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Ghosh S, Palanisamy C, Das AD, Mandal S, Guha N, Maiti S, Ghosh P, Singh NK, Koley M, Saha S. Efficacy of Individualized Homeopathic Medicines in the Treatment of Menopausal Syndrome: Double-Blind, Randomized, Placebo-Controlled Trial. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:649-664. [PMID: 37222798 DOI: 10.1089/jicm.2022.0760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Objectives: Menopausal symptoms are systemic symptoms that are associated with estrogen deficiency after menopause. Although widely practiced, homeopathy remains under-researched in menopausal syndrome in terms of quality evidence, especially in randomized trials. The efficacy of individualized homeopathic medicines (IHMs) was evaluated in this trial against placebos in the treatment of the menopausal syndrome. Design: Double-blind, randomized (1:1), two parallel arms, placebo-controlled trial. Setting: Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Howrah, West Bengal, India. Subjects: Sixty women with menopausal syndrome. Interventions: Group 1 (n = 30; IHMs plus concomitant care; verum) versus group 2 (n = 30; placebos plus concomitant care; control). Outcome measures: Primary-the Greene climacteric scale (GCS) total score and menopause rating scale (MRS) total score, and secondary-the Utian quality of life (UQOL) total score; all of them were measured at baseline and every month up to 3 months. Results: Intention-to-treat sample (n = 60) was analyzed. Group differences were examined by two-way (split-half) repeated-measure analysis of variance, primarily taking into account all the estimates measured at monthly intervals, and secondarily, by unpaired t tests comparing the estimates obtained individually every month. The level of significance was set at p < 0.025 two-tailed. Between-group differences were nonsignificant statistically-GCS total score (F1, 58 = 1.372, p = 0.246), MRS total score (F1, 58 = 0.720, p = 0.4), and UQOL total scores (F1, 58 = 2.903, p = 0.094). Some of the subscales preferred IHMs significantly against placebos-for example, MRS somatic subscale (F1, 56 = 0.466, p < 0.001), UQOL occupational subscale (F1, 58 = 4.865, p = 0.031), and UQOL health subscale (F1, 58 = 4.971, p = 0.030). Sulfur and Sepia succus were the most frequently prescribed medicines. No harm or serious adverse events were reported from either group. Conclusions: Although the primary analysis failed to demonstrate clearly that the treatment was effective beyond placebo, some significant benefits of IHMs over placebo could still be detected in some of the subscales in the secondary analysis. Clinical trial registration number: CTRI/2019/10/021634.
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Affiliation(s)
- Shubhamoy Ghosh
- Department of Pathology & Microbiology, D.N. De Homoeopathic Medical College and Hospital, The West Bengal University of Health Sciences, Government of West Bengal, Kolkata, West Bengal, India
- Department of Pathology & Microbiology, Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, The West Bengal University of Health Sciences, Government of West Bengal, Howrah, West Bengal, India
| | - Chithra Palanisamy
- Department of Case Taking and Repertory, Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Howrah, West Bengal, India; Affiliated to The West Bengal University of Health Sciences
| | - Aakash Deep Das
- Department of Case Taking and Repertory, Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Howrah, West Bengal, India; Affiliated to The West Bengal University of Health Sciences
- Department of Repertory, JIMS Homoeopathic Medical College & Hospital, The Kaloji Narayana Rao University of Health Sciences, Shamshabad, Telangana, India
| | - Sanjukta Mandal
- Department of Forensic Medicine and Toxicology, Bengal Homoeopathic Medical College and Hospital, The West Bengal University of Health Sciences, Asansol, West Bengal, India
- Department of Materia Medica, Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, The West Bengal University of Health Sciences, Government of West Bengal, Howrah, West Bengal, India
| | - Nilanjana Guha
- Department of Materia Medica, Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, The West Bengal University of Health Sciences, Government of West Bengal, Howrah, West Bengal, India
- Department of Cancer Epidemiology, Tata Memorial Center, Varanasi, India
| | - Shukdeb Maiti
- National Tuberculosis Elimination Program Wing, Imambara Sadar Hospital, Chinsurah, Hooghly, West Bengal
- Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Government of West Bengal, The West Bengal University of Health Sciences, Howrah, West Bengal, India
| | - Priyanka Ghosh
- Department of Organon of Medicine and Homoeopathic Philosophy, D.N. De Homoeopathic Medical College and Hospital, The West Bengal University of Health Sciences, Government of West Bengal, Kolkata, West Bengal, India
| | - Navin Kumar Singh
- Department of Repertory, The Calcutta Homoeopathic Medical College and Hospital, The West Bengal University of Health Sciences, Government of West Bengal, Kolkata, West Bengal, India
| | - Munmun Koley
- Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Government of West Bengal, The West Bengal University of Health Sciences, Howrah, West Bengal, India
- East Bishnupur State Homoeopathic Dispensary, Chandi Daulatabad Block Primary Health Centre, Under Department of Health & Family Welfare, Government of West Bengal, West Bengal, India
| | - Subhranil Saha
- Department of Repertory, D. N. De Homoeopathic Medical College and Hospital, The West Bengal University of Health Sciences, Government of West Bengal, Kolkata, West Bengal, India
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Degez M, Caillon H, Chauviré-Drouard A, Leroy M, Lair D, Winer N, Thubert T, Le Floch P, Desroys du Roure V, Randet M, Ducarme G, Dochez V. HE4 in the Diagnostic Approach of Endometrial Cancer in Patients with Postmenopausal Bleeding, the METRODEC Protocol: Protocol for a Multicenter Prospective Study. Diagnostics (Basel) 2021; 11:diagnostics11071274. [PMID: 34359357 PMCID: PMC8304032 DOI: 10.3390/diagnostics11071274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/08/2021] [Accepted: 07/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Endometrial cancer is the most common pelvic gynecological cancer in France. The most frequent symptom is post-menopausal bleeding and is one of the primary reasons for consultation in gynecological emergencies. The treatment is very codified and consists of a surgical intervention for anatomopathological analysis. The latter is frequently reassuring. These interventions are often performed in mild situations and there is currently no element to be sufficiently reassuring to avoid surgery. This study aims to explore the sensitivity of an innovative marker: Human Epididymis 4 (HE4) in the diagnosis approach of endometrial cancer in case of postmenopausal bleedings. Methods: This is a prospective multicenter diagnostic study with three centers involved. Inclusion criteria are any patient with post-menopausal bleeding who is to undergo hysteroscopy, endometrial biopsy, or endometrial resection. In accordance with the recommendations for the management of post-menopausal bleedings, the medical conduct consists of performing a clinical examination, an ultrasound and, in general, even in case of paraclinical examination reassuring, an anatomopathological analysis. This pathological analysis can be obtained in several ways: biopsy, hysteroscopy-curettage (which is the most frequently performed surgery), and hysterectomy. Our protocol consists of taking a blood sample from each woman who will undergo one of the interventions mentioned above. The dosage of HE4 and CA125 requires the withdrawal of an additional heparinized tube during the preoperative assessment usually performed. This research is therefore classified as non-interventional. The primary outcome is to evaluate the sensitivity of the HE4 marker in patients with postmenopausal bleeding in the diagnosis of endometrial cancer. The secondary outcomes are other parameters (specificity, VPP, VPN) of HE4, Evaluating the diagnostic capabilities of the CA125 marker alone and associated with HE4, as well as those of the REM and REM-B algorithms. We aim to include 100 patients over a period of one year in three centers. Discussion: As of now, there is no biological marker used in routine practice in the diagnosis of endometrial cancer. The ultimate goal of HE4 in endometrial cancer is to avoid surgery for those who are identified as non-sick. This study is the precursor of others for use in routine practice, HE4 would represent a great help to diagnosis if our study demonstrates it as reliable in the management of these patients and avoid many unnecessary and risky surgeries.
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Affiliation(s)
- Manon Degez
- Service de Gynécologie-Obstétrique, CHU de Nantes, 44000 Nantes, France; (M.D.); (N.W.); (T.T.)
| | - Hélène Caillon
- Service de Biochimie, CHU de Nantes, 44000 Nantes, France;
| | - Anne Chauviré-Drouard
- Centre d’Investigation Clinique CIC 1413, INSERM, CHU de Nantes, 44000 Nantes, France;
| | - Maxime Leroy
- Plateforme de Biométries et Biostatistiques, CHU de Nantes, 44000 Nantes, France;
| | - David Lair
- Département Promotion, Direction de la Recherche, CHU de Nantes, 44000 Nantes, France;
| | - Norbert Winer
- Service de Gynécologie-Obstétrique, CHU de Nantes, 44000 Nantes, France; (M.D.); (N.W.); (T.T.)
- Centre d’Investigation Clinique CIC 1413, INSERM, CHU de Nantes, 44000 Nantes, France;
| | - Thibault Thubert
- Service de Gynécologie-Obstétrique, CHU de Nantes, 44000 Nantes, France; (M.D.); (N.W.); (T.T.)
- Centre d’Investigation Clinique CIC 1413, INSERM, CHU de Nantes, 44000 Nantes, France;
| | - Pauline Le Floch
- Unité de Recherche Clinique, CH de Saint-Nazaire, 44600 Saint-Nazaire, France;
| | | | - Mélanie Randet
- Service de Gynécologie-Obstétrique, CH de Saint-Nazaire, 44600 Saint-Nazaire, France;
| | - Guillaume Ducarme
- Service de Gynécologie-Obstétrique, CH Départemental Vendée, 85000 La Roche sur Yon, France;
| | - Vincent Dochez
- Service de Gynécologie-Obstétrique, CHU de Nantes, 44000 Nantes, France; (M.D.); (N.W.); (T.T.)
- Centre d’Investigation Clinique CIC 1413, INSERM, CHU de Nantes, 44000 Nantes, France;
- Correspondence: ; Tel.: +33-240-08-78-00
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