Tuesday, February 19, 2019

Commercial CBD: Buyer beware!

Lead Pesticides Mold and Half the CBD ... otherwise.... it sounds great! JR

I-Team Tests CBD Products, 

But Finds Results Alarming

 That report revealed that two of the brands of oils tested had samples rejected by the lab because they do not meet California standards for quality control.
The brand Lazarus Naturals was flagged by Evio Labs because it’s sample contained dangerous amounts of lead according to FDA standards.
“It had four times the amount of lead than is approved. If a child gets their hands on these products, it could be life threatening,” Martinez told the I-Team.
 " Jolly Green CBD oil online and in store.
“This is 500mg,” one of the store clerks told us.
Turns out, that was not the case, according to the test results.
Martinez told NBC 4 New York: “Less than half of the samples that were tested actually had the stated amount of CBD inside the product.”
The lab test showed every sample contained less than half of the advertised amount on the packaging. The company did not respond to our requests for comment


Autism and the Cunningham Panel. Clinical value in PANS/ PANDAS?

How valuable is the Cunningham panel in PANS Pandas? 
  • Sensitivity 15 to 60%
  • Specificity 28 to 92%
  • PPV 7-40%
  • NPV 44 to 74%

Positive predictive value - The PPV of a test is a proportion that is useful to clinicians since it answers the question: ‘How likely is it that this patient has the disease given that the test result is positive?’ In this case 7-40%

Negative predictive value The NPV of a test answers the question: ‘How likely is it that this patient does not have the disease given that the test result is negative?’ In this case 44 to 74%.

To me, this data suggests that a negative test does not rule out PANS/PANDAS and a positive test is NOT diagnostic. Is the panel better than a coin flip in this clinical scenario?

As a comparison, estimates of mammography sensitivity range from 75% to 90% with specificity from 90% to 95%. The positive predictive value of mammography for breast cancer ranges from 20% in women under age 50 to 60% to 80% in women age 50-69. (https://cdn.ymaws.com/acpm.site-ym.com/resource/resmgr/policy-files/polstmt_breast.pdf)

 I am interested in learn more about how this test is used clinically. 


 2017 Nov 15;312:31-37. doi: 10.1016/j.jneuroim.2017.09.002. Epub 2017 Sep 9.

Biomarkers for diagnosis of Pediatric Acute Neuropsychiatric Syndrome (PANS) - Sensitivity and specificity of the Cunningham Panel.



Pediatric Acute Neuropsychiatric Syndrome (PANS) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are conditions marked by sudden onset of obsessive-compulsive disorder (OCD), tics, or avoidant/restrictive food intake in combination with multiple psychiatric symptoms. A diagnosis of PANS or PANDAS may be supported by the Cunningham Panel, a commercially available set of immunologic assays currently in clinical use. However, the relationship between Cunningham Panel results and patient symptoms remains unclear. This study was done to assess the diagnostic accuracy of the Cunningham Panel in patients with suspected PANS or PANDAS.


All Swedish patients who had taken the Cunningham Panel prior to June 2014 (n=154) were invited and 53 patients participated in the study. Based on comprehensive psychiatric assessment (the reference standard of diagnosis), subjects were classified as PANS, PANDAS, or neither. Prior Cunningham Panel test results were collected from patient records, and new blood samples were similarly analyzed within the scope of this study. In addition, results were compared to healthy controls (n=21) and a test-retest reliability analysis was performed.


Sensitivities of individual biomarkers in the Cunningham Panel ranged from 15 to 60%, and specificities from 28 to 92%. Positive predictive values ranged from 17 to 40%, and negative predictive values from 44 to 74%. A majority of the healthy controls had pathological Cunningham Panel results and test-retest reliability proved insufficient.


Clinical use of the Cunningham Panel in diagnosing PANS or PANDAS is not supported by this study.


Antibodies; Biomarkers; Calcium/calmodulin kinase II; Obsessive-compulsive disorder; PANDAS; PANS; Sensitivity and specificity
[Indexed for MEDLINE] 
Free full text

Wednesday, February 13, 2019

ADHD & Omegas? Where do they work in the brain?


Kurt Schulz*1, Beth Krone1, Lenard Adler2, Stephen Faraone3, Jeffrey Newcorn4
Icahn School of Medicine at Mount Sinai, 2NYU School of Medicine, 3SUNY Upstate Medical
University, 4Mount Sinai Medical Center

Background: The reluctance of patients to rely on pharmacological treatments for attention- deficit/hyperactivity disorder (ADHD) has increased interest in alternative therapies, such as omega-3 fatty acid supplementation. Meta-analyses have revealed small but significant effects of omega-3 fatty acid supplementation on symptoms of ADHD, and possibly emotional lability. These diet-derived fatty acids influence neuronal membrane fluidity and phospholipid composition, which can alter the structure and function of embedded proteins, and thereby may influence dopamine neurotransmission. However, little is known about the mechanisms by which omega-3 fatty acids exert their therapeutic effects for ADHD. This study tested changes in brain activation related to clinical improvement with omega-3 fatty acid supplementation in adults with ADHD.

Methods: Seventy-eight adults with ADHD were scanned twice with event-related functional magnetic resonance imaging while performing an emotional go/no-go task before and after 16 weeks of omega-3 fatty acid supplementation (n=23) or 8 weeks of placebo lead-in followed by 8 weeks of omega-3 fatty acid supplementation (n=27) or placebo (n=28). The current study used an enrichment design to restrict analyses to the 31 of 55 (56%) participants who did not respond to placebo during the lead-in period. Whole-brain activation for affective response inhibition was regressed on clinical response with age, sex, and baseline ADHD severity as covariates.

Results: Following placebo lead-in, 8 weeks of omega-3 supplementation (n=17) was associated with slightly greater clinical improvement than 8 weeks of placebo (n=14) (p<0 .05="" acid="" activation="" and="" associated="" b="" between="" changes="" clinical="" did="" differ="" execution="" fatty="" for="" gains="" go="" groups.="" improvement="" in="" inhibition="" no-go="" not="" omega-3="" on="" response="" supplementation="" task-related="" task="" the="" two="" was="" with="">pre-supplementary motor area (pre-SMA) and premotor cortex and reductions in caudate nucleus and precuneus activation compared to placebo (p<0 .001="" b="" kappa="50" voxels="">

Conclusions: These results provide preliminary evidence that inhibitory mechanisms in caudate nucleus and frontally-based visuomotor integration and motor programming processes contribute to the therapeutic actions of omega-3 supplementation in adults with ADHD. These changes in brain activation suggest that clinical improvement for omega-3 supplementation may involve dopaminergic and non-dopaminergic effects.