Epidemiology of organophosphate intoxication and predictors of intermediate syndrome

Abstract

In the cotton zone of Punjab, Pakistan, only 20% of wheat is sown at the optimum sowing time, i.e. the first fortnight of November, while the remaining sowing is done from late November (30%) to December (50%) (Khan et al. 2002). Wheat has a determinate growth habit and a delay of each day in sowing from mid-November onward decreases the number of tillers, leaf area, and total dry matter. Moreover, late sowing of wheat also delays anthesis, which ultimately reduces grain yield at a rate of 30-40 kg day -1 ha -1 (Hussain et al. 1998;Akmal et al. 2011). Late-sown wheat has to complete its life cycle in a short duration because starch accumulation terminates at the same time in both normal and late-sown plants ( Khan et al. 2010). Late sowing results in poor germination and delayed emergence due to the prevalence of low temperatures at that time. In consequence, a weak crop stand and less tillering affect grain yields. Moreover, high temperatures at later growth stages enforce shortening of the grain filling period and early maturity.Limited availability of canal irrigation water and low precipitation are also common in the cotton-wheat cropping system of the South Punjab, Pakistan, and when coupled with late sowing, they severely affect wheat yields. Crop production in this region mainly depends on irrigation, but unfortunately per capita water availability is declining at an alarming rate, from 5260 m 3 in 1951 to 1066 m 3 in 2010, and it will be less than 870 m 3 per capita by 2025 (Ahmad et al. 2009). Due to scarcity in irrigation and water supply, and increasing competition for water demand from nonagricultural sectors, the focus is already shifting from maximizing the production per unit area towards the maximization of the production per unit of water consumed, often termed as water productivity (Fereres and Soriano 2007). For that purpose, and to optimize crop economic returns under conditions of less irrigation water use (irrigation supply below full crop water requirement, evapotranspiration [ETo]), new strategies should be developed. These challenges may be overcome either by minimizing the water losses or by improving the crop water use efficiency. These can be achieved by promoting a large and early canopy development of growing plants.

Acute Organophosphate Poisoning; Electrocardiographic Manifestations

“…Karki et al 9 observed both prolonged PR interval and atrial fibrillation in 5.4% of cases respectively, which is nearly comparable to this study. Atropine administration for the treatment of OP poisoning has been associated with ventricular arrhythmias, 15,16 however no such finding was observed in our study subjects.…”

Decrease in Butyrylcholinesterase Accompanied by Intermediate-like Syndrome after Massive Ingestion of a Glyphosate-surfactant

“…B-CHE can act as a backup for acetylcholinesterase and as a scavenger for poisons that might inhibit acetylcholinesterase activity (9). In organophosphate-induced neurotoxicity, A-CHE and/or B-CHE inhibition was found to be correlated with the occurrence of intermediate syndrome (10). In addition, Yilmaz et al prospectively performed therapeutic plasma exchange for patients who developed intermediate syndrome during follow-up for organophosphate intoxication (11).…”

Autonomic Nervous System Team-Based Learning Module

“…With organophosphate poisoning, students are also required to explore a wide range of pharmacological issues, since the treatment not only involves a global measure (atropine) but also includes targeted therapy for symptoms that do not respond. In addition, because organophosphates are a common method for attempted suicide worldwide 15–17 and also have the potential for use as a chemical weapon, 18,19 they are a hot topic from the perspectives of public health and the Liaison Committee on Medical Education. After much discussion, we felt the TBL could be expanded to cover other clinical scenarios as well.…”