Organophosphorus Pesticide Poisoning Research Articles

Serial repetitive nerve stimulation studies in organophosphorus poisoning indicate two distinct pathophysiological processes occur at the neuromuscular junction in the intermediate syndrome

Introduction Intermediate syndrome is an important cause of respiratory failure following acute organophosphorus pesticide poisoning. The objective of this study was to examine the pathophysiology of this syndrome by analysis of sequential repetitive nerve stimulation studies in patients with acute organophosphorus pesticide poisoning. Methods Thirty-four consenting symptomatic patients with acute organophosphorus pesticide poisoning with intermediate syndrome (n = 10) or a milder forme fruste intermediate syndrome (n = 24) were assessed prospectively with daily physical examination and repetitive nerve stimulation done on the right and left median and ulnar nerves. The compound muscle action potential at 1, 3, 10, 15, 20 and 30 Hertz was measured with a train of ten stimuli. The amplitudes of the resulting stimuli were normalized to the first stimulus (100 per cent) and plotted against time. The decrease in the area under the curve of all the second stimulus compound muscle action potentials in the first 0.3 seconds was measured as a means of quantifying the refractory block. The decrease in the area under the curve under the 10, 15, 20 and 30 Hertz compound muscle action potentials relative to this pooled second stimulus compound muscle action potentials-area under the curve indicated the extent of additional rate-dependent block (decreasing compound muscle action potential-area under the curve over the first 0.3 seconds after the first stimulus with increasing Hertz). Results These new measurements strongly correlated with the severity of weakness. Refractory block was seen in most patients but was more severe in those with intermediate syndrome than those with forme fruste (partial) intermediate syndrome (median 55 per cent versus 16 per cent, P = 0.0001). Similar large differences were found for rate-dependent block (30 per cent versus 7 per cent, P = 0.001), which was uncommon in forme fruste intermediate syndrome but found in nine out of 10 patients with intermediate syndrome. Rate dependent block was generally only observed after 24 hours. The simplest strong predictor was total block at 30 Hertz repetitive nerve stimulation (89 per cent [interquartile range 73 to 94 per cent] versus 21 per cent [4 to 55 per cent]; P < 0.0001), which was very similar to total block calculated by summing other calculations. Discussion These findings likely represent depolarization and desensitization block from prolonged excessive cholinergic stimulation but it is not clear if these are from pre- or post-synaptic pathology. An animal model of intermediate syndrome with repetitive nerve stimulation studies might enable a better pathophysiological understanding of the two types of block. Limitations The limited number of repetitive nerve stimulation studies performed were sufficient to demonstrate proof-of-concept, but further studies with more patients are needed to better define the correlates, clinical relevance and possible diagnostic/prognostic roles for the use of this technique. Conclusion There are two easily distinguishable pathophysiological abnormalities in the neuromuscular block in intermediate syndrome. While they often coincide, both may be observed in isolation. The total and rate-dependent block at 30 Hertz are strongly associated with more severe weakness.

TRPV4 modulation participates in paraoxon-induced brain injury via NMDA and NLRP3 regulation

ABSTRACT Background Organophosphorus pesticide poisoning can lead to severe brain damage, but the specific mechanisms involved are not fully understood. Our research aims to elucidate the function of the TRPV4 ion channel in the development of brain injury induced by paraoxon (POX). Methods In vivo, we examined the survival rate, behavioral seizures, histopathological alterations, NMDA receptor phosphorylation, as well as the expression of the NLRP3-ASC-caspase-1 complex and downstream inflammatory factors in the POX poisoning model following intervention with the TRPV4 antagonist GSK2193874. In vitro, we investigated the effects of GSK2193874 on NMDA-induced inward current, cell viability, cell death rate, and Ca2+ accumulation in primary hippocampal neurons. Results The treatment with the TRPV4 antagonist increased the survival rate, suppressed the status epilepticus, improved pathological damage, and reduced the phosphorylation level of NMDA receptors after POX exposure. Additionally, it inhibited the upregulation of NLRP3 inflammasome and inflammatory cytokines expression after POX exposure. Moreover, the TRPV4 antagonist corrected the NMDA-induced increase in inward current and cell death rate, decrease in cell viability, and Ca2+ accumulation. Conclusion TRPV4 participates in the mechanisms of brain injury induced by POX exposure through NMDA-mediated excitotoxicity and NLRP3-mediated inflammatory response.

Enhanced treatment of acute organophosphorus pesticide poisoning using activated charcoal-embedded sodium alginate-polyvinyl alcohol hydrogel.

The adsorption of activated charcoal is currently a major clinical treatment for acute organophosphorus pesticide poisoning (AOPP). However, the adsorption duration and efficiency of this method is unstable. In this study, a hydrogel embedding activated charcoal was prepared and its alleviating effects on AOPP were investigated. A composite hydrogel using sodium alginate and polyvinyl alcohol (SA-PVA) hydrogel was prepared in this study. The structural properties of the SA-PVA hydrogel were characterized via multiple analysis including FTIR, TGA, XRD, SEM, tensile strength and expansion rate. Based on these, activated charcoal (AC) was embedded within the SA-PVA hydrogel (SA-PVA-AC) and it was used for the treatment of AOPP. Structural characterization indicated SA-PVA hydrogel possesses excellent mechanical properties and biocompatibility. The invivo study demonstrated that SA-PVA-AC significantly alleviated the inflammation and oxidative damage in the liver, as evidenced by reduced levels of IL-6, TNF-α, and, IL-1β, SOD, and MDA. Furthermore, SA-PVA-AC treatment effectively re-regulated the activities of serum AST and ALT, exhibiting an improved effect on liver function. The findings suggest that activated charcoal embedded within SA-PVA hydrogel has significant potential as a therapeutic agent in treating AOPP, and offering a novel approach to managing pesticide-induced toxicity.

Evaluation of organophosphorus pesticide tyrosine adducts for postmortem change by human serum albumin with liquid chromatography quadrupole Orbitrap mass spectrometry.

Organophosphorus pesticides (OPPs) having a phosphate ester moiety, such as malathion (MA) and methidathion (DMTP), are widely used and have been detected in many fatal cases of accidental exposure or suicide in Japan. In forensic toxicology, the accurate determination of blood OPP concentration is mandatory to prove death by OPP poisoning. However, fatal pesticide concentration in blood at autopsy varies depending on the circumstances surrounding the dead body. In this study, we found that 16 OPPs were degraded by human serum albumin (HSA) in a temperature-dependent fashion. The mechanism underlying MA, DMTP, azinphos-methyl, etrimfos, fenthion (MPP), pirimiphos-methyl, (E)-dimethylvinphos, (Z)-dimethylvinphos, vamidothion, edifenphos (EDDP), fosthiazate, and pyraclofos degradation involves the formation of adducts with tyrosine residues in HSA. The mass spectra obtained by liquid chromatography quadrupole Orbitrap mass spectrometry revealed that phosphate ester amino acid adducts such as Y-adduct1, Y-adduct2, Y-adduct3, Y-adduct4, and Y-adduct5 were formed in HSA solution incubated with OPPs. These results indicate that the 16 OPPs are postmortem changed by HSA. The detection of phosphate ester amino acid adducts such as Y-adduct1, Y-adduct2, Y-adduct3, Y-adduct4, and Y-adduct5, instead of MA, DMTP, azinphos-methyl, etrimfos, MPP, pirimiphos-methyl, (E)-dimethylvinphos, (Z)-dimethylvinphos, vamidothion, EDDP, fosthiazate, and pyraclofos per se, may be used to determine death by these OPPs poisoning.

Effectiveness of calcium channel blockade for organophosphorus and carbamate pesticide poisoning – study protocol for an open label, pragmatic, 3-arm RCT repurposing two widely available medicines

Pesticide self-poisoning is one of the three most important global means of suicide, killing an estimated 110–168,000 people each year, mostly in poor rural Asian communities. Organophosphorus (OP) and carbamate anticholinesterase insecticides are responsible for about two-thirds of these deaths. Calcium channel blocking medicines (CCB) may reduce the effect of pesticides and prevent deaths. Two preclinical rodents’ studies and eight clinical studies utilising nimodipine and magnesium sulphate (MgSO4), respectively, showed mixed results. We have established a multi-centre randomised controlled trial (RCT) of patients with OP or carbamate self-poisoning admitted to at least six major hospitals in Bangladesh. The study aims to recruit maximum 3,243 patients over four years. One-third of the patients selected at random will receive standard treatment, while one-third will be treated with additional nimodipine and one-third with additional MgSO4. The additional treatments will be given for 48 h. We will check mortality (currently an estimated 11% die with standard treatment) and need for intensive care for mechanical ventilation across the three groups. This could lead to development of the first novel treatment for anticholinesterase poisoning in 50 years and its introduction into routine hospital practice worldwide.

Retracted: Expression of Hypersensitive Troponin I and Soluble ST2 in Acute Organophosphorus Pesticide Poisoning.

[This retracts the article DOI: 10.1155/2022/1427231.].

A STUDY OF SERUM PSEUDOCHOLINESTERASE LEVELS ON ADMISSION AS A PROGNOSTIC INDICATOR OF SEVERITY AND DURATION OF HOSPITAL STAY IN ORGANOPHOSPHOROUS POISONING IN TERTIARY CARE CENTRE, KAKINADA

Introduction: In most parts of the world, acute poisoning from organophosphorus pesticides (OP) has reached pandemic proportions, with a frequent fatality ratio of 20%, their ease of access and socio-cultural variables have a signicant impact on the decision to use OP as a self-poison. In the current scenario, c Results: linical manifestations such as miosis, secretions, changed neurological state, muscle fasciculations, bradycardia, and a characteristic pesticide odour are used to determine the severity and the basis of treatment. Monitoring the degree of inhibition in cholinesterase levels may a Conclusion: id in the early detection and treatment of OP poisoning and to adjust the dose regimen based on the clinical condition of the patients.

Evaluation and Use of Organs from Donors Poisoned by Organophosphorus Pesticide.

BACKGROUND The aim of this study was to explore the evaluation and use of donor organs from donors with brain death caused by acute severe organophosphorus pesticides and provide a basis for the use of such donor organs. MATERIAL AND METHODS Seven cases of brain dead donors caused by acute organophosphorus pesticide poisoning from January 2014 to December 2018 in the hospital were collected, and a retrospective analysis was made of the donors' age, race, physiological and pathological changes, donor organ function changes and the organ use, liver or kidney function recovery, and complications of the recipients. The 18 recipients were followed up until June 31, 2022. RESULTS We found that 71.42% of organ donors were male, and 71.42% of organ donors were under 50 years old. The main cause of death was respiratory failure caused by organophosphorus pesticide poisoning. The liver and kidney functions of 7 donors were damaged, and 3 livers could not be used due to severe functional damage, but the liver or kidney function of 18 recipients gradually recovered after transplantation. Delayed recovery of graft function occurred after transplantation accounted for 21.43%, and the grafts had good short-term to medium-term performance. CONCLUSIONS Although the function of organs from donor with brain death due to acute severe organophosphorus pesticide poisoning is seriously damaged, most of the organs can still be used for transplantation. Individualized functional maintenance according to the situation of donors is conducive to improving the quality of organs.

Mean Cholinesterase Level among Organophosphorus Poisoning Patients Visiting the Emergency Department in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Acute organophosphorus pesticide poisoning is widespread and the most common in many developing countries, including Nepal. Through the inhibition of acetylcholinesterase, organophosphorus poisoning is characterised by the clinical picture of acute cholinergic crisis. Many researchers have shown increased levels of liver enzymes and decreased levels of serum cholinesterase in organophosphorus poisoning, however, very little work has been done in Nepal that studies the correlation between serum cholinesterase and liver enzymes in organophosphorus poisoning. The aim of the study is to find out the mean cholinesterase level among organophosphorus poisoning patients visiting the Emergency Department in a tertiary care centre. This was a descriptive cross-sectional study done among 94 organophosphate poisoning cases visiting the emergency department of a tertiary care centre from August 2021 to August 2022 after obtaining approval from the Institutional Review Committee (Reference number: 04102021/06). Convenience sampling was done. Blood workups were done for cholinesterase and liver function tests. Point estimate and 90% Confidence Interval were calculated. The mean cholinesterase level among organophosphorus poisoning patients was 1978.82±1878.22 (1660.17-2297.47, 90% Confidence Interval). The mean cholinesterase level among organophosphorus poisoning patients was similar when compared to other studies done in similar settings. cholinesterases; liver function tests; organophosphorus poisoning.

Role of hemoperfusion combined with hemodialysis in acute severe organophosphorus pesticide poisoning: a meta-analysis

Abstract Background Acute severe organophosphorus pesticide poisoning is a common severe emergency in developing countries. Our meta-analysis aimed to clarify the efficacy of hemoperfusion combined with hemodialysis on acute severe organophosphorus pesticide poisoning. Methods Several databases were searched. After formulating relevant inclusion and exclusion criteria, qualified studies were included, and the data were extracted. The outcome indicators were the success rate of rescue, the time of hospitalization, the incidence of complications, the time for the cholinesterase level to return to normal, the coma time, and the atropine dosage. The results were analyzed using risk ratios, weighted mean difference, standard mean difference, and 95% confidence interval. The Cochrane Collaboration tool was used to assess the risk of bias in all the included studies. In terms of statistical methods, we used RevMan software (version 5.3; The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) and Stata (versions 14 and 16; StataCorp, College Station, TX, USA) for the data analysis. Results We included 92 randomized controlled trials with 6899 participants. Compared with the conventional emergency treatment group (CET group), the hemoperfusion group (HP + CET group), and the hemodialysis group (HD + CET group), the use of hemoperfusion combined with hemodialysis based on CET (HP + HD + CET group) significantly increased the success rate of rescue and reduced hospitalization time, the incidence of complications, time for cholinesterase level to return to normal, coma time, and atropine dosage. Conclusion Hemoperfusion combined with hemodialysis is effective in the treatment of acute severe organophosphorus pesticide poisoning. In the future, more scientifically designed, large-scale, high-quality, multicenter randomized controlled trials are needed to validate this study further.

ORGANOPHOSPHORUS POISONING PRESENTING WITH EXTRAPYRAMIDAL INTERMEDIATE SYNDROME

Organophosphorus (OP) pesticide poisoning which is common in rural India, usually presents with acute cholinergic crisis, which is due to increased acetylcholine because of the inhibition of the enzyme acetyl-cholinesterase. Central Nervous System (CNS) manifestations are rare, and even rarer is the presentation with extrapyramidal symptoms. The authors report a case of organophosphorus poisoning presenting with torticollis 4 days after organophosphorus exposure. The patient had inhalational exposure to organophosphorus compound while spraying in the elds and developed intermediate syndrome 4 days later. But rather than having respiratory depression, the patient developed torticollis. The patient was successfully managed with Inj Pralidoxime and supportive care. We wish to bring awareness in the medical profession and the general public regarding this rare but life threatening presentation of organophosphorus poisoning.

The advantages of penehyclidine hydrochloride over atropine in acute organophosphorus pesticide poisoning: A meta-analysis

BackgroundPenehyclidine hydrochloride (PHC) has been used for many years as an anticholinergic drug for the treatment of acute organophosphorus pesticide poisoning (AOPP). The purpose of this meta-analysis was to explore whether PHC has advantages over atropine in the use of anticholinergic drugs in AOPP. MethodsWe searched Scopus, Embase, Cochrane, PubMed, ProQuest, Ovid, Web of Science, China Science and Technology Journal Database (VIP), Duxiu, Chinese Biomedical literature (CBM), WanFang, and Chinese National Knowledge Infrastructure (CNKI), from inception to March 2022. After all qualified randomized controlled trials (RCTs) were included, we conducted quality evaluation, data extraction, and statistical analysis. Statistics using risk ratios (RR), weighted mean difference (WMD), and standard mean difference (SMD). ResultsOur meta-analysis included 20,797 subjects from 240 studies across 242 different hospitals in China. Compared with the atropine group, the PHC group showed decreased mortality rate (RR=0.20, 95% confidence intervals [CI]: 0.16–0.25, P <0.001), hospitalization time (WMD=−3.89, 95% CI: −4.37 to −3.41, P <0.001), overall incidence rate of complications (RR=0.35, 95% CI: 0.28–0.43, P <0.001), overall incidence of adverse reactions (RR=0.19, 95% CI: 0.17–0.22, P <0.001), total symptom disappearance time (SMD=−2.13, 95% CI: −2.35 to −1.90, P <0.001), time for cholinesterase activity to return to normal value 50–60% (SMD=−1.87, 95% CI: −2.03 to −1.70, P <0.001), coma time (WMD=−5.57, 95% CI: −7.20 to −3.95, P <0.001), and mechanical ventilation time (WMD=−2.16, 95% CI: −2.79 to −1.53, P <0.001). ConclusionPHC has several advantages over atropine as an anticholinergic drug in AOPP.

A CLINICAL STUDY OF ORGANOSPHOSPHORUS COMPOUNDS POISONING WITH SPECIAL REFERENCE TO ECG CHANGES AND TROPONIN I

Background: The modern world thrives well on revolution in the agricultural practices that has resulted in a massive thrust in agricultural productivity. One of the most important step in green revolution is pesticides. In the developing world, poisoning is a common method of suicide. Organophosphorus compounds inhibit acetyl cholinesterase and butyryl cholinesterase enzymes resulting in excess acetyl choline in the neuromuscular junction causing overstimulation at the cholinergic synapses. The cardiac manifestations occur in a majority of affected patients and may range from innocuous ECG manifestations, such as sinus tachycardia, to life-threatening complications including cardiogenic pulmonary edema. Repolarization abnormalities, including ST-segment elevation and T-wave inversion as well as prolongation of the QTc interval, are among the most frequent cardiac manifestations of acute OP poisoning. . study was carried out in the Department of Medicine, Assam MedicalMethods: College &amp; Hospital,admitting in various ward of medicine,satisfying the inclusion and exclusion criteria. Patients were classied into three grades using 'Peradeniya organophosphorus poisoning scale'.76 Changes in ECG was monitored and Troponin I levels were measured at admission and repeated if required. . In our study, mean age of the cases was 44.32 years with 57.9% cases were below 40 years i.e. young adults. In theResults : study among the 190 patients 123 were males and 67 females. Among our study participants most of the cases were of suicidal OP poisoning (79.5%) while only 20.5% cases were accidental. Most common presenting symptoms in the study were blurring of vision (94.7%), lacrimation (92.1%), breathlessness (64.7%) and salivation (63.7%). In the present study out of 190 cases ECG changes were noted in 75 patients i.e 39.5% cases. Among them most common ECG nding was QTc prolongation (74.7%) followed by ST depression (24%) and T wave inversion (21.3%). A signicant association was observed between severity of poisoning and incidence of ECG changes (p&lt;0.01). Saadeh AM et al.39 in a similar study observed arrhythmias in 11 (24%); prolonged Q-Tc interval in 31 (67%), ST-T changes in 19 (41%) and conduction defects, 4 (9%) cases. Karki P et al.40 observed electrocardiographical abnormalities including prolonged Q-Tc interval in 14 cases (37.8 percent), ST-T changes in 11 cases (29.7 percent), and conduction defects in two cases (5.4 percent). In our study out of 190 cases raised troponin I levels were seen in 30 (15.8%) cases. A signicant association was observed between severity of poisoning and increase in troponin I levels (p&lt;0.01). Wan WG et al.45 discussed the diagnostic value of cardiac enzyme and troponin in acute organophosphorus pesticide poisoning (AOPP). We thus conclude thatConclusions: organophosphorus compounds poisoning is a major cause of morbidity and mortality and is suicidal in most of the cases. ECG abnormalities and myocardial injury is associated with OP poisoning and are more in POP severe grade of poisoning. Morbidity and mortality increases in patients with ECG changes (especially prolonged QTc) and raised Troponin I levels. Therefore, early hospitalization, treatment and follow up with ECG monitoring can be lifesaving in organophosphorus poisoning.

Application of Shewhart Control Chart in Controlling Adverse Events in Patients with Severe Acute Organophosphorus Pesticide Poisoning Undergoing Blood Purification.

Objective To explore the application effect of the Shewhart control chart in controlling adverse events in patients with severe acute organophosphorus pesticide poisoning (AOPP) undergoing blood purification. Methods A retrospective analysis was performed on the clinical data of 102 patients with severe AOPP admitted to the hospital between January 2020 and December 2021, including 47 cases in the control group and 55 cases in the observation group. The control group was given routine emergency nursing, while the observation group was given emergency nursing under the guidance of the Shewhart control chart on the basis of the control group. The specialized operations, basic operations, specialized theory, and basic theory of nursing staffs were scored to compare the comprehensive nursing quality. The total incidence of adverse nursing events in both groups was statistically analyzed. The dosage of atropine, disappearance time of muscarinic symptoms, recovery time of CHE activity to 60%, and hospitalization time in both groups were recorded. The total incidence of complications in both groups was statistically analyzed. The satisfaction of family members was statistically analyzed by a satisfaction questionnaire. Results The scores of specialized operations, basic operations, specialized theory, and basic theory of nursing staffs in the observation group were significantly higher than those in the control group (P < 0.05), total incidence of adverse nursing events was significantly lower than that in the control group (P < 0.05), dosage of atropine, disappearance time of muscarinic symptoms, recovery time of CHE activity to 60%, and hospitalization time were significantly lower than those in the control group (P < 0.05), total incidence of complications was significantly lower than that in the control group (P < 0.05), and scores of nursing attitude, communication process, psychological relief, and drug preparation were significantly higher than those in the control group (P < 0.05). Conclusion The Shewhart control chart can effectively improve the clinical effect, comprehensive nursing quality, and satisfaction of patients with severe AOPP and effectively reduce complications and adverse events.

A sensitive and selective fluorescent probe for acetylcholinesterase: Synthesis, performance, mechanism and application

The detection of acetylcholinesterase (AChE) activity is of great significance for studying the physiological functions of AChE and clinical diagnosis of pesticide poisoning. Herein, a small-molecule fluorescent probe BDFA was rationally designed and readily synthesized via a one-step reaction, which enables qualitative and quantitative detection of AChE. BDFA emits a slight fluorescence in an aqueous medium, while the fluorescence is significantly enhanced under the catalysis of AChE. Mechanism studies reveal that BDFA eliminates the N, N-dimethyl carbamate protective group in the presence of AChE and then spontaneously undergoes intramolecular cyclization conversion to generate an intense fluorescent product. Based on the above mechanism, BDFA exhibits a sensitive, selective, rapid and stable “turn-on” fluorescence response to AChE, without interference from pH, ions, thiols, amino acids and other enzymes. The fluorescence intensity of BDFA at 525 nm has a linear relationship with the AChE concentration in the range of 0.0045–1.0 U/mL, and the detection limit is 4.5 mU/mL. Moreover, BDFA is suitable for rapidly diagnosing AChE activity in blood samples, thus providing an efficient and convenient tool for diagnosing organophosphorus and carbamate pesticide poisoning. Compared with the reported AChE fluorescent probes, BDFA exhibits apparent advantages including simple synthesis, low detection limit and fast response speed.

Study on the Effectiveness and Complication Rate of Hemoperfusion and Hemodialysis in the Treatment of Emergency Patients with Severe Organophosphorus Pesticide Poisoning

Study on the Effectiveness and Complication Rate of Hemoperfusion and Hemodialysis in the Treatment of Emergency Patients with Severe Organophosphorus Pesticide Poisoning

Clinical Analysis of Acute Organophosphorus Pesticide Poisoning and Successful Cardiopulmonary Resuscitation: A Case Series.

Acute organophosphorus pesticide poisoning (AOPP) with cardiac arrest has an extremely high mortality rate, and corresponding therapeutic strategies have rarely been reported. Therefore, this study aimed to explore the prognostic factors and effective treatments of AOPP-related cardiac arrest. This retrospective study was conducted in our department in the years 2018–2021. We conducted a descriptive analysis of the clinical manifestations, rescue strategies, and prognosis of patients with AOPP who had experienced cardiac arrest and successful cardiopulmonary resuscitation. This study included six cases of patients with AOPP in addition to cardiac arrest; in four cases, cardiac arrest occurred <12 h after ingestion, and in two, cardiac arrest occurred more than 48 h after ingestion. Five patients had not undergone hemoperfusion therapy before cardiac arrest, and all six were treated with atropine during cardiopulmonary resuscitation and subsequent pralidoxine. Four patients recovered and were discharged from the hospital, one died in our department, and one was transferred to a local hospital and died there 2 h later. The last two patients had severe pancreatic injuries and disseminated intravascular coagulation. This, along with their death, might have been related to their prognosis. Cardiac arrest can occur in patients with severe AOPP for whom antidote administration was insufficient or not timely. Application of atropine and pralidoxine in a timely manner after cardiac arrest following AOPP is the key to successful treatment. This study provides useful guidelines for the treatment of similar cases in the future.

Analysis of risk factors for hemorrhage in patients with acute poisoning treated with hemoperfusion

Objective: To explore the clinical characterist ics and risk factors of hemorrhage complicated by hemoperfusion therapy in patients with acute poisoning. Methods: In January 2021, the clinical data of 196 patients with acute poisoning who received hemoperfusion therapy in the Second Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2020 were analyzed, and the patients were divided into bleeding group and non-bleeding group according to whether the patients were complicated with bleeding. Multivariate logistic regression was used to analyze the independent risk factors for hemorrhage in patients treated with hemoperfusion. Results: A total of 21 patients in the bleeding group and 175 patients in the non-bleeding group were included. There was no significant difference in general data such as gender, age, and body mass index between the two groups (P>0.05) . Organophosphorus pesticides (χ(2)= 4.56, P=0.030) , HA230 perfusion device (χ(2)=4.12, P=0.042) , platelet count (t=-2.33, P=0.009) and activated partial thromboplastin time (t=14.53, P<0.001) at 2 h of perfusion were the influencing factors of hemorrhage in patients with acute poisoning treated with hemoperfusion. Among them, organophosphorus pesticides, 2 h perfusion activated partial thromboplastin time ≥35 s and other factors were independent risk factors forcomplicated bleeding (P<0.05) . Conclusion: Patients with acute poisoning, especially organophosphorus pesticide poisoning, are at greater risk of bleeding during hemoperfusion therapy. Monitoring of changes in activated partial thromboplastin time should be strengthened and the dose of anticoagulants should be adjusted in time to reduce the risk of bleeding.

High-Fidelity Patient Simulation Incorporated Into a Flipped Classroom Improves Students' Long-Term Knowledge Retention of Acute Organophosphorus Pesticide Poisoning.

The flipped classroom (FC) approach and high-fidelity patient simulation (HFPS) training have shown promising effects in short-term acquisition or long-term retention of knowledge in medical education. In this study, we aimed to explore the incorporation of HFPS into the FC and the impact on the long-term (3 months after classes) knowledge retention of medical undergraduate students learning about acute organophosphorus pesticide poisoning (AOPP). Eighty-two fifth-year medical students were randomly divided into an HFPS group (HG, n = 40) and an FC group (FG, n = 42). A postclass quiz and preinternship quiz were performed to assess the short-term knowledge acquisition and long-term (3 months after classes) knowledge retention of both groups of students. Feedback questionnaires were administered immediately after the class and before the internship to assess the students' self-perceived competency. In the postclass quiz, the scores achieved by the students from the HG and FG were 15.58 ± 2.69 and 14.62 ± 2.19, respectively. No significant difference was found between the 2 groups (P = 0.19). In the preinternship quiz, the scores achieved by the students from the HG (14.50 ± 2.16) were significantly higher than those achieved by the students from the FG (11.40 ± 2.07, P < 0.001). There was no significant difference between the postclass quiz and preinternship quiz scores achieved by the HG students (P = 0.05). However, scores in the preinternship quiz showed a significant decline compared with the postclass quiz for the FG students (P < 0.001). Students in the HG gave significantly higher scores for self-perceived confidence in dealing with AOPP patients in the forthcoming internship on the postclass and preinternship questionnaires. The incorporation of HFPS into the FC approach could improve students' long-term knowledge retention of AOPP and enhance their confidence in caring for these patients in their internship.

Expression of Hypersensitive Troponin I and Soluble ST2 in Acute Organophosphorus Pesticide Poisoning.

The role of soluble growth stimulating gene 2 protein and highly sensitive cardiac troponin in the diagnosis of early myocardial injury caused by acute organophosphorus pesticide poisoning was studied. 171 inpatients with AOPP were divided into three experimental groups according to their mild, moderate, and severe conditions. 20 healthy people were selected as the control group. The levels of cTnI, HS-CTNI, NT proBNP, and ST2 were measured at the 4th and 12th hours after the experiment. The measured data were expressed by mean standard deviation. The independent sample t-test was used for the detection between the two groups, and one-way ANOVA was used for the analysis and comparison between multiple groups. The relevant data were analyzed by Spearman correlation test (P < 0.05). The levels of cTnI and HS cTnI in the experimental group increased with the extension of time and the deepening of poisoning degree; four hours after admission, ST2 and NT proBNP water in the control group and the experimental group increased significantly on average. According to the analysis of the data, there was a positive correlation between HS TnI and ST2 in patients with AOPP (r = 0.938, P < 0.001, r = 0.827, P < 0.001). The more serious the disease, the higher the concentrations of HS TnI and ST2, and the more serious the myocardial injury.