From the Desk of the Editor-in-Chief ... AN IJCP GROUP PUBLICATION October-December 2021 Volume 14, Number 4 Pages 8 In This Issue www.ijcpgroup.com In this issue ............7 Time to Laugh z z According to the WHO, in 2020, 4.9% of the global population suffered from disturbances in liver health.1 z z The incidence of chronic liver diseases, in any stage of disease severity, can be seen in 1.5 billion people worldwide.2 z z The hepatitis B virus can survive outside the human body for at least 7 days.3 z z Perinatal transmission and horizontal transmission are the common types of transmission of hepatitis B virus in highly endemic regions.3 z z Immune dysregulation due to SARS-CoV-2 can cause liver diseases.4 z z Globally, 100 to 400 million dengue infections are reported every year.1 z z The dengue virus has 5 serotypes—DENV-1, -2, -3, -4, and -5.2 z z The immunity derived from one serotype provides only temporary and partial cross-immunity to the other serotypes of the dengue virus.1 z z Asecondary infection by the dengue virus increases the risk of developing severe dengue.1 z z The partial thromboplastin time and prothrombin time prolong because of the damage caused to the liver during dengue fever.2 Dear Doctor, This issue of Alloveda focuses on the two most common public health concerns—respiratory tract infections (RTIs) and menstrual irregularities (MIs). According to the WHO, RTIs rank first in terms of the burden of the disease measured by years lost through death or disability (ie, disability-adjusted life years). While upper RTIs are usually selflimiting, lower RTIs are the third leading cause of death worldwide, after cardiac and encephalic vascular illnesses. According to Ayurveda, the Prana Vayu is responsible for respiration in the human body. The channels in which Prana Vayu flows are called Pranavaha Srotas, and this has been correlated to the respiratory system. Any imbalance in the doshas governing the normal functions of Pranavaha Srotas adversely affects respiratory health. Influence of Nutritional Insufficiency on Menstrual Irregularities ............2 Issue sponsored by: Menstrual Irregularities: An Ayurvedic Perspective ............2 Evecare Capsules in the Management of Dysfunctional Uterine Bleeding ............2 Macrolide-Resistant Mycoplasma Pneumonia ............4 Vol 14 • No. 3 (Jul–Sep 2021) of Alloveda was not published. Irregular menstruation significantly affects the quality of life of women. A dysregulated hypothalamic– pituitary–adrenal axis, diabetes mellitus, obesity, underweight, polycystic ovarian syndrome, poor lifestyle, and stress are some of the common causes of MIs. The menstrual cycle, known as Rutu Chakra inAyurveda, is regulated by the 3 doshas—Vata, Pitta, and Kapha, but is predominantly a function of Apana Vata, a subtype of Vata dosha. Any imbalance in the Apana Vata can result in MIs. In this issue, interesting articles pertaining to RTIs and MIs have been featured. In addition, abstracts of clinical trial reports evidencing the role of Septilin in the management of RTIs and Evecare in the management of MIs have been featured. Furthermore, this issue also discusses the pharmacologic actions of the herbs, Yashtimadhu, Shatavari, Shallaki, and Hadjod. Liver Diseases: Facts and Statistics Dengue Infection: Facts and Statistics z z Biomarkers associated with liver injury such as aspartate transferase, alanine transferase, alkaline phosphatase, and g-glutamyl transferase are commonly elevated in patients with COVID-19.4 z z Patients with hepatocellular carcinoma are more susceptible to the severity of COVID-19 than patients with other cancers.4 References 1. International Agency for Research on Cancer. World Health Organization. Liver. https://gco.iarc.fr/today/data/factsheets/ cancers/11-Liver-fact-sheet.pdf. Accessed November 8, 2021. 2. Cheemerla S, Balakrishnan M. Clin Liver Dis. 2021;17(5): 365–370. 3. World Health Organization. Fact sheets. Hepatitis B. https://www. who.int/news-room/fact-sheets/detail/hepatitis-b. Published July 27, 2021. Accessed November 8, 2021. 4. Martinez MA, Franco S. Hepatol Commun. 2021;5(7):1138–1150. Septilin in the Management of Chronic Nonspecific Pharyngitis ............4 Herbs: Boswellia serrata Cissus quadrangularis ............6 Scan the QR code below to subscribe to Alloveda Interview: Dr Hemangi Umesh Dalal ............3 Interview: Dr B Ramana Rao ............5 Dr Veena Aggarwal Consultant, Women's Health CMD and Editor-in-Chief, IJCP Group & Medtalks Trustee, Dr KK’s Heart Care Foundation of India In Fond Memory of… The Late Dr KK Aggarwal Founder Editor IJCP Group of Publications z z Thrombocytopenia and associated platelet dysfunction can result in dengue hemorrhagic fever.2 z z A fetus or a newborn can be infected by the dengue virus through the infected mother either during gestation or labor.3 References 1. World Health Organization. Dengue and severe dengue. https://www. who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue. Published May 19, 2021. Accessed October 17, 2021. 2. Adane T, Getawa S. PLoS Negl Trop Dis. 2021;15(8):e0009666. 3. Centers for Disease Control and Prevention. Transmission. https:// www.cdc.gov/dengue/transmission/index.html. Reviewed September 26, 2019. Accessed October 17, 2021. Asparagus racemosus ............3 Respiratory Health: An Ayurvedic Perspective ............4 Glycyrrhiza glabra ............5 In the management of liver health post COVID-19… ® Liv.52 ( S Y R U P, TA B L E T ) Liv.52 Unparalleled in liver care
2 Influence of Nutritional Insufficiency on Menstrual Irregularities A woman's reproductive health can be ascertained through the regularity of the menstruation pattern. Irregular menstruation is an indicator of a dysfunctional sex hormone profile and disorders of the reproductive organs. Abnormalities in the menstrual cycle can range from dysfunctional bleeding patterns such as amenorrhea, dysmenorrhea, menorrhagia, and hypomenorrhea to ovulatory disorders. Ovulatory dysfunction in women is mostly a result of temporary or chronic disturbances in the hypothalamic–pituitary–ovarian axis. Internal factors (eg, anemia and hormonal imbalance) and external factors (eg, diet, physical activity, stress, smoking, alcohol intake, and medications) can influence the onset of menstrual irregularities. Limited food intake, poor dietary choices, insufficient nutritional intake, and psychologic stress can lead to Aim To evaluate the efficacy of Evecare capsules in relieving the symptoms of dysfunctional uterine bleeding (DUB) Materials and Methods This study enrolled 70 women (age, 20–45 y) with a history of DUB. Their medical history was recorded, and they were subjected to general physical and pelvic examinations. They were also subjected to extensive laboratory investigations including a complete hemogram coagulation profile to establish the degree of blood loss, for evidence of iron-deficiency anemia (IDA), and to exclude any bleeding disorder(s). At entry, 18 women had a normal duration of menstruation, but increased menstrual flow, 21 women had normal flow but increased duration, and 31 women had increased flow and increased duration. All the women were given Evecare capsules at a dosage of 2 capsules, BID, for 3 months. They were evaluated for the duration of menstruation and amount of blood loss, degree of IDA, and general condition during and at the end of the treatment period. Results All the 70 women completed the study. The results showed that the duration of menstruation and the amount of menstrual flow started to normalize by the end of the second month of the treatment with Evecare capsules. By the end of 3 months, 90% of the women had a normal duration of menstruation (Table 1). After the treatment, the amount of menstrual flow was normalized in 59 women. Table 2 presents data about the effect of Evecare capsules on the amount of menstrual flow. A total of 57 women experienced complete relief from the symptoms of DUB after Capsules in the Management of Dysfunctional Uterine Bleeding obesity, underweight, diabetes, and hypertension. Poor eating habits can affect the secretion of Sources: Park YJ, et al. Int J Environ Res Public Health. 2021;18(1):233. Gupta DS, et al. J Evolution Med Dent Sci. 2021;10(15):1048–1053. reproductive hormones such as estrogen and progesterone that regulate menstrual cycles. Results from a Danish study comprising 18- to 40-year-old women confirmed that women with binge eating habits showed a higher frequency of amenorrhea or oligomenorrhea than women with no binge eating habits. An imbalanced diet or nutritional insufficiency can lead to painful menstruation. Consumption of a healthy diet with the right balance of macronutrients and micronutrients supports a healthy and normal menstrual cycle. The menstrual cycle is termed as Rutuchakra in Ayurveda. The word “chakra” signifies its regular onset at regular intervals, just like a cycle. All 3 doshas (Vata, Pitta, and Kapha) have an influence at different stages of the menstrual cycle, and any impairment in these doshas leads to Menstrual Irregularities: An Ayurvedic Perspective menstrual irregularities (MIs). Vitiation of doshas and tissues (rasa and rakta) and blockage of channels of the female reproductive system (artavavaha srotas) are major causes of MIs. Abnormalities in the menstrual flow can be of 2 types—increased and decreased menstrual flow. Based on the dominance of the vitiated dosha (which results in altered color, smell, frequency, and consistency of menstrual fluid), MIs are of 8 types. The other MIs mentioned in Ayurveda are amenorrhea (nashtartava), oligomenorrhea (artavakshaya), metrorrhagia (asragdara), and dysmenorrhea (kashtartava). Table 1. The Effect of Treatment With Evecare Capsules on the Duration of Menstruation in Women With DUB Duration of Menstruation, d No. of Women (N = 70), n (%) Before Treatment After Treatment 3–4 (Normal) 18a (26) 63 (90) (6a [9]) 5–8 36 (51) 3 (4) > 8 16 (23) 4 (6) Total 70 (100) 70 (100) aWomen who had normal duration of menstruation but severe menstrual flow. DUB, dysfunctional uterine bleeding. Table 2. The Effect of Treatment With Evecare Capsules on the Amount of Menstrual Flow in Women With DUB No. of Sanitary Pads Changed Per Day No. of Women (N = 70), n (%) Before Treatment After Treatment 3–4 (Normal) 21a (30) 59 (84) (2a [3]) 4–5 30 (43) 7 (10) > 5 19 (27) 4 (6) Total 70 (100) 70 (100) aWomen who had a normal menstrual flow but prolonged duration of menstruation. DUB, dysfunctional uterine bleeding. Evecare is recommended for the management of uterine disorders. Evecare regularizes endogenous hormonal secretion, corrects cyclical rhythm, and offers relief from the symptoms of dysfunctional uterine bleeding (DUB) and premenstrual syndrome. Evecare enhances endometrial receptivity and assists full-term pregnancy. Evecare has a regularizing influence on the menstrual cycle by virtue of its uterine-stimulant action. Evecare’s stimulatory effect on the ovarian tissue helps regularize endogenous hormonal secretion, helps enhance the repair of the endometrium, and thus, helps control abnormal uterine bleeding. Pharmacologic Actions z z Phytoestrogenic action z z Gonadotropin agonist action z z Antihemorrhagic action z z Antimicrobial action z z Anti-inflammatory and analgesic actions z z Antispasmodic action z z Antioxidant action z z Adaptogenic action Indications z z Menstrual irregularities – DUB: Menorrhagia, metrorrhagia – Oligomenorrhea z z Dysmenorrhea z z Premenstrual syndrome (PMS) z z Polycystic ovarian syndrome (PCOS) z z Assisted conception s with tagline Curved h the treatment with Evecare capsules. There were no adverse effects reported during the study. Discussion and Conclusion The phytoestrogens present in the herbs of Evecare capsules produce a healing effect on the endometrium. The herbs also exhibit a styptic action, which helps limit the bleeding by inducing vasoconstriction of the microvessels that supply blood to the endometrium and by increasing the myometrial contractility to produce hemostasis. The results of this study show that Evecare capsules are effective in relieving the symptoms of DUB. An excerpt of the clinical study conducted by Prasad Nevrekar et al published in the journal Obstetrics & Gynaecology Communications is featured here. Brand names with tagline Open type Curved Builds the body’s own defense mechanism Evecare® Ensures complete uterine care (CAPSULE, SYRUP) Septilin® (SYRUP, TABLET)
3 English name: Asparagus Sanskrit name: Shatavari Morphology and Habitat Asparagus racemosus is awoody climber that grows to a height of 1 to 2 m. The plant has pine needle–shaped leaves; small, white flowers arranged in spikes; and tuberous and succulent roots.1 A racemosus is a perennial plant growing in the tropical and subtropical regions of India and the Himalayas. It is also found in Australia, Sri Lanka, tropical Africa, and Indonesia.2 Medicinal Uses A racemosus is a popular Rasayana herb in Ayurveda. It is known to increase longevity, enhance immunity, and improve mental health. The root extract has antiulcer, antioxidant, antidiarrheal, anti-inflammatory, antiseptic, antispasmodic, galactagogue, antidiabetic, and immunomodulatory properties. It is most commonly used for its phytoestrogenic property that is rendered by steroidal saponins and isoflavones.3,4 Myometrium relaxants help in alleviating dysmenorrhea. A study investigated the effects of ethanolic extracts of A racemosus roots on the myometrium of pregnant and nonpregnant rat uteri. The effects of the extract on spontaneous, high-K-depolarization–induced, and oxytocin-induced contraction in the uteri were examined by measuring the isometric force. The results showed that the A racemosus root extract significantly decreased the force produced by all the 3 mechanisms, in a dose-dependent manner, with more potency in pregnant rats compared with that in nonpregnant rats. Thus, these results prove that A racemosus acts as a potent uterine relaxant by decreasing the force produced by both Ca-dependent and Ca-independent pathways. A racemosus is useful in the management of dysmenorrhea.5 Astudy done on immature female rats reports that administration of A racemosus root extract caused a significant rise in the serum follicle-stimulating hormone levels.4 References 1. Sharma K, Bhatnagar M. Int J Pharm Biol Arch. 2011;2(3):855–863. 2. Chughtai MFJ, et al. Sch J Food Nutr. 2020;3(3):364–367. 3. Jain PK, Agrawal RK. J Res Educ Indian Med. 2009;15(1):15–18. 4. Kushwah P, et al. Res J Pharm Tech. 2018;11(1):418–420. 5. Suwannachat A, et al. Proc Physiol Soc. 2012;PC365. https://www.physoc.org/abstracts/shatavariasparagus-racemosus-extract-can-relax-the-myometrium/ Asparagus racemosus Inte r v iew Doctor, does lifestyle play a role in the development of menstrual irregularities (MIs)? Yes, changes in food and eating habits, such as untimely intake of food, skipping breakfast, and consumption of junk food, can significantly affect the functioning of the female reproductive system. The excessive saturated fatty acids in junk foods affect the metabolism of progesterone. Also, stress is another important factor that can cause a delay in ovulation. Besides, reduced physical activity increases the risk of developing premenstrual syndrome (PMS). Adopting a healthy lifestyle can help keep these menstrual problems at bay. Who is at a higher risk of developing dysmenorrhea? Any woman can develop dysmenorrhea, but the risk is higher in women who consume excessive alcohol and/or smoke, obese women, and women with early menarche (before 11 y of age). Genetic factors are also known to cause dysmenorrhea. Do menstrual cycles affect psychologic health? Menstrual cycles can affect mood at various junctures from ovulation to menstruation. PMS, premenstrual dysphoric disorder, and perimenopausal depression (PMDD) are some menstruation-related mood disorders. Serotonin, a neurotransmitter, helps regulate mood, the sleep cycle, and appetite. With the changes in the serotonin level during the luteal phase of the menstrual cycle, feelings of sadness and irritability are triggered. Unusual food cravings and insomnia are also experienced by some women. When should one seek medical attention for menstrual problems? Any woman (16 y or older) who has not had a menstrual period; has missed at least 3 consecutive menstrual periods (without being pregnant); experiences spotting between periods or after menopause; or has menorrhagia with large clots should consult a gynecologist. How can one deal with MIs? A few lifestyle modifications such as following a healthy diet, exercising, and adopting a regular sleep pattern can help regulate MIs. Reducing refined sugars, salt, nicotine, caffeine, and alcohol in the diet and exercising regularly for 30 minutes, 5 days a week or for at least 20 to 30 minutes thrice a week, can help in regularizing menstrual cycles. Establishing a bedtime routine with consistent sleeping hours can also help in managing MIs. Doctor, do you prescribe any herbal formulation for treating menstrual problems? I prescribe Evecare, a polyherbal formulation from Himalaya Wellness Company, for the management of uterine disorders. Evecare has phytoestrogenic, gonadotropin-agonist, antihemorrhagic, antimicrobial, analgesic, and antispasmodic properties. It has a stimulatory effect on the ovarian tissue and as a result helps regularize endogenous hormonal secretion, enhance the repair of the endometrium, and thus, control abnormal uterine bleeding. Evecare normalizes the cyclical rhythm and offers relief from symptoms of dysfunctional uterine bleeding and PMS. Dr Hemangi Umesh Dalal, MBBS, DGO Consultant Obstetrician and Gynecologist Dr Dalal Hospital Opposite CIDCO Colony Boisar-Tarapur Road, Boisar Thane 401510, Maharashtra India Evecare In common uterine disorders… Ensures complete uterine care • Restores regular menstrual cycles by vir tue of its uterinestimulant action • Stimulates the ovarian tissue, which helps regularize endogenous hormonal secretion • Has potent estrogenic action due to phytoestrogens, which regulate estrogen levels and help heal the inflamed endometrium during menstruation • Exhibits antispasmodic action • Possesses adaptogenic activity, which reduces psychological stress and the incidence of dysmenorrhea (CAPSULE, SYRUP) ® Indications • Irregular menstruation • Dysmenorrhea Dosage Capsule: 1 capsule twice daily. Syrup: 10–15 ml twice daily. In severe cases, 2 capsules twice daily. Treatment should be continued for a minimum of 3 months. Evecare Ensures complete uterine care Asparagus racemosus is an ingredient of Evecare Capsule and Syrup.
4 Macrolide-Resistant Mycoplasma Pneumonia in the Management of Chronic Nonspecific Pharyngitis Atypical pathogens are known to cause a disproportionate disease burden in children and adolescents. Atypical pneumonia is most commonly caused by Mycoplasma pneumoniae, Legionella pneumoniae, Chlamydophila pneumoniae, Coxiella brunette, and Francisella tularensis. The intracellular nature of the atypical pathogens makes it difficult to culture under standard methods, and hence, they are not apparent on a Gram stain. Classic diagnostic findings of atypical pneumonia include patchy infiltrates (sometimes distributed bilaterally) and interstitial patterns. Mycoplasma pneumonia (MP) has become a leading cause of pediatric community-acquired pneumonia (CAP). It is responsible for 25% of all CAP cases. The clinical symptoms are usually mild and selflimiting in adults, but the infection can occasionally Aim To evaluate the efficacy of Septilin in chronic nonspecific pharyngitis, in comparison with Actifed Materials and Methods This randomized, double-blinded, placebo-controlled clinical trial included 50 outpatients with chronic nonspecific pharyngitis (both sexes; age, 18–49 y). The enrolled patients were divided into 2 groups of 25 each, ensuring equal distribution based on age, sex, and symptom similarity. The complete medical history and physical andENTexamination data of the patientswere recorded before starting the therapy. Group 1 patients received 2 tablets of Septilin, TID, and group 2 received 2 tablets of Actifed, BID. The duration of therapy was 3 weeks in both the groups. At the end of the treatment period, the outcomes of the treatment in both the groups were evaluated and compared, and the response was categorized as Good, Satisfactory, Poor, and No Response. Results In the posttreatment assessment, a good relief in persistent sore throat was observed in 70% of the patients in group 1 and in 52% of the patients in group 2. The response to halitosis was significantly better in group 1 (57%) than in group 2 (22%). The response to congestion of the mucosa was also better in group 1 (88%) than in group 2 (76%). Response with respect to other symptoms (eg, discomfort in swallowing) and hypertrophy of lymphoid tissue was marginally better in group 1. Asuccessful outcome was seen in 68% of the patients in group 1 in comparison with 40% in group 2 patients (Tables 1 and 2). No Septilin, a phytopharmaceutical formulation, is recommended for the treatment and management of various infections and to prevent their recurrence. The immunomodulatory action of Septilin potentiates the immune responses of the body. Septilin also reduces inflammation and allergy and corrects the underlying pathologic features associated with recurrent infections. When coprescribed with antibiotics, Septilin ensures faster recovery and prevents recurrence. Pharmacologic Actions z z Immunomodulatory action z z Antioxidant action z z Anti-inflammatory action z z Antimicrobial action Indications z z As an immunomodulator in the management of: – RT and ENT infections (tonsillitis, pharyngitis, bronchitis, sinusitis, and otitis media) – Skin and soft tissue infections – Dental and periodontal infections – Ophthalmic infections – Bone and joint infections – Urinary tract infections z z For early recovery in postoperative conditions z z To reduce recurrence in infection-prone individuals z z As an adjuvant to anti-infective therapy z z Resistance to antibiotic therapy Sources: Stamm DR, Stankewicz HA. Atypical Bacterial Pneumonia. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2021. Loconsole D, et al. Infect Dis Rep. 2021;13(3):811–820. cause extra-respiratory manifestations such as skin lesions, hematologic disorders, and cardiovascular and neurologic diseases. Macrolides, tetracyclines, and fluoroquinolones are considered the first choice of treatment for MP in adults, and only macrolides are recommended for children. However, inappropriate use or overuse of macrolides has led to a worldwide occurrence of macrolide-resistant MP (MR-MP) strains. MR-MP is found more commonly in children than in adults, and the infection leads to persistent symptoms of fever and cough and a prolonged carriage. The emergence of MR-MP has raised the global antimicrobial resistance threat, with reports of resistance rates of 80% to 90% in Asia. Further studies on genome sequencing are required to decode the genome of MR-MP strains to understand better the mechanisms underlying their resistance. Ayurveda defines Prana as the life force that is necessary to carry out the vital functions of life. The Prana Vayu is responsible for respiration in the human body. The channels or tracts (Srotas) in which Prana Vayu flows are called Pranavaha Srotas, and this has been correlated to the respiratory system. Pranavaha Srotas structurally and functionally combine various organs such as naasa (the nostrils), hrudaya (the chest cavity and the cardiac region), mahasrotas pranavahani Respiratory Health: An Ayurvedic Perspective dhamanis (the lungs and the arteries), and the respiratory center in the brain. Any imbalance in the doshas governing the normal functions of Pranavaha Srotas leads to pranavaha srota dusti (vitiation). The major doshas related to the respiratory system are Vata and Kapha. Symptoms of vitiation of Pranavaha Srotas not only include the respiratory system but also involve the circulatory and central nervous systems. The characteristic manifestations of the vitiation of Pranavaha Srotas are atisristam-atibaddham (too long or too restricted respiration), kupita (disturbed pattern of respiration), alpa-alpam (shallow or frequent respiration), and sashabdam sashoolam (respiration associated with altered sound and pain). Kaasa (cough) is a very common presentation. Based on the dosha involved, it can be dry or productive. Table 1. Posttreatment Clinical Assessment Symptom Group 1 Group 2 Persistent Sore Throat 7 11 Discomfort in Swallowing 9 12 Halitosis 3 7 Hypertrophy of Lymphoid Tissue 9 11 Congestion of Mucosa 9 3 Table 2. Posttreatment Clinical Score Assessment Criteria Score Group 1 Group 2 No Symptoms (Good) 9 (36%) 4 (16%) Symptoms Present but Not Troublesome (Satisfactory) 8 (32%) 6 (24%) Symptoms Troublesome, but Not Interfering With Normal Activities (Poor) 2 (8%) 8 (32%) Symptoms Interfering With Normal Activities (No Response) 6 (24%) 7 (28%) s with tagline Curved h adverse effects were observed with the use of Septilin during the study. However, 9 patients on Actifed complained of significant sedation. Conclusion Septilin, a phytopharmaceutical formulation from Himalaya Wellness Company, has distinct immunomodulatory and anti-inflammatory properties that potentiate the nonspecific immune responses of the body, reduce inflammation and allergy, and correct the underlying pathologic features associated with recurrent infections. Septilin does not induce sedation, and thus, could be a useful alternative in ambulatory patients suffering from chronic nonspecific pharyngitis. An excerpt from the clinical study conducted by Nehru V published in the journal The Indian Practitioner is featured here. Brand na es with tagli e Open type Curved Builds the body’s own defense mechanism Evecare® Ensures complete uterine care (CAPSULE, SYRUP) Septilin® (SYRUP, TABLET)
5 Inte r v iew Glycyrrhiza glabra Doctor, how prevalent are respiratory tract infections (RTIs)? Most RTIs follow seasonal patterns, with a high incidence during winter. Several laboratory and clinical studies suggest that inhaling cold air and a lowered body temperature can cause vasoconstriction in the respiratory tract mucosa and suppress the immune system functioning. This leads to an increased susceptibility to infections of the respiratory tract. Per the WHOʼs reports, 2 to 5 million cases of RTIs are reported every year. COVID-19 is the latest addition to the etiology of respiratory infections. The infection is asymptomatic or mildly symptomatic in a majority of patients, but it can progress to severe complications and become lifethreatening. What are the red-flag symptoms of RTIs that could be lifethreatening? A majority of the RTIs that affect the upper respiratory tract are self-limiting. However, infections of the lower respiratory tract require medical attention to prevent serious consequences. Rapid respiratory rate, difficulty in breathing, intermittent apnea, hypoxia, and a history of chronic lung disease are some of the warning signs of worsening RTIs. Superinfection of the respiratory tract by bacteria such as Streptococcus pyogenes, Streptococcus pneumoniae, Mycoplasma pneumoniae, and Haemophilus influenzae can further cause adverse effects if timely diagnosis is not done. It is important to be watchful of these red flags during diagnosis. Could you brief us about severe acute respiratory infection (SARI)? SARI is an acute respiratory infection that lasts for 10 days with a fever of ≥ 100°F and cough and requires hospitalization. SARI is most commonly caused by influenza A and B viruses, parainfluenza viruses, respiratory syncytial viruses, adenoviruses, rhinoviruses, and coronaviruses. SARI is among the leading causes of hospitalization and deaths worldwide. Due to the overlapping of symptoms of SARI and COVID-19, it is important to consider all patients with SARI for COVID-19 monitoring. Doctor, why are some individuals prone to recurrent RTIs? Transmission of respiratory pathogens occurs more frequently during winter, through aerosol droplets or by direct contact. Rhinoviruses account for more than 50% of recurrent RTIs. People with asthma or allergic rhinitis are more prone to recurrent RTIs. Exposure to external factors such as air pollution and passive smoking also increases the risk of developing recurrent RTIs. What do you prescribe to your patients with RTIs? I often prescribe Septilin to my patients with RTIs. Septilin is a polyherbal formulation from Himalaya Wellness Company, known for its immunomodulatory, antimicrobial, anti-inflammatory, antioxidant, and expectorant properties. Septilin’s immunity-boosting property has been proven to be beneficial in treating various infections including RTIs and also for preventing their recurrence. Dr B Ramana Rao, MBBS, FAGE, MD, FICA, FAIID Consulting Physician and Cardiologist Village Clinic T Begur, Nelamangala Taluk Bengaluru 562123, Karnataka India English name: Licorice Sanskrit name: Yashtimadhu Morphology and Habitat Glycyrrhiza glabra is a perennial shrub that grows up to 2.5 m.1 The leaves are pinnate, and the flowers are purple to pale whitish blue. The fruits are 2- to 3-cm long legumes or pods.2 The herb grows abundantly in temperate, warm, and subtropical climates and remains dormant in winter. It is mainly found in Spain, Italy, Turkey, Iran, Iraq, Central Asia, and northwestern China.3 Medicinal Uses G glabra is used for its antiviral, antioxidant, antimicrobial, antispasmodic, antiallergic, anti-inflammatory, immunomodulatory, antitussive, and expectorant properties.1 Glycyrrhizan GA, an acidic polysaccharide derived from the stolon of G glabra, has been shown to significantly increase the activity of the reticuloendothelial system and also to enhance phagocytosis. 18β-Glycyrrhetinic acid, a primary metabolite of glycyrrhizin, is a potent inhibitor of the classical complement pathway.3 G glabra is known for its anti-inflammatory property. A study shows that the anti-inflammatory effect of glycyrrhizin is due to the inhibition of generation of reactive oxygen species by the neutrophils.4 The administration of glycyrrhizin prior to carrageenan exerted a potent anti-inflammatory effect in mice.3 In a study, the antibacterial activity of different concentrations (2.5, 5, and 10 mg/mL) of the ethanolic root extract of G glabra was tested against Streptococcus mutans, Streptococcus sanguis, Streptococcus salivarius, Streptococcus mitis, and Lactobacillus acidophilus using the disk diffusion technique. Results showed that all the concentrations of G glabra exhibited antibacterial activity. The ethanolic root extract was highly effective against S mutans, with a good zone of inhibition. The minimum bactericidal concentration and minimum inhibitory concentration values were low (2 mg/mL) for S mutans and S sanguis, indicating the high efficacy of the extract.5 References 1. Kaur R, et al. Int J Pharm Sci Res. 2013;4(7):2470–2477. 2. Pastorino G, et al. Phytother Res. 2018;32(12):2323–2339. 3. Lim TK. Edible Med Non-Med Plant. 2015;354–457. 4. Akamatsu H, et al. Planta Med. 1991;57(2):119–121. 5. Geetha RV, Roy A. Int J Drug Dev Res. 2012;4(4):161–165. Septilin® Builds the body’s own defense mechanism Manage recurrent respiratory infections with… Septilin Builds the body’s own defense mechanism ® Regd. Trademark ( SYRUP , TABLET ) • Corrects the underlying pathological features of infections and allergies • Offers beneficial antimicrobial and antiviral actions • Improves the body’s immune defenses Indications • Recurrent RT and ENT infections (tonsillitis, pharyngitis, bronchitis, sinusitis, and otitis media) • Resistance to antibiotic therapy • As an adjuvant to anti-infective therapy Glycyrrhiza glabra is an ingredient of Septilin Syrup and Tablets.
HERBS Evaluation of Osteogenic Potential of Cissus quadrangularis on Mandibular Alveolar Ridge Distraction Boswellia serrata Order: Sapindales Family: Burseraceae Genus: Boswellia Species: serrata English name: Indian Frankincense Sanskrit name: Shallaki Morphology and Habitat Boswellia serrata is a deciduous tree that grows up to 18 m tall. The leaves are lanceolate or ovate, and the flowers are white. B serrata commonly grows in the dry and hilly regions of India, northern Africa, and the Middle East.1,2 Principal Phytoconstituents Boswellic acids are the main biologically active phytoconstituents found in the resin of B serrata and have promising anti-inflammatory activity.3 Pharmacologic Actions In a study, patients with knee osteoarthritis (OA) were administered B serrata extract (containing Cissus quadrangularis Order: Vitales Family: Vitaceae Genus: Cissus Species: quadrangularis English name: Winged Treebine Sanskrit name: Hadjod Morphology and Habitat Cissus quadrangularis is a perennial climber. The stem is stout, fleshy, and quadrangular and dichotomously branched, and the leaves are reniform. C quadrangularis grows extensively in tropical and subtropical countries including India, Sri Lanka, South Africa, Thailand, Java, and the Philippines.1 Principal Phytoconstituents The major phytoconstituents of C quadrangularis are flavonoids, iridoids, anabolic steroids, triterpenoids, stilbene derivatives, phytosterols, and α- and β-amyrins.2 The plant also contains ascorbic acid, carotene A, ketosteroid, and calcium.1 3-acetyl-11-keto-β-boswellic acid with β-boswellic acid) or placebo for 120 days. The B serrata group reported significantly improved functional ability and reduced pain and stiffness of the knee joint compared with the placebo group. Radiographic assessments in the B serrata group showed a distinct change in the OA condition, wherein there was an increase in the knee joint gap and decrease in the osteophytes. They also had significantly reduced levels of serum high-sensitive C-reactive protein, a potential inflammatory marker associated with knee OA. Thus, B serrata exerts antiarthritic and antiinflammatory activities.4 References 1. Siddiqui MZ. Indian J Pharm Sci. 2011;73(3):255–261. 2. Sultana A, et al. Int J Pharm Sci Res. 2013;4(6):2106–2117. 3. Iram F, et al. Asian Pac J Trop Biomed. 2017;7(6):513–523. 4. Majeed M, et al. Phytother Res. 2019;33(5):1457–1468. Pharmacologic Actions A study evaluated the effect of C quadrangularis (500 mg capsules) on the healing process of maxillofacial fractures in patients treated through open reduction internal fixation. Upon follow-up of these patients, an acceleration in the healing of fractured jaw bones and a reduction in pain and swelling were noted.3 C quadrangularis promotes fracture healing by increasing the uptake of minerals such as calcium, strontium, and sulfur by the osteoblasts.4 In ovariectomized mice, the administration of C quadrangularis extract prevented bone loss in the cancellous and cortical bones of the femur and the proximal tibia.5 References 1. Zaki S, et al. Int J Clin Microbiol Biochem Technol. 2020;3:49–53. 2. Sundaran J, et al. Bioinformation. 2020;16(8):579–585. 3. Brahmkshatriya HR, et al. Ayu. 2015;36(2):169–173. 4. Ghouse MS, Baig MS. Int J Pharmacog. 2015;2(11):527–531. 5. Banu J, et al. J Osteoporos. 2012;2012:101206. This randomized clinical trial was designed to evaluate the osteogenic potential of Cissus quadrangularis in alveolar distraction to facilitate implant installation. Twenty patients with atrophic ridge were treated through alveolar distraction. After completing distractor activation, the patients were randomly divided into 2 equal groups—the placebo group and the C quadrangularis or study group. After a consolidation period, distractors were removed, and implants were inserted. Clinical evaluation was done to assess wound healing and stability of the distractor and the implant. Histologic evaluation was performed at the time of implant insertion. Radiographic evaluation was performed to assess the bone volume and density after distraction as well as the density and bone loss around the implant. Radiographic and histologic evaluation results showed that the bone formation and maturation were faster in the study group than that in the control group. There was a significant increase in the bone density in the distracted area and around the implant in the study group than in the control group. There was a significant bone loss by the end of the consolidation Source: Altaweel AA, et al. BMC Oral Health. 2021;21:491. period and around the implant by the end of the study in the control group than in the study group. C quadrangularis administration during the consolidation period is associated with an increased osteogenic potential in the distracted bone. The histologic and radiographic findings of this study proved that C quadrangularis not only enhances the rate of new bone formation but also increases bone density to withstand the biomechanical requirements of implant placement in a shorter time. Brand names with tagline Open type Curved Septilin® Builds the body’s own defense mechanism Evecare® Ensures complete uterine care ShallakiHimalaya The key to healthy joints HadjodHimalaya Accelerates fracture healing and increases bone strength Brand names with tagline Open type Cu ved Septilin® Builds the body’s own defense mechanism Evecare® Ensures complete uterine care ShallakiHimalaya The key to healthy joints Hadj Himalaya Accelerates fracture h al and increases bo strengt Brand names with tagline Open type Curved Septilin® Builds the body’s own defense mechanism Evecare® Ensures complete uterine care Sha lakiHimalaya The key to healthy joints HadjodHimalay Accelerates fracture healing and incr ases bone stren
J 7 Copyright 2021 IJCP Publications Ltd. All rights reserved. The copyright for all the editorial material contained in this newsletter Alloveda, in the form of layout, content including images and design, is held by IJCP Publications Ltd. No part of this publication may be published in any form whatsoever without the prior written permission of the publisher. This newsletter is Published and Edited by IJCP Academy of CME at Regd. Office: 3rd Floor, 39 Daryacha, Hauz Khas Village, New Delhi - 110 016. E-mail: editorial@ijcp.com, Website: www.ijcpgroup.com, HIP/IN/Bengaluru/3848 as a part of its social commitment toward upgrading the knowledge of Indian doctors. Disclaimer: Although great care has been taken in compiling and checking the information given herein to ensure that it is accurate, the Publisher shall be in no way directly or indirectly responsible for any errors, omissions or inaccuracies in this publication whether arising from negligence or otherwise. IJCP Publications Ltd. does not guarantee, directly or indirectly, the quality or efficacy of the product or service described in the advertisements or other material which is commercial in nature in this publication. Printed at Sri Sudhindra Offset, Bengaluru, on behalf of IJCP Publications Ltd. Q: How will you distribute 8 mangoes equally between 6 people? A: By making a mango milkshake! Q: What do you call a funny mountain? A: Hill-arious! Q: Where do ants go for vacation? A: Ant-artica! Nate: Do you know why school was easier for cave people? Kate: No, why? Nate: Because there was no history to study! Stevie: Hey, Mom! I got a 100 in school today! Mom: That’s great. In what? Stevie: A 40 in reading and a 60 in spelling! Mom: What did you do at school today? Mark: We did a guessing game. Mom: But I thought you were having a math exam. Mark: That’s right! Teacher: Donald, what is the chemical formula for water? Donald: H-I-J-K-L-M-N-O. Teacher: What are you talking about? Donald: Yesterday you said it was H to O! Time laugh To Riddles 1. A man is looking at a photograph of someone. His friend asks who it is. The man replies, “Brothers and sisters, I have none. But that man’s father is my father’s son.” Who was in the photograph? 2. What 5-letter word becomes shorter when you add 2 more letters to it? 3. Using only addition, add eight 8s to get the number 1000. 4. Paul’s height is 6 feet, he’s an assistant at a butcher’s shop, and wears size 9 shoes. What does he weigh? Scan the QR code below or write to publications@himalayawellness.com to provide feedback/suggestions on Alloveda Answers: 1. His son 2. Short 3. 888 + 88 + 8 + 8 + 8 = 1000 4. Meat ShallakiHimalaya(TABLET) The key to healthy joints In pain and inflammation… Accelerates fracture healing and increases bone strength Hadjod Himalaya (TABLET) Indications Fractures of various etiologies: • Traumatic fractures (fractures caused by accidents/sports/stress) • Pathological fractures (fractures induced by osteoporosis and fragile bones) Multiple actions of Himalaya Hadjod ensure “early ossification and proper remodeling of bones,” resulting in faster healing and quicker recovery time. Cissus quadrangularis | Winged Treebine Each tablet contains 250 mg extract of Hadjod stem. Available in 60s Dosage 2 tablets twice daily. Hadjod Himalaya Accelerates fracture healing and increases bone strength ShallakiHimalaya The key to healthy joints • Decreases the degradation of glycosaminoglycans, thereby helping to prevent the destruction of articular cartilage1 • Boswellic acid has significant anti-inflammatory property.2 • Decreases knee pain, increases knee flexion and walking distance3 • Possesses anti-arthritic and analgesic properties3 • Well tolerated on oral administration4 Indications • Osteoarthritis • Rheumatoid arthritis • Back pain • Myalgia and arthralgia Available in 60s Dosage 2 tablets twice daily. 1. Indian J Pharmacol. 2007;39:27–29. | 2. DNA and Cell Biol. 2005;24(4):244–255. 3. Phytomedicine. 2003;10(1):3–7. | 4. Phytomedicine. 2004;11(2–3):255–260. Boswellia serrata | Boswellia Each tablet contains 125 mg extract of Shallaki oleo gum resin. In fractures associated with various etiologies…
® Regd. Trademark Dosage 2 to 5 years: 2.5 mL to 5 mL twice daily. 5 to 10 years: 5 mL to 10 mL twice daily. 10 to 18 years: 10 mL to 15 mL twice daily. Carica papaya complex with bioenhancer for low platelet count Indication Thrombocytopenia Improves platelet count • Modulates the production and differentiation of platelets through the action of thrombopoietin • Promotes the differentiation of megakaryocytes into platelets • Carica papaya in Platenza is well repor ted to decrease peripheral platelet destruction. Reduces fever in dengue • Piper nigrum and Tinospora cordifolia offer antipyretic proper ty. Safe for the pediatric population • No adverse effects repor ted Makali, Bengaluru 562162, India Only for reference by a registered medical practitioner, hospital, or laboratory In line with Himalaya’s commitment toward a green future, Alloveda newsletter is printed with VOC-free, vegetable-based inks on eco-friendly paper made from sustainable sources.
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