Homeopathic Products
اسلاید 1: www.tabaye.ir
اسلاید 2: Homeopathic Products
اسلاید 3: Principle of analogy or Law of SimilarsSmall or infinitesimal doses (3X-30C)Avogadro’s number=6x1023 = ~23XSuccussion and potentization (see http://www.boiron.com/en/htm/02_medi_homeo/prepa_medi.htm)Ultra-high dilution effectsFinal productWorld MarketUSA
اسلاید 4: Evidence??In vitro studiesAnimal studiesHuman studiesMeta-analyses of human studiesImplausibility, entrenched skeptics and overenthusiastic zealots
اسلاید 5: In: Vallance AK. J Alt Compl Med 1998;4:49-76.
اسلاید 6: In: Vallance AK. J Alt Compl Med 1998;4:49-76.
اسلاید 7: In: Vallance AK. J Alt Compl Med 1998;4:49-76.
اسلاید 8: Reilly et al. Lancet 1994;344:1601-06asthma
اسلاید 9: Linde et al. Lancet. 1997 Sep 20;350(9081):834-43 .
اسلاید 10: : Barnes et al. J Clin Gastroenterol. 1999;25(4):628-33. Homeopathy and postoperative ileus
اسلاید 11: Jacobs et al. Pediatr Infect Dis J. 2003;22:229-34.
اسلاید 12: Jacobs et al. J Alt Compl Med 2000;6:131-139 n=126 in Nepal
اسلاید 13: Jacobs et al. Pediatr Infec Dis 2001;20:177-183. N=75
اسلاید 14: Jacobs et al. Pediatr Infec Dis 2001;20:177-183. N=75
اسلاید 15: Shang et al. Lancet 2005;366:726-732
اسلاید 16: Odds ratio for large, high quality trials (the lower the value the higher the benefit):Homeopath. N=8 OR=0.88Conventional. N=6OR=0.58Conclusions: “clinical effects of homeopathy are placebo effects”Critique: how about giving the OR for all included studies and also the OR for the”higher quality” studies (n=21 for homeopathy and n=9 for conventional). The selection of “clinical topics” for study seem to favor conventional drugs, e.g. respiratory infections.Shang et al. Lancet 2005;366:726-732
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اسلاید 19: http://www.homeopathicpharmacy.org/index.htm
اسلاید 20: Haworth Press 2007
اسلاید 21: Probiotics Terms:Probiotic – Probiotics are live microorganisms (bacteria or yeasts) which, when administered in adequate amounts, confer a health benefit on the host Prebiotic - nutritional supplement taken to increase the amounts of beneficial bacterial in the gut or vagina. Example “FOS” (fructose oligosaccharides)Biotherapeutic agent - microorganism used for specific therapeutic activity in humansNutriceutical - food products with beneficial effects in preventing or treating diseases
اسلاید 22: Predominant Flora: StomachStomach (0-103 cfu/ml): Gram+ aerobes, Lactobacillus & Streptococcus
اسلاید 23: Predominant Flora: VaginaVagina: diverse aerobes & anaerobes including Lactobacillus jensenii, Lactobacillus acidophilus, Lactobacillus casei.
اسلاید 24: Predominant Flora: Urinary TractKidneys: sterileBladder: sterileUrethra: 101-102 E. coli
اسلاید 25: Predominant Flora: IntestinesSmall intestine: Proximal ileum (103-104 cfu/ml) aerobic Gram+ Distal ileum (1011-1012 cfu/ml) Gram- anaerobesColon (1011-1012 cfu/ml): Bacteroides, Eubacteria, Peptostreptococci, E. coli, Bifidobacterium, Fusobacteria
اسلاید 26: Functions of Normal FloraDigestionProduction of vitaminsMucosal maturationStimulate Immune SystemAttachmentIntestinal transitColonization resistance
اسلاید 27: Use of Probiotics for infections in Controlled Trials in HumansPrevention of DiarrheaAntibiotic associated diarrheainfantile diarrheatraveler’s diarrheaTreatment of Diarrhea acute diarrheaClostridium difficile diseaseHIV associated diarrheaInflammatory Bowel DiseasesBacterial Vaginosis
اسلاید 28: Stop AntibioticStart AntibioticStart yeast or placeboStop Studyyeast or placebo continued for 14dSaccharomyces boulardii and Antibiotic Associated Diarrhea in Hospitalized Patients N=180; site: University of WashingtonSurawicz et al., Gastroenterol. 1989;96:981
اسلاید 29: Surawicz et al., Gastroenterol. 1989;96:981
اسلاید 30: Stop AntibioticStart AntibioticStart yeast or placebo Stop Studyyeast or placebo continued for 3dSaccharomyces boulardii and Beta lactam Antibiotic Associated Diarrhea in Hospitalized Patients N=193; site: University of Washington, University of KentuckyMcFarland et al. Am J Gastroenterol 1995;90:439-448
اسلاید 31: McFarland et al. Am J Gastroenterol 1995;90:439-448
اسلاید 32: Antibiotic Associated Diarrhea McFarland LV. Am J Gastroenterol 2006;101:812-822
اسلاید 33: Lactobacillus GG & Prevention of Infantile Nosocomial Diarrhea [Methods]DBPC in Poland81 hospitalized children (1-36 months old)No diarrhea on admissionRandomized during stay: – L. GG (12 x 109 CFU/d) – PlaceboSzajewska H. J Pediatr 2001;138:361-5.
اسلاید 34: Lactobacillus GG & Prevention of Infantile Nosocomial Diarrhea [Results]6.7*2.2*33.316.7*p<0.05L. GG (n=45)Placebo (n=36)Szajewska H. J Pediatr 2001;138:361-5.
اسلاید 35: Probiotic Prevention of Traveler’s DiarrheaNYC travelers to developing countries; n=225 (Hilton et al. J. Travel Med 1997;4:41-43)7.4%/exposure day for placebo3.9%/exposure day for Lactobacillus GG (p=0.05)Austrian travelers to Turkey; n-1016 (Kollaritsch et al. Fortschr Med 1993;111:152-156)39.1% placebo28.7% S. boulardii (p=0.02)
اسلاید 36: Lactobacilli and Pediatric Diarrhea Treatment (L. rhamnosus and L. reuteri in hospital setting)N=69 Rosenfeldt et al., Pediatr Infec Dis 2002;21:411
اسلاید 37: Huang, et al., Digestive Diseases and Sciences, Vol.47, No. 11 (Nov 2002)
اسلاید 38: McFarland et al., JAMA; 271, 1913-1918, (1994).
اسلاید 39: S. boulardii & High Dose Vancomycin for Recurrent C. difficile Disease50%16.7%*Surawicz CM. Clin Infect Dis 2000;31:1012-7.S. boulardii (n=18)Placebo (n=14)*p=0.05
اسلاید 40: Other Uses for Probiotics –Crohn’s Disease-see slideUlcerative Colitis-see slideIrritable Bowel Syndrome-see slideAllergy/Exema-see slide Pouchitis-VSL#3 mixture is effective in reducing inflammationLactose Intolerance-yogurt helps somewhatBacterial Vaginosis-speeds recovery and decreases recurrence
اسلاید 41: Respiratory infections in children*-one study showed 17% decrease risk in those taking Lactobacillus GG probiotic milk productDental caries*High Cholesterol*Urinary Tract Infections*Helicobacter pylori*Candida vaginal infections**Limited evidence
اسلاید 42: From Elmer et al. The Power of Probiotics Haworth Press 2007
اسلاید 43: O’Mahony et al. Gastroenterology 2005;128:541-551IBS n=77, 8 weeks
اسلاید 44: Table 6.1. Controlled clinical trials evaluating probiotics and Crohn’s disease (from Elmer et al. The Power of Probiotics, Haworth Press 2007) Probiotic N Result RefL. rhamnosus GG 4510.5% placebo 16.6% LGG, ns Prantera 7L. rhamnosus GG112/4 relapse placebo3/5 relapse LGG, ns Schultz 8Saccharomyces boulardii174.6 stools/day placebo3.3 stools/day in Sb* Plein 9Saccharomyces boulardii 326/16 relapse in mesalamine1/16 relapse in mesalamine/Sb Guslandi 10E. coli Nissle 1917287/12 relapse in prednisone 4/12 relapse in prednisone/EcMalchow 11 * probiotic significantly better than control, p<0.05; ns=probiotic not significantly different than control
اسلاید 45: Table 6.2. Clinical trials evaluating probiotics and ulcerative colitis (from Elmer et al. The Power of Probiotics Haworth Press 2007) ProbioticNResult RefE. coli (Nissle 1917)11673% relapse in mesalamine67% relapse in Ec, ns Rembacken 16E. coli (Nissle 1917)10311% relapse in mesalamine16% relapse in Ec, nsKruis 17E. coli (Nissle 1917)32736% relapse in mesalamine45% relapse in Ec, nsKruis 18Saccharomyces boulardii2417/24 had successful outcomeGuslandi 10VSL#3 (mix)2015/20 had no relapse in 12 monthsVenturi 19 ns= probiotic not significantly different than standard treatment
اسلاید 46: Lactobacillus GG to Prevent Infantile Atopic Disease DBPC in FinlandFamily history atopic disease (eczema, allergic rhinitis, asthma)Mothers randomized: – Lactobacillus GG (1 x 1010 CFU/d) – PlaceboMothers treated 2-4 weeks before delivery Infants treated for 6 monthsFollowed for 2 yearsKalliomaki M. Lancet 2001;357:1076-9
اسلاید 47: Lactobacillus GG and Infantile Atopic Disease [Results]23%*46%Kalliomaki M. Lancet 2001;357:1076-9*p=0.008L. GG (n=64)Placebo (n=68)
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اسلاید 49: Multiple Mechanisms of ActionResistance is InfrequentUse May Reduce Exposure to AntibioticsDelivery of Microbial EnzymesWell ToleratedBenefit to Risk Ration is FavorableFew Controlled TrialsPersistence PossibleTranslocation PossibleTransfer of Resistance Plasmids?Infection PossibleQuality Control IssuesRegulatory Issues in USAAdvantagesDisadvantagesPotential Advantages and Disadvantages of Probiotics
اسلاید 50: Evidence supporting commercially available (USA) probiotics*condition VSL#3 L. reueri LGGSbNA=not available (no studies), None=negative studies
اسلاید 51: Probiotics SummaryLiving microorganisms with multiple mechanisms of actionGood safety profileSome applications to prevent and treat infectious diseasesAn alternative to antibiotics in some situationsMay have other applications, e.g. allergy, cancer, colitis, Crohn’s Disease, Ulcerative Colitis, IBSProduct selection is very important
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