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"Gaskill, Al"
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Gastric cancer in Central America: a scoping review
Stomach cancer is the second most common cause of cancer-related death in Central Latin America and the fifth most common cancer by incident in the region. Understanding the epidemiology of stomach cancer is crucial to the appropriate planning, implementation and evaluation of comprehensive cancer control programs. The objective of this scoping review was to quantify the population-based incidence of stomach cancer in Central America from available data, identify reported risk factors, presentation and oncologic stage and explore the frequency of treatment used and survival outcomes for stomach cancer in Central America. Primary reports, cancer registries, hospital registries, endoscopy registries, case studies and case series focusing on the epidemiology of gastric cancer in Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama, along with its treatment modalities and mortality rates were included. After identifying 616 citations, 20 studies met the inclusion criteria and were selected for data extraction. 12 were from Costa Rica and 5 from Honduras, with few studies from other countries such as Belize, El Salvador and Panama. Crude rates of gastric adenocarcinoma varied widely across different studies, with rates ranging from 0.09/100,000 to 32.04/100,000 in Costa Rica between 1996 and 2015. Overall, there was a general decrease in crude rates over recent study periods. Studies in El Salvador and Panama reported lower crude rates compared to Costa Rica. Non-cardia cancers were more common than cardia cancers. Surgery was the main treatment discussed in the reviewed papers. Mortality data were limited. Our review highlights the need for reliable cancer registries in this region. Often, cancer registries provide the only opportunity for properly assessing the extent and nature of cancer burdens in developing countries. This information is crucial in creating priorities for cancer control public health programs.
Journal Article
Antiviral and Anti-inflammatory Effects of Cannabidiol in HIV/SIV Infection
Persistent reservoirs and chronic immune activation are hallmarks of HIV, despite the effectiveness of antiretroviral therapy (ART) in suppressing viral replication. Here, we use rhesus macaques and primary and induced pluripotent stem cell (iPSC)-derived human immune cells to evaluate the virologic and immunologic consequences of cannabidiol (CBD) exposure during HIV/SIV infection. We show that CBD, in the absence of ART, suppresses viral replication and establishment of the viral reservoir to levels comparable with first-line therapies during acute SIV infection of rhesus macaques. This antiviral effect of CBD extended to
HIV infection of human macrophages, T cells, and microglia. Immunologically, we observe CBD slowed CD4+ T cell decline and polarization, decreased CD14+CD16+ monocyte expansion, and reduced interferon-inducible cytokine release in rhesus macaques. We identify comparable effects on cytokine production with
CBD treatment of human macrophages, T cells, and microglia. Importantly, we find CBD inhibits cytokines only when an immune response is elicited by HIV, suggesting it is not broadly immunosuppressive. Finally, we determine CBD regulates endocannabinoid receptors, modulators, and transporters and inhibits NF-κb and STAT1 activation when mediating its antiviral and anti-inflammatory effects. These findings show beneficial effects of CBD in laboratory models of untreated HIV, thus placebo-controlled clinical trials to evaluate the safety and effectiveness of adjunctive CBD use with ART is warranted.
Journal Article