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Many thousands of people die every year because of poisoning by organophosphate pesticides. Most of the deaths are in developing countries. Drugs known as oximes are used as part of the standard recommended treatment, even though many doctors have said that they don't seem to have any benefit. This research has produced mixed evidence. Many of the studies had substantial limitations. Generally, the studies done to date do not support the routine use of oximes, however, they cannot exclude that there would be some doses or situations where a benefit would occur. The reviewers found that not enough research has been done to see whether oximes are actually effective or to define the doses that are more likely to be helpful. More research is needed before any firm conclusions can be drawn.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Many people, particularly in developing countries, are poisoned by organophosphorus pesticides (OPs) used in agriculture or for killing insects in the home. Poisoning may be accidental or intentional. Even when the usual antidotes are given, 10 to 20% of those poisoned still die. Research in animals has suggested that use of sodium bicarbonate (baking soda) or similar chemicals which make the blood alkaline might save people poisoned by OPs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Bibliographic details: Luo Z, Wei XC, Lin J.  Meta analysis of outcomes of penehyclidine hydrochloride and atropine in treatment of acute organophosphorus poisoning. Chinese Journal of Industrial Hygiene and Occupational Diseases 2010; 28(1): 63-6520426991

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

This review concluded that oxime therapy for organophosphate poisoning is associated with either no effect or possible harmful effects compared with standard therapy, and ongoing assessment is necessary. Given the poor reporting of review methods, the limited search strategy and variation between the included studies, the authors' conclusions should be interpreted with caution. However, the identified need for further assessment seems appropriate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Bibliographic details: Mirfazaelian H, Nikfar S, Salarian AA, Abdollahi M.  An updated meta-analysis on the efficacy of oximes in acute human organophosphorus poisoning. International Journal of Pharmacology 2014; 10(7): 345-356 Available from: http://www.scialert.net/abstract/?doi=ijp.2014.345.356

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Bibliographic details: Mirfazaelian H, Nikfar S, Resvanfar MA, Abdollahi M.  Efficacy of plasma transfusion in acute human organophosphorus poisoning: a systematic review and meta-analysis. International Journal of Pharmacology 2014; 10(6): 299-306 Available from: http://www.scialert.net/abstract/?doi=ijp.2014.299.306

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Serum paraoxonase (PON1) is an esterase that is involved in the detoxification of organophosphate insecticides. Emerging lines of evidence have shown that functional polymorphisms in the PON1 gene might play a critical role in increasing susceptibility to organophosphate toxicity, but individually published studies showed inconclusive results. This meta-analysis aimed to derive a more precise estimation of the associations between the PON1 polymorphisms and organophosphate toxicity risk. Nine case-control studies were assessed with a total 1,042 patients with organophosphate toxicity and 1014 healthy controls. The meta-analysis results showed that the PON1 192Q and 55L polymorphisms may increase the risk of organophosphate toxicity. Further subgroup analyses by ethnicity showed significant associations of the PON1 192Q and 55L polymorphisms with increased risk of organophosphate toxicity among the Caucasian populations. However, similar associations were not observed among the Asian populations. In conclusion, the current meta-analysis indicates that the PON1 192Q and 55LM polymorphisms may increase the risk of organophosphate toxicity, especially among the Caucasian populations.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

This review assessed the effectiveness of oximes in the treatment of acute organophosphate poisoning. The authors concluded that oximes are not an effective treatment for organophosphate poisoning and can be harmful. There was insufficient information about the included studies to adequately assess the evidence and the authors' conclusions cannot be considered reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

This review assessed the effect of gastric lavage in acute organophosphorus pesticide poisoning. The authors concluded that there was no high quality evidence available to support the clinical effectiveness of single or multiple gastric lavages for organophosphorus pesticide poisoning. Given the methodological and reporting limitations of the primary study data, this conclusion appears appropriate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

The guideline covers care provided by healthcare professionals who have direct contact with and make decisions about the care of people with chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy) (CFS/ME). It covers care provided in primary and secondary care, and in specialist centres/teams.

NICE Clinical Guidelines - National Collaborating Centre for Primary Care (UK).

Version: August 2007

When young children suddenly experience the onset of diarrhoea, with or without vomiting, infective gastroenteritis is by far the most common explanation. A range of enteric viruses, bacteria and protozoal pathogens may be responsible. Viral infections account for most cases in the developed world. Gastroenteritis is very common, with many infants and young children experiencing more than one episode in a year.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: April 2009

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