Antitussive Research Articles

Characteristics of the drinking habits of people who overdose over-the-counter drugs: Insights from a nationwide Japanese survey.

To analyze the drinking habits of individuals who overdosed on over-the-counter (OTC) drugs, such as cough suppressants, antitussives, antipyretic analgesics, and combination cold medications, in Japan. This cross-sectional study analyzed data collected from 2881 participants through a national survey conducted in Japan in 2023. Through a self-administered questionnaire, the participants were categorized into OTC (overdosed OTC drugs in the past year) and control (did not overdose OTC drugs) groups. Variables related to drinking habits, social background, smoking habits, use of other medications, such as analgesics, tranquilizers, controlled drugs, and products containing high concentrations of caffeine, and perception of OTC drugs were compared between the two groups. Additionally, we matched the participants in the OTC (n = 25) and control (n = 100) groups by sex and age in a 1:4 ratio to assess these variables. Multivariate analyses were performed to examine how these factors are associated with drinking habits in individuals with OTC drug overdose. OTC drug overdose was prevalent among teenagers and those in their 50s, and was associated with habitual binge drinking and consumption of energy drinks. Those overdosing on OTC drugs obtained them mostly from drugstores and pharmacies. This is the first study to show a relationship between drinking habits and OTC drug overdose. An understanding of the characteristics of drinking habits in those who overdose on OTC drugs can help reduce fatal health risks in this population.

Hypoglycemic and antihyperglycemic effects of Abelmoschus esculentus and Alchornea cordifolia in normal and alloxan-induced diabetic rats

BackgroundAbelmoschus esculentus and Alchornea cordifolia are commonly used in Traditional Chinese Medicine (TCM) to treat several diseases. Abelmoschus esculentus is used to treat infertility and menorrhagia, while Alchornea cordifolia is used for the treatment of venereal diseases, cough, and diarrhoea. However, very few studies assessed the antidiabetic effects of these plants. Therefore, this study aimed to investigate the hypoglycemic and antihyperglycemic effects of aqueous extract of A. esculentus fruits and A. cordifolia leaves. Material and MethodsFresh Abelmoschus esculentus fruits and the powder from the dried leaves of Alchornea cordifolia leaves were prepared by maceration in the aqueous phase (200g/100mL and 50g/100mL respectively) for 24 hours, then filtered and concentrated in an oven at 45°C. Diabete was induced to male Wistar rats by a single intraperitoneal injection of alloxan (150 mg/kg, b.w). Rats with a blood glucose level greater than or equal to 200 mg/dL were selected, divided into groups and were daily administered orally with either aqueous extracts of A. esculentus at 30 mg/kg (AEAE30) or A. cordifolia at 400 mg/kg (AEAC400) for 14 consecutive days. For comparison, acarbose (100 mg/kg), glibenclamide (5 mg/kg), and metformin (500 mg/kg) were administered orally as reference drugs. Moreover, insuline was also used as a positive control and administered intraperitoneally at a dose of 5 IU/kg. Then, blood glucose levels, oral glucose tolerance test, oral maltose tolerance club, body weight and hemoglobin were assessed. For evaluation of the aqueous extracts in the intestinal transit, imodium (2 mg/kg, p.o) and fructine (5 mg/kg, p.o) were used as a positive control to determine the spasmolytic and laxative activities, respectively. The histopathological study of the liver, kidney, pancreas, testis, epididymis, and seminal vesicle was also carried out using the hematoxyline & eosin (H&E) technique. ResultsAEAE30 and AEAC400 significantly reduced (P<0.001) fasting blood glucose (FBG) levels and significantly prevented (P<0.001) postprandial glycemia in AI-db rats following oral glucose tolerance test (OGTT) and oral maltose tolerance test (OMTT) in alloxan-induced diabetic rats (AI-db). In normoglycemic and insulin-resistant (IR) rats, AEAE30 significantly prevented the post-prandial blood glucose level during the OGTT (P<0.01) only in normoglycemic rats. At the end of treatment, AEAE30 significantly reduced the relative weight of the liver (P<0.01) and significantly increased (P<0.001) the relative weight of the testes and pancreas while AEAC400 significantly increased the relative weight of the testes compared to untreated AI-db rats. The histopathological study revealed a restoration of alloxan-induced tissue damage close to the normal control group in AI-db animals treated with plant extracts, as well as an increase in sperm density in the epididymis unlike in the untreated AI-db group. ConclusionThese findings suggested that AEAE and AEAC exhibited hypoglycemic and antihyperglycemic activities and could be therefore a useful source of antidiabetic agent.

Current aspects of differential diagnosis and treatment of cough

Cough is a common and important respiratory symptom that can cause significant complications for patients and be a diagnostic challenge for physicians. An organized approach to the evaluation of cough begins with classifying it as acute, subacute, or chronic based on duration and time of onset. Acute cough (up to 3 weeks) is most often one of the main symptoms of acute respiratory viral infections and acute bronchitis. Subacute cough, lasting from 3 to 8 weeks, is usually postinfectious postviral in origin. Common causes of chronic cough lasting more than 8 weeks with a normal chest X-ray are cough variant of bronchial asthma, chronic obstructive pulmonary disease, upper airway cough syndrome / postnasal drip syndrome, non-asthmatic eosinophilic bronchitis, gastroesophageal reflux, and medications (primarily angiotensin-converting enzyme inhibitors). The spectrum of possible causes of cough is diverse, however, respiratory pathology comes to the forefront in the differential diagnostic search. Successful treatment of cough is an important task in clinical practice. Given the possible multicomponent nature of cough, the presence of catarrhal-respiratory and broncho-obstructive syndromes in the clinical picture along with bronchitis syndrome, combination drugs become the drug of choice. In conclusion, the possibilities of a combined (bromhexine + guaifenesin + salbutamol) expectorant against cough, its effectiveness and safety are considered.

Refractory Chronic Cough: A State-of-the-Art Review for Otolaryngologists.

Patients with refractory chronic cough (RCC) are being seen in increasing numbers within otolaryngology clinics. Identifying the next steps in the evaluation and management of cough in patients who have had first-line treatment for gastroesophageal reflux, sinonasal disease, pulmonary disease, and angiotensin-converting enzyme inhibitor-related cough is paramount. This state-of-the-art review focuses on emerging treatments for RCC from an otolaryngology perspective. Pubmed. The available literature on chronic cough, with a focus on RCC, emerging paradigms concerning pathophysiology, and evolving treatment approaches was reviewed and summarized. Guided by a more detailed understanding of refractory cough physiology, a myriad of new treatment options have been developed to treat RCC. These are primarily aimed at disrupting what is thought to be a hypersensitive cough reflex, whether by a dampening of its sensory inputs or an alteration in motor activity, and are inclusive of neuromodulator treatments, superior laryngeal nerve blockade, vocal fold augmentation, botulinum toxin injection, topical capsaicin, and potentially the eventual use of P2X3 antagonists. Improved laryngopharyngeal reflux diagnosis and management, as well as the potential benefit of behavioral cough suppression therapy, are also discussed. The literature supporting each of these strategies is growing-and as more patients with RCC seek otolaryngology care, knowledge of these various approaches may improve the overall treatment of this condition.

Prescription and nonprescription drug misuse and abuse in community pharmacies in Iraq: a cross-sectional survey.

There is little known regarding prescription and nonprescription medicine nonmedical use (abuse and misuse) in Iraq, with limited treatment. Pharmacists could be a valuable source of information in the absence of any national monitoring system. This study aimed to explore Iraqi community pharmacists' perspectives on prescription and nonprescription medicine abuse/misuse, including motives for use and how often they encounter people whom they think are misusing or abusing medicines. A cross-sectional survey was undertaken between November 2020 and February 2021. Community pharmacists in Iraq were asked to complete a prepiloted self-administered questionnaire, distributed through online social media platforms. 300 pharmacists completed the questionnaire. The most commonly reported nonprescription drugs suspected of abuse/misuse were cough and cold medications (n = 80, 26.6%), topical corticosteroids (n = 54, 17.9%), and allergy products (n = 33, 11%). The most common reported prescription drugs suspected of abuse/misuse were systemic antibiotics (n = 111, 36.9%), gabapentinoids (n = 56, 18.6%), and moderate-weak opioids (n = 34, 11.3%). The most commonly method used by pharmacists to limit access to such drugs was responding that the requested medication was unavailable (n = 273, 51.7%), followed by advising on risks (n = 152, 33.2%). Prescription/nonprescription medicine abuse and misuse are suspected in community pharmacies in Iraq. Current methods for controlling the problem are likely to be ineffective in the absence of prescription drug enforcement. Pharmacists could have a more proactive role in managing this issue, networking with other pharmacists, and referring suspected users to support.

Formulation and Evolution of Polyherbal Cough Syrup

Polyherbal formulation of multi components which produce synergistic effect cough is common respiratory system that can have a significant impact on the quality of life. Cough is chronic and acute disease. Polyherbal formulation have been used for to treat cough and other respiratory infection. In this we study, we prepared a polyherbal cough syrup using a various combination of Medicinal plant. plant which is used as Natural Ingredients, like Ginger: Zingiber and Liquorice: Turmeric: Curcuma longa (Zingiberaceae), Tulsi: Ocimum santum. (Labiatae) and Liquorice: Glycyrrhiza glabra (Leguminosae).

An Evaluation of Drug Prescribing Patterns and Prescription Completeness.

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.

Overzealous over-the-counter cough syrup ingestion leading to serious manifestation in a child – A case report

ABSTRACT Cough is a protective reflex that allows clearance of secretions from upper respiratory tract. It is not a disease by itself but a symptom of underlying disease. In a majority of cases, it is self-limiting and requires only supportive care. But over-the-counter cough syrups are inadvertently used to relieve cough in Indian settings. We hereby report a case of a 6-year-old girl child who presented to pediatrics emergency services with complaints of loss of consciousness and abnormal body movement after ingestion of dextromethorphan and chlorpheniramine containing cough syrup. All investigations including cerebrospinal fluid examination, neuroimaging, and electroencephalogram revealed no significant abnormality. The child was admitted for 5 days and discharged after that in stable conditions.

Minimizing the risk of ethylene glycol and diethylene glycol poisoning in medications: A regulatory and pharmacopoeial response

Pharmaceutical and personal care products, including syrups and toothpastes, extensively use glycerin, sorbitol, and propylene glycol. However, past incidents of ethylene glycol (EG) and diethylene glycol (DEG) contamination in these products have raised serious health concerns. Recently, several child deaths linked to contaminated cough syrup consumption have heightened concerns regarding the safety of Indian pharmaceuticals. In response, Indian drug regulatory authorities and the Indian Pharmacopoeia have implemented several measures to enhance the quality, safety, and efficacy of pharmaceuticals manufactured in India. These measures encompass risk-based inspections of manufacturing facilities, rigorous quality control checks of medicinal products intended for export, and increased transparency in the supply chain of excipients prone to EG and DEG contamination. Further, the Indian Pharmacopoeia has updated monographs for five high-risk excipients: glycerin, propylene glycol, sorbitol solution (70%, both crystallizing and non-crystallizing), and liquid maltitol. These efforts are consistent with global regulatory standards and aim to ensure the overall quality and safety of pharmaceuticals produced in India.

Evaluation of Antimicrobial Activity of Methanol Extract of Abrus precatorius Leaf Against Selected Clinical Isolates (Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Candida albican)

Abrus precatorius is one of the herbal plants that have been reported to have medicinal properties. The leaves is widely used for the treatment of cough, cancer and swollen tonsils. Abrus precatorius is also known for its abundant chemical constituents that could be very important antibacterial agent. This study evaluated the antimicrobial activity of Abrus precatorius leaf extracts against isolated clinical bacteria and fungi. The study employed agar disc diffusion method of antimicrobial sensitivity testing (50 µg/mL, 100 µg/mL, 200 µg/mL and 400 µg/mL), and Minimum Inhibitory Concentration (MIC) model. The results showed a dose dependent antimicrobial potential of Abrus precatorius leaf extract against the test organisms with zone of inhibition ranging from 4 – 18mm against Escherichia coli, 6 – 19mm against Pseudomonas aeruginosa, 4 -22mm against Staphylococcus aureus and 2 – 15mm against Candida albican. The extract also showed an MIC of 25mg/ml for Staphylococcus aureus, 50mg/ml for Escherichia coli and Pseudomonas aeruginosa and the least MIC of 100mg/ml for Candida albican. The outcome of the study suggest that Abrus precatorius leaf extract exert broad spectrum antibacterial activity against both Gram-positive and Gram-negative bacteria. These findings validate the use of the plants for the treatment of infections, and indicate the potential roles of the plants in drug development programs of the pharmaceutical industry.

Essential Oils from the Leaves and Stem Barks of Pluchea Indica (L.) Less.: Chemical Analysis, Cytotoxicity, Anti-inflammation, Antimicrobial Activity, Molecular Docking, and ADMET Profiling.

Pluchea indica (L.) Less. is a medicinal plant native to Asia. Traditionally, it is known for numerous traditional uses, such as treatments for fever, cough, and digestive issues. The present investigation aims to determine the chemical compositions of essential oils from its fresh leaves and stem barks. By using hydro-distillation and the GC-FID/MS (gas chromatography-flame ionization detection/mass spectrometry) analysis, the studied samples were dominated by sesquiterpene hydrocarbons (76.8-82.2 %) and their oxygenated derivatives (8.4-19.0 %). β-Selinene (42.0-43.5 %) and silphinene (21.1-22.9 %) were the main compounds. Significantly, the stem bark essential oil strongly monitored the growth of four cancer cell lines K562, HeLa, HepG2, and MCF-7 with IC50 values of 2.89-7.34 μg/mL. Both studied samples showed strong anti-inflammatory activity against NO (nitric oxide) production with IC50 values of 21.81-23.18 μg/mL. The studied sample also exhibited antimicrobial activity at different levels. The molecular docking study revealed that β-selinene exhibited the strongest binding affinity for all four cancer-related protein targets: epidermal growth factor receptor (EGFR), human epidermal growth factor receptor 2 (HER2), Abelson tyrosine-protein kinase 1 (ABL1), and phosphatidylinositol 3-kinase (PI3 K-α). The ADMET profiles of the major compounds were also predicted to provide insights for further research considerations.

Formulation And Evaluation Of Herbal Cough Syrup Of Tulsi By Using Molasses Base

Syrup is generally useful and popular dosage form which is used for the treatment of cough and cold. We prepared the herbal cough syrup by adding Extraction of herbal drugs such as Tulsi, black pepper and Molasses as a base. The herbal cough syrup is formulated by using Extraction and decoction method. Adding the decoction of herbal drugs with base of Molasses is helpful to the formulation for thick and preserve the formulation. That was helpful to increase the shelf life of formulation of herbal syrup.

“The complexity of what to do” – clinical perspectives of tailored physiotherapy interventions in patients with respiratory symptoms in post-COVID condition

Purpose Knowledge gaps exist regarding the effects of interventions due to continuing respiratory symptoms in patients with post-COVID condition. The aim of the present study was to present the clinical outcomes of individualised treatments for patients with remaining respiratory symptoms due to post-COVID condition. Methods This prospective longitudinal study included a consecutive series of 57 patients with remaining respiratory post-COVID symptoms. Breathing pattern, thoracic pain/mobility, occurrence of cough, and respiratory muscle strength were assessed before and after the administration of individually tailored physiotherapy interventions. Results The median treatment duration was 3 months (range 1–36 months). Dysfunctional breathing pattern was the most common symptom (n = 55/57) at inclusion. After treatment, 95% of patients had a normalised or improved breathing pattern (p < 0.001). The treatments for pain, productive and unproductive cough, and respiratory muscle strength resulted in significantly improved symptoms (p < 0.01). With other targeted treatments, inspiratory muscle strength improved by 20 cmH2O and expiratory muscle strength by 11 cmH2O (both p < 0.001). Conclusions This study indicates positive outcomes of physiotherapy treatment based on the patient’s symptomatology and test results. Therefore, individualised physiotherapy treatment of post-COVID conditions may have an impact on recovery.

Prunella vulgaris and Tussilago farfara demonstrate anti-inflammatory activity in rabbits and protect human adipose stem cells against thermal stress in vitro

Ethnopharmacological relevancePrunella vulgaris L.(PV) and Tussilago farfara (TF) are perennial herbs rich in flavonoids and phenolic compounds with immense medicinal value. PV extract (PV-E) possesses potent antipyretic, anti-inflammtory, antioxidant, antiseptic, anti-cancer and immune stimulatory properties and have been traditionally known for the treatment of wounds, ulcers and sores. TF extract (TF-E) has been known for antibacterial, antioxidant, anti-inflammatory, anti-viral, anti-diabetic, anti-cancer, anti-obesity and wound healing effects. Additionally, TF-E infusions have been used for asthma, cough, and bronchopneumonia treatments. Aim of the studyThe therapeutic efficacy of transplanted human adipose stem cells (hASCs) is abrogated under the deteriorating effects of heat stress offered by burn wounds. Earlier researches has documented antioxidant priming as an effective strategy to enhance stem cell performance. As both PV-E and TF-E are known for their potent antioxidant effects. The present study aims to examine the cryoprotective effects of PV-E and TF-E priming on hASCs against in-vitro heat-induced thermal stress. Moreover, we determined the anti-inflammatory potential of both PV-E and TF-E on rabbits. MethodsAntioxidant capacity of both PV-E and TF-E is examined via DPPH assay and anti-inflammatory activity is assessed in rabbits using carrageen-induced paw edema model of inflammation. Next, we investigate the efficacy of different doses (1.25–100 μg/ml) of PV-E and TF-E on hASCs; MTT, LDH, calcein AM staining, and wound scratch assay were used to assess cell viability, cytotoxicity, proliferation ability and cell migration potential in the cells. Then, hASCs were pretreated for 24 h with optimum doses of PV-E and TF-E determined from MTT assay results and were subsequently exposed to in-vitro thermal injury (51 °C,10 min). The cytoprotective effects of both PV-E and TF-E priming under thermal stress were investigated via MTT, LDH, annexin-V staining and gene expression analysis. ResultsBoth PV-E and TF-E extracts demonstrated potent antioxidant and effective anti-inflammatory activities, with a clear reduction in inflammation. Study on hASCs exhibited improved cell viabilities, enhanced cell proliferation and migration abilities of both extracts. While heat stress data revealed that PV-E (2.5 μg/ml) and TF-E (5 μg/ml) pretreatment significantly ameliorated effects of thermal-injuries in hASCs as depicted by significantly enhanced cell viabilities, low LDH release profile, and lower annexin-V expression and regulated gene expression of the pretreated cells. ConclusionPV-E and TF-E priming effectively enabled hASCs to combat thermal injury by significantly promoting cell survival than untreated cells. Hence, these findings suggest that PV-E and TF-E priming could be used to attain improved cellular responses and enhanced therapeutic efficacy in burnt tissue.

Pseudo-Hyperaldosteronism Arising from Licorice Cough Syrup Self-Ingestion: A Case Report

Background: 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.

Ethnopharmacological Insights into the Use of Chenopodium ambrosioides for Cough Treatment among Togolese Traditional Healers

Togo has an ethnobotanical potential with a great diversity of medicinal plants widely used to treat human diseases. Cough associated with respiratory diseases is one of the pathologies traditionally treated with medicinal plants in Togo. Chenopodium ambrosioides (L.) is a species used in the traditional treatment of cough in Togo. The aim of this study was to document the ethnopharmacological uses of Chenopodium ambrosioides in Togolese traditional medicine for treatment of cough. An ethnopharmacological survey was conducted using the semi-structured interview method among Traditional Medicine Practitioners (TMPs) from six health districts spread across four health regions. The ethnopharmacological and ethnobotanical data collected were analyzed using the User Value (UV) and Frequency of Citation (FC) of medicinal plants associated with the species. A total of 127 TMPs participated in this study and 96 (76%) of them were male and 31 (34%) were female. 73% of the informants claimed usually use Chenopodium ambrosioides in the cough treatment compared to 27% who claimed to not use it to treat cough. Chenopodium ambrosioides was used in combination with fifty-two (52) other botanical species in the treatment of cough and in the study area, Abrus precatorius Linn. (13.59%) followed by Ocimum gratissimum Linn. (11.58%), Zingiber officinale Rosc. Trans. Linn. (9.73%), Mangifera indica Linn. (6.21%), Eucalyptus citriodora Hooker (4.87%), Xylopia aethiopica (Dunal) A. Rich. (4.36%) and Eugenia caryophyllata Thunb. (4.19%) were the most popular plants used for cough treatment among the plants recorded. Sixteen (16) other pathologies including pulmonary infections are also treated by Chenopodium ambrosioides (L.). Abscesses, intestinal parasitic diseases, incurable wounds, stomach aches and headaches are the most pathologies commonly treated by this plant. The whole plant (72%) and leaves (22%) are the primary parts utilized for medicinal purposes. Decoction (77.50%) is the main preparation method, with oral (80.83%) and cutaneous (10.83%) routes being the most common modes of administration. The findings from this study provide a solid ethnopharmacological foundation for future pharmacological and toxicological investigations into Chenopodium ambrosioides (L.).

Comparative clinical trial of Langenlianqiao oral liquid and Lianhuaqingwen capsule in the treatment of mild cases of coronavirus disease 2019 (COVID-19)

ObjectiveTo evaluate the clinical efficacy of Langenlianqiao (LGLQ) oral liquid treatment and provide a reference basis for the clincal treatment of coronavirus disease 2019 (COVID-19).DesignAn experimental clinical study was conducted on three groups with confirmed diagnoses of COVID-19.SiteThis study was conducted at Changde Hospital.ParticipantsA total of 253 patients were enrolled in this study.MethodsThe patients were divided into the LGLQ treatment group (100 cases), the Lianhuaqingwen (LHQW) treatment group (100 cases) and the placebo control group (53 cases), according to the treatment each group received. The occurrence of major clinical symptoms, the duration of symptom disappearance, the number of days in hospitalisation and the duration of infection were compared among the three groups.ResultsCompared with the placebo control group (10.0 [1.2] d, 9.4 [1.3] d), the duration of infection and hospitalisation effectively decreased in the LGLQ group (6.8 [0.6] d, 7.4 [0.8] d) and the LHQW group (6.8 [1.0] d, 7.3 [1.0] d). Furthermore, the incidence of fatigue in the LGLQ group (4.0%) was lower compared to the LHQW group (14.0%) and the placebo control group (15.1%), but this difference was not statistically significant (P = 0.580 for LGLQ vs. LHQW, P = 0.246 for LGLQ vs. placebo). In the treatment of cough, the LGLQ group showed a significantly different effect compared to both the LHQW group (P = 0.014) and the placebo group (P = 0.016). Additionally, for dry cough specifically, LHQW was effective in reducing its incidence compared to the placebo control group (P < 0.05), while LGLQ showed no statistically significant difference from either LHQW (P = 0.39) or the placebo group (P = 0.14). However, neither the LGLQ group nor the LHQW group showed a reduction in the duration of symptom disappearance in patients with pre-existing symptoms (P > 0.05).ConclusionsCompared with the placebo control group, the LGLQ group showed an improvement in the clinical symptoms of COVID-19 and a decrease in the duration of hospitalisation and infection, which confirmed that the LGLQ treatment had the same antiviral effect as the LHQW treatment. This may provide in-depth insights for antiviral therapy research.

Efficacy of ensitrelvir for cough due to COVID-19 Omicron variant in medical healthcare workers.

We evaluated the efficacy of ensitrelvir for the treatment of cough due to coronavirus disease 2019 Omicron variant in medical healthcare workers. A total of 633 patients were registered in this study: 206 patients chose ensitrelvir and 427 patients chose symptomatic treatment. Difference in score changes using the Leicester Cough Questionnaire between groups was 3.17 on day 4, 3.24 on day 7, and 2.46 on day 14. The analysis demonstrated a significant difference at all time points.

8239 Recurrent Superior Laryngeal Nerve Glucocorticoid Injections: A Likely Cause Of Secondary Adrenal Insufficiency In An Otherwise Healthy Man

Abstract Disclosure: A. Lorin: None. M.C. Pranger: None. J. Park: None. C.A. Clutter: None. Background: Secondary adrenal insufficiency is well described in the literature with various offending agents implicated. Superior laryngeal nerve (SLN) glucocorticoid injections, however, have rarely been recorded as causal agents of secondary adrenal insufficiency. We present a case of a generally healthy man with secondary adrenal insufficiency after chronic administration ofsuperior laryngeal nerve glucocorticoid injections without other identifiable etiologies. Clinical Case: A 68-year-old man with no significant medical history presented to endocrinology clinic due to persistent nausea and severe fatigue. His initial labs were notable for morning cortisol of 1.66 mcg/dL (5-25) and an undetectable ACTH (&amp;lt;3.2 pg/mL, 10-60) suggestive of adrenal insufficiency. FSH/LH, testosterone, FT4, and IGF-1 were otherwise normal. On initial review of his medication history, the only glucocorticoid exposure appeared to be intranasal beclomethasone, with remote courses of oral prednisone. Further history revealed that the patient was receiving superior laryngeal nerve glucocorticoid injections for chronic cough every three weeks for over a year. The injection consisted of 1:1 mixture of 1 mL of triamcinolone acetonide 200 mg/5 mL and local anesthetic, which is equivalent to triamcinolone 40 mg or hydrocortisone 200 mg. Given the volume and chronicity of the glucocorticoid injections, the patient developed secondary adrenal insufficiency as above. Since the diagnosis, the patient discontinued SLN glucocorticoid injections and was placed on physiologic hydrocortisone replacement, with gradual recovery of his HPA axis. Conclusions: Sequelae of percutaneous glucocorticoid injection into the superior laryngeal nerve for treatment of chronic cough are not well documented in terms of their effects on the HPA axis. While an effective and increasingly common treatment for chronic cough, SLN glucocorticoid injection has the potential to cause suppression of the HPA axis and cause secondary adrenal insufficiency. Excess glucocorticoid appeared to solely inhibit ACTH production, as the other anterior pituitary hormones were not affected. Understanding consequences of glucocorticoid use in any formulation is important when considering such therapies, as these may alter normal HPA function with recurrent dosing. Recovery from a disrupted HPA axis may be achieved with the use of physiologic doses of hydrocortisone replacement in the case of secondary adrenal insufficiency. Presentation: 6/3/2024

8676 Hereditary Fructose Intolerance Unmasked: Report of a Pediatric Case Exploring Differential Diagnosis of Hypoglycemia and Genetic Insights

Abstract Disclosure: N. Solano: None. D. Baboun: None. A. Granados: None. A. Carrillo-Iregui: None. Introduction: Hereditary fructose intolerance (HFI) is an uncommon autosomal recessive metabolic disorder characterized by a deficiency of aldolase B, a crucial enzyme involved in fructose metabolism. This deficiency causes an accumulation of fructose-1-phosphate, which triggers a cascade of metabolic disturbances including hypoglycemia, lactic acidosis, and hepatic dysfunction. If left untreated, HFI can lead to severe complications, including liver failure and even death. Diagnosing HFI can be challenging due to its nonspecific clinical presentation and the absence of routine screening tests. Case presentation: A 4-year-old girl was referred from an outside hospital for hypoglycemia requiring intravenous dextrose infusion. The patient became lethargic 30 minutes after consuming a honey-based cough syrup. Upon presentation to the emergency department, her blood glucose level was 41 mg/dL. Her past medical history revealed an episode of lethargy and persistent vomiting at age 21 months, coinciding with an intussusception. A finger blood glucose test at the time was undetectable, and further evaluation revealed metabolic acidosis, elevated liver enzymes, and a normal ammonia level. Plasma amino acid, acylcarnitine, carnitine, urine acylglycine, carnitine, and urine organic acid levels were all within normal limits. Fatty acid oxidation and glycogen storage disease panels were also negative. On inquiry into her dietary habits, her parents recalled she would spit fruits out whenever tasting them, suggesting an innate aversion to fructose-rich foods. Initial comprehensive inpatient workup, including a critical sample, yielded no definitive results. She underwent a strict 24-hour inpatient fast and remained asymptomatic, with blood glucose levels above 65 mg/dL, ruling out hyperinsulinism. A broader next-generation sequencing (NGS) hypoglycemia panel was ordered, which identified a heterozygous pathogenic variant, c.178C&amp;gt;T (p.Arg60*) maternally inherited, and a likely pathogenic variant, c.379+1G&amp;gt;T (Splice donor) paternally inherited, in the aldolase B gene. Both confirmed the diagnosis of hereditary fructose intolerance (HFI). The family received comprehensive dietary and genetic counseling. Conclusion: HFI is an uncommon but potentially life-threatening inborn error of metabolism. Maintaining a high index of suspicion, considering a broad differential diagnosis, and obtaining a detailed dietary history, including fruit consumption, are crucial for identifying and managing HFI in infants and children with unexplained hypoglycemia. This case highlights the importance of early diagnosis and dietary intervention to prevent severe complications in patients with HFI. Additionally, it emphasizes the need for comprehensive dietary counseling and education for patients' families to ensure lifelong adherence to a fructose-restricted diet. Presentation: 6/2/2024