Study of role of prognostic markers in the management of organophosphorus poisoning patients

Background: POP scale and serum cholinesterase levels may be effective indicators for mortality in organophosphorus poisoning. The objective of this study was to assess the POP scale score and serum cholinesterase levels at initial presentation in OP poisoning and its correlation with need for ventilator support and mortality.Methods: One hundred and fifty eligible participants were recruited, and POP scale and serum cholinesterase levels were assessed.Results: Total 32.7% patients died; of which 30 out of 75 belonged to moderate and 19 out of 22 patients belonged to severe group; as per POP scale score. 49 out of 75 in moderate poisoning and all patients in severe poisoning required ventilator support. With respect to serum cholinesterase level; 20 out of 23 and 29 out of 77 patients died in the severe and moderate poisoning categories respectively. Forty eight out of 77 in moderate poisoning and all patients in severe poisoning required ventilator support.Conclusions: Assessment by POP scale and serum cholinesterase levels is useful in assessing the need for ventilator support and are indicators of mortality in OP poisoning cases.

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A Study on Correlation Between Serum Cholinesterase Level and Clinical Severity Based on Pop Scale in Organophosphorus Poisoning

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v18i2.38903 ◽

2021 ◽

Vol 18 (2) ◽

pp. 55-58

Author(s):

Anil Shrestha ◽

Aasim Kidwai ◽

Richa Shrestha ◽

Suman KC

Keyword(s):

Organophosphorus Pesticides ◽

Case Fatality ◽

Public Health Problem ◽

Initial Presentation ◽

Clinical Severity ◽

Serum Cholinesterase ◽

Major Public Health Problem ◽

Age Group ◽

Suicidal Intention ◽

Organophosphorus Poisoning

Introduction: Organophosphorus (OP) compounds are the most commonly used pesticides worldwide and Organophosphorus poisoning has become the major public health problem especially in developing countries.The case fatality rate following ingestion of Organophosphorus pesticides in developing countries in Asia is 5-20%.Due to limited availability of facilities and resources in Nepal, it is important to prioritize treatment based on severity of poisoning as all patients can’t be managed in Intensive Care Unit. Aims: To study the correlation between serum cholinesterase level and clinical severity based on Peradenya organophosphorus poisoning scale in Organophosphorus poisoning. Methods: The study was conducted in the department of Medicine, Nepalgunj Medical College, Kohalpur, Banke from November 2019 to November 2020. It is based on the descriptive study of 66 patients with Organophosphorus poisoning attending to the emergency department. All patients with history of exposure to Organophosphorus poisoning were included in the study. Peradenya Organophosphorus Poisoning scale was used to assess the clinical severity as mild, moderate and severe. At the same time venous blood samples were collected for serum cholinesterase level. Results: Age group ranged from 16-60 years and majority of patients were in the age group of 20-29 years (34.85%). 53% were females. 74.2% of the patients were from lower socioeconomic status. 83.3% of the patients consumed poison with suicidal intention. Majority of the patients were from tharu ethinicity (40.9%) and were farmers (30.3%). It was observed that there is significant correlation between serum cholinesterase level and severity of poisoning based on Peradenya Organophosphorus Poisoning scale at initial presentation (p value <0.001). Conclusion: There is significant correlation between severity of poisoning and degree of derangement of serum cholinesterase level at the initial presentation. As the facility for the estimation of serum cholinesterase level is not available in all regions of Nepal.

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ROLE OF SERUM CHOLINESTERASE IN ACUTE ORGANOPHOSPHORUS POISONING: A HOSPITAL BASED CROSS SECTIONAL STUDY

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2015/745 ◽

2015 ◽

Vol 4 (30) ◽

pp. 5102-5108

Author(s):

Giridhar Patil ◽

Nimbal N V ◽

Arun V. Joshi ◽

Archana Dambal ◽

Madhavaranga M P ◽

...

Keyword(s):

Cross Sectional Study ◽

Serum Cholinesterase ◽

Sectional Study ◽

Cross Sectional ◽

Organophosphorus Poisoning ◽

Acute Organophosphorus Poisoning

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A study on serum cholinesterase level in organophosphorus poisoning and its correlation with severity of organophosphorus poisoning

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20183140 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1021

Author(s):

Vilas Honnakatti ◽

Naren Nimbal ◽

Prakash Doddapattar

Keyword(s):

Developing Countries ◽

Rural Areas ◽

Initial Presentation ◽

Serum Cholinesterase ◽

Steady Increase ◽

Age Group ◽

Low Socioeconomic ◽

Medical College ◽

Organophosphorus Poisoning ◽

Major Route

Background: There has been a steady increase in the use of organophosphates (OPs) as pesticides in most of the developing countries including India for more than 50 years. OPs tend to be the commonest cause of poisoning worldwide and are persistently and deliberately used in suicides in Agrarian areas. As stated by WHO, 3 million cases of pesticide poisoning occur every year, of these about 1 million are accidental and 2 million are suicidal poisonings, resulting in more than 0.25 million deaths per year. As there is limited availability of facilities and resources in developing countries, all OP poisoning patients are not managed in intensive care units. Hence it is important to understand the clinical features and other factors that indicate severity of poisoning which should be identified in the initial examination.Methods: It was a hospital based prospective study of 100 OP poisoning patients that were attending to casualty of BIMS Hospital and Medical College Belagavi, India. Over a period, patients fulfilling inclusion criteria were included and patients were categorized according to Peradeniya Organophosphorus Poisoning (POP) scale. Serum cholinesterase level measured at the time of admission.Results: The patients were in the age group of 18 to 70 years. Majority of the patients were in the age group of 21-30 years (51%). Sixty nine percent of the patients were from rural areas and 38% of them were farmers. Sixty nine percent of patients were from low socioeconomic stratum. Major route of intake of poison was ingestion. Eighty four percent of patients consumed poison with a suicidal intent. In this study, authors observed that there is a significant correlation between the severity of poisoning categorized by the POP scale and the serum cholinesterase at the time of initial presentation of the patients (P<0.001).Conclusions: Present study concluded that significant correlation between the degree of derangement in serum cholinesterase level and severity of poisoning at the initial presentation. Higher the score on the POP scale, the greater was the degree of derangement in the serum cholinesterase level.

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Evaluation of Serum Creatine Phosphokinase as a Marker of Severity in Organophosphorus Poisoning

International Journal of Biomedical Research ◽

10.7439/ijbr.v9i5.4767 ◽

2018 ◽

Vol 9 (5) ◽

pp. 179

Author(s):

Yogendra V. Bansod ◽

Swapnil G. Bhedodkar

Keyword(s):

Creatine Phosphokinase ◽

Prognostic Significance ◽

Clinical Severity ◽

Serum Cholinesterase ◽

Serum Creatine Phosphokinase ◽

Organophosphorus Poisoning ◽

Severe Clinical Picture ◽

Scale Category ◽

Global Health Problem

Background & Objectives: Organophosphorus (OP) poisoning is an important global health problem. Estimation of erythrocyte cholinesterase (EChE) and butyrylcholinesterase (BChE) as an evidence of OP poisoning is costly and not regularly performed. There are emerging options for new cheaper biochemical markers in relation to OP poisoning like creatine phosphokinase (CPK). The objectives of this study were to measure serum CPK level and correlate it with severity of poisoning, to evaluate clinical and prognostic significance of CPK in OP poisoning, to assess if serum CPK level can be used as an alternative of BChE level to stratify OP poisoning severity.Method: Total 100 patients of OP poisoning without any prior treatment, presenting within 12 hours, were selected and their clinical severity was categorized according to Peradeniya Organophosphorus Poisoning (POP) scale. Level of serum CPK, blood BChE and pH were measured and total dose of atropine required (mg) until final clinical outcome was calculated.Results: Out of 100, 43% patients had mild, 36% moderate and 21% severe clinical picture. There was a significant positive correlation between serum CPK value and requirement of atropine dose in patient with severe POP scale category and negative correlation with pH and serum cholinesterase levels, indicating that more severe the poisoning more will be serum CPK and requirement of atropine doses while less will be pH and serum cholinesterase, (p<0.0001).Conclusions: This study suggests role of serum creatine kinase as surrogate, relatively cheap and easily quantifiable markers of severe OPC exposure and their association.

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Evaluation of the Possible Role of S100B, Troponin I and C- Reactive Protein Levels as Prognostic Markers in Cases of Traumatic Intra-Cerebral and Subarachnoid Hemorrhage

Ain Shams Journal of Forensic Medicine and Clinical Toxicology ◽

10.21608/ajfm.2014.18678 ◽

2014 ◽

Vol 23 (2) ◽

pp. 90-102

Author(s):

Abeer Sheta ◽

Haidy Megahed ◽

Mohamed Megahed ◽

Osama Mansour

Keyword(s):

Subarachnoid Hemorrhage ◽

Troponin I ◽

Prognostic Markers ◽

C Reactive Protein ◽

Protein Levels ◽

Reactive Protein

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NF-κB, JNK, and TLR Signaling Pathways in Hepatocarcinogenesis

Gastroenterology Research and Practice ◽

10.1155/2010/367694 ◽

2010 ◽

Vol 2010 ◽

pp. 1-10 ◽

Cited By ~ 39

Author(s):

Shin Maeda

Keyword(s):

Hepatocellular Carcinoma ◽

Signaling Pathways ◽

Inflammatory Cell ◽

Prognostic Markers ◽

Tumor Promotion ◽

Neoplastic Cell ◽

Nuclear Factor ◽

Tlr Signaling ◽

The Third

Hepatocellular carcinoma (HCC) is the third largest cause of cancer deaths worldwide. The role of molecular changes in HCC have been used to identify prognostic markers and chemopreventive or therapeutic targets. It seems that toll-like receptors (TLRs) as well as the nuclear factor (NF)-κB, and JNK pathways are critical regulators for the production of the cytokines associated with tumor promotion. The cross-talk between an inflammatory cell and a neoplastic cell, which is instigated by the activation of NF-κB and JNKs, is critical for tumor organization. JNKs also regulate cell proliferation and act as oncogenes, making them the main tumor-promoting protein kinases. TLRs play roles in cytokine and hepatomitogen expression mainly in myeloid cells and may promote liver tumorigenesis. A better understanding of these signaling pathways in the liver will help us understand the mechanism of hepatocarcinogenesis and provide a new therapeutic target for HCC.

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Lower peripheral blood Toll-like receptor 3 expression is associated with an unfavorable outcome in severe COVID-19 patients

Scientific Reports ◽

10.1038/s41598-021-94624-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Maria Clara Saad Menezes ◽

Alicia Dudy Müller Veiga ◽

Thais Martins de Lima ◽

Suely Kunimi Kubo Ariga ◽

Hermes Vieira Barbeiro ◽

...

Keyword(s):

Mechanical Ventilation ◽

Peripheral Blood ◽

World Health ◽

Control Group ◽

Pyrin Domain ◽

Peripheral Blood Gene Expression ◽

Severe Group ◽

Health Organization ◽

The Impact

AbstractThe role of innate immunity in COVID-19 is not completely understood. Therefore, this study explored the impact of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection on the expression of Pattern Recognition Receptors (PRRs) in peripheral blood cells and their correlated cytokines. Seventy-nine patients with severe COVID-19 on admission, according to World Health Organization (WHO) classification, were divided into two groups: patients who needed mechanical ventilation and/or deceased (SEVERE, n = 50) and patients who used supplementary oxygen but not mechanical ventilation and survived (MILD, n = 29); a control group (CONTROL, n = 17) was also enrolled. In the peripheral blood, gene expression (mRNA) of Toll-like receptors (TLRs) 3, 4, 7, 8, and 9, retinoic-acid inducible gene I (RIGI), NOD-like receptor family pyrin domain containing 3 (NLRP3), interferon alpha (IFN-α), interferon beta (IFN-β), interferon gamma (IFN-γ), interferon lambda (IFN-λ), pro-interleukin(IL)-1β (pro-IL-1β), and IL-18 was determined on admission, between 5–9 days, and between 10–15 days. Circulating cytokines in plasma were also measured. When compared to the COVID-19 MILD group, the COVID-19 SEVERE group had lower expression of TLR3 and overexpression of TLR4.

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Differences in coagulopathy indices in patients with severe versus non-severe COVID-19: a meta-analysis of 35 studies and 6427 patients

Scientific Reports ◽

10.1038/s41598-021-89967-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Alberto Polimeni ◽

Isabella Leo ◽

Carmen Spaccarotella ◽

Annalisa Mongiardo ◽

Sabato Sorrentino ◽

...

Keyword(s):

Platelet Count ◽

Meta Analysis ◽

Severe Disease ◽

Coagulation Factors ◽

Primary Analysis ◽

Severe Group ◽

Intravascular Coagulopathy ◽

The Difference ◽

D Dimer

AbstractCoronavirus disease 2019 (COVID-19) is a highly contagious disease that appeared in China in December 2019 and spread rapidly around the world. Several patients with severe COVID-19 infection can develop a coagulopathy according to the ISTH criteria for disseminated intravascular coagulopathy (DIC) with fulminant activation of coagulation, resulting in widespread microvascular thrombosis and consumption of coagulation factors. We conducted a meta-analysis in order to explore differences in coagulopathy indices in patients with severe and non-severe COVID-19. An electronic search was performed within PubMed, Google Scholar and Scopus electronic databases between December 2019 (first confirmed Covid-19 case) up to April 6th, 2020. The primary endpoint was the difference of D-dimer values between Non-Severe vs Severe disease and Survivors vs Non-Survivors. Furthermore, results on additional coagulation parameters (platelet count, prothrombin time, activated partial thromboplastin time) were also analyzed. The primary analysis showed that mean d-dimer was significantly lower in COVID-19 patients with non-severe disease than in those with severe (SMD − 2.15 [− 2.73 to − 1.56], I2 98%, P < 0.0001). Similarly, we found a lower mean d-dimer in Survivors compared to Non-Survivors (SMD − 2.91 [− 3.87 to − 1.96], I2 98%, P < 0.0001). Additional analysis of platelet count showed higher levels of mean PLT in Non-Severe patients than those observed in the Severe group (SMD 0.77 [0.32 to 1.22], I2 96%, P < 0.001). Of note, a similar result was observed even when Survivors were compared to Non-Survivors (SMD 1.84 [1.16 to 2.53], I2 97%, P < 0.0001). Interestingly, shorter mean PT was found in both Non-Severe (SMD − 1.34 [− 2.06 to − 0.62], I2 98%, P < 0.0002) and Survivors groups (SMD − 1.61 [− 2.69 to − 0.54], I2 98%, P < 0.003) compared to Severe and Non-Survivor patients. In conclusion, the results of the present meta-analysis demonstrate that Severe COVID-19 infection is associated with higher D-dimer values, lower platelet count and prolonged PT. This data suggests a possible role of disseminated intravascular coagulation in the pathogenesis of COVID-19 disease complications.

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Non-Coding RNAs as Prognostic Markers for Endometrial Cancer

International Journal of Molecular Sciences ◽

10.3390/ijms22063151 ◽

2021 ◽

Vol 22 (6) ◽

pp. 3151 ◽

Cited By ~ 2

Author(s):

Roberto Piergentili ◽

Simona Zaami ◽

Anna Franca Cavaliere ◽

Fabrizio Signore ◽

Giovanni Scambia ◽

...

Keyword(s):

Endometrial Cancer ◽

Prognostic Markers ◽

Classification Systems ◽

Prognostic Role ◽

Protein Coding ◽

Pathological Characteristics ◽

Epigenetic Events ◽

Cancer Types ◽

Non Coding Rnas

Endometrial cancer (EC) has been classified over the years, for prognostic and therapeutic purposes. In recent years, classification systems have been emerging not only based on EC clinical and pathological characteristics but also on its genetic and epigenetic features. Noncoding RNAs (ncRNAs) are emerging as promising markers in several cancer types, including EC, for which their prognostic value is currently under investigation and will likely integrate the present prognostic tools based on protein coding genes. This review aims to underline the importance of the genetic and epigenetic events in the EC tumorigenesis, by expounding upon the prognostic role of ncRNAs.

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