IntroductionCannabinoid hyperemesis syndrome (CHS), is characterized by recurrent episodes of severe nausea and intractable vomiting, preceded by chronic use of cannabis. A pathognomonic characteristic is compulsive bathing in hot water. The resolution of the problem occurs when cannabis use is stopped. However, patients are often reluctant to discontinue cannabis. Treatment with anti-emetic medication is ineffective. Case series suggested haloperidol as a potential treatment. Other antipsychotics as olanzapine has been used as anti-emetic treatment in chemotherapy.ObjectivesTo describe three cases of patients with CHS whom showed a successful response to olanzapine, even when, haloperidol had failed.AimsTo present an alternative treatment for CHS which can offer benefits over haloperidol.MethodsWe present three cases of patients who suffered from CHS and were admitted to emergency department. All patients were treated with olanzapine after conventional anti-hemetic treatment failure. One patient was also unsuccessfully treated with haloperidol.ResultsAll three patients showed a good response to olanzapine treatment. Different presentations were effective: velotab and intramuscular. Their nausea, vomits and agitation were ameliorated. They could be discharge after maintained remission of symptoms.ConclusionsOlanzapine should be considered as an adequate treatment for CHS. Its suitable receptorial profile, its availability in different routes of administration and its side effects profile could offer some benefits over haloperidol.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Background: Targeted therapy (TT) and immune-check-point inhibitors (CPi) have improved the survival of patients (pts) with advanced melanoma (mel). Real-world data of these treatments are needed to confirm the results of clinical trials.Methods: GEM1801 is a prospective observational study including 400 pts with resected stage III and advanced mel diagnosed since 2018 in Spain. Objectives were to analyze the clinical and pathological presentation, treatment choice and health outcomes. We report results of the advanced mel group (N¼357).Results: Median age was 65 years, ECOG 0-1 85.7% and AJCC 8 th Ed stage IV 90.7% (24.9% a, 14.3% b, 34.7% c and 16.9% d). BRAF, reported in 348 pts (97.5%), was BRAF V600 -mutated (Mut) in 50.4%. LDH, reported in 302 pts (84.6%), was > upper limit normal (ULN) in 32.8%. First-line (1L) was CPi in 94.9% of BRAF-wild-type (wt) and 30% of BRAF V600 -Mut. For TT, BRAF+MEK inhibitors were selected as 1L in 64.1% of BRAF V600 -Mut. Median follow up was 18.3 months (m) (95% CI 17.1-19.6). Median overall survival (OS) was (estimated) 28.1 m (95% CI 22.9-NA). With 1L CPi, 12 and 18m OS was 79.4% and 70.5% respectively for BRAF-wt group and 90.2% and 82% for BRAF V600 -Mut (median OS not reached in either group). In pts with BRAF V600 -Mut and TT, 12 and 18m OS was 62.4% and 50.9% respectively and median OS 18.5m (95% CI 13.3-28.1). OS according to ECOG, LDH and M1 stage is in the table G3-4 AEs appeared in 7.9% of pts treated with TT and 9.2% with CPi.
IntroductionClozapine (CZP) is the only antipsychotic approved for resistant schizophrenia 1. Due to its side effects, CZP is not the first therapeutic option in a psychotic episode. Its anticholinergic effects often cause constipation, however, diarrhea have also been described in literature.ObjectivesWe describe a patient with two episodes of severe diarrhea after clozapine initiation, which lead to CZP discontinuation.AimsDiscuss about the differential diagnosis of diarrhea in CZP patients and the needing of a further studies for clarify the more appropriate management in CZP induced diarrhea.MethodsWe present a case report of a 46 years man diagnosed with schizoaffective disorder who presented two episodes of severe diarrhea with fever, which forced his transfer to internal medicine and UCI after CZP initiation.ResultsAt the first episode analytical, radiological and histological findings led to Crohn's disease diagnosis, which required budesonide and mesalazine treatment. In the second episode, the digestive team concluded that the episode was due to clozapine toxicity despite the controversial findings (clostridium toxin and Crohn's compatible biopsies)ConclusionsDiarrhea caused by CZP has been controversial in the literature. However due to the severity of digestive episodes and the paucity of alternative treatments further studies for a better understanding of its physiopathology are warranted.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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