Cannabis use remains common among adolescents, and evolving product potency and routes of administration raise concern for underrecognized effects on oropharyngeal and esophageal function. A 16-year-old male presented with globus sensation, dysphagia, and hypersalivation after 2 years of daily cannabis use. Extensive evaluation, including flexible laryngoscopy and barium esophagram, was unremarkable. Empiric treatment with proton pump inhibitors, antibiotics, and allergy medications offered minimal benefit. Symptoms partially improved after cannabis cessation and with glycopyrrolate, with further resolution following sustained abstinence. This case highlights a temporal association between chronic cannabis use and unexplained aerodigestive symptoms, including dysphagia, globus sensation, and hypersalivation in an adolescent. Adult studies suggest cannabinoid-mediated alterations in esophageal motility, but adolescent-specific data are limited. Alternative etiologies, including eosinophilic esophagitis, which was not excluded due to the absence of endoscopy with biopsies, remain possible.

Tonic immobility (TI) is a temporary state where a chicken remains immobile after restraint. It is a commonly used fear test in research, where a longer latency to right is equated with more fear. Despite its commonality, there is limited research done on the physiological systems that underlie TI. The objective of our study was to examine the roles of the sympathetic (SNS) and parasympathetic nervous systems (PNS) on TI. In experiment 1, sixteen Dekalb White hens (43 weeks of age) were given 0.1 mL/kg of either saline as a control (CON), labetalol (5 mg/mL) to inhibit the SNS (LAB), or glycopyrrolate (0.2 mg/mL) to inhibit the PNS (GLY). In experiment 2, eight Hy-Line Silver hens (20 weeks of age) were given either 0.2 mL/kg of saline as a control (CON2) or 0.2 mg/kg of a 1:1 glycopyrrolate and labetalol mixture (DRUG). For both experiments, latency to first leg movement, first head movement, and to right were measured, as well as thermal temperatures. In experiment 1, heart rate (HR) and respiratory rate (RR) were also measured. The MIXED procedure was used to analyze latencies for experiment 1. Experiment 2 utilized a Welch's T-test. An ANOVA was used for all RR, HR, and thermal temperatures. Data were considered significant when P < 0.05 and trending when 0.05 < P < 0.10. For experiment 1, after injection and before induction, GLY had a lower respiratory rate (p = 0.019) compared to LAB and CON. This trend continued through the first minute (p = 0.020) and the average time under TI (p = 0.010). The CON group was quicker to right than the GLY (p = 0.007) and LAB (p = 0.0726). For experiment 2, the CON2 group was also quicker to right than DRUG (p = 0.052). These results indicate that both the PNS and SNS play a role in TI recovery, however further studies need to be undertaken to better understand the neurobiology of tonic immobility.

This article reviews the role of outpatient dental sedation in managing patients with dental anxiety or phobia. Sedation helps reduce pain, fear, and memory of procedures while improving patient cooperation and treatment outcomes. The article discusses commonly used sedative and adjunct medications, including midazolam, remimazolam, propofol, ketamine, opioids such as fentanyl and remifentanil, and supportive drugs like dexmedetomidine, diphenhydramine, atropine, glycopyrrolate, and ondansetron. Newer agents such as remimazolam and ketofol combinations may offer improved safety and recovery profiles. Overall, the article emphasizes individualized patient care and thorough pharmacologic knowledge to ensure safe and effective outpatient dental sedation.

Spinal anesthesia is a preferred technique for lower limb surgeries in elderly patients but often leads to hypotension due to sympathetic blockade and diminished cardiovascular adaptability. Glycopyrrolate, an anticholinergic agent, may mitigate this response by sustaining heart rate and venous return. Hence, this prospective randomized study evaluated 50 elderly patients (≥ 60 years) undergoing elective lower limb surgery under spinal anesthesia, divided into a glycopyrrolate group (0.2 mg IM given 30 minutes pre-block) and a control group without premedication. Hemodynamic parameters were recorded intraoperatively and compared between groups. The glycopyrrolate group showed significantly fewer cases of hypotension, better maintenance of mean arterial pressure and heart rate and a reduced need for vasopressors, without notable adverse effects such as tachycardia or dry mouth. Thus, we show that the pre-anesthetic intramuscular glycopyrrolate is a simple, safe and effective measure to enhance hemodynamic stability and prevent hypotension in elderly patients receiving spinal anesthesia.

Manufacturers are adopting propellants for use in pressurized metered-dose inhalers (pMDIs) that have lower global warming potentials (GWPs) than the propellants traditionally used in pMDIs. Hydrofluoroalkane (HFA)-134a has been used as the propellant in the pMDI used to deliver the fixed-dose triple combination of budesonide, glycopyrrolate, and formoterol fumarate (BGF); following successful clinical evaluation, the BGF pMDI is now being transitioned to the next generation propellant hydrofluoroolefin (HFO)-1234ze(E), which has near-zero GWP. We describe formulation development efforts that led to the selection of HFO-1234ze(E) over another propellant, HFA-152a, for reformulation. Propellant-specific studies evaluated active pharmaceutical ingredient (API) stability and aerodynamic particle size distribution (aPSD). Those analyses have been complemented by in silico regional lung deposition modeling conducted after the clinical evaluation of the reformulated BGF pMDI. HFO-1234ze(E) supported favorable stability and aPSD characteristics for BGF pMDI reformulation, compared with HFA-152a, and modeling predicted regional deposition consistent with therapeutic intent. Given that each pMDI is a unique combination of APIs, device, propellant, and excipients, propellant substitution requires product-specific evidence and regulatory approval, and typically takes several years. Targeted analyses, such as those described here, helped to identify the most suitable candidate propellant for successful substitution in the BGF pMDI.

Chronic cough in patients with systemic lupus erythematosus can be difficult to evaluate, especially when initial testing is unrevealing. We report the case of a 33-year-old woman with long-standing systemic lupus erythematosus, biopsy-proven lupus nephritis, prior extrapulmonary pericardial tuberculosis, and no active or passive smoking exposure who developed a persistent dry cough for six months. She was initially treated for gastroesophageal reflux disease with pantoprazole, without meaningful relief. Chest radiography and swallowing assessment were normal. Initial pulmonary function testing in July 2023 was formally interpreted as moderate obstructive airways disease, mild parenchymal restriction, and a moderately severe diffusion defect, without a significant bronchodilator response. High-resolution volumetric computed tomography of the chest with dynamic airway assessment showed no emphysema, bronchiectasis, interstitial lung disease, tracheomalacia, or acute cardiopulmonary process. Her cough improved substantially after inhaled therapy with albuterol and budesonide/glycopyrrolate/formoterol fumarate. Repeat pulmonary function testing in October 2023 showed improved spirometric values, but the forced expiratory volume in one second/forced vital capacity ratio remained preserved, and hemoglobin-adjusted diffusing capacity remained reduced at 64% predicted. This case highlights a diagnostic pitfall: inhaler-responsive chronic cough and a pulmonary function report suggesting obstruction should be evaluated together with post-bronchodilator spirometry, diffusing capacity, imaging, and exposure history. In systemic lupus erythematosus, a persistent cough may be associated with clinically relevant pulmonary function abnormalities even when chest imaging is unrevealing.