Role of Triphala Kwatha Gandusha in the management of Aphthous ulcer: A review study

Mukhapaka (Stomatitis) is a common ailment seen in general practice. The Pittaja Mukhapaka (Aphthous ulcer) is fully described in Ayurveda under the term Mukha rogas. Oral ulcers are estimated to impact 4% of the global population, with aphthous ulcers being the most frequent, affecting up to 25% of the global population. Psychological stress, hormonal impacts, dietary sensitivity, and nutritional insufficiency are the primary causes of Pittaja Mukhapaka (Aphthous ulcer). It is a painful and frequently recurring inflammatory disorder of the oral mucosa that can develop as a result of several well-defined disease processes. As a result, Gandusha is described as one of the key therapies in the Ayurvedic system of medicine for both preventing and treating oral cavity illnesses. Triphala (tri means three and phala means fruits) is an Ayurvedic preparation made up of three equal parts of Indian subcontinent herbal fruits: Terminalia belerica, Phyllanthus emblica, and Terminalia chebula. Triphala includes powerful antioxidants as well as other bioactive substances such as flavonoids, saponins, anthraquinones, amino acids, fatty acids, and different carbohydrates. As a result, it promotes the maintenance and promotion of oral hygiene by exerting a cleansing activity and strengthening the defence mechanism in the oral cavity. An attempt is made in this regard to discuss the role of Triphala Kwatha Gandusha in Pittaja Mukhapaka.

Characteristics of Oral Mucosal Lesions and Their Association with Socioeconomic Status and Systemic Health in A Remote Rural Area in China: A Cross-Sectional Study of 146 Cases

Background: Epidemiological data of oral mucosal lesions (OMLs) are required to develop practical oral care policies. However, limited data are available for rural areas in China. We aimed to estimate the spectrum and prevalence of OMLs and to identify their associated socioeconomic status (SES) and systemic health in a remote rural area in Yunnan, China. Methods: We screened patients for OMLs in an oral medicine clinic in rural Yuannan, China, from August 2020 to February 2021. OMLs were documented. SES, including the highest education level achieved and the previous month’s household income, as well as the patient’s systemic health, including a history of smoking, alcohol use, and chronic disease, were obtained from the Medical History/Health Questionnaire Form and patient medical records. Results: A total of 146 patients were found to have OMLs. The most frequent OML was aphthous ulcer (n = 41, 28.1%), followed by burning mouth syndrome (BMS) (n = 16, 11.0%), viral ulcer (n = 14, 9.6%), and oral lichen planus (OLP) (n = 9, 6.2%). In these patients, the most common chronic diseases were sleep apnea (n = 35, 24.0%), hypertension (n = 23, 15.8%), bronchitis (n = 16, 11.0%), reflux (including gastroesophageal reflux disease) (n = 12, 8.2%), and arthritis (n = 11, 7.5%). On adjusted regression, the patients without chronic diseases had a lower risk of BMS than those with chronic diseases (odds ratio [OR], 0.2; 95% confidence interval [CI], 0.03–0.9). Age was an independent protective factor for viral ulcers (OR, 1.0; 95% CI, 0.9–1.0). Patients with low-income levels had a lower risk of OLP than those with high-income levels (OR, 0.2; 95% CI, 0.05–0.9). Conclusions: In rural Yunnan in China, the most frequent OML was aphthous ulcer, which was followed by BMS, viral ulcer, and OLP. Chronic diseases were associated with BMS. Age was an independent protective factor for oral viral ulcers. A high-income level was associated with the presence of OLP. Oral care policies should be prioritized among patients with aphthous ulcer. Preventive strategy of BMS should be targeted to people with chronic disease for health equalities.

Comparative Evaluation of Efficacy of Jasminum grandiflorum with Honey and Corticosteroids in Management of Recurrent Aphthous Stomatitis- A Study Protocol

Aim: To determine the efficacy of J grandiflorum in the treatment of aphthous ulcer on the basis of reduction in size of the ulcer, erythema and pain. Study Design: Prospective, Observational. Place and Duration: Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Deemed to be University, Sawangi (Meghe), Wardha. Duration: One year. Methodology: One Hundred and Twenty patients visiting to the dental OPD and diagnosed to have aphthous ulcer will be selected. The patients will be divided in three groups and the formulated gel will be prescribed to one group of patient and other will be given corticosteroid and monitoring will be done. Expected Results: With all the studies performed till now it is expected that the j. grandiflorum and honey together will have good synergistic effect over aphthous ulcer and will help in reduction of size, pain and erythema level of aphthous ulcer. Conclusion: J grandiflorum and honey may be effective in management of recurrent aphthous stomatitis.

Development of Mucoadhesive Film-Forming Systems Containing Black Ginger Extract for Aphthous Ulcers

Film-forming systems (FFSs) were developed by using Eudragit® E100 as a film former. Kaempferia parviflora (black ginger) extract was used as an anti-inflammatory agent for aphthous ulcers. The FFS could rapidly form a thin film in only 5 s when it was applied to a wet surface e.g. an aphthous ulcer. When the FFS was applied to a dry surface, the FFS without extract could form a film in 2-4 min. The incorporation of this extract contributed to delaying the film-formation time in the dry state; hence, the film-forming time increased to 6-8 min. The mucoadhesive property of FFSs was verified with the wash-off method. To simulate oromucosal conditions, the FFSs were applied on a cellophane membrane coated with mucin and washed by phosphate buffer of pH 6.8. The formulations without mucoadhesive polymers could not withstand flushing with a medium for more than 8 min without dislodging. Therefore, three different mucoadhesive agents were trialed: PVP K90, HPMC E15 LV, and HPC SL. The highest adhesion results were obtained when HPMC was added at 5%(w/w) as well as, the residence time was 22 min. In vitro release of black ginger extract from FFS showed a gradual release for 2 h. This study indicated that the FFS with HPMC E15 LV was an appropriate alternative formulation as a local delivery system for an aphthous ulcer.

Observations on the clinical efficacy of rhaFGF combined with Vitamin B complex for patients with Severe Recurrent Aphthous Ulcer

Objectives: To observe the therapeutic effect of rha FGF combined with vitamin B complex on severe recurrent aphthous ulcers (RAUs). Methods: Ninety patients with severe RAU (grade III and IV) admitted to Chinese PLA General Hospital from May 2018 to May 2019 were selected and divided into two groups using a random number table, 45 patients/group. Patients in the control group gargled with a mixture of vitamin B complex (250 ml of 9% normal saline +250 ml of vitamin B complex +160,000 U of gentamicin +25 ml of lidocaine) after oral cleaning; patients in the observation group gargled with a mixture of the same ratio after oral cleaning and then sprayed rhaFGF on their oral ulcers. The clinical symptoms and treatment effects of the 2 groups within 1 week of medication were compared. Results: The total effective rate of treatment was 97.78% in the observation group and 82.22% in the control group; the difference was statistically significant (P <0.05). The time to ulcer pain disappearance and eating recovery and the ulcer healing time in the observation group were significantly shorter than those in the control group (P <0.05). Conclusion: rhaFGF combined with vitamin B complex has a significant therapeutic effect for patients with severe RAU; it can relieve pain and illness faster and shorten the healing time of ulcers. doi: https://doi.org/10.12669/pjms.37.7.4364 How to cite this:Sun H, Gao J, Li D, Li B. Observations on the clinical efficacy of rhaFGF combined with Vitamin B complex for patients with Severe Recurrent Aphthous Ulcer. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4364 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Novel poly herbal muco-adhesive formulation for treatment of oral aphthous ulcer

Background: Oral ulcers are the most frequent lesions that cause discomfort for which the patients seek treatment for alleviating pain and facilitate early healing. Various treatment modalities from modern medicine and Ayurveda are used in the form of ointments and mouthwashes with varying efficacy. Anti-inflammatory medicines, enzymatic preparations, gamma globulins and immune suppressants have been used.Methods: Extracts of five chosen herbs, Glycyrrhiza glabra, Acacia catechu, Punica Granatum, Curcuma longa and Mentha piperita were used for preparing mucoadhesive gel for the treatment of oral aphthous ulcers of any etiology. Gel was prepared by cold method of Schmolka at M/s Pharmanza Herbals Pvt. Ltd., India. Five formulations were prepared with using different concentration of active pharmaceutical ingredient (API) extracts.Results: Formulations were analyzed for different physical and chemical properties. Preliminary trial was done with five formulations. The F5 formulation has the premier viscosity because of its higher polymer content; it is able to remain on mucous surface long enough to release its API effect. Since the uniformity, proper appearance, stability and acceptable viscosity and gel strength the F1 formulation was selected as the superior formulation which could prove ideal for treatment of oral aphthous ulcers.Conclusions: The results provide strong evidence that polyherbal gel containing extracts of Glycyrrhiza glabra, Acacia catechu, Punica granatum, Curcuma longa and Mentha piperita on the basis of their analgesic, anti-inflammatory, antioxidant, wound healing, antimicrobial and local anesthetic properties can be used as an effective and safe alternative for the management of aphthous ulcers.

Development and validation of a new algorithm model for differential diagnosis between Crohn's disease and intestinal tuberculosis: a combination of laboratory, imaging and endoscopic characteristics

Background Sometimes in clinical practice, it is a great challenge to distinguish Crohn's disease (CD) and intestinal tuberculosis (ITB), we conducted this study to identify simple and useful algorithm for distinguishing them. Methods We retrospectively reviewed the medical history of the patients who were diagnosed as ITB or CD. We firstly identified ITB patients, and then the patients diagnosed with CD were matched by age, sex, and admission time in a 1:1 ratio. Patients who admitted between May 1, 2013 and April 30, 2019 were regarded as training cohort, and patients admitted between May 1, 2019 and May 1, 2020 were regarded as validation cohort. We used multivariate analysis to identify the potential variables, and then we used R package rpart to build the classification and regression tree (CART), and validated the newly developed model. Results In total, the training cohort included 84 ITB and 84 CD patients, the validation cohort included 22 ITB and 22 CD patients. Multivariate analysis showed that, positive interferon-gamma release assays (IGRAs), ≥ 4 segments involved, longitudinal ulcer, circular ulcer, and aphthous ulcer were confirmed as independent discriminating factors. Using these parameters to build the CART model made an overall accuracy rate was 88.64%, with sensitivity, specificity, NPV, and PPV being 90.91%, 86.36%, 90.48% and 86.96%, respectively. Conclusion We developed a simple and novel algorithm model covering laboratory, imaging, and endoscopy parameters with CART to differentiate ITB and CD with good accuracy. Positive IGRAs and circular ulcer were suggestive of ITB, while ≥ 4 segments involved, longitudinal ulcer, and aphthous ulcer were suggestive of CD.