Acute Organophosphorus Poisoning Research Articles

The Role of Neutrophil-to-Lymphocyte Ratio in Predicting Outcomes of Acute Organophosphorus Poisoning: A Comprehensive Review

The Role of Neutrophil-to-Lymphocyte Ratio in Predicting Outcomes of Acute Organophosphorus Poisoning: A Comprehensive Review

Serum Organophosphorus compound levels as a surrogate marker for severity assessment and management in Acute Organophosphorus Poisoning- A novel approach.

Organophosphorus (OP) compounds are the most extensively used pesticides’ class worldwide; cause most self‑poisoning deaths especially in India. Thus, it is utmost important for early identification and aggressive management of OP poisoning from the clinical perspective to prevent serious complications by using sophisticated LC-MS/MS approach. This was a prospective study involving 103 patients of OP cases admitted to Karnataka Institute of Medical Sciences from June 2022 to May 2023, based on the inclusion and exclusion criteria patients were subjected to study. On admission, venous blood was collected from patient with Malathion and Profenofos OP poisoning history and subjected to serum biomarker and to LC-MS/MS analysis. Out of the 103 patients, 68 patients consumed Profenofos (66%) and 35 patients consumed Malathion (34%). Pseudocholinesterase levels among the of OP cases revealed that the 33 patients had mild toxicity, 40 patients had moderate toxicity and 30 patients had severe toxicity of OP poisoning. Subsequently LC-MS/MS analysis showed that the results obtained are not in correlation with indirect serum marker pseudocholinesterase levels. On the other side, LC-MS/MS results are in correlation with the clinical outcome of the patients with respect to morbidity and mortality. Thus, LC-MS/MS approach to assess the OP levels in patients could be used as potential diagnostic and prognostic marker for the absolute quantification of OP compounds compared to indirect OP levels estimation.

A cross-sectional study of neutrophil to lymphocyte ratio as a prognostic marker in acute organophosphorus poisoning in a tertiary care hospital in Central India

Background Acute organophosphorus poisoning remains a significant public health concern, with variable clinical outcomes. Prognostic markers are crucial for patient management and risk stratification. This study aims to investigate the Neutrophil Lymphocyte Ratio (NLR) as a potential prognostic marker and its associations with severity and clinical outcomes in acute organophosphorus poisoning. Methods This cross-sectional observational study will be conducted over two years, involving patients presenting with acute organophosphorus poisoning in the Medicine Ward and Intensive Care Unit of DMIHER Wardha. Informed consent will be obtained, and detailed clinical assessments, laboratory investigations, and NLR calculations will be performed. The Nambaet, Peradeniya, and Bardin classification scales will be used to measure severity. Statistical methods will be applied to explore the relationships between NLR, clinical parameters, and clinical outcomes, including descriptive statistics, bivariate analysis, correlation analysis, multivariate regression, and ROC analysis. Expected Results The study is anticipated to elucidate the role of NLR as a prognostic marker in acute organophosphorus poisoning. Initial assessments and correlations between NLR and clinical parameters will be presented. The predictive capability of NLR for clinical outcomes, including the need for ventilatory support and length of hospital stay, will be explored. Agreement and discrepancies between the classification scales will be evaluated.

Assessment of the Peradeniya Organophosphorus Poisoning Scale as a Severity and Prognostic Marker in Patients With Acute Organophosphorus Poisoning Presenting to an Emergency Medicine Department.

Background Organophosphorus (OP)compound poisoning is the most common toxicological medical emergency in India, where the majority of the population lives on agriculture. The Peradeniya Organophosphorus Poisoning (POP) scale can be a simple and effective system to determine the need for ventilatory support early in the course of admission. The objective of this study was to evaluate the prognostic value of the clinical parameters of the POP scale in predicting the severity of organophosphorus compound poisoning, by comparing early predicted patient prognosis evaluated by the POP scale on admission with the patient outcome. Methods This was a prospective observational study of acute organophosphorus compound poisoning presenting to the emergency department of Sir Sayajirao General (SSG) Hospital and Medical College, Baroda. We included patients over 12 years of age with a history of, or symptoms suggestive of, acute OP poisoning. The patients receivedinitial resuscitation according to airway, breathing, circulation, disability, and exposure simultaneously with decontamination and gastric lavage by Ryle's tube. They also received the standard antidotes of atropine and pralidoximeimmediately. We appliedthe POP scale to each patient uponadmission and graded the poisoning severity as mild (a POP scale score of 0-3), moderate (4-7), or severe (8-11). This scale assessed the patients' need for mechanical ventilation and ICU management and their final clinical outcome. Results We enrolled 60 patients in the study. Most of themwere under 20 years of age, and 65% of them were male. Social laborers were the major population, and most of them had suicidal intention. Monocrotophos was the most commonly consumed OP compound. Most of the patients were brought to the hospital within two to sixhours of consumption. Vomiting and profuse secretions were the primary presenting symptoms. A majority of the patients (47) fell into the mild POP scale range. None of the patients had severe poisoning. Out of 60 patients, 49 patients improved and 11 patients died. Seven patients (15%) with mild POP scale scores and four patients (31%) with moderate scores died. Overall, 61.7% of patients with mild POP scale scores and 100% of patients with moderate scores needed mechanical ventilation. Conclusion The POP scale is an effective tool to measure severity and make a prognosisin patients with acute OP compound exposure. It may be asimple, inexpensive tool that may help predict the need for ventilatory support at admission. Early identification of danger signs may help in the reduction of mortality and morbidity when resources are limited. However, we found incorporating other clinical parameters and biochemical markers provides better prognostication than using the POP scale alone.

CLINICO-EPIDEMIOLOGICAL PROFILE OF PATIENTS WITH ORGANOPHOSPHORUS POISONING

Background: Acute organophosphorus poisoning is common in developing countries due to easy availability and less awareness among the farmers. Aim: Present study is done to study the clinical features and epidemiological characteristics of these patients. Methods: A 2 year crosssectional study was conducted among patients presenting with history of Organophosphorus poisoning at BMCRI, Bangalore. Results: Atotal of 90 patients were included in the study. Poisoning was most common among age group between 21-30 years (36.7%) ; Majority subjects 73 (81.1%) were Male patients; Most common mode of poisoning was Suicidal (96.7%) ; Poisoning was most common among farmer (32.2%) followed by coolie (21.1%). Most common poison consumed was chlorpyrifos (48.9%), followed by dichlorvos (14.4%). Most common symptom was Nausea and vomiting(92.2%) followed by abdominal cramps (60%). Most Common clinical sign is miosis (82.2%) followed by bradycardia (63.3%). Conclusion: Present study showed that majority of patients were of young age with males outnumbering females with suicidal intent more common than accidental. Chlorpyrifos was the most common type of poison. Nausea and Vomiting was the common symptom reported by the patients and miosis was the most common sign observed

A study of serum creatine phosphokinase and severity of organophosphorus poisoning

Organophosphorus (OP) poisoning is an important global health problem especially in developing countries. Estimation of erythrocyte cholinesterase (EChE) and plasma cholinesterase (BChE) as an evidence of OP poisoning is costly, not regularly performed and shows wide inter-individual variability. To study the feasibility of using serum creatine phosphokinase (CPK) as a predictor for severity of OP poisoning. Thirty four patients were included in this study who were admitted to tertiary care centre with history of OP poisoning less than 24hrs. The clinical severity of patients categorized according to Peradeniya organophosphorus poisoning (POP) scale. In our study 53.0% were male, 47.0% were female. Incidence of OP poisoning was more common among age group 21-30 years. Farmers (38.2%) were more common among occupation. Monocrotophos (46.0%) was commonly used compound for poisoning. 38.2% patients were severe. There was significant reduction in plasma cholinesterase and significant increase in CPK levels. There was a highly significant correlation between initial serum CPK levels and severity of acute OP poisoning. This study recommends CPK as an alternative biomarker for acute OP poisoning.

Correlation of Serum Amylase with Serum Cholinesterase in Assessing the Severity of Acute Organophosphorus Poisoning

Correlation of Serum Amylase with Serum Cholinesterase in Assessing the Severity of Acute Organophosphorus Poisoning

Comparison of the Poisoning Severity Score, Sequential Organ Failure Assessment Score, and Acute Physiology and Chronic Health Evaluation II Score with Lactate to assess the outcome in Acute Organophosphorus Poisoning

Introduction: Organophosphorus pesticide self-poisoning is estimated to kill around 200000 people yearly. Earlyrecognition is life-saving as the mortality rates are high following OP Poisoning. Acute Physiology and ChronicHealth Evaluation II Score (APACHE II) Sequential Organ Failure Assessment Score (SOFA), and PoisoningSeverity Score (PSS) with Lactate, are used to evaluate the prognosis.Materials and Methods: This prospective observational study included 236 individuals with acute OP poisoningwho presented to the emergency department and were hospitalized in the critical care unit and step-down ICU.PSS, SOFA, and APACHE II scores were calculated at Emergency Department and followed up with the patientuntil discharge or death.Results and Discussion: Patients had a mean age of 32.8 ± 13.4 years and were 49.2% female and 50.8% male.Out of 236 patients, 22 patients died and 214 were discharged. The best cut-off values for predicting mortalitywith PSS, SOFA, and APACHE II scores were 2, 3, and 15, with AUROC of 0.929, 0.970, and 0.984. In additionto Lactate to the above scores, the AUROC increased to 0.981, 0.993, and 0.992, respectively. The study foundthat SOFA and APACHE II scores with Lactate are significantly associated with mortality and have strongdiscriminative power in predicting mortality.

Role of Paraoxonase-1 Enzyme in Prediction of Severity and Outcome of Acute Organophosphorus Poisoning: A Prospective Study

Role of Paraoxonase-1 Enzyme in Prediction of Severity and Outcome of Acute Organophosphorus Poisoning: A Prospective Study

Latent class trajectories of biochemical parameters and their relationship with risk of mortality in ICU among acute organophosphorus poisoning patients

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.

Prevalence of Delayed Neuropathy and Intermediate Syndrome in Acute Organophosphorus Poisoning: A Cross-sectional Toxicological/Clinical Study

Background: Organophosphates are among the most common causes of poisoning worldwide—responsible for 3 million poisoning and 200000 deaths every year. Nearly 15% of people who are poisoned die. This cross-sectional toxicological/clinical study aimed to investigate the prevalence and influential factors in the incidence of delayed peripheral neuropathy and intermediate syndrome in acute poisoning with organophosphorus toxins. The study was conducted in Loghman Hakim Hospital, Tehran City, Iran, from 2017 to 2020. Methods: The study data were obtained from the patients’ records during follow-up. Data included demographic information (age, sex, etc.), vital signs, muscarinic, nicotinic, and neurological symptoms at admission, atropine therapy status, and pralidoxime intake status. Post-discharge complications were obtained, and patients’ Electromyography (EMG) and Nerve Conduction Velocity (NCV) results were recorded and evaluated during hospitalization and follow-up. Statistical analysis was performed using SPSS software, version 22. Results: Of 63 studied patients, 61.9% were female. The Mean±SD age of the patients was 31.90±13.128 years. Male patients were significantly (P<0.010) older than female ones. The most common muscarinic symptoms were nausea and vomiting (73.2%), diarrhea (34.92%), and abdominal pain (33.33%). Regarding the nicotinic symptoms, sweating (30.16%) and fasciculation (19.05%) were the commonest. Neurological complications were less common; seizures were observed in 3 cases (4.76%) and coma in 2 cases (3.17%). Most patients (79.4%) received pralidoxime with atropine. The Mean±SD days of treatment with atropine and pralidoxime were 5.51±3.52 and 4.06±4.62 days, respectively. Only one death was recorded. The results of the initial EMG-NCV test on the second day of hospitalization showed abnormalities in 4 patients (6.3%), indicating the presence of the intermediate syndrome. Conclusion: The results of the EMG-NCV tests at our patients’ follow-up (30 days) showed no abnormalities. Hence no cases of delayed neuropathy were seen. During hospitalization, one patient had flaccid paralysis and showed significant impairment on the EMG-NCV test (P<0.01).

Biochemical abnormalities in patients presenting with acute organo-phosphorus poisoning in a tertiary care hospital, and the prognostic significance

Background: Organophosphate poisoning is a major cause of morbidity and mortality that poses public health problems in developing countries, including India. Clinical signs and symptoms of OP compound ingestion are often non-specific and clinical signs depend on the nature of the OP compound, the amount consumed the time lapse between exposure and admission to the hospital, and the severityMethods: In this prospective cohort study, we reported the clinical presentation of 50 patients with OP poisoning, and studied the correlation of serum K+, Na+, creatinine, and BUN with the prognostic significance.Result: Elevated serum creatinine along with hypokalemia was found to be strongly correlated with high mortality rates in patients with suicidal organophosphate poisoning. The correlation of clinical outcomes and low serum K+ was found to be statistically significant (p<0.001). Our study concludes that serum K+ (<3.6 mmol/l) and serum creatinine (>1.21 mg/dl) are poor prognostic indicators for patients presenting with suicidal OP poisoningConclusions: Our study concluded the association of hypokalemia and elevated serum creatinine levels with poor clinical outcomes in OP poisoning patients, and recommends regular monitoring of these prognostic indicators in effective management of these patients

Laryngeal Dysfunction in Acute Organophosphorus and Carbamate Poisoning.

ABSTRACTBackgroundOrganophosphorus (OP) and carbamate pesticides are widely used for crop protection. We describe the spectrum of laryngeal abnormalities in patients admitted to the intensive care unit (ICU) with acute OP and carbamate poisoning as there is limited information on it.Materials and methodsConsecutive patients admitted to the ICU with acute OP and carbamate poisoning over 20 months (December 2014–July 2016) were recruited. Patients were followed up post-discharge if they had undergone tracheostomy or developed hoarseness of voice or stridor following extubation. Asymptomatic individuals who consented underwent laryngoscopy after ICU discharge. The primary outcome was the development of laryngeal dysfunction. Other outcomes included length of stay, need for ventilation, mortality, tracheostomy, and time to decannulation of tracheostomy.ResultsOf the 136 patients recruited, 71 (52%) underwent laryngoscopy. The overall mortality rate was 9.6%. Of the 71 patients who underwent laryngoscopy, 18 had abnormal findings, which included unilateral or bilateral vocal cord paresis or palsy (n = 14) and/or aspiration (n = 9), subglottic stenosis (n = 1), tracheal stenosis (n = 1), or arytenoid granuloma (n = 1). Laryngeal dysfunction was associated with the ingestion of a dimethyl OP compound (p = 0.04) and quantum consumed (p <0.001). Patients with laryngeal dysfunction had significantly (p = 0.004) longer hospital stay (19.1 ± 10.7 vs 11.8 ± 8.3 days).ConclusionLaryngeal dysfunction is not uncommon in OP and carbamate poisoning and is associated with the ingestion of larger quantity of a dimethyl OP compound and longer hospital stay. Otorhinolaryngologists could be involved early to help identify these abnormalities and initiate an appropriate treatment to ensure a functional voice and good airway.How to cite this articleMani GS, Mathews SS, Victor P, Peter JV, Yadav B, Albert RRA. Laryngeal Dysfunction in Acute Organophosphorus and Carbamate Poisoning. Indian J Crit Care Med 2022;26(2):167–173.

Impact of Serum Amylase Level in the Outcome of Acute Organophosphorus Poisoning: 2-Year Cross-Sectional Study at Rural Teaching Hospital.

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

English

BACKGROUND Organophosphorus (OP) pesticides are one of the most common cause of morbidity and mortality due to poisoning worldwide especially in agrarian countries like India. Hence it is prudent to undertake a detailed study of clinico-pathological evaluation of OP poisoning and assess the role of serum potassium as an alternative, easy and convenient prognostic indicator in estimating the severity of OP poisoning. This study was undertaken to assess serum potassium levels in patients of acute organophosphorus poisoning and determine association between serum potassium level and outcome in cases of acute organophosphorus poisoning. METHODS This was a prospective observational study conducted in Department of General Medicine, Silchar Medical College &amp; Hospital for one year from 1st June 2019 to 31st May 2020 with a sample size of 100 after satisfying the inclusion and exclusion criteria. Peradeniya organophosphorus poisoning (POP) scale was used for categorizing study population according to severity. RESULTS Among patients who were admitted with organophosphorus poisoning, 72 % of the patients discharged were having normal serum potassium levels on admission, whereas 22 % (n = 22) patients who died had hypokalaemia at the time of admission. The chi-square value for the association between serum potassium and outcome is statistically significant [P value is 0.001 (P &lt; 0.05)]. CONCLUSIONS The serum potassium level on the day of admission was significantly correlated with the severity of the acute organophosphate poisoning as determined by Peradeniya OP poisoning scale. The cases that had lower serum potassium levels on admission had poor outcome. Reduced serum potassium levels also had significant association with the need for ventilator support. Therefore, serum potassium can be used as a predictive marker of severity in organophosphorus poisoning. This can help in early triage of patients and will be helpful in reducing mortality and morbidity. KEYWORDS Organophosphorus Compound Poisoning, Serum Potassium, POP Scale

An Antidote Screening System for Organophosphorus Poisoning Using Zebrafish Larvae.

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.

Red cell distribution width as a predictor of severity and outcome of acute organophosphorus poisoned cases admitted to Poison Control Center Ain Shams University Hospitals (A prospective study)

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.

Correlation of Oxidative Stress to Severity of Acute Organophosphorus Poisoning

Organophosphorus compounds may induce oxidative stress leading to generation of free radicals and alterations in antioxidant and scavengers of oxygen free radicals. The present study included one hundred and sixteen patients who had organophosphorus (OP) poisoning of 3-5 hours duration from the time of consuming the poison. The study focused to elucidate the role of free radicals in organophosphorus toxicity by estimation of various oxidative stress markers. The results of the study suggest significant alteration of these oxidative stress markers which in turn suggests significant free radical generation due to OP poisoning. This may be due to overuse failure of the antioxidant defence system secondary to excessive reactive oxygen species production. The study also indicated that the incidence of poisoning was more common among males. Overall, the study found that accidental poisoning was far less than suicidal cases with homicidal cases being the rarest. Most of the patients belonged to rural areas. Keywords: organophosphorus, oxidative stress.

The Possible Role of Neuron Specific Enolase and Neurofilament Light Protein as Markers for Organophosphorus-induced Neurotoxicity

Background: Acute organophosphorus (OP) poisoning is a common toxic emergency all over the worldespecially in the developing countries as Egypt. Neurological damage occurs after exposure to thesecompounds can lead to respiratory failure and death. Thus, it is important to identify the severity of poisoningand predict the need to ventilation support or death.Methods: A prospective study that included 50 adult patients presented with neurological manifestationsafter acute OP poisoning admitted to the ICU of Poison Control Center of Ain shams university (PCC-ASU),and 25 healthy volunteers. Meusering levels of Neuron Specific Enolase (NSE) and Neurofilament Light(NFL) protein and correlate this with severity according to APACHE II score and outcome of patients.Conclusion: There was a significant difference between cases and controls among levels of NSE and NFLprotein, also there was a significant correlation between NSE and NFL protein levels and prediction of bothM.V. need and mortality, so NSE and NFL protein can be used as markers for neurological damage afterexposure to OP compounds.

English

BACKGROUND Organophosphorus (OP) compounds are insecticides which are widely used in agriculture. Acute organophosphorus poisoning is one of the important causes of morbidity and mortality in developing countries like India. Considering financial burden / availability of tests, we need cheap and easily measurable biomarkers for predicting prognosis / complications in a limited resource country, like India. We intend to correlate the levels of serum amylase in patients admitted with acute organophosphorus poisoning for predicting the severity of acute OP poisoning and also to correlate serum amylase association with respiratory failure. METHODS This was a prospective observational study. Total of 94 patients of OP poisoning admitted to KIMS Hospital, Hubballi between January 1st 2017 and December 31th 2017 were studied. Detailed history, clinical examination, and lab investigations like pseudocholinesterase, serum amylase and other relevant investigations were carried out. Peradeniya OP poisoning scale was applied to all the study subjects and the severity of OP poisoning was graded as mild, moderate, severe. Data obtained was analysed by different statistical methods. RESULTS OP poisoning was more common in adults of age group between 20 – 30 years, Incidence was more in male patients and mortality rate was 12.8 %. Mean values of serum amylase negatively correlate with pseudocholinesterase levels and it was statistically significant. Correlation between the severity of OP poisoning (based on Peradeniya score) and biochemical parameters like pseudocholinesterase, serum amylase was statistically significant. CONCLUSIONS The correlation between the severity of OP poisoning and biochemical parameter– serum amylase, was statistically significant and it was useful in predicting the development of respiratory failure. Pseudocholinesterase and serum amylase were also useful to predict the outcome of the patient. KEYWORDS Amylase, Organophosphorus Poisoning, Pseudocholinesterase, Peradeniya Score