RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA ANNEXURE-II

APPLICATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE & ADDRESS

PERMANENT ADDRESS

DR. SALINI.G. K.DEPARTMENT OF PAEDIATRICS,FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL,UNIVERSITY ROAD,DERLAKATTE,MANGALORE-574160KARNATAKA

D/O GOPALAKRISHNAN .P. P. “SYALEENA”RAMANATTUKARA (P.O)FEROKE CALICUT- 673633 KERALA

2. NAME OF THE INSTITUTION

FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL,DERLAKATTE,MANGALORE

3. COURSE OF THE STUDY & SUBJECT

M .D.(HOM)HOMOEOPATHIC PAEDIATRICS

4. DATE OF ADMISSION TO THE COURSE

16-6-2008

5. TITLE OF THE TOPIC

“A CONSTITUTIONAL APPROACH TO INTESTINAL HELMINTHIC

PARASITIC INFECTION IN PAEDIATRIC AGE GROUP – A CLINICAL

STUDY”.

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6. BRIEF RESUME OF THE INTENDED WORK

6.1 Need For Study:

Helminthiasis is a common parasitic infestation in childhood and the

magnitude of parasitic infection in children is a major health problem in major parts of the

world. 1 If the treatment is not given adequately there is a chance of recurrence and leads to

body wasting, anemia like complication. Recurrent worm infections are due to low

immune status, nutritional deficiency, unhygienic condition etc.

Parasitic worms (helminthes) are common in tropical climates and in

populations subject to crowding and poor sanitation. Children are most subject to

helminthic colonization. Intestinal infestations throw an additional burden on the rapidly

growing child1. It will result in poor performance in schools and will reduce their physical

activities.

It has been estimated that 6/7 of the total incidence of helminthiasis is

mainly due to ineffective disposal of human excreta. 1/3 of the population harbours some

or other parasites. The problem of Helminthic infestation in children is wide spread in

tropical countries1. Ascaris infects nearly 1/4th of the world population2.

Presence of worms always depend on a general taint of constitution (the

Psoric), joined to an unhealthy mode of living. Let latter be improved, and the former

cured Homoeopathically, which is most easily effected at this age (children), and none of

the worm remain, and children cure in this manner are never troubled with them more3.

The morbidity due to intestinal parasitic infection is very high and it

hinder with the growth and development of children. Hence I think it is the right time to

evaluate the scope of homoeopathy in this highly burden disease of childhood.

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6.2 Review of the Literature:

Definition:

Helminthiasis is a disease in which a part of the body is infested with

worms such as pin worm, round worm or tape worm. Typically the worms reside in the

gastro intestinal tract. But may burrow into the liver & other organs4. Intestinal

Helminthiasis in man is caused by 3 classes of worms.

Main Characteristic:

1. Anorexia

2. Abdominal pain

3. Grinding of teeth during sleep

4. Weight loss

5. Malnutrition

Source of Infection:

I) Soil

II) Water

III) Food

IV) Animals

V) From Persons

Mode Of Infection:

I) Oral Transmission

II) Skin Transmission

III) Direct transmission5.

Classification:

Helminthes or parasitic worms are multicellular bilaterally symmetrical,

elongated, flat or round animals. Helminthes in human belongs to two phyla.

1) Phylum Platyhelminthes

2) Phylum Nemathelminthes6

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1) Phylum PlatyHelminthes:-

The Platy helminthes or flat worms are dorsoventrally flattened, leaf like

or tape like. Their alimentary canal is incomplete or entirely lacking and the body cavity is

absent. They are mostly Hermaphrodites. Helminthes affecting man belongs to 2 classes.

a) Cestoidea: Cestodes are segmented, dorsoventrally compressed and tape like, hence

called tape worms. They vary from several millimeters to several meters, in length. Adult

cestodes or tape worms live attached to the mucosa in the small intestine and absorb food

from the host’s intestine.

Diseases due to cestoidea are:

1) Diphyllobothriasis

Diphyllobothriasis is a helminthic infection caused by Diphyllobothrium

latum it is otherwise known as fish tape worm. Man gets infection from eating

insufficiently cooked fish which carries the plerocercoid larva. The adult worm inhabits the

lumen of small intestine in illeum.7, 8.

Symptoms of Diphyllobothriasis are mainly mild abdominal pain,

diarrhoea and megaloblastic anaemia due to vitamin B12 deficiency with leucopenia7, 9.

2) Taeniasis

It is caused by 2 types of Taenia. Taenia sagina (beef tape worm) and

Taenia solium (pork tape worm). Both of these lives in the small intestine (upper jejunum)

of man. It is caused by ingestion of under cooked meat of intermediate hosts like beef &

pork. It moves against the peristaltic movement in host’s intestine8.

Symptoms of Taeniasis are abdominal discomfort, anemia and chronic

indigestion, alternating diarroea and constipation, presence of segments of the tape worm

in faeces or his own body and clothings8. Sometimes they produce anal pruritus, intestinal

obstruction, Cholangitis and appendicitis9.

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3) Echinococcosis (Hydatid disease)

It is caused by Echinococcus granulosus (dog tape worm). The larval

form of Echinococcus granulosus is the hydatid cyst. Man harbours the larval form, the

larval worm of Echinococcus granulosus causes unilocular hydatid disease.

Hydatid disease lies dormant for many years. The infection is generally

acquired in childhood but disease appears in the adult life. The manifestation depends upon

local signs and if the cyst is superficially situated then visible swelling will be there.

Rupture of hydatid cyst is associated with anaphylactic symptoms and formation of

localized or generalized secondary Echinococcosis8.

b) Trematoidea: The trematodes or flukes are leaf like flat unsegmented flat worms. They

vary in size from 1mm to several centimeters in length6. They are named trematodes

because of their suckers8. According to the habitat the

intestinal trematodes are of two types.

i) Small intestinal trematodes:-

They include Fasciolopis buski, Heterophyes heterophyes, and

Metagonimus yokogawai.

1) Fasciolaopsiasis

It is caused by Fasciolopis buski. Largest trematode infecting humans

known as giant intestinal fluke. The Fasciolopis buski causes fasicolopsiasis. The worm

can produce ulcerations & local inflammation at the site of attachment.

Heavy infection leads to Chronic diarrhoea, abdominal pain, and

asthenia8.

2) Heterophyiasis

Heterophyes heterophyes is the causative organism. It is the smallest

fluke measuring less than 2mm in length by 0.4mm in breadth. Its life span is two months.

Man is the definitive host. The worm lies in the intestinal canal on the mucous membrane.

The symptoms include colicky pain, diarrhoea8, 9.

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3) Metagonimiasis

It is caused by Metagonimus yokogawai. It is a very minute worm,

measuring 2mm in length by 0.5mm in breadth. Man is the definitive host and the adult

worm habitat in the small intestine. Due to this worm there will be Mild diarrhoea.

ii) Large intestinal trematode:-

1) Gastrodiscoides homini

This parasite is pyriform in shape. It measures 5 to 10mm in length by 4

to 5mm in breadth.The adult worm lives in the large intestine of the definitive host. It

produces mucous diarrhoea.

2) Phylum Nemathelminthes:-

c) Nematoda: They are otherwise known as round worms. Intestinal round worms are

the most common type of helminthiasis. They are unsegmented worms without

appendages. According to the habitat of adult worms the nematodes are divided in to 2,

i) Small intestinal nematode:-

They include Ascaris lumbricoides, Anchylostoma duodenale,

Strongyloides stercoralis, and Trichinella spiralis.

1) Ascariasis

The causative parasite is Ascaris lumbricoides. It is the largest nematode

seen in the intestine of man. The worm lives in the lumen of the small intestine (jejunum)

of man and maintains its position by its muscle tone. Embryonated eggs are the infective

agents. Round worm deprive the host for nutrients. It may cause intestinal obstraction.10

Symptoms due to migrating larvae ascaris pneumonia (Loffler’s

syndrome), fever, cough, dyspnoea, blood-tinged sputum with ascaris larvae, urticarial rash

and eosniphilia8, 10.

Symptoms due to adult worm are anorexia, protein energy malnutrition,

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vitamin deficiencies, urticaria, oedema of face, abdominal distention, passing of adult

worms in vomitus and feces.

Heavy infection can also cause intestinal obstruction, intussusceptions,

Protein energy malnutrition, peritonitis, like complication8, 9.

2) Anchylostomiasis

Anchylostoma duodenale is small, grayish white, cylindrical worm

which causes anchylostomiasis. Commonly they are known as hook worms due to their

curved tip. Hook worm suck 0.03-0.15 ml of blood /worm/day there for the severe

infection causes anaemia in the host.

Hook worm infection causes anaemia due to chronic blood lose and

nutritional defects, Duodenal ulcer, Steatorrhoea, failure to thrive, cutaneous larva

migrants can produce dermatitis, cutaneous tracts ground itch etc8, 9.

3) Strongyloidiasis

Strongyloides stercoralis is a parasite which lives in the wall (mucous

membrane) of intestine of man, especially in duodenum & jejunum. Filariform Larvae

constitute the infective stage & they enter the body through skin. Larvae penetrate directly

through the skin coming in contact with the soil.

The main symptom is diarrhoea with blood and Mucus8.

4) Trichinelliasis

Trichinella spiralis is one of the smallest nematode infecting man. It

starts as an intestinal parasite remaining buried in the duodenal or jejunal mucosa. There it

changes into an adult one & discharge embryo in to the circultion8.

Symptoms include diarrhoea, abdominal discomfort , vomiting and

enteritis.

ii) Caecum and Vermiform appendix nematodes :-

They include Enterobius vermicularis, Trichuris trichura.

1) Enterobiasis

Enterobius vermicularis is the causative organism of enterobiasis. It is

small more or less, spindle shaped. The adult worms live in caecum and vermiform

appendix of man. They remain there until the eggs are developed. The mode of infection is

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person to person or air borne. Auto infection is the main cause of its persistace.

Symptoms include itching of anus, Nocturnal enuresis, and perineal

pruritis.

Severe infections may lead to complications like appendicitis,

peritonitis, hepatitis and ulcerative lesions in small intestine 8, 9.

2) Trichuriasis

Trichuris trichura is the parasite. It is otherwise known as whip worm.

It is due to its whip like structure. The adult worm lives in the large intestine of man,

particularly the caecum; also in the vermiform appendix. Embryonated eggs are infective

to man. They suck approximately 0.005ml of blood/worm/day8, 9.

Symptoms include abdominal pain, mucous diarrhoea often with

blood streaked loss of weight, Rectal prolapse.

Laboratory Diagnosis:-

Laboratory studies may be useful in confirming the diagnosis of Helminthiasis

I) Stool Examination

1) Naked eye examination for worms for adult worm, or part of it.

2) Microscopical examination of faeces for eggs,

3) Direct smear test

4) NIH swab test

II) Blood tests

III) Serological test

IV) Fluorescent antibody technique

V) Radiograghs8

Prophylaxis:-

1) Prevention of pollution of water & food

2) Personal hygiene

3) Food should be thoroughly cooked especially fish, meat, oesters, crab etc

4) Vegetables & fruits should be washed properly before eating.

5) Proper sanitary control of sewage disposal.

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6) Avoid swimming in infected water.

7) Wear boots & gloves while working in soil8.

HOMOEOPATHY AND INTESTINAL HELMINTHIASIS

Homoeopathy recognizes the individuality of each patient or case.

Homoeopathy does not treat disease; it treats patients, In one word individualization11. It

means constitutional treatment based on the totality of the mental and physical reaction. It

should be able to cover the level of susceptibility, tendencies, the behavioral patterns and

the underlying miasms12. In case of helminthiasis also the patient should be individualised

on the basis of characteristics.

The role of constitution is crucial in treatment and achieving a cure.

By modifying susceptibility, the constitutional medicine has a capacity to correct the

tendencies and abnormal behaviors and reactions to environment. A constitutional

prescription should be based on the mental and physical reactions. It should be able to

cover the level of susceptibility, tendencies, the behavioral pattern and underlying miasm13.

Even in helminthiasis the constitutional medicine play a great role.

During Hannemanian time to expel and purge away the materia

peccans, or the injurious matters as they were termed, through the intestines, by means of

laxative and purgative medicines which in order to give them a more profound meaning

and a more prepossessing appearance. But Homoeopathy removes the disease in its

whole extent in the shortest, most reliable and most harmless way; If the medicines are

prescribed on the basis of individuality and constitution of the person. We shall also look

for the causes of the disease as fundamental, exciting cause or maintaining cause.

It often happens that the constitution is rendered more susceptible to

the attacks of intestinal parasites and more tolerant of their presence, by faulty hygienic

surroundings14. So the constitutional remedy can alter the susceptibility of the patient and

remove the repeated attacks by the intestinal parasites along with the hygienic advices.

A Few remedies which are useful in treating helminthiasis are given below:

Sulphur, Lycopodium, Calcarea carb, Spigellia, Cina, Bell, Baptisia,

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Ferrum mur, Bacillinum14, Phosphorus, Natrum mur, Sabadilla, Ignatia, Nux vom, Ars alb,

Silicea, Pulsatilla, Carbo veg, etc.

6.3 OBJECTIVES OF THE STUDY:

- To evaluate the role of constitutional remedies action in case of

helminthiasis

- To evaluate which type of Helminthic infection is more prevalent in

children.

MATERIALS AND METHODS:

7.1 SOURCE OF DATA:

The subjects will be selected from OPD, IPD and peripheral centers of

Fr. Muller Homoeopathic Medical College Hospital, Mangalore.

7.2 METHOD OF COLLECTION OF DATA: ( INCLUDING SAMPLING

PROCEDURE IF ANY)

SAMPLE AND SAMPLING TECHNIQUE

A sample of minimum of 30 cases will be selected by purposive sampling method

as per the inclusion criteria and will be followed for a minimum period of 4-6 months

duration.

Every case will be analyzed with reference from materia medica, repertory and

therapeutics whenever required.

The potency selection and repetition of the doses will be done

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according to the demand of the case, with consideration of susceptibility, sensitivity,

suppression (if any), the level of similarity, functional changes, structural changes, vitality

and underlying miasm.

INCLUSION CRITERIA:

1. The sample on both sexes aged from 1- 13 years

2. Diagnostic criteria is mainly on clinical presentation and local

examination

EXCLUSION CRITERIA:

1. Cases above 14 years of both sex

2. Mentally retarded children

3. Children with genetic disorders

RESEARCH HYPOTHESIS:

Homoeopathic drugs are effective in the treatment of helminthiasis in paediatric

cases.

NULL HYPOTHESIS:

There is no significant improvement among helminthiasis in paediatric cases after

homoeopathic treatment.

PLAN FOR DATA ANALYSIS:

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The data collected will be analyzed by paired t-test. With respect to the second

objective proportions or ratio will be used to measure the prevalence of Helminthiasis in

children.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS TO BE CONDUCTED

ON PATIENTS, OR OTHER HUMANS (or ANIMALS)?

IF SO DESCRIBE BRIEFLY.

Yes, the study may require following stool examinations.( If required )

*Stool Examination

Other Tests:-

*Complete Blood Count

*Serological Tests

*Radiographs

*Fluorescent antibody technique

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?

Yes, enclosed

LIST OF REFERENCES:

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1. Viswananthan J, Desai AB. Achar’s text book of pediatrics. 3rd ed. Chennai:

Orient Longman Limited; 1999. p. 379.

2. Parthasarathy A, Nair MKC, Menon PSN, Shah Raju C, Shah Nitin K, Sachdev

HPS et al. IAP text book of Pediatrics. 3rd ed. New Delhi: Jaypee Brothers

Medical Publishers (P) Ltd; 2007. p. 491.

3. Hahnemann Samuel. Organon of medicine. 6th ed. New Delhi: B. Jain

Publishers (P) Ltd; 1997. p. 49, 50.

4. http://www.answers.com/helminthiasis.

5. Paniker Jayaram CK. Text book of medical parasitology. 6th ed. New Delhi:

Jaypee Brothers Medical publishers (P) Ltd; 2002. p. 4, 5.

6. Arora DRB Arora. Medical parasitology. 2nd ed. New Delhi: CBS Publishers &

Distributers; 2008. p. 109.

7. Icchpujani RL, Bhatia Rajesh. Medical parasitology. 3rd ed. New Delhi:

Jaypee Brothers Medical Publishers (P) Ltd; p. 2, 4.

8. Chatterjee KD. Parasitology in relation to clinical medicine.12th ed. Calcutta:

Sree Sraswathi Press Limited; 1980. p. 105-86.

9. Kliegman M Robert, Behrman E Richard , Jenson B Hal, Stanton F Bonita.

Nelson textbook of pediatrics. Vol.I. 18th ed. New Delhi: Elsevier, A Division Of

Reed Elsevier India Private Limited; 2008. p.1495-1517.

10. Ghai OP, Gupta Piyush, Paul VK. Essential pediatrics. 6th ed. New Delhi:

CBS Publishers and Distributers; 2006. p. 253.

11. Close Stuart. The genius of homeopathy lectures and essays on homoeopathic

philosophy. Reprint edition. Delhi: B. Jain Publishers (P) Ltd; 1999, p. 51.

12. http://wonders of homeopathy.com/homoeopathy for children.html.

13. Tiwari Shashi Kant. Homoeopathy and child care principle, therapeutics, child

types, repertory. Reprint edition. New Delhi: B Jain Publishers (P) Ltd; 2004.

p. 28.

14. John Henry Clarke M.D. The Prescriber. Reprint edition B. Jain Publishers (p)

Ltd; 2003, p. 376.

9. SIGNATURE OF THE CANDIDATE

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10. REMARKS OF THE GUIDE

11. NAME& DESIGNATION OF(IN BLOCK LETTERS)11.1 GUIDE

PROF. DR. SHASHI KANT TIWARI

D.M.S. DIP. N.I.H., M.D. (HOM)

FR. MULLER HOMEOPATHIC MEDICAL

COLLEGE & HOSPITAL, DERALAKATTE,

MANGALORE.

11.2 SIGNATURE

11.3 CO-GUIDE

11.4 SIGNATURE

11.5 HEAD OF THE DEPARTMENT

DR JYOSHNA SHIVAPRASAD

B.H.M.S. M.D (HOM), PROFESSOR, DEPT.

PAEDIATRICS,

FR. MULLER HOMOEOPATHIC MEDICAL

COLLEGE& HOSPITAL, DERALAKATTE,

MANGALORE

11.6 SIGNATURE

12. 12.1 REMARKS OF THE

CHAIRMAN& PRINCIPAL

12.2 SIGNATURE

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