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Zhu A, Kuhnly N, Chen L, Dulu AO. A Case study of polypharmacy-induced serotonin syndrome in a cancer patient. J Am Assoc Nurse Pract 2024:01741002-990000000-00238. [PMID: 39051987 DOI: 10.1097/jxx.0000000000001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/12/2024] [Indexed: 07/27/2024]
Abstract
ABSTRACT Polypharmacy in cancer care can be complex and detrimental, particularly among younger patients, who can be easily overlooked. This report showcases a 54-year-old woman with cancer, treated for dapsone-induced methemoglobinemia with methylene blue (MB), subsequently developing serotonin syndrome (SS) due to concurrent serotonin-active medications. This case highlights the critical impact of polypharmacy, emphasizing the necessity for acute care providers to diligently assess medication interactions, especially in emergencies. It underscores the importance of considering alternative treatments and the vigilant monitoring of symptoms indicative of adverse drug interactions to ensure patient safety and optimize outcomes in complex therapeutic scenarios.
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Affiliation(s)
- Andrew Zhu
- Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nicole Kuhnly
- Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Leon Chen
- Columbia University School of Nursing, New York, New York
| | - Alina O Dulu
- Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell College of Medicine, New York, New York
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2
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Braga GÚL, Silva-Junior GJ, Brancini GTP, Hallsworth JE, Wainwright M. Photoantimicrobials in agriculture. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2022; 235:112548. [PMID: 36067596 DOI: 10.1016/j.jphotobiol.2022.112548] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/30/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
Classical approaches for controlling plant pathogens may be impaired by the development of pathogen resistance to chemical pesticides and by limited availability of effective antimicrobial agents. Recent increases in consumer awareness of and/or legislation regarding environmental and human health, and the urgent need to improve food security, are driving increased demand for safer antimicrobial strategies. Therefore, there is a need for a step change in the approaches used for controlling pre- and post-harvest diseases and foodborne human pathogens. The use of light-activated antimicrobial substances for the so-called antimicrobial photodynamic treatment is known to be effective not only in a clinical context, but also for use in agriculture to control plant-pathogenic fungi and bacteria, and to eliminate foodborne human pathogens from seeds, sprouted seeds, fruits, and vegetables. Here, we take a holistic approach to review and re-evaluate recent findings on: (i) the ecology of naturally-occurring photoantimicrobials, (ii) photodynamic processes including the light-activated antimicrobial activities of some plant metabolites, and (iii) fungus-induced photosensitization of plants. The inhibitory mechanisms of both natural and synthetic light-activated substances, known as photosensitizers, are discussed in the contexts of microbial stress biology and agricultural biotechnology. Their modes-of-antimicrobial action make them neither stressors nor toxins/toxicants (with specific modes of poisonous activity), but a hybrid/combination of both. We highlight the use of photoantimicrobials for the control of plant-pathogenic fungi and quantify their potential contribution to global food security.
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Affiliation(s)
- Gilberto Ú L Braga
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto 14040-903, Brazil.
| | | | - Guilherme T P Brancini
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto 14040-903, Brazil.
| | - John E Hallsworth
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, 19 Chlorine Gardens, Belfast BT9 5DL, Northern Ireland, United Kingdom.
| | - Mark Wainwright
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF, United Kingdom.
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Jin S, Zhang T, Fu X, Duan Z, Sun J, Wang Y. Aniline exposure activates receptor-interacting serine/threonineprotein kinase 1 and causes necroptosis of AML12 cells. Toxicol Ind Health 2022; 38:444-454. [PMID: 35658749 DOI: 10.1177/07482337221106751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
With the increased use of aniline, potential impacts on human health cannot be ignored. The hepatotoxicity of aniline is largely unknown and the underlying mechanism remains unclear. Therefore, the aim of the present study was to investigate the hepatotoxicity of aniline and elucidate the underlying mechanism. AML12 cells were exposed to different concentrations of aniline (0, 5, 10, or 20 mM) to observe changes to reactive oxygen species (ROS) production and the expression patterns of necroptosis-related proteins (RIPK1, RIPK3, and MLKL). The potential mechanism underlying aniline-induced hepatotoxicity was explored by knockout of RIPK1. The results showed that aniline induced cytotoxicity in AML12 cells in a dose-dependent manner in addition to the production of ROS and subsequent necroptosis of AML12 cells. Silencing of RIPK1 reversed upregulation of necroptosis-related proteins in AML12 cells exposed to aniline, demonstrating that aniline-induced ROS production was related to necroptosis of AML12. Moreover, aniline promoted intracellular RIPK1 activation, suggesting that the RIPK1/ROS pathway plays an important role in aniline-induced hepatotoxicity. NAC could quench ROS and inhibit necroptosis. These results provide a scientific basis for future studies of aniline-induced hepatotoxicity for the prevention and treatment of aniline-induced cytotoxicity.
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Affiliation(s)
- Shuo Jin
- Department of Occupational Health, School of Public Health, 34707Harbin Medical University, Harbin, China
| | - Tong Zhang
- Department of Occupational Health, School of Public Health, 34707Harbin Medical University, Harbin, China
| | - Xinyu Fu
- Department of Occupational Health, School of Public Health, 34707Harbin Medical University, Harbin, China
| | - Zhongliang Duan
- Department of Occupational Health, School of Public Health, 34707Harbin Medical University, Harbin, China
| | - Jianwen Sun
- Department of Occupational Health, School of Public Health, 34707Harbin Medical University, Harbin, China
| | - Yue Wang
- Department of Occupational Health, School of Public Health, 34707Harbin Medical University, Harbin, China
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Yu G, Li Y, Cui S, Jian T, Kan B, Jian X. Two cases of methaemoglobinaemia and haemolysis due to poisoning after skin absorption of 4-chloro-1-nitrobenzene. Clin Toxicol (Phila) 2022; 60:970-973. [PMID: 35438593 DOI: 10.1080/15563650.2022.2062375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION While 4-chloro-1-nitrobenzene has oxidising properties and can lead to methaemoglobinaemia and haemolysis, such reports are rare. We herein describe two cases of 4-chloro-1-nitrobenzene poisoning after skin exposure and detail relevant clinical characteristics and treatment outcomes. CASE PRESENTATION A 45-year-old man and his 32-year-old male co-worker presented at our department shortly after skin exposure to 4-chloro-1-nitrobenzene. They developed similar symptoms, including dizziness, dyspnoea, excessive fatigue, and coma. Patients' chest inspection yielded normal findings. Despite maximal oxygen supplementation, neither patient exhibited improvements in the following clinical parameters: diffuse cyanosis, chocolate-coloured blood, and decreased pulse oximetry. For patients 1 and 2, methaemoglobin levels at admission were 78.6% and 63.6%, and 4-chloro-1-nitrobenzene concentrations were 4.12 μg/mL and 2.89 μg/mL, respectively. Their symptoms and methaemoglobin levels improved after we cautiously administered methylene blue; we subsequently detected oxidative haemolysis (confirmed by peripheral blood smears) that later resolved without further aggravation. No further episodes of anaemia were documented via telephone follow-up for eight months after hospital discharge for either patient. DISCUSSION Typical features of methaemoglobinaemia included diffuse cyanosis, dark chocolate-coloured blood, elevated partial pressure of oxygen, and decreased pulse oximetry saturation. Haemolysis likely occurred secondary to the toxic effects of 4-chloro-1-nitrobenzene.
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Affiliation(s)
- Guangcai Yu
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yaqian Li
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Siqi Cui
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China.,School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tianzi Jian
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Baotian Kan
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiangdong Jian
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China.,School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
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Acquired methemoglobinemia: A systematic review of reported cases. Transfus Apher Sci 2021; 61:103299. [PMID: 34740513 DOI: 10.1016/j.transci.2021.103299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/16/2021] [Accepted: 10/22/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Acquired methemoglobinemia may cause cyanosis and tissue ischemia unresponsive to oxygen supplementation. METHODS We performed a literature search to identify cases of acquired methemoglobinemia published between 1980 and 2020. Clinical, diagnostic, and treatment details were extracted from eligible cases. RESULTS A total of 76 reports involving 87 cases were analyzed. The median age at presentation was 32.5 with male to female ratio of 1.6. Cyanosis and SpO2 <90 % were reported in 82 % and 60 % of cases, respectively. Dapsone or cocaine-based anesthetics were causative in 52 % of cases; most anesthetic-related cases occurred in the peri-procedural setting. Methylene blue (MB) and red cell transfusion were given in 71 % and 10 % of cases, respectively. Compared to MB untreated patients, MB treated patients were more likely to be cyanotic (91.9 % vs 54.2 %), had higher proportions (%) and levels (g/dL) of methemoglobin (MetHb) - 33.2 % vs 15.3 % and 3.1 g/dL vs 1.2 g/dL, respectively. We found that among cyanotic cases, the median MetHb level was 3.0 g/dL (0.4-12.3 g/dL) with 74 % of values ≥ 1.5 g/dL. An SaO2:SpO2 ratio of >1 was not universally present, but always coincided with an [SaO2-SpO2] delta value greater than zero. CONCLUSIONS Cyanosis and hypoxemia were not universal findings of acquired methemoglobinemia in our series. In addition, not all patients had cyanosis at MetHb ≥ 1.5 g/dL or an SaO2:SpO2 ratio of >1. All those with an SaO2:SpO2 >1 did, however, have a delta value greater than zero - a finding not previously reported which we feel holds diagnostic value.
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Namakizadeh Esfahani N, Zoofaghari S, Akhavan Sigari A, Dorooshi G. Plasmapheresis for the management of acute cyanide poisoning: A case report and review of literature. Clin Case Rep 2021; 9:e04228. [PMID: 34194777 PMCID: PMC8223689 DOI: 10.1002/ccr3.4228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/04/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022] Open
Abstract
In case of mild to moderate cyanide poisoning, especially when standard antidote kits are not readily available, plasmapheresis can be utilized as an alternative option alongside supportive measures.
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Affiliation(s)
| | - Shafeajafar Zoofaghari
- Isfahan Clinical Toxicology Research CenterDepartment of Clinical ToxicologyKhorshid HospitalIsfahan University of Medical SciencesIsfahanIran
| | | | - Gholamali Dorooshi
- Isfahan Clinical Toxicology Research CenterDepartment of Clinical ToxicologyKhorshid HospitalIsfahan University of Medical SciencesIsfahanIran
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Singh P, Rakesh K, Agarwal R, Tripathi PP, Dhooria S, Sehgal IS, Prasad KT, Hans R, Sharma R, Sharma N, Lad D, Aggarwal AN, Muthu V. Therapeutic whole blood exchange in the management of methaemoglobinemia: Case series and systematic review of literature. Transfus Med 2020; 30:231-239. [DOI: 10.1111/tme.12666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/07/2020] [Accepted: 01/16/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Pawan Singh
- Department of Pulmonary MedicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Kodati Rakesh
- Department of Pulmonary MedicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Ritesh Agarwal
- Department of Pulmonary MedicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Paramatma P. Tripathi
- Department of Transfusion medicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Sahajal Dhooria
- Department of Pulmonary MedicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Inderpaul S. Sehgal
- Department of Pulmonary MedicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Kuruswamy T. Prasad
- Department of Pulmonary MedicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Rekha Hans
- Department of Transfusion medicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Rattiram Sharma
- Department of Transfusion medicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Navneet Sharma
- Department of Internal MedicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Deepesh Lad
- Department of HematologyPostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Ashutosh N. Aggarwal
- Department of Pulmonary MedicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Valliappan Muthu
- Department of Pulmonary MedicinePostgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India
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Altintop I, Sanri E, Tatli M, Akcin ME, Denizbasi A. Methemoglobinemia treated with hyperbaric oxygen therapy: A case report. Turk J Emerg Med 2018; 18:176-178. [PMID: 30533564 PMCID: PMC6261104 DOI: 10.1016/j.tjem.2018.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/29/2018] [Accepted: 03/30/2018] [Indexed: 12/01/2022] Open
Abstract
Methemoglobinemia is a rare but clinically important condition that should be considered among differential diagnosis' in cyanosis. The conventional treatments of methemoglobinemia are high flow oxygen and methylene blue therapies. We present a 52-year-old male patient who admitted to emergency room with severe cyanosis and dyspnea after he was exposed to paint thinner and zinc phosphate solution. The patient was diagnosed with methemoglobinemia with a MetHb level of 49.1mm/Hg in his arterial blood gas test. Patient's symptoms and increased MetHb levels were resistant to high flow oxygen and methylene blue therapies so hyperbaric oxygen therapy (HBO) as an alternative treatment was initiated and the patient was cured promptly. In this case presentation, we aim to discuss the alternative treatment modalities in methemoglobinemia patients with persistent hypoxia and cyanosis, who are unresponsive to standard methylene blue treatment.
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Affiliation(s)
- Ismail Altintop
- University of Health Sciences, Kayseri Education and Research Hospital, Department of Emergency Medicine, Kayseri, Turkey
| | - Erkman Sanri
- Marmara University Pendik Education and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Mehmet Tatli
- University of Health Sciences, Kayseri Education and Research Hospital, Department of Emergency Medicine, Kayseri, Turkey
| | - Mehmet Emin Akcin
- University of Health Sciences, Kayseri Education and Research Hospital, Department of Undersea and Hyperbaric Medicine, Kayseri, Turkey
| | - Arzu Denizbasi
- Marmara University Pendik Education and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
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