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   Table of Contents - Current issue
Coverpage
April-June 2020
Volume 41 | Issue 2
Page Nos. 69-141

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EDITORIAL  

Potential of Ayurveda in the prevention and management of post-COVID complications Highly accessed article p. 69
Mandip Goyal
DOI:10.4103/ayu.ayu_284_21  
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ORIGINAL ARTICLES - SURVEY STUDY Top

Patterns of concomitant use of Ayurveda and conventional anti-diabetic formulations - Experiences at a tertiary care Ayurveda hospital, India p. 72
R Galib, Poonam Dang, Vijay Kumar, Rakesh Rana, Pramod Yadav, PK Prajapati
DOI:10.4103/ayu.AYU_81_20  
Background: Majority of the population relies on traditional medicines for many of their health related problems. Particularly individuals with chronic illness like diabetes mellitus (DM) are more likely to simultaneously use herbal medicines. Many of such users believe that traditional medicines are natural and therefore safe, but this is a dangerous over simplification. Some herbal medicines may be associated with adverse effects, which include interactions with prescribed drugs. Information on such concomitant use of anti-diabetic drugs along with Ayurveda medicines is limited in Indian scenario. Aims and objectives: To survey the patterns of concomitant use of Ayurveda and conventional anti-diabetic drugs by diabetic patients attending an out-patient department of a tertiary care teaching hospital in New Delhi, India through a validated questionnaire. Materials and methods: This is a questionnaire-based survey, carried out after the approval of the Institutional Ethics Committee, subsequently registered at CTRI. A questionnaire to assess the pattern of concomitant use was developed; content was validated and pre-tested by a pilot study in 40 patients, further refined and used in the survey. The data was analyzed to evaluate the patterns of concomitant use of Ayurvedic and conventional anti-diabetic drugs. Results: About 95.9% of diabetic patients were taking herbo-mineral formulations concomitantly with conventional anti-diabetic drugs. Although 45.3% of diabetics were using Ayurveda interventions under the supervision of qualified AYUSH physicians, remaining involved in procuring the drugs over the counter (OTC) or from the local vendors. In majority of these instances, the use of Ayurveda formulations was not communicated with their physicians. Conclusion: The observations reveal that a majority of the diabetics (95.9%) were taking one or the other form of herbal preparations along with their conventional anti-diabetic drugs and about 44% among them were using these concomitantly. Thus, generating awareness on good practices of drug use seems to be essential.
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ORIGINAL ARTICLES - CASE STUDY Top

Ayurvedic management for a rare disorder Takayasu arteritis – A case report p. 79
Sarvesh Kumar Singh, Kshipra Rajoria, Sanjeev Sharma
DOI:10.4103/ayu.AYU_61_19  
Takayasu arteritis (TA) is a rare disorder and it is a devastating condition of aorta. The presently available treatments for the condition in the modern medicine have limited benefits. This is case of TA which was better managed with Ayurvedic intervention. An Ayurvedic diagnosis for this case was Siragata Vata (vitiated Vata Dosha affecting the blood vessels). A 42-year-old woman was diagnosed with TA and treated on the line of management of Siragata Vata with Shastikashali Pinda Swedana (sudation with bolus of medicated cooked rice) for 16 days, Erandamuladi Niruha Basti (enema mainly with decoction) along with Ashwagandha Taila Anuvasana (enema with medicated oil) for 16 days in Kala Basti Krama (16 days in alternate order of decoction and oleation enema) followed by one day gap and then 7 days of Nasya Karma (nasal therapy) with Triphaladi Taila (oil) on alternate days along with a combination of Ayurvedic oral drugs [Brihadvatachintamani Rasa-125 mg, Dashamula Kwatha-40 ml, Narsinha Churna (powder)-3 g, Yogaraja Guggulu-1g (500mgx2tab) and Shiva Gutika-500 mg, twice a day for 1 month. Same Panchakarma procedures were repeated after 6 months. A similar combination of oral medications were continued in between and during this period. Chyavanaprasha Aveleha in the dose of 10g twice a day with milk were also added after completion of this treatment regime. Patient condition was assessed on Indian Takayasu Clinical Activity Score (ITAS-2010) for disease activity of TA. Satisfactory results were observed in the patient with improvement in ITAS-2010 scoring. TA may be managed with Ayurvedic drugs and Panchakarma procedures.
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ORIGINAL ARTICLES - CLINICAL RESEARCH Top

Effect of Opuntia elatior Mill. (Nagaphani) in the management of Pandu Roga w. s. r to iron deficiency anemia; an open labeled randomized standard controlled clinical trial p. 87
Shashikant M Prajapati, Sharada Anand, Rabinarayan Acharya, Mandip Goyal
DOI:10.4103/ayu.AYU_31_18  
Background: Pandu Roga described in Ayurveda bears resemblance to the clinical features of anemia. The fruits of Nagaphani (Opuntia elatior Mill.) of family cactaceae, are consumed by the inhabitants of Gujarat as a hematinic agent to treat general debility and anemia. Aim and objective: To evaluate the efficacy of the O. elatior fruit juice in Pandu Roga with special reference to iron deficiency anemia. Materials and method: Present clinical study was an open labeled, randomized trial, in which 105 patients of Pandu Roga (iron deficiency anemia), were divided into two groups using the coin method of randomization. Group A received Opuntia elatior fruit juice, 20 ml twice a day with lukewarm water before meal. Group B received Punarnava Mandura (standard control), well accepted after this a herbo-mineral fromulation, two tablets of 500 mg each, twice a day with Takra (butter milk) before meal. Duration of intervention was 2 months in both groups and a follow-up of 1 month. The assessment was done based on the clinical signs and symptoms and hematological parameters such as Hb% (hemoglobin %), total red blood cell (TRBC), serum iron, serum ferritin and total iron-binding capacity (TIBC), before and after completion of the treatment. The data were subjected to statistical tests (Wilcoxon signed-rank test and paired t-tests, co-efficient of variance (CV)), and analyzed. Results: Both trial drug and the standard drug produced a statistically significant increase in Hb%, TRBC and serum Iron. The standard drug provided statistically significant increase (P < 0.05) in TIBC, whereas a statistically insignificant (P > 0.05) effect was observed in the trial group. Both trial and standard drug provided statistically significant (P < 0.001) relief in Panduta (pallor), Daurbalya (general weakness), Akshikutashotha (periorbital edema) and Pindikodveshthana (calf muscle cramps). When compared between the groups, the standard drug was found to be more effective than the trial drug. Conclusion: Fruit juice of Opuntia elatior is effective in iron deficiency anemia as it increases the hemoglobin, TRBC levels in blood along with providing relief in Panduta (pallor), Daurbalya (general weakness) Akshikutashotha (periorbital edema).
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Efficacy of Sharapunkhadi powder (a polyherbal formulation) and lifestyle modification in the management of nonalcoholic fatty liver disease-A randomized placebo-controlled clinical trial p. 98
E Remya, Mandip Goyal, Jitendra Varsakiya
DOI:10.4103/ayu.AYU_281_19  
Background: Nonalcoholic fatty liver disease (NAFLD) is an expanding health problem, which varies in prevalence among ethnic groups, occurring with an estimated global prevalence of 25%. In high-risk populations, the prevalence of NAFLD may be as high as 70%–90%. No established pharmacological treatment is available for NAFLD in modern medicine and hence, there is a search for alternative treatment modalities in other systems of medicine, which is safe and cost-effective. Aim: The aim is to evaluate the efficacy of Sharapunkhadi powder and lifestyle modification in the management of NAFLD. Materials and methods: Patients suffering from any of the components of metabolic syndrome, i.e. hypertension, diabetes mellitus, hypertriglyceridemia, elevated body mass index (>25 kg/m2), truncal obesity, or presenting with the symptoms of indigestion, abdominal discomfort, flatulence. were screened with liver function tests and ultrasonography (USG) of the abdomen. A total of 93 patients confirmed with fatty liver Grade 1-3 were selected for the present trial and were randomly divided into two groups. After Mridu Virechana (mild purgation) with Haritaki powder (6–8 g) according to Koshtha, in group A (n = 46), 2 capsules (500 mg each) filled with Sharapunkhadi powder thrice a day before food with warm water along with lifestyle modification were administered for 8 weeks. In group B (n = 47), capsules filled with roasted Sooji powder in the same dose as mentioned for group A was given along with lifestyle modification and were maintained as a placebo. Relief in subjective parameters such as indigestion, abdominal discomfort, and flatulence and improvement in the grades of fatty liver evident from USG was considered for the overall assessment of the therapy in both the groups. SigmaStat 3.1 software was used for statistical calculation. Wilcoxon signed-rank test for subjective criteria and Student's paired t-test for objective criteria were applied to check the level of significance in a single group before and after treatment, while Student's unpaired t-test for objective criteria was applied to assess the level of significance of difference observed between two groups. Results: After 8 weeks of treatment, it was found from USG findings that there was a statistically significant improvement by about 39.25% in group A and 31.82% in group B, in the grade of fatty liver. The combination of Sharapunkhadi powder along with lifestyle modification provided comparatively better relief in subjective and objective parameters over the placebo control group. Conclusion: Sharapunkhadi powder is a promising herbal preparation for the management of NAFLD and the combination of Sharapunkhadi powder along with lifestyle modification can yield more significant results in the management of NAFLD than lifestyle modification alone.
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AYUSH-64 as an add-on to standard care in asymptomatic and mild cases of COVID-19: A randomized controlled trial p. 107
R Govind Reddy, Rajesh Vithal Gosavi, Babita Yadav, Amit Kumar Rai, Madhuri Prashant Holay, Manisha Talekar, Sophia Jameela, Bhagwan Sahay Sharma, Shruti Khanduri, Rakesh Rana, Arunabh Tripathi, Bhogavalli Chandrasekhararao, Narayanam Srikanth, Kartar S Dhiman
DOI:10.4103/ayu.ayu_14_21  
Background: The evidence on the efficacy and safety of Ayurveda interventions as an add-on to the standard conventional care for coronavirus disease-2019 (COVID-19) is limited. Aim and objective: This study was planned to explore the potential of AYUSH-64 as an add-on to conventional care in improving the clinical recovery and negative reverse transcription–polymerase chain reaction (RT-PCR) conversion in asymptomatic and mild COVID-19 cases. Materials and methods: An open-label randomized controlled study was conducted at Government Medical College, Nagpur, Maharashtra, India, with a sample size of 60 participants. In this study, asymptomatic or mild COVID-19 patients were randomized and allocated into intervention and control groups (CG) in a 1:1 ratio. AYUSH-64 two capsules (500 mg each) were administered thrice daily, after food with water for 30 days along with standard care in the intervention group (IG), while the CG received only standard care. The primary outcome was the proportion of participants who turned RT-PCR negative for COVID-19 at 7th, 15th, 22nd and 30th days. Secondary outcomes were the proportion of participants who attained clinical recovery at 7th, 15th, 22nd and 30th days, change in laboratory parameters on the 30th day and incidence of adverse drug reactions/adverse events. The data were compared within group using paired sample t-test/Wilcoxon signed-rank test and between group using independent sample t-test/Mann–Whitney test. Results: Statistically significant difference was not observed in the proportion of participants who turned RT-PCR negative during each of the follow-ups (P = 0.134) and both groups demonstrated comparable efficacy. The clinical recovery in terms of complete relief in symptoms in the symptomatic participants was 60% and 37% on day 15 (P = 0.098) and 100% and 85.2% on day 30 (P = 0.112) in the intervention and CG, respectively. The improvement in the inflammatory markers such as interleukin (IL)-6, tumor necrosis factor-α (TNF-α), and D-dimer was statistically significant (P < 0.05) in the IG, whereas in the CG, it was statistically significant for D-dimer only. None of the participants developed any complications nor were any significant ADR/AE observed in the groups. Conclusions: In patients with asymptomatic and mild COVID-19, AYUSH-64, as add-on to standard conventional care, contributed to improved clinical recovery and demonstrated potential in reducing the levels of pro-inflammatory markers such as IL-6 and TNF-α. Further, both the groups demonstrated comparable efficacy regarding negative RT-PCR for COVID-19.
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ORIGINAL ARTICLES - PHARMACEUTICAL STUDIES Top

Standard operating procedure of Purification of Chitraka (Plumbago zeylanica Linn.) along with pharmacognostical and analytical profiles of Plumbagin p. 117
Sonam S Bhinde, Arun Kumar Ravi, Biswajyoti J Patgiri, CR Harisha, Vinay J Shukla
DOI:10.4103/ayu.AYU_299_20  
Introduction: Shodhana (purification) is the process by which one can remove the impurity or toxicity of the raw drug and make the drug suitable for therapeutic purpose. Chitraka (Plumbago zeylanica Linn.) is well known drug in Ayurveda and root of this plant is being used for therapeutic purpose and requires purification before used as a medicine. Aims and objective: There is no data available for pharmacognostical and analytical profile of processed Chitraka, hence it was planned to develop SOP of processed Chitraka for its identity, purity and strength through pharmacognostical and analytical profile. Materials and methods: Chitraka roots were procured from Pharmacy, Gujarat Ayurved University, Jamnagar. Purification was done in five batches with Churnodaka (lime water). Organoleptic characters, microscopic features, pH, loss on drying, ash value, water soluble extracts, methanol soluble extracts and plumbagin quantification through high-performance thin layer chromatography (HPTLC) were carried out, before and after the purification. Results: Average 98.07% yield of Chitraka was obtained after purification. Differences were found in the processed samples of Chitraka in organoleptic features, pharmacognostical characters and physicochemical parameters, which show the impact of purification procedure on Chitraka. In HPTLC profile, plumbagin content was 0.29% in unpurified Chitraka powder, where in it was noted 0.98% after purification. Conclusion: Increase in plumbagin content through pharmaceutical process of Chitraka purification with lime water indicates that, this operating procedure is simple, convenient and can be considered as standard procedure. The organoleptic features, pharmacognostical characters, values of physicochemical parameters and quantity of plumbagin of purified Chitraka powder may be utilized for quality assurance in future studies.
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ORIGINAL ARTICLES - PHARMACOLOGICAL STUDIES Top

Antibacterial efficacy of different combinations of clove, eucalyptus, ginger, and selected antibiotics against clinical isolates of Pseudomonas aeruginosa p. 123
Pankaj Kumar Sagar, Poonam Sharma, Rambir Singh
DOI:10.4103/ayu.AYU_101_19  
Background: Nosocomial infections caused by multidrug-resistant Pseudomonas aeruginosa are commonly treated with conventional antibiotic which may lead to some serious side effects in the patients. Conventionally, medicinal plants, including clove, eucalyptus, and ginger, are used for the safe and effective treatment of several diseases. Aims and objectives: The aim and objective of this study is to evaluate the combined antibacterial efficacy of medicinal plants (clove, eucalyptus, and ginger) and selected antibiotic and also combined efficacy of different plants extracts against clinical isolates of P. aeruginosa. Materials and methods: A total of seven clinical isolates and one reference strain (PA01) of P. aeruginosa were included in this study. The antibacterial activity of crude methanol extracts of medicinal plants and selected antibiotics was screened using well-diffusion assay and their minimum inhibitory concentration (MIC) was determined by the microdilution method. Combined efficacy of ceftazidime and plant extracts was tested using standard checkerboard method and different plant extracts were evaluated using broth macrodilution method. Results: All of the seven clinical isolates of P. aeruginosa showed multidrug resistance pattern and were found highly sensitive to ciprofloxacin followed by ceftazidime and gentamicin. Clove exhibited better antibacterial activity as compared to eucalyptus and ginger. Synergistic interaction was found between ceftazidime and plants extracts against reference PA01 and clinical isolate 2. Highest two-fold reduction in MIC was found in the combination of clove-ginger against reference PA01 and clinical isolate 3. Conclusion: The selected medicinal plants are highly efficient for enhancing the antibacterial activity of antibiotic.
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Pharmacodynamic interaction of Tinospora cordifolia Willd. With Ocimum sanctum Linn. in isoproterenol-induced cardiac toxicity p. 130
Chetan Savant, VH Kulkarni, PV Habbu, Preeti V Kulkarni, Muhammed Majeed, Mahadeva Nayak
DOI:10.4103/ayu.AYU_127_19  
Background: Cardiovascular diseases are the leading causes of deaths despite several advancements in the current medical interventions. Among them, myocardial infarction (MI) is the most alarming disease as about 17.1 million peoples die every year due to MI. Aim: The present study was designed to investigate the potential cardioprotective effect of combination of standardized extracts of Tinospora cordifolia (SETC) (250 mg/kg and 500 mg/kg) and Ocimum sanctum (SEOS) (50 mg/kg) in isoproterenol (ISO)-induced MI. Materials and methods: MI was induced in rats by subcutaneous injection of ISO for 2 consecutive days at an interval of 24 h. Rats were pretreated with test drugs for the period of 21 days, and ISO was administered on the 20th and 21st days. At the end of experiment, i.e., on 22nd-day electrocardiograph, a hemodynamic, biochemical, and histopathological study of heart tissues was evaluated from control and experimental groups and statistically analyzed by one-way analysis of variance followed by Tukey's test. Results: ISO-administered rats showed significant changes in electrocardiograph, mean arterial blood pressure, heart rate, biochemical markers, antioxidant parameters, and histopathology of heart. The activities of cardiac biomarkers were reduced in serum, and there was an increase in antioxidants in heart tissue of test drug-treated animals. Similarly, electrocardiograph, mean arterial blood pressure, and heart rate were restored to normalcy in all test and standard drug-treated animals. Conclusion: The SETC 500 mg/kg in combination with SEOS 50 mg/kg was found to be effective in prevention of myocardial injury induced by ISO.
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Prevention of in vitro glucose-induced cataract by Vasanjana prepared by Yashtimadhu Kalka (paste of Glycyrrhyza glabra Linn) p. 136
Manjusha Rajagopala, B Ravishankar, BK Ashok, B Gupta Varun
DOI:10.4103/ayu.AYU_99_20  
Background: Cataract is a major cause of blindness worldwide. Researchers received much attention from the traditional systems such as Ayurveda for the solutions of cataract through antioxidant activities apart from the surgical extraction. Aims: A To study, the anti-cataract activity of Vasanjana (VK) prepared with Yashtimadhu (Glycyrrhyza glabra Linn) Kalka (paste) in Vasa (fat) of the domestic fowl (Gallus gallus) on glucose-induced cataract in ovine (sheep) lenses. Materials and methods: Artificial aqueous humor with 55 mM glucose was used to induce cataract in sheep eye lenses. Treatment was given with cow ghee (CG), plain fat, Vasanjana, and Vitamin E to the same media and lenses were incubated at the room temperature for 72 h. Biochemical parameters studied in the lens were total proteins, malondialdehyde (MDA), Na+ K+ ATPase activity and electrolytes (Na+ and K+). Photographic evaluation was also done. Results: The complete opacification induced by the glucose in ovine lens was observed in 72 h. Cataractous lenses showed significant increase in Na+, MDA level and significant decrease in Na+ K+ ATPase activity and total protein content. Lenses treated with Vasanjana showed non-significant increase of total protein content and decreased MDA level and prevented formation and progress of cataract by glucose, as evidenced by photographic evaluation. Glucose-induced biochemical changes were found to be reversed in statistically significant manner in CG and Vitamin E treated lenses. Conclusion: The anti-cataract activity of Vasanjana and CG may be because of the antioxidant and free radical scavenging activity. Further in vitro and in vivo studies in various experimental models are required to validate their anti-cataract activity.
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