An Updated Analysis of Clinical Outcome Measures Across Patients From the UK Medical Cannabis Registry.

Introduction: There is a growing body of literature supporting the efficacy of cannabis-based medicinal products (CBMPs). Despite an increase in prescribing globally, there is a paucity of high-quality clinical data on the efficacy of CBMPs for many conditions. This study aims to detail the changes in health-related quality of life (HRQoL) and associated clinical safety in patients prescribed CBMPs for any clinical indication from the UK Medical Cannabis Registry (UKMCR). Methods: An uncontrolled prospective case series of the UKMCR was analyzed. Primary outcomes included change from baseline in patient-reported outcome measures collected across all patients (the Generalized Anxiety Disorder Scale [GAD-7], EQ-5D-5L, and Sleep Quality Scale [SQS]) at 1, 3, and 6 months. Secondary outcomes included the self-reported incidence and severity of adverse events. Statistical significance was defined as p<0.050. Results: Three hundred twelve patients were included in the final analysis, with a mean age of 44.8. The most common primary diagnoses were chronic pain of undefined etiology (n=102, 32.7%), neuropathic pain (n=43, 13.8%), and fibromyalgia (n=31, 9.9%). Before enrolment, 112 (35.9%) patients consumed cannabis daily. The median cannabidiol and (-)-trans-Δ9-tetrahydrocannabinol doses prescribed at baseline were 20.0 mg (0.0-510.0 mg) and 3.0 mg (0.0-660.0 mg), respectively. Statistically significant improvements were observed in GAD-7, EQ-5D-5L Index, EQ-5D Visual Analog Scale and SQS scores at 1, 3, and 6 months (p<0.050). There were 94 (30.1%) reported adverse events, of which nausea (n=12, 3.8%), dry mouth (n=10, 3.2%), dizziness (n=7, 2.2%), and somnolence (n=7, 2.2%) were the most common. Conclusion: This study demonstrated CBMP treatment to be associated with a relatively low incidence of severe adverse events in the medium-term. Positive changes following treatment were observed in general, as well as anxiety and sleep-specific, HRQoL outcomes. Randomized controlled trials are still awaited to assess causation; however, real-world evidence can help inform current clinical practice, future trials, and is an important component of pharmacovigilance.

Risk of Tobacco Smoking and Consumption of Energy Drinks on Obesity and Central Obesity Among Male University Students.

Background Obesity is one of the leading causes of morbidity and premature death. The prevalence of obesity and being overweight in young adulthood is increasing exponentially globally, including Palestine. Consumption of energy drinks (EDs) and tobacco smoking are highly prevalent among Palestinian young adults. Although different studies have demonstrated that the use of caffeine and tobacco products is highly prevalent among Palestinians, especially university students, the adverse effects of these products on obesity have not been thoroughly investigated. Methodology Male students from An-Najah National University in the West Bank were recruited to fill out a self-administrated questionnaire in this cross-sectional study conducted in 2021. Obesity was measured as total adiposity by calculating body mass index (BMI) and as central obesity by measuring waist circumference. To determine the association between obesity and ED consumption and tobacco smoking, we used adjusted multiple logistic regression models. Shapiro-Wilk's test was used to assess the normality of the data. Results A total of 396 students filled the questionnaire, with a response rate of 89.4%. The prevalence of obesity and central obesity was 42% and 35.75%, respectively. The prevalence of ED consumption, cigarette smoking, and waterpipe smoking was 59.6%, 39.6%, and 43.2%, respectively. ED consumers were more likely to be cigarette smokers (odds ratio (OR) = 3.827, P < 0.001), waterpipe smokers (OR = 4.578, P < 0.001), and chocolate consumers (OR = 3.524, P = 0.001). Central obesity was associated with waterpipe smoking (OR = 2.126, P = 0.044), increased age (OR = 1.367, P = 0.001), and increased BMI (OR = 1.927, P < 0.001). On the other hand, cigarette smokingincreased the risk of being underweight (OR = 6.255, P = 0.012), and ED consumption decreased the risk of being obese (OR = 0.183, P = 0.017). Conclusions Waterpipe smoking was a risk factor for increased central obesity, and ED consumption was associated with decreased; however, smoking was associated with the underweight BMI category. Given the undesirable health consequences of consuming the closely associated tobacco and EDs, stricter measures are needed to prevent access to these products.

UK Medical Cannabis Registry palliative care patients cohort: initial experience and outcomes.

INTRODUCTION: Palliative care aims to improve quality of life through optimal symptom control and pain management. Cannabis-based medicinal products (CBMPs) have a proven role in the treatment of chemotherapy-induced nausea and vomiting. However, there is a paucity of high-quality evidence with regards to the optimal therapeutic regimen, safety, and effectiveness of CBMPs in palliative care, as existing clinical trials are limited by methodological heterogeneity. The aim of this study is to summarise the outcomes of the initial subgroup of patients from the UK Medical Cannabis Registry who were prescribed CBMPs for a primary indication of palliative care, cancer pain and chemotherapy-induced nausea and vomiting, including effects on health-related quality of life and clinical safety. METHODS: A case series from the UK Medical Cannabis Registry of patients, who were receiving CBMPs for the indication of palliative care was undertaken. The primary outcome consisted of changes in patient-reported outcome measures including EQ-5D-5L, General Anxiety Disorder-7 (GAD-7), Single-Item Sleep Quality Scale (SQS), Pain Visual Analog Scale (VAS) and the Australia-Modified Karnofsky Performance Scale at 1 and 3 months compared to baseline. Secondary outcomes included the incidence and characteristics of adverse events. Statistical significance was defined by p-value< 0.050. RESULTS: Sixteen patients were included in the analysis, with a mean age of 63.25 years. Patients were predominantly prescribed CBMPs for cancer-related palliative care (n = 15, 94%). The median initial CBD and THC daily doses were 32.0 mg (Range: 20.0-384.0 mg) and 1.3 mg (Range: 1.0-16.0 mg) respectively. Improvements in patient reported health outcomes were observed according to SQS, EQ-5D-5L mobility, pain and discomfort, and anxiety and depression subdomains, EQ-5D-5L index, EQ-VAS and Pain VAS validated scales at both 1-month and 3-months, however, the changes were not statistically significant. Three adverse events (18.75%) were reported, all of which were either mild or moderate in severity. CONCLUSION: This small study provides an exploratory analysis of the role of CBMPs in palliative care in the first cohort of patients since CBMPs legalisation in the UK. CBMPs were tolerated with few adverse events, all of which were mild or moderate and resolved spontaneously. Further long-term safety and efficacy studies involving larger cohorts are needed to establish CBMPs role in palliative care, including comparisons with standard treatments.

UK Medical Cannabis Registry: an analysis of clinical outcomes of medicinal cannabis therapy for generalized anxiety disorder.

OBJECTIVES: Anxiety disorders are one of the most common reasons for seeking treatment with cannabis-based medicinal products (CBMPs). Current pharmacological treatments are variable in efficacy and the endocannabinoid system has been identified as a potential therapeutic target. This study aims to detail the changes in health-related quality-of-life (HRQoL) and clinical safety following CBMP therapy for generalized anxiety disorder. METHODS: A case series from the UK Medical Cannabis Registry was performed. Primary outcomes included changes from baseline in patient-reported outcome measures (the General Anxiety Disorder Scale (GAD-7), EQ-5D-5L (a measure of health-related quality of life), and Sleep Quality Scale (SQS)) at 1, 3 and 6 months. Statistical significance was defined as p<0.050. RESULTS: Sixty-seven patients were treated for generalized anxiety disorder. Statistically significant improvements were observed in GAD-7, EQ-5D-5L Index Value, EQ5D Visual Analog Scale, and SQS scores at 1, 3 and 6 months (p<0.050). Twenty-five (39.1%) patients reported adverse events during the follow-up period. CONCLUSION: This study suggests that CBMPs may be associated with improvements in HRQoL outcomes when used as a treatment for generalized anxiety disorder. These findings must be treated with caution considering limitations of study design; however this data may help inform future clinical studies and practice.Plain Language SummaryAnxiety disorders are the most prevalent psychiatric illness type in the United Kingdom, with 8.2 million cases reported in 2010. Generalized anxiety disorder (GAD), the most common anxiety disorder, debilitates, and so reduces the quality of life of those who suffer from the condition.The efficacy of current treatments for GAD varies greatly from person-to-person. The endocannabinoid system in the human body is currently attracting a lot of attention in the scientific community as it can be targeted by chemicals in the cannabis plant to produce therapeutic effects in order to treat GAD. There is, however, a lack of studies investigating the effects of medicinal cannabis in GAD, and so this study aims to explore the drug's effect on quality of life in patients suffering from GAD.Sixty-seven patients who attended the Sapphire Clinics for medicinal cannabis treatment for GAD were included in the study. The results from this study highlight that medicinal cannabis may improve generalized anxiety disorder, general health-related quality of life, and sleep-specific outcomes at 1, 3, and 6 months after starting treatment. There was also a low number of severe, disabling, and life-threatening adverse events experienced by patients. Although this study explores the effects of medicinal cannabis in a real clinical setting, the results were not compared to other types of treatment. Future studies with a comparator are therefore needed before concluding the true effects of medicinal cannabis in patients with GAD.

UK Medical Cannabis registry: an analysis of clinical outcomes of medicinal cannabis therapy for chronic pain conditions.

OBJECTIVES: To explore pain-specific, general health-related quality of life (HRQoL), and safety outcomes of chronic pain patients prescribed cannabis-based medicinal products (CBMPs). METHODS: A case series was performed using patients with chronic pain from the UK Medical Cannabis Registry. Primary outcomes were changes in Brief Pain Inventory short-form (BPI), Short-form McGill Pain Questionnaire-2 (SF-MPQ-2), Visual Analogue Scale-Pain (VAS), General Anxiety Disorder-7 (GAD-7), Sleep Quality Scale (SQS), and EQ-5D-5L, at 1, 3, and 6 months from baseline. Statistical significance was defined at p-value<0.050. RESULTS: 190 patients were included. Median initial Δ9-tetrahydrocannabinol and cannabidiol daily doses were 2.0mg (range:0.0-442.0mg) and 20.0mg (range:0.0-188.0mg) respectively. Significant improvements were observed within BPI, SF-MPQ-2, GAD-7, SQS, EQ-5D-5 L index, and VAS measures at all timepoints (p<0.050). Seventy-five adverse events (39.47%) were reported, of which 37 (19.47%) were rated as mild, 23 (12.11%) as moderate, and 14 (7.37%) as severe. Nausea (n=11; 5.8%) was the most frequent adverse event. CONCLUSION: An association was identified between patients with chronic pain prescribed CBMPs and improvements in pain-specific and general HRQoL outcomes. Most adverse events were mild to moderate in severity, indicating CBMPs were well tolerated. Inherent limitations of study design limit its overall applicability.

Assessment of the Relationship of Depression With Tobacco and Caffeine Use Among University Students: A Cross-Sectional Study.

Background University students are at a higher risk of using cognitive enhancers and psychoactive substances. Depression is associated with a noticeable decline in academic performance and can increase the risk of substance use. Due to sociopolitical issues, the use of cognitive enhancers and psychoactive substances among Palestinians has spread in the last decade. However, depression among tobacco and caffeine users remains underrecognized and neglected. Methodology A self-administrated questionnaire and the Beck Depression Inventory were used to assess the association of depression and the use of cognitive enhancers and psychoactive substances among university students at An-Najah National University in 2020. Results The response rate to the questionnaires was 78.8% (n = 1,051; 38.8% males, 61.2% females). The overall prevalence of depression was high (30.6% males, 34.7% females). The prevalence of cigarette smoking (39.2% males, 3.9% females), waterpipe smoking (43.1% males, 21.6% females), energy drink consumption (59.6% males, 29.7% females), coffee consumption (85.5% for each gender), tea consumption, and chocolate consumption was high, with significant differences in accordance to gender and academic fields. The multinomial logistic regression results revealed that cigarette smokers were more likely to have a higher risk of severe (odds ratio [OR] = 4.5, p = 0.001), moderate (OR = 3.27, p < 0.001), and mild depression (OR = 2.24, p = 0.002) than non-smokers. Severe depression was less prevalent among medical students than health sciences and non-medical students (OR = 0.215, p = 0.015). Moreover, males were less likely to have moderate (OR = 0.5, p = 0.012) and mild (OR = 0.48, p = 0.001) depression than females. Conclusions Overall, the results of this study revealed the high prevalence of depression and the detrimental effects of smoking on students. Moreover, the findings suggest the urgent need to address depression and risk factors among Palestinian university students by educating them about mental health, identifying high-risk students, and offering easily accessible psychological help. Further, it is crucial to broaden the focus of studies to include students from various academic fields instead of focusing on medical students.

Metabolic Syndrome Associated with Tobacco and Caffeine Products Use Among Refugee Adolescents: Risk of Dyslipidemia.

INTRODUCTION: Due to their stressful lives, Palestinian refugees are prone to use cognitive enhancers (CE) and psychostimulant substances (PS). Recognising health problems associated with CE/PS use can indicate how preventive programs should be directed towards adolescents. Unfortunately, research has not thoroughly investigated the health problems related to tobacco and caffeine products, the most socially acceptable CE/PS among Palestinian refugee adolescents. METHODOLOGY: In 2021, schoolchildren from five Palestinian refugee camps (N=271) aged 12-<16 years agreed to give blood samples and to be interviewed to address the association between metabolic syndrome (MetS) and tobacco smoking, coffee, energy drinks (ED), black tea, and chocolate consumption. MetS was diagnosed based on International Diabetic Federation Criteria. To address the association, we used binary logistic regression models adjusted to age, gender, BMI, and central obesity. RESULTS: The prevalence of MetS was [17 (6.3%)]; (7.4%) in males, (5.1%) in females. The prevalence of substance use was as follows: ED [163 (48.9%)], coffee [255 (76.6%)], black tea [295 (89.1%)], cigarette [35 (10.5%)], waterpipe [59 (17.7%)], and chocolate [309 (93.6%)], with male predominance. Cigarette smokers have increased central obesity (p-value=0.024), and decreased HDL-cholesterol (p-value=0.015) than non-smokers. Similar results were observed for waterpipe smokers besides the increased levels of triglycerides (p-value=0.01). ED consumers have increased central obesity (p-value=0.03) and fast blood sugar (p-value=0.003) than non-consumers. Chocolate consumers have decreased central obesity (p-value=0.008) and increased HDL levels (p-value=0.04) than non-consumers. ED consumers were significantly at higher risk of MetS (OR=9.97, p-value=0.019) than non-consumers and chocolate consumers were at lower risk of MetS (OR=0.14, p-value=0.046) than non-consumers. Waterpipe smokers were at a higher risk of having increased plasma triglycerides than non-consumers (OR=3.4, p-value=0.03). CONCLUSION: The high prevalence of ED consumption and waterpipe smoking in Palestinian refugee adolescents is problematic. Their use was associated with higher odds of MetS, dyslipidemia, and central obesity, which justifies greater attention.

Eating Disorders and the Use of Cognitive Enhancers and Psychostimulants Among University Students: A Cross-Sectional Study.

BACKGROUND: University students, who are at risk of eating disorders (ED), are more liable to use cognitive enhancers and psychostimulants to improve their cognitive functions and lose weight. ED in Palestinian male students is a neglected health issue. We aimed to investigate the prevalence and the association between ED and cognitive enhancers, and psychostimulants use among An-Najah National University students (ANNU). METHODS: In a cross-sectional study conducted in 2020 at ANNU, 1047 students completed anonymous surveys for cognitive enhancers practice, the Eating Attitude Test-26 (EAT-26), Sick, Control, One, Fat and FOOD (SCOFF) screening tests. RESULTS: The prevalence of ED among ANNU students was 21.2% based on EAT-26 (17.1% in males, 23.8% in females) and 31.5% based on SCOFF (24.0% in males, 36.3% in females). The binary logistic regression revealed that students at risk to have ED were water-pipe smokers (OR: 1.471, p-value 0.047), especially males, while students who were less likely to have ED were males (OR: 0.341, p-value<0.001), coffee users (OR: 0.581, p-value 0.014) and chocolate users (OR: 0.530, p-value 0.041) than nonusers. Moreover, the risk of ED increased with increasing body mass index (p-value<0.01). Clinical medical students showed the lowest prevalence (11.1%) compared to preclinical (22.5%), health sciences (23.7%), and non-medical students (20.9%) (p-value 0.059). CONCLUSION: Our findings highlight water-pipe smoking as a significant health problem in males with ED, which may require unique treatment and prevention strategies. Moreover, coffee and chocolate consumption were associated with decreased risk of ED, only among males. The gender-gap in ED prevalence was very narrow compared to international results. These results prompt the need to focus on both genders in future studies instead of females. They also suggest the urgent need to address ED among Palestinian university students by educating students about mental health, identifying high-risk students, and offering easily accessible psychological help.

The prevalence of alcohol and psychotropic drugs in fatalities of road-traffic accidents in Jordan during 2008-2014.

OBJECTIVE: Several studies confirmed alcohol and psychotropic drug consumption as important risk factors underlying fatal accidents. This paper presents updated toxicological findings in the fatalities of road traffic accidents of Amman district, in order to have an overall picture of the occurrence of these substances in these victims in Jordan. METHOD: Over a seven-year period (2008-2014), 2743, autopsies were conducted at Jordan University Hospital in which the sum of n = 311 (11.38%) were victims of road traffic accidents. Blood samples from these victims were collected. Toxicology screening for psychotropic drugs and alcohol was conducted on these samples, and the results were analyzed according to age, sex and victim's status. RESULTS: This study revealed that Alcohol and psychotropic drugs were positive in 36.5%, (n = 58) of the cases, and for alcohol alone (n = 13, 37.1%). The majority of the victims were pedestrians (n = 155, 49.8%). Additionally, 29.6% (n = 92) of the cases were of ages 19-29. Detected psychotropic drugs were benzodiazepines, barbiturates. None of the collected specimens were positive for illicit cocaine, amphetamines or cannabis. CONCLUSIONS: The results from this study proved the existence of alcohol and psychotropic drugs in the victims of road traffic accidents; Indicating an association between the uses of these substances in accident involvement. Though having some limitations, other conclusions require further data collection, cooperation with related parties in Jordan, and utilizing simple extended toxicological screens.

Prevalence of blood-borne viral infections among autopsy cases in Jordan.

Background: Morgues are high risk areas for the spread of infection from cadavers to staff during the post-mortem examination. Infection can spread from corpses to workers by airborne transmission, by direct contact, or through needle and sharp object injuries. Objective: Knowledge about the prevalence of these infections on autopsy is essential to determine the risk of transmission and to further enforce safety measures. Methods: This is a descriptive study. All autopsies performed in the Department of Forensic Medicine at Jordan University Hospital during the study period were tested for the serology of human immunodeficiency, hepatitis B and C viruses. Positive tests were confirmed by nucleic acid testing. Results: A total of 242 autopsies were tested. Age ranged from 3 days to 94 years (median 75.5 years, mean 45.3 years (21.9 ±  SD)). There were 172 (71%) males. The cause of death was considered natural in 137 (56.6%) cases, accidental in 89 (36.8%), homicide in nine (3.7%), suicide in four (1.7%), and unknown in three (1.2%) cases. Hepatitis B surface antigen was positive in five (2.1%) cases. Hepatitis C virus antibody was positive in five (2.1%) cases and the hepatitis C virus polymerase chain reaction was positive in two (0.8%) cases. HIV antibody was not detected in any of the cases. The infection status of cases was not associated with age, sex, nationality, or cause of death. Conclusion: The study findings indicated that there is a low prevalence of virus-infected autopsies in Jordan. However, the risk of transmission remains a potential threat and therefore the necessary precautions should always be taken during autopsy.

Occupational fatalities in Jordan.

OBJECTIVE: Occupational fatalities are a worldwide problem. Certain occupations pose a greater risk than others. Recent statistics on global occupational injuries and diseases that might lead to temporary or permanent disability and even worse might lead to death, are staggering. The purpose of this study was to estimate the death rates from occupational injuries in Jordan over a period of four years; to estimate occupational fatality rate that results from accidental injuries and identify the most risky concurrent occupations with the type of injuries, the age and nationality of the victims. METHOD: A total of 88 work related fatalities were admitted to three hospitals in Amman through 2008-2012 and were examined by a forensic (occupational) physician at the time. They were categorized according to, age, nationality, occupation, type of injury and were all tested for toxic substances. RESULTS: The occupation with the most fatalities was construction (44%); falling from a height was the commonest type of accident (44%) and head injuries were the leading injury type (21.6%); 9.1% of the deaths were positive for alcohol. Moreover, 22.7% of deaths were between ages of 25-29. Consequently, the mean occupational fatality rate was 2 per 100.000 workers during 2008-2012. CONCLUSION: Constructions and other types of occupations are more extensive problems than what is usually anticipated, especially when safety precautions are not effective or implemented. They may cause injuries and death, which will have a socioeconomic burden on families, society, governments and industries. Not to mention the grief that is associated with the death of a worker at his work site to all concerned parties.

Accidental genital trauma in the female children in Jordan and the role of forensic medicine.

OBJECTIVE: To evaluate the frequency and the nature of genital trauma in female children in Jordan, and to stress the role of forensics. METHODS: This is a cross-sectional study conducted between March 2008 and December 2011 in Jordan University Hospital, Amman, Jordan. Sixty-three female children were examined for genital trauma after immediate admission. The mechanism of injury was categorized and reported by the examiners as either straddle, non-straddle blunt, or penetrating. RESULTS: Straddle injury was the cause of injuries in 90.5% of patients, and contusions were the significant type of injury in 34% of patients, followed by abrasions in both labia majora and labia minora. Only one case suffered from non-intact hymen and 2 had hematuria. These 3 cases (4.7%) required surgical intervention and follow-up after 2 weeks. CONCLUSION: Straddle injuries were the main cause of genital trauma and rarely affect the hymen; however, due to the sensitivity of the subject and the severity of the traumas, forensic physicians should provide consultation and cooperate with gynecologists to exclude or confirm hymenal injuries, where empathy is necessary to mitigate tension associated with such injuries for the sake of the child and the parents as well, along with good management of the injury type.