Efficacy of newly formulated ointment containing 20% active antimicrobial honey in treatment of burn wound infections.

BACKGROUND: Honey has been familiar to possess antimicrobial potential to clear infection against burn wound infecting bacteria since ancient times. The objective of the study was to evaluate the efficacy of the newly formulated honey ointment during the treatment of burn wound infections. The Experimental (Non comparative) study was conducted at outpatient department of Dermatology, Fauji Foundation Hospital, Rawalpindi from November 2009 to October 2010. METHODS: The antimicrobial activity of different Pakistani floral sources (Acacia nilotica species indica, Zizyphus, Helianthus annuus and Carisa opaca) honey samples were investigated by disc diffusion method against freshly isolated burn wounds infecting bacteria. Ointment containing 20% active antimicrobial honey was formulated as a sovereign remedy. A total number of twenty patients with second degree of burn wounds on different parts of the body were studied. A thin layer of honey ointment on gauze was applied to the wounds two to three times a day up to the complete healing. RESULTS: During microbiological study, Pakistani honey samples were discovered to exhibit a very promising antimicrobial activity against all the wound infecting microorganisms tested. Clinical trials demonstrated that the topical application of honey ointment have significant control of infections arising form pathogenic bacteria and up to 100% healing results were observed in all burn wound cases within mean healing time for the duration of 8.15 (3-18) days time period. CONCLUSION: Newly formulated ointment containing 20% active antimicrobial honey is more effective and low-cost alternative preparation for the treatment of burn wound infections.

Impact of clinical skill lab on students' learning in preclinical years.

BACKGROUND: As 1st year students have no prior training in handling and facing patients, Clinical Skill Lab (CSL) is the most suitable place to avoid direct doctor/patient interaction. The objective of this study was to evaluate the performance of recently established CSL and its impact on student learning in basic science subjects. METHODOLOGY: This study was carried out at the Departments of Physiology and Medical Education, Foundation University Medical College Islamabad, from January to October 2012. In this observational study, 150 of 1st year students were divided into 5 batches. Each batch attended clinical skill lab once a week. Each batch was subdivided into 6 batches of 5 students each to be facilitated by one postgraduate trainee from clinical subjects. Overall supervision was done by a consultant of status of Assistant Professor qualified to teach Medicine, Surgery and/or Physiology. Sessions were conducted for 2 hours daily (6 days a week) in which after an initial briefing, students were taught the communication skills, clinical skills and art of history taking and physical examination. Clinical integration of various modules taught in 1st year, i.e., skin, muscle and skeletal system (SMS), upper limb and breast, immunity and haematology, respiratory and cardiovascular modules was done from January to October 2012. Methods of teaching involved large group interactive sessions, small group interactive sessions, self-directed learning, tutorials, revision on computer and recordings of sessions given to students on flashes. Multiple choice questions and observed structured clinical examination were the main assessment tools. Combined assessment of 2 consecutive modules was done at the end of 2nd module making a total of 3 assessments for 1st year. Absentees were included in failures in view of impact of end of modules examinations on overall final assessment. RESULTS: More than 73% students passed examination of clinical skills securing more than 50% marks in each module. Overall impact of CSL was also seen in the subjects of Anatomy and Physiology. Result of purely anatomy SMS and breast modules increased from 64% (year 2011 class) to 79% (year 2012 class). Result of purely Physiology modules (Immunity and Haematology) increased from 77% (year 2011 class) to 94% (year 2012 class). Similarly Respiratory and Cardiovascular modules result improved from 68% to 90.5%. CONCLUSION: The performance of CSL in imparting clinical skills, communication skills, history taking and physical examination was satisfactory. The experience of integrating clinical teaching with basic sciences not only improved students' clinical experience reflected by evaluation, but was also rewarding in improving the results of various modules related to anatomy and physiology.

'Honey ointment': a natural remedy of skin wound infections.

BACKGROUND: Honey is a gift of nature, principally identified and valued to possess antimicrobial and anti-inflammatory activity and has been used as a natural remedy of wounds since ancient times. The objectives of this study were to evaluate the antimicrobial activity of honey against micro-organisms, to formulate a honey ointment and to evaluate the efficacy of such ointment by conducting clinical trials on skin wound infection. METHODS: This experimental study was conducted at Department of Pharmaceutics, Faculty of Pharmacy, University of Karachi and Out-patient Department of Dermatology, Fauji Foundation Hospital, Rawalpindi from November 2009 to October 2010. The antimicrobial activity of Pakistani floral sources (Trachysperm copticum, Acacia nilotica species indica, Zizyphus) honey samples was investigated by disc diffusion method against freshly isolated wound infecting bacteria (Staphylococci aureus, Staphylococci epidermidis, Streptococcus faecalis, Pseudomonas aeruginosa, Klebsiella pneumonia, Escherichia coli, Proteus vulgaris and Candida albicans), and Staphylococci aureus ATCC 6538, Pseudomonas aeruginosa ATCC 9022, Escherichia coli ATCC 25922, Candida albican ATCC 15146. An ointment containing 20% active antimicrobial honey was formulated. The efficacy of such ointment was evaluated by passing thought clinical trials. A total number of 27 patients (23 skin wound infection, and 4 diabetic foot ulcer) were involved in the study. Thin layer of newly formulated honey ointment on gauze were applied two to three times per day till complete healing. RESULTS: In microbiological assay the honey samples were found to exhibit a very promising antimicrobial activity against all the micro-organisms tested. In clinical trial very significant results (99.15%) healing was observed in skin wound infections cases with mean healing time of 5.86 (2-20) days, and 95% diabetic foot ulcers healed with the mean healing time of 20 (8-40) days. CONCLUSION: Newly formulated ointment containing 20% active antimicrobial honey is very effective and alternative low-cost product for the treatment of wound infections.

Effects of combined interferon alpha and ribavirin therapy on thyroid functions in patients with chronic hepatitis C.

OBJECTIVE: To determine the frequency of thyroid dysfunction in patients of chronic hepatitis C during treatment with interferon alpha-2b and ribavirin therapy. STUDY DESIGN: A cohort study. PLACE AND DURATION OF STUDY: Army Medical College and Military Hospital, Rawalpindi, from February 2006 to January 2007. METHODOLOGY: One hundred and sixty seven non-cirrhotic chronic hepatitis C patients were grouped into treatment group (n=107) and control group (n=60) awaiting treatment. Baseline serum(s.) Alanine Transferase (ALT) and S. Aspartate Transferase (AST) were measured by IFCC method. Serum Thyroid Stimulating Hormone (S. TSH), serum free thyroxine (S. Free T4) and serum total triiodothyronine (S.T3) level were determined by chemiluminescence. Study group patients underwent 24 weeks IFN and ribavirin therapy and were followed-up for thyroid dysfunction at weeks 0, 12 and 24. Control group patients underwent the same tests at weeks 0, 12 and 24. Statistical analysis was done on SPSS 15. RESULTS: Out of 107 patients of treatment group, 20 patients (18.69%) developed thyroid dysfunction. Females were at higher risk with Relative Risk (RR) of 11.25 and Attributable Risk (AR) of 91%. Hypothyroidism was more common than hyperthyroidism. CONCLUSION: Interferon-alpha and ribavirin therapy induces thyroid dysfunction in chronic hepatitis C patients. Hypothyroidism was more common. Females are at a higher risk of developing thyroid dysfunction.