Severe Organophosphate Research Articles

Detection the severity of organophosphate intoxication using sensitive serum biomarkers S100B and amyloid β (Aβ) in Egyptian subjects

Organophosphate (OP) is a compound considered the main leading cause of morbidity and mortality from poisoning worldwide. Serum pseudocholinesterase was evaluated as a diagnostic indicator; it cannot be used to monitor therapy or severity of the intoxication. The rationale of the current study was to evaluate sensitivity, specificity, and cut-off values of serum S100B and amyloid β for neurological affection severity. This study was carried out on sixty OP-impaired patients; in addition, 20 normal controls were included. Serum liver and kidney function tests, malondialdehyde, pseudocholinesterase, and the levels of S100B and amyloid β (Aβ) were determined. Data showed that Pearson’s analysis indicated that the serum level of S100B was positively correlated with Aβ. On the contrary, the activity of pseudocholinesterase was negatively correlated with both of S100B and Aβ. Serum ALT, AST, creatinine, urea, acetylcholine, and MDA levels were elevated while pseudocholinesterase activity was reduced in moderate and severe OP intoxication versus control. A drastic elevation (p<0.001) in the levels of S100B and Aβ was performed in the patient group suffering from OP intoxication versus the normal group. The diagnostic statistical validation of targeted parameters in distinguishing between moderate OP intoxication and control clarifies that S100B displayed the best AUC (0.997) followed by Aβ (AUC=0.992), while the diagnostic veracity of S100B and Aβ in setting apart severe OP-intoxicated and normal subjects stated the symmetric efficacy of potential markers. It was concluded that the significant changes in the levels of S100B and Aβ were directly proportional to the degree of severity of OP intoxication.

Prediction of acute organophosphate poisoning severity using machine learning techniques

Poisoning with organophosphate compounds is a significant public health risk, especially in developing countries. Considering the importance of early and accurate prediction of organophosphate poisoning prognosis, the aim of this study was to develop a machine learning-based prediction model to predict the severity of organophosphate poisoning. The data of patients with organophosphate poisoning were retrospectively extracted and split into training and test sets in a ratio of 70:30. The feature selection was done by least absolute shrinkage and selection operator method. Selected features were fed into five machine learning techniques, including Histogram Boosting Gradient, eXtreme Gradient Boosting, K-Nearest Neighborhood, Support Vector Machine (SVM) (kernel = linear), and Random Forest. The Scikit-learn library in Python programming language was used to implement the models. Finally, the performance of developed models was measured using ten-fold cross-validation methods and some evaluation criteria with 95 % confidence intervals. A total of 1237 patients were used to train and test the machine learning models. According to the criteria determining severe organophosphate poisoning, 732 patients were assigned to group 1 (patients with mild to moderate poisoning) and 505 patients were assigned to group 2 (patients with severe poisoning). With an AUC value of 0.907 (95 % CI 0.89–0.92), the model developed using XGBoost outperformed other models. Feature importance evaluation found that venous blood gas-pH, white blood cells, and plasma cholinesterase activity were the top three variables that contribute the most to the prediction performance of the prognosis in patients with organophosphate poisoning. XGBoost model yield an accuracy of 90.1 % (95 % CI 0.891–0.918), specificity of 91.4 % (95 % CI 0.90–0.92), a sensitivity of 89.5 % (95 % CI 0.87–0.91), F-measure of 91.2 % (95 % CI 0.90–0.921), and Kappa statistic of 91.2 % (95 % CI 0.90–0.92). The machine learning-based prediction models can accurately predict the severity of organophosphate poisoning. Based on feature selection techniques, the most important predictors of organophosphate poisoning were VBG-pH, white blood cell count, plasma cholinesterase activity, VBG-BE, and age. The best algorithm with the highest predictive performance was the XGBoost classifier.

A case of severe organophosphate poisoning used a high-dose atropine

In this study, we report the case of a 59-year-old male patient with organophosphate pesticide poisoning. He visited the local emergency medical center after ingesting 250 ml of organophosphate pesticide. The patient's symptoms improved after the initial intravenous infusion of pralidoxime 5 g and atropine 0.5 mg. However, 18 hours after admission, there was a worsening of the symptoms. A high dose of atropine was administered to improve muscarinic symptoms. A total dose of 5091.4 mg of atropine was used for 30 days, and fever and paralytic ileus appeared as side effects of atropine. Anticholinergic symptoms disappeared only after reducing the atropine dose, and the patient was discharged on the 35th day without any neurologic complications.

Suicidal ingestion of organophosphate compound (Sniper): A case report

Background: Organophosphate insecticide is one of the leading causes of poisoning in many developing Countries.Aim: To describe a typical case of organophosphate poisoning and discuss its management.Case Presentation: An 18 years old female Supermarket sales attendant presented with history of intentional ingestion of organophosphate(OP) compound(Sniper) to commit suicide. She was unconscious, and in severe respiratory distress. Her baseline vital signs were as follows: Pulse rate 52/m, Blood pressure-140/80mmHg, respiratory rate 32/m, and temperature 37.6°C.She had bilateral coarse crepitations and the SpO2 ranged between 40-65%. She was managed with intravenous normal saline, atropine at 1mg stat, then 2mg repeated every 5 minutes up to four times, followed by 8mg added to 500ml of normal saline in continuous infusion for 5 hours.Also, she was intubated and manually ventilated in addition to other supportive care in ICU. She regained consciousness within 24hours and was extubated. However, she developed a sudden acute cardiorespiratory distress and died in the second day of ICU admission.&#x0D; Conclusion: Severe organophosphate poisoning may be fatal. Early presentation to the hospital, prompt diagnosis and treatment with appropriate dose regimen of atropine, and other supportive care may improve survival.

Usefulness of serum lactate as a predictor of successful discontinuation of continuous atropine infusion in patients with severe acute organophosphate poisoning

ObjectiveIn severe organophosphate (OP) poisoning, administration of atropine via continuous intravenous infusion is typically considered. To date, there have been no studies on predicting successful atropine discontinuation through plasma cholinesterase (PChE) and serum lactate levels, which are monitored during critical care in severe acute OP poisoning. Therefore, we retrospectively evaluated the usefulness of serum lactate and PChE as predictors of successful discontinuation of atropine infusion.MethodsThis retrospective observational study was performed on consecutive adult patients treated for severe acute OP poisoning between March 2011 and December 2016. We sequentially evaluated serum lactate and PChE levels on emergency department arrival and before a discontinuation trial of atropine infusion. Discontinuation of atropine intravenous infusion was attempted in patients after clearance of respiratory secretions and cessation of bronchoconstriction. Discontinuation of atropine infusion attempts were divided into successful and failed trials.ResultsA total of 95 trials were conducted in 62 patients. Serum lactate levels before trials were significantly different between patients with successful and failed trials. The area under the curve for prediction of successful atropine discontinuation using serum lactate levels before trial discontinuation were 0.742 (95% confidence interval, 0.638 to 0.846). PChE level was not significantly different between two groups.ConclusionSerum lactate levels before the discontinuation trial of atropine infusion served to predict successful discontinuation in severe acute OP poisoning.

Organophosphate Insecticide Intoxication in a Family

Louse is an external, obligate, blood-sucking parasite, which infects human societies. Improvements in health, economics, and social status of societies have reduced the parasitic lice infestation, however, it still is a global problem. Although it affects all age groups, school children are the most vulnerable age group. The high incidence of infection in children and their long-term close contacts transmit the infestation easily among them. In some parts of our country, organophosphate pesticides are widely used to control pests. Due to the ease of access to these toxins, poisoning with them are common and according to global statistics most deaths by pesticide are associated with organophosphate pesticides. Accordingly, we report 3 cases of a family from rural areas of Babol City. Upon being sprayed with an organophosphate solution, they developed severe organophosphate intoxication (OI) associated with central nervous system suppression.

Organophosphate Insecticide Intoxication in a Family

Louse is an external, obligate, blood-sucking parasite, which infects human societies. Improvements in health, economics, and social status of societies have reduced the parasitic lice infestation, however, it still is a global problem. Although it affects all age groups, school children are the most vulnerable age group. The high incidence of infection in children and their long-term close contacts transmit the infestation easily among them. In some parts of our country, organophosphate pesticides are widely used to control pests. Due to the ease of access to these toxins, poisoning with them are common and according to global statistics most deaths by pesticide are associated with organophosphate pesticides. Accordingly, we report 3 cases of a family from rural areas of Babol City. Upon being sprayed with an organophosphate solution, they developed severe organophosphate intoxication (OI) associated with central nervous system suppression.

Evaluating Diagnostic Value of Electrophysiological Testing (EMG-NCV) Compared to the Activity Level of Acetylcholinesterase in Serum and Red Blood Cells of Patients with Moderate to Severe Organophosphate Poisoning

Abstract Background: Organophosphate compounds cause poisoning and death more than any other insecticide. These toxins can cause peripheral neuropathy which is delayed for about 3 - 6 weeks and no method has been known for predicting the incidence. It has been claimed that electrophysiological tests (EMG - NCV) can help in predicting the disorder. Objectives: The main purpose of this research was to study EMG - NCV tests in patients with moderate to severe organophosphate poisoning. Methods: This was a cross-sectional study conducted on patients with moderate to severe organophosphate poisoning from 2014 to 2016 in Imam Reza hospital of Mashhad. The minimum sample size was calculated as 68 patients and then all data was collected on the basis of inclusion and exclusion criteria using data collection form designed by the researcher, and finally data were analyzed using SPSS V.21 software, descriptive tests (including mean, median, mode) and analytical tests (K square, ANOVA). Results: Of all 78 patients with the mean age of 27.5010.0, 45 were female and the rest were male. Totally 29.5% of the patients had abnormal EMG - NCV. Although no significant differences were observed between electro diagnostic tests (EMG - NCV) and age, gender, clinical symptoms and levels of acetylcholinesterase serum activity, the relationship between EMG - NCV and RBC levels of acetylcholinesterase activity was significant. Conclusions: Electrophysiological tests are not associated with clinical symptoms (muscle weakness) and they cannot be considered as a determining factor to discharge the patients; therefore, careful examination of the patients or evaluating the level of AChE activity in red blood cells is needed.

Pancreatic Dysfunction Associated With Severe Acute Anticholinesterase Insecticide Poisoning In Adults

Background: The current study was carried out to study the effect of severe acute organophosphate compounds (OP) toxicity on the pancreatic profile in adults. Subjects and Methods: Six ml of venous blood were drawn from 260 patients (18-52 years) with severe acute OP toxicity who were admitted to the intensive care unit of Minia Poisoning Control Centre (PCC) during the period from May the 1st, 2012 to April, the 30th, 2014, and also from 20 healthy adults of the same age group acting as control. Blood samples were analyzed for: Pseudocholinestrase (PChE), serum insulin, serum α-amylase and serum lipase. Results: PChE level in intoxicated patients on the day of admission was highly significant decreased when compared with control. There was highly significant increase in the serum levels of amylase and lipase in intoxicated patients as compared to normal control group. In addition, there was highly significant increase in blood glucose level in intoxicated patients as compared with control group while there was no significant effect on the serum insulin level. A significant correlation was found between the degree of PChE inhibition and the elevation of serum amylase, lipase and serum glucose level. Conclusion: acute pancreatitis was evident in severe cases of OP intoxication on the day of admission, also OP -induced hyperglycemia is evident and most probably due to other cause rather than hypoinsulinemia.

Prediction of Acute Organophosphate Poisoning Using Glasgow Coma Sale, Serum Cholinesterase and S100B

Background: organophosphate (OP) poisoning is a major health problem worldwide, especially in developing countries, with millions of cases and hundreds thousands of deaths occurring each year. The aim of this study: was to evaluate the role of Glasgow Coma Sale (GCS), serum cholinesterase (SChE) and S100B protein levels in evaluation and prediction of outcome of patients with acute organophosphate poisoning. Material and methods: the present study was conducted on admitted patients with acute organophosphate poisoning in Tanta Toxicological Unit, Tanta University Hospital during the period from the start of July 2014 to the end of June 2015. For all patients; personal and toxicological history, complete clinical examination and measurement of SChE and S100B at admission and after 24hrs were performed for every patient. Outcome assessment; the patients were divided into two groups; group (1) included patients who survived and group (2) included patients who died. Results: the present study was carried out on 24 patients with acute severe organophosphate toxicity, their age ranged from 16-48 years. Sixteen patients (66.67%) were survived and eight (33.3%) were died. About two third of the patients were female (66.67%), half of them were students (50%) and took malathion (50%). All patients took organophosphates orally and in a suicidal attempt. The GCS was higher in survived patients (6-11) than died ones (3-5). Additionally, serum S100B level at both admission and after 24hrs, revealed significant increase in its level in died patients than survived. While, SChE showed non-significant decrease in both survived and died patients. SChE and S100B at both admission and after 24hrs cannot predict mortality. However, GCS can predict mortality with 100% sensitivity and 75% specificity at a cut off level of 9. Conclusion: both GCS and S100B had significant correlation with the patients’ outcome. Inspite of that, only GCS can predict mortality in 100% of the patients who has a GCS equal to or lower than 9. Also, 75% of survivors had GCS above this cut off value.

A new post-intoxication treatment of paraoxon and parathion poisonings using an evolved PON1 variant and recombinant GOT1

Organophosphate (OP) based pesticides are highly toxic compounds that are still widely used in agriculture around the world. According to World Health Organization (WHO) data, it is estimated that between 250,000 and 370,000 deaths occur yearly around the globe as a result of acute intoxications by pesticides. Currently available antidotal drug treatments of severe OP intoxications are symptomatic, do not reduce the level of intoxicating OP in the body and have limited ability to prevent long-term brain damage. Pesticide poisonings present a special therapeutic challenge since in many cases, such as with parathion, their toxicity stems from their metabolites that inhibit the essential enzyme acetylcholinesterase. Our goal is to develop a new treatment strategy for parathion intoxication by combining a catalytic bioscavenger that rapidly degrades the intoxicating parathion-metabolite (paraoxon) in the blood, with a glutamate bioscavenger that reduces the elevated concentration of extracellular glutamate in the brain following OP intoxication. We report on the development of a novel catalytic bioscavenger by directed evolution of serum paraoxonase 1 (PON1) that effectively detoxifies paraoxon in-vivo. We also report preliminary results regarding the utilization of this PON1 variant together with a recombinant human enzyme glutamate oxaloacetate transaminase 1 (rGOT1), suggesting that a dual PON-GOT treatment may increase survival and recovery from parathion and paraoxon intoxications.

Clinical value of serum presepsin (SCD14-ST) concentration measurement in patients with pesticide poisoning

To investigate the value of serum presepsin concentration measurement in the clinical diagnosis and treatment of patients with pesticide poisoning patients. A total of 160 patients with pesticide poisoning were enrolled as study subjects and divided into moderate organophosphate pesticide poisoning group (40 patients) , severe organophosphate pesticide poisoning group (40 patients) , abamectin pesticide poisoning group (40 patients) , and paraquat poisoning group (40 patients). A total of 20 healthy volunteers were enrolled as the control group. All the patients with poisoning received conventional treatment of pesticide poisoning immediately after admission, and serum presepsin concentration was measured on days 1 (within 24 hours after poisoning) , 3, and 7 of admission, and biochemical and radiological parameters related to the patient's condition were also examined. The patients with a Presepsin concentration of >800 pg/ml on day 1 of admission were randomly divided into conventional treatment group and ulinastatin treatment group, and the treatment outcome was compared between the two groups. Compared with the healthy control group, the groups with pesticide poisoning showed significant increases in serum Presepsin concentrations, with the highest degree of increase on day 1 (P <0.05). The serum Presepsin concentration was positively correlated with alanine aminotransferase, aspartate aminotransferase, creatine kinase, creatine kinase MB, lactate dehydrogenase, serum creatinine, blood urea nitrogen, interleukin-18, and white blood cell count, but negatively correlated with cholinesterase. In the conventional treatment group and ulinastatin treatment group, the overall response rate was 68% and 78.8%, respectively, with a significant difference between the two groups (P<0.05). In 40 patients with paraquat poisoning, 32 experienced an increase in serum presepsin concentration, and among these 32 patients, 27 (83%) experienced exudation on lung CT. Serum Presepsin concentration measurement can assist early diagnosis, evaluation of disease severity, and guidance for clinical medication in patients with pesticide poisoning, especially in those with severe pesticide poisoning and a tendency to multiple organ failure.

Intranasal delivery of obidoxime to the brain prevents mortality and CNS damage from organophosphate poisoning

Intranasal delivery is an emerging method for bypassing the blood brain barrier (BBB) and targeting therapeutics to the CNS. Oximes are used to counteract the effects of organophosphate poisoning, but they do not readily cross the BBB. Therefore, they cannot effectively counteract the central neuropathologies caused by cholinergic over-activation when administered peripherally. For these reasons we examined intranasal administration of oximes in an animal model of severe organophosphate poisoning to determine their effectiveness in reducing mortality and seizure-induced neuronal degeneration. Using the paraoxon model of organophosphate poisoning, we administered the standard treatment (intramuscular pralidoxime plus atropine sulphate) to all animals and then compared the effectiveness of intranasal application of obidoxime (OBD) to saline in the control groups. Intranasally administered OBD was effective in partially reducing paraoxon-induced acetylcholinesterase inhibition in the brain and substantially reduced seizure severity and duration. Further, intranasal OBD completely prevented mortality, which was 41% in the animals given standard treatment plus intranasal saline. Fluoro-Jade-B staining revealed extensive neuronal degeneration in the surviving saline-treated animals 24h after paraoxon administration, whereas no detectable degenerating neurons were observed in any of the animals given intranasal OBD 30min before or 5min after paraoxon administration. These findings demonstrate that intranasally administered oximes bypass the BBB more effectively than those administered peripherally and provide an effective method for protecting the brain from organophosphates. The addition of intranasally administered oximes to the current treatment regimen for organophosphate poisoning would improve efficacy, reducing both brain damage and mortality.

Organophosphate Poisoning and Subsequent Acute Kidney Injury Risk: A Nationwide Population-Based Cohort Study.

Small numbers of the papers have studied the association between organophosphate (OP) poisoning and the subsequent acute kidney injury (AKI). Therefore, we used the National Health Insurance Research Database (NHIRD) to study whether patients with OP poisoning are associated with a higher risk to have subsequent AKI.The retrospective cohort study comprised patients aged ≥20 years with OP poisoning and hospitalized diagnosis during 2000–2011 (N = 8924). Each OP poisoning patient was frequency-matched to 4 control patients based on age, sex, index year, and comorbidities of diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, coronary artery disease, and stroke (N = 35,696). We conducted Cox proportional hazard regression analysis to estimate the effects of OP poisoning on AKI risk.The overall incidence of AKI was higher in the patients with OP poisoning than in the controls (4.85 vs 3.47/1000 person-years). After adjustment for age, sex, comorbidity, and interaction terms, patients with OP poisoning were associated with a 6.17-fold higher risk of AKI compared with the comparison cohort. Patients with highly severe OP poisoning were associated with a substantially increased risk of AKI.The study found OP poisoning is associated with increased risk of subsequent AKI. Future studies are encouraged to evaluate whether long-term effects exist and the best guideline to prevent the continuously impaired renal function.

Acute severe organophosphate poisoning in a child who was successfully treated with therapeutic plasma exchange, high‐volume hemodiafiltration, and lipid infusion

Acute severe organophosphate poisoning is a serious complication seen in developing and agricultural countries. Pralidoxime and high dose atropine are the standard treatments. There is no consensus about acute severe organophosphate poisonings that are unresponsive to pralidoxime, atropine, and supportive therapies. We report a case of acute severe organophosphate poisoning that was unresponsive to standard treatments and successfully treated with high-volume continuous venovenous hemodiafiltration and therapeutic plasma exchange combined with lipid infusion. J. Clin. Apheresis 31:467-469, 2016. © 2015 Wiley Periodicals, Inc.

Reversal of Cardiovascular Toxicity in Severe Organophosphate Poisoning with 20% Intralipid Emulsion Therapy: Case Report and Review of Literature

Background: Cardiac toxicity is one of the life-threatening effects of severe organophosphate (OP) poisoning. We presented a patient with severe OP poisoning, in cardiovascular shock poorly responsive to conventional treatments, who could be resuscitated successfully with intravenous lipid emulsion (ILE) therapy. Case report: A 26-year-old female was admitted to our emergency department who had ingested unquantifiable amount of parathion. On admission, she was tachycardic, tachypneic and hypotensive with pin-point pupils. Neurological examination revealed Glasgow coma scale (GCS) of 6. Immediately, she was admitted to intensive care unit, and was intubated and put under mechanical ventilation. Standard treatments including atropine and pralidoxime (according to WHO protocol) were given to the patient. However, the patient did not show favorable response to antidotes and supportive treatments and her condition continued to deteriorate. Because of bradycardia and hypotension, she was given noradrenaline vasopressor support. Due to failure of treatments in improvement of the patient's condition, a single 100 mL bolus (1.5 mL/kg) of 20% intralipid was administered intravenously and the same dose repeated 2 minutes later. Over 15 minutes, cardiovascular condition of the patient noticeably improved. ILE was continued up to a total dose of 300 mL when extrasystoles disappeared. The patient could be extubated from ventilator with GCS score of 15 on the 5 th day of admission. Discussion: OPs are lipid soluble and ILE can move these kinds of compounds away from the site of toxicity and dissolve them in the plasma which will alleviate their toxic effects. Conclusion: This is the first human case report of OP poisoning which showed efficacy of intralipids as antidotal therapy outside the accepted setting of local anesthetic toxicity.

Muscarinic M1 receptor and cannabinoid CB1 receptor do not modulate paraoxon-induced seizures.

One of the major signs of severe organophosphate poisoning is seizures. Previous studies have shown that both muscarinic agonist- and organophosphate-induced seizures require activation of muscarinic acetylcholine receptors in the central nervous system. Seizures induced by the muscarinic agonist pilocarpine require the M1 receptor and are modulated by cannabinoid CB1 receptors. In this study, we determined whether M1 and CB1 receptors also regulated seizures induced by the organophosphate paraoxon. We found no differences in seizures induced by paraoxon in wild-type (WT) and M1 knockout (KO) mice, indicating that in contrast to pilocarpine seizures, M1 receptors are not required for paraoxon seizures. Furthermore, we found that pilocarpine administration resulted in seizure-independent activation of ERK in the hippocampus in a M1 receptor-dependent manner, while paraoxon did not induce seizure-independent activation of ERK in the mouse hippocampus. This shows that pilocarpine and paraoxon activated M1 receptors in the hippocampus to different extents. There were no differences in seizures induced by paraoxon in WT and CB1 KO mice, and neither CB1 agonist nor antagonist administration had significant effects on paraoxon seizures, indicating that, in contrast to pilocarpine seizures, paraoxon seizures are not modulated by CB1 receptors. These results demonstrate that there are fundamental molecular differences in the regulation of seizures induced by pilocarpine and paraoxon.

Chronic behavioral and cognitive deficits in a rat survival model of paraoxon toxicity

Organophosphate (OP) compounds, including paraoxon (POX), are similar to nerve agents such as sarin. There is a growing concern that OP agents could be weaponized to cause mass civilian causalities. We have developed a rodent survival model of POX toxicity that is being used to evaluate chronic morbidity and to screen for medical countermeasures against severe OP exposure. It is well known that the survivors of nerve gas and chronic OP exposure exhibit neurobehavioral deficits such as mood changes, depression, and memory impairments. In this study we investigated whether animals surviving severe POX exposure exhibited long-term neurological impairments. POX exposure produced overt signs of cholinergic toxicity. Rats were rescued using an optimized atropine, 2-PAM and diazepam therapy. Surviving rats were studied using established behavioral assays for identifying symptoms of depression and memory impairment 3-months after POX exposure. In the forced swim test, POX rats exhibited increased immobility time indicative of a despair-like state. In the sucrose preference test, POX rats consumed significantly less sucrose water indicating anhedonia-like condition. POX rats also displayed increased anxiety as characterized by significantly lower performance in the open arm of the elevated plus maze. Further, when tested with a novel object recognition paradigm, POX rats exhibited a negative discrimination ratio indicative of impaired recognition memory. The results indicate that this model of survival from severe POX exposure can be employed to study some of the molecular bases for OP-induced chronic behavioral and cognitive comorbidities and develop therapies for their treatment.

Features of myocardial injury in severe organophosphate poisoning

Background. In organophosphate (OP) poisoning cardiac complications may occur. However, the current body of knowledge largely consists of limited studies, and case reports are mainly on electrocardiogram (ECG) abnormalities. As definite myocardial injury is difficult to assess through ECG, we investigated the prevalence of myocardial injury through cardiac biochemical markers such as troponin I (TnI) in severe OP poisoning. Methods. We conducted a retrospective review of 99 consecutive OP insecticide poisoning cases that were diagnosed and treated at the emergency department of the Wonju Severance Christian Hospital between March 2008 and December 2013. Results. Based on Namba classification for OP poisoning, there were no patients with mild toxicity, 9 patients (9.1%) with moderate toxicity and 90 patients (90.9%) with severe toxicity. On ECG, normal sinus rhythm was most common, and ST depression and elevation were seen in 11 patients (11.1%). Elevation of TnI within 48 h was seen in 34 patients (34.3%). The median peak level and peak time of TnI were 0.305 (IQR, 0.078–2.335) ng/mL and 15 (IQR 6.9–34.4) hours, respectively. There were differences between patients with normal TnI and elevated TnI in terms of age (yrs), number of patients who were exposed to OP via the oral route, and initial Glasgow Coma Scale (GCS; 58 ± 17 vs. 66 ± 16, p = 0.015, 56 [87.5%] vs. 33 [97.1%], p = 0.048 and 12.0 [IQR, 8.0–15.0] vs. 9.0 [IQR, 5.8–12.0], p = 0.019). Conclusions. OP can cause direct myocardial injury during the acute early phase in severe OP poisoning. Monitoring of TnI may be needed in severe OP poisoning.

Analysis on Curative Effect of Hemopurification Treatment in Acute Severe Organophosphate Poisoning Patients

Objective To explore the feasibility and success rate of hemopurification treatment in acute severe organophosphate poisoning patients.Methods From January 2011 to December 2012,a total of 54 patients with acute severe organophosphate poisoning in Jianghan Oilfield General Hospital were included in this study.According to the treatment number of these patients,they were divided into the study group (n=27) and the control group (n=27) randomly.Patients of the control group were treated with conventional treatment,including digestive tract cleaning,catharsis,diuresis and atropine.Patients of the study group were treated with hemopurification treatment on the basis of the control group.The situation of treatment,rescuing success rate,and incidence of complications of two groups were compared.Results The average amount of atropine was (50.18 ± 33.04) mg,the average time of recovery of consciousness was (8.15± 2.50) h in study group,which were significantly reduced compared with (57.23±32.01) mg and (22.54 ±3.27) h in control group.The complication rates in study group significantly reduced,including the complication rates of respiratory failure (7.41％),liver damage (22.22％),kidney damage (40.74％).Compared with control group (18.52％,37.04％ and 55.56％),the difference was statistically significant (P＜0.05).In 27 patients of the study group,25 cases were cured,2 cases died,and the success rate was 92.95％; in 27 patients of the control group,22 cases were cured,5 cases died,and the success rate was 81.48％.The difference of success rate in two groups had statistical significance (x2=13.6,P＜0.05).Conclusions Hemopurification technology could remove the residual poisons in the blood timely,reduce the damage of poison to target organs.It has high success rate and good security,and the clinical effect is satisfactory. Key words: Comparative effectiveness research; Hemopurification; Organophosphate poisoning