Effect of Adjuvant Homeopathy with Usual Care in Management of Thrombocytopenia Due to Dengue: A Comparative Cohort StudyFunding This study was funded by the Central Council for Research in Homoeopathy, New Delhi, India.
22. Juli 2018
10. November 2018
05. März 2019 (online)
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.
• One hundred and thirty-eight patients took homeopathy along with usual care (H+UC) and 145 patients were given usual care (UC) alone.
• Comparative analysis showed significantly greater rise in platelet count on day 1 of follow-up in the H+UC group compared with UC alone.
• 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.
• These results suggest a positive role of adjuvant homeopathy in thrombocytopenia due to dengue.
- 1 World Health Organization. Dengue guideline for diagnosis, treatment, prevention and control. Geneva: World Health Organization; 2009
- 2 Vikram K, Nagpal BN, Pande V. , et al. An epidemiological study of dengue in Delhi, India. Acta Trop 2016; 153: 21-27
- 3 National Vector Borne Disease Control Program. Dengue. Govt. of India. Accessed January 9, 2019; Available at: http://nvbdcp.gov.in/index4.php?lang=1&level=0&linkid=431&lid=3715
- 4 Shepard DS, Halasa YA, Tyagi BK. , et al; INCLEN Study Group. Economic and disease burden of dengue illness in India. Am J Trop Med Hyg 2014; 91: 1235-1242
- 5 Chaudhary R, Khetan D, Sinha S. , et al. Transfusion support to dengue patients in a hospital based blood transfusion service in north India. Transfus Apheresis Sci 2006; 35: 239-244
- 6 Lee MS, Hwang KP, Chen TC, Lu PL, Chen TP. Clinical characteristics of dengue and dengue hemorrhagic fever in a medical center of southern Taiwan during the 2002 epidemic. J Microbiol Immunol Infect 2006; 39: 121-129
- 7 Sharma A, Charles K, Chadee D, Teelucksingh S. Dengue hemorrhagic fever in Trinidad and Tobago: a case for a conservative approach to platelet transfusion. Am J Trop Med Hyg 2012; 86: 531-535
- 8 Lee TH, Wong JG, Leo YS. , et al. Potential harm of prophylactic platelet transfusion in adult dengue patients. PLoS Negl Trop Dis 2016; 10: e0004576
- 9 Lye DC, Archuleta S, Syed-Omar SF. , et al. Prophylactic platelet transfusion plus supportive care versus supportive care alone in adults with dengue and thrombocytopenia: a multicentre, open-label, randomised, superiority trial. Lancet 2017; 389: 1611-1618
- 10 Kurukularatne C, Dimatatac F, Teo DL, Lye DC, Leo YS. When less is more: can we abandon prophylactic platelet transfusion in Dengue fever?. Ann Acad Med Singapore 2011; 40: 539-545
- 11 Whitehorn J, Rodriguez Roche R, Guzman MG. , et al. Prophylactic platelets in dengue: survey responses highlight lack of an evidence base. PLoS Negl Trop Dis 2012; 6: e1716
- 12 Jayanthi HK, Tulasi SK. Correlation study between platelet count, leukocyte count, nonhemorrhagic complications, and duration of hospital stay in dengue fever with thrombocytopenia. J Family Med Prim Care 2016; 5: 120-123
- 13 Chua MN, Molanida R, de Guzman M, Laberiza F. Prothrombin time and partial thromboplastin time as a predictor of bleeding in patients with dengue hemorrhagic fever. Southeast Asian J Trop Med Public Health 1993; 24: 141-143
- 14 Chikkaveeraiah SK, Reddy R, Kumar A. A prospective observational study of dengue fever with thrombocytopenia with reference to treatment. Int J Res Med Sci. 2016; 4: 902-907
- 15 Nedjadi T, El-Kafrawy S, Sohrab SS, Desprès P, Damanhouri G, Azhar E. Tackling dengue fever: current status and challenges. Virol J 2015; 12: 212
- 16 Cowperthwaite AC. Dengue. Textbook of the Practice of Medicine. Chicago: Halsey Bros. Co; 1904
- 17 Murhy R. Homeopathic Medical Repertory. 1st Indian ed. New Delhi: IBPS; 1994
- 18 Jacobs J, Fernandez EA, Merizalde B, Avila-Montes GA, Crothers D. The use of homeopathic combination remedy for dengue fever symptoms: a pilot RCT in Honduras. Homeopathy 2007; 96: 22-26
- 19 Saeed-ul-Hassan S, Tariq I, Khalid A, Karim S. Comparative clinical study on the effectiveness of homeopathic combination remedy with standard maintenance therapy for dengue fever. Trop J Pharm Res 2013; 12: 767-770
- 20 Mahesh S, Mahesh M, Vithoulkas G. Could homeopathy become an alternative therapy in dengue fever? An example of 10 case studies. J Med Life 2018; 11 (01) 75-82
- 21 Government of India. Guidelines for clinical management of Dengue fever, dengue haemorrhagic fever and dengue shock syndrome. National Vector Borne Disease Control Program. 2008. Available at: http://www.nvbdcp.gov.in/Doc/Clinical%20Guidelines.pdf . Accessed April 19, 2018
- 22 Noor NM, Al Bakri Abdullah MM, Yahaya AS, Ramli NA. Comparison of linear interpolation method and mean method to replace the missing values in environmental data set. Mater Sci Forum 2015; 803: 278-281
- 23 Lee DK, In J, Lee S. Standard deviation and standard error of the mean. Korean J Anesthesiol 2015; 68: 220-223
- 24 Jayashree K, Manasa GC, Pallavi P, Manjunath GV. Evaluation of platelets as predictive parameters in dengue Fever. Indian J Hematol Blood Transfus 2011; 27: 127-130
- 25 Choudhury N. Blood transfusion in borderless South Asia. Asian J Transfus Sci 2011; 5: 117-120
- 26 Chaurasia R, Zaman S, Chatterjee K, Das B. Retrospective review of platelet transfusion practices during 2013 dengue epidemic of Delhi, India. Transfus Med Hemother 2015; 42: 227-231
- 27 Villar L, Dayan GH, Arredondo-García JL. , et al; CYD15 Study Group. Efficacy of a tetravalent dengue vaccine in children in Latin America. N Engl J Med 2015; 372: 113-123
- 28 Halstead SB, Aguiar M. Dengue vaccines: are they safe for travelers?. Travel Med Infect Dis 2016; 14: 378-383
- 29 Halstead SB, Russell PK. Protective and immunological behavior of chimeric yellow fever dengue vaccine. Vaccine 2016; 34: 1643-1647
- 30 Pallavi P, Ganesh CK, Jayashree K, Manjunath GV. Unfurling the rationale use of platelet transfusion in dengue Fever. Indian J Hematol Blood Transfus 2011; 27: 70-74
- 31 World Health Organization Country Office for India. National Vector Borne Disease Control Programme. National Guideline for Clinical Management of Dengue Fever. Government of India; 2014
- 32 Garg P. Utility of clinical improvement and platelet count recovery time in counseling children hospitalized with suspected dengue in a resource poor setting. J Clin Diagn Res 2008; 2: 1149-1154
- 33 Neidhard C. On the efficacy of Crotalus horridus in yellow fever; also in malignant, bilious, and remittent fevers: with an account of Humboldt's prophylactic inoculation of the venom of a serpent, at Havana, Cuba. New York, NY: William Radde; 1860
- 34 Young PR, Ng LFP, Hall RA, Smith DW, Johansen CA. Arbovirus infections. In: Farrar J, Hotez PJ, Junghanss T, Kang G, Lalloo D, White NJ. , eds. Manson's Tropical Infectious Diseases. 23rd ed. London: W. B. Saunders; 2014: 129-161
- 35 Chamnanchanunt S, Kanagaraj D, Thanachartwet V, Desakorn V, Rojnuckarin P. Early predictors of clinically significant bleeding in adults with dengue infection. Southeast Asian J Trop Med Public Health 2012; 43: 890-899
- 36 King M, Nazareth I, Lampe F. , et al. Impact of participant and physician intervention preferences on randomized trials: a systematic review. JAMA 2005; 293: 1089-1099