Carbamate poisoning: treatment recommendations in the setting of a mass casualties event

Comparative analysis of organophosphorus versus carbamate pesticide poisoning: a case study

Organophosphorus poisoning is a critical condition that can cause central nervous system depression, respiratory failure, and death early on. As its clinical manifestations closely resemble those of carbamate pesticide poisoning, the aim of this case study is to present a case of misdiagnosis, initially identifying carbofuran poisoning as organophosphate in a patient suspect of a heatstroke. We also present a case of intentional self-poisoning with organophosphate dichlorvos to underline the likelihood of pesticide poisoning in patients exhibiting acute cholinergic symptoms when the ingested substance is not known. In such cases, empirical treatment with atropine and oxime can be started pending timely differential diagnosis to adjust treatment as necessary.

Plasma cholinesterase activity: A benchmark for rapid detection of pesticide poisoning in an avian scavenger

Poisoning due to exposure to organophosphate and carbamate pesticides is a common threat for many wildlife species, especially for scavengers such as vultures. The Griffon vulture population (Gyps fulvus), for instance, is deteriorating in the Eastern Mediterranean, and is considered to be critically endangered in Israel, where 48 out of 107 (45 %) known injury/mortality cases in 2010-2021 were caused by poisoning. Lack of specific clinical indications, together with levels of organophosphate or carbamate pesticides too low to detect, challenge the ability to diagnose and treat such poisoning events. The activity of cholinesterase (ChE) in plasma has the potential to serve as an effective biomarker for monitoring exposure to anticholinesterase pesticides in live vultures. Yet, the applicability of this approach has been limited by intra- and inter-species variations in ChE basal levels. The present study aims to provide a benchmark for ChE activity levels in healthy Griffons and their intra-species variation. Blood samples from free-roaming (n = 231) and captive (n = 63) Griffons were collected during routine monitoring, and ChE levels were determined using a colorimetric method. We established that the ChE in the plasma of Griffons reflects mostly acetylcholinesterase as the dominant form. ChE levels in healthy Griffons are 0.601 ± 0.011 U/ml (mean ± SE), while Griffons with suspected or confirmed pesticide poisoning display much lower levels of ChE activity (typically <0.3 U/ml). We also characterized the age dependence of ChE activity, as well as differences among groups from different locations or origins. Our study provides a rapid diagnostic tool for the detection of exposure to organophosphate and carbamate pesticides that should facilitate the lifesaving treatment and the conservation of this species. Moreover, our protocols can be adapted to other species and geographical areas, addressing pesticide poisoning worldwide and contributing to the protection of endangered species and their ecological functions (e.g. sanitation by scavengers).

Investigation of the efficacy of diosmin against organ damage caused by bendiocarb in male Wistar albino rats

Bendiocarb is a carbamate insecticide, which is used more in indoor areas, especially against scorpions, spiders, flies, mosquitoes and cockroaches. Diosmin is an antioxidant flavonoid found mostly in citrus fruits. In this study, the efficacy of diosmin against the adverse effects of bendiocarb was investigated in rats. For this purpose, 60, 2-3 month-old male Wistar albino rats, weighing 150-200 g, were used. The animals were assigned to six groups, one of which was maintained for control purposes and five of which were trial groups. The control rats received only corn oil, which was used as a vehicle for diosmin administration in the trial groups. Groups 2, 3, 4, 5 and 6 were administered with 10 mg/kg.bw bendiocarb, 10 mg/kg.bw diosmin, 20 mg/kg.bw diosmin, 2 mg/kg.bw bendiocarb plus 10 mg/kg.bw diosmin, and 2 mg/kg.bw bendiocarb plus 20 mg/kg.bw diosmin, respectively, using an oral catheter, for 28 days. At the end of the study period, blood and organ (liver, kidneys, brain, testes, heart and lungs) samples were collected. Body weight and organ weights were determined. Compared to the control group, in the group given bendiocarb alone, firstly, body weight and liver, lung and testicular weights decreased. Secondly, tissue/plasma malondialdehyde (MDA) and nitric oxide (NO) levels increased, and glutathione (GSH) levels and superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) (except for lung tissue), glutathione reductase (GR), and glucose-6-phosphate dehydrogenase (G6PD) activities decreased in all tissues and erythrocytes. Thirdly, catalase (CAT) activity decreased in erythrocytes and the kidney, brain, heart and lung tissues and increased in the liver and testes. Fourthly, while GST activity decreased in the kidneys, testes, lung and erythrocytes, an increase was observed in the liver and heart tissues. Fifthly, while serum triglyceride levels and lactate dehydrogenase (LDH), alkaline phosphatase (ALP) and pseudo-cholinesterase (PchE) activities decreased, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities and blood urea nitrogen (BUN), creatinine and uric acid levels increased. Lastly, liver caspase 3, caspase 9 and p53 expression levels significantly increased. When compared to the control group, the groups treated with diosmin alone showed no significant difference for the parameters investigated. On the other hand, it was observed that the values of the groups treated with a combination of bendiocarb and diosmin were closer to the values of the control group. In conclusion, while exposure to bendiocarb at a dose of 2 mg/kg.bw for 28 days caused oxidative stress/organ damage, diosmin administration at doses of 10 and 20 mg/kg.bw reduced this damage. This demonstrated that diosmin has pharmaceutical benefits, when used for supportive treatment as well as radical treatment, against the potential adverse effects of bendiocarb.

Newly scheduled carbamate compounds: A synopsis of their properties and development, and considerations for the scientific community

In November 2019, for the first time in the history of the Chemical Weapons Convention, changes were made to Schedule 1 of the Annex on Chemicals. While there is little in the scientific literature regarding any of these newly scheduled chemicals, the carbamates, specifically, prove to be substantially different, both in terms of their chemical composition and their toxicological effects, from all the other scheduled nerve agents and have yet to be fully reported on in the literature. Herein, we present a literature review of the available information on carbamates included in Schedule 1, as well as analogous other carbamates, and provide a summary of their utility and function as cholinesterase inhibitors in general and their toxicities. Though there is a paucity of studies in the literature related to the detection of these newly scheduled quaternary and bisquaternary carbamates and/or their biomarkers, information available on carbamate pesticides may be a solid starting point to further postulate amenable detection methodologies. Lastly, we note some implications of these newly scheduled carbamates for the nonproliferation and disarmament community.

Acetylcholinesterase (AChE) Reversible Inhibitors: The Role of Oxamyl in the Production of Poisoned Baits

Oxamyl is a highly toxic carbamate molecule with toxicological risk from contamination, used as an insecticide, nematicide, and acaricide on many field crops, vegetables, fruits, and ornamentals. Suspected poisoned animals and baits were collected between January 2018 and August 2021 from Lombardy and Emilia-Romagna regions and analyzed at the chemical toxicology laboratory of the Experimental Zooprophylactic Institute of Lombardy and Emilia-Romagna, located in Brescia. The analyses were carried out by an ion trap GC-MS system in 2467 suspected samples and showed the presence of oxamyl in 67 of these. In this study, we analyzed 47 (out of 67) positive baits: the provinces in which more cases have been recorded are Mantua, Ferrara, and Cremona, which overall had 72% of positivity. The nature of the analyzed samples was mostly corn (55.3%), followed by bird carcasses (19.1%), apples (14.8%), meatballs (2.1%), bread (2.1%), and other (8.5%). The use of oxamyl to produce poisoned baits is constantly increasing, proving that it must be considered as a public health risk for the possible consequences on target and non-target organisms, including humans.

Cholinergic crisis caused by ingesting topical carpronium chloride solution: A case report

A cholinergic crisiss is a state characterized by excess acetylcholine owing to the ingestion of cholinesterase inhibitors or cholinergic agonists. We report the first case of a cholinergic crisis after the ingestion of a carpronium chloride solution, a topical solution used to treat alopecia, seborrhea sicca, and vitiligo. An 81-year-old woman with no prior medical history was transported to our emergency department because the patient had disturbance of consciousness after ingesting three bottles of FUROZIN® solution (90 mL, 4500 mg as carpronium chloride). A family member who found the patient called for emergency medical services (EMS) personnel, who contacted the patient ten minutes after ingestion. The patient's Glasgow Coma Scale score was 12 (E4V3M5), and vital signs were as follows: blood pressure, 80/40 mmHg; heart rate, 40 beats/min. The patient vomited repeatedly in the ambulance. On arrival to the ED, the patient's systolic blood pressure and heart rate temporarily decreased to 80 mmHg and 40 beats/min, respectively. Seventy-eight minutes after ingestion, gastric lavage was performed. The patient's symptoms, which included excess salivation, sweating, and hot flush, improved 24 h after ingestion, and the patient's vital signs stabilized without atropine or vasopressors. On the second day of admission, the patient was examined by a psychiatrist and discharged without suicidal ideation. Carpronium chloride has a chemical structure similar to that of acetylcholine; therefore, it exhibits both cholinergic and local vasodilatory activities. There is limited information on the pharmacokinetics of ingested carpronium chloride; therefore, physicians should be made aware that ingesting a carpronium chloride solution may cause a cholinergic crisis.

Cumulative dietary risk assessment of chronic acetylcholinesterase inhibition by residues of pesticides

A retrospective cumulative risk assessment of dietary exposure to pesticide residues was conducted for chronic inhibition of acetylcholinesterase. The pesticides considered in this assessment were identified and characterised in a previous scientific report on the establishment of cumulative assessment groups of pesticides for their effects on the nervous system. The exposure assessments used monitoring data collected by Member States under their official pesticide monitoring programmes in 2016, 2017 and 2018, and individual food consumption data from 10 populations of consumers from different countries and from different age groups. Exposure estimates were obtained by means of a two-dimensional probabilistic model, which was implemented in SAS ® software. The characterisation of cumulative risk was supported by an uncertainty analysis based on expert knowledge elicitation. For each of the 10 populations, it is concluded with varying degrees of certainty that cumulative exposure to pesticides contributing to the chronic inhibition of acetylcholinesterase does not exceed the threshold for regulatory consideration established by risk managers.

Factors associated with outcomes in organophosphate and carbamate poisoning: a retrospective study

Organophosphate and carbamate (OPC) poisoning is a major global health hazard requiring immediate medical intervention. Atropine (ATR) is an essential antidote in organophosphate and carbamate poisoning, with the inclusion of cholinesterase reactivators and other anticholinergics, namely pralidoxime (PAM) and glycopyrrolate (GPR). This study aimed to compare the efficacy of various treatment regimens and identify the factors affecting mortality. The data of patients presented at the emergency unit with the consumption of OPC compounds between the years 2013 and 2017 were retrospectively reviewed. The study population was then categorized into four treatment patterns (1) ATR alone, (2) ATR and PAM, (3) ATR and GPR, (4) ATR, PAM and GPR. The outcome of the patients was assessed in terms of survival, intubation, ICU days, and days of ventilation and hospitalization. Univariate and multivariate analyses were performed to investigate the risk factors associated with mortality and odds ratio (OR). A total of 441 patients were included in the study, of which 69.16% were males, and 375 patients survived. Consumption of poison with a suicidal intention was reported in 98.19% of the patients, and the treatment with ATR and PAM (42.86%) was observed to have lower days of ventilation in comparison to the treatment with ATR and GPR (p = 0.003). Patients requiring intubation were also lowest in the group treated with ATR and PAM (27.51%). The age group of > 50 years (OR 4.275 [CI 2.179-8.387]), male gender (OR 2.608 [CI 1.258-5.406]), and the treatment pattern with ATR, PAM and GPR (OR 2.233 [CI 1.002-4.040]) were independently associated with mortality. In summary, male gender, elderly population, and treatment patterns followed adversely affected the outcome in patients with OPC poisoning.

A case report of cholinesterase inhibitor poisoning: cholinesterase activities and analytical methods for diagnosis and clinical decision making

Suicidal ingestion of organophosphorus (OP) or carbamate (CM) compounds challenges health care systems worldwide, particularly in Southeast Asia. The diagnosis and treatment of OP or CM poisoning is traditionally based on the clinical appearance of the typical cholinergic toxidrome, e.g. miosis, salivation and bradycardia. Yet, clinical signs might be inconclusive or even misleading. A current case report highlights the importance of enzymatic assays to provide rapid information and support clinicians in diagnosis and rational clinical decision making. Furthermore, the differentiation between OP and CM poisoning seems important, as an oxime therapy will most probably not provide benefit in CM poisoning, but—as every pharmaceutical product—it might result in adverse effects. The early identification of the causing agent and the amount taken up in the body are helpful in planning of the therapeutic regimen including experimental strategies, e.g. the use of human blood products to facilitate scavenging of the toxic agent. Furthermore, the analysis of biotransformation products and antidote levels provides additional insights into the pathophysiology of OP or CM poisoning. In conclusion, cholinesterase activities and modern analytical methods help to provide a more effective treatment and a thorough understanding of individual cases of OP or CM poisoning.

Indoxyl Acetate as a Substrate for Analysis of Lipase Activity

Lipases play a crucial role in metabolism of microbes, fungi, plants, and animals, and in analytical chemistry, they are often used in detection of fats and triglycerides. Determination of lipase activity is also important in toxicology, when lipase activity can be both increased and decreased by organophosphates and other pesticides and in medicine for diagnosis of heart diseases. The standard method for lipase activity determination is based on cleaving ester bonds in lipase buffer containing Tween. Our aim was to find a method with faster and more sensitive response. It is known that acetylcholinesterase belongs to the same group of hydrolases enzymes as lipases and it cleaves indoxyl acetate, so we assume indoxyl acetate could report a similar reaction with lipase. Our method is based on indoxyl acetate as a substrate for lipase, where indoxyl acetate is cleaved by lipase to indoxyl and acetate moiety and blue indigo is created. The method was optimized for different times and amount of enzyme and compared with the standard Tween assay. The calibration curve measured in reaction time 20 minutes with 10 μl of lipase exhibited the best analytical parameters, and it showed Michaelis-Menten response with the Michaelis-Menten constant equal to 8.72 mmol/l. The indoxyl acetate-based method showed faster and more sensitive response than the standard method for lipase activity determination, so it has great potential in biosensor construction and it could be used in industry, medicine, toxicology, and common practice where the activity of lipases is need to be measured.

Clinical manifestations, laboratory findings, treatment and outcome of acute organophosphate or carbamate intoxication in 102 dogs: A retrospective study

Organophosphates (OP) and carbamates are commonly used insecticides and important intoxication sources of humans and animals. Nevertheless, large scale studies of these intoxications in dogs are unavailable. The medical records of dogs presented to a veterinary hospital were reviewed retrospectively. The study included 102 dogs definitely diagnosed with acute OP or carbamate intoxication. The most common presenting clinical signs included muscle tremor, hypersalivation, miosis, weakness, vomiting and diarrhea. Hypersalivation, muscle tremor and tachypnea were significantly (P < 0.05) associated with survival to discharge; while weakness, mental dullness, anorexia, pale mucous membranes and paddling were significantly associated with death. Common laboratory abnormalities included decreased butyrylcholine esterase activity, acidemia, increased total plasma protein, leukocytosis, hypochloridemia, hyperbilirubinemia, increased creatinine and alanine transaminase (ALT), aspartate transaminase (AST) and creatine kinase activities, and prolonged activated partial thromboplastin time (aPTT). Compared to the survivors, the non-survivors showed significantly: higher frequencies of thrombocytopenia, hypocarbemia, prolonged prothrombin time (PT), hypernatremia, hyperkalemia, hypocholesterolemia, hypoproteinemia, hypertriglyceridemia, increased ALT activity and increased urea concentration; lower median concentrations of venous blood bicarbonate, serum chloride and total CO₂; and higher medians of PT, serum total bilirubin and urea concentrations, and ALT and AST activities. Intoxicated dogs were commonly treated with diphenhydramine, atropine-sulfate, antibiotics, diazepam and pralidoxime, while some (19.2%) required general anesthesia and mechanical ventilation. The survival rate of dogs treated by gastric lavage was higher (P = 0.041) compared to that of the remaining dogs. Development of respiratory failure and mechanical ventilation requirement were significantly associated (P < 0.001) with death. The mortality rate was 17%.

Contaminant and Environmental Influences on Thyroid Hormone Action in Amphibian Metamorphosis

Aquatic and terrestrial environments are increasingly contaminated by anthropogenic sources that include pharmaceuticals, personal care products, and industrial and agricultural chemicals (i. e., pesticides). Many of these substances have the potential to disrupt endocrine function, yet their effect on thyroid hormone (TH) action has garnered relatively little attention. Anuran postembryonic metamorphosis is strictly dependent on TH and perturbation of this process can serve as a sensitive barometer for the detection and mechanistic elucidation of TH disrupting activities of chemical contaminants and their complex mixtures. The ecological threats posed by these contaminants are further exacerbated by changing environmental conditions such as temperature, photoperiod, pond drying, food restriction, and ultraviolet radiation. We review the current knowledge of several chemical and environmental factors that disrupt TH-dependent metamorphosis in amphibian tadpoles as assessed by morphological, thyroid histology, behavioral, and molecular endpoints. Although the molecular mechanisms for TH disruption have yet to be determined for many chemical and environmental factors, several affect TH synthesis, transport or metabolism with subsequent downstream effects. As molecular dysfunction typically precedes phenotypic or histological pathologies, sensitive assays that detect changes in transcript, protein, or metabolite abundance are indispensable for the timely detection of TH disruption. The emergence and application of 'omics techniques-genomics, transcriptomics, proteomics, metabolomics, and epigenomics-on metamorphosing tadpoles are powerful emerging assets for the rapid, proxy assessment of toxicant or environmental damage for all vertebrates including humans. Moreover, these highly informative 'omics techniques will complement morphological, behavioral, and histological assessments, thereby providing a comprehensive understanding of how TH-dependent signal disruption is propagated by environmental contaminants and factors.

A suspected case of intermediate syndrome in a dog with carbamate toxicosis

CASE REPORT

A 7-year-old female spayed Labrador Retriever was managed for suspected carbamate toxicosis after confirmed ingestion of a large amount of methiocarb. Therapy included decontamination, supportive care and management for aspiration pneumonia. On the third day of hospitalisation, after an initial clinical improvement, the dog developed respiratory muscle weakness, inspiratory dyspnoea and pronounced cervical muscle weakness. These delayed clinical signs were consistent with the 'intermediate syndrome' described in some cases of organophosphate and carbamate toxicoses in humans and also described in one case of organophosphate toxicosis in the dog. Intermediate syndrome has not been reported in carbamate toxicosis in the dog.

CONCLUSION

This case report highlights the necessity for veterinarians to monitor for additional complications not commonly considered in acute carbamate toxicoses.

Removal of carbamates and detoxification potential in a biomixture: Fungal bioaugmentation versus traditional use

The use of fungal bioaugmentation represents a promising way to improve the performance of biomixtures for the elimination of pesticides. The ligninolyitc fungus Trametes versicolor was employed for the removal of three carbamates (aldicarb, ALD; methomyl, MTM; and methiocarb, MTC) in defined liquid medium; in this matrix ALD and MTM showed similar half-lives (14d), nonetheless MTC exhibited a faster removal, with a half-life of 6.5d. Then the fungus was employed in the bioaugmentation of an optimized biomixture to remove the aforementioned carbamates plus carbofuran (CFN). Bioaugmented and non-bioaugmented systems removed over 99% ALD and MTM after 8d of treatment, nonetheless a slight initial delay in the removal was observed in the bioaugmented biomixtures (removal after 3d: ALD 87%/97%; MTM 86%/99%, in bioaugmented/non-bioaugmented systems). The elimination of the other carbamates was slower, but independent of the presence of the fungus: >98% for MTM after 35d and >99.5% for CFN after 22d. Though the bioaugmentation did not improve the removal capacity of the biomixture, it favored a lower production of transformation products at the first stages of the treatment, and in both cases, a marked decrease in the toxicity of the matrix was swiftly achieved along the process (from 435 to 448 TU to values <1TU in 16d).

Ecological risk analysis of pesticides used on irrigated rice crops in southern Brazil

Based on studies conducted in the past decade in the southern region of Brazil to determine residue levels of the pesticides normally used on irrigated rice crops, changes can be observed in relation to the presence of pesticides in the waters of the main river basins in Santa Catarina State. In previous harvests, the presence of residues of 7 pesticides was determined, with the herbicide bentazon and the insecticide carbofuran being the products showing highest frequency. Following toxicological tests conducted with 8 different test organisms, deterministic and probabilistic risk analysis was performed to assess the situation of the river basins in areas used for the production of irrigated rice. Of the species tested, the herbicide bentazon showed greatest toxicity toward plants, but did not present an ecological risk because in the worst-case scenario the highest concentration of this pesticide in the environment is 37 times lower than the lowest EC50/LC50 value obtained in the tests. The insecticide carbofuran, which had the highest toxicity toward the organisms used in the tests, presented an ecological risk in the deterministic analysis, but without any associated probability. The results highlight the need for increased efforts in training farmers in crop management practices and for the continual monitor of water bodies for the presence of pesticide residues.

Development and clinical study of submicronic-atropine sulphate respiratory fluid as a novel organophosphorous poisoning antidote

CONTEXT

Increased use of organophosphate insecticides (OPI) and possibility of terror groups using stocks of nerve agents underscore the need to develop effective and safe antidotes. While intramuscular administration of antidotes like atropine sulphate (AS) has certain lacunae, intravenous route may not be always feasible in emergency field conditions.

OBJECTIVE

Objective was (a) to develop a novel inhalable submicronic-AS respiratory fluid as potential antidote for OPI poisoning, (b) in-vitro and in-vivo evaluation in terms of respiratory fraction, and (c) clinical study to assess drug bioavailability in blood and atropinization pattern post-inhalation.

METHODS

Formulation was optimized on the basis of particle size of aerosolized droplets and in-vitro nebulization rate. Anderson cascade impaction (ACI) studies were carried out to validate the advantage of test formulation in terms of respirable fraction. Six healthy volunteers were inhaled the test formulation and blood bioavailability and atropinization were noted serially. Gamma scintigraphy was used to quantify total and regional lung deposition of nebulized AS in-vivo.

RESULTS

The formulation was optimized using 30% ethanol-saline with particle size in the range of 350-500 nm. In-vitro ACI data showed high respirable fraction (82.6 ± 3.1%) for the test formulation. In-vivo scintigraphy suggested whole lung deposition of 80.2 ± 6.8% of the total inhaled dose. Early blood bioavailability and atropinization pattern confirmed that therapeutic concentration of the drug in blood was reached within 5 min.

CONCLUSIONS

3% submicronic-AS respiratory fluid might be used as potential prophylactic/therapeutic option against OPI poisoning with several advantages over intramuscular injection, including early blood bioavailability and atropinization.

Detection of Carbofuran-Protein Adducts in Serum of Occupationally Exposed Pesticide Factory Workers in Pakistan

This study was conducted to investigate the protein adducts with pesticides in a cohort of 172 factory workers that were exposed to a mixture of pesticides. The 35 samples showing considerable variation in biochemical parameters, i.e., butyrylcholinestrase (BChE), serum glutamic pyruvic transaminase (SGPT), serum glutamic oxaloacetic transaminase (SGOT), gamma-glutamyl transferase (GGT), serum glutamic pyruvic transaminase (SGPT), alkaline phosphatase (ALP/ALKP), lactate dehydrogenase (LDH), creatine phosphokinase (CPK) enzymes, and controls were analyzed by reversed-phase nanoscale liquid chromatography tandem mass spectrometry (nLC-MS/MS) on an Orbitrap mass spectrometer employing a shotgun proteomics approach. Only protein adducts with carbofuran were found on serum proteins of these workers. These adducts were of carbofuran labeled lysine (Lys-142, Lys-183, Lys-287, and Lys-467), arginine (Arg-210, Arg-242, and Arg-256) from serum albumin, and serine (Ser-07, Ser-54, and Ser-150) from immunoglobulin proteins. The arginine residues (Arg-210, Arg-242, Arg-246, and Arg-434) from albumin were also found to be glycated in serum of workers showing a high level of glucose who also had glycated arginine (Arg-1120) modified with carbofuran in their tankyrase-1-binding protein. The number of tandem mass spectra of modified peptides increased with increasing time of exposure. This is the first report to demonstrate the presence of carbofuran-labeled albumin, immunoglobulin, and glycated arginine, which shows that lysine and arginine of human albumin and serine of immunoglobulin are covalently modified in the serum of workers that were occupationally exposed to carbofuran, and the modification is detectable by tandem mass spectrometry. These peptides modified with carbofuran can potentially be used as a biomarker of carbofuran exposure.

Mutagenic and cytotoxic activities of benfuracarb insecticide

Benfuracarb is a carbamate insecticide used to control insect pests in vegetables and it has anti-acetylcholinesterase activity lower than other carbamates. Cytotoxic effects of benfuracarb were evaluated by using root growth inhibition (EC50), mitotic index (MI), and mitotic phase determinations on the root meristem cells of Allium cepa and mutagenic effects were determined in Salmonella typhymurium Ames test by TA98 and TA100 strains with and without metabolic activation. In Allium test, 1 % DMSO was used as negative control group and 10 ppm MMS was used as positive control group. 75 ppm concentration of benfuracarb was found as EC50. In MI and mitotic phases determination study, 37.5, 75 and 150 ppm doses of benfuracarb were used. Dose-dependent cytotoxic activity was found by root growth inhibition and MI studies. It was identified that mitotic inhibition activity of benfuracarb was higher than 10 ppm MMS. In Ames test, mutagenic activity was not observed and over 200 µg/plate of benfuracarb was determined as cytotoxic to S. typhymurium strains. Benfuracarb can be called as "mitotic inhibitor" but not called as mutagen.

Efficacy of Recommended Prehospital Human Equivalent Doses of Atropine and Pralidoxime Against the Toxic Effects of Carbamate Poisoning in the Hartley Guinea Pig

PURPOSE

Aldicarb and methomyl are carbamate pesticides commonly implicated in human poisonings. The primary toxic mechanism of action for carbamate poisoning is cholinesterase (ChE) inhibition. As such, it is logical to assume that the currently accepted therapies for organophosphate poisoning (muscarinic antagonist atropine and the oxime acetylcholinesterase reactivator pralidoxime chloride [2-PAM Cl]) could afford therapeutic protection. However, oximes have been shown to be contraindicated for poisoning by some carbamates.

METHODS

A protective ratio study was conducted in guinea pigs to evaluate the efficacy of atropine and 2-PAM Cl. The ChE activity was determined in both the blood and the cerebral cortex.

RESULTS

Coadministration of atropine free base (0.4 mg/kg) and 2-PAM Cl (25.7 mg/kg) demonstrated protective ratios of 2 and 3 against aldicarb and methomyl, respectively, relative to saline. The data reported here show that this protection was primarily mediated by the action of atropine. The reactivator 2-PAM Cl had neither positive nor negative effects on survival. Both blood acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activities were significantly reduced at 15 minutes postchallenge but gradually returned to normal within 24 hours. Analysis of cerebral cortex showed that BChE, but not AChE, activity was reduced in animals that succumbed prior to 24 hours after challenge.

CONCLUSION

The results suggest that coadministration of atropine and 2-PAM Cl at the currently recommended human equivalent doses for use in the prehospital setting to treat organophosphorus nerve agent and pesticide poisoning would likely also be effective against aldicarb or methomyl poisoning.

The role of multifunctional drug therapy against carbamate induced neuronal toxicity during acute and chronic phase in rats

The current study has been designed to examine the effect of multifunctional drug therapy on carbofuran induced acute (2.187 mg/kg, s.c.) and sub-acute (0.2187 mg/kg, s.c.) neurotoxicity in male wistar rats. Drug treatment which includes nimodipine (Ca(2+) channel blocker), diazepam, ropinirole (dopamine agonist) and GSPE (antioxidant) was started 2h after carbofuran administration. Morris water maze was employed for aiming spatial memory. Narrow beam walk and rotarod were employed for testing motor functions. Brain acetylcholinesterase activity, thiobarbituric acid reactive species, nitrite, reduced glutathione, catalase levels, and mitochondrial complexes were also estimated. Carbofuran treatment resulted in significant development of cognitive and motor functions manifested as impairment in learning and memory along with increased thiobarbituric acid reactive species, nitrite levels and decreased acetylcholinesterase activity, reduced glutathione, catalase levels, and mitochondrial complexes. The standard antidote therapy (atropine) was not able to provide neuroprotection but was able to provide symptomatic relief. The multifunctional drug therapy attenuated carbofuran induced cognitive and motor dysfunction, acetylcholinesterase activity and other biochemical parameters. The triple combination in sub-acute study may be avoided in future as two drug combinations provide adequate neuroprotection. Thus it can be concluded that standard antidotal therapy may not provide neuroprotection while the multifunctional drug therapy offers neuroprotection against carbofuran and may dramatically increase survival and life quality.

A comprehensive evaluation of the efficacy of leading oxime therapies in guinea pigs exposed to organophosphorus chemical warfare agents or pesticides

The currently fielded pre-hospital therapeutic regimen for the treatment of organophosphorus (OP) poisoning in the United States (U.S.) is the administration of atropine in combination with an oxime antidote (2-PAM Cl) to reactivate inhibited acetylcholinesterase (AChE). Depending on clinical symptoms, an anticonvulsant, e.g., diazepam, may also be administered. Unfortunately, 2-PAM Cl does not offer sufficient protection across the range of OP threat agents, and there is some question as to whether it is the most effective oxime compound available. The objective of the present study is to identify an oxime antidote, under standardized and comparable conditions, that offers protection at the FDA approved human equivalent dose (HED) of 2-PAM Cl against tabun (GA), sarin (GB), soman (GD), cyclosarin (GF), and VX, and the pesticides paraoxon, chlorpyrifos oxon, and phorate oxon. Male Hartley guinea pigs were subcutaneously challenged with a lethal level of OP and treated at approximately 1 min post challenge with atropine followed by equimolar oxime therapy (2-PAM Cl, HI-6 DMS, obidoxime Cl₂, TMB-4, MMB4-DMS, HLö-7 DMS, MINA, and RS194B) or therapeutic-index (TI) level therapy (HI-6 DMS, MMB4-DMS, MINA, and RS194B). Clinical signs of toxicity were observed for 24 h post challenge and blood cholinesterase [AChE and butyrylcholinesterase (BChE)] activity was analyzed utilizing a modified Ellman's method. When the oxime is standardized against the HED of 2-PAM Cl for guinea pigs, the evidence from clinical observations, lethality, quality of life (QOL) scores, and cholinesterase reactivation rates across all OPs indicated that MMB4 DMS and HLö-7 DMS were the two most consistently efficacious oximes.

Investigation of kinetic interactions between approved oximes and human acetylcholinesterase inhibited by pesticide carbamates

Carbamates are widely used for pest control and act primarily by inhibition of insect and mammalian acetylcholinesterase (AChE). Accidental or intentional uptake of carbamates may result in typical signs and symptoms of cholinergic overstimulation which cannot be discriminated from those of organophosphorus pesticide poisoning. There is an ongoing debate whether standard treatment with atropine and oximes should be recommended for human carbamate poisoning as well, since in vitro and in vivo animal data indicate a deleterious effect of oximes when used in combination with the N-methyl carbamate carbaryl. Therefore, we performed an in vitro kinetic study to investigate the effect of clinically used oximes on carbamoylation and decarbamoylation of human AChE. It became evident that pralidoxime and obidoxime in therapeutic concentrations aggravate the inhibition of AChE by carbaryl and propoxur, with obidoxime being substantially more potent compared to 2-PAM. However, obidoxime had no impact on the decarbamoylation kinetics. Hence, the administration of 2-PAM and especially of obidoxime to severely propoxur and carbaryl poisoned humans cannot be recommended.

Structural and ultrastructural study of the rabbit testes exposed to carbamate insecticide

The present study was conducted to investigate the impact of carbamate insecticide - bendiocarb on the testicular structure of adult rabbits. Bendiocarb was perorally administered daily for 10 and 30 days, at a dose 5 mg/kg of body weight. After the histological sampling the tissues were investigated and compared with control. After the bendiocarb administration the absolute and relative testicular weight decreased significantly (P < 0.001) in both time periods. The testicular parenchyma showed structural changes such the sloughing of developing sex cells, occurrence of vacuoles within Sertoli cells and inside various spermatogenic cells. The interstitial Leydig cells were smaller than their control counterpart and possessed shrivelled nuclei and strongly vacuolar dark cytoplasm. The rate of changes was directly proportional on duration of the experiment. The ultrastructural examination proved presence of various cellular defects across the germinal epithelium as well as within the interstitial Leydig cells in both experimental periods. Morphometric analysis manifested decrease in diameters of seminiferous tubules, increase of the diameters of the tubular lumina due to reduction of height of the seminiferous epithelium. Results of this study show distinct negative effects of bendiocarb on structure of rabbit testes.

Mortality rate and pattern following carbamate methomyl poisoning. Comparison with organophosphate poisoning of comparable toxicity

CONTEXT

Methomyl is a widely used carbamate insecticide. It is known that mortality rate is generally low in carbamate poisoning, but fatalities from methomyl poisoning have been reported. Nevertheless, there is no reported comparative outcome of methomyl and organophosphate poisoning of comparable toxicity concerning mortality rate and mortality pattern.

OBJECTIVE

This study aims to compare the mortality rate and pattern following methomyl poisoning with those after organophosphate poisoning of comparable toxicity.

MATERIAL AND METHODS

A retrospective study was conducted on patients with cholinesterase inhibitor poisoning admitted to our institution. Among a diverse group of cholinesterase inhibitors, we included patients who presented after ingesting methomyl or World Health Organisation hazard Class I organophosphate compounds. Patients were divided into two groups; the methomyl group and the Class I organophosphate group.

RESULTS

The methomyl group consisted of 17 patients, and the Class I organophosphate group consisted of 42 patients. Seven patients (41.2%) in the methomyl group presented with cardiac arrest, while none presented with cardiac arrest in the Class I organophosphate group (p < 0.001). In the methomyl group, patients who had not experienced cardiac arrest at presentation survived to discharge from hospital. Among the seven patients who presented with cardiac arrest, three died from multiple organ dysfunction syndrome after resuscitation from cardiac arrest. In the Class I organophosphate group, four patients died from pneumonia and complicating acute respiratory distress syndrome. Therefore, the mortality rate was 17.6% in the methomyl group and 9.5% in the Class I organophosphate group (p = 0.399).

CONCLUSION

The mortality rate of methomyl poisoning was comparable to that of World Health Organisation Class I organophosphate poisoning. All died patients in the methomyl group experienced cardiac arrest, and died from multiple organ dysfunction syndrome after resuscitation from cardiac arrest.