Does application of honey improve surgical outcome in pilonidal cyst excision with secondary intention healing? A prospective randomized placebo-controlled clinical trial

Background Pilonidal sinus disease (PSD) is a common chronic inflammatory debilitating illness caused by ingrowth of hair into the skin. Excision and healing by secondary intention is one of the acceptable managements. The post-operative wound care needs frequent and time-consuming follow-ups. Honey is considered to be a traditional remedy for wound healing. The current study aimed at finding if application of honey could improve surgical outcome in pilonidal cyst excision with secondary intention healing. Methods This study was designed as a randomized placebo-controlled parallel assignment interventional (clinical trial) study conducted at the surgical ward of Shahid Beheshti Hospital affiliated to the Yasuj University of Medical sciences, Yasuj, Iran, and was consisted of the 48 patients who underwent surgical resection for PSD with secondary intention healing (24 patients in intervention and placebo-controlled groups). The main element of honey medicinal gel was the unheated natural honey of Dena Biosphere Reserve within the Zagros Mountains. Patients' wounds were visited by a surgeon and a nurse on the days 7, 15, 30, 45, 60, and 90 post-operation. The surgical outcomes including the time to complete wound healing, pain intensity, odor, discharge at the site of surgery, use of analgesics, the time of to return to the daily activities, and occurring of any side effects including infection, erythema, and bleeding were all recorded. Results In intervention group, there was significantly lower wound healing time, the lower time to return to the daily activities, lower mean wound volume at the days of 30, 45, 60, and 90 of the follow-up, higher mean post-operative pain level at the days of 15, 30, 45, 60, and 90 of the follow-up, and more usage of analgesics at the days of 15, 30, 45, and 60 of the follow-up. There was no significant difference between intervention and placebo-controlled groups according to the foul smell and fluid discharge at the site of the operation. There were no side effects and complications in both groups of the study. Conclusions Application of honey after resection surgery with secondary wound healing is associated with a better surgical outcome and could eventually decrease healing time and reduce duration of return to normal activities, but could increase post-operation pain and analgesic consumption, and no effect on foul smell and discharge. Trial registration The project was found to be in accordance to the ethical principles and the national norms and standards for conducting research in Iran with the approval ID and date of IR.YUMS.REC.1399.088 and 2020.05.30 respectively, and is the result of a residency dissertation to get the specialty in general surgery, which has been registered with the research project number 960508 in the Vice Chancellor for Research and Technology Development of Yasuj University of Medical Sciences, Yasuj, Iran, URL: https://ethics.research.ac.ir/EthicsProposalViewEn.php?id=144742

Geochemical Characterization and Saturation Index (Si) in the Montebello Lagunar System Liquidamber Lagoon, Chiapas Mexico

The “Lagunas de Montebello” National Park located in Chiapas, Mexico, is well known for its crystal blue water bodies, some of which, in 2003, started to change color from crystalline to cloudy brown, and occasionally emit a foul smell, contains white-yellowish supernatant debris and dead fish. To determine the causes of the changes in the water characteristics of the “Liquidambar” lagoon of the Montebello lagoon system, a physicochemical characterization was carried out over the first six meters of the water column, together with geochemical speciation analysis and the saturation index calculation for different minerals. Water was classified as calcium-sulfated and the main mechanism that controlled its chemistry was rocks dissolution. Sulfide was found at all sampled depths in the range of 0.11 to 1.13 mg.L-1. The concentration of sulfate in the water column ranged from 249.21 to 298.7 mg.L-1, carbonate ranged from 140.5 to 261.4 mg.L-1, calcium and magnesium ranged from 94.5 to 146.9 mg.L-1 and 34.2 to 38.3 mg.L-1, respectively. Likewise, oxygen was also found to be oversaturated on the surface with a value of 9.32 mg.L-1. The speciation results and SI indicated that the mineral phases calcite, aragonite, and dolomite were oversaturated, being greater on the surface. The results suggested the possibility that the turbidity, the coloration change, and the whitish supernatant were due to the precipitation of carbonate minerals, microbiologically influenced by the photosynthetic activity in the upper layer of the lagoon water.

Formulation and Efficacy of Plaksha (Ficus lacor) Ointment in the Management of Non-Healing Ulcer

Chronic infected wound or non healing ulcer is commonly encountered problem faced in surgico-clinical cases. Wound healing property is most important pharmacological activity of Plaksh or Ficus lacor described by acharya Charaka and Bhavprakash, in an ancient compendia. A male patient aged 55 years, having non healing ulcer on right leg medially above the ankle joint due to trauma, reported to OPD. Wound was irregular with hyper keratinized edges, purulent discharge with foul smell, itching, redness and inflammation. Wound was cleaned with normal saline aseptically and ‘malhar’ or ointment which was prepared by using stem bark of Ficus lacor, was applied locally every day, for thirty days followed by alternate day for next fifteen days. ‘Malhar’ or ointment was prepared as per the formulation mentioned in ‘Ras tarangini’, an ancient compendia. Vitamin C, B complex and Zinc supplement was given orally. After forty five days, wound healed with healthy granulation tissue, purulent discharge and foul smell was totally absent .Bark contains phytochemicals like tannins, polyphenols caffiec acid. It possesses antioxident, anti-inflammatory, antibacterial, astringent activities. Caffeic acid have regulatory mechanism on glucose metabolism in diabetes.

Role of Sthanic Chikitsa in Stree Roga: An Ayurveda Review

Ayurveda put health of women on prime focus and gives detailed description on Stree Roga and their management through Ayurveda approaches. The common gynecological problems are Yonidaha, Yonikandu, Yoni paicchilya, Yoni strava, Yoni karkashata, Vamini and Upapluta yonivyapad, etc. The disturbed pattern of menstruation also causes many gynecological problems associated with female health. Ayurveda explains many ways for curing gynecological disorders especially Yoni Roga requiring local therapeutic measures, Sthanik Chikitsa is one of them which offers therapeutic relieves in various Stree Roga. Yoni-Pichu, Yoni Dhoopan, Yonidhawan, Yoni-Lepana, Uttarbasti, Yoni-Varti and Agnikarma, etc. are common approaches of Sthanik Chikitsa which are useful in many gynecological problems. These all approaches of Ayurveda help to maintain good health status of women and relives symptoms of white discharge, itching, burning micturation, foul smell and discharge, etc. These non-surgical and less invasive techniques offers health benefits to retain reproductive health of female and does not imparts severe side effects. Present article explains role of Sthanic Chikitsa in various Stree Roga.

Are the uplifted reef beds in North Andaman letting nesting Olive Ridley Sea Turtle Lepidochelys olivacea stranded?

During our survey to understand vegetation colonization, focused on mangroves, in the uplifted reef beds near the Radhanagar creek in North Andaman on 10 February 2021 (Lat: 13°24'40.70"N; Lon: 92°50'57.73"E), we came across four carcasses of Olive Ridley turtles within a 500 m transect. The carcasses were probably a week old and are characterized by the presence of degenerating flesh, and foul smell. The article describes the potential reasons behind turtle mortality and future research needs for the holistic understanding of such incidences.

A multicenter study on quality of life of the “greater patient” in congenital ichthyoses

Background Autosomal recessive congenital ichthyoses (ARCI) are a genetically heterogeneous group of rare and chronic disorders characterized by generalized skin scaling and hyperkeratosis, erythroderma, and palmoplantar keratoderma. Additional features include ectropion, eclabium, ear deformities, foul-smell, joints contractures and walking problems, recurrent infections, as well as pruritus and pain. No curative therapy is available and disease care mainly relies on daily application of topical emollients and keratolytics to the whole-body surface. Altogether, disease signs and symptoms and treatment modalities have a major impact on quality of life of patients and their caregivers. However, very few studies have evaluated the family disease burden in ARCI. Methods We have performed an Italian multicenter cross-sectional study to assess the secondary disease impact on family members of pediatric and adult patients with ARCI, using a validated dermatology-specific questionnaire, the family dermatology life quality index (FDLQI). Disease severity was assessed by the dermatologist in each center. Results Seventy-eight out of 82 patients who were accompanied by at least one family member filled the FDLQI. Forty-eight (61.5%) patients were aged less than 18 years. The mean FDLQI score was 10.3 (median 10), and the most affected dimensions were (1) time needed for care, (2) extra-housework, and (3) household expenditure. Higher total FDLQI score significantly correlated with more severe disease score (P = 0.003). Features associated with greater family burden included recurrent infections (P = 0.004), foul-smell (P = 0.009), palmoplantar keratoderma (P = 0.041), but also presence of scales on the face (P = 0.039) and ear deformities (P = 0.016). Conclusions Our findings highlight the major socio-economic and psychological burden imposed by ARCI on the QoL of family caregivers. In addition, they show that global evaluation of disease impact also on family members is an essential part of patient-reported outcomes. Finally, our data underline the need to develop specific measures for family support.

A Clinical Study on Sleshmala Yonivyapad through Anubhoota Yoga the ‘Patrangadi Yoga’

Sleshmala yonivyapad is one of the most common and burning problem faced by the women all around the globe. The symptoms are vaginal white discharge, itching, foul smell mild pain in vagina. On the bases of chief complaints and review of the disease the shlesmala yonivyapat is compared with Trichomonas vaginalis. There are many treatments prescribed for this problem but they are not free from side effects and with reoccurrence. Hence selection of an appropriate treatment is very essential. Study design: In the present study, 30 patients fulfilling criteria of sleshmala yonivyapat were selected under single group. Patients were given Patrangadi churna 4gms thrice a day with ushnodaka internally after food for 7 days and Yoniprakshalana with Patrangadi kashaya for 7days. This study was carried out for 21 days. The signs and symptoms were observed before and after treatment and were compared. Subjective parameters: Picchila shweta srava, Dourgandya, Kandu and Alpavedana. Objective parameters: Profuse thick creamy discharge, Red and swollen vulva with evidence of pruritis like scratch marks and wet mount showing Trichomonas vaginalis positive. Result: In the present study total 11 subjects showed complete relief, 17 subjects showed moderate relief and 2 subjects showed partial relief after treatment. And 11 subjects showed complete relief, 7 subjects showed moderate relief, 7 subjects showed partial relief and 5 subjects showed no relief after follow up. The total effect of therapy provided statistically highly significant result (p<0.001) in both subjective and objective parameters. Paired ‘t’ test is applied. Thus the study showed the effectiveness of Patrangadi churna internally as well as Patrangadi kashaya yoniprakshalana in alleviating symptoms of sleshmala yonivyapad. Key words: Sleshmala yonivyapad, Patrangadi yoga, Trichomonas vaginalis.

Sewing machine spool in cervical canal: Case report

Background: Intentional placement or forgotten foreign bodies in the lower female genital tract have been reported. Patients may selfreport or may present with an array of symptoms including pelvic pain, vaginal discharge and vaginal bleeding. Case: Ms X, 23 years old, presented to antenatal clinic at two months pregnancy with complaints of excessive discharge per vaginum. There was no bleeding or foul smell. She did not reveal any other significant history. On internal examination, uterus was 8 weeks size, and a nodular lesion was felt in the cervical canal. Transvaginal USG confirmed intra-uterine pregnancy but also aroused the suspicion of a foreign body in the cervix. At examination in the operation theatre, the spool of sewing machine was found imbedded in cervical canal. It was gently dislodged and removed. Procedure and post-operative period were uneventful. The history was then reviewed. It came to light that the spool had been inserted in the cervical canal to expedite conception, without her knowledge when the patient was examined by an untrained birth attendant. Conclusion: Fear of infertility drives women to seek treatment from any source, as illustrated in this report. The spool inserted into the cervix was possibly to function as a “conduit” for the sperms Keywords: foreign body; cervix; pregnancy; discharge.

Synthetic Analogue of Butenolide as an Antifouling Agent

Butenolide derivatives have the potential to be effective and environmentally friendly antifouling agents. In the present study, a butenolide derivative was structurally modified into Boc-butenolide to increase its melting point and remove its foul smell. The structurally modified Boc-butenolide demonstrated similar antifouling capabilities to butenolide in larval settlement bioassays but with significantly lower toxicity at high concentrations. Release-rate measurements demonstrated that the antifouling compound Boc-butenolide could be released from polycaprolactone-polyurethane (PCL-PU)-based coatings to inhibit the attachment of foulers. The coating matrix was easily degraded in the marine environment. The performance of the Boc-butenolide antifouling coatings was further examined through a marine field test. The coverage of biofouler on the Boc-butenolide coatings was low after 2 months, indicating the antifouling potential of Boc-butenolide.

CLINICAL STUDY ON SHIREESHADI AVAPEEDANA NASYA IN THE MANAGEMENT OF SURYAVARTHA (FRONTAL SINUSITIS)

Nasya karma is considered a prime treatment modality in all types of Shiroroga (Headache) and also in Suryavar- tha (Frontal Sinusitis). Suryavartha (Frontal Sinusitis) is one of the 11 types of Shiroroga. It is one of the com- mon clinical conditions found in day to day general as well as Shalakya (ENT) practice. It presents with headache as one of its cardinal features and its occurrence is found in both genders and in all age groups. Objective: To study the efficacy of Shireeshadi Avapeedana Nasya in the management of Suryavartha (Frontal Sinusitis). Ma- terial methods: Twenty patients of Suryavartha (Frontal Sinusitis) were diagnosed and registered for the clinical study irrespective of sex, socio-economic status, and religion. The study was divided into two groups - Group A and Group B. Group – A patients were treated with Shireeshadi Avapeedana Nasya for 7 days and Group – B patients were treated by Nasya with milk for 7 days. Observation and result: Among 20 patients of Suryavartha / frontal sinusitis, 20 (100%) of patients had headache, 11 (55%) had nasal blockage, 05 (25%) had nasal dis- charge, 08 (40%) had foul smell in their breath and 14 (70%) have variations from normal X-Ray. The severity of headache is significantly reduced after treatment in both Groups A and B (92.95% and 73.07%) respectively. Conclusion: Administration of Shireeshadi Avapeeda Nasya showed statistically significant improvement in the management of Suryavartha (Frontal Sinusitis). Keywords: Suryavartha, Nasya, Shireeshadi Avapeedana Nasya, Frontal Sinusitis, Shigru, Mulaka, Ksheera.