Resultados terapêuticos da homeopatia em pacientes suspeitos ou confirmados de COVID-19: um estudo longitudinal prospectivo / Therapeutic results of homeopathy in suspected or confirmed COVID-19 patients: a longitudinal study

A infecção humana causada pelo vírus SARS-CoV-2 (COVID-19), diagnosticada como pneumonia de causa desconhecida originalmente na cidade de Wuhan (China), foi considerada como pandemia pela Organização Mundial da Saúde. Com a inexistência inicial de uma vacina para proteção dos sadios, foi adotada a estratégia de isolamento social e tratamento com medidas de suporte geral e/ou avançado. Neste contexto, coube investigar a contribuição da terapêutica homeopática no enfrentamento da doença, notadamente no alívio dos sintomas desconfortáveis por ela provocados em sua fase inicial, com acompanhamento e registro dos resultados obtidos pelos médicos homeopatas. MÉTODO: Este estudo coletou, durante o período de maio a setembro de 2020 (após aprovação pelo CEP), informações de pacientes diagnosticados com a doença, tratados por médicos homeopatas com medicamentos homeopáticos escolhidos de acordo com a sintomatologia apresentada pelo paciente. Foram avaliados os efeitos no estado de saúde do paciente, por meio de escores e escalas clínicas, bem como aspectos relacionados à segurança do medicamento, variação na duração da doença e medicamentos mais associados a eventuais sucessos terapêuticos. Questionário padronizado e específico para a COVID-19 foi elaborado e e aplicado para preenchimento dos médicos colaboradores do estudo durante o acompanhamento dos pacientes. Os dados foram armazenados em planilhas eletrônicas e analisados com técnicas estatísticas descritivas e inferenciais. Os pacientes selecionados eram colaboradores do Hospital Santo Antônio - Obras Sociais Irmã Dulce (OSID) e foram submetidos a uma avaliação preliminar presencial no ambulatório de Otorrinolaringologia deste hospital. As consultas homeopáticas foram realizadas por plataforma de Telemedicina para seguimento e acompanhamento do caso. Foram avaliados 116 colaboradores, com faixa etária que variou entre 21 e 66 anos, sendo a média de idade 38 anos; destes, 84 (72%) eram do gênero feminino e 32 (16%) gênero masculino; 53 pacientes (70% dos colaboradores atendidos) eram profissionais da saúde (médicos, enfermeiros e técnicos de enfermagem); 63 (30%) eram colaboradores de áreas administrativas ou técnicas; 50 pacientes tinham critérios para inclusão no grupo de risco (43%). Quanto ao resultado do RT-PCR: 58 pacientes (50%) tiveram RT-PCR detectado (confirmados); 58 pacientes (50%) tiveram RT-PCR não-detectado - destes, 18 pacientes (31%) apresentaram anosmia em sua evolução. Dos 116 pacientes do critério de inclusão, 77 estavam incluídos na síndrome clássica da COVID19. Destes 77 colaboradores, 3 não usaram o medicamento homeopático (N=74). Os medicamentos homeopáticos mais indicados foram: Arsenicum album (42%); Bryonia (24%), Phosphorus (15%); Gelsemium (15%); Pulsatilla (2%); outros (4%). O Score médio de sintomas antes do tratamento foi 12,27 e após o tratamento foi 0,52 (p < xxxxx). Dos 57 pacientes que tiveram anosmia, houve recuperação total em 43 (75%) dos casos no momento da reavaliação. O tempo médio decorrido entre o uso da medicação homeopática e a recuperação dos sintomas foi de 9 dias. Apenas 3 pacientes (3,9%) necessitaram de internamento hospitalar sem necessidade de intubação, sendo 2 deles pertencentes ao grupo de risco. apesar destes resultados serem parciais (pois ainda existem sujeitos da pesquisa ainda em fase de avaliação), os resultados sugerem que o tratamento homeopático promoveu o restabelecimento do quadro infeccioso sem necessidade de internamento em 97% dos pacientes. A anosmia teve recuperação completa em 75% dos pacientes. Arsenicum album, Bryonia e Phosphorus foram os medicamentos predominantemente eleitos para o tratamento, o que corrobora com outros estudos homeopáticos.

The human infection caused by the SARS-CoV-2 virus (COVID-19), originally diagnosed as pneumonia of unknown cause in the city of Wuhan (China), was considered a pandemic by the World Health Organization. With the initial lack of a vaccine to protect healthy people, the strategy relating to social isolation and treatment with general and/or advanced support measures was adopted. In this context, it was necessary to investigate the contribution of homeopathic therapy in coping with the disease, particularly in terms of relieving the uncomfortable symptoms caused by it in its initial phase, with monitoring and recording of the results obtained by homeopathic physicians. METHOD: This study collected information from patients diagnosed with the disease, treated by homeopathic physicians with homeopathic medications chosen according to the symptoms manifested by the patient, from May to September 2020 (after approval by the REC). The effects on the health conditions of patients were assessed using clinical scores and scales, as well as aspects related to the safety of the medication, variations in the duration of the disease and the medications most associated with any therapeutic successes. A standardized questionnaire specific to COVID-19 was drawn up and filled in by the physicians who collaborated in the study during patient monitoring. The data was stored in electronic spreadsheets and analyzed using descriptive and inferential statistical techniques. The selected patients were employees of Hospital Santo Antônio - Obras Sociais Irmã Dulce (OSID) and underwent a preliminary in-person assessment at the otolaryngology outpatient clinic of this hospital. The homeopathic consultations were carried out via a telemedicine platform to follow-up and monitor the case. A total of 116 employees were assessed, ranging in age from 21 to 66, with the average age being 38; of these, 84 (72%) were females and 32 (16%) males; 53 patients (70% of the employees cared for) were health care professionals (physicians, nurses and nursing technicians); 63 (30%) were employees from administrative or technical areas; 50 patients met the criteria for inclusion in the risk group (43%). As for the RT-PCR result: 58 patients (50%) had RT-PCR detected (confirmed); 58 patients (50%) had RT-PCR not detected - of these, 18 patients (31%) had anosmia during their evolution. Of the 116 patients who met the inclusion criteria, 77 were included in the classic COVID-19 syndrome. Of these 77 collaborators, 3 did not use homeopathic medication (N=74). The most indicated homeopathic medications were: Arsenicum album (42%); Bryonia (24%), Phosphorus (15%); Gelsemium (15%); Pulsatilla (2%); others (4%). The average symptom score before treatment was 12.27 and after treatment was 0.52 (p < xxxxx). Of the 57 patients who had anosmia, there was full recovery in 43 (75%) of the cases at the time of reassessment. The average time elapsed between the use of homeopathic medication and the recovery of symptoms was 9 days. Only 3 patients (3.9%) required hospitalization without the need for intubation, 2 of whom belonged to the risk group. Although these results are partial (as there are still research subjects in the evaluation phase), the results suggest that homeopathic treatment promoted the re-establishment of the infectious condition without the need for hospitalization in 97% of the patients. Anosmia recovered completely in 75% of the patients. Arsenicum album, Bryonia and Phosphorus were the drugs predominantly chosen for treatment, which corroborates other homeopathic studies.

Avaliação dos ensaios clínicos homeopáticos quanto a sua eficácia no tratamento de pacientes com zumbido / Evaluation of homeopathic clinical trials for its effectiveness in treatment of patients with tinnitus

INTRODUÇÃO: Zumbido é a percepção subjetiva de sons na ausência de um estímulo sonoro no meio externo, acometendo 17% da população. Sua presença significa um sofrimento do sistema auditivo secundário a doenças e agentes agressores. A maioria das pessoas acometidas lidam bem com a situação, mas para cerca de 1%, o zumbido é um problema sério. De acordo com estudos, os métodos convencionais de tratamento ainda são limitados quanto a sua eficácia. Assim, o zumbido persiste como um sintoma de difícil tratamento, e, diante disso, a procura por terapias complementares tem aumentado nos últimos anos. A homeopatia, como ciência que busca equilibrar e tratar o doente como um todo e não apenas o sintoma ou a doença, surge como uma especialidade capaz de melhorar esses pacientes, desde que o tratamento esteja fundamentado nos princípios de Hahnemann. OBJETIVO: avaliar se os ensaios clínicos que buscam verificar a eficácia do tratamento homeopático do paciente com zumbido estão de acordo com a episteme homeopática. MÉTODO: os ensaios clínicos que utilizaram tratamento homeopático em pacientes com zumbido foram analisados quanto ao desenho de estudo, tamanho amostral, respeito aos princípios da similitude, totalidade sintomática e diluição homeopática, bem como análise estatística dos resultados. RESULTADOS: os princípios homeopáticos foram respeitados apenas no estudo de Buzescu (2015), o que compromete a fidedignidade dos achados nas demais pesquisas. CONSIDERAÇÕES FINAIS: a reprodução dos ensaios clínicos contemplados neste estudo torna-se inviável em pesquisas futuras por não considerar os critérios essenciais para fundamentar a pesquisa científica homeopática. Além disso, deve contemplar um tamanho amostral maior nos ensaios futuros.(AU)

INTRODUCTION: Tinnitus is a subjective perception of sound in absence of acoustic stimulus in the external environment, affecting 17 % of population. His presence means suffering due to auditory system diseases and aggressors. Most affected people cope well with the situation, but about 1%, tinnitus is a serious problem. According to studies, conventional treatment methods are limited as to its effectiveness. Thus, the tinnitus persists as a difficult symptom to treat, and, so, the demand for complementary therapies has increased in recent years. Homeopathy as a science that seeks to balance and treat the patient as a whole and not just the symptom or the disease arises as a specialty able to improve these patients, since the treatment is based on the principles of Hahnemann . GOAL: The aim of this study is to evaluate whether the clinical trials that seek to verify the effectiveness of homeopathic treatment for patients with tinnitus is in accordance with the homeopathic episteme. METHOD: The clinical trials of homeopathic treatment for patients with tinnitus were analyzed for the study design, sample size, compliance with the principles of similarity, symptomatic totality and homeopathic dilution, as well as statistical analysis. RESULTS: Homeopathic principles were respected only in the study of Buzescu (2015), which undermines the reliability of the results in other studies. FINAL COMMENTS: The reproducibility of clinical trials included in this study becomes impossible in future research, because do not consider the essential criteria to support the homeopathic scientific research. In addition, they should include a larger sample size in future trials.(AU)

CPAP has no effect on clearance, sputum properties, or expectorated volume in cystic fibrosis.

BACKGROUND: Positive expiratory pressure (PEP) is used for airway clearance in cystic fibrosis (CF) patients. Hypertonic saline (HTS) aerosol increases sputum expectoration volume and may improve respiratory secretion properties. CPAP may also be used to maintain airway patency and mobilize secretions. To evaluate if CPAP would increase the beneficial clearance effect of HTS in subjects with CF, we investigated the effects of CPAP alone and CPAP followed by HTS on sputum physical properties and expectoration volume in CF subjects. METHODS: In this crossover study, 15 CF subjects (mean age 19 y old) were randomized to interventions, 48 hours apart: directed coughs (control), CPAP at 10 cm H(2)O, HTS 7%, and both CPAP and HTS (CPAP+HTS). Sputum collection was performed at baseline and after interventions. Expectorated volume was determined and in vitro sputum properties were analyzed for contact angle and cough clearability. RESULTS: There were no significant differences between any treatment in arterial blood pressure, heart rate, or pulse oximetry, between the 2 time points. HTS and CPAP+HTS improved cough clearability by 50% (P = .001) and expectorated volume secretion by 530% (P = .001). However, there were no differences between control and CPAP on sputum contact angle, cough clearability, or volume of expectorated secretion. CONCLUSIONS: CPAP alone had no effect on mucus clearance, sputum properties, or expectorated volume, and did not potentiate the effect of HTS alone in CF subjects.

Brainstem evoked response in bus drivers with noise-induced hearing loss.

UNLABELLED: Studies carried out by Brainstem Evoked Auditory Potentials (BEAP) in Noise-Induced Hearing Loss (NIHL) workers show different results in relation to neuronal involvement, not involving bus drivers as study object. AIM: to use BEAP in a prospective case/control clinical study to check whether or not there is neural auditory pathway involvement in bus drivers with NIHL. MATERIALS AND METHODS: we selected 50 bus drivers between 27 and 40 years with mild to moderate NIHL, and 20 individuals between 29 and 40 years with normal hearing and without prior history of noise exposure. BEAP tests were carried out and the traces were analyzed. RESULTS: in the NIHL group, the auditory thresholds in 3, 4 and 6 kHz were significantly higher in the left ear. In the NIHL group, potentials PI, PIII and/or PV were not present in a small number of the individuals; we observed a statistically significant increase in PI, PIII and PV absolute latencies, (LIP) LIP I-III interpeak latencies, bilaterally and LIP I-V in the left ear. CONCLUSION: in the NIHL group, besides sensorial injury, changes in BEAP latencies suggest an early functional injury of the first auditory pathway afferent neuron.

Brainstem evoked response in bus drivers with noise-induced hearing loss / Audiometria de tronco encefálico em motoristas de ônibus com perda auditiva induzida pelo ruído

Studies carried out by Brainstem Evoked Auditory Potentials (BEAP) in Noise-Induced Hearing Loss (NIHL) workers show different results in relation to neuronal involvement, not involving bus drivers as study object. AIM: to use BEAP in a prospective case/control clinical study to check whether or not there is neural auditory pathway involvement in bus drivers with NIHL. MATERIALS AND METHODS: we selected 50 bus drivers between 27 and 40 years with mild to moderate NIHL, and 20 individuals between 29 and 40 years with normal hearing and without prior history of noise exposure. BEAP tests were carried out and the traces were analyzed. RESULTS: in the NIHL group, the auditory thresholds in 3, 4 and 6 kHz were significantly higher in the left ear. In the NIHL group, potentials PI, PIII and/or PV were not present in a small number of the individuals; we observed a statistically significant increase in PI, PIII and PV absolute latencies, (LIP) LIP I-III interpeak latencies, bilaterally and LIP I-V in the left ear. CONCLUSION: in the NIHL group, besides sensorial injury, changes in BEAP latencies suggest an early functional injury of the first auditory pathway afferent neuron.

Estudos realizados com os Potenciais Auditivos Evocados de Tronco Encefálico (PEATE) em trabalhadores com Perda Auditiva Induzida pelo Ruído (PAIR) apresentam resultados díspares em relação ao comprometimento neuronal, além de não contemplar motoristas de ônibus como objeto de estudo. OBJETIVO: Avaliar pelo PEATE, em estudo clínico de série caso/controle, prospectivo, se há comprometimento das vias auditivas neurais em motoristas de ônibus com PAIR. MATERIAL E MÉTODO: Foram selecionados 50 motoristas de ônibus entre 27 e 40 anos portadores de PAIR leve a moderada; e 20 sujeitos entre 29 e 40 anos com audibilidade normal e sem antecedentes de exposição a ruído. Os PEATEs foram realizados e os traçados analisados. RESULTADOS: No grupo PAIR, os limiares auditivos em 3, 4 e 6 kHz foram significativamente maiores na orelha esquerda. No grupo PAIR, os potenciais PI, PIII e/ou PV foram ausentes em uma pequena parcela; foi observado prolongamento estatisticamente significante das latências absolutas de PI, PIII e PV, das latências interpicos (LIP) LIP I-III, bilateralmente e da LIP I-V na orelha esquerda. CONCLUSÃO: No grupo PAIR, além da lesão sensorial, as modificações das latências do PEATE sugerem lesão funcional do primeiro neurônio aferente da via auditiva, de forma precoce.