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[ { "answer_id": 1522, "body": "<p>To answer this question, first it might be useful to talk about how a vaccine actually works: basically, through introducing dead or relatively harmless (attenuated) versions of a virus or bacteria (or more recently, synthetic virus-like particles meant to mimic the outside of a virus), you induce a reaction by your immune system to defend itself.</p>\n\n<p>As your immune system remembers pathogens it's encountered before based usually on a protein encountered on the outside of the virus or bacteria (an antigen), when it encounters the real deal, it can defend itself.</p>\n\n<p>Which means the ability for a vaccine to work depends <em>entirely</em> on your body's ability to recognize the vaccine you were given and the pathogen you encounter as \"the same\".</p>\n\n<p>This, in turn, is a function of how fast the virus evolves. Some viruses, like influenza, have genomes that are very conducive to swapping between strains. This is known as <a href=\"https://en.wikipedia.org/wiki/Antigenic_shift\">antigenic shift</a>. Other viruses, <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2937799/\">like HIV</a>, have relatively rapid evolution brought on by methods of copying their genomes that are \"sloppy\" or error prone. This is sometimes called antigenic drift (influenza does this as well).</p>\n\n<p>Both of these mechanisms make it likely that, over time, the difference between the vaccine and the virus is such that your body will no longer recognize one as the other.</p>\n\n<p>In contrast to RNA viruses like HIV and influenza, viruses that have their genomes stored as double stranded DNA, like smallpox, have <a href=\"http://www.virology.ws/2009/05/10/the-error-prone-ways-of-rna-synthesis/\">much lower error rates</a>, which means antigenic drift is less of a problem, and it's not prone to antigenic shift. This means that a vaccine developed against it wasn't made ineffective by the virus evolving such that it didn't provoke an immune response (known as antigenic escape).</p>\n\n<p>This stability made smallpox an excellent target for a vaccine, and the lack of stability is why developing a long-lasting vaccine against influenza and HIV is so difficult.</p>\n", "score": 14 } ]

[ "vaccination", "resistance" ]

[ { "answer_id": 3603, "body": "<p>This answer is based on the fact that you have been in a region with less sunlight for several years and continue to suffer. It therefore focuses on Seasonal Affective Disorder, which you may or may not have. </p>\n\n<p>Seasonal affective disorder is an actual illness, and a form of depression. Unfortunately, it is underdiagnosed and undertreated. It is recognized in DSM—5 as Depressive Disorder with Seasonal Pattern. </p>\n\n<p>Diagnosis and treatment are best left to a professional, and may include therapy and medication. However, there are some ways to at least try to make it less severe or that can ease \"winter blues\" that isn't severe enough to be diagnosed as SAD. </p>\n\n<ul>\n<li>Go outside when it's light as often as possible. This even helps when it's grey and cloudy outside </li>\n<li>while it's light outside, if you need to be indoors, be close to a window where your body can register that it is still light outside </li>\n<li>Exercise regularly </li>\n</ul>\n\n<p>Light therapy is effective, but is hard to get right alone - just sitting in front of a bright light occasionally is not enough. </p>\n\n<p><strong>Sources and further reading</strong></p>\n\n<p><a href=\"http://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/basics/definition/con-20021047\" rel=\"noreferrer\">Mayo Clinic: Seasonal Affective Disorder</a></p>\n\n<p><a href=\"http://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/in-depth/seasonal-affective-disorder-treatment/art-20048298\" rel=\"noreferrer\">Mayo Clinic: Light Box Therapy</a></p>\n\n<p><a href=\"http://www.aafp.org/afp/2012/1201/p1037.html\" rel=\"noreferrer\">Seasonal Affective Disorder</a> in <em>Am Fam Physician</em> (good overview with details on light therapy) </p>\n", "score": 5 }, { "answer_id": 1586, "body": "<p>While most people don't want to believe it, the effect of winter on your mood is mostly all in how you choose to deal with it.</p>\n\n<p>In Tromso Norway, winter-time depression is among the lowest rates of any population in the entire world. They also have some of the longest winters, owing to the fact that they are among the northern-most cities in the world.</p>\n\n<p>The main reason they don't experience depression is because they view the coming of winter as a positive thing. You should do anything you can to make you look forward to the season, such as taking up skiing or another winter sport. You could also ask some of your friends what they are doing during the season and see if you could join them. You can even stay inside and get the same effects, but you have to look forward to the time. Hot chocolate and a good book or favorite movie for example. </p>\n\n<p>You can read more in this article in the atlantic: <a href=\"http://www.theatlantic.com/health/archive/2015/07/the-norwegian-town-where-the-sun-doesnt-rise/396746/\" rel=\"nofollow\">http://www.theatlantic.com/health/archive/2015/07/the-norwegian-town-where-the-sun-doesnt-rise/396746/</a></p>\n", "score": 0 } ]

[ "depression", "mental-health" ]

[ { "answer_id": 25834, "body": "<blockquote>\n<p>I do not feel any pain when I sleep chest-side down other than pain on my neck, but this is only because I have to turn my face to one side, and this can be fixed if I buy a special pillow (something used at a massage shop).</p>\n</blockquote>\n<p>In any medical topic, you shouldn't assume that a habit is healthy just because it doesn't immediately cause pain.\nIf you feel pain in the neck muscles this might hurt your <a href=\"https://radianthealthchiropractic.com/blog/poor-posture-leads-to-spinal-degeneration\" rel=\"nofollow noreferrer\">posture and in turn, hurt your back</a>.</p>\n<blockquote>\n<p>We are mammals and almost all mammals live and sleep chest-side down. Dogs, for example, seem to love to rest their chest and head laid down on the floor.</p>\n</blockquote>\n<p>I think the way the dogs sleep depends more on their personality rather than anatomy. Many dogs do sleep on the side. If you look at our closer relatives - chimps they typically sleep on the side.</p>\n<p>Generally, the human spine suffers a lot from bad posture. Asymmetrical weight distributions, prolonged stretch, prolonged contractions can cause the vertebrae to wear down.\nA problem in sleeping prone is the fact that you need to contract lower back muscles and neck muscles (regardless if your face is pointing sideways or down). This causes tension which can sometimes be felt the day later. However, the main problem here is that long-term sleeping in that position will reflect on your posture and cause additional wear and tear on the back and possibly <a href=\"https://pubmed.ncbi.nlm.nih.gov/29020829/\" rel=\"nofollow noreferrer\">cumulative trauma disorders</a>.</p>\n<p>I recommend you this <a href=\"https://www.youtube.com/watch?v=JM9qGOsIfZc\" rel=\"nofollow noreferrer\">video</a> for understanding how muscles work during sleep.</p>\n<p>There are many reasons to sleep on the side, but this goes beyond the scope of the question. If you want to sleep on the stomach, you can, but you should make sure that you take care of your posture and don't overexert your lumbar and neck muscles.</p>\n", "score": 0 } ]

[ "sleep", "spine", "position", "lumbago-low-back-pain", "wrinkles" ]

[ { "answer_id": 3031, "body": "<p>There is a substance similar to caffeine - theobromine, found in cocoa. They are chemically similar, and have some similar effects*:</p>\n\n<p><a href=\"https://i.stack.imgur.com/kwZcm.png\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/kwZcm.png\" alt=\"enter image description here\"></a></p>\n\n<p>the formula above shows theobromine,</p>\n\n<p><a href=\"https://i.stack.imgur.com/OG7ex.png\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/OG7ex.png\" alt=\"enter image description here\"></a></p>\n\n<p>and this is caffeine.</p>\n\n<p>Of course, there is the concern if you react like you described to one xanthine derivative (caffeine), would you react in a similar way to another compound from this group. Also the atypical reaction to caffeine might be something you want to have checked further (i.e. consult a physician about it). </p>\n\n<p>There are many chemicals (some found in various herbs) that have various sorts of stimulating effects on the central nervous system, but tampering with the CNS can be very dangerous, and indeed many of these substances have serious side effects, far more serious than caffeine.</p>\n\n<hr>\n\n<p>An aside: depending on how alert one needs to be, a lemonade can be a quick home remedy: water will keep you hydrated (necessary for alertness), sugar (or honey) will keep your brain \"fueled\", vitamins will help your metabolic processes, and sour taste does have a short-term awakening effect. Of course, like with anything, moderation is the key.</p>\n\n<hr>\n\n<p>*Various research papers show controversial results regarding the stimulating effects on theobromine (some show some effect, some don't, and some show opposite effects in certain doses). They mostly agree that the effects are weaker than in caffeine, dose dependent, and may depend on previous use of products containing caffeine and/or theobromine. (see ref 4, 5 and 6).\nRef:</p>\n\n<ol>\n<li><p><a href=\"http://www.drugbank.ca/drugs/DB01412\" rel=\"noreferrer\">Drug Bank 4.3</a></p></li>\n<li><p><a href=\"http://www.ars-grin.gov/cgi-bin/duke/chemical.pl?THEOBROMINE\" rel=\"noreferrer\">Dr. Duke's Phytochemical and Ethnobotanical Databases</a> at United States Department of Agriculture</p></li>\n<li><p>Formulae from <a href=\"https://en.wikipedia.org/wiki/Theobromine\" rel=\"noreferrer\">Wikipedia</a></p></li>\n<li><p>Hendrik J. Smit, Elizabeth A. Gaffan, Peter J. Roger: <a href=\"http://link.springer.com/article/10.1007/s00213-004-1898-3#page-1\" rel=\"noreferrer\">Methylxanthines are the psycho-pharmacologically active constituents of chocolate</a>, Psychopharmacology, November 2004, Volume 176, Issue 3, pp 412-419</p></li>\n<li><p>Geoffrey K. Mumford, Suzette M. Evans, Barbara J. Kaminski, Kenzie L. Preston, Christine A. Sannerud, Kenneth Silverman, Roland R. Griffiths: <a href=\"http://link.springer.com/article/10.1007/BF02244744#page-1\" rel=\"noreferrer\">Discriminative stimulus and subjective effects of theobromine and caffeine in humans</a>, Psychopharmacology, June 1994, Volume 115, Issue 1, pp 1-8</p></li>\n<li><p>Matthew J. Baggott, Emma Childs, Amy B. Hart, Eveline de Bruin,\nAbraham A. Palmer, Joy E. Wilkinson, Harriet de Wit: <a href=\"http://palmerlab.org/wp-content/uploads/2012/09/Baggott-et-al-Psychopharm-2013.pdf\" rel=\"noreferrer\">Psychopharmacology of theobromine in healthy volunteers</a>, Psychopharmacology\nDOI 10.1007/s00213-013-3021-0</p></li>\n</ol>\n", "score": 8 } ]

[ "medications", "caffeine" ]

[ { "answer_id": 3157, "body": "<p>There is evidence of analgesic effects of menthol in scientific literature. It has been studied in humans and has shown to be <strong>superior to ice in delayed onset muscle soreness</strong>; in a placebo-controlled, triple-blind, cross-over clinical study <strong>menthol-based gel acutely reduced pain in subjects with carpal tunnel syndrome symptoms. In mice blockage of voltage gated Na-channels</strong> of dorsal root ganglion neurons has shed light on potential mechanisms of analgesic action.</p>\n<p>Here are the key parts of these studies:</p>\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362986/\" rel=\"noreferrer\">A comparison of topical menthol to ice on pain, evoked tetanic and voluntary force during delayed onset muscle soreness</a> has shown that:</p>\n<blockquote>\n<p>Compared to ice, the topical menthol-based analgesic decreased perceived discomfort to a greater extent and permitted greater tetanic forces to be produced. [...] Tetanic force changes illustrated a significant main effect for the treatments (p&lt;0.05; ES=1.1) with the menthol based topical analgesic allowing 116.9% greater tetanic force (89.4 N ± 60.7) output than the ice treatment (41.2 ± 43.6). [...] There was a significant (p=0.025; ES=1.2) difference in soreness perception with the VAS scale between the application of ice and the menthol based topical analgesic. Soreness perception was 63.1% less with application of the topical analgesic (1.1 ± 0.4) compared to the ice (3.1 ± 1.7).</p>\n</blockquote>\n<p>In this study menthol was applied as 3.5% gel (Biofreeze®) without substantial force or rubbing during application.</p>\n<p>Aside from cooling sensation attributed to activation of TRPM8 channel in this and other studies, another study (<a href=\"http://www.sciencedirect.com/science/article/pii/S0304395911006907\" rel=\"noreferrer\">Menthol pain relief through cumulative inactivation of voltage-gated sodium channels</a>) has tested the hypothesis that menthol could block voltage gated Na-channels:</p>\n<blockquote>\n<p>The results indicate that menthol inhibits Na+ channels in a concentration-, voltage-, and frequency-dependent manner. Menthol promoted fast and slow inactivation states, causing use-dependent depression of Na+ channel activity. In current clamp recordings, menthol inhibited firing at high-frequency stimulation with minimal effects on normal neuronal activity. We found that low concentrations of menthol cause analgesia in mice, relieving pain produced by a Na+ channel-targeting toxin. We conclude that menthol is a state-selective blocker of Nav1.8, Nav1.9, and TTX-sensitive Na+ channels, indicating a role for Na+ channel blockade in the efficacy of menthol as topical analgesic compound.</p>\n</blockquote>\n<p><a href=\"http://www.hindawi.com/journals/rerp/2014/310913/\" rel=\"noreferrer\">Acute Effect of Topical Menthol on Chronic Pain in Slaughterhouse Workers with Carpal Tunnel Syndrome: Triple-Blind, Randomized Placebo-Controlled Trial</a>:</p>\n<blockquote>\n<p>Topical gel containing menthol led to a 31% (1.3 point on 0–10 VAS) acute reduction in chronic pain associated with carpal tunnel syndrome, and the absolute change in pain symptoms between topical menthol and placebo was 1.2 corresponding to a moderate effect size</p>\n</blockquote>\n<hr />\n<p>In official monographs one can find predominantly Peppermint oil (<em>Menthae piperitae aetheroleum</em>), but since literature states that menthol is it's main ingredient (30 - 55% [WHO]) we could assume that it plays a role in the effects of the oil.</p>\n<ul>\n<li><a href=\"http://www.ema.europa.eu/docs/en_GB/document_library/Herbal_-_Community_herbal_monograph/2010/01/WC500059313.pdf\" rel=\"noreferrer\">In Community Herbal Monograph by European Medicines Agency (EMeA)</a>:</li>\n</ul>\n<p>Traditional use, indication 2:</p>\n<blockquote>\n<p>For the symptomatic relief of localised muscle pain</p>\n</blockquote>\n<ul>\n<li>In <a href=\"http://apps.who.int/medicinedocs/en/d/Js4927e/19.html\" rel=\"noreferrer\">WHO Monographs on selected medicinal plants, Volume 2</a>:</li>\n</ul>\n<blockquote>\n<p>Uses supported by clinical data</p>\n<p>Internally for symptomatic treatment of irritable bowel syndrome (15-20), and digestive disorders such as flatulence and gastritis (21-23). <strong>Externally for treatment of myalgia and headache</strong> (21, 24-27)</p>\n</blockquote>\n<p>(emphasis mine)</p>\n<ul>\n<li>Commission E (translated into English at <a href=\"http://cms.herbalgram.org/expandedE/Peppermintoil.html\" rel=\"noreferrer\">American Botanical Council</a>)</li>\n</ul>\n<blockquote>\n<p>The Commission E approved the internal use of peppermint oil for spastic discomfort of the upper gastrointestinal tract and bile ducts, irritable colon (in enteric-coated capsules), catarrhs of the respiratory tract, and inflammation of the oral mucosa; <strong>and external use for myalgia and neuralgia.</strong></p>\n<p>ESCOP [...] Its external use is indicated for coughs and colds, <strong>rheumatic complaints</strong>, pruritus, urticaria, and pain in irritable skin conditions (ESCOP, 1997).</p>\n</blockquote>\n<p>*To show the lack of bias: not an official monograph, but a respected resource, PDR for Herbal Medicines lists the cutaneous use of peppermint oil as an analgesic in myalgia and neuralgia as &quot;unproven uses&quot;.</p>\n", "score": 10 } ]

[ "pain", "muscle" ]

[ { "answer_id": 3271, "body": "<p>It sounds like you know that some lifestyle modifications have been shown to be beneficial with patients who have mild to moderate GERD and that these interventions are typically preferable to pharmacological intervention. Right on!</p>\n\n<p>The definitive information on management of GERD can be found on <a href=\"http://gi.org/guideline/diagnosis-and-managemen-of-gastroesophageal-reflux-disease/\" rel=\"noreferrer\">the website of the American College of Gastroenterology</a>.</p>\n\n<p>Here is the specific section that you're looking for:</p>\n\n<ol>\n<li><p>Weight loss is recommended for GERD patients who are overweight or have had recent weight gain. (Conditional recommendation, moderate level of evidence).</p></li>\n<li><p>Head of bed elevation and avoidance of meals 2–3 h before bedtime should be recommended for patients with nocturnal GERD. (Conditional recommendation, low level of evidence).</p></li>\n<li><p>Routine global elimination of food that can trigger reflux (including chocolate, caffeine, alcohol, acidic and/or spicy foods) is not recommended in the treatment of GERD. (Conditional recommendation, low level of evidence)</p></li>\n</ol>\n\n<p>In my personal experience, all three of these are worth trying.</p>\n", "score": 7 }, { "answer_id": 3270, "body": "<p>Effective lifestyle modifications would include:</p>\n\n<ul>\n<li><p>Weight loss - excess weight causes pressure on the stomach, overcoming the lower-oesophageal sphincter and pushing acid into the oesophagus</p>\n\n<ul>\n<li><p>Abstinence from Alcohol - alcohol irritates the gastric lining causing pain.</p></li>\n<li><p>Stopping smoking - nicotine activates receptors in the stomach wall, encouraging the secretion of acid.</p></li>\n</ul></li>\n</ul>\n\n<p>Additional recommendations would include stopping non-steroidal anti-inflammatory drugs.</p>\n\n<p>Hopefully that all helps!</p>\n", "score": 2 } ]

[ "gastroenterology", "lifestyle", "gerd-acid-reflux", "heartburn" ]

[ { "answer_id": 3320, "body": "<p>Reference ranges vary by labs. <a href=\"http://emedicine.medscape.com/article/2086819-overview\">In some assays</a>, 35 IU/mL is still considered the upper limit of normal. The reason for the dramatic difference in reference ranges is the detection limit of the assay itself. As time progresses, assays become more sensitive to small titers of antibody. In labs using newer techniques, concentrations as low as 9 IU/mL can be detected, so anything above that is considered abnormal.*</p>\n\n<p>The question of whether an antibody concentration between 9 and 35 IU/mL is as detrimental as a higher concentration is an interesting one. First, in way of background for those not familiar with anti-TPO antibodies: these are antibodies directed against the thyroid gland. They are most often measured in a patient with <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664572/\">“subclinical” hypothyroidism</a> (i.e. elevated TSH but normal free T4). In such cases <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664572/\">they have been shown to be prognostic for progression to overt hypothyroidism</a>.² </p>\n\n<p>As it turns out, <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4091497/\">there is evidence</a>¹ that the titer of antibody within the range you ask about affects prognosis. The linked study used an assay detecting levels as low as 5.5 IU/mL. Those who spontaneously improved had a mean TPO titer that was significantly lower than the group that progressed to overt hypothyroidism requiring thyroid replacement (13.85 IU/mL vs 39.9 IU/mL, p= 0.028). Note that the mean in the spontaneously improving group would have been considered “less than assay” in a test with a detection limit of 35 IU/mL. </p>\n\n<p>So yes, “somewhere between 9 and 35 IU/mL is actually not that bad”, if “bad” refers to a titer greater than 35 IU/mL and the relative prognostic value is of interest.</p>\n\n<hr>\n\n<p>_{\n* Many lab tests have a lower limit of detection within the physiologic range like this. These tend to be looking for antibodies or enzymes that are not <em>supposed</em> to be present at a detectable level. In such cases the “normal” result is “LTA = less than assay”. As lab tests get better and that detection limit goes lower, more people end up characterized as “abnormal”. Such is scientific progress.\n}</p>\n\n<hr>\n\n<p>_{\n1. Myung Won Lee, Dong Yeob Shin, Kwang Joon Kim, Sena Hwang, and Eun Jig Lee, <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4091497/\"><em>The Biochemical Prognostic Factors of Subclinical Hypothyroidism</em></a>. Endocrinol Metab. 2014 Jun; 29(2): 154–162.\n} </p>\n\n<p>_{\n2. Vahab Fatourechi, <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664572/\"><em>Subclinical Hypothyroidism: An Update for Primary Care Physicians</em></a>. Mayo Clin Proc. 2009 Jan; 84(1): 65–71.\n} </p>\n", "score": 9 } ]

[ "thyroid", "test-results", "thyroperoxidase-tpo" ]

[ { "answer_id": 3388, "body": "<p>Your units of measure are likely \"<a href=\"https://en.wikipedia.org/wiki/Dioptre\">diopters</a>.\" If someone needs glasses for <em>reading</em> (because the person is far sighted), then they would be given an prescription with a <strong>+</strong>[digit], and note that each eye could be different (and usually is, at least slightly). An example might be:</p>\n\n<pre><code>left eye: +1.5\nright eye: +0.75\n</code></pre>\n\n<p>If he has a negative number of diopters in his prescription, it just means he is instead near sighted, or <em>myopic</em>: he sees things up close probably pretty well (in the eye with a negative diopter). If both eyes are around -6 diopters (and assuming he doesn't have severe astigmatism on top of this strong near sightedness), he probably needs relatively strong lenses to see distances clearly, and can probably only read an average size font (such as 12-14 points) if it less than a foot (roughly) from his face.</p>\n\n<p>See also: <a href=\"http://www.britannica.com/technology/diopter-optics\">http://www.britannica.com/technology/diopter-optics</a>\nand \"Amplitude of accommodation\" on wikipedia</p>\n", "score": 6 }, { "answer_id": 3455, "body": "<p>I am going to assume with - 6 you mean a measurement of - 6 <a href=\"https://en.wikipedia.org/wiki/Dioptre\" rel=\"nofollow\">Dioptre </a>. If you are talking about the strength of the glasses he needs, the minus indicates that this eye is nearsighted, a positive value would indicate farsightedness. If that is a measurement of his eyesight, he is farsighted. A measurement of 0 indicates that the eye can adapt to both short and long distances without problems (though corrections may still be necessary, for example for astigmatism). Because of the definition of a Dioptre, there is no maximum/minimum number. </p>\n\n<blockquote>\n <p>A dioptre (uk), or diopter (us), is a unit of measurement of the optical powerof a lens or curved mirror, which is equal to the reciprocal of the focal length measured inmetres (that is, 1/metres). It is thus a unit ofreciprocal length. </p>\n</blockquote>\n\n<p>A measurement of -6 is certainly not nothing and will require corrective lenses. It is, however, far from being blind and can be corrected by wearing glasses or contact lenses. For nearsightedness, -6 is where <a href=\"https://en.wikipedia.org/wiki/Myopia\" rel=\"nofollow\">high-degree myopia</a> begins. </p>\n\n<p>If you are talking about whether he could be considered <a href=\"http://www.idbonline.org/legal-definition-blindness\" rel=\"nofollow\">legally blind </a>, that is a definition that only applies to how much you can see <em>with</em> correction. Since myopia of -6 can be corrected well with glasses, there should be no risk of being defined as legally blind. </p>\n", "score": 4 } ]

[ "eye" ]

[ { "answer_id": 13249, "body": "<p>The short answer: I haven't come across anything that states that patients with a mild Meniere's episode should rest on principle even if they're feeling well enough to perform activities. So, I think it would be up to the patient's own judgement about what they are comfortable doing.</p>\n\n<p>The longer answer: Meniere's disease is a disease of the inner ear, and is associated with distortions of the delicate membranes found in the inner ear. The underlying cause is not fully understood - various theories include that Meniere's disease is caused by a blockage at the endolymphatic sac, genetics, a virus, or a problem with blood vessels, but nobody knows for sure. If a person has definitively been diagnosed with Meniere's disease by a physician, then the treatment focuses on reducing symptoms. Treatments include lifestyle chances (limiting salt intake to 2-3 g per day, avoiding caffeine/alcohol/nicotine/MSG which are harmful substances that can worsen symptoms based on their effects in the inner ear, etc.). Treatments also include certain medicines (prescribed by a physician, e.g. anti-nausea medications like prochlorperazine.) There's also vestibular rehabilitation therapy which tries to help people with their balance, and hearing aids for hearing problems. Finally, there are some surgical procedures that might help in certain really severe cases of Meniere's that don't respond to any other treatments. In all my reading about Meniere's, I was not able to find any studies that suggested that patients should force themselves to rest during a mild Meniere's episode during which they would be capable of performing various activities. At the end of the day \"listening to your body\" is really a good piece of advice: if the patient feels safe and comfortable performing certain activities during a mild episode, it is probably alright; if they start to feel worse, they can stop what they are doing or take it more slowly. Of course, the best person to answer this question would be the patient's personal physician, since the physician will know the patient's full medical history and will therefore be able to give a more individualized answer. \nSource: I'm a medical student, and I referenced the article on Meniere's disease in UpToDate, a medical encyclopedia.</p>\n", "score": 2 } ]

[ "hearing", "fatigue", "dizziness", "vertigo", "menieres-disease" ]

[ { "answer_id": 3547, "body": "<p>Water isn't pure H₂O; there are all kinds of dissolved substances in it: minerals, chemicals, etc. This is why scientists use only distilled water in experiments (often twice-distilled).</p>\n\n<p>Some impurities will boil off (some volatile organic compounds, for instance) but some will remain behind. With each boil, you lose some of the water to steam, leaving a more concentrated solution of those contaminants which do not boil off.</p>\n\n<p>For example, add a teaspoon of salt to two cups of water; boil away one cup of water, and you'll be left with water that's almost twice as salty as you started with. (Some small amount of salt may be splashed out while boiling.)</p>\n\n<p>This is why you should always start out with fresh water; otherwise you're feeding your daughter water which has more contaminants than fresh water. If you want to do that for yourself, that's your choice, but your baby deserves better.</p>\n\n<p>_{<a href=\"http://water.usgs.gov/edu/waterquality.html\">Water Quality</a>}<br>\n_{<a href=\"http://water.usgs.gov/edu/earthgwquality.html\">Groundwater quality</a>}</p>\n", "score": 9 } ]

[ "water", "lifestyle" ]

[ { "answer_id": 4196, "body": "<p>Please note that the pain scale is usually used to evaluate the <em>efficacy of treatment</em>. As long as the pain is responding to treatment, there need not be objectivity <em>per se</em>. </p>\n\n<p>Was it a '7' on arrival? is it a '2' after a couple of doses of an analgesic? (if so, Great! Can we safely get it to a '1' or '0'? Did it spike to a '5' today? Why might that be? Is there something the team is missing that is causing the pain to be poorly controlled?) </p>\n\n<p>This is the goal of the pain scale. For this reason, there is no <em>need</em> for objectivity.</p>\n\n<p><strong>Can pain be objectively measured, therefore reported?</strong></p>\n\n<p>The intensity of pain (as you have mentioned) is often left to the patient to describe on a scale of 1-10, or a visual analogue of faces. There is nothing objective about these methods, nor can there be, because pain is not objective; it is subjective.</p>\n\n<p><strong>Pain is subjective</strong></p>\n\n<p><em>Pain</em> is a subjective experience; you cannot tell with certainty how much pain your fellow human is experiencing, which is why we <em>ask</em> people; they then can tell us. Pain relief (both physical and emotional) is a significant part of medicine, yet we still have \"pain scales\" for self-reported pain, one of the more common ones being the Wong-Baker Faces Pain Rating Scale:</p>\n\n<p><img src=\"https://i.stack.imgur.com/UEnH8.jpg\" alt=\"enter image description here\"></p>\n\n<p>To try to accurately assess pain (which is still <em>subjective</em>), a patient's scale should be interpreted by a caregiver using examples <em>appropriate to that patient</em> (If the person has had severe kidney stones, for example, the examiner can use that as a \"10\".) </p>\n\n<blockquote>\n <p>...the worst pain I ever had was a kidney infection where I eventually passed out. If I take that as a 10, very few things even get to a 7 ;-) which is why I am asking. So you're basically saying physicians expect a high number much earlier than that?</p>\n</blockquote>\n\n<p>No, we don't expect a lot of 8/9/10s on the scale. We hope it will be used exactly as you have described: in many cases, 10 is described by a caregiver as \"the worst pain you ever had.\" If the patient has never had severe pain before (kidney stones, childbirth [for most], etc.) the pain has to be imagined.</p>\n\n<p>Left to their own devices, a patient might look like a 6, but be reporting a 10. In this case, a nurse must try to ascertain their actual level of their pain. But still, it is their pain, and how it is felt differs from person to person, which is why no objective criteria can be assigned the pain scale.</p>\n\n<p>_{<a href=\"http://www.pnas.org/content/102/36/12950.full\" rel=\"noreferrer\">The subjective experience of pain: Where expectations become reality</a>} </p>\n", "score": 10 }, { "answer_id": 4197, "body": "<p>The Numerical Rating Scale (<a href=\"http://www.webcitation.org/6Ag75MDIq\">NRS - 11</a>) may be the easiest one to relate to. Between ranges can be looked at pretty objectively, but within ranges is more subjective. </p>\n\n<p>Rating: Pain Level</p>\n\n<ul>\n<li>0: No Pain</li>\n<li>1 – 3: Mild Pain (nagging, annoying, interfering little with ADLs)</li>\n<li>4 – 6: Moderate Pain (interferes significantly with ADLs)</li>\n<li>7 – 10: Severe Pain (disabling; unable to perform ADLs)</li>\n</ul>\n\n<p><em>ADLs are activities of daily living.</em></p>\n", "score": 5 }, { "answer_id": 5373, "body": "<p>I'll give two perspectives: 1) human factors engineer and 2) chronic pain patient. </p>\n\n<p>1) When trying to objectify a subjective item like pain, a common set of tasks are applied to level the field and serve as a reference against which to measure. A common scale is called the <a href=\"https://engineering.purdue.edu/~andrisan/Courses/AAE490A_S2010/Buffer/HCooper.pdf\" rel=\"nofollow\">Cooper-Harper scale</a>. I have used it to quantify a pilot's ability to complete tasks like landing, hovering around an airport and turning. In the case of pain, neerajit mentions activities of daily living, and those would include dressing, urinating and having bowel movements, maintaining communications, having a stable mood, eating, drinking, etc. When assessing pain, a 4-6 might interfere with the ability to do the task even significantly, but it probably would not cause deterioration of the patient's health. These scales work much better for acute pain or how pain responds to treatment in an acute setting to treatment. For chronic pain, a scale is applied like this one, <a href=\"http://probaway.com/MetaScales/Pain/Pain.htm\" rel=\"nofollow\">Scamahorn's Pain Scale</a>, but it is applied more to how much the pain interferes with activities over say the previous two weeks overall. How does it affect overall quality of life, relationships, ability to work, walk, do housework, socialize, etc. This brings me to perspective #2.</p>\n\n<p>2) Pain and experiencing the sensation of pain can be scary for someone who never experiences; the same can be true for the opposite. What I mean by that is people who are in pain and who experience it regularly do not necessarily know that their experience is different, and they learn to work within the experience of pain. </p>\n\n<p>To measure my experience of being in pain and experience too strong of sensations, I had to have people point out to me that what I experience is not what everyone else experience. I do NOT experience it the same way. In my case, this awareness was realized because I felt so much frustration in the amount of effort it took in order to accomplish similar work compared to what I used to be able to do or as compared to my colleagues. This measure is also relative because it is only against a small subset. </p>\n\n<p>Another measure that I use for my own pain is the amount of discomfort that I see my colleagues or even my own doctors in when they watch me in pain. I personally find this fascinating because most of the time, I am really just trying to get something done while pushing through. I can be just as distracting or more for them as it is for me. </p>\n\n<p>These are my two different ways to attempt to objectify a very subjective experience. A good post-script attempt to this objectification would be to somehow quantify via black-white contrast the patient's pain experience through them drawing it. When I look at Pain Art, it tends to be very raw with high contrast, and the ultimate measure for a 10 on a 0-10 scale would be no drawing at all because the patient couldn't do it. That is my afterthought.</p>\n", "score": 0 } ]

[ "pain", "diagnostics", "practice-of-medicine" ]

[ { "answer_id": 31080, "body": "<p>At the moment of death, contrary to what may common assumption, rigor mortis does not set in; at the moment of death „flattency“ sets in, which is relaxation of muscles, not fixation or arrested motion of muscles.</p>\n<p>See <a href=\"https://en.wikipedia.org/wiki/Rigor_mortis\" rel=\"nofollow noreferrer\">Wikipedia, Rigor Mortis, Physical changes</a>.</p>\n<p><em>&quot;At the time of death, a condition called &quot;primary flaccidity&quot; occurs. Following this, the muscles stiffen in rigor mortis. (...) Starting between two and six hours following death, rigor mortis begins with the eyelids, neck, and jaw. (...)&quot;</em></p>\n<p>Counterintuitely, and this might be the key to the question, a smile on the face is not produced by relaxing one's muscles. To produce that gesture affords the contracting of several muscles.</p>\n<p>There are many search results on &quot;smile muscle contraction&quot; with <a href=\"https://www.bing.com/search?q=smile%20muscle%20contraction&amp;PC=U316&amp;FORM=CHROMN\" rel=\"nofollow noreferrer\">Bing</a> and <a href=\"https://www.google.com/search?hl=de&amp;as_q=smile%20muscle%20contraction&amp;as_epq=&amp;as_oq=&amp;as_eq=&amp;as_nlo=&amp;as_nhi=&amp;lr=&amp;cr=&amp;as_qdr=all&amp;as_sitesearch=&amp;as_occt=any&amp;safe=images&amp;as_filetype=&amp;tbs=\" rel=\"nofollow noreferrer\">Google</a></p>\n<p>Google's first page incidentally tells about Duchenne smile, too (nowadays presumably termed &quot;resting b.... smile&quot;):</p>\n<p><em>&quot;All smiling involves contraction of the zygomatic major muscles, which lifts the corners of the mouth. But a Duchenne smile is characterised by the additional contraction of the orbicularis oculi, (...).&quot;</em></p>\n<p>Whereas, of course, it is literally possible to die with a smile on one's face - this may be a matter of character and circumstances and the ability to apply minimal muscle effort to produce the expression - it should be infered from the above</p>\n<p>that from the moment of death to entertain active muscle contractions is no longer feasible.</p>\n<p>Hence: <strong>No, it is not possible</strong> to have a smile on the face after death.</p>\n<p>Addendum: Wikipedia, cited above, explains the mechanism of rigor mortis - depletion of ATP, influx of calcium which may be artificially initiated applying cold. I found no sources assuming onset of rigor mortis (&quot;shortening&quot; muscles) <em>produces</em> some smile; and this issue seems not to be addressed by the question.</p>\n<p>However, as one comment above suggest, there does exist &quot;Cadaveric spasm&quot; that sets in at the moment of death, thus - in theory - conserving and literally freezing any muscle action at the very time of death, cp.</p>\n<p><a href=\"https://en.wikipedia.org/wiki/Cadaveric_spasm\" rel=\"nofollow noreferrer\">Wikipedia on Cadaveric spasm</a>:</p>\n<p><em>&quot;... may affect all muscles in the body, but typically only groups, such as the forearms, or hands. Cadaveric spasm is seen in cases of drowning victims when grass, weeds, roots or other materials are clutched (...)&quot;</em></p>\n<p>See also:</p>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/books/NBK554464/\" rel=\"nofollow noreferrer\">Almulhim / Menezem, Evaluation of Postmortem Changes</a>, 2021\n(easy accessible information on what happens after death in general):</p>\n<p><em>&quot;Rigor mortis needs to be distinguished from cadaveric spasm/instantaneous rigor, which is an immediate contraction of a small group of muscles at the instance of death, seen in scenarios of violent death like in the case of drowning.&quot;</em></p>\n<p>However disciplined such smile may be (I remember some movie's title: Drowning by numbers) instantaneous &quot;freeze&quot; seems a rare exception to the rule.</p>\n", "score": 3 } ]

[ "death", "rigor-mortis", "smile-smiling" ]

[ { "answer_id": 5149, "body": "<p>Yes, it's true, or at least it might be true for any given pill. In the US, the FDA specifically approves splitting of pills only when the manufacturer plans for it by including it in their drug approval application. By including it in their application the FDA will require the manufacturer to submit evidence that splitting the pills results in equal dosages and equal effectiveness. Without that evidence, you as a consumer have no way of being sure how it will behave. Maybe it will be okay and maybe it won't. </p>\n\n<p><a href=\"http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm171492.htm\" rel=\"nofollow\">Per the FDA</a>:</p>\n\n<blockquote>\n <p>FDA has approved drugs where tablet splitting is part of the\n manufacturer’s drug application. \"If the tablet is approved for\n splitting, the information will be provided in the drug’s professional\n prescribing information,\" says Mansoor Khan, Ph.D., director of the\n Division of Product Quality Research in FDA's Office of Pharmaceutical\n Science.</p>\n</blockquote>\n\n<p>It's pretty far fetched to think that manufacturers are going to increase profits by telling consumers their pills shouldn't be split. The percentage of patients that would even apply to would be small since doctors don't make a practice of prescribing stronger strengths than patients actually need. Also, pill dosages are sized to meet the majority of patients' needs so any increased profits they actually realized would be trivial and probably not worth the risk of the bad PR that would result from being discovered.</p>\n", "score": 5 } ]

[ "medications", "prescription" ]

[ { "answer_id": 14479, "body": "<p>Alas, you cannot protect yourself from these toxic substances once they are in your body. Further, as currently phrased this question is awfully broad. We have managed to produce a gigantic amount of different harmful substances and covering them all in this answer is really not possible. Instead this answer tries to generalise about fat-soluble and long term stable materials that get liberated in weight loss. Any substance mentioned in citations is meant as one example, most examples do not generate generally applicable advice.</p>\n<p>There are some options to consider to protect you from the harm these substances do. For obvious ethical reasons most of the following is based on experimental data <em>in vivo</em> and not nearly enough on human trials.</p>\n<p>The good news is, these substances are generally very stable, but not indestructible. They do accumulate in fatty tissues and are hardly excreted or broken down. But eventually some of them are broken down or just excreted.</p>\n<blockquote>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24275706\" rel=\"nofollow noreferrer\"><strong>The fate of inhaled (14)C-labeled PCB11 and its metabolites in vivo:</strong></a>\nThis study shows that PCB11 is completely absorbed after inhalation exposure and is rapidly eliminated from most tissues. Phase II metabolites dominated with a slower elimination rate than the PCB11 or phase I metabolites and thus can best serve as urine biomarkers of exposure.</p>\n</blockquote>\n<p>The dynamics of POP release and damage are still investigated and indeed worrisome:</p>\n<blockquote>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/29107350\" rel=\"nofollow noreferrer\"><strong>Dynamics of persistent organic pollutants in obese adolescents during weight loss:</strong></a></p>\n<p>In general, POP levels raised by 1–3.5% per kilogram weight loss. The increase in the POPs levels during weight loss did not affect the profile, which remained similar over time. Weight reduction is recommended for overweight and obese individuals in order to decrease the risk of weight-related health problems. However, the results of the present study indicate that the increase in the levels of POPs released in blood during weight loss might be of concern since literature suggested that they can be associated with endocrine disturbances. The clinical significance of the weight loss induced serum pollutants levels observed in the present study is, however, as yet unknown. Beneficial health effects of weight loss are generally expected, however, the increase in the internal exposure may adversely act on health since metabolism and/or elimination of POPs may be altered in adolescents as compared to adults. Further studies are therefore needed to address this issue.</p>\n</blockquote>\n<p>To minimise the damage they will do there are a few routes open, all of them weak and some of them based on preliminary results and reasonable speculation:</p>\n<h2>Slow down their release</h2>\n<p>Although it was already priced into the original question, the slower the weight loss the slower the release of persisten organic pollutants (POPs). The dosage makes the poison and therfore slowing the release of these unwanted materials is all the better.</p>\n<h2>Increase excretion and elimination</h2>\n<p>As should be obvious highly lipophilic substances like those in question are not easily deposed of. But the body does eliminate them, very slowly, once they are mobilised from the fatty tissues.</p>\n<p>That means drinking a lot helps, sweating a lot helps and loosing blood helps. Speeding up the metabolism, exercising or even going to a sauna seem quite beneficial.</p>\n<p>The loosing blood needs special mention since it would be unethical to go donating blood if anyone does it to get rid of toxic substances. Yet it seems strange to advise blood-letting again, even when this involves a round of the venerable <a href=\"https://en.wikipedia.org/wiki/Hirudo_medicinalis\" rel=\"nofollow noreferrer\">Hirudo medicinalis</a> treatment. But once the substances are mobilised they are transported via blood to areas you want to to avoid them ending up. Extracting this contaminated blood is not the strangest of ideas then.</p>\n<blockquote>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5360950/\" rel=\"nofollow noreferrer\"><strong>Human Excretion of Polybrominated Diphenyl Ether Flame Retardants: Blood, Urine, and Sweat Study:</strong></a>\nConclusion. Blood testing provides only a partial understanding of human PBDE bioaccumulation; testing of both blood and perspiration provides a better understanding. This study provides important baseline evidence for regular induced perspiration as a potential means for therapeutic PBDE elimination.</p>\n</blockquote>\n<p>Finally, the infamous <a href=\"https://en.wikipedia.org/wiki/Olestra\" rel=\"nofollow noreferrer\">Olestra</a> and its kind may have a role of value:</p>\n<blockquote>\n<p><a href=\"http://pubs.acs.org/doi/10.1021/acs.jafc.5b05817\" rel=\"nofollow noreferrer\"><strong>Non-dioxin-like Polychlorinated Biphenyls (PCBs) and Chlordecone Release from Adipose Tissue to Blood in Response to Body Fat Mobilization in Ewe (Ovis aries):</strong></a> <br> To be efficient in depurating animals, undernutrition should be combined with a strategy increasing the fecal lipid output and consequently the POP excretion pool, such as the <strong>supplementation of the diet with nonabsorbable lipids.</strong> This combined strategy was tested with success for hastening the removal of PCBs in chickens. Further studies are needed to assess its efficiency in larger animals such as ruminants, where only nonabsorbable lipid supplementation in well-fed growing lambs or lactating cows and goats was tested. With regard to CLD, which accumulates in the liver rather than in AT, undernutrition seems not to represent a valuable strategy because of its probable deleterious effect on liver size and metabolic activity.</p>\n</blockquote>\n<h2>Limit the damage the substances can do</h2>\n<p>There were a few theories proposed for certain mechanisms of action for these substances, one of them being endocrinal disrupters another being promoter of oxidative stress.</p>\n<p>Especially the latter has received some attention and the old adage of food being your medicine came to life again.</p>\n<p>While &quot;eat healthy&quot; seems like a no-brainer on this front it is currently the best practical advice available. These findings are very limited by their nature. Popular &quot;anti-oxidants&quot; have usually a very low bioavailability and even in those experimental settings used to study them in regard to POPs with scaffolding mechanisms their effectiveness was greater than zero, but still not very great.</p>\n<p>Curcumin, resveratrol, CoQ10, NAC and just about all of the usual suspects for such a scenario showed some promise.</p>\n<blockquote>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/28975503\" rel=\"nofollow noreferrer\"><strong>The environmental pollutant, polychlorinated biphenyls,\nand cardiovascular disease: a potential target for antioxidant nanotherapeutics:</strong></a>\nA final consideration to be made in the use of antioxidant therapies is that of the route of administration. Given their size and use, most studies have focused upon i.v. injection of nanocarrier systems. Yet, such intervention strategies are likely to be limited to acute and subacute exposures, as prolonged i.v. administration is highly undesirable. As such, exploration of alternative delivery methods, includ- ing inhalation, intratracheal, intraperitoneal, and topical administration, is needed. All of these methods have been tried for the delivery of antioxidant in free form. Clinical trials employing oral delivery of antioxidants such as curcumin in free form have been conducted several times, with variable dosage towards suppression of oxidative stress-induced inflammation. […]<br>\nChronic exposure of environmental pollutants remains a significant health concern. Even now, PCBs pose a contin- uous threat to the health and safety of our population. As a result, we need a wide array of tools and strategies to counteract these potential risks. While effective and healthful nutrition is likely to be a major player in our strategies to minimize health hazards, as seen by clinical trials of antioxidant interventions, it is unlikely that nutrition alone is enough to treat or prevent all PCB exposure-induced disorders. As such, strategies that can reduce body burden, enhance antioxidant delivery to target cells, and capture PCBs before entering the body can potentially be used to provide defense against PCB toxicity. Furthermore, we know from other treatments, such as NAC for acetamino- phen toxicity, where antioxidant therapy can be an effective antidote. In order to enhance antioxidant therapy, strategies for effectively delivering antioxidants, such as nanocarriers, are likely required. Further studies for ideal candidates will be needed to best assess which compounds will be most effective at countering the toxicity of co-planar and non-coplanar PCBs. Finally, while studies with injectable nanocarriers provide some promising results, such routes of administration are not likely acceptable for chronic delivery systems.</p>\n</blockquote>\n<p>The best treatment is of course preventing any new harmful material from entering your system. For that it might be worth considering decrease animal fat consumption:</p>\n<blockquote>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/23401324\" rel=\"nofollow noreferrer\">Plant consumption by grizzly bears reduces biomagnification of salmon-derived polychlorinated biphenyls, polybrominated diphenyl ethers, and organochlorine pesticides.</a></p>\n</blockquote>\n", "score": 5 } ]

[ "toxicity", "weight-loss" ]

[ { "answer_id": 5609, "body": "<p>Yes. The acid in the food can harm the enamel and brushing it to soon can remove it. So wait at least 30 minutes, brush before or avoid acidy foods.</p>\n<p>Brushing abrasion of softened and remineralised dentin: an in situ study\nT Attin et al. Caries Res. Jan-Feb 2004<a href=\"https://pubmed.ncbi.nlm.nih.gov/14684979/\" rel=\"nofollow noreferrer\"> [Source]</a>:</p>\n<blockquote>\n<p>It is concluded that for protection of dentin surfaces at least 30 min should elapse before toothbrushing after an erosive attack.</p>\n</blockquote>\n<p><a href=\"http://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/brushing-your-teeth/faq-20058193\" rel=\"nofollow noreferrer\">Mayo Clinic:</a></p>\n<blockquote>\n<p>If you've eaten an acidic food or drink, avoid brushing your teeth for\nat least 30 minutes. These acids weaken tooth enamel, and brushing too\nsoon can remove enamel. If you know you're going to eat or drink\nsomething acidic, brush your teeth beforehand.</p>\n</blockquote>\n<p><a href=\"http://www.colgate.com/en/us/oc/oral-health/basics/brushing-and-flossing/article/is-brushing-teeth-after-eating-good-for-you-0313\" rel=\"nofollow noreferrer\">Colgate.com</a>:</p>\n<ul>\n<li><p>Acidy foods: oranges, lemons, and grapefruit</p>\n</li>\n<li><p>Drinking water after you eat the acidy foods helps easy it away</p>\n</li>\n</ul>\n<p>Also, brushing before eating can remove a lot of bacterial buildup, before you start eating again.</p>\n", "score": 11 } ]

[ "dentistry", "hygiene", "oral-health" ]

[ { "answer_id": 9211, "body": "<p>Stems and affixes tell you the class of drug (and sometimes other properties). Drugs in the same class work in a very similar way, so therefore you can tell what other drugs it's related to.</p>\n\n<p>This is a massive list: <a href=\"https://druginfo.nlm.nih.gov/drugportal/jsp/drugportal/DrugNameGenericStems.jsp\" rel=\"noreferrer\">https://druginfo.nlm.nih.gov/drugportal/jsp/drugportal/DrugNameGenericStems.jsp</a></p>\n\n<p>Usually it's the suffix that tells you the most. For example:</p>\n\n<ul>\n<li>lisino<strong>pril</strong>, benaze<strong>pril</strong>, enala<strong>pril</strong>, rami<strong>pril</strong> are ACE-Inhibitors (commonly used for blood pressure)</li>\n<li>peni<strong>cillin</strong>, methi<strong>cillin</strong>, amoxi<strong>cillin</strong>, ticar<strong>cillin</strong> are beta-lactam antibiotics.</li>\n<li>fluo<strong>xetine</strong>, paro<strong>xetine</strong>, dulo<strong>xetine</strong>, venlafa<strong>xine</strong>, sertral<strong>ine</strong> are SSRI antidepressants (selective serotonin uptake inhibitors).</li>\n</ul>\n\n<p>In fact, sometimes we refer to classes by their stem.</p>\n\n<ul>\n<li>Her LDL cholesterol is high, she should be on a \"statin.\" (Class of HMG Co-A Reductase Inhibitors like simva<strong>statin</strong>, atorva<strong>statin</strong>)</li>\n</ul>\n\n<p>From your list:</p>\n\n<ul>\n<li>-tinib = Tyrosine kinase inhibitors</li>\n<li>-fenib = B-Raf enzyme inhibitors</li>\n<li>-mab = monoclonal antibody\n\n<ul>\n<li><a href=\"https://en.wikipedia.org/wiki/Humanized_antibody\" rel=\"noreferrer\">\"-ZUmab\" means humanized, and \"-XImab\" means chimeric</a></li>\n</ul></li>\n</ul>\n\n<p>These and related drugs are in the realm of chemotherapy and anti-inflammatory medications.</p>\n\n<p>Also, -mabs are really neat. They are antibodies (just like your body makes to recognize infections and start an immune attack), which are designed to lock onto one extremely specific thing, then cause an effect right at that spot. For example, it's been the frontier in cancer chemotherapy, as you can sometimes target to kill just the bad cells in certain cancers. Also in autoimmune diseases, they are used instead of steroids that cause effects all over the body. They're hard to produce and expensive, and not without side effects, but have lots of potential!</p>\n", "score": 20 } ]

[ "medications" ]

[ { "answer_id": 11676, "body": "<h2>Short Answer</h2>\n\n<p>Masturbating does not decrease fertility or sex drive</p>\n\n<h2>Long Answer</h2>\n\n<p>Historically, masturbation was discouraged for a variety of reasons including the thought that it lead to mental health problems. However, that was disproved. The abstract of <a href=\"http://dx.doi.org/10.1300/J056v14n02_02\" rel=\"noreferrer\">Coleman, E. (2003)</a> states</p>\n\n<blockquote>\n <p>Research on masturbation has indicated that, contrary to traditional beliefs, masturbation has been found to be a common sexual behavior and linked to indicators of sexual health. While there are no general indicators of ill health associated with masturbation, it can be powerfully negative or positive for many individuals. As an example, it is widely used in sex therapy as a means of improving the sexual health of the individual and/or relationship. Promoting masturbation as a means of a public health strategy for sexual health is highly controversial; however, there are arguments and evidence that suggest that this may be an important part of any public health approach to improving sexual health.</p>\n</blockquote>\n\n<p>Masturbation was a diagnosable psychological condition until DSM II in 1968. (Ley, 2014) The American Medical Association consensually declared masturbation as normal in 1972.</p>\n\n<p>Due to the false ideas on masturbation and mental health, there are not a lot of documented studies but I am going to concentrate on fairly recent studies to eliminate the falsehoods.</p>\n\n<p>Another point of note mentioned in <a href=\"http://dx.doi.org/10.1016/j.fertnstert.2007.05.044\" rel=\"noreferrer\">Elzanaty, S. (2008)</a> is that</p>\n\n<blockquote>\n <p>Compared with clinic-collected semen, home-collected samples had statistically significantly higher values for sperm concentration, total sperm count, rapid progressive motility, and total count of progressive motility. Semen volume, proportion of normal sperm morphology, neutral α-glucosidase, prostate-specific antigen, zinc, and fructose did not differ significantly between groups. [Therefore] results demonstrate superior semen quality in samples collected by masturbation at home compared with at a clinic. This should be taken into consideration in infertility investigations.</p>\n</blockquote>\n\n<h2>Male Masturbation</h2>\n\n<p>Since sperm are short-lived, they must constantly be replenished, so <a href=\"http://news.nationalgeographic.com/news/2010/03/100318-men-sperm-1500-stem-cells-second-male-birth-control/\" rel=\"noreferrer\">the testes produce 1,500 sperm per second</a>. Plus sperm is produced during the whole of the male life. If the dead sperm is not released through sex or masturbation, it will automatically be released by the body.</p>\n\n<p>Some males find that they are more prone to <a href=\"http://www.soc.ucsb.edu/sexinfo/article/nocturnal-orgasms-and-emissions\" rel=\"noreferrer\">nocturnal emissions</a> during times of less frequent sexual activity because they are not ejaculating as frequently from masturbation or sex with a partner, and in fact — as @Gabri pointed out, and studies have confirmed — high ejaculation frequency was related to decreased risk of total prostate cancer <a href=\"http://dx.doi.org/10.1001/jama.291.13.1578\" rel=\"noreferrer\">(Leitzmann, et al., 2004)</a>.</p>\n\n<h2>Female Masturbation</h2>\n\n<p>There is even less around for female masturbation, but one study suggests that female orgasm induces ovulation <a href=\"http://dx.doi.org/10.1002/jez.b.22690\" rel=\"noreferrer\">(Pavličev, and Wagner, 2016)</a> so that would suggest that the chances of conception would be higher. The difference between men and women is that <a href=\"http://my.clevelandclinic.org/health/articles/the-female-reproductive-system\" rel=\"noreferrer\">there is only a finite amount of eggs</a>. The human female has all their eggs at birth and no more is being produced. Once they are all released, that's it.</p>\n\n<hr>\n\n<h2>References</h2>\n\n<p>Coleman, E. (2003). <em>Masturbation as a Means of Achieving Sexual Health</em> Journal of Psychology &amp; Human Sexuality 14(2-3): pp 5-16; DOI: <a href=\"http://dx.doi.org/10.1300/J056v14n02_02\" rel=\"noreferrer\">10.1300/J056v14n02_02</a> </p>\n\n<p>Elzanaty, S. (2008). <em>Comparison of semen parameters in samples collected by masturbation at a clinic and at home</em> Fertility and Sterility (Journal of American Society for Reproductive Medicine) 89(6): pp 1718–1722; DOI: <a href=\"http://dx.doi.org/10.1016/j.fertnstert.2007.05.044\" rel=\"noreferrer\">10.1016/j.fertnstert.2007.05.044</a></p>\n\n<p>Leitzmann, M.F.; Platz, E.A.; Stampfer, M.J.; Willett, W.C. and Giovannucci, E. (2004). <em>Ejaculation Frequency and Subsequent Risk of Prostate Cancer</em> JAMA 291(13): pp 1578-1586; DOI: <a href=\"http://dx.doi.org/10.1001/jama.291.13.1578\" rel=\"noreferrer\">10.1001/jama.291.13.1578</a></p>\n\n<p>Ley, D.J. (2014). The Myth of Sex Addiction. Rowman &amp; Littlefield. p. 12. ISBN 978-1-4422-1305-0.</p>\n\n<p>Pavličev, M., and Wagner, G. (2016). <em>The Evolutionary Origin of Female Orgasm</em> Journal of Experimental Zoology 326(6): pp 326–337; DOI: <a href=\"http://dx.doi.org/10.1002/jez.b.22690\" rel=\"noreferrer\">10.1002/jez.b.22690</a></p>\n", "score": 14 }, { "answer_id": 11659, "body": "<p>There are <strong>no</strong> relevant researches that links the two things.\nMoreover, some specialists say that masturbation can prevent, or at least decrease, the risk of develop a prostate cancer. Keep in mind that these are new studies, so data are too few to create a rule.\nWith the informations that researchers obtain, they can say that the risk is reduced (1).\nBut as I stated before, there are not enough data to confirm this (2).</p>\n\n<p>In addition to this, the spermatogenic cycle is different from the female one: female have a fixed number of egg follicles, while men production of sperm is cycle (Spermatogenesys take 64 days, and it's continuous). So, if sperm cells are not used for fertilize egg cells, they will die and after short time the cycle of production start again (please, keep in mind that the process is way more difficult and specific; this is a overview to explain what the user asked).</p>\n\n<p>So, no. Masturbation doesn't decrease your fertility and if studies are confirmed, it may prevent from prostate cancer.</p>\n\n<hr>\n\n<p>Ref.</p>\n\n<p>-(1) www.medscape.com/viewarticle/844820</p>\n\n<p>-(2) www.ncbi.nlm.nih.gov/pubmed/27871956</p>\n", "score": 4 } ]

[ "reproduction", "masturbation", "sociosexual-behavior", "infertile", "conceive-conception" ]

[ { "answer_id": 16571, "body": "<p>Ibuprofen and Aspirin <a href=\"https://www.whocc.no/atc_ddd_index/?code=M01AE&amp;showdescription=no\" rel=\"noreferrer\">are both non-steroidal anti-inflammatory drugs (NSAIDs)</a>. These NSAIDs can be differentiated into selective NSAIDs and non-selective NSAIDs. </p>\n\n<p>Non-selective NSAIDs such as Ibuprofen and Aspirin are both COX-1 [<em>Cyclooxygenase-1, also known as prostaglandin-endoperoxide synthase 1 (PTGS-1)</em>] and COX-2 inhibitors [<em>Cyclooxygenase-2 respectively</em>]. (For the sake of completion: Selective NSAIDs only inhibit COX-2).</p>\n\n<p>Both PTGS inhibitors prevent prostaglandin synthesis, which is a hormone amongst many other functions responsible for transmitting pain to the brain. </p>\n\n<p>However, because <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/18549814\" rel=\"noreferrer\">a study from 2008</a> notes that COX-1 promotes the production of the natural mucus lining that protects the inner stomach and contributes to reduced acid secretion and reduced pepsin content, (and hence an inhibitor such as all non-selective NSAIDs will decrease said mucus), <a href=\"https://www.nps.org.au/australian-prescriber/articles/the-vascular-effects-of-cox-2-selective-inhibitors\" rel=\"noreferrer\">PTGS-1 inhibitors increase the <em>risk of serious gastrointestinal bleeding and ulceration</em></a> (and other stomach-upsetting symptoms).</p>\n\n<p>Hence it is recommended to consume such non-selective NSAIDs with food, <a href=\"https://www.nhs.uk/chq/Pages/866.aspx?CategoryID=73&amp;SubCategoryID=103\" rel=\"noreferrer\">because this will allegedly lessen the symptoms</a>. </p>\n\n<p>It used to be \"mandatory\" to eat food before taking such medicine, but in 2015, <a href=\"https://pharmadispatch.com/news/chnages-for-ibuprofen\" rel=\"noreferrer\">the Australian Medicines Handbook has stepped back from this standpoint and now only encourages taking it with water and eating only if it does in fact upset one's stomach.</a> A <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/18335848\" rel=\"noreferrer\">study published in 2007</a> has already found that the negative side-effects are dosage and time-dependent. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/23163547\" rel=\"noreferrer\">Furthermore, a more recent study from 2015 found that the effect of food might not be as positive as expected.</a></p>\n\n<p>So, this seems to be a pretty mixed bag. I find the solution of the Australian Medicines Handbook reasonable however: Don't take them with food unless you have gastrointestinal problems. If those problems should be severe, as always consult a physician.</p>\n\n<hr>\n\n<p>Other common painkillers such as <a href=\"https://www.whocc.no/atc_ddd_index/?code=N02BE01\" rel=\"noreferrer\">paracetamol</a> that are not NSAIDs and thus not PTGS-1 inhibitors <a href=\"http://www.familydoctor.co.nz/categories/medication/paracetamol-a-patients-guide/\" rel=\"noreferrer\">can be taken without food</a>, as they are not stomach-upsetting. </p>\n", "score": 13 }, { "answer_id": 16567, "body": "<p>It is the information leaflet, which usually comes with all drugs, that should tell you to take them with or without food.</p>\n\n<hr>\n\n<p>For <em>one/few time use,</em> it can be better to take them <strong>on an empty stomach or with water</strong> because they will pass through it quicker and will be absorbed quicker, so they will likely act quicker and stronger (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4574824/\" rel=\"nofollow noreferrer\">PubMed Central</a>).</p>\n\n<p>Examples: </p>\n\n<ul>\n<li><a href=\"https://beta.nhs.uk/medicines/paracetamol-for-adults/\" rel=\"nofollow noreferrer\">Paracetamol</a></li>\n<li><a href=\"http://theconversation.com/do-you-need-to-take-some-painkillers-with-food-to-protect-your-stomach-47156\" rel=\"nofollow noreferrer\">Aspirin, ibuprofen, diclofenac and other nonsteroidal anti-inflammatory drugs (NSAIDs) when taken for up to 3 days</a></li>\n</ul>\n\n<hr>\n\n<p>For <em>the long-term use,</em> it is better to take them <strong>with food</strong> to reduce the risk of stomach inflammation.</p>\n\n<p>Examples:</p>\n\n<ul>\n<li><a href=\"http://theconversation.com/do-you-need-to-take-some-painkillers-with-food-to-protect-your-stomach-47156\" rel=\"nofollow noreferrer\">NSAIDs, when taken for >3 days</a></li>\n</ul>\n", "score": 5 }, { "answer_id": 16573, "body": "<p>It is indeed important to differentiate the drug in question and the individual and the intention for using the drug and the way it is taken, temporally.</p>\n\n<p>Painkillers – or <a href=\"https://en.wikipedia.org/wiki/Analgesic\" rel=\"nofollow noreferrer\">analgesics</a> – come in a wide variety, be that in the form of <a href=\"https://en.wikipedia.org/wiki/Opioid\" rel=\"nofollow noreferrer\">opioids</a>, <a href=\"https://en.wikipedia.org/wiki/Cannabinoid\" rel=\"nofollow noreferrer\">cannabinoids</a>, <a href=\"https://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drug\" rel=\"nofollow noreferrer\">NSAIDs</a>, <a href=\"https://en.wikipedia.org/wiki/Channel_modulator\" rel=\"nofollow noreferrer\">ion-channel_modulators</a>, <a href=\"https://en.wikipedia.org/wiki/Myorelaxant\" rel=\"nofollow noreferrer\">myorelaxants</a> or uncategorised drugs like <a href=\"https://en.wikipedia.org/wiki/Ketamine\" rel=\"nofollow noreferrer\">ketamine</a>. Not all are usually administered orally or even effective that way, by far not all are even available prescription free. As should become clear by now, \"a general guideline\" is almost impossible to formulate.</p>\n\n<p>You have to inquire about one specific drug in question. And even then it will be complicated and our picture about every single one of all those drugs is still evolving and however detailed it may seem, incomplete. Follow the advice given on the leaflet, by your pharmacist and doctor.</p>\n\n<p>Taking the example of cannabinoids, it is common knowledge that a full stomach will delay the effects of the active ingredients, but the simultaneous ingestion of a little bit of fat will increase the absorption of them. The more interesting molecules are all lipophilic and quite waste to digest in isolation.</p>\n\n<p>It will be also a quite different story if we are talking about a one-time paracetamol administration or a long term course of aspirin, to name just one example pair.</p>\n\n<p>The possible side-effects and interactions are different for each drug in question and each individual will fall on a different place of the scale of possible consequences. That does still not take into account the different foods that might interact with the drugs and the stomachs content.</p>\n\n<p>Some important problems to keep an eye on when reading the accompanying leaflet are for example time the drug is in the stomach (gastric emptying) or the pH with the drug and with or with food (buffering).</p>\n\n<p><a href=\"https://www.physiology.org/doi/pdf/10.1152/physrev.00004.2008\" rel=\"nofollow noreferrer\">Prostaglandins, NSAIDs, and Gastric Mucosal Protection: Why Doesn’t the Stomach Digest Itself?</a> (Physiol Rev 88: 1547–1565, 2008; doi:10.1152/physrev.00004.2008.)</p>\n\n<p>Since both other answers are basically correct on their own, I will only add some details that wouldn't fit into comments.</p>\n\n<p>Concernig absorption rates: \n<a href=\"https://link.springer.com/article/10.1007%2FBF02235637\" rel=\"nofollow noreferrer\">Absorption of acetylsalicylic acid from unbuffered and buffered gastric contents</a> and <a href=\"https://doi.org/10.1002/jps.2600530203\" rel=\"nofollow noreferrer\">Gastrointestinal Factors in Aspirin Absorption: A Quantitative Study</a> but that is in contrast to <a href=\"https://doi.org/10.1016/0041-008X(60)90053-3\" rel=\"nofollow noreferrer\">Absorption of aspirin from the stomach in man</a>, <a href=\"https://doi.org/10.1002/jps.2600720727\" rel=\"nofollow noreferrer\">Influence of food on aspirin absorption from tablets and buffered solutions</a>, <a href=\"https://doi.org/10.1002/jps.2600730917\" rel=\"nofollow noreferrer\">Kinetics of aspirin absorption following oral administration of six aqueous solutions with different buffer capacities</a>.</p>\n\n<p>The most common side-effect of taking drugs orally is probably an upset stomach, but one of the more important effects might be actual bleeding, even with low dose aspirin: <a href=\"http://www.nature.com/articles/ajg2000570\" rel=\"nofollow noreferrer\">Risk of upper gastrointestinal bleeding associated with use of low-dose aspirin</a></p>\n\n<p>While the already mentioned COX inhibition is a problem in itself, many natural substances occurring naturally in food are also known to exhibit this action, very probably increasing the risk if even ever so slightly. Substances that might act in this way: </p>\n\n<blockquote>\n <p>Therefore, caution should be exercised if combining aspirin with any \"natural\" supplements with COX-2-inhibiting properties, such as garlic extracts, curcumin, bilberry, pine bark, ginkgo, fish oil, resveratrol, genistein, quercetin, resorcinol, and others.<br>\n _{<a href=\"https://en.wikipedia.org/wiki/Aspirin#Adverse_effects\" rel=\"nofollow noreferrer\">Wikipedia: Aspirin</a>}</p>\n</blockquote>\n\n<p>As a personal anecdote I might also add saffron to the list of side-effects enhancers.</p>\n\n<p>But look how aspirin and paracetamol differ in their pharmocokinetics.</p>\n\n<blockquote>\n <p>These factors would modulate the kinetics in the inflammatory focus, thereby prolonging the therapeutic action of the drug beyond that expected based on analysis of plasma pharmacokinetics. However, ion trapping also results in acidic compounds achieving high concentrations in the stomach wall and kidney, in which blockade of prostanoid synthesis causes the typical organ toxicity elicited by these compounds. Due to their lack of acidic structure, other COX inhibitors, such as dipyrone and paracetamol, are distributed homogenously throughout the body at therapeutic doses and induce analgesia, but induce no or very slight anti-inflammatory effects. This is partly due to their low concentration in inflamed tissues. (p14) </p>\n \n <p>All NSAIDs approved by the US Food and Drug Administration carry the same boxed warning for cardiovascular and gastrointestinal risk. These state “NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk” and “NSAIDs cause an increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events,” respectively. (p37/8)<br>\n _{<a href=\"https://www.springer.com/de/book/9783319338873\" rel=\"nofollow noreferrer\">Angel Lanas (Ed): \"NSAIDs and Aspirin. Recent Advances and Implications for Clinical Management\", Springer, 2016</a>. DOI 10.1007/978-3-319-33889-7\n}</p>\n</blockquote>\n", "score": 4 } ]

[ "pain", "practice-of-medicine" ]

[ { "answer_id": 20930, "body": "<p>Since it seems unlikely that these data are available already from the novel virus, I'll refer to other coronavirus strains associated with outbreaks, the <a href=\"https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome-related_coronavirus\" rel=\"noreferrer\">SARS-CoV</a> coronavirus associated with an outbreak in 2003 and <a href=\"https://en.wikipedia.org/wiki/Middle_East_respiratory_syndrome\" rel=\"noreferrer\">MERS-CoV</a>.</p>\n\n<p>In reference to the stability of the virus outside the body for SARS-CoV, the <a href=\"https://apps.who.int/iris/bitstream/handle/10665/70863/WHO_CDS_CSR_GAR_2003.11_eng.pdf\" rel=\"noreferrer\">WHO consensus document said</a>:</p>\n\n<blockquote>\n <p>Data from the Chinese University in Hong Kong indicated that SARS-CoV has\n been isolated from stool on paper, a Formica surface and a plastered wall after 36 hours, on a plastic surface and stainless steel after 72 hours, and after 96 hours on a glass slide.\n Hospital environmental samples from a number of sites, including walls and the ventilation\n system, tested PCR positive in Canada.</p>\n</blockquote>\n\n<p>A later follow-up confirmed that SARS-CoV is viable possibly for days in the right conditions:</p>\n\n<blockquote>\n <p>In the present study, we have demonstrated that SARS CoV can survive at least two weeks after drying at temperature and humidity conditions found in an air-conditioned environment. The virus is stable for 3 weeks at room temperature in a liquid environment¹</p>\n</blockquote>\n\n<p>¹Chan, K. H., Peiris, J. S., Lam, S. Y., Poon, L. L. M., Yuen, K. Y., &amp; Seto, W. H. (2011). The effects of temperature and relative humidity on the viability of the SARS coronavirus. Advances in virology, 2011.</p>\n\n<p>This suggests that SARS-CoV was better at surviving in the environment than other related strains, especially in cool temperatures. However, there was still a substantial decrease in viral titre by 1 week.</p>\n\n<p>For MERS-CoV,</p>\n\n<blockquote>\n <p>MERS-CoV virus could still be recovered after 48 hours²</p>\n</blockquote>\n\n<p>...on plastic and steel surfaces, though not at 72 hours, at 20C. The virus degraded more quickly at higher temperatures.</p>\n\n<p>²Van Doremalen, N., Bushmaker, T., &amp; Munster, V. J. (2013). Stability of Middle East respiratory syndrome coronavirus (MERS-CoV) under different environmental conditions. Eurosurveillance, 18(38), 20590.</p>\n\n<hr>\n\n<p>Assuming the new 2019-nCoV virus is similar to these, there is a risk of environmental transmission particularly in high-exposure locations like hospitals. It seems far less likely to be a risk after multiple weeks, but there is still little known about the new strain.</p>\n\n<p>I was unable to find more than speculation about rates of actual infection due to exposure in these conditions, but that speculation is mostly focused on the health care setting and in particular on transmission in health care settings despite extensive precautions.</p>\n\n<p>It's very difficult to connect culture viability to actual transmission risks, and not really ethical to swipe different concentrations of a coronavirus on the surfaces of a room and let people wander through to see how many get sick. Therefore, the best evidence for surface transmission of these viruses is when other methods of exposure can be mostly ruled out, and this is a very imperfect estimate.</p>\n", "score": 9 } ]

[ "virus" ]

[ { "answer_id": 24427, "body": "<p>Disease are officially named by the WHO, while viruses are by the International Committee on Taxonomy of Viruses (ICTV).</p>\n<p>The WHO has stated</p>\n<blockquote>\n<p>From a risk communications perspective, using the name SARS can have unintended consequences in terms of creating unnecessary fear for some populations, especially in Asia which was worst affected by the SARS outbreak in 2003.</p>\n<p>For that reason and others, WHO has begun referring to the virus as “the virus responsible for COVID-19” or “the COVID-19 virus” when communicating with the public. Neither of these designations are intended as replacements for the official name of the virus as agreed by the ICTV.</p>\n<p>^{<a href=\"https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it\" rel=\"noreferrer\">WHO</a>}</p>\n</blockquote>\n<p>Both the disease and the virus have been officially named February 11th 2020, <a href=\"https://www.who.int/news-room/detail/27-04-2020-who-timeline---covid-19\" rel=\"noreferrer\">while it has been declared a pandemic by the WHO only March 11th 2020</a>. In hindsight, it is debatable whether „<em>using the name SARS[-2] can have unintended consequences in terms of creating unnecessary fear for some populations</em>“ is true and whether this fear would have been „unnecessary“. But this is the reason we ended up with a different nomenclature of the disease and the virus.</p>\n<p>It might also be worth pointing out that many viruses are not named similar to their respective diseases:\nHIV &lt;-&gt; AIDS;\nHPV &lt;-&gt; Cervical Cancer / Genital warts</p>\n", "score": 14 } ]

[ "covid-19", "sars-cov-2" ]

[ { "answer_id": 31221, "body": "<p>In general, a <a href=\"https://en.wikipedia.org/wiki/Pandemic\" rel=\"nofollow noreferrer\">pandemic is a disease</a> that is spread across a large area. It is not based on case rates or anything similar, but rather on its global spread and potential threat to people. For example, you can visit this <a href=\"http://www.emro.who.int/pandemic-epidemic-diseases/outbreaks/index.html\" rel=\"nofollow noreferrer\">WHO EMRO site</a> and see a group of diseases that are currently in pandemic or considered pandemic potential. Note that in some of these diseases only a small handful of people are infected each year, and even fewer die. For a close comparison to COVID-19, caused by SARS-CoV-2, you can look at MERS (Middle East Respiratory Syndrome), which is caused by another coronavirus, <a href=\"https://en.wikipedia.org/wiki/Middle_East_respiratory_syndrome%E2%80%93related_coronavirus\" rel=\"nofollow noreferrer\">MERS-CoV</a>. For this disease, since the disease emerged, there have been <a href=\"https://applications.emro.who.int/docs/WHOEMCSR518E-eng.pdf\" rel=\"nofollow noreferrer\">2589 cases, with 893 deaths</a>. To quote the linked pdf, note the last bullet point!:</p>\n<blockquote>\n<ul>\n<li>At the end of March 2022, a total of 2589 laboratory-confirmed cases of\nMiddle East respiratory syndrome (MERS), including 893 associated deaths\n(case–fatality ratio of 34.5%) were reported globally. The majority of\nthese cases were reported from Saudi Arabia (2184 cases, including 813\nrelated deaths) with a case–fatality ratio of 37.2%.</li>\n</ul>\n</blockquote>\n<blockquote>\n<ul>\n<li>During the month of March 2022, one new case was reported.</li>\n</ul>\n</blockquote>\n<p>So, from this, we can see that there was 1 case in the past month, but still considered pandemic or pandemic potential.</p>\n<p>In the case of a comparison to influenza, the WHO has the same approach to this as they do to SARS-CoV-2, <a href=\"https://www.who.int/news/item/25-02-2022-recommendations-announced-for-influenza-vaccine-composition-for-the-2022-2023-northern-hemisphere-influenza-season\" rel=\"nofollow noreferrer\">creating/recommending vaccines</a> (I've worked on these personally at a <a href=\"https://www.who.int/initiatives/global-influenza-surveillance-and-response-system/who-collaboration-center-erl\" rel=\"nofollow noreferrer\">WHO collaborating center</a>), recommending treatments etc. However, sometimes, the various influenza viruses are not considered pandemic because they don't spread widely enough - this is particularly the case for things like the highly pathogenic <a href=\"https://en.wikipedia.org/wiki/Influenza_A_virus_subtype_H5N1\" rel=\"nofollow noreferrer\">H5N1</a> subtype, which can cause pandemics in birds, but <a href=\"https://www.pnas.org/doi/10.1073/pnas.0605134103\" rel=\"nofollow noreferrer\">so far haven't caused sustained transmission</a>¹ in humans, though <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2857285/\" rel=\"nofollow noreferrer\">local transmission does occur occasionally</a>². Occasionally a particular influenza spreads widely enough that it is considered a pandemic strain. A good example of this is the <a href=\"https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemic.html\" rel=\"nofollow noreferrer\">2009 H1N1 pandemic strain</a>.</p>\n<p>Now, you are directly comparing influenza and COVID-19 in terms of deaths, remember that large parts of the world don't report their infections of anything properly because of lack of resources to do complete testing, lack of facilities, healthcare, politics, etc. The figures the WHO is reporting for case rates and deaths from SARS-CoV-2 infection are the confirmed ones, announced by the various governments. These are not estimates like the numbers provided for cases and fatalities in the influenza links you provided. It is highly likely that the SARS-CoV-2 case and fatality rates are much higher than reported given the conditions I mentioned above.</p>\n<p>In addition remember that those countries reporting those numbers are those with the resources to do so, and those countries tend to be relatively wealthy, and as a consequence also have high vaccination rates, which we know <a href=\"https://www.bmj.com/content/376/bmj-2021-069761\" rel=\"nofollow noreferrer\">drop infection and fatality rates significantly for SARS-CoV-2 infections</a> ³ (this is just one of many scientific studies showing the same thing). Without the vaccinations, cases and fatalities would be much higher than influenza. In real terms, unvaccinated COVID-19 has a infection fatality rate that is <a href=\"https://www.bmj.com/content/370/bmj.m3410/rr-6\" rel=\"nofollow noreferrer\">an order of magnitude higher than influenza</a>.</p>\n<p>So, basically COVID-19 is still a pandemic because it is still causing widespread infection and a lot of deaths worldwide, which is the definition of a pandemic.</p>\n<p>1: Maines TR, Chen LM, Matsuoka Y, Chen H, Rowe T, Ortin J, Falcón A, Nguyen TH, Mai le Q, Sedyaningsih ER, Harun S, Tumpey TM, Donis RO, Cox NJ, Subbarao K, Katz JM. Lack of transmission of H5N1 avian-human reassortant influenza viruses in a ferret model. Proc Natl Acad Sci U S A. 2006 Aug 8;103(32):12121-6. doi: 10.1073/pnas.0605134103. Epub 2006 Jul 31. PMID: 16880383; PMCID: PMC1567706.</p>\n<p>2: Yang, Y., Halloran, M. E., Sugimoto, J. D., &amp; Longini, I. M., Jr (2007). Detecting human-to-human transmission of avian influenza A (H5N1). Emerging infectious diseases, 13(9), 1348–1353. <a href=\"https://doi.org/10.3201/eid1309.070111\" rel=\"nofollow noreferrer\">https://doi.org/10.3201/eid1309.070111</a></p>\n<p>3: Lauring A S, Tenforde M W, Chappell J D, Gaglani M, Ginde A A, McNeal T et al. Clinical severity of, and effectiveness of mRNA vaccines against, covid-19 from omicron, delta, and alpha SARS-CoV-2 variants in the United States: prospective observational study BMJ 2022; 376 :e069761 doi:10.1136/bmj-2021-069761</p>\n", "score": 30 }, { "answer_id": 31223, "body": "<p>Whether an outbreak of a disease is classed as a <em>pandemic</em> or not has absolutely nothing to do with the number of deaths or any other measure of the virulence or danger presented by the disease. It is only and exclusively based on whether the disease is very widely spread across the human population. Here's the WHO's <a href=\"https://www.publichealth.com.ng/world-health-organization-who-pandemic-definition/\" rel=\"nofollow noreferrer\">own definition</a> of the term:</p>\n<blockquote>\n<p>an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people.</p>\n</blockquote>\n<p>And in case you think that's somehow political, here's a <a href=\"https://www.merriam-webster.com/dictionary/pandemic\" rel=\"nofollow noreferrer\">dictionary definition</a>:</p>\n<blockquote>\n<p>: an outbreak of a disease that occurs over a wide geographic area (such as multiple countries or continents) and typically affects a significant proportion of the population : a pandemic outbreak of a disease</p>\n</blockquote>\n<p>As you can see, there is no mention of deaths or risks posed by the disease, or severity of symptoms or anything else other than geographic spread. This means that you could have a disease whose only symptom is a mild rash and which goes away after a single day and never ever kills anyone, but if it is widespread enough that would still be classed as a <em>pandemic</em>.</p>\n<p>So whether the disease is causing more or fewer deaths than another, or indeed whether it is causing any deaths at all, is completely irrelevant to whether it should be classed as a pandemic.</p>\n", "score": 20 }, { "answer_id": 31231, "body": "<p>The WHO talked about this question long before COVID. In the article <a href=\"https://apps.who.int/iris/handle/10665/270942\" rel=\"nofollow noreferrer\">The classical definition of a pandemic is not elusive</a> published in the <em>Bulletin of the World Health Organization</em> in 2011, the following is said about why only the 2009 influenza wave was declared a <em>pandemic</em>:</p>\n<blockquote>\n<p>A pandemic is defined as “an epidemic occurring worldwide, or over a\nvery wide area, crossing international boundaries and usually\naffecting a large number of people”. The classical definition includes nothing about population immunity,\nvirology or disease severity. By this definition, pandemics can be\nsaid to occur annually in each of the temperate southern and northern\nhemispheres, given that seasonal epidemics cross international\nboundaries and affect a large number of people. However, seasonal\nepidemics are not considered pandemics.</p>\n<p>A true influenza pandemic\noccurs when almost simultaneous transmission takes place worldwide. In\nthe case of pandemic influenza A(H1N1), widespread transmission was\ndocumented in both hemispheres between April and September 2009.\nTransmission occurred early in the influenza season in the temperate\nsouthern hemisphere but out of season in the northern hemisphere. This\nout-of-season transmission is what characterizes an influenza\npandemic, as distinct from a pandemic due to another type of virus.\nSimultaneous worldwide transmission of influenza is sufficient to\ndefine an influenza pandemic and is consistent with the classical\ndefinition of “an epidemic occurring worldwide”.</p>\n</blockquote>\n<p>And further:</p>\n<blockquote>\n<p>It is tempting to surmise that the complicated pandemic definitions\nused by the World Health Organization (WHO) and the Centers for\nDisease Control and Prevention of the United States of America\ninvolved severity1,10 in a deliberate attempt to garner political\nattention and financial support for pandemic preparedness. As noted by\nDoshi, the perceived need for this support can be understood given\nconcerns about influenza A(H5N1) and the severe acute respiratory\nsyndrome (SARS). However, conflating spread and severity allowed the\nsuggestion that 2009 A(H1N1) was not a pandemic. It was, in fact, a\nclassical pandemic, only much less severe than many had anticipated or\nwere prepared to acknowledge, even as the evidence accumulated.</p>\n</blockquote>\n<p>So... when would COVID cease being a &quot;pandemic&quot;? Given the WHO's pre-COVID definition this should happen when we get at least a full year of predictable seasonal spread. Given that Omicron's wave spiked all around the world near-simultaneously in January 2022, the earliest this can happen is January 2023, after which it will be declared a seasonal virus similar to the influenza.</p>\n<p>It should of course be noted that the WHO's definition of a pandemic somewhat contradicts the layman understanding of what it means. I.e. the common expression <a href=\"https://www.google.com/search?q=the%20pandemic%20isn%27t%20over\" rel=\"nofollow noreferrer\">the pandemic is not over yet!</a> references the idea that we must take <em>pandemic</em> diseases seriously, as opposed to <em>endemic</em> or <em>non-pandemic</em> diseases like influenza or the common cold. Whether or not treating COVID <em>seriously</em> is important is a matter of debate, however technically speaking that's not what the WHO means by continuing to say that we're still in a pandemic.</p>\n", "score": 3 } ]

[ "covid-19", "pandemic" ]

[ { "answer_id": 206, "body": "<p>Good question though a broad one! </p>\n\n<p>Well, it all depends on the 'pill' or 'medicine' you are on. Different medicines have different <a href=\"http://www.nottingham.ac.uk/nmp/sonet/rlos/bioproc/halflife/\">half-lives</a>. And 'half-life' is the factor that mostly decides the 'dosage/timings'. </p>\n\n<p>But, if you go by general guidelines, all doctors agree upon one thing:</p>\n\n<blockquote>\n <p>Take a missed pill the <em>moment</em> you remember it. But then, <strong>if</strong> it is almost the time for the next dose, <strong><em>skip it.</em></strong> That said, <strong>don't</strong> ever take two pills together (compensating the missed dose).</p>\n</blockquote>\n\n<p>The best practice is ask your healthcare provider about it. They can precisely tell you what should you do (though most of them would advise what I wrote). </p>\n", "score": 10 } ]

[ "medications", "dosage" ]

[ { "answer_id": 156, "body": "<p>It depends</p>\n\n<p>Extended contact of urine on skin will cause skin irritation and eventual breakdown. On the other hand, that water may contain flesh eating bacteria.</p>\n\n<p>This is a situation of a lesser of two evils. Each wound is different and the causes numerous. The only reason you would need to \"clean\" a wound is if there is something in the wound that presents a hazard. Is that hazard greater then the damage urine will cause it? </p>\n\n<p>Bleeding does not necessarily require cleaning. Bleeding in it's very nature is bleeding out and not in, decreasing the odds of infection.</p>\n\n<p>Urine is designed to remove waste materials and isn't designed for bacteria. A UTI (Urinary Tract Infection) is normally introduced externally rather then interiorly.</p>\n\n<p>As far as sterility goes, completely sterile water is uncommon. I would trust water from my water bottle more then urine, even if it does contain bacteria from my mouth.</p>\n", "score": 7 } ]

[ "wound-care", "first-aid" ]

[ { "answer_id": 277, "body": "<p>Nuts and legumes are an excellent source of fiber.^{<a href=\"http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/high-fiber-foods/art-20050948\">1</a>} ^{<a href=\"http://www.webmd.com/diet/top-10-sources-of-fiber\">2</a>} If you're looking for the highest fiber content, here are the top candidates ranked by total grams of fiber (insoluble and soluble) per ounce^{<a href=\"https://www.prebiotin.com/resources/fiber-content-of-foods/\">3</a>}:</p>\n\n<p><strong>Almonds</strong>: 2 g/oz</p>\n\n<p><strong>Lentils</strong> (dried): 1.95 g/oz</p>\n\n<p><strong>Pine nuts</strong>: 1.8 g/oz</p>\n\n<p><strong>Pistachios</strong>: 1.7 g/oz</p>\n\n<p><strong>Peanuts</strong>: 1.7 g/oz</p>\n\n<p><strong>Beans</strong> (lima, kidney, soy etc.) 1.2 - 1.7 g/oz</p>\n\n<p><strong>Pecans</strong>: 1 g/oz</p>\n\n<p><strong>Walnuts</strong>: 0.7 g/oz</p>\n\n<p>A \"mixed nut\" product that includes almonds, peanuts, pecans, and walnuts would be a great way to get an assortment of the highest-fiber nuts (plus a lot of other great nutrients and healthy fats).</p>\n\n<p>Grains such as amaranth and barley are also good sources, as are sunflower seeds. Many fruits (apples, pears, coconut, bananas, strawberries, raspberries) are high in fiber as well.</p>\n", "score": 10 }, { "answer_id": 279, "body": "<p>As already pointed out, nuts and legumes make very good snacks. My only caution with the nuts is that they are also very calorie dense, so to have a filling snack you may add more calories than you would want. You can combine them with fruit, yogurt or other similar foods to make a healthy snack that isn't as high in calories per serving.</p>\n\n<p>If you want to maintain a high fiber diet, there are many alternatives that you can mix in either as snacks or as meal focuses:</p>\n\n<p>As a comparison, 1 cup of almonds has 11 grams of fiber, 526 calories.</p>\n\n<ul>\n<li>Raspberries - 8 grams per cup, 65 calories.</li>\n<li>Avocados - (1/2 avocado) - 7 grams, 160 calories</li>\n<li>Blackberries - same as Raspberries</li>\n<li>Pears - 4 grams, 80 calories per cup.</li>\n<li>Split peas - 16 grams per cup (cooked), 231 calories</li>\n</ul>\n\n<p>Other things you can do include:</p>\n\n<ul>\n<li>Add a tablespoon of ground flaxseed to smoothies or similar - nearly 4 grams of fiber and about 30 calories. (Also adds Omega-3 fatty acids)</li>\n<li>Chia seeds - 5.5 grams per tablespoon, 65 calories</li>\n</ul>\n\n<p><a href=\"https://fullplateliving.org/high-fiber-foods/list\" rel=\"nofollow\">https://fullplateliving.org/high-fiber-foods/list</a></p>\n\n<p><a href=\"http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/high-fiber-foods/art-20050948\" rel=\"nofollow\">http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/high-fiber-foods/art-20050948</a></p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/Flax#Flax_seeds\" rel=\"nofollow\">https://en.wikipedia.org/wiki/Flax#Flax_seeds</a></p>\n", "score": 7 } ]

[ "diet", "fibre", "nuts", "snacks-snacking-snack" ]

[ { "answer_id": 278, "body": "<p>There is no cure for vitiligo, but there are treatments that may reduce the discoloring in your skin and possibly even restore skin color. The main treatments used by doctors are either restoring the skin to normal color, or bleaching the skin, so that all of the skin is an even color. They do these things in a number of ways, including topical treatments and some surgical treatments.¹</p>\n\n<p>There still might be some side-effects, though. Some people might suffer from psychological distress, but as you said, that doesn't affect you. There is also an increased risk for sunburn and even skin cancer when exposed to the sun. Vitiligo can also cause inflammation of the iris, causing you to have eye problems. There is also a chance of hearing problems. Lastly, as a side-effect of any treatments you might be receiving, you may get dry skin and feel itchy.²</p>\n\n<p>To help prevent these side-effects (besides the last one) there are many things you can do other than getting treatments. The most important thing is to protect yourself from UV light. It is recommended that you use sunscreen with at least 30 SPF(Sun Protection Factor). Try to be in the shade whenever possible and wear clothing that will protect your skin from the sun (ie: long sleeve shirts, pants, hats, etc.). Covering up will help with most side-effects, especially the sunburn and the skin cancer, which you are a higher risk for than eye or hearing problems. Also, <strong>never</strong> get a tattoo. Getting a tattoo will cause more damage to your skin, which can make more patches of vitiligo to appear on your skin.³</p>\n\n<hr>\n\n<p>^{[1] <a href=\"http://www.avrf.org/treatments-products/vitiligo-treatments.html\" rel=\"noreferrer\">Vitiligo Treatments\n</a>}</p>\n\n<p>^{[2] <a href=\"http://www.mayoclinic.org/diseases-conditions/vitiligo/basics/complications/con-20032007\" rel=\"noreferrer\">Mayo Clinic - Vitiligo Complications</a>}</p>\n\n<p>^{[3] <a href=\"http://www.mayoclinic.org/diseases-conditions/vitiligo/basics/lifestyle-home-remedies/con-20032007\" rel=\"noreferrer\">Mayo Clinic - Vitiligo Lifestyle and Home Remedies</a>}</p>\n", "score": 6 } ]

[ "dermatology", "vitiligo" ]

[ { "answer_id": 354, "body": "<p>Your skin will not make enough protective lipids regardless of whether you use moisturizer or not. With your skin, it's actually better if you use it every day, at least on areas where you get eczema.</p>\n\n<p>Eczema (or Atopic Dermatitis) is an incompletely understood skin disorder, in which the normal skin barrier function (permeability) is compromised, allowing the skin to dry out more than normal skin. The cause of the dryness in AD is thought by some to be a deficiency of a naturally occurring fatty substance in the skin called <em>ceramide</em>. Others believe it's an abnormal or missing protein which causes the skin barrier to be compromised, allowing allergens and irritants to cause immune responses more easily, triggering the itch/chronic inflammation (this might explain the response seen with topical steroids). </p>\n\n<p>Whatever the case may be, moisturizers do provide a barrier of some type to the skin and help to decrease transepidermal water loss; therefore they are highly recommended for AD. Not using moisturizer will leave you open to more problematic eczema. Your skin will not make enough protective lipids regardless of whether you use moisturizer or not. You should use it every day, at least on areas where you get eczema.</p>\n\n<p>Other things which help Atopic Dermatitis involve water temperature when bathing (the cooler, the better), patting your skin dry instead of vigorous rubbing, applying the moisturizer immediately after bathing when your skin has already been moistened by the water, getting a reasonable amount of sun on affected areas, avoiding wool and heavy clothing that might make you sweat, using \"gentle\" soaps (only soaping up areas that need cleaning), showering briefly twice a day instead of once (applying moisturizer afterwards!) etc.</p>\n\n<p>There are some new ceramide-based moisturizers that have been shown to be helpful in AD. Some are very expensive while others are more reasonably priced. Some dermatologists have recommended <em>TriCeram</em>. You can spot test it (one arm or one affected area) to save money while evaluating how well it works for you.</p>\n\n<p>Determining what kinds of moisturizers work best for you involves trial and error, but whatever works, from petrolatum or Aquaphor, coconut oil (frectionated coconut oil and Johoba oil absorb into the skin a bit better so are less greasy), or another type, don't be hesitant to use it. Your particular skin needs it. </p>\n\n<p>_{<a href=\"http://www.jaad.org/article/S0190-9622%2802%2900048-8/abstract\" rel=\"nofollow\">Ceramide-dominant barrier repair lipids alleviate childhood atopic dermatitis: Changes in barrier function provide a sensitive indicator of disease activity</a>}<br>\n_{<a href=\"http://www.sciencedirect.com/science/article/pii/S0190962214012572\" rel=\"nofollow\">Study Supports Theory That No Single Genetic Defect Explains Atopic Dermatitis</a>}<br>\n_{<a href=\"http://www.mayoclinic.org/diseases-conditions/eczema/basics/lifestyle-home-remedies/con-20032073\" rel=\"nofollow\">Atopic dermatitis - Mayo Clinic</a>}<br>\n</p>\n", "score": 7 } ]

[ "dermatology", "eczema", "moisturize", "oil-of-skin" ]

[ { "answer_id": 415, "body": "<p>No, there isn't, not in any meaningful way.</p>\n\n<p>\"The placebo effect\" is an umbrella term, used primarily in the media/pop science. That isn't to say it isn't real or valid, but it covers outcomes from a great many different studies.</p>\n\n<p>In drug trials, the effects of a drug are often compared to a placebo - a sugar pill/saline injection - even placebo <em>surgery</em>.</p>\n\n<p>The placebo \"effect\" is what happens when you compare a placebo to nothing at all, and the patients on the placebo have statistically better outcomes.</p>\n\n<p>The key points here are:</p>\n\n<ul>\n<li><p>The placebo effect is a feature of large studies. You can't perform a large study on a single patient. In individual cases, there is simply too much variability - you can never know if a difference in outcome was due to \"the placebo effect\" or some other variable.</p></li>\n<li><p>You cannot perform the two halves of the study (placebo/nothing at all) yourself. You would have to run them sequentially, i.e. on different instances of cold/flu. This adds more variables.</p></li>\n<li><p>The placebo effect requires you to not know you're taking a placebo (patients in these studies are not told what it is about, they're just given pills/injections etc.) I can't think of a way you could feasibly set up a scenario where you were A) testing yourself for \"the placebo effect\", and B) not aware you are being given a placebo.</p></li>\n</ul>\n", "score": 5 }, { "answer_id": 494, "body": "<h3>Introduction</h3>\n<p>The placebo effect is a very interesting thing to study. To keep this scientific, though, let's divide your question into three addressable points:</p>\n<ol>\n<li>Does the placebo effect work?</li>\n<li>Does the placebo effect work on you?</li>\n<li>Can the placebo effect be scientifically tested?</li>\n</ol>\n<p>If each of these points can be resolved as true, then it would be fair to call the question answered. Also, at the bottom you'll find some suggestions for a placebo self-test.</p>\n<h3>What is a Placebo, What is the Placebo Effect?</h3>\n<p>A placebo is a treatment that looks like a regular treatment, but is actually an inactive look-alike, and not a medicine. Placebos are used in medicine to evaluate the effectiveness of treatments, as often some of the benefit from a treatment will actually be due to the placebo effect. In a controlled trial, some trial subjects are given the treatment being tested, and some are given placebos. Ideally, the subjects can't tell the difference, and at the end of the study, the effectiveness of the drug can be compared to that of the placebo.<a href=\"http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/placebo-effect\" rel=\"nofollow noreferrer\">¹</a></p>\n<p>In practice, this often means sugar or cornstarch pills, but can extend to other treatments as well. In fact, even surgical procedures can be placebos. Known as sham surgeries, surgical placebos often involve the administration of anesthesia followed by several incisions similar to those that would be made during typical surgery.<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1422430/\" rel=\"nofollow noreferrer\">²</a></p>\n<p>What is the placebo effect that makes all of this necessary? The placebo effect is the improvement in a medical condition resulting from the <em>belief</em> that one is being treated, rather than the effectiveness of the treatment itself.<a href=\"http://www.nhs.uk/livewell/complementary-alternative-medicine/pages/placebo-effect.aspx\" rel=\"nofollow noreferrer\">³</a> Because patients tend to believe they are being given an effective treatment, this belief itself contributes to improvement in condition.<a href=\"https://www.psychologytoday.com/blog/brain-sense/201201/the-placebo-effect-how-it-works\" rel=\"nofollow noreferrer\">⁴</a></p>\n<h3>Does the Placebo Effect Work?</h3>\n<p>A number of examples can be used to demonstrate the effectiveness of the placebo effect. Several of them conclude that not only is the placebo effect powerful, it is sometimes more powerful than the medication alternatives.<a href=\"http://blogs.nature.com/spoonful/2014/01/migraine-study-attributes-more-than-half-a-drugs-benefit-to-placebo-effect.html\" rel=\"nofollow noreferrer\">⁵</a></p>\n<p>A migraine study conducted in 2014 compared the effect of the migraine treatment rizatriptan (sold by Merck Pharmaceuticals as Maxalt) to a placebo, by administering envelopes with drugs in them to migraine sufferers. The subjects were instructed to take the medication in case of migraine. The envelopes came in pairs labeled 'Placebo', 'Maxalt' or 'Placebo or Maxalt', however, each pair actually had one placebo envelope and one Maxalt envelope. Yet, subjects reported the same level of pain relief from placebo labeled Maxalt as from Maxalt labeled placebo, suggesting that placebos are sometimes as effective as actual medication. Patients also reported pain relief from the placebo labeled placebo, suggesting that even one who knowingly takes a placebo can still be subject to the effect.<a href=\"http://blogs.nature.com/spoonful/2014/01/migraine-study-attributes-more-than-half-a-drugs-benefit-to-placebo-effect.html\" rel=\"nofollow noreferrer\">⁶</a></p>\n<p>A study specifically designed to evaluate the placebo effect compared fake acupuncture to fake pills, a comparison of two placebos. Subjects suffering from arm pain were either prescribed acupuncture or pain medication, but the pain medication was cornstarch pills, and the acupuncture used needles with tips that retract into themselves upon touching skin, like stage knives. The subjects were warned about possible side effects of the treatment, with the side effects mentioned taken from actual side effects of either real treatment. Interestingly, one third of patients reported the exact side effects they were warned about, including excessive drowsiness in the pill group, and redness and inflammation in the acupuncture group, even though the skin wasn't actually pierced. Some patients in both groups reported extreme pain, but more interestingly, most of the subjects reported extreme pain relief.<a href=\"http://harvardmagazine.com/2013/01/the-placebo-phenomenon\" rel=\"nofollow noreferrer\">⁷</a></p>\n<h3>Does the Placebo Effect Work on You?</h3>\n<p>An effective method of proving widespread viability of the placebo effect is showcasing its virality, quite literally. When one believes he is sick, and starts developing actual symptoms as a result, the medical community refers to this condition as 'psychogenic illness,' or actual illness spawned from the belief of illness. When this believed illness is believed to be contagious, anyone who hears about it can himself become ill, experiencing the full range of purported symptoms. This is known as 'sociogenic illness', and it is potentially the most infectious category of illness in existence. This is because it &quot;infects&quot; through information, making mass media often the single greatest transmission vector. Most worryingly, the current medical opinion is that there is no particular predisposition to mass sociogenic illness and it is a behavioral condition that anyone can show in the right circumstances.<a href=\"http://bjp.rcpsych.org/content/180/4/300.full\" rel=\"nofollow noreferrer\">⁸</a></p>\n<p>A 2006 study testing individual sensitivity to GSM cellphone signals found no evidence that people with self-reported sensitivity to mobile phone signals are able to detect such signals or that they react to them with increased symptom severity. As sham exposure was sufficient to trigger severe symptoms in some participants, this condition was most likely sociogenic illness.<a href=\"http://www.bmj.com/content/332/7546/886?view=long&amp;pmid=16520326\" rel=\"nofollow noreferrer\">⁹</a></p>\n<p>A 2012 study testing whether media coverage of people sensitive to WiFi signal contributed to reports of WiFi sensitivity concluded that media reports about the adverse effects of supposedly hazardous substances can increase the likelihood of experiencing symptoms following sham exposure and developing an apparent sensitivity to it.<a href=\"http://www.jpsychores.com/article/S0022-3999(12)00335-2/fulltext\" rel=\"nofollow noreferrer\">¹⁰</a></p>\n<p>A case study about mass illness attributed to toxic exposure at a high school had features of mass psychogenic illness. Notably, widespread subjective symptoms thought to be associated with environmental exposure to a toxic substance persisted in the absence of objective evidence of an environmental cause.<a href=\"http://www.nejm.org/doi/full/10.1056/NEJM200001133420206\" rel=\"nofollow noreferrer\">¹¹</a></p>\n<p>In other words, sociogenic and psychogenic illness exist, there is no particular predisposition to mass sociogenic illness and it is a behavioral condition that anyone can show in the right circumstances.<a href=\"http://bjp.rcpsych.org/content/180/4/300.full\" rel=\"nofollow noreferrer\">¹²</a></p>\n<h3>Can the Placebo Effect be Scientifically Tested?</h3>\n<p>All of the previous studies seem to indicate that yes, the placebo effect can be scientifically tested, but as a final confirmation, a study conducted on subjects with Alzheimer's disease showed that these subjects got less pain relief from pain medications. They required higher doses, possibly because they had forgotten that they were getting the drugs, or they forgot that the pain medicines had worked for them before.<a href=\"http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/placebo-effect\" rel=\"nofollow noreferrer\">¹³</a></p>\n<p>In other words, Alzheimer's disease seems to allow the comparison of placebo effect and the lack thereof. Because Alzheimer's disease patients do not remember taking their medication, they receive far less benefit from it due to the lost contributions from the placebo effect.</p>\n<h3>A Suggestion of Methods</h3>\n<p>Now that we've scientifically proven that the placebo effect works, it is powerful, and it by all means should work for you, even if you know you are or may be taking a placebo, we may devise some methods.</p>\n<p>You will likely need an external source of entropy, and should most likely not use a placebo in place of actual necessary treatment. This would mean that you will want a medication that does not cure any particular disease, though maybe alleviating symptoms is a better bet. I assume that this is why the studies above tend to stick with pain relief for evaluating placebos. Pain relief is easy to judge and quantify on a personal level, and the lack thereof does not threaten anyone's life. If you are injured and in pain, there is your test.</p>\n<p>If you are not injured, however, and have no desire to be,<a href=\"http://guides.library.jhu.edu/c.php?g=202502&amp;p=1335759\" rel=\"nofollow noreferrer\">¹⁴</a> you may want to try medication that causes noticeable benefit rather than treatment. For example, caffeine. Find two coffees, one caffeinated, one decaffeinated, that you can't tell tell apart with taste alone. Ideally, add something with a strong taste masking ability to each to help prevent differentiation. Have a friend divide up the two coffees into numbered plastic bags, one bag for each day of the experiment, without you knowing which bags are which. Also, it is important to prevent bias that you not be able to connect different days of the experiment, so no evens and odds. Your friend's numbering system should be sufficiently random that you can't figure out which bags are which. When you are ready, begin the experiment, using a bag of your choice for each day of the experiment. Chart, on an hourly basis, the amount of &quot;buzz&quot; you experience from that coffee number, and after maybe a month try to take a guess using the chart at which bag numbers were caffeinated and which were decaffeinated. Then, ask for your friend's table of which were which, and evaluate.</p>\n<p>This was just a suggestion, but this and similar study designs should by all means allow you to test the placebo effect on yourself. Feel free to experiment, that's how science progresses.</p>\n", "score": 4 } ]

[ "scientific-method", "placebo", "stress" ]

[ { "answer_id": 487, "body": "<p>\"Gamekeeper's thumb\" - named because of the <em>chronic</em> injury incurred when rabbit keepers broke rabbits' necks between the base of the thumb and index finger - has more recently been referred to as \"skier's thumb\", now the most common <em>acute</em> mechanism of the injury. <em>If</em> you fell on an outstretched hand hyperextending your thumb (did it feel as if the thumb was stressed beyond its normal range of motion?) <em>and</em> your doctor was correct, you injured the ulnar collateral ligament (UCL) of the metacarpophalangeal joint (MCPJ) of the thumb. This would cause significant pain and swelling at the base of the thumb in the \"web space\" between thumb and index finger.</p>\n\n<p><img src=\"https://i.stack.imgur.com/EHrj3.jpg\" alt=\"enter image description here\"> <img src=\"https://i.stack.imgur.com/GEnMa.jpg\" alt=\"enter image description here\"></p>\n\n<p>As you can see in the picture on the right, the UCL appears partially torn. If it does not heal completely, it can result in an insufficiency of that ligament. In this case, the condition not uncommonly becomes chronic because of repeated injury to the already weakened UCL. It causes varying degrees of instability of that joint with pain and weakness of the pincer grasp (imagine squeezing an m&amp;m between your thumb and your index finger.)</p>\n\n<p>Initial treatment to optimize ligament healing is immobilization.</p>\n\n<p>What can you do now? If you think you re-injured it, you can apply a cold pack (e.g. a bag of frozen peas wrapped in a dry washcloth) to the thumb as tolerated for ~20 minutes, up to four times per day. </p>\n\n<p>Immobilizing the thumb with a bulky, loose ACE wrap or a commercially available thumb brace in the neutral position will help lessen the pain.\nYou can take acetaminophen or ibuprofen for pain relief if you have no contraindications*.</p>\n\n<p>The best thing you can do is see a doctor (perhaps an orthopedist or a hand specialist would be wise), since chronic pain and instability of the thumb is not insignificant. They can do a thorough evaluation of your thumb\nand either splint/cast your thumb, give you rehabilitative exercises to help you strengthen your thumb, or recommend surgery if necessary.</p>\n\n<p>*_{Contraindication = any reason you shouldn't take it.}<br>\n_{Always keep a cloth between your skin and the ice pack, and press firmly against all the curves of the affected area. Remove the ice pack if it causes pain, and don't fall asleep with the pack in place.}</p>\n\n<p>_{<a href=\"http://emedicine.medscape.com/article/97679-overview#a0199\" rel=\"nofollow noreferrer\">Gamekeeper's Thumb</a>}<br>\n_{<a href=\"http://www.wheelessonline.com/ortho/gamekeepers_thumb\" rel=\"nofollow noreferrer\">Gamekeeper's Thumb: Wheeless' Textbook of Orthopaedics</a>}</p>\n", "score": 8 } ]

[ "pain", "tendinopathy", "tendinitis", "hand" ]

[ { "answer_id": 684, "body": "<p>The German Federal Institute for Risk Assessment has established a tolerable daily intake (TDI) of <strong>0.1 mg coumarin per kg body weight</strong>, but also advises that higher intake for a short time is not dangerous. <a href=\"http://www.bfr.bund.de/en/faq_on_coumarin_in_cinnamon_and_other_foods-8487.html\" rel=\"nofollow noreferrer\">{1}</a> Meanwhile, the Occupational Safety and Health Administration (OSHA) of the United States does not classify coumarin as a carcinogen for humans. <a href=\"https://www.osha.gov/dts/chemicalsampling/data/CH_229620.html\" rel=\"nofollow noreferrer\">{2}</a></p>\n\n<p>There are two very distinct kinds of spices on the market which are commonly called \"cinnamon\". <a href=\"https://en.wikipedia.org/wiki/Cinnamon\" rel=\"nofollow noreferrer\">True cinnamon</a> (derived from the plant <em>Cinnamomum verum</em>), also called Ceylon cinnamon and <a href=\"https://en.wikipedia.org/wiki/Cinnamomum_cassia\" rel=\"nofollow noreferrer\">cassia cinnamon</a> (derived from the plant <em>Cinnamomum cassia</em>). Although they are closely related they are different species and the distinction between the two was made early on since they are not only regionally separated but also tasting slightly different. And since your tongue might already tell you that: meaning their chemical composition is different. Concerning the quality of taste: true cinnamon is commonly described as milder, weaker, more elegant. Cassia on the other hand is cheaper per volume <em>and</em> more efficient to achieve a certain level of cinnamon taste.</p>\n\n<p>I'll focus on cassia cinnamon rather than Ceylon (\"natural cinnamon\") because the levels of coumarin are higher and it's better to be safe than sorry.</p>\n\n<p>Doing the math, take your weight (in lbs.) and multiply by .221 to get the daily recommended limit in milligrams (in Germany).</p>\n\n<blockquote>\n <p>Ceylon Cinnamon has less than 0.04% Coumarin while Cassia Cinnamon has\n in the region of 4%. <a href=\"http://www.bfr.bund.de/en/faq_on_coumarin_in_cinnamon_and_other_foods-8487.html\" rel=\"nofollow noreferrer\">{1}</a></p>\n</blockquote>\n\n<p>Let's say you're petite or a developing child (80 lbs.) and can't handle as much coumarin. 80 * .221 = 17.68 milligrams of coumarin.</p>\n\n<p>If we imagine 17.68 as 4% of some daily intake of cinnamon, that would be 442 milligrams or .442 grams of cinnamon daily.</p>\n\n<p>Of course, if you happened to weigh twice as much, your intake would be twice that, and so on.</p>\n\n<p>Also, if you want to take 6 grams of cinnamon per day, <strong>it seems that Ceylon is the better choice to prevent overexposure to coumarin, since you can take close to a hundred times more.</strong></p>\n\n<p><strong>Disclaimers:</strong></p>\n\n<ul>\n<li>Levels of coumarin in cassia cinnamon <a href=\"http://www.sciencedirect.com/science/article/pii/S0956713513005379?via%3Dihub\" rel=\"nofollow noreferrer\">vary greatly</a> even in bark from\nthe same tree. <a href=\"http://www.sciencedaily.com/releases/2010/11/101103135352.htm\" rel=\"nofollow noreferrer\">{4}</a></li>\n<li>The recommended daily intake exists in Europe, <a href=\"https://nccih.nih.gov/health/cinnamon\" rel=\"nofollow noreferrer\">not US</a>.</li>\n<li>Levels of coumarin from cassia are already too high from a health standpoint if <a href=\"http://www.efsa.europa.eu/sites/default/files/scientific_output/files/main_documents/793.pdf\" rel=\"nofollow noreferrer\">eaten as a spice in comparatively low amounts</a>, intake levels needed for a \"natural supplement\" of unproven benefit will quickly exceed that range</li>\n</ul>\n\n<p><strong>Sources:</strong></p>\n\n<p><a href=\"http://www.bfr.bund.de/en/faq_on_coumarin_in_cinnamon_and_other_foods-8487.html\" rel=\"nofollow noreferrer\">http://www.bfr.bund.de/en/faq_on_coumarin_in_cinnamon_and_other_foods-8487.html</a>\n<a href=\"https://www.osha.gov/dts/chemicalsampling/data/CH_229620.html\" rel=\"nofollow noreferrer\">https://www.osha.gov/dts/chemicalsampling/data/CH_229620.html</a>\n<a href=\"http://www.sciencedaily.com/releases/2010/11/101103135352.htm\" rel=\"nofollow noreferrer\">http://www.sciencedaily.com/releases/2010/11/101103135352.htm</a></p>\n", "score": 8 } ]

[ "nutrition", "diet" ]

[ { "answer_id": 519, "body": "<p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486820/\" rel=\"nofollow\">The only known significant long-term risk of blood donation is iron deficiency.</a> Immunity (which you asked about) is primarily mediated by <a href=\"http://en.wikipedia.org/wiki/White_blood_cell\" rel=\"nofollow\">white blood cells</a>, which can be easily deployed from the lymphatic system and bone marrow to replace those lost in donation. <a href=\"http://en.wikipedia.org/wiki/Red_blood_cell\" rel=\"nofollow\">Red blood cells</a>, on other hand, are not stored as mature cells in large numbers outside of the bloodstream. They also contain hemoglobin, which requires iron for its production. The body has a limited supply of iron, and when red blood cells are removed via blood donation, this can be depleted. <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486820/#__sec4title\" rel=\"nofollow\">Approximately 200 - 230 mg of iron is lost during a standard blood donation</a> (~450 mL whole blood). It has been shown that <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/?term=15383019\" rel=\"nofollow\">short-term iron supplementation is effective in replacing iron loss</a>.¹</p>\n\n<p>The <a href=\"http://www.redcrossblood.org/donating-blood/eligibility-requirements/eligibility-criteria-alphabetical-listing\" rel=\"nofollow\">American Red Cross recommends</a> donors wait 8 weeks between transfusions. <a href=\"http://www.nhs.uk/conditions/blood-donation/pages/introduction.aspx\" rel=\"nofollow\">The NHS guideline</a> is more conservative, recommending 12 weeks for men and 16 weeks for women. The difference between the sexes in that recommendation is because women lose blood regularly through menstruation and thus tend to have lower stores of iron and can easily become anemic. The threshold hemoglobin level required for donation is also different between the US and Europe: 12.5 g/dL for both sexes in the US; 12.5 g/dL for women but 13.5 g/dL for men in the Europe.* </p>\n\n<p>The <em>optimal</em> interval for blood donation remains a bit of an open question. (Note that for women, the NHS recommendation is twice as long as the Red Cross’s recommendation!) To investigate that, there was recently <a href=\"http://www.intervalstudy.org.uk/about-the-study/\" rel=\"nofollow\">a large trial conducted within NHS</a> centers that randomized men to 12-week, 10-week, or 8-week intervals between donation while women were randomized to 16-week versus 14-week versus 12-week intervals.² They will report hemoglobin levels in donors, including the number of donations that have to be deferred due to hemoglobin levels below the recommended levels (NHS guidelines above). <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177700/\" rel=\"nofollow\">The full methodology is available online</a>, but to my knowledge the results have not yet been published. </p>\n\n<hr>\n\n<p>_{\nReferences\n} </p>\n\n<p>_{\n1. Radtke H, Mayer B, Röcker L, Salama A, Kiesewetter H. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/?term=15383019\" rel=\"nofollow\"><em>Iron supplementation and 2-unit red blood cell apheresis: a randomized, double-blind, placebo-controlled study.</em></a> Transfusion. 2004 Oct;44(10):1463-7.\n} </p>\n\n<p>_{\n2. Moore C, Sambrook J, Walker M, Tolkien Z, Kaptoge S, Allen D, Mehenny S, Mant J, Di Angelantonio E, Thompson SG, Ouwehand W, Roberts DJ, Danesh J. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/25230735\" rel=\"nofollow\"><em>The INTERVAL trial to determine whether intervals between blood donations can be safely and acceptably decreased to optimise blood supply: study protocol for a randomised controlled trial.</em></a> Trials. 2014 Sep 17;15:363. doi: 10.1186/1745-6215-15-363.\n}<br>\n </p>\n\n<hr>\n\n<p>^{<br>\n*Note: The European guideline appears to be a practical concession to the fact that many menstruating woman have hemoglobin &lt;13.5 g/dL. However, to my knowledge there is no physiologic reason to believe that women should <em>tolerate</em> an absolute hemoglobin level lower than men. Thus, the logic of it is somewhat lost on me.\n}</p>\n", "score": 8 } ]

[ "blood-donation", "donor" ]

[ { "answer_id": 1702, "body": "<p>I am focusing on one important health issue with respect to sleep position. Obstructive sleep apnea or apnoea (OSA) is a common condition where person has excessive snoring and disturbed sleep at night. These persons may also have headaches in the morning, daytime sleepiness, chronic fatigue or exhaustion, impaired functioning and emotional disturbances. Many expensive therapies are available but adjusting sleep position is an inexpensive method that may help greatly. Sleeping on the side (and not on the back) is recommended for this. Sleeping on the back causes the tongue to fall back and obstruct the airway, producing snoring and other features of sleep apnea syndrome. Extra pillows, as a pillow between the knees, may be used to get comfortable in this position. </p>\n\n<p>References:</p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/6740055\">http://www.ncbi.nlm.nih.gov/pubmed/6740055</a></p>\n\n<p><a href=\"http://umm.edu/health/medical/reports/articles/obstructive-sleep-apnea\">http://umm.edu/health/medical/reports/articles/obstructive-sleep-apnea</a></p>\n\n<p><a href=\"http://www.britishsnoring.co.uk/why_do_i_snore/sleeping_position.php\">http://www.britishsnoring.co.uk/why_do_i_snore/sleeping_position.php</a></p>\n\n<p><a href=\"http://www.webmd.com/sleep-disorders/features/sleep-position-and-sleep-quality\">http://www.webmd.com/sleep-disorders/features/sleep-position-and-sleep-quality</a></p>\n\n<p><a href=\"http://sleepapneadisorder.info/2011/08/18/the-best-sleeping-positions/\">http://sleepapneadisorder.info/2011/08/18/the-best-sleeping-positions/</a></p>\n", "score": 5 }, { "answer_id": 5695, "body": "<p>YES, your sleeping position can directly affect your health. While the best sleeping posture is generally considered to be sleeping on your back with your arms by your sides and it’s good for your neck, too, as long as you don’t use too many pillows. It observe that back sleepers tend to snore more than those in any other position.</p>\n\n<p>Regards\nMaria Bertinelli\nSenior Associate at Asonor</p>\n", "score": 0 } ]

[ "sleep", "position" ]

[ { "answer_id": 599, "body": "<p>There are two main reasons why foods are made (or advertised) as gluten free. In short it is partially to meet the needs of a small but growing group of people who are allergic to gluten and also to catch people who are taking part in the gluten free fad.</p>\n\n<p>The main reason is that there are different conditions out there that cause a person to have issues dealing with gluten one of them is a condition called celiac diease (<a href=\"http://www.webmd.com/digestive-disorders/celiac-disease/celiac-disease\" rel=\"nofollow\">WebMD</a>/<a href=\"http://celiac.org/celiac-disease/what-is-celiac-disease/\" rel=\"nofollow\">Celiac.org</a>)</p>\n\n<blockquote>\n <p>Celiac disease -- also known as celiac sprue or gluten-sensitive enteropathy -- is a digestive and autoimmune disorder that results in damage to the lining of the small intestine when foods with gluten are eaten. Gluten is a form of protein found in some grains. The damage to the intestine makes it hard for the body to absorb nutrients, especially fat, calcium, iron, and folate.</p>\n</blockquote>\n\n<p>This is something that can be a very serious issue for people that have it</p>\n\n<blockquote>\n <p>Celiac disease can leave a person susceptible to other health problems, including:</p>\n</blockquote>\n\n<p>Osteoporosis, a disease that weakens bones and leads to fractures. This occurs because the person has trouble absorbing enough calcium and vitamin D.\nMiscarriage or infertility.\nBirth defects, such as neural tube defects (improper formation of the spine) caused by poor absorption of such nutrients as folic acid.\nSeizures.\nGrowth problems in children because they don't absorb enough nutrients.\nCancer of the intestine (very rare).</p>\n\n<p>People with one of these conditions need to avoid all foods with gluten in them in order to avoid the effects of the condition</p>\n\n<p>The second reason that food are made this way are because going gluten free has become a fad and food manufacturers are just cashing in on the latest trend.</p>\n\n<p>Now when it comes to gluten free food there are some things that you need to remember. First there are types of gluten free food.</p>\n\n<ol>\n<li>Foods that are naturally gluten free and just need to be advertised as such</li>\n<li>Foods that have gluten in them but easy changes can be made to remove it</li>\n<li>Foods that have are based primarily on gluten based products and need to be changed drastically in order to be gluten free.</li>\n</ol>\n\n<p>The reason that knowledge is important is that people who have a sensitivity to gluten can easily have issue from cross contamination. An example of this would be if a pizza place was making a gluten free pizza but they used the sauce and ladle that is used on normal pizza which will bring in contaminates to the gluten free food.</p>\n", "score": 3 } ]

[ "nutrition", "diet", "benefits", "gluten", "celiac-disease" ]

[ { "answer_id": 708, "body": "<p>Adult pads have a larger area. And they provide more energy. The higher energy is needed because most adults have more body mass than children. </p>\n\n<p>Lower energy is more suitable for children. <a href=\"http://www.aedbrands.com/blog/2012/07/30/do-you-really-need-pediatric-pads/\">Source</a></p>\n\n<p>I teach CPR according to the European standards (ERC). You can use an AED with adult pads on a child, but you should put one pad on the front and the other on the back (both sides of the heart). So they can't touch.</p>\n\n<p><a href=\"http://www.aedbrands.com/blog/2012/07/30/do-you-really-need-pediatric-pads/\">http://www.aedbrands.com/blog/2012/07/30/do-you-really-need-pediatric-pads/</a></p>\n", "score": 7 } ]

[ "first-aid", "cpr" ]

[ { "answer_id": 3352, "body": "<p>The worst components of fats and oils from health point of view are <a href=\"https://en.wikipedia.org/wiki/Trans_fat\" rel=\"nofollow noreferrer\">\"trans fats\"</a>. These are unsaturated fatty acids with one or more trans configuration double bonds. MUFA (monounsaturated fatty acids) and PUFA (polyunsaturated fatty acids), on the other hand, are good types of fat and oil components.^{<a href=\"http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/mufas/faq-20057775\" rel=\"nofollow noreferrer\">Mayo Clinic</a>}</p>\n\n<p>Repeated reusing and heating oils to high temperature lead to formation of trans fats hence this should be avoided. See: <a href=\"http://www.livestrong.com/article/446570-does-overheating-olive-oil-turn-it-to-trans-fat/\" rel=\"nofollow noreferrer\">Does Overheating Olive Oil Turn it to Trans Fat?</a></p>\n\n<p>Trans fats increase the risk of atherosclerosis (plaque formation in the walls of arteries) that limit flow of blood in vital organs like heart and brain (see: <a href=\"http://www.nejm.org/doi/full/10.1056/NEJMra054035\" rel=\"nofollow noreferrer\">Trans Fatty Acids and Cardiovascular Disease</a>). Trans fats are thought to be even worse than saturated fats for their propensity to cause atherosclerosis.</p>\n\n<p>This leads to life-threatening conditions like myocardial infarction (heart attack), brain stroke and limb gangrene. Harmful health effects may also extend to other organs and diseases, e.g. Diabetes and Alzheimer.\n See: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12580703\" rel=\"nofollow noreferrer\">Dietary fats and the risk of incident Alzheimer disease</a>. </p>\n\n<p>Studies show that it is possible to completely <a href=\"http://wayback.archive.org/web/20070225021532/http://www.hc-sc.gc.ca/fn-an/nutrition/gras-trans-fats/tf-ge/tf-gt_app9iii_e.html\" rel=\"nofollow noreferrer\">eliminate trans fats from foods</a>. As a result there are limitation in many parts of world on use of trans fats (see <a href=\"http://www.medscape.com/viewarticle/706222\" rel=\"nofollow noreferrer\">Trans fat ban in NYC</a> and <a href=\"http://web.archive.org/web/20150120014755/http://www.nyc.gov:80/html/doh/html/living/nyc-transfat.shtml\" rel=\"nofollow noreferrer\">this</a>). </p>\n\n<p>FDA has made 2018 the year by which trans fat should be completely eliminated from food supply.^{<a href=\"http://www.nytimes.com/2015/06/17/health/fda-gives-food-industry-three-years-eliminate-trans-fats.html\" rel=\"nofollow noreferrer\">NY Times</a>}</p>\n", "score": 4 }, { "answer_id": 3354, "body": "<p>It seems to be that the health danger of frying past a smoking point is absorbing cancer-causing chemicals from the fumes the oil produces or from ingesting the oil itself. </p>\n\n<blockquote>\n <p>... it is believed that fats that have gone past their smoke points contain a large quantity of free radicals which contibute to (sic) risk of cancer.</p>\n</blockquote>\n\n<p>Source: <a href=\"http://www.cookingforengineers.com/article/50/Smoke-Points-of-Various-Fats\" rel=\"nofollow\">http://www.cookingforengineers.com/article/50/Smoke-Points-of-Various-Fats</a> </p>\n\n<blockquote>\n <p>When an oil is heated past its smoke point, it generates toxic fumes and free radicals which are extremely harmful to your body.\n When the smoke point is reached, you’ll begin to see the gaseous vapors from heating, a marker that the oil has started to decompose.\n Decomposition involves chemical changes that ...also create cancer-causing compounds that are harmful when consumed and/or inhaled.</p>\n</blockquote>\n\n<p>Source: <a href=\"http://www.business2community.com/health-wellness/the-danger-of-cooking-with-healthy-oils-past-their-smoke-point-0418150#jdc5hpj08paDzWEE.99\" rel=\"nofollow\">http://www.business2community.com/health-wellness/the-danger-of-cooking-with-healthy-oils-past-their-smoke-point-0418150#jdc5hpj08paDzWEE.99</a> </p>\n\n<blockquote>\n <p>Oxidative DNA damage was associated with exposure of Chinese restaurant workers to cooking oil fumes.</p>\n</blockquote>\n\n<p>Source: <a href=\"http://cebp.aacrjournals.org/content/17/12/3351.short\" rel=\"nofollow\">http://cebp.aacrjournals.org/content/17/12/3351.short</a></p>\n\n<p>As side notes,</p>\n\n<blockquote>\n <p>...the reuse of oils is one of the main reasons why eating at restaurants is discouraged,...\"; \"canola oil is always the worst choice, because it becomes toxic long before it reaches its smoke point. The high rates of lung cancer in China are largely due to the use of canola oil and rapeseed oil,...</p>\n</blockquote>\n\n<p>Source: <a href=\"http://healthwyze.org/index.php/component/content/article/539-why-rancid-healthy-oils-are-more-dangerous-than-the-bad-oils.html\" rel=\"nofollow\">http://healthwyze.org/index.php/component/content/article/539-why-rancid-healthy-oils-are-more-dangerous-than-the-bad-oils.html</a></p>\n", "score": 2 } ]

[ "diet", "oil", "cooking" ]

[ { "answer_id": 19722, "body": "<p>The study did not investigate the causes of, or possible treatments of, grey hair. However, the research focused on vitiligo, specifically looking at segmental vitiligo (<a href=\"https://www.nhs.uk/news/medication/no-evidence-of-cure-to-prevent-hair-going-grey/\" rel=\"nofollow noreferrer\">NHS, 2013</a>).</p>\n\n<p>The NHS went further by saying that:</p>\n\n<blockquote>\n <p>Though the blame for the poor reporting of the study can be put at the door of the press office of the FASEB, which issued a press release almost entirely focused on the grey hair angle. This is a textbook example of public relations officers ‘sexing up’ a dry but worthy piece of research in order to gain maximum media coverage. And – credit where credit is due – they did an excellent job of that. Unfortunately, in doing so they obscured the truth.</p>\n \n <p>Whether peer-reviewed journals should be engaging in these types of disingenuous practises, which arguably damage the public understanding of science, is a matter of debate. However, FASEB are not alone in this, as recent research found that academics, journals and news reporters all share the blame for the <a href=\"https://www.nhs.uk/news/medical-practice/half-of-medical-reporting-is-subject-to-spin/\" rel=\"nofollow noreferrer\">spin found in around half of all medical reporting</a>. (<a href=\"https://www.nhs.uk/news/medication/no-evidence-of-cure-to-prevent-hair-going-grey/\" rel=\"nofollow noreferrer\">NHS, 2013</a>).</p>\n</blockquote>\n\n<p>What the NHS was reporting on was that there were a number of newspaper articles in 2013 talking about a 2013 study by one of the researchers in the 2009 study (Karin U. Schallreuter) - <a href=\"https://doi.org/10.1096/fj.12-226779\" rel=\"nofollow noreferrer\">Schallreuter et al. (2013)</a>. Strangely enough, looking at the 2009 study, they also tested the theory on vitiligo patients.</p>\n\n<blockquote>\n <p>By analogy, we turned to vitiligo, a depigmentation disorder, as this model could hold lessons for a better understanding of the graying process (<a href=\"https://pdfs.semanticscholar.org/447f/913d88c1786ed71cb45530a7e1a5c4fb96ae.pdf\" rel=\"nofollow noreferrer\">Wood et al. 2009</a>).</p>\n</blockquote>\n\n<p>In explaining the problem, the NHS points out that:</p>\n\n<blockquote>\n <p>Vitiligo can be divided into two forms: segmental and nonsegmental vitiligo. Nonsegmental vitiligo is the more common, in which the white patches that appear are symmetrical (the same places on both sides of the body, for example both hands could be affected). In nonsegmental vitiligo, two chemicals – hydrogen peroxide and peroxynitrite – accumulate in the skin.</p>\n \n <p>Nonsegmental vitiligo can be treated with a pseudocatalase, which is activated by narrow-band UVB light. This reduces the concentrations of hydrogen peroxide, allowing the lost skin colour to return.</p>\n \n <p>In the less common segmental form of vitiligo, the affected skin lies in a dermatome, which is a particular area of skin supplied by a single nerve, so it usually affects only one side of the body.</p>\n \n <p>Segmental and non-segmental vitiligo can also co-exist, giving rise to ‘mixed’ vitiligo.</p>\n \n <p>This study aimed to see whether the accumulation of hydrogen peroxide and peroxynitrite which occurs in nonsegmental vitiligo also occurs in segmental vitiligo, and if so, if the light activated pseudocatalase could also be of use in segmental vitiligo.</p>\n</blockquote>\n\n<p>The bottom line is that, as far as I have seen, it has not been proven whether the accumulation of hydrogen peroxide is the cause of grey hair or not.</p>\n\n<h2>References</h2>\n\n<p>NHS (2013). <em>No evidence of cure to prevent hair going grey</em>. Retrieved from: <a href=\"https://www.nhs.uk/news/medication/no-evidence-of-cure-to-prevent-hair-going-grey/\" rel=\"nofollow noreferrer\">https://www.nhs.uk/news/medication/no-evidence-of-cure-to-prevent-hair-going-grey/</a></p>\n\n<p>Schallreuter, K. U., Salem, M. A., Holtz, S., &amp; Panske, A. (2013). Basic evidence for epidermal H₂O₂/ONOO⁻-mediated oxidation/nitration in segmental vitiligo is supported by repigmentation of skin and eyelashes after reduction of epidermal H₂O₂ with topical NB-UVB-activated pseudocatalase PC-KUS. <em>The FASEB Journal, 27</em>(8), 3113-3122. doi: <a href=\"https://doi.org/10.1096/fj.12-226779\" rel=\"nofollow noreferrer\">10.1096/fj.12-226779</a></p>\n\n<p>Wood, J. M., Decker, H., Hartmann, H., Chavan, B., Rokos, H., Spencer, J. D., ... &amp; Schallreuter, K. U. (2009). Senile hair graying: H₂O₂-mediated oxidative stress affects human hair color by blunting methionine sulfoxide repair. <em>The FASEB Journal, 23</em>(7), 2065-2075. doi: <a href=\"https://doi.org/10.1096/fj.08-125435\" rel=\"nofollow noreferrer\">10.1096/fj.08-125435</a></p>\n", "score": 3 } ]

[ "treatment-options", "hair", "stress", "hydrogen-peroxide", "scalp" ]

[ { "answer_id": 702, "body": "<p>Food poisoning is something of a catch-all term for any one of a number of infections caused by microbial contamination of food - it should be noted that it is not necessarily just bacterial contaminants. For example, Norovirus is actually the most common food-borne pathogen <a href=\"http://www.cdc.gov/norovirus/about/overview.html\">in the United States</a>.</p>\n\n<p>As for why not just calling it an infection, there are two reasons:</p>\n\n<ol>\n<li>It is possible to get food poisoning from microbially produced toxins within food even without an active infection. For example, <a href=\"http://en.wikipedia.org/wiki/Enterotoxin\">enterotoxins</a> might be present in sufficient quantities to produce clinical illness even if the bacteria that produced them are dead.</li>\n<li>The two are not mutually exclusive - food poisoning relates more to a common exposure source (food), and a collection of similar symptoms, such as nausea, diarrhea and vomiting, and especially in mild cases, similar treatments. </li>\n</ol>\n\n<p>Although food poisoning may be caused by an infection, it's mainly a syndromic description of a disease.</p>\n", "score": 13 } ]

[ "salmonella" ]

[ { "answer_id": 716, "body": "<p>As a medical professional I find this very important question. No, OTC drugs are not any safer than drugs needing prescriptions. They are more dangerous.</p>\n\n<p>The rationale for this statement is that always when patients are given a prescription, a detailed dosing guidelines are given to patient. Also physicians make sure that the prescripted drug is suitable to use with existing medication without any adverse interactions.</p>\n\n<p>In contrary, people can buy OTC drug as much they can and use them how ever they feel it is possible. Of course, majority of patients ask or seek for guidance, but in population level there will always be the minotiry who use OTC drugs with high doses and experience adverse events. </p>\n\n<p>They reason why paracetamol/ibuprofen/aspirin are OTC drugs is that these drugs have quite a few interactions with other drugs. Paracetamol is the safest minding the correct dosing. Daily dosage exceeding 4g are associated to liver damage. Ibuprofen and other NSAIDs cannot be used with warfarin, which is pretty much the only major interaction. Adverse effects include GE tract bleeding and kidney injury if daily dosage is high or there is pre-existing condition.</p>\n\n<p>The rest of the drugs You mention are highly spesific drugs with complex mechanism of actions and they have many significant interactions and contra-indications. Proper assessment must done by a professinal and not by common people. </p>\n\n<p>It varies from country to country and depends on local regulation which drugs are OTC. Usually the safest one are, like those you mention and for example antihistamins and some proton-pump inhibitioners. There must be an equilibrium which drugs are OTC and which are not. Certain drugs must be OTC so people can buy those freely and does not need to see a doctor every time they need paracetamol. That would pose a significant burden for health care system. Also, not all drugs should be OTC, most importantly those which have many major interactions and those which are suitable for abuse. Moreover, majority of drugs are used for treatment of chronic diseases so when people run out of prescription they must meet their doctor and thus the status of any illness can be assessed.</p>\n", "score": 6 }, { "answer_id": 738, "body": "<p>Generally, I'd say no, OTC medications are not safer than prescribed medications. However, I disagree with the opinion that they are more dangerous. Primarily I'd like to address a misconception people have about OTC medications (meds). (I will not discuss dietary supplements - also potentially very harmful - because the FDA does not regulate these.)</p>\n\n<p>Many people think that OTC meds are safe because \"the government wouldn't let a dangerous medication be sold over the counter, would they?\" In the US, the \"government\" usually is a reference to the Food &amp; Drug Administration. The answer is:</p>\n\n<blockquote>\n <p>Yes, the FDA <strong>does</strong> allow dangerous medications be sold over the counter.</p>\n</blockquote>\n\n<p>Just look at acetaminophen/paracetamol (ACAP). Before blister-packs were mandated for ACAP, it was the drug of choice for suicide in the UK.</p>\n\n<p>While it is true that the FDA must approve both OTC and prescription drugs, they are assessed for safety, efficacy, possible drug interactions, and <strong>appropriate dosages</strong>. ACAP is OTC because <em>used as directed</em>, the benefits significantly outweigh the risks. This does not address OTC meds that were once FDA approved but have lost approval because of poor labeling practices¹</p>\n\n<p>Are prescription medications safer because they are \"prescribed\"? Not really, because many patients (in many studies, up to 50-60%, which is believed to be an underestimate) don't take their medication as prescribed. This poses a significant burden to health care costs and utilization. </p>\n\n<p>Clearly not all medications eventually become OTC - I don't expect to ever see chemotherapy drugs go OTC, for instance. But many do. This has something to do with patent expiration, being beneficial to patients who can't afford a physician for treatment of common illnesses, e.g. gastric reflux or (in days bygone) gastric ulcers. Allergy medications usually become OTC, antibiotics (in Mexico and other countries), etc.</p>\n\n<p>Drugs are drugs, inherently dangerous when the risk outweighs the benefit or when used improperly. So is water. Too much or too little will kill you; it doesn't mean bottled water is safer than tap water in that instance.</p>\n\n<p>_{<a href=\"http://journal.publications.chestnet.org\" rel=\"nofollow\">1 Unapproved Prescription Cough, Cold, and Allergy Drug Products: Recent US Food and Drug Administration Regulatory Action on Unapproved Cough, Cold, and Allergy Medications</a>}<br>\n_{<a href=\"http://www.jrheum.org/content/32/11/2218.short\" rel=\"nofollow\">Patterns of use and public perception of over-the-counter pain relievers: focus on nonsteroidal antiinflammatory drugs</a>}<br>\n_{<a href=\"http://jama.jamanetwork.com/article.aspx?articleid=195142\" rel=\"nofollow\">Long-term Persistence in Use of Statin Therapy in Elderly Patients</a>}<br>\n_{<a href=\"http://link.springer.com/chapter/10.1007/978-1-4419-5866-2_4#page-1\" rel=\"nofollow\">Medication adherence</a>}</p>\n", "score": 3 } ]

[ "neurology", "medications", "migraine" ]

[ { "answer_id": 784, "body": "<p>As a pragmatic approach I would suggest the following. Back pain and neck pain are the most common reasons why people seek for massage therapy. Most common reason for back and neck pain are muscle spasms. They are painful which cause more spasm a so a vicious circle is ready. Reason why people suffer from muscle spasm is multifactorial. Static working postures, poor muscle strength or generally bad posture leads to unfavourable muscle strains and spasms.</p>\n\n<p>Massage can be really effective for the treatment of these muscle spasms. Massage relieves tension, boosts the blood flow in muscle and helps to remove lactic acid stored in muscles. However, the spasms will definitely appear again if one does not to anything to treat the fundamental reasons why muscle spasm occurs. As so there is no long term effect with massage therapy.</p>\n\n<p>There are two Cochrane reviews published in this topic <a href=\"http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001929.pub2/abstract\">(1)</a>, <a href=\"http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004871.pub4/abstract\">(2)</a>:</p>\n\n<blockquote>\n <p>Massage might be beneficial for patients with subacute and chronic non-specific low-back pain, especially when combined with exercises and education <a href=\"http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001929.pub2/abstract\">(1)</a></p>\n</blockquote>\n\n<p>There is no explicit evidence for the benefits, but what is important is that there is basically no adverse effects related to massage therapy. So in that sense massage can be helpful also for your mind and wellbeing. Exercise and education indicates the same thing I said in the beginning, in addition to relieving the spasms in your back you should also focus on the overall situation, \"why do I have backpain\".</p>\n\n<p>With regard to neck pain the evidence is much more controversial. My personal opinion is that this might be related to etiology of the pain and spasm. Lower back in more common is obese people with poor physical condition <a href=\"http://www.mayoclinic.org/diseases-conditions/back-pain/basics/causes/con-20020797\">(3)</a> whereas neck pain is associated to overuse and bad postures <a href=\"http://www.mayoclinic.org/diseases-conditions/neck-pain/basics/causes/con-20028772\">(4)</a>.</p>\n", "score": 13 }, { "answer_id": 785, "body": "<p>There are a couple of studies that show massage will help with delayed onset muscle soreness (DOMS) after exercise, but that it doesn't really impact range of motion (ROM) or peak maximal force.</p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1250256/\">This study</a> used a small cohort of 5 males, 5 females, doing arm exercises designed to produce DOMS. One arm got massaged, the other didn't. They self reported less DOMS in the massaged muscle, but it showed no impact on ROM or peak force.</p>\n\n<p><a href=\"http://bjsm.bmj.com/content/37/1/72.full\">This study</a> followed a similar path, examining hamstring contractions with a slightly larger group of 18. Each leg was exercised, and only one was massaged with similar results to the first study I cited.</p>\n\n<p>So yes, massage can reduce some of the after effects of intense exercise sessions, it hasn't been proven to actually improve performance.</p>\n", "score": 6 }, { "answer_id": 1931, "body": "<p>Beyond addressing injuries, or as a treatment, massage has been shown to have many health benefits for otherwise healthy individuals in addition to feeling good.\nHere are some examples of health benefits that have some research to back them up:</p>\n\n<ul>\n<li><a href=\"http://news.uic.edu/massage-therapy-improves-circulation-alleviates-muscle-soreness\" rel=\"nofollow\">Decreasing Blood Pressure and improved circulation</a></li>\n<li><a href=\"http://www6.miami.edu/touch-research/AdultMassage.html\" rel=\"nofollow\">Reduced anxiety</a></li>\n<li><a href=\"http://www.hindawi.com/journals/ecam/2011/561753/abs/\" rel=\"nofollow\">Improved Sleep</a></li>\n<li><a href=\"http://www.sciencedirect.com/science/article/pii/S0273229711000025\" rel=\"nofollow\">Improved interpersonal relationships and feelings of self worth</a> </li>\n<li><a href=\"http://www.sciencedirect.com/science/article/pii/S027322970500033X\" rel=\"nofollow\">Increased alertness and ability to concentrate</a></li>\n</ul>\n\n<p>Many of these benefits can also be gained by other means such as exercise or meditation, but that does not diminish the fact that massage is a means of achieving these benefits.</p>\n", "score": 2 } ]

[ "massage" ]

[ { "answer_id": 865, "body": "<blockquote>\n <p>Is it normal for a person to at times feel their heart beat in their chest without actually placing their hand on their chest, while at other times not be able to...? </p>\n</blockquote>\n\n<p>Yes, this is normal.</p>\n\n<p>Normally, people do not feel their heart beating in their chest at rest. It is one of those things similar to breathing - it's happening, but we're not often aware of it (which is good as it might be very distracting otherwise.)</p>\n\n<p>However, an alteration in the steady background of the beating heart is often perceived. Sometimes the alteration is due to increased rate or force of contractions. If so, the sensation of feeling your heart beating (normally under the circumstances) is called <em>physiological palpitations</em> (i.e. normal.) If they are a result of an \"abnormal\" rate or rhythm, the phenomenon is known as \"palpitations\".</p>\n\n<blockquote>\n <p>In normal resting conditions, the activity of the heart is generally not perceived by the individual. However, during or immediately after intense physical activity or emotional stress, it may be quite normal to become aware of one's own heartbeat for brief periods; these sensations are regarded as physiological palpitations, in that they represent the normal or expected response to a certain challenge or activity leading to an increase in the frequency and strength of the contraction of the heart. Outside of such situations, instead, palpitations are perceived as abnormal.² </p>\n</blockquote>\n\n<p>The sensory mechanisms responsible for palpitation are unknown.¹ </p>\n\n<p>What we do know, though, is that if the heart beats faster or more forcefully, we do feel this, both in our chest, and in our necks, as exemplified in the expression, \"my heart rose into my throat.\" We have baroreceptors in major blood vessels in our neck; when more blood is pushed into our arteries by a forceful beat, there is an awareness of increased pressure.</p>\n\n<blockquote>\n <p>Palpitations are a symptom defined as awareness of the heartbeat and are described by patients as a disagreeable sensation of pulsation or movement in the chest and/or adjacent areas.² </p>\n</blockquote>\n\n<p>A more forceful contraction means more blood is pumped in that heart cycle. This can happen if suddenly stressed (e.g. you're speeding and you see a police car pull into your lane behind you); the adrenaline increases both the rate and the force of your heartbeat. </p>\n\n<p>Likewise, when you have a premature ventricular contraction, or PVC. The first beat is early; this allows the next cycle to have a longer \"filling time\", and the resultant more forceful contraction will be felt. Medically speaking:</p>\n\n<blockquote>\n <p>In cases of isolated extrasystoles, the augmented post-extrasystolic beat may be felt in place of, or in addition to, the premature beat.</p>\n</blockquote>\n\n<p>If you have an irregular heartbeat - the weaker ones will not be felt, but the more forceful ones will. This often is perceived as a fluttering in the chest.</p>\n\n<p>Finally, some people are just more sensitive to their heart beat. This also occurs in hypervigilant states.</p>\n\n<p>_{<a href=\"http://www.ncbi.nlm.nih.gov/books/NBK202/\">1 Palpitations</a>}<br>\n_{<a href=\"http://europace.oxfordjournals.org/content/13/7/920\">2 Management of patients with palpitations: a position paper from the European Heart Rhythm Association</a>} </p>\n", "score": 11 }, { "answer_id": 864, "body": "<p>What you're describing is known as Palpitations.</p>\n\n<p><strong>Palpitations</strong> are feelings or sensations that your heart is pounding or racing. They can be felt in your chest, throat, or neck.</p>\n\n<p>Palpitations are not serious most of the time. Sensations representing an abnormal heart rhythm (arrhythmia) may be more serious. </p>\n\n<p>The following conditions make you more likely to have an abnormal heart rhythm:</p>\n\n<ol>\n<li>Known heart disease at the time the palpitations begin</li>\n<li>Significant risk factors for heart disease</li>\n<li>An abnormal heart valve</li>\n<li>An electrolyte abnormality in your blood</li>\n</ol>\n\n<p><strong>Causes</strong>\nAnxiety, stress, panic attack, or fear, caffeine intake, nicotine intake, cocaine or other illegal drugs.\nHowever, some palpitations are due to an abnormal heart rhythm.</p>\n\n<p><strong>When to call a doctor</strong>\nIf you have never had heart palpitations before, see your health care provider.</p>\n\n<p>Call 911 or your local emergency number if you have:</p>\n\n<ol>\n<li>Loss of alertness (consciousness)</li>\n<li>Chest pain</li>\n<li>Shortness of breath</li>\n<li>Unusual sweating,</li>\n<li>Dizziness or light-headedness</li>\n</ol>\n\n<hr>\n\n<p>Source: <a href=\"http://www.nlm.nih.gov/medlineplus/ency/article/003081.htm\" rel=\"nofollow\">http://www.nlm.nih.gov/medlineplus/ency/article/003081.htm</a></p>\n", "score": 3 } ]

[ "cardiology" ]

[ { "answer_id": 1112, "body": "<p>Rock salt is no different from sea salt or table salt, chemically speaking, as all of them consist of nearly-pure sodium chloride (NaCl) </p>\n\n<p>The UK Consensus Action on Salt and Health organisation has <a href=\"http://www.actiononsalt.org.uk/news/surveys/2011/gourmet%20salts/59309.html\" rel=\"nofollow noreferrer\">released a study</a> that showed that NaCl content of various types of standard and \"gourmet\" salts were not significantly different. </p>\n\n<p><img src=\"https://i.stack.imgur.com/3b3zM.jpg\" alt=\"enter image description here\"></p>\n\n<p>It also detailed a few misconceptions about \"gourmet\" salts:</p>\n\n<blockquote>\n <p>Myth 1. Gourmet salts contain less sodium than table salt so are\n better for your health Gourmet salts contain approximately 100% sodium\n chloride, just like your average table salt, meaning they will have\n exactly the same effect on your blood pressure and health.</p>\n \n <p>Myth 2. Gourmet salts contain minerals essential for good health\n Gourmet salts are not a good source of essential minerals, instead you\n can get all the vitamins and minerals you need from a balanced diet\n with plenty of fruit and vegetables.</p>\n \n <p>Myth 3. Gourmet salts taste better or stronger so you can use less\n There is no evidence that people use less of any type of salt. If you\n prefer the flavour of a particular type of salt, and really want to\n use it, use less to help cut down on your salt intake. Some gourmet\n salts also have a larger crystal size, these might not taste as salty\n as finer grains so the danger is you could end up using even more!</p>\n</blockquote>\n", "score": 5 } ]

[ "nutrition", "diabetes", "food-safety" ]

[ { "answer_id": 1003, "body": "<p>First of all, one has to distinguish between <a href=\"http://en.wikipedia.org/wiki/Visual_acuity\" rel=\"nofollow noreferrer\"><strong>visual acuity</strong></a> (VA), which is a measure for the maximal possible resolution your eye-brain-system can achieve, and the <a href=\"http://en.wikipedia.org/wiki/Refractive_error\" rel=\"nofollow noreferrer\"><strong>refractive error</strong></a>, which measures the deviation of the optical system of your eye from <em>emmetropy</em> (=perfectly balanced optics, sharp focus on retina without any glasses) in <em>diopters</em> of spheres and cylinders and thus determines what corrective glasses you need to wear in front of your eye in order to achieve your maximum possible visual acuity. </p>\n\n<p>Visual acuity can be measured without corrective glasses, i.e. the \"native\" VA of your eye, or with your best corrective glasses, which then gives you the value of your \"Best-corrected visual acuity\" (BCVA), and only this value is useful for comparison purposes, e.g. for driver's licenses (because errors that <em>can</em> be corrected by glasses also <em>are</em> to be corrected by law, as this is rather easy to do for everybody), and also for scientific evaluation of eye performance.</p>\n\n<p>This also explains a common misconception: When somebody is very near- or farsighted (myope or hyperope), he has to wear glasses with a high (absolute) value of diopters, e.g. -7 dpt. But if he reaches 20/20 vision with his glasses on (again, BCVA), then to an eye doctor, this will matter the most; for the glasses are neglegible in comparison to \"real\" eye diseases which can impair your eye function and lower the BCVA your eye can reach. Many people incorrectly compare their eye functions by comparing the amount of diopters in their glasses, yet this doesn't really say anything about the maximum resolution their eyes have when wearing their best glasses. Refractive errors can be corrected by glasses, contact lenses and laser surgery, but the maximum visual acuity an eye-brain-system is able to achieve can <em>not</em> be altered in any (simple) way.</p>\n\n<p>Now, when visual acuity is measured, a <em>full</em> visual acuity, i.e. \"normal\", or 100%, or any way you'd like to name it, has once simply deliberately been determined by a minimum angle of resolution of 1 arc minute, and the charts that are used for testing it have letters that correspond with this resolution. <a href=\"http://en.wikipedia.org/wiki/Minute_of_arc\" rel=\"nofollow noreferrer\">1 arc minute</a> of resolution corresponds to being able to separate two points with 2,91 cm between them at a distance of 100 m. Now note that this does <em>not</em> necessarily correspond with what most people are able to see; as said previously, the definition of 100% visual acuity was deliberate.\nThe capability to distinguish points with 1 arc minute of space between them has been defined as 20/20 (or 6/6) vision in <a href=\"http://en.wikipedia.org/wiki/Snellen_chart\" rel=\"nofollow noreferrer\">Snellen charts</a>, 1.0 vision in <a href=\"https://www.caa.co.uk/uploadedFiles/CAA/Content/Standard_Content/Medical/Visual/Files/Visual%20Acuity%20Conversion%20Chart.pdf\" rel=\"nofollow noreferrer\">decimal charts (conversion table)</a>, and later 0.0 <a href=\"http://en.wikipedia.org/wiki/LogMAR_chart\" rel=\"nofollow noreferrer\">logMAR</a>, which is the logarithm of the minimum angle of resolution and which has become <a href=\"http://www.icoph.org/dynamic/attachments/resources/icovisualacuity1984.pdf\" rel=\"nofollow noreferrer\">the gold standard in measuring and comparing visual acuity</a> (see p.13 for conversion chart), but is predominantly used for scientific purposes and less in clinical environments. </p>\n\n<p>This is basic knowledge in optics, optometry and ophthalmology. <a href=\"http://en.wikipedia.org/wiki/Visual_acuity\" rel=\"nofollow noreferrer\">Wikipedia</a> describes the correlations between the terms pretty well.</p>\n", "score": 7 }, { "answer_id": 984, "body": "<p>The 0 to 1 scale is simply a <a href=\"http://en.wikipedia.org/wiki/Visual_acuity#Expression\" rel=\"nofollow\">decimal expression</a> of the 20/20 (Imperial) or 6/6 (metric) measure of visual acuity. It's related to the smallest gap size someone can see on the <a href=\"http://en.wikipedia.org/wiki/Landolt_C\" rel=\"nofollow\">Landolt C chart</a>.</p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/Dioptre\" rel=\"nofollow\">Dioptres</a> are not a measure of eyesight quality <em>per se</em>. Rather, they're a measure of the focal length of the lenses needed to bring your eyesight to normal. An <a href=\"http://en.wikipedia.org/wiki/Eyeglass_prescription\" rel=\"nofollow\">eyeglasses prescription</a> might specify two or three such measures to correct various aberrations (eg. \"-5 diopters; -1 diopter @ 180), in such a case, the first one is a spherical correction for distance vision, while the second is a cylindrical correction for <a href=\"http://en.wikipedia.org/wiki/Astigmatism_(eye)\" rel=\"nofollow\">astigmatism</a> and the third (in the rare case that it's present) is a prism correction for <a href=\"http://en.wikipedia.org/wiki/Vergence#Vergence_dysfunction\" rel=\"nofollow\">alignment problems</a>. Eyesight expressed as a single diopter measure refers to the correction needed for distance vision.</p>\n\n<p>Your \"negative integers\" method may be diopters again: a diopter measure can be either positive or negative, depending on what vision problems it's correcting.</p>\n\n<p>I can't find a \"0 to 20+\" scale for visual acuity.</p>\n", "score": 3 } ]

[ "eye", "optometry" ]

[ { "answer_id": 5197, "body": "<p>Natural Ways to quit Smoking</p>\n\n<ul>\n<li><a href=\"https://www.caring.com/articles/10-simple-tricks-to-stop-smoking\" rel=\"nofollow\">Candy and Gum.</a> Sucking candy or chewing gum can occupy your mouth and time much the same as cigarettes. Even <a href=\"http://stopcigarettes.net/lollipops-to-you-quit-smoking/\" rel=\"nofollow\">lollipops</a> can help. </li>\n</ul>\n\n<blockquote>\n <p>The flavor of the gum keeps the mouth fresh, making smoking less\n attractive. The act of chewing relieves the desire for oral\n stimulation and keeps the mouth busy.</p>\n \n <p>The cool, tingly feeling of menthol or mint makes a smoker's mouth\n feel fresh and clean, which tricks the brain into feeling less desire\n for that hot intake of smoke.</p>\n</blockquote>\n\n<ul>\n<li><p><a href=\"http://www.webmd.com/smoking-cessation/ss/slideshow-13-best-quit-smoking-tips-ever\" rel=\"nofollow\">Avoid triggers</a>. Things you did while smoking or stress and other behaviors that encourage smoking. They vary per person. <a href=\"http://www.cancer.org/healthy/stayawayfromtobacco/quitting-smoking-help-for-cravings-and-tough-situations\" rel=\"nofollow\">They can even be drinks</a> such as coffee, alcohol or tea. </p></li>\n<li><p><a href=\"http://www.quitsmokingsupport.com/breathing.htm\" rel=\"nofollow\">Deep Breathing.</a> Some smokers while smoking inhaled deeply which promotes relaxation. Proper deep breathing as your stomach protrude on inhalation which allows the lungs to expand more and hold more air. <a href=\"http://www.livestrong.com/article/387139-breathing-exercises-after-quitting-smoking/\" rel=\"nofollow\">Other breathing exercises.</a> </p></li>\n<li><p><a href=\"http://www.everydayhealth.com/smoking-cessation/living/exercise-can-help-you-quit-smoking.aspx\" rel=\"nofollow\">Exercise.</a> 30 minutes a day can prove helpful. </p></li>\n</ul>\n\n<blockquote>\n <p>Decreases appetite, Eases nicotine withdrawal symptoms when you first\n quit smoking, Distracts you from thoughts of smoking, Improves your mood,\n Helps you cope with stress and feel more energetic</p>\n</blockquote>\n\n<ul>\n<li>Others: Adequate Hydration, appropriate diet, adequate rest, etc. \n\n<hr></li>\n</ul>\n\n<p>Additional Info:</p>\n\n<ul>\n<li><p><a href=\"http://www.webmd.com/smoking-cessation/features/first-30-days\" rel=\"nofollow\">The First 30 Days: Quit Smoking!</a></p></li>\n<li><p><a href=\"http://www.cancer.org/healthy/stayawayfromtobacco/quitting-smoking-help-for-cravings-and-tough-situations\" rel=\"nofollow\">Quitting Smoking: Help for Cravings and Tough Situations</a></p></li>\n</ul>\n", "score": 3 } ]

[ "smoking", "nicotine", "tobacco", "breaking-habits", "cravings" ]

[ { "answer_id": 1087, "body": "<blockquote>\n <p>...I don't think this is the same as the effect you get on thanksgiving.</p>\n</blockquote>\n\n<p>Actually, it probably is, and soon some people will be able to get that same sleep-inducing effect in the form of a pill.</p>\n\n<p>Your sleepiness after a meal is caused by the <s>presence or absence</s> decrease of peptides in your brain called orexins (aka hypocretins).</p>\n\n<p>In 1998, two groups of researchers simultaneously discovered 2 small neuropeptide hormones that regulate, among other things, wakefulness and feeding behavior. </p>\n\n<p>One group discovered them while searching for molecules that could bind to \"orphan\" receptors, that is, a brain receptor with an unknown \"binding\" molecule (called a ligand). They found that the prohormone <em>prepro-orexin</em> was found in a very small area of the hypothalamus which had been implicated in the regulation of feeding behavior and energy homeostasis; this suggested the possibility that the neuropeptides might be involved in the regulation of food intake. When administered into free-feeding rats' brains, one of these peptides (orexin A/hypocretin 1) stimulated food consumption in a dose-dependent manner (with attention to light and dark periods, i.e. the circadian rhythm), with a lower dose increasing rat feeding about 2-fold, and the higher dose inducing a 3+-fold increase in feeding compared to rats injected with a solution without the peptide (the other stimulated feeding to a lesser degree). The effect persisted for 4 hours. Furthermore, fasting rats produced more than twice as much orexins as rats feeding freely. For this reason, the molecules were names \"orexins\", after the Greek word <em>orexis</em>, which means \"appetite\". They speculated that the orexin-secreting neurons might somehow be modulated by glucose.</p>\n\n<p>At the same time, another group of researchers using a completely different approach found that the same group of hypothalamic neurons were stimulated by a peptide hormone similar in composition to the gut hormone <em>secretin</em>. They identified the same prohormone and its two peptides, naming them <em>hypocretins</em> for \"hypothalamus\" and \"secretin\". They found that at least one of the peptides had a neuroexcitatory activity in specific areas of the brain (they mapped effects in the hypothalamic neurons, the posterior hypothalamus, the septal nuclei in the basal forebrain, the preoptic area, the paraventricular nucleus of the thalamus, the central gray, the locus coeruleus, the colliculi, the laterodorsal tegmental nucleus, and the nucleus of the solitary tract) suggesting that the peptides acted within the central nervous system as homeostatic regulators with a role in nutritional homeostasis.</p>\n\n<p>Scientists have not decided on whether to call them <em>orexins</em> or <em>hypocretins</em> yet, so both are used. They are found in all vertebrates.</p>\n\n<p><img src=\"https://i.stack.imgur.com/b3FeV.gif\" alt=\"enter image description here\"></p>\n\n<p>_{Mammalian orexin A sequences thus far identified (human, rat, mouse, pig, dog, sheep, and cow) are all identical, whereas the sequences of orexin B show some differences among species. From <em>Orexin/Hypocretin: A Neuropeptide at the Interface of Sleep, Energy Homeostasis, and Reward System</em>, Natsuko Tsujino and Takeshi Sakurai}</p>\n\n<p>In 1999, a group of scientists found that narcolepsy (a sleep disorder characterized by extreme daytime sleepiness) was caused by a lack of a hypocretin/orexin receptor 2 gene in certain dogs, therefore establishing that they play a very important part in the regulation of wakefulness.*</p>\n\n<p>Since then, an enormous body of work has shown that orexins/hypocretins (O/H from here on in) are involved in the regulation of a wide range of behaviors, including wakefulness and vigilance (needed to find food), systems that regulate emotion and reward (including drug-seeking behavior when stressed and eating for pleasure - \"consumption beyond homeostatic needs\" - leading to obesity), and more.**</p>\n\n<p><strong>What does eating have to do with sleepiness?</strong></p>\n\n<p>Several studies report that the firing rates of O/H neurons are influenced by serum glucose, triglycerides and amino acids. </p>\n\n<p>In English, and in your case: You are awake (O/H is being secreted by O/H neurons in your hypothalamus). You eat. Your serum glucose rises. The elevated glucose causes depolarization of inhibitory neurons <em>that hyperpolarize O/H neurons decreasing the amount of O/H. released.</em> Result: wakefulness decreases. (You can barely make it to your bed, in your case!)</p>\n\n<p><strong>What about Thanksgiving in a pill?</strong></p>\n\n<p>The US Food and Drug Administration recently approved suvorexant (Belsomra) for the treatment of chronic insomnia. The (prescription only) drug is an <em>orexin receptor antagonist</em> and is the first approved drug of this type. It blocks the effect of orexin in wakefulness (isn't science grand?) Unlike benzodiazepines and other hypnotics, rather than promoting sleep, suvorexant inactivates wakefulness, and rebound insomnia and withdrawal effects were not observed when suvorexant was discontinued after 3 months or 12 months of <em>nightly</em> use. It does have risks and side effects, but so far its safety profile looks pretty good.</p>\n\n<p>_{Comparing these two papers - the first and second references - is a wonderful example of the completely different methods used by scientists to investigate unknowns and up with the same basic conclusion.}<br>\n_{<a href=\"http://www.sciencedirect.com/science/article/pii/S0092867400809496\" rel=\"noreferrer\">Orexins and orexin receptors: a family of hypothalamic neuropeptides and G protein-coupled receptors that regulate feeding behavior</a>, Cell 92 (4): 573–85}<br>\n_{<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC18213/\" rel=\"noreferrer\">The hypocretins: Hypothalamus-specific peptides with neuroexcitatory activity</a> Proc. Natl. Acad. Sci. U.S.A. 95 (1): 322–7}<br>\n_{<a href=\"http://www.cell.com/cell/abstract/S0092-8674%2800%2981965-0?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867400819650%3Fshowall%3Dtrue\" rel=\"noreferrer\">The Sleep Disorder Canine Narcolepsy Is Caused by a Mutation in the Hypocretin (Orexin) Receptor 2 Gene</a>}<br>\n_{<a href=\"http://www.nature.com/nrn/journal/v15/n11/full/nrn3837.html\" rel=\"noreferrer\">The role of orexin in motivated behaviours</a> A <em>Nature Neuroscience</em> Review}<br>\n_{<a href=\"http://www.sciencedirect.com/science/article/pii/S0306452210001582\" rel=\"noreferrer\">The role of orexin-A in food motivation, reward-based feeding behavior and food-induced neuronal activation in rats</a>}<br>\n*_{Human narcolepsy - caused by a destruction of O/H neurons - also is associated with metabolic abnormalities, including increased frequency of non-insulin-dependent diabetes mellitus and increased body mass index.}<br>\n**_{Chocolate is like a drug; a regular meal isn't. Didn't we all know that already?}<br>\n_{<a href=\"http://www.sciencedirect.com/science/article/pii/S0896627303003313\" rel=\"noreferrer\">Hypothalamic Orexin Neurons Regulate Arousal According to Energy Balance in Mice</a>}<br>\n_{<a href=\"http://pharmrev.aspetjournals.org/content/61/2/162.long\" rel=\"noreferrer\">Orexin/Hypocretin: A Neuropeptide at the Interface of Sleep, Energy Homeostasis, and Reward System</a>} </p>\n", "score": 10 } ]

[ "nutrition" ]

[ { "answer_id": 15226, "body": "<p>These patients were all female, and the tumors are described as exceedingly rare. Were you looking for males?</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/14668717\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/14668717</a></p>\n\n<blockquote>\n <p><strong>METHODS:</strong>\n A retrospective chart review from January 1946 through November 2002 identified 11 female patients with pure androgen-secreting adrenal tumors.</p>\n \n <p><strong>RESULTS:</strong>\n The mean age was 23.4 years (range, 1-52). The most common presenting symptoms were hirsutism, acne, and clitoral enlargement. Elevated 17-ketosteroids were found in seven of nine tested patients. Computed tomogram, ultrasound, or both localized tumors in six of seven patients. All tumors were surgically resected, one laparoscopically, all without complications. Five of the 11 tumors were malignant. Mean weight and mean maximal diameter for benign and malignant tumors were 44 g and 4.2 cm and 232 g and 9.8 cm, respectively. Mean hospital stay was 8.5 days, with excess androgen production resolved in all patients. Recurrence and disease-related death occurred in only one patient who had pulmonary metastases at diagnosis. The remaining patients had no recurrence of tumor at mean follow-up of 11.7 years (range, 0.5-32 years).</p>\n</blockquote>\n", "score": 2 } ]

[ "cancer", "endocrinology", "tumors", "androgen" ]

[ { "answer_id": 19330, "body": "<p><strong>TLDR:</strong> The pathogenesis of eczema is multifactorial, but broadly follows a process of genetic (or epigenetic, in the case of the early gut microbiome) dysregulation relating to barrier integrity proteins like filaggrin with corresponding changes in the skin microenvironment's ceramide content. Following these changes in protein structure and function and lipid quantity, the compromised barrier is predisposed to irritation and infection, which leads to an abnormal immunological response as Th2 cells work to resolve inflammatory processes in the skin (it's not clear how B cells participate in the pathogenesis of eczema at this time). </p>\n\n<p>Treatment options for mild-moderate eczema are generally limited to topical corticosteroids and moisturizing ointments, as well as topical immunomodulators. For more severe disease, patients can pursue phototherapy, oral (and other systemic) immunosuppressants, or, recently, the mAb dupilumab, which targets the Th2-regulated cytokines IL-4 and IL-13. Considering this mAb's efficacy, you might regard eczema as an autoimmune disease with non-immunological predisposing factors.</p>\n\n<hr>\n\n<p>Generally speaking, all of the mechanisms you've described participate in the pathogenesis of eczema. As mentioned, atopic dermatitis (eczema) is not completely understood, but a number of factors have been identified as potential targets for clinical interventions. It remains unclear whether eczema is initiated at the skin barrier (\"outside-in\") or by the immune system (\"inside-out\"), as quality evidence supports either hypothesis, but the actual etiology of eczema is likely a complex interplay between extrinsic and intrinsic physiological elements. Collectively, these factors culminate to produce chronic pruritic (itchy) skin inflammation, particularly on flexor surfaces (\"creases\" between joints).</p>\n\n<blockquote>\n <ol>\n <li>If the cause is a deficiency of ceramide, what causes this cause? </li>\n </ol>\n</blockquote>\n\n<p>Ceramide is an interesting subject in the context of eczema. There are 12 ceramide subspecies, the quantities of which are important for the organization of the epidermal barrier. We know that the epidermal barrier is compromised in eczema, and we know that relative ceramide concentrations are different on eczema patients' skin compared to healthy controls, so we say that there is an <em>association</em> between altered ceramide production and eczema, although we're not certain that this 'deficiency' of ceramide is the actual cause of eczema <a href=\"https://onlinelibrary.wiley.com/doi/full/10.1111/cod.12073\" rel=\"nofollow noreferrer\">[1]</a>.</p>\n\n<blockquote>\n <p>Ceramides are a family of waxy lipid molecules, so exactly which chemical is produced? </p>\n</blockquote>\n\n<p>From [1]: <code>The lipid bilayers of the stratum corneum consist predominantly of three different lipids: ceramides, cholesterol, and free fatty acids. The ceramides are further divided into 12 subspecies (ceramides 1–12), and are thought to be critical in the organization of the lipid bilayer. The synthesis of the lipids takes place in the stratum granulosum, from where the lipids are delivered to the stratum corneum. The lipids surround the corneocytes, which are flat nucleus‐free cells built of keratin filaments and surrounded by cross‐linked proteins called the cornified envelope.</code></p>\n\n<blockquote>\n <p>Is it because the skin produces another kind of ceramide which has lower quality, or it does not produce enough?</p>\n</blockquote>\n\n<p>From [1]: <code>Comparisons of SC ceramides in healthy skin and atopic dermatitis skin were made by different groups in the 1990s, and showed lower levels of ceramides 1 and 3, as well as a lower ceramide/cholesterol ratio, for non‐lesional atopic skin.</code></p>\n\n<blockquote>\n <ol start=\"2\">\n <li>If the cause is an abnormal or missing protein, what causes this cause?</li>\n </ol>\n</blockquote>\n\n<p>The \"key players\" in skin barrier integrity are lipids (like ceramide) and proteins (which are regulated by gene expression). Because of this known relationship, it was long-hypothesized that there was some genetic dysregulation contributing to the compromised barrier integrity in eczema, which was supported by twin studies showing that eczema was highly heritable. In 2006, mutations in the gene encoding filaggrin (FLG) were identified as a primary predisposing factor for eczema [<a href=\"https://www.nature.com/articles/ng1767\" rel=\"nofollow noreferrer\">2</a>,<a href=\"https://www.ncbi.nlm.nih.gov/pubmed?term=16815158\" rel=\"nofollow noreferrer\">3</a>].</p>\n\n<blockquote>\n <p>What protein it is?</p>\n</blockquote>\n\n<p>From [2]: <code>Filaggrin is a key protein that facilitates terminal differentiation of the epidermis and formation of the skin barrier.</code></p>\n\n<p>As it relates to ceramide, from [1]: <code>...one research group studied atopic dermatitis skin, excluding patients with filaggrin mutations to ensure that the discoveries made were independent of the mutations, and correlated the ceramide composition with the lamellar lipid organization. They found significantly lower levels of ceramide 3 in atopic dermatitis individuals than in healthy controls, as well as a correlation between a low ceramide 3 level and lamellar lipid disorganization, despite the presence of wild‐type filaggrin in both groups.</code></p>\n\n<p>We can see from these results that both proteins (filaggrin) and lipids (ceramide) are involved in the pathogenesis of eczema, but they don't appear to be significantly related to one another. <strong>It's possible that eczema/atopic dermatitis, as we currently understand it, can actually be broken up into many subphenotypes that have similar presentations (itchy, erythematous skin) but different etiologies, much like cancer and sepsis.</strong></p>\n\n<blockquote>\n <p>Is that something related to T cells (recognizing antigens) or B cells (producing antibodies)? </p>\n</blockquote>\n\n<p>As mentioned above, skin cells (not T cells) are responsible for lipid production, and filaggrin \"facilitates terminal differentiation of the epidermis\" (not lymphocyte development). However, T lymphocytes <em>are</em> involved in eczema, as it is an inflammatory process (which are regulated by these immune cells) [<a href=\"https://www.karger.com/Article/Abstract/154935\" rel=\"nofollow noreferrer\">4</a>]. To avoid going down too many rabbit holes, you might familiarize yourself with <a href=\"https://en.wikipedia.org/wiki/T_helper_cell\" rel=\"nofollow noreferrer\">helper T cells and cytokines</a> before continuing. From [4]: <code>...a subgroup of patients with atopic dermatitis has a filaggrin loss-of-function mutation. Recently, it was shown that filaggrin expression is reduced in atopic dermatitis even in the absence of any mutation. Keratinocytes differentiated in the presence of IL- 4 and IL-13 exhibited significantly reduced filaggrin gene expression and neutralization of IL-4 and IL-13 improves skin barrier integrity. This indicates that Th-2 lymphocytes directly contribute to the skin barrier defect in atopic dermatitis...Microscopic studies revealed a sparse perivascular T cell infiltrate in unaffected atopic dermatitis skin that is not seen in normal healthy skin.</code></p>\n\n<p>In terms of B cells, conflicting evidence exists regarding their participation in eczema's pathogenesis. Some patients have shown dramatic improvement in their symptoms when treated with rituximab, an anti-B cell mAb [<a href=\"https://www.sciencedirect.com/science/article/pii/S0091674907022531\" rel=\"nofollow noreferrer\">5</a>], while others have not responded to the medication [<a href=\"https://www.onlinelibrary.wiley.com/doi/full/10.1111/ced.12691\" rel=\"nofollow noreferrer\">6</a>], marking the need for a formal RCT examining rituximab's efficacy in treating eczema and further studies elucidating the role of B cells in the pathogenesis of the disease.</p>\n\n<blockquote>\n <p>Is it a skin problem or an immune system problem?</p>\n</blockquote>\n\n<p>This is really asking \"is eczema an outside-in or an inside-out problem?\" The answer, as I'm sure you've already realized, is: it's more complicated than that. The \"problem\" of eczema arises from disrupted skin permeability, which can be both caused and worsened by a variety of intrinsic and extrinsic factors [<a href=\"https://www.sciencedirect.com/science/article/pii/S0923181106001733\" rel=\"nofollow noreferrer\">7</a>]:</p>\n\n<p><a href=\"https://i.stack.imgur.com/kG26y.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/kG26y.png\" alt=\"Fig.6-Proksch2006\"></a></p>\n\n<blockquote>\n <ol start=\"3\">\n <li>Also, I heard from many sources that this is an immune system problem. And the source of this problem is the gut. They quote Hippocrates: \"All disease begins in the gut\". Is that true? </li>\n </ol>\n</blockquote>\n\n<p>It's true that studies have shown an association between reduced gut microbial diversity in early life and eczema, but best evidence doesn't support that the gut microbiome plays a definitively causative part in the pathogenesis of the disease [<a href=\"https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.14907\" rel=\"nofollow noreferrer\">8</a>].</p>\n\n<p>From [8]: <code>Culture-based studies have shown strong associations between cutaneous Staphylococcus aureus colonisation and established atopic eczema during and outside of the context of disease flares. Using the same approach, there is also evidence for an inverse relationship between gut bacterial diversity in early life and the later development of atopic eczema, in keeping with the ‘biodiversity hypothesis’...both Staphylococcus aureus and epidermidis proliferate whilst bacterial diversity drops at lesional sites when atopic eczema flares, but S. aureus elimination is not the main reason why atopic eczema gets better...studies have not found evidence that S. aureus colonisation triggers atopic eczema development...</code></p>\n\n<p>Because eczema is an inflammatory disorder, the immune system is an inherent participant in its initiation and resolution. Recent research has identified Th2 cells as important players in the pathogenesis of eczema [<a href=\"https://onlinelibrary.wiley.com/doi/full/10.1111/exd.13336\" rel=\"nofollow noreferrer\">9</a>]. From [9]: <code>Early models of aetiology attributed symptoms of [eczema] to cutaneous inflammation at lesion sites, but recent studies have established that activated immune mediators in the circulation drive disease severity. Activation of T helper 2 (Th2) and Th22 cells in the circulation appears to be the principal initiator of acute [eczema] pathology, with the emergence of Th1 and Th17/interleukin (IL)‐23 pathway activation marking the transition to a chronic state.</code></p>\n\n<blockquote>\n <p>Will just eating healthy food, adding more probiotics, and applying moisturizer help the skin effectively?</p>\n</blockquote>\n\n<p>\"Healthy food\" <em>won't necessarily</em> help, but avoiding food that contains allergens that trigger your eczema outbreaks <em>will</em>. Besides, eating healthier will make you feel better in general. \"More probiotics\" almost certainly <em>won't</em> help, as clarified by [8]: <code>...there is further evidence that a reduced diversity of the faecal microbiota precedes the development of atopic eczema, an association that appears lost in established disease.</code> If \"established disease\" doesn't feature the same reduced diversity in the fecal microbiome as before the development of eczema, then the microbiome in established disease isn't really a therapeutic target. </p>\n\n<p>\"Applying moisturizer\" <em>probably will</em> help. From [7]: <code>Application of creams and ointments containing lipids and lipid-like substances, hydrocarbons, fatty acids, cholesterol esters and triglycerides stimulates barrier repair and increases stratum corneum hydration...As AD is often accompanied by reduced lipid composition, topical application of lipids and hydrocarbons may partially correct permeability barrier defects. It has been shown that topical treatment with hydrocortisone ointments may lead to rapid improvement in barrier function in atopic skin...several research groups and companies report that creams containing ceramides and a mixture of the three key lipids are not superior to ‘‘classical’’ cream or ointment preparations, such preparations have not yet been widely used. More research is necessary to determine the significance of ceramides and the treatment composition with the most therapeutic benefit.</code></p>\n\n<p>The pathogenesis of eczema is multifactorial, but broadly follows a process of genetic (or epigenetic, in the case of the early gut microbiome) dysregulation relating to barrier integrity proteins like filaggrin with corresponding changes in the skin microenvironment's ceramide content. Following these changes in protein structure and function and lipid quantity, the compromised barrier is predisposed to irritation and infection, which leads to an abnormal immunological response as Th2 cells work to resolve inflammatory processes in the skin (it's not clear how B cells participate in the pathogenesis of eczema at this time). </p>\n\n<p>Treatment options for mild-moderate eczema are generally limited to topical corticosteroids and moisturizing ointments, as well as topical immunomodulators. For more severe disease, patients can pursue phototherapy, oral (and other systemic) immunosuppressants, or, recently, the mAb dupilumab, which targets the Th2-regulated cytokines IL-4 and IL-13 [<a href=\"https://www.ncbi.nlm.nih.gov/pubmed?term=27690741\" rel=\"nofollow noreferrer\">10</a>]. Considering this mAb's efficacy, you might regard eczema as an autoimmune disease with non-immunological predisposing factors.</p>\n\n<hr>\n\n<p>[1] Jungersted, J. M. and Agner, T. (2013), Eczema and ceramides: an update. <em>Contact Dermatitis,</em> 69:65-71. <a href=\"https://www.doi.org/10.1111/cod.12073\" rel=\"nofollow noreferrer\">doi:10.1111/cod.12073</a></p>\n\n<p>[2] Palmer, C. N. A. <em>et al.</em> (2006), Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. <em>Nature Genetics,</em> 38:441–446. <a href=\"https://www.doi.org/10.1038/ng1767\" rel=\"nofollow noreferrer\">doi:10.1038/ng1767</a></p>\n\n<p>[3] Weidinger, S. <em>et al.</em> (2006), Loss-of-function variations within the filaggrin gene predispose for atopic dermatitis with allergic sensitizations. <em>J Allergy Clin Immunol,</em> 118(1):214-219. <a href=\"https://www.doi.org/10.1016/j.jaci.2006.05.004\" rel=\"nofollow noreferrer\">doi:10.1016/j.jaci.2006.05.004</a></p>\n\n<p>[4] Werfel, T. and Wittmann, M. (2008), Regulatory Role of T Lymphocytes in Atopic Dermatitis. <em>Chem Immunol Allergy,</em> 94:101-111. <a href=\"https://www.doi.org/10.1159/000154935\" rel=\"nofollow noreferrer\">doi:10.1159/000154935</a></p>\n\n<p>[5] Simon, D. <em>et al.</em> (2008), Anti-CD20 (rituximab) treatment improves atopic eczema. <em>J Allergy Clin Immunol,</em> 121(1):122-128. <a href=\"https://www.doi.org/10.1016/j.jaci.2007.11.016\" rel=\"nofollow noreferrer\">doi:10.1016/j.jaci.2007.11.016</a></p>\n\n<p>[6] McDonald, B. S. <em>et al.</em> (2015), Rituximab as a treatment for severe atopic eczema: failure to improve in three consecutive patients. <em>Clin Exp Dermatol,</em> 41:45-47. <a href=\"https://www.doi.org/10.1111/ced.12691\" rel=\"nofollow noreferrer\">doi:10.1111/ced.12691</a></p>\n\n<p>[7] Proksch, E. <em>et al.</em> (2006), Skin barrier function, epidermal proliferation and differentiation in eczema. <em>J Derm Sci,</em> 43(3):159-169. <a href=\"https://www.doi.org/10.1016/j.jdermsci.2006.06.003\" rel=\"nofollow noreferrer\">doi:10.1016/j.jdermsci.2006.06.003</a></p>\n\n<p>[8] Marrs, T. and Flohr, C. (2016), The role of skin and gut microbiota in the development of atopic eczema. <em>Br J Dermatol,</em> 175:13-18. <a href=\"https://www.doi.org/10.1111/bjd.14907\" rel=\"nofollow noreferrer\">doi:10.1111/bjd.14907</a></p>\n\n<p>[9] Guttman‐Yassky, E. <em>et al.</em> (2017), Systemic immune mechanisms in atopic dermatitis and psoriasis with implications for treatment. <em>Exp Dermatol,</em> 27:409– 417. <a href=\"https://www.doi.org/10.1111/exd.13336\" rel=\"nofollow noreferrer\">doi:10.1111/exd.13336</a></p>\n\n<p>[10] Simpson, E. L. <em>et al.</em> (2016), Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis. <em>N Engl J Med,</em> 375(24):2335-2348. <a href=\"https://www.doi.org/10.1056/NEJMoa1610020\" rel=\"nofollow noreferrer\">doi: 10.1056/NEJMoa1610020</a></p>\n", "score": 4 } ]

[ "dermatology", "immune-system", "digestion", "eczema" ]

[ { "answer_id": 8963, "body": "<p>Couldn't find any articles directly looking at effervescent tablets and dental problems, so I took a more broad look and searched for citric acid's effect on teeth.</p>\n\n<p>The combination of citric acid and sodium bicarbonate are routinely used in effervescent tablets designed for human consumption (according to Wikipedia ;).</p>\n\n<p>Citric acid is commonly found in many fruit juices and many soft drinks we consume have an acidic pH. I found an article that looks specifically at citric acid compared with artificial saliva. </p>\n\n<blockquote>\n <p>Hence, enamel wear in the citric acid solution was significantly higher than in the artificial saliva</p>\n</blockquote>\n\n<p>The study found that citric acid had a negative affect on tooth wear compared with artificial saliva. I would be cautious trying to relate these results to something like drinking an effervescent multivitamin solution though; the tooth exposure to citric acid was probably longer than if you just drank a solution and especially if you washed your mouth and brushed your teeth after.</p>\n\n<p>So to recap:</p>\n\n<ol>\n<li><p>Effervescent tablets usually contain citric acid which is the only compound I researched, so those not containing citric acid don't apply to this</p></li>\n<li><p>Citric acid and other acids are fairly well established as \"bad\" for your teeth, most notably sodas and acidic fruit drinks</p></li>\n<li><p>I assume that brushing your teeth or washing your mouth out after use would help, but I can't back that up with any research</p></li>\n</ol>\n\n<p>So effervescent tablets containing citric acid is worse than saliva for your teeth, but how much of an effect it would have especially with infrequent use I can't really say.</p>\n\n<p>References:</p>\n\n<p>Zheng, J., Huang, H., Shi, M., Zheng, L., Qian, L., &amp; Zhou, Z. (2011). In vitro study on the wear behaviour of human tooth enamel in citric acid solution. Wear, 271(9-10), 2313-2321. doi:10.1016/j.wear.2010.11.027</p>\n", "score": 6 } ]

[ "dentistry", "side-effects", "micronutrients", "oral-health" ]

[ { "answer_id": 3908, "body": "<p>I don't know if anyone can give a definite answer as to why <em>these</em> folks so badly wanted you to donate platelets over whole blood, but there are many possible reasons.</p>\n\n<ol>\n<li><strong>Platelets give you more bang for your buck.</strong> According to <a href=\"http://www.redcrossblood.org/donating-blood/types-donations\" rel=\"noreferrer\">the American Red Cross</a>, one session of platelet apheresis can collect enough platelets for one or two transfusions. On the other hand, it can take anywhere from four to six donations of whole blood to get the same amount of platelets.</li>\n<li><strong>Platelets are always needed, at high rates.</strong> The first point is important, because those who use platelets often use them in bulk (some organ transplant patients need up to 30 units worth¹ - see <a href=\"http://www.universityhealthsystem.com/plateletpheresis/\" rel=\"noreferrer\">a page from University Health System</a>).</li>\n<li><strong>Platelets have a short shelf life.</strong> <a href=\"http://bca.coop/products-services/blood-products/platelets/\" rel=\"noreferrer\">Blood Centers of America</a> states that even with some processing, platelets need to be transfused within about five days after the donation, meaning that waiting can cause the loss of an entire donation. There is a constant need for refills (for lack of a better word). Even this narrow window has been modified in the past, shrinking or growing (see <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/21517896\" rel=\"noreferrer\">Sireis et al. (2011)</a>).</li>\n<li><strong>Platelets are used for cancer patients.</strong> The <a href=\"https://www.mskcc.org/about/get-involved/donating-blood/faqs-donating-blood-platelets/platelet-donations\" rel=\"noreferrer\">Memorial Sloan Kettering Cancer Center</a> says that patients who are suffering from leukemia or have just had a bone marrow transplant may have low platelet levels. The transfusions can be essential - life-saving.</li>\n<li><strong>People might not like donation platelets.</strong>^{[Citation needed!]} This one is a complete guess on my part, but platelet donation can take a long time, as you said. People are averse to donating blood for many reasons; as you stated, the long donation session for platelets only makes this worse. You've shown that you were willing in the past to go through with this, so the blood donation center probably thinks that you're more likely to do it again.</li>\n</ol>\n\n<hr>\n\n<p>¹ One donation can give about 6-8 -\"units\". See the <a href=\"http://apps.pathology.jhu.edu/blogs/pathology/being-an-apheresis-volunteer-platelet-donor\" rel=\"noreferrer\">Johns Hopkins Pathology page on platelets</a> for more information.</p>\n", "score": 6 } ]

[ "blood", "blood-donation" ]

[ { "answer_id": 1303, "body": "<p>I have eaten McDonalds for lunch every (week) day for the past 2+ years, I can tell you it has nothing to do with weight gain or loss.</p>\n\n<p>For the vast majority of people, losing and gaining weight is <strong>all about calories</strong>; nothing else. Genetics plays a role, but it is insignificant in the grand scheme of things.</p>\n\n<p>There are many problems with the quality of food from McDonalds, but I will focus on answering your question within regards to weight gain/loss only.</p>\n\n<p>The foods at McDonalds are very calorie-dense, and non-satiating. One big mac has ~563 calories... add on the large fires (~480) and large coke (~310) with that and it equals over 1300 calories.</p>\n\n<p><strong>1300</strong>+ calories is an INSANE amount for one meal, which won't even keep you satiated (full) for very long. </p>\n\n<p>Therefore, it's really a poor choice when it comes to weight loss.. because if you are trying to lose weight, your daily caloric intake wouldn't be too much higher than that (unless you're a bodybuilder or athlete). Some short women wouldn't even have 1300 calories total in their daily intake... that's how much calories that is.</p>\n\n<p>That being said, if you're on some kind of diet such as intermittent fasting, and you don't eat much else other than that single meal a day.. you can still successfully lose weight even if you eat this meal each day.</p>\n\n<p><strong>As long as the calories you consume each day is lower than your TDEE (Total Daily Energy Expenditure), you will lose weight.</strong></p>\n", "score": 10 }, { "answer_id": 1350, "body": "<p>While it seems logical that you only need to consider the deficit or surplus on the energy balance to see if you'll gain or lose weight, this is not going to work because the body will regulate the metabolic rate to keep a certain amount of energy reserves. How much fat reserves your body decides to keep will depend on your physical fitness and physical activity levels, the intake of minerals that are essential for maintaining physical fitness, how much sleep you get etc. etc. In general, when you live an unhealthy lifestyle, your body's regulation of its metabolic rate will tend to lead to larger fat reserves.</p>\n\n<p>From a theoretical point of view, this is quite easy to understand. Whatever the precise biochemical mechanisms are that are involved in regulating metabolism (not everything is known), it remains the case that all these mechanisms have evolved in order to maximize survival probability of animals in Nature who obviously don't do calorie counting.</p>\n\n<p>One of the problems evolution had to solve was how to make sure you don't starve to death due to a small shortage in the energy balance that you cannot make up for. Suppose you eat one sandwich a day worth 100 Kcal a day less and walk a bit more so that you expend 100 Kcal more per day. While this could lead to some weight loss, it cannot be the case that you'll continue to lose weight without limit. However, naive the calorie counting hypothesis suggests that a 200 Kcal deficit per day would lead to a long term weight loss trend of 1 kg of fat per 40 days. So, in a little over 2 years you would lose 20 kg of weight, which is clearly nonsense.</p>\n\n<p>Animals living in the wild may find themselves having to deal with a bit less food that is also a bit harder to find. If they were to lose weight because the metabolic rate is cannot be actively regulated, it would only increase due to physical exertion, the animal would be doomed. This doesn't make sense for warm blooded animals that we know have mechanisms to regulate the metabolic rate, and who have metabolic rates that are ten times higher than what they need to just barely survive.</p>\n\n<p>Instead, it makes far more sense to make the metabolic rate dependent on the degree to which the fat cells are filled. So, if there is a shortage on the energy balance, the animal will initially lose weight, but then the metabolic rate will be down regulated, correcting the energy balance, a slight surplus will be created, allowing the fat cells to be filled. </p>\n\n<p>While the biochemical mechanisms the body uses for this are not well understood, but recently <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/10967095\" rel=\"nofollow\">it has been found</a> that fat cells produce leptin, the more filled a fat cell is the more leptin is produced and besides regulating the appetite, leptin will let the hypothalamus produce more TRH, and TRH will let the pituitary gland produce more TSH and TSH will let the thyroid gland produce more thyroid hormone.</p>\n\n<p>Then the body will likely also make the set point for the fat reserves dependent on factors such as the amount of food intake, stress levels, sleep etc. The whole point of the fat reserves is to maximize survival probability, so the probability of a food emergency, the time it can survive without food etc. will all influence the set point for its fat reserves. It then makes sense that the outcome of evolution would be that the set point would be set higher when the animal has less to eat, has more stress doesn't get the optimal; amount of sleep. In that case, a food emergency is more likely and when it happens it is less likely to survive on some given amount of fat reserves. So, the smart thing to do is to save more energy under these circumstances.</p>\n\n<p>In contrast, when you sleep better, eat more and exercise more, the body will think that the prospects of a food emergency are smaller, and if that were to happen you would be in stronger position to take measures to reverse the situation. So, you'll not keep as much fat reserves, because doing so does come at the cost of having to carry all that fat ballast with you all the time.</p>\n", "score": 4 }, { "answer_id": 1306, "body": "<p>It is <em>theoretically</em> possible. However, if your goal is to lose or even maintain weight, eating fast food every day will make something already difficult even more difficult. Calories are not the whole picture. Achieving lasting weight loss requires changing one's relationship to food.</p>\n", "score": 1 }, { "answer_id": 1323, "body": "<p>Yes, it is possible. If you eat 0.0001 grams of McDonald's fast food every day, and nothing else, you will lose weight. Guaranteed.</p>\n\n<p>The point of this rather silly answer is that it's the quantity of calories you eat (and burn), not anything magic about the source of the calories.</p>\n", "score": 1 } ]

[ "diet" ]

[ { "answer_id": 1759, "body": "<p>In short, no. It is important to understand the meaning of risk and the balance of possible harm caused versus positive effect made by an intervention.</p>\n<p>Patients with diabetes have higher risk of cardiovascular disease (CVD) but not all patients with diabetes has CVD. Actually <strong>The European cardiovascular disease risk assessment model</strong> suggests that diabetes increases the risk of CVD three-fold in males and five-fold in females <a href=\"http://www.escardio.org/Guidelines-&amp;-Education/Practice-tools/CVD-prevention-toolbox/SCORE-Risk-Charts\" rel=\"noreferrer\">(1)</a>.</p>\n<p>The current guideline by European society or cardiology <a href=\"http://eurheartj.oxfordjournals.org/content/ehj/33/13/1635.full.pdf\" rel=\"noreferrer\">(2)</a> states that:</p>\n<blockquote>\n<p>Statins are recommended to reduce cardiovascular risk in diabetes</p>\n<p>Target LDL cholesterol is &lt;2.5 mmol/L, for patients without atherosclerotic disease total cholesterol may be\n&lt;4.5 mmol/L, with a lower LDL cholesterol target of &lt;1.8 mmol/L (using higher doses of statins) for diabetic\npatients at very high CVD risk</p>\n</blockquote>\n<p>Moreover, there are studies which show that statin treatment is beneficial regardless of the baseline level of LDL in patients with diabetes. However, <em>&quot;the absolute risk and treatment effect increased with rising cholesterol concentration&quot;</em> as stated in the ESC guidelines. So it is not recommended to prescribe statins to all diabetic patients since the advantage obtained the statin in patients is smaller than the potential harm caused due to side-effects. Hence, ESC has instructed LDL target level above which statin used be used since the benefits are more prominent than the potential harm caused.</p>\n", "score": 9 } ]

[ "diabetes", "heart-disease" ]

[ { "answer_id": 1813, "body": "<p>This is a good and pragmatic question.</p>\n\n<p>Just to give some insight, the benefits of aspirin in <em>high risk patients</em> (with acute or previous vascular disease or some other predisposing condition) are explicitly shown. I recommend reading the freely available <a href=\"http://www.bmj.com/content/324/7329/71.long\">meta-analysis</a> published in BMJ in 2002.</p>\n\n<p>Naturally, the patients without any disease or predisposing conditions are low risk patients, or <em>normal</em> as the asker terms.</p>\n\n<p><a href=\"http://annals.org/article.aspx?articleid=1392195\">Clinical guideline</a> by the American College of Physicians, American College of Cardiology Foundation, American Heart Association, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association and Society of Thoracic Surgeons clearly states that aspirin is recommended only for patients with <em>Stable Ischemic Heart Disease</em>.</p>\n\n<p><a href=\"http://eurheartj.oxfordjournals.org/content/33/13/1635.long\">Clinical guidelines</a> by the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice gives some more comprehensive insight.</p>\n\n<p>Chapter 4.10.1 outlines the <em>\"Antiplatelet therapy in individuals without overt\ncardiovascular disease\"</em>.</p>\n\n<blockquote>\n <p>Risk of vascular mortality was not changed by treatment\n with aspirin. Aspirin cannot be recommended in primary prevention\n due to its increased risk of major bleeding</p>\n</blockquote>\n\n<p>To answer your question, no, it is not useful for healthy individuals to take aspirin, since <strong>the harm caused exceeds the potential benefits.</strong></p>\n", "score": 10 } ]

[ "heart-disease", "prevention", "heart-attack" ]

[ { "answer_id": 5206, "body": "<p>Being optimistic is not the only factor but people who were prepared for physical losses, and who were nevertheless optimistic, were better able to maintain better physical functioning, and lower depressive symptoms. in the study below it was concluded that ageing well may depend both on public policy and societal efforts that work against stereotypical views of ageing, recognizing instead the diversity of the ageing population, and on encouraging individual optimistic views and active behaviors to promote healthy ageing. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/24527737\" rel=\"nofollow\">Optimism buffers the detrimental effect of negative self-perceptions of ageing on physical and mental health.</a></p>\n", "score": 2 } ]

[ "mental-health", "aging" ]

[ { "answer_id": 1967, "body": "<p>This event occurred in the US. In the US, enzootic (dog-to-dog) canine rabies virus has been virtually eliminated through vaccination and stray control programs, making wild animals the primary concern.</p>\n\n<p>It is quite true, as @EMT_Jedi stated, that rabies is usually caused by an animal's saliva, usually introduced by a bite (e.g. rabid cats, raccoons, etc.) However, this is <strong>not true</strong> of bat-related rabies. There is reason to be vaccinated after any strange contact with a bat. </p>\n\n<blockquote>\n <p>The most dangerous and common route of rabies exposure is from the bite of a rabid mammal. An exposure to rabies also might occur when the virus, from saliva or other potentially infectious material (e.g., neural tissue), is introduced into fresh, open cuts in skin or onto <em>mucous membranes</em> (nonbite exposure). <strong>...Exposures to bats deserve special assessment because bats can pose a greater risk for infecting humans under certain circumstances that might be considered inconsequential from a human perspective.</strong></p>\n</blockquote>\n\n<p>How dangerous is a bat encounter? From a risk to benefit ratio analysis, they are very, very dangerous. On the one hand, not all bats are infected with rabies, and there are some risks to the vaccine (fewer with the new vaccine, though.) On the other, rabies is considered universally fatal, making the benefit of treatment high. Only a few humans (including <a href=\"http://hubpages.com/hub/Rabies-in-Humans-Symptoms-and-Treatment\" rel=\"nofollow noreferrer\">Jeanna Giese</a>) have ever survived the illness^<b>*</b>; until these recent survivals, rabies was considered universally fatal.</p>\n\n<p>During 1990-2007, 34 bat-associated human cases of rabies (as determined by identification of the rabies virus variant which killed the victim) were reported in the US: 6 cases reported a bat bite, and 2 reported a probable bite; in 15 cases, physical contact was reported (e.g., the removal of a bat from the home or workplace or the presence of a bat in the room where the person had been sleeping), but no bite was documented; and in 11 cases, no bat encounter was reported, but the rabies virus was bat-specific.</p>\n\n<p>In other words: Of 34 deaths from bat-related rabies virus, only 8 (or 24%) were associated with a bite/probable bite, 15 cases (44%) involved <em>touching</em> a bat, and in 11 cases (32%) had no known exposure to a bat at all, but were caused by a bat.</p>\n\n<p><em>Any encounter with a bat, even a dead one, must be evaluated for post-exposure prophylaxis.</em> </p>\n\n<p>In the case discussed in the OP, the person was previously vaccinated. The CDC recommendation (also verified by the state department of health's epidemiologist), is,</p>\n\n<blockquote>\n <p>Previously vaccinated persons... should receive 2 vaccine doses, the first dose immediately and the second dose 3 days later.</p>\n</blockquote>\n\n<p>(Previously vaccinated persons are those 1. who have previously received complete vaccination regimens (pre-exposure or postexposure) with a cell culture vaccine or 2. persons who have been vaccinated with other types of vaccines and have previously had a documented rabies virus neutralizing antibody titer.)</p>\n\n<p>Rabies cases have occurred among exposed persons who received rabies pre-exposure prophylaxis and did not receive rabies postexposure prophylaxis, indicating that pre-exposure prophylaxis in humans is not universally effective without postexposure prophylaxis. In other words, it doesn't matter if you've been vaccinated or not, if you've been exposed - especially to a bat - you need to be treated. </p>\n\n<hr>\n\n<p>Unfortunately, in the US, animal rabies is common, and ~23,000 persons/ year receive rabies postexposure prophylaxis (PEP). (It may well be higher, as no reporting mandate exists.) With the elimination of canine rabies virus variants and enzootic transmission among dogs, human rabies is now rare in the United States, with an average of one or two cases occurring annually since 1960. </p>\n\n<p>In the US in 2013, of the three human cases reported, 2 were involved in organ transplants (raccoon rabies virus variant) and one was a Guatemalan (canine rabies virus variant). </p>\n\n<p>In 2012, one human died from an exposure to a bat. He touched a bat under a bridge. He did not report a bite to a witness. He became ill while traveling, and died in Switzerland. A number of humans exposed to his saliva (including his Swiss caregivers) received PEP.</p>\n\n<p>^<b>*</b>_{Some people in high-rabies areas without the illness have been documented to have developed antibodies to rabies. The mechanism is unknown.}</p>\n\n<p>_{<a href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5703a1.htm\" rel=\"nofollow noreferrer\">Human Rabies Prevention - United States, 2008</a>}<br>\n_{<a href=\"http://www.researchgate.net/publication/38113490_Epidemiology_of_rabies_post-exposure_prophylaxisUnited_States_of_America_20062008\" rel=\"nofollow noreferrer\">Epidemiology of rabies post-exposure prophylaxis—United States of America, 2006–2008</a>}<br>\n_{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/25356711\" rel=\"nofollow noreferrer\">Rabies surveillance in the United States during 2013</a>}<br>\n_{<a href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5902a1.htm\" rel=\"nofollow noreferrer\">Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies: Recommendations of the Advisory Committee on Immunization Practices</a>}</p>\n", "score": 12 }, { "answer_id": 1887, "body": "<p>According to the CDC (Center for Disease Control). Rabies is transmitted via saliva of infected mammals, bats in your case. You state that you were not bitten, and did not feel any type of liquid on your person. You also stated that you thoroughly washed afterwards. If you did not have any open wounds at that time, I wouldn't be too worried about the encounter with your flying friend. The CDC mentions that there are very few documented cases of rabies being transmitted solely from mucous membranes. </p>\n\n<p>If you are concerned, I would suggest being vaccinated for rabies. You can never be too cautious. </p>\n\n<blockquote>\n <p>Transmission of rabies virus usually begins when infected saliva of a host is passed to an uninfected animal. The most common mode of rabies virus transmission is through the bite and virus-containing saliva of an infected host. Though transmission has been rarely documented via other routes such as contamination of mucous membranes (i.e., eyes, nose, mouth), aerosol transmission, and corneal and organ transplantations.</p>\n</blockquote>\n\n<p>Source:\n<a href=\"http://www.cdc.gov/rabies/transmission/\" rel=\"noreferrer\">http://www.cdc.gov/rabies/transmission/</a></p>\n", "score": 5 } ]

[ "infectious-diseases", "rabies" ]

[ { "answer_id": 15252, "body": "<blockquote>\n <p>What if I am getting all my nutrition from fluids that includes vegetable and fruit juices, milk etc. Will it effect my body, metabolism, or digestive system in any way?</p>\n</blockquote>\n\n<p>What you're describing is something that I did for a several years. I went to all these dieticians because I wanted to make sure I was not killing myself slowly and none of them could give me an adequate reason.</p>\n\n<p>I will note two things that you may wish to consider:</p>\n\n<ol>\n<li><p>The GI tract may require some coarse material from time to time so that the cells lining it can be sloughed off. This was suggested to me by a professor of anatomy and it's by far the best suggestion. Things like nuts might act as abrasive material to help facilitate this process.</p></li>\n<li><p>If you decide to revert back to solids, you might want to consider doing so very slowly. I base this on having lived off a liquid diet for several years, only to lose a good 10 kg of muscle while traveling overseas and being forced onto solids. </p></li>\n</ol>\n\n<p>It's a matter of use it or lose it: if there is no need for enzymes to be excreted, then production will be downregulated. Likewise the histology of the cells lining the epithelium of the GI tract will be modified. If you switch to solids overnight, it will take time for your body to adapt, and in the interim, you may have issues will malabsorption.</p>\n\n<p>EDIT</p>\n\n<p>The following reference is quite old but a good overview of adaptive response to changes in diet. </p>\n\n<p>Some excerpts from \n<a href=\"https://rnd.edpsciences.org/articles/rnd/pdf/1980/07/RND_0181-1916_1980_20_4B_ART0013.pdf\" rel=\"nofollow noreferrer\">The adaptation of digestive enzymes to the diet: its physiological significance</a></p>\n\n<p>Dietary changes instantiate robust adjustment to digestive enzyme secretion and/or production:</p>\n\n<blockquote>\n <p>From the above analysis, it is clear that any alteration in the amount\n of protein, carbohydrate or lipid intake causes an adjustment in the\n enzymes hydrolyzing those substances. For example, increasing starch\n intake causes pancreatic amylase activity to augment, which in turn\n induces an increase in the quantity of disaccharides releas- ed. It\n was seen that the latter increase stimulates disaccharidase enzyme\n activity ; this is also true for protein and lipid digestion. The\n enzymes adapt to the diet within 2 to 3 days and this adaptation is\n stabilized after 5 to 7 days (Ben Abdeljlil and Des- nuelle, 1964 ;\n Corring and Saucier, 1972 ; Corring, 1975). However, recent studies\n have shown that quantitatively changing a substrate has a very rapid\n effect on the corresponding enzyme activity.</p>\n</blockquote>\n\n<p>And the following may be of relevance to chronic utilisation of liquid diet:</p>\n\n<blockquote>\n <p><strong>To explain why it takes a relatively long time for enzymatic\n adaptation to be established, Corring (1977) suggested that it\n depends on the adjustment of other digestive processes such as gastric emptying or intestinal motility. The\n presence of a stable amount of substrate in the intestinal lumen,\n leading to a new enzyme activity, would thus necessitate the previous\n adaptation of digestive motor processes.</strong> The stimulus of changing the\n diet composition would cause a very short-term digestive response\n which must be repeated (intake of several meals of the new diet) in\n order to establish a new enzyme activity. In studies on digestive\n enzyme adaptation to the diet, the values of enzyme activities are\n usually the daily means which do not show the immediate effects of\n intake. Moreover, the adaptation time may vary with the synthesis\n site, depending on the enzyme.</p>\n</blockquote>\n\n<p>The adaptiveness is an attempt to accommodate temporary deficiencies, and modifications to diet:</p>\n\n<blockquote>\n <p>The first part of this paper showed that the organism has a complete\n digestive equipment which can adapt to any alteration in the amount of\n substrate intake. In the second part of the paper, it was seen that\n this increase seemed to have no apparent advantage in the development\n of the normal, well fed animal. On the contrary, it would be useful\n when all the nutritional requirements are not covered by the diet.\n <strong>Dietary deficiency, particularly protein deficiency, if it is not too\n severe, is compen- sated for by digestive secretion supply ; this\n compensation is only possible because of the adaptive capacity of the\n enzymes. In man, in which malnutrition or undernourish- ment are well\n known, it would seem that such cases would be rapidly and inevitably\n fatal, if there was no process of enzyme adaptation. Dietary\n deficiency could also be the result of a lack of substrate due to\n enzymatic deficiency ; in some cases, enzyme adaptation limits its\n effects owing to digestive compensation.</strong> Although it cannot be\n considered as an endogenous digestive secretion, the intestinal\n microflora plays a crucial role which it is necessary to define, if\n the microflora is to be used as a digestive enzyme source in humans\n suffering from enzyme insufficiency or deficiency.</p>\n</blockquote>\n", "score": 1 } ]

[ "nutrition", "diet" ]

[ { "answer_id": 3273, "body": "<p>MRSA (Methicillin-resistant Staphylococcus aureus) is suspected in the face of any acute staph infection that does not respond to normal antibiotics. Even staph that is more resistant to other antibiotics than it is to methicillin is routinely called MRSA.</p>\n<p>The standard test for MRSA (differentiated from other forms of staph) is as straightforward as it seems. After S. aureus bacteria is isolated, it is cultured in the presence of methicillin and (usually) other antibiotics. If the staph grows in the face of antibiotics that usually are effective against staph, it is obviously resistant and the diagnosis of MRSA can be made.</p>\n<p>By using more than one antibiotic in the growth medium, the technician can identify for the practitioner which antibiotics are most effective. The different antibiotics are present on specific locations on the agar (or other medium) plate, usually using <a href=\"https://bio.libretexts.org/Learning_Objects/Laboratory_Experiments/Microbiology_Labs/Microbiology_Labs_I/09%3A_Kirby-Bauer_(Antibiotic_Sensitivity)\" rel=\"nofollow noreferrer\">Kirby-Bauer antibiotic discs</a>. Even among strains that are called MRSA, there are variances as to what antibiotics are effective against that particular colony.</p>\n<p>The challenging part is that the cultures can take several days, during which time the patient can be growing steadily worse. As such, sometimes it's the patient herself who becomes the most relevant growth medium.</p>\n<p>Contamination of the medium or weak growth of the bacteria can both lead to inconclusive results.</p>\n", "score": 8 } ]

[ "infection", "blood-tests", "bacteria", "antibiotics", "mrsa" ]

[ { "answer_id": 10944, "body": "<p>Even a gastroenterologist may not be able to reliable differentiate between the stomach ulcer and gallstone pain just from history/physical examination.</p>\n\n<p>This is typical (but not obligatory):</p>\n\n<p><strong>Gallstone pain:</strong></p>\n\n<ul>\n<li>Sudden onset of pain in the upper part of the right abdominal quadrant, just below the lowest rib and <strong>about 4 inches from the sternal line</strong> (or more broadly in the upper right quadrant or in the upper middle abdomen)</li>\n<li>The pain builds up to a steady level and <strong>remains constant</strong> and lasts from several minutes to few hours.</li>\n<li>The pain is typically associated with <strong>nausea</strong> (or vomiting): when the pain subsides, nausea also subsides.</li>\n<li>The pain can (not necessary) radiate around the trunk to the lower right back and into the tip of the <strong>right shoulder blade.</strong></li>\n<li>The pain is not relieved by antacids or having a bowel movement.</li>\n<li><em>Source: <a href=\"http://www.ehealthstar.com/what-does-gallbladder-pain-feel-like.php\" rel=\"noreferrer\">Gallbladder pain</a> (eHealthStar.com)</em></li>\n</ul>\n\n<p><strong>Stomach ulcer pain:</strong> (the ulcer can be in the stomach or duodenum)</p>\n\n<ul>\n<li>Burning, <strong>gnawing pain</strong> in the upper middle abdomen - <strong>below the bottom of the sternum</strong> or slightly to the left or right</li>\n<li>Pain is <strong>relieved by antacids</strong> (long-term, H2 blockers or PP inhibitors would help).</li>\n<li>Black stools (from a bleeding ulcer)</li>\n<li>Nausea or vomiting can be present or not - more likely when the cause is an infection by H. pylori.</li>\n<li>The stomach area may or may not be tender to touch.</li>\n<li><em>Source: <a href=\"http://patient.info/health/stomach-gastric-ulcer\" rel=\"noreferrer\">Stomach (gastric) ulcer</a> (Patient.info)</em></li>\n</ul>\n\n<p>NOT typical:</p>\n\n<ul>\n<li>Burping, bloating, gas, constipation and loose stools can be present but are not typical for gallstones or stomach ulcer as such.</li>\n<li>A large fatty meal can trigger gallstone pain, but the pain can be totally non-related to meals, for example, it can occur at night.</li>\n<li>The gallbladder area may or may not be tender to touch. In case of acute gallbladder inflammation, a patient could feel pain during an inspiration when a doctor presses to the gallbladder area (<a href=\"https://www.youtube.com/watch?v=Uk0zQUZphlI\" rel=\"noreferrer\">Murphy's sign - short video</a>).</li>\n<li>Food can either ease or aggravate ulcer pain.</li>\n<li>Risk factors have some statistical value, but young, slim women and those on a low-fat--or any--diet can get gallstones. Also, non-smokers, non-drinkers and non-NSAIDs users can get an ulcer.</li>\n</ul>\n\n<hr>\n\n<p>Strong indicators for an ulcer: black stools, pain relieved by antacids, positive H. pylori test</p>\n\n<p>Strong indicators for gallstones: pain in the upper right abdominal quadrant + lower right back + right shoulder blade</p>\n", "score": 5 } ]

[ "pain", "gastroenterology", "ulcers", "gallstone" ]

[ { "answer_id": 3664, "body": "<p>Telling people not to look information up themselves is indeed very strange. Especially a recently diagnosed patient has lots of questions and won't be able to ask all of them at their appointments (questions coming up between appointments, questions from relatives and friends they want to answer, forgetting to ask things, etc.). </p>\n\n<p>However, searching for information on health issues, <em>especially cancer</em>, on the internet can be problematic. There are a lot of websites around promising quick cures to all kinds of cancer, if only you eat right / use this product they are selling / stop doing a specific thing / etc. This can lead to patients doing things that they shouldn't, like discontinuing treatments. The internet site Science-based Medicine has a lot of articles in their <a href=\"https://www.sciencebasedmedicine.org/tag/cancer/\">cancer tag</a> debunking such treatments and warning of the dangers. </p>\n\n<p>A much more reasonable approach to this problem would be to provide a patient with trusted sources - pamphlets and such, of course, but also links to websites that can generally be trusted with information about medical treatment, but is accessible to laypeople, like <a href=\"http://www.cancer.gov/resources-for/patients\">the US National Institute for Cancer</a>, or <a href=\"http://www.mayoclinic.org/diseases-conditions/cancer/basics/definition/con-20032378\">the Mayo Clinic</a>. For patients a bit younger, the cancer.net website (which is a website by the the American Society of Clinical Oncology) has a list of resources for <a href=\"http://www.cancer.net/navigating-cancer-care/young-adults/resources-young-adults\">young adults</a>. They also have information on <a href=\"http://m.cancer.org/cancer/cancerbasics/cancer-information-on-the-internet\">how to evaluate information found on the internet</a></p>\n\n<p>Health care professionals should encourage patients to discuss anything they read and have questions about with a professional. The reality of today is that, even if you tell patients they shouldn't look something up, they likely will. So it's important they know how to evaluate and deal with the information they find. </p>\n\n<blockquote>\n <p>studies indicate that 16-64% of patients are using the internet to obtain health information. For the most part, patients perceive the online information to be reliable but maintain a healthy degree of skepticism. Studies objectively evaluating cancer information on the internet indicate that there is reasonable quality, although the language level of many sites is higher than that of the average American, which may limit the utility of the websites </p>\n</blockquote>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/18259953\">Internet health resources and the cancer patient</a></p>\n\n<p>If your friend wants to and has the energy to, I don't think it would be wrong to push back on this blanket policy. </p>\n\n<p>Studies done regarding this subject find that Internet use makes patients more informed and helps them take a more active role in their health care decisions, which may prevent the feeling of helplessness many cancer patients experience. </p>\n\n<blockquote>\n <p>Cancer patients’ Internet use for health information at wave one led them to want to be more active participants in medical decision making</p>\n</blockquote>\n\n<p><a href=\"http://www.sciencedirect.com/science/article/pii/S0738399110005525\">Internet use leads cancer patients to be active health care consumers</a></p>\n", "score": 14 }, { "answer_id": 3666, "body": "<p>I agree with @YviDe. There are other possible reasons not mentioned, however.</p>\n\n<p>On the internet, which is not tailored to individuals, there is no way to tell which category of a particular illness you fall into. People can read about the worst case scenario and not know how likely or unlikely it is to apply to them. No one wants a patient with cancer to suffer <em>more</em> than they are already destined to. Most likely, it is an attempt to protect the patient from unnecessary worry.</p>\n\n<p>The flip side of that is that the medical care provider needs to be able to supply all the information the patient needs.</p>\n\n<p>I do acknowledge that there is a lot of good information out there, and the best practice is probably to steer the patient to it specifically. But most often, people are not equipped to evaluate what they read on a medical site. A small but not uncommon example of this is the patient who reads about their medication's <em>possible</em> side effects on a website and decides to stop taking it (or worse yet, stop giving it to their child.) They don't know that the risk-to-benefit ratio should already have been taken into account by the prescribing physician.</p>\n\n<p>A very good case in point is the whole anti-vaccine thing. That could not have happened without the internet.</p>\n\n<p>Finally, physicians don't have the time to address all the quack claims that can be found on the internet about every illness. That might also be a reason to tell the patient to stay away from the internet. If you were a pediatrician, you could attest to how time-consuming it is to talk about vaccines with some parents, regardless of the fact that the person who published the study 1) falsified information, 2) was paid to do it, 3) lost his license to practice medicine because of his unethical behavior 4) no study has ever confirmed his findings and 5) there is copious information on the internet on the benefits of vaccinations.</p>\n\n<p>The internet has not panned out to be the godsend it was first thought it would be.</p>\n", "score": 8 }, { "answer_id": 15553, "body": "<p>Because of the sheer number of scams and misinformation.</p>\n\n<p>A few quick searches will turn up tons of \"natural\" or \"alternative\" medicine that doesn't work (in fact, a lot of these scam sites manipulate search rankings to show up on the first few pages). In the context of cancer, these are dangerous for 2 reasons: </p>\n\n<ul>\n<li>\"Natural treatments\", \"alternatives\", and \"supplements\" are largely exempt from common-sense safety standards and in some cases contain undisclosed allergens or ineffective/poisonous fraudulent substitutions (for a quick example see\n<a href=\"http://www.nytimes.com/2013/11/05/science/herbal-supplements-are-often-not-what-they-seem.html\" rel=\"nofollow noreferrer\">http://www.nytimes.com/2013/11/05/science/herbal-supplements-are-often-not-what-they-seem.html</a>)</li>\n<li>People may see these supplements or advice as a \"miracle treatment\" and stop taking their meds. Or the \"natural alternative\" could have dangerous biochemical interactions when taken with normal meds.</li>\n</ul>\n\n<p>Asking questions on open forums (\"polling the audience\") can quickly get you a lot of misinformed, false, or bad advice just because many people don't know any better.</p>\n", "score": 3 } ]

[ "cancer", "health-education" ]

[ { "answer_id": 3977, "body": "<p>First of all, your numbers are good, but they depend on when one was born, and are higher for younger people:</p>\n\n<blockquote>\n <p>The lifetime risk of cancer increased from 38.5% for men born in 1930 to 53.5% for men born in 1960. For women it increased from 36.7 to 47.5%. Results are robust to different models for projections of cancer rates.</p>\n</blockquote>\n\n<p><a href=\"http://www.nature.com/bjc/journal/v112/n5/full/bjc2014606a.html\" rel=\"noreferrer\">Trends in the lifetime risk of developing cancer in Great Britain: comparison of risk for those born from 1930 to 1960</a></p>\n\n<p>(This is for Great Britain, but at least for the US and similar countries, I don't expect too much deviation) </p>\n\n<p>Cancer Research UK has done a bit of legwork as it relates to your question. Their rough estimate is that 4 out of 10 cancers are preventable through a healthy lifestyle. From their section on <a href=\"http://www.cancerresearchuk.org/health-professional/cancer-statistics/risk#heading-One\" rel=\"noreferrer\">preventable cancers</a>:</p>\n\n<blockquote>\n <ul>\n <li>Smoking is the largest single cause of cancer in the UK, linked to an estimated 19% of cancer cases in the UK each year. Lung cancer has the highest proportion of smoking-linked cases.</li>\n <li>Diet (too little fruit, vegetables and fibre; too much red and processed meat and salt) is linked to an estimated 9% of cancer cases in the UK each year. Upper aero-digestive tract cancers (oral cavity and pharynx, oesophageal, and larynx) have the highest proportion of diet-linked cases.</li>\n <li>Overweight and obesity is linked to an estimated 5% of cancer cases in the UK each year. Uterine, kidney and oesophageal cancers have the highest proportions of bodyweight-linked cases.</li>\n <li>Alcohol is linked to an estimated 4% of cancer cases in the UK each year. Upper aero-digestive tract cancers (oral cavity and pharynx, larynx, and oesophageal) have the highest proportion of alcohol-linked cases.</li>\n </ul>\n</blockquote>\n\n<p>That's about 37 percent, all added up. They have more information on all these on the website I linked. </p>\n\n<p>I did a bit of looking around myself, just to see. </p>\n\n<p><strong>Male</strong></p>\n\n<p><a href=\"http://m.cancer.org/cancer/cancerbasics/lifetime-probability-of-developing-or-dying-from-cancer\" rel=\"noreferrer\">The main cancer risks for males are:</a></p>\n\n<ul>\n<li>Prostate, at about 15 percent </li>\n<li>Lung, at about 7.5 percent </li>\n<li>Colon, at about 5 percent </li>\n<li>Bladder, at about 4 percent </li>\n<li>Skin, at about 2.5 percent </li>\n<li>Non-Hodgkin lymphoma, at about 2 percent </li>\n<li>Kidney, at about 2 percent </li>\n</ul>\n\n<p>That adds up to about 38 percent. </p>\n\n<p>Let's see how lifestyle factors impact them. </p>\n\n<p>For <a href=\"http://m.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-risk-factors\" rel=\"noreferrer\"><em>prostate cancer</em></a>, the four factors you link possibly don't have an impact. Diet might be involved, but we don't really know how:</p>\n\n<blockquote>\n <p>Men who eat a lot of red meat or high-fat dairy products appear to have a slightly higher chance of getting prostate cancer. These men also tend to eat fewer fruits and vegetables. Doctors aren’t sure which of these factors is responsible for raising the risk.</p>\n</blockquote>\n\n<p>For <em>lung cancer</em>, smoking is of course the major risk factor. For non-smokers, risk of lung cancer is reduced by about <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170525/\" rel=\"noreferrer\">85 to 90 percent</a></p>\n\n<p>For <em>colon cancer</em>, about half of the cases <a href=\"http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/risk-factors\" rel=\"noreferrer\">are linked to lifestyle</a>. </p>\n\n<p>For <em>bladder cancer</em>, about half of the cases are <a href=\"http://www.health.harvard.edu/mens-health/bladder-cancer-men-at-risk\" rel=\"noreferrer\">linked to smoking alone</a>. </p>\n\n<p><em>Skin cancer</em> is caused by sun exposure, but also genetic disposition.</p>\n\n<p>The risk factors for <em>non-hodgkins-lymphoma</em> <a href=\"http://www.mayoclinic.org/diseases-conditions/non-hodgkins-lymphoma/basics/causes/con-20027792\" rel=\"noreferrer\">are unknown</a>. </p>\n\n<p>For <em>kidney cancer</em>, risk factors include obesity and smoking, with an estimated <a href=\"http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/kidney-cancer/risk-factors#heading-Zero\" rel=\"noreferrer\">40 percent of the risk</a> coming from lifestyle factors. </p>\n\n<p>So, as a back of the envelope calculation, if the risks for prostate and non-hodgkins-lymphoma don't decrease, the lung cancer risk decreases by about 90 percent, and the other listed cancer have a risk decrease of about half, we end up with about 25 percent of the original 38 percent for these 7 cancer types. A reduction of 35 percent. </p>\n\n<p><strong>Female</strong></p>\n\n<p>The main cancers differ for females:</p>\n\n<ul>\n<li>Breast, at about 12 percent </li>\n<li>Lung, at about 7 percent </li>\n<li>Colon, at about 4.5 percent </li>\n<li>Uterine, at about 3 percent </li>\n</ul>\n\n<p>All others are below 2 percent. These four add up to 26.5 of the lifetime risk. </p>\n\n<p>The relationship between <em>breast cancer</em> and lifestyle factors seems to be complicated, with it <a href=\"http://www.sciencedirect.com/science/article/pii/S1470204500002540\" rel=\"noreferrer\">maybe being linked to obesity and also linked to number of children</a>. </p>\n\n<p>About 40 percent of <em>Uterine cances</em> <a href=\"http://www.cancer.net/cancer-types/uterine-cancer/risk-factors-and-prevention\" rel=\"noreferrer\">are linked to obesity</a>. </p>\n\n<p>Lung and colon cancer were also on the list for males. Another back of the envelope calculation reduces the risk of these four cancers from 26.5 to 16.5 percent. A reduction of 38 percent. </p>\n\n<p><strong>Disclaimers</strong></p>\n\n<ul>\n<li>These are very rough calculations </li>\n<li>These are based only on lifetime risk of developing cancers, not lifetime risks of dying from cancers </li>\n<li>We really don't understand cancer all that well for many of them</li>\n<li>the cancers I didn't list here, like bladder/cervix/pancreatic cancer also make up quite a few percent of the lifetime cancer risk, combined </li>\n</ul>\n", "score": 7 } ]

[ "cancer", "lifestyle", "statistics" ]

[ { "answer_id": 4599, "body": "<p>Inesophet actually had a good answer there, and I'll expand on that. </p>\n\n<p>Pheomelanins impart a pink to red hue, depending upon the concentration. They are particularly concentrated in the lips, nipples, glans of the penis, and vagina.</p>\n\n<p>Meanwhile, there are two types of eumelanin: brown eumelanin and black eumelanin—which chemically differ from each other in their pattern of polymeric bonds. A small amount of black eumelanin in the absence of other pigments causes grey hair. A small amount of brown eumelanin in the absence of other pigments causes yellow (blond) color hair.</p>\n\n<p>Optional Reading: <a href=\"http://www.fasebj.org/content/5/14/2902.full.pdf\" rel=\"noreferrer\">http://www.fasebj.org/content/5/14/2902.full.pdf</a></p>\n\n<p>Sources:</p>\n\n<p><a href=\"http://www.metacyc.org/META/NEW-IMAGE?type=COMPOUND&amp;object=CPD-12380\" rel=\"noreferrer\">http://www.metacyc.org/META/NEW-IMAGE?type=COMPOUND&amp;object=CPD-12380</a>\n<a href=\"http://www.metacyc.org/META/NEW-IMAGE?type=COMPOUND&amp;object=CPD-12379\" rel=\"noreferrer\">http://www.metacyc.org/META/NEW-IMAGE?type=COMPOUND&amp;object=CPD-12379</a></p>\n", "score": 5 } ]

[ "pigment", "genitals" ]

[ { "answer_id": 4093, "body": "<p>tl; dr - The answer is yes, clinically you can react to having your blood pressure (BP) taken by having an abnormally high reading.</p>\n\n<p>What you are describing is called \"white coat syndrome\" or \"<a href=\"https://en.wikipedia.org/wiki/White_coat_hypertension\">white coat hypertension</a>\". However, from what I've found, it's not often accompanied by tachycardia (Increased heart rate). I did find a good discussion on this, and some of the ways that they determined if a person had WCH or true hypertension <a href=\"http://circ.ahajournals.org/content/98/18/1834.full\">in this article from the AHA</a>. It discusses the use of ambulatory blood pressure monitoring over clinical monitoring.</p>\n\n<p>I would encourage you to try to find some way to get a true blood pressure reading, as if you are truly hypertensive, the morbidity factors increase, and there are medications that can help reduce it.</p>\n", "score": 8 }, { "answer_id": 11105, "body": "<p>My understanding is that psychological stress is known to have short term (transient) effects on raising blood pressure, but there's less evidence that psychological stress is a risk factor for hypertension (high blood pressure for a long period of time). </p>\n\n<p>Here's a meta-study of other studies:</p>\n\n<blockquote>\n <p>Acute stress promotes transient elevation of blood pressure, but there\n is no consistent evidence that this effect results in hypertension.\n <a href=\"http://www.nature.com/jhh/journal/v23/n1/abs/jhh200874a.html\" rel=\"nofollow noreferrer\">http://www.nature.com/jhh/journal/v23/n1/abs/jhh200874a.html</a></p>\n</blockquote>\n\n<p>As @JohnP says, doctor's office blood pressure is known to be a suboptimal test of hypertension. Its a single sample, and also it may show up higher (as in the case of the White Coat Effect), or lower (as in the case of Masked Hypertension) than normal. Better determinations of hypertension can made by either wearing an \"ambulatory blood pressure\" cuff for 24h, or by making many readings with a home BP monitor (in which case your must carefully follow the instructions, be sitting, rested and keep you arm at the correct height). Bear in mind however, that readings from ambulatory and home BP devices are not directly comparable to the same BP values seems in your doctor's office. Different values correspond to the same risk (lower BP values are generally used to determine hypertension when the readings are made out of the doctor's office).</p>\n\n<p><a href=\"https://i.stack.imgur.com/xcVhP.gif\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/xcVhP.gif\" alt=\"enter image description here\"></a></p>\n\n<p>In the above image, \"home\" is the sitting self test, 24h is the \"ambulatory\" (while active) average, and nighttime and daytime are the averages of the ambulatory monitor when when asleep/awake. Its important to know there's generally (very!) large difference in risk between the same home and office readings.</p>\n\n<p>The fact that your BP returns to truly excellent levels may a good indicator in that your body is reacting appropriately to demands. That said, if you have prolonged high BP (due to stress or otherwise), you should be concerned.</p>\n", "score": 1 }, { "answer_id": 10742, "body": "<p>Of course. Just to expand a bit on why...psychological stress causes activation of an adrenal (fight or flight) response, which translates to increased release of adrenaline (epinephrine), and other circulating hormones. It's that \"rush\" you feel in your belly when you get stressed, surprised or shocked (which is where your adrenal glands are, anyway). Physiologically, adrenaline and other hormones directly induce faster pulse, and stronger heart squeeze, which of course translates to a higher blood pressure.</p>\n", "score": 0 } ]

[ "blood-pressure", "cardiology" ]

[ { "answer_id": 4158, "body": "<p>I wasn't able to find a study that looked at both meditation and exercise - besides ones about yoga - but I was able to find many that looked at each separately and seemed to indicate that combining the two is simple and effective.</p>\n\n<p><strong>Exercise</strong></p>\n\n<ul>\n<li><p>One of the best sources was a thesis by Nikelle Holbrook Hunsaker entitled <a href=\"http://digitalcommons.usu.edu/honors/105/\" rel=\"nofollow\"><strong>\"The Benefits of Exercise During Pregnancy\"</strong></a> (pdf <a href=\"http://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1119&amp;context=honors\" rel=\"nofollow\">here</a>). It is a meta-analysis of other studies in the literature. Some do not fit your criteria (e.g. some looked at exercise three times a week but not daily), but given that most recommendations do not include physical activity seven days a week, I've mentioned some here.</p>\n\n<ul>\n<li><strong>Boinpally &amp; Jovanovic (2009)</strong> wrote that 30 minutes of physical activity (aerobic or anaerobic) five a days a week before and during pregnancy greatly reduces the risk of gestational diabetes mellitus (GDM). GDM directly affects the mother, but can easily lead to side effects in the child. Preventing GDM can reduce the risk of such conditions as macrosomia and congenital diseases. This conclusion agrees with the results of <strong>Liu et al. (2008)</strong>.</li>\n<li>A similar exercise program can reduce the risk of type II diabetes, according to <strong>Kim et al. (2010)</strong>. This makes sense, because of the similarities between GDM and type II diabetes.</li>\n<li>In general, exercise can decrease the risk of preeclampsia, which can cause the death of the mother and of the fetus. <strong>Sorensen et al. (2008)</strong> found that regular recreational exercise reduced the risk of preeclampsia. The greater the intensity of the exercise, the lower the chances of preeclampsia.</li>\n</ul>\n\n<p>The thesis discussed and/or cited other studies, but most did not match your criteria. Some involved one-time physical activity.</p></li>\n<li><a href=\"http://europepmc.org/abstract/med/7674866\" rel=\"nofollow\"><strong>Sternfield et al. (1995)</strong></a> divided a group of 388 women up into four levels depending on the amount of exercise they got on a weekly basis (the highest group involved aerobic activity for at least 3 20-minutes+ sessions per week). They found no difference in the effect of exercise on the children, but did notice that the mothers experienced reduced pain and discomfort.</li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26603201\" rel=\"nofollow\"><strong>May et al. (2015)</strong></a> noted that regular exercise during pregnancy lowered heart rate and reduced symptoms from related disorders. However, they recommended that more research be done on the relation between exercise and certain other conditions.</li>\n<li><a href=\"https://www.hss.edu/conditions_exercise-during-pregnancy.asp\" rel=\"nofollow\"><strong>A page from the Hospital for Special Surgery</strong></a> gives a variety of recommendations regarding exercise during pregnancy:\n\n<ul>\n<li>Athletes can continue to exercise during the first trimester, with no adverse effects.</li>\n<li>Aquatic aerobics reduce joint stress and fluid retention.</li>\n<li>Multiple activities should be used to reduce stress if the mother exercises more than four days per week (this might explain why most studies don't cover daily exercise).</li>\n</ul></li>\n</ul>\n\n<p><strong>Meditation</strong></p>\n\n<ul>\n<li><p><a href=\"https://www.researchgate.net/profile/Maria_Muzik/publication/232235683_Mindfulness_yoga_during_pregnancy_for_psychiatrically_at-risk_women_Preliminary_results_from_a_pilot_feasibility_study/links/0912f50cc0293943b1000000.pdf\" rel=\"nofollow\"><strong>Babbar et al. (2012)</strong></a> is a meta-analysis of studies from the PubMed database from 1970 to 2011. The results were not entirely conclusive, but the studies found two results:</p>\n\n<ul>\n<li>Women who regularly (frequencies varied) performed yoga during pregnancy enjoyed reduced pain/discomfort throughout pregnancy.</li>\n<li>Babies of women who regularly preformed yoga during pregnancy had a slightly higher birth weight - nothing serious or significant, though.</li>\n</ul></li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26256135\" rel=\"nofollow\"><strong>Davis et al. (2015)</strong></a> found that an eight-week yoga intervention greatly reduced depression and anxiety in women with depression, supporting the idea that yoga and meditation reduce anxiety.</li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24873115\" rel=\"nofollow\"><strong>Oakley &amp; Evans (2014)</strong></a> state that breathing exercises and meditation increase maternal relaxation.</li>\n</ul>\n\n<hr>\n\n<p>Yoga is perhaps the most studied of all the meditation regimens out there. Indeed, a considerable number of the studies I looked at focused on the meditative component of yoga. This type of exercise should also be compatible with aerobic/anaerobic exercise, even for pregnant women. However, it is clear that during a pregnancy, women should be careful when it comes to exercise.</p>\n\n<p>To summarize the main findings:</p>\n\n<ul>\n<li>Exercise can reduce the risk of gestational diabetes mellitus, type II diabetes, and preeclampsia, as well as general pain and discomfort from the pregnancy.</li>\n<li>Meditation/yoga can reduce pain, discomfort, and stress levels.</li>\n</ul>\n", "score": 4 } ]

[ "exercise", "obstetrics", "meditation" ]

[ { "answer_id": 4257, "body": "<p>It sounds like what you're talking about is related to <a href=\"https://en.wikipedia.org/wiki/Water_retention_(medicine)\" rel=\"nofollow\">water retention</a>, a specialized case of fluid retention, which causes an effect known as edema.</p>\n\n<p>Edema (and thus generalized fluid retention) can be divided into two categories: generalized edema and localized edema. The first occurs all over the body, while the second occurs in only certain parts of the body.</p>\n\n<p>There are various causes of fluid retention. Some include</p>\n\n<ul>\n<li>Menstruation</li>\n<li>Pregnancy</li>\n<li>Diseases of the heart, liver and kidneys</li>\n<li>Severe arthritis</li>\n<li>Certain drugs</li>\n</ul>\n\n<p>The specific cause can determine whether the edema is generalized or localized.</p>\n\n<p>^{<a href=\"http://www3.betterhealth.vic.gov.au/bhcv2/bhcpdf.nsf/ByPDF/Fluid_retention/$File/Fluid_retention.pdf\" rel=\"nofollow\">Source: The Better Health Channel (approved by the government of the State of Victoria, Australia)</a>}</p>\n\n<p>To be even more general, fluid retention is caused by the swelling or increase in pressure of various cavities within the body, including capillaries, the lymphatic system, and the organs I mentioned before. This can eventually cause ruptures to occur, and fluid will leak out. This in turn will cause edema in various parts of the body - again depending on the cause.</p>\n\n<p>^{<a href=\"http://www.medicalnewstoday.com/articles/187978.php\" rel=\"nofollow\">Source: Medical News Today</a>}</p>\n\n<p>\"Water weight\" appears to be referring to the amount of this excess fluid building up outside of these body cavities. \"Water retention\" refers to the general phenomenon, while \"edema\" refers to the associated swelling.</p>\n\n<p>So yes, this is a well-documented phenomenon, although the term \"water weight\" isn't commonly used.</p>\n\n<p>A final note: As <a href=\"https://health.stackexchange.com/questions/4174/is-water-weight-a-real-thing/4257#comment6899_4174\">YviDe said</a>, the term may simply be used often in a non-technical way, to refer to some of the weight that is quickly lost in some cases.</p>\n", "score": 8 } ]

[ "weight", "water", "weight-loss" ]

[ { "answer_id": 5191, "body": "<p><a href=\"http://www.caffeineinformer.com/caffeine-absorption\">Caffeine Absorption</a> <strong><em>Caffeine Capsules - 200mg - 84-120 minutes</em></strong></p>\n\n<p>So maybe you took the caffeine, were already tired so you napped(2 hours or 120 minutes) just as it was kicking in full blown and then woke up a little later with the effects already in action, but not sleeping the full amount. </p>\n\n<p>Since the capsules take longer to kick in than liquids and gums, you fell asleep before it fully woke you up. And since some say that caffeine works less if you are <a href=\"http://www.caffeineinformer.com/caffeine-tolerance\">caffeine tolerant</a> then this may explain. </p>\n\n<hr>\n\n<h2>Other</h2>\n\n<p>According to <a href=\"http://www.mensfitness.com/life/why-does-caffeine-make-me-tired\">Mens Fitness</a> it could be a variation in your genes (CYP1A2 genes) that show how you metabolize caffeine. There is a test for that apparently, but I don't know how accurate that is.</p>\n\n<ul>\n<li><a href=\"https://www.nutrigenomix.com/tests-available\">7 Gene Test</a></li>\n</ul>\n\n<blockquote>\n <p>The 7 gene test consists of a panel of seven genetic markers that\n enable your healthcare professional to provide you with personalized\n nutritional recommendations based on your DNA. This test determines\n how your body responds to vitamin C, folate, whole grains, omega-3\n fats, saturated fat, sodium and caffeine. </p>\n</blockquote>\n\n<p>But then again, there appears a lot of reasons to why caffeine makes some people sleep:</p>\n\n<ul>\n<li><a href=\"http://www.nrcresearchpress.com/doi/abs/10.1139/y01-026#.Vu-eMeIrLIV\">Increases Insulin Response.</a> Does not happen for everybody, but the increased insulin could make you tired. <a href=\"http://www.mayoclinic.org/diseases-conditions/type-2-diabetes/expert-answers/blood-sugar/faq-20057941\">It doesn't appear to have much of a affect though.</a></li>\n</ul>\n\n<blockquote>\n <p>For most young, healthy adults, caffeine doesn't appear to noticeably\n affect blood sugar (glucose) levels, and consumption up to 400\n milligrams a day appears to be safe.</p>\n</blockquote>\n\n<ul>\n<li>Some also say it has to do with vasoconstriction and dehydration due to diuretic effects of coffee. </li>\n</ul>\n\n<p><strong><em>The above other reasons don't seem to be the case in your case, but they are interesting possibilities.</em></strong> </p>\n", "score": 6 } ]

[ "medications", "sleep", "neurology", "caffeine", "sleep-deprivation" ]

[ { "answer_id": 5565, "body": "<p>There is only marginal evidence of RICE (rest, ice, elevation and compression) improving recovery in injuries. </p>\n\n<p>For example, in a <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/14754753\" rel=\"nofollow\">review of 22 studies of ankle injuries</a>, ice and elevation had only marginal effects on recovery. </p>\n\n<p>In another review of <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/18212134\" rel=\"nofollow\">six studies in soft tissue injuries</a>, there was no evidence that ice was effective. </p>\n\n<p>In a <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/11403116\" rel=\"nofollow\">review of 45 sports medicine textbooks</a>, the advice on the use of ice varied in the textbooks. </p>\n\n<p>Some individual studies such as <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/23364294\" rel=\"nofollow\">this one</a> do show evidence for decreased pain and some increased range of motion earlier for ice used in the first 72 hours. </p>\n\n<p>Importantly, studies don't seem to suggest there is a harm. The short answer, which we often use to guide decisions in medicine, is \"Can't hurt. Might help.\"</p>\n\n<p>The \"can't hurt\" is conditional as only if done properly: don't ice directly on the skin as that is known to have caused frostbite. Wrap the ice in a cloth. Don't ice longer than 20 minutes. (Some studies say 10 minutes.)</p>\n", "score": 2 } ]

[ "pain", "treatment", "injury" ]

[ { "answer_id": 10440, "body": "<p>You can find more information <a href=\"http://www.cochrane.org/CD007868/ORAL_comparison-between-different-concentrations-of-fluoride-toothpaste-for-preventing-tooth-decay-in-children-and-adolescents\" rel=\"nofollow noreferrer\">here</a> about this issue:</p>\n\n<blockquote>\n <p><strong>Comparison between different concentrations of fluoride toothpaste for preventing tooth decay in children and adolescents</strong></p>\n \n <p>[...] Although none of the trials included in the review looked at fluorosis or mottling of the children's teeth, fluorosis may be an unwanted result of using fluoride toothpaste in young children and a Cochrane review on this topic has also been published. The possible risk of fluorosis should be discussed with your dentist who may recommend using a toothpaste containing less than 1000 ppm fluoride.</p>\n \n <p><strong>Authors' conclusions:</strong> </p>\n \n <p>This review confirms the benefits of using fluoride toothpaste in preventing caries in children and adolescents when compared to placebo, but only significantly for fluoride concentrations of 1000 ppm and above. The relative caries preventive effects of fluoride toothpastes of different concentrations increase with higher fluoride concentration. The decision of what fluoride levels to use for children under 6 years should be balanced with the risk of fluorosis.</p>\n</blockquote>\n\n<p><a href=\"http://www.cochrane.org/CD007693/ORAL_is-the-use-of-fluoride-toothpaste-during-early-childhood-associated-with-discolourationmottling-of-teeth\" rel=\"nofollow noreferrer\">Cochrane review on fluorosis which may be an unwanted result of using fluoride toothpaste in young children</a></p>\n\n<blockquote>\n <p><strong>Is the use of fluoride toothpaste during early childhood associated with discolouration/mottling of teeth?</strong></p>\n \n <p>[...] There is some evidence that brushing a child's teeth with a toothpaste containing fluoride, before the age of 12 months, may be associated with an increased risk of developing fluorosis. There is stronger evidence that higher levels of fluoride (1000 parts per million (ppm) or more) in toothpaste are associated with an increased risk of fluorosis when given to children under 5 to 6 years of age. However, for some children (those considered to be at high risk of tooth decay by their dentist), the benefit to health of preventing decay may outweigh the risk of fluorosis. In such circumstances, careful brushing by parents/adults with toothpastes containing higher levels of fluoride would be beneficial.</p>\n \n <p><strong>Authors' conclusions:</strong></p>\n \n <p>There should be a balanced consideration between the benefits of topical fluorides in caries prevention and the risk of the development of fluorosis. Most of the available evidence focuses on mild fluorosis. There is weak unreliable evidence that starting the use of fluoride toothpaste in children under 12 months of age may be associated with an increased risk of fluorosis. The evidence for its use between the age of 12 and 24 months is equivocal. If the risk of fluorosis is of concern, the fluoride level of toothpaste for young children (under 6 years of age) is recommended to be lower than 1000 parts per million (ppm).</p>\n \n <p>More evidence with low risk of bias is needed.</p>\n</blockquote>\n", "score": 5 } ]

[ "dentistry", "toothpaste" ]

[ { "answer_id": 15360, "body": "<p>First of all, <a href=\"https://en.wikipedia.org/wiki/Anorgasmia\" rel=\"noreferrer\">anorgasmia</a> can be either a primary effect caused by depression itself, along with decreased libido. But then it may also be a side-effect of the medication itself, adding to the underlying problem and quite likely decreasing not only libido, erectile function or ability to orgasm but also having a negative effect on compliance with the whole treatment regime.</p>\n\n<p>It is therefor prudent to talk about these aspects, pro-actively. Maintaining or improving <a href=\"https://en.wikipedia.org/wiki/Self-efficacy#Academic_contexts\" rel=\"noreferrer\">self-efficacy</a> and <a href=\"https://en.wikipedia.org/wiki/Locus_of_control#Applications\" rel=\"noreferrer\">locus of control</a> are to be appreciated on their own. Although this is tricky as focusing on this side-effct might also increase a <a href=\"https://en.wikipedia.org/wiki/Nocebo\" rel=\"noreferrer\">nocebo</a>-like effect. That last effect is also a big chance in that psychotherapy or even sex-therapy may also be used to improve outcomes to a limited degree. After all, if it is \"just\" reduced response to stimuli, then the intensity of stimuli might be increased to compensate.</p>\n\n<p>A still valid matrix of average effects and resulting course of action is outlined below:</p>\n\n<blockquote>\n <p><a href=\"https://www.aafp.org/afp/2000/0815/p782.html\" rel=\"noreferrer\">Robert L. Phillips &amp; James R. Slaughter: \"Depression and Sexual Desire\" (2000)</a> </p>\n\n<pre> Medication Libido Effect Other Sexual Effects\n SSRIs\nFluoxetine (Prozac), Decrease Anorgasmia, delayed ejaculation, \nparoxetine (Paxil), erectile dysfunction\nfluvoxamine (Luvox), \ncitalopram (Celexa), \nsertraline (Zoloft)\n#\nImipramine (Tofranil), Decrease Erectile dysfunction\nphenelzine (Nardil)\n#\nBupropion (Wellbutrin) Increase None\n#\nTrazodone (Desyrel) Increase Priapism (rare)\n#\nNefazodone (Serzone) No change None\n</pre>\n \n <p><a href=\"https://i.stack.imgur.com/YjDxd.gif\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/YjDxd.gif\" alt=\"enter image description here\"></a></p>\n</blockquote>\n\n<p>Then there are different medications available with differing profiles and they can be differentiated by amount of side-effects, scope of side-effects and individual tolerability. Tolerance for this case in terms of sexual function needs to be addressed, so that you may recommend a lower dose, different medications or a compensating additional treatment.Different medication does not necessarily mean immediately switching the whole class of drugs. It might also yield improvement to switch</p>\n\n<blockquote>\n <p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16871135\" rel=\"noreferrer\">Glen L. Stimmel &amp; Mary A. Gutierrez: \"Sexual Dysfunction and Psychotropic Medications\" (2006)</a><br>\n Psychotropic drugs are often associated with sexual dysfunction. The frequency of antidepressant-associated sexual dysfunction is greatly underestimated in clinical trials that rely on patient self-report of these adverse events. Direct inquiry reveals that delayed orgasm/ejaculation occurs in >50% and anorgasmia in at least one third of patients given selective serotonin reuptake inhibitors. Antidepressant-induced sexual dysfunction can be successfully managed. A different antidepressant without significant sexual effects, such as bupropion or mirtazapine, can often be substituted. Other strategies involve drug holidays or adjunctive therapy with drugs such as sildenafil. Dopamine antagonist antipsychotic drugs are most commonly associated with decreased libido. […] Because sexual dysfunction can be related to many factors, care must be taken to establish the patient's baseline sexual functioning before the initiation of psychotropic drug therapy and to rule out other etiologies before drugs are implicated as causative.<br>\n (Caution: Clear Conflicts of Interest)</p>\n</blockquote>\n\n<p>Unfortunately, this field is still under researched and all the options above are only trying to solve a poorly understood problem.</p>\n\n<blockquote>\n <p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12385082?dopt=Abstract\" rel=\"noreferrer\">Mechanisms and treatments of SSRI-induced sexual dysfunction.</a>\n SSRI-induced sexual dysfunction affects 30% to 50% or more of individuals who take these drugs for depression. Biochemical mechanisms suggested as causative include increased serotonin, particularly affecting 5HT2 and 5HT3 receptors; decreased dopamine; blockade of cholinergic and alpha-1 adrenergic receptors; inhibition of nitric oxide synthetase; and elevation of prolactin levels. Five approaches to treatment include conservative approaches such as wait and see, decrease dosage, and drug holidays. More aggressive strategy for treating SSRI-induced sexual dysfunction are changing antidepressants and augmentation. </p>\n</blockquote>\n\n<p>One possible mechanism in rats:</p>\n\n<blockquote>\n <p>5-HT(1A) receptor antagonism reverses and prevents fluoxetine-induced sexual dysfunction in rats.\n Sexual dysfunction associated with antidepressant treatment continues to be a major compliance issue for antidepressant therapies. 5-HT(1A) antagonists have been suggested as beneficial adjunctive treatment in respect of antidepressant efficacy; however, the effects of 5-HT(1A) antagonism on antidepressant-induced side-effects has not been fully examined. The present study was conducted to evaluate the ability of acute or chronic treatment with 5-HT(1A) antagonists to alter chronic fluoxetine-induced impairments in sexual function. Chronic 14-d treatment with fluoxetine resulted in a marked reduction in the number of non-contact penile erections in sexually experienced male rats, relative to vehicle-treated controls. Acute administration of the 5-HT(1A) antagonist WAY-101405 resulted in a complete reversal of chronic fluoxetine-induced deficits on non-contact penile erections at doses that did not significantly alter baselines. Chronic co-administration of the 5-HT(1A) antagonists WAY-100635 or WAY-101405 with fluoxetine prevented fluoxetine-induced deficits in non-contact penile erections in sexually experienced male rats. Moreover, withdrawal of WAY-100635 from co-treatment with chonic fluoxetine, resulted in a time-dependent reinstatement of chronic fluoxetine-induced deficits in non-contact penile erections. Additionally, chronic administration of SSA-426, a molecule with dual activity as both a SSRI and 5-HT(1A) antagonist, did not produce deficits in non-contact penile erections at doses demonstrated to have antidepressant-like activity in the olfactory bulbectomy model. Taken together, these data suggest that 5-HT(1A) antagonist treatment may have utility for the management of SSRI-induced sexual dysfunction.</p>\n</blockquote>\n\n<p>But notice the possibly contradictory explanation when relating this proposed mechanism with <a href=\"https://en.wikipedia.org/wiki/Flibanserin#Mechanism_of_action\" rel=\"noreferrer\">Flibanserin</a>:</p>\n\n<blockquote>\n <p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1573953/\" rel=\"noreferrer\">Flibanserin, a potential antidepressant drug, lowers 5-HT and raises dopamine and noradrenaline in the rat prefrontal cortex dialysate: role of 5-HT1A receptors</a></p>\n</blockquote>\n\n<p>Interestingly \"unconventional\" options are apparently not completely off in this regard:</p>\n\n<blockquote>\n <p>The Mayo Clinic Proceedings <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/27594188\" rel=\"noreferrer\">Antidepressant-Induced Female Sexual Dysfunction</a> (2016) considers the Peruvian herb/tuber Maca (Lepidium meyenii) an option because of this: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/25954318?dopt=Abstract\" rel=\"noreferrer\">A double-blind placebo-controlled trial of maca root as treatment for antidepressant-induced sexual dysfunction in women</a>.</p>\n</blockquote>\n\n<p>In conclusion this leaves not really much from the category \"definitively\" on the table right now: talk and try.</p>\n\n<blockquote>\n <p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/27514298\" rel=\"noreferrer\">Sexual Dysfunction Due to Psychotropic Medications. (2016)</a>\n Effective strategies to manage medication-induced sexual dysfunction are initial choice of a drug unlikely to cause SD, switching to a different medication, and adding an antidote to reverse SD. Appropriate interventions should be determined on a clinical case-by-case basis.</p>\n</blockquote>\n", "score": 5 } ]

[ "sex", "antidepressants" ]

[ { "answer_id": 14398, "body": "<p><a href=\"https://en.wikipedia.org/wiki/Fasting#Medical_application\" rel=\"nofollow noreferrer\">Fasting has some medical applications</a>. Among them is <a href=\"https://en.wikipedia.org/wiki/Preoperative_fasting\" rel=\"nofollow noreferrer\"><em>pre</em>-operative fasting</a> which involves wounds. </p>\n\n<p>But wound healing is basically a status of greatly increased nutritional demands. So, yes, fasting while wounded tends to be a not so good idea:</p>\n\n<blockquote>\n <p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/20692599\" rel=\"nofollow noreferrer\"><strong>Basics in nutrition and wound healing:</strong></a>\n Therefore, local wound management and good documentation of the wound is essential for non-delayed wound healing and prevention of the development of chronic wounds. During the wound-healing process much energy is needed. The energy for the building of new cells is usually released from body energy stores and protein reserves. This can be very challenging for undernourished and malnourished patients.</p>\n</blockquote>\n\n<p>From that article:<br>\nInfluence of undernutrition on wound healing\nEven in uncomplicated starvation, as during a prolonged fasting, the body of an average adult subject loses 60 to 70 g of protein (240–280 g of muscle tissue) per day. However, severe trauma or sepsis can increase the loss of body protein up to 150 to 250 g (600–1000 g of muscle tissue) per day. Wound healing is delayed in subjects who had periods of starvation (simple or stress starvation) before injury or a surgical procedure due to the lack of endogenous substrates. Further undernutrition impedes wound healing in addition to:</p>\n\n<ul>\n<li>Delayed neovascularization and decreased collagen synthesis </li>\n<li>Prolonged phase of inflammation</li>\n<li>Decreased phagocytosis by leukocytes</li>\n<li>Dysfunction of B and T cells</li>\n<li>Decreased mechanical strength of the skin</li>\n</ul>\n\n<blockquote>\n <h2>Proteins</h2>\n \n <p>Proteins play the most important role throughout the entire wound-healing process. Lymphocytes, leukocytes, phagocytes, monocytes, and macrophagesdimmune system cellsdare mainly comprised of proteins and are necessary to initiate a healthy inflammatory response in the healing process. An adequate supply with proteins is necessary for consistent wound healing. Because collagen is the protein that is produced mainly in the healing wound, a lack of protein decreases the synthesis of collagen and the production of fibroblasts.<br>\n Of course, all proteinogenic amino acids are important during wound healing. There is evidence that some amino acids are especially important for the process. Methionine and cysteine are involved in the synthesis of connective tissue and collagen. Arginine is thought to have a major influence on the proliferation of collagen accretion and on an improved immune reaction.</p>\n</blockquote>\n\n<p>And of course there is an increased need for fatty acids, vitamin C, iron, zinc etc. From a surgeon's perspective these points need to be considered:</p>\n\n<blockquote>\n <p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/17080694\" rel=\"nofollow noreferrer\"><strong>The metabolic effects of fasting and surgery:</strong></a>\n - fasting rapidly affects metabolism, although gradually adaptation occurs to minimize protein losses\n - surgery increases metabolic rate and catabolism, of which insulin resistance is related to the magnitude of surgery\n - insulin treatment in insulin-resistant patients after surgery or trauma markedly improves body metabolism and reduces morbidity and mortality\n - avoiding preoperative fasting reduces postoperative insulin resistance by about 50% and attenuates postoperative impairment in nitrogen losses, lean body mass and muscle function\n - fasting or deficient energy intake after surgery does not affect postoperative insulin resistance but does accelerate nitrogen losses\n - perioperative parenteral nutrition has been shown to reduce morbidity and mortality in patients with malnutrition, but has no beneficial effects in well fed patients\n - oral supplements perioperatively may attenuate postoperative weight loss and reduce infectious complications\n - patients undergoing surgery within a multimodal programme designed to reduce stress and to improve postoperative function display only minor insulin resistance, which allows feeding without hyperglycaemia</p>\n</blockquote>\n\n<p><a href=\"https://i.stack.imgur.com/juFZT.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/juFZT.jpg\" alt=\"Nutrition, Anabolism, and the Wound Healing Process, p2\"></a></p>\n\n<p>For a more comprehensive view of nutrition and wound healing, take a look at</p>\n\n<blockquote>\n <p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/19274069\" rel=\"nofollow noreferrer\"><strong>Nutrition, Anabolism, and the Wound Healing Process: An Overview:</strong></a>\n One is activation of the stress response to injury, and the second is the development of any protein-energy malnutrition (PEM). Any significant wound leads to a hypermetabolic and catabolic state, and nutritional needs are significantly increased. The healing wound depends on adequate nutrient flow. Of particular concern is the presence of any PEM, PEM being defined as a deficiency of energy and protein intake to meet bodily demands. PEM in the presence of a wound leads to the loss of lean body mass (LBM) or protein stores, <strong>which will in and of itself impede the healing process.</strong> Early aggressive nutrient and micronutritional feeding is essential to control and prevent this process from developing. PEM is commonly seen in the chronic wound population, especially the elderly, disabled, or chronically ill populations where chronic wounds tend to develop.</p>\n</blockquote>\n", "score": 2 } ]

[ "nutrition", "fasting" ]

[ { "answer_id": 13520, "body": "<h2>TL;DR</h2>\n\n<p><strong>Your gel does not contain an active ingredient that causes arousal.</strong></p>\n\n<p>The antifreeze agent propylene glycol will be perceived as an increase in body temperature, where-ever applied, which is supposed to turn one on.</p>\n\n<p>Most of the ingredients are about the aggregate state and lubricity of the gel. Any drugs that enhance sexual performances (<em>thanks <strong>@CareyGregory</strong> for catching that</em>) are not prescriptive-free.</p>\n\n<h2>What the producing company advertises</h2>\n\n<p>They never say that the gel will cause sexual arousal, their only claim is that a \"warming and cooling, pulsating sensation on the clitoris will be felt if applied\".</p>\n\n<h2>Currently known drugs that can enhance sexual performance</h2>\n\n<p><strong>For Men</strong></p>\n\n<p>To my knowledge, for men the PDE5 inhibitors </p>\n\n<ul>\n<li><a href=\"https://medlineplus.gov/druginfo/meds/a699015.html\" rel=\"noreferrer\">sidenafil</a> (C₂₂H₃₀N₆O₄S) </li>\n<li><p><a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/110634#section=Top\" rel=\"noreferrer\">vardenafil</a>\n(C₂₃H₃₂N₆O₄S)</p></li>\n<li><p><a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/110635\" rel=\"noreferrer\">tadalafil</a>(C₂₂H₁₉N₃O₄) </p></li>\n<li><p><a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/9869929\" rel=\"noreferrer\">avanafil</a>\n(C₂₃H₂₆CIN₇O₃)</p></li>\n</ul>\n\n<p>are the only known chemicals enhancing sexual performance.</p>\n\n<p><strong>For Women</strong></p>\n\n<p><a href=\"https://web.archive.org/web/20081004092107/http://www.femalesexualdysfunctiononline.org/commentaries/commentaries.cfm?abs_id=abs_007\" rel=\"noreferrer\">Before 2015</a>, no pharmaceutical drug has concluded its clinical trial as a substitute of viagra for women. </p>\n\n<p>Today, only the 5-HT_1A agonist </p>\n\n<ul>\n<li><a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/6918248\" rel=\"noreferrer\">flibanserin</a>\n(C₂₀H₂₁F₃N₄O)</li>\n</ul>\n\n<p>is mistakenly dubbed \"female viagra\" (the pharmacodynamics are totally different) as it is known to enhance the sexual performance of women. </p>\n\n<p>The <a href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm458734.htm\" rel=\"noreferrer\">FDA has approved of the usage of flibanserin</a>, while it is still denied in Europe <a href=\"https://link.springer.com/content/pdf/10.1007%2Fs15006-015-3559-3.pdf\" rel=\"noreferrer\">due to dangerous side-effects (especially in combination with alcohol) and uncertainty about its effectiveness.</a> (German Source Only).</p>\n\n<h2>The ingredients one by one</h2>\n\n<ul>\n<li><p><strong>Aqua</strong>:<br>\n<em>Latin for <strong>water</strong>.</em> That's what it is. </p>\n\n<blockquote>\n <p>It is used to indicate purified water in packages labelled according\n to the International Nomenclature of Cosmetic Ingredients.<br>\n <em>Source: <a href=\"https://en.m.wikipedia.org/wiki/Aqua\" rel=\"noreferrer\">Wikipedia</a></em></p>\n</blockquote></li>\n<li><p><strong>Propylene Glucol</strong>:<br>\nThis is a simple <strong>antifreeze agent</strong> which will increase the received body temperature when applied to the skin.</p>\n\n<blockquote>\n <p>Propylene glycol is a synthetic liquid substance that absorbs water.\n Propylene glycol is also used to make polyester compounds, and as a\n base for deicing solutions. Propylene glycol is used by the chemical,\n food, and pharmaceutical industries <strong>as an antifreeze</strong> when leakage\n might lead to contact with food.<br>\n <em>Source: <a href=\"https://www.atsdr.cdc.gov/substances/toxsubstance.asp?toxid=240\" rel=\"noreferrer\">CDC.gov</a></em></p>\n</blockquote></li>\n<li><p><strong>Glycerin</strong>:<br>\nThis is another name for the sugar alcohol <em>glycerol</em>, commonly used </p>\n\n<blockquote>\n <p>as a <strong>solvent</strong>, emollient, pharmaceutical agent, and sweetening agent.<br>\n <em>Source: <a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/glycerol#section=Top\" rel=\"noreferrer\">PubChem.gov</a></em></p>\n</blockquote></li>\n<li><p><strong>Hydroxyethylcellulose</strong>:<br>\nAnother name for the chemical commonly called <em>hetastarch</em>, which is a</p>\n\n<blockquote>\n <p>derivative of starch used as a <strong>plasma expander</strong> when prepared in an isotonic solution.<br>\n <em>Source: <a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/24846132#section=Top\" rel=\"noreferrer\">PubChem.gov </a></em> </p>\n</blockquote></li>\n<li><p><strong>PEG-40 Hydrogenated Castor Oil</strong>:<br>\nThis oil is mostly used as a <strong>dissolving agent</strong>:</p>\n\n<blockquote>\n <p>Functions: Fragrance Ingredient; Surfactant - Emulsifying Agent; Surfactant - Solubilizing Agent; PERFUMING<br>\n <em>Source: <a href=\"http://www.ewg.org/skindeep/ingredient/704597/PEG-40_HYDROGENATED_CASTOR_OIL/#.Wa72dD-bGEc\" rel=\"noreferrer\">EWG.org</a></em>.<br>\n .<br>\n PEG Castor Oils and PEG Hydrogenated Castor Oils help to form emulsions by reducing the surface tension of the substances to be emulsified. They also help other ingredients to <strong>dissolve</strong> in a solvent in which they would not normally dissolve.\n <em>Source: <a href=\"http://www.cosmeticsinfo.org/ingredient/peg-40-hydrogenated-castor-oil\" rel=\"noreferrer\">cosmeticsinfo.org</a></em></p>\n</blockquote></li>\n<li><p><strong>Aroma</strong>:<br>\nThis is not specific, so any types of additive that creates flavour falls under this category.</p></li>\n<li><p><strong>Benzoic Acid</strong>:<br>\nThis is one of the most <strong>common food preservatives</strong>.</p>\n\n<blockquote>\n <p>Benzoic acid is a fungistatic compound that is widely used as a food preservative.<br>\n <em>Source: <a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/243#section=Top\" rel=\"noreferrer\">PubChem.gov</a></em></p>\n</blockquote></li>\n<li><p><strong>Sodium Hydroxide</strong>:<br>\nA simple <strong>base</strong> (NaOH) used to </p>\n\n<blockquote>\n <p>to <strong>neutralize acids</strong> and make sodium salts.<br>\n <em>Source: <a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/14798#section=Top\" rel=\"noreferrer\">PubChem.gov</a></em></p>\n</blockquote></li>\n</ul>\n", "score": 10 }, { "answer_id": 13563, "body": "<p>That product is marketed boldly as \"Special formula designed to bring sensual waves of warming, cooling or tingling sensations. Increases sensitivity of her intimate areas for more intense pleasure. Up to 20 earth-shattering orgasms in 1 bottle.\" So it is intended to <em>enhance</em> not cause arousal.</p>\n\n<p>That still sounds quite a bit like an overstatement. Looking through the consumer <a href=\"http://theflipsideoffeminism.com/k-y-intense-reviews.html\" rel=\"nofollow noreferrer\">reviews</a>¹ on various sites gives mixed results, at best. Many negative <a href=\"http://liebe.gofeminin.de/forum/durex-intensiv-gel-wirkts-bei-euch-fd396307\" rel=\"nofollow noreferrer\">experiences</a> are reported (even on commercial sites selling it). Most seem concerned with bad smell, bad taste and, hm, \"lack of action\".</p>\n\n<p>The \"complete\" list of ingredients amounts to only an almost meaningless account of substances. An \"active ingredient\" or \"mechanism of action\" is nowhere to be found. Not on the product, not with the manufacturer and not on review sites or testing agencies.</p>\n\n<p>Most of the ingredients might account for anything:</p>\n\n<ul>\n<li><p><a href=\"https://www.ewg.org/skindeep/ingredient/705315/PROPYLENE_GLYCOL/\" rel=\"nofollow noreferrer\">Propylene Glycol:</a> Declared as emulsifying agent. Is also an <a href=\"http://sexualwellnessnews.com/seven/\" rel=\"nofollow noreferrer\">irritant</a> and <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857673/\" rel=\"nofollow noreferrer\">potential contact allergen</a>. \"Classified as expected to be toxic or harmful\". Hormone-like substance used to <a href=\"http://www.sciencedirect.com/science/article/pii/S0377840104000811\" rel=\"nofollow noreferrer\">increase milk production in turbo cows</a>. <a href=\"https://draxe.com/propylene-glycol/\" rel=\"nofollow noreferrer\">Long list of concerns.</a> Reduces barrier function of the skin. Thereby providing synergistic effects with other ingredients. <a href=\"https://www.codecheck.info/drogerie_toilettartikel/verhuetung_liebesspielzeuge/gleitgel/ean_4002448096870/id_1857873589/Durex_Intense_Orgasmic_Gel.pro\" rel=\"nofollow noreferrer\">Codecheck</a> label: \"slightly questionable\". <br>\nMost likely candidate for <em>the</em> \"active ingredient\". Applied to genitals the most positive way to describe this substance is: it gives reportedly a slightly warming and at the same time cooling sensation before drying out in very short time.</p></li>\n<li><p><a href=\"https://www.ewg.org/skindeep/ingredient/704597/PEG-40_HYDROGENATED_CASTOR_OIL/\" rel=\"nofollow noreferrer\">PEG</a>: <a href=\"http://www.thesmartmama.com/understanding-labels-peg-40-hydrogenated-castor-oil-greenwashing/\" rel=\"nofollow noreferrer\">Wholly classified as dangerous</a> by <a href=\"https://www.treehugger.com/style/beyond-parabens-7-common-cosmetics-ingredients-you-need-to-avoid.html\" rel=\"nofollow noreferrer\">proponents of the organic movement.</a> But also <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4505343/\" rel=\"nofollow noreferrer\">'Considered safe' by traditional standards, although it too is a penetration enhancer</a>, i.e. weakening the barrier function of the skin, again possibly giving synergistic effects with other ingredients. Additionally this substance was often found to have concerning levels of very harmful impurities. Unsafe on damaged skin. Codecheck label: \"questionable\"</p></li>\n<li><p>Aroma (<a href=\"https://www.ewg.org/skindeep/ingredient/702512/FRAGRANCE/\" rel=\"nofollow noreferrer\">Fragrance</a>, Flavour): Under current law this may contain a mix of anything from essential oils to other highly active substances. <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5044959/\" rel=\"nofollow noreferrer\">This is a legal loophole</a>: anything <em>declared</em> to be only for smell and flavour can fall under this label <a href=\"http://www.bvl.bund.de/DE/03_Verbraucherprodukte/02_Verbraucher/03_Kosmetik/02_KennzeichnungKosmetik/bgs_kosmetik_kennzeichnung_node.html\" rel=\"nofollow noreferrer\">since only 26 substances have to be listed specifically.</a> The list of ingredients is sorted by weight and Aroma features pretty high on it. Codecheck label: \"not classifiable\"</p></li>\n<li><p><a href=\"https://www.ewg.org/skindeep/ingredient/700679/BENZOIC_ACID/\" rel=\"nofollow noreferrer\">Benzoic Acid:</a> Preservative that is restricted for use in cosmetics in Japan. May have <a href=\"https://endocrinedisruption.org/interactive-tools/tedx-list-of-potential-endocrine-disruptors/search-the-tedx-list\" rel=\"nofollow noreferrer\">hormone-like effects</a> and can be an <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/8132170\" rel=\"nofollow noreferrer\">irritant or allergen.</a> Codecheck label: \"slightly questionable\"</p></li>\n</ul>\n\n<p>Summing this up: unless the manufacturer opens its playbook and explains what is there to do what, this is probably a moderately unhealthy, slightly irritating lube. Together with its advertising framing this seems to be mostly a mind thing if received as pleasurable (<a href=\"https://en.wikipedia.org/wiki/Cantharidin\" rel=\"nofollow noreferrer\">a concept not totally unheard of</a>). Published data on the ingredients and consumer reports seem to indicate that a similar effect might be achieved by mixing equal parts of peppermint and stinging nettle in a water-oil emulsion with milk. </p>\n\n<hr>\n\n<p>¹ This link leads to another product but with very similar ingredients. Main point being propylene glycol is also included in that one and it is at least halfway 'independently' reviewed. Links to commercial sellers of this product are numerous and they do not advertising coming from this site.</p>\n", "score": 3 } ]

[ "sexuality", "lubrication", "sexual-arousal" ]

[ { "answer_id": 17441, "body": "<blockquote>\n <p>I have done plenty of research and have found people only talking about E-Cigarettes, leaving me in confusion about if vapes without any nicotine contain harmful substances for your lungs. (I am not talking about E-Cigarettes, which I believe is a vape with nicotine.)</p>\n</blockquote>\n\n<p>Colloquially “vapes” = “vaporizers”. Most vaporizers are e-cigarettes, but some are not. An e-cigarette is like a miniature fog machine: wicking material draws e-liquid onto a heating coil. Dry herb vaporizers (like for cannabis) work differently (e.g. with a heated plate).</p>\n\n<p>E-cigarettes do <strong>not</strong> necessarily contain nicotine. It depends on if the e-liquid contains nicotine.</p>\n\n<p>I have not seen any evidence that the presence of nicotine changes the chemical composition of the e-cigarette vapor (aerosol) besides for the presence of nicotine¹ (obviously) and small amounts of impurities and degradation products (see <em>“Public Health Consequences of E-Cigarettes”</em> by the National Academies of Sciences, Engineering, and Medicine, <a href=\"https://www.nap.edu/read/24952/chapter/8#193\" rel=\"nofollow noreferrer\">page 193</a>). Most importantly, no relevant amounts of tobacco-specific nitrosamines have been found in e-cigarette vapor.</p>\n\n<blockquote>\n <p>In conclusion. If you decide to use a vape, without any nicotine, the question still lingers as to if it is still harmful to your lungs. Is it still causing damage?</p>\n</blockquote>\n\n<p>Well, at this point, we do not have any evidence if e-cigarettes <strong><em>with</em> nicotine</strong> cause respiratory disease or not (also one of <a href=\"http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=24952\" rel=\"nofollow noreferrer\">NASEM's conclusion</a>). So how should we make a comparison? </p>\n\n<p>The amount of known harmful (including pulmonary toxic) substances emitted by e-cigarettes doesn't depend on the nicotine but very much on other factors, like the characteristics of the device². </p>\n\n<p>It may be that nicotine exerts a synergistic effect that increases any harm to the lungs by e-cigarette vapor. You'll certainly find studies which claim that nicotine opens pathways for other substances to harm the lungs (though the context is usually conventional cigarettes in that case), but I don't see something like a scientific consensus or estimations by how much.</p>\n\n<p>Personally, I'd be surprised if the presence or absence of nicotine turns out to be an important factor compared to device design, usage (e.g. wattage) and flavouring. </p>\n\n<p>If I had to choose, I'd use an e-cigarette without nicotine, though, but just because it lacks the addictive effect.</p>\n\n<p><hr>\n¹ nicotine is typically extracted from tobacco and then purified</p>\n\n<p>² It's by thermal degradation, <strong><em>not</em></strong> combustion, how toxic carbonyls like acrolein are formed in e-cigarettes. But contrary to combustion in conventional cigarettes, thermal degradation is an <em>unwanted</em> side effect, and e-cigarette manufacturers can eliminate a lot of it without negatively impacting aerosol generation. <br> Similarly, manufacturers are able (as the study <a href=\"https://ehp.niehs.nih.gov/doi/10.1289/ehp2175\" rel=\"nofollow noreferrer\"><em>Metal Concentrations in e-Cigarette Liquid and Aerosol Samples: The Contribution of Metallic Coils.</em></a> (2018) by Olmedo et al. showed) to reduce emissions of metals down to even environmental standards (this would be an overly strict requirement since environmental standards are about <strong><em>constant</em></strong> inhalation).</p>\n", "score": 1 }, { "answer_id": 17448, "body": "<p>If you are asking about possible lung problems due to reports of <strong>popcorn lung</strong> being caused by vaping, then this is covered in <strong><a href=\"https://medicalsciences.stackexchange.com/a/15147\">my answer</a></strong> to the question <a href=\"https://medicalsciences.stackexchange.com/questions/223/e-cigarette-making-liquid-vs-buying-liquid\">E-cigarette. Making liquid vs. buying liquid</a>.</p>\n\n<blockquote>\n <p><strong><a href=\"https://www.nhs.uk/news/heart-and-lungs/flavouring-found-in-e-cigarettes-linked-to-popcorn-lung/\" rel=\"nofollow noreferrer\">Diacetyl was banned in eliquids in the UK in 2016</a></strong> under the EU Tobacco Products Directive as it was <strong><a href=\"https://vaping.com/blog/comment/diacetyl-now-officially-banned-eliquids-uk/\" rel=\"nofollow noreferrer\">attributed to the cause</a> of <a href=\"https://en.wikipedia.org/wiki/Bronchiolitis_obliterans\" rel=\"nofollow noreferrer\">popcorn lung (also known as Bronchiolitis obliterans)</a></strong>. The thing is, <a href=\"https://en.wikipedia.org/wiki/Acetylpropionyl\" rel=\"nofollow noreferrer\">Acetyl Propionyl</a> and <a href=\"https://en.wikipedia.org/wiki/Acetoin\" rel=\"nofollow noreferrer\">Acetoin</a> are chemically similar to <a href=\"https://en.wikipedia.org/wiki/Diacetyl\" rel=\"nofollow noreferrer\">Diacetyl</a> and therefore it is considered wise to avoid them too.</p>\n</blockquote>\n", "score": 0 } ]

[ "smoking", "nicotine", "smoke-inhalation", "e-cigarette-vape" ]

[ { "answer_id": 14117, "body": "<p>Hyperventilation can lead to reduced oxygen transport to cells. As a result, ineffective breathing patterns can cause cell and tissue hypoxia, chronic inflammation, immunosuppression, and many other negative effects caused by low body-oxygen levels and hypocapnia (reduced CO2 levels). </p>\n\n<p>Hypoxia has been found to be a driving force in several health conditions including heart disease, diabetes, chronic fatigue, and has become a widely known key cause of <em>cancer</em> on the cellular level. </p>\n\n<p><a href=\"https://www.nobelprize.org/nobel_prizes/medicine/laureates/1931/warburg-bio.html\" rel=\"noreferrer\">Dr. Otto Warburg</a> investigated the metabolism of tumors and the respiration of cancer cells. In 1931, he was awarded the Nobel Prize for his discovery of the nature and mode of action of the respiratory enzyme as it relates to cellular metabolism and cellular respiration. His studies led to the discovery that</p>\n\n<blockquote>\n <p>...cancerous cells can live and develop, even in the absence of oxygen.</p>\n</blockquote>\n\n<p>Under normal conditions, abnormal cells are detected by the immune system and destroyed. However, the work of macrophages, enzymes and other agents of the immune system is severely restricted when hypoxia exists.</p>\n\n<p>For example, <a href=\"https://medicine.yale.edu/intranet/facultybydept/sara_rockwell-2.profile\" rel=\"noreferrer\">Dr. Rockwell from Yale University School of Medicine</a> studied malignant changes on the cellular level and wrote in an abstract, titled ‘<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/9406244\" rel=\"noreferrer\">Oxygen delivery: Implications for the biology and therapy of solid tumors</a>,’</p>\n\n<blockquote>\n <p>The physiologic effects of hypoxia and the associated microenvironmental inadequacies increase mutation rates, select for cells deficient in normal pathways of programmed cell death, and contribute to the development of an increasingly invasive, metastatic phenotype.</p>\n</blockquote>\n\n<p>Malignant cells normally and constantly appear and exist in any human organism due to the billions of cell divisions and mutations. As described in ‘<a href=\"https://www.ncbi.nlm.nih.gov/books/NBK26891/\" rel=\"noreferrer\">Molecular Biology of the Cell. 4th Edition</a>,’</p>\n\n<blockquote>\n <p>A tumor is considered cancer only if it is malignant, that is, only if its cells have acquired the ability to invade surrounding tissue. Invasiveness usually implies an ability to break loose, enter the bloodstream or lymphatic vessels, and form secondary tumors, called metastases, at other sites in the body.</p>\n</blockquote>\n\n<p>‘<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/3759546?dopt=Abstract\" rel=\"noreferrer\">Acute hypoxia in tumors: implications for modifiers of radiation effects</a>,’ describes methods that were developed in selecting and analyzing cells from tumors as a function of their distance from the tumor blood supply. </p>\n\n<blockquote>\n <p>This information provides direct evidence that, at least for that tumor, hypoxia can result from transient fluctuations in blood perfusion.</p>\n</blockquote>\n\n<p>There is evidence about the fast growth of tumors when the condition of hypoxia is present. ‘<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/15456710\" rel=\"noreferrer\">Microenvironmental and cellular consequences of altered blood flow in tumours</a>’ gives credence to this notion, stating</p>\n\n<blockquote>\n <p>...tumor angiogenesis is triggered by various signals characteristic of the tumor microenvironment, including low oxygen tension, low extracellular pH and low glucose concentration. </p>\n</blockquote>\n\n<p>The abstract also draws a correlation between hypoxia and cancer metastasis: </p>\n\n<blockquote>\n <p>Exposure to hypoxia either induces or selects for cells that are hyper glycolytic, and this in turn produces local <em>acidosis</em> which is also a common feature of solid tumors…Evidence linking tumor acidity with increased activity of several extracellular matrix-degrading enzyme systems is examined…High levels of lactate, another end-product of glycolysis, in primary lesions have been correlated with increased likelihood of metastasis...adoption of a hyper glycolytic phenotype is a necessary feature of carcinogenesis itself and confers a survival and proliferative advantage to tumor cells over surrounding normal cells. Empirical evidence supporting this \"acid-mediated tumor invasion\" model is discussed.</p>\n</blockquote>\n\n<p>Additionally, ’<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/8640781\" rel=\"noreferrer\">Tumor oxygenation predicts for the likelihood of distant metastases in human soft tissue sarcoma</a>’ explores the relationship between tumor oxygenation and treatment outcome in human soft tissue sarcoma, claiming that tumor oxygenation predicts chances of cancer invasion.</p>\n\n<blockquote>\n <p>...anaerobic culture of fibrosarcoma and melanoma cells followed by reoxygenation led to both significant DNA over replication and an increased level of distant metastases. Entry of hypoxic cells such as these into the systemic circulation and subsequent sequestration into the oxygen-rich environment of the lungs could explain the results of the present study…</p>\n</blockquote>\n\n<p>Hypoxia can also affect cancer development, treatment, and prognosis according to ‘<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC110663/\" rel=\"noreferrer\">Regulation of Proliferation-Survival Decisions during Tumor Cell Hypoxia</a>,’</p>\n\n<blockquote>\n <p>Hypoxia may thus produce both treatment resistance and a growth advantage.</p>\n</blockquote>\n\n<p>And in ‘<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752413/\" rel=\"noreferrer\">Hypoxia and radiation therapy: Past history, ongoing research, and future promise</a>’, </p>\n\n<blockquote>\n <p>...changes in blood flow and oxygen consumption during the course of multi fraction and multi-agent therapy alter tumor oxygenation and are probably critical in determining the efficacy of many widely used therapeutic regimens.</p>\n</blockquote>\n\n<p>In ‘<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12767506\" rel=\"noreferrer\">Prognostic significance of tumor oxygenation in humans</a>, </p>\n\n<blockquote>\n <p>Low tissue oxygen concentration has been shown to be important in the response of human tumors to radiation therapy, chemotherapy and other treatment modalities. Hypoxia is also known to be a prognostic indicator, as hypoxic human tumors are more biologically aggressive and are more likely to recur locally and metastasize.</p>\n</blockquote>\n\n<p>And lastly, in ‘<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12947397\" rel=\"noreferrer\">Investigating hypoxic tumor physiology through gene expression patterns</a>,’</p>\n\n<blockquote>\n <p>Clinical evidence shows that tumor hypoxia is an independent prognostic indicator of poor patient outcome. Hypoxic tumors have altered physiologic processes, including increased regions of angiogenesis, increased local invasion, increased distant metastasis and altered apoptotic programs.</p>\n</blockquote>\n\n<p>Based on the findings of the previously mentioned studies, the appearance, development, and metastasis of cancer can be attributed to cell hypoxia which can occur as result of extended hyperventilation. Therefore, the Wim Hof method may not be advantageous when included in a cancer-prone individual's \"prevention plan\" due to the potential risks involved with hypoxia (as a potential consequence resulting from the hyperventilation component of the breathing exercise). </p>\n", "score": 9 }, { "answer_id": 14124, "body": "<p>Apart from monks and nuns who showcase impressive abilities Wim Hof is onto something. One anecdote reads as follows:</p>\n\n<blockquote>\n <p><a href=\"http://www.tdathletesedge.com/blog/2017/7/2/guest-blog-by-vince-tsai-the-power-of-breathing\" rel=\"nofollow noreferrer\">I’ve also experienced the positive changes myself, […] My cardiovascular and muscular endurance has increased substantially too, with a reduction in my run times, thanks to the over-saturation of oxygen to my cells, activation of my autonomic nervous system and the overriding my hypothalamus, and the changing of my body’s pH level to a more alkaline state. All the changes to my physiology from practicing the Wim Hof Technique consistently, has improved my overall health and athletic performance considerably.</a></p>\n</blockquote>\n\n<p>But anecdotes from believers are of course not very useful. Scientists are nevertheless intrigued by all those world records Hof has collected:</p>\n\n<blockquote>\n <p><a href=\"https://www.sciencedirect.com/science/article/pii/S0262407914616274\" rel=\"nofollow noreferrer\">At first this seems a ridiculous idea, because our body’s innate immune system has long been known to operate in an autonomic fashion: we can’t voluntarily control it. But what if this understanding was wrong? Dutchman Wim Hof, better known as “the iceman”, certainly thinks so. Hof holds several world records for withstanding extreme cold, such as immersion in ice for almost 2 hours. Over the years, he developed techniques that allowed him to withstand low temperatures. These include meditation, breathing methods and repeated exposure\n to cold. But he also made the outlandish claim that he could exert control over his immune system. In 2011, although we were sceptical, we put Hof’s claim to the test. […] When we got back to the Netherlands, we tested the volunteers’ immune responses using the endotoxin model. The results were remarkable: the volunteers trained by Hof, who practised the breathing techniques during the experiment, showed exceptionally high adrenaline levels – even higher than those measured in people bungee jumping for the first time (PNAS, vol 111, p 7379). They also reported fewer flu-like symptoms, experienced lower fevers and had cytokine levels of less than half those of the control group. These results show, for the first time, that it is indeed possible to voluntarily influence the SNS and hence the innate immune system.</a></p>\n</blockquote>\n\n<p>The same study in a peer reviewed journal comes with more data:</p>\n\n<p><a href=\"http://www.pnas.org/content/111/20/7379.short\" rel=\"nofollow noreferrer\">Voluntary activation of the sympathetic nervous system and attenuation of the innate immune response in humans</a>:</p>\n\n<blockquote>\n <p><strong>Significance</strong>\n Hitherto, both the autonomic nervous system and innate immune system were regarded as systems that cannot be voluntarily influenced. The present study demonstrates that, through practicing techniques learned in a short-term training program, the sympathetic nervous system and immune system can indeed be voluntarily influenced. Healthy volunteers practicing the learned techniques exhibited profound increases in the release of epinephrine, which in turn led to increased production of anti-inflammatory mediators and subsequent dampening of the proinflammatory cytokine response elicited by intravenous administration of bacterial endotoxin. This study could have important implications for the treatment of a variety of conditions associated with excessive or persistent inflammation, especially autoimmune diseases in which therapies that antagonize proinflammatory cytokines have shown great benefit.</p>\n \n <p><strong>Abstract</strong>\n Excessive or persistent proinflammatory cytokine production plays a central role in autoimmune diseases. Acute activation of the sympathetic nervous system attenuates the innate immune response. However, both the autonomic nervous system and innate immune system are regarded as systems that cannot be voluntarily influenced. Herein, we evaluated the effects of a training program on the autonomic nervous system and innate immune response. Healthy volunteers were randomized to either the intervention (n = 12) or control group (n = 12). Subjects in the intervention group were trained for 10 d in meditation (third eye meditation), breathing techniques (i.a., cyclic hyperventilation followed by breath retention), and exposure to cold (i.a., immersions in ice cold water). The control group was not trained. Subsequently, all subjects underwent experimental endotoxemia (i.v. administration of 2 ng/kg Escherichia coli endotoxin). In the intervention group, practicing the learned techniques resulted in intermittent respiratory alkalosis and hypoxia resulting in profoundly increased plasma epinephrine levels. In the intervention group, plasma levels of the anti-inflammatory cytokine IL-10 increased more rapidly after endotoxin administration, correlated strongly with preceding epinephrine levels, and were higher. Levels of proinflammatory mediators TNF-α, IL-6, and IL-8 were lower in the intervention group and correlated negatively with IL-10 levels. Finally, flu-like symptoms were lower in the intervention group. In conclusion, we demonstrate that voluntary activation of the sympathetic nervous system results in epinephrine release and subsequent suppression of the innate immune response in humans in vivo. These results could have important implications for the treatment of conditions associated with excessive or persistent inflammation, such as autoimmune diseases.</p>\n</blockquote>\n\n<p>A second study also sees changes resulting from practicing the technique, this time stripping the method of its Asian mysticism parts and thereby westernising it:\n<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612090/\" rel=\"nofollow noreferrer\">Neurocognitive and somatic components of temperature increases during g-tummo meditation: legend and reality:</a></p>\n\n<blockquote>\n <p>Stories of g-tummo meditators mysteriously able to dry wet sheets wrapped around their naked bodies during a frigid Himalayan ceremony have intrigued scholars and laypersons alike for a century. Study 1 was conducted in remote monasteries of eastern Tibet with expert meditators performing g-tummo practices while their axillary temperature and electroencephalographic (EEG) activity were measured. Study 2 was conducted with Western participants (a non-meditator control group) instructed to use the somatic component of the g-tummo practice (vase breathing) without utilization of meditative visualization. Reliable increases in axillary temperature from normal to slight or moderate fever zone (up to 38.3°C) were observed among meditators only during the Forceful Breath type of g-tummo meditation accompanied by increases in alpha, beta, and gamma power. The magnitude of the temperature increases significantly correlated with the increases in alpha power during Forceful Breath meditation. The findings indicate that there are two factors affecting temperature increase. The first is the somatic component which causes thermogenesis, while the second is the neurocognitive component (meditative visualization) that aids in sustaining temperature increases for longer periods. Without meditative visualization, both meditators and non-meditators were capable of using the Forceful Breath vase breathing only for a limited time, resulting in limited temperature increases in the range of normal body temperature. Overall, the results suggest that specific aspects of the g-tummo technique might help non-meditators learn how to regulate their body temperature, which has implications for improving health and regulating cognitive performance.</p>\n</blockquote>\n\n<p>That sounds indeed promising. But in what way remains mostly unclear. \"Attenuating immune response\"? Well, lowering the immune system's activity might be a bad idea in relation to cancer, putting a brake on overshooting inflammatory processes might be good. Is any of this studied in a larger group? Is any of this studied over a longer time frame?</p>\n\n<p><em>Temporary</em> short time hyperventilation or even hypoxia may have some kind of <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/29045191\" rel=\"nofollow noreferrer\">training</a> <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/29023329\" rel=\"nofollow noreferrer\">effect</a> that <em>might</em> lead to improved oxygenation of body tissues overall. Doing this repeatedly or routinely may also have quite <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/29053942\" rel=\"nofollow noreferrer\">unwelcome</a> effects. But the <em>local</em> 'tumor hypoxia' effects of cancer that appear as <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/17656037\" rel=\"nofollow noreferrer\">sustained</a> under-oxygenation of the affected cells are not necessarily the same as what happens in breathing a few times like the Hof.</p>\n\n<blockquote>\n <p><a href=\"http://www.tandfonline.com/doi/full/10.1080/23328940.2017.1329001\" rel=\"nofollow noreferrer\">There is, however, a string attached to the Wim Hof Method, <strong>that is the risk that people may think the method is scientifically valid.</strong> Wim is a wholehearted speaker, but his scientific vocabulary is galimatias. With conviction, he mixes in a non-sensical way scientific terms as irrefutable evidence. Many less scientifically literate people believe what he says and several seriously diseased people have used his method as the final straw. Stories of believers circulate on the Internet, in popular magazines and are broadcasted as well. <strong>The scientific investigations are often presented with a biased view.</strong> <br> \n When practicing the Wim Hof Method with a good dose of common sense (for instance, not hyperventilating before submerging in water) and without excessive expectations: it doesn't hurt to try. <strong>Although the effects on our health wait to be proven, people may feel healthier.</strong><br>\n All in all, I think it is worthwhile to sort out whether and which of the training aspects of Wim's method affect our immune system and metabolism. And, with respect to the extreme challenges, is Wim special? Or are we all, as he himself proclaims, ice(wo)men?</a>[emphasis added]</p>\n</blockquote>\n\n<h3>Summary</h3>\n\n<p>So, Wim Hof is onto something. But what is it? <a href=\"http://www.sciencedirect.com/science/article/pii/S0079612308621597\" rel=\"nofollow noreferrer\">Western</a> <a href=\"http://www.sciencedirect.com/science/article/pii/S0167527303003504\" rel=\"nofollow noreferrer\">science</a> has optimised <a href=\"http://online.liebertpub.com/doi/abs/10.1089/acm.2009.0044\" rel=\"nofollow noreferrer\">meditation</a> <a href=\"http://www.sciencedirect.com/science/article/pii/S0165032705002570\" rel=\"nofollow noreferrer\">techniques</a> and <a href=\"http://www.sciencedirect.com/science/article/pii/S1360859209000230\" rel=\"nofollow noreferrer\">proven</a> many benefits one can gain from these practices, even in their archaic or <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/29020861\" rel=\"nofollow noreferrer\">mysticised</a> form. Better breathing patterns and more activity as opposed to sedentary life are without question positive changes for many 'civilised' people. </p>\n\n<p>This answer assumes a somewhat mediated approach to the technique. There are always <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/15136413\" rel=\"nofollow noreferrer\">extreme</a> cases that seem to invalidate a common sense evaluation. Trying to do this in a \"cancer prone\" individual? The relation to cancer seems currently indirect at best. If you overdo it, and what is meant by that is completely undetermined, it is very probably bad. As Taylor above has found this post:<br>\n<a href=\"https://probablyhealthy.com/2016/02/15/13-observations-after-5-months-and-200-sessionsof-wim-hof-breathing-method/\" rel=\"nofollow noreferrer\">13 observations after 5 months and 200+ sessions of Wim Hof Breathing Method</a> some aspects become quite clear though: 120 minutes sessions, doing in a car or in icy water, and possibly alone, there are quite a number of such immediate risks involved in practicing this to these extremes. How much more likely cancer is due to these exercises if done so often and so long to <em>really</em> stress out and damage the system is not known via scientific studies. Overdoing it will very probably lead to very unwelcome effects, like driving off the road, so quickly that any increase in risk for cancer will be moot.</p>\n\n<p>Unless this Hof-method or the tummo meditation are more researched we have to conclude for now that there are many anecdotes but almost no real evidence as defined to our standards that this works either way or better than simply \"do more sports\". Only indicators, but a few, point into the direction of overall improved health, if one doesn't faint from the hyperventilation. </p>\n\n<p>Being the optimist I await much more studies on this. Until those arrive: I guess it doesn't hurt much, it doesn't help much.</p>\n\n<hr>\n", "score": 6 } ]

[ "cancer", "breathing", "oxygenation", "ph-levels", "hypoxia" ]

[ { "answer_id": 16618, "body": "<p><a href=\"https://www.mayoclinic.org/diseases-conditions/tuberculosis/diagnosis-treatment/drc-20351256\" rel=\"nofollow noreferrer\">Mayo Clinic</a> on the example of tuberculosis:</p>\n\n<blockquote>\n <p>Stopping treatment too soon or skipping doses can allow the bacteria\n that are still alive to become resistant to those drugs, leading to tuberculosis\n that is much more dangerous and difficult to treat.</p>\n</blockquote>\n\n<p>So, the logic behind completing the course is to kill as much bacteria as possible to prevent the surviving ones to mutate and become resistant.</p>\n\n<hr>\n\n<p>UPDATE: This question seems to be quite complicated, actually.</p>\n\n<p>According to <a href=\"https://www.bmj.com/content/358/bmj.j3418\" rel=\"nofollow noreferrer\">The BMJ (2017)</a>:</p>\n\n<blockquote>\n <p>However, the idea that stopping antibiotic treatment early encourages\n antibiotic resistance is not supported by evidence, while taking\n antibiotics for longer than necessary increases the risk of\n resistance.</p>\n</blockquote>\n\n<p>The official policies of prescribing antibiotics have not changed because of such discussions, but the BMJ authors recommend that the information material for the public should contain \"take antibiotics exactly as prescribed\" and not \"finishing the course.\" So, it's a doctor and not a patient who should decide the treatment period.</p>\n", "score": 8 } ]

[ "immune-system", "antibiotics" ]

[ { "answer_id": 25237, "body": "<p>Yes. Prevents it too. 100% in some studies, but not others, but then, the vaccines aren't proven stop it 100%, and ivermectin's safety profile is far superior.</p>\n<p>What's established/true has changed a lot since this question was asked and initially answered.</p>\n<h2>CHEST</h2>\n<p>Does CHEST only publish results of INvalid clinical evidence? No. It's v. reputable. Yes, this retrospective study shows it works, and likely works much better than the other treatments already in use.</p>\n<p>Chest Article : <a href=\"https://journal.chestnet.org/article/S0012-3692(20)34898-4/fulltext\" rel=\"nofollow noreferrer\">Use of Ivermectin Is Associated With Lower Mortality in Hospitalized Patients With Coronavirus Disease 2019</a> (Title, Link)</p>\n<hr />\n<h2>FLCCC review</h2>\n<p>And in addition to reliable clinical evidence (which Cochrane says evidence shows is as reliable as RCT evidence) there are a great many preprint results from RCT and published results from RCT. Rather than put up a static, soon to be wrong summary, I point to this:</p>\n<p>The <strong>FLCCC</strong>'s <a href=\"https://covid19criticalcare.com/flccc-ivermectin-in-the-prophylaxis-and-treatment-of-covid-19/\" rel=\"nofollow noreferrer\"><strong>comprehensive review of the emerging evidence for Ivermectin use in our I-MASK+ protocol</strong> (PDF, continuously updated)</a> (It recently had 87 citations and resolves to <a href=\"https://covid19criticalcare.com/wp-content/uploads/2020/11/FLCCC-Ivermectin-in-the-prophylaxis-and-treatment-of-COVID-19.pdf\" rel=\"nofollow noreferrer\">this URL</a> but that has changed or is sure to change.)</p>\n<p>Also, it is more than an incredibly popular preprint that has surely saved tens of thousands of lives; it has now passed peer review for publication in <em>Frontiers in Pharmacology</em>. doi: 10.3389/fphar.2021.643369.</p>\n<p>They put it thus in their review:</p>\n<blockquote>\n<p>To our knowledge, the current review is the earliest to compile\nsufficient clinical data to demonstrate a strong signal of therapeutic\nefficacy based on numerous clinical trials in multiple disease phases,\nhowever it is limited by the fact that only a minority of studies have\nbeen published in peer-reviewed publications, with the majority of\nresults compiled from manuscripts uploaded to medicine pre-print\nservers or from registered trials that have posted preliminary results\non clinicaltrials.gov.</p>\n</blockquote>\n<p>] But &quot;minority&quot; != 0. Overall, the results are largely highly significant. Results from 16 clinical trials and 3 large case series are reviewed.</p>\n<p>They even mention:</p>\n<blockquote>\n<p>Two manuscripts reviewing the scientific rationale and evolving\npublished clinical evidence base in support of the MATH+ protocol\npassed peer review and have been accepted for publication in major\nmedical journals at two different time points in the pandemic (2, 3).</p>\n</blockquote>\n<h1>E-BMC for Cochrane's <strong>Tess Lawrie</strong></h1>\n<p><a href=\"https://www.e-bmc.co.uk/#comp-k86k1hw8\" rel=\"nofollow noreferrer\"> e-bmc.co.uk </a> : This organization has published a meta-analysis to the rigorous standards of the WHO by these extremely experienced and prolific Cochrane authors.</p>\n<p>Their Tess Lawrie <a href=\"https://www.youtube.com/watch?v=rHPkR6QRcCc\" rel=\"nofollow noreferrer\">discusses it here. ESSENTIAL</a>.</p>\n<h2>Ivermectin has helped Billions of patients, is helping Millions fight the pandemic.</h2>\n<p>People have already received far over three billion &lt; sic &gt; doses, and the record of significant adverse reports indicates is about as safe as medicine gets.</p>\n<p>Another retrospective study is based on over 1 million doses distributed in one of each of several <strong>paired Brazilian cities</strong>. Another compares <strong>regions in Paraguay</strong> that did and didn't receive ivermectin. Another compares <strong>African states</strong> where ivermectin is and isn't distributed nationwide. In each study, cases and deaths, tracked over time, diverge, strongly according to ivermectin distribution.</p>\n<p>There are now several literature reviews and meta-analyses by several groups of doctors including the from FLCCC - who are some of the most experienced in emergency medicine. These are confirmed by their clinical experience as well as large population studies and medical groups in several countries on the latest research.</p>\n<h1>100% prevention???</h1>\n<p>Yup. The 100% figure comes from <a href=\"https://doi.org/10.31546/2633-8653.1007\" rel=\"nofollow noreferrer\">Carvallo</a>. It reports:</p>\n<blockquote>\n<p>The overall infection rate in health care workers recruited for this study was 20% with 237 testing positive for CoViD 19 during the 3 month study recruitment. Of those infected, all patients were from the comparator group of using PPE alone. This represented an overall infection rate of 58.2% ( 237 of 407) in the PPE group.\n<strong>No patients of the 788 treated with [IVERMECTIN] tested positive for CoViD 19 during the study.</strong></p>\n</blockquote>\n<p>I.e. 100% did not. And this was a multi-center study in 4 major hospitals, including the pilot, with 1,424 <strong>health care workers</strong>. <strong>Of the 919 who got ivermectin, 100% remained CoViD-19-free.</strong></p>\n<h2>WHO endorsements</h2>\n<p>There are two recent WHO-originated and funded endorsements of ivermectin. First, <a href=\"https://www.who.int/news/item/17-12-2020-a-parasitic-infection-that-can-turn-fatal-with-administration-of-corticosteroids\" rel=\"nofollow noreferrer\">on the WHO website, ivermectin is recommended</a> for treatment of Covid-19 patients when they are being treated with immunosuppressants.</p>\n<p>Secondly the WHO funded an evaluation of the evidence to date and Dr Hill, the expert consultant the WHO relies on for such evaluations of evidence to be used as the basis for official WHO recommendations has spoken very encouragingly regarding the evidence from randomized controlled trials demonstrating the utility of Ivermectin in treating Covid-19 that his work so far has uncovered:</p>\n\n<p>Andrew Hill for WHO: <a href=\"https://m.youtube.com/watch?v=yOAh7GtvcOs\" rel=\"nofollow noreferrer\">https://m.youtube.com/watch?v=yOAh7GtvcOs</a> (censored)\nOriginal is at <a href=\"https://medincell.com/IvermectinWorkshop/AndrewHill.mp4\" rel=\"nofollow noreferrer\">https://medincell.com/IvermectinWorkshop/AndrewHill.mp4</a>, (works) and I have a copy as well. <a href=\"https://www.dropbox.com/s/li4i3pyl52t88dy/AndrewHill%20WebOpt%2Ch265%2C0%2C-fps%2CRF31%2C%20placebo%2C%20to1920x1k%20-36%2C106%2C-94%2C-4%2CnoALL%2CHE-AAC40kbps.m4v?dl=0\" rel=\"nofollow noreferrer\">https://www.dropbox.com/s/li4i3pyl52t88dy/AndrewHill%20WebOpt%2Ch265%2C0%2C-fps%2CRF31%2C%20placebo%2C%20to1920x1k%20-36%2C106%2C-94%2C-4%2CnoALL%2CHE-AAC40kbps.m4v?dl=0</a> (works; sign-up/login NOT needed)</p>\n<p><a href=\"https://www.who.int/news/item/17-12-2020-a-parasitic-infection-that-can-turn-fatal-with-administration-of-corticosteroids\" rel=\"nofollow noreferrer\">https://www.who.int/news/item/17-12-2020-a-parasitic-infection-that-can-turn-fatal-with-administration-of-corticosteroids</a></p>\n<p>--\n(The ~Sphere data-derived paper is obviously garbage and merits scant not attention outside the tabloids.)</p>\n<p>From Hill's presentation:\n<img src=\"https://i.stack.imgur.com/Yc722.jpg\" alt=\"Sources\" /></p>\n", "score": 4 }, { "answer_id": 25015, "body": "<p>There is a paper which suggest that ivermectin is unlikely to be an effective antiviral vs. SARS-CoV-2 at recommended dosing.</p>\n<blockquote>\n<p>Please find this <a href=\"https://www.medrxiv.org/content/10.1101/2020.04.21.20073262v1\" rel=\"nofollow noreferrer\">preprint</a> or this <a href=\"https://ascpt.onlinelibrary.wiley.com/doi/10.1002/cpt.1889\" rel=\"nofollow noreferrer\">paper</a>.</p>\n</blockquote>\n<p>This paper has the following description.</p>\n<blockquote>\n<p>Recently, an article by Caly et al. reported that ivermectin inhibited severe acute respiratory syndrome‐coronavirus (SARS‐CoV‐2) in vitro causing an ~ <strong>5,000‐fold reduction in viral RNA at 48 hours with ivermectin at 5 μM</strong>. The concentration resulting in <strong>50% inhibition (IC50) of 2 μM</strong> (1,750 ng/mL) is &gt; 35× higher than the <strong>maximum plasma concentration (Cmax) of 0.05 µM</strong> (46.6 ng/mL)2 after oral administration of the approved dose (~ 200 μg/kg) and ivermectin showed little to no activity 1 μM in vitro. Because ivermectin is highly bound to serum albumin (93%), the IC50 is orders of magnitude higher than the <strong>unbound plasma Cmax after approved doses of ivermectin (0.0035 µM; 3.26 ng/mL)</strong>.</p>\n</blockquote>\n<p>Therefore, a large estimate is that the plasma concentration is 2 μM /0.0035 µM =571 times insufficient.</p>\n<p>I think the key points of above paper are as follows;</p>\n<ul>\n<li>The development of methods to realize enough concentrations of ivermectin in the lungs/plasma.</li>\n<li>Is ivermectin still safe when the enough concentration is achieved in the lungs/plasma?</li>\n</ul>\n<p>These questions follow naturally from the preprint/paper above.</p>\n<p>However, as described in the @Matthew Elvey 's answer, as of December 5, 2020, <strong>there are many clinical results which suggest that we can get enough efficiency</strong> with far less dosage than would be assumed from pharmacokinetic considerations; formulas that combine several things such as zinc and vitamins seem to be more desirable.(Added on December 5, 2020)</p>\n<p>The gap between inadequate blood levels and a strong clinical effect is one puzzle. It is an exciting scientific topic. This gap will be bridged as the mechanism of action of ivermectin is elucidated.</p>\n<p>So far, various mechanisms have been proposed, but it has not been decided which one is the mainstay. That's what Satoshi Omura said in his <a href=\"https://www.youtube.com/watch?v=aETVHbqlDbo?t=1:10:07\" rel=\"nofollow noreferrer\">open youtube lecture</a> (In Japanese, the relevant part has been headed out.) at <a href=\"https://en.wikipedia.org/wiki/Showa_Pharmaceutical_University\" rel=\"nofollow noreferrer\">Showa Pharmaceutical University</a> at the end of October, 2020.</p>\n<p>The following is a summary of the <a href=\"https://www.youtube.com/watch?v=aETVHbqlDbo?t=1:10:07\" rel=\"nofollow noreferrer\">youtube lecture</a> by Satoshi Omura.</p>\n<blockquote>\n<ul>\n<li>There are various proposed mechanisms of action by which ivermectin inhibits coronaviruses, and it is not clear which theory is definitively correct. He introduced the following two mechanisms <strong>as examples</strong>.</li>\n<li>One is that ivermectin inhibits the process by which the viral spike joins <a href=\"https://en.wikipedia.org/wiki/Angiotensin-converting_enzyme_2\" rel=\"nofollow noreferrer\">ACE2</a> and enters the cell. This is an example of the idea of inhibiting viral entry. (Figure 1, left)</li>\n<li>Dr. Maruta and colleagues in Australia have proposed a different mechanism. In that theory ivermectin acts on the human body. Briefly, when the virus binds to receptors such as <a href=\"https://en.wikipedia.org/wiki/Angiotensin-converting_enzyme_2\" rel=\"nofollow noreferrer\">ACE2</a>, a kinase called <a href=\"https://en.wikipedia.org/wiki/PAK1\" rel=\"nofollow noreferrer\">PAK1</a> is induced. This is a release kinase, which appears to be released when infection occurs and suppresses the immune system. Their idea seems to be that ivermectin also protects the immune system by inhibiting PAK1. (Figure 1, right)</li>\n</ul>\n</blockquote>\n<h2><a href=\"https://i.stack.imgur.com/6SknF.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/6SknF.png\" alt=\"enter image description here\" /></a><br>\n<strong>Fig.1</strong> Examples of proposed mechanisms of action. Adapted from a <a href=\"https://www.youtube.com/watch?v=aETVHbqlDbo?t=1:10:07\" rel=\"nofollow noreferrer\">lecture</a> given by Satoshi Omura at the end of October 2020, partially written in Japanese.</h2>\n<hr />\n<p>In September 2020, Japan's <a href=\"https://en.wikipedia.org/wiki/Kitasato_University\" rel=\"nofollow noreferrer\">Kitasato University</a> appears to have begun a physician-led clinical trial for COVID-19. Kitasato University is where <a href=\"https://en.wikipedia.org/wiki/Satoshi_%C5%8Cmura\" rel=\"nofollow noreferrer\">Satoshi Omura</a>, one of the discoverers of ivermectin, is affiliated.</p>\n<ul>\n<li><a href=\"https://jrct.niph.go.jp/en-latest-detail/jRCT2031200120\" rel=\"nofollow noreferrer\">jRCT2031200120</a>:A placebo-controlled, randomized, double-blind study in Covid-19\npatients with ivermectin; An investigator initiated trial</li>\n</ul>\n<p>They will administer the Ivermectin Tablets, sold under the brand name <a href=\"https://www.rad-ar.or.jp/siori/english/kekka_plain.cgi?n=40911\" rel=\"nofollow noreferrer\">STROMECTOL</a>, orally.\nAccording to a Japanese newspaper <a href=\"https://yakuyomi.jp/industry_news/20200923a/\" rel=\"nofollow noreferrer\">article</a> (written in Japanese), the trial is expected to be completed in March 2021. (Completion = LPI?)</p>\n<p>On the other hand, scandalous clinical data also exists.　It seems that one data analysis company, <a href=\"https://en.wikipedia.org/wiki/Surgisphere\" rel=\"nofollow noreferrer\">Surgisphere</a> published a preprint saying that ivermectin was beneficial based on analysis of real world data, but it was later retracted. According to this <a href=\"https://www.sciencemag.org/news/2020/06/mysterious-company-s-coronavirus-papers-top-medical-journals-may-be-unraveling\" rel=\"nofollow noreferrer\">article</a>, it seems to have pointed out many unnatural aspects of the data.</p>\n<hr />\n<p>By the way, Ivermectin's 'birthplace' features hot news about Ivermectin. Note that a bit slow in terms of information; as of 5 December 2020, the introduction of the paper published on 10 November is the most recent. Even more unfortunate is that the information is in Japanese. However, it will be helpful to see the trends. For many people, though, they may need the help of machine translation.<br>\n<a href=\"https://kitasato-infection-control.info/\" rel=\"nofollow noreferrer\">https://kitasato-infection-control.info/</a>\n(Written in Japanese)</p>\n", "score": 3 }, { "answer_id": 25754, "body": "<h2>We do not know. Until there is a phase 3 clinical trial and ivermectin gets FDA approval, it is too early to draw definite conclusions.</h2>\n<p>[The NIH has selected some of the studies performed and combined them into a table][1]. <strong>At the time, all of them</strong> had one or more methodical disadvantage or limitation such as no peer review, no randomisation or a small sample size (20 patients in each arm) and were deemed insufficient to draw a conclusion.</p>\n<p>The <a href=\"https://www.thelancet.com/action/showPdf?pii=S2589-5370%2820%2930464-8\" rel=\"nofollow noreferrer\">most recent study published in The Lancet</a> (one of the most prestigious scientific journals) found no statistically significant difference in clinical endpoints for the usage of ivermectin, and maybe smaller viral loads but no difference in vital signs etc. This study also had a very small sample size (12 patients in each arm, all at low risk).</p>\n<p>[1]: <a href=\"https://www.covid19treatmentguidelines.nih.gov/tables/table-2c/\" rel=\"nofollow noreferrer\">Table 2c. Ivermectin: <strong>Selected</strong> Clinical Data. NIH.gov\nLast Updated: February 11, 2021</a>.</p>\n", "score": 2 }, { "answer_id": 23042, "body": "<p>This in-vitro study reveals exciting data regarding Ivermectin, which is typically used for treatment of scabies. </p>\n\n<p>I was unable to find any clinical data to support use of Ivermectin for COVID-19. But this study definitely supports starting a clinical trial given the widespread availability of Ivermectin. Overall ivermectin is well-tolerated in both children and adults, with rash being one of the most common side effects. It may have fewer severe adverse effects than hydroxychloroquine, which can cause fatal arrhythmias like Torsades de Pointes(though this is more with chronic use; <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16615675\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/16615675</a>). This supports ivermectin as a good candidate drug to study.</p>\n\n<p>It is important to note, however, that many drugs that have shown to be effective in-vitro will fail to produce any clinical benefit when given to animals or humans. For instance, for ebola virus, chloroquine was effective in-vitro but not in guinea pigs (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26459826\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/26459826</a>). There are many factors that could contribute to these discrepancies, including issues with bioavailability, distribution to the appropriate tissues, entrance into cells, and breakdown of the drug by cellular or viral mechanisms. </p>\n", "score": 1 }, { "answer_id": 25504, "body": "<p>(What's true has changed even further!! A lot changed AGAIN - since this question was asked and initially answered, AND THEN since it was (last month) initially answered by me! So time for another new answer!)</p>\n<p>YES! In addition to several literature reviews by several groups of doctors including some of the most experienced in emergency medicine, and confirmed by their clinical experience as well as large population studies and medical groups in several countries on the latest research, there are two recent WHO-originated and funded endorsements of ivermectin. First, on the WHO website, ivermectin is recommended for treatment of Covid-19 patients when they are being treated with immunosuppressants. Secondly The WHO funded an evaluation of the evidence to date and the expert consultant the WHO relies on for such evaluations of evidence to be used as the basis for official WHO recommendations has spoken very encouragingly regarding the evidence from randomized controlled trials demonstrating the utility of Ivermectin in treating Covid-19 that his work so far has uncovered.</p>\n\n<p>Andrew Hill for WHO: <a href=\"https://m.youtube.com/watch?v=yOAh7GtvcOs\" rel=\"nofollow noreferrer\">https://m.youtube.com/watch?v=yOAh7GtvcOs</a> (censored)\nOriginal is at <a href=\"https://medincell.com/IvermectinWorkshop/AndrewHill.mp4\" rel=\"nofollow noreferrer\">https://medincell.com/IvermectinWorkshop/AndrewHill.mp4</a>, (works) and I have a copy as well. <a href=\"https://www.dropbox.com/s/li4i3pyl52t88dy/AndrewHill%20WebOpt%2Ch265%2C0%2C-fps%2CRF31%2C%20placebo%2C%20to1920x1k%20-36%2C106%2C-94%2C-4%2CnoALL%2CHE-AAC40kbps.m4v?dl=0\" rel=\"nofollow noreferrer\">https://www.dropbox.com/s/li4i3pyl52t88dy/AndrewHill%20WebOpt%2Ch265%2C0%2C-fps%2CRF31%2C%20placebo%2C%20to1920x1k%20-36%2C106%2C-94%2C-4%2CnoALL%2CHE-AAC40kbps.m4v?dl=0</a> (works; sign-up/login NOT needed)</p>\n<p><a href=\"https://www.who.int/news/item/17-12-2020-a-parasitic-infection-that-can-turn-fatal-with-administration-of-corticosteroids\" rel=\"nofollow noreferrer\">https://www.who.int/news/item/17-12-2020-a-parasitic-infection-that-can-turn-fatal-with-administration-of-corticosteroids</a></p>\n<p><img src=\"https://i.stack.imgur.com/Yc722.jpg\" alt=\"Sources\" /></p>\n", "score": 0 } ]

[ "medications", "covid-19", "coronavirus" ]

[ { "answer_id": 27513, "body": "<h1>From an Australian perspective</h1>\n<h2>Policy</h2>\n<ul>\n<li>Restrictions\n<ul>\n<li>The governemnt, especially at a state level, is willing to halt the entire functions of the area, in the hope that restrictions don't have to be enforced for as long as a result</li>\n</ul>\n</li>\n<li>Border controls\n<ul>\n<li>As a result of our position on a (remote-ish) island, border restriction were applied earlier, and haven't been opened (except to New Zealand)</li>\n</ul>\n</li>\n<li>Quarantine\n<ul>\n<li>Quarantine for people coming to Australia, which is managed by the government, rather than just telling people to stay at home, using hotels temporarily converted to isolate potentially infected people for 2 weeks</li>\n<li>In addition, home quarantine is used, when people travel between some internal areas of the country, which helps in limiting spread</li>\n</ul>\n</li>\n</ul>\n<h2>Social/Not Policy</h2>\n<ul>\n<li>There is quite a high level of pride in being 'free of covid' here, and people are willing to make sacrifices to uphold that, and unlike other countries, mostly follow restrictions</li>\n<li>The population here is quite low, especially for the size of the landmass, and almost all of the major cities are spaced quite far apart</li>\n</ul>\n", "score": 18 }, { "answer_id": 27512, "body": "<p>They're an island that <a href=\"https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-restrictions/coronavirus-covid-19-advice-for-international-travellers\" rel=\"noreferrer\">tests and quarantines visitors from outside the island</a>, <a href=\"https://www.health.gov.au/resources/apps-and-tools/covidsafe-app\" rel=\"noreferrer\">traces contacts when infections occur</a>, and <a href=\"https://www.nsw.gov.au/media-releases/new-covid-19-restrictions-for-greater-sydney-23-june-2021\" rel=\"noreferrer\">implements mandatory public health measures like social distancing and capacity restrictions that vary in intensity according to the level of infections observed</a>.</p>\n<p>There are lots of lay press articles about Australia, I'll include just a sampling here:</p>\n<p><a href=\"https://www.theguardian.com/australia-news/2021/feb/15/australia-covid-19-lockdown-rules-coronavirus-restrictions-by-state-nsw-victoria-vic-queensland-qld-western-south-australia-wa-sa-nt-act-travel-border-social-distancing-masks\" rel=\"noreferrer\">https://www.theguardian.com/australia-news/2021/feb/15/australia-covid-19-lockdown-rules-coronavirus-restrictions-by-state-nsw-victoria-vic-queensland-qld-western-south-australia-wa-sa-nt-act-travel-border-social-distancing-masks</a></p>\n<p><a href=\"https://www.businessinsider.com/expert-explains-4-key-differences-between-us-australia-coronavirus-strategy-2020-5\" rel=\"noreferrer\">https://www.businessinsider.com/expert-explains-4-key-differences-between-us-australia-coronavirus-strategy-2020-5</a></p>\n<p><a href=\"https://www.forbes.com/sites/williamhaseltine/2021/03/24/what-can-we-learn-from-australias-covid-19-response\" rel=\"noreferrer\">https://www.forbes.com/sites/williamhaseltine/2021/03/24/what-can-we-learn-from-australias-covid-19-response</a></p>\n<p><a href=\"https://www.brookings.edu/research/policy-and-institutional-responses-to-covid-19-australia/\" rel=\"noreferrer\">https://www.brookings.edu/research/policy-and-institutional-responses-to-covid-19-australia/</a></p>\n<p><a href=\"https://www.abc.net.au/news/2020-10-18/contact-tracing-coronavirus-australia-five-hallmarks-succcess/12759068\" rel=\"noreferrer\">https://www.abc.net.au/news/2020-10-18/contact-tracing-coronavirus-australia-five-hallmarks-succcess/12759068</a></p>\n", "score": 17 }, { "answer_id": 27517, "body": "<p>Australia, like other countries such as New Zealand, Singapore, and more (including China after the initial outbreak, but of course information from China is often unreliable), have applied a &quot;zero Covid&quot; strategy.</p>\n<p>The goal is to:</p>\n<ul>\n<li>prevent the virus from entering (this is really the key)</li>\n<li>whenever it still manages to enter, stop it very aggressively from spreading so that it disappears.</li>\n</ul>\n<p>The first part, for Australia and New Zealand, is made a lot easier by the fact that they are isolated islands/continents, relatively far away from other land masses, with limited continuous exchanges with neighbouring countries, and the ability to effectively cut off most travel in or out (which is <strong>very</strong> different from the UK for instance).</p>\n<p>So they applied very strict restrictions on entry into their territories, real quarantine (not &quot;please stay at home and please don't see anyone during your self isolation, or we will be very unpleased&quot;).</p>\n<p>It was also helped by the fact that during the initial spread of the virus throughout the world, before many of the important facts were known (human-to-human transmission, asymptomatic transmission, airborne transmission, fatality rate...), they were relatively spared, possibly thanks to the yet-to-be-fully-understood seasonal effect. So when they started isolating, there were few cases inside the countries, and those local clusters could be curtailed through the usual very restrictive measures which have been applied elsewhere (masks, social distancing, strict lockdowns...).</p>\n<p>At the opposite end of the spectrum, many other countries, especially in Europe and the Americas had already extensive numbers of infected people in many different places before anything could be understood, were in the middle of winter, faced significant difficulties in getting PPE when needed, and had to address varying policies and stages of the pandemic in different countries/regions/states which have extensive exchanges with them.</p>\n<p>Many European countries also faced the &quot;summer surprise&quot;: the virus seemingly vanished during the summer, only to return with a vengeance at fall, after the virus had spread out a lot more through asymptomatic cases.</p>\n<p>Once you get past a certain number of cases, you can only slow down propagation, it's a lot more difficult to really stamp out the fire. As soon as there's even a single person with the virus, the risk of it spreading to millions is still there. But getting back to 0 when you have had tens of thousands of cases per day is virtually impossible. Due to the exponential nature of contagion, it takes a lot of time, i.e. very very long lockdowns, and that is economically, psychologically, medically and politically devastating.</p>\n", "score": 6 }, { "answer_id": 27527, "body": "<p>Australia's low COVID rates can be explained by three factors: always locking down until zero community cases are reached, having no land borders and enforcing a hardcore quarantine on all arrivals. Lets compare them to the UK to see why one failed to achieve while the other succeeded.</p>\n<h2 id=\"lock-down-until-zero-cases-dnox\">Lock down until zero cases</h2>\n<p>Australia's general modus operandi has been to clamp down on all in-person activity (<a href=\"https://www.bbc.com/news/world-australia-54139669\" rel=\"nofollow noreferrer\">including a ban on protesting</a> and <a href=\"https://www.independent.co.uk/life-style/coronavirus-australia-lockdown-fine-holiday-photos-a9463906.html\" rel=\"nofollow noreferrer\">harassment of people sharing family photos</a>) until <strong>zero</strong> community cases are reached. Not a &quot;low amount&quot;, not &quot;enough to relieve the hospitals&quot;, but zero. One single case can grow into thousands and then into millions (in fact, the original COVID infection probably happened to a single person) so you can't tolerate a single infection in the community without some hardcore measures. As a result, Melbourne <a href=\"https://www.washingtonpost.com/world/2020/10/28/melbourne-australia-coronavirus-lockdown-111-days/\" rel=\"nofollow noreferrer\">has been in lockdown for 111 days</a> during their &quot;second wave&quot; and then spent a couple of weeks in lockdown <a href=\"https://www.reuters.com/world/asia-pacific/covid-19-curbs-australias-melbourne-ease-after-low-cases-2021-06-09/\" rel=\"nofollow noreferrer\">recently</a> over a few local cases.</p>\n<p>To contrast this, the UK <strong>never</strong> reached zero cases since the initial wave started in March 2020. So essentially their lockdown was pretty much a waste of time, short of relieving some stress from their hospital system. Otherwise it merely delayed the inevitable as cases avoided in spring 2020 came back roaring in the winter.</p>\n<h2 id=\"no-land-borders-mbe3\">No land borders</h2>\n<p>Australia is a relatively remote island where everyone has to arrive either by ship or by plane. This makes border control a no-brainer as you just have to ensure quarantine protocols in your airports and sea ports. Obviously a rogue traveler could in theory charter a boat and land on a beach in the middle of nowhere but that's something out of reach for the vast majority of people.</p>\n<p>Now you might argue that the UK is likewise an island (along with Ireland) and that all sea crossings are controlled but there's one huge difference: <strong>truck drivers</strong>. As a general rule truck drivers take their goods from one country, drive straight into another country and then unload them at the destination. This is in contrast with ships or planes where the cargo is unloaded at the port and then carried on to the destination by local residents. So even if the UK was absolutely perfect in securing their borders, they would still have to contend with the problem of tens of thousands of foreigners coming in without quarantine. In theory you could build a system where all trucks unload their cargo in, say, Dover and then local truck drivers carry them on, but this would take many years if not decades to complete. Stopping trucks altogether is not an option as this would cause massive disruption in the supply chain.</p>\n<h2 id=\"hardcore-quarantine-inja\">Hardcore quarantine</h2>\n<p>Four types of border control were seen during the pandemic:</p>\n<ol>\n<li>&quot;Free for all&quot; - seen in Mexico, Turkey, Brazil and a few other nations. Anyone could come in with no quarantine, though sometimes a test was required for entry.</li>\n<li>&quot;Only locals&quot; - free entry with no quarantine if you're a citizen/resident, otherwise you're banned. Implemented by the US.</li>\n<li>&quot;Home quarantine&quot; - after entering the country travelers are legally obligated to stay at home for 7-14 days and sometimes obligated to get tested on arrival. Implemented by most countries in the world, including the UK.</li>\n<li>&quot;Hotel quarantine&quot; - armed men escort all arrivals into specially designated hotels with no one allowed to go out before they spend 14 days in isolation and get multiple tests. Implemented by China, Taiwan, Australia, New Zealand</li>\n</ol>\n<p>Is #3 as good as #4? No, definitely not. Lets evaluate each solution as to how well it can stop the virus:</p>\n<ol>\n<li>Allows for at least 1 infected person to interact with the general public upon arrival</li>\n<li>Allows for at least 1 infected person to interact with the general public upon arrival</li>\n<li>Allows for at least 1 infected person to interact with the general public upon arrival</li>\n<li>Does not allow any arrivals to interact with the general public</li>\n</ol>\n<p>Is it weird that 1-3 are all the same? No, because remember once again that <strong>one</strong> case can easily grow into millions. There's no such thing as &quot;good enough&quot; when it comes to international quarantine, it has to be all or nothing. And you definitely can't pretend that the locals are all virus-free while the foreigners are all infested with COVID, as the virus does not discriminate by ones citizenship.</p>\n<p>Australia took this one step further by <a href=\"https://apnews.com/article/asia-pacific-australia-lifestyle-travel-coronavirus-pandemic-a1d239e80be05c8cf393ec67d1b6cce2\" rel=\"nofollow noreferrer\">preventing citizens</a> from leaving the country, which reduced the number of international arrivals. They've also introduced a <a href=\"https://www.nytimes.com/2021/05/03/world/australia/covid-india-travel-ban.html\" rel=\"nofollow noreferrer\">complete ban</a> on travel from India for a few weeks, which applied even to citizens.</p>\n<hr />\n<p>As a final note, its important to distinguish between &quot;success in fighting COVID&quot; and &quot;long term success&quot;. It remains to be seen if Australia can reopen the border after their vaccination campaign is complete. Its possible that they will spend many more years with <a href=\"https://www.reuters.com/world/asia-pacific/australias-new-south-wales-reports-24-locally-acquired-covid-19-cases-2021-07-01/\" rel=\"nofollow noreferrer\">localized lockdowns</a> due to strong fear of the virus and its many variants. In contrast the UK is likely to fully reopen sometime this year and just carry on with life while accepting a certain number of COVID deaths per year as unavoidable. Which scenario is a better solution still remains to be seen.</p>\n<p><strong>Update:</strong> <a href=\"https://twitter.com/NSWHealth/status/1415113868183937026\" rel=\"nofollow noreferrer\">looks like</a> Sydney/NSW is now facing a major COVID wave and would likely spend several months in lockdown to stop it. Quite unlike the US which is currently living a maskless life with zero concern for whatever cases remain in the nation. As mentioned before, we'll only be able to judge the best strategy in the long run.</p>\n", "score": 6 } ]

[ "covid-19" ]

[ { "answer_id": 14108, "body": "<p>Based on my medical knowledge and a literature search, I cannot find evidence to suggest that banana peels are a superior treatment for warts. I saw only one nearly 40-year-old study on PubMed, Warzawer-Schwarcz L. \"Treatment of plantar warts with banana skin.\" Plast Reconstr Surg. 1981 Dec;68(6):975-6. <a href=\"http://journals.lww.com/plasreconsurg/Citation/1981/12000/Treatment_of_Plantar_Warts_With_Banana_Skin.35.aspx\" rel=\"nofollow noreferrer\">http://journals.lww.com/plasreconsurg/Citation/1981/12000/Treatment_of_Plantar_Warts_With_Banana_Skin.35.aspx</a>\nThis study involved taping fresh banana peel every day to the wart using surgical tape, and then scraping chunks out of the softened wart repeatedly. It seems like the primary function of the banana peel was to make the skin damp and soft for scraping. I actually think using just duct tape instead could accomplish a similar function (keeping skin damp), with the advantage that the tape can naturally pull off chunks of wart when you rip it off. Another study found that duct tape actually can be effective for wart removal; researchers theorize this is because the duct tape may be stimulating the immune system (see here: <a href=\"https://www.webmd.com/men/news/20021015/duct-tape-gets-rid-of-warts\" rel=\"nofollow noreferrer\">https://www.webmd.com/men/news/20021015/duct-tape-gets-rid-of-warts</a>). Also, personal story, when I was a kid I got rid of a wart on my hand using the duct tape method. </p>\n\n<p>My main recommendation, though, would be to try freezing it off again, or getting it cut out. I don't know how many times you've tried freezing it, but warts can be fairly determined and may require multiple freezings to disappear. You may also want to try a different dermatologist - perhaps your current dermatologist doesn't have good freezing technique. You can also have the wart cut out, though that will have longer recovery time. </p>\n\n<p>I think you've got a lot of options - don't give up! Sometimes a combination of therapies can be effective. For example, I once also got rid of a wart on my foot using drug store salicylic acid stickers, repeated scraping to remove dead skin and dead wart tissue, followed by freezing. </p>\n\n<p>Additional information: Warts are caused by human papillomavirus (HPV). HPV16 and HPV18 cause cervical cancer; HPV6 and HPV11 cause genital warts and laryngeal papillomatosis; but there are also many types of HPV that are not sexually transmitted and merely cause skin warts (see the Wikipedia article <a href=\"https://en.wikipedia.org/wiki/Human_papillomavirus_infection\" rel=\"nofollow noreferrer\">https://en.wikipedia.org/wiki/Human_papillomavirus_infection</a>). </p>\n", "score": 1 } ]

[ "immune-system", "natural-remedy", "placebo" ]

[ { "answer_id": 64, "body": "<p>As a rule of thumb: anywhere that blood is coming out, you should be assuming that pathogens can be transferred in. In this situation I would smear with antibiotic ointment and wrap with sterile gauze every day (and after every shower) until the cracking-and-bleeding-with-motion stops.</p>\n", "score": 6 } ]

[ "wound-care", "hygiene" ]

[ { "answer_id": 394, "body": "<h1>No</h1>\n<p>Skin damage is irreversible. The only thing you can do is make sure your skin is not damaged in the first place.</p>\n<hr>\n<p>Skin damage is caused by a variety of factors, but by far the most important one for most people is UV exposure. The primary source of UV is the Sun, but tanning booths may be a significant factor for some people.</p>\n<p>While sun burn causes an extreme amount of damage, all sun exposure will have an effect. If you are in the sun often, cover your skin, and wear high-factor sun cream on any exposed areas.</p>\n<p>Skin is made up of layers:</p>\n<p><img src=\"https://i.stack.imgur.com/p5tzD.jpg\" alt=\"enter image description here\" />\n_{<em>Image source: nih.gov</em>}</p>\n<p>Skin damage from UV occurs when the rays reach and burn the dermis. This damage <strong>changes the cells' DNA</strong>, by creating <a href=\"https://en.wikipedia.org/wiki/Radical_%28chemistry%29\" rel=\"nofollow noreferrer\">free radicals</a>. For this reason, although the cells are replaced every 21 days, the new cells inherit the same damage. This same mechanism is what causes tattoos to be present even in new skin cells - they 'inherit' the ink from the source cells in the dermis.</p>\n<p>There is currently no therapy or treatment for this kind of cell damage.</p>\n<p>For cells that have metastasised into melanoma, if they are caught soon enough, they are removed entirely, leaving a scar.</p>\n", "score": 7 }, { "answer_id": 149, "body": "<p>You can't reverse the skin damage, but you can treat wounds and burns, so your skin cell can regenerate faster.</p>\n\n<p>Eating food full of antioxidants and vitamin C, such as blueberries, tomatoes, and cherries can reduce the body’s need for fluids, lowering only the risk for dehydration ^{(<a href=\"http://umm.edu/health/medical/altmed/condition/burns\" rel=\"nofollow noreferrer\">study</a>)}.</p>\n\n<p>If you have a skin sunburn, here are few advices:</p>\n\n<ul>\n<li>Do not pick, poke, scratch or peel your sunburn. It can cause even more irritation.</li>\n<li>Apply moisturizer, or low-dose hydrocortisone cream, which may provide relief in some cases.</li>\n<li><p>Apply Aloe vera lotion or gel.</p>\n\n<p>Used in traditional medicine by applying the clear gel from the Aloe plant and rubbing on the skin as ointment ^{(<a href=\"http://ntp.niehs.nih.gov/ntp/htdocs/lt_rpts/tr553.pdf\" rel=\"nofollow noreferrer\">safety study</a>)}.</p>\n\n<blockquote>\n <p>A 2007 review of aloe vera's use in burns concluded, \"cumulative evidence tends to support that aloe vera might be an effective interventions used in burn wound healing for first- to second-degree burns. Further, well-designed trials with sufficient details of the contents of aloe vera products should be carried out to determine the effectiveness of aloe vera.\".^{(<a href=\"http://en.wikipedia.org/wiki/Aloe_vera#Research_into_medical_uses\" rel=\"nofollow noreferrer\">wiki</a>)}</p>\n</blockquote></li>\n<li><p>Consider cortisone cream.</p></li>\n<li>Watch for signs of infection.</li>\n<li>Don't put ice on them, as it can damage your skin further. Instead have a cool bath or gentle shower, which may be soothing. Or apply a clean towel dampened with cool tap water.</li>\n<li>Apply a cold wet compress.</li>\n<li>Take an over-the-counter pain reliever or some topical pain reliever.</li>\n<li>Wear loose cotton clothing over sunburned areas.</li>\n<li>Don't break small blisters. See: <a href=\"https://health.stackexchange.com/questions/6/should-blisters-be-removed\">Should blisters be removed?</a></li>\n<li>Pay close attention to any medications (herbal remedies or essential oils) that list an increased sensitivity to sunlight as a side effect.</li>\n<li>Call emergency services for third-degree burns.</li>\n</ul>\n\n<hr>\n\n<p>If you've signs of heatstroke or dehydration such as weak, faint, dizzy, rapid breathing, your eyes hurt, vomiting/diarrhea or something similar - call a doctor.</p>\n", "score": 5 } ]

[ "dermatology", "micronutrients" ]

[ { "answer_id": 1127, "body": "<p>Before I answer, I have to say that I disagree with several claims stated/implied in your question:</p>\n<ul>\n<li><p>antibiotics or any treatment cannot be simply replaced by another; many factors have to be taken into account, such as the type and severity of acne, the microorganism(s) (bacteria) causing the problem and many others</p>\n</li>\n<li><p>topical use of antibiotics definitely doesn't cause antibiotic resistance <em>per se</em>, but &quot;The <strong>inappropriate use</strong> of antimicrobial drugs, including in animal husbandry, favours the emergence and selection of resistant strains, and poor infection prevention and control practices contribute to further emergence and spread of antimicrobial resistance.&quot; (<a href=\"http://www.who.int/mediacentre/factsheets/fs194/en/\" rel=\"noreferrer\">WHO</a>)</p>\n</li>\n</ul>\n<p>As for the side effects and potential risks of certain therapeutic options - no one can absolutely guarantee that every possible outcome is predicted, but if there is evidence that potential risks outweigh the benefits, the substance/product will not be approved by regulatory agencies.</p>\n<hr />\n<p>That being said, there are natural (herbal based) therapeutic options for acne. One of them is:</p>\n<h2>Tea tree oil</h2>\n<p><em>Melaleuca alternifolia</em> (Maiden and Betch) Cheel, <em>Myrtaceae</em> aetheroleum</p>\n<p>According to <a href=\"http://www.ema.europa.eu/docs/en_GB/document_library/Herbal_-_Community_herbal_monograph/2015/04/WC500185282.pdf\" rel=\"noreferrer\">EMeA's herbal monograph</a> one of its therapeutic indications is:</p>\n<blockquote>\n<p>Indication 2</p>\n<p>Traditional herbal medicinal product for treatment of small boils (furuncles and mild acne)</p>\n</blockquote>\n<p>The form in which it is used:</p>\n<blockquote>\n<p>Herbal preparation in liquid and semi-solid dosage forms for cutaneous use\n(indication 1-3)</p>\n</blockquote>\n<p>The same document contains precautions, side effects, contraindications, posology etc.</p>\n<p>Antimicrobial activity of tea tree oil (TTO) has been confirmed:</p>\n<ul>\n<li><em>in vitro</em> in various studies</li>\n</ul>\n<p>Since you are interested in antibiotic resistance, this part might be the most interesting for you:</p>\n<blockquote>\n<p><em>The activity of TTO against antibiotic-resistant bacteria has attracted considerable interest, with methicillin-resistant Staphylococcus aureus (MRSA) receiving the most attention thus far. Since the potential to use TTO against MRSA was first hypothesized (153), several groups have evaluated the activity of TTO against MRSA, beginning with Carson et al. (31), who examined 64 MRSA isolates from Australia and the United Kingdom, including 33 mupirocin-resistant isolates. The MICs and minimal bactericidal concentrations (MBCs) for the Australian isolates were 0.25% and 0.5%, respectively, while those for the United Kingdom isolates were 0.312% and 0.625%, respectively. Subsequent reports on the susceptibility of MRSA to TTO have similarly not shown great differences compared to antibiotic-sensitive organisms (39, 58, 68, 106, 115).</em></p>\n</blockquote>\n<p>from: <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360273/\" rel=\"noreferrer\">Melaleuca alternifolia (Tea Tree) Oil: a Review of Antimicrobial and Other Medicinal Properties</a> C. F. Carson,1 K. A. Hammer,1 and T. V. Riley1,2,*, Clin Microbiol Rev. 2006 Jan; 19(1): 50–62.</p>\n<ul>\n<li><em>in vivo</em> - clinical efficcacy in at least one study</li>\n</ul>\n<p>By the same source:</p>\n<blockquote>\n<p><em>One of the first rigorous clinical studies assessed the efficacy of 5% TTO in the treatment of acne by comparing it to 5% benzoyl peroxide (BP) (14). The study found that both treatments reduced the numbers of inflamed lesions, although BP performed significantly better than TTO. The BP group showed significantly less oiliness than the TTO group, whereas the TTO group showed significantly less scaling, pruritis, and dryness. Significantly fewer overall side effects were reported by the TTO group (27 of 61 patients) than by the BP group (50 of 63 patients).</em></p>\n</blockquote>\n<p>Whether the effect will be bactericidal (killing bacteria) or bacteriostatic (stopping their reproduction) depends on the concentration:</p>\n<blockquote>\n<p><em>TTO is for the most part bactericidal in nature, although it may be bacteriostatic at lower concentrations.</em></p>\n</blockquote>\n", "score": 5 }, { "answer_id": 84, "body": "<blockquote>\n <p>I ask about natural options only to kill bacteria in acne; these options should replace only antibiotics.</p>\n</blockquote>\n\n<p>Use raw, organic, unfiltered, and unpasteurized <a href=\"http://www.webmd.com/diet/apple-cider-vinegar-and-health?page=1\" rel=\"nofollow\" title=\"Apple Cider Vinegar - ACV\">apple cider vinegar</a>, but dilute it (4 parts water, 1 part vinegar, that's 1/4 cup of vinegar in 1 cup of water)^{Note 1}.</p>\n\n<p>Now swab it on your face with a rag or cotton balls; it:</p>\n\n<ul>\n<li><a href=\"http://en.wikipedia.org/wiki/Vinegar#Antimicrobial_and_medicinal\" rel=\"nofollow\">kills bacteria</a></li>\n<li>is a <a href=\"http://www.cosmeticsandtoiletries.com/formulating/category/skincare/premium-Keratolytic-Treatments-for-Acne-A-Review-208733901.html\" rel=\"nofollow\" title=\"Keratolytic Agents loosen dead skin\">keratolytic agent</a>, which helps loosen dead skin cells and opens your pores</li>\n<li>Removes excess <a href=\"http://en.wikipedia.org/wiki/Sebaceous_gland#Acne\" rel=\"nofollow\" title=\"Excess sebum oil clogs pores and produces acne\">sebum oils</a> from your skin</li>\n</ul>\n\n<p>Downsides: It smells to high heaven until it dries or you rinse it off, but if you do this at night nobody but your spouse will care. It's safe to rinse off after about five minutes.</p>\n\n<hr>\n\n<p>^{Note 1} You can get <a href=\"http://www.acne.org/messageboard/topic/153848-apple-cider-vinegar-burned-my-skin-help/\" rel=\"nofollow\" title=\"straight ACV will burn your skin\">chemical burns</a> from undiluted apple cider vinegar, so be sure to dilute it. Also some people with extra-sensitive skin might react to it, so be sure to test it on a small area of your face first (such as under your chin). If you have a reaction, you can try to dilute it more.</p>\n", "score": 2 } ]

[ "dermatology", "treatment-options" ]

[ { "answer_id": 98, "body": "<p>CO2 laser treatments work by vaporizing the damaged skin cells. After the procedure, you will need to take medication to reduce swelling in your eyes, but you can also ease the swelling by elevating your head when sleeping. You will be itchy for 12-72 hours after the procedure. For the next week, your skin will get dry and peel. Your face will also be red for 2-3 months after the procedure. Other side effects are burns from the laser, scarring, and changes in your skin's pigmentation.</p>\n<h3>Is it worth it?</h3>\n<p>It can cost upwards of $2000, but it does seem to work. The burning or scarring from the laser are unlikely, so it is up to you to decide. If you want more reviews go <a href=\"http://www.realself.com/CO2-laser/info\" rel=\"nofollow noreferrer\">here</a>.</p>\n<hr />\n<p>^{<a href=\"http://www.webmd.com/beauty/laser-skin/laser-resurfacing?page=1\" rel=\"nofollow noreferrer\">WebMD - Laser Resurfacing</a>}</p>\n", "score": 5 } ]

[ "dermatology", "laser" ]

[ { "answer_id": 15147, "body": "<p><strong>NOTE: I have no affiliation to any companies mentioned below and I am not advocating one company over another for any particular product.</strong></p>\n\n<p><strong>Links to products on sale are for examples only</strong></p>\n\n<p>There are many places including <a href=\"https://www.totallywicked-eliquid.co.uk/nico-ice-mixing-kit.html\" rel=\"nofollow noreferrer\">Totally Wicked</a>, where you can buy kits to make your own e-liquid.</p>\n\n<p>As long as you </p>\n\n<ul>\n<li>use flavourings which are made for e-liquids <strong>not food flavourings</strong></li>\n<li>use <strong>pharmaceutical grade</strong> ingredients such as those provided in Totally Wicked's kit</li>\n<li><strong>do not</strong> use ingredients containing <a href=\"https://thecleanvape.com/blogs/the-clean-vape/diacetyl-acetyl-propionyl-acetoin-and-vaping\" rel=\"nofollow noreferrer\">Diacetyl, Acetoin or Acetyl Propionyl</a>, and</li>\n<li>correctly mix the liquids in the correct ratios - maybe with the help of <a href=\"https://www.vampirevape.co.uk/advanced-mixing-calculator\" rel=\"nofollow noreferrer\">mixing calculators</a></li>\n</ul>\n\n<p>you are then doing everything you can to be as safe as possible.</p>\n\n<p><strong><a href=\"https://www.nhs.uk/news/heart-and-lungs/flavouring-found-in-e-cigarettes-linked-to-popcorn-lung/\" rel=\"nofollow noreferrer\">Diacetyl was banned in eliquids in the UK in 2016</a></strong> under the EU Tobacco Products Directive as it was <strong><a href=\"https://vaping.com/blog/comment/diacetyl-now-officially-banned-eliquids-uk/\" rel=\"nofollow noreferrer\">attributed to the cause</a> of <a href=\"https://en.wikipedia.org/wiki/Bronchiolitis_obliterans\" rel=\"nofollow noreferrer\">popcorn lung (also known as Bronchiolitis obliterans)</a></strong>. The thing is, <a href=\"https://en.wikipedia.org/wiki/Acetylpropionyl\" rel=\"nofollow noreferrer\">Acetyl Propionyl</a> and <a href=\"https://en.wikipedia.org/wiki/Acetoin\" rel=\"nofollow noreferrer\">Acetoin</a> are chemically similar to <a href=\"https://en.wikipedia.org/wiki/Diacetyl\" rel=\"nofollow noreferrer\">Diacetyl</a> and therefore it is considered wise to avoid them too.</p>\n", "score": 1 } ]

[ "smoking", "e-cigarette-vape" ]

[ { "answer_id": 368, "body": "<p>How refreshing to see someone with this attitude! Kudos.</p>\n\n<p>Doctors have been so long accustomed - and accosted - to prescribe unnecessary antibiotics (you wouldn't believe some of my experiences^***) that sometimes on a borderline case, they'll just write out the script. What a welcome question this would be:</p>\n\n<blockquote>\n <p>Doctor, I'd like to avoid antibiotics if it's safe to do so. Is there an alternative, or do you think it's better to be on one? </p>\n</blockquote>\n\n<p>No decent doctor will be dissuaded by this question from prescribing a necessary antibiotic (if they're not decent, you shouldn't be seeing them!)</p>\n\n<p>I doubt you would ever pressure a doctor to give you an antibiotic if they don't think you need one. For anyone else reading this: <strong>please don't</strong>.</p>\n\n<p>The following pertains to all members of your family.</p>\n\n<blockquote>\n <ul>\n <li>Never save the last few pills \"in case you get sick again\".</li>\n <li>Don't take anyone else's antibiotics \"'til you have a chance to see a doctor\".</li>\n <li>Better a higher dose for a shorter time than a lower dose for a longer time.</li>\n <li>Ask if a narrow-spectrum antibiotic would treat your illness as well as a broad spectrum antibiotic.</li>\n <li>Get all your recommended vaccines! Some of them are for common bacteria now. </li>\n <li>Don't ask for an antibiotic over the phone because \"this is exactly like what I had last time\". </li>\n <li>Read about when antibiotics (and doctor visits) are and aren't necessary, e.g. at the CDC's <em>Get Smart: Know When Antibiotics Work</em>, etc. (See links) </li>\n <li>Take and finish your antibiotics as prescribed.</li>\n </ul>\n</blockquote>\n\n<p>In terms of home and personal hygiene, don't be afraid of germs; there are more harmless ones out there than dangerous ones.</p>\n\n<blockquote>\n <ul>\n <li>Don't try to sanitize your house. Water and mild detergent is good enough for cleaning.</li>\n <li>Use a mild soap for bathing, something without anti-bacterials.</li>\n </ul>\n</blockquote>\n\n<p>***_{I once saw a patient who presented with \"sinusitis\" since \"this morning\". He wanted antibiotics. On reviewing his symptoms (and clinical exam), he had no evidence of sinusitis. I gently refused, explaining the common risks of unnecessary antibiotics. He persisted. I went further, explaining to him the uncommon but much more serious risks, e.g. Antibiotic-Associated Diarrhea (aka <em>C. diff</em>). He persisted. I went even further, explaining the <em>really serious - but possible - risks</em> and discussed the risk-to-benefit ratio. He called me ridiculous and left in a huff. Two days later, I got a call from the Hospital Administrator's office (my employer's boss). Turned out that the patient was a golfing buddy of his. The <em>Hospital Administrator</em> (not a physician, but a businessman) told me in no uncertain terms that he expected me to give patients antibiotics when they asked for them! (I'll spare you the details of the rest of the story.)}</p>\n\n<p>_{<a href=\"http://pediatrics.aappublications.org/content/early/2014/01/28/peds.2013-4016.full.pdf\">Reducing Unnecessary Antibiotics Prescribed to\nChildren: What Next?</a>}<br>\n_{<a href=\"http://www.cdc.gov/getsmart/community/\">Get Smart: Know When Antibiotics Work</a>}<br>\n_{<a href=\"http://www.aafp.org/about/initiatives/choosing-wisely.html\">Choosing Wisely</a>}<br>\n_{<a href=\"http://www.aafp.org/afp/2001/0915/p999.html\">Appropriate Antimicrobial Prescribing: Approaches that Limit Antibiotic Resistance</a>}</p>\n", "score": 5 }, { "answer_id": 9686, "body": "<p>I agree humans are over prescribed antibiotics. I think doctors should be more scientific. Take a culture and wait three days for sensitivities to grow (if any). Then and only then prescribe the best antibiotic.</p>\n\n<p>The real issue to me though is the use of antibiotics in livestock to promote growth more than as a prophylactic. One study in Arizona took bacterial samples from chicken, turkey, and pork from local supermarkets. They sequenced the bacterial DNA and compared them against bacterial strains from hospitalized patients. There were many matches which suggest improperly handled meat can spread antibiotic resistant bacteria that are a result from overuse in there meat industry.</p>\n\n<p>Source: http:/:www.pbs.org/wgbh/frontline/film/trouble-with-antibiotics/transcript/</p>\n", "score": 0 } ]

[ "prescription", "antibiotics" ]

[ { "answer_id": 535, "body": "<p>The basic idea is that <strong>people with pulmonary diseases that involve chronic hypoventilation rely on mild hypoxia to stimulate respiration.</strong></p>\n\n<p>To understand this, consider a basic homeostatic feedback loop that controls respiratory drive. During a breath hold, carbon dioxide levels rise and oxygen levels fall. Carbon dioxide diffuses across the blood-brain barrier and causes a decrease in CSF pH sensed at central chemoreceptors in the brainstem. The peripheral serum pH may also be depressed, stimulating peripheral chemoreceptors in the carotid and aortic bodies. In normally ventilating people, these \"hypercarbic indicators\" are the primary mediators of the drive to breath.</p>\n\n<p>In patients with chronic hypoventilation, PaCO₂ is chronically elevated. Common hypo-ventilatory diseases include:</p>\n\n<ul>\n<li>COPD (chronic obstructive pulmonary disease)</li>\n<li>obesity-hypoventilation syndrome</li>\n<li>neuro-muscular weakness syndromes (generally only in later phases when the diaphragm is affected: Becker/Duchenne muscular dystrophy, amyotrophic lateral sclerosis, etc.)</li>\n</ul>\n\n<p>The old theory goes that because these folks have chronically elevated PaCO₂*, the hypercarbic respiratory feedback loop described above “acclimates” and is no longer the primary driver of breathing. Instead, they rely on the <a href=\"http://en.wikipedia.org/wiki/Hypoxic_drive\">hypoxic respiratory drive</a>, which is secondary in normal people. These individuals may have a usual SpO₂ ~88-90%. When a non-rebreather mask is applied and suddenly drives their SpO₂ up to 100%, their respiratory drive decreases because their blunted hypercarbic response mechanisms do not respond normally to the progressive rise in PaCO₂. </p>\n\n<p>There are data in support of this theory. <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645328/#bib42\">One study in COPD patients</a> administered 100% oxygen to patients with COPD and observed a 18% decrease in ventilation after 15 minutes that returned to baseline when oxygen was removed (Aubier). However, these authors also showed that two other factors were at play explaining the observed rise in PaCO₂:</p>\n\n<ol>\n<li><p>About 30% of the increase in PaCO₂ associated with high-flow oxygen administration was attributable to the <a href=\"http://www.interactive-biology.com/6717/the-haldane-effect-and-uptake-of-carbon-dioxide-from-tissues/\">Haldane effect</a>, which is basically an offloading of CO2 by hemoglobin (due to a rightward shift of the carboxyhemoglobin dissociation curve), increasing the CO₂ dissolved in blood but not reflecting a true change in ventilation. </p></li>\n<li><p>An additional 48% of the increase in hypercapnia was due to dead space ventilation. The simplified idea is that the vessels in the lung compensate for hypoxia by vaso-constricting areas with low oxygen tension, so-called ventilation-perfusing matching. When high-flow oxygen is administered, the vaso-constriction is released so perfusion of poorly ventilated areas increases. Now a higher percentage of the blood is not being cleared of CO₂. This is called ventilation-perfusion &#8203;<strong>mis</strong>&#8203;matching. </p></li>\n</ol>\n\n<p><a href=\"http://journal.publications.chestnet.org/article.aspx?articleid=1087886\">Something similar has been demonstrated in patients with obesity-hypoventilation</a> (Wijesinghe). In light of this, <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645328/#bib42\">a recent study</a> investigated the best strategy for oxygen administration in patients with chronic hypoventilation (Kim). They found that a strategy titrating oxygen administration to achieve SpO₂ 88% to 92% minimized the risk of worsening hypoventilation while achieving adequate relief of shortness of breath and adequate oxygenation.</p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682248/\">A helpful review of these topics</a> provides a bit more detail for those interested (Abdo).</p>\n\n<hr>\n\n<p>_{\nAbdo WF and Heunks LM. <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682248/\"><em>Oxygen-induced hypercapnia in COPD: myths and facts.</em></a> Crit Care. 2012;16(5):323.\n} </p>\n\n<p>_{\nAubier M, Murciano D, Milic-Emili J, Touaty E, Daghfous J, Pariente R, Derenne JP. <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645328/#bib42\"><em>Effects of the administration of O2 on ventilation and blood gases in patients with chronic obstructive pulmonary disease during acute respiratory failure.</em></a> Am Rev Respir Dis. 1980 Nov;122(5):747-54.\n} </p>\n\n<p>_{\nKim V, Benditt JO, Wise RA, Sharafkhaneh A.<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/?term=%3A+PMC2645328\"><em>Oxygen therapy in chronic obstructive pulmonary disease.</em></a> Proc Am Thorac Soc. 2008 May 1;5(4):513-8. \n} </p>\n\n<p>_{\nWijesinghe M, Williams M, Perrin K, Weatherall M, Beasley R. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/?term=20947648\"><em>The effect of supplemental oxygen on hypercapnia in subjects with obesity-associated hypoventilation: a randomized, crossover, clinical study.</em></a> Chest. 2011 May;139(5):1018-24. .\n} </p>\n\n<hr>\n\n<p>_{\n*normal PaCO₂ = 40 mmHg; may be 50-80 mmHg in chronic retention, possibly higher\n}</p>\n", "score": 8 } ]

[ "first-aid", "oxygenation", "pulmonology" ]

[ { "answer_id": 543, "body": "<p>This seems like a common sense type of question (why don't you sleep on the floor when there's a sofa available, and why don't you sleep on a sofa when there's a comfortable bed available?), and it turns out it is.</p>\n\n<p>According to a small study done recently in a sleep laboratory,</p>\n\n<blockquote>\n <p>Information concerning the stages of sleep is one of the most important clues for determining the quality of a particular mattress. The purpose of this study was to determine the effects of mattress type on sleep quality by measuring skin temperature, by using a subjective mattress rating system, and through the use of Polysomnogram (the recording of brain waves through electroencephalography, the generation of a video graphic record of eye movement, chin movements, and heart rhythm.) ...The percentages of wake after sleep onset and stage 1 sleep were lower when subjects slept on “comfortable” mattresses. Subjective ratings of sleep quality paralleled recorded sleep data.</p>\n</blockquote>\n\n<p>\"Comfortable\" is the key word here. How comfortable a mattress is depends on personal preferences, position of sleep (side sleepers vs back/stomach), presence/absence of low back pain, heat retention properties of mattress/bedding, etc.</p>\n\n<p>While this would seem like an important area to study, there has been very little in the way of well-developed recent studies. </p>\n\n<p>Most of the recent studies on mattress types are concerned with the prevention of SIDS.</p>\n\n<p>_{<a href=\"http://www.sciencedirect.com/science/article/pii/S0169814106001508\">Quantitative effects of mattress types (comfortable vs. uncomfortable) on sleep quality through polysomnography and skin temperature</a>} </p>\n", "score": 7 } ]

[ "sleep" ]

[ { "answer_id": 550, "body": "<p>These are the steps that you want to take:</p>\n\n<ul>\n<li>If you can see the snake, be prepared to describe it. <strong>DO NOT</strong> attempt to catch it. If you can get a quick picture with a camera/cell phone, do so.</li>\n<li>Get the person out of biting distance of the snake. (Avoid getting bitten yourself)</li>\n<li>Keep the person calm, with the wound below the level of the heart, preferably lying down.</li>\n<li>Cover the wound with a loose sterile bandage.</li>\n<li>Call Emergency Medical or take the victim to an ER. Even if the person appears healthy, toxin effects can take several hours to appear, and early intervention is always better.</li>\n<li>If there is inflammation or swelling, trace around it with a pen. This can give an indication of reaction progression.</li>\n<li>Removed jewelry/rings/watches as swelling can prevent removal later. (Thanks to Shublu, I had forgotten this one).</li>\n</ul>\n\n<p>If you are not near a civilized area (Such as hiking, backpacking, camping), several \"tried and true\" methods are not actually effective:</p>\n\n<p><strong>DO NOT</strong></p>\n\n<ul>\n<li>Cut and suck: You can introduce venom into yourself, the cutting can spread the venom further, and you risk damaging underlying muscle/organs.</li>\n<li>Use ice: It doesn't prevent the spread of venom, and can cause frostbite if applied for too long</li>\n<li>Electrical shocks - Ineffective and can cause burns and/or stop the heart.</li>\n<li>Use alcohol - It may deaden pain, but will cause blood vessels to expand, increasing the spread of venom.</li>\n<li>Use a tourniquet/constriction band - Have not proven effective, and can cause more tissue damage and possibly cause limb loss if left on too long.</li>\n<li>Give aspirin - Aspirin is a blood thinner and can cause increase bleeding/spread.</li>\n</ul>\n\n<p>Again, that is a list of <strong>^^^WHAT NOT TO DO^^^</strong>.</p>\n\n<p>The good thing about snake bites is that many bites do not actually envenom the victim, and of those that do, it may not be a full dose. Keeping calm and keeping the bite victim calm are going to be the best things you can do, as panic can cause other symptoms that may be mistakenly attributed to the snakebite.</p>\n\n<p>Remember that children and small people are at a higher risk because of body size, as are people that are already compromised in some way health wise. Keep calm, make the victim comfortable and contact EMS or get to an ER.</p>\n\n<p>Here is a <a href=\"http://www.nlm.nih.gov/medlineplus/ency/article/000031.htm\" rel=\"nofollow noreferrer\">fairly comprehensive review</a> as published by the NIH (National Institute of Health, US-based entity) of the steps to take, as well as the listing of common venomous creatures encountered. My only contention is that if a person is exhibiting shock signs it recommends elevating the legs, but very often the leg is where the bite is. I would (personally, anyway) maintain a lying, neutral position in those cases.</p>\n\n<p>However, while it recommends the use of a venom kit (Sawyer makes a very popular model) it has been <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/14747805\" rel=\"nofollow noreferrer\">shown in a study</a> that such kits failed to remove any \"venom\" from the test site. (Further discussion at the <a href=\"http://www.wsj.com/articles/SB124208165196508345\" rel=\"nofollow noreferrer\">Wall Street Journal</a>).</p>\n", "score": 12 }, { "answer_id": 551, "body": "<p>In the case of snake bite, the protocol to apply varies slightly depending on the country. What follows is based on the guidelines provided by the <a href=\"http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx\" rel=\"nofollow\">National Health Service of England</a>, the <a href=\"http://www.nlm.nih.gov/medlineplus/aboutmedlineplus.html\" rel=\"nofollow\">National Institutes of Health of the United States</a> and the <a href=\"http://www.interieur.gouv.fr/content/download/36656/277162/file/PSE2.pdf\" rel=\"nofollow\">Ministry of Interior of France</a> (this last document is the national team first-aid guidelines applied by firemen and certified volunteers. It is not translated in English, sorry about that).</p>\n\n<p>A few contradictions exist between these sources regarding the position of the victim, the bandage to apply and the use of a pump suction device. I highlighted these contradictions in the protocol below. As I am certified in France, this protocol might be little \"french oriented\" though.</p>\n\n<ul>\n<li><p><strong>Don't hunt the snake</strong> (don't risk another bite). <a href=\"http://www.nhs.uk/conditions/bites-snake/pages/treatment.aspx\" rel=\"nofollow\">Try to remember the snake's color and aspect</a> as this will be useful information for the medical assistance. </p></li>\n<li><p><strong>Keep the victim calm</strong>, <a href=\"http://www.nlm.nih.gov/medlineplus/ency/article/000031.htm\" rel=\"nofollow\">reassure that snake bites can actually be handled at the hospital.</a> </p></li>\n<li><p><strong>Only if the area is not safe and cannot be secured, reach the nearest safe area</strong>. <a href=\"http://www.firstaidanywhere.com/snake-bite-first-aid.html\" rel=\"nofollow\">Movements should be minimized as much as possible</a>.</p></li>\n<li><p><a href=\"http://www.interieur.gouv.fr/content/download/36656/277162/file/PSE2.pdf\" rel=\"nofollow\"><strong>Make the victim lie down on the ground</strong></a>. \n<br />(<em>This is the French guideline. The American guideline instructs to <a href=\"http://www.nlm.nih.gov/medlineplus/ency/article/000031.htm\" rel=\"nofollow\">keep the affected area below heart level unless there is a sign of shock</a>, and the British guideline just say the bitten body part must stay <a href=\"http://www.nhs.uk/conditions/bites-snake/pages/treatment.aspx\" rel=\"nofollow\">as still as possible</a></em>)</p></li>\n<li><p><a href=\"http://www.nlm.nih.gov/medlineplus/ency/article/000031.htm\" rel=\"nofollow\"><strong>Remove any jewelry or watches</strong></a> from the bitten limb as the affected area may swell.</p></li>\n<li><p><a href=\"http://www.nhs.uk/conditions/bites-snake/pages/treatment.aspx\" rel=\"nofollow\"><strong>Loosen clothing</strong></a> if possible, but do not remove clothes.</p></li>\n<li><p>(US) <a href=\"http://www.nlm.nih.gov/medlineplus/ency/article/000031.htm\" rel=\"nofollow\">Use a pump suction device</a> should you have one \n<br />(<em>This is the American guideline. The French and English guidelines instruct <strong>NOT</strong> to use such a device, the word 'forbidden' is even used in the french guideline. It was really hard for me to write this bullet point as I would NEVER use a pump, personally</em>)</p></li>\n<li><p>Should you be able to do so, <a href=\"http://www.nlm.nih.gov/medlineplus/ency/article/000031.htm\" rel=\"nofollow\"><strong>monitor the victim's temperature, pulse, the rate of breathing</strong>, and blood pressure</a>. Try do detect any signs of shock.</p></li>\n<li><p><strong>Contact the medical assistance right away, even if the wound looks clean and is not painful</strong> as venom can take effect after hours. <a href=\"http://www.nhs.uk/conditions/bites-snake/pages/treatment.aspx\" rel=\"nofollow\"><strong>You should assume this is a medical emergency</strong></a>. So, without hurrying (very important! Being calm is gaining time):</p>\n\n<ul>\n<li>Tell your name, phone number, current location,</li>\n<li>Tell this is for a snake bite and tell the victim's gender and age</li>\n<li>Describe the circumstances of the bite, including the snake's aspect, color and size. </li>\n<li>Should you have monitored the victim's vital parameter above, list them.</li>\n<li>Describe all that you did to the victim.</li>\n<li>They will guide you in accordance with the protocol applicable in your country. This will certainly include an immobilization of the wounded limb and maybe a compression bandage. <strong>What they will tell you prevails on all what follows</strong>.</li>\n<li>Do <strong>NOT</strong> hang up the phone until instructed to do so</li>\n</ul></li>\n<li><p>(FR) If possible, <strong>apply a <a href=\"http://www.interieur.gouv.fr/content/download/36656/277162/file/PSE2.pdf\" rel=\"nofollow\">compression bandage</a></strong> to the wound. <strong>It should not stop the blood circulation</strong> (tip: you should be able to insert a finger under the bandage). \n<br />(<em>This is the French guideline. American and English guidelines instruct <strong>NOT</strong> to compress the wound</em>)</p></li>\n<li><p><strong>Immobilize the wounded limb as instructed</strong>. It can be either a sling (<a href=\"http://www.nhs.uk/conditions/bites-snake/pages/treatment.aspx\" rel=\"nofollow\">UK</a>, <a href=\"http://www.nlm.nih.gov/medlineplus/ency/article/000031.htm\" rel=\"nofollow\">US</a>), or a splint using a rigid support (<a href=\"http://www.nhs.uk/conditions/bites-snake/pages/treatment.aspx\" rel=\"nofollow\">UK</a>, <a href=\"http://www.interieur.gouv.fr/content/download/36656/277162/file/PSE2.pdf\" rel=\"nofollow\">FR</a>)</p></li>\n<li><p><strong>Watch over the victim</strong> while awaiting the ambulance</p></li>\n</ul>\n\n<p>There are also things <strong>NOT</strong> to do:</p>\n\n<ul>\n<li>Do not leave the victim on his/her own</li>\n<li>Do not cut the bite to extract the venom</li>\n<li>Do not suck the venom out of the bite</li>\n<li>Do not raise the wounded limb above the heart level</li>\n<li>Do not apply a tourniquet (<strong>Never</strong>. This may have terrible consequences!)</li>\n<li>Do not apply cold</li>\n<li>Do not give any medication</li>\n<li>Do not give anything by mouth, not even water</li>\n<li>Do not use any pump suction device \n<br />(<em>These are the French and English guidelines. American guidelines allow using such pumps, as seen above</em>)</li>\n<li>Do not apply any compressive bandage \n<br />(<em>These are the English and American guidelines. French guidelines <strong>do recommend</strong> to apply such a bandage, see above</em>)</li>\n</ul>\n", "score": 9 } ]

[ "first-aid", "venom" ]

[ { "answer_id": 638, "body": "<p>Detoxification is one of the primary functions of the liver. When you ingest something, if it is absorbed, it enters the portal vein which delivers the blood directly to the liver. There, the liver metabolizes, \"detoxifies\", excretes, synthesizes, and stores.</p>\n\n<p><strong>What needs to be stored</strong></p>\n\n<p>The liver stores excess glucose in the form of glycogen, fat-soluable vitamins A, D, K, iron used for the synthesis of red blood cells, copper (used as an integral part of enzymes), fat, B12, and some other substances. (This is why eating polar bear liver results in hypervitaminosis A.) It does not store toxins.</p>\n\n<p><strong>How the liver \"detoxifies\"</strong></p>\n\n<p>The liver has a staggering number of metabolic pathways involving a series of enzymatic reactions that neutralize and solubilize toxins for excretion by the liver or kidney. It should be noted that some of the same enzymes are used to render \"pro-drugs\" into active drugs, and that delivery of absorbed molecules directly to the liver (where they may be converted or removed, called \"first pass\" metabolism) is the reason that some drugs simply are less effective or ineffective if taken by mouth. (The gut also is responsible for some metabolism.) This is so much a feature of the liver that first-pass metabolism of medications must be taken into consideration to determine the right dose of a drug.</p>\n\n<p>Generally lipid soluble toxins are first made water soluble by any of a group of enzymes called the CYPs, e.g. cytochrome P450. Each of these enzymes has the potential to alter very many different toxins. Liver enzymes then add another water soluble molecule (called conjugation) to the toxin which renders it less toxic and water-soluable enough to be transported for excretion by the liver (with bile, which is excreted into the intestines and carried out of the GI Tract) or the kidneys (in urine).</p>\n\n<p>Toxins can kill the host, injure a specific tissue (for example, an overdose of acetaminophen can cause enough liver damage to shut down detoxification leading to death), act as carcinogens altering DNA, be metabolized and excreted, sometimes be stored in adipose tissue (fat), or take other routes through the body. I personally know of no toxin (nor could I find one) that can bypass these things and be stored in the liver.</p>\n\n<p>There are toxins that damage the liver: alcohol for example. Yet that doesn't get stored in even a damaged liver.</p>\n\n<p>Clearly there are toxins everywhere that we don't even know about, but if drugs and toxins* studied are metabolized and excreted by the liver (or follow other routes), it stands to reason that the ones we don't know about are probably being handled similarly.</p>\n\n<p>*Disclaimer: Heavy metals are handled differently. Also, this answer doesn't deal with concentration of toxins in other tissues, e.g. fat. (Some toxins are stored in fat cells, and become mobilized again on weight loss.) </p>\n\n<p>_{<a href=\"http://www.lef.org/Protocols/Metabolic-Health/Metabolic-Detoxification/Page-02?checked=1\" rel=\"nofollow\">Metabolic Detoxification</a>}<br>\n_{<a href=\"http://nlfindia.com/liverZone/functions.asp\" rel=\"nofollow\">FUNCTIONS OF THE LIVER</a>}<br>\n_{<a href=\"http://faculty.ksu.edu.sa/15218/Medical%20Books/Medical%20Physiology%202nd%202003%20Rhoades/Medical%20Physiology%202nd%202003%20Rhoades/smch28.pdf\" rel=\"nofollow\">The Physiology of the Liver</a>}<br>\n_{<a href=\"http://ajpgi.physiology.org/content/288/2/G292\" rel=\"nofollow\">Effects of yo-yo diet, caloric restriction, and olestra on tissue distribution of hexachlorobenzene</a>}</p>\n", "score": 7 }, { "answer_id": 655, "body": "<p>No, these claims do not hold any validity. As you have said, the claims are vague, often saying that these \"toxins\" (not specified) are the cause of a catch-all list of symptoms. Unsurprisingly, they are usually associated with some sort of \"detox\" product or program. After all, the premise of \"toxins accumulate\" goes hand-in-hand with \"therefore we need to detox.\"</p>\n\n<p>There is no medical standard for this type of \"detox.\" There is no consistency in the ingredients of these products. There is no scientific evidence that these things help your health. There are \"success stories.\" Some people may feel better after treatment. But those that feel worse are often told that this is part of the process, that they will feel worse before they feel better. (In other words, there is no chance of not being a success.)</p>\n\n<p>Certainly, there are <em>specific</em> substances with <em>specific</em> effects that have <em>specific</em> treatments, all scientifically validated. It is true, for example, that arsenic in drinking water over time at high enough levels can cause chronic toxicity. This is a poisoning. It has characteristic symptoms and standards for treatment. There are methods to confirm or to rule out the diagnosis. The claims you cited aren't talking about poisonings, though; they are much too nebulous.</p>\n\n<p>I recommend this article on Science-Based Medicine, which goes into more detail about this type of claim:\n<a href=\"https://www.sciencebasedmedicine.org/detox-what-they-dont-want-you-to-know/\" rel=\"nofollow\">https://www.sciencebasedmedicine.org/detox-what-they-dont-want-you-to-know/</a></p>\n", "score": 3 } ]

[ "liver", "toxicity" ]

[ { "answer_id": 651, "body": "<p>Fever blisters, or cold sores, are an infection with the type 1 or Type 2 herpes simplex virus (HSV-1, HSV-2). The herpes simplex virus usually enters the body through a break in the skin around or inside the mouth and travels into the nerve for the lip. It's been estimated that 65% of the US population has this infection (I do not have worldwide data).</p>\n\n<p>This version of the virus is relatively benign, but it never leaves the body. It takes up residence in the roots of nerves; in the case of cold sores, it is a nerve near the cheekbone. In times of stress, fever, illness or even over exposure to sunlight, it can activate and travel down the the nerve and erupt as lesions in and around the lips.</p>\n\n<p>All information contained here can be referenced through <a href=\"http://publications.usa.gov/epublications/fever-blister/fever-canker.html\">this government posting</a>, however there is a huge reference pool available. Currently there is no cure or vaccine for HSV-1 or 2 (The HSV-2 is genital herpes, however HSV-1 as has been pointed out, may be introduced through oral contact with genitalia).</p>\n", "score": 13 } ]

[ "herpes" ]

[ { "answer_id": 706, "body": "<p>It is difficult to know if your friend will experience adverse health affects associated with shift work, as everyone has different levels of tolerance for the effects of shift work. Shift work however has been shown to increase the risk of some adverse health effects. The following is a list of adverse health effects that have are commonly associated with those working shift work or working long hours:</p>\n\n<ol>\n<li><strong>Sleep</strong></li>\n</ol>\n\n<p>Scientific publications on the topic generally agree that working shift work or working long hours has adverse affects on sleep (1). In particular the quantity of sleep may be reduced by up to 2 hours per day, with a reduction in REM and stage 2 sleep.</p>\n\n<ol start=\"2\">\n<li><strong>Fatigue</strong></li>\n</ol>\n\n<p>It is logical that decreased sleep will also lead to increased levels of fatigue. Reports of fatigue among shift workers is very common, and remains an important, but vague symptom often a major cause of shift work intolerance.</p>\n\n<ol start=\"3\">\n<li><strong>Mental Health</strong></li>\n</ol>\n\n<p>There have been reports of increased anxiety and depression among shift workers. The question of whether shift work <strong>causes</strong> increased psychiatric morbidity however is still an open question, as correlation doesn't always imply causation.</p>\n\n<ol start=\"4\">\n<li><strong>Cardiovascular Disorders</strong></li>\n</ol>\n\n<p>Scandinavian studies show that shift workers have a 40% increased risk of cardiovascular disease, including angina, hypertension and myocardial infarction. It is thought this increase risk may be associated with disturbances in the circadian rhythm, increased stress, poor diet and lack of exercise. </p>\n\n<ol start=\"5\">\n<li><strong>Reproductive Disorders</strong></li>\n</ol>\n\n<p>There is increasing evidence that shift work may lead to increased risk of spontaneous abortion, low birth weight and prematurity.</p>\n\n<p>The risks of developing any of these adverse health affects from shift work may also depend on age, sex and personality. Evidence shows older people are able to tolerate shift work less than younger people.</p>\n\n<p><strong>References:</strong></p>\n\n<ol>\n<li><p>Harrington, J. Malcolm. \"Health effects of shift work and extended hours of work.\" Occupational and Environmental medicine 58.1 (2001): 68-72.</p></li>\n<li><p>Akerstedt T. Psychological and psychophysiological effects of shiftwork.\nScand J Work Environ Health 1990:16(suppl 1):67–73.</p></li>\n<li><p>Boggild H, Knuttson A. Shift work, risk factors and cardiovascular disease.\nScand J Work Environ Health 1999;25:85–99.</p></li>\n<li><p>Spurgeon A. Working time, occupational health and safety. Geneva: ILO (in\npress)</p></li>\n</ol>\n", "score": 4 } ]

[ "side-effects", "sleep", "sleep-cycles" ]

[ { "answer_id": 15581, "body": "<p>If the person is a HFE homozygote, or a compound heterozygote, then they need to be monitored yearly for signs of iron overload. Iron overload occurs more quickly if there is concurrent alcohol use and iron consumption eg. using iron cooking pots.</p>\n\n<p>In the asymptomatic patient with genetic hemochromatosis, then phlebotomy should commence when the ferritin exceeds 500 mcg/L and/or fasting transferrin saturation exceeds 50% ( though this value may vary depending where you are located ). The reason that we monitor iron levels is that it is now apparent not all patients who test homozygous for a HFE mutation go on to develop iron overload.</p>\n\n<blockquote>\n <p>The authors of several large population-based studies have performed hemochromatosis genetic testing on participants many years into the study and used stored blood samples to measure SF over time in participants found to have C282Y homozygosity.10⇓⇓⇓⇓–15 These studies demonstrate that not all C282Y homozygotes, including those with an increased SF level, are destined to have progressive iron overload.16,17</p>\n</blockquote>\n\n<p><a href=\"http://www.bloodjournal.org/content/116/3/317\" rel=\"nofollow noreferrer\">http://www.bloodjournal.org/content/116/3/317</a></p>\n", "score": 2 } ]

[ "genetics", "iron", "age", "organ-damage" ]

[ { "answer_id": 5509, "body": "<p>Using this monitoring device on children in adult mode would not give wrong results.</p>\n\n<p>I can see two reasons for using a different mode:</p>\n\n<ol>\n<li>Normal values for pulse and BP are different between adult and pediatric patients (see <a href=\"http://www.nhlbi.nih.gov/health-pro/guidelines/current/hypertension-pediatric-jnc-4/blood-pressure-tables\" rel=\"nofollow\">Blood Pressure Tables for Children and Adolescents</a>), so default alarms would be different</li>\n<li>The device measuring the blood pressure will probably function differently in adults and children: on the first attempt, the pressure will rise to a fixed value that is higher in adults and lower in children, because, on average, children have a lower blood pressure (using more pressure than necessary could provoke pain or discomfort in the arm, pain could then increase BP and heart rate). This British Medical Journal article explains how the device works: <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121444/\" rel=\"nofollow\">Oscillatory Blood Pressure Monitoring Devices</a></li>\n</ol>\n\n<p>Initially, the pressure in the cuff must be higher than the patient's blood pressure, then, the pressure diminishes slowly to get a measurement. The device is guessing the pressure on the first trial, and then it goes higher for the second attempt if the first guess was incorrect, that is, if the patient's blood pressure was higher than the maximal pressure of the cuff.</p>\n\n<p>You could probably get a more thorough and technical explanation by contacting the manufacturer.</p>\n", "score": 1 } ]

[ "pediatrics", "biological-parameter", "emergency" ]

[ { "answer_id": 804, "body": "<p>Great question! There are actually a number of resources out there that answer this question. <a href=\"http://www.cps.ca/documents/position/guiding-parents-health-information-internet\">Here</a> is a very dry (but unbiased) answer from the Canadian Paediatric Society written for paediatricians who are helping parents with this issue. </p>\n\n<p>Here are some quick question to ask yourself when appraising the website you're looking at:</p>\n\n<p>1) Most importantly, whose website is it? The most reliable are generally university or health agency websites. Next would be not-for-profit professional organizations (for example the American Academy of Cancer Researchers or the American Medical Association). Be wary of for-profit organizations and websites run by one individual or a small group of individuals.</p>\n\n<p>2) Is the information referenced and peer reviewed? An unreferenced statement is useless. Even if it's referenced, the reference should ideally point to the peer reviewed literature, not to a secondary source (such as a news site).</p>\n\n<p>3) Is the website itself peer reviewed? This isn't mandatory but it helps you have trust in the website.</p>\n\n<p>If you have the background you can go to the references and evaluate the literature itself - is the population described relevant to you? Was the intervention what you were looking for? This is advanced and probably unnecessary if you follow the other rules (especially number 1).</p>\n\n<p>The bottom line is that reputable organizations are likely to have accurate information. The NIH, CDC, or Mayo Clinic will always be more reliable than a single person's website (no matter who they are). Look for .gov or .edu at the end of the URL - these are reasonable indicators that the information has at least been vetted by more than one person.</p>\n", "score": 8 } ]

[ "research" ]

[ { "answer_id": 7127, "body": "<p>From the MayoClinic, it isn't clear why adult allergies develop:\n<a href=\"http://www.mayoclinic.org/diseases-conditions/food-allergy/expert-answers/food-allergy/faq-20058483\" rel=\"noreferrer\">http://www.mayoclinic.org/diseases-conditions/food-allergy/expert-answers/food-allergy/faq-20058483</a></p>\n\n<p>However, there is evidence that food sensitivities develop when someone has a compromised gut. If the gut is compromised, undigested food particles \"leak\" into the blood stream and the body creates antibodies against this undigested food. These sensitivities can disappear if the gut is repaired.\n<a href=\"http://www.holistichelp.net/blog/why-do-food-sensitivities-develop-and-spread/\" rel=\"noreferrer\">http://www.holistichelp.net/blog/why-do-food-sensitivities-develop-and-spread/</a></p>\n", "score": 5 } ]

[ "allergy", "allergen" ]

[ { "answer_id": 12953, "body": "<p>It is a misconception that you will start to cough up tar after smoking cessation. I can imagine why you would think that - after all, cigarettes contain tar and that has to have gone into your lungs, so it has to come out, right?<br>\nWhat happens is that you breathe in fine particles with smoking, part of which your body gets rid of in the period after you had that cigarette. Another part settles in your lungs, but it's not going to get out. I'm guessing you're visualizing it as a collection of tar/dust in your lungs which you're going to cough out eventually if you keep coughing up enough. It simply isn't. You get mucus because of irritation/inflammation of the lungs due to smoking.</p>\n\n<p>What you are going to find is that your lung function gets better with time after smoking cessation. The amount of mucus you cough up will likely also get less. <a href=\"http://erj.ersjournals.com/content/23/3/464\" rel=\"nofollow noreferrer\">This review</a> gives some interesting background information about what smoking cessation does to your lungs and body.</p>\n", "score": 1 } ]

[ "smoking", "lungs" ]

[ { "answer_id": 873, "body": "<p>It very much depends on what you mean by evidence, but if you're talking about major studies that produced meaningful results that actually captured people's attention, <a href=\"http://smm.sagepub.com/content/7/2/87.short\" rel=\"noreferrer\">it was a series of case-control studies in 1950</a>'s, followed by a fair amount of more intensive research in the late 1950's and early 1960's.</p>\n\n<p>It's a somewhat technical paper, but <a href=\"http://journals.lww.com/epidem/Citation/2010/01000/On_the_Origin_of_Risk_Relativism.2.aspx\" rel=\"noreferrer\">this paper</a> describes both some of the early results, the medical research community's reactions to them, and the broader impacts on medical research as a field.</p>\n", "score": 6 } ]

[ "research", "addiction" ]

[ { "answer_id": 915, "body": "<p>Unless you're doing something stupid like eating polar bear liver, <a href=\"https://en.wikipedia.org/wiki/Hypervitaminosis_A\" rel=\"noreferrer\">hypervitaminosis A</a> is the result of long-term overconsumption: taking one supplement in the morning and one in the evening is no more or less dangerous than taking both at once.</p>\n\n<p>According to the National Institutes of Health, the level of <a href=\"http://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/#h8\" rel=\"noreferrer\">vitamin A overconsumption</a> that presents a long-term risk to a healthy adult depends on the form that the vitamin is consumed in. For pre-formed vitamin A (retinoids), the upper level is about three times the RDA, while for vitamin-A precursors (carotenoids), there is no known toxic effect for overconsumption, though it may raise the lung cancer risk of smoking or working with asbestos.</p>\n", "score": 6 }, { "answer_id": 13148, "body": "<p>Most vitamins are best taken with some sort of food to aid in the absorption of the supplement. Taking vitamins throughout the day at different intervals also aids in maintaining proper levels of each supplement. Thus, taking vitamins in smaller dosages throughout the day provides optimal balance.</p>\n\n<p>If you are taking vitamin supplements with no contraindications to any prescriptions and your choice is to take them all at night or not at all, you are not creating a problem by taking them all[enter link description here][1] at once.</p>\n", "score": 0 } ]

[ "micronutrients" ]

[ { "answer_id": 959, "body": "<p>There is evidence that a muscular arm will produce a higher systolic reading if the wrong sized cuff is applied.</p>\n\n<p>There are two measurements in a blood pressure reading, the systolic and the diastolic. The systolic blood pressure (SBP) is the first number in a reading (Such as the 120 in 120/60), and the diastolic blood pressure (DBP) is the second number.</p>\n\n<p>The method for taking an arm blood pressure is to wrap the cuff around the upper arm, place the stethoscope over the brachial artery, and inflate the cuff until you cannot hear any sounds. Slowly bleed the air out of the cuff, and note the number when the first sound appears, and when the sound disappears to get your reading.</p>\n\n<p>The <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/19593118\">study I refer to above</a> was performed at a Mexican bodybuilding competition. When a medium cuff was used, the SBP was significantly higher than with the larger cuff. Blood pressure overall was slightly lower with the correct sized cuff as well.</p>\n\n<p>So while being muscular is not really a factor, clinicians should be aware of using the correct sized cuff to avoid artificially inflated blood pressure readings.</p>\n", "score": 8 } ]

[ "blood-pressure", "blood", "measurement" ]

[ { "answer_id": 971, "body": "<p>Assuming pregnancy takes place, the only reliable sign that a woman is pregnant is cessation of her menstrual period. If she's late, urine tests are a reliable way to confirm pregnancy, especially if the woman has irregular periods.</p>\n\n<p>Up to 50% of women will not experience nausea (the range, depending on the study, is 15-50%); while most will, when they do varies from early in the pregnancy (as early as 2 weeks after the first missed period, often peaking by the 9th week) to late (sometimes even into the early part of the second trimester). </p>\n\n<p>Urinary frequency is experienced in only about half of women in the first trimester (range 25-60%); Fatigue is subjective and depends on self-reporting; many women do not report fatigue in the first trimester, whereas nearly 100% do in the third trimester.</p>\n\n<p>_{<a href=\"http://www.medscape.com/viewarticle/708509\">Epidemiology of Nausea and Vomiting of Pregnancy: Prevalence, Severity, Determinants, and the Importance of Race/Ethnicity</a>}<br>\n_{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/15818433\">Prevalence of lower urinary tract symptoms during pregnancy in Taiwan</a>}<br>\n_{<a href=\"https://books.google.com/books?id=N2vXGuG9AZ0C&amp;pg=PA509&amp;lpg=PA509&amp;dq=epidemiology+of+frequency+of+micturition+in+pregnancy&amp;source=bl&amp;ots=zNbNRNQbCi&amp;sig=af86LwhcBh_vzIhMoARba53fFJw&amp;hl=en&amp;sa=X&amp;ei=n95UVbjBBYqQsQT8kYHoDQ&amp;ved=0CFIQ6AEwBw#v=onepage&amp;q=epidemiology%20of%20frequency%20of%20micturition%20in%20pregnancy&amp;f=false\">Dewhurst's Textbook of Obstetrics and Gynaecology</a>}</p>\n", "score": 17 } ]

[ "sex", "sexuality", "conceive-conception", "pregnancy-test", "obstetrics" ]

[ { "answer_id": 1011, "body": "<p>In general, it is the <a href=\"http://en.wikipedia.org/wiki/Basal_metabolic_rate\">basal metabolic rate (BMR) of the organism</a> which in a person who doesn't exercise more than average, consumes <a href=\"http://ajcn.nutrition.org/content/82/5/941.full\">most of the calories of the daily intake</a>. It is dependent of age, sex, population and fat-free mass, i.e. the mass of muscles in your body, which consume a lot of energy just for maintenance. Studies show that it can vary individually <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/16280423\">between 1000 and 2500 kcal/day</a> within just one population. Many factors and energy consumers contribute to the basal metabolic rate, but approximately 70% of it <a href=\"http://www.fao.org/3/contents/3079f916-ceb8-591d-90da-02738d5b0739/M2845E00.HTM\">is used for maintenance of the body's main organs</a>, and the rest is used for physical activity (in an average human) and for thermogenesis and digesting your food.</p>\n\n<p>It is not known why exactly the BMR decreases with age. While it can be partly attributed to lifestyle changes after early adulthood with decrease in exercise and physical activity, studies show that it is <a href=\"http://ajpendo.physiology.org/content/259/2/E233.short\">not the only contributing factor</a>. Part of it may be attributed to \"an alteration in tissue energy\". But when you compare age 40 with age 20, another part is that human adolescence and body growth are active until approximately <a href=\"http://humrep.oxfordjournals.org/content/15/1/227.1.long\">age 17.5 in women and age 19 in men</a>, which <a href=\"http://cdn.intechopen.com/pdfs-wm/30408.pdf\">also heavily contributes to BMR</a>.</p>\n\n<p>So, the decrease in BMR with age is multifactorial, and thus may also be influenced in many ways, the most popular one being the increase of physical activity and thus fat-free mass, which is a big contributor to it as we learned <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/16280423\">here</a> and <a href=\"http://ajcn.nutrition.org/content/82/5/941.full\">here</a>.</p>\n", "score": 8 } ]

[ "nutrition", "diet" ]

[ { "answer_id": 1051, "body": "<p>Ingestion of hydrogen peroxide (H2O2), especially very high strength H2O2, can be very dangerous and can cause some serious health risks and possibly even death. </p>\n\n<p>A United States Food and Drug Administration (FDA) announcement made in 2006^{<a href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108701.htm\">1</a>} says that drinking high strength H2O2, specifically H2O2 of 35%, is extremely dangerous and can cause several serious side effects. \"Ingesting hydrogen peroxide can cause gastrointestinal irritation or ulceration.\" It can also cause other health risks, some of which can be life threatening. </p>\n\n<p>Another article from 2007^{<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658134/\">2</a>} talks about a specific incident in which a 39 year old man accidentally drank 250mL of 35% H2O2. Though the man did not experience the worst possible side effects, he did have to go to the hospital and he did experience damage in his stomach. This is a good example of a real life situation in which H2O2 was consumed, and it did not turn out well. Another real world example^{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/24692088\">3</a>} turned out much sadder. A 2 year old girl swallowed two sips of 35% H2O2 and died. This happened because of a <a href=\"http://en.wikipedia.org/wiki/Cytotoxicity\">cytotoxic</a> (cell-killing) injury in the tissues and formation of oxygen gas (<a href=\"http://en.wikipedia.org/wiki/Oxygen_toxicity\">oxygen toxicity</a>) caused by the H2O2.</p>\n\n<p>Ingestion of 35% H2O2 is undeniably dangerous, but what about lower concentrations of H2O2, such as 3%? A study from the 1990's^{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/8667471\">4</a>} studied 670 cases of mostly children being exposed, usually orally, to 3% H2O2. \"Exposure to hydrogen peroxide 3% is usually benign, however, severe gastric injury may occur following small ingestions in children.\" Overall, they found that a majority of the children were not affected by the low concentration H2O2, but there were special cases in which bad outcomes did occur. </p>\n\n<p>Overall, we can see that safeness of drinking H2O2 varies depending on what the concentration is. High concentrations, 35%, are extremely dangerous and should never be consumed, but low concentrations, 3%, present low risks. Now, the question is do the benefits of 3% H2O2 outweigh the risks. </p>\n\n<p>I have been unable to find any reliable sources showing that health benefits of drinking H2O2 of any concentration. Usually, it is used as a topical solution for minor cuts and wounds, not as something to be taken orally. Though the ingestion of 3% H2O2 hasn't been shown to be consistently dangerous, there have been cases of damage in the stomach and other parts of the body.^{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/16740449\">5</a>} H2O2 poisoning can be very dangerous, even with low concentrations of it, so I would not recommend drinkin H2O2, ever. For more on Hydrogen Peroxide Poisoning, see <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/15298493\">here</a> and <a href=\"http://www.nlm.nih.gov/medlineplus/ency/article/002652.htm\">here</a>.</p>\n\n<hr>\n\n<p>^{[<a href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108701.htm\">1</a>] <a href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108701.htm\">FDA Warns Consumers Against Drinking High-Strength Hydrogen Peroxide for Medicinal Use: Ingestion Can Lead to Serious Health Risks and Death</a>}</p>\n\n<p>^{[<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658134/\">2</a>] <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658134/\">Accidental ingestion of 35% hydrogen peroxide</a>}</p>\n\n<p>^{[<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/24692088\">3</a>] <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/24692088\">Fatal accidental ingestion of 35 % hydrogen peroxide by a 2-year-old female: case report and literature review</a>}</p>\n\n<p>^{[<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/8667471\">4</a>] <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/8667471\">Hydrogen peroxide 3% exposures</a>}</p>\n\n<p>^{[<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/16740449\">5</a>] <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/16740449\">Hemorrhagic gastritis and gas emboli after ingesting 3% hydrogen peroxide</a>}</p>\n\n<p>^{<a href=\"http://www.ncbi.nlm.nih.gov/pubmed/15298493\">Hydrogen peroxide poisoning</a>}</p>\n\n<p>^{<a href=\"http://www.nlm.nih.gov/medlineplus/ency/article/002652.htm\">Hydrogen peroxide poisoning</a>}</p>\n", "score": 8 }, { "answer_id": 1220, "body": "<p>According to <a href=\"http://en.wikipedia.org/wiki/Hydrogen_peroxide\" rel=\"nofollow\">Wikipedia</a> this treatment is based on 2 claims: </p>\n\n<ul>\n<li><p>Cells produce hydrogen peroxide as an immune response/damaged tissue response.</p></li>\n<li><p>Pathogens can not survive in oxygen rich environment (recall H2O2 decomposes into H2O and O2)</p></li>\n</ul>\n\n<p>As you may notice the reasoning is rather flawed, even if we assume these two claims to be true. As it turns out though these claims have a weak scientific basis, making the hypothesis for the hydrogen peroxide treatment <strong><em>very</em></strong> far-fetched.</p>\n\n<p>Let's look at the (implied) reasoning:</p>\n\n<p>1) Cells make X to fight disease, so adding X would help fight disease better.<br>\nThere are 2 problems with this. Firstly, a higher concentration of X does not garantee more effectiveness--there may be side-effects to consider too. Secondly, cells may create it locally, whereas by ingesting it or injecting it into the bloodstream X may not reach the important area.</p>\n\n<blockquote>\n <p>Both the effectiveness and safety of hydrogen peroxide therapy is\n disputed by mainstream scientists. Hydrogen peroxide is produced by\n the immune system but in a carefully controlled manner. Cells called\n by phagocytes engulf pathogens and then use hydrogen peroxide to\n destroy them. The peroxide is toxic to both the cell and the pathogen\n and so is kept within a special compartment, called a phagosome.</p>\n</blockquote>\n\n<p>2)Oxygen kills pathogens, so adding oxygen to the cells will kill more pathogens.<br>\nThis claim is complete non-sense. Firstly there is the problem again that the oxygen increase is not local. Secondly this increase may be negligible compared to the normal oxygen levels in the cells.</p>\n\n<blockquote>\n <p>Claims that hydrogen peroxide therapy increase cellular levels of\n oxygen have not been supported. The quantities administered would be\n expected to provide very little additional oxygen compared to that\n available from normal respiration.</p>\n</blockquote>\n\n<p>Lastly and most important, there is no proof that oxygen is lethal to cells capable of respiration. Some cancer cells may even depend on a respiration pathway to generate ATP. So <strong>the claim that oxygen is lethal to all pathogens is false</strong>. This is not surprising as the basis for this claim, the <a href=\"http://en.wikipedia.org/wiki/Warburg_hypothesis\" rel=\"nofollow\">Warburg theory</a>, is also outdated and has been criticized for being a too simplistic view of cancer.</p>\n\n<p>Rather than saying if it is safe, because the context of the question mentions detox, this answer states that <em>there is no reason to drink it</em>.</p>\n\n<blockquote>\n <p>The American Cancer Society states that \"there is no scientific\n evidence that hydrogen peroxide is a safe, effective or useful cancer\n treatment\". The therapy is not approved by the U.S. FDA.</p>\n</blockquote>\n", "score": 3 } ]

[ "cancer", "toxicity", "hydrogen-peroxide", "detox-purge" ]

[ { "answer_id": 1026, "body": "<p>In healthy patients, a circadianic rhythm of urine excretion <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/17335055\">has been observed</a>. In average, it depends <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/17335055\">on age, sex and total (consumed) fluid volume</a>. Several factors contribute to this rhythm:</p>\n\n<ul>\n<li><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/17945293\">The rhythm of glomerular filtration rate of the kidneys</a>. They <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/2667855\">decrease filtration of urine at night.</a></li>\n<li>Many of the hormones which influence renal urine production - and also the parasympathetic/sympathetic nervous system, which controls bladder function - <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3138846/\">follow observable day and night rhythms</a>. </li>\n<li>The former study also states that there is a possibility for regulatory clock genes, which might directly influence urine production or the urge to urinate. They could be located in the bladder itself or the neurons controlling its function, <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752602/\">or in the kidneys</a>. </li>\n</ul>\n\n<p>The role of this rhythm is still unclear. <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3138846/\">In mice, the circadianic rhythm of urine excretion was lost 2 days into exposure to total darkness.</a></p>\n\n<p>So, altogether, there is evidence of multifactorial contributions to an observable circadianic rhythm of urine excretion of unknown purpose. But it is clear that at night, your kidneys filtrate and thus produce less, and the tonus of the bladder muscles is also decreased, in summary leading to your bladder preserving more urine for the morning, possibly \"to give you some rest\" at night. And it is also clear that if you're a man, <a href=\"http://onlinelibrary.wiley.com/doi/10.1046/j.1464-410x.2001.02228.x/full\">it is not going to get better with age</a>, and this is <a href=\"http://www.sciencedirect.com/science/article/pii/014067369190543X\">very likely due to the increase of their prostate volume</a>.</p>\n", "score": 9 } ]

[ "sleep", "urinary-system" ]

[ { "answer_id": 1175, "body": "<blockquote>\n<p>Thus far, more than 20 different tumor markers have been characterized and are in clinical use... There is no “universal” tumor marker that can detect any type of cancer.</p>\n<p>[L]imitations to the use of tumor markers[:] ...noncancerous conditions can cause the levels of certain tumor markers to increase. ...not everyone with a particular type of cancer will have a higher level of a tumor marker associated with that cancer. ...tumor markers have not been identified for every type of cancer. ...Although an elevated level of a tumor marker may suggest the presence of cancer, this alone is not enough to diagnose cancer. Therefore, measurements of tumor markers are usually combined with other tests, such as biopsies, to diagnose cancer.</p>\n</blockquote>\n<p>From the national Cancer institute (updated 2011) &quot;There is no universal marker for tumors&quot;. Note that marker in that context refers to samples from any source, including blood.</p>\n<p><a href=\"http://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/tumor-markers-fact-sheet\" rel=\"nofollow noreferrer\">Tumor Markers</a></p>\n<p>To answer the converse, not all tumors need have unique markers. E.g. AFP is linked to several types of cancer.</p>\n", "score": 8 } ]

[ "cancer", "blood-tests", "diagnostics" ]

[ { "answer_id": 1257, "body": "<p>Yes, mortality benefits for blood pressure medicine have been demonstrated in trials.</p>\n\n<p>Let me just preface this by saying this was much harder to find than I was expecting. Questioning the benefit of blood pressure reduction is medical heresy, so you'd think you wouldn't have trouble finding the data out there.</p>\n\n<p>First of all, let's define the question. We're asking whether treatment of hypertension leads to lower mortality in the setting of a randomized clinical trial. Reading between the lines, I think what we really want to know is whether treatment of isolated hypertension (i.e. in patients that have no strokes, heart failure or other diseases associated with hypertension) leads to lower mortality in a randomized clinical trial. Treating hypertension after a stroke or heart attack is hands down beneficial (see HOPE, PART2, IDNT, NICOLE or PREVENT trials [1-5]). You can't answer the question with this data though, because maybe the drug is really just treating the heart attack or stroke. </p>\n\n<p>To get data specifically on treating hypertension itself, not in the setting of other medical problems, you have to go back to the 1960s. The VA COOP Study Group on Antihypertensive Agents [6,7] trial specifically looked at treating people who just came into the clinic with high blood pressure. Mortality was 5% lower in the treatment group, or, for every 20 people treated for 3.3 years (the average time people were enrolled in the study), 1 person will have their life saved. Honestly, this is a pretty good outcome as far as drugs go, taking aspirin to prevent heart attacks doesn't work nearly as well, for example. The authors collected these numbers on mortality but they didn't test for whether the numbers were likely to have just popped up by chance or not (statistical significance). I crunched them myself with Fisher's exact test and the results were unlikely to have just come up by chance (p value = 0.015) </p>\n\n<p>Some caveats. This study was old (the word negro is used), but it was really well done. They had the patients go through a 2 month run in phase where they had to take pills that turned their urine orange just so they could see whether they took their pills regularly before letting them in the trial. All the patients and the doctors were blinded. They used sealed envelope randomization. Patients were enrolled from eight different sites. Of course, it was done at the VA in the 60s, so every single patient was a man. Also, the patients weren't exactly free of other diseases. For some reason, the authors didn't just say how many patients had strokes or heart attacks in the past. They devised this \"severity score\" to assess how many health problems people had at the start of the trial. The score went from 0-4 and on average the patients were less than 1. I would say most weren't very sick.</p>\n\n<p>Some other trials tried to test blood pressure medicines versus placebo but fell short. The Australian Therapeutic Trial in Mild Hypertension [8] had many fewer events than the VA study so weren't quite able to show statistical significance. The benefits to treatment that they measured in this study were way smaller. Treatment reduced death by .15%. So for every 666 people taking the drug for 1 year, 1 person's life would be saved. They were only able to show this was statistically significant when they looked at the numbers for people actually taking the drug. You want to look at everyone that entered the study in the first place though (intention to treat), because you can always invent scenarios where you get biased results if you don't do this. </p>\n\n<p>There was one other study that looked at this question. The Oslo study [9] also failed to show that treatment actually saved lives when treating patients with just hypertension.</p>\n\n<p>Keep in mind that all of these studies were able to show benefit to treating (fewer strokes, less kidney failure) but mortality was really only lower in the VA trial. My gut tells me that this was because aged American veterans were less healthy to start with then relatively healthy Norwegians and Australians (the population from the other studies). It was less of a needle-in-a-haystack challenge in the VA trial.</p>\n\n<p>Sometime in the 70s or 80s, it seems that doctors all decided that treating hypertension was the way to go no matter how healthy the patient was otherwise so we don't have any more studies. </p>\n\n<p>References</p>\n\n<ol>\n<li>HOPE (Heart Outcomes Prevention Evaluation) Study Investigators.\nEffects of an angiotensin-converting-enzyme inhibitor, ramipril, on\ncardiovascular events in high-risk patients. N Engl J Med 2000; 342:\n145–53.</li>\n<li>MacMahon S, Sharpe N, Gamble G, et al. Randomised, placebocontrolled\ntrial of the angiotensin converting enzyme inhibitor,\nramipril, in patients with coronary or other occlusive vascular disease.\nJ Am Coll Cardiol 2000; 36: 438–43.</li>\n<li>Lewis E, Hunsicker L, Clarke W, et al. Renoprotective effect of the\nangiotensin-receptor antagonist irbesartan in patients with nephropathy\ndue to type 2 diabetes. N Engl J Med 2001; 345: 851–60.</li>\n<li>Dens J, Desmet W, Coussement P, et al. Usefulness of nisoldipine for\nprevention of restenosis after percutaneous transluminal coronary\nangioplasty (results of the NICOLE study). Am J Cardiol 2001; 87:\n28–33.</li>\n<li>Pitt B, Byington R, Furberg C, et al. Effect of amlodipine on the\nprogression of atherosclerosis and the occurrence of clinical events.\nCirculation 2000; 102: 1503–10.</li>\n<li>Effects of Treatment on Morbidity in Hypertension: Results in Patients With Diastolic Blood Pressures Averaging 115 Through 129 mm Hg. JAMA. 1967;202(11):1028-1034. doi:10.1001/jama.1967.03130240070013.</li>\n<li>Effects Morbidity of Treatment on in Hypertension: II. Results in Patients With Diastolic Blood Pressure Averaging 90 Through 114 mm Hg. JAMA. 1970;213(7):1143-1152. doi:10.1001/jama.1970.03170330025003.</li>\n<li>THE AUSTRALIAN THERAPEUTIC TRIAL IN MILD HYPERTENSION: Report by the Management Committee, The Lancet, Volume 315, Issue 8181, 14 June 1980, Pages 1261-1267, ISSN 0140-6736, <a href=\"http://dx.doi.org/10.1016/S0140-6736(80)91730-4\">http://dx.doi.org/10.1016/S0140-6736(80)91730-4</a>.\n(<a href=\"http://www.sciencedirect.com/science/article/pii/S0140673680917304\">http://www.sciencedirect.com/science/article/pii/S0140673680917304</a>)</li>\n<li>Anders Helgeland, Treatment of mild hypertension: A five year controlled drug trial: The Oslo study, The American Journal of Medicine, Volume 69, Issue 5, November 1980, Pages 725-732, ISSN 0002-9343, doi: 10.1016/0002-9343(80)90438-6.</li>\n</ol>\n", "score": 6 }, { "answer_id": 1254, "body": "<p>Yes. </p>\n\n<p>This is one of the few areas of <a href=\"http://phprimer.afmc.ca/Part1-TheoryThinkingAboutHealth/Chapter4BasicConceptsInPreventionSurveillanceAndHealthPromotion/Thestagesofprevention\" rel=\"nofollow noreferrer\">primary prevention</a>* where the data are clear. </p>\n\n<p>The (intelligently) skeptical tone of your question suggests to me that you would be (appropriately) wary of drawing conclusions based on <a href=\"https://stats.stackexchange.com/a/13311\">observational data</a> or <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884846/\" rel=\"nofollow noreferrer\">surrogate endpoints</a>. Fortunately, you have asked a question about an area where rigorous data are available showing reductions in the risk of cardiovascular disease and mortality on the basis of randomized, controlled trials.</p>\n\n<p><strong>Cardiovascular events</strong> </p>\n\n<p>In large-scale randomized trials of people with primary hypertension, antihypertensive therapy produces a nearly 50 percent relative risk reduction in the incidence of heart failure, a 30 to 40 percent relative risk reduction in stroke, and a 20 to 25 percent relative risk reduction in myocardial infarction.^1,2,3,4 </p>\n\n<p>The benefits show a consistent \"dose-response\" relationship. That is, larger improvements in blood pressure control are associated with greater decreases in risk. This is an important point, since it adds credibility to the association. This is demonstrated in graphs like this one:</p>\n\n<p><img src=\"https://i.stack.imgur.com/W7MzT.png\" alt=\"enter image description here\"></p>\n\n<p>_{Image from Reference 1, below: <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386598/\" rel=\"nofollow noreferrer\">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386598/</a>} </p>\n\n<p>On the x-axis you see the degree of blood pressure lowering achieved with medications. On the y-axis is “relative risk” (RR). By definition, a null intervention yields RR=1. A relative risk of 0.5 represents a 50% decreased risk, etc. </p>\n\n<p>The graph is showing meta-analysis data, i.e. data compiled from many clinical trials in order to increase statistical power. The basic idea is that each circle is a clinical trial and bigger circles represent “stronger” data (i.e. with lower variance). The regression line shows that there is a linear relationship between the degree of blood pressure lowering and the relative risk reduction (here for a composite endpoint of stroke, myocardial infarction, and heart failure.) This analysis included 31 randomized, placebo-controlled trials, with 190,606 participants. These are strong data. </p>\n\n<p><strong>Mortality data</strong> </p>\n\n<p>In addition to the dramatic reductions in adverse cardiovascular outcomes, blood pressure control has also been shown to reduce mortality. One meta-analysis used data from 42 randomized, controlled studies including nearly 200,000 subjects (Psaty). They found a reduction in cardiovascular disease mortality (RR, 0.81; 95% CI, 0.73-0.92); and total mortality (RR, 0.90; 95% CI, 0.84-0.96). The fact that these relative risk (RR) confidence intervals do not cross 1 demonstrates statistical significance. </p>\n\n<p>Although the RR value of 0.90 is considerably less impressive than the reductions in more specific outcomes (stroke, heart failure, etc), this is expected due to the myriad of other factors affecting mortality. A statistically significant relative risk of 0.90 for <strong>mortality</strong> is actually quite dramatic. One would be challenged to find any other intervention for primary prevention that, in randomized trials, can be shown to decrease overall mortality with this degree of certainty.</p>\n\n<p><strong>Conclusion</strong> </p>\n\n<p>There are many interventions in modern medicine that are of questionable long-term benefit to healthy patients (i.e. primary prevention).** These include cholesterol lowering medications, aspirin, various forms of cancer screening, etc. In most cases, the disease-specific improvements in outcomes are subtle and debated, and randomized data showing a reduction in overall mortality are lacking or inconsistent. The use of blood pressure lowering medications in patients with hypertension falls into a different category. These medications are effective. </p>\n\n<p>_{\n*That is, interventions aimed at preventing disease in <em>healthy</em> people. This is in contrast to <em>secondary</em> prevention, treating people after they have already had an adverse outcome. In general, secondary prevention is a much \"easier\" arena in which to demonstrate benefit because the risk of adverse outcomes is so much higher.\n} </p>\n\n<p>_{\n**Here, I’m considering hypertension, hyperlipidemia to fall within the range of “healthy” because these abnormalities are only problematic if they cause a cardiovascular event of some sort.\n}</p>\n\n<hr>\n\n<p><strong>References</strong> </p>\n\n<ol>\n<li><p>Blood Pressure Lowering Treatment Trialists' Collaboration, Turnbull F, Neal B, Ninomiya T, Algert C, Arima H, Barzi F, Bulpitt C, Chalmers J, Fagard R, Gleason A, Heritier S, Li N, Perkovic V, Woodward M, MacMahon S. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=18480116\" rel=\"nofollow noreferrer\">Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials.</a> BMJ. 2008 May 17;336(7653):1121-3.</p></li>\n<li><p>Law MR, Morris, Wald NJ. <a href=\"http://www.bmj.com/content/338/bmj.b1665\" rel=\"nofollow noreferrer\">Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies.</a> BMJ 2009; 338.</p></li>\n<li><p>Kostis JB, Davis BR, Cutler J, Grimm RH Jr, Berge KG, Cohen JD, Lacy CR, Perry HM Jr, Blaufox MD, Wassertheil-Smoller S, Black HR, Schron E, Berkson DM, Curb JD, Smith WM, McDonald R, Applegate WB. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/9218667\" rel=\"nofollow noreferrer\">Prevention of heart failure by antihypertensive drug treatment in older persons with isolated systolic hypertension. SHEP Cooperative Research Group.</a> JAMA. 1997 Jul 16;278(3):212-6.</p></li>\n<li><p>Gueyffier F, Boutitie F, Boissel JP, Pocock S, Coope J, Cutler J, Ekbom T, Fagard R, Friedman L, Perry M, Prineas R, Schron E. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/?term=9148648\" rel=\"nofollow noreferrer\">Effect of antihypertensive drug treatment on cardiovascular outcomes in women and men. A meta-analysis of individual patient data from randomized, controlled trials. The INDANA Investigators.</a> Ann Intern Med. 1997 May 15;126(10):761-7.</p></li>\n<li><p>Psaty BM, Lumley T, Furberg CD, Schellenbaum G, Pahor M, Alderman MH, Weiss NS. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/?term=12759325\" rel=\"nofollow noreferrer\"><em>Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis.</em></a> JAMA. 2003 May 21;289(19):2534-44.</p></li>\n</ol>\n", "score": 4 } ]

[ "blood-pressure" ]

[ { "answer_id": 15369, "body": "<p>Let's first clarify that \"<strong>vasomotor rhinitis (VMR) otherwise known as non-allergic rhinitis</strong>\" is the non-allergic reaction (NAR), which can be similar in symptoms to the allergic reaction (AR), but not the same.</p>\n\n<blockquote>\n <p>Vasomotor rhinitis is a poorly understood disorder which mimics many\n of the symptoms of nasal allergy, but has a completely different\n basis. Failure to recognize these differences has led to a great deal\n of misunderstanding about this disorder.</p>\n</blockquote>\n\n<p>This symptom might be more common in allergic rhinitis (AR), though we can't really be sure, since we don't know how commonly it occurs in everyone else. (It breaks down into a statistics problem which we can only approximate with certain assumptions.)</p>\n\n<p>However, based on this study:\n<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3650992/\" rel=\"nofollow noreferrer\">Nonallergic Rhinitis, With a Focus on Vasomotor Rhinitis Clinical Importance, Differential Diagnosis, and Effective Treatment Recommendations</a></p>\n\n<blockquote>\n <p>[One survey of US medical practices] suggest that <strong>at least 57% of rhinitis\n patients have some\n contribution from NAR [Nonallergic rhinitis] causing their rhinitis symptoms.</strong> Similar\n European studies have found that <strong>approximately 1 in 4 patients\n complaining of nasal symptoms has pure NAR</strong> [2].</p>\n</blockquote>\n\n<p>So it seems that people often mix up Allergic Rhinitis (AR) and NAR so much, that even many cases of \"AR\" are actually still just NAR. So maybe people with AR have AR occurances <em>instead</em> of NAR, and NAR to NR ratio is about 1-to-1. However, if we assume that all people have relatively the same number of NAR symptoms, then it seems likely that people with AR have at least slightly higher occurances of this symptom.</p>\n", "score": 2 } ]

[ "sleep", "breathing", "oxygenation", "nasal-congestion", "vasomotor-rhinitis" ]