Perioperative allergy: uncommon agents

Sodium alginate-modified alkali-activated eggshell/Fe3O4 nanoparticles: A magnetic bio-based spherical adsorbent for cationic dyes adsorption

Herein, a mixture of eggshell (ES) and magnetite nanoparticles (MNPs) was alkali-activated using NaOH/Na2SiO3 solution and then, impregnated with sodium alginate (SA) to prepare a magnetic bio-based adsorbent (namely SAAES/SA/MNPs) for the decontamination of water containing basic dyes, in particular, methylene blue (MB) and crystal violet (CV). The physicochemical properties of magnetic spheres of SAAES/SA/MNPs were characterized using XRD, FTIR, FESEM, EDX, elemental mapping, TEM, and zeta potential techniques. Dye adsorption equilibrium was studied experimentally at pH 8.0 and 25-55 °C, and a statistical physics multilayer model was applied to understand the removal mechanism of these dyes including the adsorption orientations on the adsorbent surface. The number of adsorbed dye molecules per functional group (n) of this bio-based adsorbent ranged from 0.70 to 0.91, indicating the presence of vertical and horizontal adsorption orientations for these organic molecules at all tested solution temperatures. The calculated saturation adsorption capacities (Qsat) were 332.57-256.62 mg/g for CV and 304.47-240.62 mg/g for MB, and an exothermic adsorption was observed for both adsorbates. The estimated adsorption energies (∆E) were < 25 kJ/mol, confirming that the SAAES/SA/MNPs-dye interactions were governed by physical forces as electrostatic interactions. This bio-based adsorbent was effectively regenerated using ethanol and it can be reused showing a removal of 71 and 74 % of MB and CV, respectively, after fourth adsorption-desorption cycles. Overall, the results of this article suggest the attractive performance of SAAES/SA/MNPs for removing basic dyes from aqueous solutions, thus highlighting the promising potential of this magnetic bio-based adsorbent for sustainable wastewater treatment at an industrial level.

Intraoperative anaphylaxis due to aprotinin after local application of fibrin sealant diagnosed by skin tests and basophil activation tests: a case report

Background

There are few cases of anaphylaxis after local application of fibrin sealant diagnosed by skin tests.

Case presentation

A 49-year-old woman underwent partial lung resection under general anesthesia. Anesthesia was induced uneventfully. Shortly after applying absorbable suture reinforcement felt that contained fibrin sealant, her systolic blood pressure fell to approximately 70 mmHg, along with facial flushing. Anaphylaxis was diagnosed based on the clinical symptoms and high serum tryptase levels. Three months after the event, skin tests were performed with all agents and were positive only for fibrin sealant vial no. 2, whose main component is aprotinin. Subsequently, basophil activation tests using fibrin sealant vial no. 2 and pure aprotinin demonstrated that the causative agent was likely aprotinin.

Conclusions

We diagnosed aprotinin-induced anaphylaxis using skin tests and basophil activation tests. The occurrence of anaphylaxis should be considered when changes in vital signs are observed after the use of fibrin sealant.

Acetylbritannilactone attenuates contrast-induced acute kidney injury through its anti-pyroptosis effects

Contrast-induced acute kidney injury (CI-AKI) is a severe complication caused by intravascular applied radial contrast media (CM). Pyroptosis is a lytic type of cell death inherently associated with inflammation response and the secretion of pro-inflammatory cytokines following caspase-1 activation. The aim of the present study was to investigate the protective effects of acetylbritannilactone (ABL) on iopromide (IOP)-induced acute renal failure and reveal the underlying mechanism. In vivo and in vitro, IOP treatment caused renal damage and elevated the caspase-1 (+) propidium iodide (PI) (+) cell count, interleukin (IL)-1β and IL-18 levels, lactate dehydrogenase (LDH) release, and the relative expression of nucleotide-binding domain, leucine-rich repeat containing protein 3 (NLRP3), apoptosis-associated speck-like protein (ASC), and gasdermin D (GSDMD), suggesting that IOP induces AKI via the activation of pyroptosis. Furthermore, the pretreatment of ABL partly mitigated the CI-AKI, development of pyroptosis, and subsequent kidney inflammation. These data revealed that ABL partially prevents renal dysfunction and reduces pyroptosis in CI-AKI, which may provide a therapeutic target for the treatment of CM-induced AKI.

Purification and Characterization of Protamine, the Allergen from the Milt of Large Yellow Croaker (Pseudosciaena crocea), and Its Components

The protamine in fish milt can cause anaphylaxis in humans. To determine the allergen in the milt of large yellow croaker (Pseudosciaena crocea), crude extracts were incubated with sera from allergic patients. The results showed that a 12 kDa multicomponent protein was the major allergen in the milt of large yellow croaker. The multicomponent protein was purified, and physicochemical characterization showed that it was a glycoprotein, highly stable in acid-alkali conditions, and weakly retained immunoglobulin E (IgE)-binding activity at high temperatures. Separation and immunoreactivity analysis of the components of the multicomponent protein showed that it had six components, and component 5 had the strongest IgE-binding activity with patient sera. N-terminal sequencing confirmed the multicomponent protein was protamine. Following analysis of protamine from different fish by reversed-phase liquid chromatography and circular dichroism spectra, the protamines from different fish were found to have a similar secondary structure, although their components were different.

Anaphylactic reaction 5 minutes after the start of surgery: a case report

BACKGROUND

Natural latex rubber products have been known to cause severe anaphylactic reactions during surgery. Even 25 years after the first description of anaphylactic reactions in the literature, natural latex rubber products are still used in pediatric surgery.

CASE PRESENTATION

The following article describes the case of a healthy 4.5-year old Caucasian boy who simultaneously developed severe hypotension, tachycardia and bronchospasm during surgery for congenital strabismus sursoadductorius under uneventful anesthesia. An allergy test conducted afterwards showed natural latex rubber as the trigger for this severe intraoperative anaphylactic reaction. This case was special because of the absence of any previous clinical or anamnestical evidence of natural latex rubber allergy. The fact that the child had been previously exposed to natural latex rubber - because the boy's mother used disposable gloves for her work as a cosmetician at home - was only discovered later. Such contact may have had a slight sensitizing effect that manifested after the initial contact with the conjunctiva through the surgeon's natural latex rubber gloves.

CONCLUSION

Natural latex rubber products have caused severe anaphylactic reactions time and again. Diagnosis is impeded by the highly variable clinical symptoms of anaphylaxis, the non-responsivity of patients, anesthesia-induced changes in blood pressure, surgical drapes, and blood loss. Therefore, use of alternative products and implementation of the right course of action in clinical routine seems to be even more important than raising awareness for allergies to natural latex rubber.