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\title{Managing Shingles (HZ) in Elderly with Topical Application of Acyclovir 5 Mg and Increasing Immunity with Matily Herbal Drink -A Case Study}
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             \author[1]{John T.  Eapen}

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\date{\small \em Received: 11 December 2019 Accepted: 2 January 2020 Published: 15 January 2020}

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\begin{abstract}
        


Introduction-Varicella zoster virus (VZV) causes chickenpox, a self-limited disease with disseminated skin lesions that occurs mostly in childhood. It usually persists symtomatically in the dorsal root ganglia of anyone who has had chickenpox. It reactivates from its dormant state and travel along the sensory nerve, causing vesicular lesions in the dermatome supplied by that nerve in about 25% of people who had chickenpox in their childhood. These lesions, known as Herpes zoster or shingles and it causes a painful eruption of a rash, usually unilaterally. It occurs more frequently in older adults and immunocompromised individuals (1). HZ afflicts millions of older adults worldwide and causes significant suffering because of acute and chronic pain, or postherpetic neuralgia (PHN) (2).It is believed that the potential risk factors for HZ are aging and suppression of cellular immunity (1,2,3).They treat HZ with topical application of Acyclovir 5% cream. In severe cases, they prescribe Acyclovir 800 mg 5 times daily for 7 to 10 days and, they recommend taking plenty of water along with medication (4). Therefore, it is for patients with normal cardiac and kidney function.

\end{abstract}


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\let\tabcellsep& 	 	 		 
\section[{Introduction}]{Introduction}\par
aricella zoster virus (VZV) causes chickenpox, a self-limited disease with disseminated skin lesions that occurs mostly in childhood. It usually persists symtomatically in the dorsal root ganglia of anyone who has had chickenpox. It reactivates from its dormant state and travel along the sensory nerve, causing vesicular lesions in the dermatome supplied by that nerve in about 25\% of people who had chickenpox in their childhood. These lesions, known as Herpes zoster or shingles and it causes a painful eruption of a rash, usually unilaterally. It occurs more frequently in older adults and immunocompromised individuals \hyperref[b0]{(1)}. HZ afflicts millions of older adults worldwide and causes significant suffering because of acute and chronic pain, or postherpetic neuralgia (PHN) \hyperref[b1]{(2)}.\par
It is believed that the potential risk factors for HZ are aging and suppression of cellular immunity \hyperref[b0]{(1,}\hyperref[b1]{2,}\hyperref[b2]{3)}.\par
They treat HZ with topical application of Acyclovir 5\% cream. In severe cases, they prescribe Acyclovir 800 mg 5 times daily for 7 to 10 days and, they recommend taking plenty of water along with medication (4). Therefore, it is for patients with normal cardiac and kidney function.\par
In this communication, we want to present a case of an older adult with HZ who managed with only topical acyclovir 5\%. He could not take Acyclovir 800mg orally because he had to limit his water intake to just 1 to 1.5 liter because of his medication for the heart. The only option available to the patient was to increase his cellular immunity with Matily herbal drink \hyperref[b4]{(5)}. 
\section[{II.}]{II.} 
\section[{Case Study}]{Case Study}\par
An elderly male, 64 years old with a history of Congestive Heart Failure (CHF), was resting at home and could not move around because of COVID 19 lockdown. He was a diabetic patient for nine years. He took medication for diabetes in the first month when the doctor diagnosed him as a diabetic patient. The medication increased his appetite, and therefore he stopped it. He manages his hyperglycemia with diet and exercise. His diet comprises natural home-cooked food with no preservatives or anti-caking agents. He used to walk at least 2 km a day, and all these kept his blood sugar under control.\par
During the lockdown period, the patient had a recurrence of CHF and was resting at home. Lockdown restricted his physical activity of walking. After a few weeks, the patient had HZ in the thoracic region.\par
The dermatologist recommended-acyclovir 5\% cream for topical application and oral intake of acyclovir 800 mg 5 times daily for 7 to 10 days. Oral intake of acyclovir recommends drinking plenty of water. In the present case study, the Cardiologist had recommended not to take over 1 to 1.5 liter in a day. During the lockdown period, the combined consultation of a cardiologist and dermatologist was not available in the town where he was staying.\par
Under the above condition, the patient increased his cellular immunity with Matily herbal he had made two years ago to control his hyperglycemia and hyperlipidemia. We give elsewhere the details of the drink \hyperref[b4]{(5)}. 
\section[{III.}]{III.} 
\section[{Results}]{Results}\par
IV. 
\section[{Discussion}]{Discussion}\par
Herpes Zoster (HZ), known as shingles, results from reactivation of latent varicella-zoster virus and occurs more frequently in older adults and in immunocompromised individuals (1). Aging and decreased cellular immunity are the potential risk factors. Vaccination is available for preventing HZ. However, the vaccination has a life of only 7years.\par
Against such a backdrop, we may prefer the present method as it increases cellular immunity with natural products. In the present case studies, hyperglycemia resulting from oxidative stress was a risk The combination of topical application of Acyclovir 5 mg and intake of Matily Herbal drink gave relief to the patient. The pain subsided, and the lesions were in the healing process. There were about five or six post herpatic neiralgia which gave severe pain in the beginning. Later on, the pain subsided and all were healed. Though major lesions healed in a week's time, the PHN took nearly one and a half month for complete healing. Thus, combination of topical application of Acicyclovir 5 mg and Matily Herbal Drink helped in the recovery of shingles.\par
factor. Reduced physical activity because of CHF and lockdown may have caused this. Hyperglycemia produces free radicals in the body and increases the demand for antioxidants in the body. When adequate antioxidants are not present the cellular immunity alone cannot eliminate free radicals. Free radical production in the body speeds up aging. All these may contribute to reduced cellular immunity.\par
Matily drink has both hypoglycemic and hyperlipidemia properties \hyperref[b4]{(5)}. It is rich in polyphenols which act as antioxidants. It increases bioavailability when it ferments a few hours at room temperature. We describe elsewhere the contributions of all the ingredients in the concoction \hyperref[b4]{(5)}. Thus Matily Herbal Drink may have increased cellular immunity, and we can undoubtfully consider it as a secondary treatment method.\par
In the ongoing discussion we want to point that Matily Herbal Drink may also contribute to the primary treatment of the viral disease because the ingredients in the drink contain ani-viral constituents in them.\par
Pudina belongs to Mint Family (Labiatae) has ani-viral properties \hyperref[b5]{(6)}. Fresh ginger has anti-viral properties as reported \hyperref[b7]{(7)}. Similarly, curry leaves have many medicinal properties \hyperref[b8]{(8)}.\par
In the present case study, the patient never had a common cold in the last two years. Perhaps the antiviral constituents in the herbal drink had some protective effect on the patient.\par
We want to conclude with following notes. 1) Given all the properties of the constituents in the herbal drink, it may have some primary action on the HZ which warrants further study. 2) Since Matily Herbal Drink is slightly viscous depending on the quantity of lemon juice used, it is worth studying the effect of the drink in preventing COVID 19 virus attaching with ACE receptors in the human throat region. Incidentally, the patient mentioned here developed slight throat pain after passing through a containment zone for some urgent work. He felt slight throat pain and tiredness. Then after returning home, he sipped the above drink and found complete relief after taking rest for a few hours.\par
The author holds a hypothesis that any plant susceptible to virus attack in their vegetative stage develops anti-viral substances in their fruit and seeds to ward off virus attack and continue life on earth. Example -Tomato plants are prone to viral attack (9) but their fruits and seeds contain anti-viral constituents in them \hyperref[b10]{(10)}. Viruses affect citrus trees \hyperref[b11]{(11)} but the lemon fruits have excellent anti-viral properties \hyperref[b12]{(12)}. We well know it controls influenza virus. Similarly, virus attack okra cultivation in India \hyperref[b13]{(13)}. However, references to any antiviral compounds in okra is not available. It reports the immunomodulatory effect of okra \hyperref[b14]{(14)} and beneficial effects of bioactive compounds in them \hyperref[b15]{(15)}. We believe that the mucilage in okra pods may have anti-viral action and protect the seeds. Its action could be mainly through physico-chemical properties of the mucilage. The mucilage reduces surface tension of water (  {\ref 16}) just like soap in water. It is an emulsifier \hyperref[b17]{(17)}. It promotes flocculation \hyperref[b18]{(18)}. Mucilage is viscous depending on the pH and temperature. Under normal circumstances the mucilage in them may prevent the virus particles attaching with host cells. Thus mucilage in the pods may protect the growing seeds in them. Thus mucilage in the okra pods may have anti-viral protection mainly by their physical properties.			\footnote{Managing Shingles (HZ) in Elderly with Topical Application of Acyclovir 5 Mg and Increasing Immunity with Matily Herbal Drink -A Case Study} 		 		\backmatter  			  				\begin{bibitemlist}{1}
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\end{bibitemlist}
 			 		 	 
\end{document}
