الفهرس | Only 14 pages are availabe for public view |
Abstract In Egypt and developing countries, anticholinesterase compounds are among the most often utilized chemical substances due to their availability and effectiveness. The WHO estimates that there are 3 million cases of pesticide poisoning each year and up to 220,000 deaths in developing countries. There is an annual increase in the number of acute anticholinesterase poisoning cases in Eygpt whether suicidal or accidental. These compounds act by inhibiting acetylcholine esterase enzyme causing overstimulation of acetylcholine receptors. The clinical manifestations of poisoning are mainly due to muscarinic, nicotinic, and central nervous system (CNS) receptors overstimulation. Acute anticholinesterase poisoning is associated with oxidative stress, lipid peroxidation, low glutathione level, and damage to cell membranes resulting in cell death and adverse effects on multiple systems in the body. Routes of exposure involve inhalation, ingestion, or dermal contact. Peradynia organophosphorus poisoning scale was proposed for evaluating the severity of acute anticholinesterase poisoning cases. Diagnosis of acute anticholinesterase poisoning is based on the history of exposure, the presence of symptoms and signs, and the decrease in serum pseudocholinesterase enzyme levels . Caspases are a family of endoproteases that cut proteins at specific sequences and play essential roles in inflammation and apoptosis. The members of the caspase family are classified as inflammatory or apoptotic. The caspases-1, 4, -5, and -11 are grouped as inflammatory caspases and the caspases -2,-3,-6,-7,-8,-9, and – 10 are grouped as apoptotic caspases. These apoptotic caspases are further subdivided into two groups: the initiator caspases (caspase-2, -8, -9, and -10), which are the first to be activated in response to a signal, and the executioner or effector caspases (caspase-3, -6, and -7) that carry out apoptosis and cell death . Anticholinesterase compounds directly interact with cellular membranes causing disturbances in their structure, mitochondrial dysfunction, enhanced production of reactive oxygen species (ROS), and subsequent lipid peroxidation. Lipid peroxidation is accompanied by an alteration of the antioxidant defense system in different organs. The increase in the activity of caspase biomarkers after acute exposure to anticholinesterase compounds may be due to oxidative stress through releasing of cytochrome C that activates them to induce apoptosis and cell death . The cause of death in acute anticholinesterase poisoning cases is usually due to respiratory failure, but may also be due to other complications such as arrhythmia, pneumonia, pulmonary edema, pancreatitis, and renal failure . Hence, this study aimed to assess the pattern and outcome of acute anticholinesterase poisoning cases admitted to Menoufia Poison & Control Center (MPCC) over one year, as well as to explore the potential role of biochemical caspase markers in predicting the outcomes. |