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. |

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|9. |SIGNATURE OF THE CANDIDATE | |

|10. |REMARKS OF THE GUIDE | |

|11. |NAME & DESIGNATION OF | |

| |(IN BLOCK LETTERS) | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

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| | | |

| |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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