Maya phytomedicine in Guatemala - Can cooperative research change ethnopharmacological paradigms?

ETHNOPHARMACOLOGICAL RELEVANCE: This paper presents one of the first large-scale collaborative research projects in ethnopharmacology, to bring together indigenous stakeholders and scientists both in project design and execution. This approach has often been recommended but rarely put into practice. The study was carried out in two key indigenous areas of Guatemala, for which very little ethnopharmacological fieldwork has been published. AIM OF THE STUDY: To document and characterize the ethno-pharmacopoeias of the Kaqchikel (highlands) and Q'eqchi' (lowlands) Maya in a transdisciplinary collaboration with the two groups Councils of Elders. MATERIALS AND METHODS: The project is embedded in a larger collaboration with five Councils of Elders representing important indigenous groups in Guatemala, two of which participated in this study. These suggested healing experts reputed for their phytotherapeutic knowledge and skills. Ethnobotanical fieldwork was carried out over 20 months, accompanied by a joint steering process and validation workshops. The field data were complemented by literature research and were aggregated using a modified version of the International Classification of Diseases (ICD-10) and Trotter & Logan's consensus index. RESULTS: Similar numbers of species were collected in the two areas, with a combined total of 530 species. This total does not represent all of the species used for medicinal purposes. Remedies for the digestive system, the central nervous system & behavioral syndromes, and general tissue problems & infections were most frequent in both areas. Furthermore, remedies for the blood, immune & endocrine system are frequent in the Kaqchikel area, and remedies for the reproductive system are frequent in the Q'eqchi' area. Consensus factors are however low. The Kaqchikel, in contrast to the Q'eqchi', report more remedies for non-communicable illnesses. They also rely heavily on introduced species. DISCUSSION AND CONCLUSIONS: The transdisciplinary research design facilitated scientifically rigorous and societally relevant large-scale fieldwork, which is clearly beneficial to indigenous collaborators. It provided access and built trust as prerequisites for assembling the largest comparative ethnopharmacological collection, vastly extending knowledge on Maya phytotherapy. The collection represents knowledge of the two groups' most reputed herbalists and is a representative selection of the Guatemalan medicinal flora. ICD-10 proved useful for making broad comparisons between the groups, but more refined approaches would be necessary for other research objectives. Knowledge in the two areas is highly diverse and seems fragmented. New approaches are required to assess how coherent Maya phytotherapy is. The documented 'traditional' ethno-pharmacopoeias demonstrate dynamic change and acculturation, reflecting the two linguistic groups' sociocultural history and context. This highlights the adaptive potential of phyto-therapeutic knowledge and calls the equation of local indigenous pharmacopoeias with 'traditional' medicine into question. We suggest using the term 'local' pharmacopoeias, and reserving the term 'traditional' for the study of indigenous pharmacopoeias with a clear delineation of ancient knowledge.

[Usefulness of the qualitative detection of hCG in cervicovaginal lavage for the diagnosis of premature rupture of membranes]. / Utilidad de la detección cualitativa de hCG en el lavado cervicovaginal para el diagnóstico de rotura prematura de membranas.

BACKGROUND: The detection of human chorionic gonadotropin (hCG) in cervicovaginal lavage has proved useful in establishing the diagnosis of premature rupture of membranes, but the methods used for determining time-consuming. OBJECTIVE: To qualitatively determine the concentration of hCG in cervicovaginal lavage to establish the diagnosis of premature rupture of membranes. PATIENTS AND METHODS: Prospective observational study conducted in 149 pregnant women divided into three groups: group I (n = 50), patients with premature rupture of membranes, group II, with suspected ruptured membranes and group III, with premature rupture of membranes confirmed. The diagnosis was established by clinical examination and testing nitrazina and crystallography. In all patients was conducted and cervicovaginal lavage fluid obtained hCG was determined with a rapid qualitative test (sensitivity 25 mlU/mL). We calculated the sensitivity, specificity and positive and negative predictive value of the method. RESULTS: The mean gestational age was 34.6 +/- 5.2 weeks. In 8.7% of the cases were considered "inconclusive" qualitative hCG test, so only 136 samples were analyzed. The sensitivity was 95.6%, specificity 100%, the positive predictive value of 100% and negative 97.8%. CONCLUSION: The qualitative determination of hCG in cervicovaginal lavage is useful for establishing the diagnosis of premature rupture of membranes.