From:



From:

Dr. AJAY KUMAR

Post Graduate Student,

Post Graduate Dept.of Homoeopathic Repertory,

DBHP Sabha’s. DR. B. D. Jatti Homoeopathic Medical College,

Hospital & P.G. Research Centre,

D.C. Compound, Dharwad – 580 001.

To:

The Registrar

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore.

Through: [The Principal, DBHP Sabha’s. DR. B.D.Jatti Homoeopathic Medical College, Hospital & P.G. Research Centre, Dharwad]

Respected Sir,

Subject: Submission of Completed Proforma of synopsis for Registration of

Subject for Dissertation.

I request you to kindly register the below mentioned subject against my name for the submission of dissertation to the Rajiv Gandhi University of Health Sciences, Karnataka. Bangalore, in partial fulfillment for the award of the degree of M.D. (Homoeopathy) in Homoeopathic Repertory.

Title of Dissertation:

“THE REPERTORIAL APPROACH IN THE MANAGEMENT OF BENIGN PROSTATE HYPERPLASIA”

I am herewith enclosing completed Proforma of synopsis for registration of subject for dissertation.

Thanking you,

Yours faithfully,

Place: Dharwad.

Date:

(Dr. AJAY KUMAR.)

“THE REPERTORIAL APPROACH IN THE MANAGEMENT OF BENIGN PROSTATE HYPERPLASIA”

SYNOPSIS

Submitted to

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE.

BY

Dr. AJAY KUMAR.

Through

DBHPS’S

DR. B.D. JATTI HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL & P.G. RESEARCH CENTRE, D.C. COMPOUND, DHARWAD – 580 001 (KARNATAKA).

In partial fulfillment of requirement for the

DOCTOR OF MEDICINE (HOMOEOPATHY) in

HOMOEOPATHIC REPERTORY

Under the guidance of

Dr. S. S. MOHARANA. M.D. (Hom.)

Professor and H.O.D

Dept. of Homoeopathic Repertory.

DR. B.D. JATTI HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL & P.G. RESEARCH CENTRE, D.C. COMPOUND, DHARWAD – 580 001 (KARNATAKA).

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,

BANGALORE.

Annexure-II

REGISTRATION OF SUBJECT FOR DISSERTATION

| | | |

|1. |NAME OF CANDIDATE & ADDRESS |Dr. AJAY KUMAR. |

| | |Post Graduate Student, |

| | |Post. Graduate Dept of Homoeopathic Repertory. |

| | |DR. B. D. Jatti Homoeopathic Medical College, Hospital & P.G. Research |

| | |Centre, |

| | |Dharwad – 580 001. |

| | | |

| |PERMANENT ADDRESS |Dr. AJAY KUMAR. |

| | |S/o Sri Amar Jeet Singh, |

| | |Vill: Bhewaraha, |

| | |Post: Amari (T.P.Nagara), |

| | |Dist: Jaunpur. |

| | |Uttar Pradesh. |

| | | |

| | | |

|2. |NAME OF THE |D.B.H.P.Sabha’s |

| |INSTITUTION. |DR. B. D. Jatti Homoeopathic Medical College, Hospital & P.G. Research |

| | |Centre, |

| | |D.C. Compound, |

| | |Dharwad – 580 001. |

| | | |

|3. |COURSE OF STUDY AND SUBJECT. |M.D. (Homoeopathy) in Homoeopathic Repertory. |

| | | |

|4. |DATE OF ADMISSION TO COURSE. |30-06-2009. |

| | | |

| | | |

|5. |TITLE OF THE TOPIC. |“THE REPERTORIAL APPROACH IN THE MANAGEMENT OF BENIGN PROSTATE HYPERPLASIA” |

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|6. | |BRIEF RESUME OF THE INTENDED WORK |

| | | |

| |6.1 |NEED FOR STUDY: |

| | | |

| | |Benign Prostate Hyperplasia is disease of old age above the 50 years but more common above the age of 80 years |

| | |about 75-80 % are affected. |

| | | |

| | |Benign Prostate Hyperplasia is prevalence throughout the world and occurs in all ethnic group. |

| | | |

| | |Benign Prostate Hyperplasia is multifactorial disease caused by complex genetically, hormonal and environmental|

| | |factor but only hormonal factor can be find out. |

| | | |

| | |It is common problem of male above the 70 years of age that occur due to imbalance between the androgen and |

| | |oestrogenic level. As the age advance the androgen are diminishes but oestrogen are not decrease equally so the|

| | |Benign Prostate Hyperplasia is due to predominance of oestrogenic hormone. |

| | | |

| | |Benign prostate hyperplasia is chronic disease and undergoing exacerbation and remission if left untreated. |

| | | |

| | |In other system the treatment is conservative and surgical. Surgery is done in acute or chronic retention of |

| | |urine but Prostectomy should be done to avoid the complication of renal failure. |

| | | |

| | |There are different type of Post operative complication may be found i.e., Haemorrhage, Infection, |

| | |Epididymitis, Stricture, Renal Failure, Cardiac and Respiratory complication. |

| | | |

| | |After observing the different type of complication due to Allopathic Drug and Surgical Treatment. Another mode |

| | |of treatment is very useful and has no side effect, economic and responsible for betterment of patient. |

| | | |

| | |The Homoeopathic treatment is based on holistic approach and concept of individualization which is based on |

| | |easily comprehensible principle adopts during the treatment of man as a whole not the disease of man in the |

| | |treatment of Benign Prostate Hyperplasia. |

| | | |

| | |In Homoeopathic treatment we reduce the suffering of the patient by rapid, gentle and permanent cure of the |

| | |patient and complication that occur on modern surgical procedure. |

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| | | |

| | | |

| | |There is more risk to, given anaesthesia of old patients so we prefer the Homoeopathic treatment for old |

| | |patients who have the anaesthetic approach. |

| | | |

| | |A systematic and scientific study of Homoeopathic management of Benign Prostate Hyperplasia of prostate is |

| | |needed to ascertain the utility of different types of Repertories. Hence this study is undertaken. |

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| |6.2 |REVIEW OF LITERATURE: |

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| | |1. Benign Prostatic Hyperplasia (BPH) is Non-neoplastic tumour like enlargement of prostate. It is commonly |

| | |called benign nodular hyperplasia (BNH) or benign enlargement of prostate (BEP). It very common in old age men |

| | |above 50years and considered normal ageing process. It’s incidence approaches 75-80% in men above 80 years.1 |

| | |2. The Process of ageing is associated with an increasing frequency of both benign and malignant alternation of|

| | |the prostate gland. These condition reflect the uncontrolled growth of both the stromal and epithelial |

| | |component of gland. Autopsies of men in the eighth decade of life show hyperplasia changes in > 90 % and |

| | |malignant changes in > 70 %.2 |

| | |3. Benign Prostatic Hyperplasia occur in men over 50 years of age, by the age of 60 years 50 % men have |

| | |histological evidence of Benign Prostatic Hyperplasia. It is common cause of lower urinary tract symptom and is|

| | |the most common cause of bladder outflow obstruction (BOO) in men > 70 years of age.3 |

| | |4. Though the Pathology of Benign Prostatic Hyperplasia is well established but its cause is not known |

| | |definitely. Two Theories put forward for cause of Benign Prostatic Hyperplasia, of which first is more accepted|

| | |than second one. |

| | |Hormonal Theory-------The main hormone which acts on prostate is testosterone which secreted from testis under |

| | |control of Luteinising Hormone of Anterior pituitary which is again under control of Luteinising Hormone |

| | |Releasing Hormone of hypothalamus. An enzyme 5-α reductase which present in high concentration in prostate, |

| | |converts testosterone into1,5—dihydroxytestosterone. In old age serum oestrogen increased which act on the |

| | |hypothalamus decrease the secretion of Luteinising Hormone Releasing Hormone (LHRH) and hence Luteinising |

| | |Hormone, causing decrease in serum testosterone level. So the prostate may have enlarged due to relative |

| | |predominance of oestrogenic hormone. It well established that enzyme 5-α reductase turn testosterone to |

| | |1,5—dihydroxytestosterone which influence growth of prostates. |

| | | |

| | |Neoplastic Theory--- According to this theory benign enlargement of the prostate is considered to be a benign |

| | |neoplasm i.e., adenoma or adenomyoma of the gland.4 |

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| | |5. The Prostatic parenchyma can be divide into biologically distinct region i.e., peripheral, transitional and |

| | |periurethral zone. The proliferative lesions are different in each region for examples the hyperplastic lesion |

| | |arise in the transitional & peripheral zones. The Prostatic hyperplasia is characterised by proliferation of |

| | |both stromal and epithelial elements. |

| | |Benign Prostatic Hypertrophy (BPH) a time-honored synonym for nodular hyperplasia of the prostate is both |

| | |redundant and a misnomer, because all hypertrophies are benign and fundamental lesion is hyperplasia rather |

| | |than a hypertrophy. Benign Prostatic Hypertrophy not occur in male castrated before the onset of puberty nor in|

| | |men with genetic disease that block androgen activity.5 |

| | |6. After the age of 40 years prostate increase in volume by 2.4cm3 per year on average. Associated symptom |

| | |common after 60 years of age and 50 % men over 80 years will have lower urinary tract symptom associated with |

| | |benign prostatic hyperplasia (BPH). The Primary Symptom is hesitancy, poor prolonged flow and sensation of |

| | |incomplete emptying. Secondary (irritative) Symptom consists of urinary frequency, urgency of micturation and |

| | |urges incontinence not specific to Benign Prostatic Hypertrophy.6 |

| | |7. Investigation : |

| | |International Prostate Symptom Scored (IPSS)---symptoms are scored on International Prostate Symptom Score |

| | |which serves as valuable assessment of urinary problem. The IPSS assessment should include assessment of |

| | |Quality of Life which is a reflection of the degree of “bother” caused by patient and symptom.6 |

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| | |Flow rate are accurately measured with a Flow Meter and advice to patient for maintaining the frequency volume |

| | |diary.6 |

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| | |Direct Rectal Examination (DRE)---Direct Rectal Examination –It is used for assessment of prostate gland benign|

| | |enlargement. It is smooth, convex and typically elastic, but the fibrous element may give the prostate a firm |

| | |consistency.7 |

| | | |

| | |Trans Rectal Ultrasound Scan (TRUS)---Trans Rectal Ultrasound Scan—It is used for measurement of Prostate |

| | |volume accurately.6 |

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| | |Ultra Sonography---This can detect the size of Prostate most accurately. In fact due to the progress made in |

| | |the quality of ultra sound examination over the last few years, the need of excretory urography has been |

| | |diminished.4 |

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| | |Objective assessment of obstruction is only possible by urodynamics. They should be performed on the following |

| | |patients. |

| | |Men with suspected neuropathy (Parkinson’s disease, Dementia, Longstanding Diabetes, Previous Stroke, Multiple |

| | |Sclerosis) |

| | |Men with dominant history of irritative symptom and men with life long urgency and frequency. |

| | |Men with doubtful history and those with flow rates in the near normal range (~or > 15mts-1) |

| | |Men with invalid flow rate measurements.3 |

| | | |

| | |vii) Investigation of men with Lower Urinary Tract Symptom (LUTS). |

| | |Essential Investigation---- |

| | |Urine analysis by dipstick for blood, glucose and protein. |

| | |Urine culture for infection. |

| | |Serum creatinine. |

| | |Urinary flow rate and residual volume measurement |

| | |. |

| | |Additional Investigation : |

| | |Prostate Specific Antigen if indicated. |

| | |Pressure flow studies.3 |

| | | |

| | |Repertorial Approach : |

| | |8. Prostate---- Acon., Aspar, Bar. c., Caps., Clem., Cub., Dig., Nat.s., Plus., Rhus a., Senec., Thuj.8 |

| | |9. Old age, senility, agg., in: Alu., Amb., am-c., anac., Ant-c., ant.t., arn., ARS., AUR., BAR-C., bry., |

| | |calc_c., cam., Carb-a., carb-v., caus., chin., cic., cocl., CON., Flu-ac., gins., hyo., kre., LACH., LYC., |

| | |nux-v., OP., pho., pho-ac., rhus-t., rut., SEC-C., sele., stan., Sul., sul-ac., ver-a.9 |

| | |10. PROSTATE GLAND : |

| | |Enlargement : Aloe, alum., am-m., apis, asar., aspar., aur-m., Bar-c., benz-ac., berb., cact., Calc., |

| | |cann-s.,canth., cic., chin., clem., Con., cop., Dig., ferr-m., hyos., iod., kali-i., kali-p., lith., lyc., |

| | |med., merc., nat-c., nat-p., nat-s., nit-ac., nux-v., pareir., phos., psor., Puls., sec., sel., sence., sil., |

| | |spong., staph., sulph., thuj., uva-u. |

| | |Dribbling urine after stool and urine: Sel. |

| | |Senile: Aloe, Bar-c., benz-ac., con., Dig., iod, nux-v., sabal., Sel. staph., sulph. |

| | |Sensation of : Alum., berb., bry., chin.., cycl., nux-v., ther.10 |

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| | |11. PROSTATE Gland general – aesc., aloe, apis, bar-c., baros., caust., chim., CON., crot-h., dam., dig., fab.,|

| | |ferr-pic., hep hydrang., iod., kali-i., lyc., med., mela., merc., pareir., phos., phyt., pic-ac., polyg., pop.,|

| | |PULS., SABAL., sel., sep., solid., staph., sul-i., sulph., THUJ. |

| | |Rectal troubles, with-podo.11 |

| | |12. Prostate, Affections of: Aesc., Aloe, Cact., Euphr., Hydrn-a., Kali-i., Mela., Ol-an., Phyt., Pop-t., |

| | |Sabal., Staph., Sul-i., Tur. |

| | |Enlargement of : Arg-n., Bac-c., Dig., Iod., Pareir., Sabal., Solid.12 |

| | |13. PROSTATE GLAND: Hypertrophy: -Alf.; Aloe., Am.m.; Arg.n.; Bar. c.; Benz.ac.; Calc.f.; Calc.i.; Chim.; |

| | |Chr.s.; Cimic.; Con.; Eup. pur.; Ferr. Pic.; Gels.; Graph.; Hep.; Hydrang.; Iod.; Kali bi.; Kali br.; Lyc.; |

| | |Med.; Ol . Sant.; Oxyd.; Pareir; Pic. Ac.; Pip.m.; Pop.; Puls.; Rhus a.; Sabal; Sars.; senec.; Solid.; Staph.; |

| | |Sulph.; Thiosin.; Thuj; Thyr.; Trib.; Tritic.13 |

| | |14. PROSTATE GLAND: Ap; Bar-c; Chim; CON; Crot-h; Dig; Lyc; Med; Par-b; Pho; Polyg; PUL .; Sabal; Sele; Sep; |

| | |Solid; STAP; Sul; THU. |

| | |Enlarged: Apoc; Bar-c; Calc; Cann; Chim; Con; Dig; Med; Ol-an; Par-b; Pic-ac; Pul; Sabal; Senec; Sil; Ther.14 |

| | |15. Prostate Gland, spong, 111, thuj. 181., |

| | |Prostate Gland.___ Dr.J.Stephenson recommends Spongia for chronic enlargement of the prostate gland. |

| | |Diseases of the Prostate Gland : Thuja is indicated with frequent pressing to urinate with but small |

| | |discharge; the patient strains much during urination; discharge of prostatic fluid in the morning after |

| | |awakening; sensation in the rectum as though a bladder had formed; stitches from the rectum into the urethra; |

| | |cutting pain in the region of the bladder just before and during urination; urine bloody or depositing a |

| | |brick-dust sediment.15 |

| | | |

| |6.3 |AIMS AND OBJECTIVES OF THE STUDY: |

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| | |1. Study of clinical and pathological rubrics of different repertories in the treatment of Benign Prostate |

| | |Hyperplasia. |

| | |2. The comparative evaluation of the efficacy of repertories in the management of Benign Prostate Hyperplasia. |

| | |3. To study the clinical presentation of Benign Prostate Hyperplasia. |

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|7. | |MATERIALS AND METHODS: |

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| |7.1 |PRIMARY SOURCE: |

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| | |The subject for this study will be collected from OPD/IPD/Rural camp of DR. B.D. Jatti Homoeopathic Medical |

| | |College, Hospital and Post Graduate Research Centre, Dharwad. |

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| |7.2 |METHOD OF COLLECTION OF DATA (Including sampling procedures, if any,) |

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| | |Definition of study subject: |

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| | |Patients are considered on the basis of clinical presentations .i.e., hesitancy, frequency first at night then |

| | |day, urgency, dysuria, retention of urine on pressure, urination discomfort, on radiological changes and |

| | |complication in adjacent organ. |

| | |Following are the inclusion criteria : |

| | |1. Subjects of old age group and only men and all ethnic groups. |

| | |2. Subjects clinically diagnosed to be having uncomplicated Benign Prostate Hyperplasia. |

| | |Following are the exclusion criteria : |

| | |1. Subjects with any complications of Benign Prostate Hyperplasia. |

| | |2. Subjects with Prostate Carcinoma. |

| | | |

| | |STUDY SAMPLING DESIGN : |

| | |Sampling method : |

| | |Simple Random Sampling Method. |

| | |Sampling size : |

| | |Prevalence rate of Benign Prostate Hyperplasia is in our hospital is 2% considering the 95% confidence interval|

| | |at 5% permissible error, sample size works out to be 32 subjects. Since it is a time bound study, subjects |

| | |admitted to IPD/ attending the OPD, and peripheral OPD during the study period will be considered for the |

| | |study. |

| | | |

| | |Study design : |

| | |Simple random method of selection of cases. The cases are selected according to inclusion and exclusion |

| | |criterias. |

| | |Follow up : |

| | |Follow up of the cases would depend on severity of the symptom, preferably once in week for One Month and later|

| | |on once in 15 days. |

| | |Parameters used are : |

| | |Change in clinical findings like the presenting symptoms, signs, and investigations. |

| | |Study period : |

| | |From: 30th November-2009 to 30th November-2011. |

| | |Statistical tests : |

| | |Appropriate test will be used depending upon the data available at the end of study. |

| | | |

| |7.3 |DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN OR |

| | |ANIMALS? IF SO DESCRIBE BRIEFLY. |

| | | |

| | |The study requires following investigations to be conducted on patients |

| | |Ultrasonography of Abdomen and pelvis, (If required). |

| | |Direct rectal examination, (DRE). |

| | |Trans rectal ultrasound scan (TRUS), (If required). |

| | |Urine examination: Routine and microscopic, (If required). |

| | |Blood examination: Hb gm%, Total Leucocyte Count, Differential Leucocyte Count, Erythrocyte Sedimentation Rate,|

| | |(If required). |

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| | | |

| | |HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION? |

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| |7.4 |Yes, Ethical clearance has been obtained from the institution. |

|8. | |LIST OF REFERENCE: |

| | | |

| | |1. Mohan Harsh Text Book of Pathology 5th Edition-2005 by.,Jaypee Brothers Medical Publisher (P) Ltd., New |

| | |Delhi INDIA. Page.743. |

| | |2. Braunwald Eugene, Fauci. S.Anthony, Kasper. L. Dennis, Hauser. L. Stephene, Longo. L. Dan, Larry Jameson. |

| | |J, Harrison’s Principle of Internal Medicine 15th Edition-1999, Vol-I. McGraw-Hill Medical Publishing |

| | |Division. Page. 608. |

| | |3. Love’s and Bailey Short Practice of Surgery 25th Edition-2008 Hodder Arnold Publisher Ltd. Page.1345. |

| | |4. Das Somen A Concise Text Book of Surgery 5th Edition Calcutta-2008 Page.1259. |

| | |5. Michel. N Richard, Fausto Nelson, Abbas. K Abdul, Kumar Vinay, Robbins Basic Pathology 8th Edition-2007 |

| | |Saunders Elsevier, a division of Reed Elsevier India Private Limited, New Delhi. Page .696. |

| | |6. Hunter A.A. John, Walker R Brian, Colledge. R Nicki, Boon. A Nicholas,Davidson’s Principles and Practice of|

| | |Medicine 20th Edition-2006, Churchill Livingstone Elsevier Limited. Page .510. |

| | |7. Glynn Michael, Swash Micheal, Hutchinson’s Clinical Methods 22nd Edition-2007, Saunders Elsevier Limited, |

| | |Page: 135. |

| | |8. Allen. T.F. Boenninghausen’s Therapeutic Pocket Book, B.Jain Publisher Pvt Ltd. Page. 94. |

| | |9. Bradford. T.L. Boger Boenninghausen’s Characteristics and Repertory with Corrected and Abbreviation and |

| | |Word Index, C.M. Boger, B.Jain Publisher Pvt Ltd. Page. 1134. |

| | |10. Kent. J.T. Repertory of the Homoeopathic Materia Medica, 6th American Edition, B.Jain Publisher Pvt Ltd. |

| | |Page. 667. |

| | |11. Murphy Robin, Homoeopathic Medical Repertory, 1st Indian Edition, Indian Books & Periodicals Syndicate, |

| | |Karol Bagh, New Delhi. Page. 977. |

| | |12. Clarke. J.H. Condensed Homoeopathic Materia Medica and Repertory, B.Jain Publishers Pvt Ltd., New Delhi. |

| | |(India). Page .1230. |

| | |13. Boericke William, New Manual of Homoeopathic Materia Medica, 9th Edition, B.Jain Publishers Pvt Ltd., |

| | |New Delhi. (India). Page. 834. |

| | | |

| | | |

| | |14. Phatak. Dr.S.R. Concise Repertory of Homoeopathic Medicines, 3rd Revised Edition, B.Jain Publishers Pvt |

| | |Ltd., New Delhi. (India). Page No.:325. |

| | |15. Hoyne. S Temple. Clinical Therapeutics, Vol-II, B.Jain Publishers Pvt Ltd., New Delhi. (India). Page .111,|

| | |181,639. |

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| 9. | |Signature of the candidate | |

|10. | |Remarks of the guide | |

| | | | |

| |11.1 |Name and Designation of (IN BLOCK LETTER) |Dr.S. S. MOHARANA , |

| | |Guide |M.D.(Hom.) |

| | | |PROFESSOR and H.O.D. |

| | | |Post Graduate Dept. of Homoeopathic Repertory. |

| | | |DR. B.D. Jatti Homoeopathic Medical College, Hospital & |

| | | |P.G.Research Centre, Dharwad-01. |

| |11.2 |Signature | |

| |11.3 |Co-guide (if any) | |

| |11.4 |Signature | |

| |11.5 |Head of the Department. |Dr. S. S. MOHARANA, |

| | | |M.D. (Hom.) |

| | | |PROFESSOR and H.O.D. |

| | | |Post Graduate Dept. of Homoeopathic Repertory, |

| | | |DR. B.D. Jatti Homoeopathic Medical College, Hospital & |

| | | |P.G.Research Centre, Dharwad-01. |

| |11.6 |Signature | |

|12. |12.1 |Remarks of Principal | |

| |12.2 |Signature. | |

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