Clinical outcomes of adverse cardiovascular events in patients with acute dapsone poisoning

Dapsone for the treatment of acne vulgaris: do the risks outweigh the benefits?

Dapsone is a "4,4'-diamino diphenyl sulfone" compound and an aniline derivative from synthetic sulfones. Sulfonamides were first used in humans as antimicrobial agents to treat streptococcal infections. Dapsone derived from sulfonamides was first used in the treatment of leprosy in 1940. Today, Dapsone treatment is among the treatment options for many dermatological diseases. Acne vulgaris is a chronic inflammatory disease, which causes scar formation and changed pigmentation. Acne affects 85% of teenagers, but can occur at any age and can last into adulthood and even lifelong. Through its antimicrobial, anti-inflammatory and antioxidant effects, dapsone treatment (local or systemic) can also be used in the treatment of acne. Dapsone treatment can cause a variety of side effects that can be categorized as pharmacological, dose-related, allergic, or idiosyncratic reactions. In this review article, the risks and benefits of using dapsone treatment in acne vulgaris will be evaluated in light of the literature.

Specific Treatment Exists for SARS-CoV-2 ARDS

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), seems to be difficult to overcome. A pandemic of such a scale has not been seen since the 1918 influenza pandemic. Although the predominant clinical presentation is respiratory disease, neurological manifestations and sequelae are increasingly being recognized. We observed a case series of rapid recovery of ARDS within 24 h in the preliminary clinical features of COVID-19 ARDS-associated neurological disease. It was also noted that by 15 April, 2021, there was no SARS-CoV-2 ARDS on Sorok Island in South Korea, where lepers had been living together. We compared each of dapsone’s effects on humans and considered those of SARS-CoV-2. Dapsone showed different effects in the brain. The Sorokdo National Hospital reported a relationship between dapsone and the neuroinflammasome of Alzheimer’s disease (AD) in Sorok Island from January 2005 to June 2020. AD prevalence was low in the leprosy patient group who took dapsone regularly. The preliminary cross-sectional study of the trial group (22 subjects) and the control group (22 subjects) in the Hunt Regional Hospital reported the following results: The chi-square statistic is 5.1836. The p-value is 0.022801. The result is considered significant at p < 0.05. The results from the medical treatment from 21 December to 29 December 2020 were considered. The mortality rates at the ARDS onset stage were 0% with dapsone administered as a standard COVID-19 treatment and 40% without dapsone administered as a standard COVID-19 treatment, respectively. Based on the respiratory failure and sudden high death rate originating from the involvement of the brainstem, especially the pre-Bötzinger complex, dapsone can be used to significantly reduce the incidence of the cases of acute respiratory distress syndrome and other illnesses caused by SARS-CoV-2.

The Neuroinflammasome in Alzheimer's Disease and Cerebral Stroke

Aim/Background

This review investigated a patient with Alzheimer's disease (AD) treated with 4,4′-diaminodiphenyl sulfone (DDS) as a neuroinflammasome competitor.

Methods

We monitored AD's progression through numeric clinical staging (NCS) with a new biomarker. NCS was determined by the presence of AD symptoms and neuropsychiatric (NP) symptoms caused by anti-AD (AAD) drugs (D) as a biomarker. We also monitored the function of DDS for stroke in a no-intake emergency state.

Results

By introducing (D), AD's progression was monitored through NCS staging. AAD side effects and neuropsychiatric symptoms were identified. DDS was stopped in patients with stroke with NCS 6 caused by AAD, and it rapidly proceeded to cerebral infarct.

Conclusions

AAD can occasionally exacerbate AD and stroke. DDS can alleviate mild cognitive impairment (MCI), early AD and stroke. We clinically confirmed the role of DDS as a neuroinflammasome competitor after stroke. DDS preserved neuronal survival within 24–55 h in the Seoul Study cohort.

4,4'-Diaminodiphenyl Sulfone (DDS) as an Inflammasome Competitor

The aim of this study is to examine the use of an inflammasome competitor as a preventative agent. Coronaviruses have zoonotic potential due to the adaptability of their S protein to bind receptors of other species, most notably demonstrated by SARS-CoV. The binding of SARS-CoV-2 to TLR (Toll-like receptor) causes the release of pro-IL-1β, which is cleaved by caspase-1, followed by the formation and activation of the inflammasome, which is a mediator of lung inflammation, fever, and fibrosis. The NLRP3 (NACHT, LRR and PYD domains-containing protein 3) inflammasome is implicated in a variety of human diseases including Alzheimer's disease (AD), prion diseases, type 2 diabetes, and numerous infectious diseases. By examining the use of 4,4'-diaminodiphenyl sulfone (DDS) in the treatment of patients with Hansen's disease, also diagnosed as Alzheimer's disease, this study demonstrates the diverse mechanisms involved in the activation of inflammasomes. TLRs, due to genetic polymorphisms, can alter the immune response to a wide variety of microbial ligands, including viruses. In particular, TLR2Arg677Trp was reported to be exclusively present in Korean patients with lepromatous leprosy (LL). Previously, mutation of the intracellular domain of TLR2 has demonstrated its role in determining the susceptibility to LL, though LL was successfully treated using a combination of DDS with rifampicin and clofazimine. Of the three tested antibiotics, DDS was effective in the molecular regulation of NLRP3 inflammasome activators that are important in mild cognitive impairment (MCI), Parkinson's disease (PD), and AD. The specific targeting of NLRP3 itself or up-/downstream factors of the NLRP3 inflammasome by DDS may be responsible for its observed preventive effects, functioning as a competitor.

A Bitter Taste in Your Heart

The human genome contains ∼29 bitter taste receptors (T2Rs), which are responsible for detecting thousands of bitter ligands, including toxic and aversive compounds. This sentinel function varies between individuals and is underpinned by naturally occurring T2R polymorphisms, which have also been associated with disease. Recent studies have reported the expression of T2Rs and their downstream signaling components within non-gustatory tissues, including the heart. Though the precise role of T2Rs in the heart remains unclear, evidence points toward a role in cardiac contractility and overall vascular tone. In this review, we summarize the extra-oral expression of T2Rs, focusing on evidence for expression in heart; we speculate on the range of potential ligands that may activate them; we define the possible signaling pathways they activate; and we argue that their discovery in heart predicts an, as yet, unappreciated cardiac physiology.

The usefulness of the SOFA and APACHE II scoring systems for the early prediction of mortality in patients with dapsone poisoning

The rate of mortality from dapsone poisoning is high because of the long absorption half-life of dapsone. This study aimed to evaluate the usefulness of the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) scoring systems for the early prediction of mortality in patients with dapsone poisoning. This is a retrospective and observational study of consecutive patients diagnosed with dapsone poisoning. The SOFA and APACHE II scores were obtained within the first 24 h of admission. Patients were divided into survivor and non-survivor groups. In total, 106 patients were included. The SOFA scores of the survivor and non-survivor groups were 1 (0–8) and 4 (1–10), respectively ( p < 0.001). The APACHE II scores of the survivor and non-survivor groups were 9 (1–25) and 14 (3–23), respectively ( p < 0.001). Based on these scores and in-hospital mortality cases, the standardized mortality ratios for the APACHE II and SOFA were 1.00 (95% confidence interval (CI): 0.64–1.48) and 1.00 (95% CI: 0.64–1.49), respectively. In the model adjusted for clinically important variables and variables with significant differences between the survivor and non-survivor groups, the area under the curve of the SOFA (0.907; 95% CI: 0.834–0.955) was significantly higher than that of the APACHE II (0.793; 95% CI: 0.703–0.867) ( p = 0.008). The SOFA and APACHE II score systems had good discrimination and satisfactory calibration performance in patients with dapsone poisoning. However, the SOFA score was a more useful method in predicting mortality than the APACHE II score.

Therapeutic effect of ascorbic acid on dapsone-induced methemoglobinemia in rats

Objective

Dapsone (diaminodiphenyl sulfone, DDS) is currently used to treat leprosy, malaria, dermatitis herpetiformis, and other diseases. It is also used to treat pneumocystis pneumonia and Toxoplasma gondii infection in HIV-positive patients. The most common adverse effect of DDS is methemoglobinemia from oxidative stress. Ascorbic acid is an antioxidant and reducing agent that scavenges the free radicals produced by oxidative stress. The present study aimed to investigate the effect of ascorbic acid in the treatment of DDS induced methemoglobinemia.

Methods

Male Sprague-Dawley rats were divided into three groups: an ascorbic acid group, a methylene blue (MB) group, and a control group. After DDS (40 mg/kg) treatment via oral gavage, ascorbic acid (15 mg/kg), MB (1 mg/kg), or normal saline were administered via tail vein injection. Depending on the duration of the DDS treatment, blood methemoglobin levels, as well as the nitric oxide levels and catalase activity, were measured at 60, 120, or 180 minutes after DDS administration.

Results

Methemoglobin concentrations in the ascorbic acid and MB groups were significantly lower compared to those in the control group across multiple time points. The plasma nitric oxide levels and catalase activity were not different among the groups or time points.

Conclusion

Intravenous ascorbic acid administration is effective in treating DDS-induced methemoglobinemia in a murine model.

Analysis of Patients with Acute Toxic Exposure between 2009 and 2013: Data from the Korea Health Insurance Review and Assessment Service and the National Emergency Department Information System

BACKGROUND

According to domestic studies, patients visiting the emergency departments (ED) with acute toxic exposure comprise 0.68%-5.5% of all ED patients, with various causes and motives. The purpose of this study is to investigate the clinical and social characteristics of patients with toxic exposure visiting the ED.

METHODS

This study spanned a period of five years, from January 1, 2009 to December 31, 2013. The data were extracted using the National Emergency Department Information System (NEDIS) and The Korea Health Insurance Review and Assessment Service (HIRA).

RESULTS

From the HIRA database, during the study period (2009-2013); 310,159 (2009), 289,829 (2010), 288,906 (2011), 285,514 (2012), and 279,575 (2013) patients, respectively, visited EDs with diagnoses related to exposure to toxic substances. The number of patients who presented with acute toxic exposure compared to all ED visits significantly decreased consistently (7.8%, 6.9%, 6.0%, 5.0%, 4.1%) over 5 years. Regarding the cause of toxic exposure, substances other than drugs accounted for the largest percentage, and increased annually. Acetylcysteine was the most commonly prescribed antidote, and patients in their 40s and 50s showed the most frequent visits. The monthly distribution was highest in July-September, and higher in January than in other months.

CONCLUSION

This study found that the percentage of patients visiting the ED is decreasing, the exposure to quasi-drugs was the most common, and the exposure to antipsychotic drugs was the most frequent.