Harshit B Joshi MSc, Aswathy S Nair MSc, Ramya Bellave MSc
et al.
Modifiable and non-modifiable risk factors in Type 2 Diabetes (T2D) contribute to chronic inflammation characterized by elevated pro-inflammatory mediators and constitutively activated immune cells. Chronic inflammation in T2D leads to perturbations in metabolism, resulting in altered immuno-metabolic axis and further vascular complications. Hence, reducing inflammation by targeting modifiable risk factors such as adiposity, sedentary lifestyle and psychological stress in T2D may facilitate efficient clinical management. Yoga has been shown to improve glucose metabolism, reduce psychological stress, and decrease obesity, hence we sought to review the role of Yoga on cellular mechanisms regulating the immuno-metabolic axis in T2D. Elevated levels of inflammatory mediators such as IL-1b, IL-6, TNF-a, and CRP contributing to insulin resistance are reduced upon practicing Surya Namaskara, Pranayama, and meditation and further improved glycemic index in T2D individuals. Specific Asanas and Pranayama significantly decreased adipokines including leptin, adiponectin, and vaspin in subjects with high BMI, triglycerides and HOMA-IR values, and concomitantly reduced inflammation. Bidirectional activation of inflammatory mediators and stress hormones including epinephrine, catecholamines and cortisol manifesting in diabetes are also reduced upon practising meditation and Yoga. Yoga practices such as Pranayama, Asanas and Mudras improve insulin sensitivity, contribute to weight management, mitigate stress levels in T2D, and maintain immuno-metabolic homeostasis.
Clement N. Zuuri, Evans Akwasi Appiah, Joseph N. Suglo
et al.
Background:
The incidence of diabetes is rising in low- and middle-income countries, with many cases undiagnosed until complications, such as diabetic foot ulcers (DFUs), manifest. Effective management of DFUs requires a multidisciplinary approach involving various Healthcare Professionals (HCPs) such as doctors, nurses, physician assistants, and disease control officers among others. This study assessed the factors influencing the management of DFUs among HCPs at the primary healthcare level in the Bosomtwe District, Ghana.
Methodology:
A cross-sectional study where a quantitative approach was used across three purposively selected health facilities. A sample size of 231 respondents was selected using a simple random sampling technique. Data were collected using self-designed, pretested questionnaires and analyzed using descriptive and inferential statistics with STATA version 16.
Results:
Majority (71%) of the participants were registered nurses, with no podiatrist available in the district. While 69.5% of the respondents had general knowledge about managing DFUs, they lacked specific knowledge on dressings and offloading devices. Nearly all the respondents (99.75%) did not follow evidence-based guidelines for DFU management due to the absence of a universal protocol. However, there is a strong association between regularly consulting evidence-based guidelines and better DFU management outcomes (P < 0.001, odds ratio [OR] = 0.36, confidence interval [CI] =0.17–0.72). Furthermore, challenges in HCPs adhering to these guidelines (P = 0.001, OR: 0.03 CI = 0.04–0.22), patient difficulties in following treatments (P < 0.001, OR = 0.04, CI = 0.02–0.81), and low confidence in diagnosing DFUs (P < 0.001 OR = 0.65, CI = 0.55–0.76) are also significantly linked to poorer management outcomes.
Conclusion:
The study revealed major gaps in knowledge and adherence to guidelines in DFU management among HCPs in the Bosomtwe District. The study also found that lack of universal protocols, low diagnostic confidence, and patient noncompliance are some of the issues relating to poor DFU management. Standardized protocols, targeted training, and better patient education are needed to improve outcomes according to the study.
Divya Taneja,1,* Renu Mittal,1,* Shashank Atrey,1 Nitu Barod,1 Shweta Singh,1 Niharika Jain,2 Roshni,1 Subhash Kaushik1 1Public Health Coordination, Headquarters, Central Council for Research in Homoeopathy, Delhi, India; 2Hospital Wing, DR. B. R. Sur Homoeopathic Medical College, Hospital and Research Centre, Delhi, India*These authors contributed equally to this workCorrespondence: Divya Taneja, Headquarters, Central Council for Research in Homoeopathy, Jawahar Lal Nehru Bhartiya Chikitsa Avam Homoeopathy Anusandhan Bhawan, Janakpuri, Delhi, India, Tel +91 9810305068, Email drdivyataneja@gmail.comPurpose: Good health status has traditionally been linked to greater levels of patient satisfaction. With the emergence and integration of various medical modalities, including Homeopathy, Ayurveda, and other complementary and alternative medical treatments, patients are likely to have different satisfaction levels during their interaction with different practitioners. Amidst this diversity, the efficacy, accessibility, and cost-effectiveness of these treatment approaches have garnered significant attention. Hence, a tool was developed to assess the patient’s interaction with Complementary and Alternative Medicine treatments specifically Homeopathy. The objective of this study is to evaluate the validity and reliability of the Patient Satisfaction Assessment Tool (PSAT) developed to assess patient interaction with homeopathic outreach services.Methods: A new structured questionnaire was developed using a standardized procedure. After obtaining clearance from the scientific and ethics committee of the Central Council for Research in Homoeopathy, data was collected from consenting participants above 18 years of age attending the Dr. D.P. Rastogi Central Research Institute for Homoeopathy, Noida, Uttar Pradesh, India. Data was then computerized and analyzed by principal component analysis as the extraction method and orthogonal varimax as the rotation method.Results: A total of 285 participants were enrolled for psychometric validation, and 254 participants were included in the final analyses after exclusion. The mean (±Standard Deviation) age of participants was 37.63 (± 12.9) years (range 18– 79). The final 34-item questionnaire was arranged into nine domains as per rotated component matrix analysis. The overall internal consistency of the final questionnaire, as calculated by Cronbach’s alpha, was 0.79, and the measure of sampling adequacy was 0.85 (Kaiser–Meyer–Olkin test).Conclusion: Initial results from the pilot tests suggest that Patient Satisfaction Assessment Tool (PSAT) is effective in capturing key aspects of patient satisfaction, from homeopathic clinical services which can guide future quality improvement initiatives in alternative medicine healthcare facilities.Keywords: consultation quality, health consciousness, homeopathy, outpatient department, treatment quality
Subhash Chander, Reetika Sharma, Anuradha Sharma
et al.
Introduction: Timely diagnosis of bacteremia/sepsis is essential for the initiation of antimicrobial therapy and further reducing morbidity and mortality. Aims and Objective: This study is undertaken to find out the importance of toxic granulations in neutrophils in the diagnosis of sepsis. Materials and Methods: This was a cross-sectional type of study which was carried out for 1 year (August 2020 to August 2021). A total of 100 cases were included in the study. The smears were studied to assess the differential leukocyte count and neutrophils toxic granules. Observations and Results: The age of the patients ranged from 11 to 92 years, with M:F ratio 1:1. Total leukocyte count (TLC) ranged from 1.6 to 37.3 × 109/l with a mean of 14.7 × 109/l. Absolute neutrophil count (ANC) varied from 1.31 × 109/l × to 32.4 × 109/l with a mean of 10.4 × 109/l. On peripheral smear examination, 31% of cases showed no granules in the neutrophils, 35% of cases showed scattered darkly stained granules in the cytoplasm of neutrophils (1+), 29% showed an increase in the number of granules and increase in intensity (2+), and only 5% cases showed numerous granules with increase blue–black stain. However, none of the cases showed numerous coarse granules crowing the cytoplasm (4+). Conclusion: In this study, we found that none of the single parameters, for example, the TLC and ANC, toxic granulations, and left shift are diagnostic of sepsis but all these are complementary to each other in predicting the diagnosis of sepsis.
Ishwarpreet Kaur, Amarjeet Singh, Vanita Suri
et al.
BACKGROUND: Polycystic ovarian syndrome (PCOS) has now become a common problem among adolescent girls and young women in India. However, little is known about the treatment and satisfaction incurred from it. Our study aimed to assess the treatment-seeking behaviour among patients with PCOS.
MATERIALS AND METHODS: The cross-sectional study was carried out in gynecology OPD of PGIMER, Chandigarh. Women with PCOS, 275, visiting the gynecology OPD were included. The treatment-seeking behavior for PCOS was elucidated among cases using a questionnaire. This included parameters like healthcare consulted, preferred system of medicine, referral pattern, treatment efficacy, and expenses incurred. Univariate descriptive analysis was used to present the results.
RESULTS: The majority (68%) of the study participants were less than 25 years of age. The average weight was 66.78 (±13.0) Kg. Half of the participants were students. More than 70% belonged to the upper or upper-middle class. The study participants were diagnosed with PCOS at an average age of 21.4 (±4.7) years. The minimum age reported at diagnosis was 11 years, and the maximum age of diagnosis was 36 years. Most respondents preferred Allopathic treatment followed by homeopathy and Ayurveda. Few also opted for other treatment choices like diet therapy, yoga & meditation, weight loss supplements, and home remedies. Treatment efficacy ranged between 17.3%-34.2%. The majority of respondents reported the treatment to be moderately expensive. Most respondents (58.91%) were hardly influenced, while 16% were quite influenced by PCOS medicine or treatment advertisements.
CONCLUSION: PCOS patients opt for different treatment options but generally find the treatment less effective and expensive.
Special aspects of education, Public aspects of medicine
Amira E. Joseph MD, Rajat N. Moman MD, MA, Ross A. Barman DO
et al.
Slow deep breathing (SDB) may help patients with acute pain. The primary aim of this systematic review and meta-analysis is to investigate the effects of SDB on acute pain. Secondary aims include investigating the effects of SDB on acute pain-related physical and emotional functioning. An a priori protocol was registered and a database search was conducted by a reference librarian. Randomized controlled trials (RCT) were eligible for inclusion and exclusion criteria included studies of SDB for non-pain indications and studies that applied SDB as a component of an encompassing intervention. The risk or bias was assessed using the Cochrane Collaboration's revised tool for assessing risk of bias in randomized trials. Meta-analysis was conducted using the random effects model. A total of 11 968 studies were screened and seven RCTs met inclusion criteria; five were judged to have low risk of bias. Meta-analysis of post-intervention pain scores demonstrated that SDB was associated with significantly lower pain scores compared with a control group, but with high levels of heterogeneity. Subgroup analyzes demonstrated that trials of burn pain were associated with a larger reduction in pain which partially explains the heterogeneity. Very low certainty evidence suggests that SDB may reduce acute pain intensity. Further research is needed to identify patients who are candidates for SDB and determine the best approach to deliver this therapy.
Babita Shukla, Sumedha Saxena, Shazia Usmani
et al.
Abstract Plumbago zeylanica L. (Plumbaginaceae) commonly known, as chitrak is pharmacologically important plant. Various studies have been undertaken to assess the pharmacological potential of different parts of the plant namely like roots, stem, flower, and leaves as antimicrobial, hepatoprotective, anticancer, antifertility, antiulcer, antifungal and wound healing. The intention of the present review is to deliver a concise account on its ethnobotanical uses, phytochemistry with an in-depth study of its phytoconstituents, facts and prospects of its potential pharmacological activities of this golden plant. An extensive literature survey was undertaken through different online platforms viz. Google Scholar and online databases namely PubMed, Science Direct and Springer. All papers based on traditional medicinal uses and pharmacological properties were included. Sixty three research articles and review articles were found to be apt for inclusion into the review. About 150 articles were retrieved for the purpose. The elaborative results vindicated that Plumbago zeylanica L. holds significant prospects in major health conditions such as diabetes, cardiovascular disorders, ulcer, liver problems, obesity, wound healing, cancer etc.
AbstractThe controversial issue of homeopathy's scientificity will, in all probability, not be settled by means of clinical trials alone, as long as uncertainty or ignorance about methodological, philosophical, and socio-economical essentials prevail on both sides of the argument. Rather than uncritically adopt the standards of the currently predominant paradigm, homeopathy should not forget its roots, peculiarities, and self-conception. Contrary to conventional medicine, it is based on a teleological image of humanity, a holistic and sustainable approach towards curing sickness, and an up-to-date concept of medical theory in terms of healing arts. However, under today's frameworked conditions of industrialisation, commercialisation and commodification, the strengths of homeopathy tend to be disregarded or even attacked, and a special kind of reductionist and materialist rationality, compatible with expanding markets and profits, is preferably facilitated. To reveal and demonstrate these developments and relationships on a scientific level, there is a need for multidisciplinary research on the part of the humanities, such as history and theory of medicine, history and theory of science, history of economics, sociology of scientific knowledge, and philosophy.
Abstract Background Barringtonia acutangula (L.) Gaertn, Garcinia indica (Thouars) Choisy, and Feronia limonia (L.) Swingle is widely utilized in traditional folk medicine against diabetes, obesity, and metabolic syndrome but lacks the evidence of compound-protein interaction for the treatment. Methods Phytocompounds were retrieved from herbs databases and public repositories. Probable protein targets were predicted using BindingDB (p ≥ 0.7). The pathways modulated by compounds were analyzed using the STRING and KEGG pathways. The compound-protein-pathway network was constructed using Cytoscape v3.6.1. Druglikeness was predicted by Molsoft. Docking was performed by AutoDock vina by PyRx 0.8v. Results Among three plants, eleven triterpene saponins from B. acutangula showed druggable characteristics and identified to inhibit the 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1/HSD11B1) as a key protein target and also inhibit/modulate other 27 protein molecules involved in the 3 major pathways i.e. Metabolic syndrome, cGMP-PKG signaling, and insulin resistance pathways and also these compounds showed interactions with the active site amino acid residues of 11β-HSD1. Among eleven compounds Barringtogenol B scored the highest binding affinity by forming a hydrogen bond with Ile218 active site residue of 11β-HSD1. Conclusion Triterpene saponins contained in B. acutangula bark and seed inhibits 11Β-HSD1 and this multi-compound contained enriched fraction could be the potent treatment regimen for T2DM, obesity, and MetS.
Dipa Islam, Monisha Banerjee Shanta, Samina Akhter
et al.
Abstract Background Myocardial Infarction (MI), also known as heart attack, is one of the most common cardiovascular diseases. Although certain drugs or mechanical means are used, day by day natural products such as herbs and spices based MI treatment is getting much popularity over the drugs or mechanical means for their pharmacological effects and have low or no side effects. This study was designed to assess the cardio-protective effect of methanolic extract of Bangladeshi multi clove garlic (Allium sativum) cultivar, a highly believed spice having cardioprotective activity, against isoproterenol (ISO) induced MI through cardiac histopathology as well as cardiac apoptotic caspase-3 gene expression study in female Wistar albino rats. Four groups containing 35 rats treated with respective agents like distill water / garlic extract (200 mg/kg-body-weight/day) up to 28 days and normal saline / ISO (100 mg/kg-body-weight/day) on 29th and 30th day were sacrificed (two rats/group/sacrifice) on the day 31, 46 and 61 and collecting the heart, cardiac histology and gene expression analysis were performed. Results ISO induced MI rats pretreated with garlic extract revealed up regulated expression of the cardiac apoptotic caspase-3 gene at the initial stage but finally the expressions gradually getting down regulated along with gradual improving the cardiac damage caused by apoptosis. Furthermore, only garlic extract pretreated rats were found undamaged cardioarchitecture and normal expressions of this gene. Conclusions These findings suggested that garlic extract confers having significant cardioprotective effect and consuming this spice with regular diet may reduce the risk of MI.
Nazia Hoque, Md. Hossain Sohrab, Farhana Afroz
et al.
Abstract Background Thysanolaena maxima (Roxb.) Kuntze, a perennial grass plant, is usually distributed in hilly regions of the Indian Subcontinent. Different parts of T. maxima have been used as herbal medicine by traditional healers of this region. In this present study, T. maxima plant extract has been screened for examination of its secondary metabolite content with their probable cytotoxic activity. Methods Secondary metabolites of the crude T. maxima plant extract were isolated by different chromatographic methods. The structures were elucidated by spectroscopic data (1H NMR, 13C NMR) as well as comparison with available literature sources. Antiradical activity by DPPH radical scavenging assay and antimicrobial activity by disc diffusion method of the fractions and cytotoxic activity by trypan blue exclusion method of the isolated compounds were also evaluated. Results Three phenolic compounds 4-hydroxybenzaldehyde (1), 4-hydroxycinnamic acid (2), 4-hydroxybenzoic acid (3) and two steroids stigmast-4-en-3-one (4) and β-stigmasterol (5) were isolated from the aerial part of T. maxima. Among the compounds 4-hydroxycinnamic acid, 4-hydroxybenzoic acid and stigmast-4-en-3-one exhibited notable cytotoxic activity against African Green Monkey Kidney Cell line (Vero cell). Conclusion Bioassay investigation of the isolated compounds and fractions suggested that T. maxima could be a potential source of bioactive secondary metabolites. Graphical abstract
Igor A. Zupanets, Yuri V. Pidpruzhnykov, Valerii E. Sabko
et al.
Abstract Background Study of pharmacokinetics of quercetin (Qu) and its derivatives after infusion is required in order to better understand mechanisms of therapeutic action of the formulation and development the strategic approaches to treat the underlying disease and pathologically similar syndromes. A pharmacokinetic study of Qu products is a complex analytical problem. Results We developed and validated a new method for quantification of Qu and its metabolites in human plasma and urine following intravenous administration of Qu formulation. The method is based on the solid-phase extraction with the help of Oasis® HLB cartridges and ultra-performance liquid chromatography - tandem mass spectrometry (UPLC-MS/MS) quantification. The calibration curves plotted for concentration range of 25–3000 ng/ml for Qu and isorhamnetin in blood plasma and of 100–8000 ng/ml for the same substances in urine were best described by a quadratic function. Qu conjugates underwent preliminary hydrolysis by the mixture of enzymes of sulphatase and β-glucuronidase. The antioxidant L-cysteine mixed with ascorbic acid was used for stabilization of Qu and its metabolites during handling of samples and chromatographic runs with mass detection. The method validation as well as the stability study results confirmed that the developed method meets the established requirements (selectivity, lower limit of quantification, accuracy, precision, recovery). The main pharmacokinetic parameters of Qu and its metabolites were determined in blood plasma and urine after intravenous administration of Corvitin® (parenteral formulation combining Qu and polyvinylpyrrolidone at a ratio of 1:9) in 12 healthy volunteers. Conclusions We showed that the method development for Qu quantification in biological matrixes is valuable and reliable.
Physical activities during and after cancer treatment have favorable psychosocial effects. Increasingly, yoga has become a popular approach to improving the quality of life (QoL) of women with breast cancer. However, the extant synthetic evidence on yoga has not used other exercise comparison conditions. This meta-analysis aimed to systematically assess yoga-specific effects relative to any other physical exercise intervention (eg, aerobics) for women with breast cancer. QoL was the primary outcome of interest. Eight randomized controlled trials with 545 participants were included. The sample-weighted synthesis at immediate postintervention revealed marginally statistically and modest practically significant differences suggesting yoga’s potentially greater effectiveness: d = 0.14, P = .10. However, at longer term follow-up, no statistically or practically significant between-group difference was observed. This meta-analysis preliminarily demonstrated that yoga is probably as effective as other exercise modalities in improving the QoL of women with breast cancer. Both interventions were associated with clinically significant improvements in QoL. Nearly all of the yoga intervention programs, however, were very poorly resourced. Larger and better controlled trials of well-endowed yoga programs are needed.
V. M. Svistushkin, G. N. Nikiforova, L. A. Toporkova
The article describes the etiology, elements of pathogenesis and clinic of the main types of chronic rhinitis. The emphasis is made on such forms as vasomotor and atrophic rhinitis, diagnosis and options for conservative treatment. As a comprehensive treatment of these forms of rhinitis is considered a homeopathy: the use of Thuja oil (Thuja occidentalis) and «Fleming ointments» with the problem of nasal obstruction and rinorea. The results of the study of the effectiveness of Fleming ointment for conservative treatment of vasomotor rhinitis are presented. The experience of the use of Thuja oil in the treatment of patients with symptoms of nasal obstruction and rhinorrhea, with the phenomena of atrophic rhinitis.
Usana Chatturong, Tanwarat Kajsongkram, Sakara Tunsophon
et al.
This study aims to investigate the effect of oral administration and the direct action of ginger extract or [6]-gingerol on small intestinal contractility. The direct effect of 10 minutes preincubation of ginger ethanolic extract (10, 100 and 300 μg/mL) or [6]-gingerol (1, 30, and 100 μM) on 0.01 to 30 μM ACh-induced contractions of all parts of the small intestine isolated from normal rats was investigated using the organ bath technique. For in vivo study, the rats were orally administered with extract (10, 20, and 100 mg/kg/d) or [6]-gingerol (2 mg/kg/d) for 7 days, followed by determining the contractile responses to ACh of rat isolated duodenum, jejunum, and ileum and their histology were assessed. Direct application of the extract or [6]-gingerol attenuated ACh-induced contractions in each small intestinal segment, E max was reduced by 40% to 80%, while EC 50 increased 3- to 8-fold from control. Similarly, in the in vivo study ACh-induced contractions were reduced in all parts of the small intestine isolated from rats orally treated with ginger extract (20 and 100 mg/kg/d) or [6]-gingerol (2 mg/kg/d). E max decreased 15% to 30%, while EC 50 increased 1- to 3-fold compared to control. No discernable changes in the histology of intestinal segments were detectable. Thus, the results support the clinical application of ginger for disorders of gastrointestinal motility.
Pabitra Kumar Sardar, Shrabanti Dev, Md. Abdullah Al Bari
et al.
Abstract Background Acanthus ilicifolius L. is admired for its traditional usage in the folk medicine for the treatment of numerous diseases including allergy and helminthiasis in various parts of the planet. The ethanolic extract of the aerial parts of this shrub (EEAI) was investigated in the present study for its major phytochemical groups, antiallergic activity, anthelmintic activity, cytotoxicity and for acute toxicity. Methods Antiallergic activity was carried out using Toluene 2, 4-diisocyanate (TDI)-induced allergic mice model by assessing various symptoms of allergic rhinitis like sneezing, scratching, swelling and watery rhinorrhea as well as counting the total and differential leukocytes profile of blood. The paralysis and death time of parasites, Haemonchus contortus (Nematoda) and Paramphistomum cervi (Trematoda) were used for anthelmintic activity test. Mortality of mice was counted to evaluate the acute toxicity whereas the mortality of brine shrimp was taken into account to assess cytotoxic potential of the extract. Results Phytochemical screening of the extract demonstrated the presence of alkaloids, phenolic compounds, tannins, flavonoids, glycosides, saponins, steroids and triterpenoids. Oral pretreatment of the extract significantly ameliorated the TDI-induced allergic symptoms like sneezing (p < 0.05), scratching (p < 0.05), swelling and watery rhinorrhea in experimental mice. The extract also reduced the differential count of leukocytes in the blood which was increased due to induction of allergic conditions through TDI sensitization. In anthelmintic activity test the extract revealed a dose dependent decrease in the relative index of paralysis and death for both H. contortus and P. cervi parasites and thus indicated the extract to be parasiticidal at higher concentrations. In brine shrimp lethality bioassay of toxicity assessment, the LC50 of the standard drug vincristine sulfate was 0.43 μg/mL whereas the extract showed the LC50 as 44.57 μg/mL indicating a promising cytotoxicity of the extract. In acute toxicity study the highest dose 3 g/kg failed to show any mortality in Swiss albino mice and thus confirmed the safety of the extract for in vivo administration. Conclusions The present study corroborated the traditional uses of the aerial parts of Acanthus ilicifolius L. in allergic diseases and in helminthiasis.
Silybum marianum (L) Gaertn (milk thistle) seeds, Urtica dioica L (nettle) leaves, and Boswellia serrata (olibanum gum) resin are used traditionally by Iranian diabetic patients. The aim of this study was to evaluate the antihyperglycemic effects of these herbs in an herbal formulation in patients with type II diabetes mellitus. Sixty patients diagnosed as type II diabetes mellitus with fasting blood glucose level from 150 to 180 mg/dL, glycosylated hemoglobin level from 7.5% to 8.5%, and on oral antihyperglycemic drugs, were allocated to receive the mix herbal formulation or placebo for 90 days in a double-blind randomized placebo-controlled clinical trial. The mean serum fasting blood glucose, glycosylated hemoglobin, and triglyceride in the herbal drug group were significantly less than placebo group’s values after 3 months of the intervention. The study showed a potential antihyperglycemic and triglyceride lowering effect of the herbal formulation, while it did not have any significant cholesterol or blood pressure lowering effect.