3 role of antioxidants in health health from herbs what are 4 ... -...

Fact File10

Laugh a While11

Event Calendar10

Clinical Studies 4

In Focus 8

Product Feedback 6

Health from Herbs3

Health News7

Fitness10

Latest in Medicine9

Health Tips6

Himalaya’s Health Digest for You • Vol LI • No 3 • Jan–Mar 2012

What are Antioxidants?Antioxidants are substances that scavenge free radicals and help to decrease the incidence of oxidative stress-induced damage. Recent developments in the field of medicine reports a number of diseases associated with free radicals. The risk of diseases due to oxidative stress is compounded by unhealthy lifestyle, exposure to chemicals, pollution, smoking, drugs, illness, stress, etc. Earlier, traditional herbal medicines and dietary foods were the main source of antioxidants that protected people from the damage caused by free radicals.

Oxygen is an indispensable element for life. Its oxidative property plays a vital role in various biological phenomena. However, oxygen can also aggravate the damage within the cell by oxidative events. It is used by the cell to generate energy and as a consequence of adenosine triphosphate production by the mitochondria free radicals are formed. Reactive oxygen species (ROS) and reactive

Role of Antioxidants in Health

nitrogen species (RNS) are the by-products resulting from the cellular redox process. These reactive species are well recognized for playing a dual role as both toxic and beneficial compounds in humans. The “two-faced” character of these reactive species is undoubtedly a key aspect of life. At low or moderate levels, reactive species exert beneficial effects on cellular redox signaling and immune function, but at high concentrations, they produce oxidative stress, a harmful process that can damage cell function and structures.

Free radical-induced oxidative stress is now believed to be a fundamental mechanism underlying a number of

cardiovascular, neurologic, and other disorders in humans. Antioxidants are the crucial defense against free radical-induced damage, and are critical for maintaining optimum health and wellbeing. The antioxidants are also associated with reduction of free radical generation and improve antioxidant status in patients, thus it may be beneficial to restore normal body function and treat various diseases.

Oxidative Stress and Molecular DamageThe harmful effect of free radicals causing potential biological injury is termed oxidative stress. The relation between free radicals and

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Oxidative stress, caused by an imbalance between the production of reactive oxygen species and the ability of a biological system to readily detoxify the reactive intermediates, is known to play a crucial role in various neurodegenerative diseases, coronary artery disease, diabetes, and dermatosis. The cover page article discusses about the protective effects of antioxidants against free radicals.

Oxitard, a phytopharmaceutical formulation of The Himalaya Drug Company, is recommended in the management of oxidative stress associated with these conditions by inhibiting oxidation reactions, thereby preventing the damage caused by free radicals. The “Clinical Studies” section of this issue features a clinical study that highlights the safety and efficacy of Oxitard in the management of oxidative stress.

The section also features other articles that discuss about the clinical efficacy and safety of Mentat in the treatment of attention deficit hyperactivity disorder, Himcocid in nonulcer dyspepsia, and Bleminor in the management of facial blemishes.

The “Health from Herbs” section discusses about the clinical benefits of Withania somnifera and Bacopa monnieri.

In addition, this newsletter features interesting sections such as “Health Tips,” “Health News,” “Fitness,” “Fact File,” and “Event Calendar.” Please write to us at [email protected] with your feedback on the new look and content of Capsule.

Happy reading!– Editor

E D I T O R I A L

2 • Jan–Mar 2012 • Vol LI • No 3 www.himalayahealthcare.com

molecular damage can be described by the concept of oxidative stress. The term oxidative stress has been coined to describe a harmful condition caused by the excess of ROS production and/or a decrease in antioxidant levels. Similarly, overproduction of reactive nitrogen species is named as nitrosative stress.

Oxidative stress is the condition described as a shift toward the pro-oxidants in the pro-oxidant/antioxidant balance that can occur as a result of an increase in oxidative metabolism. Prolonged exposure to free radicals, even at a low concentration, may be responsible for the damage of biologically important molecules and potentially lead to tissue injury. Oxygen is essential for the generation of all ROS and RNS. Thus, though molecular oxygen is absolutely essential for aerobic life, it can be toxic under certain conditions and this phenomenon has been termed the oxygen paradox.

Oxidative stress has been implicated in various diseases like cancer, cardiovascular diseases, neurological disorders, diabetes, and aging. The damage is caused through four critical steps: membrane lipid peroxidation, protein oxidation, DNA damage, and disturbance in reducing

equivalents of the cell, which leads to cell destruction, altering signaling pathways.

Different mechanisms are involved in the pathogenesis of such diseases such as “mitochondrial oxidative stress” conditions, which can exemplify by pro-oxidants shifting the thiol/disulphide redox state and damaging glucose tolerance; “inflammatory oxidative conditions” and increased activity of either NADPH oxidase or xanthine oxidase-induced formation of ROS; or by both.

Aging is caused mainly due to the result of lipid peroxidation, DNA damage, and protein oxidation by free radical action. Every biological molecule present in our body is at risk of damage by free radicals. Such damaged cell molecules can impair cell functions or can lead to cell death ultimately resulting in diseased states.

Antioxidants and HealthProtective effects of antioxidants against free radicals include the following mechanisms: (a) the catalytic systems neutralizing or diverting ROS, (b) binding or inactivation of metal ions preventing generation of ROS by Haber-Weiss reaction, (c) suicidal and chain breaking antioxidants that scavenge

and destroy ROS, (d) energy absorption, electron and quenching of ROS.

In the recent times, demand for intake of antioxidant food or dietary antioxidant is increasing to prevent the oxidative stress induced by free radicals and also to help protect cellular systems from oxidative damage and lower the risk of chronic diseases.

Antioxidants in Traditional Medicinal SystemsSince ancient times, people are consuming different fruits and vegetables, and also medicines derived from natural sources like plant, animal, and mineral origin, which contain antioxidant constituents responsible for several health benefits. In traditional medicinal systems, plants are the primary component used for the treatment of various diseases. Many research studies have identified antioxidant activity in a wide array of plants and they play an important role in the prevention of cardiovascular and chronic diseases.

Excerpted from:Sen S, Chakraborty R.

The role of antioxidants in human health. In: Oxidative

Stress: Diagnostics, Prevention, and Therapy. Chap. 8.

Washington, DC: American Chemical Society;

2011:235-253.

The antioxidant capacity of a particular food/drug is evaluated based on their ability to neutralize free radicals by a process known as oxygen radical absorbance capacity (ORAC). Higher the ORAC score, better is the ability of the substance in neutralizing free radicals. Oxitard, a phytopharmaceutical formulation from The Himalaya Drug Company, possesses ORAC value equivalent to vitamin C. Oxitard neutralizes free radicals effectively and maintains the right REDOX balance, thereby managing oxidative stress associated with coronary artery disease, diabetes mellitus, dermatosis, oral submucous fibrosis, and postoperative recovery.

www.himalayahealthcare.com Jan–Mar 2012 • Vol LI • No 3 • 3

Health from Herbs

English nameThyme-leaved gratiola

Sanskrit/Indian name Brahmi

English name Winter cherry

Sanskrit/Indian name AshvagandhaWithania somnifera, an evergreen, erect, branching shrub with fleshy and stout roots, grows extensively in the subtropical regions of India, Nepal, Bangladesh, Pakistan, and Sri Lanka. The leaves of W somnifera are ovate with entire margin and arranged in an alternate manner. The flowers are greenish in color, and fruits are small, round, and orange red when mature. W somnifera has nervine tonic, aphrodisiac, and sedative properties. In traditional systems of medicine, W somnifera has been used as aphrodisiac and geriatric tonic and also in treating rheumatism and general weakness.

In a study conducted to evaluate the effect of W somnifera root extract on social isolation-induced behaviors such as anxiety

and depression in isolation-reared rats, it was observed that the administration of W somnifera showed antidepressant effect and mood-stabilizing activities. It was noted that administration of W somnifera increased the time spent and entries into the open arms on elevated plus maze (EPM) test and reduced immobility time in forced swim test (FST), indicating the use of this herb as a mood stabilizer in social isolation-induced behavior.1

Another study showed that W somnifera brought significant relief from anxiety symptoms and fatigue, and improved mental health, concentration, vitality, social functioning, and overall quality of life in patients with moderate-to-severe anxiety.2

Bacopa monnieri, a small creeping herb commonly grown in marshy places throughout India. The stems of B monnieri are obtuse-angular, the leaves are short-petioled, cuneate to obovate, and the capsules are ovoid. B monnieri has been used as a nerve tonic in traditional system of medicine. B monnieri is widely known for its memory- enhancing ability and improvement of brain function.

A recent study reported that B monnieri exhibits remarkable anti-ageing effect, ameliorates age-associated neurochemical and neurobehavioral deficits, and prevents hippocampal neuronal degeneration in the brain cortex of middle-aged and aged rat models. The study also documented that long-term oral administration of bacosides (a principal constituent of B monnieri) resulted

in significant attenuation of age-dependant elevation of proinflammatory cytokines (associated with age-related neurodegeneration and progression of senile dementia of Alzheimer’s type [SDAT]) in the brain cortex of these rats.3

Another study documents that the alcoholic extract of B monnieri could be a useful adjuvant in protecting brain cells against oxidative-mediated neurodegenerative disorders involving oxidative stress conditions.4

In addition, B monnieri is also known to possess diuretic, astringent, cardiotonic, and adaptogenic properties.

Bacopa monnieri

Withania somnifera

References1. Gupta GL, Rana AC. Indian J Physiol Pharmacol. 2007; 51(4):345-353.

2. Cooley K, et al. PLoS One. 2009;4(8):e6628.

3. Rastogi M, et al. Neurochem Res. 2011.

4. Shinomol GK, et al. Neurotox Res. 2011.


Table 1. Follow-up of Psychological Test Scores (% Improvement) During Trial

ParametersPercentage of improvement (median range)

Baseline – 2 months



Conner’s test

Mentat 5.5 (–37–50) 18.75 (–25–50) 38.8 (–30.30–88.34)Placebo 23.6 (–55–83.33) 30.95 (–25–100) 36.36 (–50–100)

z = 1.77, P = .07 z = 2.075, P = .03 z = 2.43, P = .015

Gestalt closure

Mentat 10.79 (–66–50) 19.09 (–33–100) 30.76 (0–100)Placebo 11.76 (–50–140) 15 (–100–160) 22.2 (–50–180)

Z = –0.5, P = .59 z = 0.44, P = .65 z = 1.2, P = .22

Spatial memory

mentat 9.09 (–3.03–100) 14.28 (–66.6–53.8) 16.6 (–66.6–100)Placebo 0 (–42.85–75) 7.69 (–8.3–150) 18.18 (–28.57–150)

Z = 1.41, P = 0.32 Z = 0.30, P = 0.76 Z = –0.01, P = 0.99

Bender Gestalt

Mentat 22.5 (–40–80) 36.6 (–100–75) 46.1 (– 300–100)Placebo 36.6 (–50–100) 46.4 (–100–100) 59 (0–100)

Z = 0.98, P = .32 Z = –1.2, P = .22 Z = –0.23, P = .81

CodingMentat 18.52 (–43.75–450) 7.9 (–28.94–733) 25.8 (–19.85–750)Placebo 16.44 (–46.25–63.15) 14.8 (–35.7–84.21) 27.65 (–14.28–128)

Z = 0.63, P = .52 Z = 0.082, P = .93 Z = 0.15, P = .87

Clinical Studies

Efficacy of Mentat in Children with Attention Deficit Hyperactivity DisorderA randomized double-blind placebo-controlled trial was conducted to evaluate the efficacy of Mentat, in school going children with attention deficit hyperactivity disorder (ADHD). A total of 195 children were screened, out of which 60 satisfied the DSM-IV criteria for ADHD. Among those enrolled in the study, 30 received Mentat and 30 received placebo at a dosage of 2 tablets per day for a period of 6 months. An assessment of academic functioning was made along with psychological tests 6 months before and after the treatment. Malin’s intelligence scale for Indian children (MISIC), Conner’s 10-point rating scale, Kaufman assessment battery for children (KABC), and brain SPECT (simple photon emission computed tomography) scans and subtests were assessed.

The Conner’s test and Gestalt closure subtest of KABC showed a statistically significant improvement in the Mentat group as compared to the placebo group (Table 1). The coding subtest (measures concentration, visual motor co-ordination, and speed of processing); spatial memory (measures attention and concen-tration); and Bender-Gestalt test (identifies perceptual motor difficulties) found improvement in Mentat group (Table 1).

Safety and Efficacy of Himcocid in the Management of Nonulcer DyspepsiaThe purpose of this study was to evaluate the safety and efficacy of Himcocid in relieving symptoms of nonulcer dyspepsia. One hundred patients with symptoms of nonulcer dyspepsia like epigastric discomfort, heart burn, nausea, vomiting, belching, flatulence, fullness in stomach, and abdominal distension were selected from the clinical unit of Department of Dravyaguna, S.S. Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi and randomly divided into two groups, with 50 patients in each. One group was treated with Himcocid tablet and the other group with Digene tablet. The dosage of both drugs was 1 tablet, thrice daily. After 6 weeks, a 100% relief of symptoms in Himcocid-treated patients was observed (Table 1). In Digene-treated group, most of the symptoms relapsed and remained incompletely relieved in few patients even after 6 weeks of continuous treatment. No untoward side effects were found in both groups. The study shows promising effect of Himcocid in nonulcer dyspepsia.

Table 1. Patients Showing Clinical Response of Himcocid in Nonulcer Dyspepsia

Symptoms

No.

of p

atie

nts

Cure

d at

w

eek

2

Cure

d at

w

eek

4

Cure

d at

w

eek

6

Not

com

plet

ely

cure

d at

wee

k 6

Base

line

scor

e

Scor

e at

wee

k 6

Rela

pse

Epigastric discomfort

46 (92%)

2 (4.35%)

42 (91.30%)

46 (100%) 0 134 0 0

Heartburn 50 (100%)

3 (6%)

49 (98%)

50 (100%) 0 148 0 0

Nausea 27 (54%)

9 (33.33%)

27 (100%)

27 (100%) 0 54 0 0

Vomiting 10 (20%)

7 (70%)

8 (80%)

10 (100%) 0 15 0 0

Belching 36 (72%)

3 (8.33%)

24 (66.67%)

36 (100%) 0 89 0 0

Flatulence 47 (94%)

1 (2.13%)

18 (38.30%)

47 (100%) 0 124 0 0

Fullness in stomach

49 (98%)

2 (4.08%)

20 (40.82%)

47 (95.92%)

2 (4.08%) 111 2 2

Abdominal distension

42 (84%)

2 (4.76%)

16 (38.10%)

40 (95.24%)

2 (4.76%) 115 2 2

– Dwivedi KN, Kulkarni KS.Med Update. 2003;10(12):83-86.

– Kalra V, et al.Neurosci Today. 2002;4:223-227.


Table 1. Effect of Oxitard Capsules on Pain over the Lesions

Degree of pain Number of patients (n=42)

Entry level 1st month 2nd month 3rd month

Nil —0 03 18 30* 40*

Mild—1 14 8 5* 0*

Moderate—2 12 6 4* 2*

Severe—3 13 10 3* 0*

*P<.05 compared to “entry level” values.

Table 1. Evaluation of the Effect of Bleminor in Facial Blemishes

Clinical symptoms Initial 2 weeks 4 weeks 6 weeks

Facial blemishes 2.91 ± 0.32 2.13 ± 0.65 1.33 ± 0.48 0.63 ± 0.23*

Reduction in dark spots/pigmentation

2.96 ± 0.24 2.12 ± 0.60 1.63 ± 0.54 1.08 ± 0.42*

Moisturizing effect – 0.36 ± 0.16 1.28 ± 0.34 2.3 ± 0.41*

Soothing effect – 0.40 ± 0.97 1.50 ± 0.97 2. ± 0.67*

Values are expressed in mean ± SD. *P<.01 as compared to “at entry” values.

Role of Oxitard Capsules in the Treatment of Oral Submucous FibrosisOral submucous fibrosis (OSF) is a chronic debilitating disease of the oral cavity. It is characterized by inflammation and progressive fibrosis of the oral submucous tissues. The purpose of this study was to evaluate the role of Oxitard capsules in the treatment of OSF. A total of 48 patients with chronic OSF lesions were evaluated in this study. Oxitard was given to all patients at the dosage of 2 capsules, twice daily for a period of 3 months. All patients were evaluated at monthly intervals, for a period of 3 months, for parameters such as difficulty in opening mouth, hyperkeratosis, pain, and lesion size (Table 1). All the parameters were evaluated by a random score as 0–nil, 1–mild, 2–moderate, and 3–severe. Results were analyzed statistically by using Student t test. The minimum level of significance was fixed at a 99% confidence limit and P value of <.05 was considered significant. All values were expressed as mean ± SEM. The parameters of difficulty in opening the mouth, pain over the lesion, and hyperkeratosis reduced significantly. There was a mild decrease in the size of the lesion. Thus, Oxitard capsules brought statistically significant improvement in symptoms such as difficulty in opening the mouth, pain in the mouth, and hyperkeratosis. Oxitard was also found to be safe and well-tolerated in the dose administered to the patients.

Clinical Efficacy of Bleminor in the Management of Facial BlemishesFacial blemishes, sometimes known as hyperpigmentation, are often characterized by skin discoloration or dark spots and are a result of acne whiteheads, blackheads, or pimples. This clinical study was conducted to evaluate the clinical efficacy and safety of Bleminor in the management of facial blemishes. Sixty subjects of either sex, aged more than 18 years with facial blemishes were included in the study. All the subjects were instructed to apply Bleminor twice daily over the affected area for a period of 6 weeks. Subjects were clinically evaluated on entry, and after 2, 4, and 6 weeks of treatment. Statistical analysis was carried out using GraphPad Prism software version 4.03 by using repeated measures of ANOVA. All the subjects completed the study and significant reduction in facial blemishes was observed after 6 weeks of treatment and also displayed significant moisturizing and soothing effects (Table 1). There were no significant adverse reactions, either reported or observed, during the entire study period and overall compliance to the treatment was good. The beneficial clinical efficacy of Bleminor in the management of facial blemishes could be due to the synergistic actions of its ingredients. Therefore, it may be concluded that Bleminor is clinically effective and safe in the management of facial blemishes.

– Singh BP, et al.The Antiseptic. 2009;106(10):503-507.

– Grandhi S, et al.IJCP. 2011;22(4):163-167.


Health Tips Product Feedback

Oral Hygiene I have experienced good results from Cystone in the prevention and management of small renal stones (3 –5 mm). Due to its

diuretic, mucin-dissolving, and antibacterial activities, majority of the stones disappeared with long-term administration of Cystone. I have not come across any significant adverse reactions with Cystone. It can be liberally recommended for the treatment of small renal calculi.

– Dr T Narender Consultant Urologist and Andrologist

Emergency and Critical Care Abhaya Hospitals

Khammam, Andhra Pradesh

I am prescribing Lukol for the past 9 to 10 years and found it to be very effective in nonspecific leukorrhea, leukorrhea

post-IUCD and tubectomy, and leukorrhea associated with pelvic inflammatory disease. Lukol shows maximum benefits after 3 months of treatment.

– Dr Usha Sharma Consultant Obstetrician and Gynecological Surgeon

Obs & Gyne Surgical Clinic Patna, Bihar

I have recommended Tentex forte tablets to more than 1 lakh patients in the past 25 years. I prescribe Tentex forte at a

dosage of 2 tablets BID for improving libido and maintaining penile erection. It acts as a complete Kayakalp, aphrodisiac, and stimulant and helps in rejuvenating the genito-urinary tract. Tentex forte is ten times more potent when compared to other medications for ED.

– Dr Shaikh AH Navjeevan Ayurvedic Dispensary

Near Central Bus Stand Aurangabad, Maharashtra

Liv.52 is very useful, effective, and safe medicine in the treatment of liver disorders.

I am prescribing Liv.52 for the last two decades in cases of viral hepatitis, drug-induced hepatitis, and fatty liver. It has provided excellent results. I also use Liv.52 in patients who are on anti-tubercular drugs. The products and services of The Himalaya Drug Company are very good.

– Dr KK Sharma 217-E, Civil Lines, Near Church

Etawah, Uttar Pradesh

Brushing and flossing are very essential for oral health. But as surprising as it may seem, most people do not do either of these daily rituals correctly; and fail to take other small, but highly effective steps to protect their oral health. Poor oral health has been linked to heart disease and other chronic diseases, such as diabetes and respiratory infections. Each person’s specific oral care needs are different, but most people can complete the following steps in about 3 to 5 minutes each time they brush.

1. Type of toothbrush: Use both types of toothbrushes, electric and manual (soft-bristle). Electric and ultrasonic toothbrushes produce more strokes per minute while manual toothbrush helps to access those teeth that may not have been fully reached.

2. Brushing: Most dentists recommend brushing for 2 minutes in the morning and again in the evening. However, if one has tiny spaces between the teeth or an advanced gum condition, such as periodontitis, he/she may need to brush for 4 to 6 minutes to adequately clean the teeth. Brushing the gums is equally important as it can help toughen the gums and keep the gum tissue more tightly attached to the tooth.

3. Flossing: Most dentists recommend flossing once daily. But people who have areas in their mouths in which food routinely gets trapped should floss after each meal, as well as after they brush. Flossing after brushing allows one to remove food particles that may have been pushed into any spaces between one’s teeth with the toothbrush.

4. Scraping: Bacteria become trapped and breed on the tongue’s rough surface, which can lead to bad breath and cavities. Scrape the tongue whenever a grayish or whitish coating is seen on it. A healthy tongue should be pinkish in color.

5. Mouthwash: Although mouthwash is easier to use than floss, it should be used only as a supplement to brushing, flossing, and irrigating. Mouthwash is generally thought as a breath freshener and bacteria fighter, but some brands contain added minerals and claim to also build enamel.

6. Dental irrigator: Dental irrigators rinse away leftover food particles that brushing and flossing leave behind. Not everyone needs a dental irrigator, but those who have pockets (between the gum and the teeth) of more than 4 mm should use one.

– Extracted from:BottomLine Health. 2011;25(12):15-16.


Health News

Effective Use of Antibiotics Curbs Antibiotic Resistance

older. In a recent study in the Journal of Clinical Endocrinology & Metabolism, UCLA researchers looked at more than 13,000 American adults and found that those with higher muscle mass (relative to body size) were more likely to have better insulin sensitivity and less likely to develop prediabetes than those with less muscle. It is well known that increased body fat, especially obesity, increases the risk of diabetes. But this research suggests that regardless of body weight, it is essential to maintain muscle strength.

– Wellness Letter. 2011;28(3):8.

Eating Healthy Does Not Cost More!

Patients coughing up green or yellow phlegm does not necessarily mean a bacterial infection requiring antibiotics. A large study from Cardiff University in Wales found that antibiotics did not speed recovery in adults coughing up discolored phlegm. Patients often ask for antibiotics and doctors are often willing to prescribe them for such symptoms, yet the drugs have side effects and add to the growing problem of antibiotic resistance. Mucus can turn greenish or yellow with any respiratory infection—viral or bacterial. However, if the patients continue to have discolored phlegm after 7 to 10 days, they should consult a doctor.


Strength Training for a Healthy LivingIt is important to take up strength training to reduce the risk of developing type 2 diabetes as people grow

It is a myth that eating healthy necessarily costs more. A USDA study of food

prices found that while some healthier foods, such as whole grains, do cost more, others cost less than less-healthy alternatives. For instance, in most markets across the country, nonfat or low-fat milk costs 10% to 20% less than reduced fat and whole milk. And while dark green vegetables cost 20% to 80% more than starchy vegetables (such as potatoes), orange-colored vegetables (such as carrots and winter squash) often cost less than starchy vegetables. Still, there is much regional variation in food prices, not to mention store-to-store variations.


Carrying Medicines Effectively and Safely

For optimal quality and effectiveness, most medications should be kept between 68°F and 77°F, says the US Pharmacopeia. A wider temperature range (59°F to 86°F) is generally okay too, but excessive heat should be avoided. That is, if traveling by car with medications, it is better to keep them in the passenger compartment than in the trunk. And in air travel, they should be taken in the carry-on bag. Particular

attention should be paid if drug labels warn about proper storage temperature (some drugs, such as insulin, require refrigeration). When ordering for medications by mail, it is better to ask for overnight shipping; drugs that are particularly heat-sensitive are often sent in special packaging that keeps them cool.


Too Much TV Decreases Life Expectancy

Research findings suggest that watching too much TV shortens life span. Researchers studied lifestyle and health data on 11,000 adults (ages 25 and older) and found that for every hour of sedentary TV-watching per day, life expectancy was reduced by 22 minutes, on average. A 6-hour daily TV habit after age 25, reduced life expectancy by nearly 5 years. Watching TV may be as dangerous as cardiovascular risk factors such as smoking and obesity.

– BottomLine Health. 2011;25(12):1.


In Focus

A Preliminary Study on the Safety and Efficacy of HD-03/ES* in Patients with Chronic Hepatitis BBhattacharya AK, et al.

J Herb Med Toxicol. 2009;3(2):137–141.

Aim The objective of this clinical study was to determine whether HD-03/ES, an herbal formulation consisting of 125 mg each of hydroalcoholic extracts of the herbs Cyperus rotundus and Cyperus scariosus, is safe and effective for human administration in the management of chronic hepatitis B.

Materials and MethodsAn open prospective controlled clinical trial was conducted to determine the safety and efficacy of HD-03/ES alone in the management of chronic hepatitis B infection. The study included 112 patients aged between 18 and 45 years and with a history of hepatitis B or HBsAg carriers for at least 6 months, who still had symptoms and signs of hepatitis as well as abnormal liver function and positive HBsAg. Of the 112 patients enrolled, 106 completed the study of 6 months duration. HD-03/ES was administered at a dosage of 2 capsules daily for a period of 24 weeks. Liver function tests were done every month after initiating treatment. Serum was analyzed for HBsAg and HBV DNA at baseline and 16 and 24 weeks after therapy.

The primary endpoint was HBsAg clearance. Secondary endpoints included HBV DNA levels and alanine aminotransferase (ALT) normalization to 40 IU/L at the end of treatment as well as clinical signs and symptoms.

ResultsTreatment with HD-03/ES resulted in progressive weight gain in the patients; however, the levels did not reach statistical significance. Clinical manifestations of hepatitis improved significantly in HD-03/ES-treated patients and jaundice had virtually disappeared in all, but one of the patients after 24 weeks of therapy.

There was a progressive and statistically significant reduction in the levels of ALT, and the level was normalized in many patients treated with HD-03/ES (Tables 1 and 2).

HBsAg became negative in 45% of the patients within 3 to 6 months after initiation of HD-03/ES therapy. Of the 106 patients, 52 (49%; P<.001) had undetectable HBsAg at the end

of the treatment. HBV DNA loss occurred more frequently during treatment with HD-03/ES and those 38 patients who were positive for HBV DNA initially, were negative at the end of therapy (Table 2).

No serious or life-threatening side effects were observed. Tiredness was the only adverse effect reported by 16 patients and was not severe enough to warrant withdrawal of the therapy. Renal function tests showed normal level of BUN and blood creatinine during the study period.

ConclusionFrom the above findings, it can be concluded that HD-03/ES is safe and effective in the management of patients with chronic hepatitis B infection.

Table 1. Effect of HD-03/ES Therapy on Liver Function Tests in Patients with Chronic Hepatitis B (n = 106)

ParametersTime (weeks)

0 16 24ALT (IU/L) 1498.1 ± 682 63.2 ± 50.1* 34. 8 ± 13.9*Aspartate aminotransferase (AST) (IU/L)

479.8 ± 404.9 65.1 ± 53.0** 29.7 ± 15.7**

Total protein (g/dL) 6.7 ± 0.6 6.6 ± 0.8 6.7 ± 0.8Protein globulin fraction (g/dL)

2.9 ± 0.6 3.0 ± 0.6 3.1 ± 0.6*

Total bilirubin (mg/dL) 6.7 ± 0.9 1.5 ± 0.8** 1.1 ± 0.4**

*P<.05; **P<.01; values are mean ± SD.

Table 2. Biochemical and Serological Response to 24 Weeks of HD-03/ES Therapy in Patients with Chronic Hepatitis B (n = 106)

Variable HD-03/ESALT normalization (%)16 weeks 3424 weeks 65HBsAg loss Positive Negative0 weeks 106 016 weeks 73 3324 weeks 54 52HBV DNA loss0 weeks 70 3616 weeks 51 5524 weeks 32 74P<.05*HD-03/ES is marketed as Liv.52 HB.


Latest in Medicine

Oral Submucous Fibrosis: A Clinicopathologic Review of 205 Cases in IndiansAngadi PV, Rekha KP

Oral Maxillofac Surg. 2011;15(1):15-19.

Oral submucous fibrosis (OSMF) is a disease due to a chronic, insidious change in fibro-elasticity, characterized by burning sensation in the oral cavity, blanching, and stiffening of the oral mucosa, and oro-pharynx leading to trismus and inability to open the mouth. The symptoms and signs depend on the progression of the lesions and number of affected sites. It is predominantly seen in Indians and other Asians. Once the disease has developed, there is neither regression nor any effective treatment. There are only few studies on the frequency and clinicopathological feature of OSMF in the Indian population in recent years.

The present study evaluated 205 cases of OSMF for the age, sex, site of involvement, duration of disease at the time of diagnosis, associated habits and common presenting symptoms, presence of other mucosal lesions, malignant potential, and the histopathology.

OSMF was seen in younger age (20–30 years) than that reported in literature and showed a characteristic male preponderance. A total of 11.6% of cases were associated with malignancy and occurred predominantly in males. A strong association with smokeless tobacco use especially arecanut in the form of gutkha was established and was related to earlier development of OSMF, that is, within a year of the habit.

Postinflammatory Hyperpigmentation: Etiologic and Therapeutic ConsiderationsCallender VD, et al.

Am J Clin Dermatol. 2011;12(2):87-99.

Postinflammatory hyperpigmentation (PIH) is a reactive hypermelanosis and sequela of a variety of inflammatory skin conditions. PIH can have a negative impact on a patient’s quality of life, particularly for dark-skinned patients. Studies show that dyschromias, including PIH, are one of the most commonly

present complaints of dark-skinned racial ethnic groups when visiting a dermatologist. This is likely due to an increased production or deposition of melanin into the epidermis or dermis by labile melanocytes. A variety of endogenous or exogenous inflammatory conditions can culminate in PIH and typically most epidermal lesions will appear tan, brown, or dark brown while dermal hypermelanosis has a blue-gray discoloration. Depigmenting agents target different steps in the production of melanin, most commonly inhibiting tyrosinase. These agents include hydroquinone, azelaic acid, kojic acid, arbutin, and certain licorice (glycyrrhiza) extracts. Other agents include retinoids, mequinol, ascorbic acid (vitamin C), niacinamide, N-acetyl glucosamine, and soy, and these products depigment by different mechanisms. Certain procedures can also be effective in the treatment of PIH including chemical peeling and laser therapy. It is important to note that these same therapeutic modalities may also play a role in causing PIH. Lastly, those lesions that are not amenable to medical or surgical therapy may experience some improvement with cosmetic camouflage.

Reflux Revisited: Advancing the Role of PepsinBardhan KD, et al.

Int J Otolaryngol. 2012;2012:646-901. Epub 2011 Nov 10.

Gastroesophageal reflux disease is mediated principally by acid. Recently, it has been found that reflux reaches beyond the esophagus, where pepsin, not acid, causes damage. Extraesophageal reflux occurs both as liquid and probably aerosol, the latter with a further reach. Pepsin is stable up to pH 7 and regains activity after reacidification. The enzyme adheres to laryngeal cells, depletes its defences, and causes further damage internally after its endocytosis. Extraesophageal reflux can today be detected by recognizing pharyngeal acidification using a miniaturized pH probe and by the identification of pepsin in saliva and in exhaled breath condensate by a rapid, sensitive, and specific immunoassay. Proton pump inhibitors do not help the majority with extraesophageal reflux, but specifically formulated alginates, which sieve pepsin, give benefit. These new insights may lead to the development of novel drugs that dramatically reduce pepsinogen secretion, block the effects of adherent pepsin, and give corresponding clinical benefit.

Editor in chief: Dr Pralhad S Patki • Managing Editor: Dr Jayashree B Keshav • Editorial Team: Shruthi VB, Rashmi Raj, Shahina KR • Layout Artists: Dayananda Rao S, Santosh G Edited and published by Dr PS Patki, MD. Printed at M/s Sri Sudhindra Offset Process, #97, DT Street, 8th Cross, Malleshwaram, Bangalore - 560 003


Fitness Fact File

Event Calendar

is worthwhile.

Here are some balance exercises one can do at home and need no special training or equipment. Stand near something which can be held for support if needed, or do them with a partner.• Test one’s balance by

seeing how long he/she can stand on one foot with the eyes closed. Most people over 40 years of age cannot withstand this for 15 seconds. Even if it is possible, try to extend the time.

• Without holding onto anything, rise up on toes for about 10 times. Repeat this exercise with eyes shut.

• Stand on one leg, bending the other knee slightly, for 10 to 15 seconds; switch legs; repeat 10 times. Then do again with the eyes closed.

• Walk a straight line, placing the heel of one foot directly in front of the toes of the other foot.

References1. Wellness Letter. 2011;28(2):6.2. Balance Exercises. Mayo

Clinic. Last accessed January 25, 2012.

Ordinarily, we take our balance for granted, but it is an important and vital part of daily life. Balance involves various sensory and motor systems. About one in three people over 65 years of age fall at least once in a year, and 10% to 15% of these falls result in serious injuries. Older people often have poor balance due to loss of muscle strength and joint flexibility, as well as reduced vision and reaction time. Inner ear dysfunction, which can throw one off balance, increases with age. Lack of exercise, consumption of alcohol, obesity, neuropathy in the lower legs, certain drugs, or medical conditions, even wearing the wrong eyeglasses can interfere with balance at any age.

Although balance declines with age, balance exercises can help one maintain balance and confidence at any age. Balance exercises can also help prevent falls and improve coordination. For older adults, balance exercises can also promote independence. Exercises such as brisk walking, running, and strength training help improve balance. Any activity that increases strength, especially in lower limbs, as well as agility,

Balance Exercises Depression• Depression is often associated with chronic illness and can

worsen the health of people.• Depression is an important global public health problem

due to both its relatively high lifetime prevalence and the significant disability that it causes.

• In 2002, depression accounted for 4.5% of the worldwide total burden of disease (in terms of disability-adjusted life years).

• Depression is also responsible for the greatest proportion of burden attributable to nonfatal health outcomes, accounting for almost 12% of total years lived with disability worldwide.

• Without treatment, depression has the tendency to assume a chronic course, to recur, and to be associated with increasing disability over time.

– Source: World Health Statistics. 2007;Part 1, p 16.

18th European Congress of Physical & Rehabilitation Medicine

Theme: Presentations covering all the fields of physical and rehabilitation medicine

Date: May 28 to June 1, 2012

Venue: Thessaloniki, Greece

For more details, visit: http://www.esprm2012.eu/en/

Clinical Aspects of Immunological Disorders in Patients with Broncho-pulmonary Disease and their Immune Correction

Theme: Provide evidence-based information on a variety of medicine dilemmas

Date: May 26 to 27, 2012

Venue: Kiev, Ukraine

For more details, visit: http://www.nbscience.com/17.html

NBScience limited Medical Conferences in Ukraine

Write to UsWe would like to hear from you. Write to us at [email protected].


“Wisdom is knowing what to do next; skill is knowing how to do it, and virtue is doing it.”

— David Starr Jordan

There was a lawyer and he was just waking up from anesthesia after surgery, and his wife was sitting by his side. His eyes fluttered open and he said, “You’re beautiful!” and then he fell asleep again. His wife had never heard him say that so she stayed by his side. A couple of minutes later his eyes fluttered open and he said, “You’re cute!”

Well, the wife was disappointed because instead of “beautiful” it was “cute.” She said, “What happened to “beautiful”? His reply was, “The drugs are wearing off!”

• • •

On New Year’s Eve, Peter was in no shape to drive, so he sensibly left his van in the car park and walked home. As he was wobbling along, he was stopped by a policeman.

“What are you doing out here at 4 o’clock in the morning?” asked the police officer.

“I’m on my way to a lecture,” answered Peter.

“And who on earth, in their right mind, is going to give a lecture at this time on New Year’s Eve?” enquired the constable sarcastically.

“I agree, but my wife will,” slurred Peter grimly.

• • •

For months Bill had been Lynn’s devoted admirer. At long last he had collected sufficient courage to ask her the momentous question.

“There are quite a lot of advantages to being a bachelor,” Bill began, “but there comes a time when one longs for the companionship of another being, a being who will regard one as perfect, as an idol; whom one can treat as one’s absolute own; who will be kind and faithful when times are hard; who will share one’s joys and sorrows.”

To his delight, Bill saw a sympathetic gleam in Lynn’s eyes. Then she nodded in agreement, “I think it’s a wonderful idea! Can I help you pick out a puppy?”

• • •

In a small town in the US, there was a rather sizable factory that hired only married men. Concerned about this, a local woman called on the manager and asked him, “Why is it you limit your employees to married men? Is it because you think women are weak, dumb, cantankerous….or what?”

“Not at all, Ma’am,” the manager replied.

“It is because our employees are used to obeying orders, are accustomed to being shoved around, know how to keep their mouths shut, and don’t pout when I yell at them.”

Peter called his doctor’s office for an appointment.

“I’m sorry,” said the receptionist, “we can’t fit you in for at least 2 weeks.”

Peter said, “But I could be dead by then!”

Receptionist replied, “No problem. If your wife lets us know, we’ll cancel the appointment.”

• • •

John: Did you hear that a baby was fed on elephant’s milk and gained twenty pounds in a week.

Peter: That’s impossible. Whose baby?

John: An elephant’s.

• • •

Laugh a While, It’s Healthy!

A quarterly journal dedicated to the emerging multidisciplinary field of perinatal medicine

Indexed in EMBASE, the Excerpta Medica database, CINAHL® database, and Cumulative Index to Nursing and Allied Health Literature® print index

To subscribe, write to us at: [email protected]

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Only for reference by a registered medical practitioner, hospital, or laboratory.

www.himalayahealthcare.comE-mail: [email protected]

Bonnisan – Keeps babies healthy and happy

Dosage 1 capsule twice daily.

• Possesses ORAC value equivalent to vitamin C Neutralizes free radicals more eectively, thus preventing progression of degenerative disorders.• Contains ingredients that are a rich natural source of vitamins A, C and E, carotenoids, bioflavonoids, polyphenols, zinc, and selenium.• Maintains the right REDOX balance in the body.• Possesses cardioprotective, gastroprotective, oculoprotective, and neuroprotective properties. Prevents end organ damage in diabetes mellitus.• Improves overall quality of life.

• Infants up to 6 months • An eective appetite stimulant and carminative – Stimulates digestive enzymes• From 6 to 9 months • Helps adapt to weaning & assists weight gain – Relieves indigestion, bloating & constipation, and improves assimilation• 9 months & above • Facilitates easier teething – Prevents excessive salivation, teething diarrhea, and painful gums

IndicationsOxidative stress associated with• Coronary artery disease • Dermatosis• Diabetes mellitus • Postoperative recovery• Oral submucous fibrosis • Convalescence

Well-defined role in every stage of a baby’s growth

DosageDrops:Infants up to 1 month : 5 to 10 drops three times daily.1 month to 6 months : 10 to 20 drops three times daily.Liquid:Infants up to 1 month : ½ teaspoon three times daily.1 month to 6 months : 1 teaspoonful three times daily.6 months to 3 years : 2 teaspoonfuls three times daily.

Indications • For the treatment of common digestive complaints in infants and children • As a daily health supplement in infants and children – To prevent common digestive complaints – To promote healthy growth

Oxitard – The natural antioxidant

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