Category: 8. Health

• Two new H5N1 outbreaks confirmed in North West and Mpumalanga provinces.
• Government plans first-ever mass poultry vaccination campaign underway.
• Past 2023 epidemic led to culling of 10.5 million birds and $529 million losses.

South Africa’s poultry sector faces renewed threats from avian influenza after two new H5N1 outbreaks were reported, raising fears of another crisis in an industry still recovering from the devastating 2023 epidemic.

The World Organisation for Animal Health (WOAH) announced on July 2 that South African authorities confirmed outbreaks on poultry farms in North West and Mpumalanga provinces, killing 1,150 birds.

This new detection of the virus comes just four months after the Ministry of Agriculture identified H5N1 in wild birds on Marion Island, where cases were recorded in six species, including the wandering albatross and the king penguin.

Nearly two years have passed since the industry endured its worst avian influenza outbreak in 2023. That crisis, driven by simultaneous H5N1 and H7N1 strains, forced farmers to cull around 10.5 million birds—about a third of the national poultry stock—resulting in estimated economic losses of over $529 million.

A Proactive Government Response

While it is too early to predict if the current situation will escalate to a similar scale, the reemergence of H5N1 has renewed urgency for preventive measures. The Ministry of Agriculture recently announced plans for the country’s first-ever mass poultry vaccination campaign against avian influenza.

On June 5, Minister of Agriculture John Steenhuisen explained that the initiative aims to prevent the catastrophe an epidemic could cause by strengthening the immunity of the local poultry stock against pathogenic avian influenza, drawing on the best international practices and lessons learned from other countries.

In a statement on June 30, Astral Foods, South Africa’s leading chicken meat producer, confirmed it had received authorization to vaccinate 5% of its flock in a pilot program against the H5 strain.

“The vaccine will ensure that the birds develop immunity to infection from any potential circulating strain of the H5 virus in the field. This immunity will develop within three weeks of being vaccinated. The vaccine is designed to prevent the birds from succumbing to bird flu infection through the immunity that they will develop. The vaccine does not prevent infection from a H5 bird flu virus, but the producer will at least not suffer huge financial implications from losing their breeding stock or having to cull the birds due to infection,” the company stated.

Astral Foods clarified that the current vaccine does not target the H7N1 strain, which contributed heavily to the high bird mortality during the 2023 outbreak. As vaccination efforts begin, vigilance remains critical for the poultry industry.

This article was initially published in French by Stéphanas Assocle

Edited in English by Ange Jason Quenum

New research from the University of Sydney has uncovered a key brain protein involved in the development of Parkinson’s disease, and identified a way to modify it, offering hope for future treatments.

Led by Professor Kay Double at the Brain and Mind Centre, the team has spent over a decade investigating the biological mechanisms that drive Parkinson’s. The condition affects more than 10 million people worldwide and is the second most common neurological disorder after dementia.

From discovery to breakthrough

In 2017, Professor Double’s team published a study identifying the abnormal presence of a protein called SOD1 in the brains of people with Parkinson’s. While SOD1 normally serves a protective function in the brain, in Parkinson’s patients it becomes faulty, clumping together and damaging neurons.

Building on this, the latest study, published in Acta Neuropathologica Communications, has shown that targeting this malfunctioning protein can dramatically improve motor function in animal models.

“All the mice we treated saw a dramatic improvement in their motor skills which is a really promising sign it could be effective in treating people who have Parkinson disease too,” said Professor Double. “We hoped that by treating this malfunctioning protein, we might be able to improve the Parkinson-like symptoms in the mice we were treating – but even we were astonished by the success of the intervention.”

Treating the protein with copper

The study involved two groups of mice bred to show Parkinson’s-like symptoms. One group was treated for three months with a special copper supplement, while the other received a placebo.

The results showed that mice in the placebo group continued to experience worsening motor symptoms. However, the mice treated with the copper supplement were protected from these effects and retained normal movement.

“The results were beyond our expectations and suggest, once further studies are carried out, this treatment approach could slow the progression of Parkinson’s disease in humans,” Professor Double said.

Understanding Parkinson’s disease

Parkinson’s disease occurs when dopamine-producing cells in the brain die off, resulting in tremors, stiffness, slow movements and poor balance. While the exact causes remain unclear, this research strengthens the case that the faulty SOD1 protein is a key player in its progression.

“As our understanding of Parkinson’s disease grows, we are finding that there are many factors contributing to its development and progression in humans – and faulty forms of the SOD1 protein is likely one of them,” said Professor Double.

Toward multi-faceted treatments

The findings also point to the need for combination therapies, echoing lessons from other complex diseases.

“Just as researchers found with HIV, Parkinson’s disease is a complex condition that likely requires multiple interventions. A single treatment may have a small effect when used alone but, when combined with other interventions, contributes to a significant overall improvement in health,” Professor Double added.

What’s next?

The team’s next goal is to determine how best to target the faulty SOD1 protein in human clinical trials. If successful, it could be the beginning of a new class of treatments aimed at slowing – or even halting – the progression of Parkinson’s disease.

Many modern devices – from cellphones and computers to electric vehicles and wind turbines – rely on strong magnets made from a type of minerals called rare earths. As the systems and infrastructure used in daily life have turned digital and the United States has moved toward renewable energy, accessing these minerals has become critical – and the markets for these elements have grown rapidly.

Modern society now uses rare earth magnets in everything from national defense, where magnet-based systems are integral to missile guidance and aircraft, to the clean energy transition, which depends on wind turbines and electric vehicles.

The rapid growth of the rare earth metal trade and its effects on society isn’t the only case study of its kind. Throughout history, materials have quietly shaped the trajectory of human civilization. They form the tools people use, the buildings they inhabit, the devices that mediate their relationships and the systems that structure economies. Newly discovered materials can set off ripple effects that shape industries, shift geopolitical balances and transform people’s daily habits.

Materials science is the study of the atomic structure, properties, processing and performance of materials. In many ways, materials science is a discipline of immense social consequence.

As a materials scientist, I’m interested in what can happen when new materials become available. Glass, steel and rare earth magnets are all examples of how innovation in materials science has driven technological change and, as a result, shaped global economies, politics and the environment.

Glass lenses and the scientific revolution

In the early 13th century, after the sacking of Constantinople, some excellent Byzantine glassmakers left their homes to settle in Venice – at the time a powerful economic and political center. The local nobility welcomed the glassmakers’ beautiful wares. However, to prevent the glass furnaces from causing fires, the nobles exiled the glassmakers – under penalty of death – to the island of Murano.

Murano became a center for glass craftsmanship. In the 15th century, the glassmaker Angelo Barovier experimented with adding the ash from burned plants, which contained a chemical substance called potash, to the glass.

The potash reduced the melting temperature and made liquid glass more fluid. It also eliminated bubbles in the glass and improved optical clarity. This transparent glass was later used in magnifying lenses and spectacles.

Johannes Gutenberg’s printing press, completed in 1455, made reading more accessible to people across Europe. With it came a need for reading glasses, which grew popular among scholars, merchants and clergy – enough that spectacle-making became an established profession.

By the early 17th century, glass lenses evolved into compound optical devices. Galileo Galilei pointed a telescope toward celestial bodies, while Antonie van Leeuwenhoek discovered microbial life with a microscope.

Lens-based instruments have been transformative. Telescopes have redefined long-standing cosmological views. Microscopes have opened entirely new fields in biology and medicine.

These changes marked the dawn of empirical science, where observation and measurement drove the creation of knowledge. Today, the James Webb Space Telescope and the Vera C. Rubin Observatory continue those early telescopes’ legacies of knowledge creation.

Steel and empires

In the late 18th and 19th centuries, the Industrial Revolution created demand for stronger, more reliable materials for machines, railroads, ships and infrastructure. The material that emerged was steel, which is strong, durable and cheap. Steel is a mixture of mostly iron, with small amounts of carbon and other elements added.

Countries with large-scale steel manufacturing once had outsized economic and political power and influence over geopolitical decisions. For example, the British Parliament intended to prevent the colonies from exporting finished steel with the iron act of 1750. They wanted the colonies’ raw iron as supply for their steel industry in England.

Benjamin Huntsman invented a smelting process using 3-foot tall ceramic vessels, called crucibles, in 18th-century Sheffield. Huntsman’s crucible process produced higher-quality steel for tools and weapons.

One hundred years later, Henry Bessemer developed the oxygen-blowing steelmaking process, which drastically increased production speed and lowered costs. In the United States, figures such as Andrew Carnegie created a vast industry based on Bessemer’s process.

The widespread availability of steel transformed how societies built, traveled and defended themselves. Skyscrapers and transit systems made of steel allowed cities to grow, steel-built battleships and tanks empowered militaries, and cars containing steel became staples in consumer life.

Control over steel resources and infrastructure made steel a foundation of national power. China’s 21st-century rise to steel dominance is a continuation of this pattern. From 1995 to 2015, China’s contribution to the world steel production increased from about 10% to more than 50%. The White House responded in 2018 with massive tariffs on Chinese steel.

Rare earth metals and global trade

Early in the 21st century, the advance of digital technologies and the transition to an economy based on renewable energies created a demand for rare earth elements.

Rare earth elements are 17 chemically very similar elements, including neodymium, dysprosium, samarium and others. They occur in nature in bundles and are the ingredients that make magnets super strong and useful. They are necessary for highly efficient electric motors, wind turbines and electronic devices.

Because of their chemical similarity, separating and purifying rare earth elements involves complex and expensive processes.

China controls the majority of global rare earth processing capacity. Political tensions between countries, especially around trade tariffs and strategic competition, can risk shortages or disruptions in the supply chain.

The rare earth metals case illustrates how a single category of materials can shape trade policy, industrial planning and even diplomatic alliances.

Technological transformation begins with societal pressure. New materials create opportunities for scientific and engineering breakthroughs. Once a material proves useful, it quickly becomes woven into the fabric of daily life and broader systems. With each innovation, the material world subtly reorganizes the social world — redefining what is possible, desirable and normal.

Understanding how societies respond to new innovations in materials science can help today’s engineers and scientists solve crises in sustainability and security. Every technical decision is, in some ways, a cultural one, and every material has a story that extends far beyond its molecular structure.

A new review published in Lipids has highlighted the potential of plant-based omega-3 oils in promoting gut health.¹

The article delves into how omega-3 oils rich in stearidonic acid (SDA) can influence the microbiome, promote optimal gut barrier function, help mitigate systemic inflammation and boost overall wellness.

Published by researchers from the University of Southampton, the piece also explores the rising interest in plant-based omega-3 sources.

According to Baker et al., this trend is primarily driven by the increased  intrigue towards both ethical and sustainable dietary choices — with many now turning away from fish oil products in favour of more environmentally-friendly options. 

The review covers: 

• How very long chain polyunsaturated fatty acids (VLF-PUFAs) present in plant-based extracts can balance the gut microbiome 
• How VLF-PUFAs exhibit a prebiotic effect within the gut 
• The potential of SDA-rich oils in mitigating inflammation as well as promoting gut barrier and immune function
• How SDA oils modulate the gut-brain/gut-liver axes
• How users can gain similar omega-3-related health and wellness benefits from plant-based sources compared with traditional fish oil
• Why plant-based omega-3s are more sustainable than traditional fish oils

Notably, the researchers tout the benefits of Nature Crops International’s branded Ahiflower oil, which is derived from Buglossoides arvensis.

Oil from this particular botanical species is rich in SDA, which promotes efficient omega-3 EPA conversion and DHA formation in the liver and brain; despite its inability to raise DHA levels in the red blood cells.

This suggests that the beneficial fatty acids produces are being metabolised and used by the body more efficiently, according to Baker.

“As we uncover the power of omega-3s in promoting cardiovascular, gut, skin, immune-inflammatory and mental health, there will continue to be an increase in demand for these products — creating an unsustainable supply chain if we were to rely solely on marine sources,” she says.

“To overcome this issue, it’s crucial to embrace plant-based omega-3 options — which are demonstrably beneficial for all these health goals.”

“Ahiflower oil is one of nature’s richest sources of omega-3, and this newly published research only further underscores its key role in overall wellness. By choosing a clean-label, regeneratively farmed omega-3 solution, supplement manufacturers can not only enhance the benefits of their product, but also choose a sustainable option,” Baker concludes.

Reference 

1  https://pubmed.ncbi.nlm.nih.gov/40574533/#:~:text=Recent%20studies%20highlight%20the%20efficient,distinct%20SDA%2Dderived%20metabolites).

Popular weight-loss drugs like Ozempic and Zepbound have revolutionized how we tackle obesity. But now, emerging reports about potential side effects have prompted a new investigation by UK health regulators.

Hundreds of people reported experiencing severe pancreas problems after taking these drugs, according to the BBC.

The UK government is now asking anyone who’s been affected to contact them. They are particularly interested in understanding whether genetic factors may predispose certain individuals to such severe reactions.

As always with health alerts, it’s crucial to put this news into perspective. There’s no clear evidence yet that these drugs are directly causing pancreas damage. Their known side effects are already well-documented and they remain approved as safe for use when prescribed and overseen by a doctor.

Related: Ozempic Alternative Ditches The Needle And One Major Side Effect

And that last part – doctor oversight – is vital: it’s not safe to obtain these drugs through unofficial channels. Even if you can be sure you’re getting what you asked for – which you can’t – these medications aren’t right for everyone.

It’s important to note that when any medication is taken up by a large number of people, it will inevitably reach some who will experience health issues regardless of the drugs they’re on, and rare adverse reactions will likely also occur.

But the sheer number of reports of acute or chronic pancreatitis warrants further examination, and the cases so far involve up to 10 fatalities. The investigation is being managed by the Medicines and Healthcare products Regulatory Agency and Genomics England.

Collectively, the drugs being looked at are known as GPL-1 (glucagon-like peptide-1) receptor agonists, because they target cells in the body usually activated by the natural GLP-1 hormone, which controls blood sugar and appetite – hence why they’re used for diabetes and weight loss.

These medications can be split into two types: those based on semaglutide (such as Ozempic and Wegovy), and those based on tirzepatide (including Mounjaro and Zepbound). The latter type also targets glucose-dependent insulinotropic polypeptide (GIP) receptors, as well as GLP-1 receptors, for a stronger effect.

To date, almost 400 reports of acute pancreatitis have been received from people using GLP-1 drugs such as Mounjaro, Wegovy, Ozempic, and liraglutide, as per The Guardian. Nearly half of those, 181, involve the tirzepatide-based drug sold as Mounjaro.

Genetic risk is one of the factors being studied, which may mean some people are more prone to pancreatic issues. In the case of acute or chronic pancreatitis, this manifests itself as severe stomach pain that won’t go away.

Those in the UK aged over 18, who have a strong adverse reaction to one of these weight loss and diabetes drugs are being asked to register their details on the Yellow Card website (the official UK system for reporting issues with approved medications).

From there, you’ll be asked to submit more information and a saliva sample, if you’re chosen to take part in a study of GLP-1 drugs and pancreatic issues.

The effects of all medications have to be considered in relation to other factors, including existing health conditions, genetics, age, and sex. Even the most effective drugs can come with risks.

“GLP-1 medicines like Ozempic and Wegovy have been making headlines, but like all medicines there can be a risk of serious side effects,” says geneticist Matt Brown from Genomics England.

“We believe there is real potential to minimize these, with many adverse reactions having a genetic cause.”

The latest report on global fertility by the United Nations Population Fund (UNFPA) says infertility is a key barrier to reproductive autonomy for almost 13 per cent of Indians. Studies also show that among the approximately 28 million people in the country who face infertility, male-factor infertility accounts for 40-50 per cent of the cases.

Despite such a significant proportion, male fertility remains under-discussed and underdiagnosed, with little to no awareness beyond sperm count. This leaves no room to acknowledge the complex causes and possible solutions to the condition. Dr Vaani Mehta, fertility specialist at Birla Fertility and IVF, Chandigarh, lists the lesser-known factors impacting male fertility:

Genetics: Genetic abnormalities are often left out of discussions when talking about infertility even though they can be significant contributors. One such example would be microdeletions in the Y chromosome, particularly in the Azoospermia Factor or AzF gene. If any part of AzF is deleted or mutated, it can disrupt the entire process of spermatogenesis and lead to a severely low sperm count or even complete absence of sperm in semen, resulting in infertility.

Sexual dysfunction: Sexual dysfunction that affects fertility can manifest in many ways, with symptoms such as erectile dysfunction, problems relating to ejaculation and even low libido. In a 2023 study by the American Society for Reproductive Medicine, a projected 322 million men around the world were to be impacted by sexual dysfunction in 2025. Despite its impact, male sexual dysfunction is often underdiagnosed or undertreated. Recognising such symptoms early and addressing them through medical, psychological or lifestyle changes can significantly improve chances of natural conception.

Unhealthy lifestyle: Unhealthy lifestyle is another big factor that impacts male infertility. Several factors, such as obesity, diet or nutrition, stress, smoking and alcohol use, affect not just sperm count but also motility, morphology and sperm DNA.

Stress and emotional wellbeing: Our societal construct pressures men to curb their emotions, which leads to underlying stress and loneliness. Couple this with the stress and pressure to conceive and it negatively impacts their emotional health. It is essential for men and couples to put emotional wellbeing in focus and regulate stress to ease their fertility journey.

Comorbidities: Underlying health issues, such as diabetes and hypertension, can also have a major impact on male fertility. High blood sugar levels can reduce sperm mobility, damage sperm DNA and hamper sperm morphology. Similarly, hypertension can affect blood flow to reproductive organs and even impact hormone regulation.

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Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy that can lead to significant maternal and fetal morbidity. One of the rare but serious complications of HG is Wernicke Encephalopathy (WE), a neurological, potentially life-threatening condition caused by thiamine deficiency, which is essential for glucose metabolism [15].

It is known that human neurons account for only 10% of brain cells, but are responsible for as much as 90% of glucose consumption in the brain. Since glucose is the main source of energy for neurons, thiamine deficiency impairs the utilisation of glucose as a substrate for neuronal energy metabolism, resulting in selective neuronal death. This causes oxidative stress, reduced ATP production, glutamate excitotoxicity, inflammation, lactic acidosis, impaired astrocyte function, and decreased neurogenesis — resulting in metabolic imbalance and neurological complications [16]. In the absence of supplementation, thiamine deficiency can develop within 2 to 3 weeks. Early manifestations of WE may include nonspecific symptoms such as fatigue, memory impairment, sleep disturbances, and emotional lability. The classic clinical triad of ataxia, ophthalmoplegia, and altered mental status is only present in 16–20% of patients at initial evaluation, which further complicates timely diagnosis [15]. The diagnosis of WE remains based on clinical symptoms. There are no rapid, routine diagnostic tests for this condition. Blood thiamine levels can be measured, but there is no established threshold level that would be safe for patients before brain damage develops. Magnetic resonance imaging has high specificity but poor (53%) sensitivity and can therefore only confirm clinical suspicion of WE [16]. Non-specific clinical symptoms and rare occurrence make it difficult to diagnose WE, especially in pregnant women. The association between WE and hyperemesis gravidarum is well documented, therefore, caregivers of pregnant women must consider WE and treat this condition immediately in women reporting severe vomiting and inability to eat, as two to three weeks of unbalanced nutrition can lead to thiamine depletion and life-threatening complications. Awareness of possible predisposing factors and maintaining a high level of clinical suspicion are the best tools for early diagnosis, which is crucial for preventing neurological sequelae [17]. Prevalence data on Wernicke encephalopathy (WE) comes primarily from autopsy studies, which report rates ranging between 1% and 3%. Several studies have shown that clinical records tend to underestimate the true prevalence, as the diagnosis is often overlooked or missed. The incidence of WE is thought to be higher in developing countries, largely due to widespread vitamin deficiencies and malnutrition [15]. In the context of HG, thiamine deficiency is primarily related to insufficient intake and impaired absorption due to persistent nausea and vomiting, as well as the increased metabolic demands of the growing fetus and the hypermetabolic state of pregnancy [17].

Persistent vomiting in hyperemesis gravidarum significantly contributes to thiamine depletion, particularly in pregnancy, where maternal demands are elevated. Women with hyperemesis gravidarum (HG) are frequently dehydrated and suffer from significant weight loss, malnutrition, electrolyte imbalances, and vitamin deficiencies [17]. Malnutrition associated with WE in pregnancy is a rare but serious and preventable consequence of hyperemesis gravidarum, which requires attention due to its rapid onset and unfavourable course. Unfortunately, as reported by the authors of a systematic review, symptoms of WE are currently often overlooked or exacerbated by the administration of glucose, leading to poorer outcomes for the mother and foetus, which could have been avoided by the prophylactic administration of thiamine injections [2]. In our case, glucose-containing fluids were administered before thiamine supplementation as part of routine intravenous therapy for vomiting, at a time when thiamine deficiency had not yet been suspected. It is therefore possible that this contributed to the clinical manifestation of WE. This underscores the importance of empirical thiamine supplementation in pregnant patients at risk of deficiency, especially before administering glucose-containing fluids. Similar risks are observed in patients undergoing cancer treatment, where chemotherapy-induced nausea and poor intake can also lead to severe nutritional deficiencies. Other risk factors include bariatric surgery, prolonged intravenous nutrition without adequate supplementation, chronic hemodialysis, and magnesium depletion [9, 18]. Given that magnesium is a cofactor for thiamine-dependent enzymes, its deficiency can further impair thiamine utilization, increasing the risk of neurological complications. Diets high in carbohydrates or containing thiaminase-rich foods further heighten the risk. Moreover, chronic alcohol use, restrictive diets, or food consumption with thiamine antagonists are linked to impaired utilization of this essential nutrient. These complex interactions underline the multifactorial etiology of thiamine deficiency, which, if unresolved, may progress to severe neurological conditions such as WE and even further to Wernicke-Korsakoff syndrome (WKS). Although Wernicke Encephalopathy is classically associated with chronic alcohol use, recent evidence highlights its occurrence in various non-alcoholic contexts. Chamorro et al. demonstrated that non-alcoholic WE may differ in clinical presentation and is frequently underdiagnosed due to atypical or subtle symptomatology [19]. Moreover, Koca et al. reported a case of WE in a patient with cholangiocellular carcinoma, illustrating how persistent vomiting and malnutrition, even in the absence of alcohol use, can precipitate severe thiamine deficiency [20]. These findings align with our case and emphasize the need for heightened awareness and early intervention in at-risk non-alcoholic populations, particularly in pregnancy and oncology settings.

To address prolonged or severe nausea and vomiting in pregnancy, particularly in cases persisting beyond the first trimester, early screening for complications and timely intervention are needed in women. Identifying and addressing nutritional deficiencies, especially thiamine deficiency, should be a priority for midwives and women’s health providers [8, 9, 21]. This is crucial for preventing complications such as WE [21].

The use of a validated, clinically practical, and easy to use tool that measures severity of NVP, such as the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scoring system (PUQE-12 or PUQE-24), can assist with monitoring progression and treatment. The PUQE scoring system is a validated tool for assessing the severity of NVP and can help guide management decisions. Despite its utility, it is not consistently applied in practice, potentially delaying recognition of severe cases [11]. In addition to PUQE scores, clinicians should be aware of red flag symptoms that warrant urgent intervention, such as persistent ketonuria, signs of dehydration, significant weight loss, electrolyte imbalances, altered mental status, or any neurological symptoms suggestive of thiamine deficiency.

Currently, there are no universally accepted guidelines specifying exact blood thiamine levels that should trigger therapeutic intervention. Given this, clinical decision-making should prioritize early recognition of symptoms and implementation of preventative strategies, rather than relying solely on laboratory-confirmed deficiency [22]. Reference values may vary between laboratories, and the interpretation of results should take into account the patient’s clinical status and symptoms suggestive of thiamine deficiency. In cases where thiamine deficiency is suspected, such as in hyperemesis gravidarum, chronic malnutrition, prolonged parenteral nutrition, or alcohol use disorder, early administration of high-dose thiamine is recommended, even before laboratory confirmation. While thiamine deficiency is typically defined as a blood thiamine level below 28 µg/L (2.1 nmol/L), a severe deficiency requiring urgent intervention is generally considered when levels fall below 7 µg/L (0.5 nmol/L) [11, 12, 22]. However, the presence of neurological symptoms consistent with WE (ophthalmoplegia, ataxia, confusion) should prompt immediate administration of 500 mg IV (intravenous) thiamine every 8 h for 3 days, followed by 250 mg IV daily for 5 additional days, in accordance with recent clinical guidelines [6, 9, 11, 12]. The presence of neurological symptoms is emphasized in the diagnostic criteria for Wernicke encephalopathy, as decreased thiamine levels alone is insufficient to establish the diagnosis [14]. Given the potentially irreversible neurological damage associated with thiamine deficiency, particularly in high-risk populations, preventive supplementation (oral 100 mg tds or intravenous as part of vitamin B complex) should be considered in individuals with prolonged vomiting, severe malnutrition, or other conditions predisposing to tiamine depletion [11]. Although there are recommendations for the treatment of Wernicke encephalopathy, they are not specifically tailored to pregnant women. Existing guidelines for pregnant women in the context of hyperemesis gravidarum (HG) mainly focus on the prevention of WE. There are some case reports of WE in pregnancy with various doses of thiamine administered (ranging from 100 to 500 mg a day orally or intravenously) [9].

In instances where standard dietary and lifestyle measures fail to control symptoms, timely pharmacological intervention may be warranted. Pharmacological antiemetic therapy is still used with great caution by some patients and health care providers to treat NVP and is erroneously considered to be contraindicated in pregnancy [23]. However, substantial evidence supports the safety and efficacy of specific antiemetics, such as pyridoxine-doxylamine, antihistamines (e.g. diphenhydramine, meclizine), phenothiazines (e.g. promethazine), and ondansetron, when used appropriately.

Beyond pharmacological management, dietary and lifestyle modifications play a significant role in alleviating symptoms. Encouraging patients to consume small, frequent meals with an emphasis on protein rather than fats and carbohydrates while avoiding strong odors, greasy foods, and overly sweet items can help reduce nausea [24, 25]. Proper hydration strategies should also be emphasized, including separating liquid intake from solid meals to minimize gastrointestinal discomfort [26]. For women requiring intravenous hydration, normal saline (0.9% NaCl) with added potassium chloride is recommended, with administration guided by daily electrolyte monitoring. In cases where a single antiemetic is ineffective, a combination of agents should be considered.

Before considering termination of pregnancy, all possible therapeutic measures should be explored to ensure optimal management of severe NVP and HG. This includes the use of corticosteroids in treatment-resistant cases, as recommended by clinical guidelines, given their potential efficacy when other options have failed.

Early recognition and timely intervention in Hyperemesis Gravidarum (HG) are crucial for preventing weight loss, general weakness, and recurrent hospitalizations. Comprehensive treatment should include medical management, patient education, dietary and lifestyle modifications, and emotional support. Such an approach not only improves maternal health and quality of life during pregnancy but also reduces the need for parenteral therapy, alleviating both the financial and emotional burden on families and the healthcare system [4, 10, 21].

There is limited evidence suggesting that pregnant women with HG often found interactions with healthcare professionals challenging, with many reporting that their concerns were dismissed and that the complications of HG were downplayed [27]. In response to these challenges, Irish researchers have strongly advocated for the establishment of dedicated HG clinics. This type of service is an example of both individualized and multidisciplinary care. These interdisciplinary services offer comprehensive care, treatment, and support from midwives, dietitians, obstetricians, and mental health specialists. Patients attending these clinics receive an individualized assessment from a dietitian at each visit, with specialists determining the necessity of intravenous (IV) fluid therapy and vitamin supplementation, as well as reviewing or adjusting medication doses. As concluded in the study, dedicated multi-disciplinary HG clinics, available nationally and internationally for all women with HG, are strongly recommended [28].

Severe HG when left unmanaged, can progress to serious complications, including WE, necessitating a coordinated, interdisciplinary approach to patient care. This collaboration involves obstetricians, midwives, neurologists, psychiatrists, addiction specialists, dietitians, and social workers, each contributing their expertise to address the multifaceted needs of affected patients [29].

Midwives and obstetricians are often the first to detect signs of excessive vomiting and associated nutritional deficiencies during pregnancy. Their role includes monitoring for symptoms such as severe dehydration, weight loss, and neurological changes that could indicate the development of WE. Educating healthcare providers on the early neurological signs of thiamine deficiency, beyond the classical triad of WE, is essential to prevent delayed diagnosis. Early referral to neurologists is essential for assessing and managing potential cognitive or motor impairments resulting from thiamine deficiency that are a hallmark of WE [21, 23, 30].

In cases where hyperemesis may be linked to alcohol misuse, psychiatrists and addiction specialists are vital for evaluating and treating underlying dependency issues [30,31,32]. Comorbid psychiatric conditions, such as anxiety and depression, are common in HG and require integrated mental health support. This includes addressing the psychosocial challenges that may exacerbate the condition, such as stress, anxiety, or inadequate social support. Dietitians play a crucial role in monitoring and addressing nutritional deficits, ensuring adequate thiamine supplementation, and providing dietary strategies to minimize symptoms of HG [33, 34].

Social workers complete the interdisciplinary framework by assessing the patient’s broader circumstances, including access to food, housing stability, and overall well-being. They can facilitate interventions when social determinants of health, such as financial hardship or unsafe living conditions, hinder recovery.

Our case highlights the importance of early identification and treatment of thiamine deficiency in pregnant patients with hyperemesis gravidarum to prevent irreversible neurological damage. Understanding the risk factors, the need for screening and early intervention, and algorithmic management of treatment is crucial. When considering the evidence from our case report alongside findings from the literature, it becomes evident that a comprehensive, multidisciplinary approach not only enhances maternal outcomes but also protects fetal development. This underscores the importance of early detection, holistic care, and coordinated efforts among healthcare providers to prevent severe complications associated with thiamine deficiency [29].