HOMOEOPATHIC MEDICINES AS ADJUVANT THERAPY IN THE MANAGEMENT OF BLEEDING EPISODES AND PAIN IN HEMOPHILICS

HOMOEOPATHIC MEDICINES AS ADJUVANT THERAPY IN THE MANAGEMENT OF BLEEDING EPISODES AND PAIN IN HEMOPHILICS

Tapas Kundu, Afroz Shaikh, Afzal Kutty ,Aparna Nalavade ,Sudhir Kulkarni,

Ranjana Kulkarni, Kanjaksha Ghosh1.

Haemophilia Care Centre: Nashik Chapter, Niramay Nursing Home, Adwait Colony ,

Canada Corner, Saharanpur Road, Nashik -422-005. India.& 1president , haemophilia federation of India, New Delhi. India.

Key words: Haemophilia, Pain relief, Haemarthrosis, Developing country, Thrombostat, Genetic Constitutional Similimum, Adjuvant therapy.

Background:

Hemophilia is an X-linked genetic disorder where the mechanism of coagulation is defective.90% of severe hemophiliacs live in developing countries, where appropriate health care resources are severely limited. Conventionally, these patients are treated with required factor infusion and later on by physiotherapy. Now factor infusion being very costly, a majority of patients cannot afford it even when it is required. In such a scenario, prophylactic factor infusion in country like India with huge number of needy patients, is indeed a very difficult task as compared to the developed nation where factor infusion are given on a regular basis from birth as a prophylactic measure. Moreover pain relief in these patients is also suboptimal as except paracetamol other analgesics which can be given to these patients safely are not easily available in India.

Hence the present study was conducted on efficacy of Homoeopathic medicines in the management of bleeding episodes of hemophiliacs in a double blind placebo controlled trial.

Materials and Methods:

53 consecutive patients with hemophilia (A&B) received standard management as is given in this centre along with placebo homoeopathic medicines for 1 year. Thereafter they received the same management with active homoeopathic drugs in subsequent year. Transfusion requirement, bleeding scores and pain score were evaluated by blind evaluators.

Homoeopathic medicines were selected by experienced homoeopathic physicians by using a combination of constitutional therapy & acutely acting polychrest medicines depending on clinical condition of the patients. Standard statistical evaluations were used to evaluate the difference in scores with and without active homeopathic medicines under following criteria:

1) Frequency of (open &closed) bleeding.

2) Duration of healing.

3) Factor requirement.

4) Pain Score ratings

Result:

Addition of properly selected homoeopathic medicines by homoeopathic physicians not only improved the subjective well being of hemophilic patients during the therapy, there were also significant and noticeable improvement in the frequency of (open & closed) bleeding episodes, duration &extent of bleeding, amount of blood product consumed and in pain scores (p< 0.0001).

Correspondence: Prof. (Dr) Tapas Kumar Kundu B.H.M.S (Cal), P.G.D.P.C., M.S.(IBMS)

Professor and Head of Medicine Motiwala Homoeopathic Medical College and Hospital, Nashik Email: dr_kundu2002@yahoo.co.in

Conclusion:

Well selected homoeopathic medicines by homoeopathic physicians proved to be efficient in managing the bleeding episodes of hemophiliacs there by improving their quality of life at home, workplace & school. Similarly it was found that the subsequent reduction in factor infusion not only lessened the economic burden on the family but also reduced anxiety on the part of the patients and the society as well.

INTRODUCTION:

Hemophilia is an X- linked genetic disorder where the mechanism of coagulation is defective, especially related to factor VIII or IX. A hemophilic patient does not bleed more intensely than a normal person but for a longer period of time, there by wasting a lot of precious blood. The amount of blood loss during each episode depends on site affected or injured, duration of bleeding and frequency of bleeding episode. It become more disastrous when the bleeding is concealed i.e. bleeding joint spaces (haemarthrosis) & bleeding in body cavities (intracranial (1) & intracoelomic) . Conventionally these patients are treated by required factor infusion, which being very costly, a majority of patient cannot afford it even when needed. The factor concentrate are very costly mainly because they are imported and have deficient supply in almost all chapters of India (2) as in West Bengal(3).

It was estimated in a survey that, for the easy availability of factor to PWH in India, the country has to be self sufficient with 100 million units of factor VIII concentrates & 200 million units of factor IX concentrates which is a formidable task at the moment.(4)

So in present scenario, factor infusion on a prophylactic measure to the PWH is certainly very difficult & even when they are sparingly infused they have chances of developing factor inhibitor(5), which is one of the major problem faced by developed nations. Likewise the risks of transmission modalities like Hepatitis B &C and HIV increases fore fold with the frequent use of blood products adding further more misery to the patients.

To sum up, in order to facilitate the needs of hemophiliacs, it is important to exploit the scope of alternative medicine like Homoeopathic medicines. They are not only cost effective but also serve as effective supportive therapy for the betterment of hemophiliacs.

MATERIALS AND METHODS:

53 Consecutive patients with hemophilia A& B received standard management as is given in this center along with placebo homoeopathic medicines for 1 year, thereafter, they received the same management with active homoeopathic medicines in subsequent years.

Patients were diagnosed as Hemophilia and the severity was classified with factor assay from National Institute of Immunohaematology at KEM Hospital, Mumbai. Relevant consent from the patients and their parents for the trial was taken & the study was sanctioned by Institutional review board.

The patients were interviewed according to the homoeopathic principle of case taking and the data was entered in a specific case record format (6). After formative analysis and evaluation, the indicated medicine was prescribed by experienced homoeopathic physician

(6, 7)The action of the medicines has been analytically observed as per Dr. Kents observation

All the patients kept a diary noting the number of bleed, amount of factor concentrate/blood product consumed, treatment taken for pain relief, days of absence from school/workplace, daily activities, behavioral changes during pain etc. They were regularly given physiotherapy by AN.

These Patients were periodically evaluated at an interval of 3 months under following criteria:

1. Wong Baker pain rating scale (8).

2. Frequency of bleeding and control measures.

3. Joint mobility and functioning were blindly evaluated by AN and SK.

Treatment Plan:

In case of acute bleeding / swelling -RICE therapy is given i.e. Rest, Ice, Compression and Elevation along with Homoeopathic thrombostatic drug i.e. Hamamelis Virginica Q which is used along with ice to give cold fomentation at the affected site. When a larger area is injured we add 50 drops of Hamamelis Q in 200 ml of icy cold water and apply locally. We have observed that Hamamelis Virginica, due to its astringent effect causes tightening up of protein in the skin and across the surface of abrasion. This creates protective covering that increases resistance to inflammation and promotes healing of broken skin. Unlike Hamamelis Virginica, Arnica Montana has property of reabsorption of blood from the injured tissues which breaks the clot and resumes the bleeding (9, 10, 11) that is why Arnica seems to be contraindicated in active bleeding phage.

Acutely acting drugs for pain and swelling along with RICE therapy are orally administered considering acute totality criteria like nature of injury, sensation, modalities(12), sides affected and only when the indicated medicine have no antagonist relation with constitutional medicine as per Gipson Miller remedy relationship chart(13).

Genetic constitutional similimum (14) is administered during non- bleeding phase. The selection depends on his basic disposition, constitution, temperament any dominant behavior of the patient, upbringing of the child and any other important incidence in life, its impact on the patient and feeling developed in response to it.

RESULTS:

There was substantial reduction of frequency of bleeds during active homeopathic therapy ie from 7.25 +/- 7.15 to 0.75 +/- 1.08( m+/-1sd) p +++ no bodyache, no fever or chest pain

.

Same patient came up with following complaints

15-12-2010 = Dry Cough has to wake up at night due to sudden spasmodic cough.

Again suffering increased; fever, Thirstless, weakness, exhausted,

Dullness and desire to do nothing, feels sleepy

16-12-2010 Nose Yesterday sticky yellow discharge today dryness ++,

dry spasmodic cough < 4.30 AM ; Headache +++ fells as if to give hard

pressure, said sister to stand on forehead , Thirstless +++ feeling

weakness , Fever 102 f

Prescription: Drosera 200 tds x 2 days

17-12-2010 Cough intensity reduced thirst improved and rest of all features

disappeared.

18-12-2010 Prescription: Thuja 200 one dose followed by constitutional coming

morning. Which brought on recovery till date.

CONCLUSION

With this two episodes of Acute Bronchitis in a case where patient presented with unique and same totality. She got relived with Drosera.

Uniqueness is observed in terms of cough-spasmodic, Headache/Bodyache, Thirstlessness

After going through literature Drosera when observed it has the same intensity and type of cough ,Bodyache but the thirst which has strong accompaniment in both the episode and was get relieved after Drosera.

Now the case records of Drosera as a remedy with the thirst pecularity needs to be looked so as to raise Drosera as a THIRSTLESS drug.

Sourse book Drosera Thirst talks about Febrile shivers over whole body and heat of the face and icy coldness of hands without thirst.

Repertory- Thirsty-2 marks and Thirst intense

An Observation on Aphorisms 215 and 216 of Organon of Medicine Edition 6

Dr Madhuram Kamlam (Dept of Organon and Homoeopathic Philosophy)

A Few Weeks back, an army officer doing a course, committed suicide. He was talking with some of his friends. Around 11.00 p.m. he received a telephone call and he excused himself and went to his room. Next morning he was found hanging from the ceiling fan.

My husband and I sat discussing this incident. That night this officer had been talking very cheerfully with his friends. He was actually writing an appreciation of the Tactics leg of the course that he was doing. He was doing well in his course. So it probably could not have been the pressure of having to perform in his course. In the army whatever other pressures it does put on its officers, the officers are really relaxed while doing the courses. The happiest and most relaxed tenures of all officers in the army are generally while they are doing one or the other of the courses.

With the recent suicide by hanging from the ceiling fan which has made IIT-K from taking a decision to remove ceiling fans from all the hostel rooms at the back of our mind, we were joking whether it was high time for the army too to resort to pedestal fans and ACs.

Then we came to the point of the telephone call that this officer received. And my husband confirmed my suspicion the phone call was from his fiance. And my first reaction was to ask him if this girl had broken off their engagement. My husband did not know the details of that side of the story. But he said that this officer had been engaged for some months now to this girl. He had also invited his father-in-law-to-be to one of the weekly social gatherings at the officers institute and introduced him to his brother officers. We did not have anymore information about this officer.

The reason for the suicide seemed mysterious. Our conversation went on to other topics and my husband then remembered and casually remarked that this officer had in fact recently suffered from bone-marrow cancer and had gone to the US where he was successfully treated for the same.

To me it was a bolt from the blue everything was very clear now, the cause of the suicide was no longer a mystery to me. If we have read Hahnemanns Organon - we have the reason for the suicide.

215, 216, Organon of Medicine, 6th Edition

Hahnemann says:

1. almost all so-called mental and emotional diseases

2. are nothing but corporeal diseases

3. in these corporeal diseases the derangement of the mind and disposition peculiar to each of them is increased,

4. whilst the corporeal symptoms decline (more or less rapidly)

5. till soon the disease attains the most striking one-sidedness

6. It is almost as if it was a local disease in the invisible subtle organ of the mind or disposition

7. cases are not rare in which

8. so called corporeal diseases that threaten to be fatal

a suppuration of the lungs

or deterioratation of some other important viscus

some other disease of acute character, e.g. in childbed

9. become transformed into insanity, into a kind of melancholia or into mania

10. by a rapid increase of psychical symptoms that were previously present

11. whereupon the corporeal symptoms lose all their danger

12. the corporeal symptoms improve almost to perfect health

or rather they decrease to such a degree that their obscured presence can only be detected by the observation of a physician gifted with perseverance and penetration

13. The affections of the grosser corporeal organs become, as it were transferred and conducted to the almost spiritual mental and emotional organs

14. which the anatomist has never yet and never will reach with his scalpel.

Now I became agitated. Why is our modern system of medicine so one-sided??? Why do they believe in only material proof? If they cannot find a single cancerous cell, how do they assume that they have cured the person of his disease? Are the pathological end-products the only basis of disease?

Why cannot the modern day doctors see the truth in the simple observations that Hahnemann made 200 years back?

Footnote 2, to 6, Organon of Medicine, 6th edition

I know not, therefore, how it was possible for physicians at the sick-bed to allow themselves to suppose that, without most carefully attending to the symptoms and being guided by them in the treatment, they ought to seek and could discover, only in the hidden and unknown interior, what there was to be cured in the disease, arrogantly and ludicruously pretending that they could, without paying much attention to the symptoms, discover the alteration that had occurred in the invisible interior, and set it to rights with (unknown!) medicines, and that such a procedure as this could alone be called radical and rational treatment. (the bold and italics are mine)

I believe that in the above case of the army officer the fundamental cause for the suicide was psora and the proximate exciting cause could probably(I say probable because I do not know what that last conversation was about) have been the last conversation that the officer had or something else.

Can We accuse the doctors who treated him for cancer of negligence for saying that he has been cured when the disease had only changed its location? Or for having driven the disease from the corporeal plane to the mental plane?? Are these doctors also a link in the chain of causes for this officers suicide???

RESEARCH PRIORIZATION

- Rinky Nishad

- Seema Chaure

INTERNS (2010-2011)

WHY IT SHOULD BE DONE?

RESEARCH prioritization is a dynamic process.

Research priorities need to be established because research planning also confronts a scarcity of human and financial resources.

Another reason is that determinants and pattern of diseases or conditions and their effect on the population at large are constantly changing. This leads to inequality in the health status of the people.

The final aim of research prioritization is how best well balanced research can support and complement the health system to achieve the national goals for health.

CRITERIA FOR SELECTION OF PRIORITY AREAS :-

1) The research area should relate to a priority health problem in the countries.

2) The problem should be of major importance in terms of relationship to the socio-economic development of the countries.

3) Impactthe extent of the burden disability, mortality, and economic costsimposed by a condition, including effects on patients, families, communities, and societies.

4) The problem should have a demonstrable potential for solution, and there should be strong probability of the solutions being applied within a reasonable time and at reasonable cost.

5) The solution or clarification of the problem would lead to the development or improvement of a broad national health programme destined ultimately to strengthen national and/or international health development involving large number of people.

6) The research would lead to the development of new scientific knowledge and/or adaptation in various national contexts.

7) The problem would require regional collaborative efforts for its solution, e.g.

(a) Variations in the frequency and distribution of a disease in different geographic areas.

(b) Differences in ecological settings that influence manifestations of a

Disease and response to health interventions, and

(c) the opportunity it would provide to pool together the resources of the

Countries of the region in studying common problems.

8)The issue to be addressed have a significant impact on the current and future health status of the people with respect to mortality, morbidity, quality of life, cost of health service.

Teaching Learning Methods in Medical Profession

Dr. S. M. Yadav

Prof. Dept. of Surgery & Homeopathic Therapeutics

The variety of teaching and learning methods which is used within a course is an important

ingredient in creating a course with interest to students. A course with a large proportion of

its teaching taking place in lectures will need to have a high level of intrinsic interest to students

to keep them engaged. Over the past few years, a wide range of different teaching and learning

methods have been introduced and tested, often with the aim of developing skills which more

didactic methods are poorly adapted to do.

Definition: Teaching/Learning media are the means of communicating educational information. It has been observed that retention to memory is approximately:

20% of what is only heard

40% of what is only seen and

70% of what is seen and heard

Due to the limitations of oral communication, a variety of T/L media have developed to facilitate teaching and learning.

Classification: T/L media are classified as shown below:

1. Non projected visual aids

a. Chalkboard

b. Display boards, cards and charts

2. Projected Visual aids

a. Overhead projector

b. Slide projector

c. Episcope and micro projector

3. Audio aids

a. Public address system

b. Audio tape system

4. Written aids

5. Patients and real objects

6. Three-dimensional representation

a. Models

b. Simulators

7. Simulation and role play

8. Audio visual aids

a. Videotape system

b. Tape-slide system and cine films

c. Computer & CD systems.

9. Mass communication

a. Radio

b. Television

BRIEF OUTLINE ON VARIOUS TEACHING METHODS

1. LARGE GROUP TEACHING

(Learner group consisting of 30 or more persons)

1.1 LECTURE

This is a careful presentation of facts with organized thoughts and ideas by a qualified person (please refer to the hand-out- on Lecture-method).

1.2 SYMPOSIUM

a)Definition:

A symposium is a series of prepared speeches given by a few experts (2 to 5) or spokesmen on many aspects of a topic or a problem under a chair-person. The talk should be short and to the point (10 to 25 minutes). There is no discussion between speakers. The audience is passive except at question time towards the end.

d) Advantages:

i) Concise and logical presentation of (new) ideas.

ii) Fair analysis of different aspects of a controversial issue.

iii) Short speeches and change of speakers maintain interest and help keep the audience alert.

c)Disadvantages:

i) Formal atmosphere

ii) Passive audience

d)Scope as a T/L method:

When an expert overview of many aspects of a new subject or a controversial topic has to be conveyed to a large group, symposium is effective.

1.3 THE PANEL

a)A group of four or more persons under a moderator who have special knowledge of the topic sits at a table in front of an audience; they hold an orderly and logical conversation on an assigned topic. Each member makes an opening remark (for 3-5 minutes) before exchanging ideas.

b)Advantages:

i) Panel identifies and explores a problem or issue.

ii) Audience can understand various aspects of the problem or issue.

iii) Frequent change of speaker and viewpoint maintain attention and interest of the audience.

iv) Establishes informal contact with the audience.

c)Limitations:

i) The panelists may not cover all aspects of problem and may overemphasise only certain aspects of it.

ii) Skilled moderator is necessary to ensure logical and balanced coverage by the panel.

iii) Audience is passive (unless some question-time is permitted).

d) Scope as a T/L. method;

Essentially similar to symposium. When interaction between the experts is deemed desirable then panel method is preferred to symposium.

2.SMALL GROUP TEACHING

(Learner group consisting of less than 30 members)

2.1 GROUP DISCUSSION

a)Definition:

Group discussion may be defined as a face to face interaction between members of a relatively small group (usually 5 to 20 persons). The group interaction as a method and a structure but it can still be informal and democratic. To be more than just a random unstructured conversation, the group members should have a common concern regarding a problem to be solved, a decision to be made or a desire for information.

b)Advantages:

i) This a democratic and demands activity on the past of the part of the learner.

ii) Learner discovers his strength and weakness in comparison to fellow-learners and gains new insight.

iii) Provides opportunity for synthesis of varied T/L experiences and data (e.g., from lectures, laboratory clinical, bed side teaching and text-book reading).

c)Disadvantages:

i) Necessity of an optimum teacher-student ratio

ii) Poorly prepared or inexperienced group is ineffective in providing meaningful interactions.

iii) Since learner-aptitude varies widely, some may find the proceedings too fast or too slow.

iv) A subject may not be adequately covered to the satisfaction of the group especially it time is pre-fixed and short.

Despite all the these shortcomings, Bloom has opined that learning outcome from a badly conducted group discussion is still better than that from a good lecture.

d) Scope as a T/L method is very wide provided the basic conditions (refer definition) are met.

e) Improving effectiveness:

Group discussion can be improved if the group strives for it.

I) Group Leader (Instructor):

must prepare well enough to guide the flow of comments, to clarify various doubts, to bring out controversies and explore the topic from various angles.

Should know each member of the group. This knowledge of their personalities helps in following (and regulating, if needing) the group-dynamics.

Should plan for a suitable environment.

Should be experienced in leading group discussions.

II) Regulating the group:

if the students are not forthcoming, one of them could lead the group, a second student could be the recorder and the teacher could continue to the role of subject-expert (resource-person).

if discussion goes, astray, a student may be asked to summarise progress thus far. This helps group members to return back to the mainstream of discussion.

OTHER METHODS RELATED TO GROUP DISCUSSION

2.1.1 CONTROLLED DISCUSSION:

In this method, the general direction of discussion is strictly controlled by the teacher, i.e., it is not democratic like a group discussion.

Scope:

Normally used at the end of presentation to a class (large group), to help in revision of facts, understanding and feedback.

2.1.2. FREE GROUP DISCUSSION

Here, the teacher acts as an observer and the student group controls the topic and discussion.

Scope:

This method helps change in attitudes, feelings and human relations; improve observation, self awareness and willingness to receive and consider new ideas.

2.1.3. BUZZ-GROUP

Here, groups of 2-6 members discuss issues or problems for a brief period within a lesson.

Scope:

Encourages group cohesion and reticent students; active learning progress; break from monotony of a long lecture hence Buzz groups could be allowed within a lecture to help (1) consolidate memory, (2) learn new terminology by usage, and (3) gain arousal feedback.

2.1.4. BRAIN STORMING

This is an intensive group discussion where spontaneous ideas and slolutions to a problem are received, WITHOUT CRITICISM.

Scope:

Generates new ideas, helps problem-solving and decision making. Improves creative thinking.

a)Synetics is a special type of brain-storming where the group members are chosen from diverse fields to generate more ideas and help solve complex problems.

2.1.5. SYNDICATE

This method is a group activity where the class is divided into groups of about six members. They work on the same or related problems. Intermittent contact with teacher is allowed. A joint report is written in the end for the appraisal of the whole class.

Scope:

Develops sensitivity in human relations; improves self-awareness.

2.1.6. T-GROUP

This a therapeutic group technique where group members discuss their relationships and their problems in human-relationships.

Scope:

Develops sensitivity in human relations; improves self-awareness.

2.2 SEMINAR

a) Definition:

This consists of a group of persons engaged in advanced study of a subject (or research in related fields) meet under the general direction of an expert staff member. This form of group discussion leads to an in-depth study. Usually there is no audience.

b) Advantages:

In addition to all the advantages of group-discussion method of learning, the availability of an authority on the subject enables (1) in-depth discussion, and (2) authoritative guidance.

c)Disadvantages:

i) difficulty in getting a resource person.

ii) Members may not spend enough time for an in depth pre-seminar preparation.

iii) The authority, if dominant, may inhibit the participation by some members of the group.

d)Scope:

Whenever a suitable resource-person is available for the guidance of advanced learners (say, PG students, research scholars, etc.,) then seminar is an ideal method for an intensive in-depth learning of the subject.

2.3TUTORIAL

a)Definition:

Here, a small group of learners are guided by a teacher to help clear doubts, improve understanding and enhance knowledge of the subject.

b)Advantages:

i)Active learning situation.

ii)Ideal teacher-student ratio.

iii)opportunity to correct mistakes and to find out extent of learning are the advantages of this method.

c)Disadvantages:

i)Authority-dependant relationship is maintained

ii)Poor preparation make it less effective.

2.3.1.GROUP TUTORIAL

To reduce the formality of a tutorial, Group Tutorial could be organized. Here, the tutor confines to giving general directions but the conduct of discussion id left to yhe student group. This informal milieu may help thinking and understanding of the group members.

2.4DEMONSTRATION

a)Definiton:

This is a method where a teacher performs some operation to demonstrate a skill or a phenomenon while the students watch.

b)Advantages:

i)Observation of skills

ii)Knowledge of the principles and of the skills demonstrated.

2.5 PRACTICALS/BEDSIDE TEACHING/FIELD WORK:

Advantages:

i)Active learning process

ii)Limited group of learners

iii)Permi9ts evaluation of all three domains

iv)Bridges the gap between theoretical knowledge and practical reality.

v)Develops qualities of SCIENTIFIC THOUGHT (Observation, problem solving and decision making)

Disadvantage:

i)High personnel costs.

ii)Poor standardization

iii)Cases (Patient) may be put in difficult situation

2.6ROLE PLAY

Acting out a situation. It enables a group to sudy the behaviour of role-players, develops empathy and self-awareness; works off tension; creates attitudinal change.

Scope:

Role-play is effective in manipulating attitudes (affective domain).

2.7WORKSHOP

a)Definition:

A meeting during which experienced persons in responsible positions come together with experts to find solutions to problems that have cropped up in the course of their work.

b)Advantages:

Active involvement by each participant who works and learns from PRACTICAL(Hands-on) EXPERIENCE.

c)Disadvantages:

A lot of ground work and initial preparation is needed to make workshop effective and successful.

3. INDIVIDULA TEACHING/LEARNING

3.1READING

Reading is an effective method of self-learning of facts, which are not too difficuilt to grasp without guidance. It develops thinking and ability to seek out and acquire information.

3.2PROGRAMMED LEARNING

A method of self-learning using a programmed set of instructions (using a wowrk book, a mechanical or a microprocessor or device) to help the learner attain a specific level of performance.

a)Advantages:

i) Provides instructions in small steps.

ii) Provides instant feedback on learner responses, right or wrong.

iii) Provides instant feedback on learner responses, right or wrong.

b)Disadvantages:Enormous time and effort are needed to write out an effective and interesting programmed module.

3.3PROJECT

A significant practical unit of activity having educational value, aimed at one or more goals of understanding. It involves investigation of problems and formulation of solutions)

3.3 (a)INDIVIDUAL TASK is a minor version of a project; usually a problem to be worked out in a class but may be other activities performed individually.

Scope: Active learning; involves all learners; develops problem-solving ability.

3.4 (a)COUNSELLING is similar to conference except that students voluntarily consult the tutor regarding academic or personal difficulties.

3.5SIMULATION

A teaching method in which a real situation is simulated by various means (on paper, using models, using live, mechanical or computerized simulators). The learner plays an appropriate role to tackle the situation. E.g., Cardiac-pulmonary resuscitator, a physician solving a patient-management problem, etc. (Note; unlike role-play, there are usually no observers in simulation.).

Scope:

Simulation has a very varied scope depending on how it is put to use. It can develop psycho-motor skills, problem solving ability or bring about attitudinal change and self-awareness.

CONCLUSION

A perusal of various teaching methods and their scope makes it clear that there is no single-ideal method for medical education. An effective teacher has to combine various methods to achieve the educational objectives in an optimum way.

Approach Towards Jaundice

Dr Bhalerao Sachin .( Department of Medicine )

Introduction :-

Accumulation of bilirubin in blood stream causes yellowish pigmentation of Plasma , leading to discoloration of heavily perfused tissues

Serum Bilirubin level accumulates , when its production from Haem Exceed its metabolism & Exceretion

Imbalance between production & Clearance may result either from increased bilirubin pressure into blood stream .

Clinically Hyperbilirubinemia appears as jaundice or icterus, yellow pigmentation of Skin & Sclera

Jaundice can usually be detected when serum blilirubin level exceed 2-2.5mg/dl ( 34-44micromol /litre)

Jaundice is frequently obscured in a person of dark Skin

Scleral tissue is rich in elastin which has High affinity to serum Bilirubin so scleral icterus is usually more definite sign of Hyperbilirubinemia

Early sign of hyperbilirubinemia is Darkening of Urine

Step I etiological consideration of Jaundice

1. Once Jaundice is recognized clinically next step is to determined whether jaundice is due to Unconjugated or Conjugated hyperbilirubinemia

2. A simple approach is to determined whether bilirubin is present in urine

3. Its absence in urine suggest unconjugated hyperbilirubinemia

4. Its presence in urine suggests Conjugated hyperbilirubinemia

An appprach to classify jaundice based on this important distinction. Derangement of Bilirubin metabolism occur in any four mechanism

1. Over production

2. Decreased Hepatic Uptake

3. Decreased Hepatic Conjugation

4. Decreased Excreation of Bilirubin into Bile ( due to either , intra or Extrahepatic mechanism )

Step II :- Evaluation of Jaundice

1. present task in evaluation of jaundice is to consider whether Hyperbilirubinemia

Is due to haemolysis or Hepatobiliary disease this distinction easily accomplished by measuring direct & indirect bilirubin

2.

2. Predominantly unconjugated hyperbilirubinemia ( Indirect increased ) Indicates Haemolytic disorder

3.Jaundice with conjugated hyperbilirubinemia ( Direct increased ) result from three group of disease

a) Hepatocellular disease

b) Intra hepatic biliary obstruction ( Cholestasis )

c) Extrahepatic biliary obstruction .

Step III :- Carefull clinical evaluation

1. Histroy of determination of length of Symptom presence & characteristic of Abdomen pain .

2. Fever , Change in appetite , weight , Bowel Habit

3. History of Blood transfusion

4. History of Arthralgia suggest Acute Viral Hepatitis , History of travel.

5. Priritus is commonly associated with chronic Cholestasis

6. Acholic stool ( Lack or absence of Bile ) develops more common in patients with extrahepatic biliary obstruction ( Tumor/choleccholithiasis )

7. presence of Acholic & Heme positive stools ( Silver stool) suggest tumor of distal biliary tract such as Ampullary , periampulary or cholangiocarcinoma

8. pregnancy predisposes to cholestasis , steatosis , Acute liver failure .

9. Right heart failure result in hepatic congestion & cholestasis .

10. Physical examination finally associated with specific liver disease include , distended neck veins , Hepatojugular reflux , xanthoma ( primary biliary cirrhosis ) , Kayser fleischer ring ( Wilson disease)

Homoeopathic first aid kit

Dr. S.R.Patil

Prof. of AnatomyA homoeopathic first aid kit is a very useful item to have around the house, in the car on a vacation.

The information provided is for guidance in treating First Aid situations.

It is not intended to replace consultations with your doctor or your existing healthcare professional, or to replace diagnosis or treatment.

The following twelve homeopathic remedies will be useful to treat most first aid situations.

Aconite, Apis Melifica, Arnica, Belladonna, Cantharis, Chamomilla, Gelsemium, Graphites, Hypericum, Ledum, Nux Vomica, Rhus Tox.

Homoeopathic remedies are made in different potencies. The most common potencies that you can purchase are 6c, 12c and 30c. Once you have chosen a remedy, the next consideration is how often to take it.

For First Aid situations take one tablet every one to two hours for the first six doses (you can take fewer if the condition is relieved before this).

If the condition does not improve after six doses, continue with one tablet two or three times a day until the symptoms are relieved.

Once the condition is relieved, stop the treatment immediately.

Treatment

Mental & emotional aspects

Physical aspects

Modalities

Aconite

Aconite is useful for treating ailments that develop suddenly. This remedy is useful when any of the following are indicated:

Anxiety and great fear Feelings of doom and gloom, especially when accompanied by illness A strong fear of death, the dark and ghosts Agoraphobia and panic Any form of shock Worry and stress about the future Nightmares Panic attacks Vivid imagination Unhappiness Emotional and physical tension that drain energy from the mind and the body.

Headaches with a hot and heavy sensation Sore, gritty eyes Sore nose, throat or ear problem Tightness and pressure around the chest Coughs, colds and influenza Sleep problems Feelings of restlessness Palpitations Nervous twitching of the eye Sunburn, when Accompanied by shaking and fever.

Better: for fresh air and warmth. Worse: in the evening and at night.

Apis Mellifica

Apis Mellifica is an excellent remedy for treating burning and stinging pain that responds well to being treated with a cool remedy. It is useful for swollen and itchy skin, particularly following insect bites and stings. Useful when there is any sudden swelling or puffiness of the skin. It is a remedy to consider when any of the following are indicated:

Poor memory Feelings of jealousy Being hard to please Tearfulness Apathy and indifference Constantly complaining and hard to please Fear of death

Clumsiness Headaches with a stabbing and stinging pain Fever with a lack of thirst accompanied by skin that is sensitive to the touch Itchy, stinging skin All eye problems that sting and burn Arthritis when the pain is burning in sensation Cystitis and other unrinary tract infections that cause stinging on passing urine Insect bites and stings A constant but spasmodic cough

Better: cool water and a cool room;the application of cold compresses. Worse: for pressure and touch; heat.

Arnica

Arnica is a key remedy for all forms of muscular pain and bruising. It is also very useful applied topically to unbroken skin in a cream or ointment form or as a compress using the tincture. It is a useful remedy for the physical and emotional impact of childbirth. It is a remedy that is useful when any of the following are indicated:

All forms of shock Bereavement Agoraphobia Irritability Nervousness and oversensitivity Inability to focus on a task for long Forgetfulness and indifference

Accidents and falls Bruising Black eyes Sprains Swelling Sore muscles Backache and joint pain Hot, sensitive, aching headache Heavy tired eyes Concussion Nose bleeds Over-exertion Labour pains and childbirth Post-surgical convalescence Virtigo

Better: for lying down. Worse: for moving, cold, damp weather

Belladonna

This is an excellent remedy for acute complaints, particularly when accompanied by hot, throbbing sensations. It is a useful remedy when any of the following are indicated:

Sudden anger Sudden temper tantrums and a red face Stress Depression triggered by agitation Feelings of guilt

All pain where there is heat, burning, redness or throbbing Cold, coughs and influenza Sore Throats Earache, made worse by getting the head wet or cold Labour pains Cystitis Teething pain Boils Insomnia All infections that result in inflammation

Better: for sitting up. Worse: for noise and movement

Cantharis

Cantharis is an excellent remedy for the treatment of cystitis, especially when the condition worsens without warning. It is a useful remedy when any of the following are indicated:

Severe anxiety Screaming with rage Irritability and anger leading to rage and violence Addiction to sex

All conditions where there is stinging, burning, itching and pain Burns Insect stings and bites Burning, sore throat Sore, stinging eyes Sunburn and inflammation of the skin Diarrhoea with burning sensation Hot, aching sensation in the stomach Cystitis and all urinary tract infections, with pain when urinating

Better: for gentle rubbing. Worse: for touch and movement

Chamomilla

Chamomilla is a good remedy for the treatment of children or babies. Chamomilla will help the baby to calm down and sleep. It is a good bedtime remedy for a baby. Teething problem or colic may cause the baby to cry out and be restless. It is a remedy that is useful when any of the following are indicated:

Irritability and whining Bad temper and anger when unwell Impatience Oversensitivity, which can lead to short tempered behaviour towards loved ones Difficult to satisfy

All skin conditions, including eczema, inflamed skin, Earache, Toothache, Insomnia, Coughing, particularly at night, Sleeplessness and colic in children, Diarrhoea

Better: for mild weather. Worse: for heat; for cold winds or fresh air; when angry

Gelsemium

It is the main homeopathic remedy for influenza. Also excellent for coughs, colds and sore throats, particularly if accompanied by shivering and fever. Gelsemium is useful when any of the following are indicated:

Fears and phobias when accompanied by shaking and trembling Fear of doctors and dentists Fear of being left alone Anxiety about forthcoming events, such as meetings Panic attacks Dislike of insects and creatures that creep and crawl Drowsiness and confusion Difficulty in sleeping

Influenza Coughs and colds Fatique, exhaustion and drowsiness Shivering Sore throat with red tonsils Difficulty swallowing Sneezing with a hot and flushed face Migraine and headaches, in particular at the base of the skull or the back of the head Sore, inflamed eyes Weakness and heaviness in the extremities Diarrhoea that is made worse when anxious

Better: for rest and stillness; after going to the toilet. Worse: for cold, damp weather

Graphites

Graphites is useful to treat the first outbreak of skin complains, in particular eczema and dermatitis, particularly where there is a discharge. In these cases, the remedy should be supported topically with an application of the homeopathic ointment or cream. It is a useful remedy when any of the following are indicated:

Post-menopausal depression Depression Indecisiveness Timidness Bulimia Fidgeting, in particular when nervous and anxious

Eczema, particulary behind the knees, on the wrist, inside and outside of ears Contact dermatitis particulary on the palms of the hands and between the fingers Psoriasis Dry, cracked and sore skin Cold sores Itchiness or skin eruptions of the scalp Stomach problems Cramp Constipation Morning headaches Styes Nail problems Chillblains Erratic menstrual cycle

Better: for eating. Worse: for heat

Hypericum

Hypericum is a good homeopathic remedy to use after an injury to the skin, particularly were there is a risk of infection. It is useful when any of the following are indicated:

Shock through injury or emotional trauma Depression after surgery or after injury Stress and anxiety that cause spasms and feeling of tightness in the body Depression with tiredness and lethargy Vertigo

Puncture wounds received from sharp objects (glass, nails, splinters etc) All wounds and injuries, in particular if crushing is involved Nerve pain or stabbing Neuralgia Shooting pains Minor eye injuries Injuries to the hands feet and spine Toothache Haemorrhoids with pain and bleeding.

Better: for resting the head bent backwards; for gentle massage. Worse: for cold, damp and foggy weather

Ledum

Ledum is an ideal homeopathic remedy for puncture wounds. It can prevent any infection caused through bites, stings and cuts. It is a useful remedy when any of the following are indicated:

Timidness Impatience Sleep disturbance with night sweats

Wounds Stings with bruising and puffiness Bites Injury to the eyes Arthritic and rheumatic pain affecting the ankles, knees or lower legs Hot, burning sensations in the limbs Feelings of hotness and swelling triggered by stress Gout

Better: for cold compresses. Worse: at night; with heat

Nux vomica

The homeopathic hangover remedy. It is also good for aiding digestion and promoting the appetite. Nux vomica is useful when any of the following are indicated:

Cravings for stimulants such as alcohol, tobacco and rich foods Tendency to over-indulge Fear of failure Addictive nature Argumentative Critical Fear of spiders and beetles Frustration Hyperactivity Insomnia Depression

Food poisoning Digestive problems, such as heartburn and indigestion Vomiting Constipation Diarrhoea Stomach cramps Lower back pain Hiccups Headache and migraines Hay fever colds and influenza Heavy, aching muscles Morning sickness and cramp in pregnancy

Better: for sleep. Worse: in the morning

Rhus Tox

Rhus Tox is an excellent remedy for muscular aches and pains. Eczema and other skin problems often respond to this remedy when others fail. Rhus tox is useful when any of the following are indicated:

Anxiety at night Anxiousness Irritability Depression Lack of joy in life

Muscular aches and pains Stiffness Joint pain Back pain Arthritis and rheumatism Sprains and strains Jaw pain Frozen shoulder Neuralgia Post-operative recovery Repetitive strain injury Cold sores Nappy rash Sciatica Chicken pox Shingles Influeza

Better: for movement; for a warm, dry atmosphere Worse: for rest and stillness; for cold, damp weather

Aumway

Mrs. Smita Bhardwaj

AUM is root of all mantras. Mantra is atypical combination of words which affects the surroundings and human beings through vibrations .If these mantras are chanted for enormous no. of times one gets miraculous results. Each and every mantra starts with AUM and mostly ends with AUM / OM.

OM can be seen through the eyes, listened to via ears and chanted via tongue It is somewhat simpler to concentrate on the above 3 sense organs, so it is easy to concentrate the mind directly on the object. This is achieved by fixing OM as a target for meditation on which 3 sense organs are focused. In addition to this the chanting of AUM has tranquilizing effect on the mind, which helps to concentrate easily.

Keep a picture of ,and then see ,visualize and concentrate on the structure of AUM. Sit in the posture with closed eyes. Take a deep breath, and while releasing the breath taken say the OMKAR. The A ,U, M all 3 are to be recited in continuation. There should not be 3 separate parts .

One Omkar can be said in 10 secs. The proportion is 2 sec. for A, 3 sec. for U, and 5 sec. for M. Omkaar is an exercise for vocal cords, which give them strength. Omkar is the basic form of sound. It consists of A {akaar}, U {ukaar}, and M {makaar}

A-Separate the lips gently open the mouth and say A. Vibrations are created near the

Umbilicus i.e. Manipur chakra.

U-Bring the lips closer and say U.Vibrations are near necki.e. Vishuddha chakra

M-Close the mouth completely and say M.Thevibrations can be felt allover /inside the

Cranial cavity i.e. Sahasrar chakra.

Advantages

- AUM chanting is the real way to total tranquility.

-AUM chanting helps in cleansing the mind, and also to have control over emotions.

-AUM recitation improves the concentration, memory, and understanding capacity so it is

an essential supplement for growing children to cope up with the competition.

-AUMKAR relaxes one physically, mentally, and emotionally and so is again an essential supplement for adults and elderly persons.

Effects

-Omkaar recitation is an important yogic practice. The vibrations due to Omkaar recitation increases the efficiency of cells and the concerned organs.

-Generally any mantra starts with AUM. So we find it easier to chant it in a continuous manner and concentrate our mind In the Omkar recitation, the first pronunciation A creates the vibrations, which affect on the spinal cord to increase it's efficiency. Second pronunciation U creates the vibrations in the throat and affects the Thyroid Glands, while the last pronunciation M, brings the vibrations to the brain, thereby activating the brain centres, as a result of which, the efficiency of a brain increases. Therefore the effect of Omkar chanting increases the concentration, memory, receiving power of brain and ultimately decreases the level of fatigue.

Concentration is a measure of accuracy of work and receiving power is a measure of understanding while memory is a measure of ability to reproduce the knowledge / known things.

Ideal place

One particular place should be fixed, which is without any type of disturbance, for OM practice. There should be cleanliness and fresh atmosphere. All type of care should be taken for purity and serenity of the place, ambiance, Sadhakas body and mind.One can burn agarbatti/ dhup. One can keep fresh flowers.

Ideal time and posture

Before sunrise one should take bath and sit for practicing omkaar.

Padmasana is the most appropriate posture. If it is not possible then Vajrasana or Swastik aasana can be ideal choices for chanting OM

Position of fingers-Thumb and index finger are touching each other and rest fingers are slightly raised.

HOW TO CONCENTRATE

The purpose of generating vibrations through the recitation of OM is to concentrate at mind as well as at body level.

When we achieve this stage,stop recitation and THEN TRY TO HEAR THE OMKAR SOUND AND RECOLLECT THE IMAGE OF AUM.

Finally try to minimize the image .This is Sookshma dhyana.

.

PREMATURE MENOPAUSE - An UNDERDIAGNOSED ISSUE

Sneha Tidke, Sayli Gunjal, Chaitali Tile, Priyanka.

A pan India survey, conducted by Bangalore-based institute for Social & Economic change [ISEC], highlighted that the percentage of young menopausal women was the highest in Andhra Pradesh at 31.4%. Bihar-21.7% & Karnataka-20.2% were no better-Kerla-11.6% was tad better while west bangal-12.8% & Rajasthan-13.1% was just a rung lower.

The finding of the ISEC survey also highlight that on an avg. nearly 4% of Indian women are already menopausal between the ages of 29-34 yrs, one of the lowest thresholds for menopause in the world. The natural age for menopausal onset is between 45-55 yrs with a mean age of 51yrs, world wide.

This survey has confirmed our worst fears that womens health is simply not a priority in our country.

The changing dynamics of the Indian family, the increased stress upon women to be financially independent & the whittling down of the familial support structure have all put tremendous physical, emotional & mental strain on our women. These pressures couples with lack of proper nutrition & education about health play havoc with female hormones, resulting in a skinned menstrual pattern & giving rise to a premature menopause or premature ovarian failure.

Q. What is premature menopause or premature ovarian failure [POF]..?

Premature ovarian failure is the loss of ovarian function in women under the age of 40 women with POF do not ovulate (release of egg) each month. This loss of function can be due to a less than normal amt. of follicles or a dysfunction in the ovaries.

A woman can be affected by POF at any age or time in her life. It can happen before or after she has had children or she is still planning for her family. No matter what season of life, it is overwhelming & many times there are several questions that are left unanswered.

Before we began to understand ovarian failure we need to understand OVULATION.

A woman is born with about 2 million ovarian follicles. As she gets older & reaches puberty. She will only have about 3-4 lakhs follicles left. The body does not make anymore. These follicles are very important because they mature to be eggs that will be released during ovulation. Though there are so many follicles, not every follicle becomes a mature egg.

When a girls menstrual cycle begins, her estradiol (estrogen) levels are low. Her hypothalamus ( which is in charge of maintaining hormone levels) sends out a message to her pituitary gland, which then sends out a follicle stimulating hormone(FSH).-this FSH triggers a few of your follicles to develop into mature eggs. Remember only one follicle will be the lucky one to become a mature egg.

As the follicles mature they send out another hormone, Estrogen. Estrogen sends a message to the hypothalamus to stop producing FSH. If the follicles do not mature & produce estrogen to stop the production of FSH, FSH will continue to produce & rise to high levels. This is why women with POF are checked for high levels of FSH.

Once the levels of estrogen are high enough, the hypothalamus & pituitary gland know that there is a mature egg. A leutinizing hormone (LH) is then released; this is referred to as LH surge. Within 24-36 hrs of the LH surge the mature egg is released & ready for fertilization.

If fertilization does not occur, then the egg dissolves & a few days later the hormone levels decreases & uterine lining begins to shed. This is called menstruation (menstrual period) & brings us back to day 1 of the cycle. The journey then begins all over again. And this repeats till the age of 50-51 in most women every month.

Is there a difference between premature ovarian failure (POF) & menopause?

Menopause mainly occurs on avg. around age 51 premature ovarian failure can occur at any age before 40, usually on avg. around age 27. When a women experiences menopause, she no longer has follicles to produce into eggs & therefore no longer gets her menstrual period.

On the other hand, a woman with premature ovarian failure, or premature menopause, may still have follicles, but there may be a depletion or dysfunction of these. Therefore, she can still get her period, however, most of the time her period is irregular. Irregular period are one of the sings for POF. However there may be other explanation for an irregular period.

Symptoms for premature ovarian failure (POF)

-Irregular periods

-Hot flashes

-Night sweats

-Decrease in sexual drive

-Irritability

-Painful sex

-Thinning & drying of vagina

-Thyroid dysfunction

-Weight gain

-Increased appetite

-Hair loss.

Some women may continue to have normal periods & show no symptoms. Diagnosis may only be discovered when the FSH levels are measured & come back with elevated levels.

What cause premature ovarian failure (POF)?

Unfortunately, for most women the cause is unknown. There are, however, some causes that may be identified which include

-Autoimmune disorder

-Genetics

-The end of a treatment for cancer with radiation or chemotherapy.

-Hysterectomy with both ovaries removed.

-Thyroid dysfunction

-Turner syndrome

-Viral infection

-Inadequate gonadotropin secretion or action

-Eating disorders.

Diagnosis

-Pregnancy test

-Thyroid dysfunction test

-Measurement of estradiol level

However, the most important test used to diagnose premature menopause is a blood test that measures follicle-stimulating hormone (FSH). This test has to be performed twice with 1 month interval.

How is premature menopause treated?

There is no treatment to reverse premature menopause. Hormone replacement therapy (HRT) can prevent the common symptoms of menopause & lower the long term risk of osteoporosis.

Estrogen, which is found to relieve the unpleasant symptoms of menopause, including the hot flashes & vaginal dryness is especially important for women who go through premature menopause. The long term health risks of menopause (osteoporosis & increased risk of heart disease) are even more likely to occur after premature menopause.

However, women who have certain medical conditions (like liver diseases, uterine cancer, or breast cancer) may not be candidates for estrogen.

If a women still has her uterus after premature menopause, she will also need to take progesterone along with the estrogen. If her uterus has been removed estrogen alone will be enough.

-

Behavioral Finance

Compiled by Shantanu Malpathak (C.A)

Background:-

Behavioral Finance (BF) is that part of Economics which studies the human behaviors and its impact on his/her personal economic well being .Behavioral finance applies theories of human behavior derived from psychology, sociology and anthropology to understand the behavior of financial market participants.

In its origin days, Behavior Finance (BF) theories were developed to study the up and down movements in financial markets based on human behaviors, emotions and thoughts. It was essentially a study of financial errors committed by participants (human beings) because of their particular kind of behavior.

Its original BF definition was as follows-Behavioral finance attempts to explain how and why emotions and cognitive errors influence lay persons and investors and creates stock market anomalies such as bubbles and crashes.

Behavior Finance is not an exact science .It is merely a branch of classic Economics. Very little literature is available on the subject. What ever little literature is available, it is based on US and western market backdrop.

Theories of Behavior Finance:-

There are many theories / hypothesis developed to study why and how movement in financial markets are linked to human behavior.

Let us not go into details of these theories . Instead study the above theories in relation to financial errors committed by common human beings and its impact on their personal finances.

Current thinking on BF:-

New theories and concepts of human behavior are being framed to know how human beings financially act or decide irrationally and their adverse impact on their personal finances. I have also tried to include some based on my personal experience. The backdrop for this is the recent financial meltdown in the US and its spread to other economies like India.

The concepts are based on the reasons of particular human behavior . Let us take the theory/concept/hypothesis one by one

1. Over confidence or over estimation :-

Year 2006 & 2007 were very good for many . Based on this immediate past history many projected their future incomes based on earnings of 2006 and

2007.Many took heavy loans/commitments or obligations projecting even better future .However, good times rarely last long as the business or market run in cycles. After the meltdown, many small businesses went busy or many were rendered jobless.

These persons are finding it difficult to service these heavy loans / commitments or obligations.

2.Herd Mentality :-

It is the mentally followed by herd of sheep. All of them go in one direction/road without any thought. Human beings having superior brains are expected to show more maturity than this. However ,this is rarely practiced in actual life. We find safety in numbers. When we see that many others are following a particular financial product /practice/procedure, we tend to follow them. However ,that particular financial product is suitable to our own needs is lost sight of. When everybody in a herd commits the same mistake, it pinches less to a person than when only that person commits the mistake. Its the human tendency. It requires great guts not to follow the herd and act otherwise. Not many persons have that. Many simply follow others in doing the same thing repeatedly.

3. Acting rich:-

This particular phenomenon forces a person to do/act things which are beyond that persons financial means. This is particularly evident when the going is good. But the person erroneously carries it on even when the going is tough. Buying an expensive car/big house or apartment / jewellary /furniture or watches beyond ones financial limits to show others his higher financial status is an example of acting rich. Age old saying of acting within your financial means is often forgotten. This habit ruins a person financially especially done over a long period of time.

4. National & Intangible gains v/s real and tangible losses:-

When considering any financial decision / commitment, people tend to over emphasize notional and intangible gains in that decision / commitment and also tend to ignore real and tangible losses. Notional and intangible gains do not result in actual financial gain or income. These are mainly emotional or sentimental gains. however, on the other hand, real and tangible losses / commitments result in actual cash outflow. This makes the decision incorrect in the long run.

5. Spur of the moment decisions:-

There is the old famous saying-Act in haste and repent in leisure. Many persons ,especially young persons; have a tendency to take financial decisions on spur of the moment. such decisions often prove wrong in the long run. Modern retain stores often encourage spur of the moment purchases. In many cases, articles or products purchased through such spur of the moment decisions are not even used afterwards.

6.Looking good:-

Looking good is a human tendency to say / think or projects only his good things to others and deliberately hide the negative things. This trait is present in every human being in varying degrees. A person having this trait will try hard to say / think or project only good things in his life such as higher sales, capital gain, new purchase of a costly item etc. simultaneously such person hides negative things in his life like indebtedness, losses etc. If this behavior is repeated over time; the person tends to overlook or neglects these negative things in his actual life or tries to push them under the carpet. The negative things become bigger over time and ruin the person financially . This person is also often found acting rich.

7. Comparing with others:-

When one person compare his life style, income and spending pattern with other persons and tries to repeat it, he often lands in trouble. This particular phenomenon happens because of herd mentality cited above. However, each person / family has unique income and spending pattern, obligations and number of dependents etc. Trying to ape others without regards to ones financial ability invariably leads to trouble. Besides it is forgotten that the other person may be acting rich.

8. Forgetting Margin of safety:-

Margin of safety means safety gap deliberately kept in any financial decision / commitment. It comes into picture when your assumption go wrong by a certain degree. In normal situation; even if your assumptions (for example about your future income) go wrong, you should be in a position to comfortable sail through with the help of margin of safety. Margin of safety is decided based on personal experience , mind set and projections. Many persons were found to have no margin of safety. Many families were found with no or inadequate savings. This is especially true in India. This is because there is no social security in India as in the US. similarly, joint family network has broken down. This has increased the importance of Retirement planning.

9. Irregular income and regular expenses:-

This is a very dangerous situation. A person having irregular income but regular expenses will find it extremely difficult to balance the situation. If not handled properly it leads to piling of debts. It is important to have regular monthly income. This phenomenon explains how a large legacy /gift/inheritance/property sale amount does not last long; if the person receiving it does not act prudently.

Topics for dissertation

To promote the research orientation our college is carrying out research

related activities from the interns. Here is the brief summary of the dissertations submitted by the interns in the year 2009-2010

Thesis no

Title of Dissertation

Name of the Interns

Date of Submission

205

Dissertation on Leucorrhoa

Dr. Shobha Gambire

Dr. Ganesh Gaikwad

30/01/09

206

Role of homoeopathy in dentitional complaint

Dr. Anup Gawande

Dr. Dipti Sabhadra

Dr.Harshada Wani

28/02/09

207

To study and compare homoeopathy with dietary supplements in the treatment of Anaemia

Dr. Sachin Patil

Dr. Amruta Khivsars

Dr. Priyanka Shah

28/02/09

208

A clinical study of Kents philosophy regarding remedy responce

Dr. Vrushali Ahirrao

Dr.Vinaya Acharya

Dr.Mukund Dusane

28/02/09

209

Homoeopathic constitutional medicine in Leucoderma

Dr.Ratna Kokare

Dr.Deepti Lokhade

Dr. Parimal Musale

28/02/09

210

Comararative study of Sulphur 30 & constitutional medicine in cases of scabies

Dr.Sachin Kute

Dr.Shrikrishna Mandlik

Dr.Mukesh Musale

Dr.Chetan Salve

28/02/09

211

Efficacy of Sabal serrulataQ in increasing Body mass

Dr.Pankaj Biraris

28/02/09

212

Efficacy of Constitutional medicine against combination medicine in Infantile Diarrhoea

Dr.Gargi Gujarathi

Dr.Bhavesh Pujara

Dr.Kunal Telgote

28/02/09

213

To Assertain the efficacy of Constitutional medicine against specific Baryta Mur 30X in Mild Hypertension

Dr.Balkrishna singh

Dr.Kuldip Sharma

Dr.Suhas Bhosle

28/02/09

214

Role of Phytolacca Q in Management of Obesity

Dr.Chothe Sneha

Dr.Garge Yogita

Dr.Dhanwate Shilpa

02/03/09

215

Miasmatology Of Reccurent Urinary Tract Infection

Dr.Priyanka kompelli

Dr.Sheetal Pardeshi

Dr.Pratiksha Lad

02/03/09

216

To study Role of Symphytum in Healing fracture of Long Bone

Dr.Swati Amale

Dr.Shalaka Deore

Dr.Prashant Gawande

02/03/09

217

Second Prescription & its Clinical Significance

Dr.Rohit Deshpande

Dr.Shahid Sayyad

Dr.Varsha Wagh

02/03/09

218

Role of Homoeopathic Medication in spasmodic Dysmenorrhoea

Dr.Patil Chhaya

Dr.Patil Dipali

Dr.Hareshwar Deepti

03/03/09

219

Role of Homoeopathy & Isopathy in HIV/AIDS

Dr.Das Radha

Dr.Sapna Khairnar

Dr.Daksha Kare

03/03/09

220

Investigating various route of Administering Homoeopathic medicines

Dr.Deepali Gite

Dr.sapna Khairnar

Dr.Daksha Kare

03/03/09

221

Role of specific (Cina) verses Constitutional Remedies in Worm infestation of Preschool & School Group Children

Dr.Prashant Bhawsar

Dr.Poonam Sable

Dr.Sujata Daware

Dr.Pallavi Dhapatkar

03/03/09

222

Dissertation on Homoeopathic Management in Tuberculosis

Dr.Milind Patil

Dr.Sunil Kadam

04/03/09

223

To Study the Natrum Group remedies with Special Emphasis of Natrum Muriaticum

Dr.Amrut Sonawane

04/03/09

224

To study the Role of Homoeopathic medicine in cases of Leucorrhoea in Reproductive Age group

Dr.Borse Radhika

Dr.Shinde Priyanka

Dr.Deore Rohini

04/03/09

225

Behavioral Problems in Children

Dr.Ulde Sadaf

Dr.Shinde Bharat

Dr.Subramanian Subitha

05/03/09

226

Role of Homoeopathy medicines in Osteoarthritis

Dr.Rehana Shaikh

Dr.Poonam Katyare

07/03/09

227

Role of Homoeopathic Medicines in Migraine

Dr.Neha.P.Patil

Dr.Deepti.D.Patil

Dr.Anand Nahar

07/03/09

228

Efficacy of LM Potencies

Dr.Vrushinit Saudagar

07/03/09

229

The Role of Homoeopathic Similimum in Acute Paediatric Diarrhoea

Dr.Tushar Yeole

Dr.Anand Rokade

Dr.Nilesh Abhale

14/03/09

230

Insomnia & its Homoeopathic management

Dr.Sonia Gill

Dr.Leena Kajarekar

Dr.Sunita Jadhav

18/03/09

231

Management of Alzheimers Disease by application of suitable Homoeopathic Drugs

Dr.Sheeba Khan

03/05/09

232

Role of Homoeopathy in typeII Diabetes Mellitus

Dr.Vaibhav Joshi

Dr.Reyhan Reyhani

Dr.Devika Tripathi

Dr.Akanksha Dixit

11/09/09

233

Role of Homoeopathy & Isopathy in HIV/AIDS

Dr.Pooja ahirrao

Dr.Mihir Shah

11/09/09

234

A clinmical study of Tarentula Hispanica

Dr. Rashmi Hatkar

Dr. Kanchan Pawar

11/09/09

235

A comparative sudy on surgical & conservative mehod of treatment in cases of Tonsilitis

Dr. Pranjal Gangurde

Dr. Leena Desai

Dr. Priyanka Nerkar

Dr. Sonali Bhutada

16/09/09

236

Exploring the role of passifloraQ in cases of insomnia

Dr. Gauri Joshi

Dr.Leena Desai

Dr. Priyanka Nerkar

Dr. Sonali Bhutada

17/03/09

237

Efficacy of Homoeopathy in he management of GORD

Dr. Parag Kasliwal

Dr. Sunil R. Patil

17/03/09

238

The efficacy of PlantagoQ & comparative study of Plantago&acut medicine in cases of toothache in dental caries

Dr. Sahita Sarkar

Dr. Aparna Singh

Dr. Tejashree Torane

Dr. Aafiya Shaikh

17/03/09

239

The role of Homoeopathic specific gentiana lutea in Paediatric cases of Anorexia

Dr. Megha Pahade

Dr. Pooja Pardeshi

Dr. Deepika Patil

Dr. Sanket Nagare

17/03/09

240

Efficacncy of Homoeopathic management &treatment of PCOS

Dr. Raghav Mohim

Dr. Nivedita Madne

Dr. Tejashree Khandve

Dr. Anuja Karande

17/03/09S

241

The role of Homoeopathy in Lowbackache of Parimenopausal females

Dr. Sandip Patil

Dr. Bhushan Pawar

Dr. Pravin Rathod

Dr. Swapnil Nagare

18/03/09

242

Comarative study of physiological &pathological Leucorrhoea&to determine the effect of homoeopathy

Dr. Deepali Patel

Dr. Pooja Patil

Dr. Geetali Patil

18//03/09

243

Efficancy of Homoeopathy in chronic Urticaria

Dr. Chanchal Pawar

Dr.Trupti Pansare

Dr. Obing Nair

Dr. Deepak Patil

19/03/09

244

A comparative study of Cocculus Indicus verses Constitutional remedies in Motion Sickness

Dr. Radhika Bhutada

Dr. Amruta Gaikwad

19/03/09

245

Nosodes with Indication of Carcinosin

Dr. Priyanka Lupane

19/03/09

246

To study different types of tongue for comprehensive clinical study

Dr. Sonal Salunke

Dr. Shrikant Patil

Dr. Shyam Patil

Dr. Pritika Nemude

20/03/10

247

Utility of Ferum Phos 6x in Anaemia as per Biochemic system of Medicine

Dr. Amruta Shah

Dr. Supriya Wagh

Dr. Devanshi Somaiya

Dr. Nishant Shaikh

20/03/10

248

Efficacy of Homoeopahic remedies in cases of post Vaccination syndrome

Dr. Snehal Gaikwad

Dr. Ashvini Biraris

Dr. Mayuri Geldo

Dr. Shweta Bhamre

22/03/10

249

Comparative syudy of Borax with constitutionl medicine in Apthous Ulcer

Dr. Amruta Shinde

Dr. Jagruti Sawant

Dr. Vaishali Shelke

22/03/10

250

Role of Homoeopathy in obacco De-Addicion

Dr. Pallavi Khairnar

Dr. Geetanjali Khairnar

Dr. Nikita Khalane

24/03/10

251

Role of Homoeopathic medicines in treatment of Allergic Rhinitis

Dr. Pradnya Gurav

Dr. Dipeeka Chavan

Dr. Preshita Gosavi

Dr. Sheetal Gawale

24/03/10

252

Efficancy of Homoeopathy in HIV/AIDS

Dr. Sachi Gupta

Dr. Arati Mulay

Dr. Bablu Konojiya

24/03/10

253

Role of Auxillary mode of treatment in management of Joint Pain

Dr. Mukti Luthra

Dr. Yogini Mahajan

Dr. Sangita Gurukul

Dr. Nitin More

26/03/10

254

Scope of Homoeopathy in the treatment of attention deficit Hyperactivity Disorder

Dr. Rahul Hajare

Dr. Rahul Ganore

Dr. Narendra Chavan

26/03/10

255

Homoeopahic approach towards Cough

Dr. Snehal Nigal

Dr. Gitanjali Pawar

Dr.Navneet Patil

Dr.Amol Pail

26/03/10

256

To ascertain the efficacy of constitutional Medicine against Staphysagria in Recurrent Stye

Dr.Rekha Singh

26/03/10

257

Gestures in Children & their Clinical Relevance between 0 to 5 years

Dr.Pallavi Mane

Dr.Taranjeet Maini

Dr.Rajesh Kuyate

26/03/10

258

Management of Pain with Nash Trio of pain

Dr.Kunal Wagh

Dr.Ganesh Shivade

Dr.Bhushan Tayade

Dr. Aniket Upasani

02/04/10

259

Biochemic system of medicine

Dr.Jitesh Khairnar

Dr.Sachin Khandbahale

02/04/10

260

Efficacy of homoeopathic constitutional remedies in cases of Insulin dependent DM

Dr.Purnima Choudhary

Dr.Bhakti Ghuge

Dr.Sameer Ahire

08/04/10

261

Therapeutic role of homoeopathic medicines in cases of Allergic rhinitis

Dr.Pankaj Adhik

Dr.Sandesh Deore

Dr.Tulshiram Kartule

Dr. Sandeep Wagh

06/09/10

262

Role of homoeopathic in cases of Renal calculi

Dr.Rakhee Sharma

Dr. Shubhangi Sapnar

Dr. Smita Gaikawad

Dr.Sainath Patil

06/09/10

263

Exploring Utility of Temperament for selection of similimum

Dr.Rupali Patil

Dr. Poonam Bhamare

Dr. Amit Deshmukh

13/09/10

264

Role of homoeopahic medicine as supportive Therapy to reduce the frequency of dialysis in chronic renal failure patients

Dr.Nerisha Budhwani

14/09/10

265

Efficacy of Sanguinaria Canadensis in Migraine

Dr.Sandeep Shinde

Dr. Amol Jadhav

Dr.Samiksha Jadhav

Dr.Ashwini Vidhate

Dr.Shilpa Mahale

09/10/10

FILLLERS

DRUGS vs BUGS

REFERENCE: The Indian EXPRESS, 19TH August, 2010

In this article the bugs refers to the bacteria. The article is about the resistance caused by the bacteria. But the question is how these bacteria acquires resistance?

BUGS AND RESISTANCE:

As Human has 21 chromosomes, the bacteria has only one big chromosome. And they also have an extra chromosome which is 1000 times smaller, which can pass from one bacteria to another regardless of species. And this extra chromosome contains the ANTIBIOTIC-RESISTANT ENZYME which can jump from one strain of bacteria to another. Like this the antibiotic resistance usually gets transmitted from one bacteria to other.

ANTIBIOTIC RESISTANCE:

It usually develops as follows-

1. Due to judicious use of drugs

2. Hospital acquired resistance develops whenever in the hospital environment, bacteria acquires immunity against antibiotics.

For Example:

In infectious wards, if healthcare workers and visitors visit, they carry these resistant bacteria from inside to outside. And whenever the individual with these resistant bacteria falls ill, and if culture and sensitivity of that individual is done he is already resistant to that bacteria which has caused the disease.

3. It also develops due to the habit of symptomatic treatment- prescribing medicine without knowing the exact source of problem, and by doesnt knowing the exact species of bacteria BROAD SPECTRUM ANTIBIOTICS are prescribed to the patient.

4. It also develops in those who never complete the course of the prescribed drug.

5. Also develops through the sources like animal products and plant products under antibiotics.

Because there is the mechanism of antibiotic filtering into the body through other sources like animal products and plant products.

Souche says milk from cow under antibiotic treatment can contain antibiotics.

Meat or plant products where the plant had been getting water contaminated with antibiotics.

6. It also develops through the indiscriminate prescription

7. Increasing resistance to a lot of antibiotics is due to a lot of misuse and overuse of drugs. Many hospitals do not have a proper antibiotic policy. Open ICUs admit patients and multiple antibiotics are prescribed without much rationale.

THE FIGHTBACK:

Prof. Gopal Nath (Microbiologist, Banaras University) points out that The silver lining here is that bugs have short memories.

It means that if bacteria is resistant to particular drug and that drug is withdrawn today, it will regain sensitivity to that drug within a few years.

Other foolproof method of containing bacteria attack is through vaccination.

Naths research provides the 3rd option , a cocktail of killer viruses is unleashed against bacteria. The virus cocktail, Nath said, has been successfully used in case of pseudomonas aeruginosa , an antibiotic resistant strain and through the experiments are still at the laboratory stage, phage therapy still holds out considerable hope of the future.

CONCLUSION:

Without knowing the actual species of bacteria, antibiotic should not be given.

Pharmacist should not give any antibiotic without prescription by authorized person.

Antibiotic should be administered in required dose as per the individuals age and weight. And overdose should be avoided.

While developing the newer antibiotics, the effectivity of older one should be rechecked because of the fightback mechanism.

Self image _ what does it mean?

Self image is how you see yourself. It is important as it affects yourself esteem & confidence. It is number of self impressions that have built up over time. What are your &dreams? What have you done throughout your life & what did you want to do?

These self images can be very positive giving a person confidence in their thoughts & actions, or negative, making a person doubtful of their capabilities & ideas.

TO DO!

1. List all your strengths & read them every day.

2. Note the things that you do not like about yourself, & see what you can do about them.

3. Accept certain things about you as true & learn to be positive about them.

4. Note the compliments you receive from friends, teacher & family.

5. Make changes in your clothes, appearance & behavior to enhance your personality .

EXCERCISE: TAKE YOURSELF LESS SERIOUSLY& LIGHTEN UP!

Believe in your self

Useful 16

The best day- Today

The hardest thing to do-To begin

The greatest handicap-Fear

Easiest thing to do- Finding faults

Most useless asset-Pride

Most useful asset-Humility

The greatest mistake-Giving up

Worse bankruptcy_ Loss of enthusiasm

The greatest need -Common sense

Meanest feeling Regret at anothers success

Best gift Forgiveness

The hardest thing n most painful to accept Defeat

The greatest moment- Death

The greatest knowledge -Experience

The greatest thing -Love

The greatest success in Peace of mind the world

Appreciate others

What is the meaning of jealousy?

Jealousy is a disturbing emotion because of which a person feels resentment against a rival or competitor. Jealously may trigger mental urge that can lead to destructive behavior towards others.

What happen when you are feeling jealous?

When you feel jealous, you are undergoing an emotional combination of anger, hurt, self-doubt & insecurity.

What are some ways of dealing with jealously?

Focus on the good things you have & not on what you dont have

Focus on developing more self confidence & attractiveness

Be honest with yourself

Jealousy shows your lack of self esteem & uncertainty of your own worth

Avoid negative feeling .do not let the pangs of jealousy turn in to indicative feelings towards the individual

Learn to look at the things you have in life & be grateful for them.

Dealing with jealousy & insecurity is indeed difficult. But, if you make sincere attempts then you will be able to lead a happy & contented life.

FIND THE RIGHT ROAD

Before we decide to go anywhere we must first choose our destination. To some this may be easy. Some people are born with ambition to become a Doctor or an Astronaut. But there are many others who find their path as they travel down lifes winding streets. There are also those who creates there own path.

Accept, Adapt & Achieve. These are the three watchwords for success in todays ever changing situation. Sticking to goals is vital. But knowing when to change them requires wisdom & humility. The realization that a goals need to be modified not be very easy to accept.

Its true-you are unique, you are special. But that does not mean you cannot benefit from what others have to offers. Simply relying on yours personal experiences may not be enough. You can always learn from the experience of others. Take a page from someones book & write it in your handwriting in your book of life. Keep your identity, follow your own dream, but a little help does not make your success somebody elses. But there is something more difficult than saying Yes .The ability to say No at the right time. This is what draws the line between being an achiever and a push over.Thus, you have to decide what it is that you are willing to give up for the right reason & what it is that you defend with everything that you have.

Only one minute

It takes only a minute,

To say a word of cheer.

It takes only a minute,

To dry a falling tear.

It takes only a minute,

To lead a helping hand.

It takes only a minute,

To try & understand.

It takes only a minute,

To brighten someones day.

Then use this very minute

Before it slips away.

Happy recipe for the development & good health of an institution

Teamwork 4 cups

Concern -2 cups

Faith 5quarts

Understanding 5 teaspoons

Discipline -3 cups

Excellence -1 cup

Hope 2table spoons

Joy -1barrel.

Method

Take teamwork & concern, mix thoroughly with faith, blend with discipline & understanding, add excellence, sprinkle with hope, bake with joy ,serve generous helpings.

MOTIWALA HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL, NASHIK.

Motiwala Nagar, Gangapur-Satpur Link Road, Via Y.C.M.O.U. Gangapur.

Nashik-422222 Tel: Off- (0253)-2351693,2354819. Fax (0253) 2369401.

Email: HYPERLINK "mailto:mhmc1_nsk@yahoo.co.in" mhmc1_nsk@yahoo.co.in, HYPERLINK "mailto:mhmc1@hotmail.com" mhmc1@hotmail.com

Website: www.motiwala.org.in

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02468101214161

Medicine Used In 53 Patients (Improved)

Lachesis( 14)Silicea (10)Lycopodium (6)Sulphur (5)Merc Sol (4)

Pulsatilla (4)

Calc Carb (2)Sepia (2)TuberCulinum (2)Phos (1)Medorrhinum (1)Hyos (1)Verat A (1)

Chart4

141065442221111

Lachesis( 14)

Silicea (10)

Lycopodium (6)

Sulphur (5)

Merc Sol (4)

Pulsatilla (4)

Calc Carb (2)

Sepia (2)

TuberCulinum (2)

Phos (1)

Medorrhinum (1)

Hyos (1)

Verat A (1)

Medicine Used In 53 Patients (Improved)

Sheet1

Lachesis( 14)14

Silicea (10)10

Lycopodium (6)6

Sulphur (5)5

Merc Sol (4)4

Pulsatilla (4)4

Calc Carb (2)2

Sepia (2)2

TuberCulinum (2)2

Phos (1)1

Medorrhinum (1)1

Hyos (1)1

Verat A (1)1

Sheet1

Lachesis( 14)

Silicea (10)

Lycopodium (6)

Sulphur (5)

Merc Sol (4)

Pulsatilla (4)

Calc Carb (2)

Sepia (2)

TuberCulinum (2)

Phos (1)

Medorrhinum (1)

Hyos (1)

Verat A (1)

Medicine Used In 51 Patients (Improved)

Sheet2

Sheet3