Controlled clinical trial of IV cyclophosphamide versus IV methylprednisolone in severe neurological manifestations in systemic lupus erythematosus.

BACKGROUND: Severe neurological involvement in systemic lupus erythematosus (NPSLE) is one of the most dreadful complications of the disease. OBJECTIVE: To identify the best drug, dose, and treatment. PATIENTS AND METHODS: The study was a controlled clinical trial at two tertiary care centres of patients with SLE according to the ACR criteria, with incident (no more than 15 days) onset of severe NP manifestations such as seizures, optic neuritis, peripheral or cranial neuropathy, coma, brainstem disease, or transverse myelitis. Induction treatment with 3 g of IV methylprednisolone (MP) followed by either IV monthly cyclophosphamide (Cy) versus IV MP bimonthly every 4 months for 1 year and then IV Cy or IV MP every 3 months for another year. The primary end point was response to treatment: at least 20% improvement from basal conditions on clinical, laboratory, or specific neurological testing variables. RESULTS: Overall, a response rate of 75% was observed. Of the 32 patients studied, 18/19 receiving Cy and 7/13 receiving MP responded to treatment (p<0.03). CONCLUSIONS: Cy seems to be more effective than MP in the treatment of acute, severe NPSLE.

Effect of plasma volume expansion on auricular natriuretic peptide in non-dependent insulin diabetic patients with autonomic neuropathy.

The objective of this study was to determine the role of atrial natriuretic peptide (ANP) in autonomic neuropathy and to learn the effect of saline solution infusion on ANP. Twenty one subjects were distributed in three groups: 1) control group, 2) diabetic patients with autonomic neuropathy, and 3) diabetic patients without autonomic neuropathy. The levels of ANP, renin, aldosterone and cortisol were determined at baseline and 30, 60, and 75 min after saline infusion. At baseline ANP was lower in diabetic patients with autonomic neuropathy (32.9 +/- 13) than control group (34 +/- 15). ANP increased statistically significantly at 30 min after solution administration in control group (60 +/- 35, F = 4, p < 0.05), but it did not change in diabetic patients (Group II: 34.3 +/- 9.3 and Group III 34.6 +/- 10.7). Sixty and 75 min after saline infusion ANP returned to basal levels in control group, but they did not change in diabetic patients. A delayed response of renin, aldosterone and cortisol to saline solution administration was observed in diabetic patients. There was no correlation between ANP levels and alteration of autonomic tests. It is concluded that independent of autonomic neuropathy, the levels of ANP did not increase with saline infusion in diabetic patients.

[Hypoglycemic action of Opuntia streptacantha Lemaire: study using raw extracts]. / Acción hipoglucemiante de Opuntia streptacantha Lemaire: investigación con extractos crudos.

To find out the extent of the hypoglycemic effect of crude extracts of Opuntia streptacantha eight patients with type II diabetes mellitus were studied. Five tests were performed to each patients with the intake of (A) supernatant, (B) precipitate, (C) complete homogenate of 500 g of crude O. streptacantha stem (D) 400 ml of water, and (E) 500 g of broiled Opuntia stems. Serum glucose levels were measured at 0,30,60,120 and 180 minutes. Crude extracts did not cause a significant decrease of glycemia, and the results were similar to the water control test (P greater than 0.05). The intake of broiled Opuntia stems caused a significant decrease of serum glucose level, that reached 48.3 +/- 16.2 mg/dl lower than basal values at 180 minutes (P less than 0.01). Perhaps heating of O. streptacantha is necessary to obtain the hypoglycemic effect.

[Effect of a dehydrated extract of nopal (Opuntia ficus indica Mill.) on blood glucose]. / Influencia de un extracto deshidratado de nopal (Opuntia ficus-indica mill.) en la glucemia.

To assess if a dehydrated extract of nopal stems retains the effect on glycemia of the entire nopal stems two experiments were performed. A. Six patients with type II diabetes mellitus in fasting condition received 30 capsules containing 10.1 +/- 0.3 g of the extract, and serum glucose levels were measured hourly from 0 to 180 minutes. B. Six healthy volunteers received 30 capsules with the extract followed by 74 g of dextrose orally. Serum glucose measurements were made in a similar fashion. In each experiment a control test with empty capsules was performed. Nopal extract did not reduce fasting glycemia in diabetic subjects. Nevertheless, the extract diminished the increase of serum glucose which followed a dextrose load. Peak serum glucose was 20.3 +/- 18.2 mg/dl (X +/- SD) lower in the test with nopal than in the control one (P less than 0.025). Dehydrated extract of nopal (Opuntia ficus-indica Mill) did not show acute hypoglycemic effect, although could attenuate postprandial hyperglycemia.

[Effect of different doses of Plantago psyllium mucilage on the glucose tolerance test]. / Efecto de diferentes dosis de mucílago de Plantago psyllium en la prueba de tolerancia a la glucosa.

To assess the effect of different doses of Plantago psyllium mucilage on glucose tolerance test, four oral glucose tolerance tests were performed to eight healthy volunteers. Glucose load (75 g) was mixed with 0 (control test), 10.20 and 30 g of mucilage. Serum glucose levels were measured at 0, 30, 60, 120 and 180 minutes. Maximum peak of glucose at 30 minutes, and the area under the curve of glucose were significantly lower in the test with 20 and 30 g of mucilage than the tests with 0 and 10g. There was a significant relationship (r = 0.44 p less than 0.025) between the dose of P. psyllium mucilage and its attenuating effect of hyperglycemia.

Indices de septicemia en el adulto.Estudio preliminar. / Index of septicemia in adult. Preliminary study

En 12 adultos con septicemia y 13 adultos con infecciones localizadas se evaluo la utilidad de un indice que ayudara al diagnostico de septicemia. En los sujetos con esta se observo un incremento significativo en las cifras de los leucocitos polimorfonucleares, en tanto que los valores de hemoglobina, hematocrito y velocidad de eritrosedimentacion fueron menores que en los testigos. Un indice superior a 8.0, obtenido al dividir los neutrofilos segmentados entre el producto de la velocidad de eritrosedimentacion por el valor hematocrito, establecio una diferencia entre los pacientes con septicemia y los que cursaban con infecciones localizadas. El indice tuvo especificidad de 69 por ciento y sensibilidad de 72 por ciento, por lo que puede ser de alguna utilidad en el diagnostico precoz aunque no substituye al conjunto de datos clinicos y bioquimicos que se presentan en la septicemia

Effecto del nopal (Opuntia sp.) sobre los lipidos sericos, la glucemia y el peso corporal. / Effects of nopal (Opuntia sp.) on serum lipids, glycemia and body weight

Con objeto de investigar si la ingestion de nopal, al igual que de algunas fibras dieteticas, disminuye los lipidos sericos, la glucemia y el peso corporal se estudiaron ocho individuos sanos, 14 obesos y siete diabeticos a quienes se les administraron 100 g de hojas asadas de nopal antes de cada alimento durante 10 dias. Despues de este periodo se encontro disminucion significativa del colesterol total en los tres grupos y de colesterol beta, trigliceridos y peso corporal en los obesos y en los diabeticos. El colesterol alfa no se modifico. La glucemia disminuyo en promedio 63,4 mg/dl (3.5 mmol/l) en los diabeticos (p < 0.001), y 3.86 mg/dl (0.21 mmol/l) en los no diabeticos (p < 0.05).La ingestion de nopal antes de los alimentos puede ser util para tratar algunas hiperlipidemias, la diabetes mellitus y la obesidad