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A Pilot Project on Avian Flu Prof. (Dr.) Niranjan Mohanty. Dean of the Homoeopathic faculty, Utkal University, Orissa National President, Indian Institute of Homoeopathic Physicians Email – [email protected] Prof.(Dr.) N. Mohanty 1. Auduhon- Dauphin island 2. Suncoast- Alabama 3. Currumbin- Australia 4. Pelican mans 5. Jack minor World map showing sanctuaries of bird Bird sancturies 1. Bharatpur- Rajastan 2. Thattekad- kerala 3. RanganthittuKarnatak 4. Assam BarrageUttaranchal 5. NeyyarParambikulam 6. Karera- Madhya Pradesh India Map showing sanctuaries of bird Migratory Birds H5N1 Virus is detected as the cause of Avian Flu in Asia in domestic poultry 2004-05 Prolonged contact Consumptio n of raw & infected chicken Through tears saliva/ faeces Carry full repertoire of the genes of the different strains H1N1, H2N2, H3N2, H4N6, H5N1, H5N2, H6N1, H7N3, H7N7, H9N2, H9N3. Infection Chain Recombination takes place P a n d e m i c s p r e a d Spanish 1918-H1N1 Asia – 1957 – H2N2 Hong Kong –1968 –H3N2 2006 – Germany (H5N1) 2005 – Thailand & Vietnam (H5N1) 2006 – In INDIA (H5N1) • Maharastra • Gujrat • Karnataka Aetiopathogenesis Poultry population Influenza A virus Influenza A / H5N1 Low pathogenicity High pathogenicity Avian Influenza Virus Hemagglutinin Neuraminidase 1 – 16 sub types 1 – 9 sub types H5N1 Most virulent type of AIV Influenza A virus contains 8 separate genes: 1. HA gene encoding hemagglutinin which produces about 500 copies. 2. NA gene encoding neuraminidase which produces about 100 copies. 3. NP gene encoding nucleoprotein. Influenza A,B,C are distinguished by their nucleoproteins. 4. M gene encoding two matrix proteins (M1 & M2 ) by using different reading frames from the same RNA segment. 5. NS gene encoding two distinct nonstructural proteins by using different frames from the same RNA segment. 6. PA gene encoding an RNA polymerase. 7. PB1 gene encoding an RNA polymerase. 8. PB2 gene encoding an RNA polymerase. PATHOGENESIS ROUTE OF ENTRY IS RESPIRATORY TRACT REDUCES THE VISCOSITY OF MUCUS FILM LINING OF RESPIRATORY TRACT EXPOSES THE CELL SURFACE RECEPTORS FOR VIRUS ABSORPTION SURVIVAL OF THE VIRUS 1. It can survive for at least 35 days at 4o C in manure. 2. It can be isolated from lake water where water fowls are present. 3. It can survive several days in carcasses at ambient temperature and up to 23 days if refrigerated. TRANSMISSION OF THE VIRUS Clinical Features: Signs and symptoms in birds: 1. 2. 3. 4. 5. 6. Depression Profuse watery diarrhoea Reddening of legs Laboured respiration Blue and swollen combs Respiratory signs of cold Fever Headache Myalgia Sore throat Dry cough Sneezing Congestion of nose Redness of conjunctiva Diffused rales Nausea / Vomting Otitis Media Flushed face Cyanosis Coldness of Extremities Dyspnoea Mottled extremities Signs of consolidation DDIFFERENTIAL DIAGNOSIS: Birds: (i) (ii) (iii) (iv) (v) (vi) (vii) Features of New Castle disease Infections , laryngo tracheitis Duck plague Acute poisoning Acute fowl cholera Bacterial cellulitis Chronic respiratory diseases Human being : (i) Early bacterial pneumonia (ii) Severe streptococcal pharyngitis (iii) Acute respiratory illness caused by any varieties of respiratory virus LLABORATORY DIAGNOSIS: (BIRDS / HUMAN BEING ) 1 Demonstration of the virus antigen by immunofluorescence by using specific monoclonal antibody and haemagglutination inhibition assay. 2 Detection of influenza-specific RNA by reverse transcriptase-polymerase chain reaction (RT-PCR) is extremely sensitive. 3 Serological identification by measuring the specific antibodies. V virus culture A simple way to reduce the risk of illness: • Wearing of masks and gloves by persons handling poultry. • Cleaning kitchen surfaces and utensils before and after use. • Cooking chicken till boiling temperature is reached. • Controlling human traffic into poultries. A simple way to reduce the risk of illness: Hand washing (In order to be effective hand should be washed with soap from 20 to 25 seconds). TREATMENT AVAILABLE IN HOMOEOPATHY HOMOPATH – Human being TREATMENT AVAILABLE IN HOMOEOPATHY RADAR-HUMAN BEING TREATMENT AVAILABLE IN HOMOEOPATHY Radar - Bird TREATMENT AVAILABLE IN HOMOEOPATHY Hompath - Bird Avian Flu Belladonna Arsenicum album Sulphur Calc. carb. Nux vom. Pulsatilla Mercurius Phosphorus Rhus tox. Causticum Avian Flu Natrum mur. Lycopodium Silicea Sepia Allium cepa Ars. hydr. Arum triph. Chelidonium Avian Flu Dulcamara Gelsemium Phellandrium Phytolacca Sabadilla Senega Silphium Sticta pulm. Spigelia Tuberculinum METHODOLOGY FOR MATHEMATICAL MODEL AIM: To ascertain the preventive and curative medicine for avian flu. Methods: A diagnostic criterion was determined by taking clinical features such as Fever, Headache, Myalgia, Sore throat, Dry cough, Sneezing, Congestion of nose, Redness of conjunctiva, Nausea/ Vomiting, Otitis media, Flushed face, Cyanosis, Coldness of extremities, Dyspnoea, Mottled extremities, Diffused rales, Signs of consolidation. Results : The above symptoms were repertorised with the help of RADAR & HOMPATH Software. RADAR Software Human being Bell – 36/15 Calc. carb.- 34/15 Nux vom. – 32/15 Ars. alb. – 36/14 Bry. Alb. – 30/14 Phos. – 30/14 Sulph – 34/15 Puls – 32/14 Rhus tox. – 30/14 RADAR Software Avian (Bird) Ars. alb. – 18/7 Carbo veg. – 20/7 Merc. – 18/7 Calc. carb. – 19/7 Nat. mur. – 18/7 Phos. – 19/7 Sil. Sulph. – 19/7 Nat. sulph. – 17/7 Sepia – 16/8 – 18/7 HOMPATH Software Human being Ars. alb. – 39/16 Lach. – 35/14 Bell. – 37/16 Nat. mur. – 34/16 Nux vom. – 36/16 Silicea – 33/15 Sulph. – 36/15 Rhus tox. – 32/16 Puls. – 35/16 Bry. alb. – 32/15 HOMPATH Software Avian (Bird) Calc. carb. – 17/7 Merc. – 16/7 Phos. – 17/7 Silicea – 16/7 Puls. – 17/7 Nat. mur. – 16/6 Sulph. – 17/7 Lach. – 15/7 Ars. alb. – 15/6 Carbo veg. – 17/6 Aims and objectives To determine the efficacy of the drugs evolved through mathematical model (Repertorisation) for preventive and curative aspect of Avian Flu either in single or in serial or in combined form. To ascertain the suitable potency(s) To determine the effective dose(s) To find out the repetition schedule(s) To find out the most effective therapeutic options Target groups - Domesticated / Commercial birds - Human being of globe The experiment is to be “Randomized double blind control trail”. It is to be of multicentric. Route of administration of drug will be oral A standardized case recording format will be adopted for documentation of data & follow up will be done periodically, which will be as follows: Particulars • • • • • • Name Address Age Sex Occupation Presenting Complaints Presenting Complaints Location Head Muscles Throat Chest Nose Nose Sensation Modalities Fever Headache Myalgia Sore throat Dry cough Sneezing Congestion Concomitants / / Extension Presenting Complaints Location Sensation Modalities Conjunctiva Stomach Ear Face Redness Nausea / vomiting Otitis media Flushed face Cyanosis Coldness of extremities Dyspnoea Mottled Diffused rales signs of consolidation Extremities Respiration Extremities Chest Chest Concomitants / Extension Laboratory Investigations Tests a) Viral culture b) Polymerase Chain reaction C) Immunefluroscent Assay D) Serological identification Results Diagnostic Criteria Inclusion Criteria Birds (A) Clinical Features Depression Profuse watery diarrhea Reddening of the legs Laboured respiration Blue & swollen combs Respiratory sign of cold (B) Laboratory Diagnosis Viral culture Polymerase chain reaction Immune fluroscent Assay Serological identification Human Being (A) Clinical features Fever Headache Myalgia Sore throat Dry cough Sneezing Congestion of nose Redness of conjunctiva Nausea/ vomiting Otitis media Flushed face Cyanosis Coldness of extremities Dyspnoea Mottled extremities Diffused rales Signs of consolidation (B) Laboratory Diagnosis: i) Viral culture ii) Polymerase Chain reaction iii) Immunofluoroscence assay vi) Serological identification 2.Exclusion criteria BIRDS Features of New castle disease Infectious Laryngo tracheitis Duck plague Acute poisoning Diseases that can cause swelling of combs wattles includes Acute Fowl cholera Bacterial cellulites Chronic respiratory diseases Exclusion criteria Human Being Early bacterial pneumonia Severe streptococcal pharyngitis Acute respiratory illness caused by any varieties of respiratory virus Different Therapeutic Drug Options (Preventive / Curative purposes) Single Drug (A single drug will be given at one time and waiting for the change) Human Being Belladonna Calc. carb. Sulphur Pulsatilla Ars. alb. Nux. vom. Single Drug (A single drug will be given at one time and waiting for the change) Bird Phos. Ars. alb. Carbo veg. Nat. mur. Calc. carb. Belladonna Multiple Drugs in Serial (Both for Bird / Human being) [ Drugs will be given serially at specific time gap] a. Belladonna Calc. carb. Tuberculinum b. Belladonna Sulphur. Tuberculinum c. Ars. alb Calc. carb. Tuberculinum d. Rhus. tox Pulsatilla Sulphur Combined drugs [A group drugs will be mixed to prepare a compound with a new name] Belladonna Calc.carb Tuberculinum Pulsatilla Rhus.tox Ars.Alb ----------------- Ars.hydro Rhus.tox Sulphur Bryonia Belladonna Nux.vom Phelandrium ----------- Nux.vom Pulsatilla Belladonna Ars.alb Calc.carb Sulphur Silphinum.lanc Dulcamara Various potency options To ascertain the most effective potency various potencies will be tried. A comprehensive type should be as follows Single medicine a. 30 b. 200 c. 1M Multiple drugs in serial a. 30 b. 200 c. 1M Combination of drugs a. 3x b. 6x c. 30 DIFFERENT DOSAGE OPTIONS Single Medicine Adult Children a) 4 globules (glb. No – 20 a) 2 globules b) ½ drop b) ¼ drop c) 1 drop c) ½ drop DIFFERENT DOSAGE OPTIONS Multiple drugs in serial Adult 4 globules (glb. No – 20 ½ drop 1 drop Children 2 globules ¼ drop ½ drop DIFFERENT DOSAGE OPTIONS Combination of drugs For human being Adult Children For birds Adult young a) 1 drop each ½ drop a) ½ drop ¼ drop b) 5 drops 2 ½ drops b) 1 drop ½ drop c) 2 drops 1 drop c) 10 drops 5 drops Different repetition schedule To fix the repetition schedule in different types of therapeutic options following classification and categorisation will be tried Single medicine a. One dose only b. One dose daily for three days c. Two dosages daily for three days Repetition after 15 days / 1 month / 3 month / 1 year Different repetition schedule To fix the repetition schedule in different types of therapeutic options following classification and categorisation will be tried Multiple drugs in serial a. One dose from each drug consecutively b. One dose from each day for three days c. Two dosages from each day continuously one after another Repetition after 15 days / 1 month / 3 month / 1 year Different repetition schedule To fix the repetition schedule in different types of therapeutic options following classification and categorisation will be tried Combination of drugs a. One dose daily for three days b. Two dose daily for three days Repetition after 15 days / 1 month / 3 month / 1 year Different Age Group: For documentation of the efficacy of different therapeutic option on different age group, following classification will be used. Human being Children Adults Birds Young Adult PARAMETERS TO ASSESS THE RESULTS 1. POSITIVE RESPONSE 2. NEGATIVE RESPONSE Complete disappearance of sign &symptoms with negative pathological findings. - No improvement of signs/symptoms along with pathological symptoms. - Dropped out – did not stick to therapy. PROPOSED RESULTS 1. Out of different therapeutic options the most effective therapeutic procedure needed for combacting Avian flu will be determined. 2. Most effective potency(ies), dose(s), repetition schedule(s) will be determined. 3. Which age group is amenable to homoeopathic medicament will be ascertained. 4. Which strain is better amenable to the therapy will be unfurled. CONCLUSION / RECOMMENDATIONS 1. The drug(s) evolved after clinical trial can be used as preventive & curative purposes for preventing / controlling Avian flu both for Avian and homosapiens. 2. As the strains are very often undergoing mutation the research should be a continued process to unveil the role of Homoeopathic medicament at different epoch of the time.