Comparing recurrence between cautery techniques in pediatric epistaxis.

OBJECTIVE: To compare the risk of recurrent epistaxis between children treated with silver nitrate (SN) in the office or electrocautery (EC) in the operating room (OR). METHODS: Patients aged 2-18 diagnosed with epistaxis (ICD R04.0) in 2018 and treated with SN or EC were retrospectively reviewed. Epistaxis laterality, history of nasal trauma, and personal or family history of a bleeding disorder were recorded. Patients with prior cautery or epistaxis secondary to a procedure were excluded. Recurrence was defined as initial encounter after cautery with documented epistaxis. Patients were followed up into 2022 to track onset of recurrence. Time to recurrence between SN and EC was compared with hazard curves with predictors for recurrence analyzed via Cox's proportional hazard regression. RESULTS: Among 291 patients cauterized for epistaxis, 62 % (n = 181) received SN compared to 38 % (n = 110) who underwent EC. There was significantly higher risk of recurrence when treated with SN compared to EC (Hazard ratio 2.45, 95 % CI: 1.57-3.82, P < 0.0001). Median time to recurrence was not statistically different between techniques (6.39 months (SN) (IQR: 2.33, 14.82) vs. 4.11 months (EC) (IQR: 1.18, 20.86), P = 0.4154). Complication rates were low for both groups (1.16 % (SN) vs. 0 % (EC), P > 0.05). CONCLUSION: Among patients with epistaxis, risk of recurrence is significantly higher in those cauterized with SN compared to EC. Time to recurrence is not significantly different between cautery techniques.

[Accidental silver nitrate inhalation]. / Inhalation accidentelle de nitrate d'argent.

INTRODUCTION: Silver nitrate pencil is often used to treat local granuloma caused by tracheotomy and tracheostomy cannula orifice. CASE REPORT: We report the case of a 69-year-old patient who accidentally inhaled silver nitrate lead from the tip of a pencil during treatment of local granuloma. Inhalation of this product, which is known to cause burns and a risk of perforation of the mucous membranes, could suggest locoregional complications. Clinical monitoring and radiological and endoscopic examinations were carried out. Antibiotics and corticosteroids were administered because of inflammatory lesions. After 6 months, the patient had recovered with restitutio ad integrum of anatomical structures. CONCLUSION: Silver nitrate pencil should be used with caution. Given the high risk of perforation, painstaking and repeated monitoring are necessary in case of accidental inhalation. Bronchial endoscopy is of central importance as a means of localizing the foreign substance, following which bronchial cleaning is performed, using physiological serum. Corticosteroid appears to be effective to limit the risk of inflammatory bronchial stenosis.

Lesson of the month: management for aspiration of a silver nitrate pencil tip during tracheostomy care.

We present the cases of two laryngectomised patients who were treated for granulomas of the tracheostomy orifice with a silver nitrate pencil. During tracheostomy care, the tip broke off, was aspirated and fell into the bronchial tree. Necrotising ulcerative injuries of the right bronchial tree with clear delineation were found without lesions in the subsegmental division. To prevent the risk of secondary stenosis of the small airways induced by the spread of silver nitrate, we did not irrigate with saline solution as previously reported. Antibiotherapy and endoscopic monitoring were performed. Complete healing in 4-6 weeks was found without stenosis of the bronchial tree or bleeding.

Use of Silver Nitrate Application as Mini-Invasive Treatment of Pilonidal Sinus Disease.

OBJECTIVES: To investigate the cure rate and adverse effects of silver nitrate application for treatment of pilonidal sinus disease (PSD). Methods: Number of sinus pit orifices, and complications with silver nitrate application and debridement for sacrococcygeal PSD between January 2015 and July 2018 were analyzed in this retrospective study. Data were obtained from surgical, discharge, and outpatient follow-up records. Among 56 patients who were treated with silver nitrate stick, 11 patients with incomplete hospital records were excluded from the study. Demographic data including age, gender, length of follow-up, number of silver nitrate applications, number of involved sinuses and recurrence and complication rates were recorded. Results were expressed as frequencies, means, and range of values. The Mann Whitney U and chi square tests were used to evaluate significance. Results: Mean age was 24.3 +- 5.18 (range, 14 - 36) years, and recurrence occurred in 4 (8.9%) patients. Complications developed in 10 (22.2%) patients and included abscess, erythema, and necrosis in 5 (11.1%), 2 (4.4%), and 3 (6.6%) patients, respectively. The recurrence rate was significantly higher in patients who developed abscesses during the follow-up period (p = 0.001) than those who did not. There was no statistically significant correlation between the recurrence rate and number of sinuses or the number of silver nitrate applications. CONCLUSION: Low morbidity and high healing rates achieved with silver nitrate provide support for this application as a feasible and effective conservative outpatient treatment for PSD in certain patients.

The addition of silver nitrate cautery to antiseptic nasal cream for patients with epistaxis: A systematic review and meta-analysis.

OBJECTIVE: To compare the outcomes of the addition of silver nitrate cautery versus antiseptic cream alone in paediatric patients with recurrent epistaxis. METHODS: A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines and a search of electronic information was conducted to identify all Randomised Controlled Trials (RCTs) and non-randomised studies comparing the outcomes of the addition of silver nitrate cautery versus antiseptic cream alone in paediatric patients with recurrent epistaxis. Treatment success and persistence of bleeding were primary outcome measures. Secondary outcome measures included treatment side effects. Fixed effects modelling was used for the analysis. RESULTS: Four studies enrolling 240 patients were identified. There was no significant difference between silver nitrate cautery group and antiseptic cream alone group in terms of complete resolution (Odds Ratio [OR] = 1.07, P = 0.81), the partial resolution (OR = 1.02, P = 0.96) and persistence of bleeding (OR = 0.91, P = 0.71). For secondary outcomes, antiseptic nasal cream was associated with few side effects such as rash in one case and several complaints of bad smell or taste. CONCLUSIONS: The addition of silver nitrate cautery is not superior to the use of antiseptic cream alone in paediatric patients with recurrent epistaxis as it does not improve treatment success or persistence of bleeding.

A clinical mimicker of melanoma with distinctive histopathology: Topical silver nitrate exposure.

Exposure to silver-containing compounds can result in reversible discoloration of the skin, presenting as an irregular brown or black macule, which can have a clinical appearance similar to melanoma. Both the clinical scenario and the histopathology are unique. Silver nitrate darkens with exposure to light, and the area can appear to change over time. On microscopic examination, there are coarse pigmented granules dispersed throughout the corneal layer, and largely absent from the remainder of the epidermis-although the precise location may depend on the duration of topical exposure. While argyria, its irreversible counterpart, has been well-characterized, only a single source has previously reported the histopathology of transient topical silver nitrate exposure. We present two cases, review the clinical and histopathologic differentials, and detail the distinctive histopathology that enables a diagnosis to be suggested in this clinical mimicker of melanoma.

Morphological changes in the sphenopalatine ganglion on the background of metabolic disorders in the experiment at rats

The sphenopalatine ganglion occupies a special place in neuropathology and dental neuropathy, accompanied by such pronounced symptoms as "vegetative storm". The aim of the research was obtaining information on the external structure of the sphenopalatine ganglion, the morphometric characteristics of its neurons in norm and in experimental diabetes. The study was carried out on male Wistar rats weighing 260-300 g: with a stereoscopic biological microscope, using ophthalmic instruments, we removed almost the entire gland that was not accompanied by significant bleeding under general anesthesia. Peculiarities of the external structure of the sphenopalatine ganglion of the white rat were studied by macro-micro preparations under a binocular microscope at 50 objects pervaded with silver nitrate, according to Christen-sen

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CG Demethylation Leads to Sequence Mutations in an Anther Culture of Barley Due to the Presence of Cu, Ag Ions in the Medium and Culture Time.

During plant tissue cultures the changes affecting regenerants have a broad range of genetic and epigenetic implications. These changes can be seen at the DNA methylation and sequence variation levels. In light of the latest studies, DNA methylation change plays an essential role in determining doubled haploid (DH) regenerants. The present study focuses on exploring the relationship between DNA methylation in CG and CHG contexts, and sequence variation, mediated by microelements (CuSO4 and AgNO3) supplemented during barley anther incubation on induction medium. To estimate such a relationship, a mediation analysis was used based on the results previously obtained through metAFLP method. Here, an interaction was observed between DNA demethylation in the context of CG and the time of culture. It was also noted that the reduction in DNA methylation was associated with a total decrease in the amount of Cu and Ag ions in the induction medium. Moreover, the total increase in Cu and Ag ions increased sequence variation. The importance of the time of tissue culture in the light of the observed changes resulted from the grouping of regenerants obtained after incubation on the induction medium for 28 days. The present study demonstrated that under a relatively short time of tissue culture (28 days), the multiplication of the Cu2+ and Ag+ ion concentrations ('Cu*Ag') acts as a mediator of demethylation in CG context. Change (increase) in the demethylation in CG sequence results in the decrease of 'Cu*Ag', and that change induces sequence variation equal to the value of the indirect effect. Thus, Cu and Ag ions mediate sequence variation. It seems that the observed changes at the level of methylation and DNA sequence may accompany the transition from direct to indirect embryogenesis.

Advances of native and non-native Antarctic species to in vitro conservation: improvement of disinfection protocols.

Plants that inhabit Antarctica have raised scientific interest due to their resilience to climate change, abiotic tolerance mechanisms and potential biological applications. In vitro propagation is useful for conservation, genetic material availability of these species and avoiding mass collection in their habitat. In vitro culture protocols for the native plants Colobanthus quitensis and Deschampsia antarctica and the non-native Juncus bufonius have been affected by endophytic microorganisms that proliferate when introduced to tissue cultures. This study evaluated the microbicidal and phytotoxic effect of calcium hypochlorite (Ca(ClO)2), silver nitrate (AgNO3) and silver nanoparticles (AgNPs), and their use at different concentrations for different time periods. The Ca(ClO)2 at 100 mg mL-1 showed the best microbial contamination control in D. antarctica (applied for 20 min) and for the three C. quitensis populations (applied for 15 min). In J. bufonius, AgNO3 at 10 mg mL-1 for 10 min reduced the microbial growth, but oxidative damage was generated. AgNPs did not prevent contamination or have adverse effects on tissues. Survival plantlets from each treatment, population or species were effectively introduced to the tissue culture and their propagation was successful. These results constitute a fundamental advance for the introduction, propagation and conservation of Antarctic species and their use in scientific research.

Knowledge and practice of nursing professionals about prophylaxis of ophthalmia neonatorum / Conocimiento y la práctica de profesionales de enfermería sobre profilaxis de la oftalmía neonatal / Conhecimento e prática de profissionais de enfermagem sobre profilaxia da oftalmia neonatal

Abstract Objective: To analyze the knowledge and practice of nursing professionals about the prophylaxis of ophthalmia neonatorum. Method: Descriptive study, of qualitative approach, carried out in the first semester of 2018, in a city hall hospital located in the lake area of the Rio de Janeiro's state, through semi-structured interviews with 14 Nursing professionals participating in the care of the newborn, whose data were submitted to the Thematic Analysis. Results: From the three emerging thematic categories, there are gaps in knowledge related to ophthalmia neonatorum, silver nitrate and the instillation procedure of this prophylactic solution, as well as differences in care practice regarding care before, during and after the procedure. Conclusion and implications for practice: The data point to the importance of training the Nursing team in the prophylaxis of ophthalmia neonatorum, the revision of guidelines and procedures aimed at standardizing the procedure, as well as emphasizing the need for adequate follow-up of pregnant women in prenatal care.

Resumen Objetivo: Analizar el conocimiento y la práctica de los profesionales de Enfermería sobre la profilaxis de la oftalmía neonatal. Método: Estudio descriptivo, de naturaleza cualitativa, realizado en el primer semestre de 2018, en un hospital municipal ubicado en la bajada costera del estado de Río de Janeiro, a través de entrevistas semiestructuradas desarrolladas con 14 profesionales de Enfermería, que participan en la asistencia al recién nacido, cuyos datos se sometieron al análisis temático. Resultados: A partir de las tres categorías temáticas emergentes se evidencian lagunas en el conocimiento relacionadas a la oftalmía neonatal, al nitrato de plata y al procedimiento de instilación de esa solución profiláctica, además de divergencias en la práctica asistencial en cuanto a los cuidados antes, durante y después de la realización del procedimiento. Conclusión y las implicaciones para la práctica: Los datos apuntan a la importancia de la capacitación del equipo de Enfermería para la realización de la profilaxis de la oftalmia neonatal, de la revisión de directrices y conductas que visen la estandarización del procedimiento, además de resaltar la necesidad de un acompañamiento adecuado de las gestantes en el prenatal.

Resumo Objetivo: Analisar o conhecimento e a prática de profissionais de Enfermagem sobre profilaxia da oftalmia neonatal. Método: Estudo descritivo, de natureza qualitativa, realizado no primeiro semestre de 2018, em um hospital municipal localizado na baixada litorânea do estado do Rio de Janeiro, por meio de entrevistas semiestruturadas com 14 profissionais de Enfermagem, que participam da assistência ao recém-nascido, cujos dados foram submetidos à Análise Temática. Resultados: A partir das três categorias temáticas emergentes evidenciaram-se lacunas no conhecimento relacionadas à oftalmia neonatal, ao nitrato de prata e ao procedimento de instilação dessa solução profilática, além de divergências na prática assistencial quanto aos cuidados antes, durante e após a realização do procedimento. Conclusão e implicações para a prática: Os dados apontam para a importância da capacitação da equipe de Enfermagem para a realização da profilaxia da oftalmia neonatal, da revisão de diretrizes e condutas que visem a padronização do procedimento, além de ressaltar a necessidade de um acompanhamento adequado das gestantes no pré-natal.

Emergency Department care of childhood epistaxis.

OBJECTIVE: The aim of this review is to determine an efficient and safe primary strategy care for paediatric epistaxis. DATA SOURCES: We searched PubMed and Cochrane databases for studies referenced with key words 'epistaxis AND childhood'. This search yielded 32 research articles about primary care in childhood epistaxis (from 1989 to 2015). Bibliographic references found in these articles were also examined to identify pertinent literature. We compared our results to the specific management of adult epistaxis classically described in the literature. RESULTS: Epistaxis is one of the most common reasons for referral of children to a hospital ENT outpatient department. The bleeding usually originates from the anterior septum, as opposed to adults. Crusting, digital trauma, foreign bodies and nasal colonisation with Staphylococcus aureus have been suggested as specific nosebleed factors in children. Rare aetiologies as juvenile nasopharyngeal angiofibroma appear later during adolescence. There are different modes of management of mild epistaxis, which begin with clearing out blood clots and bidigital compression. An intranasal topical local anaesthetic and decongestant can be used over 6 years of age. In case of active bleeding, chemical cauterisation is preferred to anterior packing and electric cauterisation but is only feasible if the bleeding site is clearly visible. In case of non-active bleeding in children, and in those with recurrent idiopathic epistaxis, antiseptic cream is easy to apply and can avoid 'acrobatic' cauterisation liable to cause further nasal cavity trauma. CONCLUSIONS: Aetiologies and treatment vary with patient age and the existence or not of active bleeding at the time of the examination. Local treatments are usually easy to perform, but physicians have to ponder their indications depending on the possible complications in order to inform parents and to know paediatric epistaxis specificities.

Chemical Closure of Tympanic Membrane Perforation: Call for Caution.

Chemical closure of tympanic membrane perforation is a commonly practiced office-based otological procedure, which is labeled to be effective and safe. In this paper, we report a case of a young lady with disastrous complications following an attempt of chemical cauterization of her perforated tympanic membrane.

Silver nitrate burn of the lower lip: a case report.

Silver nitrate is used in medicine to treat a number of conditions because of its cauterizing properties. This case report describes management of a silver nitrate burn of the oral mucosa that resulted in a large mass of necrotic tissue and accompanying pain in a 41-year-old man. The patient bit his lip and received silver nitrate treatment from a physician. Significant swelling and pain occurred over a period of 3 weeks after application. Analysis of a biopsy specimen revealed necrotic tissue with chronically inflamed granulation tissue. The lesion persisted, and it was determined that debridement was necessary to enhance wound healing and prevent significant scar formation. The patient was reexamined 10 days and 1 month after debridement. The lesion had significantly decreased in size, and the patient reported notable reduction of pain. The final follow-up at 3 months showed a desirable result with minimal scar formation. Use of concentrated silver nitrate for cautery can result in significant damage to mucous membranes, including oral mucosa.

Case Report: Beware the Silver Nitrate Stick--A Risk Factor for Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ).

Topical silver nitrate may be used in oral and maxillofacial clinical settings owing to its astringent, caustic and disinfectant properties. Uses of the toughened silver nitrate pencil stick include haemostasis at bleeding points and for the management of aphthous ulcers, hypergranulation tissue, warts and verrucas. We present an interesting case of apparent silver nitrate-induced, bisphosphonate-related osteonecrosis of the hard palate following mucosal lesion biopsy in a multiple myeloma patient receiving zoledronic acid intravenous infusions. Our review of the literature indicates that this is the first report of such a scenario. CPD/Clinical Relevance: Clinicians must consider all potential sources of chemical and mechanical trauma to the bone and overlying mucosa when managing patients at risk of developing bisphosphonate-related osteonecrosis of the jaw.

The effectiveness of the biannual application of silver nitrate solution followed by sodium fluoride varnish in arresting early childhood caries in preschool children: study protocol for a randomised controlled trial.

BACKGROUND: The application of 38 % silver diamine fluoride (SDF) has been shown to be effective in arresting early childhood caries (ECC). Since SDF is not available in certain countries, some dentists use adjunctive application of 25 % silver nitrate (AgNO3) and 5 % sodium fluoride (NaF) to arrest ECC. This randomised controlled trial will systematically compare the efficacy of a 25 % AgNO3 solution followed by 5 % NaF varnish with that of a 38 % SDF solution in arresting ECC when applied at half-yearly intervals over a 30-month period. METHODS/DESIGN: This study is a randomised, double-blinded, non-inferiority clinical trial. The hypothesis tested is that adjunctive application of 25 % AgNO3 followed by 5 % NaF is at least not appreciably worse than a 38 % SDF in arresting ECC. Approximately 3100 kindergarten children aged 3-4 years will be screened and at least 1070 children with caries will be recruited. This sample size is sufficient for an appropriate statistical analysis (power at 90 % (ß = 0.10) with a 2-sided type-I error of α = 0.05), allowing for an overall 20 % drop-out rate. The children will be randomly allocated into 2 groups to treat their caries over a 30-month period: Group A - biannual adjunctive application of a 25 % AgNO3 solution and a 5 % NaF varnish, and Group B - biannual adjunctive application of a 38 % SDF solution followed by a placebo varnish. Clinical examinations will be conducted at 6-month intervals. Primary outcome measured is the number of active caries surfaces which are arrested. Information on confounding factors such as oral hygiene habits will be collected through a parental questionnaire. DISCUSSION: We expect that adjunctive application of 25 % AgNO3 solution and 5 % NaF varnish and of 38 % SDF solution can both effectively arrest ECC. Lower concentrations of silver and fluoride are contained in 25 % AgNO3 and 5 % NaF, respectively, than in 38 % SDF; therefore, AgNO3/NaF are more favourable for use in young children. Because its use for caries management is painless, simple, low-cost, and approved in many countries, AgNO3/NaF could be widely recommended and promoted as an alternative treatment to conventional invasive management of ECC. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02019160 . Date of registration: 11 December 2013.