From:

Dr.Fatimabi.Singoti

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 – 580001.

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 forRegistration 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:

“TO STUDY UTILITYOF ESSENTIAL SYNTHESIS

REPERTORY INTHE MANANGEMENTOF PHARYNGITIS”

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

Thanking you,

Yours faithfully,

Place: Dharwad.

Date: (Dr.FATIMABI SINGOTI)

“TO STUDY UTILITY OF ESSENTIAL SYNTHESIS

REPERTORY IN THE MANANGEMENT OF PHARYNGITIS”

SYNOPSIS

Submitted to

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE.

BY

Dr.FATIMABI SINGOTI

Through

DBHPS’S

DR. B.D. JATTI HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL &

P.G. RESEARCH CENTRE, D.C. COMPOUND, DHARWAD – 580001 (KARNATAKA).

In partial fulfillment of requirement for the

DOCTOR OF MEDICINE (HOMOEOPATHY) in

HOMOEOPATHIC REPERTORY

Under theguidance of

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

Professor

Dept.of Homoeopathic Repertory.

DR. B.D. JATTI HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL & P.G. RESEARCH CENTRE, D.C. COMPOUND, DHARWAD – 580001 (KARNATAKA).

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

Annexure-II

REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF CANDIDATE & ADDRESS / Dr.Fatimabi Singoti
Post Graduate Student,
Post. Graduate Dept of Homoeopathic Repertory.
DR. B. D. Jatti Homoeopathic Medical College, Hospital& P.G. Research Centre,
Dharwad– 580001.
PERMANENT ADDRESS / Dr. FATIMABI SINGOTI
D/o Gousemohiyuddin.A.Shingoti,
Bhandiwaid base, C.B.T,
Near Kabadi hospital,
Hubli (karnataka),
Pincode: 580020.
2. / NAME OF THE
INSTITUTION. / D.B.H.P.Sabha’s
DR. B. D. Jatti Homoeopathic Medical College, Hospital & P.G. Research Centre,
D.C. Compound,
Dharwad– 580001.
3. / COURSE OF STUDY AND SUBJECT. / M.D. (Homoeopathy) in Homoeopathic Repertory.
4. / DATE OF ADMISSION TO COURSE. / 17-11-2012.
5. / TITLE OF THE TOPIC. / “TO STUDY UTILITY OFESSENTIAL SYNTHESISREPERTORY IN THE MANAGEMENT OF PHARNGITIS”
6. / BRIEF RESUME OF THE INTENDED WORK
6.1 / NEED FOR STUDY:
Inflammation of mucous membrane and lymphoid tissues of the pharynx, usually as a result of infection. It is the commonest disease of the throat,among all age groups commonly seen in children below the age group of 3 yrs. Poor oral hygiene is the important predisposing factor for pharyngitis
Pharyngitis account for 10% of all office visit to primary care cliniciansand 50% of out-patient antibiotic use
Pharyngitis is important to recognize and treat early, because of its potential to develop or result in post streptococcal glomerulonephritis and acute rheumatic fever as its complications.
  • In conventional system of medicine, sometimes has side effects and causes intolerance to sensitive individuals and there is more chances of recurrence. These conventional drugs try to inhibit and suppress symptoms sometimes leading to even more serious symptoms. Conventional physicians do not usually recognize the new series of symptoms as being related to the old. Thus, they treat them as new and unrelated problems.
  • Homoeopathy has history of treating pharyngitis that is Safe, effective, gentle and cost effective. The remedy that best matches the symptoms of large subjects will afford good results.
  • A healthy life style and constitutional treatment with homoeopathy will lower prevalence of pharyngitis. Thus homoeopathic remedy prescribed on the basis of disposition, trait and characteristic particulars will confront the pharyngitis successfully as it is said to be having much efficacy in treating pharyngitis because of its holistic approach and concept of individualization and it also reduces the complications of pharyngitis
  • Since pharyngitis presents with lot of clinical symptom with various constitution, the essential synthesis repertory is taken which is complete in all respect.
  • So here is a sincere effort to study the utility of Essential Synthesis Repertory in the Management of Pharyngitis.
RESEARCH HYPOTHESIS:
Homoeopathy has treatment in pharyngitis.
6.2 / REVIEW OF LITERATURE:
1.Inflammation of the pharynx is one of the commonest diseases of the throat, not only in child-life but among adults as well1.
2.Pharyngitis and tonsillitis account for 10% of all office visits to primary care clinicians and 50% of outpatient antibiotic use2.
3.PEAK INCIDENCE: Late winter/ early spring (group A streptococcal infections)3.
4. It may occur as a primary infection of the pharynx itself or may secondarily occur as a result of the upper respiratory tract usually following viral infection. Common causative bacteria include haemolytic streptococcus, unhygienic conditions and overcrowding promote quick transmission of infection. Poor orodental hygiene,poor nutrition and congested surroundings are important predisposing factors for the disease4.
5.There are 2 main types of pharyngitis:acute and chronic.Acute pharyngitis can either be non-specific pharyngitis and specific infection e.g.: Diphtheria.Chronic pharyngitis can be further classified in to non-specific infections and specific infection e.g.: Tubercular pharyngitis and syphilitic pharyngitis5.
6.Acute pharyngitis more frequently occurring primarily during winter) months and less often in autumn months and spring6.
7.The symptoms vary with severity of infection. The predominant symptoms are :
  • Sore throat
  • Difficulty in swallowing.The child may refuse to eat anything due to local pain.
  • Fever.It may vary from 380c to 400c.Throat feels dry, raw, hoarseness, uncomfortable/pain on swallowing. On examination reveals throat obvious redness. Cervical nodes are enlarged, palpable and tender. In children mouth should be examined for koplik’s spots is the precursor of measles.
  • Constitutional symptoms. They are usually more marked than seen in simple pharyngitis and may include headache,general body acheand malaise7.
8.SIGNS
The Pharynxbecomes congested and swollen.
Secretions increase and become tenacious.
Movements of the Palate become impeded due to pain.
Halitosis:Foul breath may be present8.
9.Chronic pharyngitis usually results from repeated attacks of acute pharyngitis in which the pharynx become progressively damaged and provides a reservoir for infective organisms9.
10.Peritonsillar abscess or quinsy is the most common complication of acute pharyngitis; retropharyngeal abscess may also occur. Infection with beta haemolytic streptococcus may result in the sequel of scarlet fever, rheumatic fever or glomerulonephritis10.
11.To prevent rheumatic fever and glomerular nephritis, sore throat, pharyngitis and tonsillitis orthodox (modern) physician use Penicillin and other antibiotics. Long term use of penicillin may causes S.L.E and immune-suppression so there is a debate when to use antibiotics and how much to use, as described in the paper.
“The most appropriate management continues to be debated because some of the issue is deceptively complex, but consensus has increased in recent year the main concern is determining who is likely to have a group A beta-haemolytic streptococcal infection (GABHS), as this can lead to subsequent complication such as rheumatic fever and glomerular nephritis. A second public health policy concern is reducing the extraordinary cost (both in dollars and in the development antibiotics –resistant S pneumonia) in the United State associated with unnecessary antibiotics use. Questions now being asked: Is there still role of culturing a sore throat, or have rapid antigen tests supplanted this procedure under most circumstances? Are clinical criteria alone a sufficient basis for decisions about which patient should be given antibiotics? Should any receive any antibiotics other than penicillin (or erythromycin if penicillin-allergic)? For how long should treatment be continued? Numerous well-done studies in the past few years as well as increasing experience with rapid laboratory tests for detection of streptococci (eliminating the delay caused by culturing) appear to make a consensus approach more possible. So Homoeopathic treatment not only reduces acute phase.
Of pharyngitis but also prevent further sequel of pharyngitis.”2
12.A throat swab for culture and sensitivity is a useful test11.
13.Prevention:-
  • Wash your hands frequently.
  • Avoid sharing cups and eating utensils with anyone who had a sore throat, cold, flu, or bacterial infection.
  • Vitamin c supplement: study shows that vitamin c improves components of the human immune system such as antimicrobial and natural killer cell activity.
  • Zinc supplement: zinc is thought by many nutrients to be most important mineral supplement because its commonly deficient in diet. The mineral is essential to lymphocyte activity it may directly involved in antibody production to help you fight infection.
  • Don’t smoke and avoid exposure to second hand smoke12.
HOMOEOPATHIC APPROACH:
14.RICHARD HUGHES sayschronic pharyngitis- the follicular or granular angina of professional, the “clergyman’s sore throat” of popular nomenclature. Some preparation of mercurius has generally been relied upon in homoeopathic practice for the treatment of this affection. Cinnabar has cured it; but since Dr.G.W.Cook, in America and Dr. Black, in England, published their experiences with the iodide, mercury has mostly been given in this form, as you may see from, a discussion on the subject at the British homoeopathic society, initiated by Dr. Edward Blake. The lower triturations seem most in favours. You will see that antimoniumtartaricum and kalibichromicum also are commended. While with medicines such as these you are exerting an alternative effect upon the morbid mucous membrane of the throat, you may do good deal with intercurrent remedies to relieve the subjective symptoms which are nearly always present. Lachesis is the chief of these, as I have mentioned when speaking of it. Another is capsicum, which is very useful when the throat is red and hot, and much dry cough is present.
Where a chronic sore throat is obviously the expression of an unhealthy state of the general system (gouty, haemorrhoidal, or herpetic),sulphur is its best remedy; and belladonna may be given with advantage intercurrently, as recommended by Dr. Jousset. There are also other medicines which occasionally find place in the treatment of chronic morbid condition of the faucial mucous membrane, among which I may mention acidum oxalicum, aesculus, alumina, arum, and ignatia. The indication for each are those mentioned in my ‘Pharmacodynamics’’. Alumina should be especially useful in the “rarefying dry catarrh” described by Wendt.Dr Dyce brown, in the article on “follicular pharyngitis” in the Monthly Homoeopathic Review of 1877,give indication and recommendation regarding aesculas,hepar sulphur, lachesis and kali bichromicum; and in the same number of the journal, Dr. Clifton relates a series of recent cases occurring within a few days of one another, in which the first-named medicines proved the specific remedy. Schussler’s calcarea florata seems to be remedial where plugs of mucus are contionally forming in the tonsillar mucous glands 13.
15.W.A.DEWEY says Mercurius:The preparations of mercury are all great sore throat remedies.
Mercurius corrosives, mercurius protoiodide, mercurius bin iodide, phytolacca, kali-muriaticum, kali-bichromicum, guaiacum, pulsatilla, hepar sulphur, nitric acid14.
16.Samuel Lilienthalrecommends some of the following remedies:
For simple uncomplicated inflammation give: Acon.,Bell,Canth., Lach., Merc.
Inflammation , with spasmodicconstriction of fauces:
  1. Bell., Hyosc., Lach., Stram., Veratr;
Or
  1. Alum., Ars., Cic., Cocc., Ign., Laur., Lyc., Merc., Nux v., Op15.
17.Rubrics of pharyngitis as found in Essential Synthesis Repertory
  • -Pharynx (=pharyngitis): acon aesc allox Alum am-c ant-t ars ars-I arum-d arum-m bapt bar-c bart-m bell brom bry calc canth caps carb-ac cinnm cortico crot-h dros dub dubo-m dys ferr-p guja hed Hep hepat influ kali-bi kali-c Lac-c lach luf –op lyss mangi med mentho Merc mer-c morg-p nat-m nit-ac nux-v oxyte-chl parat-b parathyr phos Phyt polyg-h prot psor rhus-t sabad salv sangin-n Sil sin-n sulph syph tub Wye
  • Right: bar-c Bell guaj lyc mag-p merc-i-f nicc Phyt podo sang Sulph
  • Extending to left :lyc
  • Left: brom crot-h lach mer-i-r sabad
  • Extending to right:lach-c lach sabad
  • Afternoon:lach
  • Acute:Acon Aesc apis arg-n arum-t Bell bry canth Caps caust cis eucal ferr-p Gels glyc guaj gymno Hep iod Just kali-bi kali-c kali-m lach lachn led
  • Acute: Mentho Mer mer-c merc-i-f mer-i-r naja nat-ar nat-I nux-v Phyt quill sal-ac sang sangin-n Sil squil syph wye
Atrophic:sabal
  • Bed agg: in Mer mer-i-f
  • Chronic:aesc alum am-br Am-caust arg-I Arg-met arg-n ars arum-t aur bar-cbar-m brom Cal cal-p calc-sil cann-I carb-v caust cinnb cist Coc-c cub ferr-p Fl-ac graph Hep Hydr Iod Kali-bi kali-c kali-chl kali-I Lac-c lach Lyc med Merc merc-c mer-i-f naja Nat-c Nat-m Nux-v ox-ac pen Petr phos Phyt puls Rumx sabad sabal sang sec seneg sep Sil stann sulph sumb tab toxo-g Wye
  • Cold:
Agg:cist fl-ac hep lyc
Air:
Agg:Sabad
Inspiration | amel: Samg
Drinks | Amel: Apis
  • Follicular: Wye
  • Acute: Aesc apis vell caps Ferr-p iod kali-bikali-m mrc phyt sangin-n wye
  • Chronic: Aesc Alum am-br arg-n arn ars-I arum-t calc-f calc-p caust cinnb cist dros Hep Hydr ign kali-bi kali- m lach nerc-cy merc-i-I nat-m nux-v phos phyt sangin-n stict still sulph wye
  • Gangrenous: Caps16.

6.3 / AIMS AND OBJECTIVES OF THE STUDY
1.To study the clinical presentation of pharyngitis.
2.To study frequently used group of remedies in the management of pharyngitis.
3.To study the utility ofessential synthesis repertory in the management of pharyngitis.
7. / MATERIALS AND METHODS:
7.1
7.2
7.4 / PRIMARY SOURCE:
The subject for this study will be collected from OPD/ Peripheral OPD / IPD of DR. B.D. Jatti Homoeopathic Medical College, Hospital and Post Graduate Research Centre, Dharwad.
METHOD OF COLLECTION OF DATA (Including sampling procedures, if any,)
Definition of study subject : Patients are considered on the basis of clinical presentations .i.e., sore throat, difficulty in swallowing, fever and constitutional symptoms like headache, general body ache etc. and with physical and mental generals.
Following are the inclusion criteria :
1. Subjects of all age group, of both sexes, and all ethnic groups.
2. Subjects clinically diagnosed to be having uncomplicated pharyngitis.
Following are the exclusion criteria :
1. Subjects with complications of pharyngitis are excluded
2. Subjects with pharyngitis associated with othersystemic diseases which are on active treatment.
STUDY SAMPLING DESIGN :
Sampling method :
Simple Random Sampling Method.
Sampling size :
Prevalence rate of pharyngitis 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 and peripheral camp during the study period will be considered for the study.
Study design :
It is the prospective single blind controlled study.
Simple random method of selection of cases. The cases are selected according to inclusion and exclusion criteria’s.
Follow up :
Follow up of the cases would depend on severity of the symptom, and as per the need and necessity of the case, preferably for seven days to visit once after 3 days, then once in week for One Month and later on once in 15 days.
Improvement Parameters used are :
Change in clinical findings like the presenting symptoms, signs, change in investigation are parameter for accessing following criteria.
Marked improvement: Patients having relief of his / her sign and symptoms up to 70% to 100%.
Moderate improvement: Patients having relief of his / her sign and symptoms up to 50% to 69%.
Mild improvement: Patients having relief of his / her sign and symptoms up to 10% to 49%.
Status quo: Patient is not improved at all or having below 09% improvement of her sign and symptoms.
Aggravation: Patient is aggravated with old and new symptoms appear.
Drop outs : The patients did not come for second visit for follow up of case.
Study period : From 1st May 2013 to 30th April 2015
Research and Statistical procedure : The study will be represented with research hypothesis, null hypothesis, alternative hypothesis, method of repertorisation, concept of totality, control group data, experimental group data, appropriate tables, histograms, diagrams of percentage and statistical significance test.
Research Hypothesis: To determine the effectiveness of The Essential Synthesis Repertory in the management of pharyngitis.
Null hypothesis:There is no difference between Control group and Experimental group i.e. μ1 = μ2.In the study the intention is to reject the null hypothesis to validate that Homoeopathic medicine is efficacious in treatment of pharyngitis.
Alternative hypothesis:There is a difference between Control group and Experimental group i.e. μ1 ≠ μ2. In the study the intention is to accept the alternative hypothesis to validate that Homoeopathic medicine is efficacious in treatment of pharyngitis.
The null hypothesis is to be rejected by Chi square test.
The alternative hypothesis is to be accepted by Chi square test.
Control group: Minimum 16 patients of mild pharyngitis would be kept in Control group. The control group patients would be given warm saline gurgle and placebo (4 sugar pills). For 7 days
Then the patients not relieved by warm saline gurgle and placebo, would be treated with homoeopathic medicines and kept in Experimental group.
Experimental group: 16 patients and above it are kept in Experimental group which are given medicine by totality of symptoms through repertorisation.
Method of Repertorisation : Scientific method of repertorisation (Total addition method of repertorisation)
Selection of Repertory: Since pharyngitis presents with lot of clinical symptom with various subjective and objective symptoms, physical and mental generals, the essential synthesis repertory is taken which is complete in all respect.
Concept of totality :
Since Essential Synthesis is higher version of Kent’s repertory, the Kentian concept of totality is applied for synthesis of case to get conceptual image and repertorial totality.
Statistical significance test: Chi square test wouldbe done to validate its significance as its data is qualitative (non – parametric).
DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS? IF SO DESCRIBE BRIEFLY.