Efficacy of rifaximin in the different clinical scenarios of hepatic encephalopathy. / Eficacia de la rifaximina en los diferentes escenarios clínicos de la encefalopatía hepática.

Hepatic encephalopathy is a frequent complication in patients with cirrhosis of the liver and is associated with a high mortality rate. Costs attributed to the management of patients with cirrhosis are especially high due to complications, such as hepatic encephalopathy, given that they increase the number of days of hospital stay. Different drugs are currently used to treat hepatic encephalopathy, and the main ones are lactulose, L-ornithine L-aspartate (LOLA), and certain antibiotics, especially rifaximin-α (RFX). Even though many of them have been shown to be effective to greater or lesser degrees, it is important to understand the differences between them, so that every patient receives individualized treatment and the best option is chosen, in accordance with the different clinical scenarios. Thus, the aim of the present study was to analyze the evidence on the advantages and disadvantages of the individual or combined use of the 3 main treatments for hepatic encephalopathy, specifically taking into consideration their different degrees of efficacy, their impact on quality of life, prophylaxis, and cost reduction.

Bowel symptoms in patients that receive proton pump inhibitors. Results of a multicenter survey in Mexico. / Síntomas intestinales en pacientes que reciben inhibidores de bomba de protones (IBP). Resultados de una encuesta multicéntrica en México.

INTRODUCTION: Proton pump inhibitors (PPIs) have been associated with small intestinal bacterial overgrowth (SIBO), which increases with prolonged PPI use, and SIBO has been associated with irritable bowel syndrome (IBS). OBJECTIVE: The aim of the present study was to study the prevalence of bowel symptoms in patients treated with PPIs in Mexico. METHODS: Gastroenterologists in 36 cities surveyed patients treated with PPIs, utilizing an ad hoc questionnaire to determine the presence of bowel symptoms and IBS. RESULTS: Two hundred and fifteen physicians interviewed 1,851 patients. PPI indications were gastritis (48.8%), gastroesophageal reflux (38.5%), peptic ulcer (6.2%), and others (6.5%). A total of 77.5% of the patients received treatment for ≤6 months and 11.9% for ≥1 year. Symptoms were reported in 92.3% of the patients: abnormal bowel habits (90%), bloating (82%), abdominal pain (63%), flatulence (58%), and abdominal discomfort (53%). A total of 67.5% of the patients fit the Rome III criteria for IBS. Symptoms presented in 55.9% of the patients before PPI intake and in 44.1% of the patients after PPI use (P<.005). Constipation (63.8%) predominated in the former, and diarrhea (56.5%) in the latter (P<.0001). The treatments prescribed for managing those symptoms were antispasmodics, antibiotics, prokinetics, and antiflatulents, but patients stated greater satisfaction with antibiotics (mainly rifaximin) (P<.0001). CONCLUSION: The association of PPIs with bowel symptoms and IBS is frequent in Mexico. Diarrhea and bloating predominate, and antibiotics produce the greatest treatment satisfaction, suggesting that SIBO or dysbiosis is the cause of the PPI-related bowel symptoms. However, that remains to be confirmed.

Susceptibility to rifaximin and other antimicrobials of bacteria isolated in patients with acute gastrointestinal infections in Southeast Mexico. / Susceptibilidad a la rifaximina y otros antimicrobianos de bacterias aisladas en pacientes con infecciones gastrointestinales agudas en el sureste de México.

INTRODUCTION: Enteropathogenic bacteria isolated in Mexico City have shown a high rate of resistance to different antibiotics, with the exception of rifaximin (RIF). RIF is a nonabsorbable antibiotic that reaches high fecal concentrations (≈ 8,000µg/g). Susceptibility to antimicrobials can vary in different geographic regions. AIM: To study the susceptibility to rifaximin and other antimicrobials of enteropathogenic bacteria isolated in patients with acute diarrhea in the southeastern region of Mexico. MATERIAL AND METHODS: A total of 614 strains of bacteria isolated from patients with acute diarrhea from 4 cities in Southeast Mexico were analyzed. An antibiogram with the following antibiotics was created: ampicillin (AMP), trimethoprim/sulfamethoxazole (T-S), neomycin (NEO), furazolidone (FUR), ciprofloxacin (CIP), chloramphenicol (CHL), and fosfomycin (FOS), assessed through the agar diffusion method at the standard concentrations recommended by the Clinical and Laboratory Standards Institute (CLSI) and the American Society for Microbiology (ASM), and RIF, assessed through microdilution at 4 concentrations. RESULTS: The bacteria were Escherichia coli (55%), as the majority, in all its pathogenic variants, Shigella (16.8%), Salmonella (15.3%), Aeromonas (7.8%), and less than 5% Campylobacter, Yersinia, Vibrio, and Plesiomonas. The accumulated overall susceptibility to RIF was 69.1, 90.8, 98.9, and 100% at concentrations of 100, 200, 400, and 800µg/ml, respectively. Overall susceptibility to other antibiotics was FOS 82.8%, CHL 76.8%, CIP 73.9%, FUR 64%, T-S 58.7%, NEO 55.8%, and AMP 23.8%. Susceptibility to RIF at 400 and 800µg was significantly greater than with the other antimicrobials (P<.001). CONCLUSIONS: The data of the present study were similar to those of a previous study carried out in Mexico City: susceptibility to RIF in > 98% of the bacterial strains and a high frequency of resistance to several common antimicrobials.

Susceptibility of bacteria isolated from acute gastrointestinal infections to rifaximin and other antimicrobial agents in Mexico.

BACKGROUND: Bacterial resistance may hamper the antimicrobial management of acute gastroenteritis. Bacterial susceptibility to rifaximin, an antibiotic that achieves high fecal concentrations (up to 8,000µg/g), has not been evaluated in Mexico. OBJECTIVE: To determine the susceptibility to rifaximin and other antimicrobial agents of enteropathogenic bacteria isolated from patients with acute gastroenteritis in Mexico. MATERIAL AND METHODS: Bacterial strains were analyzed in stool samples from 1,000 patients with diagnosis of acute gastroenteritis. The susceptibility to rifaximin (RIF) was tested by microdilution (<100, <200, <400 and <800µg/ml) and susceptibility to chloramphenicol (CHL), trimethoprim-sulfamethoxazole (T-S), neomycin (NEO), furazolidone (FUR), fosfomycin (FOS), ampicillin (AMP) and ciprofloxacin (CIP) was tested by agar diffusion at the concentrations recommended by the Clinical & Laboratory Standards Institute and the American Society for Microbiology. RESULTS: Isolated bacteria were: enteropathogenic Escherichia coli (E. coli) (EPEC) 531, Shigella 120, non-Typhi Salmonella 117, Aeromonas spp. 80, enterotoxigenic E. coli (ETEC) 54, Yersinia enterocolitica 20, Campylobacter jejuni 20, Vibrio spp. 20, Plesiomonas shigelloides 20, and enterohemorrhagic E. coli (EHEC 0:157) 18. The overall cumulative susceptibility to RIF at <100, <200, <400, and <800µg/ml was 70.6, 90.8, 99.3, and 100%, respectively. The overall susceptibility to each antibiotic was: AMP 32.2%, T-S 53.6%, NEO 54.1%, FUR 64.7%, CIP 67.3%, CLO 73%, and FOS 81.3%. The susceptibility to RIF <400 and RIF <800µg/ml was significantly greater than with the other antibiotics (p<0.001). CONCLUSIONS: Resistance of enteropathogenic bacteria to various antibiotics used in gastrointestinal infections is high. Rifaximin was active against 99-100% of these enteropathogens at reachable concentrations in the intestine with the recommended dose.

Hemodynamic and oxidative stress profile after exercise in type 2 diabetes.

This study investigated the effect of an acute bout of exercise (>85% VO2Max) on biochemical, hemodynamic and oxidative stress variables in sedentary and physically active subjects with type 2 diabetes (T2D). Blood measurements were taken before and after a treadmill test on 12 sedentary non-diabetes subjects (ND), 12 sedentary type 2 diabetes (T2S) and 9 physically active T2D subjects (T2DA). T2DS subjects before and after the treadmill test showed a higher plasma glucose (123.2 +/- 19.0 mg/dL versus 108.9 +/- 16.8 mg/dL, p < 0.001), HbA1C (8.7 +/- 2.4% versus 7.3 +/- 1.2%, p < 0.001) and body fat% (21.3 +/- 5.7% versus 34.6 +/- 4.5%, p < 0.001) than T2DA subjects. T2DA had higher VO2Max (37.7 +/- 3.5 versus 29.5 +/- 3.2, p < 0.05), time on treadmill (22.3 +/- 2.1 min versus 16.1 +/- 2.1 min, p < 0.05), hemoglobin (17.9 +/- 0.9 g/dL, p < 0.05) and lower blood pressure levels in comparison to ND and T2DS subjects. Thiobarbituric acid substances (TBARS) in T2DS were higher than in T2DA subjects (0.27 +/- 0.1 nmol/mL versus 0.21 +/- 0.1 nmol/mL, p < 0.05). Glutathione (GSH) levels were similar among the groups. Physically active type 2 diabetes subjects had a more favorable biochemical, hemodynamic and oxidative stress profile than sedentary subjects. The coexistence of a poor cardiopulmonary performance and high oxidative stress environment can determine a profile of high risk for serious cardiovascular events in patients with diabetes.

[Oxidative stress. Should it be measured in the diabetic patient?]. / El estrés oxidativo. Es necesario medirlo en el paciente diabético?

Oxidative stress has been defined as a loss of counterbalance between free radical or reactive oxygen species production and the antioxidant systems, with negative effects on carbohydrates, lipids, and proteins. It is also involved in the progression of different chronic diseases and apoptosis. Diabetes mellitus is associated to a high oxidative stress level through different biochemical pathways, i.e. protein glycosylation, glucose auto-oxidation, and the polyol pathway, mainly induced by hyperglycemia. Oxidative stress could also be involved in the pathogenesis of atherosclerotic lesions and other chronic diabetic complications. Measurement of oxidative stress could be useful to investigate its role in the initiation and development processes of chronic diabetic complications and also to evaluate preventive actions, including antioxidative therapy. Different attempts have been made to obtain a practical, accurate, specific, and sensitive method to evaluate oxidative stress in clinical practice. However, this ideal method is not currently available to date and the usefulness of the current methods needs to be confirmed in daily practice. We suggest quantifying oxidated and reduced glutation (GSSG/GSH) and the thiobarbituric reactive substances (TBARS) with currently alternatives. Currently available alternative methods while we await better options.

Risk factors for steroid diabetes in rheumatic patients.

BACKGROUND: Steroid induced diabetes (SDM) has been known for a long time, but its pathophysiological mechanisms as well as its predisposing factors remain unknown. METHODS: In order to investigate the different factors related to the development of steroid diabetes (SDM) in patients with rheumatic diseases, we studied 27 patients with SDM, and 27 age- and sex-matched controls who also received therapy with glucocorticoids. In every case, family history of DM, body mass index, associated treatment, steroid dose and treatment duration were studied; fasting serum insulin, "C" peptide, growth hormone and glucagon levels were measured. RESULTS: All of the patients received prednisone. Cumulated prednisone dose was the only factor significantly associated with the development of SDM. Patients with SDM had a cumulated dose of 26.6 +/- 28 g (M +/- SD), while the control group received 11.6 +/- 11 g (p < 0.02) (odds ratio, 6.35). Serum insulin levels were not significantly different, but insulin/glucose ratio was lower in SDM (0.104 +/- 0.05) than in the control group (0.163 +/- 0.07) (p < 0.05). CONCLUSIONS: These findings suggest that high cumulated prednisone dose may induce DM regardless of another hereditary or personal predisposing factor.

[Treatment of diabetic neuropathy]. / Tratamiento de la neuropatía diabética.

Diabetic polyneuropathy is a complication, that affects most patients with longstanding diabetes mellitus, deteriorating their quality of life. In the last few years, new therapeutic approaches have been developed that can improve symptoms and neurologic function, and which may prevent and in some cases stop nerve damage, and even, promote nerve fiber regeneration. These treatments are supported by several investigations in animals and humans: a) thigh glycemic control (insulin), b) aldose reductase inhibition (tolrestat), c) prevention of protein glycation (amino-guanidine), d) improvement of nerve ischemia (vaso-dilators, gamma-linolenic acid), and e) administration of neurotrophic factors (gangliosides). Most evidence support the usefulness for glycemic control. Early treatment is suggested, because marked nerve fiber loss is present in advanced neuropathy.

Lowering glycemic index of food by acarbose and Plantago psyllium mucilage.

BACKGROUND: A study was designed to evaluate the effect of acarbose and Plantago psyllium mucilage on glycemic index (GI) of bread. METHODS: Twelve patients with non-insulin-dependent diabetes mellitus (NIDDM) and ten healthy volunteers were studied. Three meal tests with an intake of 90 g of white bread (50 g of carbohydrates) were performed on each subject. In one test, 200 mg of acarbose was given, while 15 g of P. psyllium mucilage was given in another test, and only bread was ingested in the control test. Serum glucose and insulin concentrations were measured every 30 min from 0-180 min. Net area under curve (AUC) concentrations of glucose and insulin, GI and insulinic index were calculated. RESULTS: In NIDDM patients, AUC-glucose in the test with acarbose (1.9 +/- 0.7 mmol/L) and with P. psyllium (4.3 +/- 1.2 mmol/L) were significantly lower than in the control test (7.4 +/- 1.5 mmol/L) (p < 0.01). GI of bread plus acarbose was 26 +/- 13, and of bread plus P. psyllium, 59 +/- 10 (p < 0.05). AUC-insulin and insulinic index behave similarly. In healthy individuals, AUC-glucose and GI did not significantly change with the treatments; however, insulinic index with acarbose was 17 +/- 16, and with P. psyllium was 68 +/- 15 (p < 0.05). Acarbose or P. psyllium decreased GI of bread in NIDDM patients and diminished insulinic index in NIDDM and in healthy subjects. CONCLUSIONS: Adding acarbose or P. psyllium to meals may reduce glycemic index of carbohydrate foods and may help diabetic control.

[Influence of the velocity of meal ingestion on postprandial glycemia]. / Influencia de la velocidad de la ingestión de la comida en la glucemia postprandial.

To assess the influence of the velocity of meal ingestion on postprandial glycemia, 10 healthy volunteers and 10 patients with non-insulin-dependent diabetes mellitus (NIDDM) were studied. All the subjects had two identical meals (1980 J, carbohydrate 37%, proteins 23%, lipids 40%) on different days. One meal was ingested in 10 minutes (fast ingestion) while the other was ingested in 20 minutes (slow ingestion). Glucose serum levels were measured immediately before the meal and throughout the following 180 minutes. In NIDDM patients, serum glucose levels from 30 to 90 minutes were significantly (p < 0.05) higher after fast ingestion than after the slow intake. Area under the glucose curve (AUC) and maximal peak of serum glucose concentrations (MP) showed also higher values with fast intake: AUC was of 13 +/- 2.4 and 11.3 +/- 2.9 mmol/ L/h (X +/- SD) (p < 0.05), MP 15.8 +/- 4.3 and 12.9 +/- 2.6 mmol/L (p < 0.05) with fast and slow ingestion respectively. No differences in serum glucose levels between test were noticed in healthy subjects. Slow meal ingestion might be a dietary recommendation in patients with NIDDM.

Monounsaturated fatty acid (avocado) rich diet for mild hypercholesterolemia.

To assess the effect of a high monounsaturated fatty acids (MFA) diet on serum lipids, 30 healthy adult normolipidemic volunteers and 37 adult patients with mild hypercholesterolemia (5.4-9.3 mmol/l), 15 of them also with hypertriglyceridemia (2.3-4.8 mmol/l), were studied. Fifteen healthy and 30 hypercholesterolemic subjects (15 of them with associated type 2 diabetes mellitus) received an avocado enriched diet (2000 Kcal, lipids 53% MFA 49 g saturated/unsaturated ratio 0.54), and seven non-diabetic hypercholesterolemic individuals received an isocaloric control diet (MFA 34 g, saturated/unsaturated ratio 0.7). Serum total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride concentrations were measured before and after a 7-day diet period. In healthy individuals a 16% decrease of serum total cholesterol level followed the high MFA diet, while it rose after the control diet (p < 0.001 between diets). In hypercholesterolemic subjects a significant (p < 0.01) decrease of serum total cholesterol (17%), LDL-cholesterol (22%) and triglycerides (22%), and increase of HDL-cholesterol (11%) levels occurred with the avocado diet, while no significant changes were noticed with the control diet. High lipid, high MFA-avocado enriched diet can improve lipid profile in healthy and especially in mild hypercholesterolemic patients, even if hypertriglyceridemia (combined hyperlipidemia) is present.

[Primary hypokalemic periodic paralysis. Presentation of 18 cases]. / Parálisis periódica hipokalémica primaria. Presentación de 18 casos.

The clinical features of 16 males and 2 females with hypokalemic periodic paralysis (HPP) are presented. Five patients had familial HPP, 4 thyrotoxic HPP and 9 sporadic disease. The age of onset ranged from 6 to 42 years. Clinical pictures varied from paraparesis to severe quadriplegia. The disease onset was earlier in familial HPP (p < 0.05) while sporadic cases showed the most severe, albeit shorter paralysis (p < 0.05). On admission, serum potassium levels ranged from 1.5 to 3.3 mEq/L; they did not correlate with the severity of paralysis. Glucose-insulin provocation test was positive in 5/5 patients. Oral potassium chloride and amiloride were useful to prevent paralysis. Contrasting with reports from USA and Europe, in México, HPP is not exceptional, and should be considered in the differential diagnosis of acute paralysis.

[Increase in neuroendocrine secretion granules in submaxillary and parotid glands in patients with non-insulin dependent diabetes mellitus]. / Aumento de los gránulos de secreción neuroendócrina en glándulas submaxilares y parótidas en pacientes con diabetes mellitus no dependiente de insulina.

The amount of neuroendocrine granules in microgranular cells of salivary glands were investigated in necropsies of 20 non-insulin dependent diabetics (NIDDM) and in 20 non-diabetic subjects with Grimelius and Fontana-Masson stainings. Granules in serous acini, and intercalated ducts were observed in both groups; however, a significant higher number of granules and microgranular cells were observed in NIDDM subjects as compared with non-diabetics. Both parotid and submaxillary glands were significantly heavier in NIDDM than in the non-diabetic group. These granules may be related to immunoreactive glucagon which has been found in submaxillary glands of rodents and might play a role in the pathogenesis of NIDDM. Further investigations should be performed to clarify whether these cells are the site of glucagon synthesis and also clarify the pathogenesis of NIDDM.

[Evaluation of nopal capsules in diabetes mellitus]. / Evaluación de cápsulas de nopal en diabetes mellitus.

To find out if commercial capsules with dried nopal (prickle-pear cactus, Opuntia ficus indica may have a role in the management of diabetes mellitus, three experiments were performed: 30 capsules where given in fasting condition to 10 diabetic subjects and serum glucose was measured through out 3 hours; a control test was performed with 30 placebo capsules. OGTT with previous intake of 30 nopal or placebo capsules was performed in ten healthy individuals. In a crossover and single blinded study 14 diabetic patients withdrew the oral hypoglycemic treatment and received 10 nopal or placebo capsules t.i.d. during one week; serum glucose, cholesterol and tryglycerides levels were measured before and after each one-week period. Five healthy subjects were also studied in the same fashion. Opuntia capsules did not show acute hypoglycemic effect and did not influence OGTT. In diabetic patients serum glucose, cholesterol and tryglycerides levels did not change with Opuntia, but they increased with placebo (P < 0.01 glucose and cholesterol, P = NS triglycerides). In healthy individuals glycemia did not change with nopal, while cholesterol and triglycerides decreased (P < 0.01 vs. placebo). The intake of 30 Opuntia capsules daily in patients with diabetes mellitus had a discrete beneficial effect on glucose and cholesterol. However this dose is unpractical and at present it is not recommended in the management of diabetes mellitus.

The (Ca2+, Mg2+)-ATPase activity in erythrocyte membranes from essential hypertensive patients.

The erythrocyte (Ca2+,Mg2+)-ATPase activity from 12 hypertensive and 14 normotensive subjects have been compared. No differences were found in the calcium-ATPase activity from both studied groups. When the calcium-ATPase assay was carried out in the presence of EGTA, we observed a partial stimulatory effect of the activity, but a blunted stimulation by calmodulin in both membrane preparations. When the EGTA was removed and a total concentration of calcium (100 uM) was kept constant in the incubation media, calmodulin stimulated the ATPase four fold over the non stimulated conditions in both studied groups. It is concluded that the use of EGTA buffers in the assay of the calcium-ATPase in the erythrocyte membrane of normotensive and hypertensive patients, must be used with caution, since a different enzyme sensitive to EGTA in the normotensive and the hypertensive membranes could give an erroneous interpretation of the results. This condition could partially explain the controversies in recent reports investigating the (Ca2+,Mg2+)-ATPase activity and calcium transport in different cell systems isolated from hypertensive patients.

Delayed insulin absorption due to subcutaneous edema.

A prospective study to determine if subcutaneous edema interferes with insulin absorption was performed. Forty-six patients entered the study. Three groups were formed. Twenty patients with generalized edema (Group 1), ten of them with non-insulin dependent diabetes mellitus (NIDDM). Twenty patients without edema (Group II). 10 of them with NIDDM; and six patients with mild edema (Group III). The disappearance of I125-insulin was measured throughout 360 minutes. The rate of absorption in group I was significantly lower and delayed than in group II. The amount of insulin absorbed at 360 minutes was 3 to 4 fold lower in group I than in group II (p 0.001). Group III had intermediate values. The peak of plasma I125-insulin level was 3 to 4 fold lower in group I than group II. The impairment of insulin absorption in subjects with edema was more evident in those with NIDDM. In conclusion, this study demonstrates that subcutaneous edema impairs insulin absorption. Insulin absorption from subcutaneous tissue varies due to several conditions, resulting in a difficult glycemic control. Previous studies have shown that insulin absorption is affected by several factors as the site of injection, room and skin temperature, physical exercise, the thickness of adipose tissue, local massage, and local degradation of insulin. Edema due to chronic complications such as nephropathy and cardiopathy often occurs in long-standing diabetic subjects. However, the effects of edema of the skin and subcutaneous tissue on insulin absorption has not been previously examined. The aim of this study was to assess if edema affects the absorption of insulin.

[The glycemic index of some foods common in Mexico]. / Indice glucémico de algunos alimentos comunes en México.

To investigate the increase of glycemia due to the ingestion of usual food in Mexico, portions with 50 g of carbohydrate form white corn tortilla, yellow corn tortilla, spaghetti, rice, potatoes, beans brown and black, nopal (prickle pear cactus) and peanuts, compared with white bread, were given to 21 healthy and 27 non-insulin-dependent diabetic subjects. Serum glucose and insulin were measured every 30 min for 180 min long. Glycemic index was obtained as: (area under curve of glucose with test food/area under curve of glucose with white bread) X 100. A corrected index was calculated subtracting the area corresponding to initial values. Insulin index was obtained similarly. Each sample was studied 14-18 times. Glycemic and insulin indexes of white and yellow corn tortilla, spaghetti, rice and potatoes were not different from bread (P greater than 0.05). Corrected glycemic indexes of brown beans (54 +/- 15, +/- SE) and black beans (43 +/- 17) were low (p less than 0.05), as well as corrected insulin indexes (69 +/- 11 and 64 +/- 10 respectively, (P less than 0.02). Peanuts had low glycemic (33 +/- 17, P less than 0.01), but normal insulin index. Nopal had very low glycemic and insulin indexes (10 +/- 17 and 10 +/- 16, P less than 0.0001). These data might be useful in prescribing diets for diabetic subjects.

[Activity of Opuntia streptacantha in healthy individuals with induced hyperglycemia]. / Acción de Opuntia streptacantha en individuos sanos con hiperglucemia inducida.

Hypoglycemia effect Opuntia streptacantha which occur in diabetic has not been found in healthy subjects. To find out if this effect appears also in healthy individuals if they are hyperglycemic, two tests were performed to 7 healthy volunteers. In both tests 500 ml of 20% dextrose were infused in two hours, 500 g of O. streptacantha were given orally before one test, and 400 ml of water as control were given before the other one. Serum glucose was measured every 30 minutes during three hours. Glucose rising was significantly (P less than 0.025) lower with Opuntia than in control test at 90 and 120 minutes (143 +/- 58 vs 193 +/- 9 and 135 +/- 25 vs 163 +/- 13 mg/dl respectively). Area under curve of glucose was also smaller in Opuntia than in control test (P less than 0.05). Hypoglycemic effect of O. streptacantha also occur in healthy subjects in hyperglycemia is present.

[Duration of the hypoglycemic action of Opuntia streptacantha Lem]. / Duración de la acción hipoglucemiante de Opuntia streptacantha Lem.

To assess the duration of Opuntia streptacantha Lem. hypoglycemic effect, two tests in fasting conditions, one with the intake of 500 g of broiled Opuntia stems and the other one with 400 ml of water as control, were performed in eight type II diabetics. Serum glucose levels were measured hourly during six hours. In the Opuntia test the decrease of serum glucose levels was more pronounced at the fourth hour (P less than 0.01 vs control test), serum glucose levels remained unchanged the following two hours. No significant changes on glycemia occurred in the control test. Difference between both tests was significant from the second to the sixth hour.

[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.