The efficacy of topical Marham-e-Akbar in chronic atopic dermatitis - an open-label interventional study.

OBJECTIVES: Chronic atopic dermatitis (AD) is an inflammatory skin condition marked by intense pruritus, dry skin, and severe impact on the life quality of the patients. Conventionally, it is managed by using emollients, calcineurin inhibitors, and topical corticosteroids. In Unani medicine, eminent scholars advocated many drug formulations including topical Marham-e-Akbar for effective healing of AD but scientific evidence is scarce. Hence, this study was designed. METHODS: This was a single-arm clinical trial conducted on 30 participants aged 18-65 years suffering from chronic AD after obtaining written informed consent. The trial intervention was Marham-e-Akbar consisting of Murdar Sang (Plumbi oxidum); Sindur (red lead); olive oil (Olea europaea oil); Kath (Acacia catechu extract); Safeda Kashgari (Zinc oxide); Sirka (vinegar); and Phitkiri (alum) to be applied twice daily for 42 days. The objective parameters were SCORAD and DLQI, while the subjective parameters included itching, scaling, and erythema assessed on a customized VAS scale and 4-point Likert scale. RESULTS: The pre-post analysis inferred statistically significant attenuation in subjective parameters (itching, scaling, and erythema) and objective scales (SCORAD) and (DLQI) with p<0.001. CONCLUSIONS: The study findings deduced that Marham-e-Akbar is effective in the amelioration of chronic atopic dermatitis and quality of life of the patients as well.

Frequency of stress hyperglycaemia and its' influence on the outcome of patients with spontaneous intracerebral haemorrhage.

OBJECTIVE: To observe the frequency of admission hyperglycaemia and its influence on the outcome of patients with intracerebral haemorrhage. METHODS: This case series study included 450 consecutive patients received in medical wards at Liaquat University Hospital Jamshoro/Hyderabad with a diagnosis of Spontaneous Intracerebral Haemorrhage within 24 hours of their first stroke onset, between September 2006 to December 2008. The patients with haemorrhage secondary to brain tumours, trauma, haemorrhagic transformation of cerebral infarct, with previous history of haemorrhagic stroke, and patients with Glycosylated Haemoglobin greater than 8.5% were excluded from the study. Hyperglycaemia was defined as an admission or in-hospital fasting blood glucose level of 126 mg/dl (7 mmol/liter) or more or a random blood glucose level of 200 mg/dl (11.1 mmol/liter) or more on 2 or more determinations. The patients were divided into 2 broad groups, good outcome groups (i.e. patients who survived), and poor outcome group (patient died). Categorical variables such as age, sex, volume of haematoma, GCS score, presence of admission hyperglycaemia, Mean arterial pressure (MAP), and site of haematoma were expressed as percentage and frequency. Chi-square test was applied for comparing categorical variables such as hyperglycaemia, GCS score, and age with the outcome of the patients. Multivariate logistical regression analysis was done. A p-value 0.05 was considered as statistically significant. All calculations were done using SPSS version 16 (Chicago, IL, USA). RESULTS: Of the 450 consecutive patients, 399 fulfilled the inclusion criteria. Males were 261(65.4%) and females 136 (36, 4%).Patients of over 65 years age numbered 222 (55.6%) and 177 (44.4%) were less than 65 years. Stress hyperglycaemia was present in 109 (27.3%) cases and 290 (72.7%) patients were normoglycaemic. Of the 109 patients who died during hospitalization, 59 (54.12%) had presented with admission hyperglycaemia (0.001). CONCLUSION: Stress hyperglycaemia is a common finding in patients presenting with intracerebral haemorrhage. It is a marker of poor outcomes and higher mortality, more so in patients with no known history of diabetes.

Frequency of lower extremity amputation in diabetics with reference to glycemic control and Wagner's grades.

OBJECTIVE: To determine the frequency of minor and major amputations in diabetic patients at different Wagner s grades of severity and to correlate it with the glycaemic control. DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Department of Orthopedic Surgery, Jinnah Postgraduate Medical Centre, Karachi, over a period of 3 years from August 1999 to August 2002. SUBJECTS AND METHODS: The study included 60 patients of diabetic foot disease, who were distributed in to six grades of severity according to the Wagner s method. Glycaemic control was determined by baseline fasting and random blood sugar and HbA1c levels. Patients were treated accordingly and followed-up. Frequencies of minor and major amputations were found and these were correlated with the glycemic control of the patients. RESULTS: There was no patient in grade-0, 6 (10%) patients in grade-I, 13 (21.6%) in grade-II, 14 (23.3%) in grade-III, 18 (30%) in grade-IV and 9 (15%) patients in grade-V respectively. Thirty-seven (61.6%) patients were male. The mean age of the patients was 50.88 +/- 11.06 years. In 40 (66.7%) patients, the duration of diabetes was 8 years or longer. Fifty six (93.3%) were having NIDDM and 35 (58.3%) were smokers. Staphylococcus aureus was the most common pathogen isolated from the wound. Only 1 (16.6%) patient in grade I underwent minor amputation, while 3 (23.7%), 8 (57.14%) and 8 (44.44%) underwent minor amputation in grades II, III and IV respectively. Three (21.42%), 10 (55.55%) and all 9 (100%) underwent major amputation in grade III, IV and V respectively. Below-the-knee amputation was the most commonly performed procedure. Overall frequency of minor and major amputation were 20 (33.3%) and 22 (36.3%) respectively. Patients with poor glycaemic control had higher percentage of minor and major amputation (p-value = 0.001). CONCLUSION: The frequency of minor and major amputation increases with the higher grades of diabetic foot. Poor glycaemic control is a significant risk factor for amputation in diabetic foot patients.