Acute organophosphorus (OP) pesticide poisoning is widespread and is the most common poisoning in many developing countries and varies in different geographic regions. Accidental and occupational exposures were estimated to cause 1 million cases with 200,000 deaths [1]. Recent data from the National crime bureau of India shows a mortality rateof26.6% (34,869) in the year 2017 by the consumption of pesticides. Accidental Intake of Insecticides was reported among 1403 males, 812 females in the age group of 18 -30 years. The majority of suicides were reported in Maharashtra (17,646) followed by 14,459 suicides in Tamil Nadu, 12,014 suicides in West Bengal [2]. Poisoning is the fourth most common cause of mortality in rural India. In North India aluminum phosphide and organophosphate, poison is common. Aluminum phosphide or organophosphate, these substances were developed to control insects and pests and have become major contributors in the causation of poisoning death [3].

Organophosphorus (OP) compounds are used as pesticides, herbicides, and chemical warfare agents in the form of nerve gases. Being predominantly an agricultural country, pesticides and insecticides are used abundantly for cultivation, and access to these poisonous chemical substances by the population is easy [4]. More than 100 different OP compounds have been synthesized. Most of the OP pesticide poisoning and subsequent deaths occur in developing countries following a deliberate self-ingestion particularly in young, productive age groups, as highly toxic pesticides are readily available at the moments of stress.The most well-known are malathion, parathion, fenthion, diazinon, dimethoate, chlorpyrifos, paraoxon, and soman [5].

Organophosphorus compounds are anti acetylcholine sterases which exert their toxicity by interfering with the normal function of acetylcholine, an essential neurotransmitter throughout the autonomic and central nervous system. OP acts by inhibiting the enzyme cholinesterase, results in the accumulation of acetylcholine at synapses and myoneural junction leading to cholinergic overactivity [6]. Patients die mostly from respiratory failure and lung injury, although there is variability in the clinical symptoms and signs depending on the nature of compounds, amount consumed, severity, the time gap between exposure, and presentation in the hospital.

A total of 100 subjects were included in the final analysis.

Table-1: Descriptive analysis of age and gender distribution. (N=100)

The majority of the subjects were males (80%) with maximum belonging to the age group of 21-40 years (66%)(Table 1).

Fig-1: Nature of compound in the study population (N=100)

The most common OPC to be consumed was Methyl parathion (27%), followed by Chlorpyrifos (22%) The least common compound was Phorate (4%) (Figure 1).

Table-4: Descriptive analysis of clinical presentation in the study population (N=100)

Organophosphates are frequently used pesticides can result in serious morbidity and mortalitywith over 50,000 organophosphorus compounds have been synthesized since the first one by Clermont in 1857. The clinical symptoms range from the classic cholinergic syndrome to flaccid paralysis and intractable seizures,with mortality ranging from 10 to 22% [8].

In the present study, two-thirds (66%) of poisoning cases were in the age group 21-40 years. In the studies conducted by George et al [8], Selvaraj et al [9]. 60-80% of patients were in the 21-40 years age group with a peak incidence between 21-30 years.The people in this age group are described to be the most stressful, emotionally weak, and vulnerable to minor conflicts, failures, or disappointments during this phase of life.

The present study showed male predominance in OP poisoning. The incidence of poisoning was higher in males than in females (80% vs 20%). The male to female ratio in the present study was 4:1. A similar trend was also observed by Padmanaba et al [10] and Joshi et al [11] where the male to female ratio is 1.2:1.The reason behind this may be males are the main working group in the outdoor field, i.e. they are more involved in spraying crops in the farms. Methyl parathion was the most common poison consumed (27%) followed by Chlorpyrifos (22%) in this study. Methyl parathion was also

A high mortality rate might be due to the greater time taken for admission in the hospital in the present study. Most of the duration from the ingestion of poisoning to initiation of treatment was spent traveling/arranging transport to the hospital. Efforts to minimize the period between ingestion of poison and initiation of specific treatment may help to decrease the chance of death.

The cross-sectional and descriptive nature of the study was the chief limitation, precluding us from performing any hypothesis testing. Assumption of the nature of the compound based on the history and description in few cases would have introduced some bias. Considering the smaller sample size and limited catchment area, the generalizability of the study findings is limited.

It can be concluded that OP poisoning is more common among the younger population, below 40 years with male preponderance.The majority had a moderate grade of poisoning with a high mortality rate.Timely administration of an antidote insufficient dose and duration are much more important in the patients with evidence of a moderate and severe degree of OP poisoning. Such patients need to be monitored and observed closely with good supportive care. Similarly, strict implementation of the pesticide act and involving a new policy by the government to educate the public and youth in large about the dangerous life-threatening effects of Organophosphorus compounds could help ameliorate the harmful effects of such poisoning.

A high mortality rate was observed with OP poisoning. Measures to be taken to reduce the time taken for admission in the hospital.

Dr. Yuri Gagarin has conceptualized the study and played a primary role in compiling analysis, and interpretation of the data. All the drafts were prepared, reviewed and the final draft was approved by Dr. R. Lavanya Rajagopal have contributed tothe fine-tuning of the proposal, contributed to data collection and entry,reviewed the results and contributed to preparation and review of drafts. All the authors have read and approved the final