Non-invasive treatment of an acute sinusitis after open maxillary sinus floor augmentation with simultaneous bone graft and implant placement: case report

Currently, the maxillary sinus floor augmentation technique is one of the most common procedures used in implantology. Despite being a straightforward techn istula, epistaxis, perforation of the Schneiderian membrane and acute sinusitis. Although many theories have been proposed as to the etiology of sinusitis, the majority of cases are due to idiopathic causes. Its treatment can often be very complex and traumatic for the patient. It normally involves antibiotic treatment combined with surgical or endoscopic procedures. The following case describes the full resolution of this disorder with abundant sinus rinsing with salt water and combined treatment of antibiotics and mucolytics without the need for removal of the implant or bone graft. Despite the disorder in this case being eradicated with a different approach combining antibiotics, mucolytics and sinus rinses, it is concluded that more studies are necessary before it is established as a definitive treatment procedure.

Actividad expectorante y toxicológica de una formulación elaborada a partir de Eucalyptus globulus Labill, Borago officinalis L, Y Sambucus Nigra L / Expectorant and toxicological activity of a formulation made from Eucalyptus globulus Labill, Borago officinalis L., and Sambucus Nigra L

Introducción: Eucalyptus globulus Labill., (eucalipto), Borago officinalis L. (Borraja) y Sambucus nigra L. (saúco) son especies vegetales de amplio uso popular por sus propiedades antitusígenas y mucolíticas. Objetivo: evaluar los efectos farmacológico y toxicológico de un fitofármaco elaborado con el extracto de la mezcla de las tres plantas. Métodos: a partir de las hojas secas de cada especie, se elaboraron dos extractos fluidos de las tres plantas: E. globulus B. officinalis y S nigra, mezcladas en proporción 25:25:50, respectivamente, se empleó el método de percolación y como disolventes etanol de concentraciones al 30 y 70 por ciento. Para la evaluación del efecto mucolítico se empleó el modelo de Rojo Fenol en secreciones de ratón y se ensayaron los extractos de concentraciones alcohólicas al 30 y 70 por ciento. El estudio toxicológico se realizó al extracto de concentración alcohólica al 70 por ciento. Resultados: en la evaluación farmacológica se encontró que los extractos hidroalcohólicos al 30 y 70 por ciento presentaron efecto mucolítico, con una efectividad ligeramente superior para el extracto en alcohol al 70 por ciento. Cuando se evaluó toxicológicamente, este extracto no presentó efecto tóxico en el ensayo de toxicidad aguda a dosis límite. Conclusiones: las formulaciones elaboradas con los extractos fluidos de las plantas empleando etanol al 30 y 70 por ciento, mostraron efecto mucolítico en el modelo de rojo fenol en secreciones de ratón y con las condiciones experimentales del estudio. El extracto de las plantas en etanol al 70 por ciento no presentó efecto tóxico en el ensayo de toxicidad aguda a dosis límite(AU)

Introduction: Eucalyptus globulus Labill. (eucalyptus), Borago officinalis L. (borage) and Sambucus nigra L. (elder) are plant species commonly used in folk medicine for their antitussive and mucolytic properties. Objective: Evaluate the pharmacological and toxicological effects of a drug made with an extract obtained from a mixture of the three plants. Methods: Two fluid extracts were obtained from dry leaves of the three species, E. globulus, B. officinalis and S. nigra, mixed in a 25:25:50 proportion. The method used was percolation and the solvents were 30 percent and 70 percent ethanol. The mucolytic effect was evaluated with the phenol red model in mouse secretions, and assays were conducted of the 30 percent and 70 percent alcoholic extracts. Toxicological analysis was performed on the 70 percent alcoholic extract. Results: Pharmacological evaluation found that 30 percent and 70 percent hydroalcoholic extracts display a mucolytic effect, effectiveness being slightly higher in the 70 percent alcoholic extract. When evaluated toxicologically, this extract did not show any toxic effect in the dose-limiting acute toxicity test. Conclusions: The formulations developed with fluid plant extracts using 30 percent and 70 percent ethanol were found to have a mucolytic effect in the red phenol model in mouse secretions under experimental test conditions. The 70 percent ethanolic plant extract did not have a toxic effect in the dose-limiting acute toxicity tes(AU)

Expectorant and Antitussive Effect of Hedera helix and Rhizoma coptidis Extracts Mixture

PURPOSE: This study aims to investigate the additive effect of the Hedera helix (HH) and Rhizoma coptidis (RC) extracts mixture on antitussive and expectorant activities in animals. MATERIALS AND METHODS: The expectorant assay was performed with phenol red secretion in mice trachea. Mice or guinea pigs were randomly divided into groups of 8 each, including negative and positive control groups. After gastric administration of the test extracts in mice, 2.5% phenol red solution (0.2 mL) was intraperitoneally injected. Trachea was dissected and optical density of tracheal secretion was measured. After gastric administration of the test extracts in guinea pigs, the antitussive activities were assessed using a citric acid-induced cough measurement. RESULTS: The extracts of HH and RC significantly increased tracheal secretion and inhibited cough. The mixture of HH and RC extracts in a 1:1 concentration at a dose of 200 mg/kg showed a more potent effect on phenol red secretion (25.25+/-3.14) and cough inhibition (61.25+/-5.36) than the individual use of each extracts [phenol red secretion; HH 13.39+/-4.22 (p=0.000), RC 20.78+/-2.50 (p=0.010), cough inhibition; HH 9.89+/-4.14 (p=0.010), RC 30.25+/-7.69 (p=0.000)]. A 3:1 ratio mixture of HH to RC demonstrated an optimal expectorant effect (p<0.001), and this mixture showed expectorant and antitussive effects in a dose-dependent manner. CONCLUSION: This study provides evidence for antitussive and expectorant effect of a 3:1 mixture of HH and RC, which may be a useful therapeutic option for respiratory diseases.

Drug therapy for the common cold

The common cold is an acute, self-limiting viral infection of the upper respiratory tract involving the nose, sinuses, pharynx and larynx. Drug therapies for the common cold are normally aimed at relieving the symptoms of the illness. Over-the-counter cough and cold medications should not be used in children younger than four years old because of potential harms and lack of benefit. Antibiotics, antitussives, anti-histamines, and inhaled corticosteroids are not effective in children. Products that may improve symptoms in children include expectorants, mucolytics, honey, vitamin C, zinc lozenges, geranium extract, and nasal saline irrigation. In adults, antihistamines, intranasal corticosteroids, codeine, intranasal ipratopium, and antibiotics are not effective. Decongestants, antihistamine/decongestant combi-nations, expectorants, and mucolytics may improve cold symptoms in adults. Nonsteroidal anti-inflammatory drugs and acetaminophen reduce pain secondary to upper respiratory tract infection in adults. Among complementary and alternative medicinetherapeutics, products containing vitamin C, zinc, or garlic may improve cold symptoms in adults. Prophylactic use of probiotics may decrease the frequency of colds in adults and children.

Fisiopatologia da Fibrose Cística e drogas habitualmente utilizadas nas manifestações respiratórias: o que devemos saber / Pathophysiology of Cystic Fibrosis and drugs commonly used in respiratory manifestations: what should we know

INTRODUÇÃO: A fibrose cística é caracterizada por infecções crônicas nas vias respiratórias e alterações no trato digestório. É uma doença de herança autossômica recessiva e pode ser diagnosticada na infância através de programas como a triagem neonatal e, dessa forma, estabelecer tratamento precoce. OBJETIVO: Identificar a fisiopatologia das manifestações respiratórias causada pela fibrose cística, relacionando o tratamento com as principais drogas administradas. MÉTODOS: Trata-se de uma revisão da literatura, com ênfase nos últimos 12 anos, utilizando-se artigos científicos publicados em revistas indexadas nas bases de dados SciELO, Lilacs, PubMed e MedLine, nos idiomas português e inglês. Foram selecionados estudos clínicos randomizados, observacionais, experimentais, epidemiológicos, entre outros, com significância estatística de 5%. RESULTADOS: A divulgação de forma mais ampla da doença e seu tratamento está relacionada a locais onde hajam centros de referência. O estudo da fisiopatologia da enfermidade e as drogas habitualmente utilizadas nas manifestações respiratórias visa demonstrar quais medicamentos e posologias vem sendo habitualmente utilizado com eficácia , com isso , uma melhora do quadro clinico dos pacientes e qualidade de vida. CONCLUSÃO: É uma doença que acomete uma variedade de órgãos e que há uma variedade de fármacos disponíveis para o tratamento, acompanhamento e melhora na sobrevida dos fibrocísticos, principalmente quando são oferecidos a estes pacientes o acesso às políticas públicas de saúde como o diagnóstico precoce e a assistência para a aquisição de medicamentos especializados, disponíveis para os usuários de programas especializados e de alta complexidade do Sistema Único de Saúde.

INTRODUCTION: Cystic fibrosis is a disease characterized by chronic airway infections and changes in the digestive tract. It is an autosomal recessive disease and can be diagnosed in children through programs such as newborn screening and thus establish early treatment. OBJECTIVE: Identify the pathophysiology of respiratory disease caused by cystic fibrosis, correlating with the main treatment administered drugs. METHODS: This is a review of the literature with emphasis on the last 12 years, using scientific articles published in journals indexed in databases SciELO, Lilacs, PubMed and MedLine, in Portuguese and English. After the survey were selected randomized clinical trials, observational, experimental, epidemiological, among others, with statistical significance of 5%. RESULTS AND DISCUSSION: The dissemination more broadly the disease and its treatment is related to places where there are reference centers and several difficulties encountered in the treatment and monitoring. Thus, the study of the pathophysiology of the disease and drugs commonly used in respiratory symptoms aims to demonstrate current drugs, which has shown a proven and significant improvement in the clinical picture of patients and quality of life. CONCLUSION: Cystic Fibrosis is a disease that affects a variety of organs and that there are a variety of drugs available for treatment, monitoring and improvement in survival of CF patients, especially when these patients are offered access to public health policies as early diagnosis and assistance for the acquisition of specialized medicines available for users of specialized programs and high complexity of the Unified Health System

Review of Mesna (Mistabron) as a Mucolytic for Preventing Plumonary complications in Intensive Care Setting.

Impaired mucus clearance or mucus hypersecretion are important feature of many pathological respiratory conditions and in ICU patients. Mesna is a potent mucolytic available as 200 mg/ml solution for neublization and endotracheopulmonary instillation. As effective “mucus clearance” is critical in managing post-operative and other ICU conditions to prevent complications like atelectasis and hypoxia, there is a need to review the clinical results of mucolytic agent Mesna, and its role in mucociliary clearance in critical care patients and in other respiratory conditions.

Effect of Zhifei mixture combined western drugs on symptoms and signs of children with mycoplasma pneumonia / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effect of three Chinese medical formulae (Zhifei Mixture I , Zhfei Mixture II, and Zhifei Mixture II) on main and secondary symptoms and signs of children with Totally 70 mycoplasma pneumonia in treating three types of children mycoplasma pneumonia.</p><p><b>METHODS</b>children with mycoplasma pneumonia were assigned to the control group (38 cases) and the treatment group (32 case). All patients were intravenously injected with Azithromycin and took Ambroxol Hydrochloride and Clenbuterol Hydrochloride Oral Solution. Those in the treatment group additionally took Zhifei Mixture I , Zhfei Mixture II, and Zhifei Mixture Ill by syndrome typing. Their main and secondary symptoms and signs were observed before and after treatment (main symptoms and signs covered fever, cough, abundant sputum, short breath, and anoxia; secondary symptoms and signs covered aversion to cold, heart rate, facial complexion, spirit, appetite, and sweating).</p><p><b>RESULTS</b>Seven patients were lost in this study. Compared with before treatment in the same group, scores for main and secondary symptoms and signs decreased in the treatment group (P <0.01). The therapeutic effect on fever and cough was obviously better in the control group (P <0.01). The main and secondary symptoms and signs were more obviously improved in the treatment group than in the control group (P <0.01). Commpared with the control group, scores for main and secondary symptoms and signs decreased more in the treatment group (P <0.01). Patients' main and secondary symptoms and signs were more obviously improved (P <0.05).</p><p><b>CONCLUSIONS</b>Zhifei Mixture combined Western drugs could significantly improve main and secondary symptoms and signs of mycoplasma pneumonia children patients. Its efficacy was superior to that of using Western medicine alone.</p>

Valuation on analgesic, expectorant and antitussive effects of compatible use of Aconiti radix cocta and Fritillaria cirrhosa or Fritillaria thunbergii / 中国中药杂志

<p><b>OBJECTIVE</b>To study the analgesic, expectorant and antitussive effects of the compatible use of Aconiti Radix Cocta and Fritillaria cirrhosa or F. thunbergii with different matching ratio or dose in mice.</p><p><b>METHOD</b>The two-factor, seven-level uniform design method was adopted to observe the analgesic, expectorant and antitussive effects of the oral administration with the two combined decoctions in rats, with frequency of body torsions induced by acetum, secretion of phenol red in tracheas and frequency of coughs as indexes. Significant matching proportions and doses were collected for verification.</p><p><b>RESULT</b>The effect on the frequency of body torsions: The combined decoctions could effectively reduce the frequency of body torsions. According to a regression analysis, Aconiti Radix Cocta and F. cirrhosa had the synergistic effect, which was maximized with a ratio of 1: 1. The 1: 1 combined decoction played the least role in reducing the frequency of body torsions with a total dose of more than 5 g x kg(-1). The effect on the secretion of phenol red in tracheas. The combined decoctions could effectively increase the secretion of phenol red in tracheas. According to a regression analysis, Aconiti Radix Cocta and F. thunbergii had the antagonism, which was maximized at the ratio of 1: 1, and minimized with a total dose of less than 10 g x kg(-1) and a ratio of 5: 1 between F. thunbergii and Aconiti Radix Cocta. The effect on the frequency of coughs. The combined decoctions could effectively reduce the frequency of coughs. According to a regression analysis, Aconiti Radix Cocta and F. cirrhosa had the antagonism, which was maximized at the ratio of more than 1: 5 and less than 10: 1. There was no interaction between Aconiti Radix Cocta and F. thunbergii. F. thunbergii could reduce the frequency of coughs, whereas Aconiti Radix Cocta showed no effect.</p><p><b>CONCLUSION</b>The compatible application of Aconiti Radix Cocta and F. cirrhosa could enhance the analgesic effect of Aconiti Radix Cocta and reduce the expectorant and antitussive effects of F. cirrhosa, which vary according to different matching ratio and dose. The compatible application of Aconiti Radix Cocta and F. thunbergii shows no effect on the antitussive effect of F. thunbergii. This study provides experimental basis for in-depth studies on the combined effect of Aconiti Radix Cocta and Fritillaria--two of eighteen incompatible pairs.</p>

Kartagener's syndrome with immunoglobulin G subclass deficiency

Kartagener syndrome is characterized by the triad of situs inversus, bronchiectasis, and chronic paranasal sinusitis. Recurrent sinopulmonary infection, the major determinant for diagnosing immunodeficiency, is the most common clinical manifestation of the disease. A 17-year-old female patient presented with dyspnea, cough, sputum, nasal congestion, and rhinorrhea for more than 5 years. Nasal symptoms and dyspnea had not been controlled by intermittent treatment with mucolytics and antibiotics from primary clinics since 3 months before visiting our clinic. Chest X-ray and computed tomography showed situs inversus, dextrocardia and bronchiectasis. Paranasal sinus series revealed mucosal thickening and haziness on both maxillary sinus. Serum immunoglobulin (Ig) G4 was decreased, but total IgG was within normal range. Under the diagnosis of Kartagener syndrome with IgG4 deficiency, monthly intravenous IgG (IVIG) treatment was performed for 6 months. Her symptoms were well controlled and the frequency of antibiotics use was markedly decreased. We report a patient having the Kartagener syndrome with IgG4 deficiency that was successfully controlled with a 6-month-treatment of IVIG.

Antitussive and mucoactive drugs

Cough is the most frequent complaint from medical patients even though coughing is a protective reflex. The principle of relief from a cough is treatment of its underlying disease. However, when the treatment of the cause of coughing is not effective, cough suppression therapy just to relieve the symptom may be attempted. Antitussives and mucoactive drugs are used for this purpose. Unfortunately, the currently available agents are not consistently effective and frequently have intolerable side effects. Therefore, understanding the side effects and mechanism of action of these agents is definitely needed. This review provides a summary of the currently available antitussives and mucoactives.

Degradação forçada e análise fatorial para caracterização da estabilidade de formulações líquidas de carbocisteína / Forced Degradation and Factorial Analysis of Stability of Liquid Formulations containing Carbocisteine

Este estudo teve como objetivo avaliar a estabilidade de xaropes contendo carbocisteína, submetidos à degradação forçada, utilizando Desenho Experimental Fatorial (DEF). Os fatores avaliados foram pH (5,0; 6,5; 8,0), presença ou ausência de EDTA dissódico e metabissulfito de sódio (0,1%). Para o estudo de degradação forçada, as formulações foram submetidas a estresse térmico (50 °C e 75% UR) e oxidação com peróxido de hidrogênio a 3%. Posteriormente, as formulações foram analisadas quanto ao pH, propriedades organolépticas e teor de fármaco por CLAE-UV, nos tempos 0, 15 e 35 dias. Os resultados mostraram que as formulações submetidas à degradação forçada sofreram uma diminuição no teor do fármaco, enquanto que o pH se manteve relativamente estável. Em relação a cor, apenas as formulações que não possuíam antioxidantes mostraram-se mais escuras. A análise dos resultados do DEF mostrou interação significativa (p<0,05) para os fatores pH/metabissulfito e EDTA/metabissulfito. As formulações contendo metabissulfito em pH 5,0 apresentaram maior degradação e as formulações com metabissulfito sem EDTA também não foram eficientes para impedir a degradação da carbocisteína.

The aim of this study was to use Factorial Design (FD) to assess the stability of carbocisteine syrups subjected to forced degradation. The factors assessed were pH (5.0; 6.5; 8.0), presence or absence of disodium EDTA and sodium metabisulfite (0.1%). For the study of forced degradation, the formulations were subjected to thermal stress (50°C and 75% RH) and oxidation with 3% hydrogen peroxide. The formulations were analyzed for pH, organoleptic properties and drug content by HPLC-UV, at 0, 15 and 35 days. The results showed that the formulations exposed to forced degradation suffered a fall in drug content, while the pH remained relatively stable. Regarding the color, only the formulations without antioxidant exhibited a darker coloration. The results of FD revealed significant interactions (p<0.05) for pH/metabisulfite and EDTA / metabisulfite. Formulations containing metabisulfite at pH 5.0 showed the greatest degradation and those with metabisulfite and without EDTA were also not effective in preventing the degradation of carbocisteine.

Tosse: neurofisiologia, métodos de pesquisa, terapia farmacológica e fonoaudiológica / Cough: neurophysiology, methods of research, pharmacological therapy and phonoaudiology

Introdução: A tosse é o sintoma respiratório mais comum em crianças e adultos. Objetivo: Apresentar uma revisão sobre a neurofisiologia e os métodos para estudo do reflexo da tosse, bem como a farmacoterapia e terapia fonoaudiológica da tosse, baseada nos trabalhos publicados entre 2005 e 2010 e indexados nas bases Medline, Lilacs e Biblioteca Cochrane sob os unitermos "tosse" ou "antitussígenos". Síntese dos dados: O reflexo da tosse envolve ativação de múltiplos receptores vagais nas vias aéreas e de projeções neurais do núcleo do trato solitário para outras estruturas do sistema nervoso central. Técnicas experimentais permitem estudar o reflexo da tosse ao nível celular e molecular para desenvolver novos agentes antitussígenos. Não há evidências de que antitussígenos isentos de prescrição médica tenham eficácia superior à do placebo para o alívio da tosse. A terapia fonoaudiológica pode beneficiar pacientes com tosse crônica refratária ao tratamento farmacológico, sobretudo quando coexiste movimento paradoxal das pregas vocais. Comentários Finais: A abordagem multidisciplinar tem papel fundamental no diagnóstico etiológico e tratamento da tosse. O otorrinolaringologista deve informar os pacientes sobre os riscos dos antitussígenos de venda livre a fim de prevenir intoxicações e efeitos adversos, especialmente em crianças...

Introduction: The cough is the more common respiratory symptom in children and adults. Objective: To present a revision on the neurophysiology and the methods for study of the consequence of the cough, as well as the pharmacotherapy and phonoaudiology therapy of the cough, based on the works published between 2005 and 2010 and indexed in the bases Medline, Lilacs and Library Cochrane under them to keywords "cough" or "anti-cough". Synthesis of the data: The consequence of the cough involves activation of receiving multiples becomes vacant in the aerial ways and of neural projections of the nucleus of the solitary treatment for other structures of the central nervous system. Experimental techniques allow studying the consequence of the cough to the cellular and molecular level to develop new anti-cough agents. It does not have evidences of that anti-cough exempt of medical lapsing they have superior effectiveness to the one of placebo for the relief of the cough. The phonoaudiology therapy can benefit patients with refractory chronic cough to the pharmacological treatment, over all when paradoxical movement of the vocal folds coexists. Final Comments: The boarding to multidiscipline has basic paper in the etiological diagnosis and treatment of the cough. The otolaryngologist must inform the patients on the risks of the anti-cough of free sales in order to prevent adverse poisonings and effect, especially in children...

HPLC determination of the related substances in erdosteine / 药学学报

An HPLC method was established for the determination of the related substance in erdosteine. Waters ODS-SunFire (250 mm x 4.6 mm ID, 5 microm) column was used, the mobile phase was composed of methanol-acetonitrile-0.01 mol x L(-1) citric acid (20:4:76, the pH value was adjusted by triethylamine to 2.5). The flow rate was 1 mL x min(-1). The detection wavelength was 254 nm. The related substances in the sample of erdosteine taken were calculated by self control with or without the response factor of impurity relative to that of erdosteine. Under the chromatographic condition developed, the impurities in erdosteine were isolated well. The detection limit was 0.2 microg x mL(-1) (signal/noise = 3) by principal component calculated. The method can be adopted to control the related substances in erdosteine.

Efeitos da N-acetilcisteína na função pulmonar e renal em ratos com sepse sob ventilação mecânica invasiva / Effects of N-acetylcysteine on pulmonary and renal function on septic rats in invasive mechanical ventilation

Introdução: A sepse pode causar alterações renais e pulmonares. Nos casos mais graves, a ventilação mecânica invasiva (VMI) torna-se necessária para melhorar as trocas gasosas e fornecer adequado oxigênio as células. Entretanto, seu uso está associado com piora da função renal. O estresse oxidativo está aumentado na sepse e relaciona-se com o aumento da mortalidade. O uso de um antioxidante como a N-acetilcisteína (NAC) pode ser útil na sepse, por diminuir principalmente o estresse oxidativo. Objetivo: Avaliar os efeitos do NAC na função renal e pulmonar em ratos com sepse em VMI. Materiais e Métodos: A sepse foi induzida pelo modelo punção e ligadura cecal (CLP) em ratos Wistar. Os grupos estudados foram: G1: Controle, G2: CLP e G3: CLP+NAC (4,8g/L). A ingestão do NAC iniciou-se 2 dias antes da CLP na água de beber e foi mantida até o dia do estudo. A VMI foi definida como: Volume corrente (Vt) de 8 ml/Kg , PEEP de 6 cmH2O e FiO2 50%. Foram analisados 24 horas após a indução da CLP, o clearance de inulina, fluxo sanguíneo renal, gasometria arterial, mecânica respiratória, pressão arterial e estudo dos co-transportadores (NKCC1 e -ENaC) no tecido pulmonar. Resultados: A sepse causou importantes alterações na mecânica pulmonar tais como aumento da resistência de vias aéreas (RAW) e da elastância pulmonar (HTIS). Os animais sépticos desenvolveram lesão pulmonar aguda (LPA). O uso de NAC nos animais com sepse melhorou a mecânica respiratória. Observamos nos animais com sepse maior contagem de polimorfonucleares e maior índice de edema pulmonar quando comparados aos animais que ingeriram NAC. O estresse oxidativo diminuiu nos animais com sepse+NAC. Houve um aumento na expressão do canal ENaC nos animais com NAC e isto pode ter contribuído para a melhora do edema pulmonar. No sistema renal, a sepse causou importante insuficiência renal aguda em 24 horas, entretanto, foi revertida com o uso do NAC. Conclusão: O NAC administrado de forma preventiva foi capaz...

Introduction: Sepsis can cause renal and pulmonary alterations. In several cases, the invasive mechanical ventilation can be useful to ameliorate the gas exchange and supplies oxygen to organs and systems. However, the IMV can worsen the renal function by decreasing glomerular filtration rate. The oxidative stress is increased in sepsis and it is associated to high mortality. The use of an antioxidant as N-acetylcysteine (NAC) can be useful in sepsis, mainly by decreasing the oxidative stress. Purpose: To evaluate the effects of NAC on renal and pulmonary function in rats with CLP submitted to invasive mechanical ventilation (IMV). Material and Methods: The sepsis was induced by cecal and puncture ligation (CLP) in Male Wistar rats. The groups evaluated were: G1: Control; G2: CLP; and G3: CLP+NAC (4,8g/L). The NAC was added to drink water two days before the CLP and keep until the day of study. The IMV was set as Vt: 8 ml/kg, PEEP: 6 cmH20 and FiO2: 50%. The inulin clearance, renal blood flow, arterial blood gas, respiratory mechanics, mean arterial pressure and co-transporters (NKCC1 and -ENaC) on pulmonary tissue was analyzed 24 hours after the CLP procedure. Results: Sepsis caused important alterations on respiratory mechanics such as increase in airway resistance (RAW) and in lung elastance (HTIS). The septic animals developed an acute lung injury. The use of NAC ameliorated respiratory mechanics. The CLP animals had increase in neutrophils polimorphynuclears and edema index when compared to animals with NAC. The oxidative stress was lower in CLP+NAC group. There was an upregulation in channel ENaC in animal with NAC and this can contribute to improve edema index. In renal system, sepsis caused an important acute renal injury in 24 hours, however NAC reverted this clinical condition. Conclusion: The preventive use of NAC was able to prevent the pulmonary and renal alterations caused by sepsis, in the CLP model.

Clinical observation of mucoregulatory agents' application after chronic rhinosinusitis surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the effect of mucoregulatory agents during endoscopic sinus surgery.@*METHOD@#Ninety-seven cases with chronic rhinosinusitis were randomly divided into three groups, with 31 cases in B group treated by ambroxol, 33 cases in C group treated by eucalyptol-limonene-pinene enteric soft capsule and 33 cases in control group (A group). The follow-up visit lasted for 6 months for three groups. Then, the therapeutic effects were evaluated and compared among these three groups.@*RESULT@#By the end of 6 months after treatment,the effective rate was 90.3% and 97.0% for cases in the B and C groups respectively, and only 75.8% in A group. The difference between A and C was statistically significant (P < 0.05).@*CONCLUSION@#Eucalyptol-limonene-pinene enteric soft capsule,as a multicomponent mucoregulatory agent, can obviously improve the secretion of mucosa and epithelial recovery, thus accelerate healing of the disease. It can also improve the success rate of functional endoscope sinus surgery, and may play a promising role in clinical application.

Pharmacokinetics and Tolerability Evaluation of Fudosteine after Oral Administration in Healthy Korean Volunteers

BACKGROUND: Fudosteine, (-)-(R)-2-amino-3-(3-hydroxypropylthio)propionic acid, is a cysteine derivative that was approved in Japan, as a new mucoactive agent. The aim of this study was to evaluate the tolerability and pharmacokinetics (PK) of fudosteine in healthy Korean subjects. METHODS: A randomized, open-label, parallel, escalating single-dose study was conducted in 16 healthy Korean male subjects. The subjects were allocated to single-dose groups of 400 or 800 mg. Serial blood samples for PK analysis were collected immediately prior and after dosing up to 24 hours, and plasma concentrations were determined by high performance liquid chromatography (HPLC). Safety profiles were evaluated by monitoring adverse events and clinical evaluations throughout the study. RESULTS: Median time to peak concentration (Tmax) of both dosing group were around 0.5 hours and half-life (t1/2) were around 3 hours. Mean peak concentration (Cmax) of 400 mg and 800 mg dosing group were 10.8 and 21.5 microg/mL and the mean area under the plasma concentration versus time curve from the dosing time to infinity (AUCinf) were 26.8 and 55.0 microg.h/mL, respectively. Mean dose-normalized Cmax were 0.0271 and 0.0269 microg/mL/mg (P=0.923), respectively and dose-normalized AUCinf were 0.0669 and 0.0688 microg.hr/mL/mg (P=0.093), respectively. Fudosteine was well tolerated without any serious adverse events or clinical laboratory abnormalities. CONCLUSION: This study showed that fudosteine has a linear PK property and is well tolerated within 800 mg in healthy Korean volunteers.

The Efficacy and Safety of Cough and Cold Medicines for Infants

Common cold is a conventional term for a mild upper respiratory illness characterized by symptoms of nasal stuffiness, rhinorrhea, sneezing, sore throat, and cough. Management of the common cold is intended to provide temporary relief of symptoms until the cold completes its natural history, as well as to reduce the risk of complications. However, most studies for cold preparations focus on adults, and there are limited and conflicting evidences for children. Various preparations for cough/cold are available, which include antihistamines, decongestants, antitussives, expectorants, analgesics/antipyretics, and some combination products. Nonpharmacologic therapies are also important and it is generally agreed that such supportive cares should form the mainstay of treatment for children with common colds. Adverse effects of the specific types of cold preparations should be considered carefully for very young children. In addition, it is very important to educate parents about the natural course of common cold, along with appropriate use correct dosages and potential adverse effects of cold preparations.

Antitussives, mucolytic agents and expectorants in clinical practice / 대한내과학회지

Cough is a protective reflex and also a common symptom of many respiratory diseases. The basic principle of management in chronic cough is treatment of its underlying cause. However, certain situations will necessitate cough suppressant therapy on a short-term basis for symptomatic relief of cough. Antitussives, expectorants and mucolytic agents are often used as the cough suppressant. Most of these drugs, however, are not consistently effective in reducing cough in adequately performed clinical trials. The aim of this brief review is to provide the list and some rationale for the currently available antitussive agents to practitioners.