CNS toxicity involving methylene blue: the exemplar for understanding and predicting drug interactions that precipitate serotonin toxicity

Methylene Blue Reduces Electroretinogram Distortion and Ganglion Cell Death in a Rat Model of Glaucoma

Glaucoma is the second leading cause of blindness worldwide and is, in most cases, a consequence of elevated intraocular pressure (IOP), ultimately resulting in the death of retinal ganglion cells (RGCs). Current treatments are mostly focused on normalizing IOP, but we propose the additional use of neuroprotective agents, including methylene blue (MB), to block the loss of RGCs. Wistar rats were subjected to episcleral vein cauterization (EVC) in the left eye while the right eye was sham-operated. One week later, they were divided into two groups, which were injected with either 2.0 mg/kg MB or phosphate-buffered saline (PBS), twice a day, for 7 days. Fifteen days after surgery, rats were tested with scotopic electroretinography (ERG) or pattern electroretinography (PERG). After sacrifice, the number of RGCs and the thickness of the inner retina (IR) were evaluated both in the peripheral and central areas of the retina. Scotopic ERG showed a marked reduction (p < 0.0001) on the a- and b-wave amplitude and oscillatory potential (OP) complexity of the eyes subjected to EVC. These parameters were significantly (p < 0.01) restored by the application of MB. PERG indicated that EVC was responsible for a very significant decrease in N2 amplitude (p < 0.0001) and prolongation of N2 implicit time (p < 0.0001). Treatment with MB significantly restored N2 amplitude (p < 0.0001). In parallel with the ERG results, morphological analysis showed a significant loss of RGCs (p < 0.0001) and IR thickness (p < 0.0001) in both the peripheral and central retinas subjected to EVC, which was significantly prevented (p < 0.0001) by MB treatment. We have shown that MB treatment can be effective in preventing physiological and morphological hallmarks of optic neuropathy in a model of ocular hypertension, which faithfully recapitulates human open-angle glaucoma. Due to its high safety profile, this drug could therefore represent a new pharmacologic strategy to prevent vision loss in glaucoma patients.

When Pain Relief Turns Perilous: Uncovering the Hidden Dangers and Advanced Management of Benzocaine-Induced Methemoglobinemia

Benzocaine-induced methemoglobinemia is a rare complication associated with benzocaine, a local anesthetic known for its rapid pain relief. Acquired methemoglobinemia occurs when hemoglobin is oxidized to a ferric state, impairing oxygen binding. This condition can lead to respiratory distress and potentially fatal outcomes if not promptly diagnosed and treated. We present the case of a 61-year-old Caucasian female admitted with respiratory distress after lumbar stenosis surgery. She developed acute hypoxemic respiratory failure due to pneumonia. Although initially responsive to antibiotics and oxygen, her condition worsened overnight despite non-invasive bilevel-positive airway pressure (BiPAP) therapy. The use of benzocaine spray for throat pain led to suspected methemoglobinemia. She was treated with high-dose vitamin C and methylene blue, resulting in significant improvement. This case report aims to raise awareness among healthcare workers and emphasizes that timely recognition and management are crucial for better outcomes.

Quantitative analysis of intestinal perfusion with indocyanine green (ICG) and methylene blue (MB) using a single clinically approved fluorescence imaging system: a demonstration in a porcine model

BACKGROUND

Near-infrared fluorescence (NIRF) angiography with intraoperative administration of indocyanine green (ICG) has rapidly disseminated in clinical practice. Another clinically approved, and widely available dye, methylene blue (MB), has up to now not been used for this purpose. Recently, we demonstrated promising results for the real-time evaluation of intestinal perfusion using this dye. The primary aim of this study was to perform a quantitative analysis of bowel perfusion assessment for both ICG and MB.

METHODS

Four mature female Landrace pigs underwent laparotomy under general anesthesia. An ischemic bowel loop with five regions of interest (ROIs) with varying levels of perfusion was created in each animal. An intravenous (IV) injection of 0.25 mg/kg-0.50 mg/kg MB was administered after 10 min, followed by NIRF imaging in MB mode and measurement of local lactate levels in all corresponding ROIs. This procedure was repeated in ICG mode (IV dose of 0.2 mg/kg) after 60 min. The quest spectrum fluorescence camera (Quest Medical Imaging, Middenmeer, The Netherlands) was used for NIRF imaging of both MB and ICG.

RESULTS

Intraoperative NIRF imaging of bowel perfusion assessment with MB and ICG was successful in all studied animals. Ingress (i/s) levels were calculated and correlated with local lactate levels. Both MB and ICG ingress values showed a significant negative correlation (r = - 0.7709; p =  < 0.001; r = - 0.5367, p = 0.015, respectively) with local lactate levels. This correlation was stronger for MB compared to ICG, although ICG analysis showed higher absolute ingress values.

CONCLUSION

Our fluorescence quantification analysis validates the potential to use MB for bowel perfusion assessment besides the well-known and widely used ICG. Further human studies are necessary to translate our findings to clinical applications.

Neuroleptic malignant syndrome and serotonin syndrome: a comparative bibliometric analysis

OBJECTIVE

This study aimed to analyze and map scientific literature on Neuroleptic Malignant Syndrome (NMS) and Serotonin Syndrome (SS) from prestigious, internationally indexed journals. The objective was to identify key topics, impactful articles, prominent journals, research output, growth patterns, hotspots, and leading countries in the field, providing valuable insights for scholars, medical students, and international funding agencies.

METHODS

A systematic search strategy was implemented in the PubMed MeSH database using specific keywords for NMS and SS. The search was conducted in the Scopus database, renowned for its extensive coverage of scholarly publications. Inclusion criteria comprised articles published from 1950 to December 31st, 2022, restricted to journal research and review articles written in English. Data were analyzed using Microsoft Excel for descriptive analysis, and VOSviewer was employed for bibliometric mapping.

RESULTS

The search yielded 1150 articles on NMS and 587 on SS, with the majority being case reports. Growth patterns revealed a surge in NMS research between 1981 and 1991, while SS research increased notably between 1993 and 1997. Active countries and journals differed between NMS and SS, with psychiatry journals predominating for NMS and pharmacology/toxicology journals for SS. Authorship analysis indicated higher multi-authored articles for NMS. Top impactful articles focused on review articles and pathogenic mechanisms. Research hotspots included antipsychotics and catatonia for NMS, while SS highlighted drug interactions and specific medications like linezolid and tramadol.

CONCLUSIONS

NMS and SS represent rare but life-threatening conditions, requiring detailed clinical and scientific understanding. Differential diagnosis and management necessitate caution in prescribing medications affecting central serotonin or dopamine systems, with awareness of potential drug interactions. International diagnostic tools and genetic screening tests may aid in safe diagnosis and prevention. Reporting rare cases and utilizing bibliometric analysis enhance knowledge dissemination and research exploration in the field of rare drug-induced medical conditions.

Turn Up the Heat: A Case Report of Malignant Hyperthermia During Ambulatory Surgery

Malignant hyperthermia is a rare complication of general anesthesia involving the uncontrolled release of calcium when exposed to triggers such as depolarizing muscle relaxants or volatile anesthetics. It presents as a hypercatabolic skeletal muscle syndrome that results in tachycardia, hyperthermia, hypercapnia, muscle rigidity, acidosis, rhabdomyolysis, and hyperkalemia. This report presents the case of a 67-year-old female without a personal or family history of complications with anesthesia who experienced malignant hyperthermia during an elective hysterectomy. The patient was given multiple doses of dantrolene, with the ultimate resolution of her symptoms several days after surgery. She was discharged one week after surgery.

Combining Double-Dose and High-Dose Pulsed Dapsone Combination Therapy for Chronic Lyme Disease/Post-Treatment Lyme Disease Syndrome and Co-Infections, Including Bartonella: A Report of 3 Cases and a Literature Review

Three patients with relapsing and remitting borreliosis, babesiosis, and bartonellosis, despite extended anti-infective therapy, were prescribed double-dose dapsone combination therapy (DDDCT) for 8 weeks, followed by one or several two-week courses of pulsed high-dose dapsone combination therapy (HDDCT). We discuss these patients' cases to illustrate three important variables required for long-term remission. First, diagnosing and treating active co-infections, including Babesia and Bartonella were important. Babesia required rotations of multiple anti-malarial drug combinations and herbal therapies, and Bartonella required one or several 6-day HDDCT pulses to achieve clinical remission. Second, all prior oral, intramuscular (IM), and/or intravenous (IV) antibiotics used for chronic Lyme disease (CLD)/post-treatment Lyme disease syndrome (PTLDS), irrespective of the length of administration, were inferior in efficacy to short-term pulsed biofilm/persister drug combination therapy i.e., dapsone, rifampin, methylene blue, and pyrazinamide, which improved resistant fatigue, pain, headaches, insomnia, and neuropsychiatric symptoms. Lastly, addressing multiple factors on the 16-point multiple systemic infectious disease syndrome (MSIDS) model was important in achieving remission. In conclusion, DDDCT with one or several 6-7-day pulses of HDDCT, while addressing abnormalities on the 16-point MSIDS map, could represent a novel effective clinical and anti-infective strategy in CLD/PTLDS and associated co-infections including Bartonella.

Adverse Clinical Effects Associated With Non-catecholamine Pharmacologic Agents for Treatment of Vasoplegic Syndrome in Adult Cardiac Surgery

Vasoplegic syndrome is a relatively common complication that can happen during and after major adult cardiac surgery. It is associated with a higher rate of complications, including postoperative renal failure, longer duration of mechanical ventilation, and intensive care unit stay, as well as increased mortality. The underlying pathophysiology of vasoplegic syndrome is that of profound vascular hyporesponsiveness, and involves a complex interplay among inflammatory cytokines, cellular surface receptors, and nitric oxide (NO) production. The pharmacotherapy approaches for the treatment of vasoplegia include medications that increase vascular smooth muscle contraction via increasing cytosolic calcium in myocytes, reduce the vascular effects of NO and inflammation, and increase the biosynthesis of and vascular response to norepinephrine. Clinical trials have demonstrated the clinical efficacy of non-catecholamine pharmacologic agents in the treatment of vasoplegic syndrome. With an increase in their use today, it is important for clinicians to understand the adverse clinical outcomes and patient risk profiles associated with these agents, which will allow better-tailored medical therapy.

Advances in photocatalytic degradation of organic pollutants in wastewaters: harnessing the power of phthalocyanines and phthalocyanine-containing materials

Access to clean water is increasingly challenging worldwide due to human activities and climate change. Wastewater treatment and utilization offer a promising solution by reducing the reliance on pure underground water. However, it is crucial to develop efficient and sustainable methods for wastewater purification. Among the emerging wastewater treatment strategies, photocatalysis has gained significant attention for decomposing organic pollutants in water, especially when combined with sunlight and a recoverable photocatalyst. Heterogeneous photocatalysts have distinct advantages, as they can be recovered and reused without significant loss of activity over multiple cycles. Phthalocyanine dyes, with their exceptional photophysical properties, are particularly valuable for homogeneous and heterogeneous photocatalysis. By immobilizing these photosensitizers in various supports, hybrid materials extend their light absorption into the visible spectrum, complementing most supports' limited UV light absorption. The novelty and research importance of this review stems from its discussion of the multifaceted approach to treating contaminated wastewater with phthalocyanines and materials containing phthalocyanines. It highlights key aspects of each study, including photocatalytic efficiency, recyclability characteristics, investigation of the generation of oxygen species responsible for degradation, identification of the major degradation byproducts for each pollutant, and others. Moreover, the review includes tables that illustrate and compare the various phthalocyanines and supporting materials employed in each study for pollutant degradation. Additionally, almost all photocatalysts mentioned in this review could degrade at least 5% of the pollutant, and more than 50 photocatalysts showed photocatalytic rates above 50%. When immobilized in some support, the synergistic effect of the phthalocyanine was visible in the photocatalytic rate of the studied pollutant. However, when performing these types of works, it is necessary to understand the degradation products of each pollutant and their relative toxicities. Along with this, recyclability and stability studies are also necessary. Despite the good results presented in this review, some of the works lack those studies. Moreover, none of the works mentions any study in wastewater.

Construction and demolition waste as a high-efficiency advanced process for organic pollutant degradation in Fenton-like reaction to approach circular economy

The Fenton-like reaction is a promising organic wastewater treatment reaction among advanced oxidation processes (AOP), which has emerged to replace the conventional Fenton reaction. Recycled construction and demolition waste (CDW), which is porous and rich in iron, manganese, and magnesium, can be reused as a Fenton-like catalyst. This study proposes an AOP wastewater treatment strategy using recycled porous CDW mixed with hydrogen peroxide (H2O2) to decompose methylene blue (MB) wastewater. According to the apparent first-order rate (Kapp) of 10 ppm MB adsorption, CDW-3, having the highest specific surface area, also has the highest Kapp of 0.23 min-1 g-1. The optimized conditions recommended by the Taguchi method include a 0.3 g mL-1 CDW-3 concentration, a 0.254 g mL-1 H2O2 concentration, and 10 ppm MB, resulting in an about 2.01 min-1Kapp value. In addition, MB concentration is observed as the most influential factor for Kapp, which decreases with increasing MB concentration and is about 0.62 min-1 at 1000 ppm MB. Repeating the Fenton-like reaction five times at 100 p.m. MB using the same CDW-3, the Kapp is about 0.64 min-1, which is 86% of the initial run. The synergistic effect index (ξ) is defined to quantify the level of interaction between CDW and H2O2, which produces free radicals during the Fenton-like process. The ξ of CDW-3 is about 2.16. Overall, it is demonstrated that CDW is a promising catalyst for Fenton-like reactions, and the synergistic effect index (ξ) can be used as a reference index to evaluate the catalytic generation of free radicals between the catalyst and H2O2.

Comparison of the Efficacy of Longer versus Shorter Pulsed High Dose Dapsone Combination Therapy in the Treatment of Chronic Lyme Disease/Post Treatment Lyme Disease Syndrome with Bartonellosis and Associated Coinfections

Twenty-five patients with relapsing and remitting Borreliosis, Babesiosis, and bartonellosis despite extended anti-infective therapy were prescribed double-dose dapsone combination therapy (DDDCT), followed by one or several courses of High Dose Dapsone Combination Therapy (HDDCT). A retrospective chart review of these 25 patients undergoing DDDCT therapy and HDDCT demonstrated that 100% improved their tick-borne symptoms, and patients completing 6-7 day pulses of HDDCT had superior levels of improvement versus 4-day pulses if Bartonella was present. At the completion of treatment, 7/23 (30.5%) who completed 8 weeks of DDDCT followed by a 5-7 day pulse of HDDCT remained in remission for 3-9 months, and 3/23 patients (13%) who recently finished treatment were 1 ½ months in full remission. In conclusion, DDDCT followed by 6-7 day pulses of HDDCT could represent a novel, effective anti-infective strategy in chronic Lyme disease/Post Treatment Lyme Disease Syndrome (PTLDS) and associated co-infections, including Bartonella, especially in individuals who have failed standard antibiotic protocols.

Human Tau Aggregates Are Permissive to Protein Synthesis-Dependent Memory in Drosophila Tauopathy Models

Tauopathies including Alzheimer's disease, are characterized by progressive cognitive decline, neurodegeneration, and intraneuronal aggregates comprised largely of the axonal protein Tau. It has been unclear whether cognitive deficits are a consequence of aggregate accumulation thought to compromise neuronal health and eventually lead to neurodegeneration. We use the Drosophila tauopathy model and mixed-sex populations to reveal an adult onset pan-neuronal Tau accumulation-dependent decline in learning efficacy and a specific defect in protein synthesis-dependent memory (PSD-M), but not in its protein synthesis-independent variant. We demonstrate that these neuroplasticity defects are reversible on suppression of new transgenic human Tau expression and surprisingly correlate with an increase in Tau aggregates. Inhibition of aggregate formation via acute oral administration of methylene blue results in re-emergence of deficient memory in animals with suppressed human Tau (hTau)0N4R expression. Significantly, aggregate inhibition results in PSD-M deficits in hTau0N3R-expressing animals, which present elevated aggregates and normal memory if untreated with methylene blue. Moreover, methylene blue-dependent hTau0N4R aggregate suppression within adult mushroom body neurons also resulted in emergence of memory deficits. Therefore, deficient PSD-M on human Tau expression in the Drosophila CNS is not a consequence of toxicity and neuronal loss because it is reversible. Furthermore, PSD-M deficits do not result from aggregate accumulation, which appears permissive, if not protective of processes underlying this memory variant.SIGNIFICANCE STATEMENT Intraneuronal Tau aggregate accumulation has been proposed to underlie the cognitive decline and eventual neurotoxicity that characterizes the neurodegenerative dementias known as tauopathies. However, we show in three experimental settings that Tau aggregates in the Drosophila CNS do not impair but rather appear to facilitate processes underlying protein synthesis-dependent memory within affected neurons.

Combining computational and experimental evidence on the activity of antimalarial drugs on papain-like protease of SARS-CoV-2: A repurposing study

The development of inhibitors that target the papain-like protease (PLpro) has the potential to counteract the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the agent causing coronavirus disease 2019 (COVID-19). Based on a consideration of its several downstream effects, interfering with PLpro would both revert immune suppression exerted by the virus and inhibit viral replication. By following a repurposing strategy, the current study evaluates the potential of antimalarial drugs as PLpro inhibitors, and thereby the possibility of their use for treatment of SARS-CoV-2 infection. Computational tools were employed for structural analysis, molecular docking, and molecular dynamics simulations to screen antimalarial drugs against PLpro, and in silico data were validated by in vitro experiments. Virtual screening highlighted amodiaquine and methylene blue as the best candidates, and these findings were complemented by the in vitro results that indicated amodiaquine as a μM PLpro deubiquitinase inhibitor. The results of this study demonstrate that the computational workflow adopted here can correctly identify active compounds. Thus, the highlighted antimalarial drugs represent a starting point for the development of new PLpro inhibitors through structural optimization.

Effective Removal of Metal ion and Organic Compounds by Non-Functionalized rGO

Effective removal of heavy metals from water is critical for environmental safety and public health. This work presents a reduced graphene oxide (rGO) obtained simply by using gallic acid and sodium ascorbate, without any high thermal process or complex functionalization, for effective removal of heavy metals. FTIR and Raman analysis show the effective conversion of graphene oxide (GO) into rGO and a large presence of defects in rGO. Nitrogen adsorption isotherms show a specific surface area of 83.5 m2/g. We also measure the zeta-potential of the material showing a value of -52 mV, which is lower compared to the -32 mV of GO. We use our rGO to test adsorption of several ion metals (Ag (I), Cu (II), Fe (II), Mn (II), and Pb(II)), and two organic contaminants, methylene blue and hydroquinone. In general, our rGO shows strong adsorption capacity of metals and methylene blue, with adsorption capacity of qmax = 243.9 mg/g for Pb(II), which is higher than several previous reports on non-functionalized rGO. Our adsorption capacity is still lower compared to functionalized graphene oxide compounds, such as chitosan, but at the expense of more complex synthesis. To prove the effectiveness of our rGO, we show cleaning of waste water from a paper photography processing operation that contains large residual amounts of hydroquinone, sulfites, and AgBr. We achieve 100% contaminants removal for 20% contaminant concentration and 63% removal for 60% contaminant concentration. Our work shows that our simple synthesis of rGO can be a simple and low-cost route to clean residual waters, especially in disadvantaged communities with low economical resources and limited manufacturing infrastructure.

Review of Postoperative Care for Heart Transplant Recipients

The early postoperative management strategies after heart transplantation include optimizing the function of the denervated heart, correcting the causes of hemodynamic instability, and initiating and maintaining immunosuppressive therapy, allograft rejection surveillance, and prophylaxis against infections caused by immunosuppression. The course of postoperative support is influenced by the quality of allograft myocardial protection prior to implantation and reperfusion, donor-recipient heart size matching, surgical technique of orthotopic heart transplantation, and patient factors (eg, preoperative condition, immunologic compatibility, postoperative vasomotor tone, severity and reversibility of pulmonary vascular hypertension, pulmonary function, mediastinal blood loss, and end-organ perfusion). This review provides an overview of the early postoperative care of recipients and includes a brief description of the surgical techniques for orthotopic heart transplantation.

Systematic Review of the Therapeutic Role of Apoptotic Inhibitors in Neurodegeneration and Their Potential Use in Schizophrenia

Schizophrenia (SZ) is a deleterious brain disorder affecting cognition, emotion and reality perception. The most widely accepted neurochemical-hypothesis is the imbalance of neurotransmitter-systems. Depleted GABAergic-inhibitory function might produce a regionally-located dopaminergic and glutamatergic-storm in the brain. The dopaminergic-release may underlie the positive psychotic-symptoms while the glutamatergic-release could prompt the primary negative symptoms/cognitive deficits. This may occur due to excessive synaptic-pruning during the neurodevelopmental stages of adolescence/early adulthood. Thus, although SZ is not a neurodegenerative disease, it has been suggested that exaggerated dendritic-apoptosis could explain the limited neuroprogression around its onset. This apoptotic nature of SZ highlights the potential therapeutic action of anti-apoptotic drugs, especially at prodromal stages. If dysregulation of apoptotic mechanisms underlies the molecular basis of SZ, then anti-apoptotic molecules could be a prodromal therapeutic option to halt or prevent SZ. In fact, risk alleles related in apoptotic genes have been recently associated to SZ and shared molecular apoptotic changes are common in the main neurodegenerative disorders and SZ. PRISMA-guidelines were considered. Anti-apoptotic drugs are commonly applied in classic neurodegenerative disorders with promising results. Despite both the apoptotic-hallmarks of SZ and the widespread use of anti-apoptotic targets in neurodegeneration, there is a strikingly scarce number of studies investigating anti-apoptotic approaches in SZ. We analyzed the anti-apoptotic approaches conducted in neurodegeneration and the potential applications of such anti-apoptotic therapies as a promising novel therapeutic strategy, especially during early stages.

Application of magnetic carbon nanocomposite from agro-waste for the removal of pollutants from water and wastewater

Water pollution has significant impact on water usage, and various contaminants, such as organic and inorganic compounds, heavy metals, dyes, pharmaceuticals compounds, pathogens and radioactive compounds, are implicated. The quest for globalisation, structural developments and other related anthropogenic activities promote the release of contaminants that induce water pollution. Hence, treatment and remediation options that can remove pollutants from watercourses and wastewater have been developed. Applied nanotechnology using carbon nanocomposites has recently drawn attention because it has the advantages of low preparation cost, high surface area, pore volume and environmental stability. Magnetic carbon nanocomposites usually exhibit excellent performance in adsorbing contaminants from aqueous solutions, and thus expanding the use of nanotechnology in water treatment is of great importance. Therefore, this review explores the geographical outlook of water pollution, sources of water pollution and types of contaminants found in water and discusses the use of carbon nanocomposites as an emerging sustainable technology for water pollutant removal. The various properties of carbon-based composites influence the extent of pollutant adsorption during water treatment processes. Most carbon-based nanocomposites are generated from biomass produced by agro-waste materials. Magnetic activated carbon nanocomposites produced from walnut shells and rice husk waste can remove 78% of Cd(II) from contaminated aqueous systems. Magnetic nanocomposites from peanut shell, tea waste, curcumin nanoparticles, sunflower head waste, rice husk, hydrophyte biomass, palm waste and sugarcane bagasse facilitate hydrothermal carbonisation, chemical precipitation, co-precipitation, chemical activation, calcination and fast pyrolysis. These nanocomposites have benefitted wastewater treatment by increasing efficiency in removing pharmaceutical, dye and organic contaminants, such as promazine, ciprofloxacin, amoxicillin, rhodamine 6G, methyl blue, phenol and phenanthrene. Hence, this review discusses the relatively low costs, good biocompatibility, large surface-to-volume ratio, magnetic separation capability and reusability carbon materials and highlights the advantages of using magnetic carbon nanocomposites in the removal of contaminants from water or wastewater through adsorption mechanisms.

Methylene blue: a controversial diagnostic acid and medication?

A narrative review of the literature was conducted to determine if the administration of methylene blue (MB) in humans has potential risks. Studies were identified from MEDLINE, Web of Science, Scopus, and Cochrane. MB is a diagnostic substance used during some diagnostic procedures and also a part of the treatment of several diseases including methemoglobinemia, vasoplegic syndrome, fosfamide-induced encephalopathy, and cyanide intoxication, and the detection of leaks or position of parathyroid corpuscles during surgery. Although the use of MB is historically justified, and it ought to be safe, because it originated as a diagnostic material, the basic toxicological characteristics of this substance are unknown. Despite reports of severe adverse effects of MB, which could significantly exceed any possible benefits evaluated for the given indication. Therefore, the clinical use of MB currently represents a controversial problem given the heterogeneity of available data and the lack of preclinical data. This is in conflict with standards of safe use of such substances in human medicinal practice. The toxic effects of the application of MB are dose-dependent and include serious symptoms such as hemolysis, methemoglobinemia, nausea and vomitus, chest pain, dyspnoea, and hypertension. Some countries regard MB as harmful because of the resulting skin irritation and triggering of an adverse inflammatory response. MB induced serotoninergic toxicity clinically manifests as neuromuscular hyperactivity. This review aims to summarize the current understanding concerning the indications for MB administration and define the potential adverse effects of MB.

Efficacy of Short-Term High Dose Pulsed Dapsone Combination Therapy in the Treatment of Chronic Lyme Disease/Post-Treatment Lyme Disease Syndrome (PTLDS) and Associated Co-Infections: A Report of Three Cases and Literature Review

Lyme disease and associated co-infections are increasing worldwide and approximately 20% of individuals develop chronic Lyme disease (CLD)/Post-Treatment Lyme Disease Syndrome (PTLDS) despite early antibiotics. A seven- to eight-week protocol of double dose dapsone combination therapy (DDDCT) for CLD/PTLDS results in symptom remission in approximately 50% of patients for one year or longer, with published culture studies indicating higher doses of dapsone demonstrate efficacy against resistant biofilm forms of Borrelia burgdorferi. The purpose of this study was, therefore, to evaluate higher doses of dapsone in the treatment of resistant CLD/PTLDS and associated co-infections. A total of 25 patients with a history of Lyme and associated co-infections, most of whom had ongoing symptoms despite several courses of DDDCT, took one or more courses of high dose pulsed dapsone combination therapy (200 mg dapsone × 3-4 days and/or 200 mg BID × 4 days), depending on persistent symptoms. The majority of patients noticed sustained improvement in eight major Lyme symptoms, including fatigue, pain, headaches, neuropathy, insomnia, cognition, and sweating, where dapsone dosage, not just the treatment length, positively affected outcomes. High dose pulsed dapsone combination therapy may represent a novel therapeutic approach for the treatment of resistant CLD/PTLDS, and should be confirmed in randomized, controlled clinical trials.

A review on colorimetric indicators for monitoring product freshness in intelligent food packaging: Indicator dyes, preparation methods, and applications

Intelligent food packaging system exhibits enhanced communication function by providing dynamic product information to various stakeholders (e.g., consumers, retailers, distributors) in the supply chain. One example of intelligent packaging involves the use of colorimetric indicators, which when subjected to external stimuli (e.g., moisture, gas/vapor, electromagnetic radiation, temperature), display discernable color changes that can be correlated with real-time changes in product quality. This type of interactive packaging system allows continuous monitoring of product freshness during transportation, distribution, storage, and marketing phases. This review summarizes the colorimetric indicator technologies for intelligent packaging systems, emphasizing on the types of indicator dyes, preparation methods, applications in different food products, and future considerations. Both food and nonfood indicator materials integrated into various carriers (e.g., paper-based substrates, polymer films, electrospun fibers, and nanoparticles) with material properties optimized for specific applications are discussed, targeting perishable products, such as fresh meat and fishery products. Colorimetric indicators can supplement the traditional "Best Before" date label by providing real-time product quality information to the consumers and retailers, thereby not only ensuring product safety, but also promising in reducing food waste. Successful scale-up of these intelligent packaging technologies to the industrial level must consider issues related to regulatory approval, consumer acceptance, cost-effectiveness, and product compatibility.

Mechanistic insights into the adsorption of methylene blue by particulate durian peel waste in water

This study aims to investigate the adsorption of methylene blue (MB) over particulate durian peel waste, which is chemically activated with hydrogen peroxide. The equilibrium data are well described by the Freundlich isotherm model, which indicates that the MB adsorption takes place predominantly on multilayers and heterogeneous surfaces of the biosorbent. The Freundlich adsorption constants, K_F and n, are 11.06 L/g and 2.94, respectively. Thermodynamic data suggest that the MB adsorption occurs spontaneously and endothermically. The enthalpy and entropy for the MB adsorption are obtained as 10.26 kJ/mol and 0.058 kJ/mol K, respectively, in the temperature range of 303-323 K. Based on the stepwise desorption method, the adsorption of MB is dominated by physical interactions, particularly hydrogen bonding.

Pharmacologic Similarities and Differences Among Hallucinogens

Hallucinogens constitute a unique class of substances that cause changes in the user's thoughts, perceptions, and mood through various mechanisms of action. Although the serotonergic hallucinogens such as lysergic acid diethylamide, psilocybin, and N,N-dimethyltryptamine have been termed the classical hallucinogens, many hallucinogens elicit their actions through other mechanisms such as N-methyl-D-aspartate receptor antagonism, opioid receptor agonism, or inhibition of the reuptake of monoamines including serotonin, norepinephrine, and dopamine. The aim of this article is to compare the pharmacologic similarities and differences among substances within the hallucinogen class and their impact on physical and psychiatric effects. Potential toxicities, including life-threatening and long-term effects, will be reviewed.

Carbon Adsorbents from Spent Coffee for Removal of Methylene Blue and Methyl Orange from Water

Activated carbons (ACs) were prepared from dried spent coffee (SCD), a biological waste product, to produce adsorbents for methylene blue (MB) and methyl orange (MO) from aqueous solution. Pre-pyrolysis activation of SCD was achieved via treatment of the SCD with aqueous sodium hydroxide solutions at 90 °C. Pyrolysis of the pretreated SCD at 500 °C for 1 h produced powders with typical characteristics of AC suitable and effective for dye adsorption. As an alternative to the rather harsh base treatment, calcium carbonate powder, a very common and abundant resource, was also studied as an activator. Mixtures of SCD and CaCO₃ (1:1 w/w) yielded effective ACs for MO and MB removal upon pyrolysis needing only small amounts of AC to clear the solutions. A selectivity of the adsorption process toward anionic (MO) or cationic (MB) dyes was not observed.

TEMPORARY REMOVAL: Acute cell stress screen with supervised machine learning predicts cytotoxicity of excipients

The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Methylene Blue Application to Lessen Pain: Its Analgesic Effect and Mechanism

Methylene blue (MB) is a cationic thiazine dye, widely used as a biological stain and chemical indicator. Growing evidence have revealed that MB functions to restore abnormal vasodilation and notably it is implicated even in pain relief. Physicians began to inject MB into degenerated disks to relieve pain in patients with chronic discogenic low back pain (CDLBP), and some of them achieved remarkable outcomes. For osteoarthritis and colitis, MB abates inflammation by suppressing nitric oxide production, and ultimately relieves pain. However, despite this clinical efficacy, MB has not attracted much public attention in terms of pain relief. Accordingly, this review focuses on how MB lessens pain, noting three major actions of this dye: anti-inflammation, sodium current reduction, and denervation. Moreover, we showed controversies over the efficacy of MB on CDLBP and raised also toxicity issues to look into the limitation of MB application. This analysis is the first attempt to illustrate its analgesic effects, which may offer a novel insight into MB as a pain-relief dye.

Fabrication of Photoactive Electrospun Cellulose Acetate Nanofibers for Antibacterial Applications

The aim of the study was to investigate the process of electrostatic fabrication of cellulose acetate (CA) nanofibers containing methylene blue (MB) as a photosensitizer. The electrical, physicochemical, and biocidal properties of the prepared material were given. CA nanofibers were prepared by electrospinning method using a solvent mixture of acetone and distilled water (9:1 vv−1) and different concentrations of CA (i.e., 10–21%). Additionally, methylene blue was implemented into the polymer solution with a CA concentration of 17% to obtain fibers with photo-bactericidal properties. Pure electrospun CA fibers were more uniform than fibers with MB (i.e., ribbon shape). Fiber diameters did not exceed 900 nm for the tested polymer solutions and flow rate below 1.0 mL h−1. The polymer properties (i.e., concentration, resistivity) and other parameters of the process (i.e., flow rate, an applied voltage) strongly influenced the size of the fibers. Plasma treatment of nanofibers resulted in reduced biofilm formation on their surface. The results of photo-bactericidal activity (i.e., up to 180 min) confirmed the high efficiency of inactivation of Staphylococcus aureus cells using fibers containing methylene blue (i.e., with and without plasma treatment). The most effective reduction in the number of biofilm cells was equal to 99.99 ± 0.3%.

Transpupillary collagen photocrosslinking for targeted modulation of ocular biomechanics

The central vision-threatening event in glaucoma is dysfunction and loss of retinal ganglion cells (RGCs), thought to be promoted by local tissue deformations. Here, we sought to reduce tissue deformation near the optic nerve head by selectively stiffening the peripapillary sclera, i.e. the scleral region immediately adjacent to the optic nerve head. Previous scleral stiffening studies to treat glaucoma or myopia have used either pan-scleral stiffening (not regionally selective) or regionally selective stiffening with limited access to the posterior globe. We present a method for selectively stiffening the peripapillary sclera using a transpupillary annular light beam to activate methylene blue administered by retrobulbar injection. Unlike prior approaches to photocrosslinking in the eye, this approach avoids the damaging effects of ultraviolet light by employing red light. This targeted photocrosslinking approach successfully stiffened the peripapillary sclera at 6 weeks post-treatment, as measured by whole globe inflation testing. Specifically, strain was reduced by 47% when comparing treated vs. untreated sclera within the same eye (n = 7, p=0.0064) and by 54% when comparing the peripapillary sclera of treated vs. untreated eyes (n = 7, p<0.0001). Post-treatment characterization of RGCs (optic nerve axon counts/density, and grading), retinal function (electroretinography), and retinal histology revealed that photocrosslinking was associated with some ocular toxicity. We conclude that a transpupillary photocrosslinking approach enables selective scleral stiffening targeted to the peripapillary region that may be useful in future treatments of glaucoma.

Solid-State Synthesis of Direct Z-Scheme Cu2O/WO3 Nanocomposites with Enhanced Visible-Light Photocatalytic Performance

In this paper, we report the preparation of visible-light active direct Z-scheme Cu2O/WO3 nanocomposite photocatalyst by a solid-state reaction avoiding the otherwise inevitable formation of CuWO4 phase in wet syntheses. Structure, morphology, and thermal and optical properties of prepared WO3 nanoplatelets decorated by Cu2O were investigated by XRD, Raman spectroscopy, SEM/TEM, combined thermogravimetric (TG)/differential scanning calorimetry (DSC) analysis, and UV–VIS spectroscopy. The photocatalytic performance of the prepared samples under UV and visible light was studied through monitoring discoloration of methylene blue under illumination by selected wavelengths, allowing for the distinguishing between the contributions of the two semiconductive components. Experimental results showed that the decoration of WO3 nanoplates by Cu2O nanoparticles led to an improvement in photocatalytic performance, regardless of used LED (Light-Emitting Diode) wavelength, even at low concentrations. By using scavengers selectively blocking reactive species involved in the discoloration reaction, we determined that the Cu2O/WO3 nanocomposite exhibited the characteristics of direct Z-scheme-type photocatalyst.

Methylene blue induces an analgesic effect by significantly decreasing neural firing rates and improves pain behaviors in rats

Methylene blue (MB) is a blue cationic thiazine dye and currently used in different medical settings. Notably, there have been several attempts to introduce MB for attenuating pain in the last decade. Some clinical studies reported remarkable results, which, however, have been much debated. In addition, accumulating evidence have revealed that MB diminishes voltage-gated sodium channel currents. Accordingly, in the present study, we conducted in vivo experiments, including in vivo single nerve recording and behavioral test, to investigate whether MB dampens neural firing rates and ultimately contributes to pain relief. As a result, neural firing rates significantly decreased and finally converged to zero after MB administration. This event lasted longer than that of lidocaine and was dose-dependently modulated. Furthermore, there was a marked improvement in pain behaviors. The withdrawal threshold and latency of hind paws significantly rose post-MB administration. Therefore, these results demonstrate that MB lessens pain by significantly weakening neural excitability, which implies a strong possibility that this dye may be developed as a pain-relieving medication in the future. This is the first in vivo study to elucidate the effect of MB on nerves and pain relief.

Unusual cause of persistent dyspnea in a patient with nephrotic syndrome: dapsone-induced methemoglobinemia

Acquired methemoglobinemia is a rare, but important cause of tissue hypoxemia, which often results from commonly prescribed medications. We report a case of an 83-year-old female with stage III chronic kidney disease, who was started on high-dose prednisone for nephrotic syndrome and dapsone for pneumocystis jirovecii pneumonia prophylaxis. A week after initiation of dapsone, this patient presented with shortness of breath, and an oxygen saturation gap while on supplemental O2 via nasal cannula, with no obvious cardiopulmonary cause. Methemoglobin level was elevated on arterial blood gas. Our patient was treated with IV methylene blue. Dapsone was determined to be the culprit and immediately discontinued. Patient responded with a rapid decrease in methemoglobin levels and resolution of symptoms. This case report highlights the importance of maintaining a high index of suspicion and careful review of medication history for prompt and successful management of methemoglobin poisoning, as not all patients present with classical signs of methemoglobinemia such as cyanosis and/ or dark red blood.

Sulfobetaine Cryogels for Preferential Adsorption of Methyl Orange from Mixed Dye Solutions

New cryogels for selective dye removal from aqueous solution were prepared by free radical polymerization from the highly water-soluble crosslinker N,N,N',N'-tetramethyl-N,N'-bis(2-ethylmethacrylate)-propyl-1,3-diammonium dibromide and the sulfobetaine monomer 2-(N-3-sulfopropyl-N,N-dimethyl ammonium)ethyl methacrylate. The resulting white and opaque cryogels have micrometer sized pores with a smaller substructure. They adsorb methyl orange (MO) but not methylene blue (MB) from aqueous solution. Mixtures of MO and MB can be separated through selective adsorption of the MO to the cryogels while the MB remains in solution. The resulting cryogels are thus candidates for the removal of hazardous organic substances, as exemplified by MO and MB, from water. Clearly, it is possible that the cryogels are also potentially interesting for removal of other compounds such as pharmaceuticals or pesticides, but this must be investigated further.

Photosensitizers attenuate LPS-induced inflammation: implications in dentistry and general health

Antimicrobial photodynamic therapy (aPDT) is a complementary therapeutic modality for periodontal and endodontic diseases, in which Gram-negative bacteria are directly involved. Currently, there are few evidences regarding the effects of aPDT on bacterial components such as lipopolysaccharide (LPS) and it would represent a major step forward in the clinical use of this therapy. In this context, this study aimed to evaluate the efficacy of different photosensitizers (PSs) used in aPDT in LPS inhibition. Four PSs were used in this study: methylene blue (MB), toluidine blue (TBO), new methylene blue (NMB), and curcumin (CUR). Different approaches to evaluate LPS interaction with PSs were used, such as spectrophotometry, Limulus amebocyte lysate (LAL) test, functional assays using mouse macrophages, and an in vivo model of LPS injection. Spectrophotometry showed that LPS decreased the absorbance of all PSs used, indicating interactions between the two species. LAL assay revealed significant differences in LPS concentrations upon pre-incubation with the different PSs. Interestingly, the inflammatory potential of LPS decreased after previous treatment with the four PSs, resulting in decreased secretion of inflammatory cytokines by macrophages. In vivo, pre-incubating curcumin with LPS prevented animals from undergoing septic shock within the established time. Using relevant models to study the inflammatory activity of LPS, we found that all PSs used in this work decreased LPS-induced inflammation, with a more striking effect observed for NMB and curcumin. These data advance the understanding of the mechanisms of LPS inhibition by PSs.

Bi3TaO7/Ti3C2 heterojunctions for enhanced photocatalytic removal of water-borne contaminants

Novel catalysts are of great interest for improved photocatalytic environmental remediation. Using a hydrothermal method, 0D/2D Bi₃TaO₇/Ti₃C₂ heterojunctions were designed rationally and characterized systematically as excellent photocatalysts for photocatalytic degradation. The hybrid catalyst exhibits superior performance in visible-light-driven photocatalytic degradation of methylene blue (about 99% degradation efficiency after 2 h) and excellent stability (up to 10 cycles) under visible light irradiation (300 W Xe lamp; λ > 420 nm; light intensity 150 mW cm^-2). In addition, Bi₃TaO₇/Ti₃C₂ has a larger rate constant (0.032 min^-1) than pristine Bi₃TaO₇ (0.006 min^-1). Quantum yield (2.27 × 10^-5 molecules/photon) and figure of merit (23.3) of the system were obtained, suggesting that our catalyst has potential for application. Both experimental and computational results indicate that synergistic effects between Bi₃TaO₇ and Ti₃C₂ improve photocatalytic performance by enhancing electron-hole pair separation, electronic transmission efficiency, and interfacial charge transfer. These findings contribute to the synthesis of efficient visible-light-driven Bi-based photocatalysts and to the understanding of photocatalytic degradation reactions.

Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions

Serotonin syndrome (SS) (also referred to as serotonin toxicity) is a potentially life-threatening drug-induced toxidrome associated with increased serotonergic activity in both the peripheral (PNS) and central nervous systems (CNS). It is characterised by a dose-relevant spectrum of clinical findings related to the level of free serotonin (5-hydroxytryptamine [5-HT]), or 5-HT receptor activation (predominantly the 5-HT_1A and 5-HT_2A subtypes), which include neuromuscular abnormalities, autonomic hyperactivity, and mental state changes. Severe SS is only usually precipitated by the simultaneous initiation of 2 or more serotonergic drugs, but the syndrome can also occur after the initiation of a single serotonergic drug in a susceptible individual, the addition of a second or third agent to long-standing doses of a maintenance serotonergic drug, or after an overdose. The combination of a monoamine oxidase inhibitor (MAOI), in particular MAO-A inhibitors that preferentially inhibit the metabolism of 5-HT, with serotonergic drugs is especially dangerous, and may lead to the most severe form of the syndrome, and occasionally death. This review describes our current understanding of the pathophysiology, clinical presentation and management of SS, and summarises some of the drugs and interactions that may precipitate the condition. We also discuss the newer novel psychoactive substances (NPSs), a growing public health concern due to their increased availability and use, and their potential risk to evoke the syndrome. Finally, we discuss whether the inhibition of tryptophan hydroxylase (TPH), in particular the neuronal isoform (TPH2), may provide an opportunity to pharmacologically target central 5-HT synthesis, and so develop new treatments for severe, life-threatening SS.

Filipe CD, Didar TF. Intelligent Food Packaging: A Review of Smart Sensing Technologies for Monitoring Food Quality

Food safety is a major factor affecting public health and the well-being of society. A possible solution to control food-borne illnesses is through real-time monitoring of the food quality throughout the food supply chain. The development of emerging technologies, such as active and intelligent packaging, has been greatly accelerated in recent years, with a focus on informing consumers about food quality. Advances in the fields of sensors and biosensors has enabled the development of new materials, devices, and multifunctional sensing systems to monitor the quality of food. In this Review, we place the focus on an in-depth summary of the recent technological advances that hold the potential for being incorporated into food packaging to ensure food quality, safety, or monitoring of spoilage. These advanced sensing systems usually target monitoring gas production, humidity, temperature, and microorganisms' growth within packaged food. The implementation of portable and simple-to-use hand-held devices is also discussed in this Review. We highlight the mechanical and optical properties of current materials and systems, along with various limitations associated with each device. The technologies discussed here hold great potential for applications in food packaging and bring us one step closer to enable real-time monitoring of food throughout the supply chain.

A reassessment of the safety profile of monoamine oxidase inhibitors: elucidating tired old tyramine myths

This review appraises over 150 recent original papers reporting data that demonstrate the greatly reduced tyramine content of modern-day 'foods', about which the medical literature has a paucity of information. It discusses the cardiovascular pharmacology of tyramine and the characteristics, extent, risks, and treatment of the blood pressure increases that sometimes result from tyramine ingestion (the pressor response). In past decades, cheese was the only food associated with documented fatalities resulting from hypertension. Today, few foods contain problematically high tyramine levels, which is a result of changes in international food production techniques (especially the use of starter cultures), and hygiene regulations. Nowadays, even 'matured' cheeses are usually safe in healthy-sized portions. The mechanism by which tyramine may be produced in foods (by certain micro-organisms) is explained and hundreds of recent estimations of cheeses are reviewed. Numerous other previously inadequately documented foods are reviewed, including fish and soy sauces, salami-type sausages, dried meats, beers, wines, and various condiments. Evidence that the risk of harm from the pressor response has previously been overstated is reviewed, and the iatrogenic harms from hasty and aggressive treatment of hypertensive urgency are re-evaluated. Evidence now suggests that MAOIs are of comparable safety to many newer drugs and are straightforward to use. Previously held concerns about MAOIs are misplaced and some are of over-estimated consequence. The variability of pressor sensitivity to tyramine between individuals means that the knowledge and judgement of doctors, and some care, are still required.