Application Of Silver Nitrate Research Articles

Local application of silver nitrate as an adjuvant treatment before deep lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment.

The purpose of this study is to evaluate the efficacy and safety of the local application of silver nitrate (LASN) as an adjuvant treatment before deep lamellar keratoplasty (DLKP) for fungal keratitis responding poorly to medical treatment. A total of 12 patients (12 eyes) with fungal keratitis responding poorly to medical treatment (for at least 2 weeks) were included. LASN was performed using 2% silver nitrate, the ulcer was cleaned and debrided, and then, the silver nitrate cotton stick was applied to the surface of the ulcer for a few seconds. The effect of LASN was recorded. The number of hyphae before and after treatment was determined by confocal microscope. After the condition of the ulcer improved, DLKP was performed. Fungal recurrence, best-corrected visual acuity (BCVA), loose sutures, and endothelial cell density (ECD) were recorded in detail. Clinical resolution of corneal infiltration and edema was observed, and the ulcer boundary became clear in all 12 patients after 7-9 days of LASN. Confocal microscopy showed that the number of hyphae was significantly reduced. Ocular pain peaked on days 1 and 2 after treatment, and 9 patients (75%, day 1) and 1 patient (8.3%, day 2) required oral pain medication. During the follow-up period after DLKP, no fungal recurrence and loose sutures were observed. After the operation, the BCVA of all patients improved. The mean corneal ECD was 2,166.83 ± 119.75 cells/mm2. The LASN was safe and effective and can be well tolerated by patients. Eye pain can be relieved quickly. LASN as an adjuvant treatment before DLKP might be a promising therapeutic strategy.

Umbilical Granuloma: A case report

After birth, remnants of the umbilical cord should separate spontaneously from the neonate within 1-2 weeks. However, in certain instances, following separation, a small red or pink moist bump forms in a neonate’s umbilical stump known as an umbilical granuloma. Treatment options include the application of silver nitrate, salt application, double-ligature technique, cryosurgery, and surgical excision. We present a 7 week old male with an umbilical granuloma treated with the double ligature technique using an absorbable suture with the disappearance of the lesion at a 1 week follow up visit. The ligature technique is one of several methods used in the treatment of umbilical granuloma. Although non-absorbable silk sutures are commonly used for this technique, absorbable sutures can be used for lesions with a narrow stalk.

Effectiveness of silver nitrate application on plant growth and bioactive compounds in Agastache rugosa (Fisch. & C.A.Mey.) kuntze

The objective of this study was to determine the optimal dose of silver nitrate (AgNO3) for plant growth and to increase the main bioactive compounds in A. rugosa cultivated in a hydroponic system. The application of soaked diniconazole (120 μmol mol−1) to all plants at 7 days after transplanting (DAT) for dwarfing plant height, optimizing cultivation space in the plant factory. Subsequently, plants were soaked with 50, 100, 200, and 400 μmol mol−1 AgNO3 for 10 min at 25 DAT and harvested at 39 DAT. The results indicated that 200 and 400 μmol mol−1 treatments tended to severely decrease plant growth parameters compared to treatments with lower concentrations. The net photosynthetic rate was significantly reduced by the 200 and 400 μmol mol−1 treatments compared to treatments with other concentrations. The 400 μmol mol−1 treatment led to the lowest concentrations of chlorophyll a, chlorophyll a/b, total carotenoid, chlorophyll b, and the total chlorophyll. However, 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity was considerably increased in 50, 100, 200, and 400 μmol mol−1 compared to that of the control plants. A higher rosmarinic acid (RA) concentration in the whole plant was noticed with the 400 μmol mol−1 treatment compared with that of the untreated plants. The 100 μmol mol−1 treatment exhibited the highest concentration and content of tilianin in the whole plant. Concentration of acacetin 1 significantly increased in the whole plant with 100 and 200 μmol mol−1 treatments compared with that of the untreated plants. Concentrations of acacetin 2 and 3 in the whole plant were the highest with 100 and 200 μmol mol−1 treatments, respectively. The results demonstrated that 100 μmol mol−1 treatments can be used to increase bioactive compounds without severely limiting the plant growth and reducing chlorophyll concentrations of A. rugosa. Implementing this optimal dose can enable growers and researchers to cultivate A. rugosa more efficiently, enhancing bioactive compound content and overall plant performance, thus harnessing the potential health benefits of this valuable plant species.

Medical management versus chemical cautery with medical management in treatment of inferior turbinate hypertrophy: a comparative study

Patients having inferior turbinate hypertrophy causing intractable sneezing, rhinnorhoea which is non-responsive to conventional medication require alternative therapies. Aim of the study was to compare medical management vs chemical cautery with medical management in treatment of inferior turbinate hypertrophy since both these treatments are easily accessible, cost effective to the patients as well as not associated with major complications. The complaints sneezing, rhinorrhoea, nasal blockage, headache, eye irritation and redness of patients are reduced and quality of life of patients improved after chemical cautery with medical management as compared to medical management alone. 50 patients of age group 15-75 years with c/o Sneezing, rhinorrhoea, nasal blockage and headache were included in our study. Inferior turbinate hypertrophy was diagnosed on the basis of anterior rhinoscopy and diagnostic nasal endoscopy. Patients were divided randomly in 2 group-group A (medical management), group B (chemical cautery with medical management). The 22 question sino-nasal outcome test (SNOTT22) score and rhinomanometry was done before and after treatment to compare the efficacy and detect symptom free period in both groups. Percentage of relief was more among group B patients as compared to group A patients. Symptom free period was more in group B patients as compared to group A patients and both of them were analysed on the basis of SNOTT22 score and rhinomanometry. Chemical cautery with topical application of silver nitrate coupled with medical management is more effective in treatment of inferior turbinate hypertrophy as compared to medical management alone.

Dental Pulp Response to Silver-Containing Solutions: A Scoping Review

Dentists used silver-containing solutions for deep cavity disinfection before restoration. This review aims to identify the silver-containing solutions reported in the literature for deep cavity disinfection and summarize their effects on dental pulp. An extensive search was performed using the search words "(silver) AND (dental pulp OR pulp)" in ProQuest, PubMed, SCOPUS, and Web of Science to identify English publications on silver-containing solutions for cavity conditioning. The pulpal response to the included silver-containing solutions was summarized. The initial search identified 4112 publications and 14 publications met the inclusion criteria. Silver fluoride, silver nitrate, silver diamine nitrate, silver diamine fluoride, and nano-silver fluoride were used in deep cavities for antimicrobial purposes. Indirect silver fluoride application induced pulp inflammation and reparative dentine in most cases, and pulp necrosis in some cases. Direct silver nitrate application caused blood clots and a wide inflammatory band in the pulp, whilst indirect silver nitrate application caused hypoplasia in shallow cavities and partial pulp necrosis in deep cavities. Direct silver diamine fluoride application induced pulp necrosis, while indirect silver diamine fluoride application induced a mild inflammatory response and reparative dentine formation. No evidence of the dental pulpal response to silver diamine nitrate or nano-silver fluoride was available in the literature.

Cura seca versus cura en ambiente húmedo aplicadas a la cirugía menor en la exéresis de fibromas blandos: ensayo clínico aleatorizado

ObjectiveTo compare which skin tag approach tecniques, while adding a new technique, in order to find which produces less complications, less cost and an earlier healing. DesignNon-blinded randomized clinical trial with consecutive sampling. SiteÁrea Básica de Salud Balaguer. ParticipantsN = 240 skin tags. InterventionsThe corresponding randomized technique was performed and subsequent follow-up until epithelialization. Main measurementsSex, age, family history of skin tags, location of the lesion, diabetes, cost, healing time, complications and technique used. The techniques used were: cryotherapy, electrosurgery, excision with silver nitrate application (SNA) and excision with moist wound healing treatment (MWH). ResultsAccording to techniques, healing time is lower in MWH (3.3[±1.0] days) than in dry healing (cryotherapy 4.5[±2.3] days, electrosurgery 8.2[±4, 2] days and SNA 10.7 [±4.8] days), p < 0.001. There was also a significant difference in the number of complications in MWH (0.0%) compared to dry-healing techniques: cryotherapy 1 (3.0%), electrosurgery 4 (11.4%), SNA 22 (57.9%), p < 0.001. Finally, a lower economic cost was observed in skin tags treated with MWH (146[±9.0] euros) versus those treated with dry cure (cryotherapy 235[±22.2] euros, electrosurgery 272[±41.1] euros, SNA 213[±43.2] euros), p < 0.001. ConclusionsTreatment of skin tags by MWH is the best technique to treat these lesions because of its shorter healing time, lower cost and fewer complications. SNA stands out as the technique that has the highest number of complications and the longest healing time.

Treating Chronic Rhinitis and Turbinate Hypertrophy Without Surgery: The Effectiveness of Silver Nitrate Cauterization.

Chronic rhinitis and chronic turbinate hypertrophy are conditions that affect the quality of life of individuals. The conchas, or the three half-crescent-shaped structures in the nasal cavity, play a crucial role in the respiratory system by filtering and humidifying the air we breathe. The growth of the conchas outside of normal physiological conditions can lead to conditions such as hyperplasia of the inferior turbinate and hypertrophy of the inferior turbinate. The study was conducted between June 2020 and December 2022 and aimed to evaluate the effect of silver nitrate cauterization on patients with chronic rhinitis and chronic turbinate hypertrophy. A total of 638 patients and 520 controls with nasal obstruction were included in the study and underwent silver nitrate cauterization without the need for surgical intervention.The treatment was performed under local anesthesia and involved the application of silver nitrate on the anterior one-centimeter part of the medial surface of both inferior turbinates. Patients were instructed to use an isotonic solution nasal spray and take an antihistamine pill for seven days. A significant improvement was observed in the overall inspiratory function without the need for nasal decongestant sprays or surgery in all patients after one and three months. There was also a significant improvement noted three months after the silver nitrate cauterization in the Nasal Obstruction Symptom Evaluation (NOSE) scores, which measure the level of nasal obstruction. Silver nitrate cauterization showed to be an effective treatment for patients withturbinate hypertrophy, leading to an improvement in overall inspiratory function and reducing the severity of nasal obstruction. This treatment can serve as an alternative to surgical intervention for these conditions.

Our treatment outcomes in bartholin cysts or abscesses

The purpose of this study was to examine the outcomes of Bartholin abscess or cyst surgery, silver nitrate therapy, and cyst or abscess excision in terms of recurrence, duration of the procedure, and healing times. The files of 100 patients treated in our hospital for Bartholin cysts or abscesses between March 2022 and December 2022 were reviewed retrospectively. The patients’ demographic characteristics were recorded. Demographic data, the location and size of Bartholin abscesses, complaints at presentation, and cases with recurrence were noted. The patients were divided into three groups according to the treatment applied and were compared with one another, especially in terms of recurrence, operative time, and recovery time. Group 1 consisted of those who underwent drainage due to Bartholin cyst or abscess, Group 2 of those treated with silver nitrate, and Group 3 of those who underwent cyst excision. Recurrence was detected in 12 (40%) of the cases in Group 1. Relapsed cases were treated with silver nitrate. Recurrence was observed in only one patient in the group treated with silver nitrate (Group 2). Bartholin cyst excision was performed on that patient. Mean operation times were 2.80 min in Group 1, 4.40 min in Group 2, and 23 min in Group 3 (p=0.0001). Mean recovery times were 3.37±0.49 days in Group 1, 6.13±0.73 days in Group 2, and 13.70±2.09 days in Group 3 (p=0.0001). A comparison of the patients in all three groups revealed that the recurrence rate was higher in the group receiving abscess drainage. While recurrence was observed in only one patient in the silver nitrate group, no recurrence occurred in the cyst excision group (p&lt;0.001). This study emphasizes that silver nitrate application is a simple practical method that can be performed using local anesthesia, and involving minimal scar tissue, a faster procedure time, and faster recovery.

76. Robot-assisted Vaginoplasty: A Multidisciplinary Technique for Gender Affirmation

Background: Gender affirming trans female bottom surgery is critical in treating gender dysphoria but can result in complications such as stricture/stenosis development, neovaginal prolapse, and rectal injury. The authors describe a multidisciplinary robot-assisted technique incorporating a free peritoneal graft to alleviate these complications. Methods: Patients who met the World Professional Association for Transgender Health (WPATH) criteria for bottom surgery, underwent robotic-assisted penile inversion vaginoplasty with senior author (J.D.K), and had at least three months of follow-up were included in the study. Patients undergoing zero-depth vaginoplasty or revision vaginoplasty were excluded. The free peritoneal graft is harvested robotically and used as a strip of mucosal-like tissue for a more anatomic neovagina and sutured to scrotal skin grafts over a vaginal conformer. The construct is sutured to the remaining penile shaft skin and then then inverted and passed through the perineal body into the robotically-created space. The apex of the neovaginal lining created by the skin graft-peritoneal graft construct is then sutured to the peritoneal reflection with barbed suture in two layers intra-corporally via the robot. Results: Thirty-eight patients were included in our study. Average age at the time of initial consult was 31 years. All patients were on hormone therapy and 42% of patients had previously undergone top surgery. The average length of follow-up was 230 days. The most common complication was stricture/stenosis secondary to non-compliance with post-operative dilation protocol. Eight patients (21%) experienced stricture, four of which were managed with aggressive dilation. Three patients required surgical revision and one patient did not require any intervention. Seven patients (18%) experienced wound dehiscence with four patients requiring operative repair. Four patients (11%) developed labial banding/webbing that required revision. Other complications included one hematoma, one infection, and two episodes of post-operative bleeding. Eleven patients (29%) developed symptomatic granulation tissue during the healing process that was treated with silver nitrate application and resolved with time. Lastly, two patients (5%) had labial asymmetry that did not interfere with function, but who desired revision for cosmesis. Eighty-four percent of patients used Soul Source vaginal dilators (Sour Source Therapeutic, North Hollywood, CA) post-operatively and of those patients 53% could dilate with the orange dilator (the largest, 1 1/2 inch diameter), 13% with teal (1 3/8 inch diameter), 16% with blue (1 ¼ inch diameter) and 19% with purple (1 1/8 inch diameter). All dilators are 9 inches in length. Patients are cleared for sexual intercourse three months after surgery. Many patients had return of sensation to light touch of the neo-clitoris and were able to achieve organism through direct neo-clitoral stimulation. Conclusion: With experience and an interdisciplinary team, robotic-assisted vaginoplasty with free peritoneal grafting is safe and effective with a low complication rate and high neo-vaginal patency rate. Many patients report successful penetrative intercourse and the ability to achieve orgasm post-operatively.

Marsupialization versus Word catheter in the treatment of Bartholin cyst or abscess: retrospective cohort study

Objective:Bartholin cysts or abscesses are observed in approximately 2% of women, usually in their reproductive years. Although none of the treatments appear to be superior, there are several options including drainage with basic incision, Word catheter application, marsupialization, silver nitrate application, and excision. The primary outcome in this study was to evaluate the recurrence rates in patients who underwent marsupialization or Word catheter for the treatment of Bartholin cyst or abscesses, and the secondary outcome was to evaluate the rates of patient satisfaction.Material and Methods:A total of 196 patients who underwent either Word catheterization or marsupialization for the treatment of Bartholin cyst or abscesses between 2014 and 2017 were included in this retrospective cohort study. The size and location of the cyst/abscess, the operation duration, and the recurrence was recorded. A 5-point visual analog scale (VAS) was used to assess patient satisfaction and whether patients would recommend thier treatment to others.Results:Recurrence was observed in 11 (8.3%) patients in the marsupialization group, and 12 (18.8%) patients in the Word catheter group (p=0.034). Median (range) VAS scores in the marsupialization group were better than the Word catheter group [4 (1-5) vs 3 (1-5); p<0.001].Conclusion:Higher recurrence rate and dissatisfaction level were found in the Word catheter group. The only advantage of using Word catheter was its short operation time. These results appear to show that marsupialization should be the first-line treatment for Bartholin cysts and abscesses. However, the small number of cases and the retrospective nature of this study mean that larger, prospective studies are required to support this hypothesis.

Office-based management of Bartholin cysts and abscesses: a comparison of three surgical methods

Aim: In the present study, we aimed to compare the effectiveness of incision + drainage alone, marsupialization, and incision + drainage followed by silver nitrate application for the office management of Bartholin cysts/abscesses.&#x0D; Material and Method: A total of 128 women who presented to our clinic, diagnosed with Bartholin cysts/abscesses and underwent Bartholin gland sparing office-based surgery were included in this retrospective study. Patients’ demographic data, laterality and size of the cyst, surgical method performed, operational time, presence of recurrence, and treatment method of recurrent cysts/abscesses were recorded. Patients were divided into three group according to the operation they have undergone as incision + drainage alone, incision + drainage followed by silver nitrate, marsupialization. &#x0D; Results: The mean cyst diameter was found as 3.00±1.05 cm. Eighteen (14.1%) patients developed recurrence. Of all patients, 37.5% underwent incision + drainage alone, 8.6% incision + drainage followed by silver nitrate application and 62.5% marsupialization. The mean operational time was significantly longer in the marsupialization group compared to incision + drainage alone and incision + drainage followed by silver nitrate groups (both, p

Ecotoxicity and fate of silver nanomaterial in an outdoor lysimeter study after twofold application by sewage sludge

The increasing use of antibacterial silver nanomaterials (AgNM) in consumer products leads to their release into sewers. High amounts of AgNM become retained in sewage sludge, which causes their accumulation in agricultural soils when sewage sludge is applied as fertilizer. This increase in AgNM arouses concerns about toxicity to soil organisms and transfer within trophic levels. Long-term field studies simulating the sewage sludge pathway to soils are sparse, and the effects of a second sewage sludge application are unknown. In this perennial field lysimeter study, a twofold application of AgNM (NM-300K, 2 + 3 mg AgNM/kg dry matter soil (DMS)) and a onefold application of silver nitrate (AgNO3, 2 mg Ag/kg DMS) by sewage sludge to the uppermost 20 cm of the soil (Cambisol) were applied. The response of microorganisms to the applications was determined by measuring the inhibition of ammonium-oxidizing bacteria (AOB). Silver concentration in soil, leachates, and crops were measured after acid digestion by inductively coupled plasma mass spectrometry (ICP-MS). Almost no vertical Ag translocation to deeper soil layers and negligible Ag release to leachates suggest that soil is a large sink for AgNM and AgNO3. For AgNM, an increase in toxicity to AOB was shown after the second sewage sludge application. The application of AgNO3 resulted in long-term toxicity comparable to the toxicity of AgNM. Low root uptake from both AgNM- and AgNO3-spiked lysimeters to crops indicates their incomplete immobilization, which is why food chain uptake cannot completely be excluded. However, the root-shoot barrier for wheat (9.8 → 0.1 mg/kg) and skin body barrier for sugar beets (1.0 → 0.2 mg/kg) will further reduce the accumulation within trophic levels. Moreover, the applied AgNM concentration was above the predicted environmental concentration, which is why the root uptake might be negligible in agricultural practice.

Painful, bleeding fingertip papule

A 66-year-old man presented with a 3-month history of a painful and bleeding fingertip papule that had temporarily improved after silver nitrate application. Pertinent history included stage IV clear cell renal cell carcinoma (ccRCC) treated with radical nephrectomy and adjuvant ipilimumab/nivolumab. Recent imaging confirmed continued regression of metastases, and the patient was clinically doing well. Examination demonstrated a violaceous and hyperkeratotic papule (Fig 1). Biopsy revealed a dermally based, lobulated, eosinophilic epithelioid cell population with extravasated red blood cells (Fig 2).

Medical uses for silver nitrate in the urinary tract (Review)

Silver nitrate has been used for centuries for the treatment of a variety of diseases and in the prevention of infection. Silver nitrate exerts astringent, cauterizing and corrosive effects, as well as antimicrobial activities. Silver nitrate injection therapy has a long history of use in urology. It is reportedly effective for hemorrhagic cystitis, interstitial cystitis, renal hematuria and chyluria. The present review article summarizes the medical applications of silver nitrate in urology. The published studies available on the medical uses of silver nitrate are essentially older and retrospective, involving smaller numbers of patients. In the absence of comparative studies with other treatments, it is thus impossible to determine the relative benefits of silver nitrate. However, the outcomes of silver nitrate therapy have been fairly well established. Silver nitrate therapy may prove to be a treatment option for patients who are poor candidates for invasive treatment. Further studies on the uses of silver nitrate however, are required, and improvements also need to be made in the injection technique to reduce the rate of complications.

Effect of Silver Nitrate Application on the Success of Endoscopic Dacryocystorhinostomy.

To compare the clinical outcomes of patients undergoing additional procedures in endoscopic endonasal dacryocystorhinostomy (End-DCR) surgery and discuss the factors affecting the success of End-DCR surgery in light of relevant literature. The study included 155 patients who underwent End-DCR surgery in our clinic due to epiphora. This was a prospective randomized, single-blind, controlled trial. Group I (control) included 54 patients who did not undergo silicone stent insertion or silver nitrate application, group II included 51 patients who underwent silicone stent insertion only, and group III included 50 patients who underwent silver nitrate application only. Statistical analysis was performed on follow-up data regarding anatomic and functional success rates. Revision surgery was performed in 16 patients who developed persistent epiphora in the postoperative period, including 6 in group I, 7 in group II, and 3 in group III (P = .4). The most common reason for revision surgery was stenosis of the neo-ostium (n = 8), followed by granulation tissue formation (n = 5) and synechia formation (n = 3). Granuloma formation was the most common postoperative complication, and a significant difference was found among the groups with regard to granuloma formation (P = .04). At postoperative month 12, the functional success rate was estimated to be 88%, 86%, and 94%, and the anatomic success rate was estimated to be 94%, 92%, and 96% in groups I, II, and III, respectively, with no significant difference, found among the 3 groups with regard to both rates (P = .79 and P = .76, respectively). The results indicated that stenting and silver nitrate application did not affect surgical success. Our preliminary results on silver nitrate cauterization showed that it is an effective, inexpensive, and practical method to reduce granulation formation in the postoperative period.

Effect of Silver Nitrate Cauterisation of Nasal Mucosa on Quality-of-Life and Histology in Patients with Intractable Chronic Rhinitis.

Patients with chronic rhinitis causing intractable sneezing which is non-responsive to conventional medication require alternative therapies. The aim of the study was to ascertain the effect of topical 10% silver nitrate solution on the inferior turbinate mucosa as well as quality of life in such patients. Patients with severe chronic rhinitis who failed conventional therapy had application of 10% silver nitrate solution to inferior turbinate mucosa. The number of sneezes/day and mini Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score was noted before and 8 to 16 weeks after treatment. Pre- and post treatment turbinate biopsies were performed to assess histological changes. At baseline, 67 patients had a mean of 36.6 sneezes/day and mean mini RQLQ score of 4.0 ± 0.7. Pre-treatment biopsies showed epithelial denudation and hyalinization of basement membrane. Following 10% silver nitrate application, 64/67 (95.5%) patients showed significant reduction in number of sneezes both at 1 week (p < 0.001) and 8–16 weeks (mean = 5.5 ± 7.8; p < 0.001). Post- treatment mean global mini RQLQ score was also significantly reduced (mean = 1.3 ± 1.1; p < 0.001). A single application was sufficient in 70.1% patients. There were no complications. Squamous metaplasia (p = 0.005) and epithelial hyperplasia (p = 0.013) as well as epithelial and basement membrane restoration occurred following therapy. 10% silver nitrate solution application is an effective and safe office- based procedure which significantly reduces sneezing improves QoL with corresponding histological changes.

Approach to Bartholin's abscesses and recurrences under office conditions

ObjectiveThe aim of this study is to investigate the various treatment methods and recurrence rates regarding Bartholin's gland abscesses under office conditions in our clinic. MethodsIn our study, the data of 155 patients who applied to the gynaecology and obstetrics clinic of our hospital between January 2017 and November 2020 and had Bartholin's abscess that was treated with surgical methods under office conditions were analyzed retrospectively. ResultsOf the 155 patients included in the study, 111 underwent incision drainage, 22 underwent marsupialization, and 22 underwent incision drainage+ silver nitrate. Bartholin's abscess was localized on the right side in 48.4% of the patients and on the left side in 51.6% of the patients. Recurrence was detected in 53 of 155 patients included. Recurrence was detected in 39.6% of the patients who underwent incision drainage in the first treatment, 31.8% of those who underwent marsupialization, and 9.1% of those who underwent incision+silver nitrate. The difference in success, based on recurrence rates, was found to be statistically significantly in favour of silver nitrate (p<0.05). In secondary treatments for recurrent cases, marsupialization or incision+silver nitrate treatment was effective in over 90% of cases, while incision drainage was effective in 30% of patients. ConclusionThe findings of our study show that silver nitrate application led to a lower recurrence rate than the other two methods. In view of this, we recommend that marsupialization or silver nitrate be preferred, especially in the treatment of recurrent cases.

Simplified management of epistaxis.

Primary care, urgent care, and emergency department providers periodically treat epistaxis, either as recurrent nosebleed or an acute persistent episode. Silver nitrate application to the decongested and anesthetized nasal mucosa addresses the former in most cases. The plethora of commercial nasal packing devices testifies to the discomfort, technical difficulty, and frustration associated with traditional gauze-packing methods. Inflatable anterior nasal balloon packs reliably control most nosebleeds. Addition of a Foley catheter nasopharyngeal balloon pack manages most posterior epistaxis. Cautery and the two packing techniques mentioned above should treat most cases not requiring otolaryngology consultation or interventional radiology. Appropriate anesthetic and analgesics lessen the unpleasantness for both the patient and the provider. Topical moisturizing facilitates mucosal healing. Oxymetazoline 0.05% nasal spray provides the patient means to address rebleeding after discharge from treatment.

Cadmium Chloride and Silver Nitrate Affect the Gene Expression, Stevioside, and Rebaudioside: A Production in Stevia rebaudiana (Bert.)

Stevia rebaudiana (Bert.) produces steviol glycoside sweeteners that are sweeter than sucrose. Stevioside and rebaudioside A are important steviol glycosides used in food production. This study was conducted to investigate the effect of different concentrations of cadmium chloride (0, 20, 40, 60 and 80 mg/L) and silver nitrate (0, 15, 30, 45 and 60 mg/L) and different sampling times on stevioside and rebaudioside A production and Ent-kaurenoic acid 13-hydroxylase, uridine diphosphate-glycosyltransferase 74G1 and uridine diphosphate-glycosyltransferase 76G1 genes expression in in vitro conditions. The results showed that the application of cadmium nitrate and silver nitrate decreased stevioside and rebaudioside A production. Among various concentrations of cadmium chloride, the highest concentrations of stevioside and rebaudioside A were respectively 39.76 mg/g and 2.27 mg/L dry weight 96 and 72 h after elicitation with 20 mg/L cadmium chloride. Among different concentrations of silver nitrate, the highest amounts of stevioside and rebaudioside A were respectively 33.33 mg/g dry weight was 2.19 mg/L obtained at control condition after 96 h and elicitation with 60 mg/L for 24 h. In elicitation with cadmium chloride the expression all three genes were increased but silver nitrate elicitation increased uridine diphosphate-glycosyltransferase 76G1 gene expression and decreased the Ent-kaurenoic acid 13-hydroxylase and uridine diphosphateglycosyltransferase 74G1 genes expression. The correlation analysis showed that Ent-kaurenoic acid 13-hydroxylase gene expression was not correlated with uridine diphosphate-glycosyltransferase 74G1 and uridine diphosphate-glycosyltransferase 76G1 genes expression, while uridine diphosphateglycosyltransferase 74G1 was inversely correlated with uridine diphosphate-glycosyltransferase 76G1. Also, positive correlations were observed between uridine diphosphate-glycosyltransferase 74G1 gene expression with stevioside synthesis and uridine diphosphate-glycosyltransferase 76G1 gene expression with rebaudioside A.

Surgical management options for Bartholin’s gland abscess

Bartholin's glands, also known as greater vestibular glands, are two mucus-secreting glands located in the posterolateral wall of the vagina opening. The function of these glands is to produce mucus that moisturizes the vestibule of vagina. When the outflow path from the gland is blocked, a cyst forms. When the abscess is formed usually it is infections with a polymicrobial background.The most common symptoms of a Bartholin's gland cyst or abscess include pain in the vulva, swelling, difficulty walking, dyspareunia, and fever.The procedure of choice in this case is surgery. The operator can choose from among many possible options, among others there is simple incision and drainage of the cyst, marsupialization, a Word catheter, silver nitrate application, alcohol sclerotherapy, excision and laser CO2 and, as a last resort, surgical removal of the gland.The aim of this study is to review the most common surgical procedures used in Bartholin's gland cyst or abscess.