[Persistence of a magic-religious ritual to treat indigestion among patients attending a gastroenterology outpatient clinic]. / Persistencia de una práctica de medicina mágico-religiosa para la cura del empacho entre los enfermos que acuden a consultas externas de digestivo.

INTRODUCTION: Knowledge of popular medicine is essential to the practice of integrated medicine. Empacho (stomach upset) is a known folk illness that has been the object of several studies, especially in Iberoamerica and among the Hispanic population in the United States. In the Autonomous Community of Valencia (Spain) a magic-religious ritual known as "trencar lenfit" (TE) is still performed. This ritual has no apparent equivalent among the numerous remedies described for this illness. OBJECTIVES: To study the frequency and characteristics of the practice of TE among patients attending the gastroenterology outpatient clinic of a district hospital. PATIENTS AND METHOD: The geographical area was the region of La Safor (Valencian Community) with three main nuclei (Gandia, where the hospital is situated, Oliva and Tavernes de Valldigna) and 28 smaller municipalities. Random interviews were performed in patients attending a second consultation over a period of 5 months. RESULTS: Of 539 patients interviewed, 320 (59.4%) had undergone TE at some time in their lives and 25.0% had undergone this ritual in the previous 10 years. In 95.9% of cases, the person performing the ritual was a woman. Of the patients who had undergone TE, 40 (12.5%) knew how to perform the ritual, 35 of which were women (p < 0.0001). No significant differences were found between sexes but users were younger (51.8 +/- 15.9 versus. 55.5 +/- 17.7 years +/- SD, p < 0.05). Small municipalities and Oliva showed a frequency of 65.6% versus. 54.0% in Gandia and Tavernes (p < 0.005). Use was greater among natives of the Valencian Community (66.0%) compared with those from other parts of Spain (25.0%) (p < 0.0001). Patients who completed primary or secondary school showed greater use of TE (60.5% and 72.1%, respectively) than the illiterate (42.1%), those who had completed a 3-year higher education course (48.4%) and university graduates (36.0%) (p < 0.001). TE was more frequent among consumers of medicinal herbs than among non-consumers (69.0% versus. 54.3%) (p < 0.001). No relationship was found among TE and the use of alcohol, medication in general and smoking. However, an association was found between the use of psychotropic drugs (69.8% versus. 55.4%) (p < 0.005). No clear association was found with broad diagnostic group or with the functional/organic nature of the digestive disorder studied. Variables found to be significant on univariate analysis remained significant in multivariate analysis (logistic regression). CONCLUSION: The present study confirms the high use of TE among patients attending the gastroenterology outpatient clinic of La Safor and their belief in this ritual. "Experts" in performing TE were widely available, and were almost exclusively women. The profile of maximal use of TE corresponds to a man or woman, aged less than 60 years, a native of the Valencian Community, with primary or secondary school education, residing in particular municipalities (usually small) and consumer of psychotropic drugs and medicinal herbs.

Persistencia de una práctica de medicina mágico-religiosa para la cura del empacho entre los enfermos que acuden a consultas externas de digestivo / Persistence of a magic-religious ritual to treat indigestion among patients attending a gastroenterology outpatient clinic

Introducción: El conocimiento de la medicina popular resulta básico para el ejercicio de una medicina integrada. El empacho es una enfermedad conocida de la medicina popular cuyo estudio ha motivado diversas publicaciones, especialmente en el área iberoamericana y entre la población hispana de Estados Unidos. En la Comunidad Valenciana persiste un ritual de medicina mágico-religiosa conocido como trencar l’enfit (TE) (romper el empacho), sin paralelismo aparente entre los múltiples remedios descritos para esta dolencia. Nuestro objetivo ha sido estudiar la frecuencia y las características de la práctica de TE entre los pacientes que acuden a consultas externas de digestivo de un hospital comarcal. Pacientes y método: El ámbito geográfico fue la comarca de La Safor (Comunidad Valenciana), con 3 núcleos principales (Gandia, sede del hospital, Oliva y Tavernes de Valldigna) y 28 municipios menores. Se realizaron entrevistas de forma aleatoria a los pacientes que acudían a segundas visitas, durante 5 meses. Resultados: De los 539 pacientes entrevistados, 320 (59,4%) habían realizado TE en algún momento de su vida y un 25,0% en los 10 últimos años. La persona que realizaba el ritual fue en un 95,9% de los casos mujer. De los pacientes que habían practicado TE, 40 (12,5%) sabían realizar el ritual; de éstos 35 eran mujeres (p < 0,0001). No hubo diferencias significativas entre sexos, pero fueron más jóvenes los usuarios (media de edad ± desviación estándar: 51,8 ± 15,9 frente a 55,5 ± 17,7 años; p < 0,05). Las poblaciones pequeñas y Oliva presentaron una frecuencia del 65,6%, frente al 54,0% de Gandia y Tavernes (p < 0,005). El uso fue mayor entre las personas originarias de la Comunidad Valenciana (66,0%) que entre las procedentes de otros lugares de España (25,0%) (p < 0,0001). Los pacientes con estudios primarios o EGB-bachillerato presentaron el uso máximo de TE (el 60,5 y el 72,1%, respectivamente), frente a los analfabetos (42,1%), titulados medios (48,4%) y titulados superiores (36,0%) (p < 0,001). Los consumidores de hierbas medicinales habían practicado TE más que quienes no las consumían (el 69,0 frente al 54,3%; p < 0,001). No se encontró relación de la utilización del TE con el consumo de alcohol, tabaco y medicamentos en general, pero sí con el de psicofármacos (el 69,8 frente al 55,4%; p < 0,005). No hubo relación clara con los grandes grupos diagnósticos ni con el carácter funcional/orgánico de la enfermedad digestiva estudiada. El análisis multivariante (regresión logística) confirmó la asociación independiente de las variables significativas en el estudio univariante. Conclusión: Se corrobora una elevada utilización y considerable vigencia de TE entre los pacientes que acuden a consultas externas de digestivo de La Safor. Se constata una amplia difusión de las personas «expertas» en la realización de TE, con predominio casi absoluto del sexo femenino. El perfil de máximo uso de TE se podría acercar al siguiente: varón o mujer, menor de 60 años, de origen valenciano, con estudios medios-primarios, residente en determinadas poblaciones (en general, pequeñas), consumidor/a de psicofármacos y de hierbas medicinales

Introduction: Knowledge of popular medicine is essential to the practice of integrated medicine. Empacho (stomach upset) is a known folk illness that has been the object of several studies, especially in Iberoamerica and among the Hispanic population in the United States. In the Autonomous Community of Valencia (Spain) a magic-religious ritual known as «trencar l’enfit» (TE) is still performed. This ritual has no apparent equivalent among the numerous remedies described for this illness. Objectives: To study the frequency and characteristics of the practice of TE among patients attending the gastroenterology outpatient clinic of a district hospital. Patients and method: The geographical area was the region of La Safor (Valencian Community) with three main nuclei (Gandia, where the hospital is situated, Oliva and Tavernes de Valldigna) and 28 smaller municipalities. Random interviews were performed in patients attending a second consultation over a period of 5 months. Results: Of 539 patients interviewed, 320 (59.4%) had undergone TE at some time in their lives and 25.0% had undergone this ritual in the previous 10 years. In 95.9% of cases, the person performing the ritual was a woman. Of the patients who had undergone TE, 40 (12.5%) knew how to perform the ritual, 35 of which were women (p < 0.0001). No significant differences were found between sexes but users were younger (51.8 ± 15.9 versus. 55.5 ± 17.7 years ± SD, p < 0.05). Small municipalities and Oliva showed a frequency of 65.6% versus. 54.0% in Gandia and Tavernes (p < 0.005). Use was greater among natives of the Valencian Community (66.0%) compared with those from other parts of Spain (25.0%) (p < 0.0001). Patients who completed primary or secondary school showed greater use of TE (60.5% and 72.1%, respectively) than the illiterate (42.1%), those who had completed a 3-year higher education course (48.4%) and university graduates (36.0%) (p < 0.001). TE was more frequent among consumers of medicinal herbs than among non-consumers (69.0% versus. 54.3%) (p < 0.001). No relationship was found among TE and the use of alcohol, medication in general and smoking. However, an association was found between the use of psychotropic drugs (69.8% versus. 55.4%) (p < 0.005). No clear association was found with broad diagnostic group or with the functional/organic nature of the digestive disorder studied. Variables found to be significant on univariate analysis remained significant in multivariate analysis (logistic regression). Conclusion: The present study confirms the high use of TE among patients attending the gastroenterology outpatient clinic of La Safor and their belief in this ritual. «Experts» in performing TE were widely available, and were almost exclusively women. The profile of maximal use of TE corresponds to a man or woman, aged less than 60 years, a native of the Valencian Community, with primary or secondary school education, residing in particular municipalities (usually small) and consumer of psychotropic drugs and medicinal herbs

[Consumption of medicinal herbs in patients attending a gastroenterology outpatient clinic]. / Consumo de hierbas medicinales en los pacientes de consultas externas de digestivo.

The consumption of medicinal herbs is one of the most important topics in alternative and complementary medicine. The widespread use of these substances among the general population gives rise to the possibility of therapeutic or toxic effects in patients seeking conventional medical assistance. To determine the frequency of medicinal herb use, the species consumed and the profile of medicinal herb consumers among patients with gastrointestinal disorders, patients attending the gastroenterology outpatient clinic of the Francesc de Borja district hospital (Gandía, Spain) over a 5-month period were interviewed and 539 valid questionnaires were obtained. A total of 34.7% of the interviewees had taken medicinal herbs at some time and 26.9% had used them in the last year. Self-prescription was reported by 67.1%. Medicinal herbs were mainly obtained in the pharmacy or herbalist's (74.7%). The results of medicinal herb therapy were considered good or excellent by 80.3% of the interviewees, average by 18.6% and poor by 1.1%. In the univariate analysis, medicinal herb consumption was positively associated with female sex (p < 0.001), a university education (p < 0.05), consumption of psychotropic drugs (p < 0.005), use of trencar l'enfit (TE, a common practice of magic medicine in Valencia) (p < 0.001), functional gastrointestinal disorders (p < 0.005) and a diagnosis of lower gastrointestinal disorder (p < 0.01). In the multivariate analysis, the variables that remained statistically significant were female sex (p < 0.005), university education (p < 0.01), use of TE and a diagnosis of lower gastrointestinal disorder. Fifty-seven botanical varieties were used. The most frequent varieties were Santolina chamaecyparissus (18.8%), Tilia platyphyllos (6.5%), Thymus vulgaris (6%), Equisetum ramosissimum (4.7%), Mentha pulegium (4.4%) and Valeriana officinalis (4.4%). The results show that consumption of medicinal herbs is frequent among patients attending the gastroenterology outpatient clinic of a district hospital. The probable profile of those showing maximum consumption is: female sex, university education, lower gastrointestinal disorder, functional gastrointestinal disorder, psychotropic drug consumption and use of TE.

[Autoimmune hepatitis and anti-Ro antibodies. Is there a link?]. / Hepatitis autoinmune y anticuerpos anti-Ro positivos. ¿Alguna relación?

Antinuclear antibodies (ANA) are considered to be markers of autoimmune disease. Several specific reactivities of ANA are known, among them the Ro (SS-a) complex. Although the presence of anti-Ro antibodies is widely known in systemic connective tissue diseases such as lupus erythematous or Sjögren's syndrome, few studies have attempted to link this finding with autoimmune hepatitis (AIH). We present a case of acute AIH in a 55-year-old woman who tested positive for anti-Ro 60 kD antibodies. The Ro (SS-A) antigen is a complex ribonucleoprotein whose structure is still the subject of debate. Two fractions, of 50 and 60 kD, have been identified. A review of the literature revealed frequencies of 21-34% for anti-Ro 52 kD and of 9-13-6% for anti-Ro 60 kD in AIH. Although no relationship has been demonstrated between this complex and the etiopathogenic mechanisms or clinical patterns of AIH, we propose that multicenter investigations with large series should be performed before the possible involvement of anti-Ro antibodies in these diseases is definitively ruled out.

Studies on epidermis reconstructed with and without melanocytes: melanocytes prevent sunburn cell formation but not appearance of DNA damaged cells in fair-skinned caucasians.

To assess the photoprotective role of melanocytes in the epidermis, we studied the effects of ultraviolet B on an epidermis reconstructed with and without melanocytes. To address more specifically the role of melanin in fair-skinned individuals, experiments were done with cells obtained from human skin of low phototypes (II-III). To study the effect of constitutive melanin and possibly that of newly synthesized melanin precursors, a single dose of ultraviolet B (0.10 or 0.15 J per cm2, corresponding to a 4-5 minimal erythema dose in vivo) was administered to reconstructs and the effects were monitored over the first 24 h. When reconstructs with and without melanocytes were compared, no difference was found for DNA damage/repair assessed with antibodies to cyclobutane pyrimidine dimers and 6-4 photoproducts. More necrotic/apoptotic cells, however, were noted 24 h following ultraviolet B irradiation in reconstructs lacking melanocytes. Twenty-four hours following ultraviolet B irradiation the number of necrotic/apoptotic cells and the number of cyclobutane pyrimidine dimer positive cells was coarsely concentration-dependent. The number of cyclobutane pyrimidine dimer positive cells, however, was independent of the type of reconstruct used (with/without melanocytes). In conclusion, low phototype melanocytes seem to protect epidermal basal cells against ultraviolet B-induced apoptosis/necrosis and may preserve the overall integrity of the epidermis after ultraviolet B irradiation. On the contrary, such melanocytes do not seem to have a protective role against DNA damage and may not prevent cancer.

Influence of applied quantity, water-immersion and air-drying on covering and microstructure of physical sunscreen films.

The features of topically applied suncream films depend on the applied quantities and could be modified by water immersion and air drying. The aim of this study was to investigate the effects of the aforementioned factors on physical sunscreen films and to establish the correlation between the in vitro determined Sun Protection Factor (SPF) and the microstructure of the mineral coating. The assessments were conducted by using UV spectroscopy and electron microscopy on sunscreen films applied on both synthetic membranes and human skin. The results emphasize the paramount role played by the applied quantity to produce a continuous and protecting sunscreen film. The microscopic findings show that water immersion induces mainly a compactness of the sunscreen films, whereas no significant alterations were noted after air drying. Lastly, the SPF values, measured before and after water immersion, disclose the satisfactory water resistance of the broad-spectrum physical sunscreen considered.

[Recurrence factors in benign gastric ulcer]. / Factores de recidiva de la úlcera gástrica benigna.

Among 7015 upper gastrointestinal endoscopies done during five consecutive years (1984-1988) 642 patients were diagnosed as having benign gastric ulcer. Of this group, 213 patients have been followed-up during an adequate period of time. A recurrence was diagnosed endoscopically in 43 (20.18%). The authors analyze the influence on recurrences of general factors (age, sex, alcohol, tobacco and drugs), family history and local factors (site and size of the ulcer, histological lesions, concomitant duodenal ulcer or single or multiple ulcers). The conclusions are that in females and in males over 60 years of age, NSAIDS are the factors which greatly influence recurrences, while in males under 60 years of age, excessive smoking and alcohol. Chronic gastritis and intestinal metaplasia are common in recurrent ulcers. Multiple ulcers as well as those associated with duodenal ulcers have a greater tendency to recur. Recurring ulcers are more common at the incisura angularis. Recurrences are usually located at the site of a previous ulcer.