Prions Discovered in Skin of Patients With Creutzfeldt-Jacob Disease

Abnormal Proteins Discovered in Skin of Patients With Rare Brain Disease

By Denise Grady

NY Times Nov. 22, 2017  NY Times Link.

Finding so-called prions in skin samples may lead to early diagnosis of Creutzfeldt-Jakob disease. But the discovery also hints at possible risks from surgery.

The discovery suggests that skin samples might be used to improve detection of the disorder, Creutzfeldt-Jakob disease, which now is usually diagnosed with much more difficult procedures, like brain biopsies or autopsies.

The researchers said that although the disease had been transmitted decades ago by corneal transplants and certain neurosurgical procedures, there was no definitive evidence that other types of surgery had ever spread it. And the levels found in skin are far lower than those in the brain.

Creutzfeldt-Jakob is the most common member of a family of disorders that affect people and animals called transmissible spongiform encephalopathies. The diseases eat holes in the brain, leaving it looking like a sponge (hence the name). The other human ailments include kuru, fatal familial insomnia and Gerstmann-Straussler-Scheinker disease.

Principal Investigator, Wen-Quan Zou, M.D., PHD, CJD Foundation.

Prions from BSE in green (from NY Times article)

What if You Knew Alzheimer’s Was Coming for You?

Simple blood tests may soon be able to deliver alarming news about your cognitive health.

By Pagan Kennedy

NY Times, Nov. 17, 2017

This profound and thought-provoking article appeared in the Sunday Review. You may find it to be worth reading.

What if You Knew Alzheimer’s Was Coming for You?

Comments:

Arrogance

Franz J. Ingelfinger
N Engl J Med. 1980 Dec 25;303(26):1507-11.
This is a classic article; well worth studying.
FULL TEXT:

Franz Joseph Ingelfinger  (August 20, 1910 – March 27, 1980) was a German-American physician. He served as Chief of Gastroenterology at Evans Memorial Department of Clinical Research, part of Boston University School of Medicine. He also served as Editor of the New England Journal of Medicine (NEJM) from 1967 to 1976.[1] His work was influential in the field of science journalism.

Notes from Arrobance.

FJI Obituary in BMJ

Don’t demonise prescription opioids

It is rare that we hear from those who use prescription opioids.  Their voices are important counterpoints to the loud and self-righteous jeremiads of physicians, politicians and law enforcement professionals.

This essay was published in the BMJ in October 2017.

Our preoccupationwith opioid misuse could become the tail wagging the dog

Bob Roehr biomedical journalist.  BMJ

“I use an opioid drug, hydrocodone, every six hours, and have done so for about a decade.“Demonising prescription opioids can come to no good end."

F.W. Peabody: Classic Articles

Francis Weld Peabody was a Boston physician who died in October 1927 at age 45 from gastric carcinoma. He was a humanistic physician whose article "The Care of the Patient" was published in JAMA in 1927 a few months before his death.

This article is one of the most widely cited publications in the medical literature. Two other of Peabody's articles are classics, however one of these has never been published.
 

Oglesby Paul's 1991 biography "The Caring Physician: The Life of Dr. Francis W Peabody is a classic but may be hard to find. Peabody's classic articles are found in the appendices to Paul's book.

For the readers ease, these articles will be linked here:

1. TheCare of the Patient.  FWP, JAMA 1927
This paper originally appeared in JAMA in 1927. It is as valid and inspiring today as it was 90 years ago.  It is the most cited and revered article in the medical literature. Peabody’s wife remembered him saying, “I am absolutely sure that this little lecture will be remembered long after anything of a scientific nature I have written has been forgotten.”

2. The Patient and the Man: (Presented by Francis W. Peabody, MD before the New York Academy of Medicine, November 22, 1922) 
Chemistry, physiology, psychology—these and other sciences are making the foundations of medicine stronger from year to year, but medicine itself can never become merely an applied science. The proper employment of the fundamental sciences in the study of disease has become an essential for good medical practice, but over and above this, there must be something which correlates the scientific findings with the actual problems of the individual case—the art of medicine, which carries us beyond the patient to the man.   

3. Notes on the Effects of Morphine (unpublished.  Finished 5 days before his death)

This unpublished essay is “[a]n example of how FWP the scientist used his

illness to make clinical observations on himself with his description of his reactions

to injections of morphine. This document was completed on October 8, 1927, five days

before his death, and is a unique and vivid record of one physician-patient’s response to the powerful narcotic.” This is an extraordinary essay. Why it was never published is a

great mystery tome; but may lie in the fact that morphine was and still  is a much-maligned drug. Herein, we see how it allowed FWP remain lucid and function masterfully until the his death.

    

How We Shun The Mortally Ill

Richard Smith's: "How we shun the mortally ill" appeared in the BMJ Opinion October 10, 2017 is a definite Keeper

"When you develop a mortal illness, as you will do if you’re not one of the fifth of the population who dies suddenly, you are likely to find that many friends desert you. The same will happen if somebody in your family develops such an illness. And if you’re a doctor then the people most likely to shun you are your medical colleagues. The isolation of the seriously ill and their relatives is the great unrecognised scandal of our age, said Neil Vickers, reader in English literature and medical humanities at King’s College London, at a recent symposium on Ambiguities and Paradoxes in Clinical Medicine. The able bodied in this way make the suffering of the seriously ill much worse."

Importantly, Smith references the famous 1982 article in the New England Journal of Medicine by the endocrinologist David Rabin from Vanderbilt Medical Center who described how when he developed amyotrophic lateral sclerosis he became isolated from most of his fellow physicians.

The Latest on Lice

by Perri Klass  (anything written by Perri Klass is worth reading)

NY Times, October 10, 2017

Full Text.

We spend a billion dollars a year on treatments for head lice, according to the American Academy of Pediatrics.

Head lice is spread from person to person.  It is an infestation, not an infection — they do not actually carry infections.  The AAP argues first and foremost that children should not miss school because of head lice or nits.  It’s not necessary to treat all the children in a classroom, or all the people who live in the house, though anyone who shares a bed should get treated.

It can be helpful to treat more than once, usually after about nine days, if you are using a product that does not kill the eggs, or if you see live lice after a first treatment.

There should never be a case for a child with head lice spending days out of school. Families should be notified, they should be able to access topical medication and they should be able to re-enter the next day.”

Perri Klass is a respected pediatric writer.  This is a level-headed. helpful review.

An effective nonchemical treatment for head lice: a lot of hot air.

Goates BM, et. al. Pediatrics. 2006 Nov;118(5):1962-70.

“RESULTS:  The most successful method, which used a custom-built machine called the LouseBuster, resulted in nearly 100% mortality of eggs and 80% mortality of hatched lice. The LouseBuster was effective in killing lice and their eggs when operated at a comfortable temperature, slightly cooler than a standard blow-dryer. Virtually all subjects were cured of head lice when examined 1 week after treatment with the LouseBuster. There were no adverse effects of treatment.

[Strangely, I think the authors of this article had a conflict of interest.The LouseBuster was made in Salt Lake City and Groates does his research there, too.While hot air is an attractive remedy, it may no be practical. DJE]