O analista no divã: reflexões sobre a vulnerabilidade narcísica do analista / The analyst on the couch: reflections on the analyst's narcissistic vulnerability / El analista en el diván: reflexiones sobre la vulnerabilidad narcisista del analista

Este artigo discute a importância de os analistas refletirem sobre sua própria vulnerabilidade narcísica, que se revela por meio dos sentimentos contratransferenciais provocados na relação terapêutica. Abordar essas feridas específicas e sua origem, em nossas histórias pessoais, é uma tarefa importante que os analistas precisam realizar, para evitar o enactment inconsciente, durante o encontro terapêutico. As projeções idealizadas dos pacientes contribuem para que o analista permaneça no papel de "bom terapeuta", o que pode ser em detrimento do crescimento psíquico e da transformação de ambos, na relação diádica. Reconhecer nossas limitações e dinâmicas de sombra pode colaborar para uma maior sintonia com o campo intersubjetivo entre analista e paciente.

This article discusses the importance of analysts reflecting on their own narcissistic vulnerability which is revealed through countertransference feelings provoked in the therapeutic relationship. Addressing these specific wounds and their origin in our personal histories is an important task that analysts need to undertake in order to avoid unconscious enactment during the therapeutic encounter. Idealized projections from patients contribute towards analysts remaining in the role of "good therapist", which may be to the detriment of psychic growth and transformation of both persons in the dyadic relationship. Acknowledging our limitations and shadow dynamics can contribute towards greater attunement to the intersubjective field between analyst and patient.

Este artículo discute la importancia de que los analistas reflexionen sobre su propia vulnerabilidad narcisista que se revela a través de los sentimientos contratransferenciales provocados en la relación terapéutica. Abordar estas heridas específicas y su origen en nuestras historias personales es una tarea importante que los analistas deben emprender para evitar la enactment inconsciente durante el encuentro terapéutico. Las proyecciones idealizadas de los pacientes contribuyen a que los analistas permanezcan en el papel de "buen terapeuta", lo que puede ir en detrimento del crecimiento psíquico y la transformación de ambas personas en la relación diádica. Reconocer nuestras limitaciones y dinámicas de sombra puede contribuir a una mayor sintonía con el campo intersubjetivo entre analista y paciente.

5. How Should They Respond to the Suffering of Patients with Illnesses That They Themselves Have Not Experienced? / 医学教育

Physicians are expected to listen and respond to their suffering patients. But how should they respond to the suffering of patients with illnesses that they themselves have not experienced?　The scope of palliative care has expanded to emphasize the provision of palliative care to patients with "SERIOUS ILLNESS," regardless of whether or not they are cured. In addition to cancer, physicians have had to deal with the suffering of patients with heart failure, respiratory failure, cerebrovascular disease, etc., but their treating physicians are still clueless about how to face their suffering and how to respond to their suffering. Whole Person Care is a systematic educational program to enable people to face their suffering patients by helping them to adjust to their own condition. This paper provides an overview of "Responding to Patient Suffering".

Survey and documentation of anthelmintic plants used in traditional medicine system of tribal communities of Udalguri district of Assam, India

The present study was aimed to survey and document the anthelmintic medicinal plants traditionally used by the tribalcommunities of Udalguri district of Assam. The survey was conducted in different villages of the district followinga face-to-face interview and a readymade questionnaire. The study found that a total of 75 plant species belonging to67 genera and 44 plant families were used as deworming agents. The result showed that Andrographis paniculata,Ananas comosus, Hydrocotyle sibthorpioides, and Centella asiatica were the most popular plant species. Acanthaceaefamily was found to be most common among the traditional healers. The leaves were found to be commonly used plantparts for herbal preparation. Decoction, infusion, and raw preparations were found to be the most commonly usedtraditional formulation methodologies. The present study could be used to identify the potential anthelmintic plantsand in designing new anthelmintic drug having better property and efficacy

The Indigenous Cultural Ways of Diagnosis in the Ashanti Region of Ghana

The primary aim of this study is to make the indigenous cultural ways of identifying diseases known in order to promote and remove the mystery and superstition associated to them.Due to the nature of the study, the purposive sampling technique was largely employed.Interviews and observations were the main datacollecting instruments used. The four study areas which are Bongari Shrine at Adumakasekese, Asuo Abresua Shrine of Ahwirewam, Bokankye Akua Gyabon Shrine (currently situated at Mankranso Peposo), and Apomasu Kwao Shrine of Ntenserewere purposively selected.The study revealed that the traditional healers use items ranging from natural to artificial such as eggs, talismans, cowries, money and other objects to diagnose various diseases. In diagnosing of diseases, the traditional healers take a holistic approach which are the social, natural, spiritual and the cosmic environment which are not in the case of the orthodox medication.It is therefore importantfor government and stakeholders to give recognition to these diviners and spiritual healers by putting up nice buildings (clinics and hospitals) and providing them the necessary needs like what they have been doing for the orthodox health centres and if possible integrate the traditional medication into the orthodox ones.

Antioxidant activity, total phenolic and flavonoid contents of selected medicinal plants used for liver diseases and its classification with chemometrics

Liver disease has become one of the major health problems in the world, and the death rate is going rapidly toincrease. Oxidative stress plays a crucial role in the emerging, development, and the progression of liver diseases.Ethnobotanical research has an undoubted profound impact on the development of numerous new drugs. The aimof this research, therefore, was to examine the antioxidant activities of 14 selected plants used for treating liverdiseases by traditional healers of Indonesia ethnicities and to classify these plants using chemometrics of principalcomponent analysis (PCA). The extraction using methanol as the solvent was performed with two stages maceration.Total phenolic and flavonoid compounds were determined by Folin–Ciocalteau and AlCl3 method, respectively,whereas antioxidant activity was estimated using 2,2′-diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging,trolox equivalent antioxidant capacity (TEAC), and ferric reducing antioxidant power (FRAP) assay. Among 19methanol extracts of 14 plants, the leaves of Baccaurea racemosa, Macaranga subpeltata, and Piper sp. showed thehighest antioxidant properties. The phenolic content correlated with TEAC, FRAP, and DPPH radical scavengingactivity, while flavonoid did not significantly affect these antioxidant activity methods. PCA successfully classifiedthe plant samples using the variables of antioxidant activities and phenolic-flavonoid contents. The selected plantshave promising antioxidant properties which support their utilization for either liver diseases medication or oxidativestress-related diseases prevention

Traditional Healing – At What Cost ?: A Case Report from Rural India

In rural parts of India still the “magico-religious beliefs” regarding the occurrence of the psychiatric disordersand “magico-religious treatments” of the psychiatric disorders often seen and prevail. Such beliefs andtreatments many times lead to physical as well as psychological trauma to an individual suffering from anypsychiatric disorder and may lead to delay in seeking an appropriate professional help in time. The presentcase report attempts to depict what kind of physical and psychological trauma a person with psychiatricdisorder suffered at the hands of faith healer in absence of lack of awareness about the psychiatric disordersamong family members and other villagers.

O curador-ferido e a individuação / The wounded healer and individuation / El curador-herido e la individuación

Este trabalho tece reflexões a respeito da importância da elaboração do arquétipo do curador-ferido na vida do analista. A autora discorre sobre livros e artigos de periódicos que endereçam o tema.

This article reflects on the importance of the elaboration of the wounded healer archetype in the life of the analyst. The author talks about books and articles that adresses the theme.

Este trabajo hace reflexiones que tratan de la importancia de la elaboración del arquetipo del curador-herido en la vida del analista. La autora escribe sobre libros y textos de periódicos que se dirigen al tema.

Del Behique al médico militar / From Behique to Militar Phsician

La historia de la medicina cubana ha transitado por diferentes etapas y ha tenido sus orígenes en el hechicero-curandero, también llamado Behique, quien fue el iniciador de los procederes terapéuticos en las luchas de los aborígenes contra el invasor. Esta actividad se desarrolló en condiciones difíciles por los médicos que participaron en las guerras independentistas como integrantes de la sanidad militar mambisa. Esta tradición también estuvo presente en los galenos del ejército rebelde y al triunfar la revolución en 1959 se incrementó con la formación de los que ejercen esta profesión en la esfera militar, utilizando además los adelantos científicos-tecnológicos en el campo de la medicina. Se pretende hacer un recorrido por la historia de la formación del profesional de salud que participó en los conflictos bélicos desde el origen de los Behiques hasta los momentos actuales(AU)

The history of Cuban medicine has traveled through different stages and its origins are sorcerer-healer, also called behique, who was the initiator of the therapeutic procedures in the aboriginal struggles against the invader. This activity was developed under difficult conditions by doctors who participated in the wars of independence as members of the mambí military health corp. This tradition was also present in the doctors of the rebel army. When the Revolution triumphed in 1959, this practice of training increased for those in the military sphere, also using scientific and technological advances in the field of medicine. It is intended to make a journey through history of the health professional formation who participated in the warlike conflicts since its original behique to the present times(AU)

Medicinal Plants for Treatment of Neonatal Jaundice by Community of Attars (Traditional Healers) of Several Urban Areas in Mazandaran Province, Northern of Iran.

Aims: This study aimed to determine the use of specific medicinal plants based on traditional medicine from community of Attars (Traditional healers) in the province of Mazandaran (North Iran). Place and Duration of Study: The province of Mazandaran in north Iran, between March until July 2015. Methodology: Eighty-eight Traditional healers consisting of 62 men (70.5%) and 26 women (29.5%) from among the community of Attars (i.e. The Owners of shops, selling medicinal plants, providing traditional medications and some time act as traditional healer) of the province of Mazandaran in north Iran were randomly selected using questionnaires from March until July 2015. Results: In this study, 50 plant species belonging to 29 plant families were recommended for treating neonatal jaundice. Asteraceae, Fabaceae and Rosaceae were the most commonly used plant families. The five main plants with the highest reported use included: Contoneaster discolor, Descurainia sophia, Cichorium intybus, Alhagi camelorum, and Fumaria parviflora. The most important reason for prescribing medicinal herbs was to help detoxify the body, and the most important reason that people visit Attaries (i.e., shops selling medicinal plants, providing traditional medications) to receive remedies was stated as the lower side effects of these traditional remedies. Conclusion: This study shows that numerous medicinal plants are recommended for treating neonatal jaundice in Mazandaran province by Attars (Traditional healers). To the best of our knowledge, the wide range of herbs used for the treatment of neonatal jaundice has not been previously reported in any other study as extensively as shown here. Naturally, it is necessary to perform comprehensive studies on the above-mentioned medicinal plants to make use of these herbal remedies.

Unintended consequences of regulating traditional medicine.

The World Health Organization (WHO) has the noble goals of advancing traditional medicine and simultaneously promoting the regulation and professionalization of traditional healers. However, such regulation has the unintended consequence of withholding power from traditional practitioners. This review explores this concept through a historical analysis of traditional medicine in both India and Zimbabwe. During the post-colonial period in both countries, traditional medicine contributed to the creation of national identity. In the process of nationalizing traditional medicine, regulations were set in place that led to a rise in the university-style teaching of traditional healing. This period of professionalization of traditional healers resulted in certain types of traditional medicine being marginalized, as they were neither included in regulation nor taught at university. Since then, the current era of globalization has commoditized traditional healing. Private industries like ZEPL and Dabur have rapidly and vastly altered the role of traditional healers. Consumers can now buy traditional medication directly from companies without visiting a healer. Additionally, disputes over patents and other intellectual property rights have led to important questions regarding ownership of certain plants traditionally known for healing properties. Through regulation and commercialization of traditional medicine, healers have lost some of their independence to practise.

Análise dos níveis das interleucinas tipo 10 e 1β após aplicação da pasta de iodofórmio na região peri-implantar: estudo piloto / Interleukins 10 and 1β levels in peri-implant region after using iodoform paste in periimplant region: a pilot study

O dano tecidual que leva a perda do implante dentário está intimamente relacionado à resposta inflamatória local. A utilização de medicamentos tópicos tem sido estudada como forma de controlar essa resposta inflamatória, evitando assim perda óssea após o período de osseointegração. Objetivo: avaliar os níveis de IL-10 e IL-1β no fluido crevicular peri-implantar após utilização de uma pasta à base de iodofórmio em humanos. Material e métodos: vinte regiões em 3 pacientes foram divididas em dois grupos: grupo A (reabertura dos implantes e instalação do cicatrizador) e grupo B (reabertura do implante e instalação do cicatrizador juntamente com uma pasta de iodofórmio). Quinze dias após a exposição dos implantes, amostras do fluido crevicular peri-implantar (FCPI) foram obtidas, utilizando filtro de papel absorvente inserido ao sulco peri-implantar, durante 30 s, após a remoção do cicatrizador. Os níveis de IL-10 e IL-1β nas amostras foram determinados por ELISA utilizando o kit DuoSet ELISA Development System DY217B. Após o Teste de Shapiro-Wilk, o teste de Tukey foi utilizado para determinar o valor de p na avaliação das diferenças entre os grupos, com nível de significância de 0,05. Resultados: não houve diferença significativa entre as concentrações de IL-10 nos dois grupos (p=0.34). No entanto, diferença significativa foi evidenciada entre os grupos A e B em relação aos níveis de IL-1β (p=0.03). O grupo B mostrou significativa menor concentração de IL-1β comparado ao grupo A. Conclusão: a pasta de iodofórmio é capaz de diminuir a resposta pró-inflamatória orquestrada pela IL-1β em um curto período de tempo

The tissue damage around dental implant is strictly related to inflammatory response. The use of local drugs has been studied as a tempt of controlling this response in order to avoid the bone loss after osseointegration period. Aim: to evaluate the interleukins 10 and 1β levels in peri-implant crevicular fluid after using iodoform paste in humans. Material and methods: twenty regions, in 03 patients, were divided in 2 groups; group A (implant exposure and healing insertion) and group B (implant exposure and healing/ iodoform paste insertion). Fifteen days after exposure, samples from peri-implant crevicular fluid were collected. ELISA technique determined the interleukins 10 and 1β levels by using DuoSet ELISA Development System DY217B kit. Tukey test analysed differences between groups, considering 0.05 significant level. Results: no difference was observed between groups considering interleukin 10 levels (p=0.34). however, significant differente was observed considering the interleukin 1β levels (p=0.03). Group B showed significant smaller IL-1β level than group A. Conclusion: iodoform paste is able to decrease the pro-inflammatory response conduct by interleukin 1β.

Heart rate variability during meditation in pranic healers.

Background: Heart rate variability (HRV) can be measured non-invasively in humans to study the physiological responses to various stimuli. The sympathetic branch increases heart rate and the parasympathetic branch decreases heart rate. HRV is an indicator of the dynamic interaction and balance between these two divisions of the Autonomic Nervous System. The pranic healers practice meditation which utilizes unification of body and mind. A reduced HRV is associated with increased risk of cardiac and overall mortality. Studies suggest a number of non-pharmacological techniques for the improvement of HRV. These techniques are believed to stabilize the ANS by modulating the parasympathetic nervous system and in turn improve HRV. The impact of these techniques on HRV and their effectiveness as therapeutic tools in patients with reduced HRV is to be determined.Methods: This study included 15 professional pranic healers as subjects in the age group 18-40 years. ECG was recorded during the phases, Series 1 (before meditation) and Series 3 (during meditation). HRV parameters were computed with the aid of suitable software and were analyzed. Results: The HRV parameters (Mean, Low frequency / LF, High frequency / HF, Total power, pNN50%) were compared. Power spectrum analysis showed distinctive change in frequency components. Low frequency component (LF; 0.04Hz to 0.15Hz), high frequency component (HF; 0.15Hz to 0.40Hz) and total power were significantly higher during the meditation phase (p = 0.05). pNN50% showed a trend towards decrease (though not significant) during the meditation phase (p = 0.066).Conclusions: The variance of the heart rate during meditation was significantly higher during meditation than before meditation for all subjects. These techniques are believed to stabilise the ANS by modulating the parasympathetic nervous system and in turn improve HRV.

Help-seeking Pathways for In-patients with First-episode Psychosis in Hospital Kuala Lumpur

Introduction: Help-seeking pathway in psychiatry is the important link between the onset of a mental disorder and mental health service provision. Understanding of the help-seeking pathway can help us to device more effective strategies for early detection and treatment. Objectives: To determine the help-seeking pathways and treatment delaying factors of in-patients with first-episode psychosis in Hospital Kuala Lumpur (HKL). Methods: This is a hospital-based cross-sectional descriptive study of 50 in-patients with first-episode psychosis in HKL. Structured Clinical Interview for DSM-IV - Clinical Version for Axis I Disorders (SCID-CV) was used for establishing diagnosis. Socio-demographic data, information on help-seeking pathways, and treatment delaying factors were determined through faceto- face interview and semi-structured questionnaires. Results: The number of non-psychiatric helpseeking contacts prior to first consultation with psychiatric service ranged from 0 to 10. The mean number of contacts was 2.3 ( 2.6), and median was 1 (IQR = 0 to 3). About a third of them (32%) had three or more non-psychiatric contacts. The most common point of first non-psychiatric contact was with traditional healer 24 (48%), followed by general practitioners 12 (24%), and only 14 (28%) of them sought help directly from psychiatric service. The most common reason reported for delay in seeking psychiatric treatment was, “not aware that changes were related to mental illness” (74%). Conclusions: History of contacts with traditional healers was common among in-patients with first episode psychosis in HKL. Treatment delay was mainly contributed by factors related to lack of awareness on psychosis. More strategic mental health education program is needed for early detection and treatment of psychosis.

Traditional healers are causing treatment delay among patients with psychosis in Hospital Kuala Lumpur: Fact or Fallacy?

Objective: Mental health services in Malaysia often face competition from traditional healers especially among patients with psychosis. The objective of the study is to determine whether patients who sought help earlier from traditional healers had longer duration of untreated psychosis (DUP), and more adverse experiences in pathways to psychiatric care. Methods: This is a hospital-based cross-sectional study of 50 inpatients with first-episode psychosis in Hospital Kuala Lumpur. Structured Clinical Interview for DSM-IV (Diagnostic and statistical manual, 4th edition) Clinical Version for Axis I Disorders (SCID-CV) was used for establishing diagnosis. Onset of psychosis was defined as any one positive symptom with a score of >3 on the Positive and Negative Syndrome Scale (PANSS). Socio-demographic data, information on pathways and treatment delaying factors were determined through face-to-face interview and semi-structured questionnaire. Results: Fifty-four percent of the patients had at least one contact with traditional healers prior to consulting psychiatric service, and it was the most popular first point of non-psychiatric help-seeking contact (48%). Contact with traditional healers was not associated with age, gender, ethnic, education level, longer DUP or treatment delay, and admissions with violent behaviour or police assistance. Of those who had sought help from traditional healers, one third were recommended by at least one of their traditional healers to seek medical help. Conclusion: Consultation involving traditional healers was a popular choice, and not associated with treatment delay. Traditional healers in an urban setting may be potential collaborators in managing patients with first-episode psychosis. Future research should explore the frontiers of such collaborative work.

Intoxicated children at an intensive care unit: popular medicine risks, complications and costs / Niños intoxicados en la unidad de cuidado intensivo: riesgos de la medicina popular, complicaciones y costos

Introduction: The Hospital Universitario del Valle (HUV) at the Pediatrics Intensive Care Unit (PICU) admits intoxicated patients, erroneously medicated by "teguas" or family members with serious aggravation of basic diseases or generating severe intoxications. Absent reports of these practices in Colombia motivated the publication of this case series. Objective: To report a series of pediatric intoxication cases secondary to oral or dermatological application of varied substances by healers (®teguas¼) or family members, leading to admission at the PICU, and to describe complications and hospital costs of these events. Methodology: Clinical charts of patients admitted to the PICU with diagnosis of exogenous intoxication during May 2001 to September 2004, were reviewed. Of 28 registered cases during that time, only 14 clinical charts were recovered. Variables evaluated included: age, gender, proceeding, administered substance, person responsible for the administration, complications, days of mechanical ventilation, total days at the intensive care unit and average costs. Of the 14 medical records with exogenous intoxications only 5 cases were involuntary and 9 were related to the administration of substances by quacks or family members; these are the ones reported in this series. Results: We report a total of 9 intoxicated patients, 5 girls and 4 boys, with an age range from 1 to 24 months, all from Cali. Topical administered substances: alcohol 6/9, vinegar 1/9; oral: aspirin 2/9, paico 1/9, and unidentified herbs 1/9. Administered substances by teguas: 6 patients; 3 by family members. All patients had metabolic acidosis with an increased anion gap: 27 in average (range from 21 to 32). All required mechanical ventilation (2 to 32 day range). Average hospital day costs were $6’657,800 pesos (around U$3,000.oo). Three patients died and 4 presented acute renal failure, 2 convulsions, 2 nosocomial infections, 1 subglotic stenosis.

Introducción: A la Unidad de Cuidado Intensivo Pediátrico (UCIP) del Hospital Universitario del Valle (HUV) ingresan pacientes intoxicados, que antes han sido medicados de manera errónea por teguas o familiares con grave empeoramiento de las enfermedades de base o con intoxicaciones severas. La ausencia de informes sobre estas prácticas en Colombia motivó la publicación de esta serie de casos. Objetivo: Informar una serie de casos pediátricos con intoxicaciones, secundarias a la administración oral o dérmica de sustancias administradas por curanderos (teguas) o familiares conducta que implicó hospitalización en UCIP, describir las complicaciones y sus costos hospitalarios. Materiales y métodos: Se revisaron las historias clínicas de los niños que ingresaron a la UCIP del HUV con diagnóstico de intoxicación exógena, en el período de mayo 2001 a septiembre 2004. De los 28 casos registrados en tiempo sólo se recuperaron 14 historias clínicas. Se aplicó un formulario para obtener información de ellas que permitiera evaluar características socio-demográficas (edad, género, procedencia), tóxico administrado, persona responsable de la administración, complicaciones, días y costos de la hospitalización. De estas 14 historias, solamente 5 fueron intoxicaciones accidentales y 9 se asociaron con administración de sustancias por teguas o familiares, que son las que se comunican en esta serie.Resultados: Se informa un total de 9 pacientes intoxicados, 5 de género femenino con rango de edad 1 a 24 meses todos provenientes de Cali. Las sustancias administradas fueron por vía tópica: alcohol, 6/9; vinagre, 1/9; por vía oral: aspirina, 2/9; paico, 1/9; y otras hierbas no identificadas, 1/9. La administración de las sustancias fue hecha por teguas en 6 pacientes, y en 3 por familiares.

Improvement for indwelling healer tube in prevention and cure the conglutination for children patiens after the surgery operation Flexor tendon tenosynovitis / 国际外科学杂志

Objective Evaluate the safety and efficacy of indwelling healer tube in prevention and cure the conglutination after the surgurey of flexor tendon tenosynovitis. Methods During the year of 2001～2006, We have 38 young patients treated with indwelling of healer tube into the local or partial of the recovering muscle and sinew, then anesthetic and sodium hyaluronate were injected in the tube in certain intervals to lubicate and prevent conglutination after the operations of joint of children flexor tendon tenosynovitis. Then let the young patients do some healing training attne earlystage after surgery. Groups of patient were set up to make comparative analysis and evaluate the effectiveness of indwelling of the healer tubes according to the recovery status of the function of arthrosis and grasp after surgery. Results The result is that the rate of choiceness of 46 sinew is 89.1% in 34 cases with indwelling healer tube after the observing period from 6 months to 2 years, whereas the other group of 44 sinew in 30 cases has the rate of choiceness of 63.6%. The comparison has the significant conclusion of statistics (P<0.05). Conclusion It is convenient and safe to use indwelling healer tube to prevent the conglutination after the operation of joint the broken finger muscle and sinew of children. Therefore it is worth popularizing and promoting.

Practice of the Assimilation of Kampo and Western Medicine / 日本東洋医学雑誌

Chinese herbal remedy (KAMPO) is no longer an out-of-date medicine. It is now transforming into a new medical care system that attracts world-wide attention. The therapeutic system of Oriental Medicine is different in various aspects from that of Occidental Medicine. In this regard, appropriate harmonization of East and West (Oriental Medicine and Occidental Medicine) by comparison with merits and demerits in the understanding of diseases, methods of consultation, usage of drugs, etc. is expected to improve the quality of medical care. Considering that most of the drugs used in the Occidental Medicine are based on “single effective ingredient” that is artificially synthesized while herbal drugs are produced by combining crude drugs that contain various ingredients, the method of administration should naturally be changed.Such stance of Kampo medicine is based on the “respect for and understanding of individual constitution and disposition while paying attention to the gender difference and individuality” with the patient as the protagonist (treatment that is centered on client) and is also based on understanding and respecting the gender difference and individuality that are the basis of so-called “Science and Art” of practical medicine.