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Gonçalves Â, Matias M, Salvador JAR, Silvestre S. Bioactive Bismuth Compounds: Is Their Toxicity a Barrier to Therapeutic Use? Int J Mol Sci 2024; 25:1600. [PMID: 38338879 PMCID: PMC10855265 DOI: 10.3390/ijms25031600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Bismuth compounds are considered relatively non-toxic, with their low solubility in aqueous solutions (e.g., biological fluids) being the major contributing factor to this property. Bismuth derivatives are widely used for the treatment of peptic ulcers, functional dyspepsia, and chronic gastritis. Moreover, the properties of bismuth compounds have also been extensively explored in two main fields of action: antimicrobial and anticancer. Despite the clinical interest of bismuth-based drugs, several side effects have also been reported. In fact, excessive acute ingestion of bismuth, or abuse for an extended period of time, can lead to toxicity. However, evidence has demonstrated that the discontinuation of these compounds usually reverses their toxic effects. Notwithstanding, the continuously growing use of bismuth products suggests that it is indeed part of our environment and our daily lives, which urges a more in-depth review and investigation into its possible undesired activities. Therefore, this review aims to update the pharmaco-toxicological properties of bismuth compounds. A special focus will be given to in vitro, in vivo, and clinical studies exploring their toxicity.
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Affiliation(s)
- Ângela Gonçalves
- CICS-UBI—Health Sciences Research Centre, University of Beira Interior, Av. Infante D. Henrique, 6201-506 Covilhã, Portugal; (Â.G.); (M.M.)
| | - Mariana Matias
- CICS-UBI—Health Sciences Research Centre, University of Beira Interior, Av. Infante D. Henrique, 6201-506 Covilhã, Portugal; (Â.G.); (M.M.)
| | - Jorge A. R. Salvador
- Laboratory of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal;
- CNC—Centre for Neuroscience and Cell Biology, University of Coimbra, 3004-517 Coimbra, Portugal
| | - Samuel Silvestre
- CICS-UBI—Health Sciences Research Centre, University of Beira Interior, Av. Infante D. Henrique, 6201-506 Covilhã, Portugal; (Â.G.); (M.M.)
- CNC—Centre for Neuroscience and Cell Biology, University of Coimbra, 3004-517 Coimbra, Portugal
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Razuan NA, Mun OK, Ghauth S, Toong LY. Iodide-Induced Severe Encephalopathy: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2023:1455613231189047. [PMID: 37551681 DOI: 10.1177/01455613231189047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
A physically independent and mentally competent 61-year-old gentleman was diagnosed with left upper alveolar spindle cell carcinoma. He underwent left infrastructure maxillectomy with reconstruction and had bismuth iodoform paraffin paste packed in the post-operative cavities. The patient subsequently exhibited labile emotions and acute delirium. Further investigation showed that his urine iodine level was highly elevated. He eventually made a full recovery and returned home.
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Affiliation(s)
- Nur Aida Razuan
- Department of Otorhinolaryngology, Head and Neck Surgery, University Malaya, Kuala Lumpur, Malaysia
| | - Ooi Kar Mun
- Department of Otorhinolaryngology, Head and Neck Surgery, University Malaya, Kuala Lumpur, Malaysia
| | - Sakina Ghauth
- Department of Otorhinolaryngology, Head and Neck Surgery, University Malaya, Kuala Lumpur, Malaysia
| | - Liew Yew Toong
- Department of Otorhinolaryngology, Head and Neck Surgery, University Malaya, Kuala Lumpur, Malaysia
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de Carvalho Machado C, Dinis-Oliveira RJ. Clinical and Forensic Signs Resulting from Exposure to Heavy Metals and Other Chemical Elements of the Periodic Table. J Clin Med 2023; 12:jcm12072591. [PMID: 37048674 PMCID: PMC10095087 DOI: 10.3390/jcm12072591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/19/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Several heavy metals and other chemical elements are natural components of the Earth’s crust and their properties and toxicity have been recognized for thousands of years. Moreover, their use in industries presents a major source of environmental and occupational pollution. Therefore, this ubiquity in daily life may result in several potential exposures coming from natural sources (e.g., through food and water contamination), industrial processes, and commercial products, among others. The toxicity of most chemical elements of the periodic table accrues from their highly reactive nature, resulting in the formation of complexes with intracellular compounds that impair cellular pathways, leading to dysfunction, necrosis, and apoptosis. Nervous, gastrointestinal, hematopoietic, renal, and dermatological systems are the main targets. This manuscript aims to collect the clinical and forensic signs related to poisoning from heavy metals, such as thallium, lead, copper, mercury, iron, cadmium, and bismuth, as well as other chemical elements such as arsenic, selenium, and fluorine. Furthermore, their main sources of occupational and environmental exposure are highlighted in this review. The importance of rapid recognition is related to the fact that, through a high degree of suspicion, the clinician could rapidly initiate treatment even before the toxicological results are available, which can make a huge difference in these patients’ outcomes.
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Affiliation(s)
- Carolina de Carvalho Machado
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Correspondence: (C.d.C.M.); or (R.J.D.-O.); Tel.: +351-224-157-216 (R.J.D.-O.)
| | - Ricardo Jorge Dinis-Oliveira
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- TOXRUN—Toxicology Research Unit, University Institute of Health Sciences (IUCS), CESPU, 4585-116 Gandra, Portugal
- UCIBIO-REQUIMTE-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- MTG Research and Development Lab, 4200-604 Porto, Portugal
- Correspondence: (C.d.C.M.); or (R.J.D.-O.); Tel.: +351-224-157-216 (R.J.D.-O.)
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Tan R, Neo S, Gan J, Fu E, Lim MY, Li H. Myoclonus From Intoxication by Bismuth Iodoform Paraffin Paste (BIPP) Nasopharyngeal Packing. Cureus 2021; 13:e18530. [PMID: 34754681 PMCID: PMC8570226 DOI: 10.7759/cureus.18530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/25/2022] Open
Abstract
Bismuth iodoform paraffin paste (BIPP) gauze is widely used as an antiseptic wound packing in otolaryngology, head, and neck surgery. Uncommonly, BIPP can cause intoxication. Our report highlights an elderly patient who developed encephalopathy and overt myoclonus after nasopharyngectomy secondary to intoxication by the components of the BIPP gauze. The patient’s impaired renal function, the amount of BIPP packing and the extensive nature of his wound likely predisposed him to BIPP toxicity. The myoclonus and delirium resolved promptly after removal of the BIPP packs. Clinicians should be aware of the clinical features of BIPP intoxication because of its common usage.
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Affiliation(s)
- Rong Tan
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, SGP
| | - Shermyn Neo
- Department of Neurology, National Neuroscience Institute, Singapore, SGP
| | - Jereme Gan
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, SGP
| | - Ernest Fu
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, SGP
| | - Ming Yann Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, SGP
| | - Hao Li
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, SGP
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Quest for the Ideal Nasal Pack in Post Operative Cases of Septo-Turbinoplasty: Study in a Tertiary Care Hospital. Indian J Otolaryngol Head Neck Surg 2020; 72:463-467. [PMID: 33088776 DOI: 10.1007/s12070-020-01919-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022] Open
Abstract
To compare the efficacies and post operative outcomes of patients with nasal packing with merocel, intranasal splints and merocel along with intra-nasal infant feeding tubes following septo-turbinoplasty, in patients with nasal obstruction secondary to septal deviation and inferior turbinate hypertrophy. A prospective study was done in 60 patients of symptomatic deviated nasal septum with inferior turbinate hypertrophy. Septoturbinoplasty was performed. Patients' nasal cavity was packed for 48 h after being randomly divided into 3 groups: (1) packing using merocel, (2) intra-intra nasal septal silicone splint, (3) packing using truncated merocel along with infant feeding tube. Patients were given a questionnaire 24 h post operatively and their reponse was analysed to compare nasal blockage, epistaxis, epiphora and headache. Pain on pack removal was recorded after 48 h. We found that merocel with infant feeding tube had better tolerance than plain merocel in almost all cases, with symptoms of nasal blockage, epiphora, headache and pain on pack removal being lesser than with plain merocel, and comparable to the results produced by nasal splints. Also the epistaxis control in merocel with infant feeding tube was better than with nasal splints. Truncated merocel with infant feeding tubes provides a suitable and cheap replacement for nasal splints which may not be affordable to a lot of patients, or may not in available in many settings. The results are superior to plain merocel and the control of post operative bleeding is better than with intra nasal splints.
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Abstract
Although it has been used for centuries, bismuth remains one of the least understood elements in the periodic table. Metallic bismuth and bismuth compounds have been widely used in the manufacture of alloys, pigments, cosmetics, and pharmaceuticals. As a “green” heavy metal, the substitution of lead with bismuth in some industries may partially resolve the environmental problems related to heavy metal pollution. In health care, as bismuth has low toxicity to humans, bismuth-based drugs such as colloidal bismuth subcitrate (CBS), ranitidine bismuth citrate (RBC), bismuth subsalicylate (BSS), bismuth iodoform and radioactive bismuth (212Bi/213Bi) complexes have been developed and used in clinics to treat various diseases. In most cases, bismuth therapies exhibit high therapeutic efficacies and little side effects; nevertheless, there are still reported cases of bismuth toxicity caused by bismuth over-dosage.
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Neurotoxicity Secondary to Bismuth Iodoform Paraffin Paste Packing in an Orbital Exenteration Cavity. Ophthalmic Plast Reconstr Surg 2018. [DOI: 10.1097/iop.0000000000001070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wound Healing Concepts in Clinical Practice of OMFS. J Maxillofac Oral Surg 2016; 16:403-423. [PMID: 29038623 DOI: 10.1007/s12663-016-0880-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 02/05/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Wound healing is a complex and dynamic process and a thorough knowledge of the basics of physiology of wound healing is a must to implement principles of chronic wound care. Understanding wound healing at multiple levels-biochemical, physiologic, cellular and molecular provides the surgeon with a framework for basing clinical decisions aimed at optimizing the healing response. OBJECTIVE This review article describes the classification of wounds and aims to highlight the fundamentals of wound repair, enumerating the dressings used commonly and also, the newer concepts of wound healing. MATERIALS AND METHODS Search engines and medical databases were tapped to gather information on the subject. Search words employed were "Wounds", "wounds in OSMF", "Wound healing", "Repair", "Dressings in OMFS". RESULTS The search resulted in total of 153 articles which we reviewed to add to the literature the concepts of wound healing and to throw some light on recent advances in wound care. CONCLUSIONS Wound healing remains a challenging clinical problem and correct, efficient wound management is essential to positively influence the wound healing course and reduce potential complications.
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Atwal A, Cousin G. Bismuth toxicity in patients treated with bismuth iodoform paraffin packs. Br J Oral Maxillofac Surg 2016; 54:111-2. [DOI: 10.1016/j.bjoms.2015.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 09/11/2015] [Indexed: 11/28/2022]
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Abstract
AbstractIntroduction:This article reviews the literature pertaining to bismuth iodoform paraffin paste.Overview:Bismuth iodoform paraffin paste is used in most otolaryngology departments on a daily basis. Questions about its properties are common in postgraduate otolaryngology examinations. This article reviews bismuth iodoform paraffin paste's current and historical usage, constituents, properties, side effects, and radiographic properties, and its alternatives in otological and rhinological practice.
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Abstract
Although it has been used for centuries, bismuth remains one of the least understood elements in the periodic table. Metallic bismuth and bismuth compounds have been widely used in the manufacture of alloys, pigments, cosmetics, and pharmaceuticals. As a ‘green’ heavy metal, the substitution of lead with bismuth in some industries may partially resolve the environmental problems related to heavy metal pollution. In health care, as bismuth has low toxicity to humans, bismuth-based drugs such as colloidal bismuth subcitrate (CBS), ranitidine bismuth citrate (RBC), bismuth subsalicylate (BSS), bismuth iodoform, and radioactive bismuth (212Bi/213Bi) complexes have been developed and used in clinics to treat various diseases. In most cases, bismuth therapies exhibit high therapeutic efficacies and little side effects; nevertheless, there are still reported cases of bismuth toxicity caused by bismuth over-dosage.
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Al Hail A, Al Qahtani A. Allergic Reaction to Bismuth-lodoform-Paraffin Paste (BIPP) Following Ear Surgery. Qatar Med J 2010. [DOI: 10.5339/qmj.2010.1.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Bismuth Iodoform Paraffin Paste (BIPP) impregnated ribbon gauze is one of the most commonly used packs after external and middle ear surgery. Allergic reaction to BIPP is rare. We report two cases of hypersensitive BIPP reaction following tympanoplasty surgery. To our knowledge no such cases have been reported previously in Qatar. We reviewed the literature and discuss the management and its prevention.
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Affiliation(s)
- A. Al Hail
- ORL-HNS (ENT), Surgery Department, Hamad Medical Corporation, Doha, Qatar
| | - A. Al Qahtani
- ORL-HNS (ENT), Surgery Department, Hamad Medical Corporation, Doha, Qatar
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