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      Marijuana: A systems-based primer of adverse effects associated with use and an overview of its therapeutic utility


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          Marijuana use is on the rise in the United States. By the end of 2019, 33 states have legalized marijuana use and marijuana byproduct use for medical purposes. However, marijuana use does not come without side effects. This manuscript reviews the increasing usage of marijuana and the different forms (natural and synthetic) that patients may use when presenting to clinicians. It also addresses the biochemical and behavioral changes observed with marijuana use, including the location and changes associated with cannabinoid receptors (abbreviated CB1 and CB2). These two topics lead into an extensive review of the side effects of marijuana use. This manuscript discusses gastrointestinal side-effects, such as Cannabinoid Hyperemesis Syndrome, pancreatitis, and hepatotoxicity. It also briefly reviews cardiovascular, neurologic, and pulmonary side effects. This article provides an overview of therapeutic effects of marijuana including the antiemetic effect, its medical utility as an appetite stimulant, and usefulness in cancer patients post-chemotherapy. A thorough social history pertaining to marijuana use is an important consideration for clinicians in patients presenting with a variety of symptoms, including those effecting the gastrointestinal, cardiovascular, pulmonary, or neurologic systems.

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          Most cited references106

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          Molecular characterization of an enzyme that degrades neuromodulatory fatty-acid amides.

          Endogenous neuromodulatory molecules are commonly coupled to specific metabolic enzymes to ensure rapid signal inactivation. Thus, acetylcholine is hydrolysed by acetylcholine esterase and tryptamine neurotransmitters like serotonin are degraded by monoamine oxidases. Previously, we reported the structure and sleep-inducing properties of cis-9-octadecenamide, a lipid isolated from the cerebrospinal fluid of sleep-deprived cats. cis-9-Octadecenamide, or oleamide, has since been shown to affect serotonergic systems and block gap-junction communication in glial cells (our unpublished results). We also identified a membrane-bound enzyme activity that hydrolyses oleamide to its inactive acid, oleic acid. We now report the mechanism-based isolation, cloning and expression of this enzyme activity, originally named oleamide hydrolase, from rat liver plasma membranes. We also show that oleamide hydrolase converts anandamide, a fatty-acid amide identified as the endogenous ligand for the cannabinoid receptor, to arachidonic acid, indicating that oleamide hydrolase may serve as the general inactivating enzyme for a growing family of bioactive signalling molecules, the fatty-acid amides. Therefore we will hereafter refer to oleamide hydrolase as fatty-acid amide hydrolase, in recognition of the plurality of fatty-acid amides that the enzyme can accept as substrates.
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            Adverse Health Effects of Marijuana Use

            New England Journal of Medicine, 370(23), 2219-2227
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              The early prediction of mortality in acute pancreatitis: a large population-based study.

              Identification of patients at risk for mortality early in the course of acute pancreatitis (AP) is an important step in improving outcome. Using Classification and Regression Tree (CART) analysis, a clinical scoring system was developed for prediction of in-hospital mortality in AP. The scoring system was derived on data collected from 17,992 cases of AP from 212 hospitals in 2000-2001. The new scoring system was validated on data collected from 18,256 AP cases from 177 hospitals in 2004-2005. The accuracy of the scoring system for prediction of mortality was measured by the area under the receiver operating characteristic curve (AUC). The performance of the new scoring system was further validated by comparing its predictive accuracy with that of Acute Physiology and Chronic Health Examination (APACHE) II. CART analysis identified five variables for prediction of in-hospital mortality. One point is assigned for the presence of each of the following during the first 24 h: blood urea nitrogen (BUN) >25 mg/dl; impaired mental status; systemic inflammatory response syndrome (SIRS); age >60 years; or the presence of a pleural effusion (BISAP). Mortality ranged from >20% in the highest risk group to <1% in the lowest risk group. In the validation cohort, the BISAP AUC was 0.82 (95% CI 0.79 to 0.84) versus APACHE II AUC of 0.83 (95% CI 0.80 to 0.85). A new mortality-based prognostic scoring system for use in AP has been derived and validated. The BISAP is a simple and accurate method for the early identification of patients at increased risk for in-hospital mortality.

                Author and article information

                SAGE Open Med
                SAGE Open Med
                SAGE Open Medicine
                SAGE Publications (Sage UK: London, England )
                9 March 2021
                : 9
                [1 ]Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
                [2 ]Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
                [3 ]Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
                [4 ]Department of Cardiology, St. Luke’s University, Bethlehem, PA, USA
                [5 ]Department of Family Medicine, Samaritan Medical Center, Watertown, NY, USA
                [6 ]Department of Nephrology, Guthrie Robert Packer Hospital, Sayre, PA, USA
                Author notes
                [*]Michael Albosta, Department of Internal Medicine, Central Michigan University College of Medicine, 1000 Houghton Avenue, Saginaw, MI 48602, USA. Email: albos1ms@ 123456cmich.edu
                © The Author(s) 2021

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                : 8 January 2021
                : 12 February 2021
                Custom metadata
                January-December 2021

                epidemiology/public health,gastroenterology/hepatology,pharmacoepidemiology/drug safety,cannabis,side effects


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