Monthly Archives: June 2012

Clinical Study on Homeopathy in Hypertension

Dr Arun Prasad K P

Introduction
“A man’s life may be said to be a gift of his blood pressure, just as Egypt is a gift of the Nile”. So said Sir William Osler, an icon of modern medicine and the man said to be the most influential physician in history.

Sir Osler may be indeed right, as arterial pressure is essential for sustaining life, the most important factor which ensures that the circulation of blood reaches all the tissues in our body. At the same time, an elevated blood pressure can be most inimical to life, if persisting over a period of time.

The pioneers in the study of arterial pressure, Reverend Stephen Hale, who made the first blood pressure measurement on animals, and Scipione Riva Rocci, who invented the blood pressure cuff, were probably not aware of the full significance of their discoveries. It was only in the late 1950’s that the medical world became aware of the importance of high blood pressure as a precursor of complications commonly attributed to “old age”.

At the present day, an elevated blood pressure level is recognized as the most important public health problem in the developed countries, and essential hypertension is held responsible for more than 95% of the cases. It is common, asymptomatic, and lead to lethal complications if left untreated. The “silent killer” as it is known, is gradually becoming a problem of enormous proportions in the developing world also.

The practitioners of the allopathic system of medicine have tried to combat this malady by trying to develop drugs designed to reduce the high arterial pressure. Over the years they have been successful in developing drugs with profound blood pressure lowering capabilities, but the magnitude of the problem at the community level has remained. The reasons for this are many, including the adverse effect of drugs and relatively higher cost of treatment, but the absence of a holistic view of disease is probably the most important. As with other conditions, the inclination is to treat the “results” of disease. This ultimately proves less successful, and is also detrimental to the health of the patient.

The homoeopathic physician on the other hand, considers disease as a disturbance of the life force, made known to him only through signs and symptoms. He understands that the patient is sick prior to the localization of disease. The hypertension, like other diagnoses, is considered only as a part of the whole. The homoeopathic approach also does not have the other drawbacks seen with the allopathic system, like adverse effect of drugs and high cost of treatment. Thus it is potentially suitable to deal with the problem of essential hypertension, especially in a developing country like India.

Unfortunately there is little information regarding the management of hypertension in homoeopathic literature. Many of the classical therapeutic text books and materia medicae do not mention the condition at all. This is possibly due to the lack of awareness about hypertension during the earlier days of homoeopathy. Clinical studies on the effectiveness of homoeopathic medicines in hypertension also has been few. Off the studies published, most have tried to evaluate the action of “specific” drugs rather than use an individualized approach.

All these factors, have encouraged me to take up this study on the efficacy of homoeopathic medicines in the management of essential hypertension. It is hoped that useful information will be gained both on the entity of essential hypertension, as well as the homoeopathic approach to its management.

Essential Hypertension: Homoeopathic research
Documented research on the efficacy of homoeopathic medicines on the management of essential hypertension are very few. Most of the published work has not focused on an individualized approach to treatment.
The remedies administered has been mostly those with a reputation for effectiveness in cases of hypertension.
Bignamini et al. examined73 the effect of Baryta carbonica 15C in 34 elderly hypertensive subjects. Overall the trial result did not show a significant effect of the medicine , compared to placebo. But an interesting observation was that the patients who exhibited symptoms of Baryta carbonica, had a considerable reduction in blood pressure.

A study74 conducted by Dr. Farokh J. Master has shown a decided improvement in the treatment group. Here the medicines used were Adrenalinum, Eel serum and Baryta muriatica.
At present the Central Council for Research in Homoeopathy in India is conducting a study on hypertension in its unit in Hyderabad, the results of which are awaited.

Materials and Methods
The material for this study comprised of patients with essential hypertension, registered for treatment in the out patient department of Govt. Homoeopathic medical college, Thiruvananthapuram. Keeping the aims and objectives in mind, and to help in drawing valid conclusions from the study, the following inclusion and exclusion criteria were followed

Inclusion criteria
” Diagnosis of essential hypertension – History, examination and routine investigations show no evidence of secondary causes
” Age group – patients within 35 – 65 years of age
” Sex – Both sexes included
” Cases falling into low and medium risk groups after risk stratification

Exclusion criteria
” Diagnosis uncertain or findings from the history, physical examination or routine investigations arouse suspicion of a secondary cause for the hypertension
” Cases falling into the very high risk group after risk stratification
” Isolated systolic hypertension
” Cases with wide fluctuations of blood pressure
” Cases with serious illnesses or conditions affecting function of different organs or systems – e.g. hepatic disorders, impaired renal function, pregnancy etc.

Population under study
The study population was comprised of cases of essential hypertension registered at the Govt. Homoeopathic Medical College, Trivandrum, during the period 1997 – 2000. They included patients who wanted treatment for their hypertension and those in whom a raised blood pressure was discovered during the examination in the various out patient departments.

Selection of sample
The hypertensive status of the study population was initially confirmed after measuring the blood pressure twice on two separate occasions. The blood pressure was measured using a mercury sphygmomanometer of standard cuff size, with the subject in the sitting position, after 5 minutes rest.

The patients whose hypertensive status was confirmed was subjected to a preliminary enquiry and examination to exclude causes of secondary hypertension. They also underwent laboratory investigations, which included a blood count, urine for protein, glucose and blood, blood urea and serum creatinine, serum cholesterol, random blood glucose, chest X-ray, and an electrocardiogram.

Further their blood pressure was graded and different risk factors analyzed to assess the overall cardiovascular risk in individual cases. For this purpose the criteria laid down by the WHO-ISH was followed.
The patients who finally got through the various inclusion and exclusion criteria, formed the study sample. They were twenty in number, including – males and – females.

Study design
The study consisted of subjecting patients with essential hypertension to homoeopathic treatment and assessing the efficacy by comparing the systolic and diastolic blood pressures before and after the period of study.
The feasibility of a placebo-controlled study was examined, but was rejected because of ethical and logistical reasons. It was decided to conduct a clinical trial without a placebo control, with the understanding that a placebo controlled trial may be attempted in the future if the results from the current trial is encouraging.

Period of study
The cases were followed up for three months, from the date of the first prescription. The study period was fixed considering the importance of assessing the efficacy of treatment within a reasonable time frame. This is especially so in the case of essential hypertension, with its known risks of prolonged uncontrolled blood pressure. It also helps in comparing the results with conventional treatment, which is known to show improvement in blood pressure within a short period of time.

Treatment intervention
Case taking and analysis
Every patient included in this study was interrogated in detail from a homoeopathic perspective, and the history and examination findings were recorded in a case record book.
In all the cases, a detailed analysis and evaluation of the symptoms were done, before erecting a totality. An examination of the miasmatic basis of the symptoms was also carried out to understand the different miasmatic influences in each case. Further they were repertorized with Synthesis repertory (Synthesis: Repertorium Homoeopathicum Syntheticum ed. 7.1 by Schroyens F, published by Homoeopathic Medical Publishers, London, Published in India by B Jain Publishers (P) Ltd.). In certain cases, other repertories were also consulted.

Remedy selection
The final differentiation of the remedies were made after reference to the different materia medicae, and a remedy matching the totality was chosen, taking care that it also corresponded to the predominant miasmatic influence in the case. In some cases, especially where characteristic symptomatology was lacking, remedy selection was influenced by factors like causation, keynotes, marked modalities etc.

Potency and dose
The potency selection depended on the individual case. Different factors like, the degree of similarity, presence of reversible or irreversible pathological changes, clear or vague image of sickness, and the general vitality of the patient etc were considered for selection of the appropriate potency. When there was no clear trend towards either a higher or lower potency, a medium potency was chosen, usually the 30th .
The drugs selected were given in a single dose (in sugar of milk), along with placebo in the form of blank tablets. They were advised to take the remedy at night before going to bed, and the placebo in most cases were to be taken in the morning and evening.

Additional measures
The patients on anti-hypertensive drugs were asked to reduce the dosage gradually and then stop, corresponding to the pace of improvement.
All the patients were given instructions regarding diet and regimen, keeping in mind their socioeconomic status and level of education. The usual measures included avoiding coffee, smoking, alcohol or other substances having a medicinal nature. They were also advised to restrict salt and fat in their daily diet and were encouraged to undertake more physical activity.

Follow up visits
The follow up examination of the patient were usually made at 2-3 week intervals. They were also asked to report even before the scheduled date, in the event of experiencing any troublesome symptom or serious illness. In addition, they were made aware of the necessity of being faithful to the follow up schedule.
At each follow up the patients were evaluated in detail with special reference to changes in general well being, change in presenting symptoms and addition of new symptoms. In addition, the physical examination, including measurement of blood pressure, was repeated.
During the follow up visits, the remedy was repeated only when necessary, in the same potency or with a change in potency. Likewise a change in remedy also was considered only when essential, after careful evaluation of the follow up. In cases where both were not necessary, only placebo was prescribed, in the form of sugar of milk powders and blank tablets.

Outcome measures
The primary outcome measure is the systolic and diastolic blood pressure values after the period of the study. These were compared with the initial values, and the difference analyzed using statistical tests, to find the efficacy or otherwise of the treatment.
Secondary outcome measures include change in grade of hypertension before and after treatment, and change in other symptoms associated with hypertension.

Statistical tests
Statistical tests were used only for the main outcome measure. For the purpose of this study, the statistical analyses were conducted separately for systolic and diastolic blood pressure values, using the paired t test. The test helps to establish whether the changes observed before and after treatment were significant or not.
The same test was also used to estimate any difference in the changes observed in systolic and diastolic values, to understand specific effects if any.

Observation & Discussion
A total of twenty cases were selected for this study. Out of the many cases screened, only those, which passed all the inclusion and exclusion criteria were selected. Some of the cases were excluded, as subsequent measurements of blood pressure showed a fall in blood pressure into the normotensive range.
Some were rejected after analysis of the risk factors showed that they fall in the very high-risk category, due to very high blood pressure, complications like coronary artery disease, or concomitant illness like diabetes mellitus. Only one case was excluded due to the clinical suspicion of a secondary cause(hypothyroidism) for the hypertension.

Limitations of the study
A. Small sample size
Due to the small sample size, it would be difficult to generalize the results from this study
B. Duration of the study
The study duration was three months, and hence the study does not reflect the efficacy of homoeopathic treatment in the long term.
C. Lack of placebo control
The role of the placebo affect of treatment if any, cannot be assessed in the absence of placebo control.
D. Age & sex distribution
Although a wide age group was selected for the study, most of the cases are in the 55-65 years age group. In the sex distribution also there is predominance of the female sex. Both of these factors may possibly confound the results obtained
E. Selection criteria
Most of the hypertensive complications and concomitant illnesses are excluded from this study, and one cannot assume the efficacy of homoeopathic treatment in such cases. Such cases may also warrant the use of many partially proved or smaller remedies, and the efficacy of such remedies has not been assessed in this study.

Summary & Conclusion
Essential Hypertension is a major health problem, especially in the developing countries. It is a key risk factor for important cardiovascular diseases like coronary heart disease and stroke, both of which account for a good proportion of the deaths worldwide.
Conventional anti-hypertensive treatment, while effective in reducing the blood pressure, has its own draw backs. Non compliance with the treatment regimen is a major problem. The asymptomatic nature of the illness, adverse effects of drugs and high cost of treatment has resulted in the “rule of halves”, where less than half the hypertensive population is adequately treated.
In this scenario, Homoeopathy has a lot of potential to help in reducing the proportion of the hypertensive population in the community, and thereby make a contribution in reducing overall cardiovascular mortality levels. The holistic nature of homoeopathy is ideally suited for this, as even the practitioners of allopathic medicine are realizing the fallacy in treating the blood pressure or other risk factors in isolation. The cheaper cost of treatment also makes it a more attractive option at the community level.
The present study was primarily aimed at determining the effectiveness of the homoeopathic approach in the management of essential hypertension. An attempt was also made to find out if possible, remedies which are more useful in treating the condition. To achieve these aims, twenty cases of essential hypertension were subjected to three months of homoeopathic treatment, and the change in blood pressure levels before and after treatment were evaluated.

The study has shown that homoeopathic medicines have a positive effect on the hypertensive status of the patients in the study sample . The efficacy is demonstrated by the results of the statistical analyses (p < .001for both diastolic and systolic levels ), which show that the pretreatment and post treatment levels of blood pressure are indeed, different. An analysis of the change in grade of hypertension before and after treatment has also shown that thirteen cases or 65% have changed from a higher to a lower grade of hypertension. The group which responded the most to treatment was patients in grade II hypertension with 72.7 % showing change to a lower grade. Finally, an analysis of the cardiovascular risk profile before and after treatment has also demonstrated a reduction in the percentage of cases in the higher risk groups.

The remedies used in this study were essentially prescribed based on the chronic totality. Due to the relatively small size of the sample, no single remedy could be identified as clearly more efficacious than the others. However, remedies like Natrum mur, Calcarea carb, Kali carb and Sepia were found to be effective in more cases than others. China and Carcinosinum were found to be effective in one case each, though both are not mentioned in the general repertories under the rubric for hypertension. The potencies used also has varied, and no single potency was found to have a superior effect.

Bearing in mind the limitations of the study, It would be premature to draw absolute conclusions about the effect of homoeopathic medicines in the management of essential hypertension. But the results of this study are certainly encouraging, and warrants further studies with more stringent criteria. Such a study, with a good sample size, will also help in evaluating the relative efficacy of various medicines in the treatment of essential hypertension.

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Dr Arun Prasad K.P. BHMS,MD(Hom)
Department of Materia Medica
Govt. Homeopathic Medical College. Calicut. Kerala
Email : appoo@sancharnet.in

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Migraine- A study on the effectiveness of Homeopathy

Dr Rajitha K Nair

Preface
Migraine is the commonest form of headache seen in younger age groups. The incidence of migraine is increasing now days probably due to modern food habits and the stresses and strains of life.

We are able to manage successfully these migrainous attacks with Homoeopathic medicines because our treatment is mainly based on subjective and other mental symptoms. So I thought it would be worthwhile to make a study on the effectiveness of homoeopathic medicines in the treatment of migraine.

The cases that I am presenting in this case study have been taken from the case records of special OP on Migraine functioning under the department of Case taking and Repertorisation at Govt. Homoeopathic Medical College Trivandrum. I believe this study will help me to treat Migraine confidently and effectively.

INTRODUCTION
Head ache
Almost 60-70% of patients presenting in the family physician’s clinic for relief of pain comes in the complaint of headache. This can affect all age groups and all sexes. The common causes of headache can be divided as follows:

Acute Head Ache
Sudden, severe, never before headache accompanied by vomiting, altered levels of consciousness and even coma is generally due to a vascular cause in the brain, most likely a bleed. This requires immediate shifting of the patient to a major health institute.

Chronic Headache
This headache can again be classified into
> A recurring headache which is likely to be migraine or tension head ache
> A dull headache which causes most of the time and patients may get used to it. This could be due to Refractive errors or
astigmatism, Sinusitis or Cervical spondilitis leading to pain in the back of head

Migraine
Simply defined , it is the worst form of headache imaginable. Often confined to one side of the head, it is preceded by distortion
of vision (aura) and accompanied by nausea and vomiting

Migraine is the commonest from of vascular headache. It is characterised by episodic throbbing hemicranias headache beginning in childhood, adolescence or early adult life which tends to decrease in intensity and frequency as age advances. These are periodic headaches which are typically unilateral and are often associated with visual disturbances and vomiting.

Incidence
It is estimated that 5% of population suffers from migraine, Women are slightly more affected. Positive family history is elicit able in most cases. There are probably over five million people in India alone who suffer form this illness. In some fortunate cases, migraine only strikes 2 or 3 times in a lifetime. In most people, attacks recur again and again as frequently as two or three times a week- but fortunately for many suffers, with diminishing intensity and frequency as they get older. There is complete freedom from distress between attacks. Like backache sufferers, migraine sufferers generally get little sympathy, yet it is a condition which can disrupt marriage, affect a job and in severe cases, completely ruin living.

Classification of Principal Forms Of Migraine.
Classical migraine” visual or sensory symptoms precede or accompany the headache.
Common migraine- no visual or sensory features, associated with headache, nausea, vomiting and photophobia.
Basilar artery migraine-occipital head ache preceded vertigo, diplopia, dysarthria with or without visual and sensory symptom,sometimes associated with loss of consciousness.
Hemiplegic migraine – prolonged headache lasting hours or days followed by hemiparesis, which recovers slowly over several days.

Another Classification Is:
Migraine with aura,
Migraine without aura.

Migraine With Aura
(Formerly Known As Classical Migraine)
In this type the pre-attack is pronounced, and accompanied by neurological symptoms mainly connected with vision flashing lights and distorted sight.

Migraine Without Aura
(Formerly known as common migraine)
In this type pre attack symptoms are absent or slight. Although there can be a feeling of being unwell or irritable. Headache is often followed by nausea leading to vomiting, the time cycle in both cases usually lasts from a few hours to as long as 2 or 3 days, often followed by another days or two of exhaustion before the full recovery.

What Are The Symptoms?
In migraine with aura the sufferer often gets a warning signal. Strangely enough this can be a feeling of unusual well being on the day preceding an attack, but in most cases the warning signals only appear 30 minutes, or even only 15 minutes, before the onset of the attack.

A more common advance symptom in Migraine with aura is a gradual worsening of the eyesight, starting with blurred vision, and leading to blind spots in the center of the eye and even, in extreme cases to temporary loss of vision

In some sufferers’ pins and needles or numbness in the hand or in one arm, or one side of the face, or the chin, mouth or tongue, precede an attack of migraine. This can be particularly disturbing in people with heart or circulation disorders, as they may easily misinterpret the symptoms. A common feature of all migraine attacks is acute discomfort (burning, pressing, and stabbing in one of the eyes) later leading to the actual pain.

In general, during an attack, the sufferer is weak, pale, irritable and tries to relieve the intense pain by emitting loud groans, with giddiness, partial toss of vision and difficulty m speaking correctly, the sufferer deserves full sympathy.

Who is likely to 6et migraine?
Migraine can strike anyone, mate or female, at any age. although it is unusual for an older person to have their first attack
after the age of 50. Cases have been noted as young as 3 years of age, and as old as 78 years of age.

In women, there is a strong hereditary tendency and, for many a connection between the menstrual cycle, the contraceptive pill and the incidence of migraine has been established.

Stress, worry, tension and anxiety in private and business life bring on migraine in many cases, although the relaxation syndrome of weekends and days off work adversely affect others.

What provokes or aggravates an attack migraine?
The most likely triggers, which can cause an attack, can be classified into five general categories.

Physical (fatigue / over – exertion / relaxation)
Psychological (depression / worry / shock / anxiety)
Diet (consumption of alcohol / various type of food and drink, e.g.chocolates).
Medical (contraceptives/ blood pressure / menstruation)
Other factors (loud noises / glaring lights/ TV/ strong smells).

These factors cover such a wide field, that you can say that almost anything out of the ordinary might affect the position. It is therefore important and very useful that suffers keep a day to day record of such factors to determine which affects them adversely if a pattern of attack has to be identified.

Mechanism of migraine
Exact mechanism is unknown; it is the consensus that an attack of migraine consists or a neuromuscular disorder of the intracranial as well as extra cranial vessels. Sequential studies of cerebral blood flow shows an initial reduction, which may be localized or generalized followed by increases in blood flow later. The basic cause of these circulatory disturbances is unknown. it is found those blood levels of serotonin, histamine and norepinephrine increases during the attacks. There is also and increase in platelet aggregablity. This may account for strokes, which complicates migraine. The headache has been attributed to extreme pulsation of extracranial as well as. intracranial arteries.

There is now good evidence that in classical migraine there is extreme cerebral oligeamia at the onset of the attack. This is often occipital in site but may spread to the parietal and temporal lobes. Oligeamia may be secondary to some primary cortical dysfunction, since attack can be set off by neural stimuli like bright light or strong odors. Others believe that vasospasm is responsible for the initial dysfunction.

During headache phase there is dilatation and edema the extra cranial arteries and probably some alteration in pain sensitivity in their walls. These vascular changes may be due to fluctuation in blood 5 hydroxy tryptamine levels.

There is a genetic predisposition. Approximately three” quarters of patients who suffer form migraine have close relatives similarly affected.

Migrainious attacks may be precipitated by a variety of factors such as menstruation, flashing lights, stress and anxiety. Che6se, chocolate, sherry and red wine are all common precipitants and are all rich in tyramine, experimental ingestion of which will often provoke an attack. Reserpine, which liberates 5 hydroxy tryptaminein brain also, can cause migraine.

Clinical features
The condition usually starts after puberty and continues until late middle life. Attacks occur at intervals, which varies from a few days to several months. They last from a few hours to several days and leave the patient weak and exhausted.

Classical migraine
Here episode begins with prominent neurological symptom such as visual disturbances as zig zag fines, spreading scotoma homonymous hemianopia, field defects or rarely total blindness, sensory disturbances as affecting one half of body or parasthesia, disturbances of speech or hemiparesis may be present. These symptoms are associated with focal cerebral oligeamia. There is commonly a sensation of white or colored lights, scintillating spots, wavy lines or defects in visual fields. Sometimes there may be numbness of both hands and around the mouth. These symptom may last for upto half an hour and are followed by head ache which begins in one spot and subsequently involve the whole one side of head, this may be same side or side opposite to the visual or sensory disturbances.

The side affected is not constant with each attack and headache often becomes bilateral. The pain is usually severe and throbbing and is associated with vomiting, photophobia pallor sweating and prostration, which may necessitate the patient taking to bed in a dark room. All these events may last for 1-2 days. In majority of cases duration is much shorter.

Common migraine
Here there are no preceding neurological symptoms but there is unheralded onset of headache nausea and vomiting following the same sequence.

Cluster headache
(Horton’s syndrome, histamine head ache)
It is a vascular headache or a migranious variant. The name cluster headache refers to its occurrence 4n bouts. Disease is more common in males. Male: Female ratio is 4:1. The headache starts within 3 hours of falling asleep, it is non throbbing unilateral and orbital In location.

Along with pain there may be lachrymation, nasal obstruction, rhinorrtioea and sometimes miosis, ptosis. flushing and edema of cheek all lasting approximately an hour or two. It tends to occur every night for weeks or months followed by complete freedom for years. Such dusters of headache may occur over years. Periods of headache are brought on by stress; prolonged strain, overwork and emotional disturbances, alcohol, nitroglycerine and tyrosine containing foods may precipitate headache.

Diagnosis
Diagnosis is made mainly from history as
Long duration of illness
Onset during childhood
Positive family history
Relief with ergot derivatives is in favor of migraine.

Course and prognosis of migraine
In majority of patients migraine tends to be chronic with periods of exacerbation’s and remissions. With increasing age attack tends to come down. Complications may occur rarely in some cases and these include cerebrovascular accidents, ocular palsies and other cranial nerve palsies.

Differential diagnosis of migraine.
Chronic paroxysmal hemicranias
This term refers to brief spells of headache recurring frequently and following chronic unremitting course. It differs from cluster headache in the brevity of attacks.

Hang over headache
Headache following an alcoholic bout is thought to be due to vascular mechanism. Vascular dialatation and headache may be a feature of hypercapnia in patients with respiratory failure. Severe arterial hypertension may cause headache. In elderly localized temporal headache may be due to cranial arthritis.

Psychogenic head ache
Headache is a common symptom of psychiatric disorders. Such headaches involve the whole head or may be confined to front or vertex. It is a sort of pressure or tightness felt by the patient. Tension headache tends to occur following emotional excitement or other stresses and persists continuously for days or weeks. Prominent symptom of depression, anxiety or hypochondria’s may be present.

Management
Physician should give full explanation of the nature and phenomena of migraine to the patient and this often relieves his anxiety and helps to relax his morale. All known precipitating factors such as emotional tension, exposure to  foods such as cheese and chocolate, bright light and oral contraceptives should be avoided.

Treatment
In spite of increased research, no definite cure has been found as yet. Tremendous progress has. and is, being made alt the time. As there is no single cause for migraine, there is no single drug available for all treatment. Your doctor will have to investigate your symptoms closely before deciding on which of very many forms of treatment should be prescribed. If one particular medication does not give the required relief, others are available. If the side effects are distressing, other drugs can be prescribed.

Many sufferers take such medicines at the first signs of an impending attack and, if possible, try to lie down in a quiet, darkened room. Some sufferers find relief by placing ice packs on the head or soaking their feet in hot water. It is well worth experimenting to find the best solution for relief.

REPORTORIAL REPRESENTATION

BOERICKE’S REPERTORY
HEAD- Migraine(megrim, nervous)-anac, arg n, bell, calc ac, can ind, dm, coco, coff, eye/, epiph, gels, guar, ign, iris, kali c, lac deft,lach, meli, menisp, nux vom, onos, puts, sang, scutel, sep

CONCISE REPERTORY- PHATHAK
MIGRAINE- chio, gels, ipec, kalibi, lac defl, nat mur, nat sul, onos,psor. lob, sang, spig, sil, ther

KNERR REPERTORY
Inner head- hemicrania(megrim, migraine)- Cham, sil, apis, arg nit,am, ars, asar. bar c, bry. calc, caps, clem, chin, cocc, cornus, gels,indigo, kali bi, kreos, lach, lac defl, syph, ver

BOGER’S REPERTORY
Head internal – Migraine – COLO. PULS. NUXVOM, SANG. SEP

KENT’S REPERTORY
No direct rubric
Head – Pain vomiting with
Head – Pain vomiting amel
Vision flickering – Head ache before

HOMOEOPATHIC MANAGEMENT
Scutellaria: In nervous sick headaches, which do excitement andover-exertion cause. Frequent scanty urination.
Tongo : Migraine and neuralgic affections.
Chionanthus: Migraine due to acidity and sluggishness of liver.
Damiana : An excellent remedy for migraine.
Calcarea Lac: It is useful in T.B diathesis. Give in 3x dilution.

Iris V : Periodical nervous sick headache, which comes on afterthe patient relaxes, form a mental strain. With schoolteachers it comes on Saturday or Sunday, and with preachers on Monday. The patient usually vomits bitter bilious substances and the vomiting gives relief to the pains in the head. Migraine of the eye with constipation. Objects could only be seen in halves. Bilious headache with burning and acidity. Throbbing and severe pain causes disturbances of vision. Vomiting which is bitter relieves pain.

Cyclamen: fails this remedy may be tried provided migraine is accompanies with sparkling before the eyes.
Coffea : An excellent remedy for headache caused by loss of sleep following excitement.
Ignatia : When due to grief in hysterical patients. Frequent urination, profuse or scanty.

Belladonna : Headache in plethoric and healthy persons. The cause is some disturbance of the circulatory system. The headache is violent, pounding and throbbing. Throbbing and bursting headache in temples with fiery red and hot face. Eyes bloodshot and red. Face flushed. The pains disappear as suddenly as they appear. Sun headache with full bounding pulse. Unconsciousness

Iris Tenax: Headache which begins on or before rising, beginning on left eye extending thence to left half of head.

Gelsemium: Pains beginning in the nape of neck and shift over to head, causing a bursting sensation in the forehead and eyeballs.Feels as if head is full and big. Unconsciousness. As if there is a band the head.

Glonine: Headache due to working under gaslight, in the sun when heat falls on the head. Head feels enormously large, Sunstroke and sun headache without unconsciousness.

Natrum Mur: When the headache increases with the rise of the sun and stops at sun-set Headache with sweat. The greater the pain the greater the sweat. Headache of schoolgirls or boys, worse on eye straining. Fiery zigzag before headache. Hammering headache as If hammers are knocking the head.

Spigelia: Nervous headache beginning in the morning at base of brain, spreading over the head and locating in eye orbit and temple of left side. Intolerable pressive pain in the eye balls. Tic douloureux of left side. Pain disappears in the evening. Sensation as though the head were bound around the vertex.

Sanguinaria Canadensis: For the same symptoms as in “Spigelia”, except that it is a right-sided remedy. Biliious headache when going without food. Veins and temples distended. Headache once in seven days begins on waking in the morning in occiput and travels to the right eye and temple; the patient is driven into a dark room and has to lie down. starts vomiting bile, which relieves him. Heat of palms and soles. Bursting headache worse with sunrise. Has false hunger with aversion to thought and smell of food.

Cedron: Severe unbearable pains recurring daily at 6 p.m. Tic douloureux.
Bryonia: Headache when stooping as if brain would burst through forehead. Worse on motion. Headache brought on by playing or watching the play.

Melilotus: Violent congestive and nervous headache, which is relieved by epistaxis (bleeding form the nose). Congestive
headache as though the brain would burst through the forehead.

China Off: Headache congestive, throbbing and hammering like on temples, worse by slightest contact and better by hard
pressure.

Kali Bi: If headache begins with blurred vision. Sight returns as headache increases.
Lac Vac: Headache with nausea and constipation or at the time of menstruation; relieved by frequent urination.

Ruta : Brought on by reading and eye-strain. Head remedy for eye-strain
Oleander: As if heavy weight is put on the scalp which is crushing the head; better by looking sideway or crossing eyes.

Arnica Montana: When trauma (injury) is the cause, pain aching. bruised, occasionally sharp, as if nails were being driven into the brain; mental confusion. Aching pain is aggravated by rinsing the head and is relieved by having the head elevated.

Hypericum: Headache due to indulging in alcoholic and other stimulants. It has aching pain as if beaten; tensive; heavy; dull; confused; sinking; and bruised with associated symptoms of nausea and vomiting of sour and nasty matter. Ineffectual urging for stool. Headaches better in the evening.

Chamomilla: Headache with peevishness. The patient is cross and angry. This headache occurs normally in patients who use alcohol in excess and take opium to counteract its effect or who take strong coffee to quieten the nerves

Iodium: Headache as if tied up with a band, worse by going into the warm room or near fire. Better in cold room and in cold air and white eatino.

Calcarea phos: Headache of school girls and boys who apply themselves too closely to their books, especially children who are growing rapidly and whose mental development is out of
proportion to their physical strength.

Thuja : Headache as if a nail were driven into the occiput or into the frontal eminence.
Robinia: Bilious headache with gastric symptoms, pain in stomach, sour vomiting and acidity. Feels as if the head is full of boiling water.

Tarentula Hispania: As if thousand needles were piercing in head; worse by noise, touch and strong light.. Better by rubbing.
Lac Defloratum: Sick headache begins in forehead extending to occiput with throbbing, nausea, vomiting, blindness and obstinate constipation, at the time of menses; relieved by frequent urination.

Veratrum Alb: Nervous headache with vanishing of sight and icy cold sensation in vertex better by cold application. Headache that changes the face almost inducing insanity.
Chionanthus: Specific for sick headaches. Listless and apathetic. Dull frontal headache over root of nose. Over eyes, through temples, worse stooping and moving,. Use mother tincture.

Epiphegus: Nervous headache with characteristic symptom of spitting constantly, saliva viscid, Headache preceded by hunger.

Ignatia: Nervous headache after grief. Terminates with a profuse flow of urine. Headache in hysteria. Pain as if a needle or nail were driven into the head.

Silicea; Headache relieved by wrapping and covering. Worse in the dark and bettter in light. Nervous headache caused by
excessive study at school.
Onosmodium: Due to strain, or eye strain; vertigo; nervous headache, neurasthenia

Actea R.: Frontal, vertical or occipital headache with great pain in eyeballs, better by pressure and worse by slightest motion.
Sepia : Headache darting pains right side head and face rolling and beating against frontal bone; darting and tearing pain in left temple, over left eye extending towards occiput. Headache on vertex, throbbing, feels as though head would open on top, worse from noise. Aversion to food of any kind with feeling of emptiness and goneness sensation in stomach. Better after meals and relieved completely by sleep.

Staphisagria.: Headache after eating beef. Headache with roaring in ears. Aching, stupefying pain in head, especially forehead. Pains are pressing inwards and outwards; they are increased on slightest touch.
Crotalus Hor: Sick headache, vomiting of bile in large quantities. Cannot lie on right side or on back without producing black bilious vomiting

Anacardium: Headache relieved entirely by eating; worse during motion and working. Gastric and nervous headaches.
Cocculus: Pain in the back of the head, as if the parts were alternately opening and closing. Headache comes on like a
shadow. Can hear what is going on while asleep, even snoring. Nervous headache with giddiness and nausea and vertigo. Holds
the nape of neck firmly with hands owing to the severity of pain.

Ptelia: Bilious headache with burning sensation of skin, face and even breath that burns the nostrils.
Psorinum: Headache due to hunger, wants to eat but cannot eat enough.

Alumina silicate: Headache worse by binding the hair, biting the teeth together, before and during menses, stepping heavily,better by cold air and cold application, moving the head and from walking.
Selenium: Headache caused by indulgence in alcohol or tea, by hot weather over study and aggravated by strong odours.
Increased flow of urine during headache.

Phosphorus: Headache relieved by cold application and is aggravated in a warm room and by warm applications. Sense of coldness in the base of brain

Lachesis: Violent headache during the menstrual period when the flow slackens. Headache, like the menstrual pain is relieved by the flow. Bursting and hammering headache with blood running to the head.
Calcarea carb: Chronic headache in fatty persons with tendency for sweating of the face. icy coldness of hands and clamminess of the extremities.

CASE STUDY
The cases which I am presenting here in this case study is an abstract of 50 cases treated in special OP on migraine functioning on alt Fridays in Govt: Homoeopathic Medical College. Trivandrum. I was in charge of this OP from April 2000 To March 2001. These cases were treated during this period.

CONCLUSION
Of the fifty cases taken for this study thirty six cases showed  marked improvement of complaints without any recurrence after six months of treatment. Yet they are continuing treatment in the OPD regularly.

I have found from these cases that if the correct remedy is administered in suitable potencies even in severe acute cases,patient gets relief within few hours.

The important symptoms to be considered for selecting a remedy in migranious attacks are
1. Generals both physical and mentals
2. Peculiar rare and uncommon symptoms
3. Characteristic particulars
4. Constitutional symptoms
5. Characteristic modalities and concomitants

Bibliography
1. Davidson’s Principles and practise of medicine
2. A short Text book of medicine by Dr:K V. Krishna Das
3. Inches book of health care By Dr: C.H.Asrani
4. Select your remedy By Bishamber das
5. Clinical repertory appended to the materia medica-boericke
6. Concise repertory of homoeopathic medicines-S.R.Pathak
7. Repertory of homoeopathic materia medica -Dr: J.T.Kent
8. Repertory of hering’s guiding symptoms of our materiamedica- C.B.Knerr
9. Boenninghausen’s characteristics and repertory- Dr: C.M.Boge

Dr Rajitha K Nair BHMS,MD(Hom)
Department of Repertory
Govt. Homeopathic Medical College. Trivandrum
Email : drrajithakn@rediffmail.com

medicines

A Study about Injudicious use of Antibiotics in Common Cold

medicinesNoufira,Sakkir Hussain,Rubeesh Hassan  (3rd Year MBBS Students.Govt.Medical College.Calicut)

CONTENTS
1. BACKGROUND
2. REVIEW FROM PREVIOUS STUDY
3. RESEARCH QUESTION
4. OBJECTIVES OF STUDY
5. MATERIAL & METHOD
6. IMPLEMENTATION OF STUDY
7. ANALYSIS
8. CONCLUSION
9. COMMON COLD

I. Background
Common cold is an upper respiratory tract infection caused by viruses. which cannot be helped by antibiotics. Most do not require treatment and antibiotics are not necessary in uncomplicated cases. But in the present scenarios we see that antibiotics are used indiscriminately for common cold. Most of the doctors justify the use by giving the following reasons (1) Most of the common cold patients come to doctor 3-4 days after the onset of symptoms. In such a case if not treated with antibiotic may lead to severe complication and once they are developed it is difficult to control. (3) it is said proper rest will resolve the common cold in a week. but at present no one has time to rest. So every one like to get rid of the disease as soon as possible.

But these indiscriminate use of antibiotic results in increase in avoidable adverse effects, development of antibiotic resistance & unnecessary increase of cost of therapy

ii. Review from previous studies
A) A study conducted in USA by Dr. Arroll B. Kenealy T shows following results
There is no enough evidence of important benefits from the treatment of common with antibiotic. (Cochranereview. org)
B) Another study result
Antibiotic for common cold not only increases the cost of treatment unnecessarily, increase drug side effects & contribute to the evolution of antibiotic resistant bacteria..(Rosenstein, N, The common cold – principle of judicious use of antimocrobeal agent)

iii. Research question
Will a comparative study among 25 common cold patients treated with supportive medication and 25 patients treated with antibiotics in addition to supportive medication reveal more complication in former group.

IV. Objectives of study
1. To detect the complication of common cold in 25 patients treated with supportive medication by the help of questionnaire and personal contact
2. To detect the complication of common cold in 25 patients treated in addition with antibiotics by questionnaire and personal contact.
3. Compare the complications in both groups from the collected information and to asses the effect of antibiotic therapy for common cold
4. To compare the treatment expense in both groups

V. Material & method
Design of study: Descriptive study
Subjects: 50 diagnosed cases of common cold 25 of them treated with supportive medication and 25 treated in addition with prophylactic antibiotic therapy.
Inclusion criteria: patient presented with running nose, Sneezing. Throat pain, Cough are diagnosed as common cold
Exclusion criteria: Patient without watering. Sneezing, Nasal block, are excluded. Patient with allergic rhinitis

VI. Implementation of study
Prepare 50 questionnaire containing details to be gathered from the patients with the help of Dr. Bindu (Dep. of Community Medicine).
With the help of this questionnaire details of clinical presentation & treatment taken are to be collected from 25 patients using antibiotic and 25 patients taking symptomatic treatment.
These patients are followed up for 10 days. Assess the out come of their illness by noting development of complication after the end of follow up period.
Compare the complication developed in both group by analyzing the information obtained and comment whether prophylactic antibiotic therapy required in all cases of common cold.

VII. Analysis
50 patients are selected. Age groups are given below-

Age group (yrs) Cases
1-10        2
11-20     11
21-30     27
31-40      4
41-50      4
50-60      2
Table-Vll” a

From this Table it is clear that only few cases are in extreme age group( In extreme age groups prophylactic antibiotics are usually indicated since they
are more prone to develop complication

Frequency of clinical presentation
Watering from nose
Group 1    76%
Group II   92%
Gp – I – patients using antibiotic
Gp – II – patients using only supportive Rx

Sneezing
Group 1       80%
Group 11     76%

Throat pain
Group 1      84%
Group 11   52%

Cough
Group 1     80 %
Group 11   48%

Nasal block
Group 1     60%
Group 11   76%

Fever
Group 1     68%
Group 11   56%

Head ache
Group 1    68%
Group 11  36%

Above tables shows the clinical presentation of the patients. Most of the patients among group I presented with watering from nose, Sneezing , Throat
pain. Cough. Group II patients most present with watering sneezing and nasal block. This shows that both groups of patients came with more or less similar symptoms.

Duration of time between first symptom and consultation: –
1-3 days       4-7 days
Group 1     72%             28%
Group 11   72%             28 %

Most of the patients (72 %) consult the doctor with in 1 -3 days

Treatment details:
Usa
ge of house holds remedies:
Group1       42%
Group 11    32%

Self-medication:
Group 1      30%
Group 11    16%

Follow up Details
75 % cure rate after 10 days.
75 % cure               Complicated
Group 1        60%                          40%
Group 11      60%                          40%
Value      Df          Assymp – sig
Pearson chi   .000        1             1.000
square

Complication among group I to group II:
Purulent sputum                                                      value       df        Assy-sig
Group I    36%                         Pearson chi square –  .000        1          1.000
Group II   24%

Fever                                                                         Value    Df     Assymp sis
Group 1     36%                             Pearson chi square  1.587    1       .208
Group 11   20%

Chest pain                                                                    Value  Df    Assym-siq
Group1    24%                                   Pearson chi square .000   1        1.000
Group11  8%

Sneezing                                                           Value     Df     Assym-siq
Group I    16%                        Pearson chi square   2.000   1        .157
Group II    4%

Cough                                                   Value  Df     Assym-siq
Group 1    44%         Pearson chi square .000    1          1.000
Group 11  44%

Above table (VII – m to VII – r) shows that there is no significant difference is complication developed in group one and group two. Even though comparison of tables shows some difference in percentage of complication developed, chi square test of each complication developed gives Assym-siq of >.05- To say there is significant difference, this value should be less than 0.05]

Side effect of the usage of Antibiotics:-
Side effect               % of patients getting this complication
Gastric irritation            20%
Diarrhea                       12%
Metallic taste                 4%
Loss of appetite              4%

Working day loss due to common cold
Group 1      48%
Group 11    16%

Tables VII -s shows some complication that came due to the use of antibiotic
Table VII -1 shows the working day loss in both groups of patients

Cost of therapy
Average expense of treatment for patient receiving antibiotic therapy was found to be Rs – 85 /- and patient taking symptomatic treatment was Rs:
16/-

Vl11. Conclusion
50 People aged between 3 – 58 yrs were included in this study. Their course of illness (common cold) studied. Results show that there is no added complication among the patient taking symptomatic treatment compared to patients taking antibiotic. It is found that patients taking antibiotic spend more money for treatment, than other group, even though there is no added benefit. .’ ‘

Since the sample size taken for study was small (50 patients) further study including large groups are recommended to confirm the result.

COMMON COLD

Colds are minor infections of the nose and throat caused by several different viruses.

A cold may last for about one week, but some colds last longer, especially in children, elderly people, and those in poor health. Adults get an average of two to four colds per year, mostly between September and Many young children suffer from an averages of six to eight colds per year.

Colds are highly contagious. They most often spread when droplets of fluid that contain a cold virus are transferred by touch. These droplets may also be inhaled.

Cold Symptoms
Between one and three days after a cold virus enters the body, symptoms stat developing, such as:
Runny nose
Congestion
Sneezing
Weakened senses of taste and smell
Scratchy throat
Cough

Infants and young children are more likely than adults and teens to develop a fever. Smokers usually have more severe symptoms than non- smokers.

WHAT CAN BE DONE IF YOU CATCH A COLD?
Symptom Relief

Over – the – counter medications Can provide temporary relief of symptoms and should be used as soon as you feel a cold coming on.
Acetaminophen (paracetamol) is the preferred over – the counter medication for relief of the aches and pains associated with a cold. It is less likely to upset your stomach than other non- steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen 9e.g., Motrin IB ®). Studies have shown thataspirin or any other NSAID may worsen asthma and /or peptic ulcers. Acetaminophen (e.g., Tyienol dD) seems less likely to worsen asthma. Aspirin should not be used in children under eighteen years old because it may play a role in causing Reye Syndrome, a rare but severe liver and central nervous system condition. Be sure to discuss all medication choices with your doctor.

Congestion , cough and nasal discharge are best treated with a combination of decongestant and antihistamine. There are many over- the counter cold remedies that contain both of these ingredients, such as..paracetamol <8) Cold Severe Congestion.

REMEMBER
to follow dosage instructions oh all product labels and know what is in the medication you are taking. Many combination products- both prescription and over- the counter – contain acetaminophen (e.g.. paracetamol ) , ibuprofen (brufen), or aspirin. It is important to read the ingredients on each product label to avoid accidentally taking too much of these

There are no antiviral medications available for treating the common cold. Antibiotics are not useful for treating a cold, and should only be taken to treat bacterial complications that arise from it.

Other remedies
Herbs and minerals such as Echinacea. eucalyptus, garlic, honey, lemon, menthol, zinc, and vitamin c have been getting a lot of publicity as cold remedies. However, none of these claims are solidly supported by scientific studies.

Adequate liquid intake i
s a must. Eight glasses of water and / or juice per day are recommended. This will help keep the lining of the nose and throat
from drying out. so that mucus remains moist and easy to clear from the nose.

Avoid coffee, tea or cola drinks that contain caffeine. Also avoid any drinks that contain alcohol. Caffeine and alcohol lead to dehydration, the opposite of what you want.
Bed rest is a good idea for a speedy recovery.
If you smoke, stop! Stay away from other smokers; inhaling their smoke will further irritate your throat and make you cough even more.

What can you do to prevent a cold?
Colds are extremely difficult to prevent entirely. The following suggestions may help:

Avoid close contact with people who have a cold. especially during the first few days when they are most likely to spread the infection.Wash your hands after touching someone who has a cold, after touching an object they have touched, and after blowing your own nose. If your child has a cold, wash his or her toys after play.

Keep your fingers away from your nose and your eyes to avoid infecting yourself with cold virus particles that you may have picked up.Put up a second hand towel in the bathroom for healthy people to use. Keep an eye on the humidity of your environment so that your sinuses do not dry out. Do not inflict
your cold on others 1 Cover your nose and mouth with a tissue when you cough or sneeze, than throw the tissue away land wash your hands. Also. stay away from people who are most vulnerable, including anyone who has asthma or another chronic ling disease, or at least try to limit close contact.

Until recently, it was thought that a single vaccine could not be developed for the different cold viruses. New research approaches may enable the development of a single vaccine for most types of colds.

Complications of a cold
Colds get better within a few days to weeks, whether or not you take medication. However, a cold virus can pave the way for other infections to invade the body. including sinus or ear infections, and bronchitis. A common complication is a sinus infection with a prolonged cough. Inhaled steroids may be useful. If you have asthma, chronic bronchitis, or emphysema, your symptoms of those condition may be worsened for many weeks even after your cold has gone away

High Blood Pressure – Recent Advances

Dr K V Sahasranam

Systemic hypertension or High Blood Pressure (HBP) is a common cardiovascular disease, which affects a large population of adults. An approximate incidence of the disease would be 12 – 18 % of adults over the age of thirty. It is a disease with minimal symptoms and often fatal complications; so much so, it has been aptly called the “silent killer”. In a country like the United States, 50 million Americans have HBP. Worldwide prevalence estimates 1 billion individuals to be hypertensive and about 7.1 million deaths per year may be attributable to this disease. Exact statistics are not available from India but the prevalence in various studies has been stated to be about 12 – 15 %. This emphasizes the magnitude of the problem and the seriousness of the disease.

The other aspect of the disease is that only a small percentage of the people are aware of the disease. Hence the disease may remain undetected for a long time or be detected only accidentally. Even those patients who are aware of the disease are not on treatment or are on inadequate dose of drugs for the disease.

Let us in brief look at the various aspects of the disease, its classification, co-morbid conditions, other risk factors that we have to look for when we diagnose HBP and the complications of the disease

Classification
Category   Systolic BP (mm. Hg)     Diastolic BP (mm. Hg)
Normal                < 120                             <80
Pre hypertension 120 – 139                        80 – 89
Stage I HBP       140 – 159                       90 – 99
Stage II HBP      ≥ 160                              ≥ 100

Other associated Risk Factors
When HBP is diagnosed, other associated risk factors for cardiovascular disease (CVD) are to be looked for in the patient by clinical examination or laboratory tests. Let us enumerate them one by one.

1. Diabetes mellitus:
It is a disease most commonly associated with HBP. A combination of HBP with diabetes places a patient at an increased risk of CVD. Hence all patients with HBP should have a blood glucose test.

2. High Serum Lipids: Another risk factor for the CVD is high levels of Cholesterol and Triglyceride in blood. Hence all patients with HBP should have their serum lipid profile done to know the levels of Cholesterol and Triglyceride and if high, are to be treated appropriately.

3. Cigarette smoking:
Cigarette smoking increases the risk of CVD especially myocardial infarction and stroke. When cigarette smoking is associated with other risk factors too, the risk of CVD events increase multi fold. Hence the need to advise patients to stop smoking.

4. Obesity:
The Body Mass Index (BMI) is calculated by dividing the weight of the individual (in Kg.) by the square of the height (in meters). Eg. 65 Kg ⁄ 1.7 * 1.7 = 22.5 (BMI). The normal BMI ranges from 20 – 25. 25 – 30 is considered “overweight” and > 30 is called “Obesity”. Obesity is a definite risk factor for various diseases and also for CVD. Hence the need to control the weight in patients with HBP.

5. Physical Inactivity:
Lack of exercise is also a risk factor for CVD and adequate regular physical exercise helps to control many risk factors like obesity, HBP, diabetes mellitus and high levels of serum lipids. All HBP patients are hence encouraged to exercise regularly.

6. Age:
Men above the age of 55 and women over 65 are at increased risk of CVD. However, this is a risk factor that, unlike the other previous risk factors, cannot be modified. The importance lies in that in the elderly, all other risk factors including HBP need to be well controlled.

7. Family History:
Individuals who have parents with HBP, diabetes or myocardial infarction (before age 55) are at higher risk of developing similar illnesses. Though family history is unmodifiable, individuals with a positive family history can resort to modifications in their lifestyle and control other risk factors, if any.

Target Organ Damage
High blood pressure causes complications in the form of damage to various organs and blood vessels. The chief organs targeted by HBP are the heart, brain, kidneys and eyes. Longstanding, uncontrolled HBP causes damage to one or more of these target organs leading on to complications. Often the first clinical presentation may be complication.

1. Heart: HBP produces left ventricular hypertrophy as the earliest cardiac change. This may be detected by ECG or Echocardiography. Later, severe left ventricular hypertrophy may lead on to acute left ventricular failure or congestive heart failure. Progressive coronary atherosclerosis is another complication of HBP, which may present as angina pectoris, acute myocardial infarction or as sudden death.

2. Brain: The complication of HBP on the brain leads to stroke either due to cerebral hemorrhage or due to cerebral infarction. Chronic HBP can lead to dementia.

3. Kidneys: Chronic renal failure occurs in longstanding HBP when the kidneys are damaged. This causes elevation of blood urea and creatinine levels.

4. Eye: The retina of the eye shows various changes of hypertensive retinopathy, which leads to progressive loss of vision.

How to work up a patient with High Blood Pressure?
1. First of all, establish that the patient has a HBP by recording the blood pressure at 2- 3 occasions.
2. Look for other risk factors for CVD as discussed above.
3. Look for target organ damage by clinical examination, appropriate tests like blood test, ECG, echocardiography, ophthalmoscopic examination and urinalysis.
4. Institute treatment for other risk factors and for hypertension.

Lifestyle Modification:
All patients with HBP benefit by modifying their lifestyles. In those patients where the HBP is mild, life style modification alone may be enough to reduce the HBP. In those where life style modification alone does not control HBP, or in those with very high blood pressure initially, drugs must be added to the treatment of HBP. The major aspects of Life Style Modification are as follows.

  1. Regular physical exercise of which walking is the best and easiest. Other aerobic exercises like swimming, playing tennis, jogging or cycling are equally good.
  2. Reduction of weight by diet control and regular exercise should form part of any regimen for life style modification. Reduction in the intake of fatty foods and high sugar containing foods should be stressed upon.
  3. Reduction of salt intake to about 6 gms (1 teaspoonful) per day is advisable. A practical advice is to use minimal salt in cooking and avoid high salt foods like pickles, pappads, salted nuts, chips, tinned foods etc.
  4. Alcohol should be totally avoided or restricted to the minimum as a high alcohol intake (> 2 drinks a day) increases blood pressure.
  5. In addition to the control of salt, the diet should contain increased amounts of fiber, fruits and vegetables. The intake of meat and milk need to be restricted.

When life style modification alone is not enough, drugs should be added to the treatment of HBP to control the blood pressure to normal levels.

The advantage of controlling HBP has been proved in many studies where it has been shown that a good control of HBP reduces the incidence of stroke by 35 – 40 %, myocardial infarction by 20 – 25 %, and heart failure by 50 %. Hence the importance of diagnosing and treating HBP in individuals and in the general population is an important responsibility of every medical practitioner.

Dr K V Sahasranam M.D., D.M.
Former Professor of Cardiology Medical College, Calicut.
Senior Consultant Cardiologist.Baby Memorial Hospital, Calicut.
Email : koz_sahakv@sancharnet.in

A study on Homoeopathy in tobacco smoking and alcoholism

A Research study showing the efficacy of Homoeopathic and Bio-chemic medicine for removing the habit of tobacco smoking and alcoholism.
Prof (Dr) M Abdul Lethif
Former Principal & Controlling officer of Homeopathy
Government Homoeopathic Medical College,Trivandrum

Abstract
Homoeopathic medicines were given to 652 patients after detailed study. Science, Technology and Environment Committee, Govt. of Kerala had given Rs.50,000/- as grant for a research study for two years from 15th December 1991. Follow up study was conducted on 279 patients while 373 was drop out. 71.43% was the success rate within two weeks and 23.8% after two weeks in alcoholics. In tobacco smoking the success rate was 62.18% within two weeks and 60.78% after two weeks. The success rate was 73.52% for alcoholics and 66.17% in tobacco addict in persons who used to drink and smoke cigarette. After two weeks the result was 33.23% and 38.97% in alcoholism and tobacco smoking respectively.

Introduction
Homoeopathic therapeutic books are enriched with medicines effective for alcoholism and tobacco smoking. As in all other cases a medicine that produces symptom/ disease in a healthy human being during trial, is effective for removing the symptom/ disease in the sick. This methodology was applied in this work, according to the principles of Homoeopathy. Addicted persons are motivated and their problems were studied and recorded. After a thorough analysis of the entire case a constitutional or symptomatic medicine was prescribed. For the first two or three weeks acute medicines like Calc.
Phos 6X, Nat.Mur 3X for tobacco smoking and sterculia Q, Quercus Q, Capsicum Q for alcoholism were dispensed.

Result: From the second day onwards patients used to develop disgust for the addicted substances and gradually reduced to drink alcohol to meager and nil. Conclusion: Withdrawal symptoms are practically minimised. Loss of satisfaction and aversion for tobacco and alcohol are noticed along with return of appetite.

Materials and Methods: Homoeopathic and Bio-chemic medicines are purchased from reputed firms and their distributors. Acute medicines for one week was given for out patients and daily dose for in-patients. Sterculia Q, 10 drops (one dose) three times daily was given for alcoholics having no appetite and for others Quercus Q as above. Basic or symptomatological medicines according to Homoeopathic principles were given and thus differing in different patients. If improvement was noted placebo was given. The Biochemic medicines was selected by considering the Mental/emotional aspect of the patient. Nat.Mur 3X or 6X differs with Calc. Phos 3X or 6X with an aggregation of complaints if anybody console a patient. Tobacum 200 – one dose was prescribed to patients who had fresh desire after abstinence. In certain persons the higher potency was given,

Methods: The study was done in the following manner.

a) Distribution of cases and study according to type
1. Alcoholism.
2. Tobacco smoking.
3. Alcoholism & Tobacco smoking (combined)

b) Distribution of cases and study according to age and sex.
cl Distribution of cases and study according to nativity, i.e., urban/rural.
d) Distribution of cases and study according to religion.
e) Distribution of cases and study according to marital status.
f) Distribution of cases and study according to grade/group.

There are three groups for smoking tobacco. Those who smoke but below twenty cigarettes or beedies comes under Group I. Persons who smoke above twenty numbers but without any subjective and objective symptoms came under Group 11 and with subjective and objective symptoms came under Group 111. Similarly there are two groups for alcoholism. Those who are addicted but without complications are Group I and those having complications are grouped under Group II.

TABLE I. Smoking (Alone)
A) Distribution cases and study according to the age & sex.
No.    Age  Male   Female    Total

I. Below 20  13                    13
2. 20-29      84                     84
3. 30-39     92                      92
4 40-49      86          3          89
5. 50-59    41           2          43
6. 60 and above13             13
Grand Total                     334
The highest number of patients (92) came between the age group of 30 – 39.

TABLE 11 B. Distribution and study according to nativity.
Urban                               Rural                           Grand Total
Male   Female Total    Male    Female    Total
131       Nil      131      200        3           203               334
Out of 334 patients203 came from the rural side.

TABLE III C. Distribution and study according to the Religion
Hindu Christian Muslim Total
190       17        127      334

TABLE IV. D. Distribution and Study according the Marital Status.
M
arried     Unmarried     Total
233             95            334

TABLE V .E. Distribution and study according to the Group
1st Group         2nd Group           3rd Group         Total
177                   99.                    58                  334

TABLE VI.F. Result of treatment
Within two weeks                                               After two weeks
% of success          Drop out              % of success                         Drop out
25%                       14                         25%                                      7
50%                       23                        50%                                       7
75%                       27                        75%                                      31
100%                     10        215            100%          17                       17

Success rate within two weeks 62.18%
Success rats after two weeks 60.78%

TABLE VII. G.Old case reported 3-5 months after
Total No. of cases: 31
Results of treatment

Within two weeks                       After two weeks
% of success   Drop out        % of success    Drop out
25% •                                      25%
50%                                        50%                    1
75%                 5                     75%                   13
100%       2     10                    100%    3            Nil

Success rate within 2 weeks: 33.3%
Success rate after 2 weeks; 80.95%

ALCOHOLISM (ALONE)
TAB
LE VIII
No. of cases: 39
A. Distribution of cases and study according to the age and Sex.
No. Age          Male    Female      Total
1. Below 20     Nil – –
2. 20 – 29        1 –                            1
3. 30 – 39       17 –                         17
4. 40 – 49      10 –                          10
5, 50- 59        8              1               9
G. 60 and above 2 –                         2
Total                                             39

TABLE IX .B. Distribution of cases and study according to nativity
Urban    Rural    Total
11         28       39

TABLE X .C. Distribution of cases according to Religion
Hindu Muslim Christian Total
29     5           5          39

TABLE XI.D. Distribution of cases according to Marital Status
Married Unmarried Total
34         5            39

TABLE XII.E. Distribution of cases according to Group
Ist group       2nd group         Total
25                 14                   39

TABLE XIII.F.Results of treatment:
Results Within two weeks ;                     Results After two weeks .
% of success      Drop out             % of success                  Drop out
25%                                              25%
30%    2           18                          50%
75%                                              75%                                1
100% 13                                       100%   4                         Nil
Success rate within two weeks : 17.43%
Success rate after two weeks : 23.8%

TABLE XIV.Total No. 4.G. Old cases reported 3-5 months after
Results Within two weeks                  Results After two weeks
% of success  Drop out                     % of success    Drop out
25%                                                  25%                 1
50%                                                 50%
75%                                                  75%
100%                                                100%                   3
Success rate after 2 weeks : 100%

ALCOHOLISM + SMOKING
TABLE XV
No. Age               Male       Female      Total
1. Below 20           2                               2
2. 20 29               58                             58
3. 30 39               95                              95
4. 40 49               93                              93
5. 50 59               27                              27
6. 60 and above     1                                 1
Grand                                          Total 276

TABLE XVI.B. Distribution of cases and study according to Nativity
Urban          Rural       Total
151             125            276

TABLE XVII.C. Distribution of cases and study according to Religion
Hindu Christian Muslim Total
215       17          44     276

TABLE XVIII.D. Distribution of cases and study according to Marital status
Married Unmarried Total
222       54           276

TABLE XIX. E.Distribution of cases and study according to Group
Smoking                                                                Alcoholism
1st Group 2nd Group      3rd Group  Total      Ist Group  2nd Group      Total
133            101               42         276            205          71               276

TABLE XX.F.Result of treatment of alcoholism & Smoking
within 2 weeks                                                             After 2 weeks
% of Relief    Alcoholism     Smoking     Drop out     % of Relief      Alcoholism       Smoking     Drop out
25%            12             20                                 25%                  9                   15
50%             15            17                                  50%                  6                     6
75%             26            38                                  75%                  9                    20
100%             47            15                140             100%               28                   12                  Nil
Total                 100           90                  140                                   52                    53

Success rate within 2 weeks : Alcoholism : 73.58%
Smoking : 66.17%
Success rate after 2 weeks : Alcoholism : 38.23%
Smoking : 33.97%

TABLE XXI.C. Old cases reported 3-5 months after
Total No. of cases : 49
within 2 weeks                                                                               after 2 weeks
% of Relief     Alcoholism      Smoking      Drop out        % of Relief      Alcoholism       Smoking     Drop out
25%                1                    1                                    25%                2                    12
50%                1                    4                                    50%                2                      3
75%                                      1                7                  75%                9                      11               Nil
100%              11                    3                                  100%              16                       3
Total                 13                     9                7                                      29                      29

Success rate within 2 weeks : Alcoholism : 30.95%
Smoking : 21.43%
Success rate after 2 weeks : Alcoholism : 69.05%
Smoking : 69.05%

Discussions:
Out of the 334 patients who have taken medicine for tobacco smoking alone 215 are drop out cases. The remaining 119 Patients ware observed. The success rate within two weeks was 62.18% and 60.76% after two weeks with a drop out of 17 patients. 31 patients reported 3- 5 months after abstinence with a drop out of 10 and a success rate of 33.3% within two weeks. The success rate after two weeks was 80.95% without a single drop out. The number of patients to whom medicine for alcoholism were given are 315 (39 consumes alcohol and 276 consumes alcohol and smoking tobacco) success rate was 71.43% within two weeks and 23.8% after two weeks with a drop out of 18 from 39. In the combined case the success rats was 73.52% in alcoholism and 66.17% in smoking wilhin two weeks. After two weeks the percentage of success was 38.23% in alcoholism and 38.97 in tobacco smoking with a total drop out of 140 from 276. 49 cases were reported 3 – 5 months after abstinence with 7 drop out having a success rate of 30.95% in alcoholism and 21.43% in smoking within two weeks and 69.05% each in alcoholism and smoking. Staphisagaria was the drug for 84 persons addicted to smoking while 72 for Calc-phos, 47 for Nux Vomica, 20 for Natrummur and 13 for Lachesis Similarly, 29 cases of alcoholism were prescribed with Nuxvomica, 22 to Lachesis, and 21 to Staph. 33 cases of addiction to tobacco smoking was responded within one week to Calc Phos, 27 cases to Staphisagria 17 cases to Nuxvomica, 7 cases to Natrummur were also responded within 7 days. 18 cases of Alcoliolism was responded to Nuxvomica and 10 cases to Lachesis with in 7 days.

Effective Homeopathic Treatment of Seborrheic Dermatitis

Using a Low Dose,  Oral Homeopathic Medication Consisting of Potassium Bromide, Sodium Bromide, Nickel Sulfate, and Sodium Chloride in a Double-Blind, Placebo-Controlled Study.

Dr. Steven A. Smith MD,FACP: Clinical dermatologist in Tuls,OK.Specialising in the treatment of psoriasis, eczema and seborrheic dermatitis.President Loma Lux Laboratories.
Address : 5801,E41* St Ste.220.Tulsa.OK 74135 Email : ssmith@lomalux.com

Dr.Ardith.E.Baker.MS : Professor and clinical statistician Tulsa,OK Employed by Loma Lux Laboratories at the time of this study.

Dr.John.H.Williams Jr.,MS : consultatnt with expertise in clinical studies Tulsa,OK .Employed by Loma Lux Laboratories at the time of this study.

Download full paper : www.similima.com/pdf/Seborrhea.pdf

pharmacy

Quality control and standardization of Homeopathic medicine

pharmacyPranav shah MD(Hom.Pharmacy)

Quality control is total procedure for providing the standard medicines to the patients. QC is not only a laboratory procedure, but also the procedures through which a raw material is transformed to a drug and the finished product till it is used by the patient.One of important function of QC dept is to establish specifications for *raw materials,* packing materials, *intermediates and *finished products to assure the quality.

APEX BODY of quality control and standardization
The Homeopathic Pharmacopoeia Laboratory (HPL) (1975) under the ministry of Health and Family Welfare, Government of India. Subordinate institute of department of ISM & Homeopathy, GOI. Recognized by Dept of Science & Technology, GOI as Scientific, Technological and Research Institution Recognized as   Central Drugs Laboratory – for testing of Homeopathic drugs (under Rule 3A, under section-6 of D &C Act). Functioning as STANDARD setting –cum-drug testing laboratory at National level.

Homeopathic Pharmacopoeia India (HPI)
Standards as worked out by laboratory are approved by Homeopathic pharmacopoeia committee  (sept 1982) are published in the form of  Homeopathic Pharmacopoeia India (HPI) Total number of  MONOGRAPHS in HPI = 1016

Homeopathic  pharmacopeias codex publish in 2004 contain detail of 1000 drugs.

Homeopathic Pharmacopoeia India (HPI) Total number of  MONOGRAPHS in HPI = 1016

Volumes Year of publication No of drugs
1 1971 180
2 1974(revise eddi. 1982) 100
3 1978 105
4 1984 107
5 1986 114
6 1990 104
7 1999 105
8 2000 101
9 2006 100

Monograph of each drug contain

  • Details for identification
  • Details for collection
  • Part to be used
  • Method of preparation
  • Assessment of purity
  • Limits of impurity 

For QC and standardization – Pay attention during
Sampling of raw materials®,identification of adulterants,®comparison with standards and analyzed,®testing of purity®manufacturing, ®processing®different methods of preparation, ® utensils, ® machinery, ® analysis of finished products, ® manufacturing area,®monitoring industrial waste ® packaging ® storing ® dispensing,®handling and packaging of medicines while dispensing, the shelf in the physicians clinic.

The patients methods of usage of medicines ® in the patients wardrobe till the patients consume the medicine.

Aim
Quality control is total procedure for providing the standard medicines to the patients. Quality control for efficacy and safety of homeopathic products is of paramount importance.

Introduction:
Quality can be defined as the status of a drug that is determined by identity, purity, content, and other chemical, physical, or biological properties, or by the manufacturing processes.Quality control is a term that refers to processes involved in maintaining the quality and validity of a manufactured product.

In general, quality control is based on three important pharmacopoeial definitions:

  • Identity:  Is the herb the one it should be?
  • Purity:       Are there contaminants, e.g., in the form of other herbs which should not be there?
  • Content or assay: Is the content of active constituents within the defined limits?

There are two types of standardization
In the first category, “true” standardization, a definite phyto-chemical or group of constituents is known to have activity. Ginkgo with its 26% ginkgo flavones and 6% terpenes is a classic example. These products are highly concentrated and no longer represent the whole herb, and are now considered as phytopharmaceuticals. In many cases they are vastly more effective than the whole herb.

The other type of standardization is based on manufacturers guaranteeing the presence of a certain percentage of marker compounds; these are not indicators of therapeutic activity or quality of the herb.

Strict guidelines have to be followed for the successful production of a quality drug.

Parameters for Quality Control and standardization of Drugs

  • Of raw materials
  • Of manufacturing process,
  • Of finished products and
  • Of storage and packaging 

Raw marital

1. Medicinal

  •   Minerals, Herbs and animals etc
  •   Microbes, pathological products, healthy tissues, drugs

2.Non medicinal (vehicles)

  •   Alcohol, Lactose ,Sugar ,White petroleum jelly ,Maize starch ,Coconut oil, Wax
  •   The quality of raw materials are ascertained and standardized referring HPI.
  •   In case of raw material resources it is mandatory to follow the guidelines of 

GAP– Good Agricultural Practices

GHP- Good Harvesting  Practices

GLP- Good Laboratory Practices

  • Incoming raw material
  • Transfer
  • STORE
  • Sampling
  • Identification
  • Analyses
  • Purity testing
  • Manufacture 

Of manufacturing process

  • Manufactury
  • Equipments
  • Inspected
  • Assessed
  • Control of microbial contamination
  • Finished Products 

Of finished products

  • Finished products
  • Representative samples analysed
  • Documented 

Packaging and labeling

Rule 106-A :

Homoeopathic medicine : Name of Medicine

  1. Pharmacopoeial name as given : Homoeopathic Pharmacopoeia of India, German Homoeopathic Pharmacopoeia Homoeopathic Pharmacopoeia of UK or  US Homoeopathic Pharmacopoeia
  2. For other drugs, Descriptive name

a.    Potency in decimal, centesimal and millisimal Name and address of Manufacturer or seller.

b.    Alcohol percentage in volume, for packing bigger than 30 ml.,

c.    Batch No. and Manufacturing license No.

d.    Single ingredient shall not bear proprietary name on its label.

  RULE 106-B

  Homoeopathic medicine having more than 12% Alcohol shall be packed in 30 ml only.

  For Hospitals/Dispensaries 100 ml packing is allowed.

A study on efficacy of antimiasmatic medicines in Urolithiasis

From the evaluation of results obtained after the statistical analysis of the pre-treatment and post-treatment disease intensity scores, it is obvious  that anti miasmatic medicines selected on the basis of the totality of  symptoms are highly effective in the management of Urolithiasis.

The   mental   generals   and   physical   generals   should   be   given   prime importance.

The tendency to the recurrence of calculi can be controlled/eradicated by  the exact simillimum

Psora and Sycosis are found to be the predominant miasms in urolithiasis

The other observed facts in this study are the maximum age incidence (40 to 50 years), sex incidence (83.33% males) highlights some of the risk factors of the disease

Antimiasmatic deep acting constitutional medicines like Lycopodium, Nux vomica, Sulphur, Pulsatilla, Silicea, Stapysagria etc were found to be effective for controlling both the acute attacks and also for preventing  recurrence, when given after strict individualisation.

Many cases, which are recommended to do surgery, can be effectively  treated with homoeopathic constitutional medicine.

It can also be claimed that homoeopathy is far more cost effective when compared with expensive drugs and other procedures like lithotripsy used  in other systems of medicines

To conclude, limited reliability can only be guaranteed with such a study involving a chronic disease, with 30 cases, for two year period. A long term   follow-up   study   will   be   more   reliable   as   the   disease   is   exhibiting recurrence. Comparative studies involving other systems of medicine can also be accomplished with better results.

Download full paper : www.similima.com/pdf/antimisamatic-urolithiasis.pdf

Benefits & risks of Homoeopathy: Rejoinder to Lancet article

Prof. Chaturbhuja Nayak
Former  Director,   Central Council for Research in Homoeopathy
New Delhi, INDIA

 The    Lancet    has   recently   published    a   comment      entitled  “Benefits     and   risks   of      homoeopathy”  . The commentator Ben Goldacre has denigrated Homoeopathy by citing the results of five studies      which have not produced statistically significant benefit over    placebo. But, he has taken a partial view of the results of some of the studies, referred by   him,  where  the     authors  have  not    totally  branded  homoeopathy   as  placebo  response.

Rather    the  authors   have   admitted    that  there  was   some evidence   that  homoeopathic treatments are more effective than placebo, that the evidence of clinical trials is positive.

However, they have suggested to undertake further high quality studies to confirm these  results. While many high  quality trials with proven efficacy of homoeopathy have been   done, Ben Goldacre has cherry-picked five only to suit his own conclusions.

Goldacre has rightly cited that during the Cholera epidemic in the 19th century, death rate  at  London     Homoeopathic  Hospital    was   three  times   lower   than   those   at  Middlesex   hospital. While admitting that the then contemporary treatments were harmful, he is not   ready  to  accept  the  credibility  of  London  Homoeopathic  Hospital, where  the  mortality  rate was three times less than  an  allopathic hospital. On the other hand, he j okes, “the  homoeopathic       treatments    were   at  least  inert”.  How     could   the  inert  homoeopathic medicines result in 3 times less mortality than the conventional medicine?

Download full paper : www.similima.com/pdf/benefits-homeopathy.pdf

camel

Revalence and pattern of alternative medicine in Saudi Arabia

camelFrom the  Department of Family & Community Medicine, King Saud University, Riyadh, Saudi Arabia,  National Guard Health Services, Riyadh,   Saudi Arabia,  Ministry of Health, Riyadh, Saudi Arabia, and   Division of Community Health Sciences: GP Section, University of Edinburrgh, United Kingdom

Correspondence and reprints: Prof. Eiad Al-Faris · Department of Family & Community Medicine (34) College of Medicine, King Saud University  · PO Box 2925, Riyadh 11461 Saudi Arabia · T: 966-1-467-1965 F: 966-1-467-1967 · efarisx2@gmail.com · Accepted for publication November  2007

BACKGROUND AND  OBJECTIVES: Alternative  medicine  (AM)  encompasses  all  forms  of  therapies  that  fall   outside the mainstream of medical practice. Its popularity is on the increase. Because previous surveys were  limited and not generalizable, we estimated the prevalence, pattern and factors associated with use of AM in  the community.

SUBJECTS AND METHODS: A multistage cluster cross-sectional household survey was conducted among Saudi residents of the Riyadh region. Data were collected in 2003 by trained interviewers from primary health care centers using a specially designed questionnaire.

RESULTS: Of 1408 individuals participating in the study, 39% were men. The mean (±SD) age for the study pop  ulation was 35.5 (±13.9) years. Sixty-eight percent of the respondents had used AM during the last 12 months.

The Holy Quran as a therapy was the most frequently used AM (50.3%), followed by honey (40.1%), black seed    (39.2%) and myrrh (35.4%). The health belief model was found to be the most important determinant of AM use.

Factors independently associated with AM use included perceived failure of medical treatment, the perceived  success of AM, a preference for natural materials, and long appointment intervals to see physicians.

CONCLUSIONS AND RECOMMENDATIONS: There is a high prevalence of AM use in the Riyadh region and  the most important determinant of AM use was the perceived failure of medical treatment.

The study results call for intensive health education campaigns in the media addressing wrong beliefs regarding AM and modern   medicine. The popularity of AM in this community should alert decision makers to look at the difficult acces sibility to the health system.

Download full original paper : www.similima.com/pdf/prevalence-am-survey.pdf