Clinical outcome data of chronic pain patients treated with cannabis-based oils and dried flower from the UK Medical Cannabis Registry.

BACKGROUND: The following study evaluated the clinical outcomes of patients enrolled in the UK Medical Cannabis Registry, who were treated with inhaled dried flower (Adven® EMT2, Curaleaf International, Guernsey), and sublingual/oral medium-chain triglyceride-based oils (Adven, Curaleaf International, Guernsey) for chronic pain. METHODS: In this cohort study, the primary outcomes were changes in validated patient reported outcome measures (PROMs) at 1, 3, and 6 months compared to baseline, and adverse event analysis. Statistical significance was defined as p < 0.050. RESULTS: Three hundred and forty-eight (45.7%), 36 (4.7%), and 377 (49.5%) patients were treated with oils, dried flower, or both, respectively. Patients treated with oils or combination therapy recorded improvements within health-related quality of life, pain, and sleep-specific PROMs at 1, 3, and 6 months (p < 0.050). Patients treated with combination therapy recorded improvements in anxiety-specific PROMs at 1, 3, and 6 months (p < 0.050). 1,273 (167.3%) adverse events were recorded, with previously cannabis naïve users, ex-cannabis users, and females more likely to experience adverse events (p < 0.050). CONCLUSIONS: This study observed an association between initiation of CBMP treatment and improved outcomes for chronic pain patients. Prior cannabis use and gender were associated with adverse event incidence. Placebo-controlled trials are still necessary to establish the efficacy and safety of CBMPs for chronic pain.

Práticas de cuidado em saúde com crianças quilombolas: percepção dos cuidadores / Prácticas de cuidado de salud con niños quilombolas: percepción de los cuidadores / Health care practices with Quilombola children: caregivers' perception

Resumo Objetivo analisar, na percepção dos cuidadores, as práticas de cuidado em saúde prestadas às crianças quilombolas. Método estudo exploratório-descritivo, qualitativo, realizado na comunidade quilombola Santa Rita de Barreira, São Miguel do Guamá, Pará, Brasil. Os dados foram produzidos entre julho e setembro de 2021, com cuidadores de crianças de zero a cinco anos, por meio de entrevistas individuais guiadas com instrumento semiestruturado. Para análise, utilizou-se o Microsoft Office Excel 2019 e o software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires 0.7, alpha 2, por meio da Classificação Hierárquica Descendente. Resultados participaram 18 cuidadores do sexo feminino, com idade entre 20 e 67 anos. Relacionaram o cuidado à prevenção e ao tratamento de doenças, aos hábitos de vida, ao acesso aos serviços de saúde e às práticas populares que valorizam a medicina tradicional. Conclusões e implicações para a prática os saberes e as ações das mulheres expressaram influências de sua cultura, suas crenças e seus modos de interpretar e simbolizar a realidade. Reconhecer e problematizar as práticas quilombolas no cuidado às crianças é um desafio que ultrapassa o discurso biomédico, reducionista e estigmatizante, contexto no qual é preciso ampliar o debate interdisciplinar sobre o tema.

Resumen Objetivo analizar, en la percepción de los cuidadores, las prácticas de atención a la salud que se brindan a niños quilombolas. Método estudio exploratorio-descriptivo, cualitativo, realizado en la comunidad quilombola Santa Rita de Barreira, São Miguel do Guamá, Pará, Brasil. Los datos fueron recolectados entre julio y septiembre de 2021, con cuidadores de niños de cero a cinco años, a través de entrevistas individuales guiadas con instrumento semiestructurado. Para el análisis, se utilizó el programa Microsoft Office Excel 2019 y el software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires 0.7, alpha 2, a través de la Clasificación Jerárquica Descendente. Resultados participaron 18 cuidadoras, con edades entre 20 y 67 años. Relacionaron el cuidado con la prevención y tratamiento de enfermedades, hábitos de vida, acceso a los servicios de salud y prácticas populares que valoran la medicina tradicional. Conclusiones e implicaciones para la práctica los saberes y acciones de las mujeres expresaron la influencia de su cultura, sus creencias y sus formas de interpretar y simbolizar la realidad. Reconocer y cuestionar las prácticas quilombolas en el cuidado de los niños es un desafío que va más allá del discurso biomédico, reduccionista y estigmatizador, contexto en el que es necesario ampliar el debate interdisciplinario sobre el tema.

Abstract Objective to analyze, in caregivers' perception, the health care practices provided to Quilombola children. Method an exploratory-descriptive, qualitative study carried out in the Quilombola community Santa Rita de Barreira, São Miguel do Guamá, Pará, Brazil. Data were produced between July and September 2021, with caregivers of children aged zero to five years, through individual interviews guided with a semi-structured instrument. For analysis, Microsoft Office Excel 2019 and the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires 0.7, alpha 2 were used, through Descending Hierarchical Classification. Results eighteen female caregivers participated, aged between 20 and 67 years. They related care to disease prevention and treatment, life habits, health services access and popular practices that value traditional medicine. Conclusions and implications for practice women's knowledge and actions expressed influences from their culture, their beliefs and their ways of interpreting and symbolizing reality. Recognizing and questioning Quilombola practices in child care is a challenge that goes beyond the biomedical, reductionist and stigmatizing discourse, a context in which it is necessary to expand the interdisciplinary debate on the subject.

Alkaloidal Phytoconstituents for Diabetes Management: Exploring the Unrevealed Potential.

The main characteristic feature of diabetes mellitus is the disturbance of carbohydrate, lipid, and protein metabolism, which results in insulin insufficiency and can also lead to insulin resistance. Both the acute and chronic diabetic cases are increasing at an exponential rate, which is also flagged by the World Health Organization (WHO) and the International Diabetes Federation (IDF). Treatment of diabetes mellitus with synthetic drugs often fails to provide desired results and limits its use to symptomatic treatment only. This has resulted in the exploration of alternative medicine, of which herbal treatment is gaining popularity these days. Owing to their safety benefits, treatment compliance, and ability to exhibit effects without disturbing internal homeostasis, research in the field of herbal and ayurvedic treatments has gained importance. Medicinal phytoconstituents include micronutrients, amino acids, proteins, mucilage, critical oils, triterpenoids, saponins, carotenoids, alkaloids, flavonoids, phenolic acids, tannins, and coumarins, which play a dynamic function in the prevention and treatment of diabetes mellitus. Alkaloids found in medicinal plants represent an intriguing potential for the inception of novel approaches to diabetes mellitus therapies. Thus, this review article highlights detailed information on alkaloidal phytoconstituents, which includes sources and structures of alkaloids along with the associated mechanism involved in the management of diabetes mellitus. From the available literature and data presented, it can be concluded that these compounds hold tremendous potential for use as monotherapies or in combination with current treatments, which can result in the development of better efficacy and safety profiles.

The efficacy of a novel topical spray composed of sodium benzoate, alcohol and botanical oils for the treatment of Malassezia dermatitis in dogs - a split body, randomised, blinded study.

BACKGROUND: Treatment of Malassezia pachydermatis dermatitis can be performed by systemic or topical route. As M. pachydermatis is located on the stratum corneum, topical therapy alone may be sufficient to resolve the infection. Owing to systemic antifungal resistance and adverse effects, topical treatment alone may improve treatment outcome. HYPOTHESIS/OBJECTIVES: To evaluate the efficacy of a topical spray composed of sodium benzoate, alcohol and botanical oils, compared to a shampoo containing 2% chlorhexidine gluconate and 2% miconazole nitrate for the treatment of Malassezia pachydermaitis dermatitis in dogs. ANIMALS: Sixteen client owned dogs diagnosed with symmetrical interdigital lesions as a result of secondary Malassezia dermatitis. METHODS: The study design was prospective, randomised and single-blinded, using a split body protocol. Malassezia yeasts were determined by cytology at the inclusion day (day0) and after treatment (day14). All dogs were treated during 14 days with both shampoo at one paw and spray on the other paw. RESULTS: At day 14 a reduction of Malassezia dermatitis was shown at both paws. No statistical difference was demonstrated between treatment with shampoo or spray. CONCLUSIONS AND CLINICAL IMPORTANCE: We could not show a difference in efficacy between application of the test spray once daily and the topical use of 2%miconazole/2%chlorhexidine shampoo every other day. No adverse effects were reported.

Contexte - Le traitement de la dermatite à Malassezia peut être réalisé par voie systémique ou topique. Comme M. pachydermatis est situé sur la couche cornée, un traitement topique seul peut suffire à résoudre l'infection. En raison de résistance antifongique systémique et d'effets indésirables, le traitement topique seul peut améliorer les résultats du traitement. Hypothèses/Objectifs - Évaluer l'efficacité d'un spray topique composé de benzoate de sodium, d'alcool et d'huiles végétales, par rapport à un shampooing contenant 2 % de gluconate de chlorhexidine et 2 % de nitrate de miconazole pour le traitement de la dermatite à Malassezia chez le chien. Animaux - Seize chiens appartenant à des clients ont reçu un diagnostic de lésions interdigitées symétriques à la suite d'une dermatite à Malassezia secondaire. Méthodes - La conception de l'étude était prospective, randomisée et en simple aveugle. Les levures Malassezia ont été évaluées par cytologie au jour de l'inclusion (jour0) et après traitement (jour14). Tous les chiens ont été traités pendant 14 jours avec du shampooing sur une patte et un spray sur l'autre patte. Résultats - Au jour 14, une réduction de la dermatite à Malassezia a été observée aux deux pattes. Aucune différence statistique n'a été mise en évidence entre le traitement shampooing ou spray. Conclusions et importance clinique - Nous n'avons pas pu montrer de différence d'efficacité entre l'application du spray test une fois par jour et l'utilisation topique du shampooing 2%miconazole/2%chlorhexidine tous les deux jours. Aucun effet indésirable n'a été signalé.

Introducción- el tratamiento de la dermatitis por Malassezia pachydermatis se puede realizar por vía sistémica o tópica. Como M. pachydermatis se encuentra en el estrato córneo, la terapia tópica sola puede ser suficiente para resolver la infección. Debido a la resistencia antifúngica sistémica y los efectos adversos, el tratamiento tópico podría mejorar los resultados terapeúticos. Hipótesis/Objetivos - Evaluar la eficacia de un spray tópico compuesto por Benzoato de Sodio, alcohol y aceites botánicos, en comparación con un champú que contiene gluconato de clorhexidina al 2% y nitrato de miconazol al 2% para el tratamiento de la dermatitis por M. Paquydermatis en perros. Animales- dieciséis perros de propietarios particulares diagnosticados con lesiones interdigitales simétricas como resultado de una dermatitis secundaria por Malassezia. Métodos- el diseño del estudio fue prospectivo, al azar y simple ciego, utilizando un protocolo de cuerpo dividido. La presencia de levaduras Malassezia se determinó mediante citología el día de inclusión (día 0) y después del tratamiento (día 14). Todos los perros fueron tratados durante 14 días con champú en una pata y spray en la otra pata. Resultados- en el día 14 se mostró una reducción de la dermatitis por Malassezia en ambas patas. No se demostró diferencia estadística entre el tratamiento con champú o spray. Conclusiones e importancia clínica- no pudimos demostrar una diferencia en la eficacia entre la aplicación del aerosol a prueba una vez al día y el uso tópico de champú con miconazol al 2%/clorhexidina al 2% en días alternos. No se detectaron efectos adversos.

Contexto - O tratamento da dermatite por Malassezia pachydermatis pode ser realizado por via sistêmica ou tópica. Como a M. pachydermatis fica localizada no estrato córneo, a terapia tópica unicamente pode ser suficiente para resolver a infecção. Devido à resistência antifúngica e aos efeitos adversos, terapia tópica em monoterapia pode melhorar o resultado do tratamento. Hipótese/Objetivos - Avaliar a eficácia de um spray tópico contendo benzoato de sódio, álcool e óleos botânicos, comparado a um shampoo de gluconato de clorexidina a 2% e nitrato de miconazol a 2% para o tratamento de dermatite por Malassezia pachydermaitis em cães. Animais - Dezesseis cães de clientes diagnosticados com lesões interdigitais simétricas resultantes de infecção secundária por Malassezia. Métodos - O delineamento do estudo foi prospectivo, randomizado e simples-cego, utilizando um protocolo de corpo dividido. As leveduras identificadas como Malassezia foram determinadas por citologia no dia da inclusão (dia 0) e após o tratamento (dia 14). Todos os cães foram tratados por 14 dias com shampoo em uma pata e spray na outra. Resultados - No dia 14, observou-se um declínio na dermatite por Malassezia em ambas as patas. Não houve diferença estatística entre o tratamento com shampoo ou spray. Conclusões e importância clínica - Não pudemos encontrar diferenças na eficácia entre a aplicação do spray teste uma vez ao dia e o uso tópico de um shampoo contendo 2%miconazol/2%clorexidine em dias alternados. Não foram relatados efeitos adversos.

Long-term Cannabis-based oil therapy and pain medications prescribing patterns: an Italian observational study.

OBJECTIVE: Chronic pain is one of the most common medical conditions in developed countries. The 2020 Italian National Report on Medicines shows how, in the last years, there was a light but constant increase in the prescription of pain medications. The purpose of our study was to assess the effects of long-term cannabis-based oil consumption on the distribution of patients with analgesics prescriptions for chronic pain in a Pain Medicine Unit in Northern Italy. PATIENTS AND METHODS: This is a retrospective, observational study in which patients treated with long-term medical cannabis-based oils, followed between June 2016 and July 2019, were enrolled. The effects of cannabis-based oil consumption on the distribution of patients with pain medications, before and after its long-term use, were evaluated with a Related Samples McNemar Test. Subgroups analyses were performed based on sex, age, comorbidity, duration of cannabis treatment, and condition driving cannabis prescription. RESULTS: A significant difference in opioid non-users after a long-term cannabis-based oil therapy was identified (from 32.1% to 55.4%, p = 0.0023), while no significant differences were found in the distribution of anticonvulsant, antidepressant, and benzodiazepine users. A high benzodiazepine use prevalence was revealed, while subgroup analyses showed increased antidepressant use in people over 65 years old (from 93.7% to 56.2%; p = 0.0313). CONCLUSIONS: Pain medication patterns of prescribing show how necessary it is to improve prescription practices among chronic pain patients. Opioid-sparing medications represent a crucial aspect of the pain treatment process, along with deprescribing protocols. Clinicians and clinical pharmacologists must cooperate to meet the need of a guide that can represent the most possible appropriate therapy for these patients.

Aceites esenciales con actividad antibacteriana: posible aplicación y administración en odontología / Essential oils with antibacterial activity: possible uses and administration in the dental practice

Resumen Introducción la caries dental es una de las enfermedades de mayor prevalencia a escala mundial, cuyas consecuencias clínicas se encuentran relacionadas directamente con la calidad de vida de los individuos. Asimismo, la atención odontológica exige un elevado costo y muchas veces lejos del alcance de ciertas comunidades. Si bien esta enfermedad se produce por la confluencia de distintos factores, uno de ellos es el económico, por lo que se busca una opción medicinal de bajo costo, y el abordaje a su vez de otro factor, tal vez el más importante, que implica el desarrollo y multiplicación del microorganismo iniciador de esta enfermedad, que es Streptococcus mutans. Actualmente se conoce el consumo de medicinas de origen natural para el tratamiento de algunas enfermedades, entre ellas, la caries. El uso y mecanismo de acción de aceites esenciales que impidan el desarrollo de S. mutans en el biofilm dental está siendo investigado. El objetivo de este trabajo es actualizar los conocimientos sobre la acción biocida de aceites esenciales y sus posibles aplicaciones en odontología. Resultados. Los aceites esenciales provenientes de los cítricos como limón, mandarina, naranja, como así también de eucalipto y orégano, presentan actividad bacteriostática, y en algunos casos, bactericida frente a bacterias Gram + y Gram -. Conclusión de acuerdo con la información recopilada, el uso de estos aceites mediante la biotecnología sería beneficioso y contribuiría al manejo de la salud bucal sin alterar la microflora oral normal del ser humano.

Abstract Dental caries is one of the most prevalent diseases worldwide, whose clinical consequences are directly related to the quality of life of individuals. Likewise, dental care requires a high cost and is often beyond the reach of certain communities. Although this disease is produced by the confluence of different factors, one of them is the economic factor, which is why a low-cost medicinal alternative is sought, and the approach in turn of another factor, perhaps the most important, which implies the development and multiplication of the initiating microorganism of this disease that is Streptococcus mutans. Currently, the consumption of medicines of natural origin is known for the treatment of some diseases, including tooth decay. The use of essential oils that prevent the development of St. mutans in dental biofilm is being investigated and the objective of this work is to update the knowledge about its biocidal action and its applications in dentistry. The objective of this work is to update the knowledge on the biocidal action of essential oils and their possible applications in dentistry. Results The essential oils from citrus fruits such as lemon, mandarin, orange, as well as eucalyptus and oregano, show bacteriostatic activity, and in some cases, bactericidal against Gram + and Gram - bacteria. Conclusion according to the information collected, the use of these oils through biotechnology would be beneficial and would contribute to the management of oral health without altering the normal oral microflora of the human being.

The Effect of Ostrich Oil as a Complementary Medicine on the Severity of Pruritus and Quality of Life in Hemodialysis Patients.

INTRODUCTION: Pruritus is one of the most common problems in a uremic syndrome that reduces the quality of life due to the constant unpleasant feeling. The purpose of this study was to investigate the effect of ostrich oil massage on the severity of pruritus and quality of life in hemodialysis patients. METHODS: In this study, 68 hemodialysis patients with pruritus were selected based on the available sampling method. The intervention group used 1 mL ostrich oil on the pruritus area for 10 min each night for 1 month. The control group received a placebo massage. Pruritus severity questionnaire-based itch severity scale and quality of life questionnaire were completed, respectively, at the end of each week and at the end of the period. Statistical analysis was done using SPSS software version 23 and applying on independent t test, paired t test, and analysis of covariance. RESULTS: During the first and second weeks after the treatment, there was no statistical difference between the mean scores of pruritus severity in both groups (p > 0.05); however, in the third and fourth weeks after the treatment, the mean severity level of pruritus in the ostrich oil group was lower than in the placebo group, and these differences were statistically significant between the two groups (p < 0.05). There was no significant difference in quality of life between two groups of ostrich and placebo. CONCLUSION: The use of ostrich oil was effective in reducing pruritus in hemodialysis patients. This method can be proposed as a complementary method for relieving pruritus in hemodialysis patients.

Orally administered emu oil attenuates disease in a mouse model of Crohn's-like colitis.

Crohn's disease is a severe, incurable inflammatory bowel disease. Orally administered emu oil has demonstrated anti-inflammatory properties in previous models of gastrointestinal disease. We aimed to determine whether orally administered emu oil could attenuate disease in a mouse model of Crohn's-like colitis. Female ARC(s) mice (CD-1 equivalent, n = 10/group) were intra-rectally administered water (120 µL) or trinitrobenzene sulfonic acid (TNBS; 3 mg in 50% ethanol; 120 µL bolus) on day 0. Mice were orally administered water (80 µL) or emu oil (80 µL or 160 µL) daily for five days and euthanized on day six. Bodyweight and disease activity were recorded daily. Colonoscopy, burrowing activity, facial grimace, histological parameters (damage severity, small intestinal villus height/crypt depth and colonic crypt depth), myeloperoxidase activity and intestinal permeability were assessed. P < 0.05 was considered statistically significant. TNBS decreased bodyweight (days 1, 2, 4; P < 0.05) and increased disease activity (days 1-6; P < 0.01), compared to normal controls. Emu oil (80 µL) attenuated disease activity on days 5-6 (P < 0.05), although bodyweight loss was not significantly impacted (P > 0.05). Facial grimace and colonoscopy scores were significantly increased in TNBS-control mice; effects attenuated by both volumes of emu oil (P < 0.001). TNBS increased histological damage severity compared to normal controls (P < 0.05); an effect attenuated by 80 µL emu oil (proximal and distal colon; P < 0.05) and 160 µL emu oil (distal colon; P < 0.01). In the ileum, villus height and crypt depth were unaffected by TNBS or emu oil treatment compared to normal (P > 0.05). TNBS-induced distal colonic crypt lengthening was unaffected following emu oil administration (P > 0.05). Remaining parameters, including burrowing, myeloperoxidase activity and intestinal permeability, were unchanged across all treatment groups (P > 0.05). In normal mice, emu oil treatment did not significantly impact any parameter compared to normal controls. In conclusion, emu oil reduced overall disease severity and facial grimace scores in TNBS mice. These results suggest therapeutic potential for orally administered emu oil in the management of Crohn's disease.

Mechanistic insights into the attenuation of intestinal inflammation and modulation of the gut microbiome by krill oil using in vitro and in vivo models.

BACKGROUND: The anti-inflammatory property of ω-3 polyunsaturated fatty acids (PUFA) has been exploited in the management of inflammatory bowel disease (IBD) with promising results. However, it remains unclear if PUFA play a significant role in the resolution of inflammation and promotion of mucosal healing. Krill oil (KO) is a natural product rich in PUFA and the potent antioxidant, astaxanthin. In this study, we attempted to understand the mechanisms through which KO modulates the gut microbiome and metabolome using in vitro and in vivo colitis models and a multi-omics based approach. RESULTS: KO significantly decreased LPS-induced IL1ß and TNFα expression in human macrophages in vitro in a dose-dependent manner by regulating a broad spectrum of signaling pathways, including NF-κB and NOD-like receptor signaling, and displayed a synergistic effect with COX2 and IKK2 inhibitors in attenuating inflammatory pathways. Moreover, KO was involved in the resolution of inflammation by promoting M2 polarization and enhancing macrophage-mediated intracellular bacterial killing. Parasite-dependent intestinal mucosal damage and microbial dysbiosis induced by Trichuris suis infection in pigs were partially restored by feeding KO. KO supplementation reduced the abundance of Rickettsiales and several species of Lactobacillus, which were among the important features identified by random forests analysis contributing to classification accuracy for KO supplementation. Several microbial signatures with strong predictive power for the status of both infection and supplementation were identified. The inhibitory effect of KO on histidine metabolism was identified using untargeted metabolomics. KO supplementation reduced several key metabolites related to histamine metabolism by suppressing the expression of a gene encoding L-histidine decarboxylase in the colon mucosa and reducing histamine biosynthesis of microbial origin. Moreover, the pro-resolving properties of KO were validated using a Citrobacter rodentium-induced Th1-dependent colitis murine model. Further, microbial signatures with high prediction accuracy for colitis-related pathophysiological traits were identified in mice. CONCLUSION: The findings from this study provided a mechanistic basis for optimizing microbiome-inspired alternative therapeutics in the management of IBD. The microbial signatures identified, particularly those with strong predictive accuracy for colitis phenotypes, will facilitate the development of biomarkers associated with appropriate dietary intervention to manage intestinal inflammation. Video abstract.

Ozone Therapy Attenuates NF-κB-Mediated Local Inflammatory Response and Activation of Th17 Cells in Treatment for Psoriasis.

Ozone therapy has been widely used to treat many skin diseases, including infections, allergic dermatosis, and skin ulcers. However, its efficacy as a treatment for psoriasis is unclear. In this study, we explored the clinical efficacy and the underlying molecular mechanisms of ozone therapy on psoriasis. We found that topical ozone treatment significantly decreased patients' psoriasis area and severity index (PASI) scores and the expression of psoriasis-associated cytokines in their peripheral blood CD4+ T cells. In the IMQ-induced psoriasis mouse model, topical ozone treatment significantly inhibited the formation of IMQ-induced psoriasis-like lesions and the expression of psoriasis-associated inflammatory factors. High-throughput sequencing confirmed that IMQ-induced activation of toll-like receptor 2 (TLR2)/ nuclear factor-κB (NF-κB) signaling pathway was significantly suppressed in psoriasis-like lesions after topical ozone treatment. Furthermore, the activation of spleen T helper (Th) 17 cells was blocked in the mouse model; this was associated with the downregulation of cytokines and NF-κB pathways upon topical ozone treatment. Ozone therapy can attenuate local inflammatory reactions and the activation of Th17 cells in psoriasis by inhibiting the NF-κB pathway. Our results show that ozone therapy is effective in treating psoriasis. We recommend further evaluations for its clinical applications.

Economic Evaluation of Cannabinoid Oil for Dravet Syndrome: A Cost-Utility Analysis.

INTRODUCTION: Cannabinoid oils are being increasingly used to treat Dravet syndrome, yet the long-term costs and outcomes of this approach are unknown. Thus, we examined the cost effectiveness of cannabinoid oil as an adjunctive treatment (added to clobazam and valproate), compared with adjunctive stiripentol or with clobazam and valproate alone, for the treatment of Dravet syndrome in children. METHODS: We performed a probabilistic cost-utility analysis from the perspective of the Canadian public health care system, comparing cannabinoid oil and stiripentol (both on a background of clobazam and valproate) with clobazam and valproate alone. Costs and quality-adjusted life-years (QALYs) were estimated using a Markov model that followed a cohort of children aged from 5 to 18 years through model states related to seizure frequency. Model inputs were obtained from the literature. The cost effectiveness of adjunctive cannabinoid oil, adjunctive stiripentol, and clobazam/valproate alone was assessed through sequential analysis. The influence of perspective and other assumptions were explored in scenario analyses. All costs are expressed in 2019 Canadian dollars, and costs and QALYs were discounted at a rate of 1.5% per year. RESULTS: The incremental cost per QALY gained with the use of adjunctive cannabinoid oil, from the health care system perspective, was $32,399 compared with clobazam and valproate. Stiripentol was dominated by cannabinoid oil, producing fewer QALYs at higher costs. At a willingness-to-pay threshold of $50,000, cannabinoid oil was the optimal treatment in 76% of replications. From a societal perspective, cannabinoid oil dominated stiripentol and clobazam/valproate. The interpretation of the results was insensitive to model and input assumptions. CONCLUSION: Compared with clobazam/valproate, adjunctive cannabinoid oil may be a cost-effective treatment for Dravet syndrome, if a decision maker is willing to pay at least $32,399 for each QALY gained. The opportunity costs of continuing to fund stiripentol, but not cannabinoid oil, should be considered.

Ganoderma lucidum spore oil induces apoptosis of breast cancer cells in vitro and in vivo by activating caspase-3 and caspase-9.

ETHNOPHARMACOLOGICAL RELEVANCE: The mushroom Ganoderma lucidum (G. lucidum) is a traditional Chinese medicine reported to have a variety of pharmacological properties, including anti-cancer activity. G. lucidum spore oil (GLSO) is a lipid substance extracted from sporoderm-broken spore of G. lucidum. However, the effect of GLSO on breast cancer and the underlying molecular mechanism remain unclear. AIM OF THE STUDY: The aim of this study was to identify the effects of GLSO on breast cancer cells in vitro and in vivo as well as to investigate the mechanistic basis for the anticancer effect of GLSO. MATERIALS AND METHODS: First, in vitro MDA-MB-231 cells were treated with GLSO (0.2, 0.4, and 0.6 µL/mL). The protein levels of B-cell lymphoma-2 (Bcl-2), Bcl-2-associated X (Bax), X-linked inhibitor of apoptosis (XIAP), total poly (ADP-ribose) polymerase (PARP), caspase-3 and caspase-8 were examined using western blotting. The mRNA expression levels of Fas-associated protein with death domain (FADD), TNF receptor-associated factor 2 (TRAF2), caspases-3, -8, -9 and Bax were examined using qRT-PCR. Second, in vivo the anticancer properties of GLSO were assessed by H&E, TUNEL and immunohistochemistry in BALB/c mice injected with 4T1 cells. In addition, the levels of caspase-9/caspase-3 signaling pathway proteins in tumor tissue were evaluated by immunoblotting. Finally, MDA-MB-231 cells were treated with caspase inhibitors to measure cell viability, the protein levels were examined with western blotting. RESULTS: The results in vitro showed that GLSO up-regulated the expression of Bax and caspase-3 in MDA-MB-231 cells, but had no effect on the expression of caspase-8. Moreover, the growth of tumors in vivo was significantly suppressed in the GLSO-treated group. The results of Western blot were consistent with in vitro. In vitro, co-treatment of MDA-MB-231 cells with caspase inhibitors reduced the inhibitory effect of GLSO on cell growth. CONCLUSIONS: GLSO inhibits the growth of MDA-MB-231 cells and tumors in vivo by inducing apoptosis, which may be achieved through the mitochondrial apoptotic pathway.

Exogenous lipoid pneumonia in children: A systematic review.

OBJECTIVES: To describe the clinical-radiological-pathological characteristics and treatment outcomes of children with suspected exogenous lipoid pneumonia (ELP). DESIGN: Systematic review. We searched electronic databases and reference lists published between 1967 and 2018, restricted to non-accidental cases. RESULTS: Forty-four studies including 489 participants aged 1 day to 17 years from 13 countries were included. Cultural, medical, and behavioural rationale for oil-use was described. The clinical-radiological presentation varied widely. Diagnostic certainty was deemed highest if ELP was confirmed on bronchoalveolar lavage/frozen section lung biopsy with documented extracellular lipid on cytological staining and/or fat analysis. Non-tuberculous mycobacteria infection was identified in six studies: Mycobacterium fortuitum/chelonei, Mycobacterium smegmatis and Mycobacterium abscessus. Treatment comprised supportive therapy, corticosteroids, stopping oil, therapeutic lung-lavage and surgical resection. Outcomes were reported inconsistently. CONCLUSION: Paediatric ELP resulting from cultural and medical practices continues to be described globally. Preventive interventions, standardized reporting, and treatment efficacy studies for cases not averted, are lacking. Protocol registration: PROSPERO CRD42017068313.

Calanus oil in the treatment of obesity-related low-grade inflammation, insulin resistance, and atherosclerosis.

Calanus oil (COil) is a natural product extracted from marine zooplankton Calanus finmarchicus found in the North Atlantic Ocean. This oil is rich in wax esters of polyunsaturated fatty acids (PUFAs) and has been projected as the best alternative to fish oil because its production cannot keep pace with the demands from the growing markets. The COil is the only commercially available marine source of wax esters, whereas classic ω-3 PUFAs comes from triglycerides, ethyl esters, and phospholipids. It has, in recent decades, been seen that there is an unprecedented rise in the use of PUFA-rich oil in the aquaculture industry. A simultaneous rise in the demand of PUFAs is also observed in the health care industry, where PUFAs are suggested preventing various disorders related to lifestyles such as obesity, diabetes mellitus, chronic low-grade inflammation, atherosclerosis, and brain and cardiovascular disorders (CVDs). In this review, we will explore the metabolic aspects related to the use of COil as an antioxidant, anticholesterinemic, and anti-inflammatory dietary source and its impact on the prevention and therapy of obesity-related metabolic disorders.

Combined Nutraceuticals: A Novel Approach to Colitis-Associated Colorectal Cancer?

Ulcerative colitis is an unremitting and lifelong inflammatory bowel disease that is increasing in prevalence worldwide. Patients display various clinical symptoms such as abdominal pain, diarrhea and fatigue. The etiology of ulcerative colitis remains unknown and the current pharmaceutical treatments are variably effective and not curative, highlighting the need for improved therapeutic approaches. Furthermore, patients with ulcerative colitis are at an increased risk of developing colorectal cancer. Some naturally sourced agents, named nutraceuticals, have been identified to possess anti-inflammatory and antioxidant properties. Of particular interest is Emu Oil, grape seed extract and Japanese Kampo medicine. Previously, Emu Oil has protected and repaired intestinal damage in models of gastrointestinal diseases including colitis and colitis-associated colorectal cancer. Additionally, grape seed extract possesses anticancer properties in vitro. Moreover, Kampo medicine, composed of herbal ingredients, is widely used in Japan for the treatment of various medical conditions and has demonstrated efficacy in targeting cancer cells in vitro. Nutraceuticals in combination have not yet been widely investigated in a setting of colitis-associated colorectal cancer. Investigation into the efficacy of Emu Oil combined with other nutraceuticals, including grape seed extract and Kampo medicine, is warranted as they may provide a novel approach to conventional colitis and colorectal cancer management.

Preparation, Characterization and in vivo Anti-inflammatory Studies of Ostrich Oil Based Nanoemulsion.

Ostrich oil, a natural bird fat oil, has significant biological activities in preventing various pains and inflammation. The aim of the current study was to develop ostrich oil loaded nanoemulsions to check the anti-inflammatory efficacy. The developed nanoemulsions(F1-F3) were evaluated in vitro for various physicochemical parameters including thermodynamic stability, nanoemulsifying potential, mean droplet size, polydispersity index (PDI), zeta potential (ZP), viscosity (η), refractive index (RI) and transmittance (%T).Optimizednanoemulsions(F2) had mean droplet size (99.8 nm), PDI (0.084), ZP (-84.2 mV), viscosity (43.5cp), RI (1.344) and transmittance (94.1%).TEM photomicrograph of F2 nanoemulsion were spherical in shape with smooth surface, supporting DLS measured droplet size. Furthermore, anti-inflammatory activity of optimized nanoemulsion (F2) in rats was much better as compared to pure ostrich oil.

Efficacy of combination of ozonated water with oil for treatment of tinea pedis.

OBJECTIVE: To evaluate efficacy of combined therapy with ozonated water and oil on patients with tinea pedis.
 Methods: A total of 60 patients with tinea pedis were divided into 2 groups in a randomized and blinded test. Patients in a control group were treated with naftinfine hydrochloride and ketoconazole cream once a day. Patients in an ozone group were treated with ozonated water bath and then ozonated oil topical application once a day. Patients in the 2 groups were treated for 4 weeks. Clinical and laboratory data were collected for both groups at the end of the 1st week, the 2nd week, and the 4th week. The Pearson chi-square was performed to compare scores of the clinical signs and symptoms (CSS) and the mycological result between the 2 groups. Independent samples T-test was performed to compare the curative effect between the 2 groups.
 Results: After 4 weeks' treatment, 6 patients were positive in the control group determined by mycological examination while 1 patient was positive in the ozone group, with no significant difference between the 2 groups (P>0.05). Changes in CSS at the end of the 1st week, 2nd week, and 4th week were obtained and showed no significant difference between the 2 groups at the 3 different time points (P>0.05). No side effects were observed.
 Conclusion: Combination of ozonated water with oil is effective on treatment of tinea pedis and it shows no side effects.

[Clinical efficacy of ozonated oil in the treatment of psoriasis vulgaris].

OBJECTIVE: To compare the efficacy and safety between ozonated oil and compound flumethasone ointment in the treatment of psoriasis vulgaris.
 Methods: A left/right self-controlled, parallel group study was conducted. Forty patients with stable psoriasis vulgaris were enrolled in the study, whose lesions were symmetrical and involvement areas were <30% body surface. The patients were divided into 2 groups. Patients with left lesions served as a test group were treated daily for ozonated oil twice, and patients with right lesions served as a control group were treated daily for compound flumetasone ointment twice. The patients in the 2 groups were treated for 4 weeks. The clinical efficacy and safety were observed at 1, 2 and 4 weeks after the treatment.
 Results: After 1 week treatment, the effective rates of the test group and the control group were 60.58% and 72.28%, respectively, with significant difference between them (P<0.05). At 2 weeks and 4 weeks after the treatment, the efficacy in the test group was similar to that in the control group. The effective rates in the test group and the control group were 69.84% and 70.25% after 2 weeks, respectively, 70.88% and 71.23% after 4 weeks, respectively. There was no significant difference between the 2 groups (P<0.05). In addition, the reflectance confocal microscope results in both the test group and the control group after 4 weeks showed that the epidermis was approximately normal. There were few inflammatory cells infiltration in the dermal papilla, and the inflammatory cells infiltration was significantly reduced after treatment.
 Conclusion: Ozonated oil treatment for stable psoriasis is safe and effective, and its efficacy is equivalent to the effect of glucocorticoid topical preparations.

Microbial diversity and composition in different gut locations of hyperlipidemic mice receiving krill oil.

Low-dose (LD, 100 mg kg-1 day-1), moderate-dose (MD, 200 mg kg-1 day-1), and high-dose (HD, 600 mg kg-1 day-1) krill oil treatments have a stepwise, enhanced effect on alleviating hyperlipidemia, and 16S rRNA sequencing of the fecal samples demonstrates that krill oil treatment alters microbial communities. Feces may not represent all microbial communities in the gastrointestinal (GI) tract. Therefore, in this study, the stored ileal and colon samples collected from LD and HD groups were sequenced, and the location-specific modulations of microbial communities were observed after krill oil treatments. The 16S rRNA sequencing of the ileal samples showed that the LD and HD groups have similar patterns between control and high-fat diet (HFD) treatments, and six most abundant genera and 40 operational taxonomic units that respond to krill oil treatment were identified. However, the 16S rRNA sequencing of the colon samples showed that LD krill oil shifts the structure from the HFD to that of the control, whereas the HD group was distributed between the control and HFD groups. The corresponding most abundant genera and responsive OTUs totaled 4 and 45, respectively. In conclusion, different gastrointestinal tract locations contain different microbial communities. These results will help to provide a comprehensive understanding of the role of dietary krill oil in modulating the gut microbiota and alleviating hyperlipidemia.