ABSTRACT
Background:POP scale andserum cholinesterase estimation are purported to be meaningful indicators for mortality prediction in the cases of organophosphorus poisoning. The present study was undertaken to substantiate the correlation ofPOP scale score and serum cholinesterase levels in acute OP poisoning with mechanical ventilation requirement and mortality in our setting. Methods:Data of 150 eligible participants was collected, with POP scale andserum cholinesterase levels being assessed during initial presentation in each of them. Clinical course of the cases was monitored anddocumented. Results:The observed case fatality rate was 32.7%. POP scale scoring revealed 30out of 75 patients to be from moderate group and 19 out of 22 patients to be from severe group. Forty nine outof 75 in moderate group & all patients in severe group required ventilator support. With respect to Serum Cholinesterase level; 20 out of 23 and 29 out of 77 patients died in the severe & moderate poisoning categories respectively. Forty eight out of 77 in moderate poisoning andall patients in severe poisoning required ventilator support. Conclusions: POP scale scoring and serum Cholinesterase level assessments are clinically relevant indicators in acute OP poisoning cases and are of great utility towards assessment ofmechanical ventilation requirement and mortality prediction.
ABSTRACT
Background: Organophosphorus compounds are anticholinesterases by inhibiting cholinesterase it protects acetyl chorine from hydrolysis. So, acetylcholine accumulates at the synapses, and all the clinical manifestation are due to that. So, this study has been designed to establish the reactive between level of serum and prognosis of op poisoning patients.Methods: Patient with history of organophosphorus poisoning admitted into the emergency department with following exclusion and inclusion criteria were included in this study. All patients were managed as per standard treatment protocol of op poisoning. Various parameters like demography of the patients, sign and symptoms, severity of intoxication, clinical and lab parameter manoring, Serum cholinesterase was measured every alternate day.Results: 22(47.84%) patients have mild symptom out of that 20 patient抯 serum cholinesterase was more than 2000 IU/L, and 2(4.3%) patients serum cholinesterase was between 1000-2000 IU/L. In eighteen patient抯 severity as per POP scale was moderate, out of that 2(4.3%) patients have serum cholinesterase was below 1000 IU/L, 8 having serum cholinesterase between 1000 to 2000 IU/L, and remaining eight having serum cholinesterase above 2000 IU/L.Conclusions: Serum cholinesterase was less in patient with high severity score or low serum concentration of cholinesterase was associated with high severity score. Serum cholinesterase was improved as days passes.
ABSTRACT
Objective To explore the effects of ziprasidone and clozapine on serum cholinesterase (CHE) concentration in schizophrenia patients. Methods 126 schizophrenia patients were randomly divided into the observation group and the control group. The observation group was treated with ziprasidone. The control group received clozapine. The serum CHE concentration was assayed at 7, 14 and 28 days after treatment. Results ① The PANSS scores in both groups were significantly reduced after treatment, while the control group was lower than the observation group (PANSS score for positive symptoms: 15.3±4.7 vs 22.4±4.8, P<0.01; negative symptoms: 14.6±4.5 vs 21.8±5.2, P<0.01; general psychiatric symptoms: 13.3±3.4 vs 19.2±3.9, P<0.01). ② CHE levels were decreased in both groups after treatment. The control group exhibited greater decrease than the observation group. ③ The observation group had lower adverse reaction rate (34.9%) compared to control group (71.4%). Conclusion ziprasidone has weaker inhibitory effect on CHE activity compared to clozapine. This may explain that ziprasidone has lower therapeutic efficacy and better safety profile.
ABSTRACT
Background: Pesticides are extensively used in floriculture where workers are mostly unskilled and may not have appropriate knowledge about safety. Acute accidents during spraying are reported, chronic exposure goes unnoticed. There are not many Indian studies regarding health risks and safety practices among floriculture workers in India. Hence this study to assess pesticide exposure, to find their determinants and suggest appropriate preventive measures.Methods: Study was cross sectional in Floriculture Park, Talegaon (D), Pune, Maharashtra, India using cluster sampling from February 2018 to July 2019. Prevalence of morbidities being 63% sample size was calculated as 111 (allowable error 15%). Socio-demographic, work and health related variables were recorded using a pretested structured questionnaire. Clinical examination and laboratory investigations were done by medical experts.Results: A total of 118 workers participated. Only half (51.2%) were using personal protective devices. None were following reentry guidelines. 13.3% males and 4.1% females had low serum cholinesterase level which is a biomarker of pesticide exposure. Sprayers had significantly high risk of low serum cholinesterase levels (OR=3.31) as compared to others. With exposed subjects which included both sprayers as well as polyhouse workers the association increased with OR=4.27. However association was not significant when working in polyhouse alone was considered as a risk factor (OR=1.256).Conclusions: Presence of exposure was the only factor that had a statistically significant association with low Serum Cholinesterase levels. Safe occupational practices like use of personal protective devices, rotation of exposed workers, monitoring of serum cholinesterase levels and health education of workers should be undertaken.
ABSTRACT
Objective To investigate the value of serum cholinesterase (S-ChE) levels in judgment of severity and prognosis in patients with severe pneumonia. Methods The clinical data of patients with severe pneumonia, who were admitted to the Department of Internal Medicine in the First Affiliated Hospital of Sun Yat-sen University, or the Department of Neurology in the Third People's Hospital of Foshan from May 2011 to May 2015, whose hospital time was longer than 24 hours, were retrospectively analyzed. They were divided into survival group and death group according to the final outcome. Lab data, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, multiple organ dysfunction syndrome (MODS) score, the improved pneumonia score of British Thoracic Society (confusion, uremia, respiratory, blood pressure, age 65 years, CURB-65), and S-ChE levels of all patients were collected after they were hospitalized into the intensive care unit (ICU) within 24 hours. Independent risk factors for prognosis were analyzed by binary logistic regression analysis, and receiver operating characteristic curve (ROC) was plotted. Best truncation point analysis was used to compare their estimated value for prognosis of patients with severe pneumonia. Results Eighty-six patients with severe pneumonia were studied. Among them 46 patients survived, and 40 patients died. By the single factor analysis, the following lab data in the death group were found significantly lower than those in the survival group: S-ChE levels (kU/L: 2.748±0.826 vs. 4.489±1.360, t' = 7.274, P = 0.000), arterial partial pressure of oxygen [PaO2 (mmHg, 1 mmHg = 0.133 kPa): 52.55±18.29 vs. 60.83±16.65, t = 2.196, P = 0.031], oxygenation index (mmHg: 114.20±48.01 vs. 167.10±69.68, t' = 4.229, P = 0.000), and carbon dioxide combining power [CO2-CP (mmol/L): 22.85±5.44 vs. 26.00±7.63, t' = 2.225, P = 0.029]. The following clinical data were significantly higher in the death group than those in the survival group, namely body temperature (℃: 38.67±1.18 vs. 37.74±1.18, t = -3.627, P = 0.000), pulse (bpm: 130.65±15.72 vs. 107.26±19.61, t' = -6.133, P = 0.000), the ratio of concomitant chronic lung disease [45.0% (18/40) vs. 13.0% (6/46), χ2 = 10.860, P = 0.001], fraction of inspired oxygen [FiO2: 0.495 (0.410, 0.600) vs. 0.380 (0.290, 0.500), Z = -3.265, P = 0.001], APACHE Ⅱ score (25.80±5.07 vs. 16.39±5.12, t =-8.540, P = 0.000), CURB-65 score [3 (3, 4) vs. 2 (1, 2), Z = -5.562, P = 0.000], MODS score (8.15±2.49 vs. 4.35±2.01, t = -7.832, P = 0.000), international normalized ratio [INR: 1.22 (1.08, 1.31) vs. 1.07 (1.00, 1.10), Z = -4.231, P = 0.000], and activated partial thromboplastin time [APTT (s): 33.80 (32.13, 38.75) vs. 28.50 (25.70, 36.00), Z = -3.482, P = 0.000]. Binary logistic regression analysis showed that, S-ChE levels, APACHE Ⅱ score and MODS score were found to be the independent risk factors for prognosis in the patients with severe pneumonia, respectively [S-ChE: odds ratio (OR) = 0.084, 95% confidence interval (95%CI) = 0.017-0.424, P = 0.003; APACHE Ⅱ score: OR = 1.675, 95%CI = 1.098-2.556, P = 0.017; MODS score: OR = 2.189, 95%CI = 1.262-3.800, P = 0.005]. The area under ROC (AUC) for S-ChE levels, APACHE Ⅱ score and MODS score were 0.874±0.036, 0.889±0.033 and 0.884±0.035, respectively (all P > 0.05 as compared between any two means). At the best truncation points of S-ChE levels, APACHE Ⅱ score and MODS score were 3.372 kU/L, 19.5 score, and 6.5 score respectively. The sensitivity, specificity, positive predictive value and negative predictive value in predicting death risk in patients with severe pneumonia were (80.0%, 78.0%, 76.19% and 81.82%), (95.0%, 70.0%, 73.08% and 94.12%) and (70.0%, 91.0%, 87.50%, 77.78%), respectively. If S-ChE levels was combined with APACHE Ⅱ score or combined with MODS score, the sensitivity, specificity, positive predictive value and negative predictive value [S-ChE levels combined APACHE Ⅱ score: 100%, 92.0%, 93.75% and 100%; S-ChE levels combined MODS score: all 100%] were higher than single power of S-ChE levels, APACHE Ⅱ score or MODS score. Conclusions S-ChE levels can be considered as an effective and practical index to estimate the severity and prognosis in patients with severe pneumonia. The combined application of S-ChE levels and APACHE Ⅱ score or MODS score can obviously improve the prognostic power in patients with severe pneumonia.
ABSTRACT
Background: Acute organophosphorus (OP) poisoning is one of the most common poisonings in India contributing to significant morbidity and mortality. Irreversible inhibition of cholinesterase enzymes is attributed to the serious clinical outcomes in these patients, which is assessed by the estimation of serum cholinesterase (SChE) levels. The present study was undertaken to evaluate the utility of serial estimation of SChE levels in patients of OP poisoning in predicting the clinical outcome. Methods: Medical records of 31 patients from January 2013 to December 2013 admitted in our institute with acute OP poisoning were analyzed for SChE at admission, 48 hrs, 72 hrs and 120 hrs after admission. Data regarding clinical findings at admission and outcomes were recorded. Results: Monocrotophos (55%) was the most commonly used OP compound. Mean serial SChE levels (in KU/L) at admission, 48, 72, and 120 hrs in patients who survived are 0.18±0.10, 0.28±0.14, 0.41±0.21, 0.46±0.16 and in patients who expired are 0.02±0.01, 0.05±0.02, 0.03±0.02, 0.03±0.02, respectively. SChE levels at admission in survived group, compared to those in expired group were statistically significant (p<0.001). About 92% patients in moderate to severe grade of poisoning (SChE levels <0.2 KU/L) were mechanically ventilated. The relationship between serial SChE levels in survival group and was found to be statistically significant (p<0.01). Conclusion: In the present study, significant increase in serial SChE levels were correlating with better clinical outcome as evidenced by an improvement with mechanical ventilation and survival rates in acute OP poisoning.
ABSTRACT
La exposición ocupacional a plaguicidas de uso agrícola como riesgo a la salud, es tema de discusión internacional, y se recomienda la evaluación clínica y toxicológica en aquellos individuos, cuyos estilos de vida, pone en riesgo además a familiares y comunidad en general. Con esta premisa, la presente investigación tuvo como objetivo determinar los niveles de Colinesterasa sérica en embarazadas del Municipio José María Vargas, Estado Táchira, durante el primer semestre de 2010. Se realizó un estudio descriptivo, y transversal en una población de 74 mujeres gestantes de la cual fue seleccionada una muestra no probabilística e intencional de 26 embarazadas, que cumplieron criterios de inclusión. Los resultados reportaron una media de 24,6 años, con dedicación laboral a las actividades agrícolas con promedio de 18,9 semanas de gestación y residentes en las localidades: El Cobre (34,6%) y El Molino (26,9%). Los valores de Colinesterasa sérica se encontraron en rangos entre 6.155,65 y 13.996,0 U/Lt, con una media 10.353,95. El 57,7% se encuentra por encima del valor normal, lo que significa que no hay riesgo a la salud de la embarazada y la progenie. Se evidenció el uso y aplicación de Penncap; Carbosulfan (Máster); Mancozeb (Fungithane), 200pm Abamectina, aplicables por fumigación manual y a motor. Se recomienda la intervención gerencial, técnica y operativa para mejorar las condiciones ambientales y laborales y promover la medidas de prevención, control y vigilancia de higiene y seguridad en el trabajo en las comunidades del Municipio José María Vargas del Estado Táchira.
Occupational exposure to agricultural pesticides, is the subject of international discussion, and recommended clinical and toxicological evaluation in those individuals whose lifestyles, further threatening family and community. With this premise, the present investigation was to determine serum cholinesterase levels in pregnant José María Vargas Municipality, Tachira State, during the first half of 2010. We performed a descriptive, cross and a population of 74 pregnant women which was selected a convenience sample of 26 pregnant and intentional, that met inclusion criteria. The results indicated an average of 24.6 years, labor-time farming with an average of 18.9 weeks of gestation and residents in the localities: El Cobre (34.6%) and El Molino (26.9%) . Serum cholinesterase values were found to range between 6155.65 and 13996.0 U / Lt, with half 10,353.95. The 57.7% is above the normal value, which means no risk to the health of pregnant women and progeny. It showed the use and application of Penncap; Carbosulfan (Master) Mancozeb (Fungithane) Abamectin 200pm applicable by spraying manual and motor. Intervention is recommended managerial, technical and operational capacity to improve environmental and working conditions and promote the prevention, control and monitoring of health and safety at work in the communities of the Jose Maria Vargas Municipality, Tachira State.
ABSTRACT
The study period is 11 months that is from 01-01-2007 to 28-11-2007, 35 cases of organ phosphorus poisoning were admitted at Mamata General Hospital, khammam, Andhra Pradesh, India. The cases were studied on various epidemiological parameters and Proforma prepared for detailed data. In our study the majority of victims were males, married, Hindu, Literate, from rural area, medium socioeconomic group and common age of victims is 21 to 30 years. The common mode of poisoning is suicidal, one is accidental poison in child and one is occupational as contact poison while spraying .No homicidal poison was reported in our study. Majority victims have consumed poison in day time, commonly abused poison is monochrotophos, and approximate amount of poison consumed by majority of the victims is 250 ml to 500 ml and majority were admitted within 3 to 6 hours of consumption of poison. The common motive of poisoning was suicidal in both male [24 cases] and female [10 cases], especially young victims from rural domicile with agricultural occupation. The majority of victims consumed poison in summer followed by winter season. The probable reason is rain dependent agricultural occupation, unemployment, joint family and medium socioeconomic status of population of this area.
Subject(s)
Adult , Cholinesterases/blood , Epidemiology , Female , Humans , India , Male , Organophosphate Poisoning/epidemiology , Organophosphate Poisoning/mortality , Organophosphorus Compounds , Suicide/etiology , Young AdultABSTRACT
OBJECTIVE:To investigate the relationship between butyrylcholinesterase (BChE) activities (total and band specific) and diabetes mellitus. SUBJECTS AND METHODS: BChE activities (BChEA, AC 4/5, AC OF and RC5) were analyzed in 101 type 1 (DM1) and in 145 type 2 (DM2) diabetic patients, in relation to phenotype, weight and incidence of metabolic syndrome (MS) in these patients. The C4/5 and C5 complex were separated from other molecular forms (C OF) using an acid agar gel. RESULTS: The BChE activity (BChEA) and the absolute activities of C4/5 (AC4/5) and C OF (AC OF) showed a high positive correlation coefficient to weight in the CHE2 C5- group, while the relative activity of C5 complex (RC5) showed a negative correlation to weight. CONCLUSIONS: The present study suggests that the positive correlation of the BChE activities to diabetes mellitus and to insulin resistance may depend on the CHE2 locus variability. High values of BChE activities were associated with insulin resistance only in CHE2 C5- diabetic patients, while in CHE2 C5+ diabetic patients, the presence of C5 complex, especially in a relatively high proportion, leads to less fat storage and better protection against metabolic syndrome.
OBJETIVO: Investigar a associação entre as atividades (total e banda específica) da butirilcolinesterase (BChE) e diabetes melito. SUJEITOS E MÉTODOS: As atividades da BChE (BChEA, AC4/5, AC OF e RC5) foram analisadas em 101 pacientes diabéticos do tipo 1 (DM1) e 145 do tipo 2 (DM2) em relação aos fenótipos, ao peso e à incidência da síndrome metabólica. Os complexos C4/5 e C5 foram separados das outras formas moleculares (C OF), usando gel de ágar ácido. RESULTADOS: A atividade da BChE (BChEA) e as atividades absolutas de C4/5 (AC4/5) e de C OF (AC OF) mostraram altos coeficientes de correlações positivos com peso no grupo de CHE2 C5-, enquanto a atividade relativa do complexo C5 (RC5) mostrou correlação negativa com o peso. CONCLUSÕES: O presente estudo sugere que as correlações positivas das atividades da BChE com diabetes melito e com a resistência à insulina podem depender da variabilidade do loco CHE2. Altos valores nas atividades da BChE estão associados com a resistência à insulina somente nos pacientes diabéticos CHE2 C5-, enquanto nos pacientes diabéticos CHE2 C5+ a presença do complexo C5, especialmente em alta proporção relativa, leva a um menor estoque de gordura e à maior proteção contra a síndrome metabólica.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Butyrylcholinesterase/blood , Cholinesterases/genetics , Diabetes Mellitus, Type 1/enzymology , /enzymology , Body Mass Index , Body Weight/physiology , Butyrylcholinesterase/genetics , Case-Control Studies , Diabetes Mellitus, Type 1/blood , /blood , Insulin Resistance/physiology , Metabolic Syndrome/blood , Phenotype , Regression AnalysisABSTRACT
Prolonged neuromuscular blockade following succinylcholine may be seen when anticho- linesterase had been administered prior to reverse nondepolarizing muscle relaxant-induced paralysis, possibly anticholinesterase has been reported to inhibit serum cholinesterase activity. Our study was undertaken in order to understand the effect of a nondepolarizing muscle relaxant (vecuronium) following neostigmine pretreatment. In this study, we assessed the effect of vecuronium induced neuromuscular blockade using a train of four, 2 Hz stimulations on ulnar nerve. Patients admitted to our hospital for elective operations were divided into two groups, each group consisting of 16 patients. In group I, vecuronium 0.1 mg/kg was .administered according to the priming principle following normal saline, in group II, vecuronium 1.0mg/kg was administered according to the priming principle following neostigmine 0.05 mg/kg and glycopyrrolate 0.003 mg/kg pretreatment. Then the time for Tl to reach 5% or less(second), and the time for Tl to reach from 25% to 75%(recovery index) were measured in both groups. The time for Tl to reach 5% or less in group I(92.8+/-14.72 second) and group II(97.5+/-16.43 seconds) were not siginificant. However the recovery indexof group I(10.2 5+/-1.93 minute) and group II(8.5+/-1.80 minute) showed significant shortening in group II(p<0. 05)
Subject(s)
Humans , Cholinesterases , Glycopyrrolate , Neostigmine , Neuromuscular Blockade , Paralysis , Succinylcholine , Ulnar Nerve , Vecuronium BromideABSTRACT
The serum cholinesterase level is influenced by a variety of disease states, especially in pregnancy as is well established now, although the reasons for the fall in the enzyme in certain conditions and its clinical significance are less clear. This known decrease in plasma cholinesterase activity could lead to the conclusion that the duration of paralysis from succinylcholine will be prolonged in pregnant patients. The purposes of this study were to evaluate the serum cholinesterase activity in nonpregnant women of the child-bearing age group and pregnant women and to evaluate the changes of serum cholinesterase following succinylcholine administration. The results were as follows: 1) The mean value of serum cholinesterase in 60 nonpregnant women of the child-bearing age group was 992.29-1,112.27 U/L. 2) The mean value of serum cholinesterase in 60 pregnant women was 769.40-826-27 U/L. 3) Pregnant women had a diminution of serum cholinesterase activity compared with nonpregnant women of the child-bearing age group, and this diminution was statistically very significant (p<0.01). 4) In Cesarean section patients treated with succinylcholine, there was further diminution of serum cholinesterase activity (P<0.01). With the above results, the possible clinical importance of marked diminution of a serum cholinesterase activity in pregnant women is outlined.