Abstract
Acute poisoning by cholinesterase enzyme inhibitors insecticide continues to be a detrimental problem and a potential cause of mortality especially in developing countries. Early intervention in such cases is proven to be helpful. The aim of the present work was to assess the role of serum β-glucuronidase level as probable marker for the assessment of acute cholinesterase enzyme inhibitors insecticides poisoning. Subjects and methods: the study included 60 cases of acute poisoning by cholinesterase enzyme inhibitors insecticides, admitted to the Poison unit of Alexandria Main University Hospital, another 15 healthy volunteers were included as control group. All the cases were subjected to: thorough history taking, full clinical examination, grading of poisoning severity score (PSS), laboratory investigations (serum cholinesterase activity level (CHE) and serum β-glucuronidase level (βG). Results: Serum CHE levels were significantly decreased, while Serum βG were significantly increased in the patients compared with the controls, and also, with increasing severity of poisoning. A significant negative correlation was detected between level of serum CHE and duration of hospitalization, while a significant positive correlation was found between serum level of βG and length of hospital stay. In addition, a significant inverse correlation was found between levels of CHE and βG whether in control group or in cases. Data obtained from ROC curve analysis revealed that serum βGlevel was more helpful in diagnosis of OP poisoning than CHE (accuracy 100% versus 80%), while both serum CHE andβG levels were of equal accuracy percentage for detection of poisoning severity and for prediction of outcome (100% and 91.67% each). Conclusion: SerumβG could be used as a good biomarker for the diagnosis and prognosis of cholinesterase enzyme inhibitors insecticide poisoning.
Highlights
Organophosphates (OPs), carbamates, and other cholinesterase inhibitors, are the most commonly used insecticides worldwide and account for more human poisonings and death annually than any other pesticide class (Watson et al, 2003).Estimates from the WHO indicate that each year, million accidental poisonings and two million suicide attempts involving organophosphorus insecticides occur worldwide
Age and sex The present study showed that 53.3% of cases were females (n=32) and 46.7% were males (n=28), with female to male sex ratio of 1.14: 1. The youngest age encountered was one year and the oldest age was 40 years with a mean age of 17.4 ± 10.03years
The mortality rate for OP poisoning is high, with fatality often related to a delay in diagnosis or improper management (Sungur and Guven, 2001)
Summary
Organophosphates (OPs), carbamates, and other cholinesterase inhibitors, are the most commonly used insecticides worldwide and account for more human poisonings and death annually than any other pesticide class (Watson et al, 2003). Estimates from the WHO indicate that each year, million accidental poisonings and two million suicide attempts involving organophosphorus insecticides occur worldwide. One third of the suicides occurring globally are due to deliberate self-ingestion of pesticides (Chowdhary et al, 2014). In developing countries; exposure to insecticides constitutes one of the most common causes of poisoning. The primary reason for this is availability and easy access of pesticides together with lack of surveillance system to control its use. The mode of exposure varies including dermal, gastrointestinal and inhalational. Maximum toxic effect is through inhalation followed by gastrointestinal and dermal absorption (Kesavachandran et al, 2009)
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