Canabinoides como uma nova opção terapêutica nas doenças de Parkinson e de Alzheimer: uma revisão de literatura / Canabinoid as a new therapeutic option in Parkinson's and Alzheimer's diseases: a literature review

Os derivados canabinoides podem ser vistos como novos potenciais terapêuticos para o tratamento da doença de Parkinson e Alzheimer. Assim, esta revisão teve como objetivo descrever os efeitos terapêuticos e adversos do uso de canabidiol e de delta-9-tetrahidrocanabinol nas doenças de Parkinson e de Alzheimer. Para tanto, foi realizada uma busca na base de dados Medline no período entre 2007 e 2017. Os descritores utilizados foram (Tetrahydrocannabinol OR Cannabidiol) AND (Parkinson OR Alzheimer) AND (Treatment OR Therapeutics). Os resultados mostraram efeitos terapêuticos promissores do canabidiol e do delta-9-tetrahidrocanabinol nestas doenças, tais como redução de sintomas motores e cognitivos, e ação neuroprotetora. Estes resultados podem ser explicados, em parte, pelos efeitos antioxidante, antiinflamatório, antagonista de receptores CB1, ou pela ativação de receptores PPAR-gama produzido por estas substâncias. Além disso, poucos efeitos adversos foram descritos, como boca seca e sonolência. Nesse contexto, estes resultados evidenciam a necessidade de novas pesquisas a respeito dos efeitos terapêuticos e adversos de canabinoides com maiores doses e períodos de exposição, para quem sabe, em um futuro próximo, ser possível olhar estas substâncias como uma opção terapêutica mais eficaz e segura para estes pacientes.

Cannabinoid derivatives can be viewed as a novel therapeutic potentials for the treatment of Parkinson's and Alzheimer's disease. Thus, this review aimed to describe the therapeutic and adverse effects of the use of cannabidiol and delta-9-tetrahydrocannabinol in Parkinson's and Alzheimer's disease. A search of the Medline database was carried out between 2007 and 2017. The descriptors used were (Tetrahydrocannabinol OR Cannabidiol) AND (Parkinson OR Alzheimer) AND (Treatment OR Therapy). The results showed promising therapeutic effects of cannabidiol and delta-9-tetrahydrocannabinol in Parkinson and Alzheimer's diseases, such as the reduction of motor and cognitive symptoms and neuroprotective action. These results may be explained, in part, by the anti-inflammatory and antioxidant effects, by CB1 receptor antagonism, or by the activation of PPAR-gamma receptors, produced by these substances. In addition, few adverse effects have been reported, such as dry mouth and drowsiness. In this context, these results highlight the need for further research on the therapeutic and adverse effects of cannabinoids with higher doses and periods of exposure, for whom, in the near future, it is possible to view these substances as a more effective and safe therapeutic option for these patients.

Estudio Transversal: Consumo de Sustancias Psicotrópicas en Pacientes que Acuden al Servicio de Psicología del Centro de Salud No 1 de Azogues - Ecuador, 2017 / Cross ­ Sectional Research: Consumption of psychotropic substances in Psychology service patients´ of the Health Center No. 1 of Azogues, 2017

INTRODUCCIÓN: El consumo de sustancias psicotrópicas de manera continua actúan sobre el sistema nervioso central, estimulando o deprimiéndolo. Los objetivos del estudio fueron determinar la prevalencia del consumo de sustancias psicotrópicas en pacientes que acuden al servicio de Psicología, establecer cuáles son los psicotrópicos que se consumen, su frecuencia, su asociación con edad y sexo e identificar riesgo. MÉTODOS: Se trata de un estudio transversal, con un universo de 1182 pacientes, obtenidos del registro diario automatizado de consultas y atenciones médicas ambulatorias del Ministerio de Salud Pública, que midió la prevalencia del consumo de psicotrópicos en el área de Psicología del centro de salud No 1 de Azogues ­ Ecuador, durante el año 2017. Se utilizó la clasificación internacional de enfermedades 10 para los respectivos diagnósticos y se tabuló en los programas estadísticos SPSS versión 22 y EPIDAT 3.1. RESULTADOS: El 52.2 % eran hombres, la media de edad fue de 26 años. Se estableció una prevalencia de 9 % para el consumo de sustancias psicotrópicas. Los psicotrópicos más consumidos fueron: alcohol (3.6 %), cannabinoides (2.9 %) y múltiples drogas (1.8 %), teniendo más frecuencia de consumo, el sexo masculino (15.4 % frente a 1.9 % del femenino) y en el grupo etario de 10 - 19 años con un 13.9 %, seguido de los de 20 ­ 29 años con 11.1%. El uso nocivo tuvo una prevalencia de 57.55 %, la dependencia 34.9 % y la abstinencia un 7.55 %. CONCLUSIONES: Existe asociación estadística entre el consumo y las variables sexo y edad (ambas P: 0.000). El sexo masculino y ser adolescente/joven (10 ­ 29 años) constituyen factores de riesgo para el consumo de sustancias psicotrópicas (RP 7.9; LC: 4.2 ­ 14.6 y RP 2.5; LC: 1.6 ­ 3.7 respectivamente).

BACKGROUND: The consumption of psychotropic substances acts continuously on the central nervous system, stimulating or depressing it. The aim of the study they should determine the prevalence of use of psychotropic substances in patients who attended the psychology service, establish which psychotropic drugs are consumed, their frequency, their association with age and sex, and identify the risk. METHODS:It is a cross-sectional study, with a universe of 1182 patients, obtained of the automated daily record of outpatient consultations and medical attentions of the Ministry of Public Health, which measured the prevalence of psychotropic use in the area of Psychology of the health center Nº 1 of Azogues - Ecuador, during the year 2017. It was used the international classification of diseases 10 for the respective diagnoses and it was tabulated in the statistical programs SPSS version 22 and EPIDAT 3.1. RESULTS: The 52.2 % were men, the average age was 26 years. A prevalence of 9 % was established for the consumption of psychotropic substances. The psychotropics most consumed were: alcohol (3.6 %), cannabinoids (2.9 %) and multiple drugs (1.8 %), having more frequency of consumption, the male sex (15.4 % versus 1.9 % of the female) and in the age group of 10 -19 years with 13.9 %, followed by those aged 20 - 29 with 11.1 %. Harmful use had a prevalence of 57.55 %, dependence 34.9 % and abstinence a 7.55 %. CONCLUSIONS: There was a statistical association between consumption and sex and age variables (both P: < 0.001). Male and adolescent / young (10 - 29 years) are risk factors for the consumption of psychotropic substances (RP 7.9, LC: 4.2 - 14.6 and RP 2.5; LC: 1.6 - 3.7 respectively).

¿Tienen algún rol los cannabinoides en el control del glaucoma? / Do cannabinoids play a role in the control of glaucoma?

INTRODUCCIÓN: El uso de cannabinoides en diversas condiciones clínicas es hoy un tema de debate. Se ha planteado su uso para el control del glaucoma. Sin embargo, existe controversia sobre su real efectividad y seguridad. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cinco revisiones sistemáticas que en conjunto incluyen 3 estudios primarios, todos correspondientes a ensayos aleatorizados. Concluimos que, si bien los cannabinoides podrían disminuir la presión intraocular, lo hacen de forma transitoria y se asocian a efectos adversos frecuentes.

INTRODUCTION: The use of cannabinoids in diverse clinical conditions is today a subject of debate. Its use has been proposed for the control of glaucoma. However, there is controversy about its real effectiveness and safety. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified five systematic reviews including three studies overall, all of them randomized controlled trials. We concluded that although cannabinoids could decrease intraocular pressure, the effect would be transient and associated with frequent adverse effects.

Cannabis en el tratamiento del dolor crónico no oncológico / Cannabis treatment of chronic non-cancer pain

Cannabis or marijuana is a herbaceous species of the family cannabaceae related to pain since ancient times. Cannabis sativa, scientific name, is used from the pre-Christian era in the area of health and interest for its pharmacological properties, reproducing its effects and to understand its mechanism of action. It has been studied for many decades, going through periods of extensive and widespread use gobally with little evidence, until its prohibition in many countries because it is considered a drug. Currently is appearing a growing interest for its usage, with many publications in the scientific field for its management of pain, spasticity, epilepsy, nausea in cancer and many other effects.With this article, which is focused on Cannabis,its management of chronic pain, the explanation of its possible mechanisms of action following the discovery of the endocannabinoid receptors canabionides and, with intracellular modulatory action, its therapeutic role and the evidence we have for indications as a drug, in relation to the expected effect and safety, some questions are going to be developed in order to provide an objective view that means a contribution to the future discussions on this topic of growing interest...

Tratamiento farmacológico de dolor neuropático de tipo central en pacientes con esclerosis múltiple / Systematic review of the literature: pharmacologic therapy in central neuropathic pain for multiple sclerosis patients

Conclusiones: La disminución significativa del dolor neuropático de tipo central en pacientes que padecen esclerosis múltiple se presentó con la molécula dronabinol, los efectos secundarios fueron leves, siendo los más comunes: vértigo, somnolencia, boca seca y alteraciones en el equilibrio. La evidencia de los estudios de tratamiento de dolor neuropático en esclerosis múltiple con cannabinoides no son conclusivos y es necesario realizar ensayos clínicos con la molécula de dronabinol vs otras farmacoterapias y placebo para así proveer mayor información de la dosis terapéutica eficaz y segura para el tratamiento. Se requieren de más estudios clínicos basados en la evidencia respecto al tratamiento del dolor neuropático de tipo central en esclerosis múltiple dado que es una patología cada día de mayor incidencia poblacional y es necesario realizar estudios donde se presenten resultados específicos que comparen y muestren los medicamentos con mayor efectividad y menos efectos secundarios que eviten el abandono del tratamiento por parte de los pacientes y que garanticen una mejor calidad de vida.

Conclusions: The significant reduction of neuropathic pain in patients with central type with multiple sclerosis presented with dronabinol the molecule, the side effects were mild, the most common: dizziness, drowsiness, dry mouth and changes in the balance. Evidence from studies of the treatment of neuropathic pain in multiple sclerosis cannabinoids are not conclusive and need to conduct clinical trials with the molecule of dronabinol and other drug vs. placebo in order to provide more information on the safe and effective therapeutic dose for treatment. Further studies are needed evidence-based clinical trials regarding the treatment of central neuropathic pain such as multiple sclerosis is a disease every day with the highest incidence and population studies are needed where specific results are presented comparing drugs and show greater effectiveness and fewer side effects that prevent the abandonment of treatment by patients and ensure a better quality of life.