The effects of Δ9-tetrahydrocannabinol on the dopamine system

Δ(9)-tetrahydrocannabinol (THC), the main psychoactive ingredient in cannabis, is a pressing concern to global mental health. Patterns of use are changing drastically due to legalisation, availability of synthetic analogues (‘spice’), cannavaping and aggrandizements in the purported therapeutic effects of cannabis. Many of THC’s reinforcing effects are mediated by the dopamine system. Due to complex cannabinoid-dopamine interactions there is conflicting evidence from human and animal research fields. Acute THC causes increased dopamine release and neuron activity, whilst long-term use is associated with blunting of the dopamine system. Future research must examine the long-term and developmental dopaminergic effects of the drug

Steroid-Resistant immune thrombocytopenia: Challenges and solutions

Immune Thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a platelet count of <100 × 109/L in the absence of other underlying causes of thrombocytopenia and increased risk of bleeding. Glucocorticoids are the mainstay drugs of treatment for ITP. The response rate to steroids is around 60%–70% in adults, but only 10%–15% of these patients will have a durable response. If patients do not respond to steroids by 4 weeks, they are considered to have steroid-resistant ITP. Some patients though they respond, need frequent courses of steroids to maintain a platelet count above 30 × 109/L or to avoid bleeding and are considered nonresponders to steroids. A number of potential mechanisms for this resistance to steroids have been suggested, including receptor downregulation by glucocorticoid exposure and negative inhibition by the beta-isoform of the glucocorticoid receptor. The available treatment options for these patients include various drugs including rituximab, thrombopoietin receptor agonists, fostamatinib, danazol, immunosuppressive drugs, and biological therapies including intravenous immunoglobulin, Rh immunoglobulins, and immunoadsorption. Splenectomy has been performed surgically, by radiation, or chemoembolization. Supportive treatment includes screening for osteoporosis and management, vaccination, and platelet therapy. Newer therapies such as veltuzumab, belimumab, and toralizumab which deplete B-cells have been tried. Nearly 70% of adult chronic ITP patients failing to respond to splenectomy still achieve stable remission with additional therapies

Hypercoagulability in pediatric autologous hematopoietic progenitor cell collection – Is it the time to reconsider screening? – A case report

Peripheral blood hematopoietic progenitor cell harvest by apheresis in pediatric patients, a double-edged sword, has advantages and disadvantages over conventional bone marrow transplantation. The effect of granulocyte colony-stimulating factor (G-CSF) mobilization on hemostasis in literature is very scarce. A 3-year-old female child with metastatic neuroblastoma planned for autologous transplant. Following G-CSF mobilization (75 mg; 4 days), the procedure was performed with all default parameters in Spectra Optia with an acid citrate dextrose (ACD) flow rate 1:12, assuming 3-total blood volume (TBV) to be processed with 150 ml of expected collection with target yield of 6 × 106 CD34 cells/kg. Despite normal coagulation laboratory parameters, it was abandoned for reasons such as low-flow alarms and thrombi in the kit tubings. In the subsequent procedures, the ACD to whole blood ratio was decreased to 1:16, and used bolus of heparin was followed by continuous heparin infusion throughout the procedure. Despite using heparin anticoagulation, a long thrombus was aspirated at needleless port. The procedure was completed with continuous low-flow alarms. A cumulative dose of 5.67 × 106 CD34 cells/kg was achieved over four procedures, but the cause of hypercoagulability was unknown. All the coagulation parameters were within normal limits before and after the procedure. The exact cause for hypercoagulability remains elusive. There are no studies or case reports in the pediatric population on hypercoagulability following apheresis procedure after G-CSF mobilization, but evidence is available for adults, with lack of explanation. It can also be due to low draw flow from the patient side or embolization of thrombi developed in the anticoagulant unprimed site in the kit tubings. More extensive studies are required to explain the mechanism of hypercoagulability during apheresis procedures in the pediatric population

Assessment of pain management after orthognathic surgery by the administration of montelukast: An original research

Introduction: Opioid may cause undue risk after surgical procedures like orthognathic surgeries. The present study was aimed to determine how the preoperative administration of oral montelukast affected the degree of postoperative discomfort following bimaxillary orthognathic surgery (BOS). Methodology: This study included all skeletal class III subjects scheduled for BOS. The participants were split into placebo and montelukast groups at random. Every patient received a 10-mL serving of apple juice an hour prior to the surgery; however, for the intervention group, a montelukast 10 mg pill was dissolved in the juice. The same surgical team and general anesthetic guidelines were used for all procedures. The visual analog scale (VAS) was used to calculate postoperative pain at designated intervals. The significance level for the statistical analysis was determined using the Statistical Package for the Social Sciences (SPSS) version 23. Results: The control subjects had a higher level of pain at all the intervals than the intended drug test group. Also, the control group needed more analgesics than the test group. There was one observation made that the length of the surgery had an impact on the postoperative pain. Conclusion: Preoperative montelukast medication may be useful in minimizing postoperative discomfort following bimaxillary orthognathic surgery. More research is required for greater relevance