Self reported benefits of participating in group prayer in a hospital outpatient setting: A cross-sectional observational study.

BACKGROUND: Prayer had long been used as a tool to bring hope among patients suffering with intractable diseases. Most clinical researches conducted so far on prayer were done upon indoor patients. Effects of prayer involving patients and health care providers in a hospital outpatient setting have never been explored. OBJECTIVES: This cross sectional study aimed to observe the self-perceived changes post prayer among patients and hospital staff involved in the health care delivery and who actually have participated in the prayer sessions. MATERIAL AND METHOD: Survey was conducted with the help of a structured questionnaire on routine OP days at Ayurveda -Arthritis Treatment and Advanced Research Center, Lucknow. Patients visiting the center for OP based consultation and hospital staff who has participated in any prayer session were eligible to participate in the survey. RESULTS: 49 hospital staff and 85 patients have participated in the survey. Among most important self-reported attributes following the prayer sessions in patients were Positive Attitude (84.70%), Optimism about cure (92.90%), Feeling of well-being (95.30%), Optimism about future (95.30%) and Changes in energy level (89.40%). Among hospital staff the important attributes were related to change in energy level (93.90%), increased empathy (93.90%), feeling of universal good (96.00%), less fatigue post prayer (69.40%), sustained effects (81.60%) and healthier feeling (81.60%). CONCLUSION: This observational study suggests that a simple prayer session in outpatient department may be helpful in inculcating hope and building self-esteem among patients and can bring a better self-image, efficiency and connectedness in the hospital staff. Eventually, this may help in improving the outcomes and quality of care being provided at outpatient setting at any hospital.

'Obesity and arthritis' as the morbid duo: Designing and experimenting a novel strategy for weight reduction at a secondary care ayurveda -arthritis center.

Obesity has been a critical confounding factor in arthritis. Its impacts are seemingly more apparent in conditions like knee osteoarthritis but it affects the net outcome in almost every type of arthritis. Reduction of weight is the obvious first advice by a treating physician in such cases. In the absence of a clear roadmap however to reach the goal, It remains an unmet advise for most arthritis patients. Obesity combined with arthritis, becomes a morbid combination where addition of weight adds to intensity of arthritis and arthritis induced limitation of movements adds to the weight. Weight reduction is much tougher in arthritis due to the physical limitations. Noticing this gap of knowledge between desired and achieved, Ayurveda -arthritis treatment and advanced research center at Lucknow has designed a strategic plan as a real help to such people and executed it through the activities focusing upon educating the obese arthritis patients for causes and concerns of obesity in general and individualized management plan through an interactive workshop. A workshop of its own kind was conducted on 24 April 2022. 28 obese arthritics as participants had offered to understand the real need and feasibility of doing these strategically focused activities aiming at weight reduction. This has come up as a new opportunity of help to the obese arthritis patients by empowering them with practical knowledge and tools to reduce weight suiting to their individual capacities and needs. The feedback of the participants provided at the end of the workshop was highly encouraging and has shown that strategically focused activities to bridge the gaps in clinical practice are highly desired and useful.

Development and validation of an ama instrument for assessing the disease activity on the basis of constitutional features in Amavata (Rheumatoid Arthritis).

BACKGROUND: Rheumatoid Arthritis (RA), having a striking clinical resemblance to amavata in traditional Indian medicine (Ayurveda) presents an opportunity to look at disease from two different healthcare perspectives. This differential information may potentially supplement one system with the knowledge of the other for optimal application. This study is the first of its kind, where Ayurvedic concepts of amavata have been adopted to enhance the knowledge about RA where optimal care is still beyond the common reach. OBJECTIVE: The study was conducted to develop and validate a novel ama score based upon constitutional features of ama as depicted in ayurvedic literature as a disease activity indicator in RA. MATERIAL AND METHODS: The study was conducted in two parts comprising development and textual validation of the ama assessment instrument (AAI) followed by its clinical testing. AAI comprising ten items, was developed where each item was provided with a range of scores to offer the assessment close to the patient's observations. The score obtained through AAI was clinically and statistically tested on 79 RA/amavata patients randomly selected for validity and reliability. The score obtained through AAI was tested for its correlation with the DAS-28 score and ESR. RESULTS: Ama Assessment Instrument could find a slight correlation with acute phase reactant ESR (r-value between ESR and AMA at baseline is 0.287, and at 1st, 2nd, and 3rd follow-up is 0.276, 0.276 and 0.160 respectively) and DAS-28 (The r value between DAS and AMA at baseline is 0.231, and at 1st, 2nd and 3rd follow up is 0.218, 0.201 and 0.247 respectively). It however emerged as an independent disease status marker since it could mark the changes in the study population on a time scale more precisely as compared to DAS -28 or ESR. When the ama values at different follow-ups were compared, a significant difference was observed consistent with disease activity marker catching constitutional and GI related domain of the patients. When reducing values of ama score were compared to overall improvements as reported by the patients, a similar trend was observed showing that a change in ama score is reflective of a change in disease status and the impact of the disease on the patient. CONCLUSION: This study provided a quantitative measure for the abstract concept of ama which could be used to mark the disease activity in amavata or RA. The change in ama based scores can be used to assess disease status and the intervention related benefits. The observations prompt for the possible inclusion of AAI in RA composite score to make it more dynamic in terms of disease activity identification in RA.

A survey of patients visiting an Ayurvedic teaching hospital for factors influencing the decision to choose ayurveda as a health care provider.

STUDY BACKGROUND: In a pluralistic health care delivery model, it is important to assess whether the individual's health care choices are based upon evidences of efficacy and safety. Since the essence of medical pluralism lies in the fact that all such systems are equally accessible to a seeker, in such situation, it is highly relevant to check what defines such choices in real life. OBJECTIVE: To identify the factors influencing the health care choices in a subpopulation seeking Ayurveda health care in an Ayurvedic teaching hospital. MATERIALS AND METHOD: The study was an all-inclusive cross sectional survey, done on randomly selected out patients visiting an Ayurveda teaching hospital. The data was collected using a 21 items questionnaire refined through pilot testing from 7.9.2017 to 30.9.2017. RESULTS: The data of 289 respondents who have given their consent were included in statistical analysis. Out of 21 variables studied for their agreement or disagreement in the study population 8 were found to have a significant proportion in favour of agreement. Among these relative safety (Item 9); disease eradicating potential (Item 14); belief (Item 3) and indirect evidences of efficacy (Item 4) were found to have high significance (p < 0.001). CONCLUSION: Participants chose Ayurveda treatment due to its perceived safety and probability of helping in a particular clinical condition. Contrary to the common perception, enabling factors like availability, accessibility and affordability were given less importance by the participants in making health care choices related to Ayurveda.

Idiosyncratic adversity reported after oral consumption of an ayurvedic formulation containing bhallataka (Semecarpus anacardium): A case report.

Drugs associated adversities are common in health care practice. These adversities are often associated with the dose-related, time-related and methods of drug intake and their rationality in a given condition but can also be unrelated to either of these causes. Such unpredictable drug reactions are highly important from the perspective of safe use of a drug and to prevent complications from any such adversity which is relatively uncommon. The case reported here is a likely case of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) like idiosyncratic adversity after oral consumption of an ayurvedic formulation containing Bhallataka (Semecarpus anacardium). DRESS is found associated with many other classes of drugs but its association with ayurvedic drug has not yet been reported. Upon Naranjo probability scale the event scored 6, putting it into the category of probable drug related adversity. This report widens our understanding towards the possibility of delayed and idiosyncratic drug adversities upon the consumption of certain ayurvedic drugs.

Telemedicine for Ayurveda consultation: Devising collateral methods during the COVID-19 lockdown impasse.

COVID-19 pandemic and subsequent measures to mitigate it have presented the world with certain unprecedented situations. Lockdown with effective closure of all services including routine health care services has tested the nerves of health care providers for finding novel ways of providing services without getting into the risk of exposure. Telemedicine had been an ideal option for such situations allowing all channels of communication that leverage Information Technology platforms, including voice, audio, text and digital data exchange as a help to diagnosis, prescription and follow up evaluation. Unfortunately this versatility of Telemedicine as a patient -physician interface could not be harnessed well for its technical complexities and unpreparedness of institutions and individuals. Smartphone based video calling using whatsapp messenger has been proposed as a feasible Telemedicine application to provide outpatient services in this scenario. A pilot run of outpatient services during lockdown period through whatsapp facilitated video calling at Ayurveda Gathiya Clinic, State Ayurvedic College and Hospital, Lucknow has shown a way forward of running such services with a mass appeal, ease of operation and high interface gratification among users and service providers. Within its limitations related to the quality and quantity of information sought, this comes as a viable method of patient -physician interfacing during the phase of lockdown.

Preclinical renal chemo-protective potential of Prunus amygdalus Batsch seed coat via alteration of multiple molecular pathways.

Prunus amygdalus Batsch (almond) is a classical nutritive traditional Indian medicine. Along with nutritive with anti-oxidant properties, it is, clinically, used in the treatment of various diseases with underlying anti-oxidant mechanism. This study is an effort to scrutinise the renal protective effect of P. amygdalus Batsch or green almond (GA) seed coat extract and its underlying mechanism in animal model of Ferric nitrilotriacetate (Fe-NTA) induced renal cell carcinoma (RCC). RCC was induced in Swiss Albino Wistar rats by intraperitoneal injection of Fe-NTA. The rats were then treated with ethanolic extract of GA (25, 50 and 100 mg/kg per oral) for 22 weeks. Efficacy of GA administration was evaluated by change in biochemical, renal, macroscopical and histopathological parameters and alterations. Additionally, interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß) and inflammatory mediator including prostaglandin E2 (PGE2), nuclear factor-kappa B (NF-κB) were also observed to explore the possible mechanisms. The oral administration of GA significantly (p < .001) altered the Fe-NTA induced RCC in rats by inhibition of renal nodules, decolourisation of tissues, tumour promoter marker including thymidine 3[H] incorporation, ornithine decarboxylase, renal parameters and anti-oxidant parameters in serum. Additionally, GA treatment significantly (p < .001) down-regulated the IL-6, IL-1ß, TNF-α, inflammatory mediators PGE2 and NF-κB in a dose-dependent manner. Histopathology observation supported the renal protective effect of GA by alteration in necrosis, size of Bowman capsules and inflammatory cells. Hence, it can be concluded that GA possesses observable chemo-protective action and effect on Fe-NTA induced RCC via dual inhibition mechanism one by inhibiting free radical generation and second by inhibiting inflammation.

Targeting the ß-clamp in Helicobacter pylori with FDA-approved drugs reveals micromolar inhibition by diflunisal.

The ß-clamp is the processivity-promoting factor for most of the enzymes in prokaryotic DNA replication; hence, it is a crucial drug target. In the present study, we investigated the ß-clamp from Helicobacter pylori, aiming to seek potential drug molecules against this gastric-cancer-causing bacterium. An in silico screening of Food and Drug Administration (FDA) approved drugs against the H. pylori ß-clamp, followed by its in vitro inhibition using a surface competition approach, yielded the drug diflunisal as a positive initial hit. Diflunisal inhibits the growth of H. pylori in the micromolar range. We determined the structure of diflunisal in complex with the ß-clamp to show that the drug binds at subsite I, which is a protein-protein interaction site. Successful identification of FDA-approved molecules against H. pylori may lead to better and faster drug development.

Formulation, functional evaluation and ex vivo performance of thermoresponsive soluble gels - A platform for therapeutic delivery to mucosal sinus tissue.

Mucoadhesive in situ gelling systems (soluble gels) have received considerable attention recently as effective stimuli-transforming vectors for a range of drug delivery applications. Considering this fact, the present work involves systematic formulation development, optimization, functional evaluation and ex vivo performance of thermosensitive soluble gels containing dexamethasone 21-phosphate disodium salt (DXN) as the model therapeutic. A series of in situ gel-forming systems comprising the thermoreversible polymer poloxamer-407 (P407), along with hydroxypropyl methyl cellulose (HPMC) and chitosan were first formulated. The optimized soluble gels were evaluated for their potential to promote greater retention at the mucosal surface, for improved therapeutic efficacy, compared to existing solution/suspension-based steroid formulations used clinically. Optimized soluble gels demonstrated a desirable gelation temperature with Newtonian fluid behaviour observed under storage conditions (4-8°C), and pseudoplastic fluid behaviour recorded at nasal cavity/sinus temperature (≈34°C). The in vitro characterization of formulations including rheological evaluation, textural analysis and mucoadhesion studies of the gel form were investigated. Considerable improvement in mechanical properties and mucoadhesion was observed with incorporation of HPMC and chitosan into the gelling systems. The lead poloxamer-based soluble gels, PGHC4 and PGHC7, which were carried through to ex vivo permeation studies displayed extended drug release profiles in conditions mimicking the human nasal cavity, which indicates their suitability for treating a range of conditions affecting the nasal cavity/sinuses.

Development of soy lecithin based novel self-assembled emulsion hydrogels.

The current study reports the development and characterization of soy lecithin based novel self-assembled emulsion hydrogels. Sesame oil was used as the representative oil phase. Emulsion gels were formed when the concentration of soy lecithin was >40% w/w. Metronidazole was used as the model drug for the drug release and the antimicrobial tests. Microscopic study showed the apolar dispersed phase in an aqueous continuum phase, suggesting the formation of emulsion hydrogels. FTIR study indicated the formation of intermolecular hydrogen bonding, whereas, the XRD study indicated predominantly amorphous nature of the emulsion gels. Composition dependent mechanical and drug release properties of the emulsion gels were observed. In-depth analyses of the mechanical studies were done using Ostwald-de Waele power-law, Kohlrausch and Weichert models, whereas, the drug release profiles were modeled using Korsmeyer-Peppas and Peppas-Sahlin models. The mechanical analyses indicated viscoelastic nature of the emulsion gels. The release of the drug from the emulsion gels was diffusion mediated. The drug loaded emulsion gels showed good antimicrobial activity. The biocompatibility test using HaCaT cells (human keratinocytes) suggested biocompatibility of the emulsion gels.

Mutual Amide Prodrug of Etodolac-glucosamine: Synthesis, Characterization and Pharmacological Screening.

Etodolac, a nonsteroidal antiinflammatory drug, widely used in arthritis is associated with gastric ulceration and irritation due to presence of free carboxylic group. The current investigation reports synthesis of mutual amide prodrug of etodolac by masking free carboxylic group with glucosamine, a nutritional supplement for treatment of arthritis. Confirmation and characterization of the structure of the synthesized prodrug done by elemental and spectroscopy analysis, melting point, determination of migration parameters (Rf, RM, and Rt) by using thin layer chromatography and high performance liquid chromatography, respectively. Partition coefficient and solubility study confirms its lipophilic character so can be suitable candidate for controlled release delivery. In vitro hydrolytic studies of prodrug confirms good rate of hydrolysis in blood plasma, fecal matter, and simulated intestinal fluid while stable in gastric simulated fluid. In vivo pharmacological screening performed on animals. Prodrug with respect to etodolac shows good analgesic, antiinflammatory, and antiarthritic activity. The prodrug was assessed for their probable damaging effects by ulcerogeniticity and histopathological analysis. The histopathological studies showed less ulceration in the gastric region when treated with prodrug, thereby proving the prodrug to be better in action as compared to etodolac and are advantageous in having less gastrointestinal side effects.