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1.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1801589

ABSTRACT

Many novel drugs were used in COVID19 pandemic to improve outcome. One such molecule is Methylene blue which is a, tricyclic phenothiazine compound approved for the treatment of acquired methemoglobinemia and some other uses US FDA. This molecule was found to inhibit the interaction of COVID19 virus and target cells in dose dependent manner. It was also found to inhibit interaction of viron with host cells, by inhibiting interaction of SARS CoV2 spike protein and ACE inhibitor receptor interactions. MATERIAL AND METHODS: A) Aim & Objectives: To evaluate the effect of Nebulised Methylene blue on the clinical course and outcomes of patients with COVID-19 infections. B) Study design Observational Study C) Participants 63 COVID19 RT-PCR positive cases divided in 3 groups. Group 1 consists of patients who were prescribed Methylene blue nebulization in form of Methylene blue 0.5 mg via nebulization along with bronchodilator Levosalbutamol (1.25 mg) + Ipratropium (500 mcg) three times a day . Group 2 consists of patients with Methylene blue nebulization in form of Methylene blue 0.5 mg via nebulization along with inhalational steroid Budesonide (1 mg). Group 3 acted were those patients who had no Methylene blue nebulisation in their treatment. OBSERVATION: 1) Analysis 63 cases were divided in 3 groups of 21 each, descriptive and frequency analysis of cases in groups are shown. CONCLUSION: No statistically significant difference in outcome measures like Spo2, duration of hospital stay or inflammatory markers. A general trend of fall in inflammatory markers and O2 requirements in group receiving methylene blue but this difference was not consistantly statistically significant.


Subject(s)
COVID-19 , Methemoglobinemia , COVID-19/drug therapy , Humans , Methylene Blue/pharmacology , Methylene Blue/therapeutic use , Pandemics , SARS-CoV-2
2.
J Med Case Rep ; 16(1): 106, 2022 Mar 14.
Article in English | MEDLINE | ID: covidwho-1745429

ABSTRACT

BACKGROUND: Glucose-6-phosphate dehydrogenase deficiency is a rarely recognized predisposing factor for rhabdomyolysis. Rhabdomyolysis with coronavirus disease 2019 has been increasingly seen during the pandemic. We report the uncommon occurrence of coronavirus disease 2019 pneumonia, severe rhabdomyolysis, and acute renal failure in the setting of glucose-6-phosphate dehydrogenase deficiency. CASE PRESENTATION: A 19-year-old African American male presented with myalgias, diaphoresis, and dark urine. Testing for severe acute respiratory syndrome coronavirus 2 was positive. He had severe rhabdomyolysis with creatine kinase levels up to 346,695 U/L. He was oliguric and eventually required hemodialysis. Progressive hypoxemia, methemoglobinemia, and hemolytic anemia occurred following one dose of rasburicase for hyperuricemia. Glucose-6-phosphate dehydrogenase deficiency was diagnosed. Full recovery followed a single volume exchange transfusion and simple packed red blood cell transfusions. CONCLUSIONS: Glucose-6-phosphate dehydrogenase deficiency may predispose individuals to rhabdomyolysis due to severe acute respiratory syndrome coronavirus 2, presumably due to altered host responses to viral oxidative stress. Early screening for glucose-6-phosphate dehydrogenase deficiency can be useful for management of patients with rhabdomyolysis.


Subject(s)
COVID-19 , Glucosephosphate Dehydrogenase Deficiency , Methemoglobinemia , Pneumonia , Rhabdomyolysis , Adult , COVID-19/complications , Glucosephosphate Dehydrogenase Deficiency/complications , Glucosephosphate Dehydrogenase Deficiency/diagnosis , Humans , Male , Methemoglobinemia/complications , Methemoglobinemia/diagnosis , Pneumonia/complications , Rhabdomyolysis/etiology , Young Adult
3.
J Burn Care Res ; 43(3): 716-721, 2022 05 17.
Article in English | MEDLINE | ID: covidwho-1429265

ABSTRACT

Wound infections and sepsis are significant causes of morbidity after burn injury and can be alleviated by early excision and grafting. In situations that preclude early surgery, topical agents allow for a safer delay. Cerium nitrate compounded with silver sulfadiazine (Ce-SSD) is a burn cream that provides broad antibacterial activity, forms a temporary barrier, and promotes re-epithelialization. Methemoglobinemia is a rare, but oft-cited, systemic complication of Ce-SSD. In this retrospective review, 157 patients treated with Ce-SSD between July 2014 and July 2018 were identified, and the monitoring protocol for methemoglobinemia during Ce-SSD treatment was evaluated. The median age was 59 years (interquartile range [IQR], 47-70.5 years), with TBSA of 8.5% (IQR, 3-27), adjusted Baux score of 76 (IQR, 59-94), and inhalation injury present in 9.9% of patients. Primary endpoints included incidence of symptomatic and asymptomatic methemoglobinemia. Of the 9.6% (n = 15) of patients with methemoglobinemia, 73.3% (n = 11) had maximum methemoglobin levels ≥72 hours from the time of the first application. One patient developed clinically significant methemoglobinemia. Patients with TBSA ≥20% were more likely to develop methemoglobinemia (odds ratio 9.318, 95% confidence interval 2.078-65.73, P = .0078); however, neither Ce-SSD doses nor days of exposure were significant predictors. Ce-SSD application to temporize burn wounds until excision and grafting is safe, effective, and, in asymptomatic patients with TBSA <20%, can be used without serial blood gas monitoring. Vigilant monitoring for symptoms should be performed in patients with TBSA ≥20%, but routine blood gases are not necessary.


Subject(s)
Anti-Infective Agents, Local , Burns , Methemoglobinemia , Aged , Anti-Infective Agents, Local/adverse effects , Burn Units , Burns/drug therapy , Cerium , Humans , Methemoglobinemia/chemically induced , Methemoglobinemia/drug therapy , Middle Aged , Silver Sulfadiazine
6.
BMJ Case Rep ; 14(3)2021 Mar 16.
Article in English | MEDLINE | ID: covidwho-1138315

ABSTRACT

We report a case of a 91-year-old Caucasian woman with a history of chronic lymphocytic leukaemia who developed acute hypoxic respiratory failure (AHRF) requiring intubation for less than 24 hours after receiving rasburicase. Laboratory workup was significant for methemoglobinemia and acute anaemia, and blood film demonstrated evidence of oxidative haemolysis with bite cells. The patient was given a presumptive diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency and was managed conservatively with successful resolution of AHRF and stabilisation of haemoglobin level. Seven days after admission, she passed away due to subsequent complications; hence, follow-up G6PD level could not be obtained. Haemolytic anaemia and methemoglobinemia in the setting of recent rasburicase administration should raise clinical suspicion for G6PD deficiency. In non-emergent cases, patients should be screened prior to receiving rasburicase regardless of risk factors. Because rasburicase is often needed emergently, patients at high risk of tumour lysis syndrome should be screened early for G6PD deficiency.


Subject(s)
Glucosephosphate Dehydrogenase Deficiency , Methemoglobinemia , Aged, 80 and over , Female , Glucosephosphate Dehydrogenase Deficiency/complications , Hemolysis , Humans , Methemoglobinemia/chemically induced , Methemoglobinemia/diagnosis , Methemoglobinemia/drug therapy , Urate Oxidase/adverse effects
7.
Exp Lung Res ; 46(5): 157-161, 2020.
Article in English | MEDLINE | ID: covidwho-1017073

ABSTRACT

Multiple pharmacological interventions tested over the last decades have failed to reduce ARDS mortality. This short note recounts past data indicating that (i) neutrophils home along an IL-8 gradient, (ii) in ARDS, massive neutrophil accumulation and degranulation in and along bronchoalveolar spaces contributes to damage and hypoxia, (iii) large increases in IL-8 are one of the chemotaxic signals drawing neutrophils to the ARDS lung, and (iv) old data from dermatology and glioblastoma research showed that the old drug against Hansen's disease, dapsone, inhibits neutrophils' chemotaxis to IL-8. Therefore dapsone might lower neutrophils' contributions to ARDS lung pathology. Dapsone can create methemoglobinemia that although rarely problematic it would be particularly undesirable in ARDS. The common antacid drug cimetidine lowers risk of dapsone related methemoglobinemia and should be given concomitantly.


Subject(s)
Anti-Infective Agents/therapeutic use , Dapsone/therapeutic use , Neutrophils/drug effects , Respiratory Distress Syndrome/drug therapy , Anti-Infective Agents/pharmacology , Cimetidine/therapeutic use , Dapsone/pharmacology , Histamine H2 Antagonists/therapeutic use , Humans , Methemoglobinemia/chemically induced , Methemoglobinemia/prevention & control
8.
A A Pract ; 14(9): e01287, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-992616

ABSTRACT

Methemoglobinemia is a rare disorder of the blood in which there is an increase in methemoglobin, which occurs when hemoglobin is present in the oxidized form. Methemoglobin impairs hemoglobin's ability to transport oxygen, produces functional anemia, and leads to tissue hypoxia. We report the successful management of a case of refractory hypoxia due to acutely acquired methemoglobinemia in a patient undergoing treatment for coronavirus disease 2019 (COVID-19) pneumonia. The cause of methemoglobinemia in this patient remains unknown. Hypoxia and methemoglobinemia did not respond to methylene blue and required administration of packed red blood cell transfusions.


Subject(s)
Coronavirus Infections/complications , Hypoxia/etiology , Methemoglobinemia/complications , Pneumonia, Viral/complications , Respiratory Insufficiency/etiology , Acute Kidney Injury/complications , Acute Kidney Injury/therapy , Aged , Antibodies, Monoclonal, Humanized/therapeutic use , Antioxidants/therapeutic use , Ascorbic Acid/therapeutic use , Betacoronavirus , COVID-19 , Coronavirus Infections/drug therapy , Corynebacterium , Corynebacterium Infections/complications , Corynebacterium Infections/therapy , Cytokine Release Syndrome/complications , Enzyme Inhibitors/therapeutic use , Erythrocyte Transfusion , Hematinics/therapeutic use , Humans , Hydroxocobalamin/therapeutic use , Hydroxychloroquine/therapeutic use , Hypoxia/therapy , Male , Methemoglobinemia/therapy , Methylene Blue/therapeutic use , Pandemics , Pneumonia, Bacterial/complications , Pneumonia, Bacterial/therapy , Pneumonia, Viral/drug therapy , Renal Replacement Therapy , Respiratory Insufficiency/therapy , SARS-CoV-2 , Shock, Septic/complications
10.
BMJ Case Rep ; 13(8)2020 Aug 24.
Article in English | MEDLINE | ID: covidwho-827667

ABSTRACT

Methaemoglobinaemia is a rare disease that is typically caused by a medication or other exogenous agent, with dapsone being the most common. It occurs when the concentration of methaemoglobin rises via ferrous haeme irons becoming oxidised to the ferric state, which shifts the oxygen dissociation curve to the left. The net result of an elevated methaemoglobin concentration is functional anaemia and impaired oxygen delivery to tissues. At lower blood levels, this can cause symptoms such as cyanosis, lethargy, headache and fatigue, whereas at higher levels it can be fatal. Here we discuss a subtle case of dapsone-induced methaemoglobinaemia presenting as subacute mental status changes and apparent hypoxia, thus highlighting the association between methaemoglobinaemia and dapsone. This case demonstrates the importance of thorough medication reconciliation and maintaining a broad differential diagnosis, while also recognising the significance of conflicting data and their implications for the workup.


Subject(s)
Anti-Infective Agents/adverse effects , Dapsone/adverse effects , Methemoglobinemia , Aged , Confusion/chemically induced , Female , Humans , Memory Disorders/chemically induced , Methemoglobin/analysis , Methemoglobinemia/chemically induced , Methemoglobinemia/diagnosis , Oxygen/blood
11.
Emerg Infect Dis ; 26(9)2020 Sep.
Article in English | MEDLINE | ID: covidwho-614161

ABSTRACT

We report a case of intravascular hemolysis and methemoglobinemia, precipitated by severe acute respiratory syndrome coronavirus 2 infection, in a patient with undiagnosed glucose-6-phosphate dehydrogenase deficiency. Clinicians should be aware of this complication of coronavirus disease as a cause of error in pulse oximetry and a potential risk for drug-induced hemolysis.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Glucosephosphate Dehydrogenase Deficiency/virology , Methemoglobinemia/virology , Pneumonia, Viral/complications , COVID-19 , Coronavirus Infections/blood , Coronavirus Infections/virology , Glucosephosphate Dehydrogenase Deficiency/blood , Humans , Male , Methemoglobinemia/blood , Middle Aged , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/virology , SARS-CoV-2
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