Determination of 10 organophosphorus flame retardants in drinking water by On-line SPE-UPLC-MS/MS / 公共卫生与预防医学

Objective To establish a method for the determination of 10 organophosphorus flame retardants in drinking water by on-line solid phase extraction coupled with high performance liquid chromatography-tandem mass spectrometry (On-line SPE-UPLC-MS/MS). Methods After adding the internal standard, the water sample was filtered by Millipore filtration, and then concentrated and detected by Online SPE-UPLC-MS/MS. Samples were concentrated by C8 SPE column and separated by C18 column with acetonitrile-water-formic acid as the mobile phases gradient elution，and were detected by multiple reaction monitoring (MRM) acquisition under anion mode. Results The 10 organophosphorus flame retardants all displayed good linear relationships within a certain range of concentrations, with the correlation coefficients being more than 0.990. The method detection limits were 0.60-5.50 ng/L, and the spiked recoveries of low, medium and high concentrations were 64%-106% , 83%-104% and 85%-99%, respectively. Conclusion The method is simple, sensitive, rapid, accurate and reliable, so it is applicable for the determination of 10 organophosphorus flame retardants in drinking water.

Integrative analysis in toxicological assessment of the insecticide Malathion in Allium cepa L system / Análise integrativa na avaliação toxicológica do inseticida Malation no sistema Allium cepa L

For many centuries human populations have been suffering and trying to fight with disease-bearing mosquitoes. Emerging and reemerging diseases such as Dengue, Zika, and Chikungunya affect billions of people around the world and recently has been appealing to control with chemical pesticides. Malathion (MT) is one of the main pesticides used against mosquitoes, the vectors of these diseases. This study aimed to assess cytotoxicity and mutagenicity of the malathion for the bioindicator Allium cepa L. using a multivariate and integrative approach. Moreover, an appendix table was compiled with all available literature of insecticides assessed by the Allium cepa system to support our discussion. Exposures during 48h to 0.5 mg mL-¹ and 1.0 mg mL-¹ MT were compared to the negative control (distilled water) and positive control (MMS solution at 10 mg L-¹). The presence of chromosomal aberrations, micronuclei frequency, and mitotic index abnormalities was evaluated. Anaphase bridges were the alterations with higher incidence and presented a significantly elevated rate in the concentration of 0.5 mg mL-¹, including when compared to the positive control. The integrative discriminant analysis summarizes that MT in assessed concentrations presented effects like the positive control, corroborating its potential of toxicity to DNA. Therefore, it is concluded that MT in its pure composition and in realistic concentrations used, has genotoxic potential in the biological assessment of A. cepa cells. The multivariate integrative analysis was fundamental to show a whole response of all data, providing a global view of the effect of MT on DNA.

Por muitos séculos, as populações humanas sofrem e tentam combater os mosquitos transmissores de doenças. Doenças emergentes e reemergentes como Dengue, Zika e Chikungunya afetam bilhões de pessoas em todo o mundo e, recentemente, vem apelando ao controle com pesticidas químicos. O Malation (MT) é um dos principais pesticidas usados contra mosquitos, vetores dessas doenças. O objetivo deste estudo foi avaliar a citotoxicidade e a mutagenicidade do MT para o bioindicador Allium cepa L. usando uma abordagem multivariada e integrativa. Além disso, uma tabela suplementar foi compilada com toda a literatura disponível de inseticidas avaliada pelo sistema Allium cepa para apoiar nossa discussão. Exposições ao MT durante 48h a 0,5 mg mL-¹ e 1,0 mg mL-¹ foram comparadas a um controle negativo (água destilada) e um controle positivo (10 mg L-¹ de MMS). Foram avaliadas a presença de aberrações cromossômicas, frequência de micronúcleos e anormalidades no índice mitótico. As pontes anafásicas foram as alterações com maior incidência e apresentaram uma taxa significativamente elevada na concentração de 0,5 mg mL-¹, inclusive quando comparadas ao controle positivo. A análise discriminante integrativa resume que o MT nas concentrações avaliadas apresentou efeitos semelhantes ao controle positivo, corroborando seu potencial de toxicidade para o DNA. Portanto, conclui-se que o MT, em sua composição pura e nas concentrações realistas utilizadas, possui potencial genotóxico na avaliação biológica de células de A. cepa. A análise integrativa multivariada foi fundamental para mostrar uma resposta completa de todos os dados, fornecendo uma visão global do efeito da MT no DNA.

Integrative analysis in toxicological assessment of the insecticide Malathion in Allium cepa L. system

Abstract For many centuries human populations have been suffering and trying to fight with disease-bearing mosquitoes. Emerging and reemerging diseases such as Dengue, Zika, and Chikungunya affect billions of people around the world and recently has been appealing to control with chemical pesticides. Malathion (MT) is one of the main pesticides used against mosquitoes, the vectors of these diseases. This study aimed to assess cytotoxicity and mutagenicity of the malathion for the bioindicator Allium cepa L. using a multivariate and integrative approach. Moreover, an appendix table was compiled with all available literature of insecticides assessed by the Allium cepa system to support our discussion. Exposures during 48h to 0.5 mg mL-1 and 1.0 mg mL-1 MT were compared to the negative control (distilled water) and positive control (MMS solution at 10 mg L-1). The presence of chromosomal aberrations, micronuclei frequency, and mitotic index abnormalities was evaluated. Anaphase bridges were the alterations with higher incidence and presented a significantly elevated rate in the concentration of 0.5 mg mL-1, including when compared to the positive control. The integrative discriminant analysis summarizes that MT in assessed concentrations presented effects like the positive control, corroborating its potential of toxicity to DNA. Therefore, it is concluded that MT in its pure composition and in realistic concentrations used, has genotoxic potential in the biological assessment of A. cepa cells. The multivariate integrative analysis was fundamental to show a whole response of all data, providing a global view of the effect of MT on DNA.

Resumo Por muitos séculos, as populações humanas sofrem e tentam combater os mosquitos transmissores de doenças. Doenças emergentes e reemergentes como Dengue, Zika e Chikungunya afetam bilhões de pessoas em todo o mundo e, recentemente, vem apelando ao controle com pesticidas químicos. O Malation (MT) é um dos principais pesticidas usados contra mosquitos, vetores dessas doenças. O objetivo deste estudo foi avaliar a citotoxicidade e a mutagenicidade do MT para o bioindicador Allium cepa L. usando uma abordagem multivariada e integrativa. Além disso, uma tabela suplementar foi compilada com toda a literatura disponível de inseticidas avaliada pelo sistema Allium cepa para apoiar nossa discussão. Exposições ao MT durante 48h a 0,5 mg mL-1 e 1,0 mg mL-1 foram comparadas a um controle negativo (água destilada) e um controle positivo (10 mg L-1 de MMS). Foram avaliadas a presença de aberrações cromossômicas, frequência de micronúcleos e anormalidades no índice mitótico. As pontes anafásicas foram as alterações com maior incidência e apresentaram uma taxa significativamente elevada na concentração de 0,5 mg mL-1, inclusive quando comparadas ao controle positivo. A análise discriminante integrativa resume que o MT nas concentrações avaliadas apresentou efeitos semelhantes ao controle positivo, corroborando seu potencial de toxicidade para o DNA. Portanto, conclui-se que o MT, em sua composição pura e nas concentrações realistas utilizadas, possui potencial genotóxico na avaliação biológica de células de A. cepa. A análise integrativa multivariada foi fundamental para mostrar uma resposta completa de todos os dados, fornecendo uma visão global do efeito da MT no DNA.

Integrative analysis in toxicological assessment of the insecticide Malathion in Allium cepa L. system / Análise integrativa na avaliação toxicológica do inseticida Malation no sistema Allium cepa L

Abstract For many centuries human populations have been suffering and trying to fight with disease-bearing mosquitoes. Emerging and reemerging diseases such as Dengue, Zika, and Chikungunya affect billions of people around the world and recently has been appealing to control with chemical pesticides. Malathion (MT) is one of the main pesticides used against mosquitoes, the vectors of these diseases. This study aimed to assess cytotoxicity and mutagenicity of the malathion for the bioindicator Allium cepa L. using a multivariate and integrative approach. Moreover, an appendix table was compiled with all available literature of insecticides assessed by the Allium cepa system to support our discussion. Exposures during 48h to 0.5 mg mL-1 and 1.0 mg mL-1 MT were compared to the negative control (distilled water) and positive control (MMS solution at 10 mg L-1). The presence of chromosomal aberrations, micronuclei frequency, and mitotic index abnormalities was evaluated. Anaphase bridges were the alterations with higher incidence and presented a significantly elevated rate in the concentration of 0.5 mg mL-1, including when compared to the positive control. The integrative discriminant analysis summarizes that MT in assessed concentrations presented effects like the positive control, corroborating its potential of toxicity to DNA. Therefore, it is concluded that MT in its pure composition and in realistic concentrations used, has genotoxic potential in the biological assessment of A. cepa cells. The multivariate integrative analysis was fundamental to show a whole response of all data, providing a global view of the effect of MT on DNA.

Resumo Por muitos séculos, as populações humanas sofrem e tentam combater os mosquitos transmissores de doenças. Doenças emergentes e reemergentes como Dengue, Zika e Chikungunya afetam bilhões de pessoas em todo o mundo e, recentemente, vem apelando ao controle com pesticidas químicos. O Malation (MT) é um dos principais pesticidas usados ​​contra mosquitos, vetores dessas doenças. O objetivo deste estudo foi avaliar a citotoxicidade e a mutagenicidade do MT para o bioindicador Allium cepa L. usando uma abordagem multivariada e integrativa. Além disso, uma tabela suplementar foi compilada com toda a literatura disponível de inseticidas avaliada pelo sistema Allium cepa para apoiar nossa discussão. Exposições ao MT durante 48h a 0,5 mg mL-1 e 1,0 mg mL-1 foram comparadas a um controle negativo (água destilada) e um controle positivo (10 mg L-1 de MMS). Foram avaliadas a presença de aberrações cromossômicas, frequência de micronúcleos e anormalidades no índice mitótico. As pontes anafásicas foram as alterações com maior incidência e apresentaram uma taxa significativamente elevada na concentração de 0,5 mg mL-1, inclusive quando comparadas ao controle positivo. A análise discriminante integrativa resume que o MT nas concentrações avaliadas apresentou efeitos semelhantes ao controle positivo, corroborando seu potencial de toxicidade para o DNA. Portanto, conclui-se que o MT, em sua composição pura e nas concentrações realistas utilizadas, possui potencial genotóxico na avaliação biológica de células de A. cepa. A análise integrativa multivariada foi fundamental para mostrar uma resposta completa de todos os dados, fornecendo uma visão global do efeito da MT no DNA.

A study to correlate serum pseudocholinesterase and serum creatine phosphokinase levels in acute organophosphorus poisoning with respect to Peradeniyaorganophosphorus poisoning scale

Background: Organophosphorus insecticides are one of the most common causes of poisoning in India. It has a high mortality rate and accounts for a third of suicidal deaths in south-east Asia.Methods: The objectives were to estimate serum pseudocholinesterase and creatine phosphokinase (CPK) levels in organophosphorus poisoning and correlate them with theseverity and prognosis described by the Peradeniya organophosphorus poisoning (POP) scale at initial presentation.This was a cross-sectional study conducted over 18 months. A total of 180 organophosphorus-poisoning subjects were divided into mild, moderate and severe grades based on POP scale at admission. Serum pseudocholinesterase and CPK levels were estimated at admission. The outcome was noted, and the results were statistically analysed.Results:It was found that 112 (62.2%), 51 (28.3%) and 17 (9.4%) patients had mild, moderate and severe poisoning, respectively, according to POP scale. Mean pseudocholinesterase level (units/litre) was 2393.29, 1104.37 and 638.18 and mean serum CPK level (units/litre) was 153.41,344.94 and 280.53 in mild, moderate and severe poisoning, respectively. ICU and ventilator were required for 84 (46.75%) and 72 (40%) patients, respectively. Mortality was 17.8%. Negative, weak and significant correlation was seen between POP score and pseudocholinesterase (r=-0.265, p=0.00). Positive, moderate and significant correlation was seen between POP score and CPK levels (r=0.449, p=0.00).Conclusions: POP scale applied at admission along with serum pseudocholinesterase and CPK levels serve as a simple and effective system to determine early need for ventilation and mortality in rural, peripheral centres in developing nations.

Recent research development on human health associated with organophosphorus flame retardants / 环境与职业医学

Organophosphorus flame retardants (OPFRs) pollution and its impacts on human health are of global concern. The review briefly reviewed the current state-of-knowledge on exposure assessment and epidemiological evidence of OPFRs-related health effects. Specifically, this paper provided an overview and comparison of the levels of respiratory and gastrointestinal exposure to OPFRs and their body burden in different populations worldwide; summarized potential adverse effects of long-term low-level OPFRs exposure on children's neurodevelopment, adults' reproductive system, and thyroid function. Available epidemiological studies have revealed that the OPFRs exposure level of Chinese population is low, and rice consumption may be a potential source of exposure to OPFRs; OPFRs such as tris (1-chloro-2-propyl) phosphate (TCIPP) and tris (2-chloroethyl) phosphate (TCEP) have both neurotoxicity and reproductive toxicity, and possibly affect the thyroid function in adults and increase the risk of wheezing and eczema in children. Finally, the future research focus on population exposure and health effects of OPFRs was prospected.

Clinical study on revised penehyclidine hydrochloride treatment program for acute severe organophosphorus pesticide poisoning / 环境与职业医学

Background The current treatment program with penehyclidine hydrochloride (PHC) for acute severe organophosphorus pesticide poisoning (ASOPP) patients exerts a positive effect but with concerned adverse reactions. Objective To evaluate the treatment effect of a revised ASOPP treatment program with PHC. Methods A prospective single-blind randomized controlled trial was conducted. A total of 157 patients with ASOPP were divided into a revised treatment group (82 cases) and a conventional treatment group (75 cases) by random number table. The two groups received the same basic treatment measures including active life support, routine gastric lavage, catharsis, and pralidoxime treatment. The revised treatment group followed a revised PHC treatment protocol initiated by first a small dose of PHC and followed by small doses of PHC administration/discontinuation through frequent observations at different time points. The conventional treatment group received the conventional program. Treatment effects and incidence rates of possible adverse reactions were compared between the two groups. Results Compared with the conventional treatment group, the revised treatment group obtained delay in penetrogenation time point, higher success rate in catharsis, earlier cholinesterase-turning time, and shorter hospitalization period with statistical significance (all Ps＜0.05). No differences were found in terms of time for symptoms of poisoning to disappear, incidence rates of intermediate myasthenic syndrome and delayed polyneuropathy, mechanical ventilation time, and cure rate (all Ps＞0.05). Less adverse reactions occurred in the revised treatment group including tachycardia and delirium than in the conventional treatment control group (all Ps＜0.05). Conclusion The revised ASOPP treatment program with PHC is similar to the current recommended treatment program in treatment effects, but with less adverse reactions.

A dual-signal sensor for the analysis of parathion-methyl using silver nanoparticles modified with graphitic carbon nitride / 药物分析学报

A highly sensitive and selective method was developed for both UV-vis spectrophotometric and fluo-rimetric determination of organophosphorus pesticides(OPs).This method used silver nanoparticles(AgNPs)modified with graphitic carbon nitride(g-C3N4).The AgNPs reduced the fluorescence intensity of g-C3N4.Acetylthiocholine(ATCh)could be catalytically hydrolyzed by acetylcholinesterase(AChE)to form thiocholine,which induces aggregation of the AgNPs.This aggregation led to the recovery of the blue fluorescence of g-C3N4,with excitation/emission peaks at 310/460 nm.This fluorescence intensity could be reduced again in the presence of OPs because of the inhibitory effect of OPs on the activity of AChE.The degree of reduction was found to be proportional to the concentration of OPs,and the limit of fluorometric detection was 0.0324 μg/L(S/N = 3).In addition,the absorption of the g-C3N4/AgNPs at 390 nm decreased because of the aggregation of the AgNPs,but was recovered in presence of OPs because of the inhibition of enzyme activity by OPs.This method was successfully applied to the analysis of parathion-methyl in real samples.

Electrochemical detection of methyl-paraoxon based on bifunctional cerium oxide nanozyme with catalytic activity and signal amplification effect / 药物分析学报

A new electrochemical sensor for organophosphate pesticide(methyl-paraoxon)detection based on bifunctional cerium oxide(CeO2)nanozyme is here reported for the first time.Methyl-paraoxon was degraded into p-nitrophenol by using CeO2 with phosphatase mimicking activity.The CeO2 nanozyme-modified electrode was then synthesized to detect p-nitrophenol.Cyclic voltammetry was applied to investigate the electrochemical behavior of the modified electrode,which indicates that the signal enhancement effect may attribute to the coating of CeO2 nanozyme.The current research also studied and discussed the main parameters affecting the analytical signal,including accumulation potential,accumulation time,and pH.Under the optimum conditions,the present method provided a wider linear range from 0.1 to 100 μmol/L for methyl-paraoxon with a detection limit of 0.06 μmol/L.To validate the proof of concept,the electrochemical sensor was then successfully applied for the determination of methyl-paraoxon in three herb samples,i.e.,Coix lacryma-jobi,Adenophora stricta and Semen nelum-binis.Our findings may provide new insights into the application of bifunctional nanozyme in electro-chemical detection of organophosphorus pesticide.

Current status of organophosphorus pesticide residues in root and rhizome medicinal materials and research progress of rapid detection methods / 中国中药杂志

The medicinal plants with roots and rhizomes as the medicinal parts account for about 1/3 of Chinese medicinal herbs. Root and rhizome medicinal materials are widely used in clinical practice, whereas their wild resource reserves are insufficient to meet the market demand. With the expansion of planting areas, the formation of large-scale production areas, and the increase in planting years, diseases and insect pests of these medicinal plants, which are diverse and have broad transmission routes, strong concealment, and heavy damage, have become more and more serious. The prevention and control of these diseases and insect pests is characterized by multiple ways of pesticide application, large consumption of pesticides, susceptibility to soil barrier, difficulty in the control, and unstable control efficiency. Organophosphorus pesticides(OPPs) are widely used in the cultivation of Chinese medicinal plants because of their diverse varieties, broad-spectrum, good efficacy, and low residues, and have a positive effect on the yield and quality of Chinese medicinal materials. However, the abuse of OPPs not only increases the planting cost, but also affects the quality and safety of Chinese medicinal plants, the safety of clinical use of Chinese medicine, and the ecological safety of production areas. This paper reviewed the research and development progress of OPPs, the registration status of OPPs used in root and rhizome medicinal materials, residue limit standards, residue status, and rapid detection technology progress of OPPs. This review aims to provide research ideas and references for standardizing the use of OPPs in root and rhizome medicinal materials, reducing OPP residues, and establishing a fast, efficient, accurate, and reliable method for the detection of OPP residues in Chinese herbal medicine.

Efficacy in treatment of moderate to severe degree organophosphorus poisoning with fresh frozen plasma, atropine and 2-pyridine aldoxime methyl chloride as compared to treatment with atropine and 2-pyridine aldoxime methyl chloride in Western Odisha

Background: Organophosphorus (OP) compounds are one of the most common agents used for suicidal poisoning. People in the middle socioeconomic status are mainly affected. The most important determinant of death in OP poisoning is the severity. The ideal treatment of OP poisoning, this study was undertaken to compare the efficacy of fresh frozen plasma (FFP) along with the standard regimen of atropine and oximes.Methods: 80 patients were taken in this study (40 cases and 40 controls) with history and biochemical pictures suggestive of acute OP poisoning. Normality assumption and equality of variance were satisfied for most of quantitative variables. As a comparison of the baseline data of the study groups did not reveal any significant difference (p>0.05), the result at a given point of time between two groups were also compared with the same methods of assess the comparative changes.Results: Total 80 patients >15 years of age were taken for the study. Out of the total 63.7% are female and 36.3% are males. OP compounds are commonly used as suicidal agent. Salivation is the most common presenting symptoms in both cases and controls. The mean value of serum cholinesterase on day -1 in cases and controls are nearly same but the subsequent mean values as the days progresses are higher in cases than that controls.Conclusions: FFP showed its positive effect in reducing the development of intermediate syndrome/ fatality/ ventilatory support.

Clinical profile and outcome of organophosphorus poisoning in a tertiary care centre, a prospective observational study

Introduction: Acute organophosphorus (OP) pesticide poisoning is widespread in the developing world. Being predominantly an agricultural country, pesticides and insecticides are used abundantly for cultivation, and access to these poisonous chemical substances by the population is easy. The objectiveof the study was to identifythe nature of the demographic profile, type of compound, clinical manifestations, and outcome of organophosphate poisoning presenting to a tertiary care teaching hospital in India. Material and methods: A cross-sectional study was conducted among 100 patients admitted with OPC poisoning inthe department of general medicine,Velammal Medical College Hospital and Research Institute, Madurai from January 2016 to July 2019. The diagnosis was made based on history or evidence of exposure to OP compound within 24 hours; characteristic manifestations of OP poisoning include, miosis, fasciculations, excessive salivation, improvement of signs and symptoms with administration of atropine were recorded. IBM SPSS version 22 was used for statistical analysis. Results:The majority of the subjects were males(80%). The majority (66%) were in the age group of 21-40 years. The most common OPC to be consumed was Methyl parathion (27%), followed by chlorpyrifos (22%). The major GIT complications were abdominal pain/cramps (100%), followed by nausea and vomiting (83%). Mechanical ventilation was needed in 40% and mortality was reported in 25% of the subjects. Conclusion:OP poisoning affects resonantly males in their economically productive phase of life. Considering the high mortality, adequate strengthening of health services, especially at the primary level is the need of the hour.

Catalytic and structural effects of flexible loop deletion in organophosphorus hydrolase enzyme: A thermostability improvement mechanism

Thermostability improvement of enzymes used industrially or commercially would develop their capacity andcommercial potential due to increased enzymatic competence and cost-effectiveness. Several stabilizing factorshave been suggested to be the base of thermal stability, like proline replacements, disulfide bonds, surface looptruncation and ionic pair networks creation. This research evaluated the mechanism of increasing the rigidity oforganophosphorus hydrolase enzyme by flexible loop truncation. Bioinformatics analysis revealed that themutated protein retains its stability after loop truncation (five amino acids deleted). The thermostability of thewild-type (OPH-wt) and mutated (OPH-D5) enzymes were investigated by half-life, DGi, and fluorescence andfar-UV CD analysis. Results demonstrated an increase half-life and DGi in OPH-D5 compared to OPH-wt.These results were confirmed by extrinsic fluorescence and circular dichroism (CD) spectrometry experiments,therefore, as rigidity increased in OPHD5 after loop truncation, half-life and DGi also increased. Based onthese findings, a strong case is presented for thermostability improvement of OPH enzyme by flexible looptruncation after bioinformatics analysis.

A prospective study to assess glycemic status as a possible prognostic marker in non diabetic acute organophosphate poisoning patients

Background: Organophosphates (OP) are a diverse group of insecticides used for pest control. Due to easy availability of these compounds over the counter, organophosphate poisoning continues to be a major cause of deliberate self-harm. Although choline esterase inhibition plays a key role in OP poisoning, other metabolic factors like dysglycemia contribute to the severity of poisoning. The present study attempts to assess glycaemic variability as a probable prognostic factor in acute OP poisoning. Aim of the study was to correlate the blood glucose levels with the severity and treatment outcome of acute organophosphate poisoning.Methods: 100 patients of acute organophosphate poisoning admitted in the hospitals affiliated to Bangalore Medical College and Research Institute during the study period from August 2018 to July 2019, were enrolled into the study as per the inclusion criteria and graded into mild, moderate & severe, based on Peradeniya organophosphorus poisoning (POP) scale. Random blood sugar (RBS) was estimated at the time of admission and patients were followed up till recovery/death.Results: The patients in this study were categorized into hypoglycemics (10%), euglycemics (75%) and hyperglycemic (15%). 16% of euglycemics, 30% of hypoglycemics and 60% of hyperglycemics had severe grade of poisoning. The ventilator requirements in hypoglycaemics, euglycemics and hyperglycemics were 40%,48% and 80% respectively. The outcome in terms of mortality was 8% in euglycemics group and 20% in hyperglycemics group. Hence hyperglycemia was found to be a poor prognostic marker in acute organophosphate poisoning.Conclusions: RBS at admission in acute organophosphate poisoning patients is a simple, inexpensive tool that may help to predict the clinical outcome. Early identification of the poor prognostic indicators may help in timely intervention, to reduce morbidity and mortality, especially in a resource limited country like India.

A prospective evaluation of correlation between cholinesterase level and severity of organophosphorus poisoning

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.

Role of penehyclidine in acute organophosphorus pesticide poisoning / 世界急诊医学杂志（英文）

BACKGROUND@#Penehyclidine is a newly developed anticholinergic agent. We aimed to investigate the role of penehyclidine in acute organophosphorus pesticide poisoning (OP) patients.@*METHODS@#We searched the Pubmed, Cochrane library, EMBASE, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical literature (CBM) and Wanfang databases. Randomized controlled trials (RCTs) recruiting acute OP patients were identified for meta-analysis. Main outcomesincluded cure rate, mortality rate, time to atropinization, time to 60% normal acetylcholinesterase (AchE) level, rate of intermediate syndrome (IMS) and rate of adverse drug reactions (ADR).@*RESULTS@#Sixteen RCTs involving 1,334 patients were identified. Compared with the atropine-or penehyclidine-alone groups, atropine combined with penehyclidine significantly increased the cure rate (penehyclidine+atropine vs. atropine, 0.97 vs. 0.86, RR 1.13, 95% CI [1.07–1.19]; penehyclidine+atropine vs. penehyclidine, 0.93 vs. 0.80, RR 1.08, 95% CI [1.01–1.15]) and reduced the mortality rate (penehyclidine+atropine vs. atropine, 0.015 vs. 0.11, RR 0.17, 95% CI [0.06–0.49]; penehyclidine+atropine vs. penehyclidine, 0.13 vs. 0.08, RR 0.23, 95% CI [0.04–1.28]). Atropine combined with penehyclidine in OP patients also helped reduce the time to atropinization and AchE recovery, the rate of IMS and the rate of ADR. Compared with a single dose of atropine, a single dose of penehyclidine also significantly elevated the cure rate, reduced times to atropinization, AchE recovery, and rate of IMS.@*CONCLUSION@#Atropine combined with penehyclidine benefits OP patients by enhancing the cure rate, mortality rate, time to atropinization, AchE recovery, IMS rate, total ADR and duration of hospitalization. Penehyclidine combined with atropine is likely a better initial therapy for OP patients than atropine alone.

Observation of the therapeutic effect of different time intake on patients with acute oral organophosphorus pesticide poisoning / 中国实用护理杂志

Objective@#To study the best time of early feeding in patients with acute oral organophosphorus pesticide poisoning.@*Methods@#A prospective study was conducted on 123 patients with acute oral organophosphorus poisoning admitted from January 2018 to May 2019 in Department of Emergency, the Affiliated Hospital of Binzhou Medical University. The patients were divided into four groups, A(<6 h), B(≥6 h-<12 h), C(≥12 h-<24 h) and D(≥24 h), according to the time of poisoning at the time of admission. All the patients in the four groups were fed immediately upon admission with the same method. The cholinesterase activity at 24, 48, 72, 120 h after poisoning, the incidence of rebound after poisoning, the disappearance time of clinical poisoning symptoms were compared among the four groups.@*Results@#Compared with the other three groups, group A had a statistically significant difference in the cholinesterase activity at 24, 48, 72, 120 h after poisoning (H value was 9.466-24.933, P<0.05 or 0.01). There was no significant difference between the two groups in B, C, D group (P>0.05). The incidence of rebound after poisoning in A, B, C, D group was 3.448%(1/30), 7.407%(2/29), 6.452%(2/33), 6.897%(2/31), respectively, with no statistically significant difference (χ2 value was 0.431, P>0.05). Compared with the four groups, the disappearance time of clinical poisoning symptoms in group A was shorter than that in the other three groups, and the difference was statistically significant (H value was18.199, P<0.05).@*Conclusions@#The earlier the patients ate, the faster the recovery of cholinesterase activity, the earlier the improvement of poisoning symptoms, and the incidence of gastrointestinal reaction and rebound after poisoning is not increased.The best time for early feeding is less than 6 h after poisoning.

Effect of hemoperfusion on ChE activity and toxicant clearance in patients with organophosphorus poisoning / 中国基层医药

Objective@#To investigate the effect of hemoperfusion (HP) on the activity of ChE in blood of patients with organophosphorus poisoning, and its toxicant clearance effect.@*Methods@#From January 2017 to January 2019, 60 patients with organophosphorus poisoning in Shengjing Hospital Affiliated to China Medical University were divided into observation group and control group according to random number table method, with 30 cases in each group.The control group was treated with routine treatment, while the observation group was treated with HP on the basis of routine treatment.The therapeutic effects of the two groups were compared.@*Results@#The duration of mechanical ventilation and conscious awakening in the observation group were (3.07±1.14) d and (1.42±0.37) d, respectively, which were significantly shorter than those in the control group[(4.15±1.22) d, (2.01±0.58)d](t=3.543, 4.697, all P<0.05). The dosage of atropine in the observation group[(252.57±28.44)mg]was significantly less than that in the control group[(282.61±29.82)mg](t=3.993, P<0.05). The activity of cholinesterase after 12 h and 24 h of treatment was significantly higher than those before treatment (all P<0.05). After 12 h and 24 h of treatment, the cholinesterase activities in the observation group were (1 128.64±152.49)U/L and (1 422.08±184.68)U/L, respectively, which were higher than those in the control group[(912.73±144.61)U/L and (1 165.32±173.27)U/L](t=5.627, 5.553, all P<0.05). After 1 d and 3 d of treatment, the concentrations of organophosphorus poisons in the observation group were (1.08±0.30)mg/L and (0.62±0.18)mg/L, respectively, which were significantly lower than those in the control group[(1.32±0.35)mg/L and (0.84±0.27)mg/L](t=2.852, 3.713, all P<0.05). The incidences of rebound, intermediate syndrome and multiple organ failure in the observation group were 3.33% (1/30), 6.67% (2/30) and 13.33% (4/30), respectively, which were lower than those in the control group[23.33% (7/30), 23.33% (7/30), 36.67% (11/30)](χ2=5.192, 3.278, 4.356, all P<0.05).@*Conclusion@#HP has obvious effect on the activity of ChE and the concentration of blood poisons in patients with organophosphorus poisoning.It is worthy of popularizing and applying in clinic.

Effect of hemoperfusion on ChE activity and toxicant clearance in patients with organophosphorus poisoning / 中国基层医药

Objective To investigate the effect of hemoperfusion (HP) on the activity of ChE in blood ofpatients with organophosphorus poisoning,and its toxicant clearance effect.Methods From January 2017 to January 2019,60 patients with organophosphorus poisoning in Shengjing Hospital Affiliated to China Medical University were divided into observation group and control group according to random number table method , with 30 cases in each group.The control group was treated with routine treatment ,while the observation group was treated with HP on the basis of routinetreatment.Thetherapeuticeffectsof thetwogroupswerecompared.Results Thedurationof mechanical ventilation and conscious awakening in the observation group were (3.07 ±1.14) d and (1.42 ±0.37) d,respectively, which were significantly shorter than those in the control group [(4.15 ±1.22) d,(2.01 ±0.58)d](t=3.543, 4.697,all P<0.05).The dosage of atropine in the observation group [(252.57 ±28.44) mg] was significantly less than that in the control group [(282.61 ±29.82)mg](t=3.993,P<0.05).The activity of cholinesterase after 12 h and 24 h of treatment was significantly higher than those before treatment (all P<0.05).After 12 h and 24 h of treatment,the cholinesterase activities in the observation group were (1128.64 ±152.49) U/L and (1422.08 ± 184.68)U/L,respectively,which were higher than those in the control group[(912.73 ±144.61) U/L and (1165.32 ± 173.27)U/L](t=5.627,5.553,all P<0.05).After 1 d and 3 d of treatment,the concentrations of organophosphorus poisons in the observation group were (1.08 ±0.30) mg/L and (0.62 ±0.18) mg/L,respectively,which were significantly lower than those in the control group[(1.32 ±0.35)mg/L and (0.84 ±0.27)mg/L](t =2.852, 3.713,all P<0.05).The incidences of rebound ,intermediate syndrome and multiple organ failure in the observation group were 3.33％(1/30),6.67％(2/30) and 13.33％(4/30),respectively,which were lower than those in the control group［23.33％(7／30),23.33％(7／30),36.67％(11／30)］(χ2 ＝5.192,3.278,4.356,all P ＜0.05).Conclusion HP has obvious effect on the activity of ChE and the concentration of blood poisons in patients with organophosphorus poisoning.It is worthy of popularizing and applying in clinic.

Arterial Blood Gas as a Prognostic Tool in Organophosphorus Poisoning Patients – A Prospective Observational Study

Introduction: Organophosphorus (OP) compounds constitute a heterogeneous category of chemicals specifically designed forthe control of pests, weeds, or plant diseases. Intentional ingestion of OP pesticides has been common and now the preferredform of poisoning due to its easy access in central and Southern parts of India. This predominantly occurs in rural communities.As a result of widespread use, OP poisoning is a major cause of morbidity and mortality worldwide.Aim: This study aims to access the arterial blood gas (ABG) analysis as a prognostic prediction tool in OP poisoning patients.Materials and Methods: This is a prospective study from February 2017 to March 2018, out of 114 patients who presented tothe emergency department, 14 patients were excluded from the study and the remaining 100 patients were included in the study.Results: Males were the most predominant group in OP ingestions in this study. In 29% of patients, the ABG interpretationwas normal and metabolic acidosis in the initial ABG had a mean intensive care unit (ICU) stay value of 12.92; respiratoryacidosis had a mean ICU stay value of 12.36; mixed acidosis had a mean ICU stay value of 9.33; respiratory alkalosis had amean ICU stay value of 5.37; metabolic alkalosis had a mean ICU stay value of 4.66. P-value was calculated and found to bestatistically significant. Moreover, it was also found that the patients who presented with extreme acidosis (≤7.1) had increasedmean ICU stay value (17.5).Conclusion: This study concludes that ABG analysis at the initial presentation could help in assessing the prognosis of OPpoisoning patients much earlier, which could help in intensifying the management.