RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
BANGALORE.
ANNEXURE – II
APPLICATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION
|1. |NAME OF THE CANDIDATE & ADDRESS |Dr T.SUREKHA |
| |(IN BLOCK LETTERS) |DEPARTMENT OF MATERIA MEDICA, |
| | |FATHER MULLER HOMOEOPATHIC |
| | |MEDICAL COLLEGE AND HOSPITAL, |
| | |UNIVERSITY ROAD, DERALAKATTE, |
| | |MANGALORE – 575 018, |
| | |KARNATAKA. |
| |PERMANENT ADDRESS |Dr T.SUREKHA |
| | |D/O PROF T. SUBBA RAO |
| | |DEPARTMENT OF PHYSICS, |
| | |S.K.UNIVERSITY, |
| | |ANANTHAPUR - 515003 |
| | |ANDHRA PRADESH. |
|2. |NAME OF THE INSTITUTION |FATHER MULLER HOMOEOPATHIC |
| | |MEDICAL COLLEGE AND HOSPITAL, |
| | |UNIVERSITY ROAD, DERALAKATTE, |
| | |MANGALORE – 575 018, |
| | |KARNATAKA. |
|3. |COURSE OF THE STUDY AND SUBJECT |M.D. (HOM) |
| | |MATERIA MEDICA |
|4. |DATE OF ADMISSION TO THE COURSE |16-07-2012 |
|5. |TITLE OF THE TOPIC |
| |“TO ENDEAVOR THE EFFECT OF JUSTICIA ADHATODA IN LOWER POTENCIES IN CHRONIC BRONCHITIS ” |
|6. |BRIEF RESUME OF THE INTENDED WORK |
| |6.1 NEED FOR THE STUDY: |
| |Chronic bronchitis is a chronic inflammation of bronchi in the lungs. It is generally considered as one of the forms of Chronic |
| |obstructive pulmonary disease and other being the emphysema. Patients with advanced chronic obstructive pulmonary disease having |
| |primary Chronic bronchitis were commonly referred as “Blue bloaters” because of the bluish color of the skin and lips (cyanosis) |
| |along with hypoxia and fluid retention1. |
| |From the studies we knew that Chronic bronchitis can be diagnosed according to clinical criteria if the patient suffers chronic |
| |production of sputum for at least 3 months a year for minimum of 2 consecutive years. Once the general diagnosis has been made, then |
| |physicians who made studies had wish to divide patients with Chronic bronchitis into three subgroups as those suffering from simple |
| |bronchitis; those whose sputum is mucopurulent under microscopic examination and who have chronic or recurrent mucopurulent |
| |bronchitis; those whose clinical histories, including a review of pulmonary function studies compatible with airway obstruction. |
| |The prevalence rate of Chronic bronchitis was similar in men and women, whereas in most parts of the world much lower rates are |
| |recorded in women. In England the number of work days is lost because of Chronic bronchitis has increased from 22 million in 1955 to |
| |approximately 30 million in 1974. The prevalence of chronic bronchitis in smokers is five times more than non-smokers. The prevalence|
| |is more in age group of 17yrs -65yrs. Sharp et al made studies on men in industrial area 19.6% had persistent cough, 16.7% had |
| |persistent expectoration and 10.7% had persistent cough and expectoration10. |
| |In this scenario, people are looking for alternative therapies. So it is the time to prove the efficacy of homoeopathy. Apart from |
| |constitutional treatment, a specific remedy plays a role in treating chronic bronchitis. WHO has estimated that 80% of the earth’s |
| |inhabitant relied on traditional medicines in primary health care needs and most of these therapies involved of use of plant extract |
| |or in their active compounds. As it is known that Justicia Adhatoda is a primary herb used in cough, bronchial asthma and symptoms of|
| |common cold in the Ayurvedic system of medicine. It is already known that in homeopathy this remedy is used in acute catarrhal |
| |conditions in respiratory tract infections. So, this study is made to know how effective Justicia Adhatoda is in lower potencies in |
| |cases of Chronic bronchitis, and to know how effective the action as expectorant and a tonic 4. |
| |6.2 REVIEW OF LITERATURE: |
| |DEFINITION: |
| |Chronic bronchitis has been defined as the presence of chronic productive cough for three months during each of two successive years |
| |in a patient in whom other causes of chronic cough, such as infection with mycobacterium tuberculosis, Carcinoma of the lung, |
| |Bronchiectasis, Cystic fibrosis and Chronic congestive heart failure, have been excluded. |
| |EPIDEMIOLOGY: |
| |Chronic bronchitis affects approximately 14 million people or 5% population, making it the seventh ranking chronic condition in the |
| |nation. Chronic bronchitis appears in people older than 40 yrs of age and more common in chronic smokers and exposure to |
| |environmental and occupational irritants. |
| | |
| |RISK FACTORS: |
| |Cigarette smoking. |
| |Air pollution. |
| |Industrial irritants. |
| |Infections. |
| |Allergies14. |
| | |
| |PATHOGENESIS: |
| |The earliest feature of Chronic bronchitis is hypersecretions of mucous in large airways, associated with hypertrophy of the |
| |submucosal glands in the trachea and bronchi. Proteases released from neutrophils, such as neutrophil elastase and cathepsin, and |
| |matrix metalloproteinases, stimulates this mucous hypersecretions. As Chronic bronchitis persists there is also marked increase in |
| |goblet cells of small airways- small bronchi and bronchioles leading to excessive mucous production that contribute airway |
| |obstruction. |
| |Mucous hypersecretions in large airways is the cause of sputum overproduction. Alternations in the small airways of the lungs can |
| |result in physiologically important and early manifestations of chronic airway obstructions. When bronchitis is accompanied by |
| |moderate to severe airflow obstruction, however coexistent emphysema is the dominant lesion. Cigarette smoke predisposes to the |
| |infection in one way which interferes ciliary action of the respiratory epithelium. It may cause direct damage to airway epithelium |
| |and it inhibits the ability to bronchial and alveolar leucocytes to clear bacteria. Viral infection can also cause acute |
| |exacerbations of Chronic bronchitis. |
| | |
| |CLINICAL FEATURES: |
| |Chronic bronchitis can also occur due to repeated occurrences of acute bronchitis. The clinical manifestations can vary according to |
| |the age, reaction of the problem activity and posture. Early stage of the problem is usually starts with mucous producing morning |
| |cough. Many sufferers also complain regarding sinus congestion or postnasal drip or bad breath. The severity of the cough and amount |
| |of mucous and phlegm increases as the disease progress. After sometime, shortness of breath and wheezing can also happen. These occur|
| |because the inflammation is narrowing the airways which combine with the mucous leads to shortening of breath. Expectorations differ |
| |in colour as the exacerbation is usually triggered by viral diseases12. |
| | |
| |INVESTIGATIONS: |
| |Pulmonary function test: - Measurement of lung volumes and diffusing capacity, which generally requires a specialized laboratory, may|
| |also be helpful, particularly in determining whether airway limitation is due to emphysema or to airway disease |
| |Chest radiography: - Increased thickness of bronchial walls viewed on end and an increased prominence of lung markings suggest the |
| |diagnosis of Chronic bronchitis but neither specific nor sensitive14. |
| |Sputum examination: - Sputum is mucoid and microscopic examination reveals a predominance of macrophages, bacteria are few. During |
| |exacerbation the sputum is often grossly purulent to an influx of neutrophils. |
| |Complete blood count:- White blood cell count may be raised due to inflammation, |
| |C-Reactive protein may be elevated. |
| |High resolution computed tomography / CT scan1. |
| |COMPLICATIONS: |
| |Chronic pulmonary obstructive disease. |
| |Cor pulmonale. |
| |Pneumonia. |
| |Bronchiectasis. |
| |Bronchial asthma14. |
| |DIAGNOSTIC CRITERIA: |
| |Chronic productive cough for 2-3 months of 2 successive years. |
| |Sputum production and cough are related to cigarette smoking. |
| |Pathologically characterized by increased sputum production. |
| |Symptoms more in the age group of 20-60yrs. |
| |Shortness of breath may be severe8. |
| | |
| |HOMOEOPATHIC APPROACH: |
| |Constitutional remedies are the best remedies in treating the patient. When constitutional picture is not clear, in such cases we can|
| |go through specific remedy. In such cases Justicia Adhatoda is prescribed as specific remedy. The medicinal forces are stronger than |
| |the natural disease forces says Hahnemann (aph 30 to aph 33) because the susceptibility of living organism for natural diseases is |
| |comparably less than it is for medicinal diseases5. In aph 78 Dr Hahnemann says that “the true natural chronic diseases are those |
| |that arise from a chronic miasm, which when left to themselves and unchecked by the employment of those remedies that are specific |
| |for them, always go on increasing and growing worse, notwithstanding the best the best mental and corporeal regimen, and torment the |
| |patient to the end of his life with ever aggravated sufferings10…” |
| |Some remedies which are helpful in chronic bronchitis are Justicia adhatoda, Antimonium tart, Bryonia, Calcarea carb, Dulcamara, |
| |Hepar sulph, Pulsatilla, Kali-Bichromicum and many more. Based on the knowledge of Justicia Adhatoda , a study will be taken to know |
| |the efficacy of this drug in the treatment of Chronic bronchitis. |
| |JUSTICIA ADHATODA: |
| |Botanical name: Adhatoda vasika. |
| | |
| |Family: Acanthaceae. |
| | |
| |Common name: Vasaka or Malabar nut. |
| | |
| |Proved by: Dr.Sarat Chandra Ghose, Calcutta, India. |
| |It is a bushy plant, named after James Justice, and 18th century Scottish gardener, first grown in Australia in 1850. |
| | |
| |Description: |
| |A dense evergreen, often gregarious shrub 1-2.5 meter high. Stem with yellowish bark, terete, glabrous branches many, ascending |
| |leaves 12-20 cm long, ellipticlanceolate, acuminate, tapering to the base, minutely puberulous, dark green above pale beneath. |
| |Flowers in short dense axillary pedunculated spikes 2.5-7.5cm long arranged towards ends of the branches; peduncles stout, shoter |
| |than the leaves, bract upto 22mm long, elliptic, sub-acute glabrous or nearly 5-7 nerved, closely reticulate, bracteoles 18mm long, |
| |1- nerved margin ciliate, calyx 8-12mm long hairy outside, tube 12mm long, upper half much inflated laterally upper lip round, |
| |filaments hairy at the base, ovary and lower position of style hairy. Capsule 18mm or more in length clavate, pubescent, seeds |
| |orbicular9. |
| |Active principle: - Vasicine and Vasicinone. |
| |Ayurvedic use:- |
| |Adhatoda vasica is traditionally used in Ayurvedic and Unani medicine, particularly for respiratory tract aliments.It is said to be |
| |called as Vaidyamatha because of its medicinal uses and not fatal in long use. It has been in India as an anti-spasmodic for asthma |
| |and intermittent fever, also as an expectorant in cases of Chronic bronchitis and phthisis. Adhatoda is beneficial in asthma because |
| |it is anti-asthmatic and as an expectorant. It is also used in skin conditions both externally and internally. It is also indicated |
| |in internal hemorrhage. |
| |In clinical research studies found that leaves of the plant contain alkaloid vasicine is responsible for persistent bronchodilation |
| |and an essential oil chiefly responsible for the expectorant action. Branded drug containing vasaka as an ingredient is used to clear|
| |the airways by decreasing the mucous secretions and opening the passages. The drug makes sputum more fluid thereby facilitates its |
| |removal, also facilitates breathing. This plant is a source of vitamin –C and has medicinal uses like anti -inflammatory, anti – |
| |bleeding and bronchodilator7. |
| |Homoeopathic use: |
| |Mind: - Irritability, easily angered, Bad humor. Anxious and discouraged. Depression of spirits. Aversion to conversation. Sensitive |
| |to external impression. |
| |Head: - Hot, full and heavy head. Lachrymation of eyes. |
| |Limbs: - Puffy hands and feet in morning. |
| |Liver: - Jaundice. Liver weakness. |
| |Respiratory: - Acute catarrhal conditions of the respiratory tract. Severe dyspnea with cough, Bronchitis, Rattling in bronchi, tough|
| |mucous. Paroxysmal cough with suffocative obstruction of respiration. Tightness across chest, as it would burst. Hoarseness, painful |
| |larynx. Dry and painful during empty swallowing, tenacious mucous13. Cough with sneezing, dry cough from sternal region all over the |
| |chest. Paroxysmal cough with suffocation, obstruction of respiration, whooping cough. Allergies and hay fever. Profuse, fluent coryza|
| |with constant sneezing. Coryza with cough. Fits of sneezing with lachrymation and loss of smell and taste. Tenacious mucus in the |
| |throat which cannot be brought out without coughing. Dryness in the throat, excoriation during empty deglutition. Also useful in |
| |consumption and other lung affections attended with cough and hectic fever6. |
| |Modalities: - Worse in a close room, from dust, noise, eating. |
| |Dose:- Usually used in 3x, 6x, 30C and Q |
| | |
| |6.3 OBJECTIVE OF THE STUDY:- |
| | |
| |1. To study the effect of Justicia Adhatoda in acute exacerbation of Chronic bronchitis. |
| |2. To study the effectiveness or action in Lower potencies.(3x, 6x and 30c) |
|7. |MATERIALS AND METHODS |
| |7.1. SOURCE OF DATA: |
| |The subjects will be selected from OPD, IPD and peripheral centers of Father Muller Homoeopathic Medical College and Hospital, |
| |Mangalore. |
| |7.2. METHOD OF COLLECTION OF DATA: (INCLUDING SAMPLING TECHNIQUE) |
| |A sample of minimum 30 cases will be selected on symptom similarity. Cases will be followed for a minimum period of 6-8 months. The |
| |cases will be selected for lower potencies |
| |INCLUSION CRITERIA: |
| |The sample is taken from both the sexes of age 20 – 60. |
| |Diagnostic criteria based on clinical features mentioned above. |
| |Cases of acute exacerbation in chronic bronchitis. |
| |Lab investigations which includes Complete blood count, necessary If Chest Radiography. |
| |Other scales used are Visual Analogue Scale, 6 Minute walk test. |
| |EXCLUSION CRITERIA: |
| |Patients of above 60yrs and below 20yrs of both sexes. |
| |Subjects with systemic complications are not taken for study |
| |Cases of other type of LRTI are not taken for study. |
| |TOOLS: |
| |Standardized case record. |
| |Visual analogue scale (VAS). |
| |6 Minute walk test (6MWT). |
| | |
| |RESEARCH HYPOTHESIS: |
| |Justicia adhatoda is effective for Chronic bronchitis in Lower potencies. |
| |NULL HYPOTHESIS: |
| |Justicia adhatoda is not effective for Chronic bronchitis in Lower potencies. |
| |PLAN FOR DATA ANALYSIS: |
| | |
| |The collected data analyzed by frequency, percentage, mean, standard deviation add by paired t-test. |
| | |
| |7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS TO BE CONDUCTED ON PATIENTS, OR OTHER HUMANS (OR ANIMALS)? IF SO PLEASE DESCRIBE |
| |BRIEFLY. |
| |Yes, Any or all of the above investigations are needed to be done. |
| |Complete blood count. |
| |If necessary chest X – ray. |
| |Other scales used are VAS, 6MWT |
| |7.4 HAS ETHICAL COMMITTEE CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3? |
| |Yes, enclosed. |
| | |
| | |
|8. |LIST OF REFERENCES: |
| |Available from UR: L: bronchitis Accessed on |
| |dt 2.1.13. |
| |Available from URL: adhatoda Accessed on |
| |dt 31.1.13. |
| |Available from URL: Accessed on dt 17.2.13. |
| |A Review of Adhatoda Vasica, , A International journal on pharmaceutical sciences, dt. 17.2.13. |
| |B.K Sarkar, Hahnemann’s Organon of medicine, 2011-12, 10th edition. |
| |Boericke W. New manual of homeopathic materia medica & repertory, New Delhi: B. Jain publisher’s Pvt. Ltd. 2000. |
| |Dhankhar et al_ A review on Justicia adhatoda A potential source of natural medicine_ Afr_ J_ Plant Sci_ 6 October, 2011.mht. dt |
| |2.1.13 |
| |Fauci, Braumwald, Kasper, Hauser, Longo, Jameson, Loscalza, Signs and symptoms in pulmonary medicine , Frederick L. Glauser, 1983, |
| |pg- 212-213. |
| |Government of India, Ministry of Health, Homeopathic pharmacopeia of India, 1971, First edition, First volume. |
| |Hahnemann Samuel, Organon of medicine, 6th edition, B.jain publisher Pvt.Ltd.pg.166. |
| |James E. Pennington, Respiratory infections diagnostic and management, 1983 USA, pg.113-116. |
| |Kumar, Abbas, Fausto. Robbins and cotron pathologic basis of disease, 7th edition. 2005, pg- 722 -723. |
| |Lotus materia medica, Robin Murphy ND, 2010, third edition. pg- 1027-1028. |
| |Murrey and Nadel text book of respiratory medicine, 4th edition, 2005, Vol – 1. Pg.1115-1141. |
| | |
| | |
|9. |SIGNATURE OF THE CANDIDATE | |
|10. |REMARKS OF THE GUIDE | |
|11. |NAME & DESIGNATION OF | |
| |(IN BLOCK LETTERS) | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| |11.1 GUIDE |Dr AMITHA.P.BALIGA |
| | |M. D. (HOM) |
| | |ASSISTANT PROFESSOR, |
| | |DEPT OF HOMOEOPATHIC MATERIA MEDICA. |
| | |FR. MULLER HOMOEOPATHIC |
| | |MEDICAL COLLEGE & HOSPITAL |
| | |DERLAKATTE, MANGALORE. |
| |11.2 SIGNATURE | |
| |11.3 CO-GUIDE | |
| |11.4 SIGNATURE | |
| |11.5 HEAD OF THE DEPARTMENT |Dr SRINATH RAO. C |
| | |M. D. (HOM) |
| | |PROFESSOR AND HEAD OF THE DEPT. OF HOMOEOPATHIC MATERIA MEDICA |
| | |FR. MULLER HOMOEOPATHIC |
| | |MEDICAL COLLEGE & HOSPITAL |
| | |DERLAKATTE, MANGALORE. |
| |11.6 SIGNATURE | |
|12. |12.1 REMARKS OF THE | |
| |CHAIRMAN& PRINCIPAL | |
| |12.2 SIGNATURE | |
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