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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 8  |  Issue : 3  |  Page : 57-60

Clinical spectrum of organophosphorus poisoning in a rural medical college


1 Department of Medicine, Chirayu Medical College, Bhopal, Madhya Pradesh, India
2 Department of Medicine, GEMS, Medical College, Srikakulam, Andhra Pradesh, India

Date of Submission30-Oct-2020
Date of Decision08-Nov-2020
Date of Acceptance10-Nov-2020
Date of Web Publication25-Nov-2020

Correspondence Address:
Dr. Shirish Ardhapurkar
Department of Medicine, GEMS, Medical College, Ragolu, Srikakulam, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjhs.mjhs_22_20

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  Abstract 


Background: Significant morbidity and mortality is caused by acute pesticide poisoning. Reliable data are not available regarding the morbidity and mortality from India.
Objective: The objective of this study is to study the clinical spectrum of organophosphorus poisoning.
Materials and Methods: A hospital-based, cross-sectional study was carried out among 120 patients admitted with organophosphorus poisoning at a rural medical college. Patients with acute poisoning were included. Detailed history, clinical examination, and required investigations were done and noted in the study questionnaire.
Results: Males (56.7%) were more than females (40.8%). Majority of the study participants belonged to the age group of 30–39 years (43.3%) followed by 20–29 years of age, i.e., 29.2%. The most common clinical feature was miosis 88.2% in males and 86.5% in females followed by nausea and vomiting (76.5%) in males and pain abdomen (63.5%) in females. The most common poison consumed by both males and the females was malathion, i.e., it was consumed by 42.6% of males and 36.5% of females. The next most common poison consumed was diazinon by 32.4% of males and 30.8% of females. In males, it has been observed that the incidence of organophosphate (OP) poisoning decreased from 42.6% in the rainy season to 27.9% in the summer season. However, in females, it was the same, i.e., 38.5% for both rainy season and the winter season, but like in males, it decreased in the summer season.
Conclusion: Males are more affected than females, miosis was most common and malathion was most commonly consumed agent. The incidence of OP poisoning was more in the rainy season.

Keywords: Clinical spectrum, organophosphorus, poisoning


How to cite this article:
Elyas M, Ardhapurkar S. Clinical spectrum of organophosphorus poisoning in a rural medical college. MRIMS J Health Sci 2020;8:57-60

How to cite this URL:
Elyas M, Ardhapurkar S. Clinical spectrum of organophosphorus poisoning in a rural medical college. MRIMS J Health Sci [serial online] 2020 [cited 2021 Jan 21];8:57-60. Available from: http://www.mrimsjournal.com/text.asp?2020/8/3/57/301481




  Introduction Top


Globally, acute organophosphorus compound poisoning is a major public health problem. The main attributes of this public health problem are agriculture intensification as well as globalization, especially in India. Since 1950s, the use of pesticides has increased. It has been projected for them that without its use, it is difficult to develop. However, this has led to the major public health problem of poisoning. Each year many die and many suffer its effects.[1]

It is an important public health problem in India. Organophosphates (Ops) are the important causes in the southern and central parts of India, whereas aluminum phosphide is an important factor in North India.[2]

Significant morbidity and mortality are caused by acute pesticide poisoning. Reliable data are not available regarding the morbidity and mortality from India.[3]

In developing countries, OP poisoning is one of the important reasons of frequent admissions to hospitals. It was traditionally considered that the clinical features are due to effect of the OP poisoning on the central nervous system, nicotinic receptors, and muscarinic receptors. The evidence that atropine is useful in reversing the muscarinic effects made the traditional clinical features classification easy, but it did not apply to the nicotinic neuromuscular effects. Atropine can also reverse the central nervous system effects as it can cross blood–brain barrier.[4],[5]

Hence, depending upon the time when the clinical features appear, they should be classified. This is one kind of approach which can be used to classify the clinical features. Certain symptoms appear immediately within sometime after OP poisoning while some are delayed. Patients with neuromuscular weakness are likely to develop the extra-pyramidal effects later. One more approach for the classification of the clinical features of OP poisoning is based on the organs involved such as cardiovascular system, respiratory system, or neurologic system.[6],[7]

The present study was carried out to study the clinical spectrum of organophosphorus poisoning.


  Materials and Methods Top


Study design

Hospital-based cross-sectional study.

Settings

The study was conducted at the department of general medicine at a tertiary care hospital.

Sample size

One hundred and twenty patients with acute OP poisoning during the study period.

Study period

One year from August 2018 to July 2019.

Ethical considerations

The Institution Ethics Committee permission was obtained before the start of the study by submitting the study protocol. After the approval, the study data collection was initiated in the predesigned, pretested, semi-structured study questionnaire which was developed based upon the extensive review of the literature. Written informed consent was obtained from the attenders of all the eligible patients. Confidentiality was maintained by not asking the names or other identifying information from all the patients. All patients were treated promptly as per the standard guidelines. It was ensured that data collection did not affect the patient management.

Inclusion criteria

  1. Patients with acute OP poisoning and contacted within 24 h of admission
  2. Age group of 20 years to 60 years of either sex
  3. Attenders of the patients willing to give consent for data collection.


Exclusion criteria

  1. Patients of OP poisoning who were admitted and contacted after 24 h of admission to the inpatient department of the general medicine wards at the tertiary care hospital
  2. Patients with severe other comorbidities.


Methodology

After approval from the Institution Ethics Committee permission, the data collection was initiated in the predesigned, pretested, semi-structured study questionnaire which was developed based upon the extensive review of the literature. Written informed consent was obtained from the attenders of all the eligible patients. Confidentiality was maintained by not asking the names or other identifying information from all the patients. All patients were treated promptly as per the standard guidelines. It was ensured that data collection did not affect the patient management.

Baseline characteristics, sociodemographic details, clinical features, and nature of OP compound were recorded.

All patients were treated as per the standard protocol, and the outcome was noted down.

Statistical analysis

The data were analyzed using the proportions.


  Results Top


[Table 1] shows the distribution of study participants as per age and sex. Males (56.7%) were more than females (40.8%). Majority of the study participants belonged to the age group of 30–39 years (43.3%) followed by 20–29 years of age, i.e., 29.2%.
Table 1: Distribution of study participants as per age and sex

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[Table 2] shows the distribution of the study participants as per the clinical features. The most common clinical feature was miosis 88.2% in males and 86.5% in females followed by nausea and vomiting (76.5%) in males and pain abdomen (63.5%) in females. Least common clinical feature in both males and females was other symptoms and signs than listed in the table.
Table 2: Distribution of the study participants as per the clinical features

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[Table 3] shows different types of pesticides consumed by patients. The most common poison consumed by both males and the females was malathion, i.e., it was consumed by 42.6% of males and 36.5% of females. The next most common poison consumed was diazinon by 32.4% of males and 30.8% of females.
Table 3: Different types of pesticides consumed by patients

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[Table 4] shows the distribution of the study participants as per the season and poisoning. In males, it has been observed that the incidence of OP poisoning decreased from 42.6% in the rainy season to 27.9% in the summer season. However, in females, it was the same, i.e., 38.5% for both rainy season and the winter season, but like in males, it decreased in the summer season. This incidence correlates with the farming activities when the pesticides are easily available.
Table 4: Distribution of the study participants as per the season and poisoning

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  Discussion Top


Males (56.7%) were more than females (40.8%). Majority of the study participants belonged to the age group of 30–39 years (43.3%) followed by 20–29 years of age, i.e., 29.2%. The most common clinical feature was miosis 88.2% in males and 86.5% in females followed by nausea and vomiting (76.5%) in males and pain abdomen (63.5%) in females. The most common poison consumed by both males and the females was malathion, i.e., it was consumed by 42.6% of males and 36.5% of females. The next most common poison consumed was diazinon by 32.4% of males and 30.8% of females. In males, it has been observed that the incidence of OP poisoning decreased from 42.6% in the rainy season to 27.9% in the summer season. However, in females, it was the same i.e., 38.5% for both rainy season and the winter season, but like in males, it decreased in the summer season. This incidence correlates with the farming activities when the pesticides are easily available.

Chintale et al.[8] noted from their study that males were more, i.e., 74.26% compared to the females, i.e., 25.73% and we also found that males were more affected than females. The authors noted that the male-to-female ratio was 2.9:1. Suicide was the most common reason in 35% of the cases while 13.97% of the cases were accidental and remaining only 3.67% were due to homicidal intention. We did not study this aspect in the present study. Suicidal poisoning was found to be more among those married (75.73%). The authors stated that the common risk factors were problems at society, home, abuse of the alcohol, and marital issues. In 71.73% of the cases, ingestion was the most common route of entry of the poison.

Peter et al.[9] carried out a systematic review and meta-analysis pertaining to OP poisoning. Out of more than five thousand articles, they included 452 articles for data extraction. They concluded that “Different approaches to the symptoms and signs in OP poisoning may better our understanding of the underlying mechanism that in turn may assist with the management of acutely poisoned patients.”

Sreekanth et al.[10] found in their study that the incidence of OP poisoning was more in males, i.e., 53.3% compared to the females i.e., 46.6%. These findings of sex differentiation were similar to the findings of the present study. They noted that nausea was the most common symptom in 93.3% of the cases while we found that the most common clinical feature was miosis in 88.2% of the cases. The authors noted that the OP poisoning was more common in young age group these findings of age differentiation were similar to the findings of the present study.

Ahmed et al.[11] observed that the incidence of the OP poisoning was 53.3% in the age group of 21–30 years while we found that the incidence of the OP poisoning was 29.2% which is lower than these authors reporting. They found that the incidence of OP poisoning was more in males, i.e., 53.3% compared to the females, i.e., 46.6%. These findings of sex differentiation were similar to the findings of the present study. They found miosis in only 16.7% of the cases while we found it in 88.2% of the cases.

Rao et al.[12] studied clinical profile, complications, and outcome of the OP poisoning cases over a 12-year period among children. Seventy-four percent of the children were found to be above the age of 5 years. Male children were 77.78% thus males were more than females which is also a common observation in the adult studies also. However, in contrast to the adult studies where suicide was the most common reason of OP poisoning, in children the authors noted that accidental poisoning was the most common reason in 94.59% of the cases. The authors concluded that Chlorpyrifos was the most common agent and such cases required support on the ventilator. The authors found that the risk factors for the accidental poisoning were due to improper storage, unawareness among the parents, lack of training, and lack of proper regulations.


  Conclusion Top


Males are more affected than females, miosis was most common and malathion was most commonly consumed agent. The incidence of OP poisoning was more in the rainy season.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Roberts DM, Karunarathna A, Buckley NA, Manuweera G, Sheriff MH, Eddleston M. Influence of pesticide regulation on acute poisoning deaths in Sri Lanka. Bull World Health Organ 2003;81:789-98.  Back to cited text no. 1
    
2.
Shrinivas RC, Venkateshwarlu V, Surrender T, Eddelstone M, Nick AB. Pesticide poisoning in South India-opportunities for prevention and improved clinical management. Trop Med Int Health 2005;10:581-8.  Back to cited text no. 2
    
3.
Thundiyil JG, Stober J, Besbelli N, Pronczuk J. Acute pesticide poisoning: A proposed classification tool. Bull World Health Organ 2008;86:205-9.  Back to cited text no. 3
    
4.
Balme KH, Roberts JC, Glasstone M, Curling L, Rother HA, London L, et al. Pesticide poisonings at a tertiary children's hospital in South Africa: An increasing problem. Clin Toxicol (Phila) 2010;48:928-34.  Back to cited text no. 4
    
5.
Wadia RS, Sadagopan C, Amin RB, Sardesai HV. Neurological manifestations of organophosphorous insecticide poisoning. J Neurol Neurosurg Psychiatry 1974;37:841-7.  Back to cited text no. 5
    
6.
Anand S, Singh S, Nahar Saikia U, Bhalla A, Paul Sharma Y, Singh D. Cardiac abnormalities in acute organophosphate poisoning. Clin Toxicol (Phila) 2009;47:230-5.  Back to cited text no. 6
    
7.
Saadeh AM, Farsakh NA, Al-Ali MK. Cardiac manifestations of acute carbamate and organophosphate poisoning. Heart 1997;77:461-4.  Back to cited text no. 7
    
8.
Chintale KN, Patne SV, Chavan SS. Clinical profile of organophosphorus poisoning patients at rural tertiary health care centre. Int J Adv Med 2016;3:268-74.  Back to cited text no. 8
    
9.
Peter JV, Sudarsan TI, Moran JL. Clinical features of organophosphate poisoning: A review of different classification systems and approaches. Indian J Crit Care Med 2014;18:735-45.  Back to cited text no. 9
  [Full text]  
10.
Sreekanth P, Jayaraju B, Srinivas Y. Clinical spectrum of organophosphorus poisoning in emergency department. Global J Res Analysis 2018;7:21-3.  Back to cited text no. 10
    
11.
Ahmed I, Razaak A, Srinivas S, Reddy R, Anil Kumar R, Khan F. Clinical spectrum of organophosphorus poisoning in ICU. Int J Recent Sci Res 2017;8:17059-61.  Back to cited text no. 11
    
12.
Rao KV, Ramesh G, Acharya A. Prospective study of spectrum, clinico-epidemiology, profile complication and outcome of pesticide poisoning in children. Int J Contemp Pediatr 2019;6:333-7.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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