Natural drugs industry bodies in India are searching to improve sales and acceptance of these types of conventional drugs amid India’s big force to develop into a hub for option therapies.
Rise IN Attractiveness For the duration of PANDEMIC
The COVID-19 pandemic has presented the choice medication field a raise.
Ayurvedic drug firms recorded far more than US$18 billion in sales in 2020, 4 moments the amount of money in 2014.
“During the COVID-19 pandemic, individuals observed that modern medication wasn’t handy for all people. There was a development of people today drinking herbal concoctions that produced people them sense superior, and it was so effortless. That designed folks have confidence in herbal cures,” claimed Ms Rajni Jain, co-founder of the Sansthanam Abhaydanam Ayurvedic Medical center.
As a end result of the pandemic, her ayurvedic orchard has grow to be extensively preferred, and now she and her team are looking at manufacturing their personal medicines in a bid to capitalise on marketplace-wide need.
The growth of the alternate drugs field has occur on the back of a concerted energy by the Indian authorities to increase the sector.
It created regulatory frameworks, delivers tax incentives and supplies study funding.
The establishment of a dedicated ministry to oversee all items substitute medicines in 2014 encouraged self-confidence among the quite a few initially-time customers and diminished counterfeit solutions recommended by non-licensed practitioners that experienced ailed the sector for many years, market gamers stated.
Mr Milan Mehta, secretary of the Ayurvedic Drug Suppliers Affiliation mentioned absent are the days when standard medication intended questionable unfastened powder.
“That may possibly be a marketplace at the village level. But at city amount and export – it’s given in suitable packaging with adherence to most current principles and laws expected by the regulators of India and abroad,” he claimed.
Improving Standards
Indian’s sector bodies want makers to adhere to the greatest techniques approved by the Earth Overall health Corporation (WHO) to strengthen exports.
They regard the WHO’s stamp of acceptance as very important for the intercontinental uptake of standard medication.
The worldwide health and fitness entire body is also keen to widen the use of classic medicine.
In April this year, the world wide health and fitness body’s director-basic Dr Tedros Ghebreyesus stated: “As nonetheless, the contribution of regular medication in direction of countrywide overall health techniques is not thoroughly realised. This international centre for regular medicine will be a highly effective auto for taking their journey ahead.”
WHO has also recognised India’s purpose in the world of option medication – it labored with the federal government to establish the region as the herbal drugs capital of the planet.
In March this 12 months, it established up the WHO World Centre for Traditional Medicine in Prime Minister Narendra Modi’s household state Gujarat.
In spite of the growing recognition and acceptance of ayurvedic medicine, practitioners of far more conventional drugs are sceptical, amid lingering issues more than excellent.
Lots of say substituting classic drugs for modern medication could guide to a community well being disaster.
The fact however is that by the WHO’s estimate, all around 80 for every cent of men and women about the entire world previously use conventional drugs.
Authorities hope that rigid regulation could be what will make sure the excellent of alternate medications and minimise wellness threats.
In March 2020, as the pandemic swept into the United States, I relocated my healthcare observe in suburban Detroit to my desktop personal computer, “seeing” people from the security of my house and theirs.
Some of my individuals wondered how I — a gynecologist — could deal with them on the internet. Would pelvic exams go virtual?
No. Pelvic tests have stayed in person. But my apply is staying on the internet.
Even with my early misgivings, the pandemic has now confident me that telemedicine has a definitive job in wellness care, together with gynecology.
I have been a practicing OB/GYN for virtually 5 decades and have put in the past 20 years specializing in menopausal medication, which signifies most of my people are center-aged or older women. Study confirmed that the bulk of my individuals — who’d experienced regular Pap smears for at least 30 many years — no more time desired annual Pap smears or pelvic examinations, which opened a door to my online practice.
As telehealth visits become far more common, here are strategies you can make the most of your consultation
Thanks to telemedicine, even at the height of the pandemic, I could overview patients’ histories, address their additional instant overall health problems, explore other pertinent clinical information, renew or adjust their prescriptions, and email them an get for a yearly mammogram or a bone density examination. They could print these paperwork and consider them to any exam facility in close proximity to them, with the results promptly faxed to me.
Still, with out analyzing each lady physically, I feared I was carrying out an incomplete occupation of being their gynecologist. But several months of good experiences with digital care, and a assessment of the appropriate professional medical literature published by the American University of Obstetricians and Gynecologists (ACOG), reinforced my belief that, in lots of women’s health visits, regimen pelvic tests and Pap smears contribute nothing to the ultimate treatment method of the patient.
Sufferers and medical practitioners who embraced telehealth through the pandemic dread it will turn out to be harder to obtain
The finest employs of telemedicine in gynecology are for menopausal session, suspected urinary tract infections, renewal of oral contraceptives, procedure of vaginal yeast bacterial infections and consultation for premenstrual syndrome, stated Cynthia Abraham, an associate professor at Icahn College of Drugs at Mount Sinai in New York. She formally reviewed the March 10 ACOG report.
The ACOG report even further defines circumstances in which only in-workplace consultations are appropriate, this kind of as fever with a vaginal infection indicators of an ectopic being pregnant, like pain in the pelvis, stomach or back again and significant vaginal bleeding. A further sign for a live take a look at is the failure of the distant come upon to resolve the issue. If telemedicine is not doing work, the default method is normally an in-individual evaluation.
The superior and bad about home clinical assessments
Much more commonly, anybody who is hemorrhaging, or possessing intense upper body ache, a seizure or other new symptoms that are frightening, or possibly major coronavirus signs and symptoms, should really go to a physician, in person, or to the nearest crisis area or urgent care facility.
I’ll confess that there have been some surprises on the web. At the time, I didn’t recognize a longtime client on the net in her residing room with out her makeup. Another female had a big, white chook on each individual shoulder and asked if I minded that she experienced her pets with her during the check out. I agreed that the Wellbeing Insurance Portability and Accountability Act most likely didn’t increase to companion animals.
A few patients stated I looked distinctive devoid of my white coat and tie. I also discovered that, for privacy motives, many individuals perform their appointments from their automobile — which is high-quality, as very long as they are not driving. And a person girl despatched me a “selfie” of her genital wart but accidentally applied the electronic mail handle I share with my wife.
Telemedicine also calls for a higher degree of patient duty than normal, in-workplace visits.
Numerous months back, a lady I’d been dealing with for decades known as complaining of intermittent vaginal bleeding various several years following menopause. I referred her to a colleague’s workplace for analysis and cure. But she was unvaccinated against covid-19 and determined to hold out many months right before last but not least looking at the doctor. When she ultimately made it in for a pay a visit to, she was identified with uterine cancer.
The good thing is for her, the most cancers had not spread outside her uterus, and she was handled effectively with robotic surgical treatment.
Telemedicine has labored well for my time-crunched people, many of whom have aging mothers and fathers or in-regulations who require their interest, an unwell wife or husband or partner who requires psychological assistance, children to elevate and often a total-time position they had been joyful to steer clear of driving to the business, parking and sitting down in a waiting home. For those people patients who have been hesitant to give up their yearly in-man or woman exam, I referred them to yet another women’s overall health expert for further care.
On the web medicine has proved so effective in the pandemic that the American Clinical Association and Medicare aid continuing coverage for distant visits even publish-pandemic. Other insurers frequently adhere to Medicare’s lead.
Telemedicine is booming for the duration of the pandemic. But it is leaving people at the rear of.
Right before using the total telemedicine plunge, I’d advise that sufferers do some study on possibilities, such as checking their wellbeing insurance policy provider’s insurance policies, ideally before any health and fitness crisis.
But in this new world of cyber appointments, individuals now have the alternative of a screening take a look at from their home to identify the severity of a challenge, with both fast reassurance and treatment method nearly, or timely referral to an emergency facility. This can help you save anxiety, time and cash for both of those the buyer and the overall health-treatment procedure.
Jerrold H. Weinberg is a physician in suburban Detroit and a Fellow of the American Faculty of Obstetricians and Gynecologists. He is doing the job on a book titled “A Male Gynecologist Goes By Menopause.”
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Crystal Pauley, a former physician assistant, didn’t believe in so-called chronic Lyme disease — until she became sick.
Many health care providers reject chronic Lyme disease as a diagnosis. One 2010 survey found that just six out of 285 primary care doctors surveyed in Connecticut — an epicenter for the tick-borne infection — believed that symptoms of Lyme disease persist after treatment or in the absence of a positive Lyme test.
When Pauley worked for the La Crosse, Wisconsin-based Gundersen Health System, she remembered hearing about a friend from high school battling chronic Lyme in Australia. But she had her doubts. “I’m working in the medical field,” she said. “We’ve never learned about that.”
Years later, Pauley has changed her mind. Pauley tested positive for Lyme in 2020. She suffers from unrelenting fatigue, joint pain and brain fog. She walks up stairs sideways because of the unbearable knee pain. Pauley said she has become “pseudo-Lyme literate” because of her own personal journey.
Pauley belongs to a cohort of patients with Lyme-like symptoms but negative test results or patients with positive test results who suffer from lingering symptoms long after treatment. They call it chronic Lyme disease, while the Centers for Disease Control and Prevention labels it as Post-Treatment Lyme Disease Syndrome (PTLDS). The CDC says there is no known treatment for the condition.
“Their symptoms are always real. They’re experiencing them,” said Dr. Joyce Sanchez, an infectious-disease associate professor at the Medical College of Wisconsin who treats Lyme patients with persistent symptoms.
“If someone is having physical symptoms and isn’t feeling listened to, then they’ll have mental health repercussions and then that will impact their physical well-being,” she said. “And then it’s a spiral that if you don’t address both components of health, you’re not going to make much progress on either side. And they will continue to feel sick.”
Wisconsin Watch talked with five Wisconsin patients, all women, who have been searching for validation and experimenting with personalized treatments as part of a long and sometimes grueling battle with the illness. The infection comes from tiny ticks primarily found in the northeastern United States, including in Wisconsin — which is a hot spot for Lyme, ranking No. 5 among states for Lyme cases in 2019.
One of the five tested positive for Lyme using a two-step testing recommended by the U.S. Centers for Disease Control and Prevention. Three others tested positive using a test not recommended by the CDC. The fifth woman was diagnosed as possibly suffering from the disease by a “Lyme-literate” practitioner.
Pauley, 37, who as a student cranked through medical textbooks, began having trouble remembering a simple medication direction. She put up sticky notes around her office to jar her memory.
Alicia Cashman, 57, runs the Madison Area Lyme Support Group. She recalled unbearable pelvic pain beginning in 2010. “This causes pain of a magnitude that makes you want to die,” she said.
The pain metastasized quickly. She felt joint pain, headaches, insomnia and extreme fatigue. “It was so bad that I just wanted to be in a dark room with no smell, no sound, no light. Your body has succumbed to this,” she said.
Shelbie Bertolasi, 47, is a stay-at-home mother in Waukesha with four children ages 5 to 24. Until about seven years ago, she was healthy and stuck to a workout routine.
Shelbie Bertolasi was diagnosed with Lyme disease in July 2020 after suffering for many years with a variety of medical issues, including sweats, joint pain, rashes, intestinal issues and a miscarriage of twins. A naturopath finally recommended a Lyme test after she visited numerous doctors who she says failed to take her symptoms seriously. “I just want people to understand that Lyme is real. It’s not in our head. I want doctors to understand. I told doctors about my brain fog. My regular doctor wouldn’t even believe me.” She is seen at her home in Waukesha, Wis., on Dec. 1, 2021. (Coburn Dukehart / Wisconsin Watch)
Bertolasi’s health steadily deteriorated starting in early 2015 when she miscarried twins. Then, she developed a high fever, with stomach and intestinal pain. She lost 30 pounds in a month due to constant diarrhea. Doctors flagged and treated excessive bacteria in her small intestine. She felt better but gradually was beset by continual pain in her joints, back, knees and hip.
Sometimes, she loses feeling in her feet. “It’s a nuisance when you’re in the middle of (driving), and you can’t feel the pedals that well,” she said.
Judy Stevens, 52, a former school counselor and psychotherapist from Wauwatosa, says shortly after the loss of her father, she was hit by joint pain, brain fog, insomnia, hair loss and night sweats. She was an athletic person, a cross-country coach at school and a triathlete.
None of these women recalled seeing a tick, except Jessica Croteau, who lives in Rice Lake. The 34-year-old noticed a tick on her neck in the summer of 2019 at home and started to have flu-like symptoms, but she tested negative for Lyme. Croteau suffered bouts of low-grade fever, a stiff neck and gastrointestinal problems. She ended up visiting the emergency room when her blood pressure spiked.
Going down ‘rabbit holes’
Often, chronic Lyme patients present multiple symptoms that make their diagnosis challenging. They bounce from one specialist to another to tackle each problem, but each diagnosis cannot explain all of the symptoms they are experiencing.
Cashman underwent an MRI because of her severe pelvic pain, and the results found two deflating ovarian cysts which can cause severe pain in the lower abdomen. But that diagnosis did not explain the unbearable pain that gravitated to her knees and to her head. She recalled that the swollen knee “got red hot to touch,” and she developed a fever.Cashman began to look for causes. “Not everything is Lyme, but everything can be (Lyme),” she said. “It’s a weird thing, but you got to go down these rabbit holes.”
Croteau saw specialists, including emergency physicians, a cardiologist, a kidney specialist and an immunologist. All the tests she took were negative for Lyme disease. She was told the problems may be related to psychological issues.
“So basically, it’s been a timeline of two years of not being taken seriously, just pushed away — either told I can’t do anything for you (or) there’s nothing really wrong with you,” Croteau said.
Judy Stevens, 51, was diagnosed with Lyme disease in July 2017, but thinks she may have had it since childhood. Her symptoms included brain fog, depression, insomnia, and she said she was often treated as a psychiatric patient by the more than 30 different doctors she saw. Prior to remission in 2020, she says she was taking more than 40 herbs and supplements a day. She estimated it cost her $25,000 to $50,000 a year to treat her Lyme disease. “It was a huge strain on us. I can’t even imagine not having the resources,” she said. “This is people’s reality. It’s really costly to get better and stay better.” She is pictured at her home in Wauwatosa, Wis., on Dec. 1, 2021. (Coburn Dukehart / Wisconsin Watch)
A medical provider suggested that she seek counseling and increase her dose of anti-anxiety medicine. But the pain in her joints and wrists were real, and her knuckles often got swollen. The brain fog made it hard for her to punch in a phone number correctly.
Bertolasi saw a pain specialist, a psychiatrist, a spinal therapist and a neurologist. They diagnosed her with SI joint dysfunction. Back surgery, therapy and exercise relieved some of her pain, but her knees continue to hurt. She was told, “You’re getting older, (so) things don’t work as well as they used to.”
Unsatisfied, in 2019, Bertolasi saw a rheumatologist who ordered several tests, including for rheumatoid arthritis and lupus, and the results were all negative. And the forgetfulness has persisted; she has left her phone in the refrigerator.
“You’re just surrounded by this dark (mental) fog, and you just don’t know how to navigate your way through,” she said.
After seeing around 30 specialists, Stevens had a bag of medications, including many prescribed psychotropic drugs. She went on those drugs, and her psychiatric symptoms got worse. However, she doesn’t blame doctors, who generally specialize in one area of the body or a family of diseases.
“When you have a whole slew of symptoms, it’s hard for the physicians to dig deeper,” she said.
Sometimes, patients with waning and waxing symptoms are labeled as malingerers who are faking symptoms to get attention. “This is very common with people with Lyme,” Stevens said.
Sanchez, the infectious disease doctor, worries that patients who do not get answers from mainstream medicine may gravitate toward unproven — and expensive — alternatives. But she sees no harm in some strategies that may offer relief, including meditation, tai chi, acupuncture or massage therapy.
No quick fix
Two of the five women interviewed by Wisconsin Watch have been diagnosed through the CDC’s two-step testing regimen: the ELISA test followed by the Western Blot, two different ways of looking for Lyme antibodies in the patient’s blood. Pauley tested positive for Lyme using the CDC’s recommended criteria, and Stevens tested positive on just one of the two tests.
Two others used a laboratory that administers the same tests but uses less-stringent criteria to determine whether a person has Lyme. Cashman and Bertolasi both tested positive through that testing. A 2014 Columbia University study found that some labs using their own criteria reported more false positive results — 57{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} — among people with no history of Lyme than the 25{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} false-positive rate using CDC criteria. Croteau used three different laboratories but tested negative each time.
With a Lyme disease diagnosis, Pauley took the standard treatment, doxycycline, for three weeks.
Judy Stevens is seen in the September 2015 photo when she says she was suffering from undiagnosed chronic Lyme disease. “I had lost 30 pounds and was almost put on a feeding tube. I clearly look very distressed and weak. At this time, I was diagnosed with an eating disorder, even though I was eating,” she said. Ten days later she had symptoms of Bell’s palsy in her face, and her husband took her to the emergency room because he thought she was having a stroke. She was told it was likely stress and was sent home. (Courtesy of Judy Stevens)
But when she completed the antibiotic therapy, she felt even worse. While her memory has improved, she has developed muscle pain, and her knees hurt even more. She felt tired, saying she could sleep 10 to 16 hours a day. But her doctor, following standard protocol, has told her she is done with treatment.
The same thing happened to Stevens. The doctor prescribed her 30 days of doxycycline and suggested that she seek a “Lyme-literate” doctor as she could not prescribe any longer course of antibiotics.
Stevens’ doctor followed CDC guidance, which recommends against prolonged antibiotic treatment, saying the harm outweighs the benefit. Sanchez echoed the argument, saying that doctors must weigh the risks and benefits of antibiotics, just like other prescribed medications.
“If we don’t see any plus side benefit to it, then we’re only exposing people to unnecessary risks,” she said. “Nothing comes with a free lunch. It’s important to be thoughtful about the right antibiotic at the right dose for the right amount of time.”
She also said some antibiotics could bring down inflammation as a side effect, making some patients feel better. This is also the point at which some patients begin experimenting with treatments that mainstream medicine does not recognize.
Sufferers try unconventional treatments
Cashman, living in Cataract, Wisconsin was also diagnosed with Bartonella, or Cat scratch disease, and went through five years of “systemic, holistic” treatments, which included a host of herbs, antibiotics, a high dose of vitamin C and supplements. She also received ozone therapy and laser therapy for pain relief. She is now nearly symptom-free, but still deals with spine stiffness.
Alicia Cashman shows a variety of treatments she uses for her chronic Lyme disease. Seen on her counter is a jar of homemade Japanese knotweed tincture, as well as a bottle of Dimethyl Sulfoxide (DMSO) and MSM power, which she puts into a homemade pain ointment — seen in the jar on the right. “We call it a ‘do it yourself disease’ because you have to be an active participant in your own healing,” she says. “I attribute my health today to doctors who were willing to work outside the box.” Photo taken Jan. 31, 2020. (Coburn Dukehart / Wisconsin Watch)
A bottle of A-Bart, an herbal supplement, is seen at the home of Shelbie Bertolasi in Waukesha, Wis., on Dec. 1, 2021. The bottle costs $90 and is just one of the many supplements Bertolasi takes to treat her chronic Lyme disease. “We spend tons and tons of money on treatments. There are things my family can’t do because of all the money we have to spend to treat the Lyme,” she says. (Coburn Dukehart / Wisconsin Watch)
Stevens found two Lyme-literate doctors in Wisconsin who are versed in both Western and alternative medicine. She said she was co-infected with Relapsing Fever, Babesiosis and Bartonella. She said her treatments are highly individualized, and her doctors tweak her therapies from time to time. At one point, Stevens was on more than 40 types of herbs and supplements.
“I’m living proof that I got better as a result of all those herbal treatments,” she said. “I was not on antibiotics for four or five months.”
Bertolasi turned to a Lyme-literate doctor who also treats one of her friends with similar symptoms. Besides Lyme, she was also diagnosed with Bartonella. She has completed a 14-month course of antibiotics. Now, besides taking herbal supplements, Bertolasi follows a strict diet excluding alcohol, dairy, gluten and sugar to reduce inflammation in her body.
Shelbie Bertolasi explains the variety of supplements she takes to treat her Lyme disease. Bertolasi has spent the past few years treating her symptoms with a variety of supplements, some of which cost anywhere from $30 to $90 a bottle. She estimates she spends about $500 a month on supplements. She is seen at her home in Waukesha, Wis., on Dec. 1, 2021. (Coburn Dukehart / Wisconsin Watch)
She said she is at least 80{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} better than about a year ago. Her memory has somewhat returned. Still, brain fog waxes and wanes — as does pain in her joints and lower back.
Croteau tested negative with three Lyme disease tests, but she was diagnosed by a Lyme-literate doctor with Bartonella and “questionable” Lyme disease. The doctor prescribed her doxycycline, triggering a severe reaction that Lyme-infected patients sometimes experience during treatment.
When Croteau found herself pregnant, the doctor suggested she take amoxicillin and clindamycin in low doses during her pregnancy. She stopped taking them after giving birth to her second child in late October 2021 and has been symptom free for the following two months. Croteau said her symptoms have returned since January, including fatigue and brain fog, neck stiffness, headache and nausea. She cares for her newborn at home and hasn’t started any treatment due to financial constraints.
‘A rich person’s disease’
Since chronic Lyme is not a recognized disease, it’s difficult to get insurance coverage, so patients are usually stuck paying out of pocket for treatment.
Pauley, who lives in Woodstock, Illinois, is still searching for affordable treatments.
Her dementia-like symptoms made it impossible to continue working as a veterinary assistant, and she quit her veterinary clinic job in 2020. Previously, she had quit her physician assistant job in La Crosse and moved back to Illinois.
“It was hard,” she said. “I went from the middle-upper class to the poverty line.”
She went to see a Lyme-literate doctor in Milwaukee in August, when she was also suspected to have Bartonella. Pauley was charged $525 per hour for the initial consultation fee, not counting testing fees and supplements. She was irritated to hear the doctor refer to it as “a rich person’s disease.”
“It’s hard to understand any doctors that charge like Beverly Hills lifestyle out in the Midwest,” she said. “We’re not celebrities, and I don’t get paid 30 million per film.”
Stevens said her average costs out of pocket range from $25,000 to $50,000 a year. “It was a huge strain on us,” she said. “This is why a lot of people can’t get better, because they can’t afford it.”
Cashman knows the financial burdens chronic Lyme patients bear, too.
She estimates she has spent $150,000 out of pocket for treatments that she and her husband — who also is a chronic Lyme patient — have taken over the years. Cashman has found ways to reduce the costs by, for example, buying pounds of ground herbs and making her own capsules at home.
Although all five women interviewed by Wisconsin Watch have tried unconventional treatments, they say they are skeptical about anyone who claims their chronic illness can be cured quickly.
Alicia Cashman leads a meeting of the Madison Area Lyme Support Group at the East Madison Police Station in Madison, Wis., on Feb. 8, 2020. About 13 other people were in attendance, some of whom had driven from more than an hour away. The group shared personal experiences with chronic Lyme disease. Also pictured is Olivia Parry of Madison, Wis. (Coburn Dukehart / Wisconsin Watch)
“(If it) is just a quick fix to make money, and I’m just very leery of it,” Bertolasi said.
And they are using their experiences to help others. Pauley has become an advocate for lower health care costs. Bertolasi is writing a Lyme-friendly cookbook to chronicle recipes that have worked for her.
Although Stevens said being a chronic Lyme patient is “like a full-time job,” she wants people to know there is hope.
“You can be in terrible shape, but you can get better,” Stevens said. “It’s really easy to go down the road of ‘poor me,’ but it is possible to get better. There is hope. You can reach remission.”
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by Zhen Wang / Wisconsin Watch, WisconsinWatch.org June 9, 2022
University of New South Wales (UNSW) researchers have made a much less expensive and fewer invasive different to traditional fertility treatment options that is now readily available at Sydney’s Royal Clinic for women.
In vitro fertilisation or IVF has been the founded remedy for infertility for a extensive time. Even so, this technique is pricey, and to promote egg progress ahead of extraction, it calls for sufferers to inject follicle-stimulating hormones (FSH) that can inflict considerable discomfort and lead to some health-related difficulties.
UNSW’s recently produced option to IVF, CAPA in vitro maturation (CAPA-IVM), involves retrieving immature eggs from the ovaries and maturing them outdoors the overall body, demanding less hormone injections at a reduced cost. The cure was created by Prof. Robert Gilchrist from UNSW Medicine & Health in Sydney, and Prof. Johan Smitz from Vrije Universiteit Brussel (VUB) in Brussels, Belgium.
“The IVM fertility method originates from UNSW laboratory analysis, so this is a great illustration of the lifecycle of investigate and the large variation it can make in people’s lives,” explained Gilchrist in a UNSW information launch.
“It is evidence that ‘bench-to-bedside’ research is alive and nicely in Australia,” he ongoing.
“I’ve labored for a lot of decades on this system with my analysis associates, and getting it translated into a fertility remedy available to individuals in Australia is quite fulfilling.”
Embryologist Ric Ross retains a dish with human embryos at the La Jolla IVF Clinic on Feb. 28, 2007, in La Jolla, California. (Sandy Huffaker/Getty Images)
How Do CAPA-IVM Solutions Work
Ahead of the discovery of CAPA-IVM, the in vitro maturation technique was not the advised variety of fertility procedure mainly because pregnancy prices following IVM ended up reduced than IVF.
“IVM has been all over for many years, but it’s by no means been pretty effective since it’s challenging to replicate what the ovary does in a laboratory,” explained UNSW Professor Bill Ledger from the Royal Medical center for Ladies.
“The trouble has been when you acquire an egg out of the human human body, it matures incredibly rapidly, even when it could not be ready to, but this new technique referred to as CAPA switches off the progression of the egg for 24 hours,” Ledger explained. “So it grows extra slowly, and it matures much more healthily. And it’s much more fertile when you introduce it to the sperm. It’s providing us a for a longer time window of time to function with the egg.”
Prof. Gilchrist mentioned that the CAPA-IVM treatments are comprised of two techniques that have been made to imitate the pure processes of egg development and maturation that manifest in the ovaries. To command egg maturation in cell cultures, CAPA-IVM adds a advancement factor called cumulin, which was uncovered by Gilchrist, and cAMP modulators—small signalling molecules that keep organic egg processes— to the egg cells.
”We have demonstrated that it is attainable to make improvements to egg high quality and embryo produce with next to no medicines, applying strong expansion aspects produced by the egg,” Gilchrist explained in the before UNSW launch that circulated CAPA-IVM.
The treatment was to start with tested on pigs, and then, after the trials showed improvements in egg high-quality and a doubling in embryo manufacturing when compared to existing IVM therapies, preclinical trials on human eggs have been launched. The preclinical trials had been done by Prof. Smitz from VUB’s Follicle Biology Laboratory in Brussels and showed related outcomes to the pig trials, with the high-quality of eggs improving and embryo generation raising by 50 percent.
A donated human embryo is witnessed through a microscope at the La Jolla IVF Clinic in La Jolla, Calif., on Feb. 28, 2007. The clinic accepts donated embryos from around the region through The Stem Cell useful resource, which are then presented to stem cell analysis labs for analysis. (Sandy Huffaker/Getty Visuals)
Long run of CAPA-IVM
Prof. Jeremy Thompson, from the University of Adelaide’s Robinson Study Institute said that the CAPA-IVM therapy was a substantial progression in fertility investigate.
“It will remove the have to have for a girl to inject herself with high doses of hormones for up to 12 times,” Thompson said. “Most importantly, it could give a lady nearly the very same opportunity of starting to be pregnant as with hormone-stimulated IVF.”
“A new randomised demo in Vietnam discovered pregnancy charges had been the identical with CAPA-IVM as they are in regular IVF, despite the fact that IVF patients experienced far more embryos to freeze,” Gilchrist stated.
Having said that, IVM therapies are not for everybody. It is estimated that only about 15 p.c of infertile women of all ages will be qualified for CAPA-IVM.
The ladies most effective suited for this cure involve individuals with polycystic ovarian syndrome (PCOS) and these who have been diagnosed with most cancers and urgently will need to get preservative action to safe their fertility. According to Fertility Specialists of WA, the hormone injections included in IVF can stimulate most cancers cells and bring about women of all ages with PCOS to produce the affliction ovarian hyperstimulation syndrome—swelling and soreness in the ovaries—.
Professor Michel De Vos at UZ Brussel said in the before release that the new cure would eradicate the risk of ovarian hyperstimulation syndrome.
“Young women experiencing cancer cure, who desire to preserve their fertility but usually don’t have time to freeze their eggs, will also profit from this breakthrough,” Prof. De Vos reported.
The Royal Hospital for Women was permitted by the Therapeutic Merchandise Administration to present CAPA-IVM procedure in 2021, producing it one of the initial 5 places to make the procedure out there. Additionally, this is Australia’s initially medical center outside the house of Perth to supply IVM solutions.
We have all listened to it: “Climbing is a risky activity.” Of class we should normally exercise caution and adhere to the very best safety techniques, but we can be wounded even when we do every little thing proper. Your muscle mass, tendons, ligaments, and nerves are all at possibility for long-term breakdown and injuries from overuse. Accidents and discomfort can restrict your satisfaction of our great sport and even shorten your athletic or leisure profession. Bottom line, climbing is an athletic action and you need to have to treat yourself like an athlete.
1 of the keys for remaining injury free is to increase your recovery concerning fitness center classes. When the standbys are icing, rest and foam rollers for improved restoration, the truth is that most of us want a lot more than that. Query is, which other therapies are truly worth the time, dollars and energy?
Weekend Whipper: Massively Runout on “Rhapsody,” 5.14 Trad
For Sustained Performance
Therapeutic massage therapy is the go-to for quite a few athletes for restoration, worry reduction and enhanced effectiveness. Does massage actually perform? Analysis is contradictory. A therapeutic massage can lessen blood pressure and stress when growing the perception of recovery. It can also quickly maximize flexibility. However a 2008 report in the North American Journal of Athletics Actual physical Remedy concluded that massage has commonly unsuccessful to demonstrate beneficial outcomes on sports activities performance and physiological parameters linked to muscle mass soreness. Therapeutic massage has also not been demonstrated to engage in a considerable part in rehabilitation of athletics accidents. So … it feels fantastic, but it’s possible not really worth the cash if restoration is the aim.
Chiropractic therapy is supposed to restore ordinary neology and biomechanics of the spinal and extremity joints. On the surface area, it’s simple to see how athletes could benefit from adjustments: peak overall performance can only be reached with exceptional mobility and nerve perform. Opponents of the exercise place out that these types of changes could trigger irregular spinal mechanics and muscle activation, therefore disrupting the intricate chain of coordinated movements required for most sporting activities, in particular climbing. Several scientific tests postulate the rewards of chiropractic care for sporting activities efficiency, but exploration is insufficient to convincingly support the statements. Most research are unsuccessful to exhibit statistical differences between athletes who have undergone chiropractic procedure and those who have not. The studies that do display favourable consequences from adjustments are modest, and the authors can only conclude that a probable association exists. A 2010 critique of chiropractic remedy and the enhancement of activity effectiveness in The Journal of the Canadian Chiropractic Affiliation concluded that it would be more exact for chiropractors to say that their tactics “may” indirectly have an impact on effectiveness. Chiropractic remedy feels good, but might not be the very best for ideal restoration.
Cryotherapy is the latest development in athletics restoration. The remedy destinations you in a specialised chamber for two to 4 minutes at temperatures beneath -148 levels. One more kind of cryotherapy takes advantage of a chilly wand to concentrate on trouble regions. Cryotherapy is considered to make improvements to mental and bodily well being, while quite a few of the probable positive aspects continue to be unproven. Preliminary scientific studies propose cryotherapy can reduce discomfort and inflammation, encourage tissue mend, enhance metabolic rate, strengthen mental states, address migraines, and even avoid an array of chronic conditions. A 2017 report in the International Journal of Sports Medication concluded that cryotherapy decreased muscle mass soreness 80 per cent of the time. Cryotherapy was also discovered to decrease entire-physique irritation and reduce systemic markers for muscle mass-cell problems. Even further analysis is required to locate the optimal duration and frequency of cryotherapy, but this is a remedy to hold an eye on.
She Forgot That Climbing Can Be Lethal And Texted Though Belaying
Cupping is 1000’s of a long time previous, employed through Asia to deal with pain and other ailments. Customarily for this cure, a glass cup is heated to create suction and placed on the pores and skin. More frequently, the cups are attached to a pump to develop the suction. The cups are claimed to carry connective tissue, loosen adhesions, increase blood move, and drain fluids and toxic compounds.
The 2018 Journal of Alternative and Complementary Medicine reviewed the results of cupping on 500 patients and concluded that no advice could be created for or against the method. However, it is tough to overlook a therapeutic method that has these types of deep historic roots
For Injuries-Rehabilitation Functionality
Dry Needling requires applying a thin filiform needle to penetrate the pores and skin and accessibility tender tissues. It was to start with proposed in the 1940s based mostly on Western medical tactics, and differs from acupuncture in design and style and philosophy. Dry needling is rooted in modern-day neuromuscular science and agony designs.
Most scientific studies examining dry needling as therapeutic procedure surmise that it is successful for lessening ache and could make improvements to harmony and toughness. The 2010 version of Acupuncture in Drugs: Journal of the British Medical Acupuncture Society concluded that dry needling may perhaps support keep rotator-cuff mobility and reduce the likely for injury, a salient point for climbers supplied our propensity for shoulder injuries.
Extracorporeal shockwave treatment is a reasonably new technological innovation that delivers shockwaves into soft tissues by means of a cylindrical handheld machine. The shock waves may well bring about microtrauma in deep tissue and encourage mobile fix of connective tissue. The remedy also might encourage the manufacturing of new blood vessels, enhance nutrient delivery and boost dissolution of calcium deposits fashioned by long-term damage. The treatment hyperstimulates the nerves that deliver discomfort indicators to the mind, diminishing nerve activity and minimizing suffering. More than longer periods of ongoing procedure, shockwave remedy may well activate a “reset” button to diminish discomfort perception and take care of serious tendinopathies. A 2014 study in the Annals of Inner Medication prompt that it is an underutilized remedy for shoulder conditions, which are historically hard to deal with.
Small-degree laser therapy is the application of gentle at red or around infrared wavelengths to specific tissues. The method may perhaps minimize agony and swelling as nicely as increase tissue repair and regeneration of weakened tissues. Gentle therapy has been made use of to take care of several illnesses, including arthritis, tendinopathies, and nerve-connected situations these kinds of as carpal tunnel. Lasers in Healthcare Science, a 2018 research by Fabio Lanferdini, identified that laser therapy could make improvements to VO2 kinetics and raise time to exhaustion. This may well be of individual curiosity to lead or multipitch climbers. Proponents encouraged a few to 4 classes for each week to raise mobile exercise and improve physiological problems. Provided that a substantial frequency of remedy is necessary, this remedy may perhaps be most effective reserved for particular accidents somewhat than continual exhaustion or ache.
Acupuncture is hundreds of several years aged, originating inside of Chinese medication and getting to be well known throughout the world. Acupuncture is used to treat a large array of situations and health conditions as nicely as psychological states. The method can supposedly help in ache perception and increase physical efficiency, toughness, cardio conditioning, and flexibility. A review in 2017 in the Journal of Complementary and Integrative Medicine demonstrated that acupuncture could even be used to cut down anxiety prior to competitiveness. Panic reduction would be of distinct use for athletes that are struggling to maintain a interesting head prior to an significant levels of competition.
E-stem or “Electrical stimulation” is the software of minimal-stage electrical frequencies to focused muscle groups. This procedure stimulates muscle mass contractions of lower depth and limited length, which is identical to what the athlete would do for the duration of lively-recovery physical exercise. Nevertheless, most scientific tests do not present convincing evidence for E-Stem’s usefulness. A 2014 report in the International Journal of Athletics Physiology and General performance as opposed electrical stimulation to energetic and passive restoration interventions. The report concluded that electrical stimulation was less powerful than energetic restoration and equivalent to passive recovery. Alternatively of throwing cash at the scenario, it may be better to commit 10 additional minutes at the finish of a training session carrying out a amazing down.
After Alzheimer’s disease, Parkinson’s disease (PD) is the second most common age-related neurodegenerative disease [1]. A PD diagnosis can be devastating for the person who has it and the family, who often would also be the caregivers. Moreover, despite the surgical and pharmacological interventions, the patient’s physical and mental health declines from a certain period after the onset of the disease.
PD is characterized by loss of dopamine due to dysfunctional dopaminergic neurons and can be classified as a hypokinetic disorder. Dopamine is not only directly involved in movement and cognition but also plays a broad role in many other nervous system processes. Therefore, the loss of dopamine can lead to a broad range of sometimes severe neuropsychological symptoms, including motor defects, cognitive impairment, and depression. The PD progression is divided into six stages, each associated with a distinct area in the CNS. The first stage appears due to the lesions/dysfunction in the lower medulla oblongata. It includes subtle symptoms like unilateral resting tremors and changes in facial expression. The second stage ensues with damage to the raphe’s lower nuclei, which manifests as motor symptoms affecting walking and posture. Stage 3 of the disease progresses to the substantia nigra, and patients begin to progress to motor symptoms such as difficulty balancing. The temporal mesocortex is affected in the fourth stage, followed by neocortical temporal fields. Many daily tasks are not possible, and even walking may need assistance. Finally, the cortex will be involved in stage 6, and patients are almost completely immobile and can have psychological manifestations such as hallucinations [2]. Although there are distinct stages of PD after diagnosis, initial symptoms of the disease (bradykinesia, resting tremor, and postural instability) are not present until approximately 70{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}-80{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of dopaminergic neurons have been damaged [3]. Due to this fact, PD is considered a disease with a long latency period as the diagnosis is not likely to occur for years after the initial damage. It is, therefore, essential to diagnose PD as early as possible. The physical progression of the disease through the CNS is accompanied by a drastic worsening of symptoms and a decrease in treatment effectiveness [2].
Oxidative stress leading to dopaminergic neuron dysfunction in the substantia nigra has been considered the most plausible cause of PD [4,5]. Reactive oxygen species (ROS) can activate the caspase cascade in mitochondria, resulting in the cell’s death [6]. Heavy metal poisoning, for example, often results in the accumulation of these toxins in the nigra material, resulting in reactive oxidative harm [2].
In addition, alpha-synuclein aggregation is a common finding in PD. These aggregations are harmful to dopaminergic neurons and may cause the formation of Lewy bodies (LB) and eventual necrosis [4]. The formation of LB can trigger a cascade of events. In a non-pathological state, LB aggregates are usually scavenged by a proteasome complex or lysosome. However, defects in these scavenging pathways are common in PD, which causes a further spread of aggregates [2]. LB are considered a defining pathological characteristic of PD and are also commonly found in dementia. It has been assumed that the initial alpha-synuclein travels through the vagus nerve, the major parasympathetic unit, from the enteric nervous system [2].
A cytochrome P450 2D6-deficient individual is nearly 2x more likely to develop PD in the presence of pesticides [2]. The normal function of this cytochrome is to metabolize pesticides, and the deficiency leads to the build-up of toxins. In addition, the presence of any ROS is likely to increase the risk of developing PD [2].
Antioxidants, natural sources, have recently gained popularity in combating the effects of ROS. The Zingiberaceae family contains the rhizome turmeric (Curcuma longa). For centuries, it has been used in India, China, and Southeast Asia for flavoring, food processing, coloring, and as traditional medicine [7]. Turmeric has long been used to treat rheumatism, eye infections, and liver problems [8]. Curcumin, turmeric’s active ingredient, has antioxidant, anti-apoptotic, and anti-inflammatory properties that protect tissues from the harmful effects of ROS [9]. The phenol moiety, which donates a proton to ROS, is thought to be responsible for curcumin’s antioxidant properties [8]. Curcumin also protects against A53T α-synuclein aggregation and monoamine oxidase B, becoming a compound of interest in treating neurodegenerative disorders such as PD [10,11]. Curcumin has been found to protect nigrostriatal dopaminergic neurons from damage in animal models. Curcumin had protective effects on alpha7-nicotinic acetylcholine receptors after administration of 6-hydroxydopamine (6-OHDA) in rats with a curcumin dose of 200 mg/kg [12]. Curcumin restored nigrostriatal dopamine neurons to 87.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} and 84.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} after low-dose 11-methyl-4-phenyl-1, 2, 3,6-tetrahydropyridine (MPTP) administration, compared to 49.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} in the MPTP group [3]. The use of tyrosine hydroxylase (TH) immunohistochemistry to determine dopamine denervation in coronal parts of the brain [12] further confirmed these findings [3].
The measurement of accurate biomarkers has become highly significant due to the long latent time between the onset of dopaminergic neuronal failure and PD symptom onset. Biomarkers to monitor the potential diagnosis of PD include neurochemical biomarkers and neuroimaging biomarkers. There are various risk factors associated with an increased likelihood of developing PD. A family genomic PD occurs earlier, but this accounts for only 10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}-15{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of all PD cases [2]. This indicates that a significant environmental factor plays a role in the pathology of PD. Any environmental factor that causes dopaminergic cell death may be considered a risk factor for developing PD.
Prevalence of PD in different ethnic groups
PD is a global condition affecting people of all races and ethnicities. However, Wright et al. examined ethnic disparities and proposed that the prevalence of PD is higher in Caucasians than in African and Asian populations. As a result, there are known differences in PD incidence between Caucasians and Asians. Wright Willis et al. [13] found that Caucasian Americans had a higher incidence of PD than African Americans and Asians in a population-based study of Medicare recipients over 65 in the United States. In a study, Pringsheim et al. [14] observed a substantial difference in the prevalence of PD between Asia (646/100,000) and North America, Europe, and Australia (1601/100,000) in the population aged 70-79 years. According to these age-based studies, there is a variation in the prevalence of PD in different races at different ages.
Wright Willis et al. [13] support their claim with data from a population-based survey of over 65-year-olds in the United States conducted between 1995 and 2005, including over 450,000 PD cases per year. According to the findings, the prevalence of age-standardized PD (per 100,000) in white males was 2168.18 (95.64), 1036.41 (86.01) in blacks, and 1138.56 (46.47) in Asians. In a meta-analysis of the prevalence of PD by Pringsheim et al. [14], a significant difference in prevalence by geographical location and age (70-79 years of age) between 1985 and 2010 is noted. The results reported a prevalence of 1,601/100,000 in individuals from North America, Europe (including France, Italy, Spain, the Netherlands, and Germany), Australia, and South America (including Brazil, Uruguay, Argentina, and Bolivia), compared to a prevalence of 646/100,000 in individuals from Asia (including India, Taiwan, Hong Kong, Korea, China, Japan, Singapore, and Saudi Arabia) (P < 0), thus concluding that the prevalence of PD was much lower in Asia than in Europe, North America, and Australia. However, there is still a large variability in results in existing studies, so there is still much debate. This is due to other factors such as geographical location, cultural beliefs, and practices.
The data reported by Wright Willis et al. [13] and Pringsheim et al. [14] show that the highest prevalence of PD is in the white population, as with most existing studies. However, it is important to note [15] that other factors beyond ethnicity affect the prevalence of PD. They proposed that geographic area, rather than race, may be a more important determinant of PD prevalence. For example, the prevalence of PD in Black Africans in sub-Saharan Africa (40/100,000) is much lower than in people of African descent in the United States. In addition, the results of age-based studies may also be confused by cultural beliefs. For example, Dotchin and Walker [15] reported that many Chinese Americans viewed Parkinsonian symptoms as a consequence of aging, leading to delayed diagnosis. This could be a point of argument that PD prevalence is the same across ethnic groups. Nagashayana et al. [16] reported that the use of Ayurveda in Indian people impacts the presentation of PD symptoms and could potentially improve the outcome of the disease. Therefore, cultural practices also have a significant role in the prevalence of PD. In addition, Ben-Joseph et al. [17] noted that there is little public evidence of differences in the prevalence of PD in different ethnic groups that accommodate health inequalities, cultural practices, and geographical location. It is, therefore, imperative to note that while there is still evidence that PD claims are more prevalent in Caucasians than in the rest of the world, it is not yet sufficient in its bulk to make a firm conclusion. These differences among races should also alert healthcare providers when they are evaluating patients of different ethnicities as the appearance and presentation of disease may be variant. Providers must be cognizant of these variations to prevent missed diagnoses.
However, we cannot say that the difference is due exclusively to these two factors; we must also consider sociocultural differences. According to Dotchin and Walker [15], many Chinese Americans believe that Parkinsonian symptoms are a result of aging. This illustrates that different societies have different meanings of disease. As a result, there is a delay in diagnosis, and, as a result, the findings of age-based research are muddled. Furthermore, there are documented inequalities in access to advanced healthcare based on race and ethnicity [17]. As a result, the medical community needs to accept and investigate allopathic treatment practices as viable for treating conditions like PD. This is because they can have a higher uptake in some populations, reducing symptom incidence and disease progression. Nagashayana et al. [16], for example, found that the use of Ayurveda in Indians affects the presentation of PD symptoms and could potentially enhance the disease’s outcome. This variation may be a result of the additional benefits of curcumin.
Current allopathic treatments for PD
Unfortunately, there is currently no curative treatment for PD. There are, however, a variety of ways to treat the symptoms and improve one’s quality of life. Currently, both medications are designed to compensate for dopamine deficiency by either increasing dopamine levels, acting as dopamine agonists, or inhibiting dopamine metabolism. Common medicines include levodopa (L-dopa, L-3,4-dihydroxyphenylalanine), selegiline/rasagiline, entacapone/tolcapone, rapamycin, and adenosine A2A antagonists [2]. Surgery is a potential treatment, but it is used as a last resort when other methods are exhausted.
For this reason, it is only used in patients with highly advanced PD who are no longer able to manage their symptoms with drugs. Surgical intervention is a deep stimulation of the subthalamic nucleus of the brain [2]. Since advanced PD does not respond to levodopa, gene therapy for PD has been a developing area of research over the last decade. Target genes include aromatic amino acid decarboxylase (AADC) and glutamic acid decarboxylase (GAD) [2]. All of the traditional allopathic PD therapies have been designed to treat symptoms. Since they are less effective in treating advanced PD, we believe that a holistic approach could provide a better prognosis for these patients.
Levodopa
Tyrosine-based levodopa is a precursor to dopamine and is one of the most effective treatments for PD. Levodopa is converted to dopamine by the enzyme dopa decarboxylase.
However, this could be problematic because the enzyme could have decarboxylated orally administered levodopa before it reaches the CNS and would, therefore, not have been able to cross the blood-brain barrier. Carbidopa or benserazide is administered in conjunction with levodopa to ensure that it is not decarboxylated before the blood-brain barrier is crossed and the CNS is reached. Carbidopa and benserazide are classified as peripheral decarboxylation inhibitors. Carboxylated levodopa, combined with these inhibitors, can reach the CNS and decarboxylated to dopamine by serotonergic neurons [18,19].
Monoamine Oxidase (MAO) Inhibitors
MAO is the oxidative deamination and neurotransmitter degradation enzyme responsible for catecholamine families. Selegiline and rasagiline are included in this class. The dopamine metabolism can result in neuronal damage in dopaminergic neurons as a byproduct of oxidative deamination caused by the growth of ROS. However, those neurons are also protected against other ROS damage from dopamine metabolites by inhibiting the degradation of dopamine and not only by increasing dopamine function throughout the CNS [20].
Catechol o Methyltransferase (COMT) Inhibitors
COMT is a brain enzyme responsible for the inactivation of levodopa via methylation. Entacapone and tocapone inhibit COMT and thus prevent the inactivation of levodopa. These drugs may allow the levodopa dose to be effective for a more extended period of time [2,18].
Autophagy Upregulators
Part of the pathophysiology of PD is the accumulation of protein aggregates and LB. Autophagy refers to a cell’s ability to destroy dysfunctional or pathogenic components. Rapamycin is a drug that can enhance the autophagy of neurons by inhibiting kinase mTOR (mammalian target of rapamycin). Therefore, the potential treatment of PD could be considered as reducing the accumulation of protein aggregates in the subthalamic nucleus [21].
Adenosine A2A
Adenosine A2A is a CNS receptor that antagonizes dopaminergic neurotransmission [22]. Adenosine A2A receptor antagonists such as caffeine have shown remarkable results in laboratory studies with transgenic mice and, more recently, in humans. Transgenic mice with mutant alpha-synuclein have been protected from PD if their adenosine A2A gene has also been removed [23]. Istradefylline has shown tremendous promise in reducing “OFF” time in PD patients. “OFF” time is considered to be the period during which PD patients return their motor symptoms and dyskinesia. Generally, “OFF” time increases the longer the patient has PD, more specifically, the longer the patient has been treated with levodopa [22,24]. Therefore, the combination of istradefylline and levodopa therapy is likely to reduce “OFF” time in advanced PD patients effectively.
Deep Brain Stimulation (DBS)
DBS is considered only when PD symptoms are extremely advanced and can no longer be controlled adequately with oral medication. Generally, DBS targets the subthalamic nucleus through an electrical stimulator using radiologically guided intracranial electrodes [25]. The diseased neuronal pathways would be either excited or inhibited by this electrical excitement. The release of dopamine could be activated through this process [25]. However, the risk of post-DBS infection and waiting time for treatment are high for PD surgery [2].
Gene Therapy
Patients with PD have shown a decrease in AADC, leading to less conversion of levodopa (L-DOPA) to dopamine. Because of this, the upregulation of this gene combined with sufficient levodopa intake would be beneficial for PD symptoms [2]. GABA is a neurotransmitter inhibitor. GAD helps GABA-ergic neurons produce more GABA. The lack of dopamine in PD triggers a chain of events that result in unnecessary muscle contractions and motor symptoms. These symptoms could be reduced by the upregulation of GAD and the subsequent increase in the inhibitory GABA neurotransmitter [26].
An alternative approach: curcumin and its neuroprotective effects
Curcumin’s Mode of Action
Curcumin’s protective properties start with its ability to cross the blood-brain barrier due to its lipophilic nature [27]. Curcumin has various protective properties in the brain, including protection against toxic metals and ROS. Toxic metal ions can interfere improperly with tissues in the brain, causing neurological damage. Curcumin, as a flavonoid, has antioxidant properties that are potentially stronger than typical antioxidants such as vitamins C and E [3]. The brain is more susceptible to oxidative damage than other body tissues because it absorbs a higher percentage of oxygen (around 20{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) than other tissues. With too much oxygen, the formation of ROS such as peroxide accumulates over time, resulting in lower mitochondrial density, lower overall ATP output, and a decreased ability to sustain intracellular ion concentrations, ultimately leading to neuron death. Curcumin’s ability to donate an H ion from the beta-diketone moiety is thought to be responsible for its anti-ROS properties [28]. Curcumin protects mitochondria and neurons from the damaging effects of ROS by donating an H ion. The development of LB is related to the onset of PD. Alpha-synuclein oligomers clump together to form LB. Curcumin has been shown to prevent alpha-synuclein oligomer aggregation [28].
Protecting Effects of Curcumin in Animal Atudies
In one study, intrastriatal 6-OHDA injections were administered to rats to induce parkinsonism. One group received 200 mg/kg of curcumin over four weeks, but not the other. A reverse response to cognitive impairment was used to determine. Average control groups over the 30-minute test averaged 8.9 ± 5 turns. The rats treated with 6-OHDA had, on average, 257.8 ± 23.4, which was considerably superior to control. There has been a significant reduction in turns with just 126.9 ± 23.8 turns in the group administered with 6-OHDA and curcumin during the 30-minute test. Following the experiment, TH antibodies stained the brains of the test animals. The staining density was used to determine the amount of fibers that produced dopamine left after each treatment.
In contrast to the control group, the curcumin rat kept 32.46{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} ± 4.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of its fibers (98.29{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} ± 5.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}). In the group with 6-OHDA without curcumin, the control was only 7.14{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} ± 3.2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} [29]. In another animal study, MPTP administration of parkinsonism was applied to rats. MPTP was given to the first group only, MPTP + 1 mg/kg of curcumin to the second group, and MPTP + 2 mg/kg of curcumin to the third group. All test groups were assessed the total movement distance in 10 minutes. The group treated with MPTP alone had a 32.0{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} decrease in movement over control. The MPTP + 1 mg/kg curcumin-treated trial group only saw a 59.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} increase, with MPTP + 2 mg/kg curcumin movement increasing by 136{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} over the control group. The experiment involved taking brain sections and the analysis of TH antibody expression. The group without curcumin but administered MPTP experienced an increase to 42.9{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} from the control of TH expression. The MPTP + 1 mg/kg group of curcumin has increased to 60.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, and the MPTP + 2 mg/kg of curcumin has increased to 74.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} compared to the control group. The dose-dependent response of curcumin has become clear in this study [30].
Limitations of the study
The differences in the prevalence of PD among different ethnicities are reported in many studies. Researchers have found that genetic factors, geographical location, and cultural practices all play a significant role in the presentation, diagnosis, and management of this complex disease. Though we speculate curcumin consumption as a significant determinant of the observed differences in the prevalence of PD, future studies directly comparing the dosage with the prevalence of PD would provide unequivocal evidence for the protective role of curcumin in PD. Current allopathic treatments are discussed in Table 1.
Allopathic Treatment
Mechanism of Action
Adverse Effects
Levodopa
Dopamine precursor (given with carbidopa to decrease peripheral metabolism)
