Salve and Burdock: A Safe, Effective Amish Remedy for Treatment of Traumatic Wounds?

BACKGROUND: Amish patients show a demonstrated preference for traditional, herbal remedies over modern medical interventions such as skin grafting. One such remedy is a mixture of Burn & Wound Ointment (B & W Ointment; Holistic Acres, LLC; Newcomerstown, Ohio) and steeped burdock leaves. Although both have demonstrated some antimicrobial and wound healing properties, burdock and/or the combination of B & W Ointment and burdock has never been studied to determine its purported ability to reduce pain, prevent infection, and accelerate wound healing. METHODS: A retrospective chart review was performed on 6 Amish patients treated with salve and burdock leaves instead of skin grafting following complex traumatic wounds to determine whether the traditional treatment incurred any patient harm. RESULTS: The time of wound epithelialization and healing complications were noted, among other data points. Time to full epithelialization ranged from 1 to 7 months. Time to full wound healing was proportional to wound size. CONCLUSIONS: Although the treatment presented here is unconventional, it did not cause harm to the patients studied.

A fase terminal do filho com câncer: percepções dos profissionais hospitalares / The terminal phase of children with cancer: perceptions of hospital professionals / La fase terminal del hijo con cáncer: percepciones de los profesionales del hospital

O confronto com o câncer de um filho e a percepção da sua morte como inevitável dão lugar a experiências parentais relevantes para a pesquisa científica. Este estudo teve como objetivo investigar, por meio da percepção dos profissionais hospitalares, o modo como os pais experienciam a fase terminal e fim de vida do filho com câncer para melhor compreender os processos psicoemocionais experienciados por esses pais diante da cronicidade da doença e da morte do filho. No sentido de alcançar esse objetivo, realizou-se um estudo qualitativo de tipo fenomenológico envolvendo 17 profissionais de dois hospitais portugueses de referência em oncologia pediátrica. Os dados foram recolhidos com recurso a um guia de entrevista semiestruturada. Na percepção dos profissionais hospitalares, os resultados evidenciam que esses pais experienciam múltiplas dificuldades e preocupações na fase terminal da doença do filho e no pós-morte, bem como um sofrimento extremo e desestruturação biopsicossocial e espiritual na família. O conhecimento aprofundado da fenomenologia desses processos é essencial para o desenho e a implementação de intervenções emocionais, cognitivas, comportamentais e sociais mais ajustadas às dificuldades e preocupações parentais vividas no fim de vida e pós-morte.(AU)

Coping with children's cancer and the perception of their inevitable death give rise to parental experiences that are important to study. This study aimed to investigate, based on hospital professionals' perspectives, how parents experience the terminal phase and end of life of their children suffering from cancer to better understand the psycho-emotional processes these parents experienced in face of the chronicity of the disease and their children's death. To achieve this objective, a qualitative phenomenological study was carried out involving 17 professionals of two Portuguese hospitals that are reference in pediatric oncology. Data were collected using a semi-structured interview guide. From the perspective of hospital professionals, results show that these parents experience multiple difficulties and concerns in the terminal phase of their children's disease and postmortem, as well as the extreme suffering and biopsychosocial and spiritual disruption of the family. A deeper understanding of the phenomenology of these processes is essential to design and implement better adjusted emotional, cognitive, behavioral, and social interventions aimed at the parental difficulties and concerns experienced at the end of life and after death.(AU)

El enfrentamiento del cáncer de un hijo y la percepción de su muerte como inevitable dan lugar a experiencias parentales importantes que deben ser estudiadas. Este estudio pretende identificar desde la percepción de los profesionales del hospital cómo los padres viven la fase terminal y el final de la vida de su hijo con cáncer con el fin de comprender mejor los procesos psicoemocionales que viven estos padres ante la cronicidad de la enfermedad y la muerte de su hijo. Para ello, se realizó un estudio cualitativo, con enfoque fenomenológico, en el que participaron 17 profesionales de dos hospitales portugueses de referencia en oncología pediátrica. Para recoger los datos se aplicó un guion de entrevista semiestructurada. En cuanto a la percepción de los profesionales del hospital, estos padres experimentaron múltiples dificultades y preocupaciones en la fase terminal de la enfermedad de su hijo y postmuerte, así como un sufrimiento extremo y una desestructuración biopsicosocial y espiritual en la familia. El conocimiento en profundidad de la fenomenología de estos procesos es esencial para elaborar e implementar intervenciones emocionales, cognitivas, conductuales y sociales más acordes a las dificultades y preocupaciones parentales que se experimentan al final de la vida y la postmuerte.(AU)

Esophageal cancer studies in the Caspian littoral of Iran: results of population studies--a prodrome. Joint Iran-International Agency for Research on Cancer Study Group.

Epidemiologic studies were undertaken on the Caspian littoral of Iran to investigate the geographic distribution of factors that might underlie the signal differences in incidence of cancer of the esophagus. In zones of contrasting incidence and sex ratio, information was obtained on food intake, smoking and drinking patterns (including tea), other personal habits, occupation, economic and agricultural practices, and methods of food storage preservation, and preparation. The diet in the highest incidence area was markedly restricted to bread and tea. The poor quality of the diet itself was thought to have a role in the increased risk of developing esophageal cancer. The use of opium and sesame oil, consumption of sheep's milk and yogurt, the chewing of nass (confined to men), and the use of dyes (confined to women) were also more prevalent in the high incidence areas. Typical dietary items were analyzed for the polycyclic aromatic hydrocarbons, volatile nitrosamines, aflatoxins, nitrates, and nitrites. The results showed no unusual levels of any of the carcinogens tested or geographic differences.

Dietary factors and esophageal cancer in the Caspian Littoral of Iran.

A study was undertaken to attempt to relate the distribution of exogenous factors to the varying incidences of esophageal cancer in the Caspian Littoral of Iran. For the study, 38 villages were chosen by random sampling in 14 regions defined by their esophageal cancer incidence and environmental characteristics. Information was obtained on the dietary, social, and cultural features of each village. In addition, an extensive 5-day study of 6 randomly selected households in each of the 38 villages was conducted. The study consisted of measured dietary intake, a historical food consumption questionnaire, and clinical examinations of adult occupants. Preliminary results show no single factor responsible for the etiology of esophageal cancer. However, there were some major dietary differences between the regions of different esophageal cancer risk. Bread was the chief staple food in high-incidence areas; rice, in low-incidence areas. In high-incidence areas, there was a low intake of vitamins A and C, riboflavin, animal protein, and fresh vegetables and fruit, but a greater consumption of sheeps and goat's milk. Analyses of food samples for aflatoxins, polycylic aromatic hydrocarbons, and nitrosamines showed low levels of these carcinogens in areas of high and low incidences. The use of tobacco and alcohol was not found to be of significance.

Sex ratio among opium addicts in Asia: influences of drug availability and sampling method.

The literature on opium addiction in Asia reveals widely different sex ratios. Analysis of these reports indicates that community surveys provide the most reliable and valid ratios. Surveys in psychiatric hospitals appear to overreport women, while case registers and surveys in addiction treatment facilities, vends and dens overreport men. The relative proportion of female addicts is greatest in poppy-producing areas and in communities with high prevalence rates of addiction. Instrumental mechanisms for these observations are explored.

Alternative medicine in a sample of 655 community-dwelling elderly.

OBJECTIVE: Use and satisfaction with herbal/homeopathic remedies, acupuncture and relaxation techniques were examined in an Italian elderly population. METHODS: Data were collected as part of a survey on an elderly population, conducted in 1996--1997 in the urban centre of Padua, Italy. A total of 1362 elderly received a letter inviting them to participate and to accept the visit of an interviewer at home. Of these, 212 were unable to do so for insurmountable reasons and 666 gave consent to take part in the study with a response rate of 65%. Eleven participants were excluded from the study because cognitively impaired. RESULTS: Among the 655 respondents, overall use of at least one alternative medicine was 29.5%. Herbs/phytotherapeutics (47%) and acupuncture (34%) were the most frequently cited therapies. The use of alternative medical practices seems rather widespread among the elderly population in Padua, especially among females with depressive symptoms, pain and discomfort, but not suffering from chronic somatic disease. A percentage of 3.7% of the sample used exclusively alternative medicines; those subjects seemed to be younger, less likely to be physically ill and to report functional disorders and chronic somatic disease. CONCLUSION: Alternative medicines seem to have a complementary role for the elderly with self-perceived psychological symptomatology or disorders, particularly of depressive nature. They may constitute an attempt at self-treatment, probably concealing the difficulties encountered by the elderly subjects in seeking specialist advice for these problems.

Postmodern attitudes about health: a population-based exploratory study.

OBJECTIVE: This paper presents a preliminary exploration of the prevalence of postmodern attitudes about health. DESIGN: In a region of southeastern Australia structured telephone interviews with a random sample of 209 participants. RESULTS: Responses suggesting postmodern attitudes to health were prevalent: the majority of respondents appear to hold a holistic view of health, believe in individual responsibility for achieving health, reject medical authority, hold consumerist values, prefer natural products over chemical drugs, think most prescription drugs have side effects, do not believe all illnesses require medication from doctors and hold anti-technology sentiments. However, results reveal that most people have much faith in science. CONCLUSION: Attitudes prevalent among the public in south eastern Australia are congruent with the philosophy of most complementary therapists. This may be one reason for the growth of complementary medicine.

[Risk of HIV-1 or 2 infection associated with transfusion in Benin]. / Risque infectieux VIH 1/2 transfusionnel au Bénin.

OBJECTIVE: To evaluate the residual risk of transmission of HIV 1/2 infection through transfusion of seronegative blood. METHODS: This study was carried out between January and July 2000. It was based on eight hundred and twenty-one (821) blood donors screened negative for HIV antibodies by ELISA using Vironostika Uni-form II plus 0 (Organon Teknika). 675 (82.2%) were men and 146 (17.8%) women all aged between 18 and 56 years with a mean age of 25.5 +/- 7.8 years. Serum aliquots of these seronegative blood donor were frozen and further tested with two tests: Enzymun-Test HIV Combi (Roche Immunodiagnostics) and Murex HIV Antigen Mab (Murex). RESULTS: Twenty six out of 821 (3.2%) seronegative specimens were repeatedly reactive for Enzymun-test. All were tested negative once again for anti-HIV antibodies by ELISA using Vironostika Uni-form II/plus 0. Out of these 26, only one was repeatedly reactive for Murex. For further analysis of the 25 donors tested negative for Murex, only 9 came back for another donation five months later. All of them were tested negative for anti-HIV antibodies by ELISA (Vironostika). CONCLUSION: Our study shows the existence of residual risk of transmission of HIV1/2 infection associated with transfusion of seronegative blood donors. This risk was higher in our countries compared with industrialised nations. Therefore implementing strategies should be a priority to avoid the residual risk and improve blood transfusion safety.

Complementary therapies and the general practitioner. A survey of Perth GPs.

OBJECTIVE: The purpose of this study was to identify the knowledge, attitudes and referral patterns of general practitioners (GPs) toward 10 specific complementary therapies. METHOD: The study was a descriptive cross-sectional postal survey, conducted between July 1998 and August 1998 inclusive. A random selection of 200 male and 200 female Western Australian GPs residing in Perth and listed in the Australian Medical Association database file of registered GPs. RESULTS: The response rate was 74.8% (n = 282). Over 90% of these GPs reported having been approached by more than 30 patients seeking their advice about complementary therapies in the past nine months. The majority of these patients were women, over the age of 35 years. Ten complementary therapies were listed in the questionnaire: acupuncture, hypnosis, meditation, spinal manipulation, yoga, homeopathy, herbal medicine, naturopathy, massage and aromatherapy. Just under half (132) of the respondents had undertaken studies in at least one of the listed complementary therapies, with over 60% reporting a wish for further training. Overall, 67.8% (191) of all respondents reported they were in favour of GP referrals to complementary therapists. However, 56.1% (158) were against complementary therapies being included in rebates for private health insurance. Overall, 75.0% (211) of GPs surveyed had already formally referred a patient to one or more of the listed therapies, the most frequent of these being acupuncture, massage, meditation, hypnosis and spinal manipulation as a part of their overall medical treatment. CONCLUSION: Perth GPs have a high level of interest in complementary therapies. Government regulation and registration of complementary therapies is seen by GPs as important in order to ensure professional standards of practice. Given the high level of interest, provision of undergraduate and postgraduate education in complementary therapies could be considered. In addition, the development of clinical guidelines would be of benefit.

Four-year experience of use of the Cobas Amplicor system for rapid detection of Mycobacterium tuberculosis complex in respiratory and nonrespiratory specimens in Greece.

To evaluate the experience of a clinical microbiology laboratory with a DNA amplification assay for routine detection of Mycobacterium tuberculosis, the Cobas Amplicor Mycobacterium tuberculosis (MTB) polymerase chain reaction (PCR) assay (Roche Diagnostics Systems, USA) was performed on 7,722 respiratory and 1,451 nonrespiratory specimens collected from 3,321 patients. The results were compared with those of culture in conventional Lowenstein-Jensen medium, culture in the MB/BacT system (Organon Teknika, France), and clinical investigations. A total of 240 of the 254 respiratory specimens culture positive for Mycobacterium tuberculosis were also positive in the PCR assay. Of the 7,300 culture-negative specimens, 45 (0.6%) were positive in the PCR. After detailed interpretation, the overall sensitivity, specificity, and positive and negative predictive values of the PCR assay were 84.5, 99.8, 94.1, and 99.4%, respectively, for respiratory specimens. The PCR assay was more sensitive for smear-positive respiratory specimens (97.1%) than for smear-negative respiratory specimens (48.6%). Of the 18 culture-positive (smear-negative) nonrespiratory specimens, 9 were positive in the PCR. None of the 1,384 culture-negative nonrespiratory specimens were positive in the PCR. The inhibition rates detected by the internal control of the test were 2.2% for respiratory specimens and 3.4% for nonrespiratory specimens. After resolving the discrepancies, the overall sensitivity, specificity, and positive and negative predictive values of the PCR assay were 82.5, 99.8, 94.3, and 99.4%, respectively, when compared to the results of diagnostic culture. In conclusion, the use of the Cobas Amplicor MTB-PCR assay might enable clinical microbiology laboratories with considerable previous experience in molecular biology testing to perform PCR and confirm tuberculosis infection immediately, leading to improved patient management.

Use of and interest in alternative therapies among adult primary care clinicians and adult members in a large health maintenance organization.

During spring 1996, random samples of adult primary care physicians, obstetrics-gynecology physicians and nurse practitioners, and adult members of a large northern California group practice model health maintenance organization (HMO) were surveyed by mail to assess the use of alternative therapies and the extent of interest in having them incorporated into HMO-delivered care. Sixty-one percent (n = 624) of adult primary care physicians, 70% (n = 157) of obstetrics-gynecology clinicians, and 50% (2 surveys, n = 1,507 and n = 17,735) of adult HMO members responded. During the previous 12 months, 25% of adults reported using and nearly 90% of adult primary care physicians and obstetrics-gynecology clinicians reported recommending at least 1 alternative therapy, primarily for pain management. Chiropractic, acupuncture, massage, and behavioral medicine techniques such as meditation and relaxation training were most often cited. Obstetrics-gynecology clinicians used herbal and homeopathic medicines more often than adult primary care physicians, primarily for menopause and premenstrual syndrome. Two thirds of adult primary care physicians and three fourths of obstetrics-gynecology clinicians were at least moderately interested in using alternative therapies with patients, and nearly 70% of young and middle-aged adult and half of senior adult members were interested in having alternative therapies incorporated into their health care. Adult primary care physicians and members were more interested in having the HMO cover manipulative and behavioral medicine therapies than homeopathic or herbal medicines.

Yeasts isolated from clinical samples of aids patients

In order to investigate yeasts in oropharyngeal secretion, urine, sputum and inguinal scales from AIDS patients, clinical samples were collected from one hundred patients interned in the Infectious and Parasitic Diseases Sector of the Hospital das Clínicas of the Universidade Federal de Pernambuco and in Hospital Universitário Osvaldo Cruz of the Universidade de Pernambuco. Yeasts were isolated from seenty-two out of one hundred and eight clinical samples. The isolated yeasts were: Candida albicans (sixty-two isolates), Candida tropicalis (four isolates), Candida glabrata (two isolates), Candida parapsilosis (two isolates), Candida krusei (one isolate) and Trichosporon pullulans (one isolate).

Aislamiento de poblaciones de Serratia marcescens de origen clínico en dos institutos pediátricos / Isolation of populations of Serratia marcescens of clinical origin in two pediatrics institutions

Introudcción. Serratia marcescens es un patógeno oportunista en hospederos inmunocomprometidos y se asocia fundamentalmente a brotes intrahospitalarios con tasas de letalidad elevadas. El propósito del presente estudio fue tipificar 2 poblaciones de S. marcescens de origen clínico aisladas en 2 institutos pediátricos semejantes. Material y métodos. Se empleó el sistema de biotipificación propuesto por Grimont para la caracterización de 65 cepas del Hospital Infantil de México, originalmente clasificadas como Enterobacter sp y 35 cepas del Instituto Nacional de Pediatría aisladas en un brote intrahospitalario. Reesultados. El biogrupo más numeroso en ambas poblaciones fue el A 5/8 y de éste los biotipos A8a y A8b; se observaron variaciones en las proporciones de los biotipos identificados acordes al hospital de aislamiento, así como en los biotipos y patrones de resistencia a los antibióticos en cepas aisladas del mismo pacientes en muestras diferentes. Conclusiones. Del presente estudio se concluye que es importante que en los hospitales se realicen estudios epidemiológicos particulares de sus poblaciones de S. marcescens, pero es más importante aún que se lleve a cabo una correcta identificación de esta bacteria para valorar adecuadamente su importancia como patógeno oportunista en nuestro medio