Sebastian Arlt

Use of homeopathic preparations in experimental studies with healthy plants

BACKGROUND The last comprehensive review of experimental research on effects of homeopathic treatments on plants was published in 1984, and lacked formal predefined criteria to assess study quality. Since then several new studies with more advanced methods have been published. OBJECTIVES To compile a review of the literature on basic research in homeopathy with healthy plants with particular reference to studies investigating specific effects of homeopathic remedies. METHODS The literature search included English, French, German, Italian, Portuguese and Spanish publications from 1920 to April 2009, using predefined selection criteria. We included experiments with healthy whole plants, seeds, plant parts and cells. The outcomes had to be measured by established procedures and statistically evaluated. We developed a Manuscript Information Score (MIS) and included only publications which provided enough information for proper interpretation (MIS>or=5). A formalised Study Methods Evaluation Procedure (SMEP) was used to evaluate these studies, and the subgroup of studies with adequate controls to identify specific effects. RESULTS A total of 86 studies in 79 publications was identified, 43 studies included statistics, 29 had MIS>or=5, and 15 studies investigated the specificity of homeopathic preparations. Specific effects of decimal, centesimal and fifty millesimal potencies were found including dilution levels far beyond the Avogadro number. In consecutive series of potencies only some of the tested potencies showed effects. There were many individual studies with diverse methods and very few reproduction trials. CONCLUSIONS Healthy plant models seem an useful approach to investigate basic research questions about the specificity of homeopathic preparations. More investigations with more advanced methods are recommended, especially in the sectors of potentisation techniques, effective potency levels and conditions for reproducibility. Systematic negative control experiments should become a routine procedure to control the stability of the experimental systems.

Influence of different oral rehydration solutions on abomasal conditions and the acid-base status of suckling calves.

The aim of the study was to investigate the influence of oral rehydration solutions (ORS) on milk clotting, abomasal pH, electrolyte concentrations, and osmolality, as well as on the acid-base status in blood of suckling calves, as treatment with ORS is the most common therapy of diarrhea in calves to correct dehydration and metabolic acidosis. Oral rehydration solutions are suspected to inhibit abomasal clotting of milk; however, it is recommended to continue feeding cows milk or milk replacer (MR) to diarrheic calves to prevent body weight losses. Three calves with abomasal cannulas were fed MR, MR-ORS mixtures, or water-ORS mixtures, respectively. Samples of abomasal fluid were taken before and after feeding at various time points, and pH, electrolyte concentrations, and osmolality were measured. The interference of ORS with milk clotting was examined in vivo and in vitro. To evaluate the effects of ORS on systemic acid-base status, the Stewart variables strong ion difference ([SID]), acid total ([A(tot)]), and partial pressure of CO2 (pCO2) were quantified in venous blood samples drawn before and after feeding. Calves reached higher abomasal pH values when fed with MR-ORS mixtures than when fed MR. Preprandial pH values were re-established after 4 to 6 h. Oral rehydration solutions prepared in water increased the abomasal fluid pH only for 1 to 2 h. Oral rehydration solutions with high [SID(3)] ([Na(+)] + [K(+)] - [Cl(-)]) values produced significantly higher abomasal pH values and area under the curve data of the pH time course. Caseinomacropeptide, an indicator of successful enzymatic milk clotting, could be identified in every sample of abomasal fluid after feeding MR-ORS mixtures. The MR-ORS mixtures with [SID(3)] values > or =92 mmol/L increased serum [SID(3)] but did not change venous blood pH. Oral rehydration solutions do not interfere with milk clotting in the abomasum and can, therefore, be administered with milk. In this study, MR-ORS mixtures with high [SID(3)] values caused an increase of serum [SID(3)] in healthy suckling calves and may be an effective treatment for metabolic acidosis in calves suffering from diarrhea.

Therapy of bovine endometritis with prostaglandin F2α: a meta-analysis.

The objective of the conducted meta-analysis was to assess the efficacy of the treatment of bovine endometritis with PGF(2α) by statistical means. Postpartum uterine infections have a high prevalence and a very negative effect on reproductive performance in dairy cattle. Because of a wide discordance between research results, a meta-analysis of the efficacy of the treatment of bovine endometritis with PGF(2α) was conducted. A comprehensive literature search was performed using online databases to reveal a total of 2,307 references. In addition, 5 articles were retrieved by reviewing citations. After applying specific exclusion criteria and evaluating specific evidence parameters, 5 publications, comprising 6 trials, were eligible for being analyzed by means of meta-analysis. Data for each trial were extracted and analyzed using meta-analysis software Review Manager (version 5.1; The Nordic Cochrane Centre, Copenhagen, Denmark). Estimated effect sizes of PGF(2α) were calculated on calving to first service and calving to conception interval. Prostaglandin F(2α) treatment of cows with chronic endometritis had a negative effect on both reproductive performance parameters. Heterogeneity was substantial for calving to first service and calving to conception interval [I(2) (measure of variation beyond chance)=100 and 87%, respectively]; therefore, random-effects models were used. Sensitivity analysis as well as subgroup analysis showed that the performance of randomization was influential in modifying effect size of PGF(2α) treatment. The funnel plot illustrated a publication bias toward smaller studies that reported a prolonged calving to conception interval after a PGF(2α) treatment. We conclude that the investigation of this subject by means of meta-analysis did not reveal an improvement of reproductive performance of cows with endometritis after treatment with PGF(2α). Furthermore, there is a shortage of comparable high quality studies investigating reproductive performance after PGF(2α) treatment of cows with chronic endometritis.

Efficacy of homeopathic remedies as prophylaxis of bovine endometritis

The objective of this study was to evaluate the efficacy of 2 different homeopathic prophylactic strategies for the prevention of endometritis. The drugs used were Lachesis compositum (Lachesis), Carduus compositum (Carduus), and Traumeel LT (Traumeel). Each drug contained a mixed formula of homeopathic remedies. All 929 cows received the first treatment within 24 h postpartum. The second to fourth treatments were conducted at 7 to 13, 14 to 20, and 21 to 27 d in milk, respectively. In the first group, the 4 treatments were Traumeel, Lachesis, Carduus, and Carduus, respectively (n = 206). In the second group, Lachesis was administered 3 times, followed by 1 treatment with Carduus (n = 198). The control group received 4 injections of saline (n = 189). In the fourth week after calving, the prevalence of clinical endometritis, uterine involution, and ovarian activity was monitored by rectal palpation and by ultrasonography. To assess the resumption of ovarian activity, blood samples were taken to determine the concentration of serum progesterone. The concentrations of beta-hydroxybutyrate and nonesterified fatty acids in blood serum were examined to evaluate energy metabolism. The incidence of clinical endometritis at 21 to 27 d in milk did not differ between the groups (44.4, 44.8, and 36.9% in the Traumeel, Lachesis, Carduus, and Carduus group; the 3x Lachesis, followed by Carduus group; and the control group, respectively). The proportion of cows with cyclic activity at 21 to 27 d in milk and the proportion of cows above threshold values of progesterone, beta-hydroxybutyrate, and nonesterified fatty acids did not differ significantly between groups. When reproductive performance data were analyzed, no significant differences were found between groups. Hence, the treatment protocols tested were not effective in preventing bovine endometritis or in enhancing reproductive performance in this study.

Evidence-based medicine in bovine, equine and canine reproduction: Quality of current literature

The objective was to evaluate deficits and differences of published literature on reproduction in cattle, horses, and dogs. A literature search was conducted in the databases Medline and Veterinary Science. Approximately five times more articles on clinical bovine reproduction (n = 25 910) were found compared to canine (n = 5 015) and equine (n = 5 090) reproduction. For the evaluation of the literature, a checklist was used. A subset of 600 articles published between 1999 and 2008 was randomly selected. After applying exclusion criteria, a total of 268 trials (86 for cattle, 99 for horses, and 83 for dogs) were evaluated and used for further analysis. For the field of canine and equine reproduction, there were fewer clinical trials with a control group compared to bovine reproduction (cattle 66%, horses 41%, and dogs 41%). For all three species investigated, few publications were identified (4%) with the highest level of evidence, i.e., controlled, randomized, and blinded trials, or meta-analyses. In cattle 33% of the publications were graded adequate to draw sound conclusions; however, only 7 and 11% were graded adequate in dogs and horses, respectively. Therefore, the veterinarian should always assess the quality of information before implementing results into practice to provide best available care for the animals. In conclusion, improvement of the quality of well-designed, conducted and reported clinical trails in animal reproduction is required.

Evidence-based medicine: quality and comparability of clinical trials investigating the efficacy of prostaglandin F 2α for the treatment of bovine endometritis

The objective of this study was to evaluate the quality and comparability of published literature, and to summarize the effect of prostaglandin F(2α) (PGF(2α)) for the treatment of endometritis. It has been postulated that there is a dearth of high-level evidence-based research results in veterinary medicine. Also, there is a marked variation in the quality of studies in veterinary and animal science. Post-partum uterine infections occur commonly in dairy cattle and are reported to have a negative impact on reproductive performance. A comprehensive literature search was conducted utilizing online databases revealing a total of 2723 references. After applying specific exclusion criteria, a total of 68 trials were eligible for further analysis. These articles were evaluated utilizing specific parameters listed in an evaluation form such as randomization and the involvement of control groups. The analysis revealed that more than half of the trials (51·5%) were at least 20 years old. Furthermore, we found that about one third (36·8%) of all trials were controlled and randomized, while 3 of those (4·4%) were also blinded. Of those trials which calculated a calving-to-conception interval (n=30), 50% of the authors claimed an improvement, which was statistically significant in 23·3% of the cases. We conclude that there is a wide discrepancy between research results investigating the efficacy of PGF(2α).

Training evidence-based veterinary medicine by collaborative development of critically appraised topics.

In current veterinary education, skills such as retrieving, critically appraising, interpreting, and applying the results of published scientific studies are rarely taught. In this study, the authors tested the concept of team-based development of critically appraised topics (CATs) in training students in evidence-based veterinary medicine (EBVM). The 116 participants were in their fifth year and attending the clinical rotation at the Clinic for Animal Reproduction. Students developed 18 CATs of varying quality on topics of their choice. Preparing the CATs in teams stimulated discussion on the topic and the quality of the retrieved papers. Evaluation of the project revealed that more than 90% of the students endorsed training in critical appraisal of information in veterinary education. In addition, more than 90% considered the development of CATs an effective exercise for assessing the quality of scientific literature. A provided literature evaluation form was perceived as a useful tool for systematically summarizing a publications quality. In conclusion, team-based development of CATs during clinical rotations is highly valuable for training in EBVM. Learning and intrinsic motivation seem to be enhanced by creating a situation similar to veterinary practice because the task is embedded into an authentic clinical problem. This approach to clinical training helps to prepare students to integrate evidence from literature into practice.

Training Students to Appraise the Quality of Scientific Literature

Implementing evidence-based veterinary medicine (EBVM) into clinical practice requires not only the ability to retrieve, interpret, and apply the results of published scientific studies, but also the ability to critically evaluate the quality of the literature. These skills, however, are not widely taught in the veterinary curriculum. The objective of this study was to test a literature evaluation form (LEF) designed to assist veterinary students in appraising the quality of literature on animal reproduction and to compare their ability to do so with that of students who were provided with a control form (CF). The 68 participants were in their fifth year of study and attended a clinical rotation at the Clinic for Animal Reproduction. Students in the LEF group determined the quality of two scientific papers, considering statements about study design, information content, and objectivity, and determined rating points to obtain an overall score. Participants using the CF ranked the quality of the article without the assistance of the quality assessment form. The LEF group was able to more correctly assess the quality of the literature and the variability of the chosen evidence levels was higher in the CF group. The questionnaire was found to be a useful tool for the systematic assessment of the quality of publications within a reasonable period of time. Seventy-eight per cent of the participants agreed that the LEF helps them evaluate the quality and validity of biomedical scientific information. We conclude that courses that introduce EBVM should be taught in the first semesters of the veterinary curriculum so that students can develop competence in defining a clinical problem, retrieving information from the literature, and developing independent critical thinking.

Prediction of Parturition in Bitches Utilizing Continuous Vaginal Temperature Measurement

The objective of this study was to determine sensitivity and specificity of a body temperature decline in bitches to predict parturition. Temperature loggers were placed into the vaginal cavity of 16 pregnant bitches on day 56-61 after estimated ovulation or first mating. This measurement technique has been validated previously and enabled continuous sampling of body temperature. The temperature loggers were expelled from the vagina before delivery of the first pup. The computed values for specificity (77-92%) were higher than sensitivity (53-69%), indicating a more precise prognosis of parturition not occurring. In conclusion, our findings may assist interpreting vaginal temperature measurements in order to predict parturition in bitches.

Application of Vaginal Temperature Measurement in Bitches

Finding innovative, non-invasive methods for continuously measuring body temperature minimizing human interference is important for accurate data collection. The objective of this study was to assess feasibility and accuracy of continuous body temperature measurements with loggers placed in the vaginal cavity of bitches. First, an in vitro experiment was performed to compare values obtained by temperature loggers (n = 26) to a calibrated liquid-in-glass thermometer. The mean differences between the two methods were low. Next, an in vivo experiment was performed using five healthy bitches, and values obtained by the vaginal loggers were compared to measurements collected rectally with digital thermometers. The results show that rectal and vaginal temperatures were correlated. The mean differences between rectal and vaginal temperatures were negligible. We conclude that the utilized temperature loggers provide accurate and reliable data.