Organophosphate Poisoning Research Articles

Delayed myelopathy after organophosphate intoxication: A case report

Organophosphate-induced delayed neuropathy, a central-distal axonopathy, passes through latent, progressive, static and improvement phases. During the improvement phase, the peripheral nerves regenerate unmasking the spinal cord lesion with myelopathic features. We report a case of a 16-year-old male who developed myelopathy 6 weeks following chlorpyrifos poisoning. He had a motor weakness of 4/5 in bilateral hips and 3/5 in bilateral knees and ankles. Spasticity and exaggerated reflexes with ankle clonus were present in the lower limbs. Sensory and the upper limb motor examinations were all normal. Pertinent blood, cerebrospinal fluid and nerve conduction tests were normal. Magnetic resonance imaging of the spine showed features of cord atrophy. Three months following physiotherapy, his power improved to 5/5 in bilateral knee and hip joints and 4/5 in bilateral ankles with spasticity. Organophosphate-induced delayed neuropathy can present as earlier as 6 weeks with myelopathy. Previous history of organophosphorous exposure is important in myelopathy or peripheral neuropathy.

Changing spectrum of acute poisoning in North India: A hospital-based descriptive study

OBJECTIVES: Evaluating local trends and continued monitoring of patterns of acute poisoning are essential for prompt recognition of the toxidromes, the establishment of immediate treatment facilities (e.g., antidote availability), and effective preventive strategies (e.g., governmental regulation on hazardous substances marketing). We aimed to describe the prevalence of the various types of poisoning and associated case fatality in our academic hospital in North India. METHODS: A prospective observational descriptive study was conducted, enrolling patients aged ≥13 years with acute poisoning for 17 months from December 2016 to December 2017 and from September 2019 to December 2019, for a total of 17 months. RESULTS: Four hundred and two patients were enrolled (median age 28 years; 63.2% males). Majority of the acute poisoning cases resulted from ingestion (n = 391, 97.3%) and the primary intention was most commonly self-harm (n = 314, 78.1%). The major types of poisoning were pesticide (n = 264, 65.7%), drug overdose (n = 77, 19.2%), and corrosive ingestion (n = 31, 7.7%). Pesticides included insecticides (n = 146, 36.3%; cholinesterase inhibitors, n = 91), fungicides (n = 76, 18.9%; all aluminum phosphide), herbicides (n = 22, 5.5%; paraquat, n = 19), and rodenticides (n = 20, 5.0%; coumarin-derived substances, n = 12). Benzodiazepines (n = 33) and opioids (n = 25) were frequent causes of drug overdose. 95.3% (n = 379) received preliminary treatment at the previous health-care center, including gastric lavage (n = 239) and antidotes (n = 73). In-hospital case fatality rate was 17.3% (n = 58). CONCLUSION: Herbicide ingestion and opioid overdose are emerging threats with a gradual decline in organophosphate and aluminum phosphide poisoning. Despite improving management of acute poisoning, the overall case fatality rate remains substantial.

Spectrum of Poisoning and Outcome among Children in a Tertiary Hospital, North-East Nigeria: A 20 Years Restrospective Review, 2000-2019

Introduction: Acute poisoning in children is cause of hospitalization and death worldwide. It is a Paediatrics emergency with significant economic cost. There are epidemiological differences in acute poisonings in children evaluated in Emergency departments across different countries and regions of the world. The aim of this study was to determine the causes of poisoning in children in our health facility during the period 2000-2019. Methodology: Case notes of children 6 months to 18 years managed for acute poisoning from January 2000 to December 2019 at Paediatrics unit, Federal Teaching Hospital Gombe (FTHG), were analysed. The International classification of Disease ICD 10 was used. Ethical Clearance was obtained. Results: 26,716 children were admitted with 76 cases of Acute poisoning giving a prevalence rate of 2.8/1000 children. 56.6% (43) were males. 63.2% (48) of children were years of age. 69.7% (53) were urban dwellers and 59.2% (45) from low socioeconomic class. 52.6% (40) of poisoning occurred in rainy season. 97.3% (74) of children had unintentional poisoning. Organophosphates 22.3% (17) and kerosine 22.3% (17) were the most common substances ingested. Snake-bite and corrosive ingestion occurred in 13.1% and 11.8% of children respectively. Ingestion was the route in 84.2% of cases. 75.0% (57) of poisoning occurred at home. ACP occurred in children aged 1 - 5 years (p-value = 0.025); More in Children from low socioeconomic status (p-value = 0.001) and urban settings (p-value = 0.001). There was no statistically significant relation between type of poisoning and gender p = 0.839, season p = 0.608, religion p = 0.504 and ethnic background p = 0.342. 4.2% (3) children died each from organophosphate, snake bite and tramadol poisoning. Conclusion: Kerosine and organophosphate were the leading cause of accidental childhood poisoning.

Treatment outcome and associated factors among patients admitted with acute poisoning in a tertiary hospital in Eastern Ethiopia: A cross-sectional study.

Introduction:Acute poisoning causes morbidity and mortality worldwide. There is scarce of information on acute poisoning in the study area.Objective:To assess treatment outcome and the associated factors among patients admitted with acute poisoning at Hiwot Fana Comprehensive Specialized Hospital, Eastern Ethiopia.Methods:A cross-sectional study was conducted. All acutely poisoned patients who had been admitted at the emergency department of Hiwot Fana Comprehensive Specialized Hospital from 1 January 2016 to 31 December 2020 who fulfilled the inclusion criteria of the study were included. Data were collected by review of medical records. Poor treatment outcome of acute poisoning was defined as the acutely poisoned patient was died, or survived with disability. Multivariate logistic regression analysis was used to determine factors associated with the outcome of acute poisoning.Result:A total of 175 patient’s medical records were reviewed. Of these, 150 patient’s medical records had complete information and were included in the final analysis. The majority of participants 89 (59.3%) were in the age group of 19–37 years. More than half of the participants 86 (57.3%) were females. Organophosphate was the most poisoning agent encountered in 62 cases. Acetaminophen was the predominant drug poisoning agent encountered in 10 participants. Among 30 patients managed with antidote, 18 patients were treated with atropine for organophosphate poisoning. Of all the poisoning cases admitted during the study period, 16.7% died. Participants who were poisoned by themselves were 2.4 times more likely to have poor treatment outcomes than those who were poisoned accidentally: 2.44 (95% confidence interval: 1.10–5.42). The odd of having poor treatment outcome in participants who were poisoned by drugs was 2.13 more likely: 2.13 (95% confidence interval: 1.21–3.32).Conclusion:Organophosphate was the predominant cause of acute poisoning encountered in 62 cases. The modes of poisoning and drug poisoning were significant risk factors associated with poor treatment outcomes of acute poisoning.

Unusual presentation of organophosphate poisoning: A case Report

Unusual presentation of organophosphate poisoning: A case Report

Prevalence of Acute Pancreatitis and Hyperamylasemia in Acute Organophosphorus poisoning in Kashmir valley (North India)

Organophosphorus poisoning is soaring due to easy availability in rural settings of developing countries. There are many reports of Acute Pancreatitis associated with OP poisoningand a casual relationship has been demonstrated in animal models. This study was therefore designed to determine the prevalence of hyperamylasemia and acute pancreatitis in organophospate poisoning in our setup and to reduce mortality and hospital stay by its early detection. This is a cross sectional hospital based study carried out in SKIMS Medical College, Srinagar, J&K which is tertiary care facility. All patients included were above 18 years of age with a recent history of organophosphate ingestion, cutaneous absorption or inhalation with clinical signs and symptoms of organophosphate poisoning. Confounding factors like drugs causing pancreatitis, ERCP within 24 hrs, previous history of pancreatitis, cholelithiasis and or any other local pathology were excluded. Serum Amylase and Lipase were measured. Imaging like ultrasonography and CT scan Abdomen was ordered. BISAP scoring was used to assess severity of acute pancreatitis. 50 patients with ingestion of organophosphates were evaluated. 23 patients developed abdominal pain, among which 11 patients had hyperamylasemia while 7 developed Clinical acute pancreatitis with high lipase and imaging findings. 2/3 of patients who developed pancreatitis had mild severity while other 1/3 had severe severity. Pancreatitis in Organophosphorus is not uncommon and needs high clinical suspicion for early diagnosis and management.

The Role of a Combination of N-Acetylcysteine and Magnesium Sulfate as Adjuvants to Standard Therapy in Acute Organophosphate Poisoning: A Randomized Controlled Trial

The Role of a Combination of N-Acetylcysteine and Magnesium Sulfate as Adjuvants to Standard Therapy in Acute Organophosphate Poisoning: A Randomized Controlled Trial

Clinical consequences of Hypotension in patient with organophosphate poisoning

Objective: Aim of study is to describe the clinical consequences of hypotension in patient with organophosphate poisoning. Method: In the retrospective cohort study, we analyzed data of 66 patients with organophosphate poisoning who were treated at Bir Hospital, Nams Kathmandu. Data from those with hypotension and normal blood pressure were compared to identify significant clinical consequences. Results: All together 66 patients were enrolled in this study out of which 44(66.7%) were female and 22(33.3%) were male. After analyzing data, we found 18.2% of case with severe poisoning (ACHE < 700 U/L). Among all, 41(62%) were found to have normal blood pressure and 25(37.9%) were found to have low blood pressure. Among those with hypotension, around 56% were found to have prolonged QTc interval, p < 0.003 and there was statistically significant association between QTc prolongation and vasopressor requirement, X2(1) = 22.98, P < 0.001. Patients requiring higher dose to reach atropinization had statistically significant hypotension, P < 0.001. Those with low blood pressure were found to require more days of hospital admission, P < 0.001. Patients with hypotension were found to have severe poisoning both on the basis of POP Score severity grading, 16(64%) P <0.002 and ACHE Severity scale, 7(28%) P < 0.05. In comparison with normal blood pressure group, low blood pressure group had significantly more chance of developing complications like septic shock (2), aspiration pneumonia (5), ARDS (1) and bed sore, P = 0.002. Vasopressor requirement was significantly more among those with low blood pressure, P < 0.001. Most of hypotensive patients were needing ICU care, found to have higher WBC count P = 0.002 and lower GCS Score at admission P < 0.001. There was positive correlation between hypotension and POP Score at admission P < 0.001. Conclusion: Hypotension is a common complication in patient with organophosphate poisoning and is associated with higher POP Score, lower ACHE level, lower GCS Score, increased vasopressor requirement, more hospital stays, increasing ICU admission, more chance of developing septic shock and aspiration pneumonia.

The Subcutaneous Injection of Organophosphate: A Case Report

Organophosphate (OP) poisoning is prevalent in developing countries. Toxicity occurs by voluntary injection, inhalation, and absorption. Self-injection is rare. The current case report describes a 61-y/o male with subcutaneous self-injected one cc OP poisoning presenting with delayed drowsiness, nausea, and vomiting. He was treated and presented a good clinical response to treatment with pralidoxime and had a successful recovery. Diagnosis of OP compound toxicity by the parenteral route is a challenge. By observing patients, the dose, and the time between poisoning until the time to start treatment, we can conclude different presentations and outcomes of OP poisoning.

Evaluation of Cardioprotective action of Suvarna gairik (Redochre) in Indian Cobra Envenomation, Aluminium Phosphide Poisoning and Doxorubicin Cardiotoxicity in Albino Rats- A Protocol

Background: Poisoning is major health issue all over the world. Poisoning is one of basic causes for Out Hospital cardiac arrest (OHCA). P-OHCA (Poison induced Out Hospital cardiac arrest) can be prevented by immediate primary management. The agent for poisoning is unknown in most cases, which leads to difficulty deciding the emergency antidote. In Ayurveda Hridyavaranchikitsa (Cardio protection) is one of the treatment modalities mentioned in all types of poisoning as first aid treatment. Suvarna Gairik (Red ochre) is one of drugs mentioned for the cardioprotection. Snake bite and organophosphate poisoning are the threats to life in India. Doxorubicin is commonly used drug for Chemotherapy in malignancies, and its major side effect is cardiotoxicity. Hence these poisonings are included in study.
 Aim and Objective: Evaluation of cardioprotective activity of Suvarna Gairik (Red ochre) in cardiac biomarker like Lactate dehydrogenase, Creatinine phosphokinase, Alkaline transferase, Cardiac Troponins and Survival Time in Indian Cobra Envenomation, Aluminium phosphide poisoning and Doxorubicin cardiotoxicity in Albino Rats.
 Methodology: Animal study is designed. 56 wistar rats will be divided in 7 groups as Vehicle Control Group, Disease control Group -1 Indian Cobra envenomation, Disease control Group -2Aluminium Phosphide poisoning, Disease control Group -3 Inj. Doxorubicin induced cardiotoxicity, Test Group -1 Indian Cobra Envenomation and Suvarna gairik Test Group -2 Aluminium Phosphide poisoning and Suvarna gairik Test control Group 3- Inj. Doxorubicin cardiotoxicity and Suvarna gairik.
 Results: Outcome will be assessed in between groups and among groups.
 Conclusion: Suvarna Gairik (Red ochre) may show statistical significant cardioprotective activity.

Management of self-inflicted oral organophosphate poisoning in adolescence - a case report

Organophosphate (OP) poisoning is more common in developing countries such as India. Here, we report a case of self-inflicted oral OP poisoning (monocrotophos) by an adolescent male patient who presented to the emergency department of a tertiary care hospital with tachycardia and frothing without seizure episode (non-linear presentation in OP poisoning). Based on the evidence of consumption of OP compound, the management of the patient went as planned and guarded with i.v. administration of pralidoxime and atropine. Gastric lavage was done soon after the patient came to the hospital and was admitted to the Intensive care unit for 5 days and in the general ward for the next 24 h. The patient was discharged from the hospital in a hemodynamically stable state after 6 days of hospital stay by managing the cardiac, muscarinic, and nervous system events as detailed in this case report.

Lipid emulsion for the treatment of acute organophosphate poisoning: an Open-Label randomized trial

Introduction Many organophosphate (OP) pesticides are lipid-soluble; therefore, intravenous lipid emulsion (ILE) has been evaluated as a possible treatment for acute poisoning. A single bolus dose of 100 ml of 20% ILE was found safe in a pilot observational study. This randomized trial aimed to assess the effectiveness and safety of an extended dose of ILE in acute OP poisoning. Methods This was an investigator-initiated, parallel-group, open-label, randomized controlled trial conducted at PGIMER, Chandigarh (India), from January 2019 to June 2020, in patients aged above 13 years with acute OP poisoning. The primary efficacy outcome was to study the change in atropine dose requirement (total and over the first 24 h) for cholinergic crisis after giving an initial bolus dose of 100 ml of 20% ILE followed by an infusion of 100 ml of 20% ILE over 6 h in addition to the standard care. The secondary efficacy outcomes were to detect the effects on hemodynamic variables, length of hospital stay, and duration of mechanical ventilation required. The incidence of adverse events was evaluated. Results A total of 45 patients were assigned to receive either ILE (intervention group, n = 23) or normal saline (control group, n = 22) in addition to standard treatment. Baseline variables in both groups were comparable. The median dose of atropine (in mg) in the first 24 h and at complete resolution in the ILE group were similar to the control group (124.0 versus 141.8, p-value 0.916; and 150.8 versus 175.0, p-value 0.935). Hemodynamic variables (systolic and diastolic blood pressures, mean arterial pressure, and pulse rate) over 24, 48, and 72 h of treatment, length of hospital stay, and duration of mechanical ventilation were also unaffected by ILE. Case fatality was 4 and not statistically different between intervention and control groups (1 versus 3, p-value 0.346). There was no excessive fever, dyspnea, elevation of serum amylase, or pancreatitis from ILE. Conclusion ILE has no apparent benefit in acute OP poisoning. However, an extended dose appears safe for the indication.

Changes of attention-related brain activity over 6 months after acute organophosphate pesticide poisoning: a prospective follow-up study

Context Ingestion of organophosphate (OP) pesticides is a common method of self-harm in developing countries. Apart from acute cholinergic effects, limited evidence implicates OP poisoning in long-term neurocognitive deficits. However, prospective neurophysiological evidence of long-term deficits is scarce in humans. We aimed to determine long-term cognitive changes of acute OP pesticide self-poisoning in a prospective follow-up study, using event-related potentials (ERPs), an electroencephalographic index of cognitive functioning. Methods We recruited 203 patients (147 men) hospitalised with OP pesticide ingestion (OP group; all had significant erythrocyte cholinesterase inhibition) and 50 patients (23 men) with paracetamol overdose (control group) as a means of self-harm. We recorded their ERPs and behavioural performance in a selective attention task at three post-exposure time points: on discharge from hospital (around 14 days post-ingestion), 6 weeks and 6 months post-ingestion. We compared the reaction time and ERP components of the two groups at each time point, adjusting for sex, age, education and comorbid depression in multiple regression models. Results OP group had significantly slower reaction times than the control group on discharge and at 6 weeks, but not at 6 months. On discharge, the OP group also showed significantly prolonged latency of the parietal P3b component, signifying delayed attentional processing. P3b amplitudes were also significantly smaller in the OP group on discharge and at 6 months. Within the OP group, greater clinical severity of poisoning was associated with smaller P3b amplitudes. Early pre-attentive cortical processing (as indexed by N1 ERP component) showed no significant intergroup differences. Conclusions Acute OP pesticide poisoning was associated with impaired behavioural and neurophysiological indices of selective attention. These deficits outlast the cholinergic phase of intoxication. The neurobehavioral impairment disappears over months, but neurophysiological deficits seem to last even after 6 months. This impairment could potentially compromise the performance and safety of patients for months following clinical recovery.

THE PATTERN OF ORGANOPHOSPHORUS COMPOUNDS POISONING AT A TERTIARY CARE TEACHING HOSPITAL AND MEDICAL COLLEGE IN NORTHERN INDIA

Objective: A retrospective study was conducted in a tertiary care hospital collaborated with a medical college, to analyze the drug therapy including antidotes administered and pattern of Organophosphorous compounds poisoning. Material and methods: The data are analytically drawn from record sheets of Organophosphorous poisoning patients. The collected tabulated data were statistically analyzed with SPSS version for the pattern of Organophosphorous compounds poisoning. Results: The demographic data of 122 Organophosphorous poisoning clinical cases documented 84.42 % suicidal tendency and 15.57 % accidental exposure of patients, 66.39 % in the age of 15-24 years, and 70.49 % were females and 70.49 % from a rural background, and 29.50 % from an urban background. Before pharmacotherapy, all patients were subjected to general supportive measures including stomach wash, and patients were administered pharmacotherapy consisting of Pralidoxime (23.77 %) and Atropine (41.80 %). Conclusion: This present concluded that patients diagnosed with Organophosphorous poisoning can be managed by alone administration of atropine as an antidote which is available as a cost-effective drug as compared to Pralidoxime. Thus cost-effectiveness can be significantly reduced by the rational drug use and strict implementation of the pesticide act to further strengthen the proper maintenance of procurement of Organophosphorous compounds for exclusive agricultural purpose.

Acute organophosphate and carbamate pesticide poisonings – a five-year survey from the National Poison Control Center Of Serbia

Pesticide poisonings, intentional as well as accidental, are common, especially in undeveloped and developing countries. The goal of this study was to analyze the clinical presentation of patients hospitalized due to acute organophosphate (OPP) or carbamate pesticide (CP) poisoning as well as to analyze the factors that potentially influenced the severity and outcome of the poisonings. A retrospective cross-sectional study was performed. The age and gender of each patient were recorded, the type of ingested pesticide, whether the poisoning was intentional or accidental, number of days of hospitalization, the severity of the poisoning, and the outcome of the treatment (i.e., whether the patient survived or not). Clinical aspects of poisonings were analyzed, as well as the therapeutic measures performed. 60 patients were hospitalized due to acute OPP or CP poisoning, out of 51 (85.00%) were cases of intentional self-poisoning. The majority of patients were poisoned by OPPs (76.67%), in one-third the causative agent was malathion, followed in frequency by chlorpyrifos and diazinon. Dimethoate poisonings were manifested with the most severe clinical picture. A 70% or lower activity of reference values of acetylcholinesterase and butyrylcholinesterase was found in 50% and 58% of patients, respectively. The most common symptom was miosis (58.33%), followed by nausea and vomiting. Pralidoxime reactivated acetylcholinesterase inhibited by chlorpyrifos or diazinon, but not with malathion or dimethoate. Impairment of consciousness and respiratory failure, as well as the degree of acetylcholinesterase and butyrylcholinesterase inhibition, were prognostic signs of the severity of poisoning. The lethal outcome was more often found in older patients (t = 2.41, p = 0.019). The type of ingested pesticide significantly affects the severity and outcome of poisoning as well as the effectiveness of antidotes.

Nurses Performance for Patient with Acute Organophosphate Poisoning

Background: Organophosphate (OP) compounds are agrochemical agents that have been frequently misused for deliberate self-harm in the world; the majority of the three million pesticides related poisonings worldwide are due to OP compounds. Early identification followed by effective management in the initial stages increases the rate of survival among patients with (OP) poisoning. Aim of the study: to assess nurses' performance (knowledge, practice and attitude) for patient with acute organophosphate poisoning. Research Design: A descriptive exploratory design was utilized. Method: A convenience sample of all available nurses (50 nurses) working in four units surgical ICU, Emergency unit, poisoning ICU, and poisoning unit in Tanta university hospital. Tools three tools used in the current study: self-administrated questionnaire, observational checklist, and nurses' attitude Likert scale. Results: 70% of studied nurses had unsatisfactory level of knowledge and 54% had incompetent practice regarding care of patient with acute organophosphate poisoning. 84% of nurses have negative attitude regarding care of patient with acute organophosphate poisoning. Conclusion: based on the results of the current study there was statistically significant correlation between the nurses' knowledge, practice and attitude regarding care of patients with acute organophosphate poisoning Recommendation: Designing teaching program for nurses to improve nurses' knowledge, practice and attitude for care of patient with acute organophosphate poisoning. Developing simplified and comprehensive booklet including basic information about organophosphate poisoning.

New Uncharged 2-Thienostilbene Oximes as Reactivators of Organophosphate-Inhibited Cholinesterases.

The inhibition of acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) by organophosphates (OPs) as nerve agents and pesticides compromises normal cholinergic nerve signal transduction in the peripheral and central nervous systems (CNS) leading to cholinergic crisis. The treatment comprises an antimuscarinic drug and an oxime reactivator of the inhibited enzyme. Oximes in use have quaternary nitrogens, and therefore poorly cross the brain–blood barrier. In this work, we synthesized novel uncharged thienostilbene oximes by the Wittig reaction, converted to aldehydes by Vilsmeier formylation, and transformed to the corresponding uncharged oximes in very high yields. Eight trans,anti- and trans,syn-isomers of oximes were tested as reactivators of nerve-agent-inhibited AChE and BChE. Four derivatives reactivated cyclosarin-inhibited BChE up to 70% in two hours of reactivation, and docking studies confirmed their productive interactions with the active site of cyclosarin-inhibited BChE. Based on the moderate binding affinity of both AChE and BChE for all selected oximes, and in silico evaluated ADME properties regarding lipophilicity and CNS activity, these compounds present a new class of oximes with the potential for further development of CNS-active therapeutics in OP poisoning.

Acute Pancreatitis Following Organophosphate Compound Poisoning: A Case Report

Organophosphate compounds are chemicals containing central phosphate molecules with alkyl or aromatic substituent’s. They occur in diverse forms and are used as pesticides, herbicides, nerve agents, etc. Organophosphate compounds are frequently used as pesticides in agrarian communities all across the world. South Asian countries such as Nepal use vast quantities of Organophosphate compounds for pest control in agriculture. Therefore, accidental and suicidal ingestion of Organophosphate compound poisoning has been common especially among the agricultural rural communities. Apart from muscarinic, nicotinic and central nervous system effects in rare instances, Organophosphate compounds are known to cause pancreatitis. Although pancreatitis is a rare complication of Organophosphate poisoning, it is necessary to evaluate patients with Organophosphate poisoning with serum lipase level, Ultrasound abdomen, and Contrast- Enhanced Computed Tomography(CECT) abdomen in patients with pain abdomen for early detection and management of acute pancreatitis.

A case report of delayed lower intestinal bleeding after organophosphate poisoning

BackgroundOrganophosphate poisoning is a serious issue and it results in significant casualties in developing countries. Since agriculture remains an important and necessary sector of human society and organophosphate are commonly used in agriculture, it is difficult to prevent organophosphate poisoning. Gastrointestinal bleeding is not a common but life threatening symptom of organophosphate poisoning. We report a rare case of gastrointestine bleeding due to organophosphate poisoning.Case presentationA 78-year-old woman presented to our hospital approximately 12 h after ingesting a mouthful of organophosphate and benzodiazepines in a suicide attempt. Six weeks after successful medical treatment for respiratory failure, she developed recurring melena. Colonoscopy and esophagogastroduodenoscopy findings were negative for ulcers or bleeding. Enteroscopy revealed severe circumferential ulcers with luminal narrowing 10 cm proximal to the ileocecal valve. The patient underwent a 100-cm ileum resection after failed medical treatment and recovered uneventfully. The resected terminal ileum demonstrated severe inflammation and a sharp transitional zone between the healthy and injured mucosa approximately 50 cm proximal to the ileocecal valve. Pathological examination revealed an injured mucosa with inflammatory cell infiltration and structural damage. This case highlights a rare event of OP poisoning with late-onset lower gastrointestinal bleeding, which prolonged the patient’s recovery course and parenteral alimentation period.ConclusionWe report a rare case of a patient with organophosphate poisoning, with late-onset lower GI tract bleeding, which raised clinical awareness regarding the organophosphate poisoning that induce intestinal symptoms.

Effects of N-acetyl cysteine on TRPM2 expression in kidney and liver tissues following malathion intoxication

ABSTRACT We investigated the effects of N-acetyl cysteine (NAC) on transient receptor potential melastatin 2 (TRPM2) channel expression in rat kidney and liver tissues following experimental malathion intoxication. We used seven groups of six male Wistar albino rats: control group, NAC, pralidoxime + atropine, malathion, malathion + pralidoxime + atropine, malathion + pralidoxime + atropine + NAC, and malathion + NAC. Single doses of 100 mg/kg N-acetyl cysteine, 40 mg/kg pralidoxime, 2 mg/kg atropine and 1/3 the lethal dose of malathion were administered. No difference in malondialdehyde (MDA) levels, apoptosis or TRPM2 immunoreactivity was found in liver tissue among the groups. In kidney tissue, MDA levels, apoptosis and TRPM2 immunoreactivity were increased significantly in the malathion and malathion + NAC groups compared to the control group. We found that organophosphate intoxication did not affect MDA, apoptosis or TRPM2 immunoreactivity in rat liver during the acute period. By contrast, we found that in kidney tissue, MDA, apoptosis, and TRPM2 immunoreactivity were increased significantly following administration of malathion. Also, NAC given in addition to pralidoxime and atropine reduced MDA to control levels.