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Evaluation of homoeopathic medicines as add-on to institutional management protocol in Acute Encephalitis Syndrome: An exploratory observational comparative study

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  • Directorate of AYUSH

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Background: Acute Encephalitis Syndrome (AES) treated according to Institutional Management Protocol (IMP) has considerable mortality and morbidity. The study was undertaken to evaluate the effect of homoeopathic treatment (H) as an add-on to IMP (IMP + H) for children affected with AES. Materials and Methods: This was an exploratory observational study carried out in the IPD setting (epidemic ward) of Baba Rhaghav Das Medical College and Nehru Hospital, Uttar Pradesh (July to November 2012) using convenience sampling. Children whose guardians gave consent were treated with IMP + H and rest remained on IMP only. Glasgow outcome scale was used at discharge for the final outcome. Results: 151 children (121 in IMP + H and 30 in only IMP) diagnosed with AES (aged 6 months to 18 years) were enrolled. The results showed 12 (9.9%) death out of 121 children administered IMP + H whereas it was 13 (43%) out of 30 children on IMP alone. Proportional odds analysis with covariate adjustment showed added benefit of Homoeopathy in children with AES as compared to IMP alone (adjusted odds ratio, 0.17, 95% confidence interval 0·06-0.45, P = 0·0001). The most useful medicines are Belladonna, Stramonium, Arsenicum album, Helleborus, Bryonia alba, Sulphur, and Cuprum metallicum. Conclusion: This exploratory observational study suggests reduction of mortality and morbidity with add-on homoeopathic medicine. Further randomized controlled trial study with comparable groups is desirable. If findings are confirmed by subsequent research, add-on Homoeopathy might have relevant implication for its management.
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Japanese encephalitis
surveillance standards*
January 2006
*From WHO-recommended standards for surveillance of
selected vaccine-preventable diseases
WHO/V&B/03.01
Complete document available online:
http://www.who.int/vaccines-documents/DocsPDF06/843.pdf
45
WHO/V&B/03.01
Japanese encephalitis
FIELD TEST VERSION
Rationale for surveillance
Japanese encephalitis (JE) is a mosquito-borne viral encephalitis that occurs in
temperate and tropical regions of Asia and is maintained in a cycle of virus transmission
between vertebrate amplifying hosts (e.g. pigs, herons, egrets) and several Culex
mosquito species. The greatest transmission to humans occurs in rural settings,
particularly those in which agricultural practices increase the potential for breeding of
vectors or infection of vertebrate hosts. In urban settings, the potential for an outbreak of
JE is low, although transmission can occur. In recent decades, JE outbreaks have
occurred in areas previously non-endemic for the disease. The high case fatality rate
(20%–30%) and frequent residual neuropsychiatric damage in survivors (50%–70%) make
JE a major public health problem.
JE is the leading form of viral encephalitis in Asia, where about 50 000 cases and 10 000
deaths are reported each year, mostly among children. However, officially reported cases
of JE greatly under-represent the true impact, due to incomplete surveillance in many
affected areas. Among the control strategies, human vaccination has proven to be the
single most effective control measure.
Infection with Japanese encephalitis virus may be asymptomatic, or may cause febrile
illness, meningitis, myelitis or encephalitis. Encephalitis is the most commonly
recognized presentation, and is clinically indistinguishable from other causes of an acute
encephalitis syndrome (AES). Syndromic surveillance therefore aims to identify patients
with AES, and among these confirm JEV infection using standardized laboratory
techniques.
In most Asian countries, the epidemiology and public health burden of JE is poorly
understood. The primary goal of disease surveillance in these countries is to
characterize the epidemiology and burden of JE so as to advocate for and guide
programmatic interventions.
Where JE immunization is already ongoing, the primary purpose of surveillance is to
identify high-risk populations or geographic areas in need of improved vaccination
coverage and areas with new disease transmission, and to document the impact of
control measures.
In summary, JE surveillance is critical to characterize the epidemiology and burden of the
disease, identify high risk areas for appropriate public health response and document the
impact of control measures.
*From WHO-recommended standards for surveillance of selected vaccine-preventable diseases
4 6 WHO-recommended standards for surveillance
Japanese encephalitis (continued)
Recommended case definition
Clinical case definition
Clinically, a case of acute encephalitis syndrome is defined as a person of any age,
at any time of year with the acute onset of fever and a change in mental status
(including symptoms such as confusion, disorientation, coma, or inability to talk)
AND/OR new onset of seizures (excluding simple febrile seizures1). Other early clinical
findings may include an increase in irritability, somnolence or abnormal behaviour greater
than that seen with usual febrile illness.
Case classification
Suspected case: A case that meets the clinical case definition for AES.
Suspected cases should be classified in one of the following four ways (see Figure 1).
Laboratory-confirmed JE: A suspected case that has been laboratory-confirmed
as JE.
Probable JE: A suspected case that occurs in close geographic and temporal
relationship to a laboratory-confirmed case of JE, in the context of an outbreak.
“Acute encephalitis syndrome” – other agent: A suspected case in which diagnostic
testing is performed and an etiological agent other than JE virus is identified.
“Acute encephalitis syndrome” – unknown: A suspected case in which no
diagnostic testing is performed or in which testing was performed but no etiological agent
was identified or in which the test results were indeterminate.
Laboratory criteria for confirmation
Clinical signs of JE are indistinguishable from other causes of AES. Laboratory
confirmation is therefore essential for accurate diagnosis of JE.
Laboratory confirmation of a JE virus infection includes:
1. presence of JE virus-specific IgM antibody in a single sample of cerebrospinal fluid
(CSF) or serum,2 as detected by an IgM-capture ELISA specifically for JE virus;3
or any of the following:
2. detection of JE virus antigens in tissue by immunohistochemistry; OR
1A simple febrile seizure is defined as a seizure that occurs in a child aged 6 months to less than 6 years old,
whose only finding is fever and a single generalized convulsion lasting less than 15 minutes, and who recovers
consciousness within 60 minutes of the seizure.
2A serum sample should be obtained at admission. Because it may not yet be positive in a JE-infected person, a
second serum sample should be collected at discharge or on the 10th day of illness onset or at the time of death
and tested for presence of JE virus specific IgM.
3Further confirmatory tests (e.g. looking for cross-reactivity with other flaviviruses circulating in the geographical
area) should be carried out: (a) when there is an ongoing dengue or other flavivirus outbreak; (b) when
vaccination coverage is very high; or (c) in cases in areas where there are no epidemiological and entomological
data supportive of JE transmission.
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WHO/V&B/03.01
Japanese encephalitis (continued)
Recommended case definition (continued)
3. detection of JE virus genome in serum, plasma, blood, CSF,4
or tissue by reverse
transcriptase polymerase chain reaction (PCR) or an equally sensitive and specific
nucleic acid amplification test; OR
4. isolation of JE virus in serum, plasma, blood, CSF,4 or tissue; OR
5. detection of a four-fold or greater rise in JE virus-specific antibody as measured by
haemagglutination inhibition (HI) or plaque reduction neutralization assay (PRNT) in
serum collected during the acute and convalescent phase of illness. The two
specimens for IgG should be collected at least 14 days apart. The IgG test should
be performed in parallel with other confirmatory tests to eliminate the possibility of
cross-reactivity, as indicated in footnote 3.
Note:
The large majority of JE infections are asymptomatic. Therefore, in areas that are
highly endemic for JE, it is possible to have AES due to a cause other than JE
virus and have JE virus-specific IgM antibody present in serum. To avoid
implicating asymptomatic JE as the cause of other AES illnesses, sterile
collection and testing of a CSF sample from all persons with AES are
recommended when feasible.
Only the first 5–10 JE cases of an outbreak need be confirmed through laboratory
testing. During periods of epidemic transmission of JE virus, laboratory
confirmation of every case may not be necessary.
Recommended types of surveillance
JE surveillance should be conducted year round. Where feasible, surveillance for and
reporting of JE should be performed within the context of integrated disease surveillance,
and linked synergistically with similar surveillance activities, such as those for acute
flaccid paralysis (AFP) or meningitis.
In all Asian countries
Comprehensive syndromic surveillance for acute encephalitis syndrome with aggregate
reporting is recommended. In sentinel hospitals, surveillance should be case-based with
specimens collected for laboratory confirmation.5 The number of sentinel hospitals can
be gradually increased if feasible logistically.
4Detection of virus genome or virus isolation in serum, plasma or blood is very specific for JE diagnosis; however,
it is not sensitive as virus levels are usually undetectable in a clinically ill JE case. Therefore a negative result
by these methods should not be used to rule out JE in a suspected case. Similarly detection of virus genome or
virus isolation in CSF is usually only found in fatal cases and therefore not very sensitive and should not be used
for ruling out a diagnosis of JE.
5During epidemics, laboratory testing can be limited to confirmation of the first 5–10 cases per geographic area per
epidemic.
4 8 WHO-recommended standards for surveillance
Japanese encephalitis (continued)
Recommended types of surveillance (continued)
In Asian countries where a high level of JE control has been achieved
Surveillance should be case-based throughout the country and include laboratory
confirmation of all suspect cases.
Regardless of the type of surveillance, reporting should be weekly or monthly and include
“zero-reporting” (i.e. no blanks should be left in the reporting forms, a zero should be
indicated when there are no cases detected). Outbreak investigations should be initiated
if there is a sudden increase in cases or if cases reported are different from historical
information, in terms of season, geographical area, age group, or case fatality.
Recommended minimum data elements
Aggregated data
The recommended elements for aggregated data are:
number of cases and deaths by week/month
number of cases by age group, sex and immunization status
number of cases by state/province.
Case-based data
The recommended elements for case-based data are:
unique identifier
age
sex
geographical area
travel history over the past two weeks
whether ever immunized against JE; 1 = yes; 2 = no; 9 = unknown
If yes, number of doses administered
if yes, type of JE vaccine (most recently received)
date of last JE immunization
date of onset of first symptoms
fever: 1 = yes; 2 = no; 9 = unknown
change in mental status; 1 = yes; 2 = no; 9 = unknown
seizure: 1 = yes; 2 = no; 9 = unknown
date CSF sample taken
date serum sample 1 taken
date serum sample 2 taken
autopsy specimen taken: 1 = yes; 2 = no; 9 = unknown
clinical diagnosis: ___________________
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WHO/V&B/03.01
Japanese encephalitis (continued)
Recommended minimum data elements (continued)
Depending on which laboratory tests used for serum or CSF:
IgM serum 1 results: 1 = positive; 2 = negative; 3 = not tested; 9 = unknown
IgM serum 2 results: 1 = positive; 2 = negative; 3 = not tested; 9 = unknown
IgM CSF results: 1 = positive; 2 = negative; 3 = not tested; 9 = unknown
virus detection (PCR, virus isolation, immunohistochemistry) results:
1 = positive; 2 = negative; 3 = not tested; 9 = unknown
HI or PRNT results on acute and convalescent sera: 1 = positive (4 fold rise or
greater); 2 = negative (<4 fold rise); 3 = not tested; 9 = unknown
date serum 1 results reported
date serum 2 results reported
date CSF results reported
date virus detection results reported
final classification: 1= laboratory confirmed JE; 2= probable JE; 3 = AES unknown;
4 = AES other agent
status at discharge: 1 = alive; 2 = dead; 9 = unknown
date of death or discharge.
Recommended data analyses, presentations, reports
Aggregated data
The recommended elements for aggregated data are:
number and incidence of suspected cases by week, month, year, age group, and
geographic area;
number and incidence of confirmed cases by week, month, year, age group, and
geographic area;
JE vaccine coverage by year and geographical area;
percentage of cases vaccinated and unvaccinated; and
completeness/timeliness of monthly reporting by geographical area.
Case-based data
The recommended elements for case-based data are the same as those for aggregated
data plus the following:
suspected and confirmed cases – age-specific, gender-specific, geographic area-
specific, and immunization status-specific incidence;
percentage of suspected cases with CSF and/or serum specimens;
percentage of cases with serum 10 or more days after onset of illness (when testing
methodology is IgM-capture ELISA);
case fatality ratio;
final classification of all suspect cases; and
proportion of AES attributed to JE.
5 0 WHO-recommended standards for surveillance
Japanese encephalitis (continued)
Recommended data analyses, presentations, reports (continued)
Performance indicators of surveillance quality
The following targets are for countries with a well established AES surveillance system
(Table 1 and Table 2). Countries commencing with JE surveillance may set intermediate
targets.
Table 1: Targets for countries with established surveillance systems
Indicator Target
Completeness of monthly reporting > 90%
Timeliness of monthly reporting > 80%
Percentage of serum samples taken > 80%
a minimum of 10 days after onset
(When the testing methodology is
IgM-capture ELISA)
In countries where a high level of JE control has been achieved, the following indicators
can be helpful as managerial tools to identify areas where corrective action is needed
(Table 2).
Table 2: Indicators to assist corrective action
Indicator Target
Percentage of all suspect cases for > 80% a
which specimens were collected
Percentage of CSF/serum samples > 80%
reaching laboratory in adequateb condition
For all tests, laboratory results reported > 80%
< 1 month after receipt specimen
aOnly applicable for countries doing nationwide case-based surveillance.
b“Adequate condition” means the specimen is transported using reverse cold chain.
51
WHO/V&B/03.01
Japanese encephalitis (continued)
Principal uses of data for decision-making
The principal uses for decision-making are to:
guide policy and strategies on JE control;
assess the impact of vaccination;
identify geographic areas or populations at high risk to further guide where
immunization coverage should be improved;
monitor the performance of surveillance;
monitor the performance of the laboratory; and
monitor vaccine efficacy.
Special aspects
For persons vaccinated with Japanese encephalitis vaccine within six months of illness
onset, testing a single serum sample for Japanese encephalitis IgM may not be
diagnostic because it may give a false positive result. In such cases, a diagnosis can
only be confirmed by demonstrating JE IgM in the CSF, JE virus isolation, a positive
nucleic acid amplification test, immunohistochemistry, or a four-fold or greater rise in
antibody titre in acute and convalescent phase serum samples.
Efforts should be made to identify other causes of AES. As a general rule, persons with
acute encephalitis should undergo a lumbar puncture to obtain CSF to identify other
treatable agents that may result in an illness that manifests as acute encephalitis
syndrome. CSF with WBC = 1000/mm3 is unlikely to be due to Japanese encephalitis or
any other arbovirus; in these cases, bacterial causes of purulent meningitis such as
Haemophilus influenzae, Neisseria meningitidis, or Streptococcus pneumoniae should be
considered. In malaria-transmission areas, malaria testing should be carried out to rule
out cerebral malaria. Health care providers should also rule out herpes encephalitis, if
possible, as it is a treatable cause of AES.
Figure 1: Final classification scheme for AES cases a
Adequate blood/
CSF specimen
No adequate blood/
CSF specimen
Suspected JE (AES)
IgM -ve
IgM +ve
Geographic / temporal
link to lab-confirmed JE
during an outbreak
No geographic / temporal
link to lab-confirmed JE
AES unknown
Lab-confirmed JE
AES unknown
Other
diagnostic tests AES other agent
Probable JE
aA suspected case of JE can also be a suspected case of bacterial meningitis (see bacterial meningitis section for
definitions). In this event, a CSF/blood sample should be sent to both bacteriology and virology laboratories to
allow rapid and appropriate case management and classification.
... The intervention resulted in drastic drop of the mortality and morbidity rates. 01 RCT by Oberai et al. [61] and 01 CC by Manchanda et al. [62] conducted in a tertiary care hospital of Uttar Pradesh, investigated effect of homoeopathic medicine as an add-on to standard care in children suffering from AES compared to standard care. Modified Glasgow coma scale assessed the severity and Glasgow outcome scale assessed the primary outcomes in terms of death, neurovegetative sate, moderate disability and severe disability and recovery. ...
... Mannitol could be provided in case of increased intracranial tension (Clinical management protocol for Nipah virus disease 2018). Homoeopathic prescriptions such as belladonna, calcarea carb, nuxvomica and hyoscyamus help to cure a wide range of symptoms like moderate to high grade fever, headache, inflammation, vomiting, respiratory complications, sensorium, convulsion, myalgia and fatigue (Manchanda et al. 2015). So, these homoeopathic drugs might be beneficial in the symptomatic management of NiV disease. ...
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Nipah virus (NiV) is one of the newly emerging paramyxoviruses affecting both humans and animals. NiV is known as 'deadly virus' and is on the top of the list of ten severe diseases identified by World Health Organization that have very high potentials for forthcoming outbreaks. NiV outbreaks have been documented in Southeast Asia mainly in Malaysia, Singapore, Bangladesh and India. From 1998 to 2018, more than 643 cases of NiV human infections were reported with a high case fatality rate. The NiV infection has an incubation period between 4 and 21 days, and the common symptoms are: rapid onset of fever, headaches, drowsiness, convulsion, disorientation, myalgia and respiratory perplexity. There is no licenced antiviral drug or vaccine available to cure NiV infection, and the available treatment is only based on intensive supportive care. Although mammalian cell-derived NiV like particles (VLP) and Canarypox virus-based vaccines have shown protection against NiV infection in various animal models, which may act as a prophylactic vaccine for human. In the same way, antiviral drugs such as ribavirin, favipiravir, GS-5734, chloroquine and monoclonal antibodies are found to be effective against NiV in various animal models. This article summarizes some of the available therapeutics and treatment regimens based on modern, complementary and alternative medicines for the cure of NiV infection.
... [27][28][29] Further exploratory observational comparative study of JE conducted showed the reduction of mortality and morbidity with add-on homoeopathic medicine. [30] Randomised controlled trial on the evaluation of homoeopathic medicines as add-on concluded that adjunctive homeopathic medicines may improve clinical outcomes associated with acute encephalitis syndrome. [31] Studies have also shown that homeopathy may be an effective adjunct in Dengue outbreak prevention. ...
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The mankind has been under the wrath of various H1N1 viruses tracing back to the Spanish flu (SF) in 1918 down to pandemics in 1957 H2N2, 1968 H3N2, 2009 H1N1 and COVID 19 in 2020. Despite a lot of advancements in genomic viral studies, laboratory techniques, medical advancement and treatment options in the form of antiviral and antibiotics, the threat of pandemics is hovering on mankind with a challenge at global and national level to fight against it. Homoeopathy has played a contributory role in the treatment and prevention in various epidemics in the past. In this overview, the role of homoeopathic medicines used in the treatment of Pandemic SF 1918, in reducing the mortality is highlighted. © 2020 Indian Journal of Research in Homoeopathy | Published by Wolters Kluwer-Medknow.
... [96,97] Another exploratory observational study in JE was undertaken in In-Patient Department (IPD) setting (epidemic ward) of Baba Raghav Das (BRD) Medical College and Nehru Hospital, Uttar Pradesh with successful reduction in mortality and morbidity rate. [98] Further, CCRH has undertaken a study in collaboration with Center for Cellular and molecular ...
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Homoeopathy is a therapeutic system founded by German physician Dr Samuel Hahnemann in the late 1700’s and has been used for 200 years around the world in acute and chronic disease conditions. Homoeopathy has also flourished during the times of epidemic diseases and the use of homoeopathic remedies as genus epidemicus and homoeoprophylaxis began with Hahnemann. Although the effectiveness of the homoeopathic remedies in epidemics has been scarcely proved by controlled studies, yet there is vast historical evidence which proves that homoeopathic remedies have been successfully used to prevent these conditions. The homoeopathic literature was searched to find out the historical evidences of the use of homoeopathic remedies during epidemics and pandemics. Homoeopathic treatment during epidemics is reviewed in Eight diseases and their results are found for epidemics of Scarlet fever, Typhus, Cholera, Dysentery, Spanish flu, Diphtheria, Measles, Whooping cough. Also the prophylactic effect of homoeopathic medicines is found in Fourteen epidemic diseases namely Scarlet fever, Smallpox, Poliomyelitis, Meningitis, Whooping cough, Dengue, Cholera, Japanese Encephalitis, Leptospirosis, Diphtheria, Influenza, Hepatitis, Malaria, Chikungunya. Many clinical trials have also been conducted during the epidemics of Chikungunya, Influenza like illness, Dengue, Acute Encephalitis Syndrome/Japanese Encephalitis. The current novel Coronavirus disease, COVID-19, has rapidly spread over the globe and has been declared as pandemic by World Health Organization. Till now, no specific treatment or vaccine has emerged to control this pandemic. However, many homoeopaths over different parts of the world have treated a wide range of COVID positive cases with different remedies. This review not only brings forward the success stories of homoeopathy during past epidemics but also presents its utility in the current pandemic.
... A recent outcome in an exploratory observational comparative study conducted by CCRH has been published where homoeopathic medicine (H) was used with Institutional management protocol (IMP) in JE virus infection of humans in IPD (epidemic ward) of a hospital at Utter Pradesh with encouraging results. The results revealed that there was marked diminution of mortality and morbidity (31.1%) in H plus IMP treated group in comparison to exclusively IMP treated group 14 . But the result of exclusively homoeopathic treatment group was essential here to compare the validity and legitimacy of homoeopathic treatment with the other group in JE virus infection on humans. ...
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Background: Different studies proved that the homoeopathic medicine "Belladonna 200C" can abate the Japanese encephalitis virus infection in experimental models. The aim of this study is to find out the recent evidence based information which will be supportive to treat the Japanese Encephalitis virus infection according to severity of disease (JE) stratified in different stages. Methods: A review of important recent studies regarding the treatment of Japanese encephalitis was made and analyzed for extraction of newer ways of homoeopathic treatment in JE.A final protocol for treatment in different stages of JE was formulated accordingly. Results: After detailed analysis of all evidences, three homoeopathic medicines-Belladonna, Helleborus and Phosphorus were found specifically effective in three different stages according to severity and complications of the disease. Belladonna is useful in first stage of encephalitis without effusion. Helleborus is effective in the second stage of the disease with effusion, stupor, dragging of legs and developing paralysis. Finally the Phosphorus is indicated when complete paralysis appears due to inflammation and degeneration of brain cells. Conclusion: This new outlook of treatment may decrease mortality and morbidity of JE virus infection besides reducing the complication and disability rates.
... The intervention resulted in drastic drop of the mortality and morbidity rates. 01 RCT by Oberai et al. [61] and 01 CC by Manchanda et al. [62] conducted in a tertiary care hospital of Uttar Pradesh, investigated effect of homoeopathic medicine as an add-on to standard care in children suffering from AES compared to standard care. Modified Glasgow coma scale assessed the severity and Glasgow outcome scale assessed the primary outcomes in terms of death, neurovegetative sate, moderate disability and severe disability and recovery. ...
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... Adjuvant homoeopathic treatment given to dengue haemorrhagic cases at a tertiary care hospital during the dengue outbreak in 2015 in Delhi showed that patients who received Homoeopathy had rapid rise in platelet count and less number of days of hospital stay compared to those who received standard care alone. [44] Similarly, in acute encephalitis syndrome/Japanese encephalitis, Homoeopathy as an adjuvant to the Institutional Management protocol (IMP) could decrease death rate by 15% in comparison to those who received only IMP. [45] Another study in 2010-2011 clearly puts forward the promising role of homoeopathic treatment in cases of chikungunya and its sequalae post-chikungunya chronic arthritis (PCCA) with complete recovery in more than 84.5% and 90% cases, respectively. [46] Results of another trial in dengue fever with a homoeopathic combination remedy of 10 drugs along with standard supportive therapy showed statistically significant improvements in blood platelet levels, haematocrit and white blood cell counts in the homoeopathic combination group compared with supportive therapy at the end of 6 days. ...
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... 37 Another Indian comparative study on patients with acute encephalitis syndrome showed reduction in mortality and morbidity in the group administered adjuvant homeopathy to standard institutional management protocols compared with standard therapy alone. 38 Another method to minimize confounding and bias before starting a study (at baseline) is to control using a matching technique. 1 The aim of a matching procedure is to find for every treated patient one (or more) control patients with similar observable characteristics against whom the effect of the treatment can be assessed. ...
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Since early civilisation human race has suffered from infectious diseases and has struggled to minimize its impact by efforts such as changing to accessory circumstances and life style modifications. Epidemics have troubled the human race time to time and now it is COVID-19 the infectious disease caused by the most recently discovered corona virus. History shows that homoeopathy reflects its potentiality in epidemic management since its inception. As India is the global leader in the field of homoeopathy, almost every new emerging disease was successfully tackled by the veteran homoeopathic physicians of India. Initiatives in government level were taken from time to time to generate evidences. It is need of the hour to build the evidence based data and present it before the sceptics.
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The high efficacy of CAM therapies is globally acknowledged; however, their scientific validations are yet to be determined. Currently, CAM therapies are applied for treating influenza, Japanese encephalitis, inflammatory diseases, and breast cancer. These nonconventional therapies strengthen whole immune system with minimal side effects and are also cost effective. CAM is a personalized medication which alleviates the disease by treating the underlying causes coupled with it. The usefulness of CAM has been increased recently and considered as a healthcare system, product, and practice that are not a part of conventional medicine. The name CAM (complementary and alternative medicine) has been recently changed to complementary and integrative health (CIH) in Australia and other Western countries.
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