BACKGROUND: Organophosphorus (OP) poisoning is a major public health problem in developing world. OP pesticides inhibit carboxylic esterase enzymes including plasma cholinesterase (PChE). Clinical manifestations following OP poisoning can be associated with the extent of decrease of PChE. This study was designed to investigate the relevance of diastolic function of the heart, severity of diastolic dysfunction and the reversibility of dysfunction in organophosphorus compound poisoning patients in relation to plasma cholinesterase (PChE) levels with the treatment. MATERIALS AND METHODS: 76 patients admitted with organophosphorus compound poisoning were evaluated for diastolic dysfunction by echocardiography. Clinical features and the nature of compound involved were recorded. Severity of diastolic dysfunction was assessed. Cholinesterase levels were assessed. Initially there was worsening of diastolic function. As the treatment progressed, there was improvement in the pattern of diastolic dysfunction with the corresponding improvement in cholinesterase level and clinical improvement. This was a cross-sectional study which was conducted from 1st January 2014 to February 2015. RESULTS: In total, mean age of patients were 31.2 (range: 19-46) years. Majority of patients were females (68.4%), and agricultural workers (75%). Main clinical findings at the time of admission were congested conjunctiva (83%), pin point pupil (89%), lacrimation (78%), vomiting (69%), non-reactive pupil (85%), respiratory distress (65%) and abdominal pain (45%). Mean (SD) PChE at 6 hours post-exposure was 3242.6 IU/L. At presentation, cyanosis, muscle weakness, convulsion, respiratory distress and fasciculation were related to cases with >75%reduction of PChE, while, constricted and nonreactive pupil, lacrimation and congested conjunctivae were related to cases with 50-75% reduction and abdominal pain, dryness of conjunctiva, vomiting and diarrhea were related to <50% reduction. 11.8% of patients had normal diastolic function. 88.1% patients were found to have diastolic dysfunction. 15.7% had grade I diastolic dysfunction which persisted in same level throughout treatment. In 72.3 % patients there was gradual worsening of diastolic function. With the treatment there was gradual improvement in diastolic function from grade III to grade I. At the end of 5 days, 19.7% patients had complete reversal of dysfunction. 68.4% patients had persistent mild dysfunction even at the time of discharge. CONCLUSIONS: Patchy myocardial involvement as a result of direct cardiac toxicity could be one of the factors responsible for cardiac complications. Continuous cardiac monitoring should be undertaken to detect dynamic cardiac changes. These findings can assist health professionals to better evaluate patients' prognosis and improve their treatment plan. KEYWORDS: Organophosphorus compound, Diastolic dysfunction, Plasma cholinesterase (PChE). The replacement of an oxygen atom in the organophosphorus structure by sulfur leads to the formation of organo...

OBJECTIVES:To assess the effect of obesity and hypertension on left ventricular (LV) diastolic function. BACKGROUND: Obese and overweight individuals are at increased risk of heart failure. LV diastolic dysfunction is an asymptomatic condition associated with future heart failure. It is unclear whether obesity and overweight are independently associated with LV diastolic dysfunction. Obesity is associated with heart failure, but an effect of weight, independent of comorbidities, on cardiac structure and function is not well established. Severe prolonged obesity in adults results in increased plasma volume, eccentric LV hypertrophy, and diastolic dysfunction. Obese people are at increased risk for the development of heart failure. METHODS: A total of eighty subjects of either gender, coming from rural background admitted in a tertiary care hospital in South India, were enrolled in this cross sectional case control study. Patients were enrolled from March 2014 to May 2015. The study sample was divided into three groups: normal weight [body mass index (BMI) <25.0], overweight ) and obese (BMI≥30). Diastolic dysfunction in each category of patients was assessed with standard methods. RESULTS: BMI was independently associated with higher E, A, and E/E′, an indicator of LV filling pressure (all p≤0.01). Overweight and obese had lower E′ (both p<0.01) and higher E/E′ (both p<0.01) than normal weight participants. E/A was lower in obese than normal weight subjects (p<0.01). The risk of diastolic dysfunction was significantly higher in overweight and obese compared to normal weight individuals. Hypertensive patients were found to have worse diastolic function as compared to those having normal blood pressure. CONCLUSIONS: Increased BMI was associated with worse LV diastolic function. The increased risk of LV diastolic dysfunction in both overweight and obese individuals may partially account for the increased risk of heart failure associated with both conditions. Overweight subjects without overt heart disease have subclinical changes of LV structure and function. These abnormalities in LV function may have important implications for explaining the myocardial dysfunction that is associated with increased cardiovascular morbidity and mortality caused by obesity. Hypertension adds to the worsening of diastolic dysfunction.