Paraquat Levels Research Articles

Paraquat Poisoning: Insights from Autopsy, Histology, and Liquid Chromatography with Tandem Mass Spectrometry in Multidisciplinary Forensic Toxicology Practice.

The herbicide paraquat (PQ) is responsible for a significant number of fatalities resulting from self-poisoning. Nevertheless, only a limited number of comprehensive studies focusing on fatal PQ poisoning, which include examination of autopsy findings, histopathology, and quantitative analysis of post-mortem samples, have been published. This study aimed to evaluate autopsy findings, histopathology, and quantitative analysis of PQ in post-mortem human serum samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS), a simple, sensitive, and specific method. Autopsies were performed on all deaths due to PQ poisoning, and serum samples were sent to the toxicology laboratory for chemical analysis. The method was successfully applied to seven human serum samples, and the results indicate its reliability for detecting PQ. The study reports fatal serum PQ levels ranging from 0.5 to 372.0 µg/mL. The comprehensive data presented in this study can be useful for further research and practical applications.

Revolutionising pesticide detection: a high-sensitivity electrochemical sensor with CdS/g-C3N4/MWCNTs for paraquat monitoring

ABSTRACT Over a decade, the Malaysia National Poison Centre found that 40% of pesticide poisoning cases may be linked to excessive paraquat (PQ) in water, soil, or food, underscoring the widespread impact on public health and emphasising the importance of detecting even trace amounts of PQ residues in the environment. Thus, this study presents a novel electrochemical sensor based on multiwalled carbon nanotubes (MWCNTs) reinforced cadmium sulphide co-anchoring on graphitic carbon nitride (CdS/g-C3N4) nanocomposites for PQ detection. The CdS/g-C3N4 nanocomposite was successfully synthesised and characterised through FTIR, XRD, EDX, FESEM and TEM analysis. The modified electrode (CdS/g-C3N4/MWCNTs PE) exhibited improved electrocatalytic activity, as demonstrated by cyclic voltammetry (CV) and impedance spectroscopy. The CdS/g-C3N4/MWCNTs PE displayed a high CV peak and low Rct value which corresponded to a higher electron transfer rate, reduced charge transfer resistance and enhanced mass transport properties. The electrochemical sensor’s performance was evaluated for the detection of PQ, and it demonstrated a linear response in a range of 1.0 µM to 0.1 mM with a limit of detection of 0.14 μM. Furthermore, the sensor exhibited selectivity with a less than 16% potential interference from various organic chemicals and inorganic ions. The sensor’s applicability was tested by quantifying PQ in real water samples, showing excellent recovery percentages ranging from 98.9% to 102.0%. The developed electrochemical sensor provides a practical solution for the rapid and accurate monitoring of PQ levels in the environment. This work establishes the foundation for the development of a selective electrochemical sensor for pesticide analysis, addressing both public health and environmental concerns.

Association of urinary chlorpyrifos, paraquat, and cyproconazole levels with the severity of fatty liver based on MRI

BackgroundThe objective of this study was to detect the urinary levels of chlorpyrifos, paraquat, and cyproconazole in residents living in Fuyang City and to analyze the correlation between these urinary pesticides levels and the severity of fatty liver disease (FLD).MethodsAll participants’ fat fraction (FF) values were recorded by MRI (Magnetic resonance imaging). First-morning urine samples were collected from 53 participants from Fuyang Peoples’Hospital. The levels of three urinary pesticides were measured using β-glucuronidase hydrolysis followed by a. The results were analyzed by using Pearson correlation analysis and binary logistic regression analysis to reveal the correlation between three urinary pesticides and the severity of fatty liver.Results53 individuals were divided into 3 groups based on the results from MRI, with 20 cases in the normal control group, 16 cases in the mild fatty liver group, and 17 cases in the moderate and severe fatty liver group. Urinary chlorpyrifos level was increased along with the increase of the severity of fatty liver. Urinary paraquat level was significantly higher both in the low-grade fatty liver group and moderate & serve grade fatty liver group compared with the control group. No significant differences in urinary cyproconazole levels were observed among the three groups. Furthermore, urinary chlorpyrifos and paraquat levels were positively correlated with FF value. And chlorpyrifos was the risk factor that may be involved in the development of FLD and Receiver Operating Characteristic curve (ROC curve) analysis showed that chlorpyrifos and paraquat may serve as potential predictors of FLD.ConclusionThe present findings indicate urinary chlorpyrifos and paraquat were positively correlated with the severity of fatty liver. Moreover, urinary chlorpyrifos and paraquat have the potential to be considered as the predictors for development of FLD. Thus, this study may provide a new perspective from the environmental factors for the diagnosis, prevention, and treatment of FLD.

Determining Kidney Damage Risk Factors Associated with Urine Paraquat Levels and Biochemical Urine Profile of Farmers in Banjarbaru, South Kalimantan, Indonesia

Abstract Aim: Kidney damage from paraquat is influenced by several factors, including the duration of work, the span of exposure from the pesticide spraying, and the nutritional status of the farmers. This damage can be indicated by the high levels of paraquat and changes of the biochemical status in the urine. The present study aimed to analyze the relationship between the length of work, duration of spraying, and the nutritional status obtained from the measurement of body mass index (BMI) values, with the paraquat levels and biochemical status of the farmer’s urine samples. Materials and Methods: This study was a cross-sectional study and was conducted in September 2022 in North Landasan Ulin Village, Banjarbaru City, South Kalimantan, Indonesia. The length of work and spraying duration were obtained from the direct interviews, while the BMI values were calculated by dividing the body weight (kg) by the body’s height (m). Analysis of the paraquat levels in the urine was measured using a spectrophotometer, while the urine’s biochemical status was obtained using the dipstick colorimetric method. Statistical analysis used: the relationship between each variable is analyzed using the Spearman rank correlation test. Results: Results from the study show that the length of work, duration of spraying, and BMI were moderately associated with an increase in the urinary paraquat levels (correlation coefficient [Rs] 0.26–0.50) (P < 0.05); although the previous factors did not appear to correlate with any changes in the urine’s biochemical status. Conclusion: In summary, prolonged exposure to the spray in combination with the farmers’ long work hours, and also factoring in the abnormal BMI values, resulted in an increase of paraquat levels in the urine.

LIVING LONGER WITH MODERATE AMOUNTS OF OXYGEN RADICALS IN FRUIT FLIES

Abstract The role of reactive oxygen species (ROS) in aging is complex and paradoxical. While the free radical theory of aging suggests that ROS cause cellular damage and senescence, some studies have shown that moderate ROS levels can enhance cellular adaptation and longevity. In this research, we used Drosophila as an in vivo model to investigate the optimal level of ROS that can promote healthy aging. We exposed flies to different concentrations of paraquat (PQ), a herbicide that generates superoxide anions, and measured their lifespan, stress resistance, and gene expression. We found that intermediate PQ levels (0.1 mM) extended lifespan and improved stress tolerance, while high PQ levels (0.5 mM) shortened lifespan and impaired stress response. We also observed an up-regulation of ROS scavenger genes, such as superoxide dismutase 1 and glutathione peroxidase, in the intermediate PQ group, suggesting a homeostatic mechanism to balance ROS levels. Our findings challenge the conventional view of ROS as harmful agents and provide novel insights into the molecular mechanisms of aging.

Determination of Paraquat in Arabidopsis Tissues and Protoplasts by UHPLC-MS/MS.

Paraquat is a cost-effective herbicide, widely used in many countries, that can induce severe oxidative stress in photosynthetic tissues. Studying plant herbicide resistance or antioxidant stress mechanisms requires determining the cellular paraquat level when plants are treated by paraquat. The traditional isotopic labeling method has the potential risk to cause problems to both human health and the environment. For radioisotope manipulation, special operation spaces and strict environmental inspection are also required. In addition, the radiolabeled paraquat is increasingly hard to buy due to the extended production cycle. Here, we describe a nonradioactive method to determine the paraquat level in a small number of Arabidopsis tissues or protoplasts, using a high resolution ultra-high-performance liquid chromatography (UHPLC)-mass spectrometry (MS)/MS method. This method is highly selective and sensitive, and more environmentally compatible and technically feasible than the isotope detection method.

Prediction of mortality and morbidity following paraquat poisoning based on trend of liver and kidney injury

BackgroundParaquat is a non-selective herbicide that causes severe tissue damage in various organs including the liver and kidney. The aim of this study was to determine the trend of the liver and kidney injury in patients with paraquat poisoning.MethodsThis retrospective cross-sectional study was performed at the Khorshid Hospital referral poisoning emergency center. The medical records of all patients with acute paraquat poisoning admitted from March 2017 to October 2020 were reviewed. Demographic factors, liver and kidney function tests and outcomes were recorded. Patients were divided into two groups based on the outcome of mortality (death or survived). The two groups were compared in terms of changes in creatinine and liver enzymes during hospitalization.ResultsA significant difference in mean creatinine levels between the two groups was observed from the third day after admission. The peak median Cr was 3.5 mg/dl for deceased patients in day 6 and 1.47 mg/dl for survived patients on 4th day. Minor elevations of ALT and AST were present in those who died. Logistic regression analysis shows patients who had level of creatinine higher than normal from the 2nd to 6th day post overdose, the risk of mortality was 4.83 to 7.44 times more than patients with normal creatinine level. The mean (SD) area under the curve for outcome prediction was reported to be excellent for creatinine on the 8th day post overdose (85.7 ± 13.2). Creatinine was higher than 2 on the 8th day post ingestion and had a sensitivity 100% and specificity 85.7% for mortality prediction (P value, 0.05).ConclusionsThe risk of mortality secondary to paraquat ingestion was highly associated with a rise in creatinine. Minor elevations of ALT and AST were also present in those who died. The creatinine concentration on different days post overdose can be helpful in predicting the severity of poisoning especially when the serum paraquat levels are not available.

The acute paraquat poisoning mortality (APPM) score to predict the risk of death in paraquat-poisoned patients

Context Mortality prediction in paraquat poisoning is a major issue since most prediction rules are inapplicable if the exact ingestion time cannot be determined and/or the serum paraquat concentration is not readily available, as in most countries. Therefore, we aimed to develop and validate a new prediction rule not requiring these two parameters. Methods We designed a 10-year observational cohort study including all consecutive paraquat-poisoned patients managed in two Taiwanese hospitals. We built one cohort to define and one cohort to validate this prediction rule. Parameters independently related to mortality determined using a multivariate analysis were used to formulate the Acute Paraquat Poisoning Mortality (APPM) score. Results Overall, 321 paraquat-poisoned patients were included, 156 in the derivation and 165 in the validation cohort. Mortality rates in the derivation and validation cohorts were 73% and 81%, respectively (p = 0.20). The three parameters chosen of 28-day mortality at presentation were urine paraquat level >10 ppm (using a colorimetric sodium dithionite-based test; odds ratio (OR), 12.70; 95% confidence interval (CI), 2.64–61.24), white blood cells >13.0 G/L (OR, 5.50; CI, 1.41–21.48) and blood glucose >140 mg/dL [7.8 mmol/L] (OR, 7.45; CI, 1.70–32.86). In the derivation cohort, the area under the ROC curve (AUC-ROC) of the APPM score did not significantly differ from AUC-ROCs of serum paraquat (0.95, p = 0.25) and the Severity Index of Paraquat Poisoning (0.95, p = 0.33). AUC-ROCs of the APPM score in the derivation and validation cohorts were 0.91 and 0.94, respectively. Conclusion We built and validated a reliable score to predict 28-day mortality in paraquat-poisoned patients at presentation, independently from the ingestion time and serum paraquat measurement.

Relationships of Light to Enzyme and Sucrose Transformations in Sugarcane Treated with Paraquat

Relationships of Light to Enzyme and Sucrose Transformations in Sugarcane Treated with Paraquat

Glucocorticoid with cyclophosphamide for oral paraquat poisoning.

Glucocorticoid with cyclophosphamide for oral paraquat poisoning.

Occupational Paraquat and Glyphosate Exposure May Decline Renal Functions among Rural Farming Communities in Sri Lanka

Extensive use of herbicides is common among rural agricultural workers in Sri Lanka. Recent studies have postulated their role in the development of chronic kidney disease of unknown etiology (CKDu). Paraquat and glyphosate are leading herbicides used by sugarcane farmers (SF), hence occupational exposure is inevitable. This study examined the expression of urinary paraquat, glyphosate and biomarkers among residential SF in CKDu emerging regions, Warunagama (WA) and Rahathangama (RH), in the Uva Province with non-endemic Matara (MA) in the Southern Province of Sri Lanka. Urinary glyphosate, Paraquat, kidney injury molecule -1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL) and β2-microglobulin (B2M) were determined using enzyme-linked immunosorbent assays (ELISA). Urinary creatinine, microalbumin, serum creatinine (SCr), serum cystatin C, estimated glomerular filtration rate (eGFR), and albumin creatinine ratio (ACR) were also assessed. Generally, herbicide residues and kidney injury biomarkers were higher in SF compared to the non-endemic MA. Creatinine-adjusted urinary glyphosate and paraquat levels were significantly higher in WA compared to MA. ACR in RH (median 14.9; IQR 5.4–393.1 mg/g) and WA (23.7; 11.5–64.6) was significantly higher than MA (4.3; 2.2–6.7). This study reports 39 individuals with impaired kidney function among SF in Sri Lanka for the first time. Urinary NGAL levels were significantly higher in both WA (median 2.14; IQR 1.28–6.15 ng/mg Cr) and RH (3.09; 1.15–9.09) compared to MA (1.28; 0.56–2.81). However, urinary KIM-1 levels in RH (3.2; 1.29–106.1 ng/g Cr) and WA (3.6; 1.94–115.1) were not significantly higher in MA (1.74; 0.76–116.9). Urinary NGAL (r = 0.493), eGFR (r = −0.147) and ACR (r = 0.171) significantly correlated with urinary glyphosate, but not with urinary paraquat levels. Urinary KIM-1 levels did not correlate with either urinary glyphosate or paraquat, while urinary B2M and serum cystatin C levels showed significant correlation with urinary glyphosate levels. The current study reports higher urinary herbicide levels among sugarcane farmers in WA and RH, and that is potentially linked to the subsequent decline in kidney function, as indicated by ACR, eGFR, and NGAL. We posit that these indicators may serve as markers to detect renal injury among herbicide-exposed SF in Rural Sri Lanka.

Acute Changes in Thyroid Hormone Levels among Thai Pesticide Sprayers.

The objective of this study was to investigate the relationship of acute pesticide exposures and acute changes in thyroid hormones among Thai farmers. We recruited 78 farmers, who were scheduled to spray insecticides (chlorpyrifos and/or cypermethrin) or herbicides (paraquat and/or glyphosate). On the day before spraying, farmers collected their first morning void urine and went for blood collection. On the spray day, urine samples were collected at end of the spraying event and they were interviewed with questionnaires. The next morning, the first morning void urine and blood samples were collected. Blood samples were analyzed for thyroid hormones. Urine samples were analyzed for the metabolites of the pesticide sprayed. The results showed that the thyroid hormones, free triiodothyronine (FT3) and total triiodothyronine (T3) were significantly reduced as urinary chlorpyrifos metabolite increased the day after spraying. Total thyroxine (T4) significantly increased as cypermethrin metabolites increased the day after spraying. T4 significantly increased as urinary glyphosate levels increased; however, FT3 and T3 decreased significantly as urinary paraquat levels increased the day after spraying. These findings suggest that acute exposures to the pesticides chlorpyrifos, cypermethrin, paraquat and glyphosate can produce acute effects on the hypothalamic–pituitary–thyroid (HPT) axis, acutely altering thyroid hormone levels.

Paraquat Poisoning: ?What We Do and Do Not Know.?

Paraquat is a quaternary compound used as an herbicide for destroying weed and is highly toxic for humans. Its ingestion leads to multi-organ dysfunction, leading to liver insufficiency and lung fibrosis, which are life-threatening due to respiratory failure. A Pubmed, EMBASE, Ovid, and Cochrane library search was done, all authors reviewed all literature and relevant studies, and data were included in references. Paraquat is available in commercial 20% concentrate form, as 2.5% granules, and 0.2% aerosol. Mortality rates are as high as 65% in patients who ingest concentrated formulation compared to 4% in those who ingest diluted solution (25% w/v). Paraquat undergoes redox-cycling to generate reactive oxygen species leads to its toxic effects. This highly reactive oxygen and nitrite species result in multi-organ toxicity which is maximally seen in the lungs. Absorption occurs primarily through the small intestine. Peak concentration in plasma and maintenance of plasma paraquat levels are the two main factors that decide its concentration in the lungs. The destructive phase is followed by the proliferative phase, in which there is the presence of extensive fibrosis. High dose intake leads to acute respiratory distress syndrome, myocardial necrosis, cerebral edema, and renal failure, which leads to multi-organ failure. The diagnosis of paraquat poisoning is based on history. Simple bedside methods like urine or plasma dithionate tests are used to assess systemic paraquat toxicity. Management stands on four pillars which are reducing absorption, supportive care, antioxidant therapy, and immunosuppression.

Paraquat Inhalation, a Translationally Relevant Route of Exposure: Disposition to the Brain and Male-Specific Olfactory Impairment in Mice.

Epidemiological and experimental studies have associated oral and systemic exposures to the herbicide paraquat (PQ) with Parkinson's disease. Despite recognition that airborne particles and solutes can be directly translocated to the brain via olfactory neurons, the potential for inhaled PQ to cause olfactory impairment has not been investigated. This study sought to determine if prolonged low-dose inhalation exposure to PQ would lead to disposition to the brain and olfactory impairment, a prodromal feature of Parkinson's disease. Adult male and female C57BL/6J mice were exposed to PQ aerosols in a whole-body inhalation chamber for 4 h/day, 5 days/week for 4 weeks. Subsets of mice were sacrificed during and after exposure and PQ concentrations in various brain regions (olfactory bulb, striatum, midbrain, and cerebellum) lung, and kidney were quantified via mass spectrometry. Alterations in olfaction were examined using an olfactory discrimination paradigm. PQ inhalation resulted in an appreciable burden in all examined brain regions, with the highest burden observed in the olfactory bulb, consistent with nasal olfactory uptake. PQ was also detected in the lung and kidney, yet PQ levels in all tissues returned to control values within 4 weeks post exposure. PQ inhalation caused persistent male-specific deficits in olfactory discrimination. No effects were observed in females. These data support the importance of route of exposure in determination of safety estimates for neurotoxic pesticides, such as PQ. Accurate estimation of the relationship between exposure and internal dose is critical for risk assessment and public health protection.

Two Potential Clinical Applications of Origami-Based Paper Devices.

Detecting small amounts of analyte in clinical practice is challenging because of deficiencies in specimen sample availability and unsuitable sampling environments that prevent reliable sampling. Paper-based analytical devices (PADs) have successfully been used to detect ultralow amounts of analyte, and origami-based PADs (O-PADs) offer advantages that may boost the overall potential of PADs in general. In this study, we investigated two potential clinical applications for O-PADs. The first O-PAD we investigated was an origami-based enzyme-linked immunosorbent assay (ELISA) system designed to detect different concentrations of rabbit IgG. This device was designed with four wing structures, each of which acted as a reagent loading zone for pre-loading ELISA reagents, and a central test sample loading zone. Because this device has a low limit of detection (LOD), it may be suitable for detecting IgG levels in tears from patients with a suspected viral infection (such as herpes simplex virus (HSV)). The second O-PAD we investigated was designed to detect paraquat levels to determine potential poisoning. To use this device, we sequentially folded each of two separate reagent zones, one preloaded with NaOH and one preloaded with ascorbic acid (AA), over the central test zone, and added 8 µL of sample that then flowed through each reagent zone and onto the central test zone. The device was then unfolded to read the results on the test zone. The three folded layers of paper provided a moist environment not achievable with conventional paper-based ELISA. Both O-PADs were convenient to use because reagents were preloaded, and results could be observed and analyzed with image analysis software. O-PADs expand the testing capacity of simpler PADs while leveraging their characteristic advantages of convenience, cost, and ease of use, particularly for point-of-care diagnosis.

A simple and rapid method for determination of paraquat in human urine and plasma by improved solid adsorption using equipment built in-house

A simple and rapid method was developed for clinical naked-eye and quantitative detection of paraquat (PQ) in human plasma and urine samples using built-in-house analytical devices followed by visual colorimetric method and UV–Vis spectrophotometry. A quantitative spectrophotometric method for PQ was also developed based on device built in-house. Different factors influencing the recovery efficiency of PQ such as the pH of the sample solution, the amount of adsorbent, the type and volume of eluent, the extraction and desorption time, the adsorption capacity and sample volume were studied and optimized in detail. Under optimal conditions, the whole analysis time of the naked-eye method was less than 5 min and it provided the detection limit observed with naked eye of 0.2 μg/mL with the detection range between 0.5 and 5.0 μg/mL for paraquat determination. PQ could be detected as low as 6.21 × 10−3 μg/mL in urine and 0.119 μg/mL in plasma with this proposed quantitative spectrophotometric method, respectively. The method was applied in monitoring PQ levels in plasma and urine at different hemoperfusion numbers in local hospitals for patients exposed to PQ poisoning. The detection result could not only enable immediate medical intervention but also benefit patients’ survival.

A Synthetic Receptor as a Specific Antidote for Paraquat Poisoning.

Accidental or suicidal ingestion of the world's most widely used herbicide, paraquat (PQ), may result in rapid multi-organ failure with a 60% fatality rate due to the absence of an effective detoxification solution. Effective, specific antidotes to PQ poisoning have been highly desired.Methods: The binding constant of PQ and a synthetic receptor, cucurbit[7]uril (CB[7]), was first determined in various pH environments. The antidotal effects of CB[7] on PQ toxicity were firstly evaluated with in-vitro cell lines. With in-vivo mice models, the pharmacokinetics and the biodistribution of PQ in major organs were determined to evaluate the influence of CB[7] on the oral bioavailability of PQ. Major organs' injuries and overall survival rates of the mice were systemically examined to evaluate the therapeutic efficacy of CB[7] on PQ poisoning.Results: We demonstrate that CB[7] may complex PQ strongly under various conditions and significantly reduce its toxicity in vitro and in vivo. Oral administration of PQ in the presence of CB[7] in a mouse model significantly decreased PQ levels in the plasma and major organs and alleviated major organs' injuries, when compared to those of mice administered with PQ alone. Further studies indicated that oral administration of CB[7] within 2 h post PQ ingestion significantly increased the survival rates and extended the survival time of the mice, in contrast to the ineffective treatment by activated charcoal, which is commonly recommended for PQ decontamination.Conclusion: CB[7] may be used as a specific oral antidote for PQ poisoning by strongly binding with PQ and inhibiting its absorption in the gastrointestinal tracts.

Rapid Simultaneous Determination of Paraquat and Creatinine in Human Serum Using a Piece of Paper.

Paraquat intoxication is characterized by acute kidney injury and multi-organ failure, causing substantial mortality and morbidity. This study aims to develop a 2-in-1 paper-based analytical device to detect the concentrations of paraquat and creatinine in human serum, which can help clinicians diagnose patients with paraquat poisoning in a more rapid and geographically unrestricted manner. The procedure involves fabrication of a paper-based analytical device, i.e., printing of design on a filter paper, heating of wax-printed micro zone plates so as molten wax diffusing into and completely through the paper to the other side, forming hydrophobic boundaries that could act as detection zones for the paraquat colorimetric assay, and finally analysis using ImageJ software. The paper employed a colorimetric sodium dithionite assay to indicate the paraquat level in a buffer or human serum system in less than 10 min. In this study, colorimetric changes into blue color could be observed by the naked eye. By curve fitting models of sodium dithionite in normal human serum, we evaluated the serum paraquat levels for five paraquat patients. In the sodium dithionate assay, the measured serum paraquat concentrations in patients 1–5 were 22.59, 5.99, 26.52, 35.19 and 25.00 ppm, respectively. On the other hand, by curve fitting models of the creatinine assay in normal human serum, the measured serum creatinine concentrations were 16.10, 12.92, 13.82, 13.58 and 12.20 ppm, respectively. We found that the analytical performance of this device can compete with the standard of Clinical Laboratory of Chang Gung Memorial Hospital, with a less complicated sample preparation process and more rapid results. In conclusion, this 2-in-1 paper-based analytical device has the advantage of being simple and cheap, enabling rapid detection of paraquat intoxication as well as assessment of renal prognosis.

Urinary paraquat concentration and white blood cell count as prognostic factors in paraquat poisoning

Purpose: To investigate the effect of white blood cell (WBC) and urinary paraquat (PQ) levels on prognostic factors in patients exposed to PQ intoxication using multivariate logistic regression analysis.Methods: A total of 104 subjects intoxicated with PQ between December 2015 and July 2016 were used in this retrospective study. They comprised patients who survived (n = 78), and patients who died (n = 26). Clinical features and prognostic parameters were analyzed in both groups. Multivariate logistic regression analysis was used to establish a prognostic correlation model based on results from single factor variables.Results: Comparison of demographic and clinical attributes between the two groups, survivors (n = 78) and non-survivors (n = 26), revealed that those who survived were not as old (33.3 ± 9.9 years) as nonsurvivors (41.5 ± 12.9 years). In addition, on admission, it was found that the survivors ingested lower amounts of PQ (31.6 ± 13.8 ml) than non-survivors (67.88 ± 31.2 ml). There were significant differences between the two groups with respect to WBC, neutrophils, lymphocytes, lactate dehydrogenase (LDH), creatine kinase (CK), amylase, uric acid (UA), pH, partial pressure of oxygen (PaO2), base excess (BE), lactic acid, and D-dimer levels (p < 0.05).Conclusion: WBC and urine PQ concentration have strong correlation with prognostic factors in PQ poisoning.Keywords: Paraquat intoxication, Dithionite test, Multivariate logistic analysis, Prognosis, Predictors

Occupational Herbicide Exposure may Induce Kidney Injury Molecule I (KIM I) and Neutrophil Gelatinase-Associated Lipocalin (NGAL) Levels in Sugarcane Farmers in rural Sri Lanka

Extensive use of herbicides is common among agriculture workers in Sri Lanka (SL). Recent studies hypothesized the role of agrochemicals in the development of mysterious chronic kidney disease termed as CKDu. Paraquat and Glyphosate were leading herbicides among sugarcane farmers (SF) hence occupational exposure is inevitable. This study reports detection of urinary Paraquat and Glyphosate residues among SF residing in CKDu emerging regions (Uva province; Warunagama and Rahathangama) of SL along with tubular injury biomarkers KIM I and NGAL. Collected urine samples were compared with non-endemic controls (CN) (Southern province; Matara). Paraquat, Glyphosate, KIM I and NGAL levels (Warunagama, n = 66; Rahathangama, n = 69; Matara, n = 66) were estimated using Enzyme Linked Immunosorbent Assays. Urinary creatinine, microalbumin and albumin creatinine ratio (ACR) were also assessed for kidney function. Generally herbicide residues and injury biomarkers were higher in SF with compared to CN. Creatinine adjusted urinary glyphosate and paraquat levels were significantly higher in Warunagama (271.3 ± 23.7 µg/g Cr, 2.08 ± 0.33 µg/g Cr; p < 0.001) but not in Rahathangama (250.4 ± 18.8 µg/g Cr, 0.79 ± 0.12 µg/g Cr; p > 0.05) when compared with CN (191.2 ± 14.2 µg/g Cr, 0.67 ± 0.05 µg/g Cr). Urinary NGAL levels were significantly higher (12.4 ± 4.7 ng/mg Cr p < 0.0001, 12.0 ± 2.8 ng/mg Cr; p < 0.0001) in both Warunagama and Rahathangama. However, urinary KIM I levels were not significant (101.6 ± 25.0 ng/g Cr, 114.6 ± 25.5 ng/g Cr; P>0.05) with compared to CN (34.9 ± 20.1 ng/g Cr, 1.8 ± 0.4 ng/g Cr). In conclusion, current study confirms higher urinary herbicides levels in SF, potentially due to occupational exposure. Similarly, higher urinary KIM I and NGAL levels were also reported in both CKDu emerging locations and could be link with elevated herbicide residue levels. However, low but detectable levels of urinary herbicide, KIM I and NGAL in non-endemic controls may support dietary exposure and warrants further studies.