Prescription of a THC/CBD-Based Medication to Patients with Dementia: A Pilot Study in Geneva.

BACKGROUND: Dementia is increasing worldwide. No effective medication is currently available for the treatment of the underlying disease and accompanying behavioral symptoms. Cannabinoids might have a beneficial effect, but clinical studies with (low-dose) synthetic THC have not been conclusive. OBJECTIVE: To test the acceptability, practical aspects, and clinical outcomes of the introduction of a THC/CBD-based oral medication in severely demented patients in a specialized nursing home in Geneva. METHODS: This was a prospective observational study. RESULTS: Ten female demented patients with severe behavior problems received oral medication with on average 7.6 mg THC/13.2 mg CBD daily after 2 weeks, 8.8 mg THC/17.6 mg CBD after 1 month, and 9.0 mg THC/18.0 mg CBD after 2 months. The THC/CBD-based oil was preferred. Neuropsychiatric Inventory, Cohen-Mansfield Agitation Inventory score, and a behavior problem visual analog scale decreased by 40% after 2 months, rigidity score by 50%. Half of the patients decreased or stopped other psychotropic medications. The staff appreciated the decrease in rigidity, making daily care and transfers easier, the improved direct contact with the patients, the improvement in behavior, and the decrease in constipation with less opioids. There was no withholding of the medication for reasons of side effects, and the effects persisted after 2 months. CONCLUSIONS: An oral cannabis extract with THC/CBD, in higher dosages than in other studies, was well tolerated and greatly improved behavior problems, rigidity, and daily care in severely demented patients.

The utility of the 13C-methacetin breath test in predicting the long-term survival of patients with decompensated cirrhosis.

AIM: The 13C-methacetin breath test (13C-MeBT) is a noninvasive tool that allows evaluation of the functional activity of the liver and the prediction of liver cirrhosis. Nevertheless, there is no information on its potential utility to predict long-term survival in patients with liver disease. METHODS: Patients with cirrhosis were selected. All patients underwent a complete clinical assessment, standard biochemical tests, and 13C-MeBT at the beginning of the study. Death was recorded during the three years of follow-up. Survival curves were calculated by the Kaplan-Meier method, and Cox proportional risk models were used to identify predictive factors. The ability to classify the overall risk was assessed by the C statistic. RESULTS: One hundred and twenty-three patients were included. A significant inverse correlation was found between delta over baseline at the 15 min point (DOB15) after ingestion of 13C-methacetin and the Child-Pugh score (r = -0.411, p < 0.001). In multivariate analysis, DOB15 ≤ 4.5‰ was associated with mortality, [HR = 2.58 95% CI (1.17-5.69)]. In conclusion, our results confirm the utility of 13C-MeBT as a simple, noninvasive tool to quantitatively assess the liver's functional reserve and as a potential predictor of long-term survival in patients with decompensated cirrhosis.

Prevalence of minimal hepatic encephalopathy and quality of life in patients with decompensated cirrhosis.

AIM: Minimal hepatic encephalopathy (MHE) affects more than 30% of patients with cirrhosis, and it has been suggested that despite no recognizable clinical symptoms of neurological abnormalities, it may affect health-related quality of life (HRQL); however, this fact remains controversial. The aim of our study was to evaluate the prevalence of MHE and HRQL in patients diagnosed with decompensated cirrhosis. METHODS: Patients with liver cirrhosis were selected independent of the etiology of the disease. All patients underwent a complete clinical history, and only patients with decompensated hepatic cirrhosis were included. Psychometric tests were applied to evaluate the presence of MHE along with the Chronic Liver Disease Questionnaire. Appetite was measured by verbal and visual analog scales. RESULTS: One hundred and twenty-five patients were included with a median age of 56.0 years. They were classified according to the Child-Pugh index as A, (n = 56), B, (n = 51) and C (n = 18). Prevalence of MHE was 44.0% (n = 55). In patients with MHE, a significant reduction was observed in domains of activity (3.3 [2.0] vs 4.8 [2.8]), fatigue (3.2 [2.0] vs 3.9 [2.3]), systemic symptoms (3.8 [2.0] vs 4.8 [1.7]), emotional function (3.6 [1.9] vs 4.0 [1.9]) and global scoring (3.7 [1.7] vs 4.3 [1.8]) when compared with non-MHE patients (n = 70). Twenty-two percent of the patients with MHE reported little appetite compared with 11% in the non-MHE group. CONCLUSION: The results suggest that MHE and a reduction in appetite are associated with deterioration in HRQL in patients with decompensated cirrhosis.

Prevalence of lactose malabsorption in Mexican children: importance of measuring methane in expired air.

BACKGROUND AND AIMS: To compare the prevalence of lactose malabsorption (LM) in children by analyzing hydrogen content in expired air vs. the inclusion of methane excretion. METHODS: A total of 138 children (4-17 years old) attending different boarding schools in Mexico were included in this study. To measure H2 and CH4 in expired air, breath samples were collected before administering whole milk (240 mL for 4- to 6-year-old children and 360 mL for 7- to 17-year-old children) and at 60, 120, 180, and 240 min afterward. A coprological examination was also carried out. RESULTS: Methane production prevalence was 47.8% (29.7% of the children produced methane and hydrogen, whereas 18.1% produced methane only). When measuring only exhaled hydrogen in expired air (H2 ≥20 ppm), prevalence of LM was 31%; however, when methane concentration was considered (H2 + (CH4 x 2)) ≥18 ppm, prevalence increased significantly to 44%. Among children with LM, 51.6% presented intestinal parasites. CONCLUSIONS: Methane should be measured in exhaled air to improve diagnosis of LM in populations with a high prevalence of methane production.