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Cannabis-based medicine among batch of new drugs approved for use in Scotland

A cannabis-based medicine can now be prescribed to sufferers of a rare genetic condition which causes seizures as part of a raft of drugs approved for use on the Scottish health service.

Epidyolex, or cannabidiol, was approved by the Scottish Medicines Consortium (SMC) on Monday for use on patients as young as two years old with seizures associated with tuberous sclerosis complex, a rare genetic condition which requires round the clock care and impacts on all aspects of life.

Consortium chairman, Mark MacGregor, said: “For people living with tuberous sclerosis complex, cannabidiol may reduce the number of seizures experienced each day, leading to marked improvements in quality of life for both patients and their carers.”

The consortium has also approved five other drugs for use on the Scottish NHS, including Ontozry, or cenobamate, as a treatment of epileptic seizures.

Provided by The Independent A raft of new drugs have been approved for use in the Scottish NHS (Jane Barlow/PA) (PA Archive)

And Enzalutamide, or Xtandi, can now be prescribed to men with prostate cancer which has spread to other parts of the body.

Amy Rylance, head of improving care at Prostate Cancer UK, described it as “fantastic news for hundreds of men in Scotland with advanced prostate cancer, particularly those who may not be able to have chemotherapy”.

“New hormonal treatments like enzalutamide are just as effective as chemotherapy but cause far fewer side-effects, which is why we’ve been working hard to make them permanently available to men,” she said.

“We’re delighted that men in Scotland will now be able to choose the treatment that is right for them and gain precious additional time with their loved ones.”

Other drugs which have been given the go-ahead to be prescribed to patients in Scotland include one for use in people with a rare lung cancer caused by exposure to asbestos.

Nivolumab, or Opdivo, was accepted for the treatment of advanced malignant pleural mesothelioma, a type of lung cancer that affects the thin membrane that lines the lungs.

The drug gives disease sufferers four months longer, on average, than conventional chemotherapy, and patients with the cancer told the SMC of the importance of the extra time with theie loved ones.

Other medicines approved by the consortium include Risdiplam, or Evrysdi, for the treatment of rare muscle wasting disease spinal muscular atrophy, and Pemigatinib, or Pemazyre, for the treatment of advanced cholangiocarcinoma, a cancer of the bile ducts in patients with a specific gene mutation.

Mr MacGregor said: “Cholangiocarcinoma is a rare form of bile duct cancer with very few effective treatment options. Pemigatinib offers a more personalised treatment and can be taken at home giving patients more quality time to spend with family.” 

High cholesterol symptoms: Two signs to spot when 'looking at your face' - doctor's advice

Cholesterol is a fatty substance found in your blood. Maintaining a delicate balance of cholesterol in your body underpins a number of important processes, such as building healthy cells. However, tip the balance and you can trigger a tsunami of problems, gravest of all being heart disease.

Unfortunately, your body does not usually alert you to high cholesterol levels, so the only way of knowing whether you have them is to get a blood test.

Occasionally, however, telltale signs of high cholesterol can emerge on your face.

According to Doctor Gary Bartlett, there are two specific signs that you may have high cholesterol levels "from looking at your face".

One "obvious" sign is xanthelasma - an accumulation of fatty deposits on your eyelids, said Doctor Bartlett.

These are "obvious yellow looking waxy deposits of cholesterol", he explained.

The other telltale sign is corneal arcus.

According to Doctor Bartlett, these are "deposits of cholesterol seen in an 'arc' like distribution within the iris (coloured part of your eye)".

How to respond

The NHS explains: "If you have high cholesterol, a doctor or nurse will talk to you about how you can lower it."

According to the health body, this might include things such as changing your diet or taking medicine.

Different foods lower cholesterol in various ways.

The Mayo Clinic explains: "Some deliver soluble fibre, which binds cholesterol and its precursors in the digestive system and drags them out of the body before they get into circulation.

"Some give you polyunsaturated fats, which directly lower LDL. And some contain plant sterols and stanols, which block the body from absorbing cholesterol."

The rule of thumb is to replace saturated fats with unsaturated fats where possible, advises cholesterol charity Heart UK.

Many foods contain saturated fat, especially animal foods such as meat, butter and dairy products, and foods that are made with them, such as cakes and biscuits.

They're also found in some plant foods including coconut oil and palm oil.

Good sources of unsaturated fat include plant-based fat spreads and oils, oily fish, nuts and seeds.

Saturated fats should make up no more than a third of your daily energy intake, notes Heart UK.

That's 20g for women and 30g for men.

Regular exercise is also integral to lowering high cholesterol levels.

"Aim to do at least 150 minutes (2.5 hours) of exercise a week," advises the NHS.

Some good things to try when starting out include:

• Walking - try to walk fast enough so your heart starts beating faster
• Swimming
• Cycling. 

Reference: Daily Express: Adam Chapman 

What is Guillain-Barre Syndrome? Everything we know about the rare autoimmune disorder 

The symptoms of GBS can develop rapidly. As the immune system attacks peripheral nerves, victims typically experience a loss of feeling that gradually spreads throughout the body.

“​​Weakness and tingling in your extremities are usually the first symptoms,” the Mayo Clinic says. “These sensations can quickly spread, eventually paralyzing your whole body. In its most severe form Guillain-Barre syndrome is a medical emergency. Most people with the condition must be hospitalized to receive treatment.”

In severe cases, muscles affecting speech, swallowing, and breathing may be paralysed. In about 20 to 30 per cent of cases, GBS can lead to respiratory failure, and between 4 and 7 per cent of patients die.

On the other hand, most people with GBS do recover, the Mayo Clinic says, and 60- to 80 per cent are able to walk again after six months.

What causes Guillain-Barre Syndrome?

The causes of GBS are mysterious. Scientists don’t know why people develop the syndrome, but it often begins not long after an infection of some kind.

“The exact cause of Guillain-Barre syndrome isn’t known,” the Mayo Clinic says. “The disorder usually appears days or weeks after a respiratory or digestive tract infection.”

One theory is that GBS is triggered by the immune system’s overreaction to a bacterial or viral infection.

How common is it?

Thankfully, Guillain-Barre syndrome is rare. In Europe and North America, it affects only one to two members of the general public out of 100,000 each year.

Is GBS caused by the Johnson & Johnson vaccine?

In very rare cases, recipients of the Johnson & Johnson (also called “Janssen”) vaccine for Covid-19 have developed Guillain-Barre Syndrome, but experts say there is not enough data to indicate that one causes the other.

Out of 12.8 million people who have received the shot, only about 100 are suspected to have developed GBS afterward. Nevertheless, the US Food and Drug Administration issued a warning to Johnson & Johnson recipients regarding the syndrome – but emphasised that the risk was extremely small, especially compared to the dangers of getting Covid.

“Although the available evidence suggests an association between the Janssen vaccine and increased risk of GBS, it is insufficient to establish a causal relationship,” the FDA said in a statement. “Importantly, the FDA has evaluated the available information for the Janssen COVID-19 Vaccine and continues to find the known and potential benefits clearly outweigh the known and potential risks.”

In the case of Ms Jameson, the actress says her GBS was definitely not caused by a vaccine.

“PS I did NOT get the jab or any jab,” Ms Jameson wrote in her Instagram post. “This is NOT a reaction to the jab. Thank you for your concern.” 

Reference: Independent: Nathan Place 

What are tonsil stones?

Tonsils can cause all sorts of issues, but what are tonsil stones?  According to Cleveland Clinic, tonsil stones are small, hard lumps that form in the tonsils. Sometimes known as tonsiliths, they are usually yellow or white and come in a range of sizes. The small formations rarely cause major health issues or pain and some people who have tonsil stones may not even realize they have them. 

Maintaining good oral hygiene can help prevent these stones from forming. You can find great tips on how to do this by reading through our pieces on how to to use an electric toothbrush and how to floss your teeth. But if you're here to find exactly how these stones are formed and where they come from, then read on. 

What causes tonsil stones?

Your tonsils are the two small masses of lymphoid tissue on each side of the root of your tongue. They work to clear away infection and keep your bodily fluids balanced. Tonsils have various gaps and folds called tonsillar crypts, which are often where tonsil stones are created.

As tonsils are a part of the immune system, they work to filter bacteria and viruses that enter your mouth via your food and your breath. Food, debris, minerals, and bacteria can get stuck in the tonsillar crypts, gradually calcifying into yellow or white stones. A tonsil stone’s size can range anywhere from a grain of rice to a grape. In a study published in ISRN Dentistry’s 2014 volume, the average size of a tonsil stone across 124 cases was 4mm, with the range being 3-11mm.  According to this study, the largest reported tonsil stone to date was 14.5cm in 1936. 

 Provided by Live Science What Are Tonsil Stones? Image shows man feeling painful throat

A person can have one or multiple small tonsil stones at a time. Some of the causes of tonsil stones are:

• Poor dental hygiene 
• Chronic tonsillitis 
• Chronic sinus problems 
• Larger tonsils 

What are the signs of tonsil stones?

While some smaller tonsil stones do not cause any symptoms to occur, some common examples of tonsiliths symptoms include: 

• Coughing 
• Halitosis, or bad breath 
• Having a bad taste in your mouth 
• Spitting up small white stones 
• A sore throat 
• An earache 
• Difficulty swallowing 
• The constant feeling of something stuck in your throat 
• White patches on your tonsils 
• Throat infections that are resistant to antibiotic treatment 

If you have a range of these symptoms, particularly halitosis and spitting up small stones, that can be a good indicator that you are suffering from tonsil stones. 

As discussed in the ISRN Dentistry study mentioned above, "Patients with tonsiliths may be asymptomatic and their tonsiliths may be discovered incidentally on pantomographs or other imaging modalities, including CTs and MRIs. Symptomatic patients may present with a wide range of symptoms and signs, including pain, dysphagia, enlarged tender neck glands, a lump in the throat, halitosis, and ear pain. Clinical examination reveals a white or yellowish hard object within the tonsillar crypt."

How to get rid of tonsil stones

What are possible tonsil stone treatments? According to Cleveland Clinic experts, there are a few ways to remove tonsil stones at home, including:

• Gargling: Intense gargling with warm salt water can soothe your throat and help dislodge the tonsil stones. Gargling just after eating can help prevent food from getting caught in the crypts 
• Coughing: Intense coughing could remove or loosen any tonsil stones in your tonsils. 
• Using a toothbrush, cotton swab, or finger: It could be possible to remove the stones with your finger or a toothbrush; we recommend being wary while using this method in case you accidentally make yourself sick or cause pain. 

Some medical interventions and treatments for tonsillitis include: 

• Minor surgery: It is possible to have your stones surgically removed by a healthcare professional if your tonsiliths are particularly large, causing severe pain, or causing recurring tonsil infections.  
• Tonsillectomy: If tonsil stones repeatedly return, your healthcare provider may suggest having a tonsillectomy. This is not always the case but can be considered when the stones cause repeated infections. 
• Laser tonsil cryptolysis: Under local anaesthetic, a medical professional uses a laser to eliminate the crypts that house your tonsil stones. 
• Coblation cryptolysis: Coblation cryptolysis uses radio waves to create charged ions from a salt solution. This reduces tonsil crypts without giving you a burning sensation. 
• Antibiotics: While antibiotics could prevent the number of bacteria in your tonsillar crypts, they do not treat the tonsil stones themselves.  

How can we prevent tonsil stones from appearing? Writing for the Mayo Clinic, Ann Bell, M.D. said: "You can help prevent tonsil stones from forming in the first place by following good oral hygiene. Brush your teeth after meals, at bedtime, and when you get up in the morning. When you brush your teeth, gently brush your tongue, as well. Floss your teeth daily. Regularly use mouthwash that does not have an alcohol base. These techniques can lower the number of bacteria in your mouth, throat, and tonsils that may contribute to the development of tonsil stones." In other words, practicing good oral hygiene could lower the bacteria level in your mouth and minimize the chances of getting tonsil stones. 

Reference: Live Science: Chloe Page