[Gastrointestinal bezoars]. / Bezoares gastrointestinales: mitos y realidades.

Gastrointestinal bezoars are a concretion of indigested material that can be found in the gastrointestinal tract of humans and some animals. This material forms an intraluminal mass, more commonly located in the stomach. During a large period of history animal bezoars were considered antidotes to poisons and diseases. We report a historical overview since bezoars stones were thought to have medicinal properties. This magic conception was introduced in South America by Spanish conquerors. In Chile, bezoars are commonly found in a camelid named guanaco (Lama guanicoe). People at Central Chile and the Patagonia believed that bezoar stones had magical properties and they were traded at very high prices. In Santiago, during the eighteenth century the Jesuit apothecary sold preparations of bezoar stones. The human bezoars may be formed by non-digestible material like cellulose (phytobezoar), hair (trichobezoar), conglomerations of medications or his vehicles (pharmacobezoar or medication bezoar), milk and mucus component (lactobezoar) or other varieties of substances. This condition may be asymptomatic or can produce abdominal pain, ulceration, gastrointestinal bleeding, gastric outlet obstruction, perforation and mechanical intestinal obstruction. We report their classification, diagnostic modalities and treatment.

Bezoares gastrointestinales: mitos y realidades / Gastrointestinal bezoars

Gastrointestinal bezoars are a concretion of indigested material that can be found in the gastrointestinal tract of humans and some animals. This material forms an intraluminal mass, more commonly located in the stomach. During a large period of history animal bezoars were considered antidotes to poisons and diseases. We report a historical overview since bezoars stones were thought to have medicinal properties. This magic conception was introduced in South America by Spanish conquerors. In Chile, bezoars are commonly found in a camelid named guanaco (Lama guanicoe). People at Central Chile and the Patagonia believed that bezoar stones had magical properties and they were traded at very high prices. In Santiago, during the eighteenth century the Jesuit apothecary sold preparations of bezoar stones. The human bezoars may be formed by non-digestible material like cellulose (phytobezoar), hair (trichobezoar), conglomerations of medications or his vehicles (pharmacobezoar or medication bezoar), milk and mucus component (lactobezoar) or other varieties of substances. This condition may be asymptomatic or can produce abdominal pain, ulceration, gastrointestinal bleeding, gastric outlet obstruction, perforation and mechanical intestinal obstruction. We report their classification, diagnostic modalities and treatment.

El empacho: revisión de una enfermedad popular infantil chilena (1674-2014) / Empacho: an historical review of popular Chilean childhood disease (1674-2014)

El empacho, el mal de ojo, los aires, el susto o espanto, son las principales y más reconocidas enfermedades populares latinoamericanas. Sobre el empacho la información médica, histórica y etnográfica es extensa y profunda, pues existen documentos que la registran desde el siglo XVI hasta tiempos recientes (2014), y para el caso chileno lo encontramos desde 1674. Para esta revisión fueron consultadas 109 fuentes documentales procedentes de las principales bibliotecas del país e incluso foráneas. Se encontró que la enfermedad es conocida en todo el territorio. Se trata de un trastorno de vías digestivas ocasionado por excesos alimentarios y la ingesta de productos poco o nada digeribles que provocan alteraciones del tránsito gastrointestinal. Los datos clínicos sobresalientes son gastralgia, diarrea o estreñimiento, vómitos, fiebre y otros malestares. La enfermedad es tratada a nivel doméstico, y en caso necesario se emplean especialistas populares, con excepcional visita al médico académico. Los tratamientos son múltiples, complejos y combinados; abarcan desde productos herbolarios hasta elementos rituales, sin faltar la denominada «quebradura del empacho¼. Esta somera revisión del empacho en Chile permitirá al médico pediatra adentrarse al mundo de los saberes y prácticas populares con la finalidad de mejorar su atención a los pacientes infantes y sus acompañantes familiares, pero también inducir al estudio serio y sistemático sobre esta entidad nosológica que seguirá existiendo a través del tiempo.

«Empacho¼ (abdominal pain and bloating), «mal de ojo¼ (evil eye), «los aires¼ (illnesses said to be caught by catching draughts), «el susto¼ or «espanto¼ (fright or panic), are the principal and most well-known popular Latin American illnesses. As regards empacho, the medical, historical and ethnographic information is extensive and detailed, since there documents recording it from the 16th century until recent times (2014), and in the case of Chile since 1674. For this review, 109 source documents from libraries in Chile, including some foreign ones, were consulted. It was found that the illness is known all over the country. It is a digestive system disorder caused by over-eating and the ingestion of products difficult to digest or indigestible, which cause problems in gastrointestinal transit. The most significant clinical data are gastralgia, diarrhoea or constipation, vomiting, fever, and other discomforts. The illness is treated at home, and if necessary, popular specialists are employed, with a visit to a qualified doctor being exceptional. There are many complex and combined treatments, which go from herbal products to ritual elements, not forgetting the so-called «quebradura del empacho¼. This review summary of empacho in Chile should enable the paediatrician to enter the world of popular knowledge and practices with the aim of improving the care of child patients and their families. It should also lead to the serious and systematic study of this nosological condition that will continue to exist in the future.

[Empacho: An historical review of popular Chilean childhood disease (1674-2014)]. / El empacho: revisión de una enfermedad popular infantil chilena (1674-2014).

"Empacho" (abdominal pain and bloating), "mal de ojo" (evil eye), "los aires" (illnesses said to be caught by catching draughts), "el susto" or "espanto" (fright or panic), are the principal and most well-known popular Latin American illnesses. As regards empacho, the medical, historical and ethnographic information is extensive and detailed, since there documents recording it from the 16th century until recent times (2014), and in the case of Chile since 1674. For this review, 109 source documents from libraries in Chile, including some foreign ones, were consulted. It was found that the illness is known all over the country. It is a digestive system disorder caused by over-eating and the ingestion of products difficult to digest or indigestible, which cause problems in gastrointestinal transit. The most significant clinical data are gastralgia, diarrhoea or constipation, vomiting, fever, and other discomforts. The illness is treated at home, and if necessary, popular specialists are employed, with a visit to a qualified doctor being exceptional. There are many complex and combined treatments, which go from herbal products to ritual elements, not forgetting the so-called "quebradura del empacho". This review summary of empacho in Chile should enable the paediatrician to enter the world of popular knowledge and practices with the aim of improving the care of child patients and their families. It should also lead to the serious and systematic study of this nosological condition that will continue to exist in the future.

Alergia alimentaria / Food allergies

Las reacciones alérgicas incluyen un amplio espectro de reacciones clínicas. Con una incidencia del 15–30% de las enfermedades alérgicas y afecta a un 8% de los niños y específicamente a la proteína de la leche de vaca entre un 5–15% de los niños. Pueden manifestarse como intolerancia o alergia dando manifestaciones respiratorias, cutáneas o gastrointestinales que pueden ser inducidos por cantidades minimas de la ingesta deproteína y cuyo tratamiento básico es la exclusión de la proteína de leche sobre todo en los primeros años de vida.

Allergic reactions include a wide spectrum of clinical reactions. With a 15-30% incidence of llergicdiseases, affecting 8% of children and specifically to the protein in cow's milk 5-15% of children hey can manifest as intolerance or allergy giving respiratory manifestations, gastrointestinal or skin can be induced by minimal amounts of protein intake and whose basic treatment is the exclusión of milk protein specially inthe early years of life.

[The empacho in Mexico during the nineteenth century]. / ¿Friegas y friegas, y el empacho pegado! El empacho en México durante el Siglo XIX.

During the 19th century, empacho as a nosological entity prompted academic research by such renowned Mexican clinicians as Miguel F. Jiménez, Eduardo Liceaga, Fernando Altamirano, José Peon y Contreras, among others. Empacho is often the result of excessive eating or difficulty in digestion of certain foods, especially fruits with a peel (oranges, limes, grapefruits, apples, etc.) and legumes (beans, sweet pea, chick peas). Empacho has a greater effect on children under the age of two. It is clinically identified by diarrhea, abdominal pain, fever, restlessness, the presence of abdominal distension, abdominal dullness to percussion, nausea, vomiting, anorexia and meteorism. The most common treatments during the 19th century sought to evacuate gastrointestinal content immediately through vomiting or purgative medication. The general population often used medicinal plants to provoke gastrointestinal purges, while academic doctors most frequently used castor oil as a laxative and ipecacuanha to induce vomiting. This work presents a description and analysis of the general characteristics of the popular illness, empacho. The information comes from doctors, pharmacists, homeopaths, botanists and popular groups.

Mortality seasonality in Escazú, Costa Rica, 1851-1921.

Mortality seasonality has been frequently reported in populations living under various ecological conditions. The number of deaths apparently varies by month as a result of fluctuating climatic variables. Here, I examine whether mortality was seasonally distributed in Escazú, Costa Rica, from 1851 to 1921. I also investigate which cause of death made the greatest contribution to mortality periodicity and which climatic variable caused the seasonality of deaths. Two different methodological approaches are used: chi-square and Freedman tests to determine the presence of seasonality and Box-Jenkins time series analysis. The tests to determine the presence of seasonality show that mortality was strongly seasonal in Escazú, with the highest number of deaths occurring during the early months of the rainy season. The Box-Jenkins analysis successfully modeled the series from 1851 to 1891 with a seasonal parameter. However, the more recent years of the data were modeled without seasonal parameters. Thus the time series approach indicates that mortality became less seasonally distributed in more recent years. An analysis of gastrointestinal- and respiratory-related deaths showed that gastrointestinal causes had a strong seasonal distribution (with more deaths in the early months of the rainy season) and that respiratory causes did not. Therefore rainfall appears to have been responsible for mortality seasonality through its impact on the frequency of gastrointestinal maladies. The analysis of cause of death also shows that the seasonal fluctuation of gastrointestinal-related deaths decreased in the more recent years. Such a decrease is reflected in the nonseasonal Box-Jenkins model for the 1892-1921 years.