A Promising Herbal topical formulation ‘PPP’ for treating Bedsores.

Abstract

The active role of siddha medicine in combating chronic diseases is being widely recognized nowadays. In that way, immobile patients who have bedsores carry a high incidence of morbidity and even mortality. 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 most common places for a pressure sore to appear include hips, back, ankles, and buttocks. A considerable number of nearly 1300 new cases of decubitus ulcers are occurring on a daily basis globally. This has resulted in deaths amounting up to 34,320 during 2000-2002 in US alone. While going through the classic Siddha literatures, the authors of this paper found out a very promising remedy PPP and decided to carryout Anti-microbial sensitivity testing to prove its efficacy in treating decubitus ulcers. 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, The test results show that the drug PPP is sensitive against Streptococcus mutans and E.coli. The clinical significance of the Anti-microbial study results are discussed in detail.

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www.siddhapapers.org Siddha Papers 2015 (1)(1)
ISSN 0974-2522 Research Article
Siddha Papers 2015 (1)(1)
A Promising Herbal topical formulation ‘PPP’ for treating Bedsores
Thomas M. Walter, R. Sweety Nirmala, S. Merish3, M. Tamizhamuthu4
1*Lecturer, Pharmacology department, Govt. Siddha Medical College, Palayamkottai, Tamilnadu.
thomaswalter@doctor.com
2 CEO, Bethesda Siddha Research Center, Tirunelveli, Tamilnadu. bethesdacam@gmail.com
3,4 Final Professional BSMS Students, Govt. Siddha Medical College, Palayamkottai, Tamilnadu.
*For correspondence: dr.thomaswalter@gmail.com
ABSTRACT
The active role of siddha medicine in combating chronic diseases is being widely
recognized nowadays. In that way, immobile patients who have bedsores carry a high incidence
of morbidity and even mortality. 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 most
common places for a pressure sore to appear include hips, back, ankles, and buttocks. A
considerable number of nearly 1300 new cases of decubitus ulcers are occurring on a daily basis
globally. This has resulted in deaths amounting up to 34,320 during 2000-2002 in US alone.
While going through the classic Siddha literatures, the authors of this paper found out a very
promising remedy PPP and decided to carryout Anti-microbial sensitivity testing to prove its
efficacy in treating decubitus ulcers. 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, The test results show that the drug
PPP is sensitive against Streptococcus mutans and E.coli. The clinical significance of the Anti-
microbial study results are discussed in detail.
Keywords: Decubitus ulcer, Bedsore, Pressure ulcer, Herbal dusting powder.

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1. INTRODUCTION
The plant kingdom harbors an inexhaustible source of active ingredients invaluable in the
treatment of many intractable challenging and chronic diseases. Infectious diseases are the
leading cause of death world-wide. Various studies have identified compounds from herbal
plants that are effective antibiotics (Basile et al., 2000)[1]. Many infectious diseases have been
known to be treated with herbal remedies throughout the history of mankind. 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)[8]. Here the Authors comes across the drug called ‘’PPP’’,which is clinically
effective for the Decubitus ulcer[2].
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 most common places for a
pressure sore to appear include hips, back, ankles, and buttocks. National Pressure Ulcer
Advisory Panel defines a pressure ulcer as an area of unrelieved pressure over a defined area,
usually over a bony prominence, resulting in ischemia, cell death, and tissue necrosis.
The World Health Organization (WHO) uses the incidence and prevalence of pressure
ulcers as an indicator of the quality of patient care services and the use of efficient prevention
measures and its treatments has become very important[4].
1.1. Aetiology
Pressure ulcers are caused by unrelieved pressure, applied with great force over a short
period (or with less force over a longer period), that disrupts blood supply to the capillary
network, impeding blood flow and depriving tissues of oxygen and nutrients. This external
pressure must be greater than arterial capillary pressure to lead to inflow impairment and
resultant local ischemia and tissue damage[5].

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1.2.Pressure Ulcer Stages defined by NPUAP-EPUAP
1.2.1. Stage I: Non-blanchable erythema
Intact skin with non-blanchable redness of a localized area usually over a bony
prominence. Darkly pigmented skin may not have visible blanching; its color may differ from
the surrounding area. The area may be painful, firm, soft, warmer or cooler as compared to
adjacent tissue. Category I may be difficult to detect in individuals with dark skin tones. May
indicate “at risk” persons.
1.2.2. Stage II: Partial thickness
Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound
bed,without slough. May also present as an intact or open/ruptured serum-filled or sero-
sanginous filled blister. Presents as a shiny or dry shallow ulcer without slough or bruising. This
category should not be used to describe skin tears, tape burns, incontinence associated dermatitis,
maceration or excoriation. Bruising indicates deep tissue injury.
1.2.3. Stage III: Full thickness skin loss
Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may
be present but does not obscure the depth of tissue loss. May include undermining and tunneling.
The depth of a Category/Stage III pressure ulcer varies by anatomical location. The bridge of the
nose, ear, occipital and malleolus do not have (adipose) subcutaneous tissue and Stage III ulcers
can be shallow. In contrast, areas of significant adiposity can develop extremely deep Stage III
pressure ulcers. Bone/tendon is not visible or directly palpable.
1.2.4. Stage IV: Full thickness tissue loss
Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be
present. Often includes undermining and tunneling. The depth of a Category/Stage IV pressure
ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not
have (adipose) subcutaneous tissue and these ulcers can be shallow. Category/Stage IV ulcers
can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making
osteomyelitis or osteitis likely to occur. Exposed bone/muscle is visible or directly palpable.

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The National Pressure Ulcer Advisory Panel (NPUAP) estimates that approximately
60,000 people in the US die annually due to complications generated by pressure ulcers and
associated expenses are estimated at between $2,000 and $25,000 per individual per year[9][10].
2. MATERIALS AND METHODS
The formula for this preparation ‘’PPP’’ was selected[3]. On the basis of the formula, a
Standard Operative Procedure (S.O.P) was prepared. The raw drugs were collected from
Tirunelveli district, and authenticated by the Staffs of Gunapadam Department. After that the
raw drugs were subject to proper purification to remove all the impurities. The purified
ingredients are well grinded till getting the paste form[7]. Then allow to dry it in sunshade for
two day and this sample was subjected to Anti-bacterial studies.
2.1.Antimicrobial Activity
2.1.1. Agar- Well Diffusion Method
2.1.2. Principle
The antimicrobials present in the plant extract are allowed to diffuse out into the medium
and interact in a plate freshly seeded with the test organisms. The resulting zones of inhibition
will be uniformly circular as there will be a confluent lawn of growth. The diameter of zone of
inhibition can be measured in centimeters[6].
2.1.3. Preparation of Extract
The plant parts were dried in shade, finely powdered and subjected to defatting using
80% Petroleum ether and the filtrate was dried and subjected to soxhilation. Briefly 50grams of
plant material was filled on extractor of a soxhlet apparatus and subjected to soxhlation of 5-7
cycles at 75oC. The extract was further condensed using rotatory evaporator and used for further
studies
2.2. Reagents
2.2.1. Muller Hinton Agar Medium (1 L)

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The medium was prepared by dissolving 33.9 g of the commercially available Muller
Hinton Agar Medium (HiMedia) in 1000ml of distilled water. The dissolved medium was
autoclaved at 15 lbs pressure at 121°C for 15 minutes. The autoclaved medium was mixed well
and poured onto 100mm petriplates (25-30ml/plate) while still molten.
2.2.2. Nutrient broth (1L)
One litre of nutrient broth was prepared by dissolving 13 g of commercially available
nutrient medium (HiMedia) in 1000ml distilled water and boiled to dissolve the medium
completely. The medium was dispensed as desired and sterilized by autoclaving at 15 lbs
pressure (121ºC) for 15 minutes.
2.2.3. Gentamycin (standard antibacterial agent, concentration: 40mg / ml)
2.3. Procedure
Petriplates containing 20ml Muller Hinton medium were seeded with 24hr culture of
bacterial strains such as E coli, Pseudomonas aeroginosa, Bacillus subtilis , Staphylococcus
aureus and Klebsiella pneumoniae. Wells of approximately 10mm was bored using a well cutter
and 25 μl , 50 μl and 100 μl of sample was added to the well. The plates were then incubated at
37°C for 24 hours. The antibacterial activity was assayed by measuring the diameter of the
inhibition zone formed around the well (NCCLS, 1993). Gentamycin was used as a positive
control.
3. RESULTS AND DISCUSSION
3.1.Organism: Streptococcus mutans
Sample
Concentration
(μg)
Zone of inhibition
(cm)
Gentamycin
3.6
MORUS
100
25
Nil
500
50
Nil
1000
100
1.2

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3.2.Organism: E coli
Sample
Concentration
(μg)
Zone of inhibition
(cm)
Gentamycin
3.5
MORUS
100
25
Nil
500
50
Nil
1000
100
1.1
3.3.Other Organisms tested
Organism
Zone of inhibition
(cm)
Pseudomonas auroginosa
Nil
Staphylococcus aureus
Klebsiella pneumonia
Figure 3 .Zone of Inhibition of PPP

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Gentamycin at a concentration of 40 mg/ml was used as the Standard Anti-bacterial agent.
The test drug, PPP was sensitive to Streptococcus mutans and E.Coli in higher concentrations
i.e., 100 μg. The drug is sensitive against micro-organisms and gives preventive and curative
effects against the infection caused by these micro-organisms in decubitus ulcer.
4. CONCLUSION
The antibiotic drugs are the greatest contribution of 20th century to the therapeutics.
Their importance is magnified in developing countries where infective diseases are predominant.
Plant-based antimicrobials have enormous therapeutic potential, and they are sufficiently proved
by the clinical applications. Some of the drugs gave triplets of unexpected results in clinical
applications. But while viewing through the scientific way, may be not significant.
5. CONFLICT OF INTEREST
The authors declare that they have no conflicts of interest.
6. REFERENCE
1. Nadkarani KM (2000). Indian Materia Medica, 3rd Edition, Vol: I, Published by Popular
Prakash, Mumbai, India.
2. Kuppusamy Muthaliar KN, Uthamarayan KS (2009). Classical text ‘Siddha Vaithya
Thirattu’, 3rd edition, published by Directorate of Indian Medicine and Homeopathy,
Chennai, India.
3. Murugesa Muthaliar (1988). Siddha Materia Medica (Vegetable section), Vol. I, Fourth
edition, Publisher, Tamilnadu Siddha Medical Council, Chennai.
4. Bluestein D, Javaheri A (2008). Pressure ulcers: prevention, evaluation, and
management. American Family Physician, 78(10), 1186-1194.
5. Whittington K, Patrick M, Roberts JL (2000). A national study of pressure ulcer
prevalence and incidence in acute care hospitals. Journal of Wound Ostomy &
Continence Nursing; 27(4), 209-215.

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6. National Committee for Clinical Laboratory Standards. (1993). Performance Standards
for Antimicrobial Disk Susceptibility Tests—5th Edition: Approved Standard M2-A5.
NCCLS, Villanova, PA.
7. Sambasivam Pillai TV(1991), Dictionary Based on Indian Medical science, 2nd edition,
Vol. 2, published by Directorate of Indian Medicine and Homeopathy, Chennai, India.
8. Gurib-Fakim A (2006). Medicinal plants: Tradition of yesterday and drugs of tomorrow,
Review article. Molecular Aspects of Medicine, 27(1), 93.
9. JoAnn Maklebust, Mary Sieggreen(2010), Pressure Ulcers: Guidelines for Prevention and
Management 3rd Edition.
10. Karen S. Clay (2008). Evidence-Based Pressure Ulcer Prevention, HCPro Publishers.