Acute Organophosphorus Pesticide Poisoning Research Articles

Serum amylase as a novel prognostic marker of organophosphorus poisoning: a retrospective study

Abstract Background This study aims to explore the significance of serum amylase levels in patients with organophosphorus pesticide (OP) poisoning and to provide a new perspective for evaluating the severity and prognosis of OP poisoning. Methods The clinical data of 67 patients with acute OP poisoning, who had been treated in the emergency department of the General Hospital of Ningxia Medical University between September 2020 and August 2022, were retrospectively analyzed. Using Spearman rank correlation, serum amylase levels during admission and severity of poisoning correlated with discharge outcomes. Based on serum amylase levels, receiver operating characteristic curves were plotted to predict the severity and mortality of patients who experience organophosphate poisoning. The optimal threshold serum amylase level at admission was determined based on the maximum Youden index. Results Using Spearman rank correlation analysis, serum amylase levels at admission positively correlated with the severity of poisoning and discharge outcomes, but the degree of correlation was weak (r s: 0.344; 0.264; P < 0.05). The patients’ serum amylase levels at admission had receiver operating characteristic area under the curve values of 0.726 and 0.735 to predict the degree of severe poisoning and death, respectively. Based on the maximum Youden index, the optimal threshold of serum amylase were 97.8 and 194.1 U/L when the degree of poisoning was severe and the discharge outcome of patients was died. In comparison to patients with serum amylase levels ≤194.1 U/L at admission, the OR values of death in patients with serum amylase levels >194.1 U/L at admission was 15.944 (95% CI: 1.825–139.274). Conclusion Serum amylase levels in patients with organophosphate poisoning correlate with the degree of poisoning and discharge outcomes. Higher serum amylase level was a risk factor for organophosphorus poisoning death.

Enhanced treatment of acute organophosphorus pesticide poisoning using activated charcoal-embedded sodium alginate-polyvinyl alcohol hydrogel.

The adsorption of activated charcoal is currently a major clinical treatment for acute organophosphorus pesticide poisoning (AOPP). However, the adsorption duration and efficiency of this method is unstable. In this study, a hydrogel embedding activated charcoal was prepared and its alleviating effects on AOPP were investigated. A composite hydrogel using sodium alginate and polyvinyl alcohol (SA-PVA) hydrogel was prepared in this study. The structural properties of the SA-PVA hydrogel were characterized via multiple analysis including FTIR, TGA, XRD, SEM, tensile strength and expansion rate. Based on these, activated charcoal (AC) was embedded within the SA-PVA hydrogel (SA-PVA-AC) and it was used for the treatment of AOPP. Structural characterization indicated SA-PVA hydrogel possesses excellent mechanical properties and biocompatibility. The invivo study demonstrated that SA-PVA-AC significantly alleviated the inflammation and oxidative damage in the liver, as evidenced by reduced levels of IL-6, TNF-α, and, IL-1β, SOD, and MDA. Furthermore, SA-PVA-AC treatment effectively re-regulated the activities of serum AST and ALT, exhibiting an improved effect on liver function. The findings suggest that activated charcoal embedded within SA-PVA hydrogel has significant potential as a therapeutic agent in treating AOPP, and offering a novel approach to managing pesticide-induced toxicity.

Serial repetitive nerve stimulation studies in organophosphorus poisoning indicate two distinct pathophysiological processes occur at the neuromuscular junction in the intermediate syndrome

Introduction 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. Methods 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). Results 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. Discussion 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. Limitations 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. Conclusion 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.

Mean Cholinesterase Level among Organophosphorus Poisoning Patients Visiting the Emergency Department in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Acute organophosphorus pesticide poisoning is widespread and the most common in many developing countries, including Nepal. Through the inhibition of acetylcholinesterase, organophosphorus poisoning is characterised by the clinical picture of acute cholinergic crisis. Many researchers have shown increased levels of liver enzymes and decreased levels of serum cholinesterase in organophosphorus poisoning, however, very little work has been done in Nepal that studies the correlation between serum cholinesterase and liver enzymes in organophosphorus poisoning. The aim of the study is to find out the mean cholinesterase level among organophosphorus poisoning patients visiting the Emergency Department in a tertiary care centre. This was a descriptive cross-sectional study done among 94 organophosphate poisoning cases visiting the emergency department of a tertiary care centre from August 2021 to August 2022 after obtaining approval from the Institutional Review Committee (Reference number: 04102021/06). Convenience sampling was done. Blood workups were done for cholinesterase and liver function tests. Point estimate and 90% Confidence Interval were calculated. The mean cholinesterase level among organophosphorus poisoning patients was 1978.82±1878.22 (1660.17-2297.47, 90% Confidence Interval). The mean cholinesterase level among organophosphorus poisoning patients was similar when compared to other studies done in similar settings. cholinesterases; liver function tests; organophosphorus poisoning.

Retracted: Expression of Hypersensitive Troponin I and Soluble ST2 in Acute Organophosphorus Pesticide Poisoning.

[This retracts the article DOI: 10.1155/2022/1427231.].

The advantages of penehyclidine hydrochloride over atropine in acute organophosphorus pesticide poisoning: A meta-analysis

BackgroundPenehyclidine hydrochloride (PHC) has been used for many years as an anticholinergic drug for the treatment of acute organophosphorus pesticide poisoning (AOPP). The purpose of this meta-analysis was to explore whether PHC has advantages over atropine in the use of anticholinergic drugs in AOPP. MethodsWe searched Scopus, Embase, Cochrane, PubMed, ProQuest, Ovid, Web of Science, China Science and Technology Journal Database (VIP), Duxiu, Chinese Biomedical literature (CBM), WanFang, and Chinese National Knowledge Infrastructure (CNKI), from inception to March 2022. After all qualified randomized controlled trials (RCTs) were included, we conducted quality evaluation, data extraction, and statistical analysis. Statistics using risk ratios (RR), weighted mean difference (WMD), and standard mean difference (SMD). ResultsOur meta-analysis included 20,797 subjects from 240 studies across 242 different hospitals in China. Compared with the atropine group, the PHC group showed decreased mortality rate (RR=0.20, 95% confidence intervals [CI]: 0.16–0.25, P <0.001), hospitalization time (WMD=−3.89, 95% CI: −4.37 to −3.41, P <0.001), overall incidence rate of complications (RR=0.35, 95% CI: 0.28–0.43, P <0.001), overall incidence of adverse reactions (RR=0.19, 95% CI: 0.17–0.22, P <0.001), total symptom disappearance time (SMD=−2.13, 95% CI: −2.35 to −1.90, P <0.001), time for cholinesterase activity to return to normal value 50–60% (SMD=−1.87, 95% CI: −2.03 to −1.70, P <0.001), coma time (WMD=−5.57, 95% CI: −7.20 to −3.95, P <0.001), and mechanical ventilation time (WMD=−2.16, 95% CI: −2.79 to −1.53, P <0.001). ConclusionPHC has several advantages over atropine as an anticholinergic drug in AOPP.

A CLINICAL STUDY OF ORGANOSPHOSPHORUS COMPOUNDS POISONING WITH SPECIAL REFERENCE TO ECG CHANGES AND TROPONIN I

Background: The modern world thrives well on revolution in the agricultural practices that has resulted in a massive thrust in agricultural productivity. One of the most important step in green revolution is pesticides. In the developing world, poisoning is a common method of suicide. Organophosphorus compounds inhibit acetyl cholinesterase and butyryl cholinesterase enzymes resulting in excess acetyl choline in the neuromuscular junction causing overstimulation at the cholinergic synapses. The cardiac manifestations occur in a majority of affected patients and may range from innocuous ECG manifestations, such as sinus tachycardia, to life-threatening complications including cardiogenic pulmonary edema. Repolarization abnormalities, including ST-segment elevation and T-wave inversion as well as prolongation of the QTc interval, are among the most frequent cardiac manifestations of acute OP poisoning. . study was carried out in the Department of Medicine, Assam MedicalMethods: College &amp; Hospital,admitting in various ward of medicine,satisfying the inclusion and exclusion criteria. Patients were classied into three grades using 'Peradeniya organophosphorus poisoning scale'.76 Changes in ECG was monitored and Troponin I levels were measured at admission and repeated if required. . In our study, mean age of the cases was 44.32 years with 57.9% cases were below 40 years i.e. young adults. In theResults : study among the 190 patients 123 were males and 67 females. Among our study participants most of the cases were of suicidal OP poisoning (79.5%) while only 20.5% cases were accidental. Most common presenting symptoms in the study were blurring of vision (94.7%), lacrimation (92.1%), breathlessness (64.7%) and salivation (63.7%). In the present study out of 190 cases ECG changes were noted in 75 patients i.e 39.5% cases. Among them most common ECG nding was QTc prolongation (74.7%) followed by ST depression (24%) and T wave inversion (21.3%). A signicant association was observed between severity of poisoning and incidence of ECG changes (p&lt;0.01). Saadeh AM et al.39 in a similar study observed arrhythmias in 11 (24%); prolonged Q-Tc interval in 31 (67%), ST-T changes in 19 (41%) and conduction defects, 4 (9%) cases. Karki P et al.40 observed electrocardiographical abnormalities including prolonged Q-Tc interval in 14 cases (37.8 percent), ST-T changes in 11 cases (29.7 percent), and conduction defects in two cases (5.4 percent). In our study out of 190 cases raised troponin I levels were seen in 30 (15.8%) cases. A signicant association was observed between severity of poisoning and increase in troponin I levels (p&lt;0.01). Wan WG et al.45 discussed the diagnostic value of cardiac enzyme and troponin in acute organophosphorus pesticide poisoning (AOPP). We thus conclude thatConclusions: organophosphorus compounds poisoning is a major cause of morbidity and mortality and is suicidal in most of the cases. ECG abnormalities and myocardial injury is associated with OP poisoning and are more in POP severe grade of poisoning. Morbidity and mortality increases in patients with ECG changes (especially prolonged QTc) and raised Troponin I levels. Therefore, early hospitalization, treatment and follow up with ECG monitoring can be lifesaving in organophosphorus poisoning.

Application of Shewhart Control Chart in Controlling Adverse Events in Patients with Severe Acute Organophosphorus Pesticide Poisoning Undergoing Blood Purification.

Objective To explore the application effect of the Shewhart control chart in controlling adverse events in patients with severe acute organophosphorus pesticide poisoning (AOPP) undergoing blood purification. Methods A retrospective analysis was performed on the clinical data of 102 patients with severe AOPP admitted to the hospital between January 2020 and December 2021, including 47 cases in the control group and 55 cases in the observation group. The control group was given routine emergency nursing, while the observation group was given emergency nursing under the guidance of the Shewhart control chart on the basis of the control group. The specialized operations, basic operations, specialized theory, and basic theory of nursing staffs were scored to compare the comprehensive nursing quality. The total incidence of adverse nursing events in both groups was statistically analyzed. The dosage of atropine, disappearance time of muscarinic symptoms, recovery time of CHE activity to 60%, and hospitalization time in both groups were recorded. The total incidence of complications in both groups was statistically analyzed. The satisfaction of family members was statistically analyzed by a satisfaction questionnaire. Results The scores of specialized operations, basic operations, specialized theory, and basic theory of nursing staffs in the observation group were significantly higher than those in the control group (P < 0.05), total incidence of adverse nursing events was significantly lower than that in the control group (P < 0.05), dosage of atropine, disappearance time of muscarinic symptoms, recovery time of CHE activity to 60%, and hospitalization time were significantly lower than those in the control group (P < 0.05), total incidence of complications was significantly lower than that in the control group (P < 0.05), and scores of nursing attitude, communication process, psychological relief, and drug preparation were significantly higher than those in the control group (P < 0.05). Conclusion The Shewhart control chart can effectively improve the clinical effect, comprehensive nursing quality, and satisfaction of patients with severe AOPP and effectively reduce complications and adverse events.

Clinical Analysis of Acute Organophosphorus Pesticide Poisoning and Successful Cardiopulmonary Resuscitation: A Case Series.

Acute organophosphorus pesticide poisoning (AOPP) with cardiac arrest has an extremely high mortality rate, and corresponding therapeutic strategies have rarely been reported. Therefore, this study aimed to explore the prognostic factors and effective treatments of AOPP-related cardiac arrest. This retrospective study was conducted in our department in the years 2018–2021. We conducted a descriptive analysis of the clinical manifestations, rescue strategies, and prognosis of patients with AOPP who had experienced cardiac arrest and successful cardiopulmonary resuscitation. This study included six cases of patients with AOPP in addition to cardiac arrest; in four cases, cardiac arrest occurred <12 h after ingestion, and in two, cardiac arrest occurred more than 48 h after ingestion. Five patients had not undergone hemoperfusion therapy before cardiac arrest, and all six were treated with atropine during cardiopulmonary resuscitation and subsequent pralidoxine. Four patients recovered and were discharged from the hospital, one died in our department, and one was transferred to a local hospital and died there 2 h later. The last two patients had severe pancreatic injuries and disseminated intravascular coagulation. This, along with their death, might have been related to their prognosis. Cardiac arrest can occur in patients with severe AOPP for whom antidote administration was insufficient or not timely. Application of atropine and pralidoxine in a timely manner after cardiac arrest following AOPP is the key to successful treatment. This study provides useful guidelines for the treatment of similar cases in the future.

High-Fidelity Patient Simulation Incorporated Into a Flipped Classroom Improves Students' Long-Term Knowledge Retention of Acute Organophosphorus Pesticide Poisoning.

The flipped classroom (FC) approach and high-fidelity patient simulation (HFPS) training have shown promising effects in short-term acquisition or long-term retention of knowledge in medical education. In this study, we aimed to explore the incorporation of HFPS into the FC and the impact on the long-term (3 months after classes) knowledge retention of medical undergraduate students learning about acute organophosphorus pesticide poisoning (AOPP). Eighty-two fifth-year medical students were randomly divided into an HFPS group (HG, n = 40) and an FC group (FG, n = 42). A postclass quiz and preinternship quiz were performed to assess the short-term knowledge acquisition and long-term (3 months after classes) knowledge retention of both groups of students. Feedback questionnaires were administered immediately after the class and before the internship to assess the students' self-perceived competency. In the postclass quiz, the scores achieved by the students from the HG and FG were 15.58 ± 2.69 and 14.62 ± 2.19, respectively. No significant difference was found between the 2 groups (P = 0.19). In the preinternship quiz, the scores achieved by the students from the HG (14.50 ± 2.16) were significantly higher than those achieved by the students from the FG (11.40 ± 2.07, P < 0.001). There was no significant difference between the postclass quiz and preinternship quiz scores achieved by the HG students (P = 0.05). However, scores in the preinternship quiz showed a significant decline compared with the postclass quiz for the FG students (P < 0.001). Students in the HG gave significantly higher scores for self-perceived confidence in dealing with AOPP patients in the forthcoming internship on the postclass and preinternship questionnaires. The incorporation of HFPS into the FC approach could improve students' long-term knowledge retention of AOPP and enhance their confidence in caring for these patients in their internship.

Expression of Hypersensitive Troponin I and Soluble ST2 in Acute Organophosphorus Pesticide Poisoning.

The role of soluble growth stimulating gene 2 protein and highly sensitive cardiac troponin in the diagnosis of early myocardial injury caused by acute organophosphorus pesticide poisoning was studied. 171 inpatients with AOPP were divided into three experimental groups according to their mild, moderate, and severe conditions. 20 healthy people were selected as the control group. The levels of cTnI, HS-CTNI, NT proBNP, and ST2 were measured at the 4th and 12th hours after the experiment. The measured data were expressed by mean standard deviation. The independent sample t-test was used for the detection between the two groups, and one-way ANOVA was used for the analysis and comparison between multiple groups. The relevant data were analyzed by Spearman correlation test (P < 0.05). The levels of cTnI and HS cTnI in the experimental group increased with the extension of time and the deepening of poisoning degree; four hours after admission, ST2 and NT proBNP water in the control group and the experimental group increased significantly on average. According to the analysis of the data, there was a positive correlation between HS TnI and ST2 in patients with AOPP (r = 0.938, P < 0.001, r = 0.827, P < 0.001). The more serious the disease, the higher the concentrations of HS TnI and ST2, and the more serious the myocardial injury.

Fatal Case of Severe Acute Organophosphorus Pesticide Poisoning Complicated with Secondary Hemophagocytic Lympho-Histiocytosis, Severe Lower Intestinal Hemorrhage and Intestinal Mucormycosis

A man in his 50’s, under influence of alcohol, accidentally ingested a pesticide, and was referred for further management and admitted to our hospital. An empty can of Curacron® was found at the site in his farm where he took the alleged pesticide. This raised the suspicion of organophosphorus pesticide poisoning and he was managed at two medical centres before getting admitted to our hospital. His hospital course was complicated with multiorgan dysfunction, shock, respiratory failure and intermediate syndrome. On day five he developed secondary hemophagocytic lymphohistiocytosis (sHLH) and had hematochezia on day six. Colonoscopy revealed multiple circumferential ulcerations in descending and sigmoid colon with luminal narrowing. Biopsy of colonic tissue showed evidence of intestinal Mucormycosis. The clinical presentation of organophosphorus pesticide poisoning in this patient was complicated with multiple issues and included sHLH, chemical gastroenteritis, hemorrhagic ulcers and intestinal zygomycosis. The organophosphorus pesticide ingested by the patient was a 50% emulsifiable concentrate of profenofos along with vegetable oil, soyabean oil and polyglycol ether alkyl aryl sulphate calcium salt 5.25% w/w as an emulsifier/spreading agent. The management of the patient is discussed. Due to the possibility of the emulsifier adhering to the gastrointestinal tract and causing mucosal injury, it is necessary to identify the drug composition and ingredients of the pesticide as soon as possible when managing organophosphorus poisoning.

The value of renal color Doppler ultrasound in evaluating the severity and prognosis of patients with acute organophosphorus pesticide poisoning complicated by acute kidney injury

Objective: To analyze the value of renal color Doppler ultrasound examination and clinical indicators in evaluating the severity and prognosis of acute organophosphorus pesticide poisoning (AOPP) complicated by acute kidney injury (AKI) . Methods: In November 2019, 86 AOPP patients complicated by AKI who were admitted from May 2018 to May 2019 were selected as the observation group, and they were divided into AKI stage 1 group (n=37) , AKI stage 2 group (n=32) and AKI stage 3 group (n=17) . 40 healthy people were selected as the control group. The differences in power Doppler ultrasound (PDU) score, renal interlobular artery resistance index (RI) value and related clinical indicators of each group were measured and analyzed, and the correlations between the indicators were analyzed. At the same time, binary logistic regression was used to analyze the risk factors of death in AOPP patients complicated by AKI. Results: There were statistically significant differences in Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱscore, mean arterial pressure (MAP) , serum creatinine (SCr) and the length of continuous renal replacement therapy (CRRT) between different groups (P<0.05) . Compared with the control group, the APACHE Ⅱscores and SCr of patients in the AKI stage 2 and resistance index AKI stage 3 groups increased, while the MAP decreased (P<0.05) . Compared with the control group, AKI stage 1 group and AKI stage 2 group, the PDU score of patients in the AKI stage 3 group was significantly decreased, and the renal interlobular artery RI value was significantly increased (P<0.05) . SCr was positively correlated with the RI value of renal interlobular arteries and CRRT days (r=0.435, 0.713, P<0.05) , and was negatively correlated with renal PDU score (r=-0.643, P<0.05) . The renal PDU score was negatively correlated with the RI value of renal interlobular arteries and CRRT days (r=-0.350, -0.556, P<0.01) . Binary logistic regression analysis showed that SCr (OR=1.017, 95%CI: 1.004-1.041) and APACHE Ⅱ score (OR=1.289, 95%CI: 1.019-1.827) were risk factors for death in patients with AOPP complicated by AKI (P<0.05) . Conclusion: Both PDU score and the RI value of renal interlobular artery can reflect the severity and stage of patients with AOPP complicated by AKI to a certain extent, but neither of them is a key factor affecting the death of patients.

Clinical significance of combined sST2 and NT-proBNP detection for the short-term prognosis of acute organophosphorus pesticide poisoning

Objective: To explore the value of soluble growth stimulation expression gene 2 protein (soluble suppression of tumorigenicity 2; sST2) and N terminal B type brain natriuretic peptide (N-terminal probrainnatriuretic peptide, NT-proBNP) in evaluating the short-term prognosis of acute organophosphorus pesticide poisoning. Methods: select 228 patients with acute organophosphorus pesticide poisoning in our hospital from October 2017 to March 2020. According to the grade of poisoning degree, it was divided into 82 cases in mild and moderate group and 146 cases in severe group. hs-cTnI、CK-MB、sST2、NT-proBNP、APACHE Ⅱ score and cholinesterase activity were detected 4 h、12 h、24 h after admission. ROC curve was used to evaluate sST2 and NT-proBNP to predict the prognosis of AOPP. Results: 4 hours after admission, there was no significant difference in the scores of hs-cTnI, APACHE Ⅱ, cholinesterase and CK-MB between the Severe Group and the mild and moderate Group (P<0.05) . At 12 and 24 hours after admission, the scores of hs-cTnI, CK-MB and APACHE Ⅱ in severe group were higher than those in mild and moderate group, and the changes of Cholinesterase were more significant than those in 12 hours after Admission (P<0.05) . 4 hours after admission, SST2 and NT-proBNP levels were significantly higher in severe group than those in mild and moderate Group (P<0.05) . The level of SST2 and NT-proBNP in the severe group was significantly higher than that in the mild and moderate group 12 and 24 hours after Admission (P<0.01) , and the level of SST2 and NT-proBNP was significantly higher than that in the mild group 12 hours after Admission (P<0.05) . Correlation analysis showed that 24 hours after admission, sST2, NT-proBNP were positively correlated with APACHE-Ⅱ scores (R=0.634, 0.723, P<0.01) . The area under sST2 combined with NT-proBNP was 0.891, higher than that under sST2 and NT-proBNP at 12 h after admission. The 24 h APACHE Ⅱ score after admission area under the curve was 0.838. Conclusion: sST2 and NT-proBNP combined detection can early predict the occurrence of recent complications in AOPP patients.

Prognostic value of the neutrophil-to-lymphocyte ratio in acute organophosphorus pesticide poisoning.

This study investigates the ability of blood neutrophil-to-lymphocyte ratio (NLR) to predict acute organophosphorus pesticide poisoning (AOPP). Clinical data of 385 patients with AOPP were obtained within 24 h of admission, and NLR values were calculated based on neutrophil and lymphocyte counts. The patients were divided into two groups – good and poor – based on prognosis. Poor prognosis included in-hospital death and severe poisoning. The factors affecting prognosis were analyzed by logistic regression analysis, and the prognostic value of NLR was evaluated using the area under the receiver operating characteristic curve (AUC). Univariate logistic regression analysis showed that NLR levels, serum cholinesterase, and creatinine levels were good predictors of AOPP. Multivariate logistic regression analysis showed that high NLR was an independent risk factor for severe poisoning (adjusted odds ratio [AOR], 1.13; 95% CI, 1.10–1.17; p < 0.05) and in-hospital mortality (AOR, 1.07; 95% CI, 1.03–1.11; p < 0.05). NLR values >13 and >17 had a moderate ability to predict severe poisoning and in-hospital mortality, respectively (AUC of 0.782 [95% CI, 0.74–0.824] and 0.714 [95% CI, 0.626–0.803], respectively). Our results show that high NLR at admission is an independent indicator of poor prognosis in AOPP and can be used to optimize treatment and manage patients.

Nursing Experience of Pre-hospital First Aid and Emergency Department in Rescuing Acute Organophosphorus Pesticide Poisoning

Nursing Experience of Pre-hospital First Aid and Emergency Department in Rescuing Acute Organophosphorus Pesticide Poisoning

Clinical Data on Acute Kidney Injury Caused by Acute Organophosphorus Pesticide Poisoning

Background: Organophosphorus pesticides (OPs) are widely used in China and some developed countries because they are powerful pesticides with minimal damage to crops. However, OPs are highly toxic, especially to the human lungs, heart, brain, kidneys. Research on the pathogenesis and risk factors of acute kidney injury (AKI) caused by OP poisoning is limited, Researches which tend to have small sample sizes and are commonly case reports. Objective: This study aims to investigate the pathogenesis and risk factors of AKI caused by acute organophosphorus poisoning syndrome (AOPP), in order to enable the adoption of early and reasonable treatment methods, to improve the prognosis of patients. Methods: Retrospective analysis was performed on the laboratory findings of 275 patients with acute OP poisoningl from January 2009 to June 2016. (1) The 275 patients with acute OP poisoning were grouped according to the presence or absence of AKI, and testing was performed for statistical differences in the relevant clinical indicators between the two groups. (2) Univariate analysis was performed to compare the differences in these indicators between the two groups, and indicators with statistically significant differences included in logistic regression and other methods to analyze the risk factors affecting AKI. Results: Among the 275 patients with acute OP poisoning, 92 (33.5%) had AKI. The cure rate of the AKI group was 69.6% and case fatality rate was 1.1% (1/92); the cure rate of the non-AKI group was 73.8% (135/183) and the case fatality rate was 0.5% (1/135); the difference in mortality rate between the two groups was not statistically significant (Z=0.94, P=0.34). Comparison of general information and clinical characteristics revealed that only the mean C-reactive protein (CRP) and SCr levels differed significantly between the two groups (Z=6.55, P<0.001; t'=-3.14, P=0.002). Multivariate logistic regression analysis showed that the time of poisoning, time to blood purification therapy and CRP level were factors influencing the onset of AKI. The relationship between CRP level and logitP(AKI=1) was non-linear, and so no interpretation was made on the OR size. Conclusion: 1. The rate of AKI about acute OP poisoning is 54.4%, Both glomeruli and tubules were involved. 2. The prognosis of patients with AKI is relatively poor. 3. The risk factors influencing AKI caused acute OP poisoning may be related to prolonged time of poisoning, prolonged time to blood purification therapy and high CRP level.

A clinic-epidemiological study of organophosphorus poisoning in children in a tertiary care medical college hospital

Background: Acute organophosphorus (OP) pesticide poisoning is widespread and is the most common poisoning in many developing countries and varies in different geographic regions. Organophosphorus compounds are anti acetyl cholinesterase which exert their toxicity by interfering with the normal function of acetylcholine, an essential neurotransmitter throughout the autonomic and central nervous system.Methods: The present study was conducted in department of pediatrics Sri Siddhartha medical college, Tumkur. All children with OP poisoning admitted in the pediatric ward were included in the study. Unknown compound/tablet poisoning, which was contradictory to the diagnosis of OP compound were excluded.Results: Out of 5,274 cases which were admitted in pediatric ward, 15 children were diagnosed as OP poisoning. In the present study the incidence of OP poisoning was 2.84%. Out of 15 cases 3 cases were below 1 year of age, 2 cases were in the age group of 1-5 years, 5 cases were in the age group of 6-10 years and 5 cases were seen in above 11 years of age. Among 15 cases 13 (86.7%) cases were accidental poisoning and 2 (13.3%) cases were attempt to suicide. Out of 15 cases 4 (26.7%) cases were seen in monsoon, 4 (26.7%) cases were seen in winter and 7 (46.6%) in summer season. Out of 15 cases 14 (93.3%) cases improved with treatment and 1 (6.7%) case discharged against medical advice.Conclusions: Most cases of accidental poisoning are preventable by close watch on the toddlers and younger children who have a habit of tasting unknown things. Educate school children in all aspects of childhood poisoning.

The role of noninvasive hemodynamic monitoring in the evaluation of acute and severe pesticide poisoning

Objective: To explore the method of noninvasive hemodynamic monitoring system (NICaS) in monitoring the hemodynamics of patients with acute pesticide poisoning, and to analyze the clinical guiding value of NICaS in hemodynamics of patients with severe pesticide poisoning. Methods: In August 2019, 200 patients with severe acute organophosphorus pesticide poisoning (AOPP) or moderate severe acute paraquat pesticide poisoning (APP) admitted to Harrison international peace hospital from January 2017 to August 2019 were randomly divided into NICaS group (n=68) , transpulmonary thermodilution method (n=67) and empirical treatment group (n=65) . The relationship between acute physiology and chronic health score (APACHE Ⅱ) , heart rate, hemodynamic indexes, survival rate and complications were analyzed. Results: There were no significant differences in age, sex ratio, body mass index, heart rate, systolic blood pressure, no treatment period and admission APACHE II score between NICaS group, Picco group and experience group (P>0.05) ; Compared with the experience group, the mortality of AOPP and app in NICaS group and Picco group were lower, and the differences were statistically significant (P<0.05) .The cardiac output (CO) had a significant correlation in the interval of 2.8-6.7 L·min(-1) (r=0.738, r(2)=0.545, P<0.01) , and peripheral vascular resistance index (SVRI) had a significant correlation in the interval of 410-1 950 d·s·cm(-5)·m(2) (r=0.792, r(2)=0.627, P<0.01) . Bland Altman analysis showed that CO and SVRI measured by Picco and NICaS had 97.01% and 95.52% consistency, respectively. Compared with the experience group, the average daily infusion volume and daily colloid infusion volume of NICaS group and Picco group were lower, the differences were statistically significant (P<0.05) . Conclusion: NICaS can effectively monitor the hemodynamic indexes of patients with acute pesticide poisoning.

Clinical profile and outcome of organophosphorus poisoning in a tertiary care centre, a prospective observational study

Introduction: Acute organophosphorus (OP) pesticide poisoning is widespread in the developing world. Being predominantly an agricultural country, pesticides and insecticides are used abundantly for cultivation, and access to these poisonous chemical substances by the population is easy. The objectiveof the study was to identifythe nature of the demographic profile, type of compound, clinical manifestations, and outcome of organophosphate poisoning presenting to a tertiary care teaching hospital in India. Material and methods: A cross-sectional study was conducted among 100 patients admitted with OPC poisoning inthe department of general medicine,Velammal Medical College Hospital and Research Institute, Madurai from January 2016 to July 2019. The diagnosis was made based on history or evidence of exposure to OP compound within 24 hours; characteristic manifestations of OP poisoning include, miosis, fasciculations, excessive salivation, improvement of signs and symptoms with administration of atropine were recorded. IBM SPSS version 22 was used for statistical analysis. Results:The majority of the subjects were males(80%). The majority (66%) were in the age group of 21-40 years. The most common OPC to be consumed was Methyl parathion (27%), followed by chlorpyrifos (22%). The major GIT complications were abdominal pain/cramps (100%), followed by nausea and vomiting (83%). Mechanical ventilation was needed in 40% and mortality was reported in 25% of the subjects. Conclusion:OP poisoning affects resonantly males in their economically productive phase of life. Considering the high mortality, adequate strengthening of health services, especially at the primary level is the need of the hour.