A 61-years-old Male, approached with his reports and complaints of generalized weakness, muscular cramps and twitching in calf muscles and minor coughing remaining after getting recovered from COVID-19. Clinically the patient was found very much stable but his reports showed variation in his haemodynamic state. 

In his reports the value of D-DIMER was highly raised even after getting recovered from COVID-19.

 

 PERSONAL HISTORY:-

• ACCOMODATION:- Good
• ECONOMIC STATUS:- Sound
• DIET & FOOD HABITS:- Addiction of alcohol
• HOBBIES:- Nothing Specific

 

• LIFE SPACE INVESTIGATION:-
  • BIRTH & EARLY DEVELOPMENT:-

All the milestones were achieved normally

• BEHAVIOUR DURING CHILDHOOD:-

NAD

• EDUCATION:- Metric pass
• OCCUPATIONAL HISTORY:- Farmer
• MARITAL HISTORY :- Normal
• CHILDREN:- One (Male)

 

• GENERAL SYMPTOMS 

PHYSICAL GENERALS:-

APPEARANCE:- Lean, thin person TASTE:- not specific

THIRST:- Increased, feels unsatisfied even if drinks a large amount of water STOOL:- NAD

URINE:- 3-4/0-1 : D/N 

SWEAT:- Profuse 

SLEEP:- sound

THERMAL REACTIONS:- ( HOT CONSTITUTION : can’t tolerate slight warmth )

 

• Nothing specific was observed in other systemic examinations.

 

 

• THERAPEUTIC INTERVENTION :-

           

        As per the deion given by patient and data obtained on                   

          questioning about his past history, family history and other 

           examination, nothing specific was found except :-

 

• Increased levels of D-DIMER
• Generalized weakness after acute viral infection
• Muscular cramps and twitching in calf muscles
• HOT thermal state of patient
• Remarkable thirst 

 

 

• PRESCRIPTION:-

So, On the basis of discussion and referring to various homoeopathic material medica,

• BOTHROPS LANCEOLATUS  200  SINGLE DOSE STAT ORALLY
• SAC-LAC 4X3X4 DAYS

 

• WHY BOTHROPS LANCEOLATUS ? : -

 

• DR. BOERICKE SAYS :-

 

• Its venom is most coagulating, (also Lachesis). We should expect to find under these remedies the symptomatology of thrombosis, also thrombotic phenomena, as hemiplegia, aphasia, inability to articulate (Linn J. Boyd). 
• Nervous trembling. 
• Pulmonary congestion. 
• Broken-down, haemorrhagic constitutions; septic states. 
• Great lassitude and sluggishness; Weakness [10] 

 

 

•  DISTINGUISHING BETWEEN BOTHROPS AND ARNICA :-

 

• The Lance snake is of the family Crotolidae; found in the island of Martinique.
• Preparations.-The poison from this snake is triturated, and dilutions are made from the 6x trituration  . Bothrops is marked under remedies for Aphasia and also stroke Rubrics. But how does it compete with arnica in coagulopathies is to be differentiated. [11]  
• The differential with Arnica is an important one for several reasons, including the fact that because we know Arnica better, we give it more frequently. [11,12]  
• When the etiology (Injury) is from the outside, the remedy is more likely to be Arnica. When the etiology is an internal process the remedy is more likely to be Bothrops. At times Bothrops is indicated even in injuries where thromboembolus arises after effects of injuries. [13]  
• Though Bothrops is given under many repertories under bleeding conditions, but Bothrops is indicated especially in bleeding after intravascular clotting and thromboembolic phenomenon.
• According to a study conducted, Bothrops has got both coagulant (clotted human fibrinogen indicating presence of Thrombin like enzyme) and anticoagulant properties (Increase in Partial thromboplastin time) .
• Clinical experience by Dr. Paul Herscu says that Bothrops initiates. Thrombi Formation leads to Fullness Restlessness, Inflammation which is followed by Bleeding, Weakness and Paralysis which brings back to the segment of thrombus Formation.
• The bleeding in Bothrops is always secondary to the coagulation, so even though there is bleeding mentioned in many locations, it rarely shows up in practice. The thrombi are much more to the point. [14]  
• FOLLOW UP:-
  • 01/05/2020 – 1st follow up:-

 

• Remarkable decrease in levels of D-DIMER (but still elevated)
• Improvement in weakness ,  ameliorated upto great extent
• Relief in muscular cramps and twitching
• Rx :- BOTHROPS LANCEOLATUS  200  SINGLE DOSE STAT ORALLY
• SAC-LAC 4 X 3 X 7 DAYS

 

• FOLLOW UP:-
  • 04/05/2020 – 2nd follow up:-
    • Levels of D-Dimer normalized 
    • Weakness absent absent
    • Muscular cramps and twitching almost relieved
    • Rx :- SAC-LAC 4 X 3 X 7DAYS

 

• DISCUSSION:-

In Indian scenario, CCRH had so far undertaken clinical trials in Dengue and Acute Encephalitis syndrome/JE with Homoeopathy as an add-on to usual care in tertian care setups. In Dengue Hemorrhagic fever, add on Homoeopathy could bring early improvement in platelet count and decrease in hospital stay by 2 days. Similarly, in Acute Encephalitis Syndrome/Japanese Encephalitis homeopathy as an adjuvant to the Institutional Management protocol could decrease death rate by 15% in comparison to those who received only Institutional Management protocol.   

In both the studies, adverse effect was not observed. Keeping in view the clinical success in above mentioned severe viral diseases, Homoeopathy as an adjuvant to the usual care may be tried in COVID-19 patients. Thus, homeopathy can play significant therapeutic roles.

Covid-19 presenting as Acute viral pneumonia causes thrombotic complications leading to Respiratory failure and ultimately multi system dysfunction. The COVID-19- associated coagulopathy (CAC) are distinct from those seen with bacterial Sepsis-Induced Coagulopathy (SIC) and disseminated intravascular coagulation (DIC). The CAC usually shows increased D-dimer and fibrinogen levels with minimal abnormalities in Prothrombin time and platelet count.

Coagulation is the main cause to prevent complications in covid19. In pulmonary complications Hypoxia leads to thrombus and in turn Thrombosis leads to hypoxia. The complication of coagulation leads to further damage further to multi organ failure. In coagulation resulting from Covid 19, D-Dimers are of diagnostic value which predicts the severity of Coagulation and assess the prognosis of diseases. Homoeopathic remedies though act well when selected on individualisation basis, in some acute emergency setups, specific remedies need to be given as the need of the hour. 

 

REFERENCES :-

1. Interactive web-based dashboard at the coronavirus Resource center at Johns Hopkins university. https://coronavirus.jhu.edu/map.html [cited February 20, 2021]

2. Mathie R.T., Lloyd S.M., Legg L.A., Clausen J., Moss S., Davidson J.R. Randomised placebo-controlled trials of individualised homeopathic treatment: systematic review and meta-analysis. Syst. Rev. 2014;3:142. doi: 10.1186/2046-4053-3-142. 

 3. Weiermayer P., Frass M., Peinbauer T., Ellinger L. Evidence-based homeopathy and veterinary homeopathy, and its potential to help overcome the anti-microbial resistance problem - an overview. Schweiz. Arch. Tierheilkd. 2020;162:597–615. 

4. Jacobs J. Homeopathic prevention and management of epidemic diseases.  Homeopathy.  2018;107:157–160. 

5. Frass M., Linkesch M., Banyai S., Resch G., Dielacher C., Löbl T. Adjunctive homeopathic treatment in patients with severe sepsis: a randomized, double-blind, placebo-controlled trial in an intensive care unit. Homeopathy. 2005;94:75–80.

6. Conde Diez S., Viejo Casas A., Garcia Rivero J.L., Lopez Caro J.C., Ortiz Portal F., Diaz Saez G. Impact of a homeopathic medication on upper respiratory tract infections in COPD patients: results of an observational, prospective study (EPOXILO) Respir. Med. 2019;146:96–105. 

7. Prajapati S., Sharma M., Kumar A., Gupta P., Narasimha Kumar G.V. An update on novel COVID-19 pandemic: a battle between humans and virus. Eur. Rev. Med. Pharmacol. Sci. 2020;24:5819–5829.

8. Chakraborty P.S., Lamba C.D., Nayak D., John M.D., Sarkar D.B., Poddar A. Effect of individualized homoeopathic treatment in influenza like illness: a multicenter, single blind, randomized, placebo-controlled study. IJRH. 2013;7:22–30. 

9. Basu N., Das B.C., Tandon S. Interim management of COVID-19 by repurposed homeopathic medicines. Homeopathy. 2020;109:182–183.

10. Hahnemann S. sixth ed. B. Jain Publishers Ltd.; New Delhi: 1994. Organon of Medicine. 

11. Boericke W W. ninth ed. Boericke and Runyon, Boericke and Tafel, Inc.; Philadelphia, PA: 1927. Pocket Manual of Homoeopathic Materia Medica Comprising the Characteristic and Guiding Symptoms of All Remedies. 

12. Dawre MS, Suresh Baburaj D, Rajan S (1987) Nomenclatural changes in Indian homeopathic medicinal plants. J Econ Taxon Bot 11: 217-223.

13. Suresh Baburaj D, Nain SS (1992) Further nomenclatural; changes in Indian Homoeopathic Medicinal Plants. Ancient Science of Life 11(4): 118-125. 4. Suresh Baburaj D, Rajan S, Sethuraman M (1992)          

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