Indian Traditional Treatments for Psoriasis: A Critical Appraisal of Available Evidence Supporting Efficacy.

OBJECTIVE: To examine data from studies supporting the clinical efficacy of medical approaches from India traditional systems of medicines like Ayurveda, Unani, Siddha, and Homeopathy for psoriasis using outcome indicators employed in clinical practice and research. METHODS: Searches were conducted between December 2019 and September 2020 in databases PubMed, Scopus, Web of Science and Ovid Medline using search terms including traditional, complementary, psoriasis, Kushtha, Ayurveda, Siddha, Unani, Homeopathy and clinical. Controlled trials, case series and case reports published from India were included. RESULTS: Data of 17 selected studies were extracted. Treatment efficacy in terms of improvement in Psoriasis Area and Severity Index (PASI) score or/and percentage reduction in score (PASI 50, PASI 75 and PASI 90) or/and patient-reported outcomes using instruments like Dermatology Life Quality Index and Psoriasis Disability Index were noted. All studies reported good improvement as per the study specific outcome. However, study characteristics, including study design, sample size, follow-up period, inclusion and exclusion criteria were heterogeneous, and the choice of outcome measures was not adequate to conclude the effectiveness of intervention. The use of some herbs as common ingredients in several formulations across different systems of medicines were noted in analyzing individual formulation. CONCLUSIONS: Future studies must incorporate a comprehensive study design with specific outcome measures like PASI, PASI 75, PASI 90, quality of life parameters, compliance to medications, adverse reactions, remission period, relapse rate and cost-effectiveness with long term follow-up. The currently available evidence on the roles of these herbs at molecular level in psoriasis is preliminary.

Siddha fasting in obese acute decompensated heart failure may improve hospital outcomes through empowerment and natural ketosis.

BACKGROUND: Morbid obesity (BMI > 35 kg/m2 with comorbid conditions) is present in 25 - 35% of acute decompensated heart failure (AHF) patients. Prevalence of HF increases with duration of morbid obesity from 30% at 15 years to over 90% at 30 years. There is a need to develop pragmatic therapies that address the unique physical and mental challenges faced by obese AHF patients. Siddha is 5,000 year old Tamil Medicine using yoga and mind-body methods towards higher consciousness. Hunger gratitude Experience (HUGE) is intuitive Siddha fasting method which may improve in-hospital AHF outcomes independent of weight reduction. CASE SUMMARY: We present 5 cases of morbidly obese patients with cardiorenal syndrome (CRS) that began intermittent fasting either during their AHF hospitalization or in the outpatient setting for refractory symptoms despite hospitalization. Initiation of fasting correlated with reduction of respiratory distress and edema as well as improvements in psychological wellbeing and functional capacity. DISCUSSION: Siddha fasting mediates hemodynamic and anti-inflammatory effects through natural ketosis and psychological benefits through empowerment in AHF. Potential role of fasting in reducing myocardial workload, coronary steal, angina, volume overload, and CRS needs further study in cardiac patients.

Repurposing Siddha mercurial drug for mild to moderate COVID-19 - Case series and exploration of its chemical profile.

Vajra kandi maathirai (VKM) is a mercury-based traditional Siddha drug used to treat various types of fevers and inflammatory diseases. We report our experience of using VKM successfully in the treatment of 5 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients along with its chemical profile. A family comprising of 5 members, with age ranges between 13 and 77, both male and female, one with pre-existing renal impairment, SARS-CoV-2 positive with mild to moderate category were treated with VKM along with the specific dietary practice. The drug was consumed at home quarantine. Real-Time RT-PCR from oropharynx swab, X-ray/CT scan chest, hematology, renal function, liver function, body temperature, and oxygen saturation were assessed. Blood parameters were repeated after completion of therapy to assess the safety aspect of mercury drug. With the first dose, improvement in the oxygen saturation was observed. Within 3 days of therapy, all symptoms (fever, body pain, cough, and loss of taste) were normalized and the Real-Time RT-PCR was negative for COVID-19. There were no observed side-effects and any damage to kidneys and liver were not observed. Chemical profile of the drug was done using gas chromatography-mass spectrometry and inductively coupled plasma mass spectrometry. The drug contains 22% of mercury along with a 9-Octadecenoic acid-(E), 1H-Imidazole, 4,5-dihydro-2-(phenylmethyl), and 9,12-Octadecadienoic acid (Z,Z)- as major organic compounds. VKM might be a safe drug to manage COVID-19 patients. Rigorous research is required in larger population and also for drug discovery.

Vernonia cinerea regenerates tubular epithelial cells in cisplatin induced nephrotoxicity in cancer bearing mice without affecting antitumor activity.

BACKGROUND: Traditional Siddha Medicine advises using metal-based formulations to treat cancers. In the case of any toxicities during the therapy, Siddha physicians use Vernonia cinerea (VC) whole plant kashayam (crude aqueous extract-CAE) to reverse the toxic effects. AIM: To evaluate the nephroprotective activity of CAE and its fractions in cisplatin-induced nephrotoxicity and to assess whether they compromise the anticancer efficacy of cisplatin. MATERIALS AND METHODS: Cisplatin-induced renal damage was induced in Ehrlich Ascites Carcinoma (EAC) bearing mice during mild phase of tumor growth. CAE and its butanol (BF) and aqueous (AF) fractions were administered orally from the 5th day for five days. Nephroprotective potential (serum urea, creatinine, renal histology) and effect of VC on cisplatin anticancer efficacy (tumor volume, viable tumor cells, percentage increase in life span (% ILS)) were calculated. RESULT: CAE and its fractions significantly reversed the cisplatin-induced renal damage. CAE and BF treated animals showed regeneration of 50%-75% of proximal tubular cells. Compared to EAC control mice, the % ILS of the cisplatin-treated group was 244% and it was further extended to 379% after CAE administration. The % ILS in the CAE treated group was 1.6 times higher than the cisplatin alone treated group. GC-MS study showed the presence of astaxanthin and betulin. CONCLUSION: CAE of VC reverses cisplatin-induced kidney damage as well as regenerates proximal tubular epithelial cells, without compromising the anticancer effect of cisplatin. When CAE was further fractionated, the nephroprotective activity was retained, but the beneficial anticancer effect of cisplatin was compromised.

Correction: Physiochemical characterization and cytotoxicity evaluation of mercury-based formulation for the development of anticancer therapeuticals.

[This corrects the article DOI: 10.1371/journal.pone.0195800.].

Physiochemical characterization and cytotoxicity evaluation of mercury-based formulation for the development of anticancer therapeuticals.

BACKGROUND: The present study is aimed to evaluate the physiochemical properties and cytotoxicity of mercury-based formulation for the development of anticancer therapeuticals. METHODS: The elemental and morphological features of the formulation were characterized by FE-SEM, XPS and EDS. The described formulation was evaluated for its cytotoxicity on Hek293 and MCF7 cell lines using MTT assay to study the in vitro effects. The in vivo developmental toxicity was also studied on zebrafish embryos and the lethal concentration (LC50) values were calculated as per the OECD regulations. RESULTS: The elemental and morphological characterizations confirmed the presence of mercuric compounds. The particles were spherical and stable with the size ranges between 20 and 80nm. Although the PK formulation contains mercurials it was very effective only to cancerous cells (MCF-7) and it is less toxic to normal cells (HEK 293). The in vivo assessment of developmental toxicity on zebrafish embryo confirmed the safer dosage of 100µg/ml. However, a higher dosage of 1mg/ml led to the malformation of embryos such as pericardial, tail and yolk sac edema. CONCLUSION: The physiochemical characterization of PK formulation confirmed the presence of HgS. The results of both in vitro and in vivo studies showed that the formulation is less toxic. Although the test sample contains mercurials it was very effective against cancerous cells (MCF-7) and it is less toxic to normal cells (HEK 293). FUTURE STUDIES: Further studies on effectiveness of the formulation along with inflammatory response in mice models are to be conducted.

Bioactive PLGA-curcumin microparticle-embedded chitosan scaffold: in vitro and in vivo evaluation.

Wound healing is a complex process affected by several factors. In the present work, novel biocompatible PLGA-curcumin microparticle-embedded chitosan scaffold was fabricated for wound-healing application. Process variables involved in the preparation of microparticles were optimized using design of experiment. Scanning electron microscopy (SEM) confirmed the porous nature of scaffold with embedded microparticles. A maximum release of 14% of the encapsulated curcumin was observed at 12th hour. Modified tube dilution method showed that scaffold significantly (p < 0.05) reduced multiplication of Staphylococcus aureus. More than 50% of the excised wound in rats healed in 4 days with an epithilization period of 18 days.

Infantile seborrheic dermatitis: a pediatric Siddha medicine treatise.

Siddha medicine is one of the oldest (5000 years old) well-documented Indian traditional medicines, compared with Ayurveda, Unani, and traditional Chinese medicine, by way of keen observation and experimentation. It mentions 108 diseases that occur in childhood, which are further classified and described into various subtypes based on the clinical features and different stages of a particular disease. The authors translate the elegant and detailed description of one neonatal disorder, infantile seborrheic dermatitis (cradle cap), called kabaala kuttam (KK), described in 17 stanzas of four lines for each stanza from Tamil language script into English. There are five different types of cradle cap, including white type, dark black type, red type, weeping type, and toxic type. Four polyherbal formulations are described for external and oral administration, in which there is mention of 39 herbals and pure sulfur as ingredients. The safety and efficacy of these herbal products varies and has not been fully explored in infants, but may represent options for clinical development.

Evaluation of diuretic activity of Amaranthus spinosus Linn. aqueous extract in Wistar rats.

ETHNOPHARMACOLOGICAL RELEVANCE: Traditional Siddha medicine literature claims that the Amaranthus spinosus Linn. (family: Amaranthaceae) whole plant possesses diuretic property. AIM OF THE STUDY: To evaluate the diuretic potential of Amaranthus spinosus aqueous extract (ASAE) in rats. MATERIAL AND METHODS: Different concentrations of ASAE (200, 500, 1000, 1500mg/kg), thiazide (10mg/kg) and vehicle were orally administered to rats (n=6 animals per group) and their urine output was collected after 24h. Volume, pH, Na(+), K(+) and Cl(-) concentrations of urine were estimated. RESULTS: ASAE produced increase in Na(+), K(+), Cl(-) excretion, caused alkalinization of urine, showed strong saluretic activity and carbonic anhydrase inhibition activity. These effects were observed predominantly at 500mg/kg dose and there was no dose-response relationship. CONCLUSION: Our study strongly suggests that the Amaranthus spinosus is acting as a thiazide like diuretic with carbonic anhydrase inhibitory activity which restates the claim as diuretic herb in Siddha medicine.

Antiovulatory and abortifacient effects of Areca catechu (betel nut) in female rats.

OBJECTIVES: To study the antiovulatory and abortifacient effects of ethanolic extract of Areca catechu in female rats. MATERIALS AND METHODS: For antiovulatory effect, ethanolic extract of A. catechu at 100 and 300 mg/kg doses was administered orally for 15 days. Vaginal smears were examined daily microscopically for estrus cycle. Rats were sacrificed on 16(th) day. Ovarian weight, cholesterol estimation, and histopathological studies were done. Abortifacient activity was studied in rats at 100 and 300 mg/kg doses administered orally from 6(th) to 15(th) day of pregnancy. Rats were laparotomised on 19(th) day. The number of implantation sites and live fetuses were observed in both horns of the uterus. RESULTS: The extract of A. catechu showed a significant decrease in the duration of estrus at 100 mg/kg (P = 0.015) and 300 mg/kg doses (P = 0.002) as compared with control. Metestrus phase was also significantly reduced at 100 mg/kg (P = 0.024) and 300 mg/kg doses (P = 0.002). There was a significant increase in proestrus (P < 0.001) phase. However, diestrus phase was unchanged. Histopathological study of the ovaries showed mainly primordial, primary, and secondary follicles in the test groups as compared to control. There was also a significant (P = 0.002) decrease in ovarian weight and a significant (P = 0.021) increase in ovarian cholesterol level at 100 mg/kg dose. In the study to evaluate abortifacient effect, the mean percentage of abortion with 100 and 300 mg/kg doses were 75.5% and 72.22%, respectively, which was significantly (P = 0.008 and P = 0.006, respectively) increased when compared with control. CONCLUSION: The ethanolic extract of A. catechu at doses of 100 and 300 mg/kg has antiovulatory and abortifacient effects.