RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,

BANGALORE.

ANNEXURE – II

APPLICATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND
ADDRESS / DR. KOMIRELLY RAJASHEKAR
PRESENT ADDRESS:
A.M.SHAIKH HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL & PG RESEARCH CENTER, NEHRU NAGAR,
BELGAUM-590 010
PERMANENT ADDRESS:
HOUSE NO 3-49
KONDUR ROAD
BESIDE APOLLO PHARMACY
VILLAGE & MANDAL – CHOUTUPPAL
DIST – NALGONDA
ANDHRA PRADESH - 508252
2. /

NAME OF THE INSTITUTION

/ A.M.SHAIKH HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL & PG RESEARCH CENTER,, NEHRU NAGAR,
BELGAUM-590 010
3. / COURSE OF THE STUDY AND SUBJECT / DOCTOR OF MEDICINE (HOMOEOPATHY)
HOMOEOPATHIC MATERIA MEDICA
4. / DATE OF ADMISSION TO COURSE / 01/08/2012
5. / TITLE OF TOPIC / ASSESSMENT OF HOMOEOPATHIC PROSPECTIVE IN THE MANAGEMENT OF PROTEIN ENERGY MALNUTRITION
- A RANDOMISED CLINICAL TRIAL.
6 / BREIF RESUME OF INTENDED WORK
7
8 / 6.1 NEED FOR STUDY
The principal problem amongst mankind is that many people in the world do not have sufficient land to grow, or income to purchase enough food. Harmful economic systems are the principal cause of poverty and hunger.
Now a day’s size of urban population in developing Asian countries grows at a faster rate than in the developed West. Urban cities in India are being crushed by the onslaught of population growth, migration of rural poor and industrialization, the urbanization in turn inducing social and economic changes.
Secondly, the current sex ratio is 900 females to 1000 males with nearly 50% of the population literate and the density of population at 2200 per km2. With the rapidly expanding continuous urbanization, the number of slum settlements have increased in Metropolitan cities. 29% of the population in urban areas are under the poverty line and the percentage may be higher in the city. In this situation the nutrition of the mother and child is most vulnerable.
The nutritional status of an individual reflects the balance between the supply and expenditure of nutrients. In most contexts, clinicians are concerned with the sequele of deficient intakes.
Protein energy malnutrition (PEM) is the term given to a group of clinical expressions which occur due to inadequate protein and calorie supply, especially in children. Many factors modify the adequacy of nutrition for individual child. Local custom and cultural practices may be as important as economic status. Thus, malnutrition may occur due to the inappropriate selection or preparation of nutrients
rather than any real lack in their availability.
Deficiencies of nutrients may occur either singly or in combination, but are invariably accompanied by a background of poverty, inadequate education and, in some cases, endemic disease.
The origin of PEM can be primary, when it is the result of inadequate food intake, or secondary, when it is the result of other diseases that lead to low food ingestion, inadequate nutrient absorption or use, increased nutritional requirements, and/or increased nutrient losses.
PEM is a serious worldwide problem that involves more than 50 million children younger than 5 years. According to the world health organization 49% of the 10.4 million deaths occurring in children younger than 5 years in developing countries are associated with PEM. As per the recent national family health survey in India, the most common age of PEM is between 6 months and 2 years and around 50-60% of children are malnourished by 2 years, stunting is a major problem and was observed in almost half of children. Marasmic patients frequently have 60% or less of the weight expected for their height, children have marked retardation in longitudinal growth, chronic or recurrent diarrhea, infections and, other clinical signs. Severe PEM often associated with infection contributes to high child mortality in underprivileged communities. Further early malnutrition can have lasting effects on growth and functional status.
Studies suggest that marasmus represents an adaptive response to starvation, whereas kwashiorkor represents a maladaptive response to starvation. Children may present with a mixed picture of marasmus and kwashiorkor.
In conventional treatment, lots of Protein & Calcium medicines are pushed in into the affected child that may bring upon some transient positive response. However such mode of therapy in confronting these maladies has not shown permanent solution in removing basic trait of disease. Advocating this, there is every possibility of complaints recurring from palliative therapy. Secondly suppression of such state may lead to development of grave systemic effects as mentioned above. The true cause is in the patient himself, so it is necessary to treat the man in disease not the disease in man. Homoeopathy considers mainly fundamental causes (Miasms), Psychic, Socioeconomic, Iatrogenic causes, Susceptibility to receive and to react to the stimuli.
Homoeopathic prospective that adapts holistic approach by giving importance to mind, body and part & therefore, can offer better approach in combating PEM. Since homoeopathic medicines being cost effective they are affordable by the poor people, as compared with the expenses of medicines from other system of medicines. Secondly, these are highly effective if given on the constructional basis, can help in proper development of the child in physical as well as mental aspect.
There has been abundant Homoeopathic literature available on successful confrontation of this disease. Drugs appeared in Boerickes Homoeopathic materia medica and repertory reveal a vast store house of homoeopathic medicines employed for PEM. Hence, this randomized study has been prepared to aim possible positive outcome of treating this progressively prevailing disease with constitutional therapy
Hypothesis –
Null hypothesis; Homoeopathic medicines employed on the basis of constitutional approach are not effective in the management Protein energy malnutrition.
Alternative Hypothesis: Homoeopathic drugs selected on the basis of constitutional approach are effective in the management Protein energy malnutrition.
6.2 . REVIEW OF LITERATURE
·  Protein-energy Malnutrition (PEM) arises due to deficiency of both dietary energy and proteins. Since energy is mainly supplied by carbohydrates and fats. We can say that protein energy malnutrition is due to deficiency of proteins, carbohydrates and fats in the diet. It is the most important nutritional disorder affecting the children in our country in the age period of 1-5 years. 1
·  PEM is largely responsible for the fact that in poor families many children born, do not survive to the age of 5 years. PEM results in retarded body growth of the child in both height and weight. 1
·  Clinical manifestation of under nutrition depend on the severity and duration of nutritional derivation, the age of the undernourished subject, relative lack of different proximate principles of food and the presence and absence of associate infections. In India the major limiting factor in the diet in the pre school children is energy.2
·  Nutritional marasmus and kwashiorkor are two extreme forms of malnutrition. such extremes forms account for a small proportion of cases of malnutrition.
A much larger number of subjects suffer from mild to moderate nutritional deficit 2
Variation in body composition with age in childhood
Age / Mean weight (kg) / Whole body: water % body weight / Whole body: fat % body weight / FFM: water % LBM / FFM: protein % LBM
Birth / 3.5 / 72 / 14 / 84 / 14
4 month / 7 / 60 / 26 / 82 / 15
12 month / 10 / 59 / 24 / 78 / 19
2 years / 12 / 60 / 21 / 78 / 18
5 years / 18 / 60 / 21 / 74 / 20
10 years / 32 / 60 / 17 / 72 / 20
FFM: fat-free mass; LBM: lean body mass3
Selected Enzyme Activity changes in Protein – Energy Malnutrition
Cells / Enzyme Activity a
Muscle and leukocytes
Liver / Aldolase
Amino acid dehydrogenases
Pyruvic kinase
Aminotransferases
Phenylalanine hydroxylase
Urea cycle enzymes
Amino acid activating enzymes
Each organ has a unique pattern of growth and maturation. At birth, brain weight is 25%, and at 5 years 90%, of expected adult brain weight. Seventy-five per cent of postnatal brain growth takes place in the 2 years of life. By contrast, about 30% of male adult body mass is acquired during adolescence4.
Adapted from Viteri FE. Primary protein – energy malnutrition: clinical, biochemical, and metabolic changes. In: Suskind RM, ed. Text book of pediatric nutrition. New York, Raven Press, 1981
Blood glucose concentration remain normal, mainly at the expenses of gluconeogenic amino acids and glycerol form fats, and it falls in sever PEM or when complicated by serious infections or fasting.4
·  Of Psoric origin are all those diseases that I have above termed one sided, which appear to be more difficult to cure consequences of one-sidedness’, since in all other so-called corporeal diseases the condition of the disposition and mind is always altered; and in all cases of disease we are called on to cure the state of the patients disposition is to be particularly noted, along with the totality of the symptoms, if we would trace an accurate picture of the disease, in order to be able there from to treat it homeopathically with success.5
·  Remedies for Protein-energy Malnutrition (PEM) are Abrot, Acet-Ac, Aeth, Alum, Ant-C, Apis, Arg-N, Arn, Ars, Ars-I, Ars-S-F, Arum-T, Aur, Bac, Bar-C, Bar-I, Bell, Borx, Calc, Calc-P, Calc-Sil, Carb-V, Caust, Cham, Chin, Cina, Coca, Coff, Con, Ferr, Hecla, Hep, Hydr, Iod, Kali-C, Kali-I, Kreos, Lyc, Mag-C, Med, Morg, Nat-M, Nux-M, Nux-V, Ol-J, Op, Petr, Phos, Plb, Podo, Psor, Puls, Sanic, Sars, Sel, Sep, Sil, Staph, Sul-I, Sulph, Syph, Ther, Thyr, Tub.6
6.3 OBJECTIVES OF STUDY
·  To assess the mode of uncommon presentation of protein energy malnutrition in clinical practice.
·  To analyze the miasmatic trait of Dispositions prone for protein energy malnutrition.
·  To assess cause & effect in relation to the study of a drug indicative in Protein energy malnutrition.
MATERIALS AND METHODS
7.1 SOURCE OF DATA
The subjects for this study will be taken from the Central OPD, Village camps and satellite clinics of A.M. Shaikh Homoeopathic Medical College, Hospital & PG Research center, Belgaum.
7.2 METHOD OF COLLECTION OF DATA ( INCLUDING SAMPLING PROCEDURES, IF ANY)
Type of research: Prospective Case study.
Study Design: Randomized non control sample trial.
Participant subjects: Males and females of 1 to 20 years of age with history of clinical presentation of PEM.
Selection criteria: on the basis of inclusive and exclusive criteria, history and physical findings.
Sampling method: Simple random sampling procedure.
Sample size: Minimum 30 in number.
Collection of data: A uniform case proforma will be prepared for the topic which will be used for collection of data from all selected subjects of the study.
Duration of study: All the cases of PEM registered between 1st of May 2013 to 30th Nov 2014 will be selected for study.
Follow up: Every case will be reviewed every month for minimum period of 1 year for asserting result criteria.
Indication of remedy: Remedy will be prescribed for all the cases considering the state of disposition and characteristics particulars.
INCLUSIVE CRITERIA
·  H/O prolonged poor diet intake with signs of progressive emaciation .
·  Marasmus associated with recurrent diarrhoea.
·  Late Post diarrheal complications of GIT like Protein losing enteropathy/ Protein Intolerence.
·  H/O Premature birth with associated emaciation.
EXCLUSIVE CRITERIA
·  PEM as secondary to;
Tuberculosis
Recurrent Respiratory infections
Mal absorbtion syndrome
Congenital defects
Metabolic/ Endocrinal disorders
PEM associated with OR occurred from HIV Positive/ AIDS
RESULT CRITERIA
·  Recovered
·  Improved
·  Not improved
MATERIAL USED:
Case sheet proforma, writing materials
Torch
Scraping test tools
Measuring tape
Vernier caliper
Weighing Machine.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.
All the cases will be selected on clinical analysis. However in doubtful/ borderline cases Anthropometry study will be sought.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?
Yes, the ethical clearance has been obtained from our institution for the trial study on Human subjects.
LIST OF REFERENCES.
1)  http://www.preservearticles.com/201012302094/protein-energy-malnutrition.html (Accessed on 1/4/2013).
2)  Ghai, O.P., Essential Pediatrics, 6TH Edition revised and enlarged, New Delhi: CBS Publishers and distributes. 2005, 101 pp.
3)  Geissler C.A., Powers H.J. Human Nutrition. Churchill Livingstone: Elsever; 11th ed. 2005. 276pp.
4)  Lippincott Williams, Wilkins. Modern Nutrition in Health and Disease. USA: 351 West Camden Street Maryland; 9th ed. 1999. 963-964pp.
5)  Hahnemann Samuel, Organon of Medicine, translated by Boriecke, William, New Delhi: B jain Publishers, Low priced Edition: 2004, 248 pp.
6)  Murphy Robin, Homoeopathic medical repertory, 2ND Edition, New Delhi: Indian Books & Periodicals Publishers: 1998
9. /

Signature of candidate

10. /
Remarks of the guide
11. /
NAME AND DESIGNATION OF
11.1 GUIDE / Dr. V. V. Kulkarni M.D(Hom)
Professor and Guide.
Dept. of Homoeopathic Materia Medica.
A.M. Shaikh Homoeopathic Medical college, Hospital & PG Research center,
Nehru Nagar, Belgaum –590 010.
11.2 Signature
11.3 Co-Guide (if any) / ------
11.4 Signature / ------
11.5 Head of department / Dr. C. M. MOOGI M.D(Hom),,M.B.A.
Professor, Guide & Head,
Department of Homoeopathic Materia Medica.
Co-ordinator; P.G. Studies,
A.M. Shaikh Homoeopathic Medical college, Hospital & PG Research center,
Nehru Nagar, Belgaum –590 010.
11.6 Signature
12. / 12.1 Remarks of Chairman And Principal
12.2 Signature