Epidemiology and impact of chronic disease multimorbidity in India: a systematic review and meta-analysis.

Objectives: This is the first systematic review and meta-analysis of the prevalence of multimorbidity, its risk factors including socioeconomic factors, and the consequences of multimorbidity on health systems and broader society in India. Methods: A systematic review of both published and grey literature from five databases (Medline, Embase, EBSCO, Scopus, and ProQuest) was conducted including original studies documenting prevalence or patient outcomes associated with multimorbidity among adults in India. We excluded studies that did not explicitly mention multimorbidity. Three independent reviewers did primary screening based on titles and abstracts followed by full-text review for potential eligibility. The risk of bias was independently assessed by two reviewers following the Appraisal Tool for Cross-Sectional Studies. We presented both qualitative and quantitative (through meta-analysis) summaries of the evidence. The protocol for this study was prospectively registered with PROSPERO (CRD42021257281). Results: The review identified 5442 articles out of which 35 articles were finally included in this study. Twenty-three studies were based on the primary data while 12 used secondary data. Eleven studies were conducted in hospital/primary care setting while 24 were community-based. The pooled prevalence of multimorbidity based on (n=19) studies included for meta-analysis was 20% (95% CI: 19% to 20%). The most frequent outcomes were increased healthcare utilization, reduced health-related quality of life, physical and mental functioning. Conclusion: We identified a wide variance in the magnitude of multimorbidity across age groups and regions with most of the studies from eastern India. Nation-wide studies, studies on vulnerable populations and interventions are warranted.

Association between Usage of Prophylactic AYUSH Medicines and Disease Severity in COVID-19 Patients: A Retrospective Cohort Study.

BACKGROUND: Prior vaccination is often studied for its impact on individuals' post-infection prognosis. Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH) medicines, advised by the Government of India as prophylaxis during the first wave of the coronavirus disease 2019 (COVID-19) pandemic, were consumed by the masses in 2020. A study was therefore undertaken to observe any association between the prior usage of AYUSH prophylactic medicines and post-infection severity as reported by recovered COVID-19 individuals. METHODS: This was a retrospective, multi-centre, cohort study conducted in 21 cities of India from 5th August to 30th November 2020. Data from recovered COVID-19 patients, of either sex or any age, captured information about AYUSH prophylactic medicines intake prior to infection, disease severity, symptomatology, duration of complaints, etc. The study participants were grouped into AYUSH intake and non-intake. Primary composite outcome was the disease clinical course. Secondary clinical outcomes were the rate of and time to clinical recovery. RESULTS: Data of 5,023 persons were analysed. Ayurveda or homeopathic prophylactic medicines were consumed by more than half of the study participants: that is, 56.85% (n = 1,556) and 56.81% (n = 1,555) respectively. The overall adjusted protective effect (PE) of AYUSH prophylactic intake against moderate/severe forms of COVID-19 disease was 56.7% (95% confidence interval [CI], 48.7 to 63.50; p < 0.001). Adjusted PE for homeopathy and Siddha was 52.9% (95% CI, 42.30 to 61.50; p < 0.001) and 59.8% (95% CI, 37.80 to 74.10; p < 0.001), respectively. A statistically significant association was found between AYUSH prophylactic medicine intake and clinical recovery more frequently by the 3rd day of illness (χ2 = 9.01; p = 0.002). Time to resolution of symptoms in the AYUSH intake group was on average 0.3 days earlier than in the non-intake group (p = 0.002). CONCLUSION: AYUSH prophylactics were associated with statistically significant levels of protection against COVID-19 disease severity. Amongst these, previous intake of homeopathy or Siddha medicines was associated with some protection against moderate/severe illness and with a somewhat quicker clinical recovery. Prospective studies with experimental research design are needed to validate the findings of this study. STUDY REGISTRATION: Clinical Trials Registry-India (CTRI/2020/08/027000).

Role of auto-antibodies in the mechanisms of dengue pathogenesis and its progression: a comprehensive review.

A complex interaction among virulence factors, host-genes and host immune system is considered to be responsible for dengue virus (DENV) infection and disease progression. Generation of auto-antibodies during DENV infection is a major phenomenon that plays a role in the pathophysiology of dengue hemorrhagic fever and dengue shock syndrome. Hemostasis, thrombocytopenia, hepatic endothelial dysfunction, and autoimmune blistering skin disease (pemphigus) are different clinical manifestations of dengue pathogenesis; produced due to the molecular mimicry of DENV proteins with self-antigens like coagulation factors, platelets and endothelial cell proteins. This review elaborately describes the current advancements in auto-antibody-mediated immunopathogenesis which inhibits coagulation cascade and promotes hyperfibrinolysis. Auto-antibodies like anti-endothelial cell antibodies-mediated hepatic inflammation during severe DENV infection have also been discussed. Overall, this comprehensive review provides insight to target auto-antibodies that may act as potential biomarkers for disease severity, and a ground for the development of therapeutic strategy against DENV.

Homeopathic preparation of Allium sativum abrogates OxLDL mediated atherogenic events in macrophages: An invitro and in silico approach.

BACKGROUND: Oxidized LDL (OxLDL), the key player in atherogenesis modulates endothelial dysfunction, initiates monocyte recruitment, accentuates foam cell formation, and flares up inflammatory and apoptotic events. Even though homeopathic preparation of Allium sativum has been proved to be an anti-inflammatory, anti-apoptotic and anti-atherogenic agent, its mechanism of action on abrogating OxLDL mediated foam cell formation is yet to be explored. OBJECTIVE: This study was designed to bring out the role of homeopathic preparation of Allium sativum in curbing OxLDL mediated cellular inflammation in IC-21 cells exposed with OxLDL. MATERIALS AND METHODS: OxLDL was used to induce oxidative damage in the IC-21 macrophage cells. Assessment of inflammatory cytokines, localization of NFκB, detection of apoptosis and the in silico analysis were performed in this study. RESULTS: The current study portrays the efficacy of homeopathy medicine as an anti-inflammatory agent, in reducing the levels of inflammatory cytokines and its mRNA expression, suppressing the activity of NFκB and preventing apoptosis in OxLDL treated IC-21 cells. CONCLUSION: To conclude, homeopathic preparation of Allium sativum 6C and 30C potencies are capable of controlling the transcriptional activity of NFκB and apoptosis in IC-21 cells exposed to OxLDL. These results implicate that Allium sativum homeopathic drug can be used as anti-inflammatory agent in reducing atherogenic events as it is capable of preventing OxLDL-mediated injury to macrophages.

Arsenic album 30C exhibits crystalline nano structure of arsenic trioxide and modulates innate immune markers in murine macrophage cell lines.

Macrophages are associated with innate immune response and M1-polarized macrophages exhibit pro-inflammatory functions. Nanoparticles of natural or synthetic compounds are potential triggers of innate immunity. As2O3 is the major component of the homeopathic drug, Arsenic album 30C.This has been claimed to have immune-boosting activities, however, has not been validated experimentally. Here we elucidated the underlying mechanism of Ars. alb 30C-mediated immune priming in murine macrophage cell line. Transmission Electron Microscopy (TEM) and X-ray diffraction (XRD) used for the structural analysis of the drug reveals the presence of crystalline As2O3 nanoparticles of cubic structure. Similarly, signatures of M1-macrophage polarization were observed by surface enhanced Raman scattering (SERS) in RAW 264.7 cells with concomitant over expression of M1 cell surface marker, CD80 and transcription factor, NF-κB, respectively. We also observed a significant increase in pro-inflammatory cytokines like iNOS, TNF-α, IL-6, and COX-2 expression with unaltered ROS and apoptosis in drug-treated cells. Enhanced expression of Toll-like receptors 3 and 7 were observed both in transcriptional and translational levels after the drug treatment. In sum, our findings for the first time indicated the presence of crystalline As2O3 cubic nanostructure in Ars. alb 30C which facilitates modulation of innate immunity by activating macrophage polarization.

Effect of ultrahigh diluted homeopathic medicines on the electrical properties of PVDF-HFP

In an effort to improve the electrical properties of the electroactive Poly(vinylidene fluoride-hexafluoropropylene) (PVdF-HFP), we introduced a novel and simple approach to synthesize PVDFHFP composite films by incorporating ultrahigh dilutions of two homeopathic medicines Ferrum metallicum (FM) and Zincum oxidatum (ZO) in different potencies. The homeo-PVDF-composite films (HPCF) were synthesized by simple solution casting technique. XRD, FESEM, FTIR studies were performed to check the presence of nanoparticles in the film. The electrical properties of the HPCF samples get enhanced significantly due to the incorporation of the medicines and the effect increases with the increase in potency of the medicines.

Effect of ultrahigh diluted homeopathic medicines on the electrical properties of PVDF-HFP

In an effort to improve the electrical properties of the electroactive Poly(vinylidene fluoridehexafluoropropylene) (PVdF-HFP), we introduced a novel and simple approach to synthesize PVDFHFP composite films by incorporating ultrahigh dilutions of two homeopathic medicines Ferrum metallicum (FM) and Zincum oxidatum (ZO) in different potencies. The homeo-PVDF-composite films (HPCF) were synthesized by simple solution casting technique. XRD, FESEM, FTIR studies were performed to check the presence of nanoparticles in the film. The electrical properties of the HPCF samples get enhanced significantly due to the incorporation of the medicines and the effect increases with the increase in potency of the medicines. (AU)

Derivation of an empirical relation between the size of the nanoparticle and the potency of homeopathic medicines

Homeopathic medicines are often prescribed at very high dilutions and it is a clinically observed fact that the medicinal effect of the drug remains even at these high dilutions. The increase in potency of a medicine due to potentization is still debatable from physico-chemical point of view. Out of various hypotheses to explain this phenomenon, a recent hypothesis, advanced by us and supported by others, is that the size of the constituent particles decreases and eventually achieves nano dimension due to potentization. From the experiments performed by our group, the size of nanoparticles (NPs) of Cuprum metallicum, Zincum oxydatum, Aurum metallicum, Ferrum metallicum and Aconitum napellus (6cH, 30cH and 200cH) have been estimated. A general mathematical expression of the form y = a x-n has been derived which relates the size of NPs (y) with the corresponding potencies (x). There is no method to calculate the accurate potency of the homeopathic medicine, as the potency of a medicine depends to some extent on the method of preparation, for which a standardized procedure is warranted. Also, while handling a medicine, the solvent might evaporate causing a change in the potency. Thus by measuring the size of the NPs and using our proposed standard curve, the potency may be estimated...

Derivation of an empirical relation between the size of the nanoparticle and the potency of homeopathic medicines

Homeopathic medicines are often prescribed at very high dilutions and it is a clinically observed fact that the medicinal effect of the drug remains even at these high dilutions. The increase in potency of a medicine due to potentization is still debatable from physico-chemical point of view. Out of various hypotheses to explain this phenomenon, a recent hypothesis, advanced by us and supported by others, is that the size of the constituent particles decreases and eventually achieves nano dimension due to potentization. From the experiments performed by our group, the size of nanoparticles (NPs) of Cuprum metallicum, Zincum oxydatum, Aurum metallicum, Ferrum metallicum and Aconitum napellus (6cH, 30cH and 200cH) have been estimated. A general mathematical expression of the form y = a x-n has been derived which relates the size of NPs (y) with the corresponding potencies (x). There is no method to calculate the accurate potency of the homeopathic medicine, as the potency of a medicine depends to some extent on the method of preparation, for which a standardized procedure is warranted. Also, while handling a medicine, the solvent might evaporate causing a change in the potency. Thus by measuring the size of the NPs and using our proposed standard curve, the potency may be estimated. (AU)