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Bandara P, Page A, Rajapakse T, Knipe D. Intimate partner violence, suicide and self-harm in Sri Lanka: Analysis of national data. PLoS One 2024; 19:e0298413. [PMID: 38512911 PMCID: PMC10956877 DOI: 10.1371/journal.pone.0298413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/25/2024] [Indexed: 03/23/2024] Open
Abstract
There is increasing evidence from South Asia and internationally that intimate partner violence (IPV) is strongly associated with self-harm, however its association with suicide and self-harm has not been extensively examined, nor has this relationship been explored at a national level. Using national datasets, area-level variation in IPV, suicide and self-harm in Sri Lanka were examined. In addition, the association between individual level exposure to past-year IPV and non-fatal self-harm by any household member were explored in a series of multi-level logistic regression models, adjusting for age. Similar patterns in the distribution of suicide and IPV were found, with higher rates evident in post-conflict districts, specifically Batticaloa, Kilinochchi, and Mullaitivu. Experience of past year IPV and its various forms were strongly associated with household-level self-harm in the past year (adjusted odds ratio [AOR] = 3.83 95% CI 2.27-6.46). A similar magnitude was found for physical/sexual abuse (AOR 5.17 95% CI 2.95-9.05) and psychological abuse (AOR 4.64 95% CI 2.50-7.00). A dose-response association was also evident for frequency of abuse, with an increasing risk of household-level self-harm for women reporting abuse 'less often' (AOR 2.95 95% CI 1.46-5.92), and abuse experienced 'daily, weekly, or monthly' (AOR 4.83 95% CI 2.59-9.00), compared to no abuse. This study contributes to a growing body of evidence on the relationship between IPV and suicidal behaviour in South Asia. Addressing IPV and its various forms should be a priority for suicide prevention in Sri Lanka, alongside trauma-informed approaches in post-conflict settings.
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Affiliation(s)
- Piumee Bandara
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Translational Health Research Institute, Western Sydney University, New South Wales, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, New South Wales, Australia
| | - Thilini Rajapakse
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Mottla ME, Bowler ME, Asgary R. Epidemiology, risk factors, and strategies to prevent and manage poisonings due to pharmaceuticals in children in low income and low-middle income countries: A systematic review. J Glob Health 2023; 13:04173. [PMID: 38154015 PMCID: PMC10754493 DOI: 10.7189/jogh.13.04173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
Background There are significant disparities in the burden of disease due to poisoning between children in low- and high-income countries (HICs). However, there is limited data on the impact of increasing pharmaceutical access in low income countries (LICs) and low-middle income countries (LMICs) on the epidemiology of and risk factors associated with poisoning in children in these settings. Furthermore, while strategies in HICs have effectively reduced the burden of disease due to poisonings in children, there is limited information regarding the efficacy of these interventions in LICs/LMICs. Methods We conducted a systematic review in eight databases for literature published between January 2000 to April 2022 to evaluate the epidemiology and risk factors associated with poisonings due to pharmaceuticals and effective strategies to prevent and manage them in children in LICs/LMICs. From 16 061 retrieved articles, 41 were included in the final analysis. Results Pharmaceuticals were a common cause of poisoning in children in LICs/LMICs, occurring in between 12.4% and 72.36% of cases. Major risk factors were unsafe medication storage and inadequate caregiver knowledge. Delayed access to care and younger age were associated with increased mortality. Prevention strategies that included education demonstrated improvements in knowledge; however, their impact on incidence and mortality was unclear. Management strategies detailed individual patient care interventions, most commonly gastric lavage and activated charcoal. Meanwhile, delayed presentation, limited provider knowledge, and inadequate laboratory resources to support therapeutic monitoring hindered optimal management. Conclusions The combination of educational interventions for prevention, along with regulatory processes to maximise medication storage and formulation safety, could be effective in reducing the burden of poisoning in LICs/LMICs. The development of national or regional protocols for the management of common medication poisonings, augmented by the development of poison control centers and expansion of laboratory access in facilities may help reduce the morbidity and mortality associated with pharmaceutical poisonings in children in LICs/LMICs. Further evidence regarding contextual factors, risk and benefit profiles, the pattern of poisoning, and the impact of preventive and treatment interventions specific to LICs/LMICs is needed to better refine recommendations in these settings. Registration PROSPERO: CRD42022315686.
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Affiliation(s)
- Mary Elizabeth Mottla
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Mary-Ellis Bowler
- Department of Global Health, George Washington Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Ramin Asgary
- Department of Global Health, George Washington Milken Institute School of Public Health, Washington, District of Columbia, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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3
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Elhady MM, Adly SA, Elshebiny HA, Moselhy SS. Detection the severity of organophosphate intoxication using sensitive serum biomarkers S100B and amyloid β (Aβ) in Egyptian subjects. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:105194-105201. [PMID: 37713081 PMCID: PMC10579114 DOI: 10.1007/s11356-023-29748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/03/2023] [Indexed: 09/16/2023]
Abstract
Organophosphate (OP) is a compound considered the main leading cause of morbidity and mortality from poisoning worldwide. Serum pseudocholinesterase was evaluated as a diagnostic indicator; it cannot be used to monitor therapy or severity of the intoxication. The rationale of the current study was to evaluate sensitivity, specificity, and cut-off values of serum S100B and amyloid β for neurological affection severity. This study was carried out on sixty OP-impaired patients; in addition, 20 normal controls were included. Serum liver and kidney function tests, malondialdehyde, pseudocholinesterase, and the levels of S100B and amyloid β (Aβ) were determined. Data showed that Pearson's analysis indicated that the serum level of S100B was positively correlated with Aβ. On the contrary, the activity of pseudocholinesterase was negatively correlated with both of S100B and Aβ. Serum ALT, AST, creatinine, urea, acetylcholine, and MDA levels were elevated while pseudocholinesterase activity was reduced in moderate and severe OP intoxication versus control. A drastic elevation (p<0.001) in the levels of S100B and Aβ was performed in the patient group suffering from OP intoxication versus the normal group. The diagnostic statistical validation of targeted parameters in distinguishing between moderate OP intoxication and control clarifies that S100B displayed the best AUC (0.997) followed by Aβ (AUC=0.992), while the diagnostic veracity of S100B and Aβ in setting apart severe OP-intoxicated and normal subjects stated the symmetric efficacy of potential markers. It was concluded that the significant changes in the levels of S100B and Aβ were directly proportional to the degree of severity of OP intoxication.
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Affiliation(s)
- Mostafa M Elhady
- Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Sara A Adly
- Poison Control Center, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Husam A Elshebiny
- Poison Control Center, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Said S Moselhy
- Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, Egypt.
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George AV, Sharma A, Rodha MS, Choudhary B, Bohra GK, Rohila AK, Goel AD. Clinico-Epidemiological Profile and Short-Term Outcomes of Patients with Acute Poisoning Presenting to an Emergency of a Tertiary Care Center in Western Rajasthan. Indian J Community Med 2023; 48:734-740. [PMID: 37970173 PMCID: PMC10637612 DOI: 10.4103/ijcm.ijcm_92_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/02/2023] [Indexed: 11/17/2023] Open
Abstract
Background This research aimed to evaluate the clinico-epidemiological profile and short-term outcomes of patients admitted to the emergency department of a tertiary hospital. Materials and Methods This prospective observational cross-sectional study was conducted between January 1, 2021, and June 30, 2022, in the Emergency Department of a tertiary hospital. Patients of either gender of any age attending the emergency department with acute poisoning were included. These cases were analyzed for their epidemiological profiles, poisoning characteristics, and various clinical variables influencing patient outcomes. Results Out of a total of 236 patients, 190 patients (80.5%) were aged more than 18 years. Comorbidities were present in 32 (13.5%) patients, and psychiatric illness was the most common comorbidity. The intention of poisoning was suicidal in 185 patients (78.4%) and accidental in 51 patients (21.6%). Organophosphate was the most common poisoning seen in 55 patients (23.3%), followed by drug ingestion seen in 44 patients (18.6%). Twenty-eight patients (11.8%) were transferred to the intensive care unit. Nineteen patients (8.1%) required mechanical ventilation. There were ten deaths (4.2%) in the study population. Aluminum phosphide poisoning was associated with the highest mortality rate, followed by organophosphate poisoning. Conclusions This study indicates that most poisoning cases involved young people, mainly males. Organophosphorus poisoning was one of the most common poisonings, followed by the ingestion of drugs in this part of the world. Aluminum phosphide had the highest fatality rate.
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Affiliation(s)
- Akhil V. George
- Department of Trauma and Emergency, AIIMS, Jodhpur, Rajasthan, India
| | - Ankur Sharma
- Department of Trauma and Emergency (Anesthesiology and Critical Care), AIIMS, Jodhpur, Rajasthan, India
| | - Mahaveer S. Rodha
- Department of Trauma and Emergency (General Surgery), AIIMS, Jodhpur, Rajasthan, India
| | - Bharat Choudhary
- Department of Trauma and Emergency (Pediatrics), AIIMS, Jodhpur, Rajasthan, India
| | - Gopal K. Bohra
- Department of General Medicine, AIIMS, Jodhpur, Rajasthan, India
| | - Amit K. Rohila
- Department of Trauma and Emergency (General Medicine), AIIMS, Jodhpur, Rajasthan, India
| | - Akhil D. Goel
- Department of Community and Family Medicine, AIIMS, Jodhpur, Rajasthan, India
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Waktola LG, Melese EB, Mesfin N, Altaye KD, Legese GL. Prevalence of unfavorable outcome in acute poisoning and associated factors at the University of Gondar comprehensive specialized hospital, Gondar, Northwest Ethiopia: a hospital-based cross-sectional study. Front Public Health 2023; 11:1160182. [PMID: 37361165 PMCID: PMC10285079 DOI: 10.3389/fpubh.2023.1160182] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/28/2023] [Indexed: 06/28/2023] Open
Abstract
Background Acute poisoning is a medical emergency in which the toxic effects occur almost immediately, usually within hours from the time of exposure, and can result from exposure to excessive doses of any chemical. It is the common cause of emergency admission, which may result in morbidity and mortality. There are a lot of factors that are associated with an increased magnitude of mortality and complication. Therefore, this study was carried out to assess the clinical characteristics of patients, unfavorable outcomes of acute poisoning, and associated factors to improve the quality of care, resource utilization, and decrease mortality. Objective This study aimed to assess the outcome and associated factors among acute poisoning patients at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia (2021). Methods A prospective follow-up study was conducted from January 2021 to September 2021 at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia. Data were collected using a comprehensively organized and pretested interviewer-administered questionnaire. The data were entered using EPI data version 4.6.0 statistical software and then exported to Stata 14 for analysis. The data were analyzed for descriptive statistics. Statistical analysis was performed using bivariate and multivariate logistic regression models to identify factors associated with the unfavorable outcome of acute poisoning. The result is presented in the form of tables, figures, and text using frequencies and summary statistics such as mean, SD, median, IQR, and percentage. Result A total of 233 patients were included in the study. The prevalence of unfavorable poisoning outcomes in acute poisoning was 17.6% (95% CI: 13.2, 23.1). In the multivariate logistic regression analysis, known chronic medical comorbidities [AOR: 3.846 (1.619, 9.574); value of p: 0.014] and hospital stay of less than 48 h [AOR: 6.57 (2.03, 21.273); value of p: 0.002] were found to be independent factors associated with unfavorable outcomes in acute poisoning. Conclusion The magnitude of unfavorable poisoning outcomes was high in patients with acute poisoning. Having known medical comorbid illness and short hospital stay of less than 48 h were found to be associated with unfavorable outcomes.
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Sharifi S, Valiee S. Emergency department nurses’ perceptions of caring for patients with intentional self-poisoning: a qualitative study. EMERGENCY CARE JOURNAL 2023. [DOI: 10.4081/ecj.2023.11220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Nurses have an important role in caring for patients with intentional self-poisoning. This study was attempted to explore the emergency department nurses' perception of caring for patients with intentional self-poisoning. The present qualitative study was performed using phenomenological method. This study was done on 14 emergency department nurses with experience in caring for patients with intentional self-poisoning. Data were collected through semi-structured interviews and transcribed verbatim. Data were analyzed using Colaizzi's method. Following data analysis, two themes and five sub-themes were extracted, which included being reluctant to provide care for patients with intentional self-poisoning (discomfort in providing care, and lack of desire to care for these patients) and comprehensive patient support (providing complete care and emotional support). Given that emergency department nurses are the first medical staff who face with intentional self-poisoning patients and play an important role in the care and treatment of these patients, it is necessary to improve their understanding of caring for these patients. In addition, their comprehensive support for these patients should be strengthened. Psychological support for nurses and training them on how to communicate with intentional self-poisoning patients and their families are also recommended.
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Dhanarisi J, Perera S, Wijerathna T, Gawarammana I, Shihana F, Pathiraja V, Eddleston M, Mohamed F. Relationship Between Alcohol Co-Ingestion and Clinical Outcome in Pesticide Self-Poisoning: A Systematic Review and Meta-Analysis. Alcohol Alcohol 2023; 58:4-12. [PMID: 36172715 DOI: 10.1093/alcalc/agac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 01/12/2023] Open
Abstract
AIM Alcohol is a commonly co-ingested compound during self-poisoning with pesticides. Clinical experiences suggest alcohol co-ingestion (or withdrawal) makes patient management more difficult after self-poisoning and may contribute to poor clinical outcomes. We aimed to systematically review the world literature to explore the relationship between alcohol co-ingestion and outcome in pesticide self-poisoning. METHODS We searched 13 electronic databases and Google scholar, conducted citation searching and a review of reference lists to find studies which investigated the relationship of alcohol with clinical outcome of pesticide self-poisoning in different countries. Thirteen studies, including 11 case series/reports and two cohort studies were considered for inclusion. RESULTS Meta-analysis showed that alcohol co-ingestion in pesticide self-poisoning was associated with increased risk of death [odds ratio (OR) 4.9, 95% confidence interval (CI) 2.9-8.2 P<0.0001] and that alcohol co-ingested group required intubation eight times more often than non-co-ingested group in organophosphorus insecticide self-poisoning (OR 8.0, 95% CI 4.9-13.0 P<0.0001). Cases who co-ingested alcohol were older than non-alcohol group in two studies. One cohort study demonstrated that alcohol co-ingestion was associated with larger pesticide ingestions but did not itself affect the outcome. CONCLUSIONS This systematic review indicates that alcohol co-ingestion may worsen clinical outcome in pesticide self-poisoning.
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Affiliation(s)
- Jeevan Dhanarisi
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sriyani Perera
- Medical Library, University of Peradeniya, Peradeniya, Sri Lanka
| | - Thilini Wijerathna
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Biosystems Technology, Faculty of Technology, General Sir John Kotelawala Defence University, Rathmalana, Sri Lanka
| | - Indika Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Fathima Shihana
- Biomedical informatics and Digital Health, Clinical Pharmacology and Toxicology Research Group, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Centenary Institute of Cancer Medicine & Cell Biology, The University of Sydney, NSW, Australia
| | - Vindya Pathiraja
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Ruhuna, Galle, Sri Lanka
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Pharmacology, Toxicology, & Therapeutics, University/BHF Centre for Cardiovascular Science, and Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Pharmacology, Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,National Poison Centre, Universiti Sains Malaysia, Penang Malaysia.,Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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Trend and epidemiology of suicide attempts by self-poisoning among Egyptians. PLoS One 2022; 17:e0270026. [PMID: 35709176 PMCID: PMC9202942 DOI: 10.1371/journal.pone.0270026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 06/02/2022] [Indexed: 11/19/2022] Open
Abstract
Suicide attempts by self-poisoning have become a critical health problem. This study aimed to investigate the trend, incidence, and the associated risk factors of suicide attempts by self-poisoning. A total of 7398 Egyptian patients were analyzed. The trend of suicide attempts by self-poisoning was analyzed using 6745 patients over four registry years from January 1, 2016, to January 1, 2020. Then, the associated risk factors behind attempted suicide by self-poisoning from January 1, 2019, to January 1, 2020, were assessed using 2523 suicide attempters by self-poisoning, 201 fatalities by self-poisoning, and another 653 survivors of accidental poisoning. Results showed a rising trend of suicide attempts by self-poisoning over the studied years. The incidence of suicide attempts through deliberate self-poisoning represented 26.63/1,000 (CI95%: 25.63–27.86) to the admitted patients and 26.10/100,000 (CI95%: 25.10–27.14) to the regional population. The death rate due to suicide attempts by self-poisoning was 2.08/100,000 (1.90–2.49). The case fatality rate and the proportionate mortality rate for suicide by self-poisoning were 7.38% (CI95%: 6.45–8.42) and 14.11% (CI95%: 12.4–16.0) respectively. Multivariate analysis revealed that attempted suicide by self-poisoning was predicted among patients aged <25 or 25–40 years old (OR = 27.49, CI95%: 15.28–49.64 and OR = 59.42, CI95%: 32.76–107.77 respectively), those of low or moderate socioeconomic status (OR = 35.03, CI95%: 21.32–57.56 and OR = 14.11, CI95%: 10.86–18.43 respectively), students (OR = 2.91, CI95%: 1.57–5.43) and those living in rural residency (OR = 4.12, CI95%: 3.27–5.19). Suicide attempts by self-poisoning exhibited an incremental rise across time which raises a serious concern. Efforts should be directed to overcome the mentioned risk factors triggering suicide attempts by self-poisoning.
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Bandara P, Page A, Senarathna L, Kidger J, Feder G, Gunnell D, Rajapakse T, Knipe D. Domestic violence and self-poisoning in Sri Lanka. Psychol Med 2022; 52:1183-1191. [PMID: 32912344 PMCID: PMC7612699 DOI: 10.1017/s0033291720002986] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is increasing evidence that domestic violence (DV) is an important risk factor for suicidal behaviour. The level of risk and its contribution to the overall burden of suicidal behaviour among men and women has not been quantified in South Asia. We carried out a large case-control study to examine the association between DV and self-poisoning in Sri Lanka. METHODS Cases (N = 291) were patients aged ⩾18 years, admitted to a tertiary hospital in Kandy Sri Lanka for self-poisoning. Sex and age frequency matched controls were recruited from the hospital's outpatient department (N = 490) and local population (N = 450). Exposure to DV was collected through the Humiliation, Afraid, Rape, Kick questionnaire. Multivariable logistic regression models were conducted to estimate the association between DV and self-poisoning, and population attributable fractions were calculated. RESULTS Exposure to at least one type of DV within the previous 12 months was strongly associated with self-poisoning for women [adjusted OR (AOR) 4.08, 95% CI 1.60-4.78] and men (AOR 2.52, 95% CI 1.51-4.21), compared to those reporting no abuse. Among women, the association was strongest for physical violence (AOR 14.07, 95% CI 5.87-33.72), whereas among men, emotional abuse showed the highest risk (AOR 2.75, 95% CI 1.57-4.82). PAF% for exposure to at least one type of DV was 38% (95% CI 32-43) in women and 22% (95% CI 14-29) in men. CONCLUSIONS Multi-sectoral interventions to address DV including enhanced identification in health care settings, community-based strategies, and integration of DV support and psychological services may substantially reduce suicidal behaviour in Sri Lanka.
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Affiliation(s)
- Piumee Bandara
- Translational Health Research Institute, Western Sydney University, New South Wales, Australia
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, New South Wales, Australia
| | - Lalith Senarathna
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gene Feder
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust
| | - Thilini Rajapakse
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Duleeka Knipe
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Prabhakar Abhilash K, Murugan S, S. Rabbi NA, Pradeeptha S, Kumar S, Selvaraj B, Gunasekaran K. Deliberate self-poisoning and harm: A meticulous quest of methods in vogue. J Family Med Prim Care 2022; 11:233-239. [PMID: 35309643 PMCID: PMC8930158 DOI: 10.4103/jfmpc.jfmpc_1184_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/20/2021] [Accepted: 10/06/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Deliberate self-poisoning and harm (DSPH) is an unabating problem with a wide variation in the methods used across the world. Hence, this study was conducted to understand the current spectrum of methods used for DSPH by patients in our geographic locality and catchment area with special emphasis on newer compounds and drugs used. Methods: This retrospective study included patients presenting with DSPH to the emergency department (ED) between January 2017 and December 2018. Results: This study included 1802 patients, with a mean age of 32 ± 12.7 years. Of the patients, 85% were in the young to middle age group (16–45 years). Agrochemicals (n = 604, 33.5%), drugs (n = 498, 27.6%), plant toxins (n = 150, 8.3%) and rodenticides (n = 145, 8%) were the predominantly used compounds. The major emergency resuscitation procedures required in the ED were intubation (n = 321, 18%), vasopressor support (n = 73, 4%) and cardiopulmonary resuscitation (n = 27, 1.4%). A quarter (23.2%) was discharged stable from the ED, whereas a further 56.5% were discharged stable after hospital admission. The in-hospital mortality rate was 3% (n = 47). Multivariate logistic regression analysis showed rodenticides (odds ratio (OR): 22.32; 95% confidence interval (CI): 8.05–61.88; P = 0.005) and plant poisons (OR: 23.92; 95% CI: 8.95–63.94; P = 0.005) to be the independent predictors of mortality. Conclusion: DSPH is prevalent in the highly productive young age group. Agrochemical ingestion and drug overdose are the most common methods used, whereas rodenticide and plant poisoning are associated with significant mortality.
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Nair SJ, Sujatha C, Chettiar K P S, Sasikala K. Toxico-epidemiology of acute poisoning; an exploratory study from a tertiary care hospital in South India along with global comparisons and solutions. J Forensic Leg Med 2021; 83:102247. [PMID: 34454338 DOI: 10.1016/j.jflm.2021.102247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/03/2021] [Accepted: 08/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Poisoning has been and still is a major problem faced throughout the globe. But its patterns are different and changing in different parts of the world due to local influences. This calls for a study to explore the issue in this unique South Indian state. METHODS A cross-sectional exploratory study was conducted to analyse the patterns of poisoning and the socio-demographic characteristics of the patients. Subgroups were compared using Fisher-Freeman-Halton exact test and further analysed by multivariate logistic regression. RESULTS 48% of cases were of pharmaceutical drug poisoning. 27.5% of these cases involved polymedication and Paracetamol (Acetaminophen) turned out to be the single most drug used. Suicide was the most common circumstance. 10% of patients had co-diagnoses of psychiatric disorders. Univariate analysis separately showed that females (p < 0.001), higher educated (p = 0.149), higher socioeconomic strata (p = 0.136) and non-addicts (p = 0.002) were more exposed to drugs whereas males, lower educated, lower socioeconomic strata and addicts are skewed to pesticides for poisoning. Most repeat suicide attempts were with the same poisonous agent. 70% of patients with a diagnosed psychiatric disorder have attempted suicide before using some drugs (p < 0.001). CONCLUSION Our study highlights the importance of a region-wise, targeted approach in policymaking to curb poisoning.
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Affiliation(s)
| | - Chintha Sujatha
- Department of Community Medicine, Government Medical College, Trivandrum, Kerala, India
| | | | - K Sasikala
- Department of Forensic Medicine and Toxicology, Government Medical College, Trivandrum, Kerala, India
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Pushpakumara PHGJ, Dawson AH, Adikari AMP, Thennakoon SUB, Abeysinghe R, Rajapakse TN. Exploration of associations between deliberate self-poisoning and psychiatric disorders in rural Sri Lanka: A case-control study. PLoS One 2021; 16:e0255805. [PMID: 34358271 PMCID: PMC8345854 DOI: 10.1371/journal.pone.0255805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 07/24/2021] [Indexed: 11/22/2022] Open
Abstract
Psychiatric disorders are important predictors of deliberate self-harm. The present study was carried out to determine the associations between DSM-IV TR Axis- I & II disorders and deliberate self-poisoning (DSP) in a rural agricultural district in Sri Lanka. Patients residing in the district who presented with DSP were randomly selected for the study. Both the cases and age, sex, and, residential area, matched controls were assessed for DSM-IV TR Axis- I & II disorders based on the Structured Clinical Interview for DSM-IV-TR Axis I and II Disorders (SCID I & II) conducted by a specialist psychiatrist. Cases consisted of 208 (47.4%) males and 231 (52.6%) females. More than one third (37%) of males and more than half (53.7%) of females were aged below 20 years. DSM-IV TR axis-I and/or II psychiatric diagnoses were diagnosed in 89 (20.3%) of cases and 14 (3.2%) controls. Cases with a DSM-IV TR axis-I diagnosis were older than the cases without psychiatric diagnosis (32 and 19 years), p<0.0001. Having a depressive episode was associated with a 19 times higher risk for DSP. Being a male aged > = 30 years and having an alcohol use disorder carried a 21 times excess risk for DSP. A fivefold excess risk for DSP was found among 10–19 year old females with borderline personality traits. Depressive disorder and alcohol-related disorders were significantly associated with the older participants who presented with DSP. The overall prevalence of psychiatric disorders associated with DSP in rural Sri Lanka was significantly lower compared to the rates reported in the West and other countries in the region. Therefore, health and research priorities to reduce self-harm in Sri Lanka should focus both on psychiatric and non-psychiatric factors associated with DSP.
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Affiliation(s)
- P. H. G. J. Pushpakumara
- Department of Family Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- SACTRC, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- * E-mail:
| | - A. H. Dawson
- SACTRC, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Central Clinical School, University of Sydney, Sydney, Australia
| | - A. M. P. Adikari
- Psychiatry Unit, Teaching Hospital Kurunegala, Kurunegala, Sri Lanka
| | - S. U. B. Thennakoon
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ranil Abeysinghe
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - T. N. Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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13
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Noghrehchi F, Dawson AH, Raubenheimer JE, Buckley NA. Role of age-sex as underlying risk factors for death in acute pesticide self-poisoning: a prospective cohort study. Clin Toxicol (Phila) 2021; 60:184-190. [PMID: 34032543 DOI: 10.1080/15563650.2021.1921186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is growing evidence in the literature that patients' age is associated with increased risk of death in acute pesticide poisoning. However, few studies have investigated whether the age effect differs between males and females. We aimed to examine the association between age-sex and risk of death in acute pesticide self-poisoning. METHODS A prospective cohort of deliberate pesticide-poisoned patients admitted to ten rural Sri Lankan hospitals between March 2002 and December 2019. The pesticide ingested was identified based on identification of container or history. A mixed effects logistic regression was fitted to investigate the effect of age-sex on death in acute pesticide self-poisoning adjusting for clinical symptoms on admission, measured by Glasgow Coma Scale and Poison Severity Score, and controlling for clustering among hospital sites. RESULTS In total, 201 different pesticides were ingested by patients. 6,643 patients ingested an unknown pesticide. A single pesticide was co-ingested with alcohol by 4,603 patients. Of the 28,303 patients enrolled, 2,028 patients died, resulting in case fatality of 7.2% (95% CI 6.9-7.5). The effect of age on case fatality was stronger for males after 21 years of age. The odds of dying for each 5 years increase in age was 1.26 (95% CI 1.23-1.28) times higher for males versus 1.14 (95% CI 1.10-1.19) times higher for females. Missing data were handled by multiple imputation. CONCLUSION Patient's age-sex are important risk factors for death in acute pesticide self-poisoning even after controlling for clinical effects. The age effect on the odds of dying was significantly different for males and females, with this effect being stronger for males. Given that patient's age and sex are very easy to collect on admission, our study highlights the need for incorporating these risk factors in policy and clinical decisions.
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Affiliation(s)
- Firouzeh Noghrehchi
- Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Andrew H Dawson
- Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Central Clinical School, University of Sydney, Sydney, Australia
| | - Jacques E Raubenheimer
- Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Nicholas A Buckley
- Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia
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Kaeley N, Vempalli N, Bhardwaj BB, Samal B. A case of organophosphate poisoning with intermediate syndrome and acute pancreatitis - A rare complication. J Family Med Prim Care 2021; 10:564-566. [PMID: 34017791 PMCID: PMC8132809 DOI: 10.4103/jfmpc.jfmpc_744_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/11/2020] [Accepted: 12/16/2020] [Indexed: 11/17/2022] Open
Abstract
Organophosphate (OP) poisoning is one of the serious occupational hazards worldwide and easily accessible pesticides for suicidal poisoning. It is associated with high mortality and morbidity. OP poisoning is characterized by three main syndromes – cholinergic syndrome, intermediate syndrome and syndrome of delayed polyneuropathy. Other rare complications of OP poisoning are arrhythmias, pancreatitis and hepatic dysfunction. We present 46-year-old male patient with history of OP poisoning, who developed features of intermediate syndrome and pancreatitis. The patient was immediately intubated and managed on mechanical ventilation. Patient was given symptomatic treatment and recovered completely on day 14 of illness.
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Affiliation(s)
- Nidhi Kaeley
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Nagasubramanyam Vempalli
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bharat B Bhardwaj
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Biswaranjan Samal
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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15
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Weerasinghe M, Konradsen F, Eddleston M, Pearson M, Jayamanne S, Knipe D, Hawton K, Gunnell D, Agampodi S. Factors associated with purchasing pesticide from shops for intentional self-poisoning in Sri Lanka. Trop Med Int Health 2021; 25:1198-1204. [PMID: 33463883 DOI: 10.1111/tmi.13469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE In South Asia, up to one in five individuals who ingest pesticides for self-poisoning and survive purchased them from a shop immediately prior to the event. Thus far, no research has taken place to determine whether interventions implemented through the pesticide sellers might be acceptable or effective, despite the hundreds of thousands of such risk purchases each year. We aimed to investigate factors associated with purchasing pesticides for self-poisoning in Sri Lanka. METHODS We used a case-control study. Cases (n = 50) were individuals who ingested pesticides after purchasing them for the act, and controls (n = 200) were customers who bought pesticides but did not use them for self-harm. Logistic regression analysis was used to assess socio-demographic and purchase-specific risk factors. RESULTS Alcohol intoxication (adjusted odds ratios [AOR] 36.5, 95% confidence intervals [CI] 1.7-783.4) and being a non-farmer AOR 13.3, 95% CI 1.8-99.6 were the main distinguishing factors when purchasing pesticides for self-poisoning. The positive predictive values were 93.3% (95% CI 68.0-99.8%) and 88.2% (95% CI 72.5-96.7%), respectively. One and/or other of these factors characterised 72.0% of cases but only 2.5% controls. CONCLUSION While results need to be interpreted cautiously, sales restrictions to prevent alcohol-intoxicated persons and non-farmers purchasing pesticides for self-poisoning may be effective.
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Affiliation(s)
- Manjula Weerasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Flemming Konradsen
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Melissa Pearson
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Shaluka Jayamanne
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Duleeka Knipe
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - David Gunnell
- Population Health Sciences, University of Bristol, Bristol, UK.,National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
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16
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Zhao G, Ronda E, Barrio G, Moen BE, Regidor E. Suicide in Spanish Farmers in Two Geographical Areas with Differing Rates of Pesticide Use. J Agromedicine 2020; 26:278-283. [PMID: 33040710 DOI: 10.1080/1059924x.2020.1834480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study assesses whether farmers' suicides were associated with the pesticide use in Spain. The cohort study followed 9.5 million men aged 20-64 years who were employed in 2001. The mortality among farmers and non-farmers during the period 2001-2011 was estimated in a geographical area with high pesticide use and in an area with low pesticide use. For three major causes of death (suicide, unintentional accidents, and rest of causes of death), we estimated the age-standardized mortality rates with 95% confidence intervals (CI) between farmers and non-farmers in both areas. Farmers in the high pesticide use area showed a lower mortality rate of suicide and unintentional accidents than farmers in the rest of Spain, with mortality rate ratios of 0.74 (95% CI 0.65-0.85) and 0.57 (95% CI 0.52-0.62), respectively. Our findings on pesticide use and farmers' suicide are different from those observed in several previous investigations.
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Affiliation(s)
- Guanlan Zhao
- Preventive Medicine and Public Health Area, Universidad de Alicante, Alicante, Spain
| | - Elena Ronda
- Preventive Medicine and Public Health Area, Universidad de Alicante, Alicante, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Gregorio Barrio
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Enrique Regidor
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSSC), Madrid, Spain
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17
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The Scenario of Acute Poisoning in Jashore, Bangladesh. J Toxicol 2020; 2020:2109673. [PMID: 32508916 PMCID: PMC7254068 DOI: 10.1155/2020/2109673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/30/2020] [Indexed: 11/28/2022] Open
Abstract
Background Acute poisoning is a common scenario in the emergency department of any general hospital globally, but its pattern may vary in different parts of the world and even may be a different regional variation in the same country. Objective Our recent study aims to assess the demographic characteristics, psychological aspect, pattern, and treatment outcome in different acute poisoning. Method The present cross-sectional study was conducted in the medicine department of Jashore Medical College and Hospital from 1st January to 30th June 2018, which recruited 487 eligible cases of admitted acute poisoning patients. Results The study reveals that the total incidence of acute poisoning in Jashore, Bangladesh, is 17.1 per 100,000 populations over a 6-month period. The mean age of our study population was 27 ± 11 (SD) years with having significant female preponderance in acute poisoning (female: 253/52% and male: 234/48%; p = 0.002). Female subjects were significantly younger than male (p <0.001). Moreover, the total suicidal intension of acute poisoning in our study was 97.3%, whereas the female subjects were more committed to suicidal attempts (p = 0.027). Organophosphorus compounds (OPCs) were the significant leading agents (66.1%, p = 0.029) of acute poisoning, and even, it had been significantly used as suicidal intention of poisoning substance (65.1%, p <0.001) in our observation. Muslim (97.5%, p = 0.005), 10–29 year age group (68.0%, p = 0.002), rural (99.2%), unmarried (51.3%), middle class (50.1%), students (48.9%), and secondary educational background population (76.4%) were more victimized of acute poisoning. Among different factors, familial disharmony constituted of 56.1% cases of suicidal attempt in acute poisoning. Finally, we had observed that the death incidence by acute poisoning in Jashore, Bangladesh, was 1.9 per 100,000 population over a 6-month period. Conclusion The recent study reveals that there is high incidence of acute poisoning in Jashore, Bangladesh, with a significant amount of death toll. Organophosphorus compound is the most common agent of deliberating self-poisoning in our study due to its easy availability in our agriculture-based community.
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18
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Weerasinghe M, Pearson M, Konradsen F, Agampodi S, Sumith JA, Jayamanne S, Senanayake SMHMK, Rajapaksha S, Eddleston M. Emerging pesticides responsible for suicide in rural Sri Lanka following the 2008-2014 pesticide bans. BMC Public Health 2020; 20:780. [PMID: 32450831 PMCID: PMC7249439 DOI: 10.1186/s12889-020-08871-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 05/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Sri Lanka has reduced its overall suicide rate by 70% over the last two decades through means restriction, through a series of government regulations and bans removing highly hazardous pesticides from agriculture. We aimed to identify the key pesticide(s) now responsible for suicides in rural Sri Lanka to provide data for further pesticide regulation. Methods We performed a secondary analysis of data collected prospectively during a cluster randomized controlled trial in the Anuradhapura district of Sri Lanka from 2011 to 16. The identity of pesticides responsible for suicides were sought from medical or judicial medical notes, coroners’ records, and the person’s family. Trend analysis was done using a regression analysis with curve estimation to identify relative importance of key pesticides. Results We identified 337 suicidal deaths. Among them, the majority 193 (57.3%) were due to ingestion of pesticides while 82 (24.3%) were due to hanging. A specific pesticide was identified in 105 (54.4%) of the pesticide suicides. Ingestion of carbosulfan or profenofos was responsible for 59 (56.2%) of the suicides with a known pesticide and 17.5% of all suicides. The increasing trend of suicides due to carbosulfan and profenofos over time was statistically significant (R square 0.846, F 16.541, p 0.027). Conclusion Ingestion of pesticides remains the most important means of suicides in rural Sri Lanka. The pesticides that were once responsible for most pesticide suicides have now been replaced by carbosulfan and profenofos. Their regulation and replacement in agriculture with less hazardous pesticides will further reduce the incidence of both pesticide and overall suicides in rural Sri Lanka.
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Affiliation(s)
- Manjula Weerasinghe
- Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Melissa Pearson
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Flemming Konradsen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - J A Sumith
- Office of the Registrar of Pesticides, Getambe, Peradeniya, Sri Lanka
| | - Shaluka Jayamanne
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | | | - Sandamali Rajapaksha
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. .,Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
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Patterns, Associated Factors, and Clinical Outcomes of Poisoning among Poisoning Cases Presented to Selected Hospitals in Western Ethiopia: Hospital-Based Study. Emerg Med Int 2020; 2020:5741692. [PMID: 32455021 PMCID: PMC7225863 DOI: 10.1155/2020/5741692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/26/2020] [Accepted: 03/31/2020] [Indexed: 11/18/2022] Open
Abstract
Results The broad types of poisoning were identified in about 193 (91.47%) cases of poisoning in this study. Pesticides exposure and food poisoning have, respectively, contributed for 32.70% and 20.91% of the poisoning incidence. On the other hand, chemical from industry has contributed the least percentage (2.81%). Out of a total of 24 agents identified, 26.80% of the agents were organophosphates followed by raw meat (18.40%). Difference in the incidence of poisoning was also observed as seasons in a year change. Among the victims who have taken household materials as a poisoning agent, about 47.87% of them have taken the agents during daytime. The remaining cases of poisoning developed by household chemicals occurred at night. More than half (54.98%) of the poisoned patients have encountered the incidents inside their home. Regarding the final poisoning outcome, about 7.10% poisoning cases in this study died of the poisonings. Factors such as place, time, intention, and source of poisoning were observed to determine poisoning outcomes. Although poisoning attempt was lesser among urban residents as compared to rural community, rural dwellers were four times more likely to die of poisoning they had attempted (AOR: 4.072 (1.197–13.85)). Conclusion This study has clearly showed that the incidence of poisoning was varied with seasonal variations. The encountered poisonings ended up with mixed clinical outcomes, which were also affected by patients' demographic and clinical characteristics. Fertilizers, unclean food items, household materials, and drugs have caused majority of the poisonings. Creating community awareness and designing sound prevention strategies are recommended to reduce morbidity and mortality related to poisoning.
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Knipe DW, Bandara P, Senarathna L, Kidger J, López-López J, Rajapakse T. Childhood adversity and deliberate self-poisoning in Sri Lanka: a protocol for a hospital-based case-control study. BMJ Open 2019; 9:e027766. [PMID: 31427319 PMCID: PMC6701561 DOI: 10.1136/bmjopen-2018-027766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Childhood adversity (CA) has been suggested as a key risk factor for suicidal behaviour, but evidence from low/middle-income countries is lacking. In Sri Lanka, CA, in the form of child maltreatment or as a consequence of maternal separation, has been highlighted in primarily qualitative or case series work, as a potentially important determinant of suicidal behaviour. To date, there have been no quantitative studies to investigate CA as a key exposure associated with suicidal behaviour in Sri Lanka. The aim of the research is to understand the association between CA and suicidal behaviour in Sri Lanka and to identify potentially modifiable factors to reduce any observed increased risk of suicidal behaviour associated with CA. METHODS AND ANALYSIS This is a hospital-based case-control study. Cases (n=200) will be drawn from individuals admitted to the medical toxicology ward of the Teaching Hospital Peradeniya, Sri Lanka, for medical management of intentional self-poisoning. Sex and age frequency-matched controls (n=200) will be recruited from either patients or accompanying visitors presenting at the outpatient department and clinic of the same hospital for conditions unrelated to the outcome of interest. Conditional logistic regression will be used to investigate the association between CA and deliberate self-poisoning and whether the association is altered by other key factors including socioeconomic status, psychiatric morbidity, current experiences of domestic violence and social support. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Ethical Review Committee of the Faculty of Medicine, University of Peradeniya, Sri Lanka. Researchers have been trained in administering the questionnaire and a participant safety and distress protocol has been designed to guide researchers in ensuring participant safety and how to deal with a distressed participant. Results will be disseminated in local policy fora and peer-reviewed articles, local media, and national and international conferences.
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Affiliation(s)
- Duleeka W Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Piumee Bandara
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Lalith Senarathna
- Department of Health Promotion, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - José López-López
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Thilini Rajapakse
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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21
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Titidezh V, Arefi M, Taghaddosinejad F, Behnoush B, Akbar Pour S, Mahboobi M. Epidemiologic profile of deaths due to drug and chemical poisoning in patients referred to Baharloo Hospital of Tehran, 2011 to 2014. J Forensic Leg Med 2019; 64:31-33. [PMID: 30927562 DOI: 10.1016/j.jflm.2019.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/15/2018] [Accepted: 02/15/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND In developing countries with high mortality rates, poisoning is one of the most common causes of admission to emergency rooms. To minimize future deaths related to poisoning, the epidemiological profile of deceased individuals is essential. METHODS The medical records of all dead patients due to poisoning during 2011-2014 in Baharloo Hospital, Tehran, were evaluated. Exclusion criteria include: incomplete records, unknown causes of death, and persons less than 6 years of age. Data analysis was done by means of SPSS at the significance level of P < 0.05. RESULTS The study included 184 males and 65 females. The mean age range was 37.65 ± 16.78 years. The highest mortality rate was seen in the age range of 21-30 years (30.5%). The most common cause of poisoning was aluminum phosphide (101 cases). The average time of hospitalization was 3.61 days. Most deaths occurred during the first 10 days of admission with intentional poisoning being the most common type (81.5%). CONCLUSION The outcome of this study indicates that the main cause of death among young people is intentional poisoning with AIP. This study proves that a greater focus when diagnosing mental health patients, as well as an increase in restrictions when accessing lethal drugs and toxins, is crucial.
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Affiliation(s)
- Vahid Titidezh
- Department of Forensic Medicine and Toxicology, Baharloo Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Arefi
- Baharloo Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Behnam Behnoush
- Baharloo Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Samaneh Akbar Pour
- Occupational Sleep Research Center (OSRC), Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Marzieh Mahboobi
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.
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22
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Rathish D, Jayasumana C, Agampodi S. Comparison of biochemical parameters among DPP4 inhibitor users and other oral hypoglycaemic drug users: a cross-sectional study from Anuradhapura, Sri Lanka. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2019; 38:3. [PMID: 30674350 PMCID: PMC6343272 DOI: 10.1186/s41043-019-0160-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Higher efficacy of incretin-based therapies for type 2 diabetes mellitus has been reported from Asia. Pancreatitis and hepatitis have also been suspected to occur due to dipeptidyl peptidase-4 inhibitor (DPP4I) treatment. The present study aims at comparing selected biochemical parameters among DPP4 inhibitor users and other oral hypoglycaemic drug users. METHODS Patients were recruited from the State Pharmaceutical Corporation, Anuradhapura, Sri Lanka, for a comparative cross-sectional study. Two groups were involved: "DPP4I" user group (n = 63) and "other oral hypoglycaemic" user group (n = 126). Mann-Whitney U test was performed to find a significant difference (p < 0.05) in the distributions of HbA1C, pancreatic amylase, serum lipase, AST and ALT levels between the two groups. RESULTS Contradicting to previous Asian studies, distribution of HbA1C (p = 0.569) between anti-diabetic regimes with and without DPP4 inhibitors showed no significant difference. Also, amylase (p = 0.171), AST (p = 0.238) and ALT (p = 0.347) failed to show significance. However, lipase was significantly (p = 0.012) high in the DPP4I group. CONCLUSION The study showed a significantly higher lipase level among the DPP4I users in comparison to other oral hypoglycaemic drug users, and possible reasons were discussed.
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Affiliation(s)
- Devarajan Rathish
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Channa Jayasumana
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
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Rathish D, Senavirathna I, Jayasumana C, Agampodi S, Siribaddana S. A low GLP-1 response among patients treated for acute organophosphate and carbamate poisoning: a comparative cross-sectional study from an agrarian region of Sri Lanka. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:2864-2872. [PMID: 30499084 DOI: 10.1007/s11356-018-3818-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 11/21/2018] [Indexed: 06/09/2023]
Abstract
Higher incidence of diabetes along with increased use of pesticides is seen in Southeast Asia. Recent hypothesis postulated a link between acetylcholinesterase inhibitor insecticides and type 2 diabetes through the GLP-1 pathway. This study compares the GLP-1 response between groups with low and high red blood cell acetylcholinesterase (RBC-AChE) activity. A comparative cross-sectional study was conducted amongst patients who were within 3 months after an acute organophosphate or carbamate poisoning (acute group) and amongst vegetable farmers with low (chronic group) and high (control group) RBC-AChE activity. Acute (366 mU/μM Hb) and chronic (361 mU/μM Hb) groups had significantly lower RBC-AChE activity in comparison to the control (471 mU/μM Hb) group (P < 0.0001). Only the acute group, which has had atropine therapy, showed a significantly lower 120 min value in comparison to the control group (P = 0.0028). Also, the acute group had significantly low late (P = 0.0287) and total (P = 0.0358) responses of GLP-1 in comparison to the control group. The findings of the study allude towards attenuation of GLP-1 response amongst patients after acute organophosphate and carbamate poisoning. The possibility of an atropine-mediated attenuation of GLP-1 response was discussed.
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Affiliation(s)
- Devarajan Rathish
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
| | - Indika Senavirathna
- Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Channa Jayasumana
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
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Prasadi GAM, Mohamed F, Senarathna L, Cairns R, Pushpakumara PHGJ, Dawson AH. Paediatric poisoning in rural Sri Lanka: an epidemiological study. BMC Public Health 2018; 18:1349. [PMID: 30522467 PMCID: PMC6282383 DOI: 10.1186/s12889-018-6259-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 11/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute paediatric poisoning is a common public health concern for both developed and developing countries. The type of agent and underlying cause differ depending on the social, cultural, economic and educational background. The objectives of this study were to identify the incidence and pattern of paediatric poisoning in a rural district in Sri Lanka and establish whether tertiary referral hospital data are a useful surrogate for estimating district level epidemiology of paediatric poisoning. METHODS A subset of epidemiological data were obtained from March 2011 to February 2013 from a randomized controlled trial (SLCTR/2010/008) conducted in 45 hospitals in Kurunegala district. RESULTS The age adjusted annual incidence of all cause of acute poisoning in children aged 1 to 12 years in the study area was 60.4 per 100,000. The incidence of poisoning of younger age group (1 to 6 years; 76 per 100,000) was significantly higher than older age group (7 to 12 years; 41 per 100,000) (p = 0.0001) in Kurunegala district. The annual incidence rate of paediatric admissions due to deliberate self-poisoning is 18 per 100,000 population. This study also established that admission data from primary hospitals provided the most accurate epidemiological information on paediatric poisoning. CONCLUSIONS In rural districts of Sri Lanka, acute paediatric poisoning cases were less frequent and less severe compared to adult poisoning cases (426-446 per 100,000 population). The incidence of poisoning was significantly higher among young children with compared to old children. In this study, deliberate self-poisoning among older children was more frequently seen than in other comparable countries. Because most of the admissions are directed to and managed by primary hospitals, data from referral hospitals alone cannot be used to represent the true incidence of acute poisoning within a district. The data set from all the primary hospitals (n = 44) yielded more accurate poisoning incidence amongst a paediatric population.
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Affiliation(s)
| | - Fahim Mohamed
- SACTRC, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka.,TACT, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Lalith Senarathna
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rose Cairns
- Discipline of Pharmacology, Sydney Medical School, The University of Sydney, Sydney, Australia.,New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
| | | | - Andrew Hamilton Dawson
- SACTRC, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Central Clinical School, University of Sydney, Sydney, Australia
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Sert A, Tarıkçı Kılıç E, Akdemir M, Kavak G. Retrospective Analysis of Organophosphate Poisonings in an Intensive Care Unit in Turkey: A Single-Center Study. DUBAI MEDICAL JOURNAL 2018. [DOI: 10.1159/000493768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Beltagy DM, Sadek KM, Hafez AS. Serum β-glucuronidase activity as a biomarker for acute cholinesterase inhibitor pesticide poisoning. Toxicol Ind Health 2018; 34:891-897. [PMID: 30352546 DOI: 10.1177/0748233718802068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
β-glucuronidase (BG) activity is a promising biomarker for diagnosis and prognosis after exposure to organophosphorous (OP) pesticides. The aim of this study was to evaluate the changes in serum BG activity in patients with acute OP poisoning and to determine whether these changes correlate with the severity of poisoning. Thirty patients with anticholinesterase pesticide poisoning were included, besides 10 healthy volunteers as a control group. Serum activities of butyrylcholinesterase (BuChE) and BG were measured for each subject on admission, then after 12 and 24 h. Serum levels of BuChE and BG in poisoned patients were significantly different from the control subjects; these differences persisted in repeated measurements. Moreover, the serum levels showed significant differences within each group of the three time points. A significant negative correlation was found between the serum activities of BuChE and BG in all groups at the three time points. In conclusion, serum BG activity seems a reliable marker for OP poisoning even when measured at 24 h after poisoning.
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Affiliation(s)
- Doha M Beltagy
- Biochemistry division, Department of Chemistry, Faculty of Science, Damanhour University, Damanhour, Egypt
| | - Kadry M Sadek
- Department of Biochemistry, Faculty of Veterinary Medicine, Damanhur University, Damanhour, Egypt
| | - Amal S Hafez
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Rathish D, Agampodi S, Jayasumana C. Acetylcholinesterase inhibitor insecticides related acute poisoning, availability and sales: trends during the post-insecticide-ban period of Anuradhapura, Sri Lanka. Environ Health Prev Med 2018; 23:27. [PMID: 29945568 PMCID: PMC6020334 DOI: 10.1186/s12199-018-0716-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/01/2018] [Indexed: 11/30/2022] Open
Abstract
Background Acetylcholinesterase inhibitor insecticides (AChEIIs) were used extensively in the agrarian region of Anuradhapura for the past few decades. As a result, the region faced a heightened risk of toxicity. Carbaryl, carbofuran, chlorpyrifos, dimethoate, and fenthion were the five hazardous AChEIIs banned from Anuradhapura in 2014. Assessment of post-ban trends in acute poisoning will reveal the impact of the ban. Data on availability and sales of remaining AChEIIs will guide towards preventive measures against related toxicities. Methods Cross-sectional surveys were conducted at Anuradhapura district of Sri Lanka. Details related to acute AChEII poisoning were sorted from the Teaching Hospital Anuradhapura. Main insecticide vendors in Anuradhapura were surveyed to find information on availability and sales of AChEIIs. Chi-square for goodness of fit was performed for trends in acute poisoning and sales. Results Hospital admissions related to acute AChEII poisoning have declined from 554 in 2013 to 272 in 2017. Deaths related to acute AChEII poisoning have declined from 27 in 2013 to 13 in 2017. Sales of all five banned AChEIIs had reduced by 100%. Sales of the remaining AChEIIs were declining, except for acephate, phenthoate, and profenofos. However, one of the top selling, most frequently abused carbosulfan, had the highest risk of toxicity. Chi-square for goodness of fit showed a significance (P < 0.001) between the trends of hospital admissions for acute AChEII poisoning and the sales related to AChEIIs. Conclusions Hospital admissions related to acute poisoning was declining along with the overall sales of remaining AChEIIs, during the post-AChEII ban period. Nevertheless, future vigilance is needed on the remaining AChEIIs to predict and prevent related toxicities. Electronic supplementary material The online version of this article (10.1186/s12199-018-0716-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Devarajan Rathish
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Channa Jayasumana
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
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Rathish D, Senavirathna I, Jayasumana C, Agampodi S. Red blood cell acetylcholinesterase activity among healthy dwellers of an agrarian region in Sri Lanka: a descriptive cross-sectional study. Environ Health Prev Med 2018; 23:25. [PMID: 29929492 PMCID: PMC6013882 DOI: 10.1186/s12199-018-0717-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assessment of acetylcholinesterase-inhibitor insecticide (AChEII) toxicity depends on the measurement of red blood cell acetylcholinesterase (RBC-AChE) activity. Its interpretation requires baseline values which is lacking in scientific literature. We aim to find the measures of central tendency and variation for RBC-AChE activity among dwellers of Anuradhapura, where the use and abuse of AChEIIs were rampant for the last few decades. METHODS A descriptive cross-sectional study with a community-based sampling for 100 healthy non-farmers (male:female = 1:1) was done using pre-determined selection criteria. Duplicate measurements of RBC-AChE activity were performed according to the modified Ellman procedure. Pearson's correlation and regression analysis were sort for RBC-AChE activity against its possible determinants. RESULTS RBC-AChE activity had a mean of 449.8 (SD 74.2) mU/μM Hb with a statistical power of 0.847. It was similar to values of "healthy controls" from previous Sri Lankan toxicological studies but was low against international reference value [586.1 (SD 65.1) mU/μM Hb]. None of the possible determinants showed a significant strength of relationship with RBC-AChE activity. CONCLUSION The baseline RBC-AChE activity among people of Anuradhapura is low in comparison with international reference values. This arises a need to find a causative mechanism.
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Affiliation(s)
- Devarajan Rathish
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
| | - Indika Senavirathna
- Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Channa Jayasumana
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
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Almeida TSOD, Fook SML, Mariz SR, Camêlo ELS, Gomes LCF. Suicide attempts: epidemiologic trends towards geoprocessing. CIENCIA & SAUDE COLETIVA 2018; 23:1183-1192. [PMID: 29694592 DOI: 10.1590/1413-81232018234.12452016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 06/24/2016] [Indexed: 11/21/2022] Open
Abstract
In order to study data about suicide attempts and do the mapping of occurrence areas, it was developed an ecologic and exploring study, making use of techniques of geoprocessing, based on confirmed cases of suicide attempts. Cases of self-poisoning were included in the urban area of Campina Grande county, in the period of 2010-2013. A total of 446 suicide attempts were geo-referred, pointing up an incidence of 120 cases out of each 100,000 inhabitants. The sample was mostly feminine (66.4%), and 62.3% being up to 30 years old. Kernel's map remarked hot spot areas. Compared to surrounding areas the suicide risk of populations within the hot spots was increased (38%; Relative Risk = 1.38; p= 0.0029), with an average estimative of 165 suicide attempts out of 100,000 inhabitants. Through identification of hot spots and index of living conditions of the neighborhoods, it is possible to set priorities in terms of public policies for the prevention of suicide attempts and control of the marketing of substances that are potentially toxic.
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Affiliation(s)
| | | | - Saulo Rios Mariz
- Universidade Federal de Campina Grande, Campina Grande, PB, Brasil
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30
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Yimaer A, Chen G, Zhang M, Zhou L, Fang X, Jiang W. Childhood pesticide poisoning in Zhejiang, China: a retrospective analysis from 2006 to 2015. BMC Public Health 2017; 17:602. [PMID: 28659131 PMCID: PMC5490151 DOI: 10.1186/s12889-017-4505-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/14/2017] [Indexed: 02/08/2023] Open
Abstract
Background Pesticide poisoning in children has been a serious public health issue around the world, especially in the developing countries where agriculture is still one of the largest economic sectors. The purpose of this study was to analyze epidemiological characteristics of acute pesticide poisoning in children from Zhejiang province, China. Methods The pesticide poisoning cases for children were retrieved from Occupational Disease Surveillance and Reporting System, Zhejiang Provincial Center for Disease Control and Prevention, China. The incident cases, deaths, and fatality rate of child pesticide poisoning from 2006 through 2015 were calculated. Results During the study period, totally 2952 children were poisoned by pesticides, with 66 deaths, resulting in a fatality rate of 2.24%. Among them, there were 1607 male cases with 28 deaths, and 1345 female cases with 38 deaths. Most of the cases occurred in preschool children (1349) and adolescent age group (1269). Organophosphate and carbamate insecticides were the cause of most poisonings (1130), leading to 34 deaths. The highest fatality rate (3.13%) was due to poisoning by herbicides and fungicides, causing 14 deaths out of 448 cases. Poisoning occurred mostly in rural areas (78%). And most pesticide poisoning occurred in the summer (896) and fall (811), while fewest poisoning cases in the winter (483) but with the highest fatality rate (3.52%). Conclusions This study shows that pesticide poisoning of children is a major health problem in Zhejiang, suggesting preventive strategies should be conducted to control childhood pesticide poisoning.
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Affiliation(s)
- Aziguli Yimaer
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Guangdi Chen
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Meibian Zhang
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Lifang Zhou
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Xinglin Fang
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China.
| | - Wei Jiang
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, 310058, China.
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Adinew GM, Woredekal AT, DeVos EL, Birru EM, Abdulwahib MB. Poisoning cases and their management in emergency centres of government hospitals in northwest Ethiopia. Afr J Emerg Med 2017; 7:74-78. [PMID: 30456112 PMCID: PMC6234172 DOI: 10.1016/j.afjem.2017.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction With the widespread availability of a vast number of chemicals and drugs, acute poisoning is a common medical emergency worldwide. In spite of the success of interventions to prevent toxic ingestions, acute poisoning continues to be an important public health problem. Because of weak regulations and limited health care services in developing countries, adverse outcomes from poisoning are more prevalent than in the developed world. Due to the limited Ethiopian literature on this topic, the primary objective of this study was to evaluate and report poisoning cases, their management and outcome in northwest Ethiopia. Methods This is a retrospective study of all poisoning cases admitted and managed in the emergency centres of Gondar Teaching Referral Hospital and Metema and Debark district hospitals, from September 2010 to December 2014. Data was collected through retrospective chart review of patients who were admitted due to poisoning. Results There were 543 registered poisoning cases listed in the registry during the study period, of which 344 cases (63.4%) had complete data and were included in the final analysis. There were 48,619 emergency centre visits during the study period, with poisoning cases accounting for 1.1%. Females (60%) were predominant among intentional as well as unintentional poisoning cases. Patients between 15 and 24 years of age accounted for 55% of the cases. Patients poisoned with organophosphate and bleaching agents accounted for 35% and 25%, respectively. Among the poisoning patients, 74% were treated with decontamination, while those exposed to organophosphate were treated with atropine 45.5% (55/121) of the time. Discussion Young females comprise a group at increased risk for suicidal poisonings. As a developing nation, pesticide and bleaching agents remain a significant cause of acute poisonings in Ethiopia. Intentional poisoning remains the most significant identified cause of poisoning overall.
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Rathish D, Premarathna I, Jayathilake T, Kandegedara C, Punchihewa K, Ananda L, Bandara T, Jayasumana C, Siribaddana S. Availability of essential medicines in selected public, primary and secondary health care institutions of a rural Sri Lankan district: a spot survey. BMC Health Serv Res 2017; 17:11. [PMID: 28056960 PMCID: PMC5216524 DOI: 10.1186/s12913-016-1969-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/22/2016] [Indexed: 12/01/2022] Open
Abstract
Background Assessment of the availability of essential medicines, in rural areas of countries with free state health care system, is scarce. Dependence on essential medicines among the population in rural sector is considered to be high. Assessing the availability of essential medicines in selected state owned primary and secondary health care institutions of a rural district will help to identify areas where improvement is needed. Methods A descriptive cross sectional study, covering selected five primary and one secondary care institutions of a rural Sri Lankan district, was conducted. The national list of essential medicines, Sri Lanka was used as the check list and the guidelines of the WHO–Health Action International were adapted. Results The secondary care institution recorded an overall availability of 71%, whereas the average overall availability of the primary care institutions was 56%. Central dispensaries recorded the lowest availability. Lack of availability of medicines needed for the management of chronic kidney disease, snake bite and poisoning was noted. Conclusions Availability of essential medicines in most of the primary and the secondary care institutions were fairly high. Deficiency in medicines needed for the management of emergencies was noted. A need based annual estimate of medicines based on an essential medicine list is suggested. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1969-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Devarajan Rathish
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
| | - Indika Premarathna
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Thiwanka Jayathilake
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Chathurika Kandegedara
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Kalani Punchihewa
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Lakmali Ananda
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Thejani Bandara
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Channa Jayasumana
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
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Masson P. Novel approaches in prophylaxis/pretreatment and treatment of organophosphorus poisoning. PHOSPHORUS SULFUR 2016. [DOI: 10.1080/10426507.2016.1211652] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Patrick Masson
- Neuropharmacology Laboratory, Kazan Federal University, Kazan, Russian Federation
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From organophosphate poisoning to diabetes mellitus: The incretin effect. Med Hypotheses 2016; 91:53-55. [DOI: 10.1016/j.mehy.2016.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/02/2016] [Indexed: 12/16/2022]
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Weerasinghe M, Konradsen F, Eddleston M, Pearson M, Agampodi T, Storm F, Agampodi S. Overdose of oral contraceptive pills as a means of intentional self-poisoning amongst young women in Sri Lanka: considerations for family planning. THE JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2016; 43:147-150. [PMID: 27006385 DOI: 10.1136/jfprhc-2015-101171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/02/2016] [Accepted: 02/25/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Oral contraceptive pills (OCPs) are one of the most popular family planning methods in Sri Lanka. As part of two hospital-based studies on self-harm, the use of OCPs was identified, from yet unpublished results, as a means of intentional self-poisoning. To inform future guidelines for better OCP promotion, this article aims to describe the extent, patient characteristics and outcomes of OCP self-poisoning in the North Central Province of Sri Lanka. METHODS A secondary analysis was carried out on two hospital-based self-harm case series, from January 2011 to June 2014. RESULTS Fifty-four patients (52 women and two men) with an overdose of OCP as a means of intentional self-poisoning were admitted to one of the surveyed hospitals. The median age of the patients was 19 (interquartile range, 5) years. None of the patients were severely sick from their overdose and two-thirds of the patients were discharged within a day of admission. Intentional self-poisoning with OCPs represented less than 5% of all types of intentional medicine self-poisonings recorded at the hospitals. Information available for a subset of female patients indicates that many cases (13/23, 56.5%) were in their first year of marriage. CONCLUSIONS More research is required to understand why young women in rural Sri Lanka overdose with OCPs as a means of intentional self-poisoning. Although the toxicity of OCPs is low and the public health significance of OCP poisoning remains minor, reproductive health service providers should be attentive to OCP overdose, monitor the development of this problem, and ensure appropriate information to OCP users.
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Affiliation(s)
- Manjula Weerasinghe
- PhD Fellow and Research Co-ordinator, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka and South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Flemming Konradsen
- Professor, Head of section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Michael Eddleston
- Professor of Clinical Toxicology and Lister Prize Fellow and Director of the National Poison Information Service South Asian Clinical Toxicology Research Collaboration (SACTRC), Pharmacology, Toxicology and Therapeutics, University of Edinburgh, UK, South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka and Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Melissa Pearson
- Dr, Trial Manager, South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka and Department of Pharmacology, Toxicology and Therapeutics, University of Edinburgh, Edinburgh, UK
| | - Thilini Agampodi
- Dr, Senior Lecturer, Head of the Department, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
| | - Frederikke Storm
- Research Assistant, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Suneth Agampodi
- Professor in Community Medicine, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
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Cha ES, Chang SS, Gunnell D, Eddleston M, Khang YH, Lee WJ. Impact of paraquat regulation on suicide in South Korea. Int J Epidemiol 2015; 45:470-9. [PMID: 26582846 DOI: 10.1093/ije/dyv304] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ingestion of pesticides (mainly paraquat) accounted for one-fifth of suicides in South Korea in 2006-10. We investigated the effect on suicide mortality of regulatory action, culminating in a ban on paraquat in South Korea in 2011-12. METHODS We calculated age-standardized method-specific suicide mortality rates among people aged ≥15 in South Korea (1983-2013) using registered death data. Negative binomial regression was used to estimate changes in the rate and number of pesticide suicides in 2013, compared with those expected based on previous trends (2003-11). RESULTS Pesticide suicide mortality halved from 5.26 to 2.67 per 100 000 population between 2011 and 2013. Compared with the number expected based on previous trends, the regulations were followed by an estimated 847 [95% confidence interval (CI) -1180 to -533] fewer pesticide suicides, a 37% reduction in rates (rate ratio = 0.63, 95% CI 0.55 to 0.73) in 2013. The decline in pesticide suicides after the regulations was seen in all age/sex/geographical groups. The absolute reduction in the number of suicides was greatest among men, the elderly and in rural areas. The reduction in pesticide suicides contributed to 56% of the decline in overall suicides that occurred between 2011 and 2013. There was no impact of the regulations on crop yield. CONCLUSIONS The regulation of paraquat in South Korea in 2011-12 was associated with a reduction in pesticide suicide. Further legislative interventions to prevent the easy availability of highly lethal suicide methods are recommended for reducing the number of suicides worldwide.
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Affiliation(s)
- Eun Shil Cha
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, and Department of Public Health, National Taiwan University, Taipei, Taiwan
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK, South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK and
| | - Young-Ho Khang
- Department of Health Policy and Management, Seoul National University College of Medicine, and Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea,
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Pattern of drug overdose and chemical poisoning among patients attending an emergency department, western Saudi Arabia. J Community Health 2015; 40:57-61. [PMID: 24927975 DOI: 10.1007/s10900-014-9895-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Poisoning is a medical emergency that represent a major health problem all over the world. Studies on drug overdose and chemical poisoning are very limited in Saudi Arabia (SA). We aimed to describe the current pattern and assess risk factors of drug overdose and chemical poisoning in King Khalid National Guard hospital, Jeddah, SA. Medical records of patients attended emergency department in King Khalid National Guard hospital during the period from January 2008 to December 2012 due to drug overdose and chemical poisoning were reviewed. A total of 129 cases were included in the study. The majority of the population was Saudi (97.7 %), and almost half of them were females (54.3 %). Children under 12 years were the most affected age group (44.2 %). Drug overdose was the most common cause of poisoning (92.2 %). Analgesics and non-steroidal anti-inflammatory drugs represented the highest percentage of used medications (20.4 %). The most commonly reported symptoms were symptoms of the central nervous system (57.4 %) followed by GIT symptoms (41.9 %). Intentional poisoning was reported in 34 cases (26.4 %). Female patients were significantly more likely to attempt suicide than male patients (OR = 7.22, 95 % CI = 1.70, 30.62). Children continue to be at high risk for medication and chemical poisoning. Accessibility to medications at homes encountered for most of poisoning cases among children. Implementing methods to raise public awareness and minimize children access to medications would significantly contribute to reducing burden of this problem on the community.
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Weerasinghe M, Konradsen F, Eddleston M, Pearson M, Gunnell D, Hawton K, Jayamanne S, Pabasara C, Jayathilaka T, Dissanayaka K, Rajapaksha S, Thilakarathna P, Agampodi S. Risk factors associated with purchasing pesticide from shops for self-poisoning: a protocol for a population-based case-control study. BMJ Open 2015; 5:e007822. [PMID: 25995242 PMCID: PMC4442210 DOI: 10.1136/bmjopen-2015-007822] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Pesticide self-poisoning is one of the most frequently used methods of suicide worldwide, killing over 300,000 people annually. Around 15-20% of pesticide self-poisonings occur soon after the person has bought the pesticide from a shop. We aim to determine the characteristics of individuals who purchase pesticides directly from shops and how they differ from individuals who access pesticides from other sources such as home, home garden or farmland. This information will help inform possible vendor/shop-based intervention strategies aimed at reducing access to pesticides used for self-harm. METHODS AND ANALYSIS This study will investigate risk factors associated with purchasing pesticides for acts of self-poisoning from pesticide shops, including cases identified over a 9-month period using a population-based case-control group approach. Four interviewer-administered data collection tools will be used for this study: a semistructured questionnaire, Beck Suicidal Intent Scale (SIS), Clinical Interview Schedule-Sinhalese version (CIS-Sn) and Alcohol Use Disorders Identification Test (AUDIT). Each case (expected n=33) will be compared with two groups of individuals: (1) those who have self-poisoned using pesticides from the home, home garden or farmland and (2) those who bought pesticides from the same shops as the above cases, but not did not self-poison. Logistic regression models will be used to identify risk factors of purchasing pesticides for self-poisoning from shops. ETHICS AND DISSEMINATION The study has received ethical approval from the Ethical Review Committee of the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka. A sensitive data collection technique will be used and ethical issues will be considered throughout the study. Results will be disseminated in scientific peer-reviewed articles.
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Affiliation(s)
- Manjula Weerasinghe
- Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Flemming Konradsen
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Department of Public Health, Faculty of Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Eddleston
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Department of Public Health, Faculty of Sciences, University of Copenhagen, Copenhagen, Denmark
- Pharmacology, Toxicology and Therapeutics, University of Edinburgh, Edinburgh, UK
| | - Melissa Pearson
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Pharmacology, Toxicology and Therapeutics, University of Edinburgh, Edinburgh, UK
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Keith Hawton
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Oxford, UK
| | - Shaluka Jayamanne
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Chathurani Pabasara
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Tharidu Jayathilaka
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Kalpani Dissanayaka
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Sandamali Rajapaksha
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Prasanna Thilakarathna
- Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
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Peter JV, Sudarsan TI, Moran JL. Clinical features of organophosphate poisoning: A review of different classification systems and approaches. Indian J Crit Care Med 2014; 18:735-45. [PMID: 25425841 PMCID: PMC4238091 DOI: 10.4103/0972-5229.144017] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The typical toxidrome in organophosphate (OP) poisoning comprises of the Salivation, Lacrimation, Urination, Defecation, Gastric cramps, Emesis (SLUDGE) symptoms. However, several other manifestations are described. We review the spectrum of symptoms and signs in OP poisoning as well as the different approaches to clinical features in these patients. MATERIALS AND METHODS Articles were obtained by electronic search of PubMed(®) between 1966 and April 2014 using the search terms organophosphorus compounds or phosphoric acid esters AND poison or poisoning AND manifestations. RESULTS Of the 5026 articles on OP poisoning, 2584 articles pertained to human poisoning; 452 articles focusing on clinical manifestations in human OP poisoning were retrieved for detailed evaluation. In addition to the traditional approach of symptoms and signs of OP poisoning as peripheral (muscarinic, nicotinic) and central nervous system receptor stimulation, symptoms were alternatively approached using a time-based classification. In this, symptom onset was categorized as acute (within 24-h), delayed (24-h to 2-week) or late (beyond 2-week). Although most symptoms occur with minutes or hours following acute exposure, delayed onset symptoms occurring after a period of minimal or mild symptoms, may impact treatment and timing of the discharge following acute exposure. Symptoms and signs were also viewed as an organ specific as cardiovascular, respiratory or neurological manifestations. An organ specific approach enables focused management of individual organ dysfunction that may vary with different OP compounds. CONCLUSIONS Different approaches to the symptoms and signs in OP poisoning may better our understanding of the underlying mechanism that in turn may assist with the management of acutely poisoned patients.
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Affiliation(s)
- John Victor Peter
- Department of Medical Intensive Care, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Thomas Isiah Sudarsan
- Department of Medical Intensive Care, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - John L Moran
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, South Australia 5011, Australia
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Rajapakse T, Griffiths KM, Christensen H, Cotton S. A comparison of non-fatal self-poisoning among males and females, in Sri Lanka. BMC Psychiatry 2014; 14:221. [PMID: 25103532 PMCID: PMC4149235 DOI: 10.1186/s12888-014-0221-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 07/23/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In the recent past Sri Lanka has had a high rate of attempted suicide by pesticide ingestion, among both males and females. Recent evidence suggests that these trends in self-poisoning may be changing, with increasing medicinal overdoses and changing gender ratios. In the past, attempted suicide in Sri Lanka has been described as impulsive acts, but research regarding aspects such as suicidal intent is limited, and there has been no comparison between genders. The objective of this study was to describe gender differences in non-fatal self-poisoning in Sri Lanka with respect to substances ingested, triggers, stressors, suicidal intent and psychiatric morbidity. METHODS Persons admitted to Teaching Hospital Peradeniya, Sri Lanka, for medical management of non-fatal self-poisoning over a consecutive 14-month period were eligible for the study. Participants were interviewed within one week of admission, with regard to demographic details, poison type ingested, triggers, psychiatric morbidity and suicidal intent. 949 participants were included in the study, of whom 44.2% were males, with a median age of 22 years. RESULTS Males were significantly more likely to ingest agrochemicals, whereas females were more likely to overdose on pharmaceutical drugs. Interpersonal conflict was a common trigger associated with non-fatal self-poisoning for both males and females. Alcohol use disorders and high suicidal intent were significantly more likely in males. There was no difference in rates of depression between the genders. Multiple regression for both genders separately showed that the presence of depression and higher levels of hopelessness was the strongest predictor of suicidal intent, for both genders. CONCLUSIONS Patterns of non-fatal self-poisoning in Sri Lanka appear to be changing to resemble Western patterns, with females having a greater rate of self-poisoning and more medicinal overdoses than males. Alcohol use disorder is a gender specific risk factor associated with non-fatal self-poisoning among males, indicating a need for specific intervention. However there are also many common risk factors that are common to both genders, particularly associations with interpersonal conflict as an acute trigger, and psychiatric morbidity such as depression and hopelessness being related to increased suicidal intent.
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Affiliation(s)
- Thilini Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | - Kathleen Margaret Griffiths
- National Institute for Mental Health Research, The Australian National University, Building 63, Canberra, ACT 0200 Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Hospital Road, Randwich, NSW 2013 Australia
| | - Sue Cotton
- Centre for Youth Mental Health, University of Melbourne, 35, Poplar Road, Parkville, VIC 3052 Australia
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Cha ES, Khang YH, Lee WJ. Mortality from and incidence of pesticide poisoning in South Korea: findings from National Death and Health Utilization Data between 2006 and 2010. PLoS One 2014; 9:e95299. [PMID: 24743877 PMCID: PMC3990630 DOI: 10.1371/journal.pone.0095299] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 03/25/2014] [Indexed: 11/23/2022] Open
Abstract
Pesticide poisoning has been recognized as an important public health issue around the world. The objectives of this study were to report nationally representative figures on mortality from and the incidence of pesticide poisoning in South Korea and to describe their epidemiologic characteristics. We calculated the age-standardized rates of mortality from and the incidence of pesticide poisoning in South Korea by gender and region from 2006 through 2010 using registered death data obtained from Statistics Korea and national healthcare utilization data obtained from the National Health Insurance Review and Assessment Service of South Korea. During the study period of 2006 through 2010, a total of 16,161 deaths and 45,291 patients related to pesticide poisoning were identified, marking respective mortality and incidence rates of 5.35 and 15.37 per 100,000 population. Intentional self-poisoning was identified as the major cause of death due to pesticides (85.9%) and accounted for 20.8% of all recorded suicides. The rates of mortality due to and incidence of pesticide poisoning were higher in rural than in urban areas, and this rural-urban discrepancy was more pronounced for mortality than for incidence. Both the rate of mortality due to pesticide poisoning and its incidence rate increased with age and were higher among men than women. This study provides the magnitude and epidemiologic characteristics for mortality from and the incidence of pesticide poisoning at the national level, and strongly suggests the need for further efforts to prevent pesticide self-poisonings, especially in rural areas in South Korea.
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Affiliation(s)
- Eun Shil Cha
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Young-Ho Khang
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, South Korea
- Institute of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
| | - Won Jin Lee
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
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Jørs E, Christoffersen M, Veirum NH, Aquilar GC, Morant RC, Konradsen F. Suicide attempts and suicides in Bolivia from 2007 to 2012: pesticides are the preferred method - females try but males commit suicide! Int J Adolesc Med Health 2014; 26:361-367. [PMID: 24114895 DOI: 10.1515/ijamh-2013-0309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 08/01/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Suicide attempts and suicides constitute a significant burden on communities and health systems, especially in low income countries. However, many low income countries lack epidemiological information on which to base future preventive strategies. This study reports on gender and age profiles as well as the likely background and means used for suicide attempts and suicides in Bolivia. METHOD This study presents 1124 cases from four different sources of information: (i) emergency ward data with suicide attempts by poisoning from the year 2007, (ii) psychiatric ward data including suicide attempts from July 2011 to July 2012, (iii) newspaper articles reporting attempted suicides and suicides from 2009 to 2011, and (iv) the National Statistics on Crime reporting suicides from the years 2010-2011. Data on age was stratified into three age groups: adolescents aged 10-19 years, young adults aged 20-29 years, and older adults aged above 29 years. Data from the hospital wards and Crime Statistics were pooled to compare characteristics of suicide attempts with suicides concerning age and gender. Data on age, gender, methods used, and reasons were analyzed using IBM SPSS version 21. RESULTS Hospital data showed that more females (403/657, 61%) than males (254/657, 39%) attempted suicide, and females attempted suicide at a younger age than males (p<0.05). In contrast to this, more males (208/293, 70.5%) than females (85/293, 29.5%) committed suicide, and furthermore it was most prevalent among young adults aged 20-29 years of both genders, as observed from the Crime Statistics. The dominant method was pesticide poisoning varying from 400 out of 657 (70.5%) of the hospital poisoning cases to 65 out of 172 (37.8%) of the newspaper cases. Newspaper data showed a higher mortality rate (65/77, 85.1%) among those using violent methods such as hanging and jumping compared to non-violent methods (43/84, 50.9%) such as ingesting chemicals and drugs (p<0.05). The reasons were related to interpersonal problems, economic problems, depression, and unwanted pregnancies. Many cases of suicide seemed to be hidden due to cultural and religious reasons. CONCLUSION More females attempted suicide, whereas more males realized suicide. Suicide attempts were most numerous among adolescents in contrast to suicides being most prevalent in the older age groups. Self-poisoning with pesticides was the most popular method used. Access to potential suicide materials should be restricted and psychosocial interventions initiated to prevent suicides.
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Rajapakse BN, Neeman T, Dawson AH. The effectiveness of a 'train the trainer' model of resuscitation education for rural peripheral hospital doctors in Sri Lanka. PLoS One 2013; 8:e79491. [PMID: 24255702 PMCID: PMC3821851 DOI: 10.1371/journal.pone.0079491] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 09/22/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sri Lankan rural doctors based in isolated peripheral hospitals routinely resuscitate critically ill patients but have difficulty accessing training. We tested a train-the-trainer model that could be utilised in isolated rural hospitals. METHODS Eight selected rural hospital non-specialist doctors attended a 2-day instructor course. These "trained trainers" educated their colleagues in advanced cardiac life support at peripheral hospital workshops and we tested their students in resuscitation knowledge and skills pre and post training, and at 6- and 12-weeks. Knowledge was assessed through 30 multiple choice questions (MCQ), and resuscitation skills were assessed by performance in a video recorded simulated scenario of a cardiac arrest using a Resuci Anne Skill Trainer mannequin. RESULTS/DISCUSSION/CONCLUSION Fifty seven doctors were trained. Pre and post training assessment was possible in 51 participants, and 6-week and 12-week follow up was possible for 43, and 38 participants respectively. Mean MCQ scores significantly improved over time (p<0.001), and a significant improvement was noted in "average ventilation volume", "compression count", and "compressions with no error", "adequate depth", "average depth", and "compression rate" (p<0.01). The proportion of participants with compression depth ≥40mm increased post intervention (p<0.05) and at 12-week follow up (p<0.05), and proportion of ventilation volumes between 400-1000mls increased post intervention (p<0.001). A significant increase in the proportion of participants who "checked for responsiveness", "opened the airway", "performed a breathing check", who used the "correct compression ratio", and who used an "appropriate facemask technique" was also noted (p<0.001). A train-the-trainer model of resuscitation education was effective in improving resuscitation knowledge and skills in Sri Lankan rural peripheral hospital doctors. Improvement was sustained to 12 weeks for most components of resuscitation knowledge and skills. Further research is needed to identify which components of training are most effective in leading to sustained improvement in resuscitation.
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Affiliation(s)
- Bishan N. Rajapakse
- Australian National University, Canberra, Australia
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Teresa Neeman
- Statistical Consulting Unit, Australian National University, Canberra, Australia
| | - Andrew H. Dawson
- Australian National University, Canberra, Australia
- Central Clinical School, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
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Senarathna L, Hunter C, Dawson AH, Dibley MJ. Social dynamics in rural Sri Lankan hospitals: revelations from self-poisoning cases. QUALITATIVE HEALTH RESEARCH 2013; 23:1481-1494. [PMID: 24135311 DOI: 10.1177/1049732313510361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Different hospitals produce different cultures-products of relationships between people of different staff categories and people from external community groups. These relationships demonstrate unique social dynamics in rural peripheral hospitals that form a major part of the health care system in Sri Lanka and other developing countries. Understanding the existing social dynamics might be useful when trying to implement new treatment guidelines that can involve behavior change. We aimed to explore the existing social dynamics in peripheral hospitals in rural Sri Lanka by examining the treatment related to cases of acute self-poisoning that is a common, highly interactive medical emergency. These hospitals demonstrate higher levels of community influence in treatment decisions and closer interactions between hospital staff. We argue that health care teamwork is effective in peripheral hospitals, resulting in benefits to all staff, who see these hospitals as better places to work and train, in contrast to a commonly held belief that such rural hospitals are disadvantaged and difficult places.
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Senarathna L, Buckley NA, Dibley MJ, Kelly PJ, Jayamanna SF, Gawarammana IB, Dawson AH. Effect of a brief outreach educational intervention on the translation of acute poisoning treatment guidelines to practice in rural Sri Lankan hospitals: a cluster randomized controlled trial. PLoS One 2013; 8:e71787. [PMID: 23990989 PMCID: PMC3747188 DOI: 10.1371/journal.pone.0071787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 07/02/2013] [Indexed: 11/19/2022] Open
Abstract
Background In developing countries, including Sri Lanka, a high proportion of acute poisoning and other medical emergencies are initially treated in rural peripheral hospitals. Patients are then usually transferred to referral hospitals for further treatment. Guidelines are often used to promote better patient care in these emergencies. We conducted a cluster randomized controlled trial (ISRCTN73983810) which aimed to assess the effect of a brief educational outreach (‘academic detailing’) intervention to promote the utilization of treatment guidelines for acute poisoning. Methods and Findings This cluster RCT was conducted in the North Central Province of Sri Lanka. All peripheral hospitals in the province were randomized to either intervention or control. All hospitals received a copy of the guidelines. The intervention hospitals received a brief out-reach academic detailing workshop which explained poisoning treatment guidelines and guideline promotional items designed to be used in daily care. Data were collected on all patients admitted due to poisoning for 12 months post-intervention in all study hospitals. Information collected included type of poison exposure, initial investigations, treatments and hospital outcome. Patients transferred from peripheral hospitals to referral hospitals had their clinical outcomes recorded. There were 23 intervention and 23 control hospitals. There were no significant differences in the patient characteristics, such as age, gender and the poisons ingested. The intervention hospitals showed a significant improvement in administration of activated charcoal [OR 2.95 (95% CI 1.28–6.80)]. There was no difference between hospitals in use of other decontamination methods. Conclusion This study shows that an educational intervention consisting of brief out-reach academic detailing was effective in changing treatment behavior in rural Sri Lankan hospitals. The intervention was only effective for treatments with direct clinician involvement, such as administering activated charcoal. It was not successful for treatments usually administered by non-professional staff such as forced emesis for poisoning. Trial Registration Controlled-Trials.com ISRCTN73983810 ISRCTN73983810
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Affiliation(s)
- Lalith Senarathna
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- * E-mail:
| | - Nick A. Buckley
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Professorial Medicine Unit, POW Clinical School, University of New South Wales, Sydney, Australia
| | - Michael J. Dibley
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Patrick J. Kelly
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Shaluka F. Jayamanna
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Indika B. Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Andrew H. Dawson
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Professorial Medicine Unit, POW Clinical School, University of New South Wales, Sydney, Australia
- Royal Prince Alfred Clinical School, University of Sydney, Sydney, NSW, Australia
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