The growing concern about cannabis use, the most commonly used illicit drug worldwide, has led to a significant increase in the number of human studies using neuroimaging techniques to determine the ...effect of cannabis on brain structure and function. We conducted a systematic review to assess the evidence of the impact of chronic cannabis use on brain structure and function in adults and adolescents.
Papers published until August 2012 were included from EMBASE, Medline, PubMed and LILACS databases following a comprehensive search strategy and pre-determined set of criteria for article selection. Only neuroimaging studies involving chronic cannabis users with a matched control group were considered.
One hundred and forty-two studies were identified, of which 43 met the established criteria. Eight studies were in adolescent population. Neuroimaging studies provide evidence of morphological brain alterations in both population groups, particularly in the medial temporal and frontal cortices, as well as the cerebellum. These effects may be related to the amount of cannabis exposure. Functional neuroimaging studies suggest different patterns of resting global and brain activity during the performance of several cognitive tasks both in adolescents and adults, which may indicate compensatory effects in response to chronic cannabis exposure.
However, the results pointed out methodological limitations of the work conducted to date and considerable heterogeneity in the findings.
Chronic cannabis use may alter brain structure and function in adult and adolescent population. Further studies should consider the use of convergent methodology, prospective large samples involving adolescent to adulthood subjects, and data-sharing initiatives.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Backgorund & Aims
Mushroom poisoning with Amanita phalloides or similar species can lead to liver failure with 10‐30% mortality rates. We aimed at defining the prognostic value of urinary amatoxin ...quantification in patients with hepatotoxic mushroom poisoning.
Methods
Data from 32 patients with hepatotoxic mushroom poisoning (Hospital Clínic Barcelona, 2002‐16) in whom urinary amatoxins were determined (ELISA) were retrospectively reviewed. Correlations between urinary amatoxin and collected baseline variables with outcomes including hepatotoxicity (ALT>1000 U/L), severe acute liver injury (ALI, prothrombin <50%), acute liver failure (ALF, ALI and encephalopathy), transplantation/death and hospital length‐of‐stay, were evaluated.
Results
12/32 patients developed increased aminotransferase activity. Among the 13/32 amatoxin negative patients, 1 developed ALI and 12/13 no hepatotoxicity. Among the 19/32 amatoxin positive patients, 8/19 (42%) developed hepatotoxicity, including 5 who progressed to severe ALI, of whom 3 developed ALF (2 deaths, 1 transplantation). Urinary amatoxin and prothrombin were independent predictors of hepatotoxicity, ALT peak values (along with age) and hospital length‐of‐stay. In positive amatoxins patients, urinary concentrations > 55 ng/ml (or a baseline prothrombin ≤ 83%), were associated to hepatotoxicity (presented by 8/9 patients with ALT>1000 U/L). Among 5 patients with urinary amatoxin ≥ 70 ng/ml, 4 developed severe ALI.
Conclusions
In patients with hepatotoxic mushroom poisoning, a negative urinary amatoxin quantification within 72h of intake ruled out the risk of hepatotoxicity in 92% of patients, whereas positive urinary amatoxins were associated with hepatotoxicity and severe ALI. Concentrations >55 ng/ml and ≥ 70 ng/ml were predictive of hepatotoxicity and severe ALI, respectively.
See Editorial on Page 1016
According to Harnet et al,1 in the United Kingdom, the Royal College of Emergency Medicine and the National Poisons Information Service have issued national guidance on the availability of antidotes ...in emergency departments.2 The guidance serves as a tool for improving timely availability of antidotes in hospitals to optimise how patients who have been poisoned are managed. ...of this study, recommendations on improving the availability of antidotes in hospitals were published, according to their level of complexity.7 In 2015, a virtual Antidote Network of hospital pharmacy departments was created to address the problem in Catalonia and to improve communication. ...it can improve the quality of care for patients who present at emergency departments for treatment of acute poisoning.
Jellyfish stings often cause immediate local skin reactions, and, less frequently, the affected individuals may develop delayed allergic reactions days or months after the sting. Here, we present 4 ...such cases. In all cases, color Doppler ultrasonography was performed at the time of diagnosis, and in 3 of the cases, clinical follow‐ups with ultrasonographic evaluations were performed. Ultrasonography initially showed dermal thickening with decreased echogenicity that progressively normalized during follow‐up. Ultrasonography was useful in quantifying inflammation by measuring the thickness of the dermis and was more precise than standard clinical follow‐up of cutaneous lesions in these cases.
Heavy cannabis use is associated with reduced motivation. The basal ganglia, central in the motivation system, have the brain's highest cannabinoid receptor density. The frontal lobe is functionally ...coupled to the basal ganglia via segregated frontal–subcortical circuits conveying information from internal, self‐generated activity. The basal ganglia, however, receive additional influence from the sensory system to further modulate purposeful behaviors according to the context. We postulated that cannabis use would impact functional connectivity between the basal ganglia and both internal (frontal cortex) and external (sensory cortices) sources of influence. Resting‐state functional connectivity was measured in 28 chronic cannabis users and 29 controls. Selected behavioral tests included reaction time, verbal fluency and exposition to affective pictures. Assessments were repeated after one month of abstinence. Cannabis exposure was associated with (1) attenuation of the positive correlation between the striatum and areas pertaining to the ‘limbic’ frontal–basal ganglia circuit, and (2) attenuation of the negative correlation between the striatum and the fusiform gyrus, which is critical in recognizing significant visual features. Connectivity alterations were associated with lower arousal in response to affective pictures. Functional connectivity changes had a tendency to normalize after abstinence. The results overall indicate that frontal and sensory inputs to the basal ganglia are attenuated after chronic exposure to cannabis. This effect is consistent with the common behavioral consequences of chronic cannabis use concerning diminished responsiveness to both internal and external motivation signals. Such an impairment of the fine‐tuning in the motivation system notably reverts after abstinence.
The basal ganglia are central in the motivation system. Using resting‐state fMRI, we examined basal ganglia functional connectivity in 28 chronic cannabis users without comorbid psychiatric disorders and 29 controls. Compared with controls, cannabis users showed abnormal (attenuated) functional coupling of the striatum with converging frontal and sensory cortical areas. Connectivity alterations were associated with lower arousal in response to affective pictures. Our findings suggest that functional changes associated with active cannabis use have a tendency to recover with abstinence.
Although beaches can be hazardous environments, few studies have identified injuries in broad coastal areas. We performed a retrospective descriptive study of injuries and other services provided by ...lifeguards during 2012 along the Spanish Mediterranean beaches. The trend in jellyfish stings was also examined for the period 2008–2012 using a standardised Sting Index.
Obtaining data relied on voluntary cooperation of local authorities, resulting in data provided from 183 cities out of 234 present in the study area and 760 beach lifeguard stations (LGS) out of about 1200. Lifeguard stations provided an average of 89 days of service per year, from late June to the beginning of September. A total of 176,021 injuries were reported, of which jellyfish stings were the main need for assistance with 59.7% (n = 116,887) of the injuries and 257.0/LGS, followed by wounds (14.4%, 50.9/LGS), and sunburn (3.3%, 15.8/LGS). Apart from attending injuries, beach lifeguard services provided 21,174 other services such as help to disabled people (57.9/LGS), blood pressure measurements (12.7/LGS), rescues at sea (6.5/LGS), lost children (5.7/LGS), and transfers to the hospital (4.6/LGS). Official reported fatalities for all the beaches in 2012 were 24.
We proposed a Sting Index (SI) to allow comparisons of the incidence of stings between years and/or localities by standardising jellyfish stings by the total of all injuries. Historical data were consistent enough to calculate SI between 2010 and 2012 and showed an oscillating pattern without a clear trend (2008: 2.4, 2009: 1.3, 2010: 2.4, 2011: 2.0, 2012: 2.6). Estimation of total number of jellyfish stings for all the beaches present in the area would reach 184,558 for 2012.
There were very few fatalities in comparison with other coastal regions, probably due to the combination of a calm sea, a low number of high dangerous situations, and a high percentage of lifeguarded beaches during the bathing season. Nevertheless, although Spanish Mediterranean beaches could be described as low risk, we propose measures to facilitate a precautionary management to prevent injuries based on a real-time beach assistance database of injuries to identify high-incidence assistance categories.
Multiple chemical sensitivity (MCS) is characterized by a loss of tolerance to a variety of environmental chemicals. Multiple chemical sensitivity is frequently triggered by exposure to chemical ...agents, especially insecticides. The aim of the study was to measure the sense of smell and quality of life in patients with MCS compared to the control group. We studied the sense of smell, both sensitive and sensorial characteristics, in female patients with MCS (
n
= 58, mean 50.5 ± 8.5 years) and healthy female volunteers without rhinosinusal pathologies (
n
= 60, mean age 46 ± 10.2 years). Olfactometry (Barcelona Smell Test 24/BAST-24), sinonasal symptoms (visual analogue scale/VAS 0–100 mm), and quality of life (Quick Environmental Exposure and Sensitivity Inventory/QEESI) were assessed. Multiple chemical sensitivity patients showed a significant impairment in smell identification (19 ± 12 %;
p
> 0.05) and forced choice (62 ± 18 %;
p
> 0.05), but not in smell detection (96 ± 4 %) compared to the control group. Multiple chemical sensitivity patients reported more odours as being intense and irritating and less fresh and pleasant when compared with the control group. Patients scored a high level (40–100) on QEESI questionnaire (symptom severity, chemical intolerances, other intolerances, life impact). In MCS patients, total symptom intensity (VAS/0–700 mm) score was 202 ± 135, while disease severity score was 80 ± 23. The most frequent symptoms were itching and posterior rhinorrhea. Multiple chemical sensitivity patients have an impairment in smell cognitive abilities (odour identification and forced choice, but not for detection) with increased smell hypersensitivity and poor quality of life.
We have read with great interest the article by Lionte et al., “Association of multiple glycemic parameters at hospital admission with mortality and short-term outcomes in acutely poisoned patients”, ...recently published in your journal ...
A woman stung by the box jellyfish Carybdea marsupialis (Cnidaria, Cubozoa) at a Spanish Mediterranean beach showed systemic manifestations over several months pain far from the inoculation point, ...arthralgia, paresthesia, hyperesthesia, increase in eosinophils and immunoglobulin E (IgE) in addition to the skin condition.
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