Systematic review and Meta-analysis of efficacy and safety of Shufeng Jiedu Capsules in treatment of influenza / 中国中药杂志

This study aims to systematically review the efficacy and safety of Shufeng Jiedu Capsules in the treatment of influenza. The randomized controlled trial(RCT) of Shufeng Jiedu Capsules alone or in combination with conventional western medicine for treating influenza were retrieved from PubMed, EMbase, Cochrane Library, Web of Science, SinoMed, CNKI, VIP, Wanfang, and ClinicalTrails.gov. The data analysis was performed in RevMan 5.4.1. The Cochrane risk of bias assessment tool was used to evaluate the quality of the involved RCT, and GRADEpro GDT to assess the quality of the evidence. A total of 11 RCTs involving 1 836 patients were included in this study. Compared with conventional western medicine, Shufeng Jiedu Capsules/Shufeng Jiedu Capsules + conventional western medicine improved the response rate(RR=1.09, 95%CI[1.03, 1.15], P=0.002), shortened the time to relief of cough, and increased the 3-day sore throat relief rate, whereas there was no significant difference in the time to fever abatement, the time to relief of sore throat, 3-day cough relief rate, or 3-day runny nose relief rate. Subgroup-analysis showed that Shufeng Jiedu Capsules + conventional western medicine improved the response rate(RR=1.11, 95%CI[1.08, 1.15], P<0.000 01), shortened the time to relief of cough, and increased the 3-day relief rate of symptoms(cough, sore throat, and runny nose) compared with conventional western medicine alone, while there was no significant difference in the time to fever abatement or the time to relief of sore throat. Shufeng Jiedu Capsules alone could not improve the response rate(RR=0.97, 95%CI[0.93, 1.02], P=0.19). In addition, Shufeng Jiedu Capsules/Shufeng Jiedu Capsules + conventional western medicine vs conventional western medicine were no significant difference in adverse reactions(RR=0.98, 95%CI[0.57, 1.69], P=0.95). The available evidence suggests that Shufeng Jiedu Capsules is effective and safe in the treatment of influenza, and the combination of Shufeng Jiedu Capsules with conventional western medicine can accelerate the relief of symptoms. However, since the number and quality of the included studies were low, the above findings remained to be further verified by multicenter RCT with large sample sizes.

The effect of pheniramine on fentanyl-induced cough: a randomized, double blinded, placebo controlled clinical study / Efeito de feniramina sobre a tosse induzida por fentanil: estudo clínico, randômico, duplo-cego e controlado com placebo

Abstract Background and objectives: There are many studies conducted on reducing the frequency and severity of fentayl-induced cough during anesthesia induction. We propose that pheniramine maleate, an antihistaminic, may suppress this cough. We aim to observe the effect of pheniramine on fentanyl-induced cough during anesthesia induction. Methods: This is a double-blinded, prospective, three-arm parallel, randomized clinical trial of 120 patients with ASA (American Society of Anesthesiologists) physical status III and IV who aged ≥18 and scheduled for elective open heart surgery during general anesthesia. Patients were randomly assigned to three groups of 40 patients, using computer-generated random numbers: placebo group, pheniramine group, and lidocaine group. Results: Cough incidence differed significantly between groups. In the placebo group, 37.5% of patients had cough, whereas the frequency was significantly decreased in pheniramine group (5%) and lidocaine group (15%) (Fischer exact test, p = 0.0007 and p = 0.0188, respectively). There was no significant change in cough incidence between pheniramine group (5%) and lidocaine group (15%) (Fischer exact test, p = 0.4325). Cough severity did also change between groups. Post Hoc tests with Bonferroni showed that mean cough severity in placebo differed significantly than that of pheniramine group and lidocaine group (p < 0.0001 and p = 0.009, respectively). There was no significant change in cough severity between pheniramine group and lidocaine group (p = 0.856). Conclusion: Intravenous pheniramine is as effective as lidocaine in preventing fentayl-induced cough. Our results emphasize that pheniramine is a convenient drug to decrease this cough.

Resumo Justificativa e objetivos: Há muitos estudos sobre a redução da frequência e da gravidade da tosse induzida por fentanil durante a indução da anestesia. Propomos que maleato de feniramina, um anti-histamínico, pode suprimir essa tosse. Nosso objetivo foi observar o efeito de feniramina sobre a tosse induzida por fentanil durante a indução da anestesia. Métodos: Este é um estudo clínico prospectivo, de três braços paralelos, randômico e duplo-cego, de 120 pacientes com estado físico ASA III e IV (de acordo com a Sociedade Americana de Anestesiologistas), ≥ 18 anos e programados para cirurgia cardíaca aberta eletiva sob anestesia geral. Os pacientes foram divididos aleatoriamente em três grupos de 40 pacientes cada, com números aleatórios gerados por computador: grupo placebo, grupo feniramina e grupo lidocaína. Resultados: A incidência de tosse diferiu significativamente entre os grupos. No grupo placebo, 37,5% dos pacientes apresentaram tosse, enquanto que a frequência foi significativamente reduzida no grupo feniramina (5%) e no grupo lidocaína (15%) (teste exato de Fischer, p = 0,0007 e p = 0,0188, respectivamente). Não houve alteração significativa na incidência de tosse entre os grupos feniramina (5%) e lidocaína (15%) (teste exato de Fischer, p = 0,4325). A gravidade da tosse também alterou entre os grupos. Testes post hoc com Bonferroni mostraram que a média da gravidade da tosse no grupo placebo diferiu significativamente das médias dos grupos feniramina e lidocaína (p < 0,0001 e p = 0,009, respectivamente). Não houve alteração significativa na gravidade da tosse entre o grupo feniramina e grupo lidocaína (p = 0,856). Conclusão: Feniramina por via intravenosa tem a mesma eficácia que lidocaína na prevenção da tosse induzida por fentanil. Os resultados enfatizam que feniramina é um medicamento conveniente para diminuir essa tosse.

Conscious sedation--an artist's science! An Indian experience with midazolam.

The present study was undertaken to evaluate Midazolam as a Paediatric conscious sedative agent for a routine Indian dental setup and to compare its efficacy and safety when administered by intranasal and intramuscular routes, at a dosage of 0.2 mg/kg body weight. The present study was accomplished in two phases: Phase 1: Preliminary dose finding pilot study on 10 children. Phase 2: Single dose, randomized parallel clinical trial on 40 children between the ages of 2 and 5 years. These children were randomly assigned to two groups consisting of 20 subjects each. Group M, received Midazolam intramuscularly, while Group N received Midazolam intranasally. Both the intranasal and intramuscular groups showed highly significant decrease in crying levels, motor movements and sensory perception levels, post-sedation (P P < 0.001). Midazolam could be safely and successfully employed by intranasal and intramuscular routes for Paediatric conscious sedation in a routine dental setup with basic facilities at a dosage of 0.2 mg/ kg body weight. Whenever the clinical situation warrants a faster action, peak and recovery, the intranasal route should be the obvious choice.

fentanyl induced cough at induction. the Influence Premedication and Smoking

The history of smoking and premedication did not influence the proportion of patients who had a cough response to fentanyl when administrated as first agent during induction in anesthesia

Aumento del umbral tusígeno en sujetos sanos con el uso de Levodropropizina / Increase of the cough threshold to capsaicin in healthy adults by administering Levodropropizine

A randomized, prospective, double blind and placebo controlled study was designed to evaluate in 20 non smoker healthy adult volunteers the reproducibility and modification of cough threshold (CT) induced by capsaicin after placebo and Levodropropizine (a new synthetic drug). Adult volonteers of both sexes, mean age 34.9 years old (range: 18-57 years), inhaled increasing concentrations of capsaicin to determine the basal CT: log concentration of capsaicin that induced at least two consecutive coughs. The basal CT was 2.240 µM (+/- 0.060 SE), without differences by sex or age (p: ns), In 11 out of 18 subjects the CT increased from 2.358 (+/- 0,044 SE) on placebo to 2.469 µM (+/- 0.057) after Levodropropizine (p = 0.01). Two subjects were excluded due to intercurrent disease, not related to the study. No significant adverse reactions were reported during the study. Conclusion: Capsaicin induced reproducible controlled cough in 20 healthy volunteers and Levodropropizine given orally increased the cough threshold.

Se diseñó un estudio aleatorio prospectivo, doble ciego cruzado contra placebo, para estudiar la reproducibilidad y las modificaciones del umbral tusígeno (UT) inducido por capsaicina, luego de administrar placebo y Levodropropizina (un nuevo antitusivo sintético). Se determinó el UT basal (logaritmo de la concentración de capsaicina que induce al menos dos toses consecutivas) en 20 voluntarios adultos sanos, no fumadores de ambos sexos con edad promedio de 34,9 años (rango: 18 a 57 años). El promedio del UT basal fue 2,240 µM (+ - 0,060 ES), sin haber diferencias significativas por sexo o edad (p: ns). En 11 de 18 sujetos el UT aumentó de 2,358 µM (+/ - 0,044 ES) con placebo a 2,469 µM (+/- 0,057 ES) con Levodropropizina (p = 0,01). Dos sujetos fueron excluidos por presentar una enfermedad intercurrente no relacionada con el estudio. No hubo efectos adversos significativos. Conclusión: La capsaicina indujo reproduciblemente el reflejo tusígeno en 20 voluntarios sanos, y la Levodropropizina administrada por vía oral aumentó el umbral tusígeno.

Tosse de difícil controle em otorrinolaringologia, induzida por anti-hipertensivo: inibidor fa enzima conversora da angiotensina / Difficulties in cough control in otorhinolaryngology, when provoked by anti-hypertensive angiotensin: converring enzyme inhibitors

Os autores relatam casos clínicos de tosse de longa duraçäo, de até cinco anos, em pacientes hipertensos e alérgicos, que fazem uso dos inibidores da enzima conversora da angiotensina (ECA), como hipotensores, näo melhoram com a utilizaçäo de anti-histamínicos e regridem com a mudança do inibidor da ECA por outro anti-hipertensivo

El losartán en pacientes con tos por inhibidores de enzima convertidora de angiotensina / Losartan in patients with cough indiced by angiotensin converting enzyme

Antecedentes. La tos es el efecto secundario más frecuente de los inhibidores de enzima convertidora de angiotensina (IECA); el losartán es un bloqueador de los receptores de angiotensina II, y no tiene efecto en esta enzima, por lo que la tos es poco probable. Objetivo. Determinar la tolerancia y la eficacia del losartán en pacientes con tos inducida por IECA. Material y métodos. Ensayo clínico abierto, con el paciente como su propio control, adultos, no fumadores, con historia de tos inducida por IECA, se sometieron a lavado hasta desaparecer la tos; posteriomente recibieron losartán en una dosis; se determinó la tensión arterial y el pulso al recibir IECA y a 2, 4 y 8 semanas después; en cada visita se interrogó acerca de la tos. Se hicieron mediciones de laboratorio de seguridad. Resultados. Se estudiaron 18 pacientes con una edad media de 59 años (ñ 8.8 ds); 13 toleraron el fármaco (72.2 por ciento, IC 95 por ciento=70.05 a 74.35); cinco (27.8 por ciento) desarrollaron tos. La tensión arterial se mantuvo sin cambios durante las primeras cuatro semanas, la tensión sistólica mostró a la octava semana reducción de 13.5 mmHg (IC95 por ciento=1.63 a 12.4), y 8.16 mmHg en la octava semana (IC 95 por ciento=3.4 a 12.8). No hubo diferencia en los parámetros bioquímicos. Conclusiones. El losartán es bien tolerado en la mayoría de los pacientes con historia de tos secundaria a IECA, es seguro y eficaz en la reducción de la tensión arterial en estos pacientes

Angiotensin converting enzyme inhibitors and cough--a north Indian study.

Cough is an important side effect of Angiotensin Converting Enzyme Inhibitor (ACEI) therapy. The incidence of cough was investigated in a prospective 8 week study in 250 hypertensive patients receiving ACEI alone or in combination with other agents. Enalapril (5-20 mg/day), Lisinopril (5-20 mg/day), Captopril (25-75 mg/day) or Ramipril (5-15 mg/day) was prescribed to patients, who were followed up at weekly visits. Cough developed in 73 of the 250 patients i.e. an incidence of 29.2%. Females had a higher incidence of cough as compared to males--37.9% versus 15.5% (p < 0.001) and there was no significant difference in the cough incidence in the various age groups. A dry, non-productive cough developed in all patients within 4 weeks of ACEI initiation. Increased nocturnal intensity of cough was reported by 79.4% patients. Cough incidence was 34.4%, 24.3% and 18.1% in patients on Enalapril, Ramipril and Lisinopril, respectively. Cough was not dose related and was not related to smoking. There was no statistically significant difference among patients on ACEI alone or in combination with beta blockers, calcium channel blockers or diuretics. Of the 18 patients with ACEI induced cough who received Indomethacin, 50 mg bid, 8 reported complete cure and cough was reduced in intensity in the remaining ten.

Methacholine inhalation challenge in patients with chronic cough induced by angiotensin-converting enzyme inhibitors.

Angiotensin-converting enzyme inhibitors (ACEI) cause cough in some patients, but the mechanism of this side effect is not clear. Five patients (group I) who had developed chronic cough induced by ACEI were evaluated to determine the bronchial hyperreactivity (BHR) by challenge with methacholine inhalation using a reservoir method at Respiratory Unit, Chulalongkorn Hospital University. Five patients (group II) who did not experience coughing associated with ACEI were also challenged as controls. The results revealed that two patients (40%) in group I demonstrated BHR with the mean PC20 at 15 mg/ml of methacholine solution. On the other hand, none of the patients in group II disclosed BHR. We concluded that coughing during ACEI therapy may be due to an increased inflammatory state in the airway in some susceptible subjects.

Comparación del reflejo tusígeno desencadenado por capsaicina y ácido cítrico en sujetos normales / Comparison of cough reflex due to capsaicin and citric acid in normal subjects

El reflejo de la tos se evoca habitualmente por inhalación de aerosoles. La capsaicina (C) y el ácido cítrico (AC) han sido usados clínicamente y estimularían receptores diferentes. El objetivo del presente trabajo fue comparar la respuesta tusígena a ambas sustancias en voluntarios sanos. Estudiamos 17 sujetos (18-23 años, 11 varones) que recibieron C y AC al menos con una semana de diferencia. Las drogas se administraron con un nebulizador Hudson a 8 L/min, con una pieza bucal. La C se administró con doble ciego en dosis aleatoria (0.31-20 uM) y el AC en dosis crecientes (0.5-32 porciento) ya que este último presenta taquifilaxis. Todos los sujetos presentaron tos y no hubo efectos adversos. El número de toses fue grabado y contado en duplicado. Con ambas sustancias fue posible construir curvas dosis respuestas. La media (ñES) del total acumulativo de toses provocadas por la inhalación de C fue 15.0ñ1.8. La inhalación de AC provocó 12.9ñ1.6 toses. La concentración que produjo 2 toses (media geométrica e intervalos de confianza 95 porciento) fue 4.8 uM (3.5-6.6) para C y 5.3 porciento (3.4-8.4) para AC. El número de toses provocado por C y AC estuvo correlacionado en forma significativa (r=0.71.p=0.0012), al igual que las concentraciones que provocaron 2 toses (r=0.56,p<0.001). Concluímos que tanto el AC como la C permiten analizar el reflejo tusígeno. A pesar de su diferente farmacología existió correlación en el número de toses provocadas por ambas substancias y ello permite plantear que la respuesta tusígena está condicionada en parte por susceptibilidad individual

Inappropriately treated intractable cough

Chronic, non-productive cough has a variety of causes. In most cases the etiology is readily identifiable and treatable. Occasionally drugs induce a persistent cough which necessitates withdrawal of the offending agent. A case is presented in which drug-induced cough was misdiagnosed and inappropriately managed