Physical vulnerability and fatal self-harm in the elderlyMichael Eddleston
South Asian Clinical Toxicology Research Collaboration, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK
Br J Psychiatry 189:278-9. 2006
..The high number of suicides in elderly people globally is likely to be due, in part, to the difficulty they face in surviving the effects of both the poisoning and its treatment...
- Community uptake of safe storage boxes to reduce self-poisoning from pesticides in rural Sri Lanka
Flemming Konradsen
Department of International Health, University of Copenhagen, Øster Farimagsgade 5, Denmark
BMC Public Health 7:13. 2007
..Therefore, the objective of the study presented here was to determine community perceptions and use of in-house safe storage boxes for pesticides in rural Sri Lanka...
- Pattern of pesticide storage before pesticide self-poisoning in rural Sri Lanka
Fahim Mohamed
South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka
BMC Public Health 9:405. 2009
..The aim of this large observational study was to investigate the immediate source of pesticides used for self-harm to help inform suicide prevention strategies such as reducing domestic access to pesticides...
- The global distribution of fatal pesticide self-poisoning: systematic review
David Gunnell
Department of Social Medicine, University of Bristol, Bristol, UK
BMC Public Health 7:357. 2007
..Evidence is accumulating that pesticide self-poisoning is one of the most commonly used methods of suicide worldwide, but the magnitude of the problem and the global distribution of these deaths is unknown...
- Clinical outcomes and kinetics of propanil following acute self-poisoning: a prospective case series
Darren M Roberts
South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
BMC Clin Pharmacol 9:3. 2009
..However, there is limited information about the clinical toxicity and kinetics. The objective of this study is to describe the clinical outcomes and kinetics of propanil following acute intentional self-poisoning...
- The hazards of gastric lavage for intentional self-poisoning in a resource poor location
Michael Eddleston
Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, England
Clin Toxicol (Phila) 45:136-43. 2007
..After noting probable harm from gastric lavage in Sri Lanka, we performed an observational study to determine how lavage is routinely performed and the frequency of complications...
- Multiple-dose activated charcoal in acute self-poisoning: a randomised controlled trial
Michael Eddleston
Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
Lancet 371:579-87. 2008
..We therefore aimed to assess whether routine treatment with multiple-dose activated charcoal, to interrupt enterovascular or enterohepatic circulations, offers benefit compared with no charcoal in such an environment...
- Predicting outcome using butyrylcholinesterase activity in organophosphorus pesticide self-poisoning
M Eddleston
Scottish Poisons Information Bureau, Royal Infirmary of Edinburgh, and Clinical Pharmacology Unit, University of Edinburgh, UK
QJM 101:467-74. 2008
..Previous studies have been confounded by the inclusion of multiple insecticides with differing inhibitory kinetics...
- Fatal injury in eastern Sri Lanka, with special reference to cardenolide self-poisoning with Cerbera manghas fruits
Michael Eddleston
Scottish Poisons Information Bureau, Royal Infirmary of Edinburgh, and Clinical Pharmacology Unit, University of Edinburgh, United Kingdom
Clin Toxicol (Phila) 46:745-8. 2008
..During review of fatal injuries seen in a teaching hospital in eastern Sri Lanka, we noted cases of fatal self-poisoning with Cerbera manghas (sea mango, pink eyed cerbera, odollam tree) fruits...
- Management of acute organophosphorus pesticide poisoning
Michael Eddleston
Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, England
Lancet 371:597-607. 2008
..Improved medical management of organophosphorus poisoning should result in a reduction in worldwide deaths from suicide...
- Identification of strategies to prevent death after pesticide self-poisoning using a Haddon matrix
M Eddleston
Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
Inj Prev 12:333-7. 2006
..Lessons learnt from Sri Lanka are likely to be highly relevant for much of rural Asia...
- Poisoning with the S-Alkyl organophosphorus insecticides profenofos and prothiofos
M Eddleston
National Poisons Information Service, Royal Infirmary of Edinburgh, Edinburgh, UK
QJM 102:785-92. 2009
..This chemical structure affects their responsiveness to oxime-induced acetylcholinesterase (AChE) reactivation after poisoning. However, several OP insecticides are atypical and do not have these structures...
- Relationship between blood alcohol concentration on admission and outcome in dimethoate organophosphorus self-poisoning
Michael Eddleston
University of Edinburgh and National Poisons Information Service, Royal Infirmary of Edinburgh, Edinburgh, UK
Br J Clin Pharmacol 68:916-9. 2009
..In particular, the relationships between plasma alcohol concentration and plasma organophosphorus concentration or outcome are unclear...
- The importance of poisoning vs. road traffic injuries as a cause of death in rural Sri Lanka
Michael Eddleston
Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom Ox Col Collaboration, Department of Clinical Medicine, University of Colombo, Colombo, Sri Lanka South Asian Clinical Toxicology Research Collaboration, Sri Lanka
PLoS ONE 2:e599. 2007
..In this study, we compared the importance of road traffic crashes with other forms of injury in a poor rural region of South Asia...
- Respiratory failure in acute organophosphorus pesticide self-poisoning
M Eddleston
Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
QJM 99:513-22. 2006
..Delayed failure appears to be due to respiratory muscle weakness, but its pathophysiology is unclear...
- The need for translational research on antidotes for pesticide poisoning
Nick A Buckley
South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Colombo
Clin Exp Pharmacol Physiol 32:999-1005. 2005
..4. The few effective treatments are not being recommended or delivered in an optimal and timely fashion to poisoned patients. A regional approach to facilitate appropriate pricing, packaging and delivery of antidotes is required...
- Oximes in acute organophosphorus pesticide poisoning: a systematic review of clinical trials
M Eddleston
Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK
QJM 95:275-83. 2002
..Standard treatment involves the administration of intravenous atropine and an oxime to counter acetylcholinesterase inhibition at the synapse, but the usefulness of oximes is uncertain...
- Patterns and problems of deliberate self-poisoning in the developing world
M Eddleston
Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
QJM 93:715-31. 2000
....
- Early management after self-poisoning with an organophosphorus or carbamate pesticide - a treatment protocol for junior doctors
Michael Eddleston
South Asian Clinical Toxicology Research Collaboration, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK
Crit Care 8:R391-7. 2004
..Improved management of pesticide poisoning will result in a reduced number of suicides globally...
- Speed of initial atropinisation in significant organophosphorus pesticide poisoning--a systematic comparison of recommended regimens
Michael Eddleston
South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
J Toxicol Clin Toxicol 42:865-75. 2004
..We aimed to assess variation in textbook recommendations for early atropinisation and to see whether this variation affected time to stabilisation using model data from 22 severely poisoned patients seen in a Sri Lankan clinical trial...
- Differences between organophosphorus insecticides in human self-poisoning: a prospective cohort study
Michael Eddleston
South Asian Clinical Toxicology Research Collaboration, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK
Lancet 366:1452-9. 2005
..We aimed to determine whether the three most common organophosphorus insecticides used for self-poisoning in Sri Lanka differ in the clinical features and severity of poisoning they cause...
- Epidemiology of intentional self-poisoning in rural Sri Lanka
Michael Eddleston
Department of Clinical Medicine, Faculty of Medicine, PO Box 271, 25 Kynsey Road, Colombo 8, Sri Lanka
Br J Psychiatry 187:583-4. 2005
..Although the age pattern of self-poisoning was similar to that of industrialised countries, case fatality was more than 15 times higher and the pattern of fatal self-poisoning different...
- Commentary: Time for a re-assessment of the incidence of intentional and unintentional injury in India and South East Asia
Michael Eddleston
South Asian Clinical Toxicology Research Collaboration, and Scottish Poisons Information Bureau, Royal Infirmary, 51 Little France Crescent, Edinburgh, UK
Int J Epidemiol 36:208-11. 2007
- Clinical toxicology in China: current situation and future development
Yi Li
Emergency Department, Peking Union Medical College Hospital, Chinese Medical Academy and Peking Union Medical College, Beijing, China
Clin Toxicol (Phila) 47:263-9. 2009
..The objective of this article is to survey the situation of clinical toxicology in China and give some suggestions for its development...
- Safe storage of pesticides in Sri Lanka - identifying important design features influencing community acceptance and use of safe storage devices
Manjula Weerasinghe
South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
BMC Public Health 8:276. 2008
..This aspect, however, has been poorly researched. In this paper, we report on the design and use, in rural Sri Lanka, of a variety of different lockable storage devices...
- Patterns of hospital transfer for self-poisoned patients in rural Sri Lanka: implications for estimating the incidence of self-poisoning in the developing world
Michael Eddleston
South Asian Clinical Toxicology Research Collaboration, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, England
Bull World Health Organ 84:276-82. 2006
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- Pralidoxime in acute organophosphorus insecticide poisoning--a randomised controlled trial
Michael Eddleston
Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
PLoS Med 6:e1000104. 2009
..Although the World Health Organization recommends use of pralidoxime, this antidote's effectiveness remains unclear. We aimed to determine whether the addition of pralidoxime chloride to atropine and supportive care offers benefit...
- Pesticide poisoning in the developing world--a minimum pesticides list
Michael Eddleston
Centre for Tropical Medicine, University of, Oxford, UK
Lancet 360:1163-7. 2002
..Use of safer pesticides should result in fewer deaths, just as the change from barbiturates to benzodiazepines has reduced the number of deaths from pharmaceutical self-poisoning...
- Severe propanil [N-(3,4-dichlorophenyl) propanamide] pesticide self-poisoning
Michael Eddleston
Ox Col Collaboration, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
J Toxicol Clin Toxicol 40:847-54. 2002
..It has been recorded only rarely worldwide and most current poison texts consider propanil to be of low toxicity. However, propanil self-poisoning is a significant clinical problem in parts of Sri Lanka and an occasional cause of death...
- Pesticide poisoning in south India: opportunities for prevention and improved medical management
Ch Srinivas Rao
University College of Pharmaceutical Sciences, Kakatiya University, Warangal, India
Trop Med Int Health 10:581-8. 2005
..We aimed to describe their frequency and distribution, and to assess quality of management and subsequent outcomes from pesticide poisoning in one large hospital in the district...
- Self poisoning with pesticides
Michael Eddleston
Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford
BMJ 328:42-4. 2004
- Cost to government health-care services of treating acute self-poisonings in a rural district in Sri Lanka
Kanchana Wickramasinghe
Institute of Policy Studies of Sri Lanka, Colombo, Sri Lanka
Bull World Health Organ 87:180-5. 2009
..To estimate the direct financial costs to the Sri Lanka Ministry of Health of treating patients after self-poisoning, particularly from pesticides, in a single district...
- Acute human self-poisoning with the N-phenylpyrazole insecticide fipronil--a GABAA-gated chloride channel blocker
Fahim Mohamed
South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Colombo, Sri Lanka
J Toxicol Clin Toxicol 42:955-63. 2004
..Management should concentrate on supportive care and early treatment of seizures. However, further experience is needed to determine whether increased susceptibility to fipronil or larger doses can produce status epilepticus...
- Deaths due to absence of an affordable antitoxin for plant poisoning
Michael Eddleston
Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
Lancet 362:1041-4. 2003
..Treatments for poisoning and envenoming should be included in the present campaign to increase availability of affordable treatments in the developing world...
- Prospects for treatment of paraquat-induced lung fibrosis with immunosuppressive drugs and the need for better prediction of outcome: a systematic review
M Eddleston
Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK
QJM 96:809-24. 2003
....
- Compliance for single and multiple dose regimens of superactivated charcoal: a prospective study of patients in a clinical trial
Fahim Mohamed
South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Sri Lanka
Clin Toxicol (Phila) 45:132-5. 2007
..We aimed to describe compliance in a randomized controlled trial (RCT) performed in Sri Lanka, presuming that this would set the upper limits for compliance in routine clinical use...
- Case report does not report sufficient data to support a diagnosis of fatal organophosphorus poisoning
Michael Eddleston
South Asian Clinical Toxicology Research Collaboration, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
Clin Toxicol (Phila) 43:887-8. 2005
- Acute human self-poisoning with imidacloprid compound: a neonicotinoid insecticide
Fahim Mohamed
Department of Clinical Medicine, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
PLoS ONE 4:e5127. 2009
..This study reports the clinical outcomes and toxicokinetics of the neonicotinoid insecticide imidacloprid following acute self-poisoning in humans...
- Choice of poison for intentional self-poisoning in rural Sri Lanka
Michael Eddleston
South Asian Clinical Toxicology Research Collaboration, Center for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, England
Clin Toxicol (Phila) 44:283-6. 2006
..We aimed to determine why Sri Lankan self-poisoning patients choose particular poisons, and whether acts of self-harm with highly dangerous poisons were associated with more premeditation and effort...
- Refractory status epilepticus following self-poisoning with the organochlorine pesticide endosulfan
Darren M Roberts
Ox Col Collaboration, Department of Clinical Medicine, University of Colombo, Colombo, Sri Lanka
J Clin Neurosci 11:760-2. 2004
..In this case report, we discuss the management of status epilepticus and refractory status epilepticus. Further, we specifically discuss the clinical pharmacology and toxicology of endosulfan...
- Does gastric lavage really push poisons beyond the pylorus? A systematic review of the evidence
Michael Eddleston
Department of Clinical Medicine, University of Colombo, Colombo, Sri Lanka
Ann Emerg Med 42:359-64. 2003
..In conclusion, it seems that no published data support the statement that gastric lavage forces poison into the small bowel...
- OpdA, a bacterial organophosphorus hydrolase, prevents lethality in rats after poisoning with highly toxic organophosphorus pesticides
Steven B Bird
Department of Emergency Medicine, Division of Toxicology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
Toxicology 247:88-92. 2008
..Our results demonstrate that OpdA is able to improve survival after poisoning by two chemically distinct and highly toxic OP pesticides...
- Reducing acute poisoning in developing countries--options for restricting the availability of pesticides
Flemming Konradsen
Department of International Health, Institute of Public Health, University of Copenhagen, Panum, Blegdamsvej 3, 2200 Copenhagen, Denmark
Toxicology 192:249-61. 2003
..These should be addressed through preventive health programmes and community development efforts...
- Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries
David Gunnell
Int J Epidemiol 32:902-9. 2003
- Management of severe organophosphorus pesticide poisoning
Michael Eddleston
Crit Care 6:259. 2002
- Why suicide rates are high in China
Michael Eddleston
Science 311:1711-3. 2006
- Influence of pesticide regulation on acute poisoning deaths in Sri Lanka
Darren M Roberts
Division of Medicine, Royal Brisbane Hospital, Queensland, Australia
Bull World Health Organ 81:789-98. 2003
..Furthermore, such regulations must be implemented alongside other strategies, such as integrated pest management, to reduce the overall pesticide availability for self-harm...
- Where is the evidence for treatments used in pesticide poisoning? Is clinical toxicology fiddling while the developing world burns?
Nicholas A Buckley
J Toxicol Clin Toxicol 42:113-6. 2004
- Overcoming apathy in research on organophosphate poisoning
Nick A Buckley
South Asian Clinical Toxicology Research Collaboration, Department of Clinical Pharmacology and Toxicology, Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia
BMJ 329:1231-3. 2004
- Intentional self-poisoning with the chlorophenoxy herbicide 4-chloro-2-methylphenoxyacetic acid (MCPA)
Darren M Roberts
South Asian Clinical Toxicology Research Collaboration, Medical School, Australian National University, Acton, Australian Capital Territory, Australia
Ann Emerg Med 46:275-84. 2005
..Our objective is to describe outcomes from intentional self-poisoning with MCPA in a prospective case series of 181 patients presenting to hospitals in Sri Lanka...
- Pesticide regulations in Sri Lanka
Michael Eddleston
Lancet 361:1657-8. 2003
- Clinical toxinology--where are we now?
Julian White
Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
J Toxicol Clin Toxicol 41:263-76. 2003
..This will require well-designed studies to define the extent of the problem, initiatives to improve the prevention and management of these conditions, and development of new, and continuation of current, antivenom supplies...
- The revised position papers on gastric decontamination
Nick A Buckley
Department of Clinical Pharmacology and Toxicology, Canberra Clinical School, ACT, Australia
Clin Toxicol (Phila) 43:129-30. 2005
- Missing deaths from pesticide self-poisoning at the IFCS Forum IV
Flemming Konradsen
Department of International Health, Institute of Public Health, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
Bull World Health Organ 83:157-8. 2005
- Pharmacokinetics of digoxin cross-reacting substances in patients with acute yellow Oleander (Thevetia peruviana) poisoning, including the effect of activated charcoal
Darren M Roberts
South Asian Clinical Toxicology Research Collaboration, Australian National University, Acton, ACT, Australia
Ther Drug Monit 28:784-92. 2006
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- Pesticide self-poisoning: thinking outside the box
Flemming Konradsen
Department of International Health, University of Copenhagen, 1014 Copenhagen K, Denmark
Lancet 369:169-70. 2007
- Improvement in survival after paraquat ingestion following introduction of a new formulation in Sri Lanka
Martin F Wilks
Syngenta Crop Protection AG, Basel, Switzerland
PLoS Med 5:e49. 2008
..We compared the outcome of paraquat self-poisoning with the standard formulation against the new INTEON formulation following its introduction into Sri Lanka...
- Human methyl parathion poisoning
Geoffrey K Isbister
Tropical Toxinology Unit, Menzies School for Health Research, Charles Darwin University, Australia
Clin Toxicol (Phila) 45:956-60. 2007
..Methyl parathion is classed as an extremely hazardous pesticide with a rodent LD50 of 6 to 24 mg/kg. It has been banned in numerous countries, but there are few reports of acute methyl parathion poisoning...
