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Background Guggulu is an oleo gum resin obtained from the plant Commiphora wightii (Arn.) Bhand., used in Ayurved ic medicines for various ailments like anti-inflammatory conditions, hyperlipidemia, thyroid disorders etc. Guggulsterones E & Z are responsible for these broad ranges of pharmacological actions. It is recommended to do Shodhana (purification) before incorporating it into medicinal formulations. Sahasrayoga , an Ayurvedic text, emphasizes the purification of Guggulu in a particular media, which is a long run practice in Kerala. Objectives To compare the physicochemical and phytochemical parameters, quantitative estimation of Guggulsterone E & Z using high performance thin layer chromatography (HPTLC) and qualitative gas chromatography-mass spectrometry (GC-MS) analysis of Guggulu before and after purification. Methods Shodhana of Guggulu was performed in Water boiled with crushed fresh leaves of Neem ( Azadirachta indica ) and fresh rhizome of turmeric ( Curcuma longa ) using a special equipment ( Dolayantra ). Preliminary physicochemical and phytochemical evaluation, quantification of Guggulsterones E & Z using HPTLC and GC-MS analysis of raw and purified Guggulu were performed. Results Phytochemical evaluation of metabolites revealed marked variations. The mean concentrations of Guggulsterone E & Z showed significant differences before and after purification (p<0.01). On GC-MS analysis, it was found that few new compounds were added in the purified Guggulu . Conclusions Therapeutic efficacy of Guggulu might have enhanced after traditional purification.

Objectives Madhulai Manappagu – a well-known sastric and widely prescribed Siddha herbal syrup formulation indicated for treating Veluppu Noi (Anaemia especially Iron deficiency Anaemia) has been in day today practice in Tamil Nadu for a quite longer decades. The syrup is a herbal preparation which has a sweet pleasant odour and a palatable taste, contain the juice of pomegranate ( Punica granatum L.) as the main ingredient. Though the formulation is a fruit juice, the safety profile of the syrup is not established and is being marketed without toxicological evaluation. The study is aimed at ascertaining the acute and sub-acute toxicity assessment of Madhulai Manappagu in Wistar Albino rats. Methods The acute and sub-acute (28day repeated oral) toxicity studies were performed as per the guidelines mentioned in the Organization for Economic Cooperation and Development (OECD) 423 (adopted on December 2001) and TG 407 (adopted on October 2008) with slight modifications respectively. For acute toxicity study, three female rats were randomly selected as control; three female rats were randomly selected and were administered a single dose of 5,000 mg/kg body weight per oral route. For sub-acute (28day repeated oral) toxicity studies, three doses of test drug MM of 500 mg/kg/day (low dose), 750 mg/kg/day (intermittent dose) and 1,000 mg/kg/day (high dose) were selected for administration. Both sexes of Wistar Albino rats were randomized into four groups of 10 animals each (five males, five females). Group I was kept as control group. Group II, III and IV served as low, intermittent and high doses of MM respectively. Animals were observed for mortality, morbidity, body weight changes, feed and water intake. Haematology, clinical biochemistry, electrolytes, gross pathology, relative organ weight and histopathological examination were performed. Results In the acute toxicity study, rats showed no toxicological signs on behavior, gross pathology and body weight of rats when treated with a single dose of 5,000 mg/kg body weight per oral route. In the subacute (28 days repeated oral) toxicity study, rats have showed no significant changes on behavior, gross pathology, body weight, and hematological and biochemical parameters when treated with Madhulai Manappagu in three different doses. Conclusions The toxicity studies which include both acute and 28 days repeated (subacute) oral toxicity studies, revealed no observed adverse effect level (NOAEL) of Madhulai Manappagu in animals. Thus the safety of the drug in human usage was ensured.

Objectives The use of Spathodea campanulata in folklore medicine for the management of reproductive disorders has been poorly reported. We sought to investigate the protective potential of the ethyl acetate fraction of S. campanulata stem bark extract (EFSC) on lead acetate-induced (LA) testicular toxicity in male rats. Methods Animals during a 28 days treatment received dimethyl sulfoxide (DMSO, 0.1%), LA (20 mg/kg), and EFSC (200 mg/kg). Others received EFSC only (100, 200, and 400 mg/kg) or vitamin E (100 mg/kg) 1 h prior to LA (20 mg/kg) administration. Results LA administration decreased sperm counts and motility by 36.39 and 40.69% respectively in rats. Also, LA-untreated rats showed elevated malondialdehyde (MDA) and decreased total proteins in testis (260, 33%) and epididymis (62, 29%) respectively. However, EFSC (100, 200, or 400 mg/kg) administrations improved sperm morphological characteristics as well as antioxidant status in LA-treated rats. EFSC (400 mg/kg) showed improved testis seminiferous tubules that were almost normal in the LA-treated rats. Further, EFSC contains a high 9-octadecenoic acid methyl ester. Conclusions Overall, evidence by LA-induced testicular toxicity, EFSC provides chemopreventive roles via antioxidant mechanisms.

Objectives Comparative evaluation of cardioprotective activity of Gala and Fuji apple juice against isoprenaline induced cardiotoxicity in rats. Methods Rats (125–150 g) were orally administered Gala (GA) and Fuji (FA) apple juice (3 mL/day, per oral) for 13 days. Myocardial injury was inducted on 14th and 15th day by the administration of Isoprenaline (85 mg/kg/day, subcutaneous). Results In treated group i.e. GA and FA, aspartate aminotransferase (AST), alanine transaminase (ALT), lactate dehydrogenase (LDH), creatine kinase (CK), Troponin-I level and malondialdehyde (MDA) content was reduced while glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) level was significantly increased. Marked reduction in cholesterol, triglyceride, phospholipids, low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL) was observed while high-density lipoprotein (HDL) level increased significantly. In tissue and serum total serum protein (TSP) level, Albumin, Globulin and A/G ratio increased very significantly in the treated group while the level of white blood corpuscles (WBC), haemoglobin (Hb), erythrocyte sedimentation rate (ESR), total fibrinogen (TF), bleeding time (BT), c-reactive protein (C-rP), red blood corpuscles (RBC), clotting time (CT) and prothrombin time (PT) showed a significant rise in the level. The level of Sialic acid, hexose, fucose and hexosamine was highly significantly increased, there was an increase in the level of K + and glycogen while a significant reduction in electrolyte and glucose level was observed when all these parameters were compared to Isoprenaline (ISO) group. The above findings were supported by histopathological examination of hearts. Cardioprotective activity was compared with standard drug, metoprolol. On comparative analysis of both juices, GA juices have found more effective when compared to FA juice. Conclusions The study was concluded that Gala and Fuji apple possessed significant prophylactic and protective effects against Isoprenaline-induced cardiotoxicity in rats through maintaining inhibiting lipid peroxidation, endogenous antioxidant enzyme activities and cytokine levels.

Objectives Early diagnosis and management of known cardiovascular disease risk attributes such as hypertension lessens morbidity and mortality as well as increase quality of life of patients. This present study was modelled to investigate the ameliorative effect of Kolaviron, an extract of Garcinia kola Heckel seeds, in ethanol- and sucrose-induced hypertension. Methods Test animals were divided into six groups of six animals each for each hypertensive model. Animals were treated daily with distilled water (10 ml/kg); 35% ethanol (3 g/kg) or sucrose (5–7%); Kolaviron (50, 100 and 200 mg/kg) separately plus ethanol or sucrose and Amlodipine (0.14 mg/kg) separately plus ethanol or sucrose for 8 weeks. Systolic, diastolic and mean arterial pressures were determined using non-invasive BP system after 8 weeks. Blood was obtained for the assessment of biochemical parameters, lipid profile and antioxidant indices. Vital organs were collected for approximation of tissue antioxidant levels. Results Results show that Kolaviron at various doses and Amlodipine significantly reduced (p<0.05–0.001) the elevated systolic, diastolic, and mean arterial pressures produced by ethanol and sucrose administration. Additionally, Kolaviron and Amlodipine significantly overturned (p<0.05–0.001) the reduction in GSH, SOD and CAT, and elevation in MDA levels elicited by ethanol and sucrose. Furthermore, Kolaviron and Amlodipine produced significant reduction (p<0.001) in levels of cholesterol, triglycerides and low-density lipoproteins, as well as significant increase (p<0.01–0.001) in levels of high-density lipoproteins. Conclusions Results from this study demonstrate that Kolaviron possibly possesses significant antihypertensive effect which may possibly be attributed to its antioxidant effects and relative improvement of lipid profile.

Attention to diet was considered important issues in improvement of men infertility in Persian Medicine (PM). The purpose of this study was to extract herbal foodstuffs introduced by Avicenna, one of the greatest PM physicians to improve the semen production and to provide evidence of their impact on the basis of current studies.“Canon of Medicine”, the most important Avecinna's book, was searched with keywords equivalent to semen, fertility and infertility, main herbal foodstuffs were extracted and was searched with keywords sperm, semen, infertility, and fertility in Google scholar, PubMed and Scopus databases. Manuscripts from 1950 up to December 2019 were selected and reviewed. Almond, Onion, Chickpea, Garlic, Coconut, Palm date, Sesame, Fenugreek, Carrot, Fig, Grapes, Pistachio, Hazelnut and Walnut are among main foodstuffs which recommended by Avicenna and there is also evidence that they have positive effects on testosterone production and improvement of various sperm parameters, including count, motility and morphology. Containing large amount of different macro and micronutrients such as vitamins including vit B, C, A and E, minerals such as Mg, Se, Zn, Cu and Fe, important unsaturated fatty acids such as linoleic and oleic acids, amino acids such as lysine and arginine and phytochemicals such as polyphenols, flavonoids, triterpenes and steroids can be considered as a main factor in the effectiveness of these foodstuffs. Designing a diet based on the fruits, vegetables, nuts and seeds that Avicenna has recommended, may be effective in treating male infertility but further studies are needed to clarify this issue. Research on the effectiveness of his other recommended foodsuffs may also offer new treatments and supplements for this purpose.

Human-to-human transmission of the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurs most often when people are in the incubation stage of the disease or are carriers and have no symptoms. SARS-CoV-2 transmission on different levels showed that the cold and dry climate, hot wind and relative humid wind, maximum wind speed, turbulent wind, intensified recirculating flow were causing transmission higher than factors. The role of environmental factors described in Ayurveda like air, water, soil, season, frequent earthquakes, sunlight exposure, frequent thunderstorm with lightening, and factors from arthropods were revalidated in perspective of COVID-19 transmission. The authors searched the information regarding epidemic diseases in Ayurveda textbooks. Pubmed, Science Direct, Wikipedia, Elsevier, Lancet, and Springer were approached for the latest knowledge relating to SARS-CoV-2 and COVID-19. Google Scholar search engine was thoroughly checked upon for scientific evidence regarding the Ayurveda drugs. Various environmental factors like soil, air, water, frequent earthquake disasters, wildlife animals, aquatic birds, space, inevitable disastrous factors, weather or seasonal hazards, violent thunderstorm with lightning, intermediate hosts, sunlight exposure etc. were considered for their role in the genesis of the disease. The Ayurvedic concepts behind the etiology and development of epidemics are the same as modern epidemiological theories. The mysteries of many aspects of the current pandemic might be deciphered by traditional medicine knowledge and thus adding upon to the integrative medicine concept.

Burning mouth syndrome (BMS) is described by an intense burning sensation of the tongue or other oral areas without a clear etiopathology. The diagnosis of BMS is challenging due to variations of manifestations. The management of BMS is complicated due to the complex etiology of the disease. Many medications and treatment methods have been recommended for BMS management, but no one confirmed as the standard method. In this study, the therapeutic approaches of BMS were evaluated. The data of the article was obtained from PubMed/MEDLINE, Cochrane Library, and Web of Science. The following terms including “burning mouth syndrome”, “therapy”, and “treatment” were used for search in the databases. A wide range of articles about the therapeutic approach of BMS was searched and reviewed. Pharmacological and non-pharmacological approaches have been used for BMS management. Pharmacological treatments are including Capsaicin, Clonazepam, Low-dose aripiprazole, Alpha-lipoic acid, Duloxetine, Amitriptyline, Gabapentin, and Pregabalin, and ultra-micronized palmitoylethanolamide. Non-pharmacological therapies for BMS are cognitive therapy, Electroconvulsive therapy, Laser therapy, Acupuncture and auriculotherapy, Transcranial Magnetic Stimulation (rTMS), Salivary Mechanical Stimulation, and Botulinum Toxin. A detailed assessment of the etiology and pathophysiology of BMS, and having information about novel therapeutic interventions are essential for the management of BMS.

Objectives In Ontario, Canada, MTs are regulated and have a common scope of practice. However, diverse practice settings and approaches to care create a need for MTs to articulate their professional identity. This study sought to answer, “what common features are foundational to the professional identity of MTs in Ontario?” Methods This quantitative research study was a part of a larger exploratory sequential mixed methods study. An online questionnaire-based cross-sectional study was conducted based on previous qualitative findings. MTs in Ontario, who held an active certificate, were invited to participate. Data were analyzed using descriptive statistics. Results The analysis revealed 17 common features that were endorsed by most respondents. Participants also reported thinking of themselves as healthcare professionals, rather than service providers, a feeling that was held across practice settings. Interesting and unexpected differences were noted in statements regarding the perception of MTs, areas of profession-specific knowledge, and the establishment of the therapeutic relationship. Conclusions This study furthers an understanding of MTs’ identity. Specifically, MTs consider themselves to be HCPs who are confident in their knowledge and abilities, especially their communication skills. They believe in providing individualized care and empowering their patients to take charge of their own health. Despite areas of overwhelming agreement, disagreement in endorsement was seen in areas such as MTs perception of their external image, use of evidence in practice, and the establishment of professional boundaries. These areas provide an opportunity for future research to continue to develop a body of knowledge regarding MTs professionalism and identity.

Objectives The modified Naranjo algorithm assesses the physician assigned cause-effect relationship for homeopathic medicines. It is being adopted in homeopathy researches, but not yet validated systematically. We intended to validate the modified Naranjo algorithm by examining its psychometric properties. Methods An online survey sought agreement of 25 experts on the 10 items of the tool on 5-point agreement scale. Next, 285 responses from collected prospectively from chronic cases enrolled under the clinical verification program of the council in 2018 were subjected to testing of construct validity using exploratory principal component analysis (PCA). Confirmatory factor analysis (CFA; n=150) was performed to verify the goodness-of-fit of the model. Reliability was tested using internal consistency, test–retest reliability, and inter-rater reliability by kappa statistics. Results Experts’ responses mean values were 4 or higher (i.e. responses were relevant) and standard deviations were less than 1 (i.e. less heterogeneous). In PCA using varimax, all the items loaded above the pre-specified value of 0.4 and identified 4 components explaining 64.1% of variation. The goodness-of -fit of the 4-component CFA model was acceptable (chi-square 89.253, p<0.001). Internal consistency (Cronbach’s alpha 0.7) was borderline; test–retest reliability was acceptable. Kappa statistics was moderate to fair, but poor for few of the items. Conclusions Statistical evaluations indicate that the modified Naranjo algorithm is useful, but needs improvement.

Objectives Many patients experience anxiety and stress before surgery. Anxiety is also different in men and women so that the prevalence of anxiety disorders in women is higher than men. The present study aimed to compare the effect of inhalation aromatherapy on emotional distress of men and women before surgery. Methods This study conducted as a randomized, single blind, placebo-controlled, prospective and clinical trial. It was performed in hospitals affiliated to Shiraz University of Medical Sciences. 90 patients were selected as candidates for surgery and were divided into two intervention groups and one control group. Patients completed the State-Trait Anxiety Inventory questionnaire before the intervention. Patients completed the State-Trait Anxiety Inventory questionnaire (STAI) after 20 min of intervention. Then the data were analyzed using SPSS software, version 16. The significance level in all testes was set at <0.05. Results Relatively severe anxiety was not observed in men after intervention with lavender and spring orange. In women, relatively severe anxiety was not observed after the intervention with lavender, but in the spring orange group, only in 6.7% of people, relatively severe anxiety and traits were observed, which has decreased compared to before the intervention. In addition, the severity of anxiety in women in the control group increased after placebo intervention (p<0.05). Conclusions The results showed that inhalation of Citrus aurantium and lavender aroma reduces anxiety in male and female patients.

Objectives Environmental stimuli in neonatal intensive care units can disrupt the physiological stability and sleep of infants. It is essential to perform nursing interventions to reduce the adverse effects of such stimuli. This study aimed to compare the effect of recorded lullabies and mothers’ live lullabies on physiological responses and sleep duration of preterm infants. Methods This study was a randomized clinical trial. The participants were 90 preterm infants selected using convenience sampling. In the intervention groups, music (recorded lullabies and mother’s live lullabies) was played for 14 days, 20 min a day, while the control group did not receive any intervention. The data were collected using physiological criteria and infant sleep checklists before, during, and after the intervention. The data were analyzed using SPSS software (Version 21.0). Results The mean scores of physiological parameters (O2 saturation and heart rate) were not significantly different in the three groups before, during, and after the intervention (p>0.05). However, there was an improvement in O2-saturation and a decrease in the heart rate in two intervention groups. The mean duration of the infants’ overnight sleep was not statistically significant between the groups before the intervention (p>0.05). However, there was a statistically significant difference in the intervention groups after the intervention, (p<0.05), and the infants’ overnight sleep was longer in the recorded-lullaby group than the other two groups. Conclusions Although performing interventions, including recorded lullaby and mother’s live lullaby did not differ significantly with that of the control group in physiological criteria, it can be clinically important. In addition, recorded-lullaby increased the infants’ overnight sleeping. Thus, it is suggested that further studies be conducted to confirm the effect of recorded lullaby and mother’s live lullaby interventions on physiological parameters and sleep duration of hospitalized infants.

Objectives This study examines the effect of hypnotherapy on exam anxiety among first-year nursing students. Nursing students have high tendency to experience stress and anxiety. Anxiety therapy which encompasses mind and body would be helpful for them. Methods Sixty first-year nursing students participated in this interventional study. The hypnotherapy sessions started eight weeks prior to second exam. Outcome of hypnotherapy were assessed by measuring the exam anxiety score using TAI and clinical measurements (serum cortisol and vital signs). The measurements were done twice, there are two exams, where first exam and measurement were 1 day before exam (without hypnotherapy) and the second exam and measurement were 1 day before exam (with hypnotherapy). Results The mean difference of exam anxiety score and serum cortisol level between pre and post hypnotherapy sessions was statistically significant. Conclusions This study found that hypnotherapy is an effective tool in the management of exam anxiety among the nursing students.

Objectives Preterm infants often suffer from nutritional problems because of gastrointestinal problems. Massage could make the infants feel more peace and comfort, but limited studies have focused on the effects of massage on the gastric function. This study aimed to investigate the effects of abdominal massage on the gastric function of preterm infants. Methods A randomized controlled trial compared gastric function of preterm infants with and without massage therapy. The preterm infants were randomly allocated to control and massage groups. The massage group received the abdominal massage before feeding, twice a day, for 15 min, over 5 days. Furthermore, the gastric function was compared between the control and experimental groups. The data were analyzed using SPSS software (Version 15.0). Results The average weight in both groups had no significant (p>0.05) changes before and after the study, and both groups showed a negative trend in the weight gain. The abdominal circumference, the frequency of vomiting episodes, the residual volume, and defecation frequency were significantly (p<0.05) different between the two groups after the intervention. Conclusions The abdominal massage could be an effective nonmedicinal method to reduce the gastrointestinal problems in the preterm infants. The abdominal massage could be offered to the preterm infants as an inexpensive, available, and feasible method to alleviate gastrointestinal problems as well as improve the gastric function.

Objectives Cardiovascular diseases have a multifaceted, it causes modern epidemic; Recognizing in the risk factor stage, is crucial, given the risk of progression to cardiovascular disease. Ibn Sīnā, described CVDs as a resultant of gradual derangement of Quwwat ghādhiya (Nutritive faculty); in which management with ghidhā’ (diet), tadābīr (regimens), dawā’ (drug) has been received. To evaluate the effect of Arjun Chāl ( Terminalia arjuna ) in CVD risk factors. And to evaluate the drug safety. Methods This is a randomized controlled clinical trial. Total 120 patients were screened at OPD of NIUM hospital, Bangalore during 2018–19, only 48 patients fulfilled the inclusion criteria and signed written informed consent and their detailed medical history was recorded. Arjun Chāl powder (5 gm BD) for eight weeks administered in test group (n=24), Amlodipine (5 mg) and Atorvastatin (10 mg) once a day for same duration administered in control group (n=24). Efficacy of the drug assessed by the Lipid profile, BP and BMI; lipid profile were performed at baseline and at 8 weeks, while BP and BMI performed at baseline, 15, 30, 45, and 60th day intervals. Study was completed by 40 patients. The results of both the therapies were then compared and statistically analyzed. Results Totally, both groups reduces assessment parameters i.e. statistically highly significant (p<0.001). Test group showed greater reduction in terms of all assessment parmeters. But, the difference between both the groups was statistically non-significant p>0.05. Conclusions Both test and control drugs were effective, but Arjun Chāl had a slight edge over amlodipne and atorvastatin, and was found to be safe and well tolerated. It has a cardio protective potential and hence effective to delay/prevent CVD in patient with cardiovascular risk factor.Keywords: Unani System of Medicine; T. arjuna ; Arjun Chāl; Efficacy; Safety; Cardiovascular risk factor.

Objectives Secondary Infertility is a major concern worldwide, accounting for about 40% of female infertility due to lifestyle factor. Secondary Infertility is having a close proximity to a disorder Vandhyatwa explained in Ayurvedic classics, due to a variety of causes. Several Ayurvedic interventions are advised such as Panchakarma (∼purification therapy) for vitiated Doshas in female reproductive organs, Snehapana (∼oral intake of medicated oil) followed by Virechana (∼purgation) to produce quality ovum. Other internal medications like Phalaghrita, Ashokarishta, Kanchanara guggulu etc. have a probable mode of action with enhancing the perceptibility of endometrium for implantation. Correlating fallopian tubes with the Artavavaha Srotas , its block is compared with the Sanga Srotodushti (obstructive pathology occurring in channels)of this Srotas . By virtue of the purification therapy and internal medication working synergistically might remove the Srotodustht. Case presentation A 30 year old female with a history of eight years post marital infertility was treated with Panchakarma along with Ayurvedic medicines after being diagnosed as infertility due to tubal blockage for a period of 16 weeks. Conclusions After 16 weeks of treatment, she reported with amenorrhoea and found Urine Pregnancy Test positive. Subsequently, confirmed the pregnancy by USG, as single live intrauterine foetus of Sonic Gestational Age – 8 weeks 5 days.