Cannabis-based medicinal products (CBMPs) for the treatment of Long COVID symptoms: current and potential applications

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection can result in a range of persistent symptoms impacting everyday functioning for a considerable proportion of patients, a condition termed Long coronavirus disease (COVID) or post COVID-19 syndrome. The severity and set of symptoms vary between patients, and include fatigue, cognitive dysfunction, sleep disturbances, palpitations, tachycardia, pain, depression, and anxiety. The high prevalence of Long COVID combined with the lack of treatment approaches has resulted in considerable unmet clinical needs. There is a growing body of evidence that cannabis-based medicinal products (CBMPs) can be used to treat symptoms including pain, anxiety, depression, fatigue, sleep, headaches, and cognitive dysfunction, which are commonly reported in Long COVID. This article provides an overview of the pathophysiology of Long COVID and discusses preliminary pre-clinical, clinical trials, and real-world evidence (RWE) for CBMPs in the context of Long COVID. This review summarises current clinical trials and studies exploring CBMPs in Long COVID. The current evidence provides a rationale to further explore CBMPs as a treatment for Long COVID symptoms. In addition to further randomised controlled trials (RCTs), the increasing availability of CBMPs globally, coupled with the continued prevalence of Long COVID in the population, also highlights the value of real-world data in the research of CBMPs in Long COVID. Critically, there is an evident need for multidisciplinary approaches of CBMPs and Long COVID in real-world clinical practice settings

The anticonvulsant actions of novel ’broad-spectrum’ Ca2+ channel blockers and low affinity, uncompetitive NMDA receptor antagonists

Epilepsy is a prominent neurological disorder. Presently available anticonvulsant drugs however fail to alleviate seizures in approximately 25% of individuals, and are often accompanied by serious side effects. More efficacious and less toxic agents are required. In this study, the effects of a range of structurally dissimilar a site ligands were examined against evoked and spontaneous epileptiform activity induced in rat hippocampal slices by perfusion with Mg2+-free medium. Extracellular recordings were made in the CA1 hippocampal region of epileptiform activity evoked by stimulation of the Schaffer collateral (SC) pathway, and of spontaneous epileptiform activity originating from the CA3 hippocampal region. Evoked and spontaneous epileptiform activity was inhibited by all compounds tested with the rank order (IC5 0 values against evoked epileptiform activity in uM): dextrorphan (2) > ifenprodil (6) > dextromethorphan (10) > l,3-di(2-tolyl)guanidine (15) > loperamide (28) > carbetapentane (38) > caramiphen (46) > opipramol (52). Ifenprodil, loperamide, caramiphen and dextrorphan were also examined for their effects on the input/output (I/O) functions along the SC pathway and on the paired pulse facilitation (PPF) ratio. An effect was observed only in the presence of caramiphen, which showed a decrease in the synaptic transmission I/O function and reduced markedly the PPF ratio. The (micromolar) concentrations required for the anticonvulsant activity of the CT ligands tested suggests that their anticonvulsant actions are not mediated by high affinity (nanomolar) binding to rj binding sites, but rather to blockade of high voltage activated Ca2 + channels and/or NMD A receptors, actions which occur at micromolar concentrations.Medicine, Faculty ofGraduat

What do emergency medicine learners want from their teachers? A multicenter focus group analysis

To the best of the authors' knowledge, there are no reports describing what learners believe are good emergency medicine (EM) teaching practices. EM faculty developers are compromised by this lack of knowledge about what EM learners appreciate in their teachers. To determine what Canadian EM learners consider to be good prerequisites and strategies for effective teaching in the emergency department (ED). Clinical clerks and residents from the Canadian College of Family Physicians, Emergency Medicine certification [CCFP(EM)] fellowship program, the Royal College of Physicians and Surgeons of Canada, Emergency Medicine certification [FRCP(EM)] fellowship program, and off-service programs from all five Ontario medical schools participated in monitored focus-group sessions. Conversations were recorded, transcribed by a third party, and coded by two independent assessors using standard grounded theory methods. The text was categorized based on the final code into basic themes and specific qualifiers, which were then sorted by frequency of mention in the focus groups. Results are presented in descriptive fashion. Twenty-eight learners participated. They identified 14 major principles for good EM teaching, and a further 30 specific qualifiers. The top five principles were: "has a positive teacher attitude," "takes time to teach," "uses teachable moments well," "tailors teaching to the learner," and "gives appropriate feedback." Agreement on classification of ideas was 86%. Learners are sensitive to the constraints of the ED teaching environment, and have consistent views about good ED teaching practices. Among 14 general principles identified, "takes time to teach," "gives feedback," "tailors teaching to the learner," "uses teachable moments," and "has a good teacher attitude" were the most commonly reported