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“MIASMATIC APPROACH IN THE TREATMENT OF LOWER

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“MIASMATIC APPROACH IN THE TREATMENT
OF
LOWER URINARY TRACT INFECTION”
by
Dr.RAGHUPATHI.V
Dissertation submitted to the
Rajiv Gandhi University of Health Sciences,
Karnataka. Bangalore,
In partial fulfillment of the
requirements for the degree of
DOCTOR OF MEDICINE (Homoeopathy)
in
ORGANON OF MEDICINE AND HOMOEOPATHIC PHILOSOPHY
Under the guidance of
Dr.G.C.HIREMATH
Department of Organon of Medicine and Homoeopathic Philosophy.
DR.B.D.Jatti Homoeopathic Medical College,Hospital And P.G.Research
Centre,Dharwad.
,KARNATAKA
2011
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
DECLARATION:
I hereby declare that this dissertation entitled “MIASMATIC APPROACH
IN THE TREATMENT OF LOWER URINARY TRACT INFECTION” is a
bonafide and genuine research work carried out by me under the guidance of
Dr.G.C.Hiremath. Professor, H.O.D. and Guide Department of Organon of Medicine
and Homoeopathic Philosophy, DR.B.D.Jatti Homoeopathic Medical College
Hospital And P.G.Research Centre. Dharwad. KARNATAKA.
Date:
Place: Dharwad
Dr. Raghupathi.V
CERTIFICATE
This is to certify that the dissertation entitled “MIASMATIC APPROACH
IN THE TREATMENT OF LOWER URINARY TRACT INFECTION” is a
bonafide research work done by Dr.RAGHUPATHI.V in partial fulfillment of the
requirement for the degree of DOCTOR OF MEDICINE IN HOMOEOPATHY
[Organon of Medicine and Homoeopathic Philosophy].
Dr.G.C.Hiremath
Date:
Guide,H.O.D, Professor,
Place: Dharwad.
Department of Organon of Medicine
& Homoeopathic Philosophy,
Dr.B.D.Jatti Homoeopathic Medical
College, Hospital And P.G.Research
.
Centre, Dharwad
CERTIFICATE
This is to certify that “MIASMATIC APPROACH IN THE TREATMENT
OF URINARY TRACT INFECTION” is a bonafide research work done by
Dr. Raghupathi.V, under the able guidance of Dr.G.C.Hiremath, Guide, H.O.D
Professor, Department of Organon of Medicine and Homoeopathic Philosophy.
Dr.Anand.A. Kulkarni
Date:
Place: Dharwad
Principal, Professor Department
of Organon of Medicine and
Homoeopathic philosophy.
Dr.B.D.Jatti Homoeopathic Medical
College, Hospital And P.G.Research
.
.
Centre, Dharwad
COPYRIGHT
I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka
shall have the right to preserve, use and disseminate this dissertation in print or
electronic format for academic / research purpose.
Date:
Place:
Dr. Raghupathi.V
Affectionately dedicated to
My
Beloved Parents
Mr.Late.V.Vishwanatha.Rao
Mrs.Lalitha.V.Rao
It is an opportunity to remember and praise them. For me they are the
greatest source of power, they are the foundation of wisdom, they are the
cause for success,
Acknowledgement
It is my privilege to humbly acknowledge the following persons who have been
of
immense
help
and
a
source
of
encouragement
in
my
endeavour.
My most sincere thanks to Dr.ANAND. A.KULKARNI,Principal,professor and guide
to the department oforganon of medicine and homoeopathic philosophy. Dr.B.D.Jatti
homoeopathic medical college hospital,and P.G.Research centre Dharwad, for his
encouragement and guidance throughout the course of my study, for which I will
forever be indebted.
My hearty thanks to Dr.G.C. Hiremath guide,professor,and head of the
department of organon of medicine and homoeopathic philosophy Dr.B.D.Jatti
homoeopathic medical college hospital and P.G.Research centre Dharwad.for his
valuable guidance, inspiration, encouragement and supervision, without which this
work would be difficult to complete.
I thanks to Dr.R.C.Hiremath for the timingly advices during my studies. My
special thanks to evermemmorable person Dr.R.Y.Nadaf Ex-Principal, guide, and
HOD of department of material medica,Dr.B.D.Jatti homoeopathic medical college
hospital and P.G. Research centre Dharwad, for his ever advice and suggestions.
I owe my sincere thanks to Dr Madappa for his support in extending his expertise
and suggestions during this work.
I express my deep sense of gratitude to Dr.Kiran. C. Gaddi. P.G. Co ordinator ,
Dr.B.D.Jatti homoeopathic medical collage hospital and P.G.Research centre
Dharwad, for being the ray of hope when all the hours of hard work seemed to reap
noresults.
I am greatful to all my teachers,specially Dr.M.H.M.Vijaykumar,Dr.A.S.Gadag
who welcomed my queries and for theire valuable advise throughout my study.
.
I appreciate the librarians for letting me rummage through reference books
round the clock.
Without co-operation of my mother, brother, sister brotherinlaw, sisterinlaws,
I wouldnot be able accompalish much.Iam extremelythankful to Mrs.Lalitha.v.rao,
MrRavi.V.Rao,Mrs.Sharada.R.Rao,Mr.Chandrashekhar.V.Mrs.Ranjini.C.
Mrs.Shivakumar.V.Rao. Mrs.Shobha.S.Rao. Mrs.Vijaykumar.V.
I greatly thank the management of Dr.B.D.Jatti homoeopathic medical college
hospital and P.G. Research centre Dharwad, for giving me an opportunity to study and
acquire varied knowledge in the theory and practical of homoeopathy.I also thank the
patients whome I subjected to study, non teaching staff,and office staff of Dr.B.D.Jatti
homoeopathic medical college hospital and P.G.Research centre,Dharwad, for theire
kind co-operation.
Last but not the least I thank my lifepartner- wife
Dr.Gayathri.R.RAO.M.B.B.S,M.S(OB&G)
and
Rohith.R.RAO for all the co-operation extended.
my
dear
son
MASTER
Dr.Raghupathi.V.
.
LIST OF ABBREVIATIONS:
A
Asthma
Alum
Alumina
Ars. alb
Arsenicum Album
B
Burning
Ba
Backache
B.M
Burning Micturition
Bry
Bryonia
B.T
Burning in throat
Canth
Cantharis
Const
Constipation
C.P
Chicken Pox
Dm
Diabetes
D.M
Difficulty in micturition
DNE
Dilatation and Curettage
Dysm
Dysmenorrhoea
Ecz
Eczema
Exp
Expectoration
FM
Frequent micturition
G
Gastritis
GE
Gastroenteritis
GW
General Weakness
H
Headache
H/W
Housewife
H.D
Heart Disease
Hm
Haemorrhoids
HTN
Hypertension
LA
Loss of appetite
Lach
Lachesis
Lc
Leucorrhoea
LE
Lower extremities
Lyco
Lycopodium
NS
Not significant
Nit. Ac
Nitric acid
NV
Nux Vomica
OF
Oedema feet
P
Pain
PA
Pain abdomen
Puls
Pulsatilla
RC
Renal calculus
R HypoG
Right Hypogastrium
RL
Right Lumbar region
Rtd.
Retired
S
Sleeplessness
St
Stiffness
Sep
Sepia
Staph
Staphysagria
Sulph
Sulphur
ABSTRACT
BACKGROUND AND OBJECTIVES
The urinary tract,like the respiratory and digestive tracts,ends on the body
surface and therefore can never be sterile throughout its length.However ,when the
tract is anatomically and physiologically normal,and local and systemic defence
mechanisms intact,organisms confined to the lower end of the urethra.U.T.I. is
associated with the multiplication of organisms in the urinary tract,that is more than
100000 organisms per ml in a mid stream sample. Following intrarenal reflux of
infected urine, renal damage may occur by a direct effect of the bacteria, ischaemia
with reperfusion damage & or an inflammatory response. The conventional system of
medicines uses antibiotics to treat this condition. The symptoms of pain, dysuria,
frequency and urgency can be very well treated with Homoeopathic drugs, without
any side effects, which tend to occur after antibiotics.
The following objectives were fixed up for the study:
1.
To study the miasmatic background of U.T.I.
2.
To study the role of homoeopathic remedies( miasmatic remedies) in
the treatment of UTI.
3.
To study the Clinical presentation of U.T.I
Methods:
The subject for this study will be collected from OPD/IPD/Rural camp of
DR. B.D. Jatti Homoeopathic Medical College, Hospitjal and Post Graduate Research
Centre, Dharwad.
Patients are considered on the basis of clinical presentations. That is asymptomatic
bacteruria, symptomatic acute urethritis and cystitis acute prostatitis, acute
pylonephritis, septicaemia( usually gram negative).
Inclusion criteria:
1. Subject of adult age groups of uncomplicated lower urinary tract infection
will be selected for the study, irrespective of their occupation and
socioeconomic status and based on clinical presentation.
2. Subjects of irrespective sex will be included.
3. Clinical diagnosis done on case history.
Following are exclusion criteria:
1. Subjects with STD
2. Infants and paediatric cases.
3. Upper UTI.
4. Complicated Lower Urinary Tract Infections.
Study sampling design:
Prevalence rate of UTI in our hospital is 3% considering the 95%confidence interval
at 5% permissible error, sample size works out to be 30 cases.
Since it is a time bound study all admitted and OPD and Rural cases are
included in my study period.
Study design :
Simple random method, Hospital Based time bound study.
Follow up :
Cases are followed for every 15 days for the first 3 months and then monthly
once till the end of study period. Physical, radiological, and laboratory examinations
done periodically when ever needed.
.
The following parameters were fixed according to the type of response
obtained after treatment:
Recovered: Feeling of mental and physical well being and no other similar complaints
observed for a period of 6 months.
Improved: Feeling of mental and physical well being along with reduction in
frequency of complaints.
Not improved:
•
No response.
•
No reduction of complaints even after defined period of treatment.
Results
14 of the 30 cases (46.66%) recovered totally, 11 cases improved (36.66%) and 5 did
not improve (16.68%).
Interpretation and Conclusion
In the present out of 30 patients taken up for study, 14 cases recovered totally,
5 did not improve and 11 improved. The most commonly indicated acute drugs in this
study were Aconite, Apis, Arsenic album, Belladona, Cantharis, Nitric acid and
Staphysagria. The constitutional drugs were Berberis, Lycopodium, Nux. vomica,
Pulsatilla, Sars, Sulphur, & Thuja. The miasmatic basis of UTI in this study were as
follows: Psoro-Sycotic – 12 cases i.e. (40.%), Psoro-Syco-Syphilitic – 8 cases i.e.
(26.67%), Psoric – 10 cases i.e. (33.33%). The results of the study were highly
satisfying and the role of Homoeopathic remedies in the treatment of UTI have been
very effective.
CONTENTS
Sl. No.
Topic
Page No.
1
Introduction
1-5
2
Objectives
6-7
3
Review Of Literature
8-56
4
Methodology
57-60
5
Results
61-70
6
Discussion
71-75
7
Conclusion
76-77
8
Summary
78-79
9
Bibliography
80-85
ANNEXURES
1
Annexure I
i-x
2
Annexure II
xi-xvii
3
Annexure III
xviii-xxxvii
4
Annexure IV
xxxviii-xli
LIST OF TABLES
Sl. No.
Tables
Page No
1
Age Incidence(Table No. 1)
62
2
Sex Incidence(Table No. 2)
63
3
Other Associated complaints(Table No. 3)
64
4
Family History (Table No. 4)
65
5
Miasmatic Background (Table No. 5)
66
6
Acute Remedies (Table No. 6)
67
7
Constitutional Remedies (Table No. 7)
68
8
Type of organism found in urine
69
Culture. (Table 8)
9
Results of Treatment
(Table 9)
70
LIST OF FIGURES
Sl. No.
Figures
Page. No.
1
Male and Female Urinary
2
Tract Infection. (Fig. –1)
2
E-coli and KMB agar
17
3
Role of reflux
26
LIST OF GRAPHS
Sl. No.
Graphs
Page. No.
1
Graphs of Sex Incidence
xii
2
Age Incidence
xii
3
Other Associated Complaints
xiii
4
Family History
xiv
5
Miasmatic Background
xv
6
Acute Remedies
xv
7
Constitutional Remedies
xvi
8
Type of Organism found in Urine Cuture
xvi
9
Results
xvii
INTRODUCTION
1
INTRODUCTION
MALE AND FEMALE URINARY TRACT
The function of the urinary tract is to store and eliminate urine. To do this
effectively it is lined with a waterproof mucosa, which does not significantly alter the
volume or constituents of the contained urine, it has a muscular wall which will allow
storage but also give complete emptying of the system, it has a built-in mechanism to
protect upper urinary tract function (the anti refluxing vesico-ureteric junction) and it
has nerve supply to coordinate its various activities and bring it under voluntary
control.
UTI is an inflammatory response of the urothelium to bacterial invasion i.e.,
usually associated with bacteriuria and pyuria. Bacteriuria is the presence of bacteria
in the urine, which is normally free of bacteria, and implies that these bacteria are
from the urinary tract and are not contaminants from the skin, vagina or prepuce. The
possibility of contamination increases as the reliability of the collection technique
decreases from suprapubic aspiration, to catheterization, to voided specimens.
2
Pyuria is the presence of white blood cells (WBC’s) in the urine and is
generally indicative of an inflammatory response of the urothelium to bacterial
invasion.
UTIs are a serious, but common health problem affecting millions of people
each year. UTI can either involve the upper urinary tract (kidneys) pyelonephritis, or
the lower urinary tract (bladder and urethra) cystitis and urethritis respectively.
Infections are generally defined by their presumed site of origin.
Acute pyelonephritis is a clinical syndrome of chills, fever and flank pain i.e.,
accompanied by bacteriuria and pyuria, a combination i.e., reasonably specific for an
acute bacterial infection of the kidney.
Chronic pyelonephritis describes a shrunken, scarred kidney, diagnosed by
morphologic radiologic or functional evidence of renal disease that may be post
infections but is frequently not associated with UTI.
Cystitis is inflammation of the bladder whether used as a histologic,
bacteriologic or cystoscopic description or a clinical syndrome i.e., usually
accompanied by an abrupt onset of dysuria, increased frequency, urgency and
suprapubic pain.
Urethritis like cystitis also refers to inflammation, but of the urethra rather
than the bladder. Symptoms arising from urethritis and cystitis are difficult, if not
possible, to distinguish from one another in the female, but pure urethritis in the
female – unlike that in the male – is very rare.
Classification:
Infection in the urinary tract can be divided into four categories:
•
Isolated infections
•
Unresolved infections
3
•
Recurrent UTIs that are reinfections
•
Recurrent infections resulting from bacterial persistence.
UTIs are a result of interactions between a uropathogen and a host. Increased
bacterial virulence appears to be necessary to overcome strong host resistance, and,
with minimal virulence characteristics are able to infect patients who are significantly
compromised.
Routes of infection:
Ascending route – Most bacteria enter the urinary tract from the faecal
reservoir via ascent through the urethra into the bladder. It is now generally believed
that uropathogenic bacteria are selected from the faecal flora by the presence of
virulence factors that enable them to adhere to colonise the perineum and urethra and
migrate to the urinary tract.
Haematogenous route – Infection of the kidney by the haematogenous route is
uncommon in normal individuals. However, the kidney is occasionally secondarily
infected in patients with Staphylococcus aureus bacteremia form oral sites or with
Candida fungemia.
Lymphatic route – Direct extension of bacteria from the adjacent organs via
lymphatics may occur in unusual circumstances such as a severe bowel infection or
retroperitoneal abscesses.
Conditions affecting pathogenesis – Gender and sexual activity.
The female urethra appears to be particularly prone to colonization with colonic gramnegative bacilli because of its proximity to the anus, its short length (about 4 cms),
and its termination beneath the labia. Sexual intercourse causes the introduction of
4
bacteria into the bladder and is temporarily associated with the onset of Cystitis ; it
thus appears to be important in the pathogenesis of UTIs in younger women.
Voiding after intercourse reduces the risk of Cystitis probably because it
promotes the clearance of bacteria introduced during intercourse. In addition, use of
spermicidal compounds with a diaphragm or cervical cap or of spermicide-coated
condoms, dramatically alters the normal introital bacterial flora and has been
associated with marked increases in vaginal colonization with E.coli and in the risk of
UTI.
This present dissertation includes a study of 30 cases of uncomplicated lower
UTI, which are more common in women of the reproductive age group i.e. 15-45
years.
Here an endeavour is made to study the clinical presentation of UTI
(Individualization), the Miasmatic basis of UTI, the Homeopathic approach and plan
of treatment, the investigations of the disease and finally the role of Homoeopathic
medicines in the treatment of UTI.
5
OBJECTIVES
6
OBJECTIVES
1.
To study the role of Homoeopathic remedies in the treatment of U.T.I.
2.
To study the Miasmatic basis of U.T.I
3.
To study the Clinical presentation (Individualization) of U.T.I
7
REVIEW
OF
LITERATURE
8
REVIEW OF LITERATURE
Acute infections of the urinary tract fall into two general anatomic categories:
lower tract infection (urethritis and cystitis) and upper tract infection (acute
pyelonephritis, prostatitis, and intrarenal and perinephric abscesses). Infections at
various sites may occur together or independently and may either be asymptomatic or
present as one of the clinical syndromes. Infections of the urethra and bladder are
often considered superficial (or mucosal) infections, while prostatitis, pyelonephritis,
and renal suppuration signify tissue invasion.1 (harrisons)
Bladder infections are most common in young women, with 10% of women
getting an infection yearly and 60% having an infection at some point in their life
Pyelonephritis occurs between 18–29 times less frequently. Nearly 1 in 3 women will
have had at least 1 episode of urinary tract infections requiring antimicrobial therapy
by the age of 24 years.
The prevalence of urinary tract infections in pre-school and school girls is 1%
to 3%, nearly 30-fold higher than that in boy. Approximately 5% of girls will develop
at least one urinary tract infection during their school years.
Bacteriuria appears to increase in prevalence with age in women, still being 50
times greater than the one in males. It is estimated that bacteriuria will be experienced
by 20 to 50% of older women and 5 to 20% of older men. In non-institutionalized
elderly populations, urinary tract infections are the second-most-common form of
infection, accounting for nearly 25% of all infections. The condition rarely occurs in
men who are younger than 50 years old and who did not undergo any genitourinary
9
procedure. However, the incidence of urinary tract infections in men tends to rise after
the age of 50.2 (Wikipedia)
2Uncomplicated infection is used to describe an infection in a healthy patient with a
structurally and functionally normal urinary tract.
Complicated infection describes an infection in a patient who is compromised
and/or has a urinary tract with a structural and functional abnormality that would
increase the chance for acquiring infection and/or reduce the efficacy of therapy.
Isolated infections – An acute UTI or first infection occurs as a solitary event
and has no relation to any other infection or infecting organisms. It is usually
separated from other infectious events by at least 2-3 months. Acute infections are
usually caused by autoinfection from the patient’s own faecal stream, by an E-coli
organism which is sensitive to almost any antimicrobial used for UTI. These patients
have not been exposed to antimicrobials, and therefore their flora is not resistant.3
Recurrent infections are due to either reinfection or bacterial persistence.
Reinfection is recurrent infection from outside the urinary tract.
Bacterial
persistence or relapsing infection refers to a recurrent UTI caused by the same
bacteria from a focus within the urinary tract, such as an infection stone or the
prostate.3
There is such a rich endogenous urethral flora that it raises the question of its
role as a host defence mechanism by blockage of bacterial adhesion sites on its
mucosal surface. Studies on urethral urine samples have identified a rise in the mean
number of species per sample from the premenarcheal to the reproductive to the postmenopausal woman. Aerobes are dominant in the post-menopausal group. No aerobic
gram-negative rods can be isolated from the premenarcheal group once over the age
10
of 4 or from women of reproductive age; however 50% of post-menopausal women
carry gram-negative rods although they only account for 1% of the flora.
Bollgren and Winberg (1976) studied the urethral flora of female infants and
found that Escherichia coli was the predominant organism isolated, but that by 6
months the colonization had begun to diminish and that by the age of 5 years
Escherichia coli were absent.
In premenarcheal females Corynaebacterium dominate the urethral flora,
while in the reproductive female Lactobacillus is dominant, influenced by the
hormonal changes. The anaerobic bacillus melanino-genicus can be isolated on a high
percentage of all groups and quantitatively is the dominant organism in the postmenopausal age group. In males under 6 months the urethra is colonized by
Escherichia coli and above this age, up to puberty, Proteus is equally commonly
isolated. In the adult male, the external urinary meatus is colonized by Diptheroids,
Streptococcus and Staphylococcus epidermidis.
The Periurethral flora is similar to the urethral flora in both male and female
infants and is characterized by a heavy colonization of E. coli, Enterococcus and
Staphylococcus. The colonization by E. coli and Enterococcus diminishes in the first
year of life and is rare at the age of 5 years. The anaerobic flora of the periurethral
area in females aged 5-14 years is dense; obligate anaerobic bacteria accounting for
95% of the count. On an average seven different anaerobic and two to seven aerobic
strains are isolated predominantly gram-positive cocci and rods.
Females in the reproductive age range have cyclical periurethral colonisation.
During the first week of the menstrual cycle there is significant rise in the density of
11
group-B Streptococcus. Colonisation by gram-negative rods occurs during
menstruation in a few individuals.4 (Bollgren et al, 1978).
Introital colonization
The non-pathogenic vaginal flora fluctuates during the menstrual cycle but
overall is relatively constant (Fowler et al, 1977). In the reproductive age range,
Lactobacillus accounts for 80% of the nonpathogenic vaginal flora followed by
Corynebacterium,
Staphylococcus
epidermis,
Candida,
Gamma
haemolytic
Streptococcus and a small percentage of others.
“INTERSTITIAL CYSTITIS”4
Ever since Hunner’s original description of the “elusive ulcer,” the diagnosis
of “interstitial cystitis” (IC) has engendered much confusion.
We believe that the diagnosis of IC is a repository for a number of afflictions
that have similar manifestations, that is, refractory symptoms of urinary frequency,
urgency, and suprapubic and “urethral” pain or discomfort. The sensation perceived
by the patient varies directly with the amount of bladder filling; it tends to intensify as
the bladder fills and often dissipates after voiding.
Unless the diagnosis is unequivocal, we prefer the term “painful bladder
syndrome” or “sensory urgency” to many of the other near synonyms for IC because
the former are simply descriptive in nature.
The typical patient with IC is a young to middle-aged woman. Urinalysis,
urine culture, and physical examination findings are normal. Both slow-fill
12
cystometry and cystourethroscopy generally reveal only increasing pain during
bladder filling that is relieved with emptying.
Viral Cystitis1
Viral infection can cause bladder symptoms similar to bacterial infections.
These infections are most often seen in children and immunosuppressed patients.
Often, hemorrhagic cystitis is observed. The diagnosis is made by inference because
viral cultures are not routinely performed, and bacterial cultures are negative.
Candida Albicans Cystitis
Many systemic fungal infections attack the urinary tract, but the most
important and most common is candida albicans. These infections were once reported
as rare but are increasing in frequency in both children and adults. This dimorphic
fungus is a yeast that exists as a saprophyte in the vagina, oral cavity, and colon.
There are two forms – the cellular form and the more invasive pseudohyphae form. In
systematic candidiasis, the kidney appears to be a vulnerable organ where the fungus
can exist well.
Statistical data
Childhood UTIs are more common in girls except for a few months of life,
when they are more common in boys. Between 0.03% and 1.2% of boys develop UTI
during school years. 3.5% of girls develop a UTI during this time.5
UTIs are more common in women than in men except in the neonatal period.
They account for 1.2% of all office visits by women and 0.6% of all office visits by
men. Symptomatic UTI affects 30% of women between the ages of 20 and 40 years, a
prevalence i.e., 30 times more than in men. However, with increasing age, the ratio of
13
women to men with bacteriuria progressively decreases. At least 20% of women and
10% of men older than 65 years have bacteriuria.2
The prevalence of bacteriuria also increases with institutionalisation and
concurrent diseases.
Etiology
Many different microorganisms can infect the urinary tract, but by far the most
common agents are the gram–negative Bacilli. Escherichia-coli causes approximately
80% of acute infections in patients without catheters, urologic abnormalities, or
calculi. Other gram – negative rods, specially Proteus and Klebsiella and occasionally
Enterobacter, account for a smaller proportion of uncomplicated infections. These
organisms, plus Serratia and Pseudomonas, assume increasing importance in recurrent
infections and in infections associated with urologic manipulation, calculi, or
obstruction. They play a major role in nosocomial, catheter– associated infections.6
Factors affecting risk of bacteriuria and renal damage from UTI in children
•
Gender
•
Periurethral colonization
•
Genetics (uroepithelial receptors)
•
Age
•
Preputial skin
•
Native immunity
•
Faecal colonization
•
Genito-urinary abnormalities
•
Vesico-ureteral reflux
•
Neurogenic bladder
14
•
Iatrogenic factors7
Host factors predisposing to the development of UTI5
Age: During the first few weeks of life, all babies have an increased incidence of
UTIs. During this time the periurethral area of healthy girls and boys is massively
colonized with aerobic bacteria, particularly E.coli, enterococci, and staphylococci.
This colonization decreases during the first year and is unusual in children who do not
get recurrent UTIs beyond the age of 5 years.
Voiding dysfunction: Urinary tract infections in girls are particularly common around
2-3 years of age, the peak age of toilet training, presumably because of mild voiding
dysfunction that occurs during that time. In children with bladder instability that
causes diurnal incontinence beyond the age of 3-4 years, there is a tendency not to
empty the bladder completely, leaving residual urine, which also predisposes to UTI.
Vesicoureteral reflux: When urine is transported to the bladder, normally the urine
remains in the bladder until it is voided, because a physiologic flap valve prevents it
from returning back to the ureter and kidney. Children with reflux have an increased
incidence of upper urinary tract infection.
Genitourinary anomalies: Several genitourinary anomalies that cause urinary stasis
predispose the child to UTI: ureteropelvic junction obstruction, ureterovesical
junction obstruction, retrocaval ureter, ureterocele, and posterior urethral valves.
Sex: Except for the new born period, girls are more susceptible to UTIs than boys,
presumably because the urethra is much shorter in the female.
Faecal colonization: As indicated above, the presence of urinary pathogens in the
periurethral area predisposes the child to UTIs.
15
Chronic constipation: Some children with constipation are predisposed to UTIs
because the dilated rectum interferes with voiding and may cause mild retention of
urine.
Retention of foreskin: Uncircumcised male infants are more likely to develop a UTI
than boys who are circumcised, because bacteria seem to colonize the glans under the
foreskin.
Host receptor activity: Uroepithelial cells from infection-prone girls and women bind
E.coli more avidly than cells from nonsusceptible girls. Glycolipids characterizing the
P blood group system are found in host uroepithelial cells and may serve as bacterial
receptors. The P blood group phenotype has been found in 90% of girls with recurrent
pyelonephritis.
Immune status: Girls with a normal urinary tract and recurrent UTIs have significantly
lower baseline levels of urinary IgA and a blunted response to infection. Lower
baseline levels of immunoglobulins in the perineum may diminish the ability to
develop a response to infection.
An acidic urine pH, high or low urine osmolality, and high urea and organic
content resist bacterial growth. Furthermore, the ability of the bladder to empty
completely helps resist bacterial colonisation of the bladder. Polymorphonuclear
leukocytes are present in the bladder mucosal surface, which also resist infection.
Bacteria have cell surface structures called adhesions that facilitate their binding
to epithelial cell-surface receptors. Research demonstrates that certain types of
adhesions, in particular certain pili, may contribute to the virulence of an organism. P
pili in particular have been shown to be important virulence factors in pyelonephritis.
Pathogenesis
16
UTI is associated with multiplication of organisms in the urinary tract and is
defined by the presence of more than 100,000 organisms per ml. in a mid stream
sample of urine (MSU).8
Uncomplicated infections are most invariably due to a simple strain of organism.
E coli derived from the faecal
reservoir accounts for 75% of
infections, the remainder being due
to Proteus, Pseudomonas species,
Streptococci or
Staphylococcusepidermidis.
Escherichia.coli (eshВґВґ rikВґe koВґli) ,
a common bacterium that
normally inhabit
Escherichia coli cells.
E.coli colonies on EMB Agar
the intestinal tracts of humans and animals, but can cause infection in other parts of
the body, especially the urinary tract.
E.coli appear well adapted to invade the urinary tract, possibly because they possess
surface fimbriae, which allow them to adhere to surface receptors on the urothelium.
The first stage is colonization of the periurethral zone with pathogenic faecal
organisms. The urothelium of susceptible persons may have more surface receptors to
which adherent strains of E.coli become attached. Colonization is also facilitated by
tissue damage from previous UTI, by infections of the genital tract or perineal skin by
inadequate perineal hygiene and possibly by the use of disinfectants, deodorants and
certain toilet preparations. Ascent of organisms into the bladder is facilitated in
women by the short urethra and absence of bactericidal prostatic secretions. Sexual
17
intercourse causes minor urethral trauma and forces introital bacteria into the bladder.
Instrumentation of the bladder readily introduces organisms.
Bacterial adherence is a pathogenic feature and those bacteria that are Pfimbriated bind to ureteral and renal receptors and in addition are capable of
inhibiting ureteric function by release of endotoxins that induce muscular paralysis
increasing their pathogenicity.
The bacteria have pili or fimbriae, small hair like projections from the
bacterial body by which they attach themselves to the host cells. The bond they form
is a result of multiple interactions between bacterial surface ligands, and adhesions
and host receptors.
Urinary, vaginal and faecal bacterial isolates from females with urinary tract
infections have been shown to adhere equally well to vaginal and buccal cells.
Staphylococcus saprophyticus biotype3
This organism accounts for between 10-30% of acute cystourethritis in
sexually active women. The source of the organism is not clear although it is
sometimes isolated on rectal swabs.
Proteus
Proteus is capable of adherence to the urothelium. It accounts for about 2% of urinary
tract infections but is more frequent in young boys and older men.
Ureaplasma urealyticum
This organism is a cause of urethritis in men and has also been found alone in
7% of bladder urines collected by suprapubic aspiration in patients presenting with
symptoms of urinary tract infection and in a further 13% in combination with other
18
organisms. It was recovered from the bladder in relatively low numbers (less than 10
colony forming units/ml) predominantly from females. (ratio 5:1) (McDonald et al,
1982).
Fastidious organisms and anaerobes
This group of organisms includes Lactobacillus, Streptococcus milleri and
Corynebacterium which are isolated by incubation in 7% CO2 for 48 hours (Maskell
and Pead, 1980). Their role in urinary tract infections is not clear although it has been
suggested they are the infecting agents in patients with the urethral syndrome where
they may be harboured in the paraurethral ducts.
They have been isolated in pure culture following suprapubic aspiration in
pregnant women (McFadyen and Eykyn, 1968). There is, however, scant evidence of
an immunological response to these organisms and it may be that they can grow,
albeit slowly, in the bladder but because of the high oxygen tension, they are unable
to establish themselves and infect the bladder.
Factors Affecting Bacterial Growth3
Oxygen tension
The majority of urinary pathogens are facultative anaerobes, which means
they can grow either in the presence or absence of molecular oxygen, most of which
originate as commensals in the bowel.
The anaerobic organisms that have been isolated from patients with
symptomatic infections include Lactobacillus, Corynaebacterium and Strep. milleri.
Urine
The mean generation time of E.coli in urine has been shown to be significantly
shorter than Proteus, Psuedomonas, Klebsiella, Staphylococcus saprophyticus and
19
Strep. faecalis, and E.coli is capable of outgrowing other organisms in a bladder
model during a 24 hr period. (Anderson et al, 1979).
Defence Mechanisms
1. Vaginal receptor sites
Introital colonization by uropathogenic strains is an essential prerequisite
before ascent to the bladder in the absence of instrumentation. The host susceptibility
to bacterial adherence is now thought to be of greater importance than the
pathogenicity of the bacteria. It has shown that infection-prone females have a higher
receptor density and more available receptors for adherence than normal cells as
assessed by incubating E.coli with squamous vaginal cells or uroepithelial cells. The
factors determining mucosal cell receptivity has recently been clarified by incubating
vaginal and buccal cells from the same individual. A strong relationship between the
two was seen showing that the susceptibility to recurrent urinary tract infection is
associated with a widespread alteration in the surface characteristics of mucosal
epithelial cells, which could be controlled by genotype trait (Schaeffer et al, 1981)
2. Vaginal fluid
The normal constituents of vaginal fluid include glycogen, lactic acid, glucose,
maltose and several amino acids. There are specific antibacterial factors comparable
to those of the prostate except perhaps for the pH, which in premenopausal women
varies between 4 and 5. Further in vitro studies on the vaginal pH in normal and
urinary tract infection-susceptible females has not demonstrated any significant
difference in vaginal pH, nor was there any significant difference in glycogen or
oestrogen content. (Stamey and Timothy, 1975).
3. Vaginal colonisation
20
The possibility that the indigenous micro flora might interfere with
colonisation by pathogenic bacteria has been studied (Stamey et al, 1978). It was
found that heavy colonisation by uropathogenic strains rarely occurs in the absence of
at least one of the five most common non-pathogenic organisms and the suggestion
was therefore discarded as being of no importance.
4. Cervico-vaginal antibodies
It has been shown that cervico-vaginal antibodies are reduced in infectionprone women. Introital colonisation by enterobacteria can be prevented by
complement-mediated bacteriolysis, by enhanced phagocytosis or by preventing
bacterial adherence to the mucosal surface.
Colonisation stimulates the production of specific secretory IgA, the
appearance of which terminates the colonisation episode and persists for 6-8 weeks. It
has been doubted, however, that a deficiency of secretory IgA leads to an increased
susceptibility to infection in children (Tuttle et al, 1978) although it is possible that
the infecting organisms form complexes with IgA or inactivate it with their
proteolytic enzymes.
Ascent To The Bladder
The organisms colonizing the external urinary meatus include diptheroids,
staphylococci, anaerobes and transient E.coli in susceptible females. Migration of the
organisms into the bladder is achieved either by direct growth extension or by
mechanical transfer in turbulent urinary flow or by physical massage as during sexual
intercourse. The role of the latter in aiding ascent of pathogenic strains to the bladder
is convincing. In one series of 20 females with a history of urinary tract infection
clean catch urines at 1,6, and 20 hours after intercourse showed a rise in bacterial
counts greater than one log in 30%, for both pathogenic and non-pathogenic
21
organisms. The bacteriuria however was transient (Buckely et al, 1978). In another
series, 15 of 19 new patients developed symptoms the day following intercourse from
which it was concluded that intercourse was a non-specific precipitator of infections
in females with a propensity to recurrent infections. (Nicolle et al, 1982).
Urinary turbulence may be an important factor in bacterial ascent during the
gaining of bladder control in childhood. The voiding patterns often include abdominal
straining and voluntary contraction of the urethral sphincter during the void which
results in non-laminar flow, eddying and urinary reflux from the distal end of the
urethra to the bladder. In addition persistent dysfunctional voiding leads to mild to
moderate aseptic urethral inflammation that further aids the establishment of
organisms in the urethra prior to entry to the bladder.
Hydrokinetics
Voiding is an effective but incomplete primary defence mechanism as the
mucosal folds trap residual urine. The efficiency of the bladder wash-out mechanism
depends on the rate of ureteric flow, residual bladder volume and the rate of bacterial
multiplication.
Urine composition
The urine osmolality and pH can both alter bacterial growth but only at the
extremes of urinary pH and at high osmolality. Urinary urea and ammonia
concentrations can also inhibit bacterial growth. Enterobacteria, Staph. epidermidis
and Enterococci grow well in urine where as Lactobacilli and alpha, beta and gamma
streptococci grow poorly, particularly in the early phase of bacterial multiplication,
22
which explains the relative infrequency of urinary tract infection caused by normal
perineal bacteria. [Stamey and Mihara, 1980]
The bacterial colony counts in diabetic patients with urinary tract infections are
significantly higher than non-diabetics with urinary tract infections due to the effect of
glucose which is to prolong the logarithmic growth phase resulting in an increase in
the size of the maximally viable bacterial pool.
Oxygen tension
Anaerobic and micro-aerophilic organisms are unable to survive in urine under
normal circumstances. Obligate anaerobes are unable to survive in an oxygen tension
greater than 0.5kpa whereas micro-aerophils can survive in tensions upto 3kpa. The
evidence suggests that obligate anaerobes cannot survive in urine except when the
oxygen tension has been reduced such as might occur in patients with renal scarring,
bladder tumours etc. (Maskell et al, 1979)
Mucosal resistance
The bladder wall defence against bacteria is produced by a combination of the
mucous layer secreted by the mucosal cells and the configuration of the surface cells
which produce an effective water tight junction. The antibacterial mucous layer of
glycosamino-glycans (GAG) prevents bacterial adherence and aids hydrokinetic
clearance. (Parsons et al, 1980)
In addition to GAG there is an abundance of bacteria-fixing slime in the urine,
identical to Tamm Horsfall glycoprotein, which is capable of trapping E.coli with
type-1 fimbriae (Orskov et al 1980)
23
Bacterial adherence to the mucosal surface is complex and, like the adherence to
vaginal cells is related to a specific substance on the fimbriae. These hair like
structures have been identified and typed. Type-1 fimbriae contain receptors for
mannose on the host cell surface and added mannose can block bacterial attachments
to the cells.
Bladder antibodies
The urothelium does not contain complement. Immunoglobulins are present in
the urinary tract, particularly as secretory IgA (sIgA) half of which is secreted by the
urothelium as a whole. Colonization of the urinary tract stimulates IgA production
which in the first week is directed against O-antigens. This normally stops
colonization by agglutination and blocking of the bacterial ligands which are involved
in adhesion.
Ascent To The Kidney
The vesico-ureteric junction (VUJ) is normally a competent barrier against
urinary reflux and bacterial ascent. It can be incompetent congenitally, because of
bladder muscular hypertrophy, or because oedema secondary to infection. A defective
VUJ when associated with other structural abnormalities of the urinary tract greatly
impairs the host resistance to ascending infection. A low ureteric urinary flow rate
enable bacteria to maintain or increase their numbers. To reach the kidney, organisms
have either to swim up the ureter against the ureteric stream, or grow by extension or
be transported there mechanically. A defective VUJ aids bacterial ascent when the
patient is supine and particularly when the bladder contracts.
Renal defence
24
The renal defence mechanism to ascending infection in multifactorial, initially
involving complement and activated macrophages followed by the specific opsonic
activity of specific antibody coating of bacteria as detected by direct immunofluorescence
Covert Bacteriuria (CB)
The term Asymptomatic bacteriuria is a misleading one for if longitudinal
studies on patients with bacteriuria are performed it is found that 29% develop
symptomatic infections each year, a 7-times greater rate than abacteriuric controls
(Gayman et al, 1976). The preferred term is covert bacteriuria as symptomatic and
Asymptomatic bacteriuria are an integral part of the same disease process.
The bacterial strains isolated from patients with CB have been shown to be
less antigens and adhere to urothelial cells less well than the organisms grown from
patients with symptomatic urinary tract infection. Following clearance of the CB by
antibacterial treatment, further infections are more often symptomatic, presumably
due to reinfection by a more virulent organism (Svanborg et al, 1976). This evidence
suggests that CB is best left untreated unless the patient is pregnant when her chances
of developing pyelonephritis rise to 30%, or if there is obstruction to the urinary tract.
Significant Bacteriuria
To separate contamination of urine from genuine infection, Kass (1956)
proposed that >105 colonies/ml should be used to define significant bacteriuria. He
demonstrated that quantitative studies of the urine permitted the identification of
subjects who consistently had high densities of bacteria in the urine and who
25
experienced morbidity on that basis and differentiated these subjects from most
normal people who had insignificant bacteriuria due to contaminants.
Reflux Nephropathy
Reflux nephropathy is defined as chronic non-obstructive pyelonephritis with
reflux and occurs in early childhood when the kidney is still growing.
Role of reflux
When the ureters enter the bladder, they travel
through the wall of the bladder for a distance in
such a way that they create tunnel so that a flaplike valve is created inside the bladder. This valve
prevents urine from backing-up into the ureters and
kidneys.In some children, the valves may be abnormal or the ureters in the bladder
may not travel long enough in the bladder wall, which can cause vesicoureteral reflux.
Vesicoureteral reflux is a condition that allows urine to go back up into the ureters
and kidneys causing repeated urinary tract infections. The reflux of urine exposes the
ureters and kidney to infection from bacteria and high-pressure, which is generated by
the bladder during urination. If left untreated, urinary infections can cause kidney
damage and renal scarring with the loss of potential growth of the kidney and high
blood pressure later in life.Vesicoureteral reflux is treated with antibiotics, and in
severe cases surgically
The vesico-ureteric junction prevents reflux of urine during a bladder
contraction due to the oblique entry of the ureters into the bladder. A congenital lack
of obliquity of the intramural and submucosal segments will allow reflux, if mild
26
during bladder contraction, if severe during both phases of the bladder cycle. There is
a familial tendency and it can be associated with other urinary tract abnormalities
such as posterior urethral valves, ureteric ectopia and neuropathic bladder.
Role of infections
All children who have proven urinary tract infections must undergo screening,
not only to identify renal scarring and reflux but also to exclude other congenital
abnormalities.
Infection without reflux may be responsible for renal scarring in some cases
but the majorities have both, the degree of scarring being related to the severity of
reflux and intra-renal reflux.
UTI in Pregnancy1
During pregnancy, dilation of the upper tracts, decreased ureteral peristalsis,
and increased residual urine begin in the first trimester. These changes may be seen in
women on oral contraceptives, and it has been suggested that increased estrogen
levels may play a role.
The risk of developing bacteriuria may increase with the progression of
pregnancy and is highest between the 9th and 17th weeks. Bacteriuria during
pregnancy is associated with the development of pyelonephritis later in pregnancy,
usually in the third trimester.
Even asymptomatic bacteriuria should be treated: physiologic and anatomic
changes associated with pregnancy increase the risk of pyelonephritis, which may
lead to premature delivery and other potential complications.
Clinical presentation
27
Symptoms of UTIs can come on quickly. The first sign of a UTI is a strong
urge to urinate (urgency) that cannot be delayed. As urine is released, a sharp pain or
burning (Dysuria) will be felt in the urethra. Very little urine is released. The urine
may be tinged with blood. The need to urinate returns minutes later (frequency).
Soreness may occur in the lower abdomen, in the back, or in the sides.
This cycle may repeat itself many times during the day or at night (nocturia). It is
normal to urinate about six times a day. If you are urinating more often, you may have
a UTI.
If the bacteria enter the ureters and spread to the kidneys, symptoms also may include:
•
Back pain
•
Chills
•
Fever
•
Nausea
•
Vomiting
Lower UTI or an infection confined to the bladder is not associated with fever or
sepsis, which may be present in an upper UTI. The patient may rarely have a lowgrade temperature and malaise. Most of the symptoms are related to bladder
irritability caused by inflammation of the bladder mucosa or bladder wall. Frequency
of urination associated with pain on voiding or dysuria is common. The patient
usually urinates in small amounts and complains of cloudy, foul smelling urine. The
patient may experience urgency or urgency incontinence with suprapubic discomfort,
heaviness, pressure, or pain. It is not uncommon for middle-aged women to have
grossly bloody urine, but this is uncommon in men and children. The elderly
bacteriuria patient may have classical symptoms of bladder irritability, but usually are
Asymptomatic.1
28
Typically, children with cystitis have Dysuria, urgency, frequency, suprapubic
pain, and also often have incontinence. An associated symptom is malodorous urine.
In some cases the only manifestation of a UTI may be day and night incontinence or
nocturnal enuresis.5
Pyelonephritis refers to a renal infection. Typical symptoms include fever and
upper abdominal or flank pain localized to the side of the infection; some may
experience malaise, nausea and vomiting, and diarrhoea.
INVESTIGATIONS AND DIAGNOSIS
1) Urine analysis
The diagnosis of UTI usually is made from urinalysis and urine culture. The
patient will usually provide a history of signs and symptoms of a UTI. A urine
analysis is important bacteriuria with pyuria (leukocytes in the urine) should be
demonstrated. If pyuria is absent, the diagnosis of a UTI must be questioned.
The commonest method of diagnosing urinary tract infections is the
examination of a mid-stream specimen of urine, often referred to simply as an MSU.
Specimen collection is very important, and clear instructions to patients should be
provided. The external genitalia must be washed properly using soap and water. The
first portion of urine is voided to wash out any microbes from the distal part of the
urinary tract. It is the middle section of the urinary flow that is collected for laboratory
analysis
Catheter samples of urine are also frequently examined. Catheterization of the
bladder clearly introduces some meatal and urethral organisms. Similarly bacteria
enter the urine from the urethra during micturition. As voided specimens are easiest to
obtain and are non-invasive, this is the preferred method of urine culture by most
29
physicians. It is possible to obtain specimens without urethral and perineal
contaminants by careful cleansing and, in women, labial separation during the
collection. Collecting urine samples from babies poses a particular problem. To avoid
contamination problems associated with bags, supra-pubic aspirates can be
performed. If a patient is suspected of suffering from renal TB, then the number of
organisms in the sample will be low. To help in the diagnosis three consecutive early
morning specimens of urine are examined.
Having collected the specimen, for routine examination, urine is subjected to a
microscopic examination and culture. Urine microscopy reveals the presence of
leukocytes, red blood cells, bacteria and "casts". These are proteinaceous deposits
formed within the diseased kidney, and shed in the urine. They may be clear (hyaline
casts) or may have leukocytes or red cells stuck to their surface. Urine sample
containing squamous (skin-type) epithelial cells are considered contaminated.
Squamous epithelial cells are not found in the urinary tract.
2) Urine Culture
Normal urine should not contain bacteria, and in a fresh uncontaminated
specimen, the finding of bacteria is indicative of a UTI. Because each HPF views
between 1/20,000, and 1/50,000 ml, each bacterium seen per HPF signifies a bacterial
count of more than 20/1000/ml, therefore 5 bacteria/HPF reflects colony counts of
about 100,000/ml. this is the standard concentration used to establish the diagnosis of
a UTI in a clean catch specimen. The finding of any bacteria in a properly collected
midstream specimen from a male should further be evaluated with a urine culture.
Urine for culture should be carefully collected to reduce possible perineal
contamination. In the past it was widely stated that 100,000 colony forming units
30
(CFUs) had to be present to diagnose a UTI. However, the current thinking is that in
the symptomatic woman, as few as 100 CFUs/ml represent significant bacteriuria.
The diagnosis of UTI can be made rapidly and inexpensively with
examination of the urine microscopically. The urine is obtained by clean-catch
technique in most older children and adults. This technique should be explained to the
patient so that a reliable specimen can be obtained.
The mode of collection of the urine sample can influence the density of
organisms. Suprapubic aspiration contains a spuriously low density of organisms if an
acute diuresis has been provoked to distend the bladder.
The methods of collection are important in making the diagnosis of UTI.
Almost without exception, a mid-stream clean-catch urine specimen can be obtained
in a cooperative adult patient. Occasionally, a catheterized specimen is needed in a
patient who is unable to cooperate. Suprapubic aspiration or catheterisation may be
needed in neonatal patients, in children who are unable to be instructed on clean-catch
specimens, or in urgent situations. The accuracy of a midstream collection has been
well documented, and catheterisation or suprapubic is rarely needed.
In infants and in children who are not toilet trained, a clean bag is placed over
the genitalia, which have been washed. This “bag specimen” may be unreliable
because of bacterial contamination of the bag itself or contamination from bacteria
that have colonized the skin. If the urinalysis from a bag specimen shows significant
pyuria, if only one organism is cultured, and if the child is symptomatic, then the bag
specimen may be considered to be reliable. However, if any of the three criteria is not
met, one may not conclude that the child has a UTI. Instead, the infection should be
confirmed with either a catheterized urine specimen or a suprapubic tap.
31
In older patients, diagnosis of a UTI usually is based on a voided specimen,
which should grow at least 10,000 and preferably 100,000 colonies of a single
organism.
A negative culture usually means that there is no infection. However, a culture
may be repeated in 1-2 days if the symptoms persist.
The presence of bacteria, as indicated by a positive culture, indicates an
infection. Any bacterial infection may be serious and can spread to other areas of the
body if not treated. Since pain is often the first indicator of an infection, prompt
treatment, usually with antibiotics, will help to alleviate the pain.
3) Radiological investigation
A UTI often is the first manifestation of a child’s underlying anatomic or
functional urinary tract abnormality. Approximately 30% of all children who have
bacteriuria, and almost 50% of those under the age of 3 years, have abnormal
radiological studies of the urinary tract. Vesicoureteral reflux is most common.
Radiological investigation is recommended for all children under the age of 5 years
with UTI. All boys irrespective of age, all girls with pyelonephritis, and following a
second UTI in girls over 5 years old.
The initial study is a voiding cystourethrogram / micturiting cystourethrogram
(MCU) to determine whether reflux or a structural abnormality of the lower urinary
tract is present. Next, a renal ultrasound should be obtained to determine whether any
upper urinary tract abnormalities are present. If both studies are negative, then no
further evaluation is necessary. However, if either study shows an abnormality, then
further evaluation with an intravenous urogram or renal scan is necessary.
32
Preventive measures13
Changing some of your daily habits may help you avoid UTIs.
•
Drink lots of fluid to flush the bacteria from your system. Water is best. Try
for 6 to 8 glasses a day or more.
•
Drink cranberry juice or take vitamin C. Both increase the acid in your urine
so bacteria can't grow easily. Cranberry juice also makes your bladder wall slippery,
so bacteria can't stick to it.
•
Urinate frequently and go when you first feel the urge. Bacteria can grow
when urine stays in the bladder too long.
•
Urinate shortly after sex. This can flush away bacteria that might have entered
your urethra during sex.
•
After using the toilet, always wipe from front to back, especially after a bowel
movement.
•
Wear cotton underwear and loose-fitting clothes so that air can keep the area
dry. Avoid tight-fitting jeans and nylon underwear, which trap moisture and can help
bacteria grow.
•
For women, using a diaphragm or spermicide for birth control can lead to
UTIs by increasing bacteria growth. If you have trouble with UTIs, consider
modifying your birth control method. Unlubricated condoms or spermicidal condoms
increase irritation and help bacteria cause symptoms. Consider switching to lubricated
condoms without spermicide or using a nonspermicidal lubricant.
UNDERSTANDING OF PATHOLOGY IN THE HOMOEOPATHIC
PERSPECTIVE.
33
14 Stuart Close eloquently explains the understanding of Pathology and
Bacteriology in a Homoeopathic perspective. He says, Human Pathology is the
science, which treats of diseased or abnormal conditions of living human beings.
Homoeopathic medical science views the facts of the universe in general and medical
facts in particulars, from a vitalistic – substantialistic stand point, that is, from the
stand point of the substantial philosophy which regards all things and forces,
including life and mind, as substantial entities, having a real, objective existence.
Hahnemann’s generalization was based upon his new far-reaching discovery: “The
existence of living, specific, infections micro-organisms as the cause of the greater
part of all true diseases.
This brings us to a consideration of Hahnemann’s epoch making discovery of
specific, living micro-organisms as the cause of infectious diseases such as cholera
and the venereal diseases, and of the relation of Bacteriology to Homoeopathy. The
great practical, value of Hahnemann’s theory of the chronic diseases has never been
fully appreciated because it has never been fully understood. Hahnemann was so far
ahead of time that his teaching in its higher phases could not be fully understood until
science in its slower advance had elucidated and corroborated the facts upon which he
based it, and this science has done in a remarkable manner. For the suggestion of
bacteriology as the basis of a rational modern interpretation of Hahnemann’s theory of
chronic diseases, we are indebted to the late Dr. Thomas. G. McConky, of San
Francisco. Modern Bacteriological science, by long independent research, slowly
arrived at the goal Hahnemann reached more than half a century before in regard to
the nature and causes of certain forms of disease.
Hahnemann was the 1st to perceive and teach the parasitical nature of
infections or contagious diseases, including Syphilis, Gonorrhoea, Leprosy,
34
Tuberculosis, Cholera, Typhus, and Typhoid fevers, and the chronic diseases in
general, other than occupational diseases and those produced by drugs and unhygienic
living, the so called drug diseases.
Here we have anticipation by more than 50 years of Koch’s discovery of the
comma bacilli of Cholera. The names, bacilli, bacteria, microbes, microorganisms etc
had not been invented in Hahnemann’s time nor had the microscope with which Koch
was able to verify the truth of Hahnemann’s idea, been invented. Hahnemann had no
microscope, but he had a keen analytical mind, phenomenal intuition, logic and
reasoning powers, and vast erudition. He used the terminology of his day, which he
qualified to suit his purpose, thus made it clear that by the word “Miasma” amplified
by the descriptive terms “Infectious, contagious excessively minute, invisible living
creatures as applied to cholera, he meant precisely what we mean today when we use
the terms of bacteriology to express the same idea.
He found that all other natural diseases could be traced to one primary cause.
After many years of patient historical and clinical investigation, he found that cause to
be ancient, almost universally, diffused, contagious or infectious principle embodied
in a living parasitical, micro-organism, with an incredible capacity for multiplication
and growth. This organism and the disease produced by it he named PSORA.
B.K.Sarkar opines that, Hahnemann’s ideas about miasms (in a wider sense),
infection, a symptomatic latency of infection, idiosyncrasies and hypersensitiveness
on the part of the patient – all seemed a failure to make an impression on his
contemporaries as he could not substantiate his claims by experimental verifications
which alone seemed to catch their imaginations so fast. His semi – scientific and semi
– philosophical conception of miasms was laughed at by his contemporaries. So when
they got something tangible through the efforts of microbe-hunters, not only did they
35
throw overboard his theory concerning the etiology of diseases but along with that
tried to reject his most rational and humane form of drug therapy.15
In the eager quest for the specific bacterial causes of the various diseases the
principles of logic has not always been followed and applied and particularly that
principle known as the Law of Causation which reaches that every effect has a
number of causes, of which the specific cause is only the proximate or most related in
the preceding series. It also teaches that the specific cause may be modified in its
action on the subject by collateral causes or conditions affecting both the subject and
the antecedent cause so that no specific cause can be said to act unconditionally. It
follows that micro-organisms as cause of individual diseases are not the whole,
unconditioned causes; they are reduced in rank to equality with constitution, heredity,
predisposition and environment. Since the micro-organisms are only one of the many
causes of diseases, the curative remedy for the concrete resulting disease in the
individual must correspond to the combined effects of the various causes. As the
individual case of every disease vary in their causes and conditions and consequently
in their symptoms or effects, there can be no common specific remedy for a disease.
Thus mere bacteriology can never serve as a basis for reliable and efficient
therapeutics for an individual. The so-called modern scientific school of medicine is
slowly but surely realizing the futility of the slogan “Kill the bacteria and cure the
disease.”
“In considering the cause of disease attention should be, but is not always
sufficiently, paid to both the (a) “soil” or the constitution of the patient and (b) the
seed, such as germs or worms. Until the second half of the last century the diathesis (a
persisting morbid tendency) and of constitution (the make-up of the body with its
hereditary and acquired liability to reaction were the common places of every-day in
36
practice. But when the bacteriological investigations proved that many diseases were
directly caused by and could not develop in the absence of specific germs, the
somewhat intangible factors of diathesis and constitution thus contrasted with visible
micro-organism became over shadowed and until recently neglected.”
Dey S.P distinctly explains that, Bacteria cannot produce disease unless we
are hyper susceptible to be affected by them. Bacteria can only grow, multiply and
survive if they get suitable environment for the same. The defensive mechanism of
our body (the immunity) successfully resists all the bacterial and viral infection
through the specific immunoglobulins and various other factors involve in the said
mechanism. When bacteria or viruses overpower the immunological factors, the
patient becomes a victim of those particular bacteria or viruses.16
He further emphasizes, potentised Homoeopathic medicines contain only the
dynamis inherent in the medicinal substance. Naturally, this dynamis can never affect
the bacteria or any material subject directly. It can only act on another dynamis like
the vital principle, which animates the living human organism. Similarly, the dynamis
present in the bacteria, virus is responsible for their growth and multiplication. The
dynamis of the bacteria, act on the vital dynamis and if it is stronger than the vital
dynamis, it can produce disease. In order to make the vital dynamis free from the
effect of the disease dynamis, we have to take the help of another stronger dynamis
(i.e., the drug dynamis) which stimulates the vital dynamis and there by the defensive
mechanism of a body resulting in cure.
M.L.Dhawale states, “ The remedy selected by the physician, acts through the
medium of the host and not directly on the morbific agents. Physician’s interest in the
morbific agents, is strictly limited to the health he obtains from their study in arriving
at the diagnosis.17
37
Allen says, “The Homoeopathic remedy covers all the phenomenon of disease
of whatever origin it may be, even to the microorganisms. The life principle restored,
or when the perverted life force resumes its normal, it puts an end to their existence.18
MIASM – A Fundamental Tenet In Homoeopathic Prescription
Allen further says, the discovery of the chronic miasms by Hahnemann was a
death blow to the erroneous conceptions of the etiology of disease, in his day, and it is
nonetheless true in our day, although a century of years lies between, and an army of
thinkers, and investigators, along these lines have arisen, and many of them departed
this life, since Hahnemann said that Psora was the parent, or the basic element of all
that is known as disease. Since his day many an etiological structure has risen, but to
fall with its own weight, or to be torn down and its debris removed to make room for
other structures on less endurable.
Herbert Roberts aptly says, Disease endings are found in its pathology but its
beginnings no man can see, except as he sees it through law and knowledge of the
nature of the chronic miasms.20
Harimohan Choudhary remarks “This source or germ of suffering and death is
positive, demonstrable and perfectly recognizable.” Hahnemann called it the miasm.19
Allen adds, Hahnemann has recognized three special forms of miasms, which
he designated as Psora, Sycosis and Syphilis. This triune of the subversive forces also
called the chronic miasmata, are the vicarious embodiment of the internal disease,
each having its own peculiar type or character by which its sole purpose and effort is
to conform the organism to its nature. Each of these forces becomes a creative force,
and at no time is the life force able to free itself from the bond of any of them (either
alone or in combination with others), without some assistance. Just how these
38
subversive forces Psora, Syphilis or Sycosis combine in the organism, or rather with
life force, can probably never be explained or accounted for with no external
etiological reason they seem to come from within the organism itself, developing
from some peculiar dynamis within.
Kent puts forth that; Psora is the beginning of all physical sickness. Had Psora
never been established as a miasm upon the human race, the other two chronic
diseases would have been impossible, and susceptibility to acute diseases would have
been impossible. All the diseases of man are built upon Psora; hence it is the
foundation of sickness; all other sickness came afterwards. Psora is the underlying
cause. And is the primitive or primary disorder of human race. It is the disordered
state of the internal economy of the human race. This state expresses itself in the
forms of the varying chronic diseases, or chronic manifestations.21
Ortega adds that, Sycosis is the miasm or constitutional state of excess, of
exuberance, of ostentation, of flight. Morbific causes are aggressive; confronted with
aggression; the Psoric condition produces inhibition, while the sycotic one is
stimulated to flight. 22
The third miasm that we call Syphilis, (and which, as suggested by Flores
Toledo, must be distinguished somewhat from its meaning in traditional medicine), is
the constitutional state engendering perversion, i.e., destruction, degeneration,
aggressiveness.
Phyllis Speight emphatically puts forth that; Miasms are the foundation of all
the chronic diseases. The fact is we cannot select the most similar remedy possible
unless we understand the phenomena of the acting and basic miasms, for the true
Similia is always based upon the existing basic miasms. The very earmarks of the
various stigmata (Miasms) show their respective characters. 23
39
Miasmatic Background of UTI
Allen aptly says, throughout the whole urinary tract, we find latent symptoms
of all the miasms. Of the true chronic miasms, Psora and Sycosis take an active part in
the production of disease in these organs. The tubercular element, however, will be
found to be not entirely absent by any means for it is the tubercular plus the sycotic
element that gives us many of the so-called malignancies and severe diseases of these
organs.18
The tubercular patient complaints of anxiety and much loss of strength after
urination. Often in Psoric children, we have retention of urine when the body becomes
chilled; we see this also in old people; great distention of the bladder, with fullness, as
if it was extremely full, is another symptom; sense of constriction, too, is often
present. The urine in any Psoric patient will pass off frequently involuntarily when
sneezing, coughing or laughing. There is not much pain in passing urine in Psora,
generally a slight smarting, due often to acidity of the urine.
Phyllis Speight further adds that, the sycotic element is seen in children when
they scream when urinating. Sycotics have painful spasms affecting the urethra and
bladder. Also gouty concretions are present in urethra of young babies when born of
sycotic parents. Diabetic patients come under the tubercular / Pseudopsoric miasm
with offensive urine which in children may be involuntary at night as soon as they fall
asleep.
Sutherland, Allan D says, considering now the urinary organs, we find the
Psoric individual pass his urine involuntarily when sneezing, coughing or laughing.
We find a deposit in the urine white or yellowish-white in colour, phosphates or
similar deposits. In the nervous patient of the tubercular taint, we find urine, which is
40
pale and copious. We get nocturnal enuresis in children with a tubercular background.
25Under sycosis we find the symptom that children scream when urinating, on
account of the sandy deposit in the urine. 24
Hahnemann elaborately explains in regards to Psoric manifestations in UTI, he
says, Psora, during micturition has anxiety. At times too much urine is discharged,
succeeded by great weariness with painful urination. When he is chilled he cannot
urinate. At times owing to flatulence, she cannot urinate. Pressure on the bladder, as if
from an urging to urinate immediately after drinking – he cannot hold the urine for
any lengthy of time, it presses on the bladder and passes off while he walks, sneezes,
coughs / laughs. Frequent micturition at night. Whitish urine with sweetish smell and
taste. Burning micturition with lancinating pain in the urethra and neck of the
bladder.26
S. Banerjea opines that, in sycosis there are stitching and pulsating sensations
with wandering pains. Sycotic urinary symptoms are aggravated in damp, rainy
weather and from the changes of the season. In sycosis micturition is painful, there
may be contraction of the urethra, and children will scream while urinating. Scanty
urination (Psora is mainly responsible for scanty discharges), but during the rainy
season polyuria is a characteristic of Sycosis. Frequent desire to urinate before a
thunderstorm. Urinary cramps and painful spasms affecting the urethra and bladder
may be present. Sycotic patients suffer from renal calculi with pains, which are
stitching and wandering in character. 27
He adds, in syphilis there are destructive and degenerative types of malignant
tumours in the kidneys or bladders. Pyaemia with oozing of pus, stricture of the
urethra is seen. All advanced conditions of the kidneys and Genito-urinary tract, with
pyogenic inflammations can be associated with structural and pathological changes,
41
and are therefore syphilitic in origin. Burning and bursting sensation in the bladder or
loin area are syphilitic. All symptoms of syphilis are aggravated at night, in summer,
and from warmth. Irritation and burning of the parts, wherever the urine touches,
indicates the activity of this miasm.
Role of Homoeopathic Remedies in the treatment of UTI.
Therapeutics of UTI – Materia Medica
William D Gentry Aptly says as follows:28
Apis: 1) Urine:
red, leaves a brown colored sediment.
Scanty, high coloured, fetid
Copious, straw colored
Milky, albuminous
2) Albuminuria
3) Burning soreness when urinating
4) Burning as if scalded in urethra on commencing to urinate
5) Burning and stinging in urethra
6) Cystitis – retention / suppression of urine
7) Difficult – urination – must wait long before commencing
8)During
Urination
stinging,
burning,
smarting,
soreness
and
constriction of urethra
9) Frequent desire with passage of only a few drops.
10) Frequent painful, scanty, bloody urination with alterations of
dry
skin
and perspiration.
11) Frequent profuse urination with constant urging.
12) Great irritation of neck of bladder with frequent and burning
42
urination.
13) Inflammation of bladder with scanty urine.
14) Incontinence of urine with great irritation of bladder and
urethra
aggravated at night, coughing.
15) Paroxysms of pain in ureters.
16) Strangury, stricture, retention of urine with inflammation of
Ars Alb :
bladder.
1) Burning in urethra during micturition
2) Involuntary micturition
3) Suppression / retention of urine, paralysis of bladder
4) Haematuria, difficult urination
5) Retention of urine, atony of bladder
6) Urination after sweat
7) Urine – dark brown, dark yellow, turbid, fetid,
offensive, cadaverous odour, mixed with pus and blood,
scanty
and
like
thick beer, difficult, burning during urination.
Bell:
1.
Retention of urine, which passes drop by drop.
2.
Involuntary micturition; constant dribbling.
3.
Difficult, scanty urination, dull pressing pain in region of bladder during night.
4.
Urine – bright, yellow, frequent, copious, pale, blood red stains linen like
saffron, turbid with reddish sediment.
5.
Frequent desire with small quantity, region of bladder very sensitive to
pressure/jar, tenesmus of bladder.
6.
Sensation of turning and twisting in bladder as if from a large worm
43
7.
Acute cystitis, Dysuria
8.
Spasms of urethra and incontinence of urine.
Berb. V
1.
Burning pain in bladder, violent sticking, cutting pains from kidney into
bladder and urethra.
2.
Cutting, contracting and burning in urethra < after urinating. Pain in bladder
on movement
3.
Pain in loins and hips when urinating.
4.
Violent urging after urinating, especially in morning
5.
Burning, cutting pain in female urethra during and after urinating. Crampy,
contractive pain in region of bladder.
6.
Stitches in urethra, extending to bladder.
7.
Titillating pain in urethra
8.
Pain in urethra, excited/ < by movement.
9.
Urging to urinate with scanty, burning urine, pain in neck of bladder. Urine
flows very slowly with pain and pressure in front of bladder.
10.
After urinating feeling as if some urine remained in the bladder.
11.
Urine – Dark, yellow, red, copious, bright yellow with profuse mucous
sediment, blood red, dark, turbid
Nitric Acid – Smarting and burning in urethra during and after urination. Discharge of
bloody pus and mucus from urethra. Needle like stitches in meatus. Frequent urging
to urinate with scanty discharge < at night. Urine – orange, containing bile, is cold
when passed. Very offensive, like horse’s urine, scanty, dark brown, smelling
44
intolerably strong and turbid. Burning in urethra, wants to urinate, thinks urinating
will relieve burning. After urinating, violent burning and discharge of mucous.
Spasms of urethra. Ulcers in urethra. Bloody, mucous/purulent discharges. Very thin
stream, as if urethra were contracted.
Canth: Cutting and contracting pains from ureters down to penis. Dull pressing pain
with urging to urinate. Frequent painful urination. Violent pains in bladder.
Intolerable urging, tenesmus of bladder, constant burning in urethra, catarrh of
bladder. Urine scalds and passes drop by drop. Smallest quantity of urine in bladder
causes urging to urinate. Fruitless effort to urinate. Urine passes in thin, divided
stream. Dribbling of reddish discharge. Retention of urine causing pain. Dreadful
cutting pains in urethra. Urine – bloody, scanty and turbid. Pain in bladder increased
by drinking even small quantity of water. Urging < when standing. Atony of bladder.
Spasm of bladder and urethra Cystitis and with intense tenesmus
Staph: Frequent urging to urinate with scanty, thin stream / dark urine in drops.
Burning in urethra during and after urination. Urine – copious, pale, scanty, dark
yellow in a thin stream. Irritability of bladder and urethra. Urging to urinate, but very
little is passed. Pressure on bladder on walking.
Terebinthina: Tenesmus of bladder. Incontinence of urine at night. Dysuria, Cystitis,
Urethritis, Strangury, Haematuria. Inflammation of bladder, urethra with scanty,
turbid, dark urine. Distressing strangury. Burning in bladder and urethra during
micturition. Complete suppression of urine. Frequent urination at night with intense
burning.
Urine – scanty, bloody, turbid and dark. Deposits a thick, muddy, light yellow
sediment.
45
Guernsey remarks, Sulph: Urine discharged by drops, incontinence, patient lies awake
for sometime, then fall into a deep sleep in which they wet the bed. Itching about the
genitals on going to bed at night.29
Lyco: Clear transparent urine, having a heavy, red crystallized sediment. Retention of
urine, patient will get into position to urinate, but wait a great while before the water
comes, accompanied by the characteristic pain in the back, which ceases when the
urine flows, cries out with pain before urinating. Affections of urethra.
Puls: Very scanty, bloody with mucus, reddish, involuntary discharge of urine,
incontinence in bed at night, especially in mild tempered, tearful people. When going
to urinate there is a sensation as if it would gush away and they can scarcely wait.
Region over the bladder very sensitive to pressure.
Merc.S: Acid, dark, turbid, too frequent, complaints while passing and after.
Affections of the urethra.
A.V.Lippe opines Apis : Incontinence of urine, with great irritability at the parts,
worse at night and when coughing. Dark coloured and scanty urine. 30
Cantharis : Burning pain and intolerable urging to urinate and the red strands of
cantharis are:
Constant desire to urinate, passing but a few drops at a time, sometimes mixed
with blood.
Great burning, distress in the urethra. Cutting burning pains in the urethra,
with ineffectual urging to urinate.
It produces and cures most violent cystitis. Small unsatisfactory quantity of
urine passed at a time.
Violent cutting or burning pains extend from the kidneys down to ureters and
to the bladder.
46
Ars-alb – Retention of urine after confinement
Lyco – Aching pain in the lumbar region, ameliorated. after urination
Renal colic
Sandy sediment of urine
Urinary disturbances are marked
Stitches in the neck of the bladder and anus at the same time.
Heavy, red sediment in the urine
Terrific pain in the back, previous to every urination, with relief as soon as the
urine begins to flow.
Lach: Sensation as of a ball rolling in the bladder. Urine almost black, foamy,
frequent and dark. Pressure in the bladder with frequent urging, stitching, cutting pain,
or soreness in the fore part of the urethra
Nux V - Renal colic, pain extending to the genitals, urine passes in drops, with
burning and tearing in the urethra and neck of the bladder.
Shinghal. J. N, recommends Staphysagaria for painful micturition in young
wives. Urinary trouble of young nervous women after marriage where urging to
urinate becomes very troublesome to the young women. He further says,
�Staphysagaria is the most comforting to the young wife under such circumstances.31
Clarke J.H. says: Burning or scalding, painful micturition drop by drop, Canth
3,2h. Constant ineffectual desire, contraction of urethra, emission in drops, Copaiva
3,2h. Urine scanty and high coloured, burning soreness when urinating, frequent
desire, passes only a few drops, Apis 3x,2h. Sudden and frequent urging to urinate,
Petrosel Q, 8h. Flow interrupted by sudden spasm of urethra, Clem 1-30, 1h. Urine
stops suddenly and does not begin to flow again for some moments, Con. 6, 2h.32
Again, he advises, Camph. 1x, gtt 1 for acute as well as strangury due to
47
Cantharides poisoning. In less urgent cases with burning and inflammatory symptoms,
Canth, 3, ВЅ hrly. With lumbago like pain, Tereb 3,1/2 h. In women especially
Copaiva 3, 1/2h. In purely nervous cases, Bell 3, 1/2h
Pulford mentions Belladona in the treatment of UTI with the following
symptoms; Irritation of the bladder and along the urinary tract, sensitive to jar, after
urination, sits and strains, while urging is violent and sudden, women lose their urine
on becoming cold, nervous, sensitive women.33
He also advises, another drug Staphysagaria in the urinary troubles of newly
married women.
Richard Hughes says, in the treatment of UTI especially Acute Cystitis,
Cantharis is confessedly a great remedy and it should not be given lower than the
third dilution. Referring to Bahr, he says, Bahr has seen immediate aggravation from
the third decimal triturition. If there be much, general erethism or fever, Aconite may
be given but not otherwise. There is a sub acute form of catarrh of the bladder which
is apt to result from local damp and cold, and which is very liable to become chronic.
Here you will find Dulcamara very effective, at least when the deposit is mucous
rather than purulent.34
In chronic cystitis, his great favourite remedy is Chimaphila Umbellata, which
he has used with advantage. It has to be given in lowest dilution on the mother
tincture.
Boericke.W places Copaiva as one of the first grade remedies for acute
cystitis, stating that it acts powerfully on the mucous membrane especially that of
urinary tract, producing burning pressure, painful micturition by drops, retention with
pain in bladder, anus and rectum. Catarrh of the bladder, dysuria. Constant desire to
urinate. Urine smells of violets, greenish, turbid colour, peculiar pungent odor.35
48
Talking about Chimaphila Umbellata, he says �it is one of the remedies, whose
symptoms point to its employment in bladder affections, notably catarrh, acute and
chronic, especially in plethoric young women with dysuria. Scanty urine and loaded
with ropy, muco-purulent sediment. Urging to urinate. Burning, scalding during
micturition and straining afterwards.
Iyer T. S advises the following remedies in the treatment of UTI: Aconite, for
the most common cases with painful urging, for children if they put their hands to the
parts and scream, when no urine or very little urine passes, sometimes only in single
drop with great pain, the discharge is very red, dark and turbid, particularly for
women and children. If Aconite does not give relief give Cantharis;36
Pulsatilla if there are pressing, cutting pains or redness and heat in the region of the
bladder specially for the women when their menses are suppressed or are scanty; also
for less pain but much urging.
Arnica, If due to a blow or fall on the bladder or back or sudden fall of the whole
body.
Nux Vom for use after liquor or some strong medicines; after suppressed piles, with
burning, pressing and tension in the back and the region between the ribs and hip
bones.
Belladona, if the pains are more piercing, extending from the back to bladder, in
spells with great anxiety, restlessness and colic. If Belladona gives temporary relief,
give Hepar.
Mercurius when there is very violent, constant desire to urinate, the stream being very
small, with perspiration at the same time; Urine dark red, soon becoming turbid and
offensive
49
E. A. Farrington says Cantharis will be found indicated in acute cystitis more
frequently than all other remedies put together. Sometimes the patient will have the
desire to urinate every 2 or 3 minutes. The urine does not pass freely or copiously, but
dribbles away in hot, scalding, sometimes bloody drops with burning, cutting pain,
which could not be worst if the urine were molten red. This burning and urging
continues after urination. Exacerbations come on every few minutes as calls to urinate
become too urgent to resist. The urine itself shows changes in its composition. Blood
is more or less thoroughly mixed with it, according to the part of the urinary tract
from which haemorrhage proceeds. The urine of deep red color, independently of its
containing blood, and deposits a sediment of muco- fibrinous, epithelial cells, small
rolled-up membranous pieces of the lining of the parts through which it passes, or
observed under the microscope.37
Kent opines that; in Apis the urine is scanty, coming only in drops much
straining before the urine will start, and then only a few drops, dribbling a little hot
urine, burning urine, bloody urine. As soon as a few drops collect in the bladder, the
urging comes, constant, ineffectual urging. Latter the urine is almost suppressed. The
whole urinary tract is irritated, very much like Cantharis, and these two medicines
antidote each other. Stitching pain in the urethra with enuresis. Morbidity, irritability
of the urinary organs is present. “Strangury, agony in voiding urine. Retention of
urine is seen in nursing infants. Urine is scanty and foetid containing albumin and
blood corpuscles.38
Farrington E.A has elaborately explained and compared a number of remedies
in the treatment of UTI in the following way;39
50
He says Aconite frequently suits the incipiency of renal and cystic affections,
with unmodified progress into a cantharis condition. The urging to urinate, dysuria
and haematuria, are accompanied with an anxious restlessness and high fever.
Belladona causes cystitis, with violent fever, co existing brain symptoms, hot
fiery - red urine and local sensitiveness, so marked, to render touch or jarring
unbearable.
Terebinthina produces inflammation of the bladder and the urethra with
strangury and bloody urine. Urine – cloudy, dark, albuminous. Violent burning and
drawing pains.
Equisetum causes dull pain in the renal region, with urging to urinate. The
bladder is tender, sore with severe dull pain, which does not lessen after urination.
There is a constant desire to urinate, sometimes with the feeling of distension, and
with profuse urination. Urine is high coloured, scanty, containing mucous; burning in
the urethra during urination, passes a small quantity of urine, but feels as though he
had not urinated for hours.
In catarrh of the bladder, caused by stone, Uva Ursi is superior to Cantharis.
There are frequent painful attempts to urinate with burning, slimy or bloody mucus
urine. It often palliates.
Sarsaparilla, which has caused burning urination, presents skinny particles in
it. Nux vom with ineffectual urging, Merc. Sol and Merc. Aceticus, the latter with
cutting just at the close of urination. Cochlearia Armoracia has produced burning,
cutting at the glans during and after micturition. Strangury and jelly like urine.
Bloody urine with invitation or inflammation, suggest, in addition to
Cantharis: Erigeron, an excellent remedy. Erechthites, a promising remedy in bright
51
haemorrhages. Epigea, bloody sediment and vesicle tenesmus, with burning. Merc.
cor bloody urine in drops; terrible strangury with burning.
In the course of colds, fevers, pneumonia etc, the bladder symptoms are not
uncommon. If so, the case should be readily distinguished by local and concomitant
symptoms from cases calling for the following: Ant Crud, suits in cystic catarrh with
frequent, burning urination, but more often with gastric ailments. Antim tart, causes
frequent urging, spasm of the bladder, scanty urine, passing dark or even in drops and
bloody, accompanied by rattling cough, sneezing, dyspnoea, etc.
Copaiva causes urethritis, burning in the neck of the bladder and in the
urethra, milky corrosive discharge, orifice of urethra tumid, inflamed sore as if
wounded, nettle rash.
Cubeba causes cutting and constriction after micturition; mucous secretion.
40 Farrington H says, Cantharis acts especially upon the mucous membranes
of the urinary tract producing conditions ranging from irritation to violent
inflammation and destruction of tissues. It causes, frequent, irresistible, sudden urging
to urinate with burning in the neck of the bladder and the urethra. Worse during and
after urination. Urine in thin stream or bloody drops
Schussler recommends the following drugs in urinary conditions: Ferr Phos:
Incontinence of urine when every cough causes the urine to spurt. Inflammation of the
bladder, irresistible urging to urinate, < by standing with smarting pain.41
Kali Phos: Incontinence of urine in old people; scalding; bloody urine, itching of
urethra, frequent urination
Mag Phos: Spasmodic retention of urine.
Nat Phos: Catarrh of the bladder. Much mucus in urine, frequent urination.
52
Nat Sulph: Sandy deposit, brick dust sediment. Especially useful in gouty patients.
Nat mur: Cutting in urethra and after urinating, much and frequent urine. Involuntary
after coughing, when walking
Kali mur: Inflammation of bladder, dark coloured urine with sandy deposits.
Urethritis
Boericke eloquently says: Asparagus – Officinates: frequent micturition, with fine
stitches in orifice of urethra; burning; of peculiar odour. Cystitis, with pus, mucus and
tenesmus.35
Can. Sativa: Retained. Painful urging. Micturition in split stream. Stitches in urethra.
Inflammed sensation, with soreness to touch. Burning while urinating, extending to
bladder. Urine scalding. Walks with legs apart, urethra very sensitive. Zig Zag pain in
urethra.
Chimaphila Umbellata: Urging to urinate. Urine, turbid, offensive, containing
ropy\bloody mucus. Burning and scalding during micturition and straining afterwards.
Must strain before flow comes. Scanty urine. Retention unable to urinate without
standing with feet wide apart, and body inclined forward.
Copaiva: Burning pressure. Painful micturition by drops. Retention with pain in
bladder. Catarrh of bladder, Dysuria. Constant desire to urinate. Urine smells of
violets, greenish, turbid, peculiar pungent odor
Cubeba: Urethritis with much mucus, especially in women, cutting after urination
with constriction. Haematuria Cystitis.
Equisetum: Severe, dull pain and feeling of fullness in bladder not relieved by
urinating. Frequent urging with severe pain at the close of urination. Urine flows only
drop by drop. Sharp, burning, cutting pain in urethra while urinating. Retention and
dysuria
53
Eucalyptus Globulus: Haematuria. Urine contains pus, bladder feels loss of expulsive
force. Burning and tenesmus, catarrh of bladder. Diuresis
Eupatorium Purpuratum: Burning in bladder and urethra on urinating. Insufficient
flow, milky, strangury, Haematuria. Constant desire, bladder feels chill, Dysuria.
Oleum Santale: Frequent, burning, smarting and redness of meatus. Stream small and
slow. Sensation of a ball pressing against the urethra < standing. Chronic Cystitis.
Pareira Brava: Black, bloody, thick mucous urine. Constant urging, great straining,
pain down thighs during efforts to urinate. Can emit urine only when he goes on his
knees, pressing head firmly against the floor. Feeling of bladder being, distended.
Dribbling after micturition. Urethritis.
Allen adds, Apis has great burning stinging and sore pain suddenly migrating from
one part to another. There is incontinence of urine, with great irritation of the parts,
patient can scarcely retain the urine a moment and when passed, scalds severely with
frequent painful scanty blood. 42
Cantharides has constant urging to urinate, passing but a few drops at a time
which is mixed with blood with intolerable urging burning cutting pains in urethra
during micturition violent tenesmus and strangury.
Terebenthina has haematuria with blood thoroughly mixed with the urine and
sediment like coffee-grounds; cloudy, smoky, albuminous; profuse dark or black and
painless. �Also violent burning and cutting in the bladder with tenesmus, cystitis and
spasmodic retention of urine.
In Staphysagria, we see urging to urinate, patient has to sit at urinal for hours;
in young married women; after coition and after difficult labour. There is burning in
urethra when not urinating.
54
The Mercurius patient has frequent urging to urinate and the quantity of urine
voided is larger than the amount of water drunk.
Phatak rightly says that the following drugs act on the urinary organs: Aconite,
Ars alb, Causticum, Chimaphila, Cicuta, Dulc, Hep. Sulph, Hyoscyamus, Lil tig,
Lyco, Mag phos, Mercurius, Mur.ac, Opium, Petr, Plumb, Secale, Silica, Sulph.acid,
Tereb and Zinc met.43
Terebenthina has selective affinity for mucous membrane of kidneys and
bladder.
Chimaphila acts on kidneys and bladder producing gravel in kidney, and acute
and chronic. Catarrh in the bladder. The urine is ropy or muco-purulent foul and
scanty. Patient must strain before urine flows
Cicuta has involuntary urination in old men and urine is passed with great
force. There is stricture of urethra after inflammation
Causticum acts on the muscles of the bladder causing paralysis of bladder,
from long retention of urine after labour and surgical operations, and consequent
incontinence. Involuntary urination, retention of urine and burning in urethra when
urinating < after coition. Urine is passed better in sitting position
A. Teste has further remarked that the Bryonia alb patient, presents with
symptoms of nephritic colic, frequent urging to urinate, although there is but little
urine in the bladder, burning and cutting colic in the lower abdomen, before, during
and after the emission of urine, involuntary emission of a few drops of urine when
coughing, walking, incontinence of urine, diabetes and red sediment in the urine. In
Allium sativa there is sensation in the bladder and urethra as if one had to void urine,
which is however not the case, scanty and dark coloured urine, profuse whitish urine,
which is rendered cloudy by the addition of nitric acid. The pains caused by Allium
55
are mostly pressive pains from within outwards, stinging and burning or stinging with
paralytic weakness or lastly tearing and crampy pain.44
P. Ishwardas opines that Terebinthina is prescribed for urinary tantrums,
nephritis; after wetting; after any severe acute disease, preceded by drowsiness,
dropsy, strangury and flatulence. Other manifestations are burning in kidneys
extending along ureters to bladder, even urethra. Catarrhal inflammation of bladder
with burnings, also suppurative Tenesmus, strangury, any pain excites urination.
Frequent micturition from pain in bowels, with lumbago < at night, Urethritis with
painful erections; burning during urination. 45
He also says that in Nat. mur there is tension and heat in renal region, calculi,
bladder catarrhs, shake up enuresis, urine burns, brick dust sediment and diabetes
after grief.
The symptoms of Lachesis include acute nephritis with suffocation, strangury,
cystitis, polyuria < lying or during sleep, or infrequent urination, Urine: bloody, black
in various dropsies, sugar, albumin, after infections, during pregnancy, with heart
trouble, red sand and brick dust sediment in urine.
56
METHODOLOGY
57
METHODOLOGY
1.
The present study was undertaken on 30 patients attending OPD / IPD / village
camps of DR.B.D Jatti Homoeopathic medical college,hospital & post graduate
research centre, Dharwad.
2. Uncomplicated lower UTI cases were taken up for study, on the basis of inclusion
and exclusion criteria, out of which 23 were females and 07, were males.
3. The cases were recorded keeping the holistic concept in mind.
4. Case taking was done according to the scheme of Model case paper (Annexure - I)
with a special emphasis to ascertain the following points.
(a) History of present complaints:
The details of the presenting complaints along with the onset, duration and cause have
been recorded with a special emphasis to the sensation, concomitants and modalities
pertaining to the presenting complaints.
(b) Past history: History of UTI in the past pertaining to duration and treatment is
recorded. The past histories of other complaints are recorded in chronological order
with nature, treatment and results of treatment to understand the miasmatic cleavage.
(c) Family history: Detailed family history was taken to find the incidence of UTI or
any other acute or chronic diseases on the paternal side, maternal side and immediate
relations to evaluate the miasmatic background of the family.
(d) Personal History: All the generalities of the patient, to relate the patient as a whole
were recorded with a special emphasis to thermals, mental reactions, aversions and
desires, aggravation with food and habits, appetite, thirst, bowel movements,
perspiration, sleep, dreams and in case of females, menstrual and obstetric history,
findings of observation and examination.
58
(e) General physical examination: The positive findings of built, nourishment and
vital data were recorded.
(f) Systemic examination: The positive findings were noted.
(g) Investigations : Blood examination, Urine analysis, urine culture, plain X-ray
KUB and USG wherever required
(h) Diagnosis : Diagnosis of UTI cases were made on the following points:
Basic and absolute manifestation with determinative of the disease.
Determinative of the individual on the basis of totality of symptoms (Aph. 147)
(i) General Management:
All the cases were advised invariably to stop any other treatment and general
preventive measures were asked to be followed
5. Steps for homoeopathic prescription:
(a) Analysis and evaluation of symptoms: After detailed case taking, the symptoms of
the patient were analyzed into various categories like mental generals, physical
generals and particulars.
After analyzing the symptoms, they were evaluated by grading them.
(b) Repertorisation: Computer repertorisation was used when needed
(c) Miasmatic diagnosis: Symptoms were grouped according to the miasms
(d) Selection of remedy:
Selection of the remedy was done on the basis of
reportorial result, characteristic symptoms and miasmatic diagnosis of the patient.
(e) Potency and Repetition: Indicated remedy was prescribed in 30th or 200th
potency in the beginning. It was repeated depending on the severity of the complaints
and pathology. Higher potencies were administered when the lower potencies failed
to give relief depending upon the merit of the case.
59
6. All the cases were reviewed once in 7 days for the first 1 month, then once in 15
days for the remaining period of study or as per the demand of the case and the
progress was recorded.
The following parameters were fixed according to the type of response obtained after
treatment and these criteria should be fulfilled for at least 6 months.
Recovered: Feeling of mental and physical well being and no other similar complaints
observed for a period of 6 months.
Improved: Feeling of mental and physical well being along with reduction in
frequency of complaints.
Not improved:
•
No response.
•
No reduction of complaints even after defined period of treatment.
60
RESULTS
61
RESULTS
The present study includes 30 cases of UTI irrespective of their sex and age.
I. Age Incidence
Statistical study was conducted to identify the age group with the highest incidence.
STATISTICAL CHART SHOWING AGE INCIDENCE IN YEARS
Table No. 1
SL.no
Age Groups in
No. of patients
Percentage (%)
Years
1
0 – 20
05
16.66
2
21 – 40
17
56.66
3
41 – 60
06
20
4
61 – 80
02
6.68
Total
30
100
As shown in the above chart, the maximum incidence was in the age group 21
– 40 years (17 cases) i.e., 56.66%, followed by 41 – 60 years (06cases) i.e., 20% and
then followed by 0 - 20 years (05 cases) i.e. 16.66%The lowest incidence was seen in
the age group of 61 – 80 years (02 cases) i.e., 6.68%. The youngest patient in the
study was 10 years old and the oldest patient was 70 years old. [Vide Table No. 1]
62
II. Sex Incidence
The table given below shows the statistical study of sex incidence in 30
patients with UTI.
Table No. 2
Sl.
Sex
No. of
No
Percentage (%)
patients
1
Male
07
23.33
2
Female
23
76.67
Total
30
100
.
As shown in the table, the study showed maximum sex incidence in females
(23 patients) accounting to 76.67% of the total and minimum incidence in males (07
patients) accounting to 23.3 [Vide Table No. 2].
63
III. Other Associated Complaints
Table No. 3
Sl.No
Other complaints
No.of patients
Percentage (%)
1
Skin complaints
5
16.66
2
Female menstrual
disorders
1
3.33
3
Respiratory tract
infection
2
6.66
4
Renal Calculi
1
3.33
5
Gastric disorders
10
33.33
6
Other complaints
11
36.66
The study showed 5 patients i.e., 16.66% of total had skin complaints like
eczema and itching of the body. 1patients i.e.,3.33% of total had menstrual disorders.
2 patient i.e., 6.66% had respiratory tract infection like cold, coryza, sneezing. 1
patients i.e., 3.33% had renal calculi. 10patients i.e., 33.33% had gastric disorders. 11
patients i.e., 36.66% of total had other complaints like headache, fever, general
weakness, numbness sand stiffness of extremities.
[Vide Table No. 3]
64
IV. Family History
In statistical study of 30 cases incidence of diseases in the family were
analyzed.
Table No. 4
Sl. No
Family History
No. of
Patients
Percentage
(%)
1
Renal Calculi
4
13.33
2
Hypertension
3
10
3
Diabetes Mellitus
3
10
4
Skin complaints
2
6.67
5
Heart Disease
8
26.67
6
Not Significant
10
33.33
The study showed 10 patients i.e., 33.33% of total, with no significant
complaints in the family. 8 patients i.e., 26.67% had heart disease in the family. 3
patients ie.,10% had Hypertention,2 patients i.e., 6.67% had Skin complaints in the
family. 4 patients had renal calculus in the family accounting to 13.33% of total.
[Vide Table. 4]
65
V. Miasmatic Background
Statistical study of 30 cases was done to know the miasmatic background of
the patients.
Table No. 5.
Sl. No
Miasm Involved
No. of patient
Percentage
(%)
1
Psora
10
33.33
2
Psoro-sycotic
12
40
3
Psoro-syco-
8
26.67
syphilitic
In the study done maximum number of cases i.e., 12 cases accounting to 40%
of total cases had Psoro-Sycotic background. 8 cases i.e., 26.67% had Psoro-sycoSyphilitic background and 10 cases i.e., 33.33% had Psoric background. [Vide Table
No. 5]
66
VI. Acute Remedies
Statistical study of 30 cases was done to know the acute remedies used.
Table No. 6
Sl.no
Acute Remidies
No.of
patients
Percentage(%)
1
Acon
01
7.14
2
Apis
02
14.28
3
Ars.alb
01
7.14
4
Bell
02
14.28
5
Cantharis
06
42.85
6
Nit ac
01
7.14
7
Staph
01
7.14
From the above tabulation it is seen that 14 cases i.e., 46.66%out of the total
needed an acute remedy. Acon was given to 1 patient (7.14%). Apis was given to 2
patient (14.28%), Arsenic album was given to 1 patients (7.14%), Belladona was
given to 2 patient (14.28%), Cantharis was given to 6 patients (42.85%), Nitric acid
was given to 1 patients (7.14%) and Staphysagria was given to 1 patient (7.14%).
[Vide Table No. 6].
67
VII. Constitutional Remedies
Statistical study of 30 cases was done to know the constitutional remedies
used.
Table No. 7
Sl.No
Constitutional Remedies
No. of
Percentage
patients
(%)
1
Berb
05
31.20
2
Lyco
02
12.50
3
Nux.v
03
18.75
4
Puls
01
6.25
5
Sars
02
12.50
6
Sulph
01
6.25
7
Thuj
02
12.50
From the above tabulation it is seen that 16 cases i.e., 53.33% out of the total
(30 cases) needed a constitutional remedy. Berb was given to 5 patients (31.20%).
68
Lycopodium was given to 2 patients (12.50%), Natrum mur was given to 3 patient
(18.75%), Pulsatilla was given to 1patients (6.25%), Sarsaprilla was given to 2
patients (12.5%), Sulphur was given to 1 patient (6.25%) and Thuja was given to 2
patient (12.5%).
[Vide Table No. 7].
VIII. Type of Organism found in urine culture
Sl.No
Organism
No.of
Percentage (% )
patients
1
E.coli
19
63.33
2
Kleb
03
10
3
Proteus
01
3.33
4
Staphylococci
03
10
5
Pseudomonas
01
3.33
6
Nil
03
10
In the above tabulation it is seen that in 19 cases the causative organism was
E.Coli (63.33); Klebsiella,in 3 cases each (10%); proteus in 01 cases (3.33%)
Staphalococcus in 3 cases (10%);Pseudomonas were present in 1 case (3.33%) and 3
cases (10%) showed no organism in the urine culture.
69
IX. Results of treatment
Statistical study was done to know the results of treatment of 30 cases
Table No. 9
Sl.No
Results
No.of
Patients
Percentage (%)
1
Cured
14
46.67
2
Improved
11
36.67
3
Not improved
05
16.66
Out of 30 cases, maximum number of cases i.e., 14 cases accounting to
46.67% showed recovery, 11 cases i.e., 36.67% improved and 5cases i.e., 16.66 %
showed no improvement.
[Vide Table No. 9].
70
DISCUSSION
71
DISCUSSION
Homoeopathy approaches the problems of the patient in a unique way known
as individualization. Here the patient is considered as a separate unique individual.
Each person differs from the other in the reactive pattern, so is the case with
Homoeopathic medicines.
The human being right from the moment of birth lives in a dynamic
environment, which is affecting him at all time in many ways. If the stimuli are
stronger than the organism’s natural resistance, a state of imbalance will occur, with
signs and symptoms. The results can be seen on the mental, emotional and physical
level.
In the present study 30 cases of uncomplicated lower UTIs, of age groups
varying from 10 to 70 years, irrespective of sex were taken up. It was attempted to
study each case in depth in order to draw conclusions.
1) Age incidence:
The maximum incidences were in the age group 21-40 years (56.66%) in 17
cases. The minimum incidences of UTI were between 61-80 years (6.66%) in 2 cases,
6 patients had UTI in the age group of 41-60 years (20%) and 5 patients had UTI
between 0-20 years (16.66%). The youngest patient in the study was 10 years old and
the oldest was 70 years old (Vide table no.1).
2) Sex incidence
The study showed maximum sex incidence in Females i.e. in 23 patients
accounting to 76.66%, and in males 7 cases accounting to 23.33% were seen.(Vide
72
table no:2). This proves the fact that females are more likely to be affected than
males.
3) Other Associated complaints: The study showed 2 patients i.e., 6.66% of total
had skin complaints like eczema and itching of the whole body. 4 patients i.e.,
13.33% of total had menstrual disorders. 1 patient i.e., 3.33% had respiratory tract
infection like cold, coryza, sneezing. 2 patients i.e., 6.66% had renal calculi. 9 patients
i.e., 30% had gastric disorders. 12 patients i.e., 40% of total had other complaints like
headache, fever, general weakness, numbness, oedema and stiffness of extremities.
[Vide Table No. 3]
4) Family history: Tapan Kanjilal opines, “as an individual develops by and by from
the embryonic stage to death so also his disease condition goes on developing due to
its genetic cause, controlled guided and modulated by the miasmatic cause inherited
from ancestors as well as acquired by self”.
The study showed 10 patients i.e., 33.33% of total, with no significant complaints in
the family. 3 patients each i.e., 10% had hypertension and Diabetes Mellitus in the
family. 2 patients i.e., 6.67% had family history of Skin complaints, 8 patients i.e.,
26.67% had heart disease in the family. 4 patients had family history of renal calculus
accounting to 13.33%. [Vide Table. 4]
5) Miasmatic background: According to Hahnemann, Psoric miasm represents the
oldest defect, which has thoroughly permeated mankind so that hardly any one could
be said to be born free of its pernicious influence. Any structural change occurs only
when other miasms supervene on the Psoric base. Whenever such combinations
occur, the propensity to the development of disease is enhanced considerably.
In the study done maximum number of cases i.e., 12 cases accounting to 40%
of total cases had Psoro-sycotic background, 8 cases i.e., 26.67% had Psoro-syco-
73
syphilitic background and 10 cases i.e., 33.33% had Psoric background. [Vide Table
No. 5]
6) Acute Remedies
It is seen that 14 cases i.e., (46.67%) out of the total needed an acute remedy. Aconite
was given to 1 patient (7.14%), Apis was given to 2 patient (14.25%), Arsenic album
was given to 1 patients (7.14%),
Belladona was given to 2 patient (14.25%),
Cantharis was given to 06 patients (42.85%), Nitric acid was given to 1 patients
(7.14%) and Staphysagria was given to 1 patient (7.14%).
[Vide Table No. 6].
4 patients (13.33%) of the total 30 cases were given acute as well as constitutional
remedies.
7) Constitutional Remedies
It is seen that 16 cases i.e., 53.33% out of the total (30 cases) needed a constitutional
remedy. Berberis was given to 5 patients (31.20%). Lycopodium was given to 2
patients (12.50%), Nux vomica was given to 3 patient (18.75%), Pulsatilla was given
to 1 patient (6.25%), Saras was given to 2 patient (12.50%), Sulphur was given to 2
patient (6.25%) and thuja was given to 2 patients (12.5%).
[Vide Table No. 7].
4 patients (13.33%) of the total 30 cases were given acute as well as constitutional
remedies.
8) Results of treatment
74
Out of 30 cases, maximum number of cases i.e., 14 cases accounting to 46.67 %
showed recovery, 11 cases i.e., 36.67 % improved and 5 cases i.e., 16.66 % showed
no improvement.
[Vide Table No. 8].
9). Type of Organism found in urine culture
It is seen that in 19 cases the causative organism was E.Coli (63.33); Klebsiella, &
Staphylococcus aureus were seen in 3 cases each (10%); Proteus and Pseudomonas
were present in 1 case each (3.33%) and 3 cases(10%) showed no organism in the
urine culture. Hence we see that in most of the cases E. coli is the causative organism
and a few patients have sterile urine i.e they show no organisms in the urine culture.
75
CONCLUSION
76
CONCLUSION
Following were the conclusions drawn:
1.The most common age incidence prone to UTI was found to be 21 – 40 years.
2.Females were found to be more prone to suffer from UTI than males.
3.The miasmatic background in most of the cases was found to be Psoro-sycotic,
followed by Psoro-syco-syphilitic and least was Psoric.
4.The acute remedies used in the study were Acon,Apis,Ars Alb,Bell, Cantharis, Nit
Ac, Staph.
5.The most commonly used constitutional remedy was Berb.vul The other
constitutional remedies were Lyco,Nux.v,Puls,Sarsaprilla,Sulphur,Thuja.
6.It was seen that most of the remedies prescribed in this study were mainly Psorosycotic remedies.
7.It was found that 19 of the cases recovered totally and 5 of the cases improved with
the help of Homoeopathic medications, thus proving the efficacy of Homoeopathic
remedies in the treatment of UTI in this study.
77
SUMMARY
78
SUMMARY
UTI is an inflammatory response of the urothelium to bacterial invasion. It can
either involve the upper urinary tract (kidneys) pyelonephritis, or the lower urinary
tract (bladder and urethra) cystitis and urethritis respectively. Infections are generally
defined by their presumed site of origin. Acute UTIs affect 10% to 20% of women
during their lifetimes. Bladder infections are by far the most common infections that
the urologist treats and lower UTI confined to the bladder is one of the most common
bacterial infections
UTIs are a common health problem which many times go undetected or
unreported, but the symptoms of UTI can be very well treated with Homoeopathic
remedies without any side effects. The acute remedies used in the study were
Acon,Apis,Ars.Alb,Bell,Canth,Nitac,Staph.
The
constitutional
remedies
were
Berb,Lyco,Nux.v,Puls,Sars,Sulph,Thuja. To study the role of Homoeopathic
medicines in the efficacy of the treatment of UTI, 30 different cases of uncomplicated
lower UTI, of either sex, of age groups varying from 10 to 70 years, each satisfying
the inclusion and exclusion criteria, were considered. It was attempted to study each
case in depth in order to draw conclusions.
79
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80
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85
ANNEXURE I
i
DBHPS’S
DR. B. D. JATTI HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL &
POST-GRADUATE RESEARCH CENTRE, DHARWAD.
CASE PROFORMA
(BY DR. RAGHUPATHI.V UNDER THE GUIDANCE OF DR. G. C.
HIREMATH)
S. No.
OPD No.
IPD No.
Name of the Patient:
Age:
Sex:
Religion:
Marital status:
Occupation:
Address:
Phone no:
Date of consultation :
Diagnosis:
Miasmatic Diagnosis:
Remedy:
Constitutional remedy:
Results: Recovered / Improved / Not improved
ii
I. CHIEF COMPLAINTS:
II. HISTORY OF CHIEF COMPLAINTS:
III. PAST HISTORY:
Whether suffered from similar complaints before:
Disease
Suffered
Approximate
Age
Whether
Medicine &
Completely
Treatment
Recovered
Taken
Duration
From
*Any extra remarks or information
iii
Remarks
IV. FAMILY HISTORY
V. PERSONAL HISTORY:
Disposition
Diet:
Appetite:
Bowels:
Thirst:
Micturition:
Desires:
iv
Changed disposition
Aversions:
Sleep:
Dreams:
Perspiration:
Habits:
Relation with heat and cold:
Menstrual history:
Gynaec and obstetric history:
Mental disposition:
v
V. LIFE SPACE INVESTIGATION:
VI. GENERAL PHYSICAL EXAMINATION:
VII. VITAL DATA
Respiratory Rate:
Temperature:
Pulse Rate:
Blood Pressure:
Weight:
Height:
vi
VIII. SYSTEMATIC EXAMINATION
1. PER ABDOMEN;
2. CENTRAL NERVOUS SYSTEM:
3. CARDIOVASCULAR SYSTEM:
vii
4. RESPIRATORY SYSTEM:
IX) LOCAL EXAMINATION:
X) INVESTIGATIONS:
Differential diagnosis:
Clinical diagnosis:
Analysis of symptoms:
viii
Evaluation of symptoms:
Selection of symptoms for Repertorisation:
Repertorial analysis:
Repertorial Result:
Miasmatic diagnosis:
ix
Remedial analysis:
Potency selection:
Management:
TREATMENT
Date
Follow up
Remedy
x
ANNEXURE II
xi
xii
xiii
xiv
xv
xvi
xvii
ANNEXURE III
xviii
SYNOPSIS OF CASES
CASE 1:
Mrs.Rathnamma Balekundri37years W/O KallappaBalekundri came with the
complaints of burning micturation since 2months.Increased frequency of micturation
and ineffectual urgining,suprapubic pain.pain and itching in urethra.complaint
associated with retrosternal burning and feeling of bloated abdomen.sour
eructations.Gastric complaints agg by eating.Lazy in working.Foul smelling urine.She
desires fatty food.complaints of constipation.supposed to be irritable,sensitive to
noise.Chilly pt.
B.P – 140/84mm of Hg, P.R – 76b/m, R.R – 18cycles/minute.
Provisional Diagnosis –Lower Urinary Tract Infection
Clinical Diagnosis -Lower Urinary Tract Infection
Hahnemannian Diagnosis – Dynamic chronic Miasmatic fully developed disease.
Miasmatic Diagnosis – Psora-Sycosis
Result: On consultation of Meteria Medica,Nux V 200/3 days was given.The patient
was totally relieved of her complaints.The case was followedup for 6 months but there
was no sign of recurrence of symptoms.Also patient felt generally well.
CASE 2
Mrs.Shruthi 21yearsW/O SunilPol
came with the complaints of burning
micturation since 3days.She has H/O married life of 15 days.burning during and after
micturation.passes urine drop by drop.Increased frequency of micturation and
tenesmus.Foul smelling of urine.Complaints agg by drinking water.patient seems to
be anxious and restless.chilly patient. Complaint of menorrhagea.clots of dark
coloured.Generalised weakness.
xix
B.P – 120/80mm of Hg, P.R – 80b/m, R.R – 18 cycles/minute.
Provisional Diagnosis – Lower Urinary Tract Infection
Clinical Diagnosis –Lower Urinary Tract Infection
Hahnemannian Diagnosis – Dynamic chronic Miasmatic fully developed disease.
Miasmatic Diagnosis – Psora
Result: On consultation of Materia Medica, Canth 200/3 days was given. The patient
generally felt better mentally and physically. There was no repetition of similar
complaints for next 8 months.
CASE 3
Mrs.Ellavva 25years W/O Irannakumbar, came with the complaints of burning
micturation since 8 days.increased frequency, involuntary, small quantity of urine.
cloudy urine. suprapubic pain. patient in general hot and sensitive. .complaints
associated with hoarseness of voice, cold ,corryza and dry cough.
B.P – 120/80mm of Hg, P.R – 86b/m, R.R – 18 cycles/minute.
Provisional Diagnosis –Lower Urinary Tract Infection
Clinical Diagnosis – Lower Urinary Tract Infection
Hahnemannian Diagnosis – Dynamic chronic Miasmatic fully developed disease.
Miasmatic Diagnosis – Psora-Sycotic
Result: On consultation of Materia Medica, Apis 200/3 doses were given. The patient
is improved. There was no repetition of similar complaints for next 8 months.
CASE 4
Mrs Bibi Aisha28 years W/O Abdul pasha came with the complaints of burning
micturation since 1 moth. Increased frequency, suprapubic pain, bloody urine. Has
xx
past H/O Typhoid at the age of 27 years. complaint associated with bloated abdomen
,increased eructation,spasmodic pain in abdomen. Burning feet. She is restless, and
sensitive. In general chilly patient. Has habit of chewing tobacco, Disturbed sleep.
B.P – 120/80mm of Hg, P.R – 84b/m, R.R – 19 cycles/minute.
Provisional Diagnosis –Lower Urinary Tract Infection
Clinical Diagnosis -Lower Urinary Tract Infection
Hahnemannian Diagnosis – Dynamic chronic Miasmatic fully developed disease.
Miasmatic Diagnosis – Psora-Sycotic
Result: On consultation of Materia Medica, Nux vom30/3 days was given. The patient
recovered.There was no repetition of similar complaints for next 8 months.
CASE 5
Mrs.Apsha 26 years, W/O Khadar came with burning micturation since 3 moths. she
has slow stream, pain during micturation, increased frequency during night.
suprapubic pain. Complaint associated with gastritis, burning feet <covering part. Has
yellow coloured leucorrhoea, disturbed sleep. sensitive to touch. sadness during day
time. Hot patient. Father and elder brother has complaint of renal calculi.
B.P – 120/80mm of Hg, P.R – 82b/m, R.R – 18 cycles/minute.
Provisional Diagnosis – Lower Urinary Tract Infection
Clinical Diagnosis -Lower Urinary Tract Infection
Hahnemannian Diagnosis – Dynamic chronic Miasmatic fully developed disease.
Miasmatic Diagnosis – Psora-Sycotic
Result: On consultation of Materia Medica, Nux vom 30/3 days was given. The
patient generally felt better mentally and physically. There was no repetition of
similar complaints for next 8 months.
xxi
CASE 6
MrsSujatha aged 37 years W/O Mrs Mahanthesha araganji came with the complaints
of pain in the bilateral knee joints since 5years and gastric complaints since 6
months, burning micturition since 1 week. She had a family history of-Father
Dm2.Paternal grand father had osteo arthritis. The patient had disturbed sleep.
Mentally the patient was highly irritable; confused. Generally the patient was Chilly.
Patient was moderately built
B.P – 130/84mm of Hg, P.R – 86b/m, R.R – 19cycles/minute.
Provisional Diagnosis –Lower Urinary Tract Infection
Clinical Diagnosis -Lower Urinary Tract Infection
Hahnemannian Diagnosis – Dynamic Acute disease attacking individually.
Miasmatic Diagnosis – Psora
Result: On consultation of Materia medica, Lycopodium 200/3 doses was given. The
patient generally felt better mentally and physically. There was no recurrence of
similar complaints for next 8 months.
CASE 7
Mrs.Abdulsayed aged22yearsW/O Sadiquepasha came with the complaints of burning
micturation since 15 days. H/O Married life of 1month.Increased frequency, urgency
and tensmus, dribbling of urine. pricking sensation in the urethra. Disturbed sleep,
Anxiety, chilly patient. Family History-father and grandfather HTN,Mother-Dm2.
B.P – 120/80mm of Hg, P.R – 80b/m, R.R – 18 cycles/minute.
Provisional Diagnosis – Lower Urinary Tract Infection
Clinical Diagnosis – Lower Urinary Tract Infection
Hahnemannian Diagnosis – Dynamic Acute disease attacking individually.
xxii
Miasmatic Diagnosis – Psora
Result: On consultation of Materia Medica, Cantharis 30/1 dose was given. The
patient showed good improvement and was followed up for next 6 months,
CASE 8
Patient named Mr. Govindaraj aged55years s/o rajannanawar came with the
complaints of pain and swelling of fingers since2years. Burning micturation since 2
years. Bleeding per rectum since 2years.Indifferent behavior. Chilly patient. Increased
frequency with sedementaion in urine. pain more in the morning, radiates frome nape
of neck to hand and settles in finger tips. Family history-father-Dm2,elder brother had
H/O renal calculi. Sleep was disturbed.
B.P – 160/88mm of Hg, P.R – 90b/m, R.R – 22cycles/minute.
Provisional Diagnosis – Lower Urinary Tract Infection
Clinical Diagnosis – Lower Urinary Tract Infection
Hahnemannian Diagnosis – Dynamic chronic miasmatic fully developed disease..
Miasmatic Diagnosis – Psora-Syco-Syphilitic
Result: Viewing the totality the drug prescribed was Berbaris vulgaris200/3dose was
given after which the patient was totally relieved of his complaints. The case was
followed up for 8 months but there was no sign of recurrence of symptoms. Also the
patient felt generally well.
CASE 9
Mrs.Elizebath Kantha, aged45years W/O Andrew, came with the complaints of
bleeding per rectum since 1 year, Burning and pricking sensation after defication.
Protruded swelling over the anus. Constipation. She has
xxiii
fixed ideas about
everything.regarding family matter has confusion. Easily cries for simple matters. also
had associated complaint of burning micturation since 1month. Had H/O DUB at the
age of 38. Chilly patient.
B.P – 150/84mm of Hg, P.R – 88b/m, R.R – 18 cycles/minute.
Provisional Diagnosis – Lower Urinary Tract Infection
Clinical Diagnosis – LowerU rinary Tract Infection
Hahnemannian Diagnosis – Dynamic chronic miasmatic fully developed disease.
Miasmatic Diagnosis – Psora syco syphillis
Result: On consultation of Materia Medica Berbaris vulgaris 200/3dose was given.
The patient improved and felt better mentally and physically. There was no relapse of
similar complaints for next 8 months.
CASE 10
Miss.Chaitra Yemakanamaradi aged 20years D/O Chidananda yamakanamaradi came
with the complaints of recurrent boils over buttocks since 1year. Complaint starts with
itching on the affected part. She is very much sensitive.Also had complaint of burning
micturation since 2months. Increased frequency, scanty urine, suprapubic pain,
complaint associated with burning extremity. Complaints agg to cold. No significant
family history.
B.P – 120/80mm of Hg, P.R – 68b/m, R.R – 18cycles/minute.
Provisional Diagnosis – Lower Urinary Tract Infection
Clinical Diagnosis – Lower Urinary Tract Infection
Hahnemannian Diagnosis – Dynamic Chronic miasmatic fully developed disease.
Miasmatic Diagnosis – Psora-Sycotic
xxiv
Result: On consultation of material medica Sarsaprilla200/3dose was given for 4days.
Patient was improved and case was followed for 8 months.no relaps of the
complaints.
CASE 11
Mrs.Lalitha aged 65 years, W/O Rachappagasthi, came with the complaints of
burning micturation since2years.Increased frequency of urination on lying down.
Burning during, after micturation. Involuntry urination on coughing. suprapubic pain.
Used to cry for everything. Her mood changes often. prefers loneliness when she was
sad. Increased flatulence, constipation. She is a chilly patient. Diagnosed c/o urethral
stricture, uses dilator to dilate urethra. Father, mother, younger brother are Dm2 and
HTN.
B.P – 160/90mm of Hg, P.R – 86b/m, R.R – 20 cycles/minute.
Provisional Diagnosis – Lower Urinary Tract Infection
Clinical Diagnosis – Lower Urinary Tract Infection
Hahnemannian Diagnosis – Dynamic chronic Miasmatic fully developed disease.
Miasmatic Diagnosis – Psora-Sycotic-sycotic
Result: On consultation of Materia Medica Pulsatilla200/3dose for 3 days given. No
change in complaints even after visits of 2 month, then patient was discontinued
treatment.
CASE 12
Mrs.Barathikatharki, aged 25years W/O Anandkatharki came with the complaints of
Burning micturation since 20 days. Complaint associated with haematuria, suprapubic
pain,cutting pain in the lumbar area, pricking pain in the urethra. patient was anxious
xxv
about the complaints, very much restless, can not sit at a place. Suffering from
gastritis. Chilly patient, no significant family history.
B.P – 130/80mm of Hg, P.R – 84b/m, R.R – 18 cycles/minute.
Provisional Diagnosis –Lower Urinary Tract Infection
Clinical Diagnosis – Lower Urinary Tract Infection
Hahnemannian Diagnosis – Dynamic acute disease attacking individually.
Miasmatic Diagnosis – Psora
Result: On consultation of Materia Medica- Cantharis200/4 doses were given. The
patient completely recovered. There was no relapse of similar complaints for next 7
months.
CASE 13
Mr.Kuppuswamy aged 23 years S/O Alagiri came with the Complaints of Recurrent
burning micturation since 15 days.Had complaints of suprapubic pain and burning
feet. Burning after micturation. Patient even confused in his business matters. Axious
about future, cannot sit in a place. Gastric complaints were preseny. Seems to be
chilly patient. He had complaints of myalgea. Family H/O –Father-renal calculi
Mother- HTN.
B.P – 120/80mm of Hg, P.R – 82b/m, R.R – 18 cycles/minute.
Provisional Diagnosis – Lower Urinary Tract Infection
Clinical Diagnosis – Lower Urinary Tract Infection
Hahnemannian Diagnosis – Dynamic acute disease attacking individually.
Miasmatic Diagnosis – Psora
xxvi
Result: On consultation of Materia Medica- Canth 200/4 doses were given. The
patient improved, felt better mentally and physically. There was no relapse of similar
complaints for next 6 months.
CASE 14
Mr. Shrinivas gasthi, 18years S/O Sadanandagasthi came with the complaints of acute
abdomen,burning feet Kumar. S. Mogale, aged 40 years, came with the complaints of
burning micturition with dribbling since 15 days. He had a past history of typhoid 10
years back. Family history is not significant. He had an aversion for food. He was a
hot patient& mentally the patient was confused and restless. He is moderately built
and nourished.
B.P – 124/82mm of Hg, P.R – 68b/m, R.R – 16 cycles/minute.
Provisional Diagnosis – Urinary Tract Infection
Clinical Diagnosis - Urinary Tract Infection
Hahnemannian Diagnosis – Dynamic acute disease attacking individually.
Miasmatic Diagnosis – Psora
Result: On consultation of Materia Medica- Canth 200/4 doses were given. The
patient had no relief of complaints even after repeating the doses.
CASE 15
Mr.Mohamed Gayaz, aged 16 years S/O Wazid Ahmed came with the complaints of
acute abdomen, burning micturation since5 days. Increased frequency, scanty
urine,urgency. Suprapubic pain, dribbling of urine and cloudy urine.Patient is restless
even while giving case history. Sensitive to touch. C/O bloated abdomen, increased
flatulence. Family history Father-renal calculi. Chilly patient.
xxvii
B.P – 130/80mm of Hg, P.R – 76b/m, R.R – 19 cycles/minute.
Provisional Diagnosis –Lower Urinary Tract Infection
Clinical Diagnosis -Lower Urinary Tract Infection
Hahnemannian Diagnosis – Dynamic acute disease attacking individually.
Miasmatic Diagnosis – Psora
Result:
Taking
into
consideration
the
totality
and
after
repertorisation,
Cantharis200/3dose for 3 days was prescribed as an acute remedy. The symptoms
reduced drastically and the case was followed for a period of 7 months. There was no
recurrence of any symptom and the patient felt mentally better.
CASE 16
Mrs.Ashwinigotte, aged 28 years W/O Devandragotte came with the complaints of
burning micturation since 10days with increased frequency. Profuse urination,
pricking sensation in the bladder. patient is anxious about the disease, fear about
future. Haematuria, dribbling, suprapubic pain. C/O Leucorrhoea, whitish coloured.
Profuse sweating, dreams of horror. Anaemic patient. Complaints agg by hot.
B.P – 130/80mm of Hg, P.R – 66b/m, R.R – 18 cycles/minute.
Provisional Diagnosis –Lower Urinary Tract Infection
Clinical Diagnosis -Lower Urinary Tract Infection
Hahnemannian Diagnosis – Dynamic acute disease attacking individually.
Miasmatic Diagnosis – Psora
Result: Belladonna 30 was prescribed as the acute remedy. The results were satisfying
since the patient totally recovered and there was no appearance of similar complaints
even after a span of 8 months. He also felt generally better.
CASE 17
xxviii
Miss. Rukkaiah, aged29years D/O Kalil Ahmed came with the complaints of Burning
feet and burning micturation since 2 months. Increased frequency with dribbling of
urine. Patient was anxious about her disease, and restless. C/O Headache, haematuria
suprapubicpain. Hot patient. No significant family history. History of jaundice at the
age of 24.
B.P – 132/80mm of Hg, P.R – 80b/m, R.R – 18cycles/minute.
Provisional Diagnosis –Lower Urinary Tract Infection
Clinical Diagnosis – Lower Urinary Tract Infection
Hahnemannian Diagnosis – Dynamic acute disease attacking individually.
Miasmatic Diagnosis – Psora
Result: On consulting material medica-Cantharis 30 /3dose for 3days was given.
Patient was recovered, and was followed for 6 months. No repetation of the
complaints. Patient felt better physically and mentally.
CASE 18
Mrs.Amithapatil, aged 45 years W/O Ashishpatil came with the complaints of joints
pain since 10 years. Pain in the smaller joints. Swollen joints. Pain agg by moving
and winter.Burning micturation since 10 days. Increased frequency of urine.
Suprapubic pain. Complaint associated with skin eruption. Dry skin, agg during
winter. Burning extremities at night. Patient is restless. dysmenorrhoea. Family
history- Father has Dm2 skin eruptions. Mother-HTN.
B.P – 150/84mm of Hg, P.R – 86b/m, R.R – 19cycles/minute.
Provisional Diagnosis – Lower Urinary Tract Infection
Clinical Diagnosis -Lower Urinary Tract Infection
Hahnemannian Diagnosis –Dynamic chronic Miasmatic fully developed disease
xxix
Miasmatic Diagnosis –Psora-sycotic-syphillitic
Result: Sulphur was the indicated remedy and it was prescribed in the 200th potency.
Patient felt better both mentally and physically. There was no recurrence of the
similar complaints for the next 8 months.
CASE 19
Mrs.Preethikolvekar, aged 32years W/O Nithinkolvekar came with the complaints of
tingling and numbness in the extremities since a month. Enlarged tonsils with dry
cough since 20 days. Acute on set of suprapubic pain on urination .Burning
micturation since 6days. Patient was restless, fear to pass urine. Anxiety about future.
Chilly patient. Profuse sweating. No significant family history.
B.P – 120/80mm of Hg, P.R – 82b/m, R.R – 18 cycles/minute.
Provisional Diagnosis –Lower Urinary Tract Infection
Clinical Diagnosis – Lower Urinary Tract Infection
Hahnemannian Diagnosis- Dynamic acute disease attacking individually.
Miasmatic Diagnosis – Psora-Sycotic
Result: On consultation of Materia Medica- Aconite 200/3 doses were given. Patient
felt better both mentally and physically in general. There was no recurrence of similar
complaints for the next 8 months.
CASE 20
Mrs Ujwalapoojar, aged 38 W/O Rajashekarpoojar came with the complaints of
enlarged tonsils and cough since 6months Red swollen tonsils. Also had complaints of
burning micturation since 2 weeks. .Increased frequency, pain at the end of urination,
xxx
scanty urine, incontinence. Suprapubic pain. Restless,weeping tendency. Urticareal
rashes. No significant family history. C/O Leucorrhoea, watery type, non offensive.
B.P – 140/82mm of Hg, P.R – 62b/m, R.R – 18 cycles/minute.
Provisional Diagnosis – Lower Urinary Tract Infection
Clinical Diagnosis – Lower Urinary Tract Infection
Hahnemannian Diagnosis- Dynamic acute disease attacking individually.
Miasmatic Diagnosis – Psora-Sycotic
Result: On consultation of Materia Medica-Apis 30 /3 doses were given. Patient felt
better both mentally and physically in general. There was no recurrence of similar
complaints for the next 8 months.
CASE 21
Mr. Moodalappa, aged 70 years S/O Nagarajappa. Came with the complaints of pain
in glans since 1year, and burning micturation since 4 days. He was a diagnosed C/O
BPH. Increased frequency, hesitancy, urgency, Burning before urination and after
urination.Suprapubic pain, dribbling of urine. Patient is in a state of confusion
regarding every matter. Weeping tendency. No significant family history. Chilly
patient.
B.P – 180/90mm of Hg, P.R – 90b/m, R.R – 20 cycles/minute.
Provisional Diagnosis –Lower Urinary Tract Infection
Clinical Diagnosis – Lower Urinary Tract Infection
Hahnemannian Diagnosis- Dynamic chronic Miasmatic fully developed disease
Miasmatic Diagnosis – Psora-Sycotic-syphillis.
Result: On consultation of Materia Medica -Thuja 200/3 doses were given. Patient
showed no response and there was no amelioration of complaints.
xxxi
CASE 22
Mr.Edward, aged 60years S/O John was a diagnosed case of BPH, came with the
complaints of pain glans, and burning micturation. Increased frequency, hesitancy,
urgency. Slow steam of urine, suprapubic pain. Loss of apetite, epigastric pain,<
eating after food. Patient broods over the past, weeps while narrating the case. Father
and mother were Dm2. Chilly patient.
B.P – 164/90mm of Hg, P.R – 88b/m, R.R – 19 cycles/minute.
Provisional Diagnosis – Lower Urinary Tract Infection
Clinical Diagnosis – Lower Urinary Tract Infection
Hahnemannian Diagnosis- Dynamic Chronic Miasmatic fully developed disease
Miasmatic Diagnosis – Psora-Syco-Syphilitic
Result: Thuja 200/3 doses were given but the patient showed no response and there
was no amelioration of complaints.
CASE 23
Mrs. Jyothibusagari, aged 45 years W/O Sunilbusagari came with the complaints of
Irregular menses since 6 months. Profuse bleeding once in 4 months. Pain in vagina.
Burning and soreness of vagina. Diminished sexual desires. Leucorrhoea of gray
coloured. Offensive odour. Chilly patient. Patient is indifferent with her children.
Burning micturation with pain before urination. Pain in loins and thighs on urination.
Increased frequency of urination.
B.P – 160/84mm of Hg, P.R – 82b/m, R.R – 18 cycles/minute.
Provisional Diagnosis –Lower Urinary Tract Infection
Clinical Diagnosis -Lower Urinary Tract Infection
Hahnemannian Diagnosis- Dynamic Chronic Miasmatic fully developed disease
xxxii
Miasmatic Diagnosis – Psora-Sycotic
Result: Berbaris v 200/3 doses were given. The patient showed good improvement
and was followed up for 6 months, wherein her complaints reduced considerably.
CASE 24
Mrs.Felicealeo, aged 35yearsW/O Leoputt had came with the complaints of hoarsness
of voice with cold and cough since 2 months. Unable to breath that is difficulty in
breathing, suffocation, wheezing. Burning feet .She has C/O burning micturation
since 15 days with increased frequency, urgency, cloudy urine, suprapubic pain,
oedema of labia. She has C/O Change in mood, restlessness and irritable. No other
associated symptoms like fever, vomiting. Past H/O Bronchial asthma present.
Paternal grand father had bronchial asthma.In general patient was chilly.Had
dysmenorrhoea menorrhage.
B.P – 130/80mm of Hg, P.R – 68b/m, R.R – 18 cycles/minute.
Provisional Diagnosis –Lower Urinary Tract Infection
Clinical Diagnosis -Lower Urinary Tract Infection
Hahnemannian Diagnosis- Dynamic acute disease attacking individually.
Miasmatic Diagnosis – Psora-Sycotic
Result: Apis200/3 doses were given. Patient showed good improvement and there was
no recurrence of symptoms upto a period of 6 months. Patient was better physically
and mentally.
CASE 25
Miss.Kairunissa, aged 12 years D/O Farooq Ahmed was brought to the OPD with the
C/O Skin eruption in the rt medial aspect since 6 months. Wet skin oozing from the
xxxiii
affected part, blood mixed discharge. Itching < night < covering the part.. Child
seems to be irritable, cries for everything, consolation aggravation. Sensitive. Burning
micturation since 15days. Dribling of urine, urgency, cloudy urine, suprapubic pain.
Family history Father-Br .Asthma, Mother-HTN.
B.P – 120/80mm of Hg, P.R – 80b/m, R.R – 18cycles/minute.
Provisional Diagnosis –Lower Urinary Tract Infection
Clinical Diagnosis -Lower Urinary Tract Infection
Hahnemannian Diagnosis - Dynamic acute disease attacking individually
Miasmatic Diagnosis – Psora-Sycotic
Result: Arsenic alb. 30/1 dose was selected as an acute remedy. Patient felt better for
2 weeks and then Arsenic alb had to be repeated in a higher dose. Then there was no
recurrence for a further period of 6 months and the patient generally felt well.
CASE 26
Mrs.Nasrintaj aged 33 years W/O Sabbir came with the complaints of burning palm
and sole since 8 months.Burning along the border of the fingers. Ulceration around
the tip of the fingers, cutting type of pain in the finger nailbed..Itching of skin during
winter season, skin hard and indurated, dry skin. C/O Burning micturation, increased
frequency, urgency, sand in urine. sensitive patient, irritable, chilly patient.
B.P – 130/82mm of Hg, P.R – 68b/m, R.R – 18 cycles/minute.
Provisional Diagnosis –Lower Urinary Tract Infection
Clinical Diagnosis -Lower Urinary Tract Infection
Hahnemannian Diagnosis – Dynamic chronic miasmatic fully developed disease.
Miasmatic Diagnosis – Psora-Sycotic
xxxiv
Result: Sarsaprilla.200/3dose Patient showed slight improvement at first, but
complaints were still persisting, so a higher potency of Sarsaprilla was given. Still the
patient did not get any relief even after 3 months.
CASE 27
Mrs. Nirmalapatil, aged 26 years W/O Ajith Patil Came with the complaints of dry
cough since 6 month < in the midnight. Disturbs sleep. Cough starts after midnight
and persists till 5 am. <lying down, continuous cough. Pain in costal
margine,dysponea.C/O
Burning
and
itching
of
arm
bilaterally
since
5
months.Urticreal rashes <oil food, dust,> hot application. Patient was restless,
sensitive, fear of death. Burning micturation since 10 days, increased frequency,
urgency and suprapubic pain.
B.P – 120/80mm of Hg, P.R – 68b/m, R.R – 18 cycles/minute.
Provisional Diagnosis –Lower Urinary Tract Infection
Clinical Diagnosis - LowerUrinary Tract Infection
Hahnemannian Diagnosis - Dynamic chronic miasmatic fully developed disease.
Miasmatic Diagnosis – Psoro-Sycotic
Result: Arsanic Alb 200 /3 dose were given. There was no repetition of similar
symptoms nor was there any new symptoms seen in a span of 8 months.
CASE 28
Mrs.Geetha Bushatti aged 32 years W/O Basavaraj Bushatti, came with the
complaints of pain loin since 24 years. Recurrent pain in left lumbar region which
radiates to left iliac fossa. Suprapubic pain, haematuria, chills were present. Bleeding
per rectum since 8 months, with burning in anus,tenesmus. Passes bright red blood
xxxv
after defication. In general patient is chilly. She had mood changes, complaint > by
consolation. Burning micturation since 7days,with increased frequency of urine. Past
H/O gastritis, renal calculi were present. Family HISTORY, Father had H/O renal
calculi, gout. Leucorrhea of gray colour.
B.P – 132/82mm of Hg, P.R – 68b/m, R.R – 18 cycles/minute.
Provisional Diagnosis –Lower Urinary Tract Infection
Clinical Diagnosis -Lower Urinary Tract Infection
Hahnemannian Diagnosis - Dynamic chronic miasmatic fully developed disease.
Miasmatic Diagnosis – Psora-Sycotic-syphilitic.
Result: Berbaris .v 200/3dose was given . Patient showed good improvement. Case
was followed for 6 months . No repitation of the symptom.
CASE 29
Mrs. Veenapatil aged 48 years W/O Narendrapatil came with the complaints of
Bleeding per rectum since 5 months. Bright red coloured blood after passing stool,
constipation, tenesmus. Pain abdomen right hypochondriac region with retrosternal
burning. Burning micturation since 10 days .Suprapubic pain ,scanty urine. Chilly
patient, restless.
B.P – 150/84mm of Hg, P.R – 72b/m, R.R – 18 cycles/minute.
Provisional Diagnosis –Lower Urinary Tract Infection
Clinical Diagnosis -Lower Urinary Tract Infection
Hahnemannian Diagnosis - Dynamic chronic Miasmatic fully developed disease
Miasmatic Diagnosis – Psora-Syco-Syphilitic
Result: Berbaris. V. 200/3 doses were given. Patient showed no reduction of the
complaints and did not respond to treatment.
xxxvi
CASE 30
Bhagya, aged 10 years D/O Rajendra a female child was brought to the OPD with the
complaints of eating chalk and mud since 6 months. Child refuses to eat normal food
and milk. Complaints associated with the H/O pain abdomen, bloated abdomen. She
was very much irritable and sensitive to noise, pain and touch. Has also c/o foot
sweat, offensive odour, profuse sweating over palms. Soreness of toes, fingers. Chilly
patient.C/O Burning micturation since 7days.Increased frequency with scanty urine
offensive smell of urine. Stinging pain after urination. Bloody and albaminous urine.
B.P – 120/80mm of Hg, P.R – 74b/m, R.R – 20 cycles/minute.
Provisional Diagnosis –Lower Urinary Tract Infection
Clinical Diagnosis -Lower Urinary Tract Infection
Hahnemannian Diagnosis – Dynamic acute disease attacking individually.
Miasmatic Diagnosis – Psora-Sycotic
Result: Nitric acid 200/3 doses were given. Patient felt better both mentally and
physically. There was no recurrence of similar complaints for the next 8 months.
xxxvii
ANNEXURE IV
xxxviii
MASTER CHART
Occupation
Presenting
Complaints
Other
Complaints
Past
History
Family
History
F
H/W
BM ,G
G
Gastritis.
HTN
21
F
H/W
BM,
Mrs. EI
25
F
H/W
4
Mrs. B.A
28
F
H/W
BM, G
5
Mrs.A.K
26
F
H/W
6
Mrs. SM
37
F
7
Mr.A.S
22
8
Mr.G.R
9
10
Sl.
No
Name
Age
Sex
In yr.
1
Mrs.BK
37
2
Mrs. S.S
3
Acute
Remedy
Constitution
Remedy
Miasmatic
Diagnosis
Type of
organism
Result
Nux.vom
Psoro-Syco
E.coli
Recovered
-
Psoro
E.coli
Recovered
Psoro
Sycotic
E.coli
Recovered
NS
Canth
Cystitis
DM,HTN
Apis
G
Typhoid
DM
-Nux.vom
PsoroSycotic
Kleb
Recovered.
BM,BF,G
G,BF
G
RC,DM
Nux.vom
PsoroSycotic
E.coli
Recovered.
H/W
BM, G
P kneejoint
G, Pkneejoint
G, OA
RA,
DM,HTN
Lyco
Psora
Nil
Recovered
M
Bussines
BM
Psoro
E.coli
Improved
55
MS
Carpenter
BM,
PA,Haem
PA,Haem-
Berbaris.v
Psoro-SycoSyphilitic
E.coli
Improved
Mrs. E.A
45
F
H/W
BM, Haem
Berbaris.v
Psora-SycoSyphilitic
Nil
Improved
Mr. C.C
20
F
Student.
BM,Boils,Bf
Nux Vom
PsoroSycotic
E.coli
Improved
BM,Hoarsene Hoarseness,Cyst
ss,Drycough itis,Drycough
HTN,DM
Canth
PA
RC,DM,
HTN
-
Haem,DUB
DUB
DM,HTN
BF,Boils
Boils
NS
xxxix
Sarsaprilla
Sl.
No
Name
Age
Sex
In yr.
Occupation
Presenting
Complaints
Other
Complaints
11
Mrs.L.R
65
F
H/W
BM,Urethral
.S
Urethral. S
Const.
12
Mr B.A.K
25
F
H/W
BM, G
G
13
Mrs. K.A
23
M
Bussiness
BM
G
14
Mr. S.S.G
18
M
Student
BM
-
15
Mr.G.W
16
M
Velder
BM
16 Mrs.A.D.G
28
F
Teacher
BM,
17
Mrs. R.K
29
F
Clerk
BM
18
Mrs.A.A,P
45
F
H/W.
P J. Dry skin.
B.E BM
19
Mrs.P.N.K
32
F
H/W
20 Mrs. U.R.P
38
F
Teach
BM,
Numb.E,Tigli
ng.E
BM,
E.TONS,U.R
Past
History
Family
History
Bypass .S Dm2, HTN
G
Miasmatic
Diagnosis
Type of
organism
Result
-
Puls
PsoroSycoticSyphillis
Kleb
Not
improved
Psoro
E.coli
Recovered
RC,HTN
Canth
-
Psoro
E.coli
Improved
RA,Dm2
Bell
-
Psora
Nil
Recovered
RC
Canth
-
Psoro
Kleb
Recovered
Bell
-
Psoro
E.coli
Recovered
Psora
E.coli
Recovered
Sulph
PsoroSycoticSyphillis
E.coli
Improved
-
PsoroSycotic
E.coli
Recovered
PsoroSycotic
Staph
Improved
Jaundice
PJ
Canth
G.A S .E
HTN
Numb.e,
Tingling.E
E.Tons,U.R
Constitution
Remedy
Canth
-
P.J Dryskin,
Acute
Remedy
Acon
URTICREA
xl
NS
Apis
Sl.
No
Name
Age
In yr.
Sex
Occupation
Presenting
Complaints
21
Mr.MN
70
M
Former
PG,BM
22
Mr.EJ
60
M
Engineer
BM
23
Mrs.JS
45
F
H/W.
24
Mrs.FL
35
F
25
Miss.KF 12
26
Mrs.NS
27
Other
Complaints
G
Past
History
Family
History
Acute
Remedy
Constitution
Remedy
BPH
NS
--
Thuja
BPH
DM2
--
Thuja
PV,IMC,BM Leu,LL
NS
NS
--
Berberis
Clerk
BM
HV,C,DYS
Asthma
Asthma
Apis
--
F
Student
SE,BM
--
--
AST,HTN
Staph
--
33
F
H/W.
BE,SE,BM
--
--
--
---
Sars
Mrs.NA
26
F
HW
DC,BE,BM U,RL
ResC
AR,HTN
--
Ars alb
28
Mrs.GB
32
F
Teacher
Lumbago,BP
-R,BM
GA,RC,leu A,RC
--
Berberis vul
29
Mrs.VN
48
F
Clerk
BPR,BM
PA
Hae
NS
---
Berberis vul
30
Miss.BR 10
F
Student
BM,eating
UT,SF
--
--
DM2
Nit ac
---
G
xli
Miasmatic
Diagnosis
Psorasycos
yphilitic
PsoroSycoSyphilitic
Psorasycos
is
PsoroSycotic
Psora
PsoroSycotic
PsoroSycotic
Psorasycos
yphilitic
PsoroSycoSyphilitic
PsoroSycotic
Type of
organism
Result
Staph
Not
Improved
Proteus
Not
Improved
E.coli
Improved
E.coli
Improved
E.coli
Improved
E.coli
Not
Improved
Staphy
Improved
E.coli
Improved
E.coli
Not
Improved
Pseudoman
improved
as
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