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3.
Homeopathy ; 108(4): 232-239, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31357216

RESUMO

BACKGROUND: Assignment of expiry date to homeopathic medicines is a subject of important concern to its pharmacists and practitioners. This study compares the regulatory framework for the expiry of homeopathic medicines in four countries: Brazil, Germany, India and the United States. FINDINGS: Different or no expiry periods are variously followed. Whereas Germany, with some exceptions, employs a maximum expiry of 5 years for both potencies and finished products, Brazil adopts a 5-year expiry for finished products only, potencies used in manufacture being exempted from an assigned expiry date. In India, all homeopathic medicines except dilutions and back potencies have a maximum of 5 years' shelf-life, including those supplied to consumers. In the United States, homeopathic medicines are exempted from expiry dates. COMMENTS: There is neither a rational basis nor scientific evidence for assigning a short (3-5 years) expiry period for homeopathic medicines as followed in some of the countries, particularly in light of the fact that some studies have shown homeopathic medications to be effective even after 25 years. Homeopathic ultra-dilutions seem to contain non-material activity that is maintained over time and, since these exhibit different chemical properties compared to the original starting material, it is quite possible they possess properties of longer activity than conventional medicines. Regulators should acknowledge this feature and differentiate expiry of homeopathic medicinal products from that of conventional drugs.


Assuntos
Rotulagem de Medicamentos , Estabilidade de Medicamentos , Homeopatia/normas , Controle de Qualidade , Brasil , Alemanha , Humanos , Índia , Medicamentos sob Prescrição/normas , Estados Unidos
4.
Homeopathy ; 108(3): 188-200, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30999383

RESUMO

INTRODUCTION: Encephalitozoon cuniculi (E. cuniculi), a fungus that acts as an intracellular pathogen, causes a marked neurological syndrome in many host species and is a zoonotic concern. Although no well-established treatment for this syndrome is known, previous successful clinical experience using homeopathic phosphorus has been described in which symptom remission with no mortality occurred in 40/42 animals by means of unknown immunological mechanisms. The latter observation was the main motivation for this study. OBJECTIVE: To verify, in an in-vitro model, if macrophages infected with E. cuniculi can change in function after treatment with different potencies of phosphorus. MATERIALS AND METHODS: RAW 264.7 macrophages were infected with E. cuniculi in-vitro and treated with various homeopathic potencies of phosphorus. The vehicle was used as a control solution (0.06% succussed ethanol). After 1 and 24 hours, the following parameters were analyzed: parasite internalization (by the Calcofluor staining method), lysosome activity (by the acridine orange method), cytokine/chemokine production (by the MAGPIX system), and cell ultrastructure. Automatic image analysis was used when applicable, and the experiments were performed in triplicate. RESULTS: Treatment with vehicle alone increased interleukin (IL)-6, tumor necrosis factor alpha and monocyte chemotactic protein -1 production (p ≤ 0.05) and reduced the number of internalized parasites (p ≤ 0.001). A progressive and time-dependent increase in RANTES (regulated on activation, normal T-cell expressed and secreted) and lysosome activity (p ≤ 0.002) was observed only after treatment with the highest potency of phosphorus (Phos 200cH), together with decreased apoptosis rate, intense parasite digestion, and the presence of non-internalized spores. CONCLUSIONS: Phos 200 cH has a modulatory action on the activity of infected macrophages, especially a specific increase in RANTES, a key element in the prognosis of E. cuniculi-infected and of immunosuppressed patients bearing infections.


Assuntos
Encephalitozoon cuniculi/efeitos dos fármacos , Macrófagos/efeitos dos fármacos , Fósforo/uso terapêutico , Animais , Encephalitozoon cuniculi/patogenicidade , Encefalitozoonose/tratamento farmacológico , Homeopatia/métodos , Homeopatia/normas , Macrófagos/microbiologia , Fosfatos/uso terapêutico , Coelhos
5.
Homeopathy ; 108(3): 158-168, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31005060

RESUMO

BACKGROUND: Aspirin is the oldest and possibly the most widely used pharmacologically active substance still used in allopathic medicine. Its effect on fever and inflammation has paved the way to its anti-thrombotic effect. Dilutions of aspirin have been tested for many years in the University of Bordeaux, in humans as well as in animal models. METHODS: This article is a review of the totality of articles published by the Laboratory of Hematology of the Faculty of Pharmacy of the University of Bordeaux, reporting different doses and dilutions of aspirin, different kinds of inhibitors, transgenic mice and animal models of disease such as portal hypertension and cirrhosis. RESULTS: Homeopathic dilutions of aspirin, notably 15 cH, have shown a pro-thrombotic effect in humans and in in-vivo animal studies. Longitudinal studies in rats have also shown an initial anti-thrombotic effect followed by a pro-thrombotic effect of aspirin several days after a single high-dose administration. This pro-thrombotic effect seems to act by inhibiting the cyclooxygenase (COX)-2 pathway in studies performed with COX selective inhibitors and in knock-out mice without COX-1 or COX-2. This effect may explain the thrombo-embolic complications described after aspirin withdrawal for the purposes of surgery or after non-compliance with anti-platelet therapy, and it may be beneficial in normalising primary haemostasis and decreasing haemorrhage in animal models of portal hypertension and cirrhosis. CONCLUSIONS: Aspirin 15 cH acts through the inhibition of the COX-2 pathway producing a clear pro-thrombotic effect. Further studies should clarify if the pro-thrombotic effect of aspirin withdrawal and the effect of aspirin 15 cH are related, as secondary effects of the same drug. Clarifying this last outcome may be of great significance to public health.


Assuntos
Aspirina/farmacologia , Hemorragia/tratamento farmacológico , Trombose/tratamento farmacológico , Animais , Aspirina/uso terapêutico , Inibidores de Ciclo-Oxigenase 2/farmacologia , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Modelos Animais de Doenças , Homeopatia/normas , Homeopatia/estatística & dados numéricos , Humanos , Camundongos , Ratos
6.
Homeopathy ; 108(3): 150-157, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30836407

RESUMO

BACKGROUND: Dengue is an emerging threat to public health. At present, no clear modalities are available for the prevention and management of thrombocytopenia due to dengue. This article reports the clinical outcomes of integrative homeopathic care in a hospital setting during a severe outbreak of dengue in New Delhi, India, during the period September to December 2015. METHODS: Based on preference, 138 patients received a homeopathic medicine along with usual care (H+UC), and 145 patients received usual care (UC) alone. Assessment of thrombocytopenia (platelet count < 100,000/mm3) was the main outcome measure. Kaplan-Meier analysis enabled comparison of the time taken to reach a platelet count of 100,000/mm3. RESULTS: There was a statistically significantly greater rise in platelet count on day 1 of follow-up in the H+UC group compared with UC alone (mean difference = 12,337; 95% confidence interval [CI], 5,421 to 19,252; p = 0.001). This trend persisted until day 5 (mean difference = 14,809; 95% CI, 1,615 to 28,004; p = 0.02). The time taken to reach a platelet count of 100,000/mm3 was nearly 2 days earlier in the H+UC group compared with UC alone (H+UC: 3.44 days ± standard error of the mean [SEM] 0.18; 95% CI, 3.08 to 3.80; UC: 5.28 days ± SEM 0.29; 95% CI, 4.71 to 5.86; p < 0.001). CONCLUSION: These results suggest a positive role of adjuvant homeopathy in thrombocytopenia due to dengue. Randomized controlled trials may be conducted to obtain more insight into the comparative effectiveness of this integrative approach.


Assuntos
Dengue/complicações , Homeopatia/normas , Trombocitopenia/tratamento farmacológico , Trombocitopenia/etiologia , Adolescente , Adulto , Quimioterapia Adjuvante/métodos , Estudos de Coortes , Dengue/tratamento farmacológico , Feminino , Homeopatia/métodos , Homeopatia/estatística & dados numéricos , Humanos , Índia , Masculino , Materia Medica/normas , Materia Medica/uso terapêutico , Resultado do Tratamento
7.
Homeopathy ; 108(1): 24-32, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30241107

RESUMO

BACKGROUND: A significant proportion of patients with cancer consult with homeopaths. No former qualitative study has reported on experiences with homeopathy in this patient group. This study aimed to learn about the reasons for, and experiences with, treatment provided by homeopaths among Danish patients with cancer. METHODS: A small qualitative semi-structured interview study was carried out to collect preliminary knowledge to learn about reasons for and experiences with treatment provided by homeopaths as an adjunct to usual care among patients with cancer. Thematic analysis was used for the development of themes. RESULTS: Five patients, diagnosed with cancer, were interviewed. On the basis of qualitative interviews five themes emerged: concerns and hopes, obstacles and support, internal health locus of control, whole person approach, and improved well-being. CONCLUSION: The cancer patients in this study sought homeopathy to address their hopes and concerns and to help them face obstacles and find support. They were actively taking responsibility for their own health and valued the whole person approach used by their homeopaths. Participants reported improved well-being both at the physical and mental levels. The results provide a basis for further research to learn more from patients' experiences with this intervention. Such knowledge could potentially be helpful to improve healthcare practitioners' communication with patients, and thereby patients' overall care.


Assuntos
Terapias Complementares/normas , Neoplasias/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Terapias Complementares/métodos , Dinamarca , Feminino , Homeopatia/métodos , Homeopatia/normas , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
8.
Homeopathy ; 108(1): 2-11, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30458554

RESUMO

BACKGROUND: During primary teething, children suffer from running nose, mild fever, diarrhoea and other mild irritations and inflammations. A public health programme, 'Homoeopathy for the Healthy Child', was undertaken on a pilot basis focusing on promotion of healthy teething by provision of home-based care through six pre-identified homeopathic medicines for complaints commonly observed during primary teething. This article assesses the feasibility of this programme and reports the impact of this initiative on teething profile in children and episodes of diarrhoea and upper respiratory tract infection (URTI). MATERIALS AND METHODS: Accredited Social Health Activists (ASHAs) were trained in child care and usage of a kit comprising six medicines, namely Calcarea phosphoricum 6X (CP), Ferrum phosphoricum 3X, Magnesium phosphoricum 6X, Belladonna 30C, Chamomilla 30C and Podophyllum 30C. Calcarea phosphoricum was given regularly to each participating child from 6 months to 1 year of age. Home-based care for diarrhoea, URTI and mild fever was provided by ASHAs using the other five medicines in the kit. Dentition pattern and diarrhoea/URTI episodes were recorded over a period of the next 12 months. RESULTS: Eleven thousand four-hundred and twenty-six children were followed up regularly. Amongst those who enrolled at 6-7 months, a larger proportion of children were approaching expected teething in successive months as compared with children enrolled at 12 months, thus indicating that teething delays, if any, were overcome during this period. Incidence of diarrhoea and URTI showed decrease in the months after enrolment. Children responded favourably to the medicines given by ASHAs at the time of diarrhoea/URTI episodes, and ASHAs expressed satisfaction with the programme. CONCLUSION: An approach with regular use of CP and home-based care with homeopathy through health workers for common problems in teething children is acceptable to the community and enhances outreach of services to the public at large. Observations in terms of the healthy teething period may be further validated through studies of homeopathy with suitable comparator group.


Assuntos
Saúde Pública/normas , Erupção Dentária , Diarreia/epidemiologia , Diarreia/etiologia , Homeopatia/métodos , Homeopatia/normas , Homeopatia/estatística & dados numéricos , Humanos , Índia/epidemiologia , Projetos Piloto , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Infecções Respiratórias/complicações , Infecções Respiratórias/epidemiologia
10.
Homeopathy ; 107(4): 229-243, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30121049

RESUMO

BACKGROUND: This study focuses on randomised controlled trials (RCTs) of individualised homeopathic treatment (IHT) in which the control (comparator) group was other than placebo (OTP). AIMS: To determine the comparative effectiveness of IHT on health-related outcomes in adults and children for any clinical condition that has been the subject of at least one OTP-controlled trial. For each study, to assess the risk of bias and to determine whether its study attitude was predominantly 'pragmatic' or 'explanatory'. METHODS: Systematic review. For each eligible trial, published in the peer-reviewed literature up to the end of 2015, we assessed its risk of bias (internal validity) using the seven-domain Cochrane tool, and its relative pragmatic or explanatory attitude (external validity) using the 10-domain PRECIS tool. We grouped RCTs by whether they examined IHT as an alternative treatment (study design Ia), adjunctively with another intervention (design Ib), or compared with a no-intervention group (design II). For each RCT, we identified a 'main outcome measure' to use in meta-analysis: 'relative effect size' was reported as odds ratio (OR; values >1 favouring homeopathy) or standardised mean difference (SMD; values < 0 favouring homeopathy). RESULTS: Eleven RCTs, representing 11 different medical conditions, were eligible for study. Five of the RCTs (four of which in design Ib) were judged to have pragmatic study attitude, two were explanatory, and four were equally pragmatic and explanatory. Ten trials were rated 'high risk of bias' overall: one of these, a pragmatic study with design Ib, had high risk of bias solely regarding participant blinding (a bias that is intrinsic to such trials); the other trial was rated 'uncertain risk of bias' overall. Eight trials had data that were extractable for analysis: for four heterogeneous trials with design Ia, the pooled OR was statistically non-significant; collectively for three clinically heterogeneous trials with design Ib, there was a statistically significant SMD favouring adjunctive IHT; in the remaining trial of design 1a, IHT was non-inferior to fluoxetine in the treatment of depression. CONCLUSIONS: Due to the low quality, the small number and the heterogeneity of studies, the current data preclude a decisive conclusion about the comparative effectiveness of IHT. Generalisability of findings is limited by the variable external validity identified overall; the most pragmatic study attitude was associated with RCTs of adjunctive IHT. Future OTP-controlled trials in homeopathy should aim, as far as possible, to promote both internal validity and external validity.


Assuntos
Homeopatia/métodos , Homeopatia/normas , Projetos de Pesquisa/normas , Homeopatia/tendências , Humanos
11.
Homeopathy ; 107(4): 244-263, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30144789

RESUMO

BACKGROUND: Homeopathy is controversial due to its use of very highly diluted medicines (high potencies/dynamisations). METHODS: We used a multi-technology approach to examine dilutions of two commonly used homeopathic medicines: an insoluble metal, Cuprum metallicum, and a soluble plant tincture, Gelsemium sempervirens, for the presence of nanoparticles (NPs) of original substance. The homeopathic medicines tested were specially prepared, according to the European pharmacopoeia standards. We compared the homeopathic dilutions/dynamisations with simple dilutions and controls. RESULTS: Using Mass Spectrometry (Single Particle-Inductively Coupled Plasma-Mass Spectrometry) and Dynamic Light Scattering (DLS) we could not find the expected copper in the 4cH potentisation and could not confirm the results previously obtained by Chikramane et al (2010). For Gelsemium medicines, using sensitive chromatography (HPLC-UV) up to a dilution level of 6 dH (3cH = dilution 10e-6), there was no significant difference in alkaloid content between a simple dilution and a homeopathic potency.For higher potentisations, however, NP tracking analysis findings revealed the presence of particles in all samples (except for pure water). The measurements showed large differences in particle quantities, mean particle sizes and standard deviations of the mean sizes between manufacturing lines of different starting material.There was always more material in potentised medicines than in potentised pure water. Gelsemium yielded the largest quantity of material (36 times more than that from copper at the same potentisation, 30 cH). The shapes and the chemical composition of the material are differentiable between different medicines and controls. CONCLUSION: Potentisation influences specifically the nature of NPs detected. This material demonstrates that the step-by-step process (dynamised or not) does not match with the theoretical expectations in a dilution process. The Avogadro/Loschmidt limit is not relevant at all. It was not possible to reproduce the findings of Chikramane et al (2010) using inductively coupled plasma-mass spectrometry with copper. Copper NPs could not be detected at 4cH and above.


Assuntos
Cobre/isolamento & purificação , Homeopatia/normas , Jasminum , Extratos Vegetais/isolamento & purificação , Difusão Dinâmica da Luz/métodos , Homeopatia/métodos , Humanos , Técnicas de Diluição do Indicador , Espectrometria de Massas/métodos , Nanopartículas/química
12.
Homeopathy ; 107(4): 280-291, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29908526

RESUMO

INTRODUCTION: The analysis of the periodic table of elements by Jan Scholten opened the way for a new kind of classification and repertorisation of homeopathic remedies. Thereby, group analysis (resorting to series and stages) makes precise prescriptions possible. This approach appears to yield striking results, even in severe cases. Whereas Hahnemann stressed the emotional state ('Gemüthssymptome', Organon § 210) when choosing a remedy, Scholten 200 years later investigated the mental picture that represents a life conflict or even a life theme that may maintain the disease process. The person's environment, emotional traumas or a conflict drives him or her to suppress and dissect painful emotions. Such compensations can become subconscious and so strong that they can no longer be controlled; they then influence the patient with a highly destructive energy. METHODS: We present five case reports, each dealing with an unusual clinical course of severe cancer associated with homeopathic treatment using the Scholten method. RESULTS: By presenting these cases, we consider how the constitution (lifelong signs and symptoms of the patient) and the mental state are interwoven and, as a complex mechanism, might provoke disease. CONCLUSION: The appropriate homeopathic remedy, reflecting the Scholten approach, seemed to have beneficial impact on the disease process of the five individuals presented.


Assuntos
Homeopatia/métodos , Neoplasias/tratamento farmacológico , Adulto , Idoso , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/psicologia , Bryonia/metabolismo , Compostos de Cálcio/uso terapêutico , Feminino , Homeopatia/normas , Humanos , Leucopenia/tratamento farmacológico , Leucopenia/psicologia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/psicologia , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/psicologia , Masculino , Mesotelioma/tratamento farmacológico , Mesotelioma/psicologia , Pessoa de Meia-Idade , Neoplasias/psicologia , Óxidos/uso terapêutico , Fósforo/uso terapêutico , Thuja/metabolismo
13.
Nervenarzt ; 89(9): 1014-1019, 2018 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-29858643

RESUMO

The application of homeopathic treatment quickly becomes a matter of ideological confrontation; however, homeopathy is steadily gaining in sympathy in the population. Although the possible effectiveness and the modes of action are currently not scientifically elucidated and the study situation regarding homeopathic treatment in psychiatry is still manageable, there is a whole series of positive evidence for the effects of homeopathic remedies for mental disorders, such as depression, anxiety disorders and addiction. The most important studies are presented and the most important arguments are weighed up with respect to the pros and cons. It is clear that homoeopathic remedies can only be used as an add-on and not alone. These remedies belong in the hands of physicians experienced in homeopathic and psychiatric psychopharmacology. It would be advisable to at least try out homeopathy for the well-being of the patient not only in the case of very mild disorders but also in severe chronic cases, since due to the generally good tolerability, no avoidable disadvantage should result.


Assuntos
Homeopatia , Transtornos Mentais , Psiquiatria , Homeopatia/normas , Humanos , Transtornos Mentais/terapia , Psiquiatria/métodos
17.
Homeopathy ; 106(4): 194-202, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29157469

RESUMO

BACKGROUND: The comprehensive systematic review of randomised placebo-controlled trials (RCTs) in homeopathy requires examination of a study's model validity of homeopathic treatment (MVHT) as well as its risk of bias (extent of reliable evidence). OBJECTIVE: To appraise MVHT in those RCTs of non-individualised homeopathy that an associated investigation had judged as 'not at high risk of bias'. DESIGN: Systematic review. METHODS: An assessment of MVHT was ascribed to each of 26 eligible RCTs. Another 49 RCTs were ineligible due to their high risk of bias. MAIN OUTCOME MEASURES: MVHT and the prior risk of bias rating per trial were merged to obtain a single overall quality designation ('high', 'moderate', 'low'), based on the GRADE principle of downgrading. RESULTS: The trials were rated as 'acceptable MVHT' (N = 9), 'uncertain MVHT' (N = 10) and 'inadequate MVHT' (N = 7); and, previously, as 'reliable evidence' (N = 3) and 'non-reliable evidence' (N = 23). The 26 trials were designated overall as: 'high quality' (N = 1); 'moderate quality' (N = 18); 'low quality' (N = 7). CONCLUSION: Of the 26 RCTs of non-individualised homeopathy that were judged 'not at high risk of bias', nine have been rated 'acceptable MVHT'. One of those nine studies was designated 'high quality' overall ('acceptable MVHT' and 'reliable evidence'), and is thus currently the only reported RCT that represents best therapeutic practice as well as unbiased evidence in non-individualised homeopathy. As well as minimising risk of bias, new RCTs in this area must aim to maximise MVHT and clarity of reporting.


Assuntos
Ética em Pesquisa , Homeopatia/normas , Projetos de Pesquisa/normas , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
Homeopathy ; 106(4): 214-222, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29157471

RESUMO

BACKGROUND: Host immunity plays an important role in prevention of disease as is evident by the increased incidence of Tuberculosis (TB) in immuno-compromised population of HIV infected, diabetes inflicted, immune-suppressant therapy and elderly people. Rising incidence of antibiotic resistance has led to resurgence of TB of epidemic proportions. Integrated treatment with add on homeopathy in addition to anti-tuberculosis treatment (ATT) appears to improve outcome in TB. The intervention has been integrated treatment with homeopathy regime, which is using a patient specific, disease specific and supportive medicine simultaneously, all individualized for the patient and the disease. CASES: CASE 1: Pott's spine with paravertebral abscess, not responding to ATT. Addition of homeopathy led to fall in temperature, improved appetite, increase in weight and reduction of abscess. CASE 2: Recurrent sub-acute intestinal obstruction. The patient could not tolerate ATT but responded to homeopathy by reduction of abdominal pain and distension, vomiting, loose stools and queasiness. CASE 3: Pulmonary TB, treated with both ATT and homeopathy from beginning, led to rapid recovery and shortened treatment time. CONCLUSION: The addition of homeopathy to ATT is patient friendly, cost effective and appears to reduces the duration of treatment. Its role as immuno-modulatory therapy should be evaluated and explored.


Assuntos
Gerenciamento Clínico , Homeopatia/métodos , Homeopatia/normas , Tuberculose/terapia , Adulto , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Feminino , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Tuberculose da Coluna Vertebral/tratamento farmacológico
19.
Recenti Prog Med ; 108(3): 117-119, 2017 03.
Artigo em Italiano | MEDLINE | ID: mdl-28398404

RESUMO

After more than two centuries since the inception of homeopathy, it can now be stated that active ingredients of homeopathic drug products are approaching zero. Homeopathy has never been shown to be effective, and several Cochrane reviews failed to provide evidence for the effectiveness of homeopathy. In addition, according to the World Health Organization, when homeopathic medicine is used as an alternative to other effective treatments, it may cause harm resulting in increased mortality. On the basis of these considerations, it is of utmost importance that millions of Italian people taking homeopathic remedies be informed on the negative judgment by the scientific community, so that allocation of limited healthcare resources can be better redirected to increase patient access to treatments not otherwise available due to restrictions on healthcare budgets (e.g. hepatitis C medications).


Assuntos
Instituições de Assistência Ambulatorial , Acesso aos Serviços de Saúde , Homeopatia/normas , Materia Medica/uso terapêutico , Humanos , Itália , Materia Medica/efeitos adversos , Resultado do Tratamento
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