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The incidence of carbamate insecticide poisoning has increased gradually in recent years, and anticholinergic drugs are the specific antidotes. In 2020, the Peking University Third Hospital admitted a patient with carbamate insecticide poisoning, whose main clinical manifestations were dizziness, vomiting and blurred vision. During the treatment with penehyclidine hydrochloride, the patient developed delirium. This paper retrospectively analyzed the clinical data and treatment process of the patient to improve people's understanding of the side effects of penhyclidine hydrochloride in the treatment of insecticide poisoning.氨基甲酸酯类杀虫剂中毒发生率近年来逐渐增高，抗胆碱能药物为其特效解毒药。2020年北京大学第三医院收治1例氨基甲酸酯类杀虫剂中毒患者，以头晕、呕吐、视物不清为主要临床表现，应用盐酸戊乙奎醚（长托宁）治疗过程中，患者出现谵妄。本文对该患者临床资料和治疗过程进行回顾性分析，以提高人们对长托宁治疗农药中毒的不良反应的认识。.

Organophosphates (OPs) are inhibitors of acetylcholinesterase and have deleterious effects on the central nervous system. Clinical manifestations of OP poisoning include convulsions, which represent an underlying toxic neuro-pathological process, leading to permanent neuronal damage. This neurotoxicity is mediated through the cholinergic, GABAergic and glutamatergic (NMDA) systems. Pharmacological interventions in OP poisoning are designed to mitigate these specific neuro-pathological pathways, using anticholinergic drugs and GABAergic agents. Benactyzine is a combined anticholinergic, anti-NMDA compound. Based on previous development of novel GABA derivatives (such as prodrugs based on perphenazine for the treatment of schizophrenia and nortriptyline against neuropathic pain), we describe the synthesis and preliminary testing of a mutual prodrug ester of benactyzine and GABA. It is assumed that once the ester crosses the blood–brain-barrier it will undergo hydrolysis, releasing benactyzine and GABA, which are expected to act synergistically. The combined release of both compounds in the brain offers several advantages over the current OP poisoning treatment protocol: improved efficacy and safety profile (where the inhibitory properties of GABA are expected to counteract the anticholinergic cognitive adverse effects of benactyzine) and enhanced chemical stability compared to benactyzine alone. We present here preliminary results of animal studies, showing promising results with early gabactyzine administration.

Organophosphorus (OP) cholinesterase inhibitors, which include insecticides and chemical warfare nerve agents, are very potent neurotoxicants. Given that the actual treatment has several limitations, the present study provides a general method, called the zebrafish-OP-antidote test (ZOAT), and basic scientific data, to identify new antidotes that are more effective than the reference pyridinium oximes after acute OP poisoning. The reactivation capacity of a chemical compound can be measured using in vivo and ex vivo acetylcholinesterase (AChE) assays. We demonstrated that it is possible to differentiate between chemical compound protective efficacies in the central and peripheral nervous system via the visual motor response and electric field pulse motor response tests, respectively. Moreover, the ability to cross the brain-blood barrier can be estimated in a physiological context by combining an AChE assay on the head and trunk-tail fractions and the cellular and tissue localization of AChE activity in the whole-mount animal. ZOAT is an innovative method suitable for the screening and rapid identification of chemicals and mixtures used as antidote for OP poisoning. The method will make it easier to identify more effective medical countermeasures for chemical threat agents, including combinatorial therapies.

Background: Organophosphates are highly toxic compounds for human beings. Organophosphate compounds (OPCs) poisoning by unintentional or suicidal ingestion is associated with high morbidity and mortality, particularly in developing countries. Aim of the study: Assessing the prognostic value of red cell distribution width (RDW) and white blood cells (WBCs), hemoglobin and platelet count on severity and outcome in patients with acute organophosphate poisoning in conjunction with clinical signs using the Peradeniya Organophosphorus Poisoning (POP) score. This is in addition to evaluation and comparison between RDW with pseudo choline esterase (PChE) level as early OPCs poisoning predictor. Methods: A prospective cross-sectional study was done on 100 acutely OPCs intoxicated patients admitted to Poison Control Center Ain Shams University Hospitals (PCC-ASUHs) from June 2019 till December 2019. All cases were clinically evaluated. RDW was done on admission and after 24 hours while WBCs, hemoglobin, platelets, PChE level and arterial blood gases (ABG) were estimated immediately after admission prior to treatment. Results: High RDW values indicated poor prognosis. There was a highly significant correlation between RDW values and the need for mechanical ventilation (MV). There was a significant correlation between high WBCs count, severity of OPCs poisoning and the need for MV. Lower mean pH, higher mean PCO2, lower mean HCO3, lower mean PChE levels, and higher mean WBCs count were noted in patients on MV compared to patients without MV. Conclusion: RDW values on admission can be a reliable predictor of severity and outcome in contrast to PChE levels which showed nonsignificant correlation with severity. Additionally, there was a significant correlation between WBCs with the need of MV. RDW on admission can predict the need for mechanical ventilation with sensitivity (58.97%), specificity (83.61%) at cutoff value more than 14.4. RDW on admission had a sensitivity of 75% and specificity of 73.75% with a cut-off value of 14.3 in predicting mortality in patients with OPCs poisoning. Recommendations: RDW is a simple parameter that could be used in assessing the prognosis of acute organophosphorus poisoning. WBCs count could also be used in those patients to predict the need of MV.

Introduction: Organophosphate Compounds (OP) are widely used pesticides in agriculture. It is easily available and OP poisoning is most common cause of poisoning and hospital admissions. Severe poisoning is associated with high mortality. Severity of poisoning can be assessed by Peradeniya Organophosphorus Poisoning (POP) scale, Acute Physiology and chronic Health Evaluation (APACHE) II, Glasgow Coma Scale (GCS) or serum Cholinesterase Level (ChE). Serum amylase, lipase, and creatine kinase are important biomarkers raised in OP poisoning. Aim: To correlate serum amylase, lipase, and creatine kinase with severity of OP poisoning. Materials and Methods: This was a hospital based observational cohort study conducted on 130 patients of organophosphate poisoning admitted in General Medicine wards of SCB Medical College, Cuttack, Odisha from June 2019 to December 2020. Serum Acetylcholine Esterase (AChE), amylase, lipase and creatinine kinase were estimated at admission, day 2, and at discharge. Other routine investigations were done. Acetylcholine Esterase (AChE) was used to confirm the diagnosis. The severity of poisoning was assessed using POP scale and graded as mild, moderate and severe. The severity of poisoning and the level of enzymes were correlated. The parameters were tabulated and mean values and Standard Deviation (SD) were analysed using Statistical Package For The Social Sciences (SPSS) software version 22.0. Results: Out of 130 patients 91 were males and 39 were females, mostly from rural areas, both farming and non-farming community. Age ranged from 14 years to 79 years, with majority in 19 to 39 years. AChE decreased in all cases depending on severity confirming OP poisoning. Severity as assessed by POP score were mild (52 patients), moderate (46 patients) and severe (32 patients). At admission, the Amylase (U/L), Lipase (U/L), and Creatine kinase (U/L) level (mean±SD) in mild poisoning were 83.7±41.9 U, 70.9±18.6, 72.5±34.9, in moderate poisoning 153.6±109.7, 91.9±47.4, 92.6±81.5, and in severe poisoning 243.9±113.8, 195.3±147.7, 298.8±207.4, respectively. Measurements on second day also remained elevated. Among the severe cases 24 patients developed Intermediate Syndrome (IMS), and 26 patients died. There was positive correlation between increase of enzyme levels and the severity of OP poisoning as per POP score. Conclusion: Serum amylase, lipase, and creatine kinase level correlated well with the severity of organophosphorus poisoning and scan be used additionally as an indicator to assess the severity. Serum amylase is a better indicator of severity than lipase and Creatine Kinase (CPK).

This study analysed the clinical patterns and outcomes of elderly patients with organophosphate intoxication. A total of 71 elderly patients with organophosphate poisoning were seen between 2008 and 2017. Patients were stratified into two subgroups: survivors (n = 57) or nonsurvivors (n = 14). Chlorpyrifos accounted for 33.8% of the cases, followed by methamidophos (12.7%) and mevinphos (11.3%). Mood, adjustment and psychotic disorder were noted in 39.4%, 33.8% and 2.8% of patients, respectively. All patients were treated with atropine and pralidoxime therapies. Acute cholinergic crisis developed in all cases (100.0%). The complications included respiratory failure (52.1%), aspiration pneumonia (50.7%), acute kidney injury (43.7%), severe consciousness disturbance (25.4%), shock (14.1%) and seizures (4.2%). Some patients also developed intermediate syndrome (15.5%) and delayed neuropathy (4.2%). The nonsurvivors suffered higher rates of hypotension (P P P = 0.001) than survivors did. Kaplan–Meier analysis indicated that patients with shock suffered lower cumulative survival than did patients without shock (log-rank test, P P = 0.009). The mortality rate was 19.7%. Acute cholinergic crisis, intermediate syndrome, and delayed neuropathy developed in 100.0%, 15.5%, and 4.2% of patients, respectively.

Acute poisoning is a global public health challenge. Several factors played role in high mortality among acute organophosphorus poisoning (OP) poisoning patients including clinical, vitals, and biochemical properties. The traditional analysis techniques use baseline measurements whereas latent profile analysis is a person-centered approach using repeated measurements. To determine varying biochemical parameters and their relationship with intensive care unit (ICU) mortality among acute organophosphorus poisoning patients through a latent class trajectory analysis. The study design was a retrospective cohort and we enrolled data of 299 patients admitted between Aug’10 to Sep’16 to ICU of Dr. Ruth K. M. Pfau, Civil Hospital, Karachi. The dependent variable was ICU-mortality among OP poisoning patients accounting for ICU stay, elapsed time since poison ingestion, age, gender, and biochemical parameters (including electrolytes (potassium, chloride, sodium), creatinine, urea, and random blood sugar). Longitudinal latent profile analysis is used to form the trajectories of parameters. In determining and comparing the risk of ICU-mortality we used Cox-Proportional-Hazards models, repeated measures and trajectories were used as independent variables. The patients’ mean age was 25.4 ± 9.7 years and ICU-mortality was (13.7%, n = 41). In trajectory analysis, patients with trajectories (normal-increasing and high-declining creatinine, high-remitting sodium, normal-increasing, and high-remitting urea) observed the highest ICU-mortality i.e. 75% (6/8), 67% (2/3), 80% (4/5), 75% (6/8), and 67% (2/3) respectively compared with other trajectories. On multivariable analysis, compared with patients who had normal consistent creatinine levels, patients in normal-increasing creatinine class were 15 times [HR:15.2, 95% CI 4.2–54.6], and the high-declining class was 16-times [HR 15.7, 95% CI 3.4–71.6], more likely to die. Patients in with high-remitting sodium, the trajectory was six-times [HR 5.6, 95% CI 2.0–15.8], normal-increasing urea trajectory was four times [HR 3.9, 95% CI 1.4–11.5], and in extremely high-remitting urea trajectory was 15-times [HR 15.4, 95% CI 3.4–69.7], more likely to die compared with those who were in normal-consistent trajectories of sodium and urea respectively. Among OP poisoning patients an increased risk of ICU-mortality were significantly associated with biochemical parameters (sodium, urea, creatinine levels) using latent profile technique.

The aim of this study was to investigate the sociodemographic characteristics of patients based on the poison chosen and different types of organophosphorus compounds. The data were collected to explore the sociodemographic characteristics of organophosphate (OP)-poisoned patients based on the source, site, and route of poisoning, education level, occupational status, and the purpose of poisoning. Furthermore, we estimated the serotonin and dopamine levels in the plasma samples of patients, and survival plots were also described. During the study of OP pesticide poisoning in 116 human subjects and 5 healthy volunteers, we observed, based on the survival plot, that75.9% of the patients were discharged, and the remaining patients died (24.1% of the patients) due to respiratory failure followed by cardiac arrest. Our findings suggest that the serotonin levels significantly (p p

Organophosphates (OPs) inactivate the acetylcholinesterase enzyme, thus increasing the cholinergic effect. In a clinical setting, patients with OP poisoning may experience nausea and vomiting, diarrhea, and abdominal pain, or in severe cases respiratory failure, seizures, and death. Rarely, acute hemolysis has also been observed. The existing literature contains few descriptions of several delayed diseases associated with OP poisoning. This article presents the case of a patient who experienced severe hemolysis approximately one week after OP exposure. Only a small number of similar cases have been previously examined.

The current reference interval (RI) FOR red blood cell acetylcholinesterase (RBC AChE) activity in South Korea was established with data obtained from populations outside the country. The aim of this study was to assess the transferability of current RI of RBC AChE activity for organophosphate (OP) poisoning and determine the biological characteristics, real RI, and interindividual variation in RBC AChE activity in South Korea. Data were retrospectively collected for RBC AChE activity as measured by the modified Ellman's method for 782 patients who presented to our hospital. The clinical course did not differ significantly with the degree of deviation of RBC AChE activity from the currently used RI in 195 patients exposed to OP. RBC AChE activity was associated with gender and smoking status but not age or body mass index (BMI); however, a regression model incorporating age, gender, smoking status and BMI explained only a small portion of the variance in RBC AChE activity in South Korea. The RI of RBC AChE activity was 9,403-16,825 U/L, with 13.9% interindividual variation. The range of RBC AChE activity in South Korea is wider than RI currently used in clinical practice and exhibited a high degree of interindividual variation. In the absence of collecting pre-exposure values, it is recommended to conduct serial measurements, rather than one-point measurements, of RBC AChE activity as evidenced by the RI in OP poisoning.

BACKGROUND Due to the widespread use and availability of agricultural insecticides, acute organophosphate poisoning is becoming the most common type of poisoning in Kerala. The cause of death is thought to be a confluence of increased bronchial secretion, bronchospasm, respiratory muscle dysfunction, respiratory center depression and respiratory failure. The purpose of the study is to find the proportion of respiratory failure in patients with organophosphate poisoning. METHODS It is a cross sectional study done in 119 consenting patients who are known cases of organophosphorous (OP) poisoning satisfying the inclusion criteria. They underwent clinical assessment and laboratory investigations to assess complications of organophosphorous poisoning. Clinical features and lab findings were recorded as per protocol. RESULTS 65 out of 119 (54.6 %) had evidence of respiratory failure. Among these 65, 20 % succumbed to death (13). 56.5 % of males (48) and 50 % of females (17) developed respiratory failure. 72.2 % of patients more than 60 years (13) had respiratory failure. Majority of the cases were of chlorpyriphos poisoning 42 (35.3 %). 76.5 % (13) of dimethoate poisoning developed respiratory failure. 93.4 % (57) of patients with respiratory failure had elevated serum amylase levels. CONCLUSIONS Respiratory failure is a very common complication found in organophosphate poisoning. It is more common in males than females and its proportion increases with age. The incidence of respiratory failure is more with dimethoate. Serum amylase levels can be used as a marker for development of respiratory failure in organophosphate poisoning. KEYWORDS Organophosphate Poisoning, Respiratory Failure, Serum Amylase Levels

IntroductionSparse data and conflicting evidence exist on the prevalence and prognosis of organophosphate (OP)-related cardiac toxicity. We aimed to characterize the cardiac abnormalities of OP after an acute cholinergic crisis in adults without previous cardiovascular conditions.Patients and MethodsWe did a prospective observational study in a tertiary-care hospital of north India (Postgraduate Institute of Medical Education and Research, Chandigarh) in 74 patients aged ≥ 13 years admitted with acute OP poisoning after self-ingestion. A systemic evaluation, including clinical characteristics, electrocardiography, and echocardiography, was performed to estimate the prevalence and prognosis of cardiac injury. A rate-corrected QT interval was calculated using Bazett’s method, and >440 milliseconds was used to define prolongation.ResultsChlorpyrifos was the most commonly ingested OP (n = 29). The patients had a similar occurrence of hypotension (n = 10) and hypertension (n = 9) at admission, and electrocardiography demonstrated sinus tachycardia in 38 (51.3%) and sinus bradycardia in one case. During the hospital stay, 3 out of 74 patients had a prolonged rate-corrected QT interval (457, 468, and 461 milliseconds), and one patient developed supraventricular tachycardia. Eight (10.8%) patients developed the intermediate syndrome, and six (8.1%) died. None of the hemodynamic or electrocardiographic abnormalities was associated with in-hospital mortality or intermediate syndrome development on univariant analysis. Baseline echocardiography at hospital discharge was performed in 27 patients (admitted during 2018) and normal in all except mild tricuspid regurgitation in one. At a 6-month follow-up, 23 cases were available for cardiovascular screening (including echocardiography) and had a normal evaluation.ConclusionCardiac toxicity is uncommon after acute OP self-ingestion and lacks prognostic significance.

Background The long QT syndrome (LQTS) is a disorder of myocardial repolarization characterized by a prolonged QT interval on the electrocardiogram (ECG). This syndrome is associated with an increased risk of polymorphic ventricular tachycardia, a characteristic life-threatening cardiac arrhythmia also known as torsades de pointes. A rate related corrected QT interval (QTc) can be calculated as QT/√RR and normally is ≤0.44s. Some references given QTc upper normal limits as 0.43s in men and 0.45s in female. OP compound supposed to block K+ channel and Na+/Ca++ channel and hence causing prolongation of QT interval. As we know that prolongation of QT interval may precipitate polymorphic ventricular tachycardia and sudden cardiac death, so it become important in case of OP poisoning and related mortality. In this study, I calculated corrected QT interval in diagnosed cases of OP poisoning admitted at Bir Hospital and compared QTc among those with complications and without complication. I also tried to evaluate QTc as a predictor for duration of hospital stays, ICU admission, vasopressor and mechanical ventilation requirement, higher POP score and low GCS.

Oxime reactivators of acetylcholinesterase (AChE) represent an integral part of standard antidote treatment of organophosphate poisoning. Oxime K869 is a novel bisquaternary non-symmetric pyridinium aldoxime with two pyridinium rings connected by a tetramethylene bridge where two chlorines modify the pyridinium ring bearing the oxime moiety. Based on in vitro assays, K869 is a potent AChE and butyrylcholinesterase (BChE) reactivator. For the investigation of the basic pharmacokinetic properties of K869 after its intramuscular application, new HPLC-UV and LC-MS/MS methods were developed and validated for its determination in rat body fluids and tissues. In this study, the SPE procedure for sample pretreatment was optimized as an alternative to routine protein precipitation widely used in oxime pharmacokinetics studies. K869 oxime is quickly absorbed into the central compartment reaching its maximum in plasma (39 ± 4 μg/mL) between 15 and 20 min. The majority of K869 was eliminated by kidneys via urine when compared with biliary excretion. However, only a limited amount of K869 (65 ± 4 ng/g of brain tissue) was found in the brain 30 min after oxime administration. Regarding the brain/plasma ratio calculated (less than 1%), the penetration of K869 into the brain did not exceed conventionally used oximes.

Organophosphate pesticides are one of the causes of contamination in animal feed. The cholinesterase enzyme test is used to diagnose toxic exposure due to organophosphate pesticides. Quantitative research with survey design using cross sectional design using 35 samples of cows. The study was conducted in March - September 2020. Concentration measurement on cholinesterase enzyme concentrations of blood plasma used the biosystem A15 DGKC-Colorimetric Kinetic method. This study aims to evaluate the concentration of the enzyme cholinesterase as a marker of organophosphate poisoning in cattle. Blood samples were collected from the ventrolateral neck veins of male and female cattle aged 1-7 years and collected from local cattle in the Ogan Ilir area. The results showed that the cows raised in breeders were exposed to organophosphate pesticides as indicated by a decrease in the concentration and levels of the cholinesterase enzyme in the plasma of female cows. Cholinestrase enzyme levels in female cows were 0.20 ± 0.067 U / ml and bulls were 0.27 ± 0.183 U / ml. The highest concentration of cholinesterase enzyme levels occurred in cows aged 2 years, namely 0.25 ± 0.34 U / ml and the lowest was in cows aged 7 years, namely 0.12 ± 0.04 U / ml.

Acute organophosphate (OP) toxicity is a major health problem in different populations. Nearly three million cases are affected annually all over the world. The most common clinical presentations include muscarinic, nicotinic and central nervous system manifestations resulting from cholinergic overload. Nevertheless, endocrine toxicity and affection of glucose homeostasis are reported. The current study aimed to study random blood sugar (RBS) as a simple, inexpensive tool to predict mortality and major outcome events in acute organophosphate poisonings. Ninety adult patients with acute organophosphate poisoning were included in the study. Patients already known to be diabetic before exposure and those with mixed intoxication were excluded. RBS was done to all included patients on admission before receiving any medications. Patients were categorized into euglycemics (62.2%), hyperglycemic (28.9%) and hypoglycemics (8.9%). The severity of organophosphorus poisoning symptoms and signs was graded into; Mild (32.2%), Moderate (38.9%) and Severe (28.9%) grades with a statistically significant association between RBS and poisoning severity at the time of admission. In addition, RBS showed a statistically significant association with each of serum cholinesterase levels, the delay time before hospital admission, the need for intubation, mechanical ventilation and death. Meanwhile, RBS had no statistically significant association with either doses of atropine & toxogonine nor the duration of hospital stay.

Background: Organophosphate (OP) poisoning leads to atrioventricular node blockade, alterations in ST segment, prolongation of QT interval, alterations in P wave, lethal arrhythmias, and cardiac arrest through the inhibition of acetylcholinesterase and consequent accumulation of free synaptic acetylcholine level. So the present study was aimed to investigate the role of electrocardiographic (ECG) monitoring combined with the introduction of anti-arrhythmic interventions on OPs poisoning outcomes. Methods: 41 patients with OPs poisoning were included. Patients with history of heart or liver diseases, cholinesterase deficiency, anemia, and poisoning with other toxins were excluded. Demographic characteristics, the time elapsed between OP ingestion and hospital admission, need for mechanical ventilation, and serum cholinesterase level were recorded. ECG of patients was analyzed for rate, rhythm, ST-T abnormalities, conduction defects, and measurement of PR and QT intervals. Study outcomes were measures of morbidity and mortality. Results: Of 41 patients, with mean age of 34.76±13 years, 19 were male. For 68.3% of the patients, the time elapsed between ingestion and hospital admission was 3-6 hours. Eight patients were treated with mechanical ventilation. There was a significant correlation between ST segment alterations and poisoning outcomes including uncomplicated discharge, complicated discharge, and death (P=0.02). Thirty one patients were discharged without any complication, 8 with morbidity and 2 expired. ST segment changes were seen in 4 patients. Two percent had PR interval greater than 0.21s and 3% had QT interval longer than 0.45s. The mean serum cholinesterase concentration was 3011.56 U/L. Conclusion: Due to lethal cardiac arrhythmia caused by OP poisoning, continuous monitoring, managing, and preventing irreparable effects of OP poisoning is highly emphasized.

Background: Organophosphate toxicity is a worldwide problem as this is equally easily available in rural and urban areas. Furthermore, the complications and outcome of the organophosphate poisoning was also examined. Aim: to determine the frequency of organophosphate poisoning and its outcomes in this region with limited laboratory and ICU facilities. Place and duration of study: SKBZ/AK CMH Muzaffarabad from January 2019 to December 2019. Methodology: This observational, prospective analytical study was planned in Department of Medicine, SKBZ/AK CMH Muzaffarabad. A total of 110 suspected poisoned patients were included having age between 12-60 years. Patients who had taken more than one poison were excluded from the study. The organophosphate poisoning was identified through pupil size, increased secretion and Glasgow Coma Scale. Results: The average age of the patients was 24.38±6.35 years. The male to female ratio was 1:1.69. Majority 77 (70%) of the patients were single and resident in rural areas 59 (53.6%). The incidence rate of organophosphate poisoning was 90 out of 110 (81.81%). There were at least 75% cases of organophosphate poisoning among all poisoned cases with p value 0.03. The survival rate was 93.3% (84 out of 90). The most important factor affecting survival rate was the time lag between ingestion of the poison and initiation of specific therapy with p value 0.022. Conclusion: Organophosphate poisoning has high incidence although has good prognosis and not a very problematic death rate. We also concluded that the survival rate can be improved through reduction in time lag before start the treatment. Keywords: Cause of poisoning, Organophosphate poisoning, Complication of Organophosphate poisoning

Введение. Участившиеся в последние годы случаи криминальных отравлений нейротоксическими веществами антихолинэстеразного действия (органофосфатами) вновь привлекли внимание специалистов и широкой общественности к этой группе ксенобиотиков [1]. В тоже время, антихолинэстеразные пестициды, такие как органофосфаты и карбаматы широко применяются в сельскохозяйственных целях, а некоторые из них используются также в медицине, ветеринарии и быту для борьбы с насекомыми [2].В отдельных регионах соседнего с Азербайджаном Ирана органофосфатные пестициды были наиболее частой причиной острых химических отравлений и характеризовались самым высоким процентом осложнений и смертности [3].Исследование, проведенное в Турции, показало, что каждый десятый сельскохозяйственный рабочий, занятый в выращивании овощей и фруктов, испытывал симптомы отравления, обусловленные профессиональным воздействием пестицидов [4]. Отравления пестицидами являлось также основной причиной отравлений и в регионе Восточной Африки [5]. В Индии 67,8% всех смертельных отравлений обусловлены интоксикацией пестицидами [6]. Преднамеренные отравления с использованием органофосфатов составляют около трети всех случаев суицидов в мире [7].Вместе с тем, токсико-эпидемиологические данные по отравлениям веществами антихолинэстеразного действия фосфорорганического ряда в Азербайджане крайне скудны и отрывочны, и ограничены только двумя нашими ранними публикациями [8;9]. Данной работой мы поставили перед собой цель восполнить этот пробел.Материалы и методы исследования. Для достижения поставленной цели нами был проведен подробный токсико-эпидемиологический анализ базы данных Центра клинической токсикологии – единственного в Азербайджане специализированного медицинского учреждения, ответственного за лечение и профилактику всех видов химических отравлений, как у взрослых, так и у детей.Глубина сплошного исследования составила 12 лет (2009-2020 гг) и включала все случаи госпитализаций больных с кодом диагноза Т60.0 МКБ-10, что позволяет аргументированно считать собранную базу данных полной, объективной, репрезентационной и релевантной общей токсико-эпидемиологической картине отравлений органофосфатами в Азербайджане.Согласно отобранным критериям, были изучены и проанализированы данные 562 больных с острыми отравлениями веществами антихолинэстеразного действия фосфорорганического ряда, результаты которых мы представляем ниже.

Organophosphates are highly toxic compounds as they are involved in irreversible inhibition of acetylcholinesterase, causing various neurotoxic effects via acetylcholine accumulation throughout the nervous system. Traditional treatments for organophosphate poisoning are not effective enough to overcome all the toxic effects. There is a need for alternate treatment of life threatening poisoning of organophosphates. For this purpose a biomimetic nanosponge of poly (lactic- co-glycolic acid) is prepared, characterized and analysed as an antidote for organophosphate poisoning. In this nanosponge red blood cell membranes are used for coating poly lactic co-glycolic acid nanoparticles. In vitro studies are conducted to investigate the retention of acetylcholinesterase activity on the prepared nanosponge as well as to assess the scavenging ability of prepared nanosponge for model organophosphate, chlorpyrifos. In vivo studies are conducted to evaluate the detoxification potential of nanosponge in rabbit model, poisoned with chlorpyrifos. Hepatotoxicity and renal toxicity of nanosponge/chlorpyrifos complex is also studied in survived rabbits and the data is analysed statistically.

This study evaluated the most common toxic agents affecting domestic cats, the clinical signs of toxicity, and the therapeutic approaches for recovery. A survey on poisoning in cats was conducted among small animal veterinary practitioners from 2017 to 2018. Of the 748 completed questionnaires, 543 (72.6%) were evaluated. Pesticides and household cleaning supplies were the most common causes of poisoning in cats. The toxicant groups included pesticides and household cleaning supplies (organophosphates), human drugs (acetaminophen), plants/plant derivatives (lily), and veterinary drugs (tramadol). The major clinical signs for these four groups of toxicants were (1) acetaminophen poisoning, which caused oxidative erythrocyte damage; (2) muscarinic and nicotinic cholinergic syndrome, which resulted from organophosphate poisoning; (3) acute kidney injury, which resulted from intoxication of lily; and (4) serotonin syndrome, which resulted from tramadol toxicosis. Interventions for treating poisoning in cats were based on the clinical presentation of animals. In the present study, the significant toxins identified to be dangerous for cats were characterized using the obtained data in Brazil as well as the main associated clinical signs and therapy recommended by veterinarians.

Background Organophosphates are one of the most common agents of poisoning in developing countries including Egypt. Due to lack of data about characteristics of organophosphates poisoning in our localities, we aimed to evaluate its clinical pattern and factors affecting outcome. Methods It was a cross-sectional study conducted in South valley University hospital between January 2019 and December 2019. It included all children ≤16 years of age presented with organophosphates poisoning. Diagnosis was performed from the history taken from the patient’s relatives and presenting symptoms. Demographic data, mode and route of poisoning, time from exposure to presentation, clinical symptomatology, grading and routine investigations were evaluated in addition to treatment taken and outcome. Results During the study period, 108 children; mean age was 7.95 ± 4.11 years (range 1. 5-16 years) presented with organophosphorous poisoning. Sixty five (60%) cases were females and 43 (40%) were males. Unintentional acts (87%) were detected more than suicidal (13%) and inhalation route (63.8%) more than ingestion (36. 2%). Miosis was the most frequent clinical sign (100%) followed by respiratory distress (77.7%). Regarding time of presentation to emergency department, 43 (40%) cases were presented within 6 h while others presented more than 6 h post-exposure. Mechanical ventilation (MV) was needed for 14 (13%) cases and 6 (5.5%) cases died due to respiratory failure. Duration of hospital stay, mean time interval from toxic exposure to hospital presentation, leucocytosis, need for MV and cumulative dose of pralidoxime were significantly higher in non survivors than survivors while Pao2 (partial arterial oxygen) and GCS (Glasgow coma scale) were significantly lower. Conclusion This study concluded that time consumed till presentation to hospital, low GCS, need for MV, leucocytosis, decreased PaO2 and increased cumulative dose of pralidoxime were independent risk factors of mortality.

We designed this study to identify the factors associated with time to successful weaning in mechanically ventilated organophosphate (OP)-poisoned patients as the primary outcomes while duration of mechanical ventilation (MV) support, intensive care unit (ICU), and hospital length of stay (LOS) and in-hospital mortality as the secondary outcomes. We conducted a retrospective study of mechanically ventilated OP-poisoned patients admitted to the ICU of Poison Control Center of Ain Shams, Cairo, Egypt, starting from January 2019 to December 2019. Weaning was considered successful if the patient succeeded in the first spontaneous breathing trial of weaning and did not need reinstitution of MV. We used Cox proportional hazards regression models to identify factors associated with time to successful weaning in the studied patients. A total of 55 patients were enrolled in the study. Thirty-eight patients were weaned successfully. Lower initial red cell distribution width (RDW) levels [adjusted hazard ratio (HR), 0.299, 95% confidence interval (CI) (0.184-0.486)] and lower initial doses of atropine [adjusted HR, 0.97, 95% CI (0.935-0.999)] were independently associated with shorter time to achieve successful weaning. Successfully weaned patients had significantly longer hospital LOS (

Accidental poisoning in children, though underreported in our environment, is common and could prove fatal. It is important to identify the primary chemical agent that is responsible for the poisoning. We present a case of accidental ingestion of fish poisoned with aluminum phosphide (AlP) used as rat poisoning by a 14-month-old girl. At presentation, the actual chemical content of the poison was not available and clinical features were suggestive of organophosphate poisoning. She was commenced on atropine together with other treatment, on which she made remarkable improvement. The atropine was continued with complete resolution of symptoms on the third day of admission. We, therefore, report a serendipitous use of atropine in the management of AlP poisoning with successful outcome.

Introduction: Oganophosphorus compounds (OP) bind to acetylcholinesterase (AChE) and inactivate it. In the synaptic cleft, undestroyed and accumulated acetylcholine produce the acute cholinergic effects. The aim of this study was to determine the frequency, speed of onset and intensity of certain signs of paraoxon poisoning depending on dose and outcome of poisoning. Methods: The study was conducted in adult Wistar rats. The median lethal dose (LD50) of paraoxon as well as protective ratio (PR) of atropine (10 mg/kg intramuscularly) was determined. Clinical signs of poisoning were observed: fasciculations, tremor, seizures, ataxia, piloerection, lacrimation, exophthalmos, bizzare/stereotypic behaviour and dyspnoea. The time from paraoxon injection to the first appearance of the sign of poisoning was recorded as well as the intensity of poisoning with evaluation at 10 time intervals throughout the 4 h observational period. Results: The LD50 of paraoxon was 0.33 mg/kg (subcutaneously) and PR of atropine was 2.73. Dose-dependent, piloerection occurred more often (p = 0.009) and at higher intensity (p = 0.016) at higher doses. Fasciculations, tremor, seizures and ataxia occurred significantly earlier at higher doses of paraoxon (p = 0.015, 0.002, 0.021 and 0.016, respectively), as well as the intensity of seizure, tremor and fasciculation. Piloerection (p = 0.002) and seizures occurred more frequently (p = 0.009) in non-survivors. Fasciculations, tremor, seizures and ataxia occurred significantly earlier and at higher intensity in non-survivors (p < 0.001, for all parameters), as well as dyspnoea (p = 0.009 and p = 0.048). In atropine-protected rats, nicotinic effects persevered, so they were the prognostic parameter of the severity of the poisoning. Conclusion: Seizures and fasciculations followed by tremor were strong prognostic parameters of the probability of lethal outcome of paraoxon poisoning. Also, the mentioned poisoning signs were with their intensity and speed of occurrence in a clear positive correlation with the administered dose of paraoxon. Even at high doses of paraoxon, atropine blocked the muscarinic (but not nicotinic) effects and somewhat mitigated the CNS toxic effects.

Inhibition of acetylcholinesterase by either organophosphates or carbamates causes anti-cholinesterase poisoning. This arises through a wide range of neurotoxic effects triggered by the overstimulation of the cholinergic receptors at synapses and neuromuscular junctions. Without intervention, this poisoning can lead to profound toxic effects, including death, and the incomplete efficacy of the current treatments, particularly for oxime-insensitive agents, provokes the need to find better antidotes. Here we show how the non-parasitic nematode Caenorhabditis elegans offers an excellent tool for investigating the acetylcholinesterase intoxication. The C. elegans neuromuscular junctions show a high degree of molecular and functional conservation with the cholinergic transmission that operates in the autonomic, central and neuromuscular synapses in mammals. In fact, the anti-cholinesterase intoxication of the worm’s body wall neuromuscular junction has been unprecedented in understanding molecular determinants of cholinergic function in nematodes and other organisms. We extend the use of the model organism’s feeding behaviour as a tool to investigate carbamate and organophosphate mode of action. We show that inhibition of the cholinergic-dependent rhythmic pumping of the pharyngeal muscle correlates with the inhibition of the acetylcholinesterase activity caused by aldicarb, paraoxons and DFP exposure. Further, this bio-assay allows one to address oxime dependent reversal of cholinesterase inhibition in the context of whole organism recovery. Interestingly, the recovery of the pharyngeal function after such anti-cholinesterase poisoning represents a sensitive and easily quantifiable phenotype that is indicative of the spontaneous recovery or irreversible modification of the worm acetylcholinesterase after inhibition. These observations highlight the pharynx of C. elegans as a new tractable approach to explore anti-cholinesterase intoxication and recovery with the potential to resolve critical genetic determinants of these neurotoxins’ mode of action.

Poisoning by organophosphorus agents (OPs) is a serious public health issue across the world. These compounds irreversibly inhibit acetylcholinesterase (AChE), resulting in the accumulation of acetylcholine (ACh) and overstimulation of ACh receptors. A supramolecular detoxification system (SDS) has been designed with a view to deliver pyridine-2-aldoxime methochloride (PAM) with a synergistic inhibition effect on the ACh-induced hyperstimulation through host–guest encapsulation. NMR and fluorescence titration served to confirm the complexation between carboxylatopillar[6]arene (CP6A) and PAM as well as ACh with robust affinities. Patch-clamp studies proved that CP6A could exert an inhibition effect on the ACh-induced hyperstimulation of ACh receptors. Support for the feasibility of this strategy came from fluorescence imaging results. In vivo studies revealed that complexation by CP6A serves to increase the AChE reactivation efficiency of PAM. The formation of the PAM/CP6A complex contributed to enhance in a statistically significant way the ability of PAM not only to relieve symptoms of seizures but also to improve the survival ratio in paraoxon-poisoned model rats. These favorable findings are attributed to synergistic effects that PAM reactivates AChE to hydrolyze ACh and excess ACh is encapsulated in the cavity of CP6A to relieve cholinergic crisis symptoms., This work provides a feasible supramolecular strategy for improving the emergency treatment effect of OPs poisoning through synergistic effect.

Introduction: Organophosphate compounds (OPC) cause most self-poisoning deaths in India due to their easy availability and lack of stringent laws. Aim: To evaluate the clinical profile and outcome of the patients presenting with OPC poisoning and to study the prognostic value of Peradeniya Organophosphorus Poisoning Scale (POPS) in predicting the clinical outcomes. Methods and Materials: This was a prospective study involving 100 patients of OPC poisoning admitted to Tata Main Hospital from June 2018 to May 2020 based on the inclusion criteria. Demographic profile, clinical features, treatment details, and need for ventilatory support were noted. POPS was applied on admission, and the patients were followed up for the outcome in terms of morbidity and mortality. Observations: Of the 100 patients, most patients were between 20 and 29 years with male to female ratio being 1.2:1. Vomiting (94%), followed by excessive secretions (84%) were the most common symptoms. Overall mortality was 22%. On grading of severity as per the POP scale, 27% of the patients had mild poisoning, 37% patients had moderate, whereas 36% had severe poisoning. Only 11.11% of the patients with POPS 0–3 required ventilator support, whereas 16.2% of the patients with POPS 4–7, and 100% of patients with POPS 8–11 required ventilator assistance (P < 0.0001). Similarly, the total dose of atropine required (P < 0.0001), length of intensive care unit (ICU) stay, complications, and mortality (P < 0.0001) were significantly associated with higher POPS. Conclusion: POPS at admission, correlated well with the need for ventilator support, the total dose of atropine required, length of stay in the ICU, complications, and mortality. It can thus be used for prognostication and risk stratification of patients with OPC poisoning.

Acute organophosphorus pesticide poisoning (AOPP) is a worldwide health concern that has threatened human lives for decades, which attacks acetylcholinesterase (AChE) and causes nervous system disorders. Classical treatment options are associated with short in vivo half-life and side effects. As a potential alternative, delivery of mammalian-derived butyrylcholinesterase (BChE) offers a cost-effective way to block organophosphorus attack on acetylcholinesterase, a key enzyme in the neurotransmitter cycle. Yet the use of exotic BChE as a prophylactic or therapeutic agent is compromised by short plasma residence, immune response and unfavorable biodistribution. To overcome these obstacles, BChE nanodepots (nBChE) composed of a BChE core/polymorpholine shell structure were prepared via in situ polymerization, which showed enhanced stability, prolonged plasma circulation, attenuated antigenicity and reduced accumulation in non-targeted tissues. In vivo administration of nBChE pre- or post-organophosphorus exposure in a BALB/C mouse model resulted in potent prophylactic and therapeutic efficiency. To our knowledge, this is the first systematic delivery of non-human BChE to tackle AOPP. In addition, this work also opens up a new avenue for real applications in both research and clinical settings to cope with acute intoxication-related diseases.

Introduction: Organophosphorus poisoning (OPP) is one of the common medical emergencies among rural population in India due to suicide attempts. The purpose of this study was to investigate the relationship between the initial emergency laboratory parameters (electrolytes, liver function test, random blood glucose (RBS), renal function test, Hb, RBC and WBC) and severity of organophosphate poisoning based on Bardin’s Classification and type of OP compound consumed in patients admitted to emergency department with OPP. Materials and Methods: A retrospective observational study was done in OPP patients admitted to emergency medicine department. Based on Bardin’s classification all OPP cases were classified into 3 Grades of severity of poisoning.1-3 Hematological and biochemical parameters were compared based on this severity of poisoning. Results: With random sampling of 45 patients, 19 male and 26 female patients aged between 25-35 years, admitted with OPP were included in the study. The severity of poisoning was worst in females. The pseudocholinesterase, potassium and creatinine levels were significantly low in patients of grade 3 than grade 1 and grade 2 (p Conclusion: Emergency laboratory parameters in acute oraganophosphorus poisoning reflect the need for basic diagnostic facility in rural area. Laboratory parameters can also serve as possible predictive markers for severe outcomes and prognosis in OP poisoning. The knowledge of type of OP compound consumed can predict the severity of OP intoxication and need for emergency intervention. Keywords: Oragano phosphorous poisoning, Biochemical parameters.

Organophosphorus compound poisoning is a widely common problem in a developing country like Indian and it is a major clinical and public health concern. There have been efforts to find novel tools / markers to assess the prognosis and the use of RDW has been proposed in the OPCs poisoning, where in RDW can be used as a predictor of outcomes in OPCs poisoning. There have been several attempts to find out whether RDW can infact be used as a predictor of outcomes, but almost all of these studies so far have been done on a retrospective study. Hence our objective was to evaluate the association of RDW with the outcome of Organophosphate poisoning Material: The study consisted of 115 patients who were admitted to JSS hospital critical care due to consumption of Organophosphorus compounds. Patients were assessed and Blood investigations like Complete hemogram and Serum Cholinesterase levels collected after Informed consent was taken from the kin of the patients. Detailed History about the circumstances of consumption and the type of poison was collected and on arrival vitals were recorded. Observation: The mean age of the patient's in our study was 36.73 years. Out of the total patients 80% were males and 20% were females. The patients were divided into 3 groups; 1)Discharged without acute complications; 2) Discharged but had complications 3) Death; with 52% patients in group 1 and 27% patients in group 2 and 20.9% were in group 3. The most common complication in the group 2 was respiratory failure. RDW as a predictor for outcomes in Organophosphate compounds has a Sensitivity of 87.5% and specificity of 51.65% with a diagnostic accuracy of 59.13%. But as an independent predictor of mortality it was not significant. Conclusion: RDW can be used as a predictor of outcomes in Organophosphate compound poisoning cases with as RDW was elevated in cases with complications and death and was found to be significant. But as an independent predictor for mortality, it was not significant.

Sick euthyroid syndrome is abnormal findings of thyroid function tests that occur among patients with non thyroid illness with reduced level of hormones like T3 (Triiodothyronine) among acute illness of poisoning and can be detected in blood within 2 hours after acute illness. As the disease progress there is severe manifestation of syndrome associated with hypothyroidism specially with T3 and T4 while, the level of TSH are slightly elevated or are not influenced. The Present study was carried out to assess the incidence of sick euthyroid syndrome in organophosphate poisoning as well to assess the socio demographic and clinical profile of patients with organophosphate poisoning.This study was carried out at a tertiary care center for period of one year from January to December 2020 in a sample size of 74 patients(gt;18 years) admitted in ICU with the history of Organophosphate poisoning. Hemogram and thyroid profile and liver and kidney function of the patients were studied including assessment of gastric aspirates.Out of 74 patients, majority of them were males (62%) in the age group of 21 to 30 years (42%), with organophosphate (64%) followed by carbamates (15%). The incidence of sick euthyroid syndrome with organophosphate poisoning was 53%. The mean serum cholinesterase in poisoning was 913±15.3. The factors which are statistically associated with sick euthyroidism were Male (20 to 40 years), low serum cholinesterase, no prior treatment, ECG changes and miosis.Organophosphate poisoning is more common among young males with incidence of sick euthyroid being quite high among these patients. Pesticide poisoning is more common among young adult males in the age group of 20 to 40 years with the motive of suicidal tendency. The incidence of euthyroidism among organophosphate poisoning is quite high. The biochemical investigations in our study shows an elevation in organophosphate poisoning. This can be used as an indicator to assess the severity of poisoning. The serum cholinesterase and thyroid investigation can also be used as prognostic markers in assessment of severity of organophosphate poisoning. Hence, we conclude that biochemical markers and thyroid investigations helps in assessing mortality and prompt treatment of organophosphate poisoning.

A nanoreactor containing an evolved mutant of

Pesticides account for hundreds of millions of cases of acute poisoning worldwide each year, with organophosphates (OPs) being responsible for the majority of all pesticide-related deaths. OPs inhibit the enzyme acetylcholinesterase (AChE), which leads to impairment of the central- and peripheral nervous system. Current standard of care (SOC) alleviates acute neurologic-, cardiovascular- and respiratory symptoms and reduces short term mortality. However, survivors often demonstrate significant neurologic sequelae. This highlights the critical need for further development of adjunctive therapies with novel targets. While the inhibition of AChE is thought to be the main mechanism of injury, mitochondrial dysfunction and resulting metabolic crisis may contribute to the overall toxicity of these agents. We hypothesized that the mitochondrially targeted succinate prodrug NV354 would support mitochondrial function and reduce brain injury during acute intoxication with the OP diisopropylfluorophosphate (DFP). To this end, we developed a rat model of acute DFP intoxication and evaluated the efficacy of NV354 as adjunctive therapy to SOC treatment with atropine and pralidoxime. We demonstrate that NV354, in combination with atropine and pralidoxime therapy, significantly improved cerebral mitochondrial complex IV-linked respiration and reduced signs of brain injury in a rodent model of acute DFP exposure.

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.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.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%).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.acetaminophen; emergency departments; organophosphorus poisoning; prevalence.