Hubert Daisley

Reducing acute poisoning in developing countries—options for restricting the availability of pesticides

Hundreds of thousands of people are dying around the world each year from the effects of the use, or misuse, of pesticides. This paper reviews the different options to reduce availability of the most hazardous chemicals, focusing on issues in developing countries. Emphasis is placed on the fatal poisoning cases and hence the focus on self-harm cases. Overall, it is argued here that restricting access to the most hazardous pesticides would be of paramount importance to reduce the number of severe acute poisoning cases and case-fatalities and would provide greater opportunities for preventive programmes to act effectively. The aim should be to achieve an almost immediate phasing out of the WHO Classes I and II pesticides through national policies and enforcement. These short-term aims will have to be supported by medium- and long-term objectives focusing on the substitution of pesticides with safe and cost-effective alternatives, possibly guided by the establishment of a Minimum Pesticide List, and the development of future agricultural practices where pesticide usage is reduced to an absolute minimum. Underlying factors that make individuals at risk for self-harm include domestic problems, alcohol or drug addiction, emotional distress, depression, physical illness, social isolation or financial hardship. These should be addressed through preventive health programmes and community development efforts.

HTLV-I AND TROPICAL SPASTIC PARAPARESIS

Furthermore, we have shown that platelets prepared from patients admitted with the provisional diagnosis of acute myocardial infarction (AMI) tend to aggregate after heparin challenge in vitro. This was observed whether AMI was confirmed or not, provided patients had a history of, for example, myocardial infarction or peripheral vascular disease. The figures for samples producing more than 50% aggregation after the addition of heparin in vitro

1. Maternal Mortality following the Use of Misoprostol

Three cases of maternal death following the use of misoprostol are presented. In two of the cases the drug was used to procure illegal abortion, and in the third case maternal death occurred following uterine rupture, after misoprostol was used clinically for induction of labour. A brief review of the usage of misoprostol is presented, including recommendations for its safe use.

Homicide by paraquat poisoning.

We report on two cases of homicide by paraquat poisoning. Both cases occurred in children and the common clinical presentations were gastrointestinal ulceration and acute respiratory distress, with pneumomediastinitis. Bullous emphysema was a common autopsy finding. Physicians and pathologists should be aware of these findings, for they are almost diagnostic of acute paraquat poisoning.

Role of HTLV-1 co-infection in the AIDS epidemic in the Caribbean: a cause for concern.

Two case histories were presented to show some of the typical pathological features of patients afflicted with human T-cell lymphotrophic virus type 1 (HTLV-1) and HIV, which act synergistically and are predictive of a rapidly fatal outcome. AIDS progression is hastened by co-infection with HTLV-1, probably because HTLV-1 tax gene turns on T cells that harbor HIV. Thus, in persons infected with both HTLV-1 and HIV, HIV seems to proliferate more readily. Features of HTLV-1 carrier are immunoparesis, loss of immediate skin reactivity, loss of IgG anti-parasite antibodies, and reduced or absent IgE antibodies. The immunosuppression and its consequences are similar in both HTLV-1 and HIV infection. The only solution to the AIDS epidemic in the Caribbean, which is also a region endemic for HTLV-1, would be the introduction of an effective vaccine against retroviral agents, HTLV-1 and HIV.