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Thursday, July 31, 2008

Some aspects of Chickenpox with homoeopathic mode of treatment

Chicken pox is an acute, highly infectious disease of childhood caused by varicella zoster virus (VZV) which is a DNA virus belonging to the family of herpesvirus. VZV infects only humans and produces two distinct diseases in man- varicella ( chicken pox) and herpes zoster ( shingles) among which chicken pox is the primary infection occurring usually in the childhood. Chicken pox is the primary infection in the non-immune host. It almost never occurs twice in the same individual. The virus then remains latent in the dorsal root and cranial nerve ganglia for the rest of the life. If immunity is impaired which occurs in elderly persons, the virus replicates and migrates along the sensory nerves to the skin or eye causing the lesions of zoster. There are no animal reservoirs of varicella.

Age- Chicken pox is the disease of childhood. But it can occur at any age and adult chicken pox which is more common in some tropical areas for reasons not understood is much more serious.

Source of infection -The source of infection is a chicken pox or herpes zoster patient. Infectivity is maximum during the initial stages of the disease when the virus is present abundantly in the upper respiratory tract. Infectivity diminishes with the progress of the disease and the scabs are practically non- infectious.

Route of entry-The portal of entry of the virus is the upper respiratory tract.

Incubation Period- 7-23 days, average 2 weeks.

Onset-Acute.

Clinical Features- There are malaise, headache, weakness, fever and prodromal rash. In children the prodromal illness is mild and so the disease is usually noticed only when the skin lesions appear. In adults, however, prodromal fever and malaise with respiratory symptoms lasting 2-3 days are common features. True rash usually appears on the first day of the disease and is vesicular in nature. The rash is centripetal in distribution, affecting mainly the trunk along with face & scalp and sparing the distal parts of the limbs. Moreover, the rash is very superficial and does not involve the deeper layers of the skin. With each fresh crops of rash temperature rises. The vesicles are unilocular and not umbilicated. Fever subsides as soon as new lesions cease to appear. Eventually the pustules crust and heal without scarring. The illness tends to be more severe in older children and can be debilitating in adults. One of the most characteristic features of the rash is pleomorphism and so all stages of the rash that is papules, vesicles and crusts may be seen simultaneously at one time in the same area.
Laboratory Investigations- Laboratory diagnosis is seldom required because of clear-cut clinical signs. Confirmation of the diagnosis is possible by examining the direct scraping of the skin lesion under a microscope, viral cultures or a rising antibody level in convalescing blood samples.

Complications-
Secondary bacterial infection usually due to staphylococci or streptococci may occur.
Varicella pneumonia- It is an important complication that usually 1-6 days after skin eruption. Varicella pneumonia is found mainly in adults where it usually becomes fatal. Besides these, CNS ( Central nervous system) involvement occurs in rare cases. The immunocompromised are susceptible to disseminated infection with multi-organ involvement.
Prevention-Recently a vaccine has been introduced in some countries. The vaccine is effective in preventing chickenpox in a number of cases & is recommended for use between the ages of twelve and eighteen months. In the rest of the cases the severity of a chickenpox infection is lessened by the vaccine.

Prognosis- Chicken pox requires no treatment in healthy children and infection results in life-long immunity. But the disease may be fatal in the immunodeficient or the immunosuppressed. If the primary infection occurs during pregnancy, the virus may cross the placenta with subsequent infection of the foetus. Primary infection of the mother near term may lead to neonatal varicella.

Treatment- Rhus.t ( Rhus toxicodendron) 30 is very effective to cope with skin lesions & should be used six times daily for one week or till the lesions heal & then should be stopped. Dulc (Dulcamara) & Merc.s ( Mercurius –Hydrargyrum ) be also used especially for high temperature.
Labels- Microscope, Infection, Centripetal, Laboratory Investigations, Laboratory diagnosis, Chicken pox, DNA virus, Dulc (Dulcamara), Immunocompromised, Immunodeficient, Immunosuppressed, Lesion, Merc।s ( Mercurius –Hydrargyrum ), Microscope, Pleomorphism, Varicella pneumonia, Foetus, Neonatal varicella, CNS ( Central nervous system), Pleomorphism,Pustule, Rash, Multi-organ, Staphylococci, Streptococci, Incubation Period, Prevention, Complications,Clinical Features.
IN SHORT- Chicken pox is an acute, highly infectious viral disease of childhood which begins with malaise, headache, weakness, fever and a characteristic type of rash appearing mainly the trunk with pleomorphism. Treatment is as mentioned above.
But in every case a doctor should be consulted।

Sunday, July 27, 2008

Some aspects of Chalazion with homoeopathic mode of treatment

A chalazion is a chronic granuloma of one or more than one meibomian glands.

Pathology- A low grade infection, entering through a duct of the meibomian gland, causes infiltration of the wall of the duct with leucocytes along with proliferation of the epithelium of the duct. The duct, thus, becomes obstructed and the meibomian secretion accumulates within the gland. The retained secretion causes irritation resulting in infiltration of the surrounding tissues with inflammatory cells and consequently formation of a granuloma. Much of the glandular tissue is thus ultimately replaced by granulation tissue which undergoes hyaline degeneration forming a jelly-like mass.

Histology- A chalazion consists of sebaceous material in the centre surrounded by giant cells, epitheloid cells and lymphocytes.

Associated Conditions- It may be associated with blepharitis, rosacea or seborrhoeic dermatitis. Chronic chalazion may be associated with hypercholesterolemia.

Age- A chalazion is more common in adults than in children.

Presentation- Presentation is usually at any age with a gradually enlarging painless nodule (swelling).

Symptoms- Depending on the size of the chalazion, there may be a sense of heaviness in the lid and mild irritation. Occasionally an upper lid chalazion may press on the cornea inducing astigmatism and consequently blurred vision.

Signs-
(1) A single or multiple roundish, firm swellings of variable size within the substance of the lid in the tarsal plate, a little distance away from the lid margin.
(2) It is painless or there is initial tenderness followed by little or no tenderness.
(3) The swelling is fixed to the tarsus, with the skin freely moving over it.
(4) On everting the lid, the conjunctiva over it is found to be engorged and velvety in colour.
(5) The regional lymph glands are not palpable.

Course-
(1) A very small chalazion may undergo resolution.
(2) A chalazion may remain as it is.
(3) A chalazion may gradually increase in size over weeks or months and then may remain stationary & may even slowly regress.
(4) A chalazion may burst either on the skin surface or on the conjunctival surface, with granulation tissue protruding.
(5) A chalazion may be secondarily infected leading to the formation of an internal hordeolum.
(6) A chalazion may affect a meibomian duct or may protrude through a meibomian duct when the nodule is found to develop at the lid margin and is called a marginal chalazion.
(7) There may be calcification of a chalazion.
(8) A chalazion may recur.

Treatment-
(1) Lid hygiene should be promoted.
(2) Diabetes mellitus should be excluded by necessary laboratory investigations.
(3) Hypercholesterolemia should be excluded by necessary laboratory investigations
(4) Refractive errors, if any, should be corrected with proper glasses (spectacles) or contact lenses.
(5) Recurrent chalazia, especially in old people should arouse the suspicion of malignancy.
(6) Hot compresses may be applied, especially if there is pain or tenderness.
(7) Of the homeoepathic medicines, Conium 200 twice in the morning at an interval of three hours and Staph (Staphysagria) 200 twice in the evening also at an interval of three hours should be used for at least one month. If not recovered, the same dose schedule should be continued for another month and then stopped. Kali Iod 200 may also be tried.
Labels-Astigmatism, Blepharitis, Chalazion, Conium, Cornea, Homeoepathic medicine, Resolution, Kali Iod, Gland, Granuloma, Hypercholesterolemia, Internal Hordeolum, Lymph gland, Malignancy, Meibomian, Staph (Staphysagria), Treatment, Vision, Hygiene, Refractive errors, Glass, Spectacles, Contact lenses, Diabetes mellitus, Rosacea, Seborrhoeic dermatitis, Hyaline degeneration, Sebaceous, Giant cell, Epitheloid cell, Lymphocyte.

IN SHORT- Chalazion is manifested as a painless single or multiple firm swellings of variable size within the substance of the eyelid, a little distance away from the lid margin. Treatment is followed as mentioned above.
But in every case a doctor should be consulted.

Some aspects of Internal Hordeolum with homoepathic mode of treatment-

It is the suppurative inflammation of a meibomian gland of exactly same nature as stye but is comparatively rare. It is often called a suppurative chalazion and sometimes may be due to secondary infection of a chalazion.

Causative agent- Staphylococcus.

Symptoms-They are same as for stye but are more severe.

Signs-
(1) A tender, painful swelling within the substance of the lid in the tarsal plate, a little distance away from the lid margin.
(2) The point of maximum tenderness is away from the lid margin.
(3) If the lesion enlarges, the pus points on the tarsal conjunctiva and not on the root of an eyelash. It rarely points on the skin.

Treatment-
(1) Lid hygiene should be properly maintained.
(2) Blood sugar should be controlled in case of diabetes mellitus.
(3) General health of the patient should be improved with good nutrition and vitamins.
(4) Refractive errors, if any, should be corrected with suitable glasses (spectacles) or contact lenses।

(5) Hot compresses may be applied.
(6)
Homoeopathy plays a good role in its treatment. Of the different medicines, Hepar Sulph (Hepar Sulphuris Calcareum) 30 should be given six times daily for a week if there is intense pain. Silicea 30 may also be used & should be given six times daily for a week if the pain is stitching in nature.

Labels-Blood sugar, Chalazion, Conjunctiva, Contact lens, Diabetes mellitus, Hepar Sulph (Hepar Sulphuris Calcareum), Eyelash, Glass, Health, Homoeopathy, Refractive errors, Spectacle, Hygiene, Internal Hordeolum, Nutrition, Patient., Pus, Silicea, Skin, Vitamin.

IN SHORT- Internal Hordeolum is manifested as a tender, painful swelling within the substance of the lid a little distance away from the lid margin. Treatment is followed as mentioned above.

But in every case, a doctor should be consulted.

Sunday, July 20, 2008

Some aspects of External Hordeolum or Stye with homoeopathic mode of treatment -

External hordeolum or stye is a focal, acute inflammation of the follicle of an eyelash including the glands of Zeis or Moll, usually ending in suppuration.

Causative agent- Staphylococcus.

Associated Conditions- It may be associated with blepharitis, rosacea or seborrhoeic dermatitis.

Associated factors- It may be associated with uncorrected errors of refraction as well as some metabolic factors like diabetes mellitus, debility & excessive intake of carbohydrate.

Age- It may occur at any age, but more common in adults than in children.

Symptoms- Acute pain in the lid margin with a sense of heaviness & heat.

Signs-
(1) A single or multiple swellings at the margin of the affected lid pointing anteriorly through the skin.
(2) Marked tenderness at the point of inflammation on the lid margin.
(3) Swelling, redness & marked oedema of the affected lid as a whole.
(4) Congestion of the neighbouring conjunctiva which may be chemotic.
(5) Enlargement of the corresponding pre-auricular lymph glands.
(6) Finally appearance of a white pus point on the lid margin at the base of a cilium which indicates suppuration.

Course- If not treated, the pus point may burst outside & consequently the pain and swelling subsides.

Complications- Usually none but very rarely the inflammation may spread producing cellulitis of the orbital tissue.

Treatment-
(1) Lid hygiene should be properly maintained.
(2) Blood sugar should be controlled in case of diabetes mellitus.
(3) Refractive errors, if any, should be corrected with proper glasses (spectacles) or contact lens.
(4) General health of the patient should be improved with good nutrition and vitamins.
(5) Hot fomentation should be applied on the lid to hasten suppuration.
(6) If the pus points on the skin of the lid, the pus should be drained by pulling out the affected eyelash.
(7) Homoeopathy plays a good role in its treatment. Of the different medicines, constitutional medicine is Graph (Graphites) 200 for fair, fatty, flabby patients. General medicine is Staphysagria 200 twice daily. If there is severe pain, Hepar Sulph (Hepar Sulphuris Calcareum) 30 should be added with it till the pain persists in a dose of four times daily. If there is stitching pain, Silicea 200 should be added with the general medicine till the persistence of the pain. General medicine should be continued till the subsidence of stye and also for another two weeks.

Labels- Homoeopathy, Diabetes mellitus, Nutrition, Vitamins, Refractive errors, Glasses, Spectacles, Blepharitis, Rosacea, Seborrhoeic dermatitis, Swelling, Oedema, Lymph gland, Inflammation, Suppuration, Blood sugar, Health, Eyelash, Pus, Conjunctiva, Treatment, Staphylococcus, External Hordeolum, Stye, Graphites, Silicea, Hepar Sulph, Staphysagria.

IN SHORT- Stye is manifested as a single or multiple swellings at the margin of the eyelid with marked tenderness along with swelling, redness & oedema of the affected lid as a whole. Treatment is followed as mentioned above.

But in every case a doctor should be consulted.

Sunday, July 13, 2008

Some aspects of Whooping Cough with homoeopathic mode of treatment-

Whooping Cough is a type of catarrh of the entire respiratory tract which produces paroxysmal cough and a typical stridor or ‘whoop’ caused by Bordetella pertussis, a gram negative, coccobacillus. Though Bordetella pertussis is the main causative agent, a few cases, milder in nature may be caused by Bordetella parapertussis, the incidence of cases varying in different countries. Very rarely, the disease may be caused by Bordetella bronchiseptica. A whooping cough like clinical picture may also be caused by some other respiratory pathogens like adenoviruses and Mycoplasma pneumoniae. Whooping Cough is one of the most infectious of bacterial diseases and the non-immune contacts seldom escape the disease. One characteristic feature of whooping cough is that the infection is limited to the respiratory tract and the bacilli do not invade the bloodstream.

Host & reservoir of infection-Humans are both the natural hosts and reservoirs of infection.

Age- It is a disease of childhood occurring common between 1-5 years of age. However, no age is exempt.

Sex- The disease is relatively commoner in the female than in the male at any age.

Spread of infection- Infection is transmitted by droplets and fomites contaminated with oropharyngeal secretions.

Source of infection- Source of infection is a patient in the early stage of the disease. In adolescents and adults the disease is often atypical with the presentation of bronchitis who then serves as a source of infection to infants and children. Chronic carriers are not known.

Incubation Period- 7-14 days.

Pathology- It produces a local infection. The organism is not invasive. It multiplies on the surface epithelium of the respiratory tract and causes inflammation and necrosis of the mucosa which in turn may invite secondary bacterial invasion. The whole respiratory tract starting from nasopharynx down to bronchi is thus involved in a necrotizing inflammation along with inflammation of the peribronchial and tracheobronchial lymphoid tissue. As the disease progresses, inflammation of the lung produces a diffuse bronchopneumonia with desquamation of the alveolar epithelium. The stickiness of exudates causes obstruction of bronchioles and atelectasis.

Onset- Insidious.

Clinical Features- The disease usually lasts 6-8 weeks. The course of the disease is protracted and may be divided into three stages- each lasting approximately two weeks-

(1) The catarrhal stage- Clinical diagnosis at this stage is difficult. It has an insidious onset with malaise, anorexia, mucoid rhinorrhoea, conjunctivitis and a dry irritating cough. This is the stage of maximum infectivity.

(2) The paroxysmal stage-It is so called because of the characteristic paroxysms of coughing. It begins about a week later. The cough increases in intensity and comes on in distinctive bouts. The cough is more prominent at night and is increased on crying and during feeding. The characteristic feature of paroxysms of cough is that there is no apparent inspiration in between them which ends in a crowing inspiratory sound, the classic inspiratory whoop. Children under 6 months usually do not produce whoop. During this stage, there is no fever unless complicated by some other infection. These paroxysms usually terminate in vomiting. Conjunctival suffusion and petechiae and ulceration of the frenulum of the tongue may also be seen.

(3) Convalescent stage- During this stage, cough becomes less frequent and sputum is less tenacious.

Complications- The paroxysmal stage is mainly associated with complications. Bronchitis, lobar pneumonia, atelectasis, rectal prolapse etc. Cerebral anoxia may occur, especially in younger children. The respiratory complications are self-limited, the atelectasis resolving spontaneously but the neurological complications may result in permanent sequelae like epilepsy, paralysis, retardation, blindness or deafness. Bronchiectasis may be a late sequel.

Laboratory Investigations- The initial diagnosis of whooping cough is usually based on the symptoms. The following may be done-

(1) Blood examination -Blood examination shows high W.B.C count. Total count is also high with about 90% lymphocytes. No immature lymphocytes are present.

(2) Culture of the organism- The most accurate method of diagnosis of whooping cough is to culture the organisms obtained from swabbing mucus out of the nasopharynx. Unfortunately the organism is delicate. So it is unusual to get a positive culture in whooping cough. In other words, if a swab is negative, the patient can still have whooping cough.
(3) Serological Tests- Serological diagnosis is generally of no use. ELISA may be used for demonstration of specific secretory IgA antibody in nasopharyngeal secretions in culture negative cases. A better and more modern way of detecting the organism is by detecting its unique DNA pattern by means of polymerase chain reaction (PCR).

Control and prevention- Maternal antibodies do not seem to give protection against the disease. Affected individuals should be isolated to prevent contact with others. But this is seldom practicable, as infectivity is highest in the earliest stage of the disease when clinical diagnosis is difficult. Active immunization with triple antigen comprising of pertussis vaccine in combination with diphtheria and tetanus toxoid is recommended for consecutive three months starting at three months of age of the infant.

Treatment- Of the different medicines, Bell (Belladonna) 6, Dros (Drosera) 6 and Aralia (Aralia Racemosa) 6 are some of the medicines used most frequently. Each of them is administered three times daily, giving a gap of at least one hour between two different medicines. The medicines should be continued for at least one week or till cough persists. Then gradually the medicines should be stopped. If there is associated chest congestion, Ant.t (Antimonium Tartaricum ) 6 should be used thrice daily along with the above medicines.

Labels- Epilepsy, Bronchitis, Lobar pneumonia, Atelectasis, Rectal prolapse, Paralysis, Ulcer, Rhinorrhoea, Conjunctivitis, Retardation, Blindness, Deafness Polymerase chain reaction (PCR), Tetanus toxoid, Diphtheria, ELISA.etc.


Tuesday, July 8, 2008

Some aspects of Mumps with homoeopathic mode of treatment


Mumps is an acute, highly infectious disease of childhood caused by mumps virus, a RNA virus belonging to the family of paramyxoviruses which has a predilection for glandular and nervous tissues. The virus is antigenically stable and only one serotype exists. Humans are the only natural hosts. No human carriers or animal reservoirs exist. One attack confers lasting immunity and so second attacks are not seen. Introduction of aggressive immunization has dramatically reduced the incidence of the disease in the developed countries.

Age- Although no age is exempt, it is primarily a disease of childhood and young adults it is uncommon before 2 years of age. It often occurs as epidemics in children of 5-15 years as well as in young people living in groups as in army camps.

Spread of infection- This infection spreads by direct contact, airborne droplets or fomites contaminated with saliva and possibly also with urine.

Source of infection- The source of infection is a patient in the late incubation or early clinical stage of illness. The peak infectivity is about a day or two before the clinical manifestation of parotitis and subsides rapidly thereafter.

Incubation Period- Long and is about 12-25 days, average being 18 days.

Clinical Features- The prodromal symptoms are non-specific and include fever, malaise, headache and anorexia usually followed by severe pain over the parotid gland with its swelling. Sometimes parotid gland swelling may be the first clinical manifestation of the illness. Parotid swelling is unilateral to start with but may become bilateral. There is stiffness of jaw, inability to open the mouth. Dryness of the mouth with foul smell is also present. There is local pain and tenderness over the parotid gland region. There is also tenderness over the posterior ramus of the mandible. The swelling of the soft tissue may proceed downwards. The enlarged parotid glands obscure the angle of the mandible and may elevate the ear lobe. The parotitis is non-suppurative and usually resolves within a week. Rarely only the submandibular gland involvement may occur.

Complications- The most commonest complication is orchitis. It is usually unilateral but may also be bilateral when it may cause sterility due to testicular atrophy. Other less common complications are arthritis, oophoritis, nephritis, pancreatitis, thyroiditis and myocarditis. Besides these, central nervous system involvement is very often seen; it may cause ‘aseptic meningitis’ as well as meningoencephalitis in some cases. But both of these usually resolve without sequelae. A portion of patients with central nervous system involvement involvement may not show any evidence of parotid gland involvement.

Laboratory Investigations- A typical case of mumps does not need any laboratory investigation for confirmation. Laboratory investigations are needed for atypical cases.

(1) Blood Examination- Some non-specific findings may be present in the blood. The WBC may be low with lymphocytes predominating. ESR and CRP may be normal or slightly elevated. Serum amylase levels may be elevated even without pancreatic involvement.

(2) Virus Isolation - Virus can be isolated in cell culture from saliva, throat swab, urine and CSF and virus identification can be performed by neutralization or inhibition of haemadsorption by specific sera.

(3) Serologic test- Positive serologic test for serum mumps IgM antibody or four-fold rise between acute- and convalescent-phase titers in serum mumps IgG antibody level may help in the establishment of the diagnosis of the disease.

(4) Reverse transcription polymerase chain reaction (RT- PCR) Test - Detection of viral RNA by this test is also helpful for confirmation of the diagnosis.

Prophylaxis- Active immunization with a live attenuated mumps virus vaccine given as a single dose can prevent the disease in children over the age of 1 year, below which age the vaccine is not recommended as it may be inhibited by maternally acquired antibodies. The vaccine is not to be given to immunosuppressed individuals or to those with severe febrile illness and also during pregnancy.

Treatment- Homoepathy plays a vital role in the treatment of mumps. Isolation of the patient and proper maintenance of oral hygiene are the first things to be borne in mind. Of the medicines, Bell ( Belladonna) 200 and Rhus.tox (Rhus Toxicodendron) 200 are to be taken alternatively at an interval of three hours between the two medicines three times daily. This should be continued for one week. Then at least for the next two weeks, both the two medicines should be continued two times daily with the gap between them increasing to not less than four hours. If there is associated throat pain, Phytolacca 200 should be added along with four times daily till the pain persists. If temperature is present, Ferrum.Phos 6x should also be given three times daily along with the main medicines.

Labels-Anorexia, Fever, Headache, Immunization, Virus, Ferrum.Phos, Bell ( Belladonna), Reverse transcription polymerase chain reaction (RT- PCR) Test, Attenuated, Isolation, Rhus.tox (Rhus Toxicodendron), Medicine, Swelling, Temperature, Serologic test, IgM, IgG, Acute, Convalescent, Antibody, Arthritis, Oophoritis, Nephritis, Pancreatitis, Thyroiditis, Myocarditis.

IN SHORT-Mumps is an acute, highly infectious viral disease of childhood which begins with non-specific symptoms like fever, malaise, headache & anorexia and is soon followed by severe pain over the parotid gland with its swelling. The parotitis is non-suppurative and usually resolves within a week. The disease may be associated with several complications the most important of which is orchitis. Prevention is done with active immunization with a live attenuated mumps virus vaccine. Treatment is as mentioned above.

But in every case a doctor should be consulted।