Assessment of Cholinesterase inhibition activity of birds inhabiting pesticide exposed croplands and protected area in hot semi-arid region of Pakistan / Avaliação da atividade de inibição da colinesterase de pássaros que habitam áreas cultivadas e áreas protegidas expostas a pesticidas na região semiárida quente do Paquistão

Abstract Acetylcholinesterase (AChE) activity levels can be used as an indicator for AChE inhibition due to pesticide poisoning in bird species. We assessed the comparative brain cholinesterase (AChE) activity level of five bird species inhabiting pesticide exposed croplands and Protected Area i.e. Deva Vatala National Park (DVNP), Bhimber by using a spectrophotometric method. AChE activity levels ranged from 56.3 to 85.9 µmol/min/g of brain tissue of birds representing DVNP. However, AChE activity levels ranged from 27.6 to 79.9 µmol/min/g of brain tissue of birds representing croplands. AChE activity levels observed in Jungle babbler, Common babbler, and Red-vented bulbul showed significant differences (P < 0.05) at two sites. However, White wagtail and Black drongo demonstrated non-significant differences (P > 0.05). Maximum inhibition was recorded in Jungle babbler (53%) followed by Common babbler (35%), Red-vented bulbul (18%), White wagtail (15%), and Black drongo (7%). The brain cholinesterase inhibition levels under-protected ecosystems (DVNP, Bhimber) and agricultural landscape suggest insecticidal contamination and its impact on avifauna diversity. The study also emphasizes on the importance of pesticide-free zones to protect the biodiversity of birds.

Resumo Os níveis de atividade da acetilcolinesterase (AChE) podem ser usados ​​como um indicador para a inibição da AChE devido ao envenenamento por pesticidas em espécies de aves. Avaliamos o nível de atividade comparativa da colinesterase cerebral (AChE) de cinco espécies de aves que habitam áreas cultivadas expostas a pesticidas e Área Protegida, ou seja, Deva Vatala National Park (DVNP), Bhimber, usando um método espectrofotométrico. Os níveis de atividade da AChE variaram de 56,3 a 85,9 µmol / min / g de tecido cerebral de aves representando DVNP. No entanto, os níveis de atividade da AChE variaram de 27,6 a 79,9 µmol / min / g de tecido cerebral de aves representando áreas de cultivo. Os níveis de atividade de AChE observados no tagarela da selva, tagarela comum e bulbul vermelho exalado mostraram diferenças significativas (P < 0,05) em dois locais. No entanto, alvéola branca e drongo preto demonstraram diferenças não significativas (P > 0,05). A inibição máxima foi registrada no tagarela da selva (53%), seguido pelo tagarela comum (35%), bulbul vermelho (18%), alvéola branca (15%) e drongo preto (7%). Os níveis de inibição da colinesterase cerebral nos ecossistemas subprotegidos (DVNP, Bhimber) e na paisagem agrícola sugerem contaminação por inseticida e seu impacto na diversidade da avifauna. O estudo também enfatiza a importância das zonas livres de pesticidas para proteger a biodiversidade das aves.

Manejo actual de las intoxicaciones agudas por inhibidores de la colinesterasa: conceptos erróneos y necesidad de guías peruanas actualizadas / Current treatment of cholinesterase inhibitors poisoning: misconceptions and need for updated Peruvian guidelines

En el mundo existen millones de casos de intoxicaciones por inhibidores de la colinesterasa y miles de muertes por estas sustancias. Nuestro país no es escenario diferente. Actualmente se sigue estudiando cuáles son los regímenes más útiles y se debate algunas medidas de manejo hasta ahora muy utilizadas. La tendencia actual apunta a un tratamiento agresivo en vista que son muy raros los casos de eventos adversos severos que ponen en riesgo la vida producto del uso de fármacos como la atropina. En el Perú no hay investigación activa al respecto y solo se cuenta con una guía de manejo de intoxicaciones por organofosforados y carbamatos en niños elaborada por el Ministerio de Salud en el año 2005. Urge actualizar esta guía, ya que contiene conceptos que han cambiado en algunos casos de forma radical. El propósito de esta revisión es exponer brevemente la información actualizada más relevante sobre el manejo de estas intoxicaciones y finalmente sugerir recomendaciones para hacer modificaciones en la guía mencionada y a su vez hacer un llamado a las autoridades del Ministerio de Salud peruano para el desarrollo de una guía en adultos...

Millions of cases of cholinesterase inhibitors poisonings occur in the world and thousands of deaths by these substances are reported. Our country is not different scenario. The most useful treatment regimen is currently under research and some extensively used measures are on debate. The current trend is aggressive treatment as severe life-threatening adverse effects by drugs like atropine are very rare. In Peru there is no active research on this issue and only an organophosphate and carbamate poisoning in children treatment guide by the Ministry of Health in 2005 is available. It is urgent to update these guidelines, since they contain concepts that in some cases have radically changed due to current knowledge. The aim of this review is to briefly expose the most relevant updated information on treatment of these poisonings, to suggest evaluation of the mentioned guidelines, and to call attention of the Peruvian Ministry of Health authorities to develop guidelines for adults...

Pattern of Maxillofacial Fractures in Severe Multiple Trauma Patients: A 7-year Prospective Study

The incidence of facial trauma is high. This study has the primary objective of documenting and cataloging maxillofacial fractures in polytrauma patients. From a total of 1229 multiple trauma cases treated at the Emergency Room of the Santo Antonio Hospital - Oporto Hospital Center, Portugal, between August 2001 and December 2007, 251 patients had facial wounds and 209 had maxillofacial fractures. Aged ranged form 13 to 86 years. The applied selective method was based on the presence of facial wound with Abbreviated Injury Scale ≥1. Men had a higher incidence of maxillofacial fractures among multiple trauma patients (86.6%) and road traffic accidents were the primary cause of injuries (69.38%). Nasoorbitoethmoid complex was the most affected region (67.46%) followed by the maxilla (57.42%). The pattern and presentation of maxillofacial fractures had been studied in many parts of the world with varying results. Severe multiple trauma patients had different patterns of maxillofacial injuries. The number of maxillofacial trauma is on the rise worldwide as well as the incidence of associated sequelae. Maxillofacial fractures on multiple trauma patients were more frequent among males and in road traffic crashes. Knowing such data is elementary. The society should have a key role in the awareness of individuals and in prevention of road traffic accidents.

É alta a incidência de traumas na face. Este estudo teve por objetivo documentar e catalogar as fraturas maxilofaciais em pacientes com politraumatismos. De um total de 1229 casos de politraumatizados tratados na Sala de Emergência do Hospital de Santo António - Centro Hospitalar do Porto, Portugal, entre Agosto de 2001 e Dezembro de 2007, 251 pacientes tiveram ferimentos na face e 209 apresentaram fraturas maxilofaciais. As idades variaram de 13 a 86 anos. O método de seleção baseou-se na presença de ferimentos na face com Abreviated Injury Scale ≥1. Os homens apresentaram maior incidência de fraturas maxilofaciais (86,6%) entre os pacientes com múltiplos traumatismos na face e os acidentes de trânsito foram a causa principal dos traumatismos (69,38%). A região mais afetada foi o complexo naso-órbito-etmoidal (67,46%), seguido pela maxila (57,42%). O padrão e a apresentação das fraturas maxilofaciais tem sido estudado em muitas regiões do mundo com resultados variados. Pacientes com politraumatizados graves apresentaram padrões diferentes de traumatismos maxilofaciais. O número de traumatismos maxilofaciais tem aumentado à escala mundial, assim como a incidência das sequelas associadas. Entre os pacientes com traumatismos múltiplos, a maioria pertencia ao sexo masculino, assim como a causa mais frequente foram os acidentes automobilísticos. É elementar o conhecimento destes dados. A sociedade tem um papel primordial nos cuidados individuais e na prevenção dos acidentes de trânsito.

Propoxur-induced acetylcholine esterase inhibition and impairment of cognitive function: Attenuation by Withania somnifera.

Propoxur (2-isopropoxyphenyl N-methylcarbamate) is widely used as an acaricide in agriculture and public health programs. Studies have shown that sub-chronic exposure to propoxur can cause oxidative stress and immuno-suppression in rats. Carbamates are also known to exhibit inhibitory effect on cholinesterase activity, which is directly related to their cholinergic effects. In the present study, the effect of Withania somnifera (Ashwagandha), a widely used herbal drug possessing anti-stress and immuno-modulatory properties was studied on propoxur-induced acetylcholine esterase inhibition and impairment of cognitive function in rats. Male Wistar rats were divided into four groups. Group I was treated with olive oil and served as control. Group II was administered orally with propoxur (10 mg/kg b.wt.) in olive oil, group III received a combination of propoxur (10 mg/kg b.wt.) and W. somnifera (100 mg/kg b.wt.) suspension and group IV W. somnifera (100 mg/kg b.wt.) only. All animals were treated for 30 days. Cognitive behaviour was assessed by transfer latency using elevated plus maze. Blood and brain acetylcholine esterase (AChE) activity was also assessed. Oral administration of propoxur (10 mg/kg b.wt.) resulted in a significant reduction of brain and blood AChE activity. A significant prolongation of the acquisition as well as retention transfer latency was observed in propoxur-treated rats. Oral treatment of W. somnifera exerts protective effect and attenuates AChE inhibition and cognitive impairment caused by sub-chronic exposure to propoxur.

Cardiotoxicity of acute organophosphate poisoning

To study the cardiotoxicity of acute organophosphate [OP], poisoning, this study was designed to evaluate 46patients who presented to the Benha poisoning control unit over a 14 months period from the 1st of March, 2007 to 30 April 2008, with acute OP poisoning and discus their associated cardiac complication and electrocadiographical [ECG] abnormalities. The serum level of cholinesterase [AChE] was significantly lower than the normal value. At the same time serum creatinine kinase [CK-MB] and cardiac trophonin I [CTnI] levels were significantly elevated at the time of admition indicating the presence some degree of cardiac injury. ECG changes confirmed the presence of cardiac injury. These was sinus tachycardia [34.78%] which the most common ECG abnormality, sinus bradycardia occurred in 9 patients [19.56%], hypertension developed in 6 patients [14.04%] and hypotension in 6 patients [13.04%]. OP induced impaired cardiac conductivity inform of prolongation of the QTc interval [32.61%] and prolonged PR interval [8.70%] and increased cardiac excitability in the form of extracystole [6.52%], ventricular tachycardia [2.17%] and atrial fibrillation [4.35%] and also induced myocardial cell injury manifested by elevated ST segment [15.22%]. Cardiac trophonin I [CTnI] level is indicated for diagnosis of cardiac injury due to OP poising when the patient is seen 3 days after intoxication. Most of cardiac complications associated with organophosphate occur during the first few hours after exposure. Sympathetic, parasymathatic over activity hypoxemia, acidosis and electrolyte derangements and a direct toxic effect of the OP on the myocardium are major predisposing factors for the development of these complications. The cardiac complications and ECG abnormalities all returned to normal before the patients were discharged. Initial complete ECG is recommended and should be obtained immediately in the Poison Control Unit in patients with acute OP or poisoning

Impact of malathion on the biochemical parameters of gobiid fish, Glossogobius giuris (Ham).

There is a dearth of information regarding the changes in heart muscle metabolites induced by pesticides. In the present study, the gobiid fish, Glossogobius giuris, was exposed to sub lethal concentrations of (0.05, 0.25 and 0.5 ppm) organophosphorus pesticide, malathion for short duration (24 to 96 hr). The cardiac muscles showed maximum depletion of glycogen and cholesterol content during 72 and 96 hr after treatment with 0.5 ppm malathion. Whereas a slight fluctuation of protein and glycogen content was observed in low concentration (0.05 ppm) of malathion. The levels of protein showed a significant decrease at high concentration (0.5 ppm) when treated for longer duration (96 hr). The present study reports metabolic dysfunction in response to malathion toxicity in the fish.

The effect of Chlorpyrifos, an organophosphate in acetyl cholinesterase activity in freshwater fishes.

The freshwater fish Catla catla, Labeo rohita and Cirrhinus mrigala are exposed to the toxicant chlorpyrifos, an organo phosphate commonly used in agriculture as well as in aquaculture. The effect was studied on the enzyme acetyl cholinesterase activity which was inhibited in the selected tissues of the fish. In different tissues and in brain, the maximum inhibition was observed.

Effect of fenvalerate technical grade on acetyl cholinesterase activity in Indian bullfrog Haplobatrachus tigerinus (Daudin).

Indian bullfrog Haplobatrachus tigerinus (Daudin) was exposed to sublethal dose (1/3 of LC50 I.E. 1.166 mg/kg) of fenvalerate technical grade and the effect was studied on the specific activity of acetyl cholinesterase in the different tissues of frog viz., brain, muscle, liver, kidney and testis at different time periods viz., 3,6, 12, 24, 48 and 72 hours. The inhibition of specific activity of acetyl cholinesterase was in the order of kidney > brain > muscle > liver > testis. A significant inhibition was noticed in kidney at 12 hours (-64.33%) and no effect was noticed at 3 hours in testis (+0.67%). The AChE activity was inhibited in first three hours of administration of fenvalerate in all the tissue tested. The inhibition continued upto 6 hours or 2 hours in different tissue but the recovery was started by 24 hours and almost completed by 72 hours.

Subacute toxicity of anilofos, a new organophosphorus herbicide, in male rats: effect on some physical attributes and acetylcholinesterase activity.

In acute toxicity study, rats showed dose-dependent signs of cholinergic hyperactivity and behavioural alterations. Maximum intensity of symptoms was not associated with mortality. Oral LD50 was 1681 mg/kg. In subacute toxicity study, rats were orally administered 50, 100 or 200 mg/kg of anilofos once daily for 28 days. Signs and symptoms were observed mainly with 200mg/kg. At this dose, anilofos induced hypothermia and progressive weight loss. None of the anilofos-treated rats died. Weight of brain, lung, testis was not altered, while of liver, heart, spleen and kidney increased. Anilofos inhibited cholinesterase (ChE) activities of erythrocyte (41-67%), plasma (36%), blood (37-64%), brain (63-73%) and liver (28-48%). Total protein was decreased in plasma and liver. Results indicate moderate toxic potential of anilofos in mammals, substantial contribution of CNS-mediated effects in causing anilofos toxicity and no direct relationship between hypothermia and level of ChE inhibition.

Methyl parathion induced alterations in monoaminergic system of developing rat pups.

Methyl parathion induced alterations in the level of monoamines, viz. norepinephrine, dopamine and serotonin were studied in discrete regions of developing central nervous system of rat pups. A significant decrease in the level of monoamines noticed in methyl parathion toxicosis may be related to the altered neuronal activity and inefficiency, leading to depression and impairment in various behavioural activities. In contrast to AChE inhibition, monoamine oxidase (MAO) activity showed an increasing trend and it could cause deamination of catecholamines and accumulation of its metabolites. This suggests that an increased AChE inhibition may indirectly stimulate MAO activity in developing rat pups exposed to methyl parathion.

Desvio no uso de agrotóxicos (carbamatos e organofosforados): uma revisão epidemiológica, clínica e terapêutica / Deviation in the use of pesticides (organophosphates and carbamates): a review epidemiological, clinical and therapeutic

A idéia deste trabalho partiu do interesse despertado, principalmente nos últimos anos, pela disseminação do uso de inseticidas no Brasil e em especial no Rio de Janeiro. Pode-se observar um elevado número de intoxicações humanas, quer intoxicações agudas (principalmente ingestão acidental em crianças e tentativa de suicídio em adultos, desviando-se, assim, de seu uso regular), quer intoxicações crônicas ocupacionais. Dentre os inseticidas mais importantes na toxicologia ocupacional, clínica e de urgência, encontram-se os compostos inibidores da colinesterase, os inseticidas carbamatos e organofosforados. A presente faz um levantamento bibliográfico da literatura científica sobre agrotóxicos, centralizando-se nos aspectos da intoxicação aguda, tendo em vista o desvio na sua utilização legal, levantando-se aspectos crônicos e tardios destas intoxicações. Foi feito, ainda, um levantamento de dados para se traçar um perfil epidemiológico nacional, em relação às intoxicações por estes agentes. Desta forma, pretende-se demonstrar que tais produtos vêm sendo, costumeiramente desviados de seu uso regular e nada tem sido feito para que se controle este desvio. A partir desta análise, apresenta-se uma proposta de abordagem destes pacientes,tentando, desta forma, contribuir para o entendimento destas intoxicações e, assim, diminuir a mortalidade referente às mesmas.

Evaluación epidemiológica de plaguicidas inhibidores de acetilcolinesterasa en Colombia, 1996-1997 / Epidemiological evaluation of acetylcholinesterase-inhibiting pesticides in Colombia, 1996-1997

El programa de vigilancia epidemiológica d plaguicidas organofosforados y carbamatos (VEO) fue creado mediante el establecimiento de convenios de cooperación y asistencia técnico-científica entre el Laboratorio de Salud Ambiental del Instituto Nacional de Salud y las seccionales de salud del país. El programa tiene como finalidad detectar precozmente los casos de absorción elevada de plaguicidas e impulsar el desarrollo de acciones de promoción, prevención y control, que disminuyan la incidencia de intoxicaciones agudas y los efectos crónicos producidos por los plaguicidas inhibidores de la acetilcolinesterasa (ACHE). Durante 1996 y 1997, participaron en el estudio 17 entidades territoriales de salud y 21.454 personas que presentaban riesgo de exposición a plaguicidas organofosforados y carbamatos. A estas personas se les realizaron 24.167 análisis de ACHE, mediante el método de Limperos y Ranta, utilizando el equipo de Lovibond. La prevalencia de valores anormales de ACHE fue de 6,1 pro ciento, muy similar a las encontradas de 1993 a 1995. Las entidades territoriales de salud encontradas con mayores prevalencias después de realizar la estandarización directa fueron Bolívar (20,3 por ciento) en 1996 y Córdoba (17,7 por ciento) en 1997. Las variables asociadas con mayores prevalencias de anormalidad para ACHE fueron las aplicaciones aérea y terrestre en actividades económicas; el de banderero y mezclador-tanquedor-formulador en oficios y los grupos de edad de 18 a 25 años y de 6 a 11 años. Solamente 36,1 por ciento de los participantes en el estudio estaban afiliados al sistema general de seguridad social en salud (SGSSS); 63,9 por ciento no estaban cubiertos por el sistema y, de éstos, 7,1 por ciento tenían valores anormales de ACHE. La evaluación epidemiológica para 1996 - 1997 se comparó con la de los años anteriores y se determinó la población con mayor riesgo; se cuantificaron los niveles de intoxicación y se aportaron las conclusiones para fortalecer la vigilancia epidemiológica. De esta manera, a través de sus actividades y de su trayectoria, el programa VEO ha ido perfilando con mayor exactitud el riesgo ocasionado por los plaguicidas inhibidores de la ACHE en el país

Antidotal efficacy of pyridinium oximes and cholineacetyltransferase inhibitors against organophosphorus intoxication in rodents.

In an attempt to develop effective antidote against organophosphorus intoxication, some new imidazole-pyridinium mono-oximes, long chain pyridinium mono-oximes and cholineacetyltransferase inhibitors were synthesised. These compounds were evaluated for their in vivo therapeutic protection and neuromuscular function studies in rodents. The results indicate that SPK-series oximes may be useful against sarin poisoning without any beneficial effect against VX (O-Ethyl S-2-NN-diisopropylaminoethyl methylphosphonofluoridate) intoxication. The cholineacetyltransferase (ChAT) inhibitors may not be of any help against any of the OP compounds studied in this study.

Physiological, biochemical and histological changes due to physostigmine in monkeys.

Physostigmine (Phy), a short-acting reversible anticholinesterase agent is considered to be a potent prophylactic antidote for the highly toxic organophosphorous (OP) compounds. The toxic effects, if any, of the probable prophylactic doses of Phy have been evaluated by studying its physiological, biochemical and histological effects in monkeys. Phy only at 100 micrograms/kg resulted in certain cholinergic signs such as salivation, lacrymation and muscular faciculations; physiological changes such as mild tachycardia, tachypnea, higher amplitude in electrical activity of the brain, clinico-chemical effects like fall in PO2, PCO2 and alkalosis and histologically an inflammatory reaction in the lungs. On the other hand, the lower dose, i.e. 50 micrograms/kg appeared to be devoid of cholinergic signs and symptoms. However, we observed a significant inhibition of both plasma and erythrocyte ChE and increase in the rectal temperature in both the Phy treated groups. From this study, Phy at a dose of 50 micrograms/kg could be inferred as a safe, sign free intramuscular dose and may probably be used in pretreatment regimen against nerve agents.

Male reproductive toxicity of phosphamidon: histopathological changes in epididymis.

Phosphamidon, a neurotoxic insecticide, was tested for male reproductive toxicity with special reference to the epididymis. The insecticide was fed to Wistar strain male albino rat at 35 ppm concentration in drinking water ad libitum for 30 days. After vascular perfusion, thin slices of caput and cauda epididymidis were embedded in plastic, cut at 1 micron thickness and stained in toluidine blue for light microscopic observation. Principal cells of the caput epididymidis were vacuolarized and seen to pinch off fragments apically. In the proximal cauda the clear cells increased in height and in the size of the secondary lysosomal granules. In the distal cauda the clear cells appeared swollen out of proportion. Phosphamidon appears to affect the principal cells indirectly through its toxic effect on the Leydig cells; the clear cells of the cauda appear to be directly vulnerable to the toxic action of the pesticide.

Panorama epidemiológico de exposición a plaguicidas inhibidores de colinesterasa en 17 departamentos del país / An epidemiological panorama of exposure to cholinesterase pesticides in 17 of the country's departaments

Los organofosforados y carbamatos son los responsables de la mayor parte de intoxicaciones por plaguicidas que se presentan en el país; son potentes inhibidores de la enzima acetilcolinesterasa, causando graves intoxicaciones agudas de tipo laboral como también efectos a largo plazo. Ante esta problemática, en 1982, el Instituto Nacional de Salud (INS), a través del Laboratorio de Salud Ambiental creó el Programa de Vigilancia Epidemiológica de plaguicidas organofosforados y carbamatos (VEO), empleando el método Lovibond para la determinación de la acetilcolinesterasa (ACHE) como indicador, con el fin de detectar precozmente los casos de absorción elevada de plaguicidas. A partir de 1993, se cuenta con información de 17 departamentos del país, datos que se analizaron. La totalidad de las personas que participó en el estudio de 1993 a 1995 fueron 41.899, las cuales tenían antecedentes de exposición a plaguicidas organofosforados o carbamatos. el 80 por ciento de los trabajadores que ingresaron al estudio pertenecían al género masculino, siendo el grupo de edad más afectado el de 18 a 40 años. Las mayores prevalencias de anormalidad para ACHE, según actividad económica, fue para la aplicación urbana y en relación a los oficios, para mezclador-tanqueador-formulador. Con relación a la seguridad social de 23.917 trabajdores, tan sólo 31,7 por ciento se encontraba afiliada a entidades de este tipo. Los datos obtenidos permitieron establecer el panorama epidemiológico de la intoxicación por plaguicidas inhibidores de colinesterasa, determinando la población de mayor riesgo, lo que conllevará a plantear nuevos estudios de investigación en esta población

A comparative study of delayed neurotoxicity in hens following repeated administration of organophosphorus compounds.

Hens treated with Mipafox (10 mg/kg, sc), sarin (50 micrograms/kg, sc) or parathion (1 mg/kg, sc) daily for 10 days exhibited severe, moderate and no ataxia respectively on 14th day after the start of exposure. The neurotoxic esterase (NTE) activity was significantly inhibited in the brain, spinal cord and platelets of hens treated with mipafox or sarin whereas no change was noticed with parathion treatment. All three compounds significantly inhibited acetylcholinesterase (AChE) activity in the platelets. Spinal cord of hens treated with mipafox, sarin or parathion showed axonal degeneration heavy, moderate and none respectively. It is concluded that repeated administration of equitoxic doses of mipafox, sarin and parathion to hens are marked, moderate and non-delayed neurotoxic respectively.

Some haematological studies on marshal in white rats

Forty rats were used to investigate the effects of marshal insecticide on hemogram, bone marrow and blood coagulation. Treated rats were fed on a ration containing 500 ppm marshal for 3 weeks. Blood and bone marrow samples were taken weekly and subjected to examination of RBCs and WBCs count, Hb concentration, PCV, platelet count, fibrinogen, PT and APTT. In addition to determination of M/E ratio in the bone marrow. The same tests were done in the control group. A marked decrease in RBCs count, Hb concentration and PCV was noted with development of microcytic hypochromic anaemia. Bone marrow showed a marked increase in the M/E ratio. A significant decrease in platelet count was recorded while fibrinogen values, PT and APTT were significantly increased throughout the experiment

Intoxicaciones graves por inhibidores de la acetilcolinesterasa / Serious intoxications by acetylcholine esterase inhibitors

Se analizan en forma retrospectiva 17 casos de intoxicaciones graves por inhibidores de la acetilcolinesterasa ingresadas a nuestra UCI entre los años 1985-92. Se observó una incidencia de 5 casos por cada 1000 ingresos. Siendo el 76 por ciento de ellos en edad de trabajo activo, provenientes de zonas rurales que intentaron suicidarse por este medio. Se analiza el tratamiento inicial recibido por ellos, a partir de lo cual se proponen algunas sugerencias para mejorar las condiciones de su traslado al hospital de referencia. La mortalidad específica fue mayor (29 por ciento) que la que presentan la globalidad de la intoxicaciones (13 por ciento). Dicha cifra puede estar sobreestimada debido a que el diagnóstico no se pudo realizar con certeza en 3 de los 5 pacientes fallecidos