Caustic Agents Research Articles

Long term outcome of a subcutaneous colonic interposition after pharyngo-laryngectomy for strictures of the larynx and hypopharynx resulting from caustic ingestion: A case report.

IntroductionCaustic agents, also called corrosive agents, could be acids or alkali in nature. If ingested, these agents can injure any part of the aerodigestive tree. Extent of injury depends on the type, concentration, duration of exposure and volume of caustic agent ingested. Serious complications after caustic agent ingestion can occur both in the short term such as hollow viscus perforation and death and in the long term such as stricture formation causing obstruction and lifetime risk of development of carcinoma.Presentation of a caseThis is a case of a 25-year-old female who ingested an unknown substance resulting to a severe stricture of the larynx, hypopharynx, esophagus and pyloroantral region of the stomach. Six months after her tracheostomy and tube jejunostomy, she sought further medical attention in our institution due to inability to swallow food and saliva. She underwent pharyngolaryngectomy (PL) with the strictured esophagus and stomach left in-situ due to extensive adhesions. The subcutaneous colonic interposition reestablished the alimentary continuity by providing enough length for tension-free anastomosis and a more direct route for cervical anastomosis.DiscussionStricture formation is one of the most challenging late complication of corrosive injury. It results from scar formation in response to inflammation of the aerodigestive tract. Key factors in managing caustic strictures include safety of strictured segment resection, choice of replacement organ for reconstruction and route of conduit.ConclusionTiming of surgery and proper selection the surgical procedure for complications of caustic ingestion can result in excellent long term outcomes.

Caustic ingestion in children treated at a tertiary centre in South Africa: can upper endoscopy be omitted in asymptomatic patients?

Considering that clinical presentation and gastrointestinal tract (GIT) injuries post-caustic ingestion vary in children, this study aims to establish whether a correlation exists between clinical presentation and endoscopic findings. This retrospective study comprised patients referred to a paediatric surgical unit between 2016 and 2018 within 72h post-caustic ingestion. Data collected included caustic agents ingested, clinical presentation, endoscopic findings and management. Oesophageal injuries were graded according to the Zargar's endoscopic classification and gastric injuries classified as mild to severe. Fifty patients with a mean age of 2.4years were managed during the study period. Potassium permanganate (KMNO4) was the most frequently ingested substance in 27 (54%) patients. All 30 (60%) asymptomatic patients had no positive endoscopic findings regardless of clinical signs. Among the symptomatic patients (n = 20), 15 (75%) had oesophageal injuries (p = 0.01). Stridor was associated with a higher grade of oesophageal injury (p = 0.007). Clinical signs and symptoms post-caustic ingestion correlated with endoscopic findings in our study. Endoscopy can be safely omitted in asymptomatic patients, including those with isolated staining secondary to KMNO4 ingestion. Symptomatic patients should have an endoscopy performed within 48-72h of the insult to diagnose injuries.

Tratamento de cicatriz de acne com peelings, subcisão, fios de polidioxanona (PDO) e fibrina rica em plaquetas – relato de caso

Acne scarring results from tissue loss and increased tissue proliferation. Atrophic scarring is caused by the loss of collagen that occurs in the inflammatory process of acne. All scars have psychological consequences, as they can affect self-esteem and cause physical pain when moving the affected area. Chemical peels are widely used to treat acne and acne scarring. They cause an injury to the skin or accelerated exfoliation, induced by caustic agents that cause controlled damage, followed by the release of cytokines and mediators of inflammation, resulting in thickening of the epidermis, collagen deposition, reorganization of structural elements and increase in dermal volume. Among the therapeutic modalities of acne scars, subcision is a simple and safe procedure. Subcision frees the scar surfaces and induces the formation of connective tissue directly below the scar. Another method used is the application of plasma rich in platelets and fibrin that release growth factor, essential for wound healing and synthesis of extracellular matrix remodeling. Polydioxanone (PDO) threads induce collagen production, increasing the number of fibroblasts in the tissue where it was inserted. This work presented a case of acne scarring, firstly treated with two applications of 10% ATA peeling and 10% retinoic acid. Then a subcision was made with a duckbill cannula and insertion of PDO wires with PRP in the scar region.

Sequelae of Corrosive Injury in Children: An Observational Study.

Aim:This study aims to determine the sequelae of corrosive ingestion in children.Methods:A retrospective study was conducted in the Department of Pediatric Surgery at a Tertiary Center. The children presenting between January 2015 and December 2020 with a history of ingestion of caustic agents were included in the study.Results:A total of 26 children were included in the study. The children with suicidal attempts were significantly older than those who ingested the corrosive agents accidentally (14.2 ± 1.9 years vs. 6 ± 3.3 years; P < 0.01; Student's t-test). Sixteen (62%) children had esophageal strictures, 8 (31%) had pyloric strictures, and a child (4%) had both esophageal and gastric strictures. Eight (31%) children required an initial feeding jejunostomy and 6 (23%) required a feeding gastrostomy as they had significant weight loss on presentation. Eleven (65%) esophageal strictures responded to the dilatation regimen and are symptom-free on follow-up. Three (18%) children with esophageal stricture underwent esophageal replacement. Eight (31%) children had a pyloric stricture and all of them were treated with a modified Billroth I gastro-duodenostomy. The children who presented after 2 months were found to have a significantly increased need for esophageal replacement (3/9 vs. 0/17; P = 0.03; Fischer's exact test).Conclusion:The corrosive ingestion in children is associated with higher morbidity. The sequelae include esophageal and antro-pyloric strictures. A feeding gastrostomy or jejunostomy was required in more than half of the patients. The children presenting after 2 months of ingestion were associated with an increased need for esophageal replacement.

Ultrasound Guided Brachiocephalic Vein Cannulation using Supraclavicular Approach

The need of central vein cannulation has been increased since the increased case of critical patients and patients underwent high-risk patients. Supraclavicular approach of central vein cannulation is an alternative approach to central vein cannulation due to fewer anatomical variance, good longitudinal vein view, better visualization of needle during procedure, clear demarcation of landmarks, larger target area, better patient comfort, and fewer complications. This case study presents an ultrasound guided central vein cannulation using supraclavicular approach in 30 year old male patient diagnosed with septic shock, anemia, trombcytopenia, and electrolyte imbalance post laparotomy. The indication of central vein cannulation in the patient was to deliver volume resuscitation, to provide emergency vein access, to provide nutritional support, to deliver chemically caustic agents, and central vein pressure monitoring.

Outcomes Associated With Caustic Ingestion Among Adults in a National Prospective Database in France

Caustic ingestion in adults may result in death or severe digestive sequelae. The scarcity of nationwide epidemiological data leads to difficulties regarding the applicability of their analysis to less specialized centers, which are nevertheless largely involved in the emergency management of adverse outcomes following caustic ingestion. To assess outcomes associated with caustic ingestion in adults across a nationwide prospective database. Adult patients aged 16 to 96 admitted to the emergency department for caustic ingestion between January 2010 and December 2019 were identified from the French Medical Information System Database, which includes all patients admitted in an emergency setting in hospitals in France during this period. Esophageal caustic ingestion. The primary end point was in-hospital patient outcomes following caustic ingestion. Multivariate analysis was performed to assess independent predictors of in-hospital morbidity and mortality. Among 22 657 226 patients admitted on an emergency outpatient basis, 3544 (0.016%) had ingested caustic agents and were included in this study. The median (IQR) age in this population was 49 (34-63) years, and 1685 patients (48%) were women. Digestive necrosis requiring resection was present during the primary hospital stay in 388 patients with caustic ingestion (11%). Nonsurgical management was undertaken in 3156 (89%). A total of 1198 (34%) experienced complications, and 294 (8%) died. Pulmonary complications were the most frequent adverse event, occurring in 869 patients (24%). On multivariate analysis, predictors of mortality included old age, high comorbidity score, suicidal ingestion, intensive care unit admission during management, emergency surgery for digestive necrosis, and treatment in low-volume centers. On multivariate analysis, predictors of morbidity included old age, higher comorbidity score, intensive care unit admission during management, and emergency surgery for digestive necrosis. In this study, referral to expert centers was associated with improved early survival after caustic ingestion. If feasible, low-volume hospitals should consider transferring patients to larger centers instead of attempting on-site management.

Electrochemical removal of amphoteric ions

Significance Water treatment is required for a sustainable potable water supply and can be leveraged to harvest valuable elements. Crucial to these processes is the removal of charge pH-dependent species from polluted water, such as boron, ammonia, and phosphate. These species can be challenging for conventional technologies. Currently, boron removal requires several reverse-osmosis stages, combined with dosing a caustic agent. Capacitive deionization (CDI) promises to enable effective removal of such species without chemical additives but requires a deep understanding of the coupled interplay of pH dynamics, ion electrosorption, and transport phenomena. Here, we provide a detailed theory tackling this topic and show both theoretically and experimentally highly counterintuitive design rules governing pH-dependent ion removal by CDI.

Efficacy and safety of povidone iodine with dimethyl sulfoxide vs 0.05% tretinoin in treatment of molluscum contagiosum: A randomized case control study

Efficacy and safety of povidone iodine with dimethyl sulfoxide vs 0.05% tretinoin in treatment of molluscum contagiosum: A randomized case control study

Evaluation of Pediatric Early Warning System and Drooling Reluctance Oropharynx Others Leukocytosis scores as prognostic tools for pediatric caustic ingestion: a two-center, cross-sectional study.

Caustic chemicals are widely distributed in our environment. Exposure to caustic agents is a lifelong problem associated with severe tissue and mucous membrane injuries. In pediatrics, corrosive exposure is the most common cause of nonpharmaceutical exposure presenting to poison control centers. Therefore, this study evaluated the role of the Pediatric Early Warning System (PEWS) and Drooling Reluctance Oropharynx Others Leukocytosis (DROOL) scores as early in-hospital outcome predictors following corrosive ingestion. The current study was a two-center, retrospective, cross-sectional study carried out among pediatric patients diagnosed with acute caustic ingestion during the past 4 years. Most exposure occurred accidentally among boys (59.4%) living in rural areas (51.9%) of preschool age (50% were 2–4 years old). Residence, body temperature, respiratory rate, vomiting, skin and mucosal burns, retrosternal pain, respiratory distress, Oxygen (O2) saturation, Glasgow Coma Scale score, HCO3 level, total bilirubin level, anemia, leukocytosis, and presence of free peritoneal fluid were significant predictors of esophageal injuries (p < 0.05). DROOL and PEWS scoring were the most significant predictors of esophageal injuries with worthy predictive power, where odds ratio (95% confidence interval (CI)) was 1.76 (0.97–3.17) and 0.47 (0.21–0.99) for PEWS and DROOL, respectively. At a cutoff of < 6.5, the DROOL score could predict esophageal injuries excellently, with AUC = 0.931; sensitivity, 91.7%; specificity, 72.5%; and overall accuracy, 91.3%. At a cutoff of > 6.5, PEWS could significantly predict unfavorable outcomes, with AUC = 0.893; sensitivity, 94.4%; specificity, 71.9%; and overall accuracy, 89.3%. However, PEWS better predicted the need for admittance to the intensive care unit (ICU). Pediatric Early Warning System (PEWS) and Drooling Reluctance Oropharynx Others Leukocytosis (DROOL) are potentially useful accurate scorings that could predict the esophageal injuries and ICU admission following corrosive ingestion in pediatrics.

QS1: Creeping Fat Adipocytes Drive Intestinal Fibrosis Through Adipocyte-to-fibroblast Conversion in a Novel Model of Inflammatory Bowel Disease

Purpose:Crohn’s disease (CD) is a subtype of inflammatory bowel disease (IBD) characterized by patchy, transmural inflammation throughout the digestive tract and creeping fat formation. Thirty percent of CD patients develop strictures, eighty percent of which will require surgery. Creeping fat is associated with stricture formation, but its role in intestinal fibrosis remains unclear. Here, we present a novel surgical model of intestinal fibrosis and show by lineage tracing that creeping fat adipocytes convert to fibroblasts that contribute to fibrosis.Methods:We developed a novel surgical model of IBD that avoids the chronic use of caustic agents by creating a longitudinal, anti-mesenteric colotomy in the mouse transverse colon that is closed transversally. We performed Masson’s trichrome staining to assess collagen deposition. Finally, we performed lineage tracing of mature adipocytes in Adiponectin-Cre; mTmG mice and characterized adipocyte-derived cells by immunostaining.Results:Our surgical model mimics key features of human strictures, including the formation of creeping fat around the injury site, increased bowel wall thickness, collagen deposition, and transmural adipocyte infiltration by post-operative day (POD) 7. Immunostaining for adipocyte and fibroblast markers confirmed the presence of transmural adipocytes adjacent to fibroblasts. Lineage tracing of mature adipocytes in Adiponectin-Cre; mTmG mice revealed adipocyte-derived cells that infiltrate the wound site that lose expression of adipocyte lineage markers, gain expression of fibroblast markers, produce collagen, and respond to TGF-β signaling.Conclusions:Our novel surgical colotomy model represents a viable approach to study intestinal fibrosis and creeping fat without the long-term use of caustic agents. Lineage tracing of mature creeping fat adipocytes demonstrates that adipocytes convert to fibroblasts that infiltrate the injury site and participate in fibrotic responses. Taken together, these findings suggest that creeping fat contributes to intestinal fibrosis in part through the local conversion of adipocytes to fibroblasts.

Rapid Establishment of Tracheal Stenosis in Pigs Using Endotracheal Tube Cuff Overpressure and Electrocautery.

To apply a new airway treatment to humans, preclinical studies in an appropriate animal model is needed. Canine, porcine and leporine tracheas have been employed as animal airway stenosis models using various methods such as chemical caustic agents, laser, and electrocautery. However, existing models take a long time to develop (3-8 weeks) and the mechanism of stenosis is different from that in humans. The aim of the present study was to establish a new and fast tracheal stenosis model in pigs using a combination of cuff overpressure intubation (COI) and electrocautery. Fourteen pigs were divided into three groups: tracheal cautery (TC) group (n=3), COI group (n=3), and COI-TC combination group (n=8). Cuff overpressure (200/400/500 mmHg) was applied using a 9-mm endotracheal tube. Tracheal cautery (40/60 watts) was performed using a rigid bronchoscopic electrocoagulator. After intervention, the pigs were observed for 3 weeks and bronchoscopy was performed every 7 days. When the cross-sectional area decreased by > 50%, it was confirmed that tracheal stenosis was established. The time for tracheal stenosis was 14 days in the TC group and 7 days in the COI-TC combination group. In the COI group, no stenosis occurred. In the COI-TC group, electrocautery (40 watts) immediately after intubation for >1 h with a cuff pressure of 200 mmHg or more resulted in sufficient tracheal stenosis within 7 days. Moreover, the degree of tracheal stenosis increased in proportion to the cuff pressure and tracheal intubation time. The combined use of cuff overpressure and electrocautery helped to establish tracheal stenosis in pigs rapidly.

Carbon nanotubes-based sensor for ammonia gas detection – an overview

A sensitive, selective and reliable sensing techniques for ammonia (NH3) gas detection have been highly demanded since NH3 is both a commonly utilized gas in various industrial sectors, and considered as a toxic and caustic agent that can threat human health and environment at a certain level of concentrations. In this article, a brief on the fundamental working principles of sensor specifications of the analytes detection techniques relying has been reviewed. Furthermore, the mechanism of NH3 detection and recent progress in the development of advanced carbon nanotubes (CNTs)-based NH3 gas sensors, and their performance towards the hybridization with the conductive polymers wascomprehensively reviewed and summarized. Finally, the future outlook for the development of highperformanceNH3 sensors was presented in the conclusions part.

Caustic ingestion: CT findings of esophageal injuries and thoracic complications.

Ingestion of caustic substances, whether accidental or for the purpose of suicide, can cause severe lesions of the lips, oral cavity, pharynx, upper gastrointestinal system, and upper airways. In particular, caustic agents could be responsible for severe esophageal injuries resulting in short- and long-term complications. Because of these important clinical implications, timely diagnosis and appropriate management are crucial. In the evaluation of esophageal injuries, thoraco-abdominal computed tomography (CT) is preferable to endoscopy as it avoids the risk of esophageal perforation and allows the evaluation of esophageal injuries as well as of the surrounding tissue. In this review, we report CT findings of esophageal injuries and possible related thoracic complications caused by caustic ingestion.

PYLORIC STENOSIS CAUSED BY INGESTION OF CORROSIVE AGENTS : A CASE REPORT

&lt;p&gt;Corrosive or caustic is a group of chemical which has the capacity to cause tissue injury on contact by a chemical reaction.Ingestion of a substance that causes a chemical reaction with mucosal tissue and injures the gastrointestinal and respiratory tract is caustic ingestion. Accidental ingestion of caustic agents may cause devastating injury in children. Eighty percent of corrosive poisoning occurs in children below five years. Children are particularly susceptible to the accidental exposure to such substances due to inadequate parental supervision and careless storing of these chemicals at homes. Pyloric stenosis or gastric outlet obstruction is a well-known complication of caustic acid ingestion. The stenosis mostly occurs at the pylorus and antrum due to the pooling of the corrosive agent and the reflex pyloric spasm of the stomach after the ingestion. Typically corrosive acid ingestion leads to local reaction, oesophageal damage and gastric injury in that order. Isolated injury to the stomach resulting in pyloric stenosis is very rare, accounting to as little as 3,8% of all the cases of corrosive ingestion as reported in literature. A proper management including surgery is needed in this case to treat a child with pyloric stenosis caused by ingestion of corrosive agents.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;Keyword : Pyloric stenosis, accidental ingestion, corrosive agents.&lt;/p&gt;

Discovery of Dipeptides as Potent Botulinum Neurotoxin A Light-Chain Inhibitors.

The botulinum neurotoxin, the caustic agent that causes botulism, is the most lethal toxin known to man. The neurotoxin composed of a heavy chain (HC) and a light chain (LC) enters neurons and cleaves SNARE proteins, leading to flaccid paralysis, which, in severe occurrences, can result in death. A therapeutic target for botulinum neurotoxin (BoNT) intoxication is the LC, a zinc metalloprotease that directly cleaves SNARE proteins. Herein we report dipeptides containing an aromatic connected to the N-terminus via a sulfonamide and a hydroxamic acid at the C-terminus as BoNT/A LC inhibitors. On the basis of a structure-activity relationship study, 33 was discovered to inhibit the BoNT/A LC with an IC50 of 21 nM. X-ray crystallography analysis of 30 and 33 revealed that the dipeptides inhibit through a competitive mechanism and identified several key intermolecular interactions.

Use of 27-gauge Tuberculin Syringe for Trichloroacetic Acid Chemical Reconstruction of Skin Scars (TCA-CROSS).

Chemical Reconstruction of Skin Scars (CROSS) is a minimally invasive, safe, and cost effective technique for the management of ice pick acne scars that are otherwise generally resistant to treatment. 100% trichloro acetic acid (TCA) is usually applied using toothpicks and the end point is white discoloration of skin. The concentrated caustic agent quite often spills onto surrounding normal skin leading to superficial burns and post-inflammatory pigmentation. Use of 27-gauge tuberculin syringe gives a much more controlled access to apply TCA leading to better cosmetic outcome and fewer adverse effects.

The treatment of animals in Galicia in the middle ages

The treatment of animals in Galicia in the middle ages

Interactive PHREEQ-N-AMDTreat water-quality modeling tools to evaluate performance and design of treatment systems for acid mine drainage

The PHREEQ-N-AMDTreat aqueous geochemical modeling tools described herein simulate changes in pH and solute concentrations resulting from passive and active treatment of acidic or alkaline mine drainage (AMD). The “user-friendly” interactive tools, which are publicly available software, utilize PHREEQC equilibrium aqueous and surface speciation models and kinetics models for O2 ingassing and CO2 outgassing, iron and manganese oxidation and precipitation, limestone dissolution, and organic carbon oxidation combined with reduction of nitrate, sulfate, and ferric iron. Reactions with synthetic caustic chemicals (CaO, Ca(OH)2, NaOH, Na2CO3) or oxidizing agents (H2O2) also may be simulated separately or combined with sequential kinetic steps. A user interface facilitates input of water chemistry data for one or two (mixed) influent AMD solutions and adjustment of kinetic variables. Graphical and tabular output indicates the changes in pH, metals and other solute concentrations, total dissolved solids, and specific conductance of treated effluent plus the cumulative quantity of precipitated solids as a function of retention time or the amount of caustic agent added. By adjusting kinetic variables or chemical dosing, the effects of independent or sequential treatment steps that have different retention time (volume/flow rate), aeration rate, quantities of reactive solids, and temperature can be simulated for the specified influent quality. The size (land area) of a treatment system can then be estimated using reaction time estimates (volume for a corresponding treatment step is the product of reaction time and flow rate; area is volume divided by depth). Given the estimated system size, the AMDTreat cost-analysis model may be used to compute approximate costs for installation (capital) and annual operations and maintenance. Thus, various passive and/or active treatment strategies can be identified that could potentially achieve the desired effluent quality, but require different land area, equipment, and costs for construction and operation.

Biofilm removal efficacy using direct electric current in cross-flow ultrafiltration processes for water treatment

Biofouling of membranes in water treatment is considered as one of the major practical problems. A novel and an efficient approach for cleaning biofilm grown on the membrane surface is proposed by applying a direct electric current (124 mA, 90 s) through platinum electrodes inside a cross-flow ultrafiltration channel. Depending on the electrochemical reactions occurring at the electrodes, either chlorine or hydrogen-producing configuration is realized by interchanging the current polarity. Baseline determination of the amount of chlorine generated and change in pH is assessed as a function of current intensity, linear cross-flow velocity, and duration of applied current. The efficiency of the proposed method is determined by investigating electrically treated biofilm through bacterial inactivation using Confocal Laser Scanning Microscopy (CLSM), bacterial cell structure changes through Scanning Electron Microscopy (SEM), and by estimating the amount of biomass removal through Optical Coherence Tomography (OCT). When a chlorine-producing electrode is placed at the inlet of the flow cell, 68% of bacterial inactivation is achieved without any modification of bacterial cell shape. Furthermore, a high and near-complete biomass removal is achieved (99%) after a subsequent forward flush of the electrically treated biofilm. However, placing a hydrogen-producing electrode at the inlet reveals a slightly lower bacterial inactivation (65%) and lower biomass removal (77%). Additional systematic experiments using individually sodium hydroxide (NaOH), sodium hypochlorite (NaOCl), or gas microbubbles enabled to elucidate the cause of biofilm removal, synergic effect of caustic agent NaOH and microbubbles.

Corrosive Esophagitis and Gastritis Induced by Glutaraldehyde Ingestion

Corrosive esophagitis and gastritis are characterized by caustic damage due to ingestion of chemical agents. Caustic agents cause tissue destruction through liquefaction or coagulation reactions. Here, we report a case of corrosive esophagitis and gastritis caused by accidental ingestion of glutaraldehyde in Korea. A 62-year-old man presented to the emergency department 8 hours after ingesting glutaraldehyde, which is widely used for the prevention of foot-and-mouth disease in pigs. Urgent endoscopic examination revealed severely damaged mucosae of the esophagus and stomach. With conservative treatment, the patient’s condition was improved, and he was discharged on the 35th day of admission.