Issue 17: Diamond Coated Implants, Lassa Fever, IPF, Daytime Sleepiness

Blinged Out Diamond Hip Replacements 
Diamond Coated Titanium. Image Credit: RMIT
Researchers from Australia recently made a world first by creating a 3D printed diamond encrusted titanium implant. The next time your grandmother needs a hip replacement she could potentially be getting straight blinged out. But let me explain why diamonds are a hip replacement patients’ best friend. Titanium has been the standard for implants because they can be produced safely and reliably, but our bodies sometimes have trouble accepting the metal. Dr. Kate Fox and her team at RMIT coated the titanium implants with tiny nanodiamonds (which apparently aren’t that expensive to find) which provides for a better more comfortable surface for human cells to get all up close to. The diamond also can reduce pesky bacterial attachment over long periods of time. Dr. Kate Fox sums it up by saying, "Not only could our diamond coating lead to better biocompatibility for 3D-printed implants, but it could also improve their wear and resistance. It's an exceptional biomaterial."

Lassa Fever in Nigeria 
Kids walking in Nigeria
Nigeria is currently experiencing an outbreak of Lassa Fever, that has infected 353 people since January 1st of this year. Already more than the 143 reported cases in all of 2017. Lassa Fever is an acute hemorrhagic disease that can be transmitted to humans from rat urine and droppings. Unfortunately hospitals in Nigeria are understaffed, so treating all the patients on the wards remains difficult. The exact reasons for the outbreak this year are currently unknown, however, the Nigerian Centre for Disease Control has proposed several possible reasons including viral mutations and more public awareness which leads to better reporting.To make things worse Lassa Fever has no vaccines or drugs for treatment and kills 20-30% of those it infects. 

What's up with the lung disease killing dentists? Let the CDC know if you find out

High Resolution CT of IPF. Image from Cleveland Clinic
Idiopathic Pulmonary Fibrosis (IPF) affects 200,000 Americans every year, but a strange statistic stands out: according to the CDC Morbidity and Mortality Weekly Report, dentists are 23 times more likely to be affected by IPF. IPF presents with largely non-specific symptoms, including weight loss, dry cough, joint pains, and eventual clubbing of fingers. The median survival range post-diagnosis of IPF is approximately 3-5 years, making the discovery of a root cause essential. Preliminary studies by the CDC show that dentists are exposed to silica, polyvinyl siloxane, and alginate--all potential hazards when inhaled, though the exact relationship of these toxins to IPF has yet to be determined. While the prognostic outcome of IPF isn't looking too great, simple prevention methods including proper ventilation and wearing respirators during procedures might be enough to protect dentists from this terrible potential side effect of their job. 

The childhood obesity epidemic is (sadly) here to stay
Despite recent claims that the obesity crisis in America is improving, the latest analysis of federal data published in Pediatrics showed that there was no statistical difference in childhood obesity rates between 2013-2014 and 2015-2016. This data is based on the NHANES survey, the government's major indicator of childhood obesity. In fact, the data is quite grim--the percentage of obese children aged 2 through 19 increased from 14 percent in 1999 to 18.5 percent in 2016. If that wasn't jarring enough, this latest analysis reports that since 2014, there has been an increase in obesity in children aged 2 through 5 from 9 percent to 14 percent. That means we are failing children at their youngest years of development, a statistic that makes doctors like Dr. David Ludwig of Boston Children's Hospital to call for a "national, comprehensive strategy to tackle this epidemic." We can, and must, do better!  

Cigna Buys Express Scripts
Map of Pharmacy Benefit Managers
Just this week, CVS finalized the merger with Aetna at a whopping $69 billion. Meanwhile, another giant merger deal was cooking up: Cigna signals to buy Express Scripts for $67 billion. So what does this all mean? Now, Express Scripts is the nation’s biggest Pharmacy Benefit Manager (PBM). PBM is theoretically a lobbyist for some of your pharmacy benefits so you can get the best rebates and discounts, but it has been on the chopping block for inflating the overall cost of medications. A vertical integration of an insurance company with a PBM can sound optimistic to the layman. I mean, wouldn’t it be wonderful to have one entity control your medical insurance and pharmacy benefits? Wouldn’t that somehow lower administrative and various other costs? But the old faithful evidence-based approach shows doubt. UnitedHealth’s PBM, Optum, bought the PBM, Catamaran, in 2015 with big claims to improve efficiencies, but benefits to customers have not been proven. At this rate, the PBM’s will all go under insurance companies and become even less transparent. Will all these giant mergers effectively control rising drug costs and make healthcare lean? Or will it allow for more covering up of the already bloated healthcare cost in the U.S.? 

Daytime Sleepiness and Alzheimer’s
If your grandparents enjoy that sweet nap in the afternoon, ready to get nervous. A recent JAMA Neurology article was a study in Mayo Clinic that showed increased build-up of amyloid plaques in brain scans of patients over 70  who reported they were very sleepy during the day, in a span of seven years. This is the first study to show the relationships between poor sleep and amyloid plaques over extended period of time. It’s one step closer to treating the perhaps holy grail, billion dollar question of Alzheimer’s Disease. Whether you are a believer of fixing Tau tangles or Amyloid plaques to potentially cure Alzheimer’s, we know amyloid plaques are the harbinger of Alzheimer’s, and they sneak up on patients before symptoms of dementia are manifested. We still have lingering questions. What exactly is disturbing their sleep quality? Does this mean we have to keep our grandparents awake during the day? How do we help them improve their sleep quality at night? Either way, caregivers will have to stay up to help them prevent Alzheimer’s Disease.