Aims. For a study on the timeline of gout from the Corpus Hippocraticum to the Renaissance, encompassing some 26 authors, we have focussed on a Latin manuscript - "De podagra" - of the Middle Ages (posthumous edition dated to the 7th-8th century AD) of Rufus of Ephesus (98-117 AD), during the reign of Trajan. A multipurpose study has been devised to 1) translate into English and Italian the Medieval Latin treatise of the 7th-8th century AD of Rufus of Ephesus on "De podagra"; 2) define the role of Rufus in the historical timeline of gout from the Corpus Hippocraticum to the Renaissance ; 3) analyze causes, clinical presentations and therapy of acute attacks and chronic gout; and 4) identify the plant-based remedies described therein. Neither an English nor an Italian translation of "De podagra", nor the identification of the plants described therein, has been attempted before. Methods. Plants were identified taking into account methods used for studies on Dioscorides and Galen. Results. The findings highlight the originality of Rufus of Ephesus's clinical approach to therapy and the vast knowledge of diseases treated by plants. Conclusion. Rufus of Ephesus, the third most famous figure in medicine after Hippocrates and Galen, celebrated for his studies in obstetrics, gynecology, pediatrics, and neurology, a gouty physician, left a personal mark in the history of gout by making full use of his clinical skills that had been maximized by the severe apprenticeship in anatomy and in the Corpus Hippocraticum.

Gout is among the most prevalent etiologies of chronic inflammatory arthritis in the United States, which is characterized by monosodium urate (MSU) monohydrate crystals deposition in the tissues.[1][2] Gout was first recognized even before the common era. Hence it is arguably the most understood and manageable disease among all rheumatic diseases.[3][4] 

Gout is the oldest recorded form of inflammatory arthritis to affect humankind, with roots stretching back to 2640 BC and known in Greece by 1700 BCE. It is due to deposition of sodium monourate driven by hyperuricemia. The association of humours with causation stems from Hippocrates (460-370 BCE). More specifically, a toxic humour was suspected by Celsus (25 BCE-50 CE) and Rufus of Ephesus (98-138 CE), and confirmed by Alfred Garrod in 1849. Its therapy has been based on colchicine since Severus Iatrosophista, Theodosius the Philosopher, and Jacobus Psychrestos, introducing Colchicum as an innovative treatment for podagra in the early Byzantine period. A breakthrough in treatment was the introduction of allopurinol in 1966. This study aimed to examine gout in the Corpus Hippocraticum. For Hippocrates, gout is a disease caused by bile and phlegm, not by the wrath of a god. Gout is mentioned in the Corpus 20 times, and a total of five Aphorisms are dedicated to podagra. In Affections, "Gout is a disease that induces burning pains in the joints; it comes to paroxysms, now in one limb, now in the other, where it causes ailments of variable severity". In Prorrhetics, it is described as a disease not amenable to cure in the elderly patients with tophi - a goal achievable in the young patient willing to adhere strictly to the therapy suggested by the physician.

Gout is the commonest form of inflammatory arthritis. Flares are the commonest presentation of gout. Typically, gout flares present as acute monoarthritis, and most often affect the first metatarsophalangeal joint ('podagra'). Other joints in the lower limbs are affected more often than those in the upper limbs. Joint aspiration followed by examination of the synovial fluid using a polarised light microscope is the gold standard for a definite diagnosis of gout. Gout may be diagnosed without recourse to joint aspiration if there is podagra, elevated serum urate and no suspicion of infection. Ultrasonography and dual energy computed tomography may be used to diagnose gout if joint aspiration is unsuccessful or not feasible. Oral colchicine, NSAIDs and glucocorticoids have similar efficacy for controlling gout flare with differing adverse effect profiles. Consequently, the drug choice depends on comorbidities and patient preference.

Unlike the intense redness and painful swollen joint seen in acute gouty arthritis, classically affecting the first metatarsophalangeal joint called podagra, painless gouty tophi nodules can be found in any soft tissue throughout the body. While they frequently affect areas like the toes, fingers, and olecranon bursae, it is rare to see monosodium urate crystal deposits in the facial region, particularly the ear. This case highlights a patient with uncontrolled hyperuricemia, presenting with an uncommon manifestation of gouty tophi on the auricle. The diagnosis of auricular gouty tophi should be the primary consideration in patients with a nodular auricular mass, whitish material, uncontrolled hyperuricemia, and multiple gouty tophi. Although clinical history, examination findings, and biochemical investigations provide important diagnostic clues, definitive confirmation necessitates surgical excision and histopathological analysis.

The species of the Empis subgenus Enoplempis Bigot from western North America, including the Rocky Mountains westward, are revised. A total of 75 species are recorded from this region, including 54 new species. The western species are classified into 12 species groups as follows: the Empis (En.) arrecta species group-E. (En.) arrecta sp. nov., E. (En.) diokra sp. nov., E. (En.) occidentalis sp. nov., E. (En.) shoshona sp. nov.; the Empis (En.) bigoti species group-E. (En.) aerobatica Melander, E. (En.) bigoti Melander, E. (En.) collinsi sp. nov., E. (En.) montgomeryi sp. nov., E. (En.) multifaria sp. nov., E. (En.) paraerobatica sp. nov., E. (En.) podagra Melander; the Empis (En.) canaster species group-E. (En.) arizonensis sp. nov., E. (En.) canaster Melander, E. (En.) chillcotti sp. nov., E. (En.) contrasta sp. nov., E. (En.) falcata Melander, E. (En.) fitzgeraldi sp. nov., E. (En.) safra sp. nov., E. (En.) sagehenensis sp. nov., E. (En.) spokanensis sp. nov., E. (En.) subcanaster sp. nov.; the Empis (En.) clava species group-E. (En.) clava sp. nov., E. (En.) mariposa sp. nov., E. (En.) tularensis sp. nov.; the Empis (En.) delumbis species group-E. (En.) delumbis Melander, E. (En.) floricola sp. nov., E. (En.) sphaera sp. nov., E. (En.) spiculata sp. nov., E. (En.) tripenicillata sp. nov.; the Empis (En.) geneatis species group-E. (En.) fisheri sp. nov., E. (En.) geneatis (Melander), E. (En.) oharai sp. nov., E. (En.) subgeneatis sp. nov.; the Empis (En.) manca species group-E. (En.) bova sp. nov., E. (En.) manca Coquillett, E. (En.) submanca sp. nov., E. (En.) wilderae sp. nov.; the Empis (En.) mira species group-E. (En.) macdonaldi Sinclair, Brooks & Cumming, E. (En.) mira (Bigot), E. (En.) submira Sinclair, Brooks & Cumming, E. (En.) williamturneri Sinclair, Brooks & Cumming, E. (En.) winkleri Sinclair, Brooks & Cumming; the Empis (En.) nodipoplitea species group-E. (En.) nodipoplitea Steyskal; the Empis (En.) teres species group-E. (En.) scotti sp. nov., E. (En.) scutica sp. nov., E. (En.) teres Melander, E. (En.) undulasetosa sp. nov.; the Empis (En.) turgida species group-E. (En.) turgida sp. nov., E. (En.) woodleyi sp. nov.; and the Empis (En.) valentis species group-E. (En.) aeripes Melander, E. (En.) disconvenita Melander, E. (En.) dolabraria Melander stat. rev., E. (En.) flavobulla sp. nov., E. (En.) fresno sp. nov., E. (En.) mixopolia Melander, E. (En.) paraeripes sp. nov., E. (En.) subaeripes sp. nov., E. (En.) valentis Coquillett. Additionally, the following 17 western species are unplaced to species group: E. (En.) aphela sp. nov., E. (En.) blodgettensis sp. nov., E. (En.) californica sp. nov., E. (En.) cerina sp. nov., E. (En.) culcitella sp. nov., E. (En.) delnortensis sp. nov., E. (En.) dubitata sp. nov., E. (En.) genista sp. nov., E. (En.) holoptica sp. nov., E. (En.) manning sp. nov., E. (En.) missoula sp. nov., E. (En.) oregonensis sp. nov., E. (En.) poplitea Loew, E. (En.) richardvockerothi sp. nov., E. (En.) sierraensis sp. nov., E. (En.) susanae sp. nov., E. (En.) yakimensis sp. nov. The following new synonymy is designated: E. (En.) bullifera Kessel & Kessel = E. (En.) bigoti. Lectotypes are designated for the following species: E. (En.) aeripes, E. (En.) disconvenita, E. (En.) dolabraria, E. (En.) mixopolia, E. (En.) aerobatica, E. (En.) podagra, E. (En.) canaster, E. (En.) falcata, E. (En.) delumbis, E. (En.) manca, E. (En.) teres and E. (En.) poplitea. A key to all the western species is presented with distributions illustrated. The form of nuptial gift presentation displayed within this group, including the use of balloons (with or without prey) and unwrapped prey is indicated for species when known. In addition, new eastern records are listed and two new species from eastern North America are described (E. (En.) deceptiva sp. nov. and E. (En.) joanae sp. nov.). A complete list of all known species and species groups in the subgenus Enoplempis is also provided.

Gout is typically characterized by hyperuricemia and monosodium urate deposition in and around the joints. In individuals affected by gout, the condition can progress through the following phases: asymptomatic hyperuricemia, monosodium urate crystal deposition, acute gout, intercritical period, and chronic gout. Two of the following are required to establish the diagnosis of gout: at least two attacks, observation or a history of podagra or the presence of a tophus, and prompt response after starting treatment with colchicine. A 65-year-old man whose acute gout attack presented with a warm, exquisitely tender, erythematous, area of swelling that affected the first metatarsal of his left great toe (podagra) is described. A short oral course of prednisone treatment successfully managed his acute gout attack. His subsequent workup revealed a slightly elevated serum uric acid level and bilateral gout-related bone changes that were demonstrated on the roentgenograms of his feet. Several systemic medications are available for the management of acute and chronic gout and to prevent the recurrence of gout. However, for individuals who cannot tolerate or are unwilling to use these drugs, an approach that incorporates alternative and complementary medicine may be considered. The patient was not able to be treated with the standard systemic medications that are usually used for individuals with gout. He decided to take vitamin C (at a daily dose alternating from 500 mg to 1000 mg) after his acute attack resolved, since vitamin C has been demonstrated to lower serum uric acid levels and reduce the risk of gout. After a follow-up period of nearly one year, he has not had a recurrent acute gout attack. In conclusion, several systemic medications are recommended for the treatment and prevention of gout; however, for those individuals in whom the standard drugs for managing gout are either ineffective or contraindicated, alternative and complementary medicines may be used for the management of gout.

Introduction: Cardinal Decio Azzolino Jr. (1623-1689), a leading figure at the Roman curia in the 17th century met in 1655 queen Christina of Sweden, arrived in Rome after her conversion to Roman Catholicism. The queen appointed the cardinal as her universal testamentary heir before her death on April 16th, 1689. Azzolino died of a sudden death shortly after, on June 8th. The article aims to question Azzolino's sudden death through the analysis of the cardinal's illnesses from which he was afflicted in the last decades of his life, examining the most likely causes of his demise. Methodology: Various unpublished epistolary letters were analysed, according to the chronological order of production between 1660 and 1689. A philological approach coupled with clinical-medical hypothesis inferable by the examined sources. Results: The cause of death is identified as an unexpected dropsy in some letters and the death certificate. The analysis of the letters allows the reconstruction of Azzolino' state of health and illnesses in the last two decades of life: bilious excesses, inflammations, podagra and gout, which appeared with the inflammation of the knee and walking difficulties, and, finally, asthenia, dyspnea and a probable stroke. Conclusion: The dropsy is a symptom underlying various possible pathologies. The cardinal's state of health had been precarious and already marked by various symptoms, which were progressively worsening over the last decades of his life. The hypothesis of a stroke is also plausible. His death was not sudden as the Roman curial environments lead us to believe.

Introduction Gout, a chronic inflammatory joint disease, is increasingly prevalent worldwide, mainly affecting men, young females, and post-menopausal women. This study aims to investigate gout epidemiology in Al-Baha, Saudi Arabia, addressing the dearth of localized data on prevalence, risk factors, and management practices. Methods A cross-sectional analysis was conducted at King Fahad Hospital, Al-Baha, Saudi Arabia, covering 116 patients from March 2016 to November 2017. Data encompassed demographics, clinical presentations, and biochemical markers relevant to gout. Results Among 116 patients, 41 (35.3%) were diagnosed with gout, with males exhibiting a significantly higher prevalence than females (43.9% vs. 24%). Significant associations were found between gout prevalence and residency, occupational status, education level, clinical presentations (podagra, arthralgia/arthritis), and biochemical markers. Conclusion This study enriches global knowledge by providing localized insights into gout's epidemiology and highlighting demographic influences and clinical presentations specific to the Saudi context. The findings underscore the importance of tailored approaches in gout management, considering regional variations in prevalence, risk factors, and clinical manifestations.