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[ { "answer_id": 26359, "body": "<p><strong>Full Background</strong></p>\n<p>The full-text of the study that Dr. Goldstein discusses is available online at:\n<a href=\"https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.032995\" rel=\"nofollow noreferrer\">https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.032995</a></p>\n<p>Chen MH, Tsai SJ, Su TP, Li CT, Lin WC, Chen TJ, Pan TL, Bai YM. Increased Risk of Stroke in Patients With Obsessive-Compulsive Disorder: A Nationwide Longitudinal Study. Stroke. 2021 May 27:STROKEAHA120032995. doi: 10.1161/STROKEAHA.120.032995. Epub ahead of print. PMID: 34039028.</p>\n<p>The study used computer-stored data from the Taiwan Health Insurance Research Database. People with a diagnosis of obsessive compulsive disorder (OCD) were identified along with a matched group of people without (OCD) of equal size. The factors used to match the people without OCD to those with OCD included age, sex, income, and, among others, several factors that are known to be important risk factors for ischemic stroke—smoking, ischemic heart disease, dyslipidemia, hypertension, diabetes, and obesity. As the authors point out, prior research has shown an association between OCD and risk factors for stroke including diabetes and obesity.</p>\n<p>The people were “followed” (in the database) through 2010 to identify cases of ischemic and hemorrhagic stroke in the two groups.</p>\n<p>The number of people in the OCD and non-OCD groups were equal (28,064) and the two groups had identical percentages with the stroke related risk factors (smoking, ischemic heart disease, dyslipidemia, hypertension, diabetes, obesity) in the two groups (OCD and non-OCD). At the end of “follow-up,” there were 82 ischemic strokes in the OCD group (0.29%) and 24 in the non-OCD group (0.09%).</p>\n<p><strong>Dr. Goldstein’s Comment</strong></p>\n<p>Dr. Goldstein’s refers to factors that “the researchers could not control for” as a possible explanation for the study findings. His difficult to follow sentence follows:</p>\n<blockquote>\n<p>“He pointed out that there was no assessment of the types or\neffectiveness of risk factor controls over time in reducing stroke\nodds.”</p>\n</blockquote>\n<p><strong>Effect of Risk Factor Management on the Risk of Ischemic Stroke</strong></p>\n<p>A recent review of stroke prevention discusses interventions to prevent ischemic stroke.\n<a href=\"https://www.ncbi.nlm.nih.gov/books/NBK470234/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/books/NBK470234/</a></p>\n<p>Reduction in blood pressure using anti-hypertensive drugs, statin treatment in people with hyperlipidemia, aspirin treatment in people with ischemic heart disease, and careful management of elevated blood glucose in people with diabetes prevent ischemic stroke and/or cerebral atherosclerosis.</p>\n<p><strong>What the Study Did and Did Not Do</strong></p>\n<p>The people with OCD and without OCD were well-matched for the main risk factors for ischemic stroke.</p>\n<p>No attempt was made to account for possible differences in the management/treatment of these risk factors comparing the people with OCD and without OCD.</p>\n<p><strong>Answer to the Question Posed</strong></p>\n<p>Differences in the management of risk factors for ischemic stroke during follow-up comparing people with OCD and those without OCD is a possible explanation for the higher risk of ischemic stroke in people with OCD that was observed in this study.</p>\n", "score": 2 } ]

[ "statistics", "clinical-study", "stroke", "contributing-factors", "obsessive-compulsive" ]

[ { "answer_id": 27426, "body": "<p>MAO enzymes have two isoforms (MAO-A and MAO-B).</p>\n<p><a href=\"https://i.stack.imgur.com/YTBLn.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/YTBLn.png\" alt=\"MAO isoforms\" /></a></p>\n<p>Now, as you said on the description, tyramine (as well as noradrenaline, adrenaline, dopamine)</p>\n<blockquote>\n<p>is a substrate for both isoforms A and B of MAO <a href=\"https://www.sciencedirect.com/topics/neuroscience/tyramine\" rel=\"nofollow noreferrer\">reference</a></p>\n</blockquote>\n<p>There's also three types of MAOIs <a href=\"https://link.springer.com/article/10.2165/00023210-199503020-00006\" rel=\"nofollow noreferrer\">reference</a>:</p>\n<ul>\n<li>first generation - irreversible nonselective (older)</li>\n<li>second generation - irreversible, selective drugs</li>\n<li>third generation - <strong>reversible, selective MAO-A</strong> [also known as RIMAs (reversible inhibitors of MAO-A)]</li>\n</ul>\n<p>Regarding the tyramine and RIMAs reaction <a href=\"https://bpspubs.onlinelibrary.wiley.com/doi/pdfdirect/10.1038/sj.bjp.0706464\" rel=\"nofollow noreferrer\">reference</a></p>\n<blockquote>\n<p>reversibility allows competition and so ingested tyramine (or other dietary amine) is able to displace the inhibitor from the enzyme and be metabolized in the normal way, in the gut and liver</p>\n</blockquote>\n<p>Although better than the previous generations, RIMAs still have their limitations (to be metabolized normally) and in that sense the <em><strong>European Food Safety Authority</strong></em> recommends</p>\n<blockquote>\n<p>[less than] 50 mg [of tyramine] for those taking third generation MAOI <a href=\"http://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2011.2393\" rel=\"nofollow noreferrer\">reference</a></p>\n</blockquote>\n<p>to sum up, the best solution when taking this sort of medication is still follow a restrictive diet, low in tyramine (or other dietary amines).</p>\n", "score": 2 } ]

[ "medications" ]

[ { "answer_id": 27396, "body": "<p>Vaccine-induced immune thrombotic thrombocytopenia (VITT): the incidence is unknown but it appears to be exceedingly rare. Risk factors for VITT are also unknown, although female sex and younger age (&lt;55-60 yrs) were proposed as possible risk factors on initial reports.\nA blood test before taking these vaccines will not be informative.</p>\n<p>When VITT is suspected and the patient has received one of adenoviral-vectored vaccines (Astra Zeneca or Janssen/Johnson and Johnson) within the previous 5 to 30 days, appropriate tests including but not limited to blood counts are indicated and should be evaluated by a physician.</p>\n<p>References:</p>\n<p>Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination.\nN Engl J Med. 2021;\n<a href=\"https://pubmed.ncbi.nlm.nih.gov/33835769/\" rel=\"nofollow noreferrer\">https://pubmed.ncbi.nlm.nih.gov/33835769/</a></p>\n<p>Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination.\nN Engl J Med. 2021;\n<a href=\"https://pubmed.ncbi.nlm.nih.gov/33835768/\" rel=\"nofollow noreferrer\">https://pubmed.ncbi.nlm.nih.gov/33835768/</a></p>\n", "score": 2 } ]

[ "covid-19", "vaccination", "blood-tests" ]

[ { "answer_id": 27421, "body": "<p>You may not have had a chance to see this from the WHO: <a href=\"https://www.who.int/news-room/feature-stories/detail/the-sinovac-covid-19-vaccine-what-you-need-to-know\" rel=\"nofollow noreferrer\">https://www.who.int/news-room/feature-stories/detail/the-sinovac-covid-19-vaccine-what-you-need-to-know</a></p>\n<blockquote>\n<p>&quot;The WHO Strategic Advisory Group of Experts (SAGE) on Immunization\nhas issued Interim recommendations for the use of the inactivated\nCOVID-19 vaccine, Sinovac-CoronaVac, developed by Sinovac/China\nNational Pharmaceutical Group.</p>\n</blockquote>\n<p>...</p>\n<blockquote>\n<p>Is it safe?</p>\n<p>SAGE has thoroughly assessed the data on quality, safety and efficacy\nof the vaccine and has recommended its use for people aged 18 and\nabove.</p>\n<p>Safety data is currently limited for persons above 60 years of age\n(due to the small number of participants in clinical trials).</p>\n<p>While no differences in safety profile of the vaccine in older adults\ncompared to younger age groups can be anticipated, countries\nconsidering using this vaccine in persons older than 60 years should\nmaintain active safety monitoring.</p>\n<p>As part of the EUL process, Sinovac has committed to continuing submit\ndata on safety, efficacy and quality in ongoing vaccine trials and\nrollout in populations, including in older adults.</p>\n<p>How efficacious is the vaccine?</p>\n<p>A large phase 3 trial in Brazil showed that two doses, administered at\nan interval of 14 days, had an efficacy of 51% against symptomatic\nSARS-CoV-2 infection, 100% against severe COVID-19, and 100% against\nhospitalization starting 14 days after receiving the second dose. Does\nit work against new variants of SARS-CoV-2 virus?</p>\n<p>In an observational study, the estimated effectiveness of\nSinovac-CoronaVac in health workers in Manaus, Brazil, where P.1\naccounted for 75% of SARS-CoV-2 samples was 49.6% against symptomatic\ninfection (4). Effectiveness has also been shown in an observational\nstudy in Sao Paulo in the presence of P1 circulation (83% of samples).</p>\n<p>Assessments in settings where the P.2 Variant of Concern was widely\ncirculating – also in Brazil - estimated vaccine effectiveness of\n49.6% following at least one dose and demonstrated 50.7% two weeks after the second dose. As new data becomes available, WHO will update\nrecommendations accordingly.</p>\n<p>SAGE currently recommends using this vaccine, according to the WHO\nPrioritization Roadmap.&quot;</p>\n</blockquote>\n<p>Also note that this vaccine is a killed-virus type of vaccine, different from the adenovirus-vector types of vaccines that have been in the news recently due to possible very very rare blood clot issues.</p>\n<p>More detailed resources:</p>\n<p>&quot;Interim recommendations for use of the inactivated COVID-19 vaccine, CoronaVac, developed by Sinovac&quot;\n<a href=\"https://www.who.int/publications/i/item/WHO-2019-nCoV-vaccines-SAGE-recommendation-Sinovac-Coronavac\" rel=\"nofollow noreferrer\">https://www.who.int/publications/i/item/WHO-2019-nCoV-vaccines-SAGE-recommendation-Sinovac-Coronavac</a></p>\n<p>&quot;Annexes to the recommendations for use of the Sinovac-CoronaVac vaccine against COVID-19: Grading of evidence, Evidence to recommendation tables&quot;\n<a href=\"https://www.who.int/publications/i/item/WHO-2019-nCoV-vaccines-SAGE_recommendation-Sinovac-CoronaVac-annexes-2021.1\" rel=\"nofollow noreferrer\">https://www.who.int/publications/i/item/WHO-2019-nCoV-vaccines-SAGE_recommendation-Sinovac-CoronaVac-annexes-2021.1</a></p>\n<p>&quot;Background document on the inactivated vaccine Sinovac-CoronaVac against COVID-19&quot;\n<a href=\"https://www.who.int/publications/i/item/WHO-2019-nCoV-vaccines-SAGE-recommendation-Sinovac-CoronaVac-background\" rel=\"nofollow noreferrer\">https://www.who.int/publications/i/item/WHO-2019-nCoV-vaccines-SAGE-recommendation-Sinovac-CoronaVac-background</a></p>\n", "score": 1 } ]

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

[ { "answer_id": 27420, "body": "<p>Nobody knows.</p>\n<p>There are three main models for the effects of low-dose radiation. The mainstream model, and the most conservative of the three, is the <a href=\"https://en.wikipedia.org/wiki/Linear_no-threshold_model\" rel=\"nofollow noreferrer\">linear no-threshold model</a>. It assumes that high-dose effects can be linearly extrapolated clear down to zero (that is, zero dose has zero effect, any non-zero dose carries a non-zero level of risk).</p>\n<p>The most controversial model is the <a href=\"https://en.wikipedia.org/wiki/Radiation_hormesis\" rel=\"nofollow noreferrer\">hormesis model</a>. It posits that very small doses of radiation are actually beneficial, by activating cellular repair mechanisms that would otherwise be idle, with the effects of the repair mechanisms outweighing any radiation damage.</p>\n<p>In between are various threshold models, which assume that there's a threshold below which radiation has no health effect. Threshold models are <a href=\"https://en.wikipedia.org/wiki/Threshold_model#Toxicology\" rel=\"nofollow noreferrer\">widely accepted in chemical toxicology</a>, so it's not unreasonable to extend the idea to radiation.</p>\n<p>In any case, the effects of low-dose radiation are very small, and particularly in the case of cancer, are masked by other effects.</p>\n", "score": 1 } ]

[ "radiation", "dna", "radioactivity", "nuclear-radiation" ]

[ { "answer_id": 27465, "body": "<p>There are good reasons why some drugs are bilayered. A company could decide to produce a bilayered drug formulation for the same drug if it's necessary to produce a formulation in which the drug in one of the layers is released instantly while the drug in the second layer is released gradually to produce prolonged effect, sustained release. This helps to reduce the frequency of administeration. By reducing the frequency of administeration a drug that is administered every 8 hours can be administered every 24 hours or so. This enhances Patient compliance.\nTwo compatible/incompatible drugs can be made Into a bilayered formulation. Clinical experience has shown that patient compliance can be improved by reducing the quantity of drugs that is administered. Instead of taking two or three different tablets to treat certain disease condition/conditions, one formulation containing the whole drugs can be taken. Also some disorders, such as hypertension, are better managed using a combination of drugs that act through different mechanisms. The rationale behind this is beyond the scope of this question.</p>\n<p><a href=\"https://www.researchgate.net/publication/344267062_Bilayer_tablets_A_developing_novel_drug_delivery_system\" rel=\"nofollow noreferrer\">https://www.researchgate.net/publication/344267062_Bilayer_tablets_A_developing_novel_drug_delivery_system</a></p>\n", "score": 2 } ]

[ "medications", "drug-metabolism", "drug-interactions" ]

[ { "answer_id": 27456, "body": "<blockquote>\n<p>I know clinical trials have answered these question</p>\n</blockquote>\n<p>They have not. The reason for the specific windows specified for vaccination is that these windows are what was studied in the trials. Other windows were not studied. Therefore, it is unknown what level of protection will be provided outside that window. It could even be better, but is probably about the same.</p>\n<p>It's reasonable to infer that small deviations from the instructions will not matter much, and that a second dose of the vaccine any time will be better than never getting it, but that's all. Similar questions have been asked and answered by experts in all sorts of lay press, here's one example: <a href=\"https://www.scientificamerican.com/article/is-it-safe-to-delay-a-second-covid-vaccine-dose/\" rel=\"nofollow noreferrer\">https://www.scientificamerican.com/article/is-it-safe-to-delay-a-second-covid-vaccine-dose/</a></p>\n", "score": 4 } ]

[ "covid-19", "vaccination" ]

[ { "answer_id": 27487, "body": "<p><a href=\"https://www.fda.gov/media/144035/download\" rel=\"nofollow noreferrer\">This fact sheet</a> on the Elecsys Anti-SARS-CoV-2 S test from Roche, the test manufacturer, has useful information.</p>\n<p>In particular it notes:</p>\n<blockquote>\n<p>You should not interpret the results of this test as an indication or\ndegree of immunity or protection from infection.</p>\n</blockquote>\n", "score": 1 } ]

[ "sars-cov-2" ]

[ { "answer_id": 27490, "body": "<p>They increase UV sensitivity for as long as you use them, so sunscreen is recommended if doing any activity outside in the sunlight.</p>\n<p>Retinoids simply make your skin more sensitive because it stimulates renewal of skin cells and these cells are thinner and more photosensitive, allowing more UV to penetrate and cause harm.</p>\n<p>Also, the retinoids themselves are sensitive to UV radiation so the sunlight would reduce the effectiveness.</p>\n<p>There are studies going back to the eighties about retinol side effects which cite these two issues.</p>\n<p><a href=\"https://www.skincancer.org/blog/when-beauty-products-cause-sun-sensitivity/\" rel=\"nofollow noreferrer\">https://www.skincancer.org/blog/when-beauty-products-cause-sun-sensitivity/</a></p>\n", "score": 2 } ]

[ "dermatology", "sunlight" ]

[ { "answer_id": 27524, "body": "<p>The study the book refers to seems to be <a href=\"https://doi.org/10.1212/01.wnl.0000291618.32247.2d\" rel=\"nofollow noreferrer\">DaSilva et al. (2007)</a>.</p>\n<blockquote>\n<p>Thickening in the SSC is in line with diffusional abnormalities observed in the subcortical trigeminal somatosensory pathway of the same migraine cohort in a previous study. Repetitive migraine attacks may lead to, or be the result of, neuroplastic changes in cortical and subcortical structures of the trigeminal somatosensory system.</p>\n</blockquote>\n<p><a href=\"https://doi.org/10.1177/0333102414531155\" rel=\"nofollow noreferrer\">Kim et al. (2014)</a> studied this.</p>\n<blockquote>\n<h3>Methods</h3>\n<p>Fifty-six female migraine patients without aura and T2-visible white matter hyperintensities and 34 female controls were scanned on a 3T magnetic resonance imager. Cortical thickness was estimated and compared between patients and controls using a whole-brain vertex-by-vertex analysis. Correlation analysis was conducted between cortical thickness of significant clusters and clinical variables.</p>\n<p><strong>[...]</strong></p>\n<h3>Conclusions</h3>\n<p>We have provided evidence for interictal cortical abnormalities of thickened prefrontal cortex and somatosensory cortex in female migraine patients without aura. Our findings of greater thickening of the somatosensory cortex in relation to increasing disease duration and increasing headache frequency suggest that repeated migraine attacks over time may lead to structural changes of the somatosensory cortex through increased noxious afferent input within the trigemino-thalamo-cortical pathway in migraine.</p>\n</blockquote>\n<p>A longitudinal study over 4 years was conducted by <a href=\"https://doi.org/10.1212/wnl.0000000000005819\" rel=\"nofollow noreferrer\">Messina et al. (2018)</a></p>\n<blockquote>\n<h3>Objective</h3>\n<p>To explore cross-sectional and longitudinal gray matter (GM) volume changes in patients with migraine and their association with patients' clinical characteristics and disease activity.</p>\n<p><strong>[...]</strong></p>\n<h3>Results</h3>\n<p><strong>[...]</strong></p>\n<p>Over the follow-up, migraineurs developed an increased volume of frontotemporoparietal regions, which was more prominent in patients with a higher baseline disease activity: long disease duration and high attack frequency. Migraineurs also developed decreased GM volume of visual areas, which was related to higher pain severity. Patients with an increased attack frequency at follow-up experienced both increased and decreased volume of nociceptive regions. In migraineurs, reduced GM volume of extrastriate visual areas during the follow-up was significantly correlated to baseline disease activity: shorter disease duration and lower attack frequency.</p>\n<h3>Conclusion</h3>\n<p>In this cohort, the migraine brain changes dynamically over time, and different pathophysiologic mechanisms can occur in response to patients' disease severity. The interaction between predisposing brain traits and experience-dependent responses might vary across different nociceptive and visual areas, thus leading to distinct patterns of longitudinal GM volume changes.</p>\n</blockquote>\n<h2>References</h2>\n<p>DaSilva, A. F., Granziera, C., Snyder, J., &amp; Hadjikhani, N. (2007). Thickening in the somatosensory cortex of patients with migraine. <em>Neurology, 69</em>(21), 1990-1995. <a href=\"https://doi.org/10.1212/01.wnl.0000291618.32247.2d\" rel=\"nofollow noreferrer\">https://doi.org/10.1212/01.wnl.0000291618.32247.2d</a></p>\n<p>Kim, J. H., Kim, J. B., Suh, S. I., Seo, W. K., Oh, K., &amp; Koh, S. B. (2014). Thickening of the somatosensory cortex in migraine without aura. <em>Cephalalgia : an international journal of headache, 34</em>(14), 1125–1133. <a href=\"https://doi.org/10.1177/0333102414531155\" rel=\"nofollow noreferrer\">https://doi.org/10.1177/0333102414531155</a></p>\n<p>Messina, R., Rocca, M. A., Colombo, B., Pagani, E., Falini, A., Goadsby, P. J., &amp; Filippi, M. (2018). Gray matter volume modifications in migraine: a cross-sectional and longitudinal study. <em>Neurology, 91</em>(3), e280-e292. <a href=\"https://doi.org/10.1212/wnl.0000000000005819\" rel=\"nofollow noreferrer\">https://doi.org/10.1212/wnl.0000000000005819</a></p>\n", "score": 0 } ]

[ "migraine" ]

[ { "answer_id": 27550, "body": "<p>Toxicity of gadolinium-based contrast agents can generally be classified as acute (short term) and chronic (longer term) and include<a href=\"https://pubmed.ncbi.nlm.nih.gov/30204075/\" rel=\"nofollow noreferrer\">¹</a>:</p>\n<ul>\n<li>Acute allergic-like reactions</li>\n<li>Acute physiologic reaction</li>\n<li>Chronic kidney injury (called nephrogenic systemic fibrosis)</li>\n</ul>\n<p>Additionally, there is evidence that a small amount of contrast agent is retained in various tissues of the body (including the brain), for years<a href=\"https://pubmed.ncbi.nlm.nih.gov/30204075/\" rel=\"nofollow noreferrer\">¹</a>, or potentially for life. The health effects of this gadolinium remain unknown.</p>\n<p>Chronic kidney injury after gadolinium administration is overwhelmingly seen among individuals with pre-existing kidney disease<a href=\"https://pubmed.ncbi.nlm.nih.gov/30204075/\" rel=\"nofollow noreferrer\">¹</a>.</p>\n<p>There is some experimental evidence in animal models and retrospective review of patient data that suggests adequate intravenous hydration may decrease the risk of kidney injury<a href=\"https://pubmed.ncbi.nlm.nih.gov/33450989/\" rel=\"nofollow noreferrer\">²</a>.</p>\n<p>However, for individuals without kidney disease, I can find no evidence that hydration, either IV or oral, would have any clear effect on any adverse effects of gadolinium.</p>\n", "score": 3 } ]

[ "mri" ]

[ { "answer_id": 27585, "body": "<p>It doesn't mean anything without more information from the data source. An event marker is just that...it marks events. Those events could be triggered by another device (like with a TTL pulse), could be marked manually by an operator, triggered by the patient, anything.</p>\n", "score": 2 } ]

[ "sleep" ]

[ { "answer_id": 27592, "body": "<p>The New York Times (<a href=\"https://www.nytimes.com/live/2021/07/06/world/covid-19-vaccine-coronavirus-updates\" rel=\"nofollow noreferrer\">https://www.nytimes.com/live/2021/07/06/world/covid-19-vaccine-coronavirus-updates</a>) presents several studies indicating good 2-dose protection against symptomatic infection: Britain and Canada reporting 87-88%, and Scotland reporting 79%.</p>\n<p>A recent report from Israel claims only 64% protection, but that report is heavily marred by lack of transparency: According to Forbes (<a href=\"https://www.forbes.com/sites/roberthart/2021/07/06/pfizer-shot-much-less-effective-against-delta-israel-study-shows---heres-what-you-need-to-know-about-variants-and-vaccines/\" rel=\"nofollow noreferrer\">https://www.forbes.com/sites/roberthart/2021/07/06/pfizer-shot-much-less-effective-against-delta-israel-study-shows---heres-what-you-need-to-know-about-variants-and-vaccines/</a>), &quot;Israel’s health ministry has not revealed the data or the methodology it used to obtain its results.&quot;</p>\n<p>Therefore, the most logical conclusion at this time is that full mRNA vaccination continues to provide superior protection, probably in the 80%-90% range. The 64% number should be rejected as a dubious outlier until more transparency is provided.</p>\n<p><strong>Updating answer with new data recently in</strong> - an article presenting data from the New England Journal of Medicine. The numbers are 88% protection from 2-dose Pfizer vs. Delta (consistent with the above consensus), 67% protection from 2-dose AstraZeneca vs. Delta.</p>\n<p>Source (<a href=\"https://www.reuters.com/business/healthcare-pharmaceuticals/two-doses-pfizer-astrazeneca-shots-effective-against-delta-variant-study-finds-2021-07-21/\" rel=\"nofollow noreferrer\">https://www.reuters.com/business/healthcare-pharmaceuticals/two-doses-pfizer-astrazeneca-shots-effective-against-delta-variant-study-finds-2021-07-21/</a>):</p>\n<blockquote>\n<p>The study, published in the New England Journal of Medicine, confirms\nheadline findings given by Public Health England in May about the\nefficacy of COVID-19 vaccines made by Pfizer-BioNTech and\nOxford-AstraZeneca (AZN.L), based on real-world data.</p>\n<p>Wednesday's study found that two doses of Pfizer's shot was 88%\neffective at preventing symptomatic disease from the Delta variant,\ncompared to 93.7% against the Alpha variant, broadly the same as\npreviously reported.</p>\n<p>Two shots of AstraZeneca vaccine were 67% effective against the Delta\nvariant, up from 60% originally reported, and 74.5% effective against\nthe Alpha variant, compared to an original estimate of 66%\neffectiveness.</p>\n</blockquote>\n", "score": 1 } ]

[ "covid-19", "vaccine" ]

[ { "answer_id": 27609, "body": "<p>They read very similarly to each other but I am sure they are viewing the cardiac cycle from different points.</p>\n<p>2 is to explain atrium and ventricle are contracting alternatively(they are not in systole at the same time).\n1 is to explain there are three distinct periods in the cardiac cycle: atrial systole, ventricular systole, both diastole.</p>\n", "score": 2 } ]

[ "cardiology", "homework" ]

[ { "answer_id": 27619, "body": "<p>The <a href=\"https://www.cdc.gov/ticks/pdfs/FS_TickBite.pdf\" rel=\"nofollow noreferrer\">CDC says</a>:</p>\n<blockquote>\n<p>Your risk for Lyme disease is very\nlow if a tick has been attached for\nfewer than 36 hours. Check for ticks\ndaily and remove them as soon as\npossible.</p>\n</blockquote>\n<p>You don't have evidence you were bitten by a tick, let alone having had one feed for over 36 hours. Without any known bite from a tick, without any signs or symptoms of a bite without noticing the tick, it does not seem the CDC would recommend you be concerned.</p>\n", "score": 3 } ]

[ "diagnosis", "lyme-disease" ]

[ { "answer_id": 27677, "body": "<p>This is a link to the full-test of the article whose results are presented in the post.</p>\n<p><a href=\"https://www.acpjournals.org/doi/full/10.7326/M21-1577\" rel=\"nofollow noreferrer\">https://www.acpjournals.org/doi/full/10.7326/M21-1577</a></p>\n<p>The study reported used a study design called a “test negative case-control” design. References 15-17 in the published explain the “test negative case-control design and the rationale for its use to evaluate vaccine effectiveness after the introduction into use. Only reference 17 is available full-text online for free.</p>\n<p><a href=\"https://academic.oup.com/aje/article/184/5/345/2389013\" rel=\"nofollow noreferrer\">https://academic.oup.com/aje/article/184/5/345/2389013</a></p>\n<p>As described in the linked article, using this design, among people undergoing testing for the agent that is of interest (in this case, SARS-CoV-2 virus) in a health care setting (in this case, VA facilities):</p>\n<blockquote>\n<p>“those testing positive for …….virus are defined as cases, and those\ntesting negative form the comparison [control] group. Data on\npatients' vaccination histories and confounder profiles are also\ncollected. Vaccine effectiveness is estimated from the odds ratio\ncomparing the odds of testing positive for ……[the agent of interest]\namong vaccinated patients and unvaccinated patients, adjusting for\nconfounders.”</p>\n</blockquote>\n<p>In the study about the effectiveness of the Pfizer and Modern vaccines in preventing infection with the SARS-CoV-2 virus, to control for confounding, cases (test positive for SARS-CoV-2) and controls (test negative for SARS-CoV-2) were matched on potential confounders based on a propensity score.</p>\n<blockquote>\n<p>“For each person who tested positive, we identified a propensity\nscore–matched control participant who tested negative, matched by age,\nsex, race, body mass index, Charlson Comorbidity Index score, and\ngeographic location.”</p>\n</blockquote>\n<p>The actual derivation of the propensity score is not described in the paper.</p>\n<p>After one-to-one matching on the propensity score, the analysis used conditional logistic regression to estimate the odd for being test-positive given being vaccinated and the odds for being test-positive given being non-vaccinated. Conditional logistic regression takes into account the matched nature of the study.</p>\n<p>In the study, vaccine effectiveness was estimated as:</p>\n<blockquote>\n<p>“1 − Odds(T+|Vaccinated) / Odds(T+|Nonvaccinated)”</p>\n</blockquote>\n<p>This equation can also be expressed as:</p>\n<pre><code>1 - OR (odds ratio from a 2 by 2 Table)\n</code></pre>\n<p>In the post, the calculations shown use the difference as a measure of vaccine effectiveness. While the risk difference CAN be used to measure vaccine effectiveness, the risk ratio (or odds ratio) is the most usual measure. See CDC.</p>\n<p><a href=\"https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section6.html\" rel=\"nofollow noreferrer\">https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section6.html</a></p>\n<p>The data shown in the past are from Table 2 of the published paper. The title of Table 2 indicates that the estimate of effectiveness is from a conditional logistic regression analysis. The estimated odds ratios based on a conditional logistic regression will be different from the odds ratio calculated from the “raw” data in Table 2. The conditional odds ratio estimates cannot be determined from the data shown in the Table.</p>\n<p>As a quick check on how the use of a conditional analysis might have affected the estimates shown in the Table, the “raw” data in Table 2 can be used to estimate the odds ratios for being test-positive for SARS-CoV-2 (a case) &gt;=7 days after 2 doses. This was the primary measure of effectiveness specified in the paper.</p>\n<p>For the Moderna vaccine, using the “raw” data in Table 2, for vaccination &gt;= 7 days after 2 doses, the odds ratio for being test positive is:</p>\n<pre><code>(45 x 36,538) / (1688 x 44,560) = 0.022\n</code></pre>\n<p>For the Moderna vaccine, the estimated effectiveness of vaccination &gt;=7 days after 2 doses (compared with being unvaccinated) is:</p>\n<pre><code>1 – OR or 1 – 0.022 = 0.978 \n</code></pre>\n<p>which is 97.8% expressed as a percentage.</p>\n<p>For the Pfizer vaccine, using the “raw” data in Table 2, for vaccination &gt;= 7 days after 2 doses, the odds ratio for being test positive is:</p>\n<pre><code>(121 x 36,538) / (2245 x 44,560) = 0.044\n</code></pre>\n<p>For the Pfizer vaccine, the estimated effectiveness of vaccination &gt;=7 days after 2 doses (compared with being unvaccinated) is:</p>\n<pre><code>1 – OR or 1 – 0.044 = 0.956\n</code></pre>\n<p>which is 95.6% expressed as a percentage.</p>\n", "score": 3 } ]

[ "vaccination", "statistics", "effectiveness" ]

[ { "answer_id": 27675, "body": "<p>A few-year-old review that might be useful is:</p>\n<p>Pardi, N., Hogan, M., Porter, F. et al. mRNA vaccines — a new era in vaccinology. Nat Rev Drug Discov 17, 261–279 (2018). <a href=\"https://doi.org/10.1038/nrd.2017.243\" rel=\"noreferrer\">https://doi.org/10.1038/nrd.2017.243</a></p>\n<p>The tricky part of creating an mRNA vaccine once the &quot;platform&quot; has been developed remains exactly what mRNA sequence do you put into it? Remember, the virus sequence is selected for infection and replication; the sequence for the vaccine should NOT do that, but still should generate an immune response that will stop the actual virus (perhaps antibodies, perhaps cellular, perhaps both). And of course, you don't want something that accidentally causes a bad side effect like a misdirected immune response.</p>\n<p>For Covid, it turns out a key factor in creating successful vaccines has been pre-existing work to modify the spike protein so it holds a certain shape that normally is only transient: see <a href=\"https://cen.acs.org/pharmaceuticals/vaccines/tiny-tweak-behind-COVID-19/98/i38\" rel=\"noreferrer\">https://cen.acs.org/pharmaceuticals/vaccines/tiny-tweak-behind-COVID-19/98/i38</a></p>\n<p>In any case, you've still got to test your candidate to make sure it generates an effective immune response and doesn't have any major side effects.</p>\n", "score": 5 }, { "answer_id": 27674, "body": "<p>From the links you've supplied, none of these other vaccines have gotten further than phase 2 trials yet. Most seem to only have phase 1 trials started or merely planned so far.</p>\n<p>These vaccines are not yet available because they have not completed clinical trials that demonstrate safety and efficacy.</p>\n", "score": 2 } ]

[ "vaccination", "herpes", "herpes-simplex", "vaccine", "mrna" ]

[ { "answer_id": 27673, "body": "<p>This isn't personal medical advice. I would suggest to see a licensed speech therapist to professionally guide your friend. Dyslexia is usually diagnosed by an educational psychologist. An ophthalmologist, audiologist and neurologist should be able to exclude other possible causes that cause dyslexia-like symptoms.</p>\n<p>Generally speaking, as far as I know, style types can improve reading in dyslectic people. Such as changing the font type and size and changing the text and background color. See for example this article from the British Dyslexia Association: <a href=\"https://www.bdadyslexia.org.uk/advice/employers/creating-a-dyslexia-friendly-workplace/dyslexia-friendly-style-guide\" rel=\"nofollow noreferrer\">https://www.bdadyslexia.org.uk/advice/employers/creating-a-dyslexia-friendly-workplace/dyslexia-friendly-style-guide</a>. There are even two fonts specifically developed for people with dyslexia:</p>\n<ul>\n<li><a href=\"https://www.dyslexiefont.com/\" rel=\"nofollow noreferrer\">https://www.dyslexiefont.com/</a></li>\n<li><a href=\"https://opendyslexic.org/\" rel=\"nofollow noreferrer\">https://opendyslexic.org/</a></li>\n</ul>\n<p>These fonts scored quite well according to this article: <a href=\"https://www.dyslexicadvantage.org/the-best-fonts-for-dyslexia/\" rel=\"nofollow noreferrer\">https://www.dyslexicadvantage.org/the-best-fonts-for-dyslexia/</a>. <em>I'm not sure how this &quot;study&quot; was performed.</em></p>\n<p><a href=\"https://i.stack.imgur.com/0mSvc.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/0mSvc.png\" alt=\"graph\" /></a></p>\n<p>Colour Coded Language (CCL) also is a method often used as far as I know for dyslexic children. See for example this article: <a href=\"https://yoohoo.org.uk/blogs/news/how-colour-coded-language-can-support-your-dyslexic-child\" rel=\"nofollow noreferrer\">https://yoohoo.org.uk/blogs/news/how-colour-coded-language-can-support-your-dyslexic-child</a>.</p>\n<p><em>Regarding education I know that in The Netherlands most children that are officially diagnosed with dyslexia get (30 minutes) extra time during all (not just language) exams.</em></p>\n", "score": 1 } ]

[ "dyslexia-dyslexic" ]

[ { "answer_id": 28725, "body": "<p><strong>Q1 - Does artificial dilation assistance during labor pose a risk that natural dilation does not?</strong></p>\n<p>You are not going to be able to insert a catheter into the cervix without risk of harming the baby or mother's cervix. Once labour has started, that risk is higher.</p>\n<p>Your second link which talks about Foley bulb induction (along with induction methods other than balloon dilation) gives you the answer.</p>\n<blockquote>\n<p>The end of your pregnancy can be an uncomfortable time. You may have back pain, trouble walking, or difficulty sleeping. If you’re past your due date, you may welcome an induction. But it’s important to understand the possible risks of labor induction, which include:</p>\n<ul>\n<li>need for a cesarean delivery</li>\n<li>drop in heart rate from labor-inducing medications</li>\n<li>infection</li>\n<li>umbilical cord problems</li>\n<li>bleeding after birth</li>\n<li>uterine rupture</li>\n</ul>\n<p>Given the potential risks, your doctor can choose the safest induction method for your situation.</p>\n</blockquote>\n<p><strong>Q2 - Does labor have some beneficial function other than to dilate the cervix?</strong></p>\n<p>Labour is the whole process of giving birth, not just dilation of the cervix. Plus, you state there are 2 stages when in actual fact, <a href=\"https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/the-stages-of-labour-and-birth/\" rel=\"nofollow noreferrer\">there are 3 stages of labour</a></p>\n<ul>\n<li><p><strong>Stage 1</strong><br>The cervix softens making opening easier and contractions start opening the cervix. Established labour is when your cervix has dilated to about 4cm and regular contractions are opening your cervix.</p>\n</li>\n<li><p><strong>Stage 2</strong><br>Giving birth to the baby - The cervix is at least 10cm dilated (fully dilated).</p>\n</li>\n<li><p><strong>Stage 3</strong><br>&quot;Afterbirth&quot; (Expelling the placenta). After which, the midwife will need to check that the whole placenta is expelled to prevent further problems due to <a href=\"https://medicalsciences.stackexchange.com/q/17620/7951\">post-partum haemorrhage</a>.</p>\n</li>\n</ul>\n", "score": 1 } ]

[ "obstetrics", "childbirth" ]

[ { "answer_id": 28775, "body": "<p><a href=\"https://www.fda.gov/drugs/development-approval-process-drugs\" rel=\"nofollow noreferrer\">https://www.fda.gov/drugs/development-approval-process-drugs</a> provides some general information on how the FDA makes their decisions. <strong>There is no general &quot;efficacy&quot; threshold that must be met</strong> for approval.</p>\n<p>Summarizing the bullets on that site, approval depends on:</p>\n<blockquote>\n<p>Analysis of the target condition and available treatments</p>\n</blockquote>\n<p>If there are already treatments for something, FDA will consider the efficacy of those treatments in approval. If the target condition is something cosmetic, they aren't going to tolerate much as far as side effects; if it's something life-threatening, then serious side effects may be acceptable if it saves lives on net. Vaccines in particular must be very safe for broad approval, because many of the people getting the vaccine don't currently have the illness.</p>\n<blockquote>\n<p>Assessment of benefits and risks from clinical data</p>\n</blockquote>\n<p>Trials give information about both safety and efficacy. Both will be considered along with considering the disease characteristics and available treatments.</p>\n<blockquote>\n<p>Strategies for managing risks</p>\n</blockquote>\n<p>This is pretty much the labeling, and deciding on any restrictions (for example, not giving a novel drug to pregnant women if it wasn't tested in pregnant women; for a hypothetical HIV vaccine perhaps to target vulnerable groups only rather than the general population) to limit possible concerns.</p>\n<p>The FDA will make decisions about vaccine approval based on the seriousness and prevalence of the disease, safety and efficacy of a given candidate vaccine, and presence of other approved competing vaccines.</p>\n", "score": 3 } ]

[ "covid-19", "vaccination", "regulatory-agencies" ]

[ { "answer_id": 28842, "body": "<p><a href=\"https://en.wikipedia.org/wiki/ICD-10\" rel=\"nofollow noreferrer\">ICD-10</a> is the &quot;International Statistical Classification of Diseases and Related Health Problems&quot;; it is <strong>not</strong> limited to mental health and is used for medical records, statistical, and billing purposes across the whole gamut that may cause someone to have an interaction with medical services of some sort.</p>\n<p>The &quot;F##&quot; designations cover &quot;Mental and behavioural disorders&quot; and &quot;G##&quot; cover &quot;Diseases of the nervous system&quot; which can be a bit of a hybrid; the rest are primarily physical.</p>\n", "score": 3 } ]

[ "icd-intrntl-classif-disea" ]

[ { "answer_id": 28867, "body": "<p>The Center's for Disease Control and Prevention provides <a href=\"https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html\" rel=\"nofollow noreferrer\">recommendations</a> for all vaccines appropriate for adults.</p>\n<p><a href=\"https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html#note-hpv\" rel=\"nofollow noreferrer\">For HPV</a>:</p>\n<blockquote>\n<p>Age 15 years <strong>or older</strong> at initial vaccination: 3-dose series at 0, 1–2 months, 6 months (minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 12 weeks / dose 1 to dose 3: 5 months; repeat dose if administered too soon)</p>\n</blockquote>\n<p>In the United States, the Gardasil 9 formulation of HPV vaccine <a href=\"https://www.fda.gov/news-events/press-announcements/fda-approves-expanded-use-gardasil-9-include-individuals-27-through-45-years-old\" rel=\"nofollow noreferrer\">is approved up to age 45</a>. The FDA notes in their press release that the trial data they used to expand the approval to age 45 used the standard 3 dose regimen.</p>\n<p>Note, however, the vaccine is only &quot;recommended&quot; to age 26.</p>\n<blockquote>\n<p>HPV vaccination recommended for all persons through age 26 years</p>\n</blockquote>\n<p>Individuals age 26 to 45 should discuss their individual situation with their healthcare provider to consider if the vaccine is right for them. Some insurance companies may not pay for vaccine doses in this age group because it is not recommended.</p>\n", "score": 1 } ]

[ "vaccination", "virus", "vaccine", "hpv" ]

[ { "answer_id": 28893, "body": "<p>Cocaine is highly addictive and an astonishing waste of money. You also come across as attempting to normalize or explain what is probably already an addiction. I have heard the same lines from dozens of people experimenting with addictive drugs.</p>\n<p>The main danger is cutting agents as these can include glass, crushed caffeine pills, pain-killers, amphetamines etc.</p>\n<blockquote>\n<p>Common cocaine additives include:\nLaundry detergent\nLaxatives\nCaffeine\nBoric acid\nLocal anesthetics like procaine\nCreatine</p>\n</blockquote>\n<p><a href=\"https://americanaddictioncenters.org/cocaine-treatment/cut-with\" rel=\"nofollow noreferrer\">americanaddictioncenters.org/cocaine-treatment/cut-with</a></p>\n<p>You can also experience serious heart failure if you exhaust yourself during the high, this can be in a club, going for a run or during sexual activities.</p>\n<p>Cocaine will definitely cause serious heart problems if you take up the habit frequently and some people die in there 40's because of this.</p>\n<p>Mental health issues I have seen associated with cocaine abuse are by far some of the worst of any drug. You can also expect it to cause brain damage, schizophrenia and paranoia, memory issues, anger management issues, inflated sense of self and ego and you are far more likely to endanger your own life while high.</p>\n<blockquote>\n<p><strong>Short term effects</strong>;\nconfusion,\nparanoia,\nagitation,\npanic,\nanxiety,\nerratic, and\nviolent behavior.</p>\n</blockquote>\n<p><a href=\"https://cocaine.org/effects/effects-of-cocaine-on-your-mental-health/\" rel=\"nofollow noreferrer\">cocain.org/effects</a></p>\n<p>Mixing cocaine with alcohol is 5 times worse for your health at least, according to most experts. Similar to a Marijuana use mixing the buds with tobacco leaf. So all of the above, but around 5 times worse.</p>\n<blockquote>\n<p>Other harmful effects of mixing alcohol and cocaine can include:\nThe risk of cocaine overdose can be increased by mixing it with alcohol.\nStroke.\nIntracranial haemorrhage (bleeding in the brain).\nHeart attack.\nChronic cardiac toxicity.\nCardiac arrhythmia.</p>\n</blockquote>\n<p><a href=\"https://www.alcohol.org/mixing-with/cocaine/\" rel=\"nofollow noreferrer\">alcohol.org/coke</a></p>\n<p>To answer your question, If the product is high quality maybe half a gram a week is reasonably safe if you are not drinking or physically exerting yourself. I would be careful though, it is unlikely but theoretically one line could kill you. It is also worth noting if you are offered a line by a stranger you should refuse it as it could be spiked with a date-rape drug and you could be robbed, raped or murdered. Just don't trust people on this drug.</p>\n<p>Dangerous levels I would say if you ever begin using every day or two nights in a row. And if you ever get the urge to sprinkle it on your cornflakes. Then you have a 'Cocaine problem'</p>\n", "score": 2 }, { "answer_id": 28938, "body": "<p>To add to Chris' answer, if you consider heart attack and sudden cardiac arrest to be negative health effects, then the answer is almost any dose at any frequency.</p>\n<p>Cocaine is a <a href=\"https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.002937\" rel=\"nofollow noreferrer\">powerful vasoconstrictor and also a powerful stimulant that raises your blood pressure and heart rate</a>. So if you happen to have, say, an asymptomatic partial blockage of one of your cardiac arteries and you use cocaine, it's possible the coke will turn that partial blockage into a complete blockage, resulting in a potentially fatal heart attack.</p>\n<p>Even if you avoid such a severe outcome, since it increases the workload on your heart while limiting the heart's blood supply, it can and will exacerbate any existing cardiac conditions.</p>\n<p>Anecdote: I lost a good friend to cocaine at the age of 33. He was an athlete and the picture of health, and yet a heart attack took him in the prime of his life minutes after snorting coke. Autopsy confirmed the cause as described above.</p>\n", "score": 2 } ]

[ "recreational-drugs" ]

[ { "answer_id": 28889, "body": "<p>First, the question is pretty badly framed as there's can't be a &quot;consensus on the rate of breakthrough infections with delta and pfizer vaccine&quot; simply because that absolute risk depends on prevalence in a country/region. Second, as you'll see, it depends on when the vaccine was administered (relative to when the PCR test is made.)</p>\n<p>What the Israel Ministry of health has published in some detail (albeit not [yet] in a scientific journal, as far as I know) is the rate of infection <em>as a function of when the vaccine was administered</em>. And not only have they [self-]published this info, but they acted on it, by initiating a 3rd/booster shots for the elderly, now <a href=\"https://www.timesofisrael.com/israel-offers-covid-booster-shot-to-all-eligible-for-vaccine/\" rel=\"nofollow noreferrer\">extended to everyone</a> over 12 y.o. who had their last dose more than 5 months ago. Here are some slides from the <a href=\"https://www.gov.il/BlobFolder/reports/vaccine-efficacy-safety-follow-up-committee/he/files_publications_corona_two-dose-vaccination-data.pdf\" rel=\"nofollow noreferrer\">July presentation</a>, which basically justified their booster decision.</p>\n<p><a href=\"https://i.stack.imgur.com/FD2YQ.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/FD2YQ.png\" alt=\"enter image description here\" /></a></p>\n<p><a href=\"https://i.stack.imgur.com/pZrpM.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/pZrpM.png\" alt=\"enter image description here\" /></a></p>\n<p><a href=\"https://i.stack.imgur.com/QCaxv.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/QCaxv.png\" alt=\"enter image description here\" /></a></p>\n<p>So basically, it depends when you had your last vaccine dose, but they observed a noticeable decrease in effectiveness for vaccines administered 5+ months before. There's also a <a href=\"https://www.medrxiv.org/content/10.1101/2021.08.03.21261496v1\" rel=\"nofollow noreferrer\">paper preprint</a> in English (which doesn't have all those graphs though) with a similar conclusion:</p>\n<blockquote>\n<p>There was a significantly higher rate of positive results among patients who received their second vaccine dose at least 146 days before the RT-PCR test compared to patients who have received their vaccine less than 146 days before: odds ratio for infection was 3.00 for patients aged over 60 (95% CI 1.86-5.11); 2.29 for patients aged between 40 and 59 (95% CI 1.67-3.17); and 1.74 for patients aged between 18 and 39 (95% CI 1.27-2.37); P&lt;0.001 in each age group.</p>\n</blockquote>\n<p>Now (going back to the slides) the 39% is the overall observed vaccine effectiveness [at preventing infections] in one particular period (approximately a month). It's also substantially lower than e.g. the rate at which hospitalization was prevented in the vaccinated (88%).</p>\n<p><a href=\"https://i.stack.imgur.com/kE6aP.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/kE6aP.png\" alt=\"enter image description here\" /></a></p>\n<p>This &quot;39%&quot; isn't a number of great importance in itself. E.g. as booster shots are being administered now, you can expect it to go up again. (It was <a href=\"https://medicalsciences.stackexchange.com/questions/27584/a-recent-israeli-study-found-the-pfizer-covid-19-vaccine-to-have-only-64-effica\">64% a month</a> before.) The [95%] confidence interval reported for this &quot;39%&quot; figure is pretty wide (9-59%). Also, the 39% hides quite a bit more variation relative to vaccine administration date; see the left-most cluster in the last slide.</p>\n<p><a href=\"https://i.stack.imgur.com/ySs0a.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/ySs0a.png\" alt=\"enter image description here\" /></a></p>\n<p>By month of vaccination, the relative effectiveness was 16% (January-administered vaccine), 44% (Feb), 67% (Mar) and 75% for April and later administrations, relative to infections in the mid-of-June to mid-July one-month observation interval.</p>\n<p>Finally, they've already <a href=\"https://www.reuters.com/world/middle-east/israel-finds-covid-19-vaccine-booster-significantly-lowers-infection-risk-2021-08-22/\" rel=\"nofollow noreferrer\">announced</a> a reversed trend on August 22. The Reuters story says new slides have been uploaded on the ministry's (or rather some vaccine panel's) site, but I've not located them yet... See also <a href=\"https://www.sciencemag.org/news/2021/08/grim-warning-israel-vaccination-blunts-does-not-defeat-delta\" rel=\"nofollow noreferrer\">Science's coverage</a> of the Israeli booster, albeit this comes from a week before.</p>\n<p>I did find the ministry's <a href=\"https://www.gov.il/BlobFolder/reports/vpb-12082021/he/files_publications_corona_vpb-12082021-01.pdf\" rel=\"nofollow noreferrer\">data from Aug 8 (published Aug 11)</a> though. There is a flattening (or reverse) that I'm guessing is more apparent in later data. Not clear (at all) if this is causal with the 3rd/booster dose just from that graph.</p>\n<p><a href=\"https://i.stack.imgur.com/nh8Sa.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/nh8Sa.png\" alt=\"enter image description here\" /></a></p>\n", "score": 2 } ]

[ "covid-19", "vaccination", "immune-system" ]

[ { "answer_id": 28993, "body": "<p>The only risks I've heard about is <a href=\"https://www.europeanurology.com/article/S0302-2838(16)00377-8/fulltext\" rel=\"nofollow noreferrer\">one 20-year longitudinal study on prostate cancer</a> (last update published in 2016.)</p>\n<blockquote>\n<p>Evidence suggests that ejaculation frequency may be inversely related to the risk of prostate cancer (PCa), a disease for which few modifiable risk factors have been identified. [...]</p>\n<p>The study includes 31,925 men who answered questions on ejaculation frequency on a 1992 questionnaire and followed through to 2010. [...] During 480,831 person-years, 3839 men were diagnosed with PCa. Ejaculation frequency at age 40–49 yr was positively associated with age-standardized body mass index, physical activity, divorce, history of sexually transmitted infections, and consumption of total calories and alcohol. Prostate-specific antigen (PSA) test utilization by 2008, number of PSA tests, and frequency of prostate biopsy were similar across frequency categories. In multivariable analyses, the hazard ratio for PCa incidence for ≥21 compared to 4–7 ejaculations per month was 0.81 (95% confidence interval [CI] 0.72–0.92; p &lt; 0.0001 for trend) for frequency at age 20–29 yr and 0.78 (95% CI 0.69–0.89; p &lt; 0.0001 for trend) for frequency at age 40–49 yr. Associations were driven by low-risk disease, were similar when restricted to a PSA-screened cohort, and were unlikely to be explained by competing causes of death.</p>\n</blockquote>\n<p>The association was statistically significant, but a hazard ratio of around 0.8 probably isn't too concerning from a clinical perspective. On the other hand, this was a contrast between groups that had <em>some</em> ejaculation vs those that had frequent ones. It's hard to say how this might translate to those that have none. There were probably not enough real-life cases like that for them to include in that kind of study...</p>\n<p>Aside: I double-checked <a href=\"https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html\" rel=\"nofollow noreferrer\">elsewhere</a> that 1 in 8 men indeed get diagnosed with prostate cancer in their lifetime. (I wasn't aware of that an the incidence in this study seemed pretty high.) Given that, a reduction in risk even by just a factor 0.8 is not insignificant from a public health perspective, but I suspect there isn't a whole lot the average man can do to increase their ejaculation rate by the 3x-5x as in that study... A more recent (2018) <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6497009/\" rel=\"nofollow noreferrer\">review</a> flatly stated that</p>\n<blockquote>\n<p>There is no evidence yet on how to prevent prostate cancer.</p>\n</blockquote>\n<p>It does however have a section on ejaculatory frequency, which is mostly discussing the aforementioned study... which it characterizes as &quot;weak evidence&quot;.</p>\n", "score": 2 } ]

[ "reproduction" ]

[ { "answer_id": 28994, "body": "<p>This isn't an exhaustive list, but a non-sterile puncture is</p>\n<ul>\n<li>a <a href=\"https://www.cdc.gov/tetanus/about/causes-transmission.html\" rel=\"nofollow noreferrer\">risk of tetanus</a> (infection with Clostridium tetani):</li>\n</ul>\n<blockquote>\n<p>The spores can get into the body through broken skin, usually through injuries from contaminated objects. Tetanus bacteria are more likely to infect certain breaks in the skin. These include:</p>\n<p>Wounds contaminated with dirt, poop (feces), or spit (saliva)\nWounds caused by an object puncturing the skin (puncture wounds), like a nail or needle.</p>\n<p>Tetanus bacteria can also infect the body through breaks in the skin caused by [...] Intramuscular injections (shots given in a muscle)</p>\n</blockquote>\n<ul>\n<li>if the needle was actually used on someone else... a substantially wider spectrum of <a href=\"https://www.nhs.uk/common-health-questions/accidents-first-aid-and-treatments/what-should-i-do-if-i-injure-myself-with-a-used-needle/\" rel=\"nofollow noreferrer\">risks exist of various blood-borne illness</a>. Most of those probably aren't much risk via fomites, i.e. merely touching the needle, but hepatitis is not something I'd totally [exclude]as the virus[es] causing these can transmit through other bodily fluids and in some experimental settings can <a href=\"https://pubmed.ncbi.nlm.nih.gov/24273176/\" rel=\"nofollow noreferrer\">persist</a> a surprisingly long time even in dried state.</li>\n</ul>\n", "score": 3 } ]

[ "infection", "blood", "injections" ]

[ { "answer_id": 29030, "body": "<p>I think it's a matter of energy minimization. It simply doesn't make sense for the heart to beat so fast when your body doesn't need the huge amount of oxygen and nutrients the heart cycles through the body with the advanced speed it operates.</p>\n<p>The heart -- a muscle -- may actually suffer damage from sustaining contraction at max speed at all times.</p>\n<p>As research on excessive endurance exercise and its effect on the heart shows,</p>\n<blockquote>\n<p>Heavy and sustained ET [exercise training] generates large quantities of free radicals\nthat likely outstrip the buffering capacity of the system, leaving\nthese individuals susceptible to oxidative stress and transient\ncardiomyocyte dysfunction.</p>\n</blockquote>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538475/\" rel=\"nofollow noreferrer\">Potential Adverse Cardiovascular Effect From Excessive Endurance Exercise</a></p>\n<p>Not to mention, the heart operating at max speed will not pump enough blood to the organs and extremities, actually <em>reducing</em> blood flow to throughout your body as compared to a heart with variable heartrate.</p>\n<p>Supraventricular tachycardia, a heart condition that features episodes of an abnormally fast heart rate, is a short-term example of your 'max heart rate' hypothesis.</p>\n<p>According to NHSinform.scot,</p>\n<blockquote>\n<p>In SVT [Supraventricular tachycardia], the heart muscle is contracting\nso fast that it cannot relax between contractions. This reduces the\namount of blood being pumped around the body, which can make you feel\ndizzy and short of breath.</p>\n</blockquote>\n<p>And sustained tachycardia (&gt;= 30 seconds) is especially dangerous for the human heart.</p>\n<blockquote>\n<p>It [sustained tachycardia] may lead to more serious ventricular arrhythmias, such as\nventricular fibrillation.</p>\n</blockquote>\n<blockquote>\n<p>Ventricular fibrillation involves sudden, rapid, irregular, and\nchaotic heartbeats in the ventricle. These erratic electrical\nimpulses, sometimes triggered by a heart attack, cause your heart’s\nventricles to quiver.</p>\n</blockquote>\n<p><a href=\"https://nhsinform.scot/illnesses-and-conditions/heart-and-blood-vessels/conditions/supraventricular-tachycardia\" rel=\"nofollow noreferrer\">Supraventricular tachycardia\n</a></p>\n<p>[Ventricular Tachycardia][3]</p>\n<p>[3]: <a href=\"https://www.hopkinsmedicine.org/health/conditions-and-diseases/ventricular-tachycardia#:%7E:text=But%20when%20sustained%2C%20ventricular%20tachycardia,threatening%20arrhythmia\" rel=\"nofollow noreferrer\">https://www.hopkinsmedicine.org/health/conditions-and-diseases/ventricular-tachycardia#:~:text=But%20when%20sustained%2C%20ventricular%20tachycardia,threatening%20arrhythmia</a>)</p>\n", "score": 3 } ]

[ "heart-disease" ]

[ { "answer_id": 30604, "body": "<p>The following table taken from <a href=\"https://pubmed.ncbi.nlm.nih.gov/20163944/\" rel=\"nofollow noreferrer\">Continuous versus on-demand pharmacotherapy of allergic rhinitis: evidence and practice</a> by Laekeman et al., lists H1 antihistamines with their respective half-life and duration of action. In this table, you can see the antihistamines are grouped based on their <em>class</em>: Ethanolamines, Alkylamines, Piperazines, Phenothiazines, Phtalazinones, and Piperidines.</p>\n<p><a href=\"https://i.stack.imgur.com/ljxlV.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/ljxlV.png\" alt=\"H1 Antihistamines: class, half-life, duration of action\" /></a></p>\n<p>These classes seem to be independent of the generation of the drugs--Alkylamines and Piperazines have both 1st and 2nd gen antihistamines.</p>\n", "score": 0 } ]

[ "medications", "antihistamines" ]

[ { "answer_id": 29063, "body": "<p><strong>You could address bone metabolism.</strong></p>\n<p>Bone contains osteoclasts and osteoblasts. Osteoclasts break down and resorb bone. Osteoblasts lay down new bone.</p>\n<p>If osteoclasts are inhibited, bone resorbtion is inhibited. This is how bisphosphates and RANK-ligand inhibitors work. Both categories of drug are used to inhibit bone loss due to cancer or to osteoporosis. In theory, these drugs could inhibit bone loss due to osteomyelitis also.</p>\n<p>If osteoblasts are stimulated, they will lay down more new bone. Bone Morphogentic Protein stimulates osteoblasts and has been used clinically to accelerate and augment orthopedic surgeries. In theory, BMP could stimulate osteoblasts associated with infected bone to lay down new bone and counter bone loss.</p>\n", "score": 2 } ]

[ "homework", "infection" ]

[ { "answer_id": 29071, "body": "<p>Lethality of radiation varies with the type of radiation, area of the body exposed, the intensity of exposure to a particular location, and access to medical care</p>\n<p>However, the <a href=\"https://www.nrc.gov/reading-rm/basic-ref/glossary/lethal-dose-ld.html\" rel=\"nofollow noreferrer\">US Nuclear Regulatory Commission</a> provides an estimate of the LD50/30, defined as:</p>\n<blockquote>\n<p>The dose of radiation expected to cause death to 50 percent of an exposed population within 30 days</p>\n</blockquote>\n<p>The LD50/30 is:</p>\n<blockquote>\n<p>Typically... in the range from 400 to 450 rem</p>\n</blockquote>\n<p>For X-rays and gamma rays, rad and rem are approximately equivalent. For other types of radiation, use the following <a href=\"https://news.mit.edu/2011/explained-radioactivity-0328\" rel=\"nofollow noreferrer\">approximations</a>:</p>\n<div class=\"s-table-container\">\n<table class=\"s-table\">\n<thead>\n<tr>\n<th>Type</th>\n<th>Rad</th>\n<th>Rem</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>X-rays</td>\n<td>1</td>\n<td>1</td>\n</tr>\n<tr>\n<td>Gamma rays</td>\n<td>1</td>\n<td>1</td>\n</tr>\n<tr>\n<td>Neutrons</td>\n<td>1</td>\n<td>5-20</td>\n</tr>\n<tr>\n<td>Alpha</td>\n<td>1</td>\n<td>20</td>\n</tr>\n</tbody>\n</table>\n</div>\n<p>In <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5941165/\" rel=\"nofollow noreferrer\">a review of individuals exposed accidentally to ionizing radiation and who received modern medical care</a>, the vast majority of individuals exposed to more than 600 rad expired within 1 year.</p>\n", "score": 3 } ]

[ "radiation" ]

[]

[ "dermatology", "diagnosis", "basal-cell-carcinoma", "biopsy" ]

[ { "answer_id": 29386, "body": "<p>Achondroplasia is caused by very specific genetic changes of the <em>FGFR3</em> gene encoded on chromosome 4.</p>\n<p>According to the <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK1152/\" rel=\"nofollow noreferrer\">GeneReviews on Achondroplasia</a>:</p>\n<blockquote>\n<p>The p.Gly380Arg pathogenic variant resulting in achondroplasia causes constitutive <strong>activation</strong> of FGFR-3</p>\n</blockquote>\n<p>The section on <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK1152/#_achondroplasia_Genetically_Related_Allel_\" rel=\"nofollow noreferrer\">other disorders caused by the same gene</a> lists:</p>\n<blockquote>\n<p>CATSHL syndrome (camptodactyly, tall stature, hearing loss) (OMIM <a href=\"https://omim.org/entry/610474\" rel=\"nofollow noreferrer\">610474</a>), an overgrowth disorder caused by pathogenic <strong>loss-of-function</strong> variants in <em>FGFR3</em></p>\n</blockquote>\n<p>So in fact, there is a disorder which is caused by the same gene, but inactivation rather than activation. However, it is called CATSHL, and is not exactly as you have described. It is inherited in an autosomal dominant pattern.</p>\n", "score": 4 } ]

[ "genetics" ]

[ { "answer_id": 30488, "body": "<p>A basal cell carcinoma (BCC) may have more than 1 subtype: if the biopsy is too small, the histopathologist may miss a subtype.</p>\n<p>From {1}:</p>\n<blockquote>\n<p>More than 26 different subtypes of BCC appear in the literature, but the more common, distinctive, clinicopathologic types include: nodular, micronodular, superficial, morpheaform, infiltrative and fibroepithelial (also known as fibroepithelioma of Pinkus). Combinations of these types can occur as well. The majority of BCCs are amelanotic, but variable amounts of melanin may be present within these tumors.</p>\n</blockquote>\n<p>Missing a BCC subtype might result in deleterious consequences, e.g. one <a href=\"https://medicalsciences.stackexchange.com/a/29275/43\">wouldn't want</a> to treat a BCC with Imiquimod cream thinking that it is just a superficial BCC while it is in fact infiltrative.</p>\n<hr />\n<p>References:</p>\n<ul>\n<li>{1} <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK482439/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/books/NBK482439/</a></li>\n</ul>\n", "score": 1 } ]

[ "dermatology", "biopsy" ]

[ { "answer_id": 29419, "body": "<p><a href=\"https://doi.org/10.53347/rID-22725\" rel=\"nofollow noreferrer\">Radiopeadia</a> helps with locating the nasion.</p>\n<blockquote>\n<p>The nasion (also known as bridge of the nose) is the midline bony depression between the eyes where the frontal and two nasal bones meet, just below the glabella.</p>\n</blockquote>\n<p>They cite Moore &amp; Dalley (1999) for reference.</p>\n<p><a href=\"https://elementsofmorphology.nih.gov/anatomy-nose.shtml\" rel=\"nofollow noreferrer\">The NIH website provides a way</a> to locate the root of the nose and where it is in relation to the nasion. It is the</p>\n<blockquote>\n<p>most depressed, superior part of the nose along the nasal ridge.</p>\n</blockquote>\n<p><a href=\"https://i.stack.imgur.com/48MTv.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/48MTv.jpg\" alt=\"The anatomy of the nose\" /></a>\n^{Image source: <a href=\"https://elementsofmorphology.nih.gov/anatomy-nose.shtml\" rel=\"nofollow noreferrer\">https://elementsofmorphology.nih.gov/anatomy-nose.shtml</a>}</p>\n<h2>References</h2>\n<p>Moore, K. L., &amp; Dalley, A. F. (1999). Clinically oriented anatomy. Lippincott Williams &amp; Wilkins, Philadelphia. <em>PJ Kelly, Editor</em>, 550-575. ISBN: 1451119453</p>\n", "score": 2 } ]

[ "terminology", "anatomy", "face" ]

[ { "answer_id": 29451, "body": "<p>Generally in leukemia patients there are long term complications related to the treatments given including the usually curative treatment called &quot;Allogenic hematopoietic stem cell transplantation&quot;.\nThe treatment involves taking sane stem cells from a donor and transplant them in the patient after depleting his bone morrow by total body radiation or chemotherapy (radiation/chemotherapy before transplantation is called pre transplantation preparation).</p>\n<p>After the cells are transplanted they start to recognize the cancerous cells that are still present as foreign cells and starts attacking them which protects the body from these cell. The problem is that these cells also recognize the normal cells of different organs of the patient as foreign cells and start attacking them leading to one of the most common complication of transplantation treatment called Graft versus host disease (GVHD). It is a type of autoimmune disease where different organs in the body are attacked by the new cells formed from the transplanted stem cells, for example metabolic syndrome could be a complication of the transplantation itself through GVHD. (<a href=\"https://www.astctjournal.org/article/S1083-8791(16)30079-9/fulltext\" rel=\"nofollow noreferrer\">https://www.astctjournal.org/article/S1083-8791(16)30079-9/fulltext</a>)</p>\n<p>Here is a link that explains GVHD without complicated medical terms:\n<a href=\"https://my.clevelandclinic.org/health/diseases/10255-graft-vs-host-disease-an-overview-in-bone-marrow-transplant\" rel=\"nofollow noreferrer\">https://my.clevelandclinic.org/health/diseases/10255-graft-vs-host-disease-an-overview-in-bone-marrow-transplant</a></p>\n<p>The preparation process for transplantation in many cases involves total body radiation which could lead to abnormalities in endocrine system due to the effect of radiation on glandular cells. (<a href=\"https://www.karger.com/article/fulltext/495698\" rel=\"nofollow noreferrer\">https://www.karger.com/article/fulltext/495698</a>).\nThese alterations could manifest as sicca syndrome (lacrimal and salivary glands cannot secrete), diabetes (beta cells are harmed in pancreas) and so on.</p>\n", "score": 1 } ]

[ "autoimmune-disease" ]

[ { "answer_id": 29458, "body": "<p>Non-surgical, non-medical treatments are typically referred to as involving &quot;lifestyle&quot;; lifestyle intervention, lifestyle modification, lifestyle treatment, lifestyle change, etc. &quot;Lifestyle factors&quot; or just simply &quot;lifestyle&quot; is also used to mean behavioral factors that influence health (diet, exercise, smoking/drinking, etc).</p>\n<p><a href=\"https://scholar.google.com/scholar?hl=en&amp;as_sdt=0%2C50&amp;q=%22lifestyle+modification%22&amp;btnG=\" rel=\"nofollow noreferrer\">https://scholar.google.com/scholar?hl=en&amp;as_sdt=0%2C50&amp;q=%22lifestyle+modification%22&amp;btnG=</a>\n<a href=\"https://scholar.google.com/scholar?hl=en&amp;as_sdt=0%2C50&amp;q=%22lifestyle+intervention%22&amp;btnG=\" rel=\"nofollow noreferrer\">https://scholar.google.com/scholar?hl=en&amp;as_sdt=0%2C50&amp;q=%22lifestyle+intervention%22&amp;btnG=</a>\n<a href=\"https://scholar.google.com/scholar?hl=en&amp;as_sdt=0%2C50&amp;q=%22lifestyle+change%22&amp;btnG=\" rel=\"nofollow noreferrer\">https://scholar.google.com/scholar?hl=en&amp;as_sdt=0%2C50&amp;q=%22lifestyle+change%22&amp;btnG=</a>\n<a href=\"https://scholar.google.com/scholar?hl=en&amp;as_sdt=0%2C50&amp;q=%22lifestyle+treatment%22&amp;btnG=\" rel=\"nofollow noreferrer\">https://scholar.google.com/scholar?hl=en&amp;as_sdt=0%2C50&amp;q=%22lifestyle+treatment%22&amp;btnG=</a></p>\n<p>You may find other terms used, too, like &quot;behavior&quot;; like with most things in language, there's more than one way to say something.</p>\n", "score": 3 } ]

[ "terminology" ]

[ { "answer_id": 30506, "body": "<p>I don't know much about this drug (seems like it isn't marketed in the US where I am), but it appears to be an &quot;<a href=\"https://en.wikipedia.org/wiki/Cinnarizine\" rel=\"noreferrer\">antihistamine and calcium channel blocker</a>&quot;.</p>\n<p><a href=\"https://en.wikipedia.org/wiki/Histamine\" rel=\"noreferrer\">Histamine</a> is involved in the sleep-wake cycle and acts as a neurotransmitter in addition to its role in the immune system (where it's probably best associated with a role in allergic responses).</p>\n<p>It's common for <a href=\"https://en.wikipedia.org/wiki/Histamine_H1_receptor\" rel=\"noreferrer\">H1 receptor</a> antagonists to have drowsiness as a side effect; newer antihistamines used to treat allergies avoid this by poorly crossing the blood-brain barrier. Older antihistamines like <a href=\"https://en.wikipedia.org/wiki/Diphenhydramine\" rel=\"noreferrer\">diphenhydramine</a> are sometimes used specifically as sleep aids.</p>\n<p>Since the intended targets of this drug are in the CNS, it's not surprising that it readily crosses the blood-brain barrier so it should be expected to cause drowsiness like all other H1 antagonists that cross the blood-brain barrier. I doubt there is any investigation into the drowsiness mechanism by this drug specifically rather than other antihistamines more generally, since sedating effects of H1 receptor antagonists are quite familiar.</p>\n", "score": 5 } ]

[ "drowsy" ]

[ { "answer_id": 30508, "body": "<p>You would probably need to do a trial where you directly compare AI diagnosis to professional diagnosis in a real-world setting.</p>\n<p>To be convincing, you'd need to consider that diagnosis in the clinic is not a simple consideration of information present at one time, but is an iterative process that often involves cycles of different tests in different conditions, attempts at treatment for simple causes, and may involve consultation with multiple professionals with different expertise.</p>\n<p>You'd need to consider that &quot;accuracy&quot; can be a useless and misleading statistic. For example, you can achieve 99.999% accuracy if you simply never diagnose a rare condition that occurs in &lt;1/100000 cases. This is neither impressive nor meaningful. There is highly variable risk in different types of misdiagnosis - in some cases, a (false-positive) misdiagnosis can be costly in the area of additional testing and treatment, yet those costs are reasonable in the face of the alternative of not making that diagnosis when it is true (false-negative). So, your machine (and your trial) needs to consider the weighted risk of some diagnoses over others.</p>\n<p>You also will suffer from lack of a &quot;gold standard&quot; for many diagnoses. If there was a better method for diagnosing, it would be used in the clinic, so you may not be able to consider your estimated ground truth as an actual ground truth without making your study artificial and not particularly generalizable.</p>\n<p>This may sound daunting. It is. You're describing an entire field of research:</p>\n<p><a href=\"https://scholar.google.com/scholar?hl=en&amp;as_sdt=0%2C50&amp;q=AI+diagnosis&amp;btnG=\" rel=\"nofollow noreferrer\">https://scholar.google.com/scholar?hl=en&amp;as_sdt=0%2C50&amp;q=AI+diagnosis&amp;btnG=</a></p>\n<p>There is never a simple answer in research, all the simple answers and low-hanging fruit have been found very long ago. What remains are hard questions, difficult study designs, costly experiments. People spend their entire careers on these sorts of things without making substantial progress.</p>\n", "score": 3 } ]

[ "diagnosis" ]

[ { "answer_id": 30510, "body": "<p>No, and we can state this authoritatively, because to become infectious, the person has be able to put out virus, which means at least a single replicative cycle of the virus before any would be emitted.</p>\n<p>For SARS-CoV-2, the generation time is somewhere around 10 hours in cell culture, it would probably take longer in an infection <em>in-vivo</em>. There's a handy info-graphic <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7224694/\" rel=\"nofollow noreferrer\">here</a>¹, with information about the virus and many aspects of infection.</p>\n<p>The bit you are looking for is the <em>Replication Timescales</em> section. The <a href=\"https://medical-dictionary.thefreedictionary.com/eclipse+period\" rel=\"nofollow noreferrer\">eclipse period</a> part is the generation time, and is a measure of the time between entry and production of mature virions.</p>\n<p>So, at a minimum, an infected person could potentially be emitting viruses within half a day, but not immediately.</p>\n<p>For interpretation of those numbers, as @bryankrause says, you can't simply arithmetically work with them. A symptom onset of 2 days means that they simply show symptoms early, but it still doesn't affect the replication kinetics of the virus.</p>\n<p>¹ Bar-On <em>et al</em>., eLife. 2020; 9: e57309.</p>\n", "score": 4 } ]

[ "covid-19", "disease-transmission" ]

[ { "answer_id": 30561, "body": "<p>When you look up &quot;plane of cleavage definition&quot; online, you most often get the definition within Crystallography, <a href=\"https://encyclopedia2.thefreedictionary.com/cleavage+plane\" rel=\"nofollow noreferrer\">such as</a>.</p>\n<blockquote>\n<p>Plane along which a crystalline substance may be split</p>\n</blockquote>\n<p>Applying this to surgical procedures, you will be talking about places where splitting can occur, vertically or horizontally.</p>\n", "score": 3 } ]

[ "implant", "scalp" ]

[ { "answer_id": 30598, "body": "<p>Yes, Creutzfeldt–Jakob disease is an example.</p>\n<p>In Creutzfeldt–Jakob, a spontaneous misfolding of a protein in the brain gives rise to a prion. A prion is a misfolded protein that is able to 'transmit' its pathological shape onto the normal variant of the same protein. The disease progresses as more and more proteins become misfolded. This is known as <em><strong>sporadic</strong></em> Creutzfeldt–Jakob disease [1].</p>\n<p>When a healthy person comes in contact with the tissue containing the prions, they can get Creutzfeldt–Jakob disease too. (For example, a pathologist performing an autopsy.) This is known as <em><strong>acquired</strong></em> Creutzfeldt–Jakob disease [2].</p>\n<hr />\n<p>[1] Kumar, V., Abbas, A. K., Aster, J. C., &amp; Robbins, S. L. (2013). Robbins Basic Pathology (9th ed.). (pp. 831-832). Elsevier Gezondheidszorg.<br />\n[2] &quot;Creutzfeldt-Jakob Disease Fact Sheet&quot;, NINDS, Publication date May 2018. - NIH Publication No. 18-NS-2760. <a href=\"https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Creutzfeldt-Jakob-Disease-Fact-Sheet\" rel=\"nofollow noreferrer\">https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Creutzfeldt-Jakob-Disease-Fact-Sheet</a></p>\n", "score": 1 } ]

[ "disease-transmission", "pathophysiology" ]

[ { "answer_id": 30712, "body": "<p>Smokers have generally more <a href=\"https://pubmed.ncbi.nlm.nih.gov/32269089/\" rel=\"nofollow noreferrer\">ACE-2 enzymes in their lungs</a>, which is the primary receptor for SARS-CoV-2. Some hypothesize that this means that having more ACE-2 receptors automatically means there is more risk of severe COVID infection, but the mechanism seems not so clear-cut (like nothing in the biochemical pandemonium we call 'human body').</p>\n<p>Contrary to the above, it is hypothesized that the free-floating ACE-2 enzymes <a href=\"https://pubmed.ncbi.nlm.nih.gov/32522666/\" rel=\"nofollow noreferrer\">on lung macrophages</a> may bind more virus particles, leading to <em>less</em> lung infection, and better response to infection (i.e. less risk of cytokine storm among smokers), further complicated since ACE-2 also stimulates <a href=\"https://en.wikipedia.org/wiki/Angiotensin_(1-7)\" rel=\"nofollow noreferrer\">angiotensin 1–7</a>, dilating blood vessels.</p>\n<p>Still there is some evidence that ACE-inhibitors <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265882/\" rel=\"nofollow noreferrer\">may be therapeutic against COVID</a>\nand <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394697/\" rel=\"nofollow noreferrer\">reduces pneumonia in general</a>.</p>\n<p>This seems to explain the much-publicized <a href=\"https://www.qeios.com/read/FXGQSB.2\" rel=\"nofollow noreferrer\">French paper</a> hypothesizing that smoking protects against COVID (through nictotine leading to more ACE expression), and conversely others <a href=\"https://pubmed.ncbi.nlm.nih.gov/32341101/\" rel=\"nofollow noreferrer\">hypothesizing that smoking increases severe COVID risk</a> through the same mechanism!</p>\n<p>I personally feel that if there is a correlation for smokers getting less severe COVID infection, that this could be explained because smokers tend to get more fresh air, and that a proper ceteris paribus will make smokers more likely to contract severe disease because of poorer general health. The nicotine/ACE story is interesting, and would like to see a more targeted experiment with nicotine injections, patches or chewing gum. Again, it <a href=\"https://clinicaltrials.gov/ct2/show/NCT04598594\" rel=\"nofollow noreferrer\"><em>could</em> help</a>, or it could harm, the evidence is generally weak.</p>\n<p>It is sometimes reported that there are less smokers admitted to the ICU than would be expected, but there may be confounding factors, and the statistics may not be trustworthy. At least, I don't have robust numbers readily available. (Sorry!)</p>\n", "score": 2 } ]

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

[ { "answer_id": 30762, "body": "<p>The old saying correlation does not equal causation applies here. In this case the correlation assumed by the question is that masks cause more transmission i.e. Mask mandate -&gt; transmission + infection.</p>\n<p>However, there is another correlation that could be the opposite of the assumed, with the causal relationship being that with increased transmission (and subsequent infections) you get a mask mandate to try to limit spread. For this relationship: transmission + infection -&gt; mask mandate. This equation and the one in the first paragraph are not the same!</p>\n<p>If you look closely at the graphs, if it were masks causing the transmission, you would expect the increases to happen after masks mandates were put in place, and for the transmission to continue and increase throughout the period during which mask mandates were in place. You would not expect to see the same rate of infection before the masks were used - note the two other times when mask mandates introduced on April 10 and July 17, you can see an obvious increase in cases before each mask mandate was introduced. Also note the shape of the curve in the period between May 8 and June 15 where the number of cases increases for a while, then reduces until mask mandates were removed on June 15. In addition, after the return of mask mandates on July 17, the curve slope doesn't change after the mask mandate was put in place, instead the rate of infection is more or less constant between early July and early August. Lastly on this point, if masks did increase the spread, you would expect in each case, after the mandate was introduced, that the curve would have a slope something like the one on the extreme right of the graph. This is patently not so, so it can't be the masks causing it.</p>\n<p>What is shown in December 2021 and Jan 2022 is the effect of the highly transmissible Omicron variant. This has a <a href=\"https://en.wikipedia.org/wiki/Basic_reproduction_number\" rel=\"nofollow noreferrer\">reproduction number</a> (R₀) of about <a href=\"https://www.nature.com/articles/s41586-022-04462-1\" rel=\"nofollow noreferrer\">3-times that of the Delta variant</a>¹. Delta has a <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8687713/\" rel=\"nofollow noreferrer\">R₀ of about 5 (range 3.2-8.0 in the literature</a>)², compared to the original SARS-CoV-2, which had an R₀ of about 3. This means that if you had Delta you would, on average, infect about 5 other people. With Omicron, you could be infecting up to 15 people. Masks alone don't work in this case, you also need people to comply with all the other public health measures that are available, such as hand washing, physical distancing, limiting time in close proximity, &quot;isolation bubbles&quot; etc., to be able to limit spread.</p>\n<p>Masks have been <a href=\"https://doi.org/10.1073/pnas.2014564118\" rel=\"nofollow noreferrer\">proven to limit spread of SARS-CoV-2</a>³, and mask mandates result in greater levels of mask wearing than you <a href=\"https://doi.org/10.1371/journal.pone.0253510\" rel=\"nofollow noreferrer\">might get otherwise</a>^4,5. Thus, the conclusion that mask mandates might be introduced when there is increased spread of SARS-CoV-2 is a logical one to make, and the opposite causal relationship is highly unlikely.</p>\n<p><b>Note:</b> The references provided are not the only ones around, there are tons of others showing the same things. I only took the first ones that popped up in my quick searches. The only ones that weren't first links coming up were for the R₀ values (refs 1, 2).</p>\n<p>1: Suzuki, R., Yamasoba, D., Kimura, I. et al. Attenuated fusogenicity and pathogenicity of SARS-CoV-2 Omicron variant. Nature (2022). <a href=\"https://doi.org/10.1038/s41586-022-04462-1\" rel=\"nofollow noreferrer\">https://doi.org/10.1038/s41586-022-04462-1</a></p>\n<p>2: Khan NA, Al-Thani H, El-Menyar A. The emergence of new SARS-CoV-2 variant (Omicron) and increasing calls for COVID-19 vaccine boosters-The debate continues. Travel Med Infect Dis. 2022;45:102246. doi:10.1016/j.tmaid.2021.102246</p>\n<p>3: Jeremy Howard, Austin Huang, Zhiyuan Li, Zeynep Tufekci, Vladimir Zdimal, Helene-Mari van der Westhuizen, Arne von Delft, Amy Price, Lex Fridman, Lei-Han Tang, Viola Tang, Gregory L. Watson, Christina E. Bax, Reshama Shaikh, Frederik Questier, Danny Hernandez, Larry F. Chu, Christina M. Ramirez, Anne W. Rimoin. An evidence review of face masks against COVID-19. Proceedings of the National Academy of Sciences Jan 2021, 118 (4) e2014564118 <a href=\"https://doi.org/10.1073/pnas.2014564118\" rel=\"nofollow noreferrer\">https://doi.org/10.1073/pnas.2014564118</a></p>\n<p>4: Scott et al., The introduction of a mandatory mask policy was associated with significantly reduced COVID-19 cases in a major metropolitan city. PLOSone July 21 2021. <a href=\"https://doi.org/10.1371/journal.pone.0253510\" rel=\"nofollow noreferrer\">https://doi.org/10.1371/journal.pone.0253510</a></p>\n<p>5: Wadud Z, Rahman SM, Enam A. Face mask mandates and risk compensation: an analysis of mobility data during the COVID-19 pandemic in BangladeshBMJ Global Health 2022;7:e006803. <a href=\"https://doi.org/10.1136/bmjgh-2021-006803\" rel=\"nofollow noreferrer\">https://doi.org/10.1136/bmjgh-2021-006803</a></p>\n", "score": 4 } ]

[ "covid-19", "statistics", "correlation" ]

[ { "answer_id": 30794, "body": "<p>Measuring esophageal manometry is a procedure measuring the strength (therefore motility and function) of the muscles relating to your swallow ability (in the esophagus). A flexible catheter is placed into your nose, which travels to your esophagus and then your stomach. You then swallow multiple times, and the data is recorded. It takes about 45 minutes to complete.</p>\n<p>Esophageal pH impedance is a test for how much acid moves up from your stomach into your esophagus. The other end is then connected to a small device you wear for about 24 hours. This is so we can gain a good understanding of A) if acid ever comes up from the stomach into the esophagus, especially during certain normal activities.</p>\n<p>Stomach acid should never really be 'refluxing' or moving 'up' into the esophagus, because this can injure the cells within the esophagus, especially this area called the 'z-line.'</p>\n", "score": 1 } ]

[ "gastroenterology", "test", "esophagus" ]

[ { "answer_id": 30873, "body": "<p>Basically, yes, it definitely means it's a single point of injury. But if the report didn't specify any modifiers like &quot;focal&quot; or &quot;diffuse&quot; I wouldn't assume it says anything about length of the tear at all. I think it's only safe to say that using the word &quot;focal&quot; means it's a single, localized area. If it were more extensive, the report would have said &quot;diffuse&quot; or similar language.</p>\n<p>According to <a href=\"https://www.mypathologyreport.ca/focal/\" rel=\"nofollow noreferrer\">this site</a>, which I believe to be credible and reliable, pathologists use the word &quot;focal&quot; like this:</p>\n<blockquote>\n<p><strong>What does focal mean?</strong></p>\n<p>Focal is a word pathologists use to describe something seen in only a\nsmall part of the tissue sample examined. Focal changes can be seen\nwhen the tissue is examined by eye (this is called the gross\nexamination) or under the microscope.</p>\n<p>The opposite of focal is diffuse. Pathologists use the word diffuse to\ndescribe something seen throughout the tissue sample examined. Like\nfocal, diffuse changes can be seen when the tissue is examined by eye\nor under the microscope.</p>\n</blockquote>\n", "score": 1 } ]

[ "terminology", "mri", "orthopedics", "ligament" ]

[ { "answer_id": 30956, "body": "<p>Yes. Foreign bodies are a rare cause of appendicitis. Sama and colleagues <a href=\"https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-016-0922-7\" rel=\"nofollow noreferrer\">report</a> a case (2016. PMCID <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4881009/\" rel=\"nofollow noreferrer\">4881009</a>):</p>\n<blockquote>\n<p>[A] woman presented to our unit with a 1-week history of vague colicky lower abdominal pains occasionally radiating to her right iliac fossa (RIF), which progressively increased in intensity over the last 4 days and localized to her RIF. She also developed nausea and anorexia but reported no episodes of vomiting. She took self-prescribed doses of ibuprofen with no relief, prompting a consult at our health unit. ... An abdominal ultrasound scan was requested which revealed a thickened appendiceal wall and fluid collection around her RIF. ... Her appendix was found to be inflamed and an appendectomy was performed. No intraoperative complication occurred and her abdomen was closed in layers. Due to an unusual feel, we blindly dissected the resected appendix and found an incomplete piece of a rubbery material which was consistent with a condom</p>\n</blockquote>\n", "score": 7 } ]

[ "appendix" ]

[ { "answer_id": 30982, "body": "<p>I agree with Bryan Krause that the terms are used inconsistently in the literature. However, at least to a subset of authors (and to me), the biologic difference is clear.</p>\n<h4>Preprohormones</h4>\n<p>Preprohormones are peptide hormones that have just been translated from their mRNA.</p>\n<p>Rehfeld provides an excellent review of many types of peptide hormones (2004. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/9587068/\" rel=\"nofollow noreferrer\">9587068</a>). However, here is a more accessible figure from Marshall and colleagues (2013. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/23742999/\" rel=\"nofollow noreferrer\">23742999</a>):</p>\n<p><img src=\"https://ars.els-cdn.com/content/image/1-s2.0-S0196978113002003-gr1.jpg\" alt=\"Figure of Gastrin Production\" /></p>\n<p>^{Figure 1 from Marshal et al 2013 available <a href=\"https://doi.org/10.1016/j.peptides.2013.05.009\" rel=\"nofollow noreferrer\">here</a>.}</p>\n<p>As we can see, preprogastrin is converted to progastrin by the activity of a signal peptidase that removes the localization signal.</p>\n<h4>Prohormones</h4>\n<p>Prohormones are peptide hormones that have had their signal peptide removed. They need further modifications to become biologically active.</p>\n<p>Progastrin, like many other peptide hormones need further post-translational modifications including by sulfotransferases. Once these modifications are complete, the prohormones undergo proteolytic cleavage by peptidases to generate biologically active hormones. As a fun aside, there is some evidence that preprogastrin actually has a small amount of biologic activity (Dockray et al 2001. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/11181951/\" rel=\"nofollow noreferrer\">11181951</a>), so this further throws the distinction into disarray.</p>\n<h4>Prehormone</h4>\n<p>In contrast to peptide hormones, small molecule hormones like 25-OH vitamin D, are initially excreted as biologically inactive small molecules that require conversion in peripheral tissues (Vieth 2004. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/15225841/\" rel=\"nofollow noreferrer\">15225841</a>). With titles like <a href=\"https://pubmed.ncbi.nlm.nih.gov/15225841/\" rel=\"nofollow noreferrer\">&quot;Why &quot;Vitamin D&quot; is not a hormone&quot;</a>, you can see this is a touchy subject for some authors.</p>\n<p>The problem that Bryan Krause notes is that many authors seem to use prehormone and prohormone interchangeably for ultimate small molecule hormones.</p>\n", "score": 3 }, { "answer_id": 30981, "body": "<h2>These terms do not appear to be used consistently in the literature</h2>\n<p>In this classification, it seems they are possibly using <a href=\"https://en.wikipedia.org/wiki/Prohormone\" rel=\"nofollow noreferrer\">prohormones</a> specifically to indicate <strong>protein/peptide</strong> precursors to peptide hormones (similar to the term &quot;<a href=\"https://en.wikipedia.org/wiki/Zymogen\" rel=\"nofollow noreferrer\">proenzyme</a>&quot;), and <a href=\"https://en.wikipedia.org/wiki/Prehormone\" rel=\"nofollow noreferrer\">prehormone</a> for non-peptide hormone precursors. In this terminology, prohormones will always be a longer peptide chain than the hormone, and the hormone is formed by proteolysis. In that case, preprohormones are just peptides that are cut to make a prohormone, so they are longer chains than the prohormones.</p>\n<p>It's also possible they are intending to separate based on <em>where the conversion takes place</em>, and a prohormone is modified to the final form in the source tissue, whereas a prehormone is released and then modified in target tissue. An example from an old paper, <a href=\"https://muse.jhu.edu/article/406237/pdf\" rel=\"nofollow noreferrer\">Baird et al 1963</a>:</p>\n<blockquote>\n<p>Emmens [1] has defined a prohormone as a substance which exerts its\nbiological effect by peripheral conversion to a more active compound.</p>\n<p>...</p>\n<p>Prehormones may be defined as substances normally present in the\nbody and usually secreted by endocrine glands, which have little or no biological potency themselves but are converted peripherally to more\nactive compounds</p>\n</blockquote>\n<p>I don't think these delineations are particularly consistent from author to author... <a href=\"https://scholar.google.com/scholar?hl=en&amp;as_sdt=0%2C50&amp;q=prohormone+t4\" rel=\"nofollow noreferrer\">T4 is called a prohormone</a>, too, sometimes, and at least in Google Scholar appears with that word much more often than <a href=\"https://scholar.google.com/scholar?hl=en&amp;as_sdt=0%2C50&amp;q=prehormone+t4&amp;btnG=\" rel=\"nofollow noreferrer\">&quot;prehormone&quot;</a>.</p>\n<p>Some urge that the delineation is on whether the modification occurs locally or elsewhere; for example <a href=\"https://www.sciencedirect.com/science/article/pii/S0960076004000858\" rel=\"nofollow noreferrer\">this paper</a> argues T4 should not be considered a prohormone because a prohormone is something produced and converted to the final hormone form locally, in the same gland, whereas prehormones are modified to their final form in target tissues.</p>\n<p>Yet another case, <a href=\"https://www.sciencedirect.com/science/article/pii/S2405844019363121\" rel=\"nofollow noreferrer\">this paper</a> refers to a peptide hormone where they call the longest chain &quot;prehormone&quot; which is then shortened to a &quot;prohormone&quot; which is finally shortened to the final product.</p>\n<p>For your course, I'd focus on whatever distinction your textbook/instructor wants to make, but for the rest of life (and this is general advice for all terms in biology) I'd advise:</p>\n<ol>\n<li><p>Make sure you know the basis of what you're being taught, not just the term. Most terminology in biology is just <em>labels</em>, you cannot reason backwards from the term to learn about the world, the term is just a shorthand to cluster some concepts together to organize communication and knowledge.</p>\n</li>\n<li><p>Recognize that terminology is not consistent and you always need to clarify what is specifically meant. Authors of papers and textbooks are not necessarily consistent, as they may have different focuses and values. See also <a href=\"https://en.wikipedia.org/wiki/Lumpers_and_splitters\" rel=\"nofollow noreferrer\">https://en.wikipedia.org/wiki/Lumpers_and_splitters</a> for one cause of this, and <a href=\"https://xkcd.com/927/\" rel=\"nofollow noreferrer\">https://xkcd.com/927/</a> for one result when people try to &quot;fix&quot; things to be more standard.</p>\n</li>\n</ol>\n", "score": 2 } ]

[ "endocrinology", "health-education", "physiology" ]

[ { "answer_id": 31013, "body": "<p>Anticholinergic medications are called this way because they <a href=\"https://en.m.wikipedia.org/wiki/Anticholinergic\" rel=\"nofollow noreferrer\">block transmission via the neurotransmitter acetylcholine</a>. To be more precise, there are different types of acetylcholine receptors: <a href=\"https://en.wikipedia.org/wiki/Nicotinic_acetylcholine_receptor\" rel=\"nofollow noreferrer\">nicotinergic</a> and <a href=\"https://en.wikipedia.org/wiki/Muscarinic_acetylcholine_receptor\" rel=\"nofollow noreferrer\">muscarinergic</a> acetylcholine receptors. What we refer to as anticholinergica are usually selective inhibitors of the muscarinergic receptors. By this, they inhibit parasymphatic transmition and this is why they are also called (maybe a better term) <a href=\"https://en.wikipedia.org/wiki/Parasympatholytic\" rel=\"nofollow noreferrer\">parasympatholytics</a>.</p>\n<p>Anti-histaminic drugs however block the various histamine receptors.</p>\n<p>In principle, anticholinergic and antihistaminic drugs are separate agents. The most common anticholinergic drugs are atropine, butylscopalamine and scopolamine.</p>\n<p>Atropine has a (very low) <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3224288/\" rel=\"nofollow noreferrer\">affinity for histamine receptors</a> and could therefore be considered anti-histaminic; but I have not found references whether it actually has an effect on humans in vivo. I could not find anything related to scopolamine and butylscopalamine.</p>\n<p>In clinical practice, anticholinergic drugs are not considered antihistaminic drugs, and vice versa antihistaminic drugs are not considered anticholinergic.</p>\n", "score": 4 } ]

[ "muscle", "itching", "antihistamines" ]

[ { "answer_id": 31045, "body": "<p>The World Health Organization <a href=\"https://www.who.int/health-topics/obesity\" rel=\"nofollow noreferrer\">defines</a> obesity:</p>\n<blockquote>\n<p>Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. A body mass index (BMI) over 25 is considered overweight, and <strong>over 30 is obese</strong>.</p>\n</blockquote>\n<p>The US Centers for Disease Control and Prevention <a href=\"https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html\" rel=\"nofollow noreferrer\">notes</a> that the standard formula for BMI is:</p>\n<blockquote>\n<p>weight (kg) / [height (m)]²</p>\n</blockquote>\n<p>Since BMI is proportional to weight, as weight increases, so too does BMI. Therefore, the side effect of water retention can cause BMI to rise. Should the individual's initial BMI be close enough to 30 kg/m², this increase in mass could cause the individual's BMI to cross in to the obese range.</p>\n<h4>Thus, water retention can cause obesity in the strict sense of the definition.</h4>\n<p>Returning to the WHO's <a href=\"https://www.who.int/health-topics/obesity#tab=tab_2\" rel=\"nofollow noreferrer\">guidance</a>:</p>\n<blockquote>\n<p>Overweight and obesity are major risk factors for a number of chronic diseases, including cardiovascular diseases such as heart disease and stroke, which are the leading causes of death worldwide. Being overweight can also lead to diabetes and its associated conditions, including blindness, limb amputations, and the need for dialysis. ... Carrying excess weight can lead to musculoskeletal disorders including osteoarthritis. Obesity is also associated with some cancers, including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney and colon.</p>\n</blockquote>\n<p>Of course, only a subset of these risks will increase from the additional mass of interstitial fluid.</p>\n", "score": 2 } ]

[ "obesity", "edema" ]

[ { "answer_id": 31065, "body": "<p>Recent guidelines by Schwartz and colleagues (2017 PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/28045591/\" rel=\"nofollow noreferrer\">28045591</a>) note that removal of the earwax should result in resolution of symptoms:</p>\n<blockquote>\n<p>Clinicians should assess patients at the conclusion of in-office treatment of cerumen impaction and document the resolution of impaction. If the impaction is not resolved, the clinician should use additional treatment. <strong>If full or partial symptoms persist despite resolution of impaction, the clinician should evaluate the patient for alternative diagnoses.</strong></p>\n</blockquote>\n<p>In an interesting study by Lewis-Cullinan and Janken (1990 PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/2358577/\" rel=\"nofollow noreferrer\">2358577</a>), the authors assess geriatric patients for earwax buildup that they were unaware of.</p>\n<blockquote>\n<p>On either the second or third day of hospital stay, subjects were given a hearing test using an AudioScope and then their ear canals were examined for impacted cerumen. Ear canal irrigations were performed on those subjects with impacted cerumen. All subjects received a second hearing test. ... A significant interaction (F = 146.83, d.f. = 2/223, P less than 0.0001) between hearing tests and cerumen removal was found indicating that those with no occlusion had no change in hearing whereas both occluded groups increased with the greatest change for the bilateral group.</p>\n</blockquote>\n<p>In other words, patients who had no idea they had hearing loss had their ear wax removed and had resolution by the next day.</p>\n", "score": 3 } ]

[ "ear", "earwax" ]

[ { "answer_id": 31116, "body": "<p><strong>Firstly the causes of liver failure in those taking the drug (<a href=\"https://www.ncbi.nlm.nih.gov/books/NBK548754/\" rel=\"nofollow noreferrer\">1</a>):</strong></p>\n<blockquote>\n<p>The cause of liver injury due to Isoniazid is believed to be\naccumulation of a toxic intermediate of its metabolism. Rates of\ninjury may be somewhat higher in patients with a slow acetylation\nstatus, marked by genotypic variants in N-acetylation, or with\nabnormalities in CYP 2E1, the second major enzymatic pathway of its\nmetabolism. [..] Despite the lack of prominent features of\nhypersensitivity, rapid recurrence of injury can occur with\nrechallenge, suggesting that the injury is immune-mediated, at least\nin part.</p>\n</blockquote>\n<p><strong>- The <a href=\"https://www.sciencedirect.com/topics/medicine-and-dentistry/cyp2e1\" rel=\"nofollow noreferrer\">CYP 2E1</a> referred to is thought to be responsible for clearing the body of drugs and toxins:</strong></p>\n<blockquote>\n<p>Human CYP2E1 catalyses the metabolism of low-molecular-weight\nxenobiotics, including drugs [..], solvents [..] and procarcinogens\n[..].</p>\n</blockquote>\n<p>There are many known versions of this, the prevalence of some is known to vary by race (<a href=\"https://www.sciencedirect.com/topics/medicine-and-dentistry/cyp2e1\" rel=\"nofollow noreferrer\">3</a>):</p>\n<blockquote>\n<p>Both rs3813867:C and rs2031920:T alleles are common in Asian\npopulations but rare in Caucasians and Africans (Zavras et al., 2002).</p>\n</blockquote>\n<p>But no detailed research of the link between specific CYP2E1 variants present and liver toxicity to Isoniazid in African subjects.</p>\n<p><strong>- Genotypic variants in N-acetylation (<a href=\"https://www.researchgate.net/publication/11287717_Differences_in_N-acetylation_genotypes_between_Caucasians_and_Black_South_Africans_Implications_for_cancer_prevention\" rel=\"nofollow noreferrer\">2</a>).</strong></p>\n<p>This refers to a group of alleles that are thought to be involved in the production of enzymes or other substances which render environmental substances (typically plant or bacterial toxins and the like) harmless, and reduce their carcinogenicity. There are in excess of 14 known variants of this, and the number of variants in African-heritage peoples is typically larger than that found in Caucasian subjects. The implication being that the greater diversity in this part of the genome confers a disadvantage in breaking-down Isoniazid, as a narrow set of variants, which are found more frequently in Caucasians is more effective in rendering it non-noxious.</p>\n<ul>\n<li><strong>Conclusion.</strong></li>\n</ul>\n<p>There are indicators that more than one variation in the phenotypes which are more common in Africans may well result in lower tolerance to the toxic effects of this drug or its metabolites, however the research has yet to definitively predict which variants will be at risk especially as it seems to be potentially more than one factor at play including an immune-mediated response.</p>\n<p>(1) <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK548754/\" rel=\"nofollow noreferrer\">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury</a> National Library of Medicine.</p>\n<p>(2) <a href=\"https://www.researchgate.net/publication/11287717_Differences_in_N-acetylation_genotypes_between_Caucasians_and_Black_South_Africans_Implications_for_cancer_prevention\" rel=\"nofollow noreferrer\">Differences in N-acetylation genotypes between Caucasians and BlackSouth Africans: implications for cancer prevention</a> Researchgate.</p>\n", "score": 2 } ]

[ "liver", "tuberculosis", "race" ]

[ { "answer_id": 31239, "body": "<p>There's a lot of overlap between OCD and other anxiety disorders, which are also treated with antidepressants, and possibly depression as well (which itself often overlaps with anxiety). Some papers discussing these relationships and categorization:</p>\n<p><em>Bartz, J. A., &amp; Hollander, E. (2006). Is obsessive–compulsive disorder an anxiety disorder?. Progress in neuro-psychopharmacology and biological psychiatry, 30(3), 338-352.</em></p>\n<p><em>Bienvenu, O. J., Samuels, J. F., Wuyek, L. A., Liang, K. Y., Wang, Y., Grados, M. A., ... &amp; Nestadt, G. (2012). Is obsessive–compulsive disorder an anxiety disorder, and what, if any, are spectrum conditions? A family study perspective. Psychological medicine, 42(1), 1-13.</em></p>\n<p><em>Gentes, E. L., &amp; Ruscio, A. M. (2011). A meta-analysis of the relation of intolerance of uncertainty to symptoms of generalized anxiety disorder, major depressive disorder, and obsessive–compulsive disorder. Clinical psychology review, 31(6), 923-933.</em></p>\n<p><em>Stein, D. J., Fineberg, N. A., Bienvenu, O. J., Denys, D., Lochner, C., Nestadt, G., ... &amp; Phillips, K. A. (2010). Should OCD be classified as an anxiety disorder in DSM‐V?. Depression and anxiety, 27(6), 495-506.</em></p>\n<p>&quot;Antidepressant&quot; is just a category of psychiatric drugs that happen to work for depression; there's nothing about their mechanism that limits them to working only in that category.</p>\n<p>As far as the biological/biochemical point of view... well, that's something that remains not well understood for depression, let alone anxiety disorders or OCD. We know a lot about how antidepressants work on a molecular level; for example, <a href=\"https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor\" rel=\"nofollow noreferrer\">SSRIs</a> are selective serotonin reuptake inhibitors: their molecular function is right in the name, they block serotonin reuptake (and, in particular, they are selective for serotonin reuptake over other monoamines like dopamine). The missing link is <em>why exactly does blocking serotonin reuptake relieve symptoms of depression (or OCD)</em>: we don't really know. There are multiple theories that are all difficult to test because it is not straightforward to interfere with only one mechanistic pathway.</p>\n<p>So, if we don't know what the biological mechanism is, how is it possible to use these drugs? Well, they aren't used because we know exactly how they work, but because studies of actual people with the thing being treated show that they do better with the drug than with a placebo. Some examples of reviews/meta-analyses:</p>\n<p><em>Gorman, J. M., &amp; Kent, J. M. (1999). SSRIs and SNRIs: broad spectrum of efficacy beyond major depression. Journal of Clinical Psychiatry, 60(4), 33-39.</em></p>\n<p><em>Greist, J. H., Jefferson, J. W., Kobak, K. A., Katzelnick, D. J., &amp; Serlin, R. C. (1995). Efficacy and tolerability of serotonin transport inhibitors in obsessive-compulsive disorder. A meta-analysis. Archives of General Psychiatry, 52(1), 53-60.</em></p>\n<p><em>Greist, J. H., &amp; Jefferson, J. W. (1998). Pharmacotherapy for obessive-compulsive disorder. The British Journal of Psychiatry, 173(S35), 64-70.</em></p>\n<p><em>Pizarro, M., Fontenelle, L. F., Paravidino, D. C., Yuecel, M., Miguel, E. C., &amp; de Menezes, G. B. (2014). An updated review of antidepressants with marked serotonergic effects in obsessive–compulsive disorder. Expert opinion on pharmacotherapy, 15(10), 1391-1401.</em></p>\n<p>Brains are complicated, we don't quite know how they work yet, so it's not surprising that it's much easier to measure the psychiatric effects of a drug on patients than to know how exactly it works. Importantly, the reverse is true, too: lots of drugs that have a well-known biological mechanism of action that supports their use as treatments for, say, cancer (especially in animal models), don't actually work when given to people, so they aren't used.</p>\n", "score": 4 } ]

[ "psychiatrist-psychiatry", "biochemistry" ]

[ { "answer_id": 31248, "body": "<p>This site seems to give a reasonable overview:</p>\n<p><a href=\"https://www.ema.europa.eu/en/human-regulatory/overview/public-health-threats/coronavirus-disease-covid-19/covid-19-latest-updates\" rel=\"nofollow noreferrer\">https://www.ema.europa.eu/en/human-regulatory/overview/public-health-threats/coronavirus-disease-covid-19/covid-19-latest-updates</a></p>\n<p>On 10th May the review for Spikevax started. No news for BioNtech.</p>\n", "score": 1 } ]

[ "covid-19", "vaccination", "pediatrics" ]

[ { "answer_id": 31262, "body": "<p>You may find <a href=\"https://www.nlm.nih.gov/healthit/snomedct/index.html\" rel=\"nofollow noreferrer\">SNOMED CT</a> useful. As you can see from this screenshot from the <a href=\"https://www.nlm.nih.gov/research/umls/knowledge_sources/metathesaurus/index.html\" rel=\"nofollow noreferrer\">UMLS Metathesaurus</a>, SNOMED CT contains many allergies organized into a useful <a href=\"https://en.wikipedia.org/wiki/Ontology#Types_of_ontologies\" rel=\"nofollow noreferrer\">ontological hierarchy</a>:</p>\n<p><a href=\"https://i.stack.imgur.com/bmQXQ.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/bmQXQ.png\" alt=\"Image showing the hierarchy of allergy to peanut\" /></a></p>\n<p>Here &quot;allergy to peanut&quot; is an &quot;allergy to pulse vegetable&quot;, which in turn is an &quot;allergy to food&quot;.</p>\n<p>By starting at &quot;allergy to substance&quot; you can get many thousands of allergies.</p>\n<p>Note that you need a <a href=\"https://www.nlm.nih.gov/healthit/snomedct/snomed_licensing.html\" rel=\"nofollow noreferrer\">license to use SNOMED CT</a> and in South Africa, you'll need an <a href=\"https://ihtsdo.freshdesk.com/support/solutions/articles/4000039015-how-do-i-obtain-a-snomed-ct-affiliate-license-\" rel=\"nofollow noreferrer\">affiliate license</a>.</p>\n", "score": 4 } ]

[ "side-effects", "allergy", "allergen" ]

[ { "answer_id": 31339, "body": "<p>Every government is going to have their own regulations for this sort of thing.</p>\n<p>For the US, <a href=\"https://www.ecfr.gov/current/title-21/chapter-I/subchapter-C/part-206\" rel=\"nofollow noreferrer\">the law states</a>:</p>\n<blockquote>\n<p>Unless exempted under § 206.7, no drug product in solid oral dosage form may be introduced or delivered for introduction into interstate commerce unless it is clearly marked or imprinted with a code imprint that, in conjunction with the product's size, shape, and color, permits the unique identification of the drug product and the manufacturer or distributor of the product. Identification of the drug product requires identification of its active ingredients and its dosage strength. Inclusion of a letter or number in the imprint, while not required, is encouraged as a more effective means of identification than a symbol or logo by itself. Homeopathic drug products are required only to bear an imprint that identifies the manufacturer and their homeopathic nature.</p>\n</blockquote>\n<p>In summary, you need to be able to ID a pill based on it's size, shape, color, and label. Anything else may be allowed but is not required.</p>\n<p>I think if you printed a long name there would be serious limits on the possible font size, and this would make the pill difficult to identify. An abbreviation could easily be confused for a different drug; much safer for someone to have a pill that they can't identify and know they can't identify, than to have a pill that they think they've identified correctly but are actually wrong because they misunderstood the abbreviation intended.</p>\n<p>Note also the requirement to identify &quot;manufacturer or distributor of the product&quot; - while you might think it would be more convenient for all manufacturers to have the same appearance for the same drug, that's not necessarily good from a regulatory perspective, where it may be very important that a pill can be identified as coming from a particular source if it is found to be contaminated or otherwise not conforming to specifications.</p>\n", "score": 5 }, { "answer_id": 31365, "body": "<p>A few answers compiled from the comments, which are no own answers yet:</p>\n<p>Links:</p>\n<ul>\n<li><a href=\"https://www.ecfr.gov/current/title-21/chapter-I/subchapter-C/part-206\" rel=\"nofollow noreferrer\">The regulations the require pill imprinting</a></li>\n<li><a href=\"https://www.pharmacytimes.com/view/2006-03-5374\" rel=\"nofollow noreferrer\">The Evolution of Imprint Identification</a></li>\n<li><a href=\"https://www.drugs.com/pill_identification.html\" rel=\"nofollow noreferrer\">Pill Identifier by drugs.com</a></li>\n</ul>\n<p>Ideas:</p>\n<ul>\n<li>Some pills have an imprint that actually makes them identifiable but it is too small for reading without magnification</li>\n<li>Indentions on a pill make it more likely to crumble.</li>\n<li>Some pills have numbers that together with the shape yield good search results, e.g., on Google.</li>\n<li>One usually wouldn't take a lost and found pill anymore.</li>\n<li>There just is not enough place for, e.g., a full name. This would not prevent using a short unique code, though.</li>\n</ul>\n<p>From the comments it also looks a bit like pills in <a href=\"https://upload.wikimedia.org/wikipedia/commons/2/28/Aspirin1.jpg\" rel=\"nofollow noreferrer\">American pill bottles</a> may have more often <em>have</em> an imprint than ones in <a href=\"https://upload.wikimedia.org/wikipedia/commons/9/9c/Lamictal-Tabletten.jpg\" rel=\"nofollow noreferrer\">Blister packages</a> which are more common in Europe which usually contain the name on the foil.</p>\n", "score": 2 } ]

[ "pill", "european-union" ]

[ { "answer_id": 31450, "body": "<p>There is one case where you might be able to differentiate parent and child, taking advantage of the fact that <a href=\"https://en.wikipedia.org/wiki/Human_mitochondrial_genetics\" rel=\"nofollow noreferrer\">mitochondrial DNA is only inherited from the mother</a>.</p>\n<p>If one genome is female and the other male, but the mitochondrial DNA are almost identical, then the male genome is that of the child and the female genome is the parent. If the mitochondrial DNA are different, and you definitely know that the samples are from one parent and one child, then the male genome would be the parent, and the female genome would be the child.</p>\n<p>If both genomes are male, and the mitochondrial DNA are different, you haven't learned anything. If the mitochondrial DNA are the same, you've learned that they can't be parent and child.</p>\n<p>If both genomes are female and the mitochondrial DNA are the same, you haven't learned anything. If they are different, you've again learned that they can't be parent and child.</p>\n<p>Generally though I think you are going to need a trio of samples to be able to distinguish parent from child (two parents and a child or one parent and two siblings).</p>\n", "score": 3 } ]

[ "genetics", "dna" ]

[ { "answer_id": 31456, "body": "<p>My edition of Mims' Medical Microbiology (3rd edition, 2005, p. 213) has this to say about otitis externa (emphasis mine):</p>\n<blockquote>\n<p><em>Causes of otitis externa are</em> Staph. aureus, Candida albicans <em>and Gram-negative opportunists</em>.</p>\n<p>Infections of the outer ear can cause irritation and pain, and must be distinguished from otitis media. In contrast to the middle ear, the external canal has a bacterial flora similar to that of the skin (staphylococci, corynebacteria and, to a lesser extent, propionibacteria), and the pathogens responsible for otitis media are rarely found in otitis externa. The warm moist environment favours <em>Staph. aureus, Candida albicans</em> and Gram-negative opportunists such as <em>Proteus</em> and <em><strong>Pseudomonas aeruginosa</strong></em></p>\n</blockquote>\n<p>Now this is referring to otitis externa - inflammation of the ear canal itself, not the pinna. However, the presence of a pathogen such as <em>P. aeruginosa</em> in the ear canal could result in opportunistic infections of wounds to the pinna. I too would expect Staph infection to be the prime cause of an infection of a wound on the cartilaginous part of the pinna, apart from possibly the tragus or choncha.</p>\n<p>Reference:</p>\n<p>Mims, C; Dockrell, HM; Goring, RV; Roitt, I; Wakelin, D; Zuckerman, M; (2005) Medical Microbiology 3rd Edition. Elsevier Mosby, Edinburgh, UK, ISBN 0323035752</p>\n", "score": 5 } ]

[ "ear", "otolaryngology", "microbiology" ]

[ { "answer_id": 31459, "body": "<p>From <em>Furukawa, C. T., &amp; Lodewick, M. J. (2007). β-adrenergic agonists. In Allergic Diseases (pp. 335-342). Humana Press.</em>:</p>\n<blockquote>\n<p>Epinephrine has both α- and β-adrenergic actions, which make it the drug of choice\nfor the treatment of anaphylaxis. It is effective as an injection, but not orally, because\nepinephrine and other catecholamines are rapidly inactivated by the action of catechol O-methyltransferase (COMT), an enzyme present in the gastrointestinal wall</p>\n</blockquote>\n<p>So, it's not effective to give orally because it breaks down in the GI tract and isn't effectively absorbed. I'd also add that it's not really an anti-allergy medicine but rather for specifically treating <em><a href=\"https://en.wikipedia.org/wiki/Anaphylaxis\" rel=\"nofollow noreferrer\">anaphylaxis</a></em>, and it also is not great for anything besides emergencies because it has a lot of (especially cardiovascular) side effects and has a short half-life.</p>\n", "score": 4 } ]

[ "allergy", "endocrinology" ]

[ { "answer_id": 31460, "body": "<p>That's not how receptors work. Receptors for hormones, neurotransmitters, etc. convey some biochemical signal. The strength of histamine signal is given by the presence of available receptors (i.e., those that aren't blocked) and the concentration of histamine.</p>\n<p>Blocking the receptor or reducing histamine have generally the same effect: less of that biochemical signal. Histamine isn't &quot;metabolized&quot; when it binds a receptor, it just binds for a bit and then floats away (perhaps to bind another receptor somewhere else).</p>\n<p>The <a href=\"https://en.wikipedia.org/wiki/Histamine_H1_receptor\" rel=\"nofollow noreferrer\">H1 histamine receptor</a> specifically is a G-protein coupled receptor with downstream signaling through <a href=\"https://en.wikipedia.org/wiki/Phospholipase_C\" rel=\"nofollow noreferrer\">phospholipase C</a> and <a href=\"https://en.wikipedia.org/wiki/Inositol_trisphosphate\" rel=\"nofollow noreferrer\">IP₃</a>. This can have all sorts of downstream effects in different cell types, including changes in gene expression.</p>\n", "score": 2 } ]

[ "antihistamines" ]

[ { "answer_id": 31514, "body": "<p>Yes, the brain is well-protected from physical hits. The skull and scalp protect the brain from direct blows, and the cerebrospinal fluid (CSF) cushioning system protects it from jarring forces. However, even a hit that doesn't result in a full-blown concussion can cause injury to the brain.</p>\n<p>The severity of a brain injury depends on many factors, including the force or impact of the blow, where on the head it lands, and how fast and hard the head is moving at the time of impact. Brain injuries can range from mild (where symptoms disappear within a few days or weeks) to severe (leading to permanent disability or death).</p>\n<p>Here's a relevant reference for further reading: <a href=\"https://www.bbc.com/future/article/20200702-the-helmets-that-can-keep-your-brain-safe\" rel=\"nofollow noreferrer\">https://www.bbc.com/future/article/20200702-the-helmets-that-can-keep-your-brain-safe</a></p>\n", "score": 2 } ]

[ "brain", "protection" ]

[ { "answer_id": 31518, "body": "<p>In solution, none of these original chemical salts matter because they dissociate entirely. All you have once you add water are ions in solution. Potassium ions in solution are potassium ions in solution, it doesn't matter what they were previously bound with before dissolving.</p>\n<p>Phosphate, however, is itself an <a href=\"https://en.wikipedia.org/wiki/Hypophosphatemia\" rel=\"nofollow noreferrer\">important ion in biology</a>, and when you refer broadly to <a href=\"https://en.wikipedia.org/wiki/Electrolyte#Physiological_importance\" rel=\"nofollow noreferrer\">&quot;electrolytes&quot;</a>, phosphate is included. Presumably that's why these formulations include some phosphate salt. The reasons for using a potassium salt of phosphorus are likely just by convenience and relative concentrations.</p>\n", "score": 3 } ]

[ "exercise", "sports", "hydration", "potassium", "electrolytes" ]

[ { "answer_id": 31576, "body": "<p><strong>TL;DR:</strong> No, decompensated cirrhosis is not a contraindication.</p>\n<p>However, <a href=\"https://www.drugs.com/pro/sovaldi.html#s-34070-3\" rel=\"nofollow noreferrer\">the safety and efficacy of Sovaldi have not been established in patients with decompensated cirrhosis</a>:</p>\n<blockquote>\n<p><strong>Hepatic Impairment</strong></p>\n<p>No dosage adjustment of Sovaldi is required for\npatients with mild, moderate or severe hepatic impairment (Child-Pugh\nClass A, B or C) [see Clinical Pharmacology (12.3)]. <strong>Safety and\nefficacy of Sovaldi have not been established in patients with\ndecompensated cirrhosis.</strong> See peginterferon alfa prescribing\ninformation for contraindication in hepatic decompensation.</p>\n</blockquote>\n<p>(Emphasis mine)</p>\n<p>It appears the concern is that since Sovaldi is primarily metabolized by the liver, decompensated cirrhosis could be dangerous. But that hasn't been established, so it's not being recommended, but it's not contraindicated.</p>\n", "score": 1 } ]

[ "virus", "pathophysiology", "antivirals", "hepatitis" ]

[ { "answer_id": 31589, "body": "<p>Well,</p>\n<blockquote>\n<p>that's because that's where they are the most different</p>\n</blockquote>\n<p>is exactly right. You have two electrode sites, &quot;blue&quot; and &quot;pink&quot;. <a href=\"https://en.wikipedia.org/wiki/Voltage\" rel=\"nofollow noreferrer\">Voltage</a> is an electrical potential <em>difference</em>.</p>\n<p>If you sum up all the charges near &quot;blue&quot; and sum up all the charges near &quot;pink&quot; (where &quot;near&quot; means that closer charges matter more than those further away), in either your upper right or lower left plot, you'll get the same sum at blue and pink, so pink-blue = 0 = voltage.</p>\n<p>If you sum up all the charges near &quot;blue&quot; in the top left plot, you'll get a negative number, if you sum up all the charges near &quot;pink&quot; in the top left plot you'll get a positive number.</p>\n<p>When you &quot;flip&quot; a charge, it's going to affect both blue and pink, but it will affect the one it's closest to more. Therefore, if you were trying to design a scenario with the biggest difference, you'd want all the charges closest to blue to be opposite the charges closest to pink.</p>\n<p>If you're somewhere in between the top two plots, say, take one of the positive charges to the right of the green arrow near pink and make it negative, you'll make both red and pink more negative. If the position of this charge were equally between the two electrodes, it would affect them both equally, and there'd be no difference in voltage. However, everything to the right of the green arrow is closer to pink, so any change there affects pink more than blue. That means that changing one of those positive charges to negative makes the positive pink electrode less positive by a larger amount than it makes the negative blue electrode more negative, so the difference is smaller.</p>\n", "score": 1 } ]

[ "physiology", "electrocardiogram" ]

[ { "answer_id": 31624, "body": "<p>I talked with an author of the paper and the answer is, in principle, yes. Sarcoidosis is on their radar.</p>\n", "score": 1 } ]

[ "immune-system", "cardiology", "scar-tissue-scars", "inflammation" ]

[ { "answer_id": 31650, "body": "<p>Please clarify your question, since paracetamol is not an antibiotic. Are you asking if the patient's symptoms are relieved by paracetamol <em>and</em> antibiotics, or do you mean if patient's symptoms are relived by paracetamol <em>or</em> antibioitcs? Thank you.</p>\n<p>If a patient's symptoms are relieved by paracetamol it does <strong>not always</strong> mean their symptoms are caused by an infection. Paracetamol is an antipyretic and analgesic, it reduces a patient's fever and provides pain relief.\nHowever, not every source of fever and/or pain is caused by an infection. There are many non-infectious sources of fever. Most of them are immune-related diseases e.g. rheumatoid arthritis, lupus. Some are not, e.g. acute pancreatitis, cholecystitis, some neoplasias. But all are inflammatory <em>(usually)</em> .</p>\n<p>As for antibiotics, if a patient's symptoms are relieved by antibiotics it is <strong>highly likely</strong> their symptoms were caused by an infectious disease. It's possible some antibiotics can be used to treat some non-infectious diseases. Personally I have never prescribed nor have I seen any medical professional prescribe antibiotics for this reason. But like many things, there are no absolutes.</p>\n<p>I hope this answers your question, have a good day.</p>\n", "score": 3 } ]

[ "infection", "pain", "antibiotics", "acetaminophen", "pelvis-pelvic-bone" ]

[ { "answer_id": 31705, "body": "<p>It is true that the BMJ did publish <a href=\"https://www.bmj.com/content/375/bmj.n2635\" rel=\"noreferrer\">an article with whistleblower concerns</a> and even published <a href=\"https://www.bmj.com/content/376/bmj.o95\" rel=\"noreferrer\">a response to the LeadStories article</a></p>\n<p>I won't reproduce the article here, but I will provide some relevant quotes:</p>\n<blockquote>\n<p>Beginning on 10 November, The BMJ’s readers began reporting a variety of problems when trying to share its investigation on Facebook. Some reported being unable to share it. Many others reported having their post flagged with a warning about “Missing context . . . Independent fact-checkers say this information could mislead people.” Facebook told posters that people who repeatedly shared “false information” might have their posts moved lower in its news feed. In one private Facebook group, of people who had long term neurological adverse events after vaccination, group administrators received a message from Facebook informing them that a post linking to The BMJ’s investigation was “partly false”</p>\n<p>Readers were directed to a “fact check” performed by Lead Stories,5 one of the 10 companies contracted by Facebook in the US,6 whose tagline is “debunking fake news as it happens.” An analysis last year showed that Lead Stories was responsible for half of all Facebook fact checks...</p>\n<p>...The Lead Stories article, though it failed to identify any errors in The BMJ’s investigation, nevertheless carried the title, “Fact Check: The British Medical Journal Did NOT Reveal Disqualifying and Ignored Reports of Flaws in Pfizer COVID-19 Vaccine Trials.”...</p>\n<p>...Lead Stories did not mention that the investigation was externally peer reviewed, despite this being stated in the article, and had published its article under a URL that contained the phrase “hoax-alert.”...</p>\n<p>...The BMJ based its story on dozens of original documents provided by the experienced clinical trial auditor turned whistleblower Jackson and was confident in the authenticity of her evidence....</p>\n<p>...In a subsequent email, Alan Duke, editor in chief of Lead Stories, told The BMJ that the “Missing Context” label was created by Facebook specifically “to deal with content that could mislead without additional context but which was otherwise true or real.” He added that the article was widely being shared and commented on by antivaccine activists on Facebook. “We agree that sometimes Facebook’s messaging about the fact checking labels can sound overly aggressive and scary. If you have an issue with their messaging you should indeed take it up with them as we are unable to change any of it.”</p>\n</blockquote>\n<p>So, it would seem that the issue was that Facebook flagged links to the article as &quot;potential misinformation&quot; and that this response was biased against articles that criticized Pfizer. From this it would seem that the problem was not so much the BMJ, but rather Facebook's content flagging service... which is in part run by Lead Stories (half of Facebook's fact checking is performed by them).</p>\n<p>Lead Stories has a conflict of interest here - they both audit Facebook's content and publish articles on that content; and it just so happens (totally co-incidentally I am sure. \\s) that one of those articles, on the BMJ and the whistleblowing incident, is perhaps misleading in itself.</p>\n<p>To me it looks like the BMJ did not mislead at all, rather Lead Stories published misleading information regarding the BMJ article(s).</p>\n", "score": 6 } ]

[ "healthcare-data" ]

[ { "answer_id": 31778, "body": "<p>Based on the very specific pair of antibiotics you have asked about, I will assume that your hypothetical senario is regarding <a href=\"https://en.wikipedia.org/wiki/Mycoplasma_genitalium\" rel=\"nofollow noreferrer\"><em>Mycobacterium genitalium</em></a> infection.</p>\n<p>The US Centers for Disease Control and prevention <a href=\"https://www.cdc.gov/std/treatment-guidelines/mycoplasmagenitalium.htm\" rel=\"nofollow noreferrer\">recommends</a> the following as a potential treatment regimen:</p>\n<blockquote>\n<p>Doxycycline 100 mg orally 2 times/day for 7 days followed by moxifloxacin 400 mg orally once daily for 7 days</p>\n</blockquote>\n<p>The CDC goes on to note:</p>\n<blockquote>\n<p>As part of this approach, doxycycline is provided as initial empiric therapy, which reduces the organism load and facilitates organism clearance</p>\n</blockquote>\n<p>A paper by Read and colleagues (2019. PMCID <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6355821/\" rel=\"nofollow noreferrer\">6355821</a>) concurs:</p>\n<blockquote>\n<p>Because several studies have shown that <em>M. genitalium</em> infections with lower loads were more likely to be cured, it may be that doxycycline lowered bacterial load, rendering <em>M. genitalium</em> more susceptible to a subsequent macrolide [11, 13, 20].</p>\n</blockquote>\n<h5>Thus, the two treatments are consecutive because the first (doxycycline) decreases the number of bacteria which can be better handled by the body during the second treatment.</h5>\n<p>I have not been able to find any specific trials of using the two drugs together concurrently, but <a href=\"https://www.drugs.com/interactions-check.php?drug_list=1659-0,940-0\" rel=\"nofollow noreferrer\">online drug interaction checkers</a> do not indicate any conflicts between doxycycline and moxifloxacin.</p>\n", "score": 1 } ]

[ "bacteria", "antibiotics" ]

[ { "answer_id": 31833, "body": "<p>CO2 is a simple asphyxiant, which means it's only toxic when it's displacing oxygen. And since your question proposes that the O2 level is being supplemented, then if the percentage of O2 in the air remains about its normal level of 21% and the other gases are inert, such as CO2, nitrogen, argon, etc, then it will be harmless.</p>\n<p><a href=\"https://www.fsis.usda.gov/sites/default/files/media_file/2020-08/Carbon-Dioxide.pdf\" rel=\"nofollow noreferrer\">https://www.fsis.usda.gov/sites/default/files/media_file/2020-08/Carbon-Dioxide.pdf</a></p>\n<blockquote>\n<p>What are the health effects of carbon dioxide? CO2 is considered to be\nminimally toxic by inhalation. The primary health effects caused by\nCO2 are the result of its behavior as a simple asphyxiant. A simple\nasphyxiant is a gas which reduces or displaces the normal oxygen in\nbreathing air.</p>\n</blockquote>\n", "score": 1 } ]

[ "breathing", "oxygenation", "oxygen", "hypoxia", "carbon-dioxide" ]

[ { "answer_id": 31879, "body": "<p>There hasn't been anything like this published to my knowledge, but this will almost entirely be because this sort of thing doesn't really mean anything unless taken in the context of the socio-economic and medical factors of the country, so generalizations of the sort you are trying to determine are not useful and very hard to make.</p>\n<p>For instance, country A has a great economy, free public healthcare, excellent vaccination rates (against COVID-19) and people generally willing to follow public-health advice/government regulations (this sort of country might be New Zealand, Norway, Taiwan, Japan, Singapore etc.). In this context, dropping masks might be sensible at a 1% infection rate, as most of those infected will mostly be well protected by vaccination (i.e. few get sick, very few die) and the healthcare system can cope with it easily.</p>\n<p>On the other hand, country B might have a low vaccination rate, poor economy, poor healthcare (even if free), high levels of poverty, high population density etc (e.g. almost any &quot;3rd world&quot; countries). In this context, a very very low rate of infection could easily rise into a catastrophic epidemic - as was seen in almost all &quot;first world&quot; countries with good healthcare systems and good socio-economic factors in the early days of the COVID-19 pandemic, despite all the benefits of being rich and well set-up.</p>\n<p>There are, of course, those in the middle - case in point would be the USA. Excellent healthcare, if you can afford it. Good economy, good infrastructure, decent socio-economic factors in most places. However, very mediocre vaccination rates, lots of &quot;anti-government&quot; sentiment and consequently poor compliance with mandates, as well as states effectively running as independent areas in terms of political decision-making. As was seen in 2020 and 2021, this resulted in massive infection rates and huge numbers of deaths in some states, but lower rates in others. How to make a decision on when to drop wearing a mask in this context is almost impossible.</p>\n<p>Personally, I live in one of the more fortunate countries which currently has a relatively high rate of infection (for us at least, it is about 1% I think) and wear a mask in areas where there are high densities of people - supermarket, library, cinema, malls, Dr's surgery, hospital (in healthcare locations everyone is still required to wear masks) etc., but not at work, unless in a meeting with many others from outside my building or when visiting people (unless they request it).</p>\n", "score": 1 } ]

[ "covid-19", "public-health", "who-world-health-org", "pandemic" ]

[ { "answer_id": 31948, "body": "<p><a href=\"https://www.merriam-webster.com/dictionary/clearance\" rel=\"nofollow noreferrer\">Clearance</a> is &quot;an act or process of clearing&quot;.</p>\n<p><a href=\"https://www.merriam-webster.com/dictionary/clear\" rel=\"nofollow noreferrer\">Clear</a> in this context is &quot;CLEAN, PURE&quot; as in &quot;free from blemishes&quot;.</p>\n<p>Clearance of psoriatic plaques would indicate the plaques are going away; &quot;increase the clearance&quot; indicates going away faster (though no statement is made here about appearance of <em>new</em> plaques).</p>\n<p>There are other hints in the paragraph you quote from like:</p>\n<blockquote>\n<p>more effective at <strong>clearing</strong> psoriatic plaques</p>\n</blockquote>\n<blockquote>\n<p>Medicated creams and ointments applied directly to psoriatic plaques can help reduce inflammation, remove built-up scale, reduce skin turnover, and <strong>clear affected skin</strong> of plaques</p>\n</blockquote>\n", "score": 1 } ]

[ "psoriasis" ]

[ { "answer_id": 31967, "body": "<p>What you're describing sounds like the human condition, not &quot;a condition&quot;.</p>\n<p>Eccles and colleagues note (2013. PMID <a href=\"https://pubmed.ncbi.nlm.nih.gov/24060271/\" rel=\"nofollow noreferrer\">24060271</a>):</p>\n<blockquote>\n<p>Ingestion of cold products such as ice-lollies and ice cream is perceived as pleasant because of pleasure associated with satiation of thirst and a refreshing effect. Cold is perceived differently in the skin and oral mucosa, leading to different effects on temperature regulation, and perception of pleasure or dis-pleasure, depending on the body temperature and the temperature of the external environment.</p>\n</blockquote>\n<p>Thus, humans are evolved to enjoy cold beverages because it satisfies thirst. The authors also note the same is true for lower mammals as well. Evolutionary pressures were unable to foresee that we'd suddenly invent refrigeration.</p>\n", "score": 2 } ]

[ "neurology" ]

[ { "answer_id": 31976, "body": "<p>When you don't understand a word the first place to go is a dictionary.</p>\n<p><a href=\"https://www.merriam-webster.com/dictionary/intermittent\" rel=\"nofollow noreferrer\">https://www.merriam-webster.com/dictionary/intermittent</a></p>\n<blockquote>\n<p>: coming and going at intervals : not continuous</p>\n<pre><code>intermittent rain\n</code></pre>\n<p>also : OCCASIONAL</p>\n<pre><code>intermittent trips abroad\n</code></pre>\n</blockquote>\n<p>So intermittent administration means occasional administration, administration that isn't continuous. That could mean administration on some sort of schedule (daily, weekly, etc), or it could mean administration on an irregular basis. What you've quoted doesn't tell us if it's a regular schedule or not.</p>\n", "score": 0 } ]

[ "terminology", "blood-pressure" ]

[ { "answer_id": 32064, "body": "<p>Each gram of ethanol provides\n<a href=\"https://www.health.harvard.edu/blog/should-alcoholic-drinks-come-with-calorie-labels-201505017971#:%7E:text=seven%20calories%20per%20gram\" rel=\"nofollow noreferrer\">7 Calories of energy</a>\n(which isn't surprising given that fermenting 2 grams of sugar produces 1 gram of ethanol).</p>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527027/#:%7E:text=Ethanol%20is%20nonoxidatively%20metabolized%20by,phospholipid%20known%20as%20phosphatidyl%20ethanol.\" rel=\"nofollow noreferrer\">Overview: How Is Alcohol Metabolized by the Body?</a> lists many pathways, but as you say, none of them lead to glucose.</p>\n<p>But there is no need for it to directly produce glucose.</p>\n<p>Consider fructose. When it gets digested, unlike all the other carbohydrates, it is not converted into glucose.\nInstead it is metabolized into a lipid.\nWhen the blood lipid level become higher than a certain concentration, those lipids are converted into fat and stored in the adipose tissue.</p>\n<p>Only if the glucose level in the blood becomes too low will the liver convert the lipids into glucose.<br />\n(Moral: if you just drank a high fructose soft drink and you don't feel hungry before your next meal, that fructose will be adding to your weight, not to your energy.)</p>\n<p>But, glucose isn't the only source of energy for the body's cells.<br />\nThe cited paper mentions glucose only once, and that is in connection with alcoholism:</p>\n<blockquote>\n<p>It is hypothesized that upon chronic alcohol intake the brain starts using acetate rather than glucose as a source of energy.</p>\n</blockquote>\n", "score": 2 } ]

[ "alcohol", "metabolism", "calories", "drug-metabolism", "ethanol" ]

[ { "answer_id": 32088, "body": "<p>One vaccination alone will not protect you for life, but <strong>as for the childhood vaccination programs</strong>:</p>\n<h2>The recommendations depend on your country.</h2>\n<p>In the US, adults need 1 booster shot of the Td vaccine (a type of vaccine which protects preteens, teens, and adults from tetanus and diphtheria) every 10 years as part of their routine vaccine schedule (for more on that, see the <a href=\"https://www.hhs.gov/immunization/diseases/tetanus/index.html\" rel=\"nofollow noreferrer\">Tetanus (Lockjaw)</a> page from the U.S. Department of Health &amp; Human Services). If you get a deep cut or a burn, you may need the booster earlier — especially if the cut or burn is dirty.</p>\n<blockquote>\n<p>If you missed the Tdap booster as a teen, you’ll need to get a Tdap booster instead to make sure you have protection from whooping cough.</p>\n</blockquote>\n<p>If you are in the UK, a total of 5 doses of tetanus vaccine are recommended for life (see the <a href=\"https://www.nhs.uk/conditions/tetanus/\" rel=\"nofollow noreferrer\">NHS Tetanus</a> page for more).</p>\n<blockquote>\n<p>The tetanus vaccine is given as part of the NHS childhood vaccination programme.</p>\n<p>The full course of vaccination includes 5 injections, usually given on the following schedule:</p>\n<ul>\n<li>the first 3 doses are given as part of the 6-in-1 vaccine at age 8, 12 and 16 weeks</li>\n<li>a booster dose is given as part of the 4-in-1 pre-school booster at age 3 years and 4 months</li>\n<li>a final dose is given as part of the 3-in-1 teenage booster at age 14</li>\n</ul>\n<p>This course of 5 injections should provide long-lasting protection against tetanus. However, if you or your child has a deep or dirty wound, it's best to get medical advice.</p>\n<p>If you're not sure whether you've had the full vaccination course, contact your GP surgery for advice. It's possible to fully vaccinate older children and adults who were not vaccinated when they were younger.</p>\n</blockquote>\n<p>The same page also states that if you're planning to travel abroad and have not been fully vaccinated against tetanus, or you're going to an area with limited medical facilities and your last vaccine dose was more than 10 years ago, contact your GP surgery for advice.</p>\n<blockquote>\n<p>You'll be offered the 3-in-1 teenage booster. This injection, which also protects against diphtheria and polio, is usually free on the NHS.</p>\n</blockquote>\n", "score": 3 } ]

[ "tetanus-shot" ]

[ { "answer_id": 32109, "body": "<p>No current literature in my review supports a direct relationship between an 'extreme' lack of movement with heartburn. The single word you are referring to regarding the tendency not to move or exercise is called being 'sedentary.'¹</p>\n<p>For accuracy purposes, let us define heartburn. Heartburn is more accurately referred to as dyspepsia or indigestion.² This is the uncomfortable feeling in the upper abdominal region, commonly described as burning or bloating in character.² In some cases, individuals with heartburn also complain of the burning sensation traveling as far up as their mouth. This is caused by regurgitation of stomach acid, commonly seen in gastroesophageal reflux disease (GERD).³</p>\n<p>Although there is known research linking obesity to GERD and increased incidence of indigestion,⁴ it would be a false (illusory) correlation to link a sedentary lifestyle to obesity which is related to the increased incidence of GERD or indigestion, based on the literature. Instead, other outside factors may be involved including diet habits, which have been found to increase indigestion and GERD,³ as well as a positive link to obesity.</p>\n<p>On a theoretical note, one thing that comes to mind in an attempt to address the link you are trying to make between indigestion/GERD is the association between the autonomic nervous system. The nervous system can be categorized in many different ways. One way is through sympathetic and parasympathetic responses (within the autonomic category).⁵ Consider that at any one point in time, you are either in a sympathetic mode, parasympathetic mode, or within a degree of one. The sympathetic mode is also known as 'fight or flight,' and the parasympathetic mode is also known as 'rest and digest.'⁵ If you feel threatened, or are playing a sport, you are in sympathetic mode. After you eat, sometimes you may feel tired; this would be an example of being in a parasympathetic mode. If you are sedentary, then you are predominantly in parasympathetic mode, which plays a large role in your digestive system being stimulated. Part of that stimulation would include secretion (or hypersecretion) and production of stomach acid. Excess stomach acid, in the absence of food content, may result in indigestion and/or reflux. Again this is a theoretical link that has not been observed in statistical or published literature that can be directly cited.</p>\n<p>References</p>\n<ol>\n<li>Sedentary Definition &amp; Meaning - Merriam-Webster. Accessed April 3, 2023. <a href=\"https://www.merriam-webster.com/dictionary/sedentary\" rel=\"nofollow noreferrer\">https://www.merriam-webster.com/dictionary/sedentary</a></li>\n<li>Definition of INDIGESTION. Published March 29, 2023. Accessed April 3, 2023. <a href=\"https://www.merriam-webster.com/dictionary/indigestion\" rel=\"nofollow noreferrer\">https://www.merriam-webster.com/dictionary/indigestion</a></li>\n<li>Antunes C, Aleem A, Curtis SA. Gastroesophageal Reflux Disease. In: StatPearls. StatPearls Publishing; 2023. Accessed April 3, 2023. <a href=\"http://www.ncbi.nlm.nih.gov/books/NBK441938/\" rel=\"nofollow noreferrer\">http://www.ncbi.nlm.nih.gov/books/NBK441938/</a></li>\n<li>Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med. 2005 Aug 02;143(3):199-211.</li>\n<li>McCorry LK. Physiology of the Autonomic Nervous System. Am J Pharm Educ. 2007;71(4):78. Accessed April 3, 2023. <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1959222/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1959222/</a></li>\n</ol>\n", "score": 2 } ]

[ "exercise", "physiology", "sedentary-lifestyle", "heartburn" ]

[ { "answer_id": 32125, "body": "<p>For the US, see <a href=\"https://www.law.cornell.edu/cfr/text/9/317.345\" rel=\"nofollow noreferrer\">9 CFR § 317.345</a></p>\n<blockquote>\n<p>The nutrition label data for products covered in paragraphs (a)(1) and (a)(2) must be based on either the raw or cooked edible portions of meat cuts with external cover fat at trim levels reflecting current marketing practices. If data are based on cooked portions, the methods used to cook the products must be specified and for products covered in paragraphs (a)(1) and (a)(2) must be those which do not add nutrients from other ingredients such as flour, breading, and salt. Additional nutritional data may be presented on an optional basis for the raw or cooked edible portions of the separable lean of meat cuts.</p>\n</blockquote>\n<p>Some of the other sections and references may also be relevant, but the parts that seem most relevant to your question are &quot;<em>must be based on either the raw or cooked edible portion</em>&quot; and &quot;<em>If data are based on cooked portions, the methods used to cook the products must be specified</em>&quot;. You'll have to check the labels that you're reading: if they don't say how it's cooked, it's based on raw.</p>\n<p>You could substitute reference categories mentioned in the statue from the USDA, e.g. <a href=\"https://fdc.nal.usda.gov/fdc-app.html#/?query=bacon\" rel=\"nofollow noreferrer\">https://fdc.nal.usda.gov/fdc-app.html#/?query=bacon</a> - these can also be used for labeling.</p>\n", "score": 2 } ]

[ "body-fat", "calories" ]

[ { "answer_id": 32220, "body": "<p>We breath in volatile organic compounds (VOCs) without realizing it <em>all the time</em>. Not all of them are equally harmful, and many are downright wonderful to the psyche.</p>\n<p>My favorite gardening chore is weeding or otherwise tending to lavender and rosemary; a mere brush of the hand releases tons of VOCs which are (imo) intoxicating. Many people love the smell of a newly mown hayfield, and the aroma of steak being grilled (talk about toxic VOCs!*) is mouth-watering for most carnivorous humans. <em>Every odor we can detect is caused by VOCs,</em> therefore I would consider the presence of an odor indicates the presence of VOCs. Their relative toxicity, however, is not detectable without expensive equipment.</p>\n<p>To answer your question generally, the absence of an odor upon using a respirator indicates a significant reduction in the presence of VOCs, but does not guarantee their complete absence.</p>\n<blockquote>\n<p>...could you be harmed by VOCs that are so low concentration that you can't consciously detect them through smell?</p>\n</blockquote>\n<p>Probably. But I would consider it like I consider sunlight and the risk of skin cancer. Every exposure has the potential to cause a mutation in a gene of a dividing skin cell, but one single exposure is extremely unlikely to cause a deleterious mutation, and the degree of harm is dependent on many factors: length and frequency of exposure, one's personal genetic constitution, one's immune status, and other mitigating factors (e.g. the presence or absence of susceptible lesions.)</p>\n<p>You cannot avoid VOCs. However, the risk is most likely affected by the degree of exposure, the particular VOC(s), etc.</p>\n<p>_{Personally, I am surprised by the frequent use of products to scent one's environment. Unscented products are less likely to expose one to high amounts of VOCs.}</p>\n<p>*_{My field of research as a molecular biologist was polycyclic aromatic hydrocarbons/co-carcinogens, which positively <em>abound</em> in the smoke of grilled meat and grilled meat itself.}</p>\n<p>_{<a href=\"https://www.tandfonline.com/doi/abs/10.1080/02652030701474235\" rel=\"nofollow noreferrer\">Well-Done Meat Intake, Heterocyclic Amine Exposure, and Cancer Risk</a>}<br />\n_{<a href=\"https://www.tandfonline.com/doi/abs/10.1080/10406638.2018.1559208\" rel=\"nofollow noreferrer\">Heterocyclic Amines and Polycyclic Aromatic Hydrocarbons in Cooked Meat Products: A Review</a>}<br />\n_{<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018511/\" rel=\"nofollow noreferrer\">INDOOR AIR QUALITY: Scented Products Emit a Bouquet of VOCs</a>}</p>\n", "score": 3 } ]

[ "chemical", "smell" ]

[ { "answer_id": 32228, "body": "<p><a href=\"https://en.m.wikipedia.org/wiki/Biopharmaceutical\" rel=\"nofollow noreferrer\">Wikipedia mentions that the definition varies by you who ask</a>, and since there are some regulations that apply specifically to biologics you'd need to see those specific regulations to see how they apply, but generally my impression agrees with the general idea the Wikipedia article conveys: biologics are <em>derived from biological sources</em>.</p>\n<p>Yes, all drugs <em>affect</em> biology, but most small molecules are created synthetically, even if they're motivated by things originally identified in living things. Large molecules like proteins (including antibodies), though, are only practical to make in biological systems.</p>\n", "score": 2 } ]

[ "terminology" ]

[ { "answer_id": 32234, "body": "<p>Non allergic sensitivity turns to be a very broad term, too broad to even cover psychological situations. Nutritional sensitivities that don't cause an immunological problem are not likely to be treated by allergists or immunologists.</p>\n<p>The &quot;About&quot; section in the website of the American Academy of Allergy, Asthma and Immunology (AAAAI)^{<a href=\"https://www.aaaai.org/About/About-Allergists-Immunologists\" rel=\"nofollow noreferrer\">(1)</a>} doesn't mention anything outside the scopes of allergy medicine or immunology.</p>\n<blockquote>\n<p>An allergist / immunologist (commonly referred to as an allergist) is a physician specially trained to diagnose, treat and manage allergies, asthma and immunologic disorders including primary immunodeficiency disorders. These conditions range from the very common to the very rare, spanning all ages and encompassing various organ systems.</p>\n</blockquote>\n<p>In the &quot;About&quot; section in the website of the British Society for Allergy and Clinical Immunology (BSACI) doesn't mention anything outside the scopes of allergy medicine or immunology as well^{<a href=\"https://www.bsaci.org/about-bsaci/who-are-bsaci/\" rel=\"nofollow noreferrer\">(2)</a>}.</p>\n<hr />\n<p>If nutritional intolerance isn't causing an allergy or an immunity problem but rather another problem, then in general, depending on what that problem is, another field of expertise would be suitable.<br>\nAn allergist / immunologist might be able (or not disallowed) to try to treat such patient's intolerance but that's unlikely that he will.</p>\n", "score": 3 } ]

[ "nutrition", "allergy", "general-practitioners" ]

[ { "answer_id": 32295, "body": "<p>To form a clear image, light must be focused on the retina, which detects the light and sends signals through the optic nerve to the visual centre of the brain. To achieve the focusing, most <a href=\"https://en.m.wikipedia.org/wiki/Refraction\" rel=\"nofollow noreferrer\">refraction</a> of light happens at the cornea, with the ciliary muscles adjusting the lens for fine-tuning.</p>\n<p><a href=\"https://i.stack.imgur.com/LEcG8.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/LEcG8.jpg\" alt=\"Eye anatomy\" /></a></p>\n<p>When the lens is relaxed, the eye is focused at infinity - i.e. parallel light rays from distant objects will be in focus.</p>\n<p>For a near object, the ciliary muscles have to work harder the closer the object is, to adjust the lens to manage diverging rays. Most people have a <a href=\"https://en.m.wikipedia.org/wiki/Near_point\" rel=\"nofollow noreferrer\">near point</a> of about 30cm, but it gets further away as we age, due to natural longsightedness, known as <a href=\"https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/presbyopia#:%7E:text=What%20is%20presbyopia%3F,the%20back%20of%20the%20eye\" rel=\"nofollow noreferrer\">presbyopia</a>.</p>\n<p>This image shows the rays being refracted coming from a far object (parallel rays) and a near object (divergent rays).</p>\n<p><a href=\"https://i.stack.imgur.com/eEz1n.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/eEz1n.png\" alt=\"Eye focusing far and near objects\" /></a></p>\n<p>Adjusting the lens (and constricting the pupil) in response to a near object is called <a href=\"https://en.wikipedia.org/wiki/Accommodation_reflex\" rel=\"nofollow noreferrer\">accommodation</a> - the lens needs to converge the rays more strongly for a near object.</p>\n<p>This is a reflex coordinated by the second cranial nerve (<a href=\"https://en.wikipedia.org/wiki/Optic_nerve\" rel=\"nofollow noreferrer\">optic nerve</a>) as the <a href=\"https://en.wikipedia.org/wiki/Afferent_nerve_fiber\" rel=\"nofollow noreferrer\">afferent</a> arc (sending a sensory signal to the brain) and the third cranial nerve (<a href=\"https://en.wikipedia.org/wiki/Oculomotor_nerve\" rel=\"nofollow noreferrer\">oculomotor nerve</a>) as the <a href=\"https://en.wikipedia.org/wiki/Efferent_nerve_fiber\" rel=\"nofollow noreferrer\">efferent</a> arc (receiving signals back from the brain and enacting a motor response). This is shown in the diagram below.</p>\n<p><a href=\"https://i.stack.imgur.com/FU2bX.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/FU2bX.jpg\" alt=\"Accomodation reflex arc\" /></a></p>\n<p>For an object closer than the near point, the eye will need the help of lenses to focus the divergent light rays sufficiently. Any sort of prolonged focus closer than infinity will be tiring, but more so the closer the object is.</p>\n<p>That is why convex lenses are used for near-eye displays, like in a virtual reality headset. The same type of lenses are used for long-sightedness, when the eye cannot focus diverging light rays from near objects sufficiently to form a focused image on the retina.</p>\n<p>This image shows a convex lens focusing parallel rays to a point, and also a diverging or concave lens (which is less relevant here, but is used to correct short-sightedness).</p>\n<p><a href=\"https://i.stack.imgur.com/cfdQt.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/cfdQt.jpg\" alt=\"Convex and concave lenses\" /></a></p>\n<p>Ideally, you would have the eyes completely relaxed and use lenses to provide an image in focus in this state. This is not practically possible, but the <a href=\"https://en.wikipedia.org/wiki/Virtual_image\" rel=\"nofollow noreferrer\">virtual image</a> that the person sees can appear further in front of them, well beyond the natural near point.</p>\n<p>The image below shows one example of this.</p>\n<p><a href=\"https://i.stack.imgur.com/otqk2.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/otqk2.jpg\" alt=\"Lens arrangement in a near-eye headset\" /></a></p>\n<p>The image taken from an interesting paper by <a href=\"https://www.researchgate.net/figure/Basic-optical-design-of-our-near-eye-display-system_fig3_335144486\" rel=\"nofollow noreferrer\">Xia et al</a> describing a novel approach for a mixed reality headset that is adjustable for those with <a href=\"https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/refractive-errors#:%7E:text=Refraction%20is%20the%20bending%20of,that%20can%20cause%20blurry%20vision\" rel=\"nofollow noreferrer\">refractive errors</a> (i.e. who wear glasses or contact lenses).</p>\n<p>The middle lens is the main focusing lens, with the one nearer the eye being adjustable. At the far right you can see the virtual image, which is where the wearer will experience the display being; comfortably beyond their near point.</p>\n<hr />\n<p>So in summary, the eye cannot be tricked into relaxing unless you’re displaying an image it can perceive to be far away, or at least as far away as possible. While in the example of the VR headset above, this creates a virtual image further away from the eye, it is optics rather than trickery!</p>\n", "score": 1 }, { "answer_id": 32289, "body": "<p>Should better be considered a comment rather than answer - but what you are asking is covering a range of topics. involving optics, neural reflexes &amp; Neural reflexes involving the image formation at the retina &amp; psychic Level.</p>\n<p>Basically in simplest terms the feedback system at Psychic level is regulating the Lens curvature for optimum formation of image at psychic level. e.g., when &quot;attention&quot; focuses in a sea of awareness from a distant object to some object of reference then eyes move (reflexes), lens widens through ciliary muscle relaxation causing the new clear image of <strong>object of interest</strong> to form at psychic level.</p>\n<p>I would refer you to neuro-opthalmology texts for further research.</p>\n", "score": 0 } ]

[ "optometry", "ophthalmology", "eye-strain" ]

[ { "answer_id": 32375, "body": "<p>The <a href=\"https://vaers.hhs.gov/\" rel=\"nofollow noreferrer\">VAERS</a> (Vaccine Adverse Event Reporting System) is a publicly available USA government searchable database for (as the name suggests) reporting vaccine adverse events. The actual searchable part is known as CDC Wonder and is available from the <a href=\"https://vaers.hhs.gov/data.html\" rel=\"nofollow noreferrer\">VAERS Data Page</a>. It is fully capable of giving you data directly on the adverse events associated with vaccine lot. The answer from @BipedalJoe is an aggregator that queries the CDC and provides summaries of some of this data.</p>\n<p>It should be noted that VAERS comes with some very important caveats; in particular those noted in the disclaimer you will need to click &quot;I have read and understand&quot; to get past when accessing the data. I have reproduced it here, with my own emphasis:</p>\n<blockquote>\n<p>VAERS accepts reports of adverse events that occur following vaccination. <strong>Anyone, including healthcare providers, vaccine manufacturers, and the public, can submit reports to the system</strong>. While very important in monitoring vaccine safety, <strong>VAERS reports alone cannot be used to determine if a vaccine caused or contributed to an adverse event or illness</strong>. Vaccine providers are encouraged to report any clinically significant health problem following vaccination to VAERS even if they are not sure if the vaccine was the cause. In some situations, reporting to VAERS is required of healthcare providers and vaccine manufacturers.</p>\n<p><strong>VAERS reports may contain information that is incomplete, inaccurate, coincidental, or unverifiable</strong>. <strong>Reports to VAERS can also be biased</strong>. As a result, there are limitations on how the data can be used scientifically. Data from VAERS reports should always be interpreted with these limitations in mind.</p>\n</blockquote>\n<p>It is also important to note that many healthcare providers are required to provide reports to VAERS of <em>ANY</em> event following vaccination, whether it may be related to the vaccination or not. For this reason, you get reports of things like <a href=\"https://wonder.cdc.gov/controller/datarequest/D8;jsessionid=E30270DABF9837AC7AB76D595AD4\" rel=\"nofollow noreferrer\">car crashes on icy roads</a> in VAERS. You should also be aware of some answers I have made on similar topics over the past couple of years, which might be of relevance: <a href=\"https://medicalsciences.stackexchange.com/questions/29184/does-this-covid-19-vaccine-study-suggests-a-1-to-718-rate-of-adverse-effects/29207#29207\">Does covid vaccine have a ratio of 1:718 of adverse events?</a>, <a href=\"https://medicalsciences.stackexchange.com/questions/31685/are-vaccinated-people-more-or-less-healthy-than-unvaccinated-people-in-the-long/32039#32039\">Are vaccinated people more or less healthy after vaccination?</a>, <a href=\"https://medicalsciences.stackexchange.com/questions/31981/how-bad-are-covid-vaccines/31982#31982\">How bad are covid vaccines?</a>.</p>\n<p>In a comment @BryanKrause provided a link to an <a href=\"https://www.science.org/content/article/antivaccine-activists-use-government-database-side-effects-scare-public\" rel=\"nofollow noreferrer\">news article published in the journal <em>Science</em></a> ¹, which provides an excellent overview of some more of the issues associated with VAERS data and common problems in interpretation of the data. I've mentioned the problems covered in the disclaimer, but another serious issue is interpretation of the results. To quote the article:</p>\n<blockquote>\n<p>People may misinterpret VAERS, which is easily searchable, as a catalog of actual side effects, rather than possible or suspected ones.</p>\n</blockquote>\n<p>This means that just because VAERS has a report, that it is a causal relationship between the event and vaccination. Known causal side effects of the vaccines are included in the datasheet provided with the vaccines. I believe that the supply of this information is mandated by law in many countries for any therapeutic or prophylactic, and is supplied with the actual vials. You should be able to ask your vaccination supplier for it and/or search these online.</p>\n<p>Anyway, on to the question at hand:</p>\n<p>Within the CDC Wonder page you can change the &quot;group by&quot; selection box in the first section and ask to group by &quot;vaccine lot&quot;:</p>\n<p>Before:</p>\n<p><a href=\"https://i.stack.imgur.com/Z3cUAm.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/Z3cUAm.png\" alt=\"before\" /></a></p>\n<p>After:</p>\n<p><a href=\"https://i.stack.imgur.com/cqi3im.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/cqi3im.png\" alt=\"after\" /></a></p>\n<p>In the second section, you can select specific symptoms if you wish.</p>\n<p>The 3rd section is more relevant - it is the one for the type and manufacturer, as well as dose, choose the one(s) you want. You can also select a particular lot if you know this information. See the box, bottom right:</p>\n<p><a href=\"https://i.stack.imgur.com/Y8kDr.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/Y8kDr.jpg\" alt=\"enter image description here\" /></a></p>\n<p>Sections 4-11 allow you to select locations, event characteristics (type of injury for example), vaccination date, adverse event date, death rate etc, if you are interested.</p>\n<p>Section 12 allows you to access/see the data, including in a downloadable format.</p>\n<p>Ref:</p>\n<ol>\n<li>Wadman M., Antivaccine activists use a government database on side effects to scare the public. 06 May 2021. doi: <a href=\"https://doi.org/10.1126/science.abj6981\" rel=\"nofollow noreferrer\">https://doi.org/10.1126/science.abj6981</a></li>\n</ol>\n", "score": 5 }, { "answer_id": 32360, "body": "<p>The side effects of COVID-19 vaccines are not typically batch-specific. In other words, the side effects associated with a particular vaccine are generally the same, regardless of the batch from which your dose came.</p>\n", "score": 2 } ]

[ "covid-19", "vaccination", "side-effects" ]

[ { "answer_id": 32396, "body": "<p>6 m/20 feet is about the infinity distance for the human eye - actual infinity is infinity, but the accommodation between 6 m and infinity is minimal. this is known as the <a href=\"https://en.wikipedia.org/wiki/Far_point\" rel=\"nofollow noreferrer\">Far Point</a>.</p>\n<p>The actual best practice will be to focus on things further than 6 m, as in the Canadian quote you provided, so as to provide an infinity point - basically any distance 6 m or greater works. If you follow the Canadian link you provided, you will find references to support the</p>\n<p>But I agree with the comment from Bryan Krause - keep it simple and memorable and it is more likely to get complied with. Indeed I found an <a href=\"https://www.optometrytimes.com/view/deconstructing-20-20-20-rule-digital-eye-strain\" rel=\"nofollow noreferrer\">Optometry Times article</a>¹ where the author tracked down the originator of the phrase, who was simply wanting a simple easy phrase to remember:</p>\n<blockquote>\n<p>“In speaking to corporate workers, I needed a way to get them to take breaks while at the same time allowing them to accomplish their work,” Dr. Anshel says. “The general ‘rule’ at the time was to take a 15-minute break every two hours. Yet most people with visual stress noticed problems earlier than two hours into their workdays.”</p>\n<p>Thus, the 20-20-20 Rule was born.</p>\n<p>Dr. Anshel says The Rule gives computer users a quick and easy “tag” to remember when using their computers.</p>\n<p>“The tag came from TV and radio interviews that time,” he says. “The interviewers asked what people can do about computer eyestrain, so I honed this into something easy to remember. I started with the ‘3B’ approach: blink, breathe, and break. Then the 20-20-20 Rule came out of the ‘break’ recommendation.”</p>\n<p>The basis behind the 20-20-20 Rule, according to Dr. Anshel, comes from studies that found benefits of shorter, more frequent breaks for musculoskeletal disorders.10-13 He adapted the information to the visual system.</p>\n</blockquote>\n<p>Having said that, there seems to be a lack of actual studies that support the use of this rule as being better than no intervention. <a href=\"https://pubmed.ncbi.nlm.nih.gov/36473088/\" rel=\"nofollow noreferrer\">One small study</a>² published this year suggested no impact, a did a <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10391416/\" rel=\"nofollow noreferrer\">larger study</a>³, though one paper in <a href=\"https://avehjournal.org/index.php/aveh/article/view/554/1316\" rel=\"nofollow noreferrer\">African Vision and Eye Health</a>⁴ suggested a positive impact.</p>\n<p>Refs:</p>\n<ol>\n<li><p>Deconstructing the 20-20-20 Rule for digital eye strain. Optometry Times. Feb 22, 2018. <a href=\"https://www.optometrytimes.com/view/deconstructing-20-20-20-rule-digital-eye-strain\" rel=\"nofollow noreferrer\">https://www.optometrytimes.com/view/deconstructing-20-20-20-rule-digital-eye-strain</a>. Accessed August 2023.\nBrian Chou.</p>\n</li>\n<li><p>Johnson S, Rosenfield M. 20-20-20 Rule: Are These Numbers Justified? Optom Vis Sci. 2023 Jan 1;100(1):52-56. doi: <a href=\"https://doi.org/10.1097/OPX.0000000000001971\" rel=\"nofollow noreferrer\">https://doi.org/10.1097/OPX.0000000000001971</a>. Epub 2022 Dec 6. PMID: 36473088.</p>\n</li>\n<li><p>Datta S, Sehgal S, Bhattacharya B, Satgunam PN. The 20/20/20 rule: Practicing pattern and associations with asthenopic symptoms. Indian J Ophthalmol. 2023 May;71(5):2071-2075. doi: <a href=\"https://doi.org/10.4103/ijo.IJO_2056_22\" rel=\"nofollow noreferrer\">https://doi.org/10.4103/ijo.IJO_2056_22</a>. PMID: 37203083; PMCID: PMC10391416.</p>\n</li>\n<li><p>Alghamdi, W., &amp; Alrasheed, S. (2020). Impact of an educational intervention using the 20/20/20 rule on Computer Vision Syndrome. African Vision and Eye Health, 79(1), 6 pages. doi:<a href=\"https://doi.org/10.4102/aveh.v79i1.554\" rel=\"nofollow noreferrer\">https://doi.org/10.4102/aveh.v79i1.554</a></p>\n</li>\n</ol>\n", "score": 1 } ]

[ "eye", "eye-strain" ]

[ { "answer_id": 1134, "body": "<p>A proper diagnosis would require more questions for your particular situation. For example:\n - Do you have, or have you had, a fever since you noticed this bump? \n - Do you any other skin reactions anywhere else on your body? \n - Did you have any scratches or broken surface of the skin in the area of the bump before you noticed it and the swelling started? \n - Do you know of insects, ticks, or spiders that may be common in your area? If so, do you feel you may have been exposed to these?</p>\n\n<p>It appears one possibility is a localized reaction resulting from an insect bite. The symptoms you are noticing are common after an arthropod bite, such as local discomfort or pain; pruritis (itchiness); and erythema (redness). Because there is blanching in the center with a ring of erythema around this, it may suggest a bite.</p>\n\n<p>Another less likely possibility is cellulitis. Cellulitis is an infection of the skin and subcutaneous layer of tissue just below the skin. This can result from trauma to the skin such as a cut or a bite, when bacteria are able to enter through the disturbed skin surface. However, accompanying symptoms also include tenderness/pain at the site; chills; fever; and swollen lymph nodes near the site.</p>\n\n<p>Ibuprofen (e.g. Motrin) taken orally should help decrease inflammation around the site of the swelling, thereby alleviating some of the itching and discomfort. The topical corticosteroids available over the counter may not be in the strength you need to counter an inflammatory or allergic reaction. Due to this, it would be prudent to consult your health care provider if this does not start to resolve within the next 24 hours as it sometimes may two to three days for the initial symptoms to subside if this resulted from a bite. Also, if you develop other symptoms such as fever, nausea, decreased appetite, fatigue, or hives you should see your provider right away.</p>\n\n<p><a href=\"http://www.nlm.nih.gov/medlineplus/insectbitesandstings.html\" rel=\"nofollow\">http://www.nlm.nih.gov/medlineplus/insectbitesandstings.html</a>\n<a href=\"http://www.uptodate.com/contents/skin-and-soft-tissue-infection-cellulitis-beyond-the-basics?view=print\" rel=\"nofollow\">http://www.uptodate.com/contents/skin-and-soft-tissue-infection-cellulitis-beyond-the-basics?view=print</a></p>\n", "score": 4 } ]

[ "dermatology" ]

[ { "answer_id": 1764, "body": "<p>You're essentially asking if you can eat food and then eat more food. Whey protein and mass gainer at the most basic level are: carbs, proteins, and fat. In the case of mass gainer, it usually has large amount of both carbs and protein. So, yes, you can consume them at the SAME TIME, just as you can consume 2 or 10 cheeseburgers at the same time. The underlying question I believe you intended to ask was, \"What is the value/repercussions in doing so?\" And, the not so simple answer is, it <em>depends</em></p>\n\n<p>It depends on your target Calorie consumption. Are you aiming to intake 2000 calories or 5000? How many calories are you burning during your regular activities and during your athletic activities? If you're looking for optimal muscle protein synthesis, you would be more interested in BCAAs - specifically <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/21775557\" rel=\"nofollow\">Leuceine</a>. </p>\n\n<p>I can tell by your question that you're a novice with regards to nutrition, and a single forum post will not suffice. Please google \"Jordan Feigenbaum\". He has written extensively on nutrition in the setting of weightlifting. As always, read everything with a critical eye. Best of luck.</p>\n", "score": 4 } ]

[ "nutrition", "diet", "proteins" ]

[ { "answer_id": 1892, "body": "<p>8 months is a long time, so should see a doctor. Write down everything you have noticed that has changed (e.g. you may be losing weight, you may have heart palpitations, you may be eating a lot more or your appetite may be a lot less than what it used to be, etc. etc.). Then go to the doctor and mention everything that has changed. The doctor will likely ask a lot of questions, but if you have thought about your symptoms in advance then you are more likely to give the right answer. A potential problem is that when complaints have existed for long, you may get used to certain things causing you to give a wrong answer relating to changes in your body. </p>\n", "score": 2 } ]

[ "digestion" ]

[]

[ "micronutrients", "blood-tests" ]

[ { "answer_id": 3794, "body": "<p>(This answer is related to my answer on <a href=\"https://biology.stackexchange.com/questions/40221/bacteria-resistance-to-natural-antibiotics\">Bacteria resistance to natural antibiotics</a> on the Biology SE) </p>\n\n<p>First of all: When it comes to evolution, Biology doesn't talk of 'strong' and 'weak' , it talks of 'fitness' (\"survival of the fittest\", for example), which is about how well adapted to their environment an organism is. Fitness includes how well it can survive in its environment and how much it can produce vital offspring. </p>\n\n<blockquote>\n <p>This seems logical because in ordinary environment, the wild type of virus should be the strongest one. Any mutation of it is to fight back the drug, hence it is not the strongest one anymore</p>\n</blockquote>\n\n<p>This is a misunderstanding of evolution. The wild type of a species is not the fittest this organism can be. That it is the wild type just means that it evolved and spread. Something that doesn't evolve can't spread (as an hyperbolic example, it might be advantageous for humans to have wings, but since we didn't evolve it, our wild type doesn't include it). </p>\n\n<p>It also helps to remember that \"the wild type\" is not a uniform thing. There are many genetic variations which we still consider to be the wild type. Even bacteria that reproduce through asexual reproduction are not all the same, even within one host. </p>\n\n<p>In the natural environment of the bacteria you are talking about, an antibiotic resistance confers little benefit because they don't encounter it. So if it evolves, it won't help these organisms survive and would only spread throughout the population by chance. On the contrary, it might even confer a disadvantage - for example, penicillin resistance required producing the protein beta-lactamase. In a penicillin free environment, this might just be a costly extra without a benefit. Over time, it might get lost. </p>\n\n<p>In a human taking antibiotics, however, these bacteria with an antibiotic resistance are indeed fitter and have a survival advantage. Bacteria with multiple resistances even more so. Between bacteria, these resistances can actually be transferred by something called \"transformation\" that involves actually picking up genetic material, so evolving multiple resistances also isn't as uncommon as it may seem. </p>\n\n<p>As for your virus example, without knowing more, I'd guess that the fitness reduction in the more resistant virus strain is probably a side effect of the resistance. Getting more or less fit through evolving resistance to treatment is not, in itself, a difference between viruses and bacteria. </p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2937522/\" rel=\"nofollow noreferrer\">Origins and Evolution of Antibiotic Resistance</a></p>\n\n<p><a href=\"http://archinte.jamanetwork.com/article.aspxhttp://archinte.jamanetwork.com/article.aspx?volume=151&amp;page=886\" rel=\"nofollow noreferrer\">Mechanisms of Bacterial Resistance to Antibiotics</a></p>\n\n<p><a href=\"http://evolution.berkeley.edu/evolibrary/article/evo_27\" rel=\"nofollow noreferrer\">What is fitness?</a></p>\n", "score": 2 }, { "answer_id": 3790, "body": "<p>In short, because mutations are not defined as specific. </p>\n\n<p>A mutation of any bacteria could be mutation that could be weak or strong. </p>\n\n<p>Weak &amp; Strong would be quantified by our technology, treatments and comprehension of the bacteria. </p>\n\n<p>There are two factors important to understanding the change of the bacteria. </p>\n\n<blockquote>\n <p>Epigenetic Adaptation (No Genetic Mutation)</p>\n \n <p>Genetic Adaptation (Genetic Mutation and Selection)</p>\n</blockquote>\n\n<p>Bacteria can acquire large pieces of DNA from other bacteria, viruses and the environment.</p>\n\n<blockquote>\n <p><strong>How Does Selective Pressure Impact Antibiotic Resistance?</strong></p>\n \n <p>In order for a gene to remain functional and a part of the bacteria’s\n genome over an extended period, it has to help improve the survival\n and/or competitiveness of the bacteria. If a gene stops being helpful\n it will eventually become non-functional and will be removed from the\n genome. This means that the development and maintenance of antibiotic\n resistance is usually dependent on the bacterial population being\n frequently exposed to non-lethal doses of the antibiotic (note: some\n bacteria are intrinsically resistant to particular antibiotics). This\n process eliminates those bacteria that have lost resistance, and\n increases the percentage of resistant bacteria. In real life, this\n means that antibiotic resistance is likely to emerge in environments\n where bacteria are frequently exposed to antibiotics. On an individual\n level, this means that a person is more likely to develop an\n antibiotic resistant infection from undergoing long-term or\n prophylactic antibiotic treatment, as opposed to short-term antibiotic\n treatments of acute infections. This also means that bacteria may\n lose resistance to antibiotics that are no longer frequently used.</p>\n</blockquote>\n\n<p>Check out <a href=\"http://thescienceofacne.com/how-do-bacteria-become-resistant-to-antibiotics/\" rel=\"nofollow\">This Article</a> for more information.</p>\n", "score": 1 } ]

[ "bacteria", "resistance", "evolution" ]

[ { "answer_id": 4226, "body": "<p>This answer is more speculative than I like my answers here to be, but I think it still has some value. </p>\n\n<p>It is highly unlikely that a single six-day period of working the night shift will have a permanent negative effect. </p>\n\n<p>The problem is, this can't really be proven, and that is twofold. </p>\n\n<p>First, pretty much all studies on the subject are either done on long-term effects on people who are working like this for a long time (shift workers), or they are done on people temporarily exposed to this, and with no follow-up on permanent effects. </p>\n\n<p>Examples for the first type:</p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2082105/\" rel=\"nofollow\">Circadian Rhythm Sleep Disorders: Part I, Basic Principles, Shift Work and Jet Lag Disorders - An American Academy of Sleep Medicine Review</a>, a review on the effects of shift work on sleep </p>\n\n<p><a href=\"http://m.oem.bmj.com/content/58/11/747.short\" rel=\"nofollow\">Is there an association between shift work and having a metabolic syndrome? Results from a population based study of 27 485 people</a> - study on whether obesity and metabolic syndrome is more prevalent in shift workers </p>\n\n<p>Examples for the second type: </p>\n\n<p><a href=\"http://m.pnas.org/content/111/6/E682\" rel=\"nofollow\">Mistimed sleep disrupts circadian regulation of the human transcriptome</a> - study measuring the short-term effects of delayed sleep on gene expression. No conclusions can be drawn for the long-term effects. </p>\n\n<p>And second, this kind of study is also not really feasible. A lot of people go through a short or even medium term period of delayed sleep or even sleep deprivation in their lives. Think of, for example, students studying for exams not sleeping enough for a week or two. Patients receiving medication with the side effect of insomnia. Parents not sleeping enough for weeks, months, or even years. Teenagers partying late for several days in a row. </p>\n\n<p>Getting a control group for such a study would be hard to impossible - I'd go as far as suggesting that by the time someone is 40 or 50 years old (so that we could compare long-term effects), almost nobody would even qualify as a control group subject who had never experienced sleep deprivation or delayed sleep for more than two days or so. </p>\n\n<p>There are long-term effects of long working hours (12 hours is long) and shift work, but that is really another question and six days is unlikely to cause any of them. </p>\n", "score": 1 } ]

[ "sleep", "sleep-cycles", "sleep-deprivation" ]

[ { "answer_id": 4823, "body": "<p>According to <a href=\"http://www.ultrasoundpaedia.com/normal-spleen/\" rel=\"nofollow noreferrer\">this</a>, height is not the only criteria for determining if a spleen is enlarged.</p>\n\n<p><a href=\"https://i.stack.imgur.com/cJfae.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/cJfae.png\" alt=\"enter image description here\"></a></p>\n", "score": 1 } ]

[ "immune-system" ]

[ { "answer_id": 5531, "body": "<p>Diabetics when calculating insulin doses for a meal look at the <a href=\"http://www.joslin.org/info/Carbohydrate_Counting_101.html\" rel=\"nofollow\">carbohydrate content for the whole meal</a>. It's not important if the sugars are taken in one mouthful, or dissolved and taken over the whole meal. So, to answer your question, the approach taken is that functionally it makes no difference.</p>\n", "score": 1 } ]

[ "diet", "sugar", "metabolism" ]

[ { "answer_id": 5618, "body": "<p>Your link doesn't say that. They say that they found no relationship between asthma and final height in the study population.</p>\n\n<p>But height is used to produce predicted lung volumes, and the explanation is as follows:</p>\n\n<blockquote>\n <p>In normal humans, lung size is a function of height, sex, race and age.2-4 Each lung fills a pyramidal box with a height and radius. Height is the distance from base (diaphragm) to apex of the box. Because of racial differences in limb:trunk length ratios, there is a racial correction for height. A 6-foot tall Caucasian has shorter legs (and therefore a longer trunk) than a 6-foot tall African American. A 6-foot tall North American Indian or Hispanic has even shorter legs (and therefore a longer trunk), than a Caucasian. So for the same height, different races have different lung volumes (lung sizes). African Americans have 10% less TLC than Caucasians for the same height, and Hispanics about 10% more.</p>\n</blockquote>\n\n<p><a href=\"http://www.ishlt.org/ContentDocuments/2012JulLinks_Spotlight.html\" rel=\"nofollow\">http://www.ishlt.org/ContentDocuments/2012JulLinks_Spotlight.html</a></p>\n", "score": 3 } ]

[ "lungs" ]

[ { "answer_id": 8872, "body": "<p><em>During my last course called &quot;Physical Examination of the Abdomen&quot; (at medical school), we learned to palpate the abdominal aorta, which can be easily palpated in +/- lean patients.</em></p>\n<p><em>This book (freely available here <a href=\"http://www.ncbi.nlm.nih.gov/books/NBK350/\" rel=\"noreferrer\">http://www.ncbi.nlm.nih.gov/books/NBK350/</a>)\n&quot;Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition&quot; gives you a description on how to palpate the abdominal aorta and listen to possible bruits:</em></p>\n<blockquote>\n<p>The abdominal aorta is an upper abdominal, retroperitoneal structure\nwhich is best palpated by applying firm pressure with the flattened\nfingers of both hands to indent the epigastrium toward the vertebral\ncolumn. For this examination, it is essential that the subject's\nabdominal muscles be completely relaxed; such relaxation can be\nencouraged by having the subject flex the hips and by providing a\npillow to support the head.</p>\n</blockquote>\n<p><em>Here a figure from the book:</em></p>\n<p><a href=\"https://i.stack.imgur.com/5XAP0.png\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/5XAP0.png\" alt=\"Palpation abdominal aorta\" /></a></p>\n<p>The abdominal aorta is retroperitonal so it is possible that some bowel distension or feces impaction (which can occur in IBS) might influence the palpation but there is no direct correlation between IBS and the impossibility to palpate the abdominal aorta. <strong>Factors that for sure influence the palpation are obesity and massive abdominal musculature.</strong></p>\n<p>Finally (in contrast to what has been suggested in a previous answer), I have never heard about &quot;palpating the celiac artery&quot; and I don't think it is possible to really palpate (and be precise enough to say it is the celiac artery) it through all the organs which surround it (see image below, some parts of the liver have been removed to be able to see the artery)</p>\n<p><a href=\"https://i.stack.imgur.com/87eif.jpg\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/87eif.jpg\" alt=\"Celiac Artery\" /></a></p>\n<p><em>Sources</em>: Figure 2: wikipedia: <a href=\"https://en.wikipedia.org/wiki/Celiac_artery\" rel=\"noreferrer\">https://en.wikipedia.org/wiki/Celiac_artery</a></p>\n", "score": 5 } ]

[ "digestion", "gastroenterology", "cardiology" ]

[ { "answer_id": 9001, "body": "<p>The actual mechanism of intestinal gas is that \"normal intestinal bacteria\" in the large intestine produce it. If you consume certain nutrients, these bacteria will consume them and produce gas. Everyone has these bacteria, so this is not a problem, the problem can be nutrients by which you \"feed them\":</p>\n\n<ol>\n<li><p><strong>Soluble fiber</strong> in foods, such as barley, oats, legumes (beans, peas, lentils) and some fruits. Check for more detailed <a href=\"http://www.nutrientsreview.com/carbs/dietary-fiber-soluble-insoluble.html\" rel=\"nofollow\">list of foods high in soluble fiber</a>.</p></li>\n<li><p><strong>Lactose,</strong> mainly in milk, but also in ice cream or yogurt (not in cheese or butter). People with lactose intolerance cannot digest lactose, so this travels from the small to large intestine, where bacteria degrade it and produce gas.</p></li>\n<li><p><strong>Fructose</strong> in certain fruits (apples, pears, mango, agave), honey and beverages sweetened with high fructose corn syrup (HFCS) can cause bloating and lose stools in individuals with fructose malabsorption.</p></li>\n</ol>\n\n<p>To reduce all 3 nutrients at once you may consider a <a href=\"http://www.med.monash.edu/cecs/gastro/fodmap/low-high.html\" rel=\"nofollow\">low-FODMAP diet</a>.</p>\n\n<p>Constipation may worsen bloating because intestinal bacteria have more time to degrade substances in your stool. Constipation can be prevented by being physically active (walking), drinking enough water (not \"a lot,\" just enough) and avoiding certain foods. People with IBS commonly report that sugary foods, carbonated, caffeinated and alcoholic beverages, cheese and chocolate...and certain other foods...irritate them.</p>\n\n<p><strong>EDIT:</strong> Few more causes of irregular bowel movements and bloating:</p>\n\n<ul>\n<li><p>Intestinal parasites, including worms and unicellular parasites, like Giardia (stool tests are available)</p></li>\n<li><p>Celiac disease - an intolerance to gluten, which is in wheat, rye and barley.</p></li>\n<li><p>Chronic infection of stomach by the bacterium H. pylori can cause bloating in the upper abdomen--this is stomach bloating--a typical symptom that can differ it from intestinal bloating is frequent burping (belching). </p></li>\n</ul>\n\n<p>Two common causes of constipation are dehydration and anxiety.</p>\n\n<p>Excessive worrying may worsen IBS and is probably one of the causes of IBS. But thinking how to solve stomach problems is just OK.</p>\n", "score": 2 } ]

[ "nutrition", "digestion", "mental-health", "gastroenterology", "weight" ]

[ { "answer_id": 9243, "body": "<p>These could be symptoms of different medical problems, depression, anxiety, or other issues. In lieu of personal advice or a discussion of treatments, I advise seeing your primary care provider as a starting point for evaluation and management; they can guide you best.</p>\n\n<p>In addition to a medical evaluation, <a href=\"https://www.psychiatry.org/news-room/apa-blogs/apa-blog/2016/06/mindfulness-practices-may-help-treat-many-mental-health-conditions\" rel=\"nofollow\">mindfulness medication</a> and deep breathing are techniques commonly used in behavioral health for stress, anxiety, and other issues. They use principles of quieting the external stimuli and internal stimuli and being present in the moment, still, at peace. </p>\n\n<p>However: this would be in addition to, not instead of, seeing a medical professional to evaluate potential causes of your multiple symptoms.</p>\n", "score": 3 } ]

[ "pain", "mental-health", "treatment", "brain", "neurology" ]

[ { "answer_id": 9741, "body": "<ol>\n<li><p>Better sleep: Research shows that losing 5 percent of your body weight can help you sleep better and longer throughout the night.</p></li>\n<li><p>Better hormonal balance: When you rid your body of excess fat, your hormones steady and as a result it's easier for you to maintain or even further your weight loss.</p></li>\n<li><p>Improved sex drive: According to experts, weight loss has been linked to boosted testosterone levels and an increased libido, and dropping just 10 pounds is enough to stimulate sex hormones </p></li>\n<li><p>Increased sexual performance: Between the energy boost you get from loosing weight and the uptick in stamina from hours spent at the gym, if you really wanted to go all night, you could. Increased physical fitness has been associated with greater satisfaction in the bedroom, according to Smith.</p></li>\n<li><p>Better mood: Working out releases feel good chemicals called endorphins. Endorphins are responsible for that high you feel post workout. They interact with the receptors in your brain, reducing your perception of pain and deliver a positive feeling in the body similar to that of morphine.</p></li>\n</ol>\n\n<p><a href=\"http://www.mensfitness.com/weight-loss/burn-fat-fast/25-surprising-benefits-weight-loss\" rel=\"nofollow\">http://www.mensfitness.com/weight-loss/burn-fat-fast/25-surprising-benefits-weight-loss</a></p>\n", "score": 1 } ]

[ "weight", "weight-loss", "body-weight", "fad-diet", "benefits" ]

[ { "answer_id": 9788, "body": "<p>Homeopathy is a pseudosience with no proven effectiveness in treating any condition. Degenerative diseases are hard to treat, but don't lose hope that new research will discover a treatment that works in the future. In the meantime, looking for \"alternative\" cures will not only leave your eyes the same, it will also hurt your wallet.</p>\n", "score": 3 } ]

[ "eye" ]

[ { "answer_id": 11101, "body": "<p>Magnetic, no. As Variax points out.</p>\n\n<p>A potential risk would be one of heat from the battery and components within the laptop itself, which gets hotter as the laptop works harder, especially if the cooling vents are blocked (by clothing, cushions, cats, etc.).</p>\n\n<p>Heat is a form of radiation, but it's just that - heat.</p>\n", "score": 4 }, { "answer_id": 10775, "body": "<p>The electromagnetic radiation emitted by a laptop is completely harmless, both by its amount and by its spectrum. No harmful effects occur from this kind of exposition, regardless of the affected area or the time of exposure.</p>\n", "score": 1 }, { "answer_id": 13477, "body": "<p>The heat can increase scrotal temperature, which may influence male fertility <a href=\"https://academic.oup.com/humrep/article/20/2/452/603276/Increase-in-scrotal-temperature-in-laptop-computer\" rel=\"nofollow noreferrer\">1</a>. However, that study is from 2005 and laptops are much less hot these days so I would not think its that much of an issue...</p>\n\n<p><a href=\"https://academic.oup.com/humrep/article/20/2/452/603276/Increase-in-scrotal-temperature-in-laptop-computer\" rel=\"nofollow noreferrer\">Increase in scrotal temperature in laptop computer users</a></p>\n", "score": 1 } ]

[ "mental-health" ]

[ { "answer_id": 11569, "body": "<p>The CDC recommends:</p>\n<blockquote>\n<p>Vaccination to prevent influenza is particularly important for persons who are at increased risk for severe complications from influenza, or at higher risk for influenza-related outpatient, ED, or hospital visits. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to the following persons who do not have contraindications (no hierarchy is implied by order of listing):</p>\n<ul>\n<li>ll children aged 6 through 59 months;</li>\n<li>all persons aged ≥50 years;</li>\n<li>adults and children who have chronic pulmonary (including asthma) or cardiovascular (except isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus);</li>\n<li>persons who have immunosuppression (including immunosuppression caused by medications or by HIV infection);</li>\n<li>women who are or will be pregnant during the influenza season;</li>\n<li>children and adolescents (aged 6 months–18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infection;</li>\n<li>residents of nursing homes and other long-term care facilities;</li>\n<li>American Indians/Alaska Natives; and</li>\n<li>persons who are extremely obese (BMI ≥40).</li>\n</ul>\n</blockquote>\n<p><a href=\"https://www.cdc.gov/mmwr/volumes/65/rr/rr6505a1.htm?s_cid=rr6505a1_w\" rel=\"nofollow noreferrer\">https://www.cdc.gov/mmwr/volumes/65/rr/rr6505a1.htm?s_cid=rr6505a1_w</a></p>\n<p>The reasons for this are countless, if you can handle it read the article in the above link.</p>\n<p>So in short: people at risk of complications of flu. &quot;Normal&quot; people can handle a &quot;normal&quot; flu very well. An example of how things can go wrong is the spanish flu where healthy mid-aged people where more vulnerable.</p>\n<p>This is for the USA. I'm from Holland and we use almost the same criteria, except for the extreme obese and only for persons aged &gt;60 years. Also health professionals get a shot. <strong>AND we don't recommend giving the vaccine to children/babies! Only in some cases with bowel disease.</strong></p>\n<p>Hope this makes sense.</p>\n", "score": 3 } ]

[ "vaccination", "influenza", "benefits", "physiology" ]

[ { "answer_id": 12277, "body": "<p>The USA Today article you linked to provides two potential explanations:</p>\n\n<blockquote>\n <p>The FDA said the spike is because of improvements made to its reporting system over the last two years. Pharmacy industry experts believe the numbers also reflect more people are filling more prescriptions than ever.</p>\n</blockquote>\n\n<p>The first explanation seems quite plausible, as it's unlikely that the error rate would increase organically that fast in six years.</p>\n", "score": 4 } ]

[ "medications", "united-states", "public-health" ]

[ { "answer_id": 12325, "body": "<p>I am not a doctor nor a person that has any medical degree, but I read a lot about the human body, including pregnancy. The situation \"almost impossible,\" as you describe it, can also be possible if certain conditions were achieved. </p>\n\n<p>Getting pregnant is actually not something easy, even though you can find a lot of crazy discussions on women getting pregnant from trees, bullets, air, oral and anal sex, etc. It's a whole crazy world out there. </p>\n\n<p>The fertility of the egg is decreasing significantly after the ovulation, so according to your time-frame, she should be okay (see graph). \n<a href=\"https://i.stack.imgur.com/AEnwo.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/AEnwo.png\" alt=\"enter image description here\"></a></p>\n\n<p>As you see, the danger would have been before the ovulation or during the ovulation. In your case, there are two days after the ovulation (if the app calculations are correct). Fertility also depends on her age. The older a person gets, the lower the fertility, so also consider that. </p>\n\n<p>I would say that you should use science and ask her to make a pregnancy test. That instrument should give you a better \"opinion\" than mine. Also, if she is really scared about it, there are the so-called \"morning after pills\" which are quite efficient in terminating an eventual fertilization. She can get one next time you are in similar situation, rather than stressing out. However, NEVER use those pills as a contraceptive method. Use it ONLY for emergency purpose. </p>\n\n<p>Disclaimer: I'm just a person who likes to read about the technicalities of the human body. I'm not an expert in the field nor the right person to give you medical advice. Use science for that ;) </p>\n", "score": 1 }, { "answer_id": 16627, "body": "<p><strong>Short answer</strong>: \nThe odds of her being pregnant are non-zero but negligible given that the sex was non-penetrative. The vagina is an acidic environment that's quite hostile to sperm so even if some swam inside they would likely die well before reaching the cervix. It's quite a journey for the sperm even in the best of times.</p>\n\n<p><strong>Long answer</strong>:</p>\n\n<p>I'm not a doctor but I have been practising fertility awareness methods for over 4 years. </p>\n\n<p>First, drop the calendar. It's not 'the day of the month' that determines whether or not you are fertile but rather how close to ovulation you are.</p>\n\n<p>The day before ovulation is the best time to try to get pregnant: <a href=\"https://academic.oup.com/humrep/article/14/7/1835/2913179\" rel=\"nofollow noreferrer\">https://academic.oup.com/humrep/article/14/7/1835/2913179</a></p>\n\n<p>Two days before also has a good chance to become pregnant. There are generally 6 fertile days per cycle: 5 days before and 1 day after.</p>\n\n<p>A woman can ovulate on different days per cycle. In my own charts, I've seen ovulation occur anywhere from CD12 to CD18. Luckily, the female body begins to excrete cervical mucus around 6-9 days before ovulation in this pattern: dry, sticky, creamy, egg white. Egg white mucus comes directly before ovulation (4+ days) and dries up after. You can further pinpoint ovulation using an OPK kit, cervical position monitoring, basal body temperature. </p>\n\n<p>So you cannot know the probability of getting pregnant on a given day without knowing the day you ovulated. Once the egg has dissolved you cannot get pregnant from that moment until the next menstrual cycle.</p>\n\n<p>You can read more about fertility awareness here: <a href=\"https://en.wikipedia.org/wiki/Fertility_awareness\" rel=\"nofollow noreferrer\">https://en.wikipedia.org/wiki/Fertility_awareness</a></p>\n\n<p>NFP can be very effective if done properly and there are no side effects!\n<a href=\"https://www.sciencedaily.com/releases/2007/02/070221065200.htm\" rel=\"nofollow noreferrer\">https://www.sciencedaily.com/releases/2007/02/070221065200.htm</a></p>\n\n<p><strong>Please don't start using it unless you have taken classes with a practitioner first.</strong></p>\n\n<p>I really don't recommend that a woman should take oral contraceptives. I am a woman by the way.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=ORAL+CONTRACEPTIVES+AND+MOOD%2FSEXUAL+DISORDERS+IN+WOMEN\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/?term=ORAL+CONTRACEPTIVES+AND+MOOD%2FSEXUAL+DISORDERS+IN+WOMEN</a></p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/24014598\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/24014598</a></p>\n\n<p>Increased risk of depression, sexual dysfunction, breast cancer, nutritional deficiencies!</p>\n", "score": 1 } ]

[ "sex" ]