Caffeine Thought to Reduce the Risk of Death in Patients with Chronic Kidney Disease

Chronic kidney disease has recently been named the ninth leading cause of death in the United States. The kidneys are an important part of the body and are responsible for filtering the body’s entire plasma volume 60 times each day. Filtration specifically takes place in the glomerulus where as reabsorption and secretion take place in the renal tubules. Once filtered, the renal tubules reabsorb substances like NaCl, NaHCO₃, filtered nutrients (glucose and amino acids), divalent ions (Ca^2+, HPO₂^4-, and SO₄^2-), and water back into the blood. Substances like NH4+, endogenous, and exogenous solutes that were not filtered in the glomerulus are secreted into the lumen of the tubule and prepared for excretion. Chronic kidney disease (CKD) is when the kidneys lose their ability to filter the previously mentioned products. When patients are diagnosed with CKD, dialysis and a kidney transplant are their only options moving forward.

In a recent study, researchers at a hospital in Portugal looked at the association of caffeine consumption and mortality rate among patients with chronic kidney disease. The sample included 2328 patients between 1999-2010. The subjects were divided up into four groups based on their daily caffeine intake. The first group were those who consumed under 29.5 milligrams, the second group consumed 30.5-101 milligrams, the third group consumed 101.5-206 milligrams, and finally the fourth group consumed 206-1378.5 milligrams. For comparison, a normal cup of coffee is said to have round 95 milligrams of caffeine in it.

The results showed a dose-dependent inverse association between caffeine and all-cause mortality. The second group showed a 12% lower risk of dying, the third group showed a 22%, and finally the last group showed 24% lower risk of dying than group one. Given that the study was observational, they are unable to prove cause an effect between caffeine intake and reduced mortality in patients with CKD. It is a good place to start thinking about clinical trials though!  

On the contrary, long term hypertension has been linked to kidney failure. We also know that caffeine can increase blood pressure. Any thoughts?  

Caffeine consumption may help kidney disease patients live longer. NewsRx Health, 26 Nov. 2017, p. 32. Health & Wellness Resource Center

Prion Disease Transmission via Skin to Skin Contact

Sporadic Creutzfeldt- Jakob disease is the most common prion disease. Unlike many contractible diseases, prion diseases are not produced by another species residing within its host; prion diseases are caused by a natural protein (PrPc) that animals (including humans) possess on their cell membranes. In order for a prion disease to occur, normal cellular PrPc has to be misfolded into the diseased protein form, scrapie protein (PrPsc). The presence of one misfolded PrPsc protein in an animal can cause a prion disease because that one PrPsc has the ability to bind to PrPc and change its configuration within the brain.

There are three mechanisms in which humans acquire a misfolded PrPsc protein. The first of these mechanisms is genetic inheritance and the second is random misfolding within a human’s brain, the latter being what causes Sporadic Creutzfeldt- Jakob disease. However, a prion disease can also be passed from one organism to another, and human to human transmission can spread a prion associated disease. Human to human transmission has been found in hospitals due to contaminated instruments or brain transplant tissue during surgery. However, according to the National institute of health (n.d.), medical procedure transmission is quite rare which causes scientists to question how prions can be transmitted from person to person.

According to new research done on sporadic Creutzfeldt- Jakob disease human transmission might be possible through skin to skin contact (Orrú, 2017). In this particular study scientists used biopsied or autopsied skin from 38 human donors. Of the 38 donors, 23 were diagnosed with Creutzfeldt- Jakob disease and the other 15 acted as controls. Using western blot technique the skin samples were analyzed for the presence of PrPsc.  Orrú and his colleagues found PrPsc in seven tissue samples from donors known to have Creutzfeldt- Jakob disease. Although seven out of 23 seems like a small percentage, this study also found that all 23 donors with the disease had prion activity occurring within their epithelial cells.

This study suggests that human to human transmission via skin contact is not impossible due to dermal prion activity and PrPsc presence. This is a very scary thought because prion diseases are degenerative and fatal diseases without effective treatment. With such a possibility more research should be done to see if skin to skin contact is a significant way in which humans can possess Creutzfeldt- Jakob disease.

References:

National Institute of Health. (n.d.). Creutzfeldt-Jakob Disease Fact Sheet. Retrieved December 03, 2017, from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Creutzfeldt-Jakob-Disease-Fact-Sheet 

Orrú, C. D., Yuan, J., Appleby, B. S., Li, B., Li, Y., Winner, D., & ... Zou, W. (2017). Prion seeding activity and infectivity in skin samples from patients with sporadic Creutzfeldt-Jakob disease. Science Translational Medicine, 9(417), doi:10.1126/scitranslmed.aam7785

Gastric Bypass Surgery: A Cure for Type II Diabetes?

Type II diabetes had become a major epidemic in the United States with about 1.4 million people being diagnosed every year. The cost of this disease, including the medications needed to maintain the symptoms and the serious complications that can arise, has cost the United States $245 billion dollars (Daousi, et.al. 2006). Type II diabetes is defined as an insensitivity to insulin, which prevents the body from up taking glucose, the cells main source of energy. Usually patients with Type II diabetes are left taking many medications to regulate their glucose levels and to treat the symptoms, but are left with little hope for a cure, until now.

In a recent study, done by Albers and his team, shows a significant correlation between patients who undergo Roux-en-Y surgery and a reversal of Type II diabetes. Roux-en-Y is a type of gastric bypass surgery that is used in obese patients to aid in weight loss. In this surgery, the jejunum of the small intestines is connected to the end of the esophagus, which allows deglutinated food to bypass the stomach. A unique feature of this weight loss surgery is that the stomach is left intact and is connected back to the small intestines, which still allows the gastric enzymes, like pepsin, and pancreatic bile to be released jejunum of the small intestines to aid in digestion (Albers, et. al. 2016).

The study has found that 80% of patients who underwent the Roux-en-Y surgery showed signs of increased insulin sensitivity in just 3 months and of those patients 72% of them showed no signs of having Type II diabetes by 12 months post-op. The mechanism of how this surgery causes the insulin sensitivity to be regain is unknown. They hypothesize that adipose tissue might have a larger direct effect than previously thought, but more research is needed (Albers, et. al. 2016).

One of the ethical considerations of this finding is whether the reversal of Type II diabetes will outweigh the long-term effects of the Roux-en-Y surgery. In any gastric bypass surgery, the risk of malnutrition becomes a genuine concern. Patients who have the surgery are unable to digest and absorb the nutrients that they need and so they must be supplemented and carefully monitored. For obese patients, the Roux-en-Y surgery gives them a chance to have a happy and healthier life, which includes the remission of Type II diabetes. But for some patients’ surgery’s side effects will not outweigh the benefits and this will cause the physicians practice beneficence to make judgment calls on whether the Roux-en-Y surgery will not harm the patients more then it will help.

Daousi, C., Casson, I. F., Gill, G. V., MacFarlane, I. A., Wilding, J. P. H., & Pinkney, J. H. (2006). Prevalence of obesity in type 2 diabetes in secondary care: association with cardiovascular risk factors. Postgraduate Medical Journal, 82(966), 280–284. http://doi.org/10.1136/pmj.2005.039032

P H. Albers, K N. Bojsen-Møller, C Dirksen, A K.Serup, D E. Kristensen, J Frystyk, T R. Clausen. American Physiological Society (APS). "Gastric bypass surgery improves blood sugar handling and insulin sensitivity, study finds." ScienceDaily. ScienceDaily, 5 October 2016. <www.sciencedaily.com/releases/2015/10/151005082602.htm>.

Pain Regulation

Pain is an extremely common human ailment, but is very poorly understood. Only recently has a neurologic pattern for pain been identified (Wager, Atlas, Lindquist, Roy, Woo, 2013). Pain is not only a physical experience, but also an emotional one--it is influenced by things such as state of mind and can even be altered by positive or negative experiences preceding the painful event itself (Stolberg Nes, Roach & Segerstrom 2009).

What is most interesting, however, is the ability to change perception of pain via self-regulation. A 10-week meditation course provided to those with chronic pain proved to significantly decrease the frequency and intensity of the pain experienced, as compared to those with chronic pain who did not undergo the meditation course (Kabat-Zinn, Lipworth & Burney 1982).

The discovery of self-regulation is a revolutionary tool for solving the opiod-addiction crisis. Part of the problem is that pain is both subjective and objective, and as of now, treatment of "subjective pain" is lacking. As physicians, it is unethical to dismiss a patient's complaints of pain without offering treatment, however, many patients abuse pain medications. The doctor must differentiate between what pain or how much pain is caused by physical injury to tissue, and how much of that pain is psychologically enhanced. This, of course, is not an exact science, and even the most experienced diagnosticians can make a mistake; even the best self-regulation on pain cannot completely conquer pain if it is physically induced (Wager, Atlas, Lindquist, Roy, Woo, 2013), leading to unintended patient suffering. This dilemma becomes increasingly complicated in cases of known prior opiod addiction and deciding when it is appropriate to deny pain medication when the patient complains of unbearable pain. Hopefully, with more research on self-regulation techniques, the use of opiod based pain medications can be reduced.


Works Cited

Kabat-Zinn, J., Lipworth, L. & Burney, R. J Behav Med (1985) 8: 163. https://doi.org/10.1007/BF00845519

Solberg Nes, L., Roach, A.R. & Segerstrom, S.C. ann. behav. med. (2009) 37: 173. https://doi.org/10.1007/s12160-009-9096-5

Wager, T., Atlas, L., Lindquist, M., Roy, M., Woo, C., et al. “An FMRI-Based Neurologic Signature of Physical Pain — NEJM.” New England Journal of Medicine, 11 Apr. 2013, www.nejm.org/doi/full/10.1056/NEJMoa1204471.

Sisterhood of the Traveling Ink

Permanent tattoos are generated from a multitude of needle pricks depositing ink into the dermis layer, an area rich with blood vessels and nerves. Macrophages are immune cells that form in response to an infection-- tattoos are a type of infection as the ink is a foreign thing invading the body-- removing the majority of the deposited ink outside of the fibroblasts or macrophages. The ink that is trapped inside the fibroblasts and macrophages are what provide the color we see on people. Unfortunately, the macrophages do not remove all of the ink deposited that is not trapped within the fibroblasts or macrophages, some of that ink travels through the blood vessels.

After noticing pigmentation in the lymph nodes of patients with tattoos during biopsies a group of researchers decided to analyze the lymph nodes of six cadavers, four having tattoos and the others not. The cadavers without tattoos acted as a type of control against those that did. The scientist noticed that when deposited ink is broken down into nanoparticles the particles are able to travel through to the lymph nodes, leaving them pigmented. The researcher noted that carbon black which is a common ingredient in tattoo ink is able to easily break down into the nano-particles that were found in the lymph node. One of the exceptions they found to the nanoparticle assumption was titanium dioxide which is found in white pigmented tattoo ink. Titanium dioxide does not readily break down to nano-particles but was still found in the lymph nodes of the cadavers among other heavy metals.

More tests have been done with tattooed mice which indicated that the pigmentation from tattoos can additionally travel to the liver. The researchers for these tests stated that the same effects will not necessarily accumulate in humans as the physiology of mice is different, namely the density of their skin. The researchers do question how the implementation of tattoo ink effects the body, with current research suggesting a correlation between enlarged lymph nodes and blood clotting. There have not yet been any long-term studies conducted that definitively state whether the traveling of tattoo ink is harmful.

https://www.livescience.com/60503-tattoo-ink-body.html

http://tophealthnews.net/this-is-what-happens-to-your-body-when-you-get-a-tattoo/

https://www.nature.com/articles/s41598-017-11721-z

Medical Marijuana to treat an active seizure

With the legalization of medical marijuana in many states, the clinical uses of the drug has been brought to the forefront of the discussion of the need for these laws.  One area of interest to me that has potential to be treated with cannabis is uncontrollable seizure activity.  There have been many reports of people who were unable to stop their seizures by other means using cannabis to bring themselves down.  Further, it has been reported that others can even use a spray to bring loved one out of a long lasting seizure. This is important because during a seizure, the person is not breathing.  Long lasting seizures can cause brain damage and even result in death if they remain untreated.  But how does any of this work?

There are two types of receptors in the brain that are activated by cannabis CB1 and CB2.  For seizure activity, the CB1 is the main receptors of interest as these are responsible, in part, for calcium influx in the brain.  When too much calcium rushes in to neural pathways, seizures occur.  Thus if cannabis can block the receptor from activating an influx of calcium, it can help to stop seizures.

There is also two components of cannabis the psychoactive, delta-9- tetrahydrocannabinol (THC) and the non-psychoactive cannabidiol (CBD).  In animal models, both components have been shown to have an effect on stopping epileptic seizures, however THC has the effect of "being high" generally undesirable in a medication that is needed for daily function.  This is why many medical marijuana growers have developed marijuana that is high in CBD and low in THC - allowing the benefits of the drug without the dramatic "high".

Could high CBD, low THC cannabis be a safer alternative to stronger anti-convulsive medications like Versed, which is so dangerous that it can only be administered by a healthcare professional?  Possibly, but more research must be done.  Because medical cannabis is still not legal at the federal level, clinical trails approved by the FDA are hard to come by.  Perhaps someday it will become the recommended treatment, but only after much more research can it be relied upon.