Current state of cannabis use, policies, and research across sixteen countries: cross-country comparisons and international perspectives

Abstract Introduction Varying public views on cannabis use across countries may explain the variation in the prevalence of use, policies, and research in individual countries, and global regulation of cannabis. This paper aims to describe the current state of cannabis use, policies, and research across sixteen countries. Methods PubMed and Google Scholar were searched for studies published from 2010 to 2020. Searches were conducted using the relevant country of interest as a search term (e.g., "Iran"), as well as relevant predefined keywords such as "cannabis," "marijuana," "hashish," "bhang "dual diagnosis," "use," "addiction," "prevalence," "co-morbidity," "substance use disorder," "legalization" or "policy" (in English and non-English languages). These keywords were used in multiple combinations to create the search string for studies' titles and abstracts. Official websites of respective governments and international organizations were also searched in English and non-English languages (using countries national languages) to identify the current state of cannabis use, policies, and research in each of those countries. Results The main findings were inconsistent and heterogeneous reporting of cannabis use, variation in policies (e.g., legalization), and variation in intervention strategies across the countries reviewed. European countries dominate the cannabis research output indexed on PubMed, in contrast to Asian countries (Thailand, Malaysia, India, Iran, and Nepal). Conclusions Although global cannabis regulation is ongoing, the existing heterogeneities across countries in terms of policies and epidemiology can increase the burden of cannabis use disorders disproportionately and unpredictably. There is an urgent need to develop global strategies to address these cross-country barriers to improve early detection, prevention, and interventions for cannabis use and related disorders.

Primary liposarcoma of the orbit.

Liposarcoma is the most common sarcoma in adults, but is an extremely rare tumor of the orbit. We report 4 cases of primary orbital liposarcoma treated at our center. All cases had tumor localized to the orbit and underwent exenteration followed by radiotherapy in one patient. None of the patients had a recurrence until a follow-up of 1-5 years (mean: 4 years).

Anatomical and functional graft survival, 10 years after epikeratoplasty in keratoconus.

Purpose: To report outcomes of epikeratoplasty in keratoconus (KC), utilizing manually-prepared plano donor lenticules in terms of flattening of the cone, reduction in astigmatism and improvement in the visual acuity. Materials and Methods: Patients with KC, having visual acuity <20/200, astigmatism >12 diopters (D) but without corneal opacity underwent epikeratoplasty, using manually prepared plano donor lenticules from fresh or M.K preserved corneas, between 1990 - 2000 and followed for 10 years, were included in this report. Visual acuity slit-lamp-biomicroscopy, keratometry, and refraction were performed at 8 weeks, 12 weeks, and 6 months for all 59 patients. The same were carried out at 1 year, 5 years, and 10 years depending upon the availability of the patient for that period. Results: Of the 59 patients, only 26 were available for follow-up after 10 years. At 3 months, 1 year and 5 years, best corrected visual acuity of (BCVA) ≥20/60 were achieved in 84.7%, 84.4% and 80.3% of eyes, respectively. BCVA was 73% at 10-year follow- up, which was due to the presence of posterior subcapsular cataract (PSC). The average keratometric astigmatism and average flattening in diopters stabilized at the end of 3 months, which remained constant at 1, 5, and 10-year follow-up. The average diopter of myopia was stabilized by 1 year, which was almost same at 10 year. Graft was clear in all but 1 eye at 10 year follow-up. Conclusion: Epikeratoplasty is a useful technique for keratoconic eyes without apical scarring who fail or unable to use contact lenses.

A sphenoid sinus mucocele simulating as retro bulbar optic neuritis.

A 25-year-old male presented with complaints of sudden diminution of vision with pain on eye movement in the left eye which was diagnosed clinically as retro bulbar optic neuritis. However, magnetic resonance imaging (MRI) showed lesion consistent with sphenoid sinus mucocele. Early surgical removal of mucocele led to complete recovery of vision, contrast and visual field. A high index of suspicion is necessary for intracranial lesions in all cases of retro bulbar neuritis, especially those with atypical symptoms.

Ahmed glaucoma valve in post-penetrating-keratoplasty glaucoma: A critically evaluated prospective clinical study.

Aim: The aim was to evaluate the outcome of Ahmed glaucoma valve (AGV) in post-penetrating-keratoplasty glaucoma (PKPG). Materials and Methods: In this prospective study, 20 eyes of 20 adult patients with post-PKPG with intraocular pressure (IOP) >21 mmHg, on two or more antiglaucoma medications, underwent AG (model FP7) implantation and were followed up for a minimum of 6 months. Absolute success was defined as 5 <IOP <21 mmHg and qualified success as 5 <IOP <21 mmHg with medications or minor procedures. Results: The mean IOP decreased from 42.95 ± 10.24 to 17.69 ± 3.64 mmHg (P <0.001) and the use of medications dropped from 2.92 to 0.39 (P <0.001) after AGV implantation. The absolute success was achieved in 11 eyes and qualified success in 9. There was no significant change in best corrected visual acuity, graft clarity, or graft thickness. Six device-related complications occurred after AGV implantations which were successfully managed with medical or minor surgical therapy. Conclusions: Postkeratoplasty refractory glaucoma managed by AGV implantation revealed a satisfactory outcome up to 6 months of follow-up.

Residual triamcinolone acetonide at macular hole after vitreous surgery.

Post traumatic macular holes have shown successful anatomic outcomes with vitrectomy with internal limiting membrane (ILM) peeling and gas injection. Intraocular use of triamcinolone acetonide (TA) crystals is gaining popularity in patients for visualization of the vitreous cortex, posterior vitreous detachment induction and ILM peeling during macular hole surgery. However, the possibility of residual steroid crystals clogging the hole at the conclusion of surgery exists. In our case, residual TA was observed biomicroscopically in the fovea on the seventh day after surgery, Optical Coherence Tomography (OCT) image of the eye showed a hyper reflective mass corresponding to the TA. However, a repeat OCT carried out four weeks after surgery showed recovery of the foveal morphologic features to an almost normal depression, with closure of the hole. Residual TA crystals in the macular hole post vitreous surgery may not interfere with ultimate macular hole closure or visual improvement.

Does device-based testing save time during automatic implantable cardioverter-defibrillator implantation?

BACKGROUND: Defibrillation testing can be done either via an external cardiac defibrillator or directly via the implanted defibrillator during implantation (device-based testing). The advantage of one testing methodology over the other has not been adequately studied. METHODS AND RESULTS: Seventy-four patients (72% men) were randomized into two groups depending on the defibrillation testing methodology used--external cardiac defibrillation and device-based testing groups. R-wave, pacing threshold, pacing impedance, defibrillation threshold, defibrillation pathway impedance and total procedure time were not significantly different between the two groups. CONCLUSIONS: Device-based testing did not significantly reduce the procedure time. Lead and defibrillation parameters were similar in both the groups; lead repositioning and replacement were required in three patients in the external cardiac defibrillation group.

Radiofrequency ablation of incessant orthodromic tachycardia in a young child with a univentricular heart.

The incidence of supraventricular tachycardia is high in infants and children with congenital heart disease. We report a case of incessant orthodromic tachycardia in a child with a univentricular heart, which was successfully treated with radiofrequency ablation.

Radiofrequency ablation of incessant atrial tachycardia in an infant.

Ectopic automatic atrial tachycardia, an uncommon type of supraventricular tachycardia in children and adults, has been reported to be resistant to medical therapy unlike reentrant supraventricular tachycardia. We report a case of incessant atrial tachycardia in an infant, which was successfully treated with radiofrequency catheter ablation.

Catheter ablation of atrial tachycardia using a real-time position management mapping system.

Catheter ablation for atrial tachycardia is limited by its low success rate and prolonged procedure time because of difficulties in mapping the site of the tachycardia. A new three-dimensional mapping system, the Cardiac Pathways mapping system, using an ultrasound transducer, has recently become available. We report a case of focal atrial tachycardia ablation with this system.

Successful retrieval of transradially delivered unexpanded coronary stent from the left main coronary artery.

Stent dislodgment during percutaneous coronary intervention is a rare complication. We report a case of successful retrieval of a dislodged stent from the left main coronary artery. It was retrieved via the transradial route using a 6 F coronary guiding catheter supported by an inflated percutaneous transluminal coronary angioplasty balloon distal to the stent.

Direct coronary stenting through the radial approach in an anomalous coronary artery.

An anomalous origin of the coronary artery is an infrequent finding on coronary angiogram. Percutaneous coronary intervention may sometimes be difficult in such situations. We report two cases of anomalous coronary arteries in whom direct stenting was done via the radial approach.

Effect of weight loss on QT dispersion in obesity.

BACKGROUND: Sudden cardiac death in patients on a liquid protein diet has been suggested to be related to repolarization abnormalities. Although increased QT dispersion is also associated with sudden cardiac death, it has not been examined in the setting of weight loss using liquid protein diet. METHODS AND RESULTS: Sixty-three patients (mean age 42 years, 18 men) with a mean initial weight of 116 kg were randomly chosen from patients who had completed 26 weeks of liquid protein diet therapy. QT, corrected QT interval, QT dispersion and corrected QT dispersion were measured blindly along with serum albumin and electrolytes at the beginning and end of 26 weeks of liquid protein diet therapy. In 57 patients (89.5%) (group 1), QT dispersion shortened after weight loss while it was prolonged in 6 patients (10.5%) (group 2). The mean weight loss (group 1: 115+/-21 to 91+/-16 kg; group 2: 122+/-21 to 98+/-13 kg), and serum albumin and electrolyte levels before weight loss were the same in both groups. The decrease in QT dispersion in group 1 was due to increase in the minimum QT interval (350+/-22 v. 375+/-21 mis, p<0.01) after weight loss. However, the QT dispersion increase in group 2 was due to prolongation of the maximum QT interval (402+/-27 v. 441+/-19 ms, p<0.05) after weight loss. This suggests that shortening of the minimum QT interval causes the increased QT dispersion in obesity. Half the patients in group 2 showed a drop in the serum albumin level and 2 patients had an abnormally high phosphorous level at the end of the treatment. CONCLUSIONS: QT dispersion shortens in most patients (89.5%) using liquid protein diet for weight loss. However, increase of QT dispersion is seen in 10.5% of patients. The cause of increased QT dispersion in obesity (before weight loss) differs from that in patients after weight-loss using liquid protein diet. QT dispersion changes observed in this study may explain the risk of sudden cardiac death in these patients.