Serum Cholinesterase Levels Research Articles

Preoperative serum cholinesterase levels as a risk factor of postoperative complications for the elderly undergoing emergency surgery.

An accurate assessment of preoperative malnutrition in the elderly is critically important to predicting postoperative complications. The aim of this study is to evaluate the predictive value of the preoperative serum cholinesterase levels as a risk factor for postoperative complications in the elderly who have undergone emergency surgery. The study comprised 60 elderly patients who had undergone emergency major gastroenterological surgery. We retrospectively investigated the relationship between the preoperative serum cholinesterase levels and postoperative complications (Clavien-Dindo classification ≥ II). Univariate and multivariate analyses were performed to evaluate the risk factors for postoperative complications. Thirty-three patients (55%) developed postoperative complications. According to the univariate analysis, hemoglobin (P = 0.018), albumin (P = 0.0036), cholinesterase (P < 0.001), C-reactive protein (P = 0.043), prognostic nutritional index (P = 0.0050), the Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (P < 0.001) and operation time (P = 0.042) were identified to be risk factors for postoperative complications. According to the multivariate analysis, low preoperative serum cholinesterase levels were found to be an independent risk factor for postoperative complications (P = 0.029). In the extremely elderly (80-95years), the cholinesterase-low group had a higher complication rate compared to the cholinesterase-high group (77.8 vs 43.8%, P = 0.028). The preoperative serum cholinesterase levels may be a risk factor for postoperative complications in elderly patients after emergency surgery, thus suggesting the significance of cholinesterase in evaluating the nutritional status.

Characteristics of adrenal insufficiency in hemodialysis patients

BackgroundAdrenal insufficiency causes abnormal subjective symptoms such as general fatigue, signs such as hypotension, and abnormalities such as hypoglycemia and leads to poor prognosis. However, all these are also observed in hemodialysis (HD) patients without adrenal insufficiency. The morphology of the adrenal glands in HD patients with adrenal insufficiency is unclear. Therefore, this study was performed to clarify the characteristics of adrenal insufficiency in HD patients.MethodsSeventeen HD patients who had abnormal subjective symptoms and test results indicating adrenal insufficiency and whose serum cortisol levels were less than 18 μg/dL were recruited.ResultsSeven HD patients were diagnosed with adrenal insufficiency. No significant differences were found about abnormal subjective symptoms and images between patients with and without adrenal insufficiency. The levels of serum cortisol and serum cholinesterase were significantly lower in patients with adrenal insufficiency than in those without adrenal insufficiency. A plasma cortisol level of 8.45 μg/dL showed the highest sensitivity and specificity in the receiver operating characteristic curve. The serum cortisol levels were significantly and negatively associated with the plasma ferritin levels in patients with adrenal insufficiency. Multiple linear regression analyses revealed that the serum cortisol levels showed a significant negative association with the plasma ferritin levels after adjustments.ConclusionsIt is difficult to infer adrenal insufficiency in HD patients by subjective symptoms and images of the adrenal glands. Adrenal insufficiency correlates with nutritional and inflammatory status, and the levels of serum cholinesterase and plasma ferritin might reflect their corresponding status.

Cholinesterase is Associated With Prognosis and Response to Chemotherapy in Advanced Gastric Cancer.

Background: Cholinesterase (CHE) is a routine serum biomarker in gastric cancer (GC). However, little research has been done on its clinical value in advanced GC. In addition, it is not clear whether it can be used as biomarker for the response and prognosis of advanced GC patients. Methods: Between Jan. 2013 and Dec. 2016, a total of 150 patients with advanced GC treated with first-line chemotherapy were admitted to Changzhou Tumor Hospital Affiliated to Soochow University. We retrospectively identified serum CHE level on the day before chemotherapy and at the end of chemotherapy and abstracted clinicopathologic features and treatment outcomes. Univariate and multivariate survival analyses were performed to assess the relationship between serum CHE levels and progression-free survival (PFS) and overall survival (OS). Results: A total of 150 advanced GC patients were included and divided into serum level ≥5,000 IU/L and serum level <5,000 IU/L. CHE level lower than 5,000 IU/L was associated with poorer PFS (HR, 1.60; 95% CI, 1.141–2.243; p = 0.006), poorer OS (HR, 1.76; 95% CI, 1.228–2.515; p = 0.002) and trend of poorer response (HR, 0.56; 95% CI, 0.272–1.129; p = 0.104). In univariate and multivariate logistic regression analysis, only liver metastasis and PS score were significantly associated with objective response (p < 0.05). The medium PFS was 8.0 months in patients with post-treatment CHE increased vs. 3.8 months in patients with CHE decreased after chemotherapy (HR, 1.82; 95% CI 1.28–2.57; p = 0.0002). The medium OS was 13.1 months in patients with increased post-treatment CHE vs. 8.1 months in patients with decreased post-treatment CHE (HR, 1.87; 95% CI 1.29–2.71; p = 0.0002). Conclusion: Advanced GC with CHE levels below 5,000 IU/L was significantly associated with poor PFS and OS. The results suggested that CHE analysis before chemotherapy was a promising prognostic marker for advanced GC.

English

BACKGROUND Organo phosphorous compound poisoning is one of the most common suicidal poisonings in India. The various clinical entities that determine the clinical course and outcome in the ICU of OPC poisoning patient are type of the compound and dose of poison. Delayed presentation and multi-organ failure are some of the major factors that decide the outcome of the patient. This study was conducted to assess the clinical outcome of patients with OPC poisoning on assisted ventilation and assess the various factors that determine the outcome. METHODS A prospective observational study was conducted for a period of 6 months at a government tertiary care hospital in Chennai. All patients with history and clinical signs of OPC poisoning requiring mechanical ventilation for respiratory support were included as our study subjects. Outcome of patients was measured in terms of either recovery or death and factors influencing the outcome such as type of OPC compound, amount consumed, onset and duration of respiratory muscle weakness and pseudocholinesterase levels were considered. RESULTS In the 172 subjects, 108 (62.7 %) patients were successfully extubated from mechanical ventilator and 64 (37.2 %) patients expired. Patients aged more than 40 years, patients who consumed methyl parathion with quantity of poison more than 50 ml, patients with serum cholinesterase levels less than 500, patients who were atropinised for more than 3 days and who were on mechanical ventilation for more than 3 days were the factors found to have a statistically significant association (P &lt; .05) for causing death among patients with OPC poisoning. CONCLUSIONS The mortality among the OPC poisoning patients who were on mechanical ventilation was found to be very high. Early resuscitation of patients with OPC poisoning might reduce the morbidity and mortality. KEYWORDS Organo-Phosphorous Compound Poisoning, Mechanical Ventilation, Clinical Outcome

Glycemic status as a predictor for the outcomes in patients with acute organophosphorus pesticides poisoning

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.

Clinical outcome of cardiac surgery in patients with remitted or active hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is one of the most common primary cancers worldwide. HCC has unique characteristics such as co-existing chronic liver damage and a high recurrence rate. A negative impact on the surgical outcome due to these backgrounds could be expected. We aimed to evaluate the clinical outcomes of cardiac surgery in these patients. Between January 2000 and December 2019, 16 patients with remitted cancer and 5 patients with active HCC who underwent open heart surgery were studied. The clinical data were retrospectively evaluated from hospital records. Follow-up information was collected via telephone interviews. The major cause of HCC was viral hepatitis. Eighteen patients (86%) were classified as having Child-Pugh class A cirrhosis. The mean model of end-stage liver disease (MELD) score was 7.2 ± 5.2. There was no 30-day mortality. During follow-up, 11 patients died due to HCC. The 1-, 3-, and 5-year survival rates were 80.0, 42.5, and 22.3%, respectively. A univariate analysis identified a higher preoperative MELD score and lower serum cholinesterase levels as prognostic factors for long-term survival. We could safely perform cardiac surgery in selected patients with remitted and active HCC. The postoperative life expectancy of these patients was limited but acceptable.

Serum C-reactive protein, cholinesterase and prealbumin are correlated with prognosis of severe coronavirus disease 2019 patients

Objective: To retrospectively analyze the relationship between serum C-reactive protein (CRP), serum cholinesterase (ChE), prealbumin (PA) and mortality in severe patients with coronavirus disease 2019 (COVID-19). Methods: During the period from January 29 to March 30, 2020, a total of 344 COVID-19 patients were admitted to west branch of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. One-hundred and ninety-two patients were diagnosed with common type and excluded, and 34 patients were transferred to LeiShenShan or other medical units. The remaining 118 patients were severe cases, and 18 cases were excluded due to incomplete data. A total of 100 severe COVID-19 patients were finally collected. According to the outcome, the patients were divided into death group (37 cases) and survival group(63 cases), and the levels of serum CRP, ChE and PA were compared. Statistical analysis were performed by SPSS25.0. Results: There were 53 male patients in this study. The level of CRP in death group was significantly more elevated compare to the survival group [(95.72±39.56) mg/L vs. (22.21±20.75) mg/L, P<0.01]. On the contrary, serum ChE in death group was remarkably decreased [(5 082±1 566) U/L vs. (7 075±1 680) U/L, P<0.01]. Also, serum PA in death group was significantly lower [(86.18±47.94) mg/L vs. (167.40±57.82) mg/L, P<0.01]. Univariate analysis showed that CRP and PA had an impact on the survival of critical patients, but multivariate Cox regression analysis suggested that CRP was the independent factor affecting the survival of critical patients. Conclusions: CRP is generally elevated in severe patients with COVID-19, and serum ChE and PA accordingly decrease. CRP and PA have influence on patients' survival, but only CRP demonstrates predictive value for prognosis in critical patients with COVID-19.

Risk factors for peritoneal dialysis withdrawal due to peritoneal dialysis-related peritonitis

BackgroundPeritoneal dialysis has become commonly used for renal replacement therapy; however, some patients withdraw from peritoneal dialysis due to complications, including peritoneal dialysis-related peritonitis, resulting in the low number of patients on peritoneal dialysis. Risk factors for peritoneal dialysis withdrawal due to peritoneal dialysis-related peritonitis are less certain. This retrospective study aimed to investigate these risk factors. MethodsWe retrospectively analyzed clinical characteristics, laboratory data, and causative microorganisms of 204 episodes of peritoneal dialysis-related peritonitis between 2007 and 2018 at our institution. ResultsOf the 204 episodes, 38 resulted in withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis. The number of peritonitis episodes per patient-year and the incidence of cardiovascular disease were significantly higher in the withdrawal group. Similarly, this group had low levels of serum creatinine, urea nitrogen, serum albumin, alanine aminotransferase, cholinesterase and high C-reactive protein, and second dialysate cell counts after antibiotic administration. Multivariate logistic regression analysis revealed that serum albumin (odds ratio: 0.465; 95% confidence interval: 0.249–0.868; P=0.016) and cardiovascular disease (odds ratio: 2.508; 95% confidence interval: 1.184–5.315; P=0.016) exhibited significant differences. ConclusionsThe results of this study suggest that hypoalbuminemia and the presence of cardiovascular disease were independent risk factors for withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis.

Serum cholinesterase as a prognostic biomarker for acute heart failure.

The association between serum cholinesterase and prognosis in acute heart failure (AHF) remains to be elucidated. We investigated the serum cholinesterase level at discharge from hospitalization for AHF and its association with clinical outcomes in patients with AHF. Among 4056 patients enrolled in the Kyoto Congestive Heart Failure multicentre registry, we analysed 2228 patients with available serum cholinesterase data. The study population was classified into three groups according to serum cholinesterase level at discharge: low tertile (<180 U/L, N = 733), middle tertile (≥180 U/L and <240 U/L, N = 746), and high tertile (≥240 U/L, N = 749). Patients in the low tertile had higher tricuspid pressure gradient, greater inferior vena cava diameter, and higher brain natriuretic peptide (BNP) levels than those in the high tertile. The cumulative 1-year incidence of the primary outcome measure (a composite endpoint of all-cause death and hospitalization for HF) was higher in the low and middle tertiles than in the high tertile [46.5% (low tertile) and 31.4% (middle tertile) vs. 22.1% (high tertile), P < 0.0001]. After adjustment for 26 variables, the excess risk of the low tertile relative to the high tertile for the primary outcome measure remained significant (hazard ratio 1.37, 95% confidence interval 1.10-1.70, P = 0.006). Restricted cubic spline models below the median of cholinesterase demonstrated incrementally higher hazards at low cholinesterase levels. Low serum cholinesterase levels are associated with congestive findings on echocardiography, higher BNP, and higher risks for a composite of all-cause death and HF hospitalization in patients with AHF.

The Role of Cholinesterase in Differential Diagnosis between Gastric Cancer and Benign Gastric Diseases.

Gastric cancer is the fifth most common malignancy worldwide. In early stages, no obvious symptoms are usually observed in gastric cancer patients, and it is especially hard to distinguish gastric cancer from benign gastric diseases, resulting in delayed diagnosis and poor prognosis. Common biomarkers of gastric cancer, such as CEA and CA19-9, are also elevated in benign diseases. There is an urgent need to develop a convenient and reliable biomarker for differentiating between gastric cancer and benign gastric diseases. This study retrospectively analyzed the data of 126 patients, including 73 gastric cancer patients and 53 benign gastric disease patients. Patient characteristics collected for analysis included age, gender, laboratory data, and clinical staging. Unpaired t-test was used to check the difference of cholinesterase level between the gastric cancer group and the benign gastric disease group. Kruskal Wallis H test and Mann-Whitney U test were used to check the difference of cholinesterase level among different stage groups. Receiver operating characteristic (ROC) curve was used to assess whether cholinesterase level can be used as a biomarker for differentiating between gastric cancer and benign gastric diseases. Serum cholinesterase level was decreased significantly in the gastric cancer group in comparison to that of the benign gastric disease group (p < 0.001). In addition, cholinesterase level of stage IV patients was significantly lower than stage I patients. ROC curve analysis revealed that with a cutoff of 5,969.00 U/L, cholinesterase level showed an area under the curve of 0.819 (95% CI 0.732 - 0.905, p < 0.001) in differentiating between gastric cancer and benign gastric diseases. No significant difference in the levels of CEA and CA19-9 was observed between gastric cancer patients and benign gastric disease patients. This study indicated that serum cholinesterase level could be considered as a potential biomarker for differentiating between gastric cancer and benign gastric diseases.

Decreased Serum Cholinesterase Activity- A Reliable Diagnostic Aid for Tuberculosis

Introduction: Siderophore, the low molecular weight ferric iron chelator, is secreted extracellularly by Mycobacterium tuberculosis, an obligate aerobe. The pathogenic mycobacteria need iron as co-factor for the extracellularly secreted enzyme Superoxide Dismutase (SOD) for its pathogenicity as well as it requires iron for its metabolic functions like reduction of oxygen for synthesis of Adenosine Triphosphate (ATP), etc. The termination of impulse conduction is endorsed by the rapid hydrolysis of Acetylcholine (ACh) by Acetylcholinesterase (AChE) in the central as well as peripheral nervous system (cholinergic pathway). The inhibitors to Cholinesterase (ChE) might lead to accumulation of ACh, hyper stimulation of nicotinic and muscarinic receptors and also disruption of neurotransmission. Possibility of an inhibitor substance for AChE in Tuberculosis (TB) patients interestingly correlates with the symptom of night sweating in those subjects. Aim: To assay the level of serum ChE in normal control, lung disease control and tubercular subjects;circumvent the serum ChE level as a diagnostic potential in TB at an early stage. Materials and Methods: The study was conducted on total 124 subjects, and were divided into three groups: Group 1: normal control (n=31), Group 2: lung disease control (n=31) and Group 3: patients suffering from TB {3A: pulmonary TB (n=31) and 3B: extrapulmonary TB (n=31)}. Serum ChE activity for all the subjects were measured according to the method of Hestrin S. Serum ChE level was assayed for group 3 subjects after additional one month’s anti-TB drug treatment and also for group 2 subjects after one month with usual treatment. The level of significance was assessed using Student’s t-test. Results: There was a significant inhibition of serum ChE activity in both pulmonary and extrapulmonary TB patients in comparison to that of in normal control as well as lung disease control subjects (p&lt;0.01). With the anti-tubercular drug therapy for one month, there was significant recovery in the serum ChE activity in pulmonary as well as extrapulmonary tubercular subjects (p&lt;0.01). Conclusion: It appears that the high level of hydroxamate type of siderophores (secreted by Mycobacterium tuberculosis for acquiring iron) might form ACh ferric hydroxamate complex binding more strongly with serum ChE resulting in inhibition of serum ChE activity in tubercular subjects. With anti-tubercular drug therapy, there was decrease in serum ACh ferric hydroxamate complex level resulting in recovery of serum ChE activity.

Correlation of Serum Amylase, Lipase and Creatine Kinase with Severity of Organophosphate Poisoning- A Cohort Study

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).

Факторы риска, иммунологические механизмы и биологические маркеры тяжелого течения COVID-19 (обзор исследований)

The article presents the conducted analysis of risk factors, immunological mechanisms and biological markers of the severe COVID-19 course. Official statistical data and scientific publications on the problem of assessing the risk of severe COVID-19 course were used in this analysis. It was found that elderly age, male gender, the presence of comorbidity (diabetes mellitus, cardiovascular, respiratory, renal and autoimmune diseases, and immunodeficiency conditions) increase the risk of an adverse outcome in COVID-19. The following immunological mechanisms of the disease manifestation and prognostic significance of different biological markers were determined: elevated levels of SAA, C-reactive protein, procalcitonin, IL-6, urea, creatinine, direct bilirubin, LDH, D-dimer and serum cholinesterase. Lymphopenia (abnormally low level of lymphocytes) and neutrophil-to-lymphocyte ratio (NLR) are the most common described prognostic markers in COVID-19. Thrombocytopenia and elevated D-dimer levels may indicate coagulopathies in patients with COVID-19 and predict morbidity and mortality even at the onset. Thus, the determination of risk factors and levels of inflammatory markers (commonly found in severe cases of COVID-19) should be used to choose the right treatment tactics to improve the clinical outcome. KEYWORDS: COVID-19, risk factors, immunological mechanisms, comorbidity, biological markers. FOR CITATION: Bilichenko T.N. Risk factors, immunological mechanisms and biological markers of severe COVID-19 course (study overview). Russian Medical Inquiry. 2021;5(5):237–244 (in Russ.). DOI: 10.32364/2587-6821-2021-5-5-237-244.

Serum Cholinesterase Level as a Marker of Systemic Low-Grade Inflammation in Isolated Systolic Hypertension: A Cross-Sectional Study

Background: Autonomic regulation of local and systemic inflammation through the ‘cholinergic anti-inflammatory pathway’ may have role in persistence of low-grade systemic inflammation in isolated systolic hypertension (ISH). The augmented activity of the enzyme cholinesterase (ChE) leads to degradation of the main anti-inflammatory neurotransmitter ‘acetylcholine’ of this pathway. Despite the role of inflammation in hypertension, serum level of cholinesterase enzyme has not been determined till now in ISH. The study aimed to measure the serum levels of inflammatory marker ChE in comparison to high sensitivity C-reactive protein (hsCRP) to predict the presence of low-grade systemic inflammation and their correlation with blood pressure in ISH patients.&#x0D; Methods: A cross-sectional study was conducted in ISH patients (n=30; mean age, 51.00±1.24 years; male/female (M/F) number=18/12). Age and sex matched healthy subjects (n=30, mean age, 51.86±1.40 years; M/F=16/14) were taken as control. Subjects were divided into three groups based on hsCRP levels; group I (healthy: hsCRP≤1.0mg/L), group IIa (patients with mild inflammation: hsCRP≤1.0mg/L), group IIb (patients with moderate to severe inflammation: hsCRP 1.0-10.0mg/L). Overnight fasting blood samples were collected and ChE and hsCRP were assessed using Cholinesterase Liqui-Check and hsCRP turbi-latex diagnostic kits, respectively.&#x0D; Results: hsCRP and ChE levels were found significantly high in hypertensive patients than in healthy subjects (p&lt;0.05). In patients at mild stage of inflammation, there was an increase in both ChE and hsCRP, but not linearly as they had no significant correlation with each other. But at moderate to severe inflammation stage, there was a linear rise in both hsCRP and ChE levels. SBP, DBP and PP were significantly correlated with both ChE and hsCRP in patients (p&lt;0.01). Moreover, as the SBP was increased from grade I to II, both hsCRP and ChE levels were also increased.&#x0D; Conclusion: Many factors interplay in propagating inflammatory cascade in ISH and all biomarkers of inflammation may not elevate at same point in time and in linear manner. ChE may act as a marker of low-grade systemic inflammation but its comparison must be tested against a standard marker such as hsCRP in large scale studies for finding its true significance in predicting cardiovascular disease risk.

Influence of Serum Cholinesterase Levels on Patients Suspected of Having Stable Coronary Artery Disease.

Objective The serum cholinesterase (ChE) level has been used for the evaluation of the nutritional status in daily practice. It has been reported that the serum ChE level is significantly more elevated in patients with three-vessel coronary disease than in normal subjects. Thus, the aim of this study was to assess the influence of serum ChE levels in patients suspected of having stable coronary artery disease (CAD). Methods The relationship between myocardial ischemia and the serum ChE levels was evaluated in 559 consecutive patients suspected of having stable CAD without a history of cardiovascular disease admitted to our hospitals to undergo coronary angiography. Results This study revealed that, in patients suspected of having stable CAD, 1) the frequency of myocardial ischemia was significantly increased in accordance with the serum ChE levels (p<0.001); 2) higher ChE levels were associated with a higher body mass index (p<0.001) and the co-existence of dyslipidemia (p<0.001), including higher values of low-density lipoprotein-cholesterol (p<0.001) and triglycerides (p<0.001) and serum albumin (p<0.001), as well as a younger age (p<0.001); 3) the specificity and sensitivity of myocardial ischemia were 0.599 and 0.658 at the ChE level of 286 IU/L, respectively; and 4) an increased serum ChE (OR=1.66, p<0.001) was an independent risk factor for myocardial ischemia, in patients suspected of having stable CAD. Conclusion The serum ChE level may be an important diagnostic biomarker in patients suspected of having stable CAD.

Importance of determination of serum cholinesterase level in the diagnostics of intestinal motility disorders in children

Annotation. Chronic colostases are characterized by the absence of independent bowel movements due to disturbance of intestinal contractility and evacuatory function of the large intestine which have a negative influence on the development of an organism. The purpose of the study is to evaluate a possibility of predictive diagnostics of motility disorders of the large intestine in children with chronic constipation due to organic causes. The study is based on the determination of serum cholinesterase level in 67 patients of both sexes (main group) which included 25 children suffering from pathology of aganglionic genesis and 42 patients with non-aganglionic congenital anomalies of the large intestine. The average age of the patients was 11.5±0.8 years. The control group included children without any pathologies of gastrointestinal tract and central nervous system. The quantitative determination of cholinesterase level was performed by the photometric method described by Molander and Friedman. The group of children suffering from large intestine anomalies of non-aganglionic origin showed an increase in serum cholinesterase level by 1.08 times. The group of children with anomalies of aganglionic origin showed an increase in cholinesterase level by 1.15 times. The increase in cholinesterase level in patients suffering from colostases of non-aganglionic origin can be regarded as a prognostic indicator having the signs of a factor of organic origin. The increase in cholinesterase level in patients suffering from disorders of aganglionic origin shows the presence of neurobiological changes which cannot be solved simply by surgical correction of a congenital anomaly of the intestine.

PON1 Q192R Gene Polymorphism and Pesticide Exposure Status of Rice Farmers, Suphan Buri, Thailand

PON1 Q192R (rs662) polymorphism in coding region is conveying differential catalytic activity oforganophosphate. Study was aimed to investigate PON1 Q192R gene polymorphisms in rice farmers alongwith pesticide knowledge and practices; and to evaluate the relationship of gene polymorphisms and serumcholinesterase (SChE) levels. Information of pesticide exposure, knowledge and practices were collectedfrom 50 rice farmers and 50 control respondents by questionnaire interviewing. Each blood sample wasobtained by venipuncture and prepared to serum for SChE activity test by paper test and automatic analyzer;to EDTA blood for genotyping by PCR-RFLP. Exposure status, knowledge and practices on pesticide usewere represented as frequency. Chi-square was used to analyze on the different of personal information;and of polymorphism. Independent t-test was used for comparison of SChE levels. Person correlation wasevaluated relationship between SChE level and genotypes. 60% of rice farmers were used pesticide over10 years. Rice farmers were long-term pesticide exposure with good on pesticide knowledge, howeverpoorly practice. Means of SChE level of both groups were within reference value and significantly different(p = 0.033). Polymorphisms were included wild type (QQ), heterozygote (QR) and homozygote (RR);and were significantly different between rice farmers (high frequency of RR genotype) and control (p =0.02). Relationship of polymorphism and SChE level were negative correlated (r = -0.261; p = 0.031). Thispolymorphism may useful biomarker for chronic pesticide exposure in Thai rice farmer and corresponded todecline of serum cholinesterase; and RR genotype was high risk group.

CYP2D6 (G1934A) Gene Polymorphism in Rice Farmers with Long-term Pesticide Exposure, Suphan Buri, Thailand

CYP2D6 G1934A (rs 3892097) gene polymorphism in coding region is leads to catalytic rate of cytochromeP450 enzyme activity toward xenobiotic, including insecticide. Study was aimed to investigate CYP2D6(G1934A) gene polymorphism in rice farmers along with occupational health risks and behaviors; and toevaluate the relationship of gene polymorphisms and serum cholinesterase (SChE) levels. Cross-sectionalstudy was carried out from June 2019 to February 2020. Data had collected from health service programby U-Thong district health promoting hospital. Gathered information concerning of pesticide exposuresfrom 50 rice farmers and 50 control respondents was conducted by questionnaire interviewing. Eachserum sample was determined SChE activity test by paper test and automatic analyzer; and EDTA bloodwas analyzed genotyping by PCR-RFLP. Chi-square was used to analyze on the different of personalinformation; and of polymorphism. Person correlation was evaluated relationship between SChE level andgenotypes. 60% of rice farmers were used pesticide over 10 years. Means of SChE level of both groupswere within reference value and significantly different (p = 0.033). Polymorphisms were included wild type(GG), heterozygote (GA) and homozygote (AA); and were significantly different between rice farmers andcontrol (p = 0.0001). GA genotype in rice farmers was more frequent and AA genotype was not detected.Relationship of polymorphism and SChE level were negative correlated (r = -0.258; p = 0.009). CYP2D6gene polymorphism may useful biomarker for duties assignments in agricultural workers especially riskgroup (GA genotype).

Occupational Pesticides Intoxication among Agricultural Workers

Background: Pesticide intoxication is a public health problem in many developing countries. Approximately 18.2 per 100 000 agricultural workers worldwide have occupational-related pesticide acute and chronic toxicity symptoms. Objective: This study aimed to investigate the toxic symptoms in pesticide-exposed agricultural workers. Patients and Method: A cross sectional study was conducted on 390 agricultural workers using an interview questionnaire that consists of socio-demographic and exposure data, safety practices and self-reported toxicity symptoms. Physical examination and investigations were done. Results: Among the self-reported toxicity symptoms, cough was the most common acute symptom (59%) while skin problems were the most reported chronic symptoms (11.5%). There was a statistically significant difference regarding age between those with & without blurring of vision [(median, 50 and 39 years respectively) P < .001], muscle spasm [(median, 49 and 40 years respectively) P < .001] and skin problems [(median, 48 & 41 years respectively) P < 0.007]. Regarding duration of exposure, there was a statistical significant difference between those with & without blurring of vision [(median, 10 and 50 years respectively) P < .001], muscle spasm [(median, 10 and 6 years respectively) P < .001] and skin problems [(median, 12 and 6 years respectively) P < .001]. There was statistical significant negative correlation between serum cholinesterase level and age, duration of pesticides exposure and body mass index. Conclusions: The most self-reported pesticides toxicity symptom was cough (59%) while walking problems were the least reported one (5.9%). Age and duration of pesticides exposure are significant risk factors for pesticides toxicity.

Serum Cholinesterases, a Novel Marker of Clinical Activity in Inflammatory Bowel Disease: A Retrospective Case-Control Study.

Background The aim of our study was to investigate whether serum cholinesterase (ChE) levels were associated with inflammatory bowel disease (IBD). Materials and Methods We conducted a retrospective case-control study to clarify the relationship between serum ChE levels and IBD that included 142 patients with ulcerative colitis (UC), 60 patients with Crohn's disease (CD), and 264 healthy controls (HCs). We used ROC curves to evaluate the diagnostic value of serum ChE levels for IBD. Results Substantially lower serum ChE levels were detected in patients with UC than in HCs (6376 U/L versus 8418 U/L, P < 0.001) and in patients with CD than in HCs (5181 U/L versus 8418 U/L, P < 0.001). Additionally, patients with CD displayed significantly lower serum ChE levels than patients with UC (5181 U/L versus 6376 U/L, P < 0.01). We also found that there was a negative association between serum ChE levels and the Crohn's Disease Activity Index (CDAI) score of patients with CD (P = 0.011) and the Simple Clinical Colitis Activity Index (SCCAI) score of patients with UC (P = 0.018). The area under the curve (AUC) for serum ChE for the diagnosis of IBD was 0.826, and the AUCs of serum ChE for the diagnosis of CD and UC were 0.890 and 0.800, respectively. Conclusions Serum ChE levels have important clinical significance in the diagnosis and assessment of clinical activity in patients with IBD, and the cholinergic anti-inflammatory pathway may provide new ideas for targeted treatment of IBD.