Homeopatía: una breve descripción de esta especialidad médica / Homeopathy: a brief description of this medical specialty

La homeopatía es una forma de medicina con 200 años de historia. A lo largo de este tiempo, ha demostrado su capacidad para resolver problemas, a bajo costo, con un amplio alcance y con una aceptación social incuestionable. Según las estimaciones, aproximadamente 500 millones de personas utilizan la homeopatía en todo el mundo, lo que corresponde a alrededor del 7% de la población mundial. Sin embargo, aún existen obstáculos para su integración en la medicina convencional, los cuales deben ser puestos en perspectiva y eliminados. El propósito del presente artículo es contextualizar la homeopatía como una ciencia y un arte tanto en Brasil como en el resto del mundo. Analizamos algunos aspectos relevantes, como el perfil de sus usuarios, las razones para elegir la homeopatía, así como los contextos históricos y sociales para su inclusión en los sistemas educativos y de atención médica. Concluimos que la homeopatía es un sistema medico ético que ofrece un tratamiento sistémico y seguro a los pacientes, con una optima relación costo-beneficio. La homeopatía debe incluirse en las universidades, escuelas de medicina, así como en todos los niveles del sistema de atención médica, asegurando así su naturaleza histórica como especialidad médica.

Homeopathy is a medical approach with 200 years of history. Along this time it demonstrated its ability to solve problems, with low cost, broad scope and unquestionable social acceptance. According to estimates, approximately 500 million people use homeopathy worldwide, corresponding to about 7% of the world population. However, there are still hindrances to its integration into conventional medicine which need to be put into perspective and removed. The aim of the present article is to contextualize homeopathy as a science and an art in Brazil and worldwide. We analyzed some relevant aspects, such as the profile of users, their reasons to choose homeopathy, and historical and social contexts for the inclusion of homeopathy into health care and educational systems. We conclude that homeopathy is an ethical medical system that provides systemic and safe treatment to patients with optimal costbenefit ratio. Homeopathy should be included in universities, schools of medicine and at all levels of the healthcare system, thus ensuring its historical nature as a medical specialty.

La solidez de la investigación homeopática fundamental / The strength of fundamental homeopathic research

La investigación fundamental en homeopatía ha avanzado considerablemente en los últimos 20 años: desde estudios exploratorios con animales y plantas hasta la caracterización de los efectos sistémicos de los medicamentos homeopáticos y estudios in vitro con sistemas celulares aislados para evaluar los cambios en los mecanismos de adaptación celular y señalización intracelular frente a tratamientos homeopáticos variables. El número de artículos publicados a lo largo del tiempo ha permitido realizar varias revisiones sistemáticas. Recientemente, la demostración de que los medicamentos homeopáticos podrían modificar las funciones celulares a través de mecanismos epigenéticos (metilación y desmetilación de ADN) preparó el camino para un campo de investigación completamente nuevo. En paralelo, el descubrimiento de las nanopartículas y propiedades físicas específicas de las diluciones homeopáticas ha arrojado luz hacia un campo antes poco conocido, dado que se consideraba que las diluciones homeopáticas no consistían más que de agua. Así las cosas, los retos para el futuro conciernen a la demostración, o no, de la interrelación entre ambos fenómenos.

Fundamental research in homeopathy has much advanced in the past 20 years. From exploratory studies with animals and plants to the characterization of the systemic effects of homeopathic medicines and in vitro studies with isolated cell systems to assess changes in the mechanisms of cell adaptation and intracellular signaling facing variable homeopathic treatments. The amount of articles published over time enabled several systematic reviews. Recently, demonstration that homeopathic medicines might modify cell functions through epigenetic mechanisms (DNA methylation and demethylation) paved the road for a fully new field of research. In parallel, the discovery of nanoparticles and specific physical properties of homeopathic dilutions brought light to a previously poorly known field, as it was believed that homeopathic dilutions consist in nothing but water. Thus being, challenges for the future concern the demonstration, or not, of the interrelationship between both phenomena.

Efectos de las diluciones homeopáticas altas sobre los modelos in vitro: revisión de la literatura / Effects of high homeopathic dilutions on in vitro models: a review of the literature

Los efectos de las diluciones homeopáticas altas (HD, por sus siglas en inglés) son controvertidos debido a que superan el número de Avogadro. Objetivo: Realizar una revisión de la literatura sobre los efectos de las HD sobre los modelos in vitro. Métodos: Se realizó una búsqueda sistemática en la base de datos PubMed de estudios que evaluaran las HD simples sobre modelos in vitro, publicados de 2007 en adelante. Resultados: 28 publicaciones cumplieron con los criterios de inclusión/exclusión. 26 estudios mostraron efectos evidentes de las HD simples sobre modelos in vitro. La mayor parte de tales estudios fueron realizados en países en donde la homeopatía ha alcanzado un alto nivel de institucionalización. Conclusiones: Los modelos in vitro evidencian de forma clara la actividad biológica de las HD superiores al número de Avogadro y dan cuenta de los efectos encontrados en la práctica clínica. La mayor parte de los estudios fueron realizados en países en donde la homeopatía es reconocida oficialmente, lo cual facilita el acceso a recursos para el desarrollo de la investigación.

the effects of homeopathic high dilutions (HDs) are controversial because they exceed Avogadro's number. Aim: to perform a literature review on the effects of HDs on in vitro models. Methods: a systematic search was performed in database PubMed for studies assessing simple HDs on in vitro models published from 2007 onward. Results: 28 publications met the inclusion/exclusion criteria; 26 studies demonstrated patent effects of simple HDs on in vitro models; most such studies were conducted in countries where homeopathy attained a high level of institutionalization. Conclusions: in vitro models patently evidence biological activity of HDs above Avogadro's number and account for effects found in clinical practice. Most studies were conducted in countries where homeopathy is officially recognized, which facilitates access to resources for the development of research.

¿Los medicamentos homeopáticos provocan agravación o efectos adversos dependientes de los fármacos? / Do homeopathic medicines cause aggravation or drug-dependent adverse effects?

La valoración crítica de la seguridad de los medicamentos homeopáticos se ha desarrollado recientemente. Esta cuestión es relevante para la toma de decisiones de los médicos, pacientes y dependencias regulatorias de fármacos. A pesar de la aparente inverosimilitud de la acción de los medicamentos homeopáticos debido a los procesos farmacotécnicos de la dilución y agitación empleados para su preparación, existen reportes en la literatura médica convencional sobre la toxicidad de los medicamentos homeopáticos, incluyendo eventos que aparentemente ponen en riesgo la vida. Las revisiones sistemáticas de estudios clínicos controlados aleatorizados muestran que los medicamentos homeopáticos provocan más efectos adversos que el placebo, aunque leves y transitorios. El establecimiento de un sistema de monitoreo en línea para la recolección de datos sobre los efectos adversos de los medicamentos homeopáticos, herbolarios o convencionales, es relevante para una evaluación no sesgada de la información reunida a partir de los consumidores y proveedores de atención médica.

Critical appraisal of the safety of homeopathic medicines developed recently. This matter is relevant for decision making by doctors, patients and drug regulatory agencies. Despite the apparent implausibility of the action of homeopathic medicines due to the pharmacotechnical processes of dilution and agitation used for their preparation, there are reports in the conventional medical literature on the toxicity of homeopathic medicines, including apparently life-threatening events. Systematic reviews of randomized controlled trials show that homeopathic medicines cause more adverse effects than placebo, albeit mild and transient. Establishing an online monitoring terapéusystem for collection of data on the adverse effects of homeopathic, herbal or conventional medicines is relevant for non-biased assessment of the information gathered from consumers and health care providers.

Bases científicas del principio de curación homeopática en la farmacología moderna / Scientific bases of the homeopathic healing principle in modern pharmacology

La homeopatía emplea el denominado 'principio de similares' como método terapéutico ­ el cual consiste en administrar medicamentos que provocan ciertos síntomas en individuos sanos para tratar síntomas similares en individuos enfermos (similia similibus curantur) - para inducir una reacción curativa secundaria del cuerpo en contra de sus propios trastornos. Esta reacción secundaria (vital, homeostática o paradójica) del cuerpo se basa en el 'efecto de rebote' de los fármacos modernos, un tipo de evento adverso que se produce después de interrumpir varias clases de fármacos prescritos según el 'principio de los contrarios' (contraria contrariis curantur). Objetivo: La presente revisión ha buscado justificar científicamente el principio de curación homeopática frente a la farmacología clínica y experimental a través de un estudio sistemático del efecto de rebote de los fármacos modernos o reacción paradójica del cuerpo. Métodos: Empleando como referencia estudios y revisiones sobre el tema publicados a partir de 1998, actualizamos los datos añadiendo estudios recientes incluidos en la base de datos PubMed. Resultados: El efecto de rebote se produce después de interrumpir varias clases de fármacos con acción contraria a los síntomas de las enfermedades, exacerbándolos a niveles superiores a aquellos previos al tratamiento. Independientemente de la enfermedad, fármaco, dosis y duración del tratamiento, el fenómeno del rebote se manifiesta en una pequeña proporción de los individuos susceptibles. Siguiendo las premisas homeopáticas, los fármacos modernos también podrían usarse según el principio de la similitud terapéutica, empleando entonces el efecto de rebote (reacción paradójica) con propósito curativo. Conclusiones: Evidenciado por cientos de estudios que constatan la similitud de conceptos y manifestaciones, el efecto de rebote de los fármacos modernos justifica científicamente el principio de la cura homeopática. Aunque el fenómeno de rebote es un evento adverso estudiado por la farmacología moderna, no es conocido por los profesionales de la atención médica, lo cual priva a los médicos de un conocimiento indispensable para el manejo seguro de los fármacos.

Homeopathy employs the so-called 'principle of similars' as therapeutic method - which consists in administering medicines that cause certain symptoms in healthy individuals to treat similar symptoms in sick individuals (similia similibus curantur) - to induce a secondary and healing reaction by the body against its own disorders. This secondary (vital, homeostatic or paradoxical) reaction of the body is based on the 'rebound effect' of modern drugs, a type of adverse event that occurs following discontinuation of several classes of drugs prescribed according to the 'principle of contraries' (contraria contrariis curantur). Aim: The present review sought to scientifically substantiate the homeopathic healing principle vis-à-vis experimental and clinical pharmacology through a systematic study of the rebound effect of modern drugs or paradoxical reaction of the body. Methods: Employing as reference studies and revisions on the subject published since 1998, we updated the data adding recent studies included in database PubMed. Results: The rebound effect occurs after discontinuation of several classes of drugs with action contrary to the symptoms of diseases, exacerbating them to levels above the ones before treatment. Regardless of disease, drug, dose and duration of treatment, the rebound phenomenon manifests in a small proportion of susceptible individuals. Following the homeopathic premises, modern drugs might also be used according to the principle of therapeutic similitude, thus employing the rebound effect (paradoxical reaction) with curative intent. Conclusions: Evidenced by hundreds of studies that attest to the similarity of concepts and manifestations, the rebound effect of modern drugs scientifically substantiates the principle of homeopathic cure. Although the rebound phenomenon is an adverse event studied by modern pharmacology, it is not known by health care professionals, thus depriving doctors of knowledge indispensable for safe management of drugs.

¿Los medicamentos homeopáticos inducen síntomas en voluntarios aparentemente sanos? Contribución brasileña al debate sobre los estudios patogénicos homeopáticos / Do homeopathic medicines induce symptoms in apparently healthy volunteers? Brazilian contribution to the debate on homeopathic pathogenic studies

La valoración crítica de la seguridad de los medicamentos homeopáticos se ha desarrollado recientemente. Esta cuestión es relevante para la toma de decisiones de los médicos, pacientes y dependencias regulatorias de fármacos. A pesar de la aparente inverosimilitud de la acción de los medicamentos homeopáticos debido a los procesos farmacotécnicos de la dilución y agitación empleados para su preparación, existen reportes en la literatura médica convencional sobre la toxicidad de los medicamentos homeopáticos, incluyendo eventos que aparentemente ponen en riesgo la vida. Las revisiones sistemáticas de estudios clínicos controlados aleatorizados muestran que los medicamentos homeopáticos provocan más efectos adversos que el placebo, aunque leves y transitorios. El establecimiento de un sistema de monitoreo en línea para la recolección de datos sobre los efectos adversos de los medicamentos homeopáticos, herbolarios o convencionales, es relevante para una evaluación no sesgada de la información reunida a partir de los consumidores y proveedores de atención médica.

Critical appraisal of the safety of homeopathic medicines developed recently. This matter is relevant for decision making by doctors, patients and drug regulatory agencies. Despite the apparent implausibility of the action of homeopathic medicines due to the pharmacotechnical processes of dilution and agitation used for their preparation, there are reports in the conventional medical literature on the toxicity of homeopathic medicines, including apparently life-threatening events. Systematic reviews of randomized controlled trials show that homeopathic medicines cause more adverse effects than placebo, albeit mild and transient. Establishing an online monitoring terapéusystem for collection of data on the adverse effects of homeopathic, herbal or conventional medicines is relevant for non-biased assessment of the information gathered from consumers and health care providers.

Efectos de las diluciones homeopáticas altas sobre las plantas: revisión de la literatura / Effects of high homeopathic dilutions on plants: a review of the literature

Entre los supuestos no convencionales de la homeopatía, el uso de medicamentos en diluciones altas (HD, por sus siglas en inglés) es una causa de objeciones y escepticismo entre la comunidad científica, formada dentro del paradigma de la dependencia de la dosis de la farmacología clásica. La investigación que busca evidenciar los efectos de las HD homeopáticas recurre a varios modelos experimentales (in vitro, plantas y animales). Objetivo: Describir los resultados de estudios con alta calidad metodológica que han demostrado los efectos positivos de las HD homeopáticas sobre las plantas. Métodos: Tomando como fuente de referencia las revisiones publicadas hasta 2015, actualizamos la información añadiendo datos de estudios recientes incluidos en la base de datos PubMed. Resultados: De los 167 estudios experimentales analizados, 48 cumplieron los criterios mínimos de calidad metodológica, de los cuales 29 detectaron efectos específicos de las diluciones homeopáticas altas sobre las plantas mediante la comparación con controles adecuados. Conclusiones: A pesar de que la mayor parte de los experimentos presentaba una calidad metodológica por debajo del estándar, los estudios que emplearon sistemáticamente reproducibilidad y controles negativos demostraron indiscutibles efectos significativos de las HD homeopáticas sobre las plantas.

Among the non-conventional assumptions of homeopathy, the use of medicines in high dilutions (HD) is a cause for objections and skepticism among the scientific community, trained within the dose-dependency paradigm of classic pharmacology. Research aiming at evidencing the effects of homeopathic HD has resource to several experimental models (in vitro, plants and animals). Aim: To describe the results of studies with high methodological quality that demonstrated positive effects of homeopathic HD on plants. Methods: Taking reviews published until 2015 as reference source, we updated the information through addition of data from recent studies included in database PubMed. Results: From 167 experimental studies analyzed, 48 met the minimum criteria of methodological quality, from which 29 detected specific effects of homeopathic high dilutions on plants through comparison to adequate controls. Conclusions: Despite the substandard methodological quality of most experiments, studies with systematic use of negative controls and reproducibility demonstrated significant indisputable effects of homeopathic HD on plants.

Estudio aleatorizado, doble ciego, sobre la eficacia del tratamiento homeopático en niños con amigdalitis recurrente / Randomized, double-blind study on the efficacy of homeopathic treatment in children with recurrent tonsillitis

La eficacia y seguridad del tratamiento homeopático fueron investigadas en niños con amigdalitis recurrente para la que se indicaba cirugía. Métodos: Estudio clínico prospectivo, aleatorizado, doble ciego, que incluyó 40 niños de entre 3 y 7 años de edad; 20 niños fueron tratados con medicación homeopática y otros 20 niños, con placebo. El seguimiento fue de 4 meses por niño. La evaluación de los resultados fue clínica mediante un cuestionario estándar y examen clínico el primer y último día de tratamiento. La amigdalitis recurrente se definió como ocurrencia de 5 a 7 episodios de amigdalitis bacteriana aguda al año. Resultados: Del grupo de 18 niños que completó el tratamiento homeopático, 14 no presentó episodio alguno de amigdalitis bacteriana aguda; del grupo de 15 niños que recibió placebo, 5 pacientes no presentaron amigdalitis. Esta diferencia fue estadísticamente significativa (p = 0,015). Ninguno de los pacientes presentó efectos secundarios. Conclusiones: El tratamiento homeopático fue efectivo en niños con amigdalitis recurrente, en comparación con el placebo; a 14 niños (78%) ya no se les indicó cirugía. El tratamiento homeopático no se asoció con eventos adversos.

The efficacy and safety of homeopathic treatment was investigated on children with recurrent tonsillitis justifying surgery. Methods: Prospective, randomized,double-blind clinical trial that included 40 children between ages of 3 to 7 years old;20 children were treated with homeopathic medication and 20 children with placebo. Follow up was 4 months per child. Assessment of results was clinical by means of a standard questionnaire and clinical examination on the first and last day of treatment.Recurrent tonsillitis was defined as 5 to 7 episodes of bacterial acute tonsillitis per year. Results: From the group of 18 children who completed homeopathic treatment, 14 did not present any episode of acute bacterial tonsillitis; from the group of 15 children whoreceived placebo 5 patients did not present tonsillitis; this difference was statistically significant (p= 0,015). None of the patient exhibited side effects. Conclusions: Homeopathic treatment was effective in children with recurrent tonsillitis compared to placebo, 14 children (78%) were no longer indicated surgery. Homeopathic treatment was not associated with adverse events.

Investigación clínica en homeopatía: revisiones sistemáticas y estudios clínicos aleatorizados / Clinical research in homeopathy: systematic reviews and randomized clinical trials

Se considera que las revisiones sistemáticas y estudios clínicos aleatorizados (RCT) presentan el nivel de evidencia más alto. Objetivo: Realizar una revisión descriptiva de las revisiones sistemáticas y estudios clínicos controlados aleatorizados (RCT, por sus siglas en inglés) sobre la efectividad y eficacia de la homeopatía. Métodos: Los datos del reporte publicado por la Liga Medicorum Homeopathica Internationalis (LMHI) en 2014 fueron actualizados mediante una búsqueda en la base de datos PubMed. Resultados: Se localizaron 7 revisiones sistemáticas con meta-análisis, 6 de las cuales concluyeron que los efectos de la homeopatía no son compatibles con el efecto placebo; sólo una revisión sistemática llegó a la conclusión opuesta, aunque fue severamente criticado debido a sus errores metodológicos. Un total de 19 RCT fueron publicados a lo largo del periodo analizado. El 84.2% tuvo por lo menos un resultado positivo. Conclusiones: Con base en las evidencias disponibles del más alto nivel, no es posible afirmar que los efectos de la homeopatía son exclusivamente un efecto placebo. Por el contrario, se han detectado efectos específicos en varios estudios.

Systematic reviews and randomized clinical trials (RCT) are considered to have the highest level of evidence. Aim: To perform a descriptive review of systematic reviews and RCT on the effectiveness and efficacy of homeopathy. Methods: Data from the report published by Liga Medicorum Homeopathica Internationalis (LMHI) in 2014 were updated by means on a search conducted in database PubMed. Results: 7 systematic reviews with meta-analysis were located, 6 of them concluded that the effects of homeopathy are not compatible with placebo effect; only 1 systematic review arrived to the opposite conclusion, but was severely criticized due to methodological flaws. A total of 19 RCT were published along the analyzed period; 84.2% had at least one positive outcome. Conclusions: Based on the available evidences of the highest level it is not possible to assert that the effects of homeopathic are exclusively placebo effect. On the opposite, specific effects were detected in several studies.

Formación médica en la terapéutica no convencional en el mundo (homeopatía y acupuntura) / Medical training in non-conventional therapeutics in the world (homeopathy and acupuncture)

Utilizadas de forma complementaria, alternada o integrada con la medicina convencional, la demanda de la población por las terapias no convencionales se ha incrementado considerablemente en las últimas décadas, requiriendo de los médicos un conocimiento de las nociones básicas de tales enfoques terapéuticos para orientar a sus pacientes en relación con tratamientos distintos a aquellos que suelen prescribir. Entre las mismas, la homeopatía y la acupuntura se han considerado especialidades médicas en Brasil durante varias décadas. Objetivo: Describir el estado actual de la formación médica en terapias no convencionales (homeopatía y acupuntura) alrededor del mundo. Métodos: Actualizamos los datos relacionados con los estudios y revisiones publicados hasta 2013 a través de una revisión de los estudios más recientes incluidos en la base de datos PubMed. Resultados: En todos los países, la enseñanza de terapias no convencionales se considera un tema relevante para la formación de médicos como una función del creciente interés de la población en su uso, con un amplia variedad de enfoques dirigidos a los estudiantes de licenciatura y posgrado, médicos residentes y profesionales con otras especialidades médicas. Conclusiones: Las escuelas brasileñas de medicina deben proporcionar a los estudiantes de licenciatura y posgrado, así como a los médicos residentes, un conocimiento preciso de los supuestos teóricos y enfoques clínico-terapéuticos propios de la homeopatía y la acupuntura, entre otras terapias no convencionales.

Used as complementary to, alternating or integrated with mainstream medicine, the population's demand for non-conventional therapies has substantially increased in the past decades, requiring from doctors knowledge on the basic notions of such therapeutics to orient their patients regarding treatments different to the ones they usually prescribe. Among them, homeopathy and acupuncture are considered medical specialties in Brazil for various decades. Aim: To describe the current state of medical education in non-conventional therapies (homeopathy and acupuncture) around the world. Methods: We updated data resulting from studies and reviews published until 2013 through a review of more recent studies included in database PubMed. Results: In all countries the teaching of non-conventional therapies is considered a relevant topic for the training of doctors as a function of the increasing interest of the population in their use, with a broad range of approaches targeting undergraduate and graduate students, medical residents and doctors from other medical specialties. Conclusions: The Brazilian medical schools must provide undergraduate and graduate students and medical residents accurate knowledge on the theoretical assumptions and clinical-therapeutic approaches proper to homeopathy and acupuncture, among other non-conventional therapies.

Estrógeno potenciado en el tratamiento homeopático del dolor pélvico asociado a endometriosis: un estudio aleatorizado, doble ciego, controlado con placebo, de 24 semanas / Potentiated estrogen in the homeopathic treatment of pelvic pain associated with endometriosis: a 24-week randomized, double-blind, placebo-controlled study

Evaluar la eficacia y seguridad del estrógeno potenciado en comparación con el placebo en el tratamiento homeopático del dolor pélvico asociado a endometriosis (EAPP, por sus siglas en inglés). Diseño del estudio: El presente fue un estudio clínico aleatorizado, doble ciego, controlado con placebo, de 24 semanas, el cual incluyó a 50 mujeres de entre 18 y 45 años de edad con diagnóstico de endometriosis infiltrante profunda con base en ultrasonido transvaginal o imágenes de resonancia magnética después de preparación intestinal, así como puntaje ≥ 5 en una escala visual analógica (VAS: rango de 0 a 10 puntos) para el dolor pélvico asociado con la endometriosis. Se administró estrógeno potenciado (12cH, 18cH y 24cH) o placebo dos veces al día por vía oral. La medida principal de resultado fue el cambio en la severidad de los puntajes parcial y global de EAPP (VAS) de la línea basal a la semana 24, determinada como la diferencia en el puntaje medio de cinco modalidades de dolor pélvico crónico (dismenorrea, dispareunia profunda, dolor pélvico no cíclico, dolor intestinal cíclico y/o dolor urinario cíclico). Las medidas secundarias de resultado fueron la diferencia media de puntaje para la calidad de vida evaluada con el Cuestionario de Salud SF-36, los síntomas de depresión en el Inventario de la Depresión de Beck (BDI) y los síntomas de ansiedad en el Inventario de Ansiedad de Beck (BAI). Resultados: El puntaje global de EAPP (VAS: rango de 0 a 50 puntos) se redujo en 12.82 (p < 0.001) en el grupo tratado con estrógeno potenciado de la línea basal a la semana 24. El grupo que utilizó estrógeno potenciado también presentó una reducción en el puntaje parcial (VAS: rango de 0 a 10 puntos) en tres modalidades de EAPP: dismenorrea (3.28; p < 0.001), dolor pélvico no cíclico (2.71; p = 0.009) y dolor intestinal cíclico (3.40; p < 0.001). El grupo de placebo no mostró cambio significativo alguno en los puntajes global o parcial de EAPP. Además, el grupo de estrógeno potenciado mostró un mejoramiento significativo en tres de ocho ámbitos de SF-36 (dolor de cuerpo, vitalidad y salud mental) y síntomas de depresión (BDI). El grupo de placebo no mostró un mejoramiento significativo a este respecto. Estos resultados demuestran la superioridad del estrógeno potenciado sobre el placebo. Se asociaron pocos eventos adversos con el estrógeno potenciado. Conclusiones: El estrógeno potenciado (12cH, 18cH y 24cH) en dosis de 3 gotas dos veces al día durante 24 semanas fue significativamente más efectivo que el placebo para reducir el dolor pélvico asociado con la endometriosis. Registro del estudio clínico: ClinicalTrials.gov Identificador: https://clinicaltrials.gov/show/NCT02427386.

To evaluate the efficacy and safety of potentized estrogen compared to placebo in homeopathic treatment of endometriosis-associated pelvic pain (EAPP). Study design: The present was a 24-week, randomized, doubleblind, placebocontrolled trial that included 50 women aged 18-45 years old with diagnosis of deeply infiltrating endometriosis based on magnetic resonance imaging or transvaginal ultrasound after bowel preparation, and score ≥ 5 on a visual analogue scale (VAS: range 0 to 10 points) for endometriosis-associated pelvic pain. Potentized estrogen (12cH, 18cH and 24cH) or placebo was administered twice daily per oral route. The primary outcome measure was change in the severity of EAPP global and partial scores (VAS) from baseline to week 24, determined as the difference in the mean score of five modalities of chronic pelvic pain (dysmenorrhea, deep dyspareunia, non-cyclic pelvic pain, cyclic bowel pain and/or cyclic urinary pain). The secondary outcome measures were mean score difference for quality of life assessed with SF-36 Health Survey Questionnaire, depression symptoms on Beck Depression Inventory (BDI), and anxiety symptoms on Beck Anxiety Inventory (BAI). Results: The EAPP global score (VAS: range 0 to 50 points) decreased by 12.82 (p < 0.001) in the group treated with potentized estrogen from baseline to week 24. Group that used potentized estrogen also exhibited partial score (VAS: range 0 to 10 points) reduction in three EAPP modalities: dysmenorrhea (3.28; p < 0.001), non-cyclic pelvic pain (2.71; p = 0.009), and cyclic bowel pain (3.40; p < 0.001). Placebo group did not show any significant changes in EAPP global or partial scores. In addition, the potentized estrogen group showed significant improvement in three of eight SF-36 domains (bodily pain, vitality and mental health) and depression symptoms (BDI). Placebo group showed no significant improvement in this regard. These results demonstrate superiority of potentized estrogen over placebo. Few adverse events were associated with potentized estrogen. Conclusions: Potentized estrogen (12cH, 18cH and 24cH) at a dose of 3 drops twice daily for 24 weeks was significantly more effective than placebo for reducing endometriosis-associated pelvic pain.

Observations on 73 Vaccine breakthrough COVID-19 infected patients and its individualized homeopathic treatment

Since the initiation of vaccine rollout, breakthrough COVID-19 infections have been reported. While conventional therapy is the accepted mode of treatment, there has been little recognition of the role played by the alternative therapies like homeopathy. The purposes of this study were to identify the clinico-symptomatic profile of the vaccine breakthrough covid-19 infections and to assess the response of individualized homoeopathic treatment in these breakthrough cases. A retrospective data analysis of patients treated with homoeopathic medicines who confirmed the breakthrough infection criteria: positive infection ≥14 days after completion of both the recommended doses of an authorized COVID-19 vaccine was conducted. IBM SPSS Statistics 21.0 was used for data analysis with a p-value below 0.05 defined as significant. WHO Clinical Progression Scale and Outcome in Relation to Impact on Daily Living score were used as outcome measures. In total 73 cases were reported to be vaccine breakthrough infections. The median recovery time reported in the data set was 9 ± 2 days. While 5 patients dropped out, 68 (93.15%) patients responded positively to homeopathic treatment, and 55 (75.34%) recovered completely with normalized serological markers/ nasal swabs/ HRCT Chest. About 29 (39.72%) of these presented with mild clinical manifestations, 26 (35.61%) moderate, 17 (23.28%) severe and 1 (1.36%) was critical. 10 homeopathic remedies were prescribed to these 73 patients. Majority of the patients attained an ORIDL score of 4. Maximum patients reported a WHO clinical Progression score of 3. Statistical analysis showed a significant response to homeopathic treatment in the study group. Vaccine breakthrough cases occur in a fraction of vaccinated people. Despite the limited number of study subjects, homoeopathy showed some promising results in the present setup. The response rate was highest in the moderate and severe cases which suggest the importance of consideration of alternative medicine in the current pandemic. Further exploratory research studies and comparative clinical trials may be encouraged.

A case report of Budd-Chiari syndrome with cardiac complications and low SPO2 successfully managed by an integrated-approach

Budd-Chiari syndrome [BCS] is a rare, potentially life-threatening condition characterized by the triad of abdominal pain, ascites, and hepatomegaly (with or without jaundice). There will be an underlying disorder in most cases. The diagnosis, as well as management of the case, requires a multidisciplinary approach. The treatment should aim at reducing the presenting symptoms as well as removing the underlying pathology. Here we explain a case report of a 21-year-old male patient in the subacute stage of BCS with its complications and considered as a candidate for liver transplantation. His liver enzymes, PT/INR, D- dimer, and homocysteine values were above normal levels. The arterial oxygen saturation level was subnormal, and he was on supportive oxygen supplement. Inferior venacava [IVC] Doppler revealed a non-obstructive intrahepatic thrombus. The patient was treated with Homoeopathic medicine Arsenicum album and Arnica montana, given as an adjuvant to conventional treatment.

La gioconda effect, homeopathy and self-organizing factors of biofield methodology

The phenomenon of people's attraction to Homeopathy throughout its history is a known fact by all homeopaths. This attraction is noted in polarization of people's opinions, some for and some against. People in favor of Homeopathy use dynamizeddrugs and contribute to the area, for example, the development of the methodology Self-Organizing Factors of Biofield (BioFAO). In contrast, people against Homeopathy try to stop its use and feed endless discussions. Despite be aware of these events, there was no prior description about the whole process identified as an effect to make easy the development of an appropriate response. This understanding was published in a brief explanation of the phenomenon exemplified by development of BioFAO. Due to similar behavior of people that happened with another great work, which is a famous painting, the phenomenon was called La Gioconda Effect. Aims: The purpose of this paper is to describe the La Gioconda Effect. Methodology:After comparing both Homeopathy's and Mona Lisa'shistories found at bibliographic review, the La Gioconda Effect was revealed, described qualitatively, and published. Results and discussion:The relationship between people with Homeopathy showed several similarities with people and Mona Lisa. Both workssurvived on a secular scale, influenced generations, have a period of social acceptance, many people show extreme interest in the use, education, research and dissemination of them. A remarkable example of the development of Homeopathy is the creation of BioFAO, which is a protocol with a complex of dynamizeddugs. The description of La Gioconda Effect helps to understand the history and development of Homeopathy, as well as people's behavior. Conclusion:La Gioconda Effect demonstrates people's attractionto Homeopathy.

The use of homeopathy and flower therapy as an aid in the treatment of climacteric symptoms: an integrative review

Climacteric is characterized as the set of symptoms that usually start in the period of transition from the reproductive phase to female senility, and directly impacts woman's quality of life. Currently, the treatments approved by the FDA for this pathology mainly involve the use of antidepressants and hormone replacement, both having side effects. Clinical studies carried out in 2002, showed an increased risk of breast cancer, and other pathologies related to the prolonged use of these drugs. The impact ofthe studies resulted in a greater interest in complementary and alternative medicines (CAMs), such as the use of homeopathy and flower remedies for the treatment of climacteric symptoms. This abstract aims to present an integrative review on the use of homeopathy and flower remedies in the treatment of climacteric symptoms, in order to identify it main scientific evidence. For this, metodology consisted of research in the databases Web of Science, Google Scholar, HomeoIndex, LILACS and SciELO. The inclusion criteria were original human studies, totally available, and published in the last 10 years in Portuguese, English and Spanish, presenting the use of floral remedies or homeopathic treatment. The main homeopathic medicines used were Lachesis mutus, Belladona, Sepia officinalis, Sanguinaria canadensis and Sulfur. The main flower remedies were Cherry plum, Agrimony, Gentian, Walnut, Olive and Larch. The findings in this review demonstrate a positive outcome trend in favor of the effectiveness of these practices through the studies evaluated, encouraging the expansion of new designs and research that fully contemplate the principles of these practices. Thus, this work contributes to the advancement in the understanding of each one of these rationalities, making this work a source of consultation for health professionals and for future research, resulting in a strengthening of CAMs in the field of health.

Teaching and practice in Homeopathy via pharmacobotany and pathophysiology

Semiology, Clinical Pathophysiology, Phytotherapy and Homeopathy were taught through active methodology by the Moodle platform (HL) also using apps for monitoring injuries through SAPB site, building rationality for the external topic use of homeopathic and herbal medicines.At the 7th Infirmary of General Hospital Santa Casa de Misericordia in Rio de Janeiro, the clinical medical team of the Benoit Mure Nucleus of Assistance Teaching and Research,made a medicinal plant gardenwith the agricultural/environmental educator, and communityethnicalleaders. Undergraduate students from UNIFASE/FMP Academic League of Physiology and Pathophysiology plantedCalendula Officinalis seedlings, destined to research in pharmacobotany and to be in touch with pharmacotechnical prepares. Aims: To follow-up the study since from seedling of Calendula Officinalistill to prepare of HUD. Methodology: To prepare medicinal garden: plant seedlings of Calendula offin accordance with good agricultural techniques. At first: Three seeds in ten pots, made in triplicate (N = 90), to obtain explants of quality analyzed whose evaluation was about plant development (explants percentual: weight, size, viability, morphology). To visit pharmacy-school to learn how to preparematrix extracts and High Ultra-Diluted Solutions (HUD) of Calendula off 6DH. Results and Discussion: The stages of teaching semiology and practice in pharmacobotany, besides cultive plant have been completed.Viability was impaired because of lack of irrigation during 4 months (50%). Weight, sizewere minor than usual but with no statistical significance (p>0.05). Morphology was maintained. Unfortunately, the visit to pharmacy-school couldn't be performed at this period. Conclusion: Through hybrid learning and face-to-face activities completely realized, students had qualitative perception of the relevance about morphology and quality of plant development, chemistry plant production, aiming for resolutive actions based upon pathophysiology of chronic diseases. Because of pandemic, it was described just a preliminary experience. After returning to normal activities the experiment will be repeated.

Series of experiments performed with the droplet evaporation method on low potencies

Homeopathic preparations in low potencies, containing still measurable quantities of the starting substance, constitute a unique research field in homeopathic basic research. Here a series of experiments is presented carried out by means of the droplet evaporation method (DEM), investigating the specificity of the method, and presumed effects of the succussion procedure applied in the production of homeopathic preparations. Methods:DEM analysis consisted in the evaporation of droplets of the potencies perse placed on microscope slides. Resulting patterns were photographed. Images were evaluated by means of ImageJ software, by measuring grey level distribution, texture, and fractality. The experimentation consisted of four series: (i) screening (1x­6x potencies from 19 substances), (ii) differentiation experiments (2x­6x potencies of Echinacea, Baptisia, Luffa, and Spongia), (iii) differentiation between succussed (100 or 10 times) and unsuccussed samples (Echinacea 2x, Baptisia 3x, Baptisia 4x, Luffa 4x, and Spongia 6x). (iv) investigation of the influence upon the patterns of single compounds present in a remedy complex. The experimental set-up stability was examined by systematic positive control experiments. Results:(i) Homeopathic preparations of mineral origin showed the greatest form variety, whereas those of vegetal origin created fractal patterns in the potency range 2x­4x. (ii) Differentiation of potencies of different origin at the same dilution level was possible from 2x to 4x. (iii) In all potency levels, succussed (100 and 10 times) and unsuccussed variants could be significantly differentiated. Significant differences between all variants were found in some cases in potency levels 4x and higher. In general, application of succussion reduced size, homogeneity, and complexity of the DEM patterns. (iv) Patterns of a remedy complex Luffa 4x -Mercurius bijodatum 9x showed a clear predominance of the Luffa 4x; however also the second component, present in a much lower concentration, influenced significantly the pattern of the remedy complex as also differed significantly from the pattern of succussed water control. Conclusions:The results suggest that DEM is a suitable tool for scientific investigation of homeopathic preparations in the low potency range. DEM might be applied to assess further research questions, such different potentization procedures (vessel shape, overhead volume, material), storing time, and difference between batches.

Practical teaching of pathophysiology to LAFFH at the IPD outpatient clinic of FMP/FASE: Historical Repor

Undergraduate students of UNIFASE/FMP, through the Academic League of Human Physiology and Pathophysiology (Liga Acadêmica de Fisiologia e FisiopatologiaHumana -LAFFH), participate in a supervised internship to outpatient at the Infectious and Parasitic DiseasesService of FMP/FASE, authorized by Clinical Direction (October 2018). Patients received conventional therapy in addition to complementary therapy with Homeopathy, for external use for cleaning skin lesions and modulating inflammatory responses, whose mechanisms of action are already described in the scientific literature and authorized by ANVISA. Aims: Make approach of undergraduate students to Homeopathic pathophysiology. Methodology: The supervised clinical internship of LAFFH students is in two service rooms with 6 students in each, based on prior appointment due to spontaneous demand, with medical records registered by the IPD outpatient service secretary. Outpatient clinical care addresses the pathophysiology and miasms of the symptoms and signs of neglected chronic parasitic diseases prevalent in our country, identified by anamnesis and physical examination. They are correlated to biological activities in plant chemistry classes, besides official homeopathic pharmacopoeia. So, it was adopted the external use of HUD Ledum palustre 6ch for the cleansing of skin lesions with torpid evolution at IPD. Results and discussion: Two patients with edemaand varicose ulcers were treated with the ointment offered. Edema extension which was +++/4+ to both patients diminished to +/4+ in 30 days of interval. Indeed, ulcers remained at the same shape and size, but their bases were cleaned, without purulence. Novel clinical sessions did not occur because of social distancing needed. Conclusion: It has been developed a positive perception among patients and students about the action of homeopathic remedies. The practical teaching activity initiated encourages students in clinical reasoning about complementary therapeutic association with Homeopathy for patients whose evolution is below the expected prognosis with conventional therapy. Project of clinical observation will be elaborated to research ethics committee.

Macrophage activity regulation by high dilution of aspirin and its possible mechanism

Under LPS-stimulus, platelets can activate macrophagesby a cell-to-cell contact or through cytokine degranulation. Rebound effects of anti-thrombotic agents, such as prostanoids and COX inhibitors can lead to thrombosis, infarct, and stroke. Aspirin has been prescribed for decades due to its powerful antiplatelet action, but it is also related to paradoxical effects such as withdrawal syndrome peaks, resistance, and thrombogenesis. Ultra-diluted aspirin can also produce the same effect in one hour, regardless of Cox-2, by still unknown pathways. Antithrombotic effects of aspirin are also reversed by its high dilutions.Aims: This study aims to characterize the effects of aspirin 15cH on macrophages challenged with LPS, a Cox-2 activator.Methodology: RAW 264.7 macrophages were sown in 24 wells plates using R10medium, boosted with 1µg/ml LPS,and treated with aspirin 15 cH and controls. The activity was evaluated after 24 hours. Supernatants were evaluated for cytokines, nitric oxide, and dielectric oscillations, through solvatochromic dyes (Cartwright's method).Results and discussion: macrophage spreading was increased by aspirin 15 cH, anLPS-like effect. Paradoxically, a significant reduction of this effect was noted when both, LPS and aspirin 15 cH, were added. Succussed water reversed the effect of LPS, leading to TNF (p<0.05) production close to baseline levels. Also, the single treatment with succussed water inhibited IL-10 production (p<0.05), but aspirin 200 µg/mL (positive control) highly increased it (p<0.0001), showing the validity of the model. Nitric oxide production was strengthened by LPS presence (p<0.0001), as expected, but partially downregulated after treatment with aspirin 200 µg/mL, water and succussed water. A pilot study with solvatochromic dyes showed no significant difference among treatments.Conclusion: The main data suggest that aspirin 15 cH increases macrophage activity but presents a paradoxal effect when mixed with LPS. On the other hand, succussed water itself has modulatory effects on macrophages.

Lycopodium clavatum as a homeopathic treatment in Magellanic penguins (Sphenicus magellanicus)

Uric acid is the main form of excretion of nitrogenous components in birds. The assessment verification samples, control, check of uric acid concentrations is widely used to detect kidney disease. High concentrations (up to five times) of uric acid in plasma can lead to the precipitation of this acid in the form of crystals, which accumulate in the tissues, mainly in the synovial joints and the viscera surface. Aims: report the evolution of homeopathic treatment in increased uric acid in Magellanic penguins (Spheniscus magellanicus) from Santo André Municipal Zoo. Methodology: 12 animals showed an increase in uric acid (reference values 0,3-16,1mg/dL) and received homeopathic treatment with Lycopodium clavatum 6cH. The protocol established was the administration of two globules of Lycopodium clavatum 6cH, once a day, inside fishes offered in the animal's beak. Treatment started on 25/09/2019. On 30/10/2019 was collected a new blood sample, those who were not discharged were kept on treatment and new collections were made on 27/11/2019 and 17/12/2019. Results: 8 animals had an average uric acid of 20.45mg /dl and responded to the 35-days treatment, normalizing the biochemical values with an average of 12.24mg /dl. Two animals with 18.27 mg /dl were discharged in 62 days with 11.70 mg /dl and another two penguins with 19.85 mg /dl were discharged in 82 days later with 9.57 mg /dl of uric acid. Conclusion: Homeopathy proved to be successful in the treatment of increased uric acid in Magellanic penguins, easy to administer, affordable and without side effects.