those who used the guideline found it provided useful information for the identification of unlabelled pesticides products and promoted reporting these cases to the National Department of Health for surveillance purposes. In addition, it appeared to facilitate the prompt diagnosis and treatment of APP cases, and most intended to continue using it for training and educational purposes.
Mobile health applications appear to support overburdened medical education programmes and promote better patient care. However, since most participants were not aware of the existence of the pesticide guideline within the studied essential medicine application, there is potential for the use of healthcare applications to play a more central role in healthcare systems and medical training. Furthermore, the field of medical informatics could support HCPs through mobile applications in improving reporting of APP.

To estimate prevalence of acute pesticide poisoning (APP) and its association with neurobehavioural symptoms in Ethiopian pesticide applicators.
We performed a cross-sectional survey among 256 pesticide applicators from small-scale irrigated farms, a large-scale open farm and large-scale greenhouses. APP was ascertained using a modified WHO case definition, and neurobehavioural symptoms were collected with a standardised questionnaire (Q16). Exposure to pesticides was estimated using detailed exposure algorithms specifically developed for Ethiopian farms. Multiple logistic regression models were used to estimate risk of APP and its association with neurobehavioural symptoms.
Overall APP prevalence was 16%. Working as an applicator in greenhouses was strongly associated with APP (OR 3.00, 95% CI 1.38 to 6.54). Estimated annual pesticide exposure was also associated with APP (OR 1.14, 95% CI 1.00 to 1.20). Longer duration of employment appeared to be negatively associated with APP. Having had an APP was strongly associated with reporting more neurobehavioural symptoms (OR 2.15, 95% CI 1.01 to 4.58) independent of cumulative pesticide exposure. Cumulative exposure to pesticides appeared to be associated with neurobehavioural symptoms among applicators without and with APP.
We showed a substantial prevalence of APP that differed between farming systems and was strongly associated with neurobehavioural symptoms. Intensity of exposure was also clearly associated with these symptoms. Reduction and control of occupational exposure to pesticides is urgently needed in Ethiopia.

To determine the relationship between the oral ingestion volume of xylene and methyl hippuric acid (MHA) in urine, we measured MHA in 11 patients whose ingested xylene volume was identified. The best-fit equation between urine MHA and ingested amount of xylene was as follows: y (ingested amount of xylene, mL/kg) = -0.052x² + 0.756x (x = MHA in urine in g/g creatinine). From this equation, we estimated the ingested xylene volume in 194 patients who had ingested pesticide of which the formulation was not available. Our results demonstrated that oxadiazole, dinitroaniline, chloroacetamide, organophosphate, and pyrethroid were xylene-containing pesticide classes, while the paraquat, glyphosate, glufosinate, synthetic auxin, fungicide, neonicotinoid, and carbamate classes were xylene-free pesticides. Sub-group univariate analysis showed a significant association between MHA levels in urine and ventilator necessity in the pyrethroid group. However, this association was not observed in the organophosphate group. Our results suggest that MHA in urine is a surrogate marker for xylene ingestion, and high urine MHA levels may be a risk factor for poor clinical outcome with some pesticide poisoning.

BACKGROUND: Acute pesticide poisoning in developing countries is a considerable problem, requiring diagnosis and treatment. This study describes how training of health care workers in Uganda affects their ability to diagnose and manage acute pesticide poisoning.
METHODS: A postintervention cross-sectional study was conducted using a standardized questionnaire. A total of 326 health care workers in Uganda were interviewed on knowledge and handling of acute pesticide poisoning. Of those, 173 health care workers had received training, whereas 153 untrained health care workers from neighboring regions served as controls.
RESULTS: Trained health care workers scored higher on knowledge of pesticide toxicity and handling of acute pesticide poisoning. Stratification by sex, profession, experience, and health center level did not have any influence on the outcome.
CONCLUSIONS: Training health care workers can improve their knowledge and treatment of pesticide poisonings. Knowledge of the subject is still insufficient among health care workers and further training is needed.