Caustic Agents Research Articles

Protocolo diagnóstico y terapéutico de la ingesta de cáusticos

The ingestion of caustic agents is a medical emergency due to the serious injuries they can cause to the upper digestive tract. It is estimated to have a frequency of 38.7 cases/100,000 inhabitants and a mortality rate of 1%–4% in Western countries. There are two typical scenarios: accidental ingestion, of small quantity and with a more benign course, and ingestion with the purpose of self-harm, of larger quantity and with a worse prognosis. The initial management consists of ensuring hemodynamic stability and airway permeability, avoiding actions such as inducing vomiting or the use of neutralizing substances. Radiological tests together with endoscopy allow for assessing severity and stratifying the risk of complications. Treatment varies according to the Zargar classification, ranging from outpatient management to emergency surgery in cases of perforation. Long-term follow-up allows for the detection of complications such as esophageal stricture, esophagobronchial fistulas, and esophageal cancer.

Interfacial charge transfer in sheet Ni2P-FePx heterojunction to promote the study of electrocatalytic oxygen evolution.

The substantial expense associated with catalysts significantly hampers the progress of electrolytic water-based hydrogen production technology. There is an urgent need to find non-precious metal catalysts that are both cost-effective and highly efficient. Here, the porous Ni2P-FePx nanomaterials were successfully prepared by hydrothermal method, nickel foam as the base, iron nitrate solution as the caustic agent and iron source, and finally phosphating at low temperature. The obtained porous Ni2P-FePx nanosheets showed excellent catalytic activity under alkaline PH = 14, and an overpotential of merely 241 mV was required to achieve a current density of 50 mA cm-2. The morphology of the nanosheet can still be flawlessly presented on the screen after 50 h of working at high current density.

Clinical evaluation and treatment outcomes of caustic ingestion injuries in Syrian pediatric patients: A retrospective study: Short title: High-dose steroids for pediatric caustic ingestions in Syria.

Accidental ingestion of caustic agents poses a significant concern in pediatric emergency departments globally. It is a growing public health concern in low-to-middle income countries, which often lack comprehensive data reporting. This study examines high doses of corticosteroid treatment outcomes of caustic ingestion injuries in Syrian pediatric patients, addressing clinical features, and associated variables. A retrospective observational study was conducted at University Pediatric Hospital from January 2016 to January 2019. Medical records were reviewed for patients aged <10 years with esophagoscopy-confirmed grade IIa, IIb, or III burns. Data collected included sociodemographics, esophagoscopy results, treatment details, and outcomes. Among 114 pediatric patients, 76 (67%) were males and 38 (33%) were females. Age groups included <1 year (11%), 1-3 years (39%), 3-5 years (29%), 5-7 years (11%), and >7 years (11%). Alkaline burns accounted for 54% of injuries, acidic for 32%, and other substances for 13%. Complications included bleeding (19%) and psychomotor disability (7%). The most common burn site was the entire esophagus (62%), with 81% having grade II burns. Healing was achieved in 71% of patients with high doses of corticosteroids treatment, and 29% required dilation, with final 92% healing rate. The use of corticosteroids for esophageal strictures remains inconclusive, demanding further robust research with larger sample sizes and control groups. While our study revealed that high doses of corticosteroids treatment followed by esophageal dilation had a 92% success rate. However, our study demonstrates promising results, methodological limitations and absence of a control group underscore the need for more definitive evidence. Both alkali and acidic ingestion contribute to stricture development.

Hepatic Portal Venous Gas (HPVG) after Ingestion of Chlorine Bleach: A Transient Phenomenon.

We present a case involving a 32-year-old man who ingested chlorine bleach with self-defeating intent. The ingestion of bleach can lead to a wide range of consequences, from mild mucosal burns to severe complications, rarely resulting in death. This case highlights the association between chlorine bleach ingestion and the development of hepatic portal venous gas (HPVG), a radiological finding traditionally thought to carry poor prognoses. The HPVG in this case resolved spontaneously within 24 h with conservative management, indicating its transient nature. The exact pathophysiological mechanisms responsible for HPVG after the ingestion of toxic substances .remain only partially understood. One hypothesis suggests that extensive damage to the gastrointestinal wall caused by caustic agent may allow enteric gas to enter the portal system. While HPVG after toxic ingestion is often transient, its consequences and potential risks should be carefully considered. Hyperbaric oxygen therapy is suggested in cases with neurological symptoms. In conclusion, HPVG is not a specific disease but rather a manifestation of various underlying factors, and its development in the context of chlorine bleach ingestion represents an additional insight to its understanding. It can be associated with severe medical conditions, but it is also found in less severe cases that can be managed conservatively.

Assessment the Risk Factors for the Complications of Gastric Pull-Up Method in Esophageal Stenosis due to Ingestion of Caustic Agents

Assessment the Risk Factors for the Complications of Gastric Pull-Up Method in Esophageal Stenosis due to Ingestion of Caustic Agents

A rare case of congenital adult pharyngeal web causing airway obstruction managed by coblation technology

Congenital pharyngeal web is a rare anomaly almost always diagnosed in the paediatric population due to airway obstruction and feeding difficulties. The combination of congenital oropharyngeal and laryngopharyngeal web in an adult is extremely rare and has not commonly been published in the literature. We experienced a 47-year-old woman undiagnosed with pharyngeal web until difficult intubation upon surgery. A 47-year-old woman diagnosed with right ovarian complex cyst was scheduled for total laparoscopic hysterectomy and bilateral salpingo-oopherectomy. pharyngeal webs were incidentally found during intubation and necessitated a reschedule of surgery and tracheostomy. The patient had no history of dysphagia, weight loss or other symptoms of airway obstruction. Fibre optic laryngoscopic examination revealed a combination of congenital oropharyngeal and laryngopharyngeal webs. Patient denied previous history of caustic agent ingestion, oral airway surgeries, chemoradiation. After 2 days, awake tracheostomy with endoscopic guided coblator assisted excision of pharyngeal web was done first, followed by total laparoscopic hysterectomy and bilateral salpingo-oopherectomy in the same sitting. Coblation assisted excision of the pharyngeal web will allow the airway to be feasible for intubation in the future. Congenital pharyngeal webs are extremely rare findings, especially in adult patients. Prediction of difficult airways preoperatively is necessary to prevent difficult airway situations. Controlled ablation of the pharyngeal web gives a good outcome in terms of less post-operative pain and blood loss.

Predicting Factors of Clinical Outcomes in Patients Hospitalized after Esophageal Foreign Body or Caustic Injuries: The Experience of a Tertiary Center

Ingestion of foreign bodies (IFB) and ingestion of caustic agents are frequent non-hemorrhagic causes of endoscopic urgencies, with the potential for severe complications. This study aimed to evaluate the predicting factors of the clinical outcomes of patients hospitalized as a result of IFB or ingestion of caustics (IC). This was a retrospective single-center study of patients admitted for IFB or IC between 2000 and 2019 at a tertiary center. Demographic and clinical data, as well as preliminary exams, were evaluated. Also, variables of the clinical outcomes, including the length of stay (LS) and other inpatient complications, were assessed. Sixty-six patients were included (44 IFB and 22 IC). The median LS was 7 days, with no differences between the groups (p = 0.07). The values of C-reactive protein (CRP) upon admission correlated with the LS in the IFB group (p &lt; 0.01) but not with that of those admitted after IC. In the IFB patients, a diagnosis of perforation on both an endoscopy (p = 0.02) and CT scan (p &lt; 0.01) was correlated with the LS. The Zargar classification was not correlated with the LS in the IC patients (p = 0.36). However, it was correlated with antibiotics, nosocomial pneumonia and an increased need for intensive care treatment. CT assessment of the severity of the caustic lesions did not correlate with the LS. In patients admitted for IFB, CRP values may help stratify the probability of complications. In patients admitted due to IC, the Zargar classification may help to predict inpatient complications, but it does not correlate with the LS.

Opposing Roles of Blood-Borne Monocytes and Tissue-Resident Macrophages in Limbal Stem Cell Damage after Ocular Injury.

Limbal stem cell (LSC) deficiency is a frequent and severe complication after chemical injury to the eye. Previous studies have assumed this is mediated directly by the caustic agent. Here we show that LSC damage occurs through immune cell mediators, even without direct injury to LSCs. In particular, pH elevation in the anterior chamber (AC) causes acute uveal stress, the release of inflammatory cytokines at the basal limbal tissue, and subsequent LSC damage and death. Peripheral C-C chemokine receptor type 2 positive/CX3C motif chemokine receptor 1 negative (CCR2+ CX3CR1-) monocytes are the key mediators of LSC damage through the upregulation of tumor necrosis factor-alpha (TNF-α) at the limbus. In contrast to peripherally derived monocytes, CX3CR1+ CCR2- tissue-resident macrophages have a protective role, and their depletion prior to injury exacerbates LSC loss and increases LSC vulnerability to TNF-α-mediated apoptosis independently of CCR2+ cell infiltration into the tissue. Consistently, repopulation of the tissue by new resident macrophages not only restores the protective M2-like phenotype of macrophages but also suppresses LSC loss after exposure to inflammatory signals. These findings may have clinical implications in patients with LSC loss after chemical burns or due to other inflammatory conditions.

Extra-Thoracic Subclavian Vein Access: The Tips And Tricks

The success of any trans-venous procedure involves the rate liming step, which is the access. The procedure cannot be performed without the access site. It is the key that open the success of the procedure. There are many procedures that require extra-thoracic subclavian vein. These procedures may include: central venous pressure monitoring, administration of multiple medications and drips, high volume/flow resuscitation, emergency venous access, inability to obtain peripheral venous access, repetitive blood sampling, administering hyperalimentation, vasopressors, caustic agents, or other concentrated fluids; insertion of transvenous cardiac pacemakers, hemodialysis or plasmapheresis and insertion of pulmonary artery catheters. In this review, we discuss the various techniques of accessing the vein and it tips and tricks..

Social factors behind rising trends of intentional ingestions of caustic agents in adult population of Pakistan. A study from tertiary health care center, Islamabad.

Objective To evaluate factors associated with rising trends of intentional ingestion of caustic agents for suicidal attempts in Pakistan. Study Design: Cross Sectional, Observational study. Setting: Tertiary Health Care Center of Islamabad. Period: January 2019 to December 2020. Material &amp; Methods: One hundred subjects with intentional ingestion of caustic ingestion treated in Gastroenterology unit were interviewed on a written questioner after their recovery and informed consent. Non-probability purposive was sampling method used. Results: Out of 100 patients 63% were female, mean age was 28.81 years and 58% had suicidal intension. Disturbed marital/ family life was main factor behind suicidal attempts. (P= 0.025). Conclusion: factors like female gender, younger age, poor socioeconomic status and disturbed marital/ family life in study group had statistically significant association with suicidal intentions.

Reconstruction of the upper gastrointestinal tract using intra-thoracic Roux-en-Y technique after caustic agent ingestion: a case report from Aleppo, Syria

BackgroundCaustic substance ingestion is a high-risk medical emergency associated with high mortality and morbidity. To date, there are several treatment options with no standard method of care.Case presentationWe report a case of a corrosive agent ingestion complicated with third-degree burns and severe stenosis of the esophagus and gastric outlet. After failure of conservative treatment, the patient underwent jejunostomy placement for nutritional support followed by transhiatal esophagectomy with gastric pull-up and intra-thoracic Roux-en-Y gastroenterostomy with good outcomes. The patient recovered from the procedure and has been tolerating oral intake very well with significant weight gain.ConclusionWe put a new technique for treating severe gastrointestinal injuries caused by corrosive agent ingestion that resulted in both esophageal and gastric outlet strictures. These rare complex cases requires difficult treatment decisions. We believe that this technique provides many benefits for such cases and might be a feasible alternative for colon interposition.

Order-of-magnitude enhancement in boron removal by membrane-free capacitive deionization

Increasing global water stress motivates a growing interest in seawater desalination by reverse osmosis. Boron is typically weakly removed by reverse osmosis membranes at seawater pH, necessitating expensive post-processes such as caustic agent dosing of the permeate followed by additional filtration steps. It has been previously demonstrated that membraneless capacitive deionization can enable chemical-free boron removal from reverse osmosis permeate, with basic design rules established. However, the level of boron electrosorption per cell charge was limited to ∼0.5 µmol/g, a level too low for practical applications. We here explore, both theoretically and experimentally, methods to enhance boron removal by capacitive deionization. We found that reversing the polarity of the applied voltage during the discharge step resulted in an order of magnitude increase in boron electrosorption to nearly 4 µmol/g with promising energy consumption of 0.2 kW⋅h/m3. The promise of these results is highlighted when compared with recently-developed boron electrosorption cells requiring bipolar membranes, which demonstrate similar boron removal of 4.35 µmol/g but with much higher energy consumption of 18.3 kW⋅h/m3 while incurring significant membrane costs. Overall, we demonstrate for the first time that membrane- and chemical-free electrochemical technologies can remove sufficient boron from RO permeate in a single pass, significantly enhancing its potential to provide energy- and cost-efficient boron removal.

Effectiveness of sucralfate in preventing esophageal stricture in children after ingestion of caustic agents.

Ingestion of caustic agents by children is a serious health issue that can affect the patient for the rest of his life. The role of sucralfate in preventing stricture caused by caustic agents is controversial, and limited studies have been conducted in this field. We aimed to investigate the effect of sucralfate on preventing esophageal stricture in children. Sixty children with mean age of 36.69 ± 20.50months and grade II B esophageal burns due to ingestion of caustic agents were enrolled in the study. In the intervention group, in addition to the usual treatment, sucralfate was administered orally at a dose of 80mg/kg every 2h for 3days. For the control group, only the usual treatment was prescribed. Stricture development was compared between groups based on endoscopic and radiologic findings. Of the 60 patients enrolled in the study, 53 were examined. The incidence of esophageal stricture in the intervention group was significantly lower than in the control group (37% versus 67%, P-value = 0.042). In addition, the odds of esophageal stricture after sucralfate intervention was significantly reduced after adjustment for potential confounders (OR = 0.198, P-value = 0.031). Conclusions: The results of this study showed that sucralfate may reduce the development of esophageal stricture in children when used to manage IIB esophageal burns due to ingestion of caustic agents. What is Known: •Ingestion of caustic agents by children is a serious health issue that can affect the patient for the rest of his life. •The role of sucralfate in preventing stricture caused by caustic agents is controversial and limited studies have been conducted in this field. What is New: • It seems that sucralfate significantly reduces the incidence of esophageal stricture following the ingestion of caustic agents in children compared to the control group. •We believe that the prognosis may be improved and the risk of stricture formation may be reduced with high doses of sucralfate therapy in grade IIB esophageal injury.

Colon interposition in the management of post-corrosive strictures

: Stricture of the esophagus is the most frequent late sequelae of the ingestion of caustic agents. It is disabling, lead to chronic pain and malnutrition. Endoscopic dilatation still remains the first-line management but cannot be effective in all patients. When surgery is indicated, only selected patients can be submitted to an esophago-gastroplasty. Colon interposition for esophageal replacement is more frequently performed for treatment of caustic burns, but many questions still remain about colonic tract to be used (right or left), route of transposition and timing of the operation. Surgeon’s experience is the most important factor to choose the right colonic tract as esophageal substitute. Age, psychiatric disorders, massive ingestion, emergency tracheotomy, extended visceral resections, short delays in reconstruction, and pharyngeal involvement worsen surgical outcomes, therefore surgery should be performed in high-volume centers. Follow-up of these patients should not tend only to verify the patency of the transit and weight maintenance, but it should identify any lesion of the graft and any metabolic alteration referring to an altered permeability of the transposed colic segment. In this review, we present the main step of preoperative, intraoperative and postoperative pathway of esophageal reconstruction for caustic strictures with a colonic graft, critically exposed according to our experience.

Effects of partially replacing dietary corn with sugars in a dual-flow continuous culture system on the ruminal microbiome.

The objective of this study was to evaluate the effects of feeding sugars as a replacement for starch on the ruminal microbiome using a dual-flow continuous culture system. Four periods of 10 days each were conducted with 8 fermenters in a 4 × 4 replicated Latin square design. Treatments included: 1) control with corn-CON, 2) molasses-MOL, 3) untreated condensed whey permeate-CWP, and 4) CWP treated with a caustic agent-TCWP as a partial substitute for corn. Sugars were defined as the water-soluble carbohydrates (WSC) concentration. Diets were formulated by replacing 4% of the diet DM in the form of starch from corn with the sugars in byproducts. Microbial samples for DNA analysis were collected from the solid and liquid effluent containers at 3, 6, and 9 h after feeding. Bacterial community composition was analyzed with sequencing the V4 region of the 16S rRNA gene using Illumina MiSeq platform. Data were analyzed with R 4.1.3 packages vegan, lmer, and ggplot to determine the effects of treatment on the relative abundance of taxa in the solid and liquid fractions, as well as the correlation of Acetate: Propionate ratio and pH to taxa relative abundance. Treatments did not affect alpha or beta diversity. At the phylum level the relative abundance of Proteobacteria was increased in CON compared to sugars in the solid fraction. In the liquid fraction, Firmicutes had greater relative abundance in sugar treatments while Bacteroidota and Spirochaetota were present in lower relative abundance in CWP. For solid and liquid samples, the family Lachnospiraceae had greater relative abundance in sugar treatments compared to CON. The decreased relative abundance of Christensenellaceae and Rikenellaceae paired with the greater relative abundance of Selenomonadaceae in CWP could help explain greater propionate molar proportion and decreased ruminal pH previously observed for this treatment. The genera Olsenella a lactic acid-producing bacterium, had the greatest relative abundance in MOL. Incorporating TCWP or MOL as a partial replacement for starch was more conservative of fibrolytic bacterial taxa compared to CWP. Additionally, TCWP did not increase bacterial taxa associated with synthesis of lactate as compared to MOL. Overall, replacing starch with sugars is mostly conservative of the ruminal microbiome; however, changes observed coincide with differences observed in acetate and propionate proportions and ruminal pH.

Esophageal emergencies.

The esophagus is a deeply located organ which traverses the neck, the thorax, and the abdomen and is surrounded at each level by vital organs. Because of its positioning injuries to the esophagus are rare. Their common denominator is the risk of the organ perforation leading to spillage of digestive contents in surrounding spaces, severe sepsis and eventually death. Most frequent esophageal emergencies are related to the ingestion of foreign bodies or caustic agents, to iatrogenic or spontaneous esophageal perforation and external esophageal trauma. Early diagnosis and appropriate management are the keys of successful outcomes.

291 Caustic Ingestions: Does Intent Matter

Clinicians may encounter patients who consume caustic agents for either exploratory/accidental means, or for suicidal purposes. There is some debate in the literature with regards to the evaluation of asymptomatic individuals who consume caustics for suicidal purposes, with some advocating esophagogastroduodenoscopy (EGD) for all suicidal patients, even if asymptomatic. The primary purpose of this study was to evaluate if asymptomatic suicidal patients who ingest caustic agents routinely need an EGD performed.

657. COMPARISON BETWEEN GASTRIC TUBE AND COLOPLASTY IN ESOPHAGECTOMY AND ESOPHAGEAL BYPASS IN ESOPHAGEAL STENOSIS DUE TO INGESTION CORROSIVE SUBSTANCE

Abstract The treatment of ingestion of caustic agents is controversial in the literature. Surgical therapy has been shown to be the best way to proceed, but the surgical methodology has been varied according to the patient's involvement. This study aims to expose the experience of a single institution in relation to the methodology used for the surgical treatment of esophageal stenosis by ingestion of a caustic substance. A retrospective study was carried out in which data were collected from 27 patients who underwent a surgical procedure for the treatment of esophageal stenosis due to alkali ingestion at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo between 2010 and 2019 and their subsequent comparison between the conduits used in the surgical intervention. Fisher's test was performed to compare the groups regarding cervical leakage and post-surgical symptoms with a significance level of 5%. Of the 27 surgical procedures for esophageal stenosis due to alkali ingestion, 12 performed gastric conduits and 15 colon conduits. When comparing the groups regarding cervical leaks, no statistically significant difference was noted (p = 0.7060). There were also no statistically significant differences regarding the presence of symptoms in the postoperative period (p &amp;gt; 0.99...) Surgical intervention by both gastric and colon conduits showed no differences in cervical leakage and symptom control. Surgical intervention by both gastric and colon conduits showed no differences in cervical leakage and symptom control.

A literature review of the use of phenol for nail matrix ablation on pregnant and breastfeeding patients: implications for safe use

Background Nail surgery using phenol to chemically ablate the nail matrix is a technique that has been performed for many years. The phenolic technique of nail surgery has been refined and established as a safe and effective procedure. Although it is used in small quantities podiatrically, phenol is readily absorbed through multiple routes such as ingestion, dermal absorption, and inhalation - the latter two being the most likely in podiatric practice. However, given its pervasiveness as a caustic agent in nail surgery, there is a paradoxically small narrative on the safety aspects of phenol's use in pregnant and breastfeeding patients. This paper reviews the available literature to provide a narrative response to this concern. Method A literature search to identify research evidence from electronic databases and reference lists was performed. Evidence was also sought using Google Scholar free text keywords. A narrative review of the literature was then performed, with agreement from all authors. Discussion Although patient safety concerns have been raised for the clinical use of a range of phenols, humans are environmentally exposed to such compounds in food, cosmetics, plastics, and resins. For the general population, cigarette smoke and smoked food products are the most common sources of phenol exposure. The data on phenol exposure during nail surgery and potential health consequences to the foetus are discussed. Conclusion Following calculations for the potential absorption of phenol via an EZ swab, the authors suggest that the purported risks associated with the podiatric use of phenol are overly cautious given that there is no clear association between occupational exposure to phenol and adverse pregnancy outcomes. Although phenols are ubiquitous in the environment, these exposures have previously not been compared to those of phenol matricectomy. Future research in this area would be highly beneficial, for example, the urinalysis of phenol before and after nail surgery in non-pregnant females.

Benign Esophageal Stricture

Benign esophageal strictures, characterized by fibrotic narrowing of the esophageal lumen, are frequently encountered in clinical practice. Benign esophageal strictures are associated with a multifactorial etiology and may occur across various age and population groups. Common causes of benign esophageal strictures include gastroesophageal reflux disease (peptic stricture), esophageal injury secondary to surgery (anastomotic strictures), radiotherapy, caustic agent ingestion, or endoscopic resection. Benign esophageal strictures are categorized into simple and complex types based on their size, area involved, surface features, extent of luminal narrowing, and margins. Esophageal strictures often present clinically with dysphagia and may lead to severe complications. Regardless of the underlying cause, therapy is aimed at relief of dysphagia and prevention of stricture recurrence. Benign esophageal strictures are commonly treated using endoscopic balloon or bougie dilation, followed by disease-specific approaches to treat underlying inflammation. However, based on the underlying cause, the risk of recurrence of benign esophageal strictures is 10~30%. Therapeutic options for refractory or recurrent esophageal strictures include endoscopic incisional therapy, esophageal stent placement, or intralesional injection of steroids or mitomycin C. The pathophysiology of esophageal strictures is complicated, and thorough understanding and patient cooperation are important for optimal management. Physicians should familiarize themselves with the various dilation strategies available and their application for management of specific types of stenotic lesions. In this article, we review the evaluation and management of patients with esophageal strictures.