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Clinical Ophthalmology (Auckland, N.Z.) 2023Dry eye disease (DED) is a chronic ocular surface disorder often characterized by decreased tear production and rapid tear evaporation that affect tear film stability... (Review)
Review
Safe and Effective Management of Dry Eye Symptoms with Hydroxypropyl Guar and Hyaluronic Acid Dual-Polymer Lubricating Eye Drops: A Review of Preclinical and Clinical Studies.
Dry eye disease (DED) is a chronic ocular surface disorder often characterized by decreased tear production and rapid tear evaporation that affect tear film stability and homeostasis. The common symptoms of DED include ocular discomfort, visual disturbances, dryness, and itching. Artificial tears are the mainstay of DED management and supplement one or more layers of the tear film. Artificial tear drops are available as a combination of viscosity-enhancing agents (demulcents/lubricants), humectants, and buffers either with or without preservatives. Artificial tears, as a combination of components (polymers/demulcents/viscosity-enhancing agents), can provide synergistic action compared with a single component for the management of multifactorial signs and symptoms of DED. This review describes the formulation components, physicochemical properties, mechanism of action, and summary of preclinical and clinical evidence on the hydroxypropyl guar-hyaluronic acid (HPG-HA) dual-polymer lubricant eye drops (SYSTANE HYDRATION). The dual-polymer eye drops consist of dual demulcents (propylene glycol and polyethylene glycol 400) and the polymers hydroxypropyl guar (HPG) and hyaluronic acid (HA). When instilled on the ocular surface, HPG forms a cross-linked gel matrix with borate ions that prolongs the retention of demulcents, thus providing long-lasting lubrication and ocular surface protection. Additionally, HA stabilizes the tear film, increases corneal wettability, and reduces friction during blinks due to its hygroscopic and viscoelastic properties. Preclinical evidence demonstrates that HPG HA dual-polymer lubricant eye drops provide protection against desiccation by cell hydration and surface retention, cell barrier protection, prolonged lubrication, and promotion of corneal re-epithelialization. Clinical scientific evidence demonstrates that HPG HA dual-polymer lubricant eye drops are safe and effective in the management of DED. Specifically, they reduce the signs and symptoms of DED, reduce dry eye symptoms post-cataract surgery, and improve tear film quality in healthy eyes.
PubMed: 38105908
DOI: 10.2147/OPTH.S428725 -
Journal of Bodywork and Movement... Jul 2023Non-specific low back pain is a leading contributor to disease burden and works absenteeism worldwide with a lifetime prevalence of 60-70% in industrialized countries.... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Non-specific low back pain is a leading contributor to disease burden and works absenteeism worldwide with a lifetime prevalence of 60-70% in industrialized countries. This clinical study aimed to assess the efficacy of hot fomentation with half-baked medicated bread (khubz) compared to hot water bag fomentation to alleviate pain and disability in non-specific low back pain.
METHODS
In this randomized-controlled study, fifty-four patients with low back pain were randomly assigned into two groups to receive either hot fomentation (Takmīd-e-haar) with half-baked medicated bread in the test group or hot water bag fomentation in the control group, on the lumbosacral region daily for 30 min for 15 consecutive days. Patients were assessed statistically using the visual analogue scale (VAS) and Oswestry disability index (ODI) at baseline, 7th and after treatment (15th day).
RESULTS
After the intervention, statistically significant improvements (p < 0.001) were observed in VAS and ODI scores in both the groups on the intragroup comparison. The test treatment showed better efficacy in comparison to the control treatment with a mean difference of 1.75 in VAS (p < 0.0001) and 8.20 in ODI (p = 0.001).
CONCLUSION
The tested intervention showed significantly better efficacy in comparison to the hot water bag fomentation probably due to the analgesic (musakkin-i-alam), anti-inflammatory (muḥallil-i-awrām), and demulcent (mulaṭṭif) properties of the ingredients of tested Unani formulation in addition to the effects of heat. It may therefore be concluded that medicated fomentation is an effective, safer, feasible, and less expensive regimen for patients with non-specific low back pain.
TRIAL REGISTRATION
The Clinical Trials Registry-India (CTRI/2020/03/024107).
Topics: Humans; Low Back Pain; Lumbosacral Region; India; Treatment Outcome
PubMed: 37330769
DOI: 10.1016/j.jbmt.2023.04.075 -
Journal of Separation Science Mar 2023The lichen Cetraria islandica is traditionally used as a demulcent for the symptomatic treatment of irritations of the mouth and throat and associated dry cough, as well...
The lichen Cetraria islandica is traditionally used as a demulcent for the symptomatic treatment of irritations of the mouth and throat and associated dry cough, as well as for the treatment of temporary loss of appetite. In addition to depsides and depsidones, thalli contain paraconic acids, a group of secondary metabolites commonly found in lichens and fungi. Among those, protolichesterinic acid has shown promising pharmacological activities. However, the efficient isolation of paraconic acids is quite complex due to their very similar chemical structures and their weak ultraviolet absorption. In the present work, a two-step isolation protocol of protolichesterinic acid and lichesterinic acid from a complex paraconic acid mixture is described using Sephadex LH20 column chromatography and fast centrifugal partition chromatography. Final purities higher than 95% and recoveries above 50% are achieved. Additionally, reliable qualitative techniques for detecting and differentiating paraconic acids are described. Finally, some data on compound stability and enantiomeric purity are shown.
Topics: Parmeliaceae; 4-Butyrolactone; Lichens; Chromatography, Liquid
PubMed: 36630529
DOI: 10.1002/jssc.202200805 -
Clinical Ophthalmology (Auckland, N.Z.) 2022Dry eye disease (DED) is a chronic condition of the ocular surface characterized by a loss of the tear film homeostasis and accompanied by symptoms such as eye... (Review)
Review
Dry eye disease (DED) is a chronic condition of the ocular surface characterized by a loss of the tear film homeostasis and accompanied by symptoms such as eye discomfort and visual disturbances. DED is classified as aqueous deficient dry eye (ADDE), evaporative dry eye (EDE), and mixed dry eye etiologies. The mainstay treatment in the management of DED is artificial tear drops or lubricant eye drops that replenish the aqueous and/or lipid layer of the tear film. These are available as both lipid-based and non-lipid-based formulations, with/without preservatives. Lipid-based lubricant eye drops can stabilize the tear film lipid layer, reduce tear evaporation, and improve signs of EDE. In this review, we present the formulation components, mechanism of action, and summary of preclinical and clinical evidence on a lipid-based formulation - propylene glycol-hydroxypropyl guar (PG-HPG) nanoemulsion lubricant eye drops (Systane Complete). These eye drops consist of the demulcent (lubricant), PG (0.6%). HPG forms a soft, thin, cross-linked in situ gel matrix with borate ions, when exposed to the tear film, which prolongs lubricant retention and provides ocular surface protection. Dimyristoyl phosphatidyl glycerol, an anionic phospholipid, helps in replenishing the lipid layer of the tear film. Moreover, the nanoemulsion formulation serves as a depot for delivery of dimyristoyl phosphatidyl glycerol to enhance ocular surface coverage. Preclinical and clinical evidence demonstrate that PG-HPG nanoemulsion lubricant eye drops are safe and effective in providing temporary relief of symptoms of DED, regardless of its subtypes. Specifically, it provides sustained reduction in dry eye symptoms, improves tear film stability/lipid layer grade, and improves ocular surface characteristics.
PubMed: 36237486
DOI: 10.2147/OPTH.S377960 -
West African Journal of Medicine Sep 2022Cough from URTI is common, leads to discomfort, sleep loss and stress in caregivers, leading to use of ineffective and potentially harmful over-the-counter medications.... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND AND OBJECTIVE
Cough from URTI is common, leads to discomfort, sleep loss and stress in caregivers, leading to use of ineffective and potentially harmful over-the-counter medications. Honey is cost-effective and safe for children above one year of age. It is readily available and is a potentially valuable demulcent for treatment of childhood cough. The study aimed to determine the effect of honey on cough frequency and severity among children with URTI in outpatient setting.
METHODS
A single-blind randomised control trial involving children presenting with cough from URTI attending the GOPC of FMC Keffi. Eighty-four children presenting with cough from URTI were recruited, randomised into two groups of 42 and administered Honey (intervention) and Diphenhydramine (control) in three consecutive bedtime doses. Socio-demographic and clinical data including cough frequency, severity and impact on children and caregivers was collected using Paediatric Cough Questionnaire and Kingston Caregiver Stress Scale tool. Data was analysed using SPSS version 25. A p<0.05 was considered statistically significant.
RESULTS
Majority (56.0%) of the participants were males, with a mean age +SD of 4±1.47 years. Median cough frequency score for intervention and control groups pre and post intervention decreased (5.00 and 0.00 vs 5.00 and 3.00, p<0.001). Median cough severity score decreased (4.00 and 0.00 vs 4.00 and 3.00, p<0.001), Post intervention pooled caregivers' burden significantly reduced, (5.00 and 11.00 for intervention and control respectively) and sleep pattern improved among children and caregivers (0.00, 2.00 p<0.001; and 0.00, 2.00 p<0.001, for children and caregivers respectively.
CONCLUSION
Night-time honey doses given to children with cough from URTI significantly reduces symptoms and improves children and caregivers sleep compared to Diphenhydramine DPH.
Topics: Antitussive Agents; Child; Cough; Demulcents; Diphenhydramine; Female; Honey; Humans; Male; Respiratory Tract Infections; Single-Blind Method
PubMed: 36126325
DOI: No ID Found -
Biological Trace Element Research Jun 2022Plantago lanceolata L., folium (ribwort plantain) is an active pharmaceutical ingredient in traditional herbal medicinal products (THMP) available in pharmacies as a...
The Level of Cadmium Impurities in Traditional Herbal Medicinal Products with Plantago lanceolata L., folium (Ribwort Plantain Leaves) Available in Polish Pharmacies - Comprehensive Toxicological Risk Assessment Including Regulatory Point of View and ICH Q3D Elemental Impurities Guideline.
Plantago lanceolata L., folium (ribwort plantain) is an active pharmaceutical ingredient in traditional herbal medicinal products (THMP) available in pharmacies as a demulcent for the symptomatic treatment of oral or pharyngeal irritations and associated dry cough. This kind of THMP is widely applied among the European population; however, recently, voices have been heard in the public about alleged cadmium impurities. The idea of our study was a comprehensive risk assessment of the Cd impurity exposure and its effect on human health. Our assessment strategy was based on regulatory aspects (raw results versus limits set by FAO/WHO for herbal medicines) and toxicological risk assessment approach based on ICH Q3D guideline for elemental impurities in final pharmaceutical products. The cadmium was determined by electrothermal atomization atomic absorption spectrometry based on our previously described methodology. Obtained results show that all analysed THMP with P. lanceolata L., folium available in the Polish pharmacies contain cadmium impurities, but at a very low level (ranged 0.73 - 20.6 μg/L). The content of Cd in a single dose (ng/single dose) is also very low and is not a threat to patients. The estimated maximum daily exposure (ng/day) of Cd based on the 'worst-case scenario' (maximum concentrations by oral administration) meets the standards of ICH Q3D guideline (all results were below oral permitted daily exposure; PDE for Cd, i.e. < 5.0 µg/day). It can be concluded that all analysed samples of THMP with P. lanceolata L., folium should not represent any health hazard to the patients due to cadmium levels. To the best of our knowledge, this is the first study about Cd impurity level in THMP with P. lanceolata L., folium (ribwort plantain leaves) available in European pharmacies.
Topics: Cadmium; Humans; Pharmaceutical Preparations; Pharmacies; Plant Leaves; Plantago; Plants, Medicinal; Poland; Risk Assessment; Vegetables
PubMed: 34373979
DOI: 10.1007/s12011-021-02861-5 -
Ear, Nose, & Throat Journal Dec 2023To determine the efficacy of flurbiprofen 8.75 mg lozenges for patients with laboratory-confirmed streptococcal pharyngitis both before and concomitant with antibiotics. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To determine the efficacy of flurbiprofen 8.75 mg lozenges for patients with laboratory-confirmed streptococcal pharyngitis both before and concomitant with antibiotics.
METHODS
This post hoc analysis comprised adult participants from 2 earlier randomized, double-blind, placebo-controlled studies evaluating the analgesic efficacy of flurbiprofen 8.75 mg lozenges in acute pharyngitis. Throat swabs were obtained to diagnose streptococcal infection. Prior to and 2 hours after each dose of study medication (flurbiprofen or placebo lozenges), patients rated 3 symptoms of acute pharyngitis (sore throat pain, difficulty swallowing, and swollen throat) using visual analogue scales. Appropriate antibiotic treatment was initiated when culture results were reported. Mean changes in each pharyngeal symptom were compared over the immediate 24 hours before and during the initial 24 hours of antibiotic treatment.
RESULTS
Twenty-four patients provided both preantibiotic and concomitant antibiotic efficacy outcomes. Relief of throat pain was 93% greater in the flurbiprofen group than in the placebo group before antibiotic coadministration and 84% greater than placebo during antibiotic administration (both P < .05). Relief of difficulty swallowing was 71% greater in the flurbiprofen group than in the placebo before antibiotic administration (P = .16) and 107% greater during concomitant antibiotic administration (P = .04). Relief of the sensation of throat swelling was 295% greater with flurbiprofen than placebo before antibiotic administration (P = .008) and 70% greater during concomitant antibiotic administration (P = .06). For placebo-treated patients, relief from throat pain and difficulty swallowing were similar before and during antibiotic treatment (P > .05), indicating no benefit with antibiotic administration for these symptoms. No treatment-related discontinuations or serious adverse events were reported.
CONCLUSIONS
Irrespective of antibiotic use, flurbiprofen 8.75 mg lozenges provide well-tolerated, effective relief of pharyngeal symptoms in patients with streptococcal infection. In the 24 hours after administration, antibiotics provide no relief of throat pain or difficulty swallowing beyond the topical demulcent effects of placebo lozenges.
Topics: Adult; Humans; Flurbiprofen; Anti-Bacterial Agents; Treatment Outcome; Pharyngitis; Pain; Streptococcal Infections; Deglutition Disorders; Double-Blind Method
PubMed: 34261371
DOI: 10.1177/01455613211025754 -
Ayu 2021(Linn.) Sweet (), generally called as "" is a plant of high medicinal importance. The plant possesses several beneficial effects such as cooling, laxative, digestive,...
BACKGROUND
(Linn.) Sweet (), generally called as "" is a plant of high medicinal importance. The plant possesses several beneficial effects such as cooling, laxative, digestive, analgesic, anti-inflammatory, astringent, diuretic, expectorant, antihelmintic, aphrodisiac, and demulcent which is widely used in the Ayurveda system of medicine.
AIM
The current study is aimed to establish the macroscopy, powder microscopy and physicochemical analysis of fruits.
MATERIALS AND METHODS
The Pharmacognostical studies on fruits, including parameters such as morphological evaluation, powder microscopy, ash values, foreign organic matter, extractive value, phytochemical, fluorescence studies, and high-performance thin-layer chromatography fingerprint profile, are established in the current study.
RESULTS
Fruit powder microscopy has shown diagnostic characteristics such as stellate hairs of different sizes, testa, lignified endocarp, and palisade cells. The loss on drying value of fruit powder was 7.7% w/w. The total ash values of the drug were found to be 10.5% and acid insoluble ash 2.4% w/w with respect to the air-dried crude drug. Water-soluble and alcohol-soluble extractives were found to be 9.64% w/w and 9.04% w/w, respectively.
CONCLUSION
Phytochemical characterization of aqueous, alcoholic extracts of fruit revealed the presence of proteins, carbohydrates, phenols, flavonoids, saponins, and steroids. The powder microscopical and phytochemical studies observed in this study can serve as a valuable resource for the authentication of fruits.
PubMed: 37303858
DOI: 10.4103/ayu.AYU_264_20 -
Clinical & Experimental Optometry Nov 2021Hydroxypropyl-guar (HPG) is a thickening agent first added to lubricating eye drops in 2003. This agent, which enhances viscosity, has been used in the SYSTANE® family... (Review)
Review
Hydroxypropyl-guar (HPG) is a thickening agent first added to lubricating eye drops in 2003. This agent, which enhances viscosity, has been used in the SYSTANE® family of lubricant eye drops (Alcon Laboratories, Inc., Fort Worth, TX, USA). HPG forms a partially linked gel with borate to prolong the retention of demulcents, such as polyethylene glycol and propylene glycol, on the eye. This helps to protect the ocular surface, thereby reducing the symptoms of dry eye disease (DED). The definition of DED has evolved with advances in research, leading to changes in HPG-containing eye care solutions. This article reviews current knowledge on the use of HPG-containing lubricating eye drops in the management of DED.
Topics: Cyamopsis; Dry Eye Syndromes; Humans; Lubricant Eye Drops; Ophthalmic Solutions; Propylene Glycol; Tears
PubMed: 34137675
DOI: 10.1080/08164622.2021.1925208 -
Clinical Ophthalmology (Auckland, N.Z.) 2021Dry eye disease (DED) is a multifactorial ocular condition characterized by a loss of homeostasis of the tear film resulting in ocular symptoms of discomfort,... (Review)
Review
Dry eye disease (DED) is a multifactorial ocular condition characterized by a loss of homeostasis of the tear film resulting in ocular symptoms of discomfort, irritation, and visual disturbance, all of which significantly impact the patients' social and occupational quality of life. While management of DED depends on the severity of symptoms and signs, use of artificial tear products (ATPs) that replace or supplement the deficient natural tear film is the mainstay treatment option. In this review, we present a decade of evidence on Systane Ultra (polyethylene glycol [PEG]/propylene glycol [PG] with hydroxypropyl guar [HP guar]) in effectively managing DED. The active demulcents in Systane Ultra-PEG, PG, along with HP guar gelling technology-provide optimal ocular surface protection and lubrication to heal damaged areas of the cornea caused by DED and, therefore, are recommended for patients with both aqueous and/or mucin layer deficiencies. Over the years, several clinical studies have shown that PEG/PG with HP guar provides long-lasting relief from dry eye and has often been chosen as a standard or comparator against other ATPs. Here, we describe the salient features of PEG/PG with HP guar-its constituents and their mechanisms of action. Furthermore, we summarize results from a systematic literature search that identified 23 relevant publications further emphasizing on the effectiveness and safety of PEG/PG with HP guar in alleviating the signs and symptoms of DED.
PubMed: 34135570
DOI: 10.2147/OPTH.S294427