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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA, ANNEXURE-II APPLICATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION DR RAMASHEELA J. R 1. NAME OF THE CANDIDATE & DEPARTMENT OF PAEDIATRICS, ADDRESS FATHER MULLER HOMOEOPATHIC MEDICALCOLLEGE AND HOSPITAL, UNIVERSITY ROAD,DERALAKATTE, MANGALORE-575018 KARNATAKA. PERMANENT ADDRESS DR RAMASHEELA J. R D/O RAMANAYAKA J. KUMARA RAMA KRUPA 8TH MAIN . P L D BANK ROAD. K.R. EXTENSION MADHUGIRI – 572132, TUMKUR (D) KARNATAKA 2. NAME OF THE INSTITUTION FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL, DERALAKATTE, MANGALORE. 3. 4. COURSE OF THE STUDY & M .D.(HOM) SUBJECT HOMOEOPATHIC PEDIATRICS DATE OF ADMISSION TO THE COURSE 5. 11.10.2012 TITLE OF THE TOPIC “A CLINICAL STUDY TO EVALUATE THE EFFICACY OF HOMOEOPATHIC MEDICINES IN CASES OF PAEDIATRIC EOSINOPHILIA” 1 6. BRIEF RESUME OF THE INTENDED WORK 6.1 NEED FOR STUDY: Eosinophilia is one of the commonest clinical conditions which we get to see very often in Pediatric Age Group. Many times child will be brought to the doctor with the complaints of recurrent respiratory infections, itching etc.. when it is undiagnosed the condition treated symptomatically. The term Eosinophilia refers to condition in which abnormally high amounts of Eosinophils are found in either the blood or in body tissues. It is due to many causes, Very common causes include allergic reactions parasitic infestations and other systemic infections. It is becoming one of the major cause to cause ill health in the school going children leading to poor performance in academics. In cases of allergic respiratory conditions& parasitic infestation indirectly causes nutritional deprivation. Many paediatric eosinophilic cases are managed by administrating corticosteroids in inhaled form, topical treatment, pills, and injections and also with antihistamines like cetirizine leads to drug reaction in chronic administration and also gives only temporary relief in allopathy. According to modern medicine there is no cure of allergic disorders and only it can be only managed. Homoeopathy being a therapeutic system in holistic approach in such cases it removes the basic cause or root of the cause... At least five minimum numbers of cases out of thirty cases in OPD is due to allergic reaction. In order to manage eosinophilia or hypersensitivity reactions in children efficiently physicians must understand common and uncommon causes for or eosinophilia 2 symptoms, pathology immune reactions of the body signs & symptoms treatment management in these cases. During the period of 1981-82 in a survey of 21 schools in four villages of North Arcot Ambedkar Dist of Tamilnadu among the population of 4282 children it is detected 92 with respiratory eosinophil count greater than1000/cumm, with worm infestation, 37 with pulmonary eosinophilia, 14 with wheezing, cough, 6 with respond to diethyl carbamazine and 17 others following deworming required further therapy for eosinophilia4. Epidemiology of pulmonary eosinohilia in Rural South India prospective study 1981 -86 subject with eosinophilia more than or equal to 2000/cumm and this study found that pulmonary eosinophilia either or alone with worm infestation was a major cause of morbidity in the rural population4. In keeping all the above mentioned points above we need to do research work on eosinophilia cases in paediatric age group and to know the effectiveness of homoeopathic medicines. 6.2 REVIEW OF THE LITERATURE: Eosinophilia is a condition in which eosinophil count in the peripheral blood exceeds 0.45*109/L. or 450/µl eosinophils are a type of white blood cells produced in the bone marrow and normally found in the blood stream and gut lining and hundreds times more abundant in tissues. They survive longer than neutrophils. Increased 3 production of eosinophils in the bone marrow and normally found in the blood stream and gut lining and hundred times more abundant in tissues than in the blood. The immune system recognizes and kills pathogens and tumor cells to protect the host. The immune system is composed of two major subdivisions, the innate or nonspecific immune system and the adaptive or specific immune system. Innate immunity that is constitutively present and is immediately mobilized upon infection acts as the first line of defense against invading organisms. It is non-specific and reacts equally well to a variety of organisms. While the adaptive immune system acts as a second line of defense, responding specifically and generating immunological memory. Both innate immunity and adaptive immunity have humoral response and cell-mediated responses. In the innate immune system, humoral responses involve cytokines, complement system, coagulation system, lysozymes and other secreted substances; cell-mediated responses involve a wide number of cell types, including phagocytes (neutrophils, monocytes/macrophages, and dendritic cells), natural killer cells (NK cells), basophils, mast cells and eosinophils. In the adaptive or specific immune system, humoral responses (also called antibody responses) and cell-mediated responses are carried out by B cells and T cells, respectively. PROPERTIES OF EOSINOPHIOPHILIA Eosinophils are bone marrow derived granulocytes that are abundant in inflammatory infiltrates of late phase reactions and contribute too many of the 4 pathologic processes in allergic diseases. Eosinophils release granule proteins that are toxic to parasitic organisms and antigens may injure the normal tissues. Eosinophils can kill microorganisms by antibody –dependent cell mediated cytotoxicity (ADCC) with the use of FcERI and perhaps FcR. DURING THIS PROCESS eosinophils bind to micro-organisms coated with IgE antibody and their granule contents are released on to microorganisms. The granule content of eosinophil include lysosome hydrolase found in the other grnulocytesas well as eosinophil-specific proteins that are particularly toxic to helminthic organisms, including major basic protein and eosinophil cationic protein. These 2 cationic and polypeptides have known enzymatic activities and toxic to bacteria helminthes and normal tissue1. CLASSIFICATION : INTRINSIC: The problem inside the eosinophils EXTRINSIC : The problem outside the eosinophils AETIOLOGY : ALLERGIC DISORDERS : Asthma, hay fever, urticaria, allergic rhinitis, food allergy IMMUNOLOGIC DISORDERS: Hyper IgE syndrome, wiskott Aldrich syndrome, graft versus host disease, severe congenital neutropenia. 5 SKIN DISORDERS: Pemphigoid, scabies PARASITIC INFESTATION: Ascariasis, filiariasis, echinococcosis, toxocariasis, amoebiasis, malaria, aspergillosis, toxoplasmosis enterobiasis., HEMATOLOGICAL DISORDERS: Eosinophilic leukaemia, acute mylogenous leukaemia, Hodgkin’s disease, T-cell lymphoma. FAMILIAL EOSINOPHILIA : Sometimes eosinophilia is genetic. IRRADIATION : Post irradiation of abdomen, INFECTIOUS DISEASES : Bacterial : (TB), leprosy, syphilis, Fungal, protozoan, viral, arthropod. OTHERS: Vasculitis, RA, IBS, scleroderma, eosinophilic esophagitis, eosinophilic lung disease, sarcoidosis, hypersensitivity drug reactions. GRADES ACCORDING TO ABSOLUTE NUMBER IN CICULATING BLOOD : Mild Eosinophilia : 400 -500/ cumm Moderate Eosinophilia : 1500-5000/cumm Severe eosinophilia : Greater than 5000/cumm CLINICAL FEATURES : Worldwide the most common cause of eosinophilia is parasitic infestation & this remains as an important cause of eosinophilia. The most common 4 causes of eosinophilia documented in an Italian series of nearly 2000 patients were Atopy including asthma 79.9% Parasites 8.2% 6 Hematological Neoplasm 2.4% Allergic/Atopic skin disease 2.1%.10 Certain features which are associated with eosinophilia are listed below Skin allergy Cough & frequent cold attack with throat irritation Muscle weakness Weight loss Lymph node enlargement Night sweats Fever. GENERAL CONSIDERATIONS TO APPROACH PATENT WITH EOSINOPHILIA: Given the diversity of medical conditions that may be associated with increased blood Eosinophilia, the evaluation of such patients must include diverse medical conditions that may contribute to Eosinophilia. Levels of blood Eosinophilia are labile, and absolute thresholds for various clinical conditions cannot be definitively established. In the setting of asthma, eosinophils level are usually less than 1500/ cumm. In the setting of Churg-Strauss Syndrome (often with asthma), however, blood eosinophils are greater than 1500/ cumm. However, sustained elevated levels of blood Eosinophilia should prompt ongoing pursuit of an etiology for the Eosinophilia and monitoring for organ associated damage. 7 HOMOEOPATHIC APPROACH : Homoeopathy is a holistic system of medicine which is based on law of similar Homoeopathy “Miasms” are the fundamental cause of sickness. He says in homoeopathy is the most popular holistic systems of medicine. This is the only way through which a state of health can be regained. The aim of homoeopathy is not only to treat eosinophilia but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to treat eosinophilia that can be selected on the basis of cause, sensation, and modalities of the complaints. Homoeopathic medicines stimulate the immune power to act against the disease. So homeopathy acts well in cases of eosinophilia. There is a special mention about allergic disease in homoeopathy literature under the heading Idiosinchracy. According our system individual that becomes sick first. The objective of treatment should be the improvement of the constitution and also by constitutional approach we can prevent the recurrence of the complaints. MAIN REMEDIES IN THE CASES OF EOSINOPHILIA: Some of the remedies which are commonly used in treating the eosinophilia are Arsalb, acon, allium cepa, cina, bry, Cal carb, Drosera, Cina, Echinacea, phos, Nat-m, Puls 8 6.3 OBJECTIVE OF THE STUDY: 1. To assess the effectiveness of homoeopathic medicines in eosinophilia 2. To evaluate the various factors of eosinophilia 3. To study the various apertures of homoeopathy in eosinophilia 7. MATERIALS AND METHODS 7.1 SOURCE OF DATA: The subjects will be selected from OPD, IPD, peripheral centers, and village camps of Father Muller Homoeopathic Medical College, Mangalore. 7.2 METHOD OF COLLECTION OF DATA: A sample of minimum of 30 cases will be selected 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 according to the demand of the case, with consideration of potency selection criteria such as Acute or Chronic, Susceptibility, Vitality and Suppression (if any), changes in structural and functional level and the degree of correspondence to the remedies selected. 9 INCLUSION CRITERIA: 1. Children between the age group of 2 to 14years of both sexes will be included 2. Diagnostic criteria is mainly based on clinical presentation, eosinophil value or absolute eosinophil count EXCLUSION CRITERIA: 1. Children below2yrs and above14 years of age of both sexes are excluded 2. Children with ADHD, autism, are excluded. 3. Children with chromosomal and congenital abnormalities are excluded. RESEARCH HYPOTHESIS: Homoeopathic medicines are effective in the treatment of eosinophilia in pediatric age group. NULL HYPOTHESIS: There is no significant improvement among the cases of eosinophilia in pediatric age group after homoeopathic treatment... PLAN FOR DATA ANALYSIS: The collected data will be analyzed by paired ‘t’ test and data will be presented in the form of mean standard deviation, the frequency and percentage. 7.3 Does the study require any investigations to be conducted on patients, or other humans (or animals)? If so please describe briefly. The diagnosis of eosinophilia is mainly established on the basis of clinical 10 presentation and lab investigations. To confirm the enuresis following investigations should be done. CBC DC TC AEC 7.4 Has ethical clearance been obtained from your institution in case of 7.3? Yes, enclosed. 11 8. LIST OF REFERENCES: 1. Abbas K abdul , Litchman H.Andrew , Cellular and Molecular immunology . 5th edition. Pg 444,437, 314, 449, 204,254 2. Thomas jones .Mackie & james elvins McCartney, Practical Medical Microbiology. 14th edition. 3. http://en.wikipedia.org/wiki/eosinophilia Accessed on 16-10-2013 4. www.ncbi.nlm.nih.gov.pubmed.eosinophilia Accessed on 16-10-2013 5. http://www.aaaai.org . Accessed on 16-10-2013 6. www.mdhil.com.Accessed on 16-10-2013 7. http://www.homeopathy world community.com Accessed on 16-10-2023 8. Kumar Vinay, Abbas K Abdul, Fausto Nelson, Robins & Cotran, pathologic basis of disease 8th edition ,pg 72, 200,395, 780, 632, 704 9. Kindt J.Thomas , Osborne A. Barbara, Goldslay A. Richard , Kuby , immunology 6th edition . pg 383, 37, 38. 10. http://.icid.salisbury.nhs.uk/Clinical Management/Haemotology/Pages/Eosinophilia-c...on 2-6-2013. 11. Robert , owen, Ian, Paediatric Hemotology and oncology 3rd edition. Pg 235, 236, 242, 606 607.. 12. Denis & Robert, Blood diseases of infancy & Childhood 6th edition. 12 9. SIGNATURE OF THE CANDIDATE 10. REMARKS OF THE GUIDE 11. 11.1 NAME AND DR.GURUPRASAD. M N DESIGNATION OF THE B. H.M S, MD (HOM) GUIDE (IN BLOCK LETTERS) PROFESSOR, DEPT. OF MATERIA MEDICA FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL, DERALAKATTE, MANGALORE. 11.2 SIGNATURE 11.3 CO-GUIDE (IF ANY) 11.4 SIGNATURE 11.5 HEAD OF THE DR.JYOSHNA S.B.H.M.S,M.D (HOM), DEPARTMENT PROFESSOR,DEPT OFPEDIATRICS, FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE& HOSPITAL, DERALAKATTE, MANGALORE. 11.6 SIGNATURE 12. 12.1 REMARKS OF THE CHAIRMAN & PRINCIPAL 12.2 SIGNATURE 13