Ethnoveterinary Medicine and Ethnopharmacology in the Main Transhumance Areas of Castilla-La Mancha (Spain).

In this study, we document the practices of ethnoveterinary medicine and ethnopharmacology in the context of traditional transhumance routes that cross Castilla La Mancha from north to south. Transhumance is a type of grazing system that allows advantage to be taken of winter pastures (wintering places) and summer pastures by seasonal movement, twice a year, of cattle and their shepherds. Our study is based on over 200 interviews (from 1994 to 2021) conducted in 86 localities along eight major transhumance routes "cañadas reales" and 25 other minor transhumance routes, and involved 210 informants, 89 single and 121 groups, and 562 individuals, of which the majority were men. Sixty-three recorded pathologies and their treatments are discussed. Two hundred and two species and substances, belonging to 92 different families, have been recorded from the interviews, of which most are plants. Amid the toxic plant species, the most cited in the interviews are Erophaca baetica (L.) Boiss., Lupinus angustifolius L., and Oenanthe crocata L. Some of the species reported as toxic were reservoirs of pathogens or markers for dangerous areas. One of the fields most widely covered in our study is that of prevention, protection, and control of endo- and ectoparasites. This control is carried out mainly by means of aromatic plants. As a polyvalent species, Daphne gnidium L. is outstanding, and it contributes one-tenth of the records of our study. Among the species of fundamentally therapeutic use, Cistus ladanifer L. stands out by far. Principal Coordinate Analysis (PCoA) based on the repertories of ingredients, separates the routes whose most important sections run through siliceous terrain with its characteristic flora, especially in the provinces of Ciudad Real and Toledo, from the routes that run through the limestone terrain of Albacete and Cuenca, and link the Eastern Mancha and the "Serranía de Cuenca" with Andalusia and the Spanish Levant.

[An unusual association of malakoplakia and adenocarcinoma of the prostate]. / Asociación inusual de malacoplaquia y adenocarcinoma prostático.

Malakoplakia is a chronic inflammatory process caused by a lysosomal defect in bacterial digestion. Although rare, it occurs more frequently in the genitourinary tract and in patients with immune dysfunction. The bladder is the most commonly affected site, although cases have been reported in other organs, including the prostate gland. Clinically, this lesion can be confused with malignant tumours, both on physical examination and imagining techniques. This is particularly pronounced in the prostate, making the differential diagnosis challenging. Histologically, characteristic aggregates of histiocytes with basophilic intracytoplasmic inclusions composed of calcium and iron salts are found. We present a case diagnosed on transrectal biopsy as acinar adenocarcinoma with a Gleason 5 + 5 = 10 score. Prostatectomy revealed an unusual association of diffuse prostate malakoplakia and an area of acinar adenocarcinoma with a Gleason score of 3 + 4 = 7.

Asociación inusual de malacoplaquia y adenocarcinoma prostático / An unusual association of malakoplakia and adenocarcinoma of the prostate

La malacoplaquia es un proceso inflamatorio crónico causado por un defecto lisosomal en la digestión bacteriana. El trastorno, aunque raro, aparece con mayor frecuencia en pacientes con disfunción inmunitaria y en aparato genitourinario. La vejiga es el sitio más comúnmente afectado, aunque se han informado casos con involucro de otros órganos, incluyendo la glándula prostática. Desde una perspectiva clínica, la lesión puede simular tumores malignos durante la exploración física y en estudios de imagen, en particular en próstata, por lo que el diagnóstico diferencial suele ser desafiante. Su expresión morfológica se caracteriza histológicamente por agregados histiocíticos con inclusiones basófilas intracitoplasmáticas, compuestas por sales de calcio y hierro. Se presenta un caso que fue diagnosticado en biopsia transrectal como adenocarcinoma acinar con suma de Gleason 5 + 5 = 10. En la prostatectomía se evidenció la asociación excepcional de malacoplaquia prostática difusa y un foco de adenocarcinoma acinar Gleason 3 + 4 = 7.(AU)

Malakoplakia is a chronic inflammatory process caused by a lysosomal defect in bacterial digestion. Although rare, it occurs more frequently in the genitourinary tract and in patients with immune dysfunction. The bladder is the most commonly affected site, although cases have been reported in other organs, including the prostate gland. Clinically, this lesion can be confused with malignant tumours, both on physical examination and imagining techniques. This is particularly pronounced in the prostate, making the differential diagnosis challenging. Histologically, characteristic aggregates of histiocytes with basophilic intracytoplasmic inclusions composed of calcium and iron salts are found. We present a case diagnosed on transrectal biopsy as acinar adenocarcinoma with a Gleason 5 + 5 = 10 score. Prostatectomy revealed an unusual association of diffuse prostate malakoplakia and an area of acinar adenocarcinoma with a Gleason score of 3 + 4 = 7.(AU)

Cross-continental comparison of safety and protection measures amongst urologists during COVID-19.

OBJECTIVES: To determine the well-being of urologists worldwide during the coronavirus disease 2019 pandemic, and whether they have adequate personal protective equipment knowledge and supplies appropriate to their clinical setting. METHODS: Urologists worldwide completed a Société Internationale d'Urologie online survey from 16 April 2020 until 1 May 2020. Analysis was carried out to evaluate their knowledge about protecting themselves and others in the workplace, including their confidence in their ability to remain safe at work, and any regional differences. RESULTS: There were 3488 respondents from 109 countries. Urologists who stated they were moderately comfortable that their work environment offers good protection against coronavirus disease 2019 showed a total mean satisfaction level of 5.99 (on a "0 = not at all" to "10 = very" scale). A large majority (86.33%) were confident about protecting themselves from coronavirus disease 2019 at work. However, only about one-third reported their institution provided the required personal protective equipment (35.78%), and nearly half indicated their hospital has or had limited personal protective equipment availability (48.08%). Worldwide, a large majority of respondents answered affirmatively for testing the healthcare team (83.09%). Approximately half of the respondents (52.85%) across all regions indicated that all surgical team members face an equal risk of contracting coronavirus disease 2019 (52.85%). Nearly one-third of respondents reported that they had experienced social avoidance (28.97%). CONCLUSIONS: Our results show that urologists lack up-to-date knowledge of preferred protocols for personal protective equipment selection and use, social distancing, and coronavirus disease 2019 testing. These data can provide insights into functional domains from which other specialties could also benefit.

Ethnopharmacology in the Upper Guadiana River area (Castile-La Mancha, Spain).

ETHNOPHARMACOLOGICAL RELEVANCE: Determining traditional remedies for human pathologies is relevant, when compared with the standard materia medica of the pharmacopoeias and dietary supplement databases, because we can assess the species and uses that have been previously studied and target understudied species for further pharmacological investigation. BACKGROUND: The aim of this study was to systematically record and analyze medicinal uses of natural resources (Plantae, Animalia, Fungi and minerals), mostly local, in the territories adjoining the upper Guadiana River and its tributaries. We were particularly interested in recording resources and pathologies linked to wetland areas, especially in the National Parks Las Tablas de Daimiel and Cabañeros. Wetlands are interesting because they present a double face in relation with human health: Wetlands furnish hydration, safe water, nutrition, and medicinal resources; are places from which people derive their livelihood. However wetlands are also sites of exposure to pollution or toxicants, and infectious diseases; and sites of physical hazards. We wanted to identify procedures for preparation of medicinal formulae and routes of administration. We also intended to detect whether a geographical pattern exists or not in our records in relation to the use of local resources. METHODS: We used semi-structured interviews with one-to-one informants or groups, from 1998 to 2018. Raw data were introduced in a Firebird database and analyzed. To identify ingredients and pathologies we consulted local floras and epidemiological literature. Finally, we compared documented pathologies, remedies and ingredients in the historical context of medicinal uses of natural resources in Castile-La Mancha and especially in Ciudad Real. RESULTS: 126 pathologies and 220 species furnishing ingredients have been recorded from the interviews. In total, 188 are plants and 20 animals. The most commonly used species include Malva sylvestris, Phlomis lychnitis, Genista tridentata and Thymus mastichina. Most records refer to flowers, or fruits, of locally available plant species, classified as Mediterranean, European or widespread that belong to the Lamiaceae, Compositae or Leguminosae. Ingredients which are collected in open shrublands, known as "garrigue", and dry grasslands furnish a relevant proportion of records while the imported ingredients remain marginal. The contribution of wetlands, riverine habitats and irrigated fields and gardens as a source of medicinal resources is 36% of the records. It is relatively high considering its limited presence in terms of total extension within the study area. The most frequently reported diseases are respiratory, gastrointestinal, dermatological and infectious or parasitic. CONCLUSIONS: Along the Guadiana River in the Ciudad Real province exists a wide and deep knowledge of traditional remedies for the treatment of common pathologies, based fundamentally on the use of local flora, fauna and mineral resources. The uses and ingredients documented are useful for further pharmacological investigation to improve health care for a wide range of pathologies.

Androgen-targeted therapy in men with prostate cancer: evolving practice and future considerations.

BACKGROUND: Androgen deprivation therapy (ADT) is foundational in the management of advanced prostate cancer (PCa) and has benefitted from a recent explosion in scientific advances. These include approval of new therapies that suppress testosterone (T) levels or inactivate its function, improvements in diagnostic and assay technologies, identification of lower therapeutic targets for T, discovery of the relevance of germline genetic mutations and identification of the benefits of sequential and combination therapies. METHODS: This review discusses the clinical profiles of the most up-to-date options for ADT, best practices for managing patients with advanced PCa and future directions in therapy. RESULTS AND CONCLUSIONS: Modern assay technologies reveal that bilateral orchiectomy results in a serum T level of approximately 15 ng/dL as compared to the historical definition of castration of T < 50 ng/dL. Evidence shows that lowering T levels to <20 ng/dL improves patient survival and delays disease progression. Routine monitoring of T in addition to prostate-specific antigen throughout treatment is important to ensure continuing efficacy of T suppression. New drugs that inhibit androgen signaling in combination with traditional ADT suppress T activity to near zero and have significantly improved patient survival. When personalizing ADT regimens physicians should consider a number of factors including initiation and duration of ADT, monitoring of T levels and PSA, the possibility of switching monotherapies if a patient does not achieve adequate T suppression, and consideration of intermittent vs. continuous ADT according to patients' lifestyles, comorbidities, risk factors and tolerance to treatment.

Is there nothing new under the sun? The influence of herbals and pharmacopoeias on ethnobotanical traditions in Albacete (Spain).

ETHNOPHARMACOLOGICAL RELEVANCE: This paper has two overarching aims: (1) presenting the results of studying the Albacete tariff of medicines of 1526 and (2) broadly analyzing the origin and influences of medicinal traditional knowledge in the region of Albacete, Spain. We use historical and modern literature that may have influenced this knowledge. Our primary goal was to determine the ingredients used in the pharmacy in the 16th century CE in Albacete through the analysis of the tariff, and our secondary goal was to investigate until when ingredients and uses present in pharmacy and herbals persisted in later periods. METHODS: The identity of medicines and ingredients was determined by analyzing contemporary pharmacopoeias and classical pharmaceutical references. We analyzed further 21 sources (manuscripts, herbals, and books of medicines, pharmacopoeias, pharmacy inventories, and modern ethnobotanical records) for the presence/absence of ingredients and complex formulations of the tariff. Using factorial and cluster analysis and Bayesian inference applied to evolution models (reversible-jump Markov chain Monte Carlo), we compared textual sources. Finally, we analyzed the medicinal uses of the top 10 species in terms of frequency of citation to assess the dependence of modern ethnobotanical records on Renaissance pharmacy and herbals, and, ultimately, on Dioscorides. RESULTS: In Albacete 1526, we determined 101 medicines (29 simple drugs and 72 compound medicines) comprising 187 ingredients (85% botanical, 7.5% mineral, and 7.5% zoological substances). All composed medicines appear standardized in the pharmacopoeias, notably in the pharmacopoeia of Florence from 1498. However, most were no longer in use by 1750 in the pharmacy, and were completely absent in popular herbal medicine in Albacete 1995 as well as in Alta Valle del Reno (Italy) in 2014. Among the ingredients present in different formulation are the flowers of Rosa gallica, honey (Apis mellifera), the roots of Nardostachys jatamansi, and Convolvulus scammonia, pistils of Crocus sativus, grapes and raisins (Vitis vinifera), rhizomes of Zingiber officinale, bark of Cinnamomum verum, leaves and fruits of Olea europaea, mastic generally of Pistacia lentiscus, and wood of Santalum album. The statistical analysis of sources produces four well-separated clusters (Renaissance Herbals and Pharmacopoeias, Ethnobotany and Folk Medicine, Old phytotherapy, and Modern phytotherapy including Naturopathy) confirming our a priori classification. The clade of Renaissance Herbals and Pharmacopoeias appears separated from the rest in 97% of bootstrapped trees. Bayesian inference produces a tree determined by an initial set of two well-distinct core groups of ingredients: 64, locally used in Mediterranean Europe during centuries; and 45, imported, used in pharmacy during centuries. Complexity reached its maximum in Albacete 1526 and contemporary pharmacopoeias, gradually decreasing over time. The analysis of medicinal uses of the top 10 ingredients showed low coincidence between Dioscorides and different Renaissance herbals or medical treatises and of all of them with ethnobotany in Albacete. CONCLUSIONS: Regarding our question: is there something new under the sun? In some aspects, the answer is "No". The contrast between expensive drugs, highly valued medicines, and unappreciated local wild medicinal plants persists since the Salerno's school of medicine. Old medicine in Mediterranean Europe, as reflected by Albacete 1526 tariff of medicines, involved strict formulations and preferences for certain ingredients despite other ingredients locally available but underappreciated. This confirms the fact that any system of medicine does not get to use all available resources. Ethnobiological records of materia medica, in rural areas of Albacete, describe systems with a high degree of stability and resilience, where the use of local resources, largely wild but also cultivated, is predominant in contrast with the weight of imported exotic products in pharmacy.

La palmera datilera y la palmera canaria en la medicina tradicional de España / The date palm and canary islands date palm in the traditional herbal medicine of Spain

En la actualidad son muy pocos los usos vigentes. Aunque los dátiles son la materia utilizada con mayor frecuencia, también se han empleado la savia, el polen y el cogollo tierno o palmito. Los dátiles de Phoenix dactylifera se utilizaron como analgésico y para tratar la anemia y trastornos digestivos, o para fortalecer las encías, en el tratamiento de la disfunción eréctil y como afrodisiacos, para facilitar el parto y calmar los dolores postparto, y tratar el prolapso de la matriz o para el exceso de flujo menstrual. También se utilizaron como diuréticos, para la disuria y en trastornos de la vejiga. El uso que más claramente ha persistido es el tratamiento de diversos problemas respiratorios. En uso externo se utilizaron para tratar problemas de la piel, heridas, hemorragias y hemorroides. De la palmera de Canarias (Phoenix canariensis), especialmente en la isla de la Gomera, la savia cruda o guarapo, su concentrado o miel de palma y los resultantes de su fermentación (vino de palma) se consumen como alimento y también se utilizan como diurético, remedio de trastornos génitourinarios, digestivo, para infecciones de la cavidad bucal, expectorante, antitusígeno y para las irritaciones de garganta. En el Toledo de Al-Andalus las espatas de P. dactylifera se utilizaron, hace casi mil años, en el tratamiento de la debilidad, los dolores, nefritis, las enfermedades de la vejiga, trastornos hepáticos (también como preventivo), diarrea, trastornos digestivos, dolores en el abdomen y en el estómago, excesivo sangrado menstrual, úlceras en la piel y sarna, dolores articulares y trastornos cardiacos. La fitoterapia racional debería prestar atención a este recurso, considerar la evidencia científica disponible (farmacológica e incluso clínica) e incorporarlo a nuestro repertorio terapéutico (AU)

O uso medicinal da tamareira e seus produtos foi relativamente comum em Espanha, tendo alcançado o topo da diversidade e importância durante a Idade Média, tanto no Al-Andalus como nos territórios cristãos da fronteira norte, mas foram-se perdendo progressivamente. Estudou-se a evolução histórica dos usos medicinais da tamareira e da tamareira das Ilhas Canárias, tanto na Península Ibérica como nas ilhas Canárias e Baleares .Actualmente, são muito poucos os usos que se mantêm. Relativamente à parte utilizada, as tâmaras são as mais referiadas, mas também existem registos para a seiva, pólen e palmito. As tâmaras de Phoenix dactylifera foram usados como analgésicos, e para o tratamento de anemia e distúrbios digestivos, ou para fortalecer as gengivas, no tratamento da disfunção eréctil e como afrodisíacos, para facilitar o parto e acalmar as dores pós-parto, para tratamento do prolapso uterino ou do fluxo menstrual excessivo. As tâmaras também foram utilizados como diuréticos em disúria e distúrbios da bexiga e são ainda utilizados para o tratamento de vários problemas respiratórios. Externamente foram usados para tratar problemas de pele, feridas, hemorragias e hemorróidas. Da tamareira das Ilhas Canárias (Phoenix canariensis), especialmente na ilha de La Gomera, a seiva (localmente conhecida por guarapo), o seu concentrado (mel de palma), e os produtos resultantes da sua fermentação (vinho de palma) consomem-se como alimentos mas também se utilizam como diuréticos, para tratamento de problemas genito-urinários e digestivos, para infecções orais, como expectorante, antitússico e para tratar irritações da garganta. Há quase mil anos, em Toledo, usavam-se as espatas de P. dactylifera no tratamento de fraqueza, dores, nefrites, doenças da bexiga, doenças do fígado (também em prevenção), diarreia, distúrbios digestivos, dores no abdômen e estômago, fluxo menstrual excessivo, úlceras de pele e sarna, dores articulares e problemas cardíacos.A fitoterapia racional deveria prestar atenção a este recurso, considerar a evidencia científica disponível (farmacológica e mesmo clínica) e incorporá-lo no nosso repertório terapêutico

In Spain the medicinal use of date palm and its products has been relatively common, reaching the highest level of diversity and importance during the Middle Ages, both in Al Andalus and the Christian territories of the northern border. However, uses have become less common since then. Here the historical evolution of medicinal uses of date palm and Canary Island palm in both the Iberian Peninsula and the Canary and Balearic islands are reviewed. At present there are very few reported uses. The dates are the most commonly used product, but the sap, pollen and tender bud of palm (palmito) are also used. The dates of Phoenix dactylifera were used as analgesic, and to treat anaemia and digestive disorders, to strengthen the gums, and in the treatment of erectile dysfunction and as an aphrodisiac, to facilitate childbirth and soothing postpartum pains and treating matrix prolapse or excessive menstrual flow. Dates were also used as diuretics in dysuria and bladder disorders and are still used for the treatment of various respiratory problems. Externally they were used to treat skin problems, wounds, bleeding and haemorrhoids. Canary Palm (Phoenix canariensis) raw juice or sap, or concentrated palm juice, or fermented juice (palm wine) are consumed, especially on the island of La Gomera, as food and are also used as diuretic, as a remedy for genitourinary, digestive, for oral infections, as an expectorant, antitussive and to treat cavity and throat irritations disorders. Almost a thousand years ago in Al-Andalus' Toledo, spathes of P. dactylifera were used, in the treatment of weakness, pain, nephritis, bladder diseases, liver disorders, diarrhea, digestive disorders, pain in the abdomen and stomach, excessive menstrual bleeding, skin ulcers and scabies , joint pain and heart disorders. Modern rational Phytotherapy should pay closer attention to this resource and its potential, considering the available scientific evidence (pharmacological and even clinical) and incorporate it into our modern therapeutic repertoire (AU)

Árnica: a multivariate analysis of the botany and ethnopharmacology of a medicinal plant complex in the Iberian Peninsula and the Balearic Islands.

ETHNOPHARMACOLOGICAL RELEVANCE: Medicinal plant complexes of different species sharing vernacular names, morphological and aromatic characteristics and uses are common in traditional medicine of different cultures. A quantitative methodology as a tool for ethnopharmacological studies is presented for systematically analyzing morphological and therapeutic features shared by several species integrating such complexes. AIM OF THE STUDY: The aim of this paper is to apply a novel methodology to determine whether complexes are homogeneous and species within the complexes are completely interchangeable or not. Moreover, to find out if those species giving the name to the complex are also those which provide a large number of complex descriptors. For this purpose we study the complex of medicinal plant species which share the vernacular name "Árnica" in the Iberian Peninsula and the Balearic Islands, through the systematic recording of past and current local therapeutic uses and administration forms, plant-parts and localities where the different species are used. Being a newly introduced name in the region, "Árnica" offers an interesting field to study the genesis and dynamics of ethnopharmacological categories and medicinal plant complexes. METHODS: A systematic review of the botanical, ethnobotanical and ethnopharmacological literature from 1895 to 2010 and of databases was performed in order to obtain information on the use of plants locally named as "Árnica" or with binomials that include the word "Árnica", in the Iberian Peninsula and the Balearic Islands. RESULTS: The "Árnica" complex includes 32 different plant species in the Iberian Peninsula, belonging to six families of Angiosperms, which partially share morphological characteristics and therapeutic properties. These are some of the most popular medicinal species of the Iberian Peninsula and are mainly used to treat inflammation, wounds, hematoma, and contusion. The vegetal materials are primarily macerated or decocted, and the methods of administration are plasters, washes, frictions or direct application of the plant. CONCLUSIONS: Medicinal plant complexes are frequent in ethnopharmacological contexts and require being clearly detected, and systematically studied. Plant species within each complex are only partly interchangeable because the sharing of characters, including medicinal uses, is low. "Árnica" medicinal plant complex is extremely dynamic in the Iberian Peninsula. In less than two hundred years up to 32 different plant species belonging to six different plant families became labeled "Árnica". Medical staff was extremely influential in the adoption of "Árnica" as a vernacular name between 1785 and 1864 in Spain and Portugal but not in the repertory of uses adopted for the plants within the complex. In terms of total descriptors shared in the complex, Arnica montana L. is less relevant than other three species, belonging to the Inuleae Cass. tribe, of the Asteraceae (Chiliadenus glutinosus (L.) Fourr., Inula montana L. and Dittrichia viscosa (L.) Greuter). Thus "Árnica" complex is labeled by three different Inuleae Cass. species and receives the name from a fourth Madieae Jeps. species (Arnica montana L.).

Evidencia histórica sobre la génesis y difusión del concepto de "Árnica" en Europa Occidental / Historical evidence on the genesis and spread of the concept of "arnica" in Western Europe

El concepto de "árnica" está ligado a diferentes especies de la familia Asteráceas o incluso de otras familias. Era desconocido para los clásicos greco-romanos y tampoco se mencionó en los textos de la Alta Edad Media. Lo introdujo el editor de la obra Physica de Santa Hildegarda de Bingen, en 1533, para referirse a una planta con propiedades medicinales, mágicas y fabulosas. La especie Arnica montana L., fue descrita por Linneo en 1753. Alcanzó gran éxito en el siglo XVIII en el tratamiento de golpes e inflamaciones y se popularizó a lo largo de los siglos XIX y XX. Estudiamos la nomenclatura del árnica en la Europa Central y Occidental en lenguas germánicas (alemán, walser o tisch, moqueno) y romances (francoprovenzal, occitano, francés, italiano, ladino, español, catalán y portugués) y la evolución del concepto en diferentes autores botánicos. Esto nos permite concluir que los usos del árnica, muy arraigados en el mundo alpino, son recientes en el mediterráneo (segunda mitad del Siglo XVIII), llegando a la medicina popular a través de médicos y farmacéuticos (AU)

The concept of "árnica" is linked to different species of Asteraceae or other plant families. Unknown to the Classic Greeks and Romans it was not cited in the Early Medieval texts. It was first introduced in 1533 by the editor of St. Hildegard’s Physica to name a magical plant species. Arnica montana L., was described by Linneus in 1753. It was introduced during the 18th century in the medicine for the treatment of inflammation and hematoma, becoming widely used in the 19th and 20th centuries. The nomenclature of Arnica in Western and Central Europe is analyzed in Germanic (German, Walser or Tisch, Mochene) and Romance languages (Francoprovençal, Occitan, French, Italian, Ladino, Spanish, Catalan and Portuguese) and the evolution of the concept in different authors. This allows us to conclude that the use of Arnica is deeply rooted in the Alpine traditions, whereas in the Mediterranean is recent (2nd half of the 18th century), reaching the folk-medicine through physicians and pharmacists (AU)

O conceito de "arnica" está ligada a diferentes espécies da família Asteraceae e, inclusivamente a espécies de outras famílias. Era desconhecido para os clássicos greco-romanos e também não é mencionado nos textos da Alta Idade Média. Foi introduzido pelo editor da Physica de Santa Hildegarda de Bingen, em 1533, para se referir a uma planta com propriedades medicinais, mágicas e fabulosas. A espécie Arnica montana L., foi descrita por Lineu em 1753. Alcançou grande sucesso no século XVIII para o tratamento de feridas e inflamações e tornou-se popular durante os séculos XIX e XX. Estudámos a classificação de arnica na Europa Central em línguas germânicas (alemão, walser ou tisch, moqueno) e românicas (franco-provençal, occitano, francês, italiano, ladino, espanhol, catalão e português) e da evolução do conceito em diferentes autores botânicos. Isso permitenos concluir que as utilizações da arnica, muito arreigadas na zona Alpina, são recentes na região do Mediterrâneo (segunda metade do século XVIII), chegando à medicina popular através de médicos e farmacêuticos (AU)

[Antimicrobial and clinical efficacy of nitrofurantoin in the treatment of acute lower urinary tract infections in adults]. / Antimikrobielle und klinische Wirksamkeit von Nitrofurantoin in der Behandlung akuter Infekte der unteren ableitenden Harnwege bei Erwachsenen.

BACKGROUND AND PURPOSE: In the light of increasing resistance to antibiotics used for the treatment of acute urinary tract infections, nitrofurantoin currently experiences a renaissance. Nitrofurantoin shows good efficacy against most bacteria expected in urinary tract infection, and the development of resistance is low. A study on the antimicrobial and clinical efficacy of nitrofurantoin in the treatment of acute lower urinary tract infections was conducted in Mexico City, an area where resistance rates of uropathogens to trimethoprim/sulfamethoxazole (cotrimoxazole) are high. PATIENTS AND METHODS: In this open-label, single-arm study 20 adult patients (18 females, 2 males) with positive urine culture were treated orally with nitrofurantoin sustained release 100 mg twice daily for 7 days. Urinary nitrofurantoin concentrations were determined at baseline and day 4 of the study. Primary endpoint was the antimicrobial efficacy of nitrofurantoin at 12 to 16 days after baseline, assessed by changes in urine culture results. RESULTS: In the patient population treated per protocol, primary endpoint analysis revealed a microbial eradication rate of 92.3%. At 35 to 42 days, the eradication rate was 83.3%. At these times, all patients in the per protocol population were free of symptoms. In patients with complicating factors, e.g. diabetic polyneuropathy, both antimicrobial and clinical efficacy appeared to be reduced. Urinary nitrofurantoin concentrations were mostly above minimum inhibitory concentrations of the isolated uropathogens. The study drug was generally well tolerated. Most frequent drug-related adverse event was mild headache, occurring in 10.8% of patients. Two patients discontinued the study due to rash. CONCLUSION: The results of the present study indicate good antimicrobial and clinical efficacy of nitrofurantoin in the treatment of acute uncomplicated urinary tract infections as well as acceptable tolerability in adults.

Diagnosis and staging of penile cancer.

A comprehensive literature study was conducted to evaluate the levels of evidence (LEs) in publications on the diagnosis and staging of penile cancer. Recommendations from the available evidence were formulated and discussed by the full panel of the International Consultation on Penile Cancer in November 2008. The final grades of recommendation (GRs) were assigned according to the LEs of the relevant publications. The following consensus recommendations were accepted: physical examination of the primary penile lesion is mandatory, evaluating the morphologic and physical characteristics of the lesion (GR A). Evaluation of the primary lesion with ultrasonography is of limited value for local tumor staging (GR C); however, evaluation of the primary tumor with magnetic resonance (MRI) imaging during artificial erection induced by intracavernosal injection of prostaglandin might be more useful (GR B). Histologic or cytologic diagnosis of the primary lesion is mandatory (GR A). For accurate histologic grading and staging, a resected specimen is preferable to a biopsy specimen alone (GR B). Penile cancer should be staged according to the TNM system; however, the 1987/2002 TNM staging system requires revision using data from larger patient cohorts to validate the recently proposed modifications (GR B). The histopathology report should provide information on all prognostic parameters, including the tumor size, histologic type, grade, growth pattern, depth of invasion, tumor thickness, resection margins, and lymphovascular and perineural invasion (GR B). Physical examination of the inguinal and pelvic areas to assess the lymph nodes is mandatory (GR B). Ultrasound-guided fine needle aspiration cytology is indicated for both palpable and nonpalpable inguinal nodes. If the findings confirm lymph node metastasis (LNM), complete inguinal lymph node dissection is indicated (GR B). In patients with nonpalpable inguinal nodes, if the ultrasound-guided fine needle aspiration cytology findings are negative for tumor, dynamic sentinel node biopsy can be performed if the equipment and technical expertise are available (GR C). In patients at high risk of inguinal LNM according to the available guidelines and nomograms, surgical staging can be performed by complete, bilateral inguinal lymph node dissection, which might also be curative (GR B). In patients at intermediate risk of LNM, sentinel node biopsy or modified (limited) inguinal lymph node dissection might be performed (GR B). In patients with nonpalpable inguinal nodes, imaging with computed tomography (CT) or MRI is not indicated, because they are not useful in detecting small-volume LNM. Also, it is very unlikely that large-volume LNM (detectable by CT/MRI) would be present in the pelvic nodes (GR B). In patients with confirmed inguinal LNM, CT of the pelvis is indicated to detect iliac LNMs (GR B). Abdominal CT and chest radiography are advisable if the pelvic CT findings are positive (GR B).

A Comparative Assessment of Zootherapeutic Remedies From Selected Areas in Albania, Italy, Spain and Nepal.

Zootherapy is the treatment of human ailments with remedies derived from animals and their products. Despite its prevalence in traditional medical practices worldwide, research on this phenomenon has often been neglected in comparison to medicinal plant research. Interviews regarding zootherapeutic traditions were conducted with informants from Albania, Italy, Nepal and Spain. We identified 80 species used in zootherapeutic remedies, representing 4 phyla in the animal kingdom: Annelida, Arthropoda, Chordata, and Mollusca. Remedies were ranked by consensus indices. Our studies show that the selection of medicinal fauna is mediated by human subsistence patterns. Concepts of health and disease differ among our study sites in the Mediterranean and Asia, and these differences also play a substantive role in the selection and use of animal-based remedies.

[Efficacy and safety of vardenafil in patients with erectile dysfunction. Results of the Mexican Multicentric Study]. / Eficacia y seguridad del vardenafil en pacientes con disfunción eréctil. Resultados del estudio multicéntrico mexicano.

UNLABELLED: The objective of the present study was to determine the efficacy and safety of a fixed dose of vardenafil in the treatment of patients with erectile dysfunction (ED). MATERIAL AND METHODS: This was an open label, prospective and multicentric trial. After a 4-week wash out period, all patients received 20 mg of vardenafil given on demand for 12 weeks. Primary efficacy variables were the erectile function domain of the International Index of Erectile Function (IIEF), answers to questions 2 and 3 of the Sexual Encounter Profile (SEP) and the Global Assessment Question (GAQ). All adverse events were recorded and reported. RESULTS: 229 patients were screened. 177 received at least one dose of vardenafil and were included in the safety analysis. Mean age was 54.4 years old. Etiology of ED was organic or mixed in 77% of the patients. Erectile function domain of the IIEF changed from a basal mean score of 14.8 to 25.5 at the end of the study. 80.5% of the patients reported erections of rigidity and duration enough for satisfactory sexual intercourse and 93.3% improved their erections at the end of the study. Adverse events were mild to moderate and the most common were headache, dyspepsia, rhinitis and facial flushing. The drop out rate due to adverse events was 1.7%. CONCLUSIONS: This multicenter study confirms the high efficacy of this new phosphodiesterase type 5 inhibitor, vardenafil. There was a low rate of discontinuations due to adverse events and a favorable safety profile. The results of this study are similar to the results of other studies conducted in other parts of the world.

Fisiopatogenia de la hiperplasia prostática / Phisiopathology of prostatic hyperplasia

Con el propósito de difundir mayores conocimientos en torno a la hiperplasia prostática el comité Mexicano para el Estudio de la Próstata se ha dado a la tarea de efectuar una serie de revisiones que en su conjunto logren que el urólogo y el internista puedan diagnosticar y tratar adecuadamente los casos de hiperplasia prostática. En este artículo se hace una completa revisión de la fisiopatogenia de esta afección desde su mecanismo hormonal, teoría de la célula precursora hasta la teoría de la interacción estremo-epitelial.

Absceso renal y tomografia axial computadorizada / Compurarized axial tomography in the diagnosis of renal abscess

Para valorar la utilidad de la tomograía axial computaorizada (TAC) en el diagnóstico y manejo del absceso renal se analizaron en forma retrospectiva 15 casos de absceso renal comparándose este método radiológico con el ultrasonido renal, la urografía excretora y la placa simple de abdomen. La urografía excretora fue diagnósica en el 71.4%, el ultrasonido en el 80%, la placa simple de abdomen en el 33.3% y la TAC en el 100 por ciento. De los 15 pacientes, en 12 el tratamiento fue quirúrgico y en tres casos con servador con antibióticos parenterales. La mortalidad global fue del 16.6 por ciento. Los resultados de nuestro trabajo indican que la TAC es un elemento diagnóstico sensible y superior a los métodos radiológicos convencionales para la detección del absceso renal. Por otro lado, determina con mayor precisión su localización y extensión