Volume 16, Issue 3 -

Ayurveda recommends sound and healthy life. It basically focuses on prevention rather than treatment. It includes a systematic lifestyle pattern which is composed of several principles and activities. Dinacharya (Daily routine) is one of the important principles. It includes various activities started from just before sunrise. All these activities are necessary for the maintenance of homeostasis of the body. Tooth brushing is one of the essential routines of Ayurveda daily practices. Traditionally it has been advocated with a soft twig of medicinal plants with or without herbal tooth powder. There are so many medicinal plants have been described in this context. Contradictory plants have also been described. Oral hygiene products are so much advanced and globalized nowadays. There are so many types of toothbrushes; dentifrices, dental floss, tongue scrapers, mouthwashes, oral irrigators, etc. are available along with specifications. Contemporary oral hygiene products esp. dentifrices are chemically rich and have their own side effects. No doubt these products have their own advantages like easy availability and adjustability according to current lifestyle. But their safety is questionable on long-term use. Herbal products have additional benefits over it that those are natural and easily adjustable and acceptable with body physiology.

Dietary antioxidants are widely distributed in various types of our food. They are strongly associated with reduced risk of many chronic diseases such as atherosclerosis, cancer, and Alzheimer’s diseases. They include vitamins such as vitamins A, E, C, and carotenoids. Also, some minerals like; zinc, manganese, copper, iron, and selenium are essential for the activity of antioxidant enzymes. Furthermore, dietary polyphenols and flavonoids are considered as potent antioxidant compounds. Vegetables, fruits, and edible herbs are the richest sources of such antioxidants. Antioxidants reduce oxidative stress, either directly by reducing reactive species or indirectly by enhancing the body antioxidant defense mechanisms in different ways. These may include upregulating gene expression of some antioxidant enzymes via a nuclear factor erythroid 2 related factor2 pathway. Administration of a mixture of antioxidants is beneficial since they act synergistically in various phases. The aims of this review are to summarize the different antioxidants from dietary sources and their role in the prevention of different diseases.

Background Migraine is a disabling disease and conventional treatment has many side effects. Dietary supplements and various herbs have reported valuable effects on migraine. Aim The present study systematically review the effects of these dietary supplements and herbs on migraine. Methods The literature search was done on electronic databases PubMed, Google Scholar and Science direct (2005–2015). The quality of articles was assessed through a criteria list of methodological quality assessment of randomized controlled trials (RCTs). The papers got C 50 points considered to be of good quality methodology. The maximum score was 100. Results Fourteen RCTs on migraine were included in this review. The range of quality score varied from 37 to 65 points. Conclusion Various RCTs suggested that dietary and vitamin supplementation and different herbs might be effective in treatment of migraine. Evaluated RCTs have various methodological shortcomings. So, a firm conclusion can’t be made for the efficacy of dietary supplementation and herbs in the treatment of migraine.

Background Herbal medicines have been used in the treatment of liver diseases for a long time. In recent years, the use of herbal medicines for protection from other strong antibiotics as well as drugs that can damage the liver during their metabolism in liver and for treatment of liver diseases has increased all over the world. It is important to mention that a number of organic solvents are used at different stages of extraction/formulation development for these traditional preparations in industries/pharmacies. In addition, some of these solvents possess established carcinogenic properties and may enter the formulation as residual solvents. Hence as per ICH guidelines it is mandatory to keep the level of these solvents up to permissible limits. There has been a lot of hue and cry that ayurvedic formulations available in the market are not properly standardized for their quality due to lack of stringent regulations and standards from regulatory authorities. Therefore the aim of present work was to assess the compliance of ICH guidelines for level of organic volatile impurities in common marketed ayurvedic hepatic formulations. Methods In this study, 25 ayurvedic herbal formulations available as OTC product have been assessed for presence of residual solvents using gas chromatography with flame ionization detector. Results This study on 25 fast moving hepatic formulations in the market reflects that no residual solvents were detected in any of the formulations however if present were within prescribed permissible limits of ICH guidelines. The data was also subjected to statistical analysis (F-test and t-test at 95% confidence level). Conclusions Results indicate the safety of these hepatic formulations with respect to residual solvents. In addition presents a simple, linear, specific, accurate, precise and rugged gas chromatographic method for estimation of residual solvents.

Background The use of plants for the treatment and prevention of diseases in man and his animals has led to a renewed scientific interest in the use of medicinal plants for therapeutic purposes. The nephroprotective properties of methanol stem bark extract of Abrus precatorius against gentamicin-induced renal damage in rats was evaluated in this study. Methods Thirty male Wistar rats were divided into five equal groups. Group A was the negative control group while B was the positive control group which received gentamicin 100 mg/kg intra-peritoneally for 6 days. Group C were pretreated with 100 mg/kg extract for the 3 days and then concurrently with gentamicin 100 mg/kg for 3 days and group D were pretreated with 200 mg/kg extract for 3 days and then concurrently with gentamicin 100 mg/kg for 3 days. Group E received gentamicin intraperitoneally for 6 days followed by administration of 200 mg/kg of the extract for 3 days. Blood samples, kidneys and kidney homogenates were collected for haematological, biochemical, histopathological and immunohistochemical analysis. Results The results showed that no significant haematological changes were noted. The groups treated with extract exhibited significant increase in body weight gain. While group B significantly exhibited focal areas of inflammation, fatty degeneration, congestion of vessels, tubular necrosis and glomerular atrophy, the lesions were mild with the treated groups. Treated groups exhibited a dose dependent significant decrease in serum creatinine, urea, XO, NO and Myeloperoxidase, AOPP, Protein carbonyl, H 2 O 2 generated and MDA levels when compared with group B. There were significant dose dependent improvements in SOD, GST, GSH, Protein thiol, and non-protein thiol levels in the treated groups when compared with group B. In immunohistochemistry, Group B exhibited over expression of CRP and NF-κB levels, and marked reduction in expression of Bcl-2 while the reverse was seen in the groups treated with methanol extracts of Abrus precatorius . Conclusion The methanol extract of Abrus precatorius plays a vital role against gentamicin induced renal damage by reducing levels of renal markers of oxidative stress, inflammation and apoptosis, enhancing enzymatic and non enzymatic renal antioxidant system, alongside an increase in Bcl-2 and a decrease in NF-κB and CRP expressions.

Background Myrtus communis L. is an aromatic evergreen plant common in Morocco. In addition to its culinary uses, it has been used medicinally as a disinfectant, an antiseptic or as a hypoglycemic agent. However, its cytotoxic activity has not been well investigated so far. The current study describes the chemical composition, cytotoxic and antioxidant activities of Myrtus communis L essential oil obtained from different regions of Morocco. Methods Myrtus communis essential oils were obtained by hydrodistillation, and analyzed by gas chromatography coupled with mass spectrometry. Cytotoxic activity was evaluated in murine mastocytoma P815 and MCF-7 breast cancer cells, using the MTT assay. In addition, DNA fragmentation was assessed by gel electrophoresis. The antioxidant effect was determined by measuring bleaching of β-carotene with the linoleic acid and the DPPH radical scavenging methods. Results GC-MS analysis showed high amounts of methyl eugenol (18.7%), α-terpineol (15.5%) and geranyl acetate (11.64%) in essential oil from the Benslimane region. In contrast, essential oil from Ouazzane was particularly rich in 1,8-cineole (36.3%). The cytotoxicity results showed that MCF-7 cells were more sensitive than P815 cells to the essential oils from Ouazzane and Benslimane regions with IC 50 values of 4 and 6.25 µg/mL, respectively. Moreover, this cytotoxicity was partly associated with DNA fragmentation, which is one of the characteristics of apoptosis. The tested essential oils did not show strong antioxidant activity. Conclusions Myrtus communis L. essential oil exhibits a weak antioxidant effect, but induced remarkable cytotoxic activity by a mechanism related to apoptosis, suggesting a possible application of the bioactive compounds as natural anticancer compounds.

Background The cytotoxic properties of nanoparticles have attracted a great deal of attention in the field of nanoscience and nanotechnology due to their small size and ability to penetrate cellular membranes. Methods The silver nanoparticles were synthesized using Elaeodendron croceum stem bark and characterized. The oral acute toxicity studies were carried out by administration of 500, 1000, 2000 mg/kg body weight to Wister rats in respective groups. An in vitro cytotoxicity assay was evaluated in MDA-MB-231 breast cancer cells using the WST-1 Cell Proliferation assay. The percentage of cell viability after treatment with aqueous extracts of Elaeodendron croceum (ECE) and Elaeodendron croceum silver nanoparticles (ECAgNPs) was compared with that of paclitaxel. Results The in vivo studies revealed that the LD 50 was higher than 2000 mg/kg and there was no significant difference (p>0.05) between the treatment groups compared with the control group for mean organ-to-body weight ratio except in the liver and in all hematological parameters except WBC and hematocrit. Similarly, there was no significant difference (p>0.05) for serum electrolytes (Na + , Mg 2+ K + , Cl − , and Ca 2+ ), total protein, urea, ɣ-glutamyl transferase (GGT), Aspartate aminotransferase (AST), Alkaline phosphatase (ALP), Alanine aminotransferase (ALT), albumin, total and conjugated bilirubin between the treatment and the control group. However, there were changes in creatinine, urea, and cholesterol. In the in vitro assays, ECE and ECAgNPs showed IC 50 values of 70.87±2.99 and 138.8±3.98 µg/mL respectively against MDA-MB-231 cells compared to paclitaxel, which showed an IC 50 value of 80 ng/mL. Conclusion The results showed that the LD 50 of the ECE and ECAgNPs in Wister rats was determined to be greater than 2000 mg/kg body weight. The aqueous extract also showed more cytotoxic than the ECAgNPs suggesting that the toxic compounds in aqueous extract were involved in the capping of the AgNPs.

Background Antidiabetic activity of aqueous root extract of Strophanthus hispidus (SHP) was evaluated based on its folklore used in traditional medicine for the treatment of diabetes. Objectives: This study aimed to investigate the in-vitro and in-vivo antidiabetic potential of the aqueous root extract of SHP. Methods SHP (50, 100 and 200 mg/kg p.o .), glibenclamide (5 mg/kg p.o .), normal saline (10 mL/kg; diabetic control) and distilled water (10 mL/kg; normal control) were administered once daily for 28 days, with the measurement of fasting blood glucose level at 7 days interval. Blood samples were collected on day 28 for serum biochemical (albumin, total protein [TP], creatinine, alanine transaminase [ALT], aspartate transaminase [AST], alkaline phosphatase [ALP], triglycerides [TG], total cholesterol [TC], high-density lipoprotein [HDL], low-density lipoprotein [LDL], bilirubin and urea) and hematological assays. The in-vitro antidiabetic activity was investigated using α-amylase and α-glucosidase enzymes inhibitory assays. Results SHP produced a day-dependent reduction in glucose level. Peak reduction (82.94 %; p < 0.05) was produced at the dose of 100 mg/kg. SHP significantly (p < 0.05) increased the level of HDL and TP but significantly (p < 0.05) reduced the levels of TG, LDL, TC, AST, ALT, ALP, bilirubin, creatinine and urea compared with diabetic control rats. Furthermore, SHP significantly (p < 0.05) increased the level of catalase, superoxide dismutase and reduced glutathione compared to diabetic control rats. SHP significantly (p < 0.05) inhibited α-amylase and α-glucosidase enzymes compared with acarbose. Conclusion The findings in this study showed that SHP possesses beneficial antidiabetic activity.

Background Conduct a pilot study addressing the efficacy of acupuncture in the treatment of chronic idiopathic pruritus to aid in the design of a larger clinical trial. Routine laboratory tests to assess systemic inflammation in addition to subjective patient surveys were performed provide documentation of efficacy of treatment. Methods Patients with chronic pruritus who did not respond to standard treatment were recruited to participate. After exclusion of systemic or known reversible causes, each patient received up to 10 treatments which were performed approximately one week apart. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured before and after a series of acupuncture treatments to evaluate levels of inflammation and pre- and post-treatment surveys were conducted to evaluate levels of perceived itch. Results Only one of the ten patients in this study possessed an elevation of ESR before treatment. This patient's ESR value returned to normal range after treatment and this participant reported subjective relief of her pruritus. Conclusions Future studies on the efficacy of acupuncture in the treatment of chronic idiopathic pruritus should focus on those patients with measurable levels of inflammation at the initiation of the study or utilize alternative and more comprehensive values to monitor disease response.

Background Despite growing demand for medicinal plants, there is little data about their use by patients with dyslipidemia. We aimed to determine the prevalence, pattern, and associated factors for the use of medicinal plants among patients with dyslipidemia. Methods A 17-item semi-structured questionnaire was filled out by 195 patients with dyslipidemia in a cross-sectional study carried out in two academic endocrinology clinics in Shiraz, Iran. The questionnaire comprised of three main domains of demographic data (6 questions), clinical data (2 of them), and data related to the use of medicinal plants (totally 9 questions). Results A total of 77.4% of patients took medicinal plants. The most common medicinal herbs used by dyslipidemic patients were Zataria multiflora, Cinnamomum zeylanicum , and Zingiber officinale . Duration of dyslipidemia was significantly longer in herbal users than non-herbal users (p = 0.04). Patients believing that concomitant use of conventional drugs and herbal preparations had synergic positive effects in addition to those persuaded that herbal preparations possessed less side effects, were significantly more likely to use medicinal plants (p = 0.008 and 0.005, respectively). Additionally, most of the medicinal herb users (87.4%) changed neither the pattern nor the dosage of their medications all during herbal preparations use. Conclusions This study demonstrated a high prevalence of medicinal plants’ use among patients with dyslipidemia, which was associated with the duration of dyslipidemia, patients’ viewpoints about herbal preparations’ synergic positive effects, and their fewer side effects.

Background To assess the effectiveness and harms of music to reduce anxiety and pain in cystoscopy. Methods We searched MEDLINE (OVID), EMBASE, LILACS and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to nowadays. We included clinical trials, involving the assessment of the effect of music in cystoscopy. The primary outcomes were pain and anxiety measured by any scale and the secondary outcomes were length of stay, physiological parameters (blood pressure or heart rate) and adverse effects. Cochrane Collaboration tool was used to assess the risk of bias. We performed the statistical analysis in R and reported information about mean difference (MD) with 95% CI. Heterogeneity was evaluated using the I2 test. Results We included six studies in our qualitative and quantitative analysis. Five studies used a flexible cystoscope and the other one performed the procedure with a rigid cystoscope. Music was played during the procedure in five studies, while the other was before it. All studies compared music vs. no intervention. Almost all items were assessed as low risk of bias; however, the allocation concealment was unclear in all the studies. We found a MD of −1.33 (95% CI −2.45 to −0.21) (I 2 =97.2%) favoring music for pain and a MD of −8.42 (95% CI −15.02, −1.82) (I 2 =99.6%) was found, favoring music for anxiety. Conclusions Playing music might be an effective intervention that lowers pain and anxiety in patients who undergo cystoscopy.

Background Fenugreek seeds have shown antinociceptive effect in animal studies. This double-blind placebo controlled trial was designed to study the effect of fenugreek transdermal patch 10% (FDP) for management of inguinal hernia (IH) post-operative pain. Methods Standardized extract of fenugreek seeds was used for FDP formulation. Ninety patients treated with 10% FDP, diclofenac dermal patch 1% (DP) and placebo twice daily after IH surgery. The pain intensity score was evaluated using a visual analogue score (VAS) up to 48 h after operation. Morphine consumption and diclofenac suppository demand were evaluated too. Results The pain score was significantly reduced in FDP group in comparison with the placebo group. This effect was also significantly different from DP up to 6 h after surgery (p<0.05). Morphine consumption and diclofenc suppository demand were significantly decreased in FDP group (p<0.05). Conclusion In all, results of the present study indicated that FDP decreases pain score and demand for morphine in post-surgery patients in comparison to diclofenac patch, and this preparation could be a suit option as a natural antinociceptive agent for pain management.

Background Anxiety in patients with myocardial infarction (MI) which has a very negative effect on the prognosis of their disease and their physical and mental health. We performed this study in order to find the impact of a peer based education (PE) on anxiety in patients with MI. Methods This was a randomized clinical trial study. The study participants included 60 patient with MI, who were randomly divided into two groups. The first group received routine education and the other one received PE. We assessed anxiety before and 30 days after the intervention through a valid questionnaires. Data were analyzed by independent sample t-test, two-way ANOVA and the Bonferroni test. Results The majority of samples were male, married, self-employer, and living in city. After 30 days intervention the anxiety score was significantly lower in the PE group compare to the control group. Conclusion Our findings indicated that the implication of PE as an educational element in decreasing anxiety score and can be considered as a method for continuing of care, and could as well as be a good approach for other patients.

Background Diabetic patients are at increased risk for coronary artery disease. Since phytotherapy has been greatly common, finding safe and effective treatments is of importance. This study aimed to evaluate the effects of a Melissa officinalis L. based product (MO) in patients with type 2 diabetes. Methods A randomized double-blinded controlled study was conducted with 37 dyslipidemic diabetic patients, assigned to either MO or placebo (P) groups receiving two 500 mg capsules daily for 3 months. Finally, 32 cases completed the study and were included in the analysis; MO (n=16) and P (n=16). Results Safe and significant effects in terms of decreasing the serum level of triglyceride (TG) in all patients after 2 months (p-value=0.02) and in patients with higher baseline serum levels of TG (TG≥200 mg/dl) after 3 months (p-value=0.04) were shown in the MO group. However, no metabolic significant changes were seen compared to the control group. Significant decrease in both systolic and diastolic blood pressure from baseline values were also found in patients with higher systolic blood pressure (SBP≥130 mmHg) (p-value=0.02) and those with higher diastolic blood pressure (DBP≥85 mmHg) (p-value=0.02) in the MO group. Conclusion This study showed that MO might be safe and beneficial in decreasing the serum TG level in dyslipidemic diabetic patients. Although, larger long-term studies are required.

Background Traumatic comatose patients may experience disturbances in hemodynamic indices due to the nature of their disorder. This study aimed to compare the effects of nature sounds and reflexology on hemodynamic indices in traumatic comatose patients. Methods This randomized clinical trial using a factorial design was conducted on 120 traumatic comatose patients in two teaching hospitals in two urban areas of Iran. The patients were selected using a sequential sampling method and assigned into randomized quadruple blocks as control, nature sounds, reflexology and nature sounds-reflexology (combined) groups. The interventions were performed twice daily in two consecutive days lasting 30 min each time. The hemodynamic indices were measured before, and immediately, 30 min, and 2 h after the intervention using calibrated monitors. Descriptive and inferential statistics, including one-way ANOVA, Scheffe ad hoc, repeated measure ANOVA, Bonferroni ad hoc Chi-square test and Fisher’s exact tests were used for data analysis via the SPSS software V.16. Results Significant differences were reported in terms of the mean arterial pressure between the control and reflexology groups (p=0.002), and the combined group (p=0.008) immediately after the interventions. The combined group showed statistically differences in systolic blood pressure compared to the nature sounds (p=0.007) and control (p=0.015) groups 30 min after the interventions. The nature sounds group showed differences in the pulse rate from the reflexology (p=0.048) and control (p=0.015) groups 30 min after the interventions in the second day. Conclusions While the immediate effects of the interventions on induction of the feeling of relaxation and tranquility, and reduction of hemodynamic indices were reported, they diminished over time. Nature sounds and reflexology as low-cost and relaxing tranquilizing methods can be used for the reduction of tension and improvement of hemodynamic indices among traumatic comatose patients.

Background The study aimed to investigate natural remedies use (NRU) for oral diseases among female patients. Methods Dental patients attending the female section of Taibah University Dental Hospital were invited to complete an online questionnaire which explored demographic data, and pattern of NRU for oral diseases. Results A total of 540 patients participated in the survey. A total of 232 patients (43%) used natural remedies to treat oral diseases. The most commonly cited reasons for NRU were financial reasons (n=79, 34.1%). The practice had a statistically significant association with older participants (p=0.003), and those working as employees (p=0.031). Most of the natural remedies used (n=17) were herbal, with cloves (71.1%) and miswak (26.7%) being the most frequently reported. Acute dental pain (n=157, 67.7%) and halitosis (n= 51, 22%) were the most frequently cited oral conditions associated with NRU. A percentage of 87.1% of patients using natural remedies (n=202) perceived improvement of symptoms upon use of natural remedies, however, 2.2% (n=5) reported complications. Conclusions Substantial proportion of patients use natural remedies to treat their oral disease. Patients were mostly satisfied with natural remedies in terms of effectiveness and lack of complications.

Diabetic foot ulcers (DFUs) are the results of the combined effects of diabetes-related vascular disease and neuropathy. DFUs are responsible for more hospitalizations than any other complication of diabetes. It can impair patients’ quality of life and affect social participation and livelihood. It is one of the big challenges for podiatric surgeons to salvage the foot upto optimum. A case of DFU of a patient of 70 years of age with repeated history of Ray’s Amputation was managed by an integrated approach (Ayurveda and Allopathy medications and procedures).