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Background and Aims: Liver injury is one of the common complications of paraquat (PQ) poisoning, but whether the degree of liver injury is related to patient prognosis is still controversial. This study aimed to investigate whether liver injury was a risk factor for death in PQ‐poisoned patients. Methods: We conducted a retrospective cohort study of PQ‐poisoned patients from the past 10 years (2011–2020) from a large tertiary academic medical centre in China. PQ‐poisoned patients were divided into a normal liver function group (n = 580) and a liver injury group (n = 60). Propensity score matching (PSM) analysis was then performed. Results: A total of 640 patients with PQ poisoning were included in this study. To reduce the impact of bias, dose of PQ, urinary PQ concentration and time from poisoning to hospital admission were matched between the two groups. A 3:1 PSM analysis was performed, ultimately including 240 patients. Compared with the normal liver function group, patients in the liver injury group were older, had a higher R value ([ALT/ULN]/[ALP/ULN]) (p <.001) and had a higher mortality rate. Cox regression analysis showed that there was no significant association between alanine aminotransferase, alkaline phosphatase, total bilirubin levels and hazard of death, but age, PQ dose, creatine kinase isoenzyme, creatine kinase, white blood cell count, neutrophil percentage and lymphocyte percentage were associated with mortality in patients with PQ poisoning. Conclusions: The occurrence of liver injury within 48 h after PQ poisoning was a risk factor for mortality, and such liver injury was likely of a hepatocellular nature. Age, PQ dose, creatine kinase isoenzyme and white blood cell count were positively correlated with mortality, while creatine kinase, percentage of neutrophils and lymphocytes were inversely correlated. [ABSTRACT FROM AUTHOR]

This umbrella review presents different therapeutic approaches for Paraquat (PQ) poisoning to reach a general conclusion on what is the best treatment to reduce mortality. A comprehensive electronic search of relevant databases was conducted from inception to April 2022. Only systematic reviews with or without meta‐analysis were eligible for this review. Initially, 123 titles were retrieved, and after removing the duplicates, 89 titles and abstracts were reviewed. Finally, 34 full texts were screened, and of these, 11 qualitative systematic reviews and quantitative meta-analyses (including 12 trials) were eligible. The mortality rate following all included interventions was 24% less likely to occur than in routine management (RR: 0.763, 95% CI 0.649–0.897; p = 0.001). In subgroup analysis, the efficacy of immunosuppressive therapy and Ambroxol was higher than other interventions. The mortality rate following Ambroxol was 31% less likely to occur than routine management (RR: 0.690, 95% CI 0.552–0.863; p = 0.001). This rate was similar to the immunosuppressive therapy (RR: 0.700, 95% CI: 0.627–0.782; p < 0.001). Other interventions did not affect the reduction of the mortality rate (p > 0.05). To conclude the accurate result, further studies are recommended to evaluate the efficacy and safety of immunosuppressive therapy. [ABSTRACT FROM AUTHOR]

Paraquat poisoning results in significant pulmonary damage, but current treatments are only minimally effective in repairing the injured lung tissues. Recent research has highlighted the promise of using stem cell therapy, namely mesenchymal stem cells, as a new method for treating paraquat toxicity. These cells have shown effectiveness in decreasing inflammation, apoptosis, and fibrosis in the mice lungs subjected to paraquat. The therapeutic implications of mesenchymal stem cells are believed to arise from their release of bioactive proteins and their capacity to regulate inflammatory responses. However, additional clinical study is required to validate these therapies' efficacy. This review thoroughly explores the pathophysiology of paraquat poisoning and the properties of mesenchymal stem cells. Additionally, it critically assesses the long-term safety and effectiveness of mesenchymal stem cell therapies, which is crucial for developing more dependable and effective treatment protocols. In summary, although mesenchymal stem cells offer promising prospects for treating lung injuries, more investigations are required to optimize their therapeutic promise and ensure their safe clinical application in the context of paraquat poisoning. [ABSTRACT FROM AUTHOR]

Background: Paraquat poisoning remains a critical public health issue with no established effective treatment. Hemoperfusion (HP) has been recognized for its potential to remove toxins and is widely employed in several developing countries for managing acute paraquat poisoning cases. However, the reluctance of some patients to undergo this recommended treatment has been observed but not thoroughly investigated. This study aimed to explore the factors associated with the refusal of HP in patients suffering from paraquat intoxication. Materials and Methods: In this retrospective study, data of 358 patients with acute paraquat poisoning were analyzed in Xi'an, China. The outcome of our study was mortality, and the influential factors were age, gender, marital status, educational level, symptoms at presentation, and laboratory findings. A logistic regression model was utilized to explore the independent risk factors. Results: In a total of 358 paraquat-poisoned patients, the significant differences were found between patients who underwent HP and those who did not, particularly regarding mean age (48.02 years vs. 42.32 years; P = 0.01), mental disorders (15.6% vs. 6.1%; P = 0.01), poisoning severity score (2.36 vs. 2.57; P = 0.03), organ failure (10.9% vs. 23.5%; P = 0.02), and mechanical ventilation (18.8% vs. 33.3%; P = 0.02). Patients who refused HP exhibited a higher mortality (20.3% vs. 10.9%; P = 0.03) compared to those who received HP. Age (odds ratio (OR), 1.76; 95% confidence interval (CI): 1.01-3.82; P = 0.01) and history of mental disorders (OR, 2.81; 95% CI: 1.19-6.61; P = 0.02) were identified as significant independent predictors for the refusal of HP. Conclusion: The results of this study showed that elderly individuals and those with a history of mental disorders were independently associated with refusing HP in patients with acute paraquat poisoning. [ABSTRACT FROM AUTHOR]

Background: Patients with paraquat poisoning (PP) have a mortality rate comparable to that of advanced malignancies, yet palliative care is seldom considered in these patients. This audit aimed to identify triggers for early palliative care referral in critically ill patients with PP. Methods: Medical records of patients with PP were audited. Predictors of mortality within 48 hours of hospitalization and 24 hours of intensive care unit (ICU) admission were considered as triggers for palliative care referral. Results: Among 108 patients, 84 complete records were analyzed, and 53 out of 84 (63.1%) expired. Within 48 hours after hospitalization, the lowest oxygen partial pressure in arterial blood to a fraction of inspired oxygen [the ratio of partial pressure of oxygen in arterial blood (PaO2) to the fraction of inspiratory oxygen concentration (FiO2) (PaO2/FiO2)] was the independent predictor of mortality, cut-off ≤ 197; the area under the curve (AUC), 0.924; sensitivity, 97%; specificity, 78%; p <0.001; and 95% confidence interval (CI): 0.878-0.978. Kaplan-Meier survival plot showed that the mean survival time of patients with the lowest PaO2/FiO2, ≤197, was 4.64 days vs 17.20 days with PaO2/FiO2 >197 (log-rank p < 0.001). Sequential organ failure assessment (SOFA) score within 24 hours of ICU admission had a cut-off ≥9; AUC, 0.980; p < 0.001; 95% CI: 0.955-1.000; 91% sensitivity; and 90% specificity for mortality prediction. Out of the total of 84 patients with PP analyzed, there were 11 patients admitted to the high dependency units (13.1%) and 73 patients admitted to the ICU (86.9%). Out of the total of 84 patients of PP in whom data was analyzed, 53 (63.1%) patients required ventilator support. All the 53 patients who required ventilator support due to worsening hypoxemia, eventually expired. Conclusion: The lowest PaO2/FiO2 ≤ 197 within 48 hours of hospitalization, SOFA score ≥9 within 24 hours of ICU admission or need for mechanical ventilation are predictors of mortality in PP patients, who might benefit from early palliative care. [ABSTRACT FROM AUTHOR]

Background: Paraquat (PQ) plays an important role in agricultural production due to its highly effective herbicidal effect. However, it has led to multiple organ failure in those who have been poisoned, with damage most notable in the lungs and ultimately leading to death. Because of little research has been performed at the genetic level, and therefore, the specific genetic changes caused by PQ exposure are unclear. Methods: Paraquat poisoning model was constructed in Sprague Dawley (SD) rats, and SD rats were randomly divided into Control group, paraquat (PQ) poisoning group and Anthrahydroquinone-2,6-disulfonate (AH2QDS) treatment group. Then, the data was screened and quality controlled, compared with reference genes, optimized gene structure, enriched at the gene expression level, and finally, signal pathways with significantly different gene enrichment were screened. Results: This review reports on lung tissues from paraquat-intoxicated Sprague Dawley (SD) rats that were subjected to RNA-seq, the differentially expressed genes were mainly enriched in PI3K-AKT, cGMP-PKG, MAPK, Focal adhesion and other signaling pathways. Conclusion: The signaling pathways enriched with these differentially expressed genes are summarized, and the important mechanisms mediated through these pathways in acute lung injury during paraquat poisoning are outlined to identify important targets for AH2QDS treatment of acute lung injury due to paraquat exposure, information that will be used to support a subsequent in-depth study on the mechanism of PQ action. [ABSTRACT FROM AUTHOR]

Objective To summarize the effect of the timing of lung transplantation and related treatment measures on clinical prognosis of patients with paraquat poisoning. Methods Clinical data of a patient with paraquat poisoning undergoing bilateral lung transplantation were retrospectively analyzed. Clinical manifestations, auxiliary examination, diagnosis and treatment of this patient were summarized and analyzed. Results A 17-year-old adolescent was admitted to hospital due to nausea, vomiting, cough and systemic fatigue after oral intake of 20-30 mL of 25% paraquat. After symptomatic support treatment, the oxygen saturation was not improved, and pulmonary fibrosis continued to progress. Therefore, sequential bilateral lung transplantation was performed under extracorporeal membrane oxygenation (ECMO). After postoperative rehabilitation and active prevention and treatment for postoperative complications, the patient was discharged at postoperative 50 d. Conclusions The timing of lung transplantation after paraquat poisoning may be selected when the liver and kidney function start to recover. Active and targeted prevention of potential pathogen infection in perioperative period and early rehabilitation training contribute to improving clinical prognosis of lung transplant recipients. [ABSTRACT FROM AUTHOR]

Rationale: Multi-organ failure is a symptom of paraquat poisoning, resulting in high mortality and morbidity rates. Though paraquat is widely available, poisoning through inhalation is rare. Patient's Concern: A 37-year-old male reported to the emergency department with complaints of vomiting after an alleged history of inhalation of paraquat while at work. Diagnosis: Paraquat poisoning. Interventions: Supportive management along with multiple sessions of hemodialysis. Outcomes: Renal complications caused by paraquat were improved after multiple sessions of hemodialysis. However, the patient developed respiratory complications and later due to persistent hypoxemia and non-responsive to supportive therapy, he succumbed to his illness. Lessons: Acute kidney injury is a complication of paraquat poisoning. However, kidney involvement with the inhalational mode is rare. It is caused by reduction and oxidation cycles, as well as the formation of reactive oxygen species, necessitating hemodialysis as the treatment. Without a clear history, a specific clinical trait, or a diagnostic test, diagnosis can be difficult. Our case thus highlights the inhaled paraquat poisoning, presenting with acute kidney injury with late respiratory impairment as a consequence.

Background: Paraquat poisoning is one of the leading causes of fatal poisoning in many parts of the world, especially in agricultural countries. Its high toxicity even in small amounts causes rapid damage to multiple organs, especially the kidneys, lungs, and liver, mainly through free radical-mediated injury. As no specific antidote is yet available, early diagnosis and the importance of supportive therapy are critical parts of management. Some evidence suggests a survival benefit from using immunosuppressive drugs. Case report: This case presentation concerns a 15-year-old boy from a village with a history of herbicide poisoning, later confirmed to be paraquat. Despite supportive therapy her condition continued to deteriorate with features of kidney and lung damage. The patient was then treated with methylprednisolone 500 mg daily for 5 days, along with other supportive care, and has made a remarkable recovery. Conclusions: High efficacy as an herbicide, availability and low cost make paraquat an easy-to-encounter poison for suicidal or accidental use. Its high fatality calls for urgent and effective strategies to save lives. Methylprednisolone may play a role in its treatment.

Aims and objectives: This case series is done to know the Clinico-epidemiological profile of paraquat poisoning in children and also the implication of available treatment guidelines in improving outcomes in the paediatric population as there are no standard treatment guidelines available. Materials and Methods: Nine children were selected during the study period of October 2021 to February 2023, demographic data were collected, clinical parameters were assessed with details such as time of presentation, symptoms and first aid received, laboratory parameters such as LFT, RFT, chest radiographs obtained and serial values monitored. Treatment as per the available recommendation was initiated with immunosuppressive therapy and haemodialysis on a case-to-case basis. Results: Among the 9 children, there were 6 females (67%) with an average age group of 15-18 years. eight (89%) of the 9 children developed acute renal failure. Seven children underwent haemodialysis. Five (55%) children developed hepatic dysfunction. Among the 9 children, 3 (67%) survived. Conclusion: The study reveals that the mortality rate can be reduced, if the child presented to the hospital within 8 hours of ingestion of the compound, amount ingested is less than 20 ml, and early initiation of Haemodialysis within 8 hours and a trail of immunosuppressive therapy. [ABSTRACT FROM AUTHOR]

The lack of a highly sensitive method to evaluate paraquat (PQ)-induced pulmonary fibrosis and predict disease progression remains an unresolved clinic issue. Fibroblast activation protein (FAP) may play an important role in the pathogenesis of PQ-induced pulmonary fibrosis. We aimed to evaluate the role of FAP in the PQ-induced pulmonary fibrosis and the utility of fibroblast activation protein inhibitor (FAPI) for positron emission tomography (PET) imaging in PQ-induced pulmonary fibrosis. In our study, two cases of PQ poisoning were presented and FAPI PET/CT was performed as a novel imaging technique. The uptake of FAPI increased in both cases of PQ poisoning. Animal experiments were then performed to validate the findings in the patients. Physiological FAPI lung uptake was higher in mice of the PQ group than in the control group. The results of histological analysis and Western blot were consistent with the findings of PET/CT imaging. The pulmonary fibrosis animal model was developed by intragastric gavage of PQ. PET/CT imaging was performed after injection of FAPI. Lung tissues of mice were collected for fibrosis assessment after imaging. Immunohistochemistry for FAP, histology and Western blot for collagen were performed to further validate the imaging findings. In conclusion, FAPI was involved in the pathogenesis of fibrosis induced by PQ, and PET/CT with FAPI could detect lung fibrogenesis, making it a promising tool to assess early disease activity and predict disease progression. [ABSTRACT FROM AUTHOR]

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Background: Paraquat poisoning is characterized by acute lung injury, pulmonary fibrosis, respiratory failure, acute kidney injury and multi-organ failure, resulting in a high rate of mortality and morbidity. Several prognostic markers have been found to have prognostic significance in the evaluation of PQ (Paraquat Poisoning) poisoning at present, such as plasma PQ concentration, arterial lactate level, severity scoring system and arterial blood gas analysis and C-reactive protein is an acute phase reactant and its level is positively correlated with the degree of inflammation during the early course of illness. Due to similar inflammatory response in PQ poisoning CBC may also be used as prognostic indicator in patient with PQ poisoning. Objective: To determine the prognostic value of haematological parameters and CRP (C-reactive Protein) in patients with acute paraquat poisoning. Method: It was a prospective observational study done over a period of 1 year (December 2020 to December 2021). The study protocol was approved by the institutional ethics committee at our hospital (IEC Appln. No. 697). Observation: The prognosis of patients with paraquat poisoning based on their SOFA (Sequential Organ Failure Assessment) scores. As many as 40 (80.0%) out of 50 patients were having a SOFA score of less than 6 and only 10 (20.0%) and a score between 7 and 12 at the end of 24 hours. The mean CRP score among patients with multiple organ dysfunction syndrome at 48 hours. Conclusion: NLR, Leukocyte and Neutrophil counts, CRP level may be simple and potentially significant parameters for evaluating prognosis in the patients with PQ poisoning. However, larger prospective studies should be warranted to further confirmation of these findings. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to examine long-term survival of patients with acute paraquat poisoning using computed tomography (CT) images and spirometry. Methods: A total of 36 patients with long-term survival after paraquat poisoning were followed-up and divided into mild (11 patients), moderate (17 patients), and severe (8 patients) paraquat poisoning groups. Differences among the groups were compared using clinical indicators, such as peripheral capillary oxygen saturation, arterial partial pressure of oxygen and 6-min walk test (6-MWT), chest CT, spirometry, and serum immunoglobulin E (IgE). Results: The 6-MWT distance was significantly shorter in the severe paraquat poisoning group than that in the mild and moderate paraquat poisoning groups. In the mild paraquat poisoning group, CT revealed no obvious lung injury, and spirometry showed normal lung function in most patients. In moderate or severe paraquat poisoning group, CT images showed fibrotic lesions as cord-like high-density shadows, reticulations, and honeycombs. In addition, other pulmonary changes, including bronchiectasis, increased lung transparency, and pulmonary bullae, were discovered. In moderate or severe paraquat poisoning group, obvious obstructive ventilation dysfunction with slight restrictive and diffuse impairment were observed in some patients, with positive bronchial relaxation test and high serum IgE level. Conclusion: In the long-term follow-up, patients with severe paraquat poisoning showed the lowest exercise endurance. In moderate or severe paraquat poisoning group, CT images revealed diversified changes, not only dynamic evolution of pulmonary fibrosis process, but also signs of bronchiectasis, and chronic obstructive pulmonary disease. Some patients with moderate or severe paraquat poisoning developed obstructive ventilatory dysfunction with airway hyperresponsiveness. [ABSTRACT FROM AUTHOR]

Introduction: paraquat is a cheap and easy access herbicide which its intoxication is limited in Iran. The current study aims to provide some epidemiologic data within paraquat poisoning from the most crowded referral center of clinical toxicology in Iran.Methods: We investigated the paraquat poisoning patients who were admitted to Loghman-Hakim Hospital in Tehran, Iran from 2008 to 2016.Results: A total of 12 patients participated in this study, 50% of these patients were between 10-20 years old, 41.7% were between 26-40 years old, and 8.3% were above 55 years old. About 83.3% were male, and 16.7% were female. Treatments which were given in the hospital include cyclophosphamide (58.3%), cortisol (75%), vitamin C (50%), vitamin E (83.3%), N-acetyl cysteine (83.3%). 66.6 percent of hospitalized patients required invasive measures to preserve their airways, with 3.33 percent undergoing tracheostomy and the same percentage undergoing intubation. There were five fatalities among the patients, three of which were related to pulmonary and renal failure.Conclusions: This study indicates that the majority are younger than 40 years and males. Prevention and limited access to this substance is necessary in terms of the lack of antidote.

Objective: To explore the protective effects of anthrahydroquinone- 2,6-disulfonate (AH2QDS) on the kidneys of paraquat (PQ) poisoned rats via the apelin-APJ pathway. Methods: Male Sprague Dawley rats were divided into four experimental groups: control, PQ, PQ+sivelestat, and PQ+AH2QDS. The PQ+sivelestat group served as the positive control group. The model of poisoning was established via intragastric treatment with a 20% PQ pesticide solution at 200 mg/kg. Two hours after poisoning, the PQ+sivelestat group was treated with sivelestat, while the PQ+AH2QDS group was given AH2QDS. Six rats were selected from each group on the first, third, and seventh days after poisoning and dissected after anesthesia. The PQ content of the kidneys was measured using the sodium disulfite method. Hematoxylin-eosin staining of renal tissues was performed to detect pathological changes. Apelin expression in the renal tissues was detected using immunofluorescence. Western blotting was used to detect the expression levels of the following proteins in the kidney tissues: IL- 6, TNF-α, apelin-APJ (the apelin-angiotensin receptor), NF-κB p65, caspase-1, caspase-8, glucose-regulated protein 78 (GRP78), and the C/EBP homologous protein (CHOP). In in vitro study, a PQ toxicity model was established using human tubular epithelial cells treated with standard PQ. Twenty-four hours after poisoning, sivelestat and AH2QDS were administered. The levels of oxidative stress in human renal tubular epithelial cells were assessed using a reactive oxygen species fluorescence probe. Results: The PQ content in the kidney tissues of the PQ group was higher than that of the PQ+AH2QDS group. Hematoxylin-eosin staining showed extensive hemorrhage and congestion in the renal parenchyma of the PQ group. Vacuolar degeneration of the renal tubule epithelial cells, deposition of crescent-like red staining material in renal follicles, infiltration by a few inflammatory cells, and a small number of cast formation were also observed. However, these pathological changes were less severe in the PQ+sivelestat group and the PQ+AH2QDS group (P

Introduction: Paraquat is a widely used herbicide and a potent toxin. Ingestion, rather than inhalation, is the typical route of exposure associated with human toxicity. There have been systemic reactions following skin exposure after direct exposure to the skin (soaking of the skin with paraquat) or when the skin integrity has been breached (preexisting skin lesions or burn). Most paraquat deaths result from suicidal intent. Although paraquat ingestion leads to acute gastrointestinal tract necrosis and multiorgan failure, the lung is the target organ for toxicity among those surviving the immediate postingestion period. Material and Methods: This is a retrospective study conducted in the Department of Critical Care at NRI Medical College & General Hospital, Guntur. The study included patients with the ages above 14 years old who were presented to the Emergency Department with paraquat poisoning. This includes patients who were self-admitted or with witness account of paraquat exposure (ingestion, inhalational, mucosal or skin contact). Results: In our study, most of the patients were belongs to 26-35 years 17(48.5) followed by 18-25 years 9 (25.7), 36-45 years 6 (17.1), 46-55 years and more than 56 years were 5.7% and 2.8% respectively. The majority were male (n=29, 82.8%) and female (n=6, 17.1%) were least. The main symptoms and signs of studied patients include nausea (94.2%); vomiting (88.5%); Abdominal pain (91.4%); Paraquat tongue (88.5%), Oliguria (45.7%); Jaundice (37.1%), Respiratory distress (2.8%). For survived and non-survived patients, the Amount of ingested paraquat (mL) the mean ± SD was 25.6±5.6 ml and 295±28 ml respectively. The difference was statistically significant (P=0.001). Conclusion: It is important to establish the diagnosis early and to pursue aggressive decontamination and prevention of further absorption. Increased awareness of the clinician and availability of the laboratory diagnostic methods will definitely help in successful management of paraquat poisoning. Paraquat poisoning is still a concern in developing countries. It may be useful to educate public health professionals and the general population about the serious consequences of exposure to this toxic agent. Paraquat poisoning is still no cure. [ABSTRACT FROM AUTHOR]

Introduction:Paraquat is a commonly used herbicide in India. It is classified as a viologen. It is a quickly acting non-selective herbicide widely used in Asia. It is highly toxic to humans and can cause multisystem involvement. No specific antidote is available for its treatment till now. Because of its toxicity, it has been forbidden in western countries. Material and Methods: The data of 10 cases of paraquat consumption admitted in past 1 year were collected from MIMS medical record section. On admission to casualty, diagnosis of paraquat consumption was established by clinical history and documentation of paraquat compound from consumption bottle. The amount of compound consumed was documented. Detailed clinical examination was done and relevant investigations were done. Patients were classified to have renal dysfunction if the serum creatinine was above 1.2 mg/dl Acute Kidney Injury if serum creatinine increases by 1.5-1.9 times baseline or if urine output less than <0.5ml/kg/hr for 6-12 hours. RESULTs:A total of 10 patients were included in this study and their details have been tabulated. Eight patients were admitted within 6 hours of paraquat ingestion. The commonest symptoms were burning sensation in throat, chest region (90%) followed by vomiting (80%), oral ulceration or dysphagia (70%), altered sensorium (60%), dyspnea (50%), chest pain or palpitations (10%). Hypotension was documented in four patients. Lung injury was document in 6 patients, of the 6 patients who had undergone chest x ray 5 had infiltrates. Seven patients needed dialytic support. During hospitalization, 8 patients died and 2 survived. Conclusion:Paraquat poisoning is life-threatening with multi-organ failure and pulmonary fibrosis which is having high fatality rate. Our study showed that in-hospital mortality rate of 80%. In the absence of effective antidote and specific treatment, paraquat continues to cause very high mortality rates and if not monitored closely for few weeks, the patient may succumb to multiorgan failure. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical efficacy and safety of fractionated plasma separation and adsorption combined with continuous veno-venous hemofiltration (FPSA-CVVH) treatment in patients with acute bipyridine herbicide poisoning., Methods: A retrospective analysis of 18 patients with acute bipyridine herbicide poisoning was conducted, of which 9 patients were poisoned by diquat and 9 patients by paraquat. All patients underwent FPSA-CVVH treatment. The serum cytokine levels in pesticide-poisoned patients were assessed. The efficacy of FPSA-CVVH in eliminating cytokines, the 90-d survival rate of poisoned patients, and adverse reactions to the treatment were observed., Results: Fourteen patients (77.8%) had acute kidney injuries and 10 (55.6%) had acute liver injuries. The serum cytokine levels of high mobility group protein B-1 (HMGB-1), interleukin-6 (IL-6), IL-8, interferon-inducible protein-10 (IP-10), monocyte chemotactic protein-1 (MCP-1), and macrophage inflammatory protein-1β (MIP-1β) were significantly elevated. A total of 41 FPSA-CVVH treatment sessions were administered. After a single 8-h FPSA-CVVH treatment, the decreases in HMGB-1, IL-6, IL-8, IP-10, MCP-1, and MIP-1β were 66.0%, 63.5%, 73.3%, 63.7%, 53.9%, and 54.1%, respectively. During FPSA-CVVH treatment, one patient required a filter change due to coagulation in the plasma component separator, and one experienced a bleeding adverse reaction. The 90-d patient survival rate was 50%, with 4 patients with diquat poisoning and 5 patients with paraquat poisoning, and both liver and kidney functions were restored to normal., Conclusion: Cytokine storms may play a significant role in the progression of multiorgan dysfunction in patients with acute bipyridine herbicide poisoning. FPSA-CVVH can effectively reduce cytokine levels, increase the survival rate of patients with acute bipyridine herbicide poisoning, and decrease the incidence of adverse events.

This paper reports on a 22-year-old male presenting with persistent chest pain accompanied by mediastinal emphysema. We firstly considered mediastinal emphysema induced by community acquired pneumonia. Pathogen detection was performed but no positive results were found. Based on the results of a subsequent lung CT scan, paraquat poisoning was suspected. Although there was no trace of paraquat in the blood, the nebulizer masks used by patient at home was found to be positive for paraquat. The diagnosis was ultimately established as paraquat poisoning via inhalation with mediastinal emphysema. This case report explores the clinical manifestations, diagnostic challenges, and treatment complexities of inhaled paraquat poisoning, emphasizing the importance of recognizing this rare poisoning route and its atypical symptoms., (© 2024. The Author(s).)

Background: Paraquat is a herbicide commonly used for controlling weeds in India. The primary target organs for paraquat poisoning are the lungs and the kidneys. Acute cases of poisoning with paraquat are admitted to the hospital with various stages of acute kidney injury. Aim: To study the clinical presentation and outcome of paraquat poisoning in a tertiary care setting. Materials and Methods: A retrospective observational study was conducted at SDM College of Medical Sciences and Hospital, Dharwad. In this study we included the data of all patients admitted to the hospital with paraquat poisoning for a period of three-year and four months between January 2018 to April 2021. Results: A total of 12 participants were included in the final analysis. All the patients consumed paraquat with the suicidal intention only. The quantity of paraquat ingested was quite varied, ranging from as low as 5ml to as high as 200ml. Acute Kidney Injury (AKI) was diagnosed in 58.3% of patients. Among which three patients were in stage 1, one was in stage 2, and three were in stage 3. The mortality rate was 58.33%. The major cause of death for these patients was multiple organ dysfunction syndromes (71.42 %). Conclusion: Acute kidney injury is the major clinical outcome of paraquat poisoning other than lung injury. This may result in multiple organ dysfunction syndrome (MODS) and mortality. Paraquat poisoning is due to consumption with suicidal intent. Most of them were young. Early management with hemoperfusion may have a positive effect on reducing mortality. [ABSTRACT FROM AUTHOR]

This is a case of a 22-year-old male student who took paraquat as a substance abuse. He presented with flu-like symptoms and chest X-ray depicting changes of acute respiratory distress syndrome (ARDS). After looking at his purchase history in his cell phone, he was found to have purchased paraquat dichloride online and its use was later confirmed by his roommate. The patient developed respiratory distress with renal failure and succumbed to his condition after 11 days of hospital admission. This report highlights an important social issue of probable substance abuse with paraquat which is a commonly used contact herbicide in rural settings but not-so-common in urban population. Also, the report highlights the unusual complication sequalae of pneumothorax. The high mortality with this substance is because of the unavailability of an antidote and of its unscrutinized availability.

This case series examined the demographic details and outcome of seven pediatric paraquat (PQ) poisoning patients admitted to a teaching hospital in North India from February to October 2020 during the COVID-19 pandemic. All were adolescents and had intentionally ingested PQ for suicide; four died in spite of best recommended immunomodulator and anti-inflammatory therapy and hemodialysis (HD) due to multiorgan failure. We hope that the data would be of useful to clinicians who deal with poisoning.

Paraquat poisoning is a grave public health problem in the Andaman and Nicobar islands of India. To evaluate various aspects of paraquat poisoning that influence the outcome, a retrospective study was planned. In this case series study, the information about all cases of acute paraquat poisoning who were admitted to GB Pant Hospital, Port-Blair, in a 12-year period (January 2007–December 2018) were evaluated. A total of 29 referred patients were evaluated with the majority from the early productive age of 16–30 years (68.97%). The case fatality rate was 100%. Most of the incidents took place in South Andaman district (68.97%) and during the rainy season (55.17%). Initially, they presented with local symptoms like mouth and throat pain with ulceration (48.27%), vomiting (44.82%), breathlessness (34.48%), epigastric and abdominal pain (31.03%), hematemesis (27.58%), and oliguria (20.68%). Later on, major organ dysfunctions like a respiratory failure (65.51%), acute kidney injury (62.08%), acute liver failure (55.17%), cardiac dysfunction (31.03%), and multiorgan failure (58.62%) ensued. Patients who were referred early had a significantly longer hospital stay. Few received advanced care, like, methyl prednisolone (24.12%), cyclophosphamide (10.34%), Mesna/NAC (06.89%), charcoal tablets (10.34%), mechanical ventilation (06.89%), and hemodialysis (10.34%). Apart from hemodialysis in acute kidney injury patients and steroid pulse, no other modalities showed improved hospital survival duration. Primary prevention especially government laws, public awareness, and education of health professionals regarding the seriousness of this problem are the keys to get rid of this incurable poisoning in these islands. The government should prioritize preventive works in the south Andaman district and during the rainy season to avoid catastrophe each year and if possible should ban it. Methyl prednisolone therapy and hemodialysis might be advocated to have a better outcome.

Paraquat (PQ) is a bipyridine dichloride non-selective herbicide, which was widely used in the world in the last century. It is banned in most countries because of the extremely high death rate and the lack of specific detoxification drugs, but the death cases of poisoning still occur frequently, so it is of great clinical significance to study the molecular mechanism of poisoning and detoxification drugs. Its poisoning causes dysfunction of lung, liver, kidney, myocardium, brain and other organs with complex molecular mechanism. There are excessive inflammatory reaction theory, REDOX reaction imbalance, oxidative stress free radical damage, calcium overload, NO molecular damage, apoptosis, etc. For the treatment of poisoning, PQ antibody, pathway target blocker and related factor antibody have been newly developed in recent years. Although certain effects have been achieved, the treatment efficiency has not been significantly improved. This paper summarized the mechanism of signal transduction pathways involved in lung injury caused by PQ poisoning in order to provide a theoretical basis for further research. [ABSTRACT FROM AUTHOR]

Introduction: paraquat is a cheap and easy access herbicide which its intoxication is limited in Iran. The current study aims to provide some epidemiologic data within paraquat poisoning from the most crowded referral center of clinical toxicology in Iran. Methods: We investigated the paraquat poisoning patients who were admitted to Loghman-Hakim Hospital in Tehran, Iran from 2008 to 2016. Results: A total of 12 patients participated in this study, %50 of these patients were between 20-10 years old, %41.7 were between 40-26 years old, and %8.3 were above 55 years old. About %83.3 were male, and %16.7 were female. Treatments which were given in the hospital include cyclophosphamide (%58.3), cortisol (%75), vitamin C (%50), vitamin E (%83.3), N-acetyl cysteine (66.6 .)%83.3 percent of hospitalized patients required invasive measures to preserve their airways, with 3.33 percent undergoing tracheostomy and the same percentage undergoing intubation. There were five fatalities among the patients, three of which were related to pulmonary and renal failure. Conclusions: This study indicates that the majority are younger than 40 years and males. Prevention and limited access to this substance is necessary in terms of the lack of antidote. [ABSTRACT FROM AUTHOR]

Background: Acute paraquat poisoning-induced multiple organ dysfunction syndrome (MODS) leads to the high mortality. This study aimed to investigate the clinical significance of microRNA-200b-3p (miR-200b-3p), an upstream inhibitor of high-mobility group box 1 (HMGB1), in acute paraquat poisoning patients for the prediction of MODS and survival. Methods: This study enrolled 80 patients with MODS induced by paraquat and 94 healthy volunteers. The interaction between miR-200b-3p and HMGB1 was identified by luciferase reporter assay. miR-200b-3p levels were measured by quantitative real-time (QRT) PCR. High-mobility group box 1 levels were measured by enzyme-linked immune sorbent assay (ELISA). Receiver operating characteristic analysis was used to evaluate the diagnostic value of miR-200b-3p in screening MODS patients. The relationship between miR-200b-3p and the 28-day survival of MODS patients was evaluated by Kaplan–Meier curves and log-rank test. Cox regression analysis was used to assess the prognostic value of miR-200b-3p. Correlation between miR-200b-3p and HMGB1 was confirmed by Pearson's correlation analysis. Results: miR-200b-3p directly target HMGB1. miR-200b-3p, decreased in MODS patients, had high diagnostic value to screen MODS patients from healthy controls. Additionally, serum miR-200b-3p was decreased in non-survivors, and patients with low miR-200b-3p level had poor 28-day survival. Serum miR-200b-3p could independently predict the survival prognosis. Moreover, serum HMGB1 level was increased in MODS patients, and was negatively correlated with miR-200b-3p level. Conclusion: Decreased miR-200b-3p may function as a biomarker for the diagnosis and survival prognosis of MODS patients, and miR-200b-3p may be involved in the progression of acute paraquat-induced MODS via regulating inflammatory responses by targeting HMGB1. [ABSTRACT FROM AUTHOR]

Introduction: Pulmonary fibrosis (PF) encompasses a spectrum of lung conditions characterized by the abnormal accumulation of scar tissue in the lungs, leading to impaired respiratory function. Various conditions can result in severe PF, among which viral infections have emerged as significant triggers. In addition to viral infections, exposure to toxic substances such as paraquat represents another significant risk factor for PF. Therefore, this study aimed to explore the dissimilarities and similarities between PF triggered by viral infections and chemical toxicants, using the mechanism of PF in IPF as a reference., Methods: Data-independent acquisition proteomics technology was employed to identify COVID-19 and paraquat-induced PF from the autopsy of lung tissue samples obtained from individuals who died due to PF. Bioinformatics was employed for differential protein analysis, and selected indicators were validated on pathological sections., Results: Our results showed that the differential proteins associated with the two causes of PF were enriched in similar lung fibrosis-related signaling pathways, such as the Wnt signaling pathway. However, differences were observed in proteins such as CACYBP, we verified the consistency of the results with proteomics using the IHC approach., Conclusion: This study illuminates distinct protein-level differences by investigating pulmonary fibrosis pathways in severe COVID-19 and paraquat poisoning. Although both conditions activate lung-protective and repair pathways, COVID-19 shows limited phosphorylation-independent ubiquitination of β-catenin compared to paraquat toxicity. These findings shed light on potential therapeutic targets for PF induced via diverse factors., Competing Interests: The authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Min, Jiaqi, Lihua, Qianqian, Shujuan, Xiang, Liang, Liang, Yiwu and Qian.)

Competing Interests: None declared.

Objective: To study and analyze the epidemiological regularity of acute poisoning in Tianjin-Hebei region from 2020 to 2022, and to provide reference for the treatment and prevention of related patients. Methods: In December 2023, the analysis results and clinical data of 4695 patients with drug poisoning from January 2020 to December 2022 in multiple centers of Tianjin-Hebei region were collected as research objects. Gender, age, type of drug poisoning, season and poisoning route of the research objects were analyzed, and statistical analysis was conducted as well. Results: The sex ratio of men and women was 1∶1.16 (2173/2522). The poisoning of antidepressants and benzodiazepines were the most common drug poisonings, accounting for 1550 and 1274 cases respectively (33%, 27.1%). Paraquat poisoning has decreased year by year, while the poisonings of herbicides with low toxicity such as diquat, glyphosate and cremart have increased. The number of cases reached a peak during May to August which was the poisoning season, while was relatively fewer during October to December. Conclusion: Effective intervention measures should be taken according to the age of high incidence of poisoning, different seasons and populations. Essential drug poisoning prevention measures should be established and improved. The systems of sedative drug management and use should be established, and pesticide management and storage need to be strengthened.

Background: Paraquat poisoning remains a critical public health issue with no established effective treatment. Hemoperfusion (HP) has been recognized for its potential to remove toxins and is widely employed in several developing countries for managing acute paraquat poisoning cases. However, the reluctance of some patients to undergo this recommended treatment has been observed but not thoroughly investigated. This study aimed to explore the factors associated with the refusal of HP in patients suffering from paraquat intoxication., Materials and Methods: In this retrospective study, data of 358 patients with acute paraquat poisoning were analyzed in Xi'an, China. The outcome of our study was mortality, and the influential factors were age, gender, marital status, educational level, symptoms at presentation, and laboratory findings. A logistic regression model was utilized to explore the independent risk factors., Results: In a total of 358 paraquat-poisoned patients, the significant differences were found between patients who underwent HP and those who did not, particularly regarding mean age (48.02 years vs. 42.32 years; P = 0.01), mental disorders (15.6% vs. 6.1%; P = 0.01), poisoning severity score (2.36 vs. 2.57; P = 0.03), organ failure (10.9% vs. 23.5%; P = 0.02), and mechanical ventilation (18.8% vs. 33.3%; P = 0.02). Patients who refused HP exhibited a higher mortality (20.3% vs. 10.9%; P = 0.03) compared to those who received HP. Age (odds ratio (OR), 1.76; 95% confidence interval (CI): 1.01-3.82; P = 0.01) and history of mental disorders (OR, 2.81; 95% CI: 1.19-6.61; P = 0.02) were identified as significant independent predictors for the refusal of HP., Conclusion: The results of this study showed that elderly individuals and those with a history of mental disorders were independently associated with refusing HP in patients with acute paraquat poisoning., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Research in Medical Sciences.)

Introduction: Parquet poisoning has been elaborated to be very common among developing countries, particularly in regions with agriculture economy. One of the most common presentations of paraquat poisoning is oropharyngeal burns. Herein, we report a patient from a dry and warm district in the geographic center of Iran where agriculture and, as a result, paraquat poisoning are not commonly reported. Case Presentation: A 25-year-old man presented to hospital subsequent to a suicide attempt by ingesting oral paraquat poison. He gradually developed odynophagia and trismus-like appearance that, after a psychiatric consultation, was misdiagnosed as a drug side effect in the form of dystonia. Upon further physical examination, oral ulcers on his tongue were revealed to be responsible for the symptom. Conclusion: Paraquat poisoning is very rare in regions with lower rates of agriculture activities. In any patient with poisoning, however, it is necessary to consider intraoral examination to rule out any other suspected diagnosis.

Paraquat is a bipyridilium herbicide which is highly toxic. Due to its corrosive effects, it can lead to esophagitis, esophageal rupture, and gastritis. It leads to the formation of reactive oxygen species which causes multiorgan damage, prominent among those being pulmonary, renal, and liver dysfunction. One of the rare causes of respiratory distress after paraquat poisoning is spontaneous pneumothorax due to pneumocyte injury, also known as the “Daisley Barton Syndrome.” We report a case of paraquat poisoning who developed alveolitis initially and later had bilateral spontaneous pneumothorax. Bilateral chest tubes were inserted, and the patient recovered initially but later deterorated due to other complications. We should be aware of this phenomenon, and sudden worsening of the respiratory parameters should alert the clinician for prompt treatment.

It is noted that elevated serum amylase levels suggesting pancreatic damage has an association with prognosis in PQ patients. This study aimed to determine whether PQ can cause pancreatic damage. The two conventional models (intragastric infusion (iG) and intraperitoneal injection (iP)) may exhibit different effects on the pancreas depending on whether or not they pass through the digestive tract. In this study, the rats were divided into four groups: the intragastric infusion group (PQ-iG, n = 45), intraperitoneal injection group (PQ-iP, n = 53), normal control group 1 (NC-iG, n = 6) and normal control group 2 (NC-iP, n = 6). Pancreatic damage was compared between groups using serum amylase activity assay, hematoxylin and eosin (H&E) staining, TUNEL assay, and transmission electron microscopy (TEM). Serum amylase levels in group PQ-iG were significantly higher than in group PQ-iP (p < 0.05). Examination of the H&E sections showed damage to the pancreas. Both experimental groups were displayed inflammatory infiltration within 9 h of PQ treatment. After 9 h, patchy necrosis was observed in group PQ-iP, when inflammatory infiltration was still the dominant pathology. Necrosis appeared and gradually worsened in group PQ-iG, in which necrosis was the dominant pathology. The TUNEL assay showed significantly higher numbers of apoptotic cells in the pancreas of PQ-groups than in the control NC- groups (p < 0.05). TEM showed expansive endoplasmic reticulum lumens and mitochondria swelling in the pancreas of the PQ-groups. It is concluded that both methods of modeling could cause pancreatic damage and the type and degree of damage would change over time. Note that pancreatic damage in group PQ-iG was more severe than that in group PQ-iP. Therefore, clinical practitioners should pay close attention to pancreatic damage caused by PQ, especially when the route of PQ administration was oral.

To analyze the clinical characteristics and therapeutic effects of transoral paraquat poisoning combined with Esophagitis dissecans superficialis (EDS). A retrospective observational study was conducted on paraquat poisoning patients between January 1, 2011 and August 30, 2016 in Qilu hospital. Fifteen patients with EDS were enrolled in this study. The clinical characteristics, prognosis, and pathological features of esophageal necrosis mucosa of these patients were retrospectively analyzed and summarized. Esophageal mucosal dissection occurs mainly within 3–8 days after transoral paraquat poisoning in 15 patients. Dosage of paraquat is range from 50 to 100 ml. Most patients have physical problems with swallowing before the intramural esophageal dissection occurred. And there are other symptoms, including sore throat or dysphagia (100%), nausea and vomiting (86.7%), heartburn or upper abdominal pain (73.3%), hematemesis (60%), abdominal distension (20%) and cough frequently (6.7%). In death group, most patients demonstrate features of the multiple organ failure when the esophageal mucosal stripping happened, including lung injury, renal failure, and hepatic failure. The shape of esophageal dissection was tubular in 60%, irregular in 40%, and they vary in size. Pathological examination showed extensive injury, necrosis and hemorrhage of digestive tract epithelium, and obvious inflammatory reaction of epithelial tissue. Transoral paraquat poisoning has certain damage to the patient's esophageal mucosa, and some may be complicated with EDS, and the prognosis is poor, especially when combined with multiple organ dysfunction. Esophageal damage is mainly located in the esophageal mucosa and have different degrees. Special attention should be paid on such patients. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of reduced glutathione and ulinastatin on the expressions of interleukin-6 (IL-6), soluble interleukin-6 receptor (sIL-6R), and soluble glycoprotein 130 (sgp130) in peripheral blood of paraquat-poisoned patients. Methods: In this retrospective study, 88 patients with paraquat poisoning admitted to Dongying People's Hospital, Dongying, China from February 2017 to October 2020 were divided into control group (n = 40) and study group (n = 48), based on treatment type. The control group received conventional treatments, while the study group was given reduced glutathione in combination with ulinastatin. Treatment efficacy and peripheral blood expression levels were compared. Results: Compared to the control group, curative effect was significantly higher in the study group (p < 0.05). The expression levels of IL-6, sIL-6R, and sgp130 in the peripheral blood at the early, middle and late periods in the study group were markedly lower. The number of patients with flake-like or dotted opacity, increased lung texture, pleural effusion and ground glass opacity in the study group during the early period was lower (p < 0.05). Moreover, the number of patients with pulmonary edema, fibrous cord, pleural effusion, ground glass opacity and reticular opacity during the middle period was markedly lower for the study group, while the population of patients with honeycomb lung, fibrous cord, nodules and reticular opacity in the study group was higher t (p < 0.05). Conclusion: A combination of reduced glutathione and ulinastatin produces significant therapeutic effect on paraquat poisoning by down-regulating the serum expressions of IL-6, sIL-6 and sgp130, inhibiting inflammation, and mitigating pulmonary lesions. [ABSTRACT FROM AUTHOR]

Paraquat poisoning is a grave public health problem in the Andaman and Nicobar islands of India. To evaluate various aspects of paraquat poisoning that influence the outcome, a retrospective study was planned. In this case series study, the information about all cases of acute paraquat poisoning who were admitted to GB Pant Hospital, Port-Blair, in a 12-year period (January 2007–December 2018) were evaluated. A total of 29 referred patients were evaluated with the majority from the early productive age of 16–30 years (68.97%). The case fatality rate was 100%. Most of the incidents took place in South Andaman district (68.97%) and during the rainy season (55.17%). Initially, they presented with local symptoms like mouth and throat pain with ulceration (48.27%), vomiting (44.82%), breathlessness (34.48%), epigastric and abdominal pain (31.03%), hematemesis (27.58%), and oliguria (20.68%). Later on, major organ dysfunctions like a respiratory failure (65.51%), acute kidney injury (62.08%), acute liver failure (55.17%), cardiac dysfunction (31.03%), and multiorgan failure (58.62%) ensued. Patients who were referred early had a significantly longer hospital stay. Few received advanced care, like, methyl prednisolone (24.12%), cyclophosphamide (10.34%), Mesna/NAC (06.89%), charcoal tablets (10.34%), mechanical ventilation (06.89%), and hemodialysis (10.34%). Apart from hemodialysis in acute kidney injury patients and steroid pulse, no other modalities showed improved hospital survival duration. Primary prevention especially government laws, public awareness, and education of health professionals regarding the seriousness of this problem are the keys to get rid of this incurable poisoning in these islands. The government should prioritize preventive works in the south Andaman district and during the rainy season to avoid catastrophe each year and if possible should ban it. Methyl prednisolone therapy and hemodialysis might be advocated to have a better outcome. [ABSTRACT FROM AUTHOR]

Objective To observe the effect of intragastric administration of febuxostat on paraquat-induced lung injury in rats and to explore its mechanism. Methods Twenty-one rats were randomly divided into three groups：the control group，paraquat group，and paraquat+febuxostat group. The rats in the paraquat group and paraquat+febuxostat group were given paraquat by gavage；in the paraquat+febuxostat group，febuxostat was given by gavage for 24 h，but rats in the control group and paraquat group were given the same volume of normal saline every day. Rats in each group were sacrificed after the intragastric administration for 14 d，the lung tissues were separated，and blood were taken from the heart. HE staining was used to observe the pathological changes of the lung tissues of rats in each group. The colorimetric method was used to detect the serum lactate dehydrogenase（LDH），and ELISA was used to detect the serum soluble receptor for glycation end products（sRAGE）. Colorimetric method was used to detect oxidative stress markers xanthine oxidase （XO），superoxide dismutase（SOD），total antioxidant capacity（TAC），malondialdehyde（MDA），and hydroxyproline in the lung tissues. Western blotting was used to detect PI3K，Akt，β-catenin protein in rat lung tissues，and double antibody sandwich ELISA method was used to detect matrix metalloproteinase-9（MMP-9），interleukin-8（IL-8），and vascu⁃ lar endothelial growth factor（VEGF）in the lung tissues. Results The alveolar structure of rats was normal in the control group，but severe fibrous tissue hyperplasia，mixed inflammatory cell infiltration and pulmonary edema were found in rats of the paraquat group，snd the lung tissues of rats in the paraquat+febuxostat group showed moderate fibrous tissue hyper⁃ plasia and inflammatory cell infiltration. Compared with the control group，the serum LDH level and sRAGE level significantly increased in the paraquat group（both P<0. 05）. Compared with the paraquat group，the LDH level in the paraquat+ febuxostat group decreased significantly，and sRAGE level increased（both P<0. 05）. Compared with the control group， the levels of XO，MDA，and hydroxyproline significantly increased in the paraquat group（all P<0. 05），and the levels of SOD and TAC were significantly reduced（both P<0. 05）. Compare with the paraquat group，the XO，MDA，and hydroxyproline levels were significantly reduced（all P<0. 05），and SOD and TAC levels increased significantly in the paraquat+ febuxostat group（both P<0. 05）. Compared with the control group，the relative expression of PI3K，Akt，β-catenin protein and the levels of MMP-9，IL-8 and VEGF in the lung tissues of rats in the paraquat group significantly increased（all P<0. 05）. Compared with the paraquat group，the relative expression of PI3K，Akt，β-catenin protein and the levels of MMP-9，IL-8，and VEGF in the lung tissues of rats were significantly reduced in the paraquat-febuxostat group（all P< 0. 05）. Conclusion Intragastric administration of febuxostat can alleviate the paraquat-induced lung injury in rats，and the mechanism may be related to the inhibition of XO and related oxidative stress，down-regulation of PI3K/Akt pathway protein expression，and inhibition of β-catenin protein expression. [ABSTRACT FROM AUTHOR]

Diquat (DQ), paraquat (PQ), glufosinate (GLU), and glyphosate (GLYP) are commonly used herbicides that have been confirmed to be toxic to humans. Rapid and accurate measurements of these toxicants in clinical practice are beneficial for the correct diagnosis and timely treatment of herbicide-poisoned patients. The present study aimed to establish an efficient, convenient, and reliable method to achieve the simultaneous quantification of DQ, PQ, GLU, and GLYP in human plasma using liquid chromatography-tandem mass spectrometry (LC-MS/MS) without using derivatization or ion-pairing reagents. DQ, PQ, GLU, and GLYP were extracted by the rapid protein precipitation and liquid-liquid extraction method and then separated and detected by LC-MS/MS. Subsequently, linearity, limit of detection (LOD), limit of quantification (LOQ), precision, accuracy, extraction recovery, matrix effect, dilution integrity, and stability were evaluated to validate the method based on the FDA criteria. Finally, the validated method was applied to real plasma samples collected from 166 Chinese patients with herbicide poisoning. The results showed satisfactory linearity with low LOD (1 ng/mL for DQ and PQ, 5 ng/mL for GLU, and 10 ng/mL for GLYP, respectively) and low LOQ (5 ng/mL for DQ and PQ, 25 ng/mL for GLU and GLYP, respectively). In addition, the precision, accuracy, extraction recovery, and stability of the method were acceptable. The matrix effect was not observed in the analyzed samples. Moreover, the developed method was successfully applied to determine the target compounds in real plasma samples. These data provided reliable evidence for the application of this LC-MS/MS method for clinical poisoning detection., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)

Abstract: Paraquat poisoning poses a significant and emerging public health challenge in developing countries. The distribution and usage of Paraquat, a potent herbicide, remain unrestricted in many regions despite its high fatality rate and absence of a specific antidote. Paraquat mostly involves lungs but can also involve the kidneys and liver. Diagnostic challenges and a lack of available samples at presentation contribute to underreporting and limited awareness among healthcare providers, making paraquat poisoning a neglected toxicological emergency. Herein, we present a case of a 40-year-old male who presented to the emergency department on the fourth day after ingesting paraquat in a suicidal attempt. Upon presentation, he had erosion on the tongue and posterior pharyngeal wall, along with deranged renal function tests and elevated serum creatinine levels. The patient developed acute kidney injury, with serum creatinine levels rapidly rising from normal to 3.85 mg/dl, accompanied by a decrease in daily urine output. He was managed conservatively, and his hospital stay was uneventful.

An 18-year female presented with an alleged history of the conception of liquid paraquet of an unknown quantity on 3rd August 2021. On examination, the patient was unconscious and disoriented. She was further diagnosed with Multiple Organ Dysfunction Syndrome. She had no pallor, icterus, cyanosis, clubbing, pedal adeno, and no lymphadenopathy. Paraquet is basically a toxic herbicide. It is a brown colored syrup liquid. It has chronic toxicity because of its rapid deactivation in contact with soil. After the ingestion, the herbicide is liable for further causative lesions. A very low dose or as little as one mouthful is very severe and dangerous. Although, Herbicides poisoning cases are very uncommon in India. [ABSTRACT FROM AUTHOR]

This is a case of a 22-year-old male student who took paraquat as a substance abuse. He presented with flu-like symptoms and chest X-ray depicting changes of acute respiratory distress syndrome (ARDS). After looking at his purchase history in his cell phone, he was found to have purchased paraquat dichloride online and its use was later confirmed by his roommate. The patient developed respiratory distress with renal failure and succumbed to his condition after 11 days of hospital admission. This report highlights an important social issue of probable substance abuse with paraquat which is a commonly used contact herbicide in rural settings but not-so-common in urban population. Also, the report highlights the unusual complication sequalae of pneumothorax. The high mortality with this substance is because of the unavailability of an antidote and of its unscrutinized availability. [ABSTRACT FROM AUTHOR]

• PQ induces myofibroblasts differentiation of lung epithelial cells and fibroblasts to promote pulmonary fibrosis. • PQ activates Wnt/β-catenin signaling pathway in pulmonary fibrogenesis. • DKK1 suppresses the myofibroblasts differentiation and ameliorates pulmonary fibrosis via inhibiting Wnt/β-catenin signaling. Paraquat (PQ) poisoning-induced pulmonary fibrosis always results in fatal harm to patients. Our study aimed to investigate the functions of the Wnt/β-catenin pathway in PQ-induced pulmonary fibrosis. By comparing the proteomic profiles of rat lung tissues using protein array in the absence or presence of PQ, the Wnt/β-catenin signaling, as a fibrosis-related pathway, was discovered to be profoundly activated by PQ. The protein levels of Wnt/β-catenin signaling components including MMP-2, β-catenin, Wnt3a, Wnt10b, Cyclin D1, and WISP1 were increased in PQ-treated rat lung tissues. Surprisingly, PQ was found to be able to promote lung epithelial cells and fibroblasts differentiating into myofibroblasts by activating Wnt/β-catenin signaling pathway. Dickkopf-1 (DKK1), an antagonist of Wnt/β-catenin signaling pathway, could inhibit the myofibroblast differentiation and attenuate PQ-induced pulmonary fibrogenesis in vitro and in vivo. The expression levels of fibroblasts markers Vimentin, α-smooth muscle actin (α-SMA) and Collagen I was detected and found to be increased when PQ treated and restored with additional DKK1 treatment. In summary, these assays indicated that Wnt/β-catenin signaling pathway played a regulatory role in the differentiation of lung epithelial cells and fibroblasts, and the pathogenesis of pulmonary fibrosis related to PQ. Inhibition of the Wnt/β-catenin signaling pathway may be investigated further as a potential fibrosis suppressor for pulmonary fibrosis therapy. [ABSTRACT FROM AUTHOR]