fuck_off

AQUI TA O TRABALHO COMPLETO http://www.cmaj.ca/c...maj.110837.long Spasticity is a common and disabling symp tom that remains a substantial problem for many patients with multiple sclerosis. Some patients have adverse effects from conventional antispasticity medications; for others, spasticity persists despite treatment. A report from the Institute of Medicine in the United States concluded that the active compounds of cannabis (marijuana) are potentially effective in treating neurologic conditions and “should be Tested rigorously in clinical trials.”1 There is evidence that the cannabinoid receptors CB1 and CB2 may be involved in the control of spasticity in multiple sclerosis2 and that the endogenous ligand of CB1, anandamide, is itself an effective antispasticity agent.3 CB1 receptors are primarily presynaptic; their activation inhibits calcium influx and glutamate release, and reduces neuronal excitability by activating somatic and dendritic potassium channels.4 Although many patients with multiple sclerosis endorse smoking cannabis as therapy, evidence that it relieves spasticity is largely anecdotal, as most trials focus on orally ad min istered cannabinoids. We sought to assess the safety and efficacy of smoked cannabis versus placebo in patients with multiple sclerosis who have treatmentresistant spasticity. Methods Participants We recruited participants from a regional multiple sclerosis clinic and by referral from special- ists. Our eligibility criteria were spasticity and at least moderate increase in tone (score ≥ 3 points on the modified Ashworth scale5 at the elbow, hip or knee). Participants were allowed to continue other treatments for spasticity, with the exception of benzodiazepines, if they had been taking stable doses for three months or longer. Participants could continue disease -modifying therapy (e.g., interferon β-1a, interferon β-1b, gla tiramer) if they had been on a stable regimen for at least six months. We prohibited any changes to medications that were expected to affect spasticity scores during the trial. Participants could be cannabis-naive or cannabisexposed; if the participants had been previously exposed to can nabis, we asked that they refrain from smoking cannabis for one month before screening and during the trial. We excluded patients with a history of major psychiatric disorder (other than depression) or substance abuse, substantial neurologic disease other than multiple sclerosis (e.g., epilepsy, head trauma) and severe or unstable medical illnesses, known pulmonary disorders (tuberculosis, asthma), patients who used benzodiazepines to control spasticity or high doses of narcotic medications for pain, and women who were pregnant or breastfeeding. Our study was approved by the Human Re - search Protections Program at the University of California, San Diego, the Research Advisory Panel of California, the Drug Enforcement Administration, the US Food and Drug Administration and the National Institute on Drug Abuse. Our study was monitored by an independent data safety monitoring board through the University of California Center for Medicinal Cannabis Research. Study design We used a randomized, double-blind, placebocontrolled crossover design. We evaluated participants during eight visits over a period of two weeks. Visit 1 was a screening visit during which the participants gave their informed consent. At this time, we took medical/medication histories, screened participants for substance abuse (using urine toxicology) and psychiatric disorders, and determined spasticity using the modified Ashworth scale.5 Participants with a positive toxicological screening result (e.g., presence of delta-9 tetrahydrocannabinol, amphetamines, benzodiazepines, cocaine and/or benzoylecgonine) were excluded. A second screening visit took place within seven days of the first. At this time, we completed the expanded disability status scale, determined spasticity again using the modified Ashworth scale and conducted a battery of cognitive tests to reduce practise effects. During this second visit, participants were given a “practise session” with a placebo cigarette, although they were not told that it was a placebo. Treatment began within seven days of the second screening visit, including randomization to placebo or smoked cannabis. Phase 1 was followed by an 11-day washout period, after which participants crossed over to the opposite treatment group for phase 2. We assessed each patient before and after treatment for three consecutive days during each phase. The examiner was blind to the treatment group to which each patient was assigned. We assessed patients using the modified Ashworth scale, a visual analog scale for pain, a timed walk and cognitive tests such as the Paced Auditory Serial Addition Test (PASAT). We as sessed treatment - emergent effects about 45 minutes after treat- ment. We collected urine for toxicological screening at the beginning (baseline) of each phase. We assessed participants at the same time of day to regulate food, medication and time of cannabis intake. Participants smoked either a placebo or a cannabis cigarette, using the Foltin uniform puff procedure (inhalation for 5 s, followed by a 10-s breath-hold and exhalation, with a 45-s wait between puffs),6 under supervision in a ventilated room. Participants completed an average of four puffs per cigarette. Prerolled cannabis and placebo cigarettes with identical appearances and weight (about 800 mg) were provided by the National Institute on Drug Abuse. Cannabis cigarettes contained about 4% delta-9-tetrahydrocannabinol (delta-9- THC) by weight; placebo cigarettes had the same base material but with the delta-9-THC removed. We chose to use the 4% delta-9-THC cigarette available from the National Institute on Drug Abuse because it most closely resembled the strength of cigarettes available in the community at the time of the study (typically between 5% and 6%).7 We assessed safety and adverse effects by monitoring participants’ vital signs in addition to self-report by participants.

boa pergunta msm.....acredito q seria facil diferenciar.... pq sera que usaram cannabis "fumada" e nao vap ou ingerida? nao fala tbem se o trabalho eh duplo/triplo cego EDIT- eh duplo cego

esse "impacto cognitivo" eh bom ou eh ruim? acho q depende do ponto de vista

realmente, bem emocionante.... por mais careta que uma pessoa possa ser, NAO EH POSSIVEL que continue hipócrita depois de ler entrevistas como essa da Deyse...

SOMOS 2 SONINHA!

fotos legais!!!

sempre qdo ta chegando perto das marchas aparecem essas bizarrices

Deus seja louvado