Organophosphorus poisoning (OPP) poses a significant threat to human health, necessitating accurate prognostic markers for timely intervention and improved outcomes. This review evaluates the potential of the neutrophil-to-lymphocyte ratio (NLR) as a prognostic indicator in acute organophosphorus poisoning (AOPP). A comprehensive analysis of existing literature reveals that elevated NLR values correlate with increased severity of poisoning and adverse clinical outcomes, including mortality and morbidity. NLR assessment offers valuable prognostic information beyond traditional markers, aiding risk stratification and guiding clinical decision-making. Integration of NLR into clinical practice holds promise for optimizing patient care through the early identification of high-risk individuals and tailored therapeutic interventions. Further research is needed to validate the utility of NLR in larger patient cohorts and standardize its incorporation into clinical guidelines. Leveraging NLR as a prognostic tool can enhance risk stratification, optimize treatment strategies, and ultimately improve outcomes in AOPP.

UNASSIGNED: Acute severe organophosphorus pesticide poisoning (ASOPP) is one of the major diseases that endanger human life and health. However, the effects of conventional therapy including gastric lavages, mechanical ventilation, muscarinic antagonist drugs, and cholinesterase reactivators were uncertain. This meta-analysis aims to investigate the safety and efficacy of hemoperfusion combined with hemofiltration besides routine therapy for ASOPP.
UNASSIGNED: A comprehensive search for candidate publications was performed through PubMed, Medline, Cochrane Library, WanFang, Chinese Biomedical Literature, and China National Knowledge Infrastructure from database inception to May 12, 2020. The retrieved studies were screened by the predefined inclusion and exclusion criteria. The data of important end points were extracted. The risk ratio (RR) and weighted mean difference (WMD) were pooled for categorical variables and continuous variables, respectively. Meta-analyses and publication bias were conducted by using STATA software version 15.1.
UNASSIGNED: A total of 11 randomized controlled trials with 811 patients were included. Compared to conventional therapy group, patients in the hemoperfusion plus hemofiltration group were significantly superior with regard to mortality (RR 0.38, 95% confidence interval [CI] [0.25, 0.57], P < 0.001), total atropine dosing (WMD -147.34 mg, 95% CI [-199.49, -95.18], P < 0.001), duration of mechanical ventilation (WMD -2.34 days, 95% CI [-3.77, -0.92], P < 0.001), cholinesterase recovery time (WMD -2.49 days, 95% CI [-3.14, -1.83], P < 0.001), and length of stay (WMD -4.52 days, 95% CI [-5.31, -3.73], P < 0.001).
UNASSIGNED: Combined hemoperfusion and hemofiltration was a very safe and effective treatment protocol for ASOPP, not only resulting in significantly decreased mortality but also resulting in reduced total atropine dosing, duration of mechanical ventilation, cholinesterase recovery time, and length of stay.

Introduction: Organophosphorus (OP) insecticide self-poisoning is a global problem, killing tens of thousands of people every year. Oxidative stress has been proposed to play a pathological role in OP poisoning, but whether it plays a direct toxic role is currently unclear.Objectives: To determine whether there is consistent evidence of oxidative stress in patients with acute OP insecticide self-poisoning, and whether there are animal or human trial data that indicate that treatment of oxidative stress provides clinical benefit, which would suggest a direct toxic effect of oxidative stress.Methods: We conducted a systematic review using the PubMed, EMBASE and MEDLINE databases, and the Cochrane Database of Systematic reviews, based upon the following search terms and keywords: \"organophosphate poisoning\", \"oxidative stress\" and \"antioxidant\". All articles relevant to the aims of the study were included. Articles related to chronic OP poisoning, to use of medicines without antioxidant benefits, or to subjects other than oxidative stress were excluded. The search returned 256 results of which 17 studies were considered relevant and grouped under the following categories: observational human studies (n = 11) and intervention studies in animals (n = 4) and humans (n = 2).Oxidative stress markers in human studies: Oxidative damage to lipids and proteins was reported in all eleven human studies. Eight of nine studies reported variable increases in a weak marker of lipid peroxidation, malondialdehyde. In two case-control studies, erythrocyte membrane malondialdehyde concentrations were 380% and 160% higher in cases than controls, while plasma malondialdehyde concentrations were ∼63% higher in cases than controls in three case-control studies. In a prospective study, plasma malondialdehyde did not increase significantly from baseline in moderate or severely poisoned patients. Five case-control studies measured thiol residues as markers of protein oxidative damage and found variable changes after poisoning. No evidence of oxidative DNA damage was found in the one study that investigated it.Antioxidant intervention studies in animals: After treatment with an antioxidant, all four studies showed an improvement in either markers of oxidative damage or antioxidant activity. One mouse study with a relatively low risk of bias showed that administration of acetylcysteine 200 mg/kg reduced malondialdehyde by 35% and increased survival by more than 60%.Antioxidant intervention studies in humans: We found two small randomised controlled trials reporting the use of acetylcysteine as an adjunct to standard treatment in acute OP poisoning. The trials found that acetylcysteine reduced atropine requirements by 77% and 55%, but did not affect clinically relevant outcomes.Conclusions: Several studies showed evidence of OP insecticide-induced oxidative damage and antioxidant activity, suggesting that endogenous antioxidant defences are triggered in acute OP poisoning. However, the markers of lipid peroxidation used were weak, there was high inter-individual variability between studies in results and quality, and marked variation between the OP insecticides involved. Animal data provide some evidence that antioxidants alleviate adverse effects of acute poisoning, suggesting that oxidative stress may directly cause clinical harm. Acetylcysteine appeared beneficial in animal studies, but this could be mediated via increased synthesis of the endogenous detoxifying agent, glutathione, rather than through a direct antioxidant effect. The two human clinical studies were too small to provide any clear evidence to support the use of acetylcysteine in OP poisoning. Further research into the mechanisms of oxidative stress in acute OP poisoning, combined with large unambiguous clinical trials of antioxidants, are required before they can be used routinely in treatment.