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1.
Dermatol Ther ; 32(4): e12940, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30990239

RESUMO

The treatment of cutaneous viral warts caused by human papillomavirus (HPV) infection is often subject to local recurrence and a long clinical and treatment course. Our aim was to analyze real-life data on the treatment of difficult-to-treat warts from a multicenter postmarketing surveillance assessment on the efficacy, tolerability, and safety of a commercially available nitric-zinc complex solution (NZCS). Dermatologists from 14 Italian centers completed a questionnaire about their clinical experience on treatment of "difficult-to-treat" warts, which included warts in the plantar, periungual, anogenital and aesthetically sensitive areas. The questionnaire was designed to obtain detailed information on wart treatment and compare NZCS efficacy with previous treatments. Of 106 questionnaires returned, 83 reported NZCS use; 67 had previous treatments (23 cryotherapy, 2 electrocoagulation, 12 other topical application, and 30 combined treatment, such as laser, cryotherapy, and/or electrocoagulation). NZCS had superior efficacy to that of previous treatments (p < .0001), resulting in 84.1% with a full or partial clearance (vs. 44.8% for previous treatments), and had better local tolerability (p < .0001). NZCS showed better efficacy and tolerability than other previous wart treatments.


Assuntos
Ácido Nítrico/administração & dosagem , Infecções por Papillomavirus/tratamento farmacológico , Verrugas/tratamento farmacológico , Zinco/administração & dosagem , Administração Cutânea , Adolescente , Adulto , Criança , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/efeitos adversos , Feminino , Humanos , Itália , Masculino , Ácido Nítrico/efeitos adversos , Vigilância de Produtos Comercializados , Inquéritos e Questionários , Resultado do Tratamento , Verrugas/virologia , Adulto Jovem , Zinco/efeitos adversos
3.
Acta Clin Belg ; 72(4): 278-288, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27615356

RESUMO

We describe a nonlethal, delayed onset case of combined acute inhalation of hydrofluoric acid (HFA) and nitric acid (NA) together with a review of the literature. Our patient was exposed to fumes of a 12% HFA and 22% NA solution in a closed environment and suffered during several months after the incident from exertional dyspnoea but recovered completely. Since HFA and NA are dangerous and widely used substances, preparedness for exposure is mandatory. After inhalational exposure, the principles of decontamination with attention to treatment of the skin for HFA burns together with general medical incident management should be applied. The severity of combined NA and HFA intoxication depends on the concentration, the nature of the contact and the duration of exposure but other factors may also be involved. Therapy resistant hypoxia and death have been reported in the literature. Inhalation injury from HFA alone is rare but systemic toxicity should be anticipated. Calcium is advocated as the cornerstone of local and systemic therapy. NA inhalation alone is very rare and causes heavy pulmonary irritation. Massive pulmonary secretions seem a sign of very severe intoxication and treatment appears to be mainly supportive.


Assuntos
Dispneia/induzido quimicamente , Ácido Fluorídrico/efeitos adversos , Exposição por Inalação/efeitos adversos , Ácido Nítrico/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade
4.
G Ital Dermatol Venereol ; 150(6): 643-8, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26513041

RESUMO

AIM: Treatment of plantar and periungueal warts (so called "difficult-to-treat" warts, DTW) and external genital warts (EGW) remains unsatisfactory. Medical or invasive procedures are partially effective and/or painful. Furthermore recurrences rates after treatments are still a relevant problem for all the available therapies. Nitric-zinc complex is a solution for topical application containing nitric acid, zinc, copper and organic acids able to induce a caustic effect of the wart trough mummification and proteins denaturation/coagulation action. Nitric-zinc complex has been shown to be an effective and well tolerated treatment of common warts. METHODS: We evaluated in a prospective open label 4-centre trial, the efficacy and local tolerability of nitric-zinc complex in the treatment of EGW and DTW. A total of 37 immunocompetent subjects (20 men and 17 women; mean age: 45 years) with single or multiple lesions, were enrolled, after their informed consent. A total of 30 subjects had EGW, 2 subjects had plantar warts, 2 warts of the hand and 3 periungueal lesions. Nitric-zinc aqueous solution was applied topically using a 30 mL capillary tube over the lesions until a whitening/yellowish reaction appeared. A second (or more, if needed) application was performed at two-week interval until a complete clinical cure rate was observed. Primary outcome of the study was the clinical evaluation with picture documentation of the evolution of lesions classified as total cure, partial disappearance or no effect. Topical tolerability was evaluated through patient's reported adverse events. RESULTS: All subjects completed the study. A complete cure of lesions was observed in 31 subjects (90%) after one and up to four applications. Three patients with EGW (8%) showed a partial disappearance of lesions and one (2%) subject was no responder to four nitric-zinc complex applications. The product was well tolerated. No serious adverse events were observed or recorded. CONCLUSION: Nitric-zinc complex topical solution has shown to be an effective and well tolerated treatment of EGW and "difficult-to-treat" warts with a 90% of subjects with a total cure after one or up to four applications. A total or partial response was observed in 99% of the subjects. Nitric-zinc complex could be considered an easy-to-use effective treatment strategy of "difficult-to-treat" warts and external genital warts. Additional studies comparing nitric-zinc complex to other strategies are warranted.


Assuntos
Fármacos Dermatológicos/uso terapêutico , Verrugas/tratamento farmacológico , Administração Tópica , Adulto , Condiloma Acuminado/tratamento farmacológico , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/efeitos adversos , Feminino , Dermatoses do Pé/tratamento farmacológico , Doenças dos Genitais Femininos/tratamento farmacológico , Doenças dos Genitais Masculinos/tratamento farmacológico , Dermatoses da Mão/tratamento farmacológico , Humanos , Imunocompetência , Masculino , Pessoa de Meia-Idade , Ácido Nítrico/administração & dosagem , Ácido Nítrico/efeitos adversos , Ácido Nítrico/uso terapêutico , Estudos Prospectivos , Soluções , Resultado do Tratamento , Zinco/administração & dosagem , Zinco/efeitos adversos , Zinco/uso terapêutico
5.
Burns ; 41(4): 658-79, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25280586

RESUMO

This manuscript highlights and critically analyses clinical and forensic signs related to chemical burns. Signs that may lead to suspicion of a particular chemical are thoroughly discussed regarding its underlying mechanisms. Burns due to sulfuric, hydrofluoric, nitric, hydrochloric (muriatic) and acetic (including derivatives) acids, hydrogen sulphide, sodium (caustic soda) and calcium (cement) hydroxides, paraquat, burns after inflation and rupture of airbags, povidone-iodine, chlorhexidine/alcohol (in preterm infants), laxatives, and vesicants (warfare agents), will be reviewed since these are the most common agents found in daily practice, for which relevant and timed information may be helpful in formulating an emergency treatment protocols and toxicological analysis.


Assuntos
Ácidos/efeitos adversos , Anti-Infecciosos Locais/efeitos adversos , Queimaduras Químicas/patologia , Cáusticos/efeitos adversos , Substâncias para a Guerra Química/efeitos adversos , Medicina Legal , Irritantes/efeitos adversos , Ácido Acético/efeitos adversos , Air Bags/efeitos adversos , Poluentes Atmosféricos/efeitos adversos , Cimentos para Ossos/efeitos adversos , Queimaduras Químicas/etiologia , Hidróxido de Cálcio/efeitos adversos , Clorexidina/efeitos adversos , Substâncias Explosivas/efeitos adversos , Herbicidas/efeitos adversos , Humanos , Ácido Clorídrico/efeitos adversos , Sulfeto de Hidrogênio/efeitos adversos , Laxantes/efeitos adversos , Ácido Nítrico/efeitos adversos , Paraquat/efeitos adversos , Povidona-Iodo/efeitos adversos , Hidróxido de Sódio/efeitos adversos
7.
J Endod ; 40(2): 211-6, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24461406

RESUMO

INTRODUCTION: Studies to evaluate the diagnostic power of imaging examinations to detect root resorption have been based on simulations produced by burs. Standardized, round, and well-outlined access cavities do not reproduce the characteristics of physiological lesions and may facilitate diagnosis, masking the true accuracy of imaging techniques. A methodology to simulate internal root resorption by using acid demineralization was developed. METHODS: Eleven extracted single-rooted teeth were mesiodistally sectioned into homologous halves. Root canals were labeled to ensure restricted and controlled action of fluids. The protocol was composed of 24-hour cycles (5% nitric acid for 12 hours, rinsing with deionized water, and 8% sodium hypochlorite for 10 minutes). At the end of each cycle 1 tooth was removed from treatment, defining an exposure time that cumulated to the last tooth. Electron microscopy imaging was assessed to determine lesion area and depth. RESULTS: Minimum and maximum and areas and depths were 3.14 mm² and 10.34 mm² and 0.22 mm and 1.59 mm, respectively. Resorption simulated by the protocol proposed reproduced lesions of different sizes. CONCLUSIONS: The irregular shape and larger diameter:depth ratio suggest that these lesions are more similar to in vivo internal root resorption, compared with bur-induced lesions.


Assuntos
Reabsorção da Raiz/etiologia , Tomografia Computadorizada de Feixe Cônico/métodos , Dente Canino/diagnóstico por imagem , Dente Canino/efeitos dos fármacos , Dente Canino/patologia , Dentina/diagnóstico por imagem , Dentina/efeitos dos fármacos , Dentina/patologia , Humanos , Processamento de Imagem Assistida por Computador/métodos , Técnicas In Vitro , Incisivo/diagnóstico por imagem , Incisivo/efeitos dos fármacos , Incisivo/patologia , Microscopia Eletrônica de Varredura , Ácido Nítrico/efeitos adversos , Odontometria/métodos , Reabsorção da Raiz/diagnóstico por imagem , Reabsorção da Raiz/patologia , Hipoclorito de Sódio/efeitos adversos , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos
8.
Plant Physiol Biochem ; 64: 41-51, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23353765

RESUMO

To study whether differential responses occur in photosynthesis and antioxidant system for seedlings of Liquidambar formosana, an acid rain (AR)-sensitive tree species and Schima superba, an AR-tolerant tree species treated with three types of pH 3.0 simulated AR (SiAR) including sulfuric-rich (S-SiAR), nitric-rich (N-SiAR), sulfate and nitrate mixed (SN-SiAR), we investigated the changes of leaf necrosis, chlorophyll content, soluble protein and proline content, photosynthesis and chlorophyll fluorescence characteristics, reactive oxygen species production, membrane lipid peroxidation, small molecular antioxidant content, antioxidant enzyme activities and related protein expressions. Our results showed that SiAR significantly caused leaf necrosis, inhibited photosynthesis, induced superoxide radical and hydrogen peroxide generation, aggravated membrane lipid peroxidation, changed antioxidant enzyme activities, modified related protein expressions such as Cu/Zn superoxide dismutase (SOD), l-ascorbate peroxidase (APX, EC 1. 11. 1. 11), glutathione S transferase (GST, EC 2. 5. 1. 18) and Rubisco large subunit (RuBISCO LSU), altered non-protein thiols (NPT) and glutathione (GSH) content in leaves of L. formosana and S. superba. Taken together, we concluded that the damages caused by SiAR in L. formosana were more severe and suffered from more negative impacts than in S. superba. S-SiAR induced more serious damages for the plants than did SN-SiAR and N-SiAR.


Assuntos
Chuva Ácida/efeitos adversos , Ácidos não Carboxílicos/efeitos adversos , Antioxidantes/metabolismo , Liquidambar/fisiologia , Fotossíntese , Estresse Fisiológico , Theaceae/fisiologia , Membrana Celular , Peróxido de Hidrogênio/metabolismo , Peroxidação de Lipídeos , Liquidambar/metabolismo , Ácido Nítrico/efeitos adversos , Folhas de Planta , Ribulose-Bifosfato Carboxilase/metabolismo , Plântula , Compostos de Sulfidrila/metabolismo , Ácidos Sulfúricos/efeitos adversos , Superóxidos/metabolismo , Theaceae/metabolismo , Árvores
10.
J Emerg Med ; 39(1): 39-43, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18842383

RESUMO

BACKGROUND: Nitric acid (HNO(3)) is a solution of nitrogen dioxide (NO(2)) in water commonly used as an industrial chemical and cleaner. Oxides of nitrogen liberated as nitric acid interact with the environment to cause inhalation injuries. The coexistence of HNO(3) with varying oxides of nitrogen likely results in the large continuum of symptoms related to HNO(3) exposure and varying times of onset--acute, subacute, and delayed. Furthermore, dyspnea and evidence of acute lung injury may not occur for several hours after exposure and can lead to rapidly progressive acute respiratory distress syndrome (ARDS). OBJECTIVES: This case illustrates to physicians and occupational health personnel that HNO(3) inhalation may initially appear benign and that onset of severe effects may be delayed. CASE REPORT: A 66-year-old man developed delayed-onset pulmonary edema, ARDS, and fatal circulatory collapse 53 h after occupational exposure to HNO(3). CONCLUSION: This case serves to increase awareness among emergency physicians, as well as occupational health personnel, that patients exposed to HNO(3) may initially be asymptomatic. Patients should be evaluated and observed regardless of the severity or benign nature of symptoms, which occur immediately after exposure, as the most severe symptoms are often delayed in onset and rapidly progressive.


Assuntos
Ácido Nítrico/efeitos adversos , Exposição Ocupacional , Edema Pulmonar/induzido quimicamente , Idoso , Gasometria , Oxigenação por Membrana Extracorpórea , Evolução Fatal , Humanos , Masculino , Edema Pulmonar/sangue , Edema Pulmonar/terapia , Fatores de Tempo
11.
J Plast Reconstr Aesthet Surg ; 63(4): e358-63, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19875347

RESUMO

Nitric acid burn traumata often occur in the chemical industry. A few publications addressing this topic can be found in the medical database, and there are no reports about these traumata in children. A total of 24 patients, average 16.6 years of age, suffering from nitric acid traumata were treated. Wound with I degrees burns received open therapy with panthenol-containing creams. Wound of II degrees and higher were initially treated by irrigation with sterile isotonic saline solution and then by covering with silver-sulphadiazine dressing. Treatment was changed on the second day to fluid-absorbent foam bandages for superficial wounds (up to IIa degrees depth) and occlusive, antiseptic moist bandages in combination with enzymatic substances for IIb degrees -III degrees burns. After the delayed demarcation, necrectomy and mesh-graft transplantation were performed. All wounds healed adequately. Chemical burn traumata with nitric acid lead to specific yellow- to brown-stained wounds with slower accumulation of eschar and slower demarcation compared with thermal burns. Remaining wound eschar induced no systemic inflammation reaction. After demarcation, skin transplantation can be performed on the wounds, as is commonly done. The distinguishing feature of nitric-acid-induced chemical burns is the difficulty in differentiation and classification of burn depth. An immediate lavage should be followed by silver sulphadiazine treatment. Thereafter, fluid-absorbent foam bandages or occlusive, antiseptic moist bandages should be used according to the burn depth. Slow demarcation caused a delay in performing surgical treatments.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Queimaduras Químicas/diagnóstico , Substâncias Explosivas/efeitos adversos , Ácido Nítrico/efeitos adversos , Ácido Pantotênico/análogos & derivados , Sulfadiazina de Prata/administração & dosagem , Pele/lesões , Administração Tópica , Adolescente , Bandagens , Queimaduras Químicas/terapia , Seguimentos , Humanos , Pessoa de Meia-Idade , Pomadas , Ácido Pantotênico/administração & dosagem , Pele/efeitos dos fármacos , Pele/patologia , Irrigação Terapêutica , Índices de Gravidade do Trauma , Resultado do Tratamento , Cicatrização/efeitos dos fármacos
14.
Resuscitation ; 75(1): 184-8, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17507140

RESUMO

Two patients presented with potentially fatal pulmonary oedema after accidental exposure to nitric and hydrofluoric acid fumes during electroplating. Despite aggressive respiratory support, one succumbed to respiratory failure 3.5h after inhalation. The other patient also rapidly progressed to respiratory failure. Extracorporeal life support (ECLS) was started 5h after exposure at the ED. During ECLS, hypoxia improved, but pulmonary oedema shown by chest radiography became aggravated. N-Acetyl cysteine and calcium gluconate were given i.v. on the first day of admission and nebulised for 48 h after exposure. Pulmonary secretions were significantly reduced 24 h after the nebulising therapy began. Ultimately, the patient was discharged without serious pulmonary or neurological complications after 28 days of hospitalisation. In this case, early ECLS, nebulised antioxidant and antidote were available to treat potentially fatal pulmonary oedema after exposure to nitric and hydrofluoric acid fumes.


Assuntos
Substâncias Explosivas/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Ácido Fluorídrico/efeitos adversos , Ácido Nítrico/efeitos adversos , Edema Pulmonar/induzido quimicamente , Edema Pulmonar/terapia , Adulto , Poluentes Ocupacionais do Ar/efeitos adversos , Galvanoplastia , Substâncias Explosivas/administração & dosagem , Evolução Fatal , Humanos , Ácido Fluorídrico/administração & dosagem , Masculino , Ácido Nítrico/administração & dosagem , Exposição Ocupacional/efeitos adversos
17.
Swiss Med Wkly ; 136(7-8): 103-13, 2006 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-16633954

RESUMO

Prevention of coronary artery disease (CAD) and reduction of its mortality and morbidity remains a major public health challenge throughout the "Western world". Recent evidence supports the concept that the impairment of endothelial function, a hallmark of insulin resistance states, is an upstream event in the pathophysiology of insulin resistance and its main corollaries: atherosclerosis and myocardial infarction. Atherosclerosis is currently thought to be the consequence of a subtle imbalance between pro- and anti-oxidants that produces favourable conditions for lesion progression towards acute thrombotic complications and clinical events. Over the last decade, a remarkable burst of evidence has accumulated, offering the new perspective that bioavailable nitric oxide (NO) plays a pivotal role throughout the CAD-spectrum, from its genesis to the outcome after acute events. Vascular NO is a critical modulator of coronary blood flow by inhibiting smooth muscle contraction and platelet aggregation. It also acts in angiogenesis and cytoprotection. Defective endothelial nitric oxide synthase (eNOS) driven NO synthesis causes development of major cardiovascular risk factors (insulin resistance, arterial hypertension and dyslipidaemia) in mice, and characterises CAD-prone insulin-resistant humans. On the other hand, stimulation of inducible nitric oxide synthase (iNOS) and NO overproduction causes metabolic insulin resistance and characterises atherosclerosis, heart failure and cardiogenic shock in humans, suggesting a "Yin-Yang" effect of NO in the cardiovascular homeostasis. Here, we will present a concise overview of the evidence for this novel concept, providing the conceptual framework for developing a potential therapeutic strategy to prevent and treat CAD.


Assuntos
Doença da Artéria Coronariana/etiologia , Ácido Nítrico/metabolismo , Estresse Oxidativo , Yin-Yang , Humanos , Resistência à Insulina , Ácido Nítrico/efeitos adversos , Estresse Oxidativo/fisiologia , Suíça
18.
J Pediatr Gastroenterol Nutr ; 35(3): 360-2, 2002 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12352528

RESUMO

Gastric outlet obstruction is a common late result after acid ingestion; early complications, such as gastric necrosis or perforations are unusual. This is a report of a patient with the history of strong acid ingestion who underwent total gastrectomy due to perforation and extensive necrosis of the stomach.


Assuntos
Ácido Nítrico/efeitos adversos , Gastropatias/induzido quimicamente , Estômago/lesões , Pré-Escolar , Gastrectomia , Humanos , Masculino , Estômago/cirurgia , Gastropatias/cirurgia
19.
J UOEH ; 23(1): 69-75, 2001 Mar 01.
Artigo em Japonês | MEDLINE | ID: mdl-11279843

RESUMO

We report two patients who suffered from acid burns while working in chemical factories. Case 1: a 44-year-old man who received burn induced by nitric acid on the face and extremities. Despite his protecting facial mask, he was exposed to nitric acid on his face through a gap between the mask and skin surface. Nitric acid was also sprinkled on his scalp which was not covered by a helmet or a protecting device. In addition, he suffered from acid burn on the right scapular region, the right upper arm, and the lower extremities through the work clothes. Case 2: a 26-year-old man who suffered from sulfuric acid burn on the forearms. Both patients were accidentally exposed to acids while they filled tanks with the acids through a hose. Following the manual of the factories, they washed the exposed skin with water for more than 15 minutes after the exposure. Although they recovered without any serious sequel, there remained partial deep tissue destruction of the skin. We reviewed these two cases from the aspect of industrial medicine, and proposed the following three points for improvement in the workplace to prevent accidental acid burns. 1) re-education or enlightenment activities for the well-experienced workers to avoid negligence to the danger of strong acid. 2) recommendation to take a complete shower to avoid overlooking of unaware acid injury. 3) improvement in the protecting facial mask. In addition, clinicians who examine acid-burn patients should not pass over the presence of deep ulcers lying behind the thick crust on the injured area.


Assuntos
Queimaduras Químicas/etiologia , Dermatite Ocupacional/etiologia , Ácido Nítrico/efeitos adversos , Saúde do Trabalhador , Ácidos Sulfúricos/efeitos adversos , Adulto , Humanos , Masculino , Equipamentos de Proteção
20.
Cir. Urug ; 70(3/4): 127-132, jul.-dic. 2000.
Artigo em Espanhol | LILACS | ID: lil-335826

RESUMO

Se analiza el caso de una paciente que realizó un intento de autoeliminación por inyección intraperitoneal de ácido nítrico. No hemos encontrado comunicaciones similares a la actual en la literatura consultada. Destacaremos elementos de la clínica, la fisiopatología y el tratamiento, así como también analizaremos otras eventuales opciones terapéuticas


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Ácido Nítrico/efeitos adversos , Peritonite , Gastrectomia
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