Search Results (15)

Symptoms of respiratory tract infections (RTI) caused by viral or bacterial triggers include sore throat and cough. Plantago lanceolata (ribwort plantain) is used in herbal medicine to treat symptoms of RTI. This study evaluated the pharmacological actions of P. lanceolata extract (PL) and StrepCough Plantain-Dry cough syrup (PLS) in in vitro models of sore throat and cough. Human tonsil epithelial cells (HTEpiC) cells were stimulated with a combination of lipoteichoic acid and peptidoglycan in the presence or absence of PL or PLS. Levels of TNF-α, IL-6, PGE₂, and COX-2 were measured using ELISA, while phospho-p65 protein levels were measured using Lumit^® immunoassay. The effects of PL and PLS on bradykinin-induced inflammation and increased intracellular Ca²⁺ were investigated in bronchial epithelial cells (BEAS-2B), cells over-expressing TRPV1. Results showed that the pre-treatment of HTEpiC cells with PL and PLS resulted in a significant (p < 0.05) reduction in the LTA + PGN-induced increased production of TNFα, IL-6, PGE₂, as well as COX-2 and phospho-p65 protein levels. Bradykinin-induced increased levels of TNFα, IL-6, and PGE₂ in BEAS-2B cells over-expressing TRPV1 were also reduced by PL and PLS, while reducing levels of intracellular Ca²⁺. This study has demonstrated that extract of P. lanceolata and StrepCough Plantain-Dry cough syrup reduce inflammation in human tonsil epithelial cells. The extract and syrup also reduced TRPV1-mediated inflammation and increased intracellular Ca²⁺ in BEAS-2B bronchial epithelial cells. This study has provided pharmacological evidence for the use of P. lanceolata in healthcare interventions to treat symptoms of respiratory tract infection. Full article

Background: Self-medication (SM) among women during pregnancy poses a critical risk to maternal health, and SM is still commonly practiced in Saudi Arabia. Therefore, this study aims to assess the factors, attitudes, and prevalence of SM among pregnant women in the Ministry of Health (MOH) First Health Cluster. Methods: A cross-sectional design was used among 400 pregnant women who received care at primary, secondary, and tertiary healthcare levels. A structured tool was adopted and modified based on the literature review, expert and focus group interviews, and the experiences of the target participants. The dependent variables included history of illness, access to healthcare services, medication usage, and perception of SM, while the independent variables included socioeconomic status. Statistical Package for the Social Sciences (SPSS), Version 25 was used for analysis. Results: The prevalence of SM was 36.5%. Cough syrup and antipyretics were the most commonly used medications, while hair problems and weight loss were the most frequently reported reasons for SM. The primary sources of information guiding SM behavior were prior prescriptions and previous experience. Education level, occupation, age, number of pregnancies, and miscarriage history were all significantly associated with SM (p < 0.05). Conclusions: SM was found to be frequent among pregnant women in the First Health Cluster, highlighting the need for educational interventions and regulatory measures to reduce unsafe practices and improve maternal health. Full article

Background/Objectives: The rational use of medicines, in accordance with the World Health Organization (WHO) guidelines, is crucial for optimizing healthcare outcomes. This cross-sectional study aimed to evaluate drug prescribing patterns and assess prescription completeness based on the WHO core drug use criteria. A comprehensive analysis was conducted at the University Clinic in the Northern region, Kingdom of Saudi Arabia (KSA). Methods: The study assessed drug prescribing patterns and examined prescription completeness by analyzing various parameters recommended by the WHO core drug use criteria. Results: Upon analyzing the 615 prescriptions, it was observed that each prescription had a mean of 2.56 prescribed drugs. Multiple medicines per prescription were prevalent in 71.4%, whereas polypharmacy was evident in 2.9%. Analgesics were the most frequently prescribed medication, accounting for 50.4% of the prescriptions, followed by supplements (31.7%), decongestants (16.1%), cough syrup (12%), and antihypertensive and diabetes treatments at 17%. Furthermore, antimicrobials were prescribed in 21.5% of the prescriptions. During the evaluation, it was found that 19.8% of the prescriptions were incomplete, lacking important information on dosing, duration, and drugs not suited to the diagnosis. Conclusions: Most of the parameters evaluated in this study were determined to fall outside the range of recommended guidelines criticized by the WHO. As a result, the implementation of efficient intervention programs, such as education initiatives, is recommended to enhance the practice of rational drug use. Contribution: This study highlights the importance of improving prescription indicators at the national level, focusing on both medication prescribing characteristics and prescription quality as a practice. Full article

Background and Clinical Significance: Licorice (glycyrrhiza glabra) cough syrup intoxication is manifested with refractory hypokalemia, hypertension, and metabolic alkalosis. The transformation of glycyrrhiza glabra metabolic into glycyrrhetic acid after ingestion further inhibits the 11-β-hydroxysteroid dehydrogenase-2 enzyme, impeding the conversion of cortisol into cortisone. The accumulation of cortisol can also stimulate mineralocorticoid receptors, which leads to a pseudo-hyperaldosteronism-like effect. Case Presentation: We report a 60-year-old male patient with licorice intoxication due to the chronic consumption of licorice cough syrup. He exhibited a transient seizure lasting approximately one minute. Initially, hypokalemia (potassium level was 2.0 mmol/L), metabolic alkalosis, and QT interval prolongation with premature ventricular complexes were demonstrated on his electrocardiogram. Despite the administration of both intravenous and oral potassium supplements over two days, there was no significant improvement in hypokalemia. Spironolactone, an aldosterone receptor antagonist, was administered in addition to ongoing potassium supplementation from the 3rd day. This intervention led to a rapid normalization of hypokalemia in one day. The patient was ultimately discharged on the 6th day without any subsequent complications. Conclusions: The licorice-induced chronic intoxication, which led to pseudo-hyperaldosteronism and refractory hypokalemia, was successfully managed with aggressive potassium supplementation and spironolactone treatment. Full article

Cough is a common presenting symptom for patients in a primary care setting and significantly impacts a patient’s quality of life. Cough involves a complex reflex arc beginning with the stimulation of sensory nerves that function as cough receptors that stimulate the cough center in the brain. This “cough center” functions to receive these impulses and produce a cough by activating efferent nervous pathways to the diaphragm and laryngeal, thoracic, and abdominal musculature. Drugs that suppress the neural activity of cough are non-specific as those treatments are not directed toward pathogenic causes such as inflammation and oxidative stress. Moreover, they block a reflex called the watchdog of the lung and have a defense mechanism. Acute respiratory infections of the upper and lower airways most commonly cause acute cough. In contrast, the most common causes of chronic cough are upper airway cough syndrome, asthma, and gastroesophageal reflux disease, all associated with an inflammatory reaction at the level of the cough receptors. The use of natural compounds or herbal drugs such as carob syrup, dry blackcurrant extract, dry extract of caraway fruit, dry extract of ginger rhizome, dry extract of marshmallow root, and dry extract of ivy leaves, to name a few, not only have anti-inflammatory and antioxidant activity, but also act as antimicrobials, bronchial muscle relaxants, and increase gastric motility and empty. For these reasons, these natural substances are widely used to control cough at its deep roots (i.e., contrasting its causes and not inhibiting the arch reflex). With this approach, the lung watchdog is not put to sleep, as with peripheral or central inhibition of the cough reflex, and by contrasting the causes, we may control cough that viruses use at self-advantage to increase transmission. Full article

Background: Coronavirus disease 2019 (COVID-19) has rapidly spread worldwide and is characterized by different presentations ranging from asymptomatic to severe pneumonia. COVID-19 affects all age groups, including pediatric patients. We observed numerous children complaining of a cough post-COVID-19, even if it was trivial. The most reported persistent symptoms after recovery from COVID-19 were insomnia, coughing, fatigue, dyspnea, loss of taste and/or smell, and headache. To date, residual cough post-COVID-19 has been reported in pediatrics and adolescents. Method: we conducted a retrospective study, with a self-administered questionnaire by the patient or caregiver, 12 months post-COVID-19-infection. Result: A total of 94.8% of patients were Saudi citizens and were mainly from the southern region of Saudi Arabia (50.0%). Mothers (64.4%) submitted most of the results. The ages were as follows: 6–14 years (51.0%), 3–5 years (32.3%), and younger than 2 years of age (only 16.7%). Females accounted for 41.7% of those studied. Nearly half of the patients (48.5%) had had a previous COVID-19 infection in 2022, with only 2.1% infected in 2019. Only 27/194 (13.9%) patients required hospital admission, and 7 of them (4.2%) required intensive care treatment. A total of 179 (92.2%) patients still reported persistent symptoms 4 weeks post-COVID-19-infection. A cough was reported in 69.8% of patients, followed by cough and wheezing in 12.3%. The cough was described as dry in 78.0% and nocturnal in 54.1%, while 42.5% did not notice any diurnal variation. For those reporting residual cough, 39.3% found that it affected school attendance and daily activities, 31.1% reported associated chest pain, 51.9% associated it with wheezing, and 27.1% associated it with shortness of breath. For 54.4%, the residual cough lasted less than one month, while 31.4% reported a 1–2 month duration. Only 1.0% had a duration of cough of more than 3 months. For cough relief, 28.2% used bronchodilators, 19.9% used cough syrup, 16.6% used a combination of bronchodilators and steroid inhalers, and 1.7% used antibiotics. Surprisingly, 33% attempted herbal remedies for cough relief. Sesame oil was used the most (40.0%), followed by a mixture of olive oil and sesame oil (25.0%), and 21.7% used male frankincense. The majority (78.4%) sought medical advice for their post-infection cough, either from general pediatricians (39.5%) or via specialist pediatric pulmonology consultations (30.9%). A total of 11.0% with a residual cough reported having pets at home, while 27.2% reported secondhand smoke exposure in the household. Before infection with COVID-19, only 32.6% were diagnosed with asthma, while 68.2% reported a diagnosis of atopic skin. Conclusions: There was a high prevalence of residual cough post-COVID-19, extended for a minimum of two months, and the characteristics of the cough were very similar to those of asthmatic patients. There was still a high prevalence of using cough syrup and herbal remedies, especially olive oil, sesame oil, and male frankincense. A residual cough adversely affected school attendance in daily activities, and there was a high prevalence of other siblings in the family being affected. The study showed that a minority of patients were seen by the pulmonologist; luckily, long COVID was rare in our study, and so further studies are highly needed to confirm the association with asthma. More educational programs are highly needed regarding herbal remedies and cough syrup. Full article

The public generally believes OTC medicines to be helpful for treating minor ailments. From a survey point of view, that position often originates from feedback obtained when these medicines are considered as one broad category. The objective of the study was to assess the properties of 15 categories of agents across three dimensions—effectiveness, safety, and familiarity. Data were gathered via an online non-random survey in one Canadian province, where residents were asked to consider 15 OTC medicine categories in terms of those dimensions. Five hundred and seventy-five completed surveys were obtained out of 3000 sent. On the 10-point effectiveness scale, values ranged from 5.1 (Athlete’s foot cream) to 7.3 (headache medicine). For safety, the medicines were closely grouped (6.0 to 7.4). Cough syrups for children were perceived as less safe than those for adults. There was a trend in that, as product familiarity grew, so did impressions of safety and effectiveness. The results support other reports where OTC medicines are described as safe and effective, although safety ratings were not particularly high. Responders considered these medicines to generally be higher in safety than effectiveness. Full article

Self-medication (SM) is characterized by the procurement and use of medicines by bypassing primary healthcare services and without consulting a physician, usually to manage acute symptoms of self-diagnosed illnesses. Due to the limited availability of primary healthcare services and the anxiety associated with the COVID-19 pandemic, the compulsion to SM by the public has increased considerably. The study aimed to assess the characteristics, practices, and associated factors of SM by the public during the COVID-19 pandemic in Sargodha, Pakistan. χ²-tests and univariable analyses were conducted to explore the identification of characteristics and the potential contributing factors for SM during COVID-19, while multivariable logistic regression models were run to study the effect of variables that maintained a significant association. The study was performed during July–September 2021, with n = 460 questionnaires returned overall (response rate: 99.5%). The majority of respondents were males (58.7%, n = 270) who live in the periphery of the town (63.9%, n = 294), and most of the respondents belonged to the age group of 18–28 years (73.3%, n = 339). A large number, 46.1% (n = 212), of the participants were tested for COVID-19 during the pandemic, and among them, 34.3% (n = 158) practiced SM during the pandemic; the most common source of obtaining medicines was requesting them directly from a pharmacy (25.0%; n = 127). The chances of practicing SM for medical health professionals were 1.482 (p-value = 0.046) times greater than for non-medical health personnel. The likelihood of practicing SM in participants whose COVID-19 test was positive was 7.688 (p-value < 0.001) times more than who did not test for COVID-19. Allopathic medicines, acetaminophen (23.6%), azithromycin (14,9%), and cough syrups (13%), and over the counter (OTC) pharmaceuticals, vitamin oral supplements, such as Vitamin C (39.1%), folic acid (23.5%), and calcium (22.6%), were the most commonly consumed medicines and supplements, respectively; being a healthcare professional or having a COVID-test prior showed a significant association with the usage of Vitamin C (p < 0.05 in all cases). Respondents who mentioned unavailability of the physician and difficulty in travelling/reaching healthcare professionals were found 2.062-times (p-value = 0.004) and 1.862-times (p-value = 0.021) more likely to practice SM, respectively; SM due to fear of COVID was more common in individuals who had received COVID-tests prior (p = 0.004). Practices of SM were observed at alarming levels among our participants. Consciousness and understanding about the possible adverse effects of SM must be established and validated on a continuous level; in addition, on a commercial level, collaboration from pharmacists not to sell products (especially prescription-only medicines) without a certified prescription must be developed and implemented. Full article

The geographical and ecological features of Transylvania enable the wide ethnobotanical use of pine species. The aim of this study was to survey the current ethnomedicinal and other traditional use of pine species of Hungarian-speaking ethnic groups in Transylvania and to compare them with earlier reports performed in Transylvania and from other countries related to the Carpathian Basin. Information on pine species was obtained using semi-structured interviews with 515 Transylvanian informants from 18 villages in the period 2007–2019. The young shoots of Abies alba Mill., Picea abies (L.) H. Karst., Pinus nigra J. F. Arnold, and Pinus sylvestris L. were applied to treat respiratory diseases, while the resin was used for dental problems. Syrup and decoction were made from the cones of all species, except Abies alba. Picea abies was the most frequently documented with seven preparations from different parts (even needles), and this species was mentioned in the treatment of 21 diseases. The least recorded was Abies alba, which was applied for coughs and decayed teeth. We recorded the use of the cones and needles of Picea abies for dyspnoea, thyroid glands, and kidney disorders, previously unknown in ethnomedicinal literature. Our data on the pine species confirm their current use and significance in Transylvania. Full article

A reversed-phase high-pressure liquid chromatography (RP-HPLC) method was developed and subsequently validated for the simultaneous determination of butamirate citrate (BC) and benzoic acid (BA) in cough syrup. The separation was performed employing a cyanopropyl column with a mobile phase consisting of 50%/50% v/v MeOH/NaH₂PO₄ * H₂O 50 mM aqueous solution pH = 3.0. The quantitation was achieved with a diode array detector (DAD) at 210 nm. The method demonstrated a congenitally satisfactory separation, yet the acquired peaks were asymmetrical. This effect was eliminated by using 1% triethylamine in the buffer solution as a silanol blocker. In addition, the method was found to unequivocally assess the target analytes in the sample matrix and fulfilled the required specifications in relevance to specificity, linearity, accuracy, precision and stability of both the standard solutions and of the sample solutions. Lastly, an experimental design was designed in order to assess the robustness of the proposed assay. To this purpose, a graphical and a statistical approach were utilized and compared to identify the factors that should be strictly controlled during each execution of the method. Full article

Expectorant phytomucolytic syrups are widely used pediatric OTC-medicines. Physicians, pediatricians, and pharmacists are traditionally concerned with the efficacy of the active ingredients in cough syrups, and rarely consider the safety aspects of excipients that however are not absolutely “inactive” and are proved to initiate some negative reactions and interactions with other drugs. This paper presents a review, categorization, and comparative analysis of the safety profile of excipients contained in the 22 best-selling OTC pediatric phytomucolytic syrups available in pharmaceutical markets in Ukraine and Germany and proposes an approach to the consideration of the excipients’ safety risks for a pharmacist in the process of pharmaceutical care. The study has revealed that only one of the twenty-two analyzed syrups does not contain any potentially harmful excipients. The results of this analysis were used for developing a specific decision tool for pharmacists that can be used for minimizing excipient-initiated reactions when delivering OTC phytomucolytic syrups for children. Full article

Eco-design is included within the framework of the standard for “Environmental management systems—Guidelines for incorporating Eco-design” (ISO 14006:2011). Eco-design process, as defined in standard, has six steps: (i) Specify product functions; (ii) Environmental assessment of products; (iii) Strategies of improvement; (iv) Environmental objectives; (v) Product specification; and (vi) Technical solutions. Step (ii), determination of the stage or process of the product life cycle that has the highest environmental impact; this is perhaps the most controversial step because the standard does not specify which tool should be used. This lack of specification has generated some distrust with regard to eco-design, hindering its development. In order to make a trustworthy eco-design, Life Cycle Assessment (LCA) should be applied as a tool for environmental impact quantification. The main objective of this work is to apply standardised eco-design methodology for the reduction of the environmental impact of an industrial product in Spain using LCA as a tool for the environmental product assessment. LCA standardised process (ISO 14040,14044:2006) is included in the eco-design process. A glass container intended for cough syrup delivery has been selected as an industrial product to be eco-designed. Following the methodology described, the overall normalised impact decreased 35.1% when a PET container substituted a glass container. Environmental impacts have been reduced following standardised eco-design and LCA methodologies, serving as an example to industry and administration regarding how to eco-design with the confidence of obtaining reliable results. Full article

Plants have been used since antiquity to treat and prevent diseases. Plantain (Plantago lanceolata L.) is traditionally used for the treatment of the common cold and associated symptoms such as cough. This study was designed to evaluate the oral toxicity of plantain leaf extract-containing syrup. In preparation of the toxicological examination and to ensure the quality of the herbal preparation, analytical methods were developed and validated, and stability testing was performed. Physicochemical and microbial quality, thin layer chromatography patterns and high performance liquid chromatography fingerprints complied with the specifications during the entire period of stability testing. The marker substance, acteoside, remained within the stability-defining limits of 90%–110% for quantitative determinations. No hint of toxicity emerged from 14-day repeat dose toxicity testing in rats. The animals were given doses of 3, 6, or 12 mL of syrup per kg body weight by gavage twice daily. All animals showed normal appearance and behavior. Body and organ weights at the end of the study were similar to those in the control group. Overall, P. lanceolata syrup was found to be stable and non-toxic under the test conditions. Full article

The treatment and management of acute cough due to common cold costs billions of dollars of healthcare expenditure and there is a growing opinion that a simple linctus containing glycerol with flavourings such as honey and lemon is a safe and effective treatment for acute cough in children and adults. Glycerol is a component of most cough syrups, and although it is often thought of only as a solvent or thickening agent in cough syrups, it may be a major component for the efficacy of cough syrups due to its special properties of lubrication, demulcency, sweetness, and acting as a humectant. The major benefit of cough syrups in soothing cough is likely due to the properties of the syrup rather than the active ingredients and this review discusses the special properties of glycerol in relation to the treatment of acute cough. Full article

Guaco (Mikania glomerata Sprengel) syrup is one of the most popular herbal medicines used to treat the symptoms of asthmatic bronchitis, cough and hoarseness. The coumarin 2H-1-benzopyran-2-one, is one of the major constituents of Guaco and contributes to its pharmacological effects. The pharmaceutical capsule form of dry extract of Guaco is recommended by the Brazilian Program of Medicinal Plants and Herbal Medicines and used in primary health care. In order to identify a new protocol to obtain the raw material for Guaco capsule production we evaluated two methods, including a freeze-drying process (lyophilization) and the spray-dryer technique, as well as the use of two adjuvants, Maltodextrins and Aerosil^®, in different concentrations. The coumarin levels of the dried extracts were analyzed by UV-spectrophotometry and HPLC-UV/DAD. The adjuvant Aerosil^® 8% showed better dry powder physical appearance. Lyophilization was observed to be the best process to obtain the dry extract of Guaco based on the measured coumarin levels. Full article