Individualized Homeopathic Medicines in the Treatment of Knee Osteoarthritis: Double-Blind, Randomized, Placebo-Controlled Feasibility Trial.

INTRODUCTION: This study aimed at examining the feasibility issues of comparing individualized homeopathic medicines (IHMs) with identical-looking placebos for treating knee osteoarthritis (OA). METHODS: Forty eligible patients participated in this double-blind, randomized (1:1), placebo-controlled feasibility trial in the outpatient clinics of a homeopathic hospital in West Bengal, India. Either IHMs or identical-looking placebos were administered, along with mutually agreed-upon concomitant care guidelines. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was the primary outcome measure, and derived Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores from KOOS, EQ-5D-5L questionnaire, and Visual Analog Scale (VAS) were the secondary outcomes; all measured at baseline and after 2 months. Group differences and effect sizes (Cohen's d) were estimated using an intention-to-treat approach. p-Values less than 0.05 (two-tailed) were considered statistically significant. RESULTS: Enrolment/screening and trial retention rates were 43% and 85% respectively. Recruitment was difficult owing to the coronavirus disease 2019 (COVID-19) lockdown. Group differences were statistically significant, favoring IHMs against placebos in all the KOOS sub-scales: symptoms (p < 0.001), pain (p = 0.002), activities of daily living (p < 0.001), sports or recreation (p = 0.016), and quality of life (p = 0.002). Derived WOMAC scores from KOOS favored IHMs against placebos: stiffness (p < 0.001) and pain (p < 0.001). The EQ-5D-5L questionnaire score (p < 0.001) and EQ-5D-5L VAS scores (p < 0.001) also yielded significant results, favoring IHMs over placebos. All the effect sizes ranged from moderate to large. Sulphur was the most frequently prescribed homeopathic medication. Neither group reported any harm or serious adverse events. CONCLUSION: Although recruitment was sub-optimal due to prevailing COVID-19 conditions during the trial, the action of IHMs was found to be superior to that of placebos in the treatment of knee OA. Larger and more definitive studies, with independent replications, are required to substantiate the findings. TRIAL REGISTRATION: CTRI/2021/02/031453.

Homeopathic Medicines Used as Prophylaxis in Kolkata during the COVID-19 Pandemic: A Community-Based, Cluster-Randomized Trial.

INTRODUCTION: There is some evidence that homeopathic treatment has been used successfully in previous epidemics, and currently some countries are testing homeoprophylaxis for the coronavirus disease 2019 (COVID-19) pandemic. There is a strong tradition of homeopathic treatment in India: therefore, we decided to compare three different homeopathic medicines against placebo in prevention of COVID-19 infections. METHODS: In this double-blind, cluster-randomized, placebo-controlled, four parallel arms, community-based, clinical trial, a 20,000-person sample of the population residing in Ward Number 57 of the Tangra area, Kolkata, was randomized in a 1:1:1:1 ratio of clusters to receive one of three homeopathic medicines (Bryonia alba 30cH, Gelsemium sempervirens 30cH, Phosphorus 30cH) or identical-looking placebo, for 3 (children) or 6 (adults) days. All the participants, who were aged 5 to 75 years, received ascorbic acid (vitamin C) tablets of 500 mg, once per day for 6 days. In addition, instructions on healthy diet and general hygienic measures, including hand washing, social distancing and proper use of mask and gloves, were given to all the participants. RESULTS: No new confirmed COVID-19 cases were diagnosed in the target population during the follow-up timeframe of 1 month-December 20, 2020 to January 19, 2021-thus making the trial inconclusive. The Phosphorus group had the least exposure to COVID-19 compared with the other groups. In comparison with placebo, the occurrence of unconfirmed COVID-19 cases was significantly less in the Phosphorus group (week 1: odds ratio [OR], 0.1; 95% confidence interval [CI], 0.06 to 0.16; week 2: OR, 0.004; 95% CI, 0.0002 to 0.06; week 3: OR, 0.007; 95% CI, 0.0004 to 0.11; week 4: OR, 0.009; 95% CI, 0.0006 to 0.14), but not in the Bryonia or Gelsemium groups. CONCLUSION: Overall, the trial was inconclusive. The possible effect exerted by Phosphorus necessitates further investigation. TRIAL REGISTRATION: CTRI/2020/11/029265.

Photodissociation dynamics of benzoyl chloride at 235 nm: resonance-enhanced multiphoton ionization detection of Cl and HCl.

The photodissociation dynamics of benzoyl chloride at 235 nm has been investigated and compared with that of 2-furoyl chloride. Atomic Cl and molecular HCl channels have been detected in benzoyl chloride by employing resonance-enhanced multiphoton ionization technique and time-of-flight mass spectrometry. Both the Cl fragments, Cl((2)PJ=3/2, relative quantum yield 0.70 ± 0.15) and Cl*((2)PJ=1/2), show isotropic angular distribution and bimodal translational energy distributions. The predominant high kinetic energy channel contributes 72% to the C-Cl bond scission and arises from the S1 state having nπ* character of benzoyl chloride. However, the low-energy Cl and HCl channels originate from the ground electronic state. The most plausible mechanism of HCl formation is proposed based on molecular orbital calculations. In contrast to benzoyl chloride, the HCl channel is not observed in 2-furoyl chloride on excitation at 235 nm, and this is attributed to an energy constraint.

Kinetics of gas-phase reaction of OH with morpholine: an experimental and theoretical study.

Kinetics of reaction of OH radical with morpholine, a heterocyclic molecule with both oxygen and nitrogen atoms, has been investigated using laser photolysis-laser-induced fluorescence technique, in the temperature range of 298-363 K. The rate constant at room temperature (k(298)) is (8.0 +/- 0.1) x 10(-11) molecule(-1) cm(3) s(-1). The rate constant decreases with temperature in the range studied, with the approximate dependence given by k(T) = (1.1 +/- 0.1) x 10(-11) exp[(590 +/- 20)/T] cm(3) molecule(-1) s(-1). The rate constants are high compared with those of similar heterocyclic molecules with oxygen atom but comparable to those reported for aliphatic amines. Ab initio molecular orbital calculations show that prereactive complexes, 5-7 kcal mol(-1) lower in energy as compared with the reactants, are formed because of hydrogen bond interaction between OH and the N/O atom of morpholine. The stability of the complex involving the nitrogen atom is found to be more than that involving the oxygen atom. The optimized transition-state structures and energies for the different pathways of hydrogen abstraction from these prereactive complexes explain the observation of negative activation energy.

Photodissociation dynamics of 2-nitropropane and 2-methyl-2-nitropropane at 248 and 193 nm.

Dynamics of formation of electronically excited NO2 and formation of OH fragment, during photo dissociation of 2-nitropropane (NP) and 2-methyl-2-nitropropane (MNP), were investigated at 193 and 248 nm. The radiative lifetime of the electronically excited NO2 fragment, observed at 193 nm, was measured to be 1.2 ( 0.1 micros and the rate coefficient of quenching of its emission by MNP was measured as (2.7 ( 0.1) x 10(-10) molecule(-1) cm3 s(-1). Formation of the ground electronic state of OH was confirmed in both molecules. State selective laser induced fluorescence technique was used to detect the nascent OH (X 2Pi, v'', J'') fragments in different ro-vibrational states, and to obtain information on energy partitioning. Though MNP and NP differ in the types of the available H atoms, the dynamics of OH formation is found to be the same in both. The relative population in different rotational states does not follow Boltzmann equilibrium distribution in both the molecules at 193 and 248 nm. The translational energies of the OH fragments, calculated from the Doppler width, are 21.2 ( 7.2 and 25.0 ( 2.5 kcal mol-1 for NP at 248 and 193 nm, respectively. The translational energies of the OH fragments, in the case of MNP, are found to be lower, 17.5 ( 4.1 and 22.0 ( 3.2 kcal mol-1,respectively, at 248 nm 193 nm. These results are compared with the earlier reports on photodissociation of nitromethane (NM), nitroethane (NE), and other nitroalkanes. All possible dissociation pathways of these molecules--NM, NE, NP, and MNPs leading to the formation of the OH fragment were investigated computationally, with geometry optimization at the B3LYP/6-311+G(d,p) level and energy calculation at the MP4(SDQ)/6-311+G (d,p) level. The results suggest that in NM, OH is formed after isomerization to CH2N(OH)O, whereas in all other cases OH is formed from HONO, a primary product of molecular elimination of nitroalkanes, formed with sufficient internal energy.

Studies on photodissociation dynamics of butadiene monoxide at 193 nm.

Butadiene monoxide (BMO) undergoes the S(0)-->S(1) transition, involving the excitation of both pi and n electrons to pi(*) orbital, at 193 nm. After relaxing to the ground electronic state via internal conversion, BMO molecules undergo intramolecular rearrangement and subsequently dissociate to form unexpected OH radicals, which were detected state selectively by laser-induced fluorescence technique, and the energy state distribution was measured. OH is produced vibrationally cold, OH(nu(")=0,J(")), with the rotational population characterized by a rotational temperature of 456+/-70 K. The major portion (approximately 60%) of the available energy is partitioned into internal degrees of the photofragments, namely, vibration and rotation. A considerable portion (25%-35%) also goes to the relative translation of the products. The Lambda doublet and spin-orbit ratios of OH were measured to be nearly unity, implying statistical distribution of these states and, hence, no preference for any of the Lambda doublet (Lambda+ and Lambda-) and spin-orbit (Pi(3/2) and Pi(1/2)) states. Formation time of the nascent OH radical was measured to be <100 ns. Different products, such as crotonaldehyde and methyl vinyl ketone, were detected by gas chromatography as stable products of photodissociation. A reaction mechanism for the formation of all these photoproducts, transient and stable, is proposed. The multiple pathways by which these products can be formed have been theoretically optimized, and energies have been calculated. Absorption cross section of BMO at 193 nm was measured, and quantum yield of OH generation channel was also determined.

Dynamics of OH radical generation in laser-induced photodissociation of tetrahydropyran at 193 nm.

Tetrahydropyran (THP) undergoes photodissociation on excitation with ArF laser at 193 nm, generating OH radical as one of the transient photoproducts. Laser-induced fluorescence technique is used to detect the nascent OH radical and measure its energy state distribution. The OH radical is formed mostly in the ground vibrational level (v"=0), with low rotational excitation. The rotational distribution of OH (v"=0,J) is characterized by a temperature of 433+/-31 K, corresponding to a rotational energy of 0.86+/-0.06 kcalmol. Two Lambda-doublet levels, 2Pi+(A') and 2Pi-(A"), and the two spin-orbit states, the 2Pi(3/2) and 2Pi(1/2), of OH are populated statistically for all rotational levels. The relative translational energy associated with the photoproducts in the OH channel is calculated to be 21.9+/-3.2 kcal mol(-1), from the Doppler-broadened linewidth, giving an ft value of approximately 43%, and most of the remaining 57% of the available energy is distributed in the internal modes of the other photofragment, C5H9. The observed distribution of the available energy is explained well, using a hybrid model of energy partitioning, with an exit barrier of 40 kcal mol(-1). The potential-energy surface of the reaction channel was mapped by ab initio molecular-orbital calculations. Based on experimental and theoretical results, a mechanism for OH formation is proposed. Electronically excited THP relaxes to the ground electronic state, and from there, a sequence of reactions takes place, generating OH. The proposed mechanism first involves C-O bond scission, followed by a 1,3 H atom migration to O atom, and finally, the C-OH bond cleavage giving OH.

Detection of OH radical in laser induced photodissociation of tetrahydrofuran at 193 nm.

On excitation at 193 nm, tetrahydrofuran (THF) generates OH as one of the photodissociation products. The nascent energy state distribution of the OH radical was measured employing laser induced fluorescence technique. It is observed that the OH radical is formed mostly in the ground vibrational level, with low rotational excitation (approximately 3%). The rotational distribution of OH (v"=0,J) is characterized by rotational temperature of 1250+/-140 K. Two spin-orbit states, 2Pi3/2 and 2Pi1/2 of OH are populated statistically. But, there is a preferential population in Lambda doublet levels. For all rotational numbers, the 2Pi+(A') levels are preferred to the 2Pi-(A") levels. The relative translational energy associated with the photoproducts in the OH channel is calculated to be 17.4+/-2.2 kcal mol-1, giving an fT value of approximately 36%, and the remaining 61% of the available energy is distributed in the internal modes of the other photofragment, i.e., C4H7. The observed distribution of the available energy agrees well with a hybrid model of energy partitioning, predicting an exit barrier of approximately 16 kcal mol-1. Based on both ab initio molecular orbital calculations and experimental results, a plausible mechanism for OH formation is proposed. The mechanism involves three steps, the C-O bond cleavage of the ring, H atom migration to the O atom, and the C-OH bond scission, in sequence, to generate OH from the ground electronic state of THF. Besides this high energy reaction channel, other photodissociation channels of THF have been identified by detecting the stable products, using Fourier transform infrared and gas chromatography.

Therapeutic Response of Urticaria Pigmentosa to Doxepin.

on in urticaria pigmentosa are discussed.