Introduction Low back and neck pain are common musculoskeletal disorders with multiple treatment options. India's traditional medical systems, known as Ayush (Ayurveda, Yoga and Naturopathy, Unani, ...Siddha, Sowa-Rigpa and Homoeopathy) offer range of interventions and are widely used. In view of limited documentation of adverse events following Ayush interventions for lumbar and cervical spondylosis, we synthesized evidence and estimated proportion of studies reporting adverse events. Methods We systematically searched all published documents from biomedical and multidisciplinary abstract and citation databases and Ayush-specific repositories from their inception to April 2021. We selected studies as per inclusion criteria and extracted information, adhering to PRISMA guidelines. We systematically reviewed the qualitative evidence form the selected studies. Results Majority (94%) of the selected 113 studies were interventional studies and included 77 (68.1%) journal articles and 35 (31%) academic dissertations. Among the Ayush systems, considerable proportion was from Ayurveda (32.7%), followed by Siddha (24.8%), Yoga (22.1%), Unani (15.9%) and Homoeopathy (4.4%). Almost three-fourths of the studies were on lumbar spondylosis (65%; n = 74), followed by cervical spondylosis (31%; n = 35), and the remaining four included both. Thirteen percent of the 113 studies described adverse events Yoga = 9.7%; Unani = 1.8% and Homoeopathy = 1.8%. More adverse events were reported among the studies on lumbar (9.7%) than cervical spondylosis (2.7%). The nature of interventions were non-pharmacological (10.6%; n = 12), pharmacological (n = 2; 1.8%) or combined (n = 1; 0.9%). Conclusions Only one in eight studies reported any adverse event following Ayush interventions for cervical and lumbar spondylosis. There could be certain degree of underreporting of adverse events and requires further exploration. PROSPERO Registration ID CRD42020167433. Keywords: Adverse reactions, Adverse events, Ayurveda, Yoga and Naturopathy, Unani, Siddha, Homoeopathy, Musculoskeletal disorders
The Coronavirus disease 2019 (COVID-19) pandemic increased the utilisation of healthcare services. Such utilization could lead to higher out-of-pocket expenditure (OOPE) and catastrophic health ...expenditures (CHE). We estimated OOPE and the proportion of households that experienced CHE by conducting a cross-sectional survey of 1200 randomly selected confirmed COVID-19 cases.
A cross-sectional survey was conducted by telephonic interviews of 1200 randomly selected COVID-19 patients who tested positive between 1 March and 31 August 2021. We collected household-level information on demographics, income, expenditure, insurance coverage, direct medical and non-medical costs incurred toward COVID-19 management. We estimated the proportion of CHE with a 95% confidence interval. We examined the association of household characteristics; COVID-19 cases, severity, and hospitalisation status with CHE. A multivariable logistic regression analysis was conducted to ascertain the effects of variables of interest on the likelihood that households face CHE due to COVID-19.
The mean (95%CI) OOPE per household was INR 122,221 (92,744-1,51,698) US$1,643 (1,247-2,040). Among households, 61.7% faced OOPE, and 25.8% experienced CHE due to COVID-19. The odds of facing CHE were high among the households; with a family member over 65 years OR = 2.89 (2.03-4.12), with a comorbid individual OR = 3.38 (2.41-4.75), in the lowest income quintile OR = 1.82 (1.12-2.95), any member visited private hospital OR = 11.85 (7.68-18.27). The odds of having CHE in a household who have received insurance claims OR = 5.8 (2.81- 11.97) were high. Households with one and more than one severe COVID-19 increased the risk of CHE by more than two-times and three-times respectively AOR = 2.67 (1.27-5.58); AOR = 3.18 (1.49-6.81).
COVID-19 severity increases household OOPE and CHE. Strengthening the public healthcare and health insurance with higher health financing is indispensable for financial risk protection of households with severe COVID-19 from CHE.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
COVID-19 resulted in loss of human lives owing to respiratory failure caused by dysregulated immune system. Though many treatments are evaluated, the most appropriate is yet to be established.
To ...determine the safety and efficacy of Siddha add-on therapy in COVID -19 in terms of accelerated recovery, reduced hospital stay & mortality and follow up assessment of post discharge status until 90 days as compared to the Standard Care management.
In a randomized, controlled, single-center, open-label trial conducted on 200 hospitalized COVID-19 patients, they were allocated equally to be treated with add-on Siddha regimen with Standard care or only Standard care. Standard care was in accordance to the Government norms. Recovery was defined as amelioration of symptoms, viral clearance and attaining SpO2 > 94% in room air indicating the derived score of zero on WHO clinical progression scale. The primary and secondary end points were accelerated recovery (≤ 7 days) and mortality comparison between the groups respectively. Also, disease duration, length of hospital stays and laboratory parameters were assessed for safety and efficacy. Patients were followed through for 90 days after admission.
In this study the accelerated recovery was 59.0% and 27.0% in treatment and control groups (ITT analyses) (p < 0.001) respectively and Odds for it were four times higher in the treatment group (OR: 3.9; 95% CI: 1.9, 8.0). The estimated median time for recovery in the treatment group was 7 days (95% CI: 6.0, 8.0; p=0.003) and 10 days (95% CI: 8.7, 11.3) in control. Hazard ratio for death in control was 2.3 times that of treatment group. No adverse reactions or alarming laboratory values were observed in response to intervention. In Severe COVID treatment group (n=80), mortality was 15.0% and 39.5% in control (n=81). The COVID stage progression was 65% less in test group. Mortality during treatment and 90 days follow up in Severe COVID patients were 12 (15%) and 35 (43.2%) in treatment and control groups respectively.
The selected Siddha regimen when co-administered with Standard of Care have demonstrated that they can synergistically act to improve oxygenation status of patients, enhance the recovery rate from COVID-19 and reduce the mortality better when compared to administration of only Standard of Care.
CTRI/2020/06/025768 Registered on: 09/06/2020.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
In view of the growing popularity, reach and access for Massive Open Online Courses (MOOCs), India's apex body for medical education, the National Medical Commission (NMC) mandated uniform ...foundational course on research methods for the medical post graduates (PGs) and faculty members of the medical institutions under NMC as MOOC. This course is a pioneering effort in the field of India's PG medical education. NMC entrusted Indian Council of Medical Research (ICMR)-National Institute of Epidemiology (NIE) to design and offer the MOOC, named as Basic Course in Biomedical Research (BCBR). We describe the experience of designing and that of implementation challenges in the inaugural cycle of the course.
The course objective was to inculcate the fundamental concepts in research methods covering epidemiology and biostatistics in the form of video lectures, resource materials, discussion forum, assignments, feedback and a final proctored examination. The course was delivered over 16 weeks through MOOCs platform under the Indian Ministry of Education. We reviewed records, documents and faculty notes and described the course conceptualization, development, design and implementation process. We abstracted information from course portal on enrolment profile of the participants, self-reported course feedback (structured and open-ended on format, lectures and quality of contents), examination registration form, scores obtained in the assignments/examination and that of the participant queries. We described quantitative data using descriptive statistics. We presented the thematic analysis of qualitative data from open-ended questions in the feedback system and that of email interactions.
The inaugural cycle (September-December 2019) was taken by 24,385 participants. Majority, 15,879 (65%) were from medical background. 13,242 (54%) were medical postgraduates and 2637 (11%) were medical teachers. Among the enrolled, 14,720 (60%) cleared the assignments. A total of 11,392 (47%), 8,205 (62%) medical PGs and 896 (34%) faculty members successfully completed the course. Feedback from 1305 (5%) participants had mean score of 4.5/5 (±0.7) for quality of teaching. We faced challenges in customizing the course for medical participants, unawareness among target group, digital illiteracy and the ongoing pandemic.
During the inaugural cycle of the online Basic Course in Biomedical Research course, nearly half of the enrolled participants successfully completed and received the certificate. India's MOOC for enhancing research capabilities of future medical researchers encountered successes and challenges. Lessons learnt from the inaugural cycle will guide future directions and to address larger issues in terms of sustainability and replication by stakeholders in medical education in India or elsewhere.
The incorporation of digital technologies is recognized as one of the inevitable factors to achieve better health care services. Recently, Indian Ministry of AYUSH (MoA) embraced digitalization ...extensively for development, education and research in AYUSH. In this context, we describe India's digital initiatives for AYUSH systems of medicine for information, research, and academia at various levels. We reviewed the websites and documents available from the MoA and its research councils/institutes along with the plan documents. We described the identified digital initiatives under categories of (1) Health information system (2) Research database/library (3) Academic (4) Information Education and Communication (IEC). We specified the purpose and target group of the identified digital initiatives. We identified 19 key digital initiatives. The AYUSH hospital management information system (A-HMIS), National AYUSH Morbidity and Standardized Terminologies Electronic Portal (NAMASTE), AYUSH Suraksha, e-Aushadhi, e-Charak, Triskandha Kosha, SiddAR APP were categorized under health information system. The Traditional Knowledge Digital Library (TKDL), AYUSH research portal, DHARA, e-CHLAS, Research Management Information system (RMIS), e-Granthasamuccaya and AYUSH Sanjivani App were categorized under research database/library. The Ayurveda e-learning and Ayurvedic Inheritance of India were categorized as the academic initiatives. The Siddha–NIS App, Yoga locator, and Naturopathy-NIN App were categorized as Information, education and communication (IEC) initiatives. The digital initiatives from the MoA were a key to reform the traditional systems of medicines and could improve the education, quality of research and accessibility of the AYUSH healthcare services.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Kabasura Kudineer (KSK) is a Siddha polyherbal decoction recommended by the Ministry of AYUSH and the Tamil Nadu government to prevent and manage COVID-19 in India.
We aimed to determine the outcome ...of integrated therapy for COVID-19 using KSK in virologic clearance and length of hospital stay.
It was a single-centre, retrospective cohort study. We included the COVID-19 patients admitted to SRM Medical College Hospital and Research Centre, Chennai, during May–June 2020. KSK was administered along with the standard of care for all the patients. We collected data pertaining to demographic, clinical, and laboratory parameters and presented as frequencies and proportions.
We collected 204 COVID-19 positive patients’ data. The mean (SD) age was 39.5 (13.4) years with a range of 13–79. Majority of the patients were male (n = 157; 77%), 28% (n = 58) had any co-morbidities, and 61% (n = 131) had mild symptoms. Fever (n = 57; 27.9%) and cough (n = 53; 25.9%) were the commonly reported symptoms. Paracetamol (n = 135; 66.7%) and Zincovit (n = 197, 96.6%) were the commonly administered medicines along with KSK. About 74% of asymptomatic (n = 54) and 65% of mild symptomatic (n = 85) patients turned negative for COVID-19 in RT-PCR within 4–7 days. There was a significant difference in the blood parameters (p < 0.05) after the integrated treatment.
The use of KSK with standard care of treatment in COVID-19 treatment had notable results in the duration taken for virologic clearance, thereby reducing the length of hospital stay and improvement in laboratory parameters.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Coronavirus disease-2019 (COVID-19) had a multidimensional impact on human life. It affects the health-related quality of life (HRQoL) which is a perceived measure of physical and mental health. We ...estimated the EuroQol utility value for COVID-19 and the associated factors for those managed at Siddha COVID care centres in Tamil Nadu.
A cross-sectional study was conducted by a telephonic interview of 2000 randomly selected COVID-19 adults tested positive during June 2020 to Jan 2021. We collected sociodemographic, clinical and EQ-5D-5L profile. Mean EQ-5D-5L summary utility values and EQ-VAS scores were estimated. Multivariate regression was used to examine the factors associated with EQ-5D-5L. Study protocol was approved by the Institutional ethics committee of Government Siddha Medical College, Chennai (GSMC–CH–3401/ME-2/050/2021). The committee waived the written informed consent considering the pandemic situation of emerging infectious diseases.
We interviewed 1047 participants. Of the total 68% were males with the median age (IQR) of 38 (29–51) years. The mean EQ-5D-5L utility score and EQ-VAS scores are 0.98 ± 0.05 and 92.14 ± 0.39 respectively. COVID-19 asymptomatic group reported a mean utility score of 0.99 ± 0.03 which is relatively more than the symptomatic group (0.97 ± 0.06),. EQ-VAS score was also reported high among the asymptomatic (95.45 ± 5.95) than the symptomatic (91.40 ± 8.69COVID-19.
The severity of illness and the comorbidity are significantly associated with a low HRQoL of COVID-19 patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Proteus mirabilis is known to cause Catheter-associated urinary tract infections (CAUTIs), which exhibit virulence factors linked to forming biofilms. Aptamers have recently been explored as ...potential anti-biofilm agents. This study demonstrates the anti-biofilm activity of aptamer (PmA2G02) targeting P. mirabilis 1429T, a pathogenic bacteria known to cause Catheter-associated urinary tract infections (CAUTIs). The studied aptamer inhibited biofilm formation, swarming motility, and cell viability at a concentration of 3 μM. The study also showed that the PmA2G02 had a binding affinity towards fimbrial outer membrane usher protein (PMI1466), flagellin protein (PMI1619), and regulator of swarming behavior (rsbA), which are responsible for adhesion, motility, and quorum sensing, respectively. Crystal violet assay, SEM, and confocal imaging confirmed the effectiveness of the PmA2G02 as an anti-biofilm agent. Moreover, as verified by qPCR, the expression levels of fimD, fliC2, and rsbA were significantly reduced compared to the untreated group. This study suggests that aptamer may be a potential alternative to traditional antibiotics for the treatment of CAUTIs caused by P. mirabilis. These findings shed light on the mechanisms by which the aptamer inhibits biofilm formation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The silver-cheeked toad fish, Lagocephalus scleratus, was recorded for the first time on 25 September 2014. Two specimens of this fish species were collected from the by-catch landed by a commercial ...deep-sea trawler at Kasimedu Fishing Harbour, Chennai coast, Southeast India. The morphometric and meristic characters of the recorded specimens are described and discussed. The specimen was compared with earlier reports.
The silver-cheeked toad fish, Lagocephalus scleratus, was recorded for the first time on 25 September 2014. Two specimens of this fish species were collected from the by-catch landed by a commercial ...deep-sea trawler at Kasimedu Fishing Harbour, Chennai coast, Southeast India. The morphometric and meristic characters of the recorded specimens are described and discussed. The specimen was compared with earlier reports.
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