The Budd-chiari syndrome is a heterogeneous group of disorders characterized by hepatic venous outflow obstruction at the level of the hepatic venules, the large hepatic veins, the IVC or the right atrium(1). Hyper coagulable states of the blood are the most common etiology of this disorder(2); amongst which sickle cell disease is a rare cause(2). This part of Orissa is having high incidence of SCD and trait. No such case report has been done earlier.
Sickle cell disease is a type of Hemoglobinopathy characterized by production of abnormal sickle Hemoglobin (Hbs). This abnormality is due to the substitution of valine for glutamic acid at the 6th position of  chain of globin(34). The abnormal HbS tends to polymerize on deoxygenation and the RBCs containing HbS become less pliable and consequently deform into the characteristic sickle shape, for which the disease is named so. This disorder is acquired by inheriting abnormal sickle genes from both the parents.

Patients Initial: A S
Age: 02 months
Sex: Male
Date of Case taking: 5th Oct�08
Treating Physician: Dr. Nilesh J Shah M D (Hom) Bhakti Homoeopathy Dispensary, Pune � 37.
Probable Clinical Diagnosis: Lobar Pneumonia clinically diagnosed with High grade fever, cough, Chest auscultation findings of coarse crepitation in right mid zone.
O D P: Patients mother called up at 6:00 p.m. saying that doctor Abdullah is admitted for past four days and his fever is not coming down yet. Further mother said that he is very restless for past four days is continuously crying and is not pacified by any thing or in any way. He has not slept for past four days nor any one of us have slept. Please doctor if you can come and see him in the hospital.
This is all what the mother had narrated and I assured her that I will come after my clinic hours. I had repertorised before going to the hospital and had taken the medicine.
On approaching hospital I saw that the child was sedated as he was restless, and he had fever.
Presently on visiting he c�s /o
Location Sensation Modality Concomitant
Lung, Right side Pneumonia Crying continously not knowing for what nil
Not relieved by any act
Past history: Recurrent history of cold coryza since birth

References:
Repertory: Synthesis
Complete
Materia Medica: Clarke�s Dictionary
Close coming remedies:
1. Cina
2. Ars A
Final Prescription: Chamomilla

Potency: Cham 200 single dose on 5th Oct�08
S L 4 pills TDS
Patient was having good susceptibility and the disease was of Acute nature.
Remedy Repetition: Single dose was prescribed
Follow up next day
Follow up Analysis
6th Oct�08 Mother called at 8:00 a.m. saying doctor thank you very much we all could sleep yesterday. That is all what was required. She said that there was no fever since night and had peaceful sleep. And asked what next to do, we kept him on SL
7th Oct�08 She again called and said doctor since yesterday he is passing green stools, I asked her whether he was at ease or not, she said he is at ease and again I advised her to continue with SL pills
8th Oct�08 Patients grand mother came to my clinic and said that in hospital

Learning from the experience of this case
1. Acute cases also need to be worked with prime importance paid to the altered state of Mind.
2. Do not get baffled when particulars are not found in Materia Medica
4. Homoeopathy works FASTEST confirming Aphorism 1 & 2.

DO HOMEOPATHIC DRUGS CONTAIN STEROIDS ?

The answer is a definite '�NO'�.
When appropriate Homeopathic medicines act fast & help acute conditions, people often ask or feel that the physicians are using steroids in the garb of Homoeopathy for quick results.
First of all, can steroid cure all the conditions? No, it will give only a palliative relief for the time being. Also, if you take steroids for a long time, it would induce puffiness of face �moon face�, excessive body hair, osteoporosis, weight increase etc. You can�t find in a single patient using Homeopathic drugs any of the above symptoms of steroid drugs. We don�t use any steroidal drugs since it is against the law of Homeopathy. i.e. steroid suppresses the immune mechanism where as Homeopathy stimulates the immune mechanism for expelling the disease.
The commonly performed test to find out steroids is the "Colorimetric Method test" which gives a false positive result for any reducing sugar & aldehyde. As you know, most homoeopaths use lactose as a base for holding the pills, containing the homeopathic remedy, together in the powders. The pills themselves are made of cane sugar, a reducing sugar. Moreover, almost all Homeopathic remedies have alcohol as a diluting agent. One can see how Homeopathic remedies, either as pills, powders or in alcohol, are likely to give a false positive test for steroids if this method is used. The best test to find out if the medicine contains steroids is the "Liberman Buchard" test, Thin Layer Chromatography Method & a UV Absorption Method. This method helps in differentiating & finding out if the substance indeed contains steroids.
Thus it is clear that before accepting a claim that the tested medicine does contain a steroid, one must find out what testing procedures were used to eliminate the possibility of a misleading result. Unsubstantiated allegations against any doctor or system of medicine are most unfair and damaging to his professional integrity and indeed to the profession.
Homeopathic medicines are completely safe and non-addictive. They can be used without any anxiety by anyone, including small babies, children, pregnant women, breast-feeding mothers, the elderly, and the chronically ill.

Knowledge Dissemination: Continued Medical Education

Key words: Knowledge, Medical Knowledge , hoarding , dissemination


Introduction:

At the simplest level, dissemination is best described as the delivery and receipt of a message, the engagement of an individual in a process, or the transfer of a process or product. It is also helpful to think about dissemination in three broadly different ways, viz., dissemination for awareness, for understanding , and for action. Indeed, effective dissemination of a knowledge product will most likely require that it satisfy all three in turn: utilization is the goal. Knowledge is a "thing" that simply needs to find a good home� Nowhere is this more apparent than in the worthy effort to define dissemination as consisting of four activities: spread, exchange, choice, and implementation.

Definitions of dissemination also reflect differing assumptions and beliefs about the ways in which knowledge is used, indeed about the very nature of knowledge itself. The focus varies from perceiving dissemination and utilization as linear, mechanical processes of "transfer," in which knowledge is packaged and moved from one "place" to another, much as an appliance might be packaged and shipped, to characterizing the process as highly complex, nonlinear, interactive, and critically dependent on the beliefs, values, circumstances, and needs of intended users.

Scholarly research makes a profound contribution to the social, cultural and economic wealth of a country. The results of research, referred to here as "scholarly knowledge", is created, organized, preserved and disseminated within the scholarly communication system. Many countries are undertaking national research strategies aimed at understanding and navigating these changes. In order to optimize the dissemination of scholarly knowledge, it is critical that we develop a comprehensive research strategy to examine the future of scholarly communication in this country.

Creation, manipulation, management and dissemination of knowledge cannot go on forever without determining what impact it is having on those who create it and those who use it. This paper explores methods of determining the impact of disseminated Knowledge. It does this by first defining what knowledge is. This is followed by a discussion on different mediums through which knowledge may be disseminated. It then discusses two questions � when do we know when to disseminate knowledge and how do we know when it has been disseminated.(1)


MEDIUMS OF KNOWLEDGE DISSEMINATION

Contrary to Plato and Foskett�s definition of knowledge, it is postulated that knowledge is information that is acceptable to a norm about a subject. In treating different mediums that may be used to disseminate knowledge, it is argued that mediums of disseminating knowledge can be grouped into two main categories, namely natural and man made mediums. Natural mediums of knowledge dissemination include audio and gestures, which are performed by all leaving beings whereas; man-made mediums include all mediums of communication that man has developed out of transforming matter.

Knowledge itself cannot be monitored, only presence in its carrier can. Ipso facto, analyzing different carriers of it or usethereof, not knowledge itself, can do evaluation of knowledge because an indisputable truth is that presence of knowledge is only manifest in its application. In monitoring and evaluating knowledge as transformed matter, the criteria of process and progress; relevance, efficiency, effectiveness, impact and sustainability may be used respectively. Techniques of analyzing applied knowledge data abound. For something to count as knowledge, it must actually be true. I see knowledge as information that is acceptable to a norm about a subject. As long as the information that you have conforms to an established and acceptable societal norm, it is knowledge it does not have to be true. If it conforms to an established norm, it will always be believed. As soon as the norm changes, what you know becomes information. When people do not believe you, it is simply because what you say to them is not acceptable to their norm. Good knowledge is useful knowledge. It permits man�s survival by allowing him to use it to solve his problems.

When we attend schools or listen to priests preach to us and accept what they tell us as reasonable and pass it on to other people or use it to solve our problems, what we are doing is simply accepting new norms about new or existing subjects. According to Polanyi, ��tacit knowledge is what is in our heads and explicit knowledge is what we have codified� Given that tacit knowledge is knowledge that is in our heads the easiest and the only way to disseminate this type of knowledge is through organs of the body. We can communicate it through voice. This method of communication is largely applied in schools from primary to tertiary. Besides explicit communication, a lot of information and knowledge is passed on from one person to another through gestures. Laughing is a simple sign of happiness. Shrugging your shoulders indicates that you do not know. Of unique interest to note though is that gestures are not universal, they are unique to societies. Nodding one�s head means that one is in agreement with what is being said after the European fashion. The converse is true in the Asian culture. In the Asian culture when you shake you head from side to side this means concurrence with what is being said. One of the notable efforts to try to address the problem of different norms and standards on gestures is what has come to be known as the sign language which came into being as an effort to address different human beings impairments such as speech and hearing. This confirms the definition made earlier on that knowledge is that which conforms to a norm about any subject.

The second type of knowledge is explicit knowledge. This is knowledge that has been codified. How can knowledge be codified? Codification of knowledge came as a result of man�s application of tacit knowledge to transform matter into various useful objects for his survival. Writing is the oldest form of codifying knowledge. Most of the world�s knowledge is in written form in the form of books. With further transformation of matter through application of tacit knowledge other ways of codifying knowledge have emerged over time. We now find knowledge in medium such as recorders, the INTERNET and others. Of particular interest to me is knowledge that is manifest in transformed matter.

HOARDING KNOWLEDGE

There is no stipulated rule on where and when knowledge should be disseminated. The simple answer to this question is knowledge is ready to be disseminated when the holder of it feels it is ready to be. Besides, it does not make sense to acquire knowledge to hoard it. In fact, it is impossible to hoard knowledge because we need to constantly exchange it for survival. Hoarding of knowledge makes sense only when one does it in order to gain comparative advantage over other human beings. Even this is not eternal. Overtime, the hoarded knowledge gets known and is further exchanged. Dissemination of knowledge is often done with a certain intention in mind. When this is the key reason for knowledge dissemination, it is important to determine whether knowledge dissemination has really taken place. This is important for a number of reasons. One, it allows for learning on whether knowledge was successfully disseminated so that if not other means of disseminating it successfully could be devised. For example, at institutions of learning gauging of knowledge dissemination is done through tests and examinations as we all know and two, for accountability purposes. (4) However, the key gauge of whether knowledge has been disseminated is its application. As indicated earlier, as tacit knowledge, knowledge application is seen in the development of different solutions in the form of products and services. In a codified form, knowledge dissemination is seen in the use of the products and services to solve societal problems. Note before, knowledge use does not only lead to useful solutions to societal problems, at times it creates more problems and leads to societal ills. A clear epitome of this is the atomic bomb that was dropped by the Americans on Hiroshima and the current nuclear age in which nuclear bombs, which are an epitome of man�s application of his knowledge, are a threat to humanity.


MEDICAL KNOWKEDGE

Medical doctors claim that their discipline is founded on scientific knowledge. Yet, although the ideas of evidence-based medicine are widely accepted, clinical decisions and methods of patient care are based on much more than just the results of controlled experiments. Clinical knowledge consists of interpretive action and interaction�factors that involve communication, opinions, and experiences. The traditional quantitative research methods represent a confined access to clinical knowing, since they incorporate only questions and phenomena that can be controlled, measured, and counted. (2)
Biomedical knowledge is expanding at an unprecedented rate-one that is unlikely to slow anytime in the future. While the volume and scope of this new knowledge poses significant organizational challenges, it creates tremendous opportunities to release and direct its power to the service of significant goals. One can achieve those by integrating numerous resource-intensive, technology-based initiatives-including personnel, services and infrastructure, digital repositories, data sets, mobile computing devices, high-tech patient simulators, computerized testing, and interactive multimedia-in a way that enables the center to provide information tailored to the needs of students, faculty and staff on the medical center campus and its surrounding health sciences colleges.
Emphasis must be made on discovering, applying, and sharing new knowledge, information assets, and technologies in this way is a collaborative process. This process creates open-ended opportunities for innovation and a roadmap for working toward seamless integration, synergy, and substantial enhancement of the academic medical center's research; educational, and clinical mission areas (5)
Continuing Medical Education
Continuing medical education (CME) plays a key role in test ordering, while pharmaceutical manufacturers� representatives are important sources of information concerning new therapeutic agents. The dissemination of information is a complex process. Physicians frequently use multiple sources of information in the decision making process. Physicians and planners of CME must be aware of what types of educational activities are best suited for their needs (6)
The tacit knowing of an experienced practitioner should also be investigated, shared, and contested. Qualitative research methods are strategies for the systematic collection, organization, and interpretation of textual material obtained from talk or observation, which allow the exploration of social events as experienced by individuals in their natural context. Qualitative inquiry could contribute to a broader understanding of medical science. The Internet is a convenient but complex source for health information used by an increasing number of health consumers. Especially for people suffering from a chronic illness (e.g., diabetes), information seeking forms a part of the daily management of the disease, a �project of life.� The study of Web texts examines the citation patterns for a specific and controversial health issue: the beneficial or hazardous use of dietary chromium supplementation in diabetes self-management. Texts from different categories of Web sources (scientific, professional, educational, and commercial sources, as well as diabetes discussion groups) were analyzed in order to study how knowledge is transferred between sources, and how diabetics participating in discussion groups refer to and make sense of the information from different sources on the Internet. The citation patterns suggest that deviations from the traditional models of scientific knowledge dissemination can occur in the Internet environment (1).
It is beyond argument that Continued Medical education (CME) should play a very significant role in the changing health care environment. There are various types of literature (e.g., concerning learning and adult development principles, problem-based/practice-based learning, and other topics) that contribute to ways of thinking about and understanding CME. It is gratifying that the Association of American Medical Colleges (AAMC) has made a commitment to helping CME be more effective in the professional development of physicians.
The professional development of physicians is a lifelong commitment that builds on formal and informal opportunities to learn emerging science, apply innovations in clinical settings, and expand understandings of caring for patients. One essential element in that commitment has been continuing medical education (CME), the final part of the education continuum. Although CME has a long history in supporting physicians as lifelong learners, it has become increasingly important and focused during the past ten to 15 years as a result of the impact of changing educational, social, and political forces on medical practice. People in academic medicine can support continuing medical education to respond to the changed and changing health care environment, and suggest new directions for individuals and institutions involved with continued learning.
CONCLUSION
As far as medical knowledge dissemination it is imperative that collaboration among the appropriate academic groups, professional associations, and health care institutions, with leadership from the state bodies, is essential to create the best learning systems for the professional development of physicians.
Building new knowledge-based systems today usually entails constructing new knowledge bases from scratch. It could instead be done by assembling reusable components. System developers would then only need to worry about creating the specialized knowledge. New systems should interoperate with existing systems, using them to perform some of its reasoning. In this way, declarative knowledge, problem- solving techniques, and reasoning services could all be shared among systems. This approach would facilitate building bigger and better systems cheaply. The infrastructure to support such sharing and reuse would lead to greater ubiquity of these systems, potentially transforming the knowledge industry. One sees a vision of the future in which knowledge-based system development and operation is facilitated by infrastructure and technology for knowledge sharing. It is believed that newer initiatives currently under way to develop these ideas would pave a long way in the complex yet simpler process of knowledge sharing and dissemination. The future is looking expectantly to realize this vision.





References:

1. Enabling Technology for Knowledge Sharing
Robert Neches, Richard E. Fikes, Tim Finin, Thomas Gruber, Ramesh Patil, Ted Senator, William R. Swartout AI Magazine, Vol 12, No 3


2. Health discussions on the Internet: A study of knowledge communication through citations: Marianne Wikgrenv Department of Information Studies, �bo Akademi University, Tavastgatan 13, FIN-20500 �bo, Finland




3.Continuing Medical Education: A New Vision of the Professional Development of Physicians
Bennett, Nancy L. PhD; Davis, Dave A. MD; Easterling, William E. Jr. MD; Friedmann, Paul MD; Green, Joseph S. PhD; Koeppen, Bruce M. MD, PhD; Mazmanian, Paul E. PhD; Waxman, Herbert S. MD Academic Medicine: December 2000 - Volume 75 - Issue 12 - p 1167-1172

4. Www.researchutilization.org/matrix/resources/review/ -

5. Managing Knowledge and Technology to Foster Innovation at The Ohio State University Medical Center
Cain, Timothy J. PhD; Rodman, Ruey L. MLS; Sanfilippo, Fred MD, PhD; Kroll, Susan M. MLSAcademic Medicine:
November 2005 - Volume 80 - Issue 11 - pp 1026-1031

6. Information sources and clinical decisions: journal of General Internal Medicine Jeoffrey K. Stross Vol 2., No.3 May, 1987, 155-159


NB: This was a lecture delivered at the KNOWLEDGE GLOBALIZATION conference at Dhaka May 2010.Dr Patnaik was invited to chair the session on session of Education. The key note was delivered by Noble Laurate Dr Mohd Yunus. The conference was aimed at sharing knowledge with scholars and researchers across geographic and academic boundaries. It was a
global multidisciplinary conference with delegates from across the world.

Aphim is a vish-dravya.
Guna � sukshma, ruksha
Ras � tikta kashay
Vipak � katu
Veerya � ushna
Prabhav � maadak
Doshagnata � kaphavaatshaamak, pittaprakopak
Overdose � ojakshay and tadjanya vaatprakop- pralapadi lakshanas and mrutyu.
Dose - 1/4 to 1 gunja. (in less dose � uttejak. In large doses � avasaadak)
Kalpa � ahiphenasav, nidroday vati, karpur ras, dugdha vati etc.
Aphim shuddhi - Firstly dissolve in water, filter it and boil it on low- flame. After that give 21 bhavanas of ardrak swaras to dried aphim. By this aphim get shudhdh but vishatava does not vanish.
Chemical composition of Aphim �
There are 29 active principles in aphim, mainly morphin, codeine, thebaine and narcotine .

Rogaghnata �
1) As it is vyavaayi-vikasi-maadak and ushna in guna, acts well as vedana-sthaapak, nidrajanan and akshepaghna. Useful in udarshool, ashmari-shool, grudhrasi-shool, parshwa-shool. Useful in Nidranaash. As it is akshepaghna so useful in Apasmaar, apatantrak, kampavaat, dhanusthambh, kuchala-vishbadha.
2) Useful in ati-lala-straav. Aamashayshoth, pakvatisaar, vaatatisaar, vishuchika-prarambhik avastha.
3) Hrudbalya. Raktastambhak, hrudayksheenatajanya shwaas, hrudshool.
4) Shwasankendre avasaadak. Kaphanashak , shwasaghna, vaat-kaphaja kaas, phuphphusavaran-shoth, peenas
5) Purushatva-ghatak. But shukrastambhan is there due to aphim. So in shighra-patan it is useful

Absorption and Excretion �
Amashaye � mand-shoshan
Antra � shighra � shoshan
90% of aphim is excreted by mutra and remaining 10% through purish, sthanya, amashaygat ras and sweda.
Generally within 6 hours, aphim is excreted from body. 75% of aphim is excreted within 24 hours through mutra.
Aphim � where should not be given ? �
1)phuphphusavaran-shoth
2)chhinna-shwaas
3)mastishkavaran-shoth
4)jwar and ati-shramjanya mastishkagat raktastraav
5)Serious vrukka vikruti specially uremia
6)In baal rugna and vrudhdha rugna
7)Generally addiction of aphim is seen if given for long time in jeerna-vyadhi

Lakshana of aphim-vish-badha -
1)tandra
2)nidra
3)sanyaas
4)avasaad
5)shwasavarodh
6)mrutyu

Firstly netra-tarakaa (pupils) sankuchan (pin pointed) is seen. But before few minutes of death they are dilated. Generally avasaad is seen in 4-6 hours and death is seen in 6-12 hours.
Death by aphim is not so painful. On the contrary, patient of phim death doen not know that he is dying.
Upachaar for aphim-vish-baadha �
1)shodhan - arishta(ritha)- jal or sarshap sidhha jal for vaman. Stomach wash till clean water returns.
2)antidotes of aphim � Ritha, Hing, Amalaki, Erand, Karpaas, Dronapushpi, Ghrut, Tejapatra, Nimb, Patha
Take care - the patient should not sleep till aphim vish-badha vanishes.