Caesalpinia bonduc (L.) Roxb. (Kuberaksha) is an Ayurvedic herb used in the management of malaria, liver disorders, worms, edematous conditions, etc. Based on classical Ayurvedic textual indications and recent pharmacological studies, its leaf powder was selected for studying its effect clinically on filaria. Before conducting the clinical trails, this leaf powder was subjected to certain chemical studies to find the pH, ash value, extractive values, High Performance Thin Layer Chromatography (HPTLC), etc. for standardization of the drug.
Acid insoluble ash; analytical study; Caesalpinia bonduc; Kuberaksa leaf powder; loss on drying; pH value; total ash
Lymphatic filariasis is a disease of considerable socioeconomic burden in the tropics. Presently used antifilarial drugs are able to strongly reduce transmission and will thus ultimately lower the burden of morbidity associated with the infection, however, a chemotherapeutic principle that directly induces a halt or improvement in the progression of the morbidity in already infected individuals would constitute a major lead. In search of such a more-effective drug to complement the existing ones, in an area endemic for bancroftian filariasis in Ghana, 33 microfilaremic and 18 lymphedema patients took part in a double-blind, placebo-controlled trial of a 6-wk regimen of 200 mg/day doxycycline. Four months after doxycycline treatment, all patients received 150–200 μg/kg ivermectin and 400 mg albendazole. Patients were monitored for Wolbachia and microfilaria loads, antigenemia, filarial dance sign (FDS), dilation of supratesticular lymphatic vessels, and plasma levels of lymphangiogenic factors (vascular endothelial growth factor-C [VEGF-C] and soluble vascular endothelial growth factor receptor-3 [(s)VEGFR-3]). Lymphedema patients were additionally monitored for stage (grade) of lymphedema and the circumferences of affected legs. Wolbachia load, microfilaremia, antigenemia, and frequency of FDS were significantly reduced in microfilaremic patients up to 24 mo in the doxycycline group compared to the placebo group. The mean dilation of supratesticular lymphatic vessels in doxycycline-treated patients was reduced significantly at 24 mo, whereas there was no improvement in the placebo group. Preceding clinical improvement, at 12 mo, the mean plasma levels of VEGF-C and sVEGFR-3 decreased significantly in the doxycycline-treated patients to a level close to that of endemic normal values, whereas there was no significant reduction in the placebo patients. The extent of disease in lymphedema patients significantly improved following doxycycline, with the mean stage of lymphedema in the doxycycline-treated patients being significantly lower compared to placebo patients 12 mo after treatment. The reduction in the stages manifested as better skin texture, a reduction of deep folds, and fewer deep skin folds. In conclusion, a 6-wk regimen of antifilarial treatment with doxycycline against W. bancrofti showed a strong macrofilaricidal activity and reduction in plasma levels of VEGF-C/sVEGFR-3, the latter being associated with amelioration of supratesticular dilated lymphatic vessels and with an improvement of pathology in lymphatic filariasis patients.
Lymphatic filariasis, caused by filarial worms, is transmitted by mosquitoes. The infection leads to pathology such as edema of the legs (lymphedema) or the scrotum (hydrocele). About 120 million people are estimated to be infected, and 1.2 billion are at risk of infection. The currently used drugs (diethylcarbamazine [DEC] or ivermectin plus albendazole) to treat the disease are able to kill most of the larval stage (microfilariae) in the blood but have either no (ivermectin) or partial (DEC) effect on the adult worms that cause the pathology. They also do not sufficiently halt the progression of pathology, such as, lymph vessel dilation, hydrocele, and lymphedema.
In search of a more effective drug capable of killing the adult worms, and also of halting the progression of the disease in already infected individuals, the authors recruited, in an endemic area in Ghana, 33 people who were infected with the worm and microfilaremic but had not yet developed the disease, as well as 18 lymphedema patients, and treated them with either 200 mg/d doxycycline or matching placebo for 6 wk. The findings presented here reveal that doxycycline is able to kill the adult worms, improves lymphatic vessel dilation, and ameliorates the conditions of lymphedema patients significantly. This suggests that doxycycline can be used to treat lymphatic filarial infections and pathology, making doxycycline the first drug already approved for human use and considered for use as an adjunct to current control programs, which in addition to parasite control achieves improvement of the quality of life of persons with pathology.
Wound a clinical entity, is commonly seen as a result of various etiological factors like trauma etc. Kanchanara a plant origin drug. Many of the Nighantu's have mentioned vrana shodhana and vrana ropana properties of Kanchanara. Hence present study of evaluating wound healing property of Kanchanara bark in the form of churna and ointment [sikta taila base] preparations has been taken up.
Albino rats were the experimental model. 36 albino rats were selected and divided into 6 groups of 6 rats each. 3 groups were used for excision wound model and remaining 3 groups were used for incision wound model, one group being served as the control and remaining two group for the trial drug. Churna and ointment were used for both excision and incision groups. Albino rats were wounded under aseptic conditions using wound techniques suggested by Marton and Malone  and also by hunts model. In case of excision wound area of wound was measured once in 4 days by using graph sheet. In case of incision wound tensile strength was found out by using tensinometer on 10th post wounding day.
The statistical values of both groups were compared with control group and it showed that: 1. Kanchanara ointment promoted epithelization, wound contraction and period of epithelization was reduced in case of excision wound. 2. In incision wound also Kanchanara ointment helps in increasing collagenation and tensile strength. Both ointment and churna group are highly significant when compared with control group. On comparison of ointment group with churna group it statistically showed insignificance. No untoward side effects were noticed during the trial and the wound, healed with minimal scar.
Kanchanara ointment and its churna is an effective, safe and well tolerated therapy in the treatment of both excision and incision wound.
Dhatura is an important deliriant poison grouped under sthavara upavisha and phalavisha. It affects the Central Nervous system. Dhatura is important ingredient of large number of medicinal formulations. In the Ayurvedic text,, Basavarajeeyam, Chincha Rasa (Tamarind) has been described to be possessing antidote action to counter toxicity of Dhatura. This study attempts to establish the activity and mechanism of action of chincha rasa against toxic effects of Dhatura by means of chemical analysis.
1) Collection of drugs, 2) Authentication of three drugs in Govt. authorised institute, 3) i) Preparation of Chincha rasa (According to charaka), ii) Preparation of Chincha pakwa phal (According to Sharangdhar), 4) Physical and Chemical study of Dhatur seed, i) Preparation of Dhatur Churna (According to Sharangdhar) and Analytical Study of three drugs, 5) Methods of determination of an antidote.
Laboratory experiments were carried out to obtain values of specific parameters for Dhatur seeds, chincha patra ras (tamarind leafe juice) and chincha pakwa phal (ripe tamarind fruit).
On the basis of observations and results found in chemical study and reported literature, the study came with the following conclusions. 1) The chincha patra rasa and Chincha pakwa phal rasa both contain Hordenine which has the antibacterial activity and stimulates the central nervous system providing relief from unquenchable thirst, muttering and delirium (indistinct and inaudible words unsteady gait) 2) Because of tannins, Chinchapatra ras and Chincha pakwaphal ras have astringent property, which counteract the toxic symptoms of Dhatur like dermatitis, rash and exfoliation of the skin. 3) Because of glycosides and tannins, chincha patra rasa and chincha pakwaphal have diuretic property which counteract the toxic symptoms of dhatura like urinary retention and inability to pass urine. 4) The tartaric acid present in chincha patra ras and chincha pakwaphal ras causes gastric irritation and thus induces vomiting. 5) Chincha patra ras and Chincha pakwa phal ras have flavonoids (Vit. P. and Citrin) which strengthens the blood vessels and lowers blood pressure and works as anti-inflammatoryagent. 6) The Chincha patra ras and Chincha pakwa phal ras have vit. ‘C’ which lead the blood circulation towards the heart which prevent the cardiac arrest produced in the Dhatura poisoning. 7) Chincha patra ras aqueous extract 1% and 10% has the pH of 5.91 and 5.45 and the pH of chincha pakwa phal ras aqueous extract of 1% and 10% has pH of 4.72 and 4.50. Both are acidic but the pH of Dhatura in aqueous extract of 1% is 8.19 and 8.00. Therefore, they neurtralize each other and reduce the toxic effect of dhatura. Similarly, the action of chincha rasa can be explained through the concepts of Ayurveda.
1.To find out an easily available and considerably low cost, safe and effective remedy for the treatment of Vicharchika. 2. Clinical assessment of the efficiency of Brihat haridrakhanda orally & Arka taila as per in the management of Dry eczema. 3. To evaluate the clinical efficacy of Brihat haridrakhanda ora lly & Arka taila as per in the management of Wet eczema. 4. To compare the effect of Brihat haridrakhanda orally & Arka taila on Dry & wet Eczema.
30 cases of Vicharchika were selected randomly from OPD and IPD of Kaumarabhritya S.D.M. College of Ayurveda and Hospital, Hassan. Study is carried out in two groups, each containing 15 patients. Dry group Patient with dry lesion (Shushka Vicharchika). Wet group Patient with wet lesion. (Sravi Vicharchika)Both groups had given Brihat Haridrakhanda orally & Lepa of Arka Taila for 1month along with follow up for 1 month and results observed. Dose:a) Brihat Haridrakhand: 5gms mixed with lukewarm milk; twice daily half an hour before food.b) Arkataila: required quantity for external application.
The study showed there was statistically significant improvement in Kandu (83.33 %),Pidaka (58%),Vaivarnata (55 %) Rookshata (66.66 %) & number of patches (50%) in dry group & there was statistically significant improvement in Kandu (63.63 %), Pidaka (40 %), Vaivarnata (59.26 %), Srava (60 %) & number of patches (50%) in wet groupThe study concluded that there was better improvement in the Dry group in reduction of Kandu, Pidaka, Daha, & Number of patches compares to wet group while in wet group there was better improvement seen in reduction of Vaivarnata & Area of patch compare to Dry group.
Local application and oral medication is more effective. The drugs are having the property Kaphahara, Kandughna, Sravahara & helps in reduction of Rookshata. Brihat Haridrakhanda is sweet and easily palatable.
A Global Programme to Eliminate Lymphatic Filariasis was launched in 2000, with mass drug administration (MDA) as the core strategy of the programme. After completing 13 years of operations through 2012 and with MDA in place in 55 of 73 endemic countries, the impact of the MDA programme on microfilaraemia, hydrocele and lymphedema is in need of being assessed.
During 2000–2012, the MDA programme made remarkable achievements – a total of 6.37 billion treatments were offered and an estimated 4.45 billion treatments were consumed by the population living in endemic areas. Using a model based on empirical observations of the effects of treatment on clinical manifestations, it is estimated that 96.71 million LF cases, including 79.20 million microfilaria carriers, 18.73 million hydrocele cases and a minimum of 5.49 million lymphedema cases have been prevented or cured during this period. Consequently, the global prevalence of LF is calculated to have fallen by 59%, from 3.55% to 1.47%. The fall was highest for microfilaraemia prevalence (68%), followed by 49% in hydrocele prevalence and 25% in lymphedema prevalence. It is estimated that, currently, i.e. after 13 years of the MDA programme, there are still an estimated 67.88 million LF cases that include 36.45 million microfilaria carriers, 19.43 million hydrocele cases and 16.68 million lymphedema cases.
The MDA programme has resulted in significant reduction of the LF burden. Extension of MDA to all at-risk countries and to all regions within those countries where MDA has not yet reached 100% geographic coverage is imperative to further reduce the number of microfilaraemia and chronic disease cases and to reach the global target of interrupting transmission of LF by 2020.
The mass drug administration (MDA) programme to eliminate lymphatic filariasis (LF) was initiated in 2000. By the end of 2012, the programme was in place in 55 endemic countries. During these first 13 years (2000–2012) of programme implementation, 6.37 billion annual single dose anti-filarial treatments were offered and 4.45 billion doses were consumed by the target populations. This massive programme is estimated to have prevented or cured 96.71 million LF cases that include 79.20 million microfilaria carriers, 18.73 million hydrocele cases and a minimum of 5.49 million lymphedema cases, a 59% reduction of initial LF levels. It is further estimated that, currently, i.e. after 13 years of the MDA programme, 67.88 million LF cases remain, including 36.45 million microfilaria carriers, 19.43 million hydrocele cases and 16.68 million lymphedema cases. Progressive reduction in this burden is possible as the programme extends to the endemic countries and regions within endemic countries that have not yet been covered by the MDA programme, and if the morbidity management component of the programme can be effectively implemented.
Approximately 14 million persons living in areas endemic for lymphatic filariasis have lymphedema of the leg. Clinical studies indicate that repeated episodes of bacterial acute dermatolymphangioadenitis (ADLA) lead to progression of lymphedema and that basic lymphedema management, which emphasizes hygiene, skin care, exercise, and leg elevation, can reduce ADLA frequency. However, few studies have prospectively evaluated the effectiveness of basic lymphedema management or assessed the role of compressive bandaging for lymphedema in resource-poor settings.
Between 1995 and 1998, we prospectively monitored ADLA incidence and leg volume in 175 persons with lymphedema of the leg who enrolled in a lymphedema clinic in Leogane, Haiti, an area endemic for Wuchereria bancrofti. During the first phase of the study, when a major focus of the program was to reduce leg volume using compression bandages, ADLA incidence was 1.56 episodes per person-year. After March 1997, when hygiene and skin care were systematically emphasized and bandaging discouraged, ADLA incidence decreased to 0.48 episodes per person-year (P<0.0001). ADLA incidence was significantly associated with leg volume, stage of lymphedema, illiteracy, and use of compression bandages. Leg volume decreased in 78% of patients; over the entire study period, this reduction was statistically significant only for legs with stage 2 lymphedema (P = 0.01).
Basic lymphedema management, which emphasized hygiene and self-care, was associated with a 69% reduction in ADLA incidence. Use of compression bandages in this setting was associated with an increased risk of ADLA. Basic lymphedema management is feasible and effective in resource-limited areas that are endemic for lymphatic filariasis.
Lymphatic filariasis is a parasitic disease that is spread by mosquitoes. In tropical countries where lymphatic filariasis occurs, approximately 14 million people suffer from chronic swelling of the leg, known as lymphedema. Repeated episodes of bacterial skin infection (acute attacks) cause lymphedema to progress to its disfiguring form, elephantiasis. To help achieve the goal of eliminating lymphatic filariasis globally, the World Health Organization recommends basic lymphedema management, which emphasizes hygiene, skin care, exercise, and leg elevation. Its effectiveness in reducing acute attack frequency, as well as the role of compressive bandaging, have not been adequately evaluated in filariasis-endemic areas. Between 1995 and 1998, we studied 175 people with lymphedema of the leg in Leogane, Haiti. During Phase I of the study, when compression bandaging was used to reduce leg volume, the average acute attack rate was 1.56 episodes per year; it was greater in people who were illiterate and those who used compression bandages. After March 1997, when hygiene and skin care were emphasized and bandaging discouraged, acute attack frequency significantly decreased to 0.48 episodes per year. This study highlights the effectiveness of hygiene and skin care, as well as limitations of compressive bandaging, in managing lymphedema in filariasis-endemic areas.
Lymphedema management programs have been shown to decrease episodes of adenolymphangitis (ADLA), but the impact on lymphedema progression and of program compliance have not been thoroughly explored. Our objectives were to determine the rate of ADLA episodes and lymphedema progression over time for patients enrolled in a community-based lymphedema management program. We explored the association between program compliance and ADLA episodes as well as lymphedema progression.
A lymphedema management program was implemented in Odisha State, India from 2007–2010 by the non-governmental organization, Church's Auxiliary for Social Action, in consultation with the Centers for Disease Control and Prevention. A cohort of patients was followed over 24 months. The crude 30-day rate of ADLA episodes decreased from 0.35 episodes per person-month at baseline to 0.23 at 24 months. Over the study period, the percentage of patients who progressed to more severe lymphedema decreased (P-value = 0.0004), while those whose lymphedema regressed increased over time (P-value<0.0001). Overall compliance to lymphedema management, lagged one time point, appeared to have little to no association with the frequency of ADLA episodes among those without entry lesions (RR = 0.87 (0.69, 1.10)) and was associated with an increased rate (RR = 1.44 (1.11, 1.86)) among those with entry lesions. Lagging compliance two time points, it was associated with a decrease in the rate of ADLA episodes among those with entry lesions (RR = 0.77 (95% CI: 0.59, 0.99)) and was somewhat associated among those without entry lesions (RR = 0.83 (95% CI: 0.64, 1.06)). Compliance to soap was associated with a decreased rate of ADLA episodes among those without inter-digital entry lesions.
These results indicate that a community-based lymphedema management program is beneficial for lymphedema patients for both ADLA episodes and lymphedema. It is one of the first studies to demonstrate an association between program compliance and rate of ADLA episodes.
Lymphatic filariasis (LF) is characterized by clinical manifestations of limb swelling, lymphedema, and elephantiasis. LF is the world's second-leading cause of disability, with up to 15 million people with limb lymphedema or elephantiasis. The Global Programme to Eliminate LF aims to eliminate the disease through two pillars: (1) interruption of transmission and (2) treatment of clinical disease among those already affected. The Church's Auxiliary for Social Action (CASA), an Indian NGO, began a lymphedema management program in Khurda District, Odisha State, India in 2007. We evaluated the impact of the program on two clinical LF outcomes: acute episodes of adenolymphangitis (ADLA) and chronic lymphedema progression. The monthly rate of ADLA episodes decreased significantly after enrollment for two years in the program. Additionally, program compliance was found to be associated with ADLA rate among some clinically distinct groups. Compliance to soap was associated with a decreased rate of ADLA episodes among those without inter-digital entry lesions. The percentage of patients who progressed to more severe lymphedema decreased significantly over time, while those whose lymphedema regressed increased significantly. These results indicate that a community-based lymphedema management program is beneficial for lymphedema patients for both ADLA episodes and lymphedema. It is one of the first studies to demonstrate an association between program compliance and ADLA episodes.
Sitopaladi churna (SPC) is a popular polyherbal ayurvedic formulation used in the treatment of allergy and respiratory diseases.
The present study was aimed to justify the classical use of antiallergic claim by performing the mast cell stabilizing activity of extracts of SPC.
Materials and Methods:
The protective effect of aqueous extract and methanolic extract - of SPC against compound 48/80-induced mast cell degranulation model was carried out.
Sitopaladi churna aqueous extract (SPCA) at the dose of 300 mg/kg and Sitopaladi churna methanolic extract (SPCM) at the doses of 150 and 300 mg/kg showed better protection of mast cell degranulation (65%-74%) and were comparable to the standard drug ketotifen (79%), when peritoneal mast cells were treated with compound 48/80. The protection against mast cell degranulation was significant (P < 0.0001).
From the above results, it has been justified that SPC can be used to treat allergic disorders.
Compound 48/80; mast cell stabilizing; Sitopaladi churna
Thrombus formed in blood vessels lead to atherothrombotic diseases such as myocardial or cerebral infarction. Thrombolytic agents are used to dissolve the already formed clots in the blood vessels; however, these drugs sometimes cause serious and fatal consequences. Herbal preparations have been used since ancient times for the treatment of several diseases although they show little toxicity in some cases. Aqueous extracts of herbs used in thrombolysis have been reported before with cytotoxic data, however, the organic extracts of herbs have not been documented. This study aims to investigate whether organic extracts possess thrombolytic properties with minimal or no toxicity.
An in vitro thrombolytic model was used to check the clot lysis effect of six Bangladeshi herbal extracts viz., Ageratum conyzoides L., Clausena suffruticosa, Leea indica (Burm.f.) Merr., Leucas aspera Willd., Senna sophera L. Roxb., and Solanum torvum Swartz. using streptokinase as a positive control and water as a negative control. Briefly, venous blood drawn from twenty healthy volunteers was allowed to form clots which were weighed and treated with the test plant materials to disrupt the clots. Weight of clot after and before treatment provided a percentage of clot lysis. Cytotoxicity was screened by brine shrimp lethality bioassay using vincristine sulfate as positive control.
Using an in vitro thrombolytic model, Ageratum conyzoides, Clausena suffruticosa, Leea indica, Leucas aspera, Senna sophera and Solanum torvum showed 18.12 ± 2.34%, 48.9 ± 2.44%, 39.30 ± 0.96%, 37.32 ± 2.00%, 31.61 ± 2.97% and 31.51 ± 0.57% and clot lysis respectively. Among the herbs studied Clausena suffruticosa, Leea indica and Leucas aspera showed very significant (p < 0.0001) percentage (%) of clot lysis compared to reference drug streptokinase (75.00 ± 3.04%). In brine shrimp cytotoxic assay, the extracts Ageratum conyzoides, Clausena suffruticosa, Leea indica, Leucas aspera, Senna sophera and Solanum torvum showed LC50 values 508.86 ± 6.62,41.16 ± 1.26, 2.65 ± 0.16, 181.67 ± 1.65, 233.37 ± 7.74 and 478.40 ± 3.23 μg/ml, respectively, with reference to vincristine sulfate (LC50 0.76 ± 0.04).
Through our study it was found that Clausena suffruticosa, Leea indica and Leucas aspera possessed effective thrombolytic properties whereas Senna sophera and Solanum torvum showed moderate to mild thrombolytic effects while Ageratum conyzoides showed no significant effect. No extract was found cytoxic compared to positive control. Clausena suffruticosa, Leea indica and Leucas aspera could be incorporated as a thrombolytic agent with in vivo effects to improve the atherothrombotic patients. However, Clausena suffruticosa could be the best one to use in this purpose.
Thrombolysis; Clausena suffruticosa; Leea indica; Leucas aspera; Streptokinase
Nearly 45% of people living at risk for lymphatic filariasis (LF) worldwide live in India. India has faced challenges obtaining the needed levels of compliance with its mass drug administration (MDA) program to interrupt LF transmission, which utilizes diethylcarbamazine (DEC) or DEC plus albendazole. Previously identified predictors of and barriers to compliance with the MDA program were used to refine a pre-MDA educational campaign. The objectives of this study were to assess the impact of these refinements and of a lymphedema morbidity management program on MDA compliance.
A randomized, 30-cluster survey was performed in each of 3 areas: the community-based pre-MDA education plus community-based lymphedema management education (Com-MDA+LM) area, the community-based pre-MDA education (Com-MDA) area, and the Indian standard pre-MDA education (MDA-only) area. Compliance with the MDA program was 90.2% in Com-MDA+LM, 75.0% in Com-MDA, and 52.9% in the MDA-only areas (p<0.0001). Identified barriers to adherence included: 1) fear of side effects and 2) lack of recognition of one's personal benefit from adherence. Multivariable predictors of adherence amenable to educational intervention were: 1) knowing about the MDA in advance of its occurrence, 2) knowing everyone is at risk for LF, 3) knowing that the MDA was for LF, and 4) knowing at least one component of the lymphedema management techniques taught in the lymphedema management program.
This study confirmed previously identified predictors of and barriers to compliance with India's MDA program for LF. More importantly, it showed that targeting these predictors and barriers in a timely and clear pre-MDA educational campaign can increase compliance with MDA programs, and it demonstrated, for the first time, that lymphedema management programs may also increase compliance with MDA programs.
Global elimination of lymphatic filariasis requires giving drugs at least annually to populations who live at risk of becoming infected with the parasite. At least 80% of people at risk need to take the drugs annually for 5 or more years to stop transmission of the infection. People suffering from the long-term effects of infection, such as swollen legs, benefit from programs that teach self-care of their affected limbs. In this study, we assessed the impact of an educational campaign that, after addressing previously identified predictors of compliance, significantly improved drug compliance. The specific factors improving compliance included knowing about the drug distribution in advance, knowing that everyone is at risk for acquiring the infection, knowing that the drug distribution was for lymphatic filariasis prevention, and knowing at least one component of leg care. We also found that areas with programs to assist people with swollen legs had greater increases in compliance. This research provides evidence that program evaluation can be used to improve drug compliance. In addition, our work shows for the first time that programs to benefit people with swollen legs caused by lymphatic filariasis also increase the participation of people without disease in drug treatment programs.
Lymphatic filariasis (LF) infects approximately 120 million people worldwide. As many as 40 million have symptoms of LF disease, including lymphedema, elephantiasis, and hydrocele. India constitutes approximately 45% of the world's burden of LF. The Indian NGO Church's Auxiliary for Social Action (CASA) has been conducting a community-based lymphedema management program in Orissa State since 2007 that aims to reduce the morbidity associated with lymphedema and elephantiasis. The objective of this analysis is to evaluate the effects of this program on lymphedema patients' perceived disability.
For this prospective cohort study, 370 patients ≥14 years of age, who reported lymphedema lasting more than three months in one or both legs, were recruited from villages in the Bolagarh sub-district, Khurda District, Orissa, India. The World Health Organization Disability Assessment Schedule II was administered to participants at baseline (July, 2009), and then at regular intervals through 24 months (July, 2011), to assess patients' perceived disability. Disability scores decreased significantly (p<0.0001) from baseline to 24 months. Multivariable analysis using mixed effects modeling found that employment and time in the program were significantly associated with lower disability scores after two years of program involvement. Older age, female gender, the presence of other chronic health conditions, moderate (Stage 3) or advanced (Stage 4–7) lymphedema, reporting an adenolymphangitis (ADL) episode during the previous 30 days, and the presence of inter-digital lesions were associated with higher disability scores. Patients with moderate or advanced lymphedema experienced greater improvements in perceived disability over time. Patients participating in the program for at least 12 months also reported losing 2.5 fewer work days per month (p<0.001) due to their lymphedema, compared to baseline.
These results indicate that community-based lymphedema management programs can reduce disability and prevent days of work lost. These effects were sustained over a 24 month period.
Lymphatic filariasis (LF) is the world's second-leading cause of disability and causes limb lymphedema and elephantiasis in up to 15 million people and lymphedema or hydrocele in over 40 million people, worldwide. A massive global effort has been undertaken to eliminate LF as a public health problem. LF elimination is based on two pillars: (1) interruption of transmission and (2) treatment of clinical disease among those already affected. The Indian NGO, Church's Auxiliary for Social Action (CASA), has been providing community-based treatment of lymphedema in Khurda District, Orissa State, India, since 2007. We evaluated the impact of this treatment program on the participating patients' perceived disability using the WHO Disability Assessment Schedule II (WHO-DAS II). After two years of enrollment in the program, patients had significantly lower levels of perceived disability. We found that being employed and time enrolled in the program were associated with significant reductions in disability scores. Compared to baseline, patients enrolled in the program for at least 12 months reported 2.5 fewer days of work lost in the previous 30 days due to their lymphedema. These findings indicate that participation in a community-based lymphedema management program can reduce patients' disability and prevent days of work lost due to lymphedema.
Balacaturbhadrika churna has an important place in pediatric practice in Ayurveda. Millennia of use of this formulation bears testimony to its safety when used for prolonged duration in children. This prompted us to initiate a long-term, acute oral toxicity evaluation of Balacaturbhadrika churna in rats. The study was carried out by administering Balacaturbhadrika churna orally once only in a dose up to 2000 mg/kg. For long-term toxicity, Balacaturbhadrika churna was administered in doses of 450 and 900 mg/kg orally for 45 consecutive days. The effects of the drug on ponderal changes, hematological, biochemical and histological parameters were noted. The acute toxicity experiment showed that the drug did not produce any signs and symptoms of toxicity (or mortality) up to the dose of 2000 mg/kg. Long-term toxicity results showed that, even at higher dose of 900 mg/kg, Balacaturbhadrika churna did not affect the parameters studied, to a significant extent. The doses employed for these toxicity studies were several times higher than normal clinical doses of Balacaturbhadrika churna, hence the observed changes will probably not become apparent at therapeutic dose level.
Aconitum heterophyllum; acute toxicity; Balacaturbhadrika churna; long-term toxicity
Rotaviruses are the single most important cause of severe diarrhea in young children worldwide. The developments of specific, potent and accessible antiviral treatments that restrain rotavirus infection remain important to control rotavirus disease.
150 plant extracts with nutritional applications were screened in vitro on MA-104 cells for their antiviral activity against rhesus rotavirus (RRV). One extract (Aspalathus linearis (Burm.f.) R.Dahlgren) was also tested for its effect on the loss of transepithelial resistance (TER) of Caco-2 cells caused by simian rotavirus (SA-11) infection.
Aqueous extracts of Nelumbo nucifera Gaertn. fruit, Urtica dioica L. root, Aspalathus linearis (Burm.f.) R.Dahlgren leaves, Glycyrrhiza glabra L. root and Olea europaea L. leaves were found to have strong significant antiviral activity with a 50% inhibitory concentration (IC50) < 300 μg/ml. The pure compound 18ß-glycyrrhetinic acid from Glycyrrhiza glabra was found to have the strongest antiviral activity (IC50 46 μM), followed by luteolin and vitexin from Aspalathus linearis (IC50 respectively 116 μM and 129 μM) and apigenin-7-O-glucoside from Melissa officinalis (IC50 150 μM). A combination of Glycyrrhiza glabra L. + Nelumbo nucifera Gaertn. and Urtica dioica L. + Nelumbo nucifera Gaertn. showed synergy in their anti-viral activities. Aspalathus linearis (Burm.f.) R.Dahlgren showed no positive effect on the maintenance of the TER.
These results indicate that nutritional intervention with extracts of Nelumbo nucifera Gaertn., Aspalathus linearis (Burm.f.) R.Dahlgren, Urtica dioica L., Glycyrrhiza glabra L. and Olea europaea L. might be useful in the treatment of diarrhea caused by rotavirus infection.
Rotavirus; Antiviral activity; Transepithelial resistance; Plant extracts
The disease Amavata can be presented as very similar to Rheumatoid Arthritis. Rheumatoid Arthritis is chronic in nature and affects mostly middle aged people. For this disease there is no satisfactory medicine is available till date. But in Ayurveda there are many drugs described for Amavata which are cost effective and easily available with no side effects. The present clinical study evaluated the effect of Chitrakadi Churna and Kshar Basti in the management of Amavata.
30 clinically diagnosed patient of Amavata were registered and completed the trial. In this 15 patients (Group A) administered Chitrakadi Churna 4gm twice daily with lukewarm water after meal. Another 15 patients (Group B) administered Chitrakadi Churna 4gm twice daily with lukewarm water after meal and Kshar Basti as per Kalbasti krama i.e 16days followed by local Snehan Swedan.
Results of this trial were encouraging as there is improvement in each symptom of patient like pain, stiffness, swelling, and tenderness. Group A in which only Chitrakadi Churna was administered there was no significant improvement seen statistically. But Group B in which Chitrakadi Churna as well as Kshar Basti was administered highly significant improvement seen statistically. Details of the Statistical test and other important will be discussed at the time of paper presentation.
From present clinical trial it is concluded that this therapy is very useful for pain, swelling, tenderness and stiffness, which were chief complaint of the patient. Chronicity more than 3 years did not show marked improvement. And also this drug is supposed to be very good combination of Vedanashamaka, Shothaghna, Amapachaka Dravyas. No untoward effects were seen except mild loss of weight.
Avipattikar churna, a poly-herbal formulation, is one of the popular ayurvedic formulations which is used for peptic ulcer diseases but the scientific documentation with regards to its effect for the indication is lacking.
Aims: This study was carried out to evaluate the anti-secretory and the anti-ulcerogenic activities of the churna and to compare its activity with that of ranitidine in a pyloric ligated model of rats.
Material and methods: Four groups of rats with 6 animals in each served as the ulcer controls, churna low dose (500 mg/kg), churna high dose (750mg/kg) and ranitidine (25mg/kg). The control group rats received only vehicle (2% (v/v) gum acacia), while the rats of the other groups received the respective dose of the churna or ranitidine which was suspended in the vehicle. The treatments were given twice a day, orally, for two days. After 1 hour of the last dose, pyloric ligations were performed and the rats were sacrificed for evaluation after four hours of the ligations. The gastric contents were collected and its volume, pH and acidity were measured. The numbers of ulcers and their lengths were measured which were used to calculate the gastric irritancy index and the curative ratio. The histological examinations of the gastric tissues were also performed.
Results: The churna, in both doses, significantly decreased the volumes of the gastric contents, the ulcer score, the length of the ulcer, the gastric irritancy index and pH increased as compared to those in the control group. The effects of the churna were comparable to that of ranitidine. The histopathological evaluation of the gastric tissue also supported the results.
Avipattikar churna has anti-secretory and anti-ulcerogenic effects which are comparable to those of ranitidine in peptic ulcer diseases.
Avipattikar churna; Gastric acid; Peptic ulcer; Pyloric ligation; Ranitidine, Rats
Guduchi (Tinospora cordifolia wild miers) is a well-known medicinal plant, which is abundantly used in different ayurvedic formulations utilizing varieties of media. The drug has properties like Rasayana (rejuvenating property), Krimighna (anthelmintics), and Kushtghna (used in skin disorders), as described in ayurvedic literature. Taila (oil) and Ghrita (ghee) are used as media in Ayurvedic Sneha (oleaginous) formulations. Both the test drugs, Guduchi Taila and Ghrita, are prescribed in Vatrakta (gout) and also indicated for Kushtha (skin disorder). With all these details, the Guduchi Taila and Guduchi Ghrita samples, prepared by using Taila and Ghrita as media, have been subjected to comparative pharmacological investigations, to assess the impact of the media on the expression of pharmacological activity. The formulations have been evaluated for immunomodulation, anti-inflammatory, and anti-stress activities. Both the formulations have been found to be active in most of the experiments, however, with the change of media, their results vary at different levels. Taila prepared from Guduchi was found to have an immunostimulating activity. The formulation prepared with Ghrita exhibited an anti-stress effect with an immunosuppressing activity.
Guduchi (Tinospora cordifolia wild miers); Guduchi Taila; Guduchi Ghrita; Immunomodulation; Anti-inflammatory; Anti-stress
In its first 8 years, the Global Programme to Eliminate Lymphatic Filariasis (GPELF) achieved an unprecedentedly rapid scale-up: >1.9 billion treatments with anti-filarial drugs (albendazole, ivermectin, and diethylcarbamazine) were provided via yearly mass drug administration (MDA) to a minimum of 570 million individuals living in 48 of the 83 initially identified LF-endemic countries.
To assess the health impact that this massive global effort has had, we analyzed the benefits accrued first from preventing or stopping the progression of LF disease, and then from the broader anti-parasite effects (‘beyond-LF’ benefits) attributable to the use of albendazole and ivermectin. Projections were based on demographic and disease prevalence data from publications of the Population Reference Bureau, The World Bank, and the World Health Organization.
Between 2000 and 2007, the GPELF prevented LF disease in an estimated 6.6 million newborns who would otherwise have acquired LF, thus averting in their lifetimes nearly 1.4 million cases of hydrocele, 800,000 cases of lymphedema and 4.4 million cases of subclinical disease. Similarly, 9.5 million individuals—previously infected but without overt manifestations of disease—were protected from developing hydrocele (6.0 million) or lymphedema (3.5 million). These LF-related benefits, by themselves, translate into 32 million DALYs (Disability Adjusted Life Years) averted. Ancillary, ‘beyond-LF’ benefits from the >1.9 billion treatments delivered by the GPELF were also enormous, especially because of the >310 million treatments to the children and women of childbearing age who received albendazole with/without ivermectin (effectively treating intestinal helminths, onchocerciasis, lice, scabies, and other conditions). These benefits can be described but remain difficult to quantify, largely because of the poorly defined epidemiology of these latter infections.
The GPELF has earlier been described as a ‘best buy’ in global health; this present tally of attributable health benefits from its first 8 years strengthens this notion considerably.
Lymphatic filariasis (LF) is a vector-borne, chronically disabling parasitic infection causing elephantiasis, lymphedema, and hydrocele. The infection is endemic in 83 countries worldwide, with more than 1.2 billion people at risk and 120 million already infected. Since 1998, the Global Programme to Eliminate Lymphatic Filariasis (GPELF) has targeted elimination of LF by 2020. In its first 8 operational years, the program has scaled-up to provide more than 1.9 billion treatments through annual, single-dose mass drug administration (MDA) to ∼570 million individuals living in 48 LF-endemic countries. Not only do the GPELF drugs prevent the spread of LF, they also stop the progression of disease in those already infected. In addition, since two of the three drugs used for LF elimination have broad anti-parasite properties, treated populations are freed from both intestinal worms and from skin infections with onchocerca, lice, and scabies. To better understand the public health benefit of this ongoing global health initiative, we undertook an analysis of Programme data made available to WHO by participating countries. Our conservative estimates show that the GPELF has had an unprecedented public health impact on both LF and other neglected tropical diseases; it justly deserves the accolade of ‘a best buy’ in global health.
A major factor in the progression of lymphedema is acute dermatolymphangioadenitis (ADLA).
To study ADLA episodes and antigenaemia in patients with different grades of filarial lymphedema at pre- and two years post-treatment.
Setting and Design:
A prospectively conducted study from May 2008 through May 2010.
Patients and Methods:
Forty five patients complaining of limb swelling with present or past history of limb redness suggestive of ADLA attacks were included. Patients were clinically examined for lymphedema grading, detection of potential entry points and diagnosis of microfilaraemia. Wuchereria bancrofti antigen titer was estimated by “Trop-Ag W. Bancrofti” ELISA kit. Basic lymphedema management and treatment with antifilarial drugs were applied.
Mann–Whitney test and Chi-square test were used.
The number of ADLA attacks in the pretreatment period, ranged from one to three per year. Mean duration of the attacks was 3.87±0.79 days. Entry points were detected in 82% of cases. The study revealed statistical significance between extension and grade of lymphedema and number of ADLA attacks per year (P=0.018 and 0.022, respectively). Microfilaraemia was detected in four cases and positive filarial antigenaemia were detected in 29 patients (64.4). The number of ADLA attacks per year significantly decreased from the pre-treatment period (mean: 2.05±0.560) to be 1.23±0.706 after one year and 0.89±0.575 after two years post treatment. There was a significant decrease in the mean antigen titer one year and two years after treatment.
Basic lymphedema management is effective for controlling ADLA attacks in areas where lymphatic filariasis is endemic.
Acute dermatolymphangioadenitis; Filarial; Lymphedema
Lymphedema related to lymphatic filariasis (LF) is a disabling condition that commonly manifests in adolescence. Fifty-three adolescents, 25 LF infected and 28 LF non-infected, in age and sex-matched groups, using the Binax ICT rapid card test for filarial antigen were recruited to the study. None of the participants had overt signs of lymphedema. Lymphedema assessment measures were used to assess lower limb tissue compressibility (tonometry), limb circumference (tape measure), intra- and extra-cellular fluid distribution (bioimpedance) and joint range of motion (goniometry). The mean tonometric measurements from the left, right, and dominant posterior thighs were significantly larger in participants with LF compared to participants who had tested negative for LF (p = 0.005, p = 0.004, and p = 0.003, respectively) indicating increased tissue compressibility in those adolescents with LF. ROC curve analysis to define optimal cut-off of the tonometry measurements indicated that at 3.5, sensitivity of this potential screening test is 100% (95%-CI = 86.3%, 100%) and specificity is 21.4% (95%-CI = 8.3%, 41.0%). It is proposed that this cut-off can be used to indicate tissue change characteristic of LF in an at-risk population of PNG adolescents. Further longitudinal research is required to establish if all those with tissue change subsequently develop lymphedema. However, thigh tonometry to identify early tissue change in LF positive adolescents may enable early intervention to minimize progression of lymphedema and prioritization of limited resources to those at greatest risk of developing lifetime morbidity.
The effects of lymphatic filariasis (LF) on the lymphatic system often become apparent during adolescence when the lower limb swells due to lymphedema and males develop hydrocele. Currently there is no simple or mobile field method to identify those at greatest risk of developing lymphedema or those with early subclinical lower limb change. Fifty-three adolescents, 25 LF infected and 28 LF non-infected were recruited to the study. The groups were compared with respect to lower limb tissue compressibility (tonometry), limb circumference (tape measure), intra- and extra-cellular fluid distribution (bioimpedance) and hip, knee and ankle joint range of motion (goniometry). Tonometry, is a simple, inexpensive tool, which measures the distance a plunger will indent the soft tissues. Those adolescents who were LF positive had significantly increased soft tissue compressibility when assessed with tonometry than adolescents who were LF negative. Tonometry has high levels of sensitivity to identify adolescents who test positive to LF. If we are able to identify adolescents before they have overt symptoms, management practices to decrease disease progression can be implemented. This could prevent lifetime morbidity and allow allocation of scarce resources to those identified to be most at risk of developing lymphedema.
In the last few decades, there has been exponential growth in the field of herbal remedies. Pharmacopoeial preparations like avleha or paka (semi-solid), swarasa (expressed juice), kalka (mass), him (cold infusion) and phanta (hot infusion), kwatha (decoction) and churna (powder) form the backbone of Ayurvedic formulations. Newer guidelines for standardization, manufacture, and quality control, and scientifically rigorous research will be necessary for traditional treatments. This traditional knowledge can serve as powerful search engine that will greatly facilitate drug discovery.
The aim of the present study is to standardize Saubhagya Shunthi Paka in churna (powder) form. The powder form makes this traditional drug more stable for long-term storage and hence, easier to preserve.
Materials and Methods:
Saubhagya Shunthi Paka is an ayurvedic formulation containing Shunthi (Zingiber officinalis) as one of its chief ingredients. The basic preparation of this drug is a semisolid. We checked the microbial load and nutrient values (using International Standard IS and Association of Official Analytical chemists AOAC methods)
The powdered form of Saubhagya Shunthi Churna yielded a weight loss of approximately 17.64% of the total weight of ingredients. The total energy of Churna (calculated based on nutrient content) was found higher over Paka.
Saubhagya Shunthi Churna may be a good therapeutic and dietary medicine for Indian women, which may be easily prepared at home.
Ayurveda; Churna (powder); saubhagya shunthi paka; paka (semi-solid); puerperium
According to Sushruta, disease in which plaque formed on teeth and hardened by the action of deranged Vayu, lies in a crystallized form at root of teeth is called as Dantasharkara. According to Vagbhata, accumulation of dirt on teeth by not cleaning them daily or of Kapha dehydrated by Vata adhering to the teeth, becoming hard and emits bad odor is known as Dantasharkara (Tartar). Tartar manifests as a deposit of inorganic salts composed primarily of calcium carbonate and phosphate mixed with food debris, bacteria and desquamated epithelial cells which reduce the quality of whiteness and strength of the teeth. Teeth loss is also not uncommon in tartar sufferers. Such deposits tend to destroy the healthy growth and function of teeth. It should be removed in such a way as not to hurt the roots of the teeth and then parts should be rubbed (Pratisarana) with Laksha Churna and Madhu. In trial group, management of tartar is attempted by local rubbing of Laksha Churna with Madhu on the surface of teeth and gingiva. Regeneration, repair and new attachment are the aspects of periodontal healing that are achieved by gingival physiotherapy on scaling wound. Pratisarana of Laksha Churna with Madhu is easy to apply, cost effective and free from side effects in comparison to systemic use of modern drugs.
Dantasharkara; Laksha Churna; Madhu; Pratisarana; Vranaropaka
Vyanga is one of the Kshudraroga, characterized by the presence of Niruja (painless) and Shavavarna Mandalas (bluish-black patches) on face. It is one of the most common diseases as regards the face is concerned. On the basis of clinical features, it can be compared with facial melanosis, one of the hyper pigmented disorders. Drugs with Rakta Prasadaka, Twak Prasadaka and Varnyakara properties are helpful in the management of Vyanga, that pacifies aggregated Doshas and help in Raktashodhana (blood purification).
To evaluate the efficacy of Arjunatwak Lepa and Panchanimba Churna in Vyanga.
Materials and Methods:
In this study, the trial drugs used were Arjunatwak Churna for Lepa (tropical application) and Panchanimba Churna for oral administration. A total 30 patients of Vyanga were selected from outpatient department and inpatient department of Shalakya Tantra Department and allotted randomly in two groups. In group-A, the patients were treated with external application of Arjunatwak Churna and Madhu for 21 days, while in group-B, patients received Panchanimba Churna orally for 21 days in addition to Arjunatwak Churna for Lepa. Effect of therapy on chief complaint i.e., bluish-black pigmentation in Group A was 60% relief, while in Group B 80% relief was found.
The clinical study has shown that combined therapy gives better results than topical treatment.
Arjunatwak Churna; facial melanosis; Panchanimba Churna; Vyanga
The diseases related to nutrition constitute the most important health problem of the world. It may be due to over nutrition in the form of obesity (Sthula) as in developed countries and due to under nutrition in the form of underweight (Karshya) as in the developing countries. It has been estimated that as many as two third of the world population suffer by under nutrition. According to Ayurvedic classics Vataja Prakriti person has lean body constitution and there is continuous degradation and aggradations in the body (Chakrapani Tika). So in person of Vataja Prakriti this phenomenon of degradation will lead to undernourishment thus resulting in difficulty for the person to cope with requirements of his life and falling prey to many disease even death.
Aims and objectives: To study the effect of oral administration of “Tila Taila” in Karshya person. To include “Tila Taila” in the food for well-being of the person.
Materials and Method:
The study was carried out in 80 individuals of Karshya, which were divided into 2 Groups. Group A having 35 persons were treated with Tila taila and Group B having 37 persons were treated with Mahish ghrita.
Result & Observations:
It was found that Group A i.e. treatment with Tila taila showed highly significant results in BMI followed by Group B showing significant results in serum cholesterol. Percentage of relief in symptoms was better in Group A but statistically both group shows significant result separately.
Maximum individuals i.e. 25% are with weight gain between 0.6 1kg. Mean change in serum cholesterol in Group A was 8.45 and in Group B was 18.27 and p value was 0.0001. Mean change in BMI in Group A was 0.43 and in Group B was 0.29 and p value was <0.05.
No satisfactory effective treatment is available yet to cure diabetes mellitus. Though, synthetic drugs are used but there are several drawbacks. The attributed antihyperglycemic effects of many traditional plants are due to their ability for the management of diabetes mellitus.
Materials and Methods:
A hydromethanolic extract was administered orally at a dose of 250 mg/kg of body weight per day for 21 days. Its effects on the fasting blood glucose (FBG) level, activities of key carbohydrate metabolic enzymes like hexokinase, glucose-6-phosphatase, and glucose-6-phosphate dehydrogenase, and antioxidant enzymes like catalase and superoxide dismutase along with the effect on the lipid peroxidation level in hepatic tissues were measured. Glycogen levels were also assessed in hepatic and skeletal muscles and some toxicity parameters, such as serum glutamate oxaloacetate transaminase, glutamate pyruvate transaminase, and alkaline phosphates activities were measured.
Treatment of the hydromethanolic extract of the seeds of Caesalpinia bonduc resulted in a significant (P < 0.05) recovery in the activities of carbohydrate metabolic enzymes along with correction in FBG and glycogen levels as compared with the untreated diabetic group. The extract also resulted in a significant (P < 0.05) recovery in the activities of toxicity assessment enzyme parameters. Activities of antioxidant enzymes like catalase and superoxide dismutase along with the lipid peroxidation levels were also recovered significantly (P < 0.05) after the treatment of the extract. The corrective effects produced by the extract were compared with the standard antidiabetic drug, glibenclamide.
Our findings provide that the extract shows possible antihyperglycemic and antioxidative activities.
Antihyperglycemic; antioxidative; C. bonduc; streptozotocin