Síndrome de hiperémesis por cannabinoides: caso clínico / Cannabinoid hyperemesis syndrome: clinical case

Background. The cannabinoid hyperemesis syndrome (CHS) was first described in 2004. It is considered as a functional gastrointestinal syndrome characterized by the presence of nausea, severe and cyclic morning vomiting, epigastric abdominal pain, hot water bathing for symptom relief, in patients that use cannabis regularly and has a resolution of the syndrome after cessation of cannabis consumption. Clinical Case. Report of a 29 year old male, with daily consumption of cannabis, with history of intense epigastric abdominal pain and recurrent vomiting that partially responded to the use of antispasmodics. After 4 visits to the emergency department he was hospitalized for study and treatment. Laboratory and image exploration are carried out without positive results for organic disease. Therefore, a functional gastrointestinal syndrome is thought, and a cannabinoid hyperemesis syndrome was suspected. A psychiatric evaluation is carried out, diagnosing a cannabis use disorder. Discussion and conclusion. CHS is a syndrome that has been described recently and is not usually considered as a differential diagnosis for patients with hyperemesis. However, the current high prevalence of cannabis consumption, will probably lead to a more frequent presentation of the syndrome at different health providers. Therefore, it is important to diffuse and update the knowledge about this syndrome to recognize it and develop a timely treatment, avoiding medical complications from invasive exploratory methods and the use of unnecessary resources. (AU)

Convenção-Quadro para o Controle do Tabaco: adesão e implantação na América Latina / WHO Framework Convention on Tobacco Control: adherence and establishment in Latin America

OBJETIVO:Traçar o panorama de adesão mundial à Convenção-Quadro para o Controle do Tabaco (CQCT) e descrever a implantação das medidas preconizadas pela CQCT em países latino-americanos. MÉTODOS: Este estudo descritivo baseou-se em análise de dados secundários para determinar o status de adesão, no ano de 2015, dos países das seis regiões definidas pela Organização Mundial da Saúde (OMS) à CQCT. Depois disso, realizou-se um mapeamento da implantação, até o ano de 2012, das medidas preconizadas pela CQCT no total de Estados Partes e particularmente em 12 Estados Partes latino-americanos. Finalmente, Brasil, Chile, Colômbia, México e Venezuela foram avaliados quanto ao grau de implantação da CQCT (incipiente, intermediária e avançada). Foram consideradas neste passo medidas englobadas por quatro eixos - redução da demanda por tabaco, redução da oferta de tabaco, redução dos danos ao ambiente e à saúde das pessoas causados pelo tabaco e apoio ao abandono do tabaco. RESULTADOS: Até agosto de 2015, 180 países haviam ingressado no rol de Estados Partes da CQCT. Considerando os 126 países que enviaram relatórios de progresso global da implantação no ciclo de 2012, as medidas mais prevalentes adotadas referiam-se à proteção contra a exposição à fumaça do tabaco (83,0% para o total de países e 100% para o conjunto de países latinoamericanos). Entre os cinco países selecionados para análise detalhada, as medidas destinadas à redução da demanda e da oferta do tabaco foram as mais frequentes. As medidas relacionadas à redução de danos ao ambiente foram raras. Brasil e México apresentaram a situação mais avançada de implantação entre os países estudados. CONCLUSÕES: A América Latina apresentou uma alta proporção de Estados Partes que implantaram as medidas preconizadas pela CQCT. A heterogeneidade da situação de implantação nos cinco países selecionados sugere que as políticas de controle de tabaco são condicionadas por particularidades nacionais.

OBJECTIVE: To draw an overview of the adherence of countries around the world to the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) and to describe the establishment of WHO FCTC recommended measures in Latin American countries. METHODS: This descriptive study was based on analysis of documents and secondary data to determine the status of countries from the six WHO regions regarding adherence to the FCTC. After that, the establishment of recommended measures until the year 2012 was mapped in all States Parties and particularly in 12 Latin American States Parties. Finally, the degree to which FCTC measures had been established in Brazil, Chile, Colombia, Mexico, and Venezuela was assessed (incipient, intermediate, or advanced). This step took into consideration the measures covered by four domains - reduction in the demand for tobacco, reduction in the offer of tobacco, reduction in damage to the environment and to the health of people caused by tobacco, and support for quitting the use of tobacco. RESULTS: Until August 2015, 180 countries had joined as States Parties to the FCTC. Considering the 126 countries that submitted global progress reports in the 2012 cycle, the most prevalent measures adopted referred to the protection against exposure to tobacco smoke (83.0% for all countries and 100% for the group of Latin American countries). Among the five countries selected for detailed analysis, the measures referring to the reduction of demand and offer of tobacco were the most frequent. Measures focused on reducing environmental damage were rare. Brazil and Mexico had the most advanced FCTC status among the studied countries. CONCLUSIONS: Latin America presented a high proportion of States Parties with established FCTC recommended measures. The heterogeneity of the FCTC status in the five selected countries suggests that the implementation of tobacco control policies depends on specific aspects of each country.

Brain stem evoked response audiometry of former drug users.

UNLABELLED: Illicit drugs are known for their deleterious effects upon the central nervous system and more specifically for how they adversely affect hearing. OBJECTIVE: This study aims to analyze and compare the hearing complaints and the results of brainstem evoked response audiometry (BERA) of former drug user support group goers. METHODS: This is a cross-sectional non-experimental descriptive quantitative study. The sample consisted of 17 subjects divided by their preferred drug of use. Ten individuals were placed in the marijuana group (G1) and seven in the crack/cocaine group (G2). The subjects were further divided based on how long they had been using drugs: 1 to 5 years, 6 to 10 years, and over 15 years. They were interviewed, and assessed by pure tone audiometry, acoustic impedance tests, and BERA. RESULTS: No statistically significant differences were found between G1 and G2 or time of drug use in absolute latencies and interpeak intervals. However, only five of the 17 individuals had BERA results with adequate results for their ages. CONCLUSION: Marijuana and crack/cocaine may cause diffuse disorders in the brainstem and compromise the transmission of auditory stimuli regardless of how long these substances are used for.

Potenciais evocados auditivos de tronco encefálico de ex-usuários de drogas / Brain stem evoked response audiometry of former drug users

As drogas ilícitas são conhecidas pelos seus efeitos deletérios no sistema nervoso central; no entanto, elas também podem atingir o sistema auditivo, provocando alterações. OBJETIVOS: Analisar e comparar os resultados dos potenciais evocados auditivos de tronco encefálico (PEATE) de frequentadores de grupos de apoio a ex-usuários de drogas. MÉTODO: Estudo transversal, não experimental, descritivo e quantitativo. A amostra foi composta por 17 indivíduos divididos conforme o tipo de droga mais consumida: 10 indivíduos no grupo maconha (G1) e sete no grupo crack/cocaína (G2). Eles foram subdivididos pelo tempo de uso de drogas: um a cinco anos, seis a 10 anos e mais que 15 anos. A avaliação foi feita por meio de anamnese, audiometria tonal liminar, medidas de imitância acústica e PEATE. RESULTADOS: Ao comparar os resultados de G1 e G2, independente do tempo de uso de drogas, não se observou diferença estatisticamente significante nas latências absolutas e nos intervalos interpicos. No entanto, apenas cinco dos 17 indivíduos tiveram PEATE com resultados adequados para a faixa etária. CONCLUSÃO: Independentemente do tempo de utilização das drogas, o uso de maconha e crack/cocaína pode provocar alterações difusas no tronco encefálico, comprometendo a transmissão do estímulo auditivo.

Illicit drugs are known for their deleterious effects upon the central nervous system and more specifically for how they adversely affect hearing. OBJECTIVE: This study aims to analyze and compare the hearing complaints and the results of brainstem evoked response audiometry (BERA) of former drug user support group goers. METHODS: This is a cross-sectional non-experimental descriptive quantitative study. The sample consisted of 17 subjects divided by their preferred drug of use. Ten individuals were placed in the marijuana group (G1) and seven in the crack/cocaine group (G2). The subjects were further divided based on how long they had been using drugs: 1 to 5 years, 6 to 10 years, and over 15 years. They were interviewed, and assessed by pure tone audiometry, acoustic impedance tests, and BERA. RESULTS: No statistically significant differences were found between G1 and G2 or time of drug use in absolute latencies and interpeak intervals. However, only five of the 17 individuals had BERA results with adequate results for their ages. CONCLUSION: Marijuana and crack/cocaine may cause diffuse disorders in the brainstem and compromise the transmission of auditory stimuli regardless of how long these substances are used for.

Ganga: the Jamaican connection

The controversy and issues about the good and evil effects of cannabis has grown exponentially over the last 20 years. Some of the findings have detracted from the issues of criminalization to focus on its potential as a major medicinal agent. This has led to exploratory studies into the theraputic utility of cannabis. At this time a number of areas of potential medicinal applications have been identified and investigated, for example glaucoma, asthma, pain and multiple sclerosis to name a few. The legal minds, usually with little appreciation for science and medicinal investigation, are the ones that usually put obstacles in the path of future development in this very vital area. The present knowledge about these issues is scattered all over the literature. This book is an attempt to present a reader friendly account of the knowledge and issues at this time, with an emphasis on the knowledge and experience about the subject as it relates to Jamaica

Profesor Armando Roa y su aporte al estudio clínico de la marihuana en la perspectiva actual / Professor Armando Roa and his contribution to the clinical study of the marijuana in the present perspective

Se revisan los aspectos fundamentales del uso de la marihuana, a la luz del conocimiento actual, junto a los aspectos clínicos descritos por el Profesor Armando Roa sistematizados en su libro La Marihuana; se comenta sobre la importancia de su aporte a la clínica de este fenómeno

"Cannabis sativa": revisäo farmacológica e discussäo social / \"Cannabis sativa\": Phamacologic review and social discussion

No artigo, o contexto atual da maconha é dissecado através de uma revisäo histórica, farmacológica e clínica. Resumem-se seus efeitos, mecanismo de açäo, conseqüências da dependência, usos terapêuticos e, assim, obtém-se o conhecimento necessário para uma tentativa de discussäo dos problemas sociais gerados pelo uso da droga.

Prenatal marijuana use and neonatal outcome.

In a longitudinal study of marijuana and other substance use during pregnancy, women were interviewed at each trimester of pregnancy. Growth parameters, morphological abnormalities and gestational age were assessed for the 519 liveborn singletons. There were few significant effects of marijuana use during pregnancy on birth weight, head or chest circumference, gestational age, or growth retardation after adjustment for covariates using a regression model for analysis. There was a small but significant negative effect of marijuana use during the first two months of pregnancy on birth length and a positive effect of marijuana use during the third trimester on birth weight.

La drogadicción y el sistema inmunológico / Drogaddiction and the inmune system

La presente revision pretende reunir algunas de la evidencias existentes acerca del efecto de marihuana, morfina, heroina y cocaina sobre el sistema inminologico. Se hace en primer lugar una breve introduccion sobre los aspectos farmacologicos de cada una de las drogas para luego presentar la informacion relacionada con parametros inmunologicos bien sea en humanos, en modelos animales o in vitro. La conclusion general es que todas estas sustancias tiene accion moduladora sobre la expresion de receptores a nivel de las membranas celulares. El efeto de la cocaina parece ser de modulacion positiva, es decir que mejora las respuestas lo cual se corelaciona con la poca evidencia de enfermedades de origen infeccioso en adictos a esta sustancia, a diferencia de los opiaceos y la marihuana. Es necesario, sinembargo, disenar experimentos con un control mas estricto de todas las variblaes involucradas en la drogadiccion a fin de depurar resultados aparentemente contradictorios que impiden llegar a conclusiones definitivas

This paper reviews some available evidence on the immunological effects of marijuana, morphine, heroine and cocaine. After a short introduction on the pharmacological aspects of these drugs, we present human, animal and In vitro data on different parameters related with the immune system. A general conclusion is that all these drugs modulate the expression of receptors on cellular membranes. Cocaine seems to be a positive modulator since it increases immune responses which agrees with the fact that cocaine addicts do not frequently develop infectious problems. On the contrary, the other drugs seem to induce some immuno suppression and those with addiction to them present infections with a higher frequency. Nevertheless, before a final conclusion can be made, more studies carefully controlling all variables involved in drug addiction should be done in order to solve some of the apparent contradictions frequently found In the Literature

Critique of a study on ganja in Jamaica.

In the study of "Ganja in Jamaica" by Rubin and Comitas, no significant differences between heavy ganja smokers and controls could be demonstrated in physical and psychological symptoms or social adjustment. This lack of difference may be attributed to methodological limitations in the sampling technique and examinations performed. The number of subjects studied was small (30 in both control and test group). The selection of controls was inadequate: only 12 controls had never smoked ganja, and 8 were current occasional users. Methodological limitations flawed the physical examinations of the lung and cardiovascular system, cytogenetic studies, psychological assessment and psychiatric evaluation. Acceptance by the authors of a positive motivational influence of cannabis smoking and other socially beneficial properties of such smoking was based more on philosophical premises than on objective observations performed by others in Jamaica and other countries.

Critique of a study on ganja in Jamaica

In this study of "Ganja in Jamaica" by Rubin and Comitas, no significant differences between heavy ganja smokers and controls could be demonstrated in physical and psycological symptoms or social adjustment. This lack of difference may be attributed to methodological limitations in the sampling technique and examinations performed. The number of subjects studied was small (30 in both control and test group). The selection of controls was inadequate: only 12 controls had never smoked ganja, and 8 were current occasional users. Methodological limitations flawed the physical examinations of the lung and cardiovascular system, cytogenetic studies, psycological assessment and psychiatric evaluation. Acceptance by the authors of a positive motivational infleunce of cannabis smoking and other socially beneficial properties of such smoking by others in Jamaica and other countries. (AU)