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[ { "answer_id": 20289, "body": "<p>I believe the answer is somewhere between 0.5% and 1% (about 500-1000 deaths per 100000 births). Below is the list of the sources I reviewed. Some sources provide higher estimates, but those should be attributed to unsanitary conditions in hospitals in the past (in the past births in a hospital were more dangerous than at home, because of contamination by the doctors).</p>\n\n<ul>\n<li>Chamberlain Geoffrey. <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1633559/\" rel=\"noreferrer\">British maternal mortality in the 19th and early 20th centuries.</a> J. R. Soc. Med. 2006;99:559–563.</li>\n<li>Loudon I. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/3511335\" rel=\"noreferrer\">Deaths in childbed from the eighteenth century to 1935</a>. Med Hist. 1986 Jan;30(1):1-41.</li>\n<li>Loudon I. <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3807776/\" rel=\"noreferrer\">Ignaz Phillip Semmelweis' studies of death in childbirth</a>. J R Soc Med. 2013 Nov; 106(11): 461–463; doi: 10.1177/0141076813507844; PMCID: PMC3807776; PMID: 24158918</li>\n<li>Max Roser and Hannah Ritchie (2019) - \"Maternal Mortality\". Published online at OurWorldInData.org. Retrieved from: '<a href=\"https://ourworldindata.org/maternal-mortality\" rel=\"noreferrer\">https://ourworldindata.org/maternal-mortality</a>' [Online Resource]</li>\n</ul>\n", "score": 5 } ]

[ "death", "healthcare-data", "childbirth" ]

[ { "answer_id": 20414, "body": "<p>Medical oxygen in liquid or compressed cylinders is typically <a href=\"http://ftp.uspbpep.com/v29240/usp29nf24s0_m59550.html\" rel=\"noreferrer\">>99% O₂</a>, but it is not typically administered at full strength. Instead, patients inspire a mixture of O₂ and room air.</p>\n\n<p>Oxygen concentrator units concentrate to <a href=\"http://ftp.uspbpep.com/v29240/usp29nf24s0_m59560.html\" rel=\"noreferrer\">90-96%</a>, which is called \"93% oxygen\". The remainder is mostly nitrogen.</p>\n", "score": 9 } ]

[ "oxygen" ]

[ { "answer_id": 20459, "body": "<p>You're right, the best placebos are ones where the subject can't really know which group they are in. However, it still makes sense to have a control group, and even if a placebo isn't ideal it can be better than nothing.</p>\n\n<p>For studies of psychedelics, for example, there are a few key points:</p>\n\n<p>A) At the very least, the placebo is a control for the drug administration. In the study you linked, drugs are being given IV. It's expected that DMT is going to cause behavioral effects, and so of course is going to be detectable by the subjects, but in a study like this they are measuring EEG which isn't something the subjects are likely to be able to manipulate. Both groups get an IV injection, so the placebo makes sure that the brain changes aren't from the IV itself.</p>\n\n<p>B) Additionally, they are asking subjective questions about the experience the subjects are having, so if subjects are just \"making it up\" you'd expect the same scores in the placebo and DMT groups. Of course the DMT does have an effect, but that's fine: it's expected to have an effect and the subjects are expected to report that effect. If the placebo group says they're having a really intense experience then it seems likely that some of the result is just because the subjects <em>expected</em> they would be getting DMT, rather than actually getting it.</p>\n\n<p>C) Symptoms of, for example, depression or pain tend to change with time. Except for the most extreme cases of treatment-resistant depression, if you take a group of people who meet the criteria for depression today, you would expect that on average they will have a reduction in depressive symptoms at a future time point. This is an example of <a href=\"https://en.wikipedia.org/wiki/Regression_toward_the_mean\" rel=\"noreferrer\">regression to the mean</a>. Therefore, a control group is really important. This, however, is where the lack of a psychoactive placebo may be a bit of a problem. I would say this is a good reason for long-term follow-up, because long-term symptom relief is less likely to be due to placebo effects of the drug.</p>\n\n<p>D) These studies typically (always, from my experience with the literature) include a substantial therapy component as well as the psychedelic treatment. The placebo group also gets this therapy, in addition to their placebo drug.</p>\n\n<p>E) The placebo choice is often selected to be something that does have some physical effect that isn't psychedelic in nature. <a href=\"https://en.wikipedia.org/wiki/Niacin\" rel=\"noreferrer\">Niacin</a> for example can cause some sort of tingling feeling. Subjects may be told that the study involves different doses of a psychedelic, so (especially psychedelic-naive subjects) may not know whether they've gotten a low dose or a placebo.</p>\n", "score": 6 } ]

[ "placebo" ]

[ { "answer_id": 20585, "body": "<blockquote>\n <p><strong>Question:</strong> How reliable is the determination method of reference ranges for blood tests?</p>\n</blockquote>\n\n<p><strong>Short answer:</strong> The tests for which you can find different reference ranges may not be unreliable because of different ranges but because they are unreliable as such. For example, <em>all</em> reference ranges for vitamin B12 in the blood are unreliable, because the blood levels of B12 only poorly reflect the actual B12 status in the body. It is often only <strong>a combination of tests</strong> that can reliably reflect a certain situation. </p>\n\n<p>In general, the reference ranges of the blood tests have been determined on the basis of decades of studies from around the world that have shown which ranges have been associated with minimal incidence of symptoms and diseases. Different health authorities may judge the background evidence differently, so this is why reference ranges can be different.</p>\n\n<p>There is a suggestion that every <strong>country</strong> should determine their own reference ranges:</p>\n\n<blockquote>\n <p>International guidelines recommend that every country must establish\n reference intervals for healthy individuals belonging to a group of\n homogeneous population. (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/23105819/\" rel=\"nofollow noreferrer\">Indian Journal of Clinical Biochemistry, 2009</a>)</p>\n</blockquote>\n\n<p>...and some countries have and others haven't determined them. Sometimes, reference ranges can also differ among hospitals and labs, and they can change with time.</p>\n\n<hr>\n\n<p>Here are few examples how the blood tests need to be judged regardless of reference ranges: </p>\n\n<p><strong>1) NORMAL BLOOD VALUES MAY NOT REFLECT DEFICIENCY - Calcium</strong></p>\n\n<p>Blood calcium levels can remain normal for years even in a person with severe calcium deficiency, because calcium leached from the bones maintains normal blood levels.</p>\n\n<p><a href=\"https://academic.oup.com/ndt/article/21/1/29/1819075\" rel=\"nofollow noreferrer\">What serum calcium can tell us and what it can't (Nephrology, Dialysis, Transplantation, 2005)</a>:</p>\n\n<blockquote>\n <p>When dietary calcium intake is inadequate (&lt;600 mg/day in young\n adults) and/or intestinal calcium absorption abnormal, the serum\n calcium level can be kept stable only at the cost of a gradual\n depletion of bone calcium stores.</p>\n</blockquote>\n\n<p>So, the <a href=\"https://www.radiologyinfo.org/en/info.cfm?pg=dexa\" rel=\"nofollow noreferrer\">bone mineral density</a> can more accurately show the calcium status.</p>\n\n<p><strong>2) PERSONAL DIFFERENCES - Vitamin B12</strong></p>\n\n<p>Symptoms of vitamin B12 deficiency can occur at very different B12 levels in different individuals:</p>\n\n<blockquote>\n <p>Subclinical vitamin B12 deficiency (usually defined as a total serum\n B12 of &lt;200 pmol/L) presents asymptomatically or with rather subtle\n generic symptoms that oftentimes are mistakenly ascribed to unrelated\n disorders. Numerous studies have now established that <strong>serum vitamin\n B12 has limited diagnostic value as a stand-alone marker.</strong> Low serum\n levels of vitamin B12 not always represent deficiency, and likewise,\n severe functional deficiency of the micronutrient has been documented\n in the presence of normal and even high levels of serum vitamin B12. (<a href=\"https://www.frontiersin.org/articles/10.3389/fmolb.2016.00027/full\" rel=\"nofollow noreferrer\">Frontiers in Biomolecular Sciences, 2016</a>)</p>\n</blockquote>\n\n<p>Methylmalonic acid (MMA) levels may more accurately reflect the B12 status, because they indicate a metabolic change that is highly specific to B12 deficiency (<a href=\"https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/\" rel=\"nofollow noreferrer\">Office of Dietary Supplements</a>).</p>\n\n<p><strong>3) ETHNIC FACTORS - blood cells</strong></p>\n\n<p>Normal reference ranges can differ among ethnic groups:</p>\n\n<blockquote>\n <p>This current study included 3,077 participants aged 18–65 years\n who reported their health status as “Excellent,” “Very good,” or\n “Good,” with known race/ethnicity as white, black, Hispanic, or Asian.\n Quantile regression analyses adjusted for sex were conducted to\n evaluate racial/ethnic differences in the normal ranges of 38\n laboratory tests. <strong>Significant racial/ethnic differences were found\n in almost all laboratory tests.</strong> Compared to whites, the normal range\n for Asians significantly shifted to higher values in globulin and\n total protein and to lower values in creatinine, hematocrit,\n hemoglobin, mean cell hemoglobin, mean cell hemoglobin concentration,\n and mean platelet volume. (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26468426\" rel=\"nofollow noreferrer\">Hawai'i Journal of Medicine and Public Health, 2015</a>)</p>\n</blockquote>\n\n<p><strong>4) ENVIRONMENTAL FACTORS - Vitamin D</strong> </p>\n\n<p>Nordic populations have low sun exposure but have one of the highest <a href=\"https://en.wikipedia.org/wiki/List_of_countries_by_milk_consumption_per_capita\" rel=\"nofollow noreferrer\">milk consumption per capita</a> on the world (milk is high in vitamin D) and they have one of the highest <a href=\"https://commons.wikimedia.org/wiki/File:Vitamin_D_serum_levels_in_adults_world_map.svg\" rel=\"nofollow noreferrer\">blood vitamin D levels in average (a map)</a>. So, the environmental factors can influence <em>actual</em> blood levels but they do not need to influence what <em>reference ranges</em> should be. For example:</p>\n\n<blockquote>\n <p>The large majority of adults living close to the Arctic Circle in\n Sweden have adequate D3 levels even during the second half of the dark\n winter.</p>\n \n <p>Levels used for definitions were...adequate, D3≥50 nmol/l (20 ng/ml).\n <em>(<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4432023/\" rel=\"nofollow noreferrer\">International Journal of Circumpolar Health</a>)</em></p>\n</blockquote>\n\n<p>So, the \"adequate\" D3 level in the above study in Sweden was considered ≥50 nmol/l (20 ng/ml), which is the same as \"sufficient\" level in the United States (<a href=\"https://www.cdc.gov/nchs/products/databriefs/db59.htm\" rel=\"nofollow noreferrer\">CDC.gov</a>). Anyway, to properly evaluate vitamin D levels, one should also check calcium levels and other tests.</p>\n", "score": 4 } ]

[ "blood", "blood-tests", "hematology", "biochemistry" ]

[ { "answer_id": 26262, "body": "<p>Yes you can just close the eyes to relax them. The cure for fatigue is rest. It's not just the intraocular muscles that need to be relaxed. Even the extraocular muscles need the rest. Moreover, it also helps to relax the face muscles and neck muscles. I've recovered from severe eye strain. I know. The 20-20-20 rule didn't work for me, since my strain was severe. However, the simple fact of getting periodic rest was proven beneficial (Ref1). Getting 8 hours of sleep every night and closing my eyes after 20 minutes of computer use, slowly cured my strain and proper sleep and nutrition is also studied and accepted by researchers (Ref2).</p>\n<p><a href=\"https://pubmed.ncbi.nlm.nih.gov/28546777/\" rel=\"nofollow noreferrer\">Ref1</a>: &quot;<em>rest breaks for 30 seconds every 30 minutes of computer use, and 15-minute rest break (in the morning and the afternoon)...was associated with reduction in percentage of eye strain</em>&quot;.<br />\n<a href=\"https://pubmed.ncbi.nlm.nih.gov/24195055/\" rel=\"nofollow noreferrer\">Ref2</a>: &quot;<em>analysis revealed a significant relationship between the use of computer and asthenopia...Good sleep...were found to be strong predictors of decreasing the occurrence of asthenopia complaints.</em>&quot;</p>\n", "score": 2 } ]

[ "eye", "eye-strain" ]

[ { "answer_id": 20846, "body": "<h2>ACUTE effects of drinking distilled water</h2>\n\n<p>The idea behind the myth that distilled water is harmful is that its low osmolality (\"tonicity\") could dangerously decrease the blood osmolality, which is normally: 285-295 mmol/kg. But distilled water has only slightly lower osmolality (0 mmol/kg) than tap water (~3 mmol/kg) (<a href=\"https://sgsm.ch/fileadmin/user_upload/Zeitschrift/54-2006-3/Osmolality_54_3_06.pdf\" rel=\"nofollow noreferrer\">SGSM.ch, Table 2</a>), <strong>so if drinking appropriate amounts of tap water does not significantly lower blood osmolality, distilled water also shouldn't.</strong> </p>\n\n<p>What happens when you drink distilled water:</p>\n\n<ul>\n<li>It is mixed with gastric acid and fluids in the intestine, so at the time of absorption, it's no longer distilled water. Also, at a certain time before and after drinking distilled water, you probably eat something and thus likely get more minerals with food than with most types of water.</li>\n<li>When absorbed, it <em>tends</em> to lower the blood osmolality, which is sensed by osmoreceptors in the hypothalamus, which signal the pituitary gland to decrease the secretion of the antidiuretic hormone, which stimulates water excretion in the kidneys until the blood osmolality is corrected (<a href=\"http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/adh.html\" rel=\"nofollow noreferrer\">Colostate.edu</a>).</li>\n</ul>\n\n<p>You can find \"distilled,\" \"demineralized,\" \"reverse osmosis\" and \"purified\" bottled waters in grocery stores on the shelves together with other beverages, so they are not likely \"dangerous.\"</p>\n\n<h2>CHRONIC effects of drinking distilled water</h2>\n\n<p>The idea behind the hypothesis that long-term intake of distilled water could be harmful is that it could leach minerals from your body. A 1980 report by <a href=\"https://www.who.int/water_sanitation_health/dwq/nutrientsindw.pdf\" rel=\"nofollow noreferrer\">World Health Organization</a> says:</p>\n\n<blockquote>\n <p>Salts are leached from the body under the influence of drinking water\n with a low TDS. <em>(TDS = total dissolved solids)</em></p>\n</blockquote>\n\n<p>The 1980 WHO report has been criticized in a 1993 report by <a href=\"https://www.wqa.org/Portals/0/Technical/Technical%20Fact%20Sheets/1993_ConsumptionOfLowTDSWater.pdf\" rel=\"nofollow noreferrer\">Water Quality Association</a> who have found no reliable evidence about harmful effects of water with a low TDS on health:</p>\n\n<blockquote>\n <p>It has been concluded that the consumption of low TDS water, naturally\n occurring or received from a treatment process, does not result in\n harmful effects to the human body.</p>\n</blockquote>\n\n<p>Another argument against distilled water is that it doesn't contain \"healthy\" minerals, such as calcium and magnesium. But <a href=\"http://www.mgwater.com/mgrank.shtml\" rel=\"nofollow noreferrer\">a list of tap waters from 100 US cities</a> shows that average tap water contains less than 50 mg Ca and less than 10 mg Mg per liter. So, by drinking 2 liters of tap water per day you could expect to get less than 100 mg Ca and less than 20 mg Mg, which contributes only little to the <a href=\"http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2019/DRI-Tables-2019/6_DRIValues_Summary.pdf?la=en\" rel=\"nofollow noreferrer\">Recommended Dietary Allowance</a> for adults (Ca = 800-1,000 mg/day; Mg = 350 mg/day).</p>\n\n<h2>About water intoxication</h2>\n\n<p><em>Any</em> water, distilled or tap, and other beverages that are low in sodium can cause <a href=\"https://en.wikipedia.org/wiki/Water_intoxication\" rel=\"nofollow noreferrer\">water intoxication</a> (dilutional hyponatremia) if you <strong>drink them a lot in a short time, for example, more than 1.5 liters per hour for several hours in a row</strong> (<a href=\"https://www.researchgate.net/publication/228550291_Current_US_Military_Fluid_Replacement_Guidelines/link/0c960532708622c10b000000/download\" rel=\"nofollow noreferrer\">Research Gate</a>), because your kidneys may not be able to excrete more than 1 liter of water per hour. Again, distilled water is not significantly worse than tap water in this regard.</p>\n\n<h2>In conclusion:</h2>\n\n<p>Distilled water is not acutely dangerous and there is no reliable evidence of its eventual chronic harms. Anyway, demineralized/distilled water may not be the optimal beverage because it has a flat taste and does not contribute to calcium and magnesium intake.</p>\n", "score": 6 } ]

[ "water", "folk-medicine" ]

[ { "answer_id": 21013, "body": "<p>Blood is not always drawn from the veins depending on the medical need and situation. In most of the cases and for general tests, however, blood is drawn from veins which is known as <a href=\"https://en.wikipedia.org/wiki/Venipuncture\" rel=\"nofollow noreferrer\">Venipuncture</a>. (<a href=\"https://biology.stackexchange.com/questions/27799/why-draw-blood-from-veins-rather-than-arteries/27800\">Why draw blood from veins rather than arteries?</a></p>\n\n<p>The integrity of the sample taken is dependent on using good technique, drawing from an\nappropriate site, and avoiding hemolysis or contamination of a sample.<a href=\"https://sci-hub.tw/10.1016/B978-1-4160-3001-0.50009-5\" rel=\"nofollow noreferrer\">Link</a></p>\n\n<p><strong>Site selection for venipuncture</strong></p>\n\n<p><a href=\"https://www.sciencedirect.com/science/article/pii/B9780323400534000238\" rel=\"nofollow noreferrer\">Factors to be considered for site selection:</a></p>\n\n<ol>\n<li>Condition of the Superficial Veins</li>\n<li>Relationship of the Vein to other Anatomic Structures</li>\n<li>Duration of the Venipuncture</li>\n<li>Clinical Status of the Patient</li>\n<li>Age (Size) of the Patient</li>\n</ol>\n\n<p>Characteristics of good veins for venipuncture include bouncy, soft, refills when depressed, has a large lumen, straight, visible and is well supported.</p>\n\n<p><a href=\"http://www.shropscommunityhealth.nhs.uk/content/doclib/10899.pdf\" rel=\"nofollow noreferrer\">Veins to avoid during venipuncture</a></p>\n\n<ul>\n<li>Veins that may be irritated from previous use</li>\n<li>Veins in lower extremities</li>\n<li>Areas of joint flexion</li>\n<li>Veins close to arteries and deeper-lying vessels</li>\n</ul>\n\n<blockquote>\n <p>The antecubital area of the arm is usually the first choice for routine venipuncture. This area contains the three vessels primarily used by the phlebotomist to obtain venous blood specimens: the median cubital, the cephalic and the basilic veins.\n Although the veins located in the antecubital area should be considered first for vein selection, there are alternate sites available for venipuncture. These include the top of the hand, the side of the wrist, and the forearm. These sites should only be considered after determining that the veins of the antecubital area cannot be accessed or cannot be used.<a href=\"https://www.labce.com/spg263718_explore_the_possibilities.aspx\" rel=\"nofollow noreferrer\">Link</a><a href=\"https://i.stack.imgur.com/GGnGc.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/GGnGc.png\" alt=\"enter image description here\"></a></p>\n</blockquote>\n\n<p>In practice, the usual preference is the arm, with the leg used when arm veins are inadequate or in emergency situations in which the arm may be unavailable or unsuitable for use. </p>\n\n<blockquote>\n <p>Use of the leg for venipuncture is usually reserved for the infant or child, in whom arm veins are smaller and less superficial than in the adult, or the adult with a disability, in whom a venipuncture site in the foot may be more easily secured than one on the arm.</p>\n \n <p>Advantages of the foot or ankle for venipuncture include the following:</p>\n \n <ol>\n <li>Superficial vessels</li>\n <li>Relatively large vessels</li>\n <li>Anatomically safe</li>\n <li>No need to immobilize the venipuncture site</li>\n </ol>\n \n <p>Disadvantages of the foot and ankle as a venipuncture site include the following:</p>\n \n <ol>\n <li>Accessibility is more limited than with the upper limb.</li>\n <li>Veins roll when contacted by the needle.<a href=\"https://www.sciencedirect.com/science/article/pii/B9780323400534000238\" rel=\"nofollow noreferrer\">Link</a></li>\n </ol>\n</blockquote>\n\n<p>In the case of difficult venipuncture, an individual may make a maximum of two attempts before having someone else try. A third stick is allowable if a partial sample has been obtained and you as the drawer feel reasonably confident that you can obtain the specimen on the next try.<a href=\"https://www.akronchildrens.org/lab_test_specimen_procedures/PERFORMING_A_VENIPUNCTURE.html\" rel=\"nofollow noreferrer\">Link</a></p>\n\n<p><a href=\"https://i.stack.imgur.com/07Nnh.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/07Nnh.png\" alt=\"https://www.labce.com/spg263747_unacceptable_sites_for_venous_blood_collection.aspx\"></a></p>\n", "score": 4 } ]

[ "blood-tests" ]

[ { "answer_id": 23430, "body": "<p>I cannot answer about South Korea, but as far as other drive-in test stations are concerned the rules I've seen are: </p>\n\n<ul>\n<li>Call ahead to get checked whether testing is indicated, get issued a special testing number.</li>\n<li>Go there, get tested with the testing number.</li>\n<li>Go back home, get test result via mail.</li>\n</ul>\n", "score": 2 } ]

[ "covid-19", "test", "pcr" ]

[ { "answer_id": 23173, "body": "<p>An article in National Geographic summarizes several theories on why COVID-19 is less lethal in children (but not infants): <a href=\"https://www.nationalgeographic.com/science/2020/03/coronavirus-spares-most-kids-these-theories-may-help-explain-why/\" rel=\"nofollow noreferrer\">https://www.nationalgeographic.com/science/2020/03/coronavirus-spares-most-kids-these-theories-may-help-explain-why/</a></p>\n\n<p>They cite Ming S. Yip et al. (2011), which implicates antibody-dependent enhancement (ADE) triggered by prior infections of other endemic coronaviruses (common colds). Ming suggests that because adults have more past exposure to priming strains of coronavirus, SARS-CoV-1 is able to enter human immune cells through an antibody-mediated pathway. See: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3019510/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3019510/</a></p>\n\n<p>More recently, Jason A. Tetro (2020) suggests geographic differences in COVID-19 mortality further support the theory that ADE contributes to symptom severity and risk of death from SARS-CoV-2 infection. See: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102551/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102551/</a></p>\n", "score": 2 }, { "answer_id": 23175, "body": "<p>I'm probably not going to do <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7113798/\" rel=\"nofollow noreferrer\">Cristiani at al. (Apr 2)</a> much justice with this answer, but to use just their conclusion figure</p>\n<blockquote>\n<p><a href=\"https://i.stack.imgur.com/TagHI.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/TagHI.png\" alt=\"enter image description here\" /></a></p>\n<p>We can speculate that high ACE2 receptor concentrations, trained immunity and a constitutional high lymphocyte count in children may partially explain the mild disease observed in this group of patients (fig. 1). Real reasons will probably remain a mystery fortunately because the number of infected [by which they probably mean tested] children is too low to allow good-sized immunological studies.</p>\n</blockquote>\n<p>By &quot;trained immunity&quot; they mostly seem to mean cross-reactivity to other vaccines administered in childhood. (They do mention NK cells as playing a role in that; see also in-depth <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5087274/\" rel=\"nofollow noreferrer\"><em>Science</em> article</a> on this fairly rencent notion of &quot;trained immunity&quot; aka &quot;innate immune memory&quot;.)</p>\n<p>Frankly their last argument (high lymphocyte count) seems a bit in doubt because a <a href=\"https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e4.htm\" rel=\"nofollow noreferrer\">CDC study (April 10)</a> found that infants &lt;1yo actually might &quot;get it worse&quot; than the 1-17 y.o. group:</p>\n<blockquote>\n<p>Children aged &lt;1 year accounted for the highest percentage (15%–62%) of hospitalization among pediatric patients with COVID-19. Among 95 children aged &lt;1 year with known hospitalization status, 59 (62%) were hospitalized, including five who were admitted to an ICU. The percentage of patients hospitalized among those aged 1–17 years was lower (estimated range = 4.1%–14%), with little variation among age groups.</p>\n</blockquote>\n<p>So it's not an entirely uniform effect (by age).</p>\n<p>Also from the CDC study, another mystery is why male children seem to get it (somewhat) more often:</p>\n<blockquote>\n<p>In this preliminary analysis of U.S. pediatric COVID-19 cases, a majority (57%) of patients were males. Several studies have reported a majority of COVID-19 cases among males (4,9), and an analysis of 44,000 COVID-19 cases in patients of all ages in China reported a higher case-fatality rate among men than among women (10). However, the same report, as well as a separate analysis of 2,143 pediatric COVID-19 cases from China, detected no substantial difference in the number of cases among males and females (5,10). Reasons for any potential difference in COVID-19 incidence or severity between males and females are unknown. In the present analysis, the predominance of males in all pediatric age groups, including patients aged &lt;1 year, suggests that biologic factors might play a role in any differences in COVID-19 susceptibility by sex.</p>\n</blockquote>\n", "score": 2 } ]

[ "covid-19" ]

[ { "answer_id": 21630, "body": "<p>In the <strong>United States</strong>, any ventilator must fulfill:</p>\n\n<ol>\n<li>Safety and </li>\n<li>Efficacy </li>\n</ol>\n\n<p>requirements as set forth in <a href=\"https://www.meddeviceonline.com/doc/an-introduction-to-international-medical-device-standards-0001\" rel=\"nofollow noreferrer\">Medical Device Standards</a>. </p>\n\n<p>Sales of medical devices are regulated by the FDA: a lengthy (data intensive) and paperwork intensive process. FDA <a href=\"https://www.fda.gov/medical-devices/letters-health-care-providers/ventilator-supply-mitigation-strategies-letter-health-care-providers\" rel=\"nofollow noreferrer\">ventilator specific guidance</a> within the context of COVID respirator demand </p>\n\n<p>I would suggest that you identify testable system requirements. The quickest way to learn is to operate an existing device: if you have access to a healthcare professional (Anesthesiologist or Respiratory Therapist), he / she would be the best functional resource. A good starting point (do your homework before talking to anyone) is this <a href=\"https://www.youtube.com/watch?v=gk_Qf-JAL84\" rel=\"nofollow noreferrer\">functional explanation on youTube</a>. </p>\n\n<p>Challenges for hacking a ventilator for the COVID crisis comprises:</p>\n\n<ol>\n<li>A design where parts (Bill of Materials) are readily available (100K to 1M devices needed)</li>\n<li>A testbed to demonstrate Safety and Efficacy testing + any required regulatory approval</li>\n<li>Skilled labor to manufacture assemble and test </li>\n</ol>\n\n<h1>UPDATE</h1>\n\n<p>April 8 2020: <a href=\"https://techcrunch.com/2020/03/30/medtronic-is-sharing-its-portable-ventilator-design-specifications-and-code-for-free-to-all/\" rel=\"nofollow noreferrer\">Medtronic is sharing its portable ventilator design specifications and code for free to all</a> That being said, a 510K and all the document would be required by the FDA ensure requirements discussed above are met.</p>\n", "score": 5 }, { "answer_id": 23109, "body": "<p>This is not my work, but there is now a Youtube video that goes into the complex details of actual medical ventilators, and what needs to be done for a DIY device to do it safely.</p>\n\n<p><strong>A Guide To Designing Low-Cost Ventilators for COVID-19</strong></p>\n\n<p>By Real Engineering, published April 4, 2020</p>\n\n<p><a href=\"https://www.youtube.com/watch?v=7vLPefHYWpY\" rel=\"nofollow noreferrer\">https://www.youtube.com/watch?v=7vLPefHYWpY</a></p>\n", "score": 0 } ]

[ "covid-19", "medical-device" ]

[ { "answer_id": 22895, "body": "<p><img src=\"https://i.stack.imgur.com/PP66A.jpg\" alt=\"\" /></p>\n<p>Covid-19 is the result of a zoonotic outbreak from bats to an intermediate ( and unidentified host ) thence to humans. It is thought that bats don't suffer the disease themselves as they carry low levels of virus but the intermediate host modifies the virus, and amplifies it so that it vastly increases the amount of virus that can shed into the environment infecting humans. One possible scenario is that bat coronavirus combined with a fish coronavirus inside the intermediate host. This is based on the observation that the SARS-CoV-2 spike gene shares a 39-base insertion with a type of soldierfish that swims in the South China Sea.</p>\n<p>The SARS-CoV-2 infects humans via the ACE2 surface receptor, but this receptor is not only found in humans. Other animals have similar but not exactly the same ACE2 receptors and several dogs and one cat have returned positive swabs for SARS-CoV-2. The cat developed covid-19 symptoms. The first dog died two days after being released back to its owner but that might have been from the stress of quarantine in a 17 year old Pomeranian. Ferrets also have an ACE2 receptor which also binds strongly to the SARS virus so presumably are also at risk. Mice appear to be less at risk.</p>\n<blockquote>\n<p>This is the first human-to-cat transmission of the novel coronavirus (SARS-CoV-2). About a week after its owner got sick with COVID-19, after returning from a trip to Northern Italy, the cat developed coronavirus symptoms: diarrhea, vomiting and respiratory issues, Steven Van Gucht, virologist and federal spokesperson for the coronavirus epidemic in Belgium, told Live Science.</p>\n<p>The owner sent samples of vomit and feces to Dr. Daniel Desmecht's lab at the Faculty of Veterinary Medicine of Liège. Genetic tests showed high levels of SARS-CoV-2 in those samples, he said. &quot;The cat recovered after 9 days,&quot; Van Gucht said.</p>\n</blockquote>\n<p>The Hong Kong Govt is now asking that pets of infected patients must now be quarantined for 14 days.</p>\n<p>The CDC gives the following advice (which is out of date based on the above):</p>\n<blockquote>\n<p>If you are sick with COVID-19 (either suspected or confirmed), you should restrict contact with pets and other animals, just like you would around other people. Although there have not been reports of pets or other animals becoming sick with COVID-19, it is still recommended that people sick with COVID-19 limit contact with animals until more information is known about the virus. This can help ensure both you and your animals stay healthy.</p>\n<p>When possible, have another member of your household care for your animals while you are sick. Avoid contact with your pet including, petting, snuggling, being kissed or licked, and sharing food. If you must care for your pet or be around animals while you are sick, wash your hands before and after you interact with them. For more information visit: What to Do if You are Sick.</p>\n</blockquote>\n<p>We don't have information on cows but presume that they may also be susceptible.</p>\n<p>EDIT: Experimental data suggests cats are more susceptible to the virus than dogs</p>\n<blockquote>\n<p>The team, led by virologist Bu Zhigao, infected five domestic cats with SARS-CoV-2 through the nose. When two of the cats were euthanized six days later, the researchers found viral RNA, as well as infectious virus particles, in their upper respiratory tracts.</p>\n<p>The other three infected cats were put in cages next to three uninfected felines. The team later detected viral RNA in one of the non-infected cats, which suggests that they contracted the virus from the infected cats through respiratory droplets. All four cats also produced antibodies against SARS-CoV-2. Surveillance for SARS-CoV-2 in cats should be considered as part of efforts to eliminate COVID-19 in humans, the authors note in the preprint, which has not been peer reviewed.</p>\n</blockquote>\n<p>6 April 2020</p>\n<p>7 lions and tigers reported infected by a zoo keeper at NY's Bronx zoo. A Malayan Tiger first fell ill.</p>\n<p>and</p>\n<blockquote>\n<p>Dogs, however, were less susceptible to the virus. The researchers infected five young dogs and found that two excreted viral RNA in faeces, but none contained infectious virus.</p>\n<p>Similar investigations in pigs, chickens and ducks identified no viral RNA in animals deliberately infected with the virus, or those exposed to the infected animals</p>\n</blockquote>\n<p><strong>Edit 21 May 2020</strong></p>\n<p>A paper from April 2020 shows a high affinity for bovidae ACE2 for the COVID-19 binding region which suggests that cows can be easily infected.</p>\n<blockquote>\n<p>In conclusion, we found that Bovidae/Cricetidae ACE2 but not turtle/snake ACE2 could recognize SARS‐CoV‐2 RBD. More attention should be paid to Bovidae and Cricetidae in hunting the potential intermediate host for SARS‐CoV‐2.</p>\n</blockquote>\n<p><a href=\"https://www.wsj.com/articles/hong-kong-says-pets-of-coronavirus-patients-need-to-be-quarantined-11582888486\" rel=\"noreferrer\">https://www.wsj.com/articles/hong-kong-says-pets-of-coronavirus-patients-need-to-be-quarantined-11582888486</a></p>\n<p><a href=\"https://www.livescience.com/cat-infected-covid-19-from-owner.html\" rel=\"noreferrer\">https://www.livescience.com/cat-infected-covid-19-from-owner.html</a></p>\n<p><a href=\"https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/animals.html\" rel=\"noreferrer\">https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/animals.html</a></p>\n<p><a href=\"https://blogs.plos.org/dnascience/2020/02/20/covid-19-vaccine-will-close-in-on-the-spikes/\" rel=\"noreferrer\">https://blogs.plos.org/dnascience/2020/02/20/covid-19-vaccine-will-close-in-on-the-spikes/</a></p>\n<p><a href=\"https://link.springer.com/content/pdf/10.1007%2F978-0-387-33012-9_93.pdf\" rel=\"noreferrer\">https://link.springer.com/content/pdf/10.1007%2F978-0-387-33012-9_93.pdf</a></p>\n<p><a href=\"https://www.nature.com/articles/d41586-020-00984-8\" rel=\"noreferrer\">https://www.nature.com/articles/d41586-020-00984-8</a></p>\n<p><a href=\"https://i.stuff.co.nz/world/americas/120836675/coronavirus-tiger-at-new-yorks-bronx-zoo-tests-positive-for-covid19\" rel=\"noreferrer\">https://i.stuff.co.nz/world/americas/120836675/coronavirus-tiger-at-new-yorks-bronx-zoo-tests-positive-for-covid19</a></p>\n<p>SARS‐CoV‐2 spike protein favors ACE2 from Bovidae and Cricetidae\n<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228376/\" rel=\"noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228376/</a></p>\n", "score": 11 } ]

[ "covid-19", "disease-transmission", "coronavirus", "zoonotic-diseases" ]

[ { "answer_id": 22902, "body": "<p>Seasonal coronaviruses come back year after year and we continue to suffer with them</p>\n<blockquote>\n<p>Researchers do know that reinfection is an issue with the four seasonal coronaviruses that cause about 10 to 30% of common colds. These coronaviruses seem to be able to sicken people again and again, even though people have been exposed to them since childhood.</p>\n<p>&quot;Almost everybody walking around, if you were to test their blood right now, they would have some levels of antibody to the four different coronaviruses that are known,&quot; says Ann Falsey of the University of Rochester Medical Center.</p>\n<p>After infection with one of these viruses, she says, antibodies are produced but then the levels slowly decline and people become susceptible again.</p>\n</blockquote>\n<p>Similarly, the Herpes Zoster or chicken pox virus you recover from but when your antibody levels drop, it can reappear as shingles.</p>\n<p><a href=\"https://www.npr.org/sections/goatsandsoda/2020/03/20/819038431/do-you-get-immunity-after-recovering-from-a-case-of-coronavirus\" rel=\"nofollow noreferrer\">https://www.npr.org/sections/goatsandsoda/2020/03/20/819038431/do-you-get-immunity-after-recovering-from-a-case-of-coronavirus</a></p>\n<p><a href=\"https://www.cdc.gov/shingles/about/transmission.html\" rel=\"nofollow noreferrer\">https://www.cdc.gov/shingles/about/transmission.html</a></p>\n", "score": 4 }, { "answer_id": 22909, "body": "<p>Short answer seems to be that there is such a category and it includes most respiratory viruses, <a href=\"https://jvi.asm.org/content/89/6/2995\" rel=\"nofollow noreferrer\">including</a> coronaviruses:</p>\n<blockquote>\n<p>Although the severe acute respiratory syndrome-associated coronavirus (SARS-CoV) epidemic was controlled by nonvaccine measures, coronaviruses remain a major threat to human health. The design of optimal coronavirus vaccines therefore remains a priority. Such vaccines present major challenges: <strong>coronavirus immunity often wanes rapidly,</strong> individuals needing to be protected include the elderly, and vaccines may exacerbate rather than prevent coronavirus lung immunopathology.</p>\n</blockquote>\n<p>Alas this paper considers it such a well-known fact that they don't actually bother to cite any studies in support of that particular claim. (So, if you want to further challenge this, Skeptics SE awaits you...)</p>\n<p>And regarding the closest know relatives of SARS-CoV-2, that is SARS (and MERS) the data on long-term immunity is not very encouraging either, as a March 18, <em>Nature</em> editorial <a href=\"https://www.nature.com/articles/d41586-020-00798-8\" rel=\"nofollow noreferrer\">relates</a>:</p>\n<blockquote>\n<p><strong>Immunity is short-lived for the coronaviruses that cause common colds</strong>; even people who have high levels of antibodies against these viruses can still become infected, says Stanley Perlman, a coronavirologist at the University of Iowa in Iowa City.</p>\n<p><strong>The evidence is more equivocal for the two other coronaviruses that have triggered epidemics: those that cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).</strong> Perlman says his team has found that after people recover from MERS, their antibodies against the virus drop precipitously. He also says that his team has gathered data — not yet published — showing that SARS antibodies are still present in the body 15 years after infection. <strong>But it’s not clear whether this immune response is enough to prevent reinfection.</strong> “We don’t have good evidence of long-lasting immunity, but we also don’t have really good data from both SARS and MERS,” Perlman adds.</p>\n</blockquote>\n<hr />\n<p>More tangential info below:</p>\n<p>The immune system can be damaged by some pathogens making them vulnerable to others, even if you had prior exposure to those. Besides the well-known HIV which causes general immunodeficiency, measles can do this to some extent as well, and you do get cured from measles proper. This from a <a href=\"https://www.nytimes.com/2019/10/31/health/measles-vaccine-immune-system.html\" rel=\"nofollow noreferrer\">NYT article</a>, I haven't checked the actual science publications:</p>\n<blockquote>\n<p>Measles is far more dangerous than most people realize, new research shows.</p>\n<p>The disease itself can cause a severe and sometimes deadly illness, but two new studies published on Thursday found that even when patients recover, the virus can inflict lasting harm on their immune systems.</p>\n<p>The weakened immunity leaves a child vulnerable for several years to other dangerous infections like flu and pneumonia. The damage occurs because the virus kills cells that make antibodies, which are crucial to fighting off infections.</p>\n<p>Scientists call the effect “immune amnesia.” During childhood, as colds, flu, stomach bugs and other illnesses come and go, the immune system forms something akin to a memory that it uses to attack those germs if they try to invade again. The measles virus erases that memory, leaving the patient prone to catching the diseases all over again.</p>\n</blockquote>\n<p>Technically this a bit besides what you're asking about. The technical term is &quot;immunomodulation&quot;.</p>\n<p>Also, the adaptive response <a href=\"https://www.virology.ws/2009/12/28/reinfection-with-2009-influenza-h1n1/\" rel=\"nofollow noreferrer\">takes</a> a bit longer than people might suspect:</p>\n<blockquote>\n<p>These individuals were likely resusceptible to reinfection with the same strain of influenza virus due to a confluence of unusual events. First, all three were reinfected within three weeks, before their primary adaptive response had sufficiently matured. Another contributing factor was the high level of circulation of the pandemic strain. [...]</p>\n<p>Could reinfection also occur after immunization with influenza vaccine? Yes, if the immunized individual encounters the virus before the primary antibody response matures, which occurs in 3-4 weeks. This is more likely to occur during pandemic influenza when circulation of the virus is more extensive than in non-pandemic years.</p>\n<p>[Citing:]</p>\n<ul>\n<li>Perez CM, Ferres M, &amp; Labarca JA (2010). Pandemic (H1N1) 2009 Reinfection, Chile. Emerging infectious diseases, 16 (1), 156-7 PMID: 20031070</li>\n</ul>\n</blockquote>\n<p>And it's suspected that it's not actually true (as claimed in the question) that prior exposure to a family of viruses, e.g. influenza, always makes subsequent infections with different influenza strains milder. In fact, there's <a href=\"https://academic.oup.com/emph/article/2019/1/18/5298310\" rel=\"nofollow noreferrer\">some evidence</a> that the W shaped mortality curve (by age) for the 1918 influenza was due to the exposure in infancy of some age groups (but not others) to a somewhat similar viruses that primed a overreaction of the immune response, which was often responsible for the rapid swelling of the lungs:</p>\n<blockquote>\n<p>The 1918 pandemic was caused by an H1N1 virus (with a Group 1 HA). Those whose first exposure had been to a putative H3N8 (Group 2) virus that emerged in 1889 were at high risk of death [20]. Crucially, because children born several years prior to a newly emerged IAV strain can experience that virus as their first (or among their first) IAV infections, one should not expect a clean demarcation of increased risk to coincide with the year of emergence of that H3N8 strain. Although the young-adult mortality rate from the 1918 virus has a sharp peak in those born very near 1889, it stretches back to include those born up to a decade or so prior to 1889 (Fig. 3b). Interestingly, it also stretches forward only a decade or so, possibly because a new H1 virus emerged in the early years of the 20th century, displacing the 1889 H3 virus [20, 24]. This idea is supported by the lack of evidence of anti-H3 antibodies in those born after the turn of the century—despite clear evidence of N8 reactivities until shortly before 1918—as well as by the low mortality during the 1968 H3N2 pandemic in those born before, but not after, about 1900 [20].</p>\n<p>[...] Nevertheless, results indicating that the 1918 virus is unusually lethal in mice [27], along with the fact that introduction of all new internal proteins in the 1918 virus could have played some role in its unusual virulence (due, e.g., to absent cellular immunity to new T cell epitopes) [20], suggest that the overall virulence of the 1918 virus may have been affected by factors other than antigenic imprinting in childhood. These uncertainties make the recovery of archival viral strains from prior to 1918 particularly attractive: exposing experimental animals such as ferrets, pigs or mice to reconstructed versions of putative H3N8 and H1N8 viruses that may have provided distinct imprinting of different cohorts in 1918 [20] may be the only way to resolve these questions and answer, finally, why this pandemic was so catastrophic.</p>\n</blockquote>\n<p>Unfortunately no genomes of pre-1918 influenzas have been reconstructed insofar, so it's presently impossible to experimentally verify this kind of &quot;kindling&quot; hypothesis, at least for 1918 pandemic.</p>\n<p>And more generally, <a href=\"https://www.statnews.com/2020/02/04/two-scenarios-if-new-coronavirus-isnt-contained/\" rel=\"nofollow noreferrer\">it's suspected</a> that nobody becomes &quot;fully immune&quot; to coronaviruses and some other respiratory viruses like the RSV:</p>\n<blockquote>\n<p>The toll of a seasonal-flu-like coronavirus also depends on immunity — which is also scientifically uncertain. Exposure to the four endemic coronaviruses produces immunity that lasts longer than that to influenza, [Richard] Webby, an influenza expert at St. Jude Children’s Research Hospital] said, but not permanent immunity. Like respiratory syncytial virus, which can re-infect adults who had it in childhood, coronavirus immunity wanes.</p>\n<p>“Everyone, by the time they reach adulthood, should have some immunity to some coronavirus,” said Tim Sheahan, a coronavirus researcher at University of North Carolina’s Gillings School of Global Public Health. But because it doesn’t last, older people can get reinfected. The elderly also have a higher death rate from coronaviruses such as SARS and MERS, a pattern 2019-nCoV is following.</p>\n<p>“There is some evidence that people can be reinfected with the four coronaviruses and that there is no long-lasting immunity,” Dr. Susan Kline, an infectious disease specialist at of the University of Minnesota. “Like rhinoviruses [which cause the common cold], you could be infected multiple times over your life. You can mount an antibody response, but it wanes, so on subsequent exposure you don’t have protection.” Subsequent infections often produce milder illness, however.</p>\n</blockquote>\n<p>I'll try to find some actual studies on this as it's the most central issue relating to the question. There are lot of papers in pubmed about <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=waning+immunity\" rel=\"nofollow noreferrer\">&quot;waning immunity&quot;</a> but most are about vaccines, so that may or may not fully answer your question. But to <a href=\"https://academic.oup.com/jid/article/217/6/851/4833004\" rel=\"nofollow noreferrer\">pick an example</a> (of such a paper on vaccines waning):</p>\n<blockquote>\n<p>For mumps, protection appears to wane over decades, prompting the use of additional doses of vaccine for outbreak control [18]. Transmission models have been used to study long-term age-specific time trends of pertussis and mumps. The best-fitting models require waning immunity, leading to the inference that vaccine protection does indeed wane, as well as providing an estimate of the rate of waning [19, 20].</p>\n</blockquote>\n<p>I think I found some <a href=\"https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.2006601\" rel=\"nofollow noreferrer\">research</a> that might satisfy you a bit more, but it's alas not about influenzas etc.:</p>\n<blockquote>\n<p>Determining the duration of protective immunity requires quantifying the magnitude and rate of loss of antibodies to different virus and vaccine antigens. A key complication is heterogeneity in both the magnitude and decay rate of responses of different individuals to a given vaccine, as well as of a given individual to different vaccines. We analyzed longitudinal data on antibody titers in 45 individuals to characterize the extent of this heterogeneity and used models to determine how it affected the longevity of protective immunity to measles, rubella, vaccinia, tetanus, and diphtheria. Our analysis showed that the magnitude of responses in different individuals varied between 12- and 200-fold (95% coverage) depending on the antigen. Heterogeneity in the magnitude and decay rate contribute comparably to variation in the longevity of protective immunity between different individuals. We found that some individuals have, on average, slightly longer-lasting memory than others—on average, they have higher antibody levels with slower decay rates. We identified different patterns for the loss of protective levels of antibodies to different vaccine and virus antigens. Specifically, we found that for the first 25 to 50 years, virtually all individuals have protective antibody titers against diphtheria and tetanus, respectively, but about 10% of the population subsequently lose protective immunity per decade. In contrast, at the outset, not all individuals had protective titers against measles, rubella, and vaccinia. However, these antibody titers wane much more slowly, with a loss of protective immunity in only 1% to 3% of the population per decade. Our results highlight the importance of long-term longitudinal studies for estimating the duration of protective immunity and suggest both how vaccines might be improved and how boosting schedules might be reevaluated.</p>\n</blockquote>\n", "score": 2 } ]

[ "immune-system", "virus", "disease-transmission", "disease" ]

[ { "answer_id": 22972, "body": "<p>The purpose of fasting before a procedure involving anesthesia is to avoid aspiration of stomach contents, not anything related to drug efficacy. Your anesthesiologist/physician/dentist/nurse wants you to have an empty stomach so you don't regurgitate and then inhale food while your reflexes are suppressed.</p>\n\n<p>Fasting procedures can depend on the specific patient and operation, so it's important for patients to follow those instructions.</p>\n\n<p>Anesthetic drugs are typically given intravenously or are inhaled when used in surgical procedures, not orally, so stomach contents don't matter for the drug effects.</p>\n\n<p>From the ASA guidelines (citation below):</p>\n\n<blockquote>\n <p>The purposes of these guidelines are to provide direction for clinical practice related to preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration and to reduce the severity of complications related to perioperative pulmonary aspiration. Clinical practice includes, but is not limited to, withholding of liquids and solids for specified time periods before surgery and prescribing pharmacologic agents to reduce gastric volume and acidity.</p>\n</blockquote>\n\n<p>...</p>\n\n<blockquote>\n <p>Complications of aspiration include, but are not limited to, aspiration pneumonia, respiratory compromise, and related morbidities.</p>\n</blockquote>\n\n<hr>\n\n<p><a href=\"https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2596245\" rel=\"noreferrer\">Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology 2017;126(3):376-393.</a> doi: <a href=\"https://doi.org/10.1097/ALN.0000000000001452\" rel=\"noreferrer\">https://doi.org/10.1097/ALN.0000000000001452</a>.</p>\n", "score": 6 } ]

[ "surgery", "fasting", "anesthesia" ]

[ { "answer_id": 23135, "body": "<p>The first case of covid-19 was thought to have been diagnosed on the 17th November 2019 involving a 55 year old resident of Wuhan with viral pneumonia. With a R0 of 2.5 they would have already infected at least 2.5 other persons but for simplicity's sake let's say that on 17th November, 2019 there were 2 cases including the person diagnosed.</p>\n\n<p>At that time the epidemic doubling time was said to be 5.2 days, let's say 5 days for simplicity.</p>\n\n<blockquote>\n <p>The epidemic doubling time (the time it takes for daily incidence to double) was 5.2 (4.6–6.1) days before Wuhan was quarantined and public health interventions implemented within Wuhan </p>\n</blockquote>\n\n<p>As an independent test to this, we know that Dr Li Wenliang reported to his WeChat group of classmates on the 30th Dec, 2019 that a SARS like pneumonia was being diagnosed in Wuhan Central Hospital where he worked. At that time there would have been about 2^^8.6 or 288 cases. About 5% would have needed ICU care so that means that about 14 cases would have passed through various hospital ICUs at that time.</p>\n\n<blockquote>\n <p>Li raised the alarm after he saw seven patients with SARS-like symptoms. Li reported the suspected outbreak to his colleagues in a closed group on the WeChat social media platform after learning that patients were being quarantined.</p>\n</blockquote>\n\n<p>The ECDC report refers to cases as of 17th January 2020, which is 61 days after the 17th November 2019 or approximately 12 * 5 doubling periods. So, this means at the 17th January 2020, they should have had 2^12 cases, or 4096, but the report only identified 44 cases. This indicates that they failed to identify the majority of cases at that time, and suggests that their testing kit was inaccurate. Adding to the problem was at that time they didn't realise that asymptomatic cases could also transmit disease.</p>\n\n<p>And it was only 6 days later, on the 23rd January 2020, that Wuhan was locked down with neighbouring cities in Hubei province following shortly. </p>\n\n<blockquote>\n <p>By 22 January 2020, the novel coronavirus had spread to major cities and provinces in China, with 571 confirmed cases and 17 deaths reported. Confirmed cases were also reported in other regions and countries, including Hong Kong, Macau, Taiwan, Thailand, Japan, South Korea, and the United States.</p>\n</blockquote>\n\n<p>The lack of accurate testing has also been a problem in the USA, and elsewhere.</p>\n\n<p><a href=\"https://www.scmp.com/news/china/society/article/3074991/coronavirus-chinas-first-confirmed-covid-19-case-traced-back\" rel=\"noreferrer\">https://www.scmp.com/news/china/society/article/3074991/coronavirus-chinas-first-confirmed-covid-19-case-traced-back</a></p>\n\n<p><a href=\"https://www.nature.com/articles/s41591-020-0822-7\" rel=\"noreferrer\">https://www.nature.com/articles/s41591-020-0822-7</a></p>\n\n<p><a href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30382-2/fulltext\" rel=\"noreferrer\">https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30382-2/fulltext</a></p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/2020_Hubei_lockdowns\" rel=\"noreferrer\">https://en.wikipedia.org/wiki/2020_Hubei_lockdowns</a></p>\n", "score": 8 } ]

[ "covid-19", "test" ]

[ { "answer_id": 23168, "body": "<p>From the very article you've linked:</p>\n<blockquote>\n<p>Making a vaccine for a new flu strain is very different from making a vaccine for something completely new like COVID-19, the novel coronavirus that emerged in 2019. Doctors and scientists first developed viable flu vaccines in the 1940s, so they were not starting from scratch when they went to work on the 1957 flu vaccine. Still, Hilleman bypassed regulatory agencies in his efforts to push the vaccine forward because he worried those agencies would slow the process down.</p>\n</blockquote>\n<p>And an apt analogy from <a href=\"https://www.theatlantic.com/health/archive/2020/02/covid-vaccine/607000/\" rel=\"nofollow noreferrer\">The Atlantic</a> on testing:</p>\n<blockquote>\n<p>Like other drugs, vaccines require a long testing process to see whether they indeed protect people from disease, and do so safely. What this company—and others—has done is copy a bit of the virus’s RNA that one day could prove to work as a vaccine. It’s a promising first step, but to call it a discovery is like announcing a new surgery after sharpening a scalpel.</p>\n<p>Though genetic sequencing is now extremely fast, making vaccines is as much art as science. It involves finding a viral sequence that will reliably cause a protective immune-system memory but not trigger an acute inflammatory response that would itself cause symptoms. (While the influenza vaccine cannot cause the flu, the CDC warns that it can cause “flu-like symptoms.”) Hitting this sweet spot requires testing, first in lab models and animals, and eventually in people. One does not simply ship a billion viral gene fragments around the world to be injected into everyone at the moment of discovery.</p>\n</blockquote>\n<p>And since SARS is the closest relevant relative of Covid-19 (same source):</p>\n<blockquote>\n<p>During the SARS outbreak in 2003, researchers moved from obtaining the genomic sequence of the virus and into a phase 1 clinical trial of a vaccine in 20 months. Fauci wrote that his team has since compressed that timeline to just over three months for other viruses, and for the new coronavirus, “they hope to move even faster.”</p>\n<p>[...] Overall, if all pieces fell into place, Hatchett guesses it would be 12 to 18 months before an initial product could be deemed safe and effective. That timeline represents “a vast acceleration compared with the history of vaccine development,” he told me. But it’s also unprecedentedly ambitious. “Even to propose such a timeline at this point must be regarded as hugely aspirational,” he added.</p>\n<p>Fauci’s initial optimism seemed to wane, too. Last week he said that the process of vaccine development was proving “very difficult and very frustrating.” For all the advances in basic science, the process cannot proceed to an actual vaccine without extensive clinical testing, which requires manufacturing many vaccines and meticulously monitoring outcomes in people. [...]</p>\n<p>“If we’re putting all our hopes in a vaccine as being the answer, we’re in trouble,” Jason Schwartz, an assistant professor at Yale School of Public Health who studies vaccine policy, told me. The best-case scenario, as Schwartz sees it, is the one in which this vaccine development happens far too late to make a difference for the current outbreak. The real problem is that preparedness for this outbreak should have been happening for the past decade, ever since SARS. <strong>“Had we not set the SARS-vaccine-research program aside, we would have had a lot more of this foundational work that we could apply to this new, closely related virus,” he said. But, as with Ebola, government funding and pharmaceutical-industry development evaporated once the sense of emergency lifted. “Some very early research ended up sitting on a shelf because that outbreak ended before a vaccine needed to be aggressively developed.”</strong></p>\n</blockquote>\n<p>Some experts have <a href=\"https://www.nature.com/articles/d41586-020-00798-8\" rel=\"nofollow noreferrer\">expressed</a> skepticism that current single-focus on the spike protein of SARS-CoV-2 would suffice:</p>\n<blockquote>\n<p>The Moderna vaccine consists of an RNA molecule. Like many of the other SARS-CoV-2 vaccines in development, it is designed to train the immune system to make antibodies that recognize and block the spike protein that the virus uses to enter human cells.</p>\n<p>“I think it’s reasonable as a first pass, but we will learn that, perhaps, antibody responses to the spike exclusively may not be the whole story,” says [Michael] Diamond [--a viral immunologist at Washington University in St. Louis, Missouri]. A successful SARS-CoV-2 vaccine might need to prompt the body to generate antibodies that block other viral proteins, for instance, or make T cells that can recognize and kill infected cells.</p>\n</blockquote>\n<p>Also (same source):</p>\n<blockquote>\n<p>If humans do develop immunity, how long does it last?</p>\n<p>That’s another big unknown. <strong>Immunity is short-lived for the coronaviruses that cause common colds; even people who have high levels of antibodies against these viruses can still become infected</strong>, says Stanley Perlman, a coronavirologist at the University of Iowa in Iowa City.</p>\n<p>The evidence is more equivocal for the two other coronaviruses that have triggered epidemics: those that cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). Perlman says his team has found that <strong>after people recover from MERS, their antibodies against the virus drop precipitously</strong>. He also says that his team has gathered data — not yet published — showing that <strong>SARS antibodies are still present in the body 15 years after infection. But it’s not clear whether this immune response is enough to prevent reinfection.</strong> “We don’t have good evidence of long-lasting immunity, but we also don’t have really good data from both SARS and MERS,” Perlman adds.</p>\n</blockquote>\n<p>The same source discusses the risks of <a href=\"https://en.wikipedia.org/wiki/Antibody-dependent_enhancement\" rel=\"nofollow noreferrer\">&quot;disease enhancement&quot;</a> which are thought to be fairly low for SARS-CoV-2, but not inexistent. Actually Wikipedia has a somewhat deeper/different perspective on this:</p>\n<blockquote>\n<p>Non-human primates vaccinated with modified vaccinia Ankara (MVA) virus encoding full-length SARS-COV spike glycoprotein and challenged with the SARS-CoV virus had lower viral loads but suffered from acute lung injury due to antibody enhancement.[3] [...] Antibody-dependent enhancement as been observed in both severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) animal models allowing the respective viruses to enter cells expressing Fc𝛾R including myeloid lineage cells.[5]</p>\n<p>Moreover, antibody-dependent enhancement of acute lung injury has been documented in both SARS and MERS. Rabbits intranasally infected with MERS-COV developed a pulmonary infection characterized by viremia and perivascular inflammation of the lung.[6] Interestingly, when challenged with MERS-COV a second time, rabbits were not protected from disease, despite having measurable antibody responses.[6] Moreover, the rabbits developed more severe lung disease on re-exposure to MERS-COV.[6] Similarly in SARS, mice vaccinated against SARS-COV had measurable antibody responses.[7] However, all mice within two days of challenge developed lung pathology.[7] The lack of protection from antibodies, and exacerbation of lung pathology has been a major challenge for coronavirus vaccine development and may similarly impact SARS-COV-2 vaccine research.</p>\n</blockquote>\n", "score": 4 }, { "answer_id": 23199, "body": "<p>The 1957 influenza pandemic caused <a href=\"https://www.cdc.gov/flu/pandemic-resources/1957-1958-pandemic.html\" rel=\"nofollow noreferrer\">1.1 millions deaths worldwide</a>.</p>\n\n<p>According to History.com, the 1957 influenza vaccine was developed as <a href=\"https://www.history.com/news/1957-flu-pandemic-vaccine-hilleman\" rel=\"nofollow noreferrer\">the result of having serum from people over many past years with prior influenza infections</a>. Scientists were able to compare the 1957 flu virus against previous flu viruses and began working on a fundamentally different vaccine, but with the “head start” of flu vaccine development in general.</p>\n\n<p>According to History.com:</p>\n\n<blockquote>\n <p>Doctors and scientists first developed viable flu vaccines in the\n 1940s, so they were not starting from scratch when they went to work\n on the 1957 flu vaccine.</p>\n</blockquote>\n\n<p>Dr. Maurice Hilleman played an instrumental role in the vaccine development and production through Merck, where we worked. According to a <a href=\"https://www.inquirer.com/philly/health/maurice-hilleman-influenza-pandemic-vaccine-merck-20180125.html?outputType=amp\" rel=\"nofollow noreferrer\">profile of him written in 2018</a>, US pharmaceutical companies had produced a vaccine by June of 1957, and distributed 40 million doses by late fall.</p>\n\n<p>By comparison, for novel coronavirus causing COVID-19, vaccine development has evolved in the past 50 years to examine safety and efficacy more closely.</p>\n\n<p>However, <a href=\"https://www.nejm.org/doi/full/10.1056/NEJMp2005630\" rel=\"nofollow noreferrer\">several challenges have been noted by scientists</a>:</p>\n\n<ul>\n<li>what to target with the vaccine. Scientists believe the spike protein is a good target, but whether to target the whole protein or just a piece is a challenge.</li>\n<li>prior experience with MeRS and SARS suggests the need for caution. This is because some types of immune response may actually worsen lung disease. This begets the need for animal models testing and safety monitoring — neither of which appeared to be part of the 1957 influenza vaccine development process.\n\n<ul>\n<li>“as with naturally acquired infection, the potential duration of immunity is unknown; similarly, whether single-dose vaccines will confer immunity is uncertain.” </li>\n</ul></li>\n</ul>\n\n<p>That said, extraordinary steps are being taken to accelerate coronavirus vaccine development. A <a href=\"https://www.nejm.org/na101/home/literatum/publisher/mms/journals/content/nejm/0/nejm.ahead-of-print/nejmp2005630/20200406/images/img_medium/nejmp2005630_f1.jpeg\" rel=\"nofollow noreferrer\">chart</a> from the NEJM article illustrates the “parallel track” acceleration, beginning manufacturing well before the vaccine is proven out in clinical trials.</p>\n\n<p></p>\n", "score": 1 } ]

[ "vaccination", "sars-cov-2" ]

[ { "answer_id": 23343, "body": "<p>At this point in time no one can say for sure why many people appear to have asymptomatic infection, and figures range from 20-80% though part of the problem appears to be from false positives in antibody tests. Nevertheless there have been large numbers picked up on rt-PCR who carry the virus but at the time do not show symptoms. Some, if not most, go on to develop symptoms so they are the pre-symptomatic.</p>\n\n<p>We know there's an age distribution so that those under the age of 5, and those over the age of 60 are more likely to have severe disease, and we know women have less severe disease than men.</p>\n\n<p>We also know that also the virus attacks cells via the ACE2 receptor, as one of its attack points, and these are more numerous in the young, and in women. So, one could posit that for any given dose or innoculm of virus, then the higher the dose relative to the number of ACE2 receptors, the worse the disease might be. So, this would explain why it's worse in very young children as they have a smaller body size and fewer cells relative to the inoculum, then as you get older you have the peak number, and then as you age the numbers drop off again so the dose becomes relatively higher.</p>\n\n<p>Then we now know the virus is mutating rapidly and this may explain why symptoms and disease severity may differ rapidly. And even in the same person you may have a number of different mutations present.</p>\n\n<p>And then there are the odd observations that some children have had asymptomatic viral pneumonia picked up on CT scan. So, they're developing lower respiratory tract disease without fever. Fever, muscle aches and pains are often on account of cytokines released during the innate immune response which appears to be highly variable in this disease. Many people who have died go on to develop a highly active innate immune response called a cytokine storm which causes death.</p>\n\n<p>In all the immune response appears to be highly variable, and there are host factors including co-morbities, that influence the disease response as well as mutations in the virus itself.</p>\n\n<p><a href=\"http://publichealth.lacounty.gov/phcommon/public/media/mediapubhpdetail.cfm?prid=2328\" rel=\"noreferrer\">http://publichealth.lacounty.gov/phcommon/public/media/mediapubhpdetail.cfm?prid=2328</a></p>\n\n<p><a href=\"https://www.medrxiv.org/content/10.1101/2020.04.14.20060160v1\" rel=\"noreferrer\">https://www.medrxiv.org/content/10.1101/2020.04.14.20060160v1</a></p>\n", "score": 6 }, { "answer_id": 23337, "body": "<p>The reason why many people who contract COVID-19 are asymptomatic is simple. It is because your immune system can kill the pathogen before you show symptoms. In other words, your body overwhelms the virus before it takes over larger areas of your body.</p>\n\n<p>The answer to your second and third question is yes and no. Most people, that recover quickly without showing symptoms, signifies that they had a good immune system to fight it.</p>\n\n<p>This is the general response to any pathogen that enters your body and is not distinct to COVID-19. Your immune system immediately starts fighting the pathogen off. And if your body is able to find the antibody fast enough, the pathogen will be immobilized and will be restrained from infecting more cells.</p>\n\n<p>My source is these immune system videos:</p>\n\n<p>(1) <em><a href=\"https://www.youtube.com/watch?v=GIJK3dwCWCw\" rel=\"nofollow noreferrer\">Immune System, Part 1: Crash Course A&amp;P #45</a></em></p>\n\n<p>(2) <em><a href=\"https://www.youtube.com/watch?v=2DFN4IBZ3rI\" rel=\"nofollow noreferrer\">Immune System, Part 2: Crash Course A&amp;P #46</a></em></p>\n\n<p>(3) <em><a href=\"https://www.youtube.com/watch?v=rd2cf5hValM\" rel=\"nofollow noreferrer\">Immune System, Part 3: Crash Course A&amp;P #47</a></em></p>\n", "score": 5 }, { "answer_id": 23411, "body": "<p>Recent studies have reported that about 80% of people infected with SARS-CoV2 are asymptomatic, it means they are \"silent carriers\". These patients show no or very mild symptoms. As it is known that viruses need to get into living cells to divide and survive.\nSame applies with SARS-CoV2, this virus attaches its spike protein present on the outer shell with the human cell's protein receptor, called <a href=\"https://en.wikipedia.org/wiki/Angiotensin-converting_enzyme_2\" rel=\"nofollow noreferrer\">Angiotensin converting enzyme 2</a> (ACE2). These ACE2 receptors are normally found in the lungs, kidneys, heart and gut.\nAfter getting infected with this virus, it take incubation period of about 14 days for symptoms to arise. Having healthy immune system during this incubation period can reduce the viral load and thus prevent it from entering the lungs.</p>\n\n<p>Our immune system provides us two lines of defense.\nFirst one is <a href=\"https://en.wikipedia.org/wiki/Innate_immune_system\" rel=\"nofollow noreferrer\">innate component</a> including physical barriers such as skin and mucosal membranes, variety of proteins and some of the white blood cells for attacking foreign material. This immune response is non-specific and works fast. The second one is <a href=\"https://en.wikipedia.org/wiki/Innate_immune_system\" rel=\"nofollow noreferrer\">adaptive component</a>. This works slowly but is specific for particular infection and holds memory of infection.</p>\n\n<p>Specific genetic variations in humans might also play role in determining the intensity of sickness. By producing fast adaptive immune response, the body may recognize virus early and work against it. General health also determines the immune response.</p>\n\n<p>If SARS-CoV-2 virus still survives during this entry to the body, it makes entry into lungs via mucosal respiratory tract. There it binds to ACE2 receptors and replicates further, which triggers immune response. The amount of virus which one gets into lungs also determines severity of sickness. </p>\n\n<p>In many patients, the immune response is intense which results in \"cytokine storm\". Cytokines are proteins that act as signals to generate immune response. This can lead to excessive inflammation which can cause organ damage and can be fatal.</p>\n\n<p>(Via:<br>\n<a href=\"https://www.youtube.com/watch?v=UGxgNebx1pg&amp;list=PLQ_IRFkDInv-NvRRUN0aqe51sMs188k8z&amp;index=58&amp;t=0s\" rel=\"nofollow noreferrer\">https://www.youtube.com/watch?v=UGxgNebx1pg&amp;list=PLQ_IRFkDInv-NvRRUN0aqe51sMs188k8z&amp;index=58&amp;t=0s</a></p>\n\n<p><a href=\"https://www.youtube.com/watch?v=AToF8O5T86s&amp;list=PLQ_IRFkDInv-NvRRUN0aqe51sMs188k8z&amp;index=25&amp;t=396s\" rel=\"nofollow noreferrer\">https://www.youtube.com/watch?v=AToF8O5T86s&amp;list=PLQ_IRFkDInv-NvRRUN0aqe51sMs188k8z&amp;index=25&amp;t=396s</a></p>\n\n<p><a href=\"https://www.youtube.com/watch?v=qqZYEgREuZ8&amp;list=PLQ_IRFkDInv-NvRRUN0aqe51sMs188k8z&amp;index=49&amp;t=274s\" rel=\"nofollow noreferrer\">https://www.youtube.com/watch?v=qqZYEgREuZ8&amp;list=PLQ_IRFkDInv-NvRRUN0aqe51sMs188k8z&amp;index=49&amp;t=274s</a></p>\n\n<p><a href=\"https://www.youtube.com/watch?v=1vZDVbqRhyM&amp;list=PLQ_IRFkDInv-NvRRUN0aqe51sMs188k8z&amp;index=27&amp;t=0s\" rel=\"nofollow noreferrer\">https://www.youtube.com/watch?v=1vZDVbqRhyM&amp;list=PLQ_IRFkDInv-NvRRUN0aqe51sMs188k8z&amp;index=27&amp;t=0s</a>)</p>\n", "score": 1 } ]

[ "covid-19", "coronavirus", "health-education", "public-health", "asymptomatic" ]

[ { "answer_id": 23408, "body": "<p>Most PT assays contain <strong>polybrene</strong>, which neutralizes heparin. According to \"<a href=\"https://ashpublications.org/hematology/article/2012/1/460/83815/Coagulation-assays-and-anticoagulant-monitoring\" rel=\"nofollow noreferrer\">Coagulation assays and anticoagulant monitoring</a>\":</p>\n\n<blockquote>\n <p>Polybrene is a positively charged material that will neutralize UFH, and this is a component of many clot-based reagents. Polybrene is added to the majority of PT reagents (clinicians may want to confirm that the PT reagent used in their laboratory contains polybrene) and is also present in many assays used in the detection of a LA (lupus anticoagulant), such as the dilute Russell's viper venom time (dRVVT) and Staclot LA (Diagnostica Stago) kits.</p>\n</blockquote>\n\n<p>Theoretically, a high enough dose of Heparin to overcome polybrene neutralizing activity can prolong PT, but this is not consistent enough to warrant monitoring with PT.</p>\n\n<p>Heparin activity can instead be monitored with <strong>activated partial thromboplastin time (aPTT)</strong> or <strong>anti-factor Xa activity</strong></p>\n", "score": 2 } ]

[ "blood-tests", "hematology", "coagulation" ]

[ { "answer_id": 31875, "body": "<p>Many websites tracking COVID-19 source their data from John Hopkins. You can <a href=\"https://github.com/CSSEGISandData/COVID-19/tree/master/csse_covid_19_data\" rel=\"nofollow noreferrer\">explore the data here</a>:</p>\n<ul>\n<li><a href=\"https://github.com/CSSEGISandData/COVID-19/tree/master/csse_covid_19_data\" rel=\"nofollow noreferrer\">https://github.com/CSSEGISandData/COVID-19/tree/master/csse_covid_19_data</a></li>\n</ul>\n<h4>Our World In Data</h4>\n<p>My favorite site for viewing this data is Our World In Data. For example, you can see the number of positive test cases per capita (7-day rolling average) in the US here:</p>\n<ul>\n<li><a href=\"https://ourworldindata.org/explorers/coronavirus-data-explorer?facet=none&amp;Metric=Confirmed+cases&amp;Interval=7-day+rolling+average&amp;Relative+to+Population=true&amp;Color+by+test+positivity=false&amp;country=%7EUSA\" rel=\"nofollow noreferrer\">https://ourworldindata.org/explorers/coronavirus-data-explorer?facet=none&amp;Metric=Confirmed+cases&amp;Interval=7-day+rolling+average&amp;Relative+to+Population=true&amp;Color+by+test+positivity=false&amp;country=~USA</a></li>\n</ul>\n<p><a href=\"https://i.stack.imgur.com/O4BuQ.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/O4BuQ.png\" alt=\"Daily new confirmed COVID-19 cases per million people in Germany and the United States\" /></a></p>\n<h4>Coviz</h4>\n<p>I created a tool that takes this one step further: extrapolating the (cumulative) curve to predict future spread of the virus:</p>\n<ul>\n<li><a href=\"https://coviz.org/\" rel=\"nofollow noreferrer\">https://coviz.org/</a></li>\n</ul>\n<p><a href=\"https://i.stack.imgur.com/gBPeb.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/gBPeb.png\" alt=\"COVID-19 cases per capita in the Germany with 2-degree polynomial extrapolation 1 month into the future\" /></a></p>\n", "score": 2 }, { "answer_id": 23513, "body": "<p>From your link, <em>The Atlantic</em> has its data tracking project at <a href=\"https://covidtracking.com/data\" rel=\"nofollow noreferrer\">https://covidtracking.com/data</a></p>\n\n<p>If you go there you can drill down by state, the number of cumulative positive and negative results. They show the number of new daily tests and so you can extract the data you want from there about the positivity rates</p>\n\n<p>So, the cumulative data for <a href=\"https://covidtracking.com/data/state/alabama#historical\" rel=\"nofollow noreferrer\">Alabama</a> </p>\n", "score": 1 } ]

[ "covid-19", "test", "public-health", "united-states" ]

[ { "answer_id": 23717, "body": "<h2>Where do you get the antibodies from?</h2>\n<p>You could theoretically use <a href=\"https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/donate-covid-19-plasma\" rel=\"nofollow noreferrer\">donor blood from infected patients</a>, but apparently it is still unclear if the transmission of those antibodies is safe. Also, those patients who generate the antibodies for everyone else couldn’t benefit from the treatment. And you‘d always need some who develop their own immune response. This is like a pyramid scheme, only the other way around.</p>\n<p>You could use monoclonal antibodies but the production cost <a href=\"https://www.bmj.com/content/345/bmj.e8346\" rel=\"nofollow noreferrer\">is really expensive (as in a single dose costs &gt; 50k$ for any type of antibody), and this is due to the complex production. Once patents expire, the cost for generics is expected to fall only by 20% (compared to 80% for non-mAb medication)</a> (sorry for the pay-wall).</p>\n<p>To my knowledge, we do not have other viable options at the moment to produce antibodies in a large fashion.</p>\n<hr />\n<p>Antibodies are limited in usage. They only work against the specific antigen. Many antibiotics and antivirals work at least against a class of pathogens, if not more. They usually target vital intracellular enzymes or factors (gyrase inhibitors block the gyrase enzyme, vital for procaryontic cell replication as an example). <a href=\"https://en.wikipedia.org/wiki/Intrabody_(protein)\" rel=\"nofollow noreferrer\">Intracellular antibodies do exist</a>, but they are usually expressed in transgenic animals for research purposes (included into the genome), and research for human cytosolic antibodies humans is still basic. You are effectively limited to membrane proteins and glycosides of the outer cell membrane as possible targets, which are not as universally conserved as the replication machinery.</p>\n<hr />\n<h2>Recent Developments</h2>\n<p><a href=\"https://mappbio.com/leafbio-announces-conclusion-of-zmapp-clinical-trial/\" rel=\"nofollow noreferrer\">Monoclonal antibodies have been testet for Ebola</a>, but the first trial concluded with only 72 patients because the pandemic was waning.</p>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328111/\" rel=\"nofollow noreferrer\">This paper</a> highlights some limitation of mAbs:</p>\n<blockquote>\n<p>Second, for fatal diseases, such as rabies, where highly effective polyclonal antibodies are available, but short in supply, conducting randomized controlled trials present ethical and logistical challenges. Therefore, researchers need alternative study designs to evaluate mAbs against such diseases. Furthermore, polyclonal antibodies are conceived to neutralize more virus strains than mAbs. [...]\nFourth, high costs may limit access, especially to those in low-resource settings. Although the production costs of mAbs have been reduced over the last decade, the cost is still high (about 100 United States dollars per gram), especially if several grams are needed for treatment. [...]</p>\n<p>Fifth, for several disease targets, investors and people working with product development need clarity on whether public health agencies will procure and use the new therapeutics or postexposure prophylactics. Without a known market, biotechnology companies are hesitant to invest in mAb research and development. [...]</p>\n<p>Finally, the use of approved mAbs products for persistent infections and/or mutating pathogens is of concern. As with other drugs, antimicrobial resistance to mAbs is a potential threat. However, this threat may be overcome by targeting highly conserved epitopes or by using antibody cocktails containing more than one mAb. [..]</p>\n<p>^{Sparrow, Erin et al. <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328111/\" rel=\"nofollow noreferrer\">“Therapeutic antibodies for infectious diseases.”</a> Bulletin of the World Health Organization vol. 95,3 (2017): 235-237. doi:10.2471/BLT.16.178061}</p>\n</blockquote>\n<p>This is the conclusion of <a href=\"https://www.nature.com/articles/s41541-017-0019-3\" rel=\"nofollow noreferrer\">a nature paper on the issue</a>:</p>\n<blockquote>\n<p>A third key challenge is the complexity of pathology, epidemiology, and immunology that can be associated with infection. The way kinetics of infection informs therapeutic strategy, for instance, explains why no dengue mAbs are in clinical trials and why vaccination is the preferred method to control influenza. For dengue and influenza A, symptoms often appear after the peak of viremia; an antibody applied for passive immunotherapy would have to be used before the onset of symptoms to be early enough to avoid viremia. One potential solution is matching a therapeutic antibody with a rapid, point of care diagnostic test. The diagnostic could be used to identify patients with infection and susceptibility to severe disease who would benefit from passive immunotherapy with the therapeutic antibody. Finally, viruses can have complexity that prevents development of a single lasting treatment, for instance multiple strains, rapid evolution, and obscure mechanisms of infection and neutralization escape.</p>\n<p>^{Salazar, G., Zhang, N., Fu, T. et al. <a href=\"https://www.nature.com/articles/s41541-017-0019-3\" rel=\"nofollow noreferrer\">Antibody therapies for the prevention and treatment of viral infections</a>. npj Vaccines 2, 19 (2017). <a href=\"https://doi.org/10.1038/s41541-017-0019-3\" rel=\"nofollow noreferrer\">https://doi.org/10.1038/s41541-017-0019-3</a>}</p>\n</blockquote>\n<p>However, recently there has been an increased effort to create antibody treatment for COVID-19 and first trials are on the way.</p>\n<blockquote>\n<p>No one has yet completed a large, randomized study of an antibody therapy against COVID-19, but results from such trials are expected in the coming months. Lundgren’s trial, announced on 4 August, aims to enrol 1,000 people with COVID-19. Another large trial, sponsored by the NIH and Regeneron, a biotechnology company in Tarrytown, New York, launched on 6 July and will test a cocktail of two antibodies against SARS-CoV-2. Results are expected in late September.</p>\n<p>^{Ledford, H. (2020). <a href=\"https://www.nature.com/articles/d41586-020-02360-y\" rel=\"nofollow noreferrer\">Antibody therapies could be a bridge to a coronavirus vaccine — but will the world benefit?</a> Nature, 584(7821), 333-334. doi:10.1038/d41586-020-02360-y}</p>\n</blockquote>\n<blockquote>\n<p>The ACTIV-3 study will begin by studying the investigational monoclonal antibody LY-CoV555, which was identified in a blood sample from a recovered COVID-19 patient. Antibodies are infection-fighting proteins made by the immune system that can bind to the surface of viruses and prevent them from infecting cells. Synthetic versions of antibodies can be reproduced in a laboratory. These manufactured antibodies are known as monoclonal antibodies. The LY-CoV555 antibody was discovered by Abcellera Biologics (Vancouver, British Columbia) in collaboration with NIAID’s Vaccine Research Center. Subsequently, it was developed and manufactured by Lilly Research Laboratories, Eli Lilly and Company (Indianapolis, Indiana), in partnership with AbCellera. The investigational product also is being tested in another ongoing NIAID study, ACTIV-2, which is studying its safety and efficacy in people with mild to moderate symptoms of COVID-19 who have not been hospitalized. Safety data and other findings will be shared across the ACTIV-2 and ACTIV-3 studies through the DSMB.</p>\n<p>^{Elizabeth Deatrick. (2020) <a href=\"https://www.nih.gov/news-events/news-releases/nih-launches-clinical-trial-test-antibody-treatment-hospitalized-covid-19-patients\" rel=\"nofollow noreferrer\">NIH launches clinical trial to test antibody treatment in hospitalized COVID-19 patients</a>. NIH.gov}</p>\n</blockquote>\n<p>It will be interesting to see if they are efficient and effective at treating COVID-19. However, they will not be able to prevent infections or prevent transmission. To control the pandemic, it makes sense to also focus on vaccines at the same time.</p>\n<hr />\n<p>Prevention is much better! Think about it, rather than investing money for novel antibody therapies, you could invest the money to develop vaccines and prevent people from getting infected in the first place.\nThis means you‘d have lower health care cost because patients wouldn’t need to be treated, and for the patient it is also better because they won’t suffer from the infectious disease (even if there is a therapy, it’s still unpleasant and dangerous to become ill).</p>\n", "score": 4 } ]

[ "treatment", "infectious-diseases", "antibodies" ]

[ { "answer_id": 23794, "body": "<p>SARS-Cov-2 is a distinct virus that causes a distinct disease: COVID-19.</p>\n\n<p>Virus influenzae is a distinct virus (or a term for a small group of similar viruses) that causes a distinct disease: seasonal influenza or \"flu.\"</p>\n\n<p>This is why you can compare death rates of SARS-Cov-2 and influenza virus, or COVID-19 and flu.</p>\n\n<p>\"<a href=\"https://www.medicinenet.com/common_cold/article.htm\" rel=\"nofollow noreferrer\">Common cold</a>\" refers to a group of various viral infections of the nose and throat, which can be caused by at least 200 different viruses. This means you can't compare death rates of a diverse group of diseases called common cold and a single disease, such as COVID-19 or flu.</p>\n\n<p>When a common cold extends to the lower respiratory tract, it is, by definition, no longer called common cold, but laryngitis, bronchitis or pneumonia, for example. </p>\n\n<p>When a person gets a common cold that becomes complicated as pneumonia and dies from it, the cause of death is recorded as pneumonia not as a common cold.</p>\n\n<p>If you stick with a definition of common cold linked above:</p>\n\n<blockquote>\n <p>Common cold is a <em>self-limited</em> contagious disease that can be caused by a\n number of different types of viruses. The common cold is medically\n referred to as a viral upper respiratory tract infection.</p>\n</blockquote>\n\n<p>...then you can't even say that common cold is deadly.</p>\n", "score": 5 }, { "answer_id": 23791, "body": "<p>I had trouble finding any specific estimates for your question after various searches, but given the common cold is much milder than the flu, one can presume it is significantly less than the CFR of the flu.</p>\n\n<p>The issue with the common cold isn't the virus itself, but instead the complications that patients can get after the virus, which can rarely but potentially become dangerous. For instance, a bacterial sinus infection can develop -- in children, <a href=\"https://pubmed.ncbi.nlm.nih.gov/11533355/\" rel=\"nofollow noreferrer\">5-13% of bacterial sinus infections have a preceding viral infection</a>. Serious but rare neurological diseases, like <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991291/\" rel=\"nofollow noreferrer\">Guillain-Barre Syndrome</a>, can also occur after a common cold.</p>\n\n<p>The common cold can also <a href=\"https://www.sciencedirect.com/science/article/pii/S0012369215353794?casa_token=sYuwlTkcj9UAAAAA:cfxpxmeoiWCNRRkzz0MdhxsbSxGwkk_zspZmtglVcrn4N6mwVGLTyNtuRQRcx97JnwKYdATbzw\" rel=\"nofollow noreferrer\">exacerbate the symptoms</a> one has from other health conditions, such as COPD, which is a common cause for hospitalization among adults with COPD. </p>\n", "score": 2 } ]

[ "covid-19", "immune-system", "virus", "common-cold", "mortality-rate" ]

[ { "answer_id": 23995, "body": "<p>Edited to correct misunderstanding of the question (thank you, @Tobias Fritz.)</p>\n<p>According to the <a href=\"https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html\" rel=\"nofollow noreferrer\">CDC</a>, 2,886,267 people in the US have tested positive for SARS-CoV-2, of which 129,811 have died (which is likely a conservative number).</p>\n<p>That means that 4.5% of infected persons die from the infection (129811 is 4.4975395554188% of 2886267.)</p>\n<p>You ask</p>\n<blockquote>\n<p>...for what definition of &quot;significant&quot; is that quoted statement [that 99 percent of infected people have no significant illness from it] true?</p>\n</blockquote>\n<p>It would need to be <strong>more significant than death</strong> for that statement to be true, since the death rate exceeds 1% by about 4.5 times.</p>\n", "score": 3 } ]

[ "covid-19" ]

[ { "answer_id": 24329, "body": "<blockquote>\n<p>Although serum levels of the acute‐phase reactant C‐reactive protein (CRP) usually parallel disease activity in inflammatory states, it is widely believed that systemic lupus erythematosus (SLE) is an exception.</p>\n</blockquote>\n<p><a href=\"https://onlinelibrary.wiley.com/doi/full/10.1002/art.24316\" rel=\"nofollow noreferrer\">https://onlinelibrary.wiley.com/doi/full/10.1002/art.24316</a>.</p>\n<p>Well, since it is an exception we cannot say CRP levels are not reliable indicators of inflammation. The explanation for the relatively low levels of CRP in many patients with SLE has remained unclear despite many years of study. Another such exception is of systemic sclerosis.</p>\n<blockquote>\n<p><strong>Your question</strong><br />\n1.Is it possible that a person with an autoimmune disease (e. g. autoimmune hemolytic anemia) and without an impaired CRP production has a non-detectable level of C-reactive protein in their blood serum (0,0 mg/l)?<br />\n2.can there be no C-reactive protein in blood serum of a patient with an autoimmune disease?</p>\n</blockquote>\n<p>I don't really understand why do you say '0' or 'no' levels of CRP level when a normal healthy person do have some CRP level. Less than 0.3mg/dl is normal range seen in most healthy individuals. But if you question that:- Can a person with autoimmune disorder have CRP levels within the normal range, I will say Yes!</p>\n<blockquote>\n<p>CRP levels within normal limits do not mean there is no disease progression. In 10% of RA cases with active disease acute phase reaction(APR) levels may be within normal limits.</p>\n</blockquote>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5366934/#!po=15.2174\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5366934/#!po=15.2174</a>.</p>\n<blockquote>\n<p>Inflammatory marker such as ESR or C- reactive protein(CRP) are normal in about 60% of patients with early RA.</p>\n</blockquote>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079582\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079582</a>.</p>\n", "score": 5 }, { "answer_id": 24332, "body": "<p>I have a auto immune inflammatory arthritis and Vietnam time my crp was elevated was xinhua chest infection. They measure my c3 and c 4 which are elected and I'm Told more accurate markers.</p>\n", "score": 1 } ]

[ "blood-tests", "autoimmune-disease", "inflammation", "crp-c-reactive-protein" ]

[ { "answer_id": 29096, "body": "<p>I am not a doctor, nor medical scientist. But I have read this article from pubmed: <a href=\"https://pubmed.ncbi.nlm.nih.gov/32653658/\" rel=\"nofollow noreferrer\">https://pubmed.ncbi.nlm.nih.gov/32653658/</a> which leads to <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7346807/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7346807/</a> . As you may read at the end of:</p>\n<blockquote>\n<p>As is well known, preexisting antibodies, memory B cells, and memory T cells are three key components against viral reinfection. Previous studies suggest that the specific memory B cell and T cell responses to SARS-CoV, which are critical for protection from reinfection, can be maintained for several years in recovered SARS patients [6]. SARS-CoV-2 is quite similar to SARS-CoV based on phylogenetic analysis, and putatively uses the same cell entry receptor. The newly discharged patients had developed SARS-CoV-2-specific T cells [4]. Potential anamnestic B cell and T cell responses existing in COVID-19 patients after recovery remain unclear. Therefore, convalescent COVID-19 patients without detectable antibodies might not indicate the loss of immunity to SARS-CoV-2 reinfection. Further studies are required to detect in large clinical trials and to evaluate the SARS-CoV-2-specific humoral and cellular immunity in COVID-19 patients and determine whether recovered patients are at risk for reinfection and would therefore benefit from vaccination.</p>\n</blockquote>\n<p>So in other words &quot;Further studies are required to detect in large clinical trials&quot;.</p>\n", "score": 2 } ]

[ "covid-19", "immune-system", "infection", "virus" ]

[ { "answer_id": 24458, "body": "<p>There has been surprisingly little research on the topic, and as might be expected given the lack if new data, recent studies have not supported a general libido lowering effect of vasectomy. A study in Brazil from 2005 looked at 64 patients undergoing vasectomy and found a small but statistically significant (at p &lt; 0.001) improvement in international index of erectile function scores driven by increases in desire and sexual satisfaction. However, it should be noted that while 67% had improved scores, 17% had worse scores, 16% reported no change (Botero et al, Braz J Urol. Sep-Oct 2005;31(5):452-8)</p>\n<p>Orr and Moore found from a group of 1000 consecutive vasectomies that only 1% reported &quot;psycho-sexual problems such as decreased libido, ejaculatory problems, depression&quot; (r Med J. 1989 Feb;82(1):19-20.) However this analysis appeared to be more focused on detecting surgical complications.</p>\n<p>Islam et al. (Bangladesh Med Res Counc Bull. 1991 Jun;17(1):17-22.) did a follow-up study of 300 tubectomy and 300 vasectomy cases from urban and rural parts of the Mymensingh district in Bangladesh. They found no significant effect on libido in either group, though I was not able to examine the instrument used to survey patients.</p>\n<p>It should be noted the same critique may be made of the Dias article referenced by wikipedia (Acta Psychiatr Scand. 1983 May;67(5):333-8). However like the Islam et al. article, I was able to find the abstract online. The Nielsen and Genster article cited in wikipedia is in Danish, and furthermore no abstract is available online in any language. Thus it requires access to a paper copy to know what it reports, let alone its methods. It does not appear to be available in the holdings at the the University of Washington Health Sciences library, the most comprehensive journal source available to me. Thus I cannot assess it.</p>\n<p>It should also be noted that there are other reports of similar age as the two referenced in wikipedia that address libido and vasectomy. For example, Jackson and Avant (J R Coll Gen Pract. 1982 Mar; 32(236): 172–173) looked at 2000 men on follow-up fron vasectomy with a very brief 3 question questionnaire that asked one question (with follow up to explain positive or negative answers) about the effects in their mental health. Twelve men reported decreased sexual drive but did not regret the procedure. Katila and Rimón (oz Praventivmed. 1979 Oct;24(5):346-8) found on follow-up of 107 men average 4.7 yrs after vasectomy that only 2% were dissatisfied with results. 32% reported improved 'sexual potency' while 3% reported impairment of sexual function. Thus the articles cited in wikipedia are by no means the only data available. Nor are they completely typical of the data at the time of publication except in that some papers reported a tendency towards worse function and others improved.</p>\n<p>Finally, in regards to who might more likely to report worse libido after vasectomy, Buchholz et al. (J Psychosom Res. 1994 Oct;38(7):759-62) looked at 45 men chosen at random from a vasectomized group of 254 men, as well as 18 men from a group of 180 men with erectile dysfunction who attributed their dysfunction to a vasectomy. They &quot;analysed the social background, motivation for vasectomy and postoperative changes of sexual life or behaviour of the partners. The partnership constellation, particularly the role of a predominant female partner seems to be an important feature for vasectomy acceptance. Low acceptance might cause erectile dysfunction.&quot; Essentially, they found that when men were getting a vasectomy felt it was being imposed on them by their partner, they were more likely to report dysfunction. When the men reported they wanted the vasectomy, they were more likely to report improved sexual function.</p>\n<p>In general the recommendation for pre-vasectomy education is to note that evidence does not support the idea that vasectomy changes sexual function See example by J Murtagh (Aust Fam Physician. 1993 May;22(5):806) or Mayo clinic patient education (see <a href=\"https://www.mayoclinic.org/tests-procedures/vasectomy/about/pac-20384580\" rel=\"nofollow noreferrer\">https://www.mayoclinic.org/tests-procedures/vasectomy/about/pac-20384580</a>).</p>\n<p>Most recent research on libido and male contraception has focused on the effects of proposed chemical contraception in males, such as with low dose testosterone.</p>\n<p>My own reading of the literature suggests that older articles tend to report more negative effects on libido compared to more recent ones though the amount of data is unimpressive. If this qualitative trend really is present (and this assessment is extremely subjective not at all a quantitative assessment such as with a meta analysis), it could just as easily represent changes in attitudes and expectations about vasectomy as direct physiologic effects of the procedure. Indeed this would be my working hypothesis, though it should be noted I an a psychiatrist and neuroscientist and as such am likely biased towards this hypothesis.</p>\n", "score": 4 } ]

[ "sex" ]

[ { "answer_id": 28838, "body": "<p>Placebos are an extremely powerful treatment for many medical conditions. Although you have asked for case reports, <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345649/\" rel=\"noreferrer\">a paper published</a> in 2015 by Espay and colleagues in <em>Neurology</em> is one of my favorite papers of all time.</p>\n<p>In it, the authors randomized participants with Parkinson disease (a neurologic disease characterized by tremor, slow movement and rigidity) to receive a placebo which they referred to as a &quot;novel injectable dopamine agonist&quot;. One of the first line treatments for Parkinson disease is dopamine. Half were randomized to be told the drug was &quot;cheap&quot; and the other half were told it was &quot;expensive&quot;. They assessed motor function and did some brain imaging blinded to the randomization status. Then they crossed the participants over to the other group (that is the cost branch they had not yet received) and repeated the process.</p>\n<p>As can be seen in <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345649/figure/F2/\" rel=\"noreferrer\">Figure 2</a>, the &quot;expensive&quot; placebo, but not the &quot;cheap&quot; placebo significantly improved the motor function of the participants. There were also fMRI changes, but the results are more complicated.</p>\n<p><strong>Still, salt water that the participants thought was expensive actually made them tremor less and move more easily.</strong></p>\n<p>Think about that the next time you take some acetaminophen.</p>\n<p>You don't state in your question the time scale you are interested in, but this is a report of 12 people with Parkinson disease who saw concrete benefits from placebo for a day.</p>\n", "score": 5 } ]

[ "placebo" ]

[ { "answer_id": 29296, "body": "<p>The most obvious reason why a vaccine may have limited use is mutation. Flu vaccinations are only useful for a season since the dominance of the many Influenza serotypes changes pretty quickly over time, and new serotypes are routinely spun off through mutation.</p>\n<p>The other likely reasons for needing boosters is differences in average immunological memory length vs. the aggressiveness or stealthiness of a pathogen. It's not fully understood why, in a general sense, these differences occur and how they interact. Immune systems and pathogens exist as a complex ecosystem, so it could very well be the case that there is no <em>general</em> answer to the question of why immunity only lasts so long for a given pathogen. We can study a pathogen as an independent thing though, and get an informed &quot;lifespan&quot; for a particular vaccine based on risk of reinfection over time and the consequences of reinfection. Risk of reinfection can be found by studying the number and types of adaptive immune system components active against a specific antigen over time in a vaccinated population. Often the data for how long a vaccination lasts also comes from epidemiological study. Essentially, watching to see when vaccinated people start getting infections again.</p>\n<p>With hepatitis B we have a lot of direct antibody measurements to work with. One vaccination generates enough memory B cells targeting HBsAg to give immunity for around ten years, which is the average lifespan for those cells. After that, HBsAg targeting helper T cells still exist and can spur the &quot;rapid&quot; production of antibodies over 25 years after vaccination. The extremely long term helper T driven immunity takes longer to actively fight a new infection, but it's fast enough to outpace hepatitis B before any significant damage is done.</p>\n<p>Currently in use inactive virus rabies vaccines create memory B cells, but the creation is delayed and not very strong. Multiple inoculations of the inactive virus generate an increasingly stronger production of memory cells until enough exist to last for their lifetime, which is around ten years. This happens because memory B cells can create more memory B cells of the same type after being activated and differentiating into a plasma cell. Through a few iterations of this, weak initial memory B production can be magnified greatly. This is one reason why boosters often give longer term immunity than the initial vaccination. However even with the strong memory B production, these vaccines don't generate sufficient memory in the longest term systems to guarantee an effective response over multiple decades. It does <em>seem</em> possible to create a vaccine against rabies which could be single dose and last decades though. There's nothing special about the rabies virus which makes this impossible, but one factor does complicate the creation of a new vaccine. With little exception, symptomatic rabies is fatal. It's a vaccine where 90% is just not good enough. If you're going to say your single dose rabies vaccine lasts 10+ years, it better work for that long practically every time.</p>\n<p>Another thing to consider is pathogens which are naturally pains to immunize against for one reason or another. The icon for this is HIV, which does a table flip on the adaptive immune system by infecting and killing T cells directly, as well as becoming latent in these very long living cells if they live long enough after infection to go dormant again. So even if you fight off the infection with a very strong immune response, even with help from medication, eventually any T cells carrying HIV DNA will activate and produce viruses again. You never become immune to HIV through the adaptive immune system, so traditional vaccines against the virus which rely on teaching this system just aren't effective. This is but one example. There's a big world of life out there with all kinds of surprising competitive behavior.</p>\n<hr />\n<p><strong>Useful references</strong></p>\n<p>Hepatitis B immunity:</p>\n<p><a href=\"https://pubmed.ncbi.nlm.nih.gov/17298912/\" rel=\"nofollow noreferrer\">https://pubmed.ncbi.nlm.nih.gov/17298912/</a></p>\n<p><a href=\"https://pubmed.ncbi.nlm.nih.gov/16171909/\" rel=\"nofollow noreferrer\">https://pubmed.ncbi.nlm.nih.gov/16171909/</a></p>\n<p>Rabies immunity:</p>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486289/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486289/</a></p>\n<p>HIV latent behavior:</p>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234450/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234450/</a></p>\n<p>General immunological memory information:</p>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/books/NBK2383/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/books/NBK2383/</a></p>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/books/NBK27158/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/books/NBK27158/</a></p>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3253344/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3253344/</a></p>\n", "score": 3 } ]

[ "vaccination", "vaccine", "protection" ]

[ { "answer_id": 30613, "body": "<p>There is a <a href=\"https://pubmed.ncbi.nlm.nih.gov/11765055/\" rel=\"nofollow noreferrer\">well documented association between strenuous exercise and menstrual irregularities in women.</a></p>\n<p>Some authors have argued this <a href=\"https://pubmed.ncbi.nlm.nih.gov/8091047/\" rel=\"nofollow noreferrer\">should not be considered pathological</a> since the effect is temporary and relieved by cessation of exercise so is rather an adaptation to demands placed on the body.</p>\n<p>There is also a related condition called the <a href=\"https://pubmed.ncbi.nlm.nih.gov/24126551/\" rel=\"nofollow noreferrer\">female athlete triad</a> which consists of:</p>\n<ul>\n<li>osteoporosis</li>\n<li>amenorrhea</li>\n<li>disordered eating</li>\n</ul>\n<p>Why do we see secondary amenorrhea in these individuals?</p>\n<blockquote>\n<p><a href=\"https://www.clinicaltherapeutics.com/article/S0149-2918(20)30052-7/fulltext\" rel=\"nofollow noreferrer\">FHA manifests from many factors influencing the complex hypothalamic–pituitary–ovarian axis. When energy stores fail to meet the energy requirements of the body, there are numerous downstream effects. At the level of the hypothalamus, gonadotropin-releasing hormone (GnRH) secretion decreases, leading to less follicle-stimulating hormone (FSH), luteinizing hormone (LH), follicular development, and estrogen secretion. Serum testing of FSH and LH levels in a female with FHA falls in the low-normal to pre-pubertal range reflecting this physiologic change. Cortisol and stress affect this axis, as increasing levels of cortisol inhibit GnRH secretion. This action helps to explain why times of high stress can lead to irregular menses and amenorrhea.</a></p>\n</blockquote>\n<p>So we can see low energy stores causes abnormalities in the female HPG axis.</p>\n<p>Males also have a <a href=\"https://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary%E2%80%93gonadal_axis?wprov=sfla1\" rel=\"nofollow noreferrer\">HPG axis</a> so is there a similar situation in the male? There is less literature on this probably owing to endocrine abnormalities having more obvious consequences in women. <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901401/#!po=1.92308\" rel=\"nofollow noreferrer\">But the answer appears to be yes.</a></p>\n<blockquote>\n<p>Cross-sectional reports of hypogonadotropic hypogonadism have been reported in male athletes, particularly in those athletes participating in endurance sports, and include evidence of low testosterone [49–52], poor semen quality/oligospermia [53, 54], and low libido [55, 56].</p>\n</blockquote>\n<p>I recommend reading this paper as there is much more detail than I can include in an answer. However some highlights:</p>\n<blockquote>\n<p>Interestingly, it is primarily in “extreme” situations consisting of high intensity, long duration exercise or simultaneous exposure to multiple stressors that significant reductions in metabolic and reproductive hormones are observed.</p>\n</blockquote>\n<blockquote>\n<p>In cross-sectional studies of chronic strenuous exercise training, it seems that very high training loads are required for impairments to be translated to the HPG axis, presumably through poor energetic status. We found that high mileage runners (108.0 ± 4.5 km/week), compared to moderate distance runners (54.2 ± 3.7 km/week) and controls, had lower testosterone levels as well as poor semen quality, including decreased sperm motility, an increased immature sperm number, and decreased bovine cervical mucus penetration, all of which are associated with infertility [53]. It is important to note that the moderate mileage runners in our study maintained a gonadal and semen profile that was similar to that of the sedentary control group, despite running approximately 40–60 km/week. We concluded that in male athletes participating in high-volume training, the findings of decreased testosterone and abnormal semen profiles (Table 1) likely reflect the failure of these athletes to increase energy intake in a manner that accommodates the increased energy expenditure associated with a high training volume [53, 54].</p>\n</blockquote>\n<p>So, to summarise, yes there can be pathological effects to these lifestyles. They are chiefly associated with the combination of very low energy input and high energy output in the form of exercise. The effect is more widely seen in women but can occur in males who are engaged in extremely strenuous exercise, especially with concomitant stressors like sleep deprivation and psychological stress. The dysfunction involves disruption of the HPG axis causing either hypoandrogenic or hypoestrogenic states in males and females respectively.</p>\n<hr />\n<p>As discussed in <a href=\"https://www.metabolismjournal.com/article/S0026-0495(20)30093-7/fulltext\" rel=\"nofollow noreferrer\">this paper</a> hypogonadotrophic hypoestrogenic states in women can result in anovulation and decreased libido which can result in infertility.</p>\n<p>Other adverse effects discussed include:</p>\n<blockquote>\n<p>low bone mineral density, osteoporosis and stress fractures, psychologic effects, diminished athletic perfor­mance, and morbidity or even death due to disordered eating patterns</p>\n</blockquote>\n", "score": 5 } ]

[ "body-fat", "sports" ]

[ { "answer_id": 31023, "body": "<p>I apologize in advance, a lot of the papers referenced may be paywalled.</p>\n<p>There's a lot of literature on the various Herpesviridae and it is a large pleotropic family, producing such viruses as <a href=\"https://en.wikipedia.org/wiki/Cytomegalovirus\" rel=\"nofollow noreferrer\">Cytomegalovirus (CMV)</a>, <a href=\"https://en.wikipedia.org/wiki/Varicella_zoster_virus\" rel=\"nofollow noreferrer\">Human alphaherpevirus-3</a>(AKA Varicella-Zoster virus (VZV)/chickenpox/shingles), <a href=\"https://en.wikipedia.org/wiki/Human_alphaherpesvirus_1\" rel=\"nofollow noreferrer\">Human alphaherpesvirus</a> (AKA <a href=\"https://en.wikipedia.org/wiki/Herpes_simplex_virus\" rel=\"nofollow noreferrer\">Herpes simplex virus</a>(HSV)/cold sores), <a href=\"https://en.wikipedia.org/wiki/Human_betaherpesvirus_6B\" rel=\"nofollow noreferrer\">Human herpevirus-6</a> (<a href=\"https://en.wikipedia.org/wiki/Roseola\" rel=\"nofollow noreferrer\">roseola</a>/sixth disease). Obviously, many of these do not have any skin involvement at all, and so won't produce scarring. However, <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK47382/\" rel=\"nofollow noreferrer\">ZVZ in both its chickenpox and shingles forms does scar</a> ¹ (I can also personally attest to the chickenpox bit, no shingles yet), and <a href=\"https://www.acpjournals.org/doi/pdf/10.7326/0003-4819-98-6-958\" rel=\"nofollow noreferrer\">HSV also scars</a> ², but often only after repeat occurrences at the same location and is a common cause of <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK47449/\" rel=\"nofollow noreferrer\">ocular scars with vision loss</a> ³.</p>\n<p>The genomes of the Herpesviridae are large and not fully studied. They are about 100,000- 250,000 base-pairs and contain quite a number of genes, generally in the 50-100 range, with a number of proteins being produced from secondary processing of the transcribed RNA (splicing etc). Not all proteins are fully characterized in any of the species that I can see. I have found a fairly complete description of the gene products and proteins for CMV in <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032930/\" rel=\"nofollow noreferrer\">Van Damme and Van Loock</a>⁴ (see <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032930/bin/DataSheet1.pdf\" rel=\"nofollow noreferrer\">supplementary PDF</a>), and <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3413377/\" rel=\"nofollow noreferrer\">Cohen</a>⁵ and <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4066823/\" rel=\"nofollow noreferrer\">Zerboni</a> <em>et al</em>⁶ for HSV, and there are a number of immune modulators and apoptosis inhibitors that affect how the cell or body respond to infection.</p>\n<p>Most notably is an <a href=\"https://en.wikipedia.org/wiki/Interleukin\" rel=\"nofollow noreferrer\">interleukin 10 (IL10)</a> homologue, vIL10 (protein UL111A in CMV), which is also found in a couple of other Herpesviridae members, but not in VZV or HSV as far as I can tell. <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3985521/\" rel=\"nofollow noreferrer\">IL10 is implicated in wound healing</a>, but is also used for a bunch of immune response maturation processes. In addition, there are a number of proteins produced that may play roles in suppressing immune responses and activate growth factors, but are not easily identifiable as they lack structural and sequence homology to currently known ones. The current state of things for VZV is nicely reviewed in Zerboni⁶, linked above, but is more focussed on how these factors affect viral output rather than healing post-infection</p>\n<p>Edited to add: One group of authors claim to have identified some <a href=\"https://www.karger.com/Article/Fulltext/453067\" rel=\"nofollow noreferrer\">fractions from cells infected with HSV that have growth-factor-like properties</a>⁷, which have been sporadically <a href=\"https://actavet.vfu.cz/67/3/0159/\" rel=\"nofollow noreferrer\">looked at</a> and <a href=\"https://pubmed.ncbi.nlm.nih.gov/1363988/\" rel=\"nofollow noreferrer\">published</a> since <a href=\"https://actavet.vfu.cz/71/1/0029/\" rel=\"nofollow noreferrer\">the</a> 1990s. In these it seems that the fractions probably contain several viral proteins that may contribute to the growth factor function, but as of 2016 no further work has been done on them. I had initially ignored these as they seemed to have not clarified exactly what was going on, but the research seems good.</p>\n<p>1 Moffat J, Ku CC, Zerboni L, et al. VZV: pathogenesis and the disease consequences of primary infection. In: Arvin A, Campadelli-Fiume G, Mocarski E, et al., editors. Human Herpesviruses: Biology, Therapy, and Immunoprophylaxis. Cambridge: Cambridge University Press; 2007. Chapter 37. Available from: <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK47382/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/books/NBK47382/</a></p>\n<p>2 LAWRENCE COREY, HARRY G. ADAMS, ZANE A. BROWN, et al; Genital Herpes Simplex Virus Infections: Clinical Manifestations, Course, and Complications. Ann Intern Med.1983;98:958-972. doi:10.7326/0003-4819-98-6-958</p>\n<p>3 Whitley R, Kimberlin DW, Prober CG. Pathogenesis and disease. In: Arvin A, Campadelli-Fiume G, Mocarski E, et al., editors. Human Herpesviruses: Biology, Therapy, and Immunoprophylaxis. Cambridge: Cambridge University Press; 2007. Chapter 32. Available from: <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK47449/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/books/NBK47449/</a></p>\n<p>4 Van Damme, E., &amp; Van Loock, M. (2014). Functional annotation of human cytomegalovirus gene products: an update. Frontiers in microbiology, 5, 218. <a href=\"https://doi.org/10.3389/fmicb.2014.00218\" rel=\"nofollow noreferrer\">https://doi.org/10.3389/fmicb.2014.00218</a></p>\n<p>5 Cohen J. I. (2010). The varicella-zoster virus genome. Current topics in microbiology and immunology, 342, 1–14. <a href=\"https://doi.org/10.1007/82_2010_10\" rel=\"nofollow noreferrer\">https://doi.org/10.1007/82_2010_10</a></p>\n<p>6 Zerboni, L., Sen, N., Oliver, S. L., &amp; Arvin, A. M. (2014). Molecular mechanisms of varicella zoster virus pathogenesis. Nature reviews. Microbiology, 12(3), 197–210. <a href=\"https://doi.org/10.1038/nrmicro3215\" rel=\"nofollow noreferrer\">https://doi.org/10.1038/nrmicro3215</a></p>\n<p>7 Lachová V, Svetlíková D, Golais F, Šupolíková M, Turianová L, Betáková T. Transforming Activity of Murine Herpesvirus 68 Putative Growth Factor Is Related to the Ability to Change Cytoskeletal Structure. Intervirology. 2016;59(3):137-142. doi: 10.1159/000453067. Epub 2017 Jan 5. PMID: 28052265.</p>\n", "score": 4 } ]

[ "dermatology", "pathophysiology" ]

[ { "answer_id": 31307, "body": "<blockquote>\n<p>Is Influenza the disease simply a shorthand for a disease caused by an\nInfluenza virus that happens to clinically present as worse than a\ncold?</p>\n</blockquote>\n<p><a href=\"https://www.cdc.gov/flu/symptoms/coldflu.htm\" rel=\"noreferrer\">Pretty much</a>. You have to bear in mind that until the last 25 years or so there were no practical laboratory tests to distinguish among the various viruses causing influenza or the common cold. Viral cultures or PCR might have been possible in a research setting, but were too expensive and required too much specialized training to be practical in the clinic.</p>\n<p>Colds and flu were mostly distinguished by the severity and course of the disease. Influenza tends to come on suddenly and is often accompanied by fever. Colds generally resolve in a couple of weeks without complications. Influenza can quickly result in life threatening complications. If you just have a runny nose, cough, and sore throat, you might have a cold or you might have a mild case of the flu. If you also have a fever, prostration, and develop pneumonia, then you most likely have the flu.</p>\n<p>The <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6185883/\" rel=\"noreferrer\">severity of the flu depends on the exact strain</a> and your immune system's previous exposure to it.</p>\n", "score": 9 } ]

[ "virus", "common-cold", "influenza" ]

[ { "answer_id": 31470, "body": "<p>Concussion rate and severity are associated with previous concussions.</p>\n<hr />\n<p>From a study of college (American) football players:</p>\n<blockquote>\n<p>Players reporting a history of 3 or more previous concussions were 3.0 (95% confidence interval, 1.6-5.6) times more likely to have an incident concussion than players with no concussion history</p>\n</blockquote>\n<blockquote>\n<p>Slowed recovery was associated with a history of multiple previous concussions (30.0% of those with ≥3 previous concussions had symptoms lasting &gt;1 week compared with 14.6% of those with 1 previous concussion)</p>\n</blockquote>\n<p><em>Guskiewicz, K. M., McCrea, M., Marshall, S. W., Cantu, R. C., Randolph, C., Barr, W., ... &amp; Kelly, J. P. (2003). Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. Jama, 290(19), 2549-2555.</em></p>\n<hr />\n<p>In a paper reviewing evidence for mechanisms, Greco et al cite the above paper and some others:</p>\n<blockquote>\n<p>Clinical and experimental evidence shows that the magnitude and duration of deficits is dependent on the number and the interval between injuries</p>\n</blockquote>\n<blockquote>\n<p>Those with multiple concussions showed greater impairment in sustained attention and executive functioning (Wall et al., 2006)</p>\n</blockquote>\n<blockquote>\n<p>While rTBI does not lead to morphological changes, it can induce structural changes including cortical thinning and enlargement of ventricles (Goddeyne et al., 2015). White matter axonal damage, and β-amyloid plaque formation, has shown to increase following multiple mild brain injuries as well (Prins et al., 2013), (Prins et al., 2010), (Grant et al., 2017) and has been linked to cognitive deficits including executive function and motor speed (Wozniak et al., 2007) and neurodegenerative disease (Grant et al., 2017). Astrocytic accumulation and impairment in a novel object recognition task were also exacerbated following multiple injuries (Prins et al., 2013)</p>\n</blockquote>\n<p><em>Greco, T., Ferguson, L., Giza, C., &amp; Prins, M. L. (2019). Mechanisms underlying vulnerabilities after repeat mild traumatic brain injuries. Experimental neurology, 317, 206-213.</em></p>\n<hr />\n<p>As far as mechanisms, Greco et al propose &quot;metabolic vulnerability&quot; which is not particularly specific but includes:</p>\n<blockquote>\n<p>following even a mTBI that there is an increase in glucose uptake due to changes in excitatory amino acid release, combined with a dissociation of cerebral metabolism, resulting in metabolic crisis (Giza and Hovda, 2014)</p>\n</blockquote>\n<blockquote>\n<p>This acute phase lasts 6 h in experimental TBI models and is followed by a period of glucose metabolic depression</p>\n</blockquote>\n<p>They also mention animal studies that seem to provide some causal support this model. However, it's difficult to be certain about causes in humans because there are also likely risk factors experienced by particular individuals due to their age, sex, and genetics/development.</p>\n<p>From a neuroscience perspective, yes, this is related to the &quot;calcium entering the nerve cell&quot; mentioned in the linked article, but it's a bit difficult to explain the relevance of this to people who are unfamiliar with neurophysiology. I think it's best to frame this in the context of <a href=\"https://en.wikipedia.org/wiki/Excitotoxicity\" rel=\"nofollow noreferrer\">excitotoxicity</a>, a type of damage to neurons that occurs in a broad range of conditions.</p>\n", "score": 5 } ]

[ "injury" ]

[ { "answer_id": 31768, "body": "<p>This might be a bit delayed but this 2016 study on 29 kidney donors might be worth a read:</p>\n<p>&quot;In healthy kidney donors, compensatory hypertrophy of the remaining kidney occurs in 79.3% of the patients, with an average increment of about 22.4%. Older patients may have a blunted compensatory hypertrophy response after surgery.&quot;</p>\n<p>Interestingly, the change in kidney size was not associated with any other examined factors such as a history of high blood pressure or the surgical approach used. However, the hypertrophy was less pronounced with increasing donor age. This may suggest that younger, healthier donors are more likely to develop unilateral renal hypertrophy following nephrectomy.</p>\n<p>Study link: <a href=\"https://pubmed.ncbi.nlm.nih.gov/27234720\" rel=\"noreferrer\">https://pubmed.ncbi.nlm.nih.gov/27234720</a></p>\n", "score": 6 } ]

[ "renal", "kidney-disease", "organ-transplant", "organ-damage", "glomerular-filtration-grf" ]

[ { "answer_id": 32272, "body": "<h1>Electrocardiography (ECG)</h1>\n<h2>ECG Leads</h2>\n<p>Firstly, it is important to clarify that a lead (like lead 2) does not refer to one of the electrodes on the patient. Each lead represents the potential difference between two of the electrodes. In the case of Lead 2, it is the potential difference between the electrodes on the left leg and the right arm.</p>\n<p>The vectors of the standard leads are approximately in the <a href=\"https://en.wikipedia.org/wiki/Coronal_plane\" rel=\"nofollow noreferrer\">coronal plane</a>, while the vectors of the chest leads are in the <a href=\"https://en.wikipedia.org/wiki/Transverse_plane\" rel=\"nofollow noreferrer\">transverse plane</a> (the chest leads V1-V6 represent the potential difference between the left leg electrode and the corresponding chest electrode).</p>\n<p>The augmented leads (aVR and aVF) are mathematical derivations based on the others.</p>\n<p>Thus, the leads taken together provide a three-dimensional representation of the average electrical potential through the body (and by minimising other muscle movement, what is left is electrical activity due to the heart).</p>\n<p><a href=\"https://i.stack.imgur.com/AsXZ8.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/AsXZ8.png\" alt=\"Electical axis of ECG leads\" /></a></p>\n<p><strong>Fig 1</strong>: Electrical axis of ECG leads (from <a href=\"https://en.ecgpedia.org\" rel=\"nofollow noreferrer\">ECGpedia.org</a>)</p>\n<h2>ECG Waveform</h2>\n<p>As regards why we arrive at the same approximate ECG tracing, remember each lead is unaware (as it were) of any individual electrical potentials within different components of the heart; they only measure the average depolarisation along their vector over time, through every part of the body between the two electrodes.</p>\n<p>Each lead assesses the depolarisation from a different perspective, so the leads vary in the relative positive or negative deflection.</p>\n<p>For example, a wave of depolarisation moving perpendicular (orthogonal) to the vector of the electrodes (on average) will not be detected. Lead 2 is often used to detect the rhythm as the depolarisation in the atria is propagated directly along the vector of lead 2, leading to the positive deflection of a P wave. Conversely, P waves are often quite flat in aVL, as the vector of average depolarisation over the atria is approximately orthogonal to aVL (see diagram above).</p>\n<p>Because all the leads are measuring the same thing at the same time, and because the heart has a set sequence (thanks to the SA and AV nodes), the tracings of each lead look broadly similar in terms of timing.</p>\n<h1>Vectors</h1>\n<p>As to why summing the overall vectors works, this is just how vectors work mathematically. They represent quantities where the direction is important, as opposed to scalar quantities, which only have a value.</p>\n<p><a href=\"https://i.stack.imgur.com/9B3mJ.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/9B3mJ.png\" alt=\"Vector addition\" /></a></p>\n<p><strong>Fig 2</strong>: Vector addition (from grc.nasa.gov)</p>\n<p>It is useful to think of the value you see in a given lead at any point in time representing the total addition and subtraction of all electrical vectors (relative to that lead).</p>\n<p>See more about vectors <a href=\"https://en.wikipedia.org/wiki/Vector_(mathematics_and_physics)\" rel=\"nofollow noreferrer\">here</a> and vector addition at <a href=\"https://www.grc.nasa.gov/www/k-12/airplane/vectadd.html\" rel=\"nofollow noreferrer\">this NASA page</a>.</p>\n", "score": 3 } ]

[ "cardiology", "heart", "electrocardiogram", "electricity" ]

[ { "answer_id": 140, "body": "<p>The exact cause of migraines is unknown, although they are thought to be the result of temporary changes in the chemicals and blood vessels in the brain. Some people find migraine attacks are associated with certain triggers, which can include starting their period, stress, tiredness and certain foods or drinks.</p>\n\n<p>There is no cure for migraines, but migraines can be usually treated with:</p>\n\n<ul>\n<li><strong>painkillers</strong> – including over the counter medicationssuch as paracetamol and ibuprofen,</li>\n<li><strong>triptans</strong> – medications that can help reverse the changes in the brain that may cause migraines,</li>\n<li><strong>anti-emetics</strong> – medications often used to reduce nausea and vomiting.</li>\n</ul>\n\n<p>Many people find that sleeping or lying in a darkened room can also help.</p>\n\n<p>Sometimes a specific trigger can cause migraines, such as stress or a certain type of food (artificial sweeteners, preservatives), so avoiding it can reduce your symptoms.</p>\n\n<p>Read more about <a href=\"http://www.nhs.uk/conditions/migraine/Pages/symptoms.aspx\" rel=\"nofollow\">symptoms of a migraine</a> and <a href=\"http://www.nhs.uk/Conditions/Migraine/Pages/Treatment.aspx\" rel=\"nofollow\">treating migraines</a>.</p>\n\n<p>Source: <a href=\"http://www.nhs.uk/Conditions/Migraine/Pages/Introduction.aspx\" rel=\"nofollow\">Migraine</a> at NHS</p>\n", "score": 2 } ]

[ "migraine", "headache" ]

[ { "answer_id": 212, "body": "<p>Ps:myopia is condition your cousin is having most likely.</p>\n\n<p>children's bodies grow, so do the eyes, which may cause a gradual increase in myopia. And just as bodily growth can be in uneven spurts, the changes in myopia may be similarly uneven. During adolescence, the change can be rather rapid and require a new, thicker eyeglass correction more than once a year, but when body growth slows or stops (usually by age 18), the myopia tends to stabilize. There is normally no reason to worry about the frequent changes in lens correction that occur during adolescence. Almost never is there any real danger to eyesight, and vision can almost always be corrected to 20/20 or better with eyeglasses or contact lenses.</p>\n\n<p>Note: There is an extremely rare type of myopia, called malignant progressive myopia, which is a serious condition and leads to gradual structural damage to the eye. This type needs regular clinical evaluation. It is not related to ordinary myopia and does not develop from ordinary myopia.</p>\n\n<ol>\n<li>For your cousin, it may be the correct time for his eyeball to stop growing . Ask him to do check up regularly. </li>\n<li>If it still continues, ask him to check his doctor. </li>\n<li>Balanced diet is recommended to prevent further deteriorating of myopia aka distant vision problem, esp vit A. </li>\n<li><p>It is an irreversible process, you can't bring his power back to normal naturally 😨</p></li>\n<li><p>But you can go for lasik surgery, but I don't recommend it personally. . It has its own line of complications </p></li>\n</ol>\n", "score": 1 } ]

[ "eye", "ophthalmology" ]

[ { "answer_id": 204, "body": "<p>This depends on the type of pill you are taking, but there are a few good rules to follow. You may also want to talk with your doctor when your medication is prescribed, in case something like this happens.</p>\n\n<ul>\n<li><p>Less than 30 minutes after - take the pill again (this is what should happen in the situation you described)</p></li>\n<li><p>More than 90 minutes after - definitely don't take the pill again; it has probably gone past your stomach</p></li>\n<li><p>30-60 minutes after - if the risk of taking the pill outweighs the benefits, take the pill; if unsure, contact your doctor</p></li>\n<li><p>60-90 minutes after - usually don't take the pill, unless the pill is really, really important; again, if unsure, contact your doctor</p></li>\n</ul>\n\n<hr>\n\n<p>These numbers are more of an estimate, combined from numbers taken from several sources.</p>\n\n<p><br></p>\n\n<p><em>^{Note: this can vary from pill to pill, so it is best to call your doctor}</em></p>\n\n<hr>\n\n<p>^{<a href=\"http://www.getpharmacyadvice.com/what-to-do-if-you-vomit-after-taking-your-medication/\" rel=\"nofollow\">What To Do If You Vomit After Taking Your Medication</a>}</p>\n\n<p>^{<a href=\"http://www.nlm.nih.gov/medlineplus/druginfo/meds/a697037.html\" rel=\"nofollow\">Azithromycin</a>}</p>\n\n<p>^{<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3379826/\" rel=\"nofollow\">Vomiting of Oral Medications by Pediatric Patients: Survey of Medication Redosing Practices</a>}</p>\n", "score": 10 } ]

[ "pill", "vomit" ]

[ { "answer_id": 244, "body": "<p>Carpal Tunnel Syndrome is compression of the median nerve. </p>\n\n<p>You have several muscles that go through a band (tunnel) which your median nerve uses as well. For whatever reason, if for overuse causing inflammation, structural damage, etc, the median nerve gets compressed you will start to feel tingling sensations.</p>\n\n<p>There are a few tests including Tinel's sign^{<a href=\"https://en.wikipedia.org/wiki/Tinel%27s_sign\" rel=\"nofollow\">1</a>}, Phalens test^{<a href=\"https://en.wikipedia.org/wiki/Phalen_maneuver\" rel=\"nofollow\">2</a>}</p>\n\n<p>Overuse can lead to pain as well. The solution here is simple, stop using it. Let it rest. Do activities with the hand that aren't repetitive motions.</p>\n", "score": 2 }, { "answer_id": 242, "body": "<p>Carpal tunnel syndrome (CTS) is very common disease and the prevalance of CTS has increased in modern times due to increased time spent on computer.</p>\n\n<p>I should point out that CTS is NOT a dangerous disease. It may be life disturbing but it is very easy to manage operatively.</p>\n\n<p>Most important symptoms associated to CTS include:</p>\n\n<ul>\n<li>numbness and tingling in fingers 1-3, rarely 4 but NEVER finger 5</li>\n<li>symptoms are most disturbing at night or at the time of awakening</li>\n<li>clumsiness while opening a door with key or while holding a mug</li>\n</ul>\n\n<p>Regardless of the reason for any hand or finger related symptoms, one could try to use a wrist brace at nights. If that helps, it is a very good indicator of stress or ergonomy related issue or CTS.</p>\n\n<p>If any progression in the symptoms occur you should refer to your GP.</p>\n", "score": 1 } ]

[ "computers", "pain", "hand", "wrist", "carpal-tunnel-syndrome" ]

[ { "answer_id": 369, "body": "<p>In <a href=\"http://www.ncbi.nlm.nih.gov/books/NBK222301/\" rel=\"nofollow\">Dietary Reference Intakes</a> by Institute of Medicine (US) Panel on Micronutrients we can read that RDA for adult men and women is 45 μg/day. The average dietary intake of molybdenum by adult men and women is 109 and 76 μg/day, respectively.</p>\n\n<p>Biego and his coworkers^{<a href=\"http://www.ncbi.nlm.nih.gov/books/NBK222301/\" rel=\"nofollow\">1</a>} in 1998 reported an average molybdenum concentration of 4 μg/L in human milk with stage of lactation not reported and much higher concentrations of molybdenum in cow's milk (50 μg/L, as does soymilk) and infant formula, however as you suggested - the data on the bioavailability of molybdenum in cow milk and infant formulas are not available.</p>\n\n<p>How much it's per cup of milk - it can really vary on milk, however <a href=\"http://www.diet.com/g/molybdenum\" rel=\"nofollow\">Diet.com</a> suggest it's around 4.9μg.</p>\n\n<hr>\n\n<p>References:</p>\n\n<ul>\n<li><a href=\"http://www.ncbi.nlm.nih.gov/books/NBK222301/\" rel=\"nofollow\">1</a>: Biego GH, Joyeux M, Hartemann P and Debry G, 1998. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/10211184\" rel=\"nofollow\">Determination of mineral contents in different kinds of milk and estimation of dietary intake in infants.</a> Food Additives and Contaminants, 15, 775-781.</li>\n</ul>\n", "score": 2 }, { "answer_id": 292, "body": "<p><a href=\"http://www.diet.com/g/molybdenum\" rel=\"nofollow\">Diet.com</a> suggests that molybdenum sources in food are between 57% and 88% efficient in absorption rates nutritionally, and additionally lists milk content as 4.9 μg per cup, which is much lower than the suggestions elsewhere. This may be a good lower bound for calculation. However, remember that the <a href=\"http://www.efsa.europa.eu/en/efsajournal/pub/1136.htm\" rel=\"nofollow\">tolerable upper limit for adults is considered to be 0.6 mg of molybdenum</a>, according to the European Food Safety Authority as of 2000. Alternatively, Diet.com listed it as 2 mg.</p>\n", "score": 1 } ]

[ "nutrition", "milk", "meal-replacement" ]

[ { "answer_id": 5566, "body": "<p>Please refer to <a href=\"https://health.stackexchange.com/a/5565/3504\">this question</a> for a discussion of the benefits of icing. (It is essentially of unproven benefit.) </p>\n\n<p>There is another more effective therapy for tendinitis: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/22097158\" rel=\"nofollow noreferrer\">stretching</a>. </p>\n\n<p>I have personally had patients with lateral epicondylitis (tennis elbow) unresolved for six months that began a regimen of stretching like below and had their symptoms resolve completely within four days.</p>\n\n<p>(1) Stretch the tendinitis in the direction that <em>hurts the most.</em> This means you have identified where the tendon needs to be more lax. </p>\n\n<p>(2) Hold the stretch for OVER 20 SECONDS. This is the most important part. Most people stretch only long enough to inflame a tendinitis. You are aiming to stretch the fibers. </p>\n\n<p>(3) Repeat multiple times a day. (We often said in medicine, every time a commercial comes on TV is a good reminder.) </p>\n", "score": 1 } ]

[ "tendinopathy", "cryotherapy" ]

[ { "answer_id": 342, "body": "<p>Tendons don't usually get replaced because there is tendon repair surgery instead. Getting your tendon (or any body part for that matter) replaced by an artificial tendon usually takes longer to recover than a tendon repair surgery, and also leaves you with some lifetime limitations, such as not be able to lift weight and you will not be able to compete in sports that involve the tendon that got replaced as actively. Tendon repair surgeries tend to take less time to recover from, and they also have a high success rate (if you do proper therapy).</p>\n\n<hr>\n\n<p>^{<a href=\"http://www.healthline.com/health/tendon-repair\" rel=\"nofollow\">Tendon Repair Surgery</a>}</p>\n\n<p>^{<a href=\"http://www.uwmedicine.org/health-library/Pages/hand-surgery-replacement-and-tendon-repair.aspx\" rel=\"nofollow\">Hand Surgery: Replacement and Tendon Repair</a>}</p>\n", "score": 4 } ]

[ "tendons" ]

[ { "answer_id": 349, "body": "<p>I am sensing some mix up here. </p>\n\n<p>Your are asking about artificial tendons but your quote is stating about joint replacements.</p>\n\n<p>Basically your equating apples and oranges.</p>\n\n<p>Joint replacements or joint arthroplasties are used to treat severely destructed joints. In four cases of five the reason for joint destruction is osteoarthrosis in which the joint cartilage has worn off resulting to pure bone to bone contact which is very painful and disabling. </p>\n\n<p>During joint replacement surgery the severely damages joint surfaces are sawed off and they are replaced with identically shaped components. These component usually have two options for fixation. They can be cemented, in which polymethylmethacrylate (PMMA) is put in both components. Then components is compressed to molded end of the bone and cement penetrates to porous bone tissue. The better and deeper the cement penetration, the firmer is the fixation. Another option is to use hydroxyaphatite (HA) coated components. Component is again compressed against bone, but the fixation is achieved by bone ingrowth to to HA coating.</p>\n\n<p>Bearing material is also important aspect in joint replacements. Knee and hip are by far the most commonly replaced joint. In hips there is usuallu metallic head bearing agains cup made from polyethylene (PE). In knee both komponents are usually metallic but there is an <em>insert</em> made from PE between components to reduce friction.</p>\n\n<p>Fixation and bearing materials are the weak links in joint replacements. Weight lifting or heavy exercises are not recommended in patients with replaced joint. Most importantly wear is always present in each and every joint replacement, current medicine does not know a bearing material which does not wear. Wear of PE correlates with use. The more you put weight or strain to your hip/knee replacement the more it wears and more likely it will result to complications associated to increased release of PE particle. </p>\n\n<p>Intense repetitive movement in the joint can also cause cement debonding or breakage in the bone-HA interface and to loosening of the components. </p>\n\n<p>Hip or knee are so complex mechanical systems that each and every movement or momentum can not be handled with current knowledge regarding mechanical aspects joint replacements. At this time joint replacements tolerate very well walking, daily activities and light weight training. </p>\n\n<p>Of course nowadays we can use all ceramic or all metallic bearings but I won´t dig in to those. Use of PE is so common and traditional in joint replacements that these restriction quoted by OP are important to >90% of patients. Tour de France winner <a href=\"https://en.wikipedia.org/wiki/Floyd_Landis#Hip_ailment\" rel=\"nofollow\">Floyd Landis</a> for example has all metallic hip replacement.</p>\n\n<p>Artificial tendons are another thing. Treatment of ruptured anterior cruciate ligament (ACL) is very common procedure these days. Most commonly ACL is replaced with autograft. That means a tissue retrieved from another site in the SAME patient. </p>\n\n<p>In ACL reconstruction common site for tendon autograft is hamstring or gracilis tendon graft. This graft is retrieved with special instruments, cut to required length ja then fixed with bioabsorbable screws to femur and tibia. With time the tendon provides perfect ingrowth to the bone since the tendon is retrieved from same patient and there is no issue regarding tissue rejection. </p>\n\n<p>Usually young patient with ACL rupture can return to heavy exercise without any restrictions after successful ACL reconstruction.</p>\n", "score": 4 }, { "answer_id": 493, "body": "<p>The cite relates to <a href=\"http://en.wikipedia.org/wiki/Joint_replacement\" rel=\"nofollow\">joint replacement</a>, a procedure of removing the painful joint surfaces and replacing them with an artificial joint (usually made of a soft synthetic material) which are placed in the ends of the bone – re-creating the joint that has been removed. The artificial surfaces of the joint replacement are shaped in such a way as to allow joint movement similar to that of a healthy and natural joint.</p>\n\n<p>Sports or occupations requiring repetitive overhead motion or heavy lifting can place a significant strain on rotator cuff muscles and tendons. Over time, as a function of aging, tendons become weaker and degenerate which can lead to complete tears of both muscles and tendons^{<a href=\"http://www.niams.nih.gov/Health_Info/Shoulder_Problems/default.asp\" rel=\"nofollow\">NIH</a>}. </p>\n\n<p>Other risk of heavy lifting (sudden trauma on the joint) can include <a href=\"http://en.wikipedia.org/wiki/Joint_dislocation\" rel=\"nofollow\">shoulder dislocation</a> as the result of loosening of the components (between the bone and the components) and weakening the muscles around the joint causing the ball of the prosthesis come out of its socket. In most cases, the hip can be corrected without surgery^{<a href=\"http://www.niams.nih.gov/Health_Info/Joint_Replacement/default.asp\" rel=\"nofollow\">NIH</a>, <a href=\"http://en.wikipedia.org/wiki/Joint_dislocation\" rel=\"nofollow\">wiki</a>}.</p>\n", "score": 1 } ]

[ "tendons", "sports" ]

[ { "answer_id": 405, "body": "<p>It appears that melatonin decreases blood pressure in a way that occurs nocturnally in normal persons. Interestingly, it is being investigated as a possible anti-hypertensive in Type 2 diabetics. It doesn't seem to have any undesirable side effects, making it an ideal anti-hypertensive.</p>\n\n<blockquote>\n <p>In patients with diabetes the mean BP during sleep was lower on melatonin than before treatment... In controls there was no significant effect of melatonin on BP. There was no significant effect of sleep duration or number of awakenings on the BP responses. </p>\n</blockquote>\n\n<p>It appears to have other effects on T2DM, but that is primarily on beta-cells, which should not affect someone with T1DM.</p>\n\n<p>_{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/15066051\" rel=\"nofollow\">Blood pressure-lowering effect of melatonin in type 1 diabetes.</a>}</p>\n", "score": 5 } ]

[ "diabetes", "type-1-diabetes", "clinical-study", "melatonin" ]

[ { "answer_id": 422, "body": "<p>Mostly it depends on the cause of the pneumonia. </p>\n\n<p>Pneumonia is the name for infection or inflammation of the lungs. It can be primary or secondary. A good example of the difference is pneumonia caused by the influenza virus.</p>\n\n<p>Influenza affects the lungs directly. That's a primary pneumonia, and yes, this is contagious, as the air one coughs out contains droplets carrying the virus. Pneumonia caused by viruses is more common in children and young adults (except for influenza, which affects all age groups), and is therefore contagious to people who have never been exposed to the virus - usually other children/young adults. In general, primary pneumonia tends to be more contagious, and besides viruses, it can be caused by mycoplasma and tuberculosis. These are contagious.</p>\n\n<p>The damage done by the influenza virus in the lungs leaves the person susceptible to attack by bacteria that would not normally gain a foothold in the lung. This is secondary pneumonia, and because <em>your</em> lungs are not damaged - and you already have the same bacteria in your mouth and throat as someone with secondary pneumonia but are not ill - you are much less likely to get sick from being exposed to bacterial pneumonia than from someone with viral pneumonia.</p>\n\n<p>Similarly, pneumonia is more common in smokers with damaged lungs, or in people with some degree of decreased immunocompetence. Alcohol, other drugs, and people with swallowing disorders can aspirate leading to pneumonia; surgery or chest injuries where deep breathing hurts can also lead to pneumonia. These pneumonias aren't likely to be contagious. Finally, some pneumonias are caused by exposure to chemicals. Since there's no infectious agent involved, you can't be affected.</p>\n\n<p>There are now vaccines against some of the bacterial pneumonias, so vaccines against influenza and others help.</p>\n\n<p>Since you might not know what kind of pneumonia someone has, practicing good hygiene is always a good idea.</p>\n\n<p>_{<a href=\"http://www.mayoclinic.org/diseases-conditions/pneumonia/basics/definition/con-20020032\" rel=\"nofollow\">Pneumonia Mayo Clinic</a>}<br>\n_{<a href=\"http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=22\" rel=\"nofollow\">Pneumonia</a>}</p>\n", "score": 7 }, { "answer_id": 7319, "body": "<p>Pneumonia may be contagious if it is caused by an infectious microbe. But if pneumonia is caused by chemical fumes or other poisons, then it is not contagious.</p>\n\n<p>If treatment for pneumonia is administered early on, then the time pneumonia is contagious for is shorter. For example, a person with bacterial pneumonia will stop being contagious within two days of taking antibiotics. For other types of pneumonia – like the one that can cause tuberculosis – the treatment may have to be administered for at least two weeks before a person is no longer contagious.</p>\n\n<p>On the other hand, individuals with viral pneumonia are less contagious after symptoms have subsided. The key is to reduce your ability to contaminate others by utilizing proper hygiene and avoiding others as best as possible.</p>\n\n<p><strong>Bacterial pneumonia</strong> can be caused by different types of bacteria, including streptococcal pneumonia (most common in adults), chlamydophila pneumonia, and H. influenza type B pneumonia (most common in children).</p>\n\n<p>The common signs and symptoms of bacterial pneumonia include high fever, cough with phlegm, chills, chest pain when breathing or coughing, rapid breathing, shortness of breath, and loss of appetite.</p>\n\n<p>Bacterial pneumonia is very contagious, so beginning antibiotic treatment right away can reduce your contagiousness.</p>\n\n<p><strong>Viral pneumonia</strong> is caused by a virus and commonly affects children. Viral pneumonia may clear up within three weeks, but does increase the risk of bacterial pneumonia. Symptoms of viral pneumonia are similar to the flu with fever, aches, and cough. Symptoms may worsen within the first two days, then proceed to improve.</p>\n\n<p>Viral pneumonia is highly contagious and can actually spread quicker than bacterial or fungal pneumonia.</p>\n\n<p>There are three subtypes of <strong>fungal pneumonia</strong>: coccidioides, histoplasma, and cryptococcus. If a person with a weakened immune system inhales a fungus that’s how they can become sick. Symptoms include fever, dry cough, fatigue, and shortness of breath. Unlike other types, fungal pneumonia is not contagious, but symptoms may appear worse in those with weaker immune systems.</p>\n\n<p>Aspiration pneumonia occurs when a person inhales food or other objects into their lungs. Although not contagious, aspiration pneumonia can be life-threatening, so immediate medical attention is required.</p>\n\n<p><strong>Walking pneumonia</strong> is a milder form of pneumonia that presents symptoms similar to a cold. Those symptoms include low-grade fever, persistent dry cough, fatigue and tiredness, shortness of breath, chest pain, and loss of appetite. Walking pneumonia is less severe than full-blown pneumonia, yet it can still be transmitted through droplet infection. Steering clear of others can help reduce transmission, along with covering your mouth and nose when coughing or sneezing.</p>\n\n<p>Source: <a href=\"http://www.belmarrahealth.com/is-pneumonia-contagious-types-and-symptoms-of-pneumonia/\" rel=\"nofollow\">Is pneumonia contagious?</a></p>\n", "score": 1 } ]

[ "disease-transmission" ]

[ { "answer_id": 558, "body": "<p>Some species are used to treat and prevent common cold, flu, and other infections.</p>\n\n<p>One study from <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/12484708\" rel=\"nofollow\">2002</a> didn't find any significant differences between the echinacea and placebo groups for any measured outcomes. Another <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/14657066\" rel=\"nofollow\">study from 2003</a> confirmed that Echinacea purpurea was not effective in treating URI (upper respiratory tract infections) symptoms in children and its use was usually associated with an increased risk of rash. The more recent one from <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24554461\" rel=\"nofollow\">2014</a> didn't provide enough benefits for treating colds by using Echinacea products, although there could be a weak benefit, but potential effects are of questionable clinical relevance.</p>\n\n<p>So two NCCIH-funded studies didn't find any benefits from using it. Others found that it may be beneficial, so the results are mixed and it's not clear whether it can prevent or effectively treat URIs (such as common cold) and NCCIH is continuing to support the study of echinacea as well as potential effects on the immune system^{<a href=\"https://nccih.nih.gov/health/echinacea/ataglance.htm\" rel=\"nofollow\">NCCIH</a>}.</p>\n", "score": 3 } ]

[ "home-remedies", "tea" ]

[ { "answer_id": 577, "body": "<p>If talking about the container itself and the chemicals it might leave on the product being consumed then these fears are mostly related to the fact that BPA (bisphenol A) is present in poly-carbonate bottles and on the adverse effects this has on the brains and development on reproductive organs of mice.</p>\n\n<p>However, when compared and related to humans, the effects <em>don't</em> seem to be that devastating to human health, see: <a href=\"http://www.bisphenol-a.org/whatsNew/20080205.html\" rel=\"nofollow\">http://www.bisphenol-a.org/whatsNew/20080205.html</a></p>\n", "score": 3 } ]

[ "toxicity", "plastic" ]

[ { "answer_id": 639, "body": "<p>Reinfection with typhoid fever is certainly possible.</p>\n\n<p>An <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2427859/?page=4\" rel=\"nofollow\">older human challenge study</a> found that individuals with an induced infection were less likely to develop an infection if they had been previously infected, but 23% of them still developed a clinical fever. <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC269142/\" rel=\"nofollow\">Another somewhat old study</a> suggests that unless immunologically boosted, immunity to typhoid fever cannot last for more than ~ 1 year.</p>\n\n<p>Even immunity that arises from <a href=\"http://www.cdc.gov/mmwr/PDF/rr/rr4314.pdf\" rel=\"nofollow\">vaccination</a> wanes and needs a booster after a few years.</p>\n\n<p>Reinfection, regardless of the success of your treatment or diet, is very possible.</p>\n", "score": 2 } ]

[ "diet", "immune-system", "infection", "typhoid" ]

[ { "answer_id": 5112, "body": "<p><a href=\"https://www.aan.com/Guidelines/home/GetGuidelineContent/303\" rel=\"nofollow\">Formal Guideline</a></p>\n\n<p>Please see the guideline. The answer to your question relies on the mix of guidelines as well as your specific situation. I can only give you information in general (See above) but should not and cannot accurately say anything about you personally, obviously.</p>\n\n<p>In general, if your pain is well controlled, then it seems like surgery would not really be something you want (there are obvious risks of head surgery). So the question is what else would the MRI reveal that would change the course of your illness. If for pain you would not need it, then what else? Multiple sclerosis (MS) is certainly on the differential for many many symptoms, but if you and your doctor think it is highly highly unlikely based on your history, then it might not be something you want to formally rule out with an MRI.</p>\n\n<p>If the concern is for a growing mass (such as cancer), the MRI can certainly be helpful. </p>\n\n<p>There is no great evidence for a person in your situation. It will have to be a decision that you and your provider make after considering the risks and benefits.</p>\n\n<p>To answer your secondary questions, your presentation is not consistent with MS diagnostically, as the McDonald criteria requires a person who has had more than 1 attack in just 1 clinically suggestive location, to have some kind of dissemination in SPACE. You have only one location thus far. Regardless, progression of MS can take years to decades. Without further information, it would be hard to say in your case how unlikely it is that you have something that will progress to MS. You can talk to your provider.</p>\n", "score": 1 } ]

[ "ears-nose-throat-ent", "jaw", "trigeminal-nerve" ]

[ { "answer_id": 629, "body": "<p>Cell membranes are made out of <a href=\"http://en.wikipedia.org/wiki/Phospholipid\">phospholipids</a> and a lot of proteins, not of hydrogen ions. A membrane of hydrogen ions doesn't make any sense chemically in any way.</p>\n\n<p>Cooking doesn't change the overall charge of molecules in food, you can't create or destroy charges out of thin air. To change the charges, essentially the pH of your solution, you need to either add acid or base. Of course you do that quite often in cooking, but the cooking process itself can't change any charges by itself. And even if it did, stomach acid has a very low pH and will change the charges of food anyway. </p>\n\n<p>The Kirlian photography is pretty, but that's it. The strength of the effect is <a href=\"http://www.sciencemag.org/content/194/4262/263\">sensitive to moisture</a> for example, there are all kinds of reasons why cooked and raw food could look differently in these images. </p>\n", "score": 9 } ]

[ "nutrition", "cooking", "minerals" ]

[ { "answer_id": 753, "body": "<p>Some of symptoms of colorectal cancer can include:</p>\n\n<ul>\n<li>A change in bowel habits, such as diarrhea or constipation</li>\n<li>A feeling that you need to have a bowel movement that is not relieved\nby doing so</li>\n<li>Rectal bleeding</li>\n<li>Blood in the stool, which may cause the stool to look dark</li>\n<li>Cramping or abdominal (belly) pain</li>\n<li>Weakness and fatigue</li>\n<li>Unintended weight loss</li>\n</ul>\n\n<p>But most importantly, in the absence of symptoms, people over age 50 should be screened regularly (every 1 to 2 years) for bowel cancer, or precancerous polyps, with a simple faecal occult blood test (FOBT) followed by colonoscopy if the result is positive.</p>\n\n<p>Screening can detect precancerous polyps early, which can then be removed before bowel cancer even begins to develop, and thus many countries now have a screening program for their citizens.</p>\n\n<hr>\n\n<p>^{<a href=\"http://onlinelibrary.wiley.com/doi/10.3322/CA.2007.0018/full\" rel=\"nofollow\">Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008</a>: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology}</p>\n", "score": 1 } ]

[ "gastroenterology", "symptoms", "colon", "cancer" ]

[ { "answer_id": 670, "body": "<p>Judging from your description, you're most probably doing everything correctly.</p>\n\n<p>But ok, if you wanted to be absolutely sure, you really would have to precisely measure your calorie intake vs calorie expenditure (with a tool like cronometer or sth).</p>\n\n<p>And as far as gaining 100 grams in 2 days goes, that's just jumping to conclusions and easily falls within normal day-to-day weight fluctuations.</p>\n\n<p>I have personally lost almost 20 pounds in just 24 hours in a weight loss experiment - just to prove how much water weight can be lost (without burning off almost no body fat). And guess what...all that lost weight came back after just 2 days on my normal diet.</p>\n\n<p>In other words, those 100 grams could easily mean you drank 1 extra dl of water, or that you didn't visit the toilet before weighing, or something similarly insignificant.</p>\n\n<p>The only way to be sure whether or not you're gaining/losing actual body fat would be if you actually measured your body fat percentage...but even in this case, the measurements would not be precise enough to confirm what's actually happening if your weight changes by mere 100 grams.</p>\n", "score": 6 } ]

[ "diet", "sports", "weight" ]

[ { "answer_id": 843, "body": "<p>I will not get into the possible association between your symptoms and treadmill or any possible etiologies regarding your symptoms. However, I am fairly certain that your numbness has nothing to do with your accident.</p>\n\n<p>When we are considering symptoms in limb and possible spinal injury the pathophysiology would be some kind of nerve or medullar compression in back causing symptoms in extremity. First of all, numbness you are feeling is not following any anatomical boundaries, ie. dermatomes <a href=\"http://emedicine.medscape.com/article/1878388-overview\" rel=\"nofollow\">(eMedicine)</a>.</p>\n\n<p>You don´t specify exactly how you hurt yourself during the accident. For example, was there any forceful forward flexion in your lower back. Anyway, if you had injured your lower back in the accident, the most dreadful injury would have been a vertebral fracture. That would have been symptomatic instantly. We can rule that out.</p>\n\n<p>Another likely outcome from the accident would have been some kind of injury or trauma to any of intervertebral discs in your lumbar region. Repetitive strain or forceful movement can cause deterioration of <em>annulus fibrosus</em> in those discs <a href=\"http://en.wikipedia.org/wiki/Intervertebral_disc\" rel=\"nofollow\">(Wikipedia)</a>. Weaking of <em>annulus fibrosus</em> would result to disc herniation some time after the accident if another forceful movement is targeted to lower back <a href=\"http://www.mayoclinic.org/diseases-conditions/herniated-disk/basics/definition/con-20029957\" rel=\"nofollow\">(MayoClinic)</a>. It is however <em>very unlikely</em> that the time interval would be one and half years. A week or two would be very likely.</p>\n\n<p>There are some other more uncommon reasons for radiculopathy in younger persons, but none of them are not a result from injury <a href=\"http://en.wikipedia.org/wiki/Radiculopathy\" rel=\"nofollow\">(Wikipedia)</a>. </p>\n\n<p>As so, I am fairly certain that your numbness is not due to the accident. Any form of neural damage or compression in peripheral nervous system is possible in your case but as far as the accident and possible injury to your lower back is considered, I will stick to the aforementioned.</p>\n", "score": 1 } ]

[ "injury", "numbness", "tingling" ]

[ { "answer_id": 743, "body": "<p>Unfortunately the answer to your question is we simply do not know. </p>\n\n<p>There have been no trials of antihistamines or corticosteroids for ACEI associated angioedema and these treatments are of unproven efficacy and\nmay be ineffective, despite often be used as standard therapy.</p>\n\n<p><a href=\"http://www.racgp.org.au/download/documents/AFP/2011/December/201112andrew.pdf\" rel=\"nofollow\">http://www.racgp.org.au/download/documents/AFP/2011/December/201112andrew.pdf</a></p>\n", "score": 2 } ]

[ "side-effects", "allergy", "medications", "steroids" ]

[ { "answer_id": 7004, "body": "<p>I found an expert answer for your question. May be this will help you to take right decision.</p>\n\n<p><a href=\"http://doctor.ndtv.com/faq/ndtv/fid/2322/Is_a_combination_of_B-complex_vitamin_and_zinc_good_for_the_hair.html\" rel=\"nofollow\">NDTV Doctors:</a></p>\n\n<blockquote>\n <p>\"There is no harm in taking a combination of B-complex vitamins with\n zinc but there is no evidence that such products have any utility in\n controlling loss of hair. Please do not rely on reports in the lay\n press because they are not always correct. Sometimes such reports are\n sponsored by manufacturers. There is some evidence that anti-oxidant\n preparations (such as Vitexid) may help in improving general well\n being of most body functions including skin of the scalp. I hope you\n are not suffering from dandruff which is a common cause of hair loss.\"</p>\n</blockquote>\n", "score": 4 } ]

[ "nutrition", "dermatology", "micronutrients" ]

[ { "answer_id": 8811, "body": "<p>I have found following peer-reviewed paper which provides a review of the nonpharmaceutic conservative interventions for the prevention of seizures:</p>\n\n<p><em>Wolf P. The role of nonpharmaceutic conservative interventions in the treatment and secondary prevention of epilepsy. Epilepsia. 2002;43 Suppl 9:2-5.</em> <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/12383271\" rel=\"nofollow\">1</a></p>\n\n<p>It says (I have kept the essential parts):</p>\n\n<blockquote>\n <p><strong>The first step is the identification of factors facilitating the\n occurrence of seizures. In the second step, strategies to control\n these factors are developed.</strong> Most common are disturbances of the\n sleep-wake cycle, especially reduction of sleep. <strong>Patients should\n follow a regular sleep schedule with deviations of not >2 h.</strong> Sometimes\n a sleep calendar is helpful. Night shifts are not compatible with\n seizure prevention in these cases. (...) O<strong>ther nonspecific\n facilitators of seizures include uncontrolled use of alcohol and\n extraordinary stress. Patients must learn how to cope with stressful\n events.</strong></p>\n</blockquote>\n\n<p>It also provides some preventive measures for specific types of epilepsies:</p>\n\n<blockquote>\n <p>In <strong>reflex epilepsies</strong>, specific precipitants of seizures are the\n targets of interventions. Thus, most patients with primary reading\n epilepsy begin to have, with prolonged reading, perioral reflex\n myoclonias, which enable them to stop reading and thus to avoid a GTC\n seizure. In <strong>photosensitive patients</strong>, seizures are often precipitated\n by television. These can be avoided by viewing from a distance and\n using a remote control, small screens in a well-lit room, and\n preferably with a 100-Hz line shift. Environmental flicker stimulation\n often comes unexpectedly, and it is advisable that the patients always\n wear sunglasses in brightly lighted surroundings. Polarized glasses\n seem to be more protective than plain sunglasses. <strong>If the patient has\n only photically induced seizures</strong>, treatment by specific prevention\n alone may be sufficient, but if spontaneous seizures also occur, drugs\n must be given in addition.</p>\n</blockquote>\n\n<p>Hope this helps!</p>\n", "score": 4 } ]

[ "seizure", "prevention" ]

[ { "answer_id": 769, "body": "<blockquote>\n <p>A low birth weight baby is one that weighs less than 2500 g at birth. As growth is a progressive process, a baby may weigh less than 2500 g at birth because it is born too soon, or because it is small for its gestational age.</p>\n</blockquote>\n\n<p>From here: <a href=\"http://www.who.int/nutrition/publications/fetomaternal/9241594004/en/\">http://www.who.int/nutrition/publications/fetomaternal/9241594004/en/</a></p>\n\n<blockquote>\n <p>LBW infants are classified as very low birth weight (VLBW) if their birth weight is less than 1.5 kg, and as extremely low birth weight (ELBW) if their birth weight is less than 1 kg.</p>\n</blockquote>\n\n<p>From here: <a href=\"http://www.who.int/maternal_child_adolescent/documents/9789241548366.pdf\">http://www.who.int/maternal_child_adolescent/documents/9789241548366.pdf</a></p>\n\n<p>These are not necessarily the original sources of those classifications - neither one is cited, so it's not even necessarily possible to follow that definition backwards along a citation path, but those are both official WHO documents.</p>\n", "score": 5 } ]

[ "weight" ]

[ { "answer_id": 13768, "body": "<p>Since all of the studies on this specific product seem not only mussel-like but downright fishy when reporting large effects the following is a bit speculative and just <em>assumes</em> that it actually works:</p>\n\n<p>Two aspects of action seem possible:</p>\n\n<p>EIB is often seen as <a href=\"http://www.jacionline.org/article/S0091-6749(07)00570-2/fulltext\" rel=\"nofollow noreferrer\">\"even cases of asthma in which exercise appears to be the only trigger of bronchial obstruction (pure EIA) may be manifestations of chronic inflammation of the airways.\"</a></p>\n\n<ul>\n<li>The clam-extract is said to contain 30 PUFAs and especially the Omega-3 fatty acids EPA and DHA. When the ratio of Omega-3 is moved towards the optimum it is commonly believed to <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/23456976\" rel=\"nofollow noreferrer\">reduce</a> <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3914936\" rel=\"nofollow noreferrer\">inflammation</a>.\n<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/28900017\" rel=\"nofollow noreferrer\">Omega-3 fatty acids and inflammatory processes: from molecules to man.</a></li>\n<li>The extract is said to be an inhibitor for the <a href=\"http://www.atsjournals.org/doi/abs/10.1164/ajrccm.157.6.mar-1\" rel=\"nofollow noreferrer\">5-lipoxygenase</a> pathway and might therefore be called an <a href=\"https://en.wikipedia.org/wiki/Leukotriene\" rel=\"nofollow noreferrer\">antileukotriene</a>.</li>\n</ul>\n\n<p>The product differs from what was marketed as an anti-arthritis medication which <a href=\"https://link.springer.com/article/10.1007%2Fs10067-005-0001-8\" rel=\"nofollow noreferrer\">largely proved unsuccessful</a>. If the main action is indeed from the PUFAs then I wonder how much exactly is in those pills and why it should not be possible to use the PUFAs and <a href=\"https://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation\" rel=\"nofollow noreferrer\">other inflammation reducing foods</a> <a href=\"http://www.webmd.com/diet/anti-inflammatory-diet-road-to-good-health\" rel=\"nofollow noreferrer\">from</a> other <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559234/\" rel=\"nofollow noreferrer\">sources</a>. A more optimised <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12442909\" rel=\"nofollow noreferrer\">ratio of fatty acids</a> is advised anyway.</p>\n", "score": 1 } ]

[ "nutrition", "asthma" ]

[ { "answer_id": 803, "body": "<p>You seem to be equating food weight with body weight, and they are not directly related.</p>\n\n<p>Yes, if you eat a pound of something, you will immediately weigh one more pound, as your body has not had a chance to digest it and process it as needed. However, that doesn't mean that you will have gained one permanent pound. The body will break down the food, distribute the end result to various places for either use or storage, and get rid of whatever is not digestible.</p>\n\n<p>Weight fluctuates during the day, so the best gauge of your weight is to weigh yourself at the same time every day, under the same conditions. Track that number, and that gives you your true weight.</p>\n\n<p>Also, weight gain/loss is a relationship between how many calories you need to sustain your day to day activities, and how many you eat. If you consistently eat more calories than you need for a day, then you will gain weight. If you consistently eat less, then you will lose weight. The rate at which you do so varies on how big the deficit/surplus is, how efficient your metabolism, type of calories, many factors such as these.</p>\n\n<p>For your main question, 3500 calories per pound of food is very calorie dense. <a href=\"http://ndb.nal.usda.gov/ndb/foods/show/4978?fgcd=&amp;manu=&amp;lfacet=&amp;format=&amp;count=&amp;max=35&amp;offset=&amp;sort=&amp;qlookup=16398\" rel=\"noreferrer\">For example, 1 lb of peanut butter is going to be ~ 2600 calories</a>. The higher the fat content, the closer you get to that mark. If you ate a straight pound of fat, for example, you would get just over 4000 calories. (<a href=\"http://www.ars.usda.gov/SP2UserFiles/Place/80400525/Data/Classics/ah74.pdf\" rel=\"noreferrer\">Using the typically accepted 9 calories per gram of fat, which is also not 100% accurate</a>). So yes, it is possible to get more than 3500 calories in a pound of food.</p>\n", "score": 7 }, { "answer_id": 4604, "body": "<p>Kind of. <a href=\"https://en.wikipedia.org/wiki/Food_energy#Nutrition_labels\" rel=\"nofollow\">Oils/fats/alcohol has 9 calories per gram</a>. <a href=\"https://duckduckgo.com/?q=1+pound+in+grams&amp;ia=answer\" rel=\"nofollow\">1 pound is 453.593 grams</a>. 9 x 454 = 4,086 calories. So eating 1 pound of oil will give you 4000 calories. <a href=\"https://en.wikipedia.org/wiki/Steatorrhea\" rel=\"nofollow\">However, you will be unlikely to keep all that</a> oil <a href=\"https://en.wikipedia.org/wiki/Laxative#Lubricant_agents\" rel=\"nofollow\">in your digestive tract</a>!</p>\n\n<p>Eating <a href=\"https://en.wikipedia.org/wiki/Hygroscopy\" rel=\"nofollow\">hygroscopic foods</a> will also make you 'gain' more than they weight, because they will attract water. Eating <a href=\"https://en.wikipedia.org/wiki/Honey#Hygroscopy_and_fermentation\" rel=\"nofollow\">honey</a> or lots of <a href=\"https://en.wikipedia.org/wiki/Dietary_fiber#Dietary_fiber_and_fecal_weight\" rel=\"nofollow\">fiber will absorb water</a> and 'appear' to gain weight while it's in your intestines, but you'd also have to drink liquids. </p>\n", "score": 1 }, { "answer_id": 23934, "body": "<p>Any answer to this type of question is going to be constrained by two basic laws of physics, which are conservation of mass and conservation of energy.</p>\n<p>Conservation of mass tells us that any weight you gain or lose is going to be equal to the difference between the mass you take in and the mass you excrete. Furthermore, the body doesn't transmute one chemical element into another, so conservation of mass can be applied separately to every element.</p>\n<p>If you could eat a pound of food and gain more than a pound of body weight, then that additional mass would have to come from some other imbalance between consumption and excretion. But this is pretty implausible because the mass of carbon is conserved by chemical reactions. Carbon is one of the main components of organic matter, so any weight gain is going to require some gain in carbon. Eating food is the only way your body has of bringing in carbon, while it has lots of ways of excreting carbon, including exhaling CO2.</p>\n<p>Of course you can gain or lose body weight by taking in or losing water, which contains no carbon. But this is not a way of doing any long-term change in body weight.</p>\n<p>In terms of energy, the body has some efficiency for digesting food, which depends on factors such as what type of macronutrient you're eating, and how highly processed the food is. This efficiency is very high when you eat fats -- I've seen estimates of 97-100%. If weight gain means storing energy in fat, then at the high end of this range you're simply transporting fat molecules through your mouth and into your tissues. In that case you could gain a pound by drinking a pound of olive oil, but you can't gain <em>more</em> than a pound of fat -- that would violate both conservation of carbon mass and conservation of energy.</p>\n", "score": 1 }, { "answer_id": 23938, "body": "<p>1 pound of pure fat, for example, <a href=\"https://fdc.nal.usda.gov/fdc-app.html#/food-details/789035/nutrients\" rel=\"nofollow noreferrer\">oil</a>, has 453.6 g x 9 kilocalories, which is 4.082 kilocalories. When metabolized, up to 5% of calories from fat can get lost due to <a href=\"https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/specific-dynamic-action\" rel=\"nofollow noreferrer\">thermic effect of food</a>, so, theorhetically, you could get ~3, 878 calories from one pound of oil, which could be theoretically converted to ~430 g of body fat. Anyway, this does not happen at any given point of time, because some of dietary fats will be quickly burnt for current metabolic needs, before even completely absorbed.</p>\n<p>I'm not aware of any nutrient or food additive that would have more than 9 kcal/g.</p>\n<hr />\n<p>From the perspective of one macronutrient (carbohydrates, proteins, fats and alcohol) promoting the absorption of another macronutrient (and ths calories): unlike in micronutrients (minerals, vitamins), this does not likely happen, because absorption of each macronutrient is independent of each other. Macronutrients can speed up or slow down the absorption of other macronutrients, but this does not likely affect the amount of total macronutrients being absorbed at the end.</p>\n<p>Certain nutrients, for example <a href=\"https://pubmed.ncbi.nlm.nih.gov/20092365/\" rel=\"nofollow noreferrer\">glycerol</a>, can promote temporary retention of water and thus temporary increase body weight (but this has nothing with promoting calorie absorption or retention).</p>\n", "score": 1 } ]

[ "nutrition", "calories" ]

[ { "answer_id": 24266, "body": "<p>Very generally speaking I would say it depends on the cause of the intolerance - if it is a primary intolerance (i. e. genetic problem with lactase persistence deficiency, the enzyme for digesting lactose) no additional exposure will cause a change in genetics. Another genetic form of lactose intolerance prevents forming of lactase enzymes.</p>\n<p>Secondary intolerance is acquired, i. e. not genetic in origin. Acquiring it usually is accompanied by some sort of intestinal inflammation and is thought to be reversible.</p>\n<p>Some more details on this can be found here: <a href=\"https://en.wikipedia.org/wiki/Lactose_intolerance#Causes\" rel=\"nofollow noreferrer\">https://en.wikipedia.org/wiki/Lactose_intolerance#Causes</a></p>\n", "score": 4 } ]

[ "digestion", "allergy", "gastroenterology", "milk", "lactose-intolerant" ]

[ { "answer_id": 836, "body": "<p>If you're saying that you have a low blood pressure and you're seeking to reestablish a phisiological value I would answer you that low blood pressure it's not a disease unless it's really too low, but this is something you should <strong>clarify with your doctor</strong>. Also, if there's a disease, you should first cure the causes instead of lookin for functional foods to use as they were pills (=&quot;I have X, I eat Y for this&quot;). Again this is something to check with doctors.</p>\n<p>If you're asking which foods have the power to increase blood pressure, I would answer: <strong>salt</strong>^{<a href=\"http://hyper.ahajournals.org/content/27/3/481.short\" rel=\"noreferrer\">1</a>}, <strong>liquorice</strong>^{<a href=\"http://europepmc.org/abstract/med/11494093\" rel=\"noreferrer\">2</a>}. Then I suggest you to <a href=\"http://www.webmd.com/heart/understanding-low-blood-pressure-treatment\" rel=\"noreferrer\">check a link</a> that might be useful.</p>\n", "score": 11 } ]

[ "blood-pressure" ]

[ { "answer_id": 861, "body": "<ol>\n<li><p><strong>Wound cleansing</strong> is especially important when bitten, as it has been shown to remarlably reduce the risk of infections from animal bites in general, and in some animal studies, the likelihood of rabies infection.</p>\n\n<p>This treatment should be immediate: irrigate with water or diluted water povidone-iodine solution.</p>\n\n<p>You should consult a doctor as soon as possible. Animal bites are, by themselves, potentially very serious puncture wounds, and have the potential for a number of other infections beyond simply rabies.</p></li>\n<li><p><strong>Post-exposure vaccination</strong> - For people who have never been vaccinated against rabies previously, post-exposure anti-rabies vaccination should always include administration of <strong>both passive antibody and vaccine</strong>.</p>\n\n<p>In the United States, post-exposure prophylaxis consists of a regimen of one dose of immune globulin and four doses of rabies vaccine over a 14-day period. Rabies immune globulin and the first dose of rabies vaccine should be given by your health care provider as soon as possible after exposure. Additional doses or rabies vaccine should be given on days 3, 7, and 14 after the first vaccination. </p></li>\n</ol>\n\n<hr>\n\n<p>Sources: </p>\n\n<p><a href=\"http://www.cdc.gov/rabies/medical_care/\" rel=\"noreferrer\">CDC - Rabies: Medical Care</a></p>\n\n<p><a href=\"http://www.cdc.gov/rabies/exposure/index.html\" rel=\"noreferrer\">CDC - Rabies: When should I seek medical attention</a></p>\n", "score": 5 } ]

[ "first-aid", "rabies" ]

[ { "answer_id": 947, "body": "<p>There seems to be some misunderstanding here, so this is going to be a long answer. </p>\n\n<p>Our body is very, very good at regulating several physical and chemical parameters inside itself ¹. he most well known is the temperature: it does not matter if the air temperature is -50 Celsius or +50 Celsius, it will do its best to keep you between 36.5 and 37 Celsius, and will mostly succeed at that, with amazing precision, unless you get exposed for a long time to temperatures which are either too hot or too cold for its capabilities to adapt. </p>\n\n<p>The system for regulating blood sugar is similarly complicated. The body is actively trying to keep the blood sugar at a level which it \"believes\" is best for it, and unless its regulation mechanism is badly broken, it's succeeding at that, at least in the long term. Short term upward spikes and downward spikes do happen in the healthy human, if you are either eating or using up sugar at a rate too quick for the body to compensate. </p>\n\n<p>There is a theory that eating too much glucose and other simple sugars can break this regulation system. The reason: they cause upward spikes when they are eaten, because they can be transformed into blood sugar very quickly, quicker than the body can stabilize the level of blood sugar. The body then goes into \"alarm! too high blood sugar!\" mode, and mobilizes whatever it can to reduce the blood sugar before it causes problems. That overreaction gets the spike down soon, but the high hormone levels stay, such that you now get a downward spike in blood sugar. </p>\n\n<p>The supporters of the \"this is unhealthy\" side of the debate (note that the matter is not yet settled in the scientific community, although I'm under the impression that it has been gaining ground lately) say that first, this creates hunger pangs (because when your blood sugar falls, one of the body's mechanisms to get it back up is to create the feeling of hunger, so you supply it with more food) and leads to overeating, and second, frequently straining the blood sugar regulation system will make it less effective over time, because it's overworked, and also because the body gets less sensitive to its signals. This leads to metabolic syndrome and later, diabetes type 2, such that the body can no longer keep the blood sugar at the level it wants it to be. </p>\n\n<p>The gist of it is: <strong>The reason why table sugar is considered unhealthy is that eating it raises blood sugar. Consequently, any other food which raises the blood sugar is just as healthy/unhealthy as table sugar</strong>. </p>\n\n<p>Now you can say that your friend seems to need her blood sugar raised, so for her, eating a food which raises it is not unhealthy. This is indeed logical, but in that case, then sugar is not unhealthy for her either. If she wants to try to raise her blood sugar with food, then pure glucose is indeed the best she can do, followed closely by table sugar. </p>\n\n<hr>\n\n<p>That being said, if I were her, I would <em>not</em> try messing with my blood sugar levels through food. Her sugar regulating system is either working well, or malfunctioning. If it is working well, then there is nothing she should be doing about it, despite it not fitting some norm. <em>If it is malfunctioning, then she must have some serious underlying condition, and she should seek diagnosis and treatment for it instead of eating sugar</em> (which is unlikely to help for timeframes over several minutes to an hour anyway). If she mistrusts her general physician's competence in that matter, she should visit an endocrinologist. If she has no symptoms from the low blood sugar and trusts him that there is no cause to worry, she should keep everything as it is, instead of trying to override her hormones by gorging on glucose, or any other food which raises the blood sugar level. </p>\n\n<p>^{There are two cases that I know of where she can have too low blood sugar measured besides this value being the right one for her or her having a hormonal disturbance/diabetes. First, if she exercises too much, or after too long a time without eating (or drinking sweetened drinks), she can cause a downward spike in an otherwise healthy body. It will go away soon by itself. Second, if she is on a ketogenic diet (only fat and proteins, no carbohydrates at all), her blood sugar will plummet permanently. The solution there is to go back to normal food - unless there is medical indication for the ketogenic diet, such as epilepsy, in which case a health professional should decide whether the side effects are worth continuing it.}</p>\n", "score": 4 } ]

[ "nutrition", "blood-tests", "endocrinology" ]

[ { "answer_id": 916, "body": "<p>While trying to measure the blood pressure, the physician is most likely interested in measuring the pressure inside the left ventricle of the heart. So it is necessary that the Sphygmomanometer and the cuff should remain at the level of the heart. If it is above the level of heart, the reading is likely to be low, and if it is below the heart, the reading is likely to be high. Also, the blood pressure varies with the posture of the body in which the measurement is taken. So the blood pressure value that exists in most guidelines (for example JNC 8) is measured in the sitting position. Hence the value we are intenting to measure is the one with the patient is sitting position, back supported, legs uncrossed, and upper arm bared. The diastolic pressure is high in sitting position, and systolic pressure is high in supine position. Not supporting the back will increase diastolic pressure, while sitting cross legged increases systolic pressure. This is due to the inherent mechanisms in the human body to maintain perfusions to certain organs. The detailed biomechanics is beyond the scope of the present discussion though.</p>\n\n<p>Reference : <a href=\"http://www.aafp.org/afp/2005/1001/p1391.html\">New AHA Recommendations for Blood Pressure Measurement</a></p>\n", "score": 5 }, { "answer_id": 31202, "body": "<p>There are numerous factors that can affect blood pressure from body position (as you mention) to stress or pain. The most important thing one can do is try and take the BP measurement the same way every time. I also think it can be beneficial keeping a journal with some additional information next to the BP. For example, if you are in pain, then make a note of that (e.g., right shoulder hurts today, 5/10); or if you are very fatigued or sick that day, note that as well. I would also always include the time of day.</p>\n<p>Even in medical offices with trained staff, it can be tough to obtain BP measurements that are done 'perfectly.'\nSee this article from Hwang et al. (2018) on the issue <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287289/\" rel=\"nofollow noreferrer\">of mistakes when taking blood pressure readings</a>. That said, here are the guidelines from the ANA on taking BP readings: <a href=\"https://www.ahajournals.org/doi/10.1161/HYP.0000000000000087\" rel=\"nofollow noreferrer\">ANA BP Readings</a>. So, individuals taking home BPs don't need to stress out about being 'perfect.'</p>\n<p>Interestingly, in adults it doesn't seem to matter if you take the BP reading in the right or left arm, just that it is at the level of the right atrium (midpoint of the sternum); however, in children, the recommendation is to take the BP in the right arm. Further, if there is obstructive arterial disease present, then the location where the BP is taken does matter.</p>\n<p>References</p>\n<p>Hwang, K. O., Aigbe, A., Ju, H. H., Jackson, V. C., &amp; Sedlock, E. W. (2018). Barriers to Accurate Blood Pressure Measurement in the Medical Office. Journal of primary care &amp; community health, 9, 2150132718816929. <a href=\"https://doi.org/10.1177/2150132718816929\" rel=\"nofollow noreferrer\">https://doi.org/10.1177/2150132718816929</a></p>\n<p>Muntner, P., Shimbo, D., Carey, R. M., Charleston, J. B., Gaillard, T., Misra, S., Myers, M. G., Ogedegbe, G., Schwartz, J. E., Townsend, R. R., Urbina, E. M., Viera, A. J., White, W. B., &amp; Wright, J. T. (2019). Measurement of blood pressure in humans: A scientific statement from the american heart association. Hypertension (Dallas, Tex.: 1979), 73(5), e35–e66. <a href=\"https://doi.org/10.1161/HYP.0000000000000087\" rel=\"nofollow noreferrer\">https://doi.org/10.1161/HYP.0000000000000087</a></p>\n", "score": 2 } ]

[ "blood-pressure" ]

[ { "answer_id": 970, "body": "<p><strong>Summary</strong> </p>\n\n<p>The primary risk of excessive water intake is hyponatremia (low sodium level in the blood). While a healthy person who drinks 6-8 liters of water daily is unlikely to suffer significant hyponatremia, people who drink this much often have psychiatric illness that is accompanied by poorly understood hormonal changes that may indeed cause hyponatremia and its attendant symptoms.</p>\n\n<p><strong>Psychogenic polydipsia</strong> </p>\n\n<p>Many patients with a variety of psychiatric disorders drink more water than normal. This is termed psychogenic polydipsia. The cause is unknown.¹ </p>\n\n<p><strong>Hyponatremia: mechanism</strong> </p>\n\n<p>Sodium levels correlate closely with serum osmolality, since sodium is the primary cation contributing to osmotic pressure. The body maintains serum osmolality within a narrow range via regulation of antidiuretic hormone (ADH, a.k.a. arginine vasopressin), a hormone that is secreted by the posterior pituitary gland (a.k.a. neurohypophysis) at the base of the brain in response to a rise in serum osmolality. The hormone circulates in the blood and acts in the kidneys to increase free water resorption, thereby lowering serum osmolality. In the case of excess free water, ADH secretion will be maximally suppressed. </p>\n\n<p>In a healthy person, ADH suppression results in urine diluted to a concentration of about 60 mmol/kg,⁴ which (assuming a normal glomerular filtration rate) corresponds to a fluid intake of about 28 L per day. Only above that level with serum osmolality be significantly compromised.</p>\n\n<p><strong>SIADH</strong> </p>\n\n<p>Unfortunately, many people can not suppress ADH maximally. As a result, urine may be ‘inappropriately’ compromised in the face of falling serum osmolality. This is called, creatively, Syndrome of Inappropriate Diuretic Hormone (SIADH). For reasons that are incompletely understood, many psychiatric patients with psychogenic polydipsia (see below) have SIADH.³ Some of the reasons that are understood: </p>\n\n<ul>\n<li>Medications including antidepressants (primarily SSRIs) and antipsychotics are well-established causes of SIADH. </li>\n<li>Schizophrenia itself appears to be associated with SIADH. </li>\n<li>Chronic hyponatremia may lead to a ‘reset osmostat’ whereby the pituitary's threshold for ADH secretion is changed. </li>\n</ul>\n\n<p><strong>Hyponatremia: consequences</strong></p>\n\n<p>The constellation of symptoms associated with hyponatremia is termed hyponatremic encephalopathy.³ It includes: headache, blurred vision, weakness, muscle tremor and cramps, nausea and vomiting, diarrhea, restlessness, confusion. This can progress, in severe cases, to seizures, coma, and death. It would be exceedingly rare for a person with purely psychogenic polydipsia to progress to this point (in part because one is likely to develop depressed consciousness and stop drinking such that the kidney can fix the problem prior to dying). </p>\n\n<p>One important point is that the level of hyponatremia required to cause these symptoms is largely dependent on the rapidity of change. Acute hyponatremia can cause symptoms at a level of 128-130 mEQ/L (normal 135-145 mEq/L). On the other hand, patients with chronic SIADH may walk around with sodium 120-125 mEq/L without symptoms. </p>\n\n<hr>\n\n<p>_{\nReferences\n}</p>\n\n<p>_{\n1. M Biswas and J S Davies. <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600061/\">Hyponatraemia in clinical practice</a>\nPostgrad Med J. 2007 Jun; 83(980): 373–378.\n} </p>\n\n<p>_{\n2. Dundas B, Harris M, Narasimhan M.<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/17521521\">Psychogenic polydipsia review: etiology, differential, and treatment.</a> Curr Psychiatry Rep. 2007 Jun;9(3):236-41.\n}<br>\n_{<br>\n3. Illowsky BP, Kirch DG .<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/?term=3285701\">Polydipsia and hyponatremia in psychiatric patients</a>. Am J Psychiatry. 1988 Jun;145(6):675-83.\n}<br>\n_{<br>\n4. Robertson GL. Chapter 340. Disorders of the Neurohypophysis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012.\n}</p>\n", "score": 11 } ]

[ "nutrition", "diet", "side-effects", "water" ]

[ { "answer_id": 983, "body": "<p>Dysmenorrhea (pain with menstruation) can be <em>primary</em> or <em>secondary</em>. The first thing a woman should do is see a physician to determine which kind of dysmenorrhea she has. </p>\n\n<p><em>Primary dysmenorrhea</em> is painful menstruation with a normal pelvic examination (no causes can be determined). It is is by far the most common gynecologic problem in menstruating women, can be worse in younger women than older ones, and is worse in smokers. Usually women refer to this kind of pain as \"menstrual cramps\", and they tend to occur just before and in the early part of menstruation. The cause is increased production of endometrial <em>prostaglandins</em>, natural hormones which cause uterine contractions. If the pain is severe enough, or in any way atypical, an pelvic ultrasound will be done to rule out pelvic pathology.</p>\n\n<p>Nonsteroidal anti-inflammatory medications (NSAIDS) are the usual treatment because they are anti-prostaglandins; NSAIDS include ibuprofen, naproxin, aspirin, etc. If NSAIDS alone do not decrease pain sufficiently, patients are often placed on oral contraceptive pills, which will make periods lighter and less painful, or continuous-use OCP's that result in suppression of menses altogether. If these are inadequate in the absence of pelvic pathology, stronger medications can be prescribed, or one can try accupuncture. Topical heat is often comforting.</p>\n\n<p><em>Secondary dysmenorrhea</em> is pain in the presence of gynecologic findings, usually endometriosis or adenomyosis (growth of endometrial tissue outside of the endometrial cavity, either outside of the uterus or in uterine muscle walls), adhesions, fibroid (benign) tumors, infection, or other problems. It tends to be more severe pain, later during the period, starts years after the onset of menses, can be associated with heavy menstrual flow or irregular cycles, or other. It's important to have a physician involved in the care of secondary dysmenorrhea. </p>\n\n<p><img src=\"https://i.stack.imgur.com/2nTaU.jpg\" alt=\"enter image description here\"></p>\n\n<p>_{<a href=\"http://patients.gi.org/topics/aspirin-and-nsaids/\" rel=\"noreferrer\">Aspirin and NSAIDS </a> - A very nice overview of NSAIDs}<br>\n_{<a href=\"http://www.aafp.org/afp/1999/0801/p489.html\" rel=\"noreferrer\">Primary Dysmenorrhea</a>}<br>\n_{<a href=\"http://patients.gi.org/topics/aspirin-and-nsaids/\" rel=\"noreferrer\">Aspirin and NSAIDS </a> - A very nice overview of NSAIDs}<br>\n_{Trials of transcutaneous electrical nerve stimulation (TENS) units, laparoscopic presacral neuronectomy, acupuncture, omega-3 fatty acids, transdermal nitroglycerin, thiamine and magnesium all demonstrated <em>some</em> relief of dysmenorrhea symptoms.} </p>\n", "score": 8 } ]

[ "treatment-options", "gynecology", "menstrual-cycle", "pain-management", "dysmenorrhea" ]

[ { "answer_id": 1057, "body": "<p>There is <a href=\"http://www.nature.com/nature/journal/v514/n7521/full/nature13793.html\" rel=\"nofollow\">a good article on that in <em>Nature</em></a>, where in a study it was found that non-caloric artificial sweeteners (NAS) in fact do lead to a rise of serum insuline levels, possibly via a induced change of the gut flora, proven by the fact that the effect could be reproduced after fecal transplantation in mice. (<a href=\"http://genie.weizmann.ac.il/pubs/2014_nature.pdf\" rel=\"nofollow\">Full article here</a>)</p>\n\n<p>And this is about the status of scientific knowledge about it. There is a good <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/25828597\" rel=\"nofollow\">review on the NAS topic in childrens' diets</a>.</p>\n\n<p>Also, <a href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0031570\" rel=\"nofollow\">Aspartame exposure during pregnancy has been found to reduce insulin sensitivity in male mice</a>, thereby showing a gender difference and other side effects.</p>\n\n<p>So, to answer the question: By today's knowledge it's yes, they may cause insulin spikes, but rather indirectly. But nonetheless, they produce measurable adverse effects on your glucose homeostasis, the pathways of which are still not quite clear but may - amongst others - have to do with your gut flora, your insulin receptor sensitivity or behaviourial mechanisms of the brain reacting to sweet taste.</p>\n", "score": 4 } ]

[ "nutrition", "diet" ]

[ { "answer_id": 1050, "body": "<p>No one can predict the future, nor can we diagnose over the internet, so I won't address that aspect of your question. However, I can tell you why the doctor wanted the following shots.</p>\n\n<p>Tetanus immunization: Any time a person gets a \"dirty\" wound* (animal bites and cat scratches are considered dirty - think of what a cat does with it's paws), tetanus immunization should be considered if the last immunization was more than 5 years ago (10 years if it's a clean wound.)</p>\n\n<p>Tetanus Immune Globulin: for dirty wounds in people with an unknown history of prior immunization, or if 2 or fewer doses in the past. Often in the past, elderly individuals were unimmunized against tetanus because of the availability and scheduling of the immunization. The TIG is recommended because the tetanus toxoid - the \"tetanus vaccine\" - takes a while (and several doses) to induce immunity. The TIG provides immediate but temporary immunity by directly providing antitoxin. </p>\n\n<p>Rabies/Rabies Immune Globulin - for any bite from an animal of unknown status. Nonbite exposures rarely cause rabies, however that does not mean <em>never</em>. Such exposures should be evaluated for possible postexposure prophylaxis administration. If someone lives in an area where a significant numbers of rabid animals are known to exist, the recommendations will be different than in an area where rabies is rarely detected.</p>\n\n<p>However, if the cat can be caught and quarantined (<a href=\"http://www.cdc.gov/rabies/exposure/animals/index.html\">if the animal can be found and held for observation</a>), a physician <a href=\"http://www.cdc.gov/rabies/exposure/index.html\"><em>may</em> delay this treatment</a>.</p>\n\n<p>It's a bit late now, but soap and water should be your first line of treatment for dirty wounds; if rabies is a possibility, apply Betadine/providone iodine after using soap and water.</p>\n\n<p>Signs of wound infection include: puffiness, warmth, pain, redness extending outward from the wound, discharge of pus, a foul smell, streaks going up from the wound towards the body, fever, chills or muscle aches.</p>\n\n<p>You can always go back to the doctor if you are worried. It's never \"too late\". You should also read about the signs and symptoms of <a href=\"http://www.cdc.gov/tetanus/\">tetanus</a>, which is the results of an infection where <strong>the toxin</strong> spreads through the body. You cannot tell by looking at a wound if it's \"tetanus\". You can only tell if it's tetanus <em>prone</em>.</p>\n\n<p>If you live in the US, you can often discuss the need for rabies prophylaxis not only with a doctor, but by calling your local or state Department of Health.</p>\n\n<p>Again, it's never too late to see a doctor, and you should do so if you have any concerns (which you clearly do.)</p>\n\n<p>Also, the doctor should address whether other tetanus shots should be given and when.</p>\n\n<p>*_{Such as, but not limited to, wounds contaminated with dirt, feces, soil, and saliva; puncture wounds; avulsions; and wounds resulting from missiles, crushing, burns, and frostbite.}<br>\n_{Persons with wounds that are neither clean nor minor, and who have had fewer than 3 prior doses of tetanus toxoid or have an unknown history of prior doses should receive TIG as well as Td or Tdap. This is because early doses of toxoid may not induce immunity, but only prime the immune \nsystem. The TIG provides temporary immunity by directly providing antitoxin. This ensures that protective levels of antitoxin are achieved even if an immune response has not yet occurred. - CDC, (Pink Book) Epidemiology and Prevention of Vaccine-Preventable Diseases, 13th Edition}<br>\n_{Nonbite exposures from terrestrial animals rarely cause rabies. However, occasional reports of rabies transmission by nonbite exposures suggest that such exposures should be evaluated for possible postexposure prophylaxis administration. - <a href=\"http://www.cdc.gov/rabies/exposure/type.html\">CDC</a>}<br>\n</p>\n", "score": 6 } ]

[ "infection", "wound", "zoonotic-diseases", "cat-scratch-fever", "tetanus-shot" ]

[ { "answer_id": 1100, "body": "<p>I summarized the mechanism of hiccups in <a href=\"https://biology.stackexchange.com/q/21865/9268\">a question on biology.SE</a> a few months ago. That may be useful background information for the answer to this question about what interventions work.</p>\n\n<p>Regarding the available data, as usual a <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=23440833\" rel=\"nofollow noreferrer\">Cochrane Review</a> provides the best meta-analysis, and as usual they conclude that there is insufficient evidence for anything. However, in practicality there are <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=8947969\" rel=\"nofollow noreferrer\">decent</a> observational <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=2024799\" rel=\"nofollow noreferrer\">data</a> available.</p>\n\n<p>Because hiccups stem from a reflex arc involving the vagal nerve, physical maneuvers that stimulate the vagus often abort hiccups.</p>\n\n<p>These may include: </p>\n\n<ul>\n<li>Breath holding</li>\n<li><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/6565684\" rel=\"nofollow noreferrer\">Valsalva maneuver</a> (exhaling against a closed glottis)</li>\n<li>Stimulating the nasopharynx or glottis (e.g. gargling cold water; upside down is often (reasonably) recommended to route water up into the nasopharynx where is is more likely to cause vagal stimulation)</li>\n</ul>\n\n<p>If none of these is successful, medications are occasionally used. The oldest and most well-established treatment is <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=13221413\" rel=\"nofollow noreferrer\">chlorpromazine</a> (a.k.a. Thorazine), a first-generation antipsychotic. Although it is approved by the U.S. FDA for treatment of hiccups, even that has only been studied in <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=13221413\" rel=\"nofollow noreferrer\">small case series</a>, mostly in patients with hiccups due to cancer. Other medications that are sometimes used off-label include <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=25069531\" rel=\"nofollow noreferrer\">metoclopramide</a> (a.k.a. Reglan) and <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=7758557\" rel=\"nofollow noreferrer\">baclofen</a>. Although the studies of these medications are small, they do appear to be effective.</p>\n\n<p>Most often, hiccups are benign, often triggered by gastric distention from over-eating or carbonated beverages. However, particularly intractable hiccups have been associated with serious conditions including intracranial problems such as stroke or encephalitis as well as many different kinds of cancer. If hiccups are occurring very frequently or are difficult to resolve, you should consult with a doctor. </p>\n\n<hr>\n\n<p>_{\n<strong>References</strong>\n} <br>\n_{\n<strong>1</strong>. Guelaud C, Similowski T, Bizec JL, Cabane J, Whitelaw WA, Derenne JP. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=7758557\" rel=\"nofollow noreferrer\"><em>Baclofen therapy for chronic hiccup.</em></a> Eur Respir J. 1995 Feb;8(2):235-7.}_{<br>\n<strong>2</strong>. Friedgood CE et al. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=13221413\" rel=\"nofollow noreferrer\"><em>Chlorpromazine (thorazine) in the treatment of intractable hiccups.</em></a> J Am Med Assoc. 1955 Jan 22;157(4):309-10.}_{<br>\n<strong>3</strong>. Friedman NL. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/8947969\" rel=\"nofollow noreferrer\"><em>Hiccups: a treatment review.</em></a> Pharmacotherapy. 1996 Nov-Dec;16(6):986-95.}_{\n<strong>4</strong>. Kolodzik PW, Eilers MA. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/?term=2024799\" rel=\"nofollow noreferrer\"><em>Hiccups (singultus): review and approach to management.</em></a> Ann Emerg Med. 1991 May;20(5):565-73.}_{<br>\n<strong>5</strong>. Moretto EN, Wee B, Wiffen PJ, Murchison AG. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=23440833\" rel=\"nofollow noreferrer\">Interventions for treating persistent and intractable hiccups in adults.</a> Cochrane Database Syst Rev. 2013 Jan 31;1.}_{<br>\n<strong>6</strong>. Wang T, Wang D. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=25069531\" rel=\"nofollow noreferrer\"><em>Metoclopramide for patients with intractable hiccups: a multicentre, randomised, controlled pilot study.</em></a> Intern Med J. 2014 Dec;44(12a):1205-9.\n}</p>\n", "score": 4 }, { "answer_id": 1118, "body": "<p>I have found a particular combination of actions has worked for me every time, and for all but one of the friends and acquaintances I recommended it to.</p>\n\n<ol>\n<li>Get a glass of water (lukewarm is best)</li>\n<li>Hyperventilate a little (this is so you can hold your breath longer)</li>\n<li>Take a very deep breath and hold it</li>\n<li>Start taking very small swallows of water (not large swallows!)</li>\n<li>Keep doing this for (almost) as long as you can hold your breath</li>\n<li>Let your breath out in an easy, relaxed flow (if you let it out all at once you can re-start your hiccups)</li>\n</ol>\n\n<p>After using it for so many years I can now simulate the underlying physical mechanism without the aids. To me it feels like with each swallow you are pushing down on that muscle between your stomach and esophagus, making it clench and at some point it just gives up and stops clenching. I can just visualize this happening (though I still have to hold my breath) and I can feel the exact moment when the hiccups stop.</p>\n\n<p>Interestingly, after reading @Susan's answer I think it might be the glottis that I feel like I'm putting pressure on. The combination of breath holding and swallowing cause the glottal pressure.</p>\n", "score": 2 } ]

[ "symptoms" ]

[ { "answer_id": 1125, "body": "<p>In the US, <a href=\"http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=101.12\" rel=\"nofollow\">21 CFR 101</a> provides reference amounts for serving sizes, which are usually followed somewhat closely (I wasn't able to determine if they are required by law) by food manufacturers.</p>\n\n<p>In the specific case of rice, the standard serving size is \"140 g prepared; 45 g dry\" listed in the format \"_ cup(s) (_ g)\".</p>\n\n<p>Usually, the nutritional label on the actual product package (no comment on databases on random websites and apps) will provide information about whether it is referring to prepared or \"raw\" state, or will provide both. The prepared state may include ingredients not provided in the package.</p>\n\n<p>For example, Cheerios has a serving size of \"1 cup (28 g)\", dry, and additionally provides a column with values for \"with 1/2 cup skim milk\".</p>\n\n<p>Kraft Macaroni &amp; Cheese Dinner gives the serving size as \"2.5 oz (70 g / about 1/2 box) (Makes about 1 cup)\", and provides columns for \"as packaged\" and \"as prepared\". Different pictures I found of the nutrition information and directions varied widely as to the calories of the \"as prepared\" column and the amount of butter called for; presumably these will match on any given box.</p>\n\n<p>I wasn't able to find any pictures of real nutrition labels for packages of plain rice.</p>\n\n<p>Google allows you to specify \"raw\" or \"cooked\" when searching for the nutrition information of rice - according to it, 100 grams of cooked long-grain brown rice has 111 calories, and 100 grams of raw long-grain brown rice has 370 calories. When the measure is switched to one cup, the calories are 216 and 684 respectively, with the weights being 195 and 185 grams. So, if your app doesn't say, it should be easy to figure out which numbers track better with how many calories it actually says a cup of rice has.</p>\n", "score": 4 }, { "answer_id": 1121, "body": "<p>There is no standard for calculating \"food volumes\". The nutrition data of all foods is only consistent by weight. Standardized nutrition data labels all give nutrients per 100 g, frequently also adding the nutrient amount calculated for other weights, for example for one unit of packaging, or one piece when the food is in discrete pieces. </p>\n\n<p>When somebody is talking of nutrition units (e.g. calories, grams of carbs, or whatever) per volume, they are probably using some volume conversion formula. But for most foods, there is no really good formula. Food volume changes a lot in preparation, and frequently it's not as predictable as the change in rice volume you describe - if you have chopped walnuts, the final volume depends on how finely they are chopped, and also how they were handled afterwards. Also, volume measurement of foods is imprecise to the point where it's useless (for example, a \"cup\" of flour can be anywhere from 100 to 160 grams for the same type of flour). </p>\n\n<p>The conclusions: 1) there is no way to predict what formula they are using (e.g. whether they are using the average for cooked or raw rice), because there is no standard for that, and 2) even if you happen to use their formula, you can't achieve precision. If you need precision, you'll have to switch to an app which lets you measure your food by weight. </p>\n", "score": 3 } ]

[ "nutrition", "statistics" ]

[ { "answer_id": 4637, "body": "<p>If you know your insulin-to-carb ratio and your correction factor (how much your blood sugar drops per unit of insulin), you should be able to calculate how much you should have had fairly simply &ndash; at least in theory. </p>\n\n<p>Assuming that your blood sugar would have remained level had you not eaten (which will not usually be the case in real life), you just need to subtract your <em>expected</em> blood sugar from your <em>actual</em> blood sugar. </p>\n\n<pre><code>85 - 200 = 115 [mg/dL]\n\n115 [mg/dL] * (correction factor) [units / mg/dL] = (insulin deficit) [units]\n</code></pre>\n\n<p>Suppose your correction factor is 1:50, e.g. 1 unit brings you down 50 mg/dL. </p>\n\n<pre><code>115 [mg/dL] * (1/50) [units / mg/dL] = 2.3 [units]\n</code></pre>\n\n<p>You can then estimate about how many extra carbs were in the meal, using your insulin-to-carb ratio: </p>\n\n<pre><code>(insulin deficit) [units] * (carb ratio) [g carb/unit] = (excess carbs) [g carb]\n</code></pre>\n\n<p>Suppose your ratio is 1:10, e.g. 1 unit covers 10g of carb: </p>\n\n<pre><code>2.3 [units extra needed] * 10 [g carb/unit] = 23 [g carb more than estimated]\n</code></pre>\n\n<p>If you use 15g carb = 1 exchange/choice: </p>\n\n<pre><code>23 g / 15 g = 1.5 exch\n</code></pre>\n\n<p>So, you now know that the meal had 23g more carb in it than you expected, and that in the future you would take 2.3 more units. </p>\n\n<p>Of course, in reality it's not quite so simple. Different foods take longer to digest, convert to glucose, and enter the bloodstream. Activity level, injection site, and other factors affect how quickly insulin kicks in. The above calculation is the most straightforward way to calculate the food/insulin/blood sugar balance, but there will always be other factors at play. </p>\n", "score": 3 } ]

[ "diabetes", "type-1-diabetes" ]

[ { "answer_id": 1156, "body": "<p>Honey is rich in glucose (<a href=\"http://en.wikipedia.org/wiki/Honey#Nutrition_and_composition\">31%</a>) and contains other insulin-triggering sugars such as sucrose and maltose. <a href=\"http://ajcn.nutrition.org/content/34/3/362.full.pdf\">One study</a> found that it has a glycaemic index of 87, much higher than that of table sugar (59), but note that GI is rather fickle to measure and you can probably find differing numbers for both. I've seen sources (not peer reviewed) which claim that honey's GI is somewhat lower than that of sugar. </p>\n\n<p>A diabetic can consume honey just like any other carbohydrate. He will have to adjust the amount of honey and other carbohydrates in the same meal such that his blood sugar does not overshoot the target amount. If he is insulin-dependent, he will have received guidelines how to adjust insulin injections depending on the amount of carbohydrates eaten, and will have to include the amount of honey he consumed in his calculation. </p>\n\n<p>If the diabetic is on a low-GI diet, honey may not be allowed by the diet-specific rules. This will be explained by the specialist who prescribed the diet. </p>\n", "score": 8 } ]

[ "diabetes" ]

[ { "answer_id": 1359, "body": "<p>TL;DR: using expired condom might lead to irritation on the skin of the sex organs involved in the act, and might also lead to skin inflammation and rash.</p>\n<hr />\n<p>After some self research, I found <a href=\"https://www.selfgrowth.com/articles/complications-associated-with-using-expired-condoms\" rel=\"nofollow noreferrer\">this article</a> which while not scientific and official, is written by someone who appears to know what they're talking about.</p>\n<p>Quoting the relevant part: (part about pregnancy isn't relevant to my case since the question is purely about health)</p>\n<blockquote>\n<p>Here are some of the common risks linked with using expired condoms:</p>\n<p>...</p>\n<ul>\n<li>Irritation: As mentioned earlier, a condom which has crossed its expiration date may get dried and weak. A dried and weak condom can cause irritation on the skin of your sex organ and also in the vagina. It can also lead to skin inflammation and rash.</li>\n</ul>\n</blockquote>\n", "score": 2 } ]

[ "contraception" ]

[ { "answer_id": 1193, "body": "<p>There's <a href=\"https://www.soylent.com\">Soylent</a>, which is designed for exactly what you describe. </p>\n\n<p>But even without considerations of taste, I'm very suspicious of this approach, because it's based on some assumptions that I would question. One is that we know exactly what the human body needs and can just put it in a shake. But what if there are micronutrients in real food that we just haven't discovered yet? Or what if the nutrient in the shake simply doesn't work when distilled into pure form, without the natural packaging provided by, say, the apple it came from. We evolved to eat food, and assuming that we can eat a processed version may be misguided.</p>\n", "score": 9 } ]

[ "nutrition" ]

[ { "answer_id": 1224, "body": "<p>Heart rate variability (HRV) is a measure of the variation in the beat-to-beat interval. The heart rate (HR) is the number of heart beats in some unit time (generally expressed as the number of beats per minute). In general, because measures of HR are an average over time, it will smooth out the variability in the heart rate. The amount of HRV cannot be estimated from a measure of the HR at a single time point. Estimating the amount of HRV from multiple measures of HR at different times is possible, but will be corrupted by changes in the average heart rate over time. So in summary, no HRV cannot be estimated from measures of HR.</p>\n", "score": 2 } ]

[ "research", "cardiology", "biological-parameter" ]

[ { "answer_id": 1246, "body": "<p>There are complications involved with TB itself and with the treatment. </p>\n\n<p>The TB itself is likely to resolve (assuming it isn't resistant which it should have been tested for). Thus no complications caused by TB should occur which would be damage to structures in the neck or elsewhere affected by TB and disease if TB had spread across the body. </p>\n\n<p>The treatment has a number of side effects. These include</p>\n\n<ul>\n<li>The oral contraceptive might not work</li>\n<li>Can damage your liver and eyes. For this reason your liver and eyes are tested before treatment and during treatment</li>\n<li>Rash</li>\n<li>Vomit</li>\n<li>Numbness</li>\n</ul>\n\n<p>If any of these occur, she should see a doctor. And honestly, she should discuss which complications she might face with a doctor.</p>\n", "score": 4 } ]

[ "infection", "symptoms" ]

[ { "answer_id": 1252, "body": "<p>Your doctor wants to know what the stones are made of (e.g. Calcium oxalate, etc.) Being in the container will not be alter that, nor will drying out. </p>\n\n<p>Just put all the stones you find in the container, and follow the advice you were given about fluids, foods, etc. Drop the stones off whenever it's convenient - a week or two is fine. The sooner they are analyzed, however, the sooner your doctor can give you tailored advice on measures you can take that will decrease the likelihood of more stones forming.</p>\n", "score": 4 } ]

[ "kidney-stones" ]

[ { "answer_id": 1301, "body": "<p>Your own Wikipedia page already states that \"There is no scientific evidence of a therapeutic use for untreated urine\" and \"According to the American Cancer Society, \"available scientific evidence does not support claims that urine or urea given in any form is helpful for cancer patients\" \"</p>\n\n<p>But lets me show you more detailed evidence. First urine is nothing more than : </p>\n\n<blockquote>\n <p>Urine is an aqueous solution of greater than 95% water, with the remaining constituents, in order of decreasing concentration, urea 9.3 g/L, chloride 1.87 g/L, sodium 1.17 g/L, potassium 0.750 g/L, creatinine 0.670 g/L and other dissolved ions, inorganic and organic compounds (see this <a href=\"http://ntrs.nasa.gov/archive/nasa/casi.ntrs.nasa.gov/19710023044_1971023044.pdf\">nasa study</a>)</p>\n</blockquote>\n\n<p>We know that urine is <a href=\"https://www.sciencenews.org/blog/gory-details/urine-not-sterile-and-neither-rest-you\">not 100% sterile</a>, but usually won't harm a healthy people if you drink it (and the urine is from a healthy person too that didn't drink any drug or poisons) but the only situation i can see it would be good to drink your own urine is if you are dehydrating to death and even that is not really recommended ( see this wonderful question on <a href=\"https://skeptics.stackexchange.com/questions/1540/is-it-a-good-idea-to-drink-your-own-urine-in-a-survival-situation\">skeptics.se</a> ) </p>\n\n<p>But you could think if we have potassium and other minerals in urine why not drink it? Because you can get much more by eating food and hormones are produced by your own body you don't need to drink pee to replace that, and they become urine for a good reason, see the conclusion of <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3032614/\">this study</a> :</p>\n\n<blockquote>\n <p>It is strongly suggested that alternative therapies should be non-hazardous, and therefore, inappropriate administration of remedies, such as urine therapy in pediatric health conditions should be discouraged, considering the fact that no documented scientific / clinical evidence of the beneficial effect of urine therapy in clinical had been reported, while multiple antibiotic resistant bacterial species had also been recovered from such urine.</p>\n</blockquote>\n\n<p>Edit: About your medicines listed.</p>\n\n<ul>\n<li><p><a href=\"http://www.drugs.com/cons/metrodin.html\">Metrodin</a> = Wrong. Metrodin is is a man-made hormone called follicle-stimulating hormone (FSH). FSH is produced in the body by the pituitary gland. <strong>May</strong> appear on urine, however in <strong>very low</strong> concentrations to justify drinking your own pee.</p></li>\n<li><p><a href=\"http://www.drugs.com/cons/pergonal.html\">Pergonal</a> = Wrong. Menotropins are a mixture of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) that are produced in the body by the pituitary gland. <strong>May</strong> appear on urine, however in <strong>very low</strong> concentrations to justify drinking your own pee.</p></li>\n<li><p><a href=\"http://www.druglib.com/druginfo/panafil/description_pharmacology/\">Panafil</a> = Wrong.It is a proteolytic enzyme derived from the fruit of carica papaya. The only <strong>possible</strong> (not 100%) way its going to end up in your urine is if you are eating the fruit.</p></li>\n<li><p><a href=\"http://www.chemocare.com/chemotherapy/drug-info/cladribine.aspx\">2-CdA</a> = 2-CdA is the trade name for cladribine. Leustatin and 2-chlorodeoxyadenosine are other names for cladribine. It <strong>was</strong> extracted from urine and according to Wikipedia it was first synthesized at Brigham Young University (meaning they don't extract it from urine anymore), they do appear in urine but in <strong>too low</strong> concentrations to justify drinking your own pee.</p></li>\n<li><p><a href=\"http://www.drugs.com/mtm/urokinase.html\">Urokinase</a> and <a href=\"https://en.wikipedia.org/?title=Urokinase\">Wikipedia page</a> = Urokinase is a man-made product developed using a protein that occurs naturally in the kidneys. Urokinase is made from human kidney cells and albumin (part of the blood) which may contain viruses and other infectious agents. Urokinase was originally <strong>isolated</strong> from human urine, but is present in several physiological locations, such as blood stream and the extracellular matrix. Again, they do appear in urine but in <strong>too low</strong> concentrations to justify drinking your own pee.</p></li>\n</ul>\n\n<p>Why drinking your own pee to get this substances is completely non-sense?</p>\n\n<blockquote>\n <p>A single <a href=\"http://www.livescience.com/45005-banana-nutrition-facts.html\">Banana</a> have 450mg of potassium or 13% of our recommended intake. 2L of urine have 1500mg potassium or ~31% of recommended daily intake. But at this scale you would get 18,6g of urea, 3,74g of chloride and 2,34g of sodium too.</p>\n</blockquote>\n\n<p>Now <a href=\"http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/Frequently-Asked-Questions-FAQs-About-Sodium_UCM_306840_Article.jsp\">American Heart Association in 2010 chose to recommend that Americans eat less than 1,500 mg/day sodium as part of the definition of ideal cardiovascular health.</a>. So you going 840mg above your ideal sodium consumption only with urine, <strong>long term drinking urine and a diet high in sodium will really hurt your health.</strong> (I don't think i have to cite the consequences of too much sodium right? Just google for it)</p>\n\n<p>Now see the dangers of excess of <a href=\"http://chemocare.com/chemotherapy/side-effects/hyperchloremia-high-chloride.aspx\">Chloride</a> note that <strong>The normal adult value for chloride is 97-107 mEq/L.</strong> and you will be consuming 3,74g to get only ~31% of your potassium intake. I didn't find a good converter online so i will let this to someone who can do this math. But just 1g/l is a lot more than 107meq/l. You only going to make your poor kidney to work much harder to handle all this chloride.</p>\n\n<p>Now about urea, this <a href=\"http://www.epa.gov/iris/toxreviews/1022tr.pdf\">study</a> says:</p>\n\n<blockquote>\n <p>There is limited information to suggest that the liver, kidney, and pituitary could be targets of urea toxicity. Under the Guidelines for Carcinogen Risk Assessment (U.S. EPA, 2005a), there is “inadequate information to assess the carcinogenic potential” of urea. Epidemiologic studies of humans chronically exposed to urea alone or urea-containing mixtures are limited.</p>\n</blockquote>\n\n<p>But drinking 18,6g of urea daily surely can't be good to you. There is no scientific evidence for health benefits of drinking this. Lack of studies is not equal to no toxicity! </p>\n\n<p>For hormones i think you can see why is totally no-sense, the amount of urine you would have to drink to get any considerable amount would be insane and toxic.</p>\n", "score": 9 } ]

[ "treatment" ]

[ { "answer_id": 1327, "body": "<p>These interaction checkers are great tools and many physicians use them in making prescription decisions. A very experienced physician will already know this information about medications they prescribe regularly, but there is so much information and so many medications now, it is good for healthcare consumers to educate themselves about what they are putting into their bodies.</p>\n\n<p>The next part of that education is to bring these results and your concerns to your healthcare provider and ask them to explain the risk/benefit balance they believe is being achieved with this particular mix of medications. At the same time, make sure they are aware of the over-the-counter medications you are using as well, and get their advice on which of those to use or avoid with the mix of medications you are on. </p>\n\n<p>Your question was, \"How offput should one be by this?\"</p>\n\n<p>The ultimate answer for you question is be offput enough to <em>really</em> understand the decisions being made for you in the physician's office, so you can help in making those decisions. That is how you become a participant, rather than just a consumer, in your healthcare.</p>\n\n<p><a href=\"http://www.fda.gov/Drugs/ResourcesForYou/ucm163354.htm\">Drug Interactions: What You Should Know</a> is an article published by the U.S. Food and Drug Administration about this very topic.</p>\n", "score": 5 }, { "answer_id": 1333, "body": "<p>These programs tend to flag <em>all</em> interactions, making it difficult for the patient to interpret the reaction's significance.</p>\n<p>A decreased effect is usually not as dangerous (or as noticeable) as an increased effect (depending on the medication, of course), for example decreasing the metabolism of coumadin - a blood thinner - or it's active metabolites by adding an agent which inhibits it's clearance (e.g. an antifungal agent, ketaconazole). This can result in a life-threatening increased effect of coumadin.</p>\n<p>Note also that not all drug checkers are alike in their ability to calculate risks/side effects.</p>\n<p>For example, at Web.MD, the combination of ketoconazole oral + warfarin oral will give you a &quot;serious&quot; risk:</p>\n<blockquote>\n<p>ketoconazole oral will increase the level or effect of warfarin oral by altering drug metabolism</p>\n</blockquote>\n<p>But <a href=\"http://www.drugs.com/interactions-check.php?drug_list=1412-0,2311-0&amp;types%5B%5D=major&amp;types%5B%5D=minor&amp;types%5B%5D=moderate&amp;types%5B%5D=food&amp;professional=1\" rel=\"nofollow noreferrer\">Drugs.com</a> gives only a &quot;moderate&quot; risk, with the &quot;professional&quot; option going into more detail:</p>\n<blockquote>\n<p>MONITOR: Azole antifungal agents that are potent inhibitors of CYP450 3A4 such as itraconazole, ketoconazole, and posaconazole may increase the plasma concentrations and hypoprothrombinemic effect of warfarin... (etc.)</p>\n<p>MANAGEMENT: Patients receiving warfarin should be closely monitored during concomitant therapy with azole antifungal agents that are potent inhibitors of CYP450 3A4. The INR should be checked frequently and warfarin dosage adjusted accordingly, particularly following initiation, change of dosage, or discontinuation of azole antifungal therapy. The same precaution may be applicable during therapy with other coumarin anticoagulants, although clinical data are lacking. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.</p>\n</blockquote>\n<p>And gives you references!</p>\n<p>This is not a recommendation of one over another, but an example of how online checkers differ. A third option is to Google only the drugs you're mixing, which will give you not only several calculators but specific papers.</p>\n<p>In my opinion, the best advice you can get is from a clinical pharmacologist, or from programs written for professionals by clinical pharmacologists. These programs cost money.</p>\n<p>You might be wise to approach drug interactions by asking both your doctor (when the drug is prescribed) <em>and</em> your pharmacist; if they have different advice, they should resolve it by discussing with a clinical pharmacologist.</p>\n<p>_{Even though I check for and advise patients about possible drug interactions, I <em>always</em> tell them to check with their pharmacist as well (in fact, it's a written part of my discharge instructions when I've prescribed a drug, mostly because many patients don't report all the drugs they are taking, don't consider OTC medications as drugs, etc.) This is a case where two heads are better than one.}</p>\n", "score": 4 } ]

[ "medications" ]

[ { "answer_id": 1311, "body": "<p>You can import 90 days (3 months) drug prescription supply - it sounds like you can do this in multiple times. There is a concise summary of this at \n<a href=\"https://answers.yahoo.com/question/index?qid=20140321030753AARucHH\" rel=\"nofollow\">https://answers.yahoo.com/question/index?qid=20140321030753AARucHH</a> but the closest (imperfect) primary source I've found is <a href=\"http://travel.gc.ca/travelling/health-safety/medication\" rel=\"nofollow\">http://travel.gc.ca/travelling/health-safety/medication</a> :</p>\n\n<p>\"The drug must be for your use or for the use of a person who is travelling with you and for whom you are responsible. The drug must be shipped or carried in hospital or pharmacy-dispensed packaging, the original retail packaging, or have the original label attached to it clearly indicating what the health product is and what it contains\"</p>\n\n<p>However I also remember finding this from a more direct government source a year ago when I looked for myself.</p>\n", "score": 2 } ]

[ "medications", "prescription" ]

[ { "answer_id": 10548, "body": "<p>There is some agreement that the calories and other nutrition data, except the percent of alcohol, do not need to be shown on the labels of alcoholic beverages.</p>\n\n<p>But these nutrition facts are listed in the <a href=\"https://ndb.nal.usda.gov/ndb/search/list\" rel=\"nofollow noreferrer\">USDA.gov nutrients database</a> (search for beer, wine, vodka, gin...)</p>\n\n<p>For example, <a href=\"https://ndb.nal.usda.gov/ndb/foods/show/4158?fgcd=&amp;manu=&amp;lfacet=&amp;format=&amp;count=&amp;max=50&amp;offset=&amp;sort=default&amp;order=asc&amp;qlookup=vodka&amp;ds=\" rel=\"nofollow noreferrer\">1 jigger or 1.5 oz of 80 proof vodka has 97 Calories.</a> These calories represent \"metabolic energy,\" which is energy that can be actually used by your body.</p>\n\n<p>A source that claims that alcohol provides metabolic energy:</p>\n\n<ul>\n<li><a href=\"http://www.nature.com/ejcn/journal/v61/n1s/fig_tab/1602938t3.html\" rel=\"nofollow noreferrer\">European Journal of Clinical Nutrition</a>: Alcohol has 29.6 kJ (7 Cal) of combustible energy and 29 kJ (6.9 Cal) of metabolic energy per gram.</li>\n</ul>\n", "score": 4 }, { "answer_id": 1314, "body": "<p>I have seen many lists of macro-nutrients that exclude alcohol but this is often due to the fact that alcohol is not essential to our survival. Alcohol is the only other substance that provides the body energy in addition to the three main macro-nutrients.</p>\n\n<p>In short, alcohol definitely can be absorbed by the body (as evidenced by the behaviors exhibited by many after consuming large quantities of it) and the body is able to utilize the energy from alcohol. Therefore you should definitely include it in your Calorie counting.</p>\n\n<p>This site has a list of various alcoholic beverages and their energy contents for you to peruse at your leisure:</p>\n\n<p><a href=\"http://www.weightlossresources.co.uk/calories-in-food/alcoholic-drinks.htm\" rel=\"nofollow\">http://www.weightlossresources.co.uk/calories-in-food/alcoholic-drinks.htm</a> </p>\n", "score": 3 }, { "answer_id": 10546, "body": "<p>Alcohol metabolism has evolved in most living beings as a vital part of digesting fermenting food. This is a process that happens naturally in the gut even if you don't drink alcohol. The digestive system has evolved to not waste such a valuable source of energy many millions of years ago. There is a complete enzyme chain in place to break down and use alcohol as a source of energy. \nPlease note that naturally occurring fermentation yields only small amounts of alcohol and that our digestive system is not geared to deal long term with the large amounts of alcohol that some people ingest. Liver damage occurs when the enzymes available to break down alcohol safely get overwhelmed and leave toxic metabolites behind which then in turn damage liver cells. \nSo the answer is : yes - alcohol will definitely make you gain weight, roughly to the tune of 7 calories per gram. </p>\n", "score": 0 } ]

[ "nutrition", "alcohol" ]

[ { "answer_id": 1340, "body": "<p>We can't diagnose your friend on the internet; only her doctors can do that. Guesses are good in game shows; in medicine, it helps to have more to base a diagnosis on.</p>\n\n<p>You are correct that acute iron toxicity (for example, from children eating iron-containing vitamins because they are candy-like) can result in coma. But to my knowledge (and I have seen and treated many metallic foreign bodies), iron toxicity from such an exposure would be unlikely.</p>\n\n<p>Aside from ingestion, the two most common reasons for iron overload are </p>\n\n<p>1) repeated transfusions required for various anemias (where red blood cells are destroyed by the body and need to be replaced), or when bone marrow has stopped functioning properly and RBC's must be supplied; this is called <strong>secondary hemochromatosis</strong>,</p>\n\n<p>2) iron-overload disorders owing to genetic misregulation of iron absorption, referred to as hereditary hemochromatosis (or <strong>primary hemochromatosis</strong>). </p>\n\n<p>Primary hemochromatosis can be treated by removing blood periodically, forcing the body to use up the excess iron, or by chelation therapy. So, untreated, yes, iron overload from this source is permanent. Acute iron toxicity can be treated with chelating agents is severe enough.</p>\n\n<p>While hemochromatosis is not rare, fainting is <em>very common</em> (so common it is difficult to estimate it's occurrence due to underreporting); rough estimates are that <em>at least</em> 35% of the population will have at least one episode in their lifetime. There is a bimodal distribution, with the first peak around the late teens (one-third of medical students report at least one syncopal episode) and the second starting around the seventies.</p>\n\n<p>Again, numbers are hard to obtain for fainting (syncope), but the most common cause is vasovagal (fear, pain, prolonged standing, etc.), followed by cardiac causes.</p>\n\n<p>Although fainting is common, the only real way to determine its probable cause is to see a medical professional, who can gather the information necessary to make a diagnosis.</p>\n\n<p>_{<a href=\"http://www.cdc.gov/ncbddd/hemochromatosis/training/epidemiology/prevalence.html\" rel=\"nofollow\">Hemochromatosis (Iron Storage Disease)</a>}<br>\n_{<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3949417/\" rel=\"nofollow\">Molecular basis of HFE-hemochromatosis</a>}<br>\n_{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/23472771\" rel=\"nofollow\">Epidemiology of syncope/collapse in younger and older Western patient populations</a>}<br>\n_{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/12239256\" rel=\"nofollow\">Incidence and prognosis of syncope</a>}</p>\n", "score": 4 } ]

[ "toxicity", "poison", "toxins", "iron", "iron-supplements" ]

[ { "answer_id": 1403, "body": "<p>H = IxIxR</p>\n\n<p>Where H is the amount of heat produced when a current of I is flown through a conductor of resistance R. </p>\n\n<p>The <a href=\"https://en.wikipedia.org/wiki/Electric_shock\">resistance of human body</a> may be as high as 100,000 ohms. An average bolt produces <a href=\"https://en.wikipedia.org/wiki/Lightning\">current of 30kA</a>. If a typical lightning were to pass completely through a human body (even though this is not the case), the heat energy liberated will be 9X10^14 J which is HUGE. The human body is mostly made of protein, with water, fats, and nucleic acids for the most part. Protein coagulates and water evaporates as the temperature rises, and if it is too high the whole thing oxidises, and what will be left will unoxidisable ash and unburnt carbon.</p>\n\n<p>In short, yes it is the heat injury in lightning. But in electrocution, there can be other causes such as cardiac arrhythmia, because the amount of voltage need not necessarily be high enough to oxidise everything up. </p>\n", "score": 6 } ]

[ "injury", "electricity" ]

[ { "answer_id": 18214, "body": "<p>Seroquel (quetiapine) is quite well known to cause perhaps the <strong>most</strong> sedation among all the drugs in the 'atypical antipsychotic' class of medication due to its strong histamine and alpha receptor antagonism.</p>\n\n<p>In fact, although there is much controversy surrounding this, Seroquel is being <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/22510671\" rel=\"nofollow noreferrer\">prescribed</a> more often as an 'off-label' treatment for insomnia due to the strong sedative effects of the drug. This is somewhat controversial due to the wide ranging effects of the drug and a possible <a href=\"https://www.pharmacistanswers.com/questions/does-seroquel-quetiapine-affect-rem-sleep\" rel=\"nofollow noreferrer\">alteration</a> to REM sleep.</p>\n\n<p>It certainly stands to reason that higher doses of a drug causes more side effects. This is generally termed 'dose-related' or 'dose-dependent' side effects.</p>\n\n<p>Published information for quetiapine does reveal that somnolence is most likely dose-related, but it's not all that significant.</p>\n\n<p>In a clinical trial for the drug for the treatment of schizophrenia in children aged 13-17, the <a href=\"https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/020639s064lbl.pdf\" rel=\"nofollow noreferrer\">prescribing information</a> for Seroquel states:</p>\n\n<blockquote>\n <p>Adverse events that were potentially <strong>dose-related</strong> with higher frequency in the 600 mg group compared to the 400 mg\n group included <strong>somnolence</strong> (50% vs. 57%), nausea (6% vs. 10%) and tachycardia (6% vs. 9%). </p>\n</blockquote>\n\n<p>Additionally, the prescribing information for Seroquel XR has the following chart:</p>\n\n<p><a href=\"https://i.stack.imgur.com/MIHVR.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/MIHVR.png\" alt=\"enter image description here\"></a></p>\n\n<p>So, it certainly does seem that higher doses of Seroquel do cause a higher incidence of somnolence, but it doesn't appear to be a huge difference between doses.</p>\n", "score": 4 } ]

[ "medications", "depression" ]

[ { "answer_id": 1478, "body": "<p>The <a href=\"http://pi.lilly.com/us/zyprexa-pi.pdf\" rel=\"nofollow\">manufacturer’s prescribing information</a> (a.k.a. package insert) provides recommended dosing based on safety and efficacy data obtained during the drug development and approval process. It indicates that 10 mg/day is a “normal” target dose for most indications. A higher dose of 15 mg/day is appropriate in acute manic episodes. In the portion of the PI discussing safety data, it refers to the “maximum” dose as 20 mg/day. </p>\n\n<p>There have been reports of using up to 60 mg daily in cases of treatment-resistant schizophrenia, but this is rare and the data supporting it are weak.¹ </p>\n\n<p>In the course of normal clinical practice, including care of many psychiatric patients on atypical antipsychotics, I have never seen doses above 20 mg daily used. It is rarely used in twice daily dosing due to the long half-life of ~30 hours (as described in the <a href=\"http://pi.lilly.com/us/zyprexa-pi.pdf\" rel=\"nofollow\">PI</a>). </p>\n\n<ol>\n<li>Lehman AF, Lieberman JA, Dixon LB, et al, American Psychiatric Association, Steering Committee on Practice Guidelines. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/?term=15000267\" rel=\"nofollow\">Practice guidelines for the treatment of patients with schizophrenia, second edition.</a> Am J Psychiatry. 2004;161(2 Suppl):1-56. </li>\n</ol>\n", "score": 5 } ]

[ "medications" ]

[ { "answer_id": 8996, "body": "<p>From \"<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911011/\" rel=\"nofollow\">Consumption of Dairy Products in Relation to Changes in Anthropometric Variables in Adult Populations: A Systematic Review and Meta-Analysis of Cohort Studies</a>\" (2016):</p>\n\n<blockquote>\n <p>The current state of knowledge regarding the association of dairy products and weight gain, overweight, and obesity is based on studies reporting <strong>contradicting and inconclusive results</strong>.</p>\n</blockquote>\n\n<p>I recommend reading above review and reading through its bibliography.</p>\n", "score": 1 } ]

[ "nutrition", "diet" ]

[ { "answer_id": 1598, "body": "<p>Overdiagnosis is not the same as misdiagnosis (for example, many people are concerned that ADHD is often misdiagnosed, but call it <em>overdiagnosis</em>.*) </p>\n\n<p>Overdiagnosis and overtreatment are intertwined. Diagnostic tests are considered \"useful\" if treatment decisions are affected by the results. Although it is extremely difficult to assess when overdiagnosis has occurred in an <em>individual</em>, it is relatively easy to assess when over diagnosis has occurred in a population. Rapidly rising rates of testing and disease diagnosis in the setting of stable death rates are suggestive of overdiagnosis.</p>\n\n<p>There is some debate about how to best describe the problem, but narrowly defined, overdiagnosis can occur in at least three ways:</p>\n\n<ul>\n<li><p>when screening tests become increasingly sensitive, identifying abnormalities that are minor, non-progressive, or likely to resolve on their own</p></li>\n<li><p>when the definition of a disease changes such that conditions formerly to be thought \"compatible with normal\" are now classified as disease identifying as \"at risk\" people who will never suffer ill-effects from their condition</p></li>\n<li><p>when tests performed unnecessarily show an abnormality for which the threshold of \"normal\" is unknown</p></li>\n</ul>\n\n<p>Having a <strong>diagnosis</strong> makes well people think they're ill (overdiagnosis). If they are then treated for this overdiagnosis, they are <strong>overtreated.</strong></p>\n\n<p>An example of the first is in the newer, more sensitive tests for screening for thyroid cancer discussed in the NYT article. The overtreatment in this case is the unnecessary surgery (and complications thereof) because of the diagnosis.</p>\n\n<p>An example involving changing definitions pertains to diabetes. When the official definition of diabetes changed from having a fasting blood sugar (FBS) of \"X or greater\" to an FBS of \"(X-y) or greater\" (a bit oversimplified, but still a good example), 1.6 million new diabetics were instantly <em>diagnosed</em>, some of whom are not likely to ever develop symptoms and complications and are not likely to benefit from treatment. </p>\n\n<p>An example involving tests performed unnecessarily would be getting a head CT scan on a young, healthy person for a single seizure which could easily be explained by circumstance (e.g. being supported in an upright position during a feint), and finding an unrelated (and, say, benign) lesion, which someone then wants to biopsy.</p>\n\n<blockquote>\n <p>...[We] are in the midst of an <strong>epidemic of diagnosis</strong>. Conventional wisdom tells us that finding problems early saves lives because we have the opportunity to fix the problems early. [That t]here is no risk in finding things early. The truth is that early diagnosis is a double-edged sword; while it has the potential to help some, it has a potential to harm us. Such <em>overdiagnosis</em> leads to <em>overtreatment</em> when these “pseudo-diseases” are conventionally managed and treated as if they were real abnormalities; because these findings have a benign prognosis, treatment can only do harm. </p>\n</blockquote>\n\n<p>Prostate cancer is the poster child for overdiagnosis. Until we started widely screening for it with the prostate-specific antigen test, it was considered a disease with a uniformly bad prognosis. Only once screening (and treatment of detected tumors) was well underway did it come to light that the majority of prostate cancers detected by screening are clinically unimportant. </p>\n\n<p>Overdiagnosis should not be confused with false-positive results, that is, a positive test in an individual who is subsequently recognized not to have cancer. By contrast, an overdiagnosed patient has a tumor that fulfills the pathological criteria for cancer. Studies now estimate that 1 in 2 prostate cancers, 1 in 3 breast cancers, and 1 in 5 lung cancers are most likely overdiagnosed.</p>\n\n<p>The impact of false-positive test results is largely transitory, but the impact of overdiagnosis can be life-long and affects patients’ sense of well-being and their ability to get health insurance; overtreatment impacts their physical health, and even their life expectancy.</p>\n\n<p>What can be done? Resistance to overdiagnosis needs to be multi-pronged. The medical community, through testing and experience, needs to raise the threshold to label a test as “abnormal” or raise the threshold to intervene. (This has been done with the Prostate Specific Antigen test for prostate cancer.)</p>\n\n<p>The other is harder. Many doctors believe patients can't make informed decisions in this area. However, studies (with women who've been diagnosed with breast cancer detected on screening) have shown that patients can make good decisions when presented with the appropriate facts.</p>\n\n<p>When your doctor recommends <strong>screening</strong> for a particular cancer because of age or other demographic factors (e.g. you're a smoker), <strong>ask</strong>. Ask how you're likely to benefit from the test if it comes back positive, ask if there is any controversy about the screening test, ask if there are hand-outs explaining the risks and benefits of the screening test. </p>\n\n<p>_{N.B. <strong>This does not pertain to all tests ordered by physicians.</strong> Not all screening tests are bad, and tests need to be done when you have symptoms._{</p>\n\n<p>_{Cancer overdiagnosis may have of one of two explanations: 1) The cancer never progresses (or, in fact, regresses) or 2) the cancer progresses slowly enough that the patient dies of other causes before the cancer becomes symptomatic. Note that this second explanation incorporates the interaction of three variables: the cancer size at detection, its growth rate, and the patient’s competing risks for mortality. Thus, even a rapidly growing cancer may still represent overdiagnosis if detected when it is very small or in a patient with limited life expectancy.} </p>\n\n<p>_{<a href=\"http://www.academia.edu/7155800/The_effect_of_information_about_overdetection_of_breast_cancer_on_womens_decision-making_about_mammography_screening_study_protocol_for_a_randomised_controlled_trial\" rel=\"nofollow\">The effect of information about overdetection of breast cancer on women’s decision-making about mammography screening:study protocol for a randomised controlled trial</a>}<br>\n_{<a href=\"http://www.phac-aspc.gc.ca/cd-mc/pdf/Information_on_Mammography-eng.pdf\" rel=\"nofollow\">Mammography for Women Aged 40 and Older: A Decision Aid for Breast Cancer Screening in Canada</a>}<br>\n_{<a href=\"http://www.thyroidcancercanada.org/userfiles/files/Welch_Overdiagnosis%20in%20Cancer.pdf\" rel=\"nofollow\">Overdiagnosis in Cancer</a>}<br>\n_{<a href=\"http://books.google.com/books?hl=en&amp;lr=&amp;id=qe7XQxzAftEC&amp;oi=fnd&amp;pg=PT5&amp;dq=Welch+G,+Schwartz+L,+Woloshin+S+%282011%29+Overdiagnosed:&amp;ots=GONGUjZ8HY&amp;sig=CQy031VkHIqGxgM8Sg0vnQOCB_A#v=onepage&amp;q&amp;f=false\" rel=\"nofollow\">Overdiagnosed: Making People Sick in the Pursuit of Health</a>}<br>\n_{<a href=\"http://www.sciencebasedmedicine.org/overdiagnosis/\" rel=\"nofollow\">Overdiagnosis</a>}<br>\n<a href=\"http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001655#pmed.1001655-Welch1\" rel=\"nofollow\">Using Evidence to Combat Overdiagnosis and Overtreatment</a>}<br>\n<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/15371827\" rel=\"nofollow\">The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years?</a>} </p>\n", "score": 4 }, { "answer_id": 1643, "body": "<p>Is screening a good thing? </p>\n\n<p>-Overall yes, but with caveats.</p>\n\n<p>First, take an <em>extreme</em> example of an individual undergoing a full body CT scan at least once a year, every year after the age of 50. The upside is potentially detecting some forms of cancer early on (although the <a href=\"http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/ucm115340.htm\" rel=\"nofollow\">FDA</a> says there are no benefits for healthy individuals). The downside is increased radiation itself increases your risk of cancer. In short, preventive cancer screenings may end up giving you cancer.</p>\n\n<p>The <a href=\"http://www.cancer.gov/about-cancer/diagnosis-staging/ct-scans-fact-sheet#q7\" rel=\"nofollow\">National Cancer Institute (NCI)</a> reports that \"the extra risk of any one person developing a fatal cancer from a typical CT procedure is about 1 in 2,000 (2). In contrast, the lifetime risk of dying from cancer in the U.S. population is about 1 in 5 (3).\"</p>\n\n<p>Suppose the 1 in 2,000 figure is the average. Why are so many people concerned? A study in <a href=\"http://archinte.jamanetwork.com/article.aspx?articleid=415384\" rel=\"nofollow\">JAMA Internal Medicine</a> found that a CT scan's \"effective dose varied significantly within and across institutions, with a mean 13-fold variation between the highest and lowest dose for each study type.\" So, it's possible that, depending on where you go for your scan, you could be getting very different doses of radiation, and your lifetime risk will be affected by that.</p>\n\n<p>In addition to the dose of radiation, health care providers have many incentives for ordering tests when they aren't necessarily needed. A commonly cited reason is \"defensive medicine\" - a practice of ordering extra tests to avoid malpractice claims. However, there are other reasons as well, such as financial incentives, experience, training, etc.</p>\n\n<p>Fundamentally, <em>overtreatment</em> may have no additional health benefits, but may carry risks. </p>\n\n<p>There is now a <a href=\"http://www.choosingwisely.org\" rel=\"nofollow\">Choosing Wisely</a> campaign that partners with many professional medical organizations to develop guidelines and reduce over treatment, recognizing that it is an issue.</p>\n", "score": 4 } ]

[ "diagnostics", "thyroid", "tumors" ]

[ { "answer_id": 2015, "body": "<p>It may depend on the pH of your mouth and saliva. Some people get more plaque and tartar than other people and it's inevitable to need more work during the bi-annual cleaning. If you are lucky and your pH and composition of saliva lead to less plaque, then it's also easier to avoid bleeding.</p>\n\n<p>In any case, the dentist needs to go below the gum line and this may easily bring some limited bleeding. It doesn't mean you are not cleaning your teeth well enough.</p>\n\n<p>Source for the first paragraph: common sense but also <a href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1600-051X.2010.01673.x/abstract\" rel=\"nofollow\">http://onlinelibrary.wiley.com/doi/10.1111/j.1600-051X.2010.01673.x/abstract</a> \"The composition of the oral microbiota is influenced by temperature, pH, and atmosphere, as well as by the host defences and host genetics. In addition, the host supplies endogenous nutrients and a variety of surfaces for biofilm formation. In health, the resident oral microbiota forms a symbiotic relationship with the host, regulated by active host–microbe cross talk.\"</p>\n\n<p>Source for the second paragraph: none official.</p>\n", "score": 2 } ]

[ "dentistry" ]

[ { "answer_id": 1546, "body": "<p>This <a href=\"http://www.metrovanurology.com/content/semen-analysis#Predicting%20the%20Probability%20of%20Pregnancy%20Using%20the%20Semen%20%20Analysis\">article</a> should give an idea of the likelihood of pregnancy based on the number of sperm available. If you look at the graph of the Probability of Conception vs. the Sperm Concentration, it shows that at more than 10 million sperm/mL (or around 30-40 million total sperm, estimating average semen volume to be 3-4 mL), the probability of conception per month quickly reaches a plateau, while at under this concentration there is a roughly linear drop in the probability of conception to zero at zero sperm. <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3564677/\">Another study</a> shows a high variability in the number of sperm present in pre-ejaculate. Of the 28 men tested, only 12 produced any detectable sperm in their pre-ejaculate at all. Of these 12, the sample with the highest number of sperm contained 35 million (subject 17). If this man consistently produced this many sperm in his pre-ejaculate, I would estimate the probability of him causing conception per month as 35 million divided by 35 million (from above) multiplied by ten percent, i.e., 10%/month.</p>\n\n<p>In other words, it is possible, according to these studies, for pre-ejaculate to cause pregnancy. However, this evidence also suggests that some men, if their lack of sperm in pre-ejaculate is consistent, may be unable to cause pregnancy in this way.</p>\n", "score": 6 } ]

[ "sex" ]

[ { "answer_id": 1538, "body": "<p>There are <strong>several risks</strong> related to excessive consumption of milk. A 12 years prospective study run on around 78000 women showed that high consumption of milk (2-3 glasses per day) increased the <strong>risk of fracture</strong> when compared to people who used to drink one glass or less per week. (<a href=\"http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.87.6.992\">1</a>) Similar results were found in other studies like, for example: <a href=\"http://aje.oxfordjournals.org/content/139/5/493.short\">2</a>.</p>\n\n<p>The amount that you say, 1.5 L, contains about 1800 mg of calcium, that must be sum to other daily dietary sources (as dairy, green leaves, sesam seeds, water). A study showed that dietary intakes of calcium greater than 1400 were associated with <strong>higher death rates</strong> from all causes, cardiovascular disease and ischaemic heart disease (<a href=\"http://www.bmj.com/content/346/bmj.f228\">3</a>).</p>\n\n<p>Finally, high intakes of calcium can interfere with iron absorption and lead to <strong>iron deficiency</strong> (<a href=\"http://ajcn.nutrition.org/content/68/1/3.full.pdf\">4</a>, <a href=\"https://en.wikipedia.org/wiki/Human_iron_metabolism\">5</a>).</p>\n", "score": 7 } ]

[ "milk" ]

[ { "answer_id": 1573, "body": "<p>The study you link explains that the problem with grapefruit juice is its tendency to cause inhibition of the CYP3A4 liver enzyme, which is needed for the metabolism of many medications - including some statins prescribed to lower cholesterol. The <a href=\"https://en.wikipedia.org/wiki/Grapefruit\" rel=\"noreferrer\">wikipedia</a> article on grapefruit explains this further, in particular:</p>\n\n<blockquote>\n <p>Mechanism of grapefruit–drug interaction</p>\n \n <p>Grapefruit juice contains furanocoumarins. Furanocoumarins\n irreversibly inhibit a cytochrome P450 metabolizing enzyme called\n CYP3A4, as stated above. CYP3A4 is a metabolizing enzyme for almost\n 50% of drugs, and is found in the liver and small intestinal\n epithelial cells. As a result, many drugs are impacted by\n consumption of grapefruit juice. When the metabolizing enzyme is\n inhibited, less of the drug will be metabolized by it in the\n epithelial cells. A decrease in drug metabolism means more of the\n original form of the drug could pass unchanged to systemic blood\n circulation. An unexpected high dose of the drug in the blood\n could lead to fatal drug toxicity.</p>\n \n <p>The furanocoumarins found in grapefruit juice are natural chemicals.\n Thus, they are present in all forms of the fruit, including freshly\n squeezed juice, frozen concentrate, and whole fruit. All these forms\n of the grapefruit juice have the potential to limit the metabolizing\n activity of CYP3A4. One whole grapefruit, or a glass of 200 mL (6.8 US\n fl oz) of grapefruit juice can cause drug overdose toxicity.</p>\n</blockquote>\n\n<p>The article goes on to explain that these furanocoumarins are unique to grapefruit, and I have not heard of any other fruit being associated with grapefruit in drug interaction warnings. However, since grapefruit is a cross of pumelo and a bitter orange, and since pumelo tastes like a big grapefruit, I would be cautious of pumelo.</p>\n\n<p>However, I found no evidence that other common citrus contains furanocoumarins and would cause any adverse effects on drug metabolism. Furthermore, <a href=\"http://onlinelibrary.wiley.com/doi/10.1002/clc.4960110902/abstract\" rel=\"noreferrer\">this study</a> found that grapefruit itself lowers cholesterol and recommended it for reducing the risk of heart disease.</p>\n", "score": 6 } ]

[ "diet", "cardiology" ]

[ { "answer_id": 20026, "body": "<p><strong>Is saturated fat beneficial after all?</strong></p>\n<p>There seems to be no convincing evidence to say that high intake of saturated fat prevents any disease and the evidence about harmful effects is very inconsistent.</p>\n<p><strong>Saturated fat and stroke</strong></p>\n<p>There is some inconsistent evidence about the association between high saturated fat intake and a decreased or no risk of stroke.</p>\n<blockquote>\n<p>This meta-analysis reveals that higher SFA intake is inversely\nassociated with risk of stroke morbidity and mortality...<em>(<a href=\"https://www.heart.org/en/health-topics/heart-attack/understand-your-risks-to-prevent-a-heart-attack\" rel=\"nofollow noreferrer\">Neurological Sciences, 2016</a>)</em></p>\n<p>Saturated fats are not associated with all cause mortality, CVD, CHD,\nischemic stroke, or type 2 diabetes, but the evidence is heterogeneous\nwith methodological limitations. <em>(<a href=\"https://www.bmj.com/content/351/bmj.h3978\" rel=\"nofollow noreferrer\">systematic review and meta-analysis of observational studies, BMJ, 2015</a>)</em></p>\n<p>Studies on SAFA <em>[saturated fatty acids]</em> intakes and risk of ischemic\nstroke are inconsistent. Compared with the abundant data on SAFA\nconsumption and risk of CHD, there is insufficient evidence to support\ndietary SAFA recommendations to reduce stroke risk. <em>(<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5475232/\" rel=\"nofollow noreferrer\">Annals of Nutrition and Metabolism, 2017</a>)</em></p>\n</blockquote>\n<p><strong>Why has saturated fat been considered harmful?</strong></p>\n<p>High saturated fat intake has been <em>associated</em> with increased levels of LDL cholesterol, which in turn has been <em>associated</em> with an increased risk of cardiovascular disease, but this does not automatically mean that saturated fat <em>causes</em> cardiovascular disease (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943062/\" rel=\"nofollow noreferrer\">Current Atherosclerosis reports, 2010</a>).</p>\n<p>Large studies and study reviews according to which saturated fat intake has been associated with:</p>\n<ul>\n<li>Increased risk of cardiovascular disease: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121105/\" rel=\"nofollow noreferrer\">BMJ, 2016</a></li>\n<li>No increase of risk of cardiovascular disease or diabetes type 2: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/20071648\" rel=\"nofollow noreferrer\">AJCN, 2010</a>, <a href=\"https://annals.org/aim/article-abstract/1846638/association-dietary-circulating-supplement-fatty-acids-coronary-risk-systematic-review\" rel=\"nofollow noreferrer\">Annals of Internal Medicine, 2014</a>, <a href=\"https://www.bmj.com/content/351/bmj.h3978\" rel=\"nofollow noreferrer\">BMJ, 2015</a>)</li>\n</ul>\n<p>The conflicting results can be due to neglecting the effect of other nutrients in the diet and individual differences (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4814348/\" rel=\"nofollow noreferrer\">Circulation, 2018</a>).</p>\n<p><strong>1) The effect of other nutrients on the effect of saturated fat</strong></p>\n<p>According to some systematic reviews, replacing some saturated fat with <strong>unsaturated fat</strong> decreases the risk of heart disease (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26068959\" rel=\"nofollow noreferrer\">Cochrane, 2015</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/29174025\" rel=\"nofollow noreferrer\">NMCD, 2017</a>).</p>\n<p>A <a href=\"https://www.cochrane.org/CD012345/VASC_polyunsaturated-fatty-acids-prevention-and-treatment-diseases-heart-and-circulation\" rel=\"nofollow noreferrer\">2018 Cochrane systematic review</a> have found a weak association between increased intake of <strong>polyunsaturated</strong> fats and lower risk of cardiovascular disease, but another review in <a href=\"https://annals.org/aim/article-abstract/1846638/association-dietary-circulating-supplement-fatty-acids-coronary-risk-systematic-review\" rel=\"nofollow noreferrer\">Annals of Internal Medicine, 2014</a> has not.</p>\n<p>It is possible that not every polyunsaturated fat is beneficial. In two meta-analyses, replacing saturated fat with <strong>omega-6</strong> polyunsaturated fatty acids was associated with a higher risk of heart disease, and replacing with <strong>omega-3</strong> fatty acids with a reduced risk (<a href=\"https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/n6-fatty-acidspecific-and-mixed-polyunsaturate-dietary-interventions-have-different-effects-on-chd-risk-a-metaanalysis-of-randomised-controlled-trials/938F3F74E18033ED061F7D8CEAB0A24A/core-reader#\" rel=\"nofollow noreferrer\">Cambridge Core, 2010</a>, <a href=\"https://nutritionj.biomedcentral.com/articles/10.1186/s12937-017-0254-5\" rel=\"nofollow noreferrer\">Nutrition Journal, 2017</a>).</p>\n<p><strong>Dairy,</strong> despite being high in saturated fat, has not been associated with increased risk of cardiovascular disease (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26786887\" rel=\"nofollow noreferrer\">British Journal of Nutrition, 2016</a>, <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6244750/\" rel=\"nofollow noreferrer\">Current Nutrition Reports, 2018</a>). It was suggested that high levels of calcium and vitamin D in milk may counteract the effect of saturated fat (<a href=\"https://onlinelibrary.wiley.com/doi/full/10.1111/nbu.12283\" rel=\"nofollow noreferrer\">Nutrition Bulletin, 2017</a>).</p>\n<p><strong>Red meat</strong> and <strong>processed meat</strong> are both high in saturated fat, but processed meat intake has been associated with much higher risk of heart disease and diabetes 2 than unprocessed red meat (<a href=\"https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.109.924977?url_ver=Z39.88-2003&amp;rfr_id=ori%3Arid%3Acrossref.org&amp;rfr_dat=cr_pub%3Dpubmed\" rel=\"nofollow noreferrer\">Circulation, 2010</a>, <a href=\"https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-63\" rel=\"nofollow noreferrer\">BMC Medicine, 2013</a>). This suggests that it may not be saturated fat but preservatives (sodium, nitrates) in processed meat that can be harmful.</p>\n<p>High intake of <strong>refined carbohydrates</strong> (sugar, plain starch) in combination with saturated fat intake has been associated with increased risk of cardiovascular disease (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/21978979\" rel=\"nofollow noreferrer\">The Netherlands Journal of Medicine, 2011</a>).</p>\n<p><strong>2) Individual differences in response to saturated fat</strong></p>\n<p>Individuals who produce <strong>small dense LDL particles</strong> can be more negatively affected by saturated fat than those who produce large particles.</p>\n<blockquote>\n<p>Because medium and small LDL particles are more highly associated with\ncardiovascular disease than are larger LDL, the present results\nsuggest that very high saturated fat intake may increase\ncardiovascular disease risk in phenotype B individuals <em>[who produce a\nlarge percent of small LDL particles]</em>. <em>(<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293238/\" rel=\"nofollow noreferrer\">Plos One, 2017</a>)</em></p>\n</blockquote>\n<p>Individuals with <strong>increased risk of heart disease</strong> seem to be more prone for harmful effects of saturated fat. In a prospective PREDIMED study following 7038 participants at high risk of cardiovascular disease for 6 years, high intake of saturated fat was strongly positively associated (+81%) and unsaturated fat strongly inversely associated (-32-50%) with cardiovascular events and deaths.</p>\n<p><strong>In conclusion,</strong> the effect of saturated fat on health cannot be evaluated in isolation but only in context of overall diet and individual differences. High saturated fat intake can be harmful in individuals with risk factors for heart disease, but less likely in healthy individuals without risk factors who consume enough whole grains and unsaturated fat. There is no evidence to recommend increasing saturated fat intake.</p>\n", "score": 2 }, { "answer_id": 21141, "body": "<p>Yes, having too little saturated fat will cause health issues. There is no need for most in a Western diet to increase it though. There are several papers that can be found similar to the one below. Insufficient animal products as being the a culprit as to why Japanese suffer strokes dis-proportionally higher than those in other populations with markedly different dietary intake.</p>\n\n<p><a href=\"https://www.ahajournals.org/doi/full/10.1161/01.str.0000130426.52064.09\" rel=\"nofollow noreferrer\">Japan Stroke</a> </p>\n", "score": 1 } ]

[ "nutrition", "diet" ]

[ { "answer_id": 4114, "body": "<p>The <a href=\"http://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet#q3\" rel=\"nofollow noreferrer\">National Cancer Institute</a> has a nice summary of the relationship between oral contraceptives and cancer, based on several reports. While there were some conflicting results, there seemed to be a consensus that there is a mild increase in the risk of breast cancer among women using oral contraceptives.</p>\n\n<p>Here are the three reports:</p>\n\n<ul>\n<li><strong><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/15105794\" rel=\"nofollow noreferrer\">Burkman et al. (2004)</a>:</strong> This is a general overview of studies done since the first oral contraceptives became widely used, in the 1960s. Data indicates that there is a slightly higher risk of breast cancer among women taking oral contraceptives.</li>\n<li><strong><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/20802021\" rel=\"nofollow noreferrer\">Hunter et al. (2010)</a>:</strong> Data was complied from biannual screenings of over 116,00 women over a twelve-year period. It was found that the use of oral contraceptives in the past did not contribute to breast cancer, while the current use of these contraceptives led to a slight increase in risk. However, this focused on a specific type of oral contraceptive.</li>\n<li><strong><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/8656904\" rel=\"nofollow noreferrer\">Lancet (1996)</a>:</strong> Over 150,000 women from 54 studies were analyzed. There were three main findings:\n\n<ul>\n<li>There is a slight increase in breast cancer risk in those who stop taking oral contraceptives after using them regularly for a long time.</li>\n<li>Breast cancers in women using these contraceptives was detected or diagnosed at any earlier stage.</li>\n<li>Women who used contraceptives before the age of twenty had a slightly higher risk of breast cancer.</li>\n</ul></li>\n</ul>\n\n<p>There are, of course, other studies not mentioned in the NCI article, including these two:</p>\n\n<ul>\n<li><strong><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26667320\" rel=\"nofollow noreferrer\">Heikkinen et al. (2015)</a>:</strong> The use of general exogenous hormones in oral contraceptives and in hormone-releasing intrauterine devices. In these cases, a slightly higher risk of breast cancer was observed.</li>\n<li><strong><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26437729\" rel=\"nofollow noreferrer\">Jordan et al. (2015)</a>:</strong> This used statistics to estimate cases of breast cancer caused by the use of oral contraceptives. The result was that about 100 cases in Australia in 2010 can be attributed to the use of these contraceptives.</li>\n<li><strong><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26333690\" rel=\"nofollow noreferrer\">Zhong et al. (2015)</a>:</strong> This search of PubMed combined with data analysis methods suggested that there is no link between oral contraceptives and breast cancer.</li>\n</ul>\n\n<p>These three studies have all been published (or even only submitted to PubMed) extremely recently, so their results are not necessarily confirmed by other studies. However, they are certainly more recent than some of the other studies.</p>\n\n<p>There appears to be a slight increase in the risk of breast cancer in women who use oral contraceptives - including the types used today. However, this risk is very, very tiny, and the benefits of contraceptives far outweigh any possible risks in this regard. The results of Jordan et al. (2015), if definitive, should show that any real-world effects are negligible when looked at in the big picture.</p>\n", "score": 2 }, { "answer_id": 3371, "body": "<p>Short answer, there is no definitive link between oral contraception and breast cancer.</p>\n<p>You can find a short rundown on the relative risks in this article on <a href=\"https://www.sciencebasedmedicine.org/birth-control/\" rel=\"nofollow noreferrer\">Birth Control</a> on <em>Science-Based Medicine</em>.</p>\n<blockquote>\n<p>Information on cancer and oral contraceptives can be found <a href=\"http://www.cancer.gov/cancertopics/factsheet/Risk/oral-contraceptives\" rel=\"nofollow noreferrer\">here</a>. There is an increased risk of cervical cancer, but most cases are related to HPV infection, so hopefully the new vaccines will eliminate much of that risk. There is an increased risk of liver cancer in low risk populations but not in high-risk populations. The risk of breast cancer may or may not be slightly increased: studies do not agree.</p>\n<p>On the other hand, the pill clearly reduces the risk of uterine and ovarian cancers. And a meta-analysis found that the <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/19414526\" rel=\"nofollow noreferrer\">risk of colorectal cancer is also decreased</a>.</p>\n<p>The magnitude of these risks is small. I couldn’t find any information about overall cancer risk: whether the increase in some types of cancer outweighs the decrease in others.</p>\n</blockquote>\n<p>....</p>\n<blockquote>\n<p>[The International Agency for Research on Cancer] does classify estrogen/progesterone in the same group 1 category as cigarettes and asbestos, but all that category means is that there is sufficient evidence to prove carcinogenicity in humans.</p>\n</blockquote>\n", "score": 0 } ]

[ "cancer", "statistics", "contraception" ]

[ { "answer_id": 1671, "body": "<p><em>Behavioral therapy</em> works well. Behavioral therapists initially focus on teaching what anxiety is, helping the client to identify anxiety responses, teaching relaxation techniques, setting goals, discussing methods to achieve those goals, and helping the client to visualize phobic situations. </p>\n\n<blockquote>\n <p>One behavioral therapy often used to treat phobias is <strong>systematic\n (serial) desensitization</strong>, in which the therapist progressively exposes\n the client to the threatening object in a safe setting until the\n client’s anxiety decreases. During each exposure, the complexity and\n intensity of exposure gradually increase, but the client’s anxiety\n decreases. The reduced anxiety serves as a positive reinforcement\n until the anxiety is ultimately eliminated. - <em>Videbeck Psychiatric\n Mental health Nursing 5th edition</em></p>\n</blockquote>\n\n<p>Other behavorial therapy that can be used is <strong><a href=\"http://www.simplypsychology.org/behavioral-therapy.html\" rel=\"noreferrer\">Flooding</a></strong> (<strong>implosion therapy</strong>). It works by exposing the patient directly to their worst fears. For example, standing in a glass room in a height of 1000 feet or letting a person to be submerge in a pool for hydrophobic patients. At first the person would experience extreme panic, but later on their anxiety will subside because they have no choice but to confront their fears until they'll realize that it will do them no harm. </p>\n\n<p>However, <em>flooding</em> is rarely used because it can be dangerous if the therapist is not careful. The patient may experience extreme panic that can further lead to seizure, paralysis, or even death. </p>\n\n<p>I, too, an acrophobic and having a hard time to get over with this fear even though I am a nurse and I know how to treat it. In your case, you can use the <strong>desensitization</strong> method and expose yourself in extreme heights gradually, but I advised you to have someone or a psychologist or psychiatrist with you to assist you when something goes wrong. </p>\n", "score": 5 } ]

[ "mental-health", "anxiety-disorders" ]

[ { "answer_id": 1698, "body": "<p>Aside from its wonderful taste, green tea (obtained from the plant <em>Cammelia sinensis</em>, (L.) Kuntze, Theaceae) contains caffeine, and this might be the reason for your possible addiction. Studies have shown that caffeine withdrawal symptoms exist and that their intensity is correlated to the amount of caffeine that was being used previously, and the frequency of use. That being said, tea contains other ingredients: catechins, flavonoids, caffeic acid derivatives etc. While tea has been proven to have many beneficial effects (there have been extensive clinical studies in China and Japan, which have proven that tea consumption is correlated with decreased risk of some types of cancer)</p>\n\n<h2>7 - 8 cups of tea per day is way too much!</h2>\n\n<p>Why? There are two main reasons:</p>\n\n<h2>Caffeine</h2>\n\n<p>Aside from being addictive, too much caffeine can cause an overdose. Possible symptoms are: restlessness, tremor and elevated reflex excitability. An overdose can also cause headaches or dizziness, abnormal hearth rhythms, dehydration or sleep problems. According to PDR overdose occurs in doses corresponding to 300 mg of caffeine (approximately 5 cups of tea as a beverage). Even in \"regular\" amounts, caffeine can affect blood pressure, so people with these problems ought to be careful.\nTea is, of course, not the only source of caffeine, so when deciding on the daily amount of tea, all sources of caffeine should be taken into account.</p>\n\n<h2>Possible anemia</h2>\n\n<p>Tannines in tea precipitate iron. If this happens in your digestive system it means that iron becomes insoluble, and cannot be absorbed. This decreases the effective uptake by your body, while regular loss via excretion and desquamation remains the same, so over time you start having less and less iron at your body's disposal, which can lead to anemia. There were several studies that have proven this effect - many were epidemiological and observational. There was a clinical trial involving patients with haemochromatosis which also proved that drinking tea reduced iron absorption from the GIT.</p>\n\n<hr>\n\n<p>Possible solutions:</p>\n\n<p>Drinking decaf tea might solve the first problem, but won't solve the second. Moderation is the key. Also, drinking tea with or right after meals (especially those which are the greatest source of iron) should be avoided most of the times. Drinking tea is an indulgent ritual for many, so perhaps switching one or two cups a day for a herbal tea might help.</p>\n\n<hr>\n\n<p>An interesting aside: PDR cites studies which have proven that tea mouthwashes can reduce growth of some cavity-associated bacteria and reduce formation of plaque (the 2nd goes for oolong). But tanines can deposit on your teeth causing them to turn yellow, so rinsing your teeth with tea is a double-edged sword.</p>\n\n<hr>\n\n<p>References:</p>\n\n<ol>\n<li><a href=\"http://www.nlm.nih.gov/medlineplus/caffeine.html\" rel=\"noreferrer\">Caffeine - Medline Plus</a></li>\n<li><a href=\"http://www.hopkinsmedicine.org/Press_releases/2004/09_29_04.html\" rel=\"noreferrer\">Caffeine withdrawal - Johns Hopkins Medicine</a></li>\n<li><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/14718031\" rel=\"noreferrer\">Impact of tea drinking on iron status in the UK: a review.</a></li>\n<li><a href=\"http://gut.bmj.com/content/43/5/699.full\" rel=\"noreferrer\">Clinical trial on the effect of regular tea drinking on iron accumulation in genetic haemochromatosis</a></li>\n<li><a href=\"https://books.google.rs/books?id=pDa2QgAACAAJ&amp;dq=pdr+for+herbal+medicines+2000&amp;hl=en&amp;sa=X&amp;redir_esc=y\" rel=\"noreferrer\">PHYSICIAN'S DESK REFERENCE (PDR) FOR HERBAL MEDICINES</a>, 2nd Edition, Medical Economics Company, 2000</li>\n</ol>\n", "score": 8 } ]

[ "tea" ]

[ { "answer_id": 1775, "body": "<p>Your question took me a while to research; it goes beyond basic medicine and delves into biochemistry, pharmacology, and physiology. The short answer is: Yes! It can; however, as you will see in the studies that are linked, it's <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12953340?dopt=Abstract\">dose dependent</a>. From what I found, the primary culprit of drug interactions in grapefruit juice lies in <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/8485024\">naringenin</a>; however, other <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16338240\">compounds</a> play a role as well. Naringenin is a natural compound (a flavonoid) found in fruits such as grapefruit, oranges, and tomatoes. The concentration of naringenin can be viewed in the following studies.</p>\n\n<ul>\n<li><p><a href=\"http://www.plantphysiol.org/content/77/4/903.full.pdf\">http://www.plantphysiol.org/content/77/4/903.full.pdf</a> </p></li>\n<li><p><a href=\"http://fshs.org/proceedings-o/2007-vol-120/FSHS%20vol.%20120/288-294.pdf\">http://fshs.org/proceedings-o/2007-vol-120/FSHS%20vol.%20120/288-294.pdf</a></p></li>\n</ul>\n\n<p>For general information on Grapefruit and it's drug interactions, you will find <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1873672/\">this article</a> useful.</p>\n\n<p>Unfortunately, I could not find a \"critical level\" that would cause increased drug interactions. In light of all the studies reviewed, the best course of action would be to avoid grapefruit in any form - juice, seed, or otherwise - in order to prevent any drug interaction. I hope this answers your question.</p>\n", "score": 5 } ]

[ "side-effects", "fruits" ]

[ { "answer_id": 1834, "body": "<p>Immunoglobulin E (IgE) is an antibody which is important part of <a href=\"https://en.wikipedia.org/wiki/Type_I_hypersensitivity\" rel=\"nofollow\">type 1 hypersensitivity</a>, or allergy in common language. It is said that, ie. milk allergy is <em>IgE-mediated</em>. This means that exposure to milk protein causes the immune system to \"sensitize\" (= milk IgE is produced) to milk during the first exposure. During the subsequent exposures the milk protein activates the immune system due to the presence of these milk associated IgEs. The results of this activation is the allergic symptoms. Amount of each food-IgE level in the blood is quite good surrogate for presence of allergy. I recommend to read the <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4249938/pdf/nihms264584.pdf\" rel=\"nofollow\">Guidelines for the diagnosis and management of food allergy in the United States</a>.</p>\n\n<p>I find it strange that immunoglobulin A (IgA) levels are measured in association to IgE levels. For example, the guideline earlier has no mention of IgA with regard to food allergy. IgA may have a mediator role in type 1 hypersensivity but I have trouble finding any record that this would have any clinical significance. Moreover, there are <a href=\"https://en.wikipedia.org/wiki/Immunoglobulin_A\" rel=\"nofollow\">IgA-related diseases</a>, but these have nothing to do with food allergy.</p>\n\n<p>Corresponding guideline from Europe by <a href=\"http://onlinelibrary.wiley.com/doi/10.1111/all.12429/epdf\" rel=\"nofollow\">the European Academy of Allergy and Clinical Immunology</a> does not mention anything about IgAs. Of course, there is the non-IgE-mediated food allergy but nevertheless that does not involve IgAs.</p>\n\n<p>If these were your own test results, I would recommend you ask from the provider of the test about the clinical significance of IgAs. I would be very interest about their response.</p>\n\n<p><strong>EDIT:</strong> Are we talking about IgA or IgG here? IgA is mentioned in the text and IgG in the topic. In the case of IgG, my answer would be different.</p>\n", "score": 1 } ]

[ "blood-tests" ]

[ { "answer_id": 1778, "body": "<p>This is a very pragmatic question and I would like give you an explicit answer. Unfortunately I think that there is only so little objective information which hearing aid is the best.</p>\n\n<p>As said when the best aid is considered it is a very subjective matter. There is no clear comparative studies about different hearing aids, especially if those without ear canal implant are used. If your father suffers from fungal infection is is natural that aids figured below are not pleasant due to ear canal irritation:</p>\n\n<p><a href=\"https://i.stack.imgur.com/ckQBB.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/ckQBB.jpg\" alt=\"enter image description here\"></a> </p>\n\n<blockquote>\n <p>Many choices of hearing aid styles are available, including the following: completely in the canal (A), in the canal (B), in the ear (C), behind the ear (D), receiver in canal or receiver in the ear (E), and open fit (F).</p>\n</blockquote>\n\n<p>Sources: <a href=\"http://www.mayoclinic.org/diseases-conditions/hearing-loss/multimedia/hearing-aid-styles/img-20008215\" rel=\"nofollow noreferrer\">MayoClinic</a></p>\n\n<p>As so, <strong>Personal Sound Amplification Products</strong> (PSAP) may seem appropriate as a temporary aid <a href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/HearingAids/ucm181482.htm#1\" rel=\"nofollow noreferrer\">(FDA)</a>. It is however, important to notice that these aids are not as powerful as actual hearing aids.</p>\n\n<p><em>I would recommend to consult an audiologist to get some insight to PSAPs. Also I would seek a brick-and-mortar shop which sells these aids, since most likely the sellers have valuable consumer info on these aids and can help deciding the right aid.</em></p>\n\n<p>I would like to also remind that it is <strong>extremely important</strong> to get the fungal infection treated and return to use the ordinary aid, since <strong>hearing loss can severely reduce the quality of life</strong>.</p>\n", "score": 4 }, { "answer_id": 7570, "body": "<p><a href=\"https://en.wikipedia.org/wiki/Bone-anchored_hearing_aid\" rel=\"nofollow\">Bone Anchored Hearing Aids (BAHA)</a> do not require having anything in the ear. Rather, they are placed behind the ear and work based on bone conduction. Commercially available BAHAs are both expensive and typically require surgery (outpatient procedure with local anesthesia), but they can be used without surgery. For example, at <a href=\"http://www.hopkinsmedicine.org/hearing/hearing_aids/baha.html\" rel=\"nofollow\">John Hopkins</a> they let you test one out with a headband during your appointment. <a href=\"http://www.oticonmedical.com/Medical/YourTreatment/The%20treatment%20process/Softband%20solution.aspx\" rel=\"nofollow\">Oticon</a> sells a headband to be used with a BAHA.</p>\n", "score": 1 }, { "answer_id": 1781, "body": "<p>You can look for <a href=\"http://www.hearingaidmuseum.com/gallery/Non-Electric/index-nonelect.htm\" rel=\"nofollow\">Ear Trumpets or Conversation Tubes</a>, or instruments used in the old age. I've googled for <a href=\"https://www.google.com/?q=old%20fashioned%20hearing%20aid\" rel=\"nofollow\">old fashioned hearing aids</a>.</p>\n", "score": 0 } ]

[ "hearing", "hearing-impaired", "hearing-aids", "sound-amplification-psap" ]

[ { "answer_id": 4133, "body": "<p>There are two sub-questions that must be addressed here.</p>\n\n<p><strong>Is BPA used in can linings, and can it leach into food?</strong></p>\n\n<p>This is definitely true. <a href=\"http://www.niehs.nih.gov/health/topics/agents/sya-bpa/\" rel=\"nofollow\">The National Institute of Environmental Health Sciences</a> (part of the NIH), for example, says that</p>\n\n<blockquote>\n <p>Polycarbonate plastics have many applications including use in some food and drink packaging, e.g., water and infant bottles, compact discs, impact-resistant safety equipment, and medical devices. Epoxy resins are used as lacquers to coat metal products such as food cans, bottle tops, and water supply pipes.</p>\n</blockquote>\n\n<p>These epoxies are what is used in the cans for canned foods, and they contain BPA. It subsequently leaks out in minute quantities, although this is thought to be related to the temperature of the can, not aging.</p>\n\n<p><strong>Is BPA a hazard to human health?</strong></p>\n\n<p>This is not quite as clear. The FDA has changed <a href=\"http://www.fda.gov/newsevents/publichealthfocus/ucm064437.htm#current\" rel=\"nofollow\">its stance</a> over time as new research showed different conclusions. <a href=\"http://www.fda.gov/downloads/NewsEvents/PublicHealthFocus/UCM424266.pdf\" rel=\"nofollow\">Its most recent memo</a> reviewed previous studies. One recent one found that adults are exposed to about 0.2 micrograms of BPA per day, while young children and infants are exposed to about 0.5 micrograms per day.¹ However, other research had shown that hazardous levels were in general orders of magnitude higher than these doses. Thus, in the FDA's most recent findings, BPA in food cans is not a problem. However, the agency has made it clear that it continues to revise its recommendations as new information is available.²</p>\n\n<p>None of this should be taken to mean that BPA is not hazardous to humans. Higher amounts can prove toxic, as the chemical is thought to disrupt the endocrine system (see <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/23994667\" rel=\"nofollow\">Rochester (2013)</a> and <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26680775\" rel=\"nofollow\">Ihde et al. (2015)</a>). This can, in some cases, lead to severe effects, possibly including cancer, and especially when applied to children. It may also cause neurological harm (see <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26672480\" rel=\"nofollow\">Negri-Cesi (2015)</a> and <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26664253\" rel=\"nofollow\">Inadera (2015)</a>).</p>\n\n<p>In short, while BPA may pose a threat to humans in high enough quantities, its presence in canned food linings does not appear to be dangerous.</p>\n\n<hr>\n\n<p>^{1 This drastic difference is due to the previous use of BPA in some drinking containers used by infants. <a href=\"http://www.fda.gov/food/newsevents/constituentupdates/ucm360147.htm\" rel=\"nofollow\">The FDA has banned this</a>, but because industry leaders had stopped using it due to consumer pressure, not because of clear health concerns.}\n<br>\n^{2 The European Food Safety Authority (EFSA) has echoed the FDA's conclusions; see <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26656411\" rel=\"nofollow\">Ćwiek-Ludwicka (2015)</a>.}</p>\n", "score": 3 } ]

[ "toxicity", "plastic" ]

[ { "answer_id": 1875, "body": "<p>I have two competing theories:</p>\n\n<p>1) I guess that one problem might be that Biafine contains <a href=\"http://www.fda.gov/downloads/MedicalDevices/.../UCM284443.pdf\" rel=\"nofollow\">parabens</a>.</p>\n\n<p>European Council recently banned some forms of parabens (<a href=\"http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=OJ:JOL_2014_107_R_0002&amp;from=EN\" rel=\"nofollow\">1</a>). Furthmore, in this year EC set more restrictions for the use of parabens (<a href=\"http://europa.eu/rapid/press-release_IP-14-1051_en.htm\" rel=\"nofollow\">2</a>). It seems that parabens may have certain adverse health effects and EC think that these should be assessed before parabens are safe to use. </p>\n\n<p>More specifically, EC claims that occlusion coat or skin irritation \"<em>may allow increased penetration than intact skin</em>\". </p>\n\n<p>Perhaps due to the parabens the use of Biafine should be based on physician´s discretion.</p>\n\n<p>2) Biafine was cleared by the FDA almost two decades ago (<a href=\"http://www.accessdata.fda.gov/cdrh_docs/pdf/K964240.pdf\" rel=\"nofollow\">3</a>). I could not find the original application in the FDA website. <a href=\"http://www.accessdata.fda.gov/cdrh_docs/pdf4/k041342.pdf\" rel=\"nofollow\">Here is the FDA clearance</a> for another similar cream. In the section 5 it is stated that prescription product requires physician to diagnose the disease state. Since FDA approves many drugs based on the \"Substantially equivalent (SESE)\" (<a href=\"http://www.fda.gov/downloads/MedicalDevices/.../UCM284443.pdf\" rel=\"nofollow\">4</a>) I think very similar process was used with Biafine. So the use of Biafine requires a visit to a physician for diagnostics. Whether this limitation is due to parabens remains unclear to me.</p>\n", "score": 2 } ]

[ "prescription", "sun-burn" ]

[ { "answer_id": 2020, "body": "<p>The liver breaks down about 90% of alcohol consumed, <a href=\"http://science.howstuffworks.com/alcohol4.htm\">with only about 5%</a> excreted in the urine. To become combustible, the ethanol concentration in urine would have to approach <a href=\"https://www.quora.com/What-percentage-of-alcohol-is-needed-in-vodka-for-it-to-burn\">50%</a> at room temperature, though 20% would combust at around body temperature. However, conversion of ethanol into acetate by the liver generates one molecule of water for each molecule of ethanol consumed. Since 18 times more alcohol is metabolized by the liver than is excreted in the urine, the water from all that liver metabolism would render the urine too dilute to combust even if it were not supplied by the diet.</p>\n", "score": 9 } ]

[ "alcohol", "urine" ]

[ { "answer_id": 1966, "body": "<p><a href=\"https://en.wikipedia.org/wiki/Sucralose\" rel=\"nofollow noreferrer\">Sucralose</a> is considered to be a non nutritive sweetener, since the body does not break down the majority of the sucralose molecule. Because of that, it's considered to be non caloric, so it won't be included under the nutrition information.</p>\n\n<p>As far as the quantity, there is no requirement under FDA regulations that the specific amounts be listed, and would probably violate copyright patents, as then people could duplicate the formula. As pointed out in <a href=\"https://health.stackexchange.com/questions/283/how-do-you-read-a-us-nutrition-label\">the top answer here</a>, ingredients are listed in order of percentage, so the ingredient that makes up the most of the product is listed first, the next second, etc.</p>\n\n<p>As far as finding out, many search engines and product reviews may help, as it is just legwork and patience that will get you the information that you need (in most cases).</p>\n\n<p>However, there have been some recent <a href=\"http://www.medicalnewstoday.com/articles/262475.php\" rel=\"nofollow noreferrer\">cautions against sucralose</a>, since an Italian study showed a link between increased cancer risk with <a href=\"http://www.medicalnewstoday.com/articles/244603.php\" rel=\"nofollow noreferrer\">increased consumption of sucralose</a> (as well as aspartame). I do stress that these are early studies, and have not yet been followed up with further research.</p>\n", "score": 6 } ]

[ "nutrition", "sugar" ]

[ { "answer_id": 1984, "body": "<p>Not only are they moldy, it looks like they've also been damaged by moisture. See how the surface is rippled in spots? That's what water does to pills. </p>\n\n<p><a href=\"https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000534.htm\" rel=\"nofollow\">Bathrooms are the worst place to store medicines because of the heat and humidity from showers and bathtubs.</a></p>\n\n<p>No, the medicine is not safe to use despite being within the expiration date (see same link above). Although they might not hurt you (\"might\" being the key word), they are quite likely ineffective.</p>\n", "score": 3 } ]

[ "medications", "mold" ]