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ORIGINAL CONTRIBUTION AND CLINICAL INVESTIGATION24. Kivanc, M. and Kunduhoglu, B.(1997). Antimicrobial Activity of FreshPlant Juice on the Growth of Bacteriaand Yeasts. Journal of QafqazUniversity, 1: 26-53.25. Alhaj, N. A.; Shamsudin,M.N.; Zamri, H. F. and Abdullah,R. (2008). Extraction of EssentialOil from Nigella sativa UsingSupercritical Carbon Dioxide: Studyof Antibacterial Activity. AmericanJournal of Pharmacology andToxicology, 3(4): 225-228.26. Hammer, K. A.; Carson, C. F,and Riley, T. V. (1999). AntimicrobialActivity of Essential Oils and OtherPlant Extracts. Journal of AppliedMicrobiology, 86: 985-990.27. Elgayyar, M.; Draughon, F.A.; Golden, D. A. and Mount, J.R. (2001). Antimicrobial Activity ofEssential Oils from Plants againstSelected Pathogenic and SaprophyticMicroorganisms. Journal of FoodProtection, 64 (7): 1019-1024.28. Bakhiet, A. O.; Mohammed,S.D.; El Badwi, S. M.A.; AbdelGadir, W. S.; Alkhatim, A. H. andAdam, S. E. I. (2006). AntimicrobialActivity of Petroselinum sativum andCoriandrum sativum Seeds. Journalof Microbiology, 1 (4): 346-352.29. Dubey, A.; Mishra, N. and Singh,N. (2010). Antimicrobial Activityof Some Selected Vegetables.International Journal of AppliedBiology and PharmaceuticalTechnology, I: 994-999.30. Silva, NCC and FernandesJúnior, A. (2010) Biological Propertiesof Medicinal Plants: A Review ofTheir Antimicrobial Activity. Journalof Venomous Animals and ToxinsIncluding Tropical Diseases, 16: 402-413.31. Chao, S.; Young, G.; Oberg, C.and Nakaoka, K. (2008). Inhibition ofMethicillin-Resistant Staphylococcusaureus (MRSA) by Essential Oils.Journal of Flavour and Fragrance,23: 444-449.Answers and feedback to CME Quiz1.Metacid is an organophosphorous compound with anticholinesteraseaction.True2. Anti-cholinesterase pesticides are an uncommon cause of acutepoisoning.False3. Organophosphorous compounds readily penetrate the skin.True4. Clinical features vary depending on the relative effects onparasympathetic nerves, sympathetic ganglia and neuro-muscularjunctions.True5. Initial effects are due to parasympathetic activity.True6. Weakness of skeletal muscle is due to enzyme suppression atneuro-muscular junctions.True7. Atropine blocks parasympathetic overactivity.TrueFeedbackAnti-cholinesterase pesticides (organophoshates) are a most commoncause of acute poisoning in farmers.Organophosphates bind to acetyl-cholinesterase enzyme, inhibiting it andcausing symptoms of excessive cholinergic (parasympathetic) activity.The key signs of cholinergic overload are: frothy oral secretions, vomiting,abdominal pain, diarrhoea, constricted pupils, altered consciousness,bradycardia (or tachycardia) and muscle fasciculations.Organophosphates also suppress enzymes at nicotinic receptors, thusinhibiting neuromuscular transmission at nicotinic synapses – the majorcause of respiratory muscle paralysis.Initial management should focus on managing and stabilizing airway,breathing and circulation (ABC).There is a risk of contamination of health personnel, as well as ongoingabsorption for the patient. Ramesh’s clothing should be removed andwashed thoroughly, and his skin washed with soap and water. Healthworkers must wear rubber gloves whilst doing this to protect themselvesfrom contamination.There is no role here for GI decontamination as the pesticide was notingested by mouth, but absorbed through the skin.While the above measures are being taken, definitive treatment should bestarted without delay.18 MIDDLE EAST JOURNAL OF FAMILY MEDICINE VOLUME 10 ISSUE 7MIDDLE EAST JOURNAL OF FAMILY MEDICINE • VOLUME 7, ISSUE 10