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Sep29
NUTRITIONAL NEEDS OF CHILDREN
NUTRITIONAL NEEDS OF CHILDREN

There are two fundamentally different kinds of food needs- energy requirements & structural requirements. The body requires energy for many activities such as beating of the heart, breathing, digestion of the food & voluntary muscular activity. Energy is also needed for growth. This energy requirement expressed in calories is obtained chiefly from carbohydrates & fats.

1. Energy Requirements: The amount of energy needed in terms of calories varies from individual to individual & is dependant upon a number of variables, none of which can be considered independently but rather are part of a constellation. It differs with size. A large child requires more energy producing foods than a small child. It differs with the rate of activity of the body processes while at rest, i.e. with a basal metabolic rate. The faster the rate of basal metabolism, meaning the faster the heart beat, respiration etc. The greater the number of calories used in a given time & conversely, the lower the rate, the lower the number of calories needed.
The energy requirement differs too with the amount of voluntary activity. A very active child requires more calories per day than a quiet one. The same child will need more calories during a day of vigorous activities than during one of quiet activities.
Energy requirements differ also in accordance with the efficiency of the body in using foods. Some bodies are more economical in the use of foods than others. In some cases food is more easily digested & absorbed than in others. In all individuals some food value is lost in bowel elimination, but the amount varies considerably from child to child. Finally, the need for calories depends on the rate of growth. The fast growing child will need more calories than the slow growing child. During the periods of his life when the impetus to grow is more intense, infancy & early adolescence, the amount of energy required for growth will be greatest.
In proportion to their weight, children’s food needs are greater than those of adults because of children’s relatively greater basal metabolism, their tremendous activity & their growth. Boys generally catch up with their fathers in need for calories at 13 years & exceed them by 16 percent at 18. By 10 years of age girls already exceed their mothers by 11 % & at 13 by 16 % in their energy needs.

2. Structural Requirements: the structural requirement covers the need for materials which go to make up tissues & to regulate the functions of those tissues. The necessary food elements or nutrients are 40 in number. They include amino acids from proteins, at least one digestive product of carbohydrates (glucose), some unsaturated fatty acids or acids (derived from the digestion of fats), minerals & vitamins. The body needs all these in adequate amounts for the building & repair of its tissues & for these tissue’s daily activities. Since all foods do not contain all of these nutrients, a balanced diet of “protective” foods, i.e. foods rich in the essential nutrients, is necessary.

3. Importance of Minerals: Minerals serve as constituents of tissues. Calcium & Phosphorus are responsible for the rigidity of the bones & teeth. The softer bones of children contain less minerals than the firmer bones of adults. The process of hardening called ossification demands Calcium & Phosphorus in generous quantities. An inadequate amount of these minerals may result in poor teeth & poorly formed bones. Poor teeth are a barrier to good health & attractiveness. Poorly formed bones detract from the attractiveness of an individual & limit his physical efficiency.
Minerals serve as regulators of body process. The part played by minerals in the beating of the heart & in the activity of the nerves has been mentioned. For coagulation of the blood the body needs calcium in the blood. Phosphorus takes part in the chain of events in muscle activity & in the transfer of energy. The digestive juices such as salivary, gastric & intestinal juices, depend upon minerals for their acidity or alkalinity. Minerals regulate the flow of liquids by means of which substances are absorbed, passed to and from body cells & excreted through kidneys or intestines.

4. Importance of Vitamins: The vitamins, as regulators of body processes, have a vital role to play in keeping children well & furthering their development. The vitamins now recognized as contributing to the health & growth of children are Vitamin A, D ,C, K, Thiamine, Riboflavin, Niacin, B-6, Folic acid & B-12. Vitamin K aids in the formation of prothrombin, which is associated with the mechanism of blood clotting.

VITAMIN –A : is a necessary part of the visual process & thus is associated with the ability to see in dim light. Vit-A is also necessary for maintaining the health of epithelial tissue, namely, the tissue of skin, covering of the eye, the lining of respiratory, alimentary & genitourinary tracts. Deficiency of Vit –A structurally impairs “the body’s first line of defense”. In addition it is necessary for the orderly development of bones & teeth. It is also essential for the formation of enamel of teeth.
Source of Vitamin A - Milk, Butter, Liver, Fish Liver Oils and Egg Yolk.

VITAMIN –D : IS essential for the normal growth & mineralization of the bones & the teeth. The body cannot make proper use of the Calcium & Phosphorus supplied by food unless Vit- D is present.
Source of Vitamin D - Fish Liver Oil, Milk, Butter, and Yeast.

Thiamine (Vit- B 1) : Is one of the vitamins in the B-Complex. Thiamine is essential for the maintenance & normal function of the nervous system. It has been found that Thiamine is necessary to carry carbohydrate metabolism through an essential step.
Source - Cereals, Grains, Beans, Nuts, Pork and Duck.

RIBOFLAVIN (Vit-B 2) : Plays an important role in the internal environments in which the body cells live, where it is involved in the life processes of active cells. Riboflavin is essential to growth & to normal nutrition at all ages. A deficiency produces characteristic changes in the lips, tongue & skin.
Source - Dairy products, offal and leafy vegetable.

NIACIN: Is involved in the life processes of the cells. It prevents Pellagra, with its characteristic skin lesions, digestive & nervous disturbances, provided all other essentials are included in the diet.
Source - Found in many food stuff including plant, meat, (particularly Offal).

VITAMIN –B 6 : Is a member of the enzyme system in certain metabolic processes, including those of neural tissue. Arrested growth & disturbances in functioning of the nervous system have been noted to follow deprivation of B 6 in infancy. Also alteration in tryptophan metabolism in pregnancy has been relieved by administration of B 6 .
Sources - Widely found in animal and plant food stuff.

FOLIC ACID : Has been found to play an important part in the body’s blood forming activities. It is effective in the treatment of certain types of anaemia.
Sources - Found in green vegetables, spinach and Broccoli.

VITAMIN –B 12 (Cyanocobalmine ) : Plays an essential metabolic role & is essential for the prevention or treatment of pernicious anaemia, a disturbance of red blood cell formation.
Sources - It is found in Meat, Fish, eggs and milk but not in plant. It's also found in papayas, cantaloupes, strawberries, broccoli, Brussels sprouts, tomatoes, asparagus and parsley.

VITAMIN C : Is essential to the health of intercellular material which acts as cementing substance in holding the cells of a tissue in their precise positions.
Sources – Lemon, orange, amla, potatoes.

5. Functions of Proteins : Proteins make up a part of all body cells & participate in nearly all life processes; therefore, they are necessary for growth. Through digestion they are broken down into amino acids which are used by the body in building its tissues; bones, muscle, nerves, skin, blood etc. Eight of these amino acids cannot be manufactured in the body & so must be supplied in the diet. Deficiencies in particular amino acid may lead to specific types of injury e.g. when Argimine is deficient there is a decrease in the number of sperms & their motility.
Proteins are necessary for the manufacture of enzymes used in the hormones of the endocrine glands, such as thyroxin of the thyroid gland, epinephrine of the adrenals & insulin of the pancreas. They function in regulating the flow of fluid in & out of cells.

6. Functions of carbohydrates & fats : carbohydrates & fats as the chief sources of energy, are necessary for growth, & they furnish energy for the growth process. Carbohydrates & fats also furnish the body with adipose tissue, which serves as a protection against the loss of heat, act as a cushion to the abdominal organs & is a potential source of body energy. Certain fats perform another important function i.e. they are carriers of vitamin A & D. Glucose, a digestive product of carbohydrates is a constant constituent of the blood.

7. Role of Water: The human being lives in water, even though it is not an aquatic species. Water is a part of every tissue in the body, even of the proverbially dry bone. In children the percentage of water in tissues is higher than in adulthood. Matured bone contains nearly half its weight in water. About 75% of muscle & 80% of the grey matter of the brain are water. No cell can carry on its activities when it is absolutely dry & most cells must be constantly bathed with fluid in order to do their work. These cells have their food brought to them & their waste products removed by the water route, the blood. Many of these waste products are eliminated through the urine. Water serves as a regulator of body temperature. Evaporation from the skin, perspiration, provides one of the most important methods of removing surplus heat from the body. Water protects internal organs. The central nervous system is bathed by the cerebrospinal fluid. Fluid also lubricates joints, thereby making movements at joints easy. Water is therefore tremendously important in life. Rubner estimated that a man could lose most of his stores of glycogen & of fat & even half of his protein without serious danger to life, but a loss of 10% of body water is serious & a loss of 20% is scarcely to be endured.

Dr. Nahida M.Mulla.M.D.
Vice Principal,
Professor of Repertory & PG Guide,
HOD Repertory.
HOD Paediatric OPD,
A M.Shaikh Homoeopathic Medical College, Hospital & PG Research Centre, Nehru Nagar, BELGAUM (Karnataka)

Mobile : 09448814660


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Sep29
Breaking a child's bad habits
Breaking a child's bad habits
Breaking a child's bad habits can be challenging. Bad habits first arise in the elementary school ages. Find out ways to empower a child to let go of negative reactions to stress.
Bad habits form in the best of people. However, compulsive behaviors do not have to rule a life or prevent one from participating fully in social contexts.
In fact, most bad habits such as hair sucking, fidgeting, nail biting and even aggression appear around the ages of 5 to 7. Providing a child with the following interventions can enable a child to let go of negative behaviors. As a child forms more constructive behaviors in its stead, a child's self-esteem increases affording the child with an even greater benefit than what was originally deemed possible.
Researchers believe that the reason for the early onset to most bad habit forming is that around the ages of 5 through 7 a child recognizes that he/she is watched by peers and others in authoritative and assessing positions. A child will pick up a compulsive behavior such as hair sucking in order to release calming hormones through the blood stream. The behavior over time becomes associated with a calm and serene state.
Earlier in toddlerhood, a child might use what psychologists term as a transitional object to produce a similar effect. For instance, some toddlers have a favorite blanket or bear that is associated with comfort. Unfortunately, the child in elementary school knows that a transitional object is fodder for ridicule from one's peers. Hence, the elementary school child will substitute a comforting compulsive behavior for the transitional object in the hope that the behavior will not be noticed as easily as an object.
Be careful of ridiculing this desire. After all, how many of us adults would feel lost without our purses and wallets even when we are aware that the place or person we are seeing does not necessitate needing a purse or wallet or watch or...whatever? Yet, we find ourselves deriving similar comfort from the close proximity of these objects.
How then can a parent or teacher facilitate in the child the breaking of a bad habit?
Behaviorists warn that more important than how to facilitate the breaking of a habit is the how not to approach the negative behavior. For instance, the very reason a child forms a bad habit is that the child recognizes for the first time that his/her performance is being assessed and is, therefore, feeling conspicuous. Calling attention to the behavior in front of the child's peers is the worst thing a parent or teacher can do even if that is what instinctually arises. For instance, a teacher might abhor hair or thumb sucking; however, calling attention to the behavior in front of peers only reinforces the child's fears that he/she is being judged as falling short.
Instead, behaviorists ask that parents and teachers attempt to stop the bad habit. For example, calling attention to when the child is behaving positively is a great way of negating the child's negative thought processes or feeling judged or feeling conspicuous in a negative way.
In this manner, the child will begin to believe that he is being watched in a positive manner and will want to match all behaviors to this ideal. Eventually, the habit will no longer be needed, as the child will assume that his/her behaviors are looked upon in a positive manner, and therefore, the stress associated with feeling watched will disappear.
Moreover, child psychologists also warn against punishing bad habits. Punishment does not teach; instead, punishment stops a behavior in the short-term. meanwhile, the stress increases as the child is now handed two problems instead of the original one. For instance, the child feels stressed and the child has to let go of the behavior that provides the comfort. The use of punishment encourages sneaking of the bad habit. The child has not learned a new constructive behavior in its place. Punishment ends up hurting everyone, since noone feels at peace with the loss. Parents discover that the child still engages in the behavior and the child feels shamed for needing to do it.
Instead, behaviorists suggest that parents, teachers and the child work as allies in the habit breaking. Researchers have found that concrete objects (other than food) that the child enjoys are wonderful tools for habit breaking. However, rather than using these objects as rewards, the child should be given them at the start of each day. If the child does not engage in the negative behavior, he/she will be able to keep all of the objects. On the other hand, if the child engages in the habit (he/she will likely do so in the beginning), then the objects are eliminated one-by-one per the number of times the behavior occurs.
To illustrate, imagine that a child enjoys the sparkle of pennies or fancy looking pencils or buttons that when accrued can be turned in for a special movie viewing. Let us assume that the child bites nails at least 10 times during the day. A parent and teacher can agree that the child is able to start the day with 10 pennies, 10 buttons or 10 pencils at the beginning of the day. As this behavior change is new, the child engages in nail biting 3 times during the day. The child sees by the removal of the desired items how often the child engages or desires to engage in the behavior. This awareness renders the child more aware of the negative habit forcing the child to no longer feel numbed by it. This means that fewer feel good hormones are being released for the purpose of calming.
Moreover, the child also comes to grips with the idea that there are fewer of the chips with which he/she started encouraging a sense of personal disappointment. It should be clarified here that for one child 10 pennies is enough of a reward in itself. However, another child might want to turn in the 10 pennies or whatever token is used for a desired activity such as movie watching, internet use, game playing, etc. Each child is unique and needs to identify to the parents and/or teacher exactly what activity would mean a great deal to him/her. Parent and teacher can then identify to the child how many of the objects need to be accrued for the purpose of accessing the activity. Success of the exercise is determined by the progress of not engaging in the compulsive habit. Over time, parents, teachers and child should be able to see that the behaviors lessened in numbers each day of the experiment. The ultimate reward should come relatively soon after the first day that no negative behaviors were engaged.
Much praise should be given to the child for whatever progress is seen over time. Moreover, some habits are more easily dropped than others. For instance, a child who lives in two different houses is going to require more patience across settings than a child who lives in one. Adults are apt to experience this phenomenon as well. For instance, it is easier to diet at home than it is in a restaurant, office setting, in-laws, etc. The more places in which a child can learn these positive rewards, the more likely that stress will not resurface. So, while it may take longer to learn the new habit forming across settings, the positive behaviors are more likely to be permanently reinforced.
Ultimately, the child needs to see that he/she is encouraged by positive affirmations that he/she can and will surmount the negative habit. The bond that is formed when the child sees that he/she is part of a team is also a precious benefit that arises from working to eliminate the bad habit. Finally, sharing with the child any bad habits that the parent had in childhood also reinforces to the child that he/she is not alone. Isn't that the greatest lesson to be learned?

Dr. Nahida M.Mulla.M.D.
Vice Principal,
Professor of Repertory,
PG Guide,
HOD of Paediatric OPD.
A.M.Shaikh Homoeopathic Medical College, Hospital & PG Research Centre Belgaum – 590010 (Karnataka)

Mobile: 09448814660.


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Sep29
Building self confidence in children
Build self confidence & self-esteem in your children:
Simple ways to build your child’s self confidence and esteem for a happier child and better parent/child relationships.
All Parents want their children to be confident. Reassurance is something we are all aware of as a parental tool to build confidence, but there are other techniques you can utilize to help build your children’s confidence level. There are three simple, yet very important things to remember:
# 1. Praise.
Praise your children daily on a job well done, or a situation you observe them handling appropriately. Let them know that you approve, and why. When your youngest child colors a nice picture and is eager to show it to you, be sure to praise them. But, also be sure to pick out a singular aspect of the picture to comment on. This tells even the youngest of children that you are interested in what they have accomplished. Praise should go beyond your acknowledgement of the piece of art; it should say to the child that you have paid attention to the details in the picture as well. With this method of praising, and singling out particular reasons a child’s confidence can soar.
# 2. Reliability and Consistency.
Children of all ages not only want to know, but need to know that they can depend on their parents or guardians to be consistent. If you have set rules for a specific dinnertime, be consistent. Do not let the teenager (or any member) of your household upset a family routine or set rule due to a preference, such as eating at friend’s house at the last minute, or being late for dinner due to a game. While there will always be exceptions to this practice, if you are consistent in any given family situation or rule your children will know they can rely on you. Although this strategy might not be popular in your home at first, your family will eventually accept and expect certain rules. They will learn to respect your decisions through your dependability as well. Through the child’s confidence in you his own confidence grows.
# 3. Trust
Trust, as we all know is “earned”. You can and should start building trust between you and your children as early as toddler hood. Nothing builds confidence in humans like trust. Be sure to remain consistent (as mentioned above) when you allow your children to venture forth in new areas. It is not always easy for a parent to feel sure of their children’s abilities, albeit a new bike, or riding that bike to the neighborhood store. Start with small and realistic steps that are agreed upon and carried out. Each success is the essential ingredient to building trust between child and parent.
Building self esteem in kids:
A child’s self esteem is one of the single most important things you can help your child to develop. A good self esteem helps a child to be confident, try new things, get along well with other children, do well in school and countless other things. The way a child feels about himself affects nearly every aspect of his life and children look to adults to learn about who they are. If a child is ignored, for example, he will feel unimportant and will act out in either two ways, he will behave badly to attract attention to himself or he will fade into the woodwork, believing that he is not important enough for anyone to take notice of him. Both examples show evidence of low self esteem.
If you want to build good self esteem in your child, you need to start when they are babies. Children begin to learn about themselves from the very beginning and if you start out right, the rest will be easy. Talk to your baby and praise her often, even for tiny victories like learning to drink from a cup, give your baby applause and let her know she is spectacular. When children see that they can accomplish things it boosts their esteem, especially if it is noticed and praised by adults.
Ask your child for his opinion on things: “What do you think of that movie we just saw?” “What restaurant do you like best?” If you ask for their opinion, they will feel important and valuable. Include your child on family decisions and always consider his input. Don’t ever ridicule your child or tell him that his idea is silly, instead, even if the idea is a little silly, you could say, “That’s a different way of looking at it!” or “How creative!”
Basically, you should treat your child with the respect that you would give to any other person and give plenty of praise and acknowledgement of his status as an important part of the family. Your child will gain friends more easily when he feels comfortable with himself and you will have the peace of mind of knowing he feels good about himself.
Oh, how delicate the thing called self esteem can be! As adults, most of us have noticed that if we are told something often enough, we might end up believing it. If those things happen to be negative, it can be so destructive!
It is very damaging for a child to hear negative things about him or herself. Unfortunately, these things often come from avenues other than their peers or the school bully. Haven’t we overheard parents saying things like “take that outfit off, you look awful!” Or saying within hearing range of a child “Johnny will never make anything of himself. He won’t even sit down to do his homework.”
Too many people simply don’t stop to think of the impact their words might have on an impressionable child. If a young teen experiments with makeup, as an example, words to the effect of “wipe it off, you look like a tramp!” will damage for a very long time while saying “I think a lighter shade of that color would look even prettier” builds self esteem because their efforts have been noticed.
It is hard to determine at exactly what age a child starts “taking it all in” and building what is to be their own self image in their mind. Certainly by the time they’re old enough to understand what “if you keep being too lazy to understand that math work, you’ll never make anything of yourself in life” means. If they start believing that life will be a waste, it will be an uphill battle to build self esteem and the desire to succeed in life. It could make much difference to hear instead “I know you’re having trouble with that math work, Billy. Why don’t we sit down together and figure it out? You’re very smart and I know that between us, we can conquer it.”
How a child views himself relies greatly on those he trusts. The parents. There will be enough peer pressure and bullies over the years; and what the child hears from a parent needs to counteract negative things others will say. It only takes a few short breaths to say “I’m so proud of you!” or “You look great today!”
I recently had an interview with a delightful girl of 15. She had been having some problems in many areas of life. She finally mentioned that she was dating and had been for a while. I took the plunge and asked what led to that decision. She thought for a moment and answered, “Oh, that’s easy. My mother told me that no boy would ever want to go out with me.”
Make your children feel good about themselves. It takes little effort to voice the things you admire about a child. Something like “that shirt really brings out the color of your eyes beautifully” just might make the difference between a terrific day or lousy day for them. If there is a decision they can help with, it’s a perfect opportunity to voice something you admire. “Will you help me choose curtains for your room? You have great taste in things like that.”
Remember, a confident child is assured in love and patience. A confident child is a happy child.
Dr. Nahida M.Mulla.M.D.
Vice Principal,
Professor of Repertory & PG Guide.
HOD of Paediatric OPD.
A.M.Shaikh Homoeopathic Medical College, Hospital & PG Research centre, Nehru Nagar, Belgaum – 590010 (Karnataka)

Mobile: 09448814660.


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Sep29
LOUD SOUND CAUSES HEARING LOSS ! ACUTE DEAFNESS !
Festive seasons are on,it is a common practice in our society to crack crackers and put fire to sound bombs emitting light or fire with sound ,often we forget how much our such activites will cause damage in form of fire and noise to others but we also forget that this noisy sound of high intensity may damge our precious ear for life time.Not only this,the way we live our life everyday we listen to Radio,TV ,Ipods,mobile phones,music system,High speed Rail engines,taking off of Airplanes,Helicopter or noisy vehicles on road or high speedy noisy making machines in factories or Automobile work shops ,announcements and open speeches or mike being displayed before our home or residence by political parties or different religious celebrations or puja or Dusshera or local cultural functions where loud sound comes to us involuntarily and such sound may damage our hearing as smoker in a public places spread damage to near by innocent persons.Hearing loss also occurs when we become old (Presbycusis) or when bony growth takes place at inner ear called Otosclerosis. Protection ,prevention is the best method to get over this donot submit ourself to this noisy sound if possible,donot crack noisy sound crackers,donot listen to radio,mobile phone,TV,Ipod Phones turnig volume very high and close to ears ,in avoidable circumstances either use ear plugs or drums or fingers in ear or cotton packs to prevent hearing loss,simple formula is to avoid listening too noisy or loud sound,tooclosely listening sound and to hear loud sound for some time or continuously.
Sound intensity is measured in the form of a unit called Decibels,sounds too loud or loud sound for aggod time may damage our hearing,sound above 85 decibels may cuase hearing loss even it may be music sound.if a sound of 85 decibels is listened for 8 hrs a day or for about 5 days in a week may damge or hearing,here if sound intensity is increased only upto 03 decibels,i.e.,88 decibels will damage same in half time and a sound of 120-150 decibles or more may damage our hearing in no time.For a sound measurement 10 decibels is considered as one unit ,increase in10 decibels increase sound intensity by double i.e.,this sound is two times loud on listening.Asound below 75 decibels donot damage our hearing evenlistened for much time ,Ipod listend at 60% volume doesnot damage but 100% intensity may damage and it also depends on make,type of sound emitting,how much time and close we are to these instruments .
For example ,Awishper produce 30 decibels,a rainy storm 50 decibels,a Normal conversation 55 decibels , TV 60 decibels,a noisy office 70 decibels,a busy traffic 80 decibels,Hair dryer 90 decibels,an IPOD full volume 110-130 decibels,and same for rock concrete,loud car or home stereo or inside modern cinema house or sitting close to high sound emitting music programmes,Firecrackes and arms upto 140 decibels and same true for a loud engines even at 25 meters.
A sound wave or energy traves from our Ear pinna and Ext auditory Meatus through Bony Ear canal and produce impact on ear drum and make it vibrated and this vibration is carried to inner ear through bones of middle ear MIS and in inner ear Cochlea which contains fluid and a Basilar Membrane on which hair cells are situated are allowed to vibrate and this sound wave is changed into electrical impulse which is carried by Auditory Nerves to Auditory centres in Brain ,all this is situated in a portion clalled Labriynth which also helps us to correct our positon and balacing so damage to internal ear aslo damge our balancing system and in our early childhood Hearing and understanding it also stimulate speeching so if no good hearing speech is also affected and in the last intellegence and learning is also affected.
such hearing loss is some time so slowly that we hardly take precautions in time,so for better undestanding the defect we should be cautions if following symptoms starts as follows:----------------Do I have a problem hearing over the telephone?
Do I have trouble following the conversation when two or more people are talking at the same time?
Do people complain that I turn the TV volume up too high?
Do I have to strain to understand conversation?
Do I have trouble hearing in a noisy background?
Do I find myself asking people to repeat themselves?
Do many people I talk to seem to mumble (or not speak clearly)?
Do I misunderstand what others are saying and respond inappropriately?
Do I have trouble understanding the speech of women and children?
Do people get annoyed because I misunderstand what they say?
so if we found our selves suffering from any thing like this,we should be precautioned and avoid listening close to Mobile Phones,Music System, TV, Ipods,Radio or any cultural or Political or cultural programme or cinema sitting close to loud sound emitting system or use ear plugs at railway or airports or during takeoff and grounding of flights or at factories or at traffic jams or putting fire to crackers or sound emitting crackers or bombs or fire arms.if we prevent it Loud noise hearing loss is completely avoidable.
Dr.D.R.Nakipuria

09434143550


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Sep29
Hernia surgery(Biologic mesh)
Biologic Mesh
From SAGES Surgical Wiki
1 Introduction
2 Basic science of biologic meshes
3 Indications for use
3.1 Non contaminated setting
3.2 Bridging the gap
3.3 Reinforcement of the repair
3.4 Contaminated Setting
3.5 Prophylaxis during stoma creation
3.6 Hiatal Hernias
4 Conclusion
5 References


Introduction
Biologic mesh development resulted from a search for a biomaterial that could address the problems associated with permanent synthetic mesh, including chronic inflammation and foreign body reaction, stiffness and fibrosis, and mesh infection. Since the introduction of biologic mesh, the market has been rife with new biologic materials attached to largely unsupported claims of superiority and safety. With data comprised mainly from animal studies and Level III evidence, there has been little science regarding these materials, yet surgeons have been using these materials with increasing frequency driving a multi-million dollar market.

Basic science of biologic meshes
Most often derived from human or porcine dermis, these materials have been processed to acellular, porous extracellular matrix scaffolds of collagen and elastin. Some source growth factors remain and attract endothelial cells and subsequent fibroblasts into the mesh. These host cells release additional chemoattractants that signal the migration of other structural cells. The three-dimensional nature of the mesh and porosity allow cells to enter the mesh and adhere. What happens from there is a cycle of remodeling consisting of degradation of the biologic mesh and regeneration of the collagen scaffold with host tissue. The balance of this degradation and rebuilding process, and the speed with which it occurs, influences the ultimate strength and structure of the biologic mesh hernia repair.
The processing of the biologic mesh for production is by and large a proprietary procedure, making it difficult for surgeons to access information and answer several questions about the final products. These uncertain areas include decellularization, the sterilization process, the source of human dermis in terms of donor age and body part, and the crosslinking process. The cells are removed from the grafts in different ways: physical means such as dessication, chemical processes, or enzymatic reactions. Some of the products are terminally sterilized while others are not, resulting in variations in storage and pre-use hydration requirements. Sterilization options include gamma radiation, ethylene oxide, or hydrogen peroxide. Some companies instill chemicals, such as gluteraldehyde, into the biologic graft to induce additional crosslinking bonds in the graft to slow down the degradation process in the hope of leading to a stronger host collagen framework. However, this is a not a natural feature of the donor tissue and there is concern about the lack of remodeling in too heavily crosslinked grafts. This unintended feature could result in a poorly integrated graft and foreign body reaction, similar to some permanent synthetic meshes.
The advantage of crosslinked mesh versus non-crosslinked mesh remains a controversial area. Early investigation at Washington University presented at the 2009World Hernia Congress and the 2010 American Hernia Society Meeting showed increased stiffness for two crosslinked biologic mesh products (porcine dermis and bovine pericardium) compared to the non-crosslinked bovine pericardium mesh. 1-2 Greater cell infiltration was seen in the non-crosslinked mesh. Future investigation is warranted as to whether these characteristics are clinically important or if the crosslinked mesh poses an increased risk for infection by preventing collagen breakdown and macrophage migration.

Indications for use
The theoretical advantage of biologic mesh over synthetic mesh has appealed to surgeons, mostly in the United States. These meshes are not widely favored nor used in Europe and elsewhere due to the high cost of the biologic mesh over its cheaper and more widely applicable synthetic mesh counterpart. Over the last decade, surgeons have utilized biologic mesh in a variety of cases ranging from primary ventral and inguinal hernia repair in non-infected fields, recurrent hernias, reinforced hernia repair, hernia prophylaxis, and the most widely used application, hernia repair in the contaminated or potentially contaminated field.

Non contaminated setting
The use of biologic mesh in primary or recurrent ventral or inguinal herniorrhaphy in the noncontaminated and previously uninfected field is difficult to justify due to the high material cost without added benefit. There is very little data regarding the performance of biologic mesh in these settings.

Bridging the gap
The poor performance of the mesh in terms of laxity in a bridging repair makes this an unacceptable repair in the noncontaminated setting. Blatnik et al documented a recurrence rate of 80% for bridging repair with acellular dermal matrix at an average cost of $5,100 per patient, comparing the repair to an “expensive hernia sac.”3 The laxity associated with biologic mesh has been documented in other series.4

Reinforcement of the repair
The use of allograft or xenograft as reinforcement of a primary ventral hernia repair is felt to be a more sound approach. This fits with what we know of the science of biologic meshes in that placement in well-vascularized tissue is favorable for the ingrowth and remodeling process. Rosen’s group at Case Western investigated this and found a reduction in ventral hernia recurrence rate with a components separation midline repair reinforced with acellular dermal matrix (20%) compared to the 80% recurrence after bridging allograft repair.5

Contaminated Setting
The presence of contamination may limit the applicability of permanent synthetic mesh in some hernia repairs. Biologic mesh may be acceptable for this purpose or for placement in open wounds as a staged closure in complex abdominal wall reconstruction. There is limited data in both of these areas, with some noting a high risk of hernia recurrence and associated infection. The data is mostly limited to animal models and case series. 6,7 However, the lack of suitable alternatives has made biologic mesh attractive for contaminated field hernia repair.

Prophylaxis during stoma creation
The role of biologic mesh has been explored in prevention of parastomal hernias. An ongoing study of human dermis allograft placed at the time of construction of ileal conduits after cystectomy shows promising results with a decreased risk of hernia occurrence (30.4% v. 6.3%).8 Biologic mesh has also been used in the treatment of parastomal hernias where infection is a concern.9 With increasing reports of prophylactic synthetic mesh placement at the time of ostomy construction, the use of biologic mesh in this preventative setting may decline.

Hiatal Hernias
Biologic mesh has been utilized in the reinforcement of paraesophageal hernia repair. The randomized controlled trial of mesh repair for paraesophageal hernia lead by Oelschlager is the only Level I human study of biologic mesh.10 This study showed a decreased risk of hernia recurrence with mesh repair, from 24% to 9%. The recommendation for mesh reinforced hiatal repair is made with some caution; significant mesh complications, ranging from mesh erosion to esophageal stenosis and fibrosis, were documented in a follow-up study.11

Conclusion
In summary, biologic grafts represent a major advancement in complex hernia repair. Further investigation regarding the appropriate indications, performance of the grafts based on individual properties such as crosslinking, and potential complications is needed. Given the high cost of most of these materials and the limited available data, biologic mesh should be used judiciously and only when permanent synthetic mesh is inappropriate, such as in the contaminated field. The FDA reported complications of these materials warrant caution and sound surgical judgment.12,13




Biologic/bioresorbable graft comparison




Brand Name
Company
Type


AdditionallyCrosslinked?
Sterilized?

Alloderm®
LifeCell
Dermis
Human
No
No

Allomax™
CR Bard
Dermis
Human
No
Yes

Collamend™
CR Bard
Dermis
Porcine
Yes
Yes

FlexHD™
MTF
Dermis
Human
No
No

Periguard®
Synovis
Pericardium
Bovine
Yes
Yes

Permacol™
Covidien
Dermis
Porcine
Yes
Yes

Strattice®
LifeCell
Dermis
Porcine
No
Yes

Surgimend®
TEI
Dermis
Bovine fetal
No
Yes

Surgisis®
Cook
Intestinal submucosa
Porcine
No
Yes

Tutopatch®
Tutogen

Pericardium
Bovine
No
Yes

Veritas®
Synovis
Pericardium
Bovine
No
Yes

XenMatrix TM
CR Bard
Dermis
Porcine
No
Yes

BioA®
WL Gore
Synthetic bioabsorbable

N/A
Yes

TIGR®
Novus Scientific
Synthetic bioabsorbable


N/A
Yes





References
1. Melman L et al. Proceedings of World Hernia Congress. Berlin, Germany. 2009
2. Melman L et al. Histologic Evaluation of Crosslinked and Non-crosslinked Biologic Mesh Materials in a Porcine Model of Mature Ventral Incisional Hernia Repair. Proceedings of American Hernia Society: Hernia Repair 2010. Orlando, FL. 2010
3. Blatnik J, Jin J, Rosen M. Abdominal hernia repair with bridging acellular dermal matrix--an expensive hernia sac. Am J Surg. 2008 Jul;196(1):47-5
4. Bluebond-Langner R, Keifa ES, Mithani S, Bochicchio GV, Scalea T, Rodriguez ED. Recurrent abdominal laxity following interpositional human acellular dermal matrix. Ann Plast Surg. 2008 Jan;60(1):76-80.
5. Jin J, Rosen MJ, Blatnik J, McGee MF, Williams CP, Marks J, Ponsky J. Use of acellular dermal matrix for complicated ventral hernia repair: does technique affect outcomes? J Am Coll Surg. 2007 Nov;205(5):654-60.
6. Saettele TM, Bachman SL, Costello CR, Grant SA, Cleveland DS, Loy TS, Kolder DG, Ramshaw BJ. Use of porcine dermal collagen as a prosthetic mesh in a contaminated field for ventral hernia repair: a case report. Hernia. 2007 Jun;11(3):279-85.
7. Candage R, Jones K, Luchette FA, Sinacore JM, Vandevender D, Reed RL 2nd. Use of human acellular dermal matrix for hernia repair: friend or foe? Surgery. 2008 Oct;144(4):703-9.
8. Harold KL, et al. Early Results of a Prospective Randomized Study Using Acellular Human Dermal Matrix (Alloderm) to Prevent Parastomal Herniation. Proceedings of American Hernia Society: Hernia Repair 2010. Orlando, FL. 2010
9. Lo Menzo E, Martinez JM, Spector SA, Iglesias A, Degennaro V, Cappellani A. Use of biologic mesh for a complicated paracolostomy hernia. Am J Surg. 2008 Nov;196(5):715-9.
10. Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L. Biologic prosthesis reduces recurrence after laparoscopic
paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg. 2006 Oct;244(4):481-90.
11. Stadlhuber RJ, Sherif AE, Mittal SK, Fitzgibbons RJ Jr, Michael Brunt L, Hunter JG, Demeester TR, Swanstrom LL, Daniel Smith C, Filipi CJ. Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc. 2009 Jun;23(6):1219-26.
12. Rosen MJ. Biologic mesh for abdominal wall reconstruction: a critical appraisal. Am Surg. 2010 Jan;76(1):1-6.
13. Harth KC, Rosen MJ. Major complications associated with xenograft biologic mesh implantation in abdominal wall reconstruction. Surg Innov. 2009 Dec;16(4):324-9.
14. Gina Adrales, M.D. Biological Meshes – Indications and Shortcomings. Challenging Hernias Post-Graduate Course. 12thWorld Congress of Endoscopic Surgery. April 15, 2010


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Sep29
Achlasia Cardia
Introduction
Achalasia is an esophageal disorder of unknown cause characterized by apertistalsis of the esophageal body and non-relaxation of the lower esophageal sphincter (LES). First description is found in 1674, by Sir Thomas Willis. A sponge tipped whale bone was used by a patient to push food down after each meal. The term achalasia was coined by Hurst and Rake (1929) and is Latin for “Failure to relax”, though Von Mikulicz had suggested cardiospasm as the cause in 1981.

Achalasia is an uncommon disease occurring in 5-10 per 100,000 population. Most commonly adults are affected with mean age being 40-50 years. Idiopathic achalasia, found in the northern America closely mimics “Chagas Disease of the esophagus” occurring in South America.




Pathophysiology
Anatomic alterations
Abnormalities in all neuromuscular components of the esophagus and its central nervous connection have been described but a pathogonomic defect remains elusive. Vagal and Doral Motor Nerve Center degeneration is thought to be secondary phenomenon. Most consistently present is the inflammatory reaction with destruction of ganglionic cells in the myenteric plexus in the esophageal wall. There is progressive decrease in number of ganglionic cells with a more advanced disease indicating the loss may later in disease. There is smooth muscle hypertrophy with fibrosis and liquifactive necrosis is thought to be secondary, as is chronic mucosal changes due to irritation by the retained food in the distal esophagus. These changes result in increase incidence of SCC in patients with achalasia.

Physiologic alterations
In healthy esophagus the smooth muscle contraction and resting LES tone is maintained by excitatory cholinergic innervation. To allow peristalsis inhibitory NO/VIP mediated smooth muscle inhibition is generated in response to swallow. The key abnormality in achalasia is impairment of the post- ganglionic neurons to the smooth circular muscle.




Etiology
Genetic theory
86 families have been described but accounts for 1-2% of all patients.

Infectious theory
Possibly a neuro-trophic infectious cause. Herpes virus seems to be most plausible except that they are not uniformly identified. In Chagas disease the cause is Trypanosoma cruzi.

Autoimmune theory
50% patients have anti-bodies and the inflammatory response seen in the esophageal wall is T-cell mediated.

Degenerative theory
some suggestion that in a small percentage of patients, especially the elderly, achalasia is a result of degenerative neurological disorder.




Clinical Presentation
Overview
Mean duration of symptoms is 4.6 Yrs (1mth to 67Yrs)

Patients adapt to slowly worsening symptomatology and present late in the disease progression
Delay in diagnosis due to lack of physician understanding of esophageal motility disorders exacerbates the late presentation
This is frequently confused with GERD and treated as such for a long period of time prior to presentation



Common Symptoms
Dysphagia: This is the most frequent complaint. Liquids are often worse than solids. Usually slowly progressive with weight loss only in advanced disease. Often the patient presents with a history of being the last to finish a meal. Frequently patients report having to use a Valsalva maneuver to force food into the stomach.
Regurgitation: Presents in 75% of patients. Patients can often tell what is regurgitated as the food is undigested. There is a history of chronic saliva, mucous spitting, and drooling on the pillow at night.
Chest pain: Presents in 40% of patients. Patients are often younger with a poor and unpredictable response to dilation or surgical therapy.
Heartburn: Presents in approximately 33% of patients. This is due to undigested food and/or in situ production from fermentation of an uncleared food bolus. This is unresponsive to acid suppression usually hours after eating.
Weight loss: 50-60% of patients show a slight weight loss usually late in the disease progression. If weight loss if significant, malignancy should be suspected.
Megaesophagus: 6 cm dilation of the esophagus with tortuosity.



Diagnostic Testing
Upright Chest X-ray: Widened mediastinum, air-fluid level in the mediastinum, absence of a gastric air bubble
Barium Swallow (with fluoroscopy): this is the single best diagnostic test
No peristalsis, possible simultaneous contractions
Poor clearance (normal < 1 minute)
Bird beak tapering of the LES (smooth narrowing)
Irregular shadow on the top of the barium level: due to food and liquid in the esophagus
Esophageal dilation (sigmoid esophagus in late stages)
Esophageal Manometry: this it the gold standard for diagnosis
Aperistalsis of the esophageal body (especially in the distal 2 channels), also called simultaneous waves/non-propulsive waves
Body pressure usually less than 40 mmHg. If > 40 mmHg then this is called "vigorous achalasia"
Hypertensive non-relaxing LES
Esophageal pressurization (the baseline does not return to below gastric zero level after the catheter has been withdrawn into the esophagus). This is due to retained food and fluid in the esophagus
Inability to advance catheter into the stomach with the possibility of needing an EGD to advance the catheter
Endoscopy: This is always done to rule out other causes of the patients symptomatology (e.g. malignancy)
Dilated fluid-filled esophagus
Tortuosity
Thickened mucosa with friability
Difficult to negotiate LES
Normal LES on retroflexion view
EUS/CT Scan: used to rule out pseudo-achalasia



Treatment Options
The goal of treatment is to improve esophageal clearance.

Medical Therapy
Nitrates and Calcium channel blockers. These are used to relax a hypertensive LES

Botulinum Toxin
BTX administration to the esophagus results in paralysis of the LES with a decreased resistance and increased clearance

Technique: 100 U (4 divided doses) injected intramuscularly in the LES (1 cm above the squamo-columnar junction)
75-90% first time response
50% effect after 6 months
Repeat injections are possible but progressively less helpful
Repeat injections are reserved for those unfit or unwilling to undergo surgery
Use in pseudo-achalasia to differentiate from classical achalasia
Reports of increased risk for mucosal perforation if myotomy is required later
Pneumatic Dilation
This is the oldest known therapy and was first introduced in 1898.

Technique: Rigiflex dilator (3.0, 3.5, 4.0 cm sizes) done under fluoroscopy
2-3% full thickness perforation
50-85% symptom control at 5 years
Frequent need for repeat dilations
Progressive decrease in symptom control over longer periods
Surgical Cardiomyotomy (Heller myotomy)
First described by Heller in 1913 as trans-thoracic double myotomy (anterior and posterior), and subsequently modified to single long anterior-lateral myotomy by Zajjer (1923) has remained the standard of surgical intervention till mid 1990’s.


Pelligrini has been a pioneer in applying minimally invasive technique to the procedure and has evolved the extent of myotomy and need for fundoplication since 1990’s to now.
First reported change was use of left VATS (thoracoscopic) (1992) while maintaining a long esophageal myotomy with only minimal extension (0.5cm) on to the stomach. Reports of 80% relief of dysphagia with 42% GERD symptoms.


To decrease dysphagia the myotomy needed to be extended more on to the stomach. Hence conversion to trans-abdominal (laparoscopic) method. Initially 1.5-2 cm on to the stomach with a Dor fundoplication (1994) to prevent reflux (also the anterior fundoplication helps protect the mucosa). Since then this group has further changed to extend the myotomy 3 cm on to the stomach and use a Toupet fundoplication (1998) for anti-reflux. 95-90% relief with 13% GERD.

If Megaesophagus is encountered, treatment is either via a Heller myotomy (some have reported poor surgical outcomes) or an esophagectomy at experienced centers.

Recurrent Symptoms after previous myotomy
Previous thoracic myotomy
Recurrent dysphagia with or without GERD

Dilated distal esophagus
Perform an extended myotomy onto the stomach with fundoplication if dysphagia is the primary symptom
Esophagectomy a good option, but trans-thoracic mobilization might be needed
Previous Laparoscopic myotomy
Due to either an incomplete myotomy, refibrosis, or obstruction due to fundoplication
Redo Heller myotomy with fundoplication is treatment of choice
If needed a transhiatal esophagectomy is also a good option



References
1. VaeziMF,RichterJE.CurrentTherapiesforAchalasia:Comparisonand efficacy. J Cli Gastroenterolo 1998;27:21-35.
2. Richter JE. Achalasia. The Esophagus 4th ed. Lippincot, Williams and Wilkins. Eds. Castell, Richter.
3, Oelschlager BK, Eubanks TR, Pelligrini CA. Surgery for esophageal motor disorders. The Esophagus 4th ed. Lippincot, Williams and Wilkins. Eds. Castell, Richter.


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Sep28
Power struggle!
Getting out from the departmental store with my shopping bag, i was loading them in my car when i noticed a motorbike parked nearby. A crow was sitting on the petrol tank of the bike, and with a surreptitious look around, he delved into a pouch that was fixed on the bike and pulled out a goodie; a pistachio shell!. He looked around again, noticed another crow nearby, and quickly put the nutshell back again and nonchalantly started to look elsewhere. I am almost sure he also caught my eye!. With another look at the other crow, he seemed to be debating what to do, and then decided to carry the war right into the enemy camp. He flew to the place the other crow was sitting, and chased it away. The poor chap did not know what was happening and with a furious caw, flew away, probably cursing the chaser but deciding to leave the battle scene!.
I did not stop to see whether the crow came back for the nut shell (ironic isn’t it, all this was for not even the nut, just the shell!), but was thinking about how we humans and crows are so similar in our interpersonal relationships. I have seen this happening so often in the corporate jungle. People vie with each other for positions and power, and very often than not, the rules of the game are not followed; if they at all are, they are conveniently bent to suit the needs of the few who know how to win. The winning is all that matters. So these games are played out, in board rooms, in conferences, at meetings, and in cabins behind closed doors. The chase is subtle but it is persuasive. The victim either decides, like the crow in our story, to leave the scene but carries with it anger and resentment and even feelings of being victimised and being a scapegoat. Or he decides to give it a fight, and then the real battle ensues.
These feelings, if not handled constructively, become the emotional baggage that the person carries; and this feeling of having lost out may permeate into his other areas of living, sometimes making relationships also very dysfunctional. See the whirlpool effect?
I think it all boils down to fighting right: even in personal relationships. Squirrels have to bury food: so they do. But it is not seen as ‘hiding’ it away. It is acting in character to its species. But on second thoughts, i think the crow also acted in its nature? Don’t they say crows are supposed to thieve?? But do we humans act in our true nature? Are we not essentially supposed to be ‘good’ ? Then why do we deliberately push down, degrade other fellow beings, all for money, power, position? If we let go of the need for greed for power and control, i think a lot of our interpersonal conflicts can also resolve itself. Most of them start with power struggle: If the need for being in control: of others, not of self, is examined, and saturated not by controlling another human being, but by renouncing the need by itself, then i am sure life would be so much more fulfilling.
Mohana Narayanan


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Sep28
A PROSPECTIVE STUDY OF ALLERGIC RHINITIS IN CHILDREN & ITS HOMOEOPATHIC MANAGEMENT
ABSTRACT:
Allergic rhinitis is one of the most commonly diagnosed health disorders among children. AR affects up to 20 percent of children. Boys are twice as likely to get allergic rhinitis as girls. The median age of onset of the condition is 10 years old, meaning that equal numbers of children develop the condition before and after age 10. Half of children develop the condition before age 10, and half after that time. Allergic rhinitis is the most common chronic disease in children. About one in five children has symptoms by the age of 2 or 3 years .A study in found that 42% of children were diagnosed with allergic rhinitis by the age of six. Commonly called hay fever. Allergy symptoms can have a profound effect on a child’s health, behavior and ability to learn. Left untreated, allergic rhinitis also can lead to a host of other serious conditions, including asthma, recurrent middle-ear infections, sinusitis, sleep disorders and chronic cough.
The present study is undertaken to study the efficacy of Homoeopathic remedies in the treatment of allergic rhinitis in children. 100 cases were studied. Out of which 55% recovered ; 35 % improved & 10 % did not improve.

INTRODUCTION:
Allergic Rhinitis presents with the following symptoms:
1. Nasal allergies typically feature a clear nasal discharge with sneezing.
2. There may be itchy, watery eyes & / a dry cough.
3. Parents often notice a “rabbit nose” – A child crinkling her nose to relieve the itchy sensation inside.
4. “Allergic shiners” – dark circles under the eyes, have long been associated with allergies, but are less predictive than the other symptoms.
5. “ Allergic Salute” – A common habit of children which consists of rubbing their nose upwards. This is usually because the nose is itchy & this practice can lead to a small crease in the skin of the lower part of the nose.
6. Mouth breathing often leads to dryness & cracking of the lips & children are often very thirsty & may wake at night for a drink of water.

Types Of Allergic Rhinitis:
The two categories of allergic rhinitis include:
1. Seasonal - occurs particularly during pollen seasons. Seasonal allergic rhinitis does not usually develop until after four years of age.
2. Perennial – occurs throughout the year. This type of allergic rhinitis is commonly seen in younger children.
NEED FOR THE STUDY:
• Allergic Rhinitis in children is a commonly prevalent condition all over the world.
• Every year millions of people use over the counter (OTC) products to relieve nasal stuffiness & conditions like sneezing, running nose, sore throat & cough. The common causes of these symptoms include allergic rhinitis (Hay fever).
• Allergic rhinitis, which occurs during a specific season, is called “Seasonal allergic rhinitis”. When it occurs throughout the year, it is called “Perennial Allergic Rhinitis”.
• Allergic rhinitis in children is a common clinical condition we encounter in our OPD & the fact is that, Homoeopathy can deal with this state effectively.
• In such a common clinical condition, the conventional system of medicine has a limited scope & treat this clinical condition with antihistamines, decongestants, topical & systemic steroids, which in addition to sedation, can produce dizziness, tinnitus, blurred vision, tremors, dry mouth & poor concentration. Occasionally blood dyscracias have been reported & sensitization can occur with urticaria & eczema.
• Allergic rhinitis in children if left untreated may lead to chronic sinusitis, otitis media, allergic bronchitis etc.
• Homoeopathic medicines have been found to be having good scope in the treatment of allergic rhinitis in children. Hence there is a need for a systematic & scientific study.

Aims and Objectives: The present study was undertaken to fulfill the following objectives:
• To study the pattern of presentation of allergic rhinitis in children.
• To study the miasmatic background and its implication on allergic rhinitis in children.
• To study the Homoeopathic management of allergic rhinitis in children.
• To study the efficacy of Homoeopathic remedies in the treatment of allergic rhinitis in children.

Material and Methods:
7.1 SOURCES OF DATA
The subject for this study were taken from A.M. Shaikh Homoeopathic Medical College and Hospital, OPD/IPD and village health camps.

7.2 METHOD OF COLLECTION OF DATA (INCLUDING SAMPLING PROCEDURE, (IF ANY)

Following is the inclusion criteria fixed for the study:
Subjects from 0-12 years and of both the sexes irrespective of socioeconomic status.
Following is the exclusion criteria fixed for the study:
• Subjects with active treatment for any other chronic disease.
• Subjects with worm infestations having high eosinophil count.
Patients were selected on the basis of inclusion & exclusion criterias. A detailed case history was taken with clinical presentation.
Patients were reviewed on every seventh day for the first two months and later every 15 days for the remaining period of study.
No sampling procedure was adapted.
All the cases of allergic rhinitis were taken for the study, between the periods of December 2005 to 30th June 2008. (No new cases were taken up for the study after June 2008). Total Number of cases = 100.

CRITERIA OF BASIC ASSESSMENT OF RESPONSE:
(A) Subjective: General condition; Appetite; Thirst; Bowels; Sleep; Itching.
(B) Objective: Sneezing; Nasal discharge; Nasal obstruction.


Conclusion: The following valid conclusion can be drawn from the study.
1. The maximum incidence of the patients suffering from allergic rhinitis is in the age group of 2-10 years.
2. Males were found to be more prone to allergic rhinitis compared to females in this study.
3. The constitutional remedies which gave maximum benefit to the patients were mainly Ars Album, Nux Vom, Pulsatilla, Sulphur, Nat Mur, Kali mur, Silicea, Calc carb, Natrum sulph & Kali bich.
4. The constitutional remedies gave maximum relief to the patients. The patient improved faster after the administration of constitutional remedies.
5. The miasmatic and constitutional approach of treatment was only successful when they were integrated. This study gave me a better idea in my attempt to treat cases of Allergic rhinitis.
6. Homoeopathic Management of Allergic rhinitis is able to annihilate the disease and helps to reduce the intensity and frequency of the episode of Allergic rhinitis.
7. There is a better scope in Homoeopathic for the treatment of Allergic rhinitis, since the treatment is based on holistic and individualistic approach.
8. Homoeopathic remedies not only annihilate the disease but also prevents the complications associated with it. However further studies need to be carried out to understand the finer menaces of the disease.
9. This was a modest effort on my part to find the role of Homoeopathic medicines in the treatment of different types of Allergic rhinitis and the response in this study is quite satisfactory. Dr. Nahida M.Mulla.M.D.
Vice Principal.
Professor of Repertory & PG Guide.
HOD Paediatric OPD.
A.M.Shaikh Homoeopathic Medical College & Hospital,Nehru Nagar, Belgaum – 590010.
Mobile – 9448814660.


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Sep27
GLOBAL STRESS THE POSSIBLE ROLE OF NAMASMARAN IN TOTAL STRESS MANAGEMENT
GLOBAL STRESS
THE
POSSIBLE
ROLE
OF
NAMASMARAN
IN
TOTAL
STRESS MANAGEMENT

DR.SHRINIWAS KASHALIKAR
The ascent of our petty self and its merger into the true self i.e. cosmic self is hypothesized to be possible through the practice of NAMASMARAN.

The term cosmic self refers to the source of cosmic conscience, thoughts, ideas and their execution.

The entanglement in the petty self leads to total inertia or perverted and fanatic activities. This is characterized by indiscriminate violence, destruction of nature and brazen exploitation of others. This may be termed TAMAS.

The entanglement in the petty self; can also lead to intelligent, skilled, but sectarian and hence selfish activity aimed at the petty gains of few. This is characterized by subtle, disguised and cunning exploitation, deception, cheating, frauds, lies, hypes, through a variety of tactics and technologically advanced means. The cruelty is concealed and hence majority fall prey to it; willingly or unknowingly but readily!
This may be termed RAJAS.

The entanglement of petty self may also lead to otherwise innocuous, harmless, egalitarian activities such as involvement in the study (though inadequate) of various sciences, arts, and technology. This self contented attitude associated with kindness (though insufficient and restricted to personal favors and certain philanthropic activities) is SATVA.

More practice of NAMASMARAN by more people; is hypothesized to help more people; in the ascent of petty self and merging with the cosmic self (The source of the holistic perspective, ideas, feelings and actions i.e. superliving); and lead to commensurate rectification of everything governed by the TAMAS, RAJAS and SATVA and achieve Total Stress Management!


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Sep27
STRESS ALCOHOL AND TOBACCO
STRESS
ALCOHOL
AND
TOBACCO


DR.
SHRINIWAS
KASHALIKAR

One of the hallmarks of STRESS in our life; is discrepancy, dysrhythmia and discord within our own selves!

There is always a discrepancy, dysrhythmia and discord; between our imagination, thoughts, feelings, instincts, physical requirements and our habits! They are almost never identical or even in sequence, order or harmony. They may be not merely dissimilar; but often are; contradictory.

Thus we may not think the same; as what we imagine and we may not feel the same; as what we think (and talk and write). Our instinctual cravings also may not in tune with our emotions. Thus instinctual needs may force us to indulge in something that makes us sad and repent!

Hence even if we fantasize a utopia of some heaven on the earth, intellectually it may be inconceivable. Even if there is intellectual argument about good and bad feelings; it may not be valid in day to day emotional interactions. Even if there are deep sentiments about morality pertaining to passions; they may not match with our instinctual actions such as sexual behavior! Similarly irrespective of what we think and feel about our habits or addictions; many of us helplessly continue to indulge in them.

This is also why; spiritual perceptions occupy only a small corner of our thinking and intellectual debates occupy a small fraction of our literature and art.

In fact; adolescent and often illicit sex, voyeurism, crimes such as kleptomania, and habits such as smoking, drinking etc. form a romanticized and conspicuous part of our cinematic and dramatic creations.

On this background it should be easy to understand; why habits such as tobacco and alcohol in different forms; are popular amongst many of us; irrespective of age, sex, occupation, economic status, nationality, race, religion etc.

This continues to be so inspite of their well publicized risks for health; and their condemnation by the ministries of information and broadcast of different countries and several philanthropic organizations; in the world.

Whether the alcohol and tobacco are the culprits or whether our vulnerability to addiction; are responsible for the sway these things hold on our life; is a moot question.

Moreover; our nature also seems to vacillate between elation in hedonistic pleasures and some kind of fantasizing of austerity!
One question that tends to bother us; is; what are we going to gain by “sacrificing our pleasures and/or excitement of indulgence; while facing the reality of life; especially when no one can guarantee sound physical health and sound financial status; by abstinence?”

It is in this context that the ancient wisdom, which is valid today; guides us!

The seers of the past such as Sadguru Shri Gondavlekar Maharaj; comprehended all these and many more complexities of our nature; and provided us with; the eternally benevolent guidance.

Thus; our problem is of inadequate emergence of our consciousness, which is entrapped in pettiness of perspective, policy making, motivation and actions, inevitably associated with excitement of petty gains and misery of petty failures!

Hence; even if we are not addicted to tobacco, alcohol or anything else, (and may take pride in it); we still can be destructive to self and the others.

Hence they did not indulge in fanatic and inconsiderate condemnation or blatant encouragement of our vulnerability and weakness. In stead; they provided us with the means of empowerment and enlightenment to rise above and grow out of the vulnerability, weakness, weariness and pettiness! They enabled us to overcome the attitude of delirious justification and pride; as well as the incapacitating sense of guilt about our addictions and habits!

They showed us the way of fulfillment of our life. They actually showed us the immortal and sublimely romantic culmination of the essence of our perspective, imagination, thoughts, feelings, instincts, needs and also our habits! They gave us a holistic solution to evolve a sublimely meaningful life, instead of nagging or pampering us; about our habits in isolation!!

Hence; in stead of going into the domestic, economic, medical, cultural and other angles and issues involved in the habits/addictions (including those of tobacco and alcohol); with a fragmented approach; we should (at least provisionally) unhesitatingly accept and verify the scope and limitations of the holistic solution provided by the seers!

Which is this holistic solution?

This holistic solution is; a really universal practice of NAMASMARAN that endows the enlightenment and empowerment on us; irrespective of our age, sex, occupation, religion, race, nationality etc; to blossom all inclusively and experience the ultimate fulfillment in life!

In fact; the benevolence of NAMASMARAN does not limit to helping us to conquer alcohol and tobacco; but it reveals to us; the individual and global blossoming embodied in Total Stress Management; which is the mega synthesis or mega reunion of philosophy and science, spiritualism and materialism; and theism and atheism!


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