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This study considered whether there could be a change of mortality and length of stay as a result of inter-hospital transfer, clinical department, and size of hospital for patients with organophosphates and carbamates poisoning via National Patients Sample data of the year 2009, which was obtained from Health Insurance Review and Assessment Service...
Citations
... Malnutrition is often clinically associated with mortality and infectious complications, as addressed by the guidelines on administering adequate nutritional support in critically ill patients [11][12][13] . Many patients with organophosphate or carbamate poisoning require critical care supports, such as mechanical ventilation (MV); hence, it is important to monitor the status of neurological deterioration and adjust the dosage of atropine accordingly 1, 14,15) . ...
... Atropine has cholinergic effects and is used as an antidote for organophosphate and carbamate poisoning 3-5) . In severe organophosphate and carbamate poisoning cases, fatality has been reported to be about 9.7 to 20% 1, 14,15,17) . Patients usually die from hemodynamic instability with respiratory failure due to bronchorrhea and mental status change 1,4,14) . ...
Purpose: Atropine is an antidote used to relieve muscarinic symptoms in patients with organophosphate and carbamate poisoning. Nutritional support via the enteral nutrition (EN) route might be associated with improved clinical outcomes in critically ill patients. This study examined the administration of nutritional support in patients undergoing atropinization, including methods of supply, outcomes, and complications. Methods: A retrospective observational study was conducted in a tertiary care teaching hospital from 2010 to 2018. Forty-five patients, who were administered with atropine and on mechanical ventilation (MV) due to organophosphate or carbamate poisoning, were enrolled. Results: Nutritional support was initiated on the third day of hospitalization. Thirty-three patients (73.3%) were initially supported using parenteral nutrition (PN). During atropinization, 32 patients (71.1%) received nutritional support via EN (9) or PN (23). There was no obvious reason for not starting EN during atropinization (61.1%). Pneumonia was observed in both patient groups on EN and PN (p=0.049). Patients without nutritional support had a shorter MV duration (p=0.034) than patients with nutritional support. The methods of nutritional support during atropinization did not show differences in the number of hospital days (p=0.711), MV duration (p=0.933), duration of ICU stay (p=0.850), or recovery at discharge (p=0.197). Conclusion: Most patients undergoing atropinization were administered PN without obvious reasons to preclude EN. Nutritional support was not correlated with the treatment outcomes or pneumonia. From these results, it might be possible to choose EN in patients undergoing atropinization, but further studies will be necessary.
... Most experts agree that GL has limited utility in late-presenting ingestions or hydrocarbon co-ingestion which may increase aspiration risk [7]. GL may result in these complications: gastro-intestinal bleed, aspiration, hypoxia, oesophageal perforation and laryngeal spasm [8]. ...
... The lack of a comprehensive emergency medical system and the shortage of intensive care units may contribute to high fatality rates [8]. Although our study's case fatality rate of 7.4% is lower than most estimated rates around the globe of 30-50%, AAs are thought to be less lethal than OCPs [10]. ...
... Our study also takes place in an EC in which ECPs were trained to aggressively manage patients with poisonings. Previously, EC management has been shown to provide a mortality benefit for pesticide-poisoned patients [8]. ...
Introduction
The Global Emergency Care Collaborative and Nyakibale Hospital in Rukungiri opened the first functional emergency centre in rural Uganda. We investigated decontamination, management and outcomes of poisoned patients in the emergency centre.
Methods
An electronic database started recording charts from 24 March 2012. A search for diagnoses concerning self-poisoning was performed from 24 March 2012 to 30 December 2013 and 192 charts were found and de-identified. Data collection included: age, sex, poison and duration, intent, vital signs, physical examination, decontamination, antidote use and follow-up status.
Results
From 24 March 2012 to 30 December 2013 poisoning accounted for 96 patient encounters. Of these, 33 were associated with alpha-2 agonists and 16 were associated with organophosphorous or carbamate pesticides. The post-decontamination fatality rate was 5.7%. The fatality rate of those without decontamination was 8.3%. Of those who were given atropine, 38.8% had no known indication. Of the 96 patient encounters, there were seven deaths; six were due to pesticides.
Discussion
In resource-limited settings where antidotes and resuscitative capabilities are scarce, decontamination needs to be studied further. Repeat atropine use without indication may lead to depletion of an essential antidote. Future directions include a public health education programme and an algorithm to help guide clinical decisions.
... За численними літературними даними [7,8,10], з початку масового застосування пестициди залишаються важливими причинами отруєнь (особливо гострих) у багатьох країнах [3,9,21]. У свою чергу, за даними [7], у загальній структурі отруєння пестицидними препаратами значна частка належить саме фосфорорганічним сполукам (ФОС). ...
The paper is dedicated to the results of investigation of the impact of widely used pesticide chlorpyrifos on the oxygen-transport function of hemoglobin in rats. Сhlorpyrifos was administered orally to experimental animals in the form of oil solution. The rats were subjected to acute (30 and 70 mg/kg) and chronic (5, 10 and 15 mg/kg) poisoning. It was revealed that chronic administration of chlorpyrifos (daily for 30 days) at all applied doses led to a reducing of hemoglobin’s affinity to oxygen, that was manifested as a right shift of the oxygen – hemoglobin dissociation curve. In turn, a single injection of chlorpyrifos in 30 mg/kg resulted in statistically significant changes in the dynamics of oxygen saturation of hemoglobin only at 10th day of the experiment, while at the first, third and sixth day after poisoning, no significant effects were observed. We also found that the acute intoxication with chlorpyrifos in 70 mg/kg led to a decrease in the hemoglobin’s affinity for oxygen, which was manifested as a shift in the oxyhemoglobin dissociation curve. This trend was observed both in rats treated with only oil solution of chlorpyrifos and in animals with received the pesticide in a combination with vitamins A and E.
... All people who resided in Korea were provided with a fee-for-service system by a single healthcare agent, the NHIS. Every detail about the medical treatment, medication, and diagnosis of all patients was coded, and then input to the Health Insurance Review and Assessment Services (HIRA) [13][14][15]. In May 2012, the National In-patients Sample (NIS) data of about 13% of the in-patients and 1% of outpatients with national representativeness from the year 2009, named HIRA-NIS-2009, was provided [16,17]. ...
... Korea has a special system in which medical claims are made to the NHIS based on the resident registration number of each citizen [13,14]. The health insurance claim data contains extensive information on the use of medical services, but it may be distorted in order to receive more compensation [15]. The scale of data also makes it difficult to identify the desired clinical data for analysis. ...
... The scale of data also makes it difficult to identify the desired clinical data for analysis. HIRA-NIS-2009, verified as having national representativeness, was obtained from the health insurance claims of 2009 [17][18][19], and it is being used in some studies [15]. Based on HIRA-NIS-2009, this study found that the incidence of IHCA was 2.46 per 1,000 admissions. ...
Objectives
This study analyzed the incidence and characteristics of in-hospital cardiac arrest (IHCA) in Korea based on a sample group of patients that is representative of the population.
Methods
The incidence of IHCA in adults was extracted from HIRA-NIS-2009, a sample of all patients using medical services in Korea. IHCA patients were analyzed according to gender, age, type of medical institute, and classification under the 6th revision of the Korean Standard Classification of Diseases (KCD-6). In addition, to assess the differences arising from the size of medical institutes, the IHCA incidence was analyzed in relation to the number of inpatient beds.
Results
Based on the sample data, the total incidence of IHCA in Korea was found to be 2.46 per 1,000 admissions (95% confidence interval [CI], 2.37–2.55). A higher incidence was found among men at 3.18 (95% CI, 3.03–3.33), compared to women at 1.84 (95% CI, 1.74–1.94). The incidence of IHCA was also higher in hospitals that had more than 600 inpatients beds at 5.40 (95% CI, 5.16–5.66) in comparison to those that had less than 600 inpatients beds at 4.09 (95% CI, 3.76–4.36) (p < 0.001). By primary disease, the incidence was the highest for infectious diseases.
Conclusions
We demonstrated that the IHCA incidence based on gender, age, diagnostic group, and number of beds could be analyzed using the insurance claim data from a national representative sample.
... In addition, several factors including the route, duration, and frequency of exposure, contact with other pollutants, and compromised physiological condition (e.g. hepatic injury) may determine the degree of toxicity [7][8]. ...
... In fact, safe handling through personal protective equipment may reduce absorption of those chemicals. In the Republic of Korea, mortality studies due to organophosphate and carbamate poisoned patients (occupationally linked acute exposures or suicides) were recently reported in which 17 cases, under the age of 56.8 ± 19.2 years were found among a total of 146 [7]. Unlike other types of intoxication, there are definite antidotes for carbamates exposure. ...
... Unlike other types of intoxication, there are definite antidotes for carbamates exposure. The mortality of these disease entities could be diminished with sufficient use of atropine, 2-pyridine aldoxime methyl chloride (2-PAM, known as pralidoxime) and vigorous airway management if used from the early stage of their occurrence [7]. ...
Carbamates are an important class of pesticides used worldwide in public health, among rural and urban settings. Indeed, due to their mode of action and effectiveness, the application of these compounds is one of the best options presently offered for pest control in modern agriculture. They are also used for gardening, and as therapeutic pharmaceuticals for veterinary medicine. Carbamates have been also used in medicine for myasthenia gravis, an autoimmune disease which affects the postsynaptic element of the neuromuscular junction, and as pre-exposure protection in military settings from chemical warfare nerve agents such as Sarin and Tabun. For example carbamates such as physostigmine, and pyridostigmine have been listed as human drugs. However, current environmental concerns of the deleterious health impacts of carbamate pesticides have been increasing. Humans and other non-target species are exposed to residues of these cholinesterase-inhibiting chemicals via nutritional sources (legumes, fruits, contaminated meat, and dairy products), water and/or through environmental/occupational settings due to inappropriate handling. As other pollutants, carbamates may induce deleterious effects on both biotic (micro and macro fauna and flora) and abiotic systems. The adverse effects of several carbamate pesticides include renal, hepatic, neurological, reproductive, immune, and metabolic functions in both humans and animals. Furthermore, some of them are classified as endocrine disrupting chemicals [1], and regarded as priority pollutants by the United States Environmental Protection Agency (US EPA) [2].
In this chapter a brief overview of the current knowledge on the carbamates’ mode of action and toxicological aspects is presented. The role of in vivo studies (histological and hematological approaches), epidemiology and interdisciplinary research on assessment of the carbamates’ environmental and potential public health effects is addressed and the major contributions are discussed. In addition, this chapter presents the results of some of our laboratory experiments that focus on the evaluation of aminocarb and thiodicarb renal and hepatic toxicity, lymphoid organ damage including the spleen and thymus, and adverse effects on male reproductive organs.
The usage of carbamate pesticides in agriculture is increasing year by year. Carbamate pesticides are thioesters and esters, which are derived from aminocarboxylic acid. Carbamates are commonly utilized to improve agricultural production and protect humans and animals from disease. They were also used to control and prevent agricultural pests. However, carbamate can be highly toxic if not applied properly. Therefore, carbamate pesticides need to be monitored in fruits and vegetables. Sensitive and selective detection of carbamate pesticides using nanotechnology helps overcome the drawback of conventional methods of detecting carbamates. Nowadays, the demand for rapid, highly sensitive, and selective pesticide detection techniques is expanding to facilitate detection without complicated equipment. Due to this, this chapter focuses on nanotechnology and current detection methods for detecting residual carbamate pesticides in fruits and vegetables more precisely and faster.
