A Study on Changes in Plasma Cholinesterase in Patients with Acute Primary Angle Closure

Purpose To analyze the differences in plasma cholinesterase (pChE) among patients with acute primary angle closure (APAC), patients with chronic primary angle closure glaucoma (CPACG) and normal people scheduled for cataract surgery and to analyze the relationship between intraocular pressure (IOP) and pChE in order to explore the significance of pChE in the pathogenesis of glaucoma. Methods Retrospective case series. Nighty-four patients with APAC, 72 patients with CPACG and 95 normal controls were enrolled in this study. All patients excluding those with diseases that may affect pChE underwent routine blood biochemical examination. Pearson correlation analysis was used to further analyze the correlation of IOP with pChE. Results There was no significant difference in age or sex among the three groups. The difference in IOP among the APAC (43.8 ± 12.2 mmHg), CPACG (25.6 ± 7.4 mmHg) and normal groups (13.6 ± 1.8 mmHg) was significant (P = 0.000). There was a significant difference in pChE between patients with APAC (7450.89 ± 1748.49 IU/L) and normal subjects (7994.68 ± 1321.90 IU/L) (P = 0.000) and between patients with APAC and those with CPACG (7969.44 ± 1572.14 IU/L) (P = 0.000). There was no significant difference in pChE between CPACG patients and normal subjects (P = 0.932). There was a moderate negative correlation between IOP and pChE in APAC patients (r = -0.410, P = 0.000), while there was no significant correlation in CPACG patients (P = 0.228) or normal subjects (P = 0.341). Conclusion APAC patients with higher IOP had lower pChE, which may have been related to IOP-induced neuroinflammation. It may provide a new strategy for optic nerve protection in glaucoma patients.

Prognostic nomogram for the severity of acute organophosphate insecticide self-poisoning: a retrospective observational cohort study

ObjectiveTo develop a convenient nomogram for the bedside evaluation of patients with acute organophosphorus poisoning (AOPP).DesignThis was a retrospective study.SettingTwo independent hospitals in northern China, the First Hospital of Jilin University and the Lequn Hospital of the First Hospital of Jilin University.ParticipantsA total of 1657 consecutive patients admitted for the deliberate oral intake of AOPP within 24 hours from exposure and aged >18 years were enrolled between 1 January 2013 and 31 December 2018. The exclusion criteria were: normal range of plasma cholinesterase, exposure to any other type of poisonous drug(s), severe chronic comorbidities including symptomatic heart failure (New York Heart Association III or IV) or any other kidney, liver and pulmonary diseases. Eight hundred and thirty-four patients were included.Primary outcome measureThe existence of severely poisoned cases, defined as patients with any of the following complications: cardiac arrest, respiratory failure requiring ventilator support, hypotension or in-hospital death.Results440 patients from one hospital were included in the study to develop a nomogram of severe AOPP, whereas 394 patients from the other hospital were used for the validation. Associated risk factors were identified by multivariate logistic regression. The nomogram was validated by the area under the receiver operating characteristic curve (AUC). A nomogram was developed with age, white cells, albumin, cholinesterase, blood pH and lactic acid levels. The AUC was 0.875 (95% CI 0.837 to 0.913) and 0.855 (95% CI 0.81 to 0.9) in the derivation and validation cohorts, respectively. The calibration plot for the probability of severe AOPP showed an optimal agreement between the prediction by nomogram and actual observation in both derivation and validation cohorts.ConclusionA convenient severity evaluation nomogram for patients with AOPP was developed, which could be used by physicians in making clinical decisions and predicting patients’ prognosis.

Cholinergic syndrome: a case report of acute organophosphate and carbamate poisoning

Cholinergic syndrome is a common topic at western medical universities yet rarely observed in clinical practice. The treatment involves muscarinic antagonists, acetylcholinesterase reactivation, seizure control, and supportive measures. Here we report a case of a 52-year old Caucasian male who attempted suicide by ingesting a purple crystal powder that turned out to be a mixture of carbofuran and chlormephos. At clinical examination, the patient presented with salivation, perspiration, diarrhoea, bradypnoea, loss of consciousness, and epileptic seizures. Laboratory tests showed low plasma cholinesterase, and we started obidoxime along with supportive intensive care treatment. He was later transferred to the psychiatry department for further diagnostics and treatment.

Plasma cholinesterase activity as an environmental impact biomarker in juvenile green turtles (Chelonia mydas)

ABSTRACT: The objective of this study was to evaluate the enzymatic activity of plasma cholinesterase in Chelonia mydas marine turtles belonging to two populations, according to their capture sites, under the absence and probable influence of anthropic effects. A total of 74 animals were used and later divided into two groups, based on the capture site. Blood samples were collected from all captured animals, which were then released into the sea at the site of capture. A descriptive statistical analysis of the plasma cholinesterase activity values and an analysis comparing these values based on the capture site were performed. Samples of heparinized plasma from animals captured at the two different sites were analyzed. Plasma cholinesterase activity ranged from 121 to 248U/L, with a mean and standard deviation of 186.1±30.68U/L. When comparing plasma cholinesterase activity values in individuals based on the capture site, a significant difference was observed. Establishing reference values for different sea turtle populations is necessary to interpret future sampling results and to allow sea turtles to be used as sentinels of ecosystem health. Future studies are needed to evaluate other populations and the activity of plasma cholinesterase in juvenile marine turtles, in relation to environmental contamination.