A private hospital is looking into operations carried out by a doctor it has stopped from practising.

People who suffer bouts of vertigo and dizziness may be suffering from a type of migraine for which treatments rarely work.

But a new, preliminary study of 18 such patients found that stimulating the vagus nerve in the neck can help relieve vertigo.

Off balance and nauseous

“Vestibular migraine can occur with or without headache. It’s an uncomfortable feeling, an abnormal sense of motion. A lot of people say that they feel like they’re spinning,” explained Dr Deena Kuruvilla, an assistant professor of neurology at Yale University.

Patients feel like they’re off balance and may be nauseous. “It’s an incredibly disabling disorder,” said Kuruvilla, who was not involved in the study.

It’s a tricky condition to diagnose, she added. “Nine times out of 10, patients get misdiagnosed,” so people are best off seeing a neurologist or a headache specialist, Kuruvilla said.

However, the new treatment might help ease the condition, the authors of the new study said.

“Noninvasive vagus nerve stimulation that’s approved for migraines and cluster headaches also relieves vertigo in patients with vestibular migraine,” said lead researcher Dr Shin Beh. He’s an assistant professor of neurology at the University of Texas Southwestern Medical Center, in Dallas.

Stimulating the vagus nerve appears to calm down centres in the brain that cause migraine and vertigo, he explained.

Less pain after treatment

Vestibular migraine is not curable, Beh said, “but this adds another possible treatment.”

The stimulation is delivered via a handheld device placed against the neck during a vestibular migraine attack. The device that delivers electrical impulses to the nerve is regularly used to treat typical migraines.

Among the study participants, 14 patients were treated during a vestibular migraine attack, and four patients were treated for persistent dizziness between attacks.

After the nerve stimulation, 13 of the 14 patients had an improvement in their vertigo. In this group, two had their vertigo disappear and five experienced a 50% reduction in symptoms, the researchers found.

In addition, the five patients whose attack had an associated headache all reported less pain after the treatment.

How long the effect of the nerve stimulation lasts isn’t known, Beh said. The study wasn’t designed to see if nerve stimulation prevents future attacks.

It’s also possible that the effect could be heightened if it’s used in combination with migraine medications, he suggested.

Prohibitive cost

Unfortunately, none of the patients treated for persistent dizziness between attacks experienced any improvement.

The only discomfort from the treatment was a mild pulling sensation of the neck muscles, the researchers noted.

The study is limited by its small size and the fact that all of the patients received the real treatment, so the results can’t be compared with people given sham treatment, Beh said.

The findings were published online in the journal Neurology.

Kuruvilla said, “I don’t think the study had enough people in it to draw such a dramatic conclusion to say that each of these vertigo attacks, these dizziness attacks, are going to be completely cured with this device.”

Another drawback is the cost of the device. “The monthly cost that the company has put on the device has made it really prohibitive for the majority of people,” she added.

According to Kuruvilla, the monthly fees can run as high as $600 (±R8 600), and the treatment isn’t covered by insurance.

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The World Health Organisation estimates that 1 in 160 children around the world has an autism spectrum disorder. Autism is a condition related to the development of the brain and is usually noticeable by the time a child is three years old. Statistics aren’t available for any African country, so researchers like me in South Africa are using international prevalence rates.

Children with this neurodevelopmental disorder may have difficulty learning language and interacting with people.

Having autism does not mean that a child’s teeth and other facial features will be different. But these children are likely to develop oral health problems for a number of reasons such as unusual oral habits, medications and poor food choices. Difficult behaviours can also contribute to oral problems. These behaviours include head banging, picking at the lips, removing their tooth buds and chewing on harmful objects like stones. These children also prefer soft foods which they tend to pouch at the back of their mouths for long periods of time.

We conducted the first study in South Africa that looks into the oral health of children with autism. We examined children attending special needs schools in KwaZulu-Natal province.

Most of the children had cavities in their permanent teeth. The percentage of children with cavities was higher than the national average. This means that there is a great burden of dental caries or tooth decay for children with autism in South Africa. The decayed teeth recorded in both the permanent and primary teeth in this study were all untreated, meaning the children’s dental needs are not being met.

What we found

In 2017, we examined children between the ages of 7 and 14. We checked them for decayed, missing and filled teeth, inflammation of the gums and the presence of plaque as well as attrition and soft tissue trauma using the World Oral Health Survey Form for Children. We also asked the children’s parents to complete a questionnaire.

We found mild swelling of the gums in 43.6% of the children; evidence of fair oral hygiene practices was observed in 42.3% and mild grinding of the teeth in 47% of the children we examined. Responses from the parent questionnaire indicated that most children prefer carbohydrates, and a combination of carbohydrates and proteins. More than half (52.9%) of the children only brushed their teeth once a day. Lip biting (56.3%) was the most prevalent soft tissue trauma observed.

We found that 85.2% of the children had cavities in their permanent teeth. This rate was higher than figures from National Oral Health surveys which indicated a caries prevalence in the general population of children of 41.7% in 2002; prevalence of 55% and 56.5% was reported in 2014 and 2015 respectively.

The decayed teeth were all untreated. Unmet dental needs in the South African context are not limited to children with disabilities. They may be as a result of factors such as financial costs of dental care and poor medical insurance coverage.

In addition, the medication consumed by children with autism can also affect their gum health. Almost 45% of children and adolescents with autism use medications whose side effects have dental implications. The side effects include dry mouth, overgrown gums, toothache, changes in salivation, prolonged bleeding and altered taste.

The medications may also cause motor disturbances that may affect efficient oral care practices. Grinding of the teeth, resulting in wearing down of the tooth structure, has also been noted often in these children.

Way forward

The need for oral hygiene programmes at special needs schools is highly recommended to increase awareness and improve oral care.

Changes to oral care practices by conducting oral health programmes to educate parents and caregivers of children with autism spectrum disorder is also necessary. A structured programme for the autism spectrum disorder population at school and community level would help.

For example, the Sparkle Brush Programme was successfully introduced in four special needs schools in KwaZulu-Natal and the Western Cape. The programme is part of a collaborative community engagement initiative between the University of KwaZulu-Natal and University of the Western Cape.

This programme had two phases. Phase 1 was a full training programme for the special needs teachers, teaching assistants and nurses. Phase 2 was the demonstration of tooth brushing, hand washing and healthy eating to the children with special needs. A monthly courtesy visit and a six monthly recall visit has been scheduled with these schools.

This programme was awarded the International Social Responsibility Award for Special Needs in Brisbane in August 2019. It was presented at the International Social Responsibility conference in Brisbane, where 33 countries participated. South Africa was awarded the best social responsibility programme for special needs.

Magandhree Naidoo, Senior Lecturer Department of Oral Hygiene, University of the Western Cape

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Magandhree Naidoo, University of the Western Cape

The new cluster of viral pneumonia cases originating in Wuhan, China, marks the third time in 20 years that a member of the large family of coronaviruses (CoVs) has jumped from animals to humans and sparked an outbreak. In a new JAMA Viewpoint essay, Anthony S. Fauci, M.D., director of the NIH’s National Institute of Allergy and Infectious Diseases (NIAID), looks back at two earlier novel CoV outbreaks that initially caused global havoc and describes steps needed to contain the current one.

We all know the Colorado River, but it’s not the most mysterious water resource in the Grand Canyon; we know it moves through at a rate of about 12,000 cubic feet per second as it travels from the Rocky Mountains to the Gulf of California. But Roaring Springs, Grand Canyon National Park’s only water source, is a bigger mystery — one NAU researcher Natalie Jones hopes to have a hand in solving.

Jones, an NAU research technician and graduate student contracted by the Grand Canyon Physical Sciences program, asked where the water in Roaring Springs comes from in research she did with School of Earth and Sustainability professor Abe Springer. It’s building on previous research for both of them. They published their findings in November in Hydrogeology Journal, with Jones as the lead author and in collaboration with researchers at the Grand Canyon National Park, Nez Perce-Clearwater National Forests and the Kentucky Geological Survey at the University of Kentucky.

So, where does the water come from? It’s complicated. But this research helps to pinpoint the region feeding the springs and, importantly, the risk of contamination in that region. It takes researchers one step closer to understanding how to protect this vital resource.

Jones and her co-authors set out to investigate how to create a better way to model karst-aquifer vulnerability in the Grand Canyon. Having a model that more accurately predicts different variables in the geology and water behavior in the park will benefit future researchers and water managers as they consider individual recharge areas and how best to protect them.

What is karst and why does it matter?

Did you know water can sometimes dissolve rock? Karst is a type of rocky feature such as a cave or sinkhole that forms in dissolvable rocks. Karst creates pathways that can carry water quickly from the land surface directly to underground aquifers. Karst landscapes cover about 16 percent of the Earth’s land surface, including most of the Colorado Plateau around Flagstaff and the Grand Canyon. It’s an important geologic feature that most of us have never heard of.

Karst aquifers, which have a pipe-like flow network of caves and conduits, directly supply up to 25 percent of the world population with water for drinking, agriculture and other needs and they are uniquely vulnerable to contamination. Two such aquifers, the Redwall and Coconino aquifers, supply water to Roaring Springs and many other Grand Canyon springs. The two aquifers are stacked on top of each other. While there are many types of vulnerability models, most ignore the complication of layered karst aquifer systems; this results in oversimplified, less accurate modeling.

“Vulnerability models identify regions of high, moderate and low vulnerability on the land surface, which directly relates to how quickly and efficiently water or contaminants would sink and enter the aquifer,” Jones said. “However, existing well-regarded vulnerability modeling methods for karst aquifers did not produce realistic results for our region.”

How does the modeling work?

Jones modified the well-known concentration-overburden-precipitation method (COP). This method is effective, the researchers say, but it oversimplifies some details, which limits the model. She presented two new models that better address the factors that help scientists predict vulnerability.

The modifications more accurately account for recharge patterns in the Grand Canyon region, which has many karst features and a deep, complex aquifer system. Jones and the research team automated a process to identify sinkholes from high-resolution topography data, converted those data into sinkhole densities, and combined those data with a map of fault locations in the region. Jones then incorporated these features into the existing model using a geographic information system to produce the final vulnerability model.

It meant significant data processing, but the result was a model that produced greater resolution of vulnerability regions and fit well with previous groundwater flow path analyses. In addition to creating a better model on which future research can build, Jones found similar patterns in vulnerability between the two karst aquifers in the Grand Canyon region, despite them being separated by more than 600 meters of impermeable rock.

Jones also learned that about a fifth of the Kaibab Plateau has high vulnerability to contamination of the Redwall-Muav aquifer, which is about 1,000 meters deep, and almost half of the plateau surface (45.6 percent) has high to very high vulnerability for the Coconino aquifer, which is much closer to the surface.

What does this mean for me?

If you’ve stopped to fill your water bottle while you’re hiking the Grand Canyon or admiring the views on the canyon rim, this matters to you. Since the Roaring Springs is the only source of water in the park, its quality has significant value. This research provides better information to water managers to protect the Grand Canyon’s water resources, including creeks on the north side, which researchers think are recharged by the Kaibab Plateau.

“These springs and streams support diverse ecosystems, and many hikers and wildlife rely on them for survival,” Jones said. “This research helps narrow down where these water sources are coming from and could help us better protect them in the future.”

Living near major roads or highways is linked to higher incidence of dementia, Parkinson’s disease, Alzheimer’s disease and multiple sclerosis (MS), suggests new research published this week in the journal Environmental Health.

Medical marijuana may not provide long-term relief of sleep issues in people battling chronic pain, a new study finds, mainly because users may develop a tolerance to the drug.

The finding is important “considering the ageing of the population, the relatively high prevalence of sleep problems in this population, along with the increasing use of medicinal cannabis,” said an Israeli team led by Sharon Sznitman, from the School of Public Health at the University of Haifa.

Various sleep issues

According to the study authors, chronic pain affects between 19% to 37% of adults in the developed world, many who have sleep problems.

Some are turning to medical marijuana for help getting good shut-eye. But how well does it work?

To find out, Sznitman’s group assessed sleep and pain in 128 patients who’d had chronic pain for at least a year. All were over age 50 and about half (66) said they used medical marijuana to help manage their sleep problems.

The type of sleep issues varied: About one in four patients said they always woke up early and weren’t able to get back to sleep; one in five said they always had difficulty falling asleep, and 27% said they woke up during the night.

Of the patients who used marijuana, average duration of use was four years, using an average of 31 grams of the drug per month. Most (69%) said they smoked marijuana, and about one in five used either cannabis oil or vapour.

A downside

The study found that pot users were less likely to wake during the night, but there were no differences between users and nonusers in the time it took them get to sleep or in the frequency of early awakening.

And there seemed to be a downside: The researchers found that more frequent marijuana use was associated with greater difficulty in falling asleep, plus more frequent awakenings during the night.

“This may signal the development of tolerance,” Sznitman’s team wrote.

But the study couldn’t prove cause-and-effect, so other factors might be at play. For example, the authors said that more frequent pot use might simply be an indicator that these people were in more pain or might be depressed/anxious. That might explain these participants’ higher propensity for sleep problems.

One US sleep medicine expert said that for some patients with chronic pain, medical marijuana can offer “some hope”.

The new study is far from conclusive as to the drug’s benefits or risks, said Dr Margarita Oks, attending physician in pulmonary, critical care and sleep medicine at Lenox Hill Hospital in New York City.

Doesn’t reduce cancer pain

“There was no mention of the exclusion of sleep-related disorders, such as obstructive sleep apnoea, that can manifest with insomnia,” she said, “and this may be a huge confounder.”

And Oks said the fact that the study was done in Israel makes a difference, too.

In Israel, “cannabis is legalised and therefore concentrations of THC [the ingredient in marijuana that produces a high] can be objectively and reproducibly measured,” she explained. “In the United States this is not yet the case.”

A second study in the same issue of the journal concluded that cannabinoids (the active chemicals in medical marijuana) do not reduce cancer-related pain. This review pooled the results of five different studies involving more than 1 400 cancer patients. It was led by Dr. Jason Boland of the University of Hull in England.

Both studies were published in the journal BMJ Supportive & Palliative Care.

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A mental health trust claims it “got away with it again” over news coverage of a woman’s death.

Six people are being tested in hospitals in Scotland and Northern Ireland after showing symptoms.