Acute pancreatitis as a complication of organophosphate intoxication has been infrequently addressed. Previous reports have suggested that acute pancreatitis may follow the oral ingestion of several organophosphates. The pathogenesis of this pancreatic damage has been studied in a few animal studies. However, the association between acute pancreatits and human organophosphate intoxication may still not be widely recognized. We experienced 6 cases described as hyperamylasemia and hyperlipasemia with a presumptive diagnosis of acute pancreatitis following organophosphate intoxication, and we analyzed them to provide human baseline data for further studies and patient management. We report these case series with an analysis and a literature review.
Animals ; Diagnosis ; Eating ; Humans ; Hyperamylasemia ; Organophosphates ; Pancreatitis*

BACKGROUND: Abnormal expansion of trinucleotide repeats in genes causing spinocerebellar ataxias such as SCA2, SCA3, SCA8, or SCA17 was reported in sporadic or familial Parkinson's disease. Genetic factors play an important role especially in early-onset Parkinson's disease (EOPD). To investigate mutations of ATXN2, ATXN3, and TBP as a possible cause in Korean EOPD, we analyzed mutations in these genes. We also investgated the possibility that trinucleotide repeats numbers in these genes contribute to the development of EOPD. METHODS: Mutation analysis of ATXN2, ATXN3, and TBP was done in 153 EOPD defined as age-at-onset before 51. Distribution of CAG repeats numbers were compared between EOPD and age- and sex-matched controls. RESULTS: No patients with EOPD had CAG repeats numbers in ATXN2, ATXN3, and TBP in mutation range. There was no difference in the distribution of CAG repeats between EOPD and controls, although we found a trend that CAG repeats numbers in ATXN3 appear larger in EOPD than in controls. CONCLUSIONS: Mutations of genes causing SCA2, SCA3, or SCA17 may not be a common genetic cause in Korean EOPD.
Humans ; Organophosphates ; Parkinson Disease ; Spinocerebellar Ataxias ; Trinucleotide Repeats

Acetylcholinesterase (AChE) activity level can be used as a diagnostic marker for anticholinesterase pesticide poisoning. In this study, we aimed to establish a baseline level of normal brain AChE activity in wild birds. AChE activity was measured in the brains of 87dead wild birds (26 species). The level of AChE activity ranged from 6.40 to 15.9 µmol/min/g of brain tissue in normal wild birds. However, the brain tissue AChE activity level in wild birds exposed to organophosphate (OP) pesticide was 48.0%–96.3% of that in the normal birds. These results may serve as reference values to facilitate routine diagnosis and monitoring of OP-poisoned wild birds.
Acetylcholinesterase ; Birds ; Brain ; Diagnosis ; Organophosphates ; Poisoning ; Reference Values

Only a few case studies describe reversible parkinsonism after organophosphate poisoning and their brain imagings are found to be normal. However, we experienced chronic, irreversible parkinsonism by acute organophosphate poisoning with bilateral basal ganglia lesions found on a brain MRI. We suggest that brief, large amounts of organophosphate intoxication can produce irreversible parkinsonism according to individual susceptibility and further studies including the investigation of insecticides as an environmental factor of parkinsonism should be done using neuroimagings.
Basal Ganglia ; Brain ; Insecticides ; Magnetic Resonance Imaging ; Neurotoxins ; Organophosphate Poisoning ; Organophosphates ; Parkinsonian Disorders*

OBJECTIVETo investigate the clinical effect of hemoperfusion combined with hemodialysis in the treatment of severe organophosphate pesticide poisoning.

METHODSNinety-eight patients with severe organophosphate pesticide poisoning who were admitted to the emergency department of our hospital from March 2005 to September 2013 were equally divided into control group and observation group according to treatment methods. The control group was given conventional emergency treatment, while the observation group was given hemoperfusion combined with hemodialysis and the conventional emergency treatment. The clinical outcomes and complications of two groups were compared.

RESULTSIn the control group, 35 patients were cured and 14 patients died, so the cure rate was 71.4%. In the treatment group, 46 patients were cured and 3 patients died, so the cure rate was 93.9%. The treatment group had a significantly higher cure rate than the control group (χ² = 8.611, P < 0.05). And the treatment group had significantly shorter duration of coma (P < 0.01), mean length of hospital stay (P < 0.01), and time to recovery of cholinesterase activity (P < 0.01) and a significantly reduced dose of atropine than the control group (P < 0.01). The control group had significantly more cases of urinary retention than the treatment group (18 vs. 6, χ² = 4.991, P < 0.05). And the control group had more cases of intermediate syndrome, respiratory failure, delayed neurological damage, and rebound than the treatment group.

CONCLUSIONHemoperfusion combined hemodialysis has a good clinical effect and causes fewer complications in treating severe organophosphate pesticide poisoning, so it is worthy of clinical promotion.

Atropine ; Hemoperfusion ; Humans ; Insecticides ; poisoning ; Organophosphate Poisoning ; therapy ; Organophosphates ; Organophosphorus Compounds ; Renal Dialysis ; Time Factors

PURPOSE: Many studies have examined the mechanisms of impaired glucose homeostasis after organophosphate (OP) exposure, however no study has evaluated the clinical utility of blood glucose measurements in patients with OP poisoning. The current study was conducted to evaluate the initial glucose level at presentation and the glycemic variables during the first 3 days after admission as a predictor of mortality. METHODS: This retrospective observational case series included 228 patients with a history of OP poisoning. Among other clinical data, information on the initial glucose level at presentation and mean glucose level, delta glucose level, and the presence of a hypoglycemic event during the first 3 days of admission, was collected. RESULTS: Survivors had lower initial glucose levels at presentation and glucose variability during the first 3 days of admission compared to non-survivors. The frequency of hypoglycemic events was higher in non-survivors. In multivariate analysis, the initial glucose level (> 233 mg/dl) was an independent predictor of mortality, along with age. CONCLUSION: The initial glucose level at presentation can be helpful in prediction of mortality in cases of OP intoxication at bedside. The physician should pay attention to patients with a glucose level >233 mg/dl at presentation after ingestion of OP.
Blood Glucose* ; Eating ; Glucose ; Homeostasis ; Humans ; Mortality ; Multivariate Analysis ; Organophosphates ; Poisoning* ; Retrospective Studies ; Survivors

OBJECTIVETo evaluate the microtensile bond strength of one-step self-etching adhesives to dentin in vitro.

METHODSThree commercially available one-step self-etching bonding systems (group A: Adper Prompt, group B: Clearfil S(3) Bond, group C: Xeno III) were compared with two-step self-etching adhesive (group D: Clearfil SE Bond) in this study. The microtensile bond strength was determined with microtensile tester and the fractured bonding surfaces were observed under stereomicroscope and scanning electronic microscope (SEM). The mean bond strengths were analyzed using one-way ANOVA test (P < 0.05).

RESULTSMean microtensile bond strengths of group C, B, A and D were (34.59 +/- 3.46), (30.46 +/- 3.82), (23.36 +/- 2.55) and (45.06 +/- 5.29) MPa, respectively. Group D showed the highest bond strength (P < 0.01).

CONCLUSIONSTwo-step self-etching adhesive had a higher bond strength than one-step self-etching adhesive systems, although all of them can satisfy the clinical requirements.

Bisphenol A-Glycidyl Methacrylate ; Composite Resins ; Dentin-Bonding Agents ; Humans ; Organophosphates ; Resin Cements ; Tensile Strength

PURPOSE: Although, there have been many reports about factors involved in the severity and prognosis of organophosphate toxicity, there are few reports on integrated application of scoring methods using those factors for prognosis. Our report is about the possible application of such scoring methods in the early stage of organophosphate intoxication. METHODS: This study included organophosphate intoxication patients who were admitted to the Emergency department (ED) between March 1, 2004 and February 28, 2008. We limited enrolment in the study to patients who had required assisted mechanical ventilation and used atropine for therapy. This was a retrospective study about age, drug toxicity, mental status, existence of metabolic acidosis and QT prolongation for each patient. RESULTS: Thirty seven patients were enrolled in this study. Among the 37, 22 survived and 15 died. For survivors, drug toxicity and mental status were correlated with total dose of atropine, and the existence of metabolic acidosis was correlated with the duration of mechanical ventilation. Survivors had lower total scores than non-survivors. CONCLUSION: Application of scoring methods that include five factors (age, drug toxicity, mental status, existence of metabolic acidosis, existence of QTc prolongation) when acute, severe, organophosphate poisoning patients arrive at an ED can be helpful for their prognosis.
Acidosis ; Atropine ; Drug Toxicity ; Emergencies ; Humans ; Organophosphate Poisoning ; Organophosphates ; Prognosis ; Research Design ; Respiration, Artificial ; Retrospective Studies ; Survivors

OBJECTIVETo develop the organophosphate-induced delayed neuropathy (OPIDN) hen model with 2,4,6-trimethylbenzoyl phenylphosphonate (TOCP), and observe the change of pathology and investigate the alterations of microtubulin associated protein 2 (MAP2).

METHODS48 adult hens were randomly divided into four groups, including three experimental groups and control group (n = 12 each group). The hens in three experimental groups were treated with TOCP by gavage at single dosages of 250, 500 and 750 mg/kg respectively while the control hens received an equivalent volume of corn oil by gavage. All hens were sacrificed after 21 days of treatment. Half hens in each group were dissected for HE examination and myelin straining of brain, spinal cord and sciatic nerve while brains of another half hens were dissected for the determination of MAP2 by western blotting.

RESULTSThe delayed neurotoxicity symptoms of hens both in 500 and 750 mg/kg groups were consistently observed. The pathological changes of brain, spinal cord and sciatic nerve in 500 and 750 mg/kg groups showed nerve cells difference necrosis, increased cytoplasm basophilia, microglia proliferation, mono-nuclear and lymphocyte infiltration, myelin sheath extensive up to part of them disaggregation deletion. Compared with the control group, at 500 and 750 mg/kg respectively the increase of MAP2 was 25% and 23% (P < 0.01 and P < 0.05).

CONCLUSIONSThe histopathologic changes of OPIDN caused by TOCP have dose-response relationship. The changes of MAP2 in nervous system may contribute to the occurrence and development of TOCP induced delayed neurotoxicity.

Animals ; Brain ; metabolism ; pathology ; Chickens ; Female ; Microtubule-Associated Proteins ; metabolism ; Nervous System Diseases ; chemically induced ; metabolism ; pathology ; Organophosphates ; toxicity

PURPOSE: Extremely hazardous pesticides are classified as World Health Organization (WHO) hazard class Ia. However, data describing the clinical course of WHO class Ia OP (organophosphate) poisonings in humans are very scarce. Here, we compare the clinical features of patients who ingested hazard class Ia OPs. METHODS: This retrospective observational case study included 75 patients with a history of ingesting ethyl p-nitrophenol thio-benzene phosphonate (EPN), phosphamidon, or terbufos. The patients were divided according to the chemical formulation of the ingested OP. Data regarding mortality and the development of complications were collected and compared among groups. RESULTS: There were no differences in the baseline characteristics and severity scores at presentation between the three groups. No fatalities were observed in the terbufos group. The fatality rates in the EPN and phosphamidon groups were 11.8% and 28.6%, respectively. Patients poisoned with EPN developed respiratory failure later than those poisoned with phosphamidon and also tended to require longer mechanical ventilatory support than phosphamidon patients. The main cause of death was pneumonia in the EPN group and hypotensive shock in the phosphamidon group. Death occurred later in the EPN group than in the phosphamidon group. CONCLUSION: Even though all three drugs are classified as WHO class Ia OPs (extremely hazardous pesticides), their clinical courses and the related causes of death in humans varied. Their treatment protocols and predicted outcomes should therefore also be different based on the chemical formulation of the OP.
Cause of Death ; Classification ; Clinical Protocols ; Humans* ; Mortality ; Organophosphates* ; Pesticides ; Phosphamidon* ; Pneumonia ; Poisoning* ; Respiratory Insufficiency ; Retrospective Studies ; Shock ; World Health Organization