Of informal practitioners of biomedicine. The interplay of medicine, economy and society in India

Instead of diminishing with the spectacular advancement of medical expertise in the country , unqualified biomedical practice in India has been strengthened by the growth of the pharmaceutical production in the twenty first century. In public health discourse, the view that the informal health practitioners have to be punished and abolished has been countered by the recommendation that they could be trained and incorporated in primary health care where public health amenities are inadequate. The quality of care provided by the informal health care practitioners has also been subject to clinical assessment based on standardized patient vignettes. Based on a sociological approach, this paper examines the time line of chronically ill patients under lived conditions to arrive at an understanding of the role of informal health practitioners in long term treatment and highlights the setbacks. METHODS: This paper draws on 253 household surveys from two villages in Madhya Pradesh, in depth interviews with four unqualified practitioners in the area, twenty five unstructured interviews of chronic patients, twenty five structured interviews on the cases of untimely death and FGDs with health workers in 2021. CONCLUSION: Informal health care practitioners offer consultation cum dispensing of medicines and are the primary source of biomedical care in the remote study area without any public transport. But they are 'for profit' economic actors who are ill-equipped to handle chronic diseases. What sets them aside from the qualified private doctors in the town is their social obligation to balance their profit motive with the ethics of proximity and neighborly ties with the villagers amidst whom they reside. These features of the market and community place the informal health care practitioners at the cusp of economy and society and defy simple binaries that they are either crooks or assets.

Public Health and the Politics of Knowledge: The Role of Traditional Medicine in the Management of COVID-19 in Two South Indian States

Public health discourse about COVID-19 pandemic has mostly been framed around biomedical interventions, although there is evidence of the effective use of traditional medicine (TM) to manage the pandemic by some Asian countries such as China, Thailand, Vietnam and India. This article aims to place on record the policy of medical pluralism in the two South Indian states of Tamil Nadu and Kerala in their respective deployment of Siddha and Ayurveda in the management of COVID-19. Based on interviews with physicians of TM and health administrators, press reports, social media posts and published research, this article reconstructs the crucial yet undocumented process of incorporating TM in the biomedicine-based health bureaucracy in Tamil Nadu and Kerala to deal with infectious fevers such as dengue and chikungunya in the past and COVID-19 in the present. It is our argument that those methods of TM which are safe and in long recent use could provide low-cost and accessible means of prevention and early treatment of infectious fevers. They have to be identified and subjected to further investigation as innovations in social medicine brought forth by the state and its officials and are different from the highly expensive projects of the corporate pharmaceutical sector.

AYUSH for COVID-19: Science or Superstition?

There is a lot of discussion on COVID-19 control strategies from the mainstream approaches, but it is also necessary to examine the contributions of the Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa Riga and Homeopathy (AYUSH) sector, which is now being brought into public health interventions nationally. Although the AYUSH sector had previously joined the management of dengue and chikungunya outbreaks in some Indian states, its participation has remained contentious and there is reluctance in mainstream public health discourses to seriously examine their interventions. This is a commentary on the efforts made by the Ministry of AYUSH, state AYUSH directorates, AYUSH research institutions, and public hospitals, based on official documents as well as official statements reported in the media, with the aim of bringing out concerns in the process of adapting traditional textual knowledge and practices to public health requirements of the current age.

Evaluation of the Efficacy of Porous Titanium Granules in the Treatment of Periodontal Intrabony Defects: A Preliminary Report

BACKGROUND AND OBJECTIVES

Applications of porous titanium granule (PTG) in periodontal (furcation defects) and non-periodontal treatments have shown promising results. However, its role in periodontal intrabony defects still remains unexplored. Thus, we aim to assess the feasibility of PTG in obtaining reconstruction in intrabony defects and compare the outcome with that of open flap debridement (OFD).

METHODS

Ten patients (three females and seven males) with a mean age of 34.7 years who constituted twenty (20) bilateral intrabony defects were recruited. Each patient contributed to two defects which were randomly treated by OFD alone (control group) or by OFD followed by grafting with PTG (test group). All the clinical and radiological parameters were recorded at baseline, three, six and nine months and statistically analyzed.

RESULTS

The results of this study demonstrated that in clinical parameters there is no significant differences in the improvement from baseline to nine months. However, regarding the radiographic defect fill, there was significant gain from baseline to nine months only in the PTG sites.

CONCLUSION

Within the limits of our study, the results of this trial indicate that reconstructive periodontal surgery with PTG offers minimal radiographic defect resolution with no significant improvements in clinical endpoints compared to open flap debridement.

Effect of emotional regulation training on depression, anxiety and stress among the patients with alcohol dependence admitted in selected de-addiction centers at south India

Background The purpose of the study was to assess the effect of emotional regulation training on depression, anxiety, and stress among patients with alcohol dependence. Depression, anxiety, and stress are very common negative emotions seen in the patients with alcohol dependence which leads to relapse of the condition. The emotional regulation could help the individuals to overcome the negative emotions. Methods The present study adopted a one-group pretest and posttest in a preexperimental design. A total of 30 patients with alcohol dependence in two de-addiction centers were recruited using a convenience sampling technique. In this study, the participant received the intervention of emotional regulation training for 13 days to overcome negative emotions. On the 14th-day posttest was conducted. Results There was a statistically significant difference found in the mean scores of depression, anxiety, and stress at p<0.001 level between the pre and posttest. There was no significant association found between the scores of depression, anxiety, stress, and any of the background variables of the patients with alcohol dependence throughout the pretest and posttest. Conclusions The study proved that emotional regulation training is an effective intervention in reducing negative emotions like depression, anxiety, and stress among patients with alcohol dependence.

Anticancer Activity of Copper Oxide Nanoparticles Synthesized from Brassia actinophylla Flower Extract

There are many methods to synthesize metal and metal oxide nanoparticles. In this paper, copper oxide nanoparticles have been synthesized by solution combustion method using Brassia actinophylla i.e. Schefflera actinophylla flower extract belongs to Araliaceae family. The importance of solution combustion is one of the easy and simplest methods for the synthesis of metal oxide nanoparticle. The CuO nanoparticles were synthesized at various temperatures and the characterization has been carried out by UV, FTIR, PXRD, SEM, TEM and EDAX analysis. At lower temperature, the peak was not observed but at 400 ºC, the UV peak was observed at 340 nm. The FTIR peaks observed at 1000-500 cm-1 confirms again the presence of CuO nanoparticles. The monoclinic phase and crystalline structure of nanoparticles were revealed by PXRD pattern, by Scherrer′s method the average crystalline sizes were found to be in the range of 15 to 24 nm. The size and the shape of nanoparticles were confirmed by SEM and TEM reports. The SEM images of nanoparticles show spherical in shape and free from agglomeration. TEM analysis reports the nanoparticle sizes ranging from 2 to 20 nm. The percentage of copper (52 %) and oxygen (26 %) elements were recorded in the EDAX analysis. The study of size and stability of nanoparticles were done by zeta potential values. The antibacterial activity of CuO nanoparticles were carried out against Staphylococcus aureus and Escherichia coli bacteria's by agar well diffusion method. The MTT assay was performed in order to check the anticancer activity of CuO nanoparticles against HT-29 colon cancer cells.

Size Dependent Uptake and Hemolytic Effect of Zinc Oxide Nanoparticles on Erythrocytes and Biomedical Potential of ZnO-Ferulic acid Conjugates

Despite zinc oxide nanoparticles (ZnONPs) being increasingly used as carriers in biomedical fields due to their multifaceted properties and therapeutic importance, better understanding of the mechanisms and cellular consequences resulting from their interaction with cells and cellular components has been warranted. In the present study, we investigate the size-dependent interaction of ZnONPs on RBCs, and its impact on cell viability, DNA damage, ROS generation and morphological changes, employing cellular and analytical methods. Size, charge, stability and solubility were confirmed by DLS, zeta potential, ICP-AES and TEM analysis. Further ICP-AES, TEM, spectroscopic observations and cell based assays showed that ZnONPs exhibited a size dependent impact on RBCs and haemoglobin (Hb), particularly size <50 nm. Conversely, ferulic acid (FA) conjugates and serum albumin significantly reduced the adverse effects exhibited by ZnONPs. The extent of DNA damage and ROS generation is comparatively low in ZnONPs-FA than in ZnONPs alone treated cells. Thus our study documents a novel conceptualization delineating the influence of size on the material properties and therapeutic potential of nanoparticle.

Comparative evaluation of micron- and nano-sized intracanal medicaments on penetration and fracture resistance of root dentin - An in vitro study

Intracanal medicaments play a vital role in disinfection of root canal system. The aim of this study was to evaluate intratubular penetration and fracture resistance of roots filled with micron- and nano-sized intracanal medicaments: calcium hydroxide (CH), nanocalcium hydroxide (NCH), chitosan (CS) and nanochitosan (NCS). Their antibacterial effect on E. faecalis was tested using agar diffusion method. NCH and NCS were prepared by precipitation method and ionic crosslinking respectively. NCH and NCS particles were spherical, with an average particle size of 102±11.3nm and 130±17.6nm respectively. The medicaments were filled in extracted human teeth. Depth of penetration of the medicaments into dentinal tubules at coronal (C), middle (M) and apical (A) thirds was measured. Fracture resistance of the teeth was evaluated after 1 week and 1-month intervals. NCH showed the highest depth of penetration (C ∼746.98μm, M ∼700.30μm, A ∼134.69μm). CS showed the highest fracture resistance, whereas no significant difference was found between other medicaments, at both the time intervals. NCH (8.07±0.06) and NCS (8.13±0.06) showed significantly higher zone of inhibition than CH (7.7±0.17) and CS (7.37±0.15). Under the conditions of this study, it can be concluded that NCH and NCS can be used as potential intracanal medicaments.

Furcation Measurements: Realities and Limitations

Furcation involvement is a common sequela of severe chronic periodontal disease. Its effective management has a profound influence on the outcome of periodontal therapy. For the efficient clinical management of furcation defects, it is necessary to have a reliable diagnostic tool that can accurately measure and quantify the furcation defect. This article addresses the various diagnostic methods available and assesses their limitations. Further, it also highlights some new frontiers in the field of furcation diagnosis and measurements.

Spectroscopic and molecular docking studies on the interaction of troxerutin with DNA

Troxerutin (TXER) is a derivative of naturally occurring bioflavonoid rutin. It possesses different biological activities in rising clinical world. The biological activity possessed by most of the drugs mainly targets on macromolecules. Hence, in the current study we have examined the interaction mechanism of TXER with calf thymus DNA (CT-DNA) by using various spectroscopic methods, isothermal titration calorimetry (ITC) and molecular docking studies. Further, DNA cleavage study was carried out to find the DNA protection activity of TXER. UV-absorption and emission spectroscopy showed low binding constant values via groove binding. Circular dichroism study indicates that TXER does not modify native B-form of DNA, and it retains the native B-conformation. Furthermore, no effective positive potential peak shift was observed in TXER-DNA complex during electrochemical analysis by which it represents an interaction of TXER with DNA through groove binding. Molecular docking study showed thymine guanine based interaction with docking score -7.09 kcal/mol. This result was compared to experimental ITC value. The DNA cleavage study illustrates that TXER does not cause any DNA damage as well as TXER showed DNA protection against hydroxyl radical induced DNA damage. From this study, we conclude that TXER interacts with DNA by fashion of groove binding.

Green synthesis and characterization of selenium nanoparticles and its augmented cytotoxicity with doxorubicin on cancer cells

Green synthesis of selenium nanoparticles (SeNPs) was achieved by a simple biological procedure using the reducing power of fenugreek seed extract. This method is capable of producing SeNPs in a size range of about 50-150 nm, under ambient conditions. The synthesized nanoparticles can be separated easily from the aqueous sols by a high-speed centrifuge. These selenium nanoparticles were characterized by UV-Vis spectroscopy, scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and elemental analysis by X-ray fluorescence spectrometer (XRF). Nanocrystalline SeNPs were obtained without post-annealing treatment. FTIR spectrum confirms the presence of various functional groups in the plant extract, which may possibly influence the reduction process and stabilization of nanoparticles. The cytotoxicity of SeNPs was assayed against human breast-cancer cells (MCF-7). It was found that SeNPs are able to inhibit the cell growth by dose-dependent manner. In addition, combination of SeNPs and doxorubicin shows better anticancer effect than individual treatments.

Brassica nigra plays a remedy role in hepatic and renal damage

CONTEXT

Black mustard [Brassica nigra (L.) Koch] of the Brassicaceae (Cruciferae) family is commonly used as a spice and a cheap source of antimicrobial agents for bacterial infections.

OBJECTIVES

The present investigation was to demonstrate the protective effect of the methanol extract of B. nigra leaves against D-galactosamine (D-GalN)-induced hepatic and nephrotoxicity in Wistar rats.

METHODS

Activity of the methanol extract of B. nigra at doses of 200 and 400 mg/kg b.wt. against D-GalN (500 mg/kg b.wt.) induced toxicity, with silymarin used as the standard. Histological damage, activities of serum marker enzyme, hematological changes, metabolites such as bilirubin, urea, uric acid, and creatinine levels, tissue thiobarbutric acid reactive substance, enzymic and non-enzymic antioxidants and inflammatory marker enzymes such as myeloperoxidase, cathepsin D, and acid phosphatase were assessed.

RESULTS

The D-GalN-induced toxicity was evident from a significant increase (p < 0.001) in the serum and tissue inflammatory markers in toxic rats, when compared with the control (saline alone treated animals). The B. nigra pretreated groups (200 and 400 mg/kg b.wt.) showed significant (p < 0.001) reduction in the D-GalN-induced toxicity as obvious from biochemical parameters. Histopathological observations confirm the protective effect of B. nigra leaf extract by reduction in hepatic and renal tissue damage. Experimentals extract showed a similar effect as the standard.

CONCLUSIONS

The crude methanol extract of B. nigra leaf lacks inherent toxicity and exhibits hepatic and nephroprotective effects against D-GalN-induced toxicity in Wistar rats.

Serum chromium levels in gestational diabetes mellitus

OBJECTIVE

To measure serum chromium level in women with gestational diabetes mellitus (GDM) from Chennai, South India.

MATERIALS AND METHODS

Thirty women with gestational diabetes, 60 age matched controls.

INCLUSION CRITERIA

Gestational age 22-28 weeks, age group 20-35 years.

EXCLUSION CRITERIA

Gestational age beyond 28 weeks, malnutrition or presence of infection. Serum chromium was measured using inductive couple plasma emission spectrometer.

RESULTS

Serum chromium levels of women with GDM, 1.59+/-0.02 ng/ml (range: 0.16-4.0 ng/ml) were lower than in controls (4.58+/-0.62 ng/ml; range 0.82-5.33 ng/ml) (P < 0.001). However, there were no significant differences among cases and controls when subdivided by parity.

CONCLUSIONS

Women with GDM from a South Indian city had lower levels of serum chromium compared to pregnant women without GDM. Studies may be done whether chromium supplementation is useful in this group of women.

Identification, quantification of bioactive constituents, evaluation of antioxidant and in vivo acute toxicity property from the methanol extract of Vernonia cinerea leaf extract

CONTEXT

Vernonia cinerea (L.) Less [Compositae (Asteraceae)] is used traditionally for several medical purposes such as inflammation, pain, fever, and cancer.

OBJECTIVES

The present study identified the bioactive constituents in the methanol extract of Vernonia cinerea leaf and evaluated its antioxidant activity and acute toxicity.

METHODS

The identification of phytochemicals was accomplished by GC-MS and the major antioxidant phenolic compounds in the extract were quantified by HPTLC analysis. To quantify the essential elements, atomic absorption spectrophotometeric analysis was carried out. Total phenol and flavonoid content was measured by Folin-Ciocalteau reagent and 2% aluminium chloride, respectively.

RESULTS

GC-MS analysis identified the presence of 27 phytoconstituents. The predominant phenolic compound in the extract as quantified by HPTLC was gallic acid (1.92 mg/g) followed by rutin (0.705 mg/g), quercetin (0.173 mg/g), caffeic acid (0.082 mg/g) and ferulic acid (0.033 mg/g). The following elements were quantified: Fe (0.050 ppm), Mn (0.022 ppm), Co (0.0180 ppm), Pb (0.029 ppm), Hg (3.885 ppm) and Se (4.5240 ppm). The antioxidant activity of the extract increased with increasing concentration and the correlation (r²) for all in vitro assays were satisfactory.

CONCLUSIONS

V. cinerea extract has significant (p < 0.05) antiradical activity. Hence, V. cinerea may have potential medicinal value and can be used in the formulation of pharmacological products for degenerative diseases.

What could 'integrative' medicine mean? Social science perspectives on contemporary Ayurveda

The paper attempts to critically engage with the idea of integrative medicine as a marker of pharmaceuticalization of Ayurveda in the recent decades. It examines what it means to say ‘integrative’ medicine using the metaphor of language from philosophy of science. Drawing upon fieldwork with Ayurveda practitioners, the paper also discusses the ramifications of integrative medicine in the current scenario in which there is no organizational parity between Ayurveda and biomedicine. The paper calls for a focus on Ayurveda for public health rather than the global health market.

Parameter estimation of integrating and time delay processes using single relay feedback test

Autotuning using relay feedback is widely used to identify low order integrating plus dead time (IPDT) systems as the method is simple and is operated in closed-loop without interrupting the production process. Oscillatory responses from the process due to ideal relay input are collected to calculate ultimate properties of the system that in turn are used to model the responses as functions of system model parameters. These theoretical models of relay response are validated. After adjusting the phase shift, input and output responses are used to find land mark points that are used to formulate algorithms for parameter estimation of the process model. The method is even applicable to distorted relay responses due to load disturbance or measurement noise. Closed-loop simulations are carried out using model based control strategy and performances are calculated.

Innovation within and between Traditions

This paper seeks to bring the study of Asian medical systems from cultural studies into the ambit of social studies of science. It examines issues pertaining to innovation in indigenous systems of medicine (ISM) in contemporary India, with specific reference to siddha medicine. Drawing upon Kuhn’s theory of growth of scientific knowledge, the paper argues that only innovations within an epistemic tradition contribute to its incremental growth. On the other hand, innovations that happen in the interstices of distinct epistemic models of the body, such as the case with the laboratory trials of indigenous medical formulae, are not likely to lead to cumulative growth of ISM, even if they contribute to the biotechnology sector. The argument is set out by foregrounding the career of different kinds of practitioners of siddha medicine, showing how innovation between scientific traditions becomes invisible because of the absence of institutional closure on the norms of discovery and verification in ISM.

Modulating effect of Semecarpus anacardium Linn. nut extract on glucose metabolizing enzymes in aflatoxin B1-induced experimental hepatocellular carcinoma

The herbal remedy extended by Semecarpus anacardium nut extract against Aflatoxin B1 mediated hepatocellular carcinoma was established by studies on carbohydrate metabolizing enzymes. Since some definite correlation exists between tumour progression and the activities of glycolytic and gluconeogenic enzymes, assessment of alterations in their activity can be used as successful markers of diagnosis and prognosis. The present work compares the activities of glycolytic and gluconeogenic enzymes in hepatocellular carcinoma bearing rats with drug-treated animals. An overall increase in glycolytic enzymes namely hexokinase, phosphoglucoisomerase, and aldolase with a subsequent reduction in gluconeogenic enzymes, glucose-6-phosphatase and fructose-1,6-biphosphatase was observed in plasma and liver homogenates of hepatocellular carcinoma bearing rats. The administration of Semecarpus anacardium nut extract caused a significant decrease in the activity of glycolytic enzymes and an increase in gluconeogenic enzymes' activities to near normal values in drug-treated animals.