RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA ANNEXURE-II
APPLICATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. NAME OF THE CANDIDATE & ADDRESS
PERMANENT ADDRESS
DR. SALINI.G. K.DEPARTMENT OF PAEDIATRICS,FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL,UNIVERSITY ROAD,DERLAKATTE,MANGALORE-574160KARNATAKA
D/O GOPALAKRISHNAN .P. P. “SYALEENA”RAMANATTUKARA (P.O)FEROKE CALICUT- 673633 KERALA
2. NAME OF THE INSTITUTION
FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL,DERLAKATTE,MANGALORE
3. COURSE OF THE STUDY & SUBJECT
M .D.(HOM)HOMOEOPATHIC PAEDIATRICS
4. DATE OF ADMISSION TO THE COURSE
16-6-2008
5. TITLE OF THE TOPIC
“A CONSTITUTIONAL APPROACH TO INTESTINAL HELMINTHIC
PARASITIC INFECTION IN PAEDIATRIC AGE GROUP – A CLINICAL
STUDY”.
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6. BRIEF RESUME OF THE INTENDED WORK
6.1 Need For Study:
Helminthiasis is a common parasitic infestation in childhood and the
magnitude of parasitic infection in children is a major health problem in major parts of the
world. 1 If the treatment is not given adequately there is a chance of recurrence and leads to
body wasting, anemia like complication. Recurrent worm infections are due to low
immune status, nutritional deficiency, unhygienic condition etc.
Parasitic worms (helminthes) are common in tropical climates and in
populations subject to crowding and poor sanitation. Children are most subject to
helminthic colonization. Intestinal infestations throw an additional burden on the rapidly
growing child1. It will result in poor performance in schools and will reduce their physical
activities.
It has been estimated that 6/7 of the total incidence of helminthiasis is
mainly due to ineffective disposal of human excreta. 1/3 of the population harbours some
or other parasites. The problem of Helminthic infestation in children is wide spread in
tropical countries1. Ascaris infects nearly 1/4th of the world population2.
Presence of worms always depend on a general taint of constitution (the
Psoric), joined to an unhealthy mode of living. Let latter be improved, and the former
cured Homoeopathically, which is most easily effected at this age (children), and none of
the worm remain, and children cure in this manner are never troubled with them more3.
The morbidity due to intestinal parasitic infection is very high and it
hinder with the growth and development of children. Hence I think it is the right time to
evaluate the scope of homoeopathy in this highly burden disease of childhood.
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6.2 Review of the Literature:
Definition:
Helminthiasis is a disease in which a part of the body is infested with
worms such as pin worm, round worm or tape worm. Typically the worms reside in the
gastro intestinal tract. But may burrow into the liver & other organs4. Intestinal
Helminthiasis in man is caused by 3 classes of worms.
Main Characteristic:
1. Anorexia
2. Abdominal pain
3. Grinding of teeth during sleep
4. Weight loss
5. Malnutrition
Source of Infection:
I) Soil
II) Water
III) Food
IV) Animals
V) From Persons
Mode Of Infection:
I) Oral Transmission
II) Skin Transmission
III) Direct transmission5.
Classification:
Helminthes or parasitic worms are multicellular bilaterally symmetrical,
elongated, flat or round animals. Helminthes in human belongs to two phyla.
1) Phylum Platyhelminthes
2) Phylum Nemathelminthes6
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1) Phylum PlatyHelminthes:-
The Platy helminthes or flat worms are dorsoventrally flattened, leaf like
or tape like. Their alimentary canal is incomplete or entirely lacking and the body cavity is
absent. They are mostly Hermaphrodites. Helminthes affecting man belongs to 2 classes.
a) Cestoidea: Cestodes are segmented, dorsoventrally compressed and tape like, hence
called tape worms. They vary from several millimeters to several meters, in length. Adult
cestodes or tape worms live attached to the mucosa in the small intestine and absorb food
from the host’s intestine.
Diseases due to cestoidea are:
1) Diphyllobothriasis
Diphyllobothriasis is a helminthic infection caused by Diphyllobothrium
latum it is otherwise known as fish tape worm. Man gets infection from eating
insufficiently cooked fish which carries the plerocercoid larva. The adult worm inhabits the
lumen of small intestine in illeum.7, 8.
Symptoms of Diphyllobothriasis are mainly mild abdominal pain,
diarrhoea and megaloblastic anaemia due to vitamin B12 deficiency with leucopenia7, 9.
2) Taeniasis
It is caused by 2 types of Taenia. Taenia sagina (beef tape worm) and
Taenia solium (pork tape worm). Both of these lives in the small intestine (upper jejunum)
of man. It is caused by ingestion of under cooked meat of intermediate hosts like beef &
pork. It moves against the peristaltic movement in host’s intestine8.
Symptoms of Taeniasis are abdominal discomfort, anemia and chronic
indigestion, alternating diarroea and constipation, presence of segments of the tape worm
in faeces or his own body and clothings8. Sometimes they produce anal pruritus, intestinal
obstruction, Cholangitis and appendicitis9.
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3) Echinococcosis (Hydatid disease)
It is caused by Echinococcus granulosus (dog tape worm). The larval
form of Echinococcus granulosus is the hydatid cyst. Man harbours the larval form, the
larval worm of Echinococcus granulosus causes unilocular hydatid disease.
Hydatid disease lies dormant for many years. The infection is generally
acquired in childhood but disease appears in the adult life. The manifestation depends upon
local signs and if the cyst is superficially situated then visible swelling will be there.
Rupture of hydatid cyst is associated with anaphylactic symptoms and formation of
localized or generalized secondary Echinococcosis8.
b) Trematoidea: The trematodes or flukes are leaf like flat unsegmented flat worms. They
vary in size from 1mm to several centimeters in length6. They are named trematodes
because of their suckers8. According to the habitat the
intestinal trematodes are of two types.
i) Small intestinal trematodes:-
They include Fasciolopis buski, Heterophyes heterophyes, and
Metagonimus yokogawai.
1) Fasciolaopsiasis
It is caused by Fasciolopis buski. Largest trematode infecting humans
known as giant intestinal fluke. The Fasciolopis buski causes fasicolopsiasis. The worm
can produce ulcerations & local inflammation at the site of attachment.
Heavy infection leads to Chronic diarrhoea, abdominal pain, and
asthenia8.
2) Heterophyiasis
Heterophyes heterophyes is the causative organism. It is the smallest
fluke measuring less than 2mm in length by 0.4mm in breadth. Its life span is two months.
Man is the definitive host. The worm lies in the intestinal canal on the mucous membrane.
The symptoms include colicky pain, diarrhoea8, 9.
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3) Metagonimiasis
It is caused by Metagonimus yokogawai. It is a very minute worm,
measuring 2mm in length by 0.5mm in breadth. Man is the definitive host and the adult
worm habitat in the small intestine. Due to this worm there will be Mild diarrhoea.
ii) Large intestinal trematode:-
1) Gastrodiscoides homini
This parasite is pyriform in shape. It measures 5 to 10mm in length by 4
to 5mm in breadth.The adult worm lives in the large intestine of the definitive host. It
produces mucous diarrhoea.
2) Phylum Nemathelminthes:-
c) Nematoda: They are otherwise known as round worms. Intestinal round worms are
the most common type of helminthiasis. They are unsegmented worms without
appendages. According to the habitat of adult worms the nematodes are divided in to 2,
i) Small intestinal nematode:-
They include Ascaris lumbricoides, Anchylostoma duodenale,
Strongyloides stercoralis, and Trichinella spiralis.
1) Ascariasis
The causative parasite is Ascaris lumbricoides. It is the largest nematode
seen in the intestine of man. The worm lives in the lumen of the small intestine (jejunum)
of man and maintains its position by its muscle tone. Embryonated eggs are the infective
agents. Round worm deprive the host for nutrients. It may cause intestinal obstraction.10
Symptoms due to migrating larvae ascaris pneumonia (Loffler’s
syndrome), fever, cough, dyspnoea, blood-tinged sputum with ascaris larvae, urticarial rash
and eosniphilia8, 10.
Symptoms due to adult worm are anorexia, protein energy malnutrition,
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vitamin deficiencies, urticaria, oedema of face, abdominal distention, passing of adult
worms in vomitus and feces.
Heavy infection can also cause intestinal obstruction, intussusceptions,
Protein energy malnutrition, peritonitis, like complication8, 9.
2) Anchylostomiasis
Anchylostoma duodenale is small, grayish white, cylindrical worm
which causes anchylostomiasis. Commonly they are known as hook worms due to their
curved tip. Hook worm suck 0.03-0.15 ml of blood /worm/day there for the severe
infection causes anaemia in the host.
Hook worm infection causes anaemia due to chronic blood lose and
nutritional defects, Duodenal ulcer, Steatorrhoea, failure to thrive, cutaneous larva
migrants can produce dermatitis, cutaneous tracts ground itch etc8, 9.
3) Strongyloidiasis
Strongyloides stercoralis is a parasite which lives in the wall (mucous
membrane) of intestine of man, especially in duodenum & jejunum. Filariform Larvae
constitute the infective stage & they enter the body through skin. Larvae penetrate directly
through the skin coming in contact with the soil.
The main symptom is diarrhoea with blood and Mucus8.
4) Trichinelliasis
Trichinella spiralis is one of the smallest nematode infecting man. It
starts as an intestinal parasite remaining buried in the duodenal or jejunal mucosa. There it
changes into an adult one & discharge embryo in to the circultion8.
Symptoms include diarrhoea, abdominal discomfort , vomiting and
enteritis.
ii) Caecum and Vermiform appendix nematodes :-
They include Enterobius vermicularis, Trichuris trichura.
1) Enterobiasis
Enterobius vermicularis is the causative organism of enterobiasis. It is
small more or less, spindle shaped. The adult worms live in caecum and vermiform
appendix of man. They remain there until the eggs are developed. The mode of infection is
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person to person or air borne. Auto infection is the main cause of its persistace.
Symptoms include itching of anus, Nocturnal enuresis, and perineal
pruritis.
Severe infections may lead to complications like appendicitis,
peritonitis, hepatitis and ulcerative lesions in small intestine 8, 9.
2) Trichuriasis
Trichuris trichura is the parasite. It is otherwise known as whip worm.
It is due to its whip like structure. The adult worm lives in the large intestine of man,
particularly the caecum; also in the vermiform appendix. Embryonated eggs are infective
to man. They suck approximately 0.005ml of blood/worm/day8, 9.
Symptoms include abdominal pain, mucous diarrhoea often with
blood streaked loss of weight, Rectal prolapse.
Laboratory Diagnosis:-
Laboratory studies may be useful in confirming the diagnosis of Helminthiasis
I) Stool Examination
1) Naked eye examination for worms for adult worm, or part of it.
2) Microscopical examination of faeces for eggs,
3) Direct smear test
4) NIH swab test
II) Blood tests
III) Serological test
IV) Fluorescent antibody technique
V) Radiograghs8
Prophylaxis:-
1) Prevention of pollution of water & food
2) Personal hygiene
3) Food should be thoroughly cooked especially fish, meat, oesters, crab etc
4) Vegetables & fruits should be washed properly before eating.
5) Proper sanitary control of sewage disposal.
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6) Avoid swimming in infected water.
7) Wear boots & gloves while working in soil8.
HOMOEOPATHY AND INTESTINAL HELMINTHIASIS
Homoeopathy recognizes the individuality of each patient or case.
Homoeopathy does not treat disease; it treats patients, In one word individualization11. It
means constitutional treatment based on the totality of the mental and physical reaction. It
should be able to cover the level of susceptibility, tendencies, the behavioral patterns and
the underlying miasms12. In case of helminthiasis also the patient should be individualised
on the basis of characteristics.
The role of constitution is crucial in treatment and achieving a cure.
By modifying susceptibility, the constitutional medicine has a capacity to correct the
tendencies and abnormal behaviors and reactions to environment. A constitutional
prescription should be based on the mental and physical reactions. It should be able to
cover the level of susceptibility, tendencies, the behavioral pattern and underlying miasm13.
Even in helminthiasis the constitutional medicine play a great role.
During Hannemanian time to expel and purge away the materia
peccans, or the injurious matters as they were termed, through the intestines, by means of
laxative and purgative medicines which in order to give them a more profound meaning
and a more prepossessing appearance. But Homoeopathy removes the disease in its
whole extent in the shortest, most reliable and most harmless way; If the medicines are
prescribed on the basis of individuality and constitution of the person. We shall also look
for the causes of the disease as fundamental, exciting cause or maintaining cause.
It often happens that the constitution is rendered more susceptible to
the attacks of intestinal parasites and more tolerant of their presence, by faulty hygienic
surroundings14. So the constitutional remedy can alter the susceptibility of the patient and
remove the repeated attacks by the intestinal parasites along with the hygienic advices.
A Few remedies which are useful in treating helminthiasis are given below:
Sulphur, Lycopodium, Calcarea carb, Spigellia, Cina, Bell, Baptisia,
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Ferrum mur, Bacillinum14, Phosphorus, Natrum mur, Sabadilla, Ignatia, Nux vom, Ars alb,
Silicea, Pulsatilla, Carbo veg, etc.
6.3 OBJECTIVES OF THE STUDY:
- To evaluate the role of constitutional remedies action in case of
helminthiasis
- To evaluate which type of Helminthic infection is more prevalent in
children.
MATERIALS AND METHODS:
7.1 SOURCE OF DATA:
The subjects will be selected from OPD, IPD and peripheral centers of
Fr. Muller Homoeopathic Medical College Hospital, Mangalore.
7.2 METHOD OF COLLECTION OF DATA: ( INCLUDING SAMPLING
PROCEDURE IF ANY)
SAMPLE AND SAMPLING TECHNIQUE
A sample of minimum of 30 cases will be selected by 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
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according to the demand of the case, with consideration of susceptibility, sensitivity,
suppression (if any), the level of similarity, functional changes, structural changes, vitality
and underlying miasm.
INCLUSION CRITERIA:
1. The sample on both sexes aged from 1- 13 years
2. Diagnostic criteria is mainly on clinical presentation and local
examination
EXCLUSION CRITERIA:
1. Cases above 14 years of both sex
2. Mentally retarded children
3. Children with genetic disorders
RESEARCH HYPOTHESIS:
Homoeopathic drugs are effective in the treatment of helminthiasis in paediatric
cases.
NULL HYPOTHESIS:
There is no significant improvement among helminthiasis in paediatric cases after
homoeopathic treatment.
PLAN FOR DATA ANALYSIS:
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The data collected will be analyzed by paired t-test. With respect to the second
objective proportions or ratio will be used to measure the prevalence of Helminthiasis in
children.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS TO BE CONDUCTED
ON PATIENTS, OR OTHER HUMANS (or ANIMALS)?
IF SO DESCRIBE BRIEFLY.
Yes, the study may require following stool examinations.( If required )
*Stool Examination
Other Tests:-
*Complete Blood Count
*Serological Tests
*Radiographs
*Fluorescent antibody technique
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?
Yes, enclosed
LIST OF REFERENCES:
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1. Viswananthan J, Desai AB. Achar’s text book of pediatrics. 3rd ed. Chennai:
Orient Longman Limited; 1999. p. 379.
2. Parthasarathy A, Nair MKC, Menon PSN, Shah Raju C, Shah Nitin K, Sachdev
HPS et al. IAP text book of Pediatrics. 3rd ed. New Delhi: Jaypee Brothers
Medical Publishers (P) Ltd; 2007. p. 491.
3. Hahnemann Samuel. Organon of medicine. 6th ed. New Delhi: B. Jain
Publishers (P) Ltd; 1997. p. 49, 50.
4. http://www.answers.com/helminthiasis.
5. Paniker Jayaram CK. Text book of medical parasitology. 6th ed. New Delhi:
Jaypee Brothers Medical publishers (P) Ltd; 2002. p. 4, 5.
6. Arora DRB Arora. Medical parasitology. 2nd ed. New Delhi: CBS Publishers &
Distributers; 2008. p. 109.
7. Icchpujani RL, Bhatia Rajesh. Medical parasitology. 3rd ed. New Delhi:
Jaypee Brothers Medical Publishers (P) Ltd; p. 2, 4.
8. Chatterjee KD. Parasitology in relation to clinical medicine.12th ed. Calcutta:
Sree Sraswathi Press Limited; 1980. p. 105-86.
9. Kliegman M Robert, Behrman E Richard , Jenson B Hal, Stanton F Bonita.
Nelson textbook of pediatrics. Vol.I. 18th ed. New Delhi: Elsevier, A Division Of
Reed Elsevier India Private Limited; 2008. p.1495-1517.
10. Ghai OP, Gupta Piyush, Paul VK. Essential pediatrics. 6th ed. New Delhi:
CBS Publishers and Distributers; 2006. p. 253.
11. Close Stuart. The genius of homeopathy lectures and essays on homoeopathic
philosophy. Reprint edition. Delhi: B. Jain Publishers (P) Ltd; 1999, p. 51.
12. http://wonders of homeopathy.com/homoeopathy for children.html.
13. Tiwari Shashi Kant. Homoeopathy and child care principle, therapeutics, child
types, repertory. Reprint edition. New Delhi: B Jain Publishers (P) Ltd; 2004.
p. 28.
14. John Henry Clarke M.D. The Prescriber. Reprint edition B. Jain Publishers (p)
Ltd; 2003, p. 376.
9. SIGNATURE OF THE CANDIDATE
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10. REMARKS OF THE GUIDE
11. NAME& DESIGNATION OF(IN BLOCK LETTERS)11.1 GUIDE
PROF. DR. SHASHI KANT TIWARI
D.M.S. DIP. N.I.H., M.D. (HOM)
FR. MULLER HOMEOPATHIC MEDICAL
COLLEGE & HOSPITAL, DERALAKATTE,
MANGALORE.
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT
DR JYOSHNA SHIVAPRASAD
B.H.M.S. M.D (HOM), PROFESSOR, DEPT.
PAEDIATRICS,
FR. MULLER HOMOEOPATHIC MEDICAL
COLLEGE& HOSPITAL, DERALAKATTE,
MANGALORE
11.6 SIGNATURE
12. 12.1 REMARKS OF THE
CHAIRMAN& PRINCIPAL
12.2 SIGNATURE
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