Traditional Ayurvedic and herbal remedies for Alzheimer's disease: from bench to bedside.

INTRODUCTION: Alzheimer's disease (AD) is a progressive, neurodegenerative disorder prevalent worldwide among elderly populations. Owing to limited efficacy, side effects, and poor patient compliance for current rationally designed therapies, options are being searched from alternate therapies such as Indian (Ayurvedic), Chinese, or other traditional systems. Areas covered: Following a comprehensive literature search, the authors provide a review encompassing: (1) pathophysiological changes involved in AD, (2) Ayurvedic holistic approach and herbal medicines to manage dementia and AD, and (3) traditional plants and their phytoconstituents effective in AD with description of possible mechanism of action. Expert opinion: Traditional remedies could be adjunct therapeutic options to allay wide-ranging pathological cascades of AD. Ayurveda offers a holistic approach of treatment along with a list of nootropic herbs and formulations that are the rich sources of antioxidants, anti-amyloidogenic, neuroprotective, adaptogenic, anti-inflammatory, and immunomodulatory compounds that are found to modulate neuroendocrine-immune activities, enhance memory, intellect, rejuvenate brain functions, and improve quality of life. A strong knowledge base of traditional systems coupled with contemporary science may provide new functional leads for age-associated neurodegenerative disorders at preventive, promotive, and curative levels, and evolution of new drug therapies and development processes, though further research is needed.

Herbal and Holistic Solutions for Neurodegenerative and Depressive Disorders: Leads from Ayurveda.

Neuropsychiatric and neurodegenerative disorders such as Alzheimer's disease, Parkinson's disease, schizophrenia, epilepsy, depression and anxiety pose a sizable global health problem, accompanying substantial burden of disorders, suicides, physical comorbidities, high fiscal expenses, and poor quality of life. There is a recent upsurge in global interest toward the area of traditional therapies and phytomedicines are widely admired by researchers owing to their natural source and fewer side effects. On the contrary, conventional synthetic drugs have been reported with undesirable but inevitable ill effects having poor patient compliance. Thus, herbal medicines are being preferred over synthetic drug therapies as an effective remedy for many brain disorders. Ayurveda provides a holistic approach to treatment along with several nootropic herbs having multi-dimensional bioactivities in various disorders. Scattered information is available pertaining to traditional Ayurvedic remedial options for various mental disorders. Present review encompasses: (i) common brain disorders and the associated changes (ii) Ayurvedic holistic approach to manage neurodegenerative and depressive disorders, and (iii) important Ayurvedic single herbs and polyherbal formulations with description of their traditional usage and administration. Concomitantly, it opens up for future investigations and standardization on Ayurvedic nootropic herbs.

[Impact of symptom onset to first medical contact time on the prognosis of patients with acute ST-segment elevation myocardial infarction].

Objective: To investigate the impact of symptom onset to first medical contact (SO-to-FMC)time on the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI). Methods: The clinical data of 341 consecutive STEMI patients, who were hospitalized to our hospital and received primary percutaneous coronary intervention(PCI) from August 2011 to April 2016, were retrospectively analyzed. The patients were divided into ≤90 min group (201 cases) and >90 min group (140 cases) according to the SO-to-FMC time. The treatment time, mortality and incidence of major adverse cardiac and cerebro-vascular events(MACCE) were analyzed. The risk factor of 1-year mortality after PCI and 1-year incidence of MACCE during the post-discharge follow-up period were analyzed by binary logistic regression analysis. The predictor of 4.5-year mortality after PCI was analyzed by multivariate Cox regression analysis. Methods The door to balloon time (104(88, 125) min vs. 111(92, 144)min, P=0.023), first medical contact to balloon time(146(119, 197) min vs. 177(125, 237)min, P=0.005), and symptom onset-to-balloon time(200(170, 257) min vs. 338(270, 474)min, P<0.001)were all significantly shorter in the ≤90 min group than in>90 min group. The 30-day mortality (2.99% (6/201) vs. 7.86%(11/140), P=0.042), 1-year mortality (2.89 (5/173) vs. 9.57(11/115), P=0.015), 1-year incidence of MACCE during the post-discharge follow-up period(1.16%(2/173) vs. 6.96%(8/115), P=0.021), and 4.5-year cumulative mortality(3.00% vs. 11.20%, P=0.007) after PCI were significantly lower in the ≤90 min group than in the >90 min group. Moreover, the 4.5-year incidence with free of MACCE (97.20% vs. 88.80%, P=0.025) during the post-discharge follow-up period was significantly higher in the ≤90 min group than in the >90 min group. In-hospital mortality was similar between the two groups (2.49%(5/201) vs. 6.43%(9/140), P=0.071). Results: The door to balloon time (104(88, 125) min vs. 111(92, 144)min, P=0.023) , first medical contact to balloon time(146(119, 197) min vs. 177(125, 237)min, P=0.005), and symptom onset-to-balloon time(200(170, 257) min vs. 338(270, 474)min, P<0.001) were all significantly shorter in the ≤90 min group than in >90 min group. The 30-day mortality(2.99% (6/201) vs. 7.86%(11/140), P=0.042), 1-year mortality (2.89(5/173) vs. 9.57(11/115), P=0.015), 1-year incidence of MACCE during the post-discharge follow-up period (1.16%(2/173) vs. 6.96%(8/115), P=0.021), and 4.5-year cumulative mortality (3.00% vs. 11.20%, P=0.007) after PCI were significantly lower in the ≤90 min group than in the >90 min group. Moreover, the 4.5-year incidence with free of MACCE (97.20% vs. 88.80%, P=0.025) during the post-discharge follow-up period was significantly higher in the ≤90 min group than in the >90 min group. In-hospital mortality was similar between the two groups (2.49%(5/201) vs. 6.43%(9/140), P=0.071). Results of binary logistic regression analysis showed that the SO-to-FMC time >90 min was the risk factor of 1-year mortality(OR=2.90, 95%CI 1.22-6.92, P=0.016) and 1-year incidence of MACCE (OR=5.19, 95%CI 1.21-22.20, P=0.026) during the post-discharge follow-up period. Multivariate Cox regression analysis demonstrated that the SO-to-FMC time >90 min was the risk factor of 4.5-year mortality after PCI in patients with STEMI (HR=2.88, 95%CI 1.10-7.53, P=0.031). Conclusion: Shorting the SO-to-FMC time can significantly reduce the treatment time of STEMI patients, short and long-term mortalities and the incidence of MACCE, and improve the prognosis of patients with STEMI.

Pharmacognostic, physicochemical and chromatographic characterization of Samasharkara Churna.

BACKGROUND: Samasharkara Churna, a polyherbal Ayurvedic formulation, is prescribed for treating various conditions such as asthma and cough. Literature review suggested that characterization parameters of Samasharkara Churna are not reported. OBJECTIVE: To report characteristic parameters of Samasharkara Churna to conform its identity, quality and purity. MATERIALS AND METHODS: Samasharkara Churna was evaluated for pharmacognostic, physicochemical, microbiological, and chromatographic parameters. RESULTS: The chromatographic analysis was able to showed presence of all ingredients in Samasharkara Churna. CONCLUSION: The characterization parameters presented in this paper may serve as standard reference for the quality control analysis of Samasharkara Churna.

Direct access colonoscopy in primary care: is it a safe and practical approach?

BACKGROUND: Implementation of colorectal cancer screening programme and provision of cancer service within certain timeframe has significantly increased the workload on endoscopy services. Direct access colonoscopy in primary care centers helps offload burden on conventional colonoscopy in secondary care, thereby reducing waiting times. The aim of this study was to assess the safety and efficacy of direct access colonoscopy service. MATERIALS AND METHODS: Provision of colonoscopy service in our healthcare trust was analysed retrospectively during a two-year period. Safety and feasibility of direct access colonoscopy was analysed against conventional colonoscopy. The groups were compared for findings at colonoscopy, procedural outcomes, and complications. RESULTS: A total of 3468 colonoscopies were analysed. Of those, 1189(34.3%) were performed as direct access colonoscopy and 2279(65.7%) as conventional colonoscopy. No abnormality was detected in 408/1189(34.3%) and 825/2279(36.2%) patients in the direct access colonoscopy and conventional colonoscopy groups, respectively (p = 0.52). Colorectal cancer detection rate was similar between the groups; conventional colonoscopy vs direct access colonoscopy, 3.1% (68/2279) vs 3.2% (39/1189) (p = 0.85). However, there was significantly higher detection rate of polyps greater than 1 cm in conventional colonoscopy group compared to direct access colonoscopy group, 22.6%(518/2289) vs 12.6% (150/1189) (p = 0.02). Complication rates were comparable between the groups. CONCLUSION: Direct access colonoscopy in primary care centers is safe and feasible. Colorectal cancer detection remains comparable to that of conventional colonoscopy in secondary care despite relatively lower polyp detection rate.

Lower limb compartment syndrome following laparoscopic colorectal surgery: a review.

AIM: In spite of recent advances in technology and technique, laparoscopic colorectal surgery is associated with increased operating times when compared with open surgery. This increases the risk of acute lower limb compartment syndrome. The aim of this review was to gain a better understanding of postoperative lower limb compartment syndrome following laparoscopic colorectal surgery and to suggest strategies to avoid its occurrence. METHOD: A MEDLINE search was performed using the keywords 'compartment syndrome', 'laparoscopic surgery' and 'Lloyd-Davies position' between 1970 and 2008. All relevant articles were retrieved and reviewed. RESULTS: A total of 54 articles were retrieved. Of the 30 articles in English, five were reviews, six were original articles and 19 were case reports, of which only one was following laparoscopic colorectal surgery. The remaining 24 were non-English articles. Of these, two were reviews and 22 were case reports, of which only one was following laparoscopic colorectal surgery. The incidence of acute compartment syndrome following laparoscopic colorectal surgery is unknown. The following are believed to be risk factors for acute lower limb compartment syndrome: the Lloyd-Davies operating position with exaggerated Trendelenburg tilt, prolonged operative times and improper patient positioning. Simple strategies are suggested to reduce its occurrence. CONCLUSION: Simple preventative measures have been identified which may help to reduce the incidence of acute lower limb compartment syndrome. However, if suspected, timely surgical intervention with four-compartment fasciotomy remains the standard of care.

Estimation of heavy metals in commonly used medicinal plants: a market basket survey.

Popularity of herbal drugs is increasing all over the world because of lesser side effects as compared to synthetic drugs besides it cost effectiveness and easy availability to poor people particularly in developing countries. Keeping in view the increased market demand of herbal drugs, it is essential to ensure their chemical quality prior to use. Raw drugs and herbs are usually collected from different places, which might be contaminated with various contaminants. It is pertinent to estimate the levels of heavy metals and other micronutrients, which could be affected by their presence in the surrounding environments. Heavy metals are known to pose a potential threat to terrestrial and aquatic biota. Keeping this in view, samples of ten plants or plant parts used in drug making were collected from local markets of Punjab for heavy metal and micronutrient estimation. It was found that the samples were contaminated having cadmium, lead, chromium, iron, manganese, and zinc. The highest mean level of cadmium (23.1 µg/kg) was found in Haritaki sample. Chromium concentration of the plant samples ranged between 7.25 and 1.34 µg/kg with the highest values was in Daruharidra and lowest in Pippali. The levels of these heavy metals were within permissible limits.

A review of Brahmavaivartapurana (BVP) with reference to Ayurveda.

Brahmavaivartapurana is one of the important Mahapurana, which is considered as a Vaisnavapurana. The text is divided into four parts called khanda i.e., Brahma, Prakrti, Ganapati, and Srikrsnajanmakhanda. The total number of chapters are 276 and comprising about 20,500 verses. Brahmavaivartapurana comprises both ancient and medieval materials. It considers Ayurveda as Pancama Veda and devoted 16th chapter of Brahmakhanda which describes the origin of Ayurveda its propagaters headed by Bhaskara (sun god) and his 16 students and their corresponding books in detail. An account of the Jvara (Fever) and other diseases, Dinacarya (daily routine), Rtucarya (seasonal regimen), Tridosa (three humours), their Prakopa (Vitiation) and Prasamana (palliation) etc are described in this book. BVP deals with the do's and dont's of food intake, sleep and sexual indulgance in detail which are deemed to be Trayopastambha (three sub pillers of health). The book provides an account of Plant Tulsi's origin and its spiritual importance. Prakrti (nature's) origins, Pañcamahabhuta nature of the body are described in Prakrtikhanda. At the flag end of the book there is a legend describing the origin of Lord Dhanvantari and describes his scholarship in the field of Veda and sastra. On the whole purana provides glimpse of the life style of a Vaisnava devoutee and the people of the time when it was compiled. It serves the purpose of a practical manual to lead a healthy life and ensure spiritual growth in the life of any individual who believes in the precepts of this book.

Evolution of drug: a historical perspective.

To trace out the first person who discovered the first medicine is extremely difficult. Perhaps the origin of medicine and drug and its early history has been lost in myths. The use of medicinal plants dates back not only to human civilization but to ancient people also. Plants have been crucial in sustaining human health and well being of mankind. The word Drug, taken from French word Drogue which means Dry Herb, strongly suggests that earliest drugs were taken out from plant sources. Earliest people used to treat diseases by some unconventional methods, using plants, animal products and minerals, of them plants were given priority. World's ancient systems of medicine e.g. Chinese Medicine, Ayurveda and Greek Medicine, despite, having wider differences in their principles of treatment agree upon the point, that disease is due to imbalance within the constituents of the body and that the aim of treatment is to restore the balance with the help of herbs. So, herbs played vital role in the development of Pharmacology and Pharmacy. The splendid architect of today's advanced Pharmacology was not built in a day, but its foundation stone has been laid on old base. Pharmacology from its very beginning to the age of Chemotherapy and on words, has traversed long voyage. In this article travelogue of the Pharmacology has been discussed briefly.

A critical study of the manuscripts of Paryaya Muktavali available at Orissa.

Though the Nidana book of Madhavakara has been very popular among Ayurvedic fraternity his other deeds on Dravyaguna, Cikitsa etc. could not come to lime light due to lack of sufficient number of manuscripts for comparison and editing. One such text is Paryaya Muktavali, manuscripts of which are plentily available in the State of Orissa. This modified text redacted by Hari Charana Sena, is a bright example of scribal error and missing of verses which occur during repeated scribe in palm leaf manuscript. This is a lexicon of drugs, which is prime necessity of Dravyaguna and Rasasastra. Publication of such text will be an addition to the treasure of Ayurvedic texts.

Important Ayurveda literatures from the manuscripts available from Orissa (Cikitsarnava).

In the treasure of Ayurvedic literature, many texts are missing or partially available. Only references or few verses from many such texts are mentioned in later texts. Unfortunately, a large number of Ayurvedic texts are unexplored till today are likely to exist in palm-leaf manuscripts, which are decaying or undergoing permanent annihilation. As such many unique and valuable information contained in these texts are being lost. Though several Institutions have taken up work on literary Research, only few texts have been published during past decades. The present paper highlights the salient features of the text 'Cikitsarnava' authored by Visvanath Sena of 16th century of Orissa. Though his text on Pathyapathya has already been published, which has got a place in the pages of history of Ayurveda, a very little is known about this important text on therapeutics. Various aspects of this text and its author have been discussed to bring it in to the knowledge of fraternity of Ayurvedic physicians and Sanskrit scholars.

Some explorative information regarding 'Jwaratimirabhaskara' and its author Kayastha Camunda.

Out of the treasure of Ayurvedic literature, a few texts have come in to lime light while some are in dark and available in incomplete form. But many names of the texts with unknown or known authors have been quoted by different subsequent authors in their texts or in the explications by their commentators, for which complete texts are not available at present. Among the texts on specific diseases, one notable work is 'Jwaratimirabhaskara' written by Kayastha Camunda. Nowhere a detailed account of author's identity, time and place has been mentioned, while short references are available in some historical books. However, manuscripts of this text are available in many repositories of our country. In this article, an attempt has been made to establish the identity of the author, period of the text and also to highlight the salient features of this text.

Early peri-operative glycaemic control and allograft rejection in patients with diabetes mellitus: a pilot study.

BACKGROUND: Hyperglycemia alters the inflammatory response to infection and ischemia. We hypothesize that perioperative glycemic control could also influence the risk for allograft rejection. METHODS: Consecutive patients with established diabetes undergoing their first cadaveric renal transplantation and receiving steroid-sparing immunosuppression were identified (n=50). Records of capillary glucose observations over the first 100 hr following surgery and transplantation variables pertaining to graft function, acute rejection, and postoperative infection were identified and entered into multivariate analysis. RESULTS: Perioperative glycemic control was associated with an increased incidence of infection and acute rejection. Only 3 of 27 patients (11%) with optimal glycemic control during the 100 hr following surgery (mean<11.2 mmol/L) had rejection episodes compared with 58% of patients with poor control (>11.2 mmol/L). All patients with poor glycemic control experienced postoperative infection. CONCLUSIONS: This pilot study suggests that hyperglycemia may be associated with an increased risk of both allograft rejection and postoperative infection in patients with diabetes.