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[ { "answer_id": 13209, "body": "<ul>\n<li><p>Good breathing exercises keeps your lympha in motion and is good for cleaning and detoxing as well as making you in a better calmer state. When the fluid is in motion the body is too.</p></li>\n<li><p>Exercise in between every other 15 minutes is super important. If you can, try work while standing. Do some stretching, 3x10 squats and get your body moving. I always work out directly after work, that makes me more alert and\nnot that tired, I know it's difficult to push me go to the gym but do\na workout that's fun, crossfit? Do some strength training and some cardio afterwards for 15 minutes and enjoy a good meal after that.</p></li>\n<li><p>I'd also say that nutrition could be an 80% factor, avoid sugar in the morning, what do you eat for breakfast for example? Eat eggs, yoghurt, seeds (I do pumpkin+sunflower seeds), oats and good stuff. Avoid juice (sugar) and processed stuff. Lunch, eat a lean lunch that's not that huge and you'll get food coma, I eat salad, light protein and light grains (quinoa, brown rice, pasta). Maybe do a mozzarella salad or so. Pizza, burger and fatty stuff...avoid. Try eat as natural as possible. Have some nuts as a snack and drink a coffee after work and go to the gym :) </p></li>\n</ul>\n\n<p>Nutrition is So important here! PM me if you want and I'll help ya! \nCheers!</p>\n", "score": 1 } ]

[ "nutrition", "sleep", "exercise", "fatigue" ]

[ { "answer_id": 13228, "body": "<p>There is no correlation between something tasting \"bad\" and being good for you. Many things that taste bad are in fact bad for you, and many things that you think taste bad, other people like the taste of.</p>\n\n<p>When you juice a vegetable or a fruit, the taste is generally stronger in the juice than if you were just to eat it raw. If it's a cherry or an orange, that's considered a feature. If you don't like the taste of beets, then juicing them isn't going to make them taste nicer. However, it can put them in a form where the taste can be hidden - by adding sweet fruit juices, by adding crushed ice (cold reduces the taste of most things) and the like - or it won't last long because you can drink it quickly compared to chewing and swallowing a quantity of solid food.</p>\n\n<p>Like all vegetables, beets can be part of a healthy diet. But there is no single vegetable that must be eaten to ensure health. People all over the world go their whole, healthy lives without ever eating a beet, raw or cooked. You didn't specify what health benefits you feel it provides, but I suggest researching a little to find a different vegetable that will give you those benefits with a taste you enjoy. You could also (depending on the benefit you're looking for) consider cooking it differently in the hope of finding a preparation you enjoy. I love borscht made with lots of bacon, onions, and potatoes, and topped with sour cream. I also like dried beet chips topped with sea salt, and grated beets fried in butter with a squeeze of lime juice and some lime zest (a dish we call \"Surprise! You Like Beets!\" at my house.) But if you don't like them, eat something you do like. There are no medals for eating unpleasant things.</p>\n", "score": 1 } ]

[ "juice" ]

[ { "answer_id": 13808, "body": "<p>Likely it's <a href=\"https://en.m.wikipedia.org/wiki/Sleep_paralysis\" rel=\"nofollow noreferrer\">sleep paralysis</a> in the <a href=\"https://en.m.wikipedia.org/wiki/Hypnopompic\" rel=\"nofollow noreferrer\">hypnopompic state</a>. It's not uncommon and has a hereditary component. Drug therapy is not that useful, and it may just require some cognitive therapy.</p>\n", "score": 2 } ]

[ "sleep" ]

[ { "answer_id": 13821, "body": "<h2>There's no need to worry. Getting pregnant isn't that easy.¹</h2>\n\n<p>It's unlikely that sperm survive for 2 hours.</p>\n\n<blockquote>\n <p>On a dry surface, such as clothing or bedding, sperm are dead by the time the semen has dried. In water, such as a warm bath or hot tub, they'll likely live longer because they thrive in warm, wet places. But the odds that sperm in a tub of water will find their way inside a woman's body and cause her to get pregnant are extremely low.<br>\n <em>Source: <a href=\"http://www.webmd.com/infertility-and-reproduction/guide/sperm-and-semen-faq#1\" rel=\"noreferrer\">WebMD</a></em></p>\n</blockquote>\n\n<p>But let's assume the sperm has somehow managed to survive on the toilet seat or whatever you are proposing. \nThe sperm would then have to enter the female body via the vagina and travel through the uterus to the ampulla of the uterine tube for fertilisation.</p>\n\n<p><a href=\"https://i.stack.imgur.com/LkXBJ.jpg\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/LkXBJ.jpg\" alt=\"enter image description here\"></a></p>\n\n<p><em>Image Credit: <a href=\"http://www.pathologyoutlines.com/topic/fallopiantubesnormal.html\" rel=\"noreferrer\">pathologyoutlines.com</a></em></p>\n\n<p>This is <s>basically</s> literally impossible. </p>\n\n<p>But let's assume that, for the sake of the argument, the male sperm actually has travelled there. Even then, one can only get pregnant during ovulation, <a href=\"http://www.nhs.uk/Livewell/menstrualcycle/Pages/WhencanIgetpregnant.aspx\" rel=\"noreferrer\">which is roughly 10-16 days before the female period in the menstrual cycle</a>. Sperm only survives for several days (let's be generous and assume 4 days) in the female body, meaning that timing is pretty important. This means the chance to get pregnant at a random day is roughly 1/7.</p>\n\n<hr>\n\n<p>¹: This is one reason why IVF exists, and why quite a few couples have problems getting a child.</p>\n", "score": 6 } ]

[ "obstetrics", "sex", "health-education", "masturbation", "sperm" ]

[ { "answer_id": 14543, "body": "<p>Sleep deprivation and stress alone can cause this, but it's not the only possible cause... depression and/or anxiety also are correlated (and not unlikely given the length of exposure to chronic stress you mention)... so do see a doctor.</p>\n<p>On the <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656292/\" rel=\"nofollow noreferrer\">effects of sleep deprivation</a>:</p>\n<blockquote>\n<p>First and foremost, total SD impairs attention and working memory, but it also affects other functions, such as long-term memory and decision-making</p>\n</blockquote>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410591/\" rel=\"nofollow noreferrer\">&quot;Burnout&quot;</a> while not accepted in the psychiatric bible (DSM) is also a resonable explanation, and can have the same effect(s):</p>\n<blockquote>\n<p>A systematic review provided by Deligkaris et al. (2014) distinctly showed that burnout is associated with a decline in three main cognitive functions: executive functions, attention and memory (assessed objectively using psychometric tests instead of self-reports).</p>\n</blockquote>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4459038/\" rel=\"nofollow noreferrer\">Also</a></p>\n<blockquote>\n<p>While burnout does not appear in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders [(DSM-5)], it has been established as a legitimate justification for sick leave in several countries, for instance Sweden.</p>\n</blockquote>\n<p>I hope you live there.</p>\n<p>Also, I suggest you read <a href=\"https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/memory-loss/art-20046326?pg=2\" rel=\"nofollow noreferrer\">Mayo clinic's advice</a> for possible other causes and on dealing with memory loss. The causes I mentioned above are reversible, the neurological ones are less so.</p>\n<hr />\n<p>And if you think I'm prioritizing the above wrong, <a href=\"https://www.nhs.uk/conditions/memory-loss/\" rel=\"nofollow noreferrer\">NHS has this</a></p>\n<blockquote>\n<p>Common causes of memory loss</p>\n<p>GPs often find that people who see them about memory loss are most likely to have:</p>\n<ul>\n<li>anxiety</li>\n<li>stress</li>\n<li>depression</li>\n</ul>\n<p>Their memory loss is a result of poor concentration and not noticing things in the first place because of a lack of interest. Sleeping problems often make the memory loss worse.</p>\n<p>[...]</p>\n<p>Other common causes of memory loss are:</p>\n<ul>\n<li>a head injury – for example, after a car accident</li>\n<li>a stroke – this cuts off some of the blood supply to the brain and causes brain tissue to die</li>\n</ul>\n</blockquote>\n<p>followed by a longer/separate list of less common causes.</p>\n", "score": 1 } ]

[ "brain", "neurology" ]

[ { "answer_id": 14900, "body": "<p>Eventually I found something:</p>\n\n<p>Andrew, George M., Carole A. Guzman, and Margaret R. Becklake. \"Effect of athletic training on exercise cardiac output.\" Journal of Applied Physiology 21.2 (1966): 603-608.</p>\n\n<p>Porszasz, Janos, et al. \"Exercise training decreases ventilatory requirements and exercise-induced hyperinflation at submaximal intensities in patients with COPD.\" CHEST Journal 128.4 (2005): 2025-2034.</p>\n", "score": 0 } ]

[ "oxygen" ]

[ { "answer_id": 15066, "body": "<p>Some <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805578/\" rel=\"nofollow noreferrer\">amphetamines can cause hair loss</a>. The mechanism how this happens does not appear to be known.</p>\n\n<p>Also some anabolic steroids (AAS) can cause it, presumably through <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174066/\" rel=\"nofollow noreferrer\">conversion to DHT</a>. The situation with AAS is more complicated, as they can also <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16827963\" rel=\"nofollow noreferrer\">cause the opposite (hirsutism)</a>. The effect of AAS depends on the area, i.e. whether the hair is <a href=\"https://en.wikipedia.org/wiki/Body_hair\" rel=\"nofollow noreferrer\">androgenic</a> or not.</p>\n", "score": 1 } ]

[ "hairloss", "recreational-drugs" ]

[ { "answer_id": 15100, "body": "<p>This question is vague and could use clarification. Are you having symptoms of a tonsil infection? If so, what? Have you seen a doctor?</p>\n\n<p>First off, <strong>Staph aureus is a normal skin and mouth bacteria</strong>. In the study below, about 40% of patients had S. aureus in their throat on admission (not acquired in the hospital) (1). Since S. aureus is a normal part of our microbiome, <strong>you do not need to take antibiotics to kill it unless you have symptoms of infection</strong>, namely trouble swallowing, sore throat, fever, and pus coming from the tonsils (4). Even if you have tonsillitis, it's unlikely to be caused by staph-- the majority of cases are caused by a virus (4).</p>\n\n<p>What makes you concerned about S. aureus in particular? If you do have symptoms of infection in your tonsils, you should see a doctor. If they think the infection is likely due to staph, they will probably prescribe Bactrim, clindamycin, doxycycline, or cephalexin, though there are many good options (3). There is some evidence that citricidal may have antibacterial properties, but <strong>citricidal has not yet been tested in human subjects so there is no way of knowing how well it works compared to antibiotics</strong>(2).</p>\n\n<p>Again, many people have staph aureus on their skin and in their mouths-- this is not the same as an infection. You do not need treatment unless you have symptoms. If you are concerned, see a doctor.</p>\n\n<p>References:</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1594670/\" rel=\"nofollow noreferrer\">Rate of Colonization of Staph Aureus in the Throat</a></p>\n\n<p><a href=\"https://www.sciencedirect.com/science/article/pii/S0305417904001743\" rel=\"nofollow noreferrer\">Possible Bacteriocidal Properties of Citricidal</a></p>\n\n<p><a href=\"https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540518/all/Staphylococcus_aureus\" rel=\"nofollow noreferrer\">Antibiotics Used for Soft Tissue Staph Infections</a></p>\n\n<p><a href=\"https://www.mayoclinic.org/diseases-conditions/tonsillitis/symptoms-causes/syc-20378479\" rel=\"nofollow noreferrer\">Causes and Symptoms of Tonsillitis</a></p>\n", "score": 1 } ]

[ "antibiotics", "staph-infections" ]

[ { "answer_id": 15321, "body": "<p><strong>Preface</strong>: This is not a comment on your rash as that would be getting into the realms of medical advice; instead, I'll treat it as a general question.</p>\n<h1>Can there be a rash associated with a ketotic state?</h1>\n<p><strong>It seems so</strong>. There is a skin condition called <em>prurigo pigemntosa</em> (aka Nagashima disease), which has an unclear cause – friction, or contact dermatitis to one or more substances – but has an association with ketotic states. From DermNetNZ:</p>\n<blockquote>\n<p>Prurigo pigmentosa is a rare inflammatory skin condition of unknown cause. It is characterized by a recurrent itchy rash with netlike hyperpigmentation.</p>\n<p>...</p>\n<p>It has been associated in some patients with <strong>ketotic states</strong> associated with diabetes, fasting and post-bariatric surgery</p>\n</blockquote>\n<p>From <a href=\"https://www.dermnetnz.org/topics/prurigo-pigmentosa\" rel=\"nofollow noreferrer\"><em>Prurigo pigmentosa</em></a> on DermNetNZ.</p>\n<p>The rash has been <a href=\"https://escholarship.org/uc/item/6rv324m4\" rel=\"nofollow noreferrer\">reported to clear with resolution of ketosis</a>:</p>\n<blockquote>\n<p>Another notable association frequently reported in the literature is with ketosis resulting from diabetes, diet, eating disorders, or pregnancy. Although several authors have reported improvement of the eruption upon resolution of ketosis, there is no noted association with blood glucose levels.</p>\n</blockquote>\n<p>From <a href=\"https://escholarship.org/uc/item/6rv324m4\" rel=\"nofollow noreferrer\"><em>Prurigo pigmentosa: Report of two cases in the United States and review of the literature</em></a>.</p>\n", "score": 0 } ]

[ "rash", "ketosis" ]

[ { "answer_id": 15575, "body": "<p>This is quite simple. Prostatitis or not, you will naturally urinate more in lower temperature. <a href=\"https://www.scienceabc.com/humans/why-do-we-urinate-more-when-were-cold.html\" rel=\"nofollow noreferrer\">https://www.scienceabc.com/humans/why-do-we-urinate-more-when-were-cold.html</a> Frequent urination would probably makes you suffer more.</p>\n", "score": 1 } ]

[ "prostatitis" ]

[ { "answer_id": 15579, "body": "<p>You can find a sample format for NCS/EMG <a href=\"https://www.aanem.org/getmedia/ac9a1ad8-238a-4fc8-b3e1-86049bab33bd/Newsletter_Report.pdf\" rel=\"nofollow noreferrer\">here</a></p>\n\n<blockquote>\n <p>The report template below\n is based on the AANEM’s educational paper Reporting the\n Results of Needle EMG and Nerve Conduction Studies. A report\n template helps the EDX physician adhere to and document required\n procedures —by checking them off a list. This process will help the\n EDX physician complete a thorough analysis of the patient’s history,\n physical, and EDX data that will improve diagnostic accuracy and\n result in quality patient care. The template also will help laboratories\n applying for the laboratory accreditation program meet the criteria\n used to evaluate EDX reports. The template was developed listing\n the key elements for a EDX standard report excluding F-wave,\n H-reflex, and repetitive stimulation studies. Physicians are strongly\n urged to utilize this template to improve their reports. </p>\n</blockquote>\n", "score": 1 } ]

[ "test-results" ]

[ { "answer_id": 15651, "body": "<p>1 oz (28g) of dark has 155 calories. If you scale these 155 calories to 2000 (13 oz) then it looks like this: </p>\n\n<p><a href=\"https://i.stack.imgur.com/qUIpS.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/qUIpS.png\" alt=\"enter image description here\"></a></p>\n\n<blockquote>\n <p>^{<em>Source</em>: United States Department of Agriculture, National Nutrient Database for Standard Reference Release 28, <strong><a href=\"https://ndb.nal.usda.gov/ndb/foods/show/6451?man=&amp;lfacet=&amp;count=&amp;max=50&amp;qlookup=19902&amp;offset=&amp;sort=default&amp;format=Abridged&amp;reportfmt=other&amp;rptfrm=&amp;ndbno=&amp;nutrient1=&amp;nutrient2=&amp;nutrient3=&amp;subset=&amp;totCount=&amp;measureby=&amp;Qv=1&amp;Q12135=13&amp;Q12136=1&amp;Qv=1&amp;Q12135=1&amp;Q12136=1\" rel=\"nofollow noreferrer\">Basic Report: 19902, Chocolate, dark, 45- 59% cacao solids</a></strong>}</p>\n</blockquote>\n\n<p>Below is a table with the daily value:</p>\n\n<pre><code>% Daily Value* \nTotal Fat 9 g 13.00% 167.74%\nSaturated fat 5 g 25.00% 322.58% \nCholesterol 2 mg 0.00% 0.00%\nSodium 7 mg 0.00% 0.00%\nPotassium 158 mg 4.00% 51.61%\nTotal Carbohydrate 17 g 5.00% 64.52%\nDietary fiber 2 g 8.00% 103.23%\nSugar 14 g \nProtein 1.4 g 2.00% 25.81% \n</code></pre>\n\n<p>Naturally it is high on fat. About the only guidelines chocolate meets are cholesterol and fiber.</p>\n\n<p>Chocolate is also low on essential vitamins. </p>\n\n<p>Clearly over the long term it will negatively impact health.</p>\n\n<p>3 each 10 oz bars is even more. It is 4,650 calories. </p>\n", "score": 1 } ]

[ "nutrition", "diet", "side-effects", "food-safety" ]

[ { "answer_id": 15762, "body": "<p>Drugs may have different actions at different concentrations.</p>\n\n<p>So, for instance:</p>\n\n<blockquote>\n <p>Buprenorphine is 25 to 100 times more potent than morphine.18 Buprenorphine exhibits partial agonist behavior at the mu-receptor and exhibits antagonist behavior at the kappa-receptor. Buprenorphine has a strong affinity for the mu-receptor causing tight binding and therefore competition at the receptor, displacing other opioids, such as methadone and morphine. Also, there is incomplete dissociation from the mu-receptor, causing prolonged activity at the receptor.18 Affinity is quantified using Ki values, and the smaller the Ki value, the stronger the binding affinity to the receptor. The mu binding affinity of buprenorphine compared with other opioids can be found in Table 5. Of note, buprenorphine has a higher binding affinity compared with naloxone and therefore at higher doses where buprenorphine is most likely to be abused, not readily reversed by naloxone. It is only at lower doses where there is some competitive binding, and only then should we reasonably expect some reversal by high doses of continuous infusion naloxone. </p>\n</blockquote>\n\n<p><a href=\"http://www.pharmacytimes.com/contributor/jeffrey-fudin/2018/01/opioid-agonists-partial-agonists-antagonists-oh-my\" rel=\"nofollow noreferrer\">http://www.pharmacytimes.com/contributor/jeffrey-fudin/2018/01/opioid-agonists-partial-agonists-antagonists-oh-my</a></p>\n", "score": 1 } ]

[ "drug-metabolism", "dosage", "drug-tolerance" ]

[ { "answer_id": 15830, "body": "<p>If you are unsure of the quality of the water supply, it is advised to not rewash the produce, as this risks re-contaminating the produce.</p>\n\n<p>With chemical disinfectants, the important bit is to get the balance of chemical to water - the dilution - correct. At a certain point, the chemical becomes harmless for human consumption.</p>\n\n<p><strong>Source</strong>: <a href=\"https://inspectapedia.com/water/Produce_Disinfection.php\" rel=\"nofollow noreferrer\">Inspectapedia</a></p>\n\n<blockquote>\n <p>Watch out: If you have one of these products, read the label for the required amount of chemical to add and the wait time to use before consuming the water.</p>\n</blockquote>\n\n<hr>\n\n<blockquote>\n <p>Once produce has been disinfected, do not wash it again in tap water. Doing-so removes the disinfectant and in communities where tap water itself may not be sanitary you risk re-infecting the produce.</p>\n</blockquote>\n", "score": 1 } ]

[ "food-safety", "food-poisoning" ]

[ { "answer_id": 16148, "body": "<p>Though adults can't grow anymore, as was explained by previous answers, cosmetic bone lengthening does exist.\nSimply explained, the surgeon breaks the bones and slowly extends the gap between the bone fragments as they heal. <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4182395/\" rel=\"nofollow noreferrer\">article</a></p>\n\n<p>There is little scientific evidence about the risks of this procedure, as it rarely done in the western world. But beside the regular surgical risks of wound infections, there is the risk of infection of the materials and non-union of the bones. Nerves could be damaged by distention and the range-of-motion of the lengthened limb could be limited by complications. </p>\n", "score": 1 } ]

[ "height" ]

[ { "answer_id": 16524, "body": "<p><strong>Unvaccinated members of a population contribute to the susceptibility of the rest of the population to disease, especially vulnerable people who cannot be vaccinated.</strong> This fact is true whether or not infectious individuals are asymptomatic for a long time or a short time.</p>\n\n<ol>\n<li><p>Many (if not most) infectious diseases are contagious before symptoms clearly manifest - including all 4 of the ones you listed. Infectious diseases <em>rarely</em> fully announce themselves before they are contagious, actually, and often viral shedding is highest at or before onset of symptoms. For example herpes simplex: it actually sheds the most <em>before</em> the stereotypical blister forms. <a href=\"https://en.wikipedia.org/wiki/Subclinical_infection\" rel=\"noreferrer\">The duration of the asymptomatic period of diseases varies widely</a> - some are carried and spread for years without ever knowing it. Yes, you can catch AND transmit many diseases before you even know you have it.</p></li>\n<li><p>Each infectious disease has a specific mode of transmission, and survive different lengths of time outside the body - ranging from minutes to years. Some respiratory viruses hang in the air in tiny particles for <a href=\"https://www.nhs.uk/chq/Pages/how-long-do-bacteria-and-viruses-live-outside-the-body.aspx\" rel=\"noreferrer\">minutes to potentially hours</a> - and not just by coughing or sneezing, many are transmitted just by breathing out. Without consistent and correct hand hygiene, fecal-oral transmission diseases can spread rapidly whether the person is symptomatic or not. (Especially kids - what kid is 100% perfect with hand hygiene?) Some infectious diseases shed in unpredictable cycles, others shed constantly. </p></li>\n<li><p>The epidemiology of infectious disease transmission and the impact of vaccination are both crystal clear. Creating herd immunity - minimizing the prevalence of a disease in a population to drastically drop transmission rates (especially for those who cannot be vaccinated for medical reasons) - requires everyone's participation. Vaccination is therefore an issue of both public health and community responsibility. </p>\n\n<ul>\n<li>In no uncertain terms: an unvaccinated person poses a health risk to both themselves and to their community.</li>\n</ul></li>\n<li><p>There is an entire <a href=\"https://www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html\" rel=\"noreferrer\">catch-up schedule</a> for a reason - doing it now, even if it's a late start, is far better than never doing it.</p></li>\n<li><p>If a child already has a disease, unless they are acutely ill, it is generally not harmful to give the vaccine for it. Sometimes it's okay even when they're acutely ill. (But one should always talk with a doctor for advising on one's individual case.) With a <em>few</em> diseases, giving the vaccine can actually help the body prevent the disease from fully developing - if given early enough. But do note this is <em>NOT</em> a reliable treatment, it is a there's-a-chance-it-could-help-so-it's-better-than-nothing type strategy, and only with certain diseases. The ideal situation is to be protected <em>before ever being exposed</em> to a disease.</p></li>\n<li><p>Again in no uncertain terms: although there are estimates of disease prevalence, including asymptomatic cases, it is impossible to be certain that an asymptomatic unvaccinated child doesn't have an infectious disease - unless you test them for it.</p></li>\n</ol>\n", "score": 15 } ]

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

[ { "answer_id": 16817, "body": "<blockquote>\n <p>Depressed persons typically stop performing basic tasks such as eating regularly, taking showers, going out and other similar mundane and boring tasks that requires self some discipline.</p>\n</blockquote>\n\n<p>[citation needed]</p>\n\n<blockquote>\n <p>What I am looking for is documentation or case studies on people that have been diagnosed with depression, yet still manage to perform normal ADL (Activities of daily living) such as grocery shopping, errands, social activities. How prevalent is the stereotypical lay in bed type of depression versus functional depression, and where can I find more resources on this?</p>\n</blockquote>\n\n<p><a href=\"https://www.webmd.com/depression/features/cope-depression\" rel=\"nofollow noreferrer\">There are cases of depression with ADL, and they are at least as common as the major depressive disorder</a>.</p>\n\n<hr>\n\n<p>Depression is a highly individual disease and comes in many sizes, shapes and forms. A form of depression is <a href=\"https://web.archive.org/web/20100106064958/http://www.health.harvard.edu/newsweek/Dysthymia.htm\" rel=\"nofollow noreferrer\">dysthymia</a>, or persistent depressive disorder (PDD) a long-lasting (>2 years) depression during which the individual may be functioning, and may also suffer from episodes of major depressive disorders (known as double-depression). This does not mean that PDD is less severe than other types of depression like MDD (major depressive disorder) or post-natal depression.</p>\n\n<p>The major depressive disorder (MDD) as such is defined as <em><a href=\"http://http:\" rel=\"nofollow noreferrer\">a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.</a></em> This means that there is a form of depression which is defined by being „disabling“ in a way. This does not mean that all types (or even more than one specific type of depression) </p>\n", "score": 1 } ]

[ "research", "depression" ]

[ { "answer_id": 17058, "body": "<p>In the <a href=\"https://www.bodybuilding.com/content/protein-carbs-fat.html\" rel=\"nofollow noreferrer\">bodybuilding scene</a>, the logic that you need to consume carbohydrates to build muscles is this:</p>\n\n<blockquote>\n <p>Protein calories will be used as an energy source when the body is\n lacking fat or carbohydrate calories for fuel. When the body receives\n sufficient quantities of proteins, fats and carbohydrates, protein\n will carry out its specific functions.</p>\n</blockquote>\n\n<p>Note, that the article never says you need to consume \"a lot\" of carbohydrates or have them with every meal; they don't even need to be carbohydrates - fats will do the same: provide calories for energy, so the proteins won't get burned and could be incorporated into the muscles.</p>\n\n<p>Garri, which is made from <a href=\"https://scielo.conicyt.cl/pdf/rchnut/v40n2/art12.pdf\" rel=\"nofollow noreferrer\">cassava</a>, contains a lot of soluble fiber, which can cause a lot of gas if consumed in great amounts. There are other high-carb foods with much less soluble fiber, for example, bread, pasta, potatoes and rice.</p>\n\n<p>Having >60% carbs in your diet is a risk factor for increased blood triglycerides, which might be further associated with increased risk of diabetes or heart disease, though (<a href=\"http://Having%20%3E60%25%20carbs%20in%20your%20diet%20is%20a%20risk%20factor%20for%20increased%20blood%20triglycerides,%20which%20might%20be%20further%20associated%20with%20increased%20risk%20of%20diabetes%20or%20heart%20disease,%20though.\" rel=\"nofollow noreferrer\">PubMed, 2000</a>).</p>\n\n<p>According to the following study, carbohydrate intake as such does not help to increase muscle mass: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850644/\" rel=\"nofollow noreferrer\">Is carbohydrate needed to further stimulate muscle protein synthesis/hypertrophy following resistance exercise? (PubMed, 2013)</a></p>\n\n<blockquote>\n <p>In conclusion, whilst it cannot be excluded that carbohydrate addition\n may provide benefits for recovering athletes, on the basis of\n available data, <em>no further beneficial actions of carbohydrates,</em>\n irrespective of GI, are evident concerning muscle hypertrophy when a\n protein supplement that maximally stimulate muscle protein synthesis\n is ingested.</p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/14594866\" rel=\"nofollow noreferrer\">Another study (PubMed, 2004)</a>:</p>\n\n<blockquote>\n <p>We conclude that ingestion of carbohydrates improved net leg protein\n balance after resistance exercise. However, the effect was minor and\n delayed compared with the previously reported effect of ingestion of\n amino acids.</p>\n</blockquote>\n", "score": 2 }, { "answer_id": 17072, "body": "<p>There is a much simpler reason why bulking up on carbs is good in general, also for bodybuilding. Your body needs energy, and hole grain carbs are a healthy source of energy, as its loaded with vitamins, minerals and fiber. The alternative would be to eat fat for energy but this has two drawbacks.</p>\n\n<p>The first drawback is that fat is pretty much an empty calorie source, it contains no vitamins, no minerals, and no fibers. While we do need small amounts of fats to absorb fat soluble vitamins and to get our essential Omega-3 and Omega-6 faty acids, we don't need it for energy.</p>\n\n<p>The second drawback is that burning carbs requires less oxygen than burning fat, because carbs contain more oxygen atoms than fat molecules. This is particularity important when doing cardio exercise. A body builder might not be too much concerned with that, but most body builders do build in quite some cardio training in their routine to maintain a good weight and fitness.</p>\n\n<p>As far as general health is concerned, there is quite strong evidence that limiting fat intake to 15% of total calories is good for health. As <a href=\"https://academic.oup.com/ije/article/41/5/1225/712708\" rel=\"nofollow noreferrer\">mentioned here</a>, in Uganda in the 1950s the rate of coronary heart disease in the African population was almost zero, while in the Asian population it was similar to what it is in the Western World. The explanation according to the article, for this difference is the fat in the diet.</p>\n\n<p>A recent finding is that the Tsimané people have <a href=\"https://www.theguardian.com/society/2017/mar/17/tsimane-of-the-bolivian-amazon-have-worlds-healthiest-hearts-says-study\" rel=\"nofollow noreferrer\">extremely low levels of heart disease</a>, much lower than lowest observed results in modern societies like the Japanese people in Okinawa or people sticking to the Mediterranean diet. The Tsimané people's diet contains roughly the same amount of fat as that of the Africans in Uganda in the 1950, its roughly 15% of the calorie intake.</p>\n", "score": 1 } ]

[ "nutrition", "diet", "exercise", "weight", "carbohydrates" ]

[ { "answer_id": 17303, "body": "<p>The hair structure of an adult is divided into three parts: shaft\\fiber, root and bulb. Hair root is located inside hair follicles in epidermis, which itselff is growing a shaft. The shaft (what we usually call hair) consists basically of solid keratin and absent of DNA so it cannot be called \"alive\" in a rigorous sense (<a href=\"https://en.wikipedia.org/wiki/Hair\" rel=\"nofollow noreferrer\">details</a>).</p>\n\n<p>Hair lifecycle consists of three stages: </p>\n\n<ul>\n<li>Anagen (1000 days), growth</li>\n<li>Catagen (10 days), transition</li>\n<li>Telogen (100 days), new hair start to grow from the same folicule; old one goes out </li>\n</ul>\n\n<p>So in fact ~90% of hair is growing at at any given time and it does not depends on hair length until follicule is damaged (<a href=\"https://en.wikipedia.org/wiki/Human_hair_growth\" rel=\"nofollow noreferrer\">details</a>). </p>\n\n<p>However hair grows affected by external factors like nutrition and ambient temperature, lower temperature more intensively hair grow. So the imaginary situation can happen when a extremely hairy person shaves her/his body hair, the thermoisolation worsens, then he\\she experience intensified hair growth. </p>\n\n<p>In other words all above explanations and examples are of speculations as human body is an extremely complex system and effects of second and third order and their interactions may influence, feedback and amplify each other. In the end to regourosly answer your question there should be controlled experemint to be carried out on twins to exclude genetetic variations. I did not find such or similar experiment in literature.</p>\n", "score": 0 } ]

[ "micronutrients", "lifestyle", "hair" ]

[ { "answer_id": 17314, "body": "<p><a href=\"https://www.cdc.gov/lyme/diagnosistesting/labtest/twostep/index.html\" rel=\"nofollow noreferrer\">Two-step Laboratory Testing Process</a> is recommended for Lyme decease detection. It takes several days depends on the laboratory to make the test. </p>\n\n<p>However in accordance to your post you were bitten by tick more than 30 days ago and you did not develop <a href=\"https://www.cdc.gov/lyme/signs_symptoms/index.html\" rel=\"nofollow noreferrer\">later signs &amp;symptoms</a>. So it gives evidences that the probability of the development of Lyme decease is quite low.</p>\n", "score": 1 } ]

[ "infection", "diagnosis", "lyme-disease" ]

[ { "answer_id": 17177, "body": "<p>I haven't read the article, only the abstract, but what it's saying is that, for people with grey or white hair, darkening of hair color is an indication that anti–PD-1/anti–PD-L1 treatment for lung cancer is working. This is almost entirely unrelated to reversing age-related hair depigmentation.</p>\n\n<p>(As a side note, I consider the Daily Mail to be comparable to <a href=\"https://en.wikipedia.org/wiki/The_Onion\" rel=\"nofollow noreferrer\">The Onion</a> when it comes to accuracy in medical reporting.)</p>\n", "score": 2 } ]

[ "medications", "hair", "treatment-options" ]

[ { "answer_id": 17269, "body": "<p>The stool at the top of the image of <a href=\"https://en.wikipedia.org/wiki/Bristol_stool_scale\" rel=\"nofollow noreferrer\">Bristol stool scale</a> looks as <strong>separate hard lumps</strong> (Type 1), which means there's a lack of water in it, which can be due to:</p>\n\n<ol>\n<li>Drinking insufficient amount of water while drinking alcohol</li>\n<li>Eating foods low in fiber (meat, dairy products, chips, white bread, cookies, chocolate, fast food...), which is common during drinking sessions </li>\n</ol>\n\n<p>It's fiber, mainly <a href=\"https://www.webmd.com/digestive-disorders/dietary-fiber-the-natural-solution-for-constipation#1\" rel=\"nofollow noreferrer\">insoluble fiber</a>, that absorbs water and makes the stool bulky (\"normal\"). Examples of foods high in insoluble fiber are whole grain bread, green leafy vegetables, legumes and fruits.</p>\n\n<hr>\n\n<p>However, excessive alcohol drinking more likely results in <strong>loose stools</strong> (Type 6 or 7 in Bristol stool scale), which is a known <a href=\"https://www.health.harvard.edu/staying-healthy/7-steps-to-cure-your-hangover-and-ginkgo-biloba-whats-the-verdict\" rel=\"nofollow noreferrer\">symptom of a hangover</a>. </p>\n\n<p>It can be alcohol itself or something other in the drink that can irritate the bowel. Or it can be a mixture of drinks and foods that you are not used to or do not really go together...</p>\n", "score": 1 } ]

[ "digestion", "alcohol", "stomach", "stools", "hangover-hungover" ]

[ { "answer_id": 17465, "body": "<p>\"Good kind of pain\" is not a precisely defined medical term, but the concept is certainly a familiar one on several levels.</p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/Pain\" rel=\"noreferrer\">Pain</a> is an <a href=\"https://www.newyorker.com/magazine/2018/07/02/the-neuroscience-of-pain\" rel=\"noreferrer\">incredibly complex</a> phenomenon that indeeds needs dissection for analysis. </p>\n\n<p>Depending on definitions there are a few kinds of \"good pain\" indeed. If you eat <a href=\"https://en.wikipedia.org/wiki/Capsaicin\" rel=\"noreferrer\">capsaicin</a> your pain receptors get stimulated and after getting used to it you even start to enjoy the right dose of pain (even if it is in reality only your appreciation for your bodies response to those fake pains).<br>\nA similar response can be observed in cutting as a symptom of mental disorder or conscious body modification, or in certain techniques found in BDSM aficionados.<br>\nIn all those cases one might argue that pain perception at the neurological level as such is really irrelevant and the psychological interpretation dominates the experience, which is then obviously found \"good\" by the participant.</p>\n\n<p>Apart from philosophical considerations of what is \"good\" or \"bad\" you might also look at it from a biological, evolutionary or physiological functions perspective. What is useful is \"good\". How can pain be useful?</p>\n\n<p>It keeps people from doing dangerous things. Alas, not from doing stupid things. But in sports there is for example the adage \"no pain, no gain\". This is often executed in a detrimental manner but hints at a connection to observe:</p>\n\n<blockquote>\n <p><strong><a href=\"https://www.pthealth.ca/blog/how-to-tell-the-difference-between-good-and-bad-pain/#\" rel=\"noreferrer\">How to Tell the Difference Between Good and Bad Pain</a></strong><br>\n <strong>What is good pain?</strong>\n One of the most common forms of “good pain” is what doctors and physiotherapists may refer to as delayed onset muscle soreness,” or DOMS. It happens when you’ve challenged a muscle with something it’s not used to (new, returning or increased exercise). Within one to two days, you’ll start to feel soreness in the area and it may be tender to touch. But, it goes away quickly after that.</p>\n \n <p>The pain comes from micro trauma in the muscle caused by rigorous exercise. But that’s not a bad thing. A muscle gets stronger, building denser tissue, when it has a reason to remodel itself. When it senses the tiny trauma, the muscle repairs tissue to allow for more endurance. The key here is the “micro” part of “trauma.”</p>\n</blockquote>\n\n<p>(You need to compare that with <a href=\"https://www.hopkinsmedicine.org/orthopaedic-surgery/about-us/ask-the-experts/pain.html\" rel=\"noreferrer\">'Good Pain' Versus 'Bad Pain' for Athletes</a>)</p>\n\n<p>And most importantly, our conscious minds are often quite bad of arriving at the right conclusion through reason alone. The more basic snsation of 'pain' can be quite a good signal telling us what to do: nothing. Keep at rest when you are ill.</p>\n\n<blockquote>\n <p><a href=\"https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-germany-vicodin.html\" rel=\"noreferrer\">The anesthesiologist explained</a> that during surgery and recovery I would be given strong painkillers, but once I got home the pain would not require narcotics. To paraphrase him, he said: “Pain is a part of life. We cannot eliminate it nor do we want to. The pain will guide you. You will know when to rest more; you will know when you are healing. If I give you Vicodin, you will no longer feel the pain, yes, but you will no longer know what your body is telling you. You might overexert yourself because you are no longer feeling the pain signals. All you need is rest. And please be careful with ibuprofen. It’s not good for your kidneys. Only take it if you must. Your body will heal itself with rest.”</p>\n</blockquote>\n\n<p>The episode of that series might therefore refer to pain associated with diagnosed illness, associated with healing, not that strong and about to end soon.</p>\n", "score": 4 } ]

[ "pain" ]

[ { "answer_id": 17785, "body": "<p>Simplified from <a href=\"http://www.fao.org/docrep/006/Y5022E/y5022e04.htm\" rel=\"nofollow noreferrer\">CALCULATION OF THE ENERGY CONTENT OF FOODS - ENERGY CONVERSION FACTORS (FAO.org)</a></p>\n\n<p>Food energy can be:</p>\n\n<ul>\n<li><strong>Combustible</strong> or <strong>ingested energy</strong> = theoretical maximum energy content of a food measured using bomb calorimetry (the energy you ingest)</li>\n<li><strong>Metabolizable energy (ME)</strong> = ingested energy minus energy lost in feces by indigestible nutrients (the energy listed on nutrition labels)</li>\n<li><strong>Net metabolizable energy (NME)</strong> = metabolizable energy minus energy converted into heat due to dietary-induced thermogenesis</li>\n</ul>\n\n<hr>\n\n<p>Comparison of ME (from food labels) and NME (potentially fattening energy) in different macronutrients (<a href=\"http://www.fao.org/docrep/006/Y5022E/y5022e04.htm\" rel=\"nofollow noreferrer\">FAO.org, table 3.3.</a>):</p>\n\n<ul>\n<li><strong>Protein</strong> (Calories/gram): ME = 4, NME = 3.2</li>\n<li><strong>Fat:</strong> ME = 9, NME = 9</li>\n<li><strong>Carbohydrates:</strong> ME = 4, NME = 4</li>\n<li><strong>Dietary fiber:</strong> ME = 2 (but wrongly counted as 4 on food labels), NME = 1.4</li>\n<li><strong>Alcohol:</strong> ME = 7, NME = 6.3</li>\n</ul>\n\n<p>On food labels, <em>dietary fiber</em> is listed under carbohydrates as having 4 Cal/g, but its ME is only 2 Cal/g and NME only 1.4 Cal/g. So, a certain carbohydrate food that has a lot of fiber can have significantly less energy than stated on the food label.</p>\n\n<p>The metabolic energy (ME) of <em>individual amino acids in proteins</em> can vary from 2 to 6 Cal/g (<a href=\"https://www.researchgate.net/publication/20915822_Energy_content_of_diets_of_variable_amino_acid_composition\" rel=\"nofollow noreferrer\">ResearchGate</a>). Most proteins contain most amino acids, but in different proportions. I haven't found, so far, if this results in significantly different caloric value of various proteins, such as in beef and egg white protein, for example.</p>\n\n<p><strong>In conclusion,</strong> net metabolic energy (NME), which is potentially fattening energy, tends to be lower than metabolic energy (ME) stated on the food labels, at least for proteins, dietary fiber and alcohol.</p>\n\n<p>The NME of certain nutrients can further differ due to personal factors, such as age, state of health, etc. and nutrient combinations (e.g., fiber can slightly inhibit the absorption of fat) (<a href=\"https://www.nature.com/articles/1602938\" rel=\"nofollow noreferrer\">European Journal of Clinical Nutrition</a>). So, Calories stated on the food labels are not fixed values, but, so far, I haven't found any evidence how could be this practically important.</p>\n", "score": 2 }, { "answer_id": 17784, "body": "<p>The definition of a Calorie (Note the big C, a food calorie is actually a kilocalorie, or 1000 small calories) is simply the amount of heat necessary to raise the temperature of 1 kilogram of water 1 degree Celsius.</p>\n\n<p>To get this, originally foods were burned in a bomb calorimeter, and the calories determined by the rise in heat of the water. Now (At least in the United States), they are determined more indirectly using the Atwater system. (This was done to comply with federal labeling laws, that require it to be estimated from food components, so elements such as fiber were taken out). </p>\n\n<p>The <a href=\"https://en.wikipedia.org/wiki/Atwater_system\" rel=\"nofollow noreferrer\">wikipedia entry is decent</a>, and has links to pages pointing out the flaws in the system, and there is a short <a href=\"https://www.scientificamerican.com/article/how-do-food-manufacturers/\" rel=\"nofollow noreferrer\">https://www.scientificamerican.com/article/how-do-food-manufacturers/</a> as well.</p>\n\n<p>So as a summation, it is an estimation of the amount of food calories that are potentially in a food. As with anything, different people process in various efficiencies, so there is no true way to know how much actual energy you personally are getting out of a food item.</p>\n", "score": 1 } ]

[ "nutrition", "energy", "macronutrient" ]

[ { "answer_id": 18168, "body": "<p>First, don't hold your 4 year old child upside down when performing abdominal thrusts for choking.</p>\n\n<p>This is what you (and any bystander) should do for a choking child (Note that intervention for a choking child is appropriate for any individual to perform, though one should obtain consent from a parent if they are there. You do not need to be a healthcare provider to do this)</p>\n\n<p>Current guidelines on pediatric basic life support can be found <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741664/\" rel=\"nofollow noreferrer\">here</a>. </p>\n\n<p>For any individual experiencing foreign body airway obstruction, if they are able to cough or make a sound, <strong>do not attempt abdominal thrusts or back blows</strong>. For a child or infant this is particularly important because these interventions can convert a partial airway obstruction to a full airway obstruction.</p>\n\n<p><strong>IF AND ONLY IF THEY ARE UNABLE TO MAKE A SOUND</strong> you have a full airway obstruction. This is where you intervene. Children over 1 (e.g., the 4 year old in the OP) should receive abdominal thrusts, aka the Heimlich maneuver. Current recommendations (current today, 12/10/2018) do not include alternating abdominal thrusts with back blows. </p>\n\n<p>Correct technique for abdominal thrusts for a child are described in <a href=\"https://www.redcross.org/content/dam/redcross/atg/PDF_s/Health___Safety_Services/Training/Pediatric_ready_reference.pdf\" rel=\"nofollow noreferrer\">this red cross pamphlet</a>. Note that the algorithm in this pamphlet is outdated (it recommends alternating back blows and abdominal thrusts), but the photos demonstrating the abdominal thrust technique are useful (and correct). Don't hold your child upside down or hold them up in the air. Do get down on your knee (see the picture below) if you need to in order to put your hands in the correct position (just above the child's abdomen) and perform the thrust without lifting them off the ground.</p>\n\n<blockquote>\n <p>ABDOMINAL THRUSTS:</p>\n \n <ul>\n <li><p>Place a fist with the thumb side against the middle of the child's abdomen, just above the navel.</p></li>\n <li><p>Cover your fist with your other hand</p></li>\n <li><p>Give quick, upward abdominal thrusts</p></li>\n </ul>\n \n <p><a href=\"https://i.stack.imgur.com/uIp4w.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/uIp4w.png\" alt=\"enter image description here\"></a>\n <a href=\"https://i.stack.imgur.com/QHlDg.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/QHlDg.png\" alt=\"enter image description here\"></a></p>\n</blockquote>\n\n<p>There is a case where care of a foreign body airway obstruction involves holding a child at a downward angle. This is ONLY for infants (0-1 year old). </p>\n\n<p>Infants (0-1 year) should receive back blows alternating with chest compressions. The reason you provide chest compressions for airway obstruction in infants is because airway obstruction and respiratory failure of an infant quickly leads to cardiac arrest. The technique is described well (with pictures) in this <a href=\"https://www.redcross.org/content/dam/redcross/atg/PDF_s/Health___Safety_Services/Training/Pediatric_ready_reference.pdf\" rel=\"nofollow noreferrer\">red cross pamphlet</a>. Note again that this particular pamphlet has outdated recommendations for older children (recommending alternating back flows and abdominal thrusts), but the infant technique is current:</p>\n\n<blockquote>\n <h3>CONSCIOUS CHOKING--INFANT</h3>\n \n <p>Cannot Cough, Cry or Breathe</p>\n \n <ul>\n <li><ol>\n <li>GIVE 5 BACK BLOWS:\n Give firm back blows with the heel of one hand between the infant's shoulder blades</li>\n </ol></li>\n </ul>\n \n <p><a href=\"https://i.stack.imgur.com/BHJnG.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/BHJnG.png\" alt=\"enter image description here\"></a></p>\n \n <ul>\n <li><ol start=\"2\">\n <li>GIVE 5 CHEST THRUSTS:\n Place two or three fingers in the center of the infant's chest just below the nipple line and compress the breastbone about 1 1/2 inches. TIP: Support the head and neck securely when giving back blows and chest thrusts. keep the head lower than the chest.</li>\n </ol></li>\n </ul>\n \n <p><a href=\"https://i.stack.imgur.com/HeIVV.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/HeIVV.png\" alt=\"enter image description here\"></a></p>\n \n <ul>\n <li><ol start=\"3\">\n <li><p>CONTINUE CARE: \n Continue sets of 5 back blows and 5 chest thrusts until the: </p>\n \n <ul>\n <li><p>Object is forced out</p></li>\n <li><p>Infant can cough forcefully, cry or breathe</p></li>\n <li><p>Infant becomes unconscious</p></li>\n </ul></li>\n </ol></li>\n </ul>\n \n <p><strong>WHAT TO DO NEXT</strong>: If infant becomes unconscious--CALL 9 -1 -1, if not already done. Carefully lower the infant onto a firm, flat surface, and give CARE for an unconscious choking infant, beginning with looking for an object (PANEL 6, Step 3).</p>\n</blockquote>\n", "score": 8 } ]

[ "heimlich-maneuver" ]

[ { "answer_id": 18170, "body": "<p>Your milk and chicken both have bacteria in them. If you leave them at room temperature, those bacteria will grow rapidly. Some may produce toxins that will not be inactivated by cooking. The greater the dosage of these bacteria, the more likely they are to make you sick. Keeping stored food cold (below 40&deg;F / 5&deg;C) is an important part of basic food safety for reducing the risk of foodborne illness. Now, this doesn't mean that you will always get sick if you eat or drink milk or chicken that has been at room temperature for too long, but it does mean you will be more likely to get sick. Beyond health and safety, you will immediately notice the difference if you put a closed container of milk on the counter for 24 hours, and put another one in a cold refrigerator for 24 hours. You can run this experiment on your own (just don't drink the milk you left out).</p>\n\n<p>You can read more about the importance of refrigeration at various public health websites. Here, for example, is some good information from the <a href=\"https://www.fsis.usda.gov/shared/PDF/Refrigeration_and_Food_Safety.pdf\" rel=\"noreferrer\">US department of agriculture</a>.</p>\n", "score": 6 } ]

[ "food-safety", "refrigerate-refrigeration", "microbiology" ]

[ { "answer_id": 19468, "body": "<blockquote>\n <p>Was ECT done while being awake in 78? What about 2000 and what about now?</p>\n</blockquote>\n\n<p>Generally speaking no - the ECT done in <em>Requiem for a Dream</em> is the older so-called \"unmodified\" form where anesthesia and muscle relaxants weren't used. This was largely phased out in the 1950s and 1960s and replaced by the modern form where <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444214/\" rel=\"noreferrer\">general anesthesia and muscle relaxants are given</a> (both to avoid pain and the possible fractures to the long bones from the convulsions) so it would have been unlikely to have been in widespread use in 1978 (and even less so in 2000).</p>\n\n<p>So I think it's safe to say that Selby was taking a bit of dramatic license by using the \"unmodified\" form in his depiction (much like <em>One Flew Over the Cuckoo's Nest</em> exaggerated the minor retrograde amnesia effect into total memory loss).</p>\n\n<blockquote>\n <p>Does ECT really hurt?</p>\n</blockquote>\n\n<p>The original \"unmodified\" form most likely does - from the potential for secondary injuries to convulsing limbs if nothing else.</p>\n", "score": 5 } ]

[ "mental-health", "side-effects", "electroconvulsive-therapy" ]

[ { "answer_id": 19727, "body": "<p>With 5 or 6 through-and-through gunshot wounds to the chest, the death I would expect to see would be utter silence. Almost instant unconsciousness and cardiac arrest would be the most likely outcome from such massive damage. What people often don't realize about gunshot wounds is that as a bullet travels through flesh, it creates a wound channel much wider than the bullet itself due to <a href=\"https://www.jems.com/articles/print/volume-37/issue-4/patient-care/penetrating-trauma-wounds-challenge-ems.html\" rel=\"nofollow noreferrer\">cavitation</a> (scroll down). And if the bullet is a hollow point, it also flattens out and becomes much wider, making an even larger wound channel.</p>\n\n<blockquote>\n <p><strong>2. Cavitation</strong>: When a high-energy projectile travels through the relatively liquid human body, it forms a cavity along the track of the\n bullet. In actuality, there is both a permanent and a temporary cavity\n formed. As a bullet moves through the tissues the energy of the bullet\n causes a temporary radial stretching, forming a cavity that soon\n closes as the energy is dissipated. However, within the central\n portion of the projectile path there will be enough tissue damage to\n cause a permanent cavity. For low-velocity weapons, such as knives,\n there’s little difference between the permanent and temporary cavity.\n As the energy of the projectile increases, however, the size of the\n temporary cavity increases accordingly. In essence, a considerable\n amount of damage is done by the formation of the temporary cavity.\n This is why high-velocity/high-energy weapons can cause so much more\n damage.</p>\n \n <p><strong>3. Shock wave</strong>: This is a rapid change in pressure, temperature or density secondary to the projectile. In high-energy, high-velocity\n weapons, shock waves can sometimes approach 200 atmospheres of\n pressure. The shock wave generated by the bullet usually lasts only a\n few microseconds. However, the result can be extremely damaging.</p>\n \n <p>Several factors related to the bullet affect the subsequent injury.\n One of these is the bullet’s profile. The profile is the size and\n shape of the bullet as it contacts the human body. The larger the\n profile, the greater will be the rate of subsequent energy exchange.\n Most bullets will rotate or tumble somewhat on their axis during\n travel. Yaw often takes the bullet slightly off of its course. This\n can occur during travel through the air or as the bullet strikes the\n body. Short, high-velocity bullets tend to yaw and rotate more\n severely when they strike human tissue. Rifles contain grooves within\n the barrel (rifling) that imparts a spin on the projectile that serves\n to minimize yaw and tumble. Thus, the greater the yaw or tumble of a\n projectile, the more rapid the subsequent delivery of kinetic energy\n and resultant damage. The shape of the bullet also affects the\n subsequent energy delivery. Some bullets are designed to expand when\n they strike an object, causing more injury.</p>\n</blockquote>\n\n<p>The point of the above is that the finger-sized entrance wounds you see would become much larger internally, so the odds of all those bullets not hitting something immediately lethal is vanishingly small. With that much damage, I would expect almost instant unconsciousness from massive blood loss.</p>\n\n<p>Yes, it's remotely possible all those bullets miraculously missed his heart, aorta, and assorted other major vessels, leading to a slower, more dramatic death. For purposes of making a movie, that's certainly a more dramatic ending and the one they chose for that reason. After all, bodies lying face down on the pavement are pretty boring.</p>\n\n<p>As for the comment you asked about, that's mostly rubbish. What you see in the video that could be realistic is the <a href=\"https://en.wikipedia.org/wiki/Agonal_respiration\" rel=\"nofollow noreferrer\">agonal respirations</a>, but the comment didn't even mention that. The bit about organs shutting down, flashbacks, and nerve endings firing is a bunch of stuff from the commenter's imagination.</p>\n\n<p>What's actually going to happen is he will be bleeding massively in the chest. The physical damage and blood loss will lead to <a href=\"https://en.wikipedia.org/wiki/Cardiac_tamponade\" rel=\"nofollow noreferrer\">cardiac tamponade</a>, <a href=\"https://en.wikipedia.org/wiki/Hemopneumothorax\" rel=\"nofollow noreferrer\">hemopneumothorax</a>, <a href=\"https://en.wikipedia.org/wiki/Shock_(circulatory)\" rel=\"nofollow noreferrer\">shock</a>, unconsciousness, perhaps some agonal respirations, perhaps a brief seizure, and cardiac arrest. </p>\n\n<p><strong>TL;DR:</strong></p>\n\n<p><strong>The commenter's opinion that it's a highly realistic portrayal of death is unfounded. It is dramatized.</strong></p>\n", "score": 4 } ]

[ "death", "wound", "gunshot-wounds" ]

[ { "answer_id": 19850, "body": "<p>First, it is basal cell cancer/ basal cell carcinoma (BCC) whose leading cause is generally thought to be from sun exposure/solar radiation (1). </p>\n\n<p>Second, There has been absolutely no research into this hypothesis, nor could I find any research into circulation being cut off to ears and thus making them more susceptible to basal cell cancer. \nDo you have any research that suggests/supports your thoughts?</p>\n\n<p>Here is a really great <a href=\"https://www.researchgate.net/profile/Miguel_Cordova3/publication/325241322_Basal_Cell_Carcinoma_Part_1/links/5bc0cafb299bf1004c5b023e/Basal-Cell-Carcinoma-Part-1.pdf\" rel=\"nofollow noreferrer\">summary paper</a> written for the Journal of American Academy of Dermatology outlining most of the history, presentation, typical costs and summary statistics (what we currently know) about basal cell carcinoma. </p>\n\n<p>(1) Gallagher RP, Hill GB, Bajdik CD, et al. Sunlight Exposure, Pigmentary Factors, and Risk of Nonmelanocytic Skin Cancer: I. Basal Cell Carcinoma. Arch Dermatol. 1995;131(2):157–163. doi:10.1001/archderm.1995.01690140041006</p>\n", "score": 3 } ]

[ "cancer", "glasses" ]

[ { "answer_id": 20423, "body": "<p>Nasal mucus is made out of \" It is a viscous colloid containing inorganic salts, antimicrobial enzymes (such as lysozymes), immunoglobulins, and glycoproteins such as lactoferrin\", writes the author of the wiki page of \"mucus\", citing <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12037568\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/12037568</a>. Glycoproteins are proteins linked by polysaccharides (complex sugars)</p>\n\n<p><a href=\"https://journals.sagepub.com/doi/abs/10.1177/194589240501900203\" rel=\"nofollow noreferrer\">https://journals.sagepub.com/doi/abs/10.1177/194589240501900203</a> nasal mucus often also contains the <em>candida albicans</em> fungus.</p>\n\n<p>the prevailing belief is that snot is just a vessel to carry out pathogens, but as you see in the structural description there are immunoglobulins (antibodies), and antimicrobial enzymes, so the pathogens that get mixed up in it are also actively being destroyed. </p>\n\n<p>I've been told all my life that, when one's sick, the change in color of the mucus is an indication of the levels of pathogens in the mucus. Regardless of whether or not that's actually what's going on (I've never blown my nose on a microscope slide), the mucus in one's body doesn't have pathogens as a fundamental component, but it is a vessel for immune cells that are specialized to act against pathogens, so it does seem to expect their presence. If your nose is running because your body is expelling pathogens there's a high chance that they're in the mucus coming out, otherwise it probably varies a lot, and might get to the zero point if your body (esp around your nose and throat) is totally pathogen free. Allergy runny noses might have more histamines, and runny noses on a cold day might be the most \"blank\", with nothing but inorganic salts, antimicrobial enzymes (such as lysozymes), immunoglobulins, glycoproteins, fungi, and whatever bacteria's in your nostrils.</p>\n", "score": 3 } ]

[ "infection", "immune-system", "allergy", "bacteria", "nose" ]

[ { "answer_id": 20739, "body": "<p>Pink is a <a href=\"https://pillbox.nlm.nih.gov/results.html?medicine_name=&amp;imprint=&amp;shape=&amp;color=Pink&amp;inactive_ingredients=&amp;repackaged=false&amp;page=1&amp;items_per_page=20\" rel=\"nofollow noreferrer\">common pill color</a>. Nothing can be known about the composition of a pill based solely on its color; pink does not indicate any particular drug or class of drugs.</p>\n\n<p>In recent years, a reference to the \"little pink pill\" in the media:</p>\n\n<p><a href=\"https://www.nbcnews.com/health/sexual-health/fda-approves-controversial-female-viagra-restrictions-n412116\" rel=\"nofollow noreferrer\">https://www.nbcnews.com/health/sexual-health/fda-approves-controversial-female-viagra-restrictions-n412116</a></p>\n\n<p><a href=\"https://www.usatoday.com/story/news/nation-now/2015/08/18/addyi-drug-sprout-pharmaceuticals-fda/31963219/\" rel=\"nofollow noreferrer\">https://www.usatoday.com/story/news/nation-now/2015/08/18/addyi-drug-sprout-pharmaceuticals-fda/31963219/</a></p>\n\n<p><a href=\"https://www.wnycstudios.org/podcasts/otm/segments/little-pink-pill\" rel=\"nofollow noreferrer\">https://www.wnycstudios.org/podcasts/otm/segments/little-pink-pill</a></p>\n\n<p>may refer to the drug flibanserin, used to treat impaired libido in women, but this would not explain references in the 1960s or 1980s.</p>\n", "score": 1 } ]

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

[ { "answer_id": 20852, "body": "<p>In the US, medical device sales are regulated by the FDA much like drugs.</p>\n\n<p>Like drugs, some items are permitted for over-the-counter (OTC) sale to the public (for example, bandages and thermometers). Others can only be sold to medical professionals. Diagnostic devices that require a professional to interpret are very unlikely to be available OTC.</p>\n\n<p>Other countries have similar rules according to whatever regulatory body has jurisdiction.</p>\n", "score": 3 } ]

[ "mri", "ultrasounds" ]

[ { "answer_id": 21388, "body": "<p>The premise of your question is incorrect. The UK Government's strategy is described in <a href=\"https://youtu.be/A0chs7bVQ8Y?t=501\" rel=\"nofollow noreferrer\">this press conference</a> and involves a staged increase in social distancing and quarantine. The plan takes into account the projected epidemic trajectory and data about likely human behaviour under voluntary quarantine. </p>\n\n<p>'Flattening the curve' is explicitly stated to be the main goal of the policy.</p>\n", "score": 1 } ]

[ "covid-19", "epidemiology" ]

[ { "answer_id": 21397, "body": "<p>The linked post (which reads to me rather like rant than a news post) not the underlying CNN article indiate that the manufacturer actually applied for FDA EUA (Emergency Use Approval). Without such an application, there (rather obviously) won't be an approval. </p>\n\n<blockquote>\n <p>Was the test evaluated by the FDA?</p>\n</blockquote>\n\n<ul>\n<li><p>The clinical evaluation needs to be done by the manufacturer, not by the FDA. The FDA then evaluates the results submitted by the manufacturer with ther EUA application. </p></li>\n<li><p>The test is not on the <a href=\"https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency-use-authorizations#covid19ivd\" rel=\"nofollow noreferrer\">FDA page that lists approved tests</a>.<br>\nWe don't know why. E.g., whether they it did not pass the FDA EUA requirements (I'd think that unlikely) or the manufacturer never applied (which may be totally sensible for several reasons, e.g. if their manufacturing capactity is such that all the tests they produce are bought, say, in East Asia)</p></li>\n</ul>\n\n<blockquote>\n <p>What rigors did FDA approval of the Roche COVID test meet? </p>\n</blockquote>\n\n<ul>\n<li>see the <a href=\"https://www.fda.gov/media/136049/download\" rel=\"nofollow noreferrer\">FDA FAQ on getting EUA and requirements for using a test even before that EUA is in place</a> on the general requirements and </li>\n<li>the <a href=\"https://www.fda.gov/media/136049/download\" rel=\"nofollow noreferrer\">Roche test Manufacturer's instructions listing their validation results</a> in particular.</li>\n<li>FDA explicitly says that they want the manufacturer to be in early contact with them. </li>\n</ul>\n\n<hr>\n\n<p>A few more thoughts:</p>\n\n<ul>\n<li><p>It is not only the test kit that needs approval, the test kit gets approved for use with certain extraction equipment (manufacturer &amp; possibly model) and also the lab needs certain approval.<br>\nIt may be that in East Asia different machines (other manufacturers) are used, so that the South Korean approval cannot be used for evaluating performance with the machinery predominantly used by US labs.</p></li>\n<li><p>The first EUA for the CDC Covid test was granted by the FDA on Feb. 4th. I.e., one day before Seegene had their first test kit according to the <a href=\"https://edition.cnn.com/2020/03/12/asia/coronavirus-south-korea-testing-intl-hnk/index.html\" rel=\"nofollow noreferrer\">CNN post</a> and thus more than a week before the Seegene test got South Korean fast-track approval. </p></li>\n<li><p>That such a test with fast track validation may turn out not to be that great after all is a known risk which is accepted in the current situation in order to have tests available at all. <em>We still would not expect faulty reagents in the test kit, though.</em> </p></li>\n<li><p>Theres nothing <em>that unique</em> about the South Korean test manufacturer. There are other manufacturers and also ones that were apparently even earlier (sent out first [unapproved] tests on Jan 10th) than the South Koreans, see e.g. this new post about a <a href=\"https://www.tagesspiegel.de/berlin/tib-molbiol-berliner-firma-produziert-coronavirus-tests-fuer-die-ganze-welt/25602142.html\" rel=\"nofollow noreferrer\">Berlin manufacturer of such tests (in German)</a>. This news post reads very similar to the South Korean, just with a different company.</p></li>\n<li><p>We also don't know yet how long/where which test will perform well as mutations of the virus will happen - and they may affect the performance of some tests but possibly not others. The Berlin test manufacturer discusses this in another <a href=\"https://taz.de/Produzent-von-Corona-Tests/!5671485/\" rel=\"nofollow noreferrer\">newspaper article/interview</a>.</p></li>\n<li><p>AFAIK, other test kits also don't require manual PCR - whether in some countries the testing is done manually because the local approved labs don't have automated extraction/PCR machinery in place is a totally different question. </p></li>\n</ul>\n", "score": 2 } ]

[ "covid-19" ]

[ { "answer_id": 21443, "body": "<p>The Aloe Vera is just to help moisturize the skin and is being used when glycerine can't be bought.</p>\n\n<p>Essential oils are a waste of time, and you need to add a water based substance to moisturize the skin.</p>\n\n<p>You need ethanol or isopropylalcohol as the basis of your sanitizer so that the final concentration is over 60%.</p>\n\n<p><a href=\"https://youtu.be/WVvtF5uOX3Q\" rel=\"nofollow noreferrer\">https://youtu.be/WVvtF5uOX3Q</a></p>\n", "score": 2 } ]

[ "covid-19", "alcohol", "hygiene" ]

[ { "answer_id": 21654, "body": "<p>The big difference in Italy today is that <em>many younger, otherwise healthier patients need critical care</em> and more generally that <em>patients need critical care for a long time</em>. These patients are not necessarily dying after they get care, but the extent to which the surviving patients require ventilators and supplemental oxygen is nothing like a seasonal flu and is likely inflating the death rate substantially among those who could otherwise be treated.</p>\n\n<p>From NEJM: <a href=\"https://www.nejm.org/doi/full/10.1056/NEJMp2005492\" rel=\"nofollow noreferrer\">https://www.nejm.org/doi/full/10.1056/NEJMp2005492</a></p>\n\n<blockquote>\n <p>Contributing to the resource scarcity is the prolonged intubation many of these patients require as they recover from pneumonia — often 15 to 20 days of mechanical ventilation, with several hours spent in the prone position and then, typically, a very slow weaning. In the midst of the outbreak’s peak in northern Italy, as physicians struggled to wean patients off ventilators while others developed severe respiratory decompensation, hospitals had to lower the age cutoff — from 80 to 75 at one hospital, for instance.</p>\n</blockquote>\n", "score": 2 }, { "answer_id": 21652, "body": "<p>You're misreading the study. It's not measuring the number of deaths due to influenza, it's measuring the excess mortality rate during the flu season. This covers not just direct deaths from infection, but secondary deaths such as someone getting the flu, recovering, and then dying from a heart attack caused by the stress of being sick. It can even include highly indirect deaths, such as someone isolating themselves to avoid infection, and dying because they fell down, broke their leg, and couldn't contact anyone for help.</p>\n\n<p>Excess mortality rate is calculated by estimating how many deaths there would have been in the absence of a given cause (eg. a flu season) and then comparing that to the actual number of deaths.</p>\n", "score": 1 }, { "answer_id": 23030, "body": "<p>Adding another possible explanation (supporting what Mark said): according to an article in <a href=\"https://www.ecodibergamo.it/stories/bergamo-citta/coronavirus-the-real-death-tool-4500-victims-in-one-month-in-the-province-of_1347414_11/\" rel=\"nofollow noreferrer\">L’Eco di Bergamo</a>, the excess mortality from Covid-19 seems to be about 2.2 times more than the official mortality numbers. (Mostly due to the shortage of testing and the rules for ascribing reasons for death. The data is restricted to the most affected region only.)</p>\n", "score": 0 } ]

[ "influenza" ]

[ { "answer_id": 22962, "body": "<p>There is no known way to infect yourself with a \"safe\" dose of SARS-CoV-2. The eyes are listed as a portal of infection which is why health workers wear eye protection (goggles, face shields ).</p>\n\n<p>Once the virus infects human cells it starts to replicate creating more virus. At some stage the immune system will ramp up and detect the virus but this takes time. Even if you find a dose of the virus to infect yourself, how are you going to count a few hundred or a few thousand virus particles and make sure you don't exceed the infectious dose? And that may depend also on host factors.</p>\n\n<blockquote>\n <p>The average number of viral particles needed to establish an infection is known as the infectious dose. We don’t know what this is for covid-19 yet, but given how rapidly the disease is spreading, it is likely to be relatively low – in the region of a few hundred or thousand particles, says Willem van Schaik at the University of Birmingham, UK.</p>\n</blockquote>\n\n<p>Read more: <a href=\"https://www.newscientist.com/article/2238819-does-a-high-viral-load-or-infectious-dose-make-covid-19-worse/#ixzz6IUiniq2D\" rel=\"nofollow noreferrer\">https://www.newscientist.com/article/2238819-does-a-high-viral-load-or-infectious-dose-make-covid-19-worse/#ixzz6IUiniq2D</a></p>\n", "score": 2 } ]

[ "preventative-medicine", "sars-cov-2" ]

[ { "answer_id": 23038, "body": "<p>I believe you may be referring to the concept of heterologous immunity. This is when immunity to one virus confers some immunity to other pathogens too. There is a great review by Pusch et al (citation below) that indicates that there may be some degree of heterologous immunity between coronaviruses. Specifically, vaccination with a viral vaccine vector encoding a SARS-CoV CD4+ T cell epitope protected mice from infection with MERS-CoV, another coronavirus. However, by and large, infection with one coronavirus does not completely protect you from infections with other coronaviruses. </p>\n\n<p>Pusch, E., Renz, H. &amp; Skevaki, C. Respiratory virus-induced heterologous immunity. Allergo J Int 27, 79–96 (2018). <a href=\"https://doi-org.ezproxy.med.cornell.edu/10.1007/s40629-018-0056-0\" rel=\"nofollow noreferrer\">https://doi-org.ezproxy.med.cornell.edu/10.1007/s40629-018-0056-0</a></p>\n", "score": 1 } ]

[ "covid-19", "coronavirus" ]

[ { "answer_id": 23115, "body": "<p>Death is the result of some kind of systemic failure in the human body. What in medicine is sometimes called \"natural death\" is the kind of death that seems not violent to the observers, the distinction natural vs. unnatural does have various interpretations but no fixed meaning (check e. g. Wikipedia <a href=\"https://en.wikipedia.org/wiki/Manner_of_death\" rel=\"nofollow noreferrer\">https://en.wikipedia.org/wiki/Manner_of_death</a> that distinguishes death from infectious diseases as non-natural).</p>\n\n<p>Aside of this, it is not always very easy to determine the exact reason for death. Pathologists try to establish a chain of causes that lead to death but this is, even after post-mortem examination or autopsy, not always conclusive from a scientific point of view.</p>\n\n<p>One way to establish a death primarily by COVID-19 as causal factor would be an otherwise completely healthy person that had regular medical checkups (as not to overlook something else) that suddenly became ill with COVID-19 and died of the consequences of the disease. \nIf it has not been established that an otherwise healthy person was COVID-19 positive then a post-mortem diagnosis may be done as well (e. g. see WHO's <a href=\"https://apps.who.int/iris/handle/10665/331329\" rel=\"nofollow noreferrer\">https://apps.who.int/iris/handle/10665/331329</a> where there is a checkbox to indicate whether the sample was taken post-mortem).</p>\n\n<p>Most COVID-19 deaths occur in people having previous illnesses. One way people die in this situation is that the systemic failure due to various previous illnesses is seriously aggravated by having to fight off yet another disease that has side effects on various organ systems. This acute disease on an otherwise possibly chronically stable situation can push a person's condition from fragile but stable, i. e. compensated, to decompensation and death.</p>\n", "score": 2 }, { "answer_id": 23120, "body": "<p>You said</p>\n\n<blockquote>\n <p>But afaik a big portion of them didn't actually die because of the virus directly, but they instead were infected with it in the past and in the fight between the immune system and the virus the immune got so weak, that other viruses could attack the body with its defences down. So the person technically died to other viruses and only indirectly to the coronavirus.</p>\n</blockquote>\n\n<p>How did you know this? We have no data to suggest that any of the statements you made here are correct.</p>\n\n<p>The cause of death is determined by the treating clinician or at post mortem. Covid-19 attacks a number of organ systems including the lungs, heart, liver, kidneys, pancreas and gut.</p>\n\n<p>It's pretty obvious to the treating clinician what the cause of death is. The immediate cause may be the heart stops, but the underlying cause may be inflammation of the heart caused by virus, or because lack of oxygen triggers a heart attack and so forth. In short it's a clinical decision. If someone dies at home, then a post mortem could be done but in this current pandemic, it would be unwise and dangerous to do so without full protective equipment.</p>\n\n<blockquote>\n <p>“We’ve made it very clear, every time I’ve been up here, about the comorbidities,” Birx said Wednesday during the White House press briefing. “This has been known from the beginning. So those individuals will have an underlying condition but that underlying condition did not cause their acute death when it’s related to a Covid infection.”</p>\n</blockquote>\n\n<p><a href=\"https://edition.cnn.com/world/live-news/coronavirus-pandemic-04-08-20/index.html\" rel=\"nofollow noreferrer\">https://edition.cnn.com/world/live-news/coronavirus-pandemic-04-08-20/index.html</a></p>\n", "score": 2 } ]

[ "covid-19", "virus", "death" ]

[ { "answer_id": 23209, "body": "<p>That paper analyses the origin of the strains observed in NYC (spoiler: most came from Europe). The paper doesn't discuss at all the \"dangerousness\" of the strains. One could have spread more simply because more travellers arrived to NYC from Europe than from Washington state (the 2nd most common source/strain) or any other locally favorable factors. (For example, two prior \"failed\" introductions were one from the Middle East and another one from Europe. The paper doesn't discuss why these didn't spread in NTC, e.g. whether it was effective quarantine of the person carrying them, or some other [lucky] reason.)</p>\n\n<p>Also there's not discussion on immunity whatsoever in the paper, so drawing any conclusions from there as to antibodies for which strain protect against which [other] is completely unsupported by that paper.</p>\n", "score": 3 } ]

[ "covid-19", "vaccination" ]

[ { "answer_id": 23257, "body": "<p>Your question is very broad but I can provide some insight into obesity and vaccinations.</p>\n\n<p>One concern is that childhood obesity (and potentially adult obesity) will worsen during this lockdown. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/32227671\" rel=\"nofollow noreferrer\">In a recent editorial</a>, the author argues that children's physical activity will likely decrease during this lockdown and, with decreased access to school food, households will likely stock up on non-perishable foods that are dense in calories. In addition, <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/32227671\" rel=\"nofollow noreferrer\">they cite</a> previous research showing that children tend to gain weight during summer breaks, and the lockdown may worsen this phenomenon. </p>\n\n<p>Another concern in primary care is the inability for people to access routine vaccinations. In particular, <a href=\"https://www.who.int/immunization/diseases/measles/statement_missing_measles_vaccines_covid-19/en/\" rel=\"nofollow noreferrer\">millions of children</a> are missing out on the measles vaccine. <a href=\"https://www.cidrap.umn.edu/news-perspective/2019/09/us-measles-cases-hit-1234-brooklyn-outbreak-called-over\" rel=\"nofollow noreferrer\">In recent years there have already been outbreaks</a> of measles due to decreased rates of vaccination, and so there is high risk for more outbreaks. One can generalize that adults may also be missing out on key vaccines such as pneumococcal pneumonia or shingles -- perhaps there will be increased rates of pneumonia or shingles as a result.</p>\n\n<p>Of course, increases in both obesity and vaccine-preventable diseases can increase health risks and increase the risk of death.</p>\n", "score": 2 } ]

[ "covid-19" ]

[ { "answer_id": 23325, "body": "<p>We don't know yet whether sunlight will inactivate COVID-19.</p>\n\n<blockquote>\n <p>Sunlight contains three types of ultraviolet light — UVA, which tans your skin (and ages it) and can cause eye damage; UVB, which burns and also ages skin; and UVC, which is \"the most harmful one\" because it's quite good at destroying genetic material, explains Juan Leon, a virologist who focuses on environmental health at Emory University. Luckily, he notes, the sun's UVC rays don't reach us because they are filtered out by Earth's atmosphere.</p>\n</blockquote>\n\n<p>but data on SARS suggests it is not inactivated by sunlight</p>\n\n<blockquote>\n <p>\"Right now, there is no data on whether the UVA rays of the sun can inactivate this coronavirus,\" says Leon. However, research on SARS, another coronavirus closely related to the one causing the current pandemic, found that exposing that virus to UVA light for 15 minutes did nothing to reduce its infectivity, Leon says.</p>\n</blockquote>\n\n<p>duration didn't help</p>\n\n<blockquote>\n <p>We determined that greater than 15 min of UVC treatment inactivated the virus while <strong>UVA light had no effect on viability, regardless of duration of exposure.</strong> </p>\n</blockquote>\n\n<p>Inactivation of the coronavirus that induces severe acute respiratory syndrome, SARS-CoV\n<a href=\"https://www.sciencedirect.com/science/article/pii/S016609340400179X\" rel=\"nofollow noreferrer\">https://www.sciencedirect.com/science/article/pii/S016609340400179X</a></p>\n\n<p><a href=\"https://www.npr.org/sections/goatsandsoda/2020/04/17/836830157/coronavirus-faqs-can-sunlight-kill-the-virus-how-risky-is-an-elevator-ride\" rel=\"nofollow noreferrer\">https://www.npr.org/sections/goatsandsoda/2020/04/17/836830157/coronavirus-faqs-can-sunlight-kill-the-virus-how-risky-is-an-elevator-ride</a></p>\n", "score": 4 }, { "answer_id": 23322, "body": "<p>I'm a bit wary about the word \"all\" when it comes to medicine - what I've found with a quick Google search (GIYF):</p>\n\n<blockquote>\n <p>Under full-spectrum sunlight, all viruses investigated to date have\n been found to undergo endogenous inactivation. Among the viruses\n studied, human adenovirus (HAdV) and MS2 appear to be the most\n resistant whereas poliovirus and somatic phages are particularly\n sensitive. Even for the relatively resistant viruses, however,\n sunlight inactivation via endogenous mechanisms was found to be the\n main inactivation process in clear natural waters.\n Source: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064263/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064263/</a></p>\n</blockquote>\n\n<p>And then...\n\"Fact check: Sunlight does not kill the new coronavirus\"\n<a href=\"https://eu.usatoday.com/story/news/factcheck/2020/03/30/fact-check-sunlight-does-not-kill-new-coronavirus/2931170001/\" rel=\"nofollow noreferrer\">https://eu.usatoday.com/story/news/factcheck/2020/03/30/fact-check-sunlight-does-not-kill-new-coronavirus/2931170001/</a></p>\n\n<p>For SARS:</p>\n\n<blockquote>\n <p>RESULTS: The results showed that SARS coronavirus in the testing\n condition could survive in serum, 1:20 diluted sputum and feces for at\n least 96 h, whereas it could remain alive in urine for at least 72 h\n with a low level of infectivity. The survival abilities on the\n surfaces of eight different materials and in water were quite\n comparable, revealing reduction of infectivity after 72 to 96 h\n exposure. Viruses stayed stable at 4 degrees C, at room temperature\n (20 degrees C) and at 37 degrees C for at least 2 h without remarkable\n change in the infectious ability in cells, but were converted to be\n non-infectious after 90-, 60- and 30-min exposure at 56 degrees C, at\n 67 degrees C and at 75 degrees C, respectively. Irradiation of UV for\n 60 min on the virus in culture medium resulted in the destruction of\n viral infectivity at an undetectable level.\n Source: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/14631830\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/14631830</a></p>\n</blockquote>\n", "score": 3 } ]

[ "covid-19", "virus" ]

[ { "answer_id": 23381, "body": "<p>The <em>vaccine</em> isn't defying the 12-18 month estimate, <em>assorted company PR departments</em> are defying the 12-18 month estimate. It's unlikely that an actual vaccine will become available in the timeframe these people are promising.</p>\n", "score": 3 } ]

[ "covid-19", "vaccination", "research", "coronavirus", "practice-of-medicine" ]

[ { "answer_id": 23456, "body": "<p><a href=\"https://i.stack.imgur.com/aMZyW.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/aMZyW.jpg\" alt=\"\" /></a></p>\n<p>You could look at the open source <a href=\"https://web.archive.org/web/20210820123024/https://copper3d.com/hackthepandemic/#antimicrobial_activity\" rel=\"nofollow noreferrer\">nano-copper</a> impregnated filter material which is said to self sterilize given enough time.</p>\n<blockquote>\n<p>In the study by Borkow et al (2007)7, a 2.5 cm filter was designed containing a 2 cm thick top layer of 500 mg of non-woven polypropylen impregnated with 5% copper oxide particles. This study had a control that was non-woven polypropylen copper-free as a control.\nDiffusion of viruses through filters containing copper oxide resulted in a significant reduction in viral titers from 0.47 log10 to 4.6 log10 depending on the virus analyzed.</p>\n</blockquote>\n<blockquote>\n<p>According to this study, it can be concluded that a non-woven fabric filter impregnated with copper oxide is capable of generating filtration of viruses of different types, including respiratory viruses, as can be seen in the attached table.</p>\n</blockquote>\n<p>And there's the salt impregnated masks that was mentioned in another question here.</p>\n<blockquote>\n<p>The salt coating on the fiber surface dissolves upon exposure to virus aerosols and recrystallizes during drying, destroying the pathogens. When tested with tightly sealed sides, salt-coated filters showed remarkably higher filtration efficiency than conventional mask filtration layer, and 100% survival rate was observed in mice infected with virus penetrated through salt-coated filters. Viruses captured on salt-coated filters exhibited rapid infectivity loss compared to gradual decrease on bare filters. Salt-coated filters proved highly effective in deactivating influenza viruses regardless of subtypes and following storage in harsh environmental conditions. Our results can be applied in obtaining a broad-spectrum, airborne pathogen prevention device in preparation for epidemic and pandemic of respiratory diseases.</p>\n</blockquote>\n<p>References</p>\n<ol start=\"7\">\n<li>Borkow G, etal., (2007) Neutralizing Viruses in Suspensions by Copper Oxide-Based Filters. Antimicrobial Agents and Chemotherapy, p. 2605–2607</li>\n</ol>\n<p><a href=\"https://www.nature.com/articles/srep39956\" rel=\"nofollow noreferrer\">https://www.nature.com/articles/srep39956</a></p>\n", "score": 2 } ]

[ "covid-19", "sterilization" ]

[ { "answer_id": 23622, "body": "<p><a href=\"https://opendata.stackexchange.com/questions/16251/covid-19-clinical-data-or-statistics\">This Opendata.SE question</a> has a number of answers that have links to raw data that you can perform your own analyses by age and other demographics. There is one answer that by the description gives a full set of data for <a href=\"https://opendata.stackexchange.com/a/17366/10235\">South Korea</a>.</p>\n\n<p><a href=\"https://opendata.stackexchange.com/a/17321/10235\">Here</a> is a link to a data set with the largest volume collected from across the world, I would expect that there will be biases in collecting the data due to the nature of the collection, but you may be able to glean something useful from it.</p>\n", "score": 1 } ]

[ "covid-19-datasets" ]

[ { "answer_id": 23733, "body": "<p>This inability to mix durian with alcohol has the status of a food myth. To quote the dietetic department at Changi Hospital</p>\n<blockquote>\n<ol start=\"3\">\n<li>Eating durian and drinking beer at the same time may kill you</li>\n</ol>\n<p>There is no scientific evidence to show that this is a lethal combination. It is more likely to cause bloating, indigestion and discomfort as your liver has to work extra hard to metabolise both fats and sugars in the durians and the alcohol, especially if you have consumed both in excessive amounts.</p>\n</blockquote>\n<p>Note also that the paper you quoted says in vivo studies failed to support a relationship.</p>\n<p>In any case if you wanted to avoid a possible disulfiram reaction it depends on how much alcohol has been consumed, and your metabolism. And you can check with a breath alcohol analyser</p>\n<p><a href=\"https://www.healthxchange.sg/food-nutrition/food-tips/durian-myths-alcohol-cholesterol\" rel=\"nofollow noreferrer\">https://www.healthxchange.sg/food-nutrition/food-tips/durian-myths-alcohol-cholesterol</a></p>\n", "score": 2 } ]

[ "food-safety", "alcohol", "liver", "fruits", "food-poisoning" ]

[ { "answer_id": 23820, "body": "<p>Electrical arcs, which would be the issue here, are well-known to be energetic enough to create ultraviolet light that is powerful enough in some cases to cause eye injury (<a href=\"https://en.wikipedia.org/wiki/Photokeratitis\" rel=\"nofollow noreferrer\">\"ultraviolet keratitis\" or \"welder's flash\"</a>).</p>\n\n<p>However, the average garage welder that is the culprit of such injury is unlikely to be more energetic than 250 amps of current producing the electrical arc, with the welder's face being within, at most, three feet of their face (the arm span of a person is approximately equal to their height, and welding torches are not typically exceptionally long beyond their handle as it would make placing the weld accurately horrifically difficult). Lightning strikes, however, are many orders of magnitude larger (at approximately <a href=\"https://www.quora.com/What-is-the-voltage-and-amperage-of-an-average-lightning-bolt#:~:text=answers%20vary%20but%20his%20is,watt%20lightbulb%20for%203%20months.\" rel=\"nofollow noreferrer\">100,000 to 200,000 amps of current</a>). Lightning that is being \"watched\" rather than experienced first-hand is likely much further away, possibly multiple miles. Also, lightning lasts mere fractions of a second, whereas welding can be an ongoing arc for minutes at a time (ignoring the AC vs DC welding issue, which in this case is purely theoretical - I have never heard anyone claim that DC stick welding is more hazardous from this perspective because the arc is continuous compared to AC, or pulsed TIG). Based upon the <a href=\"https://imagine.gsfc.nasa.gov/features/yba/M31_velocity/lightcurve/more.html\" rel=\"nofollow noreferrer\">inverse square law</a>, and based upon the limited arc time of lightning, it would therefore be much less hazardous.</p>\n\n<p>Staring at the sun during an eclipse is an entirely different situation. It is not only a continuously-running nuclear fusion reactor, but it is also the largest of its kind within the solar system.</p>\n", "score": 0 } ]

[ "eye", "ophthalmology", "light" ]

[ { "answer_id": 23826, "body": "<p>There are many diseases that can't be cured, but can be kept from being lethal by supportive interventions. At its most basic level this may simply be providing a patient with shelter, food, and water while they fight off the illness. If you've never suffered from a serious illness you may not appreciate that it can weaken you so much that you may not be able to feed your self or even rise from your sick bed. It would be a shame to die of dehydration just about the time your immune system was killing off the disease.</p>\n\n<p><a href=\"https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/diagnosed-with-covid-19-what-to-expect\" rel=\"nofollow noreferrer\">We don't have a cure for Covid-19, so if you are infected, the only way you are going to recover is if your immune system is able to mount an effective defense to the virus</a>. Fortunately this is a natural and inevitable process for most of us. The problem is that it takes time, so there is a race between the damage being done by the virus and the immune system's response. There are many medical interventions that can help you survive the immediate damage, and buy you more time to mount an immune response. </p>\n\n<ul>\n<li><p>The most obvious <a href=\"https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/what-coronavirus-does-to-the-lungs\" rel=\"nofollow noreferrer\">damage caused by Covid-19 is to the lungs</a>. If your lungs aren't working effectively you don't have long to live without assistance of some sort. Hospitals can offer <a href=\"http://www.emdocs.net/covid-19-oxygen-escalation-therapy-and-noninvasive-ventilation/\" rel=\"nofollow noreferrer\">oxygen</a>, put you on a <a href=\"https://www.npr.org/sections/health-shots/2020/05/15/856768020/new-evidence-suggests-covid-19-patients-on-ventilators-usually-survive\" rel=\"nofollow noreferrer\">ventilator</a>, or even <a href=\"https://labblog.uofmhealth.org/rounds/when-ventilators-dont-help-covid-19-patients-might\" rel=\"nofollow noreferrer\">artificially oxygenate your blood outside your body</a>. </p></li>\n<li><p>Covid-19 is <a href=\"https://www.cidrap.umn.edu/news-perspective/2020/05/autopsies-covid-19-patients-reveal-clotting-concerns\" rel=\"nofollow noreferrer\">thought to cause blood clots</a>. Blood clots can keep blood from getting to your lungs or other vital organs, but there are <a href=\"https://www.sciencedaily.com/releases/2020/05/200507194907.htm\" rel=\"nofollow noreferrer\">drugs that lower the risk of blood clots forming</a>.</p></li>\n<li><p>There are also <a href=\"https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-kidney-damage-caused-by-covid19\" rel=\"nofollow noreferrer\">indications Covid-19 can cause kidney damage</a>. Being put on <a href=\"https://www.mayoclinic.org/tests-procedures/hemodialysis/about/pac-20384824\" rel=\"nofollow noreferrer\">dialysis</a> may be able to cover for your kidney damage long enough for your body to heal. </p></li>\n<li><p>Your <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7194613/\" rel=\"nofollow noreferrer\">immune system may over-react to the virus and begin attacking your own organs</a>. There are drugs that can dampen the over-reaction and limit the damage to your organs.</p></li>\n<li><p><a href=\"https://ccm.pitt.edu/?q=COVID19/SHOCK\" rel=\"nofollow noreferrer\">All these stresses on the body can send you into shock. Your blood pressure and heart function may drop below what you need to keep you alive. Again there are drugs that can help you recover from this</a>.</p></li>\n</ul>\n\n<p>None of these treatments is guaranteed to save the day, but they have helped many people. Managing these treatments is complex, and may require minute by minute monitoring by skilled ICU nurses and doctors.</p>\n", "score": 2 } ]

[ "covid-19", "coronavirus", "hospital", "respiratory-system", "quarantine" ]

[ { "answer_id": 23863, "body": "<p>If I am understanding you correctly you‘d like to know how the pharmacist and/or the software used in the pharmacy recognizes if a prescription drug requires the <strong>physicians identity</strong> to be transmitted during order.</p>\n\n<p>As far as I know the drug regulation laws in EU countries vary significantly between the individual countries so I can speak only for the country I am residing in (Germany).</p>\n\n<p>There are only very few specific cases of drugs which require the information of the prescribing physician to be submitted during order of the drug. Some of those include lenalidomide and/or thalidomide or specific programs for heroin rehab programs. But as I said before, the specific drugs this would apply to vary between countries.</p>\n\n<p>So there is no general need to have a specific detection in place, as that process differs wildly from the usual process of ordering - for a ’general’ pharmacy this would be the pharmaceutical wholesale, where generally no identity of any physician is transmitted.</p>\n", "score": 1 } ]

[ "practice-of-medicine" ]

[ { "answer_id": 24034, "body": "<p>Your stomach may contain bacteria that are harmless as long as they are in your digestive tract, but are potentially lethal if they get into other organs. A ruptured ulcer means that it's possible for the stomach contents to leak into the abdominal cavity and possibly the bloodstream. If the bacteria get established in you blood they will be carried to all the other organs creating a massive infection. The immune response to the infection may create a condition called <a href=\"https://en.wikipedia.org/wiki/Sepsis\" rel=\"noreferrer\">sepsis</a>. <a href=\"https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)00276-7.pdf\" rel=\"noreferrer\">Sepsis is a well known complication from perforated ulcers</a> and frequently leads to kidney failure.</p>\n", "score": 5 } ]

[ "gastroenterology", "physiology", "death", "kidney", "ulcers" ]

[ { "answer_id": 24042, "body": "<p>Every sample is biased.</p>\n<p>The question is whether these samples are <em>meaningfully biased</em> in a way that would like affect these results.</p>\n<p>Yes, those getting a head MRI likely have some symptoms related to their head or brain area, but the vast majority of those will have nothing to do with pineal cysts or tumors; in addition, some of the work in the paper you cite was on healthy volunteers. Healthy volunteers are often over-represented by college-aged students, which likely don't overlap as much with the medical patients.</p>\n<p>Similarly, those who require autopsy are not the same of the general population, but I can't think of any reason that the population getting autopsies would have a strong relationship to the presence of pineal cysts.</p>\n<p>Pu et al, the paper you cite, refer to differences with age and gender, and it's likely that both MRI- and autopsy-receiving cases differ on those groupings, but not to an extent that would produce a 20-fold difference in prevalence.</p>\n<p><strong>So then why such a big difference in autopsy versus imaging results?</strong></p>\n<p>I presume this question is what really led you to asking about the autopsy studies. Both the paper you link to, and a related one (Al-Holou, et al 2011) provide some quick clues. Quoting from Al-Holou, et al:</p>\n<blockquote>\n<p>It is not surprising that autopsy studies, because they include cysts that may be too small to be detected on MR imaging, have reported consistently higher prevalence rates for pineal cysts, ranging between 21% and 41%.25,65 In contrast to imaging studies, autopsy studies have included small or even microscopic cysts. For example, in the series reported by Hasegawa et al.,25 45% of all pineal cysts were 2 mm or less in maximum diameter. This detection variability may be a factor even between different estimates of prevalence on MR imaging.</p>\n</blockquote>\n<p>The paper you refer to, Pu et al 2007, specifically used a finer-detail scan:</p>\n<blockquote>\n<p>A possible explanation for the difference between the prevalence of the pineal\ncysts demonstrated in our study and that in other MR imaging\nstudies is that we used high-resolution MR imaging with a 1.0\nmm resolution on the 3D T1WI and an in-plane resolution of 1.0\nmm with an axial resolution of 2.0 mm on the T2WI. An in-plane\nresolution of 1.0mm and an axial resolution of 3.0mm were used\nin the prior MR imaging study of healthy volunteers.17</p>\n</blockquote>\n<p>If 45% of cysts from autopsies are themselves smaller than 2mm, it isn't reasonable to expect that most of those will be found on MRI scans, especially those with 3mm spacing.</p>\n<p>The autopsy numbers are certainly more accurate from a cyst-counting perspective, but as the Pu et al paper states:</p>\n<blockquote>\n<p>Most cysts are asymptomatic, with diameters ranging from 2 to 15 mm.5-8 When\npresent, however, symptoms are usually noted in patients with\ncysts larger than 15 mm in diameter.9-10</p>\n</blockquote>\n<p>If only cysts larger than 15mm are commonly clinically relevant, all we learn from counting the smaller cysts is in confirming that small cysts are common and not normally associated with symptoms.</p>\n<p>Probably the best estimate of general prevalence would come from a pre-registered sample of patients whose brains would be donated specifically for pineal histology post-mortem. I can't see a lot of support or funding for such a study, though, given the lack of clinical relevance.</p>\n<hr />\n<p>Al-Holou, W. N., Terman, S. W., Kilburg, C., Garton, H. J., Muraszko, K. M., Chandler, W. F., ... &amp; Maher, C. O. (2011). Prevalence and natural history of pineal cysts in adults. Journal of neurosurgery, 115(6), 1106-1114.</p>\n<p>Pu, Y., Mahankali, S., Hou, J., Li, J., Lancaster, J. L., Gao, J. H., ... &amp; Fox, P. T. (2007). High prevalence of pineal cysts in healthy adults demonstrated by high-resolution, noncontrast brain MR imaging. American journal of neuroradiology, 28(9), 1706-1709.</p>\n", "score": 3 } ]

[ "brain", "autopsy", "mortality-rate" ]

[ { "answer_id": 24368, "body": "<p>I assume the presupposition is that alcohol can be used as a disinfectant and therefore, can, if ingested, killed microbes that are also ingested during a meal for example - that might lead to 'food poisoning' such as Salmonella, for example.</p>\n<p>A quick search for me, illustrated two key pieces of literature on the matter of alcohol preventing food poisoning.</p>\n<p>In 2002, a Spanish group of Public Health doctors published potentially positive findings on the effects of alcohol on foodborne infectious outbreaks: <a href=\"https://www.researchgate.net/publication/11481789_The_Protective_Effect_of_Alcoholic_Beverages_on_the_Occurrence_of_a_Salmonella_Food-Borne_Outbreak\" rel=\"nofollow noreferrer\">here</a></p>\n<p>In 1992 - there was also a look at The protective effect of alcohol on the occurrence of epidemic oyster-borne hepatitis A: <a href=\"https://pubmed.ncbi.nlm.nih.gov/1637901/\" rel=\"nofollow noreferrer\">here</a> which showed that providing ABV was &gt;10%, there was a protective effect.</p>\n<p>There may well be more studies than this.</p>\n<p>To me - these represent small studies that provide an interesting assertion - but ultimately larger studies would be needed to confirm that alcohol may have some protective effect from food-borne infectious disease. This would be impossible to do in humans however, due to the need for ethical approval to infect people with such pathogens +/- alcohol!</p>\n<p>The topic is broad and not easy to answer as it depends on the alcohol concentration, the evolution of the specific pathogen of resistance to alcohol lethality (that a type of Salmonella for example has shown (<a href=\"https://concordia.ab.ca/wp-content/uploads/2017/05/Taskova-A.pdf\" rel=\"nofollow noreferrer\">here</a>), the pathogen itself (as 'food poisoning' is a very very broad term).</p>\n<p>I hope this is somewhat informative. It in no way promotes 'getting smashed' when eating Oysters though!</p>\n", "score": 0 } ]

[ "alcohol", "food-poisoning" ]

[ { "answer_id": 24740, "body": "<p><a href=\"https://www.auanet.org/documents/education/clinical-guidance/Vasectomy.pdf\" rel=\"nofollow noreferrer\">https://www.auanet.org/documents/education/clinical-guidance/Vasectomy.pdf</a> as the table comparing some occlusion techniques with and without fascial interposition (FI):</p>\n<p><a href=\"https://i.stack.imgur.com/MLmdX.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/MLmdX.png\" alt=\"enter image description here\" /></a></p>\n<p>Compare the row #2 (without FI) against the rows #1 (with FI) and #3 (with FI): the use of FI seems to have decreased the upper bound of the failure rate. Note that the study was published almost 10 years ago so I'm hoping some more recent and more rigorous studies have been published since then.</p>\n", "score": 0 } ]

[ "surgery", "sex" ]

[ { "answer_id": 24738, "body": "<p>I have found two studies so far:</p>\n<p><a href=\"https://doi.org/10.1016/S0015-0282(16)44357-8\" rel=\"nofollow noreferrer\">https://doi.org/10.1016/S0015-0282(16)44357-8</a>:</p>\n<blockquote>\n<p>The presence of a sperm granuloma [resulting from an open-ended vasectomy] at the vasectomy site prevents epididymal pressure build-up, perforation, and the formation of an epididymal sperm granuloma. It thus enhances reversibility of the vasectomy and lessens the likelihood of epididymal discomfort.</p>\n</blockquote>\n<p>but this study dates back from 1979 and is based on only 9 patients.</p>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC529470/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC529470/</a> is inconclusive but this study dates back from 2004:</p>\n<blockquote>\n<p>Additional research would also be of interest to compare an open-ended procedure with a closed-end procedure. Several investigators have suggested that leaving the testicular end open reduces post-vasectomy pain, but no randomized controlled trials have examined this issue [1,18].</p>\n<ul>\n<li>[1] Royal College of Obstetricians &amp; Gynecologists . Male and Female Sterilization, Evidence-based Clinical Guideline No 4. London: RCOG Press; 2004. [<a href=\"https://scholar.google.com/scholar_lookup?title=Male+and+Female+Sterilization,+Evidence-based+Clinical+Guideline+No+4&amp;publication_year=2004&amp;\" rel=\"nofollow noreferrer\">Google Scholar</a>]</li>\n<li>[18] Labrecque M, Dufresne C, Barone MA, St-Hilaire K. Vasectomy surgical techniques: a systematic review. BMC Med. 2004;2:21. doi: 10.1186/1741-7015-2-21. [<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC428590/\" rel=\"nofollow noreferrer\">PMC free article</a>] [<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/15157272\" rel=\"nofollow noreferrer\">PubMed</a>] [<a href=\"https://dx.doi.org/10.1186%2F1741-7015-2-21\" rel=\"nofollow noreferrer\">CrossRef</a>] [<a href=\"https://scholar.google.com/scholar_lookup?journal=BMC+Med&amp;title=Vasectomy+surgical+techniques:+a+systematic+review&amp;author=M+Labrecque&amp;author=C+Dufresne&amp;author=MA+Barone&amp;author=K+St-Hilaire&amp;volume=2&amp;publication_year=2004&amp;pages=21&amp;pmid=15157272&amp;doi=10.1186/1741-7015-2-21&amp;\" rel=\"nofollow noreferrer\">Google Scholar</a>]</li>\n</ul>\n</blockquote>\n", "score": 0 } ]

[ "pain", "surgery", "sex", "andrology" ]

[ { "answer_id": 24743, "body": "<p><a href=\"https://medicalsciences.stackexchange.com/users/7951/chris-rogers\" title=\"4,904 reputation\">Chris Rogers</a>'s comment on <a href=\"https://medicalsciences.stackexchange.com/questions/24552/is-the-quality-of-sperm-higher-when-ejaculated-outside-a-lab-building-than-when#comment47572_24552\">Aug 30 at 10:02</a> points to two references, <a href=\"https://doi.org/10.1016/j.fertnstert.2007.02.033\" rel=\"nofollow noreferrer\">Licht et al. (2008)</a> and <a href=\"https://doi.org/10.1016/j.fertnstert.2007.01.051\" rel=\"nofollow noreferrer\">Song et al. (2007)</a>, that answer the question: the quality of sperm when ejaculated outside a lab building is not higher than when ejaculated inside a lab building.</p>\n<p><a href=\"https://doi.org/10.1016/j.fertnstert.2007.01.051\" rel=\"nofollow noreferrer\">Song et al. (2007)</a>:</p>\n<blockquote>\n<p>The location of semen collection (home vs. clinic) for IUI did not affect pregnancy rates in a general infertility population (633 IUI cycles from 335 patients), if World Health Organization guidelines for time from specimen collection to use were followed. The time interval from semen collection to IUI was not different between patients who conceived and those who did not (pregnant vs. nonpregnant, 70 ± 19 minutes vs. 73 ± 18 minutes).</p>\n</blockquote>\n", "score": 0 } ]

[ "sex", "sperm", "andrology" ]

[ { "answer_id": 25520, "body": "<p>Regarding one of the topics of this subject: <em>Why can’t painkillers be both safe and effective?</em></p>\n<p><a href=\"https://www.nature.com/articles/s41598-020-71804-2\" rel=\"nofollow noreferrer\">It should be duly noted that,</a></p>\n<p>One of the most problematic conditions when using opioids in clinic is the respiratory depression that they can cause</p>\n<blockquote>\n<p>The most common cause of opioid overdose and death is opioid-induced respiratory depression (OIRD)</p>\n</blockquote>\n<p>essentially due to a neuronal malfunction at the brainstem level</p>\n<blockquote>\n<p>Opioids such as morphine depress the hypoxic ventilatory response in the brainstem by affecting the chemosensitive cells that respond to changes in the partial pressures of carbon dioxide and oxygen in the blood</p>\n</blockquote>\n<p>The difficulty to treat an overdose and the <a href=\"https://pubmed.ncbi.nlm.nih.gov/30640650/\" rel=\"nofollow noreferrer\">narrow therapeutic window that opioids are known for</a>, make them drugs that need to be monitored very well and thus not much &quot;<strong>safe</strong>&quot;; <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312206/pdf/bumc0013-0007.pdf\" rel=\"nofollow noreferrer\">although there are a lot being made to counter that effect with the new development of drugs, such as Fentanyl or Remifentanil</a></p>\n<blockquote>\n<p>Conventional µ receptor opioids have a narrow therapeutic window in part because of their mechanism of action</p>\n</blockquote>\n<p><a href=\"https://www.frontiersin.org/articles/10.3389/fphar.2014.00280/full\" rel=\"nofollow noreferrer\">The opioid receptor desensitization is also a problem,</a> that diminish their effectiveness, being also a cause of dependency and overdose.</p>\n<p>Now, regarding your question: <em><strong>Are opioids just dependency inducing or are they actually addictive to a majority of patients?</strong></em></p>\n<p>The answer is both. Opioids are in fact addictive to the majority of patients due to their ability to desensitize quickly.</p>\n<blockquote>\n<p>Opioids are required in ever-increasing doses as you develop a tolerance to them. In other words, the dose you used to take to relive your pain will eventually not work as well, which means you’ll need more of the opioid to get the same effect</p>\n</blockquote>\n<blockquote>\n<p>From a clinical standpoint, opioid withdrawal is one of the most powerful factors driving opioid <strong>dependence and addictive behaviors</strong>. Treatment of the patient’s withdrawal symptoms is based on understanding how withdrawal is related to the brain’s adjustment to opioids</p>\n</blockquote>\n<p>From a psychological point of view</p>\n<blockquote>\n<p>Other areas of the brain create a lasting record or memory that associates these good feelings with the circumstances and environment in which they occur. These memories, called conditioned associations, often lead to the craving for drugs when the abuser reencounters those persons, places, or things, and they drive abusers to seek out more drugs in spite of many obstacles</p>\n</blockquote>\n<p>And also they induce dependency essentially with the <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054/pdf/spp-01-1-13.pdf\" rel=\"nofollow noreferrer\">release of endorphins</a>.\nWith the definition being stated on the article that you have provided such that <em><strong>Dependence is characterized by the symptoms of tolerance and withdrawal</strong></em>.</p>\n<blockquote>\n<p>One of the brain circuits that is activated by opioids is the mesolimbic (midbrain) reward system. This system generates signals in a part of the brain called the ventral tegmental area (VTA) that result in the release of the chemical dopamine (DA) in another part of the brain, the nucleus accumbens (NAc). This release of DA into the NAc causes feelings of pleasure. Other areas of the brain create a lasting record or memory that associates these good feelings with the circumstances and environment in which they occur.</p>\n</blockquote>\n<blockquote>\n<p>Two clinically important results of this alteration are <strong>opioid tolerance</strong> (the need to take higher and higher dosages of drugs to achieve the same opioid effect) <strong>and drug dependence</strong> (susceptibility to withdrawal symptoms).</p>\n</blockquote>\n<p>By all those reasons chronic pain is thus a very difficult condition to treat and is usually regarded according to the principle of the <em>gate control theory of pain</em> which leads to a <em><strong>broad spectrum analgesia</strong></em> therapy.</p>\n<hr />\n<p>Regarding the fact that\n<em><strong>If the cause(s) of the chronic pain are removed and the patient is being weaned off the opioids, do the damaging behaviours associated with addiction appear in a large proportion of these patients?</strong></em></p>\n<p>Naturally a high intake for a longer duration is associated with more severe withdrawal and to better grasp this concept there is a psychological scale that enable us to measure that (Clinical Opiate Withdrawal Scale - COWS) by quantifying the severity of opiate withdrawal symptoms,</p>\n<p><a href=\"https://www.asam.org/docs/default-source/education-docs/cows_induction_flow_sheet.pdf?sfvrsn=b577fc2_2\" rel=\"nofollow noreferrer\">article</a></p>\n<blockquote>\n<p>Patients who score between 5-12 are classified as mild withdrawal, 13-24 as moderate, 25-36 as moderately severe, and over 36 as severe withdrawal</p>\n</blockquote>\n<p>On the other hand, sometimes the chronic use of opioids can lead to brain abnormalities (dependce/addiction abnormalities) and here we have a clear difference about dependence and addiction, because it will lead to different ends.</p>\n<blockquote>\n<p>The abnormalities that produce dependence, well understood by science, appear to resolve after detoxification, within days or weeks after opioid use stops.</p>\n</blockquote>\n<blockquote>\n<p>The abnormalities that produce addiction, however, are more wide-ranging, complex, and long-lasting. [...] Such abnormalities can produce craving that leads to relapse months or years after the individual is no longer opioid dependent.</p>\n</blockquote>\n", "score": 1 }, { "answer_id": 24672, "body": "<p>There is no &quot;yes&quot; or &quot;no&quot; answer to your question as far as the use of both terms are concerned.</p>\n", "score": 0 } ]

[ "addiction", "analgesics", "opioids-opiates" ]

[ { "answer_id": 24693, "body": "<p>One reference <a href=\"https://www.aafp.org/afp/2000/0115/p305.html\" rel=\"nofollow noreferrer\">https://www.aafp.org/afp/2000/0115/p305.html</a> recommends the use of sutures, and specifically the use of Vicryl or Dexon sutures as they cause less tissue reaction than the chromic suture:</p>\n<blockquote>\n<p>I did use clips for fascial interposition during no-scalpel vasectomy for a period of time. I found that they frequently hung up in the narrow tissue tract when I let the vas slide back into its normal anatomic position. This created the dilemma of whether to leave the vas in the wrong plane and possibly cause chronic pain or vasocutaneous fistula, or to pull the vas down by testicular traction and potentially dislodge the clip. Hating this choice, I abandoned clips in favor of suture for the fascial interposition. Because they are hydrolyzed rather than phagocytosed, I find that Vicryl or Dexon suture causes less tissue reaction than the chromic suture recommended by Drs. Clenney and Higgins.</p>\n</blockquote>\n", "score": 0 } ]

[ "surgery", "urology", "sutures" ]

[ { "answer_id": 24824, "body": "<p>The condensate from a dehumidifier is unlike a water distillation unit.\nIn the dehumidifier ambient air is forced across refrigerated fins, causing the high humidity air to condense on the cold surface, but it is an <strong>open</strong> <a href=\"https://www.researchgate.net/figure/Schematic-diagram-of-the-dehumidifier-unit-1_fig2_327791284\" rel=\"nofollow noreferrer\">Link</a> system that is also drawing air pollutants, dust, mites, whatever nasties are also present in the humid air. When the water condenses in that system it also takes with it all those &quot;nasties&quot;.</p>\n<p>A water distillation system (for human consumption) is a <strong>closed</strong> <a href=\"https://www.extension.purdue.edu/extmedia/wq/wq-12.html\" rel=\"nofollow noreferrer\">link2</a> system herein water is boiled (by a combination of heat and vacuum) to create saturated steam. That saturated steam is then condensed.</p>\n<p>The other difference is that the dehumidifier relies on ambient air as the source, while the water distillation (for drinking purposes) relies on water as the distilland, that is flushed out as it becomes progressively more concentrated with minerals, salts, etc.</p>\n<p>Commercial distillation systems (for human consumption) are nevertheless cleaned and disinfected, unlike your dehumidifier.</p>\n", "score": 1 } ]

[ "water", "bacteria", "safety" ]

[ { "answer_id": 24862, "body": "<p>Dexamethasone and other steroids have <a href=\"https://scholar.google.com/scholar?hl=en&amp;as_sdt=0%2C7&amp;as_vis=1&amp;q=psychological%20effects%20of%20dexamethasone&amp;btnG=&amp;oq=psychological%20effects%20of%20dexa\" rel=\"nofollow noreferrer\">well-documented</a> psychological effects. There are so many citations available that it's not necessary to pick one in particular.</p>\n<p>The definition of &quot;psychoactive&quot; as used in medicine is &quot;<a href=\"https://www.merriam-webster.com/dictionary/psychoactive\" rel=\"nofollow noreferrer\">affecting the mind or behavior</a>.&quot;</p>\n<p>Therefore, his usage was correct.</p>\n", "score": 3 } ]

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

[ { "answer_id": 25001, "body": "<p>Yes, there actually is a correct answer to this: not every autoimmune disease is antibody driven. Take coeliac disease: antibodies are just an epiphenomenon of the immune process, which is actually cell-mediated (<a href=\"https://emedicine.medscape.com/article/932104-overview#a5\" rel=\"nofollow noreferrer\">Medscape</a>). Thinking about the pathophysiology of certain autoimmune diseases should help in understanding this: something goes wrong in the antigen presenting cell - T cell interaction and a &quot;self&quot; component gets recognized as potentially harmful. T cells start attacking it, B cell start producing antibodies against it. In certain diseases, it's the antibodies that do the harm. In others, it's the cells.\nSo, by eliminating all autoantibodies you most certainly won't eradicate all autoimmune disease. Probably some (such as Myasthenia gravis, which can be treated with <a href=\"https://www.medscape.com/answers/1171206-92688/what-is-the-role-of-plasmapheresis-in-the-treatment-of-myasthenia-gravis-mg\" rel=\"nofollow noreferrer\">plasmapheresis</a>), but not all.</p>\n<p>Hope this helped, i tried using a simple language but since English is not my mothertongue I maybe overdid it.</p>\n", "score": 2 } ]

[ "autoimmune-disease", "antibodies" ]

[ { "answer_id": 25011, "body": "<p>Well, it mostly depends on what you mean by &quot;<strong>Top Professor</strong>&quot;. In my opinion, there's no thing as &quot;Top&quot;. There's the most influents on the scientific community (e.g. in my field, if <a href=\"https://scholar.google.com/citations?user=HXRv1ZAAAAAJ&amp;hl=en\" rel=\"nofollow noreferrer\">Milton Packer</a> says something about Heart failure, you're more prone to trust him because of his resumé), there's the good teachers, the ones with outstanding human qualities et cetera.</p>\n<p>Here's some hints:</p>\n<p>If you're looking for the ones that have the most impact on the scientific community, you could go and search the topic you're interested in (e.g. &quot;Placenta Previa&quot;) on google scholar and then look at the authors of the most cited articles (this method is far from being perfect because citations can be <a href=\"https://handbook-5-1.cochrane.org/chapter_10/10_2_2_3_citation_bias.htm\" rel=\"nofollow noreferrer\">biased in many ways</a>).</p>\n<p>One other thing you could do is searching for guidelines on the topic you're interested in and looking at who wrote them. For example, these are <a href=\"https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Cardiovascular-Diseases-during-Pregnancy-Management-of\" rel=\"nofollow noreferrer\">ESC Guidelines on Cardiovascular disease during pregnancy</a>.</p>\n<p>Then, if you're curious about who gives the &quot;best&quot; lectures (better: the ones you like the most), you can search on google for congresses where they were invited and give a look at their lectures.</p>\n<p>I tried to give you some directions but bear in mind that every method is not perfect and there most certainly are very good professors, super skilled at teaching, that are just average researchers and not incredibly influent.</p>\n", "score": 1 } ]

[ "obstetrics" ]

[ { "answer_id": 25072, "body": "<p>Intense cardio training over sufficiently prolonged time tend to incerease the capacity of your cadiovascular system to carry oxygen to the muscle. One aspect (among many) is the increase in volume of the left chamber of the heart which is seen in professional athletes of enurance sports.\n(<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771151/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771151/</a>)\nBlood pressure rises in excercise (not easy to measure, but can be observed in stress tests, <a href=\"https://www.ahajournals.org/doi/full/10.1161/hs0901.095395\" rel=\"nofollow noreferrer\">https://www.ahajournals.org/doi/full/10.1161/hs0901.095395</a>) to accomodate the need for extra oxygen. As the excerise continue, the arteries diameter get larger and it helps in regulating the blood pressure. It suppose to go back to normal as exercise stops and it actually goes lower than usual (<a href=\"https://www.ahajournals.org/doi/abs/10.1161/01.cir.83.5.1557\" rel=\"nofollow noreferrer\">https://www.ahajournals.org/doi/abs/10.1161/01.cir.83.5.1557</a> since the blood vessels remain large. You can also test it on yourself) for a few minutes after stopping. Prolonged aerobic training helps to reduce hypertension.</p>\n", "score": 1 } ]

[ "exercise", "cardiology", "heart" ]

[ { "answer_id": 25134, "body": "<p>According to this <a href=\"https://www.sciencedirect.com/science/article/abs/pii/S0190962213010554\" rel=\"nofollow noreferrer\">https://www.sciencedirect.com/science/article/abs/pii/S0190962213010554</a>, and this, <a href=\"https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.14499\" rel=\"nofollow noreferrer\">https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.14499</a>, sensitivity and specificity for BCC as a whole is pretty good. Predictive values for the different types of BCC is pretty good in some variants but not so much in others.</p>\n", "score": 2 } ]

[ "dermatology", "diagnostics", "basal-cell-carcinoma" ]

[ { "answer_id": 25466, "body": "<p>Your premise that this virus is &quot;new&quot; in the way you imagine it is false.</p>\n<p>The virus that causes COVID-19 is very similar to other viruses we already know about. Similar enough to one that we even call the virus <a href=\"https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome%E2%80%93related_coronavirus\" rel=\"nofollow noreferrer\">&quot;SARS-CoV-2&quot;, the &quot;2&quot; indicating it's the second such virus in that group</a>, and also similar to another virus named <a href=\"https://en.wikipedia.org/wiki/Middle_East_respiratory_syndrome\" rel=\"nofollow noreferrer\">MERS-CoV</a>.</p>\n<p>It has even more similarity to other viruses we know circulate in other animals, in particular bats. <a href=\"https://en.wikipedia.org/wiki/Coronavirus\" rel=\"nofollow noreferrer\">Coronaviruses</a> come in various categories that cause illness in a variety of species. These include forms that circulate in human populations and cause &quot;common cold&quot; symptoms. These viruses have a long history of recent evolution over the history of human civilization, as well as the distant past in other species. Quoting from Wikipedia:</p>\n<blockquote>\n<p>The most recent common ancestor (MRCA) of all coronaviruses is estimated to have existed as recently as 8000 BCE, although some models place the common ancestor as far back as 55 million years or more, implying long term coevolution with bat and avian species.[73] The most recent common ancestor of the alphacoronavirus line has been placed at about 2400 BCE, of the betacoronavirus line at 3300 BCE, of the gammacoronavirus line at 2800 BCE, and of the deltacoronavirus line at about 3000 BCE.</p>\n</blockquote>\n", "score": 1 } ]

[ "covid-19", "virus", "epidemiology" ]

[ { "answer_id": 25475, "body": "<p>On the other hand, if you want to ask if anybody is working a protein sub-unit vaccine, the answer is yes, NIH <a href=\"https://www.nih.gov/news-events/news-releases/phase-3-trial-novavax-investigational-covid-19-vaccine-opens\" rel=\"nofollow noreferrer\">announced</a> on Dec 28 that Novavax began phase III trials for NVX-CoV2373. (They are actually conducting concurrent trials in the UK and Mexico <a href=\"https://www.nihr.ac.uk/news/novavax-phase-3-covid-19-vaccine-trial-completes-enrollment-in-two-months/26321\" rel=\"nofollow noreferrer\">too</a>.)</p>\n<p>According to a <a href=\"https://www.sciencemag.org/news/2020/11/will-small-long-shot-us-company-end-producing-best-coronavirus-vaccine\" rel=\"nofollow noreferrer\">story</a> in <em>Science</em>, Novavax uses armyworm moth cells to grow these proteins; the spike protein DNA is transfected to these cells via a baculovirus. The <em>Science</em> article also mentions that Novavax has had some issues with scaling production. As I mentioned in my answer to the related question, in general &quot;manufacturers are challenged to balance the competing goals of speed to market and process optimization&quot;. (One can also find more in-depth articles on <a href=\"https://www.sciencedirect.com/science/article/pii/S0264410X20313736\" rel=\"nofollow noreferrer\">animal trials</a> and <a href=\"https://www.nejm.org/doi/10.1056/NEJMoa2026920\" rel=\"nofollow noreferrer\">phase 1-2 trials</a> for this vaccine.)</p>\n<p>There are also <a href=\"https://www.nature.com/articles/s41577-020-00480-0/tables/1\" rel=\"nofollow noreferrer\">at least two</a> Chinese vaccine candidates that use a protein sub-unit, one in phase III trials (Anhui Zhifei Longcom -- ChiCTR2000040153). This is one is interesting perhaps because it <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7321023/\" rel=\"nofollow noreferrer\">aims</a> to immunize against MERS and the original SARS as well. For the biotech inclined, there is actually a <a href=\"https://www.mdpi.com/2227-9717/8/12/1539/pdf\" rel=\"nofollow noreferrer\">technical paper</a> from a 3rd group (linked to the Swiss biotech ExcellGene) on making SARS-CoV-2 proteins in <a href=\"https://en.wikipedia.org/wiki/Chinese_hamster_ovary_cell\" rel=\"nofollow noreferrer\">CHO</a> bioreactors, which is what the aforementioned Chinese group is using as underlying tech, broadly speaking.</p>\n<p>And a <a href=\"https://www.nature.com/articles/s41586-020-2798-3\" rel=\"nofollow noreferrer\">review</a> linked from that paper discusses the challenges with these protein-sub-unit vaccines in general:</p>\n<blockquote>\n<p>such vaccines also have disadvantages. The spike protein is relatively hard to express, and this is likely to have an effect on production yields and on how many doses can be produced. The RBD is easier to express; however, it is a relatively small protein when expressed alone and, although potent neutralizing antibodies bind to the RBD, it lacks other neutralizing epitopes that are present on the full-length spike. This might render RBD-based vaccines more prone to impact from antigenic drift than vaccines that include the full-length spike protein. Many recombinant protein vaccine candidates against SARS-CoV-2 are currently in preclinical development, and several spike-protein-based and RBD-based vaccines have entered clinical trials [...]</p>\n</blockquote>\n<p>Of further note here, the (Chinese) Longcom vaccine only targets the RBD, while Novavax's targets the whole spike protein.</p>\n<p>The most recent <a href=\"https://jbiomedsci.biomedcentral.com/articles/10.1186/s12929-020-00695-2\" rel=\"nofollow noreferrer\">review</a> on vaccine candidates I found (Dec 20) mentions that some 13 companies actually have protein sub-unit vaccines in clinical trials, at various stages, with Novavax being the one that has done most testing up to date.</p>\n", "score": 2 } ]

[ "covid-19", "virus", "vaccination", "epidemiology" ]

[ { "answer_id": 25690, "body": "<p>In the United States, state and county public health departments and the Centers for Disease Control and Prevention conduct “surveillance” for a large number of infectious diseases. In the “flu season,” the public health departments present up-to-date data on trends in influenza and “influenza-like illness”</p>\n<p>Here, as an example, is a report about influenza in Arizona comparing the 2020-2021 influenza season (up to the date of the report, which was February 6, 2021 when accessed) and the five-year average data for the same date.</p>\n<p><a href=\"https://www.azdhs.gov/preparedness/epidemiology-disease-control/flu/index.php#surveillance-influenza-season\" rel=\"nofollow noreferrer\">https://www.azdhs.gov/preparedness/epidemiology-disease-control/flu/index.php#surveillance-influenza-season</a></p>\n<p>Data are also presented on emergence department (ED) visits and hospitalizations for “influenza-like illness.”</p>\n<p>Virtually all other states have similar almost “real-time” data for influenza and influenza-like illness.</p>\n<p>The Centers for Disease Control and Prevention also conducts near “real-time” surveillance of trends (by date) for (non-COVID-19) coronaviruses, human parainfluenza virus, respiratory adenovirus, respiratory syncytial virus, and human metapneumovirus.</p>\n<p>The data are readily available at the Centers for Disease Control and Prevention’s website.</p>\n<p><a href=\"https://www.cdc.gov/surveillance/nrevss/hmpv/natl-trend.html\" rel=\"nofollow noreferrer\">https://www.cdc.gov/surveillance/nrevss/hmpv/natl-trend.html</a></p>\n<p>They are published periodically in the Morbidity and Mortality Weekly Report, which has a wide distribution to physicians.</p>\n<p>While the data are readily available to physicians (and others), there is no systematic “push” of the data to physician offices and practices.</p>\n", "score": 1 } ]

[ "epidemiology" ]

[ { "answer_id": 25784, "body": "<p>So, as far as I am aware there is no specific grading of severity of fracture. Severity in fractures can be individual and based on age, debility, etc. Most classification systems I am aware of are based on describing the fracture. Open/closed, oblique, longitudinal, etc. There are also specific common fractures with names, such as a tri-malleolar fracture Colles fracture. There are some classification systems based on describing the fracture. You might look up Salter-Harris or Gustillo-Anderson, to name a few.</p>\n<p>Edit: I almost forgot to add- there are classification systems for internal organ injuries that are based on severity. The American academy of trauma surgeons has a good resource on this.</p>\n", "score": 1 } ]

[ "terminology", "treatment", "diagnosis", "bone-fractures" ]

[ { "answer_id": 29259, "body": "<p>Since (given the comments) it seems the question is about iron in ulcerative colitis (UC)... Iron doesn't <em>cause</em> (ulcerative) colitis <em>per se</em>; it's a recommended supplement in people with UC <a href=\"https://www.healthline.com/health/anemia/ulcerative-colitis-crohns-anemia-link\" rel=\"nofollow noreferrer\">because</a> they often have anemia (iron deficiency) as a result of UC, which causes poor iron absorption in the digestive tract.</p>\n<p>On the other hand, oral supplementation with iron may not be well tolerated in UC. Based on animal models, it might <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6181268/\" rel=\"nofollow noreferrer\">worsen UC symptoms</a> especially during an UC episode/flare-up. If that's the case, alternative route of iron administration, such as IV <a href=\"https://www.healthline.com/health/anemia/ulcerative-colitis-crohns-anemia-link#treatment\" rel=\"nofollow noreferrer\">is suggested</a>.</p>\n<p>However, I'm not convinced that most of the symptoms you've listed are related to UC. Tachycardia might be related be <a href=\"https://pubmed.ncbi.nlm.nih.gov/6799255/\" rel=\"nofollow noreferrer\">via hypomagnesemia</a>, i.e. magnesium deficiency, which is also sometimes present in UC. No way to know without laboratory blood tests, which of course we can't do over the internet.</p>\n<p>As for the mental health aspects, the causality relation with UC is <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4376063/\" rel=\"nofollow noreferrer\">even more complicated</a>; UC might actually be worsened by anxiety, rather than the other way around, or stress in general might exacerbate both. And panic attacks <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3547429/\" rel=\"nofollow noreferrer\">are themselves</a> related to tachycardia, even in patients without UC.</p>\n", "score": 1 } ]

[ "gastroenterology", "diagnostics", "diagnosis" ]

[ { "answer_id": 26075, "body": "<p>As of April 16, 2021, information about blood clots in people vaccinated with the Sputnik V and the CanSino COVID-19 vaccines come from news articles and press releases.</p>\n<p>Here is a link to an April 14, 2021 article in MedExpress that discusses the Sputnik V vaccine.</p>\n<p><a href=\"https://medicalxpress.com/news/2021-04-russia-sputnik-vaccine-blood-clots.html\" rel=\"nofollow noreferrer\">https://medicalxpress.com/news/2021-04-russia-sputnik-vaccine-blood-clots.html</a></p>\n<p>A statement from the state-run Gamaleya Research Institute, which developed Sputnik V vaccine, is quoted as follows:</p>\n<p>“A comprehensive analysis of adverse events during clinical trials and over the course of mass vaccinations with the Sputnik V vaccine showed that there were no cases of cerebral venous sinus thrombosis.&quot;</p>\n<p>An April 14, 2021 article in the South China Morning Post discusses blood clots for the CanSino vaccine.</p>\n<p><a href=\"https://www.scmp.com/news/china/science/article/3129553/covid-19-vaccines-chinas-cansino-distances-itself-blood-clot\" rel=\"nofollow noreferrer\">https://www.scmp.com/news/china/science/article/3129553/covid-19-vaccines-chinas-cansino-distances-itself-blood-clot</a></p>\n<p>The articles quotes CanSino Biologics, manufacturer of the vaccine, as follows:</p>\n<p>“In a filing to the Hong Kong stock exchange, the company said no serious adverse events related to blood clots had been reported among the almost 1 million doses of its COVID-19 vaccine that had been administered to date.&quot;</p>\n<p>Based on past experience with surveillance of potential adverse effects of new drugs and vaccines, one must anticipate that information about blood clots for all of the COVID-19 vaccines will evolve (and change).</p>\n", "score": 3 } ]

[ "covid-19", "vaccination" ]

[ { "answer_id": 26243, "body": "<p>No, because they don't have exactly the same DNA and the same history of exposure to pathogens, etc.</p>\n<p>Thinking about such issues in terms of ethnicity is not helpful because our DNA is so different, no matter whether or not we consider ourselves as the same ethnicity as someone else. With roughly 6 billion DNA &quot;letters&quot; in each of our cells, &quot;ethnicity&quot; tells us almost nothing about our DNA.</p>\n<p>That's why the expanding availability of complete genomic DNA sequencing promises to be helpful in guiding true individualized medical treatment.</p>\n<p>Edit: Here's a useful article with actual data on Covid disease vs. many individual factors:\nOgedegbe G, Ravenell J, Adhikari S, et al. Assessment of Racial/Ethnic Disparities in Hospitalization and Mortality in Patients With COVID-19 in New York City. JAMA Netw Open. 2020;3(12):e2026881. doi:10.1001/jamanetworkopen.2020.26881</p>\n", "score": 1 } ]

[ "covid" ]

[ { "answer_id": 26336, "body": "<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC535228/\" rel=\"nofollow noreferrer\">Varicella virus vaccine strain Oka (V-Oka) has in rare cases caused zoster in vaccinated people.</a></p>\n<p>But this study on children show that even after vaccination the wild virus still ends up settling in your body: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540599/\" rel=\"nofollow noreferrer\">&quot;VZV was found in at least some ganglia of all of the other subjects.&quot;</a></p>\n<p>What is interesting about the singles vaccine is prior to October 2017 there was only one FDA approved vaccine which was just discontinued silently in November 2020 which leaves us with one vaccine again.</p>\n", "score": 1 } ]

[ "vaccination" ]

[ { "answer_id": 27392, "body": "<p>I would flip this question on its head and ask what you think the benefit would be to changing the underlying file format? There are a few points that I can think of that might help frame the context for you, but there is probably no &quot;correct answer&quot; in the SE-sense.</p>\n<p>Imagine if a new file format were to be developed in medical imaging which stored its data in JSON. There would still need to be a separate documented standard that exhaustively details how imaging data is coded in this new format. That already exists in the form of the DICOM standard, so why rewrite it when it will still need to be interpreted by any library using this new format?</p>\n<p>Secondly, remember that in clincial practice medical software is a diverse mix of vendors from all over the world, some large, some small. There is no unifying body that mandates how software companies design their products, and interoperability is already extremely challenging. Given the established nature of DICOM, there is little incentive for these vendors to invest money in creating / utilising a different standard. Even if they were to do so, hospitals are notorious for being stuck on legacy software. <a href=\"https://www.theguardian.com/technology/2010/jan/22/internet-explorer-nhs-vulnerability\" rel=\"nofollow noreferrer\">This article</a> from 2010 gives you an idea of the state of play. Even today, one of the pieces of software I use on a daily basis only works in Internet Explorer, not in Edge/Chrome.</p>\n<p>It is probably worth noting that DICOM is not the only medical imaging file format in use, although it is probably the most prevalent in the clincial setting. For example, the <a href=\"https://nifti.nimh.nih.gov/\" rel=\"nofollow noreferrer\">NifTI format</a> is widely used in the neuroimaging research space.</p>\n<p>Bear in mind, as well, that medical imaging data is very heterogeneous and so writing a new standard is not a small task. For example:</p>\n<ul>\n<li>A chest X-ray is a 2D grayscale image</li>\n<li>A CT scan is multiple stacked 2D images, sometimes with several series (i.e. several associated stacks) in a single scan</li>\n<li>A PETCT scan would include a co-registered map onto a CT displaying tracer avidity detected by the gamma camera</li>\n<li>A 4DCT would also incorporate a time element into this</li>\n<li>DICOM-RT objects could include information such as radiotherapy dose planned to a particular voxel, or the physical position of a radiotherapy field</li>\n</ul>\n<p>This is before you get into the metadata associated with it, which ranges from patient demographics, the field strength of the MRI scanner, the frame of reference of the scan and beyond.</p>\n<p>Finally, what do you mean when you say</p>\n<blockquote>\n<p>it would significantly decrease the amount of work needed&quot;?</p>\n</blockquote>\n<p>There exist already many libraries (e.g. <a href=\"https://pydicom.github.io/\" rel=\"nofollow noreferrer\">pydicom</a>) to work with DICOM, if there were a JSON-based format they would then need to be developed for that.</p>\n", "score": 4 }, { "answer_id": 26369, "body": "<p>According to the 'History' link on the DICOM web site:</p>\n<blockquote>\n<ul>\n<li><a href=\"https://www.dicomstandard.org/history\" rel=\"nofollow noreferrer\">https://www.dicomstandard.org/history</a></li>\n</ul>\n</blockquote>\n<p>in 2013, <a href=\"https://www.dicomstandard.org/dicomweb/\" rel=\"nofollow noreferrer\">DICOMweb</a> was introduced, and this uses <a href=\"https://en.wikipedia.org/wiki/Representational_state_transfer\" rel=\"nofollow noreferrer\">RESTful</a> web services, which uses HTML, XML and JSON.</p>\n<blockquote>\n<p>Second generation RESTful web services defined to retrieve, store and query DICOM images. The suite of web services is re-branded as DICOMweb™, and is aligned with the upcoming HL7 FHIR web services:</p>\n</blockquote>\n", "score": 0 } ]

[ "computers" ]

[ { "answer_id": 26387, "body": "<p>There's nothing inherently unethical about treating a friend or family member. However, <a href=\"https://www.ama-assn.org/delivering-care/ethics/treating-self-or-family\" rel=\"nofollow noreferrer\">the AMA recommends against it</a> for other reasons:</p>\n<blockquote>\n<p>When the patient is an immediate family member, the physician’s\npersonal feelings may unduly influence his or her professional medical\njudgment. Or the physician may fail to probe sensitive areas when\ntaking the medical history or to perform intimate parts of the\nphysical examination. Physicians may feel obligated to provide care\nfor family members despite feeling uncomfortable doing so. They may\nalso be inclined to treat problems that are beyond their expertise or\ntraining.</p>\n<p>Similarly, patients may feel uncomfortable receiving care from a\nfamily member. A patient may be reluctant to disclose sensitive\ninformation or undergo an intimate examination when the physician is\nan immediate family member. This discomfort may particularly be the\ncase when the patient is a minor child, who may not feel free to\nrefuse care from a parent.</p>\n<p>In general, physicians should not treat themselves or members of their\nown families. However, it may be acceptable to do so in limited\ncircumstances:</p>\n<p>(a) In emergency settings or isolated settings where there is no other\nqualified physician available. In such situations, physicians should\nnot hesitate to treat themselves or family members until another\nphysician becomes available.</p>\n<p>(b) For short-term, minor problems.</p>\n<p>When treating self or family members, physicians have a further\nresponsibility to:</p>\n<p>(c) Document treatment or care provided and convey relevant\ninformation to the patient’s primary care physician.</p>\n<p>(d) Recognize that if tensions develop in the professional\nrelationship with a family member, perhaps as a result of a negative\nmedical outcome, such difficulties may be carried over into the family\nmember’s personal relationship with the physician.</p>\n<p>(e) Avoid providing sensitive or intimate care especially for a minor\npatient who is uncomfortable being treated by a family member.</p>\n<p>(f) Recognize that family members may be reluctant to state their\npreference for another physician or decline a recommendation for fear\nof offending the physician.</p>\n</blockquote>\n<p>Item (c) is where I suspect things are most likely to go wrong. Does Dave have a chart opened on Bob at his place of business? If another physician reviewed that chart would they find it to be complete with an exam, medical history, etc? If another doctor calls his office with questions about Bob, will Dave's staff know who Bob is and be able to provide answers?</p>\n", "score": 3 } ]

[ "medical-ethics", "legal", "dementia" ]

[ { "answer_id": 28853, "body": "<p>In the case of your MRI, it's probably very simple: if you're lying on your side, you won't fit in the machine.</p>\n<p>There's nothing inherent in the MRI scanning process that requires any particular position. Rather, the MRI scanner is made as small as possible to improve imaging quality. The platform the patient lies on occupies the bottom of the imaging area, so a scanner just barely wide enough to accommodate a patient's shoulders or hips when lying back won't be tall enough to fit a patient lying on their side.</p>\n", "score": 1 } ]

[ "mri" ]

[ { "answer_id": 28840, "body": "<p>This question is clearly answered by the CDC's <a href=\"https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html\" rel=\"noreferrer\">&quot;Myths and Facts about COVID-19 Vaccines&quot;</a></p>\n<blockquote>\n<p>Will getting a COVID-19 vaccine cause me to test positive for COVID-19 on a viral test?</p>\n<p>No. None of the authorized and recommended COVID-19 vaccines cause you to test positive on viral tests, which are used to see if you have a current infection.​</p>\n</blockquote>\n", "score": 5 } ]

[ "united-states", "vaccine", "covid" ]

[ { "answer_id": 28980, "body": "<p>Your scenario is easy to work out. The character injects his usual dose of insulin prior to a meal he's about to eat, but he gets interrupted by something and never finishes the meal. End result: hypoglycemia sufficient to render him unresponsive. When he's found, those finding him are educated enough to know they can't pour anything down his throat while he's unresponsive, so they lodge hard candies between his cheek and gums and wait for them to dissolve and give him the sugar he needs.</p>\n<p>A more nuanced treatment of the question can be found <a href=\"https://blog.nols.edu/2020/07/23/diabetes-outdoors\" rel=\"nofollow noreferrer\">here</a>:</p>\n<blockquote>\n<p>Give sugar until the responsive patient regains an adequate level of\nresponsiveness. If the patient is unresponsive, place the patient on\ntheir side and rub sugar into their gums with a gloved finger. Make\nsure to protect the patient’s airway.</p>\n</blockquote>\n", "score": 2 } ]

[ "diabetes", "coma-comatose" ]

[ { "answer_id": 29205, "body": "<p>I'm guessing this is inspired by the recently <a href=\"https://eu.usatoday.com/story/money/food/2021/10/21/salmonella-outbreak-onion-recall-prosource-mexico-onions/6115318001/\" rel=\"nofollow noreferrer\">reported</a> outbreak in the US. From the media reports I've seen it's not clear if contamination was limited to biofilm or if it grew inside onions.</p>\n<p>Generally speaking, salmonella contamination of vegetables often originates from contaminated manure used as fertilizer and can be absorbed through plant roots. Salmonella can definitely grow inside some plants thereafter (aka &quot;internalization&quot;), e.g. inside potatoes, watermelons, lettuce, oranges, or even tomatoes as shown by fluorescence microscopy and by laser scanning confocal microscopy. It can persist for weeks in such conditions, generally at room temperature.</p>\n<p>More generally, Salmonella can form <a href=\"https://en.wikipedia.org/wiki/Biofilm\" rel=\"nofollow noreferrer\">biofilm</a> and persist on many more surfaces, sometimes with the cooperation of other microorganisms. It can even do that on the surface of tomatoes (which have some anti-microbial properties otherwise). Under some washing conditions, e.g. warm fruits washed with cold water, it can actually penetrate the skin of some plants as well, so ironically that may make the problem worse.</p>\n<p>Reference for the above: <a href=\"https://www.tandfonline.com/doi/full/10.1080/01140671003767834\" rel=\"nofollow noreferrer\">https://www.tandfonline.com/doi/full/10.1080/01140671003767834</a></p>\n<p>There is actually <a href=\"https://pubmed.ncbi.nlm.nih.gov/25581176/\" rel=\"nofollow noreferrer\">one (2015) study</a> that found that Salmonella will readily grow inside onions at room temperature (0.3 log <a href=\"https://en.wikipedia.org/wiki/Colony-forming_unit\" rel=\"nofollow noreferrer\">CFU</a>/gram/hour), but will slowly degrade on the (outer, dry) skin thereof (0.3 log CFU/sample/day). Refrigeration inhibited growth inside onions.</p>\n<p>There is also <a href=\"https://pubmed.ncbi.nlm.nih.gov/31733520/\" rel=\"nofollow noreferrer\">one (2019) study</a> that discusses the issues with detecting Salmonella in spices (including onions), precisely because spices have some anti-bacterial properties retarding bacterial growth.</p>\n", "score": 3 } ]

[ "food-safety" ]

[ { "answer_id": 29392, "body": "<p>There isn't an English word that means pre-patient. If you call a doctor's office and ask for an appointment, you become known to them as a patient the minute they type your name into the system. It doesn't matter that they haven't seen you, examined you, or run any tests yet; you're still a patient. That's what I would expect your app to do. Anything else would likely be confusing.</p>\n<p>Source: Personal experience writing patient care reports and developing medical software.</p>\n", "score": 3 }, { "answer_id": 29393, "body": "<p><strong>Candidate.</strong></p>\n<p>1 b: one likely or suited to undergo or be chosen for something specified\n(e.g. a candidate for surgery).</p>\n<p>^{<a href=\"https://www.merriam-webster.com/dictionary/candidate\" rel=\"nofollow noreferrer\">Merriam Webster.</a>}</p>\n", "score": 1 } ]

[ "covid-19" ]

[ { "answer_id": 29471, "body": "<p>Chance, mostly.</p>\n<p><a href=\"https://en.wikipedia.org/wiki/Pfizer%E2%80%93BioNTech_COVID-19_vaccine#Clinical_trials\" rel=\"nofollow noreferrer\">Pfizer's mRNA vaccine</a> and <a href=\"https://en.wikipedia.org/wiki/CoronaVac#Phase_III\" rel=\"nofollow noreferrer\">Sinovac's inactivated-virus vaccine</a> both started phase III trials in July of 2020. The usual procedure for a phase III trial is to give a bunch of people either the vaccine or a placebo, and once a certain number of cases appear in the study group, check to see how many of those were in vaccinated individuals.</p>\n<p>Pfizer's phase III trial took place in the United States, which saw a late-fall surge in the number of COVID-19 cases. Sinovac's trial took place in Brazil, Chile, Indonesia, and Turkey, all of which saw steady or declining case counts over the same period. As a result, Pfizer was able to get effectiveness data before Sinovac did.</p>\n<p>(Other inactivated-virus vaccines either started trials later, or also picked trial sites that didn't see a fall surge in cases.)</p>\n", "score": 0 } ]

[ "vaccine" ]

[ { "answer_id": 30493, "body": "<p>The term you are looking for is &quot;<a href=\"https://en.wikipedia.org/wiki/Proprioception\" rel=\"nofollow noreferrer\">proprioception</a>&quot;.</p>\n<p>Briefly, it works because you have sensors in your own muscles and joints that can sense their stretch and position.</p>\n", "score": 3 } ]

[ "neurology", "neuroscience" ]

[ { "answer_id": 30564, "body": "<p>Seems like you answered your own question. Lowering the threshold for intoxication lowers the threshold for toxicity. The likelihood of acute ethanol poisoning is increased by coadministering these drugs. Strict supervision is resource intensive and probably impractical for managing such a common condition.</p>\n<p>In addition ethanol displays <a href=\"https://pubmed.ncbi.nlm.nih.gov/7004237/\" rel=\"nofollow noreferrer\">nonlinear pharmacokinetics</a>, meaning that once alcohol dehydrogenase is saturated there is metabolic autoinhibition of further alcohol breakdown - basically all the alcohol dehydrogenase is blocked up with alcohol slowing down breakdown.</p>\n<p>This changes the breakdown of alcohol from <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK499866/\" rel=\"nofollow noreferrer\">first order to zeroth order</a> according to the Michaelis Menten relationship which means that further increases in blood alcohol concentration do not affect the rate of the reaction.</p>\n<p><a href=\"https://i.stack.imgur.com/9MUAP.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/9MUAP.png\" alt=\"https://commons.m.wikimedia.org/wiki/File:Michaelis_Menten_curve_2.svg\" /></a>\n(Source: Wikimedia Commons)</p>\n<p>Accordingly, if you have blocked alcohol dehydrogenase already the threshold for reaching zeroth order elimination is lower. When this happens there is effectively a &quot;bottleneck&quot; in the elimination of ethanol and it will accumulate much faster in the plasma.</p>\n<hr />\n<p>With regard to your mention of health benefits to alcohol this is probably <a href=\"https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm\" rel=\"nofollow noreferrer\">not true.</a></p>\n<blockquote>\n<p>Although past studies have indicated that moderate alcohol consumption has protective health benefits (e.g., reducing risk of heart disease), recent studies show this may not be true.6-11 While some studies have found improved health outcomes among moderate drinkers, it’s impossible to conclude whether these improved outcomes are due to moderate alcohol consumption or other differences in behaviors or genetics between people who drink moderately and people who don’t.</p>\n</blockquote>\n", "score": 3 } ]

[ "alcohol", "liver", "drug-metabolism", "recreational-drugs", "alcoholism" ]

[ { "answer_id": 30824, "body": "<p><a href=\"https://ieeexplore.ieee.org/abstract/document/8857890\" rel=\"nofollow noreferrer\">Tiwari et al, 2019</a> found poor sensitivity and specificity for detecting stress using multiple features from a fitness watch: sensitivity 0.53, specificity 0.56, and similarly poor for anxiety: sensitivity 0.44, specificity 0.63.</p>\n<p>Of course, this measures stress/anxiety in <em>individuals</em>, which is not quite the same as measuring it in <em>populations</em>.</p>\n<p>I did not find any study that attempted to do what you describe: estimate population levels of stress or anxiety and correlate this to events, but probably the first step would be to do a validation against some gold-standard assessment.</p>\n<p>In research and publishing it's not so much about what is <em>possible</em>, which seems to be a binary &quot;yes it is possible&quot; versus &quot;no it is not possible&quot;, and more about <em>impact</em> of a given result. If you show a correlation, will people believe it? They're probably more likely to believe results that confirm their prior expectations, and disbelieve results that oppose them. For a measurement modality without a track record of success, that's the correct behavior. With more use and more evidence that a given measurement accurately reflects reality, people will begin to trust those results more than their preconceived ideas. I don't think this is something you can know or predict without having actually done the research.</p>\n<hr />\n<p>Tiwari, A., Cassani, R., Narayanan, S., &amp; Falk, T. H. (2019, July). A comparative study of stress and anxiety estimation in ecological settings using a smart-shirt and a smart-bracelet. In 2019 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) (pp. 2213-2216). IEEE.</p>\n", "score": 3 } ]

[ "stress", "data", "technology", "pulse" ]

[ { "answer_id": 31035, "body": "<p>Severe esophageal obstruction could cause choking via:</p>\n<ul>\n<li>Regurgitation leading to bronchoaspiration</li>\n<li>Compression of the adjacent trachea</li>\n</ul>\n<p>Resuscitation in such a scenario would warrant emergent protection of the airway.</p>\n<p>If there is external compression of the trachea, depending on the cause, a foreign object might have to be removed endoscopically, or if the compressions originates from a mass, the trachea could be stented.</p>\n", "score": 1 } ]

[ "emergency", "cpr", "choking", "esophagus" ]

[ { "answer_id": 31079, "body": "<p><strong>TL;DR: Placing it in the chest or abdomen actually makes perfect sense.</strong></p>\n<p>There are several reasons why your ideas won't work, at least with current technologies.</p>\n<blockquote>\n<p>why not either a) have the pulses be generated directly adjacent to\nthe electrodes, instead of having the IPG somewhere in the chest or\nthe abdomen</p>\n</blockquote>\n<p>Because IPGs are the size of pacemakers, and you can't put an object that large inside the skull. There is no spare room inside the skull, so it would displace brain tissue, possibly causing injury, and it would be a much more difficult surgery with much higher risks. I would imagine that placing a tiny electrode and wire deep in the brain is difficult enough, but placing a device the size of an iPod would be vastly more difficult and dangerous.</p>\n<p>Thanks to pacemakers, putting it in the chest or abdomen is perfected surgery that's performed hundreds of times a day worldwide in an <a href=\"https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/pacemaker-insertion#:%7E:text=A%20pacemaker%20may%20be%20performed,may%20interfere%20with%20the%20procedure.\" rel=\"nofollow noreferrer\">outpatient setting</a> with very low risk and an easy recovery. It makes perfect sense to put it there.</p>\n<p><a href=\"https://i.stack.imgur.com/IueA2.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/IueA2.jpg\" alt=\"enter image description here\" /></a>\n<a href=\"https://pratt.duke.edu/about/news/evolving-deep-brain-stimulation-patterns\" rel=\"nofollow noreferrer\">Image source</a></p>\n<blockquote>\n<p>or b) have the neurostimulator on the body instead of in the body,\nwith the leads going transcutaneously to the electrodes?</p>\n</blockquote>\n<p>This is addressed in comments by two people:</p>\n<ul>\n<li><p>bob1 points out maintenance and external wires. Replacing a battery buried deep in your brain would be a major surgical procedure with significant risk. And having an external wire that can be caught on something and yanked out of place in your brain could have catastrophic consequences. Suffering brain damage from combing your hair seems an unreasonable risk.</p>\n</li>\n<li><p>Ian Campbell points out that having a wire going from your skin into your brain would be a major infection risk. <a href=\"https://www.hopkinsmedicine.org/brain-tumor/specialty-centers/skull-base/types/csf-leak.html#:%7E:text=A%20CSF%20leak%20is%20a,and%20brain%20or%20sinus%20surgery.\" rel=\"nofollow noreferrer\">Any external pathway</a> from the outside world into your brain is dangerous.</p>\n</li>\n</ul>\n", "score": 5 } ]

[ "neurology", "brain" ]

[ { "answer_id": 31400, "body": "<p>I think this question is primarily based on a misconception about the nature of oral and genital infections with HSV-1 and HSV-2 in the modern day.</p>\n<p>HSV-1 is sometimes described as an oral herpes virus. That does not mean it is only an oral herpes virus, just that among oral herpes cases it tends to be more common.</p>\n<p>HSV-2 is sometimes described as a genital herpes virus. That does not mean it is only a genital herpes virus, just that among genital herpes cases it tends to be more common.</p>\n<p>The relative prevalence is not something like &quot;99%&quot; of one sort or the other. For example this editorial:</p>\n<p><a href=\"https://sti.bmj.com/content/82/3/189.1.short\" rel=\"nofollow noreferrer\">Wald, A. (2006). Genital HSV-1 infections. Sexually transmitted infections, 82(3), 189-190.</a></p>\n<p>points out that HSV-1 is a common cause of genital herpes:</p>\n<blockquote>\n<p>For example, a Japanese study of women, published in 1976, documented 43% of genital herpes as caused by HSV-1.2 In 1977, a university health clinic study showed that 37% of women with clinical diagnosis of genital herpes had HSV-1 isolated.3 Among people with newly acquired genital herpes in Seattle in the mid to late 1980s, 32% had genital HSV-1 infection.4</p>\n</blockquote>\n<p>The editorial further discusses the increasing prevalence of HSV-1 among genital herpes cases in reference to the article the editorial responded to:</p>\n<p><a href=\"https://sti.bmj.com/content/82/3/255.short\" rel=\"nofollow noreferrer\">Haddow, L. J., Dave, B., Mindel, A., McPhie, K. A., Chung, C., Marks, C., &amp; Dwyer, D. E. (2006). Increase in rates of herpes simplex virus type 1 as a cause of anogenital herpes in western Sydney, Australia, between 1979 and 2003. Sexually transmitted infections, 82(3), 255-259.</a></p>\n<p>and attributes this to a mixture of reduced oral HSV-1 in children, making them susceptible to genital infection as they begin sexual activity, and changes in sexual behavior to include more oral sex, especially among adolescents.</p>\n<p>There are no studies I am aware of where an experiment is done to take individuals infected with oral HSV-1, have them engage in oral sex with someone naive to HSV-1, and find out how many infections occur. I'm sure you can imagine why. It is possible to make some inferences based on prevalence and surveys of behavior, but it's typical for people to engage in a variety of sexual behaviors and also common for partners to not know they are infected or not share this information, so it often may not be possible to determine transmission routes definitively. It's also common for these studies to focus on <em>cases</em> of HSV, so they may not have a comparison group of people who are HSV-negative despite partners who are positive.</p>\n<p>Studies like this one:</p>\n<p><a href=\"https://sti.bmj.com/content/sextrans/76/3/179.full.pdf\" rel=\"nofollow noreferrer\">Löwhagen, G. B., Tunbäck, P., Andersson, K., Bergström, T., &amp; Johannisson, G. (2000). First episodes of genital herpes in a Swedish STD population: a study of epidemiology and transmission by the use of herpes simplex virus (HSV) typing and specific serology. Sexually transmitted infections, 76(3), 179-182.</a></p>\n<p>find both that genital HSV-1 is common and that:</p>\n<blockquote>\n<p>Of 26 HSV-1 infected patients, all but one\nwho answered the question about orogenital\nsex reported having practised orogenital sex in\nconnection with onset of the infection, compared with eight (57%) of 14 in the HSV-2\ngroup (p= 0.004).</p>\n</blockquote>\n<p>Or this one:</p>\n<p><a href=\"https://www.tandfonline.com/doi/full/10.1080/07448481.2010.483711\" rel=\"nofollow noreferrer\"></a></p>\n<blockquote>\n<p>Common patterns noted in patients with genital HSV-1 infections included a negative personal history of cold sores, having a sexual partner with a recent cold sore, orogenital contact, being an athlete, and cosmetic body shaving.</p>\n</blockquote>\n<blockquote>\n<p>Orogenital contact is a major factor in the transmission of genital HSV-1. Oral sex is commonly thought to be “safer” for prevention of pregnancy and sexually transmitted infections, including HIV disease, compared to vaginal or anal intercourse. Younger adolescents, especially, think of oral sex as more acceptable than vaginal intercourse, which is more likely to occur in the future for themselves and their peers. 23 College students report having oral sex and vaginal sex at about the same rate (45.2% oral sex and 48.8% vaginal sex); however, they report using condoms 52.1% of the time for vaginal sex, but only 3.8% of the time for oral sex. 24 Women who had receptive oral sex or vaginal intercourse were more likely to be HSV-1 seropositive than sexually inactive women. 25 White race, receptive oral sex, and anal intercourse were also positive predictors for HSV-1 genital infection. 18 Orogenital contact and having a single partner over the past 2 months were associated with HSV-1 infection, whereas HSV-2 was associated with a higher number of sexual partners in the last 6 months. 13</p>\n</blockquote>\n<p>This seems like strong suggestive evidence that oro-genital HSV-1 transmission is common, particularly for female recipients of oral sex (though the authors point out that it is not clear from these data whether that is due to differences in anatomy or differences in behavior). Preventative measures against sexually transmitted infections (e.g., condoms) are less common for oral sex than vaginal sex.</p>\n", "score": 3 } ]

[ "disease-transmission", "herpes", "sti" ]

[ { "answer_id": 31596, "body": "<p><em>I think there must be an error somewhere in the Vector Diagram for Lead III.\nI believe it should be pointing down-left to 8:00 not up-right to 2:00 as shown up in yellow image below.</em>\n(yes it is confusing)</p>\n<p>Kirchhoff’s second law states that the algebraic sum of all the voltages around any closed path in a circuit equals zero.</p>\n<p>This is only true when the proper polarities are followed.</p>\n<ul>\n<li>the augmented vector foot (aVF) is positive (+ve) and perpendicular to (or <em>normal to</em>) Lead I</li>\n<li>the augmented vector right (aVR) is negative (-ve) is normal to Lead II</li>\n<li>the augmented vector left (aVL) is positive (+ve) in relation to aVR and normal to Lead III, but negative (-v) in relation to aVF.</li>\n</ul>\n<h2>Summary</h2>\n<p><strong>I + III + (-II) = 0; or I + III = II</strong> using Kirchoff's Voltage Law with Einthoven's Triangle</p>\n<p>: aVF ┴ Lead I :<br />\n: aVR ┴ Lead II :<br />\n: aVL ┴ Lead III :<br />\nNote <strong>Foot</strong> means same as <strong>Left Leg</strong>, LL where electrical voltage E is measured. and right leg RL by convention is driven by negative feedback to null the common mode (CM) antenna effects of the body. But technically, it makes no difference which leg is used if swapped with the RLD feedback, so it is abbreviated to just Foot as in aVF.</p>\n<p>This negative feedback potential is more than a thousand times bigger than the sensed voltages and due to the amplifier gigaohm impedances draws no significant current. But this accurately nulls the common mode antenna effects with very high gain &gt; 1e6. However, reversing any vector differential lead polarities may result in an incorrect diagnosis.</p>\n<p><a href=\"https://i.stack.imgur.com/IiZdC.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/IiZdC.png\" alt=\"enter image description here\" /></a>\nabove Reference: VOL. 11 NO. 1 2010 REVIEWS IN CARDIOVASCULAR MEDICINE p33</p>\n<p>You are not alone in confusion looking at the triangle. The triangle appears to be equilateral vectors that don't add up. The red arrows simply show the direction of the positive differential pairs.\n<a href=\"https://i.stack.imgur.com/14R7k.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/14R7k.png\" alt=\"enter image description here\" /></a></p>\n<p>Reference:\n<a href=\"https://www.sciencedirect.com/topics/materials-science/ecg-leads\" rel=\"nofollow noreferrer\">https://www.sciencedirect.com/topics/materials-science/ecg-leads</a><br />\n<a href=\"https://www.wikiwand.com/en/Einthoven%27s_triangle\" rel=\"nofollow noreferrer\">https://www.wikiwand.com/en/Einthoven's_triangle</a></p>\n<h2>Other info</h2>\n<ul>\n<li><p>&quot;GROUND&quot; in electrical/electronic circuits means a perfect 0V by definition but only at that location.</p>\n</li>\n<li><p>Creating this &quot;virtual ground&quot; must not have interference</p>\n<ul>\n<li>This is created by shielded signals and INstrument Amplifiers (INA) with negative feedback from the neutral points (GT) of the Diff. probes'.</li>\n<li>This is found on the CM gain resistor then splitting into two 0.1% resistors and 100 pF caps so as not to conduct 50/60 Hz as the tolerance errors on a larger cap values could seriously degrade the Common Mode Rejection Ratio (CMRR) and thus the creation of the virtual ground or Ground Terminal or .and then filtering and sending this signal back to right leg drive (RLD) or somewhere nearby to cancel as much AC grid field noise and AM radio noise that radiates everywhere.</li>\n</ul>\n</li>\n<li><p>One study reported approximately 2% lead misplacement in more than 10,000 ECGs analyzed. Another study reported the incidence of lead misplacement in 0.4% of ECGs performed in an outpatient cardiology clinic and in 4% of ECGs performed in the intensive care unit.\n<em>VOL. 11 NO. 1 2010 REVIEWS IN CARDIOVASCULAR MEDICINE p34 Einthoven’s Triangle Transparency</em></p>\n</li>\n</ul>\n<p>Your missing citation was essentially the following;</p>\n<ul>\n<li>+aVL = ( I - III ) ÷2</li>\n</ul>\n<ul>\n<li>-aVR = ( I + II ) ÷2</li>\n</ul>\n<ul>\n<li>+aVF = ( II + III) ÷2</li>\n</ul>\n<p>&quot;Science direct&quot; shows an Einthoven (et al.) Vector Diagram with the neutral central point called the &quot;Wilson Central Terminal&quot; (WCT) or GT in diagram, which I assume means &quot;Ground Terminal&quot;. <strong>However Lead III arrow is reversed.</strong></p>\n<p><a href=\"https://i.stack.imgur.com/xU0jm.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/xU0jm.png\" alt=\"enter image description here\" /></a></p>\n", "score": 3 } ]

[ "physiology", "electrocardiogram" ]

[ { "answer_id": 31940, "body": "<p>On the Y-axis, you can see this is labeled as a <em>cumulative</em> incidence; cumulative means you're adding up over time. So, all the curves have to go up as you go to the right, because over time you accumulate more infections. The <em>slope</em> of the graph would be the rate of infections; a straight line would mean you have a constant rate of infection. If there were zero new infections past some point, then the line would level off at horizontal, but it would never go down because it's a cumulative plot: it's showing all infections that occurred on a given day <em>or sooner</em>.</p>\n<p>The colors and associated labels on the right indicate that the different lines are different groups of people, grouped based on the most recent time they had a COVID infection before the study started. So, if at the start of the study someone never had COVID, they'd be in the black group. If they were last infected during the Omicron BA1/BA2 phase, they'd be in the blue group. Note that the people running the study probably don't know what actual strain any individual was infected with, but they're relying on systematic differences in strains caught at different times to show up as systematic differences in these groupings.</p>\n<p>I assume the reason they're looking at these data is to try to make inferences about whether prior infections are protective in the future. Because the black line is above all the others, we are meant to assume that having some previous COVID infection provides some level of immunity. If not, you'd expect people not previously infected would be just as likely to be infected in the future. About 6% of people in the study who hadn't previously had COVID were infected over the 90 days of the study.</p>\n<p>The trend is that the other lines closest to black are infections from earlier in the pandemic. That means those people have only a little more protection than the naive group, either because the currently circulating strains are different than the ones they built immunity to or because immunity has waned over time.</p>\n<p>The people least likely to be infected are those who have been infected recently by a recent strain from the Omicron lineage, less than 2% over 90 days.</p>\n<p>There are no groupings by vaccine in this graph, so you can't use it to say anything about vaccines, and anyone that does use it to say something about vaccines is a) trying to mislead you, b) incompetent, or c) there's some misunderstanding of what they are actually saying.</p>\n", "score": 3 } ]

[ "covid-19", "vaccination", "effectiveness", "vaccine", "covid" ]

[ { "answer_id": 32067, "body": "<p>A kidney stone (nephrolithiasis) is a calculus (stone) existing within the kidney and/or the collecting system before it enters the ureter.¹ A ureteral stone (ureterolithiasis) is a calculus (stone) that has exited the kidney and exists within the ureter (the passageway between the kidney and the urinary bladder). ^1,2A nephrolithiasis (stone within the kidney) is unlikely to cause pain. On the other hand, ureterolithiasis (a stone existing within the ureter) is more than likely to cause discomfort and severe pain when 8mm in size. It would be highly unusual and unlikely for a ureteral stone of 8mm not to be painful or cause discomfort. Any ureteral stone &gt;5mm is likely to obstruct because, at that point, it is estimated to be around 11%-22% larger than the inner diameter of the ureter.³ Therefore, 8mm would more than likely be in contact with the ureteral walls, causing a pain response and obstruction. Pain response is primarily due to ureteral wall agitation, and renal capsule distention (secondary to obstruction).⁴</p>\n<p>References</p>\n<ol>\n<li>Nephrolithiasis: Practice Essentials, Background, Anatomy. Published online July 13, 2022. Accessed March 18, 2023. <a href=\"https://emedicine.medscape.com/article/437096-overview\" rel=\"nofollow noreferrer\">https://emedicine.medscape.com/article/437096-overview</a></li>\n<li>Ureter Anatomy: Overview, Gross Anatomy, Microscopic Anatomy. Published online October 14, 2022. Accessed March 18, 2023. <a href=\"https://emedicine.medscape.com/article/1949127-overview\" rel=\"nofollow noreferrer\">https://emedicine.medscape.com/article/1949127-overview</a></li>\n<li>Liu Y, Li M, Qiang L, Sun X, Liu S, Lu TJ. Critical size of kidney stone through ureter: A mechanical analysis. <em>J Mech Behav Biomed Mater</em>. 2022;135:105432. doi: <a href=\"https://doi.org/10.1016/j.jmbbm.2022.105432\" rel=\"nofollow noreferrer\">10.1016/j.jmbbm.2022.105432</a></li>\n<li>Kidney stones in adults: Diagnosis and acute management of suspected nephrolithiasis - UpToDate. Accessed March 18, 2023. <a href=\"https://www.uptodate.com/contents/kidney-stones-in-adults-diagnosis-and-acute-management-of-suspected-nephrolithiasis?search=kidney%20stone&amp;source=search_result&amp;selectedTitle=1%7E150&amp;usage_type=default&amp;display_rank=1\" rel=\"nofollow noreferrer\">https://www.uptodate.com/contents/kidney-stones-in-adults-diagnosis-and-acute-management-of-suspected-nephrolithiasis?search=kidney%20stone&amp;source=search_result&amp;selectedTitle=1~150&amp;usage_type=default&amp;display_rank=1</a></li>\n</ol>\n", "score": 4 } ]

[ "kidney-stones" ]

[ { "answer_id": 32146, "body": "<p><em><a href=\"https://en.wikipedia.org/wiki/Clostridium_botulinum\" rel=\"nofollow noreferrer\">C. botulinum</a></em> grows best in moderate temperature, low-acidity, low-oxygen conditions and requires a bit of moisture. Poorly canned/&quot;preserved&quot; food that is not sufficiently heated during canning and not sufficiently acidic and then left on the shelf is an ideal environment.</p>\n<p>Mixing honey and ghee does not by itself cause this combination of conditions, but a product containing honey and ghee is also not immune to this combination of conditions. It seems like the warning comes from some ayurvedic tradition. This is not an empirical/evidence-based tradition. It sounds to me like a case where the wrong lesson was learned; that is, some food containing honey and ghee was stored improperly, caused illness, and someone decided to blame the honey+ghee combination due to non-scientific beliefs about the &quot;essence&quot;/&quot;temperature&quot; of these ingredients, rather than the storage conditions described above.</p>\n", "score": 2 } ]

[ "nutrition", "surgery" ]

[ { "answer_id": 32210, "body": "<p>The 1 dislike on the Q seems to be right as no research effort has been put but still assuming being a student having doubts and and is still in theory stage (inexperienced) i would try to answer.</p>\n<p>Your questions seems to be flawed as you are not taking into account what is the cause of hyper/hypo states</p>\n<ol>\n<li>e.g.in hypo-parathyroidism if the cause is surgical excision of glands then shouldnt, we treat the both the cause and effect i.e. treat the hypoparathyroid state with teriparatide (rPTH) and effect of hypoparathyroidism specifically hypocalcemia using calcium supplements, thiazides conserving calcium by decreasing excretion, and using Vit D which has effects at mutiple levels</li>\n<li>similary in hyperparathyroid state if the cause of hypercalcemia is an adenoma then shouldn't we treat the functional adenoma and its effects - that is treat the hyperparathyroidism by giving cinalcet and treat the effect hypercalemia by causing excretion using furosemide.</li>\n</ol>\n<p>Hope this clarifies. This answer is targetted at UG level because beyond that guidelines based on severity of states would be better to answer. what to use in which situation.</p>\n", "score": 0 } ]

[ "medications", "treatment", "endocrinology", "thyroid", "calcium" ]

[ { "answer_id": 816, "body": "<p>Disclaimer: Some of the sources in this post should likely be considered \"Not Safe for Work\".</p>\n\n<p>Glycerine-based lubricants, which are likely the most common form of water-based lubricants on the market (consider, for example, <a href=\"http://www.astroglide.com/products/astroglide-liquid/\">Astroglide</a> or <a href=\"http://www.k-y.com/products/lubricants/k-y-liquid-lubricant-5oz\">K-Y</a>) have a number of positive properties to them (when compared to silicon or oil-based lubricants):</p>\n\n<ul>\n<li>They are safe for use with latex-based condoms. Oil-based lubricants can have negative impacts on <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/8142525\">both slippage and breakage</a> of condoms, which is of course a bit of a problem, as presumably that condom is meant for either pregnancy prevention or disease prevention, both of which rely on an intact and in-place condom.</li>\n<li>Similarly, they are safe for use with toys of various sorts. Some silicone-based lubricants can interact with silicon-based toys.</li>\n<li>Because they are water based, they are relatively easy to clean.</li>\n</ul>\n\n<p>There are also a number of drawbacks, compared to alternatives:</p>\n\n<ul>\n<li>As they are water based, they can become tacky over time, and when used in water, may wash off, resulting in an essentially unlubricated surface (water has this same effect on vaginal secretions).</li>\n<li>There is some suggestion that these products are associated with an increased risk of yeast infections when used vaginally, but at least <a href=\"http://journals.lww.com/greenjournal/Fulltext/2013/04000/Intravaginal_Practices_and_Risk_of_Bacterial.12.aspx\">one study</a> did not find such an effect.</li>\n<li>There has been some noted damage to cellular tissue from the use of some lubricants, as they may be hyperosmotic compared to the tissue they're coming into contact with. This has been shown in some <a href=\"http://www.biomedcentral.com/1471-2334/10/331\">animal models</a> and <a href=\"http://jid.oxfordjournals.org/content/195/5/703\">human studies</a>, and may not be as much of a problem in some <a href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0048328\">silicon-based lubricants</a>.</li>\n</ul>\n", "score": 8 } ]

[ "sexuality" ]

[ { "answer_id": 1715, "body": "<p>I also suffer from similar symptoms.</p>\n\n<p>For about 3 years, I have been going to the (fighting) gym every other day and training for hours. At home, I would do my own exercises as well.\nBy the end of 2-3 years, I had lots of energy throughout the day and had no real issues with sleep. (Before the 3 years is a WHOLE other story of mostly unhealthiness).</p>\n\n<p>About a year ago, I stopped going to the gym, mostly due to financial reasons. I knew once I stopped for a while, it would be incredibly hard to get back into it (especially the self-motivation part). I continued to slack off and now I do not exercise nearly as much as I used to, my cardio is completely non-existent, and my energy levels are at an extreme low.<br>\nI come home from work, and I do NOTHING for a few hours, get more tired, and fall asleep. This is not helpful at all because I end up waking up in the middle of the night, trying to find something to eat, and then am too tired to do anything and doze in and out of sleep until work in the morning. Rinse &amp; Repeat.</p>\n\n<p>My digestive system has NEVER been good my whole life, but recently has been acting up a LOT more than usual.\nI too have been eating VERY LITTLE each day and feeling relatively okay about it.</p>\n\n<p>I too am a programmer.</p>\n\n<hr>\n\n<h2>NOW</h2>\n\n<p>I have not gone to see a doctor yet (this time), but I am knowledgeable in many areas of human psychology, exercise physiology, anatomy, neuroscience, cog science, etc. and I am usually able to identify signs and symptoms and self-diagnose very well. I can tell you, I definitely have the signs of depression without the overwhelming sadness (like you described) but am yet reserved on outright calling it depression just yet.</p>\n\n<p>First of all, just because the doctor mentions something about \"pills to treat depression\", doesn't mean you HAVE TO take them or go that route. You can visit the doctors and have all your discussions without things leading to pills, and it will still help you by providing you loads of insight, especially from a medical perspective. I personally am very against taking medicine for anything and only do so if absolutely required. <strong>Taking medicine to fix your problems tends to only treat your symptoms and not the REAL UNDERLYING ISSUES.</strong> This means, you will cover up your symptoms, but old and new problems can continue to arise. Sometimes, we have no other choices, but when and if I do, I make the choice to stay away from relying on external means of balancing myself. Like any drug, your mind AND body can become addicted or dependent, whether physically or not.</p>\n\n<p>Exercise is extremely important for mental health and overall human health. There is just too much material on this to explain it fully, but regular exercise and regular sleeping patterns are so crucial to all the neurochemicals and cycles going on in your body that this would be the first thing I focus on.</p>\n\n<p>Take vitamin supplements if you do not eat well enough to get all of your nutrients. I'm not too sure on the Iron and how it could affect you in your current situation, but I am a huge fan of red meat and I do not feel lack of iron contributes to my situation.</p>\n\n<p>I suggest you hit the gym and exercise regularly. Draining your energy will only make your body realize it needs more energy. Unless you have any other health conditions that would limit your exercise habits, there should be no cause for concern. Dont go TOO HARD all at once, start slow and work your way up in a safe and controlled manner. If you get EXTREMELY tired, then stop and rest.</p>\n\n<p>Maybe get checked for diabetes. (my dad has it so I need to be on the lookout too).</p>\n\n<p>Hope it gives you something to compare to.\nMy plans are to get back into the gym and fight it out until I feel better. If this does not feel like its working, I would probably take a visit to the doctors for some medical insight and continue doing what I do on my own.</p>\n", "score": 3 } ]

[ "sleep", "exercise" ]

[ { "answer_id": 4227, "body": "<p>The term \"earwig\" <a href=\"http://www.etymonline.com/index.php?term=earwig\" rel=\"nofollow\">comes from people thinking that the animal crawled (and wiggled) into people's ears</a>. It doesn't. So this has nothing to do with using it as medication against ear infections etc. </p>\n\n<p>(In German, by the way, it's called <em>Ohrenkneifer</em> (ear pincher)) </p>\n", "score": 1 } ]

[ "medications", "history" ]

[ { "answer_id": 4484, "body": "<p>Body Mass Index, or BMI, is <a href=\"http://www.npr.org/templates/story/story.php?storyId=106268439\" rel=\"nofollow\">not really a reliable indicator</a>. It was based on statistics developed <a href=\"http://www.cutthewaist.com/bmi.html\" rel=\"nofollow\">almost 200 years ago</a>, and ignores such things as high muscle content (Muscle weighs more than fat), strong bones and also where and what type the body stores fat as.</p>\n\n<p>Visceral fat is much more dangerous health wise than subcutaneous fat, and BMI makes no distinction on this. </p>\n\n<p><a href=\"https://en.wikipedia.org/wiki/Spot_reduction\" rel=\"nofollow\">Spot reduction is also a myth</a>. It's entirely possible that you could lose another 10 lbs, and still have that \"10 mm\" of belly fat.</p>\n\n<p>Finally, \"cutting all fat\" is not really possible for long term maintenance, and <a href=\"http://pennshape.upenn.edu/files/pennshape/Body-Composition-Fact-Sheet.pdf\" rel=\"nofollow\">is in fact, unhealthy</a>. The body needs fat for vital vitamin transport, organ health, many other factors.</p>\n\n<p>As RPL suggests, you may be suffering from body dysmorphia, I would encourage you to talk to a medical professional about your weight and body goals before you go further.</p>\n", "score": 3 } ]

[ "weight" ]

[ { "answer_id": 10574, "body": "<p>Disclaimer: Health Stack Exchange is for educational purposes. I speak about these problems in general; I cannot give you health advice.</p>\n\n<p>There are several possible causes for insertional pain like you described. Women with these symptoms may have anatomical issues that make penetration painful and/or difficult (such as a thick hymen). If there are any lesions in the vaginal area, such as warts, sexually transmitted diseases, or (perhaps most likely here) unhealed areas from earlier intercourse, these all can definitely cause pain.</p>\n\n<p>Lastly, some women experience involuntary muscle spasms with penetration, which makes penetration VERY painful to her. This is often involuntary, and it isn't \"just in your head\", however it is most frequent in women with anxiety about sex, holding personal taboos or having an upbringing with strong social/cultural taboos against sex, or a history of physical or emotional trauma. Having that kind of history is not required though. Treatment involves psychotherapy and techniques to gradually help her relax those muscles (it does not happen overnight).</p>\n\n<p>As L.B. said, perhaps there are cuts there from earlier, in which the best thing may be to let them heal before irritating that area. Any of the other causes can definitely benefit from seeing a gynecologist, as doctors can help all of these issues.</p>\n\n<p>Sounds like sex has been stressful for you both! I hope you are able to relax, smile, and accept that this may take some time before it goes smoothly.</p>\n", "score": 0 } ]

[ "gynecology" ]

[ { "answer_id": 12366, "body": "<p>You can't make a diagnosis based on a few behaviours, let alone on a forum. </p>\n\n<p>If you feel these experiences are interfering with your daily life, then seek professional help - perhaps your doctor or mental health professional (e.g., clinical psychologist, psychiatrist, or psychotherapist).</p>\n", "score": 3 } ]

[ "mental-health", "disorders" ]

[ { "answer_id": 12935, "body": "<p>It is safest to be evaluated by a medical professional. The rules of HealthSE don't permit personal health advice questions. If you are still experiencing symptoms - as above, get seen urgently or phone for help.</p>\n", "score": 1 } ]

[ "neurology", "nervous-system", "shake-tremble-fidget", "central-nervous-system" ]

[ { "answer_id": 13901, "body": "<p>9 months / 40 weeks. Multiple stories have been printed over the years of women who discovered they were pregnant only while delivering a baby. Typically these women are overweight and have irregular periods. They don't get any morning sickness, and they interpret the baby's movements as gas. (To find stories on this in the popular press, just search for \"didn't know pregnant\" and plenty will appear.) In some cases they are not overweight and have even been pregnant before, but still do not notice. (Or perhaps they claim they don't notice: there is a lot of skepticism from people when women say they didn't know.)</p>\n\n<p>There's even been a <a href=\"http://www.bmj.com/content/324/7335/458.1.short\" rel=\"nofollow noreferrer\">proper medical study</a> on this. (The title takes the same position that come on, you must have known, you just denied it to yourself and others, which I find a little rude.) Roughly 1 in 500 didn't know until after 20 weeks. By 20 weeks you would expect morning sickness to be well underway, the woman to be \"showing\", and movements to be felt. Roughly 1 in 2500 didn't know until they went into labour.</p>\n\n<p>Since you asked for a maximum, there it is.</p>\n", "score": 3 } ]

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

[ { "answer_id": 14487, "body": "<p>Sounds like you have a test to avoid, in which case you can probably just say you are feeling nauseous. If you really want to make yourself (or someone else) feel nauseous, depending on your sensitivity to motion sickness, you can put wamr (or cold) water in the ear canal. This is basically what a <a href=\"https://medlineplus.gov/ency/article/003429.htm\" rel=\"nofollow noreferrer\">caloric test</a> of balance is.</p>\n", "score": 2 } ]

[ "nausea" ]

[ { "answer_id": 16029, "body": "<p>Not knowing what diets you have used, or what your current diet restrictions are, its impossible to suggest a specific food. It also sounds like you are interested in self observation of results. Knowing this, you might find an excel chart I'm working on to be helpful (<a href=\"https://drive.google.com/open?id=1dAlsYtik43Ua-ur56zjHAidiTrSN8H6v\" rel=\"nofollow noreferrer\">StapleFoodsNutrition.xlsx</a>).</p>\n\n<p>It's a work in progress, but the goal is to find a basic grouping of staple foods that check off all micro-nutritional DV's. This is useful for me so I can keep track of the foods I incorporate to my diet, check off the nutritional values I have met, observe any changes, and finally move to the next value of interest. Basically, I add a food to the list, test it the next week, adjust my serving size, observe and repeat. Sadly, you'll have to do the work to understand the file, and incorporate new foods, but its a starting point. </p>\n\n<p>So far I've learned a decent amount about each vitamin and mineral on a much broader scale, and the difficulties of incorporating each without the use of supplements. My end goal is to ease a skin condition of mine. So far results wise, I have found that I wake up consistently at an earlier time without alarms, and my extremities feel warmer (Raynaud's-like symptoms). </p>\n", "score": 2 } ]

[ "nutrition", "brain", "public-health" ]