Plasma Pseudocholinesterase Research Articles

Estimation of plasma pseudo-cholinesterase in acute organo phosphorus poisoning and its correlation with morbidity & mortality in a tertiary care centre’: A prospective study

Estimation of plasma pseudo-cholinesterase in acute organo phosphorus poisoning and its correlation with morbidity & mortality in a tertiary care centre’: A prospective study

A STUDY ON THE PREDICTORS OF MORBIDITY AND MORTALITY IN ORGANOPHOSPHORUS POISONING

Background: Poisoning from organophosphorus (OP) pesticides can occur as a result of occupational, accidental, or purposive exposure.Cholinergic syndromes,central nervous system (CNS) disorders,and cardiovascular disorders are some of the clinical manifestations.The most common causes of death are cardiovascular and respiratory failure.Aim:To assess various parameters that can predict the outcome of patients suffering from OP poisoning. Materials and Methods: A prospective study was conducted at Government general hospital vijayawada Over a one-year period of time.The clinical history of OP compound exposure and low blood levels of pseudo cholinesterase were used to make the diagnosis of OP poisoning.Results:The current study enrolled 133 patients, 98.5% of whom were suicidal and only 1.5% were exposed accidentally.The majority of cases involved young males,with an F/M ratio of 1:3.2.Younger people and patients who required prolonged ventilator support had a higher mortality rate.The death rate was proportional to the amount of poison consumed. Lag time,organ failure (Acute Renal Failure),and plasma pseudocholinesterase levels are all factors to consider. Acute complications were frequently observed and treated. There was no clear link found between liver dysfunction, electrolyte imbalance, and clinical outcome. Conclusion: According to this case study, mortality is directly proportional to the lag time, amount of OP substances consumed, and clinical severity.Acute renal failure, severity, pseudocholinesterase levels, and duration of ventilatory support are all factors to consider.This study emphasises the importance of prompt diagnosis and the initiation of early and effective treatment, which may result in fewer complications and lower mortality rates

The first and the second types of diabetes mellitus, autoimmune and non-autoimmune thyroiditis differential diagnosis possibility using the calculated index based on plasma butyrylcholinesterase isoforms activity

BACKGROUND: The possibility of using a diagnostic index based on the use of blood plasma objective indicators to differentiate the diagnosis of type 1 and type 2 diabetes mellitus, autoimmune and non-autoimmune thyroiditis is an urgent task for timely decision-making on the use of a particular type of therapy, taking into account the etiology of a particular pathology. Changing the ratio of blood plasma butyrylcholinesterase isoforms activity makes it possible to identify increased excitability, to separate them among themselves depending on the genesis, and during treatment, to assess the activity of diseases and the effectiveness of therapeutic measures.
 AIM: To develop a calculated diagnostic index for the differential diagnosis of diabetes and thyroiditis autoimmune type from symptomatically similar non-autoimmune pathologies, using the ratio of the plasma pseudocholinesterase isoforms activities.
 MATERIALS AND METHODS: The study involved 188 people: 45 patients diagnosed with type 1 diabetes; 60 patients diagnosed with type 2 diabetes; 25 patients diagnosed with autoimmune thyroiditis; 25 patients with non-autoimmune thyroiditis; the control group consisted of 33 healthy volunteers. The groups were aligned by gender and age. Patients of all groups were examined by an endocrinologist and a therapeutist. The diagnoses were made in accordance with the Clinical Guidelines of the Russian Endocrinologists Association for the Diagnosis and Treatment of Autoimmune Thyroiditis in Adults, as well as the Clinical Guidelines Type 1 Diabetes Mellitus in Adults. In the blood plasma of all patients groups, the activity of pseudocholinesterase (butyrylcholinesterase) forms was determined by analysis using a modification of the Ellmans method in combination with inhibitory analysis. The index was calculated based on the ratio of the studied enzyme typical and atypical forms activities. Based on the results of data analysis for all examined groups, diagnostic intervals were determined that are characteristic for each diagnosis, as well as for conditionally healthy people. Comparison of the patients distribution by categories of diagnosis was carried out using the -square test with Yates correction in the SPSS 22 statistical software package.
 RESULTS: The results of the blood plasma analysis determined that in the diagnoses of autoimmune thyroiditis and type 1 diabetes mellitus, there was an increase in the activity of increased activity of the butyrylcholinesterase isoform, while the activity of the atypical form remains more stable. The ratio of these forms was taken as the basis for the development of the calculated diagnostic index. Diagnostic index for the control group in the range of 12; for patients with non-autoimmune thyroiditis 2,12,9; autoimmune thyroiditis 33,5; type 1 diabetes mellitus 3,65; type 2 diabetes 01. Statistical analysis of the data showed that the diagnosis based on the index obtained in this way does not inferior to the diagnostic scales in terms of sensitivity and specificity. The findings are consistent with the evolution of data supporting each diagnosis.
 CONCLUSIONS: The calculated index on the basis of butyrylcholinesterase activity is a promising, minimally invasive, fast and budgetary method, revealing a pronounced severity of occurrence in terms of symptoms, but different in etiology, type 1 diabetes mellitus and type 2 diabetes mellitus, autoimmune thyroiditis and thyroiditis of a non-autoimmune nature, which is of critical importance when choosing a therapeutic strategy and improving the quality of life of patients.

English

BACKGROUND Organophosphorus poisoning is possibly the most common acute poisoning in the developing countries and is a global health problem.1,2 Between 750,000 and 3,000,000 of OP poisoning occur globally every year.3 OP insecticides bind and irreversibly inhibit butyrylcholinesterase. These compounds cause excessive stimulation of muscarinic and nicotinic cholinergic receptors in the central and autonomic nervous systems and at skeletal neuromuscular junctions.4 Butyrylcholinesterase (BChE) is also known as pseudocholinesterase.5 Due to the limitations in accuracy and cost of plasma pseudocholinesterase level estimation, alternate biochemical marker options for OP poisoning have been studied for evaluation of patients with OP poisoning. Increased creatine phosphokinase (CPK) levels are seen in OP poisoning in early phase.6,7 This study was conducted to correlate initial serum CPK levels with the clinical severity at presentation and the final clinical outcome. METHODS This descriptive study was carried out after reviewing case records of patients >/= 18 years with acute organophosphorus (OP) poisoning who were admitted under the Internal medicine department of Government Medical College Thiruvananthapuram between January 2019 and December 2019. The severity of poisoning was categorized based on Peradeniya organophosphorus poisoning (POP) scale. Serum CPK level, serum pseudocholinesterase, and total dose of atropine in milligrams until the outcome in the hospital were recorded. The student's t-test and Pearson's correlation coefficient were used for the assessment of statistical significance. RESULTS Clinical severity as per POP SCALE was mild (score 0–3) in 24 (27 %), moderate (score 4–7) in 50 (55.81 %) and severe (score 8–11) in 16 (18 %) patients. Serum CPK, serum pseudocholinesterase level, and total atropine dose strongly correlated with clinical severity of OP poisoning. Our study strongly recommends serum CPK as an alternative marker. CONCLUSIONS Serum CPK level can be an effective biomarker in acute OP poisoning because its level can predict the prognosis of OP poisoning. KEY WORDS Creatine Phosphokinase, Organophosphorus Poisoning, Severity.

Clinical Epidemiology and Predictors of Outcome in Chlorpyrifos Poisoning in Farming and Allied Agricultural Workers in East Godavari, Andhra Pradesh.

Background:Chlorpyrifos is the ninth most consumed pesticide for agricultural purposes in India. It is a chlorinated organophosphate that also causes poisoning in non-target species such as humans. There is a scarcity of published literature on chlorpyrifos intoxication in the Indian scenario.Objective:The objective of the study was to find out the clinical epidemiology and factors influencing the outcome of chlorpyrifos poisoning in the farming and allied agricultural workers.Methodology:The patient record-based cross-sectional study was carried out on 40 confirmed cases of chlorpyrifos poisoning in a tertiary care teaching hospital in East Godavari district, a predominantly agrarian region in the state of Andhra Pradesh. Clinic-demographic profile, aspects of poisoning, outcome in terms of recovery, death, ventilator support were obtained. Mortality or requirement of ventilator support was classified as a bad outcome. Carlsons’ Co-morbidity Index, Poison Severity Score, and Glasgow Coma Scale score at the time of admission were assessed objectively. The strength of association between the predictor variables and the outcome was represented using the odds ratio. Statistical analysis was performed using Graph Pad Prism 8.0 trial version.Results:Chlorpyrifos poisoning constituted about 10% of pesticide poisoning and 25% of such cases had a poor outcome. The mean age was 44.73 ± 10.76 years, the majority being farmers. Younger age (<40 years), early reporting to hospital, Carlsons’ Co-morbidity Index of less than 8, Glasgow Coma Scale score of more than 12, and Poison severity score of less than 2 were significantly associated with favorable outcome (P < 0.005). During admission, 60% of cases had a plasma pseudocholinesterase level of less than 1000 U/L. Lower plasma pseudocholinesterase was associated with a poor outcome (OR 9.62 CI 4.05-22.84).Conclusions:Farmers and allied agricultural workers are susceptible to chlorpyrifos intoxication. Along with clinical and laboratory parameters, Carlsons’ Co-morbidity Index, Glasgow Coma Scale score, and Poison severity score at the time of admission are seen as reliable predictors of outcome.

Blood Plasma Pseudocholinesterase as a Potential Biomarker of Autoimmune Diseases

We studied the blood plasma butyrylcholinesterase (BChE, pseudocholinesterase) activity as a potential marker for differentiating such autoimmune pathologies as type 1 diabetes mellitus (DM1), autoimmune thyroiditis (AIT) and rheumatoid arthritis (RA) from diseases having similar symptoms but different etiology. The blood plasma pseudocholinesterase activity was analyzed for patients with different types of diabetes mellitus. We showed its fivefold increase in DM1 compared to the control group, while in the second type of diabetes, which is metabolic pathology, it decreases two times. It was demonstrated that the activity of blood plasma BChE in patients with AIT and RA also increased fivefold compared to the group of patients without autoimmune disorders. Thus, the butyrylcholinesterase activity increases in diseases of an autoimmune nature, whereas in metabolic pathology it has the tendency to decrease; it indicates the adequacy of the selected criterion for the further development of a screening test-system that would allow differentiation of autoimmune diseases from the diseases of another origin, but with similar symptoms.

Morbidity and Mortality Indicators in Acute Organophosphate Poisoning in Zagazig University Hospital, Egypt: Retrospective Study

Introduction: Organ phosphorus (OP) toxicity has been studied extensively because of its world wide use. Toxicity of organophosphates is the result of inhibition of acetyl cholinesterase resulting in cholinergic signs. Aim of the Work: To evaluate initial indicators that can indicate prognosis of patients in OP poisoning. Materials and Methods: A retrospective study conducted in Zagazig university hospital over a year. OP poisoning was clinically diagnosed with history of OP compound exposure and confirmed by low pseudo cholinesterase levels. Results: In the present study, 76 patients were enrolled. Major cases were male. High mortality rates were in the youth and in prolonged ventilated patients. The mortality rate was proportionally related to lag time after exposure and plasma pseudo cholinesterase levels. Electrolyte disturbance did not affect clinical outcome. Conclusion: From this study, it could be concluded that mortality is directly proportionate to the lag time, amount of OP consumed, clinical severity, pseudo cholinesterase levels and duration of ventilator support. This study helps in rapid diagnosis, and rapid early and effective treatment, which may result in decreasing the morbidity and mortality rates. Recommendation: It is recommended to increase awareness regarding the rapid diagnosis, and rapid effective treatment of organ phosphorous.

The clinico-demographic study of morbidity and mortality in patients with organophosphate compound poisoning at tertiary care hospital in rural India

Background: Organophosphates (OP) are commonly used and potentially fatal insecticides. Given the unrestricted availability and widespread use, OP poisoning is very much common following either accidental or intentional exposures. Many parameters are proposed to predict outcome, yet there is no consensus about these parameters. This study aimed to investigate different factors associate with morbidity and mortality in rural population that can help in identifying patients in need of intensive care and treatment to prevent deaths.Methods: This was a cross-sectional observational study of 323 patients, admitted to the tertiary care rural public hospital with OP poisoning between December 2015 to November 2016.Results: Of the 323 patients studied, 62.85% were male, 227 (70.27%) were suicides, 241 (74.61%) ingested OP compounds, 40 (12.38%) patients developed intermediate syndrome and 56 (17.34%) died. There were statistically significant differences between ventilatory support group and no ventilatory group for suicidal intention, sex, comorbid psychiatric conditions, route of exposure, certain clinical features on admission, GCS score, POP scale, time from exposure to initiation of treatment, plasma pseudocholinesterase levels, oxygen saturation, and random blood sugar levels (p&lt;0.05).Conclusions: OP poisoning is a life-threatening condition which requires immediate management. Early initiation of decontamination, atropine and pralidoxime therapy, with supportive ICU care, can save lives. Different demographic, exposure related parameters; some of the clinical features, treatment variables and certain laboratory findings can provide useful prognostic information and help to predict outcomes. A measures to control unchecked availability of these compounds and early transfer of victims to health care facility is needed to save many lives.

Study of Effect of Magnesium Sulphate in Management of Acute Organophosphorous Pesticide Poisoning.

Background:Organophosphorus compound poisoning (OPCP) is a major public health problem in developing countries like India. Atropine and oximes remain the main-stay of management. Magnesium sulfate (MgSO4) has shown benefit in the management of OPCP.Aims:This study was designed to assess the effect of MgSO4 on outcome in OPCP patients admitted to Intensive Care Unit (ICU).Settings and Design:Double-blind prospective randomized clinical trial in an ICU of tertiary care institution.Methods:One hundred patients (50 in each group) of OPCP, confirmed by history and syndrome of OPCP with low plasma pseudocholinesterase, aged between 18 and 60 years were studied. Magnesium group (Group M) received 4 g of 20% MgSO4 infusion over 30 min at admission to ICU, control group (Group C) received normal saline placebo in the same manner. Patients were assessed for the need for intubation, requirement of atropine, duration of mechanical ventilation, duration of ICU stay, and its effect on mortality.Statistical Analysis:Chi-square test and Fisher's exact test for categorical data, independent sample t-test, and paired t-test for nominal data.Results:Demographics and basal serum magnesium levels were comparable. Atropine requirement was higher in Group C (74.82 ± 22.39 mg) compared to Group M (53.11 ± 45.83 mg) (P < 0.001). A total of 33 patients in Group C and 23 patients in Group M required intubation, respectively (P = 0.043). The mean duration of mechanical ventilation was 4.51 ± 2 days in Group C compared to 4.13 ± 1.6 days in Group M (P = 0.45). ICU stay was 5.36 ± 2.018 days in Group C compared to 4.54 ± 1.581 days in Group M (P = 0.026). There was no significant difference in mortality between the groups.Conclusion:Four grams of MgSO4 given to OPCP patients within 24 h of admission to ICU, decreases atropine requirement, need for intubation, and ICU stay.

Urine Carbamate Determination Compared with Plasma Pseudocholinesterase for Diagnosis of Insecticides Poisoning

Abstract 1.1.Introduction:Diagnosis of carbamate poisoning is frequently missed especially when patients present after the recovery of pseudocholinesterase inhibition. Confusion is due to the similarity of the clinical picture with that of food poisoning and other infectious syndromes. 1.2.Patients and methods:Patients (n=40) admitted within 4 hours of carbamate intoxication were included in the study. They were graded according to Poison severity score PSS. Normal volunteers (n=10) were included and served as negative control group. Normal subjects and all patients were tested for plasma pseudocholinesterase (PsChE) within 4 hours and 18 hours from carbamates exposure. Urine carbamate concentration was determined on the 18th hour and 2 days after exposure. Different PSS groups and normal volunteers were compared for their plasma PsChE and urine carbamate levels using student t test and correlation coefficient Method used for PsChE determination is the kinetic assay method. Urine carbamate concentrations were determined by spectrophotometry using modification of the method of Tamrakar. Carbamate determination method was tested for linearity, precision, recovery and limit of detection of the carbamates 1.3.Results:PsChE was significantly lower in PSS II compared to PSS I. No significant difference in PsChE was noticed between both patient’s groups and normal volunteers on the 18th hour from carbamate exposure. Urine carbamate concentration was significantly higher in PSS II compared to PSS I on the 18th hour and 2 days after exposure. No correlation was detected between the maximum urine carbamate concentration and plasma pseudocholinesterase. The method specificity increased after modification from 76.9 to 91%. Recovery ranged between 95 and 98%. Limit of detection is 0.1µg/ml and limit of quantification is 0.2 µg/ml. The technique is highly reproducible with inter-day precision RSD less than 8%. 1.4. Conclusion: A better evaluation and diagnosis of carbamate poisoning patients with delayed presentation can be achieved using urine carbamate determination rather than plasma pseudocholinesterase which is often normalized at the time of presentation.

Effect of melatonin on duration of delirium in organophosphorus compound poisoning patients: A double-blind randomised placebo controlled trial.

Background and Aims:Organophosphate compound poisoning (OPCP) is associated with high incidence of delirium. Melatonin has been tried in the treatment of delirium and has shown a beneficial effect in OPCP. This study was conducted to know the effect of melatonin on duration of delirium and recovery profile in OPCP patients.Methods:Double-blind randomised placebo control trial in which 56 patients of OPCP confirmed by history and syndrome of OPCP with low plasma pseudocholinesterase, aged >18 years and weighing between 50 and 100 kg, and Acute Physiology and Chronic Health Evaluation II score of <20 were studied. Group M (n = 26) received tablet melatonin 3 mg and Group C (n = 30) received placebo tablet at 9 PM, every night throughout the Intensive Care Unit (ICU) stay. Delirium was assessed using the Confusion Assessment Method for ICU, thrice a day. Sedation was provided with injection midazolam, fentanyl and lorazepam. Duration of mechanical ventilation, vital parameters, ICU stay, sedative and atropine requirement, were recorded.Results:The time taken to be delirium free was significantly lower in Group M (6 ± 2.92 days) compared to Group C (9.05 ± 2.75 days) (P = 0.001) and prevalence of delirium was significantly decreased in Group M compared to Group C from day 3 onwards. The requirement of midazolam (Group M - 2.98 ± 4.99 mg/day, Group C - 9.68 ± 9.17 mg/day, P < 0.001) and fentanyl (Group M - 94.09 ± 170.05 μg/day, Group C - 189.33 ± 156.38 μg/day, P = 0.03) decreased significantly in Group M. There was no significant difference in the average atropine consumption (P = 0.27), duration of mechanical ventilation (P = 0.26), ICU stay (P = 0.21) and the number of patients requiring mechanical ventilation (P = 0.50).Conclusion:Orally given melatonin in organophosphate compound poisoning patients reduces the duration of delirium and the requirement of sedation and analgesia.

Predictors of Morbidity and Mortality in Organophosphorus Poisoning: A Case Study in Rural Hospital in Karnataka, India.

Background:Organophosphorus (OP) pesticides poisoning can result from occupational, accidental or intentional exposure. Clinical manifestations include cholinergic syndromes, central nervous (CNS) system and cardiovascular disorders. Death is usually due to cardiovascular and respiratory failure.Aim:To evaluate various parameters that can predict outcome of patients in OP poisoning.Materials and Methods:A prospective study conducted in Department of Medicine, Adichunchingiri Institute Of medical Sciences and Research Centre, Karnataka, over period of 1 year. Diagnosis of OP poisoning was based on clinical history of exposure to OP compound and low serum pseudocholinesterase levels.Results:In the present study 133 patients were enrolled, out of which 98.5% were suicidal cases and only 1.5% had accidental exposure. Majority of cases were young male, with F/M ratio 1:3.2. Mortality rates were higher in younger people and in patients who required prolonged ventilator support. The mortality rate was directly proportional to amount of poison consumed, lag time, organ failure (Acute Renal Failure) and plasma pseudocholinesterase levels. Acute complications were frequently noted and were related to morbidity and mortality. No strict relationship was found between liver dysfunction, electrolyte disturbance and clinical outcome.Conclusion:This case study concluded that mortality is directly proportionate to the lag time, amount of OP substances consumed, clinical severity, pseudocholinesterase levels, Acute renal failure and duration of ventilatory support. This study highlights the importance of rapid diagnosis, and initiation of early and effective treatment, which may result in less number complications and also decreases the mortality rates.

Delayed recovery from paralysis by succinylcholine in patient with preoperatively unrecognized and inherited pseudocholinesterase deficiency

Delayed recovery from paralysis by succinylcholine in patient with preoperatively unrecognized and inherited pseudocholinesterase deficiency

Pseudocholinesterase in gestational diabetes: positive correlation with LDL and negative correlation with triglyceride

Low pseudocholinesterase (PChE) activity accompanies pregnancy, liver disease, renal failure, and certain drug therapies. The aim of this study was to investigate a possible relationship among PChE and plasma insulin levels, lipid profile, and inflammatory response ingestational diabetes. This study included 165 women aged 20–40 years. Subjects were divided into four groups as follows:Control group, 29 non-pregnant healthy women; GroupNGT, 61 healthy pregnant women (normal glucose tolerance);Group GD, 62 pregnant women with gestational diabetes; and Group AGT, 13 pregnant women with abnormal glucose tolerance. Gestational ages were between 34 and 40 weeks. Plasma PChE, triglyceride, high-/lowdensity lipoprotein (HDL, LDL), glycated hemoglobin A1c(HbA1c), insulin, C-reactive protein (CRP), and white blood cell (WBC) levels were measured in all subjects. There were no statistically significant differences in plasma PChE, insulin, and LDL levels between the groups. Plasma triglyceride, HbA1c, WBC, and CRP levels were significantly higher in Group GD and Group AGT compared to the other groups (P\0.000). There was a positive correlation between increased PChE and LDL,while a negative correlation was observed between PChE and triglyceride in Group GD. There was a positive correlation between increased CRP and HbA1c and a negative correlation among CRP and LDL and triglyceride in Group GD. PChE activity was not significantly different between the groups. However, there was a positive correlation between PChE and LDL levels in pregnant women with GD, suggesting that LDL levels in pregnant women with GD may help to predict the risk of prolonged apnea in situations in which PChE activity cannot be measured.

Homicidal Attempt by Injection of an Organophosphate Insecticide in a Seven Month-Old Baby

The present case reports the first ever case of homicidal poisoning due to injection of an organophosphate insecticide with successful resuscitation and reporting. Case: A 7-month-old baby presented to the emergency department with a history of insect bite since 5 hours by his relatives with a main complaint of irritability, disturbed conscious level, irregular respiration and wheezy chest. The injection site has appeared as oval area of redness and swelling at right elbow region that were noticed by the pediatric emergency department physician, with a medical history of resistance to medications for suspected insect bite (antihistaminic and corticosteroids in pediatric dosage) from referral hospital. By toxicological consultation, we revealed disturbed conscious level (GCS 10), pinpoint pupils and increase all body secretions, salivation, bronchorrhea and incontinence in urine and stools. The clinical toxicology consultant suspected a case of acute anticholine esterase toxicity and recommended a plasma pseudocholinesterase level that appeared to be very low, consistent with acute intoxication with organophosphate insecticide. The management of organophosphate poisoning was started, as airway management, administration of oxygen and fluids, as well as atropine in increasing doses and pralidoxime. Our case report emphasizes the necessity of a detailed history taken and careful smart medical examination for the possibility of homicide in such cases. Although injection sites may be the expected results of insect bite, medical treatment, dermal lesions also may be associated with injections of toxic substances.

Plasma pseudo cholinesterase deficiency leading to seven hour apnoea in a child undergoing adeno-tonsillectomy

Objective: We report a rare, silent, potentially fatal operative complication of seven hour apnoea in a patient undergoing adenotonsillectomy secondary to deficiency of plasma cholinesterase. Awareness of this hereditary disorder is important to otolaryngologist as; it is difficult to diagnose, can be unexpectedly alarming for parents and the surgeon. Methods: Case report and review of world literature. Results: A four-year male with obstructive sleep apnoea underwent a routine elective adenotonsillectomy; there was no spontaneous recovery of respiration following surgery. He was transferred to the intensive care unit and 7 h later was successfully weaned from the ventilator and extubated. A plasma cholinesterase level of 4561 U/L was discovered much later. Conclusion: To our knowledge this is the first case report of pseudo cholinesterase deficiency reported in otolaryngology literature and first in Oman. The patient should receive information about the condition, the associated risks, inheritance and need for testing other family members.

Accidental organophosphate insecticide intoxication in children: a reminder

Misuse of organophosphate insecticides, even in case of domestic application, can be life threatening. We report the case of siblings admitted with respiratory distress, pinpoint pupils and slurred speech. The symptoms appear after spraying the skin by insecticides. Plasma pseudocholinesterase level appeared to be very low, consistent with acute intoxication with organophosphate insecticide.Management of organophosphate poisoning consists of airway management, administration of oxygen and fluid, as well as atropine in increasing doses and pralidoxime. Decontamination of the patient's skin and the removal of the patient's clothes are mandatory in order to avoid recontamination of the patient as well as the surrounding healthcare personnel.Plasma pseudocholinesterase analysis is a cheap and an easy indicator for organophosphate insecticides intoxications and could be used for diagnosis and treatment monitoring.

Neuromuscular pharmacodynamics of mivacurium in adults with major burns

Mivacurium is metabolized by plasma pseudocholinesterase (PChE) enzyme, which is decreased in burns. We tested whether the decreased metabolism of mivacurium due to decreased PChE activity can overcome the pharmacodynamic resistance to non-depolarizing relaxants previously seen in major burns. Thirty adults with 35 (13)% [mean (sd)] burn were studied at 5-91 post-burn days and 31 non-burns matched controls. Mivacurium 0.2 mg kg(-1) was administered as a single bolus. Neuromuscular block was monitored with single-twitch response using TOF-Watch™. Onset time (drug administration to maximal twitch suppression) and spontaneous recovery were measured. Onset time was significantly prolonged in burns when compared with non-burns (115 vs 90 s; P<0.001). The PChE levels were lower in burns [1432 (916) vs 2866 (731) IU litre(-1); P<0.001] and the neuromuscular recovery to 50% of baseline twitch height was prolonged in burns (41 vs 26 min; P<0.001). There was a significant correlation between PChE and time to 50% recovery for the whole group together (r=-0.6; P<0.001). The dibucaine numbers were not different. The prolonged onset time suggests resistance to neuromuscular effects, whereas the prolonged recovery suggests increased sensitivity. This divergent response can be explained by qualitative and quantitative changes in acetylcholine receptor expression causing resistance and decreased PChE activity causing sensitivity. Despite using a relatively large dose of mivacurium (0.2 mg kg(-1)) in the presence of decreased PChE levels, this did not overcome the resistance resulting from up-regulated receptors.

Detection of landiolol using high-performance liquid chromatography/fluorescence: A blood esterase-sensitive ultra-short-acting β 1-receptor antagonist

Landiolol hydrochloride, a new adrenergic β 1-selective antagonist having an ultra-short half-life, is used to prevent tachyarrhythmia during surgery. Since landiolol is thought to be rapidly hydrolyzed to an inactivate metabolite by esterases, quantification of the drug concentration in the blood is impractical. The landiolol concentration in blood was halved within 5 min after blood sampling. This degradation was effectively prevented by pre-treatment with neostigmine (100 μg) in the sampling tube, but not by EDTA pre-treatment, indicating that landiolol could be metabolized by pseudocholinesterase in plasma. After the one-step solid-phase extraction, fluorescence detection of landiolol reduced chromatographic background signals and then improved assay sensitivity to the lower limit of 10 ng/ml in blood; this reproducible approach yielded coefficient variation of less than 6%. The blood concentration-time profile of landiolol hydrochloride in patients of the present investigation afforded more practical assessment than previously reported studies, thus improving accuracy and facilitating detailed pharmacokinetic study in relation to the pharmacological action of drug.

Relationship Between Cholinesterase Inhibitor Insecticides In Human Blood And Insecticides Residues In Drinking Water In Mansoura City- Egypt

Pesticides are classified into four major groups; insecticides, herbicides, rodenticides and fungicides. Insecticides poisoning is one of the most common poisoning affecting our population. The study investigates the relationship between cholinesterase inhibitor insecticides in human blood and insecticides residues in drinking water in Mansoura city. Sixty patients suffering from insecticides poisoning admitted to Emergency Hospital Mansoura University- Egypt in March 2005, were included in this study. Blood samples were collected from these patients. The studied patients and their relatives were asked to obtain water samples of their drinking water from the localities where they live. Thirty drinking water samples were collected. Blood and water samples were extracted using Liquid-liquid extraction technique (LLE) and analyzed for pesticides using Gas Chromatography-Mass Selective Detector (GC-MSD). In addition, blood samples were analyzed for plasma pseudo-cholinesterase level (PChE) and red blood cells acetyl cholinesterase activity (AChE). The analysis of drinking water and blood samples revealed organophosphorous (Mevinphos) and organochlorine (Aldrin) insecticides. Moderate insecticides poisoning was more common among the studied groups (65.0%) compared to mild and severe poisoning. The peak incidence of poisoning was in the age group from 20-30 years (46.67%), followed by the age group from 10-20 years (43.33%). There was a female sex predominance among the poisoned patients (56.67%). There was a negative correlation between the severity of poisoning and each of PChE levels and AChE activity % being lowest (p<0.001) in severe poisoning compared to moderate and mild poisoning.