Methylene blue, Prussian blue, da hydroxocobalamin: magungunan kawar da guba uku don matsaloli daban-daban

Magunguna uku suna da kalmar launi a sunayensu, amma kusan babu wani abu dabam da ya haɗa su. Methylene blue rini ne mai launin shuɗi da ke shiga halayen oxidation da reduction. Prussian blue tsarin kristal ne mai launin shuɗi. Hydroxocobalamin, wanda ake sayarwa da sunan Cyanokit, sinadari ne mai launin ja da ake sauyawa zuwa bitamin B12. Mai karatu da ya haɗa su bisa sunayensu zai yi tsammanin suna yin aiki iri ɗaya. Ba haka ba ne. Kowane ɗaya an samar da shi bisa wata fahimta dabam ta abin da ya lalace a jiki, kuma kowannensu ba ya aiki a wajen wannan iyaka.

Bayanin dangantakar yana da sauƙi. Methylene blue yana maido da aikin hemoglobin da oxidation ya hana aiki. Hydroxocobalamin yana ɗaure cyanide kai tsaye. Prussian blue yana kama cesium mai fitar da radiation da thallium a cikin hanji domin jiki ya fitar da su. Launi shi ne abin da ake gani a waje. Hanyar aikin da ke ƙarƙashinsa ita ce ainihin fahimtar maganin, kuma haɗa abin da ake gani da yadda maganin yake aiki shi ne tushen ruɗanin.

Wannan kwatanci ne don ilimantarwa, ba jagorar jiyya ba. Zargin methemoglobinemia, fuskantar cyanide, fuskantar carbon monoxide, ko gurɓacewa da sinadaran da ke fitar da radiation yanayi ne na gaggawa. Kira masu ba da agajin gaggawa kuma bi shawarar cibiyar kula da guba ta yankinku maimakon ɗaukar mataki bisa labari.

Methylene blue: mai miƙa electrons don maido da aikin hemoglobin

Hemoglobin na al'ada yana ɗaukar oxygen ta ƙarfe a yanayin ferrous, Fe2+. A methemoglobinemia, oxidation ya sauya wannan ƙarfe zuwa yanayin ferric, Fe3+, wanda ba zai iya ɗaure oxygen ba. Jini na iya zama ruwan kasa irin na cakulan. Auna oxygen da na'urar pulse oximetry ta yau da kullum na iya ba da sakamako mai ruɗarwa. Marar lafiya yana da ƙarancin hemoglobin mai aiki duk da cewa iska tana shiga da fita daga huhunsa.

Methylene blue yana aiki a nan saboda yana miƙa electrons, kamar yadda aka bayyana a bayanin yadda methylene blue ke motsa electrons tsakanin masu bayarwa da masu karɓa. A cikin jajayen ƙwayoyin jini, ana sauya shi ta hanyar reduction zuwa leucomethylene blue ta wata hanya da ta dogara da NADPH, sannan wannan nau'in da aka sauya yana miƙa electrons ga ƙarfen ferric ba tare da aikin enzyme ba, ya mayar da shi zuwa yanayin ferrous. Rinin yana ci gaba da zagayawa maimakon a cinye shi. Wannan hanyar aiki ita ce dalilin da ya sa amfani da methylene blue wajen methemoglobinemia hanya ce ta asibiti da ake auna matakai tare da lura da martanin jiki, ba tsarin jiyya na gida ba.

Bayanin maganin methylene blue na yanzu ya ayyana amfanin da aka amince da shi a matsayin methemoglobinemia da aka samu daga baya a manya da yara, tare da daidaitaccen adadin magani na 1 mg ga kowace kg ga manya da yara, ta jijiya cikin mintuna 5 zuwa 30, da yiwuwar maimaita shi sau ɗaya idan matakan ko alamomin sun ci gaba. An bayyana iyakokin adadin magani, ƙa'idojin maimaitawa, da lokacin da ya dace a koma wata hanyar jiyya a bayanin maganin methylene blue na yanzu, kuma an tattauna tambayoyin amfani game da hanyar ba da shi da sa ido a bayanin yadda ake ƙayyade adadin methylene blue da sa ido a kansa.

Iyakoki uku suna da muhimmanci. Na farko, ƙarancin glucose-6-phosphate dehydrogenase dalili ne da aka ayyana na hana amfani da maganin, saboda samar da NADPH da ake buƙata don reduction na rinin yana da matsala; hakan yana hana maganin aiki kuma yana ƙara haɗarin lalacewar jajayen ƙwayoyin jini. Na biyu, methylene blue yana hana aikin monoamine oxidase A a matakan nanomolar, don haka ba da shi tare da SSRIs, SNRIs, MAOIs, da wasu opioids da dama yana ɗauke da gargaɗi a cikin akwati game da serotonin syndrome, batun da aka tattauna a bayanin amincin methylene blue da hulɗarsa da wasu magunguna. Na uku, raunin aikin koda yana sauya yawan maganin da jiki ke fuskanta, kuma bayanin maganin ya iyakance masu matsakaicin rauni ko mai tsanani ga adadin magani guda ɗaya. Babu ɗaya daga cikin waɗannan da yake ƙaramin bayani. Kowannensu ya samo asali ne daga fahimtar miƙa electrons ɗin: maganin da ke amfani da electrons na ƙwayar halitta kuma yana shafar enzymes na monoamine zai yi hulɗa da duka biyun.

Methylene blue kuma yana da tarihin amfani a gubar cyanide tun daga shekarun 1930s, amma tarihi ba shi ne aikin yau ba. Masu bincike na farko sun ba da hasashen tasiri ta redox ko methemoglobin, kuma zuwa shekarun 1950s an ɗauki maganin a matsayin marar isasshen aiki wajen cyanide idan aka kwatanta da hanyoyin nitrite da thiosulfate. A yau babu amincewar amfani da shi don cyanide a Amurka. Sabbin binciken cyanide a beraye da ƙwayoyin halitta alamu ne na binciken kafin gwaji a mutane, ba dalilin amfani da shi a gaggawar cyanide ba.

Hydroxocobalamin: cibiyar cobalt da ke ɗaure cyanide

Cyanide yana toshe cytochrome c oxidase a mitochondria, don haka ƙwayoyin halitta ba za su iya amfani da oxygen ba ko da oxygen a jinin jijiyoyin fita daga zuciya ya yi kama da isasshe. Sai yawan acid ɗin lactic, sauyin yanayin sani, da rugujewar aikin zuciya da jijiyoyin jini su biyo baya. Fahimtar jiyyar ita ce kawar da cyanide kansa, ba gyara hemoglobin ba.

Hydroxocobalamin, wanda ake sayarwa da sunan Cyanokit, yana yin hakan kai tsaye. Cibiyarsa ta cobalt tana ɗaure ion na cyanide a madadin ligand ɗinta na hydroxo, tana samar da cyanocobalamin, wato bitamin B12 na yau da kullum, wanda kodan ke fitarwa. Wannan kamawa da keɓewa ne, ba zagayawar redox ba. Adadin magani da aka amince da shi ga manya shi ne 5 g ta jijiya cikin kusan mintuna 15, tare da ƙarin 5 g idan martanin bai isa ba, har zuwa iyakar 10 g. Wannan ne ya sa kwatancin methylene blue da Cyanokit yake samun amsa da sauri da zarar an fayyace tambayar: don gubar cyanide da aka tabbatar ko ake zargi, hydroxocobalamin shi ne maganin farko na zamani a Amurka, tare da wani samfurin dabam na nitrite da thiosulfate don wasu zaɓaɓɓun yanayi. Methylene blue ba madadinsa ba ne a wannan amfani.

Sakamako biyu masu muhimmanci a aikace suna tasowa daga wannan kimiyya. Maganin yana da launin ja mai tsanani, don haka ana sa ran fata da fitsari su yi ja, kuma sauyin launin fitsari na iya ɗaukar makonni a wasu lokuta. Ƙarfin shan haskensa kuma yana tsoma baki a gwaje-gwajen dakin bincike da ke amfani da launi, da ma'aunin co-oximetry na carboxyhemoglobin, methemoglobin, da oxyhemoglobin; girma da alkiblar kuskuren suna bambanta da na'urar gwaji. Ma'aikacin jinya da bai san haka ba zai iya fassara lambobin da ake amfani da su wajen tantance gubar ba daidai ba. Tsohuwar haɗakar magungunan cyanide da ta dogara da amyl nitrite, sodium nitrite, da sodium thiosulfate tana aiki ta wata hanya dabam: nitrite yana samar da methemoglobin da gangan don ya ɗaure cyanide, yayin da thiosulfate ke taimakawa wajen sauya cyanide zuwa thiocyanate. Wannan dabara tana rage ikon ɗaukar oxygen kuma tana iya rage hawan jini, abin da ba ya dacewa idan shaƙar hayaƙi na nufin carbon monoxide ma yana iya kasancewa. Hydroxocobalamin yana kauce wa wannan illa ta hanyar ɗaure cyanide ba tare da samar da methemoglobin ba.

Prussian blue: tarkon kristal da ke zama a hanji

Prussian blue, wanda ake sayarwa da sunan Radiogardase, ferric hexacyanoferrate ne da ba ya narkewa. Kalmar cyanide a wannan tsarin sinadari tana nufin ligands da aka kulle a cikin kristal na ƙarfe, ba cyanide da yake a sake ba, kuma ba shi da wani amfani wajen gubar cyanide. Amfanin da aka amince da shi shi ne gurɓacewar cikin jiki da cesium mai fitar da radiation ko thallium mai fitar da radiation ko marar fitar da radiation.

Fahimtar aikinsa ita ce musayar ions a cikin sararin hanji. Kristalan ba sa shiga jiki ta bangon hanji da yake lafiya. Suna zama a hanji, suna kama ions na cesium ko thallium cikin tsarin kristal ɗin, har da ions da aka fitar cikin ruwan bile, kuma suna katse sake zagayawar tsakanin hanji da hanta domin ƙarin ƙarfen ya fita cikin bayan gida. Shafin CDC na jiyya da Prussian blue ya bayyana wannan hanyar aiki a sauƙaƙe: yana kama waɗannan ƙarafa a hanji kuma yana hanzarta fitar da su cikin bayan gida. Tsarin magani ga manya da matasa shi ne 3 g ta baki sau uku a rana, tare da ƙananan adadin magani bisa nauyi ga ƙananan yara, kuma sau da yawa ana ci gaba da shi na kwanaki 30 ko fiye tare da sa ido kan gurɓacewar.

Wannan yana bayyana binciken bambancin Prussian blue da methylene blue kai tsaye. Methylene blue yana aiki a jini a matsayin mai miƙa electrons. Prussian blue yana aiki a hanji a matsayin tarkon da ba ya shiga jiki. Ɗaya yana maido da aikin furotin mai ɗauke da ƙarfe. Ɗayan yana rage tsawon lokacin da ƙarfe yake zama a jiki. Musanya su zai bar matsalolin biyu ba tare da jiyya ba: methemoglobin zai ci gaba da kasancewa a yanayin oxidation, kuma cesium zai ci gaba da sake zagayawa.

Carbon monoxide: inda methylene blue ba ya dacewa

Carbon monoxide yana ɗaure hemoglobin da ƙarfi mafi yawa fiye da oxygen kuma yana sauya lanƙwasar sakin oxygen, yana kuma yin tasiri a wuraren aikin zuciya da mitochondria. Jiyya ta yau da kullum ita ce cire mutum daga wurin fuskantar gubar tare da ba shi oxygen kashi 100 har sai alamomin sun gushe, yawanci na sa'o'i da dama, sannan a yi la'akari da oxygen ƙarƙashin matsin lamba mai yawa a wasu zaɓaɓɓun yanayi masu tsanani kamar matsalar aikin jijiyoyin jiki mai bayyana sosai, rasa sani, shafar zuciya, ko yawan acid mai tsanani. Madogarar gaggawa ta tarayya da aka tattara a tarin madogarar CDC kan jiyyar gaggawa sun sanya oxygen da kulawar tallafa wa jiki a tsakiyar wannan tsarin.

Saboda haka, neman bayanin methylene blue don gubar carbon monoxide ya dogara ne da kuskuren da yake da ma'ana a ji: idan rini mai shuɗi yana gyara wata matsalar hemoglobin, watakila yana gyara wata daban. Ba ya yi. Maganin ba shi da amincewar amfani don carbon monoxide, kuma tsarin yanke shawarar jiyyar carbon monoxide na yanzu ba ya haɗa shi. Tunanin tsoho ne, an gabatar da shi a binciken dabbobi a farkon shekarun 1930s kuma aka ƙi shi bayan tantancewar gwaji cikin shekara ɗaya; binciken beraye guda ɗaya na zamani da ake ambata wani lokaci ya gwada kare tsarin jijiyoyin jiki daga illar da ke bayyana daga baya bayan fuskantar gubar, maimakon kawar da carboxyhemoglobin nan take. Ƙarfen da oxidation ya sauya da ƙarfen da carbon monoxide ya ɗaure yanayi ne daban-daban na furotin ɗaya, kuma hanyar miƙa electrons da aka tsara don na farko ba ta da wani aikin da aka tabbatar a kan na biyu. Masu karatu da ke lura da wannan iyaka za su ga amfaninsa tare da cikakken bayanin yanayin binciken methylene blue, wanda ke rarrabe amfanin da aka amince da shi a mutane daga alamun binciken ƙwayoyin halitta da dabbobi.

Dubawa gefe da gefe kafin kowane kwatanci

Yi amfani da wannan tebur wajen tantance kuskure uku da aka fi yi. Kamanceceniyar sunaye ba ta nufin kamanceceniyar abin da magungunan suke nufa. Launi mai ƙarfi ba ya nufin suna da hanyar aikin magani ɗaya; jan hydroxocobalamin da shuɗin sauran biyun ba sa nuna ko za a iya musanya su. Kuma sakamakon gwaji a wata guba ba ya shafar wata guba dabam don kawai sunayensu suna kama da juna. A fara da fahimtar aikin magani, sannan sunaye, kuma a bar yanke shawarar gaggawa ga likitocin gaggawa.