Analytical study of compound Unani drug Habb-e-Mudir

The drugs used in Unani Medicine consist of materials from plant, animal and mineral origin that are either used single or in combination with other drugs as poly-pharmaceuticals. Habb-e-Mudir is a poly-ingredient formulation comprising Sibr [Aloe species], Zafran [Crocus sativus] and Hira Kasees [Ferrous Sulphate], in the ratio of 2:1:1 [NFUM I] indicated for the treatment of amenorrhoea. Present study is aimed to standardize the formulation for quality control purpose. Standard sample of the formulation was prepared in laboratory following the NFUM methodology [National Formulary of Unani Medicine]. Separate studies were undertaken for each ingredient in respect of pharmacognostical characters, physico-chemical constituents and HPTLC profile. Standard formulation was subjected to chemical analysis viz. extractive values, ash values, etc. including chromatographic profile in line with standard pharmacopoeial protocols. The results may ensure the quality of Habb-e-Mudir through determining the genuineness and quality of ingredients as well as the manufacturing process

Daa-us-sadaf [Psoriasis] and role of herbal drugs

Hippocrates, Dioscorides and other Unani Physicians also described this disease. Psoriasis is a non-contagious idiopathic skin disorder which also include the joints. It commonly causes red scaly patches appearing on the skin. Herbal or aromatherapeutic agents could be useful in this context. Here authors review the herbal drugs which have antipsoriasis property and benefited the patients of this disease. It is a review of plants drug published in MAPA [Medicinal Aromatic Plant Abstracts] and PubMed and on Wikepedia

Airway management for cervical spine injury

In this review, important factors related to initial management, diagnosis, airway, and anesthetic management of patients with cervical spine injury [CSI] are discussed. Early diagnostic and clinical evaluation is important in excluding CSI. In-line stabilization reduces movement of the cervical spine. Tracheal intubation under fiberscopic control, offers safety, and comfort to the patient. However, in cases of severe deterioration of vital functions, intubation must be performed without any delay at the site of the accident or in the emergency room. Early airway management and maintenance of spinal immobilization are more important factors in limiting the risk of secondary neurological injury than any particular technique. The current opinion is that oral intubation after intravenous induction of anesthesia and muscle relaxation along with in-line stabilization is the safest and quickest way to achieve intubation in a patient with suspected CSI

case of invasive aspergillosis in a patient with no identifiable immunodeficiencies

Invasive fungal infections usually affect patients with immunodeficiencies and very rarely patients with no known or identifiable risk factors. Diagnosis could be delayed in patients without previously known immunodeficiencies due to a low index of suspicion, leading to a delay in treatment and a potential poor outcome. We report a case of a postpartum woman with no history of immuno-compromised disease who developed left hemiparesis with evidence of invasive aspergollosis affecting the nervous system, and leading to fatal outcome. The patient had a mass-like lesion in the neuroimaging with soft tissue shadowing in the chest x-ray leading to initial diagnosis of tuberculosis. The brain biopsy showed changes consistent with a diagnosis of aspergillosis. The source of the aspergillus infection was not clear. Aspergillus infection should be considered in patients with no identifiable immunodeficiencies who have abnormal brain imaging and chest x-ray, as early treatment may alter the outcome

Tramadol as an adjuvant to intravenous regional anesthesia with lignocaine

To assess the effect of different doses of tramadol when added to lignocaine during intravenous regional anesthesia [IVRA]. Sixty patients, scheduled for hand surgery under IVRA in King Fahd University Hospital, Al-Khobar, Saudi Arabia from January 2006 to January 2007 were randomly allocated into 3 groups [20 patients each] in a double blind controlled study. All patients received 0.5% lignocaine, 40ml plus 2ml of a study solution containing either isotonic saline control group, or tramadol 50mg [group T50] or tramadol 100 mg [group T100]. Hemodynamic changes, sensory and motor block onset and recovery times, tourniquet tolerance time, the quality of intraoperative anesthesia and the duration of postoperative analgesia were assessed. All patients, 20 in each group completed the study period. Patients who received tramadol had earlier onset of sensory block [5.2 +/= 1.2; 4.9 +/= 1.2 min in the T50; and T100 groups] compared with the control group [7.6 +/= 1.4 min]. Patients who received 100mg of tramadol had better tolerance of tourniquet [p=0.011], and less intraoperative fentanyl supplementation [p=0.042]. They had also a longer time to the first postoperative analgesic request [p=0.001] compared with the control group. Tramadol 100 mg is a beneficial additive to lignocaine for IVRA since it shortened the onset of sensory block, enhanced the tourniquet tolerance and improved the perioperative analgesia

effect of etoricoxib premedication on postoperative analgesia requirement in orthopedic and trauma patients

We hypothesized that etoricoxib premedication would reduce the need for additional opioids following orthopedic trauma surgery. A double blind, controlled study, conducted in King Fahd University Hospital, King Faisal University, Dammam, Kingdom of Saudi Arabia. After obtaining the approval of the Research and Ethics Committee and written consent, 200 American Society of Anesthesiology grade I and II patients that underwent elective upper limb or lower limb fracture fixation surgeries during the period from August 2005 to October 2007 were studied. Patients were randomly premedicated using 120 mg of etoricoxib or placebo n=100, each. To alleviate postoperative pain, a patient controlled analgesia device was programmed to deliver one mg of morphine intravenously lockout time, 6 minutes. Visual analog scale and total postoperative morphine consumption over 24 hours and the adverse effects were recorded. One hundred patients in each group completed the study period. Etoricoxib premedication provides a statistically significant postoperative morphine sparing effect over 24 hours postoperatively. Total morphine consumption was 44.2 [8.2] in the placebo and 35.17.0mg in the etoricoxib groups p<0.001. The incidence of nausea and vomiting requiring treatment was lower in the etoricoxib group, p=0.014. The postoperative blood loss was similar in both groups. Etoricoxib is a suitable premedication before traumatic orthopedic surgery as it enhanced postoperative analgesia and reduced the need for morphine

Management of Infantile diarrhoea through Unani oral rehydration fluids

Children are the indicators of development of our future, and diarrhoeal diseases among children is still a major health problem in developing countries. In India alone about 1.5 million children die of dehydration due to diarrhoea every year and are indicative of tragic symbol of inefficiency of our health care system. Greater tragedy behind this fact is that most of these deaths arc preventable not by sophisticated or expensive means but by simple and cheap Unani home remedies. Oral re-hydration therapy is considered as the best medical revolution and oral rehydration fluids prepared from homely available Unani drugs can play valuable role not only to control dehydration but also to check diarrhoeal episode, and help decrease needless diarrhoeal deaths. The topic is discussed in the paper at length

Emerging bacterial resistance patterns in febrile neutropenic patients: experience at a tertiary care hospital in Pakistan

To look at the clinical presentations, spectrum and site of isolation of the organisms, sensitivity patterns of the organisms and the antibiotic prescribing practices for the treatment of febrile neutropenic patients at our hospital. The data were collected retrospectively from the records of all neutropenic patients with an absolute neutrophil count [ANC] of less than 500/ml admitted during the period of 3 years from August 1999 to July 2002 at AKUH. Out of the total of 404 patients, 65% had hematological malignancies and around half of them had leukaemia, 86% of the patients presented with fever. A total of 124 bacterial organisms were isolated from 96 patients among which 47% were gram positive and 53% were gram negative organisms; 16.1% of the patients had septicaemia. Coagulase Negative Staphylococci [CoNS] were the most common gram positive and E coli was the most commonly isolated gram negative organism. Most of the gram positive organisms were isolated from blood [67%]. There was emerging resistance to all commonly used antibiotics including imipenem, cloxacillin, vancomycin and amikacin. The average duration of neutropenia was 6.4 days. The mortality rate was 6%. There is increasing trend of gram negative organisms developing resistance to commonly used antibiotics. Gram positive bacteria including Enterococcus spp. and CoNS are also showing emerging resistance to vancomycin

Role of estrogens in the secondary hormonal manipulation of hormone refractory prostate cancer

To evaluate the role of Estrogens [Honvan] in the secondary hormonal manipulation of patients with hormone refractory prostate cancer [HRCP]. Twelve patients diagnosed as hormone refractory prostate cancer received intravenous estrogens for six days [Fosfestrol, a synthetic phosphorylated estrogen derivative], followed by a maintenance oral dose of 120 mg thrice daily as second line hormonal treatment. During the treatment they were given deep venous thrombosis prophylaxis. Their stage at initial presentation, primary treatment, mode of androgen ablation, prostate specific antigen [PSA] level, duration of remission prior of HRPC status, PSA doubling time before and after estrogen treatment were recorded. The morbidity and mortality of the treatment was also recorded. A drop in PSA of > 50% was classified as major responder. The drop of < 50% was defined as minor responders. Treatment failure was defined as a rise in PSA > the level prior to the start of treatment. The mean age at diagnosis of prostate cancer was 66.6 + 5.4 years [range 57-73]. At the time of initial diagnosis only 3 patients [25%] had localized disease and 9 [75%] had metastatic prostate cancer. Six patients each opted for surgical or medical castration [LHRH analogs] as the mode of androgen ablation. The mean initial PSA at diagnosis was 340 + 728.1 ng/ml [range 4.1-2375, Median 94]. After development of HRPC, six patients [50%] had major response, four [33%] had minor response to estrogen administration. Two patients [17%] did not respond to estrogens. The mean PSA before receiving Fosfestrol was 60.5 + 82 ng/ml [range 0.013-246]. The PSA [nadir] after treatment was 24.3 + 33.2 ng/ml [range 0.9-81.3]. One patient developed gynaecomastia and one had congestive cardiac failure. Two patients died of non cancer related deaths and one patient died of cancer related death. Synthetic estrogens are well tolerated, in-expensive agents and could be considered for palliative use against hormone resistant prostate cancer

Temperament [Mizaj] and blood groups of donors and recipients and their importance in blood transfusion

Blood groups are checked before transfusion to avoid agglutination caused due to the interaction of agglutinogen present in the red cells [khilt-e-dam] of donor and agglutinin present in the plasma of recipient or vice versa. On the basis of agglutinogens present in the red cells, human beings are divided into groups, A, B, AB and O. Unani medical science is based on the concept of four Akhlat [Humours] which remain intermixed in the blood as their name suggests. Each dominating humour in the blood constitutes a particular temperament and accordingly all individuals are divided into four humoural temperaments, sanguine, phlegmatic, choleric and melancholic. Concluded, blood of all persons are not similar but differ according to temperaments. Observations revealed that in several recipients even after transfusion of compatible blood, jaundice occurred due to haemolysis. This is indicative of incompatibility of temperament of recipient and donor. In this paper it is emphasised that besides blood groups, temperaments of donors and recipients must also be checked before transfusion and be similar, to avoid ill-effects

Assessment of mizaj [temperament] in Unani system of medicine and its relevance to modern theory of blood grouping

Mizaj [temperament] forms the bases of diagnosis and treatment in the Unani System of Medicine. Evaluation and classification of various temperaments are based on the intermixture of four akhlat [humours] in the blood in different proportions and this blood plays and important role in the constitution of Mizaj. Domination of humours e.g., blood, phlegm, bile and black bile in the blood categorises persons in sanguine, phlegmatic, choleric and melancholic temperaments respectively. Similarly, on the other hand, presence or absence of A and B antigens in the blood classifies persons into four groups, A, B, AB, and O. The study was undertaken to find out the relationship between temperaments and blood groups of 120 healthy temperaments and blood groups of 120 healthy individuals

Myelodysplastic syndromes: a case report and treatment experience with 5-azacitidine.

Myelodysplastic syndromes [MDS] are a clonal haematological disorder of one or more cell line with resultant cytopenias. Complications encountered include infection, hemorrhage, anemia and evolution into acute leukemia. MDS are difficult to treat and except for allogenic bone marrow transplant, rest of treatment like low dose chemotherapy differentiating agents and growth factors, should be considered palliative. We are presenting our experience about a case of MDS and a newer chemotherapeutic agent, 5-azacytidine which was used in this case to treat MDS, with good results

Folk medicinal plants of the Garhwal and Kumaon forests of Uttar Pradesh, India

The communication provides information on new folk medicinal uses of 96 plant species belonging to 93 genera and 59 families. The data were collected either from local healers of from the reliable old villagers during the course of ethnobotanical explorations of various forest and rural areas of Garhwal and Kumaon regions of India. Plant species with their botanical name, vernacular names, collection number, habit and medicinal usage have been enlisted. Scientific investigations of all species reported are suggested to validate the claims