In Lin C-L et al. and Goswamy R et al. studies, miosis, unconsciousness, bradycardia, fasciculation, and low PCE level were significant factors associated with respiratory failure and requirement of ventilatory support.22,23 Chaudhary SC et al. recommend quantification of PCE level at the admission time for categorization of OP poisoning severity and estimation of prognosis.24 Serum amylase showed a statistically significant negative correlation with PCE and the highest accuracy for severity assessment of OP poisoning then followed by keratin phosphokinase (CPK) and Lipase.25 The gene discussed is PIK3C2A; the disease is respiratory failure.