Rajiv Gandhi University of Health Sciences s19

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA,

ANNEXURE-II

APPLICATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION Dr KHATRI MUKESH PARMANAND P 1. NAME OF THE DEPARTMENT OF MATERIA MEDICA, 6. BRIEF RESUME OF THE INTENDED WORK CANDIDATE & ADDRESS FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL, 6.1 NEED FOR STUDY: UNIVERSITY ROAD, DERALAKATTE, Renal stone disease is one of the most common afflictions of modern society, it MANGALORE-575018 has been described since antiquity withKARNATAKA. westernization of global culture, however the PERMANENT ADDRESS Dr KHATRI MUKESH PARMANAND P site of stone formation has migrated from the lower to the upper urinary tract and the 122, RANNCHHOD PARK SOCIETY, incidence and prevalence rate is increasing. B/H PRAKASH BAKERY, RAMNAGAR, However, surgical treatment, RANDERalthough they ROAD, remove SURAT, the offending stone, do little GUJARAT-395005 to prevent the recurrence. The overall estimated annual expenditure for individual 2. NAME OF THE FATHER MULLER HOMOEOPATHIC withINSTITUTION claims corresponding to a diagnosisMEDICAL of nephrolithiasis COLLEGE AND was HOSPITAL,nearly $2.1billion in DERALAKATTE, MANGALORE. year 2000, reflecting a 50% increase since 1994.3 Given the frequency with which the 3. COURSE OF THE STUDY & M.D.(HOM) SUBJECTrenal stone recur, the developmentHOMOEOPATHIC of a medical prophylactic MATERIA program MEDICA to prevent, 4. DATE OF ADMISSION TO formation of renal stone recurrently26-05-2010. is desirable. THE COURSE 5. TITLE The OF expenditureTHE TOPIC in the management of urolithiasis cases with homoeopathy is “THE STUDY OF HOMOEOPATHIC REMEDY PROFILE IN THE very less compare to other systems of medicine. The recurrence can be prevented to MANAGEMENT OF UROLITHIASIS” great extent with homoeopathic drugs along with altering the food habits. Thus to this

end a clinical study of urinary tract stone is necessary.

Thus, this study is a sincere attempt aimed at the efficacy of homoeopathic

1 medicines on urolithiasis.

6.2 REVIEW OF THE LITERATURE:

INTRODUCTION8:

Urolithiasis (from Greek oûron,"urine" and lithos, "stone") is the condition where urinary calculi are formed in the urinary tract. The term kidney stone (or "renal calculus") is sometimes used to refer to urolithiasis in any part of the urinary tract, however it is more properly reserved for stones that are actually in the collecting duct of the kidney itself. The term nephrolithiasis can be used to describe the condition of having kidney stones, and ureterolithiasis can be used to describe the condition of having stones in the ureter.

HISTORY7:

Urinary calculus disease is one of the oldest known to man, Egyptian mummies since 3500BC have been discovered to have renal & bladder calculi. Anticipating modern lithotripsy, the Egyptians used gum to attach a diamond to the tip of a hollow rod, inserted it into the bladder per urethram and the patient ambulated, allowing the diamond to fragment the more fragile bladder stone.

DEFINITION2:

Urinary calculus is a stone-like body composed of urinary salts bound together by a colloid matrix of organic materials. It consists of a nucleus around which concentric layers of urinary salts are deposited.

EPIDEMIOLOGY:3

The lifetime prevalence of kidney stone disease is estimated at 1%-15% with the probability of having a stone varying according to

2  Age: uncommon before age 20yrs but peaks in 4th-6th decade of life.

 Gender: affects males two to three times more than females

 Geography: higher in hot arid or dry climates such mountains, desert or

tropical areas.

Prevalence in India approximately 5-7million patients suffer from stone disease and at least 1/1000 of Indian population needs hospitalization due to kidney stone disease. In India, the “stones belt” occupies parts of Maharashtra, Gujarat,

Punjab, Haryana, Rajasthan and Delhi. Once the kidney stone forms, the probability that a second will form within 5-7yrs is approximately 50%.6

AETIOLOGY2:

The important factors which influence the formation and growth of uroliths are as follow:-

A. Hyper excretion of relatively insoluble urinary constituently:-

1. Oxalate- though oxalate is the major component of 70% of all renal stones.

2. Calcium:- on regular diets normal urinary excretion of calcium ranges

between 200mg to 300mg per day.

3. Uric acid:- many patients with gout form uric acid calculi particularly when

under treatment.

4. Cysteine:- cystinuria is an hereditary disease which is more common in

infants and children.

5. Drug induced stones: - in rare cases.

B. Physical changes in urine:-

o urinary PH

3 o colloid content

o decreased concentration of crystalloids

o urinary magnesium/calcium ratio

C. altered urinary crystalloids and crystals

D. decreased urinary output of citrate

E. vitamin A deficiency

F. urinary infection

G. urinary stasis

H. hyperparathyroidism

I. nidus or nucleus of stone formation

TYPES OF RENAL CALCULI:-2

A. Primary stones: are those which appear in apparently healthy urinary tract without any antecedent inflammation, usually formed in acid urine, consists of mainly calcium oxalate, uric acid, urates, cysteine, xanthine or calcium carbonate.

1. Oxalate calculus (calcium oxalate)- this type of stone is usually single and

is extremely hard.

2. Uric acid and urate calculi: - pure uric acid calculi are rare and are not visible

in X-ray (not radio-opaque).

3. Cysteine calculi: - these stones usually appear in patients with cystinuria.

4. Xanthine calculi: - these are extremely rare.

5. Indigo calculi: - are so uncommon that these are merely academic curiosities.

B. Secondary stone2:-

1. Phosphate calculus:-majority of these stones are composed of calcium

4 phosphate, though a few are composed of ammonium magnesium phosphate,

known as ‘triple phosphate’.

CLINICAL FEATURES:

A. SYMPTOMS:-

1. Quiescent calculus2:- a few stones, particularly the phosphate stones, may lie

dominant for quite a long period. Even ‘staghorn calculus’ may be

asymptomatic.

2. Pain1:- it’s a leading symptom of renal calculus seen in 80% cases.

Renal pain-pain in renal angle

Ureteric pain-radiating pain from renal region to groin up to testis/vulva,

Vesicle pain-pain after urination

Prostatic pain

Urethral pain

3. Referred pain2:- this is quite rare and is sometimes referred to all over the

abdomen. Such pain simulates peptic ulcer or gallbladder disease.

4. Hydronephrosis2:- sometimes patient complains of a lump in the loin and a dull

ache, which are due to hydronephrosis caused by renal stone.

5. Haematuria2:- is the leading and only symptom.

6. Vomiting2

` B. SIGNS2:-

1. Tenderness

5 2. Muscle rigidity

3. Swelling

4. Abdominal distention

INVESTIGATIONS2:-

1. Blood investigation: blood urea, N.P.N, WBC count

2. Serum salts estimation (Ca, PO4, Mg, Cl)

3. Serum uric acid.

4. Urine analysis: physical, chemistry(pH, RBC, pus cells, casts, crystals)

5. Radiography: X-ray for KUB, for radio-opaque stones

6. Ultrasonography, for location of both radio-opaque & non-radio-opaque

stones.

7. Computed tomography, for location of non-radio-opaque stones.

8. Renal scan.

9. Instrumental examination-cystoscopy, for vesicle stone.

10. Examination of stone(stone analysis)

COMPLICATIONS4:-

1. Calculous hydronephrosis

2. Calculous pyonephrosis

3. Renal failure

MANAGEMENT

GENERAL MANAGEMENT2,5:

1. Fluid intake should be high at all times. Fluid should be taken at bed time so

6 that nocturia will occur. This will prevent dehydration.

2. Avoidance of milk, cheese and great deal of calcium should be advised.

3. Vitamin D should be stopped or used in very low quantity.

4. Diet rich in animal protein, sodium, and oxalate such as leafy vegetables,

carbonated beverages, & excessive vitamin C intake should be avoided.

5. Normal calcium intake should be encouraged.

6. High protein intake in the form of red meat is voided in such cases.

HOMOEOPATHIC APPROACH:

Homoeopathy recognizes the individuality of each patient or case. It does not treat disease, it treats patients, in one word individualization14 and it means constitutional treatment based on the totality of the mental and physical reaction. It should be able to cover the level of susceptibility. The behavioral patterns and the underlying miasms.15

As mentioned in aphorism 5, the physician should consider the probable exciting cause of the acute disease and physical constitution of a patient. Especially when the disease is chronic, physical constitution is determined by genetic code of the individual. Hence the physical constitution should never be neglected while arriving at the similimum.16

As given in aphorism 7, as in disease, from which no exciting or maintaining cause has to be removed, we can perceive nothing but the morbid symptoms, it must be the symptoms alone by which the disease demands and points to the remedy suited to relieve it—and the totality of these its symptoms, of this outwardly reflected picture of the internal essence of the disease, that is, of the affection of the vital force.16

In footnote of aphorism 7, it is mentioned that, it is not necessary to say that

7 every intelligent physician would first remove this where it exists; the indisposition there upon generally ceases spontaneously. He will remove from the room strong smelling flowers, to promotes the expulsion by vomiting of belladonna berries,etc., that may have been swallowed; extract foreign substances that may have got into the orifices of the body; crush the vesicle calculus; open the imperforate anus of the new- born infant.16

In Hahnemann’s 6th edition of the Organon of medicine, it is mentioned in aphorism146-209, he has mentioned regarding homoeopathic treatment of acute, chronic & one-sided diseases, in aphorism 245-261, he had mentioned regarding homoeopathic case management.17

Hence, we can prescribe in a various concepts depending upon the presenting of a case. In Homoeopathy it is possible to handle every case according to its individual presentation because of special nature of Materia Medica and its therapeutic application based on the law of similars.

COMMONLY USED REMEDIES IN MANAGEMENT OF UROLITHIASIS

Arnica Montana, Arsenic album, Apocyanum, Belladonna, Berberis Vulgaris,

Cantharis, Dioscorea, Lycopodium, Nux-Vomica, Opium, Pepermenthis, Tabacum

Calc-Urinaria, Cannabis indica, Erigeron, Eupatorium perfoliatum, Gallium,

Hydrangea, Pareira brava, Ocimum canum, Sarsaparilla, Silica, Uva, Thuja and

Zincum.9,10,11,12

6.3 OBJECTIVE OF THE STUDY:

1. To study the role of constitutional and acute mode of treatment in urolithiasis

8 2. To understand the importance of organ remedies in case of urolithiasis.

3. To prevent its recurrence.

7. MATERIALS AND METHODS 7.1 SOURCE OF DATA:

The subjects will be selected from OPD, IPD, peripheral centers, and village

camps of Father Muller Homoeopathic Medical College, Mangalore.

7.2 METHOD OF COLLECTION OF DATA:

A sample of minimum of 30 cases will be selected purposive sampling method

as per the inclusion criteria and will be followed for a minimum period of 3-6 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 according to the

demand of the case, with consideration of potency selection criteria such as Acute or

Chronic, Susceptibility, Vitality and Suppression (if any), changes in structural and

functional level and the degree of correspondence to the remedies selected.

INCLUSION CRITERIA:

1. The sample on both sexes aged 20 to 65 years.

2. Diagnostic criteria are mainly on clinical presentations & investigations.

3. Cases with urinary calculi measuring between 6-15mm.

EXCLUSION CRITERIA:

1. Cases of both sexes below 20 years and above 60 years.

2. Cases with other systemic disorders and complications.

9 3. Cases with urinary calculi measuring more than 15mm and less than 6mm.

RESEARCH HYPOTHESIS:

Homoeopathic medicines are effective in the treatment of urolithiasis.

NULL HYPOTHESIS: Homoeopathic medicines are not effective in the treatment of urolithiasis.

PLAN FOR DATA ANALYSIS: The collected data will be analyzed by paired ‘t’ test and data will be presented in the form of mean standard deviation, the frequency and percentage.

7.3 Does the study require any investigations to be conducted on patients, or other humans (or animals)? If so please describe briefly. Yes, the study may require following blood investigations, blood investigation: blood urea, N.P.N, WBC count

Serum salts estimation (Ca, PO4, Mg, Cl) Serum uric acid. Urine analysis: physical, chemistry(pH, RBC, pus cells, casts, crystals) Radiography: X-ray for KUB, for radio-opaque stones Ultrasonography, for both radio-opaque & non-radio-opaque stones. 7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, enclosed. 8. LIST OF REFERENCES:

1. Das. Somen. A Manual on Clinical Surgery, 6th edition, Calcutta published by Dr.

Somen Das sept-2005, p-409.

2. Das. Somen. A Concise Textbook of Surgery, 5th edition Calcutta published by

Dr. Somen Das march-2008, p-1189-96.

3. CAMPBELL & WALSH, UROLOGY-vol.2, 9thedition India; published by

Saunders, Elsevier, p-1363

4. Shenoy Rajgopal K. Manipal Manual of Surgery, p-538

10 5. K.V. Krishna Textbook of Medicine 5thedition, published by Jaa Pee publications,

p-1139.

6. Health Screen- no.64, vol.6, May -2010, p-14.

7. Moreies Petter. J. & Malt Ronald. A. Oxford Textbook of Surgery, vol.2,

edited by, Published 1994.

8. http://en.wikipedia.org/wike/urolithiasis, dated-20th Oct, 2010.

9. Kent Tyler J. Lectures on Homoeopathic Materia Medica, student edition, India,

B. Jain publications, New Delhi, August-2005

10. Raue. C.G. Special Pathology and Diagnostic Hints with Homoeopathic

Therapeutics, India, B. Jain publications, p-601-12.

11. Clarke Henry J. A Dictionary of Practical Material Medica, reprint edition, India,

Indian Books & Periodicals Publications.: Sept-2006,

12. Boericke W. Pocket Manual of Homoeopathic Material Medical with Indian

Medicine & Repertory,9th ed, New Delhi, Indian Book & Periodicals Publication.

13. Clarke Henry J. The Prescriber, reprint edition, New Delhi, Indian Book &

Periodicals Publication.-2003

14. Close Stuart. The genius of homeopathy lectures and essays on homoeopathic

philosophy. Delhi: B Jain Publishers (P) Ltd; 2004. p.51

15. Tiwari S.K. Homoeopathy child care therapeutics, child types, repertory. New

Delhi: B Jain Publishers (P) Ltd; 2004. p. 28.

16. Hahnemann S. Organon of medicine. 6th ed. Delhi: Indian Books & Periodical

Publishers (P) Ltd; 2001.

17. Dr. Nigam Harsh, Principles and practice of homoeopathic case management, 1st

11 edition, New Delhi B. Jain publications-2008, p-8. 9. SIGNATURE OF THE CANDIDATE 10. REMARKS OF THE GUIDE

11. 11.1 NAME AND Dr SUNNY MATHEW. DESIGNATION OF THE GUIDE (IN BLOCK LETTERS) M.D.(HOM), PROFESSOR, FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL, DERALAKATTE, MANGALORE.. 11.2 SIGNATURE

11.3 CO-GUIDE (IF ANY) 11.4 SIGNATURE 11.5 HEAD OF THE Dr SRINATH RAO DEPARTMENT MD.(HOM), PROFESSOR, DEPT OF MATERIA MEDICA, FR.MULLER HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL, DERALAKATTE, MANGALORE

11.6 SIGNATURE

12. 12.1 REMARKS OF THE CHAIRMAN & PRINCIPAL

12.2 SIGNATURE