The effectiveness of patient-tailored treatment for acute organophosphate poisoning

Organophosphorus compounds and oximes: a critical review

Organophosphorus (OP) pesticides and nerve agents still pose a threat to the population. Treatment of OP poisoning is an ongoing challenge and burden for medical services. Standard drug treatment consists of atropine and an oxime as reactivator of OP-inhibited acetylcholinesterase and is virtually unchanged since more than six decades. Established oximes, i.e. pralidoxime, obidoxime, TMB-4, HI-6 and MMB-4, are of insufficient effectiveness in some poisonings and often cover only a limited spectrum of the different nerve agents and pesticides. Moreover, the value of oximes in human OP pesticide poisoning is still disputed. Long-lasting research efforts resulted in the preparation of countless experimental oximes, and more recently non-oxime reactivators, intended to replace or supplement the established and licensed oximes. The progress of this development is slow and none of the novel compounds appears to be suitable for transfer into advanced development or into clinical use. This situation calls for a critical analysis of the value of oximes as mainstay of treatment as well as the potential and limitations of established and novel reactivators. Requirements for a straightforward identification of superior reactivators and their development to licensed drugs need to be addressed as well as options for interim solutions as a chance to improve the therapy of OP poisoning in a foreseeable time frame.

Effect of Organophasphate poisoning among patients reporting at a tertiary healthcare facility of Sindh Pakistan

OBJECTIVE

To determine the effect of organophosphate poisoning (OPP) among patients at tertiary healthcare, Pakistan.

METHODS

This cohort study was conducted over a six-year period (January 2011 to December 2016) of OPP patients admitted to the intensive care unit of Peoples University of Medical & Health Sciences for Women SBA, Hospital Pakistan and their outcome was determined.

RESULTS

Total mortality was 17.39% (84 deaths in 483 patients, excluding those referred to Karachi). Out of these 84 deaths, 65 patients (13.46%) expired due to cardiorespiratory failure, 17 deaths (3.52%) followed due to complication of mechanical ventilation & ICU acquired infection and two deaths (0.41%) occurred due to renal failure. The major cause of poisoning was deliberate self-harm /suicidal intention (93.02%), with gender distribution of female (57.07%) and male (35.95%), followed by unintentional/accidental exposure (6.98%) in males. The intensive supportive treatment, precise and appropriate respiratory care, and adequate amount of atropine and pralidoxime doses are keys to reducing the OPP patient's mortality.

CONCLUSION

Organophosphate poisoning (OPP) intoxication is common in female gender. The easy availability of these harmful compounds has resulted in increased mortality either by accidental exposure or most often by the deliberate suicidal attempt.

Effects of IL-10 on OX62, MHC-II and CD86 in bone marrow DCs in rats with organophosphate poisoning

This study investigated the effect of interleukin (IL)-10 on the expression of OX62, MHC-II and CD86 in bone marrow dendritic cells (DCs) in rats with organophosphorus poisoning. Sixty adult SD rats were randomly divided into normal control group (group A) (20 rats), 20 rats with organophosphorus pesticide poisoning (group B), 20 rats with organophosphorus poisoning, and IL-10 treated (group C). Group A was not treated with special treatment. Group B was treated with 4% omethoate by gavage to establish the model of organophosphate poisoning. Group C was treated with omethoate to establish the model of organophosphate poisoning, then the rats were given intraperitoneal injection of IL-10 for 3 continuous days. Rats were sacrificed after 3 days, bone marrow lymphocytes were extracted, DCs were collected and cultured for 7 days, the expression of DC surface antigen OX62, MHC-II, CD86 and related proteins was detected by flow cytometry and western blotting after cell maturation. The expression of DC surface antigen and corresponding protein increased in group B, and decreased in group C, the difference was statistically significant (P<0.05). The results showed that the expression of OX62, MHC-II and CD86 in bone marrow DCs is enhanced and the cellular immune function is enhanced after organophosphate poisoning. IL-10 can down-regulate the antigen presenting function of DCs, achieve anti-inflammatory effect and assist the treatment of organophosphorus pesticide poisoning.

Pralidoxime and pesticide poisoning: A question of severity?

In this issue of the Biomedical Journal, we highlight new data supporting the use of pralidoxime in the treatment of cases of organophosphate poisoning, which also suggest that WHO treatment guidelines should be updated. We also learn about a modified surgical technique to repair severe spinal injuries, as well as new insight into the structure of human adenovirus that could inform vaccine development.