Sociodemographic characSociodemographic characteristics and assessment of severity in organophosphorus poisoning in a tertiary care hospitalteristics and assessment of severity in Organophosphorous poisoning in a Tertiary care hospital

Timsinha, Sidhart; Shah, Rajesh Kumar; Kar, Suvarna Manjari

doi:10.18203/2320-6012.ijrms20173950

Cited by 4 publications

(1 citation statement)

References 7 publications

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“…On assessing the severity of the victims as per Peradeniya Organophosphorus Poisoning scale (POP scale), 38 (30.89%) patients had mild poisoning, 33 (26.83%) had moderate poisoning with 25 (20.33%) had severe poisoning in this study. Similar findings was seen in the study conducted by Timsinha S et al 26 This study shows that muscarinic effects (56.10%) predominates and appears first then nicotinic effects (29.27%). Study by Emerson et al, shows that muscarinic symptoms were found in 92% cases.…”

Section: Discussionsupporting

confidence: 91%

Epidemiological Study of Organophosphorus Poisoning at College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal

Pradhan

Upadhyay

Shrestha

et al. 2022

J Coll Med Sci-Nepal

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Introduction: Poisoning is an acute medical emergency. Organophosphorus (OP) poison, being easily available and relatively cheaper, is mostly used by people for suicide. It is a major health problem worldwide also a major cause of suicide in Nepal. The purpose of this study was to assess the overall profile of patients with Organophosphorus (OP) poisoning. Methods: A Prospective hospital based descriptive cross-sectional study was conducted on patients of organophosphorous poisoning in the emergency department (ER) of College of Medical Sciences and Teaching Hospital during one year period from 1st January 2020 to 31st December 2021. Data analysis was done using SPSS-16 software. Categorical variables were presented in the form of tables with frequency and percentage. Data was analyzed by using descriptive statistical tools. Results: A total of 123 OP poisoning cases attended in the emergency department of College of Medical Sciences over a period of one year. The overall female to male ratio was 1.19:1. Most poisoning occurred in the age group 15-25yrs. Majority of the patients were married and were students. Oral route (87.83%) was the most common route of administration. The main reason was family and personal issues. Majority of the patients stay 3-7 days in the hospital. The mortality of poisoning was 3.25%. Conclusions: Majority of the intentional poisoning occurred in the female, married & students of younger age group. The main reason was family and personal issue.

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Section: Discussionsupporting

confidence: 91%

Epidemiological Study of Organophosphorus Poisoning at College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal

Pradhan

Upadhyay

Shrestha

et al. 2022

J Coll Med Sci-Nepal

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Case fatality of agricultural pesticides after self-poisoning in Sri Lanka: a prospective cohort study

Buckley

Mohamed

Raubenheimer

et al. 2021

The Lancet Global Health

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Background Pesticide poisoning is among the most common means of suicide globally, but can be prevented with regulation of the most hazardous agents. We aimed to compare the lethality of pesticides ingested by our cohort, seek evidence on variation between human and regulatory animal toxicity, and establish change over time in the case fatality of individual pesticides in Sri Lanka. MethodsWe examined the case fatality of agricultural pesticides in a prospective cohort in nine hospitals serving rural populations in Sri Lanka. We included all patients (>11 years) who had presented to a South Asian Clinical Toxicology Research Collaboration study hospital during the study period. Patients were enrolled by clinical research assistants and were regularly reviewed. Identification of the ingested pesticide was generally on the basis of history or positive identification of the container, supported by nested blood analysis. Findings From March 31, 2002, to Dec 31, 2019, 34 902 patients (median age 29 years [IQR 21-40]; 23 060 [66•1%] male) presented with a possible or known pesticide self-poisoning. We identified 23 139 specific pesticides that were ingested. Poisoning was fatal in 2299 (6•6%) patients. Case fatality varied greatly from 0•0% (several substances) to 41•8% (paraquat). The three most toxic agents (ie, paraquat, dimethoate, and fenthion) were banned between 2008 and 2011. Since 2013, the five agents causing the most deaths (ie, profenofos, propanil, fenobucarb, carbosulfan, and quinalphos) had a case fatality of 7•2-8•6%. A steady decline was seen in overall case fatality of pesticide poisoning (10•5% for 2002-06 to 3•7% for 2013-19), largely attributable to pesticide bans. A modest fall in case fatality for nonbanned pesticides was also seen.Interpretation Declines seen in case fatalities of poisonings with non-banned pesticides suggest that medical management improved over time. The human data for acute toxicity of pesticides should drive hazard classifications and regulation. We believe that a global benchmark for registration of pesticides should include a less than 5% case fatality after self-poisoning, which could prevent many deaths and have a substantial effect on global suicide rates.

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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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Sociodemographic characSociodemographic characteristics and assessment of severity in organophosphorus poisoning in a tertiary care hospitalteristics and assessment of severity in Organophosphorous poisoning in a Tertiary care hospital

Cited by 4 publications

References 7 publications

Epidemiological Study of Organophosphorus Poisoning at College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal

Epidemiological Study of Organophosphorus Poisoning at College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal

Case fatality of agricultural pesticides after self-poisoning in Sri Lanka: a prospective cohort study

Intentional pesticide poisoning and pesticide suicides in Nepal

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