Traditional herbal medicine combined with first-line platinum-based chemotherapy for advanced non-small-cell lung cancer: A PRISMA-compliant systematic review and meta-analysis.

BACKGROUND: Non-small-cell lung cancer (NSCLC) is a major health burden in many countries. This review aimed to evaluate the efficacy of traditional herbal medicine (THM) combined with first-line platinum-based chemotherapy (PBCT) for the treatment of advanced NSCLC. METHODS: From inception to April 2021, relevant studies were retrieved from 9 electronic databases. Randomized controlled trials (RCTs) comparing survival outcomes of THM + PBCT treatment with PBCT treatment in patients with advanced NSCLC were reviewed. The risk of bias was evaluated using the Cochrane Risk of Bias Tool. Overall survival, 1-year survival, progression-free survival or time to progression, tumor response rate, and adverse effects were analyzed. RESULTS: Sixteen RCTs comprising 1445 patients were included. The meta-analysis indicated that THM + PBCT treatment, compared to PBCT alone, could improve overall survival (median survival ratio = 1.24, 95% confidence intervals [CI] [1.11, 1.39], P < .001), progression-free survival/time to progression (median survival ratio = 1.22, 95% CI [1.09, 1.37], P < .001), and the 1-year survival rate (risk ratio [RR] = 1.56, 95% CI [1.31, 1.86], P < .001). THM + PBCT also led to a higher tumor response rate (RR = 1.39, 95% CI [1.22, 1.59], P < .001) and lower incidence of thrombocytopenia (RR = 0.72, 95% CI [0.56, 0.92], P = .009) and nausea/vomiting (RR = 0.35, 95% CI [0.21, 0.57], P < .001), while there was no significant effect observed on leukopenia (RR = 0.68, 95% CI [0.34, 1.36], P = .27). CONCLUSION: THM, when used in combination with PBCT, might increase survival and the tumor response rate while decreasing the side effects caused by chemotherapy in patients with advanced NSCLC. However, considering the limited methodological qualities of the included trials, more rigorous RCTs are needed.

Real-world artificial intelligence-based opportunistic screening for diabetic retinopathy in endocrinology and indigenous healthcare settings in Australia.

This study investigated the diagnostic performance, feasibility, and end-user experiences of an artificial intelligence (AI)-assisted diabetic retinopathy (DR) screening model in real-world Australian healthcare settings. The study consisted of two components: (1) DR screening of patients using an AI-assisted system and (2) in-depth interviews with health professionals involved in implementing screening. Participants with type 1 or type 2 diabetes mellitus attending two endocrinology outpatient and three Aboriginal Medical Services clinics between March 2018 and May 2019 were invited to a prospective observational study. A single 45-degree (macula centred), non-stereoscopic, colour retinal image was taken of each eye from participants and were instantly screened for referable DR using a custom offline automated AI system. A total of 236 participants, including 174 from endocrinology and 62 from Aboriginal Medical Services clinics, provided informed consent and 203 (86.0%) were included in the analysis. A total of 33 consenting participants (14%) were excluded from the primary analysis due to ungradable or missing images from small pupils (n = 21, 63.6%), cataract (n = 7, 21.2%), poor fixation (n = 2, 6.1%), technical issues (n = 2, 6.1%), and corneal scarring (n = 1, 3%). The area under the curve, sensitivity, and specificity of the AI system for referable DR were 0.92, 96.9% and 87.7%, respectively. There were 51 disagreements between the reference standard and index test diagnoses, including 29 which were manually graded as ungradable, 21 false positives, and one false negative. A total of 28 participants (11.9%) were referred for follow-up based on new ocular findings, among whom, 15 (53.6%) were able to be contacted and 9 (60%) adhered to referral. Of 207 participants who completed a satisfaction questionnaire, 93.7% specified they were either satisfied or extremely satisfied, and 93.2% specified they would be likely or extremely likely to use this service again. Clinical staff involved in screening most frequently noted that the AI system was easy to use, and the real-time diagnostic report was useful. Our study indicates that AI-assisted DR screening model is accurate and well-accepted by patients and clinicians in endocrinology and indigenous healthcare settings. Future deployments of AI-assisted screening models would require consideration of downstream referral pathways.

Running out of time to smell the roseroots: Reviewing threats and trade in wild Rhodiola rosea L.

ETHNOPHARMACOLOGICAL RELEVANCE: Rhodiola rosea L. has a circumpolar distribution and is used in ethnomedicines of Arctic peoples, as well as in national systems of traditional medicine. Since the late 20th century, global demand for R. rosea has increased steadily, in part due to clinical research supporting new uses in modern phytotherapy. Global supply has been largely obtained from wild populations, which face threats from poorly regulated and destructive exploitation of the rootstocks on an industrial scale. AIM OF THE STUDY: To evaluate (i) the conservation status, harvesting and trade levels of R. rosea, in order to determine whether international trade should be monitored, (ii) the current state of experimental and commercial farming and whether cultivation may play a role to take pressure off wild stocks, and (iii) evidence of substitution of other Rhodiola species for R. rosea as an indicator of overexploitation and rarity. MATERIALS AND METHODS: We reviewed published studies on R. rosea biology and ecology, as well as information on impacts of wild harvest, on management measures at the national and regional levels, and on the current level of cultivation from across the geographic range of this species. Production and trade data were assessed and analysed from published reports and trade databases, consultations with R. rosea farmers, processors of extracts, and trade experts, but also from government and news reports of illegal harvesting and smuggling. RESULTS AND CONCLUSIONS: Our assessment of historical and current data from multiple disciplines shows that future monitoring and protection of R. rosea populations is of time-sensitive importance to the fields of ethnobotany, ethnopharmacology, phytochemistry and phytomedicine. We found that the global demand for R. rosea ingredients and products has been increasing in the 21st century, while wild populations in the main commercial harvesting areas continue to decrease, with conservation issues and reduced supply in some cases. The level of illegal harvesting in protected areas and cross border smuggling is increasing annually coupled with increasing incidences of adulteration and substitution of R. rosea with other wild Rhodiola species, potentially negatively impacting the conservation status of their wild populations, but also an indicator of scarcity of the genuine article. The current data suggests that the historical primary reliance on sourcing from wild populations of R. rosea should transition towards increased sourcing of R. rosea from farms that are implementing conservation oriented sustainable agricultural methods, and that sustainable wild collection standards must be implemented for sourcing from wild populations.

An evidence based efficacy and safety assessment of the ethnobiologicals against poisonous and non-poisonous bites used by the tribals of three westernmost districts of West Bengal, India: Anti-phospholipase A2 and genotoxic effects.

INTRODUCTION: To explore the ethnobiological wisdom of the tribals of three western districts of West Bengal, India against poisonous and non-poisonous bites and stings, a quantitative approach was adopted. These age-old yet unexplored knowledge can be utilized in finding lead-molecules against poisonous and non-poisonous animal-bites. Further, an evidence-based approach is needed to assess the venom-neutralization ability of plants by experimental studies. MATERIALS AND METHODS: During 2008-2009 and 2012-2017, 11 ethnomedicinal surveys were carried out to explore the use of medicinal flora and fauna via conducting open semi-structured interviews with 47 traditional healers (THs) or informants. The retrieved dataset was statistically evaluated using seven quantitative-indexes: use-value (UV), informants'-consensus-factor (ICF), fidelity-level (FL), relative-importance (RI), cultural importance-index (CI), index of agreement on remedies (IAR) and cultural agreement-index (CAI). Anti-phospholipaseA2 (PLA2) properties of selected plant extracts were also examined. In addition, the cytotoxicity and genotoxicity of the water extract of the plants showing high FL as well as significant PLA2 inhibitory potential were investigated using Allium cepa root tip assay. RESULTS: A total of 41 traditional-formulations (TFs) containing 40 plant species (of 39 genera from 28 families) and 3 animal species were prescribed by the THs. Fabaceae exhibited most number of medicinal plants. Piper nigrum (1.78) and Apis cerana indica and Crossopriza lyoni (both 0.21) exhibited the highest UV among the plants and the animals respectively. Stinging of centipede and dog/cat/hyena bite displayed highest ICF (1.00 each). Among the plants, the maximum RI (0.91) and CI (4.98) values were observed for Aristolochia indica. IAR (1.00) was recorded maximum for Achyranthes aspera, Gloriosa superba, Lycopodium cernuum, Smilax zeylanica and Streblus asper. Maximum CAI value was noted for Piper nigrum (5.5096). Among the animals, Apis cerana indica (0.31) and Crossopriza lyoni (1.52) displayed the highest RI and CI values respectively. Crossopriza lyoni (0.99) and Apis cerana indica (1.3871) exhibited maximum IAR and CAI values respectively. Plants showing higher FL exhibited higher anti-PLA2 activity via selective inhibition of human-group PLA2. In addition, Allium cepa root tip assay has indicated the safety and/or toxicity of the plant parts prescribed by the THs. Root water extracts of Aristolochia indica and Gloriosa superba exhibited significant genotoxicity and cytotoxicity. CONCLUSIONS: Three western districts of West Bengal is the natural abode for many tribal and non-tribal communities. A noteworthy correlation was established between the plants used against poisonous-bites and their anti-PLA2 activity. A few plant parts used by the THs also exhibited high toxicity. Such alternative medical practices serve as the only option in these underprivileged and backward areas during medical-exigencies.

Webpalestra COVID-19 (Coronavírus): PICS no SUS em tempos de pandemia. E eu com isso?

Assista mais vídeos sobre COVID-19 no link abaixo: https://www.youtube.com/playlist?list... Acesse os slides das nossas palestras na Biblioteca Virtual do Telessaúde ES! Confira a data da exibição e encontre o material desejado. Faça download e tenha o material preparado pelos nossos palestrantes. https://telessaude.ifes.edu.br/biblio...

The pervasiveness and policy consequences of medical folk wisdom in the U.S.

Medical folk wisdom (MFW) refers to widely held, but factually inaccurate, beliefs about disease, immunity, pregnancy, and other medically-relevant topics. Examples include the idea that fasting when feverish ("starving a fever") can increase the pace of recovery, or that showering after sex can prevent pregnancy. The pervasiveness of MFW, and whether or not it-like other forms of medically-relevant misinformation-shapes Americans' health behaviors and policy preferences is an important and under-studied question. We begin this research by proposing and validating a novel measure of MFW; including a short-form scale suitable for administration in public opinion surveys. We find that nearly all Americans-irrespective of socio-economic status, political orientation, and educational background-endorse at least some aspects of MFW. Concerningly, and consistent with the idea that folk wisdom challenges scientific expertise, we additionally find that those highest in MFW tend to place less value on medical expertise and the role experts play in shaping health policy. However, this skepticism does not appear to translate to peoples' health actions, as MFW appears to have an inconsistent effect on public participation in healthy behaviors.

The effect of traditional healer intervention prior to allopathic care on pediatric burn mortality in Malawi.

INTRODUCTION: Burn injury is a significant contributor to mortality, especially in low and middle-income countries (LMICs). Patients in many communities throughout sub-Saharan Africa use traditional health practitioners for burn care prior to seeking evaluation at an allopathic burn center. The World Health Organization defines a traditional health practitioner as "a person who is recognized by the community where he or she lives as someone competent to provide health care by using plant, animal and mineral substances and other methods based on social, cultural and religious practices based on indigenous knowledge and belief system." The aim of this study is to determine the prevalence of prior traditional health practitioner treatment and assess its effect on burn injury mortality. METHODS: A retrospective analysis of the prospectively collected Kamuzu Central Hospital (KCH) Burn Surveillance Registry was performed from January 2009 through July 2017. Pediatric patients (<13 years) who were injured with flame or scald burns were included in the study and we compared groups based on patient or family reported use of traditional health practitioners prior to evaluation at Kamuzu Central Hospital. We used propensity score weighted multivariate logistic regression to identify the association with mortality after visiting a traditional healer prior to hospitalization. RESULTS: 1689 patients were included in the study with a mean age of 3.3 years (SD 2.7) and 55.9% were male. Mean percent total body surface area of burn was 16.4% (SD 12.5%) and most burns were related to scald injuries (72.4%). 184 patients (10.9%) used traditional medicine prior to presentation. Only a delay in presentation was associated with prior traditional health practitioner use. After propensity weighted score matching, the odds ratio of mortality after using a prior traditional health practitioner was 1.91 (95% CI 1.09, 3.33). CONCLUSION: The use of traditional health practitioners prior to presentation at a tertiary burn center is associated with an increased odds of mortality after burn injury. These effects may be independent of the potential harms associated with a delay in definitive care. Further work is needed to delineate strategies for integrating with local customs and building improved networks for burn care, especially in rural areas.

Mexican Traditional Medicine: Application of a Traditional and Complementary Medicine System to Improve Opioid Use Treatment in Latinos.

Background: Initially considered a primarily rural, White issue, opioid use and overdose rates have risen faster for Latinos (52.5%) than for White, non-Hispanics (45.8%) from 2014 to 2016. With an estimated 45% to 65% of Latino immigrant families using Mexican traditional medicine (MTM) practices before seeking Western medical services, these practices could be used as a method to increase access to care and improve outcomes. Practice Model: Although not well known, MTM is founded on a defined set of theoretical tenets that comprise a whole medical system as defined by the National Center for Complementary and Integrative Health. Whole medical systems are characterized as complete systems of theory and practice that develop independently and parallel allopathic medicine. Classifying MTM as a whole medical system to encourage further research and utilization of traditional and complementary medicine (T&CM) practices could help improve health outcomes for Latino patients. Specific T&CM practices that could be used in opioid treatment integration to decrease stigma and increase treatment utilization are then discussed. Conclusion: Incorporating T&CM practices will allow more effective, culturally competent and culturally sensitive health care provision for Latino immigrants in the United States to decrease stigma, improve health care outcomes, and address disparities in opioid use treatment.

Practice of Postpartum Warming Among Mothers in Brunei.

Introduction: Postpartum warming is widely practiced among women in Asian countries despite unsubstantiated health claims. This study aimed to identify sources of knowledge and explore the practices of postpartum warming among mothers in Brunei. Methods: A cross-sectional study using a self-administered questionnaire was conducted on 124 mothers who had experience in postpartum warming. Results: Coal was commonly used for heat. Main source of knowledge came from family members. Older women had significantly lower intention to perform the practice in future pregnancies. Women who lived in nuclear families practiced it to a significantly higher frequency compared with those living in extended families. Discussion: Women still practice warming to adhere with family expectations and traditions although noticeable changes have been observed as society modernizes. It still poses a risk of carbon monoxide poisoning and fire hazard from burning coal. Future studies should focus on health and safety aspects to provide evidence on the actual health benefits and ameliorate risk factors.