4.1 Individuals (N=116) ingest various types of OP poisoning compounds on human subjects to investigate the descriptive and comparative analysis of the study.
During the three-year study, there were 116 patients' suicide attempts with acute OP poisoning compounds at the emergency department of Osmania General Hospital, Hyderabad, Telangana. The socio-demographic details of patients who ingested different types of OP compounds are given in Table 1. The most of were males and middle-aged adults and their mean aged was (34.80±14.82). 116 patients who were available for prospective study interview during the once-daily working hours except for public holidays during the three years of study period sampling methodology; other patients were discharged or referred based on the clinical picture of the medical officers and were not available for interview in the emergency ward based on this prospective study. In this study, 116 patients who were individually ingested with different types of organophosphate compounds were represented as a percentage in each OP pesticide poisoning case. The poison that is most usually encountered (expressed in percent) was as follows: OP poisoning Atmitraz (N=2.59%), Chlorpyrifos (N=6.90%), Chlorpyrifos+Cypermethrin (N=0.86%), Cyhalothrin (N=0.56%), Deltamethrin (N=0.86%), Imidacloprid (N=0.86), Monocrotophos (N=22.41%), Paraquat (N=1.72%), Phorate (N=20.69%), Profenofos (N= 6.90%).We focused on patient clinical signs and vitals from the admission time to discharge time according to patient proforma, took consent forms with the patientattenders, and also observed the patient case sheets and interviews with patient attendees as well as medical officers. We recorded vitals like pulse, blood pressure, respiratory rate, random blood glucose levels, as well as clinical symptoms like vomiting, diarrhea, hypersalivation, rhinorrhea, lacrimation, etc., in acute OP poisoning patients. During the study, we observed that N = 75.9% of patients were discharged, and the remaining cases died (N = 24.1% of patients) due to respiratory failure followed by cardiac arrest. Most of the people were exposed to monocrotophos and unknown OP compounds with the same percentage, i.e., (N = 22.41% patient), Phorate (N = 20.69% patient), whereas fewer people were exposed to chlorpyrifos (N = 6.90% patient).
4.2 Sociodemographic and case-specific information on OP poisoning (N = 116)
In this study, we analyzed the socio-demographic status based on sex; we observed males (N = 84 patients; 72.41%) were significantly more predominant than females (N = 32 patients; 27.58%); based on educational status, we observed illiterate (N = 69 patients; 59.48%) were significantly more predominant than school-completed (N = 31 patients; 26.72%) and then graduates (N = 16 patients; 13.79%); based on occupational status, we observed working individuals (N=72 patients; 62.06%) were significantly more predominant than non-working individuals (N = 44 patients; 37.93%); based on the route of exposure, we identified orally consumed (N = 93.10%) were significantly more predominant than inhalation/dermal route (N = 08 patients; 6.89%); Most patients were from rural backgrounds (N = 92 patients; 79.31%) when compared to urban (N = 24 patients; 20.68%). Based on site of poisoning at home (N = 76 patients; 65.51%), they were significantly more predominant than outside (N = 29 patients; 25.01%) and others (N = 11 patients; 9.48%); the majority of the poisons were obtained from home other than outside. The majority of these attempts was aggressive and appeared to be in response to interpersonal issues. (N = 74 patients; 63.79%), work-related or retail-related financial burdens (N = 22 patients; 18.96%), illness (N = 04 patients; 3.44%), and others (N = 16 patients; 13.79%). [Table.2].
4.3 Effect of acute OP poisoning cases with chlorpyrifos, phorate, monocrotophos, and unknown OP compounds on neurotransmitter levels (serotonin and dopamine) in human plasma samples from12 hour intervals
To investigate the effects of OP poisoning on individuals exposed to different types of OP compounds such as chlorpyrifos, phorate, monocrotophos, and unknown OP compounds on the neurotransmitters such as serotonin and dopamine levels in human plasma (N=3 in each type of OP poisoned individual) compared to normal individuals not exposed to OP poisoning. Especially in critically ill patients, it is challenging with the alteration of some neurotransmitters such as Ach, 5-HT, and dopamine levels. Apart from acetylcholine, serotonin and dopamine levels play a significant role in the neurobehavioral aspects of suicidal cases. That is why we examined these neurotransmitter levels in the plasma samples of OP poisoned patients in different types of OPs when compared to the control group by using the ELISA techniques. Based on the results, the serotonin level was significantly (p 0.001) decreased from 12 hours to36 hours in OP poisoned cases exposed to chlorpyrifos, phorate, monocrotophos, and unknown OP compound in comparison to a control group (Figure .2A). In comparison, there were no significant changes in serotonin levels in the control groups from12 hours to 36 hours. Furthermore, we have estimated the dopamine levels by ELISA technique in the plasma of OP poisoning cases when compared to control groups (Figure.2B). Based on the results, the dopamine level was non-significantly increased in OP poisoned subjects exposed to chlorpyrifos, phorate, monocrotophos, and unknown OP compounds when compared to the control group from While the dopamine level was slightly increased from 12 hours to 36 hours when compared to the control group because of cross-linking between acetylcholine and AchE inhibition in OP poisoned cases, The findings suggest that subtle changes in these neurotransmitter patterns may restore some vital organ functions, resulting in normal neurotransmitter homeostasis in the brain and preventing suicidal episodes.
4.4 To assess risk factors for mortality in acute OP poisoning in human subjects
Based on the Kaplan-Meier Survival Plot, we observed the risk factor for mortality in acute OP poisoning in human subjects exposed to chlorpyrifos, phorate, monocrotophos, and unknown OP compounds from admission, i.e., day 1–day 5 at the general tertiary hospital. In this study, a total of 116 patients were identified as acute OP pesticide poisoning cases, and the mortality rate was 24.1%, while the remaining patients survived with a survival rate of 75.9%. In this context, the results were observed compared to the control group with chlorpyrifos, phorate, monocrotophos, and unknown OP poisoning cases. The mortality started from day 2 to day 5, and we observed approximately 25% mortality (Figure. 3) Evidence suggests that subtle changes in these neurotransmitter patterns may alter some vital organ functions, leading to respiratory failure followed by cardiac arrest, resulting in mortality. Findings indicated that on early admission, knowing which type of pesticide was consumed, and reading the MSDS of these compounds by health care professionals, followed by diagnosis, and treating the patient at the earliest, improves the survivability of the patient.