Aldicarb poisoning

Aldicarb, 2-methyl-2 (methylthio) propanal o-[(methylamino)-carbonyl] oxime is a pesticide manufactured since 1965. This carbamate ester is sold under the tradename Temik and is used as an insecticide and nematicide. The Environmental Protection Agency has classified aldicarb in the highest toxicity category and has defined a strict control for its delivery and use. In Brazil and the Caribbean island of Guadeloupe, aldicarb is illegally used as a household rodenticide with a widespread risk of poisoning. Our study presents the first review of aldicarb poisoning with clinical and analytical findings and oxime treatment is discussed. Eighteen patients with cholinergic symptoms admitted to the Emergency Unit and two with a history of aldicarb poisoning who died were included in the study. As agricultural workers, only two of them could legally use Temik. Seventy percent of the patients were managed by the Emergency Mobile Unit. Serum cholinesterase activity was always < 30 percent of the normal range and aldicarb was identified by ultraviolet spectra and retention time after liquid chromatography separation. The most common muscarinic effect was diarrhoea (98 percent), the main nicotinic sign was fasciculation (78 percent) and 44 percent of the poisoned patients had central nervous system depression (Glasgow Coma Score < 8). Four patients had serious abnormalities and two of them died. These results suggest that aldicarb intoxication is always severe. Oxime treatment did not produce side effects and should be recommended whenever the pesticide involved is unknown. Effective measures should be implemented to stamp out the illicit use of aldicarb.(Au)

[Sickle cell anemia and pregnancy: review of 68 cases in Guadeloupe]. / Drépanocytose et grossesse: revue de 68 observations en Guadeloupe.

Pregnancy in women with major sickle cell syndromes is a high risk maternofetal situation. This descriptive study presents the features and the clinical course of 68 pregnancies in sickle cell women who were delivered in Guadeloupe from January 1(st) 1993 to December 31(st) 1997. Specific complications were observed in all hemoglobin types, but with a severer course in SS women. Painful vaso-occlusive crises were the main causes of hospitalisation (88% of SS pregnancies and 27% of SC pregnancies) associated most often with worsening anemia and / or infection. Acute chest syndrome was observed in all genotypes at any time throughout pregnancy and during the post partum period. One death occurred (a 16 years old SBeta(+)thal woman). Fetal mortality and morbidity were also high, intrauterine growth retardation and fetal death being the most frequent fetal complications. The rates of prematurity (21%) and caesarean section (48%) were higher than in the whole population. Three (3) neonatal deaths occurred. A multidisciplinary and specific approach, vigilance of health care providers and patient compliance are required to manage efficiently pregnancy, delivery and post partum in sickle cell women.

Aldicarb poisoning.

Aldicarb (2-methyl-2(methylthio) propanal o-[(methylamino)-carbonyl] oxime) is a pesticide manufactured since 1965. This carbamate ester is sold under the tradename, Temik, and is used as insecticide and nematicide. The Environmental Protection Agency has classified aldicarb in the highest toxicity category and has defined a strict control for its delivery and use. In Brazil and the Caribbean island, aldicarb is illegally used as a household rodenticide with a widespread risk of poisoning. Our study presents the first review of aldicarb poisoning circumstances associated with clinical and analytical findings. Moreover, the oxime treatment is discussed. Eighteen patients with cholinergic symptoms admitted to the Emergency Unit and two deceased with a history of aldicarb poisoning were included in the study. As agricultural workers, only two of them could legally use Temik. Seventy percent of the patients was managed by the Emergency Mobil Unit. Serum cholinesterase activity was always lower than 30% of the normal range and aldicarb was identified by UV spectra and retention time after liquid chromatography separation. The most common muscarinic effect was diarrhea, the main nicotinic sign fasciculation and almost half of the poisoned patients had central nervous system (CNS) depression (Glasgow Coma Score lower than 8). Four patients had serious conduction abnormalities and two of them died. These results suggest that aldicarb intoxication is always severe. Oxime treatment did not produce side effects and should be recommended whenever the pesticide involved is unknown. Effective measures should be implemented to stamp out the illicit use of aldicarb.

Leptospirosis: prognostic factors associated with mortality.

To determine the prognostic factors for leptospirosis, we conducted a retrospective study of data collected in the emergency department of our hospital between 1989 and 1993. Sixty-eight patients, for whom the diagnosis of leptospirosis was based on pertinent clinical and epidemiological data and positive serology, were included in this study. Fifty-six patients (82%) were discharged from the hospital, and 12 (18%) died. Multivariate logistic regression demonstrated that five factors were independently associated with mortality: dyspnea (odds ratio [OR], 11.7; 95% confidence interval [CI], 2.8-48.5; P < .05), oliguria (OR, 9; CI, 2.1-37.9; P < .05); white blood cell count, >12,900/mm3 (OR, 2.5; CI, 1.8-3.5; P < or = .01), repolarization abnormalities on electrocardiograms (OR, 5.9; CI, 1.4-24.8; P < or = .01), and alveolar infiltrates on chest radiographs (OR, 7.3; CI, 1.7-31.7; P < or = .01). Identification of these factors on admission might provide useful selection criteria for patients who need early transfer to the intensive care unit.

[Primary Vibrio vulnificus septicemia. 1st documented case in the French West Indies]. / Septicémie primitive à Vibrio vulnificus. Premier cas documenté aux Antilles françaises.

BACKGROUND: Vibrio vulnificus is a non-choleric halophilic vibrion widely distributed in marine environments. Contamination in humans is uncommon except in coastal areas of the United States and Asia. We report the first documented case in the French West Indies. CASE REPORT: A 57-year-old native with alcoholic cirrhosis was hospitalized for septic shock. The infectious syndrome began suddenly a few hours earlier with fever, diarrhea, and intense pain in the calf muscles. In the absence of a suspected agent, a wide spectrum antibiotic was prescribed. On day 3, bullae developed over the legs and progressed, despite early surgical debridement, to bilateral rapidly extensive necrosing cellulitis. An above the knee amputation was required but did not prevent death on day 9 due to irreversible multiple organ failure. Blood cultures were positive for V. vulnificus. DISCUSSION: Primary septicemia due to V. vulnificus is mainly observed in subjects with an underlying liver disease and usually occurs after ingestion of contamined raw halieutic products such as oysters. The clinical presentation is characteristic with secondary necrotic ulcerations on the lower limbs. Improvement in the extremely poor prognosis of these infections depends on early initiation of an effective antibiotic with wide exeresis of necrotic tissue. Physicians should be aware of this severe infection despite its low frequency.

[Pathology of travelers in the Antilles. Role of imported metropolitan pathology]. / Pathologie du voyageur aux Antilles. Place de la pathologie métropolitaine importée.

A preliminary and retrospective review--with a southern perspective--of some traveller's pathologies, mostly imported, and leading to hospital admission in Guadeloupe (FWI). End stage patients (cancer, AIDS...) frequently travel for a last, "compassional" trip. Ischemic heart disease is the leading pathology imported from the mother country (France). As well as in diabetes or psychiatric illness, destabilization frequently occurs as a consequence of travel (jet lag). Compulsive tennis plus dehydration cause the very common stone passage of nephrolithiasis. Concern is growing for heroin withdrawal syndrome or cocaine (crack)-abuse, and for supply for rare and expensive anticancer, antigraft rejection or antinfective (AIDS) agents. Much more familiar to us are photodermatitis, larva migrans, dengue, or ciguaterra, locally acquired. On the other hand some pathologies are quite "exotic" to us: Kaposi sarcoma, Lyme, or Behçet disease, familial mediterranean fever, brucellosis.

[AIDS and HIV infection in Guadeloupe]. / SIDA et infection à HIV en Guadeloupe.

By December 31, 1986, 38 cases of AIDS had been notified in Guadeloupe (French West Indies). Transmission of the disease was predominantly heterosexual; 79 p. 100 of the patients were devoid of risk factor. Sex ratio was 2.2, but the disease, which initially was mostly observed in men, seems to be developing rapidly in women. Fearing an increase in infantile mortality due to AIDS, the authors recommend routine screening of pregnant women for anti-HIV antibody.

[Analysis and criticism of hemodynamic investigations during respiratory analeptic dispensing (author's transl)]. / L'administration f'un analeptique respiratoire. Analyse et critiques des explorations hémodynamiques.

Almitrine is a respiratory analeptic acting on peripherical chemoreceptors. The hemodynamic effects have been studied with chronic respiratory diseases. The works have shown that almitrine produces an increase of pulmonary arterial pressure due to the raising of pulmonary vascular resistances by stimulation of peripherical chemoreceptors. Studying again the hemodynamic investigations with chronical respiratory failure it has been interesting to consider the effects of the produce with patients whose gazometric parameters have been normalized by artificial ventilation at FiO2 = 1, so as to produce a saturation of peripherical chemoreceptors. The results show that infused almitrine keeps hypertensive properties on pulmonary arterial with raising of pulmonary arterial resistances; the pulmonary vasoconstrictor effect is kept in spite of a normalization of blood gases. So it is necessary to look after pulmonary arterial pressure of patients receiving almitrine, that whatever the pre-existing pulmonary arterial pressure may be.

[Respiratory failure during Ogilvie's syndrom (author's transl)]. / Décompensations respiratoires au cours du syndrome d'Ogilvie.

About two cases of "Ogilvie's syndrom" so called colonic ileus or acute idiopathic dilatation of the colon, in patients with chronic bronchitis, the authors discuss the possibility of this etiology like respiratory failure. A rapid colonic decompression is necessary to prevent cecal perforation.

[Study of erythrocyte lipids after perfusion of modified fluid gelatin]. / Etude des lipides érythrocytaires après perfusion de gélatine fluide modifiée.

Study of changes in erythrocyte lipids after the infusion of 1,000 ml of modified fluid gelatin (Plasmion) demonstrated disturbances at the level of the lipid double layer with, in particular, a decrease in phosphatidyl-ethanolamines found in the serum. No erythrocyte deformation was seen.