I-methylene blue kwiikati: ukhuseleko, iziphumo ebezingalindelekanga, nesikhokelo sikagqirha wezilwanyana

Ikati isela amanzi akwibhokisi yeentlanzi esandula ukunyangwa ngenxa yokungunda. Umnini ufunda kwi-intanethi ukuba i-methylene blue incede inja ebinesiphazamiso segazi, aze azibuze ukuba ingasebenza na nakwikati. Zombini ezi meko zibonakala zifana xa zijongwa ngaphandle. Ngaphakathi ekatini, azifani.

Iikati zisengozini enkulu engaqhelekanga yohlobo oluthile lomonakalo obangelwa yi-methylene blue: umonakalo we-oxidation kwiiseli ezibomvu zegazi. Obu buthathaka bukwisakhiwo se-hemoglobin yekati ngokwayo, yaye kungenxa yoko isikhokelo seekati kufuneka sizimele. Iingcebiso ezibhalelwe iintlanzi ezikwibhokisi yeentlanzi, izinja, okanye iidayi zaselebhu azisebenzi nje kwiikati. Eli nqaku lichaza ibhayoloji, oko kuthethwa ziincwadi zonyango lwezilwanyana, noko kufuneka kwenziwe xa ikati ichanabeke kuyo.

Iiseli ezibomvu zegazi leekati zakhiwe ngokwahlukileyo

I-hemoglobin ithwala ioksijini, kodwa isakhiwo sayo sikwamisela ukuba yonakaliswa lula kangakanani na zizinto ezibangela i-oxidation. I-hemoglobin yekati inamaqela e-sulfhydryl asebenzayo amalunga nesibhozo kwi-tetramer nganye, phantse kabini kunenani elifumaneka ezinjeni okanye ebantwini. La maqela ziindawo ezihlaselwa yi-oxidation. Xa kwenzeka i-oxidation kuwo, amatyathanga e-globin aphulukana nesakhiwo sawo aze adibane abe ziingqokelela ezimnyama ezibizwa ngokuba yimizimba ye-Heinz, ezibonakala kwizithambiso zegazi ezifakwe idayi.

Ezinye iinkcukacha ezimbini ziyenza mandundu le ngxaki kwiikati. Okokuqala, iiseli ezibomvu zegazi leekati zinobuchule obulinganiselweyo bokulwa i-oxidation nokwenza i-reduction xa zithelekiswa nezinye, ngoko umonakalo uhambela phambili xa sele uqalile. Okwesibini, udakada lwekati alukwazi kakuhle ukususa imizimba ye-Heinz kwiiseli ezibomvu zegazi ngoxa lugcina iseli ingaphazamisekanga. Ezinye iintlobo zezilwanyana zenza eli nyathelo lokucoca ngcono, njengoko kuchazwe kolu phononongo lwehematoloji yeekati. Ngoko iiseli ezonakeleyo zihlala zijikeleza egazini endaweni yokulungiswa.

Iikati ezisempilweni zinokuba nenani elincinane lemizimba ye-Heinz ngaphandle kokugula. Kuxhomekeka kwincwadi ekubhekiswa kuyo nakwindlela yokufaka idayi, malunga nesihlanu ukuya kwishumi ekhulwini leeseli ezibomvu zegazi ezinemizimba ye-Heinz kusenokungabi yinto engaqhelekanga. Inkxalabo iqala xa inani liphezulu okanye iingqokelela zinkulu: enye incwadi yamayeza aselebhu ithi i-anemia iba nokwenzeka kakhulu xa imizimba emikhulu ye-Heinz ichaphazela ngaphezu kwamashumi amathathu ekhulwini eeseli ezibomvu zegazi, umda oshwankathelwe kolu hlolo ngokubanzi lwe-anemia yemizimba ye-Heinz. Ngoko xa kukho ukuchanabeka, umbuzo awupheleli ekubeni ikhona na imizimba ye-Heinz. Kukuba mingaphi, mikhulu kangakanani, nokuba kulandela i-hemolysis, oko kukuthi ukonakala kweeseli ezibomvu zegazi.

Zithini iincwadi zonyango lwezilwanyana

Uhlelo lwakudala lwe-Plumb's Veterinary Drug Handbook luthi uninzi loogqirha luthatha i-methylene blue njengengafanelekanga ukusetyenziswa kwiikati, kuba iikati zinokuba ne-anemia yemizimba ye-Heinz ne-methemoglobinemia. Iinkxalabo ezidwelisiweyo kukutshintsha kwemilo yeeseli ezibomvu zegazi, i-methemoglobinemia ephikisana nesiphumo esilindelekileyo, nokuncipha kobude bobomi beeseli ezibomvu zegazi. Sekunjalo, kwaloo ngxelo yechiza inika ithamo likaxakeka leekati le-methemoglobinemia, ngokuqhelekileyo i-1 ukuya ku-1.5 mg nge-kg nganye, linikwe emthanjeni njengonyango olunye. Oku kudityaniswa kwezinto kutyhila eyona meko: apha, ukungafaneleki kuthetha ukuliphepha ngaphandle kweemeko ezimbalwa ezithile ezonganyelweyo, kungekhona ukuba alize linikwe. Umbhalo wengxelo endala ofumanekayo ugcinwe kule kopi yencwadi ka-Plumb, ngoxa uhlelo lweshumi lwangoku lunale ngxelo kwiphepha 859.

I-Merck Veterinary Manual inembono efanayo kwisikhokelo sayo sokunyanga ityhefu ebangelwa ngamayeza okuthomalalisa iintlungu, apho idwelisa i-methylene blue eyi-1 ukuya ku-1.5 mg nge-kg nganye yesisombululo esiyipesenti enye, enikwa emthanjeni, njengendlela enokusetyenziswa ukunciphisa i-methemoglobin, kuhlolwe i-methemoglobinemia, i-anemia yemizimba ye-Heinz, ne-hemolysis. Kwenye indawo, i-Merck iphawula kuhlolo lwayo ngokubanzi lwe-anemia kwizilwanyana ukuba iikati zisengozini enkulu yokwakheka kwemizimba ye-Heinz kunezinye iintlobo zezilwanyana.

Eyona ngxelo ingqongqo yommiselo iphathelele kwiimveliso ezinikwa ngomlomo. Ummiselo wefederal 21 CFR icandelo 500.27 uchaza ukuba iimveliso ezimbini ezinikwa ngomlomo zokubulala iintsholongwane kwinkqubo yomchamo, ezine-methylene blue, zabangela i-anemia ye-hemolysis yemizimba ye-Heinz kwiikati xa zazisetyenziswa ngokwemiyalelo yeleyibhile, ngamanye amaxesha zikhokelela ekufeni, yaye i-methylene blue yachongwa njengonobangela. Lo mmiselo ugqiba ngokuthi amayeza ezilwanyana alolo hlobo ane-methylene blue nenikwa ngomlomo ayengakhuselekanga yaye engamkelwa njengasebenzayo ngaphandle kwesicelo esivunyiweyo. Izinja zafumana uhlobo olufanayo lomonakalo kuvavanyo, ngoko eli chiza alinabungozi obungekhoyo nasezinjeni. Kodwa ingozi yethamo elikwileyibhile yaboniswa kuqala kwiikati.

Iziphumo ebezingalindelekanga ezixeliweyo kwiikati zigxile egazini: ukwakheka kwemizimba ye-Heinz, i-anemia ye-hemolysis, ne-methemoglobinemia ephikisana nesiphumo esilindelekileyo xa ukuchanabeka kuphezulu okanye kuphindaphindiwe. Iincwadi eziqhelekileyo zamayeza zikwadwelisa isicaphucaphu nokugabha, kodwa ubungqina obukhethekileyo beekati buphathelele egazini, yaye kulapho kufanele kugxilwe khona ekuhlolweni.

Into ephikisanayo: unyango netyhefu kwimolekyuli enye

Ngaphakathi kwiseli ebomvu yegazi, i-methylene blue inokuguqulwa nge-reduction ibe yi-leucomethylene blue, enika ii-electron kwintsimbi ye-haem efumene i-oxidation ize ibuyisele i-hemoglobin esebenzayo. Yile ndlela yokusebenza yonyango esisiseko sokusetyenziswa kwayo kwi-methemoglobinemia, yaye ichazwe ngokubanzi ngakumbi kwingcaciso ye-methemoglobinemia. Kodwa i-methylene blue ngokwayo yinto ebangela i-oxidation. Xa ukuchanabeka kunyuka okanye iinkqubo zeseli ezenza i-reduction zingasakwazi ukumelana nayo, kwaloo molekyuli inyusa i-methemoglobin nomonakalo we-globin endaweni yokuwulungisa. Ngoko i-methemoglobinemia iyimeko ekunokunikwa eli chiza ngenxa yayo, ikwayisiphumo esibi salo. Umsantsa phakathi kwezi zimbini mncinane, yaye mncinane ngakumbi kwiikati.

Obona bungqina bucacileyo kwiikati buvela kuphononongo olulawulwayo luka-1992 lweekati ezingamashumi amane ezindala. Ithamo elinye eliyi-1.5 mg nge-kg nganye elinikwe emthanjeni layibuyisela ngokukhawuleza kwimeko yesiqhelo i-methemoglobinemia ebangelwe yi-nitrite ngaphandle kokunyusa iiseli ezinemizimba ye-Heinz ezijikeleza egazini. Amathamo amabini anjalo, ahlukaniswe ziiyure ezine, anyusa kakhulu ubuninzi bemizimba ye-Heinz, ingakumbi emva kokuchanabeka kwi-nitrite, nangona i-anemia ye-hemolysis ebonakalayo ingazange ivele ngexesha lophononongo (Rumbeiha no-Oehme, 1992). Ithamo elinye lanceda. Ithamo eliphindiweyo kwiiyure ezimbalwa latshintsha ulungelelwano lwaya kwicala lomonakalo.

Iingxelo zonyango zibonisa okufanayo. Uphononongo luka-2019 kwi-Journal of Veterinary Internal Medicine luchaza i-methylene blue enikwa emthanjeni njengonyango olukhethwa kuqala lwe-methemoglobinemia eqatha ebonakalisa iimpawu, lukhankanya ukusetyenziswa kwayo kwiikati nge-1 mg nge-kg nganye emthanjeni, luze lulumkise ukuba ikati esele ine-methemoglobinemia okanye i-anemia yemizimba ye-Heinz inokufumana umonakalo owongezelelekileyo we-oxidation. Lucebisa ukuhlolwa kwe-hematocrit kangangeentsuku ezininzi emva koko (DOI 10.1111/jvim.15637). Kwingxelo epapashiweyo, intshontsho lekati elalirhanelwa ukuba line-methemoglobinemia enxulumene namanzi okusela lasabela kwimizuzu embalwa kwi-1 mg nge-kg nganye yesisombululo esiyipesenti enye esinikwe emthanjeni, kusenziwa imilinganiselo ephindaphindiweyo ye-co-oximetry ngexesha lokulaliswa esibhedlele (ingxelo yemeko). Kwimeko kaxakeka ka-2023 yekati ye-Ragdoll eneenyanga ezintandathu eyayine-methemoglobinemia enzima nephindayo, unyango lwaqala ngokunikwa emthanjeni, lwalandelwa luthotho lwamathamo anikwa ngomlomo ngononophelo. Ikati yachacha ngaphandle kweziphumo ezibi ezibalulekileyo ezinxulumene nonyango (DOI 10.1111/vec.13298). Impumelelo nganye yayiyimeko eyahlukileyo eyonganyelweyo nehlolwayo, ingengomzekelo wokuyisebenzisa ekhaya.

Iingxelo ezindala zetyhefu zibonisa elinye icala. Kuluhlu lweemeko luka-1973, iikati ezintandathu zafumana i-anemia ye-hemolysis yemizimba ye-Heinz emva kokunikwa ngomlomo amalungiselelo enkqubo yomchamo ane-methylene blue. Ezinye iikati ezimbini ezanikwa izixa ezilinganayo kuvavanyo zafumana iingxaki ezinzima ze-hemolysis kwiintsuku ezimbalwa zaza zafuna utofelo-gazi (Schechter nabanye, 1973). Imeko ka-2016 eyakhokelela ekufeni kwekati encinane exutyiweyo ye-Angora eyayinyangelwa isifo senkqubo yomchamo yabonisa ukuguquka okuphawulekayo kwenwebu zamafinya nezicubu zaba luhlaza okwesibhakabhaka, kunye nomonakalo wesibindi nezintso. Kwafunyaniswa ukuba yayiyityhefu ye-methylene blue ngokusekelwe kwimbali yayo nakuhlolo lwezicubu (ingxelo yemeko). Akukho mda wethamo eliyityhefu onokufunyanwa ngokuthembekileyo kwezi ngxelo kuwo onke amacala okuchanabeka ngomlomo, emthanjeni, eluswini, nakumanzi ebhokisi yeentlanzi axutyiweyo, yaye eli nqaku aliniki mda unjalo.

Kukho uthelekiso olufuna ukulungiswa. I-acetaminophen yaziwa ngokuba yingozi kwiikati ngenxa yokuba ziswele ii-enzyme ezibalulekileyo ze-glucuronidation, yaye abanye ababhali basebenzisa kwaloo ngcaciso kwi-methylene blue. Oku akunabuxhaso bobungqina. I-glucuronidation ebuthathaka yindlela yokwenzeka komonakalo eqinisekisiweyo ye-acetaminophen, ephononongwe kweli phepha lokuguqulwa kwamachiza emzimbeni weekati. Kwi-methylene blue, imithombo yonyango lwezilwanyana igxininisa kwindlela ye-redox yeli chiza ngokwalo kunye nokuba sesichengeni kweeseli ezibomvu zegazi leekati, yaye i-FDA ithi indlela echanekileyo yokwenzeka komonakalo wemizimba ye-Heinz ayikaqinisekiswa ngokupheleleyo. Ingcaciso ye-acetaminophen iluncedo ekukhumbuzeni ukuba iikati ziguqula amachiza emzimbeni ngokwahlukileyo. Ayiyongcaciso yeli chiza.

Xa ikati ichanabeke kuyo: imibuzo ebuzwa rhoqo

Ikati yam isele amanzi ebhokisi yeentlanzi anyangwe nge-methylene blue. Ingaba yityhefu leyo?

Akunjalo ngokuqinisekileyo, yaye akukho nqaku linokuphendula loo mbuzo ngaphandle kwezixa ezithile. Ukusela isixa esincinane samanzi asele exutywe kwibhokisi yeentlanzi akufani nokuginya isisombululo sonyango esixinene, yaye akukho mda weekati ophononongwe ziingcali okhoyo wamanzi ebhokisi yeentlanzi axutyiweyo. Musa ukubala unyango ngokwemiyalelo yebhokisi yeentlanzi okanye ngeengxoxo zamathamo ezinja. Qhagamshelana nogqirha wezilwanyana wekati, ikliniki kaxakeka, okanye inkonzo yokulawula ityhefu kwizilwanyana, uneenkcukacha zemveliso.

Loluphi ulwazi endimele ndiluphathe?

Ileyibhile yemveliso okanye ifoto yayo, isithako esisebenzayo nokuxinana kwaso, ubungakanani besisombululo esixinene obufakwe kubungakanani obungakanani bamanzi ukuba oko kufanelekile, isixa esiqikelelwayo esiselwe yikati, ubunzima bekati, ixesha lokuchanabeka, nalo naliphi na iyeza elisetyenziswayo okanye isifo esikhoyo. Isikhokelo ngokubanzi setyhefu se-ASPCA sicela abanini bagcine isikhongozeli baze bafowune endaweni yokulinda iimpawu. Oko kuyasebenza nalapha.

Idayi ingene eboyeni. Ndenze ntoni ngoku?

Nqanda ikati ukuba ingayikhothi xa izicoca, kuba ukungcola koboya kujika kube kukuchanabeka ngomlomo ngokuzikhotha. Isikhokelo ngokubanzi se-ASPCA sokususa izinto ezingcolisayo sicebisa iiglavu, isepha ethambileyo elulwelo yokuhlamba izitya namanzi ashushu kancinci ukususa iintsalela ezininzi, ukuhlanjululwa kakuhle ngamanzi, ukugcina imveliso kude namehlo neendlebe, nokufumana iingcebiso kugqirha wezilwanyana malunga nendlela efanelekileyo yaloo nto. Buza ikliniki ngaphambi kokuhlamba ikati exinezelekileyo okanye ebonakalisa iimpawu.

Ngaba ndimele ndiyenze igabhe?

Hayi, ngaphandle kokuba ugqirha wezilwanyana okanye ingcali yetyhefu iyalela oko ngokucacileyo. Iindlela zasekhaya zokubangela ukugabha ezisetyenziswa ezinjeni, ingakumbi i-hydrogen peroxide, azifanelekanga kwiikati.

Zeziphi iimpawu ezifuna ukuhlolwa ngokukhawuleza?

Ubuthathaka okanye ukutyhafa kakhulu, ukuphefumla ngokukhawuleza okanye nzima, iintsini eziluthuthu okanye ezityheli, igazi okanye inwebu zamafinya ezimnyama okanye ezinombala omdaka, ukuwa, okanye umchamo omnyama. Qaphela ukuba umonakalo wegazi unokubonakala emva kwexesha: uncwadi lwembali lweemveliso zenkqubo yomchamo luchaza i-anemia ekhula kwiintsuku ezininzi. Ngoko ikati ebonakala iphilile ngorhatya losuku yokuchanabeka isafuna ukuhlolwa kokuqala ngugqirha wezilwanyana ukuze kuqondwe ubungxamiseko, yaye, ukuba ugqirha uyakucebisa, iimvavanyo zegazi zokulandelela eziquka i-hematocrit nokuhlolwa kwesithambiso segazi ukuze kujongwe imizimba ye-Heinz.

Kutheni isikhokelo sezinja kufuneka sihlale sahlukile

Izinja nazo zinokufumana i-anemia yemizimba ye-Heinz ngenxa ye-methylene blue, ngoko akukho nto apha ethetha ukuba eli chiza alinabungozi ezinjeni. Kodwa iikati zidibanisa i-hemoglobin ebuthathaka ngakumbi kwi-oxidation, ukhuseleko olubuthathaka lweeseli ezibomvu zegazi, nokucocwa okungasebenzi kakuhle ludakada, nto leyo inciphisa umsantsa wokhuseleko. Iincwadi zonyango ziyakubonisa oko: iindlela ezindala zonyango lwezinja zifikelela kwi-4 mg nge-kg nganye emthanjeni kwezinye iimeko, ngoxa iincwadi zeekati zigxile kwi-1 ukuya ku-1.5 mg nge-kg nganye kanye nge-methemoglobinemia, zize zilumkise ngokukhethekileyo ngokuphinda ithamo. Ukunciphisa indlela yonyango lwenja ngokobunzima bomzimba kuphosa eyona ngongoma. Umsantsa wokhuseleko, indlela igazi elisabela ngayo, nesicwangciso sokuhlola zahlukile. Kungenxa yoko izigqibo zeekati zifanele zenziwe ngugqirha wezilwanyana onokulinganisa imfuneko yonyango nomngcipheko we-oxidation aze alinganise isiphumo. Ukususa amanzi anyangiweyo kwibhokisi yeentlanzi emva kokusetyenziswa, njengoko kuchazwe kwisikhokelo sokucoca ibhokisi yeentlanzi emva konyango, ngumsebenzi oqhelekileyo wokukhathalela izilwanyana. Ukunyanga ikati akunjalo.