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Terapéutica homeopática en la Queratoconjunctivitis Epidémica
... Em outra epidemia de ceratoconjuntivite ocorrida em Cuba, 108 pacientes foram distribuídos aleatoriamente para tratamento homeopático (n=58) e alopático (n=50), empregando Pulsatilla nigricans 6cH como medicamento homeopático individualizado do gênio epidêmico da referida epidemia. O tratamento homeopático foi significativamente mais eficaz que o alopático na melhora dos sintomas, num período inferior a 72 horas [97]. ...
In addition to the recognized application in chronic diseases, individualized homeopathy can also act in a resolutive or complementary way in acute cases, including epidemic diseases. However, to achieve this intent, it presents a specific semiologic and therapeutic methodology that must be followed and respected, with the risk of not presenting the desired efficacy and safety. In the case of epidemic diseases, which due to the virulence of their agents causes a common symptomatological picture in most susceptible individuals, the individualized homeopathic medicine (homeopathic medicine of the epidemic genius) should present similarity with the set of characteristic symptoms and signs of the patients affected in the different stages of each epidemic outbreak. Studies show the efficacy and safety of this therapeutic and/or prophylactic practice in several epidemics of the past. Therefore, after the survey of possible individualized homeopathic medicine from the epidemic genius of each epidemic, its therapeutic and/or large-scale prophylactic application should be supported by previous clinical trials that demonstrate its effectiveness and safety, in line with the ethical and bioethical aspects of research involving human beings. Fulfilling these premises of good clinical practice, we developed, in March 2020, this research protocol to investigate, in a randomized, double-blind and placebo-controlled clinical trial, the effectiveness and safety of possible individualized homeopathic medicines of epidemic genius of COVID-19. If effectiveness and safety are confirmed, and only in this condition, the medicine may be used in a generalized and collective manner in the treatment and prevention of the current epidemic. To this end, we refer this project to physicians, researchers and managers of several public and private hospitals, requesting an opportunity to apply this proposal to patients hospitalized in wards and/or intensive care units for the treatment of COVID-19. //
Resumo - Além da reconhecida aplicação nas doenças crônicas, a homeopatia individualizada também pode atuar de forma resolutiva ou complementar nos casos agudos, incluindo as doenças epidêmicas. No entanto, para atingir esse intento, apresenta uma metodologia semiológica e terapêutica específica que deve ser seguida e respeitada, com o risco de não apresentar a eficácia e a segurança desejada. No caso das doenças epidêmicas, que pela virulência dos seus agentes provoca um quadro sintomatológico comum na maioria dos indivíduos suscetíveis, o medicamento homeopático individualizado (medicamento homeopático do gênio epidêmico) deve apresentar semelhança com o conjunto de sinais e sintomas característicos dos pacientes acometidos nos diferentes estágios de cada surto epidêmico. Estudos evidenciam a eficácia e a segurança desta prática terapêutica e/ou profilática em diversas epidemias do passado. Assim sendo, após o levantamento dos possíveis medicamentos homeopáticos individualizados do gênio epidêmico de cada epidemia, sua aplicação terapêutica e/ou profilática em larga escala deve ser sustentada por ensaios clínicos prévios que demonstrem sua eficácia e segurança, em consonância com os aspectos éticos e bioéticos da pesquisa envolvendo seres humanos. Cumprindo essas premissas da boa prática clínica, elaboramos, em março de 2020, esse protocolo de pesquisa para investigar, em ensaio clínico randomizado, duplo-cego e placebo-controlado, a eficácia e a segurança de possíveis medicamentos homeopáticos individualizados do gênio epidêmico da COVID-19. Caso a eficácia e a segurança se confirmem, e tão somente nessa condição, o medicamento poderá ser utilizado de forma generalizada e coletiva no tratamento e na prevenção da atual epidemia. Com esse intuito, encaminhamos este projeto a médicos, pesquisadores e gestores de diversos hospitais públicos e privados, solicitando uma oportunidade para aplicar essa proposta em pacientes internados em enfermarias e/ou centros de terapia intensiva destinadas ao tratamento da COVID-19.
... In another epidemic of keratoconjunctivitis in Cuba in 1995 [50], 108 patients were distributed in a randomized design into homeopathic (n=48) and conventional (n=50) treatment, the former using Pulsatilla nigricans 6cH as homeopathic medicine to the epidemic genius of the ongoing outbreak. Homeopathic treatment was significantly more effective than the conventional one in eliciting improving of symptoms in less than 72 hours. ...
By applying the principle of therapeutic similarity, homeopathy seeks to stimulate the organism to react against its own disturbs. For homeopathic medicines to awaken effective homeostasis responses they must be individualized, this means that they must be chosen according to their similarity to the set of characteristic symptoms in patients. In this way, by aiming at decreasing individual susceptibility predisposing to disease, homeopathic medicines have healing and preventive effects in many human illnesses. On the other hand, homeopathic medicines may have specific indications in the treatment and prevention of epidemic diseases provided they are also chosen according to the particular set of symptoms peculiar to a given epidemic, viz. the so-called “epidemic genius”, as historical examples show. This update paper discusses the epistemological foundations of Hahnemann’s homeopathy as a preventive medical approach, the scientific evidences supporting its clinical application and the minimum requirements to employ it both therapeutically and preventively in epidemics.
In addition to the recognized application in chronic diseases, individualized homeopathy can also act in a resolutive or complementary way in acute cases, including epidemic diseases. However, to achieve this intent, it presents a specific semiologic and therapeutic methodology that must be followed and respected, with the risk of not presenting the desired efficacy and safety. In the case of epidemic diseases, which due to the virulence of their agents causes a common symptomatological picture in most susceptible individuals, the individualized homeopathic medicine (homeopathic medicine of the epidemic genius) should present similarity with the set of characteristic symptoms and signs of the patients affected in the different stages of each epidemic outbreak. Studies show the efficacy and safety of this therapeutic and/or prophylactic practice in several epidemics of the past. Therefore, after the survey of possible individualized homeopathic medicine from the epidemic genius of each epidemic, its therapeutic and/or large-scale prophylactic application should be supported by previous clinical trials that demonstrate its effectiveness and safety, in line with the ethical and bioethical aspects of research involving human beings. Fulfilling these premises of good clinical practice, we developed, in March 2020, this research protocol to investigate, in a randomized, double-blind and placebo-controlled clinical trial, the effectiveness and safety of possible individualized homeopathic medicines of epidemic genius of COVID-19. If effectiveness and safety are confirmed, and only in this condition, the medicine may be used in a generalized and collective manner in the treatment and prevention of the current epidemic. To this end, we refer this project to physicians, researchers and managers of several public and private hospitals, requesting an opportunity to apply this proposal to patients hospitalized in wards and/or intensive care units for the treatment of covid-19.
Resumen
Además de su reconocida aplicación en enfermedades crónicas, la Homeopatía individua-lizada también puede actuar de forma resolutiva o complementaria en casos agudos, in-cluidas las enfermedades epidémicas. Sin embargo, para lograr este objetivo presenta una metodología semiológica y terapéutica específica que deben seguirse y respetarse, con el riesgo de no proporcionar la eficacia y seguridad deseadas. En el caso de enfermedades epidémicas, que por la virulencia de sus agentes provocan un cuadro sintomatológico co-mún en la mayoría de los individuos susceptibles, la medicina homeopática individualizada (medicina homeopática del genio epidémico) debe presentar similitud con el conjunto de signos y síntomas característicos de los pacientes afectados en las diferentes etapas de cada brote epidémico. Los estudios demuestran la eficacia y seguridad de esta práctica terapéutica y/o profiláctica en varias epidemias pasadas. Por tanto, tras estudiar posibles medicamentos homeopáticos individualizados a partir del genio epidémico de cada epi-demia, su aplicación terapéutica y/o profiláctica a gran escala debe de estar respaldada por ensayos clínicos previos que demuestren su eficacia y seguridad, en consonancia con los aspectos éticos y bioéticos de la investigación con seres humanos. Cumpliendo estas premisas de buena práctica clínica, en marzo de 2020 desarrollamos este protocolo de in-vestigación para comprobar, en un ensayo clínico aleatorizado, doble ciego y controlado con placebo, la eficacia y seguridad de posibles medicamentos homeopáticos individualizados de la epidemia de covid-19. Si se confirma la eficacia y seguridad, y sólo en esta condición, el medicamento podrá utilizarse de forma generalizada y colectiva en el tratamiento y la prevención de la actual epidemia. Con este objetivo, remitimos este proyecto a médicos, investigadores y directivos de varios hospitales públicos y privados, solicitando la oportuni-dad de aplicar esta propuesta a pacientes hospitalizados en salas y/o centros de cuidados intensivos destinados al tratamiento de la covid-19.
Background:
Viruses cause about 80% of all cases of acute conjunctivitis. Human adenoviruses are believed to account for 65% to 90% of cases of viral conjunctivitis, or 20% to 75% of all causes of infectious keratoconjunctivitis worldwide. Epidemic keratoconjunctivitis (EKC) is a highly contagious subset of adenoviral conjunctivitis that has been associated with large outbreaks at military installations and at medical facilities. It is accompanied by severe conjunctival inflammation, watery discharge, and light sensitivity, and can lead to chronic complications such as corneal and conjunctival scarring with discomfort and poor quality of vision. Due to a lack of consensus on the efficacy of any pharmacotherapy to alter the clinical course of EKC, no standard of care exists, therefore many clinicians offer only supportive care.
Objectives:
To assess the efficacy and safety of topical pharmacological therapies versus placebo, an active control, or no treatment for adults with EKC.
Search methods:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL, which contains the Cochrane Eyes and Vision Trials Register; 2021, Issue 4); Ovid MEDLINE; Ovid Embase; Latin American and Caribbean Health Sciences database (LILACS); ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), with no restrictions on language or year of publication. The date of the last search was 27 April 2021.
Selection criteria:
We included randomized controlled trials in which antiseptic agents, virustatic agents, or topical immune-modulating therapy was compared with placebo, an active control, or no treatment.
Data collection and analysis:
We used standard Cochrane methodology.
Main results:
We identified 10 studies conducted in Asia, Europe, the Middle East, and North Africa with a total of 892 participants who were treated for 7 days to 6 months and followed for 7 days up to 1.5 years. Study characteristics and risk of bias In most studies participants were predominantly men (range: 44% to 90%), with an age range from 9 to 82 years. Three studies reported information on trial registration, but we found no published study protocol. The majority of trials had small sample sizes, ranging from 18 to 90 participants enrolled per study; the only exception was a trial that enrolled 350 participants. We judged most studies to be at high or unclear risk of bias across risk of bias domains. Findings We included 10 studies of 892 EKC participants and estimated combined intervention effects in analyses stratified by steroid-containing control treatment or artificial tears. Six trials contributed to the comparisons of topical interventions (povidone-iodine [PVP-I], trifluridine, ganciclovir, dexamethasone plus neomycin) with artificial tears (or saline). Very low certainty evidence from two trials comparing trifluridine or ganciclovir with artificial tears showed inconsistent effects on shortening the mean duration of cardinal symptoms or signs of EKC. Low certainty evidence based on two studies (409 participants) indicated that participants treated with PVP-I alone more often experienced resolution of symptoms (risk ratio (RR) 1.15, 95% confidence interval (CI) 1.07 to 1.24) and signs (RR 3.19, 95% CI 2.29 to 4.45) during the first week of treatment compared with those treated with artificial tears. Very low certainty evidence from two studies (77 participants) suggested that PVP-I or ganciclovir prevented the development of subepithelial infiltrates (SEI) when compared with artificial tears within 30 days of treatment (RR 0.24, 95% CI 0.10 to 0.56). Four studies compared topical interventions (tacrolimus, cyclosporin A [CsA], trifluridine, PVP-I + dexamethasone) with topical steroids, and one trial compared fluorometholone (FML) plus polyvinyl alcohol iodine (PVA-I) with FML plus levofloxacin. Evidence from one trial showed that more eyes receiving PVP-I 1.0% plus dexamethasone 0.1% had symptoms resolved by day seven compared with those receiving dexamethasone alone (RR 9.00, 95% CI 1.23 to 66.05; 52 eyes). In two trials, fewer eyes treated with PVP-I or PVA-I plus steroid developed SEI within 15 days of treatment compared with steroid alone or steroid plus levofloxacin (RR 0.08, 95% CI 0.01 to 0.55; 69 eyes). One study found that CsA was no more effective than steroid for resolving SEI within four weeks of treatment (RR 0.84, 95% CI 0.67 to 1.06; N = 88). The evidence from trials comparing topical interventions with steroids was overall of very low level certainty. Adverse effects Antiviral or antimicrobial agents plus steroid did not differ from artificial tears in terms of ocular discomfort upon instillation (RR 9.23, 95% CI 0.61 to 140.67; N = 19). CsA and tacrolimus eye drops were associated with more cases of severe ocular discomfort, and sometimes intolerance, when compared with steroids (RR 4.64, 95% CI 1.15 to 18.71; 2 studies; N = 141). Compared with steroids, tacrolimus did not increase the risk of elevated intraocular pressure (RR 0.07, 95% CI 0 to 1.13; 1 study; N = 80), while trifluridine conferred no additional risk compared to tear substitute (RR 5.50, 95% CI 0.31 to 96.49; 1 study; N = 97). Overall, bacterial superinfection was rare (one in 23 CsA users) and not associated with use of the intervention steroid (RR 3.63, 95% CI 0.15 to 84.98; N = 51). The evidence for all estimates was of low or very low certainty.
Authors' conclusions:
The evidence for the seven specified outcomes was of low or very low certainty due to imprecision and high risk of bias. The evidence that antiviral agents shorten the duration of symptoms or signs when compared with artificial tears was inconclusive. Low certainty evidence suggests that PVP-I alone resolves signs and symptoms by seven days relative to artificial tears. PVP-I or PVA-I, alone or with steroid, is associated with lower risks of SEI development than artificial tears or steroid (very low certainty evidence). The currently available evidence is insufficient to determine whether any of the evaluated interventions confers an advantage over steroids or artificial tears with respect to virus eradication or its spread to initially uninvolved fellow eyes. Future updates of this review should provide evidence of high-level certainty from trials with larger sample sizes, enrollment of participants with similar durations of signs and symptoms, and validated methods to assess short- and long-term outcomes.
Empregando o princípio da similitude curativa, a homeopatia visa estimular o organismo a reagir contra os seus próprios distúrbios. No entanto, para que o medicamento homeopático desperte uma reação homeostática efetiva, ele precisa ser individualizado, ou seja, ser escolhido pela semelhança com o conjunto de sintomas característicos do binômio doente-doença. Dessa forma, buscando diminuir as suscetibilidades individuais que predispõe ao adoecer, o medicamento homeopático atua curativa e preventivamente em muitas doenças humanas. Por outro lado, possui indicação específica no tratamento e na prevenção das doenças epidêmicas, desde que escolhido individualmente segundo o conjunto de sintomas peculiares à epidemia (denominado "gênio epidêmico"), com exemplos históricos descritos na literatura. Nessa atualização, iremos discorrer sobre as premissas epistemológicas que fazem da homeopatia hahnemanniana uma prática médica preventiva, as evidências científicas que endossam sua aplicação clínica e os requisitos mínimos para utilizá-la terapêutica e preventivamente nas doenças epidêmicas. Abstract By applying the principle of therapeutic similitude, homeopathy seeks to stimulate the organism to react against its own disturbs. For homeopathic medicines to awaken effective homeostasis responses they must be individualized, this means that they must be chosen according to their similarity to the set of characteristic symptoms of the patients. In this way, by aiming at decreasing the individual susceptibility predisposing to disease, homeopathic medicines have healing and preventive effects in many human illnesses. On the other hand, homeopathic medicines may have specific indications in the treatment and prevention of epidemic diseases provided they are also chosen according to the particular set of peculiar symptoms to a given epidemic, viz the so-called "epidemic genius", as historical examples show. This update paper discusses the epistemological foundations of Hahnemann"s homeopathy as a preventive medical approach, the scientific evidences supporting its clinical application and the minimum requirements to employ it both therapeutically and preventively in epidemics.
Aplicando el principio de similitud terapéutica, la Homeopatía busca estimular al organismo para que reaccione en contra de su propia perturbación. Para que los medicamentos homeopáticos puedan despertar respuestas homeostáticas efica-ces deben ser individualizados, esto significa que deben ser elegidos en función de su similitud con el conjunto de síntomas característicos de los pacientes. De esta manera, teniendo el propósito de disminuir la susceptibilidad individual que predis-pone a la enfermedad, los medicamentos homeopáticos curan y generan efectos preventivos en muchas enfermedades humanas. Por otra parte, los medicamentos homeopáticos pueden tener indicaciones específicas en el tratamiento y prevención de enfermedades epidémicas, con la condición de que también se elijan de acuerdo con el conjunto particular de sínto-mas peculiares de una epidemia determinada, a saber, el llamado "genio epidémi-co", como lo muestran varios ejemplos históricos. En este trabajo se analiza la ac-tualización de las bases epistemológicas de la Homeopatía de Hahnemann desde el enfoque médico preventivo, las evidencias científicas que apoyan su aplicación clínica y los requisitos mínimos para emplearla tanto terapéutica como preventiva-mente en las epidemias.
To achieve scientific acceptance, homeopathy must investigate several questions: 1. The activity of very highly diluted preparations. The consensus of the meeting was that there is clear evidence of this. 2. The content of very highly diluted homeopathic preparations. More research is needed but evidence exists that a specific signal is present in homeopathic preparations. 3. A theoretical framework in which the effects of homeopathic diluted preparations can be explained. The 'Body Information Theory' is such a theory. 4. The clinical effectiveness of homeopathy. Because they avoid the placebo effect, animal studies are a priority. For human trials using Quality of Life questionnaires, studies on the activity, content and theoretical basis of homeopathic preparations were reviewed approximately 70% of cases; more in children showed improvement. Homeopathy reduced costs and allowed a better improvement in work-days lost compared with conventional practice. Randomised controlled trials (RCTs) implicitly test the placebo hypothesis; RCTs have been performed and meta-analyses conclude that there is clear evidence of efficacy which cannot be attributed to placebo effect. Priorities depend on the audience. More research is needed especially regarding the content of homeopathic preparations and the transmission of information. Theoretical issues are also important to avoid incorrect design of research protocols. More effort should be dedicated to veterinary research. Clinical effects analysis in humans remains important. Many other questions should be prioritised, such as the potential of homeopathy to avoid invasive procedures in children and the long-term effects of homeopathy in preventing chronic complications.
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