Symbolism and ritual practices related to hunting in Maya communities from central Quintana Roo, Mexico.

BACKGROUND: Some Mayan peasant-hunters across the Yucatan Peninsula in Mexico still carry out a hunting ritual -Loojil Ts'oon, Loj Ts'oon or Carbine Ceremony- in which they renew the divine permission for hunting in order to continue deserving the gift of prey after a period of hunt. Thus they are granted access to game by the gods and the Lords of the Animals, particularly the spirit/evil-wind call. This paper focuses on the acts within the Loojil Ts'oon -which is performed in the X-Pichil community and surrounding area- that make it unique among the hunting rituals performed in other parts of the Peninsula. METHODS: The Loojil Ts'oon hunting ritual was observed and registered in audiovisual format in two different occasions in X-Pichil (Friday 04/29/2011 and Friday 07/29/2011). Afterwards, we delivered digital videodisks (DVD) to hunters and their families and to the j-men (the magic-medic-ritual specialist) who participated in these ceremonies. This delivery produced confidence among participants to talk more openly and in-depth about the Loojil Ts'oon, revealing symbolic, psychological, and material details previously unknown to outsiders. Qualitative information was obtained through the ethnographic method using techniques such as participant observation and guided tours. Semi-structured interviews were carried out to obtain complementary information. RESULTS AND DISCUSSION: On one hand, we describe the preparation and cleansing of the "Sip soup", as well as its parading and distribution -delivery to the spirit/evil-wind Sip- on the streets of the community (highlingting the role of the rooster as a counter-gift). On the other hand, the cleansing of the jaws (of deer: Odocoileus virginianus, Mazama spp.; and peccaries: Tayassuidae) and their return to the Lords of Animals in the hills so that they may give these animals new life. CONCLUSIONS: By performing the Loojil Ts'oon, the act of killing an animal is legitimized. The kill transforms into an exchange to perpetuate life, in which gods and Lords of animals grant the hunter the solicited new game if he has completed his ritual duties and has not broken the prescribed hunting rules. The Loojil Ts'oon does not only represent the continuity and regeneration of animals, that is, fauna as a resource, but also of the whole hunting cycle. The hunter does so to maintain and recreate order and equilibrium in one's relationship with nature as a whole, with the rest of one's social group, and with oneself. Thus, hunting transcends the exclusively material dimension of a subsistence activity.

The spectrum of infections in catheter-dependent hemodialysis patients.

BACKGROUND AND OBJECTIVES: Catheter-dependent hemodialysis patients may develop access-related and nonaccess-related infections that may be managed in the outpatient arena or in the hospital. The goal of this study was to quantify infections in such patients, to characterize their clinical presentations, and to evaluate factors determining need for hospitalization. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We collected prospective data on the clinical management of catheter-dependent hemodialysis patients with suspected infection at a large dialysis center. We documented the presenting symptoms, type of infection, pathogen, and whether hospitalization occurred. RESULTS: An infection was suspected in 305 separate cases and confirmed in 88%. The 268 diagnosed infections included catheter-related bacteremia (69%), another access-related infection (19%), and nonaccess-related infection (12%). The overall frequency of infection was 4.62 per 1000 catheter-days. Hospitalization occurred in 37% of all infections, but it varied greatly (72% for nonaccess-related infection, 34% for catheter-related bacteremia, and 4% for exit-site infection). Among patients with catheter-related bacteremia, the likelihood of hospitalization varied by pathogen, being 53% for Staphylococcus aureus, 30% for Enterococcus, 23% for Staphylococcus epidermidis, and 17% for gram-negative rods (P < 0.001). The likelihood of hospitalization was not associated with age, gender, or diabetes. Fever was a presenting symptom in only 47% of cases of catheter-related bacteremia. CONCLUSIONS: Catheter-dependent patients have a high burden of infection. It is important to evaluate patients with suspected infection for various access-related and nonaccess-related infections. A low threshold is indicated for suspecting catheter-related bacteremia because the patients frequently present without fever.

Treatment of dialysis catheter-related Enterococcus bacteremia with an antibiotic lock: a quality improvement report.

BACKGROUND: Catheter-related bacteremia (CRB) is a frequent complication of tunneled dialysis catheters, and Enterococcus is a common infecting organism. CRB may be treated by instilling an antibiotic lock into the catheter lumen in conjunction with systemic antibiotics. The efficacy of this approach in Enterococcus bacteremia is unknown. DESIGN: Quality improvement report. SETTING & PARTICIPANTS: 64 catheter-dependent hemodialysis outpatients with vancomycin-sensitive Enterococcus bacteremia treated with a uniform antibiotic lock protocol. Clinical outcomes were tracked prospectively. QUALITY IMPROVEMENT PLANS: Patients received intravenous vancomycin for 3 weeks in conjunction with a vancomycin lock instilled into both catheter lumens after each dialysis session. MEASURES: Treatment failure was defined as persistent fever 48 hours after initiation of antibiotic therapy or recurrent Enterococcus bacteremia within 90 days. A clinical cure was defined as fever resolution without recurrent bacteremia. Major infection-related complications within 6 months were documented. RESULTS: Treatment failure occurred in 25 patients (39%) because of persistent fever in 10 and recurrent bacteremia in 15. Treatment success occurred in 39 patients (61%). A serious complication of Enterococcus CRB occurred in 4 of 64 patients (6%); endocarditis in 1 and osteomyelitis in 3. The frequency of serious complications was 16% (4 of 25 patients) in those with treatment failure compared with 0% (0 of 39 patients) in those with treatment success (P = 0.01). LIMITATIONS: This was a single-center study. We did not measure serum vancomycin. CONCLUSIONS: An antibiotic lock protocol permits catheter salvage in 61% of hemodialysis patients with Enterococcus CRB. Serious complications occur in 6% of patients and are more common in those with treatment failure.

Treatment of dialysis catheter-related Staphylococcus aureus bacteremia with an antibiotic lock: a quality improvement report.

BACKGROUND: Dialysis catheter-related bacteremia is often treated successfully by instilling an antibiotic-heparin solution into the catheter lumen (an antibiotic lock) in conjunction with systemic antibiotic therapy without removal of the catheter. The efficacy of this therapy is uncertain in Staphylococcus aureus bacteremia. DESIGN: Quality improvement report. SETTING & PARTICIPANTS: 113 catheter-dependent hemodialysis outpatients with S aureus catheter-related bacteremia treated with a standardized antibiotic lock protocol. Data for all patients with catheter-related bacteremia are recorded in a prospective database. QUALITY IMPROVEMENT PLAN: In conjunction with systemic antibiotic therapy (vancomycin for methicillin-resistant S aureus or cefazolin for methicillin-sensitive S aureus), an antibiotic lock was instilled into each catheter lumen after each dialysis session for 3 weeks. MEASURES: Treatment failure is defined as persistent fever after 48 hours of antibiotic therapy or recurrent S aureus bacteremia within 90 days. Clinical cure is defined as resolution of fever and no recurrence of bacteremia. Major infection-related complications within 6 months were documented. RESULTS: The catheter could not be salvaged in 67 patients (59%) because of persistent fever in 40 patients and recurrent bacteremia in 27 patients. A clinical cure was achieved in 46 patients (41%). A serious complication of catheter-related bacteremia occurred in 9.7% of all patients (11 of 113 patients). Serious complications were observed in 25% of patients (10 of 40 patients) with persistent fever, but only 1.4% of all other patients (1 of 73 patients; P < 0.0001). LIMITATIONS: This was a single-center study. Serum antibiotic levels were not measured. CONCLUSIONS: Routine antibiotic lock therapy is not appropriate for patients with S aureus catheter-related bacteremia. Serious complications occur primarily in patients with persistent fever.