Autism Spectrum Disorders comprise conditions that may affect cognitive development, motor skills, social interaction, communication, and behavior. This set of functional deficits often results in lack of independence for the diagnosed individuals, and severe distress for patients, families, and caregivers. There is a mounting body of evidence indicating the effectiveness of pure cannabidiol (CBD) and CBD-enriched Cannabis sativa extract (CE) for the treatment of autistic symptoms in refractory epilepsy patients. There is also increasing data support for the hypothesis that non-epileptic autism shares underlying etiological mechanisms with epilepsy. Here we report an observational study with a cohort of 18 autistic patients undergoing treatment with compassionate use of standardized CBD-enriched CE (with a CBD to THC ratio of 75/1). Among the 15 patients who adhered to the treatment (10 non-epileptic and five epileptic) only one patient showed lack of improvement in autistic symptoms. Due to adverse effects, three patients discontinued CE use before 1 month. After 6–9 months of treatment, most patients, including epileptic and non-epileptic, showed some level of improvement in more than one of the eight symptom categories evaluated: Attention Deficit/Hyperactivity Disorder; Behavioral Disorders; Motor Deficits; Autonomy Deficits; Communication and Social Interaction Deficits; Cognitive Deficits; Sleep Disorders and Seizures, with very infrequent and mild adverse effects. The strongest improvements were reported for Seizures, Attention Deficit/Hyperactivity Disorder, Sleep Disorders, and Communication and Social Interaction Deficits. This was especially true for the 10 non-epileptic patients, nine of which presented improvement equal to or above 30% in at least one of the eight categories, six presented improvement of 30% or more in at least two categories and four presented improvement equal to or above 30% in at least four symptom categories. Ten out of the 15 patients were using other medicines, and nine of these were able to keep the improvements even after reducing or withdrawing other medications. The results reported here are very promising and indicate that CBD-enriched CE may ameliorate multiple ASD symptoms even in non-epileptic patients, with substantial increase in life quality for both ASD patients and caretakers.
No Brasil, a expectativa de vida para as mulheres é de 75 anos e a população acima de 70 anos, atualmente, ultrapassa os 4,5 milhões de mulheres com previsão de crescimento para os próximos anos. Ao contrário do que se imaginava, a evolução clínica do câncer de mama parece ser semelhante em mulheres idosas quando comparadas às mais jovens. Estudos prospectivos randomizados com nível I de evidência envolvendo pacientes com mais de 70 anos portadoras de câncer de mama são escassos. O diagnóstico precoce, por meio da mamografia, proporciona tratamentos menos agressivos. Portanto, a mamografia não deve ser negligenciada em idosas. O tratamento cirúrgico é de baixa morbidade e mortalidade mesmo em idosas. Por outro lado, comorbidades, estado geral comprometido e limitada expectativa de vida são fatores que limitam o tratamento sistêmico e radioterápico nessas mulheres. Diante disso, as idosas estão mais sujeitas ao subtratamento com prejuízo para a sobrevida global e sobrevida livre de doença. Sempre que possível, a abordagem do câncer de mama nas mulheres acima de 70 de idade deve respeitar os protocolos previamente estabelecidos para as mais jovens. Comorbidades, performance status e expectativa de vida devem ser consideradas para a definição do tratamento individualizado.
Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferation of breast stroma, usually described as an incidental microscopic finding. Clinically, it can manifest as a palpable and well-circumscribed mass or, in rare cases, as a diffuse bilateral process, causing massive and rapid breast growth. The most widely accepted theory about PASH is the hormonal stimulation of breast myofibroblasts, mainly caused by progesterone. A definitive PASH diagnosis is based on typical findings, such as stromal hyperplasia and slit-like channels. The main clinical differential diagnosis is fibroadenoma or phyllodes tumor and, histologically, low-grade angiosarcoma. This work aims at evaluating the maternal and fetal prognosis of a diffuse PASH case in a pregnant woman. This is the case report of a 27-year-old woman with no comorbidities, previously diagnosed with PASH in January 2018, without clinical repercussion or treatment at the time. In 2019, in the 16th week of her second pregnancy, she noticed a rapid and significant breast growth. In the first trimester, she had a weight gain of 12 kg, and her breasts had a four-fold volume increase, preventing her from performing routine activities, such as standing and walking. Over the days, still with progressive breast tissue growth, she showed a considerable reduction in peripheral breast vascularity, intense pain, hyperemia, skin necrosis, overall worsening, and hemodynamic repercussion. Since this is a case little reported in the literature and given the clinical and hemodynamic conditions of the patient, the treatment chosen was bilateral mastectomy, performed with her consent in October 2019. In the immediate postoperative period, she progressed to fetal death and hemodynamic stabilization in the intensive care unit. After a few days of hospitalization, stable, and with good progress, she was discharged for outpatient follow-up. Anatomopathological results corroborated the PASH diagnosis made in 2018. Data on the final pregnancy outcome and the consequences for mother and fetus will be reported. Data analysis was based on a review of the patient's medical records. We concluded that each case should be assessed individually, taking into account the clinical, surgical, and obstetric aspects to determine the best workup and therapeutic approach.
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