Compounded Cerium Nitrate—Silver Sulfadiazine Cream is Safe and Effective for the Treatment of Burn Wounds: A Burn Center’s Four-Year Experience

Wound infections and sepsis are significant causes of morbidity after burn injury and can be alleviated by early excision and grafting. In situations that preclude early surgery, topical agents allow for a safer delay. Cerium nitrate compounded with silver sulfadiazine (Ce-SSD) is a burn cream that provides broad antibacterial activity, forms a temporary barrier, and promotes re-epithelialization. Methemoglobinemia is a rare, but oft-cited, systemic complication of Ce-SSD. In this retrospective review, 157 patients treated with Ce-SSD between July 2014 - July 2018 were identified and the monitoring protocol for methemoglobinemia during Ce-SSD treatment was evaluated. Median age was 59 years (IQR, 47-70.5 years), with total body surface area burn (TBSA) of 8.5% (IQR, 3-27), adjusted Baux score of 76 (IQR, 59-94), and inhalation injury present in 9.9% of patients. Primary endpoints included incidence of symptomatic and asymptomatic methemoglobinemia. Of the 9.6% (n = 15) of patients with methemoglobinemia, 73.3% (n=11) had maximum methemoglobin levels ≥ 72 hours from time of first application. One patient developed clinically significant methemoglobinemia. Patients with TBSA ≥ 20% were more likely to develop methemoglobinemia (OR 9.318, 95% CI 2.078 to 65.73, p = 0.0078), however neither Ce-SSD doses nor days of exposure were significant predictors. Ce-SSD application to temporize burn wounds until excision and grafting is safe, effective, and, in asymptomatic patients with TBSA < 20%, can be used without serial blood gas monitoring. Vigilant monitoring for symptoms should be performed in patients with TBSA ≥ 20%, but routine blood gases are not necessary.

EXTENDING VASE LIFE OF CUT Strelitzia reginae Aiton FLOWERS BY COBALT CHLORIDE, CERIUM NITRATE, SILVER NANOPARTICLES AND NANOSIL

Cut flowers of Strelitzia reginae Aiton (Strelitziaceae) generally have a short vase life. Vascular blockage is a major reason for this. In this paper, we evaluated the effects of pulse treatment with disinfectants including cobalt chloride (CoCl2), cerium nitrate (Ce(NO3)3), silver nanoparticles (SNP) and Nanosil on the vase life and physiological characteristics of cut S. reginae flowers stems. Cut flowers kept in the vase solution containing these disinfectants showed significant increase in solution uptake, the content of total protein and pigments of petals, the activities of antioxidantive active enzymes superoxide dismutase (SOD) and ascorbate peroxidase (APX). Also, the number of stem-end bacteria and malondialdehyde (MDA) content in cut flowers were decreased as compared to control. Based on obtained results, we introduce Ce(NO3)3 as the most effective treatment to extend the vase life of cut S. reginae flowers. More so with the concentration of 300 µM which induced the maximum solution uptake and SOD and APX activities that resulted in the longest vase life. Findings of the present study suggested that Ce(NO3)3 prolonged postharvest longevity of S. reginae by increasing the solution uptake and SOD and APX activity and decreasing the MDA content. The use of Ce(NO3)3 reduces the use of chemicals and make saving in costs. The highest bacterial population of micro-organisms on cut stem ends were Escherichia coli, Bacillus, Staphylococcus and Streptococcus. Cerium nitrate had the strongest effect on reduction of these bacterial population and yeast.

Cerium nitrate and salicylic acid on vase life, lipid peroxidation, and antioxidant enzymes activity in cut lisianthus flowers

Lisianthus is a major cut flower, but it has a short vase life. To prolong postharvest longevity and improve quantitative and qualitative traits of cut lisianthus flowers, an experiment was conducted on the basis of a Completely Randomized Design with eight treatments on 120 flower sprays in three replications. The experimental treatments included salicylic acid (SA) at the rates of 50, 100 and 200 mg L-1, cerium nitrate [Ce(NO3)3] at the rates of 20, 40, 80, and 200 μM, and control (distilled water). The results revealed that the flowers treated with 40 μM Ce(NO3)3 and those treated with 100 mg L-1 SA had the longest vase life of 15.42 and 15.20 days, respectively. Also, these treatments were most effective in improving water uptake, reducing microbial load at the stem end, and enhancing petals’ protein content. The lowest malondialdehyde (18.65 nmol g-1fresh weight) was related to the treatment of 40 μM Ce(NO3)3 and 100 mg L-1 SA. These treatments showed the lowest polyphenol oxidase (PPO) activity, too. The activity of ascorbate peroxidase (APX) and peroxidase (POD) antioxidant enzymes was significantly higher in the flowers treated with 40 μM Ce(NO3)3 and 100 mg L-1 SA. The treatment of 200 mg L-1 SA had negative effects on all the recorded traits. So, it can be concluded that the treatment of cut lisianthus flowers with 40 μM Ce(NO3)3 and 100 mg L-1 SA can prolong their postharvest longevity by reducing lipid peroxidation and increasing the activity of antioxidant enzymes.

Experience in Management of Burn Injury During Pregnancy in a Burn Unit

Burns injuries during pregnancy are rarely reported in developed countries, but an increasing in mortality and morbidity has been observed. The authors describe their experience in the treatment of pregnant women in a burn unit. A 12-year retrospective study of burns in pregnant women hospitalized was conducted. Since 2008, two pregnant women were admitted in their unit. Patient 1, a 32-year-old pregnant woman on second trimester (27s6d), suffered a second-degree burn injury, 16% total body surface area (TBSA), caused by fire. She was admitted in their burn unit and submitted to medical treatment, wound dressing, and surgical treatment. Cerium nitrate and silver sulfadiazine were used in burn lesions and the patient was submitted to debridement and skin graft surgery. No uneventful events occurred with the fetus. Patient 2 was a 32-year-old pregnant woman on second trimester (26s), HVC positive, admitted with a second-degree flash burn, 8% TBSA. She was submitted to endotracheal intubation before arriving to the hospital due to risk of airway burn. Dexamethasone was administered for fetus lung maturation. No uneventful events were observed. The incidence of thermal injury in pregnancy in Portugal is low. Active medical treatment together with conservative wound care should be the standard in each trimester of pregnancy. Although there is limited safety information on cerium nitrate or silver sulfadiazine during pregnancy, those were used with no adverse effects on one of their patients. Obstetrical management should be individualized.