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kapilpore · 3 years ago

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When Can a Doctor Help Your Back Pain?

More than eight out of ten people will suffer from upper, middle, or lower back pain at some point in their life. The most prevalent type of back pain is low back pain. In most situations, the pain subsides with time. If your back pain is severe or does not improve, seek medical attention.

Why Does My Back Hurt?

Back pain can be caused by a variety of factors, including muscular discomfort with or without spasms, disc pain, joint pain, or nerve pain. Most of the time, these are not hazardous or dangerous.

When Should I See a Doctor for Back Pain?

In the first 48 hours after your back begins to suffer, consider taking an over-the-counter pain medicine (such as aspirin, ibuprofen, or acetaminophen) and applying ice. You may apply heat after 48 hours.

Consult your family doctor if your back discomfort lasts more than two weeks and prevents you from performing typical everyday activities. If your pain is severe, you should contact a doctor as soon as possible. If you have any of the following symptoms, you should seek immediate medical attention:

Fever accompanied by back pain

Back pain following a traumatic event

Inability to control one's bladder or bowels

Loss of arm and leg strength

Weight loss that is unexplained and linked to back discomfort.

Also, if you have a family history of cancer, illness, or spine fractures, you should be extra cautious.

What Doctor Should I See for Back Pain?

If your back pain is the result of a recent strain or minor injury, your primary care physician can most likely assist you. However, if the pain is severe, persistent, or accompanied by other symptoms such as numbness or tingling in your arms or legs, you should consult a back doctor. Begin with someone who specializes in nonsurgical back pain treatment.

What If I Don’t Want Surgery for My Back Pain?

Fortunately, most people with back discomfort do not require surgery. We normally start with a cautious approach, employing a wide range of nonsurgical spine treatments.

Back pain can develop along any section of the spine as well as in the muscles, soft tissues, joints, bones, and nerves of your back. Acute back pain usually appears unexpectedly, lasts less than six weeks, and improves with rest and patience. Pulling a muscle through lifting something heavy, twisting uncomfortably, or participating in sports are all common causes.

Chronic back pain, on the other hand, lasts longer than three months, may not have a single identified cause, and usually necessitates the assistance of a pain specialist to recover.

A skilled physical therapist will lead you through exercises and stretches that will strengthen your back, improve your balance and flexibility, and increase your range of motion – all of which will relieve your discomfort and protect your spine from future injury. Physical therapists will teach you self-care stretches and exercises to help prevent future episodes of back discomfort.

Dr. Kapil A. Pore has been working in Aurangabad for the past 5 years as an expert “Orthopedic trauma and joint replacement surgeon.” He has been working in the field of orthopedics for the past ten years. He is famous for Knee Pain, Hip Pain, Bone fracture, Shoulder pain, and Back pain Doctor in Aurangabad. He is recognized as one of Aurangabad’s best rheumatologists. He graduated with honors from Dr. PDMMC, Amravati, and went on to complete his post-graduate diploma in orthopedics at the prestigious institute and India’s first government joint replacement center, “Jagjivanram Railway Hospital,” in Mumbai.

During his diploma in orthopedics at JRH Mumbai, he established exceptional clinical skills under the tutelage of Dr. J.P. Jain, Dr. A.K Mehta, and Dr. B. Natraj. Then, under the supervision of Dr. Abhijit Agashe of the Sahyadri Hospital in Pune, he honed his joint replacement talents even more.

Dr. Kapil A. Pore is a well-trained Navigation assisted Knee and Hip Surgeon in Aurangabad, having received his training at Breach Candy Hospital in Mumbai under Dr. Arun Mullaji. Dr. Kapil A. Pore has extensive experience working at various institutes in Mumbai and has performed over 1000 joint replacement procedures. He has performed more than 100 joint replacement procedures on his own.

Dr. Kapil A. Pore is one of the excellent “Orthopedic Trauma and Joint Replacement Surgeon in Aurangabad” working in the City for the last 5 years. He is one of the Best Orthopedic Surgeons in Aurangabad and He is in the field of orthopedic for the last 10 years. He has done his graduation (M.B.B.S) from Dr. PDMMC, Amravati with excellent academics then done his post-graduation Diploma in orthopedics from the prestigious institute and India’s first government joint replacement center “Jagjivanram railway hospital”, Mumbai.

#Back pain doctor in Aurangabad #Shoulder pain doctor in Aurangabad #Bone fracture doctor in Aurangabad #Knee Pain doctor in Aurangabad

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blogs231 · 2 months ago

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Anatomy and Physiology for Nursing : Arya Publishing Company

Anatomy and Physiology for Nursing by A.K. Jain published by Arya Publishing Company is a comprehensive guide tailored for nursing students, focusing on the essential concepts of human anatomy and physiology. The book covers the structure and function of various body systems, providing clear explanations of physiological processes, along with diagrams and illustrations to aid understanding.

#arya publishing #medical book publisher #medical book publisher in delhi #medical books wholesale in india #books for medical students #medical books #medical book store

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arunveda · 3 years ago

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#drakjainclinic #Best Sexologist in India #Best Sexologist in Lucknow

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parulverma1 · 4 years ago

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Spirals Health! Find Best Doctors in Your Area

Today, human civilization has reached the peak of its development. Our lifestyles and living conditions are steadily growing. In this age of machines, humans himself have become like machines. They have become so much involved in their daily lives that now they are not even worried about their physical health. And this is the main and primary reason why the more the human civilization is growing, the more the human body is becoming weaker. They don't want to spend their time in further tasks like going to a hospital to see a doctor or book an appointment with their doctor. Due to such complications, people want to book appointments with their doctors through the internet. Therefore, we have created the best platform for all types of healthcare needs.

About Spirals Health

Spirals Health is a best online portal for all your healthcare needs. Our team of doctors or medical experts is there for you every step of the way, from finding the best doctor/hospital to booking online appointments and providing the appropriate information to any medical assistance in between.

Spirals Health helps you to connect and book appointments with the best doctors in your location. Visit our website to book a doctor appointment in any part of the country, including:

Book doctor appointment in Noida extension

Book doctor appointment in Ghaziabad

Book doctor appointment in Greater Noida

Book doctor appointment in Noida

Book doctor appointment in Delhi, etc.

Book a doctor appointment in Noida extension

On Spirals Health, you can view profiles and timings of the best and top-rated doctors in the city and book a doctor's appointment in Noida extension. Here, you can select the best specialist doctors for your medical condition. You can also compare your doctor with other doctors on the list and find out the best one. Some of our best doctors in Noida extension are:

Nivedita Kumari (Dentist or Dental Surgeon)

Sachin Agarwal (Orthopedic Surgeon)

Rajesh Jha (Pediatrician)

Monika Sharma (Dentist or Dental Surgeon)

Lisa Sharma (Gynecologist & Obstetrician)

J Lal (Sexologist)

Rajendra Singh (Ophthalmologist)

Krishan Gupta (Orthopedic)

Hitik Mathur (Orthopedic surgeon)

Shailendra Kumar Goel (Urologist)

It is not a complete list of doctors to book an online appointment in Noida extension. Our list of the doctors in Noida extension contains more than 300 names.

Book doctor appointment in Ghaziabad

Spirals Health offers its visitors to choose from a vast network of experienced and well-qualified doctors across Ghaziabad to ensure that the right healthcare decision is made. We help you to book a doctor's appointment in Ghaziabad in some rapid and easy steps. Here are some of our best doctors in Ghaziabad.

Utkarsh Goel (Physiotherapist)

Alpana Kansal (Gynecologist)

Charu Garg (Family medicine physician) Pankaj Garg (Pediatrician)

Archana Sharma (Gynecologist)

S.N. Sharma (General physician)

Tarun Kaushik (Dental Surgeon & Consultant Implantologist)

Tejasvi Saigal (Dentist or Dental Surgeon)

Pallav Rastogi (Pediatrician)

Pulkit Gupta (Dentist)

Book doctor appointment in Greater Noida

As mentioned, we provide our services all over the country, including Greater Noida. We have associated with more than 300 specialist doctors in the city. You may take our help to a book doctor's appointment in Greater Noida. Some of our top-rated doctors in Greater Noida are;

Ankit Gupta (Dentist or Dental Surgeon)

Amit Jain (Homoeopath)

Sunil Mittal (Radiologist)

Antara Mathur (Psychiatrist)

Pritipal Singh (Ophthalmologist)

Anjila Gupta (Ophthalmologist)

Nikhil Dass (Dental Surgeon & Consultant)

Alpana Bansal (Gynecologist & Obstetrician)

A.C. Upadhyay (Ayurveda)

A.K. Sethi (Orthopedic Surgeon)

To know more about the doctors in your area, their qualification, and specialty, visit www.spiralshealth.com.

#book a doctor's appointment in Noida extension #Book doctor appointment in Ghaziabad #book doctor's appointment in Noida

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sarkarimirror · 4 years ago

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NHPC organizes Blood Donation Camp

13th July 2020 NHPC Limited, India’s premier hydropower company and a ‘Mini Ratna’ Category-I PSU under Ministry of Power, in association with Rotary Club of Faridabad Midtown, organized a blood donation camp on 12.07.2020 at NHPC Residential Colony, Faridabad. Shri A.K. Singh, CMD, NHPC along with his wife Smt. Sudha Singh inaugurated the camp in the presence of Shri N.K. Jain, Director (Personnel), NHPC, senior officers of NHPC and Rotary club members. Speaking on the occasion, Shri A.K. Singh said that during these unprecedented times of Covid-19 affecting the world, hospitals are running short of blood and NHPC has organized this blood donation camp as an effort to support blood banks. He lauded this initiative and urged NHPC employees and their family members to associate with this noble cause. The blood donation camp witnessed good response and total 75 units of blood were collected. On this occasion, office bearers of Rotary Club of Faridabad Midtown, Shri Pankaj Garg, President, Dr. Ashish Verma, Secretary and Shri Sachin Khosla, Treasurer thanked NHPC for taking this initiative and conducting this camp and thereby making it a successful event. Read the full article

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askdrjain · 1 month ago

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Top Picks: Best Male Sexologists Near Me for Personalized Care

When it comes to your sexual health, finding the right expert is crucial. You deserve personalized care and effective solutions to address your concerns. That's why Dr. A.K Jain Clinic is proud to be one of the top picks for the best male sexologists near you. With their expertise in sexual wellness, including the use of ayurvedic medicine for sexual weakness, Dr. A.K Jain Clinic is dedicated to providing personalized care and helping you achieve a fulfilling and satisfying sex life.

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One of the key offerings of Dr. A.K Jain Clinic is their expertise in ayurvedic medicine for sexual weakness. Ayurveda, an ancient system of medicine, offers a holistic and natural approach to restore balance and vitality. The clinic provides a range of ayurvedic medicines specifically formulated to address sexual weakness and enhance overall sexual performance. These medicines are carefully crafted using traditional ingredients and are known for their effectiveness in promoting sexual wellness.

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Don't let sexual issues hold you back from living your best life. Take the first step towards wellness by discovering the expertise of the best male sexologist near you at Dr. A.K Jain Clinic. With their personalized care, ayurvedic medicines for sexual weakness, and specialized treatment for premature ejaculation, you can regain control over your sexual health and enjoy a fulfilling and satisfying sex life. Contact Dr. A.K Jain Clinic today to schedule your consultation and start your journey towards a better sexual well-being.

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loyallogic · 5 years ago

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Preventive Detention: detrimental to Human Rights

This article is written by Samyak Jain.

Abstract

Preventive detention imposed generally as an anticipatory measure and does not relate to an offence, while criminal proceedings are to punish a person for an offence committed by him. The main rationale behind the preventive detention is not to punish but to prevent the detainees from doing any criminal activity against the state. Preventive detention is something against the nature of the democratic state because of violation of the fundamental rights. Justice K.S. Puttaswamy (Retd.) V. Union of India case talks about the privacy, i.e., right to be alone. It talks about the increasing scope of personal liberty of individuals in terms of privacy. The major concern regarding preventive detention is that arresting person on mere suspicion is absolute violation of his inalienable right to liberty. There is a conflicting view regarding preventive detention between human right activists, who are in favor of liberty of the individual and exigencies of the state on the other side. This balancing is of the utmost importance because there is a need to maintain momentum between human freedom on one hand and state’s obligations towards the national security. Just like other fundamental rights guaranteed by the Constitution, personal liberty is also not an absolute right. It can amount to certain reasonable restrictions which are imposed by state according to the law. But invasion of personal liberty by the state must follow certain basic requirements. Preventive detention is curbing liberty of an individual in an authoritarian way on the name of national security, and these types of laws need to be changed in order to secure fundamental rights of individuals.

Introduction

Detention in its simplest sense means to curb the liberty of individual i.e. without the knowledge of that individual. This can be understood by a simple example, i.e., during a party, child causes nuisance due to which his father slapped him and locked him in a room to prevent from doing further disturbance. This is termed as preventive detention because, here, father detained his child in a locked room in view of preventing his child from further nuisance, as this is different from punitive detention, which awards to a person after commission of offence while the former will be awarded to prevent any person from committing act. The basic difference between the two is that in case of preventive detention, it is anticipatory measure where the person did not commit any crime and detained only on mere suspicion for committing crime in future, while punitive detention is detaining a person for committing an offence. What thing here to ponder is contravention of fundamental rights in democratic state? The issue is that this act of detaining individuals on suspicion, likely to commit offense in future on the grounds of national security and sake of maintaining good foreign relations. This is a huge violation of fundamental rights as the state detained individuals for preventive measures, not for punitive measures.

There are several legal instruments such as the Universal Declaration of Human Rights, 1948; European Convention on Human Rights, 1950 etc.is guiding principles in pre-trial detention, arrest and administrative detention. These conventions provide significant understanding of legal rules governing arrest and detention.

Preventive detention laws in India

Parliament passed a legislation named Preventive Detention Act, 1950 which talks about the detention of a person on the grounds of defense, foreign affairs or the security of the state. The constitutionality of Preventive Detention Act, 1950 was challenged in the case of A.K. Gopalan V. State of Madras where a leader named A.K. Gopalan was detained in Madras jail from 1947. He was sentenced to various terms of imprisonment under ordinary law but every time sentence was set aside. In 1950, he served with a fresh notice that he was detained under Preventive Detention Act. He challenged the validity of the aforesaid act as this act of state of further detaining him is in violation of Articles 13, 19 and 21 and provisions of the act are not in accordance with Article 22 enshrined under the Constitution of India. The arguments by the defense counsel were that it curbs the liberty and also infringes fundamental rights guaranteed by the Constitution. The case was decided by 4:1 ratio, where majority does not recognize detention as an infringement of personal liberty under Article 21. Minority opinion was delivered by Justice Fazl Ali, which said that fundamental rights are not isolated and separate but protect a common thread of freedom and liberty. “Preventive detention, which is dealt with an Article 22, also amounts to deprivation of personal liberty which is referred to in Article 21, and is a violation of the right of freedom of movement dealt with in Article 19(1)(d)…”

The Gopalan doctrine was again revisited in R.C. Cooper and Maneka Gandhi. Justice PN Bhagwati in Cooper affirms the dissenting opinion of Justice Subba Rao in Kharak Singh case and said that the term ‘personal liberty’ is a comprehensive one and the right to move freely is an attribute of personal liberty. There is no question of being carved out one fundamental right from another. Article 21 has many attributes and some of them found in Article 19(1)(d). In other words, Article 21 covers a wide range of rights, and some of them had protection under Article 19.

The interrelationship between fundamental rights paved way for acknowledging privacy as a fundamental right in Justice K.S. Puttaswamy case by overruling MP Sharma and Kharak Singh case.

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Preventive detention laws in USA

Unlike the preventive detention laws as guaranteed by the Indian Constitution, US do not have any laws which prohibit preventive detention by the state i.e. not considered them illegally. The US congress has the power to detain individuals not convicted of crimes for preventive measures under the banner of national security.

Bail Reforms Act, 1984 talks about the procedure set for release or detain individuals by the judicial officer if govt. by showing evidence that this has committed serious felonies or not. In the case of United States V. Salerno, constitutional validity of Bail Reforms Act, 1984 and 5th Amendment of Due Process was challenged when members of American mafia was arrested. By 6:3 ratio, Supreme Court held that the Act was constitutional because the government’ act of protecting community outweighs personal liberty of individuals only in cases when government able to prove that the arrestee posed significant threat to the community.

In Hamdi V. Rumsfeld, Yaser Hamdi, an American citizen, detained by the US military in Afghanistan and was accused of fighting for the Taliban against the United States government, declared as ‘enemy combatant’. Hamdi’s father filed a writ petition of Habeas Corpus, in an attempt to declare Hamdi’s detention as unconstitutional. The government countered that the Executive branch had the right against the ‘enemy combatants’ to restrict their access to the court. The questions arises whether the act of government by not providing access to an attorney, solely on an executive declaration that he was an enemy combatant, is a violation of Fifth Amendment right to Due Process by hold him indefinitely? And is it logical to agree with the government contention of ‘Separation of power’ doctrine? By 8:1 ratio, SC said that the Fifth Amendment right guarantees every citizen of the US as an enemy combatant had the right to contest the charge before a court. The SC rejected the notion of separation of powers theory because this prevents the judiciary from hearing Hamdi’s case.

In Rumsfeld V. Padilla, an American citizen was arrested at Airport after returning from Pakistan in 2002. He was initially detained as a material witness against Al Qaeda terrorist network, but later declared as an enemy combatant by the Department of Defense under President’s constitutional powers as the commander in chief and the authorization provided by Congress for use of military force, meaning that he held in prison indefinitely without access to an attorney.

The pertinent question in this case was whether Congress’s ‘authorization for use of military force’ gives authority to the President to detain a US citizen in the US on the grounds of ‘enemy combatant’. Here, US SC does not decide the case as it was filed improperly. This case was rejected by the SC and did not answer the jurisprudential question relating to powers of US President.

Preventive detention laws in other countries

Preventive detention is an imprisonment that is justified for non-punitive purposes. Australia authorizes the preventive detention laws. Canada detains anybody which is declared by court a dangerous offender for an indefinite period of time. In Germany, preventive detention can be imposed as part of criminal sentencing and to prevent serious offenders which poses threat to society from committing grave offences. In Japan, pre-trial detention can be extended to 23 days without charge. Increasing the length of detention is at the discretion of the public prosecutor. Malaysia enacted the Internal Security Act, 1960 (ISA) for legalizing preventive detention laws under legally defined circumstances. New Zealand gives preventive detention to offenders aged above 18 years or who convicted over sexual or violent crimes.

Merits and demerits

Preventive detention is the act of detaining someone who has not committed any act but on mere suspicion that he/she is likely to commit crime in future. Preventive detention has also pros and cons of its own. Detaining a person on preventive measures is justified for people with diminished responsibility or judgment. In cases where people are suffering from acute diseases such as mental illness. For example, if any individual under the influence of drugs or alcohol, had dementia or have the capacity to commit suicide. Then in these cases temporary preventive detention would prevent harm to that person. These are termed as merits of Preventive detention.

Demerits are termed as when detaining an adult of sound mind for an indefinite period of detention. It is problematic because it would involve violation of the right of personal liberty. In general, preventive detention is good because it prevents individuals from committing crime, but bad because it infringes fundamental rights. Just like two faces of a coin, preventive detention also has its own merits and demerits. It is on the legislature and executive to use it according to the law.

Conclusion

John Stuart Mill in his essay, ‘On Liberty’ said “The only part of the conduct of any one, for which he is amenable to society, is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute. Over himself, over his own body and mind, the individual is sovereign”. While answering the question regarding the tussle between liberty and authority, Mill said that the authoritarian rule could be reined by the recognition of fundamental rights such as the right to privacy, free speech and expression, and right to assemble.

John Locke in his book ‘Second Treatise of Government’ wrote that some inalienable rights are vested in an individual such as rights of life, liberty and property by the state of nature. The notion of alienable rights are also adopted by the constituent makers of United States and embodied such words in ‘American Declaration of Independence’ in the form of life, liberty and the pursuit of happiness. This notion is based on the principle that natural rights are inherent in nature and not made according to man-made law.

Article 5(1) of European Convention on Human Rights, 1950 guarantees a person’s right to ‘liberty’ and ‘freedom’. Article 3 of the Universal Declaration of Human Rights guarantees “the right to life, liberty, and security of person”. According to the international conventions on Human rights, it is pertinent that their main focus is to preserve the personal liberty and also against the wrongful restraint of individuals. The above referred human rights conventions held that in all cases detention must be carried out in accordance with law, and not arbitrary. Arbitrariness is not equated with only ‘contrary to law’ but must be interpreted broadly in terms of inappropriateness, injustice, etc. In other words, detention must be according to the law, reasonable and also lawful.

Preventive measures

For lawful detention according to Human Rights, it is necessary to be carried out according to the procedures by the rule of law and also free from arbitrariness.

International human rights activists acknowledges that arrest and non-compliance with the lawful order of a court or in order to secure any fulfillment prescribed by the law does not amount to infringement of fundamental rights.

Detention on mere suspicion is violation of fundamental rights and in general, personal liberty of individuals.

Detention is lawful in case of preventing flight i.e. in order to prevent a person from fleeing after committing crime.

Deprivation of liberty or preventive detention is justified in cases of person suffering from mental illness in order to prevent him from harm.

Human Rights Committee prohibits detention of asylum seekers and for the purpose of extradition and deportation even in the case of illegal entry.

Preventive detention is justified in order to maintain public order for reasons of public security. It is difficult to determine what exactly comes under the definition of public order. If preventive detention is ordered under the name of public order, it must be controlled by the law and according to the procedure established by the law and also not arbitrary in nature.

Detainees had the right to be informed of the reasons for arrest and detention under which they arrest and of the charges framed against that individual.

Detainee had the right to present before the judicial magistrate under a reasonable time and also had the right to get the attorney or lawyer of his/her own choice.

In the end, it is necessary to have an independent organ which is not in control of executive and known for giving impartial judgments, which is essential in determining fundamental rights.

Preventive detention Act, 1950 validates detention of individual in cases where exigencies of the state is concerned like in case of national security, maintaining peace and public order, foreign relations etc. Validity of the said act is challenged before the court in Gopalan case where it was evident that liberty of an individual does not count under Article 21. Preventive detention Act was repealed in 1969 and in 1974; Maintenance of Internal Security Act (MISA) came. Then National Security Act, 1980 came whose purpose is to provide preventive detention in certain cases. In 2002, Prevention of Terrorism Act (POTA) came, which provide discretionary powers to the investigating authorities for matters relating to terrorism. Later, in 2004 act was repealed due to its misuse nature and in view for protecting human rights. Justice Chandrachud in Justice Puttaswamy case gave three fold requirements in case of invasion of personal liberty of individuals- (I) legality, postulates the existence of law, (II) need, defined in terms of legitimate state aim (III) proportionality which ensures a nexus between the objects and the need to achieve them. So there should be a direct nexus between the object and invasion of personal liberty.

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juniperpublishersjcmah · 5 years ago

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Pterocarpus marsupium and Gymnema Sylvestre Powder in Alleviation of Biochemical Abnormalities Associated with Human Type 2 Diabetes Mellitus- Juniper Publishers

Abstract

Objectives: This observational study investigated the antihyperglycemic, antihyperlipidemic and antioxidant potential of Pterocarpus marsupium (Vijaysaar) and Gymnema sylvestre (Gudmar) (“VG”) Therapy in patients with type 2 diabetes mellitus.

Methods: Subjects with type 2 diabetes mellitus were administered a phytochemical formulation consisting 50 ml of aqueous extract derived from 3 gm “VG” powder was administered twice a day for six months. The blood glucose levels were monitored at monthly intervals; glycosylated hemoglobin, lipid profile and biomarkers of oxidative stress, liver and kidney functions were monitored at three monthly intervals.

Results: Daily administration of the “VG” Therapy regularly for 6 months resulted in significant reduction of blood glucose and glycosylated hemoglobin levels. There was also a significant increase in high-density lipoprotein cholesterol levels with concomitant decrease in total cholesterol, triglyceride, low-density lipoprotein cholesterol, and very-low-density lipoprotein levels. Significant improvement in the biochemical markers of oxidative stress was recorded.

Conclusion: TThe results suggest that herbal formulation “VG” is beneficial in improving glucose and lipid homeostasis in type 2 diabetics and may serve as an adjunct therapy.

Keywords: Hyperglycemia; Dyslipidemia; Oxidative stress; Type 2 diabetes mellitus; Pterocarpus marsupiu; Gymnema Sylvestre

Abbrevations: BMI: Body Mass Index; DBP: Diastolic Blood Pressure; FPG: Fasting Plasma Glucose; GSH: Reduced Glutathione; HbA1c: Glycosylated Haemoglobin; HDL: High-Density Lipoprotein Cholesterol; LDL: Low-Density Lipoprotein Cholesterol; PPG: Postprandial Glucose; SBP: Systolic Blood Pressure; SOD: Superoxide Dismutase; SGOT: Serum Glutamate Oxaloacetate Transaminase; SGPT: Serum Glutamate Pyruvate Transaminase; TBARS: Thiobarbituric Acid Reacting Substances; VLDL: Very low-density lipoprotein cholesterol; VG: Vijaysaar and Gurmar

Introduction

Type 2 diabetes mellitus is reaching epidemic proportions worldwide and is a complex metabolic disorder characterized by hyperglycemia and dysregulated lipid metabolism [1,2]. Abdominal obesity and dyslipidemia (increased triglycerides, high LDL-cholesterol and low HDL-cholesterol), and hypertension, as well as altered platelet function [3] are the major risk factors contributing to type 2 diabetes. The metabolic defects that underlie the development of type 2 diabetes may include islet β-cells dysfunction, hyperglucagonemia, elevated endogenous glucose production, development of peripheral insulin resistance, inflammation of adipose tissue, and dysregulation of adipokines production [4]. Chronic elevation of blood glucose which is a central factor in the production of reactive oxygen species (ROS) [5] which in turn promote cellular damage and contribute to the development and progression of diabetic complications, such as cardiovascular disease, nephropathy, retinal blindness, neuropathy, and peripheral gangrene [6]. The conventional allopathic drugs, sulfonylureas, meglitinides, biguanides, metformin, thiazolidinediones, miglitol, acarbose, etc. although effective [7], are associated with minor or major side effects on long term use [8]. Statins used in the treatment of dyslipidemia have their own limitations [9].

Plant based Indian traditional medicines such as Ayurveda have been used since ancient times in the treatment of diabetes [10]. Ethnobotanical studies of traditional herbal medicine used for diabetes have identified more than 1,200 species of plants with hypoglycemic activity [10]. Medicinal plants are frequently considered to be less toxic and free from side effects than synthetic ones. The antidiabetic effects of several plant extracts and herbal formulations and their bioactive compounds have been identified and characterized for the treatment of diabetes mellitus [11,12].

Polyherbal formulations [13], have been shown to exhibit antidiabetic, antihyperlipidemic and antioxidant potential in animal models as well as in diabetic patients [14]. The phytochemical based formulations consisting of multiple herbs are liable to produce a large number of metabolites that may act on multiple targets in the body and hence, polyherbal formulations (Which are used in traditional practice) are preferred over mono therapeutic ones. Although, phytochemical based formulations have extensively been used, studies on their proof of efficacy are limited [15].

Gymnema sylvestre (Gudmar) is a climber grown in tropical forests of South-East and belongs to the family Asclepiadaceae G. sylvestre is considered to have a great anti-diabetic potential and used in several anti-diabetic formulations. There are several reports in animal models as well as in diabetic patients which shows that extract of G. sylvestre leaves have anti-diabetic potential [16,17], and these effects are attributes due to increase in insulin secretion [18]. Pterocarpus marsupium (Vijaysaar) is the most versatile plant with a wide spectrum of biological activities and belongs to the family Fabaceae. The P. marsupium is reported to be anti-diabetic and associated with anti-obesity, anti-hyperlipidemic, antiinflammatory, anti-oxidative, antitumorigenic functions [19-21]. The aim of this study is to explore the therapeutic potential of combined effects of the regular consumption of Pterocarpus marsupium and Gymnema sylvestre in human subjects with type 2 diabetes mellitus.

Materials and Methods

Study sample

A total of 45 type 2 diabetic patients attending the weekend diabetes clinic run by the Centre for Translational Research, School of Studies in Biochemistry, Jiwaji University, India expressed their willingness to participate in the study. Of these, 35subjects met the inclusion criteria who were then explained the necessity of maintaining defined lifestyle pattern during the course of the study. Out of 35 subjects, 8 subjects were eliminated during the course of the study due to non-compliance. The remaining 27 subjects took the drug regimen regularly as per the experimental design. Figure 1 shows the number of subjects enrolled and drop outs during the course of study. The patients’ baseline characteristics are summarized in (Table 1).

Data are expressed as Mean ± SEM;

BMI-Body mass index; SBP- Systolic blood pressure; DBP- Diastolic blood pressure; FBG-Fasting blood glucose; PPBG-Post prandial blood glucose; HbA1c: Glycosylated Haemoglobin.

Study design

The study design included following steps:

a) Selection of patients meeting inclusion criteria and those consented to participate in the study.

b) Measurement of anthropometric and biochemical parameters once before and at selected intervals during the course of the study.

c) Administration of “VG” Therapy in defined dose daily for a period of 6 months.

d) Measurement of parameters at the end of the study.

e) Analysis of the data.

Inclusion criteria

a) Non-insulin dependent diabetes diagnosed, as per the criteria of the World Health Organization;

b) Both genders between the ages of 30-65 years;

c) Body Mass Index in the range of 18.5 to 40;

d) Participants who understood the benefits of the study and signed a written informed consent;

Exclusion criteria

a) Presently using other blood glucose regulating agents;

b) Daily intake of alcoholic beverages;

c) Smokers consuming more than 1 pack/day;

d) Patients diagnosed as type I and insulin dependent type II diabetics;

e) Patients with hepatic or renal disease, pancreatitis, cardiac problems, uncontrolled hypertension, malnutrition and severe immune deficiency.

f) Non-compliance during the course of study.

Before starting the study all participating subjects were given a verbal explanation about the objectives of the study, nature of drug formulation (Kwath) to be consumed daily, (“VG” Therapy) rationale and duration of therapy in local language. They were asked to avoid a carbohydrate rich diet and advised regular walking for about 4-5 km during the course of study. The patients who consented to participate in the study were registered, anthropometric measurements; weight, height and waist were recorded at the beginning and at selected intervals during the study period. The patients were kept exclusively on “VG” therapy.

Composition of drug (VG) formulation

The “VG” formulation consisted of a mixture of Pterocarpus marsupium (Vijaysaar), and Gymnema sylvestre (Gurmar) (Table 2) and was provided by the M/S Dindayal Industries Ltd. India. The individual plants were identified by Prof. A.K. Jain, School of Studies Botany, Institute of Ethnobiology Jiwaji University Gwalior. Voucher specimens were prepared and deposited at the Centre (IOE-501 and IOE-505).

Composition of VG formulation: 1:1.

Preparation of VG kwath

3 gm of VG powder was suspended in 100 ml drinking water, kept overnight, boiled till 50% water is evaporated, cooled to room temperature and consumed on an empty stomach twice a day for six months under the supervision of an Ayurvedic Physician.

Biochemical parameters

The fasting and postprandial plasma glucose levels were monitored at monthly intervals, while the glycosylated hemoglobin (HbA1c), biomarkers of oxidative stress viz., Superoxide dismutase (SOD), catalase, reduced glutathione (GSH), Thiobarbituric Acid Reactive Substances (TBARS) and lipid profile, biochemical markers of kidney and liver functions were monitored at baseline, at the middle (3 month) and at the end (6 month) of the therapy.

Fasting and postprandial plasma glucose was estimated by the Glucose oxidase/Peroxidase method [22]. Glycosylated hemoglobin (HbA1c) was estimated by the ion exchange resin method [23]. Estimation of plasma total cholesterol by the Cholesterol oxidase Phenolaminophenazone CHOD-PAP method [24], triglyceride by GPO-PAP method [25], High density lipoprotein cholesterol (HDL) by Polyethylene glycol/CHOD-PAP method [26], Low-density lipoprotein cholesterol (LDL) and Very-low density lipoprotein cholesterol (VLDL) were calculated by the Friedewald formula, urea by the modified Berthelot method [27], uric acid by uricase/PAP method [28], creatinine by modified Jaffe’s kinetic method [29], Alanine transaminase (SGPT or ALT) and serum Aspertate transaminase (SGOT or AST) by the modified International Federation of Clinical Chemistry method [30], and bilirubin by method of L. Jendrassik [31] was assayed using standard kits from Crest Biosystems, Goa (India). Markers of oxidative stress such as super oxide dismutase (SOD) Winterbourn et al. [32], catalase by Sinha, [33], glutathione (GSH) Ellman et al. [34], and Thiobarbituric Acid Reactive Substances (TBARS) Ohkawa et al. [35] were checked.

Ethical clearance

The study protocol was duly approved by the Institutional Human Ethics Committee (JU/IHEC/2013-A/13).

Statistical analysis

Statistical analysis was carried out using a paired t test (Sigma stat 3.5). A p-value *p<0.05, **p<0.001 was considered statistically significant.

Results

Effect of VG therapy on hyper-glycemia

Table 3 shows the fasting and postprandial blood glucose levels at monthly intervals in subjects on “VG” therapy. A significant decrease was recorded for fasting (13.5% P<0.05), postprandial (15.0%, <0.001) glucose levels and glycosylated hemoglobin (9.8%) at the end of six months therapy.

Data are expressed as Mean ± SEM; *p<0.05; **p<0.001 compared to Base line values

HDL-High-density lipoprotein cholesterol; LDL-Low-density lipoprotein cholesterol; VLDL- Very- low density lipoprotein cholesterol; TC-Total cholesterol

Effect of VG therapy on lipidemia

Table 4 shows the results of the lipid profile of patients on “VG” therapy. Total cholesterol, triglycerides, LDL and VLDL were significantly decreased after six months therapy by 9.6%, 14.4%, 15.7%, and 14.4% respectively (P<0.05). HDL cholesterol was elevated from32.50±1.11 to 35.69 ± 1.02 (P<0.001).

Data are expressed as Mean ± SEM; *p<0.05; **p<0.001 compared to Base line values

HDL-High-density lipoprotein cholesterol; LDL-Low-density lipoprotein cholesterol; VLDL- Very- low density lipoprotein cholesterol; TC-Total cholesterol

Effect of VG therapy on biomarkers of oxidative stress

Significant (P<0.05, P<0.001), improvements in GSH level (from 1.98±0.17 to 2.59±0.21 mg/dl), SOD activity (from 0.63±0.05 to 0.94±0.08 μM/min/mg protein), catalase activity (from 7.64±0.24 to 9.44±0.23 μM/min/mg protein) were recorded. A significant decrease (P<0.001) in TBARS (from 457.19±8.09 to 415.15±7.47 (moles of Malondialdehyde/ml of blood) were recorded at the end of six months therapy.

Effect of VG therapy on markers of toxicity

The effect of “VG” therapy on kidney function was monitored by estimating urea, uric acid and creatinine levels in plasma at specified intervals during the course of therapy. The data presented in Table 5 showed significant (P<0.05), reductions in Urea (from 29.97±1.20 to 27.10±0.88mg/dl) and uric acid (from 5.08±0.20 to 4.67±0.20 mg/dl) and notable reduction in creatinine (from 0.78±0.06 to 0.73±0.05) at the end of six months therapy.

Data are expressed as Mean ± SEM; *p<0.05; **p<0.001 compared to Base line values

GSH: Reduced glutathione; SOD-Superoxide dismutase; TBARS- Thiobarbituric acid reacting substances.

Data are expressed as Mean ± SEM; *p<0.05; **p<0.001 compared to Base line values.

SGOT- Serum Glutamate Oxaloacetate Transaminase; SGPT- Serum Glutamate Pyruvate Transaminase.

Significant (P< 0.05), variations in biochemical markers of liver functions, namely bilirubin (from 0.83±0.06 to 0.70±0.04 mg/ml) and SGOT (from 22.47±1.61 to 18.00±1.04 IU/L) as well as SGPT (from 23.60±2.32 to 19.26±1.38 IU/L), at the end of six months was observed (Table 6).

Effect of VG therapy on hypertension and body mass index

Table 7 shows variations in systolic blood pressure (from 133.70±2.59 to 129.22±2.39 mmHg), diastolic blood pressure (from 81.70±0.97 to 79.56±0.93 mmHg) and body mass index (from 25.21±0.64 to 24.22±0.60 kg/m2) at the end of the six months therapy.

Discussion

Currently, plant based therapies (main or supplementary) are being used globally for the management of type 2 diabetes. In India, the indigenous systems of medicine viz., Ayurveda, Siddha & Unani employ plant based extracts for treatment of diabetes (Premeha in Ayurveda). Most of the Ayurveda based formulations depend on plants/herbs based decoctions, and powders. In the present study, administration of the aqueous extract of VG that consisted of equal amounts of the ingredients for over a period of 6 months to type 2 diabetic subjects resulted in significant improvements of altered biochemical markers. Significant alleviation in glucose homeostasis, as marked by noticeable changes in glycosylated hemoglobin, blood glucose levels, and lipid profile were observed. The G. sylvestre leaf extracts are reported to reduce hyperglycaemia in experimental animals [16], and human type II diabetics [17]. The G. sylvestre is reported to promote insulin secretion, probably by regeneration of pancreatic beta cells [17,18]. The gymnemagenin and gymnemic acids in G. sylvestre, showed to exhibit potent antioxidant, and hepatoprotective activities [36]. Ethanolic extract of G. sylvestre was reported to possess anti‑apoptotic potential in STZ‑induced diabetic cardiomyopathy, and affected the levels of leptin, insulin, dyslipidemia, apolipoproteins, lipids, LDH (serum lactate dehydrogenase) in experimental models [37]. Administration of deacylgymnemic acid DAGA (200mg/kg), a derivative of gymnemic acid reduced Systolic blood pressure and significantly improved the fasting plasma glucose and HOMA-IR (homeostatis model assessment insulin resistance) with marginal improvement in lipid profile [38]. The G. sylvestre is also reported to inhibit absorption of glucose from intestine. The atomic arrangement of gymnemic acid molecules is similar to that of glucose molecules and they reduce the blood glucose level by preventing the absorption of sugar molecule in the intestine. It is attributed by filling the receptor location in the absorptive external layer of the intestine by gymnemic acid molecules [39].

In a controlled study, an aqueous extract of the leaves of G. sylvestre, (GS4) when administered at the dose of 400mg/day, to subjects with insulin-dependent diabetes mellitus (IDDM), the insulin requirement came down together with fasting blood glucose, HbA1c and serum lipid levels soon after therapy. However, the GS4 administration failed to check glycosylated haemoglobin and glycosylated plasma protein levels on long term follow up. The GS4 therapy is reported to enhance insulin secretion rate, either by regeneration or revitalisation of the beta cells [40].

The effectiveness of GS4, further investigated as a supplementary drug to conventional oral anti-hyperglycemic drugs. Administration of GS4 (400mg/day) to 22 Type 2 diabetic patients receiving conventional therapy resulted in significant reductions in blood glucose and, glycosylated hemoglobin level. In addition, five of the 22 diabetic patients showed improved glycemic control with GS4 alone and were discontinue their conventional drug [17].

In another study, supplementation of the diet with G. sylvestre at the dose of 500 mg per day for a period of 3 months reduced polyphagia, fatigue, blood glucose levels with concurrent reductions in HbA1c, lipid profile suggesting beneficial effect of G. sylvestre supplementation in the management of diabetes mellitus [41].

Pterocarpus marsupium is traditionally used in Indian ayurvedic medicine for the treatment of diabetes and has been shown to control diabetes in experimental animals [42]. The phenolic C-glycosides present in P. marsupium regulated glucose homeostasis and significantly decreased the TNF-α level in experimental diabetes [43]. The phenolics, marsupsin, pterosupin, pterostilbene and (-)-epicatechin present in P. marsupium have been identified as the blood sugar lowering components [20,44].

The alcohol extract of the bark of P. marsupium Roxb shown to exhibit potent antidiabetic activity and corrected the metabolic alterations in diabetic rats [42]. Aqueous extracts of P. marsupium Linn significantly attenuated hyper insulinaemia as well as hypertriglyceridaemia and also prevented the alteration in metabolic patterns [45]. The Indian Council of Medical Research undertook an anti-diabetic phase II open trial at four centers across Indian using Vijaysar (Pterocarpus marsupium). Vijaysar was tested in newly-diagnosed or untreated non-insulin dependent diabetes mellitus (NIDDM) patients between 35 and 60 age for 12 weeks. Among the 93 patients who completed 12 wk of treatment, both the fasting and postprandial blood glucose levels fell significantly (P < 0.001), by 32 and 45mg/dl at 12 wk from the initial means of 151 and 216mg/dl respectively. Mean HbA1c Other laboratory parameters remained stable during the designated treatment period of 12 wk. Also, no side-effects were reported [46].

Our previous study done with the polyherbal formulation, “GSPF kwath” which contains Vijaysar and Gurmar as two of the ingredients has shown antidiabetic and antioxidative effects [13]. “GSPF kwath”, showed 23.5%, 26.7% and 11.7% reductions in fasting, postprandial blood glucose and HbA1c respectively. In the present study “VG” containing only two of the components of GSPF proved highly beneficial in restoring not only hyperglycemia but also lipidemia and antioxidative potential. The changes observed on glycemic, lipidemic and oxidative stress. Oral administration of “VG” therapy for 6 months had no adverse effects, either on kidney or liver functions and in fact showed a significant improvement in the functioning of these vital organs.

Conclusion

In conclusion, the “VG” administration to type 2 diabetic patients with varying degrees of glycemia, lipidemia and oxidative stress provide an efficient alternative to conventional antidiabetic drugs when coupled with active lifestyle and dietary changes. Significant decrease in biochemical markers viz., blood glucose, HbA1c, total cholesterol, triglycerides, LDL-cholesterol, and VLDL-cholesterol and higher values of HDL, following VG therapy are testimony to the anti-diabetic efficacy of VG. Further, the formulation did not show any adverse effects on liver and kidney functions and may be a potential natural and safe therapy for treatment and prevention of diabetic complications but randomized controlled trials are required to confirm these findings.

Acknowledgment

We thank M/S Dindayal Industries Ltd., Gwalior (M.P.) for the supply of the Vijaysaar and Gurmar powder and the financial support from AYUSH, New Delhi, (F.NO. Z.31014/02/2009/ EMR-CCARS) is duly acknowledged. We are grateful to all the human subjects who volunteered to participate in the study. Our profound thanks extend to colleagues of the laboratory and students for their unreserved support in conducting this study.

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Indian Exporters Eye Gains Amid Intensifying US China Trade Dispute

As work on establishing a massive garment-manufacturing unit by one of India’s leading apparel exporters enters the final stages, the company is optimistic about keeping the machines humming. Slated to begin production in August, Orient Craft’s new unit in Jharkhand, one of India’s least developed states, will employ about eight thousand workers. Inquiries from buyers in the United States, its biggest market, have increased in recent months as a trade dispute with China intensifies, according to A.K. Jain, who heads the Commercial department at Orient Craft. That is why he is upbeat about generating new business. “This is an unbelievable blessing in disguise,” he says. “It will give us an edge.” Exporters in India are reaping the benefits of the trade war between the world’s two biggest economies as business with both countries jumps, according to Ajai Sahai, who heads the Federation of Indian Export Organizations. “While overall exports have gone up by nine percent, exports to the U.S. have gone up by 13 percent and to China by 32 percent,” he says. And as the confrontation escalated last week after the two countries failed to reach a deal, his optimism increased. “Since the tariff hike is now substantial from 10 to 25 percent we feel we will have more advantage in market access.” India is among a handful of countries set to benefit from the U.S.-China trade dispute, a report by the United Nations Conference on Trade and Development stated in February. “The saying ‘it’s good to fish in troubled waters’ could apply to some bystander nations,” the report said, pointing out that most of the Chinese exports subject to U.S. tariffs will be captured by firms in third countries. While China has opened its doors wider to a range of agricultural products from India such as rice and sugar, exports to the United States have increased in areas such as chemicals, pharmaceuticals, jewelry, auto components and apparel. “In various products we were losing out to China with a very narrow margin. With the hike, we are able to offset that,” says Sahai. “That is why the tariff war has presented us an opportunity to enter markets in the U.S. in some areas we were hardly penetrating.” But even as Indian exports benefit, trade experts warn that clouds are also gathering over New Delhi’s trade relationship with Washington. In recent months, U.S. President Donald Trump has slammed Indian duties on some U.S. goods, saying that India is not providing “equitable and reasonable access” to its markets. Economists also warn that an eventual slowdown in global trade due to the U.S.-China trade spat will hit all countries including India, which is already staring at an economic slowdown Growth in the world’s fastest growing major economy flagged to 6.6 percent in the last quarter of 2018 – it’s lowest in more than a year. It is not expected to fare much better this year. The slump is blamed on slackening domestic consumption, which powers the Indian economy. Unlike East Asian countries, which have raced ahead on the back of exports, growth momentum in India is largely based on an affluent middle class snapping up goods such as cars, refrigerators, air conditioners and other consumer goods. But there are concerns as automobile sales, the barometer of consumption, plunged to the lowest in nearly eight years in recent months. At the Hyundai car showroom in the upscale business hub of Gurgaon, near Delhi, a range of swanky models beckon customers, but there are few to be seen. This is in marked contrast to the last three years when buoyant automobile sales helped India overtake Germany to become the world’s fourth largest automobile market. That prompted car makers such as Hyundai, Honda and Toyota to expand their presence in the country. “In recent years, March and April used to be good months. But now 20 to 30 percent drop is there in these months also,” says Gagan Arora, business head at the Hyundai showroom. “There is a slowdown in the whole industry. New buyers are not being added so frequently.” Economists say while rising exports to the United States and China present a silver lining, the first challenge facing India’s new government due to take office after vote counting in elections is completed this week, will be how to restore overall momentum to the economy and see why consumers are not so willing to open their wallets. from Blogger http://bit.ly/2WoDO7S via IFTTT

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