Background: Cannabis is the most used illicit drug worldwide. The increasing prevalence of cannabis use has raised concerns about the development of cannabis use disorder (CUD) and cannabis withdrawal syndrome (CWS). Thus far, however, no medications have been proven effective for treating these conditions. In this context, several cannabinoid (CB) preparations are being investigated as potential treatments. Aim: This systematic review aims to provide an overview of the key findings from medical CBs in the management of CUD and CWS, focusing on the efficacy of and users’ tolerability to different CB formulations. Conclusion: The findings suggest that certain CB preparations, such as nabiximols and cannabidiol, may effectively reduce cannabis use and enhance abstinence rates, providing hope for patients struggling with CUD. Conversely, CB receptor agonists such as dronabinol and nabilone show limited therapeutic potential, indicating the need for further research to identify effective treatments for cannabis dependence. Relevance for patients: These findings offer potential treatment options to help patients reduce cannabis use and improve abstinence from cannabis dependence.

Background:Cardiovascular disease (CVD) is recognized as a major cause of death worldwide. Sustained exposure to pesticides is a significant factor that can increase morbidity and mortality rates due to CVD. Aims: This study aimed to investigate the effects of pesticide exposure on CVD among adult participants in the Rafsanjan cohort study (RCS). Methods: Data were analyzed from 9,990 adult participants of RCS as a part of the Prospective Epidemiological Research Studies in IRAN. Data on personal habits, lifestyle, demographic characteristics, comorbidity history, physical activity, and pesticide exposure were collected via face-to-face questionnaires. The prevalence of ischemic heart disease (IHD) was assessed based on the medical history questionnaire of the participants. IHD was defined as a cardiac condition (either IHD or heart failure) diagnosed by a physician. Results: The mean age of participants with IHD was significantly higher than that of healthy participants (P < 0.001). Furthermore, the prevalence of IHD was higher in men compared to women (P = 0.003). In addition, the duration of pesticide exposure at home in men was significantly associated with IHD (P = 0.047). None of the other variables demonstrated a significant correlation with the prevalence of IHD. Conclusion: Pesticide exposure may increase the risk of IHD, as indicated by the results of the studied population. Implementing continuous, well-structured educational programs for individuals professionally exposed to pesticides is important. These programs should focus on personal protection and the safe use of pesticides to prevent or decrease the risk of CVDs. Relevance for patients: It is important for farmers, agricultural workers, and those living near agricultural areas to understand the risks that pesticides pose to cardiovascular health.

Objective: The objective of the study is to describe the clinical and laboratory characteristics of critically ill coronavirus disease-2019 (COVID-19) patients treated with dexamethasone in an intensive care unit (ICU) to provide a support tool for clinical decision-making. Design: A survey was conducted among hospitalized patients from November 2020 to March 2021, with data collected through patient interviews, medical records, and laboratory tests. Setting: This is a large hospital serving as a reference center for COVID-19 care in Bahia, Brazil. Patients: A convenience sample of 22 patients admitted to the COVID-19 ICU who signed informed consent to participate in the study. Methods: A cross-sectional study of patients admitted to the ICU with COVID-19. Data were analyzed using statistical methods. Results: The most common comorbidities among patients were hypertension (54%), diabetes (36%), and cardiovascular disease (27%). Among the deaths recorded, 55% of patients had hypertension, 44% had diabetes and/or required insulin therapy, 33% had a history of cardiovascular disease (including atrial fibrillation and congestive heart failure), and 22% had a history of stroke. Renal dysfunction (elevated creatinine); liver function abnormalities (increased alanine aminotransferase and aspartate aminotransferase); and elevated levels of ferritin, fibrinogen, and D-dimer were identified as potential indicators of disease progression. Among these factors, only elevated creatinine demonstrated a statistically significant association with an increased mortality risk. Conclusion: These findings provide a better understanding of the clinical course of severe acute respiratory syndrome coronavirus 2 infections and suggest that laboratory medicine is crucial in supporting clinical decision-making and advancing scientific and healthcare knowledge during the early phases of the COVID-19 pandemic. Relevance for patients: Identifying key risk factors, such as renal dysfunction, can improve early intervention and personalized treatment for critically ill COVID-19 patients.

Background and aim: Neoplasms are often clinically treated with radiation therapy, which is known for its therapeutic benefits. However, pre-surgical radiotherapy is associated with a high incidence of surgical wound healing complications, necessitating the exploration of new pharmacological approaches. This study investigates the effects of 100 mg/kg oral hesperidin on mice undergoing hemi-body irradiation with varying fractionated γ-radiation doses. Methods: Mice were exposed to 10, 20, or 40 Gy doses of fractionated γ-radiation (2 Gy/day) below the rib cage. Full-thickness excision wounds were created on their dorsum, and wound contractions were assessed periodically through video imaging. Biochemical profiles were analyzed by measuring collagen content, DNA synthesis, and nitric oxide (NO) levels in granulation tissue, as well as glutathione (GSH) levels, GSH peroxidase (GSHpx) activity, and lipid peroxidation (LPx) in the skin. Histological examinations were conducted at various post-irradiation intervals to assess skin regeneration. Results: Fractionated irradiation delayed wound contraction and prolonged mean wound healing time (MHT) in a dose-dependent manner, reducing collagen content, DNA synthesis, and NO levels in granulation tissue. In addition, irradiation decreased GSH concentrations and GSHpx activity while increasing LPx, with severity correlating to radiation dose. Fibroblast and vascular densities also declined following fractionated irradiation. In contrast, pre-treatment with hesperidin significantly enhanced wound contraction, reduced MHT, and increased collagen levels, DNA synthesis, and NO production. Furthermore, hesperidin treatment elevated GSH levels and GSHpx activity while decreasing radiation-induced LPx. In addition, hesperidin pre-treatment improved collagen deposition and fibroblast and vascular densities. Conclusion: This study demonstrates that hesperidin accelerates wound healing after fractionated radiation, suggesting hesperidin’s potential as a therapeutic paradigm in managing irradiated wounds. Relevance for patients: The use of hesperidin is expected to mitigate the complications of surgical wounds arising after radiotherapy of cancer patients in a clinical setting.

Background:Diabetes mellitus and osteoporosis coexist in the elderly population. However, there is no conclusive evidence as to whether diabetes affects the progression of osteoporosis in this population. In addition, diabetes-associated systemic complications may also contribute to an increased risk of fracture. Aim: To determine the prevalence and risk factors of osteoporosis in diabetic individuals above 50 years of age and to estimate the burden of the disease in males and females. Methods: A hospital-based cross-sectional, and observational study was conducted in the Department of General Medicine, All India Institute of Medical Sciences, Bhubaneswar (AIIMS). A total of 203 diabetic individuals above 50 years of age were recruited in the study, and their bone mineral density (BMD) was evaluated using a dual-energy X-ray absorptiometry scan. Other clinical and biochemical parameters were also assessed. A comparison was conducted among males and females and the three categories of BMD. Results: In our study setting, the overall prevalence of osteoporosis in diabetic individuals above 50 years of age was 40.89%. The prevalence was higher in females (56.5%) compared to males (26%). A higher proportion of individuals (51.6%) in the 71-80 years age group had osteoporosis. Increasing age and the duration of diabetes and menopause (in females) were the significant risk factors, along with serum creatinine and glycated hemoglobin. Conclusion: As there is a high prevalence of osteoporosis among diabetics, screening by assessing the BMD must be done in the elderly population to predict the fracture risk (FRAX score), implement appropriate preventive measures, and initiate treatment. Relevance for patients: Based on our findings, patients with diabetes mellitus are more prone to developing osteoporosis, which in turn increases their likelihood to fracture development. In order to prevent further morbidity, diabetics need special care for maintaining their health through the early detection and prevention of such events.

Background:In drug development, selecting the first-in-human dose is crucial. Similarly, in pediatric drug development, determining the first-in-pediatric dose is of paramount importance. Given that the pharmacokinetic, safety, and efficacy of a product are generally well established in adults, this information can be used to select an appropriate first-in-pediatric dose for pediatric clinical trials. Methods: Two simple methods - Salisbury Rule and allometric scaling - were evaluated for predicting the first-in-pediatric dose to initiate a clinical trial for antituberculosis medicines. To assess the predictive performance of these methods, the predicted doses were compared with the observed doses recommended by the World Health Organization (WHO) or the United States Food and Drug Administration (US FDA). Results: This study included seven antituberculosis drugs with 62 observations across different body weight groups. The predictive accuracy of both methods was excellent, with over 80% of the observations falling within a 30% prediction error. Conclusion: The predicted pediatric doses of antituberculosis drugs using the two proposed methods reconciled well with the recommended human doses from WHO or the US FDA. The methods are simple and can easily be calculated on a spreadsheet or calculator in a short amount of time. Relevance for patients: These two approaches are helpful for optimizing the selection of appropriate antituberculosis medication dosages in pediatric patients with tuberculosis, ensuring effective treatment, and minimizing potential risks.

Background:Iatrogenic type A dissections can be managed conservatively, but clear guidelines for treatment are lacking. Case presentation: This case illustrates a borderline situation that necessitated a change in treatment approach. A patient underwent endo-prosthetic treatment for an aneurysm. During the insertion of a guiding catheter through the axillary artery, the ascending aorta was dissected, with contrast injected into the vascular wall. Due to the mechanism of injury and the absence of an intra-aortic intimal tear (as evidenced by contrast stagnation in the false lumen), conservative management was initially chosen. A follow-up computed tomography (CT) scan showed complete resolution after 1 month. However, 10 days later, the patient was readmitted with acute chest pain, and a new CT scan revealed an acute dissection, with a free-moving intimal flap in the ascending aorta, requiring emergency surgery. Current guidelines recommend surgery for iatrogenic type A dissections that extend or propagate several centimeters into the ascending aorta. However, these guidelines do not account for the mechanism of injury, the localization, or the size of the intimal tear. Conclusion: In this case, the assumption of spontaneous healing with an intact intima was initially supported. However, further developments highlight the importance of clinical and radiological follow-up, regardless of the injury’s mechanism. Relevance for patients: Iatrogenic aortic dissection is a highly complex condition that requires close monitoring and, if necessary, a reassessment of the chosen treatment strategy.

Background: Meropenem, a broad-spectrum carbapenem antibiotic, is widely used to treat severe infections but has been associated with rare cases of drug-induced liver injury, including cholestasis. Recognizing and managing this potential adverse effect is essential for ensuring patient safety, particularly in the context of prolonged antibiotic use. Case presentation: We report a case of meropenem-induced cholestasis in a 57-year-old female patient with a history of recurrent urinary tract infections. The patient developed elevated liver enzymes and jaundice after the initiation of meropenem therapy. This report describes the clinical presentation, diagnostic workup, management, and outcome. The case was assessed using the updated Roussel Uclaf Causality Assessment Method scale, yielding a score of 9, indicating a “highly probable” causality. This case highlights the importance of vigilant liver function monitoring in patients receiving meropenem and other potentially hepatotoxic medications. Conclusion: As antibiotic stewardship becomes increasingly crucial in mitigating antimicrobial resistance, recognizing and understanding the potential side effects of these agents is essential for safer prescribing practices. Relevance for patients: This case highlights the importance of vigilant liver function monitoring in patients on meropenem, reinforcing early recognition, and discontinuation to enhance patient safety and support personalized antibiotic therapy.

A recent study revealed the crucial roles of host cells in reprogramming lipid droplet (LD) synthesis to resist viral infection. Understanding the molecular mechanisms of host resistance to viral infection is necessary to develop safe and effective strategies to control viral infection. This study provides a thorough examination of the interplay between the transcription factor YY1 and LD synthesis in the context of viral infection, with potential implications for both fundamental research and practical applications in the swine industry.