study on cholinergic insecticide poisoned cases admitted during 2002 to Menoufiya poisoning control center [MPCC]

ABSTRACT

Organophosphates and carbamates are the most frequently used insecticides worldwide. The aim of the present work is to study the problem of cholinergic insecticides among the patients admitted to MPCC, The study included 465 cases where it is clear that the cholinergic insecticides poisoned cases represented about quarter of the total number of poisoned cases admitted to MPCC during the year of 2002. The highest rate of admission was in the summer months specially June and July due to the prevalent use of pesticides during the summer season for agricultural demand. 49.6% of cases were between the ages of >18-50 years which is the age group of field working and handling of the pesticides. As regard the sex, females showed slightly higher% age [56.99%] than males [43.01%]. Patients from rural areas showed% age [66.23%] than those from urban ones [33.76%] due to conducting the study in agricultural governorate. Single subjects were [87.1%]. 60.43% of the total cases were affected indoors which may be secondary to improper storage and illegal use of insecticides. Males were more affected than females outdoors in the age group of 18-50 years due to the fact that in this age group males are exposed in farms as most of the cases were in the rural areas. As regards to the circumstances of poisoning, it was found that accidental cases had the highest% age [72.69%] which was mainly in farmers, while suicidal cases were [26.88%] which was mainly in students and females at the age group of >18-50 years. This age in the female represents the age of changeable emotional and psychological factors together with the exposure to educational, marital andsocio-economical stresses. Oral route represented the highest% age [64.5%] of cases. Females were significantly higher than males at age group of >18-50 years in taking the pesticides orally for committing suicides. As regards frequency of clinical manifestations among studied cases, it appeared that latent cases were [35.7%] of cases, the main manifestations were muscarinic [64.3%] especially constricted pupils. Patients with predominant nicotinic manifestations represented [21.9%], and [16.3%] of cases were unconscious. The severe cases were higher in children less than 7 years. It was found that cholinesterase activity is not sensitive test to measure severity of the poisoning if it is less than 10%, but it is highly specific test [98.4%] in exclusion of poisoning, if its activity is more than 50% of normal value. Analytical toxicological screening by TLC showed [8 1.93%] of cases were +ve for organophosphates, [11.82%] of cases were +ve for carbamates while [6.25%] of cases were +ve for both of them. As regards the MPCC schedule of treatment it is clear that emesis, activated charcoal and cathartics were the most common lines used in 35.7% of cases. 28.8% of cases had gastric lavage activated charcoal, cathartics and atropine. As regarding physiological antidotes, 64.3% of cases received atropine and only [1.72%] of cases were given atropine and pralidoxime, all cases received supportive treatment. As regard period of admission, the highest% age of cases [69.89%] were discharged after one day admission, [28.81%] were discharged after 2-7 days and [1.29%] after more than one week. Prognostic data showed that [96.6%] of cases were discharged with complete cure and only very low or even negligible fatality [0.4%], this may be attributed to the well organized medical facilities and the increasing experience of the medical staff in the diagnosis andtreatment of pesticide poisoning. It is clear that early ambulance to the hospital, rapid approach to diagnoses and management, are mandatory for the best outcome of the cases. it is recommended to apply laws, which limit the use of these pesticides, and their manufacture in strict circumstances, to lessen their hazards