Insecticides are toxic chemicals used at homes for controlling insects of public health importance and controlling agricultural pests at home gardens. Their application may result in accidental poisoning. Four accidental insecticide-poisoning children coupled with a scorpion bitten child were brought to the main hospital in southern Gaza for medical treatment. Primary investigation showed severe breath shortness, low heartbeat, and low blood pressure (hypotension). These symptoms are indications of potential cardiotoxicity among children. Electrocardiograms were measured and indicated various heart complications between cases. Complete blood count (CBC) determination showed the highest white blood cells (WBC) in the scorpion-bitted child suggesting the development of immune defense system. Blood electrolyte (Na + , K + , Ca 2+ ) concentrations indicated disturbances due to poisoning. An interesting outcome of the study is the dramatic alteration in blood glucose concentration. Additionally, activity of acetylcholinesterase (AChE) indicated normal activity in poisoning case 1, moderate inhibition in poisoning case 2 and case 3, normal activity in poisoning case 4 and severe inhibition in poisoning case 5. The levels of Aminotransferase (ALT) and Aspartate Aminotransferase (AST) were within the acceptable range whereas the level of Alkaline Phosphatase (ALP) was above the acceptable reference range suggesting potential Hepato-toxicity. Scorpion bitten child did not receive atropine whereas two poisoned cases were successfully cured by atropine injection. Additionally, alternative safe medical management may be used for cardiotoxicity using vitamin C, vitamin E, quercetin, and curcumin. These vitamins may be recommended as alternative medical treatments for cardiotoxicity.
El-Nahhal, Y., Nir, S., Polubesova, T., Margulies, L. and Rubin B. (1997) Organo-Clay Formulations of Alachlor: Reduced Leaching and Improved Efficacy. Proceedings of Brighton Crop Protection Conference Weeds, 1, 21-26.
El-Nahhal, Y. (2003) Adsorptive Behavior of Acetochlor on Organoclay Complexes. Bulletin of Environmental Contamination and Toxicology, 70, 1104-1111. https://doi.org/10.1007/s00128-003-0096-z
El-Nahhal, Y., Lagaly, G. and Rabinovitz, O. (2005) Organoclay Formulations of Acetochlor: Effect of High Salt Concentration. Journal of Agricultural and Food Chemistry, 53, 1620-1624. https://doi.org/10.1021/jf040383a
EL-Nahhal, Y. and Alshanti, A. (2015) Toxicity of Single and Mixtures Antibiotics to Cyanobacteria. Environment and Analytical Toxicology, 5, Article No. 274.
Schecter, A., Papke, O., Isaac, J., Hrimat, N., Neiroukh, F., Safi, J. and El-Nahhal, Y. (1997) 2,3,7,8 Chlorine Substituted Dioxins and Dibenzofuran Congeners in 2,4-D, 2,4,5-T and Pentachlorophenol. Organohalogen Compounds, 32, 51-55.
El-Nahhal, Y. and El-Nahhal, I. (2021) Cardiotoxicity of Some Pesticides and Their Amelioration. Environmental Science and Pollution Research, 28, 44726-44754. https://doi.org/10.1007/s11356-021-14999-9
El-Nahhal, Y. (2020) Pesticide Residues in Honey and Their Potential Reproductive Toxicity. Science of the Total Environment, 741, Article ID: 139953. https://doi.org/10.1016/j.scitotenv.2020.139953
El-Nahhal, I. and El-Nahhal, Y. (2021) Pesticide Residues in Drinking Water, Their Potential Risk to Human Health and Removal Options. Journal of Environmental Management, 299, Article ID: 113611. https://doi.org/10.1016/j.jenvman.2021.113611
El-Nahhal, Y. (2014) Development of Controlled Release Formulations of Thiabendazole. Journal of Agricultural Chemistry and Environment, 3, 1-8. https://doi.org/10.4236/jacen.2014.31001
Nahhal, Y. (2016) Biochemical Changes Associated with Long Term Exposure to Pesticide among Farmers in the Gaza Strip. Occupational Diseases and Environmental Medicine, 4, 72-82. https://doi.org/10.4236/odem.2016.43009
El-Nahhal, Y.Z. and Safi, J.M. (2004) Adsorption of Phenanthrene on Organoclays from Distilled and Saline Water. Journal of Colloid and Interface Science, 269, 265-273. https://doi.org/10.1016/S0021-9797(03)00607-6
Safi, J.M., Yassin, M.M., El-Nahhal, Y.Z., Abed, Y.A., Safi, M.J. and Suleiman, H.D. (2019) Childhood Lead Poisoning in Gaza Strip, the Palestinian Authority. Journal of Trace Elements in Medicine and Biology, 54, 118-125. https://doi.org/10.1016/j.jtemb.2019.04.004
El-Nahhal, Y. and Safi, J. (2004) Stability of an Organo Clay Complex: Effects of High Concentrations of Sodium Chloride. Applied Clay Science, 24, 129-136. https://doi.org/10.1016/j.clay.2003.01.002
El-Nahhal, Y. and Radwan, A. (2013) Human Health Risks: Impact of Pesticide Application. Journal of Environment and Earth Science, 3, 199-209.
El-Nahhal, Y. and Safi, J. (2005) Adsorption of Benzene and Naphthalene to Modified Montmorillonite. Journal of Food, Agriculture and Environment, 3, 295-298.
EL-Nahhal, Y., EL-Najjar, Sh. and Afifi, S. (2015) Impact of Organic Contamination on Some Aquatic Organisms. Toxicology International, 22, 45-53.
El-Nahhal, Y., Wheidi, B. and El-Kurdi, S. (2016) Development of Ecologically Acceptable Chlorpyrifos Formulation for Effective and Safe Application. Journal of Encapsulation and Adsorption Sciences, 6, 91-108. https://doi.org/10.4236/jeas.2016.63008
El-Nahhal, Y. (2003) Adsorption Mechanism of Chloroacetanilide Herbicides to Modified Montmorillonite. Journal of Environmental Science and Health: Part. B, Pesticides, Food Contaminants, and Agricultural Wastes, 38, 591-604. https://doi.org/10.1081/PFC-120023517
EL-Nahhal, I. and El-Nahhal, Y. (2020). Hyperlink “javascript:void(0)” Ecological Consequences of COVID-19 Outbreak. Journal of Water Science and Engineering, 1, 1-5.
Ellman, G.L., Courtney, K.D., Andres Jr., V. and Feather-Stone, R.M. (1961) A New and Rapid Colorimetric Determination of Acetylcholinesterase Activity. Biochemical Pharmacology, 7, 88-95. https://doi.org/10.1016/0006-2952(61)90145-9
Bessey, O.A., Lowry, O.H. and Brock, M.J. (1946) A Method for the Rapid Determination of Alkaline Phosphates with Five Cubic Millimeters of Serum. The Journal of Biological Chemistry, 164, 321-329. https://doi.org/10.1016/S0021-9258(18)43072-4
Yan, G.M., Dai, M. and Xuan, Z.H. (2015) Therapeutic Effect of Paconol on Alcoholic Fatty Liver in Rats. Journal of Chinese Medicinal Materials, 38, 550-555.
Pesticides Properties Data Base (2007) A to Z Index—University of Hertfordshire. Last Updated: 01/08/2020. https://sitem.herts.ac.uk/aeru/ppdb/en/atoz.htm
NIH (National Institutes of Health) (2021) What Should My Heart Rate Be? https://www.medicalnewstoday.com/articles/235710#normal-resting-heart-rate
University of Iowa Stead Family Children’s Hospital (2021) Vital Signs: Normal Blood Pressure (mmHg) (PICU Chart). https://uichildrens.org/health-library/vital-signs-normal-blood-pressure-mmhg-picu-chart
Jiang, J.Y., Zhang, L., Qin, L., Luo, J.Y., Fu, Y.W., Qin, J.A., Wang, C.J., Ouyang, Z. and Yang, M.H. (2020) Zhongguo Zhong Yao Za Zhi = Zhongguo Zhongyao Zazhi = China Journal of Chinese Materia Medica, 45, 3900-3907. (In Chinese) https://doi.org/10.19540/j.cnki.cjcmm.20200522.201
Cifuentes, L. (2015) Allergy to Honeybee … Not Only Stings. Current Opinion in Allergy and Clinical Immunology, 15, 364-368. https://doi.org/10.1097/ACI.0000000000000191
Pournourmohammadi, S., Farzami, B., Ostad, S.N., Azizi, E. and Abdollahi, M. (2005) Effects of Malathion Subchronic Exposure on Rat Skeletal Muscle Glucose Metabolism. Environ Toxicol Pharmacol, 19, 191-196. https://doi.org/10.1016/j.etap.2004.07.002
Farkhondeh, T., Amirabadizadeh, A., Samarghandian, S. and Mehrpour, O. (2020) Impact of Chlorpyrifos on Blood Glucose Concentration in an Animal Model: A Systematic Review and Meta-Analysis. Environmental Science and Pollution Research International, 27, 2474-2481. https://doi.org/10.1007/s11356-019-07229-w
Zepeda-Arce, R., Rojas-García, A.E., Benitez-Trinidad, A., Herrera-Moreno, J.F., Medina-Díaz, I.M., Barrón-Vivanco, B.S., Villegas, G.P., Hernández-Ochoa, I., Sólis Heredia, M.J. and Bernal-Hernández, Y.Y. (2017) Oxidative Stress and Genetic Damage among Workers Exposed Primarily to Organophosphate and Pyrethroid Pesticides. Environmental Toxicology, 32, 1754-1764. https://doi.org/10.1002/tox.22398
Tanvir, E.M., Afroz, R., Chowdhury, M., Gan, S.H., Karim, N., Islam, M.N. and Khalil, M.I. (2016) A Model of Chlorpyrifos Distribution and Its Biochemical Effects on the Liver and Kidneys of Rats. Human & Experimental Toxicology, 35, 991-1004. https://doi.org/10.1177%2F0960327115614384
El-Nahhal, Y., EL-dahdouh, N., Hamdona, N. and Alshanti, A. (2016). Toxicological Data of Some Antibiotics and Pesticides to Fish, Mosquitoes, Cyanobacterial Mats and to Plants. Data in Brief, 6, 871-880. https://doi.org/10.1016/j.dib.2016.01.051
Ramirez-Vargas, M.A., Flores-Alfaro, E., Uriostegui-Acosta, M., Alvarez-Fitz, P., Parra-Rojas, I. and Moreno-Godinez, M.E. (2018) Effects of Exposure to Malathion on Blood Glucose Concentration: A Meta-Analysis. Environmental Science and Pollution Research International, 25, 3233-3242. https://doi.org/10.1007/s11356-017-0890-5
Farkhondeh, T., Aschner, M., Sadeghi, M., Mehrpour, O., Naseri, K., Amirabadizadeh, A., Roshanravan, B., Aramjoo, H. and Samarghandian, S. (2021) The effect of Diazinon on Blood Glucose Homeostasis: A Systematic and Meta-Analysis Study. Environmental Science and Pollution Research International, 28, 4007-4018. https://doi.org/10.1007/s11356-020-11364-0
Bar-Meir, E., Schein, O., Eisenkraft, A., Rubinshtein, R., Grubstein, A., Militianu, A. and Glikson, M. (2007) Guidelines for Treating cardiac Manifestations of Organophosphates Poisoning with Special Emphasis on Long QT and Torsades De Pointes. Critical Reviews in Toxicology, 37, 279-285. https://doi.org/10.1080/10408440601177855
Eddleston, M., Eyer, P., Worek, F., Mohamed, F., Senarathna, L., von Meyer, L., Juszczak, E., Hittarage, A., Azhar, S., Dissanayake, W., Sheriff, M.H., Szinicz, L., Dawson, A.H. and Buckley, N.A. (2005) Differences between Organophosphorus Insecticides in Human Self-Poisoning: A Prospective Cohort Study. Lancet, 366, 1452-1459. https://doi.org/10.1016/S0140-6736(05)67598-8
Liang, Y., Tong, F., Huang, F., Liu, Y., Zhu, L., Le Grange, J.M., He, G. and Zhou, Y. (2020) Pathological Changes Induced by Phosphine Poisoning: A Study on 8 Children. International Journal of Legal Medicine, 134, 217-228. https://doi.org/10.1007/s00414-019-02169-z
Pereira, E.F., Aracava, Y., DeTolla Jr., L.J., Beecham, E.J., Basinger Jr., G.W., Wakayama, E.J. and Albuquerque, E.X. (2014) Animal Models That Best Reproduce the Clinical Manifestations of Human Intoxication with Organophosphorus Compounds. The Journal of Pharmacology and Experimental Therapeutics, 350, 313-321. https://doi.org/10.1124/jpet.114.214932
Hurst, C.G., Newmark, J. and Romano Jr., J.A. (2012) Chemical Terrorism: Introduction. In: Longo, D.L., Fauci, A.S., Kasper, D.L., Hauser, S.L., Jameson, J.L. and Loscalzo, J., Eds., Harrison’s Principles of Internal Medicine, 18th Edition, McGraw-Hill, New York, 1779-1788.
Zago, A.M., Faria, N., Fávero, J.L., Meucci, R.D., Woskie, S. and Fassa, A.G. (2020) Pesticide Exposure and Risk of Cardiovascular Disease: A Systematic Review. Global Public Health, 1-23. https://doi.org/10.1080/17441692.2020.1808693
El-Nahhal, Y., Lubbad, R. and Al-Agha, M.R. (2020) Toxicity Evaluation of Chlorpyrifos and Diuron Below Maximum Residue Limits in Rabbits. Toxicology and Environmental Health Sciences, 12, 177-190. https://doi.org/10.1007/s13530-020-00015-z
El-Nahhal, Y. and Lubbad, R. (2018) Acute and Single Repeated Dose Effects of Low Concentrations of Chlorpyrifos, Diuron, and Their Combination on Chicken. Environmental Science and Pollution Research International, 25, 10837-10847. https://doi.org/10.1007/s11356-018-1313-y
El-Nahhal, Y. (2017) Acute Poisoning among Farmers by Chlorpyrifos: Case Report from Gaza Strip. Occupational Diseases and Environmental Medicine, 5, 47-57. https://doi.org/10.4236/odem.2017.52005
El-Nahhal, Y. (2017) Risk Factors among Greenhouse Farmers in Gaza Strip. Occupational Diseases and Environmental Medicine, 5, 1-10. https://doi.org/10.4236/odem.2017.51001
Newmark, J. (2004) Therapy for Nerve Agent Poisoning. Archives of Neurology, 61, 649-652. https://doi.org/10.1001/archneur.61.5.649
Eddleston, M., Buckley, N.A., Eyer, P. and Dawson, A.H. (2008) Management of Acute Organophosphorus Pesticide Poisoning. Lancet, 371, 597-607. https://doi.org/10.1016/S0140-6736(07)61202-1
Pawar, K.S., Bhoite, R.R., Pillay, C.P., Chavan, S.C., Malshikare, D.S. and Garad, S.G. (2006) Continuous Pralidoxime Infusion versus Repeated Bolus Injection to Treat Organophosphorus Pesticide Poisoning: A Randomised Controlled Trial. Lancet, 368, 2136-2141. https://doi.org/10.1016/S0140-6736(06)69862-0
Marrs, T.C. and Sellström, A (2007) The Use of Benzodiazepines in Organophosphorus Nerve Agent Intoxication. In: Marrs, T.C., Maynard, R.L. and Sidell, F.R., Eds., Chemical Warfare Agents: Toxicology and Treatment, 2nd Edition, Wiley, Chichester, 331-342. https://doi.org/10.1002/9780470060032.ch16
Schittkowski, M.P. and Sturm, V. (2018) Atropin zur Prävention der Myopieprogression—Datenlage, Nebenwirkungen, praktische Empfehlungen [Atropine for the Prevention of Progression in Myopia—Data, Side Effects, Practical Guidelines]. Klinische Monatsblatter fur Augenheilkunde, 235, 385-391. https://doi.org/10.1055/s-0043-121982
Chia, A., Chua, W.H., Cheung, Y.B., Wong, W.L., Lingham, A., Fong, A. and Tan, D. (2012) Atropine for the Treatment of Childhood Myopia: Safety and Efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmology, 119, 347-354. https://doi.org/10.1016/j.ophtha.2011.07.031
Simon, G.A., Tirosh, M.S. and Edery, H. (1976) Administration of Obidoxime Tablets to Man. Plasma Levels and Side Reactions. Archives of Toxicology, 36, 83-88. https://doi.org/10.1007/BF00277566
Baiomy, A.A., Attia, H.F., Soliman, M.M. and Makrum, O. (2015) Protective Effect of Ginger and Zinc Chloride Mixture on the Liver and Kidney Alterations Induced by Malathion Toxicity. International Journal of Immunopathology and Pharmacology, 28, 122-128. https://doi.org/10.1177%2F0394632015572083
Yazdinezhad, A., Abbasian, M., Hojjat Hosseini, S., Naserzadeh, P., Agh-Atabay, A. H. and Hosseini, M.J. (2017) Protective Effects of Ziziphora tenuior Extract against Chlorpyrifos Induced Liver and Lung Toxicity in Rat: Mechanistic Approaches in Subchronic Study. Environmental Toxicology, 32, 2191-2202. https://doi.org/10.1002/tox.22432
Ibrahim, K.A., Khwanes, S.A., El-Desouky, M.A. and Elhakim, H. (2019) Propolis Relieves the Cardiotoxicity of Chlorpyrifos in Diabetic Rats via Alleviations of Paraoxonase-1 and Xanthine Oxidase Genes Expression. Pesticide Biochemistry and Physiology, 159, 127-135. https://doi.org/10.1016/j.pestbp.2019.06.006
Yavuz, T., Altuntas, I., Delibas, N., Yildirim, B., Candir, O., Cora, A., Karahan, N., Ibrisim, E. and Kutsal, A. (2004) Cardiotoxicity in Rats Induced by Methidathion and Ameliorating Effect of Vitamins E and C. Human & Experimental Toxicology, 23, 323-329. https://doi.org/10.1191%2F0960327104ht456oa
Ramadan, G., El-Beih, N.M. and Ahmed, R.S. (2017) Aged Garlic Extract Ameliorates Immunotoxicity, Hematotoxicity and Impaired Burn-Healing in Malathion-and Carbaryl-Treated Male Albino Rats. Environmental Toxicology, 32, 789-798. https://doi.org/10.1002/tox.22279