Goiter in Brazilian modernism paintings / Bócio em pinturas da arte moderna brasileira

Objective: To evaluate Di Cavalcanti's artworks in which goiters are represented before and after the introduction of iodized salt to the Brazilian population. Methods: One hundred and thirty paintings by Di Cavalcanti from the 20's to 70's demonstrating necks were evaluated. All the paintings were observed in reproductions. The neck circumference in the paintings was measured. Since there were no standard thresholds of neck circumference, cutoffs were based on the median. Baseline characteristics of artworks were compared based on high and normal neck circumference categories using Student's t-test, Mann-Whitney-Wilcoxon test, or chi square test. Results: We analyzed 29 artworks which portray the neck of 60 women (84.5%), 8 men (11.3%) and 3 children (4.2%). The analyses of the neck circumference showed 23.3% of women (14/60), 12.5% of men (1/8), and 33.3% of children (1/3) with an abnormal profile of the neck circumference. The neck circumference ratio in 29 paintings showed that the relative sizes of the necks painted between the 1920's and 1950's (r=0.45; p=0.03), and painted between the 1960's and 70's (r= 0.54; p=0.003) have linearly decreased. The decades in which the artworks were painted explained 40.0% of the variation in size of the neck circumference (p=0.002). Conclusion: Art imitates life. Di Cavalcanti was not a physician, and probably did not have the intention to illustrate a pathological condition, although the images observed in this study should be considered as goiter or enlarged neck.

Objetivo: Avaliar as obras de Di Cavalcanti em que bócios estão representados, antes e após a introdução da iodação do sal para a população brasileira. Método: Foram avaliadas 130 pinturas de Di Cavalcanti entre os anos 1920 e 1970 demonstrando pescoços. Todas as pinturas foram observadas em reproduções. A circunferência do pescoço nas pinturas foi mensurada. Como não existia limite-padrão da circunferência do pescoço, os limites foram baseados na mediana. As características básicas das obras de arte foram comparadas por categorias da circunferência do pescoço em elevadas e normais, usando o teste t de Student, o teste de Mann-Whitney-Wilcoxon ou o teste qui-quadrado. Resultados: Analisamos 29 obras de arte que representavam o pescoço de 60 mulheres (84,5%), 8 homens (11,3%) e 3 crianças (4,2%). Ao analisar a circunferência do pescoço, 23,3% das mulheres (14/60), 12,5% dos homens (1/8) e 33,3% das crianças (1/3) demonstraram perfil anormal dela. A relação da circunferência do pescoço em 29 pinturas demonstrou que as circunferências do pescoço relativas aos pescoços pintados entre os anos 1920 e 1950 (r=0,45; p=0,03) e pintados entre os anos 1960 e 1970 (r=0,54; p=0,003) reduziram linearmente. As décadas em que as obra foram pintadas explicaram 40,0% da variação no tamanho da circunferência do pescoço (p=0,002). Conclusão: A arte imita a vida. Di Cavalcanti não era médico e, provavelmente, não tinha intenção de ilustrar uma condição patológica, embora as observações das imagens, neste estudo, tenham sido consideradas como bócio ou com aumento de volume do pescoço

"Green Medicine": The Past, Present, and Future of Botanicals.

Botanicals are plant-derived products that have been consumed by humans for centuries. Today, the marketing and use of botanicals for health and wellness benefits continues to thrive worldwide, with consumers projected to spend more than $140 billion globally by 2024 (Global Analysis, Inc). However, research on the quality and safety of these products has lagged behind sales. Because of this divergence, opportunities abound for collaborations amongst scientists from industry, academia, and government to address these unmet public health needs. Clinical pharmacologists and toxicologists from all of these sectors play critical roles in developing harmonized approaches to achieve the common goal of ensuring botanical products with superior quality and safety.

" Not Intended to Diagnose, Treat, Cure or Prevent Any Disease." 25 Years of Botanical Dietary Supplement Research and the Lessons Learned.

Botanical dietary supplements (BDS) are complex mixtures of phytochemicals exhibiting complex pharmacology and posing complex research challenges. For 25 years, clinical pharmacologists researching BDS have confronted a litany of issues unlike those encountered with conventional medications. Foundational to these concerns is the Dietary Supplement Health and Education Act of 1994, which exempted BDS from premarket safety and efficacy trials. In the ensuing period, safety concerns regarding multi-ingredient products formulated as "proprietary blends" and herb-drug interactions have garnered significant attention. Idiosyncrasies unique to BDS can affect the outcome and interpretation of in vitro and in vivo studies, and although "omics" approaches hold promise in uncovering BDS efficacy mechanisms, purposeful adulteration threatens their safety. Despite a quarter century of public use, healthcare professionals still know little about BDS, thus it falls to industry, government, and academia to join forces in promoting a new paradigm for BDS research and product development.

From Pharmacognosia to DNA-Based Medicinal Plant Authentication - Pharmacognosy through the Centuries.

For centuries, pharmacognosy was essential for the identification, quality, purity, and, until the end of the 18th century, even for the efficacy of medicinal plants. Since the 19th century, it concentrated on authenticity, purity, quality and the analysis of active substances, and was established as an academic branch discipline within pharmacy and continuously developed into a modern, highly sophisticated science. Even though the paradigm in pharmacy changed in the 19th century with the discovery of morphine and concentrated on single substances that could be synthesized fast by the upcoming industry, medicinal plants always remained an important element of the Materia medica, and during the last decades, medicinal plants continue to be a source of remedies, and natural products are an inspiration for new medicine. In this research, pharmacognostic skills remain an essential element, both with regards to identity, quality assurance of botanicals (both herbal medicines and supplements), and the discovery and development of new medicines. Over the years, the specific pharmacognostical tools have changed dramatically, and most recently, DNA-based techniques have become another element of our spectrum of scientific methods.

History full circle: 'Novel' sympathomimetics in supplements.

Since the banning of ephedrine in over-the-counter nutritional supplements a decade ago, a plethora of untested and/or unsafe sympathomimetic stimulants have taken its place. This paper argues that these 'novel' stimulants in supplements recapitulate the work of synthetic chemists at commercial pharmaceutical firms during the 1930s and 1940s, all seeking substitutes for recently successful products based on ephedrine and amphetamine. Copyright © 2015 John Wiley & Sons, Ltd.

The Basis of Structure/Function Claims of Nutraceuticals.

In the United States, as in most of the world, there are large numbers of nutraceuticals that are sold and which people take to boost their immune response. There are, in addition, almost an equal number of products sold to reduce allergies. However, very few consumers, and indeed physicians, are aware of what a structure/function claim is. Structure/function claims are labeling claims that can be used to describe the potential effects of a dietary ingredient or similar substance on the structure or function of the human body. This category of claims was created by legislation contained in the Dietary Supplement Health and Education Act. The intent was to supply consumers with reasonably substantiated information that would allow them to make educated choices about their diet and health. They were not intended to have the same weight and substantiation as the claims made for conventional prescription pharmaceuticals. Rather, they were proposed to fill the gap between consumer desire for over-the-counter supplements and foods, and rigorous and generally more potent and potentially "toxic" prescription medications. The legally mandated disclaimer, stating that the U.S. Food and Drug Administration has not evaluated the structure/function claim, often leads to misinterpretation. While there should be a biologic premise underlying the claim, there is not an absolute requirement for a conventional rigorous placebo-controlled dose response trial. While this may not be the clinical standard that a typical scientific oriented society might desire, it reflects the attempts of the FDA to find common grounds and to allow consumers to use products that are generally considered as safe based on historical use and biologic comparisons. The logic of, indeed need for, structure/function claims is straightforward; however, of equal importance is that nutraceuticals should be properly labeled, have accuracy in their ingredients, be free of contamination, be safe, and have a reasonable body of data that supports their efficacy.

Pellagra Pre-Goldberger: Rupert Blue, Fleming Sandwith, and The "Vitamine Hypothesis".

The conquest of pellagra is commonly associated with one name: Joseph Goldberger of the US Public Health Service, who in 1914 went south, concluded within 4 months that the cause was inadequate diet, spent the rest of his life researching the disease, and--before his death from cancer in 1929--found that brewer's yeast could prevent and treat it at nominal cost. It does Goldberger no discredit to emphasize that between 1907 and 1914 a patchwork coalition of asylum superintendents, practicing physicians, local health officials, and others established for the first time an English-language competence in pellagra, sifted through competing hypotheses, and narrowed the choices down to two: an insect-borne infection hypothesis, championed by the flamboyant European Louis Westerna Sambon, and the new "vitamine hypothesis," proffered by Casimir Funk in early 1912 and articulated later that year by two members of the American Clinical and Climatological Association, Fleming Mant Sandwith and Rupert Blue. Those who resisted Goldberger's inconvenient truth that the root cause was southern poverty drew their arguments largely from the Thompson-McFadden Pellagra Commission, which traces back to Sambon's unfortunate influence on American researchers. Thousands died as a result.

[Consumption and Control: How Vitamin C could become a Cure-All]. / Konsum und Kontrolle: Wie Vitamin C zu einem Allheilmittel werden konnte.

Artificial vitamin C has become a bulk product. To explain how ascorbic acid could enter everyday life, one less has to look at medical necessities than at the dynamic interplay of production, promotion, and health care policy. Hence, this contribution focuses on the complex interactions of health concepts, diagnostic instruments and the physician's gaze necessary to endow ascorbic acid with a medical indication. On the one hand, this reveals the differences between a "purely scientific" and a "medical-biological" point of view. On the other hand, as man last but not least is what he eats, this points to the fact that nutrition and parts of it always are soaked with health policy and moral.

Multi-ingredient, caffeine-containing dietary supplements: history, safety, and efficacy.

PURPOSE: Our objective was to review the history, safety, and efficacy of caffeine-containing dietary supplements in the United States and Canada. METHODS: PubMed and Web of Science databases (1980-2014) were searched for articles related to the pharmacology, toxicology, and efficacy of caffeine-containing dietary supplements with an emphasis on Ephedra-containing supplements, Ephedra-free supplements, and energy drinks or shots. FINDINGS: Among the first and most successful dietary supplements to be marketed in the United States were those containing Ephedra­combinations of ephedrine alkaloids, caffeine, and other phytochemicals. A decade after their inception, serious tolerability concerns prompted removal of Ephedra supplements from the US and Canadian markets. Ephedra-free products, however, quickly filled this void. Ephedra-free supplements typically contain multiple caffeine sources in conjunction with other botanical extracts whose purposes can often be puzzling and their pharmacologic properties difficult to predict. Ingestion of these products in the form of tablets, capsules, or other solid dosage forms as weight loss aids, exercise performance enhancers, or energy boosters have once again brought their tolerability and efficacy into question. In addition to Ephedra-free solid dosage forms, caffeine-containing energy drinks have gained a foothold in the world market along with concerns about their tolerability. IMPLICATIONS: This review addresses some of the pharmacologic and pharmaceutical issues that distinguish caffeine-containing dietary supplement formulations from traditional caffeine-containing beverages. Such distinctions may account for the increasing tolerability concerns affiliated with these products.

Pulque production from fermented agave sap as a dietary supplement in Prehispanic Mesoamerica.

Although in modern societies fermented beverages are associated with socializing, celebration, and ritual, in ancient times they were also importa`nt sources of essential nutrients and potable water. In Mesoamerica, pulque, an alcoholic beverage produced from the fermented sap of several species of maguey plants (Agavaceae; Fig. 1) is hypothesized to have been used as a dietary supplement and risk-buffering food in ancient Teotihuacan (150 B.C. to A.D. 650). Although direct archaeological evidence of pulque production is lacking, organic residue analysis of pottery vessels offers a new avenue of investigation. However, the chemical components of alcoholic beverages are water-soluble, greatly limiting their survival over archaeological timescales compared with hydrophobic lipids widely preserved in food residues. Hence, we apply a novel lipid biomarker approach that considers detection of bacteriohopanoids derived from the ethanol-producing bacterium Zymomonas mobilis for identifying pulque production/consumption in pottery vessels. Gas chromatography-mass spectrometry selected ion monitoring (m/z 191) of lipid extracts of >300 potsherds revealed characteristic bacteriohopanoid distributions in a subset of 14 potsherds. This hopanoid biomarker approach offers a new means of identifying commonly occurring bacterially fermented alcoholic beverages worldwide, including palm wine, beer, cider, perry, and other plant sap- or fruit-derived beverages [Swings J, De Ley J (1977) Bacteriol Rev 41(1):1-46].

Making birth defects 'preventable': pre-conceptional vitamin supplements and the politics of risk reduction.

Since the mid-1990s, governments and health organizations around the world have adopted policies designed to increase women's intake of the B-vitamin 'folic acid' before and during the first weeks of pregnancy. Building on initial clinical research in the United Kingdom, folic acid supplementation has been shown to lower the incidence of neural tube defects (NTDs). Recent debate has focused principally on the need for mandatory fortification of grain products with this vitamin. This article takes a longer view, tracing the transformation of folic acid from a routine prenatal supplement to reduce the risk of anaemia to a routine 'pre-conceptional' supplement to 'prevent' birth defects. Understood in the 1950s in relation to social problems of poverty and malnutrition, NTDs were by the end of the century more likely to be attributed to individual failings. This transition was closely associated with a second. Folic acid supplements were initially prescribed to 'high-risk' women who had previously borne a child with a NTD. By the mid-1990s, they were recommended for all women of childbearing age. The acceptance of folic acid as a 'risk-reducing drug' both relied upon and helped to advance the development of preventive and clinical practices concerned with women's health before pregnancy.

History of U.S. iodine fortification and supplementation.

Iodine is a micronutrient required for thyroid hormone production. This review highlights the history of the discovery of iodine and its uses, discusses the sources of iodine nutrition, and summarizes the current recommendations for iodine intake with a focus on women of childbearing age.

The return of rainbow diet pills.

The US Food and Drug Administration (FDA) has recently warned consumers about the risks of weight loss supplements adulterated with multiple pharmaceutical agents. Some of these supplements combine potent anorectics, such as amphetamines derivatives, with benzodiazepines, beta-blockers, and other medications to suppress the anorectics' adverse effects. These weight loss supplements represent the most recent generation of rainbow diet pills, named for their bright and varied colors, which date back more than 70 years. Beginning in the 1940s, several US pharmaceutical firms aggressively promoted rainbow pills to physicians and patients. By the 1960s the pills had caused dozens of deaths before the FDA began removing them from the US market. We used a variety of original resources to trace these deadly pills from their origins in the United States to their popularity in Spain and Brazil to their reintroduction to the United States as weight loss dietary supplements.

Global health in conflict. Understanding opposition to vitamin A supplementation in India.

Vitamin A supplementation is a public health intervention that clinical trials have suggested can significantly improve child survival in the developing world. Yet, prominent scientists in India have questioned its scientific validity, opposed its implementation, and accused its advocates of corruption and greed. It is ironic that these opponents were among the pioneers of populationwide vitamin A supplementation for ocular health. Historically, complex interests have shaped vitamin A supplementation resistance in India. Local social and nutritional revolutions and shifting international paradigms of global health have played a role. Other resistance movements in Indian history, such as those in response to campaigns for bacillus Calmette-Guérin and novel vaccines, have been structured around similar themes. Public health resistance is shaped by the cultural and political context in which it develops. Armed with knowledge of the history of a region and patterns of past resistance, public health practitioners can better understand how to negotiate global health conflicts.

[The creation of a new nutritional market in Spain: vitamins in the press (1917-1950)]. / La creación de un nuevo mercado alimentario en España: las vitaminas en la prensa periódica (1917-1950).

AIM: To analyze the extent to which vitamins played a role in the strategy to create a new market of food, food-medicines, and medicines in Spain during the first half of the twentieth century. MATERIALS AND METHODS: A study was made of references to vitamins in the years between 1917 and 1950 in the daily newspapers "ABC", "Heraldo de Madrid", "El Imparcial", "El Liberal" and "El Sol", published in Madrid, "La Vanguardia", published in Barcelona, and the weekly publication "Blanco y Negro". The starting date was selected as the year in which the first news of vitamins appeared. The year 1950 marked the end of the harshest stage of autarky imposed by Franco's regime. The news that appeared was classified in the following categories: scientific news, nutritional advice, advertising, economy, politics, anecdotes and metaphors. RESULTS: The advertisements that used vitamins as part of their marketing strategy are the most important section with over 50% of total references to the vitamin concept in almost all the newspapers. Scientific news on vitamins ranks second in importance. References to vitamins in the remaining categories were below 5%. CONCLUSIONS: Judging by the references which appear in the most important newspapers of the time vitamins represent a fundamental element in the creation of a new food product market in Spain in the first half of the twentieth century.

An essential infusion for an essential organ.

Essential amino acid-based parenteral nutrition (PN) was found to be superior to hypertonic dextrose for patients with acute renal failure in a classical randomized trial that was published in 1973. However, subsequent trials were not able to duplicate this finding when this formulation was compared to hypertonic dextrose or to standard amino acid-based PN. As a result, this intervention has not been recommended in various guidelines for the nutrition support of patients with renal failure. However, all of these trials were relatively small, and none of them compared the intervention to a true control group-namely, patients who were not receiving any artificial nutrition. Because no trials have compared any form of artificial nutrition to no nutrition support in patients with acute renal failure, there really is no basis on which to make any level 1 evidence-based recommendation. Furthermore, a close look at all of the trials suggests that the essential amino acid-based formulation may be superior to the other types of intravenous nutrient supplementation to which it was compared. To determine whether this should be offered to patients with acute renal failure, we need data from one or more large, well-designed and executed, low risk of bias randomized trial(s) comparing essential amino acid-based PN to no nutrition therapy.

The history of Ephedra (ma-huang).

Ephedra is a Chinese shrub which has been used in China for medicinal purposes for several thousand years. The pure alkaloid ephedrine was first isolated and characterised by Nagai in 1885. It was then forgotten until it was rediscovered by Chen and Schmidt in the early 1920s. Its actions on the adrenoceptors could be classified into separate alpha and beta effects--a defining moment in the history of autonomic pharmacology. Ephedrine became a highly popular and effective treatment for asthma, particularly because, unlike adrenaline (until then the standard therapy), it can be given by mouth. Ephedrine as a treatment for asthma reached its zenith in the late 1950s, since when there has been a gradual and inevitable decline in its therapeutic use. From mainstream medicine, ephedrine moved into the twilight zone of street drugs and nutritional supplements. Ephedra and ephedrine products are now banned in many countries, as they are a major source for the production of the addictive compound methamphetamine (crystal meth).