Individualized Homeopathic Medicines in the Management of Symptomatic Adenotonsillar Hypertrophy in Children: A Prospective Observational Study.

BACKGROUND: Globally, adenotonsillar hypertrophy (ATH) is one of the most prevalent upper respiratory tract disorders of children, with associated troublesome symptoms such as sleep apnea and cognitive disturbances. In this study, we evaluated the potential role of individualized homeopathic medicines in the management of symptomatic ATH in children. METHODS: A multicenter prospective observational study was conducted at five institutes under the Central Council for Research in Homoeopathy, India. Primary and secondary outcomes (symptom score for adenoids, other symptoms of ATH, Mallampati score, tonsillar size, Sleep-Related Breathing Disorder of the Paediatric Sleep Questionnaire [SRBD-PSQ]) were assessed through standardized questionnaires at baseline and at 3, 6, 9 and 12 months. Radiological investigations for assessing the adenoid/nasopharyngeal (A/N) ratio were carried out at baseline, 6 and 12 months. All analyses were carried out using an intention-to-treat approach. RESULTS: A total of 340 children were screened and 202 children suffering from ATH were enrolled and followed up monthly for 12 months. Each patient received individualized homeopathic treatment based on the totality of symptoms. Statistically significant reductions in adenoid symptom score, Mallampati score (including tonsillar size), SRBD-PSQ sleep quality assessment and A/N ratio were found over time up to 12 months (p < 0.001). Homeopathic medicines frequently indicated were Calcarea carbonicum, Phosphorus, Silicea, Sulphur, Calcarea phosphoricum, Pulsatilla, Lycopodium and Tuberculinum. No serious adverse events were recorded during the study period. CONCLUSION: This study suggests that homeopathic medicines may play a beneficial role in the management of symptomatic ATH in children. Well-designed comparative trials are warranted.

HIV coinfection among multidrug resistant and extensively drug resistant tuberculosis patients--a trend.

Infection with human immunodeficiency virus (HIV) is found to increase the occurrence of drug resistant tuberculosis. The data for HIV and multidrug resistant tuberculosis (MDR-TB) coinfection is scarce in India. The study aims to find out the prevalence of MDR-TB and extensively drug resistant tuberculosis (XDR-TB) among chronic TB patients and to identify their trend with HIV coinfection over time. Non-responding chronic pulmonary tuberculosis patients were selected for the study from 2004 to 2007. They were all subjected to HIV screening and drug susceptibility testing (DST) for anti-TB drugs. In all 2927 chronic tuberculosis patients were assessed for DST and HIV coinfection; 2156 patients (73.7%) had culturable Mycobacterium tuberculosis in their sputum specimens; 1651 patients (56.4%) were found to have drug resistant mutants to one or more anti-TB drugs; 993 patients (33.9%) had MDR-TB and 48 (1.6%) had XDR-TB. Significantly, 17.9% of 1651 patients with drug resistance were found to have fluoroquinolone (ofloxacin) resistant strain. HIV was found to coexist with 141 (14.2%) of 993 MDR-TB patients. Three XDR-TB patients had HIV coinfection. The HIV coinfection was observed among MDR-TB patients to the tune of 12.3%, 14.7%, 17% and 12.6% during 2004, 2005, 2006 and 2007 respectively (p = 0.81). Prevalence of HIV coinfection with MDR-TB was found to be high among chronic TB patients. It would be appropriate to screen all the chronic TB patients for HIV coinfection apart from their sputa examined for drug resistant tuberculosis, especially in HIV high prevalent states. Indiscriminate use of fluoroquinolone should be stopped.