Liver transplantation and the use of KAVA: Case report.

BACKGROUND: Self-medication and the belief that herbal products are free of health risks are common in Brazil. The kava (Piper methysticum), known for its anxiolytic action, has a widespread popular use. Hepatotoxicity of kava is reported, including cases of liver transplantation and death. The kava had its use prohibited or restricted in countries like Germany, France, among others. Toxicity may be related to overdosage; however, factors such as botanical characteristics of the plant, the harvesting, storage, and production process may be associated with the development of hepatotoxic substances, such as triggering idiosyncratic reactions. HYPOTHESIS: In this case, there is a suspicion that the toxicide is intrinsic to the drug; however, the possibility of adulterants and contaminants must be ruled out. STUDY DESIGN: This study reports the case of a patient who, after using the herbal kava for 52 days, evolved into acute liver failure and liver transplantation. METHODS: The data were collected directly with the patient and compared with their clinical records. Causality was determined through the RUCAM algorithm. In addition, a phytochemical analysis of the drug used was performed. RESULTS: According to the patient's report, there is no evidence of overdosage. Results from RUCAM algorithm infer causality between liver damage and the use of kava. The analysis chemical constituents did not find any possible contaminants and major changes in the active compounds. Seven months after transplantation, the patient is well and continues to be followed up by a medical team. CONCLUSION: Our investigation indicates that there was kava-induced hepatotoxicity at standard dosages. In Brazil, self-medication by herbal medicines is frequent and many patients and health professionals do not know the risks associated with their use. Diagnosing and notifying cases in which plants and herbal medicine induce liver damage is of paramount importance to increase the knowledge about DILI and to prevent or treat similar cases quickly.

Safety evaluation of supratherapeutic dose of Maytenus ilicifolia Mart. ex Reissek extracts on fertility and neurobehavioral status of male and pregnant rats.

Maytenus ilicifolia Mart. ex Reissek is a plant commonly used in folklore medicine in the management of gastric diseases in South America. This study explores the effects of a supratherapeutic dose of aqueous and ethanol extracts of M. ilicifolia (1360 mg/kg) on fertility and neurobehavioral status in male and pregnant rats. A battery of sensory-motor developmental endpoints was carried out to assess impairments on pups of dams orally treated with the aqueous extract of M. ilicifolia during the organogenesis period of pregnancy (GD 9 through GD 14). The neuromotor maturation reflexes and physical developments of the offspring were not significantly different between the groups (p < 0.05). Also, the hippocampal morphology revealed no indices of cell loss in the CA1, CA2, CA3 and CA4 areas. As second protocol, some fertility aspects were investigated in young post pubertal male Wistar rats treated with the ethanol extract for 30 days. The semen quality and testicular tissue morphology of male rats treated with the ethanol extract of M. ilicifolia remained unaffected upon treatment. Thus, the results indicate that the high-dose of M. ilicifolia extracts have no neurotoxic potential on offspring and seem not to affect the sperm quality of male rats.

In vitro toxicological assessment of Arrabidaea brachypoda (DC.) Bureau: Mutagenicity and estrogenicity studies.

Arrabidaea brachypoda (DC.) Bureau is a shrub native Cerrado, known as "cipó-una", "tintureiro" or "cervejinha do campo" and popularly used in Southeastern and Northeastern Brazil to treatment of kidney stones and painful joints (arthritis). Nevertheless, scientific information regarding this species is scarce, and there are no reports related to its possible estrogenic and mutagenic effects. Thus, the principal objective of this study was to assess the mutagenic and estrogenic activities of the hydroalcoholic extracts of the leaves, stalks, roots, their respective fractions and isolated compounds of A. brachypoda. The mutagenic activity was evaluated by the Ames test on Salmonella typhimurium strains TA98, TA97a, TA100 and TA102, in the absence (-S9) and presence (+S9) of metabolic activation system. In the RYA was used Saccharomyces cerevisiae engineered strain BY4741 (MATaura3Δ0 leu2Δ0 his3Δ1 met15Δ0) which reproduce the natural pathway of genetic control by estrogens in vertebrate cells; it has the advantage of its simplicity and a high throughput. All extracts and aqueous fraction of leaves A. brachypoda were mutagenic. The crude extract is more active than the fraction, suggesting a synergic effect. Only hydroalcoholic extracts of leaves and roots of A. brachypoda showed significant estrogenic activity, with ERα-dependent transcriptional activation activity. The obtained results in this study showed the presence of compounds capable of interacting with the estrogen receptor and to induce damage in the genetic material. Thus, we demonstrated the risk which the population is subjected due to indiscriminate use of extracts without detailed study.

Farmacovigilancia y alertas del uso de recursos y productos en la medicina tradicional, alternativa y complementaria en el Perú (1997-2016) / Pharmacovigilance and alerts about use of resources and products in Traditional, Alternative and Complementary Medicine in Perú (1997-1976)

Objetivo: Caracterizar las notificaciones de reacciones adversas (RAM) y alertas DIGEMID, relacionadas a problemas de seguridad de las plantas medicinales y productos usados en la medicina tradicional, alternativa y complementaria (MTAC) correspondiente a los años 1997 al 2016. Materiales y métodos: Se realizó un estudio retrospectivo de las notificaciones de RAM y alertas DIGEMID de las plantas medicinales y productos usados en MTAC, las que fueron caracterizadas de acuerdo al tipo de RAM y seguridad. Resultados: En el periodo 1997 a 2016 la Autoridad Nacional de Productos Farmacéuticos, Dispositivos Médicos y Productos Sanitarios (ANM) recibió 28 notificaciones de RAM relacionados al uso de plantas medicinales y productos en MTAC, las que fueron catalogadas como grave 1 (4%), serias 4 (14%), no serias 22 (78%) y no especificada 1 (4%); las principales RAM fueron dermatitis, urticaria, prurito, erupción cutánea, mareos, convulsiones, acidosis y hepatotoxicidad. La ANM emitió 798 alertas DIGEMID, de las cuales 11 (1%) corresponde a plantas medicinales o productos usados en MTAC; de ellas, las alertas por seguridad representan el (73%), calidad (9%) y productos falsificados o venta ilegal (18%). Los principales problemas de seguridad son concordantes con las RAM mencionadas y las interacciones medicamentosas. Arnica montana, Illicium verum, I. anisatum, Desmodium molliculum, Tiquilia paronychioides, Aloe vera y Uncaria sp, o sus preparados, deben ser usadas bajo vigilancia. Conclusión: Durante los años 1997-2016 solo se notificaron 28 RAM y emitieron 11 alertas DIGEMID relacionados al uso de plantas medicinales y productos en medicina tradicional alternativa y complementaria (MTAC); por lo que, la Autoridad Nacional de Productos Farmacéuticos, Dispositivos Médicos y Productos Sanitarios (ANM) en su rol de conductor del Sistema Peruano de Farmacovigilancia y Tecnovigilancia debe proponer estrategias e instrumentos que permitan incrementar la notificación de RAM y establecer su vigilancia activa.

Mal de Simioto: práticas de saúde às crianças no interior do Brasil / Simioto's disease: health practice for children in the interior of Brazil

The "Simioto'sDisease" is a disease that has popular legitimacy and influences the search for treatment for infant health problems. This study aimed to understand the health practices related to Simioto'sDisease in a city in the interior of Brazil, from the perspective of parents of treated children. This is a qualitative and descriptive study performed by obtaining data using a semi-structured questionnaire with parents of children who were diagnosed and treated for the Simioto'sDisease. The data were subjected to content analysis. The categories discussedwere: The Simioto'sDisease pathology and its cultural aspects: symptoms, diagnosis, treatment and its indications and effectiveness; Relationship between Simioto'sDisease and professionalhealth care; The profile of healers or informal care and religiosity in the care of Simioto'sDisease. It was concluded that diagnosis and treatment are practices based on symptoms that generate a popular diagnosis. By describing the parent perspective, this practice is based on the belief of the treatmentefficacy and is legitimized by the healer reception, guidelines and precautionary measures of the disease that are passed, among other care, in addition to the baths performing frequency.

O "Mal de Simioto" é uma doença que possui legitimidade popular e queinfluencia a busca por tratamento para problemas de saúde infantil. Objetivou-se compreender as práticas de saúde relacionadas ao Mal de Simioto em um município no interior do Brasil, na perspectiva dos pais das crianças tratadas. Estudo qualitativo, descritivo, realizado através da obtenção de dados com o uso de questionário semiestruturado com os pais de crianças que foram diagnosticadas e tratadas com o Mal de Simioto. Os dados foram submetidos à análise de conteúdo.As categorias discutidas foram: A patologia Mal de Simioto e seus aspectos culturais: os sintomas, o diagnóstico, o tratamento e sua indicação e eficácia; Relação entre Mal de Simioto e os cuidados profissionais de saúde;Operfil dos curandeiros ou cuidadores informais e a religiosidade no cuidado ao Mal de Simioto. Concluiu-se queo diagnóstico e o tratamento são práticas baseadas em sintomas que geram um diagnóstico popular. Através da descrição pela perspectiva dos pais, essa práticabaseia-se na crença da eficácia do tratamento e é legitimada pelo acolhimento do curandeiro,das orientações e medidas de precaução da doença que são repassadas, entre outros cuidados, além da periodicidade de realização dos banhos.

[Herbals and herbal nutritional products hepatotoxicity]. / Hepatotoxicidad asociada a hierbas y productos nutricionales de origen botánico.

Herbs and other botanicals have been used in different cultures with medicinal and dietary purposes for centuries. Contrary to the belief of being natural and safe products, their hepatotoxic potential is recognized in several studies worldwide, and represent a health problem that deserves greater attention. The reported prevalence of hepatotoxicity associated with botanicals is variable and depends on various factors such as population, period and design of the study. There have been reports of a total of 60 products with herbal medicinal and dietary purposes, which may cause liver damage; however, the pathophysiological mechanisms involved are not fully elucidated. Their clinical and histological features, not unlike liver injury associated with drugs in most patients, have a pattern of hepatocellular injury. Diagnosis is by exclusion, and represents a clinical challenge. It is essential the clinical suspicion and the differential diagnosis with other acute and chronic conditions. Hence, future researches are aimed at improving existing diagnostic methods and introducing new toxicological, genetic and immunological technologies. Treatment is complex and presents a challenge for the specialist, as there are no antidotes. Management based on the discontinued use of the product and in the symptomatic treatment, decreases the progression to an acute fulminant hepatic failure.

Hepatotoxicidad asociada a hierbas y productos nutricionales de origen botánico / Herbals and herbal nutritional products hepatotoxicity

Las hierbas y otros productos de origen botánico, han sido utilizados por siglos en diversas culturas con fines medicinales y dietéticos. Contrario a la creencia de ser productos naturales y seguros, su potencial hepatotóxico es reconocido en diversos estudios a nivel mundial, lo que constituye un problema de salud que amerita mayor atención. La prevalencia reportada de hepatotoxicidad asociada a productos botánicos es variable y depende de diversos factores como población estudiada, período y diseño del estudio. Se han reportado un total de 60 productos a base de hierbas con fines medicinales y dietéticos, que pueden causar lesión hepática; sin embargo, el mecanismo fisiopatológico no está completamente dilucidado. Su cuadro clínico y características histológicas, no difieren de la lesión hepática asociada a medicamentos y la mayoría de los pacientes tienen un patrón de lesión hepatocelular. El diagnóstico se hace por exclusión, representando un desafío clínico importante, por lo que resulta fundamental la sospecha clínica y el diagnóstico diferencial de otras patologías agudas y crónicas. De allí que las investigaciones futuras están orientadas a mejorar los métodos diagnóstico existentes e introducir nuevas tecnologías toxicológicas, genéticas e inmunológicas. El manejo es complejo y representa un reto para el especialista puesto que no existe antídoto; el manejo se basa en suspender el uso del producto y en el tratamiento sintomático que disminuya la progresión a la falla hepática aguda fulminante.

Herbs and other botanicals have been used in different cultures with medicinal and dietary purposes for centuries. Contrary to the belief of being natural and safe products, their hepatotoxic potential is recognized in several studies worldwide, and represent a health problem that deserves greater attention. The reported prevalence of hepatotoxicity associated with botanicals is variable and depends on various factors such as population, period and design of the study. There have been reports of a total of 60 products with herbal medicinal and dietary purposes, which may cause liver damage; however, the pathophysiological mechanisms involved are not fully elucidated. Their clinical and histological features, not unlike liver injury associated with drugs in most patients, have a pattern of hepatocellular injury. Diagnosis is by exclusion, and represents a clinical challenge. It is essential the clinical suspicion and the differential diagnosis with other acute and chronic conditions. Hence, future researches are aimed at improving existing diagnostic methods and introducing new toxicological, genetic and immunological technologies. Treatment is complex and presents a challenge for the specialist, as there are no antidotes. Management based on the discontinued use of the product and in the symptomatic treatment, decreases the progression to an acute fulminant hepatic failure.

Caracterización de reacciones adversas a la Medicina Tradicional y Natural / Characterization of Natural and Traditional Medicine adverse reactions

Introducción: los productos y las técnicas de la Medicina Tradicional y Natural son empleados desde tiempos inmemorables. Los partidarios de esta modalidad terapéutica la reconocen como segura e inocua. Su uso requiere de profundas investigaciones que no se limitan al campo de la experimentación. Cobran relevancia los estudios de farmacovigilancia. Objetivo: caracterizar las reacciones adversas asociadas al uso de la Medicina Tradicional y Natural. Metodología: se realizó un estudio observacional descriptivo transversal de una muestra de 72 pacientes en los que se notificaron reacciones adversas a la Medicina Tradicional y Natural de una población de 10 428 pacientes en los que se informaron sospechas de reacciones adversas medicamentosas recibidas en la Unidad Coordinadora Provincial de Farmacovigilancia, de la Provincia de Villa Clara, en el período desde enero de 2011 a octubre de 2014. Resultados: en 14 pacientes se notificaron reacciones adversas al ajo, seguidas de las provocadas por la acupuntura y las técnicas afines; los efectos adversos fueron leves en 43 pacientes y no se informaron reacciones severas; se notificaron 57 reacciones adversas en adultos; 50 pacientes eran féminas; las reacciones adversas raras se presentaron en 26 pacientes; en cuanto a causalidad fueron probables en 54 de ellos; las reacciones adversas afectaron en 34 pacientes el sistema de órganos digestivo. Conclusiones: los fitofármacos, sobre todo el ajo, figuran como los productos de la Medicina Tradicional y Natural con una notable incidencia de reacciones adversas, las que resultan moderadas de acuerdo a la severidad, en una cantidad considerable raras según la frecuencia y, en cuanto a la causalidad, en probables.

Regulation of herbal medicines in Brazil.

ETHNOPHARMACOLOGICAL RELEVANCE: Rich Brazilian biodiversity is accompanied by a long acceptance of medicinal plants and traditional knowledge by the Brazilian population. To improve the regulatory framework for herbal medicines in Brazil, ANVISA recently revised its legislations. The aim of this study is to discuss the new Brazilian standards for herbal medicines regulation. MATERIALS AND METHODS: The national and international legislation on herbal medicines was revised to prepare new Brazilian standards. This new legislation is discussed. RESULTS: This new proposed regulation separates herbal into two categories: herbal medicines (HM) and traditional herbal product (THP). The safety and efficacy of HM must be proven by clinical data. ANVISA recognizes some plants as safe and effective; therefore, the registration of these species can be simplified. ANVISA also recognizes the monographs of the European community as simplified registrations. THP can prove their safety and effectiveness by tradition of use or following a simplified registration. CONCLUSION: Brazil has been altering their legal standards for herbal medicines, based on harmonization with internationally practiced requirements and the characteristics of the Brazilian market, facilitating the safe access and rational use of medicinal plants and herbal products to Brazilian population.

Evaluation of toxicity of Calophyllum brasiliense stem bark extract by in vivo and in vitro assays.

ETHNOPHARMACOLOGICAL RELEVANCE: Calophyllum brasiliense Camb., Clusiaceae, is commonly known as "guanandi" and its stem bark is used in Brazilian traditional medicine to treat rheumatism, vein problems, hemorrhoids and gastric ulcers. The aim of this study was to evaluate the toxicity of hexane extract of Calophyllum brasiliense stem bark (HECb) using in vitro and in vivo experimental models. MATERIALS AND METHODS: In vitro toxicity was evaluated by Alamar Blue cytotoxicity assay and micronucleus test, using Chinese hamster ovary (CHO-k1) epithelial cells. in vivo toxicity was evaluated by oral acute and subchronic toxicity assays. In the oral acute toxicity screening, a single dose of HECb was administered to mice at doses ranging from 250 to 1000 mg/kg. In the subchronic study, HECb was administered orally for 30 days to Wistar rats at doses of 100 mg/kg and 500 mg/kg. Phytochemical analyses were performed by HPLC/UV-vis, secondary metabolites were quantified by spectrophotometric methods. RESULTS: HECb presented IC50=119.94±4.31 µg/mL after a 24 h cytotoxicity test using CHO-k1 cells, showing low cytotoxicity. However, when the cells were exposed to HECb for 72 h, the IC50 value was 8.39±2.00 µg/mL, showing in this case, a pronounced cytotoxic effect. In the oral acute toxicity studies, doses up to 500 mg/kg of HECb did not cause any changes in both male and female mice. At 1000 mg/kg, male mice showed signs typical of depression and stimulation that were reversed at 72 h. Besides, female mice were more sensitive to the toxic effect of HECb at 1000 mg/kg, which initially presented typical agitation signals, followed by depression signals, leading to death of all the animals at 24h. In subchronic assay with rats, HECb administered orally at doses of 100 and 500 mg/kg did not cause significant changes in all clinical parameters evaluated. Histopathological analyses showed no deleterious effect in the vital organs of rats. Preliminary phytochemical analysis revealed the presence of phenolic compounds, steroids, and volatile coumarins. Analysis by HPLC showed two major peaks characteristic of chromanones. CONCLUSIONS: In vitro toxicological tests showed that HECb exhibited cytotoxicity especially after 72 h of exposition, and mutagenicity on the highest tested dose. The in vivo studies demonstrated that HECb produced some toxicity signs at the highest dose tested, particularly, in the acute toxicity test but showed no significant signs of toxicity in the subchronic assay. Based on these and previous pharmacological studies, it is possible to say that HECb did not exhibit significant toxicity at its effective dose. This suggests that HECb is relatively safe in humans at its effective dose.

Pharmacovigilance of herbal medicines: the potential contributions of ethnobotanical and ethnopharmacological studies.

Typically, ethnobotanical/ethnopharmacological (EB/EP) surveys are used to describe uses, doses/dosages, sources and methods of preparation of traditional herbal medicines; their application to date in examining the adverse effects, contraindications and other safety aspects of these preparations is limited. From a pharmacovigilance perspective, numerous challenges exist in applying its existing methods to studying the safety profile of herbal medicines, particularly where used by indigenous cultures. This paper aims to contribute to the methodological aspects of EB/EP field work, and to extend the reach of pharmacovigilance, by proposing a tool comprising a list of questions that could be applied during interview and observational studies. The questions focus on the collection of information on the safety profile of traditional herbal medicines as it is embedded in traditional knowledge, as well as on identifying personal experiences (spontaneous reports) of adverse or undesirable effects associated with the use of traditional herbal medicines. Questions on the precise composition of traditional prescriptions or 'recipes', their preparation, storage, administration and dosing are also included. Strengths and limitations of the tool are discussed. From this interweaving of EB/EP and pharmacovigilance arises a concept of ethnopharmacovigilance for traditional herbal medicines: the scope of EB/EP is extended to include exploration of the potential harmful effects of medicinal plants, and the incorporation of pharmacovigilance questions into EB/EP studies provides a new opportunity for collection of 'general' traditional knowledge on the safety of traditional herbal medicines and, importantly, a conduit for collection of spontaneous reports of suspected adverse effects. Whether the proposed tool can yield data sufficiently rich and of an appropriate quality for application of EB/EP (e.g. data verification and quantitative analysis tools) and pharmacovigilance techniques (e.g. causality assessment and data mining) requires field testing.

Susceptibilidade microbiana de bactérias e fungos frente ao extrato de Psidium guajara L: avaliação in vitro / Microbial susceptibility of bacteria and fungi against extracts of Psidium guajava L: in vitro evaluation

Aim: The present study aimed to evaluate the in vitro antimicrobial activity of hydroalcoholic and aqueous extracts from leaves of P. guajava on four bacterial and two fungal samples to determine the range of minimum inhibitory concentration of the extracts. Material and Methods: The antimicrobial activity of extracts of different polarities was compared using the agar dilution method. Differences in susceptibilityto the active ingredient could be observed. Results: The results showed that the hydroalcoholic extract wasactive against Escherichia coli (1024 ìg/ml) and Bacillus cereus (900 ìg/ml). The aqueous extract showedno antimicrobial activity. Conclusions: Despite demonstrating antimicrobial efficiency, the P. guajava extractmay be insufficient or may require a higher concentration to be fully effective.

Plantas medicinais cultivadas em quintais de comunidades rurais no domínio do cerrado piauiense (Município de Demerval Lobão, Piauí, Brasil) / Medicinal plants cultivated in homegardens of rural communities in the domain of Cerrado in Piaui (Demerval Lobão Municipality, Piauí State, Brazil)

O conhecimento terapêutico acumulado por populações rurais através de séculos de estreito contato com o meio possibilita a obtenção de informações acerca do uso dos recursos naturais. O objetivo do presente trabalho foi realizar um inventário das plantas medicinais cultivadas em quintais do município de Demerval Lobão, Piauí, bem como, conhecer o emprego e a importância dessas espécies na comunidade. Foram amostrados 21 quintais em nove comunidades da zona rural do município de Demerval Lobão com vegetação de cerrado. O trabalho foi conduzido com os mantenedores dos quintais a partir de entrevistas semi-estruturadas e observação direta, associada à técnica de turnê-guiada. As plantas medicinais coletadas foram catalogadas, identificadas, e depositadas no Herbário Graziela Barroso (TEPB) da Universidade Federal do Piauí (UFPI). Foram referidas 100 espécies botânicas, predominantemente herbáceas e cultivadas, distribuídas em 49 famílias, sendo Leguminosae, Euphorbiaceae e Lamiaceae as mais representativas em número de espécies. Na preparação dos remédios, as folhas foram as mais utilizadas, sendo a decocção a principal forma de preparo. As doenças mais frequentes tratadas por remédios caseiros referem-se ao sistema respiratório e digestivo. Observou-se que não há rigidez quanto à posologia e a duração do tratamento, ficando este a critério do hábito de cada pessoa entrevistada. As plantas que apresentaram índice de importância relativa e concordância de uso (CUP) acima de 60% foram cansansão (Cnidosculus urens), boldo (Plectranthus barbatus Andrews), jurema-preta (Mimosa verrucosa Benth) e cidreira (Lippia alba (Mill.) N.E.Br. ex Britton & P.Wilson). P. barbatus foi a mais citada e também a que apresentou os índices mais altos de CUP (100%), fator de correção - FC (1,00) e concordância de uso corrigido - CUPc (100%) para dores no estômago e problemas no fígado. Observou-se a necessidade de resgatar o conhecimento acerca das plantas medicinais para contribuir na melhoria da qualidade de vida dos moradores da zona rural, como primeiro passo para a valorização e adequação dos recursos da medicina popular para o tratamento de doenças mais frequentes.

Therapeutic knowledge accumulated by rural populations, through centuries of direct contact with the environment, makes possible the gathering of information concerning use of natural resources. The aim of the present study was to carry out an inventory of the medicinal plants cultivated in homegardens of Demerval Lobão Municipality, Piauí State, Brazil, as well as to learn their uses and importance in the community. A total of 21 homegardens in nine communities of the rural area of Demerval Lobão Municipality with Cerrado vegetation were sampled. The study was conducted by means of semi-structured interviews and direct observation, associated with the technique of a tour guided by the keepers of the homegardens. The collected medicinal plants were cataloged, identified and deposited in the Herbarium Graziela Barroso (TEPB) of Federal University of Piauí (UFPI). Of 100 botanical species, predominantly herbaceous and cultivated species distributed in 49 families, were cited, and the most representative families in number of species were Leguminosae, Euphorbiaceae and Lamiaceae. For the preparation of medicines, leaves were most used and decoction was the main form of preparation. The most frequent diseases treated by homemade remedies are associated with the respiratory and digestive systems. There is no rigidity as to dosage and duration of treatment; it depended on the habit of each interviewed person. The plants that presented an index of relative importance and use agreement above 60% were the following: "cansansão" (Cnidosculus urens), "boldo" (Plectranthus barbatus Andrews), black-jurema (Mimosa verrucosa Benth) and "cidreira" (Lippia alba (Mill.) N.E.Br. ex Britton & P.Wilson). P. barbatus was most cited and also the species that presented the highest indices of CUP (100%), FC (1,00) and CUPc (100%) for stomach pains and liver problems. There is the need of rescuing knowledge concerning medicinal plants to contribute to the improvement of the life quality of the inhabitants of the rural area, as a first step for the appreciation and adaptation of resources of folk medicine for the treatment of the most frequent diseases.

Picuriste/injectionist use among Haitian immigrants in Miami-Dade County, Florida: implications for HIV-related theory.

OBJECTIVES: We explore the risks reported to picuriste (injectionist) use in a non-probability sample of Haitian immigrant residents of Miami-Dade, Florida, using a mixed method approach. Picuristes typically have no formal medical training, and may use non-sterile needles. METHODS: Face to face semi-structured interviews were conducted of picuristes (n = 10) and picuriste users (n = 25). We sought to corroborate the qualitative findings by fielding a survey based on the interviews in a community-based sample of 205 Haitian immigrants. RESULTS: The findings from the interviews indicate picuriste injections do not adhere 100% to established standards for safe injections, and may pose health risks that are similar to those that exist for injection drug users. Yet, of the survey respondents (n = 205), 17.6% reported obtaining picuriste injections. CONCLUSION: Our findings shed light on a normally hidden cultural health behavior, enhancing our understanding of picuriste practice and use among Haitian immigrant residents of Miami-Dade County, Florida. We suggest that medical care must be delivered in a culturally competent, culturally sensitive manner, with open dialogue between physician and patient regarding health beliefs and practices.