Prespecified Homeopathic Medicines in the Prevention of Confirmed and Suspected Cases of COVID-19: A Community-Based, Double-Blind, Randomized, Placebo-Controlled Prophylaxis Trial.

INTRODUCTION: Homeopathic medicines have been used for decades in the prevention and treatment of infectious diseases. However, the preventive efficacy of specific homeopathic medicines in COVID-19 is not well characterized. This study aimed to evaluate the comparative efficacy of prespecified homeopathic medicines in preventing COVID-19. METHODS: A community-based, double-blind, randomized, placebo-controlled trial was conducted on 4,034 participants residing in Ward No. 27 of the Howrah Municipal Corporation in India. Participants were randomized to receive one of three prespecified homeopathic medicines [Influenzinum 30C, Arsenicum album 30C, Anas barbariae hepatis et cordis extractum 200K (Oscillococcinum®)], or placebo. The outcomes were the incidence of laboratory-confirmed and suspected cases of COVID-19 during a follow-up period of 1 month. RESULTS: During the follow-up period, a total of 13 new laboratory-confirmed COVID-19 cases were reported in the study population. Among these, 5 cases in Influenzinum group, 2 cases in Arsenicum album group, 1 case in Oscillococcinum® group, and 5 cases in Placebo group were reported. On the other hand, number of suspected COVID-19 cases was significantly less in all the three homeopathic medicine groups compared to placebo. The least number of suspected cases reported in the Oscillococcinum® group (aOR: 0.058; 95% confidence interval [CI]: 0.029, 0.114), followed by the Arsenicum album (aOR: 0.337; 95% CI: 0.238, 0.475) and Influenzinum (aOR: 0.539; 95% CI: 0.401, 0.726) groups. CONCLUSION: Prespecified homeopathic medicines, particularly Oscillococcinum® and Arsenicum album 30C, may have a role in preventing COVID-19, especially in reducing the incidence of suspected or COVID-19-like respiratory illnesses. However, the result failed to demonstrate a statistically significant difference in the occurrence of confirmed cases of COVID-19 between the study groups. Further research is needed to evaluate the efficacy of these medicines in different populations and settings.Homöopathische Arzneimittel werden seit Jahrzehnten zur Prävention und Behandlung von Infektionskrankheiten eingesetzt. Die Wirksamkeit spezifischer homöopathischer Arzneimittel zur Prophylaxe von COVID-19 ist jedoch nicht gut untersucht. Mit dieser Studie sollte die vergleichende Wirksamkeit spezifischer homöopathischer Arzneimittel bei der Prävention von COVID-19 untersucht werden.Es handelte sich um eine gemeindebasierte, doppelblinde, randomisierte, placebokontrollierte Studie mit 4.034 Teilnehmern, die im Bezirk Nr. 27 der Howrah Municipal Corporation in Indien lebten. Die Teilnehmer erhielten randomisiert eines von drei zuvor festgelegten homöopathischen Arzneimitteln [Influenzinum 30C, Arsenicum album 30C, Anas barbariae hepatis et cordis extractum 200K (Oscillococcinum®)] oder Placebo. Zielkriterien waren die Inzidenz von laborchemisch bestätigten und vermuteten COVID-19-Fällen während des Follow-up-Zeitraums von einem Monat.Während des Follow-up-Zeitraums wurden insgesamt 13 neue, laborchemisch bestätigte COVID-19-Fälle in der Studienpopulation berichtet, davon 5 Fälle in der Influenzinum-Gruppe, 2 Fälle in der Arsenicum album-Gruppe, 1 Fall in der Oscillococcinum®-Gruppe und 5 Fälle in der Placebo-Gruppe. Demgegenüber fiel Zahl der COVID-19-Verdachtsfälle in allen drei homöopathischen Arzneimittelgruppen signifikant geringer aus als in der Placebogruppe. Die wenigsten Verdachtsfälle wurden in der Oscillococcinum®-Gruppe berichtet (aOR: 0.058; 95%-KI: 0.029, 0.114), gefolgt von der Arsenicum album- (aOR: 0.337; 95%-KI: 0.238, 0.475) und der Influenzinum- (aOR: 0.539; 95%-KI: 0.401, 0.726) Gruppe.Spezifische homöopathische Arzneimittel, insbesondere Oscillococcinum® und Arsenicum album 30C, könnten bei der Prävention von COVID-19 eine Rolle spielen, vor allem bei der Senkung der Inzidenz von COVID-19-Verdachtsfällen oder COVID-19-ähnlichen Atemwegserkrankungen. Allerdings war kein statistisch signifikanter Unterschied im Auftreten von bestätigten COVID-19-Fällen zwischen den Studiengruppen nachweisbar. Weitere Untersuchungen sind erforderlich, um die Wirksamkeit dieser Arzneimittel in verschiedenen Populationen und Umgebungen zu bewerten.

Comparison of Fetomaternal Outcome Between Planned Vaginal Delivery and Planned Cesarean Section in Women with Eclampsia: Observational Study.

OBJECTIVE: The route of termination of pregnancy in eclampsia is not clearly established. This study aims to compare the fetomaternal outcome between planned vaginal delivery and planned cesarean section in women with eclampsia after 34 weeks of gestation. METHODS: This prospective observational study was conducted in the department of Obstetrics and Gynecology, Midnapore Medical College, West Bengal, India. 182 women with eclampsia carrying 34 weeks or more gestation were allocated to either cesarean(CD) or vaginal delivery (VD) group. The primary measure of outcome was severe maternal outcome. Secondary measures of outcome were perinatal mortality and morbidity. RESULTS: Of the 62 women allocated in vaginal delivery (VD) group, 60 women (32.97%) had vaginal delivery and 122 (67.03%) had undergone cesarean delivery (CD). Severe maternal outcome was more common in VD group in comparison with CD group (72.5% vs 27.5%, P < 0.00001 RR 2.64 OR 6.98). Perinatal outcome in relation to Apgar score at 5 min, still birth was better in CD group than VD group. Perinatal death was higher in VD group when compared with CD group (25.8%; vs. 8.33%; P = 0.002, RR 3.1 OR 3.83). CONCLUSION: There is increasing trend of delivering the eclampsia mother at > 34 weeks of gestation by cesarean section instead of inducing labor and delivering vaginally. Cesarean section when chosen as method of delivery does not increase morbidity or mortality.

A retrospective cohort study on effect of literacy status of HIV-positive pregnant women on possibility of child getting HIV infected.

INTRODUCTION: Prevention of parent-to-child transmission (PPTCT) program aims at reduction of HIV transmission through vertical route. Although medical intervention reduces chance of HIV transmission substantially, several demographic factors are often contributory. Minimum literacy is required for HIV-infected individuals to understand the course of medicine and to ensure compliance to the treatment which may have impact on vertical transmission. The objective of this study is to analyze relationship between maternal education and possibility of her babies to get HIV infected. MATERIALS AND METHODS: A retrospective cohort study was carried out through analysis of secondary data during the period from April 13 to September 16 from all stand-alone integrated counseling and testing centers in West Bengal. A total number of 326 HIV-exposed babies, whose 6th week HIV-Polymerase Chain Reaction (PCR) reports are available and both the mother-baby received PPTCT services, were recruited in the study, and their maternal literacy status was substantiated and analyzed. RESULTS: HIV positivity among HIV-exposed babies was found to be 6.67% whose mothers were illiterate as compared to 5.55% whose mothers were literate up to primary standard and 3.93% whose mothers were educated up to secondary standard. HIV positivity among the exposed babies whose mothers studied higher secondary standard or above showed zero HIV positivity. Chi-square was done to ascertain statistical significance but result was inconclusive although the trend shows increasing chance of HIV-exposed babies to get infected with decreasing literacy. CONCLUSION: Maternal literacy status favorably influences vertical transmission of HIV.

Medicine prescription practices of homeopathic undergraduate students in West Bengal, India.

OBJECTIVE: To our knowledge, prescription of homeopathic medicines by homeopathic undergraduate students has not been studied before though it may possess serious implications. We aimed to determine the practice and attitudes of prescription by homeopathic undergraduate students. METHODS: A cross-sectional study was carried out involving all the students from four government homeopathic schools of West Bengal, India. Ethical requirements were ensured and data were collected using self-administered questionnaires. Chi-square tests and logistic univariate regression analyses were performed to identify associations and differences. RESULTS: A total of 328 forms were completed. Of these, 264 (80.5%) homeopathic undergraduate students admitted of prescribing medicines independently and most (40.5%) said that they did this 2-3 times a year. The most common reasons for this were 'urgency of the problem' (35.2%), 'previous experience with same kind of illness' (31.8%), and 'the problem too trivial to go to a doctor' (25.8%). About 63.4% of the students thought that it was alright to independently diagnose an illness while 51.2% thought that it was alright for them to prescribe medicines to others. Common conditions encountered were fever, indigestion, and injury. Students who prescribed medicines were more likely to belong to Calcutta Homeopathic Medical College and Hospital (odds ratio = 5.8; 95% confidence interval 2.247-14.972). Prescription by students gradually increased with academic years of homeopathic schools. Many students thought it was alright for students to diagnose and treat illnesses. CONCLUSION: Prescription of medicines by homeopathic undergraduate students is quite rampant and corrective measures are warranted.

A survey exploring research perception of homeopathic undergraduate students in West Bengal, India

Background: Prioritizing undergraduate research is emphasized to develop critical analytical skills and thinking, independent writing, future clinical practice, enhanced employability, and improved research productivity. Despite far reaching consequences, research perception of homeopathic undergraduate students has barely been investigated to date. Poor participation of homeopathic undergraduates in research is reflected by a single MEDLINE indexed publication with adequate students’ contribution in the last decade. We aimed to assess their knowledge and attitude towards research and to identify barriers towards successful conduct of research. Methods: Institutional cross-sectional survey was carried out during August-September, 2013 in the four Government undergraduate homeopathic schools in West Bengal, India involving 902 participants. A semi-structured questionnaire was developed for the purpose depending on earlier studies on medical undergraduates. 364 completed responses were analyzed in the end. Results: Study sample mostly spanned 18-25 years of age group (94%), belonged to urban families (44.8%), with no gender differences (almost 1:1) and no physicians in family (73.1%). Maximum complete responses were obtained from 3rd year students (61.5%) and students of Calcutta Homeopathic Medical College and Hospital (51.2%). In spite of willingness to participate and keeping a positive attitude towards research, current involvement, training, knowledge and awareness remained quite unsatisfactory. Lack of infrastructure was identified as the chief barrier towards research. Conclusion: Undergraduates had a positive attitude towards homeopathic research, but need a realistic understanding of the research process. Opportunities for research skill development are underdeveloped.

Introdução: Estimular a pesquisa no nível de graduação é considerado um recurso importante para o desenvolvimento da capacidade de análise e pensamento críticos, redação independente, prática clínica futura, melhorar as possibilidades de inserção no mercado de trabalho e a produtividade em pesquisa. Apesar dessas consequências de amplo alcance, a percepção sobre pesquisa de estudantes de graduação em homeopatia tem sido raramente investigada. A escassa participação em pesquisas de estudantes de graduação em homeopatia é evidenciado pelo achado de um único trabalho indexado em MedLine com expressiva participação de estudantes nos últimos 10 anos. O nosso objetivo consistiu em avaliar o conhecimento e atitude em relação à pesquisa e identificar as barreiras que impedem o sucesso na realização de pesquisas. Métodos: Um estudo transversal foi realizado entre agosto e setembro de 2013 nas quatro faculdades públicas de homeopatia na Bengala Ocidental, Índia, com um total de 902 participantes. Um questionário semiestruturado foi desenvolvido especificamente para este estudo baseado nos resultados de estudos anteriores realizados com estudantes de medicina. Um total de 364 questionários completos foi incluído na análise. Resultados: A maioria dos participantes tinha entre 18 e 25 anos de idade (94%), residia em áreas urbanas (44.8%) e não incluía médicos na família (73,1%). A amostra apresentou homogeneidade em relação ao sexo (quase 1:1). O maior número de questionários completos correspondeu a estudantes do 3o ano (61,5%) e da Faculdade e Hospital Homeopático de Calcutá (51,2%) [...] Conclusão: Os estudantes manifestaram atitude positiva em relação à pesquisa em homeopatia, porém precisam adquirir uma compreensão mais realista do processo de pesquisa. As oportunidades para desenvolvimento de competências de pesquisa são muito escassas.

Qualitative systematic review of homeopathic outcome studies in patients with HIV/AIDS

Background and aims: Systematic reviews of high-quality randomized controlled trials (RCTs) are crucial in evidence-based medicine (EBM). The aim of the present review was to investigate whether there is enough evidence on the efficacy of homeopathy in individuals with HIV/AIDS based on clinical trials. Methods: The present is a criteria-based systematic review of cumulative research, and assessment of the methodological quality of published studies. The quality of the trials was evaluated using a list of validated and predefined criteria, and their outcomes were interpreted based on their quality. The main outcome measure was the methodological quality of the studies in terms of the threats to external, internal, construct, and statistical conclusion validity. Results: Among the 6 clinical outcome studies located, 3 were open-label, non-randomized, non-controlled trials, 2 were RCTs, and one was a single-set replication study. The trials were too few in number, and did not exhibit very high quality. The results showed a positive trend regardless of the quality of the trials, or the variety of homeopathic treatment used. The results of the present review may be complicated by publication bias. Conclusion: The currently available evidences do not suffice to infer definitive conclusions. Therefore, further evaluation of homeopathic treatment by means of appropriate RCTs with high methodological quality is required.

As revisões sistemáticas de estudos randomizados controlados (RCTs) são essenciais na medicina baseada em evidências (MBE). O objetivo deste estudo foi estabelecer se há evidência suficiente a favor da eficácia da homeopatia em pacientes com HIV/AIDS a partir de ensaios clínicos. Trata-se de uma revisão sistemática da pesquisa acumulada baseada em critérios, com avaliação daqualidade metodológica dos estudos publicados. A qualidade dos estudos foi avaliada medianteuma lista de critérios validados e predefinidos e os resultados foram interpretados a partir de suaqualidade. O desfecho principal analisado foi a qualidade metodológica dos estudos nos termos das ameaças a sua validade externa, interna, de construto e conclusão estatística.Dos 6 estudos clínicos informando resultados que foram localizados, 3 eram ensaios abertos, não randomizados e não controlados, 2 eram RCTs e um era um estudo de replicação com um único grupo. O número de ensaios clínicos localizados foi muito pequeno e de qualidade não muito alta. Os resultadosapontaram uma tendência positiva independentemente da qualidade dos ensaios e do tipo de tratamento homeopático utilizado. Os resultados desta revisão podem sofrer de viés depublicação. As evidências disponíveis atualmente são insuficientes para conclusões definitivas.Portanto, o tratamento homeopático ainda precisa de maior avaliação, através de RCTs adequados e de alta qualidade metodológica.

Las revisiones sistemáticas de estudios controlados aleatorizados(ECC) son esenciales en la medicina basada en evidencia (MBE). El objetivo de este estudio fue evaluar si hay evidenciasuficiente a favor de la eficacia de la homeopatía en pacientes con VIH/SIDA a partir de ensayosclínicos. Se trata de una revisión sistemática basada en criterios de la investigación acumulada,con evaluación de la calidad metodológica de los estudios publicados. La calidad de los estudiosfue evaluada mediante una lista de criterios validados y predefinidos ylos resultados fueron interpretados a partir de su calidad .El principal resultado medido fue la calidad metodológica de los estudios expresa como amenazas a su validez externa, interna, de constructo y conclusiónestadística. De los 6 estudios clínicos de resultados localizados, 3 eran ensayos abiertos, no aleatorizados y no controlados, 2 eran ECC y uno un estudio de replicación con un único grupo. El número de estudios clínicos localizados fue muy bajo y su calidad no muy alta. Los resultados indican una tendencia positiva independiente de la calidad de los estudios y el tipo de tratamiento homeopático efectuado. Los resultados de esta revisión pueden adolecer de sesgo de publicación. La evidencia actualmente disponible no permite inferir conclusiones definitivas. El tratamiento homeopático necesita mayor evaluación mediante ECC adecuados y de alta calidad metodológica.

Perceptions of couples about contraception in eastern India.

This community-based, cross-sectional study was conducted in sampled villages and municipal wards of Paschim Medinipur District of West Bengal, India among 2,000 respondents, 3/4 were from rural and 1/4 from urban areas, to determine perceptions of couples about contraception. Decision-making about fertility and contraception was mostly made by the husband. Forty-four point three percent of rural and 77.6% of urban women preferred a birth spacing of > or = 3 years. The ideal interval between marriage and first pregnancy was considered to be > or = 3 years in nearly two thirds of women. With increasing literacy level among women, the ideal birth interval between pregnancies also increased. Eighty-nine point four percent of women had correct knowledge of family planning. Only 49.4% of women knew about the Copper-T contraceptive device.

Utilization of therapeutic intervention to prevent mother to child transmission of HIV in a teaching hospital in Kolkata, India.

AIM: To assess the uptake of an HIV screening program and therapeutic intervention to minimize the risk of mother to child transmission. METHODS: This was a cross-sectional, observational study with retrospective data obtained from patient medical records. Pregnant women presenting to a tertiary care center in Kolkata, India, from 1 January 2004 - 31 December 2007 underwent HIV serology by rapid test after receiving group counseling. Care was administered using a standard national protocol by a multi-disciplinary team of health-care personnel. Main outcome measures were: acceptance of pretest counseling and HIV testing by pregnant women attending antenatal clinic services, post-test counseling rate, coverage rate of nevirapine to mother-child pairs, and averted HIV infection in children. RESULTS: Of the 52 127 new antenatal booking visits, 49 580 (95.11%) women attended pretest counseling and 47 506 (91.13%) women accepted HIV testing. Eighty-six women were found to be seropositive. The seroprevalence rate of HIV infection was 0.17%. Thirty-seven mothers (88%) and all newborn infants (100%) had received nevirapine prophylaxis. Overall nevirapine coverage rate was 48%. Twenty-four of the mother-infant pairs that we assessed had infants who were aged over 18 months by June 2008. Eleven (45.83%) of these women turned up with their babies for a blood test at 18 months. Three (27.27%) babies tested reactive. CONCLUSION: As uptake of testing is high and detection of HIV-infected women in pregnancy remains very low, a radical rethinking of policies on therapeutic intervention and their implementation now needs to be undertaken.

A comparison of two regimens of misoprostol for second trimester medical termination of pregnancy: a randomized trial.

The objective of this study was to compare the efficacy and side-effects of two regimens of vaginal misoprostol for second trimester voluntary medical termination of pregnancy (MTP) according to the MTP Act of India. A randomized trial was conducted in 185 women from January 2007 to September 2008. Women in group 1 were given vaginal misoprostol 400 microg every 6 h for a maximum of four doses. Women in group 2 were given vaginal misoprostol 400 microg every 12 h for a maximum of four doses. Our primary outcome measure was induction abortion interval. Secondary outcome measures were success rate, side-effects and completeness of procedure. Results were calculated applying Fisher's exact test, chi-square test, Z test and calculating the P value using an alpha level of 0.05 for Type I error. The mean induction abortion interval in group 1 (12.59 h) was significantly shorter (P < 0.001) than that in the group 2 (16.41 h). The percentage of women who achieved successful abortion within 12 h in group 1 (56.52%) was also significantly higher (P = 0.00005) than that in group 2 (25.80%). The incidence of side-effects was comparable and not clinically serious. It is concluded that the regimen of vaginal misoprostol 400 microg every 6 h was more effective than the regimen of misoprostol every 12 h in medical termination of second trimester pregnancy.

Life events as risk factors for myocardial infarction: a pilot case-control study in Kolkata, India.

This case-control study was conducted in the Cardiology Department of Medical College, Kolkata, India, during 2000-2001, to explore the link between stressful life events and subsequent myocardial infarction (MI). One hundred consecutive confirmed MI patients were selected as a case group. One hundred age-, sex- and income-matched controls were selected from visitors other than relatives who attended these patients. The subjects were interviewed and asked to rate 61 life events with a number between 0 and 20. They also noted which of these they had experienced in the last one year. The main exposure variables included life events as per E.S. Paykel, smoking, alcohol consumption, chewing of tobacco, marital status, literacy, employment, and monthly per-capita income. The results showed that an MI patient was likely to experience 4.16 stressful life events, which were twice as much as the control group (2.24). The total stress score was the highest for serious personal illness followed by illness of family members and unemployment for the MI patients. For the controls, conflict between husband and wife, death of friends, and personal illness had the highest total stress score. The mean stress score for the MI patients was 35.5 compared to 17.35 among the controls. The MI subjects were more likely to have experienced stressful life events than the controls.

Acute lower respiratory tract infection among under- fives in urban eastern India--an appraisal of risk factors.

200 under-fives children diagnosed as having ALRTI in pediatric OPD and indoor ward were sampled using standard case definition, and bodyweight was noted for each. All relevant factors of ALRTI were studied using pre-designed and pre-tested proforma. 90 (45%) were underweight and 143 (71.5%) had >5 episodes of ALRTI. Socio-economic status was inversely related to the percentage having >5 ALRTI episodes. 93.0% of children whose parents were up to primary education level suffered from >5 episodes of ALRTI as compared to 55.3% whose parents had higher literacy levels (Z=7.0, P<0.05). Odds ratio for absence of exclusive breastfeeding (14.1), absence of measles vaccination (6.1), attached kitchen (6.9) were very high.

A medico-social appraisal of commercial sex workers in a metropolitan city from eastern India.

This cross-sectional study of 146 commercial sex workers (CSWs) selected by stratified sampling, in a red light area of Kolkata, showed that 25.3% were teenagers and 37.0% were forced into the profession due to poverty. White discharge was present in 42.5% of the CSWs. Only 65.1% had the proper knowledge of the causes of disease, but 49.3% preferred to go to "quacks" for treatment, while 42.5% preferred traditional medicine. Knowledge of the prevention of sexually transmitted infections by condom use was correct in 44.2% of the CSWs, but 17.8% used condoms regularly. One fourth of the CSWs having 5 or more clients per day used condoms regularly.