A retrospective study of poisoning cases in Manmohan Memorial Teaching Hospital

Bajracharya, Manjita; Khadka, Prasidda; Wagle, Laxman

doi:10.3126/jmmihs.v4i1.21144

Cited by 3 publications

(3 citation statements)

References 6 publications

(7 reference statements)

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“…The current findings announced that most patients were married. This was similar to the results observed by Sunny et al (2019) and Bajracharya et al (2018) who explained these results by the fact that they bear the bulk of the family's obligations, may be constantly stressed out, and are more likely to be exposed to OPC.…”

Section: Discussionsupporting

confidence: 91%

Role of Paraoxonase-1 Enzyme in Prediction of Severity and Outcome of Acute Organophosphorus Poisoning: A Prospective Study

Alí

El-Shafey

Eldin

et al. 2022

Zagazig Journal of Forensic Medicine

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Background: Human serum paraoxonase-1 (PON-1) hydrolyzes organophosphate compounds (OPC) and so significantly alters an individual's susceptibility to the toxicity of these chemicals. Aim: The study was designed to assess the serum PON-1 activity in patients with OPC poisoning and to correlate its level with the severity and outcome of acutely organophosphate poisoned patients. Patients and methods: This was a prospective clinical study that was performed at Benha Poison Treatment and Toxicological Research Unit (BPTTRU), Benha University Hospitals, Egypt, for one year, from 1 August 2020 till 31 July 2021. Patients were divided into case and control groups. Socio-demographic information of patients, clinical findings, treatments given, length of hospital stay and outcome were collected into datasheets. Patients were classified according to degree of toxicity according to Peradeniya Organophosphorus Poisoning (POP) scale. Blood samples were collected from patients to assess pseudocholiesterase and PON-1 activities. Results: Reduction of serum pseudocholinesterase and paraoxonase-1 (PON-1) activities in poisoned patients and patients can be graded according to (POP) scale into: mild, moderate and severe cases. In conclusion: This study concluded that serum paraoxonase-1 (PON-1) activity was significantly lower in patients with severe organophosphorus compounds (OPC) poisoning as compared to patients with moderate poisoning. Lower PON-1 activity was significantly associated with lower serum cholinesterase and poorer outcomes. PON-1 activity may be considered as an indicator of prognosis in OPC poisoning.

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Section: Discussionsupporting

confidence: 91%

Role of Paraoxonase-1 Enzyme in Prediction of Severity and Outcome of Acute Organophosphorus Poisoning: A Prospective Study

Alí

El-Shafey

Eldin

et al. 2022

Zagazig Journal of Forensic Medicine

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“…OP insecticides are a common means of self-harm in the LMIC because they are very widely used in agriculture [7]. The common OPs currently used in Nepal include dichlorvos, chlorpyrifos, dimethoate and malathion [9,[22][23][24]. A hospitalbased study from five major hospitals across Nepal in 2002 showed that OP compounds were the most common agent for self-poisoning, methyl parathion and dichlorvos being the key pesticides involved [25].…”

Section: Discussionmentioning

confidence: 99%

“…Patients were most commonly: women (n ¼ 2533, 61.3%; unknown gender n ¼ 15), of the Janajati ethnic group ((n ¼ 1063 27.7%) [16], and aged 16-30 years ((n ¼ 2350, 57.5%). Median age of patients was 25 years (IQR 19-35), with a small difference between sexes (male: 27 ; female 24 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33).…”

Section: Pesticide Self-poisoning Among Patients Presenting To Hospitalsmentioning

confidence: 99%

Intentional pesticide poisoning and pesticide suicides in Nepal

Ghimire

Utyasheva

Pokhrel³

et al. 2021

Clinical Toxicology

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Introduction: Intentional pesticide poisoning is a major clinical and public health problem in agricultural communities in low and middle income countries like Nepal. Bans of highly hazardous pesticides (HHP) reduce the number of suicides. We aimed to identify these pesticides by reviewing data from major hospitals across the country and from forensic toxicology laboratories. Methods: We retrospectively reviewed medical records of 10 hospitals for pesticide poisoned patients and two forensic laboratories of Nepal from April 2017 to February 2020. The poison was identified from the history, referral note, and clinical toxidrome in the hospitals and from gas chromatography analysis in the laboratories. Data on demographics, poison, and patient outcome were recorded on a data collection sheet. Simple descriptive analysis was performed. Results: Among hospital cases (n ¼ 4148), the commonest form of poisoning was self-poisoning (95.8%) while occupation poisoning was rare (0.03%). Case fatality was 5.3% (n ¼ 62). Aluminum phosphide (n ¼ 38/62, 61.3%) was the most commonly identified lethal pesticide for deaths. Forensic toxicology laboratories reported 2535 deaths positive for pesticides, with the compounds most commonly identified being organophosphorus (OP) insecticides (n ¼ 1463/2535; 57.7%), phosphine gas (n ¼ 653/ 2535; 25.7%; both aluminum [11.8%] and zinc [0.4%] phosphide) and organochlorine insecticides (n ¼ 241/2535; 9.5%). The OP insecticide most commonly identified was dichlorvos (n ¼ 273/ 450, 60.6%). Conclusion:The data held in the routine hospital medical records were incomplete but suggested that case fatality in hospitals was relatively low. The pesticides identified as causing most deaths were dichlorvos and aluminum phosphide. Since this study was completed, dichlorvos has been banned and the most toxic formulation of aluminum phosphide removed from sale. Improving the medical record system and working with forensic toxicology laboratories will allow problematic HHPs to be identified and the effects of the bans in reducing deaths monitored.

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Suicide by pesticide ingestion in Nepal and the impact of pesticide regulation

et al. 2021

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Background Nepal recorded 5754 suicides in 2018–19 - a high number for a relatively small country. Over 24% of these suicides were by poisoning, most by ingestion of highly concentrated agricultural pesticides. Nepal has actively regulated pesticides to reduce their health impacts since 2001. We aimed to analyse Nepal’s history of pesticide regulation, pesticides responsible for poisonings, and relate them to national suicide rates. Methods Information on pesticide regulation was collected from the Plant Quarantine and Pesticide Management Centre of the Ministry of Agriculture and Livestock Development. National data on suicides from 1980 to 2019 were obtained from the National Statistical Bureau and Nepal Police. Data on the pesticides responsible for self-poisoning and pesticide suicides over time were obtained from a systematic literature review. Results As of June 2020, 171 pesticides were registered for use in Nepal, of which one was extremely hazardous (WHO Class Ia), one other highly hazardous (WHO Class Ib), and 71 moderately hazardous (WHO Class II). Twenty-four pesticides have been banned since 2001, with eight (including five WHO Class I compounds) banned in 2019. Although the suicide rate has increased more than twelve-fold since 1980, particularly for hanging (15-fold increase from 1980 to 2018), fatal pesticide self-poisoning has increased by 13-fold. Methyl-parathion is reported to be the key pesticide responsible for pesticide self-poisoning in Nepal, despite being banned in 2006. Conclusion The full effect of the recent pesticide policy reform in Nepal remains to be seen. Our analysis shows a continuing increase in suicide numbers, despite bans of the most important pesticide in 2006. This may indicate smuggling across the border and the use of the brand name (Metacid) for pesticides in general making it difficult to identify the responsible pesticide. More information is required from forensic toxicology labs that identify the individual compounds found. The effect of recent bans of common suicide pesticides needs to be monitored over the coming years. Evidence from other Asian countries suggests that HHPs bans will lead to a marked reduction in suicides, as well as fewer cases of occupational poisoning.

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A retrospective study of poisoning cases in Manmohan Memorial Teaching Hospital

Cited by 3 publications

References 6 publications

Role of Paraoxonase-1 Enzyme in Prediction of Severity and Outcome of Acute Organophosphorus Poisoning: A Prospective Study

Role of Paraoxonase-1 Enzyme in Prediction of Severity and Outcome of Acute Organophosphorus Poisoning: A Prospective Study

Intentional pesticide poisoning and pesticide suicides in Nepal

Suicide by pesticide ingestion in Nepal and the impact of pesticide regulation

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