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Medicine Apr 2024Epistaxis is one of the common emergencies in otolaryngology. There are many causes of epistaxis, but reports of epistaxis due to nasal foreign bodies like leeches are...
RATIONALE
Epistaxis is one of the common emergencies in otolaryngology. There are many causes of epistaxis, but reports of epistaxis due to nasal foreign bodies like leeches are rare.
PATIENT CONCERNS
A 55-year-old male presented with "repeated epistaxis for over 20 days." Nasal endoscopy revealed a live leech in the olfactory area of the left nostril.
DIAGNOSES
The patient was diagnosed with epistaxis caused by a live leech in the nasal cavity.
INTERVENTIONS
Under nasal endoscopy, the leech was grasped with a vascular clamp and removed from the nasal cavity. The leech measured 8 cm in length. Hemostasis was achieved using a gelatin sponge at the wound site, and the nasal cavity was packed with Vaseline gauze.
OUTCOMES
The live leech was removed via nasal endoscopy. Two days later, the Vaseline gauze packing was removed, and the patient experienced no further nasal bleeding.
CONCLUSION
Live leeches in the nasal cavity can cause epistaxis. Nasal endoscopic removal of the live leech is an effective treatment.
LESSON
There are many causes of epistaxis, which are nonspecific and prone to missed or incorrect diagnosis. In patients with a history of fieldwork or direct contact with leeches who present with recurrent nasal bleeding, the possibility of epistaxis caused by a live leech should be considered, and timely and effective treatment should be provided.
Topics: Animals; Humans; Male; Middle Aged; Endoscopy; Epistaxis; Leeches; Nasal Cavity; Nose; Petrolatum
PubMed: 38579026
DOI: 10.1097/MD.0000000000037720 -
Gels (Basel, Switzerland) Nov 2023The purpose of this work was to develop a novel topical formulation of econazole nitrate based on gel that can be easily scaled up in one pot for the potential treatment...
The purpose of this work was to develop a novel topical formulation of econazole nitrate based on gel that can be easily scaled up in one pot for the potential treatment of fungal and yeast infections. Econazole nitrate, a topical antifungal, is used to treat tinea versicolor, tinea pedis, and tinea cruris. Compared to applying cream or ointment, topical gels offer numerous advantages, one of which is that the drug is released more quickly to the intended site of action. A viscous mixture of propylene glycol, Capmul MCM C8, methyl and propyl paraben, and econazole nitrate were mixed together before being formulated into the optimized Carbopol gel bases. The gel's color, appearance, and homogeneity were assessed visually. For every formulation, the drug content, pH, viscosity, spreadability, and gel strength were characterized. The cup plate diffusion method was used to evaluate the anti-fungal activity of the prepared formulations. To assess the behavior of the developed system, studies on in vitro release and mechanism were conducted. The manufactured formulations were transparent, pale yellow, and exhibited excellent homogeneity. The pH of each formulation was roughly 6.0, making them suitable for topical use. The concentration of Carbopol 940 resulted in a significant increase in viscosity and gel strength but a significant decrease in spreadability. It was demonstrated that the prepared formulations inhibited the growth of and . In contrast, the standard blank gel showed no signs of antifungal action. By increasing the concentration of Carbopol 940, the in vitro release profile of econazole nitrate significantly decreased. Following the Korsmeyer-Peppas model fitting, all formulations exhibited n values greater than 0.5 and less than 1, indicating that diffusion and gel swelling control econazole nitrate release.
PubMed: 38131915
DOI: 10.3390/gels9120929 -
Scientific Reports Dec 2023It is uncertain whether hydrocolloid dressings, a more costly intervention than offering standard care with petrolatum, is superior to prevent pressure ulcers among... (Randomized Controlled Trial)
Randomized Controlled Trial
It is uncertain whether hydrocolloid dressings, a more costly intervention than offering standard care with petrolatum, is superior to prevent pressure ulcers among hospitalized high-risk adults. Randomized, parallel-group, open-label, superiority trial with an active control group, blinded for investigators, event validators, and analysts (December 1, 2015 to December 12, 2017). Eligible patients were ≥ 18 years of age with intact skin judged as high-risk for skin ulcers (Braden scale), admitted to surgical or medical wards of two tertiary-level hospitals. Participants were randomized (1:1) to protection with hydrocolloid dressings or petrolatum. The primary outcome was the first occurrence of pressure ulcers (with post-injury photographs adjudicated by three judges) under intention-to-treat analysis. Based on prior cost analysis, and the available resources (assumed incidence of 6 ulcers/1000 patient-days in controls), inclusion of up to 1500 participants allowed to surpass a one-sided superiority threshold > 5% based on a target efficacy > 40% for dressings. We planned an economic analysis using a decision tree model based on the effectiveness of the study results from a perspective of the third payer of health care. After inclusion of 689 patients (69 events), the trial was stopped for futility after a planned interim analysis (conditional power < 0.1 for all scenarios if the trial was completed). Pressure ulcers had occurred in 34 (10.2%) patients in the intervention group [9.6 per 1000 patient-days] and 35 (9.9%) participants in the control group [7.9 per 1000 patient-days], HR = 1.07 [95% CI 0.67 to 1.71]. The estimated incremental cost for dressings (a dominated strategy) was USD 52.11 per patient. Using hydrocolloid dressings was found similar to petrolatum for preventing pressure ulcers among hospitalized high-risk patients. As it conveys additional costs, and in this study was unlikely to demonstrate enough superiority, this strategy did not overcome conventional skin care.Trial registration: ClinicalTrials.gov identifier (NCT number): NCT02565745 registered on December 1, 2015.
Topics: Adult; Humans; Bandages, Hydrocolloid; Pressure Ulcer; Patients; Petrolatum
PubMed: 38062132
DOI: 10.1038/s41598-023-47483-0 -
Cirugia Y Cirujanos 2023To compare the protective effect of nitroglycerin ointment 2% and Dimethylsulfoxide (DMSO) in dorsal flaps of the rat.
OBJECTIVE
To compare the protective effect of nitroglycerin ointment 2% and Dimethylsulfoxide (DMSO) in dorsal flaps of the rat.
METHODS
A blind, experimental study was conducted in 24 male Wistar rats, with a mean weight of 320 (286-376) grams. Group 1: Control. Petrolatum jelly (Vaseline), n = 8, Group 2: Nitroglycerin (NTG) ointment 2% (Nitro-Bid, Altana Co.) n = 8, and Group 3: DMSO gel 90% (Neogen corp. Lexington KY, 40611), n = 8.
RESULTS
A total of 24 rats were operated on in the 6-month period of this study. Using a non-parametric Mann-Whitney U-test analysis, a statistically significant p was obtained between the control group and 2% NTG ointment, both in the area of necrosis and in the healthy area (p = 0.026). In contrast, the comparison between DMSO [CH3) 2SO] and the control group (p = 0.180) and between both study groups, with a p = 0.18, was not significant.
CONCLUSIONS
Our study concluded that there is a protective effect of 2% NTG ointment for flap survival in relation to the control group (petrolatum). DMSO administered topically did not show a protective effect, compared to the control group.
Topics: Rats; Male; Animals; Nitroglycerin; Dimethyl Sulfoxide; Ointments; Rats, Wistar; Necrosis; Petrolatum
PubMed: 37844881
DOI: 10.24875/CIRU.22000203 -
Journal of Cutaneous Medicine and... 2023Alopecia areata (AA) is a T-cell driven autoimmune disease, which results in hair loss. This study aims to determine the efficacy, tolerability and safety of different...
BACKGROUND/OBJECTIVES
Alopecia areata (AA) is a T-cell driven autoimmune disease, which results in hair loss. This study aims to determine the efficacy, tolerability and safety of different concentrations of anthralin in the treatment of pediatric AA.
METHODS
A retrospective cohort study of patients < 18 yo diagnosed with AA treated with anthralin at SickKids Hospital, Toronto dermatology outpatient clinic in 2016 - 2018. Anthralin used at 0.1%, 0.2%, 0.5% and 1% in petrolatum at short contact, at increments of 15 minutes every week until a 1 hr maximum contact achieved. No other treatment was used in conjunction. Severity of Alopecia Tool (SALT) scores (SS) were determined using photographs and descriptions to assess severity of alopecia at baseline and post anthralin treatment.
RESULTS
A total of 11 charts were reviewed in this retrospective cohort. Hair loss pattern; 3 patients with patchy, 6 had mixed (patchy and ophiasis), and 2 were totalis. All except for 1 patient had failed traditional treatments. One patient had complete hair regrowth, 3 showed more than 85% hair re-growth and 7 patients showed more than 75% hair regrowth, the average time for this to occur was 6.5 months. None of the patients experience serious side effects.
CONCLUSIONS
Our study demonstrated the efficacy and tolerability of topical anthralin 0.1% to 1% in pediatric alopecia areata. In our study, anthralin 0.2% appears to offer the best performance and tolerability profile among the different concentrations used, with treatment course of at least 6 months in order to achieve more than 75% hair regrowth.
Topics: Humans; Child; Anthralin; Alopecia Areata; Retrospective Studies; Dermatologic Agents; Petrolatum; Administration, Topical; Alopecia
PubMed: 37559401
DOI: 10.1177/12034754231191060 -
Immunity, Inflammation and Disease Jun 2023In this study, we investigated the impact of Zibai ointment on wound healing by analyzing the expression levels of two key apoptosis-related factors-B-cell lymphoma 2... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
In this study, we investigated the impact of Zibai ointment on wound healing by analyzing the expression levels of two key apoptosis-related factors-B-cell lymphoma 2 (Bcl-2) and Bcl-2-associated X protein (Bax), in patients following surgery for anal fistula.
METHODS
We included 90 patients with anal fistulas who were treated in the People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine. Patients were randomly assigned to receive treatment with Zibai ointment (n = 45) or petroleum jelly (n = 45). The levels of apoptosis-related factors Bcl-2 and Bax were evaluated using enzyme-linked immunosorbent assay (ELISA), while cell apoptosis was assessed using Terminal deoxynucleotidyl transferase (TdT) dUTP Nick-End Labeling (TUNEL) assay.
RESULTS
The results of ELISA showed that on Day 21 after the surgery, the levels of Bcl-2 and Bax in the Zibai ointment group were significantly different compared to the petroleum jelly group, with values of (60.11 ± 1.31) ng/mL and (7.05 ± 0.01) versus (83.79 ± 1.74) ng/mL and (6.00 ± 0.05) ng/mL, respectively (p < .05). Furthermore, light microscopy revealed a large number of apoptotic cells within the field of vision 14 days postsurgery in the Zibai ointment group, and the healing time in the Zibai ointment group was significantly different from that in the petroleum jelly group (p < .05).
CONCLUSION
We found that Zibai ointment effectively promoted wound healing in patients following anal fistula surgery, possibly by regulating Bcl-2 and Bax apoptosis-related factors.
Topics: Humans; Apoptosis; bcl-2-Associated X Protein; Ointments; Petrolatum; Wound Healing; Rectal Fistula; Drugs, Chinese Herbal
PubMed: 37382254
DOI: 10.1002/iid3.912 -
Yakugaku Zasshi : Journal of the... 2023To accelerate therapeutic effects, the mixtures of two or more topical pharmaceutical products having different medicinal purposes are often applied in the medical...
To accelerate therapeutic effects, the mixtures of two or more topical pharmaceutical products having different medicinal purposes are often applied in the medical field. In this study, we aimed to develop a simple mixing method/procedure to achieve excellent homogeneity in the mixture of two topical products, a steroidal ointment and a skin moisturizer. To assess an in-tube mixing method as a simple mixing procedure, we injected both topical products into an empty resin tube, a flexible hollow tube with an open end that can be closed on one side, and a closed end on the other, removed as less air as possible inside the tube, and then thermocompressed (sealed) the open end to close it. The two topical products were then mixed uniformly by repeated finger pressure along the longitudinal axis of the tube. The homogeneity of the two topical products in the tube was evaluated by measuring the content of methyl paraoxybenzoate (MP), an additive loaded in the skin moisturizer. In addition, the mixability was qualitatively evaluated from the distribution of white petrolatum, another additive loaded in the steroid ointment, using Raman spectroscopy. As a result, the measured value of MP relative to the label claim was in the range of 100±12%, and the coefficients of variation value was also less than 12%. These results indicate that the in-tube mixing method using two topical products is approximately hologenetic preparations that do not cause therapeutic problems.
Topics: Ointments; Skin; Drug Compounding; Petrolatum
PubMed: 37258186
DOI: 10.1248/yakushi.22-00224 -
BMC Pediatrics May 2023The skin is a major route of infection in the neonatal period, especially in low birthweight (LBW) infants. Appropriate and safe neonatal skin care practices are...
BACKGROUND
The skin is a major route of infection in the neonatal period, especially in low birthweight (LBW) infants. Appropriate and safe neonatal skin care practices are required to reduce this risk. The perceptions and beliefs of mothers and other caregivers towards various neonatal skin care practices in our setting have been documented. Data from Asia suggests that the application of emollient to the skin of LBW infants can promote growth, reduce serious neonatal infections, and potentially reduce mortality. This is the first study to explore the acceptability of emollients and massage as part of neonatal skin care in a low-resource setting in sub-Saharan Africa (SSA) that is representative of the majority of government health facilities in Uganda and many in SSA.
OBJECTIVE
To explore perceptions, beliefs, and current practices regarding neonatal skin care and emollient use in eastern Uganda.
METHODS
We conducted a qualitative study consisting of three focus group discussions (30 participants), eight in-depth interviews with mothers/caregivers of preterm and term neonates and 12 key informant interviews with midwives, doctors and community health workers involved in neonatal care, to explore the perceptions and practices surrounding neonatal skin care and emollient use. Data collected were transcribed and analyzed using thematic content analysis.
RESULTS
Mothers perceived that skin care began in utero. Skincare practices depended on the place of delivery; for deliveries in a health facility the skincare practices were mainly based on the health worker's advice. Vernix caseosa was often washed off due to its perceived undesirability and was attributed to sexual intercourse in the last trimester. Despite their deleterious attributes found in previous studies, petrolatum-based oils, petrolatum-based jellies and talcum baby powders were the most commonly reported items used in neonatal skin care. In our population, there was high acceptability of emollient therapy use; however, neonatal massage was treated with scepticism as mothers feared damaging the vulnerable neonate. Mothers suggested massage and emollient application be undertaken by health workers, if it becomes an intervention.
CONCLUSIONS
In eastern Uganda, the perceptions and beliefs of mothers/caregivers toward neonatal skincare influenced their practices of which some could potentially be beneficial, and others harmful. Emollient use would be easily accepted if adequate sensitisation is conducted and using the gatekeepers such as health workers.
Topics: Infant, Newborn; Infant; Female; Humans; Emollients; Uganda; Skin; Skin Care; Qualitative Research; Petrolatum
PubMed: 37147698
DOI: 10.1186/s12887-023-04040-y -
Biological & Pharmaceutical Bulletin 2023Wound-healing deficits of the skin, one of the most common complications in patients with diabetes, delay wound healing, significantly reducing the patient's QOL....
Wound-healing deficits of the skin, one of the most common complications in patients with diabetes, delay wound healing, significantly reducing the patient's QOL. Therefore, the topical treatment of wound areas with drug-containing ointments and dressings is important. In this study, we investigated the effect of various ointment bases on skin wound healing in normal and streptozotocin-induced diabetic rats (STZ rats). Three ointment bases were used: white ointment (oil-based), absorbent cream (emulsion-based, w/o), and macrogol ointment (water-based). Skin wound healing in STZ rats was delayed compared with that in normal rats. Each of the three ointment bases was applied to the skin wound area in normal rats, and there was no difference in the therapeutic effect. The therapeutic effect of both white ointment and absorbent cream was higher in the STZ rats group than that in the non-treated group, and delayed wound healing was observed in STZ rats treated with macrogol ointment. In conclusion, skin wound healing in STZ rats is affected by the properties of the ointment base, and it is important to use an ointment base that controls the drying of the wound area in STZ rats. These findings provide information for the selection of ointment bases useful for application to skin wounds in patients with diabetes.
Topics: Rats; Animals; Ointment Bases; Ointments; Streptozocin; Diabetes Mellitus, Experimental; Quality of Life; Skin; Polyethylene Glycols
PubMed: 37121696
DOI: 10.1248/bpb.b22-00871 -
Cureus Mar 2023Background is a pure and clean animal fat derived from milk and is often recognized as clarified butter. It is used in Ayurvedic medicine as an excellent base for...
Background is a pure and clean animal fat derived from milk and is often recognized as clarified butter. It is used in Ayurvedic medicine as an excellent base for preparing various formulations due to its ability to penetrate deep tissue and be easily absorbed. Cow ghee possesses antioxidant, antibacterial, anti-inflammatory, and antiseptic properties, making it beneficial for treating skin-associated problems. When applied externally, ointment bases are semisolid preparations for use on the skin or mucous membranes. They are classified into four categories: Hydrocarbon, Absorption, Water-removable, and Water-soluble. In this study, ointment bases were formulated and evaluated using cow ghee and selected conventional ones. Materials and Methods Ointment bases like Cetostearyl alcohol, stearic acid, glyceryl monostearate, soft white paraffin, soft yellow paraffin, paraffin wax, white beeswax, and wool fat were obtained from SD fine chem manufacturer Ltd., Mumbai. Cow ghee was obtained from the Go Vigyan, Anusandhan Kendra, Nagpur. The ointment bases were prepared using pharmacopeia procedures. Cow ghee was used as a base in the preparation of ointment bases with different concentrations than conventional bases. Stability testing was performed per International Conference on Harmonization(ICH) guidelines and various physicochemical parameters like color, appearance, odor, consistency, pH, Spreadability Extrudability, loss on drying, solubility, and washability. Results The ointment bases formulated using cow ghee in combination with selected conventional ointment bases were found to be stable. They exhibited desirable characteristics like non-greasy, attractive appearance, and suitability for various medications and supporting substances. The cow ghee-based ointment bases also showed good spreadability, extrudability, and solubility, indicating their effectiveness as carriers for active components. Conclusion The study demonstrates the potential of cow ghee as a natural ointment base for the preparation of various Ayurvedic formulations. The ointment bases formulated using cow ghee in combination with conventional ointment bases were stable and exhibited desirable physicochemical properties. Thus, using cow ghee as an ointment base can provide a cost-effective and easily accessible alternative for therapeutic use or as a carrier of active components.
PubMed: 37095810
DOI: 10.7759/cureus.36556