BACKGROUND: Bullous pemphigoid is the most common chronic recurrent autoimmune subepidermal blistering disorder most prevalent in the geriatric population. It varies widely in clinical presentation ranging from tense bullae to intense generalized pruritus. It is immunologic in origin with the presence of IgG antibodies.
METHODS: A 47-year-old female presented to the hospital with complaints of blisters in the lower limbs, which she self managed with neem oil, after which the blisters occurred over the body. The patient also experienced blisters over both upper and lower limbs, gluteal region, painful generalized ulcers, necrotic patches, multiple erythematous blisters, ulcer erosions over bilateral legs and upper limbs with few lesions, which were foul-smelling and oozing. On the second day of admission, the patient\'s CRP and ESR levels were tested and the levels were 33.5 and 35 mm/hr, respectively. The patient was treated with an injection of meropenem 1 g three times daily, dexamethasone 4 mg once daily, and ofloxacin 400 mg once daily. On the third day of admission, the patient complained of leg swelling, and subsequently, D-Dimer levels were checked, which showed a value of 5,740 and was treated with an injection of enoxaparin 40 mg for the same throughout the course of the hospital stay A skin biopsy confirmed the diagnosis of bullous pemphigoid. The culture test showed the growth of Klebsiella pneumonia and Acinetobacter baumani, which were resistant to most of the antibiotics. The patient was managed appropriately with modalities including antibiotics, anti-inflammatory agents, immunosuppressants, multivitamins, fluids, and albumin. The patient responded well to the treatment without new lesions or fever spikes. There was the presence of necrotic patches of old lesions alone at the time of discharge.
CONCLUSIONS: This case report was done with the purpose of presenting an exemplary case of bullous pemphigoid aggravated by the application of neem oil and emphasizing the inappropriate use of folk medicine in an autoimmune disease like bullous pemphigoid.

BACKGROUND: Animals from various taxonomic groups are commonly used in folk medicine, and their selection seems to be directly linked to their availability and accessibility. In the present study, we analyzed the use of animals as a source of folk medicines in a community in northeastern Brazil with access to aquatic and terrestrial animals. We hypothesize that the medicinal fauna is well represented by species of both habitat types.
METHODS: For the collection of information, semi-structured questionnaires were applied to local residents.
RESULTS: We recorded the use of 22 animals used as medicinal resources in the community, distributed among eight taxonomic categories, which are used to treat 38 types of diseases. Of the therapeutic animals, 14 species are terrestrial and 8 species can be considered aquatic occurring in marine or estuarine habitats.
CONCLUSIONS: Our data confirm the tendency of human communities to use affordable medicinal animals in local ecosystems. We also found that medicinal use represents a strategy of optimizing the use of resources and is related to the economic, historical, social, cultural, and ecological contexts in which the community is inserted.

Physical maltreatment is one of the most common forms of child abuse. Cutaneous injuries often raise the suspicion of child maltreatment. Nevertheless, among health professionals there is still uncertainty in the evaluation of such injuries. In the literature, there are few indications about the most important factors that allow the differentiation of physical abuse findings from signs/lesions that are caused by \"folk medicine practices\" with similar presentations. We report the case of two brothers who were brought to the Emergency Department of a pediatric hospital by their father because each of them showed one painful, circular and red-purple bruise on their back. Suspecting child abuse, the emergency physicians reported the case to a multidisciplinary unit (dedicated to child abuse). After a careful physical examination, psychological interviews, as well as the evaluation of their medical history, the operators pointed out that the lesions were the result of cupping practices (a form of folk medicine). This case highlights the need for a multidisciplinary approach and demonstrates the importance of a careful evaluation of the cultural background of the family.

This study aimed to report three representative childhood lead poisoning cases in China from domestic products exposure and to highlight their critical implications for practice, education, and policy in prevention and treatment of childhood lead poisoning by health care providers, especially public health nurses.
Three representative childhood lead poisoning cases occurring in 2017 were collected and analyzed.
The lead exposure sources of three cases were evaluated by experts in the field and determined to be tin pots, home factories for tinfoil, and contamination of folk medicine, respectively. These cases demonstrated that the lack of lead exposure risk assessment, insufficient knowledge of potential lead exposure sources, underdeveloped policy, and regulations were areas for improvement.
The best strategies for preventing lead poisoning include an appropriate risk assessment of lead exposure, implementation of comprehensive parental health education, conduction of further research by public health providers, and the application of policy strategies by the government. It was determined that public health nurses are at the frontline of prevention of lead poisoning in children.

Folk prescriptions continue to be important sources of childhood lead poisoning. Nasal spray folk prescriptions for treating rhinitis has only been reported once previously as a cause of lead poisoning.
We identified three pediatric cases of severe lead poisoning caused by nasal spray folk medicines prescribed for treating rhinitis. The three patients had similar clinical manifestations including: severe abdominal pain, headache, pale appearance and fatigue. Liver function tests were abnormal. Blood lead levels (BLLs) of the three patients were 91 μg/dL, 91 μg/dL, and 105 μg/dL, respectively. After chelation BLLs decreased. The lead content of the three folk remedies as measured by inductively coupled plasma mass spectrometry (ICP-MS) were 14.8, 22.3, and 33.4%. All the symptoms resolved during a course of chelation therapy. There were no severe side effects of treatment.
Nasal spray folk prescriptions for treating rhinitis may contain extremely high bio-accessible lead content and are potential sources of lead poisoning. Clinicians should be alert to this possibility especially in those children presenting with multisystem symptoms.

UNASSIGNED: Previous research suggests that the use of medicinal plants by a given group is mainly driven by biological variables such as the chemical composition or the ecological distribution of plants. However, other studies highlight the importance of cultural aspects such as the curative meaning given to a plant, beliefs, religion or the historical context. Such aspects could play an important role in the use, diffusion or even in the effectiveness of a plant remedy.
METHODS: Fieldwork consisted of 233 orally consented semi-structured interviews with 178 informants about medicinal uses of plants. Interviews were conducted in four historically and geographycally delimited regions of Alava and Biscay with similar environmental conditions but different sociolinguistic backgrounds: two regions were Basque- and two Spanish-speaking. Data were structured in use-reports. A Between Class Analysis was conducted to assess the intercultural and intracultural variability of medicinal plants knowledge.
RESULTS: The results show the existence of four clearly different medicinal ethnofloras. While the four ethnofloras share remedies widely distributed through the territory, each of them also includes remedies that are only shared among closely related communities. The ecological availability and chemical composition of the plants may explain why there are widely used plant remedies. On the contrary, the distribution of the locally shared remedies matches up with the cultural heterogeneity of the territory, so cultural factors, such as, language, social networks or the meaning response of the plants seem to explain the use of many traditional plant remedies. In Addition, we also found that Basque speaking territories show higher knowledge levels than Spanish speaking territories. In this sense, the development and reinforcement of Basque identity by Basque nationalism seems to have contributed to maintain the traditional knowledge in the Basque speaking regions.
CONCLUSIONS: Despite the fact that pharmacological effectiveness and ecological availability are usually considered as the main variables that shape the traditional use of medicinal plants, our results suggest that cultural factors can be at least as important as ecological and chemical factors. In fact, differences in language, in the cultural meaning of the plants, in the context related to cultural identities, and in social networks seem to play a fundamental role in the use and diffusion and maintenance or erosion of traditional knowledge about medicinal plants in the study area.