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Organophosphorus, an insecticide used in agricultural and industrial settings, is the most common cause of poisoning in India. Organophosphorus is a nerve poison that causes irreversible inhibition of acetylcholinesterase, which leads to the accumulation of acetylcholine, resulting in excessive cholinergic stimulation of several organ systems. Several complications have been reported, but pancreatitis is quite rare and mainly due to ductal hypertension and injury to parenchyma, consequent to cholinergic hyperactivity in the pancreas. We present a case series of four cases where organophosphorus poisoning was suspected. Autopsy revealed that, in all four cases, the stomach walls were congested, pancreas showed gross haemorrhage over the surface and on cut sections, with other visceral organs showing generalised congestion. Later, after visceral and histopathological examination, all cases were confirmed as organophosphorus (dichlorvos) poisoning with haemorrhagic pancreatitis. Acute pancreatitis in organophosphorus poisoning usually has a subclinical course and gets masked by the systemic effects. Haemorrhagic pancreatitis sequela of acute pancreatitis is a rare and fatal complication of organophosphorus poisoning. [ABSTRACT FROM AUTHOR]

Background: WHO has estimated that around 300 million individuals are subjected to pesticide poisoning annually, leading to roughly 200,000 deaths each year in developing nations. C reactive protein is well known as an inflammatory indicator that is elevated in injury, trauma, infection, cancer and autoimmune diseases. However very little is known about the role of CRP on acute poisoning. Objective of The Study: 1. To assess the severity and prognosis of acute organophosphorus poisoning by C-Reactive Protein. Materials and Methods: It is a prospective, observational study conducted from August 2022 to July 2024 at GIMS, Kalaburagi. Sample size included 100 individuals who were hospitalized due to organophosphorus poisoning to GIMS hospital during the study period. Patients were reviewed daily until discharge or death. C-Reactive Protein (CRP) levels were measured at admission, 72 hours post-admission and on day 7 or day of discharge/death. Results: The mean CRP levels of the expired patients were significantly higher than those of the live patients at admission, at 72 hours and at discharge (p<0.001). Conclusion: In conclusion, the present study revealed that changes in CRP was associated with the prediction of AOPP prognosis. Patients with severe acute organophosphorus pesticide poisoning show elevated levels of Creactive protein, which play a significant role in predicting the severity and prognosis of the condition. [ABSTRACT FROM AUTHOR]

Background: Organophosphorus (OP) compounds have gained significant importance globally. Although these compounds were discovered nearly a century ago, they continue to be widely utilized as insecticides worldwide. The aim of this study was to evaluate the serum creatine phosphokinase (CPK) levels in cases of OP poisoning. Materials and Methods: The present study was conducted on a sample of 60 patients who were admitted to the Department of General Medicine, Katuri Medical College, Guntur, AP exhibiting a documented history and clinical manifestations consistent with organophosphate poisoning. The study was conducted between April 2023 and September 2024. Results: Organophosphorus compounds are commonly used in acts of selfharm due to their easy availability. The main factors contributing to fatalities include the specific toxic compound involved, the severity of the poisoning, the promptness of treatment, and the availability of critical care facilities. While acetylcholinesterase plays an essential role, its inhibition leads to overstimulation of muscarinic and nicotinic receptors. This overstimulation causes a rapid onset of cholinergic crisis, which is the key clinical indicator of OP poisoning. Diagnosis is typically confirmed through patient history and supportive monitoring. Conclusion: The study found that following appropriate treatment, serum creatine phosphokinase levels returned to normal, alongside an improvement in the patient's clinical condition. Optimizing the dosage and duration of atropine and pralidoxime therapy remains crucial, especially as higher doses are often required in severe poisoning cases. [ABSTRACT FROM AUTHOR]

Organophosphorus and carbamate Insectiside is common in Asia–Pacific region consisting of 63% of the Global death. Organophosphorus and Carbamate poisoning can lead into different complications in the respiratory,digestive,neurological aspects and maybe fatal in certain cases.Besides medical management of the same,early rehabilitation is also required to manage different kinds of neurological aspects caused due to Organophosphorus and carbamate poisoning. The study was done to introspect the early intervention in swallowing and speech therapy in organophosphorus and carbamate poisoning individual,as a part of management besides medical intervention. A 19 years old female reported to the hospital with history of consuming organophos and carbamate insecticide with the intention of self harming causing cardiac arrest and as diagnosed as Flaccid Dysarthria with Oro-Pharyngeal Dysphagia when assessed with diagnostic tools respectively. Early speech and swallowing intervention was provided and introspected using MASA which showed improvement in scores during the therapeutic intervention and was statistically analysed using linear regression analysis. The result showed the improvement in MASA scores (the slope of the best fit) and proved that MASA scores improved significantly (slope = 14.3, p < 0.05) over time as the therapy sessions proceeded. The regression model was also significant (p < 0.05). The motor-speech therapeutic intervention provided improvement in the kinematics of oro-motor skills along with improvement in intelligibility of speech. This study concludes that early intervention in managing speech and swallowing abilities in Dysarthria and Dysphagia is helpful besides medical intervention in such cases. [ABSTRACT FROM AUTHOR]

Background Organophosphorus compounds, widely used in agriculture and industry, pose a serious threat to human health due to their acute neurotoxicity. Although traditional interventions for organophosphate poisoning are effective, they often come with significant side effects. Objective This paper aims to evaluate the potential of enzymes within biological organisms as organophosphorus bioclearing agents. It analyses the technical challenges in current enzyme research, such as substrate specificity, stereoselectivity, and immunogenicity, while exploring recent advancements in the field. Methods A comprehensive review of literature related to detoxifying enzymes or proteins was conducted. Existing studies on organophosphorus bioclearing agents were summarised, elucidating the biological detoxification mechanisms, with a particular focus on advancements in protein engineering and novel delivery methods. Results Current bioclearing agents can be categorised into stoichiometric and catalytic bioclearing agents, both of which have shown some success in preventing organophosphate poisoning. Technological advancements have significantly improved various properties of bioclearing agents, yet challenges remain, particularly in substrate specificity, stereoselectivity, and immunogenicity. Future research will focus on expanding the substrate spectrum, enhancing catalytic efficiency, prolonging in vivo half-life, and developing convenient administration methods. Conclusion With the progression of clinical trials, bioclearing agents are expected to become widely used as a new generation of therapeutic organophosphate detoxifiers. [ABSTRACT FROM AUTHOR]

Intermediate syndrome is an important cause of respiratory failure following acute organophosphorus pesticide poisoning. The objective of this study was to examine the pathophysiology of this syndrome by analysis of sequential repetitive nerve stimulation studies in patients with acute organophosphorus pesticide poisoning. Thirty-four consenting symptomatic patients with acute organophosphorus pesticide poisoning with intermediate syndrome (n = 10) or a milder forme fruste intermediate syndrome (n = 24) were assessed prospectively with daily physical examination and repetitive nerve stimulation done on the right and left median and ulnar nerves. The compound muscle action potential at 1, 3, 10, 15, 20 and 30 Hertz was measured with a train of ten stimuli. The amplitudes of the resulting stimuli were normalized to the first stimulus (100 per cent) and plotted against time. The decrease in the area under the curve of all the second stimulus compound muscle action potentials in the first 0.3 seconds was measured as a means of quantifying the refractory block. The decrease in the area under the curve under the 10, 15, 20 and 30 Hertz compound muscle action potentials relative to this pooled second stimulus compound muscle action potentials-area under the curve indicated the extent of additional rate-dependent block (decreasing compound muscle action potential-area under the curve over the first 0.3 seconds after the first stimulus with increasing Hertz). These new measurements strongly correlated with the severity of weakness. Refractory block was seen in most patients but was more severe in those with intermediate syndrome than those with forme fruste (partial) intermediate syndrome (median 55 per cent versus 16 per cent, P = 0.0001). Similar large differences were found for rate-dependent block (30 per cent versus 7 per cent, P = 0.001), which was uncommon in forme fruste intermediate syndrome but found in nine out of 10 patients with intermediate syndrome. Rate dependent block was generally only observed after 24 hours. The simplest strong predictor was total block at 30 Hertz repetitive nerve stimulation (89 per cent [interquartile range 73 to 94 per cent] versus 21 per cent [4 to 55 per cent]; P < 0.0001), which was very similar to total block calculated by summing other calculations. These findings likely represent depolarization and desensitization block from prolonged excessive cholinergic stimulation but it is not clear if these are from pre- or post-synaptic pathology. An animal model of intermediate syndrome with repetitive nerve stimulation studies might enable a better pathophysiological understanding of the two types of block. The limited number of repetitive nerve stimulation studies performed were sufficient to demonstrate proof-of-concept, but further studies with more patients are needed to better define the correlates, clinical relevance and possible diagnostic/prognostic roles for the use of this technique. There are two easily distinguishable pathophysiological abnormalities in the neuromuscular block in intermediate syndrome. While they often coincide, both may be observed in isolation. The total and rate-dependent block at 30 Hertz are strongly associated with more severe weakness. [ABSTRACT FROM AUTHOR]

Background: Organophosphorus compounds (OPCs) are common causes of accidental and suicidal poisoning in agricultural countries like Nepal. Serum cholinesterase, used to diagnose organophosphorus poisoning (OP), is not reliable for predicting its severity. This study aimed to assess serum potassium as an alternative prognostic indicator for OP poisoning severity. Methodology: This single-centric cross-sectional study included patients presenting with OP poisoning at a tertiary care center over six months. Total 86 cases met the inclusion criteria. The Peradeniya organophosphorus poisoning (POP) scale categorized patients by severity. The association between OP poisoning severity and serum potassium level at presentation was studied. Results: Of the 86 cases, 47 (55%) were females. The mean age was 26.96 years (SD: 8.73), ranging from 18 to 65 years. Most cases, 53% (n=46), were aged 20-29 years. Chlorpyriphos (50%) + cypermethrin (5%) was the most common OP compound, used in 29% cases. Malathion (50%) was the least used, in 7% (n=6) of cases. At presentation, 36% (n=31) had hypokalemia, among which 6 had mild poisoning (POP score: 0-3), while 25 had moderate to severe case of poisoning (POP score: 4-11). The association between OP poisoning severity and hypokalemia was statistically significant (p-value

Background: Organophosphorus (OP) and carbamate poisoning are significant concerns in developing nations. This study evaluates the effectiveness of the ChE check mobile, a cholinesterase-rapid bedside diagnostic test, in the diagnosis and management of OP and carbamate poisoning. Materials and methods: We conducted this prospective observational study, involving patients with OP and carbamate poisoning over 1 year (June 2016 to June 2017) at a single tertiary care center. Levels of RBC cholinesterase (E-AChE), butyl cholinesterase (BChE), and various other determinants were systematically coded and analyzed. Results: The study population (n = 60) consisted primarily of males (n = 43; 71.7%), with a mean age of 30.6 (SD: 13.7) years. Monocrotophos (n = 10; 20.4%) and carbofuran (n = 4; 8.1%) were the commonest OP and carbamate compounds, respectively. The median initial atropinization dose was 10 (IQR: 0, 61.5) mg, with a median total administered atropine dose of 116 (IQR: 32, 320) mg. A significant negative correlation was found between E-AChE levels and both the initial atropinization dose (ρ: -0.653, p-value < 0.001) and total atropine requirement (ρ: -0.659, p-value < 0.001) during admission. An E-AChE cut-off of 4 units/g hemoglobin provided an area under the curve of 0.73 (sensitivity: 80.0%, specificity: 68.6%, p-value < 0.001) for predicting moderate to severe peradeniya organophosphorus poisoning. Conclusion: The check mobile device can be a valuable tool for prognosticating patients. There was a significant correlation between low E-AChE levels and the atropine requirement and severity. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to determine the clinical predictors of staphylococcal ventilator-associated pneumonia (VAP) and to compare the outcomes of staphylococcal VAP with non-staphylococcal VAP. Methodology: A retrospective observational study was conducted among adult patients admitted to the medical intensive care unit (MICU) in a tertiary care hospital in India from January 2017 to December 2019. The patients were grouped based on their diagnosis into staphylococcal and non-staphylococcal VAP, and the baseline characteristics, clinical parameters, co-morbidities, and outcome parameters were compared. Results: Out of 2129 MICU admissions, 456 patients with microbiologically confirmed VAP were included, of which 69 (15.1%) had staphylococcal VAP, and the remaining 387 (84.9%) had non-staphylococcal VAP. Organophosphorus (OP) poisoning was identified as an independent predictor of staphylococcal VAP (odds ratio: 2.57; 95% CI: 1.4 to 4.73). The median duration of mechanical ventilation before VAP diagnosis was less in the staphylococcal VAP group (4 vs. 5 days; p = 0.004). The staphylococcal group also showed a better in-hospital outcome. Conclusions: OP poisoning was an independent predictor of staphylococcal VAP. Staphylococcal VAP was diagnosed earlier in patients than non-staphylococcal VAP. Screening for nasal carriage for Staphylococcus, especially in patients with OP poisoning at the time of MICU admission, may help guide antibiotic therapy. [ABSTRACT FROM AUTHOR]

Various complications of atropine therapy in cases of organophosphorus poisoning have been reported. Among them, atropine induced paralytic ileus is a serious gastrointestinal complication with very few cases published worldwide. The tendency of over atropinization in organophosphorus poisoning despite regular monitoring is common and may develop life threatening complications as well. This necessitates knowledge, thorough examination, and an experienced approach to aid in treatment and complications management. We have discussed a case of organophosphorus poisoning, with symptoms of atropine toxicity and acute abdominal complication treated with surgical approach in our setting. [ABSTRACT FROM AUTHOR]

Background: Organophosphorus (OP) compounds are widely used in India as insecticides and contribute to both acute and chronic poisoning. Several parameters have been analyzed to evaluate the severity of poisoning and to prognosticate the outcome but contradictory results have been obtained from studies for example for the relationship between hypokalemia and outcome, pseudocholinesterase (PChE) levels, and outcome. Aims and Objectives: The objectives of this retrospective study were to explore the epidemiological characteristics and clinical profile of patients admitted to intensive care unit with OP poisoning and to evaluate the outcomes including complications, in hospital mortality, and the predictors of mortality. Materials and Methods: All the patients above 18 years admitted with a history of ingestion of OP poisoning during the study period were included in the study. Data were collected from case records. Results: The mean age of the patients was 34±13.54. Fifty-four patients were male (69.2%) and 24 were female (30.8%). The correlation coefficient between intubation and PChE levels was 0.266. The mean period of ventilation was 4.16 days±2.41 days. About 80% (n=20) put on ventilator survived. Correlation of hypokalemia with patients getting ventilator support was 0.26 and that with mortality was 0.038. Conclusion: OP poisoning cases were primarily noted in the younger male group with the intent to self-harm. Chlorpyrifos was the most common compound consumed. Early admission and appropriate treatment can reduce mortality and complications as there is no single factor which can be used to predict the outcome in these patients.

Background: Organophosphorus insecticides are considered one of the commonest causes of morbidity and mortality due to poisoning worldwide. Severe organophosphorus poisoning can lead to multiple sometimes lethal metabolic and haematological abnormalities. METHODS: A total of 141 OP poisoning patients were admitted during the study period and their blood samples were collected on admission and analysed for the biochemical abnormalities. RESULTS: Out of 141 patients 76 were males (53.9%) and 65 were females (46.1%). Bradycardia with Pulse rate of less than 60 was seen in in 21 patients (14.7). Hypoxemia with oxygen saturation of less than 94% was seen in 32 (22.7%). leucocytosis with TLC o 11000 or more was seen in 19 patients (13.5%).101 patients (83.5%) had low serum choline esterase levels less than 1.5kU/L. Hypokalaemia with K+ of less than 3.5 was seen in 16 patients (9.9%). Five patients died out of 141 (3.5%). Hypoxemia Spo2 of less than 90% was seen in 3 (60%) patients who died and hypoglycaemia with blood glucose of less than 70mg/dl was seen in 2 out of 5 Patients (40%) CONCLUSIONS: low choline esterase levels less than 1.5kU/L was the most common abnormality indicating severe poisoning followed by hypoxemia. Both Hypoxemia and low acetylcholine esterase levels are bad prognostic signs and result in high mortality in organophosphorus poisoning. Keywords: Organophosphorus Poisoning, Hypoxemia, choline esterase, Hypokalaemia, Hypoglycaemia.

Pretilachlor is an extensively used herbicide worldwide that mimics the clinical presentation of Organophosphorus (OP) poisoning upon ingestion. Misdiagnosis can be a major setback and lead to inappropriate patient management. In this report, we discuss the case of a young man who presented with an alleged history of consumption of an unknown chemical compound, which was later confirmed to be pretilachlor. He had multiple episodes of emesis since the event, and the only systemic abnormality was a low heart rate of approximately 50 beats/min. Other cholinergic symptoms were absent, and atropine was administered after initial resuscitation and stabilization, with suspected OP poisoning as the top differential diagnosis. All laboratory findings, including pseudocholinesterase, were normal, which was unlikely to happen in the case of OP poisoning. Later, the consumption of the chemical pretilachlor, by the patient was confirmed. The patient was weaned off atropine and managed by systemic support and symptomatic treatment. He fully recovered within 4–5 days and was discharged in a stable condition with no risk of post-discharge complications.

Introduction: Organo-phosphates are widely used in horticulture and agriculture in developing countries and therefore poisoning with these agents is common either by unintentional or suicidal ingestion. In developing countries like India, it is still a major public health problem because of its association with high morbidity and mortality. Organo-phosphates may cause deformation of erythrocyte membranes by acute and chronic inflammation. Hence, it is expected that Red cell distribution width (RDW) levels may be increased in Organophosphorus (OP) poisoning and can thus aid in prognosis. Objectives: 1. To assess red cell distribution width and serum cholienesterase levels on admission. 2. To assess correlation between red cell distribution width and outcome in organophosphorus poisoning. Methodology: A prospective interventional study was conducted among 100 Organophosphorus poisoning cases admitted in our hospital. A detailed history was obtained using a pre-designed, structured proforma followed by a detailed systemic examination. Relevant investigations were conducted which included red cell distribution width. Chi-square test was used to assess the relation between red cell distribution width and outcome in organophosphorus poisoning. Results: Among 100 participants, majority were males (65%) and between 21-30 years age group (43%). Most common compounds involved in poisoning wereMonocrotophos (36%) Chlorpyrifos (34%), Duration of exposure for 69% of them was 1-2 hours. 50% of them had RDW ≤ 13 and 50% had RDW > 13. There were 6 deaths among 50 subjects with RDW >13 and only 1 death among 50 subjects with RDW ≤ 13 and this difference was statistically significant (P<0.05). Conclusion: In this study RDW was significantly associated with outcome and served in assessing the outcome in OP poisoning. We conclude that RDW is simple test which can be measured easily at the time of admission and used as a predictor of outcome in OP poisoning. [ABSTRACT FROM AUTHOR]

Background and Objectives: Organophosphorus compounds have assumed considerable importance in most parts of the world. Though these compounds were discovered a century ago, even now they are the widely used insecticides all over the world. Aims and objectives of these study was to assess serum creatine phosphokinase level in OP poisoning. Material and Methods: The present study was conducted on a sample of 50 patients who were admitted to Department of General Medicine, SVS Medical College and Hospital Yenugonda, Mahbubnagar, Telangana, 509001, India, exhibiting a documented history and clinical manifestations consistent with organophosphate poisoning. Study was conducted between the April 2023 to September 2023. Results: Organophosphorus chemicals are often employed substances for self-harm due to their widespread accessibility. The primary determinants of death encompass the specific toxic chemical employed, the extent of poisoning, the timing of treatment initiation, and the availability of intensive care resources. Although acetylcholinesterase has several advantages, it can result in an overstimulation of muscarinic and nicotinic receptors. The clinical presentation of cholinergic crisis typically manifests rapidly, serving as the primary basis for clinical diagnosis. Confirmation of this diagnosis is typically achieved by the patient's medical history and the use of demonstrative monitoring. Conclusion: The study observed that following treatment, levels of creatine phosphokinase returned to baseline levels, accompanied by a subsequent enhancement in the patient's clinical state. The optimization of the mean dose and duration of Atropine and pralidoxime treatment is a topic of interest, as it has been seen that greater doses are required in severe instances. [ABSTRACT FROM AUTHOR]

Background: Organophosphorus (OP) compounds are widely used in India as insecticides and contribute to both acute and chronic poisoning. Several parameters have been analyzed to evaluate the severity of poisoning and to prognosticate the outcome but contradictory results have been obtained from studies for example for the relationship between hypokalemia and outcome, pseudocholinesterase (PChE) levels, and outcome. Aims and Objectives: The objectives of this retrospective study were to explore the epidemiological characteristics and clinical profile of patients admitted to intensive care unit with OP poisoning and to evaluate the outcomes including complications, in hospital mortality, and the predictors of mortality. Materials and Methods: All the patients above 18 years admitted with a history of ingestion of OP poisoning during the study period were included in the study. Data were collected from case records. Results: The mean age of the patients was 34±13.54. Fifty-four patients were male (69.2%) and 24 were female (30.8%). The correlation coefficient between intubation and PChE levels was 0.266. The mean period of ventilation was 4.16 days±2.41 days. About 80% (n=20) put on ventilator survived. Correlation of hypokalemia with patients getting ventilator support was 0.26 and that with mortality was 0.038. Conclusion: OP poisoning cases were primarily noted in the younger male group with the intent to self-harm. Chlorpyrifos was the most common compound consumed. Early admission and appropriate treatment can reduce mortality and complications as there is no single factor which can be used to predict the outcome in these patients. [ABSTRACT FROM AUTHOR]

Objective: To study the value of some biochemical indicators and Peradeniya Organophosphate Poisoning scale in prediction and prognosis of organophosphorus poisoning. Methods: This was a hospital-based prospective, observational study. Various biochemical tests viz. complete blood count, random blood sugar, liver and renal function tests, creatine phosphokinase, and electrolytes were performed. Patients were assessed based on the Peradeniya Organophosphate Poisoning scale. All the patients were followed till the end point like recovery/death. Results: Out of the 100 patients, 72% were males and 28% were females. The majority of the patients were farmers and 21 to 30 years of age. Suicidal was the most common manner (92, 92%). Based on the Peradeniya Organophosphate Poisoning scale, 47% were mild, 34% moderate, and 19% severe. Serum creatinine, creatine phosphokinase, serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase, and alkaline phosphatase levels showed a significant correlation with severity. Conclusions: Some biochemical indicators such as creatine phosphokinase, alkaline phosphatase can be used as prognostic markers of organophosphorus poisoning. The Peradeniya Organophosphate Poisoning scale can be used for assessing severity of the poisoning. [ABSTRACT FROM AUTHOR]

Pretilachlor is an extensively used herbicide worldwide that mimics the clinical presentation of Organophosphorus (OP) poisoning upon ingestion. Misdiagnosis can be a major setback and lead to inappropriate patient management. In this report, we discuss the case of a young man who presented with an alleged history of consumption of an unknown chemical compound, which was later confirmed to be pretilachlor. He had multiple episodes of emesis since the event, and the only systemic abnormality was a low heart rate of approximately 50 beats/min. Other cholinergic symptoms were absent, and atropine was administered after initial resuscitation and stabilization, with suspected OP poisoning as the top differential diagnosis. All laboratory findings, including pseudocholinesterase, were normal, which was unlikely to happen in the case of OP poisoning. Later, the consumption of the chemical pretilachlor, by the patient was confirmed. The patient was weaned off atropine and managed by systemic support and symptomatic treatment. He fully recovered within 4-5 days and was discharged in a stable condition with no risk of post-discharge complications. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to systematically evaluate the efficacy and safety of plasma exchange combined with hemoperfusion in the treatment of organophosphorus poisoning. Methods: PubMed, Embase, the Cochrane Library, China National Knowledge Internet, Wanfang database, and Weipu database were searched for articles about this subject. Literature screening and selection were conducted in strict accordance with the inclusion and exclusion criteria. Results: 14 randomized controlled trials with 1,034 participants were included in this meta-analysis study, including 518 cases in plasma exchange combined with hemoperfusion group (the combination treatment group) and 516 cases in hemoperfusion group (the control group). Compared with the control group, the combination treatment group was associated with a higher effective rate (relative risk [RR] = 1.20, 95% confidence interval [CI] [1.11, 1.30], p < 0.00001) and lower fatality rate (RR = 0.28, 95% CI [0.15, 0.52], p< 0.0001); reduced TNF-α (standardized mean difference [SMD] = −1.95, 95% CI [−2.42, −1.48], p < 0.00001), IL-6 (SMD = −1.94, 95% CI [−3.08, −0.80], p = 0.0009), and C-reactive protein (CRP) (SMD = −1.94, 95% CI [−2.86, −1.03], p < 0.0001); shorten coma time (SMD = −1.99, 95% CI [−2.75, −1.24], p < 0.00001), recovery time of cholinesterase activity (SMD = −1.71, 95% CI [−1.90, −1.53], p < 0.00001), and hospital stay (SMD = −1.29, 95% CI [−1.59, −0.98], p < 0.00001). The incidence of complications in the combination treatment group such as liver and kidney damage (RR = 0.30, 95% CI [0.18, 0.50], p < 0.00001), pulmonary infection (RR = 0.29, 95% CI [0.18, 0.47], p < 0.00001), and intermediate syndrome (RR = 0.32, 95% CI [0.21, 0.49], p < 0.00001) was lower than that in the control group. Conclusions: The current evidence suggests that the combination of plasma exchange with hemoperfusion therapy can reduce the mortality of patients with organophosphorus poisoning, shorten the recovery time of cholinesterase activity and the time of coma, reduce the average length of hospital stay, and reduce the levels of IL-6, TNF-α, and CRP, but high-quality randomized double-blind controlled trials are still required to confirm the current findings in the future. [ABSTRACT FROM AUTHOR]

Background: Organophosphate (OP) pesticide poisoning is a primary concern in rural regions of developing nations, posing a significant clinical challenge. The mortality rate from acute OP compound poisoning surpasses any other harmful substance. In the case of stressful events like injuries and poisoning, the observed leucocytosis and neutrophilia can be attributed to neutrophil margination rather than an increase in bone marrow production. Materials and Methods: Between June 2020 and September 2021, a prospective observational study was conducted at a tertiary care institute in Tamil Nadu. The study included 50 patients admitted to the Institute’s Medical Emergency Ward with suspected Organophosphorus poisoning. These patients were categorized into three grades, mild, moderate, and severe, using Dresbach’s classification based on the severity of their manifestations. Results: Among the 50 cases studied, 29 were females, and 21 were males. The predominant agent is responsible for organophosphate (OP) poisoning was chlorpyrifos, affecting 37 patients. Most cases (78%) presented with mild manifestations, 12% presented with moderate presentations, and 10% had severe manifestations. Most (72%) of patients sought medical attention within 4 h of consumption (n = 36). Conclusion: While insufficient to confirm or rule out severe poisoning, leukocyte counts hold some moderate capacity to differentiate between patients with and without significant poisoning. As a result, these counts could have a meaningful impact on decisions regarding patient disposition.

Objective: To study the value of some biochemical indicators and Peradeniya Organophosphate Poisoning scale in prediction and prognosis of organophosphorus poisoning. Methods: This was a hospital-based prospective, observational study. Various biochemical tests viz. complete blood count, random blood sugar, liver and renal function tests, creatine phosphokinase, and electrolytes were performed. Patients were assessed based on the Peradeniya Organophosphate Poisoning scale. All the patients were followed till the end point like recovery/death. Results: Out of the 100 patients, 72% were males and 28% were females. The majority of the patients were farmers and 21 to 30 years of age. Suicidal was the most common manner (92, 92%). Based on the Peradeniya Organophosphate Poisoning scale, 47% were mild, 34% moderate, and 19% severe. Serum creatinine, creatine phosphokinase, serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase, and alkaline phosphatase levels showed a significant correlation with severity. Conclusions: Some biochemical indicators such as creatine phosphokinase, alkaline phosphatase can be used as prognostic markers of organophosphorus poisoning. The Peradeniya Organophosphate Poisoning scale can be used for assessing severity of the poisoning.

Organophosphates (OP) poisoning continues to be a major cause of deliberate self-harm and an important cause of morbidity and mortality in India. We aim to study the clinico-epidemiological features in patients presenting with OP poisoning. This prospective observational study involved 400 patients above 18 years of age admitted to the emergency department of a tertiary care institution in Northern India. The study cohort was graded into mild, moderate & severe based on the Peradeniya Organophosphorus Poisoning (POP) scale and degree of cholinesterase inhibition. The majority of patients (40%) in our study population were aged between 18-25 years. There was a significant female preponderance (82% vs. 18%; P=0.000). Suicide was the most common motive (93%) and ingestion was the most common mode of poisoning (99%). The muscarinic and nicotinic symptoms were common at the presentation. Seizures were present in 11% of patients. On the POP severity scale, mild, moderate and severe poisoning was seen at 50%, 35% and 15%, respectively. Cholinesterase inhibition was mild (>2 kU/L) in 31%, moderate (1-2 kU/L) in 46% and severe (<1 kU/L) in 23%. A total of 48% of patients had complications. Ventilator support was needed in 43% of the patients. An overall mortality of 18% was observed in the study. OP poisoning is a serious public health problem, but timely intervention may help to reduce morbidity and mortality, especially in a resource- limited country like India. [ABSTRACT FROM AUTHOR]

Background: Organophosphorus poisoning is a global health concern.This study uses an integrated strategy to assess the research landscape, combining quantitative analysis of publishing trends with automated extraction of information from text data. Methodology: R-based biblioshiny is used for integrated text mining and bibliometrics on organophosphorus poisoning research. Search query is filtered from language, publication type, and date to ensure relevant and recent articles. RStudio and biblioshiny package is used for data retrieval and analysis. This research article thematic direction analyses associations between acetylcholinesterase and animals, insects, zebrafish, and humans in forensic medicine and toxicology covering the period from 2013 to 2022. Results: The data provided presents trends in organophosphorus poisoning research topics, including frequency, temporal distribution, and prominence. Notable trends include early focus on pralidoxime, atropine, and suicide attempts in 2014-2015, shifting towards pesticides, organophosphate poisoning, humans, and compounds in later years. Different age groups and retrospective studies are widely explored in research. Conclusion: The integrated strategy of text mining and bibliometrics employed in this study has provided a wealth of valuable insights into the research landscape of organophosphorus poisoning.

Background: Organophosphorus (OP) poisoning is a common form of chemical poisoning in developing countries, leading to significant morbidity and mortality. The study aimed to determine the clinical and electrocardiographic (ECG) features of OP poisoning and their correlation with serum creatine kinase-MB (CPK-MB) levels. Methods: A prospective cross-sectional study was conducted on 350 patients with OP poisoning admitted to a tertiary care hospital. The age, gender, CPK-MB levels, and ECG changes were recorded and analyzed using appropriate statistical methods. Results: The mean age of the patients was 34.91 ± 14.36 years, and 62.6% were male. Most patients were aged between 21 to 40 years, and the male-to-female ratio was 1.7:1. The CPK-MB levels were significantly elevated on the third day of admission compared to baseline and at discharge (p < 0.05). The most common ECG changes were prolonged QT interval (21.7%) and T inversion (17%). ST elevation and prolonged QTc were associated with increased mortality (78.3% and 65.2%, respectively). Conclusion: OP poisoning is a significant public health problem associated with high morbidity and mortality. The study highlights the importance of monitoring serum CPK-MB levels and ECG changes in the management of OP poisoning. The findings suggest that ST elevation and prolonged QTc are associated with increased mortality in OP poisoning. Further research is needed to confirm these findings and identify effective management strategies for OP poisoning. [ABSTRACT FROM AUTHOR]

Introduction Prompt recognition and aggressive management of acute intoxication due to organophosphorus poisoning are essential to minimize the morbidity and mortality. The present study was undertaken to know the prognosis and outcome of organophosphorus poisoning patients with the estimation of low-cost enzymes like the serum amylase level in a population with financial constraints. Methods In this cross-sectional study, we had enrolled 100 cases that had a history of exposure to organophosphorus compounds, and the serum amylase level was measured in all the patients. We assessed the outcome of all the patients in the form of discharge, need of ventilators, intensive care unit stay, and death. Results The mean serum amylase level in discharge patients was 335.40 ± 192.45, and in the patients who died it was 843.37 ± 22.60. It was significant to predict the outcome (t-value 7.07, p-value 0.0001, statistically significant). Conclusion Serum amylase level shows significant correlation with clinical outcomes in organophosphorus poisoning.

Organophosphorus poisoning is soaring due to easy availability in rural settings of developing countries. There are many reports of Acute Pancreatitis associated with OP poisoningand a casual relationship has been demonstrated in animal models. This study was therefore designed to determine the prevalence of hyperamylasemia and acute pancreatitis in organophospate poisoning in our setup and to reduce mortality and hospital stay by its early detection. This is a cross sectional hospital based study carried out in SKIMS Medical College, Srinagar, J&K which is tertiary care facility. All patients included were above 18 years of age with a recent history of organophosphate ingestion, cutaneous absorption or inhalation with clinical signs and symptoms of organophosphate poisoning. Confounding factors like drugs causing pancreatitis, ERCP within 24 hrs, previous history of pancreatitis, cholelithiasis and or any other local pathology were excluded. Serum Amylase and Lipase were measured. Imaging like ultrasonography and CT scan Abdomen was ordered. BISAP scoring was used to assess severity of acute pancreatitis. 50 patients with ingestion of organophosphates were evaluated. 23 patients developed abdominal pain, among which 11 patients had hyperamylasemia while 7 developed Clinical acute pancreatitis with high lipase and imaging findings. 2/3 of patients who developed pancreatitis had mild severity while other 1/3 had severe severity. Pancreatitis in Organophosphorus is not uncommon and needs high clinical suspicion for early diagnosis and management. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of sequential blood purification therapy on myocardial injury and serum inflammatory cytokine levels in patients with organophosphorus poisoning., Methods: The clinical data of 67 patients hospitalized for organophosphorus poisoning from January 2020 to January 2021 in Anxi County Hospital were retrospectively analyzed. The patients were divided into a control group (n = 30, received conventional treatment plus hemoperfusion) and a research group (n = 37, received conventional treatment plus sequential blood purification therapy [hemoperfusion plus continuous veno-venous hemofiltration (CVVH)]). The clinical efficacy, myocardial injury indicators, inflammatory cytokine levels, liver and kidney function, incidence of complications, and mortality rate were compared between the two groups., Results: The research group showed a significantly higher total effective rate of 94.59% compared to 73.33% in the control group (P < 0.05). Fewer doses of penehyclidine were administered in the research group, compared to the control group (P < 0.05). In addition, the duration of penehyclidinezation, wakefulness, recovery of CHE activity, mechanical ventilation and hospitalization in the research group was significantly shorter than those in the control group (all P < 0.05). After treatment, both groups exhibited decreased levels of serum NSE, cTnI, CK-MB, LDH, Myo, WBC, CRP, PCT and IL-6, with lower levels in the research group (P < 0.05). Conversely, both groups showed elevated levels of serum CHE, BUN, Scr, urine protein, AST, TBIL and ALT, with higher levels in the control group (P < 0.05). On the 1st and 2nd days after treatment, the serum NSE levels in the observation group were lower than those in the control group, while the serum CHE levels were higher than those in the control group (all P < 0.05). On the 3rd day after treatment, serum NSE and CHE levels were not significantly different between the two groups. The incidence of rebound in the research group was significantly lower (8.11% vs. 30.00%, P < 0.05) than that in the control group. The mortality rates did not show statistically significant differences between the two groups (10.00% vs. 2.70%, P > 0.05)., Conclusion: Sequential blood purification therapy can effectively mitigate myocardial injury, reduce the expressions of inflammatory cytokines, and protect liver and kidney function in patients with organophosphorus poisoning, with a favorable safety profile., Competing Interests: None., (AJTR Copyright © 2024.)

Dyspnea experienced in the upright position which is relieved in the supine position, is known as Platypnea. Accompanying desaturation in the arterial blood associated with Platypnea is known as orthodeoxia. Various causes of Platypnea orthodeoxia syndrome, such as hepatopulmonary syndrome, patent foramen ovale and atrial septal defects, are well described in the literature. However, a rather uncommon and underreported cause of Platypnea orthodeoxia syndrome is organophosphorus poisoning. We report a case series of three cases that were reported after ingestion of organophosphorus compounds and developed breathlessness later in the course of the hospital stay, which was diagnosed as Platypnea orthodeoxia syndrome resulting from organophosphorus poisoning. All three cases were treated with supportive management, incentive spirometry and respiratory physiotherapy and responded well to the treatment. [ABSTRACT FROM AUTHOR]

Introduction: Organophosphates are potent cholinesterase inhibitors that when ingested in excessive amounts can be fatal. Organophosphorus poisoning has become an important clinical problem with increased mortality in the country from accidental or intentional ingestion of, or exposure to the pesticide. This study aimed to find out the prevalence of organophosphorus poisoning among patients admitted to the Intensive Care Unit of the Department of Internal Medicine in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients admitted to the Intensive Care Unit of the Department of Internal Medicine of a tertiary care centre after receiving ethical approval from the Institutional Review Committee (Reference number: 2003202205). The study was conducted between 1 February 2021 and 1 February 2022 using hospital records. Convenience sampling was done among the patients who met the eligibility criteria. The diagnosis of organophosphorus poisoning was made based on the patient’s history, clinical examination and the measurement of serum acetylcholinesterase levels. Point estimate and 95% Confidence Interval were calculated. Results: Among 1108 patients admitted, organophosphorus poisoning was seen in 50 (4.15%) (3.29-5.73, 95% Confidence Interval). Conclusions: Our study found that the prevalence of organophosphorus poisoning was lower when compared to similar studies done in similar settings.

Abstract Background Poisoning and deaths by organo-phosphorous (OP) compounds are one of the major causes of death in developing and poor countries, and a common admission in the emergency ward and the ICU. OP compounds act by irreversibly binding to pseudocholinesterase enzyme and hence prolong the apnea in patients being given suxamethonium. We present a unusual case of OP poisoning (OPP) in which prolonged apnea ensued in a patient of severe depression following MECT (modified electroconvulsive therapy) in which suxamethonium was used as muscle relaxant, in whom we were cautious of the side-effect of prior organophosphorus poisoning. Since the cases of OPP are very high worldwide, a thorough knowledge of the interaction of the action of the drug and the receptors on which it acts takes pride of place. This article highlights the nuances in the field of psychiatry and anaesthesia in diagnosis and management of prolonged apnea after ECT. Case presentation A 53/F patient consumed OP 38 days prior to MECT. Since existing literature recommend a delay of 4 weeks and a subminimal dose of suxamethonium to prevent prolonged apnea, both these points were taken into consideration. Despite 38 days post exposure to OP, and a dose of succinylcholine of

Background and Objectives: Organophosphate compounds are frequently used for homicidal and suicidal purposes, organophosphates account for as many as 80% of pesticide-related hospital admissions. This study was done to estimate serum amylase and plasma cholinesterase (ChE) in acute organophosphorus (OP) poisoning, to correlate serum amylase with plasma ChE levels and to study serum amylase levels as a probable prognostic marker in acute OP poisoning. Materials and Methods: The study was conducted at the hospitals attached to Bangalore Medical College and Research Institution, Bangalore, from November 2017 to May 2019, 110 cases of OP poisoning were selected based on inclusion and exclusion criteria. Patients were grouped accordingly based on ChE levels into mild, moderate, and severe. Serum amylase levels were estimated on admission, at 48 h, and at outcome either recovery or clinical deterioration. Serum amylase was used as a marker to assess severity in acute OP-poisoning cases, to predict ventilator requirement and mortality, and also for prognostication. Results: In our study, a total of 110 acute OP-poisoning cases were included. The mean serum amylase levels at admission, 48 h, and the outcome were 54.81, 54.44, and 53.35 among the nonintubated group, respectively, and 152.23, 152.67, and 141.13 among the intubated group, respectively, with a significant P value (0.000*). This shows that patients who were intubated had elevated mean serum amylase levels (>90 U/l) in comparison to patients who were not intubated. Sixty-three patients had normal amylase levels on day 1 (≤90 U/l) (normal value of serum amylase as per the laboratory was 28–90 U/l) and 47 patients had raised amylase levels on day 1 (>90 U/l). Among 47 patients with raised amylase level, 18 patients died and there were no deaths in the normal amylase level group with P = 0.00* which is statistically significant. Raised serum amylase correlated well in predicting ventilator requirement and mortality in patients with OP poisoning. Conclusion: Serum amylase can be used as a reliable biochemical marker as it is easily available, relatively cheap, and it also predicts the requirement for intubation and mortality in acute OP-poisoning cases. Increased amylase levels on admission imply poorer outcome and increased risk of mortality, and thereby, it can be used as an alternative marker to predict clinical outcome and for prognostication.

Purpose: To analyze the quality of tissues and outcome of corneal transplants from tissues harvested from the donors of organophosphorus poisoning victims. Methods: A retrospective study was carried out on corneas harvested from organophosphorus poisoning victims between January 2016 and December 2018. Details of quality of tissues and outcome following keratoplasty were collected from the eye bank and outpatient records, respectively. Results: Four hundred and seventy-eight donor corneas were collected from the victims of organophosphorus poisoning during the study period. The mean age of the donor was 38.8 ± 16.5 years. The mean donor-to-preservation time was 6.2 ± 3.2 hours. The mean endothelial cell density on specular microscopy was 2986.5 ± 369.0 cells/mm2. Four hundred and twenty-two (88.2%) donor corneas were utilized. Of the 121 corneas utilized at our institute for transplantation, 73 and 48 corneas were for optical and therapeutic/tectonic indications, respectively. Of the 73 optical grafts, 25 patients were lost-to-follow-up and 58.3% (28/48) who came for one-year follow-up were found to be clear. Conclusion: Donor corneas retrieved from organophosphorus poisoning are safe for transplantation. The postoperative outcome of the tissue utilized from these donors is satisfactory.

Organophosphorus poisoning caused by some pesticides and nerve agents is a life-threating condition that must be swiftly addressed to avoid casualties. Despite the availability of medical countermeasures, the clinically available compounds lack a broad spectrum, are not effective towards all organophosphorus toxins, and have poor pharmacokinetics properties to allow them crossing the blood-brain barrier, hampering cholinesterase reactivation at the central nervous system. In this work, we designed and synthesised novel isatin derivatives, linked to a pyridinium 4-oxime moiety by an alkyl chain with improved calculated properties, and tested their reactivation potency against paraoxon- and NEMP-inhibited acetylcholinesterase in comparison to the standard antidote pralidoxime. Our results showed that these compounds displayed comparable in vitro reactivation also pointed by the in silico studies, suggesting that they are promising compounds to tackle organophosphorus poisoning.

Introduction: Organophosphorus is an easily available compound, especially in agriculture and farming related areas. This study evaluated organophosphorus poisoning among the population in those high-risk areas. The main objective of this study is to find out the prevalence of organophosphorus poisoning among acute poisoning cases presenting to the Emergency Department of a secondary care centre. Methods: A descriptive cross-sectional study was conducted among 427 patients presenting to the Emergency Department in a secondary care centre from 17th July, 2018 to 14th January, 2022. Ethical clearance was taken from the Institutional Review Committee (Reference number: 01/2075-76). All the patients presenting to the Emergency Department were included and the patients without consent, patients with trauma, accident, severe illness and other emergency conditions were excluded. A convenience sampling was done. Data were collected and entered in Microsoft Excel version 2007 and analyzed using Statistical Package for the Social Science version 25.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: Out of 427 patients, 203 (47.54%) (42.80-52.28 at 95% Confidence Interval) had organophosphorus poisoning. It was most commonly seen in the age group 16-30 years among 103 (50.74%). Conclusions: The prevalence of organophosphorus poisoning in our study was similar when compared to other studies conducted in similar settings. Most of the organophosphorus poisoning cases were intentional and suicidal which is similar to other studies.

Background: Organophosphorus (OP) and carbamate pesticides are widely used for crop protection. We describe the spectrum of laryngeal abnormalities in patients admitted to the intensive care unit (ICU) with acute OP and carbamate poisoning as there is limited information on it. Materials and methods: Consecutive patients admitted to the ICU with acute OP and carbamate poisoning over 20 months (December 2014-July 2016) were recruited. Patients were followed up post-discharge if they had undergone tracheostomy or developed hoarseness of voice or stridor following extubation. Asymptomatic individuals who consented underwent laryngoscopy after ICU discharge. The primary outcome was the development of laryngeal dysfunction. Other outcomes included length of stay, need for ventilation, mortality, tracheostomy, and time to decannulation of tracheostomy. Results: Of the 136 patients recruited, 71 (52%) underwent laryngoscopy. The overall mortality rate was 9.6%. Of the 71 patients who underwent laryngoscopy, 18 had abnormal findings, which included unilateral or bilateral vocal cord paresis or palsy (n = 14) and/or aspiration (n = 9), subglottic stenosis (n = 1), tracheal stenosis (n = 1), or arytenoid granuloma (n = 1). Laryngeal dysfunction was associated with the ingestion of a dimethyl OP compound (p = 0.04) and quantum consumed (p <0.001). Patients with laryngeal dysfunction had significantly (p = 0.004) longer hospital stay (19.1 ± 10.7 vs 11.8 ± 8.3 days). Conclusion: Laryngeal dysfunction is not uncommon in OP and carbamate poisoning and is associated with the ingestion of larger quantity of a dimethyl OP compound and longer hospital stay. Otorhinolaryngologists could be involved early to help identify these abnormalities and initiate an appropriate treatment to ensure a functional voice and good airway. [ABSTRACT FROM AUTHOR]

Introduction Prompt recognition and aggressive management of acute intoxication due to organophosphorus poisoning are essential to minimize the morbidity and mortality. The present study was undertaken to know the prognosis and outcome of organophosphorus poisoning patients with the estimation of low-cost enzymes like the serum amylase level in a population with financial constraints. Methods In this cross-sectional study, we had enrolled 100 cases that had a history of exposure to organophosphorus compounds, and the serum amylase level was measured in all the patients. We assessed the outcome of all the patients in the form of discharge, need of ventilators, intensive care unit stay, and death. Results The mean serum amylase level in discharge patients was 335.40±192.45, and in the patients who died it was 843.37±22.60. It was significant to predict the outcome (t-value 7.07, p-value 0.0001, statistically significant). Conclusion Serum amylase level shows significant correlation with clinical outcomes in organophosphorus poisoning. [ABSTRACT FROM AUTHOR]

BACKGROUND: Butyrylcholineesterase (BChE) is a therapeutic drug and its producing as a recombinant protein is an essential issue in biotechnology. One of the highlights in this regard is choosing the best host cells and plasmids. OBJECTIVES: The aim of this study is to evaluate the production of butyrylcholinesterase in Vero, HEK-293, and CHO cell lines using a dual promoter vector. MATERIAL AND METHODS: The dual-promoter construction (pBudCE dual BChE) was transfected into cell lines categorized in three experimental groups (pBudCE dual BChE, pCMV and negative control). BChE gene expression and enzyme activity was evaluated at different times. RESULTS: All three cell lines showed higher gene expression level in pBudCE dual BChE group. BChE enzyme activity level of this group in CHO cells decreased in sixth day and increased in ninth day. In HEK-293 cells it has a downward trend from sixth to ninth day and in Vero cells its level in the ninth day was the highest. CONCLUSION: The difference of pBudCE dual BChE and pCMV groups was more pronounced in the HEK-293 cell and the BChE gene expression level of this cells was higher than the others while, CHO cells showed higher level of BChE enzyme activity. [ABSTRACT FROM AUTHOR]

Background and Introduction: Acute Organophosphorus poisoning (OP) is important cause of morbidity and mortality in India. In medical emergency 10% of admissions are due to poisoning and organophosphorus poisoning contributes to nearly 50% of cases1,2,3.The objective of the study is to study the levels of pseudocholinesterase in serum as a diagnostic aid in patients with suspected organophosphorus poisoning and to predict the prognosis based on pseudocholinesterase activity. Materials and Methods: Informed consent was taken from 50 patients suspected of organophosphorus poisoning and admitted to Medical Emergency Ward. Pseudocholinesterase levels were estimated by S- butyrylthiocholine iodide method using dibucaine as inhibitor. Serum levels of pseudocholinesterase levels of patients were examined on Day 1, Day 2, Day 3 and Day 6 of admission. Result: Patients who survived had increasing levels of pseudocholinesterase activity of 3.56% on 2nd day and further rise of 4.48% on 3rd day and a rise of 6.88% on 6th day. In patients who expired, the enzyme activity had reduced by 4.6% on Day 2 and a raise of 11% on Day 3 and a fall of 5.5% on Day 6. It was observed that the enzyme activity in patients those survived has increased on successive days indicating a better prognosis whereas the enzyme activity in patients those expired was falling except for the Day 3 where a raise of 11% was noticed. This may be probably due to the treatment given to the patients, which has caused a transient raise in enzyme levels. Conclusion: In early stages of poisoning, determining pseudocholinesterase activity is reliable diagnostic test. Mean pseudocholinesterase activity in patients who survived was above 4300 U/L and the levels had increased in the successive days above 5400 U/L, which indicated better prognosis. In the patients who expired the pseudocholinesterase activity was around 4300 U/L and was falling except for the Day 3. This point out that raise in enzyme levels is directly proportional to better prognosis.

Background and Introduction: Acute Organophosphorus poisoning (OP) is important cause of morbidity and mortality in India. In medical emergency 10% of admissions are due to poisoning and organophosphorus poisoning contributes to nearly 50% ofcases1,2,3.The objective of the study is to study the levels of pseudocholinesterase in serum as a diagnostic aid in patients with suspected organophosphorus poisoning and to predict the prognosis based on pseudocholinesterase activity. Materials and Methods: Informed consent was taken from 50 patients suspected of organophosphorus poisoning and admitted to Medical Emergency Ward.Pseudocholinesterase levels were estimated by S-butyrylthiocholine iodide method using dibucaine as inhibitor. Serum levels of pseudocholinesteraselevels of patients were examined on Day 1, Day 2, Day 3 and Day 6 of admission. Result: Patients who survived had increasing levels of pseudocholinesterase activity of 3.56% on 2nd day and further rise of 4.48% on 3rd day and a rise of 6.88% on 6th day. In patients who expired,the enzyme activity had reduced by 4.6%on Day 2 and a raise of 11% on Day 3 and a fall of 5.5% on Day 6. It was observed that the enzyme activity in patients those survived has increased on successive days indicating a better prognosis whereas the enzyme activity in patients those expired was falling except for the Day 3 where a raise of 11% was noticed. This may be probably due to the treatment given to the patients,which has caused a transient raise in enzyme levels. Conclusion: In early stages of poisoning,determining pseudocholinesterase activity isreliable diagnostic test. Mean pseudocholinesterase activity in patients who survived was above 4300 U/L and the levels had increased in the successive days above 5400 U/L, which indicated better prognosis. In the patients who expired the pseudocholinesterase activity was around 4300 U/L and was falling except for the Day 3. This point out that raise in enzyme levels is directly proportional to better prognosis.

Background: Organophosphorus (OP) are substances that are originally produced by the reaction of alcohols and phosphoric acid. These OP compounds are the main components of herbicides, pesticides, and insecticides. These are easily available in developing country like India; there is lack of awareness about these chemicals which results in high morbidity and mortality. Aims and Objectives: To estimate levels of amylase, lipase, plasma cholinesterase in acute OP poisoning. To assess severity of OP poisoning by using plasma cholinesterase levels and correlating it with other two markers. Predicting the severity of acute OP poisoning by using these biochemical markers. Materials and Methods: A hospital-based observational study was conducted on 100 subjects who were clinically diagnosed of acute OP poisoning. Subjects of either gender of all age-groups were included in the study. On admission, plasma cholinesterase, serum amylase, and serum lipase were measured. Based on plasma cholinesterase activity at the time of admission, subjects were divided into three groups. Group I-having 20-50% of plasma cholinesterase activity; Group II-10-20% of plasma cholinesterase activity; and Group III

Organophosphorus poisoning caused by some pesticides and nerve agents is a life-threating condition that must be swiftly addressed to avoid casualties. Despite the availability of medical countermeasures, the clinically available compounds lack a broad spectrum, are not effective towards all organophosphorus toxins, and have poor pharmacokinetics properties to allow them crossing the blood-brain barrier, hampering cholinesterase reactivation at the central nervous system. In this work, we designed and synthesised novel isatin derivatives, linked to a pyridinium 4-oxime moiety by an alkyl chain with improved calculated properties, and tested their reactivation potency against paraoxon- and NEMP-inhibited acetylcholinesterase in comparison to the standard antidote pralidoxime. Our results showed that these compounds displayed comparable in vitro reactivation also pointed by the in silico studies, suggesting that they are promising compounds to tackle organophosphorus poisoning. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the quality of tissues and outcome of corneal transplants from tissues harvested from the donors of organophosphorus poisoning victims.Methods: A retrospective study was carried out on corneas harvested from organophosphorus poisoning victims between January 2016 and December 2018. Details of quality of tissues and outcome following keratoplasty were collected from the eye bank and outpatient records, respectively.Results: Four hundred and seventy-eight donor corneas were collected from the victims of organophosphorus poisoning during the study period. The mean age of the donor was 38.8 ± 16.5 years. The mean donor-to-preservation time was 6.2 ± 3.2 hours. The mean endothelial cell density on specular microscopy was 2986.5 ± 369.0 cells/mm2. Four hundred and twenty-two (88.2%) donor corneas were utilized. Of the 121 corneas utilized at our institute for transplantation, 73 and 48 corneas were for optical and therapeutic/tectonic indications, respectively. Of the 73 optical grafts, 25 patients were lost-to-follow-up and 58.3% (28/48) who came for one-year follow-up were found to be clear.Conclusion: Donor corneas retrieved from organophosphorus poisoning are safe for transplantation. The postoperative outcome of the tissue utilized from these donors is satisfactory. [ABSTRACT FROM AUTHOR]

Background and aims: There has been an increasing recognition of the various metabolic abnormalities in patients with acute organophosphorus (OP) poisoning including disturbed glucose homeostasis. We assessed the glycemic status at the presentation and its role as a marker of severity and clinical outcome in patients admitted with acute OP poisoning. Material and method: This was a prospective observational study, involving 400 patients above 18 years of age admitted to the emergency department of a tertiary care institution in Northern India. The biochemical parameters including random plasma glucose, serum cholinesterase, severity and outcome were determined. Patients were grouped according to their admission plasma glucose into hypoglycemic (<70 mg/dl), euglycemic (RBS=70-199 mg/dl) and hyperglycemia (RBS≥200 mg/dl) groups. Results The hyperglycemia, hypoglycemic and normoglycemia (RBS=70-199 mg/dl) at admission was present in 29.5%, 14.5% and 56% of patients. Five patients (4.24%) among hyperglycemia presented with diabetic ketoacidosis (DKA). Extremes of glycemic status including hyperglycemia and hypoglycemic were significantly associated with prolonged hospital stay (>7 days), need for mechanical ventilation and mortality in 66% and 60%, 68% and 69%, 35% and 33%, respectively compared to 18%, 24% and 4% in normoglycemic group, respectively. Overall mortality in our study cohort was 17%. Furthermore, extremes of glycemic status at presentation were significantly associated with the clinical severity, depression in serum cholinesterase levels, add need for ICU care. Conclusions: Glycemic extremes including both hyperglycemia and hypoglycemic are common in patients with acute OP poisoning and are significantly associated with morbidity and mortality. It can be used as a simple and reliable predictive marker to identify patients in need of intensive monitoring and admission to the intensive care unit (ICU). [ABSTRACT FROM AUTHOR]

Background: Poisoning and deaths by organo-phosphorous (OP) compounds are one of the major causes of death in developing and poor countries, and a common admission in the emergency ward and the ICU. OP compounds act by irreversibly binding to pseudocholinesterase enzyme and hence prolong the apnea in patients being given suxamethonium. We present a unusual case of OP poisoning (OPP) in which prolonged apnea ensued in a patient of severe depression following MECT (modified electroconvulsive therapy) in which suxamethonium was used as muscle relaxant, in whom we were cautious of the side-effect of prior organophosphorus poisoning. Since the cases of OPP are very high worldwide, a thorough knowledge of the interaction of the action of the drug and the receptors on which it acts takes pride of place. This article highlights the nuances in the field of psychiatry and anaesthesia in diagnosis and management of prolonged apnea after ECT. Case presentation: A 53/F patient consumed OP 38 days prior to MECT. Since existing literature recommend a delay of 4 weeks and a subminimal dose of suxamethonium to prevent prolonged apnea, both these points were taken into consideration. Despite 38 days post exposure to OP, and a dose of succinylcholine of < 0.3 mg/kg, the patient remained apneic for 3 h. Suxamethionum apnea was managed with elective ventilation. After recovery, patient had no residual effect. Subsequently her pseudocholinesterase levels were done which were found to be very low. Conclusion: This case is being presented to emphasize that behaviour of post synaptic receptors cannot be relied upon after OP poisoning and pseudocholinesterase levels needs to be mandatorily checked, irrespective of duration post-exposure. In strong suspects dibucaine number and fluoride number also needs to be estimated. [ABSTRACT FROM AUTHOR]

Organophosphorus (OP) insecticide poisoning is a significant health problem in South Asian countries. Although cholinergic receptors are present at the junction between photoreceptors and the retinal pigment epithelium (RPE), human studies of the effects of OP poisoning on the visual pathways are very few. This study aims to demonstrate the pattern of changes in retina and post retinal pathways in patients with acute OP poisoning using visual electrophysiological tests. This is an observational, cross-sectional study conducted at the Neurophysiology Unit, Teaching Hospital, Peradeniya, Sri Lanka. We tested 16 patients recovered from cholinergic phase, at least 24 h after deatropinization and within 8 weeks of OP ingestion. We assessed the functional integrity of the photoreceptors and ganglion cells of the macula by pattern electroretinography (PERG); RPE by electro-oculography (EOG); and post retinal pathways by pattern reversal visual evoked potentials (PR-VEP). Latencies and amplitudes of PR-VEP and PERG, light peak (LP), dark trough (DT) and Arden ratio of EOG were determined in patients and compared with 16 controls using the Mann–Whitney U test. Of the 16 OP-poisoned patients (median age of 37 ± IQR 20 years), six (37.5%) had reduced Arden ratio with reference to the International Society of Clinical Electrophysiology of Vision cut-off value of 1.7. The median Arden ratio in patients (1.69 ± IQR 0.36) was significantly lower compared to controls (1.90 ± IQR 0.4). The median latencies and amplitudes of PR-VEP or PERG were not significantly different between patients and controls. However, three patients had prolonged P100 latencies in PR-VEP and one had prolonged P50 latency in PERG. Acute OP poisoning seems to affect the functions of the RPE and the visual electrophysiological changes outlast the cholinergic phase. Limited evidence suggests that photoreceptors of the macula region and post retinal pathway might be affected in some patients. [ABSTRACT FROM AUTHOR]

Effective intracerebral delivery acetylcholinesterase (AChE) reactivator is key for the acute organophosphorus (OPs) poison treatment. However, the blood-brain barrier (BBB) restricts the transport of these drugs from blood into the brain. Herein, we developed transferrin receptor (TfR) aptamer-functionalized liposomes (Apt-LP) that could deliver AChE reactivator (obidoxime) across the BBB to act against paraoxon (POX) poisoning. The aptamer had strong affinity for TfR and was modified with 3′-inverted deoxythymidine (dT) to improve serum stability. The uptake of Apt-LP by bEnd.3 cells was significantly higher than that of non-targeting liposomes. The ability of Apt-LP to penetrate intact BBB was confirmed in in vitro BBB mice model and in vivo biodistribution studies. Treatment of POX-poisoned mice with Apt-LP-LuH-6 reactivated 18% of the brain AChE activity and prevented brain damage to some extent. Taken together, these results showed that Apt-LP may be used as a promising brain-targeted drug delivery system against OPs toxicity. Unlabelled Image • Transferrin receptor aptamer-functionalized liposomes (Apt-LP) were developed. • Apt-LP could deliver AChE reactivator, obidoxime, across blood-brain barrier. • Apt-LP could effectively transport obidoxime across the BBB model in vitro. • Apt-LP exhibited a satisfactory efficiency in brain delivery. • Apt-LP may be used against organophosphorus poisoning. [ABSTRACT FROM AUTHOR]

Organophosphorus poisoning is a common cause of death in developing countries. These compounds inhibit acetylcholinesterase leading to accumulation of acetylcholine, causing overstimulation of nicotinic and muscarinic receptors. Atropine and oximes are the mainstay of treatment. Atropine helps in countering muscarinic effects and decreasing secretions. It also makes the secretions thick, tenacious and may obstruct the airway. We observed five cases of organophosphorus poisoning being treated with atropine developing sudden respiratory distress attributed to mucus plug obstructing the airway which was confused with intermediate syndrome. After removal of the mucus plug these patients recovered uneventfully. [ABSTRACT FROM AUTHOR]

Organophosphorus poisoning (OPP) poses a significant threat to human health, necessitating accurate prognostic markers for timely intervention and improved outcomes. This review evaluates the potential of the neutrophil-to-lymphocyte ratio (NLR) as a prognostic indicator in acute organophosphorus poisoning (AOPP). A comprehensive analysis of existing literature reveals that elevated NLR values correlate with increased severity of poisoning and adverse clinical outcomes, including mortality and morbidity. NLR assessment offers valuable prognostic information beyond traditional markers, aiding risk stratification and guiding clinical decision-making. Integration of NLR into clinical practice holds promise for optimizing patient care through the early identification of high-risk individuals and tailored therapeutic interventions. Further research is needed to validate the utility of NLR in larger patient cohorts and standardize its incorporation into clinical guidelines. Leveraging NLR as a prognostic tool can enhance risk stratification, optimize treatment strategies, and ultimately improve outcomes in AOPP., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Pradeep et al.)