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Baby boy blue … and mommy too! A rare case of methaemoglobinaemia presenting simultaneously in a mother-neonate pair

Foong SC, Hwang YC, Foong WC, Tan ML

Med J Malaysia, 2021 Nov;76(6):924-926.
PMID: 34806687

Methaemoglobinaemia occurs when there is >1% methaemoglobin in erythrocytes. In an infant, they can present either congenitally or in an acquired form. We present a rare case of methaemoglobinaemia presenting simultaneously in a mother and infant pair. The mother and infant were discharged well on Day-4 post-delivery with both mother and baby recording oxygen saturation levels of 100%. On Day-7, during a routine clinic visit, they were incidentally found to be centrally cyanosed. There were no other abnormalities. On investigation, the methaemoglobin levels were elevated in the infant (23.9%) and mother (14.3%). Treatment with ascorbic acid normalised mother's methaemoglobin levels; but baby's levels remained high until the administration of oral methylene blue. Both baby and mother remained well and pink at last follow-up at 2 years 8 months of age. This case illustrates difficulties in ascertaining the cause of methaemoglobinaemia. Postdelivery, the mother-neonate pair were pink, and their haemoglobin electrophoresis were normal, hence it was unlikely to be congenital methaemoglobinaemia. The team could not identify any triggering factors for acquired methaemoglobinaemia. There was also the uncertainty of the necessity to treat the baby. This is because treatment is not without harmful effects and despite the high methaemoglobin levels, the infant was otherwise well. Only a single published paper recommended that high methaemoglobin levels must be treated, and the recommendation was not supported by evidence. Lessons learnt from our case are that neonates with methaemoglobinaemia can be safely treated with oral methylene blue, but more research is needed on the benefitrisk profile of treatment.
Hydrogen fluoride (HF) substance flow analysis for safe and sustainable chemical industry

Kim J, Hwang Y, Yoo M, Chen S, Lee IM

Environ Sci Pollut Res Int, 2017 Nov;24(32):25137-25145.
PMID: 28924945 DOI: 10.1007/s11356-017-0152-6

In this study, the chemical substance flow of hydrogen fluoride (hydrofluoric acid, HF) in domestic chemical industries in 2014 was analyzed in order to provide a basic material and information for the establishment of organized management system to ensure safety during HF applications. A total of 44,751 tons of HF was made by four domestic companies (in 2014); import amount was 95,984 tons in 2014 while 21,579 tons of HF was imported in 2005. The export amount of HF was 2180 tons, of which 2074 ton (China, 1422 tons, U.S. 524 tons, and Malaysia, 128 tons) was exported for the manufacturing of semiconductors. Based on the export and import amounts, it can be inferred that HF was used for manufacturing semiconductors. The industries applications of 161,123 tons of HF were as follows: manufacturing of basic inorganic chemical substance (27,937 tons), manufacturing of other chemical products such as detergents (28,208 tons), manufacturing of flat display (24,896 tons), and manufacturing of glass container package (22,002 tons). In this study, an analysis of the chemical substance flow showed that HF was mainly used in the semiconductor industry as well as glass container manufacturing. Combined with other risk management tools and approaches in the chemical industry, the chemical substance flow analysis (CSFA) can be a useful tool and method for assessment and management. The current CSFA results provide useful information for policy making in the chemical industry and national systems. Graphical abstract Hydrogen fluoride chemical substance flows in 2014 in South Korea.
Catalytic removal of 2-butanone with ozone over porous spent fluid catalytic cracking catalyst

Hwang Y, Kim YM, Lee JE, Rhee GH, Show PL, Andrew Lin KY, et al.

Environ Res, 2023 Feb 15;219:115071.
PMID: 36528046 DOI: 10.1016/j.envres.2022.115071

To remove harmful volatile organic compounds (VOCs) including 2-butanone (methyl ethyl ketone, MEK) emitted from various industrial plants is very important for the clean air. Also, it is worthwhile to recycle porous spent fluid catalytic cracking (SFCC) catalysts from various petroleum refineries in terms of reducing industrial waste and the reuse of discharged resources. Therefore, Mn and Mn-Cu added SFCC (Mn/SFCC and Mn-Cu/SFCC) catalysts were prepared to compare their catalytic efficiencies together with the SFCC catalyst in the ozonation of 2-butanone. Since the SFCC-based catalysts have a structure similar to that of zeolite Y (Y), the Mn-loaded zeolite Y catalyst (Mn/Y) was also prepared to compare its activity for the removal of 2-butanone and ozone to that of the SFCC-based ones at room temperature. Among the five catalysts of this study (Y, Mn/Y, SFCC, Mn/SFCC, and Mn-Cu/SFCC), the Mn-Cu/SFCC and Mn/SFCC catalysts showed the better catalytic decomposition activity than the others. The increased distributions of the Mn3+ species and the Ovacancy sites in Mn/SFCC and Mn-Cu/SFCC catalysts which could supply more available active sites for the 2-butanone and ozone removal would enhance the catalytic activity of them.
Fulltext Global Impact of COVID-19 on Stroke Care and IV Thrombolysis

Nogueira RG, Qureshi MM, Abdalkader M, Martins SO, Yamagami H, Qiu Z, et al.

Neurology, 2021 Jun 08;96(23):e2824-e2838.
PMID: 33766997 DOI: 10.1212/WNL.0000000000011885

OBJECTIVE: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods.
METHODS: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases.
RESULTS: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions.
CONCLUSIONS: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.