Ethnomedicinal Uses of Plants in the Plains Area of the Tirunelveli-District, Tamilnanu, India

India has a rich heritage of using medicinal plants for indigenous uses and practices. Some of the country\u27s best herbal medicines have also been introduced worldwide, and new applications have been found for them in different parts of the world. This new found fame , however, has proven to be troublesome for India in some instances. For example, the “turmeric case” highlights the problems faced by this country in preventing bio-piracy. Traditional systems of medicine such as Ayurveda, Sidda, Unani, and homeopathy make use of more than 2000 plant species. Local People, medicinal practitioners and tribal healers of this country where oral tradition is closely followed, have made some of our medicinal plants world famous as they find diverse applications across the world. Traditional systems of medicine make use of nearly 7000 plant species. Out of the 17,000 economic species of angiosperms known worldwide, about 5000 occur in India. Of these, 3000 are medicinal plants in which root drugs constitute the largest number of species (680) followed by drugs originating from fruits (450). Bearing the above facts in mind, an attempt has been made here to enumerate the medicinal plants available in the Tirunelveli plains, with help of local people and medicinal practitioners. Approximately three hundred fifteen plants were at one time medicinally used in the plains area of the Tirunelveli district, of which 95 have been treated in the following account

Fourth wave of opioid (illicit drug) overdose deaths and diminishing access to prescription opioids and interventional techniques: Cause and effect

Background: In the midst of the COVID-19 pandemic, data has shown that age-adjusted overdose death rates involving synthetic opioids, psychostimulants, cocaine, and heroin have been increasing, including prescription opioid deaths, which were declining, but, recently, reversing the trends. Contrary to widely held perceptions, the problem of misuse, abuse, and diversion of prescription opioids has been the least of all the factors in recent years. Consequently, it is important to properly distinguish between the role of illicit and prescription opioids in the current opioid crisis. Multiple efforts have been based on consensus on administrative policies for certain harm reduction strategies for individuals actively using illicit drugs and reducing opioid prescriptions leading to curbing of medically needed opioids, which have been ineffective. While there is no denial that prescription opioids can be misused, abused, and diverted, the policies have oversimplified the issue by curbing prescription opioids and the pendulum has swung too far in the direction of severely limiting prescription opioids, without acknowledgement that opioids have legitimate uses for persons suffering from chronic pain. Similar to the opioid crisis, interventional pain management procedures have been affected by various policies being applied to reduce overuse, abuse, and finally utilization. Medical policies have been becoming more restrictive with reduction of access to certain procedures, with the pendulum swinging too far in the direction of limiting interventional techniques. Recent utilization assessments have shown a consistent decline for most interventional techniques, with a 18.7% decrease from 2019 to 2020. The causes for these dynamic changes are multifactorial likely including the misapplication of the 2016 Centers for Disease Control and Prevention (CDC) guidelines for prescribing opioids for chronic pain, the relative ease of access to illicit synthetic opioids and more recently issues related to the COVID-19 pandemic. In addition, recent publications have shown association of dose tapering with overdose or mental health crisis among patients prescribed long-term opioids. These findings are leading to the hypothesis that federal guidelines may inadvertently be contributing to an increase in overall opioid deaths and diminished access to interventional techniques. Together, these have resulted in a fourth wave of the opioid epidemic. Methods: A narrative review. Results: The fourth wave results from a confluence of multiple factors, including misapplication of CDC guidelines, the increased availability of illicit drugs, the COVID-19 pandemic, and policies reducing access to interventional procedures. The CDC guidelines and subsequent regulatory atmosphere have led to aggressive tapering up to and including, at times, the overall reduction or stoppage of opioid prescriptions. Forced tapering has been linked to an increase of 69% for overdoses and 130% for mental health crisis. The data thus suggests that the diminution in access to opioid prescriptions may be occurring simultaneously with an increase in illicit narcotic use.Combined with CDC guidelines, the curbing of opioid prescriptions to medically needed individuals, among non-opioid treatments, interventional techniques have been affected with declining utilization rates and medical policies reducing access to such modalities. Conclusion: The opioid overdose waves over the past three decades have resulted from different etiologies. Wave one was associated with prescription opioid overdose deaths and wave two with the rise in heroin and overdose deaths from 1999 to 2013. Wave three was associated with a rise in synthetic opioid overdose deaths. Sadly, wave four continues to escalate with increasing number of deaths as a confluence of factors including the CDC guidelines, the COVID pandemic, increased availability of illicit synthetic opioids and the reduction of access to interventional techniques, which leads patients to seek remedies on their own

Methodology for evidence synthesis and development of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain

BACKGROUND: The re-engineered definition of clinical guidelines in 2011 from the IOM (Institute of Medicine) states, clinical practice guidelines are statements that include recommendations intended to optimize patient care that is informed by a systematic review of evidence and an assessment of the benefit and harms of alternative care options. The revised definition distinguishes between the term clinical practice guideline and other forms of clinical guidance derived from widely disparate development processes, such as consensus statements, expert advice, and appropriate use criteria. OBJECTIVE: To assess the literature and develop methodology for evidence synthesis and development of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. METHODS: A systematic review of the literature including methodology of guideline development encompassing GRADE approach for guidance on evidence synthesis with recommendations. RESULTS: Some of the many factors described in 2011 continue as of 2020 and impede the development of clinical practice guidelines. These impediments include biases due to a variety of conflicts and confluence of interest, inappropriate and poor methodological quality, poor writing and ambiguous presentation, projecting a view that these are not applicable to individual patients or too restrictive with the elimination of clinician autonomy, and overzealous and inappropriate recommendations, either positive, negative, or non-committal. Thus, ideally, a knowledgeable, multidisciplinary panel of experts with true lack of bias and confluence of interest must develop guidelines based on a systematic review of the existing evidence. This manuscript describes evidence synthesis from observational studies, various types of randomized controlled trials (RCTs), and, finally, methodological and reporting quality of systematic reviews. The manuscript also describes various methods utilized in the assessment of the quality of observational studies, diagnostic accuracy studies, RCTs, and systematic reviews. LIMITATIONS: Paucity of publications with appropriate evidence synthesis methodology in reference to interventional techniques. CONCLUSION: This review described comprehensive evidence synthesis derived from systematic reviews, including methodologic quality and bias measurement. The manuscript described various methods utilized in the assessment of the quality of the systematic reviews, RCTs, diagnostic accuracy studies, and observational studies

Sintomatologia depressiva em adolescentes iniciais: estudo de base populacional Depressive symptomatology in early adolescents: population-based study

OBJETIVO: Verificar a prevalência de sintomatologia depressiva em adolescentes entre 11 e 15 anos em Pelotas, RS, e identificar seus fatores associados. MÉTODOS: Estudo transversal de base populacional com amostra representativa de adolescentes da zona urbana da cidade de Pelotas, RS. Dos 448 setores censitários existentes no município, 79 foram aleatoriamente sorteados. Os jovens entre 11 e 15 anos localizados nestes setores foram convidados a responder o questionário auto-aplicado que continha perguntas sobre: idade, sexo, vida escolar, religião, atividades físicas, entretenimento, tabaco, consumo de álcool, uso de outras drogas, relacionamentos sexuais e conduta. Além disso, a sintomatologia depressiva dos adolescentes foi avaliada por meio da escala Children's Depression Inventory (CDI), também presente no instrumento de pesquisa. Para a análise dos dados foi utilizada a regressão logística ajustada ao modelo hierárquico. RESULTADOS: A prevalência de depressão foi de 2,1%. Após a regressão logística ajustada ao modelo hierárquico, estiveram significativamente associados à depressão: baixa condição socioeconômica, histórico de fracasso acadêmico, ausência de prática religiosa, abuso de álcool nos últimos 30 dias e indicativo de transtorno de conduta. CONCLUSÃO: É evidenciada a necessidade de programas preventivos e integrados de política na adolescência para depressão e comportamentos de risco à saúde.<br>AIM: Verify the prevalence of depressive symptomatology in adolescents aged between 11 and 15 in Pelotas, RS, and identify its associated factors. METHODS: A cross-sectional base-populational study with a representative sample of adolescents of urban area of Pelotas, RS. Among the 448 census tracts in the urban area of Pelotas, 79 were randomly selected. Youths between 11 and 15 years answered a confidential self-report questionnaire on issues such as: age, gender, school life, religion, physical activities, entertainment, tobacco, and alcohol consumption, use of other drugs, sexual relationship and conduct. Children's Depression Inventory (CDI) was used to quantify the depressive symptomatology. Logistic regression was used in the data analysis, which followed a hierarchical model. RESULTS: Prevalence for high depressive symptomatology was 2.1%. After a logistic regression adjusts to a hierarchical model, it was statistically significant associated to: low social economic condition, history of poor academic performance, absence of religious practice, abuse of alcohol in the previous month and indications of conduct disorders. CONCLUSION: It is evidenced the need of preventive and integrative policy programs in adolescence for depression and health risk behaviors