Predictors of morbidity and mortality in organophosphorus poisoning: A case study in rural hospital in Karnataka, India

Banday, Tanveer Hassan; Tathineni, Bharath; Desai, Mehul Surendra; Naik, Vikas

doi:10.4103/1947-2714.159331

Cited by 36 publications

(45 citation statements)

References 18 publications

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“…In the present study the mean age for the patients was 23.4 years and most of patients were belonging to teenager and middle age group (18 -40 years) represent 44.5% of the patients in the study. This finding was in accordance with Ahmed et al (2014) and Banday et al (2015) in which the incidence was highest in patients aged less than 40 years. There were only 2% of all patients included in the study above age of 60 years and this was in agreement with Chintale et al (2016).…”

Section: Discussionsupporting

confidence: 93%

“…There were only 2% of all patients included in the study above age of 60 years and this was in agreement with Chintale et al (2016). This could be explained by the vulnerability to various emotional conflicts that can happen during this phase (teenager and middle age groups) of life in which the people are most ambitious and productive (Banday et al, 2015).…”

Section: Discussionsupporting

confidence: 67%

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The Role of APACHE II, SOFA, Serum amylase and Lipase in Assessment of Severity and Outcome of Acute Organophosphorus Poisoning

Moussa

Mohamed

Hilal

et al. 2018

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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All right received. AbstractPoisoning with Organophosphate (OP) compounds is responsible for great morbidities and mortalities all over the world especially in developing countries including Egypt. Scoring systems have been continuously developed to predict outcomes in patients with severe illness, to improve resource allocation and to assist in clinical decision-making particularly for ICU patients. The quest for biomarkers in relation to OP compound poisoning started quite a long time back but cheap and easily measurable biomarkers having prognostic value is the need of the hour. The objective of this study is to evaluate the role of acute physiology and chronic health evaluation II (APACHE II) score, the Sequential Organ Failure Assessment (SOFA) score, serum amylase and lipase in assessing severity and outcome of acute organophosphorus poisoning. A retrospective and prospective study was carried out on 200 patients of acute OP poisoning admitted to the Poison Control Center (PCC), Ain Shams University Hospitals. Information after obtaining the permission of the director of PCC and the regional ethics committee was collected from the sheets and computerized data base of the patients, an informed written consent has been obtained from each patient or from his/her caregiver for inclusion in the prospective part of the study. APACHE II and SOFA scores were calculated to each patient admitted and biochemical analysis of serum amylase and lipase were estimated in the prospective part of the study. The results were revised, coded and organized for statistical analysis. The study results revealed 180 (90%) patients discharged and 20 (10%) patients died. The study showed that there were 76% of patients had APACHE II score ≤ 9, while 12.5% of patients had APACHE II score from 10 to 14, there were 8.5% of patients had APACHE II score from 15 to 24 and APACHE II score was > 24 in 3% of patients. SOFA score in 88.5%of patients was ≤ 6, while in 4.5% of patients SOFA score was from 7 to 9 and in 7%of patients SOFA score was > 9. Hyperamylasemia observed in 83.3% of died and 33.3% of died patients had increased lipase. There was significant difference between discharged and died patients as regards APACHE II score, SOFA Score, serum amylase and lipase. It could be concluded that SOFA score, APACHEII score, serum amylase and lipase had a role in assessment of severity of acute organophosphorus poisoning but only SOFA score, APACHEII score and serum amylase could be used as predictors of outcome. SOFA score is more useful in predicting mortality, and easier and simpler than the APACHEII and serum amylase. From the previous results, our study recommends that predictors of outcome (APACHE II score, SOFA score and serum amylase) should be assessed routinely and as early as possible to evaluate the severity, improve the course of management and deciding the pathway of care.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 67%

The Role of APACHE II, SOFA, Serum amylase and Lipase in Assessment of Severity and Outcome of Acute Organophosphorus Poisoning

Moussa

Mohamed

Hilal

et al. 2018

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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“…This finding is similar to that of the previous studies. [20] The average duration of mechanical ventilation observed in this study is in agreement with observations of the previous studies,[142324] there was no difference in the duration of mechanical ventilation in patients receiving magnesium compared to control. A single dose of MgSO 4 may not be enough to maintain a sustained therapeutic level which may influence the duration of mechanical ventilation.…”

Section: Discussionsupporting

confidence: 92%

Study of effect of magnesium sulphate in management of acute organophosphorous pesticide poisoning

et al. 2017

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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.

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“…It is consensus that even among patients receiving intensive care, such as ventilatory support, gastric lavage and standard therapy with the antidotes, atropine and pralidoxime, mortality is still high for these groups of individuals. The mortality rate in intensive care units is around 10-50% even with mechanical ventilation (Banday et al, 2015;Munidasa et al, 2004;Tang et al, 2016). Munidasa et al (2004) reported that the mortality rate among the patients studied was 50%, even with mechanical ventilation and oxygen supplementation.…”

Section: Discussionmentioning

confidence: 95%

Neuroreflex control of cardiovascular function is impaired after acute poisoning with chlorpyrifos, an organophosphorus insecticide: Possible short and long term clinical implications

et al. 2018

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Although it is well-established that severe poisoning by organophosphorus (OP) compounds strongly affects the cardiorespiratory system, the effects of sub-lethal exposure to these compounds on the neural control of cardiovascular function are poorly explored. The aim of this study was to evaluate the effects of acute sub-lethal exposure to chlorpyrifos (CPF), a commonly used OP insecticide, on three basic reflex mechanisms involved in blood pressure regulation, the peripheral chemoreflex, the baroreflex and the Bezold-Jarisch reflex. Adult male Wistar rats were injected intraperitoneally with a single dose of CPF (30 mg/kg) or saline (0.9%). 24 h after injections, cardiovascular reflexes were tested in awake rats. Potassium cyanide (KCN) and phenylbiguanide (PBG) were injected intravenously to activate the chemoreflex and the Bezold-Jarisch reflex, respectively. The baroreflex was activated by phenylephrine and sodium nitroprusside infusions. Blood samples were taken for measurements of butyrylcholinesterase (BChE) activity while acetylcholinesterase (AChE) activity was measured in brainstem samples. Animals treated with CPF presented signs of intoxication such as ataxia, tremor, lacrimation, salivation, tetany, urination and defecation. The hypertensive and the bradycardic responses of the chemoreflex as well as the hypotensive and bradycardic responses of the Bezold-Jarisch reflex were attenuated in CPF treated animals (P < 0.05). Concerning the baroreflex responses, CPF treatment reduced the bradycardia plateau, the range and the gain of the reflex (P < 0.05). Plasma BChE and brainstem AChE were both reduced significantly after CPF treatment (P < 0.05). Our results showed that acute sub-lethal exposure to CPF impairs the cardiovascular responses of homeostatic and defensive cardiovascular reflexes. These effects are associated with a marked inhibition of plasma BChE and brainstem AChE.

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Predictors of morbidity and mortality in organophosphorus poisoning: A case study in rural hospital in Karnataka, India

Cited by 36 publications

References 18 publications

The Role of APACHE II, SOFA, Serum amylase and Lipase in Assessment of Severity and Outcome of Acute Organophosphorus Poisoning

The Role of APACHE II, SOFA, Serum amylase and Lipase in Assessment of Severity and Outcome of Acute Organophosphorus Poisoning

Study of effect of magnesium sulphate in management of acute organophosphorous pesticide poisoning

Neuroreflex control of cardiovascular function is impaired after acute poisoning with chlorpyrifos, an organophosphorus insecticide: Possible short and long term clinical implications

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