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SICKLE CELL ANAEMIA

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Sickle Cell anaemia is characterised by malformed sickle-shaped RBC into blood circulation.

Pathophysiology of Sickle Cell Anaemia

In Normal adult humans the RBC are bi-concave dics shaped and predominantly has Heamoglobin-A.

Heamoglobin-A is comprised of 2 apha-globulin chains and 2 beta-globulin chains. Certain mutations in gene present on chromosome 11 that is responsible for production of beta-globulin chain of heamoglobin results into formation of so-called heamoglobin S.

Heamoglobin S is fragile and less elastic. It deforms the regular bi-concaved disc shape of RBC into sickle-shape which are not only obstructive in nature but also has low oxygen carrying capacity are less elastic resulting into excessive destruction of RBC and anaemia.

Due to reduced electricity of RBC their flexibility reduces which impairs their ability to flex and pass through small capillaries also they get deformed as they aren’t able to maintain their patent form due to loss of elasticity resulting in deformed RBC in sickled shape and also due to the shape they get caught up with each other and causing blockages in blood vesseles resulting into Infarction in corresponding tissue.

These Sickled RBC’s have 1/5th to 1/10th life span (10-20days)compared to life span of normal RBC(90-120days) in healthy individuals also they are being destroyed by our immune system all these factors caused excessive hemolysis and overload on bone marrow which is constantly trying to produce more RBC to compensate loss.

SIGNS AND SYMPTOMS

Signs and symptoms of sickle cell disease usually starts appearing from early childhood like dactylitis frequently presenting as earliest sign in many cases around age of 6mnths with dactilitis usually being the very early symptoms.

SCD patient frequently presents with various mild to severe and lifethreatening symptoms. The severity of disease may vary in each individual.

  • Anaemia
  • Swelling of extremities
  • Delayed growth and puberty
  • Frequent pain in chest, abdomen, head muscles and joints
  • Deterioration of vision to complete loss vision
  • Frequent infections
  • Strokes

Symptoms are due to lack of sufficient oxygenation of various tissues due to reduced oxygen carrying capacity of sickled RBC and also reduced number of RBC(due to destruction of sickled RBC by immune system and reduced life span of sickled RBC’s), blockages of blood vessels supplying various organs causing Infarction, stressed out immune system fighting with sickled RBC’s and its complications.

Sickle Cell Anaemia reduces life expectancy.

Symptoms may vary from chronic symptoms like retinopathy, CKD, hematopoietic ulcers to severe acute complaints like “Sickle Cell Crisis” triggered by dehydration, infections, acidosis and other obscure reasons.

Sickle Cell Crisis:-

Vaso-Occulusive Crisis:-

In SCD, RBC’s due to their low elasticity gets disfigured to assume sickle shape. Due to low elasticity RBC couldn’t easily squeeze out from small capillary lumen and adding to it a sickle shape, entraps them in capillaries and arteries causing obstruction in vessels, reducing blood flow resulting in ischemia or even infarction due to complete obstruction of blood flow. It is the cause of frequent episodes of pain and stroke in SCD patients. Obstruction of arteries supplying vital organs is medical emergency.

Splenic Sequestration Crisis:-

RBCs disfigured due to low elasticity in SCD gets trapped in spleen reducing circulating heamoglobin resulting hypovolemic shock and enlarged spleen. It is medical emergency and patient can die within couple of hours if not treated.

Splenic functions are reduced considerably in SCD patients due to frequent splenic infarctions reducing its capability to remove defective cells and certain organisms from circulation, this reduces immunity of person significantly thus increasing the risk of frequent infections.

Aplastic Crisis:-

Parvovirus B19, which causes reduced production of RBC by infecting and destroying RBC’s precursor cells, is a major concern in SCD patients as the RBC lifespan is 10-20days in SCD patient as compared to 90-120days in normal individuals. So normal individual can easily cope up with reduced production of RBC due to infection as it lasts only few days but in SCD patients, already there is stress on bone marrow to produce more reticulocytes due to increased turnover as result of reduced lifespan of RBC and now adding to it parvovirus B19 infection that reduces production even further to which system cannot cope up in SCD patients and they present with Cyanosis, Tachycardia and severe Fatigue.

Hemolytic Crisis :-

Due to reduced oxygen carrying capacity of RBC there is imbalance between oxygen that body receives and oxygen radicals produced this causes further stress on already stressed out RBC in SCD patients now patients with coexisting G6PD deficiency will contribute to further hemolysis and cause sudden reduction in Heamoglobin levels.

Acute Chest Syndrome

It one of the most common complication accounting for 25% of deaths of all the SCD patients, it is characterised by co-existence of any 2 of the following symptoms:

  • Chest pain
  • Fever
  • Pulmonary infiltrate
  • Focal abnormality
  • Respiratory symptoms
  • Hypoxemia

SCD patients are at risk of:-

  • Reduced/ Abnormal immunity due to failure of functioning of spleen in SCD patients
  • Strokes
  • Avascular Necrosis of bones
  • Infarction of penis, priapism
  • Osteomylitis
  • Acute papillary necrosis of kidney
  • Hematopoietic ulcers,Leg ulcers
  • retinopathy, proliferative retinopathy, vitreous haemorrhage, retinal detachments
  • Spontaneous abortion, pre-eclampsia, intrauterine growth retardation
  • Sickle cell nephropathy causing CKD
  • Pulmonary hypertension
  • Cardiomyopathy, arrhythmias, LVDD left ventricular diastolic dysfunction, Dyspnoea on slightest exertion
  • Pain crisis of Sickle Cell Anaemia

Homeopathic Treatment

Homeopathic treatment for Sickle Cell Disease is completely dependent on how well and detailed the Homeopathic-case-taking has been done to derive exact constitutional details and individualise each patient as per totality as its a deep genetic disease a deep acting constitutional medicinal force is required to bring about gradual changes in constitution.

Homeopathic Medicines

In case of SCD, indicated homeopathic similimum medicine should be selected strictly as per homeopathic principles of case-taking, individualisation and should be supported with proper repertorisation. Other than regular constitutional medicines patients may require intercurrent homeopathic theraputic treatment during phases of acute exacerbations.

Below acute/theraputic and constitutional medicine list commonly preferred in my practice( for reference purpose only). Not to self medicate in SCD case. Always treat under guidance of qualified and registered homeopathic practitioner.

  • Cinchonna Officinalis
  • Ruta Graveolens
  • Syphillinum
  • Ferrum Phosphoricum
  • Phosphorus
  • Crotalus Horridus
  • Natrum Muriaticum
  • Arsenic Album
  • Camphora
  • Arnica Montana
  • Lachesis
  • Hyocyamus
  • Naja
  • Aspidosperma Quebracho
  • Apocyanum
  • Borrheavia Diffusa

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ASPIDOSPERMA QUEBRACHO MOTHER TINCTURE AND ITS ROLE IN COVID-19 SOCIAL MEDIA POST FACT CHECK

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Recently during second wave of COVID-19 pandemic in India, I have come accross many social media forwards about Aspidosperma Quebracho mother tincture and its Miraculous role in COVID-19 pneumonia and hypoxia, with many claiming extra-ordinary results within few minutes of administering the medicine.

Many of my patients, friends and relatives have asked me curiously about authenticity of the claims of such forwards. Hordes of people even ended up at my clinic asking for Aspidosperma Quebracho Mother tincture. So I thought of clearing the cloud created by certain exagerated social media claims on this remedy and its use in COVID-19 hypoxia; based on my years of experience with this remedy and recently since a year on COVID -19 patients as well.

I have mentioned this remedy in my earlier comprehensive post on COVID-19 disease and its homeopathic treatment that I had posted last year.

Aspidosperma Quebracho is a very common medicine used in homeopathy for treatment of respiratory ailments especially Asthma and its acute exacerbations.

  • Aspidosperma Quebracho since ages is regarded as digitalis of lungs.
  • It is known to promote oxygenation of Red Blood Cells and excretion of Carbonic acid by clearing temporary obstruction in lungs and stimulating respiratory centers thus promoting oxygen carrying capacity of blood.
  • It is indicated in cases with thrombosis of pulmonary artery as found in COVID-19 complications.
  • Also used in patients with breathlessness due to pulmonary oedema caused due to congestive cardiac failure, typically presented as wheezing, coughing, dyspnoea, bloody sputum, shortness of breath -Cardiac Asthma.
  • In patients with dyspnoea i.e. want of breath or shortness of breath due to increased blood levels of Urea and other nitrogenous waste products that are usually excreted by kidneys
  • Reduced Oxygen saturation during walk or on slightest exertion- experienced as want of breath during activity “Dyspnoea on Exertion”.

So, many of the symptoms and conditions that this homeopathic remedy can treat are found in many COVID-19 patients, so its a good remedy that can be administered to COVID-19 patients with reduced oxygen saturation.

In my experience I have not found any extraordinary miraculous results with this remedy within minutes as claimed in social media post, but yes it may help to some extent in COVID-19 patients with reduced oxygen saturation; not instantly but after administration of few doses; by stimulation of respiratory centers, also may help in clearing pulmonary obstructions and pulmonary thrombus.

It may be administered in conjunction, along with regular main stream treatment but it is definitely not a replacement or alternative to oxygen support as falsely claimed by some social media posts.

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PERNICIOUS ANAEMIA

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Pernicious Anaemia is caused due to deficiency of Vitamin B12.

Pernicious literally means deadly, if untreated patient may develop irreversible pathological changes also stomach cancer in many untreated long haulers. Untill adevent of Vitamin B12 treatment it was considered untreatable and fatal but now with proper regular vitamin B12 supplimentation it is easily treated.

CAUSES OF PERNICIOUS ANAEMIA

Pernicious Anaemia is a later stage complication of Vitamin B12 deficiency.

Vitamin B12 deficiency may be due to

  1. Dietary insufficiency of Vitamin B12
  2. Lack of Gastric Intrinsic Factor(GIF) due to various pathological factors that may damage Gastric Parietal Cells which produces Gastric Intrinsic Factor eg autoimmunity etc.
  3. Other reasons like partial or complete gastrectomy.
  4. Lack of Hepatocorin due to corresponding gene defect.

PATHOPHYSIOLOGY OF PERNICIOUS ANAEMIA

Transportation and Absorption of Vitamin B12

TCN1 gene on chromosome 11 is responsible for production of transcobalamine-1 also called as Heptacorrin which is a glycoprotein secreted by salivary glands binds with VitaminB12 to form Heptacorrin-VitaminB12 complex thus helping transport of acid-sensitive vitamin B12 safely through the acidic medium of stomach into the deudenum region of small intestine.

In deudenum, the proteases from pancreatic enzymes degrade and detach this glycoprotein carrier heptacorrin from Vitamin B12.

Vitamin B12 in then gets attached to Gastric Intrinsic Factor also called Intrinsic Factor. GIF gene on chromosome 11 is responsible for production of Gastric Intrinsic Factor which is a glycoprotein secreted by parietal cells of stomach.

After attaching to Gastric Intrinc Factor this GIF-VitaminB12 complex is then transported and absorbed by Enterocytes in ileum region of small intestine.

In ileum, the Gastric intrinsic factor is detached and degraded from this GIF-VitaminB12 and Vitamin B12 is relaeased. Vitamin B12 is then taken up by Transcobalamine-2 (TCN2) which is then transported to tissues.

Biochemical Role Of Vitamin B12

Vitamin B12 is required to synthesis 5-Methyltetrahydrofolate and Homocysteine in presence of vitamin B12 and Methionine synthase produces Tetrahydrofolate and Methionine – Due to deficiency of vitamin B12 there is depletion in this process, which causes accumulation of 5-Methyltetrahydrofolate consequently reducing formation of various other folate products required for Thymidylate and Purine affecting DNA synthesis and replication thus hampering maturation erythrocytes (Red Blood Cell) resulting into immature, large and fragile Red blood Cells a picture of Megaloblastic Anaemia a feature of Pernicious Anaemia.

SYMPTOMS OF PERNICIOUS ANAEMIA

As described earlier Pernicious Anaemia is a later stage complication of vitamin B12 deficiency. So the patients of pernicious anaemia shows symptoms of Vitamin B12 deficiency along with general symptoms of anaemia. Typically complicating each other and showing involvement of neurological, Psychological, Gastric, Cardiac, aspects as well.

  • Weakness, lethargy, general debility, malaise, weight loss.
  • impaired growth in children delayed puberty Palor, pale face, mucousa and conjunctiva.
  • Tingling numbness of limbs, altered proprioception, altered gait, muscle weakness, clumsiness, myalgia paraesthsia lower extremities,
  • Subacute combined spinal cord degeneration leading to loss of ankle relfex and increased knee and extensor plantar response.
  • Impaired Urination
  • Brain fog, lack of concentration, lack of alertness, weakness of memory, weak cognition, cant comprehend easily, sluggish response, somnolence, disturbed sleep pattern, anger, irritability, mood swings, depression, psychosis.
  • Gastritis, Hyperacidity, Gastro-Esophageal Reflux Disorder (GERD), Diarrhoea, Jaundice, Ulcerative Stomatitis, Angular Cheilitis.
  • Tachycardia, cardiac murmurs, altered blood pressure, easily gets exhausted on exertion, Dyspnoea on Exertion.
  • Pancytopenia, hemolysis, pseudo-thrombotic micro-angiopathy.
  • Thyroid disorders

DIAGNOSIS OF PERNICIOUS ANAEMIA

Blood teat for Vitamin b12 level and Complete Blood Count (CBC)report is required.

Low Vitamin B12 level and low Heamoglobim parameters pancytopenia with a picture of Megaloblastic Anaemia are suggestive criteria for diagnosis of pernicious anaemia.

HOMEOPATHIC TREATMENT OF PERNICIOUS ANAEMIA

Homeopathic treatment of pernicious anaemia depends upon presenting symptoms which systems are involved and the severity of the condition. it is also important to evaluate whether vitamin B12 deficiency is due to insufficient dietary intake or is secondary to some other pathological condition in body like autoimmune disorders etc. and accordingly the patient should be treated

Supplimenting with Vitamin B12 and increasing food rich in vitamin B12 should be first priority in all the cases to bring back vitamin B12 levels back to normal AS SOON AS POSSIBLE to prevent further damage.

HOMEOPATHIC MEDICINES FOR PERNICIOUS ANAEMIA

Constitutional remedy selection and treatment is recomended for all those who have vitamin B12 deficiency secondary to some other disease condition and not primarily due to imsufficient dietary intake of Vitamin B12.

Few of the Homeopathic remedies which may prove useful varing and depending on cases to case in treatment of pernicious anaemia are listed below

  • KALIUM PHOSPHORICUM
  • NATRUM PHOSPHORICUM
  • CINCHONNA OFFICINALIS
  • FERRUM METALLICUM
  • FERRUM PHOSPHORICUM
  • GELSEMIUM SEMPERVIRENS
  • ARSENICUM ALBUM
  • NATRUM MURIATICUM
  • ABROTANUM
  • ALFALFA
  • LYCOPODIUM
  • CHELIDONIUM MAJUS
  • CARDUS MARIANUS
  • MEDHORRINUM
  • RHUS TOXICODENDRON
  • ARNICA MONTANA

Neurology, Uncategorized

Neurons, Base Camp of life energy?

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Neurons – Base Camp Of Life Energy?

We will make a big mistake in understanding and treating the person if we ignore how all the subtle impressions can influence our body.

By the time you complete reading this article you will have a major change in your philosophy of perceiving your body and you will start having a more broader view and acceptance towards many other aspects of nature and its implications on health and Life.

Senses like Vision, Hearing, Smell, Touch, Taste generates feelings which generates desires and thoughts. Can thought generate itself in absence of all these senses?

Thought gives rise to emotions  like Love, Hatered, Anger, Fear, Sadness, Happiness etc.

Many neurotransmitters like acetylecholine, Dopamine, Serotonine, GABA(Gama Amino Butric Acid), Glutamate, Norepinephrine and there are 60 more such neurotransmitters discovered by scientists who’s secretion is triggered by thought and vice-a-versa.

Senses, Thoughts and Emotions triggers neurotrasnsmitters that determines functioning of our brain  which has hypothalamus and a pitutary glands adjoined below which is called master of orchestra of hormonal interplay in the body as it determines the level of each hormone in the body that we call Hypothalamo-pitutary-Hormonal axis. And you all know how important the hormones are seeing their profound effect on body’s functioning in general. Slightest disturbance in Hypothalamo-Pitutary-Hormonal axis results into grave, acute and chronic complaints.

As we all know that the body parts or organs that are being used more, develops better and those which are not used goes into disuse atrophy and later becomes dormant. Similarly certain functions of body change as per their necessity. We know that most of the body processes are triggered directly or indirectly by brain and our thoughts and emotions.

Certain examples of physiological impact of senses, thoughts, feelings, emotions and other abstract dynamic influences.

  • Sadness causes weeping, it activates tear glands.
  • Fear causes activation of sweat glands , shivering, piloerections, palpitations
  • Fun causes smile and Laughter.
  • Psychological stress causes Hyperacidity, Hypertension, reduced insulin production, reduced Growth hormone secretion.
  • Sight of yawning causes yawning
  • Certain thought Sound and Vision causes stimilation of sexual organs
  • Stimulation of salivary glands on sight of food
  • Nausea on certain sight and odour
  • Depression causes severe appetite and eating disorders, Hypothalamus directly controls our hunger and satiety centers slightest disturbance in this physical psychological or other may cause eating disorders leading to obesity and or alarming weightloss.
  • Depression is thought to be one of the cause of hypothyroidism and vice-a-versa.
  • Now after years of reasearch and experience modern science has accepted the fact that most of the autoimmune conditions are triggered or caused due to psychological stress as one of the major reason.

All these examples shows us that how abstract dynamic influences external or internal has impact on brain and subsequently on our body’s physiology, the prolonged changes in physiology has a wider implication on body’s each and every cells and thus changing the gene environment and epigenome thus influencing gene and finally its structure.

We know the processes of adaptation, our body gradually adapts itself to the type of stimulus we are subjected to for a longer period of time. Similarly our thoughts emotions and other psychological factors influences our body’s physiology and its profound effect for a longer period acts as an effect of a stressor and body has to adapt itself accordingly. Now adaptation initially seemingly to be phenotypic may gradually change genotype as well. Now a change at one locus in gene will have compensatory and/or counter regulatory change at other locus as the harmony is spoiled and body tries to re-harmonize or may be due to one bad sector in gene damaging other sectors(locus) due to their abnormal protein products in gene itself factoring in  new  changes. Now this leads to accumulation of many changes in the character of genome giving rise to positive or negative or mixed physiological or anatomical variations or disturbances leading to diseases.

Majority of endogenous diseases are caused due to genetic imbalance that we got it as hereditary germ line change or are acquired by external impressions and influences that has profound impact on our body.

 

to be continued…

Gastroentrology, HOMEOPATHIC TREATMENT, Uncategorized

IBD INFLAMATORY BOWEL DISEASE

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IBD Inflammatory Bowel Disease is a functional Gastrointestinal disease that mainly affects the bowel-large or small intestine.
It is the chronic relapsing inflammation of intestine.
Certain genetic and environmental factors are known to be associated with IBD.
The disturbances of immune system and impaired action of microbes leads to development of IBD.
Chrons disease and ulcerative colitis are two different entities of IBD.

Chrons disease

It is a type of IBD that may affect the GI tract from mouth to anus.
Most probably it involves sharply demarcated single or multiple areas of large intestine, terminal ileum or ileocecal region.

Risk factors and cause

Age- chrons disease can occur at any age but most commonly develops at young age.
Hereditary-About 15%of patients with chrons disease have one or more family members either with chrons disease or ulcerative colitis.
Cigratte smoking-smokers are most likely to develop chrons disease than non smokers.
Diet-high intake of refined sugars and low intake of fibre can mainly contribute to chrons disease.
Certain medications like NSAID’s.

Pathogenesis

Chrons disease is believed to be result of an imbalance between proinflammatory and anti-inflammatory cells.
There are some mutations in NOD2 gene that disrupts the mucosal defence mechanism.
NOD2 earlier known as CARD15 helps protect body against foreign Invader like bacteria and viruses through immune system cells like macrophages, monocyte and dendritic cells.
When triggered by some bacteria they become active and regulate activity of multiple genes that controls inflammatory response.
ATG16L1 is also involved in pathogenesis.it provides information for making a protein that is required for autophagy (destruction of cells in body).
It’s mutations impaires autophagy process and allows worn our cells to persist in body.
Depressed defence mechanism can stimulate microbial proliferation in body.
Under microscope biopsies of affected colon shows mucosal inflammation characteristed by inflitration of neutrophilis.
Neutrophils along with mono nuclear cells infiltrate crypt’s leading to inflammation and abscess.

Signs and symptoms

Intestinal manifestation-
-Ileum- abdominal pain and cramps
Diarrhoea
Obstructive symptoms
Mass in right iliac fossa
Acute ileitis
-colon- rectal bleeding
Intestinal stenosis
Perianal disease
-rectum-proctitis
Extraintestinal manifestation-
Eyes-it causes uveitis causing blurred vision and eye pain.Photophobia
Oral cavity-it causes apthous stomatitis, geographic tongue,chelitis granulomatosa.
Skin-erythema nodusum, ulcerative nodules.
Chrons disease can also cause osteoporosis and thinning of bones
Clubbing of fingers
Deep vein thrombosis
Fatigue

Diagnosis

Blood test-Anaemia is noted in PT with chrons disease.there are low blood cell count.

Stool test-For presence of any occult blood.

Colonoscopy-it is more accurate test that detects the ulcers and areas of inflammation.It can also be used to take biopsies.

Ultrasonography can be useful in patients with palpable abdominal mass and in order to differentiate from abscess

CT scan-this test is used to diagnose entire bowel as well as tissue outside the bowel.it has replaced barium x-rays.

MRI is useful for investigating complex perianal disease

Upper GI endoscopy- A flexible tube containing a camera is inserted in stomach and upper part of small intestine.it can also be done using a capsule.

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Air Purifying Indoor Plants

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AIR PURIFYING INDOOR PLANTS

We cant survive few minutes without Breathing, And the very basic and most essential substance of our survival Air is now not breathable due to air pollution created by population explosion, deforestation, industrialisation and civic development.

Recently in past decade with global surge in pollution levels as much as 20-40 times beyond acceptable limits; for certain extremely toxic pollutants in most cities; with Delhi as worlds most polluted megacity , with visibility not more than few feets, this is not only causing road accident pile-ups but also we have seen surge in deaths due to pollution, reduced life-span and poor quality of life due to ill health caused due to surge in Allergic Respiratory diseases , Allergic Skin diseases , Various Autoimmune diseases, Cancers , Hormonal Imbalances, PCOD and the list goes on.

But as we know trees are our best friends, so here they come for our rescue, luckily there are certain indoor plants which can efficiently takle situation and can bring down pollution and increase oxygen in the air thus making air more breathable effectively at our home.

According to study done at IIT-Kanpur, following 3 plants that require low and occasional sunlight and can efficiently absorb pollutants and release sufficient oxygen are and can grow almost in any region are easily availabe in India as well.

Money Plant, botanical name Epipremnum Aureum, its a creeper that can survive in low sunlight. Check the link for details of plant and its image  https://en.m.wikipedia.org/wiki/Epipremnum_aureum

Areca Palm also called Butterfly Palm, Botanical name Dypsis Lutes, it can survive indoor in low and required sunlight once in couple of months.Check the link for details of plant and its image  https://en.m.wikipedia.org/wiki/Dypsis_lutescens

Mother In Law Tug Plant also called Snake Plant, Botanical name Sansevieria Trifasciata, it can survive indoor in low and required sunlight once in couple of months. Check the link for details of plant and its image  https://en.m.wikipedia.org/wiki/Sansevieria_trifasciata

If 3 Erica Palm and 3 Snake Plant each 3 feet tall are planted in house supplimented with couple of short 3-6feet Money Plant creepers releases good quantity of oxygen and efficiently absorbs pollutants for a house of around 600 sqft with 4-5 members.