Cannabis and Cannabinoids in Multiple Sclerosis: From Experimental Models to Clinical Practice-A Review

BACKGROUND

As far as 80% of people diagnosed with multiple sclerosis (MS) experience disabling symptoms in the course of the disease, such as spasticity and neuropathic pain. As first-line symptomatic therapy is associated with important adverse reactions, cannabinoids have become increasingly popular among patients with MS. This review intends to provide an overview of the evidence of the role of cannabinoids in treating symptoms related to MS and to encourage further research on this matter.

AREAS OF UNCERTAINTY

To date, the evidence supporting the role of cannabis and its derivatives in alleviating the MS-related symptoms comes only from studies on experimental models of demyelination. To the best of our knowledge, relatively few clinical trials inquired about the therapeutic effects of cannabinoids on patients with MS, with variable results.

DATA SOURCES

We conducted a literature search through PubMed and Google Scholar from the beginning until 2022. We included articles in English describing the latest findings regarding the endocannabinoid system, the pharmacology of cannabinoids, and their therapeutic purpose in MS.

RESULTS

Evidence from preclinical studies showed that cannabinoids can limit the demyelination process, promote remyelination, and have anti-inflammatory properties by reducing immune cell infiltration of the central nervous system in mice with experimental autoimmune encephalomyelitis. Moreover, it has been established that experimental autoimmune encephalomyelitis mice treated with cannabinoids experienced a significant reduction of symptoms and slowing of the disease progression. Given the complexity of human immune and nervous systems, cannabinoids did not have the anticipated effects on human subjects. However, data obtained from clinical trials showed some beneficial results of cannabinoids as a single or as add-on therapy in reducing the spasticity and pain related to MS.

CONCLUSION

Considering their various mechanisms of action and good tolerability, cannabinoids remain an interesting therapy for spasticity and chronic pain related to MS.

Ecotoxicological Risk Assessment of Actellic 50 EC Insecticide on Non-Target Organisms in Parallel with the Application of Standardized Tests

This paper contributes to the ecotoxicological risk assessment of the Actellic 50 EC insecticide (with 50% pirimiphos-methyl as the active substance) tested on non-target organisms. The insecticide concentrations tested were the same for all organisms (0.1, 0.01, and 0.001 mg L^-1 of Actellic 50 EC), with an exposure of 3-5-21 days for plants and 4-5-14 days for animals. The non-target organisms tested were both plants (wheat and two ferns) and animals (the Prussian carp and marsh frog tadpoles). The tested insecticide significantly inhibited the growth of roots in wheat, a result that was also confirmed by a microbiotest application (62% root growth inhibition in sorghum and 100% germination inhibition in white mustard and garden cress). In ferns, even for the lowest concentration, the percentage of germinated spores was inhibited by 40% for Asplenium scolopendrium. The recorded toxicological effects of Actellic 50 EC upon the Prussian carp included a decrease in the respiratory rate and oxygen consumption, an increase in the number of erythrocytes and leukocytes, and an increase in blood glucose levels. The highest concentration (0.1 mg L^-1 of Actellic 50 EC) caused a 50% decrease in the survival rate of marsh frog tadpoles after 5 days of exposure, negatively affecting body volume and length. Given the high degree of toxicity of the insecticide Actellic 50 EC, we recommend continuing investigations on non-target species, including both plants and animals, as the sub-chronic effects are quite little known in the scientific literature.

The application of essential oils as a next-generation of pesticides: recent developments and future perspectives

The overuse of synthetic pesticide, a consequence of the rush to increase crop production, led to tremendous adverse effects, as they constitute a major pollutant for both soils and water, with a high toxicity towards humans and animals and, at the same time, led to development of pest resistance. In the last period, the researches were directed towards finding new solutions with a lower toxicity, less damaging behaviour towards the environment, and a better specificity of action. In this context, the use of essential oils, a complex and unique mixture of compounds, can be considered for the next-generation pesticides. This review aims to present the main applications of the essential oils as insecticides, herbicides, acaricides, and nematicides, as they emerged from the scientific literature published in the last 5 years (2015 to present). From the identified articles within the time period, only those dealing with essential oils obtained by the authors (not commercially available) were selected to be inserted in the review, characterized using established analytical techniques and employed for the envisaged applications. The review is concluded with a chapter containing the main conclusions of the literature study and the future perspectives, regarding the application of essential oils as next-generation pesticides.

Plantago media L.-Explored and Potential Applications of an Underutilized Plant

The search of valuable natural compounds should be directed towards alternative vegetal resources, and to the re-discovery of underutilized plants. Belonging to the Plantaginaceae family, the hoary plantain (Plantago media L.) represents one of the lesser studied species from the Plantago genus. The literature study revealed the under-utilization of the hoary plantain, a surprising aspect, considering its widespread. If the composition of Plantago media L. is rather well established, its applications are not nearly studied as for other Plantago species. The goal of the present paper is to summarize the findings regarding the applications of P. media, and, having as starting point the applications of related species, to propose new emerging areas of research, such as the biomedical applications validation through in vivo assays, and the evaluation of its potential towards industrial applications (i.e., development of food or personal care products), pisciculture or zootechny, phytoremediation and other environmental protection applications, or in the nanotechnology area (materials phytosynthesis). The present work constitutes not only a brief presentation of this plant's present and potential applications, but also an invitation to research groups world-wide to explore the available vegetal resources.

Is the Histopathological Subtype Important for Tumor Response to Irradiation in non-metastatic Esophageal Cancers

Esophageal cancer is still a health problem in middle income countries. The up-front treatment in localized disease is crucial for a better survival. Data from literature are in favor of a better response to radiotherapy of squamous histology. We have run a retrospective study to compare the response of histological subtypes of esophageal cancer to radiotherapy according to irradiation. Of 44 cases (53.7%) of squamous cell localized esophageal carcinoma and 38 (46.3%) of adenocarcinoma, the response after radiotherapy containing multimodal neoadjuvant treatment was 29.5% (13pts) versus 39.5% (15pts) (p=0.475). No correlation was found between histology and tumor shrinkage. Survival was found similar between the two subgroups. Indeed, median relapse free survival was 11 months for both groups with 95% CI [8.86-13.13] or 95% CI [4.526-17.47], log rank 0.394 and median overall survival was 12 months, 95% CI [9.44-14.55] in squamous versus 15 months, 95% [8.30-21.69] in adenocarcinoma cases, log rank 0.195. In univariate regression, the median relapse free survival was significantly associated with irradiation dose and the concomitance of chemotherapy to radiotherapy, while in multivariate analysis only the last variable remained significant: HR 0.425, 95% CI [0.225-0.806], p=0.009. Our analysis showed a tendency to a better response in adenocarcinoma esophageal cancer after multimodal radiotherapy containing treatment.

The Acute Hemodynamic Effects of Caffeine During Different Body Positions in Normotensive Young Adults

The aim of this study was to investigate the acute cardiovascular hemodynamic effects of administration of a fixed dose of 130 mg of caffeine versus placebo in a sample of healthy young adults (N = 32, sex ratio 1/1), who were successively placed in four distinct positions (orthostatic before ingestion, orthostatic, supine and Trendelenburg vertical positions, after ingestion) on a gravitational inversion table. The experimental design was a single-center, parallel-group, double-blind, randomized, placebo-controlled clinical trial. Following the descriptive and inferential statistical processing of the data, a statistical significant pattern (p [0.05) of acute postural cardiovascular hemodynamic adaptation of the subjects was revealed, under the influence of caffeine versus placebo ingestion.

The Significance of Ventricular Interdependence in Patients with Right Ventricular Hypertrophy and Normal Left Ventricular Function

The aim of the study is to quantify ventricular interactions by comparing tissue and spectral systolic echocardiographic parameters to allow the early identification of ventricular dysfunction. Clinical, paraclinical, electrocardiographic and echocardiographic evaluations were performed. Right ventricular hypertrophy was diagnosed in the M mode subcostal echocardiographic section. RV hypertrophy was defined by a right ventricular free wall thickness of ] 5 mm in diastole. We assessed the following RV and LV tissue and spectral systolic indices: apical systolic excursion of the lateral mitral ring (MAPSE), apical systolic excursion of the lateral tricuspid ring (TAPSE), left (Svs) and right (Svd) ventricular tissue systolic velocities, and RV and LV ejection times. We calculated the following to assess systolic ventricular interdependence: MAPSE/TAPSE, the normal value of which was considered as 0.66 � 0.14, and Svs/Svd, the normal value of which was considered as 0.76 � 0.21. The study group was compared to a control group with the same clinical features but without ventricular hypertrophy. Twenty-one patients were included in the study: 13 men (62%) and eight women (38%) with a mean age of 56 � 3.8 years. We compared the values between the study group and control group, with the following results: TAPSE = 20.4 � 0.9 vs. 24.1 � 0.76 and MAPSE/TAPSE = 0.74 � 0.06 vs. 0.75 � 0.04. MAPSE was comparable between the groups. Svs was comparable between the groups (0.09 � 0.01 vs. 0.12 � 0.02), whereas Svd was different between the groups (0.11 � 0.03 vs 0.16 � 0.03). Svs/Svd was 0.81 � 0.05 in the study group and 0.75 � 0.08 in the control group. LV ejection time was comparable between the two groups (299.8 � 23.6 ms vs. 303.3 � 28 ms), whereas, RV ejection time differed between the groups (275 � 17 ms vs. 245.5 � 28.5). Changes in TAPSE and MAPSE/TAPSE, in addition to Svd and Svs/Svd, are related to right ventricular dysfunction and suggest pathological changes in the interdependence mechanism of the ventricles in patients with RV hypertrophy. In addition, RV free wall thickness was strongly correlated with ventricular interdependence parameters, with the exception of MAPSE. Assessing these parameters and proportions in clinical practice will facilitate the early detection and appropriate treatment of right ventricular dysfunction.

Transtoracical Ecocardiographic Assessment of Severe Degenerative Aortic Stenosis with Normal Ejection Fraction and Low Transvalvular Gradient

Purpose of the study: echocardiographic evaluation of the form of degenerative aortic stenosis (DAS) with preserved ejection fraction (EF) and low transvalvular gradient, in order to formulate the indication of valvular prosthesis as early as possible; retrospective observational study that includes patients admitted or sent for ambulatory evaluation by other medical services. The echocardiographic parameters used: systolic and diastolic indices, tissue and spectral, mitral and tricuspid veins, aortic orifice area, maximal aortic systolic velocity, maximal and medium aortic transvalvular gradient, myocardial mass index, volume of left atrium, left ventricular (LV) thickness. 42 patients with severe DAS and preserved EF, average age 71.7�3.85 years. Two groups were isolated: A - with increased gradient (22 patients) and B - with low gradient (20 patients). The gender distribution was comparable: women representing 33% in group A versus 30% in group B. The average age of women in both groups was higher than that of the men: in group A: 72�8 years in the case of women vs. 67�6 years in the case of men and in group B 72�3.5 years in women vs. 68�6 years in men. Apical displacement of the mitral ring: 14�2mm in lot A vs. 11�2mm in lot B. Myocardial mass index: 120 � 9g/m2 in lot A vs. 126 � 12g/m2 in lot B. Left ventricular filling ratio E/e�: 8�2 in lot A vs. 13�2 in lot B; maximum aortic systolic velocity: 4.3�0.9m/s in lot A vs. 3.1�0.8m/s in lot B; maximum gradient: 73.9�10mmHg in lot A vs. 37�12mmHg in lot B; aortic orifice area: 0.80�10.5 in lot A vs. 0.79�0.07 in lot B. Statistical analysis shows the Pearson correlation index r with the highest values of 95% at the significance threshold between the aortic orifice area and the valve opening (r=0.87), the ratio E/e� (r=-0.85) and diastolic thickness of the posterior wall of the aortic left ventricle (r = 0.78). Aortic stenosis with preserved ejection fraction and low gradient was more common in men. The filling ratio E/e� was increased (13 � 2) in group B, suggesting the increase of filling pressures of LV in patients with DAS and low transvalvular gradient. Tissue spectral systolic and longitudinal velocities were lower in group B, suggesting the onset of systolic LV dysfunction. The aortic valve opening and the E/e� ratio showed the highest correlation coefficient with the area of the aortic orifice in both groups. The myocardial mass index and the thickness of the walls of the LV cavity are similar in the two groups, suggesting that the reduction of the LV cavity through hypertrophy may not explain, at least in totality, the form of DAS with low gradient and preserved ejection fraction.

Research on New Patterns of Antimicrobial Resistant in Bacterial Pathogens Identified in Healthcare-associated Infections

Knowledge of antibiotic resistance mechanisms is absolutely necessary to successfully fight against multi-resistant bacteria, the solutions to this issue being a direct consequence of understanding the mechanisms underlying its occurrence. Considering that in Romania more than 92.3% of patients have been receiving antimicrobial prophylaxis in surgery for more than one day, and empirical therapy is very common, the increasing antibiotic resistance is an important problem. The experiments were performed at the Military Medical Research Center on the 26 multiple drug resistance (MDR) bacterial strains from health care-associated infections (HAI): Escherichia coli (3), Klebsiella spp. (4), Pseudomonas aeruginosa 10), Proteus mirabilis (1), Staphylococcus aureus (7) and Enterobacter cloacae (1). They were isolated and initially identified by the Medical Analysis Laboratory of the Dr. Al. Gafencu Emergency Military Hospital, Constanta and the Microbiology Laboratory from the Military Medical National Institute for Research and Development Cantacuzino of Bucharest. Bacterial strains were reseeded on specific culture media, and identification was based on culture, morpho-tinctorial characters and biochemical properties. Antibiotic susceptibility testing was performed by the Kirby-Bauer diffusion method, following the CLSI 2016 guidelines. The results obtained lead to the idea of reconsidering the strategy for the use of antimicrobial substances by the following actions: performing in vitro sensitivity tests, close collaboration between the clinician and microbiologist, finding additional methods for assessing the effective concentrations of the antibiotic at the level of the infections. The observed percentage of antibiotic resistance in our study was 85.72%, that being much higher than the mentioned percentage by the European Antibiotic Surveillance Report (EARS-Net) for Romania in 2013 (25-50%).

The Influence of Diabetes Mellitus on Sodium Homeostasis in Patients with Preserved Ejection Fraction Heart Failure

The objective of the study was to analyze the characteristics of the patients with preserved ejection fraction heart failure (HfpEF) who develop hyponatremia, in relationship with the diabetes mellitus (DM). The current study is an observational retrospective one, that included 36 patients(25 women, 11 men), aged 66.6� 3.1 years, hospitalized for decompensated chronic heart failure, with a left ventricular ejection fraction ]40%. 33% (n=12) of the enrolled patients had hyponatremia, which was strong associated with DM (75% vs 17%, p[0.0005). In hyponatremic patients group was no association between DM and age, gendre, smoking, artrial hypertension, dyslipidemia, ejection fraction distribution or NTproBNP. As for medication at admission, we found an association of the presence of DM with betablockers(100% vs 67%, p[0.05) and with statins( 89% vs 67%, p[0.05). In our study, DM and non-DM patients with low serum sodium values and HfpEF have quite similar clinical profile, since the differences we found do not explain the high prevalence of DM in hyponatremic patients. As a conclusion, the presence of DM itself may explain the high prevalence of DM in hyponatremic patients, but is necessary to have larger studies with more variables included to assess HFpEF patients with DM and hyponatremia.

Advantages of Negative Pressure Therapy in Local Diabetic Foot Treatment

Diabetic foot is a current public health problem and a late consequence of diabetes. Morbidity and mortality are significant, seriously affecting the patient�s quality of life. Treatment of the diabetic foot is a long-lasting, highly resource-consumption process. Using negative pressure therapy leads to shorter hospitalization periods, better functional outcomes, significantly contributes to decreasing the number of amputations and improving patient�s quality of life. 49 year-old patient is hospitalized with necrotizing at right foot and shank, neglected type II diabetes. It is performed amputation of atypical necessity, right leg, transtarsal, open stump. After successive debridements, negative pressure therapy is installed for a period of 24 days. This favors the formation of the granular bed, the remission of the infection, allowing grafting. The graft is partially integrated and plantar reconstruction is performed with sural reversal flap. The local and functional results are satisfactory, with the flap viability and the possibility of moving with support on the right leg, preventing the amputation of the shank. Negative pressure therapy has a multitude of advantages, it is preferable to conventional therapies, and it can have higher costs, but accelerates healing and improves the quality of life of the patient.

ATR-FTIR Spectral Analysis of Ferns Using as Fingerprint for Identification of Fern Species

This study used Attenuated Total Reflection Fourier Transform Infrared (ATR-FTIR) spectroscopy to provided detail information of the organic functional group of secondary metabolites, produced by ferns. The study showed ATR-FTIR spectra of nine fern species: Asplenium scolopendrium, Asplenium trichomanes, Asplenium trichomanes-ramosum, Athyrium filix-femina, Dryopteris affinis, Dryopteris filix-mas, Polypodium vulgare, Polystichum lobatum and Phegopteris connectilis. After comparison of each plant FTIR region divided in three areas: 2800-3000 cm-1 (aliphatic region), 1600-1800 cm-1 (distinct oxygenated groups) and 700-900 cm-1 (aromatic bands). ATR-FTIR Spectroscopy combined with multivariate data analysis have been applied for the discrimination of 9 fern species.

Drug Use, a Valid Indicator of Effective Implementation of Medical Protocols

The effectiveness of pharmacological therapies is supported and guaranteed by medical protocols, which are the result of long-lasting experiments and scientific research, of course adapted to the level of competence and functional capacity of the healthcare provider. Besides pharmacological effectiveness, the therapeutic regimens should be evaluated from the point of view of economic efficiency, by assessing the financial impact of drug consumption, in correlation with other indicators specific to medical management. A retrospective comparative study of drug used in a surgical section with a capacity of 25 beds, from a county hospital is described. Study objective was to identify the relationship of influence and determination between costs with drugs and other economic and financial indicators and the use of services; objectively evaluate the effectiveness of the protocols used to limit the development of antibiotic resistance, avoiding polypharmacy and improving costs related to drug use, but especially to determine the existence of deviations from these and generating causes. The implementation of medical protocols has led to a decrease in drug costs. Tracking drug use is an effective tool to increase the quality of medical services by avoiding polypharmacy, therapeutic errors and preventing the development of antibiotic resistance. All these aspects are supported by the implementation of medical protocols and, thus, drug use can be appreciated as a valid indicator of their effectiveness and efficiency.

Corelations Between the Use of Medical Substances and the Incidence Infections Produced by Clostridium Difficile Species

Antibiotherapy is the main determinant of Clostridium difficile infection due to the imbalance determined in the intestinal flora. Clostridium difficile infection can be considered a current public health problem, given the increased incidence, both as a nosocomial infection as well as at community level, by excessive, uncontrolled and unjustified use of antibiotics, high contagiousness, negative influence on health systems in the increased number of days of hospitalization and implicitly increased costs, and last but not least, the substantial deterioration of the quality of the patient�s life. The retrospective study over a 12-month period over a group of 106 patients revealed the following profile of the patient affected by Clostridium difficile infection: females, aged 66.75 � 15.66, from the urban area, hospitalized in the medical section, who had diarrhea more than 2 days after admission, but up to 28 days after this event, due to prolonged antibiotic therapy with ceftriaxone, associated with a gastric secretion inhibitor, on a background of multiple associated pathologies. It is very important for all health systems to control this phenomenon and this is only possible by applying effective measures to prevent the onset of CDI, of relapses and contamination, thus identifying the judicious use of antibiotics.

Corelations Between the Use of Medical Substances and the Incidence Infections Produced by Clostridium Difficile Species

Antibiotherapy is the main determinant of Clostridium difficile infection due to the imbalance determined in the intestinal flora. Clostridium difficile infection can be considered a current public health problem, given the increased incidence, both as a nosocomial infection as well as at community level, by excessive, uncontrolled and unjustified use of antibiotics, high contagiousness, negative influence on health systems in the increased number of days of hospitalization and implicitly increased costs, and last but not least, the substantial deterioration of the quality of the patient�s life. The retrospective study over a 12-month period over a group of 106 patients revealed the following profile of the patient affected by Clostridium difficile infection: females, aged 66.75 � 15.66, from the urban area, hospitalized in the medical section, who had diarrhea more than 2 days after admission, but up to 28 days after this event, due to prolonged antibiotic therapy with ceftriaxone, associated with a gastric secretion inhibitor, on a background of multiple associated pathologies. It is very important for all health systems to control this phenomenon and this is only possible by applying effective measures to prevent the onset of CDI, of relapses and contamination, thus identifying the judicious use of antibiotics.

The Influence of Six Pesticides on Physiological Indices of Pelophylax Ridibundus (Pallas, 1771)

The objective of the study is to screen for morphological, biochemical and histological changes induced by six widely used pesticides (Reldan 40EC, Actara 25WG, Tilt 250EC, Champion 50WG, Fusilade Forte, Dual Gold 960EC) in the amphibian species Pelophylax ridibundus (Pallas, 1771). Highly degenerative changes were observed in animals cultured at 22-24°C, compared to those cultured at 4-6°C. The hepatosomatic index increased upon exposure to almost all of the pesticides, the erythrocyte number decreased upon exposure to all pesticides except Reldan 40EC, while leucopenia was observed only for Reldan 40EC and Actara 25WG. Hyperglycemia was observed upon administration of pesticides (except Champion 50WG and Fusilade Forte, for which hypoglycemia is registered), while a decrease in cholesterol levels was induced by nearly all pesticides. Triglycerides varied only slightly. The results suggest that chronic pesticides exposure can lead to alteration of various indices, as well as to hepatic lesions in amphibians.

The Protective Role of Thiourea on Leuciscus cephalus Exposed to Sublethal Doses of Pendigan 330EC (Pendimethalin) Herbicide

The aim of the study was to investigate the protective role of thiourea on the physiological, hematological, biochemical and histopathological parameters of Leuciscus cephalus exposed to sublethal concentration of Pendigan 330 EC herbicide. The animals were divided in four experimental groups (control, animals subjected to 1 ‰ thiourea, animals subjected to 4 × 10(-4) mL/L herbicide and, respectively, animals subjected to 4 × 10(-4) mL/L herbicide and 1 ‰ thiourea). Exposure of European chub to herbicide administered in water for 2 weeks determined installation of pathological changes in the liver and gills tissues. Also, were observed a decrease in the number of white blood cells and oxygen consumption, breathing frequency, and an increase in the number of red blood cells and glycaemia values. Thiourea counteracts the toxic action, describing itself as normal liver parenchyma and normal gills in animals intoxicated with herbicide, without lesion, and a return to normal values of the studied markers.