Nipah virus infection

                          Nipah virus infection:

  Nipah virus (NiV) infection is a newly emerging zoonosis that causes severe disease in both animals and humans. The natural host of the virus is fruit bats of the pteropodids family, Pteropus genus. Nipah virus infection was first identified during an outbreak of disease that took place in Kampung Sungai Nipah, Malaysia in 1998. On this occasion, pigs were the intermediate hosts. However, in subsequent NiV outbreaks, there were no intermediate hosts. In Bangladesh in 2004, humans became infected with NiV as a result of consuming date palm sap that had been contaminated by infected fruit bats. Human-to-human transmission has also been documented, including in a hospital setting in India. 

 NiV infection in humans has a range of clinical presentations, from asymptomatic infection to the acute respiratory syndrome and fatal encephalitis. NiV is also capable of causing disease in pigs and animals. The primary treatment for human cases is intensive supportive care.  

STUDY REPORT SUBMITTED BY THE EXPERT COMMITTEE APPOINTED BY IHMA KERALA TO IDENTIFY A PROBABLE HOMOEOPATHIC GENUS EPIDEMIC FOR THE CURRENT VIRAL EPIDEMIC – 2018 - IN KERALA. ( THE REPORT WAS FORWARDED TO DMO, DEPARTMENT OF HOMOEOPATHY, KOZHIKODE. )

Expert committee members : 

Dr.Saji K, MD(Hom) Repertory. ( Senate Member KUHS.)

Dr.Dinesh.R.S, MD(Hom) Materia Medica; MBBS, MD(Psychiatry); Psychiatrist, Mental Hospital Trivandrum.

Dr.Siju Joseph Seena, BHMS; MSC Epidemiology, Consultant Epidemiologist.

Dr.Amar Bodhi, MD(Hom) Organon; Lecturer, B.R.Sur Homoeopathic Medical College, New Delhi.

INTRODUCTION :

In the last few years, pre-monsoon viral fevers took the life of a considerable number of patients in our state and in spite of adequate preventive measures from the part of the government health authorities, newly emerging epidemics lead to a threatening situation each year. Homeopathy always played its part in such circumstances and the role of both government and private doctors in those situations was really commendable.

As Homoeopathic system has a unique method of finding out the preventive medicine by selection of genus epidemicus (GE) on the basis of collective symptomatology ( including pathology ) of the patients,  there is always a hope even in newly emerging epidemics. This is an attempt to find out a GE for the current viral epidemic encephalitis.

IDENTIFICATION OF GE, STEP 1 – COLLECTION OF SYMPTOMS FROM PATIENTS.

As direct interaction with the patient was not allowed, information about the patient’s symptoms was obtained from patients caregivers, treating physician and literature on Nipah epidemic in past. 

SYMPTOMS COLLECTED FROM PATIENTS :

1. High fever 2. Violent headache. 3. Fear of death. ( Due to knowledge about the mortality of the disease ? ) 4. Body pain. ( Muscle pain ? ) 5. Vomiting. ( H/o Gastritis ? ) 6. Weakness. 7. Scanty urine ( Retention ? Suppression ? ) 8. Confusion, disorientation. ( Time?, Place ? ) 9. Delirium, fever during 10. Heat, alternating with chill

11. Convulsions 12. Coma.

PATHOLOGICAL – FROM REPORTS :

1. Encephalitis 2. Myocarditis 3. Vasculitis

IDENTIFICATION OF GE, STEP 2 – FINDING OUT A PROBABLE SIMILIMUM FOR THE SYMPTOMS.

REPERTORISATION :

RUBRICS :

1. Fever, Zymotic fevers 2. Fever, Heat, Intense heat. 3. A headache, violent, fever during. 4. Mind, coma, fever during 5. Mind, Delirium, fever during 6. Fever, Heat, alternating with chill 7. Urine, scanty, fever during. 8. Convulsions, fever during 9. Weakness, fever during

REPERTORIAL RESULT :

Ars: 24/9   

Bell: 20/9    

Lyc: 17/9

Rhus tox: 20/8, Hyos: 18/8, Bapt: 17/8,, Bry: 17/8, 

Nat-Mur: 17/8, Puls: 17/8,  Nux vom: 16/8, Arn: 15/8

Phos: 15/8

PATHOLOGICAL CONSIDERATION :

1. Encephalitis: Ars1 Bell3 2. Carditis: Ars2, Bell2, Lyc2 3. Vasculitis: Ars3, Bell2

Ars and Bell are the Final medicines.

DIFFERENTIATION OF THE FINAL MEDICINES:

Plus points for Bell.

1. First-grade medicine in Inflammation of brain. Ars only 1 mark. 2. Bell is the only medicine ( 1 mark )under the rubric ‘ retention of urine, with congestion of brain’ 3. Previous successful h/o prophylactic use against encephalitis (JE) 4. Bell is found effective against viral encephalitis (JE) in some in vitro studies too.

Plus points for Ars

1. Main medicine for fever with weakness out of proportion to the disease.

FINALLY SELECTED MEDICINE: BELLADONNA.

PROPOSED DOSAGE :

Day 1 to 5: Bell 200/bd 

From Day 6 onwards 1 dose of bell 200 every 3rd day until the epidemic subsides.

1 dose = 2 Number 40 medicated pills

SPECIAL ADVISES :

Any person who is taking the medicine should stop the medication if any adverse symptoms appear.

Since the GE is only a proposed medication, any person who is on GE should follow the protocol on fever proposed by the health authorities. The GE offers no guarantee but there is a chance for prevention            ( provided that the individual is not already infected ) as observed in earlier preventive medicine study examples. 

Informed consent should be obtained before giving the GE.

CONCLUSION :

Since the current infection has almost 100 percent case fatality rate and as there is no available treatment except supportive care, we propose this homeopathic GE for administration to contain the epidemic. GE is a time-tested Homoeopathic method of prevention of epidemic and has yielded a positive outcome in many previous epidemics.

Hyponatremia

                               Hyponatremia

  Hyponatremia occurs when the concentration of sodium in your blood is abnormally low. Sodium is an electrolyte, and it helps regulate the amount of water that's in and around your cells.

  In hyponatremia, one or more factors — ranging from an underlying medical condition to drinking too much water — cause the sodium in your body to become diluted. When this happens, your body's water levels rise, and your cells begin to swell. This swelling can cause many health problems, from mild to life-threatening.

    Hyponatremia treatment is aimed at resolving the underlying condition. Depending on the cause of hyponatremia, you may simply need to cut back on how much you drink. In other cases of hyponatremia, you may need intravenous electrolyte solutions and medications.

Symptoms

Hyponatremia signs and symptoms may include:

• Nausea and vomiting
• A headache
• Confusion
• Loss of energy, drowsiness, and fatigue
• Restlessness and irritability
• Muscle weakness, spasms or cramps
• Seizures
• Coma

When to see a doctor

  Seek emergency care for anyone who develops severe signs and symptoms of hyponatremia, such as nausea and vomiting, confusion, seizures, or lost consciousness.

   Call your doctor if you know you are at risk of hyponatremia and are experiencing nausea, headaches, cramping or weakness. Depending on the extent and duration of these signs and symptoms, your doctor may recommend seeking immediate medical care.

Causes:

Sodium plays a key role in your body. It helps maintain normal blood pressure, supports the work of your nerves and muscles, and regulates your body's fluid balance.

A normal blood sodium level is between 135 and 145 milliequivalents per liter (mEq/L). Hyponatremia occurs when the sodium in your blood falls below 135 mEq/L.

Many possible conditions and lifestyle factors can lead to hyponatremia, including:

• Certain medications. Some medications, such as some water pills (diuretics), antidepressants and pain medications, can interfere with the normal hormonal and kidney processes that keep sodium concentrations within the healthy normal range.
• Heart, kidney and liver problems. Congestive heart failure and certain diseases affecting the kidneys or liver can cause fluids to accumulate in your body, which dilutes the sodium in your body, lowering the overall level.
• Syndrome of inappropriate anti-diuretic hormone (SIADH). In this condition, high levels of the anti-diuretic hormone (ADH) are produced, causing your body to retain water instead of excreting it normally in your urine.
• Chronic, severe vomiting or diarrhea and other causes of dehydration. This causes your body to lose electrolytes, such as sodium and also increases ADH levels.
• Drinking too much water. Drinking excessive amounts of water can cause low sodium by overwhelming the kidneys' ability to excrete water. Because you lose sodium through sweat, drinking too much water during endurance activities, such as marathons and triathlons, can also dilute the sodium content of your blood.
• Hormonal changes. Adrenal gland insufficiency (Addison's disease) affects your adrenal glands' ability to produce hormones that help maintain your body's balance of sodium, potassium, and water. Low levels of thyroid hormone also can cause a low blood-sodium level.
• The recreational drug Ecstasy. This amphetamine increases the risk of severe and even fatal cases of hyponatremia.

Risk factors:

The following factors may increase your risk of hyponatremia:

• Age. Older adults may have more contributing factors for hyponatremia, including age-related changes, taking certain medications and a greater likelihood of developing a chronic disease that alters the body's sodium balance.
• Certain drugs. Medications that increase your risk of hyponatremia include thiazide diuretics as well as some antidepressants and pain medications. In addition, the recreational drug Ecstasy has been linked to fatal cases of hyponatremia.
• Conditions that decrease your body's water excretion. Medical conditions that may increase your risk of hyponatremia include kidney disease, syndrome of inappropriate anti-diuretic hormone (SIADH) and heart failure, among others.
• Intensive physical activities. People who drink too much water while taking part in marathons, ultramarathons, triathlons and other long-distance, high-intensity activities are at an increased risk of hyponatremia.

Complications:

In chronic hyponatremia, sodium levels drop gradually over 48 hours or longer — and symptoms and complications are typically more moderate.

In acute hyponatremia, sodium levels drop rapidly — resulting in potentially dangerous effects, such as rapid brain swelling, which can result in a coma and death.

Premenopausal women appear to be at the greatest risk of hyponatremia-related brain damage. This may be related to the effect of women's sex hormones on the body's ability to balance sodium levels.

Prevention:

The following measures may help you prevent hyponatremia:

• Treat associated conditions. Getting treatment for conditions that contribute to hyponatremia, such as adrenal gland insufficiency, can help prevent low blood sodium.
• Educate yourself. If you have a medical condition that increases your risk of hyponatremia or you take diuretic medications, be aware of the signs and symptoms of low blood sodium. Always talk with your doctor about the risks of a new medication.
• Take precautions during high-intensity activities. Athletes should drink only as much fluid as they lose due to sweating during a race. Thirst is generally a good guide to how much water or other fluids you need.
• Consider drinking sports beverages during demanding activities. Ask your doctor about replacing water with sports beverages that contain electrolytes when participating in endurance events such as marathons, triathlons, and other demanding activities.
• Drink water in moderation. Drinking water is vital for your health, so make sure you drink enough fluids. But don't overdo it. Thirst and the color of your urine are usually the best indications of how much water you need. If you're not thirsty and your urine is pale yellow, you are likely getting enough water.

              Hypernatremia

  Have you ever had a doctor say you need to watch your sodium intake and drink plenty of water? The ratio of sodium to water in your body is critical for many of life's processes. If the amount of sodium gets too high, a condition called hypernatremia can result and the consequences can be deadly. Before we can discuss what's so bad about having too much sodium, let's first explore why sodium is so important.

Sodium and Water:

  Like all the electrolytes in the body, sodium exists in its charged form, Na+. Sodium is the most abundant positively-charged electrolyte in the extracellular fluid (ECF), which surrounds our cells and tissues. This is because cells actively export Na+ into the ECF using a sodium-potassium pump (Na/K pump). The pump forces Na+ out of the cell and imports a K+, creating sodium and potassium gradients. These gradients are essential for nerve cells to transmit electrical signals. When the level of sodium changes in the ECF, nerve cells can't receive or relay their messages. The Na/K pump is so important to live that approximately 10% of all the calories you eat go to maintaining these pumps in your cells!

   Another important characteristic of sodium is that it controls the movement of water throughout your body. Water follows the movement of ions through the various compartments of the body (ECF, blood, inside cells, urine, etc.). Since there is so much sodium in our body, it controls the movement of water more than any other electrolyte. If there is too much sodium in the ECF, water will leave the cells, causing the cells to shrink. If sodium was Mary, then water would be her little lamb!

 Hypernatremia:

    Too Much Sodium and Not Enough Water

Ions and water move relatively freely from the ECF to the serum, the liquid part of the blood. So, the concentration of Na+ in the ECF and blood is approximately the same. The concentration of Na+ in our blood ranges from 135-145 mEq/L.

  Hypernatremia is an abnormally high sodium concentration in the ECF and serum. This is in contrast to hyponatremia, which is an abnormally low concentration of sodium. The Latin term for sodium is natrium, which is why the symbol for sodium on the periodic table is Na. So remember - the 'na' in hypernatremia stands for sodium. Hypernatremia occurs when serum values are greater than 157 mEq/L. To remember the difference between the prefixes hyper- and hypo-, visualize a hyper child that has had too much sugar. Another way is to remember the difference is that hypo- ends in an 'O' which looks a lot like a zero (0).

Under normal conditions (left) the concentration of sodium ions (green circles) is higher in the ECF than in the cytoplasm (CP), but the movement of water into the cell balances the movement out of the cell. In hypernatremia (right), the Na+ concentration in the ECF is even higher. This leads to an increased sodium gradient, which pulls water out of the cell causing it to shrink.

Causes of Hypernatremia:

 The main source of sodium is the food we eat and beverages we drink. The main way we lose sodium is through urine made by the kidneys.

A typical western diet contains 25 times more sodium than we actually need. Thank goodness it's really hard to develop hypernatremia just by eating too much salt! There have been cases where someone has died from drinking salt water or eating excessive amounts of salt, but it's very rare. This is because our kidneys are really good at removing extra sodium from the blood.

The body uses several hormones to regulate how the kidneys retain or excrete sodium and water. Although the details are beyond the scope of the lesson, it is important to know that if there is too much or too little of these hormones, it can lead to hyper- or hyponatremia.

Surprisingly, hypernatremia is not really a result of too much sodium. It's typically caused by not having enough water. Remember that the sodium concentration is a ratio of sodium to the water. So if the amount of Na+ goes up or the amount of water goes down, hypernatremia can occur. The most common causes are:

Signs and symptoms:

  The major symptom is thirst. The most important signs result from brain cell shrinkage and include confusion, muscle twitching or spasms. With severe elevations, seizures and comas may occur.

  Severe symptoms are usually due to acute elevation of the plasma sodium concentration to above 157 mmol/L (normal blood levels are generally about 135–145 mmol/L for adults and elderly). Values above 180 mmol/L are associated with a high mortality rate, particularly in adults. However, such high levels of sodium rarely occur without severe coexisting medical conditions. Serum sodium concentrations have ranged from 150–228 mmol/L in survivors of acute salt overdosage, while levels of 153–255 mmol/L have been observed in fatalities. Vitreous humor is considered to be a better postmortem specimen than postmortem serum for assessing sodium involvement in a death.

Cause:

Common causes of hypernatremia include:

Low volume;

In those with low volume or hypovolemia:

• Inadequate intake of free water associated with total body sodium depletion. Typically in elderly or otherwise disabled patients who are unable to take in water as their thirst dictates and also are sodium depleted. This is the most common cause of hypernatremia.
• Excessive losses of water from the urinary tract – which may be caused by glycosuria,  or other osmotic diuretics (e.g., mannitol) – leads to a combination of sodium and free water losses.
• Water losses associated with extreme sweating.
• Severe watery diarrhea (Osmotic diarrhea results in hypotonic (dilute) watery diarrhea resulting in significant loss of free water and a higher concentration of sodium in the blood; this type of water loss can also be seen with viral gastroenteritis).

Normal volume:

In those with normal volume or euvolemia:

• Excessive excretion of water from the kidneys caused by diabetes insipidus, which involves either inadequate production of the hormone vasopressin, from the pituitary gland or impaired responsiveness of the kidneys to vasopressin.

High volume:

In those with high volume or hypervolemia:

• Intake of a hypertonic fluid (a fluid with a higher concentration of solutes than the remainder of the body) with restricted free water intake. This is relatively uncommon, though it can occur after a vigorous resuscitation where a patient receives a large volume of a concentrated sodium bicarbonate solution. Ingesting seawater also causes hypernatremia because seawater is hypertonic and free water is not available. There are several recorded cases of forced ingestion of concentrated salt solution in exorcism rituals leading to death.
• Mineralocorticoid excess due to a disease state such as Conn's syndrome usually does not lead to hypernatremia unless free water intake is restricted.
• Salt poisoning is the most common cause in children. It has also been seen in a number of adults with mental health problems. Too much salt can also occur from drinking seawater or soy sauce.

Happy world Hypertension Day

World Hypertension Day 

17, May 2018

Are you suffering from Hypertension try Homeopathic 

Effective, No side effects and Most natural way of cure 

Thalassemia

                           Thalassemia

Thalassemia Minor: 

 Thalassemia is a group of genetic disorders characterized by the production of abnormal hemoglobin in red blood cells.

It is sometimes called Mediterranean anemia, von Jaksch anemia or Cooley's anemia, named after the physicians who first diagnosed it. Thalassemia affects all races. People of Mediterranean descent, such as Italians and Greeks, and people in the Arabian Peninsula, Iran, Africa, Southeast Asia and southern China are genetically more prone to it.

Its prevalence is least among the black African population.

Symptoms of Thalassemia:

  The symptoms in thalassemia vary greatly according to its type. Mostly the symptoms are caused by the insufficient supply of oxygen to the tissues (anemia). Though a genetic disorder passed on from parents, all patients do not suffer the same degree.

Silent carriers :
persons having the alpha thalassemia trait or beta thalassemia trait generally have no symptoms. The condition is so mild that even the positive finding of slightly reduced red cell count and hemoglobin are incidental.

In severe forms of thalassemia, symptoms encountered are:

        Breathlessness (dyspnea)

        Jaundice

        Abdomen appears distended or protruded due to an enlarged spleen and liver.

       Pale skin due to anemia

       Bone pains

       Abnormal growth of facial bones.

      Child shows poor growth and short stature.

Causes of Thalassemia:

Thalassemia is a genetic disorder. It is the most common, inherited single gene disorder in the world. Many possible variant and mutant forms are possible.

All red blood cells contain ‘hemoglobin’. The hemoglobin in the blood picks up oxygen from the lungs and transports it to all body tissues. It also picks up carbon dioxide from these tissues and delivers it to the lungs to be expired out of our bodies.

‘Hemoglobin’ has two major components. ‘Heme’àthe ferrous (iron) component and ‘globin’ Ãthe protein part. The globin part constitutes alpha and beta protein chains.

 If the genes responsible do not produce enough of alpha or beta chains, the red cells cannot carry hemoglobin properly. The result would be anemia which starts in early childhood and lasts all through life.

There are several forms of hemoglobin (Hb). The common ones are HbA, HbA2, HbF, HbS, HbC, Hgb H, and Hgb M.

  Healthy adults only have significant levels of HbA and HbA2.

HbS is an abnormal type of hemoglobin associated with sickle cell disease. HbC is also an abnormal form of hemoglobin associated with hemolytic anemia (anemia due to increased destruction of red blood cells).

Types of Thalassemia:

   Thalassemia is classified as Alpha Thalassemia or beta Thalassemia.

Where the genes do not produce enough alpha chains, the condition is called ‘alpha’ Thalassemia. Deficient production of beta chains is termed as ‘beta’ Thalassemia.

Alpha Thalassemia:

   Alpha Thalassemia is also called “silent carrier” Thalassemia:

In this condition, the deficiency of alpha proteins is mild enough to not produce any symptoms. There are generally no health problems. The condition is an incidental finding when an apparently normal individual has a child suffering from Hemoglobin H disease or has the alpha Thalassemia trait.

Hemoglobin H disease:

   In this condition the deficiency in the production of alpha globulin in great enough to cause severe anemia and enlargement of the liver and spleen. Bone deformities and fatigue are other symptoms that occur along with anemia. Hemoglobin H is the abnormal form of hemoglobin produced by the remaining beta globulins which cause faster than usual break down of the red blood cells.

Alpha Thalassemia trait or mild alpha Thalassemia:

   Here the deficiency of alpha protein causes either no symptoms or presents with only mild anemia. The symptoms are very mild compared to the hemoglobin H disease. Often the person receives iron supplements for the mild anemia and there is no improvement as both the physician and the patient are unaware of the trait. 

Hydrops Fetalis or Alpha Thalassemia Major.:

In this condition, there is a complete absence of alpha globulins. Gamma globulins produced by the fetus form hemoglobin Barts – which is abnormal hemoglobin. Excluding very rare situations where this condition is diagnosed before birth, nearly every individual with this condition dies before or shortly after birth.

Where the person survives (within utero blood transfusions), they require life-long blood transfusions for survival.

Beta Thalassemia:

  Beta Thalassemia can range from mild to severe. There are three types of beta Thalassemia.

Beta Thalassemia minor or beta Thalassemia trait.

 A person with this condition has only a genetic trait for Thalassemia and usually doesn't experience any health problem related to Thalassemia. If mild anemia is present, it is generally confused with anemia of iron deficiency. However, the response to treatment with iron supplements is generally poor.

Thalassemia intermedia:

 This condition lies between major and minor forms. People affected require occasional blood transfusions to treat anemia, especially in stressful times for the body like pregnancy or illness.
There is a wide range of severity of symptoms in this condition. Moderately severe anemia, bone deformities, spleen enlargement are health problems in Thalassemia intermedia.

 This condition is best differentiated from the Thalassemia major by the number of blood transfusions required. The symptoms are usually not life-threatening. Blood transfusions are given to improve the quality of life and not because the symptoms are life-threatening. 

Thalassemia major or Cooley's Anemia.

 This condition is severe and has life-threatening consequences. There is complete lack of beta globulin protein. Severe life-threatening anemia is characteristic of beta Thalassemia major. Untreated patients die before the age of twenty. Frequent blood transfusions are required for survival. Bone deformities, an enlarged spleen and iron overload in the system due to frequent blood transfusions are other symptoms requiring special treatment in this condition.

Diagnosis:

 Diagnosis of Thalassemia major is confirmed by Hemoglobin electrophoresis with an increase in total hemoglobin and analysis of lymphocyte DNA.

 Hemoglobin electrophoresis show: 

. HbA decreased 

. HbA2 increased 

. HbF slightly increased or normal

. A complete count will provide information about the hemoglobin and various blood cell levels.

. Thalassemia minor is confirmed by these values from a complete blood count. 

. MVC(mean corpuscular volume)- Slightly decreased.

. MCH(mean corpuscular hemoglobin) is decreased.

. Serum iron levels when teased help in ruling out anemia due to iron deficiency.

. The blood test of a family member for family genetic help identifying possible carriers and sufferers. 

. Prenatal checking of blood also helps in knowing whether the unborn child has Thalassemia. 

Treatment of Thalassemia:

  Blood transfusion is the most common treatment required by patients with Thalassemia
Minor forms of Thalassemia does not require any treatment. Occasional transfusions are required only during surgery, after delivery or severe infections.

·         Severe forms of the disease warrant such frequent transfusions of red blood cells that the person may get up to 52 pints of red blood cells in one year. This means that people end up having one transfusion every two to three weeks. Red cell transfusions are life-saving and greatly improve the quality of life for sufferers.

Disadvantage: 

frequent episodes of red blood cell transfusions can cause an overload of iron in the circulating blood which can damage the heart and the liver. Desferal is the medication given to treat an iron overload. It is an ‘iron chelator’. Chelating agents combine with the excess iron in the body and help in eliminating them circulating blood. 

Persons suffering from Thalassemia are also prone to:

. Osteoporosis and osteopenia, even people receiving very good quality treatment eventually develop thinning and brittle bones particularly in the lumbar vertebrae and femoral bone (thigh bone).

. Short Stature

. The absence of breast in girls and absence of testicular enlargement in boys. 

. Irregular menses

. Zinc deficiency

. Diabetes.

Homeopathic Medicine for Thalassemia

Antipyrinum: Red blood cells are of different shapes.

Arsenicum Alb. : Abnormally large red cells. Anemia on account of degenerative changes in the blood.

Butyricum acidum : A salt or ester of Butyric acid can cure cell anemia – thalassemia.

Calcarea ars. : Its use increases hemoglobin and red blood cells.

Ferrum met. : It is useful for the treatment of thalassemia major, hereditary or genetically transmitted abnormalities with familial or racial incidence – mostly found in children. The trouble is worse in winter.

Lachesis: After transfusion of blood, this remedy will stop its further decomposition. The interval between the blood transfusion is increased and the progress of the disease is retarded.

Natrium cacodyl.: It increases the number of red blood cells almost to double.

Phosphorus: It stops further disorganization of blood. The skin is very pale and jaundice may be present.

Picricum Acidum: Progressive abnormality of red cells which become larger than normal resulting in pernicious anemia.

Plumbum met.  Rapid reduction in a number of red blood cells causing great paleness of the skin. Cramps in the calves. Twitching of muscles.

Thiosinaminum: This may prove useful in the treatment of the disease as it cures wasting of the spinal marrow – tabes dorsalis.

Thyreoidinum: It is useful in the treatment of this disease when there are anemia, emaciation, muscular weakness and some thyroid trouble.