[Folk medicine in Ethiopia. 1. Dermatological and health policy aspects].
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Biomedical subjects
Publications and source records attributed to J Barth.
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During the course of a controlled clinical study the patients' facial acne was assessed using a 0-10 visual-tactile grading system and by lesion counting. In addition, black-and-white photographs and colour slides were taken at each patient visit and subsequently assessed by a panel of three dermatologists. Scores obtained from each method of assessment were subjected to statistical analysis and correlations between the techniques were evaluated. We conclude that a well thought out clinical grading system is the best overall method as it provides a meaningful assessment with speed and reasonable accuracy.
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52 patients with a clinical diagnosis of verruca plantaris were entered into a randomised study of acyclovir cream versus placebo cream versus liquid nitrogen. 47 completed the initial 8-week assessment period. At first, liquid nitrogen was used as a positive control but after the entry of 33 patients it was discontinued as an initial therapy in order to obtain maximal numbers of patients on the cream treatments. At the end of the 8-week assessment period 5 of 18 (placebo cream), 7 of 18 (acyclovir cream) and 1 of 11 (liquid nitrogen) patients were completely cleared of their plantar warts. Patients who failed to clear on cream or liquid nitrogen treatments after the initial assessment period but who wished to continue therapy were subsequently treated with liquid nitrogen. Of a total of 27 patients treated vigorously with liquid nitrogen, for periods of time ranging from 2 to 34 weeks, only 11 were completely cleared of their warts at the end of the study. It is concluded that liquid nitrogen should not be considered as a routine treatment for plantar warts and that acyclovir cream is no better than placebo in the treatment of this condition.
Numerous experimental investigations have demonstrated the benefit of glucocorticoids in the initial phase of the shocklung syndrome (ARDS), showing an increasing pulmonary perfusion by blocking the formation of vasoactive substances and a stabilization of endothelial and lysosomal membranes; another effect is to be seen in the inhibition of neutrophilic chemotaxis and pulmonary leukostasis, leading to reduced inflammatory reaction and less severe pulmonary damage. Clinical studies of glucocorticoid therapy in ARDS indicate a higher rate of surviving patients, when they were treated early and with glucocorticoids in a high dosage. The ill-defined condition of ARDS, however, and the use of different dosages in most of the studies limit the comparison of success dependent on those regimes; e.g. the given dosage varies from a single dose of 250 mg. methylprednisolone to several infusions of 30 mg./kg. body weight. According to the pharmacokinetics of glucocorticoids, the desired effects cannot be expected by application of a single and small dosage. To verify the benefit of high-dosage glucocorticoids in ARDS a stronger definition is needed to mark the onset of the syndrome and the start of glucocorticoid treatment. Additionally the dosage regimen should be standardised.
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