Respiratory Tract Ailments Research Articles

Human Sputum Proteomics: Advancing Non-Invasive Diagnosis of Respiratory Diseases with Enhanced Biomarker Analysis Methods

Many ailments can be diagnosed while they are asymptomatic, meaning that the patient has no signs or symptoms of a progressing disease. If caught in their initial stage of formation, these disorders can be effectively treated, leading to successful outcomes; curative therapies can halt illnesses from advancing, thus improving the quality of life and long-term survival of the patient. Still, cutting-edge upgrades in precision technologies are necessary for early, reliable, affordable, and rapid disease detection, but also vital for the well-being of people and the future of global public health. The emerging role and utility of non-invasive and repeatable diagnostic test approaches for the detection of health conditions have been exemplified by liquid biopsies based on genomic biomarkers. As such, biological fluids permit any measurable molecular indicator or signature (e.g., proteins) to provide valuable information on an individual’s wellness and/or disease. Among the bodily secretions used for non-invasive diagnostics is sputum, a complex viscous gel-like biopolymeric network that has gained growing recognition as a rich source of biomarkers of airway infections and pulmonary diseases, and serves as a determinant to reveal other illnesses. As per the World Health Organization, the burden of respiratory conditions is exacerbated by factors ranging from considerable subjection to air pollution and occupational contaminants to tobacco smoking and second-hand smoke, in addition to poor socio-economic status. Due to the likely increase in these determinants, respiratory tract ailments are on the rise, affecting the health of many individuals, in addition to putting stress on healthcare facilities and services worldwide. The aim of this study was to perform a narrative review of sputum constituents with an emphasis on proteins and glycoproteins assessed as possible biomarkers of lung and other organ diseases. A search was conducted using mucus, sputum proteomics, sputum biomarkers, and point-of-care testing as keywords employing Google, PubMed (MEDLINE), and Web of Science, selecting the most referenced and related papers of the last decade. We, therefore, highlight the need to use expectorated or induced sputum specimens as a routine sample source for testing valuable protein biomarkers to diagnose these chronic disorders, predict inflammation and disease progression, as well as monitor the effectiveness of treatments. Further, we discuss the urgent need for fast and reliable point-of-care methods to detect and quantify crucial protein biomarkers in sputum specimens, and the limitations faced when dealing with their complex matrices.

Prevalence and Predictors of Antibiotic Self-Medication in Sudan: A Descriptive Cross-Sectional Study.

Self-medication with antibiotics (SMA) is one of the common factors which precipitate antimicrobial resistance, yet if effective implementations are amended it can be effortlessly controlled. The present study aimed to estimate the prevalence and predictors of SMA in Sudan. The study adopted a cross-sectional study design conducted in all Sudan states between June and December 2021. Multi-stage stratified cluster sampling was used. A semi-structured questionnaire was used for data collection. Descriptive statistics were used to present the data. Binary logistic regression was computed to investigate the possible factors which associated with SMA. Out of 1492 participants surveyed, 71.3% utilize antibiotics as self-medication. The derived reasons for SMA were convenience (63.3%) and cost-saving (34.8%). Tonsillitis was the most common ailment behind SMA (55.5%). Log-binominal regression revealed that non-insured and low level of education participants were more likely to predict SMA. Regarding the practice, 40% changed the dose and/or antibiotics mainly owing to improvement (53.7%) or worsening of the condition (37.9%). The most commonly used antibiotic was amoxicillin/clavulanic acid (32.5%). Two out of three individuals in Sudan practice SMA mainly to manage upper respiratory tract ailments. Thus, the necessity of implementing an antimicrobial stewardship program throughout the country, as well as implementing effective legislation to prohibit dispensing antibiotics without prescription is urgently required.

Environmental and clinical mould spore risk thresholds

Escalating environmental pollution and urbanization is associated with a rise in fungal contamination, which contributes to a variety of health concerns, particularly respiratory tract ailments such as allergic rhinitis, asthma, bronchitis, and sick building syndrome. Spore trap testing serves as a straightforward method for evaluating the number of spores/m³ in the air. Multiple studies indicate that 1000 spores/m³ represents the upper threshold for normal levels of mould exposure, with levels above this linked to adverse health effects, thereby establishing the environmental threshold. According to the literature, the clinical threshold is 3000 spores/m³ for Cladosporium and 100 spores/m³ for Alternaria. This mini review provides an overview of the existing environmental and clinical thresholds for fungal contamination to assess risk. We examine fungal threshold levels in both outdoor and indoor settings, encompassing residential homes, libraries, buildings, workplaces, and hospitals. In conclusion, environmental scientists, microbiologists/mycologists, occupational hygienists, insurance assessors, the real estate sector, clinical healthcare staff, and others must use and apply both environmental and clinical threshold levels to assess fungal contamination risk in indoor environments to protect public health. And finally, this mini review highlights the need for increased focus and research to ensure that appropriate guidelines and industry standards are developed, applied, and enforced that incorporate objective spore thresholds to quantify risk from fungal mediated adverse health in various indoor environments.

LAUQ KHAYAR SHAMBAR: A POLYHERBAL UNANI FORMULATION FOR THE MANAGEMENT OF COUGH

Cough is a physiological reflex, experienced by every human, is an important protective and defensive mechanism whose action secures the removal of foreign materials and secretions from the airways (larynx, trachea and bronchi). In various circumstances, such as respiratory tract inflammation, viral infections, allergic rhinitis, or inhalation of various irritants, it is unintentionally stimulated and a cough suppressant may be needed to relieve the cough. The currently available cough suppressants (opiates, dextromethorphan, etc.) limit their use in humans due to significant side effects such as constipation, respiratory depression, drowsiness. Lauq Khayar Shambar (LKS) is used as an antitussive in Unani medicine for centuries and is also used to treat various upper respiratory tract ailments such as asthma, dyspnoea, catarrh, productive and dry cough, pharyngitis and laryngitis. So, this review aims to explore the role of LKS in the management of cough.

Indigenous knowledge and quantitative ethnobotany of the Tanawal area, Lesser Western Himalayas, Pakistan.

Ethnobotanical field surveys were carried out in the Tanawal area of the Lesser Himalayan Region, Khyber Pakhtunkhawa, Province from April 2016 to October 2017. The area is located between 34.36 (34° 21’ 30 N) latitude and 73.07 (73° 4’ 0 E) longitude with an average elevation of 1374 meters above sea level. Ethnomedicinal data were collected through Participatory Rural Appraisal (PRA), and participants were selected through the snow-boll technique. Semi-structured, in-depth and open-ended interviews were conducted. The data were quantitatively evaluated using ethnomedicinal indices i.e. Relative frequency of citation (RFCs), Fidelity level (FL), and Use Value (UV). The ethnobotanical data were also comparatively analyzed through the Jaccard Index (JI). The study yielded 66 medicinal plants in 62 genera and 43 families. Asteraceae and Solanaceae were the most important families with five medicinal taxa each. Regarding medicinal plant part utilization, leaves (43.28%) were used predominantly, followed by whole plant (14.92%) and fruits (14.92%). Decoction was the main drug formulation applied to 21 species (31.15%) and the oral route was most common (56.1%) while 31.2% of medicinal plants were used for both oral and topical applications. Fifty health disorders were recorded and grouped in 15 categories. Maximum species were used to treat gastrointestinal disorders i.e. 13 species, dermal problems (12 species), and respiratory tract ailments (9). The calculated RFCs ranged between 81 to 31. The most important medicinal plants were Acacia modesta, Citrullus vulgaris, Tamarindus indica, and Momordica charantia with an RGFC of 81 each. The UV ranged between 0.58 and 3.6. Medicinal taxa with the highest UV were Dioscorea deltoidea (3.6), Withania coagulans (3.3), Momordica charantia (3.5), Silybum marianum and Pyrus pashia (3.2). FL values showed that 28 (41.79%) species had a FL value below 50 (74.62%) while 39 (58.20%) had higher FL values. Momordica charantia, Tamarindus indica, Acacia modesta and Citrullus vulgaris were 95.2 each. The Jaccard Index (JI) values ranged from16.77 to 0.98. The current study also reported 16 medicinal plants, commonly used around the globe, have been rarely documented for their medicinal values in the local ethnomedicinal literature i.e. Althaea officinalis, Plantanus orientalis, Jasminum sombac, Maytenus royleana, Cucurbita maxima, Phyllanthus emblica, Citrullus vulgaris. Polygonatum verticilliatum, Caseria tomentosa, Cistanche tubulosa, Bambusa arundinacea, Schinus molle, Tamarindus indica, Pongamia pinnata, Citrus limon and Catharanthus roseus. However, 48 medicinal plants had been reported in the literature but the current study reported their novel medicinal uses. Important taxa should be established in botanical gardens for in-situ conservation, chemical investigation and sustainable utilization. It would also be effective to improve the livelihoods of the local population.

Glycyrrhiza glabra: An Insight to Nanomedicine.

Glycyrrhiza glabra Linn (Fabaceae), commonly known as Licorice/Liquorice, Mulahatti; is an undershrub. The dried, peeled or unpeeled underground stems and roots are used for the treatment of upper respiratory tract ailments, immunodeficiency, endocrine disorders, skin, liver, joint and heart diseases. Medicinal properties of this plant are enormous and offer it as one of the greatest candidates in the field of Nanomedicine. The Nanomedicine has dedicated to safeguard and upgrade human health using the nanotechnology. Bioactive constituents of this plant perform versatile pharmacological actions and can be used as good Bioanalytical tools. Therefore, an updated overview on current knowledge of green synthesis of nanoparticles (NPs), nanoformulations and surface modification using G. glabra is provided here in order to explore its therapeutic potential especially antifungal and antibacterial activities. In our lab, we have synthesized silver nanoparticles (Ag NPs) using leaves and rhizome parts of G. glabra.

A possible link between recurrent upper respiratory tract infections and lower cytokine production in patients with Q fever fatigue syndrome.

Besides fatigue, many Q fever fatigue syndrome (QFS) patients also complain of frequently recurring upper respiratory tract infections with severe symptoms. We investigated whether immunologic dysregulation contributes to these complaints. Cytokine and chemokine production was measured after stimulating monocytes of QFS patients and age‐ and sex‐matched healthy controls with LPS and several viral ligands. The H3K4me3 mark of open chromatin was measured at the promoter regions of cytokines and chemokines that differed significantly from healthy controls. Monocytes of QFS patients produced significantly less TNF‐α (p = 0.032), IL‐1β (0.004, 0.024, and 0.008), IL‐6 (0.043), RANTES (0.033), IP‐10 (0.049), MCP‐1 (0.022), IL‐ 13 (0.029), and IL‐10 (0.026) than healthy controls when stimulated with various ligands. H3K4me3 expression was significantly lower in QFS patients than in healthy controls on the promoter regions of IL‐1β (p = 0.004), MCP‐1 (<0.001 and <0.001), IP‐10 (<0.001), IL‐10 (0.041), and IL‐13 (<0.001, <0.001, and 0.001). QFS patients showed diminished cytokine responses to various stimuli compared to age‐ and sex‐matched healthy controls, likely due to epigenetic remodeling and long‐term memory as a result from the acute Q fever infection. This might explain the upper respiratory tract ailments in QFS.

An epidemiological study on effect of occupational exposure of cement

Background: Construction industry chiefly depends on the cement. The constituents in the cement have various health effects in the exposed group. The present study focused to realize the health effects of cement exposure and duration of exposure.Methods: The sample size was 831 male workers. The labourers included were construction workers (masons, helpers and concrete mixers) and cement loading and unloading workers. They were categorized in to five groups which were 5-9, 10-14, 15-19, 20-24 and 25+ years based on the duration of exposure to cement. Health hazards among these labourers were categorized in to lung function impairment symptoms, cutaneous symptoms and other symptoms.Results: High frequency of respiratory tract ailments (persistent cough 54%, breathlessness 47%) was observed among loading workers as they were handling cement dust. Burning was the most observed one in concrete mixer (70%), hair loss and change in hair colour was observed in 60% of all categories of workers. Skin related ailments were more prevalent among masons, helpers and concrete mixers.Conclusions: The frequency symptoms had correlation with their nature of work in the construction industry. Prolonged exposure to hazardous substances will decline the efficiency of labourers by malfunctioning their physiological functions. Proper awareness about the hazardous substances and well taken precautions among these labours can enhance their efficacy and wellbeing.

Preparation and biological activity of nanocapsulated Glycyrrhiza glabra L. var. glabra

ABSTRACTGlycyrrhiza glabra is a medicinal plant found in Asia, the Mediterranean and parts of southern Europe. It used for the treatment of upper respiratory tract ailments including coughs, hoarseness, sore throat and bronchitis. In this study, natural polymers, chitosan and alginate were used for preparing nanocapsules containing turmeric oil and a methanol extract of G. glabra. The antimicrobial activity of G. glabra as an extract and in a nanocapsule was investigated. In the preparation of nanocapsules, a three‐step procedure involving emulsification, cross‐linking with calcium chloride and solvent removal was used. Morphological characteristics of the nanocapsules were investigated by particle size using transmission electron microscopy. The results showed that turmeric oil‐to‐extract ratio, surfactant and molecular weight of chitosan all affect the size of the nanocapsule produced. An oil‐to‐extract ratio of 10:10 mg/ml, Tween 80 and low molecular weight chitosan resulted in the optimal (smallest) nanoparticle size. Copyright © 2014 John Wiley &amp; Sons, Ltd.

Antibacterial activities of plants from Central Africa used traditionally by the Bakola pygmies for treating respiratory and tuberculosis-related symptoms

Ethnopharmacological relevanceThe antibacterial activities of 18 plants from 10 different families were investigated for their antimicrobial efficacy, based on the traditional uses of these species by Bakola pygmies living in Central Africa, especially along the Ngoyang area in Cameroon for the treatment of respiratory and tuberculosis-related symptoms. The aim of the study is to test the antimicrobial efficacy of these plants against some pathogens associated with respiratory disease and to determine if there is any validation for the traditional use against Mycobacterium species. Materials and methodsMedium polar extracts were prepared in MeOH/DCM (1:1, v/v) from the plant parts of each species used traditionally and were assayed against pathogens associated with respiratory tract ailments [Staphylococcus aureus (ATCC 25923), Klebsiella pneumoniae (ATCC 13883) and Morexella cattarhalis (ATCC 14468)] using the minimum inhibitory concentration (MIC) method. Two additional faster growing Mycobacterium strains [Mycobacterium smegmatis (ATCC 23246) and Mycobacterium aurum (NCTC 10437)] were included in the assay as predictive test organisms for the more pathogenic strain Mycobacterium tuberculosis. ResultsSome plant species, such as Alchornea floribunda, Musanga cecropioides (both leaves and stem bark), Tetracera potatoria and Xylopia aethiopica (stem bark), were effective in inhibiting Morexella cattarhalis, having MIC values between 65 and 250μg/mL. Some noteworthy antimycobacterial inhibition (MIC≤200μg/mL and as low as MIC 6.5µg/mL) for 54% of the extracts were observed. ConclusionWhile moderate activity was shown for pathogens causing respiratory tract infections, these plant species seems to be selectively targeting Mycobacteria spp. suggesting that the traditional use for treating tuberculosis related symptoms may be indeed be accurate.

Morphological differentiation of non-glandular and glandular trichomes on Marrubium vulgare L.

Marrubium vulgare L., commonly known as a white horehound or common horehound, belongs to the plant family Lamiaceae. It is a perennial aromatic herb which grows naturally in Europe, Asia, and America. Since ancient Egypt, this species has been known as a remedy for upper respiratory tract ailments. Nowadays, horehound is used in herbal medicine for treatment of liver diseases, biliary tract disorders, and for increasing the appetite and supporting the function of the stomach. The main biologically active substances in M. vulgare organs are: marrubiin, tannins, essential oils, and ursolic acid. The paper presents micromorphological analyses of non-glandular and glandular trichomes of M. vulgare. The research material was sampled from the plant collection in the Botanical Garden of the Maria Curie-Sklodowska University in Lublin (51°14′ N, 22°34′ E). The above-ground parts of horehound were collected during the flowering period in July 2013. Using light microscopy (LM) and scanning electron microscopy (SEM), the types and sizes of trichomes from the stem, leaf, calyx, and corolla were investigated. The results of the microscopic observations show that the surfaces of M. vulgare vegetative and reproductive organs are densely clothed with glandular and non-glandular trichomes. The glandular trichomes are of two main types: peltate and capitate. Peltate trichomes consist of a short stalk cell and a large head with secretory cells arranged in a circle. The height of a mature trichome is about 31.33 µm and the diameter of the head is 31.47 µm. The substance produced by secretory cells passes through the apical walls and accumulates within a space between the cuticle and the cell wall layer. Capitate long trichomes with a basal cell, long stalk, neck cell, and a unicellular head are 36.65 µm long and the diameter of the head is about 15.6 µm. There are two types of short capitate trichomes: with a bicellular head and a unicellular stalk and with four-celled head and a unicellular stalk. The length of these trichomes is on average 26.32 µm and the diameter of the head is 20.32 µm. Moreover, we observed two types of non-glandular trichomes: multicellular uniserrate and multicellular branched. The length of the non-glandular trichomes is between 60.69 µm and 1130.3 µm.

Antibiotic dispensing in Egyptian community pharmacies: An observational study

Antibiotics are commonly dispensed medications from community pharmacies, and they are frequently prescribed for inappropriate indications. In many countries, they are easily accessible without prescriptions. The inappropriate use of antibiotics results in the emergence of resistant bacterial strains, which represents a considerable public health problem, particularly in developing countries. This study aimed to describe the pattern of antibiotics dispensing from Egyptian community pharmacies and to collect baseline descriptive data on the antibiotics dispensed and their appropriateness. A cross-sectional, observational study of antibiotic dispensing encounters was conducted at 36 randomly selected pharmacies in Greater Cairo, Egypt. Data were collected during one shift at each pharmacy. Structured questionnaires recording patient demographics, antibiotics dispensed and reasons for dispensing were completed for each antibiotic dispensing encounter. The data were descriptively analysed. Overall, 1158 antibiotics were dispensed during the study period with a total cost of L.E. 24,487 (approximately 3,673 $USD). While self-medication and purchasing without medical prescriptions were common, representing around 23.3% of the antibiotics (n=270), most antibiotics were prescribed by a doctor or dentist (n=736, 63.6%). Pharmacist recommendations accounted for the remainder (n= 152, 13.1%). The main reasons for antibiotic use were respiratory tract ailments and gastroenteritis symptoms. The antibiotics most commonly dispensed were: penicillins, erythromycin, metronidazole, neomycin, clotrimoxazole and tetracyclines. Approximately 70% of the antibiotics dispensed on prescriptions were judged to be appropriate for the indications while this percentage was around 61% for antibiotics dispensed on pharmacist recommendation and patient's request. The results of this study show that antibiotics are frequently dispensed from community pharmacies in Egypt without appropriate prescriptions and for inappropriate indications. These findings support the need for strict enforcement of pharmacy laws through improved inspection processes. They highlight the need for evidence-based guidelines and educational interventions to improve antibiotic prescribing and dispensing practices.

Treating lower respiratory tract ailments in children and infants

Treating lower respiratory tract ailments in children and infants

Traditional medicine in the pristine village of ProkoÅko Lake on Vranica Mountain, Bosnia and Herzegovina.

The results of an ethnobotanical study conducted in the pristine village of Prokoško Lake (Vranica Mountain, Bosnia and Herzegovina) in summer 2007 is presented. Informal interviews involving 12 informants known as “traditional healers” provided data from 43 plants used in 82 prescriptions. The applied plants were used for a broad spectrum of indications. The most frequent were gastro-intestinal tract ailments, blood system disorders, skin ailments, respiratory tract ailments and urinary-genital tract ailments. The most frequent preparation was an infusion. Other often used preparations were ointments or balms and decocts. The special Bosnian balms known as “mehlems” were prepared from freshly chopped or freshly pressed herbal parts of various plant species. Warmed resins from Abies or Picea species, raw cow or pig lard, olive oil and honey served as basis. The traditional doctors, who usually worked as a team, enjoyed such a good reputation that people from all over the country were visiting in search of alternative ways to cure their ailments and diseases. The practical techniques applied by the healers and some of their attitudes and values are reported.

Micropropogation and Organogenesis inAdhatoda vasikaFor The Estimation Of Vascine

Adhatoda vasika (Family: Acanthaceae) commonly known as vasaka has been used in traditional system of medicine for several respiratory tract ailments. Vasicine and vasicinone are the important alkaloids of vasaka having bronchodilatory and expectorant effect. In the present study we have tried to develop callus cultures of vasaka from leaf, petiole and nodes by using different plant growth regulator (PGR) combinations. The best PGR combination in terms of growth index, bioactive secondary metabolite content and repeatability to induce callus was determined. Secondary metabolite recovered from callus was identified using a standard sample of vasicine by chromatographic and spectroscopic techniques. MS medium prepared with 10.7µM NAA (Naphthalene acetic acid) and 2 .2µM 6BA (6 benzylaminopurine) showed 90% repeatability to induce callus with 7th day callus induction and secondary metabolite concentration of 3.2 % on gram dry weight basis. An attempt to increase secondary metabolite concentration using cell suspension culture was tried and a rise in alkaloidal content was obtained during a period of one month study. Organogenesis was established using nodes as an explant and shoots were observed after 18 days. The results of the present study revealed that the developed callus, shoot and root invitro cultures can be used as alternative source for production of vasaka alkaloids of pharmaceutical interest.

Antiasthmatic potential of aqueous extract of Cassia occidentalis

Asthma is a chronic inflammatory disease of the airways characterized by the fibrosis of the airways, hyperplasia and hypertrophy of smooth muscle cells and mucus secretary cells due to infiltration of activated eosinophils and activation of mast cells and lymphocytes. Various traditional medicinal plants have been used in folk medicine to treat a wide range of physical ailments such as asthma and bronchitis. Cassia occidentalis L. (Caesalpiniaceae) leaf juice is traditionally used for the treatment of the respiratory tract ailments and is well-known drug in Ayurvedic and Unani system of medicine. This plant is abundant in the region of North Maharashtra commonly known as Kasmardan. Since no scientific studies have been carried out on the leaf the present study evaluates the antiasthmatic activity an aqueous extract of C. occidentalis (COAE) on in vitro and in vivo animal models. In vitro studies carried out on histamine- induced contraction in isolated goat tracheal chain and in vivo studies on milk- induced eosinophilia, mast cell degranulation and capillary permeability in mice (n=5). The results showed that aqueous extract of C. occidentalis inhibited the contractile effect of histamine (P<0.05). A dose dependent contraction of goat tracheal chain is observed. Treatment with COAE (200mg/ kg, i.p.) decreased eosinophilia by 71% while mast cells were protected 66% from degranulation as compared to control group. Also, COAE decreased capillary permeability by 69% in mice was evident from its effect on optical density of the dye. Thus, COAE showed antihistaminic, mast cell stabilizing and decreasing capillary permeability effect and hence possesses potential role in the treatment of asthma.

Pregnancy outcome following gestational exposure to Azithromycin: a prospective controlled study

Introduction Azithromycin is an azalide antibiotic with an extensive range of indications including upper/lower respiratory tract ailments, skin, genitourinary infections etc. It is a popular treatment option due to its convenient dosing regimen and therapeutic advantages. Available human studies addressing gestational use of azithromycin have primarily focused on efficacy, rather than fetal safety. Objective: To evaluate pregnancy outcome following gestational exposure to azithromycin. Methods: This prospective controlled study consists of an azithromycin-exposed group compared to: 1) women receiving non-teratogenic antibiotics for similar indications and 2) exposed to non-teratogenic agents. The three groups were matched for gestational age at time of call, maternal age, smoking/alcohol status. Rates of major anomalies and secondary endpoints of interest were compared. Results: Pregnancy outcome was ascertained from a total of 123 women enrolled in each group. In the exposed group, 88 pregnancies occurred in the first trimester. Statistical analysis did not show any significant differences between the three groups in the rates of major malformations; 3.4% versus 2.3% and 3.4% (P=0.9) or any other endpoints that were examined. Conclusion: To date, results do not appear suggest an increased risk above baseline with gestational azithromycin exposure, providing an evidence-based option for health professionals caring for non-compliant populations with Chlamydia. Clinical Pharmacology & Therapeutics (2004) 75, P75–P75; doi: 10.1016/j.clpt.2003.11.283

The Carbolic Smoke Ball

The Carbolic Smoke Ball was an early purpose-made dry powder inhalation device whose promotion led to a landmark court case which established an important principle of English law. The Carbolic Smoke Ball was patented in England in 1889 by a Frederick Augustus Roe, as a ‘device to facilitate the distribution, inhalation, and application of medicated powders’ [1], although in some of its promotional literature it was described as ‘a new American remedy’ (Figure 1). The original patent describes ‘a composite hollow ball or receptacle of india rubber ... having an orifice provided with a porous or perforated disc or diaphragm ... through which when the ball or receptacle is compressed, the powder will be forced in a cloud of infinitesimally small particles resembling smoke’. It appears from trade catalogues that two different forms were marketed. The author has in his possession a version which is a rounded ball-shaped vessel with a flattened bottom and short neck, black in appearance, but actually made from very dark green glass. The smoke ball’s contents were composed of a mixture of glycyrrhiza and white hellebore (Veratrum vide) together with a tarry residue that provided the odour of carbolic acid [2]; carbolic inhalations had become fashionable for the treatment of various chest ailments, including tuberculosis, since Lister’s development of a carbolic acid spray to prevent sepsis following surgery [3]. It was promoted by the Carbolic Smoke Ball Company of Hanover Square, London, as a positive cure for a variety of respiratory tract ailments including colds, hay fever, catarrh, asthma, bronchitis, and influenza – as well as neuralgia and headache. The cost of each device was 10 shillings (£0.50); it could be refilled for a further 5 shillings. It was stated to be used by a wide section of the titled classes, as well as the actors Henry Irving and Ellen Terry. It was an advertisement in the Pall Mall Gazette in 1891 which led to the Carbolic Smoke Ball Company’s appearance in court [4]. The advertisement in question differed from that illustrated here, in offering a reward of £100 to any person contracting influenza or a cold after having used the Carbolic Smoke Ball according to the printed directions. Mrs Carlill (often misprinted Carhill or Cahill) purchased and used a smoke ball as directed, but contracted influenza nonetheless. Her husband (a solicitor by training) requested the advertised compensation of £100 on her behalf, but was ignored by the manufacturers, so sued them. The case (Carlill vs The Carbolic Smoke Ball Company) came to court in 1892, in which year advertisements containing the £100 offer were still appearing in the national press (for example, The Graphic) [2]. The defence argued variously that the claim was a bet within the meaning of the Gaming Act; that the offer was merely

Pregnancy Outcome Following Gestational Exposure to Echinacea: A Prospective Controlled Study

Background Echinacea products are among the most popular phytomedicines on the North American market. Since at least half of all pregnancies are unplanned, many women inadvertently use echinacea in their first trimester. Presently, there is a paucity of information regarding the gestational safety of this herb. The primary objective of this study was to evaluate the safety of echinacea in pregnancy when used for upper respiratory tract ailments. Patients and Methods The study group consisted of women who were prospectively followed up after contacting the Motherisk Program regarding the gestational use of echinacea. This cohort was disease-matched to women exposed to nonteratogenic agents by maternal age, alcohol, and cigarette use. Rates of major and minor malformations between the groups were compared. Results A total of 206 women were enrolled in the study group after using echinacea products during pregnancy; 112 women used the herb in the first trimester. There were a total of 195 live births, including 3 sets of twins, 13 spontaneous abortions, and 1 therapeutic abortion. Six major malformations were reported, including 1 chromosomal abnormality, and 4 of these malformations occurred with echinacea exposure in the first trimester. In the control group, there were 206 women with 198 live births, 7 spontaneous abortions, and 1 therapeutic abortion. Seven major malformations were reported. There were no statistical differences between the study and control groups for any of the end points analyzed. Conclusions This first prospective study suggests that gestational use of echinacea during organogenesis is not associated with an increased risk for major malformations.

Pregnancy outcome following gestational exposure to echinacea – a prospective controlled study

Background Echinacea products are among the most popular phytomedicines on the North American market. Since at least half of all pregnancies are unplanned, many women inadvertently use echinacea in their first trimester. Presently, there is a paucity of information regarding the gestational safety of this herb. The primary objective of this study was to evaluate the safety of echinacea in pregnancy when used for upper respiratory tract ailments. Patients and Methods The study group consisted of women who were prospectively followed up after contacting the Motherisk Program regarding the gestational use of echinacea. This cohort was disease-matched to women exposed to nonteratogenic agents by maternal age, alcohol, and cigarette use. Rates of major and minor malformations between the groups were compared. Results A total of 206 women were enrolled in the study group after using echinacea products during pregnancy; 112 women used the herb in the first trimester. There were a total of 195 live births, including 3 sets of twins, 13 spontaneous abortions, and 1 therapeutic abortion. Six major malformations were reported, including 1 chromosomal abnormality, and 4 of these malformations occurred with echinacea exposure in the first trimester. In the control group, there were 206 women with 198 live births, 7 spontaneous abortions, and 1 therapeutic abortion. Seven major malformations were reported. There were no statistical differences between the study and control groups for any of the end points analyzed. Conclusions This first prospective study suggests that gestational use of echinacea during organogenesis is not associated with an increased risk for major malformations.