Cannabinoid Hyperemesis Syndrome

Legalization of marijuana use will increase the number of people who will become long-term users. A prior medical record review study in Australia, in 2004, identified 19 chronic marijuana users who entered the emergency department with recurrent vomiting associated with abdominal pain. Routine treatment of the nausea and vomiting, associated with the chronic marijuana abuse, with antiemetics is ineffective in patients with cannabinoid hyperemesis syndrome. Narcotics do not relieve the abdominal pain but may cause worsening rebound pain. The best treatment of cannabinoid hyperemesis syndrome was found to be abstinence from the recreational use of marijuana. It is important for advanced practice nurses to place cannabinoid hyperemesis syndrome in their differentials of patients presenting to the emergency department with recurrent nausea, vomiting, and abdominal pain. They need to be knowledgeable about cannabinoid hyperemesis syndrome to provide the proper management of care for this specific medical condition

Nausea, Vomiting and Retching of Patients with Cervical Cancer Undergoing Chemotherapy in Bali, Indonesia

Background: Nausea, vomiting and retching (NVR) was the frequently reported and troublesome adverse effect for patients receiving chemotherapy. Purpose: This study is a part of a larger study which aims to describe the NVR symptom experience in cervical cancer patients undergoing chemotherapy in Bali, Indonesia, and examine relationships with individual's risk factors. Method: Sixty-six patients with stage II and III cervical cancer receiving Paxus (Paclitaxel)-Cisplatin at the second or the third cycle were enrolled. NVR was measured by the Index of Nausea, Vomiting and Retching (INVR) at the second day of their chemotherapy. This current study included only patients with age ranged between 32 to 65 years (M = 47.15, SD = 9.64, min-max age 35 – 65 years). Result: The result showed that the NVR score was at a moderate level. Younger subjects (age 32-50 years old) reported significantly higher NVR scores than that of older subjects (age 51-65 years old) (t = 2.76, p = .007). The subjects with higher anxiety scores reported significantly higher NVR scores than those with lower anxiety scores (t = -2.41, p = .019). Subjects who had experience in motion sickness had significantly higher NVR scores (M = 12.69, SD = 2.60) than those who did not (M = 9.23, SD = 2.86) and the difference was statistically significant (t = 4.98, p <.01). Meanwhile, no significant difference was found between subjects who reported their expectation to have nausea and those who did not (t = 0.08, p = .94). Conclusion: The findings provide valuable information regarding NVR and the individual risk factors among patients with cervical cancer undergoing chemotherapy. Nurses should assess the anxiety level and a history of motion sickness of patients planned for chemotherapy and offer preventive interventions to prevent and control NVR occurrence and its distress

Features of aura in paediatric migraine diagnosed using the ICHD 3 beta criteria

Background In children and adolescents, the prevalence rate of migraine with aura is 1.6%. Few studies concerning migraine with aura features in paediatric population have been reported. Aim The aim of our study was to investigate clinical features of aura in a retrospective cohort of children with migraine with aura. Furthermore, we studied whether the International Classification of Headache Disorder (ICHD) 3 beta version criteria could efficiently detect migraine with aura in a paediatric population. Results We included 164 patients who experienced aura associated with headache (mean age 9.922.64 years). When the ICHD-II criteria were used, a final diagnosis of migraine with typical aura was obtained in 15.3% of patients, probable migraine with typical aura in 13.4%, and typical aura with headache in 61.8%, while in in 9.5% of patients the diagnosis was undetermined. According to ICHD-3 beta, we diagnosed migraine with typical aura in 77.7% of patients, probable migraine with typical aura in 13.4%, and an undetermined diagnosis in 9.5% (less than two attacks). Conclusion Aura features did not depend on age and were similar to those of adults. However, the headache could be difficult to classify if headache duration was considered. In this view, the ICHD-3 beta offers the advantage of not considering headache features, including pain duration, for the diagnosis of migraine with typical aura, thus making this diagnosis easier in children and adolescents

Cannabinoid hyperemesis syndrome: an underreported entity causing nausea and vomiting of pregnancy

Introduction: In the western world, cannabis is the most widely used drug of abuse. Cannabinoid hyperemesis syndrome, which seems to be a rare paradoxical reaction in individuals with a particular predisposition, is characterized by cyclic severe nausea and vomiting in long-term cannabis users. While the symptoms are unresponsive to antiemetic drugs, compulsive hot baths result in a considerable symptom relief. Methods: We report the first case of cannabinoid hyperemesis syndrome in pregnancy. A 26-year-old patient was admitted to our clinic in the 10th week of gestation. Conclusion: Before undertaking time-consuming and expensive medical examinations to rule out other medical reasons for therapy-resistant hyperemesis in pregnancy, obstetricians should determine whether compulsive bathing or showering provides symptomatic relief and ask specific questions regarding possible/suspected cannabis consumptio

Management of Adult Cyclic Vomiting Syndrome, Including the Use of Opiates

This paper was presented July 1994 at the International Scientific Symposium on Cyclic Vomiting Syndrome held at St. Bartholomew's Hospital, London England. It was also published in the Journal of Pediatric Gastroenterology and Nutrition supplement on Cyclic Vomiting SyndromeCyclic Vomiting Syndrome is a functional vomiting disorder characterized by recurrent, stereotypic episodes of overwhelming nausea and vomiting lasting hours or days, separated by intervals of relative wellness lasting weeks or months. Samuel Gee first described the condition in the English language literature in 1882. He reported a series of 9 children ranging in age from 4 to 8 years. For more than a century thereafter, CVS was viewed as a pediatric disorder with the result that it was nearly unknown by physicians practicing adult medicine. The fact that CVS is prevalent in adults has been recognized only in the past few years. There are no evidence‐based guidelines for the management of CVS in children or adults and it is my hope that this essay might contribute to further thought and clinical investigation that will lead to a way out of a therapeutic wilderness

Risk factor identification and prevention of osteoporosis in the primary care setting

On one of her visits, MB Borg, a 54 year old lady, showed concern about her risk of developing osteoporosis. Lately, she had been listening to a series of radio and TV programmes on this matter where particular emphasis was put on bone density scans. She was preoccupied about being at risk for osteoporosis and wanted to know what she could do to prevent it or even treat it if she was found to suffer from osteoporosis.peer-reviewe

Cathodal Occipital tDCS is unable to modulate The Sound Induced Flash Illusion in migraine

Migraine is a highly disabling disease characterized by recurrent pain.Despite an intensive effort, mechanisms of migraine pathophysiology, still represent an unsolved issue. Evidences from both animals and humans studies suggest that migraine is characterized by hyperresponsivity or hyperexcitability of sensory cortices, especially the visual cortex. This phenomenon, in turn, may affect multisensory processing. Indeed, migraineurs present with an abnormal, reduced, perception of the Sound-induced Flash Illusion (SiFI), a crossmodal illusion that relies on optimal integration of visual and auditory stimuli by the occipital visual cortex. Decreasing visual cortical excitability with transcranial direct current stimulation (tDCS) can increase the SiFI in healthy subjects. Moving from these issues , we applied cathodal tDCS over the visual cortex of migraineurs, with and without aura, in order to decrease cortical excitability and thus physiologically restoring the perception of a reliable SiFI. Differently from our expectations tDCS was unable to reliably modulate SiFI in migraine. The chronic, relatively excessive, visual cortex hyperexcitability, , featuring the migraineur brain, may render tDCS ineffective for restoring multisensory processing in this disease

Migraine equivalents and related symptoms, psychological profile and headache features:which relationship?

BACKGROUND: Migraine equivalents are common clinical conditions in children suffering from headache. Very few studies dealt with the psychological profile of children/adolescents with migraine equivalents. Our main aim was to compare the psychological profile between migraine children with and without migraine equivalents. Moreover, as secondary aim, exclusively in children with migraine equivalents, we investigated the possible relationship between migraine attack frequency and intensity and psychological factors. METHODS: We enrolled 136 young migraineurs. They were divided in two groups (patients with and without migraine equivalents). The psychological profile was assessed by means of SAFA Anxiety and Somatization questionnaires. RESULTS: Migraine equivalents were present in 101 patients (74.3 %). Anxiety (p = 0.024) and somatization (p = 0.001) levels, but not hypochondria (p = 0.26), were higher in patients with migraine equivalents. In children with migraine equivalents, a low frequency of attacks was related to separation anxiety (p = 0.034). CONCLUSIONS: Migraine equivalents patients tend to feel more fearful and to experience more shyness. This, together with the tendency to somatization, may lead them to become vigilant in attachment relationships with their caregivers

Modifiable and fixed factors predicting quality of life in people with colorectal cancer

BACKGROUND: People with colorectal cancer have impaired quality of life (QoL). We investigated what factors were most highly associated with it. METHODS: Four hundred and ninety-six people with colorectal cancer completed questionnaires about QoL, functioning, symptoms, co-morbidity, cognitions and personal and social factors. Disease, treatment and co-morbidity data were abstracted from case notes. Multiple linear regression identified modifiable and unmodifiable factors independently predictive of global quality of life (EORTC-QLQ-C30). RESULTS: Of unmodifiable factors, female sex (P<0.001), more self-reported co-morbidities (P = 0.006) and metastases at diagnosis (P = 0.036) significantly predicted poorer QoL, but explained little of the variability in the model (R² = 0.064). Adding modifiable factors, poorer role (P<0.001) and social functioning (P = 0.003), fatigue (P = 0.001), dyspnoea (P 0.001), anorexia (P<0.001), depression (P<0.001) and worse perceived consequences (P = 0.013) improved the model fit considerably (R² = 0.574). Omitting functioning subscales resulted in recent diagnosis (P = 0.002), lower perceived personal control (P = 0.020) and travel difficulties (P<0.001) becoming significant predictors. CONCLUSION: Most factors affecting QoL are modifiable, especially symptoms (fatigue, anorexia, dyspnoea) and depression. Beliefs about illness are also important. Unmodifiable factors, including metastatic (or unstaged) disease at diagnosis, have less impact. There appears to be potential for interventions to improve QoL in patients with colorectal cancer