Outcomes of elderly patients with organophosphate intoxication

This study analysed the clinical patterns and outcomes of elderly patients with organophosphate intoxication. A total of 71 elderly patients with organophosphate poisoning were seen between 2008 and 2017. Patients were stratified into two subgroups: survivors (n = 57) or nonsurvivors (n = 14). Chlorpyrifos accounted for 33.8% of the cases, followed by methamidophos (12.7%) and mevinphos (11.3%). Mood, adjustment and psychotic disorder were noted in 39.4%, 33.8% and 2.8% of patients, respectively. All patients were treated with atropine and pralidoxime therapies. Acute cholinergic crisis developed in all cases (100.0%). The complications included respiratory failure (52.1%), aspiration pneumonia (50.7%), acute kidney injury (43.7%), severe consciousness disturbance (25.4%), shock (14.1%) and seizures (4.2%). Some patients also developed intermediate syndrome (15.5%) and delayed neuropathy (4.2%). The nonsurvivors suffered higher rates of hypotension (P < 0.001), shock (P < 0.001) and kidney injury (P = 0.001) than survivors did. Kaplan–Meier analysis indicated that patients with shock suffered lower cumulative survival than did patients without shock (log-rank test, P < 0.001). In a multivariate-Cox-regression model, shock was a significant predictor of mortality after intoxication (odds ratio 18.182, 95% confidence interval 2.045–166.667, P = 0.009). The mortality rate was 19.7%. Acute cholinergic crisis, intermediate syndrome, and delayed neuropathy developed in 100.0%, 15.5%, and 4.2% of patients, respectively.

Toxic effect of organophosphate compounds on the kidneys

The study describes: the toxic effect of organophosphate intoxication compounds on the human and animal organism, the contribution of organophosphate to the chronic kidney disease epidemiology and the acute kidney poisoning pathophysiology caused by organophosphate compounds. The study shows oxidative stress and systemic hemodynamic disturbance in the pathogenesis of organophosphate-induced kidney injury. We summarized effects of organophosphate substances on the structural and functional kidneys tissue characteristics in humans and animals. Biomarkers useful for early diagnosis of kidneys toxic damage are shown. In study we considered microscopic and ultrastructural changes in the anatomical and histological kidney structures caused by acute and chronic organophosphate intoxication. The organophosphate compounds are highly toxic, easily overcome the epithelial integument, are able to penetrate cell membranes and the blood-brain barrier. These compounds are involved in the disruption of several key biological processes the acetylcholinesterase irreversible inhibition and the oxidative stress induction in the excretory organs cells. The kidneys are not the first target in the toxic effect of organophosphate compounds in the human body, but are actively involved in the pathological process. It was established that kidneys tissue damage by organophosphate compounds can manifest itself differently depending on the duration of exposure, type and concentration of the toxic compound. It was shown that the kidney injury pathogenesis during acute and chronic intoxication by organophosphate compounds remains not fully understood. Nephron dysfunction patterns depending from various doses and toxic agents exposure duration have not been identified.

Extracorporeal membrane oxygenation in carbamate (methomyl) intoxication: systematic review of the literature and case presentation

Background and Objective: Since methomyl shows a highly significant toxicity, the clinical outcome of acute methomyl pesticide intoxication is extremely critical. Methomyl is a kind of carbamate poisons. Similar to intoxications with other carbamate insecticides, methomyl intoxication inhibits the activity of acetylcholinesterase, which is contained within synaptic junctions between neurons. Most of the methomyl intoxication cases present with symptoms of cholinergic excess, which provokes respiratory failure, cardiovascular failure, and/or cardiorespiratory failure. Methomyl poisoning in humans has not yet been fully evaluated and most studies have reported sporadic cases or series of intoxication. Methomyl poisoning remains a continuing challenge, because this difficult-to-treat clinical condition is frequently associated with significantly high mortality and morbidity. We evaluated the usefulness of extracorporeal membrane oxygenation in the treatment of methomyl intoxication. Methods: A systematic literature review was conducted using the PRISMA guidelines without language restriction. We searched for scientific publications via PubMed, Embase, Cochrane central register of controlled trial, Google Scholar, the KoreaMed, and the Research Information Sharing Service database. The goal of this study was to report on incidence, associated complications, and morbidity/mortality of methomyl poisoning, and to draw special attention to its management with extracorporeal membrane oxygenation. Results: Only 1 case of a child treated with extracorporeal membrane oxygenation for carbamate or organophosphate intoxication was identified in the literature. After carbamate or organophosphate intoxication, the patient suffered from severe complications including neurological deficits, renal insufficiency, and severe respiratory failure. This child was treated with continuous hemofiltration and extracorporeal membrane oxygenation, but expired after 38 days of extracorporeal membrane oxygenation. In case of our patient, he recovered from the methomyl intoxication after 7 days of VA-ECMO. Conclusions: With only a few exceptions, acute methomyl poisoning is potentially life-threatening and has high incidences of morbidity and mortality. Therefore, physicians should keep in mind the possibility of extracorporeal membrane oxygenation for the quick support of intoxication. Extracorporeal membrane oxygenation support might be an alternative to overcome the cholinergic excess, such as respiratory failure, cardiovascular failure, and/or cardiorespiratory failure, especially in the case of severe acute methomyl intoxication.

Encapsulation of oxime acetylcholinesterase reactivators: influence of physiological conditions on the stability of oxime-cucurbit[7]uril complexes

The influence of physiological conditions on the host–guest chemistry of oxime acetylcholinesterase reactivators with cucurbit[7]urile was investigated to increase their effectiveness for the treatment of organophosphate intoxication.