A Randomised Non- Controlled Clinical Study on UTI in Paediatrics and its Management with Homoeopathic Medicines of 50 Millesimal Scale Potency

Dr NAHIDA M. MULLA _{MD. (HOM), MACH}
Dr NARGIS ANWAR  _{PG PAEDIATRICS (HOM)}

Abstract
Urinary Tract Infection (UTI) is a serious bacterial infection causing illness in infants and children. UTI is defined by a combination of clinical features and the presence of bacteria in urine, or it is the presence of more than 100,000 cfu / ml after doing urine culture, regardless to symptoms.

Clinical symptoms of UTI usually include frequency, dysuria, abdominal pain, back pain, fever, and urgency.  It has an impact on simple daily activities, such as work, travel, interpersonal activities, sleep etc.

In such a bothersome condition, the scope of 50 millesimal potency drugs  in the treatment of UTI was taken up for the study. The objectives of the study were as follows:

1. To study clinical manifestations and etiological factors of urinary tract infection in pediatric age group. 
2. To study the effect of LM potency in children for treatment of urinary tract infections.
3. To study homoeopathic drugs effective in the treatment of urinary tract infections in children.

The following methodology was adopted; 

1. Type of research: A Prospective case study 
2. Sampling design: Simple random sampling.
3. Selection criteria: Based on the inclusion and exclusion criteria, history and clinical symptoms. 

The treatment was based on interpretation of clinical signs and symptoms

The following results were obtained at the end of the study;

The results for the study conducted revealed that 21 cases recovered, 6 cases improved and 3 cases did not improve. 

The conclusion of the study:
After the results were statistically analyzed it showed that medicines of 50 millesimal potency have a significant role in the management of UTI.

Key words: Urinary tract infection; Burning micturition; Frequency; Urgency; Quality of life; acute totality.

Introduction
Urinary tract infection is the most common bacterial infection seen in pediatric age group resulting in distress of the child and concern of the parents affecting 8% of boys and girls in early childhood and around 46% of adolescents out of which females are more prone to it . It is classified under ICD -10 of diagnostic codes. Recurrences of these conditions can lead to serious damage of urinary tract till kidneys. It is most ignored condition in children as they fail to produce the ethical symptoms of urinary tract infection and thus sometimes complicate the case. When turning towards the treatment part the children are bombarded with antibiotics from the conventional system of medicine without securing the child from the recurrence of the same.

Homoeopathic medicines are highly effective in management of such cases and with the flexibility in potencies the child gets the best suited medicine which treats him internally securing from the recurrence of the same condition again.

Prescription of lower potencies can sometimes cause prolonged and severe aggravation of symptoms in the child and asking them to wait with patience is like asking them to ‘’ wait in the storm’’. LM potency – the renewed dynamisation provides a much gentler and rapid alternative. “Weathering the storm” of an aggravation for a few hours for one day is a lot easier than for several days. Adjustment of the potency and the dose can be done easily and immediately if there is an aggravation with the well-selected remedy, also frequent repetitions can be done in acute and severe cases without any harm.

However there is limited data and researches exploring the full potential of homoeopathy,especially 50 millesimal potency drugs in urinary tract infection of pediatric age group . Prescription of LM potency in practice is still not has come into limelight and not been explored for its fullest capacities regarding present scenarios especially in children.

This prospective study has focussed towards fulfilling the purpose of a comprehensive review and the exploration of Dr. Hahnemann’s greatest discovery i.e. 50 millesimal scale potency in the urinary tract infections of the pediatric  age group along with clinical features and listing the common etiological factors making this age group vulnerable to this infections. 

Also by prescribing the 50 millesimal potency drugs we will be aiming towards the rapid and gentle healing of the patients devoiding them of their discomfort at the earliest possible hour.

Materials and methods:

Type of research: A Prospective case study 

Sampling design: Probability method of simple random sampling procedure for subjects whose showed clinical signs of urinary tract infection.

Selection criteria: 30 cases were selected On the basis of inclusion and exclusion criteria, history and symptoms. 

Inclusion criteria:

Subjects presenting with symptoms of lower urinary tract infection.

Subjects with parental consent was taken for study.

Exclusion Criteria:

Subjects presenting with symptoms of upper urinary tract infection.

Already diagnosed with advanced renal pathology and are already under treatment.

Subjects suffering from chronic ailments like tuberculosis, HIV were  excluded    

Results:
The study was conducted between May 2017 to November 2018 and all the cases were sufficiently given time period to understand and analyse the outcome. At the end of the study following data was observed which is placed in tabular form.

Age Incidence: Statistical study was done to identify the age group with highest incidence as shown in Table No.1. 

Table No. 1 – Age Incidence

Sl.No.	Age in years	No.of Subjects	Percentage
1.	3 to 6	2	6.66%
2.	7 to 10	7	23.33%
3.	11 to 14	14	46.66%
4.	15 to 18	7	23.33%
	Total	30	100%

 As shown in table, maximum incidence of  urinary tract infection was seen in age group11-14yrs 46.66% of the subjects (14); 23.33% of subjects were in the age group of 7-10yrs (7); 23.33% of subjects were in the age groups of 15-18yrs(7);6.66% of subjects were in the age group of 3-6yrs(2).

2)  Sex Incidence: Statistical study was done to identify the sex incidence with highest incidence as shown in Table No.2

Table No. 2 –Sex Incidence

Sl.No.	Sex of subjects	No. of Subjects	Percentage
1.	Male	10	33.33%
2.	Female	20	66.66%
	Total	30	100 %

As shown in table above, 33.33%  of the subjects (10) were males and 66.66% of the subjects (20) were females.

3)   Incidence of Presenting Complaints: In the statistical study of 30 cases, the presenting complaints are shown in table no.-3. 

No. 3 – Incidence of Presenting Complaints

Sl.No.	Symptoms	No. of Subjects	Percentage
1.	Burning, frequency	11	36.66
2.	Burning, frequency, offensive urine	2	6.66
3.	Burning, frequency, urgency	4	13.33
4.	Burning, increased frequency, scanty urine	4	13.33
5.	Burning, frequency, lower abdomen pain	4	13.33
6.	Burning , dribbling of urine	3	10.00
7.	Burning, frequency, hot urine	2	6.66
	Total	30	100%

Table 4 List of common etiological factor observed

S.no	Etiological factor	No. of subjects
1.	Lack of personal hygiene	05
2.	After menstruation	03
3.	Less water intake	02
4.	Improper bladder habits	02
5.	Use of common toilets	01
6.	Travelling	01
Total		14

Table 5: Remedies prescribed

S.no	Remdies	No. of Pateints
1.	Cantharis	07
2.	Apis mellifica	04
3.	Nux vomica	03
4.	Sulphur	02
5.	Nitric acid	02
6.	Belladona	02
7.	Phosphorous	01
8.	Alumina	01
9.	Pulsatilla	01
10.	Natrum muriaticum	01
11.	Bryonia	01
12.	Chamomilla	01
13.	Staphysagria	01
14.	Arsenicum album	01
15.	Sarsaparilla	01
16.	Argentum nitricum	01
Total		30

Results  : table  6

Result of Treatment : In the statistical study of 30 cases the results of the 

treatment are summarized in Table No.8.   

Sl.No.	Results	No. of Subjects	Percentage
1.	Recovered	21	66.66%
2.	Improved	6	23.33%
3.	Not Improved	3	10.00%
	Total	30	100%

Discussion
The study undertaken here was one of the most common conditions found in our day to day life. Every person in his life time suffers from it one or the other time. This condition is not the one which may prove to be life threatening but is the one which causes lot of discomfort as the array of symptoms which it produces mainly like urgency, frequency & its affinity more towards the female sex due to anatomical structure may cause social constraints as the individual has to visit the toilet on and often and may feel awkward about it.

If left untreated there is a possibility of developing in to a persistent problem leading to further complications thereafter.

Works undertaken in the journey of this study:
The outcome of this prospective study has shown that homoeopathic medicines of 50 millesimal potency are efficient in treatment of urinary tract infection in pediatric age group.

Age incidence: In this study maximum incidence of  urinary tract    infection was seen in age group11-14yrs 46.66% of the subjects (14); 23.33% of subjects were in the age group of 7-10yrs (7); 23.33% of subjects were in the age groups of 15-18yrs(7);6.66% of subjects were in the age group of 3-6yrs(2). This result corresponds to the age incidence rates given in pediatric standard textbooks stating that adolescents age group have the peak rate.

Sex incidence: As seen in the study 20 were females and 10 were males. Prevalence couldn’t be estimated on the outcome of male: female ratio as number of female sample selected for the study was relatively large in number. The study shows that UTI prevalence is more in females but also according to the literature and various studies conducted already a female preponderance is showed mainly because of the anatomical structure which is different from males.

Incidence of presenting complaints: UTI is presented most commonly with 11 of the subjects presenting with burning, frequency, 4 of the subjects  with burning, frequency , urgency.  4 patient came with burning, increased frequency, scanty flow and burning , frequency, lower abdomen pain each. 3 pateints came up with the complaints of burning, dribbling of urine and  2 pateints showed up  with burning , frequency , hot urine and burning, frequency , offensive each.

The above nature, origin & frequency of complaints observed in 30 subjects coincide with standard pediatric and medicine textbooks where burning micturition is the commonest of the complaint first felt by the patient followed by dysuria and other complaints.

Results : In this study of 30 cases it is been observed that 20 subjects recovered; 6 were improved and 3 subjects did not report after taking medicines, therefore the prognosis of those cases were not known & they were placed under ‘not improved’ category. The above result showed that medicines of 50 millesimal scale potency had a remarkable effect in UTI cases.

Aetilogical factors found in patient : Among 30 subjects which were taken for study , 14 of them expressed clear etiological factor as evident in table  above, out of which lack of personal hygiene was found in 5 of the subjects,3 girls said it was after menstruation , whereas less water intake and improper bladder habits was confirmed by 2 subjects each.  Travelling was found to be a factor in 1 patient and also the use of common toilet was the causative factor in 1 patient.

Lack of personal hygiene remains a causation for many disease let alone urinary tract infection especially in unattended children who are all by themselves and lacks knowledge about hygiene which also include hygienic measures during and after menstruation which is peak of vulnerability for females. 

Remedies given to the patient: As evident from the study all total of 16 remedies were totally prescribed to 30 subjects, out of cantharis was the highest given remedy i.e to 7 subjects, followed by apis mellifica which was given to 4 subjects,  nux vomica to 3 subjects , belladonna , sulphur, nitric acid to 2 subjects each and Alumina, pulsatilla, natrum mur , bryonia, chamomilla, staphysagria, arsenicum album ,sarsaparilla, argentums nit to 1 patient each.

Observations and results show the homoeopathic medicines of 50 millesimal scale potency is very effective in the treatment of urinary tract infections in pediatrics age group.

After sedulous, statistical and logical testing of the result, the null hypothesis was rejected.

Conclusion 

This study which was conducted on 30 subjects of pediatric age group concentrated mainly on providing rapid relief to the subject with the utilization of 50 millesimal scale remedies and also listing out the commonest etiological factor responsible for the condition. 

It was noted that the lack of maintenance of personal hygiene played a major role as the etiological factor of urinary tract infections as seen in this study group followed by improper voiding habits in young children. Burning micturition which was the most common symptom in this study responded well to the medicines of 0/1 potency and also the subjects showed increased general wellness.

Hence, it may be concluded that 50 millesimal drugs are well efficient in the treatment of urinary tract infection in pediatric age group.

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Dr. NAHIDA M. MULLA _{MD. (HOM), MACH}
PROFESSOR & PG GUIDE
DEPARTMENT OF  PAEDIATRICS
A M SHAIKH HOMOEOPATHIC MEDICAL COLLEGE,BELGAUM -590010
E mail : drnahida.mulla@gmail.com