Diagnosis Of Organophosphate Poisoning Research Articles

The Association Between QTc-Interval and Blood Glucose with Plasma Acetylcholinesterase in Organophosphate (OP)-Poisoned Patients

Background: Organophosphate (OP) poisoning ranks among the leading causes of poisoning, morbidity, and mortality in developing countries due to its relatively high prevalence and potentially grave outcomes. Consequently, it is crucial to identify an easily accessible and cost-effective marker that can be utilized across healthcare facilities. Objectives: This study aimed to explore the relationship between the QTc interval and blood glucose levels with serum cholinesterase levels in patients poisoned by organophosphates. Methods: The sample consisted of all patients admitted with OP poisoning to a Northwest Poisoning Center in Iran during 2016 and 2017. Diagnosis of OP poisoning was confirmed through patient history, physical examination, or the measurement of acetylcholinesterase levels. Data collected were analyzed using SPSS software version 25. Results: Out of 238 patients, 104 remained after applying exclusion criteria and were included in the study. The mean age of these patients was 30.81 ± 15.04 years. A statistically significant negative correlation was found between average blood glucose and serum cholinesterase levels (P = 0.046, Pearson Correlation = -0.196). Furthermore, patients with abnormal QTc intervals exhibited significantly lower serum cholinesterase levels (P < 0.001). Conclusions: The findings indicate a significant association between QTc intervals and blood glucose levels with serum cholinesterase levels. Serum cholinesterase levels decreased with an increase in QTc intervals and blood glucose levels. Specifically, patients with a QTc interval greater than 440 milliseconds or random blood glucose levels above 200 milligrams per deciliter showed significantly lower serum cholinesterase levels.

The relationship of hs-CRP, vitronectin and NT-proBNP serum levels with the extent and severity of cardiac complications in patients with organophosphate pesticide poisoning.

Acute organophosphate poisoning kills tens of thousands of people annually around the world. These substances are widely used as insecticides in homes, industry, and agricultural environments. Due to the ease of access, they can cause accidental or intentional risks of exposure through the skin or respiratory contact. This study aimed to evaluate the serum levels of hs-CRP, Vitronectin, and NT-proBNP and their relationship with the extent and severity of cardiac complications in patients with organophosphate pesticide poisoning. In this descriptive-comparative study, 160 patients were studied with acute organophosphate poisoning. Also, for better comparison, 40 healthy individuals participated in this study. Diagnosis of organophosphate poisoning was based on clinical findings of serum butyrylcholinesterase levels. The hs-CRP measurement was performed by an autoanalyzer (Abbott, model Alcyon 300, USA) with the ELISA hs-CRP kit (The apDia Company, Belgium). Vitronectin (VN) measurements were performed by ELISA method and Glory science human VN kit with Catalog No: 11668. NT-ProBNP serum levels were analyzed by ProBNP assay kit (Roche, Germany) by ECLIA method using Elecsys 2010 Analyzer. The most important variables studied in this study were the electrical activity and conduction system of the heart, PR distance, QTC interval, and T-wave changes. In this study, most of the patients were women and girls (60.78%). The highest percentage of organophosphate poisoning was in the age group of 15-24 years (37.25%). In most cases (78.43%), poisoning was intentional or suicidal. Evaluation of electrophysiological abnormalities of the heart showed that 89 patients (55.62%) had long QTC interval (>450 msec), 43 cases (26.87%) had possible long QTC (431-450 msec), and 28 cases (17.5%) had normal QTC (<430 msec). Only 9.37% of cases (n = 15) showed an increase in P-R distance, which is characteristic of the first-degree ventricular atrial block. Sinus bradycardia occurred in 57 cases (35.62%) and sinus tachycardia in 43 cases (26.87%); in 60 cases (37.5%), the pulse rate was normal. Smooth T-wave changes were observed in 9.8% of patients and reverse T-wave was observed in 17.6%. A long T-wave was not reported in any case. In only two cases (1.25%) was grade 1 ventricular atrial block and grade 2 and 3 blocks were not observed. In general, there was a significant difference in the hs-CRP, vitronectin, and NT-proBNP serum levels between the patient and control groups in all studied variables. These parameters were also related to the extent and severity of the disease.

Clinical Evaluation of Significance of 25(Oh)D Levels in Patients with Organophosphorus Poisoning

Introduction: Organophosphate (OP) pesticide poisoning is a major challenging public-health problem in developing countries. Vitamin D deficiency is pandemic, yet it is the most under-diagnosed and under-treated nutritional deficiency in the world and it has been reported to be clinically correlated with psychiatric illness and manifestation of severe systemic inflammatory response syndrome like ARDS. Thus vitamin D deficiency may affect clinical course and outcome in cases of OPP. Aim: To evaluate status of 25 hydroxyvitamin D (25(OH)D) level in OP poisoning and its correlation with outcome of such patients. Materials and Methods: Serum 25(OH)D levels were measured at the time of hospitalization by electro-chemiluminescent Assay in 96 patients (76 male and 20 female) suffering from OP poisoning. Diagnosis of OP poisoning was made by history of poisoning including container of the poison brought by patient’s relative, clinical examination and measurement of serum butyrylcholinesterase activity. All patients were evaluated as per Performa and follow up till discharge. Results: Mean level of 25(OH)D in our cases was 24.57±9.91ng/ml and 66.7% had low levels of 25(OH)D. Our study shows linear relationship between 25(OH)D level and duration of hospital stay. All cases of OP poisoning who developed severe manifestations like ARDS, Intermediate syndrome (IMS) were having significant 25(OH)D deficiency. Our study also shows lower levels of 25(OH)D were associated with poor outcome (11.27±3.21vs 27.02±8.54, p&lt;0.001). Conclusion: Vitamin D deficiency in OP poisoning is associated with longer hospital stay, more requirement of ventilator support and high prevalence of complication (ARDS and IMS) and poor outcome. Awareness of 25(OH)D level in patients with OP poisoning may be important to improve outcome.

Activity of cholinesterases in a young and healthy middle-European population: Relevance for toxicology, pharmacology and clinical praxis

The activity of human cholinesterases, erythrocyte acetylcholinesterase (AChE; EC 3.1.1.7) and plasma butyrylcholinesterase (BChE; EC 3.1.1.8) represents an important marker when monitoring exposure to pesticides/nerve agents, and may also be used in occupational medicine in diagnosis and prognosis of some diseases. In this study “normal/baseline” AChE and BChE activity has been investigated in a young and healthy population, with subsequent evaluation of several intra-population factors including sex, age (categories 18–25, 26–35 and 36–45 years old) and smoker status.The modified Ellman's method was used for enzyme activity assessment in 387 young and healthy individuals (201 males and 186 females aged 18–45). A significant inter-sexual difference in AChE and BChE activity was found (AChE: 351±67 for males and 377±65 for females, (μmol/min)/(μmol of hemoglobin), p<0.001; BChE: 140±33 for males and 109±29 for females, μkat/l, p<0.001; mean±SD). Despite the finding that mean AChE activity somewhat decreased whereas BChE activity grew within the age categories of the tested subjects, no significant effect of age on cholinesterase activity was found (p>0.05). Smoking influenced cholinesterase activity – AChE activity in smokers was elevated (approx. 3% in males; 8% in females) relative to that in non-smokers (p<0.05). Smoking was found not to have any effect on BChE activity.Reference values based on confidence intervals for AChE and BChE activity were established. The presented results might be useful in routine clinical practice where the monitoring of blood AChE and plasma BChE activity is crucial for prognosis and diagnosis of organophosphate poisoning, in occupational medicine and in relevant mass casualty scenarios.

A Study of Prognostic Predictors in Organophosphate Poisoning in a Critical Care Unit of a Medical College of Andhra Pradesh

Background : Diagnosis of organophosphate poisoning is purely clinical, through some biochemical test will help in diagnosis of organophosphate poisoning. There is no specific prognostic predictor in terms of duration of hospital stay and course of recovery. Good prognostic predictor can guide the clinician for further treatment. Objectives : 1. To study the prognostic predictor with special reference to duration of the hospital stay. 2. To predict duration of hospital stay from initial clinical sign and biochemical parameters. Materials and method : Around 240 patients of organophosphate poisoning who were admitted in the critical care unit in the hospital from January 2007 to January 2010 were examined, investigated and interview with help of semi structured proforma. The initial clinical presentation and biochemical parameter were recorded for the study. Result: Patients who presented clinically with severe symptoms at the time of admission, increased leucocytes counts, electrolytes and low serum acetyl choline esterase level, those patients stayed more days in ICU and most of the patients required ventilator supports. Conclusio n: It is very important to predict and select the case by detailed clinical history and biochemical examination, so that better treatment and reduction of the mortality can be achieved.

Acute Abdomen Associated with Organophosphate Poisoning

Background Pesticides are extensively used in developed and developing countries. Objectives The present study was designed to evaluate the clinical course of patients with carbamate or organophosphate poisoning presenting to a University-based emergency department (ED). Methods All consecutive patients admitted to our ED due to intoxication with carbamate or organophosphate compounds over a 2-year period were enrolled prospectively. Results A total of 49 consecutive patients (26 females) were diagnosed with carbamate or organophosphate poisoning in the 24-month study period. The mean age of the patients was 32 ± 13.1 years (range 16–70 years). Signs and symptoms most frequently noted in patients with organophosphate or carbamate poisoning were perspiration, vomiting, and bronchorrhea. Abdominal pain was reported by 65.3% of the patients. Abdominal ultrasonography was performed in 22 patients who complained of abdominal pain as a leading symptom. Among these, 63.6% were found to have abdominal free fluid. Pancreatitis and peritonitis developed in one case. Atropine treatment was administered for approximately 24–36 h, with a mean total dose of 13.75 ± 6.75 mg. Pralidoxime was administered to 70.9% of patients with organophosphate poisoning, but was not used in patients intoxicated with carbamates. Endotracheal intubation and mechanical ventilatory support were required in 14.2% of the patients. Mean duration of mechanical ventilation was 3.7 ± 2.2 days. The overall mortality rate was 10.2%. Conclusion Patients with a diagnosis of organophosphate poisoning should be screened for acute abdomen. The findings in our study suggest that these patients should undergo routine abdominal ultrasonography, especially in cases with abdominal pain along with other abdominal complaints.

Acute Organophosphate Poisoning in University Hospital Emergency Room Patients

In the present study, we evaluated patients who were admitted to our emergency department with a diagnosis of organophosphate poisoning and discussed clinical, social and demographic features. A retrospective study was conducted with organophosphate poisoning patients admitted to our emergency department between January 1995 and December 2004. Data regarding the age, sex, occupation, type of agent, route of poisoning, clinical effects of cholinergic overactivity, laboratory findings, and mortality rate were obtained from the patient files. During the study period, 220 patients who had organophosphate poisoning with a known agent were admitted to the ED. The estimated mean admission time to the ED after the exposure was 3.9 +/- 3.1 (1-14) hours. There were 131 (59.5%) female and 89 (40.5%) male patients. The most affected age group was 15-24 years (40.5%), in both sexes. Oral ingestion (86.5%) was found to be the most common route of poisoning. The most frequent reason for poisoning was attempted suicide (75.9%). The most common organophosphate compounds exposed were dichlorvos, diazinon and parathion-methyl. The most frequent clinical signs were miosis, respiratory system findings, tachycardia, loss of consciousness, and hypertension. Twenty patients (9.1%) died due to sudden respiratory and cardiac arrest (45%), respiratory failure (25%), CNS depression (5%) and septic shock (25%). We think that the appropriate use of these compounds, instruction of the public about their harmful effects and restriction of their uncontrolled sales by legal regulations can reduce the incidence of organophosphate poisoning.

Long QT and ST-T change associated with organophosphate exposure by aerial spray

The relation between the electrocardiographic manifestation and the subjective symptoms accompanying organophosphate pesticide exposure caused by aerial spray was investigated. The study included 39 patients with a diagnosis of organophosphate poisoning, who visited A-clinic within 24 h of exposure to aerial spray of organophosphate pesticide in Gumma Prefecture, from July 2001 to September 2001. Ages ranged from 3 to 82 years. Thirty-five patients were female. Three were diagnosed as severe, 11 moderate, and 25 mild, judged from the score of subjective symptoms. Electrocardiographic abnormalities were bradycardia (<50) 2; prolonged PQ interval 4; prolonged QTc interval (>430 ms) 22; nonspecific ST-T change 35; supraventricular arrhythmia 13; and ventricular premature complex with R on T 1. Prolonged QTc interval developed in 2–3 severe cases, 4–11 moderate cases, and 16–25 mild cases. QT prolongation, ST-T change and arrhythmia were detected for some patients exposed to organophosphate by aerial spray.

Diagnostic aids in organophosphate poisoning.

Excerpt A recent report (1) of the undiagnosed, untreated death of 86% of patients with acute parathion intoxication underscores the need for the rapid diagnosis of organophosphate poisoning. The i...