AyuRxiv is a first of its kind free distribution service and open-access archive for scholarly articles in Ayurvedic Sciences & Traditional Medicine Research. AyuRxiv seeks to promote evidence-based research in the Ayurvedic Sciences, democratizing access to research to practitioners, researchers, and the public worldwide.
Herb-Induced Liver Injury by Ayurvedic Medicine With Severe Lactic Acidosis: A Case Report
Lactate is the basic blood parameter in the arsenal of an intensivist when managing a critically ill patient. A 62-year-old male presented with nausea and vomiting. He had been using an Ayurvedic medication, Insulin Management Expert (IME-9), for his type 2 diabetes mellitus and was found to have severe lactic acidosis that was resistant to initial fluid resuscitation and Ayurvedic medicine-induced liver injury. He required admission to critical care for organ support and ultimately recovered. Because current literature on the adverse effects of this Ayurvedic medication, particularly hepatotoxicity, is limited, causality was determined using the adverse drug association tool Roussel Uclaf Causality Assessment Method (RUCAM), which determined this as a probable cause with a strong score of seven. As a result, our case adds a vital gear to the wheel of current research literature. Keywords: critical care and hospital medicine, herbal-induced liver injury (hili), drug-induced liver injury (dili), rucam score, ayurvedic medicine
India’s Traditional Knowledge Digital Library and the Politics of Patent Classifications
This article analyzes India’s Traditional Knowledge Digital Library (TKDL) as a potential intervention in the administration of patent law. The TKDL is a database including a vast body of traditional medical knowledge from India, aiming to prevent the patenting and misappropriation of that knowledge. This article contextualizes the TKDL in relation to documentation theory as well as to existing research on the uses of databases to protect traditional knowledge. It explores the TKDL’s potential consequences for India’s traditional medical knowledge and the wider implications that traditional knowledge databases can have for the safeguarding of traditional knowledge in general. The article concludes that on the one hand the TKDL bridges the gap between the main branches of Indian traditional medicine and the formal knowledge system of International Patent Classifications. Furthermore, it has also inspired revisions of the International Patent Classification system, which makes it better adapted to incorporate traditional medical knowledge. On the other hand, critical research on traditional knowledge documentation argues that traditional knowledge databases, like the TKDL, can decontextualize the knowledge they catalogue and dispossess its original owners. The TKDL, however, also fits into a national, Indian agenda of documenting and modernizing traditional medicine that predates the formation of the TKDL by several decades and challenges the dichotomy between traditional and scientific knowledge systems that originally motivated the formation of the TKDL. Keywords: India, Patent classification, Patent law, Traditional knowledge, Traditional knowledge digital library
A review on hypo-cholesterolemic activity of Nigella sativa seeds and its extracts
Nigella sativa (N. sativa) (Family Ranunculaceae) is a popular therapeutic herb in many parts of the world. It is widely used in traditional medical systems such as Unani, Ayurveda and Siddha. Seeds and oil have a long history of folkloric use in many medicinal and culinary systems. The seeds of N. sativa have long been used to treat a variety of illnesses and disorders. Studies on N. sativa and its therapeutic potential have been investigated. This includes anti-diabetic, anticancer, immune-modulatory, analgesic, antimicrobial, anti-inflammatory, spasmolytic, bronchodilator, hepato-protective, renal protective, gastro-protective, antioxidant properties, and several others. Nigella sativa contains thymoquinone. This is a bioactive component of the essential oil with medicinal benefits. Therefore, it is of interest to report a comprehensive data on the therapeutic usefulness of N. sativa in hypo-cholesterolemic activity. Keywords: Nigella sativa, black seed, hypo cholesterolemic activity
Ayurgenomics in Anti-Viral Therapy: A Literature Synthesis
This review focuses on Ayurgenomics (AG) used in antiviral therapy. According to Ayurveda, three doshas govern Prakriti, the natural organizational structure of humans. AG is a new field in modern medicine that focuses on establishing individualized self-care. It is a modern therapeutic and preventive method that enhances a person’s mental and physical well-being. Due to the threat of emerging lethal viruses and the significant role of Ayurveda in the pandemic, modern genetics studies have emerged. Prakriti, an Ayurvedic notion that AG incorporates, correlated with three doshas (phenotypes) called vata, pitta, and kapha. Each Prakriti individual had a specific balance for each dosha. To date, the most recent field of AG, which aims to characterize Prakriti types in terms of current genetics and physiology, has provided the best definition. Four databases were searched for studies on this topic using the keywords “Ayurgenomics” and “Anti-Viral Therapy.” Four articles that demonstrated a favorable approach for the application of AG were gathered for synthesis. According to this study, employing Adhatoda Vasica and Cissampelos pareira L extracts improved the viral structure of the SAR-CoV-2 virus. Further studies involving human participants are required to rule out the positive effects of AG in real-world contexts. Keywords: ayurveda, p4 medicine, doshas, prakriti, ayugenomics
In-vitro antioxidant, lipoxygenase inhibitory, and in-vivo muscle relaxant potential of the extract and constituent isolated from Diospyros kaki (Japanese Persimmon)
Diospyros kaki (Japanese persimmon) is cultivated specious of the Diospyros genus. D. kaki is a multi-medicinal application in the folk system for the cure of ischemic stroke, angina, atherosclerosis, muscle relaxation, internal hemorrhage, hypertension, high cough, and infectious disease. The main objective of this study was the isolated bioactive metabolites from chloroform fractions of D. kaki. The extract and fractions were then tested for various in-vitro (antioxidant and lipoxygenase) and in-vivo (muscle relaxant) activities. The repeated chromatographic separation of chloroform extract afforded compound 1. Compound 1, n-hexane, and chloroform fractions were evaluated for in vitro antioxidant, lipoxygenase inhibitory, and in vivo muscle relaxant potency. The chloroform extract has 79.54% interaction with DPPH at higher concentrations (100 μg/ml) while the compound exhibited a maximum effect of 95.09% at 100 μg/ml. Compound 1 exhibited significant lipoxygenase inhibitory activity with an IC50 value of 36.98 μM followed by a chloroform extract of 57.09 μM. Similarly, compound 1 and chloroform extract showed excellent muscle relaxant effects at a higher dose. From this investigation, it is concluded that extracts and pure compounds exhibited promising antioxidant, lipoxygenase inhibitory, and muscle relaxant activity. This study excellently rationalizes the traditional usage of D. kaki in curing various diseases. Furthermore, the docking results indicate, that the isolated compound fits well into the active site of the lipoxygenase, and makes strong interactions with the target protein. Keywords: Diospyros kaki, Phytochemical, Antioxidant, Lipoxygenase, Muscle relaxant, Molecular docking
An integrated management (Ayurveda and Modern medicine) of accidental burn injury: A case study
Burn injuries are frequent, horrifying, and life-threatening conditions that are still challenging to cure. Complications like scarring, keloid formation, and contractures are the main challenges for the treating surgeon. The Ayurvedic classics explain different treatment modalities for the management of burn wounds, like oral medicines, topical applications prepared with herbal medicines, ghee, oil, and typical wound dressing techniques like Patraadaana (wound covering with medicinal leaves), and fumigation therapy, etc. Here we report a case of accidental burn injury with a TBSA of 27% First degree (superficial) and 15% second degree (deep partial-thickness) burns with complaints of fever and burning sensation at the burn site. On the basis of the symptoms listed in the classical texts of Ayurveda, the case was diagnosed as Pramadadagdha (accidental burn). To properly manage the burn wound, an integrated therapy strategy was designed. Ropanaghrita (medicated ghee) was applied locally, followed by the application of Tinospora cordifolia leaves to cover the wound, fumigation therapy, and oral medications to hasten wound healing and reduce infection. In the first seven days, modern medicine was used as emergency care in addition to Ayurvedic management. Within 60 days of receiving treatment, the burn wound had entirely healed, and the patient was able to resume her regular work activities. In the current situation, the combined strategy produced encouraging burn management outcomes. Keywords: Accidental burn, Total body surface area, Ropana ghrita, Patraadaana, Dhoopana Abbreviations: TBSA, Total body surface area
Anatomy acts concerning body and organ donations across the globe: past, present and future with a special emphasis on the indian scenario
From the era of pre-historic times, the ancient Indians and the Greeks highlighted the importance of body and organ donations thereby emphasizing the need for anatomical sciences in medicine through the use of effective dissections for the same. However, after the Renaissance, there was a surge in dissections throughout the world, particularly in Europe, as a result of which various laws were enacted by governments concerning the procurement of bodies for the purpose of scientific dissections, which were later promulgated throughout the world through various anatomical acts. The situation in India was quite similar to that of Britain until its independence in 1947, after which different Indian states formulated their own anatomy acts that had their own merits and pitfalls. Hence, this literature review serves to highlight the various acts throughout history and would serve as a guide to emphasize the future perspectives of formulating a centralized unified anatomy act for the Indian nation that could possibly be the need of the hour. Keywords: Acts, Cadaveric donation, Cadaver, Coroners and medical examiners, Medical examiners
Preclinical evidence of polyherbal formulations on wound healing: A systematic review on research trends and perspectives
The disruptions in skin integrity contribute to its disorientation, and tissue annihilations result in acute or chronic wound formation. Polyherbal formulations are widely used in traditional systems of mecdicine like ayurveda for wound healing. The combination of these traditional therapies with clinical therapies has helped in the development of various wound-healing products. Method In this systematic review, the therapeutic potency of several polyherbal formulations from different medicinal floras is summed together in response to their impact on wound healing. The literature search was performed on Pubmed, Scopus, and ScienceDirect databases between 2010–2020. PRISMA methodology was applied to extract relevant information about polyherbal formulations. Result A total of 54 articles were selected under all themes for the data extraction as per the PRISMA guidelines. These 54 articles have high-quality scores ≥3. Forty-three records were used for the narrative analysis, while nine records were used for the critical analysis in the narrative review. Further, theme-wise key data sets were screened from the selected literature and summarized in a tabular form. Bibliometric analysis of the Scopus database has also drawn attention to limited academic literature showcasing randomized clinical trials in the current subject. Most of these polyherbal formulations are tested in laboratory-scale studies, thus portraying further research options. Conclusion Polyherbal formulations are effective in promoting the wound-healing process. They can stimulate a variety of physiological functions that accelerates the process of healing. These formulations merit further investigation in clinical trials, and production up scaling will aid in the creation of a new horizon of polyherbal wound healing products. Keywords: Medicinal plants, Pharmacological activity, Polyherbal formulations, Systematic review, Wound healing Abbreviations: PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; CASP, Critical Appraisal skills Programme; RQ1, Research Question 1; RQ2, Research Question2; RQ3, Research Question 3; WHO, World Health Organization
Covid-19 and female sex workers in India: a journey of brutal reality
The present paper is focused on the devastating effect of the Covid-19 pandemic on female sex workers (FSWs) in India and the globe. In Indian scenario, it emphasises on historical factors and theoretical frameworks that explicates the ceaseless exploitation of FSWs even before the pandemic. This inquiry analyses the efficacy of legislative and judicial endeavours taken with regard to FSWs. It highlights the role of non-governmental organisations and sex workers’ community, actively working in providing support to the FSWs. Here, we attempt to document the scattered information from various reports regarding sex workers and prostitution. Literature search was done through search engines like Science Direct, Google Scholar and PubMed using keywords such as “COVID-19 pandemic” “sex workers”, “prostitutes”, “health”, and “policies”. Web hits from Google Scholar were collected using a Boolean search and retrieval method involving sex workers and the “AND” operator. During Covid-19 pandemic, due to stigmatisation of their profession FSWs are majorly excluded from government relief programs and health services. In India, the existing laws for FSWs are rigid in nature. They emphasize on prohibition of prostitution. There is an urgent need in India to move towards a substitute model which embody a flexible decriminalisation policy for sex workers. By studying relevant literature on the present topic the gap between policy formulation and implementation was identified. In case of India, it outlines recommendations, in particular providing immediate aid and relief, issuance of temporary documentation to sex workers. Keywords: Brothel, COVID-19, India, Policy, Prostitution, Sex workers
Health inequities around gender, disability and internal migration: are local governments doing enough
SETTING: The Kerala health system in India has more than 25 years of decentralised implementation experience. Decentralization could assist in addressing health disparities such as gender, disability, and migration. OBJECTIVE: To explore how inequity issues comprising gender, disability and internal migrations were being addressed at present by the decentralised Kerala health system. DESIGN: Our approach was qualitative, using document review, key informant interviews and in-depth interviews with policy makers, health staff and other stakeholders. RESULTS: Gender aspects were incorporated into planning and budgeting, with 10% funds earmarked for women. Projects were gender-specific to women, and within conventional social roles of livelihood, welfare or reproductive health. Recently, transgender focused projects were also initiated. Schemes for people with disabilities remained welfare-centric and driven by top-down policies. The local governments performed beneficiary identification and benefit disbursal. Migrant health aspects were focused on infectious diseases surveillance and later living conditions of migrant workers. CONCLUSION: The importance that health systems place on socioeconomic determinants of health and fundamental human rights is reflected in the health interventions for marginalised communities. In Kerala, there is now a passive application of central rules and a reluctance to utilise local platforms. Changing this is a necessary condition for achieving equal development. Keywords: structural vulnerability, social vulnerability, sustainable development goals, decentralization
Palliative care management committees: a model of collaborative governance for primary health care
SETTING: The community-based primary palliative care programme in Kerala, India, has received international acclaim. Programme functioning is supported through Palliative Care Management Committees (PMCs) at the local government (LG) level. OBJECTIVE: To study the functioning of the PMCs within the decentralised governance space to identify achievements, gaps and notable innovations. DESIGN: This qualitative study included seven key informant interviews (KIIs), 28 in-depth interviews and a review of relevant publicly available policies and documents. Major themes were recognised from the KII transcripts. Codes emerging from the document review and in-depth interview transcripts were mapped into the identified thematic areas. RESULTS: Successful PMCs raised resources like money, human resource, equipment, had good skilled care options for symptom relief and facilitated reduced out-of-pocket expenditure by providing home care and free medicines, and improved access to interventions that addressed the social determinants of suffering like poverty. PMCs had varying managerial and technical capacities. In some LGs, the programme was weak and mostly limited to the supply of medicines, basic aids and appliances to patients’ homes. CONCLUSION: Despite varied implementation patterns, PMCs in Kerala are examples of state-supported, community-owned care initiatives, that can potentially address medical and social determinants of suffering. Keywords: decentralisation, sustainable developmental goals, community ownership, palliative care
Therapeutic properties and pharmacological activities of asiaticoside and madecassoside: A review
Centella asiatica is an ethnomedicinal herbaceous species that grows abundantly in tropical and sub‐tropical regions of China, India, South‐Eastern Asia and Africa. It is a popular nutraceutical that is employed in various forms of clinical and cosmetic treatments. C. asiatica extracts are reported widely in Ayurvedic and Chinese traditional medicine to boost memory, prevent cognitive deficits and improve brain functions. The major bioactive constituents of C. asiatica are the pentacyclic triterpenoid glycosides, asiaticoside and madecassoside, and their corresponding aglycones, asiatic acid and madecassic acid. Asiaticoside and madecassoside have been identified as the marker compounds of C. asiatica in the Chinese Pharmacopoeia and these triterpene compounds offer a wide range of pharmacological properties, including neuroprotective, cardioprotective, hepatoprotective, wound healing, anti‐inflammatory, anti‐oxidant, anti‐allergic, anti‐depressant, anxiolytic, antifibrotic, antibacterial, anti‐arthritic, anti‐tumour and immunomodulatory activities. Asiaticoside and madecassoside are also used extensively in treating skin abnormalities, burn injuries, ischaemia, ulcers, asthma, lupus, psoriasis and scleroderma. Besides medicinal applications, these phytocompounds are considered cosmetically beneficial for their role in anti‐ageing, skin hydration, collagen synthesis, UV protection and curing scars. Existing reports and experimental studies on these compounds between 2005 and 2022 have been selectively reviewed in this article to provide a comprehensive overview of the numerous therapeutic advantages of asiaticoside and madecassoside and their potential roles in the medical future. Keywords: asiaticoside, cardioprotective, Centella asiatica, madecassoside, neuroprotective, skin
Characteristics and result reporting of registered COVID-19 clinical trials of Chinese and Indian traditional medicine: A comparative analysis
Objective To assess the main characteristics and result reporting of registered COVID-19 interventional trials of traditional Chinese medicine and traditional Indian medicine. Materials and methods We assessed design quality and result reporting of COVID-19 trials of traditional Chinese medicine (TCM) and traditional Indian medicine (TIM) registered before 10 February 2021, respectively, on Chinese Clinical Trial Registry (ChiCTR) and Clinical Trial Registry-India (CTRI). Comparison groups included registered COVID-19 trials of conventional medicine conducted in China (WMC), India (WMI), and in other countries (WMO). Cox regression analysis was used to assess the association between time from trial onset to result reporting and trial characteristics. Results The proportion of COVID-19 trials investigating traditional medicine was 33.7% (130/386) among trials registered on ChiCTR, and 58.6% (266/454) on CTRI. Planned sample sizes were mostly small in all COVID-19 trials (median 100, IQR: 50–200). The proportion of trials that were randomized was 75.4 and 64.8%, respectively, for the TCM and TIM trials. Blinding measures were used in 6.2% of the TCM trials, and 23.6% of the TIM trials. Cox regression analysis revealed that planned COVID-19 clinical trials of traditional medicine were less likely to have results reported than trials of conventional medicine (hazard ratio 0.713, 95% confidence interval: 0.541–0.939; p = 0.0162). Conclusion There were considerable between-country and within-country differences in design quality, target sample size, trial participants, and reporting of trial results. Registered COVID-19 clinical trials of traditional medicine were less likely to report results than trials of conventional medicine. Keywords: COVID-19 clinical trials, China, India, traditional medicine, a comparative analysis
Unregulated supplement use causing insidious lead toxicity
A woman with extensive chronic fatigue presented to the emergency department with vague abdominal complaints and was subsequently found to have microcytic anemia secondary to lead intoxication. Upon further investigation, the unlikely source of lead intoxication was found to be the supplements she procured from her frequent overseas trips to South Asia. Chelation therapy was started and lead levels dropped. Keywords: Ayurveda, lead, microcytic anemia, supplementation
Achieving universal health coverage and sustainable development goals by 2030: investment estimates to increase production of health professionals in India
COVID-19 has reinforced the importance of having a sufficient, well-distributed and competent health workforce. In addition to improving health outcomes, increased investment in health has the potential to generate employment, increase labour productivity and foster economic growth. We estimate the required investment for increasing the production of the health workforce in India for achieving the UHC/SDGs. Methods We used data from National Health Workforce Account 2018, Periodic Labour Force Survey 2018–19, population projection of Census of India, and government documents and reports. We distinguish between total stock of health professionals and active health workforce. We estimated current shortages in the health workforce using WHO and ILO recommended health worker:population ratio thresholds and extrapolated the supply of health workforce till 2030, using a range of scenarios of production of doctors and nurses/midwives. Using unit costs of opening a new medical college/nursing institute, we estimated the required levels of investment to bridge the potential gap in the health workforce. Results To meet the threshold of 34.5 skilled health workers per 10 000 population, there will be a shortfall of 0.16 million doctors and 0.65 million nurses/midwives in the total stock and 0.57 million doctors and 1.98 million nurses/midwives in active health workforce by the year 2030. The shortages are higher when compared with a higher threshold of 44.5 health workers per 10 000 population. The estimated investment for the required increase in the production of health workforce ranges from INR 523 billion to 2 580 billion for doctors and INR 1 096 billion for nurses/midwives. Such investment during 2021–2025 has the potential of an additional employment generation within the health sector to the tune of 5.4 million and to contribute to national income to the extent of INR 3 429 billion annually. Conclusion India needs to significantly increase the production of doctors and nurses/midwives through investing in opening up new medical colleges. Nursing sector should be prioritized to encourage talents to join nursing profession and provide quality education. India needs to set up a benchmark for skill-mix ratio and provide attractive employment opportunities in the health sector to increase the demand and absorb the new graduates. Supplementary Information The online version contains supplementary material available at 10.1186/s12960-023-00802-y. Keywords: Health workforce, Human resources for health, Investment in health, India
A comprehensive review on traditional uses, phytochemistry and pharmacological properties of Paeoniaemodi Wall. ex Royle: current landscape and future perspectives
Paeonia emodi Wall. ex Royle is commonly known as Himalayan paeony has great importance as a food and medicine. The practice of Paeonia emodi Wall. ex Royle is very ancient and it is conventionally used for a wide range of illnesses in the folk system of medicine because of its wide beneficial phytochemical profile. The main purpose of the current review was the synthesis of recent data on botany, ethnopharmacology, phytochemistry and potential pharmacological mechanisms of action of Paeonia emodi Wall. ex Royle, thus offering new prospects for the development of new adjuvant natural therapies. Using scientific databases such as PubMed/MedLine, Scopus, Web of Science, ScienceDirect, Google Scholar, Springer, and Wiley, a comprehensive literature search was performed for Paeonia emodi Wall. ex Royle. For searching, we used the next MeSH terms: “Biological Product/isolation and purification”, “Biological Products/pharmacology”, “Drug Discovery/methods”, “Ethnopharmacology, Medicine”, “Traditional/methods”, “Paeonia/chemistry”, “Plant Extracts/pharmacology”, “Phytochemicals/chemistry”, “Phytochemicals/pharmacology”, “Plants, Medicinal”. The results of the most recent studies were analyzed and the most important data were summarized in tables and figures. Phytochemical research of Paeonia emodi Wall. ex Royle has led to the isolation of triterpenes, monoterpenes, phenolic acids, fatty acids, organic compounds, steroids, free radicals and some other classes of primary metabolites. In addition, diverse pharmacological activities like antibacterial, antifungal, anticoagulant, airway relaxant lipoxygenase and beta-glucuronidase inhibiting activity, radical scavenging activity, phytotoxic and insecticidal activities have been reported for Paeonia emodi Wall. ex Royle. Different bioactive compounds of Paeonia emodi Wall. ex Royle has proven their therapeutic potential in modern pharmacological and biomedical research to cure numerous gastrointestinal and nervous disorders. In future, further in vitro and in vivo therapeutic studies are required to identify new mechanisms of action, pharmacokinetics studies, and new pharmaceutical formulations for target transport and possible interaction with allopathic drugs. Also, new research regarding quality evaluation, toxicity and safety data in humans is needed. Keywords: Paeoniaemodi, Traditional uses, Phytochemistry, Pharmacological activities
Structural investigation of Ayurveda Lauha (Iron) Bhasma
In Ayurveda, ‘Lauha’ (Iron) Bhasma is primarily used to cure diseases related to iron deficiency in humans. It is produced from purified raw metallic iron using a combination of multi-step traditional preparation processes described in the Ayurveda literature. Here, we present the results of structural investigation performed on the medicinal grade ‘Lauha’ Bhasma using various X-ray based techniques. Our results indicate that after several rounds of heating and cooling in specific conditions following the Ayurvedic preparation procedure, metallic iron eventually converts to a natural iron-oxide mineral belonging to the magnetite group. Scanning electron microscopy (SEM) and X-ray standing wave assisted fluorescence measurements carried out on powdered Bhasma specimen reveal that the magnetite micro-particles in the Bhasma specimen are usually present in the form of agglomerates of nano-particles. We anticipate that the Ayurvedic Lauha Bhasma has great potential for noninvasive localized target killing of cancer cells, particularly in sensitive parts of the human body such as the brain, spinal cord, and lungs, via necrosis by application of an alternating external magnetic field or photo electron generation through X-rays. Keywords: Ayurvedic Bhasma, Nanomaterials, X-ray fluorescence, Trace element analysis, Synchrotron radiation
Development and validation of an ama instrument for assessing the disease activity on the basis of constitutional features in Amavata (Rheumatoid Arthritis)
Rheumatoid Arthritis (RA), having a striking clinical resemblance to amavata in traditional Indian medicine (Ayurveda) presents an opportunity to look at disease from two different healthcare perspectives. This differential information may potentially supplement one system with the knowledge of the other for optimal application. This study is the first of its kind, where Ayurvedic concepts of amavata have been adopted to enhance the knowledge about RA where optimal care is still beyond the common reach. Objective The study was conducted to develop and validate a novel ama score based upon constitutional features of ama as depicted in ayurvedic literature as a disease activity indicator in RA. Material and methods The study was conducted in two parts comprising development and textual validation of the ama assessment instrument (AAI) followed by its clinical testing. AAI comprising ten items, was developed where each item was provided with a range of scores to offer the assessment close to the patient's observations. The score obtained through AAI was clinically and statistically tested on 79 RA/amavata patients randomly selected for validity and reliability. The score obtained through AAI was tested for its correlation with the DAS-28 score and ESR. Results Ama Assessment Instrument could find a slight correlation with acute phase reactant ESR (r-value between ESR and AMA at baseline is 0.287, and at 1st, 2nd, and 3rd follow-up is 0.276, 0.276 and 0.160 respectively) and DAS-28 (The r value between DAS and AMA at baseline is 0.231, and at 1st, 2nd and 3rd follow up is 0.218, 0.201 and 0.247 respectively). It however emerged as an independent disease status marker since it could mark the changes in the study population on a time scale more precisely as compared to DAS -28 or ESR. When the ama values at different follow-ups were compared, a significant difference was observed consistent with disease activity marker catching constitutional and GI related domain of the patients. When reducing values of ama score were compared to overall improvements as reported by the patients, a similar trend was observed showing that a change in ama score is reflective of a change in disease status and the impact of the disease on the patient. Conclusion This study provided a quantitative measure for the abstract concept of ama which could be used to mark the disease activity in amavata or RA. The change in ama based scores can be used to assess disease status and the intervention related benefits. The observations prompt for the possible inclusion of AAI in RA composite score to make it more dynamic in terms of disease activity identification in RA. Keywords: Disease activity score, Rheumatoid arthritis, Amavata, Ayurveda
Statistical characterization of managerial risk factors: a case of state-run hospitals in India
Public healthcare institutions are the crucial component in the social and economic development of a nation, particularly India. However, public hospitals in India confront multiple operational risk factors that compromise patient satisfaction. Although all the risk factors are essentially critical, the impact potential of any risk factor is ultimately determined by its ability to induce other risk factors. The current research derives motivation from these scenarios and investigates the characteristics of crucial operational risk factors experienced in the public healthcare sector in a South Indian state. Extensive questionnaire-based surveys were conducted among civilians and healthcare professionals in two phases, i.e., prior to the COVID-19 crisis and during the COVID-19 crisis, for identifying significant risk factors. The collected data is analysed using statistical techniques like exploratory factor analysis (EFA) and partial least squares based structural equation modelling (PLS-SEM) to characterise the inter-relationships between risk factors. The research discloses the translational effect of administrative/infrastructure constraints in public hospitals in compromising the operational performance indirectly through human-related issues rather than having a direct influence. More precisely, the presented model indicates that risk factors like the physical infrastructure limitations and shortage of staff will overburden the existing employees, resulting in human-related issues, including attitudinal issues of employees and community mistrusts and misbelieves. The results reveal seemingly resolvable budget allocation issues, but at the same time alarms the authorities to execute immediate countermeasures. Ultimately, this research seeks to empower public hospital administrators with interesting insights and managerial implications drawn from the statistical models. Keywords: Public hospitals, Operational risks, Exploratory factor analysis, EFA, Partial least squares based structural equation modelling, PLS-SEM, India
Partial least squares based structural equation modelling
Ethnopharmacology, phytochemistry and pharmacology of Benincasae Exocarpium: A review
Benincasae Exocarpium (BE, Dongguapi in Chinese), as the dried outer pericarp of Benincasa hispida (wax gourd) in Cucurbitaceae family, is one of traditional Chinese medicines with the same origin as medicine and food. Up to now, 43 compounds were isolated from BE, including flavonoids, alkaloids, tannins, phenolic acids, soluble fiber and carbohydrates. Modern pharmacological studies and clinical practice showed that BE has diuretic, hypolipidemic effects, hypoglycemic, antioxidant, antibacterial, and other effects. The folk uses, functional factors, pharmacological activities, patents and clinical applications of BE were reviewed in this paper. In addition, the paper also discussed the current problems for the further studies. The information summarized in this paper provides valuable clues for the comprehensive utilization of medicine and food resources and gives a scientific basis for the development of medicinal plants of BE. Keywords: Benincasa hispida (Thunb.) Cogn., Benincasae Exocarpium, medicine and food homology, modern pharmacology, functional constituents
‘Food and medicine continuum’ in the East and West: Old tradition and current regulation
Food-medicine products are important materials for daily health management and are increasingly popular in the global healthy food market. However, because of the biocultural difference, food-medicine knowledge may differ among regions, which hinders the global sharing of such health strategies. Aim at bridging the food-medicine knowledge in the East and West, this study traced the historical roots of food and medicine continuum of the East and West, which was followed by a cross-cultural assessment on the importance of food-medicine products of China, thereafter, the current legislative terms for food-medicine products were studied using an international survey. The results show that the food and medicine continuum in the East and West have their historical roots in the traditional medicines since antiquity, and the food-medicine knowledge in the East and West differs substantially; although the food-medicine products have common properties, their legislative terms are diverse globally; with proofs of traditional uses and scientific evidence, food-medicine products are possible for cross-cultural communication. Finally, we recommend facilitating the cross-cultural communication of the food-medicine knowledge in the East and West, thus to make the best use of the traditional health wisdom in the globe. Keywords: cross-cultural communication, food and medicine continuum, food-medicine products, regulation, tradition
Knowledge, Attitudes and Practices Regarding Traditional and Complimentary Medicine in Oman
Objectives This study aimed to assess the knowledge, attitudes and practices regarding traditional medicine (TM) in Oman and examine the factors that necessitate its use. Methods This cross-sectional, questionnaire-based study was conducted among the general population from November 2019 and March 2020. All Omani nationals above the age of 18 were eligible to be enrolled. The questionnaire consisted of questions on the knowledge, attitudes and use regarding traditional medicine in Oman. Results A total of 598 responses to the questionnaire were received (response rate: 85.4%), of which 552 were deemed complete. Most responses were received from males (62.5%) and the sample had a mean age of 33.6 ± 7.7 years. A majority of the respondents (90%) were aware of the different types of TM in Oman; a high percentage (81.5%) felt that it was effective. Most (67.8%) had tried at least one method of TM use. Individuals who were older had tried TM compared to those who had not (34.5 ± 7.8 years versus 31.8 ± 7.2 years; P <0.001); in addition, more males than females (72.2% versus 27.8%; P <0.001) and those with full-time employment than those without had tried TM (84.2% versus 14.2%; P <0.001). Herbal medications (65.8%) and traditional massage (60.4%) were the most common forms of TM practice. Among females, herbal medications (69.2%) and massage (63.5%) are most often used; among males, cupping (65.2%) followed by herbal medications (64.4%) and massage (59.3%) were used more often. Notably, back pain (74.3%) was the most common condition for which TM was reportedly used, with only a small percentage (8.3%) reporting any concomitant side-effects. Conclusion There is widespread use of TM among Oman’s urban population. An improved understanding of their benefits will facilitate their incorporation into modern health care services. Keywords: Traditional Medicine, Complementary Medicine, Knowledge, Attitude, Oman
Analgesic and Anti-Inflammatory Activities of 80% Methanol Extract and Solvent Fractions of Ehretia cymosa Thonn (Boraginaceae) Leaves in Rodents
Ethnobotanical studies in various districts of Ethiopia reported that Ehretia cymosa (E. cymosa) is used for the management of headache, abdominal pain, arthritis and rheumatism. However, there is no scientific investigation done so far to confirm these traditional claims. Thus, the aim of this study was to assess the analgesic and anti-inflammatory effects of the 80% methanol extract and fractions of E. cymosa leaves. Methods The dried and pulverized leaves of E. cymosa were soaked with 80% methanol to obtain a crude extract. Fractionation was done using chloroform, ethyl acetate and water by a soxhlet apparatus. The analgesic effects of the crude extract and solvent fractions were assessed using acetic acid-induced writhing and hot plate tests whereas anti-inflammatory activities were investigated using carrageenan-induced paw edema and cotton-pellet-induced granuloma models. Results In all the tested doses, the 80% methanol extract and solvent fractions revealed substantial (p < 0.001) analgesic activities in acetic acid induced writhing test. In the hot plate method, all the tested doses of E. cymosa crude extract and the solvent fractions produced significant analgesic activities (p < 0.05). In the carrageenan-induced acute inflammation model, all tested doses of the crude extract and solvent fractions resulted in a significant decline in paw edema. The 80% methanol extract and solvent fractions of E. cymosa at all the tested doses significantly reduced inflammatory exudates and granuloma mass formations (p < 0.001). Conclusion From the results of this investigation, it can be stated that 80% methanol extract, aqueous, ethyl acetate and chloroform fractions of E. cymosa exhibited considerable analgesic and anti-inflammatory activities, supporting the plant’s traditional use as a remedy for a variety of painful and inflammatory conditions. Keywords: analgesic, hot plate, anti-inflammatory, Ehretia cymosa, carrageenan-induced paw edema, cotton pellet granuloma
We are (not) Different from the Others: Religious Responses to the COVID-19 Pandemic in Slovakia and India
Although the narrative of modernity has been rejected by numerous scientists, it remains a powerful paradigm. Several Western countries have, during the COVID-19 pandemic, witnessed renewed interest in some archaic practices and beliefs. Based mostly on media analysis, this paper provides an insight into religious responses to the COVID-19 pandemic in Slovakia and India, two completely different cultural areas. Simultaneously, it challenges the self-identification of the West as the epicentre of rational thought, in contrast to the so-called non-Western world. The self-image of superiority adopted by the modern West in terms of religious relevance has proved to be distorted, as the tendency to turn to spiritual practices in times of crisis is not exclusively a feature of non-Western societies. Keywords: Pandemic, Religion, Prayer, Worship, Goddess, COVID-19
Plant-Derived Products with Therapeutic Potential against Gastrointestinal Bacteria
The rising burden of antimicrobial resistance and increasing infectious disease outbreaks, including the recent COVID-19 pandemic, has led to a growing demand for the development of natural products as a valuable source of leading medicinal compounds. There is a wide variety of active constituents found in plants, making them an excellent source of antimicrobial agents with therapeutic potential as alternatives or potentiators of antibiotics. The structural diversity of phytochemicals enables them to act through a variety of mechanisms, targeting multiple biochemical pathways, in contrast to traditional antimicrobials. Moreover, the bioactivity of the herbal extracts can be explained by various metabolites working in synergism, where hundreds to thousands of metabolites make up the extract. Although a vast amount of literature is available regarding the use of these herbal extracts against bacterial and viral infections, critical assessments of their quality are lacking. This review aims to explore the efficacy and antimicrobial effects of herbal extracts against clinically relevant gastrointestinal infections including pathogenic Escherichia coli, toxigenic Clostridioides difficile, Campylobacter and Salmonella species. The review will discuss research gaps and propose future approaches to the translational development of plant-derived products for drug discovery purposes for the treatment and prevention of gastrointestinal infectious diseases. Keywords: plant-derived products, antibiotic resistance, new drug targets, gastrointestinal infections, clinical trials
GC-MS Analysis of Bioactive Compounds Extracted from Plant Rhazya stricta Using Various Solvents
Worldwide, human beings have traditionally employed many folkloric herbal resources as complementary and alternative remedies, and these remedies have played a pivotal role in modern medicines for many decades, as scientists have used them to develop drugs. We studied the effects of employing solvents with varying polarity on the yields of phytochemical components extracted from the plant Rhazya stricta. We used chloroform–methanol (1:1), methanol, ethanol, diethyl ether, and ethyl acetate as extraction solvents. The results showed that the efficiencies of the solvents at extracting phytochemical compounds were in this order: chloroform–methanol < ethanol < methanol < diethyl ether < ethyl acetate extract. The chloroform–methanol extract produced the highest concentration of phenolic and flavonoid contents among the five solvents tested (13.3 mg GAE/g DM and 5.43 CE/g DM). The yields of the extracted phytochemical compounds ranged from 47.55 to 6.05%. The results revealed that the properties of the extraction solvents considerably impacted the extraction yield and the phytochemical components of the R. stricta extract. Furthermore, compared with the other solvents, the chloroform–methanol extraction led to the highest yield (47.55%) and to more phytochemical substances being extracted. The aim of this study is to investigate the phytochemical compounds extracted from R. stricta with different solvents that have different polarities. Keywords: phytochemical compounds, different solvents, Rhazya stricta, alkaloid, plant
Withaferin A: A Pleiotropic Anticancer Agent from the Indian Medicinal Plant Withania somnifera (L.) Dunal
Cancer represents the second most deadly disease and one of the most important public health concerns worldwide. Surgery, chemotherapy, radiation therapy, and immune therapy are the major types of treatment strategies that have been implemented in cancer treatment. Unfortunately, these treatment options suffer from major limitations, such as drug-resistance and adverse effects, which may eventually result in disease recurrence. Many phytochemicals have been investigated for their antitumor efficacy in preclinical models and clinical studies to discover newer therapeutic agents with fewer adverse effects. Withaferin A, a natural bioactive molecule isolated from the Indian medicinal plant Withania somnifera (L.) Dunal, has been reported to impart anticancer activities against various cancer cell lines and preclinical cancer models by modulating the expression and activity of different oncogenic proteins. In this article, we have comprehensively discussed the biosynthesis of withaferin A as well as its antineoplastic activities and mode-of-action in in vitro and in vivo settings. We have also reviewed the effect of withaferin A on the expression of miRNAs, its combinational effect with other cytotoxic agents, withaferin A-based formulations, safety and toxicity profiles, and its clinical potential. Keywords: withaferin A, cancer, apoptosis, angiogenesis, chemoresistance, formulations
Antioxidant, Antibacterial, and Anticancer Activity of Ultrasonic Nanoemulsion of Cinnamomum Cassia L. Essential Oil
Cinnamomum cassia (C. assia) has long been used in traditional holistic medicine for its medicinal properties. It is used as an antioxidant, antibacterial, anti-inflammatory and anticancer agent. Cinnamon, in particular, the essential oil of C. cassia, has significant biological properties. Despite this, the volatility, stability, and insolubility of C. cassia essential oil (CEO) remain the main disadvantages that limit its application, ultimately affecting its pharmacological efficacy. To find a solution to this problem, we developed the CEO nanoemulsion (CEO-NE). For lipophilic compounds, insoluble nanoemulsion-based formulations are a popular delivery strategy. In this research work, a highly stable dosage form named CEO-NE was successfully developed using polysorbate 80 and water. The findings show that the synthesized CEO has a uniform shape with a PDI of 0.380 and an adequate particle size of 221.8 nm. The antioxidant outcomes show excellent results for CEO-NE compared to CEO against DPPH and hydrogen peroxide. The obtained antibacterial activity of CEO-NE was more efficient than that of CEO against Klebsiella pneumonia (MTCC 8911) with 0.025% and 0.05%, respectively. The CEO-NE preparation was tested against an alveolar lung adenocarcinoma cell line (A549) with an IC50 of 50.21 µg/mL for CEO and 18.05 µg/mL for CEO-NE, respectively. These results are encouraging for future translational studies on CEO-NE use in lung cancer therapy due to its excellent antioxidant, antibacterial, and killing kinetic properties. Keywords: Cinnamomum cassia, essential oil, antioxidant, nanoemulsion, biological properties
Medical Countermeasures against Ricin Intoxication
Ricin toxin is a disulfide-linked glycoprotein (AB toxin) comprising one enzymatic A chain (RTA) and one cell-binding B chain (RTB) contained in the castor bean, a Ricinus species. Ricin inhibits peptide chain elongation via disruption of the binding between elongation factors and ribosomes, resulting in apoptosis, inflammation, oxidative stress, and DNA damage, in addition to the classically known rRNA damage. Ricin has been used in traditional medicine throughout the world since prehistoric times. Because ricin toxin is highly toxic and can be readily extracted from beans, it could be used as a bioweapon (CDC B-list). Due to its extreme lethality and potential use as a biological weapon, ricin toxin remains a global public health concern requiring specific countermeasures. Currently, no specific treatment for ricin intoxication is available. This review focuses on the drugs under development. In particular, some examples are reviewed to demonstrate the proof of concept of antibody-based therapy. Chemical inhibitors, small proteins, and vaccines can serve as alternatives to antibodies or may be used in combination with antibodies. Keywords: antitoxin, antibodies, ricin, small-molecule inhibitors, medical countermeasures, vaccines
Pan-Genomics of Escherichia albertii for Antibiotic Resistance Profiling in Different Genome Fractions and Natural Product Mediated Intervention: In Silico Approach
Escherichia albertii is an emerging, enteric pathogen of significance. It was first isolated in 2003 from a pediatric diarrheal sample from Bangladesh. In this study, a comprehensive in silico strategy was followed to first list out antibiotic-resistant genes from core, accessory and unique genome fractions of 95 available genomes of E. albertii. Then, 56 drug targets were identified from the core essential genome. Finally, ZipA, an essential cell division protein that stabilizes the FtsZ protofilaments by cross-linking them and serves as a cytoplasmic membrane anchor for the Z ring, was selected for further downstream processing. It was computationally modeled using a threading approach, followed by virtual screening of two phytochemical libraries, Ayurvedic (n = 2103 compounds) and Traditional Chinese Medicine (n = 36,043 compounds). ADMET profiling, followed by PBPK modeling in the central body compartment, in a population of 250 non-diseased, 250 cirrhotic and 250 renally impaired people was attempted. ZINC85624912 from Chinese medicinal library showed the highest bioavailability and plasma retention. This is the first attempt to simulate the fate of natural products in the body through PBPK. Dynamics simulation of 20 ns for the top three compounds from both libraries was also performed to validate the stability of the compounds. The obtained information from the current study could aid wet-lab scientists to work on the scaffold of screened drug-like compounds from natural resources and could be useful in our quest for therapy against antibiotic-resistant E. albertii. Keywords: emerging pathogens, Escherichia albertii, phytochemicals, ZipA, traditional Chinese medicine, Ayurvedic medicine, pharmcokinetics