Comparison of vildagliptin and acarbose monotherapy in patients with Type 2 diabetes: a 24-week, double-blind, randomized trial.

AIMS: To compare the efficacy and tolerability of the dipeptidyl peptidase-4 inhibitor, vildagliptin, with the alpha glucosidase inhibitor, acarbose, in drug-naive patients with Type 2 diabetes. METHODS: This multi-centre, randomized, double-blind, parallel-arm study compared the efficacy and tolerability of vildagliptin (100 mg daily, given as 50 mg twice daily, n = 441) and acarbose (up to 300 mg daily, given as three equally divided doses, n = 220) during 24-week treatment in drug-naive patients with Type 2 diabetes. RESULTS: Monotherapy with vildagliptin or acarbose decreased glycated haemoglobin (HbA(1c)) (baseline approximately 8.6%) to a similar extent during 24-week treatment. The adjusted mean change from baseline to end-point (AMDelta) in HbA(1c) was -1.4 +/- 0.1% and -1.3 +/- 0.1% in patients receiving vildagliptin and acarbose, respectively, meeting the statistical criterion for non-inferiority (upper limit of 95% confidence interval for between-treatment difference < or = 0.4%). The decrease in fasting plasma glucose was similar with acarbose (-1.5 +/- 0.2 mmol/l) and vildagliptin (-1.2 +/- 0.1 mmol/l). Body weight did not change in vildagliptin-treated patients (-0.4 +/- 0.1 kg) but decreased in acarbose-treated patients (-1.7 +/- 0.2 kg, P < 0.001 vs. vildagliptin). The proportion of patients experiencing any adverse event (AE) was 35% vs. 51% in patients receiving vildagliptin or acarbose, respectively; gastrointestinal AEs were significantly more frequent with acarbose (25.5%) than vildagliptin (12.3%, P < 0.001). No hypoglycaemia was reported for either group. CONCLUSIONS: Vildagliptin is effective and well tolerated in patients with Type 2 diabetes, demonstrating similar glycaemic reductions to acarbose, but with better tolerability.

Scorpion envenoming in two regions of Colombia: clinical, epidemiological and therapeutic aspects.

To determine clinical and epidemiological features of scorpion stings in two departments of Colombia, a descriptive study was performed in the hospitals of 10 towns from Antioquia (2 256 071 inhabitants) and five from Tolima (630 424 inhabitants). One hundred and twenty-nine cases were admitted during one year, 51 in Antioquia, 78 in Tolima and 41 were children less than 15 years old. Most stings (70.5%) occurred inside the house; 27.9% were on the hands and 26.4% on the feet. The scorpion species involved were Tityus pachyurus (51), Centruroides gracilis (31), T. fuehrmanni (29), T. asthenes (7) and Chactas spp. (1). In 10 cases the scorpion involved was not identified. Systemic envenoming signs (e.g. vomiting, tachypnea) were significantly more frequent in children than in adults (P < 0.05). Four children had hypertension, but none developed pulmonary oedema. One 3-year-old girl, stung by T. asthenes, had acute oedematous pancreatitis. Ninety-eight patients had mild envenoming. Moderate (27 patients) and severe (four patients) envenoming was significantly more frequent in children than in adults (P = 0.003; relative risk = 2.97). A pepsin-digested anti-Centruroides spp. antivenom was administered to 19 of 31 patients presenting systemic envenoming signs. No adverse reactions to antivenom were observed.

Neutralization of the edema-forming, defibrinating and coagulant effects of Bothrops asper venom by extracts of plants used by healers in Colombia.

We determined the neutralizing activity of 12 ethanolic extracts of plants against the edema-forming, defibrinating and coagulant effects of Bothrops asper venom in Swiss Webster mice. The material used consisted of the leaves and branches of Bixa orellana (Bixaceae), Ficus nymphaeifolia (Moraceae), Struthanthus orbicularis (Loranthaceae) and Gonzalagunia panamensis (Rubiaceae); the stem barks of Brownea rosademonte (Caesalpiniaceae) and Tabebuia rosea (Bignoniaceae); the whole plant of Pleopeltis percussa (Polypodiaceae) and Trichomanes elegans (Hymenophyllaceae); rhizomes of Renealmia alpinia (Zingiberaceae), Heliconia curtispatha (Heliconiaceae) and Dracontium croatii (Araceae), and the ripe fruit of Citrus limon (Rutaceae). After preincubation of varying amounts of each extract with either 1.0 microg venom for the edema-forming effect or 2.0 microg venom for the defibrinating effect, the mixture was injected subcutaneously (sc) into the right foot pad or intravenously into the tail, respectively, to groups of four mice (18-20 g). All extracts (6.2-200 microg/mouse) partially neutralized the edema-forming activity of venom in a dose-dependent manner (58-76% inhibition), with B. orellana, S. orbicularis, G. panamensis, B. rosademonte, and D. croatii showing the highest effect. Ten extracts (3.9-2000 microg/mouse) also showed 100% neutralizing ability against the defibrinating effect of venom, and nine prolonged the coagulation time induced by the venom. When the extracts were administered either before or after venom injection, the neutralization of the edema-forming effect was lower than 40% for all extracts, and none of them neutralized the defibrinating effect of venom. When they were administered in situ (sc at the same site 5 min after venom injection), the neutralization of edema increased for six extracts, reaching levels up to 64% for C. limon.

Neutralization of the edema-forming, defibrinating and coagulant effects of Bothrops asper venom by extracts of plants used by healers in Colombia

We determined the neutralizing activity of 12 ethanolic extracts of plants against the edema-forming, defibrinating and coagulant effects of Bothrops asper venom in Swiss Webster mice. The material used consisted of the leaves and branches of Bixa orellana (Bixaceae), Ficus nymphaeifolia (Moraceae), Struthanthus orbicularis (Loranthaceae) and Gonzalagunia panamensis (Rubiaceae); the stem barks of Brownea rosademonte (Caesalpiniaceae) and Tabebuia rosea (Bignoniaceae); the whole plant of Pleopeltis percussa (Polypodiaceae) and Trichomanes elegans (Hymenophyllaceae); rhizomes of Renealmia alpinia (Zingiberaceae), Heliconia curtispatha (Heliconiaceae) and Dracontium croatii (Araceae), and the ripe fruit of Citrus limon (Rutaceae). After preincubation of varying amounts of each extract with either 1.0 æg venom for the edema-forming effect or 2.0 æg venom for the defibrinating effect, the mixture was injected subcutaneously (sc) into the right foot pad or intravenously into the tail, respectively, to groups of four mice (18-20 g). All extracts (6.2-200 æg/mouse) partially neutralized the edema-forming activity of venom in a dose-dependent manner (58-76 percent inhibition), with B. orellana, S. orbicularis, G. panamensis, B. rosademonte, and D. croatii showing the highest effect. Ten extracts (3.9-2000 æg/mouse) also showed 100 percent neutralizing ability against the defibrinating effect of venom, and nine prolonged the coagulation time induced by the venom. When the extracts were administered either before or after venom injection, the neutralization of the edema-forming effect was lower than 40 percent for all extracts, and none of them neutralized the defibrinating effect of venom. When they were administered in situ (sc at the same site 5 min after venom injection), the neutralization of edema increased for six extracts, reaching levels up to 64 percent for C. limon.

Pustular generalized perforating granuloma annulare.

We report a 84-year-old man with a 13-year history of recurrent generalized asymptomatic pustular lesions. Histology revealed areas of necrobiosis surrounded by palisading granulomas and transepidermal and follicular elimination of the necrobiotic material. A dense infiltrate of neutrophils was also found. Although 26% of patients with generalized perforating granuloma annulare have some yellow pustule-like papules, these correspond histologically to the yellow viscous necrobiotic material extruding through the epidermis and not to a real neutrophilic infiltrate. This is the first case report of perforating granuloma annulare with recurrent generalized pustular lesions with a dense infiltrate of neutrophils.

[Acromelanosis]. / Acromelanosis.

Acromelanosis is an independent disease entity, characterized by increased skin pigmentation, usually located on the acral areas of the fingers and toes. It is mostly seen in newborns or during the first years of life. Only a few cases of this entity have previously been described in the medical literature. In some of these cases, the cutaneous lesions spread to affect large parts of the skin surface. A possible association with other benign and malignant diseases has been proposed. Differential diagnosis must be made with a wide variety of systemic and dermatologic conditions, especially dermatoses with acral distribution of macular hyperpigmentation, including acropigmentation. In this article, we report a new case of acromelanosis in a 5-week-old girl showing two peculiar clinical features: associated melanosis of the genital mucosa and stabilization of the lesions after an initial phase of progression and proximal spread. In addition, the most important features of this rare cutaneous disease are discussed.

Acromelanosis / Acromelanosis

La acromelanosis es una enfermedad con entidad propia, caracterizada por un incremento de la pigmentación cutánea de distribución predominantemente acral, que se observa sobre todo en recién nacidos o durante los primeros años de vida. Se han descrito un número muy reducido de casos en la literatura médica, alguno de los cuales ha mostrado una importante extensión de las lesiones hasta afectar a numerosas localizaciones de la superficie corporal y se ha propuesto su asociación a otras enfermedades tanto benignas como malignas. El diagnóstico diferencial debe establecerse con otros procesos caracterizados por la presencia de máculas hiperpigmentadas en los dedos de las manos, entre los que destaca por su similitud clínica la denominada acropigmentación. En este artículo se presenta un nuevo caso de acromelanosis, en una niña de 5 semanas de edad, que además muestra características clínicas particulares, como la asociación a melanosis de mucosa genital y la estabilización posterior de las lesiones tras un período inicial de progresión y extensión de las mismas en sentido proximal. Así mismo, se discuten las características más relevantes de esta rara enfermedad cutánea, aunque fácil de identificar (AU)

Snakebites and ethnobotany in the northwest region of Colombia. Part III: neutralization of the haemorrhagic effect of Bothrops atrox venom.

Thirty-one of 75 extracts of plants used by traditional healers for snakebites, had moderate or high neutralizing ability against the haemorrhagic effect of Bothrops atrox venom from Antioquia and Chocó, north-western Colombia. After preincubation of several doses of every extract (7.8-4000 microg/mouse) with six minimum haemorrhagic doses (10 microg) of venom, 12 of them demonstrated 100% neutralizing capacity when the mixture was i.d. injected into mice (18-20 g). These were the stem barks of Brownea rosademonte (Caesalpiniaceae) and Tabebuia rosea (Bignoniaceae); the whole plants of Pleopeltis percussa (Polypodiaceae), Trichomanes elegans (Hymenophyllaceae) and Senna dariensis (Caesalpiniaceae); rhizomes of Heliconia curtispatha (Heliconiaceae); leaves and branches of Bixa orellana (Bixaceae), Philodendron tripartitum (Araceae), Struthanthus orbicularis (Loranthaceae) and Gonzalagunia panamensis (Rubiaceae); the ripe fruits of Citrus limon (Rutaceae); leaves, branches and stem of Ficus nymphaeifolia (Moraceae). Extracts of another 19 species showed moderate neutralization (21-72%) at doses up to 4 mg/mouse, e.g. the whole plants of Aristolochia grandiflora (Aristolochiaceae), Columnea kalbreyeriana (Gesneriaceae), Sida acuta (Malvaceae), Selaginella articulata (Selaginellaceae) and Pseudoelephantopus spicatus (Asteraceae); rhizomes of Renealmia alpinia (Zingiberaceae); the stem of Strychnos xinguensis (Loganiaceae); leaves, branches and stems of Hyptis capitata (Lamiaceae), Ipomoea cairica (Convolvulaceae), Neurolaena lobata (Asteraceae), Ocimum micranthum (Lamiaceae), Piper pulchrum (Piperaceae), Siparuna thecaphora (Monimiaceae), Castilla elastica (Moraceae) and Allamanda cathartica (Apocynaceae); the macerated ripe fruits of Capsicum frutescens (Solanaceae); the unripe fruits of Crescentia cujete (Bignoniaceae); leaves and branches of Piper arboreum (Piperaceae) and Passiflora quadrangularis (Passifloraceae). When the extracts were independently administered by oral, i.p. or i.v. route either before or after an i.d. venom injection (10 microg), neutralization of haemorrhage dropped below 25% for all the extracts. Additionally, B. rosademonte and P. percussa extracts were able to inhibit the proteolytic activity of B. atrox venom on casein.

Images of the nervous system in Cajal's scientific thought.

Since his death in 1934, a wide range of publications have outlined Santiago Ramon y Cajal's (1852-1934) scientific personality as well as his contribution to the acceptance of the neuron theory. Trying to go beyond the traditional biographical approach, the present paper aims to set up the historical origins and the development of his scientific conributions. His global image of the nervous system, the neuron theory and other aspects of his scientific views are also related to his intellectual background. Not only his scientific papers, but also his own remembrances, biographical texts and general reflections are taken into account to describe the historical context of Cajal's scientific work, his discovery of the dynamic polarization of neuron cells and his contributions to the knowledge of the texture of the nervous centers and cells, the regeneration and degeneration of nerves, as well as Cajal's scientific bibliogaphy.

[Illness and death in the city of Valencia (1901-1920)]. / Enfermedad y muerte en la ciudad de Valencia (1901-1920).

PIP: "The present work analyses the origins of demographic and sanitary statistics in the city of Valencia (Spain) through the medical journals at the end of the 19th century and two specific publications: the Boletin Sanitario Municipal (1905-1913) and the Boletin de la Estadistica Municipal de Valencia (1915-1920).... The diagnostic categories of death causes are analysed and a study of urban mortality during the period 1901-1920 is proposed, in which specific mortality [by] age, cause and sex is discussed." (EXCERPT)^ieng

[The averroism in the corpuscular philosophy of Petrus of Oleza]. / El averroismo en la filosofia corpuscular de Pere d'Oleza (ca. 1460-1531).

Oleza is an obstinate defender of Atomism in the Spanish scientific world of the XVIth century. He was the author of a Summa totius philosophiae et medicinae, published in 1536, five years after his death. Probably, Oleza's stay in Montpellier and Pisa conciliated his critical disposition towards Scholastic Galenism. His scientific thought must be connected not only with the flourishing Atomism of the first half of XVIth century, but also with Scholastic Aristotelism deriving from the Arabic transmission and from its main representative, Averroes. Oleza's natural philosophy of the human body is strongly influenced by Averroes' ideology. This article supplies new elements about his life based on investigations of archives.

[Hyperthyroidism as a cause of irreversible dilated myocardiopathy]. / Hipertiroidismo como causa de miocardiopatía dilatada irreversible.

We describe the case of a young man with Graves Basedow's Disease as the unique cause of congestive heart failure, which after several months of antihyperthyroid therapy not very strictly followed, underwent heart transplantation due to severe ventricular and diastolic disfunction. The relationship between thyroid hypertension and cardiomyopathy is reviewed.

The body republic: social order and human body in Renaissance medical thought.

The representation of the human body built by medicine had historical references and analogical relations with other compounds of the culture of each particular period. The organic model, the coordinated and hierarchical dependence of the body parts, its subordination to a prevailing element (the brain or the heart, depending on the authors and times) guided directly by a soul infused by God... These are some of the aspects which reflect the relation between the image of the body and the justification of the ideological and social order, as a natural one. Among the numerous sources of Renaissance medicine that could bring significant facts about this theme, the present work is based on anatomical treatises and books of natural philosophy like those written by Bernardino Montaña de Monserrate, Alonso de Fuentes, Realdo Colombo, Hieronimus Montaltus, Andrea Cesalpino and Miguel Sabuco, all of whom are good exponents of Renaissance anatomy and physiological thought.

[Medical theories and the classification of causes of death]. / Teorias medicas y la clasificacion de las causas de muerte.

"This work sketches the main stages in the evolution of medical thought and their effect upon the creation of systems intended to classify illness....[It analyzes] the influence of the three stages of the creation of the laboratory medicine in the 19th century....Lastly, it makes a proposal and a plan for a retrospective terminological glossary that should include the nosological lexicon and death causes by means of the integration of the existing empirical material." (SUMMARY IN ENG AND FRE)

[Perspectives on pancreas transplantation in diabetes mellitus type 1]. / Perspectivas del trasplante de páncreas en la diabetes mellitus tipo 1.

Pancreatic transplantation (PT) is a therapeutical procedure which is being currently assessed for the treatment of insulin-dependent Diabetes Mellitus. Organ PT is a real alternative, whereas islets PT is a method still in its clinic and animal experimental stages. Different surgical methods of drainage, preservation, selection of donor, complications and immunosuppressive therapy are analyzed.