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Allergol Immunopathol (Madr) 2020 May 22. Epub 2020 May 22.

Department of Pediatrics, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan.

Introduction And Objectives: Methemoglobinemia has been reported to be associated with severe food protein-induced enterocolitis syndrome (FPIES). However, no reports have evaluated methemoglobin (MHb) levels in FPIES without symptomatic methemoglobinemia or the usefulness of MHb measurement for the diagnostic prediction of FPIES. To evaluate the MHb levels of patients with neonatal-onset FPIES and determine whether MHb levels are higher in FPIES than in other gastrointestinal diseases. Read More

Indian J Crit Care Med 2020 Mar;24(3):208-209

Department of Anesthesia and Intensive Care, Safdarjang Hospital and Vardhman Mahavir Medical College, New Delhi, India.

With increasing awareness of "greener" environment, market is flooded with biopesticide. Natural insecticides can be chemical, mineral, or biological. We report an unusual case of methemoglobinemia after deliberate ingestion of an insecticide containing extract of pine oil and azadirachtin oil, Ti oil, and kerosene. Read More

QJM 2020 May 19. Epub 2020 May 19.

Hematology and Oncology division, Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, United States.

Background: Acetaminophen (N-acetyl-para-aminophenol, paracetamol, (APAP) toxicity is one of the commonly encountered poisonings by emergency physicians. Methemoglobinemia is an uncommon association and rarely seen in APAP poisoning.

Methods: Retrospective analysis of all the published reports on APAP induced methemoglobinemia from 1968 to 2019. Read More

Chemosphere 2020 Jun 6;248:125754. Epub 2020 Jan 6.

Mass Spectrometry Laboratory, Institute of Physics, Maria Curie-Sklodowska University, pl. Marii Curie-Skłodowskiej 1, 20-031, Lublin, Poland.

Nitrates are bioavailable compounds, which are necessary for every living organisms. However, their excess could be harmful, because it could lead to, i.e. Read More

Am J Hematol 2020 May 15. Epub 2020 May 15.

Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai Tisch Cancer Institute, New York, USA.

CJEM 2020 May 12:1-5. Epub 2020 May 12.

Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON.

Objectives: Acquired methemoglobinemia (MetHb) is an uncommon presentation of cyanosis in the pediatric emergency department (ED), making its diagnosis and management a clinical challenge. Through this case series we hope to improve clinician ability to recognize the potential for MetHb in pediatric ED patients and to avoid overlooking this important cause of cyanosis.

Methods: This was a case series using a health records review, investigating patients diagnosed with MetHb at our pediatric ED during 2007-2018. Read More

EMBO Mol Med 2020 May 11:e11571. Epub 2020 May 11.

MOE Key Laboratory of Tumor Molecular Biology and Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, Jinan University, Guangzhou, China.

Small molecular PD-1 inhibitors are lacking in current immuno-oncology clinic. PD-1/PD-L1 antibody inhibitors currently approved for clinical usage block interaction between PD-L1 and PD-1 to enhance cytotoxicity of CD8 cytotoxic T lymphocyte (CTL). Whether other steps along the PD-1 signaling pathway can be targeted remains to be determined. Read More

Am J Hematol 2020 May 10. Epub 2020 May 10.

Department of Hematology, Amsterdam UMC, location AMC, Amsterdam, the Netherlands.

N Z Med J 2020 May 8;133(1514):88-89. Epub 2020 May 8.

Medicine, Saint Vincent Hospital, United States.

Transfusion 2020 May 1;60(5):932-939. Epub 2020 May 1.

Department of Anesthesiology, Critical Care Medicine, Pain Management and Hyperbaric Medicine, Team Health Research Institute, Englewood Medical Center, Englewood, New Jersey, USA.

Background: Hemoglobin-Based Oxygen Carriers (HBOCs) can act as an "oxygen bridge" in acute severe anemia when transfusion is indicated, but not possible. We present data on 10 Expanded Access (EA) patients treated with high cumulative doses of Hemopure (HBOC-201), to assess the ability of HBOC-201 to safely treat life threatening anemia in situations where high volumes of product were administered over an extended period of time.

Study Design And Methods: Inclusion in this study required that the patient receive at least 10 units of HBOC-201 between 2014 and 2017 under the FDA-sanctioned EA program. Read More

Diagnostics (Basel) 2020 Apr 15;10(4). Epub 2020 Apr 15.

Department of Plastic Surgery, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 46-50 Viilor St., 400347 Cluj-Napoca, Romania.

Methylene blue and proflavine are fluorescent dyes used to stain nucleic acid from the molecular level to the tissue level. Already clinically used for sentinel node mapping, detection of neuroendocrine tumors, methemoglobinemia, septic shock, ifosfamide-induced encephalopathy, and photodynamic inactivation of RNA viruses, the antimicrobial, anti-inflammatory, and antioxidant effect of methylene blue has been demonstrated in different in vitro and in vivo studies. Proflavine was used as a disinfectant and bacteriostatic agent against many gram-positive bacteria, as well as a urinary antiseptic involved in highlighting cell nuclei. Read More

Mol Genet Metab Rep 2020 Jun 16;23:100588. Epub 2020 Apr 16.

Department of Clinical Biochemistry and Metabolic Medicine, Liverpool Clinical Laboratories, Royal Liverpool University Hospitals Trust, Liverpool, UK.

Haemolysis and methaemoglobinaemia (MetHb) are rare metabolic complications that can occur in Alkaptonuria (AKU), for which there is no curative treatment. Presented is a case of a man who had AKU, and serves as a reminder of life-threatening complications that can occur with haemolysis and MetHb. This case presents an opportunity to revisit important considerations relating to the investigation and treatment of haemolysis and MetHb with a view to raising awareness, and in doing so hopefully reducing the uniformly fatal outcome. Read More

Exp Lung Res 2020 May - Jun;46(5):157-161. Epub 2020 Apr 14.

IIAIGC Study center, Burlington, Vermont, USA.

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. Read More

Intern Emerg Med 2020 Apr 10. Epub 2020 Apr 10.

Division of Hematology and Medical Oncology, Saint Vincent Cancer and Wellness Center, 1 Eaton Place, Worcester, MA, 01608, USA.

J Rural Med 2020 Apr 1;15(2):63-64. Epub 2020 Apr 1.

Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Turkey.

Although methemoglobinemia is rare in adulthood, it may have fatal consequences if unnoticed. We planned to implant an implantable cardioverter defibrillator ICD in a 50-year-old male patient for primary prevention. Following sterile draping, prilocaine 5 mg/kg (400 mg) was injected subcutaneously for local anesthesia. Read More

Adv Ther 2020 May 19;37(5):1714-1723. Epub 2020 Mar 19.

Department of Anesthesiology, Louisiana State University Health Sciences Center, Room 656, 1542 Tulane Avenue, New Orleans, LA, 70112, USA.

The objectives of this review are to describe the acquired and hereditary causes of methemoglobinemia, to recommend the most sensitive diagnostic tests, and to enable critical care clinicians to rapidly detect and treat methemoglobinemia. To meet these objectives, Internet search engines were queried with the keywords to select articles for review that included case reports, case series, observational, longitudinal, and surveillance studies. The most common causes of methemoglobinemia include oxidizing reactions to cocaine-derived anesthetics, such as benzocaine and lidocaine, to antibiotics, such as dapsone and other sulfonamides, and to gases, such as nitric oxide. Read More

Clin Med (Lond) 2020 Mar;20(2):221-223

Medical University of Graz, Graz, Austria and Austrian Red Cross, Graz, Austria.

Background: Poppers are nitrite-containing liquids, which are inhaled for their aphrodisiac and hallucinogenic effects. Despite some cases of severe poisonings, poppers are often perceived as harmless by consumers. Inhalation and ingestion of poppers are well known, but, according to our literature review, intravenous abuse has not been reported before. Read More

Int J Environ Res Public Health 2020 03 12;17(6). Epub 2020 Mar 12.

Pediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.

Methemoglobinemia (MET) should be suspected in cases where cyanosis is not associated with signs and symptoms of lung and/or heart disease, or in a cyanotic child exhibiting discrepancies in the partial pressure of oxygen in the arterial blood, the blood oxygen saturation, and the clinical assessment. A 10-month-old girl was taken to the Pediatric Emergency Department for the acute, sudden development of significant peroral cyanosis associated with gray pigmentation of the skin. The problem was evidenced approximately one hour after she ingested a homemade puree of mixed vegetables, mainly composed of potatoes and chards that had been prepared three days before and had been kept in the refrigerator since then. Read More

Int J Biol Macromol 2020 Jul 19;154:188-197. Epub 2020 Mar 19.

Department of Chemistry, The Gandhigram Rural Institute - Deemed to be University, Gandhigram, Dindigul, 624 302, Tamil Nadu, India. Electronic address:

Nitrate and phosphate are primary pollutants of water/wastewaters for eutrophication and methemoglobinemia diseases, harshly threatening the security of aquatic environments and human health as well as all living beings. The present work investigates the adsorption performance and mechanism of lanthanum encapsulated chitosan-kaolin clay (LCK) hybrid composite was prepared and utilized for the remediation of nitrate and phosphate from water. The fabricated LCK hybrid composite was characterized using XRD, SEM, BET, EDAX, TGA-DTA and FTIR analysis. Read More

J Food Biochem 2020 May 9;44(5):e13172. Epub 2020 Mar 9.

State Key Laboratory of Food Nutrition and Safety, Engineering Research Center of Food Biotechnology of Chinese Ministry of Education, Tianjin University of Science and Technology, Tianjin, China.

Nitrite salts are widely presented in food and their hazardous effects have been well documented. In this study, we evaluated the protective capacity of chlorogenic acid (CGA) against sodium nitrite (NaNO -induced damage to rat erythrocytes. Two dosing regimens of CGA were undertaken to alleviate the erythrocyte injury induced by NaNO . Read More

J Paediatr Child Health 2020 Mar 4. Epub 2020 Mar 4.

Emergency Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.

Spectrochim Acta A Mol Biomol Spectrosc 2020 May 19;232:118167. Epub 2020 Feb 19.

Department of Chemistry, University of Calcutta, 92, APC Road, Kolkata 700009, India. Electronic address:

Administration of low doses of nitrates over prolonged periods in patients suffering from coronary heart disease may lead to chronic methemoglobinemia, a disease caused by oxidation of hemoglobin. Previous reports have shown that natural products like curcumin, vitamin E, vitamin C, resveratrol, etc., are capable of inhibition of nitrite induced oxidation of hemoglobin. Read More

Pediatr Surg Int 2020 Apr 22;36(4):523-528. Epub 2020 Feb 22.

The Council of Forensic Medicine, Istanbul, Turkey.

Purpose: To perform a medical evaluation of penile necrosis causes and treatment approaches by examining patients who had penile necrosis after circumcision surgery.

Methods: A total of 24 patients with penile necrosis after circumcision surgery, who presented at various hospitals in Turkey between September 2003 and April 2013 and whose cases were being reviewed at the Institution of Forensic Medicine with regard to malpractice, were evaluated retrospectively.

Results: The mean age of the patients was 5 ± 3. Read More

Chemosphere 2020 Jun 12;249:126193. Epub 2020 Feb 12.

Department of Civil Constructions, Roads, Transportation, Hydraulics and Fluids, Universidad Francisco de Paula Santander, Cúcuta, Colombia. Electronic address:

Propanil can produce methemoglobinemia, hemolytic anemia, hepatotoxicity, metabolic disorder and nephrotoxicity. It also has a genotoxic effect, although it is not listed as a carcinogen and it continues to be applied excessively throughout the world. Consequently, in this study the cytogenotoxic effect of propanil was evaluated, using apical root cells of Allium cepa and Lens culinaris. Read More

Case Rep Emerg Med 2020 30;2020:2058624. Epub 2020 Jan 30.

Department of General Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland.

Background: Alkyl nitrites or "poppers" are widely used as sex-drugs due to their aphrodisiac and muscle relaxant effects. We describe the rare case of a large-sized dermatitis after direct skin contact with the poppers-fluid in a poppers user. . Read More

World J Emerg Med 2020 ;11(2):127-128

Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts 01608, USA.

J Pediatr Pharmacol Ther 2020 ;25(2):167-168

Toxicol Sci 2020 May;175(1):87-97

Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington, London SW7 2AZ, UK.

The metabolic fate, toxicity, and effects on endogenous metabolism of paracetamol (acetaminophen, APAP) in 22 female Landrace cross large white pigs were evaluated in a model of acute liver failure (ALF). Anesthetized pigs were initially dosed at 250 mg/kg via an oroduodenal tube with APAP serum concentrations maintained above 300 mg/l using maintenance doses of 0.5-4 g/h until ALF. Read More

J Endocr Soc 2020 Feb 18;4(2):bvz016. Epub 2019 Nov 18.

Department of Pathology, Queen Elizabeth Hospital, Jordan, Kowloon, Hong Kong.

Isolated 17,20-lyase deficiency may be caused by mutations in the (coding for cytochrome P450c17), (coding for cytochrome P450 oxidoreductase) and (coding for microsomal cytochrome b5) genes. Of these, mutations in the gene have thus far only been described in genetic males who presented with methemoglobinemia and 46,XY disorders of sex development (DSD) due to 17,20-lyase deficiency. A 24-year-old Chinese woman presented to the hematology outpatient clinic with purplish discoloration of fingers, toes, and lips since childhood. Read More

Front Vet Sci 2019 26;6:416. Epub 2019 Nov 26.

Department of Pediatrics, University of Utah, Salt Lake City, UT, United States.

The aim of this feasibility study was to investigate methemoglobin modulation as a potential magnetic resonance imaging (MRI) gadolinium based contrast agent (GBCA) alternative. Recently, gadolinium tissue deposition was identified and safety concerns were raised after adverse effects were discovered in canines and humans. Because of this, alternative contrast agents are warranted. Read More

Environ Sci Pollut Res Int 2020 Apr 8;27(12):14019-14032. Epub 2020 Feb 8.

Department of Biochemistry, Faculty of Medicine, Cairo University, Giza, Egypt.

Nitrites are found in several forms; they are widely found in water resources and used as additives and preservatives for food and as a color source. We investigated the hazardous effects of exposing rats to different doses of nitrites. Moreover, we examined such impacts, after acute ingestion, on liver and renal tissues in rats and to what extent this affects the organs' functions. Read More

Indian J Crit Care Med 2019 Dec;23(Suppl 4):S278-S281

Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Kerosene poisoning is one of the most common accidental poisoning in children in developing countries due common use of kerosene in house-hold and unsafe storage practices. Aspiration pneumonitis is the most common manifestation of kerosene ingestion due to its low viscosity, high volatility, and low surface tension. The treatment of aspiration pneumonitis due to kerosene poisoning is symptomatic including oxygen support, respiratory monitoring, and careful monitoring of fluid balance. Read More

J Assoc Physicians India 2020 Jan;68(1):105

Department of chemistry, University of calcutta.

World J Clin Cases 2020 Jan;8(1):217-221

Department of Neonatology, Children's Hospital of Soochow University, Suzhou 215025, Jiangsu Province, China.

Background: We analyzed the main features of an infant diagnosed with temporary neonatal cyanosis in order to strengthen our understanding of the disease.

Case Summary: We report a patient diagnosed with temporary neonatal cyanosis. The main clinical characteristics, gene mutation and treatment are discussed and a review of related literature was conducted. Read More

BMJ Case Rep 2020 Jan 21;13(1). Epub 2020 Jan 21.

Endocrinology and Diabetes, Royal Free Hospital, Hampstead, London, UK.

Methaemoglobinaemia is an extremely rare condition with multiple causes, both genetic and acquired. We present a severe case of methaemoglobinaemia occurring in a Brazilian hairdresser working in the UK. She presented after several days of preparing popular 'Brazilian blowdry' treatments for customers at a hair salon. Read More

Sci Rep 2020 Jan 21;10(1):845. Epub 2020 Jan 21.

United States Department of Agriculture, Animal and Plant Health Inspection Service, Wildlife Services, National Wildlife Research Center, 4101 Laporte Avenue, Fort Collins, Colorado, 80521, USA.

The invasive brown treesnake (Boiga irregularis) has extirpated much of Guam's native birdlife and poses significant threats to other parts of the western Pacific. Acetaminophen (APAP) is a proven lethal oral toxicant in reptiles but the physiological mechanism is unknown. The effects of a lethal APAP oral dose on methemoglobin (MetHb, non-oxygen carrying form) levels and other blood parameters were examined in brown treesnakes. Read More

N Z Med J 2020 01 17;133(1508):123-126. Epub 2020 Jan 17.

Professor, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Methotrexate monotherapy is a common management strategy in rheumatoid arthritis (RA). Treatment with immunosuppression can lead to opportunistic infections such as Pneumocystis jirovecii pneumonia (PJP). The treatment options for PJP include cotrimoxazole, clindamycin-primaquine and dapsone. Read More

Saudi J Med Med Sci 2020 Jan-Apr;8(1):56-59. Epub 2019 Dec 23.

Department of Pediatrics, Abha Maternity and Children Hospital, Abha, Kingdom of Saudi Arabia.

Methemoglobinemia is an increase in the methemoglobin levels in the blood. Infants are more susceptible to develop secondary methemoglobinemia because of the limited activity of methemoglobin reductase B enzyme. We report a case of life-threatening methemoglobinemia secondary to ingestion of herbal remedy in an infant who presented with cyanosis and severe respiratory distress. Read More

J Forensic Sci 2020 May 10;65(3):1016-1022. Epub 2020 Jan 10.

Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China.

Methyl nitrite is suggested to cause methemoglobinemia by generating methemoglobin, which may be lethal when the methemoglobin concentration exceeds 70%. However, intoxication with methyl nitrite is seldom reported compared with that with other nitrites. Here, we present an industrial accident involving methyl nitrite inhalation during its synthesis process that resulted in three fatalities and one survivor. Read More

Respir Med Case Rep 2020 12;29:100983. Epub 2019 Dec 12.

Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Ireland.

Background: We describe this case of a young gentleman presenting with acute dyspnoea on a background history of known, long-standing asthma. His dramatic presentation, notable for profound hypoxia and cyanosis, led to an unexpected additional diagnosis of type one congenital methaemoglobinaemia.

Case Presentation: A 26-year-old Irish gentleman was transferred urgently to the emergency department resuscitation room with marked cyanosis and tachypnoea. Read More

Hum Mutat 2020 Apr 30;41(4):737-748. Epub 2020 Jan 30.

Department of Haematogenetics, ICMR-National Institute of Immunohaematology, King Edward Memorial Hospital Campus, Mumbai, India.

NADH-cytochrome b5 reductase 3 deficiency is an important genetic cause of recessive congenital methemoglobinemia (RCM) and occurs worldwide in autosomal recessive inheritance. In this Mutation Update, we provide a comprehensive review of all the pathogenic mutations and their molecular pathology in RCM along with the molecular basis of RCM in 21 new patients from the Indian population, including four novel variants: c.103A>C (p. Read More

Prog Transplant 2020 03 2;30(1):71-72. Epub 2020 Jan 2.

Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA.

Adv Exp Med Biol 2020 ;1232:369-374

Department of Physics, Ryerson University, Toronto, Canada.

Multispectral/hyperspectral imaging is one of the imaging modalities to visualize and quantify blood supply in surface tissues such as skin or mucosa. The results of visualization can be potentially affected by various factors, for instance by elevated methemoglobin (MetHb) content (e.g. Read More

Cureus 2019 Nov 27;11(11):e6243. Epub 2019 Nov 27.

Dermatology, San Diego Family Dermatology, San Diego, USA.

This study presents the case of a man who developed a temporary and asymptomatic blue tongue. The dyschromia occurred following topical contact with gelato that contained Food, Drug, and Cosmetic (FD&C) blue dye no. 1. Read More

Pediatr Dermatol 2020 Mar 25;37(2):377-378. Epub 2019 Dec 25.

Children's Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI, USA.

Dapsone gel is a topical treatment for facial acne in adolescents and adults, and while systemic dapsone therapy is known to be associated with methemoglobinemia, once-daily topical dapsone has been well tolerated with few side effects in large randomized controlled trials. We describe the first reported case of severe methemoglobinemia in a healthy adolescent using daily topical dapsone. Although the medication was prescribed for facial use only, the patient reported topical use over her back and chest as well. Read More

Ann Emerg Med 2020 01;75(1):18-48

Department of Emergency Medicine, Maine Medical Center, Portland, ME; Tufts University School of Medicine, Portland, ME.

Am J Emerg Med 2019 Nov 30. Epub 2019 Nov 30.

Department of Internal Medicine, Saint Vincent Hospital, Worcester 01608, MA, United States.

MMW Fortschr Med 2019 12;161(21-22):32

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JAAPA 2019 Dec;32(12):28-30

Michelle Wallace is an associate clinical professor and research coordinator at Wichita State University and practices in the pediatric ED at Wesley Medical Center, both in Wichita, Kan. Caitlin Tenbarge practices at Franciscan Express Care in Indianapolis, Ind. Sofia Harlow practices at Pain & Spine Centers of Florida in Leesburg and Lady Lake, Fla. Nathan Kasting practices at Salina (Kans.) Regional Sports Medicine & Orthopedics. Justin Gooden practices in the pediatric ED at Wesley Medical Center in Wichita, Kans. The authors have disclosed no potential conflicts of interest, financial or otherwise.

Methemoglobinemia is a rare and potentially life-threatening medical emergency that can be overlooked when evaluating a patient in respiratory distress. Without early recognition, patients may develop respiratory failure and die. This article describes a teenager who presented to the ED for dyspnea and lightheadedness and failed to respond to supplemental oxygen. Read More