Repeated atrial arrhythmia induced by cochineal red poisoning:A case report

BACKGROUND Cochineal red is an organic compound widely used in food,cosmetics,pharmaceuticals,textiles,and other fields due to its excellent safety profile.Poisoning caused by eating foods containing cochineal red is rare,and repeated atrial arrhythmia due to cochineal red poisoning is even rarer.CASE SUMMARY An 88-year-old Asian female patient was admitted to hospital due to a disturbance of consciousness.Twelve hours prior to presentation,the patient consumed 12 eggs containing cochineal red over a period of 2 h.At presentation,the patient was in a coma and had a score of 6 on the Glasgow Coma Scale(E2+VT+M4).The patient’s skin and mucous membranes were pink.Electrocardiography(ECG)revealed rapid atrial fibrillation without any signs of ischemia.We prescribed cedilan and fluid replacement for arrhythmia correction.Shortly after admission,the atrial fibrillation corrected to a normal sinus rhythm.On the day 2 of admission,the patient had a sudden atrial flutter accompanied by hemodynamic instability and rapidly declining arterial oxygen saturation between 85%and 90%.The sinus rhythm returned to normal after two electrical cardioversions.Six days after admission,the skin color of the patient returned to normal,and the ECG results were normal.The patient was transferred out of the intensive care unit and eventually discharged after 12 d in hospital.At the 2-mo follow-up visit,the patient was in good health with no recurrence of arrhythmia.CONCLUSION Although cochineal red is a safe,natural food additive,excessive consumption or occupational exposure can induce cardiac arrhythmias.

Acute respiratory distress syndrome following multiple wasp stings treated with extracorporeal membrane oxygenation:A case report

BACKGROUND It is necessary for clinicians to be aware of a rare but possible acute respiratory distress syndrome(ARDS)complication caused by multiple wasp stings.Severe ARDS has a high mortality rate but no specific pharmacotherapies have been identified to date.This case study presents the first case of severe ARDS caused by multiple wasp stings,treated successfully with extracorporeal membrane oxygenation(ECMO).It also emphasizes the effectiveness of early ECMO treatment for severe ARDS with persistent hypoxemia.CASE SUMMARY A 24-year-old woman was admitted to the emergency department after being stung by more than 10 wasps within a 30-min period,with clinical symptoms of multiple rashes,dizziness,chest tightness,nausea,and vomiting.On the 2nd day of admission,the patient developed progressive dyspnea.The patient was diagnosed with ARDS based on clinical manifestations and lung computed tomography(CT)scan.Because of the progressive dyspnea,the intensive care unit physician performed endotracheal intubation and continued to provide ventilator support,but the patient’s respiratory distress worsened,as indicated by the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen.Veno-venous ECMO was initiated for 6 d.On day 7 of admission,ECMO was stopped.On the 11th day of admission,CT scan of the lungs revealed significant reduction of ground-glass opacities and consolidations.After about 2 wk,the patient recovered completely from ARDS and was discharged to home.At the 2-mo follow-up,the patient was in good health with no recurrence of dyspnea nor chest tightness.CONCLUSION ARDS complication caused by multiple wasp stings may be fatal when mechanical ventilation becomes dangerous due to persistent hypoxemia and despite optimization of ARDS management.We propose that the early implementation of ECMO is a relatively effective treatment,although the evidence is relatively limited.

Synthesis, chemical nuclease activity, and in vitro cytotoxicity of benzimidazole-based Cu(Ⅱ)/Co(Ⅱ) complexes

In this study, novel mono/di-nuclear Cu（p-2-bmb）（OH）（Cl O4）（1） and Co2（p-2-bmb）2Cl4（2）（p-2-bmb = 1-（（2-（pyridin-2-yl）-benzoimidazol-1-yl）methyl）-1H-benzotriazole） complexes with the nitrogen heterocyclic benzimidazole-based ligand were synthesized and characterized. The two complexes showed antiproliferative effects in various carcinoma cell lines, especially complex 1 in the SMMC7721 tumor cell line. Complex 1 was also able to pass through the cell membrane and enter the nucleus and mitochondrion. An analysis of in vitro chemical nuclease activity revealed that complex 1 partially intercalated to calf thymus DNA and exhibited strong unwinding activity against p BR322 superhelical plasmid DNA. The comet assay and flow cytometry analysis confirmed that 1 caused extensive DNA damage and arrested SMMC7721 tumor cells at G2/M phase of the cell cycle, leading to loss of mitochondrial membrane potential and apoptosis. These results suggest that these benzimidazole-based metal complexes could be potential anti-cancer agents.