Low Cholinesterase Levels Research Articles

Clinical impact of serum cholinesterase level on clinical outcomes in patients with lower extremity artery disease undergoing endovascular treatment

Abstract Background Cholinesterase (ChE) has been used to be an indicator of the protein synthesis ability in the liver and nutritional status. Recent findings have identified low ChE levels as a prognostic factor for heart failure. However, the relationship between serum ChE levels and clinical outcomes in patients with lower extremity artery disease (LEAD) undergoing endovascular treatment (EVT) remains unclear. Purpose This study aimed to investigate the association between pre-procedure serum ChE levels and clinical outcomes in LEAD patients undergoing EVT. Methods The subjects were 283 consecutive LEAD patients who underwent EVT at our University Hospital were included. The primary outcome measure was the cumulative incidence of major adverse cardiovascular events (MACEs) within two years, defined as the composite of all-cause death, non-fatal myocardial infarction, and non-fatal stroke. Results The mean age of the cohort was 72.6±10.6 years, with 67.5% being male. Within two years, 45 patients experienced MACE, and Kaplan-Meier curves demonstrated the cumulative incidence of MACE within two years was 19.3%. Receiver operating characteristic curve analysis showed that serum ChE was a univariable factor that predicted MACE within two years with moderate accuracy (area under the curve = 0.693, 95% confidence interval (CI) 0.615–0.771), with an optimal serum ChE cutoff level of 284 units/L. According to the optimal cut-off value, patients were divided into low ChE (ChE ≤ 284 units/L, N=189) and high ChE ((ChE > 284 units/L, N=94) groups. In the baseline characteristics between the two groups, age was significantly higher in the low ChE groups than in the high ChE group. There were no significant differences in gender, the prevalence of diabetes mellitus, hypertension, and the proportions of previous stroke, and previous myocardial infarction between the two groups. In contrast, the proportions of hemodialysis (HD) and chronic limb-threatening ischemia (CLTI) were higher in the low ChE groups. Kaplan-Meier curves demonstrated a significantly higher cumulative incidence of MACE in the low ChE group compared to the high ChE group (log-rank p < 0.001). In multivariate analysis using Cox proportional hazards models adjusting for risk factors, including HD and CLTI, low ChE group was independently associated with MACE (low ChE group: hazard ratio (HR) 4.24, 95% confidence interval (CI) 1.24-14.49, p=0.021). In addition, Cox proportional hazards models using serum ChE level and HD revealed that patients with both low-ChE and HD showed a greater risk of MACE (HR 15.19; 95% CI 3.60–64.02; P < 0.001) after EVT as compared to patients with neither low-CHE nor HD. Conclusions In LEAD patients undergoing EVT, lower ChE levels were independently associated with a higher risk of MACE, regardless of HD. Assessment of serum ChE level may provide insights into identifying high-risk LEAD patients who need careful attention after EVT.

Aerial Spraying and Its Impacts on Human Health in Banana-Growing Areas of Ecuador.

The present work examines the relationship between aerial spraying and its health impacts on the population living in the banana production areas of Ecuador (the rural sectors of the cantons Milagro and Naranjito, Guayas Province). Objectives: the objectives of this study are to obtain information on sanitation, basic services, and environmental rationality and to interpret the low levels of cholinesterase and prevalent diseases among the population. Methods: the methodology involved a face-to-face questionnaire, the formal authorization of an informed consent document, and venipuncture for cholinesterase tests. The information was processed in the EPI-INFO system 7.2 (statistical software for professionals and researchers dedicated to public health), with the certification of protocols issued by the Bioethics Committee of the Kennedy Hospital Clinic of Ecuador. Results: the results showed that 89.5% of inhabitants do not have access to drinking water, 92.5% do not have a sewage disposal service, 97.50% experience aerial spraying at their homes or workplaces, and 57% have low cholinesterase levels. Additionally, several gastrointestinal, respiratory, neurological, dermatological, and reproductive disorders were detected among the inhabitants. Conclusions: we found that companies in the banana sector have not implemented corporate social responsibility measures. For example, no blood tests are conducted to monitor cholinesterase levels or to track hereditary disorders. Moreover, entities such as the Ministry of Public Health have not taken action to serve this at-risk population.

Serum Cholinesterase, C-reactive Protein, Interleukin 6, and Procalcitonin Levels as Predictors of Mortality in Patients in the Intensive Care Unit.

The prognostic utility of inflammatory markers in survival has been suggested in patients with cancer; however, evidence on their prognostic value in severely ill patients is very limited. We aimed to explore the prognostic value of cholinesterase (ChE), C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) in predicting mortality in patients from the intensive care unit (ICU). Serum levels of ChE, CRP, IL-6 and PCT were measured in ICU patients from December 13th, 2019 to June 28th, 2022. We assessed the predictive power of ChE, CRP, IL-6, and PCT using the receiver operating characteristic (ROC) curves. Furthermore, we evaluated their diagnostic accuracy by comparing the areas under the ROC curve (AUCs) along with their corresponding 95% confidence intervals (CIs). The cut-off values were determined to dichotomise these biomarkers, which were then included in multivariable logistic regression models to examine their relationship with ICU mortality. Among 253 ICU patients included in the study, 66 (26%) died during the ICU stay. The AUCs to predict ICU mortality were 0.643 (95% CI, 0.566-0.719), 0.648 (95% CI, 0.633-0.735), 0.643 (95% CI, 0.563-0.723) and 0.735 (95% CI, 0.664-0.807) for ChE, CRP, IL-6 and PCT, respectively. After adjusting for age, sex and disease severity, lower ChE level (<3.668 × 103 U L-1) and higher levels of CRP (>10.546 mg dL-1), IL-6 (>986.245 pg mL-1) and PCT (>0.505 μg L-1) were associated with higher mortality risk, with odd ratios of 2.70 (95% CI, 1.32-5.54), 4.99 (95% CI, 2.41-10.38), 3.24 (95% CI, 1.54-6.78) and 3.67 (95% CI, 1.45-9.95), respectively. ChE, CRP, IL-6 and PCT were independent ICU mortality risk factors in severely ill patients. Elevated PCT levels exhibited better predictive value than the other three biomarkers that were evaluated.

Pesticide Exposure and Its Correlation with Hemoglobin and Cholinesterase in Farmers Who Used Pesticide

Background: Agriculture is the most important sector in basic human needs. Farmers must improve the quality of agricultural products by using synthetic chemicals, someone who experiences pesticide poisoning will have low cholinesterase levels. This study aims to analyze pesticide exposure to hemoglobin and cholinesterase levels in farmers who use pesticides.Subjects and Method: This was a systematic review study and meta-analysis conducted with the PRISMA diagram guidelines. The search for articles was carried out taking into account the eligibility criteria defined in the PICO model. Population= farmers using pesticides, Intervention= exposed to pesticides, Comparison= not exposed to pesticides, Outcome= hemoglobin and cholinesterase levels. The article search process was carried out between 2002-2022 from the Pubmed, Science Direct, Google Scholar, Springer Link, Hindawi, and Plose one databases. The keywords used were “hemoglobin”, “exposed pesticide”, “cholinesterase level”, “farmers”, “hemoglobin AND exposed pesticide”, “cholinesterase level AND farmers”, “hemoglobin AND farmers”. The inclusion criteria in this study were the full text of a cross-sectional study, discussing pesticide exposure to hemoglobin and cholinesterase levels in farmers using pesticides, published in English. Final results are presented in the mean SD of the multivariate analysis. Data analysis was performed using RevMan 5.4 software.Results: A meta-analysis was conducted on 13 articles originating from America, Asia, Africa, and Europe. The results of the meta-analysis showed that farmers exposed to pesticides experienced a decrease in hemoglobin, but it was not statistically significant (SMD= -0.28; 95% CI= -1.10 to 0.54; p=0.500). Pesticide exposure reduced cholinesterase levels in farmers using pesticides, the results were statistically significant (SMD= -2.48; 95% CI= -3.68 to -1.27; p&lt;0.001).Conclusion: The results of the meta-analysis showed that pesticide exposure decreased hemoglobin and cholinesterase levels in farmers using pesticides. Keywords: hemoglobin, cholinesterase levels, farmers Correspondence:Arum Nuryati. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: arumnuryati@student.uns.ac.id. Mobile: +6285728792097

Abstract 11011: Comparison of Prognostic Value of Liver Dysfunction Scores and Serum Cholinesterase Level in Acute Decompensated Heart Failure Patients with Preserved Left Ventricular Ejection Fraction: Insights from Pursuit-hfpef Registry

Background: Cardiohepatic interactions have been a focus of attention in heart failure. Liver dysfunction scores such as Fibrosis-4 (FIB-4) index, albumin-bilirubin (ALBI) and nonalcoholic fatty liver disease (NAFLD) scores have been shown to be useful for predicting poor outcome in patients (pts) with heart failure. On the other hand, malnutrition is one of the most important comorbidities in patients with heart failure with preserved ejection fraction (HFpEF), and serum cholinesterase level (CHE) was reported to be associated with adverse prognosis. We sought to compare the prognostic value of liver dysfunction scores and CHE in HFpEF pts admitted for acute decompensated heart failure (ADHF). Methods and Results: Data were extracted from a prospective multicenter observational study (PURSUIT-HFpEF) in which collaborating hospitals in Osaka recorded clinical, echocardiographic, and outcome data of HFpEF pts with ADHF. We analyzed 737 pts who survived to discharge. CHE, FIB-4 index, ALBI and NAFLD scores were obtained just before the discharge. During a follow-up period of 1.8±1.0 years, 157 pts had all-cause death. At multivariate Cox analysis, CHE (p&lt;0.0001) was independently and significantly associated with all-cause death after adjustment with important baseline clinical and study characteristics, although FIB-4 index, ALBI and NAFLD scores showed the association with all-cause death at univariate analysis. Receiver-operating characteristic curve analysis showed that CHE had the largest area under the curve for the prediction of all-cause death. Kaplan-Meier analysis revealed that the pts with lower CHE (&lt;208 IU/L=median value) had a significantly higher risk of all-cause death than those with higher CHE (31% vs 11%, p&lt;0.0001, adjusted hazard ratio 3.29 [95% CI 2.31 to 4.69]). Conclusion: CHE would be a more useful and simple prognostic marker for the prediction of total mortality than liver dysfunction scores in HFpEF pts with ADHF.

O-NE005. Electroneuromyography as a predictor of peripheral neuropathy symptoms after two years follow-up in farmers exposed to pesticide: A cohort study

Introduction . Farmer is one of the most common occupation in Indonesia. To increase crop production, they tend to use organophosphate or carbamate pesticides. These extensive pesticide uses could cause low cholinesterase levels in blood, and cause injury in peripheral nerve and neuropathy symptoms. With electroneuromyography (ENMG), subclinical neuropathy preceding its symptom could be found. The purpose of this study is to find association between any abnormality measurement in ENMG with neuropathic symptoms after two years. Methods . This was cohort prospective study. Farmers with history of pesticide exposure, without neuropathic symptoms in 2017, had low blood cholinesterase levels, and gave consent to have ENMG examination were recruited. Motor and sensory aspect of nerve was examined. For motor, we examined distal latency (DL), nerve conduction velocity (NCV), proximal amplitude (PA) and distal amplitude (DA) of median, ulnar, and tibial nerves. For sensory, we examined DL and PA of median, ulnar, and sural nerves. Neuropathic symptoms in 2 years follow up were determined from Total Neuropathic Symptoms Scale, with score > 0 diagnosed as having neuropathic symptoms. Results . There were 26 farmers included in this study. After statistical analyses, there were association between neuropathic symptoms after 2 years with motor NCV, motor PA and sensory DL of median nerve; motor NCV and motor PA of ulnar nerve (p-value > 0.05). After age, gender, working hour, pesticide spray duration adjustment, ENMG markers which had significant and independent association with neuropathy symptoms after two years were ulnar motor DL (p-value: 0.032), median motor NCV (p-value: 0.035), median motor PA (p-value: 0.043), and ulnar sensory DL (p-value: 0.010). Conclusion . From this study, we concluded that ENMG can be used as predictor for neuropathic symptoms in 2 years for asymptomatic farmers exposed to pesticide with low blood cholinesterase levels.

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.

Early Serum Biomarkers for Intensive Care Unit Treatment within the First 24 Hours in Patients with Intracerebral Hemorrhage.

The prognostic significance of serum biomarkers in patients with intracerebral hemorrhage (ICH) is not well investigated concerning inhospital mortality (IHM) and cardiopulmonary events within the first 24 hours of intensive care unit (ICU) treatment. The influence of troponin I (TNI) value and cortisol value (CV) on cardiopulmonary events within the first 24 hours of ICU treatment was reported in subarachnoid hemorrhage patients, but not in ICH patients up to now. The aim of this study was to investigate the role of early serum biomarkers on IHM and TNI value and CV on cardiopulmonary events within the first 24 hours of ICU treatment. A total of 329 patients with spontaneous ICH were retrospectively analyzed. Blood samples were taken on admission to measure serum biomarkers. The TNI value and CV were defined as biomarkers for cardiopulmonary stress. Demographic data, cardiopulmonary parameters, including norepinephrine application rate (NAR) in microgram per kilogram per minute and inspiratory oxygen fraction (FiO2) within the first 24 hours, and treatment regime were analyzed concerning their impact on ICU treatment and in hospital outcome. Binary logistic analysis was used to identify independent prognostic factors for IHM. Patients with initially nonelevated CVs required higher NAR (p = 0.01) and FiO2 (p = 0.046) within the first 24 hours of ICU treatment. Lower cholinesterase level (p = 0.004), higher NAR (p = 0.002), advanced age (p < 0.0001), larger ICH volume (p < 0.0001), presence of intraventricular hemorrhage (p = 0.007) and hydrocephalus (p = 0.009), raised level of C-reactive protein (p = 0.024), serum lactate (p = 0.003), and blood glucose (p = 0.05) on admission were significantly associated with IHM. In a multivariate model, age (odds ratio [OR]: 1.055; 95% confidence interval [CI]: 1.026-1.085; p < 0.0001), ICH volume (OR: 1.016; CI: 1.008-1.025; p < 0.0001), and Glasgow Coma Scale (GCS) score (OR: 0.680; CI: 0.605-0.764; p < 0.0001) on admission as well as requiring NAR (OR: 1.171; CI: 1.026-1.337; p = 0.02) and FiO2 (OR: 0.951; CI: 0.921-0.983, p = 0.003) within the first 24 hours were independent predictors of IHM. Higher levels of C-reactive protein, serum lactate, blood glucose, and lower cholinesterase level on admission were significantly associated with IHM. Patients with initially nonelevated CVs required higher NAR and FiO2 within the first 24 hours of ICU treatment. Furthermore, requiring an NAR > 0.5 µg/kg/min or an FiO2 > 0.21 were identified as additional independent predictors for IHM. These results could be helpful to improve ICU treatment in ICH patients.

Is Postoperative Adjuvant Transcatheter Arterial Infusion Therapy Effective for Patients with Hepatocellular Carcinoma who Underwent Hepatectomy? A Prospective Randomized Controlled Trial.

The effectiveness of adjuvant transcatheter arterial chemo- or/and chemoembolization therapy after curative hepatectomy of initial hepatocellular carcinoma (HCC) is controversial. This study aimed to evaluate whether hepatectomy combined with adjuvant transcatheter arterial infusion therapy (TAI) for initial HCC has better long-term survival outcomes than hepatectomy alone. From January 2012 to December 2014, a prospective randomized controlled trial of patients with initial HCC was conducted. Then, 114 initial HCC patients were recruited to undergo hepatectomy with adjuvant TAI (TAI group, n = 55) or hepatectomy alone (control group, n = 59) at our institution. The TAI therapy was performed twice, at 3 and 6months after curative hepatectomy (UMIN 000011900). The patients treated with TAI had no serious side effects, and operative outcomes did not differ between the two groups. No significant differences were found in the pattern of intrahepatic recurrence or time until recurrence between the two groups. Moreover, no significant differences were found in the relapse-free survival or overall survival. Low cholinesterase level (< 200) had been identified as a risk factor affecting relapse-free survival. Furthermore, compared with surgery alone, adjuvant TAI with hepatectomy improved the overall survival for lower-cholinesterase patients. Adjuvant TAI is safe and feasible, but it cannot reduce the incidence of postoperative recurrence or prolong survival for patients who underwent curative hepatectomy for initial HCC.

Prognostic Significance of Serum Cholinesterase Level in Patients With Acute Decompensated Heart Failure With Preserved Ejection Fraction: Insights From the PURSUIT-HFpEF Registry.

BackgroundMalnutrition is one of the most important comorbidities in patients with heart failure with preserved ejection fraction. We recently reported the prognostic significance of serum cholinesterase level and superior predictive power of cholinesterase level to other objective nutritional indices such as the controlling nutritional status score, prognostic nutritional index, and geriatric nutritional risk index in patients with acute decompensated heart failure. The aim of this study was to clarify the prognostic role of cholinesterase in patients with heart failure with preserved ejection fraction/acute decompensated heart failure and investigate incremental cholinesterase value.Methods and ResultsWe prospectively studied 274 consecutive patients from the PURSUIT‐HFpEF (Prospective Multicenter Observational Study of Patients with Heart Failure With Preserved Ejection Fraction) study. During a follow‐up period of 1.2±0.6 years, 56 patients reached the composite end points (cardiovascular death and readmission for worsening heart failure). In the multivariable Cox analysis, cholinesterase level was significantly associated with the composite end points after adjustment for major confounders. A Kaplan–Meier analysis revealed that patients with low cholinesterase levels (stratified by tertile) had significantly greater risk of reaching the composite end points than those with middle or high cholinesterase levels (P=0.0025). Cholinesterase level showed the best C‐statistics (0.703) for prediction of the composite end points among the objective nutritional indices. C‐statistics of the Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score for prediction of the composite end points were improved when cholinesterase level was added (C‐statistics, from 0.601 to 0.705; P=0.0408).Conclusions Cholinesterase was a useful prognostic marker for prediction of adverse outcome in patients with heart failure with preserved ejection fraction/acute decompensated heart failure.

RETROSPECTIVE STUDY OF ACUTE POISONING IN ELDERLY CASES ADMITTED TO MENOUFIA POISONING CONTROL CENTER (MPCC), MENOUFIA UNIVERSITY HOSPITALS FROM 2012 TO 2014

Introduction: Elderly people are exposed to poisons more than younger patients and they metabolize many drugs differently. Aim of the study: to evaluate poisoning in elderly patients. Subjects and Methods: A retrospective study was done on 255 elderly poisoned cases (≥ 60 years old) admitted to MPCC within the period from January 2012 to December 2014.The cases were evaluated and they were further statistically analyzed. Results: Out of 6556 acutely poisoned cases throughout the period of study, 3.9% elderly cases were included. 83.5% of cases were in the age group 60-<65 years. Males outnumbered females (62.4%). More than half of the cases (57.6%) were from urban areas. Housewives were the commonest (32.9%) followed by farmers (28.2%). Suicidal attempts were more in retired and free laborers groups 60% and 100% respectively, accidental exposures were 79.2% in farmers while 6.7% of manual workers and 4.2% of farmers were exposed to homicide. Organophosphate was the commonest poisoning substance among farmers (87.5%), while retired, drivers and unemployed were commonly intoxicated by drugs (40%, 40% and 50%respectively). Cases with metabolic acidosis were intoxicated by corrosives & organophosphate 33.3% for each one. Low cholinesterase level was found in 39 cases of organophosphate poisoning. Methanol level was elevated in three cases of alcohol poisoning and Toxi-lab was positive in three cases of drug poisoning. ECG was done for 25 cases, 24% of them showed bradycardia and 16% showed tachycardia. Thirty six cases underwent X-ray, 11.2% & 8.3% showed increased broncho-vascular marking and alveolar opacities respectively. Mortality rate constituted 9.4% of cases. Logistic regression analysis cleared that PH was the most predictor affecting the outcome followed by hypoxia. Conclusion and recommendation: PH, hypoxia and coma were the risk factors in the outcome. Proper evaluation and continuous monitoring of elderly poisoned cases are required to decrease the mortality rates among these patients.

Prognostic Value of Serum Cholinesterase in Non–muscle-invasive Bladder Cancer

Serum cholinesterase (ChE) has been reported to be a prognostic factor in several cancers, but its relationship with oncologic outcomes of non-muscle-invasive bladder cancer (NMIBC) has not yet been well-studied. We retrospectively assessed 1117 patients with NMIBC undergoing transurethral resection of the bladder. Cox regression analyses were performed to elucidate the association between preoperative ChE and oncologic outcomes such as recurrence-free survival (RFS) and progression-free survival. The median preoperative ChE level was 5.51 kU/L (interquartile range, 4.95-7.01), and the optimal cut-off value of ChE obtained from receiver operator characteristic analysis was 5.55 kU/L. The 5-year RFS in patients with low and normal ChE levels were 41.1% and 70.0%, respectively (P< .001). The 5-year progression-free survival in patients with low and normal ChE levels were 93.2% and 91.4%, respectively (P= .053). On multivariable analysis, ChE was significantly associated with shorter RFS (P< .001). ChE as a continuous variable and low ChE levels improved the C-index for prediction of disease recurrence by 4.0% and 2.7% to 72.4% and 71.1%, respectively. In patients stratified into the European Association of Urology high-risk category, serum ChE was also a strong predictor of disease recurrence (hazard ratio, 4.14; 95% confidence interval, 2.90-5.89). Moreover, in the European Association of Urology high-risk patients treated with bacillus Calmette-Guérin immunotherapy, serum ChE was still strongly correlated with worse RFS (hazard ratio, 5.46; 95% confidence interval, 2.91-10.2). Decreased ChE is associated with shorter RFS in patients with NMIBC undergoing transurethral resection of the bladder. Preoperative ChE could improve patients' risk stratification and selection for adjuvant therapy. The mechanisms underlying this association needs further elucidation to design potential targets for intervention.

Clinical and laboratory characteristics of juvenile myelomonocytic leukemia

To study the clinical and laboratory characteristics of juvenile myelomonocytic leukemia (JMML). The clinical characteristics and laboratory results were retrospectively analyzed in 10 children with newly diagnosed JMML. They were compared with those of 28 children with myelodysplastic syndrome (MDS) and 44 children with chronic myeloid leukemia (CML). Compared with the children with CML or MDS, the children with JMML had significantly higher rates of skin rashes, ecchymosis, and lymphadenectasis, a significantly lower serum cholinesterase (ChE) level, and a significantly higher fetal hemoglobin level (P&lt;0.05). The white blood cell count of children with JMML was significantly higher than that of children with MDS, but significantly lower than that of children with CML (P&lt;0.05). In addition, the myeloid/erythroid ratio and rate of dyshaematopoiesis were significantly lower in children with JMML than those in children with CML or MDS. The children with JMML had a significantly higher expression of mature monocyte marker CD14 than those with CML or MDS (P&lt;0.05). The levels of myeloid markers CD33, CD11b, CD13, and CD15 in children with JMML were significantly higher than those in children with MDS, but significantly lower than those in children with CML (P&lt;0.05). The levels of CD2 and CD7 in children with JMML were higher than those in children with CML, but lower than those in children with MDS (P&lt;0.05). Skin rashes, ecchymosis, lymphadenectasis, and ChE reduction are more common in children with JMML than in those with CML or MDS, while dyshaematopoiesis is less common. In addition, CD14 level increases significantly in children with JMML.

Biochemical abnormalities in OPC poisoning and its prognostic significance

BACKGROUND: Organophosphorus insecticides are arguably one of the commonest causes of morbidity and mortality due to poisoning worldwide, especially in developing countries like India due to its easy availability. Though Serum cholinesterase can be a useful tool in the diagnosis of OP poisoning, its role in prognostication is very minimal. Our study was conducted to other biochemical abnormalities to predict the severity and prognosis in OP poisoning patients. AIMS AND OBJECTIVES: (1)To measure serum electrolytes, liver enzymes, amylase, CPK, CPK-MB, and Troponin I in acute organophosphorus poisoning (2) To analyse the correlation between these biochemical parameters and serum acetylcholinesterase levels (3) To analyse the validity of these biochemical parameters in prediction of severity and prognosis in op poisoning. MATERIALS AND METHODS:This study was conducted over a period of 1 year in Mahatma Gandhi Memorial Government Hospital attached to K.A.P.V Govt Medical College, Trichy wherein 50 OP poisoning patients were selected using inclusion and exclusion criteria and their blood samples were collected on admission and analysed for the above said biochemical parameters. RESULTS: 74% of the patients were male, and 62% of the patients fall in the age group of 20 to 30 years. Statistically significant elevation of ALT, CPK, CPK-MB and Troponin I were noted in the study group. A significant fall in serum potassium level in also noted. Most of the patients in the study had a cholinesterase level of 20% to 50%. CONCLUSION: AST, ALT, ALP, and Amylase increase in acute OP poisoning. Rise in CPK, CPK-MB, Troponin I and ALT indicate the severity of OP poisoning and is also statistically significant to predict the prognosis of the patient. Hypokalaemia and associated low cholinesterase levels indicate the requirement of ventilator support and also the poor prognosis of the patient. These findings can assist health professionals to better evaluate patient’s prognosis and improve their treatment plan.

Prospective Study on Acute Poisoning Related Deaths in Menoufia Poisoning and Addiction Control Center (MPCC), Menoufia University Hospitals

Introduction: Acute poisoning is a common medical emergency that causes morbidity and mortality. Acute poisoning fatality is of medical, legal and social significance. Aim of the work: The present work aimed at describing the demographic, characters of deaths due to acute poisoning (type and manner of poisoning), management and mechanism of death. Subjects and Methods: Prospective study on deaths due to acute poisoning which admitted to MPCC through a period from 1-1-2015 to 31-12-2016. Cases were evaluated. The results were further studied by statistical tests. Results: During the study period, 4,834 acute poisoned cases were admitted in MPCC. Among which 78 cases (1.6) % were died. The most common age of deaths was 7-18 years 41% followed, by age >18-30 years 33.3%. Females surpassed males (59%), students accounted 41% followed by farmers 23%. The majority of deaths were single and from rural areas. More than fifty percent of poisoned cases were due to Aluminum phosphide followed by insecticides 25%. Oral ingestion was the prominent method of intake 94.4%. Suicidal intention was more common than accidental cases (74.4 % versus 25.6%). Suicide was significantly common in females age groups (7-18) and (>18-30) years mainly in students and non- worker cases. . Metabolic acidosis was significantly correlated to Aluminum phosphide and insecticides, while hypoxia was significantly associated with Dormex and corrosive poisoning. ECG changes showed arrhythmia in Aluminum phosphide poisoning. Meanwhile bradycardia was associated to dormex and insecticides poisoning. Low blood cholinesterase level was significantly present in insecticides poisoned cases. There was significant relation to cardiac arrest as a cause of death to Aluminum phosphide cases. Conclusion and recommendation: Suicide was significantly common in females age groups (7-18) and (>18-30) years mainly in students and non- worker cases. The majority of cases were single and from rural areas. Most commonly used agents are aluminum phosphide and insecticides. Cardiac arrest was the main cause of death in aluminum phosphide poisoned cases. The mortality due to poisoning can be reduced by conducting educational programs in rural areas, restrict the availability of aluminum phosphide and insecticides, keep pesticides away from easy to use for suicide and providing needy people by poison information danger.

Pre-therapeutic factors for predicting survival after radioembolization: a single-center experience in 389 patients

To determine pre-therapeutic predictive factors for overall survival (OS) after yttrium (Y)-90 radioembolization (RE). We retrospectively analyzed the pre-therapeutic characteristics (sex, age, tumor entity, hepatic tumor burden, extrahepatic disease [EHD] and liver function [with focus on bilirubin and cholinesterase level]) of 389 consecutive patients with various refractory liver-dominant tumors (hepatocellular carcinoma [HCC], cholangiocarcinoma [CCC], neuroendocrine tumor [NET], colorectal cancer [CRC] and metastatic breast cancer [MBC]), who received Y-90 radioembolization for predicting survival. Predictive factors were selected by univariate Cox regression analysis and subsequently tested by multivariate analysis for predicting patient survival. The median OS was 356days (95% CI 285-427 days). Stable disease was observed in 132 patients, an objective response in 71 (one of which was complete remission) and progressive disease in 122. The best survival rate was observed in patients with NET, and the worst in patients with MBC. In the univariate analyses, extrahepatic disease (P < 0.001), large tumor burden (P = 0.001), high bilirubin levels (>1.9mg/dL, P < 0.001) and low cholinesterase levels (CHE <4.62 U/I, P < 0.001) at baseline were significantly associated with poor survival. Tumor entity, tumor burden, extrahepatic disease and CHE were confirmed in the multivariate analysis as independent predictors of survival. Sex, applied RE dose and age had no significant influence on OS. Pre-therapeutic baseline bilirubin and CHE levels, extrahepatic disease and hepatic tumor burden are associated with patient survival after RE. Such parameters may be used to improve patient selection for RE of primary or metastatic liver tumors.

Hypoglycemia During the Temporary Interruption of Parenteral Nutrition Infusion in Pediatric Hematopoietic Stem Cell Transplantation.

Parenteral nutrition (PN) is required with pediatric procedures such as hematopoietic stem cell transplantation (HSCT). However, risks associated with temporary PN infusion interruption remain unclear. We retrospectively analyzed in 22 children undergoing HSCT receiving PN with the same daily routine: temporary PN infusion interruption before breakfast for administering a saline-diluted acyclovir drip. After correcting patients' glucose levels, we examined minimum blood glucose levels between preparative regimen initiation and post-HSCT day 30. Patients were divided into 2 groups according to a minimum glucose cutoff of 60 mg/dL. Patient background characteristics and hypoglycemia risk factors were compared between both groups. The hypoglycemia group had a significantly lower body surface area, higher glucose infusion rate (GIR), lower cholinesterase levels, and higher zinc levels at the onset of the minimum blood glucose level ( P < .05). Multivariate analyses revealed an association only between higher GIR (≥5 mg/kg/min) and hypoglycemia during the temporary PN infusion interruption. A time course analysis of blood glucose and immunoreactive insulin (IRI) levels in 1 patient revealed a combined high-caloric and saline flush before acyclovir initiation, causing temporary increased IRI, as the etiology for hypoglycemia. Particular attention and several precautions are required to prevent complications associated with temporary PN infusion interruption in children with higher GIR.

Establishing the Cholinesterase Levels in Jordan : An Investigation and Monitoring Model for Pesticides Outbreak = تحديد مستوى الكولين أستريز في الأردن : نموذج تقصي و رصد لحدوث انتشار التسمم بالمبيدات

Background Aims: To establish and validate the method used to analyze cholinesterase in blood and to establish a baseline level among Jordanians living in a heavy agricultural activity area and as well as among those living in an urban non-agricultural area. Materials and Methods: Modified Ellman procedure was used to analyze 851 and 1033 blood samples from heavy agricultural activity and urban area for cholinesterase activity in erythrocytes and Plasma. Results: sample collected from heavy agricultural activity showed low cholinesterase level average 1037U/L ± 279 and 23 U/gHb ± 7.9 compared with urban area average 1616 U/L ± 662 and 31 U/gHb ± 13 for plasma and erythrocyte respectively. The levels in workers living in heavy agriculture activity showed 52% inhibition in plasma and 41.1% in erythrocyte when compared to the established normal levels that were observed in urban area. Conclusions: Clinicians using cholinesterase for clinical diagnosis and management should be aware that baseline levels are different according to the residence of their patients.

Factors Influencing Poisoning Symptoms: A Case Study of Vegetable Farmers Exposed to Mixed Insecticides in Prek Balatchheng Village, Cambodia

ABSTRACTThis study aimed to identify factors influencing poisoning symptoms among 153 mixed insecticide–exposed vegetable farmers in one Cambodian village, where 153 factory workers were selected as a comparative nonexposed group. The research instruments were questionnaires and reactive-paper test kits. The majority of vegetable farmers were male, with approximately 87% of the total participants with an average age of 34 years. The personal hygiene scores of most vegetable farmers (108; 70.8%) were moderate, and knowledge scores were at poor level (131; 85.6%). Abnormally low cholinesterase (ChE) levels were detected among 119 (77.8%) farmers. Multiple logistic regression analysis was used to identify factors associated with possible poisoning symptoms. This study found that mixing an average of four to six types of insecticides (odds ratio [OR] = 4.6; P = .03) and abnormal ChE level (OR = 4.09; P = .004) was associated with central nervous system (CNS) symptoms. Age group >45 years (OR = 2.8; P = .04) and type of vegetable “other” (OR = 2.73; P = .02) were associated with gastrointestinal symptoms. Type of insecticide, organophosphates (OPs) and carbamates (CMs) (OR = 3.2; P = .04), was associated with respiratory symptoms. It is recommended that farmers should reduce insecticide spraying times, increase their use of personal protective equipment (PPE), and undergo training on insecticide use. These combined measures should improve the insecticide-related health status of vegetable farmers in this area.

734P - Analysis of Correlation Between Clinical Features and Hepatic Dysfunction After Transcatheter Arterial Chemoembolization in Patients with Primary Liver Cancer

ABSTRACT Aim: To analyze the correlation between clinical features and hepatic dysfunction after transcatheter arterial chemoembolization in patients with primary liver cancer. Methods: 251 PLC patients treated by TACE were retrospectively analyzed. k2 test and Logistic regression model were used to assess the correlation between clinical features and hepatic dysfunction after TACE. Results: 40/251 patients(15.9%) presented with hepatic dysfunction after TACE. Univariate analysis showed that tumor diameter ≥ 10cm, Child-Pugh grade, cholinesterase level and portal vein tumor thrombosis(PVTT) were associated with hepatic dysfunction after TACE in PLC patients. Multivariate analysis showed that Child-Pugh grade B, tumor diameter ≥ 10cm and low cholinesterase level were risk factors associated with hepatic dysfunction after TACE in PLC patients. Conclusions: TACE should be carefully performed to avoid hepatic dysfunction in PLC patients with tumor diameter ≥ 10cm, Child-Pugh grade B, and low cholinesterase level. Disclosure: All authors have declared no conflicts of interest.