Abstract: Background: Previous studies have shown oxidative stress in pemphigus vulgaris and pemphigus foliaceus, nevertheless, it remains unknown whether a similar response is characteristic of endemic pemphigus foliaceus in Peru. Objectives: To determine the oxidative stress response in endemic pemphigus foliaceus patients and subjects with positive for anti-desmoglein1 antibodies (anti-dsg1) from endemic areas of Peru. Subjects and Methods: This is a cross-sectional study. The study population included 21 patients with Endemic Pemphigus foliaceus and 12 healthy subjects with anti-dsg1 antibodies from the Peruvian Amazon (Ucayali), as well as 30 healthy control subjects. Malondialdehyde, an indicator of lipid peroxidation by free radicals, was measured in serum. Results: We collected 21 cases of endemic pemphigus foliaceus, 15 of them with active chronic disease and 6 in clinical remission. Serum malondialdehyde values in patients with chronic active evolution and healthy subjects with anti-dsg1 antibodies were statistically higher than those of healthy controls (p<0.001). There was no significant difference between serum values of localized and generalized clinical forms. Study limitations: The main limitation of this present study is the small number of patients with endemic pemphigus and healthy subjects positive for desmoglein 1 antibodies. Conclusions: The increased serum levels of malondialdehyde in patients with chronic active endemic pemphigus foliaceus and healthy subjects from endemic areas with anti-dsg1 antibodies may suggest a contribution of systemic lipid peroxidation in the pathogenesis of endemic pemphigus foliaceus.

Objectives. Describe the diversity of traditional healers, their links with the formal health system and changes in their therapeutic resources in two rural Andean communities in Churcampa, in the region of Huancavelica, Peru. Materials and methods. Qualitative study which combined three ethnographic techniques: in depth interviews, observations and accompaniments to traditional healers and health care personnel. Results. 58 traditional healers, classified as healers, midwives and bonesetters were identified. Most healers interviewed learned their work while young and few had a teacher or mentor. The vast majority have objections to linking with health care facilities beyond referrals. There was no coordinated work among health personnel and traditional healers. However, when it happened, health personnel preferred those healers who have the willingness to adapt to the needs of the health services. We found that most of the healers were changing their practices due to the influence of evangelical churches. No healer had disciples to transmit their knowledge and practices. Conclusions. There is great diversity of traditional healers. This diversity is decreasing, among other factors, by the advance of the evangelical churches. Traditional healers refer some patients to the health facility; while health personnel establish hierarchical working relationships with the healers. It is necessary to work on these attitudes of the health care personnel, since the basis of an intercultural approach is to have coordinated and horizontal working relationships between both systems

Objetivos. Describir la diversidad de terapeutas tradicionales, sus vínculos con el sistema de salud oficial y los cambios en sus recursos terapéuticos, en dos comunidades rurales de los andes en Churcampa, región de Huancavelica, Perú. Materiales y métodos. Estudio cualitativo en el que se combinan tres técnicas etnográficas: entrevistas en profundidad, observaciones y acompañamientos a terapeutas tradicionales y personal de salud. Resultados. Se identificaron 58 terapeutas, clasificados como curanderos, parteros y hueseros. La mayoría de terapeutas entrevistados aprendió su labor siendo joven y muy pocos tuvieron un maestro o mentor. La gran mayoría señaló tener reparos para vincularse con los establecimientos de salud más allá de las referencias. No había un trabajo articulado entre personal de salud y terapeutas tradicionales. Sin embargo, cuando sucedía, el personal de salud prefería a aquellos terapeutas que tuvieran la disposición para adecuarse a las necesidades de los servicios de salud. Se encontró que buena parte de los terapeutas estaban cambiando sus prácticas debido a la influencia de las iglesias evangélicas. Ningún terapeuta contaba con discípulos para transmitir sus conocimientos y prácticas. Conclusiones. Existe una gran diversidad de terapeutas tradicionales. Esta diversidad viene disminuyendo, entre otros factores, por el avance de las iglesias evangélicas. Los terapeutas tradicionales refieren a algunos pacientes al establecimiento de salud; mientras que el personal de salud establece relaciones jerárquicas de trabajo con los terapeutas. Se requiere trabajar estas actitudes del personal de salud pues la base de un enfoque intercultural es el trabajo articulado y horizontal entre ambos sistemas

Objectives. Describe the diversity of traditional healers, their links with the formal health system and changes in their therapeutic resources in two rural Andean communities in Churcampa, in the region of Huancavelica, Peru. Materials and methods. Qualitative study which combined three ethnographic techniques: in depth interviews, observations and accompaniments to traditional healers and health care personnel. Results. 58 traditional healers, classified as healers, midwives and bonesetters were identified. Most healers interviewed learned their work while young and few had a teacher or mentor. The vast majority have objections to linking with health care facilities beyond referrals. There was no coordinated work among health personnel and traditional healers. However, when it happened, health personnel preferred those healers who have the willingness to adapt to the needs of the health services. We found that most of the healers were changing their practices due to the influence of evangelical churches. No healer had disciples to transmit their knowledge and practices. Conclusions. There is great diversity of traditional healers. This diversity is decreasing, among other factors, by the advance of the evangelical churches. Traditional healers refer some patients to the health facility; while health personnel establish hierarchical working relationships with the healers. It is necessary to work on these attitudes of the health care personnel, since the basis of an intercultural approach is to have coordinated and horizontal working relationships between both systems

Objetivos. Describir la diversidad de terapeutas tradicionales, sus vínculos con el sistema de salud oficial y los cambios en sus recursos terapéuticos, en dos comunidades rurales de los andes en Churcampa, región de Huancavelica, Perú. Materiales y métodos. Estudio cualitativo en el que se combinan tres técnicas etnográficas: entrevistas en profundidad, observaciones y acompañamientos a terapeutas tradicionales y personal de salud. Resultados. Se identificaron 58 terapeutas, clasificados como curanderos, parteros y hueseros. La mayoría de terapeutas entrevistados aprendió su labor siendo joven y muy pocos tuvieron un maestro o mentor. La gran mayoría señaló tener reparos para vincularse con los establecimientos de salud más allá de las referencias. No había un trabajo articulado entre personal de salud y terapeutas tradicionales. Sin embargo, cuando sucedía, el personal de salud prefería a aquellos terapeutas que tuvieran la disposición para adecuarse a las necesidades de los servicios de salud. Se encontró que buena parte de los terapeutas estaban cambiando sus prácticas debido a la influencia de las iglesias evangélicas. Ningún terapeuta contaba con discípulos para transmitir sus conocimientos y prácticas. Conclusiones. Existe una gran diversidad de terapeutas tradicionales. Esta diversidad viene disminuyendo, entre otros factores, por el avance de las iglesias evangélicas. Los terapeutas tradicionales refieren a algunos pacientes al establecimiento de salud; mientras que el personal de salud establece relaciones jerárquicas de trabajo con los terapeutas. Se requiere trabajar estas actitudes del personal de salud pues la base de un enfoque intercultural es el trabajo articulado y horizontal entre ambos sistemas