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1.
Curr Opin Anaesthesiol ; 33(6): 832-840, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33093301

RESUMO

PURPOSE OF REVIEW: Growing numbers of patients, consuming cannabinoids admitted to surgery, create a challenge to anesthesia providers. This review provides a summary of recent literature related to cannabis and anesthesia, with specific recommendations to the anesthetic management of medical cannabis consumers. RECENT FINDINGS: At present, cannabis has found its way to public consensus in many countries and is penetrating slower to different medical fields. We relate and discuss recent findings investigating effects of cannabis consumption on the various aspects including perioperative measures, post-operative pain, PONV, cardiovascular stability, and anesthesia monitoring. SUMMARY: Recent surveys estimate that 10-20% of adult populations have consumed cannabis in the past year. Medical cannabis consumers are a newer group of cannabis users. Anesthesia providers have to update their knowledge on cannabis and possible anesthetic interaction. It is unreasonable to make recommendations that apply to the whole heterogeneous group of cannabis users, but is easier with the more homogenous group of Medical cannabis users, characterized by frequent use and relatively high cannabis doses, combined with good knowledge of administered composition and protocol, as well as adverse and withdrawal effects. Anesthesia providers have to know the effects and modify anesthetic plan accordingly. We provide perioperative anesthetic recommendations related to medical cannabis consumers. Collecting information of the effects of medical cannabis use in perioperative setting will further create a highly useful database for anesthetics in the close future.


Assuntos
Anestésicos , Canabinoides/uso terapêutico , Cannabis/efeitos adversos , Maconha Medicinal/uso terapêutico , Adulto , Analgésicos , Anestésicos/administração & dosagem , Anestésicos/efeitos adversos , Canabinoides/efeitos adversos , Humanos , Maconha Medicinal/efeitos adversos
2.
Curr Opin Anaesthesiol ; 33(6): 841-546, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33060386

RESUMO

PURPOSE OF REVIEW: Cannabis products have been used for various ailments since ancient times. But their use diminished in the medical community due to the legal and social concerns of substance abuse. With evolving evidence of their use in alleviating various symptoms, resurgence of interest in their medicinal use is seen in the past decade. RECENT FINDINGS: Clinical evidence for cannabis products in treating various ailments has been far from robust. Their use is based on anecdotal and low-quality evidence. This review attempts to revisit the recent medical literature available on the merits and demerits of cannabinoid use in palliative medicine. SUMMARY: A few symptoms in palliative care setting can be difficult to treat in a few patients with the available treatment measures. Anecdotal reports and early clinical data have proved cannabinoids to be a promising pharmacological option in managing this subset of patients. However, absence of robust clinical data in proving that cannabinoids have definitely favorable risk-benefit ratio, precludes the inclusion of cannabinoids in the routine recommendation for palliative symptom management. Before cannabinoids enter the broader market with patient-driven and industry-driven hype, high-quality clinical evidence is emergently needed.


Assuntos
Canabinoides/farmacologia , Canabinoides/uso terapêutico , Cannabis/química , Manejo da Dor/métodos , Cuidados Paliativos/métodos , Analgésicos , Canabinoides/efeitos adversos , Humanos , Medicina Paliativa , Resultado do Tratamento
3.
Sports Health ; 12(6): 540-546, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936058

RESUMO

CONTEXT: With increased use of cannabis-based products by the public for both recreational and medical use, sports medicine clinicians should be informed of historical context, current legal considerations, and existing evidence with regard to efficacy, safety, and risks in the athletic community. EVIDENCE ACQUISITION: A review of ClinicalTrials.gov, MEDLINE, and CINAHL from 2015 to present was conducted with emphasis on the most recent literature using search terms, cannabis, nabiximols, cannabinoids, pain management, THC, CBD, and marijuana. Bibliographies based on original search were utilized to pursue further literature search. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 3. RESULTS: At present, limited high-quality studies exist for use of cannabinoids for acute pain, chronic pain, or concussion. None of the trials involving cannabinoids included the athletic population. Thus, results from this clinical review are extrapolated to conditions of the sports medicine population. For acute pain, 2 small-randomized double-blinded crossover trials concluded no immediate effect of cannabinoid therapy. More robust evidence exists for treatment of chronic pain conditions through meta-analysis and systemic reviews. Cannabinoid therapy exhibits moderate efficacy as a treatment for some chronic pain conditions. Investigations included a broad spectrum of chronic pain conditions, including neuropathic, musculoskeletal, inflammatory, and central pain conditions, and reveal reduction in pain and improvement of quality of life with limited adverse effects. For concussion, evidence is based on preclinical in vitro and animal models revealing possible neuroprotective effects as well as 2 clinical studies involving the presence of cannabinoids for concussion (some sports-related), but there are no high-quality trials evaluating efficacy for treatment with cannabinoids at this time. CONCLUSION: Although various biochemical explanations exist on the use of cannabinoid therapy through modulation of the endocannabinoid system for several medical issues affecting athletes, recommendations from clinicians must be extrapolated from a majority of research done in the nonathletic population. Lack of strong-quality clinical evidence, coupled with inconsistent federal and state law as well as purity issues with cannabis-based products, make it difficult for the sports medicine clinician to widely recommend cannabinoid therapeutics at present. Future larger, higher quality clinical research studies with standardized pure extracts will better guide appropriate medical use going forward. At present, evidence for a multitude of therapeutic applications is emerging for cannabinoid treatment approaches. With emphasis placed on patient-centered clinical decisions, cannabinoids hold promise of treatment for athletes with chronic pain conditions. Clinicians who treat the athletic community must consider legal and ethical issues when discussing and recommending the use of cannabinoids, with acknowledgment of inconsistencies in purity of various formulations and concerns of drug testing.


Assuntos
Traumatismos em Atletas/complicações , Canabinoides/uso terapêutico , Maconha Medicinal/uso terapêutico , Manejo da Dor/métodos , Dor Aguda/tratamento farmacológico , Traumatismos em Atletas/tratamento farmacológico , Concussão Encefálica/tratamento farmacológico , Canabinoides/efeitos adversos , Dor Crônica/tratamento farmacológico , Medicina Baseada em Evidências/normas , Humanos , Uso da Maconha/legislação & jurisprudência , Maconha Medicinal/efeitos adversos , Estados Unidos
4.
Psychiatr Danub ; 32(Suppl 1): 200-206, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890390

RESUMO

BACKGROUND: Gender is a crucial factor in the development of mental illnesses, with an essential influence on clinical characteristics and not only on the prevalence of each disorder. Gender differences in cannabinoid-related disorders are highlighted by different research fields (preclinical, clinical, socio-demographic studies), but few studies focused on differential symptom expression in cannabinoid-induced psychosis. This study aims at investigating qualitative and quantitative gender differences in specific psychopathological domains in a clinical sample of subjects affected by cannabinoid-induced psychotic disorder, without psychiatric comorbidity. SUBJECTS AND METHODS: The study was carried out at the Psychiatric Inpatient Service of General Hospital of Perugia (Italy). In this cross-sectional gender study, 28 inpatients were enrolled, 14 males (M) and 14 females (F). Participants were administered a psychometric battery consisting of 7 tests (PANSS, NDS-I, YMRS, HAM-D, HAM-A, AQ, SSI) in order to investigate 7 psychopathological domains (Psychosis, Dysphoria, Mania, Depression, Anxiety, Aggressive Behaviour and Suicide Ideation). Scores obtained at each test were compared between male and females by using Mann-Whitney U test (p<0.05). RESULTS: In this study, we observed that males present higher severity of psychotic symptoms, with prominent scores in PANSS positive and general psychopathology scale (p<0.001), and an important expression of aggressive behavior (p<0.001) compared with females. Female sample, instead, shows a greater expression of dysphoria and depressive domains (p<0.001) and a lower, but statistically significant, prevalence in the anxiety domains expression (p=0.01). By these observations, we could assert that in male group thought disorders are prominent. On the other hand, in female group affective disorder are prominent. CONCLUSIONS: This study confirmed how gender influences the phenomenic expression of psychiatric disorders. In line with the precision medicine paradigm, a further clarification of different clinical profiles based on gender would allow the choice of a personalized treatment plan with better efficacy and accuracy indices.


Assuntos
Transtorno Bipolar , Canabinoides , Psicoses Induzidas por Substâncias , Transtornos Psicóticos , Canabinoides/efeitos adversos , Estudos Transversais , Feminino , Humanos , Itália , Masculino
5.
Orv Hetil ; 161(31): 1281-1285, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32750017

RESUMO

The electronic cigarette and vaping associated lung injury (EVALI) syndrome was first described in the United States (US) and was presumably strongly associated with cannabinoid vaping and exposure to vitamin E acetate, an oily additive used to dilute/cut cannabinoids vape liquids. As the case numbers were relatively low (epidemiologically) and the available data was inconsistent, several assumptions were made to explain the phenomenon. The lack of standardization of sampling, the self-reported, inhomogeneous user habits, the huge number of potential etiologies, and certain trade/legal loopholes (such as online distribution, black market penetration, or the inefficient regulatory control regarding the quantity and/or quality of ingredients/cutting agents) might question the validity of the data and the consequent conclusions. Furthermore, an interesting but by no means negligible question is the fact why no EVALI cases have been registered outside the US when electronic cigarettes and vapes have become increasingly popular worldwide. The present review seeks to answer whether vitamin E acetate is indeed the cause of this complex syndrome, what potentially non-healthcare related factors might have contributed to the rapid increase and decline in EVALI cases, and last but not least the minimum standards of safe vaping (as potential for drug delivery route for cannbinoids). Orv Hetil. 2020; 161(31): 1281-1285.


Assuntos
Canabinoides/efeitos adversos , Sistemas Eletrônicos de Liberação de Nicotina , Lesão Pulmonar/induzido quimicamente , Vaping/efeitos adversos , Canabinoides/administração & dosagem , Humanos , Autorrelato , Estados Unidos , Vitamina E
6.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32661188

RESUMO

Cannabinoids, the psychoactive compounds in marijuana, are one of the most commonly used substances in the United States. In this review, we summarize the impact of marijuana on child and adolescent health and discuss the implications of marijuana use for pediatric practice. We review the changing epidemiology of cannabis use and provide an update on medical use, routes of administration, synthetic marijuana and other novel products, the effect of cannabis on the developing brain, other health and social consequences of use, and issues related to marijuana legalization.


Assuntos
Cannabis , Uso da Maconha , Adolescente , Comportamento do Adolescente/efeitos dos fármacos , Animais , Encéfalo/efeitos dos fármacos , Encéfalo/embriologia , Encéfalo/crescimento & desenvolvimento , Canabidiol/farmacologia , Canabidiol/uso terapêutico , Canabinoides/efeitos adversos , Canabinoides/síntese química , Canabinoides/farmacologia , Cannabis/efeitos adversos , Cannabis/química , Cannabis/envenenamento , Criança , Comportamento Infantil/efeitos dos fármacos , Interações Medicamentosas , Endocanabinoides/fisiologia , Feminino , Feto/efeitos dos fármacos , Humanos , Drogas Ilícitas/efeitos adversos , Masculino , Abuso de Maconha/epidemiologia , Abuso de Maconha/terapia , Uso da Maconha/efeitos adversos , Uso da Maconha/epidemiologia , Uso da Maconha/legislação & jurisprudência , Uso da Maconha/psicologia , Meios de Comunicação de Massa , Maconha Medicinal/efeitos adversos , Maconha Medicinal/uso terapêutico , Leite Humano/química , Transtornos Neurocognitivos/induzido quimicamente , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Receptores de Canabinoides/efeitos dos fármacos , Receptores de Canabinoides/fisiologia , Uso de Tabaco/epidemiologia
7.
Am J Occup Ther ; 74(4): 7404205020p1-7404205020p15, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32602441

RESUMO

IMPORTANCE: Cannabinoids are at the center of much interest and controversy within health care and society. However, minimal research has investigated the impact of cannabinoids on quality of life (QoL) and occupation. OBJECTIVE: The literature suggests that cannabinoids may have therapeutic potential, although the available research is limited. A scoping review was conducted to address the gap in the literature regarding the impact of recreational and medicinal cannabinoids on QoL and occupational engagement. DATA SOURCES: Databases searched included Ovid and CINAHL; sources derived from a manual search of reference lists were also used. Of the 691 articles that were identified, 22 articles met the inclusion and exclusion criteria. STUDY SELECTION AND DATA COLLECTION: This scoping review was conducted in accordance with Arksey and O'Malley's five stages. Inclusion criteria included English language, clear focus or description on the impact of nonsynthetic cannabinoids on QoL and occupation, and published between January 2011 and May 2019. Exclusion criteria included minors, single case studies, animal studies, antineoplastic articles, and articles that only discussed or investigated effects of synthetic cannabinoids. FINDINGS: The findings were inconclusive, and the primary research that emerged from the literature investigated the effects of cannabinoids on pain management, sleep, appetite, and other physiological functions in both recreational and medicinal users. CONCLUSIONS AND RELEVANCE: The findings derived from the literature raised more questions, and further research is warranted. Occupational therapy practitioners have an opportunity to use their knowledge and skills to address the impact of cannabinoids on occupational engagement and QoL. WHAT THIS ARTICLE ADDS: Practitioners have the opportunity to provide education regarding cannabis use and monitor how it affects occupational engagement and QoL for both recreational and medicinal users.


Assuntos
Antineoplásicos , Canabinoides/efeitos adversos , Terapia Ocupacional , Humanos , Ocupações , Qualidade de Vida
8.
J Cardiovasc Pharmacol Ther ; 25(6): 508-522, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32588641

RESUMO

Phytogenic cannabinoids from Cannabis sativa and synthetic cannabinoids are commonly used substances for their recreational and medicinal properties. There are increasing reports of cardiotoxicity in close temporal association with cannabinoid use in patients with structurally normal hearts and absence of coronary arterial disease. Associated adverse events include myocardial ischemia, conduction abnormalities, arrhythmias, and sudden death. This review details the effects of phytogenic and synthetic cannabinoids on diverse receptors based on evidence from in vitro, human, and animal studies to establish a molecular basis for these deleterious clinical effects. The synergism between endocannabinoid dysregulation, cannabinoid receptor, and noncannabinoid receptor binding, and impact on cellular ion flux and coronary microvascular circulation is delineated. Pharmacogenetic factors placing certain patients at higher risk for cardiotoxicity are also correlated with the diverse effects of cannabinoids.


Assuntos
Síndrome Coronariana Aguda/induzido quimicamente , Arritmias Cardíacas/induzido quimicamente , Agonistas de Receptores de Canabinoides/efeitos adversos , Canabinoides/efeitos adversos , Cannabis/efeitos adversos , Coração/efeitos dos fármacos , Abuso de Maconha/complicações , Fumar Maconha/efeitos adversos , Síndrome Coronariana Aguda/fisiopatologia , Animais , Arritmias Cardíacas/fisiopatologia , Agonistas de Receptores de Canabinoides/síntese química , Agonistas de Receptores de Canabinoides/isolamento & purificação , Canabinoides/síntese química , Canabinoides/isolamento & purificação , Cannabis/química , Cardiotoxicidade , Coração/fisiopatologia , Frequência Cardíaca/efeitos dos fármacos , Humanos , Receptores de Canabinoides/efeitos dos fármacos , Medição de Risco , Fatores de Risco , Transdução de Sinais
9.
Med Clin North Am ; 104(3): 471-489, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32312410

RESUMO

The purpose of this article is to present evidence on the efficacy and safety of medical cannabis as a therapy for symptom management in palliative care. This article provides an overview of the evidence on the risks and benefits of using medical cannabis for the indications of chronic pain, cancer-related pain, cancer cachexia, dementia, and Alzheimer's disease. Currently, there is insufficient evidence to determine the effectiveness and safety of cannabinoids for most reviewed indications, with the exception of chronic pain. Future research is required before palliative care clinicians can make evidence-based decisions on the integration of medical cannabis as adjunct therapies.


Assuntos
Canabinoides/uso terapêutico , Dor Crônica/tratamento farmacológico , Maconha Medicinal/uso terapêutico , Manejo da Dor/métodos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/tratamento farmacológico , Caquexia/tratamento farmacológico , Dor do Câncer/tratamento farmacológico , Canabinoides/efeitos adversos , Demência/tratamento farmacológico , Humanos , Maconha Medicinal/efeitos adversos , Metanálise como Assunto , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Manejo da Dor/tendências , Cuidados Paliativos/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
An. sist. sanit. Navar ; 43(1): 87-91, ene.-abr. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193681

RESUMO

Presentamos un caso de hiperglucemia secundaria a intoxicación por cannabinoides sintéticos (CS). Los CS son drogas de abuso con efectos similares a la marihuana pero con diferente estructura química, lo que evita su detección con los test de drogas utilizados habitualmente, dificultando su diagnóstico. Entre los posibles efectos secundarios de su uso se encuentra la hiperglucemia. Su consumo debe sospecharse ante hiperglucemias no explicables por otra causa, especialmente en pacientes jóvenes que presenten, además, otra clínica compatible con consumo de CS, tales como agitación, cuadro confusional o psicosis; debería interrogarse al paciente sobre su uso. Es importante, además, que la población diabética conozca los efectos secundarios de los cannabinoides sintéticos, para evitar su consumo por un sector de la población especialmente vulnerable a las consecuencias de su empleo


We present a case of intoxication by synthetic cannabinoids (SC). SC are substances of abuse with effects similar to Marijuana but with a different chemical structure, which avoids its detectability by regular drug tests, making diagnosis difficult. Among the possible side effects of their use is hyperglycemia. Their presence should be suspected in cases of hyperglycemia that cannot be explained by any other cause, especially in young patients presenting another clinical picture suggestive of SC consumption such as agitation, confusional symptoms or psychosis; the patient should be questioned about their use. It is important that the diabetic population knows the side effects of synthetic cannabinoids to avoid their consumption, as it is a sector of the population especially vulnerable to the consequences of their use


Assuntos
Humanos , Masculino , Adulto , Canabinoides/toxicidade , Hiperglicemia/induzido quimicamente , Drogas Desenhadas/toxicidade , Canabinoides/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/complicações , Insulina/administração & dosagem , Soro , Canabinoides/farmacocinética
11.
JAMA Netw Open ; 3(4): e202370, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32271390

RESUMO

Importance: Cannabis withdrawal syndrome (CWS)-a diagnostic indicator of cannabis use disorder-commonly occurs on cessation of heavy and prolonged cannabis use. To date, the prevalence of CWS syndrome has not been well described, nor have the factors potentially associated with CWS. Objectives: To estimate the prevalence of CWS among individuals with regular or dependent use of cannabinoids and identify factors associated with CWS. Data Sources: A search of literature from database inception to June 19, 2019, was performed using MEDLINE, Embase, PsycINFO, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, ProQuest, Allied and Complementary Medicine, and Psychiatry online, supplemented by manual searches of reference lists of included articles. Study Selection: Articles were included if they (1) were published in English, (2) reported on individuals with regular use of cannabinoids or cannabis use disorder as a primary study group, (3) reported on the prevalence of CWS or CWS symptoms using a validated instrument, (4) reported the prevalence of CWS, and (5) used an observational study design (eg, cohort or cross-sectional). Data Extraction and Synthesis: All abstracts, full-text articles, and other sources were reviewed, with data extracted in duplicate. Cannabis withdrawal syndrome prevalence was estimated using a random-effects meta-analysis model, alongside stratification and meta-regression to characterize heterogeneity. Main Outcomes and Measures: Cannabis withdrawal syndrome prevalence was reported as a percentage with 95% CIs. Results: Of 3848 unique abstracts, 86 were selected for full-text review, and 47 studies, representing 23 518 participants, met all inclusion criteria. Of 23 518 participants included in the analysis, 16 839 were white (72%) and 14 387 were men (69%); median (SD) age was 29.9 (9.0) years. The overall pooled prevalence of CWS was 47% (6469 of 23 518) (95% CI, 41%-52%), with significant heterogeneity between estimates (I2 = 99.2%). When stratified by source, the prevalence of CWS was 17% (95% CI, 13%-21%) in population-based samples, 54% in outpatient samples (95% CI, 48%-59%), and 87% in inpatient samples (95% CI, 79%-94%), which were significantly different (P < .001). Concurrent cannabis (ß = 0.005, P < .001), tobacco (ß = 0.002, P = .02), and other substance use disorders (ß = 0.003, P = .05) were associated with a higher CWS prevalence, as was daily cannabis use (ß = 0.004, P < .001). Conclusions and Relevance: These findings suggest that cannabis withdrawal syndrome appears to be prevalent among regular users of cannabis. Clinicians should be aware of the prevalence of CWS in order to counsel patients and support individuals who are reducing their use of cannabis.


Assuntos
Abuso de Maconha/epidemiologia , Fumar Maconha/etnologia , Síndrome de Abstinência a Substâncias/epidemiologia , Adolescente , Adulto , Canabinoides/efeitos adversos , Feminino , Humanos , Masculino , Abuso de Maconha/complicações , Pessoa de Meia-Idade , Prevalência , Síndrome de Abstinência a Substâncias/complicações , Adulto Jovem
12.
Proc Natl Acad Sci U S A ; 117(18): 9991-10002, 2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32312805

RESUMO

The initial response to an addictive substance can facilitate repeated use: That is, individuals experiencing more positive effects are more likely to use that drug again. Increasing evidence suggests that psychoactive cannabinoid use in adolescence enhances the behavioral effects of cocaine. However, despite the behavioral data, there is no neurobiological evidence demonstrating that cannabinoids can also alter the brain's initial molecular and epigenetic response to cocaine. Here, we utilized a multiomics approach (epigenomics, transcriptomics, proteomics, and phosphoproteomics) to characterize how the rat brain responds to its first encounter with cocaine, with or without preexposure to the synthetic cannabinoid WIN 55,212-2 (WIN). We find that in adolescent (but not in adult) rats, preexposure to WIN results in cross-sensitization to cocaine, which correlates with histone hyperacetylation and decreased levels of HDAC6 in the prefrontal cortex (PFC). In the PFC, we also find that WIN preexposure blunts the typical mRNA response to cocaine and instead results in alternative splicing and chromatin accessibility events, involving genes such as Npas2 Moreover, preexposure to WIN enhances the effects of cocaine on protein phosphorylation, including ERK/MAPK-targets like gephyrin, and modulates the synaptic AMPAR/GluR composition both in the PFC and the nucleus accumbens (NAcc). PFC-NAcc gene network topological analyses, following cocaine exposure, reveal distinct top nodes in the WIN preexposed group, which include PACAP/ADCYAP1. These preclinical data demonstrate that adolescent cannabinoid exposure reprograms the initial behavioral, molecular, and epigenetic response to cocaine.


Assuntos
Comportamento Aditivo/genética , Comportamento Animal/efeitos dos fármacos , Canabinoides/efeitos adversos , Cocaína/efeitos adversos , Adolescente , Animais , Comportamento Aditivo/induzido quimicamente , Comportamento Aditivo/patologia , Benzoxazinas/efeitos adversos , Benzoxazinas/farmacologia , Canabinoides/farmacologia , Peptídeos e Proteínas de Sinalização do Ritmo Circadiano/genética , Cocaína/farmacologia , Epigênese Genética/efeitos dos fármacos , Epigênese Genética/genética , Regulação da Expressão Gênica/efeitos dos fármacos , Desacetilase 6 de Histona/genética , Humanos , Proteínas de Membrana/farmacologia , Morfolinas/efeitos adversos , Morfolinas/farmacologia , Naftalenos/efeitos adversos , Naftalenos/farmacologia , Fosfoproteínas/efeitos dos fármacos , Polipeptídeo Hipofisário Ativador de Adenilato Ciclase/genética , Córtex Pré-Frontal/efeitos dos fármacos , Proteoma/efeitos dos fármacos , Ratos , Transcriptoma/efeitos dos fármacos
13.
Tumori ; 106(4): 281-285, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32178596

RESUMO

OBJECTIVE: To present an investigation into the intake of cannabinoids in a population of adolescents and young adults with cancer. METHODS: Sixty-six patients took part in the research: 27 reported having used cannabinoids, 21 before diagnosis; among the latter, 10 increased use during treatment. RESULTS: Benefits were reported by 19% of responders regarding anxiety control, 24% for nausea, 29% for pain control and improvement of sleep, and 48% for appetite improvement. CONCLUSIONS: Cannabis use by patients may often be unknown to caregivers. Studying this subject may help to better define important therapeutic aspects of these substances.


Assuntos
Canabinoides/administração & dosagem , Náusea/tratamento farmacológico , Neoplasias/tratamento farmacológico , Adolescente , Adulto , Canabinoides/efeitos adversos , Feminino , Humanos , Masculino , Náusea/induzido quimicamente , Náusea/epidemiologia , Náusea/patologia , Neoplasias/epidemiologia , Neoplasias/patologia , Inquéritos e Questionários , Adulto Jovem
14.
J Trauma Acute Care Surg ; 89(1): 125-131, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32209959

RESUMO

BACKGROUND: Tetrahydrocannabinoids (THC) can modulate the coagulation cascade resulting in hypercoagulability. However, the clinical relevance of these findings has not been investigated. The aim of our study was to evaluate the impact of preinjury marijuana exposure on thromboembolic complications (TEC) in trauma patients. METHODS: We performed a 2-year (2015-2016) analysis of American College of Surgeons Trauma Quality and Improvement Program database and included all adult (≥18 year) trauma patients. Patients were stratified based on preinjury exposure to Marijuana: THC + ve and THC -ve groups. We performed propensity score matching to control for confounding variables: demographics, comorbidities, injury parameters, hospital course, and thromboprophylaxis use. Outcomes were TEC (deep venous thrombosis, pulmonary embolism, stroke, myocardial infarction) and mortality. RESULTS: Of 593,818 trauma patients, 678 patients were matched (THC + ve: 226 vs. THC -ve: 452). Mean age was 34 ± 15 years, Injury Severity Score was 14 (10-21). There was no difference between the two groups regarding age (p = 0.75), sex (p = 0.99), Injury Severity Score (p = 0.54), spine Abbreviated Injury Scale (AIS) (p = 0.61), head AIS (p = 0.32), extremities AIS (p = 0.38), use of unfractionated heparin (p = 0.54), use of low molecular weight heparin (p = 0.54), and hospital length of stay (p = 0.87). Overall, the rate of TEC was 4.3% and mortality was 4%. Patients in THC + ve group had higher rates of TEC compared with those in THC -ve group (3.5% vs. 1.1%, p = 0.03). The rate of deep venous thrombosis (6.6% vs. 1.8%, p = 0.02) and PE (2.2% vs. 0.2%, p = 0.04) was higher in THC + ve group. However, there was no difference regarding the rate of stroke (p = 0.24), myocardial infarction (p = 0.35) and mortality (p = 0.28). CONCLUSION: THC exposure increases the risk of TEC in patients with trauma. Early identification and treatment for TEC is required to improve outcomes in this high-risk subset of trauma patients. LEVEL OF EVIDENCE: Prognostic study, level III.


Assuntos
Canabinoides/efeitos adversos , Fumar Maconha , Tromboembolia Venosa/induzido quimicamente , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos
15.
Orv Hetil ; 161(11): 413-418, 2020 Mar.
Artigo em Húngaro | MEDLINE | ID: mdl-32148093

RESUMO

Over 1000 respiratory cases have been linked to vaping at the Centers for Disease Control and Prevention (Atlanta, GA, USA). So far at least 800 cases were confirmed as vaping-associated lung injuries (VALI) with 18 patients succumbing to the illness. To our present knowledge, vape fluids may contain certain compounds with toxic properties. It is not yet understood though what component or components are responsible for the cluster of cases. However, federal and state investigators are focusing on vape cartridges that likely contained cannabinoids as most patients vaped legal or illegal cannabinoids. Until recently, USA and UK public health authorities have welcomed vaping as a safer alternative to smoking. In countries where cannabis has been legalised, vaporizers became an increasingly popular form of administration, however, no human studies have been performed with vaporized cannabinoid oils, hence the safety of such device is unknown. A 2018 review concluded that although vaping might not necessarily be safe, it is still preferable for both patients and their environment to smoking cannabis. Since 2015, Hungarian, Australian and European scientific bodies have called for ban on the unregulated e-cigarettes, but encouraged future research to understand all aspects of vaping cannabinoids. Should vaping itself prove harmless, it might open new avenues for research and potential administration of medical cannabis, however, the contrary may cause landslide in the tobacco industry. Orv Hetil. 2020; 161(11): 413-418.


Assuntos
Canabinoides/efeitos adversos , Sistemas Eletrônicos de Liberação de Nicotina , Lesão Pulmonar/induzido quimicamente , Vaping/efeitos adversos , Austrália , Canabinoides/administração & dosagem , Humanos , Fumar Maconha
16.
Pediatr Rev ; 41(2): 61-72, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32005683

RESUMO

Most states in the United States have legalized medical and/or recreational cannabis in response to public demand. Trends in states adopting such legislation demonstrate an increasing prevalence of cannabis use coincident to decreasing perceptions of risk of harm from cannabis products. When providing anticipatory guidance, pediatricians should be prepared to address childhood unintentional ingestion management and prevention, adolescent problem use, and cannabis as an alternative therapy for seizure disorders and other conditions.


Assuntos
Abuso de Maconha/diagnóstico , Uso da Maconha/efeitos adversos , Uso da Maconha/legislação & jurisprudência , Adolescente , Comportamento do Adolescente , Canabinoides/efeitos adversos , Canabinoides/farmacologia , Criança , Comportamentos Relacionados com a Saúde , Humanos , Abuso de Maconha/prevenção & controle , Uso da Maconha/epidemiologia , Uso da Maconha/psicologia , Maconha Medicinal/uso terapêutico , Pediatras , Papel do Médico , Fatores de Risco , Convulsões/tratamento farmacológico , Estados Unidos/epidemiologia
17.
Yakugaku Zasshi ; 140(2): 193-204, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32009043

RESUMO

Cannabis contains over 700 known cannabinoids, terpenoids, flavonoids, and so on; however, the roles and importance of these components have yet to be fully understood. Δ9-Tetrahydrocannabinol (THC) is believed the most psychoactive component in cannabis, whereas cannabidiol (CBD), cannabinol, and cannabigerol are the most well-known non-psychoactive components. THC, but not CBD, has been shown to produce abnormal behavior in animals; these effects are caused, at least in part, by binding to cannabinoid receptor type 1 (CB1) in the brain. Regarding the risks associated with cannabis use, acute effects of THC, such as a "high", cognitive deficits, and irritability, are considered more important than potential dependence. On the other hand, CBD has shown anticonvulsant, anti-inflammatory, immunosuppressive, analgesic, and anticancer effects. However, CBD has very low affinity (in the micromolar range) for the CB1 receptor, as well as for the CB2 receptor, and its underlying mechanism remains obscure. In this review, we demonstrate that THC induces abnormal behavior such as catalepsy-like immobilization, spatial memory impairment, and high and low sensitivity to ultrasonic vocalization after an aversive air-puff stimulus. Moreover, we demonstrate that THC and CBD improve brain injury in middle cerebral artery occlusion in a mouse model through different mechanisms. These findings suggest the need to discuss the recent development of "THC and CBD pharmacology" in animal studies, as well as the utility and risk of various cannabis components in humans.


Assuntos
Cannabis/efeitos adversos , Animais , Lesões Encefálicas/tratamento farmacológico , Canabinoides/efeitos adversos , Canabinoides/uso terapêutico , Cannabis/química , Catalepsia/induzido quimicamente , Modelos Animais de Doenças , Humanos , Transtornos da Memória/induzido quimicamente , Camundongos , Risco , Memória Espacial/efeitos dos fármacos
18.
Ageing Res Rev ; 59: 101041, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32109605

RESUMO

While medical and recreational cannabis use is becoming more frequent among older adults, the neurocognitive consequences of cannabis use in this age group are unclear. The aim of this literature review was to synthesize and evaluate the current knowledge on the association of cannabis use during older-adulthood with cognitive function and brain aging. We reviewed the literature from old animal models and human studies, focusing on the link between use of cannabis in middle- and old-age and cognition. The report highlights the gap in knowledge on cannabis use in late-life and cognitive health, and discusses the limited findings in the context of substantial changes in attitudes and policies. Furthermore, we outline possible theoretical mechanisms and propose recommendations for future research. The limited evidence on this important topic suggests that use in older ages may not be linked with poorer cognitive performance, thus detrimental effects of early-life cannabis use may not translate to use in older ages. Rather, use in old ages may be associated with improved brain health, in accordance with the known neuroprotective properties of several cannabinoids. Yet, firm conclusions cannot be drawn from the current evidence-base due to lack of research with strong methodological designs.


Assuntos
Encéfalo/efeitos dos fármacos , Canabinoides/efeitos adversos , Cannabis/efeitos adversos , Transtornos Cognitivos/induzido quimicamente , Cognição/efeitos dos fármacos , Fatores Etários , Idoso , Animais , Canabinoides/uso terapêutico , Humanos , Pessoa de Meia-Idade
20.
Adv Emerg Nurs J ; 42(1): 30-36, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32000189

RESUMO

There is an emerging subset of patients who present to the emergency department (ED) with cannabinoid hyperemesis syndrome (CHS). Cannabinoid hyperemesis syndrome is a relatively new clinical condition and despite a long documented marijuana use in humans, little is known about the pathophysiology of this emerging problem. The focus of this article is to present a patient who presented with CHS. The clinical presentation, diagnostics, and treatment for this patient will be discussed. The nurse practitioner can anticipate high utilization of patients presenting to the ED with CHS. Nurse practitioners need to provide early recognition and careful management of patients who present with this condition.


Assuntos
Canabinoides/efeitos adversos , Uso da Maconha/efeitos adversos , Vômito/induzido quimicamente , Adulto , Diagnóstico Diferencial , Serviço Hospitalar de Emergência/organização & administração , Humanos , Masculino , Vômito/diagnóstico
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