SARS-CoV-2-induced myopathy: Clinical aspects, paraclinical changes, and therapeutic options

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has made a considerable global effect, posing notable challenges for clinicians, the pandemic becoming one of the most imperative international health emergencies lately. Among other more frequent manifestations, SARS-CoV-2 disease may also give rise to skeletal muscle involvement. Viral-induced skeletal muscle involvement is a potentially severe manifestation of COVID-19 (Coronavirus Disease 2019) and may be either acute, or in the context of "long-COVID”. The present review aimed to illustrate few aspects about pathomechanisms, clinical and paraclinical frames, and treatment options for SARS-CoV-2-induced muscle involvement. Notably, it has been stated that SARS-CoV-2 may have the ability to invade muscle myocytes directly, the disease having a variety of clinical manifestations, from myalgia and muscle weakness to rhabdomyolysis. Nevertheless, it is also important to take into account that most of patients with severe forms receiving mechanical ventilation for more than one week may have complications such as CIM (critical illness myopathy) and/or CIP (critical illness polyneuropathy) that may be clinically similar to SARS-CoV-2-induced myositis, yet may be differentiated paraclinically from it. Additionally, it was hypothesized that SARS-CoV-2 infection may constitute a trigger for autoimmune diseases such as polymyositis/ dermatomyositis. Presently, there are no diagnosis criteria and no specific therapeutic strategy for SARS-CoV-2-induced myositis. © 2022, Amaltea Medical Publishing House. All rights reserved.

Cool Your Jets Bro

History: Twenty-two year old male basic trainee was brought to the ED after collapsing during a routine ruck march. At mile 8/12, soldier was noted to develop an unsteady gate and had witnessed loss of consciousness. A rectal core temperature was obtained and noted to be >107degreeF. Cooling initiated with ice sheets and EMS was activated. On arrival to the ED, patient demonstrated confusion and persistently elevated core temperatures despite ice sheeting, chilled saline and cold water bladder lavage. Cooling measures were discontinued after patient achieved euthermia in the ED;however, his temperatures subsequently spiked>103degreeF. Given rebound hyperthermia, an endovascular cooling (EVC) device was placed in the right femoral vein and patient was transferred to the ICU. Multiple attempts to place EVC device on standby were unsuccessful with subsequent rebound hyperthermia. Prolonged cooling was required. Physical Exam: VS: HR 121, BP 85/68, RR 22 SpO2 100% RA, Temp 102.4degreeF Gen: young adult male, NAD, shivering, A&Ox2 (person and place only) HEENT: Scleral anicteric, conjunctiva non-injected, moist mucus membranes Neck: Supple, no LAD Chest: CTAB, no wheezes/rales/rhonchi CV: tachycardia, regular rhythm, normal S1, S2 without murmurs, rubs, gallops ABD: NABS, soft/non-distended, no guarding or rebound EXT: No LE edema, tenderness SKIN: blisters with broad erythematous bases on bilateral heels Neuro: CN II-XII grossly intact, 5/5 strength in all extremities. Differential Diagnosis: 216. Septic Shock 217. Hypothalamic Stroke 218. Exertional Heat Stroke (EHS) 219. Neuroleptic Malignant Syndrome 220. Thyroid Storm Test Results: CBC: 18.2>14.5/40.6<167 CMP: 128/3.5 88/1831/2.7<104, AST 264, ALT 80, Ca 8.8 Lactate: 7.1 CK: 11 460 Myoglobin: 18 017 TSH: 3.16 CXR: No acute cardiopulmonary process Blood Cx: negative x2 CSF Cx: Negative COVID/Influenza/EBV: Negative Brain MRI: wnl. Final Diagnosis: Exertional Heat Stroke. Discussion(s): No EVC protocols exist for the management of EHS or rebound/refractory hyperthermia. As a result, the protocol used for this patient was adapted from post-cardiac arrest cooling protocols. It is unclear if this adapted protocol contributed to his delayed cooling and rebound hyperthermia as it was not intended for this patient demographic/ pathophysiology. Furthermore, despite initiating empiric antibiotics upon admission, delayed recognition and tailored therapy for his bilateral ankle cellulitis may have contributed to the difficulty in achieving euthermia. In summary, more research needs to be done to evaluate and develop an EVC protocol for EHS. Outcome(s): Euthermia was achieved and maintained after 36 hours of continuous EVC, at which point it was discontinued. His CK, AST/ALT, creatinine and sodium down-trended after discontinuation of EVC. Patient's antibiotics were transitioned to an oral formulation for treatment of ankle cellulitis and he was prepared for discharge. He was discharged with regular follow-up with the Fort Benning Heat Clinic. Follow-Up: After discharge, patient had regularly scheduled visits with the Fort Benning Heat Clinic. His typical lab markers for exertional heat stroke were regularly monitored. He had continued resolution of his Rhabdomyolysis, acute kidney injury and hyponatremia with typical treatment. Soldier returned to duty after 10 weeks of close monitoring and rehabilitation.

A Systematic Review of New Rheumatic Immune-Mediated Inflammatory Diseases (R-Imid) Following Sars-Cov-2 Vaccinations

Background/Aims There are sporadic reports about the development of new rheumatic immune-mediated inflammatory diseases (R-IMIDs) in adults after receiving SARS-CoV-2 vaccines. This systematic review (SR) aimed to critically review and summarize the clinical profile, patient demographics, treatment, and prognosis of new-onset R-IMIDs following SARS-CoV-2 vaccination. Methods We retrieved English-language articles (Case reports and series and observational studies) on new-onset R-IMIDs following SARS-CoV-2 vaccination, published until June 2022, from standard databases (MEDLINE, Embase, Cochrane). The search strings used during the literature search incorporated 'SARS-CoV-2 vaccination' (along with related MeSH terms) and various key terms for R-IMIDs [which included (but was not limited to) inflammatory arthritis, connective tissue disease (CTD), vasculitis, systemic lupus erythematosus, Sjogren's syndrome, sarcoidosis, systemic sclerosis, idiopathic inflammatory myositis, anti-synthetase syndrome, Adult-onset Stills disease (AOSD), giant cell arteritis (GCA), and polymyalgia rheumatica (PMR)]. The protocol was registered in PROSPERO (CRD42022318561). Results Of the total 2179 articles retrieved, 1986 articles were excluded following the title- screening, and 107 articles that did not meet inclusion criteria. We included the remaining 86 articles (130 cases) upon full-text screening. Furthermore, we added four articles (six cases) based on a manual search, comprising 90 articles (136 cases) for final analysis. These 136 new R-IMID cases were reported from 27 different countries. Of these, more than one-third of the cases were reported from three countries (viz., Italy, Japan, and the USA). The patients had a mean age of 57 (range:17-90) years, and the majority were females (63.0%). Most patients developed R-IMIDs after receiving Pfizer-BioNTech vaccine (76;55%), followed by Oxford AstraZeneca vaccine (35;25%). The mean duration between SARSCoV- 2 vaccination and R-IMIDs development was 9.2 (range:1-90) days. The second dose of the vaccine resulted in more R-IMIDs (74;54%) than the first (53;39%). CTDs (34;25%) and small vessel vasculitis (33;24%) were the commonest R-IMID manifestations, followed by inflammatory arthritis and AOSD, each in 13 (9.5%) cases. Nearly half of the patients with CTDs had Idiopathic Inflammatory Myositis. PMR and GCA accounted for 16 (11.7%) and 5 (3.6%) cases, respectively. However, no cases of axial spondylarthritis were reported. Most (118;86%) R-IMID patients were treated with corticosteroids, with a small number receiving steroid-sparing drugs, such as methotrexate, rituximab and cyclophosphamide. Most (125;91%) went into either disease remission or improvement following the treatment. Only three patients were admitted to the intensive care unit (ICU) to manage their disease;One of them died due to fatal myositis and rhabdomyolysis;two surviving ICU patients had ANCA-associated vasculitis with lung involvement. Conclusion Although rare, this SR highlights the emergence of de novo R-IMIDs following SARS-CoV-2 vaccination. We cannot confirm the causality between the vaccination and the onset of R-IMID. However, further research is warranted in this area.

A severe case of rhabdomyolysis after Moderna mRNA anti-COVID-19 vaccine with a literature review.

The identification of rhabdomyolysis as a potential fatal adverse reaction to recent COVID-19 vaccines is essential. As the symptoms of rhabdomyolysis are not specific, the threshold to actively search for this complication should be low.

The Complexities of Managing Hypertriglyceridemia-Induced Pancreatitis in a Critically-Ill COVID-19 Patient

Introduction: Hypertriglyceridemia-induced pancreatitis (HTP) is a variant of pancreatitis requiring unique management. The complications of COVID-19 and its treatments can make HTP therapy more nuanced. This case describes a patient who presented in diabetic ketoacidosis (DKA) with HTP, and COVID-19. The patient developed renal and respiratory failure, necessitating hemodialysis (HD) and extracorporeal membrane oxygenation (ECMO), complicating an otherwise straightforward medical management plan. Case Description: A morbidly obese (BMI 38.9 kg/m2) 43-year-old male presented to an outside hospital with abdominal pain, and vomiting, and was found to have HTP with triglycerides (TG) >2000 mg/dL (<149 mg/dL) and presumed new-onset type 2 Diabetes (HbA1c 10.9%) with DKA. Treatment with fluids, intravenous (IV) insulin infusion and plasmapheresis were initiated. He developed hypoxia after receiving over 17 liters of fluids and was intubated, subsequently developing renal failure and was transferred to our tertiary center for HD and ECMO. On admission, he tested positive for COVID-19, rhabdomyolysis [creatinine kinase 5600 U/L (30-200 U/L)], HTP [TG 783 mg/dL (<149 mg/dL), lipase 461 U/l (7-60 U/L)], glucose 269 mg/dL (not in DKA), transaminitis [AST 184 U/L (4-40 U/L), ALT 61 U/L (4-41 U/L)] and renal failure (GFR 10 ml/min/1.73m2). IV insulin infusion was initiated for hyperglycemia worsened by COVID-19 dexamethasone treatment. Plasmapheresis was performed twice with minimal effect at maintaining a low TG. Fenofibrate was not initiated due to renal failure;Lovaza could not be given via oral gastric tube;Atorvastatin was attempted once rhabdomyolysis resolved, with subsequent worsening of liver function tests. Heparin infusion was initiated for deep vein thrombosis treatment and HTP but was stopped after development of heparin induced thrombocytopenia. The patient developed worsening hypoglycemia requiring cessation of IV insulin, hypotension requiring maximum pressor support, and worsening sepsis leading to his death. Discussion(s): This case illustrates the challenges of managing a patient with HTP and COVID-19. It demonstrates how a normally straightforward treatment algorithm can become increasingly complex when factoring the patient's comorbid conditions. The case highlights the importance of knowing both treatment indications and contraindications for HTP. In this case, HTP may have been the initial diagnosis, straightforward for most endocrinologists, but its treatments and comorbid conditions ultimately made the landscape more challenging, limiting effective management and ultimately leading to this patient's demise.Copyright © 2023

Rhabdomyolysis in Critically Ill Patients With COVID-19: A Retrospective Study.

INTRODUCTION: The total number of ICU admissions for COVID-19 patients has increased steadily. Based on the research team's clinical observations, many patients developed rhabdomyolysis, but few cases were reported in the literature. This study explores the incidence of rhabdomyolysis and its outcomes, like mortality, the need for intubation, acute kidney injury, and the need for renal replacement therapy (RRT). METHODS: We retrospectively reviewed the characteristics and outcomes of patients admitted to the ICU at a COVID-19-designated hospital in Qatar between March and July 2020. Logistic regression analysis was used to determine factors associated with mortality. RESULTS: 1079 patients with COVID-19 were admitted to the ICU, and 146 developed rhabdomyolysis. Overall, 30.1% died (n = 44), and 40.4% developed Acute Kidney Injury (AKI) (n = 59), with only 19 cases (13%) recovering from the AKI. AKI was significantly associated with increased mortality rates among rhabdomyolysis patients. Moreover, significant differences were found between groups regarding the subject's age, calcium level, phosphorus level, and urine output. However, the AKI was the best predictor of mortality for those who got the COVID-19 infection and rhabdomyolysis. CONCLUSION: Rhabdomyolysis increases the risk of death in COVID-19 patients admitted to the ICU. The strongest predictor of a fatal outcome was acute kidney injury. The findings of this study emphasize the importance of early identification and prompt treatment of rhabdomyolysis in patients with severe COVID-19.

Severe rhabdomyolysis secondary to COVID-19 mRNA vaccine in a teenager.

BACKGROUND: Rhabdomyolysis, the breakdown of skeletal muscles following an insult or injury, has been established as a possible complication of SARS-CoV-2 infection. Despite being highly effective in preventing COVID-19-related morbidity and mortality, several cases of COVID-19 mRNA vaccination-induced rhabdomyolysis have been identified. We provide the second description of a pediatric case of severe rhabdomyolysis presenting after COVID-19 mRNA vaccination. CASE: DIAGNOSIS/TREATMENT: A 16-year-old male reported to the emergency department with a 2-day history of bilateral upper extremity myalgias and dark urine 2 days after his first dose of COVID-19 vaccine (Pfizer-BioNtech). The initial blood work showed an elevated creatinine kinase (CK) of 141,300 units/L and a normal creatinine of 69 umol/L. The urinalysis was suggestive of myoglobinuria, with the microscopy revealing blood but no red blood cells. Rhabdomyolysis was diagnosed, and the patient was admitted for intravenous hydration, alkalinization of urine, and monitoring of kidney function. CK levels declined with supportive care, while his kidney function remained normal, and no electrolyte abnormalities developed. The patient was discharged 5 days after admission as his symptoms resolved. CONCLUSION: While vaccination is the safest and most effective way to prevent morbidity from COVID-19, clinicians should be aware that rhabdomyolysis could be a rare but treatable adverse event of COVID-19 mRNA vaccination. With early recognition and diagnosis and supportive management, rhabdomyolysis has an excellent prognosis.

Severe rhabdomyolysis in an infant with Multisystem Inflammatory Syndrome Related to COVID-19 (MIS-C)

Introduction: A case of severe rhabdomyolysis associated with multisystem inflammatory syndrome related to COVID-19 (MIS-C). Case of report: is presented in a one-year 10-month-old boy who presented digestive symptoms, myalgia, weakness, fever, and dark urine. COVID-19 IgM (-) IgG (+) serological test, COVID-19 PCR negative. Initial creatine kinase (CK) presented non-dosable values, with the highest reported level being 517,600 U/L. The creatinine value remained normal throughout the hospitalization. He received human immunoglobulin 2 g/Kg, Methylprednisolone 10 mg/Kg/d, and acetylsalicylic acid to manage MIS-C. Aggressive hydration and urine alkalinization were provided to manage rhabdomyolysis. Conclusion: Positive evolution with discharge after ten days. Few reported cases of rhabdomyolysis are associated with MIS-C and none with such high CK values. Based on the possible complications, performing CK dosing in all patients with MIS-C is suggested routinely.

COVID-19 and Severe Rhabdomyolysis Causing Acute Kidney Injury and Life-Threatening Hyperkalemia in a Pediatric Patient: a Case Report.

Though initially believed to primarily be a respiratory pathogen, the SARS-CoV-2 virus has manifested as a virus that has the potential to affect multiple organ systems causing a wide variety of disease and symptomatology. Children have been largely spared in comparison to adult morbidity and mortality; however, acute pediatric illness secondary to COVID-19 infection has become both more common and more serious. Here, we present a teenager with acute COVID-19 who presented to the hospital with profound weakness and oliguria and was discovered to have severe rhabdomyolysis causing life-threatening hyperkalemia and acute kidney injury. He required treatment with emergent renal replacement therapy in the intensive care unit. His initial CK was 584,886 U/L. Creatinine was 14.1 mg/dL and potassium was 9.9 mmol/L. He was successfully treated with CRRT and was discharged on hospital day 13 with normal kidney function on follow-up. Rhabdomyolysis and acute kidney injury are increasingly recognized as complications of acute SARS-CoV-2 infection and require vigilance given the potentially fatal complications and long-standing morbidity associated with these conditions.

Acute Intermittent Porphyria Attack Triggered by COVID-19 Infection.

A 45-year-old male patient who was diagnosed with acute intermittent porphyria (AIP) four years ago and had his last episode two years prior presented to our clinic with an AIP attack complicated with rhabdomyolysis triggered by coronavirus disease 2019 (COVID-19) infection. Although there are well-known factors that might trigger an AIP attack, some studies also showed an association of COVID-19 with porphyria. These studies suggest that the accumulation of by-products in the heme synthesis pathway during COVID-19 infection may cause attacks mimicking acute intermittent porphyria. In respect to that, in the early phases of the pandemic, hypotheses emerged arguing the treatment of severe COVID-19 infections with hemin as the treatment of an AIP attack. In our instance, after a two-year period during which there had not been an episode, there was no evident cause other than COVID-19 infection. We believe that patients with porphyria are particularly prone to exacerbations during a COVID-19 infection and should be monitored carefully.

Intra-hospital complications during SARS-CoV2 infection

Introduction: The SARS-CoV2 virus has a respiratory tropism. Although pulmonary complications are most often in the foreground, other complications affecting other organs have been observed and associated with a greater bad prognosis. The aim of this work was to report the various complications observed in patients hospitalized with COVID-19 pneumonia. Method(s): We carried out a retrospective study from the records of patients treated for pneumonia COVID-19 hospitalized between March 2020 and July 2021. Result(s): We collected 578 patients aged between 18 and 98 years old. Thoracic complications were dominated by bronchial superinfection(4.3%), pericarditis(3.3%), pneumomediastinum(1.2%) and pneumothorax(0.8%). Among the thromboembolic complications, we counted 30 pulmonary embolisms(5.2%), 7 acute limb ischemia (1.2%), 2 strokes(0.3%) and 1 venous thrombosis deep(0.1%). Cardiac arrhythmias were observed in 6% of cases. Bradycardia sinusitis was observed in 14 patients (2.4%) and first degree atrioventricular block in 4 patients (0.7%). Acute heart failure occurred in 31 patients (5.3%). Neurological disorders were observed in 23 patients with agitation (4%) and hallucinations (1%). Acute renal failure was the most common metabolic complication (20%) followed by rhabdomyolysis (28%) and cytolysis hepatic (36%). Two patients presented with diabetic ketoacidosis (0.3%). Complications cardiac, neurological and renal were associated with a worse prognosis (p=0.001) and the pulmonary complications with longer hospitalization (p=0.01). Conclusion(s): SARS-CoV2 infection is a polymorphic disease. Identification of the different complications respiratory and extra respiratory is essential for rapid multidisciplinary care.

Predictive factors of mortality in hospitalized patients with 2019 novel coronavirus pneumonia

Hospitalized COVID-19 patients had variable clinical progression. Identifying factors associated with mortality is necessary to improve use of medical resources in order to reduce in-hospital death. We aimed to identify factors associated with mortality in patients admitted with severe SARS-CoV-2 pneumonia. We conducted a retrospective study including patients with laboratory-confirmed COVID-19 infection hospitalized in the pulmonology department B of Abderrahmen Mami hospital between October, 2020 and August 2021. Of the 577 patients included, 457were discharged (79,2%) and 93 died (16,1%). The median age was 63 years (range 18 - 98 years). Male gender and age>65 years were associated with mortality (p<0.001 and p=0,01 respectively). A third of patients had oxygen requirements> 10 liters per minute in admission (75% in the worsening group, p<0.001). Admission lab values related with mortality were higher C-reactive protein (p=0.003), white blood cell count(p=0.02), neutrophil to lymphocyte ratio (NLR)(p<0.001), acute renal injury(p<0.001)and rhabdomyolysis(p<0.001). Multivariate analysis showed that male gender (OR: 1.8, CI: 1.02-3.1, p=0.04), high oxygen requirements in admission (OR:8.6, CI: 4.6-16, p<0.001), high NLR (OR:1.05, CI:1.01-1.1, p=0.02) and acute renal injury (OR:2.2, CI:1.2-4.1, p=0.001) were independent factors associated with mortality. Male gender, high oxygen requirements in admission, high NLR and acute renal injury were associated with greater risk of death from COVID-19 pneumonia. These findings could help clinicians to identify patients with poor prognosis at an early stage.

Neurologic Manifestations of COVID-19.

Coronavirus disease (COVID-19) caused by a new coronavirus, SARS-CoV-2, has become a serious health problem throughout the world. Although COVID-19 primarily presents as an acute respiratory tract infection, many neurological findings have also been described in patients. Neurological findings are classified into three groups as central, peripheral nervous system and musculoskeletal system. The most common central nervous system symptom is headache. Encephalitis, encephalopathy, seizures, acute ischemic stroke are also seen. The most common symptoms in the peripheral nervous system are loss of smell and taste. Myalgia, myositis and rhabdomyolysis also can be seen in musculoskeletal system involvement. Awareness of the neurological symptoms by physicians will be beneficial in early diagnosis and treatment of the disease.Copyright © 2022 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.

Rhabdomyolysis Following Administration of Comirnaty®.

INTRODUCTION: Vaccination against COVID-19 is essential to control the pandemic. The vaccines developed so far have good safety profiles but full knowledge of adverse effects will only be acquired with time and through case reports. CASE DESCRIPTION: We present the case of a man admitted with rhabdomyolysis 3 days after receiving his first dose of the Pfizer coronavirus vaccine Comirnaty® Other traumatic, infectious, endocrine, electrolyte disturbance and autoimmune causes of rhabdomyolysis were excluded. The temporal relationship between vaccine administration and disease onset indicated possible causality. The patient had a favourable evolution after receiving fluids and completely recovered. To our knowledge, there have been only 69 reports of rhabdomyolysis following Comirnaty® administration in Europe, as stated by the European Medicines Agency, and this is the first case report in Portugal. DISCUSSION: When a patient presents with rhabdomyolysis without an obvious traumatic or exertional cause, other aetiologies need to be excluded. Drug use is one of the most common causes of rhabdomyolysis in adults. CONCLUSION: We present a case compatible with an adverse effect of Comirnaty® in order to raise awareness of this condition in vaccinated patients. LEARNING POINTS: Rhabdomyolysis is frequently due to pharmacological causes.COVID-19 vaccines are safe but their adverse effects have not yet been fully elucidated and more case reporting would be beneficial.Rhabdomyolysis secondary to administration the Pfizer anti-COVID-19 vaccine Comirnaty® can be a severe adverse effect and should be considered in the relevant clinical scenario.

SARS-CoV-2 Infection with Associated Rhabdomyolysis and Probable Myocarditis.

We describe a patient with SARS-CoV-2 and severe pneumonia who required mechanical ventilation and developed associated rhabdomyolysis with probable myocardial involvement as evidenced by cardiac enzyme abnormalities and echocardiographic findings. Repeat testing should be done in cases highly suspicious for SARS-CoV-2 as initial molecular tests may be negative, as in our case. LEARNING POINTS: SARS-CoV-2 infection may be associated with rhabdomyolysis and myocarditis.Negative results for SARS-CoV-2 despite a clinical presentation suggestive of COVID-19 disease should be treated with caution.Drugs known to cause rhabdomyolysis and myocarditis should be carefully reviewed when treating SARS-CoV-2 patients.

The importance of considering rhabdomyolysis as the underlying cause of myalgia in patients with COVID-19: A case report

Objective: Since the identification and spread of the novel coronavirus disease 2019 (COVID-19) in December 2019, respiratory presentations have been introduced as the main symptoms of this new type of viral disease;however, the extra-pulmonary features are raising awareness for researchers due to the vast diversity of vital organs affected by the virus. Among the wide range of clinical manifestations, limited data are available regarding rhabdomyolysis (RML) in COVID-19. Case Presentation: In this report, we present a 58-year-old woman with COVID-19 presenting with RML, with extremely elevated creatinine phosphokinase (CPK) and lactate dehydrogenase (LDH) levels (3283 and 1280 U/L, respectively) as the second sign of disease. Since the onset of the COVID-19 pandemic, several COVID-19 induced RML cases have been reported, and timely diagnosis and proper management are of paramount importance. Conclusion: Due to the findings that rhabdomyolysis can be a critical and missed cause of myalgia in COVID-19 patients, the importance of checking the serum level of CPK in patients with myalgia and fatigue in the era of COVID-19 upon their arrival will be highlighted. © 2023 The Author(s).

Ultrasmall and highly biocompatible carbon dots derived from natural plant with amelioration against acute kidney injury.

BACKGROUND: Acute kidney injury (AKI) refers to a tricky clinical disease, known by its high morbidity and mortality, with no real specific medicine for AKI. The carbonization product from Pollen Typhae (i.e., Pu-huang in China) has been extensively employed in clinic, and it is capable of relieving the renal damage and other diseases in China since acient times. RESULTS: Inspired by the carbonization process of Traditional Chinese Medicine (TCM), a novel species of carbon dots derived from Pollen Typhae (PT-CDs) was separated and then collected using a one-pot pyrolysis method. The as-prepared PT-CDs (4.85 ± 2.06 nm) with negative charge and abundant oxygenated groups exhibited high solubility, and they were stable in water. Moreover, the rhabdomyolysis (RM)-induced AKI rat model was used, and it was first demonstrated that PT-CDs had significant activity in improving the level of BUN and CRE, urine volume and kidney index, and histopathological morphology in RM-induced AKI rats. It is noteworthy that interventions of PT-CDs significantly reduced degree of inflammatory reaction and oxidative stress, which may be correlated with the basial potential mechanism of anti-AKI activities. Furthermore, cytotoxicity assay and biosafety evaluation exhibited high biocompatibility of PT-CDs. CONCLUSION: This study offers a novel relieving strategy for AKI based on PT-CDs and suggests its potential to be a related candidate for clinical applications.

Spectrum of toxicity due to pheniramine overuse in a COVID-19 patient. How much do we know?

Pheniramine maleate is an easily accessible, potent antihistaminic compound used for the treatment of various allergic conditions. It acts on histamine one (H1) receptors on the central nervous system (CNS) and the peripheral tissues. It is a safe drug in therapeutic doses. However, overdoses as in suicidal cases, can result in serious, life-threatening drug-toxicity. These include atropine-like antimuscarinic effects like dryness of mucosal membranes, blurring of vision, hallucinations, CNS excitation such as irritability, insomnia, and seizures. Rhabdomyolysis can also occur as a result of its direct toxic effect on muscles, resulting in myoglobinuria, renal failure and electrolyte imbalance. Cardiotoxicity though rare, is also reported. We report a case of pheniramine maleate induced ventricular tachycardia, myoglobinuria with acute kidney injury (AKI) in a 20-year-old man who had consumed 50 tablets. He was incidentally also found to have SARS-CoV2 infection. However, timely intervention and aggressive supportive therapy helped in the recovery of the patient.