Himalaya’s Health Digest for You Vol LXI • No. 3 • Jan–Mar 2022 Himalaya salutes the health care community for their selfless service during the COVID-19 pandemic. Insights Into Urinary Tract Infections Urinary tract infections (UTIs), categorized as one of the most distressing clinical conditions, affect all age groups and both sexes, but are highly prevalent in adult women (50%–60%). While the majority of UTIs are caused by the uropathogen Escherichia coli, other pathogens including Klebsiella, Staphylococcus, Enterobacter, Proteus, and Enterococcus are also known to cause UTIs. The pathogenesis commences with the contamination of the periurethral space by the uropathogens, urethral colonization, and subsequent ascension of the pathogens to the urinary bladder.1 Based on the pathogen’s virulence, the host’s anatomical characteristics and immune efficiency, and availability of an appropriate therapeutic intervention, the occurrence and severity of UTIs can be categorized into the following types2: Uncomplicated UTI: It is also known as cystitis or lower UTI; it is a bacterial infection that usually involves only the bladder. An UTI that develops in patients with no comorbidities or structural and functional abnormalities in the urinary tract is classified as an uncomplicated UTI. Typically, an uncomplicated UTI is self-limiting; it can be managed otherwise with antibiotic therapy to prevent the progression of the infection into the upper urinary tract.3 Complicated UTI: The risk of contracting a complicated UTI is high during pregnancy, in the elderly, in patients with anatomical abnormalities or comorbidities such as diabetes mellitus (DM) and impaired renal function, and in immunocompromised patients. Patients with a complicated UTI require a longer course of antibiotics and often they are at a high risk of treatment failure. In case of severe infection, a complicated UTI can present as severe undifferentiated sepsis or septic shock.4 Recurrent UTI: Despite therapeutic intervention, about 30% of women experience a recurrent UTI, which is usually a new infection by a different uropathogen, occurring 3 to 4 times a year. Anatomical abnormalities leading to stasis, urinary tract obstruction, and urinary reflux can trigger recurrent UTIs. Most recurrent UTIs do not have long-term consequences; however, it is of diagnostic importance to differentiate a rapid reinfection from an infection relapse. A majority of recurrent UTIs are usually rapid reinfections.5 Prevalence of UTIs in Patients With Diabetes Mellitus Sedentary lifestyle has led to an early onset of DM. Uncontrolled or untreated hyperglycemia can lead to several micro- and macrovascular complications. Health From Herbs 3 Laugh aWhile 11 FEEDBACK Please scan the QR code or visit the link below to submit your feedback and suggestions on Capsule. https://tinyurl.com/CapsuleFeedbackForm Health News 7 Fact File 10 Research at Himalaya 4 Latest in Medicine 9 Health Tips10 Fitness 6 8In Focus
2 • Jan–Mar 2022 • Vol LXI • No. 3 E D I T O R I A L Dear Doctor, With a resurgence in the COVID-19 cases across the world, the health care system continues to stay vigilant to shield and minimize the effects of the pandemic. Himalaya extends sincere gratitude to the entire health care fraternity for their relentless service toward humanity. We present this issue of Capsule with several engaging articles. The cover page article discusses about urinary tract infections, one of the most common microbial infections, and its prevalence in patients with diabetes mellitus. The clinical studies featured in this issue provide evidence about the efficacy and safety of Evecare forte in the management of polycystic ovarian syndrome and Septilin in the management of upper respiratory tract infections. A few interesting facts about acne and eczema, health tips to ease motion sickness, and the benefits of exercising in the elderly are also featured. Besides, a well-curated compilation of medical updates is also a part of this issue of Capsule. We hope you find these articles interesting and informative. We wish you and your family good health! — Editor Besides, DM is also considered one of the leading triggers of long-term complications such as renal dysfunction and associated UTIs. A high urine glucose concentration promotes urinary colonization of uropathogens and manifests as cystitis, prostatitis, asymptomatic bacteriuria, urethritis, and pyelonephritis. Poor circulation, decreased immune function, and poor bladder contractions are some of the factors leading to the development and progression of UTIs in patients with DM. Other predisposing physiologic factors that increase the prevalence of UTIs in patients Cystone®-SF (LIQUID) Cystone-SF liquid, a phytopharmaceutical formulation from Himalaya Wellness Company, is recommended for the comprehensive management of urolithiasis and urinary tract infections (UTIs) in patients with diabetes mellitus. Cystone-SF liquid comprises key ingredients such as Tribulus terrestris, Asparagus racemosus, and Boerhaavia diffusa that possess pH-renormalizing, diuretic, antimicrobial, antiadherent, anti-inflammatory, spasmolytic, and antioxidant actions. Cystone-SF liquid expels kidney stones and ureteric stones and prevents their recurrence. Cystone-SF liquid helps prevent urinary supersaturation, inhibits mineralization, and corrects crystal–colloid imbalance. Cystone-SF liquid has a cooling action and relieves burning micturition by renormalizing urine pH. Cystone-SF liquid is known to inhibit the adherence of key uropathogenic bacteria and promote their expulsion with the natural flow of urine. The antispasmodic, anti-inflammatory, and antioxidant properties of the herbs present in Cystone-SF liquid provide relief from the symptoms of UTIs. with DM include age, gender, duration of DM, and associated complications such as neuropathy and glycosuria.6 UTIs are a critical public health concern. Treatment for UTIs is usually directed toward symptomatic relief and prevention of progression into upper urinary tract diseases. Mini-dose antibiotic therapy that typically lasts for 3 days has been proven to be effective in treating UTIs. Implementing certain preventative measures in daily routine such as increasing fluid intake (2 L/d) and maintaining washroom hygiene can reduce the recurrence of UTIs.4,5 References 1. Meštrović T, et al. Diagnostics. 2021;11(1):7. 2. Goulart DB. Res Soc Dev. 2021;10(16): e34101623190. 3. Bono MJ, Reygaert WC. Urinary Tract Infection. StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2021. 4. Sabih A, Leslie SW. Complicated Urinary Tract Infections. StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2021. 5. Aggarwal N, Lotfollahzadeh S. Recurrent Urinary Tract Infections. StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2021. 6. Aamir AH, et al. BMC Infect Dis. 2021;21:388. Copyright © 2014 Himalaya Wellness Company All contents in this journal/publication are the property of Himalaya Wellness Company and are protected by Indian and international copyright laws. Any other use, including the reproduction, modification, distribution, transmission, republication, display or performance, of the content in this journal/publication, without written permission from the owner, is strictly prohibited. For permission to reproduce articles/information published in this journal/publication, please write to publications@himalayawellness.com SUBSCRIPTION If you would like to subscribe to Capsule, please fill an online form. You can access this form through the link https://tinyurl.com/ CapsuleSubscriptionForm or the QR code
Jan–Mar 2022 • Vol LXI • No. 3 3 Health From Herbs Sanskrit name Medhika English name Fenugreek Trigonella foenum-graecum Trigonella foenum-graecum is an annual, leguminous herb cultivated in warm temperate and tropical regions. It is rich in saponins, flavonoids, and polyphenols. The herb possesses antidiabetic, anti-inflammatory, hypotensive, antitumor, antiobesity, and antioxidant properties.1,2 A clinical study was conducted to evaluate the antidiabetic potential of T foenum-graecum in patients with type 2 diabetes mellitus (aged 30–65 y; both sexes). The control group was advised dietary modification, while the treatment group was advised dietary modification along with T foenum-graecum seed powder (10 g), BID, for 2 months. At the end of 2 months, a gradual decrease in the blood glucose and glycated hemoglobin levels was noted in the treatment group, thereby demonstrating the hypoglycemic property of T foenum-graecum.2 A 28-day study evaluated the lipid-inhibitory effect of the aqueous extract of T foenum-graecum seeds. Female Wistar rats were fed a normal pellet diet (control group) or a high-fat diet (HFD; treatment groups). Two of the HFD groups were given T foenum-graecum extract (0.5 and 1.0 mg/kg body weight), orally, and 1 HFD group was treated with orlistat (10 mg/kg body weight), orally. The HFD groups treated with the T foenum-graecum extract showed significant reduction in anthropometric, hematologic, and lipid profile measurements; improvement in the levels of hepatic and cardiac function biomarkers; and normalization of antioxidant and lipogenic enzyme activities. Thus, these results show that the aqueous extract of T foenum-graecum seeds possesses potent inhibitory activity on fat accumulation and dyslipidemia.3 References 1. Plants For A Future. Trigonella foenum-graecum - L. https://pfaf.org/. Accessed December 22, 2021. 2. Rehman MH, et al. Food Sci Technol. 2021;41(2):349–354. 3. Kumar P, et al. Biomed Res Int. 2014;2014:606021. Withania somnifera Withania somnifera is an evergreen, perennial shrub that grows in India, Sri Lanka, Pakistan, and Africa and the Mediterranean regions of Europe. W somnifera has phytoconstituents such as alkaloids, steroidal lactones, withaferin A, and sitoindosides. It possesses anti-inflammatory, anxiolytic, hypotensive, and antitumor properties.1,2 An experimental study evaluated the immunomodulatory property of W somnifera in Ehrlich ascites tumor–bearing male Bagg albino mice. Mice in the treatment group were inoculated intraperitoneally with 0.1 mL of 6 × 106 viable tumor cells, 2 hours before the treatment. A dry extract of W somnifera at doses of 20, 50, or 100 mg/kg was administered for 10 consecutive days to mice in the control and treatment groups. Upon evaluation of the femoral marrow and spleen cells, an increase in cytokine production and myelopoiesis and modulation of spleen colony formation were noted in the treatment group, thus, proving the immunomodulatory potential of W somnifera.2 In another study, the role of W somnifera leaves in ameliorating obesity-associated anxiety and neuroinflammation was demonstrated in Wistar albino female rats. The rats were randomized into low-fat diet (LFD) and high-fat diet (HFD) groups, and a subgroup of rats from the LFD and HFD groups was supplemented with W somnifera leaves (1 mg/g body weight) and was put on a 12-week dietary regimen. After detailed evaluations, the results showed that W somnifera–treated rats exhibited reduced anxiety and suppressed expression of inflammatory markers and leptin levels, thus, validating the anxiolytic and anti-inflammatory potential of W somnifera.3 References 1. Plants For A Future. Withania somnifera - (L.) Dunal. https://pfaf.org/. Accessed December 23, 2021. 2. de Melo AL, et al. J Anal Pharm Res. 2021;10(2):82–91. 3. Kaur T, Kaur G. J Neuroinflammation. 2017;14(1):201. Sanskrit name Ashvagandha English name Winter Cherry
4 • Jan–Mar 2022 • Vol LXI • No. 3 Research at Himalaya Efficacy of Evecare forte™ in the Management of Polycystic Ovarian Syndrome An excerpt of the preclinical study conducted by Azeemuddin M et al published in Advances in Pharmacological Sciences is featured here. A study was conducted to evaluate the efficacy of Evecare forte on testosterone propionate (TP)–induced polycystic ovarian syndrome (PCOS) in rats. Thirty female rats were considered for the study; they were divided into 3 groups of 10 each. Group 1 served as normal control; group 2 served as positive control and was administered TP; and group 3 served as test group and was administered TP along with Evecare forte at a dose of 100 mg/kg po, for 60 days. After the 60-day study period, all the 3 groups were evaluated for the following parameters: glucose intolerance, weight of the ovaries, estrus cycle, serum testosterone level, and histoarchitecture of the ovaries. GLUT4 expression assay was done to evaluate the effect of Evecare forte on insulin resistance. Results showed that treatment with Evecare forte reduced body weight, glucose and testosterone levels, and weight of the ovaries, increased GLUT4 expression, and normalized irregular estrus cycle. Furthermore, Evecare forte caused a decrease in cystic follicle formation and atrophic changes. Evecare forte resulted in an overall recovery in the histoarchitecture of the ovaries. Thus, Evecare forte reverses the pathophysiologic changes such as metabolic dysfunction and reproductive impairment associated with PCOS. The herbs present in Evecare forte exhibit beneficial effects on the female reproductive system, proving the efficacy of Evecare forte in the management of PCOS. Evecare forte™ (LIQUID, TABLET) For the effective management of PCOS Evecare forte is a polyherbal, nonhormonal menstrual modulator indicated for the comprehensive management of polycystic ovarian syndrome (PCOS). Evecare forte helps regularize the endogenous hormonal status, helps correct the cyclical rhythm, and helps reduce the number of abnormal ovarian follicles. It improves ovulatory function and other metabolic derangements associated with insulin resistance due to its insulin-sensitizing activity. Evecare forte helps regularize menstrual cycles and helps correct symptoms of hyperandrogenism such as hirsutism and hyperpigmentation. Furthermore, it improves chances of fertility and also helps reduce mood swings, anxiety, and depression associated with PCOS. Preclinical Evidence An excerpt of the clinical study conducted by Ahalya S (yet to be published) is featured here. Forty women (aged 18–45 y) with symptoms of PCOS, such as irregular menstrual cycles, weight gain, biochemical/clinical hyperandrogenemia, and hirsutism were advised Evecare forte liquid at a dosage of 20 mL, BID, for 3 months. Clinical symptoms and physical, hematological, biochemical, and hormonal parameters were assessed in all the women, at entry and at each follow-up (months 1, 2, and 3). Ultrasonography was performed at the beginning and at the end of the study. There was a significant reduction in the duration of menstruation and the intermenstrual interval in all the women (Table). There was also a reduction in the testosterone and the luteinizing hormone levels and the number and size of ovarian follicles as evaluated through ultrasonography. There were no significant adverse effects either observed or reported during the study. Thus, Evecare forte liquid is an effective nonhormonal menstrual modulator. It helps regularize endogenous hormonal secretion, correct the cyclical rhythm, and relieve the symptoms of PCOS. Table. Effect of Evecare forte Liquid on Menstrual Symptoms Parameter At Entry Month 1 Month 2 Month 3 P Value No. of Days of Menstruation 5.31 ± 4.52 3.62 ± 0.96 3.00 ± 0.82 2.69 ± 0.75 aP < .035 Intermenstrual Interval, d 44.88 ± 19.72 44.43 ± 28.2 35.25 ± 22.19 27.5 ± 1.69 aP < .0299 Statistical test: ANOVA, Tukey’s multiple comparison test, Friedman’s test, and Dunn’s multiple comparison test. Significance was fixed at < .05. Values are given as mean ± SD. aCompared with at-entry values. Clinical Evidence
Jan–Mar 2022 • Vol LXI • No. 3 5 Septilin® in the Management of Upper Respiratory Tract Infections An excerpt of the clinical study conducted by Nigam P et al published in The Medicine & Surgery is featured here. This study enrolled 150 patients (mean age, 30.6 ± 8.6 y; male:female ratio, 2.1:1) with upper respiratory tract infections (URTIs). A detailed medical history of all the patients was obtained, and they were subjected to routine blood tests for hemoglobin, total and differential leukocyte counts, and erythrocyte sedimentation rate. A leukocyte count up to 12,000/mm3 with evidence of slight toxemia differentiated the mild from the severe grade of infection. Patients with mild infections were given Septilin, at a dosage of 1 tablet, TID, and those with severe infection were given, 2 tablets, TID, for 2 to 3 weeks. The therapeutic response was evaluated as good, fair, or poor from days 3 to 5 in acute cases and from days 14 to 21 in chronic cases. The clinical improvement was assessed based on the degree of resolution of inflammation; relief from pain, tenderness, and other symptoms; and normalization of leukocyte count. Results showed that Septilin is effective in controlling acute and chronic URTIs. The overall therapeutic response was 92%. Septilin was found to be most effective in rhinitis with nasal obstruction (100%), acute laryngitis (100%), tracheobronchitis (100%), and acute tonsillitis (100%). In 12 cases, where the therapeutic response was initially poor, Septilin acted as a good adjuvant to antibiotics, and patients soon responded to the combination of antibiotics with Septilin. There was no adverse effect due to Septilin. Patients who experienced recurrence showed varying degrees of improvement after re-treatment with Septilin; there was no resistance to Septilin with prolonged treatment. Thus, Septilin is effective and safe in the treatment of acute and chronic URTIs. Septilin® (SYRUP, TABLET) Builds the body’s own defense mechanism Septilin, a phytopharmaceutical formulation, is recommended for the treatment and management of various infections and prevention of 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. Septilin is a valuable adjuvant in infection management, as it builds the body’s own defense mechanism. When coprescribed with antibiotics, Septilin ensures faster recovery and prevents recurrence. Septilin provides excellent short- and long-term safety. Clinical Evidence 1 An excerpt of the clinical study conducted by Rahman H published in Probe is featured here. This study enrolled 42 patients (32 males and 10 females) with recurrent URTIs, such as chronic tonsillitis, laryngitis, pharyngitis, and sinusitis, that were resistant to earlier treatments with antibiotics, antiallergics, and anti-inflammatory drugs. The dosage of Septilin syrup was as follows: patients aged up to 2 years, ½ teaspoon, TID, and < 2 years, 1 teaspoonful, TID. Septilin tablets were given to patients > 6 years at a dosage of 1 tablet, TID. Six weeks’ treatment was advised in all cases; 66.7% completed the course, while 14.2% took the treatment for < 4 weeks. The results of the treatment with Septilin were good (long-term subjective and objective relief ) in 59.5% cases and fair (frequency of relapses reduced significantly) in 28.6% (Table). There was long-term subjective and objective relief with a significant reduction in the frequency of relapses in as many as 37 (88%) patients. No recurrence or side effects were seen during follow-up. Thus, this study proves that both the syrup and the tablet forms of Septilin are equally effective in the management of URTIs. Clinical Evidence 2 Table. Response to Septilin Therapy Condition Form of Medication Response to Treatment Total Good Fair Poor Recurrent URTI Syrup 18 5 4 27 Tablets 1 1 — 2 Chronic Tonsillitis Syrup 2 1 — 3 Tablets 4 3 1 8 Chronic Pharyngitis Syrup — 1 — 1 Tablets — — — — Chronic Sinusitis Syrup — — — — Tablets – 1 — 1 Total, n (%) 25 (59.5) 12 (28.6) 5 (11.9) 42 URTI, upper respiratory tract infection.
6 • Jan–Mar 2022 • Vol LXI • No. 3 Fitness Advantages of Exercising Improves general health: Exercising reduces the risk of lifestyle- and age-related disorders such as arthritis, osteoporosis, hypertension, and Alzheimer’s disease. Exercises are also known to improve the immune function.1,7 Improves bone density: Both men and women tend to lose bone density with age. Performing resistance exercises and strength training exercises regularly is proven to improve bone density.7 Improves mental health: Exercise has innumerable benefits on mental health. It helps relieve stress, improve mood, and prevent depression and anxiety.1,7 Improves cognitive function: Dementia and Alzheimer’s disease are quite prevalent in the elderly. Regular exercise can lower the incidence of these ailments.1,8 Improves sleep: Exercise improves sleep quality, which is extremely important, especially in the elderly, as they tend to suffer from insomnia and disturbed sleep patterns.1,8 References 1. The GreenFields. 5 Benefits of exercise for seniors and aging adults. https://thegreenfields.org/. Accessed December 17, 2021. 2. HelpGuide. Senior exercise and fitness tips. https://www.helpguide.org/. Accessed December 17, 2021. 3. Centers for Disease Control and Prevention. How much physical activity do older adults need? https://www.cdc.gov/. Accessed December 17, 2021. 4. National Institute on Aging. Four types of exercise can improve your health and physical ability. https://www.nia.nih.gov/. Accessed December 17, 2021. 5. familydoctor.org. Exercise and seniors. https://familydoctor.org/. Accessed December 17, 2021. 6. American Cancer Society. 5 Benefits of strength training. https://www.cancer.org/. Published October 23, 2019. Accessed December 17, 2021. 7. National Council on Aging. The life-changing benefits of exercise after 60. https://www.ncoa.org/. Published August 30, 2021. Accessed December 17, 2021. 8. The Care Workers’ Charity. 16 Benefits of exercise for the elderly. https://www.thecareworkerscharity.org.uk/. Accessed December 17, 2021. Benefits of Exercise in the Elderly The innumerable health benefits of exercising have often been proved by many studies. An active lifestyle becomes more important when one starts aging. In the elderly (65 y or older), regular exercise helps improve both mental and physical health. It also helps promote an active lifestyle so that daily chores are performed independently.1-3 The ideal workout for the elderly should be a combination of endurance training, strength training, balance exercises, and flexibility exercises. Endurance exercises: Endurance training helps improve blood circulation and overall heart and lung health. These exercises help in preventing or delaying age-related health issues. The activities that help build endurance include brisk walking or jogging, gardening and mowing, dancing, swimming, cycling, climbing stairs, and playing tennis or basketball.4,5 Strength exercises: Strength exercises help build muscle strength, increase bone density and flexibility, and reduce the risk of fractures. The exercises that help build strength include • weight lifting, • resistance band exercises, and • body weight–bearing exercises (eg, push-ups and sit-ups).4-6 Balance exercises: Balance exercises help prevent falls, a common problem in the elderly, that may lead to serious injuries. Many lower body–strengthening exercises can help improve balance. Some of them are • tai chi, • heel-to-toe walk (walking forward by placing the heel first and then the toe and one foot directly in front of the other), • standing on one foot (preferably by holding a chair), and • standing from a seated position.4,5 Flexibility exercises: These exercises stretch the muscles, and thus, keep the body flexible. Being flexible helps one perform daily life activities efficiently. A few examples of stretching exercises are • back stretch, • inner thigh stretch, • back of leg stretch, and • ankle stretch.4,5 Besides, the elderly can also practice yoga for improving muscle and bone strength and flexibility.7
Jan–Mar 2022 • Vol LXI • No. 3 7 Health News Health News Cataract Extraction Reduces the Risk of Dementia in Older Adults To address the conflicting results of the association between cataract extraction and dementia, data from an ongoing, population-based Adult Change in Thought (ACT) study were analyzed by a group of researchers at the University of Washington (Seattle, WA, USA). The analyses included patients older than 65 years from the ACT study, diagnosed with cataract or glaucoma, with apolipoprotein E genotype data, and no history of dementia. The patients were evaluated biennially for all-cause dementia and probable or possible Alzheimer’s disease dementia and scored with the Cognitive Abilities Screening Instrument. The findings confirmed that in the participants who underwent cataract extraction, the risk of all-cause dementia was significantly lower than that in participants who did not undergo cataract surgery (P < .001). However, no correlation was found between glaucoma surgery and lowered risk of dementia. Thus, cataract surgery might have clinical relevance in older adults who are at a risk of developing dementia.1 Nutritional Choices Can Influence the Mental Wellbeing of School-Going Children A new study published in BMJ Nutrition, Prevention & Health investigated the role of nutritional intake on the mental health of school-going children. A questionnaire-based survey was conducted in 5- to 13-year-old children about their home situation, adverse experiences, health and well-being, consumption of fruits and vegetables, and meal type consumed (eg, conventional breakfast, packed lunch, and energy drinks and energy bars). The mental well-being score, assessed using the Warwick–Edinburgh Mental Wellbeing Scale and the Stirling Children’s Wellbeing Scale, was 46.6 and 46.0 in the secondary and primary school children, respectively. Only 25.2% of the secondary school children and 28.5% of the primary school children reported consuming the recommended 5-a-day fruits and vegetables, while 21.1% and 11.4% of the secondary school children reported not consuming breakfast and lunch, respectively. Mental well-being was found to be strongly associated with the consumption of fruits and vegetables and the type of breakfast and lunch.3 A Three-Minute Exposure to Sunlight Can Restore Color Vision According to a study published in Scientific Reports, a single exposure of the aging retina to sunlight of long wavelength (650–900 nm), for 3 minutes, can partially restore color vision for a week. The dominant eye of healthy participants (34–70 y; both sexes), with normal color vision, was exposed to light of 670 nm wavelength, for 3 minutes, either in the morning (between 8 and 9 AM) or noon (between 12 and 1 PM). The color contrast sensitivity was measured using the Chroma Test, either 3 hours after exposure or 1 week later, and the threshold was determined. The results suggested that a single, 3-minute morning exposure of the eyes to sunlight can improve cone cells’ photoreceptor function in aged individuals for up to a week. A population-level adoption of this technique can minimize the problems associated with reduced vision and significantly improve the quality of life in adults.2 Exposure to Low Temperature and Humidity Can Increase the Incidence of Acute Myocardial Infarction An observational study published in Scientific Reports evaluated the association between the weather (temperature and humidity) and acute myocardial infarction (AMI) hospitalization in the elderly. Data pertaining to temperature and humidity and diagnosis of AMI requiring hospitalization were collected from the Japanese registry of all cardiac and vascular diseases database. Data were analyzed for the number of AMI cases that required hospitalization per day based on the seasonal changes in the average weather temperature and humidity and patient demographics using the multilevel mixed-effects linear regression models. Findings showed that, independent of the age and sex factors, the number of AMI hospitalizations was pronounced during autumn and spring because of the varying temperature and humidity. Therefore, protection of the elderly from low temperature and humidity can be effective in the prevention of AMI.4 References 1. Lee CS, et al. JAMA Intern Med. December 6, 2021 (doi: 10.1001/jamainternmed.2021.6990). 2. Shinhmar H, et al. Sci Rep. 2021;11:22872. 3. Hayhoe R, et al. BMJ Nutr Prev Health. October 28, 2021 (doi: 10.1136/bmjnph-2020-000205). 4. Higuma T, et al. Sci Rep. 2021;11:22832.
8 • Jan–Mar 2022 • Vol LXI • No. 3 In Focus Efficacy and Safety of Liv.52® DS in the Management of Nonalcoholic Fatty Liver Disease An excerpt of the clinical study conducted by Siregar G et al published in European Journal of Clinical and Experimental Medicine is featured here. Aim To evaluate the clinical efficacy and safety of Liv.52 DS in the management of nonalcoholic fatty liver disease (NAFLD) Materials and Methods Sixty patients (aged 48.2 ± 12.3 y; both sexes) with positive clinical and laboratory diagnoses for NAFLD were enrolled in this prospective, interventional clinical study. Alcoholic individuals; patients with severe metabolic disorders, hepatic or pancreatic carcinoma, allergies, systemic diseases; and pregnant and lactating women were excluded from the study. A detailed medical history of all patients was collected, and they were subjected to symptomatic evaluation and clinical examination for steatohepatitis with hepatomegaly. The patients were instructed to take 2 tablets of Liv.52 DS, BID, for 2 months. The patients were evaluated at baseline and at monthly intervals, for 2 months. Liver function parameters (aspartate transaminase [AST], alanine transaminase [ALT], alkaline phosphatase [ALP], γ-glutamyl transferase [GGT]), serum bilirubin and albumin levels, complete blood count, and lipid profile were monitored. Ultrasonography was performed to monitor hepatomegaly, and NAFLD score was calculated at each assessment. A subgroup analysis was performed to evaluate the role of Liv.52 DS in the management of NAFLD in patients with diabetes mellitus. NAFLD fibrosis score was calculated as follows: NAFLD score = -1.675 + 0.037 × age (year) + 0.094 × BMI (kg/m2) + 1.13 × IFG/diabetes (yes = 1, no = 0) + 0.99 × AST/ALT ratio - 0.013 × platelet count (×109/L) - 0.66 × albumin (g/dL). NAFLD score was evaluated as follows: NAFLD score < -1.455 = F0-F2, NAFLD score -1.455 to 0.675 = indeterminate score and NAFLD score > 0.675 = F3-F4, where F1 to F4 are fibrosis stages. The results of liver function tests and biochemical analyses and NAFLD score were analyzed using ANOVA followed by Tukey’s multiple comparison test. The hepatomegaly ultrasound data were analyzed by repeated measures ANOVA followed by Dunnett’s multiple comparison test. Results All the enrolled patients completed the study with no clinically significant adverse events. A substantial reduction in the NAFLD fibrosis score was observed at the end of the first month, which reduced further at the end of the second month of treatment (Table 1). Table 1. Effect of Treatment With Liv.52 DS on Liver Fibrosis (NAFLD Fibrosis Score) Scale N Baseline Month 1 Month 2 NAFLD Score < - 1.455 = F0-F2 33 Mean - 2.886 - 2.911 - 2.915 SD 1.044 1.061 0.8617 NAFLD Score - 1.455 – 0.675 = Indeterminate Score 27 Mean - 0.650 - 0.684 - 0.849 SD 0.484 0.543 0.667 NAFLD Score > 0.675 = F3-F4 0 0 0 0 Statistical test: ANOVA followed by Tukey’s multiple comparison test. Values are represented as mean ± SD. NAFLD, nonalcoholic fatty liver disease. A significant decrease in the number of patients demonstrating hepatomegaly (75% of patients at baseline to 42% of patients at the end of the treatment) was observed. A significant reduction in hepatomegaly from 17.44 ± 1.9 at baseline to 15.87 ± 1.79 at the end of 2 months was observed. There was a significant reduction in ALT and AST levels (Table 2), whereas hematological and biochemical parameters were within normal limits. Conclusion The significant improvements in hepatomegaly, liver function parameters, and NAFLD score observed after the treatment with Liv.52 DS may be attributed to the synergistic action of the herbs present in the formulation. The results of this study show that Liv.52 DS is effective and safe in the treatment of NAFLD in both individuals with and without diabetes. Table 2. Effect of Treatment With Liv.52 DS on AST and ALT Parameter Baseline Month 1 Month 2 AST, IU/L 60.33 ± 13.04 56.43 ± 15.47 54.12 ± 17.26 P < .0339a ALT, IU/L 70.68 ± 18.49 64.13 ± 22.07 P < .0215a 61.9 ± 22.7 P < .0022a Statistical test: ANOVA followed by Tukey’s multiple comparison test. Significance was fixed at P < .05 Values are represented as mean ± SD. aCompared with baseline. ALT, alanine transaminase; AST, aspartate transaminase.
Jan–Mar 2022 • Vol LXI • No. 3 9 Latest in Medicine A Family History of Type 2 Diabetes as a Predictor of Fatty Liver Disease in Diabetes‑Free Individuals With Excessive Body Weight De Pergola G, et al Sci Rep. 2021;11:24084. Comprehensive screening for nonalcoholic fatty liver disease (NAFLD) may serve as a prompt in the clinical management of fatty liver disease. A cross-sectional relationship between a family history of type 2 diabetes (FHT2D) and NAFLD probability was characterized in 1185 diabetes-free Apulian individuals (aged > 20 y), who were overweight or obese and were not on any medication or supplementation. Their clinical data, routine biochemistry, and NAFLD probability based on the fatty liver index (FLI) were analyzed. The study population predominantly comprised females (70.9%), of whom 48.4% had first-degree FHT2D. A high BMI, waist circumference, and diastolic blood pressure was common among individuals with a FHT2D. Altered markers of glucose homeostasis, a high triglyceride level, and poor liver function were also observed. The FLI score was significantly low in individuals without a first-degree FHT2D. According to logistic regression models, the probability of FHT2D association with NAFLD was almost 2-fold higher compared with cases without a history. A first-degree FHT2D acts as an independent determinant of NAFLD in excess weight phenotypes, regardless of the age group. NAFLD risk assessment within multidimensional screening might be useful in individuals who are overweight and report a FHT2D even in the absence of diabetes. Butyrate-Producing Microbiota Are Reduced in Chronic Kidney Diseases Gao B, et al Sci Rep. 2021;11:23530. Alterations in the gut microbiota composition have been observed in patients with chronic kidney disease (CKD). Nevertheless, the correlation between the gut microbiota and disease severity has not been investigated. In this study, a shotgun metagenomics sequencing was performed, and several taxonomic and functional signatures associated with disease severity in patients with CKD were identified. Nineteen microbial genera that were significantly associated with the severity of CKD were observed. The butyrate-producing bacteria were reduced in patients with advanced stages of CKD. In addition, functional metagenomics showed that two component systems—metabolic activity and regulation of cofactor—were significantly associated with the disease severity. This study provides valuable information for the development of microbiota-oriented therapeutic strategies for CKD. Association Between Serum Vitamin A Levels and Recurrent Respiratory Tract Infections in Children Wang X, et al Front Pediatr. 2021;9:756217. This cross-sectional study aimed to evaluate the association between serum vitamin A levels and the prevalence of recurrent respiratory tract infections (RRTIs) in children and adolescents and to provide evidence that would help decrease the prevalence of respiratory tract infections (RTIs) in children. The study included 8034 children and adolescents (aged 6 mo to 17 y). Multivariate logistic regression models were used to evaluate the association between the serum vitamin A level and RRTIs after adjusting for potential confounders. Among the included children, 8.97% were diagnosed with vitamin A deficiency, whereas 38.25% were diagnosed with subclinical vitamin A deficiency. Only 28.8% of children with vitamin A deficiency and 53.1% of children with subclinical vitamin A deficiency had no RRTI and RTI symptoms, respectively. Compared with children with normal vitamin A levels, those with vitamin A deficiency and subclinical vitamin A deficiency were at a higher risk of RRTIs. The vitamin A level was also positively associated with RTI symptoms. This study shows that a low serum vitamin A level is significantly associated with RRTI or RTI prevalence in children and adolescents.
10 • Jan–Mar 2022 • Vol LXI • No. 3 Fact File Acne and Eczema • Patients with eczema and/or acne are more prone to anxiety and depression than the general population. • A high level of serum calprotectin, a biomarker of inflammation, is seen in patients with acne. • Excessive consumption of dairy products, chocolates, and foods rich in refined carbohydrates and fats can influence the development of acne. • Deficiency of vitamin D or excess supplementation of vitamin B6, B12, or whey protein may be associated with the development of acne. • Excessive exposure to sunlight and use of headbands and shoulder pads may also contribute to the development of acne. Sources: Leung AKC, et al. Drugs Context. 2021;10:2021-8-6. Dreno B, et al. Clin Cosmet Investig Dermatol. 2021;14:623–632. Clarina® (ANTI-ACNE FACE WASH GEL, ANTI-ACNE CREAM) Clarina Anti-Acne Face Wash Gel and Clarina Anti-Acne Cream, phytopharmaceutical formulations from Himalaya Wellness Company, are recommended for the topical management of acne. Clarina Anti-Acne Face Wash Gel has cleansing action—it gently cleans the skin and leaves it feeling fresh and soft all-day long. Clarina Anti-Acne Cream provides all-day and all-night protection against acne and significantly reduces the formation of whiteheads and blackheads, the number of inflamed pustules, and overall inflammation. Health Tips Remedies to Ease Motion Sickness Motion sickness is a selflimiting condition that is typically triggered by lowfrequency physical motions experienced during air, sea, or road transit, or via virtual simulation (eg, video games). Nausea is the key symptom of motion sickness (the term nausea is derived from “naus”, the Greek word for ship). Other symptoms include bouts of headache, yawning, drowsiness, cold sweats, pallor, loss of appetite, and increased salivation. Effective Ways to Overcome Motion Sickness The following are some of the short-term measures to effectively counter motion sickness: • Holding a posture and restricting oneself from frequent body movements, especially of the head, shoulders, hips, and knees, while in motion • Practicing controlled and mindful breathing • Consuming only low-fat, starchy, and nonspicy foods • Consuming carbonated beverages such as ginger ale • Focusing on a stable object or a distant horizon, while at sea • Traveling in airplane seats that are in line with the wings • Avoiding reading in a moving vehicle • Avoiding sitting in the front seat of a moving vehicle • Abstaining from nicotine consumption • Listening to pleasant music The most effective long-term measure to prevent motion sickness, although time-consuming, is getting used to motion. Preparing and habituating to frequent traveling can eventually reduce the symptoms associated with motion sickness. With continuous exposure, the symptoms of motion sickness usually resolve within 24 to 72 hours. Sources: Takov V, Tadi P. Motion Sickness. StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2021. Ogunniyi AA. Motion sickness. https://www.msdmanuals.com/. Updated May 2021. Accessed December 31, 2021.
Jan–Mar 2022 • Vol LXI • No. 3 11 Editor: Dr Jayashree B Keshav Editorial Team: Shruthi VB, Shruthi VK, Harika GS, Shruthi M, Priyakshi M, Keerthini D Layout Artists: Dayananda RS, Santosh G, Monesh NP Worth Sharing With You The more man meditates upon good thoughts, the better will be his world and the world at large. — Confucius Laugh a While, It’s Healthy! Teacher: Why are you late, Joseph? Joseph: Because of a sign down the road, Ma’am. Teacher: What does a sign have to do with you being late? Joseph: The sign said, “School ahead, go slow”! • • • Q: What did one flag say to the other? A: Nothing, it just waved! • • • Q: Why is no one friends with Dracula? A: Because he’s a pain in the neck! • • • Q: Why are teddy bears never hungry? A: Because they’re always stuffed! • • • Little Sam (on phone): My son is down with high fever, and he won’t be able to come to school today. Teacher: Who is this? Little Sam: This is my father speaking! • • • Q: What did the limestone say to the geologist? A: Don’t take me for granite! • • • Your health is so good, I am going to recommend to your insurance company to pay you for the privilege of coverage. Product Feedback I have had prostatomegaly (BPH) for 3 to 4 years, with symptoms like frequent micturition and nocturnal enuresis. I tried Himplasia tablets for one month. It gave me fantastic results. Prostatomegaly reduced from 66% to 22%. Thanks, Himalaya. Dr Prithviraj Ghanate Hadgaon, Maharashtra I have been a practicing pediatrician for 30 years. From my house surgeon days, I have been prescribing Himalaya’s products. Some of the brands like Quista kidz, Liv.52 drops, and Septilin syrup are excellent for children. Dr K Vishwanathan Salem, Tamil Nadu
Duration of therapy: Minimum 3 weeks Dosage Children: 1/2–1 teaspoonful twice daily after meals. Adults: 1–2 teaspoonsful twice daily after meals. Indications As an adjuvant in: • UTI associated with diabetes • Burning micturition • Dysuria The natural choice for UTI in diabetes Cystone-SF( L I QU I D ) ® For the treatment of UTI associated with diabetes… Provides holistic benefits for the prevention and treatment of UTI • Exhibits bacteriostatic activity by inhibiting siderophores • Possesses anti-adherent action • Offers diuretic action • Has antispasmodic and anti-inflammatory actions ® Regd. Trade Mark Cystone-SF Printed and Published by: Dr Jayashree B Keshav on behalf of Himalaya Wellness Company Printed at: M/s Sri Sudhindra Offset Process, #97, DT Street, 8th Cross, Malleshwaram, Bengaluru 560003 Published from: Himalaya Wellness Company, Makali, Bengaluru 562162 Editor: Dr Jayashree B Keshav In line with our commitment toward a green future, Capsule newsletter is printed with VOC-free, vegetable-based inks on eco-friendly paper made from sustainable sources. www.himalayawellness.com E-mail: write.to.us@himalayawellness.com Registered with the Registrar of Newspapers for India under R.N. 9073/63 ISSN 0927-9681 Only for reference by a registered medical practitioner, hospital, or laboratory The natural choice for UTI in diabetes
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