Pharmacognosy and Effects of Cannabinoids in the Vascular System

Hidradenitis Suppurativa Symptom Relief: Pain and Itch

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that may cause debilitating pain and itch. Given their physical and psychological burden, recognition and treatment of HS-associated symptoms are critical for supporting patients with HS. The complex nature of HS pain, encompassing acute and chronic timing as well as nociceptive, neuropathic, and nociplastic character, requires a tailored treatment approach. Itch in HS, although less studied, is also a prevalent and distressing symptom. The aim of this narrative review is to apply current knowledge of HS pain and pruritus to develop a practical approach for symptomatic management in the dermatology office.

The Impact of Marijuana Use on Postoperative Outcomes in Abdominal-based Free Flap Breast Reconstruction

BACKGROUND

 There is an increasing prevalence of marijuana use in the general population yet clinical studies on marijuana's effect on surgical outcomes remain limited. Marijuana's effect on wound healing, venous thromboembolism (VTE) due to endothelial inflammation, and bleeding due to inhibited platelet function have been cited based on animal models but have not been evaluated clinically in patients undergoing microsurgical reconstruction.

METHODS

 Retrospective chart review was performed on all patients who underwent abdominal-based free flap breast reconstruction in a single institute from August 2018 to December 2022. Patient self-reported marijuana use, demographics, total narcotic use during hospitalization converted to oral morphine milligram equivalent (MME), and 90-day complications were collected and compared.

RESULTS

 A total of 162 patients were included and 13 patients (8.5%) had reported marijuana use on presurgical history. Marijuana users are more likely to be younger and report concurrent nicotine smoking. Marijuana users were also at a significantly elevated risk of developing symptomatic VTE (15 vs. 1%; odds ratio (OR) 13.4 [95% confidence interval (CI) 1.71-104.2]; p = 0.01) and marijuana use remained a significant risk factor with multivariate analysis. On postoperative 90-day complications, there was no increased risk of flap loss, reoperation, postoperative transfusion, or hematoma associated with marijuana use, and no significantly increased risk for overall donor or recipient site complications. Marijuana users required significantly more narcotics for pain control during hospitalization (100 ± 77 vs. 49 ± 45 MME; p = 0.0003), although they had similar lengths of stay, achievement of mobilization on post operative day (POD)1, and maximal pain scores.

CONCLUSION

 Marijuana use increases the risks of postoperative VTE and increased postoperative narcotic requirements in patients who underwent abdominal-based free flap breast reconstruction. Future prospective cohort study is required to further understand marijuana-associated risks in microsurgical procedures.

Comparative Study of Gas and Liquid Chromatography Methods for the Determination of Underivatised Neutral and Acidic Cannabinoids and Cholesterol

The aim of our study was to develop a gas chromatographic method coupled with mass spectrometry (GC-MS) for the determination of underivatised neutral (CBDs-N) and acidic (CBDs-A) cannabinoids (CBDs) and cholesterol (Chol). Emphasis was also placed on comparing our original GC-MS method with the currently developed C18-high-performance liquid chromatography with photodiode detection (C18-HPLC-DAD). A combination of a long GC column, shallow temperature column programme, and mass-spectrometry was employed to avoid issues arising from the overlap between CBDs and Chol and background fluctuations. The pre-column procedure for CBDs and Chol in egg yolks consisted of hexane extractions, whereas the pre-column procedure for CBDs in non-animal samples involved methanol and hexane extractions. CBDs-A underwent decarboxylation to CBDs during GC-MS analyses, and pre-column extraction of the processed sample with NaOH solution allowed for CBD-A removal. No losses of CBDs-N were observed in the samples extracted with NaOH solution. GC-MS analyses of the samples before and after extraction with NaOH solution enabled the quantification of CBDs-A and CBDs-N. CBDs-A did not undergo decarboxylation to CBDs-N during C18-HPLC-DAD runs. The use of the C18-HPLC-DAD method allowed simultaneous determination of CBDs-N and CBDs-A. In comparison to the C18-HPLC-DAD method, our GC-MS technique offered improved sensitivity, precision, specificity, and satisfactory separation of underivatised CBDs and Chol from biological materials of endogenous species, especially in hemp and hen egg yolk. The scientific novelty of the present study is the application of the GC-MS method for quantifying underivatised CBDs-A, CBDs-N, and Chol in the samples of interest.

Research progress in the management of vascular disease with cannabidiol: a review

The morbidity and mortality rates associated with vascular disease (VD) have been gradually increasing. Currently, the most common treatment for VD is surgery, with the progress in drug therapy remaining slow. Cannabidiol (CBD) is a natural extract of Cannabis sativa L. with sedative, analgesic, and nonaddictive properties. CBD binds to 56 cardiovascular-related receptors and exerts extensive regulatory effects on the cardiovascular system, making it a potential pharmacological agent for the management of VD. However, most CBD studies have focused on neurological and cardiac diseases, and research on the management of VD with CBD is still rare. In this review, we summarize the currently available data on CBD in the management of VD, addressing four aspects: the major molecular targets of CBD in VD management, pharmacokinetic properties, therapeutic effects of CBD on common VDs, and side effects. The findings indicate that CBD has anti-anxiety, anti-oxidation, and anti-inflammatory properties and can inhibit abnormal proliferation and apoptosis of vascular smooth muscle and endothelial cells; these effects suggest CBD as a therapeutic agent for atherosclerosis, stress-induced hypertension, diabetes-related vasculopathy, ischemia-reperfusion injury, and vascular damage caused by smoking and alcohol abuse. This study provides a theoretical basis for further research on CBD in the management of VD.

Venous thromboembolism and cannabis consumption, outcomes among hospitalized patients in the United States: A nationwide analysis

Venous Thromboembolism (VTE) carries significant clinical implications, and with the rise in cannabis consumption, its potential influence on VTE outcomes warrants investigation. Using the National Inpatient Sample (NIS) database (2016-2019), we analyzed 2,217,184 hospitalized VTE patients. Among these, 1.8 % (38,810) reported cannabis use. We compared demographics, comorbidities, in-hospital outcomes, and quality metrics between cannabis users and non-users with VTE. Cannabis users were chiefly younger males (average age 45 in cannabis users vs. 62 in non-cannabis users) from lower-income brackets. Notably, 5.4 % discharged against medical advice. Although in-hospital mortality was initially lower for cannabis users (2.8 % vs. 5.1 %, OR 0.6, 95 % CI 0.69-0.94, p = 0.008), this difference became non-significant post-propensity-score matching (aOR 0.9, 95% CI 0.72-1.10, p = 0.3). Non-users faced higher in-hospital complications, a trend that persisted post-PSM. Among cannabis users, key mortality predictors were peripheral vascular disease, acute kidney injury, vasopressor use, cardiogenic shock, myocardial infarction, invasive ventilation, and surgical embolectomy. Cannabis users also had a shorter hospital stay (4.2 vs. 5.4 days) and slightly reduced costs ($27,472.95 vs. $31,660.75). The significantly younger age of VTE patients who use cannabis, coupled with the considerable proportion discharging against medical advice, underscores the urgency for tailored care interventions. Additional research is vital to comprehensively understand the interplay between cannabis consumption and VTE outcomes.

Cannabinoid effects in the microvasculature - CB, or not CB? That is the question! A mini-review

Cannabinoids play critical roles in human pathophysiology through the cannabinoid (CB) receptors and non-CB receptors on variety of cells, tissues, and organs. Microvasculature with the inside bloodstream containing the plasmatic and cellular components exerts multiple functions in maintaining tissue and organ physiology through microcirculation. This review focusses on the impact of cannabinoids on the microvasculature, including mechanisms mediated by both CB receptor-related pathways and CB receptor-independent pathways.