Human intoxication by agrochemicals in the region of South Brazil between 1999 and 2014

The objective of this study was to evaluate pesticide poisonings in the southern region of Brazil between years 1999 and 2014. Data were collected from the database Sinitox. Intoxications and deaths were evaluated according to the distribution by gender (female and male), age group (≤14, 15-59 and ≥60 years), area of occurrence (urban and rural), circumstance (accident, occupational and suicide attempt) and evolution of the cases over time (cure, unconfirmed cure, death and sequelae). In the evaluated period, 21,305 cases of intoxication were registered. The results show that males between the ages of 15 and 59 years are more affected; and there is a greater representativeness in the urban area. These results are related to the application of agrochemicals being carried out by individuals between 15 and 59 years of age. The great correlation of urban area possibly occurs in function of the air currents brought from the field and as a result, population has been more affected and the consumption of contaminated food. It was observed that women handling pesticides more cautiously, in this way the accidents with male gender are more frequent, however, many women use the product intentionally to provoke suicide.

The role of ions, heavy metals, fluoride, and agrochemicals: critical evaluation of potential aetiological factors of chronic kidney disease of multifactorial origin (CKDmfo/CKDu) and recommendations for its eradication

The pollution of water and food through human waste and anthropogenic activities, including industrial waste and agricultural runoff, is a mounting problem worldwide. Water pollution from microbes causes identifiable diarrhoeal illnesses. The consumption of water contaminated with heavy metals, fluoride, and other toxins causes insidious illnesses that lead to protracted, non-communicable diseases and death. Chronic kidney disease of unusual/uncertain/unknown aetiology is one such example, began to manifest in the mid-1960s in several dry-zonal agricultural societies in developing economies that are located around the equator. In Sri Lanka, such a disease is affecting the North Central Province, the rice bowl of the country that first appeared in the mid-1990s. Several potential causes have been postulated, including heavy metals, fluoride, cyanobacterial and algae toxins, agrochemicals, and high salinity and ionicity in water, but no specific source or causative factor has been identified for CKD of multifactorial origin (CKDmfo). Three large studies conducted in the recent past failed to find any of the postulated components (heavy metals, cyanobacterial toxins, fluoride, salinity, or agrochemicals) at levels higher than those deemed safe by the World Health Organization and the US Environmental Protection Agency. At the reported low levels in water and with the heterogeneous geographical distribution, it is unrealistic to expect any of these components individually could cause this disease. However, the additive or synergistic effects of a combination of factors and components, even at lower exposure levels, together with malnutrition and harmful behaviours, and/or a yet-unidentified (or not investigated) toxin, can cause this epidemic. Because the cause is unknown, scientists need to work on broader hypotheses, so that key causative elements are not missed. Taken together the plausibility of multiple factors in the genesis of this disease, the appropriate terminology is CKDmfo, a name that also indicates the need for multi-disciplinary research programs to facilitate identifying the cause(s) and the need for multiple approaches to eradicate it. While some potential causes remain to be investigated, existing data point to polluted water as the main source of this disease. This article evaluates pros and cons of each hypothesis and highlights the importance of among others, providing clean water to all affected and surrounding communities. Available data do not support any of the postulated agents, chemicals, heavy metals, fluoride, salinity/ionicity, or individual agrochemical components, such as phosphate or glyphosate, as causative factors for CKDmfo in Sri Lanka. However, as the CKDmfo name implies, a combination of these factors (or an unknown toxin) together with harmful behaviour and chronic dehydration may cause this disease. Irrespective of the cause, prevention is the only way forward for eradication.

Poisoning by Polyethylene Glycol , An Adjuvant for Insecticides

BACKGROUND

Accidental poisoning in children with surfactant used as an agriculture adjuvant is uncommon.

CASE CHARACTERISTICS

A 7-month-old girl presented with severe respiratory distress 48 hours following ingestion of surfactant, and required intubation and mechanical ventilation.

OUTCOME

The child was successfully managed with supportive therapy.

MESSAGE

Poisoning by polyethylene glycol can be severe and life-threatening.

Environmentally induced epigenetic transgenerational inheritance of male infertility

Decreasing male fertility has been observed for the past fifty years. Examples of affected reproductive parameters include decreases in sperm count and sperm quality and increases in testicular cancer, cryptorchidism and hypospadias. Exposures to environmental toxicants during fetal development and early postnatal life have been shown to promote infertility. Environmental exposures inducing epigenetic changes related to male infertility range from life style, occupational exposures, environmental toxicants and nutrition. Exposures during fetal gonadal sex determination have been shown to alter the epigenetic programming of the germline that then can transmit this altered epigenetic information to subsequent generations in the absence of any exposures. This environmentally induced epigenetic transgenerational inheritance of disease will be a component of the etiology of male infertility.

Poultry and livestock exposure and cancer risk among farmers in the agricultural health study

PURPOSE

The purpose of this study is to evaluate cancer risk associated with raising animals as commodities, which is associated with a variety of exposures, such as infectious agents and endotoxins.

METHODS

Information was available for 49,884 male farmers in the Agricultural Health Study, who reported livestock and poultry production at enrollment (1993-1997). Cancer incidence data were obtained through annual linkage to state registries. Using Poisson regression analyses, we evaluated whether the number and type of animals raised on the farm impacted cancer risk.

RESULTS

Overall, 31,848 (63.8%) male farmers reported raising any animals. Lung cancer risk decreased with increasing number of livestock on the farm (p trend = 0.04) and with raising poultry (Relative Risk (RR) = 0.6; 95% confidence interval (CI): 0.4-0.97). Raising poultry was associated with an increased risk of colon cancer (RR = 1.4; 95% CI: 0.99-2.0) with further increased with larger flocks (p trend = 0.02). Risk of non-Hodgkin lymphoma was also elevated in those who raised poultry (RR = 1.6; 95% CI: 1.0-2.4), but there was no evidence of increased risk with larger flocks (p trend = 0.5). Raising sheep was associated with a significantly increased risk of multiple myeloma (RR = 4.9; 95% CI: 2.4-12.0). Performing veterinary services increased the risk of Hodgkin lymphoma (RR = 12.2; 95% CI: 1.6-96.3).

CONCLUSIONS

We observed an inverse association between raising poultry and livestock and lung cancer risk and some evidence of increased risk of specific lymphohematopoietic malignancies with specific types of animals and performing veterinary services. Further research into associations between raising animals and cancer risk should focus on identification of etiologic agents.

New experimental Oximes in the management of organophosphorus pesticides poisoning

Organophosphorus compounds (OPCs) are widely used in agriculture as pesticides and occasionally in industrial settings. They have also been developed as warfare nerve agents. OPCs poisoning from intentional, accidental, and occupational exposure is a major public health problem, especially across the rural developing world. The main toxic mechanism of OPCs is the inhibition of the enzymes acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE), resulting in accumulation of acetylcholine (ACh) at the synapse with cholinergic crisis and possible death. Exposure to even small amounts of an OPC can be fatal and death is usually caused by respiratory failure. Standard treatment involves the administration of intravenous atropine and an oxime to counteract acetylcholinesterase inhibition at the synapse, but the usefulness of oximes is still debated. During more than five decades, pyridinium oximes have been developed as therapeutic agents used in the medical treatment of poisoning with OPCs. They act by reactivation of AChE inhibited by OPCs. However, their activity in poisonings with pesticides and warfare nerve agents is different, and there is still no universal oxime sufficiently effective against all known OPCs. The aim of this article was to review the most recent findings in this field and compare the protection conferred by the new K-oximes and sugar oximes with the effect of the four recommended pyridinium oximes (pralidoxime, obidoxime, trimedoxime, and HI-6), in the search for a broad-spectrum AChE reactivator.

An urgent need to restrict access to pesticides based on human lethality

Matthew Miller and Kavi Bhalla discuss new research findings from Andrew Dawson and colleagues on the human toxicity of pesticides in Sri Lanka, and call for urgent reclassification of agricultural pesticides to help reduce suicides by poisonings.

Agrichemicals in surface water and birth defects in the United States

Objectives: To investigate if live births conceived in months when surface water agrichemicals are highest are at greater risk for birth defects.

Methods: Monthly concentrations during 1996–2002 of nitrates, atrazine and other pesticides were calculated using United States Geological Survey's National Water Quality Assessment data. Monthly United States birth defect rates were calculated for live births from 1996 to 2002 using United States Centers for Disease Control and Prevention natality data sets. Birth defect rates by month of last menstrual period (LMP) were then compared to pesticide/nitrate means using logistical regression models.

Results: Mean concentrations of agrichemicals were highest in April–July. Total birth defects, and eleven of 22 birth defect subcategories, were more likely to occur in live births with LMPs between April and July. A significant association was found between the season of elevated agrichemicals and birth defects.

Conclusion: Elevated concentrations of agrichemicals in surface water in April–July coincided with higher risk of birth defects in live births with LMPs April–July. While a causal link between agrichemicals and birth defects cannot be proven from this study an association might provide clues to common factors shared by both variables.

DNA damage, acetylcholinesterase activity and lysosomal stability in native and transplanted mussels (Mytilus edulis) in areas close to coastal chemical dumping sites in Denmark

Biomarkers of genotoxicity (DNA damage, measured as tail moment in the Comet assay), neurotoxicity (acetylcholinesterase inhibition, AChE) and general stress (lysosomal membrane stability, LMS) were studied in native and transplanted blue mussels (Mytilus edulis) in coastal areas of western Denmark potentially affected by anthropogenic pollution originating from chemical dumping sites. The results indicate responses to pollution in all the biomarkers applied at the suspected areas, but the results were not consistent. Seasonal fluctuations in exposure situations at the study sites make interpretation of chemical pollution complex, as seen especially in the variability in results on DNA damage, and also in regard to AChE activity. These investigations further stress the importance of understanding the effects of natural factors (salinity, temperature, water levels, rain and storm events) in correct interpretation of the biomarker data obtained. In addition, adaptation of populations to local contamination may play a role in some of the response patterns observed.

Surveillance of toxic exposures: the pilot experience of the Poison Control Centers of Milan, Pavia and Bergamo in 2006

Between 1 February and 31 March 2006, the Poison Control Centers (PPC) active in Lombardy collaborated with an integrated surveillance system carried out in Piedmont during the Olympic Games 2006. The collaborating PPC notified to the system 697 human cases of exposure occurred in Piedmont during the observation period. Among these cases, 70% were exposed accidentally, 40% were 6 years old or younger, and 45% reported at least a clinical effect. The agents more frequently reported were: cleaning substances (household) (110 cases), fumes/gases/vapors (63 cases, comprising 38 cases accidentally exposed to carbon monoxide), and sedative/hypnotics/antipsychotics (53 cases). Although very limited, the available observations focused the attention on specific hazards and were able to highlight the potential of a toxic exposure surveillance system based on the information reported by the Italian PPC.

Plasma sex steroid and thyroid hormones profile in male water frogs of the Rana esculenta complex from agricultural and pristine areas

Some chemical compounds used in intensive agriculture have been found to induce estrogenic effects; therefore a histological analysis of the testes and an evaluation of plasma levels of sex steroid, thyroid hormones, and vitellogenin were carried out in adult male water frogs of two coexisting taxa (Rana lessonae and the hemiclonal hybrid Rana esculenta) sampled in agricultural and pristine areas. Differences in seasonal profiles of hormones were found in water frogs living in the agricultural area where the presence of endocrine disrupting compounds was suspected on the basis of a previous study. In R. esculenta, sampled in the pristine area, high androgen levels were found in May; the opposite trend was found for R. esculenta sampled in agricultural areas in which the highest androgen levels were found in September, significantly lower compared with those found in R. esculenta sampled in the pristine area. Low androgen levels were also recorded in R. lessonae males sampled both in pristine and agricultural areas, while the highest levels were found in September. Regarding the trend of estradiol-17beta, an increase of this hormone was found in July both in esculenta and lessonae sampled in the agricultural area, and in the same month an estradiol-17beta peak, even though lower, was also found both in esculenta and lessonae males captured in the pristine area; detectable vitellogenin was found neither in males captured in the agricultural area, nor in those sampled in the pristine one. Moreover, while no significant changes of thyroid hormones were found either in the esculenta or lessonae males sampled in the pristine area, increased T3 and T4 titers were found in July in both esculenta and lessonae captured in the agricultural area. Morphological differences of the testes in males of parental species captured in the agricultural area were also observed. These findings indicate alterations in endocrine and reproductive function in frogs in the agricultural area, that could suggest the presence of endocrine disrupting compounds.

[Exposure to endocrine disrupting chemicals and human health: a review of epidemiological studies focused on hypospadias and cryptorchidism]

Hypospadias and cryptorchidism are common congenital anomalies. Recently, increases in the prevalence of hypospadias and cryptorchidism have been reported in various countries, including Japan. As male sexual differentiation is critically dependent on normal androgen concentrations, increased exposure to environmental factors affecting androgen homeostasis during fetal life (i.e. EDCs with estrogenic or anti-androgenic effects) may cause hypospadias or cryptorchidism. However, the results from the International Clearinghouse for Birth Defects Monitoring System (ICBDMS), hospital-based studies in each country and population-based studies in Japan are different, because in the present system there are some problems such as the standardization of diagnostic criteria and the difference of the time of diagnosis, we hope to improve the monitoring system method. Previous papers have reported that hypospadias and cryptorchidism were associated with maternal exposure to progesterone, estrogen, diethylstilbestrol (DES) and pesticide. However, there are few studies evaluating the quantity of endocrine disrupting chemicals, using biological samples. In the future, a well-designed epidemiological study is needed to elucidate the relation between endocrine disrupting chemicals and genital development.

[Agricultural pesticide-related poisonings in Italy: cases reported to the Poison Control Centre of Milan in 2000-2001]

OBJECTIVE

Aim of the present study is to provide a preliminary description of agricultural pesticide-related poisonings in Italy.

DESIGN

The study focuses on the cases with at least one sign or symptom due to exposure to agricultural pesticides occurred in 2000-2001 and referred to the Poison control centre of Milan, the Italian centre more frequently consulted nationwide.

RESULTS

During the study period, 872 agricultural pesticide-related poisonings were identified. Most of the observed cases occurred in Sicily (n=199), Lombardy (n=100), Apulia (n=99), Veneto (n=75), Emilia-Romagna (n=67) and Campania (n=59). About 86% of the observed cases were unintentional and about 76% of them were men. Children aged 10 or less accounted for about 6% of the total. The poisonings occurred more frequently at home (about 38%) than at workplace (about 24%). The chemical classes of agents more frequently reported were: organophosphates (233 cases), copper and sulphur compounds (140 cases), carbamates (126 cases) and pyrethrins/pyrethroids (102 cases). The top six pesticides associated with poisonings were methomyl (97 cases), dimethoate (59 cases), copper sulfate (58 cases), glyphosate (53 cases), sulphur compounds other than copper sulfate (47 cases), and paraquat dichloride (41 cases).

CONCLUSION

The data here presented provide an initial support to identify priorities for prevention in agricultural settings.

Pesticides and lung cancer risk in the agricultural health study cohort

The authors examined the relation between 50 widely used agricultural pesticides and lung cancer incidence in the Agricultural Health Study, a prospective cohort study of 57,284 pesticide applicators and 32,333 spouses of farmer applicators with no prior history of lung cancer. Self-administered questionnaires were completed at enrollment (1993-1997). Cancer incidence was determined through population-based cancer registries from enrollment through December 31, 2001. A lung cancer standardized incidence ratio of 0.44 (95% confidence interval: 0.39, 0.49) was observed overall, due in large part to a low cigarette smoking prevalence. Two widely used herbicides, metolachlor and pendimethalin (for low-exposed groups to four higher exposure categories: odds ratio (OR) = 1.0, 1.6, 1.2, 5.0; p(trend) = 0.0002; and OR = 1.0, 1.6, 2.1, 4.4; p(trend) = 0.003, respectively), and two widely used insecticides, chlorpyrifos and diazinon (OR = 1.0, 1.1, 1.7, 1.9; p(trend) = 0.03; and OR = 1.0, 1.6, 2.7, 3.7; p(trend) = 0.04, respectively), showed some evidence of exposure response for lung cancer. These excesses could not be explained by previously identified lung cancer risk factors. The usage levels in this cohort are considerably higher than those typically experienced by the general population. An excess risk among spouses directly exposed to pesticides could not be evaluated at this time.

Residential proximity to agricultural pesticide use and incidence of breast cancer in the California Teachers Study cohort

We examined the association between residential proximity to agricultural pesticide use and breast cancer incidence among members of the California Teachers Study cohort, a large study of professional school employees with extensive information on breast cancer risk factors, followed for cancer incidence since 1995. We identified 1552 invasive breast cancer cases, diagnosed between 1996 and 1999, among 114,835 cohort members. We used California Pesticide Use Reporting data to select pesticides for analysis based on use volume, carcinogenic potential, and exposure potential; a Geographic Information System was used to estimate pesticide applications within a half-mile radius of subjects' residences. We applied Cox proportional hazard models to estimate hazard rate ratios (HR) for selected pesticides, adjusting for age, race, and socioeconomic status. We saw no association between residential proximity to recent agricultural pesticide use and invasive breast cancer incidence. HR estimates for the highest compared to the lowest exposure categories for groups of agents were as follows: probable or likely carcinogens (1.07, 95% confidence interval (CI): 0.86-1.32), possible or suggestive carcinogens (1.06, 95% CI: 0.87-1.29), mammary carcinogens (1.15, 95% CI: 0.90-1.48), and endocrine disruptors (1.03, 95% CI: 0.86-1.25). HR estimates for other groups and individual pesticides did not differ from unity, nor was there a trend for any groupings of or individual pesticides examined. Stratifying by menopausal status or family history of breast cancer did not substantially affect our results. Our analyses suggest that breast cancer incidence is not elevated in areas of recent, high agricultural pesticide use in California.

Pulmonary function and exercise-associated changes with chronic low-level paraquat exposure

The present study was undertaken to test the hypothesis that chronic, low-level paraquat exposure causes restrictive lung function with gas transfer impairment. Three hundred thirty-eight Costa Rican farm workers from banana, coffee, and palm oil farms completed a questionnaire, spirometry, and a test of single-breath carbon monoxide diffusing capacity. Subjects 40 years of age or older, without other medical risk factors, completed maximal cardiopulmonary exercise tests. Most (66.6%) were paraquat handlers; 24.8% of handlers and 27.3% of nonhandlers reported current cigarette smoking. In linear regression models, cumulative paraquat exposure was not an independent predictor of VA, carbon monoxide diffusing capacity, peak oxygen uptake, FVC, or oxygen pulse peak. However, the ventilatory equivalent for CO(2), although within normal range, was significantly higher with increased cumulative paraquat exposure. Oxygen desaturation greater than 5% from rest to peak exercise had an odds ratio of 1.7 (95% confidence interval = 0.9-3.0) with the cumulative paraquat exposure index in models adjusted for age, weight, and smoking status. The association of paraquat exposure with ventilatory equivalent and oxygen desaturation suggests that paraquat may be associated with subclinical gas exchange abnormalities, but overall these findings are consistent with no clinically significant increases in interstitial thickening or restrictive lung disease among this population.

Intoxicações e uso de pesticidas por agricultores do Município de Paty do Alferes, Rio de Janeiro, Brasil

Este trabalho é parte de um estudo mais amplo sobre as conseqüências para a saúde da exposição a pesticidas. Em 1997, no Município de Paty do Alferes, Rio de Janeiro, 55 agricultores foram entrevistados sobre o uso de pesticidas, equipamentos de proteção e medidas de higiene, ocorrência de intoxicações, destino das embalagens vazias e o tipo de orientação técnica recebida pelos usuários destes produtos. Os pesticidas mais usados foram inseticidas como a abamectina, os compostos organofosforados e os piretróides, e os fungicidas como o mancozeb, o clorotalonil e produtos à base de cobre. Entre os trabalhadores envolvidos no preparo e/ou aplicação de pesticidas, 92% informaram não usar qualquer tipo de equipamento de proteção individual. 62% dos agricultores entrevistados informaram já ter "passado mal" ao preparar ou aplicar pesticidas. Os sintomas mais freqüentemente citados foram dor de cabeça, enjôo, vômitos, vertigem, irritação da pele e visão embaçada. Destes agricultores, 21% necessitaram de assistência médica e em mais da metade dos casos (51%), em que os lavradores identificaram os pesticidas que usavam quando "passaram mal", foram citados inseticidas organofosforados da classe toxicológica I.

Medico-legal investigation of suspected fatal poisonings in Pretoria: 2000-2001

Accurate data on the incidence and spectrum of fatal poisonings in South Africa is lacking. Most studies focus on "traditional poisons". This is a retrospective study on the medico-legal investigation of suspected fatal poisonings seen at the Pretoria Medico-Legal Laboratory. Post mortem records from January 2000 to December 2001 were examined. There were 153 cases of suspected fatal poisoning or overdose. However, toxicology results were conclusively positive in only 53 (34.64%) cases with some cases testing positive for more than one type or class of "poison". The fatal "poisons" identified in these 53 cases were as follows: pharmaceuticals (47.17%), illicit drugs (41.51%), agricultural poisons (20.75%), alcohol (13.21%), traditional medicines (3.77%) and heavy metals (3.77%). The average delay in completing toxicology analyses was 10 months. This study demonstrates that the current medico-legal investigation of fatal cases of suspected poisoning does not yield adequate results for definitive judicial administration in two-thirds of suspected cases. This creates a legal dilemma, as the primary medical cause of death remains unresolved.

[Threats to human health in the use of pesticides (a review)]

The paper presents current trends in the use of pesticides and detection of their residues in the environmental objects. Pesticides are shown to be a serious health risk factor for different groups of the population when they are irrationally used and inadequately stored. A package of measures to prevent intoxication and to reduce a risk for pesticide entry into the body is provided.

[A case of fatal chloropicrine poisoning induced by ingestion]

A case of fatal chloropicrine poisoning induced by suicidal ingestion was reported. The patient was found unconsciousness in his room with drinking about 100 ml of chloropicrine sodium at 8:55 in the morning and brought to a nearby hospital. He was transported to our ER at 10:17. 7 hours after ingestion, he died from metabolic acidosis and acute cardiac failure. It was difficult to detect chloropicrine in his serum and gastric content with GC/MS method. At the present, we must be severe to store and use chloropicrine as there is no specific treatment of chloropicrine poisoning. It is necessary to protect from exposure to volatile agricultural chemicals such as chloropicrine for prevention of secondary disaster.

Patterns and problems of deliberate self-poisoning in the developing world

Deliberate self-harm is a major problem in the developing world, responsible for around 600 000 deaths in 1990. The toxicity of available poisons and paucity of medical services ensure that mortality from self-poisoning is far greater in the tropics than in the industrialized world. Few data are available on the poisons most commonly used for self-harm in different parts of the world. This paper reviews the literature on poisoning, to identify the important poisons used for self-harm in these regions. Pesticides are the most important poison throughout the tropics, being both common and associated with a high mortality rate. In some regions, particular pesticides have become the most popular method of self-harm, gaining a notoriety amongst both health-care workers and public. Self-poisoning with medicines such as benzodiazepines and antidepressants is common in urban areas, but associated with few deaths. The antimalarial chloroquine appears the most significant medicine, self-poisoning being common in both Africa and the Pacific region, and often fatal. Paracetamol (acetaminophen) is used in many countries but in few has it reached the popularity typical of the UK. Domestic and industrial chemicals are responsible for significant numbers of deaths and long-term disabilities world-wide. Self-poisoning with plant parts, although uncommon globally, is locally popular in some regions. Few of these poisons have specific antidotes. This emphasizes the importance of determining whether interventions aimed at reducing poison absorption actually produce a clinical benefit, reducing death and complication rates. Future research to improve medical management and find effective ways of reducing the incidence of self-harm, together with more widespread provision of interventions proven to be effective, could rapidly reduce the number of deaths from self-poisoning in the developing world.

Current knowledge of water quality and safety for livestock

Basic laboratory evaluation of water quality for livestock should include measurement of TDS, sulfate, nitrate-nitrite, and coliform bacteria. Supplementary water tests may include pH, sodium, iron, magnesium, chloride, calcium, potassium, manganese, and contaminants specific to the situation. Using the best-quality drinking water available contributes to the optimal production of livestock. Restricted quantity of drinking water or drinking water containing excessive levels of nitrate, TDS, sulfate, and other constituents can affect growth and production of all classes of animals. Drinking-water quality and availability should be evaluated as a cause of poor performance or nonspecific disease conditions in livestock. It is important that attempts to evaluate water quality include obtaining a thorough history, making astute observations, and asking intelligent questions. A thorough laboratory examination of animal specimens and water samples should be evaluated in view of existing standards for livestock drinking-water quality.

[Acute neurotoxic organophosphate poisoning: insecticides and chemical weapons]

OBJECTIVE

To review clinical and therapeutic bases of an organophosphate poisoning, either with insecticide or nerve agent.

DATA SOURCES

References were obtained from computerized bibliographic research (Medline), from personal data (academic memoir, documents under approbation of the National Defense Office), from Internet's data.

DATA SYNTHESIS

Generally, organophosphate poisoning occurs during accidental exposure with agricultural insecticide or suicide. The effects of organophosphate compounds are due to the inhibition of the enzyme acetylcholinesterase. The intoxication symptoms can be divided into muscarine-like, nicotine-like effects, effects on the central nervous system and symptoms related to the dysfunction of the neuromuscular junction. The interest of biological acetylcholinesterase's measuring is minimal because it is weakly specific or sensitive. The immediate severity is due to hypoxia. Respiratory failure results from the lack of central drive inflated with excessive bronchial secretions, bronchospasm and respiratory muscles paralysis. The secondary complications are early myopathies whose gravity is correlated with the decrease of acetylcholinesterases, or later neuropathies induced by a different mechanism. Beside the symptomatic measures, atropine is the specific anticholinergic treatment. When promptly used, oximes can regenerate cholinesterases. The attempted effects of the treatment are mouth dryness, pupilar dilatation and flushing of the skin. Nerve agents are lethal toxics which have a short onset time and produce severe neurological pathology. In a terrorist incident, it is as important to identify rapidly the toxic agent and provide emergency decontamination as to manage medical care. An effective response must be multidisciplinary, involving clinicians, toxicologists, Emergency Medical Service and public's health personnel.

Forensic toxicology in urban South Africa

BACKGROUND

An analysis has been made of the pattern of deaths due to poisoning in South Africa over the period 1991-1996.

METHODS

The database held by the Forensic Science Service Laboratory, covering the period 1991-1996 was analyzed.

RESULTS

Agricultural chemicals are a major cause of mortality. Among drugs of abuse, combinations of methaqualone/diphenhydramine and cyclizine/dipipanone contribute a disproportionately high percentage of cases. Metal poisoning is common as are cases of poisoning attributed to remedies prescribed by traditional healers.

Agricultural avermectins: an uncommon but potentially fatal cause of pesticide poisoning

STUDY OBJECTIVE

Avermectins have been used in the control of parasites and insects; however, human data concerning poisoning are lacking. This study investigated the clinical spectrum of avermectin poisoning.

METHODS

A retrospective study was conducted to evaluate patients with avermectin poisoning reported to a poison center from September 1993 through December 1997.

RESULTS

Eighteen patients with abamectin (Agri-Mek; 2% wt/wt abamectin) exposure and 1 with ivermectin (Ivomec; 1% wt/vol ivermectin) ingestion were identified. There were 14 male and 5 female patients, ranging in age from 15 to 83 years. Most patients were exposed as a result of attempted suicide (14). Oral ingestion (15) was the most common route of exposure. Four patients were asymptomatic, and 8 had minor symptoms after a mean ingestion of 23 mg/kg abamectin (4.2 to 67 mg/kg), or after dermal and inhalation contact. Seven patients manifested severe symptoms, such as coma (7), aspiration with respiratory failure (4), and hypotension (3), after a mean ingestion of 100.7 mg/kg avermectin (15.4 mg/kg for ivermectin and 114.9 mg/kg for abamectin). All 7 patients received intensive supportive care; 1 patient died 18 days later as a result of multiple organ failure.

CONCLUSION

Ingestion of a large dose of avermectin may be associated with life-threatening coma, hypotension, and subsequent aspiration.

[Methamidophos intoxication: immediate and late neurological toxicity; two case reports]

Méthamidophos is an organophosphorus insecticide which delayed neurotoxicity is more frequent than with other organophosphates. Authors present a case report concerning a collective poisoning after cutaneous contact: two farm labourers presented moderate cholinergic signs quickly followed by proximal neurological signs (retrobulbar ocular neuritis for one patient, thight paresthesias for the second one). These signs decreased meanwhile new neurological symptoms appeared: sensory and motor peripheral neuropathy in both patients, with a clinical aspect of OrganoPhosphorus Induced Delayed Neuropathy (OPIDN). This unusual chronology and the disappearence of all signs at the 18th month, lead the authors to diagnose a collective methamidophos poisoning in three phases: first, anticholinesterasic acute syndrome; second, an intermediate syndrome and third an OPIDN.

Agricultural and horticultural chemical poisonings: mortality and morbidity in the United States

STUDY OBJECTIVE

To provide a comprehensive analysis of morbidity and mortality from poisoning by agricultural and horticultural chemicals in the United States.

METHODS

Descriptive analysis of national mortality data, National Hospital Discharge Survey data, and American Association of Poison Control Centers national data for 1985 through 1990.

RESULTS

There were 341 fatalities from agricultural and horticultural chemicals over the 6-year period, of which 64% were suicides, 28% were unintentional, and 8% were of undetermined intent. There were 25,418 hospitalizations; 78% were reported to be unintentional. Both deaths and hospitalizations occurred more frequently in males, and rates were higher in nonwhites than in whites. There were 338,170 poison exposures reported to poison centers for fungicides, herbicides, pesticides/insecticides, and rodenticides. Life-threatening manifestations or long-term sequelae occurred in 782 cases, and 97 deaths were reported. Pesticides and insecticides accounted for 72% of the poison center cases and 63% of the fatalities. Although they accounted for only 8% of poison exposures, herbicide deaths were disproportionately high (25%).

CONCLUSION

Poisonings with agricultural and horticultural chemicals are an important public health problem. Prevention efforts need to incorporate the fact that many serious cases, such as paraquat poisonings, are suicidal in nature.

An investigation into neurologic and neurobehavioral effects of long-term agrichemical use among deciduous fruit farm workers in the Western Cape, South Africa

Long-term exposure to organophosphates (OPs) in the absence of acute poisoning is increasingly suspected of causing chronic neurologic and neurobehavioral effects. A cross-sectional survey of 163 spray operators on deciduous fruit farms in the Western Cape, South Africa, and 84 nonspraying labororers was conducted in 1993 to investigate the relationship between long-term OP exposures and neurological and neurobehavioral outcomes. The study also sought to evaluate the performance of a set of neurobehavioral test batteries based on the information-processing theory of cognitive psychology, relative to the more established World Health Organization's Neurobehavioral Core Test Battery (WHO NCTB). These information-processing tests were designed for use in studies of subjects with little education, which are frequently conducted in developing countries in agriculture. They draw on experience from a previous South African study in which problems were encountered with a lack of cross-cultural validity of conventional test batteries. No evidence was found of a relationship between long-term OP exposure and loss of vibration sense. Small associations were found with the NCTB Pursuit-Aiming and Santa Ana (nondominant hand) subtests. The overall evidence of neurologic and neurobehavioral effects of long-term OP exposure was small; exposure misclassification may have contributed to this finding. Important confounders such as brain injury, alcohol consumption, and nutritional status were identified.

[Effects of chemical factors on health of the population in various regions of Russia]

Wide use of chemicals in agriculture is associated with higher morbidity among inhabitants of agricultural regions. Extreme increase of the morbidity is confined to the area subjected to releases of oil-processing and petrochemical enterprises and therefore results from combined exposure to agricultural chemicals and waste of oil-processing.

Chemical exposures and Parkinson's disease in residents of three Negev kibbutzim

We consider whether chemical pollutants in drinking water (including aromatic hydrocarbons, alkanes, halogenated aliphatic hydrocarbons, and phthalic acid) or used occupationally in agriculture that have shown no parkinsonism-inducing effect may be responsible for excess cases of Parkinson's disease (PD) in three adjacent kibbutzim in southern Israel (Negev). Literature data on PD pathogenesis have been compared with common pathogenetic pathways to xenobiotics effects; the following neurotoxic mechanisms, besides individual sensitivity, have been suggested: (1) impairment of the protective role of the substantia nigra against toxicants by binding of chemicals to melanin; (2) oxidative stress induction, including glutathione reduction, impaired calcium metabolism, and alteration of cytochrome P-450 activity; (3) blockade of iron chelators because of structural similarities to them or their precursors; (4) mediation of the production of endogenous dopaminergic neurotoxins, such as trichloroharmanes or isoquinolines; (5) blockade of dopamine receptors because of their resemblance to chemicals with affinity to these receptors; (6) stimulation of prostaglandin-H synthase and monooxygenase activity; and (7) stimulation of autoimmune processes and creation of autoimmunity to structures of the dopaminergic system caused by chemical similarity.

Agrichemical safety practices on farms in the western Cape

In order to study agrichemical safety practices in a rural farming area in the western Cape, an audit of 45 randomly sampled farms was performed over 3 months in 1992. A response rate of 87% was achieved, and the survey results suggest that approximately 9% of permanent and 14% of seasonal farm workers are employed in jobs with potential exposure to agrichemicals. While protective equipment was widely available, gloves and masks were seldom used, with little enforcement or commercial support from the suppliers of the equipment. Farm workers receive little training on pesticide safety, but interest in the possibility of further training for workers was high. In the absence of a system of pesticide disposal, the presence of residual, unwanted and outdated stocks of pesticides in farmers' stores, and to a lesser extent the presence of empty containers, are identified as important problems. Current pesticide storage practices require improvement by simple industrial hygiene measures. Health facilities available to workers on most farms are extremely limited, particularly in the light of statutory requirements for occupational safety and health under the Machinery and Occupational Safety Act. It is argued that collective solutions to problems of pesticide safety are possible within the ambit of a public health response, particularly given the willingness of the farming community to identify and address potential health problems. As a result, initiatives to meet these needs are currently under way in the region.

An epidemic of pesticide poisoning in Nicaragua: implications for prevention in developing countries

OBJECTIVES

The purpose of this study was to demonstrate the usefulness of the Northwestern Nicaraguan Ministry of Health surveillance system for detecting pesticide poisonings.

METHODS

Cases were reported to the regional department of epidemiology through daily telephone reports and through monthly consolidated reports from each of the 18 health centers of the National Health Service. Reporting forms were also distributed to the four area hospitals.

RESULTS

During June and July 1987, an epidemic of 548 pesticide poisoning was detected in northwestern Nicaragua. Seventy-seven percent of the poisonings were caused by carbofuran or methamidophos. Of the work-related cases (91% of reported poisonings), more than 80% occurred among maize farmers and on small to medium land holdings (fewer than 140 hectares). Nineteen percent of the work-related cases involved children under 16 years of age.

CONCLUSIONS

Unsafe working conditions such as manual application of pesticides and the use of backpack sprayers, the introduction of a hazardous powdered formulation of carbofuran highly restricted in the developed world, and agricultural subsidies that encouraged the use of hazardous pesticides all contributed to the epidemic.

[Organic pollution of water and soil in the Khramtsovsky's state farm of the Sverdlovsk region]

Sanitary and chemical examination of soil and water was carried out in State farm "Khramtsovskiy" (Beloyarsk region, Sverdlovsk province), where intoxication cases during outcropping were detected by chromatomass analysis of organic pollution. Local pesticide levels exceeding the MACs as a potential health hazard were noted.

Intracranial hemorrhage due to vitamin K deficiency in breast-fed infants with cholestasis

Since the Poison Prevention Packaging Act took effect, the number of ingestions of caustic alkali from household products has been significantly reduced. Commercial caustic alkalis used on farms, however, were not included in this legislation. Fourteen children over a 5 year period were seen after ingestion of commercial caustic alkalis used on farms. Seven of the children had ingested liquid pipeline cleaners and seven had ingested solid agents used for a variety of reasons. Six of seven children ingesting liquid agents did so from nonoriginal containers into which the caustic had been transferred for convenience. All seven children ingesting solid agents did so from the original container. Eight of the 14 children were found to have second-degree or worse esophageal involvement. Both solid and liquid caustic agents used commercially on farms can cause significant morbidity. Development of a child-resistant container for daily transfer of liquid pipeline agents could be helpful in preventing injuries from liquid pipeline cleaners. Pediatric gastroenterologists as well as primary care physicians in rural areas should be familiar with this type of injury and should take an active role in instructing parents of children living on farms to prevent such injuries. Extension of the Poison Prevention Packaging Act to caustic alkalis used on farms needs to be considered.

Problem-solving in the fields: an action-oriented approach to farmworker education about pesticides

This paper describes two educational programs initiated to address the problems of farmworker pesticide poisoning in Nicaragua and in the United States and Puerto Rico. Both programs utilize a participatory and action-oriented educational methodology known as popular education. The methodology is presented using examples to demonstrate its application to the planning, delivery and evaluation of pesticide education programs. Preliminary outcomes of using this methodology are also explored as well as implications for developing future training programs in the field.

[Contribution of the incidence of urban sewage spreading to dietary chromium]

The sewage sludges contain fertilizing matters that justify their use in agriculture. Simultaneously, they hold minerals that are directly proportional to the nature and intensity of industrial activity. The more abundant are chromium, lead, zinc; cadmium and mercury are also found. The concentration in chromium varies from 0.2 to 20.0 g/kg of dry matter. Its assimilation by the rootlet and, later, its intestinal absorption, are essentially dependent on its chemical state; the hexavalent forms have a high biodisponibility and are more toxic than the trivalent compounds. In vegetals, the assimilated chromium is stopped in the root, associated to iron hydrates; a small fraction reaches the leaves and a weaker part comes up to the grain. (Table I). If the concentration of chromium--mainly hexavalent salts--is very important in soil, the mechanism of regulation in the rootlet becomes inefficacious and chromium diffuses in the whole plant (Table II). The development of spraying of sludges and composts will increase the quantity and efficiency of chromium in vegetals, because of various factors: the wastes of many industries: chromium plating plants, tanneries, painting and dyeing industries throw out hexavalent chromium; if the sewage sludges are purified by an irradiation treatment, it will tend to oxidize the whole chromium in hexavalent forms; at last, the presence of sewage sludges in the arable soil favours the assimilation of chromium by inhibiting that of iron (Figure 1). Then, in absence of iron hydrates that regularize the diffusion of chromium in the plant, this latter tends to overrun more easily the aerial tissues and organs of vegetals. On the whole, the spraying of sewage sludges supplies the soil with chromium that will easily be assimilated by the plant, considering that it will be mainly at an hexavalent state. Compared with other trace elements held in the sludges, chromium is assimilated by the plant in a clearly more important proportion (Table III). That is why the consequences of spraying concern more particularly chromium than other elements, even if they are toxic. The intensification of spraying will contribute to increase the chromium intake that varies from 100 to 200 micrograms/day and whose 60% are provided by foods of vegetal origin. The consequences of a more important intake will be dependent on chemical state of chromium. If the hexavalent salts are predominant, an increase of intake will provoke a high intestinal absorption, a raising of chromium rate in liver, kidney, spleen, bone, etc. This situation will eventually be responsible for a chronic intoxication.(ABSTRACT TRUNCATED AT 400 WORDS)

[A case of suicide suspected of poisoning from taking some agricultural chemicals]

Forensic toxicological examination was performed on a person who was suspected of poisoning by Azomite emulsion (an acaricide), Roundup (a herbicide) and/or unidentified agricultural chemical and died after 4 days. In Japan, production of Azomite emulsion has been stopped since 1973. The unidentified agricultural chemical was identified as an agricultural chemical containing malathion, an organo phosphorous compound, by analyzing with gas chromatograph-mass spectrometer (GC-MS). When the person's serum was qualitatively analyzed with GC-MS, aramite and azoxybenzene, effective components of Azomite emulsion, were detected but not glyphosate, effective component of Roundup, and malathion. And so, quantitative analysis of aramite and azoxybenzene were performed with mass fragmentography. Aramite and azoxybenzene concentrations in the serum obtained at about 9 hours after he took Azomite emulsion were 5.20 micrograms/ml and 112 micrograms/ml, respectively. Only trace amounts of them were, however, detected in the serum obtained at about 3.5 days after that. Both aramite and azoxybenzene existed significantly in liver of the corpse, and their concentrations were 12.0 micrograms/g and 254 micrograms/g, respectively. Relatively large amounts of them were also deposited in the kidney. Severe liver and kidney disorders shown in this case were considered to be mainly induced by deposits of aramite and azoxybenzene in the liver and kidney. Also in the future, poisoning by agricultural chemicals that productions have been stopped like Azomite emulsion may happen. Therefore, it may be necessary for forensic toxicologists and medical doctors in emergency hospitals to try to be able to cope promptly with such poisoning cases.

Investigation of a fatality among parathion applicators in California

Staff of the California Department of Health Services investigated the death of a parathion applicator in California that was thought to be pesticide-related. A crew of eleven workers (including six sprayers, three mixer/loaders, one mixer/sprayer and one foreman) had been applying 0.125% parathion spray to almond orchards for approximately three weeks. On the day of the fatality, a sprayer rapidly developed symptoms of salivation, sweating, and convulsions after a half-day of work. Despite aggressive medical treatment, the worker died within one hour of his initial symptoms. Significant laboratory results for the decreased case included: parathion residue on the inner and outer garments worn by the worker, parathion in the post-mortem gastric contents, and elevated urinary metabolites consistent with acute parathion intoxication. Interviews with the work crew revealed that three of the 10 workers had complaints of headaches, vomiting, and/or sore throat; yet, subsequent plasma and red cell cholinesterase tests of the co-workers did not show any significant depressions in comparison with pre-season baseline values. This worker death is consistent with prior reports of parathion-related sprayer/applicator intoxications and is the first worker-related parathion death in California since 1972. Substitution of pesticides with less toxic active ingredients or the elimination of parathion is recommended.