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From:Dr. ATHIRA. T. R. Post Graduate Trainee.Dept. of Organon of Medicine and Homoeopathic Philosophy.DBHP Sabha’s Dr. B.D. Jatti Homoeopathic Medical College, Hospital and Post Graduate Research Centre.D.C. Compound.Dharwad- 580001.
To:The RegistrarRajiv Gandhi University of Health Sciences, Karnataka.Bangalore.
Through:The Principal. DBHP Sabha’s. Dr. B.D. Jatti Homoeopathic Medical College,Hospital and Post Graduate Research Centre.D.C. Compound.Dharwad- 580001.
Respected Sir,
Subject: Submission of Completed Proforma for Registration of Subject for Dissertation.
I request you to kindly register the below mentioned subject against my name
for the submission of dissertation to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore for partial fulfillment for the award of the degree of M.D.(Homoeopathy.) in Organon of Medicine and Homoeopathic Philosophy.
Title of Dissertation: “A CLINICAL STUDY OF BRONCHIAL ASTHMA IN CHILDREN AND ITS HOMOEOPATHIC MANAGEMENT.”
I am herewith enclosing completed Proforma for registration of subject for dissertation.
Thanking you,Yours faithfully,
Place: Dharwad.( Dr. ATHIRA.T.R. )
Date:
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“A CLINICAL STUDY OF BRONCHIAL ASTHMA IN
CHILDREN AND ITS HOMOEOPATHIC MANAGEMENT.”
SYNOPSIS
Submitted to
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA.
BANGALORE.
BY
Dr. ATHIRA. T. R.
Through
DBHPS’s
Dr. B.D. JATTI HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL AND
POST GRADUATE RESEARCH CENTRE.
D.C. COMPOUND.
DHARWAD- 580001. (KARNATAKA.)
In partial fulfillment of requirement for the
DOCTOR OF MEDICINE (HOMOEOPATHY) in
ORGANON OF MEDICINE AND HOMOEOPATHIC PHILOSOPHY.
Under the guidance of
Dr. G.C. HIREMATH. MD.(Hom.)
Professor, Guide and Head.
Dept. of Organon of Medicine and Homoeopathic Philosophy.
Dr. B.D. JATTI HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL AND
POST GRADUATE RESEARCH CENTRE.
D.C. COMPOUND.
DHARWAD- 580001 (KARNATAKA).
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA.
BANGALORE.
ANNEXURE – II
APPLICATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. NAME OF THE CANDIDATE:
PRESENT ADDRESS:
Dr. ATHIRA.T.R.POST GRADUATE TRAINEE.DBHPS’s. Dr. B.D.JATTI HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL AND POST GRADUATE RESEARCH CENTRE.D.C. COMPOUND.DHARWAD- 580001.KARNATAKA.
PERMANENT ADDRESS:
D/O. V. THANKAPPAN. PILLAI.AIKKARA MELLOOTTU VEEDU.PO: PAVITHRESWARAM.VIA: PUTHOORKOLLAM- 691507.KERALA.
2. NAME OF THE INSTITUTION:
DBHPS’s. Dr. B.D.JATTI HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL AND POST GRADUATE RESEARCH CENTRE. D.C. COMPOUND.DHARWAD- 580001.KARNATAKA.
3. COURSE OF THE STUDY AND SUBJECT
DOCTOR OF MEDICINE (HOMOEOPATHY) inORGANON OF MEDICINE AND HOMOEOPATHIC PHILOSOPHY.
4. DATE OF ADMISSION TO COURSE:
21-05-2012.
5. TITLE OF TOPIC: “A CLINICAL STYDY OF BRONCHIAL ASTHMA IN CHILDREN AND ITS HOMOEOPATHIC MANAGEMENT.’’
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6 BRIEF RESUME OF THE INTENDED WORK.
6.1
NEED FOR THE STUDY:
Bronchial Asthma is a disease characterized by an increased
responsiveness of the trachea and bronchi to various stimuli. It manifests
by widespread narrowing of the airways causing paroxysmal dyspnea,
wheezing or cough. The diffuse obstruction to the airflow is reversible in
a large majority of cases, either spontaneously or in response to
treatment.
In India prevalence of Bronchial Asthma in school going children has
been reported between 4-20% in different geographic regions. The
prevalence has increased by two fold in last two decades. Bronchial
Asthma is one of the commonest chronic illnesses during childhood. It is
responsible for significant social, economic and psychological impact on
the family.
Acute Bronchial Asthma leads to disturbed sleep, restriction in day to
day activities and school absenteeism. About half of the case develops
before age 10. In childhood, there is 2:1 male/female predominance but
sex ratio equalizes by age. The development of Bronchial Asthma
appears to be related to the complex interplay of genetic and
environmental factors.
The efficacy of other system in Bronchial Asthma is less as there is no
long lasting relief. The side effects of conventional system take the
disease inside making the person prone to other serious health hazards.
The disease through the suppressive treatment makes the person
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incurable in the long run.
In Homoeopathy, treatment is based on the totality of the symptoms
formed by mental, physical and characteristic particulars and considering
past and family history of the person and miasmatic background also will
be taken into consideration. The selected Similimum can, not only relieve
the symptoms, but also can cure it permanently and provides the person
immunity.
In children, as the case is brought to the Physician in the initial stage
of disease itself, the treatment is possible by administering selected
Homoeopathic remedy and can make them healthy.
It is my sincere effort to study the efficacy of Homoeopathic medicine
in treating Bronchial Asthma in children, where conventional system can
give only partial relief of the symptoms.
RESEARCH HYPOTHESIS:
Homoeopathy is effective in the treatment of Bronchial Asthma in
children.
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6.2
REVIEW OF LITERATURE:
Historical review:
Bronchial Asthma is derived from Greek word signified panting.
Originally it was used as a general term to describe the symptom of
virtually all respiratory illness and synonym for breathlessness1.
Definition:
Bronchial Asthma is characterized by episodic airflow obstruction
with at least initially is fully reversible. Clinically, Bronchial Asthma
presents as paroxysms of dyspnea, wheezing and cough. The attack may
last from a few minutes to hours or even days and subsides with
medication, at times spontaneously in between the attacks the person is
usually absolutely normal, unless he is in persistent broncho
constriction.2
Magnitude of the problem:
In India prevalence of Bronchial Asthma in school going children has
been reported between 4-20% in different geographic regions. Prevalence
has increased by two folds in last two decades. Risk factors associated
with development of asthma include family history of Bronchial Asthma
and Atopic diseases, Bronchiolitis during infancy, sensitization to
allergens during childhood and passive smoking. In childhood, Bronchial
Asthma is more common in boys, but following puberty females are
more frequently affected.3
Triggers of an attack of Bronchial Asthma:
a. Allergy: only few cases are directly related to the specific allergen
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exposure. Out of these important ones is smoke, hydrocarbons,
drugs such as Aspirin, NSAID.
b. Viral infections: Most frequent triggers of airway narrowing in the
young children.
c. Exercise: Occurs in genetically susceptible individuals with hyper
reactive airways because of the loss of water and heat from the
respiratory tract following exercise.
d. Weather change: Sudden weather change may result in
1. Loss of heat and water from lower airways.
2. Sudden release of airborne allergens in atmosphere.
e. Emotional factors: Emotional stress operated through vagus,
initiating bronchial smooth muscles to contract.
f. Endocrine factors: Some endocrine changes may increase symptoms
of Bronchial Asthma. Children may get increase in symptoms
during puberty.4
Classification of Bronchial Asthma:
Extrinsic Asthma: Three types of extrinsic asthma are recognized.
1. Atopic Asthma.
2. Occupational Asthma.
3. Allergic broncho pulmonary aspergillosis.
Intrinsic Asthma: Triggering mechanisms are non-immune. In this form,
a number of stimuli that have little or no effect in normal subjects can
trigger broncho-spasm. Such factors include aspirin, pulmonary
infections, especially those caused by viruses, cold, psychological stress,
exercise and inhaled irritants such as sulphur dioxide.5
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Clinical features:
Symptoms may vary from simple recurrent cough to severe
wheezing.
Children may present with recurrent cough with or without
wheezing.
The symptoms occur with change in season, aggravation by
exercise and more in night.
Acute Asthma may begin with a cold, or bouts of spasmodic
nocturnal coughing. In early phase of the attack, cough is non-
productive.
The patient becomes dyspnea, with prolonged expiration and
wheezing.
The child sweats profusely, may develop cyanosis and becomes
apprehensive and restless and looks fatigued.3
With itching under the chin, discomfort between the scapulae, or
inexplicable fear (impending doom).
Typical physical signs are inspiratory and to a great extent
expiratory. Rhonchi through the chest. There may be
hyperinflation.6
Diffrential diagnosis:
1. Bronchiolitis
2. Congenital malformations
3. Aspiration of foreign body
4. Extrinsic allergic alveolitis or hypersensitivity pneumonitis
5. Cystic fibrosis.3
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Diagnosis:
The diagnosis of Bronchial Asthma is made on the basis of clinical
history in most of the cases. But in doubtful cases or in monitoring of
response of treatment, the following objective measures are used.
Routine pulmonary function test: Decreased FEV1, hyperinflation,
improvement with broncho-dilator.
Special pulmonary function test indicates the presence of, non-specific
bronchial: Hyperactivity, broncho-constriction, occurs at lower dose in
asthma.
Challenge with specific agents occasionally performed.
Chest radiographs: Fleeting infiltrates and central Bronchiectasis in
ABPA.
Skin test: Demonstrate atopy, little value except prick test to
Aspergillus fumigatus positive in ABPA.
Blood test: Eosinophils and IgE usually increased.2
Characteristic:
1. Airflow obstruction.
2. Airway inflammation.
3. Bronchial hyper-responsiveness
Factors that may protect against asthma:
Living on farms.
Large families.
Childhood infections, including parasites.
Predominance of lactobacilli in gut flora.
Exposure to pets in early life. 4
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HOMOEOPATHIC APPROACH:
SAMUEL HAHNEMANN: §5- Useful to the physician in assisting
him to cure are the particulars of the most probable exciting cause of the
acute disease, as also the most significant points in the whole history of
the chronic disease, to enable him to discover its fundamental cause,
which is generally due to a chronic miasm. In these investigations, the
ascertainable physical constitution of the patient (especially when the
disease is chronic), his moral and intellectual character, his occupation,
mode of living and habits, his social and domestic relations, his age,
sexual function, etc., are to be taken into consideration.7
CLOSE STUART: When the Homeopathically selected medicine
administered to a sick person, the disappearance of symptom and
restoration of patient to health represents the reaction of the susceptible
organism to the impression of curative remedy.8
RICHARD HUGHES: After obtaining similar remedy we have only
to consider how to administer it. As we divided its elements of similarity
into generic, specific and individual, it should be administered, as a rule,
singly, rarely, constitutionally and minutely.9
IYER TS: In acute troubles which occur principally at nights, it is best
to administer the indicated remedy in watery solution in tea spoon doses
every two to four hours according to the severity of the case, till the acute
spasm subside and at other times, in single doses morning and evening
for a few days, till there is relief. For the better action of the remedy, the
watery solution should be stirred well each time before the doses are
taken. For chronic troubles the indicated remedy may be given weekly, or
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at longer intervals.10
ALLEN JH: As no part of the organism is freed from the presence of
miasms, When they are at all present, so the chest cavity with its contents
is a fruitful so for both these benign and malignant shadings of miasmatic
action.11
TIWARI SK: The nosological classification of disease (for eg.
Asthma, Eczema, Gastric Ulcer, and Colitis) do not reveal much about
the symptoms of person. Therefore without taking a case in detail, it is
not possible to classify a disease in terms of miasms.12
6.3
Aims and objectives of the study:
1) To study the clinical presentation of Bronchial Asthma in
children.
2) To study the Homoeopathic management of Bronchial Asthma in
children.
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7. MATERIALS AND METHODS:
7.1
Primary source:
The subjects for this study will be collected from OPD, IPD and
peripheral OPD of Dr. B.D. Jatti Homoeopathic Medical College,
Hospital and Post graduate Research Centre, Dharwad.
7.2
Method of collection of data:
Subjects will be selected on inclusion / exclusion criteria, history and
finding. The data will be represented in the standardized case proforma
prepared for cases. Every case is analyzed, with miasmatic presentation
and reference from Materia Medica, Repertory and therapeutics as per
the requirement. Treatment for each case will be on the bases of
individualization. The potency selection and repetition of the doses will
be done according to the principles of Homoeopathy. Follow up would be
analyzed as per criteria set up in each case.
In this study, the following parameters will be applied in collecting
data.
1. Study design- Non-control trial based upon simple random
sampling method
2. Type of research- Prospective case study.
Sampling size: Prevalence rate of Bronchial asthma is of 2% in our
OPD/IPD. Considering the 95% confidence interval at 5% permissible
error, sample size works out to be 32 cases. Since it is a time bound
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study, all admitted and OPD cases are included in my study period.
Inclusion criteria:
1. Patients belonging to all pediatric age group (5-12 years) of both
sex.
2. Patients irrespective of ethnic group, socio-economic status and
occupation will be considered.
3. All the patients with signs and symptoms of Bronchial Asthma
are considered.
Exclusion criteria:
1. Patients with complication of Bronchial Asthma, including Status
asthamaticus.
2. Patients suffering from immune-compromised diseases, HIV and
other chronic diseases including systemic affections of
irreversible pathological changes in the body.
3. Subjects suffering from terminal illness, those undergoing active
treatment from other systems of medicine, surgical cases, those
who are not able to communicate their symptoms.
STUDY DESIGN:
Parameters used:
Change in clinical findings like the presenting symptoms and signs,
are parameter for assessing recovered, improved and not improved
criteria.
Recovered: Total disappearance of all the clinical features of
Bronchial Asthma and general well-being of the patient for a period of at
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least 6-9months.
Improved: Disappearance of clinical features of Bronchial Asthma,
but reoccurrence of the same with less severity, and general well-being of
patient, within the period of 6 months.
Not improved: Points to be considered are,
a. No relief of complaints even after sufficient period of treatment,
till the end of this study period.
b. Dropped out (cases that have left the treatment during the study
period.)
Study period:
From 01st May 2013 to 30th April 2015.
Statistical test:
Appropriate test will be used depending upon the data available at the
end of the study.
Follow up:
Follow up of cases depend on severity of the symptoms and as per the
need and necessity of the cases, preferably once in a week in the
beginning and later every fortnight, and then monthly once, for a
minimum period of 6months.
7.3
Does the study require any investigations or any interventions to be
conducted on patients? If so describe briefly.
Bronchial Asthma is easily diagnosed on clinical examination
however to confirm the diagnosis of Bronchial Asthma in most doubtful
cases necessary investigations will be carried as per the need of case. The
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study requires following investigation.
Lung function tests:
Spirometry and Peak flow meter.
Other tests:
Chest X-ray, Skin prick test, Measurement of airway hyper
responsiveness, Sputum examination and Blood eosinophilia.
7.4
Has ethical clearance been obtained from your institute in case of
7.3?
Yes, Ethical clearance has been obtained from the institution.
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8. LIST OF REFERENCE:
1. Shah Siddharth N. API Text Book of Medicine. 7th Edition,
Association of Physicians of India, New Delhi. 2003. p: 291.
2. Carpenter, Griggs, Losscolso, Andreoli. Cecil Essentials of
Medicine. 5th Edition. Hart court India (P) Ltd, New Delhi. 2001. p:
187.
3. Ghai. OP. Piyush Gupta. Paul VK. Ghai Essential Paediatrics. 6th
Edition, Dr Ghai. Delhi-92. 2008. p: 354.
4. Boon Nicholas A. Nicki R. Colledge. Brain. R. Walkder.
Davidson’s Principals and Practice of Medicine. 20th
EditionChurchill Livingstone. Edinburg. 2006. p: 670.
5. Vinay Kumar. Cotran. S. Ramzi. Robbins. L. Stanley. Basic
Pathology. 6th Edition, Reprint. Harcourt India (P) Ltd, New Delhi.
20 p: 395.
6. Kasper., Braunwald., Fauci., Hauci., Haucer., Longo., Jameson.,
Harrisons Principles of Internal Medicine. 17th Edition. McGraw-
Hill Medical Publishing division, New York. 2008. p: 1601.
7. Hahnemann Samuel. Organon of Medicine. 6th Edition. B. Jain
Publishers (P) Ltd. New Delhi 2009. p: 95.
8. Close Stuart. The Genius of Homoeopathy. 1st Edition. 2009. B.
Jain Publishers (P) Ltd. New Delhi. 2009. p: 76.
9. Hughes Richard. The Principles and Practice of Homoeopathy. 1st
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Edition. B. Jain Publishers (P) Ltd. New Delhi. 2004. p: 106.
10. Iyer T.S. Beginners guide to Homoeopathy. 1st Edition, B. Jain
publishers (P) Ltd, New Delhi. 1994. p: 109.
11. Allen. J.H. The Chronic Miasms. Volume 1& 2; Edition B. Jain
Publishers (P) Ltd. New Delhi. 1994. p: 212.
12. Tiwari S.K. Homoeopathy and Child care, Principles, Therapeutics,
Children’s Type, Repertory. 1st Edition, B. Jain publishers, New
Delhi. 1998. p: 18.
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9. SIGNATURE OF CANDIDATE.
10. REMARKS OF THE GUIDE.
11. 11.1 NAME AND DESIGNATION OF GUIDE.
Dr .G.C.HIREMATH. MD.(Hom.)Professor, Guide and Head.Dept. of Organon of Medicine and Homoeopathic Philosophy.DBHPS’s. Dr. B.D. Jatti Homoeopathic Medical College, Hospital and Post Graduate Research Centre.Dharwad- 580001.
11.2 SIGNATURE.
11.3 HEAD OF DEPARTMENT. Dr .G.C.HIREMATH. MD.(Hom.)Professor, Guide and Head.Dept. of Organon of Medicine and Homoeopathic Philosophy.DBHPS’s. Dr. B.D. Jatti Homoeopathic Medical College, Hospital and Post Graduate Research Centre.Dharwad- 580001.
11.4 SIGNATURE.
12. 12.1 REMARKS OF PRINCIPAL.
12.2 SIGNATURE.
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