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| ORIGINAL ARTICLE |
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| Year : 2021 | Volume
: 15
| Issue : 2 | Page : 123-136 |
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A group of homoeopathic medicines for COVID-19: A systematic review of clinical features
Horacio Miguel De La Luz Escalante1, Nazmul Hasan2, Adriana Gonzalez Delgado3, Salvador Gonzalez Soto4, Jessica Maria García Vivas5
1 National Polythechnic Institute, National School of Medicine and Homeopathy, Medical Surgeon and Homeopath program, Mexico City, Mexico
2 Dr. Nazmul's Chamber, Dhaka, Mirpur-1, Bangladesh
3 National Polythechnic Institute, National School of Medicine and Homeopathy, Medical Surgeon and Homeopath program; University of Health, Subdirectorate of academic training, Mexico City, Mexico
4 National Polythechnic Institute, National School of Medicine and Homeopathy, Medical Surgeon and Homeopath program; National Polythechnic Institute, National School of Medicine and Homeopathy, Homeopathic Therapeutics Postgraduated program, Mexico City, Mexico
5 National Polythechnic Institute, National School of Medicine and Homeopathy, Medical Surgeon and Homeopath program; National Polythechnic Institute, National School of Medicine and Homeopathy, Homeopathic Therapeutics Postgraduated program, Mexico City; Dr. Nazmul's Chamber, Dhaka, Mirpur-1, Bangladesh
| Date of Submission | 12-Nov-2020 |
| Date of Acceptance | 31-May-2021 |
| Date of Web Publication | 29-Jun-2021 |
Correspondence Address:
Dr. Horacio Miguel De La Luz Escalante
National Polytechnic Institute, National School of Medicine and Homeopathy, Medical Surgeon and Homeopath program, Mexico City
Mexico
Dr. Jessica Maria García Vivas
Homeopathy Research Laboratory, National School of Medicine and Homeopathy of National Polytechnic Institute, Guillermo Massieu Helguera 239 Fracc. La Escalera C.P 07320, Mexico City
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijrh.ijrh_106_20
Background: Historically, several homoeopathic medicines are known to have attributed a significant role in the control and management of infectious epidemic diseases. Objectives: This study aimed to compile a list of prospective homoeopathic medicines for the treatment and prophylaxis of the COVID-19 epidemic by conducting a systematic review and statistical analysis of clinical characteristics of this emerging coronavirus disease. Materials and Methods: A> systematic review protocol was developed according to the reporting items of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Articles for review were selected from PubMed, World Health Organization database, MedRxiV, and BioRxiv. Studies in English and simplified Chinese from December 2019 to March 26 2020 were included. Data on clinical characteristics, laboratory and CT chest results of COVID-19 were extracted and analysed. Several symptoms and their intensity were statistically analysed. Results: Seventy-three studies were included. Amongst COVID-19 patients, fever (119.869 ± 24.425 [95% confidence intervals: 71.149–168.589]), dry cough (91.028 ± 19.555 [52.007–130.050]) and dyspnoea (24.594 ± 5.949 [12.722–36.465]) were the most common symptoms. Leucopenia (16.06 ± 5.07 [5.95–26.18]) in blood, ground-glass opacity (62.23 ± 18.82 [24.74–99.72]), patchy (21.48 ± 12.36 [3.13–46.11]) and consolidation (18.67 ± 9.18 [0.373–36.968]) in the lungs were observed. The selected sign and symptoms were repertorised, which resulted in a list of multiple homoeopathic medicines as potential medicines for COVID-19, led by Arsenic Album (94.59%) and Bryonia alba (91.89%). Conclusion: Considering the current clinical manifestations, this is a pioneer study related to finding a plausible list of homoeopathic medicines that might help the profession in the treatment as well as to select a prophylactic of COVID-19 disease.
Keywords: 'Coronavirus, 'COVID-19', 'Genus epidemicus', 'Homoeopathy'
How to cite this article:
Escalante HM, Hasan N, Delgado AG, Soto SG, Vivas JM. A group of homoeopathic medicines for COVID-19: A systematic review of clinical features. Indian J Res Homoeopathy 2021;15:123-36 |
How to cite this URL:
Escalante HM, Hasan N, Delgado AG, Soto SG, Vivas JM. A group of homoeopathic medicines for COVID-19: A systematic review of clinical features. Indian J Res Homoeopathy [serial online] 2021 [cited 2021 Oct 27];15:123-36. Available from: https://www.ijrh.org/text.asp?2021/15/2/123/319606 |
| Introduction | |  |
Several viral pneumonia cases occurred in Wuhan, China in December 2019, caused by a novel coronavirus,[1] which declared COVID-19 as a pandemic.[2],[3] Historically, several homoeopathic medicines attributed a significant role in the control and management of infectious epidemic diseases including scarlet fever (1799), asiatic cholera (1831), Spanish flu (1920), keratoconjunctivitis (1995) and Chikungunya (2007).[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14]
Enumerating an epidemic region as a 'single patient' may help to describe all the striking symptoms (including peculiar, uncommon, redline and single symptoms) which can lead to an effective Genus epidemicus medicine.[15],[16],[17],[18]
A group of experts from Ministry of AYUSH, the Indian ministry of alternative medicine, has recommended homoeopathic medicine arsenic album 30C for protection against coronavirus infection.[19] We have collected the latest studies about the clinical characteristics of COVID-19 and conducted this systematic review and statistical analysis in different populations to provide references for finding the most indicated medicines for COVID-19.
| Materials and Methods | | |
Study design
This study followed a preliminary exploratory and descriptive design. The study was conducted to find contemporary clinical manifestations of COVID-19 and analyse them to sort homoeopathic specific medicines, denominated as the most indicated medicines list.
Search databases and search strategies
A systematic review was performed and is being reported according to the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' (PRISMA) statement. We searched four databases PubMed, Global literature on coronavirus disease of World Health Organization database, MedRxiv, and BioRxiv, to identify studies reporting COVID-19. The following keywords existing in MeSH were used in the search: 'clinical findings' or 'clinical characteristics' or 'Signs' and 'Symptoms' and 'COVID-19'.
Inclusion and exclusion criteria
Articles that were published in English and Chinese from December 2019 to 26th March 2020, were considered for this study. Irrespective of any design, based on the title and abstract, the articles were listed as a primary inclusion criterion. This also included diagnosed patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were treated in intensive care unit; and the clinical features of the patients who died due to SARS-CoV-2 were also considered. The considered clinical features comprised of subjective symptoms and signs, laboratory findings, abnormal Computed Tomography (CT) imaging results, forensic reports and comorbidities.
Non-English or Chinese articles that were published more than once, and those that presented with insufficient data on clinical characteristics were not included in the systematic review.
Data extraction and quality assessment
All the articles were critically appraised using the Methodological index for non-randomized studies (MINORS).[20] Microsoft Excel database was used to record all available information. Data extraction, when available, included demographic information, clinical characteristics, abnormal chest computer tomography (CT) results, laboratory findings, the illness onset of the symptoms, comorbidities and deaths of patients.
Data analysis
We performed data analysis using meta-packages in STATA/IC 15.1.(STATA/ IC 15.1, StataCorp LLC, College Satation, Texas, USA) We first unified all units of variables and then, expressed continuous variables as mean (standard deviation) ± standard error (SE). The pooled estimated prevalence with 95% confidence intervals (95% CI) of clinical symptoms, laboratory findings and chest CT findings of COVID-19 patients were calculated using a random-effects model because high variability between studies was expected.
Selection of the most indicated medicines
To perform effectively and efficiently, a systematic approach was adopted which is as follows. The results from signs and symptoms, abnormal chest computer tomography (CT), laboratory findings and comorbidities of COVID-19 were used for constructing an epidemiological profile.
After observing the totality of clinical characteristics, both the common symptoms of the disease, as well as uncommon or peculiar symptoms found in most patients suffering from COVID-19, were converted into the repertory language. After analysing the chest CT findings, considering their pathophysiology, and its patterns of clinical manifestations, they were included into repertorisation. In this regard, we used the Complete Repertory Database from Hompath Zomeo Repertory Software version 13.7.2®.(Hompath Zomeo Repertory Software version 13.7.2®, Mind Technologies Pvt Ltd 8, Mumbai, India)[21] We also validated the equity of the data using Radar 10®[22] software that is counted in the supplementary material [Supplementary Table 1[Additional file 1]], [Supplementary Table 2[Additional file 2]], [Supplementary Table 3[Additional file 3]], [Supplementary Table 4][Additional file 4].
The selection of the homoeopathic medicines for COVID-19 was done by the standard method of determining the Genus epidemicus and a statistical approach. To complete and fulfil the totality of symptoms, according to homoeopathic philosophy, few common mental symptoms were added in the repertorisation. The number of symptoms and their intensity covered for every homoeopathic medicine was statistically analysed. Means ± SE and 95% CI were calculated to describe the distributions of categorical and continuous variables, respectively. The baseline data were analysed using the Stata version 15.1 software (STATA/ IC 15.1, StataCorp LLC, College Satation, Texas, USA).
| Results | | |
Research selection and quality assessment
A total of 266 articles were selected for the study; after deleting duplicates, a sum of 241 records was retained, of which 51 were excluded based on the title or abstract. Then, 92 were eliminated due to lack of information on clinical characteristics. Finally, 25 were eliminated after reading the full text, and a total of 73 articles were included in this study[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37],[38],[39],[40],[41],[42],[43],[44],[45],[46],[47],[48],[49],[50],[51],[52],[53],[54],[55],[56],[57],[58],[59],[60],[61],[62],[63],[64],[65],[66],[67],[68],[69],[70],[71],[72],[73],[74],[75],[76],[77],[78],[79],[80],[81],[82],[83],[84],[85],[86],[87],[88],[89],[90],[91],[92],[93],[94],[95],[96] [Figure 1]. | Figure 1: Flow diagram of the number of studies screened and included in the study
Click here to view |
Demographic characteristics and comorbidities
The study of clinical data included 73 studies with 11,139 patients. [Table 1] summarizes the demographic characteristics and comorbidities of included studies. The mean age of the patients with SARS-CoV-2 infection was 44.72 (95% CI: 40.92–48.52); the mean of male patients was 75.45 and 66.35 female. The results of the comorbidities examination showed that hypertension (23.97±, 95% CI: 13.86–34.07), diabetes (11.81±, 95% CI: 6.88–16.75), and cardiovascular disease (6.67±, 95% CI: 4.04–9.30) were more common in these patients [Figure 2].
Clinical presentation
We found that the main clinical symptoms of COVID-19 patients were fever (119.86 ± 24.42, 95% CI: 71.14–168.58), chillness (6.31 ± 3.00, 95% CI: 0.32–12.31), dry cough (91.02 ± 19.55, 95% CI: 52.00–130.05), fatigue (41.76 ± 11.02, 95% CI: 19.76–63.77), and dyspnoea (24.59 ± 5.94, 95% CI: 12.72 - 36.46); all symptoms and distribution are reported in [Table 2] and [Figure 3].
Laboratory findings
The laboratory findings of the patients showed decreased white blood cell count (16.06 ± 5.07, 95% CI: 5.95 -26.18), decreased neutrophil count (5.54 ± 1.93, 95% CI: 1.69–9.40), increased lymphocyte count (6.91 ± 3.25, 95% CI: 0.56–1.51) and decreased haemoglobin levels (5.67 ± 3.14, 95% CI: −0.59–11.94), and total data regarding laboratory results of COVID-19 patients is reported in [Table 3] and [Figure 4] and [Figure 5]. | Figure 4: Box plot of the incidence of laboratory tests of COVID-19 patients. White blood cells count (×10⁹/L), lymphocyte count (×10⁹/L), neutrophil count (×10⁹/L), haemoglobin (g/dL), platelets count (×10⁹/L) and D-dimer (mg/L)
Click here to view |
 | Figure 5: Box plot of the incidence of increased and decreased laboratory results of COVID-19 patients. White blood cells, lymphocyte, neutrophil, haemoglobin, platelets and D-dimer
Click here to view |
Chest CT findings
In the chest CT findings, it was found that the pneumonia was bilateral (46.5 ± 11.60, 95% CI: 23.37 -69.62), compromised in the right lung (1.13 ± 0.64, 95% CI: −0.14–2.41), involving predominantly lower lobe and upper lobe and peripheral distribution; total data incidence of chest CT lesions distribution is shown in [Table 4] and [Figure 6].
Ground-glass opacity (62.23 ± 18.82, 95% CI: 24.74–99.72), patchy lesions (21.48 ± 12.36, 95% CI: −3.13–46.11) and consolidation (18.67 ± 9.18, 95% CI: 0.37–36.96) were the most frequent chest CT findings; total data incidence of chest CT findings is shown in [Table 5] and [Figure 7].
The most indicated medicines of COVID-19
By summarising clinical symptoms, laboratory findings, chest CT scan and comorbidities, we constructed an epidemiological profile of COVID-19 according to our statistical analysis [Table 6].
The repertorisation is shown in [Table 7]. Other repertorisations are included in the supplementary material [Supplementary Table 1], [Supplementary Table 2], [Supplementary Table 3], [Supplementary Table 4]. Finally, a total of 37 symptoms were selected and evaluated for repertorisation according to the epidemiological profile of COVID-19. A total of 1684 medicines coincided with the symptoms repertorised.
According to the totality of symptoms and their intensity, we found that the Arsenicum album covered 94.59% of symptoms (35/37, did not cover: pain, body, all over and chest, inflammation, lungs, pneumonia and bronchopneumonia) with high intensity (3.108 ± 0.228, 95% CI: 2.64–3.57) and total intensity of 115.
Bryonia alba covered 91.89% of symptoms (34/37, did not cover: appetite, defective, loss anorexia; heart and circulation, thrombosis and heart and circulation, embolism) with high intensity (3.108 ± 0.218, 95% CI: 2.66–3.55) and total intensity of 115.
Phosphorus covered 91.89% of symptoms (34/37, did not cover: respiration, difficulty and pain, during: Chest, in; pain, body, all over; and chest, inflammation, lungs, pneumonia, apex, upper) with high intensity (3.108 ± 0.200, 95% CI: 2.70–3.51) and total intensity of 109, total statistical analysis of symptoms and their intensity from the most indicated medicines list for COVID-19 are shown in [Table 8] and [Figure 8]. | Figure 8: Box plot of the intensity of symptoms of the most indicated medicines list for COVID-19
Click here to view |
| Discussion | | |
In this study, we analysed 73 studies that happened from December 2019 to March 2020, counted numerous laboratory findings and radiological images. Clinical data of 11,139 patients' clinical data was reviewed to get a complete out-print of COVID_19. A wide variety of clinical presentations was observed in COVID_19, ranging from asymptomatic to critical states. Adults with various comorbidities including hypertension, diabetes, chronic kidney diseases and cardiovascular disease were more vulnerable than children.[32],[96]
This study summarised general symptoms of COVID-19 which included fever, chilliness, headache, dry cough, sore throat, chest pain, dyspnoea, anorexia and malaise. Furthermore, nausea, vomiting, and diarrhoea were obvious in some patients. In the recent past, researchers reported diarrhoea in Middle East respiratory syndrome-CoV and SARS-CoV in 30% and 10.6% of patients, respectively. Some other researchers indicated that SARS-CoV-2 has an increased affinity to angiotensin-converting enzyme 2 in the intestine which indicates gastrointestinal symptoms also should be considered in diagnosing COVID-19.[97],[98]
Haematological reports showed leucocytopenia, neutropenia, decreased haemoglobin, thrombocytopenia and elevated D-dimer. These findings suggest that COVID-19 may interfere with haematopoiesis. The inflammatory response initiated by SARS-CoV-2 may facilitate disseminated intravascular coagulation which reflects the severity of COVID-19.[99],[100],[101]
Our study upholds that ground-glass opacity, patchy lesions and consolidations are the distinctive radiological marks in COVID-19 patients, which is consistent with previous studies.[102],[103],[104] We also observed both the upper and lower lobes are involved along with the peripheral lung field; this indicates patients with COVID-19 symptoms should undergo computed tomography (CT) test as an alternative to real-time polymerase chain reaction to confirm.[105]
Recently, several studies have demonstrated the successful application of the Genus epidemicus concept in the epidemics of chikungunya and dengue.[7],[8],[9],[10] Following the same theory, another successful study was conducted in rabbits.[106],[107] Considering the initial symptoms, the Ministry of AYUSH, India, suggested official guidelines for homoeopathic practitioners which are consistent with our findings.[19],[108] A case study of 18 symptomatic COVID-19 patients in Hong Kong reported the successful use of Gelsemium sempervirens in 12 patients, Bryonia alba in four patients, Eupatorium perfoliatum in one patient, and Arsenicum album in only one patient.[109]
To the best of our knowledge, this current epidemiological study is a unique one to determine Hahnemann's Genus epidemicus of COVID-19 [Table 6], as this study considered and repertorised all clinical symptoms along with laboratory tests and radiological findings. The mental symptoms were not clear in COVID-19, till the time this study was conducted to fulfil the homoeopathic approach. We found Bryonia alba, Arsenic album, Phosphorus, Sulphur, Pulsatilla nigre, Lycopodium clavatum, Aconitum napellus, Nux vomica, Belladonna, Calcarea carbonica, etc., are prioritised in the list of the most indicated medicines for COVID-19. The selection of individualised homoeopathic medicine is based on a patient's presenting clinical manifestations and individualised characteristics including mental symptoms.[15] Moreover, the peculiar, rare and strange symptoms of all stages of COVID-19 and patients of different geographical regions should be considered.[16] Unfortunately, these individualised features with mental symptoms were not documented in the COVID-19 studies included in the review. However, to satisfy our quest based on Homoeopathy perspective of case description, we added 'fear of disease', 'fear of death' and 'anxiety about health' as common mental symptoms; [Table 6] and as expected, found a shuffle in the list of medicines [Figure 7].
We accept that there are limitations of this study including a lack of case studies and a control trial study to prove this theory. Furthermore, homoeopathic system of natural medicine is still facing criticism due to deficient work in identifying the bioactive agent and its mode of action pathway.
| Conclusion | | |
A list of homoeopathic medicines identified in the paper might be helpful in the treatment of COVID-19 patients. Case studies and randomised clinical trials based on this analysis are welcome for further confirmation. We also raise our hands in favour of using homoeopathic medicines along with conventional medicines for a holistic approach.
Financial support and sponsorship
Nil.
Conflicts of interest
None declared.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]
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