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Background The main objective of this study to evaluate the association between CPK-MB, CPK, LDH levels and ECG changes to find out the prognosis in patients of organophosphorous poisoning. Methods This was a prospective observational hospital-based study conducted among 94 adult patients who were admitted with history of organophosphorous compound poisoning to the Department of Toxicology in Rajiv Gandhi Government General Hospital, Chennai, after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results The comparison of initial ECG abnormalities and mean CPK, mean CK-MB, mean LDH values showed a positive correlation with statistical significance. The CPK values & CK-MB values at the time of initial evaluation were found to be significantly higher among the deceased patients in comparison to those discharged. Also, a study on the initial LDH value of deceased patients revealed significantly higher levels as compared to those that of the discharged patients. Conclusion Mortality was observed only in patients whose on admission ECG had QTc prolongation, conduction block, QRS changes, VT and VF. It was observed that the CPK, CK-MB, LDH levels recorded were frequently higher among the OPC poisoning patients. The CPK, CPKMB and LDH values recorded at the time of admission exhibited significantly higher values in the case of the deceased than that of the discharged. On admission, CPK, CK-MB, LDH levels were significantly higher in patients with abnormal ECG as compared to normal ECG. Within each ECG parameter, significant difference was observed in CPK, CK-MB, LDH levels among survived and expired patients. [ABSTRACT FROM AUTHOR]

Background: Poisoning with organophosphorous substances is the commonest cause of inpatient mortality among all poisonings in developing countries like India. This study is undertaken with an aim of assessing simple parameters like GCS and QTc (marker of ventricular arrythmias) in predicting the outcome and complications of organophosphate compound poisoning considering the mortality and sufferings of Organophosphorous poisoning patients. Aim: To assess the utility of GCS score and QTc interval in predicting prognosis in patients who had consumed organophosphate and carbamate poisoning and to assess whether the above parameters helps to identify the high risk groups requiring mechanical ventilation. Materials and methods: This study was conducted among 200 organophosphate and carbamate poisoning patients who were admitted at Government Rajaji Hospital, Madurai from February 2014 to September 2014. After taking detailed history and physical examination and investigations the Glasgow coma scale score and QTc interval at the time of admission was calculated. Patients with GCS score < 13 and QTc interval > 0.44s in males and 0.46s in females as poor outcome. Results: There was a linear relation with QTc interval and severity of Organophosphorous poisoning i.e. as the QTc interval increases the severity of poisoning increases. There was an inverse relationship between the GCS score and severity of Poisoning, .i.e. as the GCS decreases the severity of poisoning increases. Conclusion: Our study showed that respiratory failure in patients with OP compound poisoning can be predicted at admission by simple parameters like lower GCS and prolonged QTc interval in ECG. [ABSTRACT FROM AUTHOR]

Background: Organophosphorus poisoning (OPP) is a major global public health problem. Pralidoxime has been used in a complimentary role to atropine for the management of OPP. World Health Organization (WHO) recommends use of pralidoxime but studies regarding its role have been inconclusive, ranging from being ineffective to harmful or beneficial. Materials and Methods: The present study was undertaken to evaluate the effectiveness of pralidoxime. Eddleston’s study was the most compelling factor for our study, as he showed worst outcomes using pralidoxime. Our practice of continuous use of pralidoxime was based on the WHO guidelines and the study by Pawar (2006), which showed better outcome with higher doses of pralidoxime. These conflicting results suggested that a re-evaluation of its use in our clinical practice was indicated. Results: There was no difference in mortality rates, hemodynamic parameters and atropine requirements between the AP and A groups. Mean duration of ventilation (3.6 ± 4.6 in AP group vs. 3.6 ± 4.4 in A group) and Intensive Care Unit stay (7.1 ± 5.4 in AP group vs. 6.8 ± 4.7 in A group) was comparable. Serum sodium concentrations showed a correlation with mortality, with lower concentrations associated with better outcomes. Conclusion: The study suggests that add-on WHO-recommended pralidoxime therapy does not provide any benefit over atropine monotherapy. Adding pralidoxime does not seem to be beneficial and at the same time does not result in increased mortality rates. Our practice changed after completion of this study, and it has proven to be of significant benefit to patients who had to bear the expense of treatment. [ABSTRACT FROM AUTHOR]

Background: Organophosphate based pesticides are widely used and have emerged as the major contributor to ill health associated with pesticides & is a major global health problem. Despite improvements in intensive care and related disciplines& different modes of treatment, the mortality associated with Organo-Phosphorous insecticide poisoning has not decreased. Knowledge of the socio-demographic profile & the factors which led to poisoning as well as the clinical & biochemical profile, will help in the timely intervention for better prognosis & outcome as well as prevention of such hazards. Objectives: 1. To study the sociodemographic & clinical profile of the patients of organo-phosphorous poisoning, 2. To assess the clinical & biochemical parameters useful in the prognosis of these patients. Materials And Method: Around 240 patients of organophosphorus poisoning who were admitted in G.S.L Medical College & Hospital during January 2010 to January 2011 were examined, investigated & interviewed with the help of a semi structured proforma. Their socio- demographic, clinical & biochemical profiles were studied. Results: Most of the cases were in the young age group of less than 30 years group which is a sensitive age group. Most of them had history of suicide attempt. Majority of the cases were brought to the hospital with the history of consumption of an unknown pesticide. Most of the females presented with severe symptoms. Most of the patients recovered due to timely management. Though the mortality rate was less but the patients who left against medical advice were about 20% which is quite significant. Conclusions: It is suggested to create awareness & educate the people regarding organophosphorus poisoning as it is a public health problem, launch programs to change their attitude towards life, train them regarding the safety profiles of pesticide use and implementation of legislative measures in order to prevent such hazards in future. [ABSTRACT FROM AUTHOR]

We have described here a new variant of life-threatening organophosphate toxicity syndrome, which produces a brief vocal cord paralysis. A 18 years old male patient with recent ingestion of unknown quantity of Organophosphorous poison, presented to our hospital with acute symptoms of profuse sweating, increased salivation and lacrimation for the first 12 hours. Later on he developed quadriparesis-lower motor neuron (LMN) type - Acute polyneuropathy-myelinopathy. He developed hoarseness of voice and regurgitation of fluids with both 9 and 10 cranial nerve palsies. The patient had developed acute Organophosphorous poison toxicity initially, followed by Intermediate Syndrome after 24 hours of ingestion with vocal cord palsy. [ABSTRACT FROM AUTHOR]

A 32-year-old male presented with a history of consuming some organophosphorous com pound with suicidal intention. He was treated with atropine, pralidoxime, ventilator support. During stay patient had persistent irritability, tachycardiaand hypertension despite sedation and labetalol infusion. He developed headache, visual blurring hemiparesis and focal seizures. Magnetic resonance imaging of the brain revealed multifocal hyperintensities mainly in subcortical areas of parietal and occipital regions in T2-weighted images, with increased values of Apparent Diffusion Coefficient, suggesting posterior reversible encephalopathy syndrome (PRES). The possibilities of PRES caused by organophosphorous poisoning either due to hypertension caused by autonomic deregulation or direct neurological toxicity has been discussed. [ABSTRACT FROM AUTHOR]