of prolonged exposure to OP compounds. As few cases of this kind have been reported or seen in practice, this report may help others in understanding and diagnosing COPIND.

Case report
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In an attempted suicide after quarreling with his wife, a 35-year-old male farmer from the plain (Terai) region of Nepal poisoned himself with OP pesticide (malathion). He had been using OP as a pesticide in his field, as per the advice of an agriculture technician, for over a week at the time of the incident. The unconscious farmer was taken to a nearby hospital in India, near the border, where he suffered from vomiting, salivation, and diarrhea. After being on a mechanical ventilator for 9 days, he was brought to the National Medical College and Teaching Hospital, Birgunj, Nepal.The patients' record showed that his symptoms included deep coma (Glasgow Coma Scale E1V1M1), hypotension (80/56 mmHg), tachycardia (128/min), miosis, and hypersalivations. The patient was administered activated charcoal and was continuously infused with atropine sulfate. His plasma cholinesterase value was not tested due to the lack of access to the test.

After being brought to the National Medical College and Teaching Hospital, the patient was kept in the intensive care unit under breathing support with a mechanical ventilation and under 24 hours vigilance. His consciousness and respiratory status gradually improved, and he was taken off the mechanical ventilator on the 12th day of his admission. After this time, he developed irritability, restlessness, nonsensical talking, and psychosis. The neurological examination revealed resting and postural tremors, and marked cogwheel rigidity. An