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
Standardization of herbal formulations is essential in order to assess the quality of drugs, based on the concentration of their active principles. This article reports on standardization of Ajmodadi churna, a polyherbal ayurvedic medicine used as a carminative and an antispasmodic, and is a strong wormifuge, and helps in all painful conditions like sciatica and stiffness in back and also restores normal digestive functions. Ajmodadi churna was prepared as per Ayurvedic Formulary of India. In-house preparation and the marketed drug have been standardized on the basis of organoleptic characters, physical characteristics, and physico-chemical properties. The set parameters were found to be sufficient to evaluate the churna and can be used as reference standards for the quality control/quality assurance laboratory of a Pharmaceutical house.
Ajmodadi churna; physico-chemical; polyherbal formulation; standardization
Ayurvedic formulations are used to treat a wide variety of diseases including diabetes mellitus Standardization of herbal formulation is essential in order to assess the quality of drugs. The present paper reports standardization of eight herbal anti-diabetic drugs–Momordica charantia (seeds), Syzigium cumini (seeds), Trigonella foenum (seeds), Azadirachta indica (leaves), Emblica offi cinalis (fruits), Curcuma longa (rhizomes), Gymnema sylvestre (leaves), Pterocarpus marsupium (heart-wood) individually and in polyherbal marketed samples of Baidyanath Madhumehari Churna
Material and Methods:
Shivayu Madhuhari Churna, Meghdut Madhushoonya Churna and were compared to the in-house preparation for physicochemical properties.
Results and Conclusions:
The limits obtained from the different physicochemical parameters of the individual eight herbal drugs and the marketed formulations could be used as reference standard for standardization of the anti-diabetic drugs in a quality control laboratory.
Herbal antidiabetic drugs; physicochemical parameters; polyherbal formulation; standardization
Diabetic neuropathy is a relatively early and common complication affecting approximately 30% of diabetic patients. According to Ayurvedic principles there is involvement of Vata and Pitta Dosa in diabetic neuropathy. Bhumyamalaki (Phyllanthus niruri) is a plant which shows possibility to pacify these two Dosas. Another plant Atibala (Abutilon indicum) has also Vata pacifying qualities. Present study has been carried out to study the effects of Bhumyamalaki and Atibala on 33 patients of diabetic neuropathy. All the patients have been given Bhumyamalaki Churna 3 g twice a day and decoction of 10 g of Atibala-mula twice a day for 30 days. Neuropathy analyzer machine has been used for exact recording of sensory perception of vibration, cold and hot sensations before and after treatment. Changes in numbness, tingling, burning sensation and pain in lower limbs have also been assessed before and after treatment. Results have been analyzed statistically by applying the ‘t’ test. It can be stated from the results that use of Bhumyamalaki and Atibalamula in the patients of diabetic neuropathy can revert the diminished sensory perception and can reduce the symptoms significantly.
Abutilon indicum; Atibala; Bhumyamalaki; Diabetic neuropathy; Phyllanthus niruri
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
Standardization of a compound Ayurvedic formulation is a critical and essential issue to be considered in assuring the therapeutic efficacy and safety and to rationalize their use in the health care. Sitopaladi churna is a reputed polyherbal formulation of Ayurveda. It is prescribed for the treatment of pleurodynia, intercostal neuralgia, cold, cough associated with bronchitis, pneumonia, tuberculosis, viral respiratory infection, and in pharyngeal and chest congestion.
The present study aimed at physico-chemical standardization of in-house and two marketed brands of Sitopaladi churna.
Materials and Methods:
In our investigation, in-house churna and two commercial brands of Sitopaladi churna were standardized based on powder microscopy, physico-chemical evaluations, thin layer chromatography (TLC) and high performance thin layer chromatography (HPTLC) finger printing as per standard procedures.
The set parameters were sufficient to evaluate the churna based on various physico-chemical parameters.
The data evolved can be adopted for laying down the standards for the manufacturing units of Sitopaladi churna.
High performance thin layer chromatography; physico-chemical; Sitopaladi churna; standardization
Iron is one among the major metals present in the earth's crust and is essential for sound sustenance of human body. Its deficiency leads to various health ailments. Contemporary medicine advises iron supplements in iron deficiency anemia. Ayurvedic classics also quote significant information about administration of iron. Lauha Kalpas are the unique compound herbo-mineral formulations where iron (Lauha) is used as a major ingredient. Relevant literature (Bhaishajya Ratnavali, Charaka Samhita, Rasendra Sara Samgraha etc.) reviewed to gather information about Lauha Kalpas. Critical analysis of these Lauha Kalpas reveals that ancient seers administered iron in a better acceptable form. Unlike popular understanding these are not only Khalviya preparations; but Churna (powders), Avaleha (confectionaries), Rasakriya (solidified decoctions), and Putapaka (incinerated) form of preparations are also found. Apart from solid dosage forms, semisolid dosage forms mentioned in classics are very much useful. Unfortunately most of the formulations are not found in the market. Hence Pharmaceutical firms may bring these unique dosage forms in to the market to supply the healthcare needs of the community. It is interesting that iron preparations are used in Ayurveda in different medical conditions apart from anemia (Pandu). This leaves a scope for further researches on different dosage forms of iron and their indications.
Ayurveda; Bhasma; Hematinics; Iron; Lauha Kalpa; pharmaceutics; Rasaushadhi
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
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
SURADARU LEPA CHURNA’-A Compound drug formulation in Ayurvedic system of medicine was analysed. The proximate chemical analysis, the microscopic method of identifying their ingredients, flourescese study and thin layer chromatographic studies of the drug have been reported in this paper.
The epidemiological knowledge on acute condition of lymphatic filariasis is essential to understand the burden and issues on management of the disease.
A one year long longitudinal prospective surveillance of acute adenolymphangitis (ADL) was carried out in rural population of Orissa, India.
The annual incidence of ADL per 1000 individuals is 85.0, and is slightly higher (P > 0.05) in male (92.0) than in female (77.6). A steady rise in the incidence of ADL episodes along with the age is recorded. The distribution indicates that persons with chronic disease are more prone to ADL attacks. The average number of episodes per year is 1.57 (1.15 SD) per affected person, and is gender dependent. Duration of the episode varies from 1 to 11 days with mean duration of 3.93 (1.94 SD) days. The chronic disease is the significant predictor for the duration of the episode. The data show that fever and swelling at inguinal regions are most common symptoms.
The incidence, frequency and duration of ADL episodes in this community are similar to that of other endemic areas. As the loss due to these ADL episodes is substantial, it should be considered while further estimating the burden due to lymphatic filariasis. The disability and loss caused by chronic forms of filariasis is higher, and the additional incapacity caused by the ADL episode, majority of which occur among chronic filariasis patients, further poses the burden on individuals and their families. Hence, morbidity management measures to prevent ADL episodes among endemic communities are to be implemented.
In Ayurveda, various herbal preparations are clinically used to prevent or cure infectious diseases. Herbal preparations such as Triphala churna, Hareetaki churna, Dashmula churna, Manjistadi churna, Sukhsarak churna, Ajmodadi churna, Shivkshar pachan churna, Mahasudarshan churna, Swadist Virechan churna and Pipramool churna were investigated by preparing their organic solvent extract for antibacterial potential against enteric bacterial pathogens such as Escherichia coli, Staphylococcus aureus, Enterobacter aerogenes, Pseudomonas aeruginosa, Bacillus subtilis, Klebsiella pneumoniae, Salmonella typhi, Staphylococcus epidermidis, Salmonella typhimurium and Proteus vulgaris, respectively. In the present study, Triphala churna, Hareetaki churna, Dashmula churna were potent antibacterial agents against S. epidermidis, P. vulgaris, S. aureus, E. coli, P. aeruginosa and S. typhi. The study supports the use of these herbal preparations not only as dietary supplements but also as agents to prevent or control enteric bacterial infections.
Antibacterial activity; dashmula churna; hareetaki churna; triphala churna
Karpoordi Taila is a medicated oil used in Ayurvedic system of Medicine for ‘Vaathavikaram’. The drugs used in karpoorradi Taila are trachysperum ammi (Linn) Sprague (Ayamodakam) and Cinnammomum camphora (Linn) Nees and Eberm (Karpooram). The phyusico chemical standards and the Thin Layer chromatographic standards presented in this paper can be used as finger print standards for karpporadi Taila.
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
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.
The classification of Dravya has been undertaken in many ways, but according to the medicinal value, they are mainly divided into two - Bheshaja and Abheshaja. No study has been documented on Abheshaja to date as per the scholar's knowledge. Therefore, the present study was carried out to understand the concept of Abheshaja by a practical study. The drug Pippali (Piper Longum Linn.) has been contraindicated to be used for a longer duration. A clinical study was carried out on patients with Kaphaja Kasa, to evolve and assess if the drug acts as Abheshaja or not, and if yes, then under what circumstances. The patients of Kaphaja Kasa had been selected by the random sampling method. They were randomly divided into two groups - Group A and Group B. In Group A, test drug Pippali Churna was administered. Group B was a standard control group and Vasa Churna was given to this group. The dose of both the drugs was 4 g B.I.D. The result was assessed after three weeks of drug administration with the help of a specially prepared proforma. All the important hematological, biochemical, urine, and stool investigations were carried out. There was no adverse drug reaction (ADR) observed after the administration of Pippali in this particular study.
Abheshaja; Adverse drug reaction; Pippali; Piper longum Linn.; Kaphaja Kasa
Dental caries is progressive destruction of enamel, dentine and cementum, initiated by microbial activity at the tooth surface. It is one of the major problems in dentistry. On the basis of clinical features, it can be compared with Krimidanta which is one among the eight diseases of tooth. In the management of Krimidanta, Krimighna, Vataghna and Ushna Veerya dravyas are to be used which can relieve the toothache and discoloration. In this study, the trial drugs used were Jatipatradi Gutika for Pratisarana and Yavanadi Churna for oral administration. In this study, the patients of Krimidanta (dental caries) were selected from OPD of Shalakya Department and allotted randomly in different groups. In Group A, the patients were treated with Jatipatradi Gutika for Pratisarana for 30 days. In Group B, the patients were treated with Yavanadi Churna orally and Group C patients were treated with combined therapy for 30 days. The clinical study has shown that combined therapy gives better results than individual therapies.
Dental caries; Jatiptradi Gutika; Krimidanta; Pratisarana; Yavanadi Churna
Vamana Karma (therapeutic emesis) is the best therapy for the elimination of vitiated Kapha Dosha. In the present clinical practice Madanaphala (Randia dumetorum) is mainly used for Vamana Karma. Apart from Madanaphala, five other drugs, and in total 355 formulations are described in Charaka Samhita; one of them is Krutavedhana (Luffa acutangula) kalpa (formulations). Krutavedhana is specially indicated in Gadha (compact) Dosha condition like Kushtha (skin diseases), Garavisha (slow poison), and so on, for Vamana Karma. The present study aimed to observe the effect on Vamana Karma and by that its effect on Ekakushtha (Psoriasis). Krutavedhana Beeja Churna (seed powder) was given with Madhu (honey) and Saindhava (rock salt) as Vamana Yoga (emetic formulation), to compare it with Madanaphala Pippali Churna (seed powder). After the Sansarjana Krama (special dietetic schedule), Panchatikta Ghrita (medicated ghee) was given as Shamana Sneha (pacifying oleation). An average dose of Krutavedhana was 5.9 g. Krutavedhana could produce a good number of Vega (bouts), Pittanta Lakshana (bile coming out at the end of Vamana), and Pravara Shuddhi (maximum cleansing) in a majority of patients. Madanaphala is the best among all Vamaka (emetic) drugs, but Krutavedhana showed a similar to higher effect on Vamana Karma in terms of Antiki, Maniki, Vaigiki, and Laingiki
Shuddhi (cleansing criteria). Vamana Karma by Krutavedhana showed better relief in Matsyashakalopamam (silvery scale), Kandu (itching), and Rukshataa (dryness), while Madanapahala showed better relief in Krishnaruna Varna (erythema). After completion of the Shamana (pacifying) treatment, both the groups showed nearly the same effect on Asvedanam (lack of perspiration), Matsyashakalopamam, Kandu, Rukshataa, Krishnaruna Varna, and Mahaavaastu (bigger lesion).
Ekakushtha; Krutavedhana; Madanaphala; Panchatikta Ghrita; Psoriasis; Vamana Karma
In this study, the RAPD (Random Amplified Polymorphic DNA) technique was employed for determination of the components in an Ayurvedic herbal prescription, Rasayana Churna. One-hundred-and-twenty decamer oligonucleotide primers were screened in the RAPD analysis to identify three Ayurvedic medicines, dried stem of Tinospora cordifolia, dried fruit of Emblica officinalis and dried fruit of Tribulus terestris, the Ayurvedic prescription. Primer OPC-6 simultaneously generated three distinct amplicons, each specific to one component. The marker with 600 bp is specific to Tinospora cordifolia; the marker 500 bp is specific to Emblica officinalis and the remaining marker >1000 bp was present in Tribulus terestris. Presence of three herbal medicines was determined when RAPD reaction with OPC-6 was performed. The technique was proved to contribute to the identification of components in Ayurvedic herbal preparation and thus helping to serve as a complementary tool for quality control.
DNA fingerprinting; herbal medicine; RAPD; standardization
In order to initiate a disease elimination programme for lymphatic filariasis based on mass drug administration, a proper understanding of the geographical distribution and degree of risk is essential.
An investigation of lymphatic filariasis due to Wuchereria bancrofti was carried out among 785 people in four communities of Yakurr Local Government Area of Cross River State, Nigeria between March and August, 2009. Finger prick blood smear samples collected from the subjects were examined for W. bancrofti using standard parasitological protocol. The subjects were also screened for clinical manifestations of lymphatic filariasis.
Of the 785 persons examined, 48 (6.1%) were positive for microfilariae in their thick blood smear. There was a significant difference in the prevalence of lymphatic filariasis among the various age groups (P < 0.01) although peak prevalence occurred between 41 – 60 years. There was no significant difference in prevalence and density with respect to sex (P > 0.05). The overall mean microfilarial density of the infected individuals was 5.6mf/50 μl. There was a significant variation (P < 0.01) in mean microfilarial density within the communities, ranging from 4.7 to 6.4 mf/50 μl. The only clinical sign found in the study area was lymphoedema of the leg recording 2 (0.3%) prevalence.
The National Lymphatic Filariasis Elimination Programme should intervene by expanding the distribution of albendazole and ivermectin to all endemic areas including Yakurr Local Government Area of Cross River State, Nigeria.
Prevalence; Wuchereria bancrofti; Yakurr; Cross river; Nigeria
Migraine patients who do not respond to conventional therapy, develop unacceptable side-effects, or are reluctant to take medicines resort to complementary and alternative medicines (CAM). Globally, patients have been seeking various non-conventional modes of therapy for the management of their headaches. An Ayurvedic Treatment Protocol (AyTP) comprising five Ayurvedic medicines, namely Narikel Lavan, Sootshekhar Rasa, Sitopaladi Churna, Rason Vati and Godanti Mishran along with regulated diet and lifestyle modifications such as minimum 8 h sleep, 30-60 min morning or evening walk and abstention from smoking/drinking, was tried for migraine treatment. The duration of the therapy was 90 days. Out of 406 migraine patients who were offered this AyTP, 204 patients completed 90 days of treatment. Complete disappearance of headache and associated symptoms at completion of AyTP was observed in 72 (35.2%); mild episode of headache without need of any conventional medicines in 72 (35.2%); low intensity of pain along with conventional medicines in 50 (24.5%); no improvement in seven (3.4%) and worst pain was noted in three (1.4%) patients, respectively. In 144 (70.5%) of patients marked reduction of migraine frequency and pain intensity observed may be because of the AyTP. Though the uncontrolled open-label design of this study does not allow us to draw a definite conclusion, from this observational study we can make a preliminary assessment regarding the effectiveness of this ayurvedic treatment protocol.
Alternative therapy; Ayurveda; CAM; migraine
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.
Acute painful swelling of the extremities and scrotum are debilitating clinical manifestations of Wuchereria bancrofti infection. The ongoing global program to eliminate filariasis using mass drug administration is expected to decrease this and other forms of filarial morbidity in the future by preventing establishment of new infections as a consequence of eliminating transmission by the mosquito vector. We examined whether mass treatment with anti-filarial drugs has a more immediate health benefit by monitoring acute filariasis morbidity in Papua New Guinean communities that participated in a 5-year mass drug administration trial.
Weekly active surveillance for acute filariasis morbidity defined by painful swelling of the extremities, scrotum and breast was performed 1 year before and each year after 4 annual mass administrations of anti-filarial drugs (16,480 person-years of observation). Acute morbidity events lasted <3 weeks in 92% of affected individuals and primarily involved the leg (74–79% of all annual events). The incidence for all communities considered together decreased from 0.39 per person-year in the pre-treatment year to 0.31, 0.15, 0.19 and 0.20 after each of 4 annual treatments (p<0.0001). Residents of communities with high pre-treatment transmission intensities (224–742 infective bites/person/year) experienced a greater reduction in acute morbidity (0.62 episodes per person-year pre-treatment vs. 0.30 in the 4th post-treatment year) than residents of communities with moderate pre-treatment transmission intensities (24–167 infective bites/person/year; 0.28 episodes per person-year pre-treatment vs. 0.16 in the 4th post-treatment year).
Mass administration of anti-filarial drugs results in immediate health benefit by decreasing the incidence of acute attacks of leg and arm swelling in people with pre-existing infection. Reduction in acute filariasis morbidity parallels decreased transmission intensity, suggesting that continuing exposure to infective mosquitoes is involved in the pathogenesis of acute filariasis morbidity.
The global program to eliminate lymphatic filariasis recommends 5 or more annual rounds of mass anti-filarial drug administration in order to reduce the reservoir of microfilaria to a level that will not sustain continuing transmission of infection by mosquitoes. We examined the incidence of acute filariasis morbidity defined by self-reported episodes of acute painful swelling of the extremities or scrotum in residents of communities in Papua New Guinea who participated in a 5-year mass drug administration trial. Acute morbidity events primarily affected the legs and arms, lasted less than 3 weeks, increased transiently following the first annual mass drug administration, and decreased progressively after repeated annual treatments. Risk factors for acute morbidity included pre-treatment microfilaremia and filarial antigenemia, pre-existing lymphatic pathology of the legs documented by physical examination, age older than 45 years and residence in communities where pre-treatment transmission intensity was relatively high. Results of our study indicate that mass administration of anti-filarial drugs has immediate clinical benefit to endemic communities in addition to future transmission cessation.
Rasamanikya is a famous drug, frequently used by Ayurvedic physicians for Vata-Kaphaja diseases like Shwasa, Kasa and Kushtha (Skin disorders). Various methods of preparation have been found described in Rasa classics. Generally it is prepared by Shuddha Haratala which is kept between two thin transparent Abharaka Patra (mica sheets) in small scale and in sharava for large scale, heated up to desired level. There are so many methods and different liquid media have been found described for Shodhana of Haratala. Therefore the methods of preparation of Rasamanikya and Shodhana process of Haratala have been validated through various experiments. Tankana-treated Haratala (T. Treated) is found best for Shodhana process and final product too i.e. Rasamanikya in terms of pharmaceutical standards i.e. Ruby in colour, along with reproducibility of fixed quality.
Shodhana; Validation; T-Treated Haratala
Ayurvedic interventions have largely been considered helpful in chronic debilitating conditions where active management of a clinical condition is not required. It is for this notion; Ayurvedic therapies have never been approached in any critical care condition requiring an active management. A perception that herbo-metallic components of various Ayurvedic drugs may actually harm the patients who are in compromised vital status has further added to this apprehension against use of such medicines in critical care. Contrary to the conventional belief, we observed a case of grade three hepatic encephalopathy with severely compromised liver function that was successfully treated with Ayurvedic therapy containing many heavy metal containing compounds. The liver function got improved in this case following the Ayurvedic intervention. The symptomatic improvements in this case were also identifiable through biochemical tests showing the functional status of liver. This case therefore is worthy of taking a note for possible inclusion of Ayurvedic interventions in critical care where Ayurvedic therapies are discarded without being given a chance of getting evaluated.
Critical care; heavy metals; hepatic encephalopathy