Introduction Diisopropylcarbodiimide is a peptide coupler commonly used in biotechnology. Dermal and respiratory effects, due to irritant and sensitizing properties, have been reported in exposed workers and experimental studies. Neurological toxicity, as demonstrated in animal studies, has not been reported in humans. We describe three male workers who experienced dermal, respiratory, and neurological sequelae after accidental exposure to diisopropylcarbodiimide, a volatile liquid product. Methods Clinical data were collected retrospectively through review of medical files and follow-up interviews. Each worker underwent a symptom-guided clinical evaluation, including dermatological, respiratory, neurological, and neuropsychological assessment. Follow-up extended up to three years, depending on the case. Results Three workers were occupationally exposed to diisopropylcarbodiimide by inhalation and dermal contact due to a leaking barrel. All experienced similar clinical courses after the incident, including the development not only of contact dermatitis and occupational asthma, but also neurological effects (persistent headaches, neuropathic pain and paraesthesia in hands/feet, fatigue and cognitive impairment, compatible with chronic toxic encephalopathy). They also developed sleep disturbances, including new-onset obstructive sleep apnoea syndrome. Discussion The consistency of these presentations across patients, the close temporal association to a brief exposure to diisopropylcarbodiimide, and evidence from animal studies suggest a possible causal relationship. Conclusions Three workers experienced contact dermatitis, occupational asthma, severe neurological sequelae, as well as new-onset obstructive sleep apnoea syndrome after occupational exposure to diisopropylcarbodiimide. The close temporal association to a single presumably high-level exposure suggests a possible causal relationship. To prevent such health consequences, workers with potential exposure to peptide couplers must be made aware of their hazards and adequately protected.

Introduction Extracorporeal membrane oxygenation is an important therapeutic option for the critically ill poisoned patient, but data are limited mainly to case reports and case series. A lack of thorough reporting of specific extracorporeal membrane oxygenation details or the resultant physiological response may lead to misinterpretation of the effectiveness of extracorporeal membrane oxygenation, limiting its generalizability. Methods We searched MEDLINE and PubMed databases using the criteria “extracorporeal membrane oxygenation” or “ECMO” AND “poisoning” or “overdose” and limited the selection to English language publications for which full text was available. Publications were excluded if they lacked data on extracorporeal membrane oxygenation for individual cases, extracorporeal membrane oxygenation was considered but not used, or a poison(s) was not identified. Each case was analyzed separately for reporting of each component (level) of the Extracorporeal Life Support Organization Maastricht Treaty for Nomenclature in Extracorporeal Life Support recommendations, a composite outcome if multiple levels were reported, device settings, laboratory documentation of poison(s), and outcomes by journal type. A subgroup analysis evaluated the reporting of clinical evidence of therapeutic effect. Results Of 150 cases included, only 1% had documentation of all four levels, and only 28% provided both cannula location and dimension details. Documentation of device settings, laboratory documentation of poison(s), and clinical evidence of therapeutic effect were also low, regardless of journal type. Discussion It is critical for toxicologists, extracorporeal membrane oxygenation intensivists and surgeons to provide sufficient details when they report their cases so that other specialists, particularly those deciding whether to use this intervention, may determine if extracorporeal membrane oxygenation was effective for the specific poisonings reported. Conclusions Few publications provide sufficient documentation to fully assess the clinical role of extracorporeal membrane oxygenation in poisoned patients. We propose a series of recommendations to improve future publications, emphasizing that descriptions of the physical setup, device parameters, and pertinent clinical evidence of therapeutic effect should be essential components.

Introduction Organophosphorus insecticide poisoning remains a major problem in rural low- and middle-income communities. Atropine auto-injectors are used for organophosphorus nerve agent poisoning, but not organophosphorus insecticide poisoning. We explore the social and practical feasibility of introducing atropine auto-injectors in Sri Lankan villages to initiate first-line treatment for acute organophosphorus insecticide poisoning. We investigate how auto-injectors might be best integrated into the social and spatial context of rural communities with high levels of organophosphorus insecticide use and poisoning. Methods With an ethnographic approach, we combined semi-structured interviews with community members (n = 18) and healthcare workers (n = 9), focus group discussions (n = 5), participatory mapping (n = 3), oral history interviews (n = 7), and ethnographic observations in three rural villages. A collaborative thematic data analysis was performed alongside continuous discussions within the global, interdisciplinary research team. Results Acute organophosphorus insecticide poisoning was not perceived as a major public health concern that would demand an urgent intervention in communities. Following COVID-19 vaccination interventions, findings showed a lack of trust related to new medical injection technologies. Consequently, finding people to handle auto-injectors who had the capacity and willingness to take responsibility and were trusted by the community is a major challenge. Discussion Ethnographic research methods are important and relevant in planning and implementing community health interventions. They contribute to making health interventions more effective and sustainable by analyzing context-dependent and often intractable complex health problems. Conclusions While our findings do not support introducing auto-injectors in the selected communities, it suggests placing them in the ambulances used to transport patients who have ingested pesticides. To further explore the need and feasibility of auto-injectors, similar situational, ethnographic analysis should be conducted in other parts of Sri Lanka and low- and middle-income countries with high numbers of acute organophosphorus insecticide poisoning and limited infrastructure facilities.

Introduction Clinical prediction models assist healthcare providers in estimating disease likelihood using multiple patient-specific factors. While these models are increasingly used, few undergo external validation, which limits their clinical utility. In toxicology, timely diagnosis is crucial and expertise scarce, making knowledge-based systems an excellent choice to support medical decision-making. A knowledge-based system which was developed using data from the Florida Poison Information Center Network has shown promise but lacks external validation. This study aims to evaluate its performance using data from the Lyon Poison Information Center to assess its generalizability. Methods To externally validate the Florida diagnostic model, we used anonymized clinical data from the Lyon Poison Information Center. French symptom and substance descriptions were standardized and translated into English using expert-curated dictionaries. These were then mapped to the clinical effects and substances used in the original model. For each case, the model generated likelihood ratios for all possible substances, producing a ranked diagnostic list. Model performance was assessed using Top-K accuracy. Results External validation was conducted on 602 moderate to major severity poisoning cases. The overall Top-10% accuracy of the model was 75.4%, with the highest accuracy in major severity cases (87.0%) and the lowest in fatal cases (57.6%). These results were comparable to internal validation metrics reported in a prior study. In major cases, external validation even outperformed internal validation. Discussion Despite challenges related to language and database compatibility, the system showed robust accuracy, which supports its clinical applicability. Limitations include its current restriction to single-substance poisonings and the need for further validations across diverse populations. Conclusions The system demonstrates promising accuracy and highlights the importance of continued international validation to support broader clinical adoption. With further refinement and integration of additional patient-specific data, such models could play a key role in enhancing rapid, data-driven toxicological diagnoses worldwide.