Welcome back. I'm Dr. Harriet Hall and this is lecture 5 in a series of 10 lectures on science-based medicine. The topic of this lecture is homeopathy. Many of the people who use homeopathy don't have any understanding of what it is. I've run across highly educated medical professionals who thought homeopathy was just some kind of herbal medicine. When they found out what it really was, boy, it was their face red. Homeopathy is actually incredibly silly.  If coffee keeps you awake, dilute coffee will put you to sleep. The more dilute, the stronger the effect. Dilute coffee acts as a sleeping pill and more dilute coffee acts as an even stronger sleeping pill. If you dilute all of the coffee molecules out of the water, the water will remember them and the effect will be even stronger and the water's memory of coffee can be transferred to a sugar pill by dripping the water onto a sugar pill and allowing it to evaporate. Quackwatch calls homeopathy the ultimate fake and it's also been called delusions about delusions. In lecture three I explained how a single individual, D. D. Palmer, invented chiropractic all by himself on a single day in 1895. In lecture four I explained how a single individual, Dr. Nogier, invented ear acupuncture all by himself in 1957. A single individual, Samuel Hahnemann, invented homeopathy all by himself too in 1796. To set the scene, let's think about the state of medicine in Hahnemann's lifetime. Science-based medicine was far in the future. Diseases weren't well defined. They thought malaria was caused by bad air. There was no germ theory, no antibiotics, no anesthesia, no sterile techniques, no systematic testing of treatments. Doctors of his time did more harm than good. They were treating patients on the basis of a false theory of the four humors. In an attempt to balance those humors, they were bleeding patients, emptying their colons with purgatives and emptying their stomachs with a medics. They were poisoning them with medicines like mercury. They were killing people. Hahnemann was right to criticize his colleagues, but he was wrong about homeopathy. He intended homeopathy to be a kinder, gentler, more effective treatment system that would replace allopathy. That was the word he coined to disparage doctors, saying that they only treated the symptoms, not the disease itself, and that they treated with opposites instead of similars. That wasn't even an accurate characterization of what doctors were doing in his day, and it certainly doesn't describe what doctors do today. Most of us subject strenuously to being called allopathic doctors. The term is used as an insult, and it has no legitimate meaning. Just as one personal experience with a deaf janitor led DD Palmyry to invent chiropractic, a personal experience with tree bark led Hahnemann to invent homeopathy, and in both cases, they misinterpreted a single experience and extrapolated wildly from it. Sincona is a tree that grows in South America. The bark of the tree was used to treat fevers. If the fever happened to be from malaria, Sincona worked because it contained quinine, an effective malaria treatment. Hahnemann was skeptical, and he was experimenting on himself with large doses of Sincona. He developed symptoms that he thought were typical of malaria. He was wrong. His symptoms weren't typical of malaria, and today we think he probably had some unusual reaction to something in the bark. Anyway, his experience led him to deduce that the same remedy that caused a symptom could relieve it. So he tried treating with similars. He found that some people got worse before they got better. To reduce the side effects, he kept lowering the dose by diluting the remedy. Here are the two basic principles of homeopathy. First, the law of similars. Like cures like. A remedy will cure a disease in a sick person if it causes the same symptoms as the disease when given to a healthy person. If Ipocac makes a healthy person vomit, it ought to cure vomiting in sick people. Now the idea that like cures like is really just a form of sympathetic magic. Second, the law of infinitesimals. The smaller the dose, the larger the effect. That would mean the less sugar you put in your coffee, the sweeter it tastes. This law is obviously false, and it's contrary to everything we know about chemistry, pharmacology, and physics. Hanuman had another revelation. Seccussion. When he made a home visit, the patient was more likely to improve than if he saw the patient in his office. Now it's easy to see how a home visit might make more of an impression on the patient and might enhance the contextual effects of the doctor-patient encounter. But Hanuman thought up his own explanation. The remedies got jostled in his saddlebags as he rode his horse to the patient's home. He imagined that the jostling increased the potency of the remedy. He never thought to test this idea by comparing jostled and non-jostled remedies because he didn't think like a scientist. He just assumed he was right, and he recommended that when remedies were prepared, the solution should be potentized after every step of dilution by pounding the bottle repeatedly against something. He used a leather-bound book. Today some prepare is succust the remedies by hand against a leather pad, and some use machines. The remedies may be sold as a liquid or as a tiny pill. When the dilution is complete, the solution can be dripped onto tiny sugar pills and allowed to evaporate. Some remedies like granite, diamond, and platinum are not soluble in water or alcohol, so they're prepared by trituration. They grind them up with a mortar and pestle and then dilute them with lactose, milk, sugar. One triturated remedy is Berlin Wall. They take a tiny bit of ground-up concrete from the Berlin Wall and they mix it with 100 parts of sugar, lactose. Then they take one part of the resultant mixture and mix it with 100 parts of lactose. They repeat that process 200 times. One homeopath said it was such a powerful remedy that she had to store it away from her other remedies. She kept it out of the garden shed. It is used to treat feelings of confinement and oppression, shifty eyes, terror, asthma, and headaches. According to a homeopathy journal, the Wall in Berlin seems to have been immersed with the psychological emotions and thoughts of mankind. Again, magical thinking. The dilutions are where it really boggles the mind. They're labeled as X for 10 and C for 100. A 6x dilution means one part of remedy was diluted with 10 parts of water or alcohol and one part of the resulting mixture was diluted with another 10 parts of water and so on for a total of six times. In the seed dilutions, one part of the remedy is mixed with 100 parts of water at each step. 6x amounts to a solution of one part in a million. 6c amounts to one part in 10 trillion. The process is exponential. By the time you get to the 13c or the 26x level, there isn't a single molecule of the original remedy left. A 13c dilution is equivalent to diluting one third of a drop of the original substance in all the water on earth. A typical homeopathic remedy is 30c. At the 30c level, it would take a container 30 million times the size of the earth to hold enough water to make sure you were getting at least one molecule of the original substance. Another way of looking at it is that for one patient to get one molecule, you would have to give 2 billion doses per second to 6 billion people for 4 billion years. It gets worse. The most popular flu remedy is sold as a dilution of 200c. That's 10 to the 400th power. The number of atoms in the observable universe is 10 to the 80th power. My brain froze when I tried to figure out how many universes it would take to find one molecule. And 200c isn't the limit. There are remedies that are diluted far more. Above the 1000c level, they are designated as M. 1M equals 1000c. We're able to make those calculations thanks to Avogadro. Avogadro's number allows us to calculate the number of atoms or molecules in a volume of a chemical substance based on the molecular mass. The first calculations were done in 1865, 22 years after Hahnemann's death. Now we know that remedies of 13c and above are nothing but water. Hahnemann didn't have any way of knowing that. When his followers found out, they had three choices. One, they could abandon the dilute remedies. Two, they could accept metaphysical explanations, assuming that the water somehow remembers molecules that are no longer there. Or three, they could look for a scientific explanation. Most of them accepted option two, that water somehow absorbs the vitalistic essence of the remedy and remembers it. Some of them are still working on option three, trying to find an explanation that scientists could accept. Homeopaths try to justify their remedies by comparing them to vaccines. That's a false analogy. Vaccines contain measurable amounts of antigens and they work by a known mechanism. Homeopathic remedies contain no active molecules and they work by magic. They invoke hormesis. Now that's a phenomenon where a low dose of a chemical may trigger the opposite response to a high dose. But hormesis is only known to apply in certain cases. It's not a universal phenomenon by any means and it describes a response to a low dose, not to no dose. They invoke water clusters. Clusters of water molecules do form, but they only last for trillions of a second. There's no way they could register or transmit information. There's been wild speculation about quantum entanglement. That's the kind of thing that leaves quantum physicists rolling on the floor laughing. They keep doing ridiculous flawed experiments trying to prove that water can remember. One of the most famous experiments was the Benveniste affair. Jacques Benveniste claimed that he could detect biological activity of antibodies after the antibodies had been diluted out and were no longer there. The study was published in Nature with the condition that his lab would be inspected. A team including the journal's editor in chief and James Randy visited the lab and found a number of problems. The researchers were true believers who bordered on religious fervor. Their blinding procedures and controls were inadequate. The positive results were from a single technician. And when the team instituted more rigorous controls, the results couldn't be reproduced. Other labs tried to reproduce their findings and failed. And the results weren't even compatible with homeopathic theory. The effect went up and down with subsequent delusions instead of steadily upwards. Benveniste is the only person to have won two Ig Nobel awards, both for his work on homeopathy. His second Ig Nobel award was for his alleged discovery that not only does water have a memory but the information can be transmitted over telephone lines in the internet. Drugs are tested with randomized placebo control trials. Homeopathic remedies are tested with Provings. These were originally done with an undiluted remedy and later with a 30 C dilution. Healthy volunteers take it and they keep a detailed diary of every symptom they experience for an unspecified, unspecified length of time as long as they feel like doing it, sometimes for months. They write down everything. I felt angry. I burped. My big toe itched at 11 PM. I dreamed about my dog. There's no attempt to compare those symptoms to a control group. Then they're interrogated to elicit even more symptoms. Instead of looking for commonalities, they just pull all the different reports from different Provers and the whole mishmash of reported symptoms is used to guide treatments for that remedy. People mean different things by homeopathy. In classic homeopathy, only a single remedy is used at a time. In combination homeopathy, a mixture of remedies for the same symptoms is used. Today, homeopathic remedies are sold over the counter for self prescription. Something that I don't think Hanuman would ever have condoned. When homeopaths take a patient's history, they spend as much as an hour interviewing the patient. They go into excruciating detail about the chief complaint. They try to pin down the time of onset and its possible relation to life events. They ask about concomitants, seemingly unrelated symptoms like weak ankles or unusual sleeping positions. They ask about general symptoms like sluggishness, feelings of hot or cold, restless sleep, changes in appetite. They ask about family history. Did anything stressful happen to the patient's mother during her pregnancy? They ask seemingly off the wall questions like what do you love most about life? What bothers you the most about other people? What are you teased the most about? Here's a typical history that a homeopath obtained from a patient with uterine fibroids. That's a benign tumor of the uterus. He wrote down that she was loquacious, loud, anxious, doesn't want to live, desperate, feels humiliated, ashamed, used, rejected, angry, offended, lonely, religious affections, relationship problems, workaholic, absence of nurturing and childhood, parents fighting, uterine fibroids, constipated, retains fluid. The fibroids themselves are near the end of the list and the homeopath may interpret other things in the history as more important. After eliciting all these relevant and irrelevant symptoms, the homeopath looks up the symptoms in a repertory book. It lists symptoms by parts of the body. Here's an excerpt from a section on facial expression. The patient with fibroids was anxious. For anxious, 66 different remedies are listed. There are other facial expressions like anxious when child is lifted from cradle, anxious during downward movement, astonished, besotted, bewildered, changed, childish, cold, distant, and that's just the ABCs.  For each of these categories of facial expression, there is a different list of corresponding remedies. The homeopath looks up the symptoms he imagines are the most important and he selects the remedy that best matches those. The repertory is organized by symptoms. The next step is to use another book, The Homeopathic Materia Medica, that's organized by remedy. It lists all the symptoms that provings have associated with each remedy. Here's an example for a remedy called natrium muriaticum. The entry for natrium muriaticum lists symptoms in all of these areas. Mind, head, eyes, ears, nose, face, stomach, abdomen, rectum, urine, male, female, respiratory, heart, extremities, sleep, skin, fever, and modalities. Some of the examples from these areas include eyelids heavy, anemic headache of school girls, constipation and diarrhea, yes both of those, sensation of coldness of heart, palms hot and perspiring, hangnails, dreams of robbers, oily skin, warts on palms of hands, chill between 9 and 11 a.m. The list goes on and on for several pages. What is natrium muriaticum? It's common table salt. How can anyone seriously believe that table salt causes all those symptoms and can cure them? Hanuman listed 67 remedies. Today there are over 2,000 with over 1,300 officially recognized by the HP US, the homeopathic pharmacopoeia of the US. Here are some examples. Berlin Wall, eclipsed moonlight, south pole of a magnet, dog's ear wax, tears from a weeping young girl, fossilized dinosaur bone, rattlesnake venom, arsenic, poison ivy. The homeopath follows the patient's progress and if the patient is not getting better, he assumes that the first remedy was correct but that the situation has changed. So he reevaluates and prescribes a different remedy. The homeopath is constantly reevaluating and there's always another remedy to try. Aggravations are a good sign. If the symptoms get worse it means the remedy is working. If the symptoms get better it means the remedy is working too so you can't lose. If the remedy isn't working the homeopath can blame the patient for having inadvertently used antidotes that prevented the remedy from working. For instance, he drank coffee. He didn't get enough sleep. He used a cell phone. He ate spicy foods. Why did some patients fail to respond? Hanuman developed his theory of myasms to explain the failures of homeopathy. He decided that all disease was caused by three myasms. syphilis, psychosis or gonorrhea, and saura, scabies or itch. He decided that myasms had to be cleared before the remedy could work. He thought this led to an improved approach to selecting remedies. This all sounds so silly but scientists don't reject something just because it sounds silly. We still need to test whether it works. Homeopaths cite epidemics and early successes where patients treated with homeopaths did better than patients treated with conventional medicine but those successes were because doctors of that era were doing more harm than good. Homeopathy did nothing so the results were better. Homeopaths point to high levels of patient satisfaction but that doesn't mean it works. Remember all the ways that patients can be satisfied by bogus remedies and a charismatic provider. Remember medicine's beautiful idea. No matter how convinced you are you still need to test every treatment. And homeopathy was tested as early as 1832 in a hospital in Russia. One ward got conventional treatment. One ward got homeopathic treatment and one ward got no treatment but was given fake pills made of breadcrumbs and cocoa to make them think they were being treated. The no treatment ward had the best outcomes. That means that homeopathy did no good and the conventional treatments of the day didn't do any good either. In those days before science-based medicine it was better for patients to steer clear of both conventional doctors and homeopaths and just let nature take its course with no treatment. It's a wonder they didn't conclude that breadcrumbs and cocoa were an effective treatment. Homeopathy has been tested over and over since that time. Modern clinical trials have not shown that homeopathy was effective. David Reilly said either homeopathy works or control trials don't. In a sense he was right. Control trials don't work very well for studying homeopathy and other implausible health claims. As my colleague Kimball Atwood put it, trials of ineffective claims championed by impassioned advocates will appear to yield equivocal rather than merely negative outcomes. The inevitable continual citations of dubious reports will lead some to judge that the aggregate data are weakly positive or that the treatment is better than placebo. So they just call for more studies. Dr. Atwood also pointed out that homeopathy can't possibly work as claimed is the sort of basic science that can reasonably be called established knowledge. Is it realistic to assume that this level of evidence can be overthrown by ambiguous clinical trials of dubious design? The evidence against homeopathy is as strong as the evidence that the earth is spheroid rather than flat, that the planets orbit the sun rather than the earth, that mass and energy are conserved, that the earth is several billion years old, and that species evolved by a process of variation in natural selection. Jay Shelton wrote a book about homeopathy, homeopathy, how it really works. It's listed in the course guide. He concluded that homeopathy often helps people, but the remedies don't contribute. It helps through non-remedy factors like unassisted natural healing, attention, suggestion, contextual effects of the treatment encounter, regression to the mean, cessation of harmful or unpleasant treatments, lifestyle-assisted healing, and different perceptions of internal reality versus external reality. When results of clinical trials disagree with each other, we can try to resolve the disagreements with systematic analyses of all the data. Of 11 systematic reviews of homeopathy, only two were positive. When those two were re-analyzed with the low-quality trials omitted, they were negative too. The most favorable systematic review said that overall, homeopathy worked better than placebo, but it didn't work better than placebo for any specific condition. That doesn't compute. It's like saying broccoli is good for everyone, but it's not good for men or women or children. Homeopathy is a good example of changing attitudes about CAM. In 1900, there were 10,000 homeopathic physicians in the U.S. along with 79 homeopathic hospitals and 22 homeopathic medical schools. As scientific medicine gained ground, homeopathy lost ground. The last U.S. homeopathic medical school closed in 1920. By 1950, the last homeopathic hospital closed, and by 1970, there were only 75 homeopaths still practicing in the U.S. But today, homeopathy's having a revival, and remedies are sold over the counter in pharmacies. Oscilocoxinum can be found on the shelves of any local pharmacy. It's the most popular homeopathic remedy, and perhaps the funniest one ever. During the Spanish flu epidemic of 1918, a French doctor named Joseph Roy looked at the blood of flu victims under a microscope, and he thought he had observed an oscillating bacterium. He named it Oscilococcus. No one else ever saw it. He was probably confused by Brownian motion. He was probably seeing tiny particles of dust or whatever that were being jostled by the constant movement of water molecules. But he thought he'd discovered a new pathologic organisms, and when he thought he'd spotted the same organism in the liver of a duckling, he assumed that a homeopathic flu remedy could be made from the duck liver. Today, it's manufactured from the heart and liver of the Muscovy duck, diluted by 1 in 100 to the 200th power. To get one molecule of the original extract, a patient would have to consume an amount of the remedy, many orders of magnitude greater than the number of atoms in the observable universe. Oscilocoxinum is one of the 10 top-selling drugs in France, and it brings in $15 million a year in the U.S., but it's an impossibly dilute solution of something that never even existed in the first place. Here's my version of the recipe for Oscilocoxinum. Take a bit of duck liver, dilute the duck out of it, hope the water remembers the duck, and hope the memory of duck cures cold. In reality, all it remains is the quack. Would you believe there are homeopathic vaccines? They're prepared with nozodes, material taken from the saliva, blood, pus, urine, or disease tissue from victims of the disease. Health Canada has officially licensed homeopathic remedies to prevent flu, polio, measles, and pertussis. I reported one homeopath to Homeland Security because I figured they'd like to find out where he got his smallpox and anthrax nozodes, because if he could get them so could terrorists. Do you believe in magic? A well-known homeopath described how a car was fixed homeopathically. It appeared to be having electrical problems, so they wrote electricitus 200C on a piece of paper, and they placed it near the engine, and the problem was resolved. Sometimes dowsing is used to select remedies. The customer takes a pendulum to the store and holds it over each remedy until it swings the right way. Provings are done where the subject doesn't actually take the substance, but meditates about it, or dreams with it under the pillow, or prepares it by trituration, or writes it on a piece of paper and keeps the paper close to his body. Homeopaths have treated patients by telephone or telepathy. In grafting, one potentized sugar pill is added to a bottle of inert pills, and it converts them all to remedies. There are even homeopathy first aid kits for accidents and emergencies. You can buy one of these for $54.99 on amazon.com. It contains 18 vials of sugar pills labeled 200C. They're recommended for accidents, injury, infections, GI problems, burns, muscle pain, etc. For certain illnesses they advise depending on severity seek medical care. The list includes anaphylaxis, animal bites, bone injuries, third-degree burns, carbon monoxide poisoning, drug overdose, electrocution, eye injuries, poisoning, puncture wounds, and shock. It's appalling to think that patients are left to their own assessment and might think that these conditions were not severe enough to merit medical care. There's a hilarious YouTube video making fun of these kits. A young man goes out to save the world. He drops a pill from each bottle into a local stream that runs to the ocean. So the remedies will eventually reach everyone on earth in an even more dilute form. This will eliminate all the diseases the kit instructions cover from heart attacks and strokes to throttling and drowning. People say even if homeopathy is only a placebo, what's the harm in using it? It can't cause any side effects so it's safer than other treatments and patients seem to like it. But it can be very dangerous if it's used in place of effective treatments. Yanez Podgorsek was harmed in Slovenia. A homeopath named Darja Erzen treated him with homeopathic drops to prevent malaria. He got malaria anyway and then the homeopath treated him with homeopathic remedies for the malaria. He died in 1996 at the age of 42. The homeopath's license was revoked and he got two years probation. Jacqueline Alder Slade was harmed. She was a 55 year old woman who lived in Ireland. Her homeopath told her to stop taking her asthma medication and she died of an asthma attack. And little Isabella Dinley was harmed. She was a 13 month old baby in Australia and her epilepsy was treated with homeopathy and she died. And the remedies are not always benign. Sometimes remedies sold over the counter as homeopathic are low delusions like one in a hundred that may actually contain an effective ingredient to harm patients. A teething remedy, Hyland's baby teething tablets, was recalled because babies developed symptoms of Belladonna toxicity. Zycam caused adults to lose their sense of smell. Manufacturing standards were lax and the amount of active ingredient in the products varied. A skeptic group in the UK did an experiment. They sent a young woman to various homeopaths for advice about malaria prophylaxis for a trip to Africa. 10 out of 10 advised homeopathic protection instead of standard prophylaxis. One explained, they make it so your energy, your living energy doesn't have a kind of malaria shaped hole in it. The malaria mosquitoes won't come along and fill that in. The remedies sorted out. There was a case reported in the British medical journal where a woman relied on homeopathic vaccines during a trip to Togo. She developed a severe case of malaria, spent two months in intensive care, and had multiple organ failure. Water passes through the oceans in the water cycle and it gets succused by the waves. If it can remember, why wouldn't it remember fish poop? There's no such thing as absolutely pure water or absolutely clean glassware. Tiny amounts of contaminants are always present and dust and pollen grains fall out of the air into open containers of water. There are far more molecules of contaminant in a homeopathic dilution than there are molecules of the original substance. So how could the water know which substance it's supposed to remember? This poster pretty much says it all.   In the next lecture I'll talk about naturopathy.


Good morning everyone. I am Gayathri Kupaswamy, second day president from Rivey Patel Medical College, Kona Poo. My paper was showing comparison of CT-Propagraphy and Kalyadokra Valtaswamy for addiction research in synthetic patients. The study was done under the guidance of Dr. Pradeep Patel. Interaction of communicable disease and photohypotension or common clinical encounters is that disease continues to open for substantial proportion of the healthcare utilization in India. Syrosis related disease was submitted to increase and expected to be 12th leading course of death in 2020. The course of Syrosis varies in different parts of the world with the hepatitis C and anguvolysis predominating in the same countries and the hepatitis being in the mission of the Africa. In India, alcoholism is the most common cause of Syrosis while hepatitis is the cause of chronic liver disease in general and non-synoptic chronic liver disease. Elevated hydrostatic pressure within the portal room or distributed is manifesting as increase in pressure gradient between the portal room and hepatic or inferior venal killer is termed as portal hypotension. Development of portal hypotension and hypodynamic circulation is the ultimate end result in synoptic patients leading to significant immobility in mortality. Incident of esophageal illnesses in synoptic patients is 80 to 90 percent and about one-third of patients with esophageal varices may be leading to high morbidity and mutilating. Please, there is a need to develop a non-invasive reliable imaging technique for diagnosis and assessment of portal hypotension. The most common cause of death in Syrosis patient is upper GI blood due to development of esophageal varices. We must be aware of the model's homographic and CT anatomy of the portal and systemic circulation to understand the various gullatei pathways. The aim and objective of the study is to compare diagnostic efficacy of CT photography and of color Doppler ultrasound for reduction of viruses in synoptic patients. The metrology is 30 patients who diagnosed with the decompensated liver Syrosis has been sent to the department of radio diagnosis. The patients are subjected to the study after taking more concern, patient are subjected for reduction of viruses on ultrasound and findings are compared to CT photography. The inclusion criteria of this patients or decompensated patients with decompensated liver Syrosis due to any etiology included in this study. The exclusion criteria would severe hematomesis, previous history of the nodule to contrast agent, renal failure patients and hepatitis syndrome and refusal to participate in this study. The results 30 patients with cirrhotic liver, more 30, 17 and esophageal varices of different grades in the endoscopy. This table depicts a grading, more 17, four patients have grade one and 10 patients had grade two, where the three patients had grade three. This bar diagram showing the grading of esophageal varices in endoscopy and those detected in CT uncolored ophthalate ultrasound. Among 13 patients who had more varices on endoscopy, one showed varices on CT and none has been detected on ultrasound. Among four, among four grade one, three has been detected by CT none has been detected by ultrasound. Among 10 grade two esophageal varices, all the 10 has been detected by CT none has been detected by ultrasound. When the grade three, three patients had grade three, all the three has been detected by CT and only one has been detected by ultrasound. Therefore, from this result, CT can detect all the grade one and grade two varices, esophageal varices, when the ultrasound can only detect grade three esophageal varices. These are the different varices has been compared with CT photography and color Doppler, where 17 had esophageal varices. Among 17, only one has been detected on color Doppler, where nine showed the para esophageal varices on CT photogram. Among nine, only six has been detected by the ultrasound, color Doppler ultrasound. On the gastric mucosal varices, five has been detected on CT, among five, only two has been detected by ultrasound. Thirteen showed pericastric collatiles on CT photography, among thirteen, only four showed, four has been detected by ultrasound. With 24 patient showed peri umbilical collatiles on CT photography, among 24, almost all of the patient, almost 22 have showed peri umbilical collatiles on color Doppler, where 22 patient had a short sprenodinal collatiles on CT, among 22, 21 has been detected by ultrasound, where nine patients showed peri coli cystic collatiles on CT photogram. Among nine, six has been detected by ultrasound. So, this is, this table column shows a positive and both were positive in both CT and color Doppler ultrasound. CT with color Doppler money, this is only detected on CT. Therefore, the sensitivity, this table column depicts the sensitivity specificity, positive predictive value, not a predictive value of ultrasound with CT for deduction of photosystemic collatiles with the specificity and the positive, predictive value for the CT is 100% for all the varices and collatiles for all the photosystemic collatiles. Discussion in our study, most of the patient included between 30 to 60 years of with the main age of 55.7%. The cost of cirrhosis in most cases varies either chronic alcoholism or chronic hepatitis infection. Other causes include non-alcoholic fatty liver disease, extra hepatic portal venous obstruction, where two out of 30 patients had no identifiable cause and were included in cryptogenic cirrhosis category. This is the pathophysiology of development of collatiles and potent hypertension and these are the different sides of the photosystemic collatiles. When the patient developed liver cirrhosis, there is increased intrahepatic vascular resistance and there is elevated blood flow through the total venous system and there is a high pressure hepatopetal which is a normal curve, but there is a high pressure then redirected through the alternative low pressure systemic pathways and there is the formation of the extensive photosystemic collatiles. This image shows various photosystemic collatiles where we can see esophageal theory where we can see the pericastric collatiles, sclerodinal chromate collatiles and retroperitoneal and there will be a rectal collatiles and periamlical collatiles. The following states were evaluated for the presence of erasers in ultrasound and CT open, distal esophagus, parallel esophageal, perigastric, gastric metrusals, splemorhino, anterior abdominal wall, periamlical, retroperitoneal and pericolysis secretions. This is a case where 47-year-old me presented the hematomasis and abdominal distinctions where the ultrasound shows a normal G.E. junction where the CT image shows them shrunken liver, shrunken with a nodular surface, nodular surface and there is some multiple enhancing protrusion noted in the esophagus. This show, this is a show, this is a, this consistent with grade 1 varices on the endoscopy, this is the esophageal varices. This is a case of 56-year-old male patient who was in a chronic algorithmic, presented with two episodes of a hematomasis where the Doppler image shows the presence of the tortuous vessel in the stomach wall and the actual CT image shows the sephageal is collaborates in the gastric wall, which is a gastric mucosal varices. This is a case of 38-year-old male patient presented with abdominal pain and shortness of breath. The Doppler study shows the presence of tortuous vessel between the kidney, kidney is not seen in the stomach, between the spleen and the kidney, where the coronary CT image shows multiple varices in communication with the splenic vein and the renal vein is which is appears to be dilated and there is a spleen renal, this is the spleen renal colactals. This is a case of 55-year-old male with chronic alcoholic patient presented with weak abdominal discomfort, redlessness and loss of weight. The Doppler shows the presence of tortuous vessel in the pericolycystic region and the actual shows the multiple sephageal is pericolycystic colactals, which is the pericolycystic colactals. This is a CT image, the actual and the coronary CT image, where we can see the nodular and the shank and liver and the gross acetase and with the presence of large paroesophageal varices which is surrounding the esophagus circumferentially, surrounding the esophagus, this is a paroesophageal varices. Concurrention, ultrason deduce grade 3 varices and CT deduce grade 2 and 3 varices. CT is better for delineation of all proto-systemic colactals compared to ultrason, ultrason was impedable in the CT-portal venous phase in delineating complex colactal pathways. Multi-slice CT scan detects potential problematic varices by detailing the course of tortuous vessel which is important in liver transplantation, surgeries for deduction of unexpected venous that can result in significant bleeding. So, these are the references. Thank you.


Welcome to this presentation on managing refractive error. By the end of it, you should be able to define refractive error and describe its epidemiology, explore considerations for service delivery at the community level, and appraise school health programs and their management. Refractive error in the public health context is defined as a presenting visual acuity of less than 618, which can be corrected by refraction or by pinhole. Correctable myopia is defined as worse than minus 1 diopter. Correctable hyperopia is defined as plus 3 diopters or more. And it is essential to correct astigmatism of 1.5 diopters or more. The patient's presenting visual acuity is categorized using the World Health Organization's International Classification of Disease. Uncorrected refractive error is the second major cause of blindness and low vision in the world after cataract. Estimates from 2004 indicate that over 8 million people are blind and 145 million are visually impaired because they lack refractive correction. Who is most affected by refractive error? In children aged under 15, the prevalence of refractive error has been found to be higher in urban areas than in rural settings. This is possibly due to a direct cause and effect relationship between access to education and myopia. Refractive error amongst 94 million people aged over 50 includes cataract related index myopia or even uncorrected of fakia. The largest burden of refractive error is in India and China. And more research is needed about how and where to identify and treat people with uncorrected refractive error. Some estimates for service coverage shows that urban settings have better services, particularly for children. Why is there so much uncorrected refractive error? Many settings lack vision testing for children to ensure early detection and management. There is a lack of refractive services and limited affordability of spectacle correction, particularly in rural communities. Sometimes spectacles are not regarded as an essential medical intervention. And lastly, there may be cultural disincentives, which means that people choose not to wear or accept correction, especially girls. Visual impairment from refractive error impacts both individuals and society, leading to limited educational performance and success amongst children, social isolation and fewer opportunities for work in education, more exposure to morbidities and higher mortality rates, and generally a lower quality of life and poverty. There are two strategies for improving access to comprehensive community-based eye care, static and outreach. Ideally, services are planned for a population of 50,000 and they focus on increasing demand and supply. At a primary level, ophthalmic assistance or nurses can be trained to perform eye examinations and refraction. To minimize referrals, they can also be trained to dispense spectacles directly. Due to the lack of evidence, we have to use estimates to guide development of refractive error services. Estimating the demand for spectacles can be calculated from prevalence data for the target population or from similar settings. Where no data is available, 20% of the total population is a reasonable estimate. Understanding the demand allows planners and managers to appropriately allocate refraction and dispensing equipment and spectacles, as well as numbers of trained personnel. Social marketing of refraction services has been a successful model in creating demand and raising awareness, and this has been particularly successful in India through vision centres. School health programs aimed particularly at the early teenage group have also been shown to be effective. Targeting younger, economically active groups in the workplace or colleges is another option. In the over 50 age group, health promotion and access to services will also improve uptake. Refraction equipment and spectacle dispensing equipment are both necessary to deliver comprehensive services. A range of lenses and frames suitable for local preferences must also be stocked, particularly for children and girls. Equipment and consumables are managed using an inventory and a reliable supply chain. The priority age group that needs vision testing at least once is children aged 12 to 14 years. This is to detect myopia of puberty. Younger age groups are tested if resources are available. Each eye is tested and vision less than 612 in either eye is defined as a case for referral and further testing. Lower cut-off of less than one diopter correction often results in poor adherence to spectacle wearing amongst children. In some settings, school teachers can be trained to do an initial visual assessment within the school. Teachers are provided with a vision kit, referral protocol and support from local optometry services. In school vision testing programs, recruiting science teachers who can explain the benefits to parents are an ideal choice. As are teachers who wear spectacles, as they will have an understanding and empathy for a refractive error. The teachers must have the support of school authorities. The process of vision testing is made as simple as possible. Key points to remember are the teachers must all be trained and supported. Test each eye. Children that fail the 612 visual acuity cut-off must be referred using an agreed method. Train teachers to refer each case they identify. All the testing and referral information should be recorded for monitoring and evaluation of the program. Children who are prescribed spectacles should also be followed up between 3 to 6 months. And lastly, support and counselling must be provided to parents and children. Management collect data to monitor school vision testing programs in order to know the coverage. This is the number of children whose vision has been tested by the teachers. Know the uptake of referral. This is how many of the referred children actually present to optometrists. Establish how effective the teacher's testing is. If there are too many false referrals, retraining may be necessary. And understand the acceptance of refractive correction. This is achieved by revisiting the school 3 to 6 months later and identifying which children are still using their spectacles. Let's look at monitoring in more detail using an example. There are 5,000 children in the district schools aged 12 to 14 and 3,000 of them undergo vision testing. To calculate the coverage of services, we divide 3,000 by 5,000 and multiply by 100 to get a percentage. This gives us a 60% coverage. 110 children are referred for refraction and 75 of them present to the optometrist. To calculate the uptake of vision testing, we divide 75 by 110 and multiply by 100. This gives us a 68% uptake of the service. 55 children out of the 75 that presented are referred on to be prescribed spectacles. The percentage of correct referrals by teachers is calculated by dividing 55 by 75 and multiply by 100. This gives a 73% correct referral rate. This is good, but we should also establish why all the children did not come. 40 children are still wearing their spectacles 3 months later. To work out the acceptance rate, we divide 40 by 55 and multiply by 100. And this gives us a 73% acceptance rate. This data can be monitored on a monthly basis and used by management to adjust the intervention appropriately. Vision testing in schools is simple to conduct and can have a huge impact on children and their education. Services need to be planned with adequate resources, good monitoring and management and supported by effective communication between schools and optometry services. In conclusion, refractive error is the second most important cause of visual impairment and blindness globally. Correction is relatively simple and the challenges are in access, affordability and acceptance of spectacle correction. To meet the need, comprehensive service delivery at the community level is essential. And school vision testing is an important strategy to address refractive error needs in children and it can be done by trained and willing teachers.


So I just got the product myself, the Elite, which I didn't have any former ones, but everyone says it's super, it's been the quietest one. I don't have anything to compare it to, but it seems quiet for me. I play a lot of tennis, a tremendous amount of tennis. And typically it's like I'm stretching for hours after. In order to keep playing, we're doing like two hours every single day. Yeah. And it's pretty intense. But when I got there again, it was the first time that I felt at least the next day, great. It was like, I woke up, I wasn't sore. My feet didn't hurt, stepping on, getting off the bed, stepping on the ground, which was shocking to me. But anything you can just share with us about why it works, I've certainly felt the effects, but I can't explain it to anybody. Well, just a little background on that. When I first started doing this, I had buckets full of anecdotal experiences. I could go down the list of, I worked on Sloan Stevens and I went to Indian Wells and one of the trainers, I was in there working on her and one of the trainers slid the curtain back.  But it was those experiences that led to these different opportunities, if that makes sense. And watching this happen with an athlete and then taking that same thing and watching it happen in my clinic, I started realizing there's something happening here. But I couldn't Google it. And if you Googled Percussive Therapy, four or five years ago, there wasn't anything on the market. So I didn't really have a lot of science to lean on. I was watching what happened and because I was a chiropractor and I got to work in these fields, I felt like I kind of had a mobile lab. I'd go from my clinic and I'd work in my clinic on everyday people and then in 2013 and 14, I was working with NASCAR, Richard Petty's race team. And I would fly to the race, work on the team, work on the driver and they're saying the same thing that my clinic patients are saying that aren't really active. And I'm thinking, what is this? So, innovation always leads science because you're always innovating and then you have to validate it later on. I didn't know that concept, but that's what was happening. And I just sort of proved Tesla did it, Benjamin Franklin did it. They just make these things and then you have to come back and validate it. So that's what we did. We made this stuff and now I have this collection of theories. And so when I first started doing this in 2016, we launched our first study with USC and USC compared us to some of the other products on the market and they said we were significantly better at increasing blood flow, which increases oxygenation and increasing the body's ability to move or stretch or range of motion. And that was so valuable to me at the time. Fast forward now, we have 22 studies with different academic institutions around the world validating the science. So now with that understanding, I'm super proud to say that we've created more science than a lot of other companies, any other company in the space. And we lead our products are scientifically validated. And Anaya can say that, whether I'm talking to Johnny Pico, who's the head trainer for Manu or the head trainer for Arsenal or Gunnar Peterson or the guy that's in charge of the Patriots, they ask, what's the science? So what it does basically when you say that is our bodies break down.  I'm just making this really simple. They'll eat away at the tissue. So when you wake up in the morning, you have to get the blood flowing to get rid of that lactic acid or that first, second, third day burn you have. When you work out, you break down tissue, the toxins are left in your body. What Farragun does is three things. It's hitting your body at a speed that actually overrides the pain signals to your brain. So it's not painful. You're hitting the tissue. It's going deep enough into the tissue that it's causing something that's called mechanical transduction, which is mechanical heat. So now that heat draws blood there. And when you bring blood to that area, you're bringing oxygen. Oxygen and lactic acid, for lack of a better term, oxygen and lactic acid cannot be in the same space. So when you bring oxygen in with new blood flow, it pushes the lactic acid out. They can't live together. So now you have clean, pure oxygen to that area. Now your body can heal. The last thing in one of the most important components, our body cannot recover unless we are in parasympathetic state. Parasympathetic state is rest and digest. And when you're using this on your body, it's calming the nervous system and telling your brain, go to rest and digest and let's heal now. So the very best, I remember I had an NFL guy, I won't say his name, because I don't like kissing and telling, but I worked on an NFL guy and he was getting ready for camp. And the first day I worked on him really deep after a workout, he came back the next day with his eyes like this. He's like, dude, I don't even feel sore. And that's one of the best sales techniques I've had is just let me do this to you and tell me how you feel tomorrow. Hey everyone, thanks for checking out that clip. If you enjoyed it, be sure to hit the like button down below. And if you're interested in hearing the full episode, it's out right now on our YouTube channel. We've had a lot of great guests come on this show before and we've got a lot of great guests coming up in the future. So hit subscribe so that you don't miss a single episode. And one final note, we're always looking for new ideas and new companies feature on the show. So if you know of someone or know of a company, write us a comment down below letting us know who they are and what they do. We'd be happy to have them on the show. Till then, I'll just be here waiting for your comments. So, see you later.


As Christians faithful joined their counterpart across the world to celebrate Easter, Nigerians have been tasked to remain hopeful of a new country where love, peace, unity, and progress thrive. The senior pastor of the Evangelical Church of Weninghall, first aqua on one borough, Reverend Dr. James Moore, gave this charge during the Resurrection in Pre-Service in Kaduna. Reverend Moore says, Christ's sacrificial deaths and glorious Resurrection are the highest expression of love and self-giving to Mankind. It marks a special day to the believers all over the world, and that's why we as a church decided to celebrate the Lord and to celebrate the resurrection of our Lord Jesus Christ. There is still hope in the history of Nigeria, whatever the crisis, whatever the challenges that we have, because we believe that we have the resurrected Jesus Christ.  Our prayer all over for the Christians and for the nation of Nigeria is that we should remain hopeful, knowing fully that there is hope, there is hope because Jesus has brought life so we also we are celebrating. So for the history of Nigeria, we sincerely say that there is hope. This is not the end of life, but this will be the beginning of greater things the Lord will do to us as a nation. We appeal to President Bola Tinibu to roll out mechanisms to address the economic hardship and other challenges Nigerians are facing. President, I met Tinibu in as much as it is our responsibility as Christians to pray for him, which we are doing. We know that he is leading this country in a very tough time. Citizens are suffering. Life has become so tough. We pray for him that he will not lose focus, that he will look up unto the Lord as the Lord will guide him to alleviate the pains of Nigeria. People are truly suffering. Is it economy? It's not easy. Everything has become tough for Nigerians. Can the government, being led by Tinibu, come to the rescue of the people? Some of the worshipers express excitement witnessing the resurrection of Christ from the dead. As a Nigerian, we are to use this season to show love, to also preach the resurrection of Christ so that every other person, an unbeliever or a believer that has lost faith will be strengthened and believing that God will do it for us and Nigeria is going to be the best place in the planet to live. If Jesus could die and rise, give us hope as mankind. It means Nigeria has hope. This is our belief. We don't care what the nation is going through. We don't want to look at what we are going through, what we see around us. We are not moved by it, but we are moved by the fact that if Jesus is alive, Nigeria will live. Nigeria has hope.