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Shoe allergens: retrospective analysis of cross-sectional data from the eczema population with focus on patients with multiple contact allergies anxiety disorder nos 3000 best order serpina. Contact allergy in analysis of data of the Information Network of Departments of Dermatology anxiety untreated serpina 60caps low price. Contact Dermatitis patch test population: hand dermatitis is associated with polysensitization anxiety symptoms - urgency and frequent urination order serpina amex. Contact spective multicentre investigation of the German Contact Dermatitis Research sensitization to anxiety symptoms for teens discount serpina master card common haptens is associated with atopic dermatitis: new Group. Clinically relevant patch test reactions in screening patch test tray: frequency of “lost,”“found,” and “persistent” re children—a United States based study. Relevance of doubtful (“equivocal”) late Oral prednisone suppresses allergic but not irritant patch test reactions in in patch-test readings. Patch testing in patients treated sites of allergic contact dermatitis caused by nail varnish. The effect of topically applied corticosteroid on irritant and allergic irritants: a study of 17 cases seen over 4 years. North American Contact Dermatitis Group patch test results for 2007 histochemical investigation. Evidence-based diagnosis in patch ointment (protopic) reverses nickel contact dermatitis elicited by allergen testing. Patch testing for nickel suppression of recall contact and delayed-type hypersensitivity in humans. The role of vehicles in diagnostic patch greater protection against ultraviolet-radiation-induced suppression of contact testing. Development of a Patch-test results of the North American Contact Dermatitis Group 2005-2006. Screening blood test iden Comparative study with 11 common contact allergens and NiCl. Br J Dermatol 2007;157: Delayed patch test reading after 5 days: the Mayo Clinic experience. The outcome of an additional patch-test reading on and use test reactivity: an overview. The atopy patch test: an increased rate of reac appears to be more common than active sensitization. Contact Dermatitis 2008; tivity in patients who have an air-exposed pattern of atopic eczema. The current status of the weed Parthenium hyster American Contact Dermatitis Group Data, 1994-2004. Prevalence and cause of Airborne contact urticaria due to mulberry (Morus alba) pollen. Cosmetic allergy: incidence, diagnosis, and man perception of relevance and the role of titanium dioxide in cosmetics. The composition of ne fragrances is Contact sensitivity to hair dyes can be detected by the consumer open test. Alternative hair-dye products for persons should know about managing patients with fragrance allergy. Analysis of para-phenylenediamine allergic patients in relation to strength of 141. Permanent wave contact dermatitis: contact allergy to glyceryl lergens in consumer products. Relationships between age, sex, history of exposure, and reactivity hyde-releasers in cosmetics: relationship to formaldehyde contact allergy. Contact dermatitis of the hands: cross-sectional analyses of North 1996;276:972-7 (Ib). Common allergens in shoe dermatitis: our metallic orthopaedic implants before and after surgery. Systemic hypersensitivity reaction (without cuta corticosteroids: practical guidelines. Purello D’Ambrosio F, Ricciardi L, Isola S, Gangemi S, Cilia M, Levanti C, steroids. Contact Dermatitis 1987;17: children undergoing patch testing over a 7-year period. Atanaskova Mesinkovska N, Tellez A, Molina L, Honari G, Sood A, testing in children—recommendations of the German Contact Dermatitis Barsoum W, et al. Prevalence of dermatitis in the working population, United States, 2010 and suggested patch test series for clinical use. Patch testing and hypersensitivity reactions to metallic implants: establishing occupational causation and aggravation. The validity of the Mathias criteria for establishing patients undergoing joint replacement: a systematic review. Pimecrolimus inhibits the elici Positive patch test reactions in older individuals: retrospective analysis from tation phase but does not suppress the sensitization phase in murine contact the North American Contact Dermatitis Group, 1994-2008. Topical pimecrolimus in the contact allergy caused by rubber gloves—nothing has changed. Comparison of the inuence of cyclosporine analysis of contact allergy surveillance data of the Information Network of and topical betamethasone-17,21-dipropionate treatment on quality of life in Departments of Dermatology. Int Arch Occup Environ Health 2004;77: Sensitivity and specicity of the nickel spot (dimethylglyoxime) test. Contact Dermatitis 2013;69: ability of an interdisciplinary secondary prevention program for hairdressers. Guidelines for the management of con Prognosis of occupational hand eczema: a follow-up study. Prognosis and work absence due to intermittent treatment of chronic hand eczema with mometasone furoate. Patch testing and return to work process in the rst six months following diagnosis. Occupational steroid series: a retrospective review of 1188 patients during 6 years at Mayo skin disease in Sweden—a 12-year follow-up. Contact sensitizer Systemic reaction to made based on lesser evidence Glucocorticoids Oral corticosteroids when high-quality evidence is impossible to obtain and the Benadryl cream Oral diphenhydramine anticipated benets outweigh Neomycin Oral neomycin the harms. Penicillin Oral penicillin Weak (Weak) A weak recommendation means Clinicians should be Sulfonamide Para-amino sulfonamide hypoglycemics that either the quality of exible in their (tolbutamide, chlorpropamide) evidence that exists is suspect decision making Thiuram Antabuse (Grade D)* or that well-done regarding Colophony, balsam of Spices: clove, nutmeg, cinnamon, cayenne studies (Grade A, B, or C)* appropriate Peru, fragrance mix pepper show little clear advantage to practice, although Ethylenediamine Aminophylline one approach vs another. For this manuscript the allergenicity is classied as Groups A, B, C, D1, and D2 and the potency is from Class 1-7; 1 being the most potent and 7 being the weakest class. The classication of potency may vary depending on factors such as the vehicle and reference source. So it is very important to keep your baby’s skin clean, dry, safe from harm, and healthy. Babies usually get a bath within twenty-four hours of birth, unless they are very sick. If your baby is not treated with bili lights, you may bring in baby clothes to put on your baby after the bath. Ask your doctor or nurse if your baby can wear Babies who are born early can have clothes while in the hospital. If you want to learn more about bathing, ask your nurse or doctor for the handout How to Bathe Your Premature or Sick Baby (#457). However, these products cannot be used on your baby if your baby is being treated with bili lights. Your baby’s skin is so thin that anything that you put on it can go right through into the body. Powders get in the air, babies could breathe them in and they can hurt their lungs. If your baby is less than 28 weeks gestational age, your baby will need humidity to help the skin be prepared for the outside world (keratinized). If there is a concern for infection from the amniotic fuid (chorioamnionitis), then your baby will get a bath right away with sterile water and cotton balls. Monitor patches and probes for temperature and oximeter may bother your baby’s skin. Watch your baby’s skin closely for any irritation and let the doctor or nurse know if you see any areas that are red or irritated.

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It had data on the percentage of patients whose testing was completed and the Results at Ruth Clinics percentage of those meeting their goals anxiety 5 things images cheap serpina 60 caps on line. This was Ruth Clinics began implementing the Chronic valuable for the insurer and for Ruth Clinics anxiety symptoms in cats serpina 60caps without a prescription. Enter data from each visit into the disease care was done and easily documented) anxiety 911 serpina 60caps with mastercard, providers registry were able to anxiety symptoms head cheap serpina 60 caps visa bill a higher level of service without 2. Ruth Clinics has internal laboratories and 34 has increased lab revenue system wide. Urine A discount rate of 5 percent was assumed in microalbumin testing went from essentially zero to this analysis because this is a reasonable rate of more than 11,000 tests per year, which yielded a return on fxed investments. Because the time Clinics also performs HbA1c tests in the ofce, period for the analysis is short (three years), the with a comparable increase in the number of tests discount rate is of less consequence in this case and revenue. In any Group visit revenue exceeds expenses by a case, the user can easily explore the changes in the large margin, but these visits are currently done in results when alternative discount rates are used. Transcription and fling costs have All cash values are discounted back to Year been reduced. Tus, the analysis takes the point requires little or no dictation, saving physician of view of the decision-maker looking forward time and transcription costs. The initial investment costs of Ruth Clinics now receives P4P payments from $44,873. Similarly, the operating costs payment for all providers involved in diabetes care. We have not range from 93 percent to 100 percent, depending on included grant funds, which typically would not the provider. Ruth Clinics did not have a control group, so all the results are shown relative to the baseline period of 2004. Terefore, we A convenient starting place for a review of the evidence is the meta-analysis by Chodosh et al. What does it cost to implement and operate an searched Pub Med for the last three years. What are the expected short and long-term ment” and limits to “humans, English, age 19+, last consequences of improvements in care in three years, and article type: clinical trial, meta terms of prevention of adverse events, analysis, randomized controlled trial or review,” we reduction of health services utilization and found 160 additional articles. Fortunately, for tional coverage of the literature to ensure that we Question 1, recent comprehensive systematic had not missed important recent trials. Five of the recent systematic reviews1, 5, 7, 9, 12 reviews and meta-analyses are available to serve as starting places. A small number of studies are found signifcant improvements from the self-man pertinent to Question 2. Glazier listed the results but cost of intervention values here, most of the studies did not summarize them on a common scale. For Question 3, the literature is diverse and widely The Deakin review is the easiest to interpret because scattered but can be synthesized with some efort. Note, however, that the Deakin review translates into a reduction in HbA1c of “about studied group interventions relative to control 0. Fourteen comparisons characteristics of the patient population, the setting from 13 studies reported a pooled efect of -0. Tus, the values fasting glucose outcomes compared with controls provided here should only be viewed as generally subjects, which equals a “decrease of 0. The results of the meta-analyses reported decline in HbA1c is very close to the in favour of group-based diabetes educa pooled results reported by Deakin et al. Tere was also patient education, self-management or patient a reduced need for diabetes medication reminders. Terefore, reduction was again identical to that reported by for every fve patients attending a group Chodosh et al. They completion rate exceeded 80 percent and, at the estimated a mean decrease of approximately end of the course, most participants reported one-half percentage point in HbA1c. Comparing outcome mea authors cautioned that it would be more appropri sures at 12 months following the program to ate to evaluate the efectiveness of the behavioral baseline measures, Gateway found statistically intervention “in terms of the behaviors it is de signifcant improvements in HbA1c levels (8. The results demonstrate a projects around the country that diabetes self high retention rate among program participants management programs could be efective in and a persistence of program efects following the real-world settings. The 14 selected sites began a primary care setting to provide diabetes self-man 15-month planning phase in February 2003 and agement education to Mexican-American patients initiated interventions that would last 30 months of La Clinica de La Raza in Oakland, California16 on May 1, 2004. Preliminary fndings from some of HbA1c showed a statistically signifcant drop the sites were published in a special supplement of (8. An Massachusetts, initiated self-management activities interesting dose efect was observed with the over the project period that were culturally rel number of contacts per week over a one-year evant for their predominately urban, Hispanic period. This intervention did not include a Positive outcomes were also reported by comparison group and did not report data on Campesinos Sin Fronteras for its community blood pressure, lipid management, tobacco use, based program targeting farmworkers along the weight control or physical activity. For these 39 patients, the decreases in blood pressure were not (approximately $240 in current dollars) per statistically signifcant. They also reported a dose participant in a chronic disease self-management efect, with the number of total contacts, support program (not diabetes specifc) ofered to Kaiser group contacts and advocacy contacts all positively Permanente patients at 21 sites and Group Health correlated with decreases in HbA1c levels. Although all these studies were done in The program cost included leaders training, real-world settings and were demonstration program materials and administration. None of the Diabetes $712 (2004 dollars) per patient in the frst year of a Initiative projects reported intervention costs, general quality improvement collaborative, $600 in savings or revenue efects. Costs of Developing and Operating a Tat these reported program costs span a Self-Management Program broad range suggests that if a greater number of A review by Klonof and Swartz18 summarized the studies were to report their intervention costs, a costs and benefts of nine self-management pro relation could be developed between program grams for which costs were collected. Considering the diversity of settings and not trained to be concerned with the busi program content, these estimates cover a surpris ness case for the interventions. This an internal disease management program at has been seen, explicitly or implicitly, to be Geissinger Health Plan. As the feld matures, inclusion of program cost estimates in reports of guidelines regarding which costs to include may diabetes self-management studies: develop. In the meantime, the templates provided in Chapter 3 of this handbook can serve as a First, for diabetes self-management educa convenient guide for program cost analysis. In the long run, uncon diabetes self-management programs are possibly trolled diabetes can lead to macrovascular compli cost-efective. Nephropathy can lead to 11 studies21-23, 27, 30-36 that address the cost-efective end-stage renal disease; background retinopathy ness of diabetes self management. We were liberal can lead to macular edema, proliferative diabetic in our inclusion of disease management programs retinopathy and eventually blindness; and periph that included aspects of self management. We did eral neuropathy can lead to foot ulcers and eventu not search for promotional literature from com ally amputation. The same cautions raised by would not be sufcient, as it would if a societal Klonof and Swartz apply to the studies in Table 4-1. Tat is, important that we know which entity in the health patients who generate high costs in one year may have care system bears the cost of the intervention, what lower costs in the subsequent year because their costs the intervention cost is, what the cost savings from tended toward the average rather than because of the the intervention are likely to be and which entity is benefcial efects of the treatment. Tus, if an intervention is shown to programs for diabetes save money in all cases. An be cost-efective in a large health maintenance interesting debate on this topic emerged in Health organization, that result may have no infuence on Afairs. They conclud published cost of intervention and savings in hospital ed that disease management programs may be costs the year afer the intervention. Reported beneft/ management programs improve the length and cost ratios ranged from 0 to 8. All nine studies quality of life at a level of cost that is a good value were conducted from the perspective of a health for the gains achieved but still at a higher total cost insurer that would beneft from reduced hospital than the comparison group. Without external care and, furthermore, that the costs of the inter fnancial support, Huang et al. How might investi health benefts to patients and downstream cost gators estimate the future savings from reduced savings will be lost. A major difculty in answering this Other researchers have developed simulation question arises because the signifcant averted models with goals similar to the Eastman model. If we want to estimate the model in that they are discrete-event Markov averted costs of these long-term complications, we simulations that move a simulated patient through would have to use a model to forecast both the time in annual steps. Transition probabilities depend clinical progression and health care utilization on the status of the simulated patient at any given efects of the intervention of interest. Eddy and Schlessinger44, 45 Fortunately, in the last several years researchers have developed and validated a complex model of have developed computer simulation models specif the anatomy, pathophysiology, tests, treatments and ically designed to estimate the health efects and outcomes relevant to diabetes that can be used to costs of diabetes complications. An example of the make projections of the efects of a variety of clinical use of these computer models is provided by Huang and administrative interventions. Although documented improvements in care from the Health much more complicated than the Markov models of Disparities Collaborative.

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Does glycemic control with insulin therapy play a role for critically ill patients in hospital Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus anxiety symptoms in spanish purchase serpina 60 caps on-line. Comparison of basal insulin regimens on glycemic variability in noncritically ill patients with type 2 diabetes anxiety 6 year old order serpina 60caps overnight delivery. Randomized controlled trial of insulin supplementation for correction of bedtime hyperglycemia in hospitalized patients with type 2 diabetes anxiety symptoms jittery buy generic serpina from india. Comparison of basal-bolus and premixed insulin regimens in hospitalized patients with type 2 diabetes anxiety symptoms ringing in ears purchase generic serpina. Comparison of inpatient insulin regimens with detemir plus aspart versus neutral protamine hagedorn plus regular in medical patients with type 2 diabetes. Randomized study comparing a basal-bolus with a basal plus correction insulin regimen for the hospital management of medical and surgical patients with type 2 diabetes: Basal plus trial. Diabetes self-management education and support in type 2 diabetes: A joint position statement of the American diabetes association, the American association of diabetes educators, and the Academy of Nutrition and Dietetics. Inpatient diabetes education is associated with less frequent hospital readmission among patients with poor glycemic control. Impact of inpatient diabetes management, education, and improved discharge transition on glycemic control 12 months after discharge. Diabetes transitional care from inpatient to outpatient setting: Pharmacist discharge counseling. Peripheral vascular and nerve function associated with lower limb amputation in people with and without diabetes. Report and recommendations of an international workshop sponsored by the American heart association and the American diabetes association 18-20 September 1992, New Orleans, Louisiana. Accuracy of a technology-assisted eye exam in evaluation of referable diabetic retinopathy and concomitant ocular diseases. Accuracy and reliability of teleophthalmology for diagnosing diabetic retinopathy and macular edema: A review of the literature. Maculopathy and visual acuity in newly diagnosed type 2 diabetic patients and non-diabetic subjects: A 10-year follow-up study. Cost-utility analysis of screening intervals for diabetic retinopathy in patients with type 2 diabetes mellitus. Managing preexisting diabetes for pregnancy: Summary of evidence and consensus recommendations for care. Systematic review: Comparative effectiveness and safety of oral medications for type 2 diabetes mellitus. Comparative effectiveness and safety of medications for type 2 diabetes: An update including new drugs and 2-drug combinations. Diabetes medications as monotherapy or metformin based combination therapy for type 2 diabetes: A systematic review and meta-analysis. Empagliflozin monotherapy with sitagliptin as an active comparator in patients with type 2 diabetes: A randomised, double-blind, placebo-controlled, phase 3 trial. Triple therapy combinations for the treatment of type 2 diabetes a network meta-analysis. A comparison between sitagliptin or glibenclamide in addition to metformin + pioglitazone on glycaemic control and beta-cell function: the triple oral therapy. Efficacy and safety of adding pioglitazone or sitagliptin to patients with type 2 diabetes insufficiently controlled with metformin and a sulfonylurea. Canagliflozin compared with sitagliptin for patients with type 2 diabetes who do not have adequate glycemic control with metformin plus sulfonylurea: A 52-week randomized trial. The treat-to-target A1C approach to control type 2 diabetes and prevent complications. Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: A systematic review and meta-analysis. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. Association between hospitalization for heart failure and dipeptidyl peptidase 4 inhibitors in patients with type 2 diabetes: An observational Study. Risk for hospitalized heart failure among new users of saxagliptin, sitagliptin, and other antihyperglycemic drugs: A retrospective cohort Study. Cardiovascular safety for once-weekly dulaglutide in type 2 diabetes: A pre-specified meta-analysis of prospectively adjudicated cardiovascular events. Funnell10 Language is powerful and can have a strong impact on perceptions as well as behavior. The literature supports the need for a language movement in diabetes care and education. This article provides recommendations for language used by health care professionals and others when discussing diabetes through spoken or written wordsdwhether directed to people with diabetes, colleagues, or the gen eral public, as well as research questions related to language and diabetes. Words are immediately shaped into meanings when people hear or read 5Diabetes Education and Support Consulting them (5,6), and those meanings can affect how a person views him or herself. On the other hand, encouraging and collaborative messages Corresponding author: Jane K. The task force reviewed the literature re the American Diabetes Association and the garding language used in the delivery of diabetes care and education and made rec American Association of Diabetes Educators. This document represents the © 2017 by the American Diabetes Association and expert opinion of the task force. The task force members dened and adopted four the American Association of Diabetes Educators. Table 1 Readers may use this article as long as the work is properly cited, the use is educational and not presents the guiding principles. Instead, c Stigmathathashistoricallybeenattachedtoadiagnosisofdiabetescancontributetostressand put the person rst. Avoid describing per feelings of shame and judgment sons as victims or with other emotional c Everymemberofthehealthcareteamcanservepeoplewithdiabetesmoreeffectivelythrough terms that suggest helplessness (aficted a respectful, inclusive, and person-centered approach with,sufferingfrom,strickenwith,maimed). In an effort to build on those ideas and further deneeffectivecommunicationin and evidence exists demonstrating that authors of patient education publica diabetes, the task force developed ve language will change over time. These recommendations are con evidence-informed recommendations cades, a substantial amount of the lan sistent with the American Psychological (see Table 3) for person-centered and guage around diabetes has been focused Association style guidelines for nonhandi strengths-based communication as well on negative outcomes and laden with judg capping language, which originated in the as a list of words and phrases that have ment and blame, and it has not adequately Committee on Disability Issues in Psychol potentially negative connotations, along considered individual needs, beliefs, and ogy (the following is adapted from with suggestions for alternatives (see choices. This article emphasizes the ra has expanded and as more effective treat nonhandicapping-language. This article is not meant to ternational Diabetes Federation published compliant, nonadherent, poorly con suggest how people living with diabetes a Language Philosophy because of the trolled) talk or write about themselves as individu belief that there is a “responsibilityto set als. Diabetesd2017” (12) calls for “a patient information, health literacy, and health nu this article provides recommendations centered communication style that uses meracyarebeyondthe scope ofthisarticle for language related to diabetes that is active listening, elicits patient prefer and have been discussed elsewhere. Use Language That Is Neutral, diabetes educators, researchers, journal ed outcomes and health-related quality of Nonjudgmental, and Based on Facts, itors and authors, and other professionals life. Words, which Table 2—Key denitions “are inseparable from the concepts they Word/phrase Denition refer to” (5), are powerful. Medical lan Strengths-based language Opposite of a decit approach; emphasizing what people guage has an inuence over patients and know and what they can do (7). Person-rst language Wordsthatindicateawareness,asenseofdignity,andpositive Words that start out as simple descriptors attitudes toward people with a disability/disease. Places cantakeonpositiveornegativeconnota emphasis on the person, rather than the disability/disease (88). Judgmental words and messages can inict shame, leading a person to pull 1792 Consensus Report Diabetes Care Volume 40, December 2017 Table 3—Recommendations be stigmatizing terms that associate with stereotypes including “lazy,”“unmoti Use language that vated,”“unwilling,” and “don’t care” (31). In away from other people and situations foolish adults,” which is contradictory fact, the most widely reported forms of (18). While these characteristics are nonjudgmental rather than words that cussing diabetes management activities, often perceived by people with type 2 di impose blame or imply negative attitudes places responsibility on the person with abetes, there is evidence that people with (19–21). On the other hand, some riencing stigma are less likely to seek port blood glucose levels (22) or omit in people interpret “taking control” as pur follow-up care (37) and are more likely formation during health care provider posely going against what providers sug to feel psychological distress (38). In society there is value to being study of people living with diabetes vulnerable time for communication and “in control,” while being “out of control” (n53,347),datafromaself-administered self-care (24).

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The main constituents of the tradi phytomedicine for use in type 2 diabetes anxiety symptoms racing heart purchase serpina uk, more studies are tionally used water extracts are the isolated pyrones anxiety symptoms heart palpitations buy serpina 60 caps low cost, simi urgently required anxiety symptoms brain fog discount 60 caps serpina with mastercard. Acosmium panamense—conclusion panamensis Benth anxiety otc medication buy serpina with a mastercard, with traditional names “Guayacan” and Limited in vivo evidence exists for the traditionally used “Balsamo amarillo”) is a tree up to 40 m height, growing in water extract. The isolated pyrones have hypoglycaemic the tropical rain forest as a co-dominant species with Ter activity, but more studies are needed to clarify the mode of minalia amazonia and Vochysia guatemalensis (Pennington action. The main characteristic of the tree is a tall, straight trunk pyramidal treetop with ascendant branches. Cucurbita cifolia Bouche (Cucurbitaceae) the external cortex is plain and dark grey, the inner cortex is yellow and bitter. Fruit green to dark green At the end of the 19th and the beginning of the 20th legumes, 5–10 cm long (Pennington and Sarukhan, 1998). Since the middle of the last century, the It grows along the Gulf coast from Veracruz to Yucatan and consensus has been that it is of American origin. Some authors have suggested Central America or southern Mexico species from the tropical rain forest. It is often managed by local people (Heinrich, unpublished data), seems to be quite as places of origin, while others suggest South America, and abundant, but no information on the potential of sustainable more specically the Andes (Purdue University, 2004). Cucurbita cifolia is a creeping or climbing plant, monoe cious, annual, up to 10 m long. Ethnobotany with some short sharp spines dispersed over the vegetative In Oaxaca the plant is used traditionally for the treatment parts. It has ve vigorous, slightly angular stems and ovate of stomach pain, respiratory problems, diarrhoea, malaria and cordate to suborbicular-cordate leaves with 5–25 cm long “marsh fever”. The esh is sweet and tion, Acosmium panamense is utilized to treat diabetes in the the seeds are ovate-elliptical, attened, and of a dark brown village of Soteapan, Veracruz (Leonti et al. Main constituents is used externally to treat a worm that runs under the skin (like Phytochemical studies of the plant yielded several quino larva migrans) in Hidalgo (Argueta, 1994). In Mexico, the lizidine alkaloids like acosmine and acosminine, hydroxy plants is consumed widely and several dishes and candies sparteine as well as lupinane alkaloids (Balandrin and are prepared with the seeds or fruit. From the water extract of the traditionally used healers recommend the ingestion of the fruit macerated in bark (Wiedenfeld and Andrade-Cetto, 2003) caffeic acid and water. Lectins were isolated from stems and roots of 6-day old seedlings by precipitation with ethanol, afnity chromatogra 3. Pharmacology phy on Con A-Sepharose, gel ltration on Bio-gel P100 and the water and butanol extract as well as a mixture of separated by electrophoresis on polyacrylamide gel. The fruit showed a hypoglycaemic activity in all the reported studies, the lack of phytochemical information on 3. Pharmacology the juice (extract), prevents an assessment of the observed the pharmacological activity of the plant was tested in effect on a phytochemical level. The authors conclude: “Due to the negligible content of ber in rabbits were submitted to glucose tolerance test and a prepa Cucurbita cifolia and the design of the study, the observed ration of the plant or tolbutamide was administrated, the effects on glucose levels are not a consequence of glucose animals receive 2 g/kg of glucose subcutaneously at the start absorption changes in the intestine” (Acosta-Patino, 2001). The In all cases, the doses used were high and the therapeutic authors report a statistically signicant hypoglycaemic effect relevance of this effects has to be questioned. The amount of extract Extrapolating the toxicity levels reported in Alarcon- and the way of preparation are not reported in the paper. Aguilar (2002) to reach the lethal dose of 1250 mg/kg Several experiments were performed by Alarcon-Aguilar obtained from the freeze-dried juice, a person of 60 kg would et al. Mature fruits of need 75,000 mg (75 K) of fruit to have the lethal dose, and Cucurbita cifolia were cut in halves. The juice was obtained this is much higher than the traditionally recommended dose with an electric extractor and freeze-dried. More studies are needed in order to identify the was tested in healthy mice using two routes of administration, constituents of the fruits, and then test these substances. In case of Quantitative phytochemical studies on the levels of lectins the po administration, the authors report an hypoglycaemic and other potentially relevant constituents during the devel effect at 240 min with p < 0. In alloxan diabetic mice, the acute furrowed bark; twigs very sparsely to densely pubescent, with effect was also tested at 500 mg/kg. Distribution In 2001, Acosta-Patino tested the effect of the fruit juice Mountainous areas of Mexico and Central America, from in patients with moderate hyperglycaemia at 4 ml/kg (100 g Veracruz and Jalisco south to Quintana Roo. Ethnobotany another session, at least separated by 8 days, the same group the water extract of the leaves of this plant known as “Palo of patients received, the same amount of potable water as con Santo” is used orally to treat diabetes (Perez-Guerrero et al. Toxicity plant, 12-ursene and the triterpene-23,24-dimethyl 1-24 Some toxicity has been detected in the majority of ethyl-sigmast-25-ene were isolated (Fig. Pharmacology of Cucurbita cifolia fruits had toxicity when administered Blood glucose levels of normal and alloxan-treated dia intraperitoneally to mice and when it was orally adminis betic mice and rats were determined after oral administra A. Heinrich / Journal of Ethnopharmacology 99 (2005) 325–348 343 tion of the chloroform extracts of Agarista mexicana at 100 From the chloroform extract Perez et al. The oral administration of the extracts pro bioactive avone 5,7,3 -trihydroxy-3,6,4 -trimethoxyavone duced a signicant hypoglycaemic effect in normal as well (Fig. Pharmacology induced diabetic and in normoglycaemic mice at 50 mg/kg A chloroform extract of the leaves was tested in alloxan. Compound 6 showed an statistically signicant activity diabetic mice and normoglycaemic mice. The extract showed signicant activity with diabetic mice, while the effect in normoglycaemic mice was at least p < 0. Compound 7 shows statistically 180, 270 and 1440 min = 24 h; Perez-Gutierrez et al. Tolbutamide was used as positive statistically signicant activity at 90, 270 and 1440 min with control (Perez-Gutierrez and Vargas, 2001). In the the hypoglycaemic effect of the extract has been normo-glycaemic mice, 10 mg/kg showed activity only at demonstrated and two terpenes were isolated as bioactive 270 min, 25 mg/kg was active at 90 and 180 min (p < 0. In alloxan fordii a traditional Chinese plant used against rheumatoid diabetic mice, the maximum effect observed was at 270 min, arthritis and other inammatory and autoimmune disorders. In all tests, tolbutamide was However, the reported effect is of the total multi-glycoside used as control. Brickellia veronicaefolia—conclusion plant is attributed to the extract and not to a single compound. The hypoglycaemic effect was conrmed and a bioactive the mechanism of action of the isolated 12-ursene and the compound has been isolated. The possible hypoglycaemic 23,24-dimethyl 1-24-ethyl-sigmast-25-ene is currently not effect of avonoids has been discussed above, there are no known. Toxicological test, as A comparison between the water extract (traditionally well as a comparative phytochemical investigation of the tra used) and the chloroform extract tested. It is necessary to know the amount of bioactive too high for use in traditional medicine or as a phytomedicine. Botanical description the fruit of the tree is reported to be hypoglycaemic, how Bush 40 cm to 1 m tall, branched at the base with grey-red ever the reports (Perez-Gutierrez et al. Ethnobotany Tree up to 15 m, branched since the base and channelled the plant is know as “oregano de monte” the main use is trunk, external cortex dark yellow with ssures and scaly ribs. For the later, the branch is boiled in water several longitudinal furrows and a green-yellow colour. The use against the species is managed by humans to produce shade and diabetes is reported in Perez-Gutierrez et al. The following constituents have been isolated from the leaves: avones – artementin, brickellin, casticin and trime 3. Ethnobotany toxiquercetagenin, avonols, eupatin, eupatolin, patuletin the fruit and the cortex bark of the tree are boiled in water and vernicaefolin, and labdane diterpens (Argueta, 1994). Main constituents extracts at 100 mg/kg and 150 mg/kg) was tested in normal the guaianolide of lactucin-8-O-methylacrylate was iso and alloxan diabetic mice. The hypogly doses produced a signicant hypoglycaemic effect in normal caemicactivitywasreportedlyassociatedwiththiscompound as well as in diabetic mice and rats (Perez-Gutierrez et al. A hexane extract from Cirsium pazcuarense (Kunth) Spreng, (reported in the original paper as Cirsium pas 3. Chloroform and methanol extracts did nicant effects compared to the control at all observed times not produce any signicant change in blood glucose levels [90,270, 180 and 1440 (24 h) min].