Study to Evaluate efficacy of Vajravatakmandura in Iron Deficiency Anemia in...

[Full title: Study to Evaluate efficacy of Vajravatakmandura in Iron Deficiency Anemia in Adolescent Girls - A Randomized Controlled Trial]

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ISSN: 2456-3110 ORIGINAL ARTICLE Jan-Feb 2018 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2018 | Vol. 3 | Issue 1 26 Study to Evaluate efficacy of Vajravatakmandura in Iron Deficiency Anemia in Adolescent Girls - A Randomized Controlled Trial Rashmi Pareek, 1 Nisha Kumari Ojha 2 1 Assistant Professor, Shri Bhanwar Lal Dugar, Ayurveda Vishwa Bharti, Sardarshahar, Rajasthan, 2 Assistant Professor, PG Department of Kaumarbhritya, National Institute of Ayurveda, Jaipur, Rajasthan, India. I NTRODUCTION Anemia is a major public health problem worldwide and is often ignored in both developed and developing countries. Preschool children, pregnant Address for correspondence: Dr. Rashmi Pareek Assistant Professor, Shri Bhanwar Lal Dugar, Ayurveda Vishwa Bharti, Sardarshahar, Rajasthan, India. E-mail: rashmi.pareek 007@gmail.com Submission Date : 16/02/2018 Accepted Date: 25/02/2018 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.v 3 i 01.11635 women and adolescents constitute vulnerable group of anemia. Anemia may result in reduced growth and increased morbidity. Further, it causes important health and social and economic consequences, hampers cognitive development, reduce physical work capacity. Adolescence is a vulnerable period in the human life cycle for the development of nutritional anemia which affects both sexes and all age group. Particularly in developing countries, among adolescents, girls constitute most vulnerable for anemia. Adolescence is the formative period of life where maximum amount of physical, psychological and behavioral change takes place. The prevalence of anemia among adolescent is 27% in developing country and 6% in developed country [1] A A B S T R A C T Background: Anemia in adolescent girls possess greatest burden on their health as it leads to poor cognitive development, poor reproductive health and if not treated may lead to intrauterine growth retardation in their developing fetus. The prevalence of anemia among adolescent is 27% in developing country and 6% in developed country. By looking at the magnitude of the problem, an Ayurveda drug Vajravatakmandura has been selected for the study and the present study was undertaken to evaluate the efficacy of the trial drug in iron deficiency anemia in adolescent girls. Material and methods: 100 subjects satisfying inclusion and exclusion criteria were selected and were randomly divided in two groups. In group A, the trial drug Vajravatakmaņdura was administered and in group B, IFA tablets were given for two month of duration with follow up at every fortnight. Result: Both the trial and control groups showed extremely significant result over subjective parameters. Trial drug Vajravatakmaņdura in group A was found more effective over the subjective parameters - weakness, palpitation, pallor and loss of appetite with % gain of 39.77%, 39.39%, 39.17%, 38.09% respectively. Statistical analysis between before and after treatment findings of objective parameters, extremely significant (P<0.0001) improvement was found in both groups in all parameters, except for RBC count in group A, which was significant. No adverse effects were reported during entire period of study by any of the patients in trial group treated with trial drug . Conclusion: The trial drug “ Vajravatakmandura” is effective, safe and palatable for the management of iron deficiency anemia in adolescent girls. Key words: Anemia, Adolescent Girls, Iron Deficiency, Pandu Roga, Ayurveda.

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Rashmi Pareek et.al. Study to Evaluate efficacy of Vajravatakmandura in Iron Deficiency. ISSN: 2456-3110 ORIGINAL ARTICLE Jan-Feb 2018 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2018 | Vol. 3 | Issue 1 27 study which was conducted in the rural areas of Tamilnadu revealed that the prevalence of the anemia among the adolescent girls as 44.8% [2] Another study, conducted among the girls, who belonged to the low income families in Lucknow, revealed that 67% of the adolescent girls were anemic [3] Anemia in adolescent girls possess greatest burden on their health as it leads to poor cognitive development, poor reproductive health and if not treated may lead to intrauterine growth retardation in their developing fetus. The Government of India has launched National Anemia Control Programme, to prevent and control anaemia in children and adolescents. Iron and folic acid (IFA) tablets are supplied free to all children, adolescents and pregnant mothers by means of dispensaries and ASHA workers. But the problem is still persisting because of many issues like - poor palatability, intolerance to the drug used, poor absorption of the drugs used, constipation, discoloration of stool, unpleasant odor etc. result in poor compliance and therefore non adherence to the therapy which finally results in poor improvement. Also the taste and side effects of presently available drugs are not suited to children and adolescence. By looking at the magnitude of the problem greater efforts are needed to develop and implement program both to prevent and control anemia with a better and palatable drug with good taste and easy administration. In Ayurveda, symptoms of Iron deficiency anemia are described under Pandu Roga . In Ayurveda, a lot of different types of formulations are available for the management of Pandu Roga (anaemia). With this view, the present study entitled “A Study to Evaluate Efficacy of Vajravatakmaņdura in Iron Deficiency Anemia in Adolescent Girls: A Randomised Control Trial” was conducted. O BJECTIVES OF THE S TUDY The present research work was undertaken with following main objectives: 1 To evaluate the clinical efficacy of an Ayurvedic compound “ Vajravatakmandura ” in the management of Iron Deficiency Anemia in adolescent girls. 2 To establish clinical safety of the study drug. M ATERIAL AND M ETHODS Study type: Randomized Controlled Trial Masking: Open label Control: Controlled (IFA Tablets) Duration: 8 weeks End point: Safety and Efficacy No. of groups: Two Sample size: 100 T IMELINES Total trial period: 8 weeks Washout/Preparatory Period: 4 weeks (if required) Follow-Up period: 4 weeks Selection of Cases Source: Female subjects attending the O.P.D. and I.P.D. of Kaumarabhritya, PG Department of National Institute of Ayurveda, Jaipur and from various schools situated in Jaipur by survey method were screened for the present study Age Group Adolescent girls of 12-15 years of age were selected for the study. Grouping of patients Total 100 cases will be divided into two groups (50 in each) Group A: Trial drug (Vajravatakmandura) (50 cases) Group B: Control (IFA Tablets) (50 cases) Inclusion Criteria 1 Adolescent girls aged between 12-15 years. 2 Adolescent girls with iron deficiency anemia (Hb 8 g.-12 g.%). Exclusion criteria 1 Adolescent girls suffering from major systemic illness necessitating long term treatment.

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Rashmi Pareek et.al. Study to Evaluate efficacy of Vajravatakmandura in Iron Deficiency. ISSN: 2456-3110 ORIGINAL ARTICLE Jan-Feb 2018 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2018 | Vol. 3 | Issue 1 28 2 Adolescent girls with evidence of malignancy. 3 Adolescent girls with concurrent serious hepatic dysfunction (defined as AST and/or ALT>3 times of the upper normal limit) or renal dysfunction (defined as S. creatinine>1.2 mg/dl) uncontrolled pulmonary dysfunction (asthmatic and COPD subjects) 4 Co-morbidity like TB, UTI and bleeding disorders etc 5 H/o hypersensitivity to any of the trial drug or their ingredients 6 Adolescent girls who have completed participation in any other clinical trial during the past six months Assessment Criteria For assessment of the efficacy of the trial therapy, following parameters were adopted- Subjective: Based on clinical features of anemia according to both modern and Ayurveda parameters on the basis of presenting features on four point scale. Objective: Laboratory findings were assessed before and after treatment. Hb%, CBC, PBS, Stool routine and microscopic. Adverse effects To rule out the possible adverse effects of the trial drug, record of information was maintained on every follow-up i.e. gastric irritation, gastric upset, constipation, diarrhoea, teeth discoloration, other untoward effect if any. Study Drug : Vajravatakmaņdura [4] Vajravatakmandura is an Ayurveda herbo-mineral formulation for the treatment of Panduroga . The trial drug Vajravatakmaņdura was prepared in the attached Pharmacy of the institute. The compound was modified to make it in tablet form for easy administration to adolescent girls. Takra (butter milk) as mentioned in original text was taken as vehicle of the trial drug. (Schedule of the treatment is as shown in Table 1) Table 1: Showing schedule of the treatment Group A (n=50) Group B (n=50) Trial drug ( Vajravatakmaņdura ) Control drug (IFA tablets) Dose 500 mg in two divided doses 100 mg elemental iron and 500 mcg folic acid Dosage form Tablet Tablet Route Oral (After meals) Oral (After meals) Anupana Butter milk Water Duration 8 weeks 8 weeks IEC Approval Institutional Ethics committee’s approval was taken to conduct the clinical trial. Study was approved by IEC, National Institute of Ayurveda, Jaipur, and order no. - F 10 (5)/EC/2014 /7220. A voluntary signed, witnessed informed consent was obtained from the participant / parents/ guardians prior to the start of clinical trial. The trial was also registered in CTRI with registration number CTRI/2017/10/010037. O BSERVATIONS In present study, loss of appetite, improper digestion, pallor were commonly observed premonitory symptoms, while falling of hairs, weakness in feet, lack of interest in routine activities were most commonly observed symptoms. While in demographic study fatigue was most prevalent symptom which was observed during the survey. (Table 2) Table 2: Showing common observations of clinical study Factor Classification Group A (n=50) Group B (n=50) Total No % No % No % Severity of Mild (Hb<12- 36 72 38 76 74 74

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[Find the meaning and references behind the names: Hindu, Muslim]

Rashmi Pareek et.al. Study to Evaluate efficacy of Vajravatakmandura in Iron Deficiency. ISSN: 2456-3110 ORIGINAL ARTICLE Jan-Feb 2018 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2018 | Vol. 3 | Issue 1 29 Anemia 10%) Moderate (Hb <10-8%) 09 18 08 16 17 17 Severe (Hb<8%) 05 10 04 08 09 09 Age Group (in years) 12 to <13 13 26 15 30 28 28 13 to <14 18 36 17 34 35 35 14 to <15 19 38 18 36 37 37 Menarche Achieved 32 64 28 56 60 60 Not achieved 18 36 22 44 40 40 Religion Hindu 22 44 30 60 52 52 Muslim 28 56 20 40 48 48 Others 00 00 00 00 00 00 Habitat Urban Area 44 88 48 96 92 92 Rural Area 06 12 02 04 08 08 Economic status Higher 00 00 01 01 01 01 Upper Middle 10 20 07 14 17 17 Lower Middle 26 52 31 62 57 57 Lower 14 28 11 22 25 25 Immunization Status No immunization 11 22 14 28 25 25 Incomplete 08 16 06 12 14 14 Complete 10 20 07 14 17 17 Unknown 21 42 23 46 44 44 Diet Vegetarian 20 40 22 44 42 42 Mixed 30 60 28 56 58 58 Weight Average 32 64 30 60 62 62 Under weight 18 36 19 38 37 37 Over weight 00 00 01 02 01 01 Hygienic Condition Good 14 28 09 18 23 23 Moderate 30 60 27 54 57 57 Poor 06 12 14 28 20 20 Sleep Sound 32 64 26 52 58 58 Disturbed 22 44 20 40 42 42 Appetite Poor 35 70 42 84 77 77 Good 15 30 06 12 21 21 Excessive 00 00 02 04 02 02 R ESULTS Both the trial and control groups showed extremely significant result over subjective parameters. Trial drug Vajravatakmaņdura in group A was found more effective over the subjective parameters - weakness, palpitation, pallor and loss of appetite with % gain of 39.77%, 39.39%, 39.17%, 38.09% respectively. (Figure 1) Figure 1: Effect of therapy on Subjective Parameters 37.80% 32.20% 35.78% 31.52% 38.40% 36.84% 18.18% 57.14% 47.61% 36.95% 25% 39.30% 34.05% 35.68% 29.03% 39.77% 39.17% 37.50% 66.66% 6.25% 38.09% 1.38% Palpitation Dyspnoea Fatigue Vertigo Weakness Pallor Brittle Nails Ankle oedema Smooth Tongue Loss of Appetite Irritability Group B Group A

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Rashmi Pareek et.al. Study to Evaluate efficacy of Vajravatakmandura in Iron Deficiency. ISSN: 2456-3110 ORIGINAL ARTICLE Jan-Feb 2018 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2018 | Vol. 3 | Issue 1 30 Statistical analysis between before and after treatment findings of objective parameters, extremely significant (P<0.0001) improvement was found in both groups in all parameters, except for RBC count in group A, which was significant with P value 0.0248. (Table 3) Table 3: Showing pattern of Hematological changes in cases of IDA in Group A and in Group B (Paired‘t’ test) Features Gro up Mean SD SE P IP T BT AT Diff Hemoglo bin A 11 04 12 14 1.0 94 0.6 5 0.9 2 <0.00 01 ES B 10 11 11 25 1.1 14 0.5 1 0.0 7 <0.00 01 ES RBC A 4.2 77 4.6 57 0.3 79 1.1 5 0.1 6 0.024 8 S B 4.0 33 4.5 17 0.4 84 0.2 9 0.0 4 <0.00 01 ES PCV A 27 50 37 28 9.7 88 2.0 1 0.2 8 <0.00 01 ES B 27 83 36 88 9.0 50 2.9 5 0.4 1 <0.00 01 ES MCV A 68 57 78 09 9.5 16 3.3 3 0.4 7 <0.00 01 ES B 66 38 75 95 9.5 64 3.5 3 0.5 0 <0.00 01 ES MCH A 25 53 28 23 2.7 00 1.2 4 0.1 7 <0.00 01 ES B 24 61 27 60 2.9 88 1.2 7 0.1 8 <0.00 01 ES MCHC B 32 56 34 87 2.3 08 1.9 8 0.2 8 <0.00 01 ES 32 59 34 15 1.5 52 1.3 6 0.1 9 <0.00 01 ES No unpleasant outcome of the trial drug was observed throughout the study. DISCUSSION Total 122 subjects were enrolled out of which 22 subjects dropped out. Study was conducted on 100 subjects. In both control group (Iron and Folic acid) and trial group ( Vajravatakmaņdura ) 50 subjects in each group completed the course of treatment It was found that majority of subjects 74 (74%) were of mild anemia (Hb <11.5-10%). The prevalence among adolescent girls is well supported by previous studies [5] This study shows that mild variety of anemia is more prevalent among adolescent girls. Only 9 (9%) subjects were having severe anemia (Hb<8%). In these subjects with severe type of anemia other associated features were more prevalent and most of the subjects provided history of heavy bleeding during menstrual cycle. Thus, there no strong association of anemia was observed with menarche in the present study. Few studies reported no association between status of menarche and anemia which supports the present findings [6] There was no any significant difference seen between different age groups because the age group range was very small. But it was observed that anemia was more prevalent in adolescent girls aged between 14 to 15 years. Studies also document that age is not a correlated factor [7-10] Adolescent girls are particularly prone to iron deficiency anemia because of increased demand of iron for hemoglobin, myoglobin and to make up the loss of iron due to menstruation and poor dietary habits [11] The trial drug ( Vajravatakmaņdura [12] ) possesses antioxidant, anti-inflammatory, bio-availability enhancing, anti-inflammatory, anti-helminthic properties and above all Mandura Bhasma which is a good hematinic, due to which extremely significant improvement was observed. (Table 4)

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[Find the meaning and references behind the names: Jonathan, Singh, Kalpana, Ashokan, Med, Abel, Sundar]

Rashmi Pareek et.al. Study to Evaluate efficacy of Vajravatakmandura in Iron Deficiency. ISSN: 2456-3110 ORIGINAL ARTICLE Jan-Feb 2018 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2018 | Vol. 3 | Issue 1 31 Table 4: Showing properties of ingredients of Trial Drug ( Vajravatakmandura ) Drugs Effect Piper longum Anti-oxidant activity [13] Anti-inflammatory activity [14] Piper longum Anti-oxidant activity [15] Anti-inflammatory activity [16] Piper chaba Gastroprotective and cholesterol lowering properties, [17] Antioxidant activities [18] Plumbago zeylanicum Antidiarrheal activity [19] Antibacterial activity [20] Zingiberofficinale Anti-inflammatory, antitumour and antioxidant activities of ginger [21] Antiparasitic effect (L. nilotica) [22] Piper nigrum Anti-inflammation [23] Bio-availability enhancing [24] Cedrusdeodara Anti-inflammatory [25] Antibacterial action [26] Terminalia chebula Antioxidant and radical scavenging abilities, compared to the standards [27] Cytoprotective and antiaging activities [28] Terminalia bellarica Antioxidant and radical scavenging abilities [29] Emblica officinalis Antioxidant and radical scavenging abilities [30] Antiageing effects [31] Embelia ribes Antioxidant property [32] Anthelmintic activity [33] Cyperus rotundus Improving the small intestine absorption [34] Hepatoprotective activity against CCl 4 induced activity [35] Mandura (Fe 2 O 3 ) Hematinic [36] CONCLUSION Nutritional anaemia is a major public health problem in India and is primarily due to iron deficiency especially in girls where they are exposed to risk of onset of menarche. Trial drug Vajravatakmaņdura showed almost equal and extremely significant improvement as compared to control drug IFA tablets. However Vajravatakmaņdura showed better results on all cardinal features except vertigo and irritability. Extremely significant improvement was observed in all objective parameters in both groups, except for RBC count in group A in which only significant improvement was found. In intergroup comparison all subjective and objective parameters showed nonsignificant result. No adverse effects were reported during entire period of study by any of the patients in trial group treated with Vajravatakmaņdura. The trial drug Vajravatakmandoor is effective, safe and palatable for the management of iron deficiency anemia in adolescent girls. A CKNOWLEDGEMENT Author acknowledges National Institute of Ayurveda, Jaipur for providing platform for the research. Author also thanks Post Graduate Department of Kaumarbhritya, National Institute of Ayurveda for providing support in completing the trial. REFERENCES 1 Dugdale M. Anemia. Obstet Gynecol Clin North Am. 2001; 28(2):363–81. 2 Rajaratnam J, Abel R, Ashokan JS, Jonathan P (2000). Prevalence of anaemia among the adolescent girls of rural Tamilnadu. Indian Pediatrics 37: 532-36. 3 Singh J, Singh J V, Srivastava AK, Suryakant, 2006, Health status of the adolescent girls in the slumsof Lucknow. Indian J Community Med; 31(2):102-03 4 Rajeshwardutta Shastri. Bhaishajyaratnavali of Govinddas, Pandurogchikitsa prakaranam: Chapter 12, verse 38-43. Varanasi Chaukhamba Sanskrit Sansthan. (11 th ed) 1993:270–271. 5 Premalatha T, Valarmathi S, Srijayanth P, Sundar JS, Kalpana S (2012) Prevalence of Anemia and its

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Rashmi Pareek et.al. Study to Evaluate efficacy of Vajravatakmandura in Iron Deficiency. ISSN: 2456-3110 ORIGINAL ARTICLE Jan-Feb 2018 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2018 | Vol. 3 | Issue 1 32 Associated Factors among Adolescent School Girlsin Chennai, Tamil Nadu, INDIA. Epidemiol 2:118. 6 Choudhary SM, Dhage VR. A study of anemia among adolescent females in urban area of Nagpur. Indian J Community Med. 2008; 33:243-245 7 Rajini S et al,(2010) Prevalence of anemia and factors influencing among rural adolescent girls. Indian journal of maternal and child health. 8 Kaur S, Deshmukh PR, Garg BS (2006) Epidemiological correlates of nutritional anemia in adolescent girls of rural Wardha. Indian J Community Med 31: 4. 9 Rita Singh (2008) Sociodemographic factors causing anemia in adolescent girls in Meerut. Health and Population-Perspectives and Issues 38: 198-203. 10 Kotecha (2000) Prevalence of anemia among adolescent school girls, Vadodara district, Vadodara, Government Medical College, Vadodara. 11 Beard, J. L. 2000. Iron requirements in adolescent females. J. Nutr. 130: 440 S – 442 S. 12 Pandurogadhikar, Bhaisajya Ratnavali, Vidyotini Hindi Commentry By Kaviraja Sri Ambikadatta Shastri, Chaukhambha Sanskrit Sansthan, Varanasi. Edition 2004, 722. 13 Natarajan KS, Narasimhan M, Shanmugasundaram KR, and Shanmugasundaram ER, Antioxidant activity of a salt-spice-herbal mixture against free radical induction, J Ethnopharmacol, 105(1-2), 2006,76-83. 14 Constituents of Chinese Piper species and their inhibitory activity on prostaglandin and leukotriene biosynthesis in vitro. Stöhr JR, Xiao PG, Bauer RJ Ethnopharmacol. 2001 May; 75(2-3):133-9. 15 Natarajan KS, Narasimhan M, Shanmugasundaram KR, and Shanmugasundaram ER, Antioxidant activity of a salt-spice-herbal mixture against free radical induction, J Ethnopharmacol, 105(1-2), 2006,76-83. 16 Constituents of Chinese Piper species and their inhibitory activity on prostaglandin and leukotriene biosynthesis in vitro Stöhr JR, Xiao PG, Bauer RJ Ethnopharmacol. 2001 May; 75(2-3):133-9. 17 Kim KJ et al, Piperidine alkaloids from Piper retrofractumVahl. protect against high-fat diet-induced obesity by regulating lipid metabolism and activating AMP-activated protein kinase, 2011 Jul 22;411(1):219- 25. doi: 10.1016/j.bbrc.2011.06.153. Epub 2011 Jun 29.[Pubmed] 18 Luyen BT et al, A new phenylpropanoid and an alkylglycoside from Piper retrofractum leaves with their antioxidant and α-glucosidase inhibitory activity. 2014 Sep 1;24(17):4120-4. doi: 10.1016/j.bmcl.2014.07.057. Epub 2014 Jul 25 19 Kanchana N, Sadiq AM, Hepatoprotective effect of Plumbagozeylanicum on pcm induced liver toxicity on rats, Int J Pharmacy Pharma, Sci. 2011:3,151-54. 20 Ravikumar VR et al. [2011] Phytochemical and antimicrobial studies on Plumbagozeylanica (L) (Plumbaginaceae). International Journal of Research In Pharmacy and Chemistry. 1(2): 185-188. 21 Nagendra Chari KL, Manasa D, Srinivas P, Sowbhagya HB (2013). Enzyme-assisted extraction of bioactive compounds from ginger (Zingiberofficinale Roscoe). Food Chem. 139: 509-514. 22 Shirin Forouzan et al.Antiparasitic activities of Z. officinalemethanolic extract over L. nilotica.Globalveterinaria 9(2):144-148;2012 23 Patil S, Suvarna V and Fulmali S (2008) Anti- Inflammatory Activity of Piper nigrum, Linn and Ricinuscommunis, Linn. Biology-Online.org . 24 Damanhouri ZA, Ahmad A ,A Review on Therapeutic Potential of Piper nigrum L. (Black Pepper): The King of Spices. Med Aromat Plants 3:161.(2014) doi:10.4172/2167-0412.1000161 25 Uma Chandur et al, Studies of preliminary phytochemical and Anti-arthritic activity of heart wood of Cedrus deodar (Roxb.), ISSN: 0975-8585 July – September 2011 RJPBCS Volume 2 Issue 3 Page No. 654 ,Research Journal of Pharmaceutical, Biological and Chemical Sciences 26 Devmurari V P, Antibacterial evaluation of ethanolic extract of Cedrusdeodara wood, Scholars Research Library , Archives of Applied Science Research, 2010, 2 (2):179-183 27 Hazra B, Sarkar R, Biswas S, Mandal N. Comparative study of the antioxidant and reactive oxygen species scavenging properties in the extracts of the fruits of Terminalia chebula, Terminalia belerica and Emblica officinalis."BMC Complement Altern Med. 2010 May. 28 Manosroi A, Jantrawut P, Akihisa T, Manosroi WManosroi J.In vitro anti aging activities of Terminalia chebula gall extract . Pharm Biol.2010;48(4):469-81

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[Find the meaning and references behind the names: Joshi, Kavita, Padma, Radhakrishnan, Gina, Nil, Green, Prakashan, Prasad, Vimal]

Rashmi Pareek et.al. Study to Evaluate efficacy of Vajravatakmandura in Iron Deficiency. ISSN: 2456-3110 ORIGINAL ARTICLE Jan-Feb 2018 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2018 | Vol. 3 | Issue 1 33 29 Hazra B, Sarkar R, Biswas S, Mandal N. "Comparative study of the antioxidant and reactive oxygen species scavenging properties in the extracts of the fruits of Terminalia chebula, Terminalia belerica and Emblica officinalis."BMC Complement Altern Med. 2010 May. 30 Hazra B, Sarkar R, Biswas S,Mandal NComparative study of the antioxidant and reactive oxygen species scavenging properties in the extracts of the fruits of Terminalia chebula, Terminalia belerica and Emblica officinalis."BMC Complement Altern Med. 2010 May. 31 Charmi S. Mehta and Vimal R. Joshi, “Anti ageing drugs in Ayurveda” International Journal of Green and Herbal Chemistry, 2012, Vol.1.No.1, 61-74. 32 Radhakrishnan N., Gnanamani A., Prasad N R., Mandal A B. Inhibition of UVB-induced oxidative damage and apoptotic biochemical changes in human lymphocytes by 2, 5-dihydroxy-3- undecyl-1., 4-benzoquinone (embelin). Int J RadiatBiol, 88(8): 575-582, (2012).31 33 Padma Venkatasubramanian., Ashwini Godbole., Vidyashankar R and Gina R Kuruvilla. Evaluation of traditional anthelmintic herbs as substitutes for the endangered Embeliaribes, using Caenorhabditis elegans model. Current Science, 105(11):1593-1598, (2013) 34 Database on Medicinal Plants. CCRAS 35 Chemistry & Pharmacology of Ayurvedic Medicinal Plants, Vd. Mukund Sabnis, 1 st edition, Chaukhamba Amarabharati Prakashan, Varanasi, Vol-I,2006;p. no.185,186,187 36 Kavita C. mule, chandrashekhar n. mule, To study the effect of mandurbhasma in garbinipandu (iron difficiencyaneamia in preganancy) , Ayurlog: National Journal of Research in Ayurved Science, http://www.ayurlog.com V o l. 3 Special issue- 16 th Feb. 2015 ******************************* How to cite this article: Rashmi Pareek, Nisha Kumari Ojha. Study to Evaluate efficacy of Vajravatakmandura in Iron Deficiency Anemia in Adolescent Girls - A Randomized Controlled Trial. J Ayurveda Integr Med Sci 2018;1:26-33. http://dx.doi.org/10.21760/jaims.v 3 i 01.11635 Source of Support: Nil, Conflict of Interest: None declared.

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Panduroga, Terminalia chebula, Emblica officinalis, Black pepper, Medicinal plant, Adverse effect, Adolescent girl, Control group, Randomized controlled trial, Anti-inflammatory activity, Antioxidant activity, Clinical efficacy, Trial Drug, Reactive oxygen species, Ayurveda drug, Therapeutic potential, National Institute of Ayurveda, Subjective parameter, Inhibitory activity, Hepatoprotective effect, Iron deficiency anemia, Objective parameter, Oxidative damage, Ethanolic extract, Iron Deficiency, Lipid metabolism, Ayurvedic compound, Anti-arthritic activity, Bioactive compound, Study drug, High Fat Diet induced obesity, Antimicrobial studies, Piper species, Ayurvedic Medicinal Plant, Liver toxicity, Antiparasitic activities, Antibacterial evaluation, Anti-parasitic activities, AMP-activated protein kinase, Terminalia Belerica, Prostaglandin biosynthesis, Iron and folic acid, Prostaglandin and leukotriene.