Cinco especies vegetales antiinflamatorias del Libellus de Medicinalibus Indorum Herbis de México, 1552: Una revisión botánica, química y farmacológica

Background and Aims: The Libellus de Medicinalibus Indorum Herbis (Little Book of the Medicinal Herbs of the Indians) includes 185 beautifully illustrated plants, 131 interpreted to species. Only some have been investigated regarding their attributed properties. Therefore, we selected six plants used as anti-inflammatories. The objectives of this work were to corroborate their botanical identity and to determine if contemporary chemical and pharmacological information supports their ancient therapeutic applications.Methods: The illustrations of the chosen plants were compared with specimens from the MEXU Herbarium to propose their possible taxonomic identity. The phytochemistry and anti-inflammatory activity of these species were reviewed in databases.Key results: The six plants selected from the Codex correspond to five species, since we consider that tetzmitl (Folium 13r) and texiyotl (Folium 22v) plants are the same species: Sedum dendroideum. Extracts from the leaves of S. dendroideum have shown anti-inflammatory activity in different pharmacological models due to derivatives of the flavonoid kaempferol, which supports its ancient medical applications to treat swollen face, eyes, and mouth. In Folium 48v, tzihuac copalli and tlacoecapatli are prescribed when “the vein punctured by the phlebotomy swells.” We agree they are Bursera bipinnata and Litsea glaucescens, respectively. To date, their possible anti-inflammatory properties have not been investigated, but other related species do present these. The Folium 22v recommends tememetla and tequixquiçacatl to relieve inflamed mouth. We corroborate that they are Echeveria gibbiflora and Distichlis spicata, respectively. These species do not have chemical-pharmacological studies.Conclusions: The bibliographic review suggests that anti-inflammatory properties attributed to S. dendroideum in the Codex have chemical and pharmacological support. Chemotaxonomic and pharmacological information suggests that B. bipinnata and L. glaucescens could bear these attributes and should be investigated experimentally. These three species are still used as anti-inflammatory in contemporary traditional medicine.Antecedentes y Objetivos: El Libellus de Medicinalibus Indorum Herbis (Librito de las Hierbas Medicinales de los Indios) incluye 185 plantas bellamente ilustradas, 131 interpretadas a especie. Solo algunas se han investigado respecto a las propiedades que ahí se les atribuyen. Por ello, seleccionamos seis plantas utilizadas como antiinflamatorias. Los objetivos de este trabajo fueron corroborar su identidad botánica y determinar si la información química y farmacológica contemporánea respalda sus antiguas aplicaciones terapéuticas.Métodos: Para proponer las especies a las cuales posiblemente corresponden las ilustraciones de las plantas elegidas, estas se compararon con especímenes del Herbario MEXU. Se revisó en bases de datos la fitoquímica y actividad antiinflamatoria de dichas especies.Resultados clave: Las seis plantas seleccionadas del códice corresponden a cinco especies, pues consideramos que las plantas tetzmitl (Folium 13r) y texiyotl (Folium 22v) son la misma especie: Sedum dendroideum. Los extractos de las hojas de S. dendroideum han presentado actividad antiinflamatoria en diferentes modelos farmacológicos debido a derivados del flavonoide kaempferol, lo cual respalda sus antiguas aplicaciones médicas para tratar la cara, ojos y boca hinchados. En el Folium 48v se prescriben tzihuac copalli y tlacoecapatli cuando “se hincha la vena pinchada por la flebotomía”. Concordamos en que son Bursera bipinnata y Litsea glaucescens, respectivamente. A la fecha, no se han investigado sus posibles propiedades antiinflamatorias, pero sí las presentan otras especies relacionadas. El Folium 22v recomienda tememetla y tequixquiçacatl para aliviar la boca inflamada. Corroboramos que son Echeveria gibbiflora y Distichlis spicata, respectivamente. Dichas especies no cuentan con estudios químico-farmacológicos.Conclusiones: La revisión bibliográfica sugiere que las propiedades antiinflamatorias atribuidas en el Códice para S. dendroideum tienen sustento químico y farmacológico. La información quimiotaxonómica y farmacológica sugiere que B. bipinnata y L. glaucescens podrían presentarlas y deben investigarse experimentalmente. Estas tres especies aún se emplean como antiinflamatorias en la medicina tradicional contemporánea

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030