Review of health-care services for older population in India and possibility of incorporating AYUSH in public health system for geriatric care

Background:

In a developing country like India, which has 10.11% population of >60 years age and a projection of rise of the same by 300% in 2050, health care of elderly is an enormous challenge. The developed world has evolved many models for elderly care, for example, nursing home care, health insurance, etc. Indian Government has also taken multiple measures in this direction by initiating National Policy on Older Persons, 1999, the Maintenance and Welfare of Parents and Senior Citizens Act, 2007, the Old Age Pension Scheme, Rashtriya Vayoshri Yojana 2017, etc. However, there is a necessity that, India must rapidly adapt to the complex health related, social and economic challenges caused by these demographic changes. This may be an opportunity for innovation in the health system by developing a perspective for healthy and active aging, though it is a major challenge. Health care of the older people cannot be achieved unless total health, i.e., physical, social, economic, psychological, and spiritual aspects are addressed.

Objective:

The objective is to study current policies regarding geriatric health care in India and to propose the possibility to develop a model to provide comprehensive and dedicated health-care services to the older population by integrating conventional and indigenous systems of medicine dwelling in the country.

Materials and methods:

Electronic search in various scientific journals for research and review articles; electronic along with hand searching of conference proceedings, brochures, government policy documents, press releases, Ayurveda classical texts, etc., regarding geriatric health care in India and model health-care facilities in other countries and regarding of AYUSH systems in geriatric health care in India.

Results:

There is an urgent need of adaptation and modification in the National Health System to cater the actual requirements of the elderly with plans and strategies dedicated to face their health-related challenges. Adoption of inclusive health-care interventions, can improve health outcomes by making it more acceptable, accessible, and affordable.

Conclusion:

Integration of AYUSH at various levels of health-care delivery system can potentially contribute to provide unique newer dimensions to the field of geriatric care in India.

Pharmacognostical Standardization of Upodika- Basella alba L.: An Important Ayurvedic Antidiabetic Plant

OBJECTIVE

To establish the pharmacognostic standards for the correct identification and standardization of an important Antidiabetic plant described in Ayurveda.

MATERIALS AND METHODS

Standardization was carried out on the leaf and stem of Basella alba L. with the help of the macro-morphological, microscopic, physicochemical and qualitative phytochemical studies.

RESULTS

Several specific characters were identified viz. clustered calcium oxalate crystals in the cortex region, absence of trichomes, succulent, thick, mucilaginous, fibrous stem. Rubiaceous type of stomata on both sides of the leaf. Quantitative microscopy along with physicochemical and qualitative phytochemical analysis were also established.

CONCLUSION

The pharmacognostic standards could serve as the reference for the proper identification of the Basella alba L. which is an important anti-diabetic plant described in Ayurveda.

Holy basil (Ocimum sanctum Linn.) leaf extract enhances specific cognitive parameters in healthy adult volunteers: A placebo controlled study

INTRODUCTION

Ocimum sanctum (OS), known as Holy basil, has been documented to possess neuroprotective, cognition-enhancing and stress relieving effects in animal models. However there is paucity of clinical studies to document these effects.

MATERIALS AND METHODS

Effect of OS on parameters related to cognition and stress in humans was evaluated with administration of 300 milligram capsules of ethanolic leaf extracts of Ocimum sanctum (EtOS) or placebo per day, over 30 days.

RESULTS

Intra-group comparison of Sternberg and Stroop test showed improvement in both the placebo and EtOS groups, however, the improvement stabilized after day 15 in the placebo group. Intergroup comparison revealed a significant improvement of the following cognitive parameters in the EtOS as compared to the placebo: reaction time (RT) and error rate (ER) of Sternberg test, RT of neutral task of Stroop, RT and ER of interference task of Stroop. The intra-group comparison of P300 latency, salivary cortisol, and State-Trait Anxiety Inventory showed improvement over time in the EtOS group alone, though the inter-group difference was significant in the P300 latency alone. There were no changes in heart rate (HR), AHR, or galvanic skin response (GSR) or AGSR.

CONCLUSION

Ocimum sanctum leaf extract seems to have potential cognition-enhancing properties in humans.

Effects of Withania somnifera (Ashwagandha) and Terminalia arjuna (Arjuna) on physical performance and cardiorespiratory endurance in healthy young adults

Introduction:

Several medicinal plants have been described to be beneficial for cardiac ailments in Ayurveda like Ashwagandha and Arjuna. Ashwagandha-categorised as Rasayanas, and described to promote health and longevity and Arjuna primarily for heart ailments. coronary artery disease, heart failure, hypercholesterolemia, anginal pain and can be considered as a useful drug for coronary artery disease, hypertension and ischemic cardiomyopathy.

Objective:

There are no scientific clinical studies showing effect of both these drugs on exercise performance after regular administration when given as supplements The present study was therefore designed and performed to assess the effects of Withania somnifera (Ashwagandha) and Terminalia arjuna (Arjuna) individually and as a combination on maximum velocity, average absolute and relative Power, balance, maximum oxygen consumption (VO2 max) and blood pressure in humans.

Materials and Methods:

Forty normal healthy. Subjects (either sex, mean age 20.6 ± 2.5yrs and mean Body Mass Index 21.9 ± 2.2) were recruited after written informed consent was obtained. Institutional Ethics Committee permission was also obtained. Thirty participants were assigned to experimental group of which 10 received standardized root extracts of Withania somnifera, 10 received standardized bark extract of Terminalia arjuna and the rest of the 10 received standardized root extract of Withania somnifera in addition to bark extract of Terminalia arjuna both. Both the drugs were given in the form of capsules (dosage 500mg/day for both the drugs). Ten participants received placebo (capsules filled with flour). All the subjects continued the regimen for 8 weeks. All variables were assessed before and after the course of drug administration

Observations:

Our study showed that Withania somnifera increased velocity, power and VO2 max whereas Terminalia arjuna increased VO2 max and lowered resting systolic blood pressure. When given in combination, the improvement was seen in all parameters except balance and diastolic blood pressure.

Conclusion:

Withania somnifera may therefore be useful for generalized weakness and to improve speed and lower limb muscular strength and neuro-muscular co-ordination. Terminalia arjuna may prove useful to improve cardio-vascular endurance and lowering systolic blood pressure. Both drugs appear to be safe for young adults when given for mentioned dosage and duration.

Observations on Vamana procedure in healthy volunteers

Vamana Karma is one of the five Pradhana Karmas of Panchakarma which is successfully used in treating Kaphaj disorders. Panchakarma is also indicated in healthy states. (C.Su. 16/13-16) for Shodhana. Textual references are available in Ayurvedic classics, but the procedure needs to be validated in the modern times when Ahara Shakti, Bala and Agni of the individuals have decreased considerably. So the effect of procedure was observed in 30 healthy volunteers of age group 18 to 60 years. Lakshanik, Vaigiki, Maniki and Antiki Shuddhi were observed and vomitus was analyzed macroscopically, microscopically and chemically.

Mahayograj guggulu: Heavy metal estimation and safety studies

OBJECTIVE

This study was conducted to estimate the heavy metal profile and determine the safety of Mahayograj guggulu, an Ayurvedic herbo-mineral preparation.

DESIGN

Mahayograj guggulu, manufactured by Shree Baidynath Ayurved Bhawan Pvt. Ltd., Gwalior Road, Jhansi - 284 003 (of batch number-07 and manufacturing date October 2004) was procured from the local market. Heavy metal concentrations were measured using an atomic absorption spectrophotometer. A total of 40 Charles Foster strain albino rats of either sex with an average body weight of 160-250 g were divided into four groups (Groups I, II, III and IV), with 10 animals in each group. Group I served as the control, while Group II, III and IV rats received Mahayograj guggulu at a dose of 54 (dose equivalent to human therapeutic dose), 270 (five-times the dose equivalent to the human therapeutic dose) and 540 (10-times the dose equivalent to human therapeutic dose) mg/kg, p.o. for 120 days. The effect of drug administration was noted on the ponderal, biochemical, hematological and histopathological parameters. In addition, urine examination was also carried out. At the end of the study, only six rats per group were sacrificed as per the IAEC advice.

RESULTS

Mahayograj guggulu was found to be safe at all dose levels tested. No significant behavioral changes were noted in any of the groups studied. The effect on food and water consumption and fecal and urine output remained unaffected in all groups during the study period. No major alterations were observed in hematology, serum biochemistry, necropsy and histopathology at the therapeutically advocated dose level. Heavy metal content measurement indicated levels of 25.8 µg/g for lead, 0.07 µg/g for mercury and 5.19 µg/g for arsenic.

CONCLUSIONS

The test drug is well tolerated as no changes of a serious nature could be observed in any of the parameters assessed.

In vitro and in vivo antimicrobial activities of seeds of Caesalpinia bonduc (Lin.) Roxb

AIM OF THE STUDY

Caesalpinia bonduc (Lin.) Roxb. is a known drug in Ayurveda to treat various diseases specifically tumors, cysts and cystic fibrosis (CF). The aim of this study was to assess in vitro as well as in vivo antimicrobial activity of Caesalpinia bonduc seeds.

MATERIALS AND METHODS

The in vitro antimicrobial activities of seed coat and seed kernel extracts were investigated by microbroth dilution assay. In vivo activities of hydro-alcoholic extracts were investigated in rat models of chronic Pseudomonas aeruginosa pneumonia mimicking that in patients with cystic fibrosis.

RESULTS

Various extracts of plant seeds exhibited in vitro antimicrobial activities in a range of 22-350 microg/ml. The extracts also showed activity against methicillin resistant (MR) Staphylococcus aureus and ampicillin resistant (AR) Pseudomonas aeruginosa as in the sensitive strains. In rat model of chronic Pseudomonas aeruginosa pneumonia, hydro-alcoholic extracts of Caesalpinia bonduc seed kernel (CBSK) and Caesalpinia bonduc seed coat (CBSC) were injected subcutaneously in the test groups of animals. The control groups were treated with cortisone and saline. Two weeks after challenge with Pseudomonas aeruginosa, the CBSK treated animals showed a significant bacterial clearance from the lungs (P<0.04) and less severe incidence of lung abscess (P<0.05).

CONCLUSION

Results showed that Caesalpinia bonduc may have the potential to be promising natural medicine, with other forms of treatments, for CF patients with chronic Pseudomonas aeruginosa lung infections.

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 Rasaśastra. Publication of such text will be an addition to the treasure of Ayurvedic texts.

Some explorative information regarding 'Jwaratimirabhăskara' and its author Kăyastha Camunda

Out of the treasure of Ayurvĕdic 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 'Jwaratimirabhăskara' written by Kăyastha 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.

Important Ayurvĕda literatures from the manuscripts available from Orissa (Cikitsărnava)

In the treasure of Ayurvĕdic 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 Ayurvĕdic 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 'Cikitsărnava' authored by Viśvanăth Sena of 16th century of Orissa. Though his text on Pathyăpathya has already been published, which has got a place in the pages of history of Ayurvĕda, 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.

Kushtha (skin disorders) in vedic and other religious literatures - A review

In view of the description of Medical citations; Vedic literature, Buddhist literature, Jain literature, Mahabharat, Ramayan etc. have also got significant importance. Like other diseases, the description regarding Kushtha (different skin disorders) is also available in all these treatises. These are akin to the description available in Ayurveda. From the above, it is apparent that description of different diseases mentioned in Ayurveda are also available in religious literatures.

Screening of Madhumehaghna (anti diabetic) plants in Vrihattrayee

The three texts written by Charak, Sushrut and Vagbhat are considered as Vrihattrayee because of their original contributions to the basic tenants of Ayurveda and innovative uses of plants and medicine. But despite the possibility of exploring efficacious for mulations from among these classics, not much attempts have been made in this direction, due to the fact that now most of them are not in vogue in practice by majority of Ayurvedic physicians. As such, a glossary of plants as described in those texts for the management of prameha including diabetes has been collected which would be useful for studying these drugs from different angles.

A brief on Ayurvedic manuscripts preserved at Utkal University, Bhubaneswar

Amongst different institutions, "Parija Library" of Utkal University, Bhubaneswar has about 101 palm-leaf manuscripts (mss.) on Ayurveda to its credit. Most of these mss. have not been reported earlier. Herewith a brief description of these mss. has been made with the intention of bringing it out for the Ayurvedic fraternity and to enrich the literary stock of Ayurveda.

Studies on ancient Indian concept of 'role of impaired gastro - intestinal function - enteropathy', in the pathogenesis and treatment of rheumatoid arthritis - amavata

In this paper an attempt has been made to evaluate the theory of Ayurveda on rheumatoid arthritis, in relation to the modern medical concept. The evolution of the disease, its etiopathogenesis, its pathological, biochemical as well as therapeutic data published in support of this concept and finally the details of clinical trial of Sunthi in treating 265 patients are dealt with.