Govt. Siddha Medical College, Palayamkottai, Tamilnadu. ‘’Padukkai pun podi’’- a Promising Herbal topical drug for treating Decubitus ulcers S. Merish M. Tamizhamuthu Thomas M. Walter R. Sweety Nirmala Govt. Siddha Medical College, Palayamkottai, Tamilnadu. NCHMM -2014 Salem

BACKGROUND BACKGROUND Siddha Medicine is effective in combating chronic diseases A Decubitus ulcer, also called a pressure sore or bed sore, is an open wound on the skin. Pressure sores often occur on the skin covering bony areas. The common places include hips, back, ankles, and buttocks. Immobile patients having bedsores carry a high risk of morbidity and even mortality. BACKGROUND

Global incidence BACKGROUND A considerable number of nearly 1300 new cases of Decubitus ulcers are occurring on a daily basis globally. It also affects developed countries like US with death rates amounting up to 34,320 annually. While going through the classic Siddha literatures, the authors of this paper found out a very promising remedy Padukkai Pun Podi (PPP) and decided to carryout Anti-microbial sensitivity testing to prove its efficacy in treating decubitus ulcers. BACKGROUND

Herbs & Anti-microbials The plant kingdom harbors an inexhaustible source of active ingredients. Infectious diseases are the leading cause of death world-wide. Various studies have identified many compounds from herbal plants that are effective antibiotics. Many infectious diseases have been, known to be treated with herbal remedies throughout the history of mankind.

Herbs & Anti-microbials The herbal remedies of traditional healing systems, around the world, can be utilized as an important source for the discovery of new antibiotics (Okpekon et al., 2004); Some traditional remedies have already produced compounds that are effective against clinically important strains of bacteria (Kone et al, 2004).

PRESSURE ULCER BACKGROUND Pressure Ulcers are localized They tend to occur when soft tissue is compressed between a bony prominence and an external surface for a prolonged period. 2-6 times greater mortality risk 95% of pressure ulcers develop on the lower body (about 65% in the pelvic area and 30% in the lower extremities) PRESSURE ULCER BACKGROUND

AETIOLOGY BACKGROUND Immobility, Inactivity, Poor nutrition, Decreased level of consciousness, Low body weight, Fecal or Urinary incontinence, Smoking, etc. BACKGROUND

CLINICAL PICTURE BACKGROUND Foul odor from ulcer Redness/tenderness around ulcer Warm/swollen skin Fever, weakness, and confusion if infection spreads to blood or other areas of body.

4 STAGES OF PRESSURE ULCER Reddened area of skin 2. Blister/Open Sore 3. Crater (bowl shaped depression on surface) 4. Damage to muscle or bone

WHO’S AT RISK? BACKGROUND Bed ridden/wheel chair bound Fragile skin/Older age Chronic disease that prevents blood flow Spinal Cord Injury/Brain Injury/MS Alzheimer’s Disease

COMPLICATIONS BACKGROUND Cellulitis Bone and joint infections Sepsis Cancer

MEDICINES FOR PADUKKAI PUN IN SIDDHA BACKGROUND Some Other Int & Ext Medicines For Padukkai Pun In Siddha. Kukkil vennai – internal medicine Sivappu ennai – external application Pungu Nei - external Kukkil thylam – external application Arugan thylam – oil of Cyanodon dactylon – external.

BACKGROUND MATERIALS AND METHODS The reference for the prepration Padukai Pun Podi (P.P.P) was taken from Gunapadam Mooligai Vaguppu by Dr. Murugesa Muthaliyar. This powder is indicated for topical application PPP was prepared as per an SOP (Standard Operative Procedure).

RESULTS BACKGROUND Disc diffusion method was followed with Mueller Hinton Agar as the culture media. The organisms tested were Pseudomonas auroginosa, Staphylococcus aureus, Streptococcus mutans, Klebsiella pneumonia, E.coli.

RESULTS BACKGROUND Organism: Streptococcus mutans Sample Concentration Zone of inhibition (cm) Gentamycin 3.6 MORUS 100 25 Nil 500 50 1000 1.2

RESULTS BACKGROUND Organism: E coli Sample Concentration (μg) Zone of inhibition (cm) Gentamycin 3.5 MORUS 100 25 Nil 500 50 1000 1.1

DISCUSSION BACKGROUND The increasing prevalence, risk factors, mechanisms, clinical presentation of Decubitus ulcer (Padukkai Pun in Siddha) are being discussed. The Siddha medicines that are in use for treating pressure ulcers are tabulated. Anti-microbial sensitivity testing of PPP (Padukkai Pun Podi) and its inhibition against Streptococcus mutans, E. Coli are documented. The results add strength to the fact that Siddha Medicines are effective in managing chronic diseases.

Prevention and Management Bedsores are easier to prevent than to treat, but that doesn't mean the process is easy or uncomplicated. Although wounds can develop in spite of the most scrupulous care, it's possible to prevent them in many cases. Position changes Changing position frequently and consistently is crucial to preventing bedsores. Experts advise shifting position about every 15 minutes that you're in a wheelchair and at least once every two hours, even during the night, if you spend most of your time in bed. BACKGROUND

Prevention and Management BACKGROUND Skin inspection Daily skin inspections for pressure sores are an integral part of prevention. Nutrition A healthy diet is important in preventing skin breakdown and in aiding wound healing Lifestyle changes -Quitting smoking, - Exercise - Daily exercise improves circulation

CONCLUSION. BACKGROUND From the above studies, it is concluded that the trial drug Padukkai Pun Podi (PPP) is effective in combating pressure ulcers. This claim is further made evident through its anti-bacterial sensitivity against Streptococcus mutans, E. Coli .

ACKNOWLEDGEMENTS My sincere Acknowledge to Bethesda Siddha Research Center Chief and my Team members. Thanks to Biogenix Research center, Trivandrum