Dr Akash C Chudasama
Abstract:
Bothrops lanciolatus is one of the ophidia which produce thrombosis in blood vessels. It has significant action on broaca’s and wernicke’s area. Which produce aphasia and hemiparesis with hemiplegia. This article provides a repertorial understanding in case of stroke or hemiplegia where aphasia occurs and bothrops indicated.
Keywords: Bothrops, Middle Cerebral Artery, Aphasia, Stroke Syndrome
Definition: A stroke, or cerebrovascular accident, is defined as an abrupt onset of a neurologic deficit that is attributable to a focal vascular cause.
Stroke Syndrome Effect In Middle Cerebral Artery:
MIDDLE CEREBRAL ARTERY Occlusion of the proximal middle cerebral artery (MCA) or one of its major branches is most often due to an embolus rather than intracranial atherothrombosis. Atherosclerosis of the proximal MCA may cause distal emboli to the middle cerebral territory or, less commonly, may produce low-flow TIAs. Collateral formation via leptomeningeal vessels often prevents MCA stenosis from becoming symptomatic.
The cortical branches of the MCA supply the lateral surface of the hemisphere except for (1) the frontal pole and a strip along the superomedial border of the frontal and parietal lobes supplied by the anterior cerebral artery (ACA) and (2) the lower temporal and occipital pole convolutions supplied by the posterior cerebral artery (PCA). The proximal MCA (M1 segment) gives rise to penetrating branches that supply the putamen, outer globus pallidus, posterior limb of the internal capsule, adjacent corona radiata, and most of the caudate nucleus. In the sylvian fissure, the MCA in most patients divides into superior and inferior divisions. Branches of the inferior division supply the inferior parietal and temporal cortex, and those from the superior division supply the frontal and superior parietal cortex. If the entire MCA is occluded at its origin and the distal collaterals are limited, the clinical findings are contralateral hemiplegia, hemianesthesia, homonymous hemianopia, and a day or two of gaze preference to the ipsilateral side. Dysarthria is common because of facial weakness. When the dominant hemisphere is involved, global aphasia is present also, and when the nondominant hemisphere is affected, anosognosia, constructional apraxia, and neglect are found Complete MCA syndromes occur most often when an embolus occludes the stem of the artery.
Cortical collateral blood flow and differing arterial configurations are probably responsible for the development of many partial syndromes. Partial syndromes may also be due to emboli that enter the proximal MCA without complete occlusion, occlude distal MCA branches, or fragment and move distally. Partial syndromes due to embolic occlusion of a single branch include hand, or arm and hand, weakness alone or facial weakness with nonfluent (Broca) aphasia, with or without arm weakness. A combination of sensory disturbance, motor weakness, and nonfluent aphasia suggests that an embolus has occluded the proximal superior division and infarcted large portions of the frontal and parietal cortices.
If a fluent (Wernicke’s) aphasia occurs without weakness, the inferior division of the MCA supplying the posterior part (temporal cortex) of the dominant hemisphere is probably involved. Jargon speech and an inability to comprehend written and spoken language are prominent features, often accompanied by a contralateral, homonymous superior quadrantanopia. Hemineglect or spatial agnosia without weakness indicates that the inferior division of the MCA in the nondominant hemisphere is involved. Occlusion of a lenticulostriate vessel produces small-vessel (lacunar) stroke within the internal capsule. This produces pure motor stroke or sensory-motor stroke contralateral to the lesion. Ischemia within the genu of the internal capsule causes primarily facial weakness followed by arm and then leg weakness as the ischemia moves posterior within the capsule. Alternatively, the contralateral hand may become ataxic, and dysarthria will be prominent. Lacunar infarction affecting the globus pallidus and putamen often has few clinical signs, but parkinsonism and hemiballismus have been report.
Rubric which cover middle cerebral artery affection in stroke:
Complete – Mentals
APHASIA (70)
1 agar, 1 alum, 2 anac, 1 ant-m, 1 ant-t, 1 apis, 1 arag, 2 arg-n, 1 arn, 2 ars, 1 arum-m, 1 aur-m, 1 bar-acet, 2 bar-c, 1 bell, 1 bold, 2 both-l, 2 calc, 1 calc-p, 1 cann-i, 2 caust, 1 cench, 1 cham, 2 chen-a, 1 chin, 1 chin-ar, 1 cimic, 1 colch, 1 con, 1 crot-h, 1 cupr, 1 dios, 1 dulc, 1 elaps, 2 glon, 1 hydr, 1 hyos, 1 ip, 2 kali-br, 2 kali-chl, 1 kali-cy, 1 kali-p, 1 lac-c, 2 lach, 1 laur, 1 lil-t, 1 lyc, 2 mag-c, 2 merc, 1 mez, 1 naja, 3 NIT-AC, 2 nux-m, 2 nux-v, 1 oci, 1 oena, 1 olnd, 1 onos, 1 op, 1 ph-ac, 1 phos, 2 plb, 1 puls, 1 stram, 1 sulfon, 1 sumb, 1 syph, 1 tab, 1 xero, 1 zinc
Complete – Mentals
APHASIA hemiplegia, with (3)
1 both-l, 1 cench, 1 chen-a
Complete – Mentals
APHASIA inability to articulate without any affection of the tongue (1)
1 both-l
Complete – Mentals
FORGETFULNESS words while speaking, of, word hunting (65)
1 acet-ac, 1 agar, 1 alum, 1 am-br, 1 am-c, 1 anac, 1 anh, 2 arg-n, 3 ARN, 1 ars, 2 bar-c, 1 bar-s, 1 benz-ac, 3 BOTH-L, 1 cact, 1 calc, 1 camph, 3 CANN-I, 2 cann-s, 1 carb-an, 1 carb-v, 1 carbn-s, 2 cham, 1 chen-a, 1 coca, 1 cocc, 1 colch, 1 con, 1 cot, 1 crot-h, 1 dulc, 1 gad, 1 haem, 1 ham, 1 helo, 1 hydr, 1 ign, 2 kali-br, 1 kali-c, 1 kali-p, 1 kiss, 2 lach, 1 lil-t, 2 lyc, 2 med, 1 morph, 1 murx, 2 nat-m, 2 nux-v, 2 onos, 3 PH-AC, 3 PLB, 1 podo, 1 pop-c, 1 prot, 1 ptel, 1 puls, 1 rhod, 1 sil, 1 staph, 1 sulph, 1 syph, 1 tab, 2 thuj, 1 verat
Complete – Mentals
UNCONSCIOUSNESS, coma syncope (64)
1 acet-ac, 1 acetan, 2 acon, 1 aether, 1 alet, 1 am-c, 1 am-caust, 1 aml-n, 1 amyg-am, 1 ant-t, 1 apis, 1 apisin, 1 apom, 2 arn, 1 ars, 1 ars-h, 1 asaf, 1 atro, 1 aur, 1 ba-sv, 1 both-l, 1 cact, 2 canth, 1 carb-v, 1 cham, 1 chel, 1 chin, 1 cimic, 2 coll, 1 cupr, 1 cupr-ar, 3 DIG, 1 ferr, 1 glon, 1 ign, 1 ip, 1 lach, 1 lil-t, 2 lina, 1 m-arct, 1 m-p-a, 1 mag-c, 1 mag-m, 1 merc-cy, 1 mosch, 1 nux-m, 1 nux-v, 1 oena, 1 op, 1 ph-ac, 1 phase, 1 phos, 1 phys, 2 puls, 1 sep, 1 spig, 1 spong, 1 sulph, 2 sumb, 1 tab, 1 thyr, 2 tril, 1 verat, 1 zinc
Complete – Head
CEREBRAL hemorrhage (62)
3 ACON, 1 agar, 1 alco, 1 aloe, 1 anthr, 1 apis, 2 arn, 2 aur, 2 bar-c, 3 BELL, 3 BOTH-L, 1 bufo, 1 cadm-br, 1 cadm-s, 3 CALC, 1 calc-f, 2 camph, 1 carb-ac, 1 carb-v, 1 chen-a, 2 chin, 1 chlol, 3 COCC, 1 coff, 1 con, 2 crot-h, 2 cupr, 1 cur, 2 ferr, 1 ferr-p, 1 ferr-py, 1 form, 3 GELS, 1 glon, 1 hell, 1 hydr-ac, 2 hyos, 3 IP, 3 LACH, 1 laur, 2 lyc, 1 merc, 1 morg, 2 nat-m, 1 nit-ac, 2 nux-m, 2 nux-v, 3 OP, 2 phos, 1 pitu-gl, 1 plb, 2 puls, 1 rob, 1 sec, 1 sep, 2 sil, 1 stram, 1 syph, 1 verat-v, 1 vip, 2 zinc, 1 zinc-p
Complete – Head
INJURIES of the head, after (56)
1 acon, 1 alum, 1 anac, 1 apis, 3 ARN, 1 bell, 1 bell-p, 1 both-l, 2 calc, 1 calc-p, 1 calc-s, 1 calen, 1 carc, 1 chin, 2 cic, 1 cocc, 1 con, 1 cupr, 1 dulc, 1 ferr-p, 1 glon, 2 hell, 1 hep, 1 hyos, 1 hyper, 2 kali-p, 1 lac-c, 1 lac-d, 1 lach, 2 led, 2 lob, 1 mang, 1 meli, 1 merc, 2 nat-m, 3 NAT-S, 1 nit-ac, 1 nux-v, 1 op, 1 petr, 1 ph-ac, 1 phos, 1 puls, 1 pyrar, 1 rhus-t, 1 sep, 2 sil, 1 staph, 1 stram, 1 sul-ac, 1 sulph, 1 symph, 1 tell, 2 teucr, 1 verat, 1 zinc
Complete – Head
PARALYSIS nerves (1)
1 both-l
Complete – Speech and Voice
SPEECH slow (63)
2 aesc-g, 2 aeth, 1 agar, 1 agar-ph, 1 anac, 1 anh, 1 ant-c, 2 arg-n, 1 ars, 1 atro, 1 bar-c, 1 bell, 2 both-l, 2 bov, 1 bufo, 1 caj, 1 cann-i, 2 cann-s, 1 carb-an, 2 caust, 1 cere-s, 1 chin-s, 1 chlf, 1 cic, 1 cocc, 1 cupr, 1 gels, 3 HELL, 1 hyos, 2 ign, 2 kali-br, 1 kali-cy, 1 kali-p, 3 LACH, 1 laur, 1 lyc, 1 mang, 1 mang-o, 1 merc, 1 mez, 1 morph, 1 mygal, 1 naja, 1 nat-c, 1 nat-m, 1 nux-m, 1 olnd, 2 op, 1 ozone, 1 petr, 2 ph-ac, 2 phos, 1 phys, 2 plb, 1 rhus-t, 2 sec, 2 sep, 2 stram, 1 sulfon, 1 syph, 2 thuj, 1 vip, 1 zinc
Complete – Speech and Voice
SPEECH stammering (94)
2 acon, 1 aesc, 2 aesc-g, 1 agar, 1 agar-ph, 1 alco, 1 amyg-am, 1 anac, 1 anan, 1 anh, 1 arg-n, 2 arn, 1 ars, 1 ars-i, 1 atro, 1 bar-c, 3 BELL, 1 benz-n, 1 both-l, 2 bov, 2 bufo, 2 cann-i, 2 cann-s, 1 carb-an, 2 carbn-s, 1 carc, 3 CAUST, 1 cedr, 1 cere-s, 1 cham, 1 cic, 1 cocc, 1 con, 1 cortico, 2 cupr, 1 dig, 1 dulc, 1 dys-co, 2 euphr, 1 gels, 2 glon, 1 hell, 1 hep, 1 hyos, 1 ign, 1 iod, 2 kali-br, 1 kali-cy, 1 lac-c, 2 lach, 1 laur, 1 lyc, 2 mag-c, 2 mag-p, 3 MERC, 1 morph, 1 mygal, 1 naja, 1 narcot, 1 nat-acet, 1 nat-ar, 2 nat-c, 1 nat-m, 1 nat-sal, 1 nitro-o, 1 nux-m, 3 NUX-V, 1 oena, 1 olnd, 1 op, 1 ped, 2 phos, 1 phos-h, 2 plat, 1 plb, 1 psor, 1 rauw, 1 ruta, 2 sec, 2 sel, 1 sep, 1 sol-n, 1 sol-t, 1 sphing, 2 spig, 1 staph, 3 STRAM, 1 sul-i, 1 sulfon, 2 sulph, 1 thuj, 1 tril-c, 1 verat, 1 vip
Complete – Speech and Voice
SPEECH wanting (79)
1 agar, 1 agra, 1 alum, 1 am-br, 1 am-c, 1 anac, 1 ant-t, 2 apis, 1 arg, 2 arg-n, 1 arn, 2 ars, 1 atro, 2 bar-c, 3 BELL, 1 both-l, 2 bry, 1 bufo, 1 cadm-s, 2 calc, 1 canth, 2 caust, 1 chel, 1 chen-a, 1 chin, 1 chin-ar, 2 cic, 1 cimic, 1 colch, 2 con, 2 crot-c, 2 crot-h, 1 cupr, 1 gels, 2 glon, 1 hep, 1 hydr, 1 hydr-ac, 2 hyos, 1 hyper, 1 ign, 1 ip, 2 kali-br, 1 kali-c, 2 kali-chl, 1 kali-cy, 1 kali-n, 1 kali-p, 2 lach, 2 laur, 1 lyc, 2 mag-c, 2 merc, 1 mosch, 1 mur-ac, 1 naja, 3 NIT-AC, 2 nux-m, 2 nux-v, 1 oena, 1 olnd, 1 onos, 1 op, 1 ph-ac, 2 phos, 2 plb, 2 puls, 1 ruta, 1 sec, 1 sep, 1 staph, 2 stram, 1 stront-c, 1 stry, 1 syph, 1 thuj, 1 tub, 2 verat, 1 zinc
Complete – Speech and Voice
VOICE lost (166)
1 acal, 2 acon, 1 ail, 2 alum, 1 alum-p, 3 ALUMN, 1 am-c, 3 AM-CAUST, 1 am-m, 1 ambr, 1 amyg-am, 1 anan, 3 ANT-C, 2 ant-t, 3 ARG, 3 ARG-N, 1 arn, 2 ars, 1 ars-i, 1 ars-s-f, 1 arum-d, 2 arum-t, 1 arund, 1 bac, 2 bapt, 2 bar-c, 1 bar-i, 1 bar-s, 2 bell, 1 both-l, 1 bov, 3 BROM, 1 bry, 1 cahin, 1 calad, 1 calc, 1 calc-ar, 1 camph, 1 cann-i, 1 canth, 1 caps, 2 carb-ac, 1 carb-an, 3 CARB-V, 2 carbn-s, 3 CAUST, 1 cedr, 1 cham, 1 chin, 1 chin-s, 2 chlor, 1 choc, 1 cic, 2 cina, 1 coca, 1 cocain, 1 cocc, 1 coch, 1 colch, 1 con, 2 crot-c, 1 crot-h, 1 croto-t, 2 cupr, 1 dig, 2 dros, 2 dulc, 1 elaps, 1 ery-a, 2 euphr, 2 ferr, 1 ferr-ar, 1 ferr-i, 2 ferr-p, 1 ferr-pic, 2 gels, 1 glon, 1 graph, 1 haem, 2 hep, 1 hydr-ac, 2 hyos, 2 ign, 1 iod, 1 iodof, 1 ip, 2 kali-ar, 2 kali-bi, 1 kali-br, 2 kali-c, 1 kali-chl, 1 kali-chls, 2 kali-i, 1 kali-n, 2 kali-p, 1 kali-s, 2 lac-ac, 1 lac-c, 2 lach, 1 lap-c-b, 2 laur, 1 lyc, 1 mang, 1 meny, 2 merc, 2 merc-c, 2 merc-i-f, 1 mur-ac, 2 naja, 1 nat-ar, 1 nat-c, 2 nat-m, 1 nat-p, 1 nicc, 2 nit-ac, 2 nux-m, 2 nux-v, 1 ol-an, 1 olnd, 2 op, 1 ox-ac, 1 oxyg, 1 ozone, 1 paeon, 1 par, 1 petr, 3 PHOS, 2 phyt, 2 plat, 1 plb, 1 pop, 1 pop-c, 1 ptel, 2 puls, 1 pyrus, 1 rhus-g, 2 rhus-t, 2 rumx, 1 ruta, 1 sabad, 1 samb, 2 sang, 1 sec, 2 sel, 2 seneg, 1 sep, 1 sil, 2 spong, 2 stann, 1 staph, 1 still, 3 STRAM, 1 stry, 1 sul-ac, 1 sul-i, 2 sulph, 1 syph, 1 tarent, 1 ter, 2 verat, 1 verb, 1 vesp, 1 vip, 1 xan, 1 zinc, 1 zinc-m
Complete – Speech and Voice
VOICE lost paralysis, from (15)
1 alum, 1 bar-c, 1 bell, 1 both-l, 1 canth, 3 CAUST, 1 cocain, 1 cocc, 1 dulc, 2 gels, 2 kali-p, 2 lach, 1 merc, 1 ox-ac, 2 plb
Complete – Extremities
PARALYSIS General hemiplegia (83)
1 acon, 1 aeth, 2 alum, 2 alum-p, 1 alumn, 1 ambr, 2 anac, 2 apis, 1 apoc, 1 arg-n, 2 arn, 2 ars, 1 ars-s-f, 1 art-v, 2 aur, 1 bapt, 2 bar-c, 1 bar-m, 1 bell, 2 both-l, 1 brom, 2 cadm-s, 1 calc, 1 carbn-s, 3 CAUST, 1 chen-a, 1 chr-s, 1 coc-c, 2 cocc, 1 colch, 1 cop, 1 crot-c, 1 crot-h, 1 cupr, 1 cupr-ar, 1 cur, 1 elaps, 1 gels, 2 graph, 1 hell, 1 hydr-ac, 1 hyos, 1 irid, 2 kali-c, 1 kali-chl, 2 kali-i, 2 kali-p, 2 lach, 1 lath, 1 lyc, 1 merc, 2 mur-ac, 1 nat-c, 1 nat-m, 1 nit-ac, 2 nux-v, 2 olnd, 1 op, 1 ox-ac, 1 petr, 2 ph-ac, 2 phos, 1 phys, 1 pic-ac, 1 plb, 1 podo, 3 RHUS-T, 1 sang, 2 sars, 1 sec, 1 sil, 2 stann, 1 staph, 1 stram, 1 stront-c, 1 stry, 2 sul-ac, 1 sulph, 1 tab, 1 thuj, 1 verat-v, 1 vip, 1 xan
Complete – Extremities
PARALYSIS General hemiplegia right (26)
2 apis, 1 arn, 1 ars, 1 bell, 1 both-l, 1 calc, 1 carbn-s, 3 CAUST, 1 chen-a, 1 colch, 3 CROT-C, 2 crot-h, 1 cur, 1 elaps, 2 graph, 1 irid, 1 merc, 1 nat-c, 1 op, 1 phos, 2 plb, 2 rhus-t, 1 sang, 1 sil, 1 stront-c, 1 sulph
Complete – Extremities
PARALYSIS General upper limbs (89)
2 acon, 1 aesc, 3 AGAR, 1 alum, 1 alumn, 1 am-c, 1 ant-t, 2 apis, 1 arg, 1 arg-n, 1 arn, 2 ars, 1 ars-s-r, 1 arund, 1 atro, 2 bar-c, 1 bar-m, 2 bell, 1 bism, 1 both-l, 1 brom, 1 bry, 1 bufo, 1 cact, 2 calc, 1 calc-p, 1 calc-s, 3 CANN-I, 1 carbn-o, 3 CAUST, 1 chel, 1 chin, 1 cic, 3 COCC, 1 colch, 2 con, 2 crot-c, 1 crot-h, 1 croto-t, 1 cupr, 1 dig, 2 dulc, 1 ferr, 1 ferr-i, 2 gels, 1 ger, 2 hell, 1 hep, 1 kali-acet, 1 kali-ar, 1 kali-bi, 2 kali-c, 1 kali-n, 1 kalm, 1 lac-c, 1 lat-m, 1 led, 2 lyc, 1 mag-c, 2 merc, 2 merc-c, 1 mill, 1 morph, 1 nat-sil, 2 nit-ac, 2 nux-v, 1 ol-an, 2 op, 1 pall, 1 par, 1 phos, 1 phyt, 1 plat, 3 PLB, 3 RHUS-T, 1 ruta, 1 sang, 1 sec, 1 sep, 2 sil, 2 stann, 2 sulph, 1 tarent, 1 tep, 1 ter, 1 verat, 1 verat-v, 1 vip, 1 zinc
Complete – Extremities
PARALYSIS General upper limbs one arm or one leg only (1) : 1 both-l
Complete – Extremities
PARALYSIS General legs (11)
1 ars, 1 both-l, 1 chel, 1 cocc, 1 croc, 1 ign, 1 nat-m, 1 ph-ac, 1 stram, 1 stront-c, 1 thal
Complete – Generals
APOPLEXY post-hemiplegia (16)
2 arn, 1 ars, 2 bar-c, 1 bell, 1 both-l, 2 caust, 2 cocc, 1 cupr, 1 cur, 1 lach, 1 nux-v, 1 phos, 2 plb, 1 rhus-t, 1 vip, 1 zinc
Complete – Generals
HEMORRHAGE tendency or actual blood coagulate, does not, hemophilia (84)
2 adren, 1 ail, 1 alum, 1 alumn, 1 am-c, 1 anthr, 2 apis, 1 aran, 2 arn, 1 ars, 1 ars-h, 1 bell, 3 BOTH-L, 2 bov, 2 cact, 1 calc, 1 calc-l, 1 calc-p, 1 canth, 1 carb-an, 2 carb-v, 1 chin, 1 chin-s, 1 chlol, 1 chloram, 2 cinnam, 1 cortico, 1 croc, 3 CROT-C, 2 crot-h, 1 dig, 1 dor, 2 elaps, 1 erech, 1 ergot, 2 erig, 3 FERR, 1 ferr-m, 2 ferr-p, 1 fic, 1 gall-ac, 2 ger, 2 ham, 3 HIR, 2 hydrin-m, 2 ip, 1 kali-c, 2 kali-p, 1 kreos, 3 LACH, 3 LAT-M, 1 led, 1 meli, 1 merc, 1 merc-cy, 1 mill, 1 mur-ac, 1 nat-m, 1 nat-n, 2 nat-s, 2 nat-sil, 3 NIT-AC, 1 op, 1 ph-ac, 3 PHOS, 1 puls, 1 rad-br, 2 sabin, 1 sanguis, 2 sec, 1 sil, 1 stront-c, 2 sul-ac, 1 sulph, 2 ter, 1 thlaspi, 1 til, 2 tril, 1 ust, 1 verat, 1 vip, 1 visc, 1 x-ray, 1 xanth
Complete – Generals
INFLAMMATION bloodvessels (85)
3 ACON, 1 adon, 1 adren, 1 agar, 1 all-c, 1 ant-ar, 1 ant-c, 2 ant-t, 2 apis, 1 arist-cl, 3 ARN, 3 ARS, 1 ars-i, 1 aur, 1 aur-ar, 3 BAR-C, 1 bell, 1 both-l, 1 bry, 1 bufo, 1 cact, 1 calc, 1 calc-ar, 1 calc-f, 1 carb-v, 1 carbn-s, 2 cham, 1 chin, 1 chin-s, 1 clem, 1 con, 1 crat, 1 crot-h, 2 cupr, 1 echi, 1 ferr-p, 1 glon, 1 graph, 3 HAM, 1 hecla, 1 hep, 1 hir, 1 hist, 1 iod, 2 kali-c, 2 kali-i, 1 kali-m, 1 kreos, 1 lach, 1 led, 1 lyc, 1 lycps, 1 mag-c, 1 mag-f, 1 merc, 1 merc-cy, 1 merc-i-r, 1 morg, 1 mur-ac, 2 nat-i, 1 nat-s, 1 nux-v, 1 phos, 1 prot, 2 puls, 1 rhod, 1 rhus-t, 1 ruta, 1 sec, 1 sep, 2 sil, 1 spig, 1 staphycoc, 1 stront-br, 1 stront-c, 1 stroph, 1 sulfa, 3 SULPH, 1 thiop, 1 thuj, 1 tub, 1 verat, 3 VIP, 1 vip-a, 1 zin
Conclusion:
Bothrops lanciolatus produce thrombotic phenomena in blood vessels especially in cerebral arteries. Its most prominent action is on middle cerebral artery. Its produce thrombosis as well as cerebral haemorrhage. It produces aphasia by action on broca’s and wernicke’s area.
References:
- Homoeopathic software CARA PRO version v 1.4, Complete Repertory.
- HARRISON’S PRINCIPLES OF INTERNAL MEDICINE. 21st ed. Joseph Loscalzo DLKLLSFLHLJ, editor.: McGrawHill.
Dr Akash C Chudasama
PG Scholar Part 2 (Practice of Medicine) C.D. Pachchigar College of Homoeopathic Medicine and Hospital, Surat, Gujarat.
Email: chudasamaakash65@gmail.com
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