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[ { "answer_id": 1554, "body": "<p>A recent review looked at 26 studies that examined mental state after smoking cessation. The review found LESS depression among people who quit, not more.</p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3923980/\" rel=\"nofollow\">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3923980/</a></p>\n\n<p>Anything is possible, but based on this, it would be best to look elsewhere for the cause(s) of your complaint.</p>\n\n<p>Also remember that depression is a very treatable disorder, and the treatments are pretty safe. You wouldn't take a depression-treating pill if it had a 50% chance of killing you, so it would be even more unwise to start using tobacco in the mistaken idea that it could help your mood (it has a 50% chance of killing you).</p>\n\n<p>Also note: schizophrenics are the ones who self-treat with nicotine, not depressives.</p>\n", "score": 2 } ]

[ "mental-health", "smoking", "depression" ]

[ { "answer_id": 5560, "body": "<p>There is no evidence that cold drinks during or after meals adversely affects health - in fact - the opposite may be true.</p>\n\n<p>In studies of people with pure liquid meals, the temperature of the liquid had essentially <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/7153912\" rel=\"nofollow\">no effect on the time it took for the stomach to empty itself</a> (i.e. digest the food). Additionally, it is worth noting that a liquid as it travels down the esophagus is warmed and becomes almost equivalent to body temperatures within minutes. Whatever effect it would have would be gone quickly. </p>\n\n<p>It is worth noting that the <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/22231924\" rel=\"nofollow\">body heats up while digesting food</a> (it is a metabolically active process.) That actually suggests that cool drinks actually make it metabolically easier for the body to digest food because it doesn't have to work as hard to cool down after eating. That also suggests that you can burn a few more calories if you have a hot drink after eating because your body will have to work to cool the blood and maintain your temperature (i.e. homeostasis) </p>\n", "score": 1 } ]

[ "time-of-day", "meal", "heat", "water-temperature", "drinks" ]

[ { "answer_id": 1724, "body": "<p>I viewed your question in the Biology Stack and I think the answers you received are quite good. I´ll try sum up those long answers in the Biology Stack and present them more clearly.</p>\n\n<p>Major factor influencing to the presumed effects of any drug is the first pass effect <a href=\"https://en.wikipedia.org/wiki/First_pass_effect\" rel=\"nofollow\">(Wikipedia)</a>. That means that every substance taken orally must absorb from intestine to the surrounding blood stream. All this blood with all absorbed substance (incl. sugar, fat, protein from food) are transported to liver. Liver then processes all the substances in the blood.</p>\n\n<p>There are dozen of enzymes in the liver which processes the substances in the blood. One enzyme family particularly processes all the foreign substances (inc. drugs) <a href=\"https://en.wikipedia.org/wiki/Cytochrome_P450\" rel=\"nofollow\">(Wikipedia)</a>. Liver aims to remove all foreign substances from the blood, but some of the absorbed substance always escapes the liver to the systemic circulation. Only those molecules which escape liver without processing are transported to the tissues and afterwards can bind to their receptors in the tissue thus eliciting the proposed actions (ie. reducing pain).</p>\n\n<p>Enzymes in the liver processes the foreign molecules in a way that they are secreted to bile and eventually to feces. For example enzyme CYP2E1 processes paracetamol <a href=\"https://en.wikipedia.org/wiki/CYP2E1\" rel=\"nofollow\">(Wikipedia)</a>. There are three different CYP-enzymes which processes diclofenac molecules <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/12871048\" rel=\"nofollow\">(PubMed)</a>. And for naproxen two CYP-enzymes exist <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/8866821\" rel=\"nofollow\">(PubMed)</a>. </p>\n\n<p>One major reason why diclofenac does not help you but naproxen does, is the different action of these enzymes. DNA in our cell nucleus defines how each protein is expressed in our body. These enzymes are these proteins. In your case it seems that enzymes responsible for processing diclofenac are expressed in large number in your liver, resulting to very low concentration of diclofenac molecules in your bloodstream. In other word the level of diclofenac in your blood stream is out of therapeutic window to elicit any responses in the body <a href=\"https://en.wikipedia.org/wiki/Therapeutic_window\" rel=\"nofollow\">(Wikipedia)</a>. In contrary, your liver may express enzymes responsible for the processing of naproxen very little and thus many naproxen molecules may escape liver to the systematic circulation resulting the therapeutic level to elicit tissue responses.</p>\n\n<p>This only one player in this topic, although very important and influential. There are also factor influencing after the first pass effect (receptor, expression of genes responsible for receptors, binding affinity ec.) </p>\n", "score": 2 }, { "answer_id": 1738, "body": "<p>At first I want to note arkiaamu's answer is very good. If you also need a shorter answer take this:</p>\n\n<p>Naproxene and Aspirine do not only 'directly' relieve pain, they also work antiinflammatory. In many cases the inflammation itself causes pain, so these drugs have different targets to work. <a href=\"https://en.wikipedia.org/wiki/Mechanism_of_action_of_aspirin\" rel=\"nofollow\">See this</a></p>\n\n<p>Tramadol is not antiinflammatory, neither is paracetamol. </p>\n\n<p>You are not the only on feeling a difference between naproxene and diclofenac. Read the answer from arkiaamu for some ideas why. Reasons are multi-factorial including some personal things like genetics and gene-expression. </p>\n\n<p>Please note that naproxene and aspirine have dangerous adverse effects (gastrointestinal bleeding). Aspirine should not be given to children, as it has some rare but very severe adverse effects that others do not have. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/17523700\" rel=\"nofollow\">(1)</a></p>\n", "score": 1 } ]

[ "medications", "analgesics" ]

[ { "answer_id": 1848, "body": "<p>As you might very well know blood contains following substances:</p>\n\n<ul>\n<li>Plasma proteins (albumin, globulin, fibrinogen etc.)</li>\n<li>Clotting factors</li>\n<li>Glucose</li>\n<li>Electrolytes</li>\n</ul>\n\n<p>All these are essential for body homeostasis. Human body can suffer from the lack of any of these substances.</p>\n\n<p>Lack of plasma proteins results to swelling of the feet (fluid escapes blood vessels) and <a href=\"https://en.wikipedia.org/wiki/Ascites\" rel=\"nofollow\">ascites</a> (intra-abdominal fluid) due to low <a href=\"https://en.wikipedia.org/wiki/Oncotic_pressure\" rel=\"nofollow\">colloid osmotic pressure</a>. They are many albumin products available which can be used to substitute the lack of albumin in blood.</p>\n\n<p>They are not that many indications to give frozen plasma to patients (<a href=\"http://reference.medscape.com/drug/ffp-octaplas-fresh-frozen-plasma-999499\" rel=\"nofollow\">Medscape</a>, <a href=\"http://www.bcshguidelines.com/documents/FFP_28020604.pdf\" rel=\"nofollow\">British Committee for standards in haematology</a>). The main indication to frozen plasma is the treat the lack of clotting factors. <strong>Clotting factors cannot be synthesized compared other substances in the plasma and therefore frozen plasma is manufactured and given to patients.</strong></p>\n\n<p>Common reason for lack of clotting factors is major bleeding (trauma etc.) Therefore frozen plasma is routinely given to patients with major trauma and subsequent bleeding. Patients with <a href=\"https://en.wikipedia.org/wiki/Haemophilia\" rel=\"nofollow\">haemophilia</a> or coagulation factor deficiency and treated with frozen plasma. Third common indication for frozen plasma transfusion is any kind of liver disease. Liver is responsible for manufacturing coagulation factors and therefore patients suffering fro <a href=\"https://en.wikipedia.org/wiki/Liver_disease\" rel=\"nofollow\">severe liver disease</a> do not have normal levels of clotting factors in their blood.</p>\n\n<p>Of course there many other indications for frozen plasma transfusion but I think those cover the most important one and give some insight.</p>\n", "score": 4 } ]

[ "blood", "donor" ]

[ { "answer_id": 1877, "body": "<p>To get an understanding of the difference, look at a disease that has been in the news recently, Legionnaire's Disease.</p>\n\n<p>Legionella pneumophilia is a bacteria that is responsible for most cases. It lives in stagnant water under certain conditions, and is inhaled when aerosalized. This is the etiology of the disease, which is basically how it infects the host, or how it gets in.</p>\n\n<p>Once inside the body, it starts replicating and causing damage. Initial symptoms include flu like symptoms, headache, fatigue and muscle pain. As it progresses, they can expand to include dry coughing, chest pain, and eventually leading to possible mental status changes, hallucination, etc. This progression of the disease in the various stages is the pathogenesis of the disease, i.e. days 1-3 expect these symptoms, days 4-7 these other symptoms, and so on.</p>\n\n<p>To confirm the diagnosis, the doctors will take samples of various body fluids and send them to the lab for testing, as well as x-rays, etc. One of the tests is staining of the sputum that can show the Legionella bacteria. This is pathology, specifically the examination of body fluid/tissue for diagnostic purposes. (Where it gets a little confusing, is pathology also refers to the body of knowledge about disease cause and effects).</p>\n\n<p>So in a general sense you are correct, they all refer to how/why diseases spread and how to control them, but one doesn't necessarily depend on the other.</p>\n\n<p>Edited to add: Pathophysiology is kind of an intersection, to where the pathology of a condition and the physiology are taken as a whole, and describes the functions and changes associated with a condition from both the observable and the testable views.</p>\n", "score": 7 }, { "answer_id": 18807, "body": "<p>Since the OP is asking for definitions, maybe it is OK to be nitpicky. </p>\n\n<ul>\n<li>Pathogenesis is the process by which harm has occurred.</li>\n<li>Pathology is the study of harm, including the study of pathogenesis. </li>\n<li>Etiology is the investigation of causes. Doctors are most interested in the causes of harm, not in the causes of neutral or good outcomes, so most medical etiology is pathology. </li>\n<li>Pathophysiology is the study of biological processes associated with harm. The etiology of ideopathic conditions is part of pathophysiology. Pathophysiology also includes the study of recovery mechanisms. </li>\n</ul>\n", "score": 6 }, { "answer_id": 1909, "body": "<p>I don´t see any issues with JohnP´s answer. I just would approach with different example. Lets take coronary artery disease and cholesterol as an example.</p>\n\n<p>Coronary arteries are probably the most important blood veins in the body since they transport arterial blood from aorta to the heart muscle itself. Coronary artery disease means that heart muscle receives insufficient volume of blood via the coronary arteries and in some instances the blood supply may even be blocked (heart attack or critical ischemia as a milder case).</p>\n\n<p>Why blood flow to heart muscle is reduced. It is due to <em>atherosclerosis</em>. Atherosclerosis is the <strong>etiology</strong> of coronary artery disease. Atherosclerosis causes the artery walls to thicken and stiffen and when the cross area of the artery is reduced less blood is moved though coronary arteries.</p>\n\n<p>On the other hand the <strong>etiology</strong> of atherosclerosis is high blood LDL level (\"bad\" cholesterol). Fat and cholesterol which we receive from food are transported in blood and one transport vehicle is the LDL. LDL is bad since it has ability to get in to the artery wall. In there it causes an inflammation cascade which results to plaques inside the wall. These plaques (=calcifications) are hard are rock and causes the artery wall thicken and stiffen. </p>\n\n<p>The presence of the inflammation and variable sized plaques or calcifications in the artery wall are important aspects in the <strong>pathology</strong> of the atherosclerosis ad subsequent coronary artery disease. In a healthy heart there are no plaques and the artery walls are intact. Pathology describes what is abnormal in certain diseases.</p>\n\n<p>Cascade resulting to certain pathology or pathological condition is <strong>pathogenesis</strong>. I consider <strong>pathophysiology</strong> as a synonym for pathogenesis. I would even introduce a third term: <strong>etiopathogenesis</strong>. As so, the pathogenesis or pathophysiology or atherosclerosis would be the following: LDL particles are carried in the blood. Once in the coronary arteries, LDL particles penetrate the inner layer of the artery wall. Inside the wall the LDL particles are broken to smaller particles. Marophages invade the wall and they phagocytes (digest) the small LDL particles. These macrophages becomes foam cells which are non-functional fat-laden macrophages just laying in the artery wall. When this process goes on continuously the artery wall starts to thick and cross area of the artery becomes smaller (stenosis).</p>\n\n<p><strong>Epidemiology</strong> is a whole another thing. It deals with disease prevalences and incidences in a population level. Following statements from Wikipedia regarding coronary artery disease deals with epidemiology of the disease:</p>\n\n<blockquote>\n <p>CAD as of 2010 was the leading cause of death globally resulting in\n over 7 million deaths</p>\n \n <p>Coronary heart disease (CHD) is the leading cause of death for both\n men and women and accounts for approximately 600,000 deaths in the\n United States every year. According to present trends in the United\n States, half of healthy 40-year-old men will develop CAD in the\n future, and one in three healthy 40-year-old women.</p>\n</blockquote>\n", "score": 4 } ]

[ "terminology", "pathophysiology" ]

[ { "answer_id": 1926, "body": "<p>So you are searching for hung-over drugs :). I don´t see any problems with that. I have many times wondered the same thing. If you search online one will find hundreds and thousands of journal articles stating \"the remedy for hang-over\". Of course these \"remedies\" are based just on folklore.</p>\n\n<p>There is also some scientific literature on this topic. The most comprehensive is <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1322250/\" rel=\"nofollow noreferrer\">a systematic review published 2005 in British Medical Journal.</a>. Unfortunately the authors conclude: <em>\"The most effective way to avoid the symptoms of alcohol induced hangover is to practise abstinence or moderation\".</em></p>\n\n<p>I am quite sure that if an effective treatment to reduce or limit the effects of alcohol were to exist, that would have gained popularity beyond any limits.</p>\n\n<p>However, I would present on interesting theory to try. Alcohol or ethanol itself is not the bad guy. Body processes ethanol by oxidating it to acethaldehyde with the help from alcohol dehydrogenase enzyme. The acethaldehyde is responsible for all the bad, including nausea, vomiting etc. It is also a <a href=\"https://en.wikipedia.org/wiki/Acetaldehyde#Carcinogenicity\" rel=\"nofollow noreferrer\">carcinogen</a> associated most importantly to gastric cancer.</p>\n\n<p>To deal with this potential carcinogenity, a Finnish biotechnology Company Biohit has introduced a drug called <a href=\"http://www.acetium.com/\" rel=\"nofollow noreferrer\">Acetium</a>. It is a very simple drug, it only contains l-cysteine, an essential amino acid. The trick is that L-cysteine reacts with acethaldehyde forming a compound molecule which has no meaning or effect in human body. As so the Biohit aims to market this product as a pre-emptive treatment for gastric cancer.</p>\n\n<p><a href=\"https://i.stack.imgur.com/OldWs.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/OldWs.png\" alt=\"enter image description here\"></a></p>\n\n<p>But the interesting part if, that is L-cysteine neutralizes acetaldehyde, why could not it therefore be an effective treatment for hangover? Just take some Acetium before drinking and do not worry about the next Morning.</p>\n\n<hr>\n\n<p><strong>Totally unrelated to the OP</strong>. My secret dream is to perform a randomized controlled trial about this idea. Of course, prior to it, I should contact Biohit to make sure that I receive the appropriate rojalties from their sells. Let´s say this treatment really worked in my trial, I would most likely become a multi-billionaire. Alongside I would be responsible for tripling or quadrupling the amount of consumed alcohol around the world since no one would ever suffer from hang-over. People would however get more drunk since this drug only prevents hangover. As so, the rate of homicides, beatings and drunk driving would go thorough the roof. Maybe I should not be waiting any medal from the parliament or president. Perhaps I should abandon my research idea.... </p>\n", "score": 2 }, { "answer_id": 4123, "body": "<p>I am going to take most of this from my answer to <a href=\"https://health.stackexchange.com/questions/3841/what-is-the-healthiest-way-to-drink-excessively-and-chronically\">What is the healthiest way to drink excessively and chronically?</a> Most of the advice does not change when we are talking about a one-time scenario instead of a more regular occurrence. </p>\n\n<p>You mention decreasing absorption - an important thing is to get the alcohol to be delivered into the blood (and liver) slowly, definitely. That means eating before drinking, drinking slowly, and not taking any medication that worsens the effect of alcohol. </p>\n\n<p>After the damage is done, so to speak, comes reducing its effects and speeding up recovery. Drink enough additional fluids (water, juices, etc) before, during and after drinking alcohol. Get enough sleep and give your body time to recover. </p>\n\n<p>The paper <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1322250/\" rel=\"nofollow\">Interventions for preventing or treating alcohol hangover: systematic review of randomised controlled trials</a> has an overview over various hangover treatments studied in eight publications, from herbal remedies to dietary supplements, but ultimately has to conclude </p>\n\n<blockquote>\n <p>No compelling evidence exists to suggest that any conventional or complementary intervention is effective for preventing or treating alcohol hangover. The most effective way to avoid the symptoms of alcohol induced hangover is to practise abstinence or moderation</p>\n</blockquote>\n\n<p><strong>Sources</strong></p>\n\n<p><a href=\"http://www.liver.ca/liver-health/liver-disease-prevention/tips-for-healthy-liver/alcohol-consumption.aspx\" rel=\"nofollow\">How to Protect Your Liver if You Drink Alcohol</a></p>\n\n<p><a href=\"http://mcwell.nd.edu/your-well-being/physical-well-being/alcohol/absorption-rate-factors/\" rel=\"nofollow\">Absorption Rate Factors</a></p>\n\n<p><a href=\"http://www.nhs.uk/Livewell/alcohol/Pages/Hangovers.aspx\" rel=\"nofollow\">NHS hangover cures</a></p>\n", "score": 1 } ]

[ "medications", "alcohol", "toxicity", "treatment", "prevention" ]

[ { "answer_id": 3053, "body": "<p>In short, by having fewer or less serious risk factors than the other matching recipients currently on the transplant waiting list. Age is a <em>risk factor</em> that goes into the calculation, not a <em>contraindication</em>.</p>\n\n<blockquote>\n <p>Age is not a contraindication to transplantation but increasing age is\n an incremental risk factor[5] and it is often associated with other\n comorbidity; few UK patients have been transplanted above the age of\n 65 years. <a href=\"http://www.odt.nhs.uk/pdf/advisory_group_papers/CTAG/ukht_guidelines_consultation_february_2011.pdf\">1</a></p>\n</blockquote>\n\n<p>What they're saying there is that with increased age comes increased risk of failure. This is because as we age we don't tolerate and recover from major surgeries as well, and we are also more likely to have other illnesses.</p>\n\n<p>To take a hypothetical example, consider two patients:</p>\n\n<p>Patient 1 is 70 years old, suffering from heart failure but has no other significant health issues such as diabetes, COPD, etc.</p>\n\n<p>Patient 2 is 40 years old, suffering from the same type of heart failure but also has diabetes, hypertension and kidney disease.</p>\n\n<p>There's a decent chance Patient 1 would be the selected recipient in this case because he probably has better odds of surviving the procedure, and possibly even better odds of living longer afterwards. But the reality is that there are almost never just two potential recipients so this is a contrived example. Patient 1 would most likely be in \"competition\" with a dozen other recipients, most of whom will be younger and therefore won't have the age risk factor working against them.</p>\n\n<p>In summary, the older patient's best hope is that he or she is in excellent physical condition apart from the heart problems that landed them on the transplant list. The link I cited above describes many of the risks and contraindications that are taken into account in the UK, which are very similar to the factors considered in other countries.</p>\n", "score": 8 } ]

[ "surgery", "heart-transplant" ]

[ { "answer_id": 3076, "body": "<p><em>Short answer</em>:</p>\n<h2>A pack of raisins.</h2>\n<p>Yes, I've read your question through and through. Please, bear with me for a while, to see the <em>longer answer</em>:</p>\n<p>The problem with concentration when you haven't eaten arises primarily because of the lack of nutrients, i.e. glucose.</p>\n<blockquote>\n<p>Glucose is virtually the sole fuel for the human brain, except during prolonged starvation. The brain lacks fuel stores and hence requires a continuous supply of glucose. [...] Fatty acids do not serve as fuel for the brain, because they are bound to albumin in plasma and so do not traverse the blood-brain barrier. In starvation, ketone bodies generated by the liver partly replace glucose as fuel for the brain. (1)</p>\n</blockquote>\n<p>So basically, you can't focus because <strong>your brain lacks fuel</strong>. It's somewhat similar to a car: yes, you can add water to the radiator (and need to), and yes you can add sparks to make your engine start, but without fuel it just won't run.</p>\n<p><strong>Caffeine will not only fail to solve your problem, but can actually be harmful on an empty stomach.</strong> It can hurt both your stomach and can make you feel even less focused after a short while.</p>\n<blockquote>\n<p>Caffeine increases energy metabolism throughout the brain but decreases at the same time cerebral blood flow, inducing a relative brain hypoperfusion. (2).</p>\n<p>Caffeine may increase an individual's sensitivity to hypoglycemia through the combined effects of reducing substrate delivery to the brain via constriction of the cerebral arteries, whilst simultaneously increasing brain glucose metabolism and augmenting catecholamine production. [...] Under laboratory conditions, acute ingestion of caffeine markedly enhances the symptomatic and sympathoadrenal responses to hypoglycemia in both healthy volunteers and patients with type 1 diabetes. (3)</p>\n</blockquote>\n<p>To sum it up - caffeine will make you more alert for a short while, but it will eat up little fuel that you had left, and leave you almost completely without it. For the half hour, 40 minutes perhaps, you will feel better, but then the problems will start - even stronger sense of hunger, worse problems with focusing on your work and possibly light-headedness and hand trembling might occur.</p>\n<blockquote>\n<p>Heartburn is the most frequently reported symptom after coffee drinking. It is demonstrated that coffee promotes gastro-oesophageal reflux. Coffee stimulates gastrin release and gastric acid secretion [...] Coffee induces cholecystokinin release and gallbladder contraction[...] (4)</p>\n</blockquote>\n<p>Caffeine will stimulate the release of gastric acid and bile, which are meant to digest food. But, since there will be no food to digest it will begin to &quot;digest&quot; your stomach instead (well, not literally, but it can cause you pain and problems, especially if you make a regular practice of it).</p>\n<p>Water might leave you feeling fuller for a while, but it won't solve the underlying problem (lack of brain fuel), and large quantities of water, drank in a relatively short time span, on an empty stomach, might leave some feeling a bit sick (the smaller the stomach volume, the worse it gets). It's not dangerous, but can be uncomfortable.</p>\n<h2>The solutions:</h2>\n<ol>\n<li>Do you ever forget your keys? Your mobile phone? Well <strong>make a habit of not forgetting your snacks.</strong> It is simply a matter of priorities, and health is a priority. (And do make sure that the snacks are as healthy as possible).</li>\n<li>Have a contingency snack plan: keep a bag of raisins (e.g.) in your purse. If you change purses, keep a bag of raisins in every purse, or next to something that you won't forget (e.g. your keys).</li>\n<li>Keep a pack of raisins (or something similar) at work (in your desk perhaps).</li>\n</ol>\n<p>For 2 and 3 - just remember to occasionally check those places and expire dates - no one likes to find a 10-month old bag of raisins in their purse/desk/key drawer.</p>\n<hr />\n<p>References:</p>\n<ol>\n<li><p><a href=\"http://www.ncbi.nlm.nih.gov/books/NBK22436/\" rel=\"noreferrer\">Each Organ Has a Unique Metabolic Profile</a></p>\n</li>\n<li><p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/1356551\" rel=\"noreferrer\">Caffeine and the central nervous system: mechanisms of action, biochemical, metabolic and psychostimulant effects.</a></p>\n</li>\n<li><p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/11475292\" rel=\"noreferrer\">The best defense against hypoglycemia is to recognize it: is caffeine useful?</a></p>\n</li>\n<li><p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/10499460\" rel=\"noreferrer\">Coffee and gastrointestinal function: facts and fiction. A review.</a></p>\n</li>\n</ol>\n<p>** an important note: ref. 3 discusses caffeine as an indicator of hypoglycaemia in diabetic patients, BUT I can access and link just the abstract and there is no room in it to discuss how dangerous hypoglycaemia is in patients who receive insulin therapy - in these cases hypoglycaemia can be deadly, and something that would amplify the symptoms is used only so they can recognize the condition and eat something. Without food to follow immediately, caffeine is not a good solution.</p>\n", "score": 9 } ]

[ "water", "caffeine" ]

[ { "answer_id": 3166, "body": "<p>The medical way to ask your question is \"What are the <a href=\"https://en.wikipedia.org/wiki/Pharmacokinetics\" rel=\"nofollow noreferrer\">pharmacokinetics</a> of pyridoxine (B6 version that you're likely to take)?\"</p>\n\n<p>Then that brings us to both <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/8598418\" rel=\"nofollow noreferrer\">primary</a> and <a href=\"http://www.drugs.com/ppa/pyridoxine-hydrochloride-b6.html\" rel=\"nofollow noreferrer\">secondary</a> <a href=\"http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/P100.html\" rel=\"nofollow noreferrer\">sources</a>, along with <a href=\"http://dx.doi.org/10.1111/j.1749-6632.1990.tb28043.x\" rel=\"nofollow noreferrer\">a good animal model study</a>.</p>\n\n<p>\"The greatest portion reaches the brain\" will likely be shortly after the peak serum concentration, or <a href=\"https://en.wikipedia.org/wiki/Cmax_%28pharmacology%29\" rel=\"nofollow noreferrer\">Cmax</a>. The amount of time it takes for a drug to get to Cmax is Tmax. There is going to be some variability in Tmax based on age, sex, weight, diet, and B6 formulation. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/8229700\" rel=\"nofollow noreferrer\">A comparison</a> of two formulations directly found a range of 1.25 to 1.44h, which is a little tighter of the general range of 1-2 hours.</p>\n\n<p>I didn't find a source that showed peak concentrations in <a href=\"https://en.wikipedia.org/wiki/Central_nervous_system\" rel=\"nofollow noreferrer\">CNS tissue</a> or that looked at the delay in B6 crossing the <a href=\"https://en.wikipedia.org/wiki/Blood%E2%80%93brain_barrier\" rel=\"nofollow noreferrer\">blood brain barrier</a> (which it will readily given its solubility), but there is little reason to suspect that it is too delayed thereafter. <a href=\"http://dx.doi.org/10.1111/j.1749-6632.1990.tb28043.x\" rel=\"nofollow noreferrer\">Animal studies</a> have shown that the vast majority (80-90%) of B6 is stored in muscles and the liver, so even though the peak concentration for the CNS will follow Cmax, most of the B6 will not end up there.</p>\n\n<p>Your next two questions are mostly implicitly answered in the first question. The peak and greatest portion are likely to be very close together (I couldn't find any evidence of delayed metabolism in the CNS). But expanding on your third question a little, it gets there via the blood, which is pretty standard for most drugs/nutrients/vitamins in humans. As far as taking it from swallowing the pill, it then continues along the digestive tract to the small intestine. Mostly in the <a href=\"https://en.wikipedia.org/wiki/Jejunum\" rel=\"nofollow noreferrer\">jejunum</a>, but somewhat in the <a href=\"https://en.wikipedia.org/wiki/Ileum\" rel=\"nofollow noreferrer\">ileum</a> (2nd and 3rd part of small intestine) it passively diffuses into the blood, where it circulates through the heart and eventually to your brain.</p>\n\n<p>Eating more food may prolong the time the pill is in the stomach, thereby delaying the time that the B6 is absorbed in the small intestine. Generically this is called gastric emptying, and an approachable site on the subject can be found <a href=\"http://www.vivo.colostate.edu/hbooks/pathphys/digestion/stomach/emptying.html\" rel=\"nofollow noreferrer\">here</a>. Even though I'm pretty sure this is made up data to estimate the point, I think it's worth duplicating their time graph:</p>\n\n<p><a href=\"https://i.stack.imgur.com/BGyg7.gif\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/BGyg7.gif\" alt=\"%meal in stomach vs time\"></a></p>\n\n<p>I would like to point out, that this is not something that you will be able to time on a stopwatch and fine tune. Any of these values could easily vary by an hour. I also want to point out that taking high doses of B6 can be habit forming, and that the <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/11883552#\" rel=\"nofollow noreferrer\">study on dreaming</a> cited in the wiki is far from convincing. Further it was published in a relatively <a href=\"http://www.researchgate.net/journal/0031-5125_Perceptual_and_Motor_Skills\" rel=\"nofollow noreferrer\">low impact journal</a>. I'm not saying it isn't true, but I don't like the idea of people super dosing B6 for recreational dream use.</p>\n", "score": 9 } ]

[ "micronutrients" ]

[ { "answer_id": 3162, "body": "<p>The mean pressure has to be lower peripherally for blood to flow in that direction. However, it is well known that there is an amplification of systolic blood pressure in the limbs due to reflection of pressure wave from periphery (see <a href=\"http://hyper.ahajournals.org/content/51/1/112.full\" rel=\"nofollow\">http://hyper.ahajournals.org/content/51/1/112.full</a>). Vascular stiffness also affects this phenomenon. See figure 4 of this article in American Journal of Physiology: <a href=\"http://ajpheart.physiology.org/content/299/3/H584\" rel=\"nofollow\">http://ajpheart.physiology.org/content/299/3/H584</a></p>\n\n<p>The phenomenon of pressure wave reflection is shown clearly in figure 5 of this article in Advances in Physiology Education <a href=\"http://advan.physiology.org/content/37/4/321\" rel=\"nofollow\">http://advan.physiology.org/content/37/4/321</a></p>\n\n<p>This phenomenon is also exaggerated in aortic regurgitation, where it is called the Hill's sign: <a href=\"http://www.learntheheart.com/cardiology-review/hills-sign/\" rel=\"nofollow\">http://www.learntheheart.com/cardiology-review/hills-sign/</a></p>\n", "score": 5 } ]

[ "blood-pressure", "cardiology" ]

[ { "answer_id": 3295, "body": "<p>There are two types of flu vaccine - inactivated influenza vaccine (which uses 'killed' influenza virus) and live-attenuated vaccine (which uses a more mild virus that should be asymptomatic).</p>\n\n<p><a href=\"http://www.cdc.gov/flu/professionals/vaccination/vaccine_safety.htm\">According to the CDC</a>, among the contraindications for the live-attenuated vaccine is: \"Children aged &lt;2 years or adults aged ≥50 years\". This is likely because, as you mentioned, it's possible for you to shed said live virus and infect others, and while the attenuated flu strain <em>should</em> be harmless, it's not a great idea to test that on high risk groups.</p>\n\n<p>The inactivated vaccine carries no such contraindication. It is however something you should certainly bring up with your medical professional.</p>\n", "score": 4 } ]

[ "vaccination", "influenza" ]

[ { "answer_id": 13015, "body": "<p>This question is old, but the answer might help some other people:)</p>\n\n<p>First of all: yes, <a href=\"http://circ.ahajournals.org/content/123/20/2292\" rel=\"nofollow noreferrer\">high triglycerides are a risk for CVD.</a><br>\nHowever, there is <a href=\"http://www.aafp.org/afp/2011/0201/p246.html\" rel=\"nofollow noreferrer\">no evidence</a> that treatment of moderately high triglycerides will decrease the rate of CHD for primary prevention in otherwise healthy individuals. The amount of side effects of medication are more important than the very very little gain that might be expected.</p>\n", "score": 2 }, { "answer_id": 13031, "body": "<p>Triglycerides are a type of fat found in your blood. \nSome triglycerides are needed for good health. But high triglycerides might raise your risk of heart disease.</p>\n\n<p>Range of triglyceride levels:</p>\n\n<ul>\n<li><p>Normal is less than 150. </p></li>\n<li><p>Borderline-high is 150 to 199.</p></li>\n<li><p>High is 200 to 499.</p></li>\n<li><p>Very high is 500 or higher.</p></li>\n</ul>\n\n<p>If you have high triglyceride levels, you possibly have an increased risk for developing heart disease and other health issues.</p>\n", "score": 0 } ]

[ "heart-disease", "lipids", "pancreatitis", "triglycerides", "ldl" ]

[ { "answer_id": 3450, "body": "<p>Munchausen by proxy has been diagnosed for caregiver/care receiver relationships that were not parent / child. <a href=\"http://onlinelibrary.wiley.com/doi/10.1002/jhm.2268/abstract\" rel=\"noreferrer\">Munchausen by adult proxy </a> is an article reviewing 13 cases found in the medical literature where the care receiver in the relationship was an adult. Not all of the perpetrators were parents. </p>\n\n<blockquote>\n <p>The perpetrator was the victim's mother in 3 cases, <strong>wife</strong> in 2 cases, son in 2 cases, and daughter, granddaughter, <strong>husband</strong>, companion, boyfriend, or <strong>prison cellmate</strong> in 1 case each. Five (38%) worked in healthcare.</p>\n</blockquote>\n\n<p>From <a href=\"http://www.psychosomaticsjournal.com/article/S0033-3182(11)00210-6/abstract#/article/S0033-3182(11)00210-6/fulltext\" rel=\"noreferrer\">Munchausen Syndrome by Proxy :An Adult Dyad</a></p>\n\n<blockquote>\n <p>Although well-documented in the child and adolescent literature, few case reports document MSBP with an adult proxy </p>\n</blockquote>\n\n<p>The majority of cases seem to be underage children and parents (usually mothers), though. </p>\n", "score": 5 } ]

[ "mental-health", "diagnostics" ]

[ { "answer_id": 18588, "body": "<p>I can offer a UK perspective on this, using guidelines from the <a href=\"https://www.nice.org.uk\" rel=\"nofollow noreferrer\">National Institute for Health and Clinical Excellence</a> (NICE): <a href=\"https://www.nice.org.uk/guidance/cg181\" rel=\"nofollow noreferrer\">Cardiovascular disease: risk assessment and reduction, including lipid modification</a>. There is also a useful summary <a href=\"https://cks.nice.org.uk/lipid-modification-cvd-prevention\" rel=\"nofollow noreferrer\">here</a>.</p>\n\n<p>You mention the case of <a href=\"https://en.wikipedia.org/wiki/Preventive_healthcare#Secondary_prevention\" rel=\"nofollow noreferrer\">secondary prevention</a> in cardiovascular disease (CVD), when statins are used in people who have already got a diagnosis of vascular disease (e.g. heart attack or stroke). In the context of <a href=\"https://en.wikipedia.org/wiki/Preventive_healthcare#Primary_prevention\" rel=\"nofollow noreferrer\">primary prevention</a>, determining whether or not to use a statin comes down to assessing the risk of cardiovascular disease.</p>\n\n<p>Several factors influence the risk of cardiovascular disease, including diabetes, smoking, family history, hypertension, dyslipidaemia (high cholesterol), obesity, age and sex, amongst others.</p>\n\n<p>We can estimate the risk using an algorithm such as <a href=\"https://qrisk.org/three/\" rel=\"nofollow noreferrer\">QRisk</a> (the main one in use in the UK). This provides a 10-year risk of cardiovascular disease. You can experiment with values to see the effect different variables have (smoking is particularly significant). This algorithm is based on studies and meta-analyses referenced on the linked site. </p>\n\n<p>The NICE guidelines recommend this:</p>\n\n<blockquote>\n <p>Offer lipid-modification therapy to people aged 84 years and younger\n if their estimated 10-year risk of developing cardiovascular disease\n (CVD) using the QRISK®2 assessment tool is 10% or more.</p>\n</blockquote>\n\n<p>Certain disease, such as adults with <a href=\"https://en.wikipedia.org/wiki/Diabetes_mellitus_type_1\" rel=\"nofollow noreferrer\">type 1 diabetes</a>, <a href=\"https://en.wikipedia.org/wiki/Familial_hypercholesterolemia\" rel=\"nofollow noreferrer\">familial hypercholesterolaemia</a> and <a href=\"https://en.wikipedia.org/wiki/Chronic_kidney_disease\" rel=\"nofollow noreferrer\">chronic kidney disease</a> are recommended to be prescribed a statin regardless of calculated risk.</p>\n\n<p>A 10% 10-year CVD risk means that if we had 100 people exactly like the person in question in every way and followed them up over the next 10 years, we would expect 10 of them to have had a cardiovascular event (such as a heart attack or stroke).</p>\n\n<hr>\n\n<p>Before easily accessible algorithms embedded in web apps, charts such as the one below were used. They are quite useful for showing the factors that contribute to cardiovascular disease risk.</p>\n\n<p><a href=\"https://i.stack.imgur.com/mc2mC.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/mc2mC.jpg\" alt=\"Cardiovascular disease risk chart\"></a></p>\n", "score": 6 } ]

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

[ { "answer_id": 3546, "body": "<blockquote>\n <p>[S]ometimes they become more prominent again, usually for a few minutes at a time. Is this a difference in <em>perception</em> (something is causing me to notice them more) or a difference in <em>placement</em> (they've moved into the center of my field of vision for some reason and are thus harder to ignore)?</p>\n</blockquote>\n\n<p>Floaters do move, but not very much. Mostly they \"sway and settle\" when we shift our focus of vision. Noticing floaters is likely a difference in perception, for example moving your line of sight from one which is complex to one with a simple background, for (a completely made up) example, from looking at a large painting to looking at a ceiling. The lack of contrast will make the irregularities in vision caused by floaters to stand out/be noticeable for a few minutes, maybe even be bothersome and worrisome, but it soon stops. You can \"find\" floaters by doing that, especially if you look into a softly lit surface, like an x-ray view box without the x-rays. </p>\n\n<blockquote>\n <p>How do floaters \"work\"?</p>\n</blockquote>\n\n<p>The vitreous humor (the very structures gel-like collagen &amp; fluid substance in the eyeball behind the iris) starts to break down/liquify in spots as we age; this is a common and benign cause of age-related floaters. You can picture how floaters work by imagining crystal-clear jello that had set in a clear glass. If you took a hot knife and quickly swiped it through the jello, some of the jello would melt; you would see an aberration in the path of light through that spot; you wouldn't see perfectly through it. Turn the glass and the aberration would be different at different angles. That's approximately how floaters work. Some are minimal, some are more marked because of the plane of liquifaction/separation of collagen fibers. They do not \"move\", though, through the vitreous any more than that melted jello moves through the whole.</p>\n\n<blockquote>\n <p>This morning I had a particularly bad attack of this while I was looking down and reading something...</p>\n</blockquote>\n\n<p>Sudden onset of floaters disturbing your visual field are most likely not the more benign aging process of vitreous breakdown, and merit a trip (or at <em>least</em> a call) to the opthalmologist. Those kinds of floaters (sometimes associated with flashes) tend to be caused by vitreous detachment from the retina, and can lead to retinal detachments and/or hemorrhages. While often just isolated in nature, it can be a sign of more serious and vision-threatening retinal pathology.</p>\n\n<blockquote>\n <p>I'd like to avoid a recurrence.</p>\n</blockquote>\n\n<p>I don't know of any way at all to predict or restrict recurrences unless there is retinal pathology being treated by an opthalmologist.</p>\n\n<p>_{<a href=\"https://nei.nih.gov/health/floaters/floaters\" rel=\"nofollow\">Floaters</a>}<br>\n_{<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291672/\" rel=\"nofollow\">Acute-onset floaters and flashes</a>} </p>\n", "score": 5 } ]

[ "eye", "ophthalmology" ]

[ { "answer_id": 15370, "body": "<p>The question of augmentation-or-prothesis first is difficult to answer, and may even be based on the personal physiology of an individual. As such, health.se can't address that question. </p>\n\n<p>Regarding the second question, \"can chin-augmentation affect the individual's bite...\", there's a study done with porous hydroxyapatite (not sure if chin-augmentation techniques vary) that indicates:</p>\n\n<blockquote>\n <p><strong>Cephalometrically, the procedure was found to provide very stable\n results, with little change in the position of the implants and no\n appreciable resorption of the implants and bone</strong>.</p>\n</blockquote>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/10172030\" rel=\"nofollow noreferrer\">Chin augmentation with porous hydroxyapatite blocks.</a></p>\n", "score": 2 } ]

[ "chins", "jaw", "plastic-surgery", "dentures" ]

[ { "answer_id": 5203, "body": "<p>I would say consult a doctor to confirm the problem. Removal of the <a href=\"http://www.upmc.com/patients-visitors/education/womens-health/Pages/hysterectomy.aspx\" rel=\"nofollow\">Uterus usually doesn't cause to much of a shift,</a> but I am sure there are a very few instances when it does. </p>\n\n<blockquote>\n <p>The uterus typically takes up a very small space in the abdomen or\n pelvis. After a hysterectomy, the other abdominal organs shift\n slightly to fill the space. During the surgery, ligaments that helped\n to support the uterus are connected to the top of the vagina to\n support it and help keep it in its normal position.</p>\n</blockquote>\n\n<p>A <a href=\"http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/tests-and-procedures/pelvic-exenteration/?region=on\" rel=\"nofollow\">pelvic exenteration</a> would be a time when organ removal defintely would affect you a lot more. </p>\n\n<h2>Helpful:</h2>\n\n<ul>\n<li><a href=\"https://www.quora.com/After-a-hysterectomy-what-happens-to-the-extra-space-created-inside-the-womans-body-Do-other-organs-move-Are-there-risks-arising-from-this-space\" rel=\"nofollow\">After a hysterectomy, what happens to the extra space created inside the woman's body?</a> </li>\n</ul>\n\n<p>Basically, the Uterus is not that big so the bladder and other structures fill the void. Above link shows pics. </p>\n\n<p><a href=\"http://m.newhealthadvisor.com/Normal-Size-of-Uterus.html\" rel=\"nofollow\">Uterus size:</a> </p>\n\n<blockquote>\n <p>The normal size of uterus at this time is 7.6cm x 4.5cm x 3cm\n (length, width, thickness)</p>\n</blockquote>\n", "score": 3 } ]

[ "posture", "removal", "uterus", "internal-organs" ]

[ { "answer_id": 3568, "body": "<h2>Official source of information</h2>\n\n<p><a href=\"http://www.thehia.org/Resources/PressReleases/HIA-position-CBD-FINAL.pdf\" rel=\"nofollow\">http://www.thehia.org/Resources/PressReleases/HIA-position-CBD-FINAL.pdf</a></p>\n\n<blockquote>\n <p>Hemp seed oil does not contain any significant quantity of CBD. Hemp fiber and seed cultivars contain relatively minimal \n CBD and CBD production from such plants should not be considered a primary product. </p>\n</blockquote>\n\n<hr>\n\n<h2>More links</h2>\n\n<p><a href=\"http://www.chronictherapy.co/hemp-oil-vs-cbd-oil-whats-the-difference-2/\" rel=\"nofollow\">http://www.chronictherapy.co/hemp-oil-vs-cbd-oil-whats-the-difference-2/</a></p>\n\n<blockquote>\n <p>Because the plants are related, some unscrupulous sellers of hemp oil are trying to market it for its medicinal value, which is negligible.</p>\n</blockquote>\n\n<p><a href=\"http://www.mintpressnews.com/hemp-oil-versus-cbd-oil-whats-the-difference/193962/\" rel=\"nofollow\">http://www.mintpressnews.com/hemp-oil-versus-cbd-oil-whats-the-difference/193962/</a></p>\n\n<blockquote>\n <p>Consumers often confuse hemp oil with CBD oil because both are low in THC and contain CBD.</p>\n</blockquote>\n\n<hr>\n\n<p>It took me a while to wrap my head around all these quirks - I'm so detached from the nature :)</p>\n", "score": 5 }, { "answer_id": 17501, "body": "<p>Hemp oil is made from the seeds of the cannabis plants. These typically contain almost no cannabinoids, like THC or CBD. CBD-oil is any oil, not only hemp oil, enriched with CBD. The industry seems to prefer hemp-oil for that apparently. Ordinary, non-treated hemp seed oil is very low in CBD.</p>\n\n<p>Cannabinoids are found in the stem, leaves and in greatest concentration in the flowering parts of the plant. To repeat: the seeds from which the oil is made do contain CBD, but only in trace amounts.</p>\n\n<p>That means ordinary hemp seed oil does not contain CBD in meaningful quantities. Since hemp seed oil is a valuable source of fatty acids in a very nice relation to one another, it is often considered \"healthy\" on its own. But to get hemp seed oil with CBD, you need to bring the CBD from an external source into the oil. That is possible and seems like a natural choice since CBD is fat soluble and needs a carrier for the consumer to ingest it in meaningful dosage.</p>\n\n<pre><code>Feature Hemp Seed Oil Cannabidiol Oil\nPlant species of origin Industrial hemp (Cannabis sativa) Industrial hemp \n strains with high CBD content strains with low CBD content (Cannabis sativa) \nParts used to produce oil Hemp seeds Hemp flowers, leaves\nMethod of production Cold pressing CO2 (non-toxic) solvent extraction\nPurified Filtered Yes\nIndependent laboratory Not on THC content, Yes on CBD and THC \nanalysis and certification but on fatty acid profile content\nCannabinoid content Low CBD Rich CBD, Low THC\nFood supplement uses Healthy source of monounsaturated To support general well-being, \n and essential fatty acids relaxing\nDoes it produce a 'high'? No (THC not present in the seeds) No (Guaranteed low levels of THC)\nIs it a legal food supplement? Yes Yes\n</code></pre>\n\n<p>Source for table: <a href=\"https://www.healthspan.co.uk/advice/whats-the-difference-between-hemp-seed-oil-and-cannabidiol-oil-cbd\" rel=\"nofollow noreferrer\">What’s the difference between hemp seed oil and cannabidiol oil (CBD)?</a></p>\n\n<p>The legal advice in that table was quoted as is. It might be different where you live. According to <a href=\"https://www.webmd.com/pain-management/ss/slideshow-cbd-oil\" rel=\"nofollow noreferrer\">WebMD: All About CBD Oil</a> CBD might still be illegal in Idaho, Dakota and Nebraska. Worldwide there might be similarly crazy places. </p>\n", "score": 4 } ]

[ "cancer", "supplement", "oil", "marijuana" ]

[ { "answer_id": 3583, "body": "<p>As <a href=\"http://www.sleep-journal.com/article/S1389-9457%2802%2900237-X/abstract\" rel=\"nofollow\">explained here</a> [1], it is the price we've paid for our ability to speak: </p>\n\n<blockquote>\n <p>Obstructive sleep apnea is an anatomic illness caused by evolutionary changes in the human upper respiratory tract. These changes include shortening of the maxillary, ethmoid, palatal and mandibular bones, acute oral cavity-skull base angulation, pharyngeal collapse with anterior migration of the foramen magnum, posterior migration of the tongue into the pharynx, descent of the larynx and shortening of the soft palate with loss of the epiglottic–soft palate lock-up. While it is commonly believed that some of these changes had positive selection pressures for bipedalism, binocular vision and locomotion, development of voice, speech and language ultimately became a substantial contributing factor. Here it is shown that these changes are the anatomic basis of obstructive sleep apnea.</p>\n</blockquote>\n\n<p>Many people who don't have obstructive sleep apnea, will snore as a result of these evolutionary adaptations. You can let your doctor examine your throat, if you feel drowsy during the day you can do a sleep test to see of you suffer from sleep apnea. But snoring in itself doesn't necessarily have to be due to a pathological problem that needs to be treated.</p>\n\n<p>[1] T. M. Davidson, <em>The Great Leap Forward: the anatomic basis for the acquisition of speech and obstructive sleep apnea</em>, Sleep Medicine <strong>4</strong> (2003), 185–194.</p>\n", "score": 3 }, { "answer_id": 5414, "body": "<p>Snoring is the sound produced by vibrating structures of the upper airway, typically during inhalation. Those who have enlarged tonsils, an enlarged tongue or excess weight around the neck are more prone to snoring. When you sleep, muscle tone throughout your body decreases, or becomes hypotonic that results in the harsh vibratory noise.</p>\n", "score": 0 } ]

[ "sleep", "nose", "otolaryngology", "snore-snoring" ]

[ { "answer_id": 9486, "body": "<p>Your strategy is correct.</p>\n\n<p>In my experience there is no other way, really, just keep looking. The signs of a good doctor are:</p>\n\n<ul>\n<li>doctor is genuinely interested in your case and he/she is eager to explain you the particularities of your issue;</li>\n<li>doctor loves his/her work and tracks studies in the field;</li>\n<li>after the visit you feel much better, even though, no procedures were performed on you yet and you didn't take any medication.</li>\n</ul>\n\n<p>I come from the country where doctor's are paid very badly by the state and are often incompetent. Yet, recently I saw that one doctor agreed to talk to a patient online off hours (to examine and clarify test results) and then made a visit off hours too. During the visit this doctor made pretty modest (in terms of money) prescriptions and talked a lot about the condition in order to educate the patient. This doc openly stated that she loved her job.</p>\n\n<p>The above passage was just to tell you that there are doctors who love their job, even in not so good countries, regardless of remuneration they will do their best to help the patient and follow Hippocratic Oath.</p>\n\n<p>While you seek for THE doctor, you are free to submit more specific questions here on this website. You are not alone.</p>\n", "score": 2 } ]

[ "blood-tests", "quantified-self", "lifestyle" ]

[ { "answer_id": 3744, "body": "<p>There are very few (but there <em>are</em> some) medications that need to be taken at very strict time intervals; early drugs for AIDS needed to be taken even in the middle of the night.</p>\n\n<p>No one expects <em>four times a day</em> to mean, literally, every 6 hours on the minute. The dose is calculated to cover that period of rest (sleep).</p>\n\n<p>To understand this, you need to understand steady state pharmacokinetics and pharmacodynamics.</p>\n\n<p>After a certain number of doses, a drug builds up in the body <em>to a steady state</em> - meaning it stays more or less in the same concentration in the blood between doses, or to put it another way, the amount being taken in and the amount being eliminated by the body are about equal.</p>\n\n<p>It's not guesswork; researchers study the drug before it's even released to determine such things (see the second reference.) Pharmacokinetic studies determine the dosages at which the concentration of a particular drug/antibiotic is always high enough between doses such that serum levels don't fall below effective levels.</p>\n\n<p>Say a drug under investigation is given every 12 hours. Blood is drawn at frequent intervals over a number of doses for to determine peak levels (the time at which the concentration in the blood is highest) and trough levels (the time when the drug is the lowest.) If at the trough level the drug is below that needed to be effective, the dosing interval decreases: the subject must take it more frequently, say every 8 hours. This cycle continues until the ideal dosage and dose interval is established. The final recommendation takes into account how long you can go without taking the drug and still have enough drug - how to take the drug such that the steady state is maintained - if you sleep.</p>\n\n<p>If a drug falls below the effective dose quickly (say it is metabolized into an ineffective product), and a satisfactory prolonged serum level can't be arrived at, the prescribing physician will alert you to the fact that you <em>must</em> take it to as close to how it's prescribed as possible, and will tell you what to do if you miss a dose.</p>\n\n<p>When the timing of administration of life-saving drugs is <em>critical</em>, it's not uncommon to hospitalize a patient to assure such administration.</p>\n\n<blockquote>\n <p>I have heard that the impact of medication lessens if the dosage is delayed, so how come sleep through the night without medication is okay? </p>\n</blockquote>\n\n<p>That has all been calculated so that there is adequate and continuous coverage. The bacteria have no opportunity to \"develop resistance\" while you sleep.</p>\n\n<p>_{<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675903/\" rel=\"nofollow\">Pharmacokinetics and Pharmacodynamics of Antibacterial Agents</a>}<br>\n_{<a href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2125.2007.02899.x/full\" rel=\"nofollow\">The pharmacokinetics, pharmacodynamics and tolerability of dabigatran etexilate, a new oral direct thrombin inhibitor, in healthy male subjects</a> &lt;- An example of how pharmacodynamics are determied.}</p>\n", "score": 7 } ]

[ "medications" ]

[ { "answer_id": 3975, "body": "<p>It is difficult to tell from that photograph what the pigmented area represents; a good photograph of the iris is hard to get without a <em>slit-lamp</em> (an instrument for close examination of the eyes.)</p>\n\n<p>Because irises are normally pigmented, they are subject to the same kinds of lesions as other pigmented tissue. The iris can have \"freckles\" (though not caused by the sun), pigmented moles, melanomas, etc. Because the iris is also composed of layers, an absence or indentation of part of the outermost layer of the iris (called a <em>crypt</em>) can be spot-like in appearance.</p>\n\n<p>The following is a photograph of a benign nevus (mole) of the iris:</p>\n\n<p><a href=\"https://i.stack.imgur.com/DbVVsm.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/DbVVsm.jpg\" alt=\"enter image description here\"></a></p>\n\n<blockquote>\n <p>Iris nevi are, by definition, pigmented and flat. They are common, may be multiple, and occur more often in blue-eyed patients. Iris nevi are also rarely present at birth and like all other ocular nevi become apparent around puberty. </p>\n</blockquote>\n\n<p>The following is of an iris nevus taken through a slit lamp:</p>\n\n<p><a href=\"https://i.stack.imgur.com/yrFuem.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/yrFuem.jpg\" alt=\"enter image description here\"></a></p>\n\n<p>Here, you can also see freckles on the iris.</p>\n\n<p>The fact that all three photographs feature a spot in the lower half of the iris isn't coincidence. Approximately 80% of them occur in the lower half of the iris.</p>\n\n<p>Lesions in the iris can also be caused by trauma, congenital abnormalities, illnesses, infections, etc.</p>\n\n<p>Iris melanomas can also occur, and arise from iris nevi. Usually they are low-grade tumors, but can be problematic to vision/ocular health, and can become metastatic.**</p>\n\n<p>While the lesion shown in the photograph is statistically likely to be a benign iris nevus, it is impossible to say. The safest course of action is to ask your doctor what it is (even a good office opthalmoscope will afford better visualization that the photograph) and if it needs to be checked further.</p>\n\n<p>_{**Considerable controversy exists regarding the histopathologic classification and the malignant potential of iris melanomas.}</p>\n\n<p>_{Image: <a href=\"https://commons.wikimedia.org/wiki/File:Coppereyesyo.jpg#/media/File:Coppereyesyo.jpg\" rel=\"nofollow noreferrer\">https://commons.wikimedia.org/wiki/File:Coppereyesyo.jpg#/media/File:Coppereyesyo.jpg</a>}<br>\n_{Image: <a href=\"http://www.hayesoptometry.com/?mainURL=%2Fgalleryimg%2F843j%2Firis_nevus.html%3Fimage%3D843j\" rel=\"nofollow noreferrer\">Hayes Optometry</a>}<br>\n_{<a href=\"http://www.ncbi.nlm.nih.gov/books/NBK12722/\" rel=\"nofollow noreferrer\">Adult Ophthalmic Oncology: Ocular Diseases</a>}<br>\n_{<a href=\"http://emedicine.medscape.com/article/1208624-overview\" rel=\"nofollow noreferrer\">Iris Melanoma</a>}</p>\n", "score": 6 } ]

[ "optometry", "iris" ]

[ { "answer_id": 4034, "body": "<p>TSH has a quite important circadian rhythm. </p>\n\n<p>Most of the original research on it is not freely accessible, as open access wasn't really a thing when these studies were done, in the 80s, but this one is freely available: <a href=\"http://www.clinchem.org/content/42/1/135.abstract\">Physiological variations in thyroid hormones: physiological and pathophysiological considerations</a>. There is a section on circadian and seasonal rhythm and a table with some values. Quoting from the paper:</p>\n\n<blockquote>\n <p>There is a clear circadian variation in circulating TSH concentrations in animals and in humans. TSH concentrations are low during the daytime, increase in the evening, and peak shortly before sleep. Amounts decline slowly during sleep. Table 3 summarizes studies of mean, nadir, and peak serum </p>\n</blockquote>\n\n<p>They also mention that the nocturnal TSH secretion is weakened in people with hyperthyroidism. </p>\n\n<p>A chart is available in figure 2 of the paper <a href=\"http://www.sciencedirect.com/science/article/pii/S1556407X07000331\">Modulation of Endocrine Function by Sleep-Wake Homeostasis and Circadian Rhythmicity</a></p>\n\n<p><em>Hyperthyroidism</em></p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/2500558\">Significance of latent hyperthyroidism</a> is another study from the 80s on this. They found a significant circadian rhythm in normal (euthyroid) patients, but a suppressed rhythm in subjects with hyperthyroidism, the suppression getting stronger the worse the hyperthyroidism is:</p>\n\n<blockquote>\n <p>The circadian rhythm in latent hyperthyroidism is distinctly suppressed and in overt hyperthyroidism totally. Whereas in latent hyperthyroidism pulsatile secretion is extant, in overt hyperthyroidism the TSH pulses are absent. </p>\n</blockquote>\n\n<p><em>Hypothyroidism</em></p>\n\n<p>The same is basically observed in hypothyroidism, see, for example <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/11201856\">Diurnal thyrotropin secretion in short-term profound primary hypothyroidism: does it ever persist?</a></p>\n\n<blockquote>\n <p>In conclusion, diurnal rhythmicity in serum TSH levels was abolished in a uniform cohort of patients with short-term severe primary hypothyroidism.</p>\n</blockquote>\n\n<p>or <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/1286520\">Circadian changes in pulsatile TSH release in primary hypothyroidism</a>. </p>\n\n<blockquote>\n <p>The nocturnal TSH surge was absent in six out of nine patients with overt primary hypothyroidism. </p>\n</blockquote>\n\n<p>The circadian rhythm is weaker, different, or even absent. </p>\n\n<p>While I have always had doctors recommend having TSH done in the morning, without eating beforehand, <a href=\"http://my.clevelandclinic.org/services/heart/diagnostics-testing/laboratory-tests/thyroid-blood-tests\">this doesn't seem to be a general suggestion</a>. However, it's at least desirable to always have them <a href=\"http://www.thyroiduk.org.uk/tuk/diagnosis/getting_diagnosis.html\">done at the same time of day, to make values comparable</a>:</p>\n\n<blockquote>\n <p>TSH has a circadian rhythm (24 hour cycle) and levels peak between midnight and 6am. T3 has a similar circadian rhythm. It is therefore a good idea to have your thyroid tests done at the same time of day each time as your levels may differ at different times of the day.</p>\n</blockquote>\n\n<p><em>Word explanation</em>:</p>\n\n<ul>\n<li>primary hypothyroidism means that the hypothyroidism is caused by a thyroid disorder itself </li>\n<li>secondary hypothyroidism is hypothyroidism caused by, for example a problem in the part of the brain controlling the thyroid) </li>\n<li>an euthyroid patient has normal thyroid function </li>\n<li>latent thyroid problems are those that are detected in lab tests, but don't show symptoms yet</li>\n<li>subclinical is the reverse: showing symptoms, but blood tests have no significant results </li>\n</ul>\n", "score": 11 }, { "answer_id": 4506, "body": "<p>TSH concentration is subject to both circadian variation (i.e. a rhythm with a period of one day) and ultradian variation (i.e. faster oscillations).</p>\n\n<p>This fact is illustrated by the following figure:</p>\n\n<p><a href=\"https://i.stack.imgur.com/pkguJ.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/pkguJ.jpg\" alt=\"enter image description here\"></a></p>\n\n<p>This illustration was generated by computer simulations. Model 4 integrates long and ultra-short feedback control of TSH release. The pattern generated by this fourth model is identical to that of natural time series, as proved by two methods to calculate fractal dimensions [Hoermann R, Midgley JE, Larisch R, Dietrich JW. <a href=\"http://journal.frontiersin.org/article/10.3389/fendo.2015.00177/abstract\" rel=\"nofollow noreferrer\">Homeostatic Control of the Thyroid-Pituitary Axis: Perspectives for Diagnosis and Treatment</a>. Front Endocrinol (Lausanne). 2015 Nov 20;6:177. doi: <a href=\"http://dx.doi.org/10.3389/fendo.2015.00177\" rel=\"nofollow noreferrer\">10.3389/fendo.2015.00177</a>. PMID <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/26635726\" rel=\"nofollow noreferrer\">26635726</a>; PMCID <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653296/\" rel=\"nofollow noreferrer\">PMC4653296</a>].</p>\n\n<p>The following figure illustrates TSH pulsatility over three weeks in the evolution of non-thyroidal illness syndrome (NTIS) or thyroid allostasis in critical illness, tumours, uremia and starvation (TACITUS).</p>\n\n<p><a href=\"https://i.stack.imgur.com/prPAh.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/prPAh.jpg\" alt=\"enter image description here\"></a></p>\n\n<p>This time series was again created by numeric simulation, but it is identical to observations of real patients [Dietrich JW, Landgrafe G, Fotiadou EH. <a href=\"http://www.hindawi.com/journals/jtr/2012/351864/\" rel=\"nofollow noreferrer\">TSH and Thyrotropic Agonists: Key Actors in Thyroid Homeostasis</a>. J Thyroid Res. 2012;2012:351864. doi: <a href=\"http://dx.doi.org/10.1155/2012/351864\" rel=\"nofollow noreferrer\">10.1155/2012/351864</a>. Epub 2012 Dec 30. PMID <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/23365787\" rel=\"nofollow noreferrer\">23365787</a>; PMCID <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23365787/\" rel=\"nofollow noreferrer\">PMC3544290</a>.].</p>\n\n<p>All time series were created with <a href=\"http://simthyr.sourceforge.net/\" rel=\"nofollow noreferrer\">SimThyr 3</a>.</p>\n", "score": 3 } ]

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

[ { "answer_id": 4992, "body": "<p>In a dexamethasone supression test, it is measured whether given the patient dexamethasone leads to lowered cortisol levels. Lowered cortisol levels are the normal response to dexamethasone; if the level doesn't go down as much as it should, that can point to one of several conditions that cause Cushing's syndrome (see below).</p>\n\n<p>There are standard and overnight dexamethason tests, and high dose and low dose tests. In the standard test, measurements are done over three days - in the low dose test, 0.5 mg of dexamethasone are given every six hours from day 2 onward; in the high dose test, it's 2mg. In the overnight test, in the low dose variety, the patient is given 1mg of dexamethason, and in a high dose dexamethason test, the patient is given 8mg. </p>\n\n<p>Both tests can determine whether the patient's cortisol release is abnormal. This is usually due to one of three conditions: </p>\n\n<ol>\n<li><a href=\"http://pituitary.ucla.edu/body.cfm?id=54\">Cushing's Disease (a pituitary tumor)</a></li>\n<li>an <a href=\"https://www.nlm.nih.gov/medlineplus/ency/article/000407.htm\">adrenal tumor</a></li>\n<li>or a <a href=\"https://www.nlm.nih.gov/medlineplus/ency/article/000406.htm\">tumor somewhere else in the body</a> that produces a hormone called adrenocorticotropic hormone.</li>\n</ol>\n\n<p>With the high dose test, it is possible to identify whether the problem is Cushing's disease, while the low dose test can't make that distinction.</p>\n\n<p>Sources:</p>\n\n<p><a href=\"https://www.nlm.nih.gov/medlineplus/ency/article/003694.htm\">US National Library of Medicine - Dexamethasone suppression test</a></p>\n\n<p><a href=\"http://endocrinesurgery.ucla.edu/patient_education_adm_tst_dexamethasone_suppression_test.html\">UCLA Endocrine Surgery Patient Education</a></p>\n", "score": 4 } ]

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

[ { "answer_id": 8946, "body": "<blockquote>\n <p>Tefikow, S., J. Barth, S. Maichrowitz, A. Beelmann, B. Strauss, and J. Rosendahl. \"Efficacy of Hypnosis in Adults Undergoing Surgery or Medical Procedures: A Meta-analysis of Randomized Controlled Trials.\" Clinical Psychology Review 33.5 (2013): 623-36. Web. </p>\n</blockquote>\n\n<p>Here's a peer reviewed meta analysis that also found hypnosis to be beneficial during surgery when compared with standard care.</p>\n\n<p>However, most of the studies they cite aren't very large and <strong>there definitely needs to be more study in this area before any conclusions can be drawn; positive or negative</strong>. Some logistical downsides I can think of would be:</p>\n\n<ol>\n<li>Different methods of hypnosis being used can complicate studies</li>\n<li>Surgeons not being willing to perform surgery without anesthetics</li>\n<li>(To my knowledge) Hypnotists are not regulated or required to comply with any standards of practice</li>\n<li>If a patient is not fully sedated under anesthesia the dosage can be altered to achieve the appropriate degree of sedation, this cannot be done as objectively with hypnosis</li>\n<li>The use of anesthetics in the general population is better studied and documented than hypnosis, therefore surgical guidelines will favor anesthesia</li>\n</ol>\n", "score": 3 } ]

[ "anesthesia", "hypnotherapy" ]

[ { "answer_id": 4202, "body": "<p>Lowered brain activity in a PET scan isn't necessarily bad. It depends on what <em>part</em> of the brain is less active than usually and whether this is a <em>permanent</em> or <em>transient</em> state. Our brains are less active during sleep - that isn't a bad thing. </p>\n\n<p>Anyway, brain activity isn't just generally lowered during meditation. On the contrary. </p>\n\n<p><a href=\"http://mobile.journals.lww.com/neuroreport/_layouts/oaks.journals.mobile/articleviewer.aspx?year=2000&amp;issue=05150&amp;article=00041#ath\" rel=\"nofollow\">Functional brain mapping of the relaxation response and meditation</a> found (emphasis mine):</p>\n\n<blockquote>\n <p>Significant (p &lt;10−7) <strong>signal increases</strong> were observed in the group-averaged data in the dorsolateral prefrontal and parietal cortices, hippocampus/parahippocampus, temporal lobe, pregenual anterior cingulate cortex, striatum, and pre- and post-central gyri during meditation. Global fMRI signal decreases were also noted, although these were probably secondary to cardiorespiratory changes that often accompany meditation. The results indicate that the practice of meditation <strong>activates</strong> neural structures involved in attention and control of the autonomic nervous system.</p>\n</blockquote>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/15534199\" rel=\"nofollow\">Long-term meditators self-induce high-amplitude gamma synchrony during mental practice.</a></p>\n\n<blockquote>\n <p>In addition, the ratio of gamma-band activity (25-42 Hz) to slow oscillatory activity (4-13 Hz) is initially higher in the resting baseline before meditation for the practitioners than the controls over medial frontoparietal electrodes. This difference increases sharply during meditation over most of the scalp electrodes and remains higher than the initial baseline in the postmeditation baseline. </p>\n</blockquote>\n\n<p>Basically, it's a lot more complicated than meditation decreasing brain activity. </p>\n\n<p>As for recreational drugs, I am not sure where you got a generally decreased activity from, but for example long-term use of meth <a href=\"http://www.jneurosci.org/content/21/23/9414.full.pdf\" rel=\"nofollow\">decreases the amount of dopamine receptors in the brain</a>. Dopamine is important for feelings of pleasure and reward and building memories. </p>\n\n<blockquote>\n <p>Studies in methamphetamine abusers have also documented significant loss of DA transporters (used as markers of the DA terminal) that are associated with slower motor function and decreased memory. The extent to which the loss of DA transporters predisposes methamphetamine abusers to neurodegenerative disorders such as Parkinsonism is unclear and may depend in part on the degree of recovery. </p>\n</blockquote>\n\n<p>Long term use of cocaine <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851068/\" rel=\"nofollow\">decreases the actual amount of grey brain matter</a>. </p>\n", "score": 4 } ]

[ "brain", "neurology", "recreational-drugs", "meditation" ]

[ { "answer_id": 4171, "body": "<p>Treating a wound at home until emergency personnel arrive:</p>\n\n<ul>\n<li>Lay flat on the ground, although head can be elevated for comfort.</li>\n<li>Leave object in wound: This is because the object acts as a plug and slows the flow of blood from the wound, also, emergency staff are trained to take the objects out without causing more damage to internal organs and muscles.</li>\n<li>Apply pressure and dress the wounds as best as you can around the object, trying not to move it too much. If the object isn't there, use a shirt or clean fabric to apply pressure on the wound. You can also place a credit card in the wound to try to stem blood flow. If it is really bleeding badly apply pressure to the artery (pressure points) leading to the wound. In limbs this is done by tying a string of cloth around the top of the limb close to the torso. Just make sure that fingers and toes are not turning blue or black from lack of blood flow.</li>\n</ul>\n\n<p>(I learned this in first aid class, but here is the wiki that explains it: <a href=\"http://www.wikihow.com/Attend-to-a-Stab-Wound\" rel=\"nofollow\">Attend a stab wound</a>)</p>\n\n<hr>\n\n<p>There is actually a new object that the FDA just approved to help aid in the treatment of wounds like this. It's called the <a href=\"http://www.nbcnews.com/health/health-news/wound-stopping-battlefield-sponge-gun-now-ok-civilians-too-n478806\" rel=\"nofollow\">XSTAT</a>. It's been used on the battlefield already to slow blood flow in the wound(s). Basically it stuffs the wound to prevent further blood loss.</p>\n\n<p>When you're in the hospital, the object will be surgically removed. It is like any other surgery like heart valve replacements or an appendectomy. These surgeons also have to be trained for accidentally nicking an artery. You can either sew the wound together or use heat to seal the wound. It's basically like any other surgery, only they have to use things like Ultrasound and Xrays to make sure that they've closed all of the bleeds. If you want more information, you can read <a href=\"http://www.modernmedicine.com/modern-medicine/content/trauma-nursing-penetrating-chest-wounds\" rel=\"nofollow\">here</a> about a test case \"Ricky\" who was shot. </p>\n", "score": 3 } ]

[ "surgery", "first-aid", "trauma" ]

[ { "answer_id": 4184, "body": "<p>There are many factors that influence the transmission of infectious agents, and in the case of public swimming pools:</p>\n\n<ul>\n<li>the number of bathers</li>\n<li>the condition of the pool</li>\n<li>care taken to disinfect the water </li>\n</ul>\n\n<p>...will heavily influence the likelihood of contracting a disease. </p>\n\n<p>The air around us is filled with various benign fungi (including other pathogens such as bacterial and viruses). Similarly, pool water can contain bacteria, viruses and fungi [1,2]. </p>\n\n<p>These pathogens, whether it be from the air or pool water, have the capacity to infect a host, but normally is combated by the immune system in healthy individuals [ 4]. </p>\n\n<p>Individuals with a weak immune system (whether it be due to an ongoing infection, steroids or other immuno-suppresive drugs) or individuals that are immuno-compromised (HIV patient) can get infected by these pathogens [3,4]. </p>\n\n<p>In particular, fungal infections are harder to clear by the immune system due to their natural defense mechanism to avoid our immune cells <a href=\"http://www.nature.com.ezproxy3.lhl.uab.edu/nri/journal/v11/n4/full/nri2939.html\" rel=\"nofollow noreferrer\">4</a>. Therefore, it may be advisable to avoid swimming pools, especially at peak usage as the filtration system may be unable to keep up.</p>\n\n<ol>\n<li><a href=\"http://www.bmj.com/content/bmj/3/5874/260.full.pdf\" rel=\"nofollow noreferrer\" title=\"Foot infections in swimming baths\">Foot Infections in Swimming Baths</a></li>\n<li><a href=\"http://www.tandfonline.com/doi/abs/10.1080/09603120701254862\" rel=\"nofollow noreferrer\">Swimming pools and fungi: An environmental epidemiology survey in Italian indoor swimming facilities</a></li>\n<li><a href=\"http://journals.lww.com/amjmedsci/Abstract/1969/12000/Opportunistic_Infection__A_Review.7.aspx\" rel=\"nofollow noreferrer\">Opportunistic Infection: A Review</a></li>\n<li><a href=\"http://www.nature.com.ezproxy3.lhl.uab.edu/nri/journal/v11/n4/full/nri2939.html\" rel=\"nofollow noreferrer\">Immunity to fungal infection</a></li>\n</ol>\n", "score": 6 } ]

[ "infection", "sports", "swimming", "fungal-infection" ]

[ { "answer_id": 5186, "body": "<p>Before we discuss safety, I wouldn't agree that these two work 'equally well'. While ranitidine (a histamine 2-receptor antagonist - H2A) is a medicine with good efficacy, studies have shown that proton pump inhibitors - PPI (such as omeprasole) are more efficient. (1, 2)</p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/7926494\" rel=\"noreferrer\">One of these studies</a> concludes:</p>\n\n<blockquote>\n <p>Maintenance treatment with omeprazole (20 or 10 mg once daily) is superior to ranitidine (150 mg twice daily) in keeping patients with erosive reflux esophagitis in remission over a 12-month period.</p>\n</blockquote>\n\n<p>As for safety, University of Oxford, Medical Sciences Division in a Systematic review of PPI and H2A in GORD states that:</p>\n\n<blockquote>\n <p>The rate of occurrence of study withdrawals because of drug-related adverse events is shown [...]. For PPI, the rate of adverse event withdrawals was 2.5%, and for H2A it was 4.2%. This tendency for fewer adverse event withdrawals with PPI was significant - relative risk 0.61 (0.41 - 0.91). The NNH was 50 (26 - 251). <strong>This means for every fifty patients with reflux oesophagitis treated with a proton pump inhibitor, one will not have a serious treatment-related complication who would have done had they been treated with a H2A.</strong></p>\n</blockquote>\n\n<p>This refers only to serious complications. Detailed lists of possible side effects and their frequencies for each medicine can be found in their respective summaries of product characteristics - SPCs. (4, 5)</p>\n\n<p>(Edit: For long-term effects and risks, many years may pass until they are discovered, which is why safety of medicines is constantly being re-assessed, especially through pharmacovigilance system. There have been some very recent studies showing that there might be additional long-term risks associated with use of PPIs, as explained in Count Iblis's answer).</p>\n\n<p>However, <strong>in pregnancy</strong> ranitidine and other H2As have been categorised as class B medicines, whereas omeprasole has been categorised as class C medicine, the second being based on effects shown in animal studies. There is more data on safety in pregnancy obtained from humans for ranitidine than for omeprasole. Class B is regarded as safer than class C. Other PPIs are categorised as class B. (6)</p>\n\n<hr>\n\n<p><strong>Ultimately, the choice of medicine should be up to your physician, who knows the specifics of your condition and your overall health status.</strong> What's more, if the condition persists (you inquired about long term use) a medical doctor should follow your condition and the treatment progress. </p>\n\n<hr>\n\n<ol>\n<li><p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/10910310\" rel=\"noreferrer\">Effectiveness and costs of omeprazole vs ranitidine for treatment of symptomatic gastroesophageal reflux disease in primary care clinics in West Virginia.</a></p></li>\n<li><p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/7926494\" rel=\"noreferrer\">Omeprazole or ranitidine in long-term treatment of reflux esophagitis. The Scandinavian Clinics for United Research Group.</a></p></li>\n<li><p><a href=\"http://www.medicine.ox.ac.uk/bandolier/bandopubs/gordf/gord.html#Heading33\" rel=\"noreferrer\">Systematic review of PPI and H2A in GORD</a></p></li>\n<li><p><a href=\"https://www.medicines.org.uk/emc/medicine/23245#UNDESIRABLE_EFFECTS\" rel=\"noreferrer\">Ranitidine SPC</a></p></li>\n<li><p><a href=\"https://www.medicines.org.uk/emc/medicine/24226#UNDESIRABLE_EFFECTS\" rel=\"noreferrer\">Omeprasole SPC</a></p></li>\n<li><p><a href=\"http://www.medscape.com/viewarticle/515100_5\" rel=\"noreferrer\">Review Article: The Management of Heartburn in Pregnancy</a></p></li>\n</ol>\n", "score": 6 }, { "answer_id": 5187, "body": "<p>Recent research results point to serious adverse health risks with the long term use of PPIs. These medicines increase the risk of <a href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0124653\" rel=\"nofollow noreferrer\">heart disease</a>, increase the risk of <a href=\"http://archneur.jamanetwork.com/article.aspx?articleid=2487379\" rel=\"nofollow noreferrer\">dementia</a> and <a href=\"http://archinte.jamanetwork.com/article.aspx?articleid=2481157\" rel=\"nofollow noreferrer\">chronic kidney disease</a>. These adverse effects have only recently been found. The association with heart disease used to be controversial, but recently obtained evidence points to a solid causal link. The <a href=\"http://circres.ahajournals.org/content/early/2016/04/19/CIRCRESAHA.116.308807\" rel=\"nofollow noreferrer\">results of a very recent experiment</a> on cell cultures suggests that these side effects are due to PPIs interfering with endothelial function. </p>\n\n<p>As mentioned in Lucky's answer, PPIs work better than H2As, so the decision which medicine to use must be based on a solid risk assessment by your doctor. The current evidence suggests that at least the PPIs should no longer be prescribed, except to prevent life threatening problems such as intestinal bleeding.</p>\n", "score": 4 } ]

[ "medications", "digestion", "stomach" ]

[ { "answer_id": 4403, "body": "<p>The quick answer is unfortunately it depends.</p>\n\n<p>If we break this question down, there are three ways coffee would likely be able to effect a cough:</p>\n\n<ol>\n<li>The coffee directly interacts with virus (and it is most likely a virus) causing the cough</li>\n<li>Coffee could directly effect your immune system in such a way that it changed your body's ability to respond to the pathogen</li>\n<li>Coffee could be directly interacting with your nervous system which induces the cough reflex (<a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222934/\" rel=\"nofollow noreferrer\">neurogenic cough</a> is a real problem)</li>\n</ol>\n\n<p>For item 1, I've seen <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/25050906\" rel=\"nofollow noreferrer\">some evidence</a> that coffee might actually help stop flu. For the <a href=\"https://en.wikipedia.org/wiki/Common_cold\" rel=\"nofollow noreferrer\">common cold</a>, which is mostly likely (*) one of a few viruses, I couldn't find any evidence of caffeine or the other known <a href=\"http://llufb.llu.lv/conference/foodbalt/2011/FOODBALT-Proceedings-2011-110-115.pdf\" rel=\"nofollow noreferrer\">biologically active components of coffee</a> effecting them one way or the other. There could be another interaction here that we don't know about it, and it could be positive or negative, so at the moment this might be a slight reason to drink coffee, not avoid it. </p>\n\n<p>(*) It's worth noting I disagree with the breakdown of viral prevalence listed in Wikipedia, and have discussed as much in a <a href=\"https://biology.stackexchange.com/questions/21507/why-dont-we-develop-immunity-against-common-cold/21802#21802\">Bio.SE answer</a>.</p>\n\n<p>2) Ok there has been a looooot of research on caffeine and the immune system, especially when related to exercise. Some will say it <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/21558577\" rel=\"nofollow noreferrer\">helps</a>, others <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/20308693\" rel=\"nofollow noreferrer\">not much</a> (especially under <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/21152932\" rel=\"nofollow noreferrer\">usual conditions</a>), and an <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/24974722\" rel=\"nofollow noreferrer\">honest review</a> on it concludes that there are too many other factors that dictate whether caffeine has an effect (with exercise) that we can't really know. But this when considering healthy patients. With sick cells, animals, or people we can know more.</p>\n\n<p>At really <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/22149008\" rel=\"nofollow noreferrer\">high doses</a> caffeine can be anti-inflammatory, but it's probably not a good idea for the general public to be dosing that much caffeine.</p>\n\n<p>This is where things get a little confusing and more relevant. At much more normal doses, <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/19564571\" rel=\"nofollow noreferrer\">caffeine is proinflammatory</a> in the lung. So if you have an on going infection in the lung, you don't want to encourage the inflammation (which is probably causing the caugh).</p>\n\n<p>That said, if you chronically drink coffee, your <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/23465359\" rel=\"nofollow noreferrer\">body may have tolerized</a> to it, and the effect could be minimal (might be minimal anyway, see the sports guys).</p>\n\n<p>Number 3 is actually a lot harder, as things can very based on a lot of other factors (like tolerance). If you have a caffeine overdose, a lot of <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/24196726\" rel=\"nofollow noreferrer\">bad things</a> can happen. One of them is that nerves might fire <a href=\"https://en.wikipedia.org/wiki/Action_potential\" rel=\"nofollow noreferrer\">action potentials</a> at <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/8556193\" rel=\"nofollow noreferrer\">lower thresholds</a>, which could mean the nerves detecting the inflammation in your lungs could fire more easily.</p>\n\n<p><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/23465359\" rel=\"nofollow noreferrer\">Chances are</a>, however, that <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/23314542\" rel=\"nofollow noreferrer\">they won't</a>, and you won't be drinking an unusual amount of coffee.</p>\n\n<hr>\n\n<p>To conclude, in an acute infection I would recommend avoiding caffeine, but it won't cause an undo amount of harm. Decaf will even have the other compounds whose benefit would otherwise be swamped out by caffeine.</p>\n", "score": 7 } ]

[ "caffeine", "cough" ]

[ { "answer_id": 8900, "body": "<p>From &quot;<a href=\"http://medical-diss.com/medicina/znachenie-retino-epifizarnoy-sistemy-dlya-psihofarmakologicheskogo-effekta\" rel=\"nofollow noreferrer\">Значение ретино-эпифизарной системы для психофармакологического эффекта</a>&quot; by Karen Ovanesov, who is co-author of one of those Russian articles on Pubmed to which you refer:</p>\n<blockquote>\n<p>(...) the visual perception is non-stationary in time and changes during the day. The use of stimulants of mental processes, such as caffeine can not only enhance the functional activity of the retina, but also eliminate its daily fluctuations.</p>\n<p>(...) At the higher dose (0.4), the drug caused an increase of sensitivity to the retina (13%), and significantly (by 20%) shortened the latency of the motor response to visual stimuli. This shift was more pronounced in the peripheral parts of the retina. A similar pattern is set, and in the study of color vision, and a substance markedly improves the perception of red and green colors, as compared with the blue and white stimuli and control data definitions.</p>\n<p>(...) the use of caffeine leads to a smoothing of the daily rhythm of the sensitivity of the retina and improve light perception. This effect is more pronounced when using stimulant in the morning.</p>\n</blockquote>\n<p>There are more russian articles about this in bibliography section.</p>\n", "score": 1 } ]

[ "side-effects", "caffeine", "optometry", "light" ]

[ { "answer_id": 4551, "body": "<p>The reasons for 2 bones in your lower arm can be to help your hand turn and give you more control over it. The shoulder joint is a ball and socket joint and has large muscles to help control it. Since the movements and actions of a wrist and shoulder are different, different joints were needed. Wrist are more delicate and do a lot different precise task. This distribution of bones also helps keep the body strong and keep balance. More bones always equals more flexibility. We need more flexibility distal of our joints than at the joints. </p>\n\n<p><strong><em>Resources:</em></strong></p>\n\n<p>For more data try reading more on the biomechanics of bones and the skeletal system. </p>\n\n<p><a href=\"https://books.google.com/books?id=5-Ml5gJ34RYC&amp;pg=PA382&amp;lpg=PA382&amp;dq=Why%20have%202%20bones%20in%20lower%20arm/leg%20and%20only%201%20in%20upper?&amp;source=bl&amp;ots=3JdBPTmxpe&amp;sig=g-or5rDRQ5O7QCddQhZuqBbZQH0&amp;hl=en&amp;sa=X&amp;ved=0ahUKEwjw74fooM3KAhUpv4MKHQHSD_QQ6AEIVDAI#v=onepage&amp;q&amp;f=false\" rel=\"noreferrer\">Skeletal Biomechanics</a></p>\n\n<p><a href=\"http://www.enotes.com/homework-help/why-do-you-think-necessary-too-have-2-bones-lower-138873\" rel=\"noreferrer\">enotes.com</a> </p>\n\n<p><a href=\"https://answers.yahoo.com/question/index?qid=20070820065902AAZ2LjS\" rel=\"noreferrer\">Why do we have 2 bones in the forearm and only one in the upper arm?</a> <em>Not a good source, however I think their explanation is helpful. This is Yahoo answers, so if you don't care for their opinion please don't click.</em></p>\n", "score": 7 } ]

[ "broken-bones", "fibula", "tibia", "femur" ]

[ { "answer_id": 18435, "body": "<p>There would be a lot of factors involved in this question; The rate of digestion, the rate absorption of GI tract, the rate of transfer from splanchnic circulation to the liver and other organs and the rate of metabolism of an individual in including different rates of different enzymes. But since OP is asking for \"calorie to fat\" we will limit it from glucose(since calorie is already a unit of energy)to fatty acids and Triglycerides.</p>\n\n<blockquote>\n <p>During well-fed state or post-absorptive state, the body starts to\n either convert glucose into ATP/energy via glycolysis and citric acid\n cycle, into glycogen in liver or muscle or into fatty acids in the liver,\n kidney, adipose tissue etc.-excerpt from <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK22414/\" rel=\"nofollow noreferrer\">(NCBI)Food Intake and Starvation Induce Metabolic Changes</a></p>\n</blockquote>\n\n<hr>\n\n<h2>Let's start with the steps of conversion from glucose to fatty acids</h2>\n\n<p><a href=\"https://i.stack.imgur.com/442fo.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/442fo.jpg\" alt=\"metabolism\"></a></p>\n\n<p>The first step is <strong>Glycolysis</strong> - red circle. The second step is the <strong>Citric acid cycle</strong> or <strong>Kreb's cycle</strong> - green circle. The third step is <strong>Lipogenesis</strong> - blue circle.</p>\n\n<p>Glucose is converted to pyruvate in the cell cytosol<a href=\"https://www.ncbi.nlm.nih.gov/books/NBK22593/\" rel=\"nofollow noreferrer\">₁</a>. Pyruvate is converted to several substrates including citrate which is essential in lipogenesis in the cell mitochondria<a href=\"https://www.ncbi.nlm.nih.gov/books/NBK22427/\" rel=\"nofollow noreferrer\">₂</a>. Lipogenesis is the process by which acetyl-CoA is converted to triglycerides, lipogenesis encompasses both the process of fatty acid synthesis and triglyceride synthesis, where fatty acids are esterified to glycerol<a href=\"https://en.wikipedia.org/wiki/Lipogenesis\" rel=\"nofollow noreferrer\">₃</a>.</p>\n\n<hr>\n\n<h2>Rates of conversion</h2>\n\n<blockquote>\n <p>...ratios and rates varies widely depending on the nutritional status...</p>\n \n <p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1206300/?page=1\" rel=\"nofollow noreferrer\">-Citrate and the conversion of carbohydrate into fat. A comparison of citrate and acetate incorporation into fatty acids</a></p>\n</blockquote>\n\n<p>&nbsp;</p>\n\n<blockquote>\n <p>...high fat diet abolishes lipogenesis...\n The rate of lipogenesis from available carbohydrates seems to be regulated not only by the carbohydrate content of the diet; glucose utilization increases as the carbohydrate\n content increases or the fat content decreases.</p>\n \n <p><a href=\"http://www.jbc.org/content/214/1/483.full.pdf\" rel=\"nofollow noreferrer\">-DIETARY EFFECTS ON LIPOGENESIS IN ADIPOSE TISSUE</a></p>\n</blockquote>\n\n<p>&nbsp;</p>\n\n<blockquote>\n <p>When the glycogen stores are saturated, massive intakes of carbohydrate are disposed of by high carbohydrate-oxidation rates and substantial <strong>de novo lipid synthesis (150 g lipid/day using approximately 475 g carbs/day)</strong> without postabsorptive hyperglycemia.</p>\n \n <p>Glycogen storage capacity in man is approximately 15 g/kg body weight and can accommodate a gain of approximately 500 g before net lipid synthesis contributes to increasing body fat mass. </p>\n \n <p><a href=\"https://academic.oup.com/ajcn/article-abstract/48/2/240/4694971\" rel=\"nofollow noreferrer\">-Glycogen storage capacity and de novo lipogenesis during massive carbohydrate overfeeding in man</a></p>\n</blockquote>\n\n<hr>\n\n<h2>Summary</h2>\n\n<p>It depends on several variables, nutrition, rate of metabolism of an individual, lifestyle and activity etc, but mainly the <em>short term storage' glycogen stores' saturation</em>. So as long as the glycogen stores are saturated, the body will start lipogenesis.</p>\n\n<p><strong>150 grams of fat per day from 475 grams of glucose/carbs</strong></p>\n\n<p><strong>or 3.17 grams of glucose/carbs to produce 1 gram of fat</strong></p>\n\n<p>*when glycogen stores are saturated</p>\n\n<p><em>more details on <a href=\"https://academic.oup.com/ajcn/article-abstract/48/2/240/4694971\" rel=\"nofollow noreferrer\">-Glycogen storage capacity and de novo lipogenesis during massive carbohydrate overfeeding in man</a></em></p>\n\n<hr>\n\n<h2><em>P.S.</em></h2>\n\n<p>*Some biochemistry textbooks say that 1 molecule of glucose yields between 36-38 ATPs. However, the amount of energy as ATP revolves around these numbers. According to Guyton, 1 ATP has ~12,000 calories (12 kcals). Thus 38 ATPs would have 456,000 calories or 456 kcals.</p>\n\n<p>*de novo synthesis, meaning \"new\", from glucose to fat.</p>\n", "score": 1 } ]

[ "digestion", "weight", "calories", "body-fat" ]

[ { "answer_id": 4665, "body": "<blockquote>\n <p><strong>What are the benefits of high testosterone in men?</strong></p>\n \n <p>what benefits does high testosterone actually entail?</p>\n \n <p>Mental health discussion would be interesting too, if there's any\n association</p>\n</blockquote>\n\n<h2>Suggested Introduction</h2>\n\n<p>I think it is important to recognize that levels of the <a href=\"https://en.wikipedia.org/wiki/Testosterone\" rel=\"nofollow noreferrer\">testosterone hormone</a> in the male body decrease naturally in men with age.</p>\n\n<p>The level of this hormone peaks in young men starting sometime after puberty, but usually in the late teenage or early twenty age range. Typically the level of this hormone in men starts to decrease between the ages of 30 - 40 or so, and at a slow rate; generally around one percent a year.</p>\n\n<blockquote>\n <p><a href=\"http://www.mayoclinic.org/healthy-living/sexual-health/in-depth/testosterone-therapy/art-20045728\" rel=\"nofollow noreferrer\"><strong>What happens to testosterone levels with age? ₍₁₎</strong></a></p>\n \n <p>Testosterone levels generally peaks during adolescence and early\n adulthood. As you get older, your testosterone level gradually\n declines — typically about 1 percent a year after age 30 or 40. ₍₁₎</p>\n</blockquote>\n\n<h2>Testosterone Effects (physical and mental)</h2>\n\n<p>As far as high testosterone levels and its benefits are concerned, I'll give a general breakdown of typical effects (physical and mental) but I will allow you to classify these as beneficial or not depending on your perspective of these effects.</p>\n\n<p><strong>Physical Associations with High Testosterone</strong></p>\n\n<p>High levels of testosterone starting in early adulthood contribute to puberty transformations in the male body such as: genital organ growth, sexual maturity and fertility, growth of body and facial hair, and deepening of the voice. Higher levels of testosterone are also associated with <em>but not limited to</em> increased metabolism (burn fat faster), increased muscle mass, strength, and bone density.</p>\n\n<blockquote>\n <p><a href=\"http://www.mayoclinic.org/healthy-living/sexual-health/in-depth/testosterone-therapy/art-20045728\" rel=\"nofollow noreferrer\"><strong>What is testosterone? ₍₁₎</strong></a></p>\n \n <p>Testosterone is a hormone produced primarily in the testicles.</p>\n \n <p>Testosterone helps maintain men's:</p>\n \n <ul>\n <li>Bone density</li>\n <li>Fat distribution</li>\n <li>Muscle strength and mass</li>\n <li>Facial and body hair</li>\n <li>Red blood cell production</li>\n <li>Sex drive</li>\n <li>Sperm production</li>\n </ul>\n</blockquote>\n\n<p><strong>Mental Associations with High Testosterone</strong></p>\n\n<p>High levels of testosterone is associated with <em>but not limited to</em> more aggressiveness and the effects of such behavior such as feeling more competitive. It also contributes to sleeping better and feeling well-rested, having more energy, increase in sexual desire and libido, heightened focus and concentration, and more self confidence and motivation. </p>\n\n<blockquote>\n <p><a href=\"http://www.healthline.com/health/low-testosterone/effects-on-body#Central-Nervous-System\" rel=\"nofollow noreferrer\"><strong>Central Nervous System ₍₂₎</strong></a></p>\n \n <p><a href=\"https://i.stack.imgur.com/OLoJ1.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/OLoJ1.png\" alt=\"enter image description here\"></a></p>\n \n <p>The body has a system for controlling testosterone, sending messages\n through hormones and chemicals that are released into the bloodstream.\n In the brain, the hypothalamus tells the pituitary gland how much\n testosterone is needed, and the pituitary relays that information to\n the testicles. ₍₂₎</p>\n \n <p>Testosterone plays a role in certain behaviors, including aggression\n and dominance. It also helps to spark competitiveness and boost\n self-esteem. Just as sexual activity can affect testosterone levels,\n taking part in competitive activities can cause a man’s testosterone\n levels to rise or fall. Low testosterone may result in a loss of\n confidence and lack of motivation. It can also lower a man’s ability\n to concentrate or cause feelings of sadness. Low testosterone can\n cause sleep disturbances and lack of energy. ₍₂₎</p>\n \n <p>It’s important to note, however, that testosterone is only one factor\n that influences personality traits. Other biological and environmental\n factors are also involved. ₍₂₎</p>\n</blockquote>\n\n<hr>\n\n<h2>References</h2>\n\n<ul>\n<li><a href=\"http://www.mayoclinic.org/healthy-living/sexual-health/in-depth/testosterone-therapy/art-20045728\" rel=\"nofollow noreferrer\"><strong>Testosterone therapy: Potential benefits and risks as you age (1)</strong></a>\n\n<ul>\n<li><a href=\"http://www.mayoclinic.org/about-this-site/meet-our-medical-editors\" rel=\"nofollow noreferrer\"><strong>Meet the Mayo Clinic Staff</strong></a></li>\n</ul></li>\n<li><a href=\"http://www.healthline.com/health/low-testosterone/effects-on-body#Central-Nervous-System\" rel=\"nofollow noreferrer\"><strong>The Effects of Testosterone on the Body (2)</strong></a>\n\n<ul>\n<li><a href=\"http://www.healthline.com/health/about-us\" rel=\"nofollow noreferrer\"><strong>Meet the Healthline Staff</strong></a></li>\n</ul></li>\n</ul>\n", "score": 5 } ]

[ "endocrinology", "lifestyle", "benefits", "testosterone", "male" ]

[ { "answer_id": 4764, "body": "<p>Basically you have a normal ECG reading according to the machine.</p>\n\n<p>Sinus rhythm (<a href=\"https://www.google.com/url?sa=t&amp;rct=j&amp;q=&amp;esrc=s&amp;source=web&amp;cd=5&amp;cad=rja&amp;uact=8&amp;ved=0ahUKEwiMsZi60-vKAhUrkIMKHUYPA-UQFgg2MAQ&amp;url=http%3A%2F%2Fwww.springer.com%2Fcda%2Fcontent%2Fdocument%2Fcda_downloaddocument%2F9783540008699-c2.pdf%3FSGWID%3D0-0-45-103532-p7109432&amp;usg=AFQjCNGbKBEgA2Y8mt2saLkl2kWn0N9s0Q&amp;bvm=bv.113943665,d.amc\">as explained in the first section of this book chapter</a>) is normal, meaning that the heart is depolarized by a wave starting in the sinus node. That is the first part of the message. It is worth noting, that if your heart rate had been 1 beat per minute less, it would have probably said \"sinus bradycardia\" as a normal heart rate is considered to be 60-100 beats per minute (BPM). Bradycardia is a heart rate below the 60 bpm threshold (50 bpm in some sources) and tachycardia would be a heart rate above 100 (90 in some sources).</p>\n\n<p>The \"otherwise normal\" is boilerplate by the machine. As you can see by <a href=\"http://www.nasanmedical.com/pdf/specs/simulg-s.pdf\">this feature sheet</a> for the NASAN Simul-G ECG machine, \"Otherwise normal ECG\" is one of the display options. Speaking as a programmer, it's a little bit of a shortcut, so that if there is a rhythm problem but everything else is good, they can simply put \"<em>[rhythm message here]</em> otherwise normal ECG\". Better programming would be to omit the \"otherwise\" when the sinus rhythm is normal.</p>\n\n<p>Now, realize that the machine is simply applying preformatted parameters, and that when it says normal, it just means that your readings fit into what it has defined as normal. It is possible that there is some small thing that doesn't look out of place to the machine but would to a trained cardiologist. I don't say that to alarm you, but just to show you how the machine interprets it.</p>\n", "score": 6 }, { "answer_id": 7439, "body": "<p>Basically I agree with JohnP. \nThe \"otherwise normal ecg\" is an unfortunate phrase.</p>\n\n<p>Sinus rhythm is the normal rhythm of the heart.</p>\n\n<p>So the machine should interpret as:\nNormal ECG.\nRhythm:Sinus\nHeart Rate : \nPR interval:\netc etc.</p>\n\n<p>By saying otherwise normal ECG, of course creates unnecessary suspicion.Modern machines are improved in doing an automatic diagnosis(better wording too).\nNevertheless, I have deactivated the automatic diagnosis in my office, for\nsuch events exactly. They can create idiotic worries to the patients and are\na cause for wasting our time.</p>\n\n<p>P.S. I am a cardiologist.</p>\n\n<p>That sinus is the normal rhythm of the heart can be verified in millions of authoritative sources. As an example I direct.you to Guyton's.physiology, 11th edition. at the beginning of chapter.10 \"rhythmical excitation of.the heart\" one can see that the activation of the conduction system of the heart originates in the sinoatrial node. Now, there are some peculiarities in this, but for all intents and purposes and as a general knowledge it's more than enough. </p>\n", "score": 5 } ]

[ "cardiology", "medical-device" ]

[ { "answer_id": 15926, "body": "<p>In short: There is <strong>insufficient or conflicting evidence</strong> about the cancer-protecting effect of a high-fiber diet.</p>\n\n<p>Suggested mechanisms:</p>\n\n<ul>\n<li>Colorectal cancer: increased stool bulk and dilution of carcinogens in the colonic lumen, reduced transit time, and bacterial fermentation of fibre to short chain fatty acids [which are supposedly protective for colonic mucosa]</li>\n<li>Breast cancer: Dietary fibre reduce the risk of breast cancer may likely by decreasing the level of estrogen in the blood circulation.</li>\n</ul>\n\n<p>Several systematic reviews suggest that high intake of dietary fiber may protect against various types of cancer:</p>\n\n<p><strong>1.</strong> Dietary fibre, whole grains, and risk of <strong>colorectal cancer:</strong> systematic review and dose-response meta-analysis of prospective studies (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3213242/\" rel=\"nofollow noreferrer\">PubMed Central, 2011</a>)</p>\n\n<blockquote>\n <p>A high intake of dietary fibre, in particular cereal fibre and whole\n grains, was associated with a reduced risk of colorectal cancer.</p>\n</blockquote>\n\n<p><strong>2.</strong> Dietary fibre intake and risk of <strong>breast cancer:</strong> A systematic review and meta-analysis of epidemiological studies (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348370/\" rel=\"nofollow noreferrer\">PubMed Central, 2016</a>)</p>\n\n<blockquote>\n <p>...every 10 g/d increment in dietary fibre intake was associated with\n a 4% reduction in breast cancer risk...</p>\n</blockquote>\n\n<p><strong>3.</strong> Dietary fiber and <strong>breast cancer</strong> risk: a systematic review and meta-analysis of prospective studies (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/22234738\" rel=\"nofollow noreferrer\">PubMed, 2012</a>)</p>\n\n<blockquote>\n <p>...there was an inverse association between dietary fiber intake and\n breast cancer risk</p>\n</blockquote>\n\n<p><strong>4.</strong> Dietary fiber and the risk of precancerous lesions and <strong>cancer of the esophagus:</strong> a systematic review and meta-analysis (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/23815145\" rel=\"nofollow noreferrer\">PubMed, 2013</a>)</p>\n\n<blockquote>\n <p>Dietary fiber is associated with protective effects against esophageal\n carcinogenesis, most notably esophageal adenocarcinoma.</p>\n</blockquote>\n\n<p><strong>BUT:</strong></p>\n\n<p><strong>5.</strong> <a href=\"http://lpi.oregonstate.edu/mic/other-nutrients/fiber\" rel=\"nofollow noreferrer\">Linus Pauling Institute</a>:</p>\n\n<blockquote>\n <ul>\n <li>...more recent findings from large prospective cohort studies and four clinical intervention trials <strong>do not support an association\n between fiber intake and the risk of colorectal cancer.</strong></li>\n <li>Observational studies on dietary fiber intake and <strong>breast cancer</strong> incidence have reported <strong>inconsistent findings.</strong></li>\n </ul>\n</blockquote>\n\n<p><strong>6.</strong> <a href=\"http://www.cochrane.org/CD003430/COLOCA_does-dietary-fibre-prevent-recurrence-colorectal-adenomas-and-carcinomas\" rel=\"nofollow noreferrer\">Cochrane</a>:</p>\n\n<blockquote>\n <p>This review found that increasing fibre in a Western diet for two to\n eight years <strong>did not lower the risk of bowel cancer.</strong></p>\n</blockquote>\n", "score": 4 }, { "answer_id": 15586, "body": "<p>No one really knows. A high fibre diet tends, however, to be lower in the foods associated with increased cancer risk. Fibre also reduces the colon transit time so that waste carcinogens have less time to contact the bowel mucosa. High fibre diets also might reduce breast cancer by binding to estrogens, and there's now a suggestion that phytates bind to iron which is helpful since iron is thought to increase the risk for bowel cancer.</p>\n\n<p>Beans, a high fibre vegetable, also have been studied for their anticancer activity</p>\n\n<blockquote>\n <p>Dry beans contain a wide range of nutrients and nonnutrient bioactive constituents that may be protective against cancer (43,50). The nondigestible carbohydrates are all fermented by colonic microflora into butyrate, a short-chain fatty acid, with demonstrated antineoplastic (51) and anti-inflammatory actions (52,53). Furthermore, dry beans have a low glycemic index (GI), defined as the incremental area under the blood glucose curve induced by a specific carbohydrate-containing food (54), which reduces the rate of the absorption of carbohydrates and lowers the postprandial glycemic and insulinemic responses. A number of epidemiologic studies showed that a low-GI diet is associated with a reduced risk of CRC (55-57). Other bioactive constituents of dry beans that have anticarcinogenic properties and could potentially account for a protective effect include saponins, protease inhibitors, inositol hexaphosphate, γ-tocopherol, and phytosterols (49). It is also possible that the combination of several different constituents of dry beans is most effective in reducing cancer risk.</p>\n</blockquote>\n\n<p><a href=\"https://www.pcrm.org/health/cancer-resources/diet-cancer/nutrition/how-fiber-helps-protect-against-cancer\" rel=\"nofollow noreferrer\">https://www.pcrm.org/health/cancer-resources/diet-cancer/nutrition/how-fiber-helps-protect-against-cancer</a></p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1713264/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1713264/</a></p>\n", "score": 3 } ]

[ "diet", "fibre", "cancer" ]

[ { "answer_id": 4975, "body": "<p>The potential toxicity of vitamins varies enormously, but as a rough guide, fat soluble ones have a much higher potential to be stored in your body and build up to toxic levels whereas water soluble ones are likely to simply be flushed out in your urine. I would be wary of taking high doses of fat soluble vitamins over an extended period. See <a href=\"http://www.medicinenet.com/script/main/art.asp?articlekey=10736\" rel=\"nofollow\">here</a>.</p>\n", "score": 1 } ]

[ "micronutrients", "dosage" ]

[ { "answer_id": 23228, "body": "<p>The best place to find this answer is the <a href=\"https://www.uspreventiveservicestaskforce.org/uspstf/\" rel=\"nofollow noreferrer\">US Preventive Services Task Force</a>. They are an \"independent, volunteer panel of national experts in prevention and evidence-based medicine\" who make recommendations for what kinds of routine care are <em>worth doing</em> (in other words, do more good than harm) for what sorts of people (e.g. which age, sex, etc.). They give their recommendations <a href=\"https://www.uspreventiveservicestaskforce.org/uspstf/grade-definitions\" rel=\"nofollow noreferrer\">grades</a> based on how strong the evidence is and how substantial the benefit is. </p>\n\n<p>They created an <a href=\"https://epss.ahrq.gov/PDA/index.jsp\" rel=\"nofollow noreferrer\">app</a> to filter the recommendations based on someone's age, sex, pregnancy status, tobacco use, and if they are sexually active. For a 30 year old male, here are the <em>blood tests</em> that are recommended (and the answer to your question).</p>\n\n<p><strong>Grade A (recommended with substantial benefit/certainty):</strong></p>\n\n<ul>\n<li>HIV screening </li>\n<li>Syphilis screening if at increased risk</li>\n</ul>\n\n<p><strong>Grade B (recommended with moderate benefit/certainty):</strong></p>\n\n<ul>\n<li>Hepatitis B screening if at high risk</li>\n<li>Hepatitis C screening</li>\n<li>Tuberculosis screening if at increased risk</li>\n</ul>\n", "score": 4 }, { "answer_id": 5083, "body": "<p>Let's consider common diseases that a healthy 30 year old can have without noticing any symptoms. E.g. it is known that many people have undiagnosed diabetes, many people have undiagnosed hypothyroidism. Also kidney function can be impaired quite a bit (e.g. due to diabetes) without that leading to symptoms. If we focus on these issues then you could choose to the following test: Glucose and HbA1c to see if the person has diabetes, TSH and T4 to detect hypothyroidism, and creatinine, urea, sodium, potassium to detect problems with the kidneys. Also, measuring HDL and LDL cholesterol can be useful as quite a few young people have too high cholesterol levels.</p>\n\n<p>Now, to make the question better defined, one can ask how to choose some given number of blood tests such that some chosen health criterion, say, the survival probability after ten years is optimized. This can in principle be calculated from the known statistics. To see how to set up this calculation, consider doing just one blood test for disease X.</p>\n\n<p>The patient is in this case selected from a pool of people who do not have any significant symptoms of disease X. So, if X represents diabetes, the patient is currently not complaining about excessive thirsts, feeling tired etc. If X represents kidney disease then the patient is not at the stage where the kidney function is so low that it causes symptoms. This means that the probability that the patient will be found to be suffering from X should be derived from the appropriate conditional probability that conditions on the patient not having any significant symptoms (the symptoms are mild enough for it to be compatible to having no complaints).</p>\n\n<p>For any chosen X you can then calculate the health criterion (e.g. survival after ten years) in the event of a positive test compared to not doing the test. So, this depends on the known effects of early treatment, the probability for detecting X will then yield the expected improvement for this health outcome.</p>\n", "score": 0 } ]

[ "blood-tests", "prevention", "glycated-hemoglobin-hba1c", "urea" ]

[ { "answer_id": 5182, "body": "<p><strong>Original answer</strong></p>\n\n<blockquote>\n <p>You are already infected. The HSV is indeed dormant in your body. It\n keeps trying to get out, till your immune system is off guard and it\n will present as a cold sore. So when you don't have a cold sore your\n immune system is in control and you can't get \"more infected\" by your\n wife. So you can kiss without worries.</p>\n \n <p>The next question is, do you really want to if she has a sore ;)</p>\n</blockquote>\n\n<p><strong>Update:</strong>\nI'm new here, i thought I keep it simple. I will try to provide some evidence and complete the answer:</p>\n\n<p>HSV-1 infects mucosal cells, like the ones in mouth and genitalia. After infection the HSV virus infects innervating neurons causing a latent infection. While the mucosal cells are infected, CD8+ cells (which kill virus infected cells) \"learn\" to recognize the virus and kill it of. As long as your CD8+ cells function normally the virus cannot reactivate. Also antibodies agains the infecting virus are formed, protecting against reinfection (theoretically you could also reinfect yourself) (1) </p>\n\n<p>As @YviDe pointed out it is possible to get infected with multiple strains. In this a small study with 13 HSV-1 infect persons 2 where infected with more than 1 strain (2) However, there is also evidence an infection with HSV can protect against an infection with another strain. (3) </p>\n\n<p>Now, lets assume you and your wife have the same strain of virus. Then the likelihood of you reinfecting yourself is much higher than she infecting you, since you drink from your infected glass and use your infected toothbrush etc. </p>\n\n<p>If she has a different strain things are uncertain. As pointed out, your current infection could protect you but depending on numerous factors you can get reinfected or not with the different strain. If you have a cold sore your immune system (partly) compromised, so at that moment your susceptibility for a infection by this different strain is probably higher. \nHowever, changes that you get infected anyway while living under the same roof is pretty high.</p>\n\n<p>If I where you, I would worry about it to much since you can't be sure about anything without genetic sequencing of your and your wifes HSV-1 virus.</p>\n\n<p>(1) Egan KP et al, Immunological control of herpes simplex virus infections, 2013</p>\n\n<p>(2) Roest RW et al, Genotypic analysis of sequential genital herpes simplex virus type 1 (HSV-1) isolates of patients with recurrent HSV-1 associated genital herpes, 2014</p>\n\n<p>(3) Stanberry LR et al, Longitudinal risk of herpes simplex virus (HSV) type 1, HSV type 2, and cytomegalovirus infections among young adolescent girls, 2004</p>\n", "score": 5 } ]

[ "herpes" ]

[ { "answer_id": 5284, "body": "<p>Answer: 1 Kilocalorie equals 1 Calorie. Note the capital \"C\". 1 kilocalorie equals 1000 calories. Note the lowercase \"c\". So Calories and kilocalories are pretty much the same thing.</p>\n\n<p><a href=\"http://www.weightlossresources.co.uk/calories.htm\" rel=\"noreferrer\">Kilocalories</a></p>\n\n<blockquote>\n <p>It's easy to get confused about calories and kilocalories since, in a\n nutrition context, values are actually given for the number of\n kilocalories in a food, but referred to simply as calories.</p>\n</blockquote>\n\n<p>1000 calories= 1 Kcal</p>\n\n<p><a href=\"http://www.nutrition.gov/whats-food/commonly-asked-questions-faqs\" rel=\"noreferrer\">Nutrition.gov</a></p>\n\n<blockquote>\n <p>The \"calorie\" we refer to in food is actually kilocalorie. One (1)\n kilocalorie is the same as one (1) Calorie (upper case C).</p>\n</blockquote>\n\n<p><a href=\"http://www.rapidtables.com/convert/energy/1-cal-to-kcal.htm\" rel=\"noreferrer\">Rapidtables.com</a></p>\n\n<ul>\n<li>1 Cal = 1 kcal</li>\n<li>1 small calorie (cal) is equal to - 1/1000 small kilocalorie (kcal):</li>\n<li>1 cal = 0.001 kcal</li>\n</ul>\n\n<p><a href=\"http://www.caloriesecrets.net/how-many-calories-should-i-burn-a-day-to-lose-weight/\" rel=\"noreferrer\">May help you understand the relationship between them.</a> </p>\n", "score": 10 }, { "answer_id": 5285, "body": "<p>Generally speaking, 1 kilocalorie = 1000 calories (<a href=\"http://www.merriam-webster.com/dictionary/calorie\" rel=\"noreferrer\">definition here</a>).</p>\n\n<p>But the confusing part is explained here:</p>\n\n<blockquote>\n <p>The energy used in physical activity and the energy stored in foods is actually given in kilocalories (the heat energy required to raise the temperature of one kilogram of water by one degree Celsius). Often kilocalories are referred to as kcals or as large calories or as Calories, where the capital ‘C’ indicates kilocalories. However, because a calorie is such a small unit of energy the word ‘calorie’ to define a small calorie is mainly used in scientific literature. <strong>Most of the time ‘calorie’ spelled with the small ‘c’ actually refers to the kilocalories provided in food and used during exercise.</strong> (<a href=\"http://www.unm.edu/~lkravitz/Article%20folder/remarkablecalorie.html\" rel=\"noreferrer\">you can read about it more here</a>)</p>\n</blockquote>\n\n<p>So, the answer is, in your case, \"calorie\" means the same as \"Kcal\" or \"Kilocalorie\".</p>\n", "score": 7 } ]

[ "nutrition", "terminology", "calories" ]

[ { "answer_id": 5392, "body": "<p>In general a cold (usually rhinovirus), Influenza, or even a bacterial infection can have quite similar symptoms. If contracted through airborne particles, they primarily affect the respiratory system. Mucus, sneezing, fever, are all signs that the body is fighting an infection, as is fatigue as the body diverts resources to the immune system. Essentially, especially at a mild level it is difficult to tell the difference between these without a lab test. When it becomes serious - high fever, extreme fatigue - is it unlikely to be a cold. Any time you have these sort of symptoms you should seek medical attention, because it could be any number of other flus or viruses, some potentially life threatening, especially in small children, the elderly, or those already weakened by another condition.</p>\n\n<p>Allergies are a whole different thing, with a slightly different immune response, and it generally depends on how it manifests. Hayfever might produce mucus or breathing difficulty due to inflammation or muscle spasm in the airways, and can be life threatening in rare cases, even without pre-existing asthma, but it is unlikely to produce fever.</p>\n\n<p>I'm unsure how to reference this, as it's generally covered in a first year biology text, but the Mayo clinic is perhaps the most reliable and independent source for general medical questions.</p>\n\n<p><a href=\"http://www.mayoclinic.org/diseases-conditions/common-cold/expert-answers/common-cold/faq-20057857\" rel=\"noreferrer\">http://www.mayoclinic.org/diseases-conditions/common-cold/expert-answers/common-cold/faq-20057857</a></p>\n\n<p><a href=\"http://www.mayoclinic.org/diseases-conditions/flu/basics/definition/con-20035101\" rel=\"noreferrer\">http://www.mayoclinic.org/diseases-conditions/flu/basics/definition/con-20035101</a></p>\n", "score": 5 }, { "answer_id": 5411, "body": "<p>Symptoms, in short:</p>\n\n<p><strong>Common cold:</strong> blocked nose, yellow/green mucus, scratchy throat lasting for 7-14 days (usually no headache, fever or fatigue), year round</p>\n\n<p><strong>Hay fever (allergy to pollens):</strong> runny nose (not really blocked), clear mucus, itchy eyes, lasting for several weeks, mainly in spring (usually no headache, fever or fatigue)</p>\n\n<p><strong>Flu (seasonal influenza):</strong> Headache, high fever, muscle pain and profound fatigue that needs bed rest. Fever usually last for less than a week, mainly in winter (October - March).</p>\n\n<p>Even shorter: common cold = thick, yellow mucus; pollen allergy = thin, clear mucus; flu = headache + fever + fatigue</p>\n\n<p>Sometimes, common cold can present with mild fever and mild headache in which case you may not tell if it is cold or mild flu.</p>\n\n<p>Source: Cold vs Flu <a href=\"http://www.ehealthstar.com/what-is-the-difference-between-cold-and-flu.php\" rel=\"nofollow\">Ehealthstar.com</a></p>\n", "score": 5 } ]

[ "infection", "allergy", "common-cold", "influenza", "nose" ]

[ { "answer_id": 5409, "body": "<p>Burning 3,500 calories equals 1 pound of weight loss. To lose 1 kilogram of body weight, you would need to create a deficit of about 7,700 calories.</p>\n\n<p>As stated above, 3,500 calories equals about 1 pound (0.45 kilogram) of fat, you need to burn 3,500 calories more than you take in to lose 1 pound.</p>\n\n<p>So, in general, if you cut 500 calories from your typical diet each day, you'd lose about 1 pound a week (500 calories x 7 days = 3,500 calories).</p>\n\n<p>Calories burned during exercise is affected by body weight, intensity of workout, conditioning level and metabolism.</p>\n\n<p>References: \n<a href=\"http://www.livestrong.com/article/370797-how-much-weight-in-kilograms-should-you-aim-to-lose-per-week-while-dieting/\" rel=\"noreferrer\">http://www.livestrong.com/article/370797-how-much-weight-in-kilograms-should-you-aim-to-lose-per-week-while-dieting/</a></p>\n\n<p><a href=\"http://www.mayoclinic.org/healthy-lifestyle/weight-loss/basics/weightloss-basics/hlv-20049483\" rel=\"noreferrer\">http://www.mayoclinic.org/healthy-lifestyle/weight-loss/basics/weightloss-basics/hlv-20049483</a></p>\n", "score": 7 } ]

[ "weight-loss", "body-fat", "body-weight" ]

[ { "answer_id": 5455, "body": "<p>I don't see a lot of difference between drinking few sips and 1 cup (8 oz, 237 mL) of water at once.</p>\n\n<p>If you drink a large amount of water at once, for example, 500 mL (2 cups, 16 oz), all this water will be quickly absorbed and will expand the blood volume. Volume receptors in the heart will detect an increase of blood volume and will trigger excretion of some water from the blood through the kidneys before the water could reach the body cells. This way the drinking will be less efficient than drinking smaller amounts, like 1 cup at the time.</p>\n\n<p>This can be true even when you are dehydrated and you, for example, miss 2 liters of water in your body (you can know that by weighing yourself). When you drink 1 liter of water at once (still only the half of the amount you miss) you may observe that you will need to urinate shortly after that (because of mechanism described above). If you drink smaller amounts, like 1 cup (237 mL) at the time, for example, 30 min apart, you have a better chance to keep a greater percent of water in your body.</p>\n\n<p><strong>Water intoxication</strong> is not studied by experiments, from obvious reasons, so the most knowledge about this comes from case reports and newspaper news.</p>\n\n<p>According to one report, a woman who was on a low-calorie and hence low-sodium diet for about a week, drank 4 liters of water in 2 hours and later died in hospital from water intoxication (hyponatremia).\n<a href=\"http://news.bbc.co.uk/2/hi/uk_news/england/bradford/7779079.stm\" rel=\"noreferrer\">http://news.bbc.co.uk/2/hi/uk_news/england/bradford/7779079.stm</a>\nThis is the lowest amount to cause water intoxication in adults, I've heard of.</p>\n\n<p>One US military source recommends drinking only up to 1.4 liters of water per hour, when you drink it for several hours in a row.\n<a href=\"http://hprc-online.org/nutrition/files/current-u-s-military-fluid-replacement\" rel=\"noreferrer\">http://hprc-online.org/nutrition/files/current-u-s-military-fluid-replacement</a> </p>\n\n<p>More cases of water intoxication:\n<a href=\"http://www.ehealthstar.com/conditions/water-intoxication\" rel=\"noreferrer\">http://www.ehealthstar.com/conditions/water-intoxication</a></p>\n", "score": 12 }, { "answer_id": 5435, "body": "<p>The rapid ingestion of ice cold water can cause <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/10208334\" rel=\"nofollow\">death or syncope</a> so it would seem sensible to drink those more slowly. If there are no neuromuscular issues that might cause inhalation of the water, then for most people drinking slowly or quickly is a matter of preference. However, Contrary to your last list item, uncontrolled drinking can cause water intoxication which can lead to <a href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1770067/\" rel=\"nofollow\">death</a>.</p>\n", "score": 0 } ]

[ "water", "hydration", "swallow-swallowing", "drinks", "absorption-absorb" ]

[ { "answer_id": 17738, "body": "<p>To answer your question, we will look at the physiological process of Starvation, conversion of food as energy and how the human body uses that energy.</p>\n<p><strong>Conversion of food/Digestion</strong></p>\n<p>Digestion of food starts in the mouth where our enzymes in our saliva start breaking down starch. Food is mainly digested by acid and other enzymes in the stomach to further break down food to a more absorbable form and finally absorbed in the intestines. This is with an exemption to fat which can be only absorbed with the presence of bile for fat emulsification in the duodenum (the part where bile ducts enter the 1st part of small intestine). Nutrients absorbed from food can be classified into Fat, Glucose/Sugar, Proteins, Vitamins, Minerals, and Electrolytes. In this context, we will focus on Fat, Sugar, and Proteins which makes up food calories we eat that are used as energy. -excerpt from <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622968/?page=1\" rel=\"nofollow noreferrer\">The Physiology of Digestion</a></p>\n<hr />\n<p><strong>Physiology of Starvation</strong></p>\n<p>Our bodies maintain a particular level of glucose in the blood to maintain normal biological processes. That level varies from an individual but there is a <a href=\"https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html\" rel=\"nofollow noreferrer\">normal range</a>.</p>\n<blockquote>\n<p>The blood-glucose level is kept at or above 80 mg/dl by three major factors: (1) the mobilization of glycogen and the release of glucose by the liver, (2) the release of fatty acids by adipose tissue, and (3) the shift in the fuel used from glucose to fatty acids by muscle and the liver. - <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK22414/\" rel=\"nofollow noreferrer\">Biochemistry, 5th edition: Jeremy M Berg, John L Tymoczko, and Lubert Stryer</a></p>\n</blockquote>\n<hr />\n<p><strong>Energy metabolism during Starvation</strong></p>\n<blockquote>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/books/NBK22436/\" rel=\"nofollow noreferrer\">Each Organ Has a Unique Metabolic Profile</a></p>\n<p>Brain. Glucose is virtually the sole fuel for the human brain, except during prolonged starvation.</p>\n<p>Fatty acids do not serve as fuel for the brain, because they are bound to albumin in plasma and so do not traverse the blood-brain barrier. In starvation, ketone bodies generated by the liver partly replace glucose as fuel for the brain.</p>\n</blockquote>\n<p>Prolonged starvation can cause increased amounts of ketones in the body to maintain normal brain functioning. There has been a <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219306/\" rel=\"nofollow noreferrer\">study that giving ketones have improved brain functioning in patients with traumatic brain injuries.</a> Another <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874681/\" rel=\"nofollow noreferrer\">study claims\nthat ketone bodies play a neuroprotective role during starvation.</a></p>\n<hr />\n<h2>P.S.</h2>\n<p>I have looked into the description of the book you've read (<em>&quot;Unbroken is a testament to the resilience of the human mind, body, and spirit.&quot;</em>). The answer seems to be <em>&quot;will&quot;</em> or <em>&quot;spirit&quot;</em>. Or it could just be ketones.</p>\n<p>Common misnomer with <a href=\"https://en.wikipedia.org/wiki/Ketosis\" rel=\"nofollow noreferrer\">ketosis</a>, <a href=\"https://wikem.org/wiki/Starvation_ketoacidosis\" rel=\"nofollow noreferrer\">starvation ketoacidosis</a> and <a href=\"https://en.wikipedia.org/wiki/Diabetic_ketoacidosis\" rel=\"nofollow noreferrer\">diabetic ketoacidosis</a> which have very different outcomes.</p>\n", "score": 3 } ]

[ "nutrition", "diet", "memory" ]

[ { "answer_id": 5900, "body": "<p>Usually on health SE the question about specific steps and/or medication to help you would be closed as personal medical advice question, and you would be prompted to ask a medical professional's help. But, since you have given a detailed explanation why you don't think it would work for you, I hope this answer will help you and other who have a similar question in refuting the arguments you gave.</p>\n\n<p>In short, <strong>a therapist can help you with the issues you described and here is why</strong>:</p>\n\n<p>Working with a therapist to resolve shyness, social anxiety or anything else that might be the problem isn't about your interaction with the professional as a new person and practicing on them in a safe environment. It is about finding the root of the problem and finding ways to solve or mitigate it by methods that the practitioner has been trained to use. It might seem like an ordinary conversation/social interaction, but it is not, and a layperson cannot do it instead of a therapist.</p>\n\n<p>Among many techniques that exist, a well-known one is <strong>cognitive behavioural therapy</strong> also known as <strong>CBT</strong>. Whether this is the right one for you, I can't say over the internet, but a therapist who sees you in person can.</p>\n\n<p>From <a href=\"http://www.nhs.uk/conditions/Cognitive-behavioural-therapy/Pages/Introduction.aspx\" rel=\"nofollow\">NHS</a>:</p>\n\n<blockquote>\n <p>[CBT] is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle. CBT aims to help you crack this cycle by breaking down overwhelming problems into smaller parts and showing you how to change these negative patterns to improve the way you feel.</p>\n</blockquote>\n\n<p>Based on your description this seems like something you are looking for. </p>\n\n<p>You asked about a pill or a supplement. There have been studies with those as well, but <em><a href=\"https://books.google.rs/books?id=pUSG1BONmekC&amp;dq=Controlled+studies+have+shown+that+cognitive+behavioral+treatment+is+equally+or+more+efficacious,+particularly+at+long-term+.&amp;source=gbs_navlinks_s\" rel=\"nofollow\">The Corsini Encyclopedia of Psychology, Volume 4</a></em> by Irving B. Weiner, W. Edward Craighead states that: </p>\n\n<blockquote>\n <p>Controlled studies have shown that cognitive behavioral treatment is equally or more efficacious, particularly at long-term follow up.</p>\n</blockquote>\n\n<p>If your opinion that you need medication or supplements persists, you would still need to get a prescription or at leas a recommendation from a therapist, so if you already go to see one, why not try a pharma-free option first? If need be, your therapist can always add the medication.</p>\n\n<p>I should mention that there are self-help options, primarily books on the market, but while they might offer valuable advice they can't monitor your progress and adjust the advice and methods accordingly, while a therapist can and this is exactly what they do. A form of middle-ground might be computerised CBT. If you opt for therapy in person (the best option IMO) you can choose between group and individual therapy. Sometimes it might take a while to find a form of therapy or a therapist that suits you (people are different) the key is to be persistent and not to give up. Best of luck! </p>\n\n<hr>\n\n<p>_{<a href=\"https://books.google.rs/books?id=pUSG1BONmekC&amp;dq=Controlled+studies+have+shown+that+cognitive+behavioral+treatment+is+equally+or+more+efficacious,+particularly+at+long-term+.&amp;source=gbs_navlinks_s\" rel=\"nofollow\">The Corsini Encyclopedia of Psychology, Volume 4</a>, Irving B. Weiner, W. Edward Craighead John Wiley &amp; Sons, 2010}</p>\n\n<p>_{<a href=\"http://www.nhs.uk/Conditions/Cognitive-behavioural-therapy/Pages/Introduction.aspx\" rel=\"nofollow\">Cognitive behavioural therapy (CBT) at NHS</a>}</p>\n\n<p>_{<a href=\"http://www.apa.org/helpcenter/shyness.aspx\" rel=\"nofollow\">Painful Shyness in Children and Adults</a> by American Psychological Association}</p>\n\n<p>_{<a href=\"http://www.scielo.br/scielo.php?pid=S0101-81082009000300007&amp;script=sci_arttext&amp;tlng=en\" rel=\"nofollow\">Effectiveness of cognitive-behavioral therapy in social anxiety disorder</a> Sara Costa Cabral MululoI; Gabriela Bezerra de MenezesII; Leonardo FontenelleIII, Marcio VersianiIV, Rev. psiquiatr. Rio Gd. Sul vol.31 no.3 Porto Alegre Sept./Dec. 2009}</p>\n", "score": 4 }, { "answer_id": 5927, "body": "<p>Person with social anxiety here.<br>\nI want to share some personal experience with you. Most of the symptoms you described (both mental and physical) are familiar to my own.</p>\n\n<p><strong>Get help</strong><br>\nFirst, I totally agree with Lucky. Seeing a therapist/psychologist is in my honest opinion the best thing to do. This person can help in the form of giving exercises, advice or just listening to you. It doesn't matter that you can get used to him/her. That comfort might help you to talk more openly and get to the source of your problem. Your age is not important IMHO. The people in my therapy group ranged from age 20 to 65.</p>\n\n<p><strong>Work on your emotions, don't suppress them</strong><br>\nI think using supplements/pills should be a last resort. Those might help you in the moment but are not a long time solution. Try training to control your emotions and get help doing so. This is much more fulfilling and helpful. Using something like a pill to gain that control seems a bit like suppressing to me. I'm certainly not a therapist/psychologist but I believe you should learn to handle the emotions you're experiencing properly. It takes some work and time, and it might not be easy but it's worth it. You will start noticing that you converse with more and more ease overtime. This will also help you regain confidence because it will be something you achieved yourself. Supplement and pills will not address any underlying problems you might have. They will continue to exist and you will only treat the symptoms.<br>\nBut then again, I'm not a professional so get the opinion of an expert on this matter.</p>\n\n<p>I had group therapy and occasionally spoke with a psychologist. Together we came to the source of my social anxiety and started to work on it. A year later (after a year of therapy), I still have some anxious moments now and then but they are less intense and don't last that long anymore. My point is that, while therapy takes more work, it outweighs the 'quick fix' that pills and supplements offer by far.<br>\nI hope this helps and the best of luck.</p>\n", "score": 4 } ]

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

[ { "answer_id": 17867, "body": "<p>Although the etiology is unknown, we have a bit of an idea of its pathophysiology</p>\n\n<blockquote>\n <p>Etiology of RA is unknown. Although the impact of genetic factors is obvious, the genetic basis is not sufficient to explain the triggering of the immune insult. - <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/15098367\" rel=\"nofollow noreferrer\">pubmed - ncbi</a> </p>\n</blockquote>\n\n<p></p>\n\n<p>As you have mentioned, the circadian rhythm of cytokines has something to do with the classical pattern of \"morning stiffness\".</p>\n\n<blockquote>\n <p>...inflammatory cytokines, which reach peak secretion early in the morning are major players causing the morning stiffness - <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034483/\" rel=\"nofollow noreferrer\">PMC - ncbi</a></p>\n</blockquote>\n\n<p>The claim of pain relief with joint movement/activity is yet to be explained but there is a study wherein exercise in patients with rheumatoid arthritis is beneficial in terms of muscle strength improvement. <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042669/\" rel=\"nofollow noreferrer\">(Benefits of Exercise in Rheumatoid Arthritis -ncbi)</a></p>\n", "score": 3 } ]

[ "musculoskeletal-system", "inflammation", "lupus", "arthritis", "time-of-day" ]

[ { "answer_id": 7599, "body": "<p>Studies have linked oversleeping with </p>\n\n<ul>\n<li>Cognitive impairment</li>\n<li>Depression</li>\n<li>Increased inflammation</li>\n<li>Increased pain</li>\n<li>Impaired fertility</li>\n<li>Higher risk of obesity</li>\n<li>Higher risk of diabetes</li>\n<li>Higher risk of heart disease</li>\n<li>Higher risk of stroke</li>\n<li>Higher all-cause mortality</li>\n</ul>\n\n<p>You can find the detailed article here: <a href=\"http://www.webmd.com/sleep-disorders/guide/physical-side-effects-oversleeping#1\" rel=\"noreferrer\">http://www.webmd.com/sleep-disorders/guide/physical-side-effects-oversleeping#1</a></p>\n", "score": 6 } ]

[ "sleep", "lifestyle", "sleep-cycles", "fatigue", "physiology" ]

[ { "answer_id": 14624, "body": "<p><strong>Autism spectrum disorder (ASD)</strong> manifests in early childhood and is characterised by <em>qualitative abnormalities in social interactions, markedly aberrant communication skills,</em> and <em>restricted repetitive behaviours, interests, and activities (RRBs).</em> It is primarily considered a childhood disorder; however, it is <strong><em>not necessarily a childhood disorder</em></strong>. Autistic spectrum disorders <strong><em>can be and should be diagnosed even in adults</em></strong>, and there are always benefits of diagnosing them rather than not doing so. <strong><a href=\"http://www.autism.org.uk/about/diagnosis/adults.aspx\" rel=\"nofollow noreferrer\">The National Autistic Society of the United Kingdom</a></strong> declare, in their official website, the following information regarding the benefits of a formal diagnosis for adults:</p>\n\n<blockquote>\n <p><strong>Benefits of a diagnosis</strong></p>\n \n <p>Some people see a formal diagnosis as an unhelpful label, but for\n many, getting a timely and thorough assessment and diagnosis may be\n helpful because:</p>\n \n <ol>\n <li><p>it may help you (and your family, partner, employer, colleagues and friends) to understand why you may experience certain difficulties and\n what you can do about them.</p></li>\n <li><p>it may correct a previous misdiagnosis (such as schizophrenia), and mean that any mental health problems can be better addressed (however,\n it can be difficult to make a diagnosis of autism where there are\n severe mental health issues, or where someone is receiving treatment).</p></li>\n <li><p>it may help you to get access to appropriate services and benefits your employer will be required to make any necessary reasonable\n adjustments.</p></li>\n <li><p>it may help women, and those with a demand avoidant profile, who may not before have been recognised as autistic by others you can join\n the autism community – you don't need to be diagnosed to join our\n online community or subscribe to our Asperger United magazine, but you\n might need a diagnosis to join some social groups.</p></li>\n </ol>\n</blockquote>\n\n<p><strong>Your question</strong> provides some important information as you describe your case with the following words:</p>\n\n<blockquote>\n <p>… someone who has a reasonably good job and who copes easily with\n day-to-day tasks of living (cooking, cleaning, travelling etc) but who\n has no friends (or very few), very little social life, and is very\n reticent about engaging in conversation beyond basic pleasantries and\n technical work conversations with colleagues …</p>\n</blockquote>\n\n<p>The person described above <em>has reasonably good job and copes easily with day-to-day tasks of living (cooking, cleaning, travelling etc)</em> <strong>despite having</strong> features that may lead to a diagnosis of autistic spectrum disorder. Should such a person in his adult life look for a formal diagnosis? <strong>The National Autistic Society</strong> has already answered the question: </p>\n\n<blockquote>\n <p>It’s quite common for people to have gone through life without an autism diagnosis, feeling that somehow they don't quite fit in. Many people learn to cope with life in their own ways, although this can be hard work. They might be married or living with a partner, have families or successful careers. Others may be more isolated and find things much more of a struggle. </p>\n \n <p>It is up to you whether you decide to seek a diagnosis and some people are happy to remain self-diagnosed. The only way to know for sure whether you are autistic is to get a formal diagnosis.</p>\n</blockquote>\n\n<p><strong><em>On the information we have discussed above, I shall suggest that the person concerned seek a formal diagnosis, if he has not already been diagnosed, and receive the help that would surely improve the quality of his life with regard to social and interpersonal interactions.</em></strong> </p>\n\n<p>Autism in adults shall be an important health related issue; accordingly, the <strong>National Institute for Health and Care Excellence (NICE)</strong> has published its guideline on autism in adults: <strong><em><a href=\"https://www.nice.org.uk/guidance/cg142\" rel=\"nofollow noreferrer\">Autism spectrum disorder in adults: diagnosis and management</a></em></strong> in June 2012, and it was last updated in August 2016. The <strong>National Health Service of the United Kingdom (NHS)</strong> follows the NICE guideline to ensure that the diagnosis and management of Autism Spectrum Disorder in adults is carried out in a regular and consistent manner across the country. Moreover, the <strong>Department of Health</strong> also issued its statutory guideline: <strong><em><a href=\"https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/422338/autism-guidance.pdf\" rel=\"nofollow noreferrer\">Statutory guidance for Local Authorities and NHS organisations to support implementation of the Adult Autism Strategy</a></em></strong> in March 2015 in that mission.<strong><em>There is always help for people in need.</em></strong> </p>\n", "score": 4 }, { "answer_id": 14630, "body": "<p>There are many reasons as to why an individual might seek a formal diagnosis of Autism or Asperger’s Syndrome (AS). For some, it may increase self-awareness to some degree for the sake of possibly capitalizing on one's strengths and managing areas of challenge. For others who qualify, an individual may seek a diagnosis to obtain additional means of support. In order to qualify for disability benefits under most US government financial assistance programs, a formal diagnosis is also required.</p>\n\n<p>The <a href=\"https://www.ssa.gov/pubs/EN-05-10029.pdf\" rel=\"nofollow noreferrer\">Social Security disability</a> insurance program pays benefits to disabled individuals and certain family members if the individual has worked long enough and has paid Social Security taxes. The <a href=\"https://www.ssa.gov/pubs/EN-05-11000.pdf\" rel=\"nofollow noreferrer\">Supplemental Security Income (SSI)</a> program pays benefits to disabled adults and children who have limited income and resources. For more information about the Social Security disability evaluation process, see: ‘<a href=\"https://www.ssa.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm\" rel=\"nofollow noreferrer\">Disability Evaluation Under Social Security, 12.00 Mental Disorders - Adult</a>' and ’<a href=\"https://www.ssa.gov/planners/disability/dqualify5.html\" rel=\"nofollow noreferrer\">Disability Planner: How We Decide If You Are Disabled</a>'. Additionally, under the <a href=\"https://www.ada.gov/\" rel=\"nofollow noreferrer\">Americans with Disabilities Act (ADA)</a>, a diagnosis is necessary in order to request reasonable accommodations for individuals seeking employment. A publication by the U.S. Equal Employment Opportunity Commission titled, ‘<a href=\"https://www.eeoc.gov/eeoc/publications/fs-ada.cfm\" rel=\"nofollow noreferrer\">Facts about the Americans with Disability Act</a>,’ elaborates:</p>\n\n<blockquote>\n <p>Title I of the Americans with Disabilities Act of 1990 prohibits private employers, state and local governments, employment agencies and labor unions from discriminating against qualified individuals with disabilities in job application procedures, hiring, firing, advancement, compensation, job training, and other terms, conditions, and privileges of employment. The ADA covers employers with 15 or more employees, including state and local governments. It also applies to employment agencies and to labor organizations. The ADA's nondiscrimination standards also apply to federal sector employees under section 501 of the Rehabilitation Act, as amended, and its implementing rules.</p>\n</blockquote>\n\n<p>The same publication also states a relevant piece of information to take note of regarding the provision of reasonable employment accommodations for disabled individuals.</p>\n\n<blockquote>\n <p>An employer generally does not have to provide a reasonable accommodation unless an individual with a disability <em>has asked for one</em>.</p>\n</blockquote>\n\n<p>AS is now widely believed to be among a group of conditions associated with Autistic Spectrum Disorder (ASD). The National Institute of Neurological Disorders and Stroke's '<a href=\"https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Autism-Spectrum-Disorder-Fact-Sheet\" rel=\"nofollow noreferrer\">Autism Spectrum Disorder Fact Sheet</a>,' elaborates,</p>\n\n<blockquote>\n <p>The term “spectrum” refers to the wide range of symptoms, skills, and levels of disability in functioning that can occur in people with ASD. Some children and adults with ASD are fully able to perform all activities of daily living while others require substantial support to perform basic activities. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5, published in 2013) <strong>includes Asperger syndrome</strong>, childhood disintegrative disorder, and pervasive developmental disorders not otherwise specified (PDD-NOS) as part of ASD rather than as separate disorders. A diagnosis of ASD includes an assessment of intellectual disability and language impairment. </p>\n</blockquote>\n\n<p>By the same token, a test called the <strong>Autism Spectrum Quotient (AQ)</strong>, created by <a href=\"https://www.autismresearchcentre.com/people_baron-cohen\" rel=\"nofollow noreferrer\">Simon Baron-Cohen</a>, Professor of Developmental Psychopathy at the University of Cambridge was developed to measure the degree to which an adult with normal intelligence has autistic traits.</p>\n\n<p>The <a href=\"https://www.autismresearchcentre.com/project_7_asquotient\" rel=\"nofollow noreferrer\">Autism Research Centre</a>, provides further details on the Adult AQ (Autism Spectrum Quotient).</p>\n\n<blockquote>\n <p>Our studies have shown that people with a clinical diagnosis tend to score above 32 out of 50 on the AQ, first-degree relatives tend to score higher than average on the AQ, males in the general population tend to score higher than females, and scientists tend to score higher than non-scientists on the AQ. We have also found the AQ shows heritability (from twin studies) and cross-cultural stability, and that it predicts clinical diagnosis. </p>\n</blockquote>\n\n<p>Moreover, The Autism Research Centre also recognizes that at best, the AQ is</p>\n\n<blockquote>\n <p>…a screening instrument - it is not itself diagnostic.</p>\n</blockquote>\n\n<p>An article titled ‘<a href=\"http://docs.autismresearchcentre.com/papers/2005_Woodbury-Smith_etal_ScreeningAdultsForAS.pdf\" rel=\"nofollow noreferrer\">Screening Adults for Asperger Syndrome Using the AQ: A Preliminary Study of its Diagnostic Validity in Clinical Practice</a>,’ evaluates the AQ for its potential as a screening questionnaire in clinical practice on one hundred consecutive referrals to a diagnostic clinic for adults suspected of having AS or high functioning autism (AS/HFA). </p>\n\n<blockquote>\n <p>We believe our results support the AQ as a useful screening instrument in clinical practice. It provides a quick and reliable method of determining the likelihood of any individual falling on the higher functioning end of the autistic spectrum and warranting further, more detailed, assessment.</p>\n</blockquote>\n\n<p>However, there may be a percentage of individuals who potentially possess many autistic traits but who do not require any clinical support and thus, do not seek diagnosis…</p>\n\n<blockquote>\n <p>…because of a good cognitive match between their cognitive style or personality, and their family or occupational or social context. In this sense, <strong>whether a high AQ score becomes disabling may depend on environmental factors (tolerance by significant others, or being valued for contribution at work, or a place in a social network, protecting against the risks of secondary depression) rather than solely on factors within the individual</strong>. </p>\n</blockquote>\n\n<p>Also, there is increasing evidence that by diagnosing even relatively late</p>\n\n<blockquote>\n <p>…much can still be done to effectively manage the social impairments and facilitate better social inclusion.</p>\n</blockquote>\n\n<p>In conclusion, results of the same study indicate that the AQ test</p>\n\n<blockquote>\n <p>…has a good discriminative validity and good screening properties at a threshold score of 26.</p>\n</blockquote>\n\n<p>In lieu of the information provided, an Asperger/Autism Network (AANE) article titled, ‘<a href=\"http://www.aane.org/resources/adults/aspergerautism-spectrum-diagnosis-adults/\" rel=\"nofollow noreferrer\">Asperger/Autism Spectrum Diagnosis in Adults</a>,’ advises individuals to </p>\n\n<blockquote>\n <p>Keep in mind that the Asperger/Autism Spectrum diagnosis is not an absolute and fixed category of traits and characteristics. Everyone with this profile looks different and therefore the boundaries around this characterization can be challenging to define.</p>\n</blockquote>\n\n<p>While most individuals with AS can be affected by some common traits, the intensity of each trait lies along a spectrum. Hence, the extent to which AS shapes a person’s life and experiences can vary greatly from person to person. With that being said, it is highly advisable that the individual in question consults his or her primary care physician or qualified specialist for a thorough assessment, testing, diagnosis, and treatment, if needed. </p>\n", "score": 2 }, { "answer_id": 14640, "body": "<p>Two nice answers already, but both marching into the same direction. To round off the picture, this is the advocatus diaboli:</p>\n<p>While the existence of a diagnosis in general demands its application onto some individuals, some of those might indeed benefit from receiving such a diagnosis.</p>\n<blockquote>\n<p><a href=\"http://www.sciencedirect.com/science/article/pii/S0010440X04000197\" rel=\"nofollow noreferrer\"><strong>Asperger’s disorder: A review of its diagnosis and treatment:</strong></a>\nAlthough Asperger’s disorder has a preschool age of onset, it is important to tailor treatment based on the patient’s age. Parents of children with the condition become generally aware of problems in their child’s development around 30 months of age; however, they may experience significantly longer delays and greater frustration in obtaining a confirmation of diagnosis from clinicians. The practical implications of delayed diagnosis may affect adversely the prognosis in the case of the more able children with Asperger’s disorder. […]<br>\nIn the adult years, patients with Asperger’s disorder may experience increased anxiety due to stresses associated with independence and vocational demands. Educational and behavioral inclinations can be aimed at problem-solving strategies, self-understanding strategies, and management of anxiety and other comorbidity. […] <br>\nFrom the conclusion: Awareness of Asperger’s disorder’s distinctive clinical features and understanding of its historical background, epidemiology, and course, could eventually lead to more effective evaluation and management of these patients. Although the validity and usefulness of an Asperger’s disorder-specific diagnostic concept is far from resolved, it is our hope that this review will assist clinicians in evaluating and managing patients with this lifelong disorder and subsequently improve their long-term prognosis.</p>\n</blockquote>\n<p>That means that the criteria for diagnosis are far from perfected and since it was already correctly noted, these imprecisions are on a spectrum with increasing difficulties to establish valid diagnostic criteria at the extreme ends of this spectrum. It is further complicated by the research focus being mainly on childhood problems and treatment. Adult Asperger's is far less researched and conclusions might be clouded by simply transposing findings from childhood Asperger's onto Adults.</p>\n<p>So, are there really &quot;benefits&quot; from being diagnosed AS as an adult? There sure are some! But benefits often come with a cost. These have to be considered in an informed decision making process.</p>\n<blockquote>\n<p><a href=\"https://link.springer.com/article/10.1007%2Fs10803-005-3300-7?LI=true\" rel=\"nofollow noreferrer\"><strong>Screening Adults for Asperger Syndrome Using the AQ: A Preliminary Study of its Diagnostic Validity in Clinical Practice:</strong></a></p>\n<p>With <strong>increasing demands on clinical services to assess for the possibility of Asperger Syndrome,</strong> as demonstrated by the large number of referrals currently received at our clinic in Cambridge, it is important to be able to identify those people who are most likely to have AS. We believe our results support the AQ as a useful screening instrument in clinical practice. It provides a quick and reliable method of determining the likelihood of any individual falling on the higher functioning end of the autistic spectrum and warranting further, more detailed, assessment. We suggest that a more conservative threshold score of 26 would ensure that false negatives are limited, and equally avoid cases ‘slipping through the net’.<br>\nHowever, if the AQ were being used in a general population screen (and the ethical case for such a use has yet to be demonstrated) the higher cut off of 32 is likely to minimise false positives. <strong>We suspect that this is because in the general population there may be a percentage of individuals who have many autistic traits but who do not require any clinical support (and are not seeking this) because of a good cognitive match between their cognitive style or personality, and their family or occupational or social context</strong> (Baron-Cohen, 2003). <strong>In this sense, whether a high AQ score becomes disabling may depend on environmental factors (tolerance by significant others, or being valued for contribution at work, or a place in a social network, protecting against the risks of secondary depression) rather than solely on factors within the individual. This impression warrants systematic research.</strong><br>\nOf importance is that seventy-five percent of the patients seen in the clinic had been referred by their general practitioner. This figure represents all suspected cases referred by primary care practitioners as no one was excluded simply based on their AQ score.<br>\nTherefore our results are also relevant in the primary care setting where, as a result of increasing awareness of autistic spectrum conditions, there is likely to be an increase in the numbers of patients seeking assessment. The GP has the difficult task of deciding who should be referred on for in-depth assessment. We believe the AQ will facilitate this process, and is particularly useful in this setting as it is a relatively quick and easy to use screening instrument. There is increasing evidence that by diagnosing even relatively late much can still be done to effectively manage the social impairments and facilitate better social inclusion.</p>\n</blockquote>\n<p>That seems to indicate a certain 'trend' seen in clinical settings: with increasing awareness of the existence of this 'syndrome' or 'situation' or 'condition'. This is not to say it is a fad or fashionable label to attach to someone or her behaviour. But some psychological or psychiatric diagnosis approaches clearly fell out of fashion some time ago. Recently few women were diagnosed with hysteria and officially even fewer people are now 'treated' for being homosexuals.</p>\n<blockquote>\n<p><a href=\"http://www.tandfonline.com/doi/full/10.1080/09687590903534254\" rel=\"nofollow noreferrer\"><strong>‘How can a chord be weird if it expresses your soul?’ Some critical reflections on the diagnosis of Aspergers syndrome:</strong></a>\nThis paper questions the way in which the diagnosis of Aspergers syndrome has come to be widely accepted and used as an essentially medical category. It does so by drawing upon sociological and historical analyses of society, psychiatry and psychology, as well as the writings of service users, other practitioners in the autistic spectrum disorder field and the author’s own clinical experience. It is argued that the seeming popularity of this label within Western society may have as much to do with widespread social and cultural change during recent decades as with the supposed deficits of those who attract the diagnosis. The aims are to ask what this might mean for health and social care practice in this field and to encourage the growth of theories and approaches that are grounded more firmly in an awareness of the social environment, while also reflecting the varied experiences and standpoints of people who carry this label.<br>\n<strong>Conclusions</strong>\nAs a worryingly elastic diagnostic label, Aspergers syndrome seems to be capable of extension to a wide range of individuals who might otherwise have little in common save their isolation, their apparent interpersonal awkwardness, their dislike of change and, in a socially and vocationally competitive age, the understandable concern of their families. Of course, it has to be acknowledged that for many the diagnosis has its uses. For those who are able to negotiate the current health and social care systems acquisition of this label may open up pathways towards financial and material assistance and also towards improved personal assistance at school, college or work, all of which may be badly needed and, when made available, may make the person’s world an altogether more benign place. There may also be some advantage to being diagnosed with Aspergers syndrome, where the alternatives might include the more pejorative labels of ‘psychosis’ or ‘schizophrenia’.<br>\nAnd yet this kind of intervention and support can come at a price. Erstwhile helpers can become focused upon imparting narrow psychological or social skills based ‘solutions’ at the expense of seeking a broader understanding of the social and familial roots of the individual’s problems or of trying to challenge conventional ideas of what is normal or natural (Molloy and Vasil 2002). While there are no medical treatments aimed specifically at Aspergers syndrome, the indications of high rates of psychiatric drug prescribing for people in this group is worrying. This is a situation that cannot be altogether unwelcome to drug manufacturers keen to market their wares and the suspicion that autistic spectrum disorders are being widely promoted with an eye to future developments in pharmaceutical technology, or simply as a way of finding an expanded market for currently available products, is not altogether implausible (see, for instance, D. Boyle 2003).<br>\nGiven the doubts about the coherence and validity of the diagnosis, there is the nagging thought that in many, and perhaps most, instances what we are talking about is not so much a clearly demarcated ‘developmental disorder’ as a spectrum of character traits or dispositions that fit poorly with the ethos of our current business and consumer culture. More frequently than is recognised, the ‘problems’ presented by Aspergers syndrome may lie in a world that increasingly struggles to accept any form of difference from the notional norm unless, of course, such difference can be repackaged as a form of deviancy, illness or developmental difficulty, ready and waiting to be ‘managed’ by a set of self-appointed experts.<br>\nPerhaps as health professionals and even as friends and relatives of ‘people with Aspergers syndrome’ we might, in the words of one service user, try to embrace the sentiments expressed by the singer Joni Mitchell, who is reputed to have said in defense of one of her tunes ‘How can a chord be weird if it expresses your soul?’ Such acceptance (and the ability to genuinely listen that implicitly goes with it) would surely not represent anything like a complete answer to the difficult and complex questions that have been raised here, but it might be a good place to start.</p>\n</blockquote>\n<p>To sum it up: if it ain't broke, don't fix it.</p>\n", "score": 2 } ]

[ "benefits", "diagnosis", "autism", "aspergers-syndrome", "social" ]

[ { "answer_id": 7666, "body": "<p><strong>Yes (ish)</strong>, this meta-analysis proved a strong correlation between exposure to pesticides and likelihood of developing Parkinson's. Note, there is no direct X level of exposure leads to Y likelihood, just a strong correlation.</p>\n\n<blockquote>\n <p>\"Although the risk of PD increased with increased duration of exposure\n to pesticides, <strong>no significant dose-response relation was established</strong>,\n and no specific type of pesticide was identified. Our findings suggest\n that exposure to pesticides may be a significant risk factor for\n developing PD\"</p>\n \n <p><em>A meta-analysis of Parkinson's disease and exposure to pesticides.\n Priyadarshi A, Khuder SA, Schaub EA, Shrivastava S. Neurotoxicology.\n 2000 Aug;21(4):435-40.</em></p>\n</blockquote>\n\n<p>A more recent meta-analysis reviewed the aforementioned meta-analysis and while criticising some of the limitations of the study (in particular the heterogeneity of the included trials) concluded:</p>\n\n<blockquote>\n <p>The literature supports the hypothesis that exposure to pesticides or\n solvents is a risk factor for PD. Further prospective and high-quality\n case-control studies are required to substantiate a cause-effect\n relationship. The studies should also focus on specific chemical\n agents.</p>\n \n <p><em>(Pezzoli G et al. Exposure to pesticides or solvents and risk of\n Parkinson disease. Neurology. 2013 May 28;80(22):2035-41. doi: 10.1212/WNL.0b013e318294b3c8.)</em> </p>\n</blockquote>\n", "score": 7 }, { "answer_id": 18711, "body": "<p>Not directly about pesticides but I have years ago read that Parkinson's is post-Industrial Revolution disease -- that is, it started to be observed once coal started to be used in large quantities for powering industrial furnaces and engines. One could argue that the increase in life span that occurred at around the same time might be responsible for cases being observed then or simply that doctors only began to diagnose it around then but firstly, people have throughout history lived into old age and secondly, it is very plausible (to me, anyway) that anything that is neurotoxic, including particulates in coal smoke/mercury liberated by burning of coal, contributes to many neurological diseases including Parkinson's. Of course, many insecticides by design are neurotoxic to insects and were based on nerve gases developed for use on humans.</p>\n\n<p>EDIT: <a href=\"https://www.loe.org/shows/segments.html?programID=97-P13-00033&amp;segmentID=1\" rel=\"nofollow noreferrer\">https://www.loe.org/shows/segments.html?programID=97-P13-00033&amp;segmentID=1</a>\n<a href=\"https://www.poison.org/articles/2010-jun/pesticide-and-nerve-agent-commonality\" rel=\"nofollow noreferrer\">https://www.poison.org/articles/2010-jun/pesticide-and-nerve-agent-commonality</a></p>\n", "score": 1 } ]

[ "neurology", "prevention", "dementia", "parkinson" ]

[ { "answer_id": 8828, "body": "<p>When drinking alcohol, the small water-soluble ethanol enters the bloodstream and moves around till it reaches the brain. Since it is a small molecule, it enters the blood-brain barrier and passes between brain cells (neurons) interfering with the neurotransmitters of the nervous system.\nEthanol causes the release of Dopamine (Happiness Hormone) and stops Glutamate (a neurotransmitter that normally excites neurons) and this makes the brain slower and the person calmer and sleepy.</p>\n\n<p>References and for more details:\n<a href=\"http://www.drinkingandyou.com/site/uk/xdrunk.htm\" rel=\"nofollow\">http://www.drinkingandyou.com/site/uk/xdrunk.htm</a>\n<a href=\"http://health.howstuffworks.com/wellness/drugs-alcohol/how-alcohol-makes-drunk.htm\" rel=\"nofollow\">http://health.howstuffworks.com/wellness/drugs-alcohol/how-alcohol-makes-drunk.htm</a></p>\n", "score": 3 } ]

[ "brain", "alcohol" ]

[ { "answer_id": 8921, "body": "<p>First generation H1-antihistamines (such as diphenhydramine = Benadryl) are well known for their sedative effects explaining their limited use in patients with allergic rhinitis. Several pharmacological studies have shown that diphenhydramine crosses the blood brain barrier and produces CNS sedation.</p>\n\n<p>Two studies have (partly) addressed your question regarding the loss in sedation efficacy over time. Both studies focused on daytime sleepiness (as this one of the side effects which prevents prescription of diphenhydramine in patients with allergic rhinitis) but the mechanisms of tolerance can probably be extended to diphenhydramine use against insomnia.</p>\n\n<ul>\n<li>In the first study, participants receiving dimenhydrinate (an\nethanolamine antihistamine that is metabolized to diphenhydramine and\nchlorotheophylline) were asked to assess their sleepiness while in\nparallel, psychomotor performance tests where conducted. <strong>Results\nshowed a modest attenuation of subjective sedation and performance\nimpairment after successive doses during a single day of drug\nexposure.</strong></li>\n<li>In the second study authors conducted a randomised double blind\nplacebo controlled crossover study in 15 individuals. <strong>Here again, a\ntolerance to the drug was observe</strong>d: sedative effects which were\nevident on the first day became indistinguishable from placebo by the\nend of 3 days of treatment.</li>\n</ul>\n\n<p>Three possible mechanisms for the tolerance to diphenhydramine were suggested in the literature: behavioural adaptation (only if diphenhydramine was taken during the day for allergic rhinitis); (2) altered drug metabolism, e.g., increased clearance; or (3) altered neuropharmacological effect.</p>\n\n<p><strong>So according to current knowledge, there is evidence for tolerance of diphenhydramine over time.</strong></p>\n\n<p>Sources:</p>\n\n<ul>\n<li>Richardson G et al. Tolerance to Daytime Sedative Effects of H1\nAntihistamines. Journal of Clinical Psychopharmacology.\n22(5):511-515, October 2002.</li>\n<li>Manning C et al. Central nervous system effects of meclizine and\ndimenhydrinate: evidence of acute tolerance to antihistamines. J Clin\nPharmacol 1992; 32:996–1002.</li>\n</ul>\n", "score": 11 } ]

[ "medications", "sleep", "sleep-aids", "drug-tolerance", "antihistamines" ]

[ { "answer_id": 18858, "body": "<p>The information you provided </p>\n\n<blockquote>\n <p><em>Right lens</em> Sph -0,50 Cyl -0,50 axis 10<br>\n <em>Left Lens</em> Sph -0,50 Cyl -0,50 axis 170<br>\n <em>Type</em> CR39 SN ARC</p>\n</blockquote>\n\n<p>is a little bit clearer than you can sometimes see.</p>\n\n<p>When you look at your prescription for eyeglasses, you can sometimes see numbers listed <a href=\"https://www.webmd.com/eye-health/how-read-eye-glass-prescription\" rel=\"nofollow noreferrer\">under the prefixes of OS and OD, or OU</a>. They are Latin abbreviations:</p>\n\n<ul>\n<li><strong>OS (oculus sinister)</strong><br>\nmeaning the left eye<br><a href=\"https://www.perfect-eyeglasses-guide.com/eyeglass-prescription.html\" rel=\"nofollow noreferrer\">some prescriptions use LE for Left Eye</a>, <strong>and</strong></li>\n<li><strong>OD (oculus dextrus)</strong><br>\nmeaning the right eye<br><a href=\"https://www.perfect-eyeglasses-guide.com/eyeglass-prescription.html\" rel=\"nofollow noreferrer\">some prescriptions use RE for Right Eye</a></li>\n<li><strong>OU (oculus uterque)</strong><br>\nOccasionally this is used, meaning both eyes <a href=\"http://en.termwiki.com/EN/oculus_uterque_(OU)\" rel=\"nofollow noreferrer\">or literally \"each eye\"</a></li>\n</ul>\n\n<p>You have given 3 numbers (SPH, CYL and Axis) which I will explain below. There are other numbers which may be provided, which I will also go into.</p>\n\n<h2>The first number: Sphere (SPH)</h2>\n\n<p>The further away from zero the number on your prescription is, the worse your eyesight is and therefore the more vision correction (stronger prescription) you need.</p>\n\n<p>A “plus” (+)  sign in front of the number means you are farsighted (<a href=\"https://nei.nih.gov/health/errors/hyperopia\" rel=\"nofollow noreferrer\">hyperopia</a>), and you find it difficult to see things close to you without correction with spectacles or contact lenses.</p>\n\n<p>A “minus” (-) sign means you are nearsighted (<a href=\"https://nei.nih.gov/health/errors/myopia\" rel=\"nofollow noreferrer\">myopia</a>), and you find it difficult to see things far away without correction with spectacles or contact lenses.</p>\n\n<p><a href=\"https://www.webmd.com/eye-health/how-read-eye-glass-prescription\" rel=\"nofollow noreferrer\">These numbers represent diopters</a>, the unit used to measure the correction, or focusing power, of the lens your eye requires, and diopter is often abbreviated \"D.\"</p>\n\n<h2>The second number: Cylinder (CYL)</h2>\n\n<p>This refers to the \"cylinder\" or <a href=\"https://www.webmd.com/eye-health/understanding-astigmatism-basics\" rel=\"nofollow noreferrer\">astigmatism</a>, and can be a negative or a positive number. It measures in diopters the degree of astigmatism that you have. The bigger this number, the more astigmatism you have. Astigmatism is caused by an irregularly shaped cornea, causing visual distortion. The irregular cornea shape can be described as <a href=\"https://www.webmd.com/eye-health/how-read-eye-glass-prescription\" rel=\"nofollow noreferrer\">more like an American football than a basketball</a>.</p>\n\n<h2>The third number: Axis</h2>\n\n<p>It is not enough to specify how much astigmatism there is; you have to know where the difference in curvature is taking place. The Axis is a number anywhere between 0 and 180 degrees, which reveals the orientation of the astigmatism and <a href=\"https://www.specsavers.co.uk/eye-health/eye-test/your-prescription\" rel=\"nofollow noreferrer\">lets the lab know how to position your lenses</a>.</p>\n\n<h2>A fourth number: Prism</h2>\n\n<p>This usually means that your eyes do not work well as a pair. Prism lenses help prevent double vision or headaches.</p>\n\n<h2>A fifth number: Base</h2>\n\n<p>This simply tells the lab where to put the prism.</p>\n\n<h2>A sixth number: Reading Addition (ADD)</h2>\n\n<p>This is for varifocal or bifocal lenses and relates to the additional correction in + needed to correct <a href=\"https://www.mayoclinic.org/diseases-conditions/presbyopia/symptoms-causes/syc-20363328\" rel=\"nofollow noreferrer\">Presbyopia</a> in order to focus at close distances.</p>\n\n<h2>A second number: Pupil Distance (PD)</h2>\n\n<p>Also known as <a href=\"https://www.perfect-eyeglasses-guide.com/eyeglass-prescription.html\" rel=\"nofollow noreferrer\">Interpupillary Distance</a> and if separate numbers are used, they refer to the distance between each pupil and the centre of the bridge of the nose. If one number is given, it is the distance between each pupil.</p>\n\n<h2>The information under <em>Type</em></h2>\n\n<h3>The first part: CR39, Poly, NXT...</h3>\n\n<p>This refers to lens material suggested and dies not have any bearing on your prescription <em>per se</em>.</p>\n\n<p>CR39 is a type of polymer lens, not to be confused with type <em>POLY</em> which is polycarbonate.</p>\n\n<p>For more information on different lens materials used you can go to <a href=\"https://www.eyekit.co/information/lens-options-explained/lens-materials-explained.html\" rel=\"nofollow noreferrer\">this webpage from EyeKit</a> who I am not affiliated to. They are sellers of prescription glasses for sport, leisure and specialist uses, and I do not vouch for the quality of their products.</p>\n\n<h3>The second and third parts: SN and ARC</h3>\n\n<p>I have not yet been able to determine what these refer to, but again, these do not have any bearing on your prescription <em>per se</em>.</p>\n\n<h2>Sources linked</h2>\n\n<p>National Eye Institute - Hyperopia<br><a href=\"https://nei.nih.gov/health/errors/hyperopia\" rel=\"nofollow noreferrer\">https://nei.nih.gov/health/errors/hyperopia</a></p>\n\n<p>National Eye Institute - Myopia<br><a href=\"https://nei.nih.gov/health/errors/myopia\" rel=\"nofollow noreferrer\">https://nei.nih.gov/health/errors/myopia</a></p>\n\n<p>Specsavers - Your prescription explained<br><a href=\"https://www.specsavers.co.uk/eye-health/eye-test/your-prescription\" rel=\"nofollow noreferrer\">https://www.specsavers.co.uk/eye-health/eye-test/your-prescription</a></p>\n\n<p>TermWiki - oculus uterque (OU)<br><a href=\"http://en.termwiki.com/EN/oculus_uterque_(OU)\" rel=\"nofollow noreferrer\">http://en.termwiki.com/EN/oculus_uterque_(OU)</a></p>\n\n<p>WebMD - Presbyopia<br><a href=\"https://www.mayoclinic.org/diseases-conditions/presbyopia/symptoms-causes/syc-20363328\" rel=\"nofollow noreferrer\">https://www.mayoclinic.org/diseases-conditions/presbyopia/symptoms-causes/syc-20363328</a></p>\n\n<p>WebMD - How to Read Your Eyeglass Prescription<br><a href=\"https://www.webmd.com/eye-health/how-read-eye-glass-prescription\" rel=\"nofollow noreferrer\">https://www.webmd.com/eye-health/how-read-eye-glass-prescription</a></p>\n\n<p>WebMD - What Is Astigmatism?<br><a href=\"https://www.webmd.com/eye-health/astigmatism-eyes\" rel=\"nofollow noreferrer\">https://www.webmd.com/eye-health/astigmatism-eyes</a></p>\n", "score": 3 } ]

[ "eye", "optometry", "test-results", "glasses" ]

[ { "answer_id": 9803, "body": "<p>The following studies found that circumcision does have a detrimental impact on penis sensitivity.</p>\n<p>From a <a href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2012.11761.x/full\" rel=\"noreferrer\">2013 study</a> by Bronselaer et al.:</p>\n<blockquote>\n<p>The analysis sample consisted of 1059 uncircumcised and 310 circumcised men.</p>\n<p>For the glans penis, circumcised men reported decreased sexual pleasure and lower orgasm intensity. They also stated more effort was required to achieve orgasm, and a higher percentage of them experienced unusual sensations (burning, prickling, itching, or tingling and numbness of the glans penis).</p>\n<p>For the penile shaft a higher percentage of circumcised men described discomfort and pain, numbness and unusual sensations.</p>\n<p>In comparison to men circumcised before puberty, men circumcised during adolescence or later indicated less sexual pleasure at the glans penis, and a higher percentage of them reported discomfort or pain and unusual sensations at the penile shaft.</p>\n</blockquote>\n<p>From a <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/18481425\" rel=\"noreferrer\">2008 study</a> by Yang et al.:</p>\n<blockquote>\n<p>There is a statistic difference in the glans penis vibration perception threshold between normal men and patients with simple redundant prepuce. The glans penis perception sensitivity decreases after circumcision.</p>\n</blockquote>\n<p>From a <a href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2006.06685.x/full\" rel=\"noreferrer\">2007 study</a> by Sorrells et al.:</p>\n<blockquote>\n<p>The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates the most sensitive parts of the penis.</p>\n</blockquote>\n<p>From a <a href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2006.06646.x/full\" rel=\"noreferrer\">2006 study</a> by Kim et al.:</p>\n<blockquote>\n<p>However, circumcised men were more than three times more likely to report less enjoyable sex lives after circumcision than better sex lives (28 vs eight men). While decreased sensation was the most frequently cited reason (21 of 28 men) for a less enjoyable sex life, complaints about the physical effects of circumcision on their penises and consequent adverse effects on sex life were also prominent (13 of 28; multiple complaints were separately counted).</p>\n<p>In summary, we studied the effects of circumcision on sexuality. There were no differences in sexual drive, erection and ejaculation, but circumcised men reported decreased masturbatory pleasure and sexual enjoyment. We conclude that adult circumcision adversely affects sexual function in a significant number of men, possibly because of loss of nerve endings.</p>\n</blockquote>\n<p>From a <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/11597060\" rel=\"noreferrer\">2001 study</a> by Boyle et al.:</p>\n<blockquote>\n<p>A survey of the 35 female and 42 gay sexual partners of circumcised and genitally intact men, and a separate survey of 53 circumcised and 30 genitally intact men themselves, indicated that circumcised men experienced significantly reduced sexual sensation along with associated long-lasting negative emotional consequences.</p>\n</blockquote>\n", "score": 8 } ]

[ "urology", "penis", "sexuality", "circumcision" ]

[ { "answer_id": 9318, "body": "<p>Your minimum healthy weight is not dependent on city versus outdoors. Your body is not aware the calorie deficit was caused by a hike.</p>\n<p>The body is very good at storing and using fat. That is what body fat is designed to do.</p>\n<p>I am not a Dr. but if you got home without severe symptoms you did not harm yourself. Symptoms of starvation include: diarrhea, anemia, loss of muscle mass. If you went into loss of muscle mass your body would have told you big time and you would have had a very hard time finishing.</p>\n<p>Lose some body fat is the most efficient way to carry calories.</p>\n<p>Even on a medical supervised extreme diets they go up to 1 lb a day.</p>\n<p>Pro fighters move two weight classes and still perform. Look at Connor McGregor at 145 (where I think he still holds the belt). He fought Diaz at 168. Even training for a fight a pro can lose up to 1 lb a day and still train hard.</p>\n<p>For a number you should see a Dr. The Internet cannot tell you that. Even a Dr. is going have a hard time with a number. They will be more interested in symptoms of starvation.</p>\n", "score": 3 } ]

[ "weight-loss" ]

[ { "answer_id": 9362, "body": "<p><em>The literature regarding the use of sex toys in women is sparse.\nI have found two studies, which describe potential side effects related to the use of sex toys in women:</em></p>\n\n<ul>\n<li>Transmission of <strong>sexual transmitted disease</strong> due to the use of uncleaned and shared penetrative sex toys</li>\n<li>Higher prevalence of <strong>bacterial vaginosis</strong></li>\n<li><strong>Vaginal irritation and trauma</strong> in forceful insertion or when lubricants are not used</li>\n<li><strong>Allergies of the vaginal mucosa to the sex toy</strong> (depending on the sex toy's type of material)</li>\n</ul>\n\n<p><strong>Above mentionned side effects can be prevented by thorough cleaning of sex toys (or use of condoms), use of lubricants and selection of the sex toy's material.</strong></p>\n\n<p><em>References:</em></p>\n\n<p>Lee R. Health care problems of lesbian, gay, bisexual, and transgender patients. Western Journal of Medicine. 2000;172(6):403-408.</p>\n\n<p>Marrazzo JM, Coffey P, Bingham A. Sexual Practices, Risk Perception and Knowledge Of Sexually Transmitted Disease Risk Among Lesbian and Bisexual Women. Perspectives on sexual and reproductive health. 2005;37(1):6-12. doi:10.1363/psrh.37.006.05.</p>\n", "score": 8 } ]

[ "sex", "sexuality" ]

[ { "answer_id": 9458, "body": "<p>I guess the best way would be to convince a blind person to take some psilocybin mushrooms or LSD. Perhaps they would actually see some fractals and stuff, since those visions are generated in the corresponding areas of the brain. Even if not, then the blind person would definitely feel the psychedelic effects: the acute perception of self and the surrounding.</p>\n\n<p>Upd: found this blind man telling about psychedelic experience <a href=\"https://www.youtube.com/watch?v=-uXDUIC2FWM\" rel=\"nofollow\">https://www.youtube.com/watch?v=-uXDUIC2FWM</a></p>\n", "score": 4 }, { "answer_id": 31753, "body": "<p>There are TONS of trip reports on various sites—namely Reddit, Erowid, and DMT-Nexus. And while much of this is anecdotal evidence, one could do a lit review of these as a first step toward a more rigorous study.</p>\n<p>And several of those studies have been done as well. A link to one such study is mentioned in the following Reddit thread: <a href=\"https://www.reddit.com/r/Psychedelics/comments/rli4a8/if_your_blind_and_take_acid_or_shrooms_would_you/\" rel=\"nofollow noreferrer\">if your (sic) blind and take acid or shrooms...</a>. The actual article can be found on <a href=\"https://www.livescience.com/62343-psychedelics-lsd-effects-blind-people.html\" rel=\"nofollow noreferrer\">LiveScience.com</a>.</p>\n", "score": 1 } ]

[ "recreational-drugs", "blind" ]

[ { "answer_id": 16663, "body": "<p>Brief description:</p>\n\n<p><a href=\"https://www.qualsight.com/lasek-laser-eye-surgery\" rel=\"nofollow noreferrer\">LASEK and LASIK</a> - cut a flap in the eye, use a laser to remove material underneath to reshape the lens and correct vision. LASIK has been around for a while, so there have been a lot of improvements and modifications, and there are a lot of variations of it.</p>\n\n<p><a href=\"https://www.lasik.com/articles/lasik-prk-difference/\" rel=\"nofollow noreferrer\">PRK</a> - similar to LASIK, but no flap is cut. Instead a surface layer of cells is removed so the laser can go to work underneat. Longer recovery time.</p>\n\n<p><a href=\"https://www.golasik.net/2017/11/lasik-vs-rle-one-better/\" rel=\"nofollow noreferrer\">RLE and PRELEX</a> - remove the natural lens and replace it with a corrected one. Think of it as glasses implanted in your eye.</p>\n\n<p><a href=\"https://www.keywhitman.com/Blog/2015/May/All-about-limbal-relaxing-incisions.aspx\" rel=\"nofollow noreferrer\">LRI</a> - a slit at the edge of your cornea to correct astigmatism. Not a general corrective procedure.</p>\n\n<p><a href=\"https://www.allaboutvision.com/contacts/orthok.htm\" rel=\"nofollow noreferrer\">Ortho-K</a> - a molding 'contact lens' is worn overnight, which molds your lens into the correct shape so you can see the next day or two after you take it out. This is the only reversible, 'non-invasive' procedure I'm aware of that can make you see correctly without external aids (like contacts or glasses).</p>\n\n<hr>\n\n<p>All the laser based methods (LASIK, PRK, etc.) basically reshape your lens by removing material. </p>\n\n<p>In all of these methods (except for Ortho-K) the lens on your eye is basically being cut up, removed and/or sculpted by removing material. It should be obvious why'd there'd be serious potential side effects. This is also why they can sometimes only be performed once - there's only so much material to be removed. However, they have a pretty good track record.</p>\n\n<p>These techniques are all 'state of the art'. </p>\n\n<p>Which one is right for you is a long and complicated discussion depending on the details of your eye prescription and your eye health, as well as your evaluation of which risks you'd prefer to live with. You'd do best to consult with a couple of eye correction centers offering different treatments (many of them offer free consultations). The doctors will help you understand what procedures you are eligible for, and what the potential risks and benefits will be for you personally. </p>\n", "score": 3 } ]

[ "eye", "surgery", "vision", "ophthalmology", "lasik" ]

[ { "answer_id": 17938, "body": "<p>There is a reason you get tired after eating - It's due to a portion of your blood in your body moving to your gut and bowel, leaving less for the rest of your body (brain, muscles etc) and slowing you down, making you sleepy(1)! </p>\n\n<p>Whether is is healthy or not, it's neither here nor there. It can mess with your natural sleeping cycle, but it is also not good to deprive yourself of sleep. I feel the best advice I can offer is just to listen to your body and what feels right for you. We are all built slightly differently, so forcing yourself to adhere to other peoples norms certainly isn't good for you! There have been studies done showing it has very little impact on how well you learn (2).</p>\n\n<p>My apologies for the shoddy response and references, I've put 2 basic sources in, if you have any further questions I will do my best to answer them and improve my referencing. A lot of my information comes from my degree and background (Medical Physics). </p>\n\n<p>(1) - <a href=\"http://www.thejakartapost.com/life/2016/10/04/why-do-we-feel-sleepy-after-eating-a-meal.html?src=mostviewed&amp;pg=/\" rel=\"nofollow noreferrer\">http://www.thejakartapost.com/life/2016/10/04/why-do-we-feel-sleepy-after-eating-a-meal.html?src=mostviewed&amp;pg=/</a></p>\n\n<p>(2) - A nap is as good as a night, <a href=\"https://www.nature.com/articles/nn1078#references\" rel=\"nofollow noreferrer\">https://www.nature.com/articles/nn1078#references</a></p>\n", "score": 1 } ]

[ "sleep", "naps", "energy", "time-of-day", "meal" ]

[ { "answer_id": 10150, "body": "<p>Source: <a href=\"http://www.belmarrahealth.com/foamy-urine-causes/\" rel=\"nofollow noreferrer\">Bel Marra Health</a> </p>\n\n<blockquote>\n <p>Proteinuria: This is a condition in which protein is released in the\n urine in high amounts. Protein is normally released in the urine but\n in small amounts. When these levels become high, the urine can appear\n foamy. This can be a sign of an impending kidney problem as the\n kidneys are not filtering urine properly and thus release <a href=\"http://www.belmarrahealth.com/proteinuria-protein-in-urine-treatment-with-statins-and-home-remedies-to-stop-chronic-kidney-disease/\" rel=\"nofollow noreferrer\">too much\n protein</a>. Untreated high blood pressure and diabetes may contribute\n to kidney filtration problems, along with other factors like toxins,\n infections, or trauma to the kidneys.</p>\n \n <p><strong>Urinary tract infection:</strong> When bacteria enter any part of the urinary tract system you may develop an infection. Along with pain,\n higher urinary frequency and urgency, and burning while urinating,\n your urine may appear foamy as well. You should see a doctor if you\n begin to experience UTI symptoms because the earlier the treatment\n begins the less of a risk of complications you will have.</p>\n \n <p><strong>Kidney disease:</strong> Foamy urine can be a sign of kidney disease resulting from kidney stones or diabetes. A simple urine test will\n determine whether you have kidney disease.</p>\n \n <p><strong>Preeclampsia during pregnancy:</strong> Preeclampsia during pregnancy results in swollen legs, proteinuria, high blood pressure, and\n headaches. This can be a fatal condition to both mother and fetus, and\n all symptoms can worsen with its progression.</p>\n \n <p><strong>Vesicocolic fistula:</strong> A fistula is an abnormal connection which in this case develops between the bladder and the colon. This allows air,\n gas, and bacteria to travel into the bladder. Along with foamy urine,\n a person with vesicocolic fistula will have frequent infections.\n Symptoms may be similar to those of a UTI.</p>\n \n <p><strong>Rapid urination:</strong> Urinating too quickly or forcing urine to come out can be responsible for its foamy appearance. This is because air\n is introduced into the urine stream causing the bubbles. This type of\n foam typically disappears within a few minutes.</p>\n \n <p><strong>Concentrated urine:</strong> If you’re mildly dehydrated, the urine may become more concentrated, so it appears foamy. This can easily be\n resolved by drinking more fluids.</p>\n \n <p><strong>Toilet cleaner:</strong> Sometimes urine reacts with toilet cleaner which causes bubbles. If you’re unsure if your urine is foamy or whether\n it’s the toilet cleaner causing it to foam, you can urinate in a\n separate container that has not been treated with the cleaner and\n watch for foam. Semen in urine: After sex, small amounts of semen are\n left in the male urethra. This small amount won’t cause foamy urine\n unless the bladder sphincter malfunctions, causing the semen to go\n back into the bladder. In this case, urine will appear foamy.</p>\n \n <p><strong>Other causes:</strong> Other causes of foamy urine include amyloidosis, cancer, chemical poisoning, diabetes, heart conditions like an\n enlarged heart, high blood pressure, infections, kidney failure, liver\n disease, lupus, rheumatoid arthritis, sarcoidosis, and sickle cell\n anemia.</p>\n</blockquote>\n", "score": 1 } ]

[ "urine", "kidney", "bladder-infection", "urethra" ]

[ { "answer_id": 15619, "body": "<p>there's a discussion of this point <a href=\"http://amastyleinsider.com/2011/11/21/condition-disease-disorder/\" rel=\"nofollow noreferrer\">here</a></p>\n\n<blockquote>\n <p>Condition is perhaps the least specific, often denoting states of health considered normal or healthy but nevertheless posing implications for the provision of health care (eg, pregnancy). The term might also be used to indicate grades of health (eg, a patient might be described as in stable, serious, or critical condition). While this term is often used in medical discussions to specifically indicate the presence of pathology or illness, Dorland’s Illustrated Medical Dictionary provides no definition of the term used in this sense. Merriam-Webster’s Collegiate Dictionary, however, defines condition as “a usu. defective state of health,”2(p258) and the Oxford English Dictionary similarly opines that it denotes “[a] state of health, esp. one which is poor or abnormal; a malady or sickness.”1(p309)</p>\n</blockquote>\n\n<p>where disease refers to a condition where usually there is a well established pathological process.</p>\n", "score": 3 } ]

[ "terminology", "disease" ]

[ { "answer_id": 11454, "body": "<p>\"Surely there are more risks\" well, you could drown. You could be assaulted or filmed in the change room. You could get dry skin from exposure to the water or the compounds in it - when I swam daily in a semi-public pool I had to use lotion after every swim, which I don't need to do after daily swims in my own these days.</p>\n\n<p>But I expect you're more concerned about catching something communicable. As the article says, urine is sterile. People with open sores and runny noses aren't allowed in the pool (there's generally a large sign about this) and the chlorine in the water is designed to kill the germs from the people who ignore the signs. </p>\n\n<p>The article's risk isn't even about being in the water - it's about breathing and having uncovered eyes near the water. That \"chlorine\" smell we all recognize is actually <a href=\"https://en.wikipedia.org/wiki/Chloramine\" rel=\"noreferrer\">chloramines</a>, which are formed when chlorine reacts with ammonia in urine and sweat. These are the compounds that irritate the eyes and perhaps the respiratory tract. (The Wikipedia article has references.) So to reduce your risk:</p>\n\n<ul>\n<li>wear goggles and put them over your eyes as you leave the change room, rather than waiting until you're in the water and about to put your face in. Leave them over your eyes until you're well away from the water</li>\n<li>take that pre-swim shower seriously, to reduce your own organic contributions, and pee before you swim</li>\n<li>don't hang around on the \"pool deck\" of an indoor pool breathing the fumes</li>\n<li>after your swim, rinse yourself, including your hair, and your swim suit thoroughly, so that you don't carry chlorine compounds out of the area</li>\n<li>if you have a choice between an indoor and an outdoor pool, choose the outdoor one for better ventilation, but don't forget to use sunscreen in that case</li>\n<li>if you have a choice between a pool that always smells really chlorine-y and one that doesn't, choose the less smelly one: its users are presumably contributing less organics and thus creating less chloramines. I noticed a huge difference between the university pool used by (among others) students training for the Olympics and the public pool used by ages 2-92. </li>\n</ul>\n\n<p>If you spend hours a day everyday at the pool, because it's your job to train, or you're a lifeguard, these precautions are probably more important. If you go a few times a week, you don't need to be paranoid about it. </p>\n", "score": 5 } ]

[ "risks", "urine", "swimming", "sanitation" ]

[ { "answer_id": 15622, "body": "<blockquote>\n<p><strong>Ash weight and composition</strong></p>\n<p>Cremated remains are mostly dry calcium phosphates with some minor minerals, such as salts of sodium and potassium. Sulfur and most carbon are driven off as oxidized gases during the process, although a relatively small amount of carbon may remain as carbonate.</p>\n</blockquote>\n<p>And all metals implants, fillings etc are removed before the ashes are presented to the relatives. Joint prosthetics are sold for scrap metal.</p>\n<p><a href=\"https://en.wikipedia.org/wiki/Cremation\" rel=\"nofollow noreferrer\">https://en.wikipedia.org/wiki/Cremation</a></p>\n<p>So, there's nothing there harmful to the living.</p>\n", "score": 4 } ]

[ "risks", "inhalation", "cadavears" ]

[ { "answer_id": 13943, "body": "<p>The current outlook is: Dietary cholesterol is <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/21690178\" rel=\"nofollow noreferrer\">largely</a> a <a href=\"http://www.nejm.org/doi/full/10.1056/NEJM199108223250813\" rel=\"nofollow noreferrer\">non-issue</a> still overburdened with much anxiety and even <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/7730926\" rel=\"nofollow noreferrer\">hysteria</a>. While certain levels and ratios of &quot;blood cholesterol&quot; (different lipoproteins, triglycerides etc.) are still treated as indicators of <em>possible</em> trouble that <em>may</em> call for <a href=\"https://www.cdc.gov/cholesterol/treating_cholesterol.htm\" rel=\"nofollow noreferrer\">intervention</a>, that intervention is likely pharmacological in nature and less through <a href=\"http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/reduce-cholesterol/ART-20045935?p=1\" rel=\"nofollow noreferrer\">dietary means</a> of reducing cholesterol intake. <a href=\"https://heartuk.org.uk/cholesterol-and-diet/low-cholesterol-diets-and-foods/dietary-cholesterol\" rel=\"nofollow noreferrer\">Dietary</a> <a href=\"https://www.hsph.harvard.edu/nutritionsource/cholesterol/\" rel=\"nofollow noreferrer\">cholesterol</a> is not &quot;The Bad Guy&quot; to <a href=\"https://www.health.harvard.edu/blog/panel-suggests-stop-warning-about-cholesterol-in-food-201502127713\" rel=\"nofollow noreferrer\">avoid</a> at <a href=\"https://www.nature.com/articles/ncomms14241\" rel=\"nofollow noreferrer\">all</a> <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/19906248\" rel=\"nofollow noreferrer\">costs</a>.</p>\n<p><strong>So, <a href=\"https://health.clevelandclinic.org/2015/02/why-you-should-no-longer-worry-about-cholesterol-in-food/\" rel=\"nofollow noreferrer\">no</a>, eating (too much) cholesterol is not that bad in <a href=\"http://www.acc.org/latest-in-cardiology/articles/2015/08/19/12/57/the-debate-about-dietary-cholesterol\" rel=\"nofollow noreferrer\">itself</a>.</strong> (But keep in mind that 'eating too much cholesterol' may be the result of eating too much and too fat in general. <em>That</em> is bad.) The type of natural fat ingested is less important over-all and even blood cholesterol or lipo-proteins are under fire as being much less of a value in predicting health outcomes or even being a <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16398902\" rel=\"nofollow noreferrer\">worthy</a> <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12974874?\" rel=\"nofollow noreferrer\">target</a> to intervene at all:\n<a href=\"http://www.ravnskov.nu/2015/12/27/myth-9/\" rel=\"nofollow noreferrer\">People with high cholesterol live the longest</a>.\nAnd that might almost explain why decreasing cholesterol intake leads to an increase in the absorption rate and an increase in cholesterol synthesis.</p>\n<p><a href=\"https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/dietary-cholesterol-from-physiology-to-cardiovascular-risk/2AD4493E735677B9298CCC17FA790539\" rel=\"nofollow noreferrer\">Jean-Michel Lecerf and Michel de Lorgeril: &quot;Dietary cholesterol: from physiology to cardiovascular risk&quot;, British Journal of Nutrition, Volume 106, Issue 1, 14 July 2011, pp. 6-14, https://doi.org/10.1017/S0007114511000237</a>:</p>\n<blockquote>\n<p>Dietary cholesterol comes exclusively from animal sources, thus it is naturally present in our diet and tissues. It is an important component of cell membranes and a precursor of bile acids, steroid hormones and vitamin D. Contrary to phytosterols (originated from plants), cholesterol is synthesised in the human body in order to <strong>maintain a stable pool when dietary intake is low. Given the necessity for cholesterol,</strong> very effective intestinal uptake mechanisms and enterohepatic bile acid and cholesterol reabsorption cycles exist; conversely, phytosterols are poorly absorbed and, indeed, rapidly excreted. <strong>Dietary cholesterol content does not significantly influence plasma cholesterol values,</strong> which are regulated by different genetic and nutritional factors that influence cholesterol absorption or synthesis. <strong>Some subjects are hyper-absorbers and others are hyper-responders,</strong> which implies new therapeutic issues. <strong>Epidemiological data do not support a link between dietary cholesterol and CVD.</strong> Recent biological data concerning the effect of dietary cholesterol on LDL receptor-related protein may explain the complexity of the effect of cholesterol on CVD risk. [emphasis added]</p>\n</blockquote>\n<p><a href=\"http://advances.nutrition.org/content/3/5/711.short\" rel=\"nofollow noreferrer\">Mitchell M. Kanter, et al.: &quot;Exploring the Factors That Affect Blood Cholesterol and Heart Disease Risk: Is Dietary Cholesterol as Bad for You as History Leads Us to Believe?&quot;, Advances in Nutrition, September 2012, vol. 3: 711-717, doi: 10.3945/​an.111.001321</a>:</p>\n<blockquote>\n<p>For much of the past 50 years, a great deal of the scientific literature regarding dietary fat and cholesterol intake has indicated a strong positive correlation with heart disease. In recent years, however, there have been a number of epidemiological studies that did not support a relationship between cholesterol intake and cardiovascular disease. Further, a number of recent clinical trials that looked at the effects of long-term egg consumption (as a vehicle for dietary cholesterol) reported no negative impact on various indices of cardiovascular health and disease. Coupled with data indicating that the impact of lowering dietary cholesterol intake on serum LDL levels is small compared with other dietary and lifestyle factors, there is a need to consider how otherwise healthy foods can be incorporated in the diet to meet current dietary cholesterol recommendations. Because eggs are a healthful food, it is particularly important that sensible strategies be recommended for inclusions of eggs in a healthy diet.</p>\n</blockquote>\n<p><a href=\"http://ajcn.nutrition.org/content/early/2015/06/24/ajcn.114.100305.short#fn-1\" rel=\"nofollow noreferrer\">Samantha Berger et al.: &quot;Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis&quot;, American Journal of Clinical Nutrition, 102: 235-236; July 15, 2015, doi: 10.3945/​ajcn.114.100305</a>:</p>\n<blockquote>\n<p>Forty studies (17 cohorts in 19 publications with 361,923 subjects and 19 trials in 21 publications with 632 subjects) published between 1979 and 2013 were eligible for review. […] Dietary cholesterol was not statistically significantly associated with any coronary artery disease […] or hemorrhagic stroke. […] Dietary cholesterol did not statistically significantly change serum triglycerides or very-low-density lipoprotein concentrations. Reviewed studies were heterogeneous and lacked the methodologic rigor to draw any conclusions regarding the effects of dietary cholesterol on CVD risk. Carefully adjusted and well-conducted cohort studies would be useful to identify the relative effects of dietary cholesterol on CVD risk.</p>\n</blockquote>\n<p><a href=\"http://www.springer.com/us/book/9780387485706\" rel=\"nofollow noreferrer\">Erik Rifkin, Edward Bouwery: &quot;The Illusion of Certainty [Health Benefits and Risks]&quot;, Springer, New York, 2007</a>,\nchap 8: &quot;Elevated Cholesterol: A Primary Risk Factor for Heart Disease?&quot;, p. 91:</p>\n<blockquote>\n<p>But let’s <strong>assume for a moment</strong> that Fig. 8.1 is correct. Let’s say the gentle upward trend from the lowest to the highest cholesterol level is legitimate. Let’s forget about difficulties in excluding diabetics and people with genetic abnormalities, and in normalizing for age and unknown additive or synergistic effects of multiple risk factors. Then in a group of 1,000 individuals with elevated cholesterol, there will be approximately 1 additional death annually when compared to 1,000 individuals with normal cholesterol. Therefore, 99.9% of the individuals with elevated cholesterol would not be affected. [emphasis added]</p>\n</blockquote>\n<p>That is important: just assuming the hypothesis once taken for granted: &quot;eating eggs clogs your arteries&quot; (the so called &quot;diet-heart hypothesis&quot;) is correct <a href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2753.2011.01767.x/abstract\" rel=\"nofollow noreferrer\">does not translate well</a> into statistical observations for the general population or <a href=\"http://www.tandfonline.com/doi/abs/10.1080/14017430801993701\" rel=\"nofollow noreferrer\">public health</a>.</p>\n<p>To give an outdated but relatable picture to this statistical figure:\n&quot;1987 wies S. Seely nach, daß eine lebenslang durchgehaltene cholesterinarme Kost die Lebensdauer lediglich um drei Tage bis drei Monate, bestenfalls jedoch um ein Jahr erhöhe.&quot; (Translation: Seely had proven in 1987 that lifelong avoidance of dietary cholesterol would lead to prolongation of a life by just 3 days to 3 months overall, but one year at the most. Cited from: Werner E. Gerabek, Bernhard D. Haage, Gundolf Keil and Wolfgang Wegner: &quot;Enzyklopädie der Medizingeschichte&quot;, Walter de Gruyter: Berlin, New York, 2007, p. 282. Note that these calculations are <a href=\"http://bmjopen.bmj.com/content/6/6/e010401\" rel=\"nofollow noreferrer\">now viewed as likely even much less pronounced</a>.)</p>\n<p><a href=\"http://www.springer.com/de/book/9789048188741\" rel=\"nofollow noreferrer\">A. Stewart Truswell: &quot;Cholesterol and Beyond. The Research on Diet and Coronary Heart Disease 1900–2000&quot;, Springer: Dordrecht, Heidelberg, 2010</a>, p. 158/9:</p>\n<blockquote>\n<p>[citing: Dietary Prescription to Reduce the Risk of CHD from “ABC of Nutrition”, 3rd Edition (1999) [840] <em>slightly outdated now, cited here for illustration of how outdated some advice to reduce dietary cholesterol is:</em>]</p>\n<ul>\n<li><p>Total fat. Reduction is not essential for improving plasma lipids but should reduce coagulation factors and day-time plasma\ntriglycerides and contribute to weight reduction.</p>\n</li>\n<li><p>Saturated fatty acids. Principally 14:0, 16:0 and 12:0 should be substantially reduced from around 15% of dietary energy in many\nWestern diets to 8–10%.</p>\n</li>\n<li><p>Polyunsaturated fatty acids. Mainly linoleic acid (18:2 ω-6): they should be about 7% of dietary energy (present British level), up to\n10%. Omega-3 polyunsaturated fatty acids should be increased, both\n20:5 and 22:6 from seafoods and 18:3 from canola (rapeseed) oil, etc.\nMonounsaturated fatty acids. Ideal intake if total fat 30%, saturates\n10% and polyunsaturated 8% would be 12% of total dietary energy.</p>\n</li>\n<li><p>Trans fatty acids. With the help of margarine manufacturers these are being reduced. The UK Department of Health recommends no more than\n2% of dietary energy. Avoid older hard margarines.</p>\n</li>\n<li><p><strong>Dietary cholesterol. This boils down to the question of egg yolks. Eggs are a nutritious, inexpensive and convenient food. The UK\nDepartment of Health recommends for the general population no rise in\ncholesterol intake.</strong></p>\n</li>\n<li><p>Salt (NaCl). Restriction to under 6.0 g/day is advised for the general popula- tion (100 mmol Na). It is more important for coronary\npatients.</p>\n</li>\n<li><p>Fish. The UK Department of Health recommends at least twice a week, preferably fatty fish. It should not be fried in saturated fat.</p>\n</li>\n<li><p>Fibre. Oatmeal is recommended.</p>\n</li>\n<li><p>Vegetables and fruit. These are low in fat, and contain pectin and other fibres, flavonoids and other antioxidants, and they contain\nfolate. Expert Committees in Britain and the USA recommend five\nservings of different vegetables and fruit per day (400 g/day average\nweight).</p>\n</li>\n<li><p>Soy products (not salty soy sauce) recommended.</p>\n</li>\n<li><p>Alcohol in moderation, two to three drinks per day is beneficial for middle- aged people at risk of coronary heart disease but cannot be\nrecommended for the general population because of the greater danger\nof accidents in younger people and of all the complications of\nexcessive intake.</p>\n</li>\n<li><p>Coffee should be instant not filtered.</p>\n</li>\n</ul>\n</blockquote>\n<p>Even the very controversial researcher Ancel Keys had to reach this conclusion:</p>\n<blockquote>\n<p>So Keys reached the counter-intuitive conclusion “there can be little doubt that, other things being equal, the serum cholesterol level is markedly influenced by the proportion of calories supplied by fats in the diet, that vegetable as well as animal fats have this effect, <strong>and that the dietary cholesterol itself is unimportant at all levels of intake practicable with natural foods.</strong>” [p. 14; original at Keys A (1952): &quot;The cholesterol problem.&quot; Voeding, 13: 539–558.]\n_{(Notice the date of this statement and that these conclusions about fat he drew were not unbiased but <em>designed</em> to promote carbohydrates.)}</p>\n</blockquote>\n<p>Further references:</p>\n<p><a href=\"https://www.goodreads.com/book/show/16187636-cholesterol-and-saturated-fat-prevent-heart-disease---evidence-from-101\" rel=\"nofollow noreferrer\">David Evans: &quot;Cholesterol and Saturated Fat Prevent Heart Disease. Evidence from 101 Scientific Papers&quot;, Grosvenor House Publishing, Guildford, 2012</a>. (Popular translation of and comments on selected papers, obviously biased but entertaining and not entirely incorrect.)</p>\n<p><a href=\"http://www.bdi.de/fileadmin/PDF/bdi_aktuell/2002/11/Bdi02_11M.pdf\" rel=\"nofollow noreferrer\">Frank P. Meyer: &quot;Das Aus für die Cholesterol-Legende&quot;, BDI aktuell 11-2002, 14–19</a>.</p>\n<p><a href=\"http://www.thincs.org/\" rel=\"nofollow noreferrer\">The International Network of Cholesterol Skeptics</a></p>\n<p><a href=\"https://link.springer.com/978-1-60327-571-2\" rel=\"nofollow noreferrer\">Fabien De Meester, Sherma Zibadi and Ronald Ross Watson: &quot;Modern Dietary Fat Intakes in Disease Promotion&quot;, Springer: New York, Dordrecht, 2010.</a></p>\n", "score": 4 }, { "answer_id": 12371, "body": "<p>Eating cholesterol is bad for the body, and <a href=\"https://youtu.be/EJr3MUNc14Y?t=316\" rel=\"nofollow noreferrer\">this why people are saying otherwise </a>. Eating any kind of saturated fat is bad even unsaturated fats should only be used in small amounts. The only fats the body needs are the Omega-3 and Omega-6 essential fatty acids, but we only need a few grams per day of these.</p>\n\n<p>To understand the problems with eating cholesterol and (saturated) fats in general, it's helpful to get back to the basics. Our bodies have evolved for a very long time (tens of millions of years) as monkeys living in trees who got the vast majority of its energy in the form of sugars and starches from foods packed with useful nutrients. This has led to our bodies becoming dependent on a very high nutrient to calorie ratio.</p>\n\n<p>While our more recent ancestors did eat meat, indigenous populations who still live like our recent ancestors will typically get a far smaller fraction of their proteins from meat compared to us. They get the bulk of their essential amino acids from vegetables, but that requires eating vast amounts of vegetables and then you not only get the required amino acids but also vast amounts of other compounds. We may not require the amino acids from vegetables anymore because we eat more meat and dairy products, but if our bodies have evolved under the conditions where our bodies were flooded with all the compounds from the vast amounts of vegetables, then it's foregone conclusion that we're going to harm our bodies (perhaps in subtle ways) by eating less vegetables.</p>\n\n<p>Evidence that this picture is largely correct comes from studies done on indigenous populations, <a href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30752-3/fulltext\" rel=\"nofollow noreferrer\">like this recent study on the Tsimane people</a>. And <a href=\"https://nutritionfacts.org/2014/11/11/we-can-end-the-heart-disease-epidemic/\" rel=\"nofollow noreferrer\">here</a> you can read about the results of an older study:</p>\n\n<blockquote>\n <p>Maybe the Africans were just dying early of other diseases and so never lived long enough to get heart disease? No. In the video One in a Thousand: Ending the Heart Disease Epidemic, you can see the age-matched heart attack rates in Uganda versus St. Louis. Out of 632 autopsies in Uganda, only one myocardial infarction. Out of 632 Missourians—with the same age and gender distribution—there were 136 myocardial infarctions. More than 100 times the rate of our number one killer. In fact, researchers were so blown away that they decided to do another 800 autopsies in Uganda. Still, just that one small healed infarct (meaning it wasn’t even the cause of death) out of 1,427 patients. Less than one in a thousand, whereas in the U.S., it’s an epidemic.</p>\n</blockquote>\n\n<p>The problem with cholesterol in the diet is then not just the cholesterol itself, but also with this indicating that you probably eat less vegetables and fruits than that cholesterol being all that harmful by itself (but note that even a little cholesterol in the diet does do some harm). People who eat more eggs and meat and use more cooking oils, will typically not eat large amounts of vegetables. There are compounds in vegetables like broccoli (e.g. lutein and zeaxanthin) that will prevent cholesterol from oxidizing, and it's the oxidized cholesterol that causes damage. If the cholesterol doesn't do the job it's supposed to do because it's getting oxidized, your body will produce more of it, leading to even more oxidized cholesterol and more damage to your arteries.</p>\n", "score": 1 } ]

[ "diet", "cholesterol" ]

[ { "answer_id": 12497, "body": "<p>Correct me if I'm wrong but, the <em>sort</em> of sugar consumption that gets a bad rap is the consumption of simple sugars that result in <em>empty calories</em>. In other words, the consumption of sugar-laden, low-nutrient foods. </p>\n\n<p>Sugary drinks form a fine example, from pops to fruit juices: In an 8 fl. oz. serving of cranberry juice, I might consume 35g sugar. I don't get any protein, or fiber, but I get a fine dose of vitamin C; you get your 100% recommended daily value of vitamin C from a variety of sources.</p>\n\n<p>So I consumed 35g of sugar and I didn't consume anything else. If my lifestyle is sedentary, a lot of this sugar goes to the fat stores. <em>However</em>, 8 fl. oz. of cranberry juice never filled anyone up, either, and so it's quite easy to imagine that over time, as a percent of total nutrients for the day, multiple instances of \"<strong>35g aqueous sugar</strong>\" starts to become somewhat overwhelming.</p>\n\n<p>This is also why health organizations make the recommendation to switch from enriched, bleached flour products to whole grain products. The flour refinement process ends up stripping the natural nutrients, which they attempt to add back at the end of the process (<a href=\"https://wholegrainscouncil.org/sites/default/files/thumbnails/image/wg_vs_enriched_coloredHiRestext.jpg\" rel=\"nofollow noreferrer\">just an example</a>). </p>\n\n<p>Nutrient density should be a key consideration in the <em>types</em> of sugary foods you consume. But, keep in mind this depends entirely on each individual's diet plan, and so here I've made broad statements.</p>\n", "score": 1 }, { "answer_id": 12498, "body": "<p>There are two problems with eating plain sugars. The first problem is that plain sugars are empty calories, causing you to miss out on essential nutrients as explained in detail in CMosychuk's answer. Another problem is that the insulin spike is different when eating plain sugar or the same amount of sugar found in fruits, <a href=\"https://www.youtube.com/watch?v=sHEJE6I-Yl4\" rel=\"nofollow noreferrer\">see here</a> and <a href=\"https://well.blogs.nytimes.com/2013/07/31/making-the-case-for-eating-fruit/\" rel=\"nofollow noreferrer\">here</a>. The higher insulin spike after eating plain sugars causes glucose levels to drop below ideal levels, triggering a release of fatty acids. It is this response that causes damage to the body. The same mechanism plays a role in the progression of pre-diabetes to full blown diabetes. </p>\n", "score": 0 }, { "answer_id": 12693, "body": "<p>It is all down to the type of carbohydrates you consume. There are 2 main types of carbohydrate and they are <a href=\"http://www.diabetes.co.uk/nutrition/simple-carbs-vs-complex-carbs.html\" rel=\"nofollow noreferrer\">simple carbs (sugars) and complex carbs (polysaccharides)</a>.</p>\n\n<p>Because of their structures, sugars are metabolised more quickly in the body compared to complex carbohydrates. Therefore, sugars get turned into glucose more quickly for energy use, hence the term \"sugar rush\" from the build up of energy in the body. Any unused glucose will end up as fat and stored in the body's fat reserves.</p>\n\n<blockquote>\n <p>Sugars are found in a variety of natural food sources including fruit, vegetables and milk, and give food a sweet taste.</p>\n \n <p>Sugars can be categorised as single sugars (monosaccharides), which include glucose, fructose and galactose, or double sugars (disaccharides), which include sucrose (table sugar), lactose and maltose.</p>\n</blockquote>\n\n<p>What makes complex carbs different is that they are starches formed by longer saccharide chains, which means they take longer to break down.</p>\n\n<p>Chemically, they usually comprise of three or more linked sugars.</p>\n\n<blockquote>\n <p>When dietitians and nutritionists advise having complex carbohydrates, however, they are usually referring to whole grain foods and starchy vegetables which are more slowly absorbed than refined carbohydrate.</p>\n</blockquote>\n\n<p>Whole grain starches include the wheat grain and kernel which provide the majority of fibre and nutrients to be found in starchy foods.</p>\n\n<p>When it comes to picking starchy foods, such as rice, bread and any other products made from flour, it’s best to opt for whole grain versions of these products.</p>\n\n<p>We should not rely too much on carbohydrate though. Whilst whole grain foods impact upon blood glucose levels more slowly than other forms of carbohydrate, higher levels of carbohydrate can still raise blood sugar levels substantially. So whilst aiming for complex carbohydrates rather than simple carbs, you still need to keep within the recommended daily calorie intake and ratios of carbs to other nutrients such as vitamins and fibre.</p>\n", "score": 0 } ]

[ "sugar", "glucose", "carbohydrates", "fructose" ]

[ { "answer_id": 14264, "body": "<p>Reasoning with &quot;evolution&quot; and 'natural' settings is a good starting point in terms of human nutrition. But there are caveats in this:</p>\n<ul>\n<li>it tends to be <a href=\"https://academic.oup.com/jmp/article-abstract/11/2/123/890895\" rel=\"noreferrer\">armchair</a> reasoning without archaeological or paleontological evidence</li>\n<li>evolution can be very quick, even for <a href=\"http://science.sciencemag.org/content/267/5206/1907\" rel=\"noreferrer\">slowly reproducing and mutating</a> humans: before the <a href=\"https://www.cambridge.org/core/journals/cambridge-archaeological-journal/article/on-the-nature-of-transitions-the-middle-to-upper-palaeolithic-and-the-neolithic-revolution/E2C7C71267F54E0B71371C34BF11C1B5\" rel=\"noreferrer\">neolithic</a> <a href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.0950-0804.2005.00259.x/full\" rel=\"noreferrer\">revolution</a> humans did not eat so much starches or fats from grassy corns (that we <a href=\"https://en.wikipedia.org/wiki/Teosinte\" rel=\"noreferrer\">transformed</a> considerably by breeding in a very short time) and lactose <a href=\"https://muse.jhu.edu/article/476465/summary\" rel=\"noreferrer\">tolerance</a> in <a href=\"https://en.wikipedia.org/wiki/Lactase_persistence\" rel=\"noreferrer\">adults</a> <a href=\"http://www.tandfonline.com/doi/abs/10.1080/00438243.1983.9979887\" rel=\"noreferrer\">spread</a> very quickly from anatolian cattle keepers to the north and west (mainly)</li>\n<li><a href=\"http://science.sciencemag.org/content/309/5732/234\" rel=\"noreferrer\">evolution is still ongoing</a> and not a finished process we have to live with. <a href=\"https://www.nutritionjrnl.com/article/S0899-9007(03)00215-6/fulltext\" rel=\"noreferrer\">Epigenetics</a> alone indicate that genetic adaptability is intergenerationally high</li>\n<li>humans are <a href=\"http://journals.sagepub.com/doi/pdf/10.1177/053901888027002005\" rel=\"noreferrer\">true</a> omnivores and can and did survive in good health and into old age on a <a href=\"http://www.pnas.org/content/106/38/16034.short\" rel=\"noreferrer\">very broad</a> <a href=\"http://journals.sagepub.com/doi/pdf/10.1177/053901848001900603\" rel=\"noreferrer\">spectrum</a> of <a href=\"http://www.pnas.org/content/101/26/9551.short\" rel=\"noreferrer\">foods</a>. And they did so in the <a href=\"http://www.pnas.org/content/98/11/6528.short\" rel=\"noreferrer\">past</a>. This is not to be read as everyone in our supposedly golden past got quite old. Insects, game, fish, mollusks, birds, tubers, roots, grass seeds, nuts, vegetables and fruit, all on the menu but in very different ratios at differernt times.</li>\n</ul>\n<p>For the vast majority of our history the main concern with food was always: getting more in order to ensure to <a href=\"https://en.wikipedia.org/wiki/Food_security\" rel=\"noreferrer\">get enough</a>. More than enough food eaten was only a problem for a minute 'elite' of the past and starvation or malnutrition is still a big problem in some parts of this world. <a href=\"https://en.wikipedia.org/wiki/List_of_famines\" rel=\"noreferrer\">Starving</a> to death is much quicker than eating to death.</p>\n<p>It is very funny to read old recipes for &quot;war-bread&quot; in World War I Germany: when the (now so called) bad carbohydrates from grains were in short supply and <a href=\"https://books.google.de/books?id=MxqhBgAAQBAJ&amp;pg=PA87&amp;lpg=PA87&amp;dq=kriegsbrot+1917++rezept\" rel=\"noreferrer\">bran, beets and potatoes</a> were added to stretch out what was there. <a href=\"https://worldwide.espacenet.com/publicationDetails/biblio?locale=de_EP&amp;CC=GB&amp;NR=131402\" rel=\"noreferrer\">What</a> today is sold as &quot;health-food&quot; was once one of the very sparse reasons for ordinary <a href=\"https://en.wikipedia.org/wiki/Turnip_Winter\" rel=\"noreferrer\">Germans to riot</a> and rebel and make a revolution!</p>\n<h1>The <a href=\"http://Conversion%20ratios%20of%20n-3%20fatty%20acids%20between%20plasma%20and%20erythrocytes:%20a%20systematic%20review%20and%20meta-regression.\" rel=\"noreferrer\">conversion rate</a> for EPA and DHA is <a href=\"http://www.dhaomega3.org/Overview/Conversion-Efficiency-of-ALA-to-DHA-in-Humans\" rel=\"noreferrer\">usually low</a> but not necessarily too low</h1>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3927474/\" rel=\"noreferrer\">If fed much omega-3 the conversion rate in rats can exceed the brain's uptake limit.</a> And in humans this is quite similar.</p>\n<blockquote>\n<p>The conversion efficiency of ALA to EPA varies between 0.2% and 21%, and that of ALA to DHA varies between 0% and 9% (Andrew et al. 2006; Williams and Burdge 2006). The conversion of ALA to EPA and DHA is affected by multiple factors such as sex and competitive inhibition of Δ6-desaturase by LA and ALA. […]\n<strong>Besides the amount of PUFA, the ratio of ω6/ω3 is known to be of nutritional importance as it is the key index for balanced synthesis of eicosanoids in the body</strong> (Steffens 1997). For optimal infant nutrition, the ratio of n-6/n-3 must be not higher than 10 (Gerster 1998). In Coastal states where mothers consumed high amounts of fish rich in n-3 PUFA, n-6/n-3 ratios were significantly lower than that of other countries (6.5 and 8.5, respectively) (Kneebone et al. 1985; Boersma et al. 1991). High consumption of plant oils rich in n-6 PUFA and consumption of relatively low marine foods (as source of n-3 PUFA) increases the n-6/n-3 ratio. When one has a diet rich in ALA and lower LA consumption levels, EPA and DHA in muscle tissue increased due to reduced competition for Δ6 desaturase. In most Indian consumers, the n-6/n-3 intake ratio is equal to 1/30-70, but the ideal ratio is 1/5-10 to protect human health. Japanese are the only people who take an ideal ratio of 1/2-4 and this is due to their consumption of seafood (Aleksandra et al. 2009). In communities in the west, consumption of ω6 is much higher than that of ω3; such that in the United States, consumption of ω6 is 10–30 times more than that of ω3. Nutritional scientists suggest the 2:1 to 4:1 n-6/n-3 ratio, which indicates a high consumption of seafood (Aleksandra et al. 2009).\nFrom: <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237475/\" rel=\"noreferrer\">Long-chain polyunsaturated fatty acid sources and evaluation of their nutritional and functional properties</a></p>\n</blockquote>\n<p>This is partially illustrated here:\n<a href=\"https://i.stack.imgur.com/Vm4Lv.png\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/Vm4Lv.png\" alt=\"eicosanoid synthesing pathways.\" /></a></p>\n<p>As you can see, both pathways use the same enzymes, making them the limiting factor:</p>\n<blockquote>\n<p>More specifically, most studies in humans have shown that whereas a certain, though restricted, conversion of high doses of ALA to EPA occurs, conversion to DHA is severely restricted. The use of ALA labelled with radioisotopes suggested that with a background diet high in saturated fat conversion to long-chain metabolites is approximately 6% for EPA and 3.8% for DHA. <strong>With a diet rich in n-6 PUFA, conversion is reduced by 40 to 50%.</strong> It is thus reasonable to observe an n-6/n-3 PUFA ratio not exceeding 4-6. From: <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/9637947\" rel=\"noreferrer\">Can adults adequately convert alpha-linolenic acid (18:3n-3) to eicosapentaenoic acid (20:5n-3) and docosahexaenoic acid (22:6n-3)?</a></p>\n<p><a href=\"https://www.nutraingredients-usa.com/Article/2010/11/08/Omega-3-ALA-intakes-enough-for-EPA-DPA-levels-for-non-fish-eaters\" rel=\"noreferrer\">Omega-3: ALA intakes enough for EPA/DPA levels for non-fish eaters?<br>\nThe conversion of the plant-based omega-3 ALA to the long-chain EPA and DHA may be increased in vegans and vegetarians who do not eat fish, suggest results from the European Prospective Investigation into Cancer and Nutrition (EPIC).</a></p>\n</blockquote>\n<p>So while it is true that artificial transfats are really bad, and otherwise industrially damaged fats should be avoided at all cost it is not true that saturated fats have a bad influence on eicosanoid status.\nTotal consumption of plant based alpha-linoleic acid (ALA) is one key, over abundance of <a href=\"https://en.wikipedia.org/wiki/Omega-6_fatty_acid\" rel=\"noreferrer\">omega-6</a> acids like arachidonic acid (AA) and linoleic acid (LA) is another. That is quite ironic because a vegetarian or vegan diet that is not well planned tends to increase this unhealthy ratio of fatty acids.</p>\n<p>While the view that the ratio of all <a href=\"https://en.wikipedia.org/wiki/Essential_fatty_acid_interactions\" rel=\"noreferrer\">fatty acids to one another</a> has come under attack, the rate of conversion is still dependent on dietary ALA in this view:</p>\n<blockquote>\n<p><a href=\"http://ajcn.nutrition.org/content/84/1/44.full\" rel=\"noreferrer\">Conversion of α-linolenic acid in humans is influenced by the absolute amounts of α-linolenic acid and linoleic acid in the diet and not by their ratio</a></p>\n</blockquote>\n<p>Too much PUFAs of the wrong kind is detrimental.</p>\n<p>Beef from cows that are <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846864/\" rel=\"noreferrer\">grass fed tends</a> to be <a href=\"http://www.berkeleywellness.com/healthy-eating/food/nutrition/article/grass-fed-beef-omega-3s\" rel=\"noreferrer\">a much richer source of omega-3 acids</a> than those fed soy and maize to fatten <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16500874\" rel=\"noreferrer\">them and us up</a>.</p>\n<p>If you look at these sources of <a href=\"http://lpi.oregonstate.edu/mic/other-nutrients/essential-fatty-acids\" rel=\"noreferrer\">essential fatty acids</a>:</p>\n<p><a href=\"https://i.stack.imgur.com/XtZJ7.png\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/XtZJ7.png\" alt=\"Pauling illustration of EFAs and sources\" /></a></p>\n<p>Apart from leaving out sources of good fat, like the nutritious monkey brain that's full of DHA because that <a href=\"https://news.ohsu.edu/2014/02/05/monkeys-that-eat-omega-3-rich-diet-show-more-developed-brain-networks\" rel=\"noreferrer\">ape ate all</a> the good stuff away from us: You see an important ingredient in our diet suspiciously absent from that picture. The same article, however, does list it partially elsewhere:</p>\n<pre><code>Food Sources of Linoleic Acid (18:2n-6) (157)\nFood Serving Linoleic Acid (g)\nSafflower oil 1 tablespoon 10.1\nSunflower seeds, oil roasted 1 oz 9.7\nPine nuts 1 oz 9.4\nSunflower oil 1 tablespoon 8.9\nCorn oil 1 tablespoon 7.3\nSoybean oil 1 tablespoon 6.9\nPecans, oil roasted 1 oz 6.4\nBrazil nuts 1 oz 5.8\nSesame oil 1 tablespoon 5.6\n</code></pre>\n<p>Sunflower-fat and oils from grains are a major contributor of PUFAs in a suboptimal ratio, providing too much <a href=\"https://en.wikipedia.org/wiki/Arachidonic_acid\" rel=\"noreferrer\">AA</a> and LA. And this is one part of refining fat: feeding animals the wrong kind of fodder that then ends up damaging us. Only eating the plants with this ratio directly might be even more damaging. A vegan cooking his gluten-rich seitan-steak in sunflower oil is very likely on the wrong track.</p>\n<p>That means from an evolutionary view it is perfectly <a href=\"https://books.google.de/books?id=7f9lgCviA4IC\" rel=\"noreferrer\">reasonable</a> to <a href=\"https://www.taylorfrancis.com/books/e/9781466594876\" rel=\"noreferrer\">assume</a> that <a href=\"http://onlinelibrary.wiley.com/doi/10.1002/ajhb.20683/abstract\" rel=\"noreferrer\">humans evolved to eat what was/is found in the African savannah far from the coast</a>. Only after the neolithic revolution when our <a href=\"https://books.google.de/books?id=ixACN_MMHVsC\" rel=\"noreferrer\">western diet slowly</a> came into the abysmal shape it is today did we decrease our ability to synthesise EPA and DHA so much that adding external i.e. marine sources for them is now <a href=\"http://www.springer.com/us/book/9781588296689\" rel=\"noreferrer\">almost</a> mandatory. If one wants to keep the high amount of omega6 in the diet.</p>\n<p>Parts of the reasoning in the question are perfectly valid. But the unqualified call for poly-unsaturated essential fatty acids is the <a href=\"http://www.sciencedirect.com/science/article/pii/S0753332202002536\" rel=\"noreferrer\">culprit</a>. Mono-unsaturated acids and saturated fats might raise concerns because of their energy density, not because of their effect on DHA/EPA conversion. While omega-6 acids <em>are</em> necessary, they have been present in western diets in much to <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/12442909\" rel=\"noreferrer\">high ratios</a>. It is therefore unwise to call for an increase in all PUFAs across the board.\nIt is not the use of cooking oil per se that brought us into this situation. It is industrialised agriculture and food preparation that favoured the very <a href=\"http://www.tandfonline.com/doi/abs/10.1081/FRI-120028831\" rel=\"noreferrer\">lopsided</a> narrowing of our meal plans into the unhealthy category for way too many people.</p>\n<blockquote>\n<ol>\n<li>Limit total fat intake, avoid trans fatty acids, and reduce saturated fats.</li>\n<li>Make monounsaturated fatty acids the primary dietary fat</li>\n<li>Include good sources of ALA (omega-3 fatty acids from plants) daily.</li>\n<li>Reduce intake of omega-6 fatty acids, if excessive.</li>\n<li>Consider a direct source of EPA and DHA.<br>\n[from: <a href=\"http://www.todaysdietitian.com/newarchives/020810p22.shtml\" rel=\"noreferrer\">Vegetarian’s Challenge — Optimizing Essential Fatty Acid Status]</a></li>\n</ol>\n</blockquote>\n", "score": 9 } ]

[ "omega-3" ]

[ { "answer_id": 14297, "body": "<p><a href=\"https://nei.nih.gov/health/errors/myopia\" rel=\"noreferrer\">Myopia</a>, or nearsightedness, occurs when the eye grows too long from front to back. According to the <a href=\"https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/myopia\" rel=\"noreferrer\">American Optometric Association</a>,</p>\n\n<blockquote>\n <p>Myopia occurs if the eyeball is too long or the cornea (the clear front cover of the eye) is too curved. As a result, the light entering the eye isn't focused correctly, and distant objects look blurred.</p>\n</blockquote>\n\n<p>Instead of focusing images on the <a href=\"https://www.britannica.com/science/retina\" rel=\"noreferrer\">retina</a>, the <a href=\"https://www.britannica.com/science/lens-eye-structure\" rel=\"noreferrer\">lens</a> of the eye focuses the image in front of the retina. In a normal eye, the light focuses on the retina. However, in individuals with myopia, the eyeball is too long and focuses light in front of the retina. </p>\n\n<p>Although genetics plays a major role in the development of myopia, it's development may also be affected by how an individual uses their eyes. For example, individuals who spend a considerable amount of time doing near-work such as reading, writing, and working on a computer have an increased risk of developing myopia. Although it primarily presents in school-aged children, adults may also develop the condition as a result of visual stress or as a complication of another health condition such as diabetes.</p>\n\n<p><strong>Can myopia reversible, naturally or through medication?</strong></p>\n\n<p>Although a cure for nearsightedness has yet to be discovered, several studies suggest it may be possible to at least control myopia by <em>slowing its progression</em>.</p>\n\n<p>An article published by the American Academy of Ophthalmology: ‘<a href=\"https://www.aao.org/eye-health/news/eye-drops-nearsighted-children\" rel=\"noreferrer\">Eye Drops That Can Slow Down Nearsightedness in Children</a>’ references a <a href=\"https://www.aao.org/assets/28fe020e-5f93-4d06-aac1-889cecb15fb2/635835505202800000/atropine-for-myopia-5-yr-clinical-trial-ophthalmology-2015-pdf?inline=1\" rel=\"noreferrer\">clinical trial on atropine</a> which was conducted to compare the safety and efficacy of different concentrations of atropine eye drops for the control of myopia progression. Results of the five-year trial indicate that <strong>a low concentration of atropine drops could potentially be an effective treatment for myopia</strong>.</p>\n\n<blockquote>\n <p>In a five-year clinical trial, investigators there showed that <strong>0.01 percent atropine drops safely slowed down the progression of myopia by about 50 percent</strong> with almost no side effects.</p>\n</blockquote>\n\n<p>'<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4697954/\" rel=\"noreferrer\">The Safety of Orthokeratology - A Systematic Review</a>' evaluates the ocular safety of orthokeratology (also known as Ortho-K or OK) for the treatment of myopia.</p>\n\n<blockquote>\n <p>There is sufficient evidence to suggest that <strong>OrthoK is a safe option for myopia correction</strong> and retardation. Long-term success of OrthoK treatment requires a combination of proper lens fitting, rigorous compliance to lens care regimen, good adherence to routine follow-ups, and timely treatment of complications.</p>\n</blockquote>\n\n<p>Another study analyzes the efficacy of atropine eye drops and orthokeratology lenses in controlling myopia progression and elongation of axial length. ’<a href=\"https://bmcophthalmol.biomedcentral.com/articles/10.1186/1471-2415-14-40\" rel=\"noreferrer\">Overnight orthokeratology is comparable with atropine controlling myopia</a>,' a retrospective study, included <strong>105 patients (210 eyes) who wore OK lenses</strong> and <strong>105 patients (210 eyes) who applied 0.125% atropine</strong> every night during the 3 following period.</p>\n\n<blockquote>\n <p>The change in axial length per year was 0.28 ± 0.08 mm, 0.30 ± 0.09 mm, and 0.27 ± 0.10 mm in the OK lens group, and 0.38 ± 0.09 mm, 0.37 ± 0.12 mm, and 0.36 ± 0.08 mm in the atropine group for years 1, 2, and 3, respectively. Linear regression analysis revealed an increase in myopia of 0.28 D and 0.34 D per year, and an increase in axial length of 0.28 mm and 0.37 mm per year in the OK lens and atropine groups, respectively. Repeated measure ANOVA showed significant differences in myopia (p = 0.001) and axial length (p &lt; 0.001) between the atropine and OK lens groups; in astigmatism, there was no significant difference in these parameters (p = 0.320). </p>\n</blockquote>\n\n<p>Comparison of increases in axial length in relation to baseline myopia showed significant correlations both in the OK lens group and atropine group. </p>\n\n<blockquote>\n <p>High myopia patients benefited more from both OK lenses and atropine than did low myopia patients. The correlation of baseline myopia and myopia progression was stronger in the OK lens group than in the atropine group.</p>\n</blockquote>\n\n<p>Results of the study reveal that the <strong>OK lens is a useful method for controlling myopia progression</strong> even in <a href=\"https://www.aao.org/eye-health/ask-ophthalmologist-q/high-myopia\" rel=\"noreferrer\">high myopia</a> patients. </p>\n\n<p>In conclusion, although myopia cannot be reversed (yet), several studies concur that it is possible to control or slow the progression of nearsightedness. </p>\n", "score": 5 }, { "answer_id": 14298, "body": "<p>There appear to be both genetic and environmental factors for the development of myopia. The results from the Sydney Myopia study found that</p>\n\n<blockquote>\n <p>RESULTS: Children who became myopic spent less time outdoors compared with children who remained nonmyopic (younger cohort, 16.3 vs. 21.0 hours, respectively, P&lt;0.0001; older cohort, 17.2 vs. 19.6 hours, respectively, P=0.001). Children who became myopic performed significantly more near work (19.4 vs. 17.6 hours; P=0.02) in the younger cohort, but not in the older cohort (P=0.06). Children with 1 or 2 parents who were myopic had greater odds of incident myopia (1 parent: odds ratio [OR], 3.2, 95% confidence interval [CI], 1.9-5.2; both parents: OR, 3.3, 95% CI, 1.6-6.8) in the younger but not the older cohort. Children of East Asian ethnicity had a higher incidence of myopia compared with children of European Caucasian ethnicity (both P&lt;0.0001) and spent less time outdoors (both P&lt;0.0001). A less hyperopic refraction at baseline was the most significant predictor of incident myopia. The addition of time outdoors, near work, parental myopia, and ethnicity to the model significantly improved the predictive power (P&lt;0.0001) in the younger cohort but had little effect in the older cohort.</p>\n</blockquote>\n\n<p>In adults refractive surgery can ameliorate myopia but I'm not aware of any drugs that can do this in the adult.</p>\n\n<p>It would seem prudent, especially in at risk populations such as east Asian, and if one has a parent with myopia, to spend adequate hours outside in sunlight to help prevent the development or progression of myopia.</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/m/pubmed/23672971/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/m/pubmed/23672971/</a></p>\n", "score": 2 } ]

[ "medications", "eye", "cure", "myopia-nearsightedness" ]

[ { "answer_id": 24057, "body": "<p>There is no consensus on the exact cause, although in Chronic Epstein-Barr Activation (CEBA) it has been linked to the effects of inflammation (eg a cytokine storm), plus immune activation and <a href=\"https://www.sciencedirect.com/science/article/abs/pii/S0165032707003321\" rel=\"nofollow noreferrer\">tryptophan degradation</a>.</p>\n<p>In the more common, non-CEBA Epstein-Barr infection immune system responses are also suggested to be linked to the fatigue.\n<em>&quot;Presently, therefore the is no proven fatigue-causing substance or fatigue transmitting substance.\nHowever, the most probable candidates for such fatigue-inducing or fatigue transmitting substances are cytokines, including interferon.&quot;</em><a href=\"http://www.med.or.jp/english/pdf/2006_01/027_033.pdf\" rel=\"nofollow noreferrer\">2</a></p>\n<p>Lasting fatigue is found in a number of viruses, including a number of Covid-19 patients.<a href=\"https://link.springer.com/article/10.1186/s12974-017-0796-7\" rel=\"nofollow noreferrer\">3</a> This may be related to Interleukin-1 levels, an inflammatory cytokine.</p>\n<p>Long term fatigue is often termed &quot;Chronic fatigue&quot;, &quot;post-fatigue infection&quot; or &quot;post-viral fatigue&quot; (without the syndrome part).</p>\n", "score": 1 }, { "answer_id": 23353, "body": "<p>According to <a href=\"https://emedicine.medscape.com/article/222040-differential\" rel=\"nofollow noreferrer\">Emedicine medscape</a>:</p>\n\n<blockquote>\n <p>Appreciate that EBV may trigger chronic fatigue, but it does not cause chronic fatigue. </p>\n</blockquote>\n\n<p>In their page on <a href=\"https://emedicine.medscape.com/article/235980-overview#a4\" rel=\"nofollow noreferrer\">Chronic Fatigue Syndrome</a>:</p>\n\n<blockquote>\n <p>CFS is a biological illness, not a psychologic disorder. The <strong>exact pathogenesis is unknown</strong>. Numerous mechanisms and molecules have been implicated that lead to abnormalities in immune dysfunction, hormonal regulation, metabolism and response to oxidative stress to include impaired natural killer cell function and/or T-cell function, elevated cytokines, and autoantibodies (rheumatic factor, antithyroid antibodies, antigliadin, anti–smooth muscle antibodies, and cold agglutinins). [3, 4] Infections have been suspected; however, no causal role has been established.</p>\n</blockquote>\n\n<p>The sources cited:</p>\n\n<ol start=\"3\">\n<li><a href=\"https://www.cdc.gov/me-cfs/index.html\" rel=\"nofollow noreferrer\">https://www.cdc.gov/me-cfs/index.html</a></li>\n<li><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/28760971\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/pubmed/28760971</a></li>\n</ol>\n", "score": 0 } ]

[ "infection", "fatigue", "cause-and-effect", "mononucleosis" ]

[ { "answer_id": 13904, "body": "<p>That problem is already solved for you, at least in the US.</p>\n\n<p>Current guidelines issued by the American Heart Association no longer require rescue breathing. Chest compressions alone are now <a href=\"http://cpr.heart.org/AHAECC/CPRAndECC/Programs/HandsOnlyCPR/UCM_473196_Hands-Only-CPR.jsp\" rel=\"nofollow noreferrer\">the standard</a> for community CPR (vs professional CPR). They refer to it as <em>hands only CPR</em>.</p>\n\n<p>On an anecdotal note, I've done mouth-to-mouth on a perfect stranger. He was a young adult male drowning victim. It's not as off-putting as you might think. However, had he vomited, which is common in cardiac arrest, that would have made me wish for a pocket mask. </p>\n\n<p><strong>Edit in response to edit to the question:</strong></p>\n\n<p>If protective equipment like a pocket mask isn't available and omitting mouth-to-mouth isn't an option, then there aren't many options left. A piece of cloth used as a barrier might help reduce the gross factor, but I doubt it will do much to protect you from bacteria and viruses. If vomit is present, you need to clear the airway first anyway, which should have been covered in your CPR class. If blood is present, now you have to ask yourself how much risk you're willing to take since you could be exposing yourself to dangerous bloodborne pathogens. Although it's okay to wipe the mouth and face off with a wet cloth, it's not okay to try and rinse the mouth. </p>\n\n<p>Honestly, should you find yourself in the situation of using your CPR training, I think you'll find that you'll be too busy and focused to even notice the off-putting aspects unless the patient is a real mess. Just do what needs to be done and what your risk assessment allows you to do. You'll probably be surprised how much work CPR is. Even professionals come away from a 'code' sweating. </p>\n", "score": 11 }, { "answer_id": 13907, "body": "<p>The British came across this exact problem. CPR was seen as a tricky business, especially when it was considered complicated and might involve mouth-to-mouth. </p>\n\n<p>Their solution was (as Carey Gregory mentioned) to recommend chest-compressions in time to a relatively popular (and more importantly, catchy) song. Their logic was that even a simple step like that was much better than people standing about doing nothing out of fear of getting it wrong.</p>\n\n<p>There was a big push to get this message out via an advert the British Heart Foundation ran with a famous actor (Vinnie Jones) in which he literally says the line: \"No kissing, you only kiss your Mrs on the lips\".</p>\n\n<p>You can find it here: <a href=\"https://www.youtube.com/watch?v=hcQG2MMegXw\" rel=\"nofollow noreferrer\">https://www.youtube.com/watch?v=hcQG2MMegXw</a> or by searching \"Vinnie Jones' hard and fast hands-only CPR\". </p>\n", "score": 3 } ]

[ "first-aid", "cpr" ]

[ { "answer_id": 25135, "body": "<p>Tension pneumothorax is an emergency in that it an kill somebody quickly.\nVenous catheters are part of standard management in trauma or resuscitation settings.</p>\n<p>As for pneumothorax itself; keep in mind that the needle decompression is not actually a definitive treatment but rather something to buy you time to do something more definitive like a tube thoracostomy.</p>\n<p>If you read the article carefully, you can see that those recommendations are in a prehospital setting for a patient that will essentially die if you don't do something right away.</p>\n", "score": 1 } ]

[ "practice-of-medicine", "chest", "pneumothorax", "thorax" ]

[ { "answer_id": 14747, "body": "<p>The long-term impact of testosterone on women's health is still not clarified enough, so it's not easy to predict them exactly.\nSome common <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3971358/\" rel=\"noreferrer\">side-effects of high testosterone level</a> are acne and increased oiliness of the skin and hair. High level of testosterone con also lead to infertility and are commonly seen in polycystic ovarian syndrome.\nThere're side-effects related to high-dozage intake of testosterone: liver-damage, hirsutism, masculinization.</p>\n\n<blockquote>\n <p>One of the 20 randomized, placebo-controlled trials examined the risk of liver disease in women receiving androgens and showed no change in hepatic enzymes. In the literature, this has been reported only in cases in which the blood testosterone levels increased to supraphysiological levels.</p>\n \n <p>Other adverse effects of the use of testosterone in women, such as hirsutism, deep voice, and an enlarged clitoris, should not be neglected. However, the most common adverse effects are acne and increased oiliness of the skin and hair, which were also reported in 3 of the studies shown in Table 1. In addition, 10% of patients receiving 1.25 mg/day or 2.5 mg/day of methyltestosterone and 45% of those receiving 10 mg/day of the same were reported to have experienced these side effects.</p>\n \n <p>Masculinization is rare and is due to the administration of high doses of androgens. Implants containing up to 300 µg/day of testosterone initially produce supraphysiological blood peaks, although these are transient and do not induce virilization.</p>\n</blockquote>\n\n<p>Testosterone intake is connected with some <a href=\"https://www.sciencedirect.com/science/article/pii/S0378512213000121#bbib0210\" rel=\"noreferrer\">myths and mysconceptions</a>, which was revealed. </p>\n\n<ol>\n<li><p>Testosterone is a ‘male’ hormone</p>\n\n<blockquote>\n <p>Testosterone is the most abundant biologically active hormone in women</p>\n</blockquote></li>\n<li><p>Testosterone's only role in women is sex drive and libido</p>\n\n<blockquote>\n <p>Testosterone is essential for women's physical and mental health and wellbeing</p>\n</blockquote></li>\n<li><p>Testosterone masculinizes females</p>\n\n<blockquote>\n <p>Outside of supra-pharmacologic doses of synthetic androgens, testosterone does not have a masculinizing effect on females or female fetuses</p>\n</blockquote></li>\n<li><p>Testosterone causes hoarseness and voice changes</p>\n\n<blockquote>\n <p>There is no conclusive evidence that testosterone therapy causes hoarseness or irreversible vocal cord changes in women</p>\n</blockquote></li>\n<li><p>Testosterone causes hair loss</p>\n\n<blockquote>\n <p>Testosterone therapy increases scalp hair growth in women</p>\n</blockquote></li>\n<li><p>Testosterone has adverse effects on the heart</p>\n\n<blockquote>\n <p>There is substantial evidence that testosterone is cardiac protective and that adequate levels decrease the risk of cardiovascular disease</p>\n</blockquote></li>\n<li><p>Testosterone causes liver damage</p>\n\n<blockquote>\n <p>Non-oral testosterone does not adversely affect the liver or increase clotting factors</p>\n</blockquote></li>\n<li><p>Testosterone causes aggression</p>\n\n<blockquote>\n <p>Testosterone therapy decreases anxiety, irritability and aggression</p>\n</blockquote></li>\n<li><p>Testosterone may increase the risk of breast cancer</p>\n\n<blockquote>\n <p>Testosterone is breast protective and does not increase the risk of breast cancer</p>\n</blockquote></li>\n<li><p>The safety of testosterone use in women has not been established</p>\n\n<blockquote>\n <p>The safety of non-oral testosterone therapy in women is well established, including long-term follow up</p>\n</blockquote></li>\n</ol>\n\n<blockquote>\n <p>Long-term data exists on the efficacy, safety and tolerability of doses of up to 225 mg in up to 40 years of therapy. In addition, long term follow up studies on supra-pharmacologic doses used to ‘female to male’ transgender patients report no increase in mortality, breast cancer, vascular disease or other major health problems</p>\n</blockquote>\n\n<p>The result of testosterone intake relates of dosages and initial testosterone level. <a href=\"https://steroidssaleguide.com/high-low-and-normal-testosterone-levels-in-women-signs-symptoms/\" rel=\"noreferrer\">Normal testosterone levels for all women</a> values from 0.26 to 1.3 ng/ml. The rate of free testosterone varies with age, for the age 21-39 it's 0,12-3,1 pg/ml.</p>\n", "score": 8 } ]

[ "endocrinology", "testosterone", "female" ]

[ { "answer_id": 14880, "body": "<p>Nicely, sunlight <em>is</em> best. While we are still not knowing nearly enough concerning all the details, that's a safe bet. Even the supplement lobby acknowledges that:</p>\n<blockquote>\n<p><a href=\"https://www.vitamindcouncil.org/vitamin-d-supplementation-and-sun-exposure-can-we-pick-and-choose/\" rel=\"nofollow noreferrer\">Despite the increased risk of non-melanoma skin cancers, the Vitamin D Council recommends moderate sun exposure and 5,000 IU of vitamin D3 on days you do not get sun exposure. We are not alone. Recent studies imply that sun exposure does more than simply make vitamin D and that one cannot fully replace the benefits of sun exposure by simply taking a vitamin D supplement.</a></p>\n</blockquote>\n<p>There are differences. Differences between sunlight synthesised and supplemented. But also between those two types compared to D derived from food.</p>\n<p>Just one example: Sunlight D remains twice as long in the blood compared to ingested D:</p>\n<blockquote>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/\" rel=\"nofollow noreferrer\"><strong>Vitamin D: The “sunshine” vitamin</strong> (2012)</a><br>\n<strong>Sources of vitamin D</strong></p>\n<p>A major source of vitamin D for most humans is synthesized from the exposure of the skin to sunlight typically between 1000 h and 1500 h in the spring, summer, and fall. <strong>Vitamin D produced in the skin may last at least twice as long in the blood compared with ingested vitamin D.</strong> When an adult wearing a bathing suit is exposed to one minimal erythemal dose of UV radiation (a slight pinkness to the skin 24 h after exposure), the amount of vitamin D produced is equivalent to ingesting between 10,000 and 25,000 IU. A variety of factors reduce the skin's production of vitamin D3, including increased skin pigmentation, aging, and the topical application of a sunscreen. An alteration in the zenith angle of the sun caused by a change in latitude, season of the year, or time of day dramatically influences the skin's production of vitamin D3.</p>\n</blockquote>\n<p>Further, producing D uses up cholesterol and sulfate, since D is found in more forms in the human body than just those D1-3 compounds:</p>\n<blockquote>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/26708628\" rel=\"nofollow noreferrer\"><strong>Determination of four sulfated vitamin D compounds in human biological fluids by liquid chromatography-tandem mass spectrometry. (2016)</strong></a><br>\nThe determination of both the water-soluble and lipid-soluble vitamin D compounds in human biological fluids is necessary to illuminate potentially significant biochemical mechanisms. The lack of analytical methods to quantify the water-soluble forms precludes studies on their role and biological functions; currently available liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods are able to determine only a single sulfated form of Vitamin D. We describe here a highly sensitive and specific LC-MS/MS method for the quantification of four sulfated forms of vitamin D: vitamins D2- and D3-sulfate (D2-S and D3-S) and 25-hydroxyvitamin D2- and D3-sulfate (25(OH)D2-S and 25(OH)D3-S). A comparative evaluation showed that the ionization efficiencies of underivatized forms in negative ion mode electrospray ionisation (ESI) are superior to those of the derivatized (using 4-phenyl-l,2,4-triazoline-3,5-dione (PTAD)) forms in positive ion mode ESI. Separation was optimised to minimise co-elution with endogenous matrix compounds, thereby reducing ion suppression/enhancement effects. Isotopically labelled analogues of each compound were used as internal standards to correct for ion suppression/enhancement effects. The method was validated and then applied for the analysis of breastmilk and human serum. The detection limits, repeatability standard deviations, and recoveries ranged from 0.20 to 0.28fmol, 2.8 to 10.2%, and 81.1 to 102%, respectively.</p>\n</blockquote>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pubmed/29173203\" rel=\"nofollow noreferrer\">Different forms</a> have different <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/29045457\" rel=\"nofollow noreferrer\">actions</a> and even if all forms might be transformed from D3 alone that requires enzymes whose efficiency is not necessarily equally adequate across the whole population or whose inter-actions involves competing pathways. Supplements usually contain only one single form.</p>\n<p>But since skin colour, clothing habits or necessities, and latitude make it almost impossible for many people to get enough sun exposure there is just no other way but too increase the D level by ingesting <em>some</em> form to reach amounts needed or amounts considered 'optimal' or beneficial.</p>\n<p>As can be seen from the second link: <br>\nsunlight &gt; D-containig food &gt; supplements</p>\n<p><a href=\"http://www.nice.org.uk/guidance/ng34/resources/sunlight-exposure-risks-and-benefits-1837392363205\" rel=\"nofollow noreferrer\">Sunlight</a> (as always: in <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/28323044\" rel=\"nofollow noreferrer\">moderation</a>) has other beneficial effects beyond D, but even as food might not provide enough D, supplements <em>then</em> are still very probably a <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/29299734\" rel=\"nofollow noreferrer\">worthwhile option</a>.</p>\n", "score": 6 } ]

[ "micronutrients" ]

[ { "answer_id": 15477, "body": "<p>Yes.</p>\n\n<p><a href=\"https://medlineplus.gov/ency/article/000313.htm\" rel=\"nofollow noreferrer\">MedlinePlus</a>:</p>\n\n<blockquote>\n <p>People with <strong>type 2</strong> diabetes often have no symptoms at first. They may not have symptoms for many years.</p>\n</blockquote>\n\n<p><a href=\"https://books.google.si/books?id=sZODtZoWvlEC&amp;pg=PA413&amp;lpg=PA413&amp;dq=%22type%201%22%20%22asymptomatic%20hyperglycemia%22%20months&amp;source=bl&amp;ots=m5eziNcqgX&amp;sig=-Vc1_dQ_lvsbLtSZJ9SFNw0IlFY&amp;hl=en&amp;sa=X&amp;redir_esc=y#v=onepage&amp;q=%22type%201%22%20%22asymptomatic%20hyperglycemia%22%20months&amp;f=false\" rel=\"nofollow noreferrer\">Google Books: The Epidemiology of Diabetes Mellitus, p. 413...Recent Trends In Screening and Prevention of <strong>Type 1</strong> Diabetes</a>:</p>\n\n<blockquote>\n <p>Mild asymptomatic hyperglycemia precedes by months or years overt insulin dependence among persons with islet auto-antibodies.</p>\n</blockquote>\n\n<p>In diabetes type 1, symptoms usually develop much quicker, though.</p>\n\n<p><a href=\"https://www.diabetes.co.uk/diabetes-symptoms.html\" rel=\"nofollow noreferrer\">Diabetes.co.uk</a>:</p>\n\n<blockquote>\n <p>In type 1 diabetes, the signs and symptoms can develop very quickly,\n and can develop significantly over the course of weeks or even days -\n particularly in children or adolescents.</p>\n</blockquote>\n", "score": 6 }, { "answer_id": 16870, "body": "<p>Speaking for type 1 diabetes, and supposing that a patient has exited his/her \"Honeymoon\" phase, the timespan before accusing severe symptoms (hypo/hyperglycemia) is very short and highly depending on <strong>what it is being eaten</strong> and on the <strong>physical activity</strong> done.<br> There are several indicators that could raise red flags, like: <strong>drinking a high amount of water</strong> (5-6 to 9-10 litres per day) with the consequent high frequency of urinating (a symptom of hyperglycemia), the <strong>need of eating voraciously</strong> and with more quantities (a symptom of hypoglycemia), and so on. <br> \nThe fastest way to detect whether or not these symptoms are related to diabetes is with a simple finger stick blood sugar test.</p>\n\n<p><a href=\"http://www.jdrf.org/t1d-resources/symptoms/\" rel=\"nofollow noreferrer\">Symptoms</a> <br>\n<a href=\"https://www.diabetes.co.uk/blood-glucose/honeymoon-phase.html\" rel=\"nofollow noreferrer\">Honeymoon period</a><br>\n<a href=\"https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/diagnosis-treatment/drc-20353017\" rel=\"nofollow noreferrer\">Diagnostic</a></p>\n", "score": 3 } ]

[ "diabetes" ]

[ { "answer_id": 15875, "body": "<p>To answer this question you would need to find the source of the information. I found the study mentioned in the article in the Toronto Star (<a href=\"https://doi.org/10.1016/S0140-6736(16)32399-6\" rel=\"noreferrer\">Chen, et al. 2017</a>); and while studying risks of dementia, Parkinson's disease and multiple sclerosis, with emphasis mine, they said:</p>\n\n<blockquote>\n <p>In this population-based cohort study, we assembled two population-based cohorts including all adults aged 20–50 years (about 4·4 million; multiple sclerosis cohort) and all adults aged 55–85 years (about 2·2 million; dementia or Parkinson's disease cohort) who resided in Ontario, Canada on April 1, 2001. <strong>Eligible patients were free of these neurological diseases, Ontario residents for 5 years or longer, and Canadian-born.</strong></p>\n</blockquote>\n\n<p>Between 2001, and 2012, they identified </p>\n\n<ul>\n<li>243,611 incident cases of dementia,</li>\n<li>31,577 cases of Parkinson's disease, and</li>\n<li>9,247 cases of multiple sclerosis.</li>\n</ul>\n\n<p>They provided adjusted hazard ratios in the study - a comparison of the effect of different variables on survival or other outcomes that develop over time (Dawson, 2008). See also <a href=\"https://www.sciencedirect.com/topics/medicine-and-dentistry/hazard-ratio\" rel=\"noreferrer\">https://www.sciencedirect.com/topics/medicine-and-dentistry/hazard-ratio</a></p>\n\n<p>The adjusted hazard ratio of incident dementia was</p>\n\n<ul>\n<li>1·07 for people living less than 50 m from a major traffic road (95% CI 1·06–1·08),</li>\n<li>1·04 (1·02–1·05) for 50–100 m,</li>\n<li>1·02 (1·01–1·03) for 101–200 m, and</li>\n<li>1·00 (0·99–1·01) for 201–300 m\nversus further than 300 m (<em>p</em> for trend=0·0349).</li>\n</ul>\n\n<blockquote>\n <p>No association was found with Parkinson's disease or multiple sclerosis.</p>\n</blockquote>\n\n<p>Based on the averages used in the study, statistically speaking you will need to be living at least 200 metres (just over 218.5 yards) away from any major road to be relatively free of risk.</p>\n\n<h2>References</h2>\n\n<p>Chen, H., Kwong, J. C., Copes, R., Tu, K., Villeneuve, P. J., Van Donkelaar, A., ... &amp; Wilton, A. S. (2017). Living near major roads and the incidence of dementia, Parkinson's disease, and multiple sclerosis: a population-based cohort study. <em>The Lancet</em>, 389(10070), 718-726.<br>DOI: <a href=\"https://doi.org/10.1016/S0140-6736(16)32399-6\" rel=\"noreferrer\">10.1016/S0140-6736(16)32399-6</a></p>\n\n<p>Dawson, G. F. (2008). Measures of Effect. In: <em>Easy Interpretation of Biostatistics: The Vital Link to Applying Evidence in Medical Decisions</em>. Philadelphia, PA: Saunders<br>DOI: <a href=\"https://doi.org/10.1016/B978-1-4160-3142-0.50027-4\" rel=\"noreferrer\">10.1016/B978-1-4160-3142-0.50027-4</a> (Free Preview)</p>\n", "score": 7 }, { "answer_id": 18228, "body": "<p>There are many factors to consider. The pollution level (and risk) depends on at least the following:</p>\n\n<ul>\n<li>typical wind direction during rush hour</li>\n<li>density of trees between you and the road</li>\n<li>elevation difference between you and the road</li>\n<li>presence of a noise wall between you and the road</li>\n<li>level and type of traffic on the road</li>\n</ul>\n\n<p>This page aggregated a large number of studies to try to answer this and settled on greater than 300 meters. Based on the studies cited in it and everything I've seen, that seems reasonable.</p>\n\n<p><a href=\"http://blog.cityprojections.com/2018/12/how-far-should-you-live-from-road-to.html\" rel=\"nofollow noreferrer\">http://blog.cityprojections.com/2018/12/how-far-should-you-live-from-road-to.html</a></p>\n", "score": 4 } ]

[ "lungs", "cardiovascular-disease", "air-quality", "asthma", "dementia" ]

[ { "answer_id": 17812, "body": "<blockquote>\n <p>Do some proteins survive human digestion?</p>\n</blockquote>\n\n<p>Yes. Prions are misfolded proteins with abnormal tertiary or quaternary structures. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/24338008\" rel=\"noreferrer\">That grants them resistance (to some extent, at least) to proteases (1)</a>. </p>\n\n<p>Also, researchers believe that <a href=\"http://www.nejm.org/doi/full/10.1056/NEJM199609193351218\" rel=\"noreferrer\">prions are able to replicate (2)</a>, by changing the structure of other proteins.</p>\n\n<p>Besides, <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/3060169\" rel=\"noreferrer\">It has been shown that small quantities of intact proteins do cross the gastrointestinal tract in animals and adult humans (3)</a>, and that this is a physiologically normal process required for antigen sampling by sub-epithelial immune tissue in the gut.</p>\n\n<p><strong>So, the resistance to the proteases and the ability to replicate in certain conditions might explain the odds of a prion crossing the gastrointestinal tract and infecting an individual.</strong></p>\n\n<hr>\n\n<p><strong>References:</strong></p>\n\n<ol>\n<li><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/24338008\" rel=\"noreferrer\">http://www.ncbi.nlm.nih.gov/pubmed/24338008</a></li>\n<li><a href=\"http://www.nejm.org/doi/full/10.1056/NEJM199609193351218\" rel=\"noreferrer\">http://www.nejm.org/doi/full/10.1056/NEJM199609193351218</a></li>\n<li><a href=\"http://www.ncbi.nlm.nih.gov/pubmed/3060169\" rel=\"noreferrer\">http://www.ncbi.nlm.nih.gov/pubmed/3060169</a></li>\n</ol>\n", "score": 5 } ]

[ "digestion", "proteins", "enzyme" ]

[ { "answer_id": 20705, "body": "<p><strong>In summary,</strong> intermittent fasting could help decrease <em>appetite</em> and thus make weight loss easier for some people, but there is no convincing evidence that it would <em>stimulate catabolism</em> more than other methods of weight loss.</p>\n\n<hr>\n\n<blockquote>\n <p>If you're fasting for 16 hours, eat 100 calories, then fast 16 more,\n how significantly different is that from fasting 32 hours?</p>\n</blockquote>\n\n<p>If you burn, let's say, 2,400 Calories/day, that is 100 Calories/hour, you can see that consuming 100 Calories will pause the fasting metabolic processes only for about an hour and then you will be again in the fasting mode. If at least a part of those 100 calories come from carbohydrates, they can prevent you to go into ketosis, which could otherwise occur toward the end of your second part of fast - you can see <a href=\"https://medicalsciences.stackexchange.com/a/20485/3002\">this answer</a> for explanation. But again, ketosis as such is not associated with increased catabolism.</p>\n\n<blockquote>\n <p>Is there something special about exactly 0 calories vs 1 calorie?</p>\n</blockquote>\n\n<p>No, consuming 1 vs 0 Calories will make only the effect that 1 Calorie can make on your metabolism, that is providing energy for about half of a minute and then continuing as if on zero calorie diet. </p>\n\n<p>According to <a href=\"https://pubmed.ncbi.nlm.nih.gov/26384657-do-intermittent-diets-provide-physiological-benefits-over-continuous-diets-for-weight-loss-a-systematic-review-of-clinical-trials/\" rel=\"nofollow noreferrer\">Do Intermittent Diets Provide Physiological Benefits Over Continuous Diets for Weight Loss? A Systematic Review of Clinical Trials (Molecular and Cellular Endocrinology, 2015)</a>, intermittent fasting can reduce appetite and thus help in weight loss, but not necessary better than other diets:</p>\n\n<blockquote>\n <p>While intermittent fasting appears to produce similar effects to\n continuous energy restriction to reduce body weight, fat mass,\n fat-free mass and improve glucose homeostasis, and may reduce\n appetite, it does not appear to attenuate other adaptive responses to\n energy restriction or improve weight loss efficiency.</p>\n \n <p>Intermittent fasting thus represents a valid--albeit apparently not\n superior--option to continuous energy restriction for weight loss.</p>\n</blockquote>\n", "score": 2 } ]

[ "nutrition", "calories", "fasting", "glucose" ]

[ { "answer_id": 16833, "body": "<h2>The ingredients one by one</h2>\n\n<ul>\n<li><p><strong>Sorbitol</strong>:<br>\nAn alcohol sugar, and a sugar substitute. However, xylitol has become more widely used because a few type of bacteria (Streptococcus mutans) can process sorbitol and as such it is more anticariogenic.</p>\n\n<blockquote>\n <p>In addition, sorbitol has one-third fewer calories and 60 % the sweetening activity of sucrose and is used as a sugar replacement in diabetes.<br>\n <em>_{Source: <a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/5780#section=Top\" rel=\"nofollow noreferrer\">PubChem</a></em>}</p>\n</blockquote></li>\n<li><p><strong>L-theanine</strong>:<br>\nThe use of theanine is widely debated:</p>\n\n<blockquote>\n <p>The German Federal Institute for Risk Assessment, an agency of their Federal Ministry of Food and Agriculture, objects to the addition of L-theanine to beverages. The European Food Safety Authority EFSA advised negatively on health claims related to L-theanine and cognitive function, alleviation of psychological stress, maintenance of normal sleep, and reduction of menstrual discomfort. Therefore, health claims for L-theanine are prohibited in the European Union.<br>\n _{<em>Source: <a href=\"https://pubchem.ncbi.nlm.nih.gov/compound/439378#section=Top\" rel=\"nofollow noreferrer\">Pubchem</a></em>}</p>\n</blockquote>\n\n<p>Its mechanism of action is pretty complicated, it appears to be mostly are neuro-agent (although literature is contradictive there as well), but I'll research more.</p></li>\n<li><p><strong>Caffeine</strong>:<br>\nCaffeine is a vasoconstrictor. As such, it constricts the arteries and - in this case more importantly - the arterioles. The skin turns paler because less blood reaches it surface. This way, heat radiation from the skin is limited in the extremities. This also happens when you feel cold, and it explains why feet and hands start to get cold first. This is however the opposite of what you describe (but similar to the way Raynauds affects your body temperature)</p></li>\n<li><p><strong>Calcium Stearate</strong>:<br>\nNothing more than a flow agent and surface conditioner, also used in other candies such as Smarties</p></li>\n<li><p><strong>Steviol Glycoside</strong>:<br>\nArtificial sweetener, more commonly known as Stevia. </p></li>\n<li><p><strong>Acesulfame K (potassium)</strong>:<br>\nAnother artificial sweetener </p></li>\n<li><p><strong>Vitamins and Flavour Agents</strong><br>\nThey won't have anything to do with it.</p></li>\n</ul>\n\n<hr>\n\n<p>Speculations:</p>\n\n<ol>\n<li><p>It is the caffeine.\nThis is kind of contradicting what I wrote above, but <a href=\"https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-study-suggests-caffeine-intake-may-worsen-menopausal-hot-flashes-night-sweats/\" rel=\"nofollow noreferrer\">some studies</a> associate the caffeine with hot flashes in the female menopause. The underlying mechanism is not yet understood (and in fact, other studies claim that caffeine decreases the risk), but that might be.</p></li>\n<li><p>It's a placebo effect. Maybe you once felt warmer due to other reasons after consuming it, and now it's just a placebo. </p></li>\n</ol>\n", "score": 2 }, { "answer_id": 16895, "body": "<p>Your experience that alcohol warms your fingers and the fact that the drug <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/2076403\" rel=\"nofollow noreferrer\">nifedipine</a> is used in Raynaud's symptoms relief suggest that the mechanism involved in warming fingers is <em>vasodilation.</em></p>\n\n<p>From the list of ingredients in your product, <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/22819553\" rel=\"nofollow noreferrer\"><strong>L-theanine</strong> can cause arterial vasodilation</a> and could therefore be theoretically responsible for symptoms relief.</p>\n\n<p><strong>Caffeine</strong> can have a vasoconstricting effect, but, according to <a href=\"https://www.uptodate.com/contents/initial-treatment-of-the-raynaud-phenomenon\" rel=\"nofollow noreferrer\">UpToDate</a>, \"its xanthine-related properties may result in systemic vasodilation,\" which may result in fingers warming.</p>\n\n<p>I have not found any credible medical source that would suggest either L-theanine or caffeine for treatment of Raynaud's, though.</p>\n\n<p><strong>Melatonin</strong> can also have a vasodilating effect (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044053/\" rel=\"nofollow noreferrer\">PubMed</a>):</p>\n\n<blockquote>\n <p>When ingested as a supplement in humans, melatonin enhances the\n cutaneous vasodilating response during heating and blunts the\n cutaneous vasoconstrictor response during cooling. </p>\n</blockquote>\n", "score": 1 }, { "answer_id": 17471, "body": "<p>EDIT: Its thoracic outlet syndrome. If I do certain stretches it goes away</p>\n\n<h2>Old:</h2>\n\n<p>So I looked into it, and I found those ingredients are actually good for \"carpel tunnel\" which has been found to be related to raynauds in some cases... this is essentially a pinched nerve due to bad posture (common in computer scientists). I don't think I have this in my hands, but probably in my shoulders or back (from hunching over a computer all day over years). So I started looking into youtube videos relating to this and got some suggestions for things to try. Luckily I have found that when I straighten my <strong>neck back</strong> (and decompress the right bone/nerve), I can feel the problem going away immediately. Its weird, I can't really explain it but I also notice an almost immediate difference in the way my hands feel.</p>\n\n<p>Anyways, I'm going to a good chiropractor to investigate and hopefully correct this problem, I will update this thread later with any updates. We will see.</p>\n\n<p>Also important to note I've never had it in my toes or anything.</p>\n", "score": 1 } ]

[ "nutrition", "neurology", "blood-circulation", "nervous-system", "b-12-supplements" ]

[ { "answer_id": 17711, "body": "<p>There is a similar question from biology section(<a href=\"https://biology.stackexchange.com/questions/15712/how-do-viruses-or-bacteria-survive-outside-the-body-long-enough-to-spread\">https://biology.stackexchange.com/questions/15712/how-do-viruses-or-bacteria-survive-outside-the-body-long-enough-to-spread</a>) but your question focuses more on the pathophysiology.</p>\n\n<p>There will be several factors affecting it's ability to 'infect'. One is the virus' ability to survive outside a host cell, viruses aren't technically alive hence they can't be killed, only inactivated. If your skin is exposed to a viral protein of an inactivated virus, it will no longer be capable of injecting the said proteins inside the cell. Inactivated virus is also a method of vaccination.</p>\n\n<p>Another factor would be the amount of pathogen required to cause an active infection. Some viruses would need 1 and some hundreds to cause a disease.</p>\n\n<p>Source:\nOne Virus Particle Is Enough To Cause Infectious Disease</p>\n\n<p><a href=\"https://www.sciencedaily.com/releases/2009/03/090313150254.htm\" rel=\"nofollow noreferrer\">https://www.sciencedaily.com/releases/2009/03/090313150254.htm</a></p>\n\n<p>Viral inactivation</p>\n\n<p><a href=\"https://en.m.wikipedia.org/wiki/Virus_processing\" rel=\"nofollow noreferrer\">https://en.m.wikipedia.org/wiki/Virus_processing</a></p>\n", "score": 3 } ]

[ "disease-transmission", "virus", "infectious-diseases", "hiv" ]

[ { "answer_id": 17632, "body": "<p>I share your feelings about gallbladder removal being barbaric.</p>\n\n<p>Here is some reasoning why most gallbladder conditions are treated by gallbladder removal.</p>\n\n<ol>\n<li>Alternative treatments, such as <strong>gallstone dissolution</strong> with ursodeoxycholic acid is effective only for <strong>small gallstones (&lt;0.5 cm);</strong> also, after discontinuation of treatment, the stones often reappear (<a href=\"https://emedicine.medscape.com/article/175667-treatment#showall\" rel=\"nofollow noreferrer\">Emedicine</a>).</li>\n<li>Making a cut in the gallbladder and removing gallstones is a major risk for a serious abdominal infection (peritonitis), which can occur even after gallbladder removal (<a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464996/\" rel=\"nofollow noreferrer\">PubMed</a>). This is especially critical in <strong>acute gallbladder inflammation.</strong></li>\n<li><strong>Chronic gallbladder inflammation</strong> can cause pain and gallbladder removal is pretty much the only known treatment (<a href=\"https://medlineplus.gov/ency/article/000217.htm\" rel=\"nofollow noreferrer\">MedlinePlus</a>).</li>\n<li>To effectively treat <strong>gallbladder cancer,</strong> you typically need to remove some tissue around it (safe margin) and this is most reliably done by removing the gallbladder.</li>\n</ol>\n\n<p>It is true that about 1/3 of people, after gallbladder removal, will have long-term problems with diarrhea, but this is due to irritation by large amounts of bile that constantly flows from the liver to the intestine and not due to fat maldigestion (<a href=\"https://www.mayoclinic.org/tests-procedures/cholecystectomy/expert-answers/gallbladder-removal/faq-20058481\" rel=\"nofollow noreferrer\">Mayo Clinic</a>). Many people will have no symptoms.</p>\n\n<p>If the origin of pain is in the gallbladder, the pain should disappear after gallbladder removal. The pain that persists after the removal usually arises from the <em>bile ducts</em> that stay in the body, for example, due to stones in the bile ducts or sphincter of Oddi dysfunction.</p>\n\n<p>In elderly or severely ill individuals, who are not fit enough to undergo gallbladder removal, drainage of the gallbladder can be performed as a palliative measure with a temporary effect (<a href=\"https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0058062/\" rel=\"nofollow noreferrer\">PubMed Health</a>). </p>\n", "score": 6 }, { "answer_id": 17707, "body": "<p>Simple answer. \"Once a stone former, always a stone former\"</p>\n\n<p>\"Gallstones recur in about 50% of patients, and that the risk of recurrence is confined mainly to the first 5 years after dissolution.\" Hence, we remove them</p>\n\n<p>Source:</p>\n\n<p>Management of recurrent gallstones.\nReview article\nLanzini A, et al. Baillieres Clin Gastroenterol. 1992</p>\n\n<p><a href=\"https://www.ncbi.nlm.nih.gov/m/pubmed/1486214/\" rel=\"nofollow noreferrer\">https://www.ncbi.nlm.nih.gov/m/pubmed/1486214/</a></p>\n", "score": 2 } ]

[ "gallbladder", "gallstone" ]

[ { "answer_id": 17822, "body": "<p><strong>NOTE: I cannot give you any references in english, since the documentation I have to backup these claims is in Portuguese.</strong></p>\n\n<blockquote>\n <p>Do medical laboratories determine accuracies for their blood tests that have numerical results?</p>\n</blockquote>\n\n<p>In order for a lab to be certified (in my country at least, but I reckon this is probably true for other countries), periodic calibrations and validations of the lab equipment and methodology are required.</p>\n\n<p>Different types of tests require different methods of validation but they usually fall into two (very) broad categories:</p>\n\n<ol>\n<li><p>Validation against a known substance/quantity;</p>\n\n<p>Example: To check if the chlorine reader is working properly, you test the machine against a sealed vial containing a known concentration of chlorine.</p></li>\n<li><p>Blind checks against the results of another certified labs.</p>\n\n<p>Example: Blood cell count (automatic or manual (by a human, on a microscope)). A blood sample is divided evenly into two vials and one is sent to another certified lab. Usually several measures of the same sub sample are performed, in order to reduce sampling error.</p></li>\n</ol>\n\n<p>For a lab to reach the maximum certification level, both types of tests are performed several times for each lab test.</p>\n\n<hr>\n\n<blockquote>\n <p>If so, where can I find these accuracies? If not, why not?</p>\n</blockquote>\n\n<p>Regarding the \"accuracy\", it depends on many factors (method of collecting samples, method of transportation of sample, the time bewteen collection and test run, etc...). </p>\n\n<p>But for automatic tests, but the most important is the \"machine\" used to test it. The machine's manual usually gives you the <strong>value of the error</strong> or <strong>the confidence interval</strong>.</p>\n\n<p>So, in order to get a pretty good estimate of the \"accuracy\" of the lab test, you only need to know the \"machine\" used and you can google search for the manual or brochure to find that out. <a href=\"http://www.bio-rad.com/webroot/web/pdf/lsr/literature/Bulletin_6814.pdf\" rel=\"nofollow noreferrer\">example</a>. Or, failing that, call the manufacturer and ask for that value.</p>\n\n<p>If your country or state has a certification level, a quicker way might be through the certification level of the lab. Each level has a \"tolerance\" value, that is, the maximum acceptable deviation from the expected value.</p>\n\n<p>Also, for tests that rely heavily on humans, the \"tolerance\" value is the only way you can estimate the \"accuracy\" of the test.</p>\n\n<hr>\n\n<p>sources:</p>\n\n<p><a href=\"https://www.dgs.pt/departamento-da-qualidade-na-saude/ficheiros-anexos/manual-de-standards-para-laboratorios-clinicos_print_-v31.aspx\" rel=\"nofollow noreferrer\">Manual for Clinical Lab standards (in portuguese)</a></p>\n", "score": 6 } ]

[ "test-results" ]

[ { "answer_id": 17815, "body": "<p>In the case of spirometry, after taking the deepest possible breath, there are two values used most often:</p>\n\n<ol>\n<li>FVC (forced vital capacity) is the total volume of air that the person can exhale. There will still be some air in the lungs even after exhaling to the max possible.</li>\n<li>FEV1 (<a href=\"https://www.sciencedirect.com/topics/medicine-and-dentistry/spirometry\" rel=\"noreferrer\">Forced Expiratory Volume in 1 second</a>) is how much air a person can exhale in 1 second when trying to exhale as fast as they can. As you can see below, since the normal ratio of FEV1/FVC is 0.8, the majority of air can be expelled within one second normally.</li>\n</ol>\n\n<p>Obstructive lung pathology, for example what happens in asthma and COPD, reduces the ability to rapidly expel air due to \"air trapping\" and therefore the FEV1 drops.</p>\n\n<p>Restrictive patterns like fibrosis do not have that kind of air trapping, so the FEV1/FVC ratio is normal or even higher than normal - but FEV1 is lower because the overall lung volume is lower due to the restrictive pathology.</p>\n\n<p>(Of course this is a simplification; there are mixed patterns and fine details that are out of scope of this question.)</p>\n\n<p>Your actual question about why exactly 1 second as opposed to 0.5 or 1.5 is most likely not answerable beyond the above. Often during research on topics, values are chosen because they are simple to use, and then stick. There are a number of odd values in physiology that were chosen by someone who researched it and now we all memorize it.</p>\n\n<p><a href=\"https://i.stack.imgur.com/dHOS8.png\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/dHOS8.png\" alt=\"Spirometry patterns\"></a></p>\n", "score": 5 } ]

[ "lungs" ]

[ { "answer_id": 17832, "body": "<p>Your thought process is correct; in the absence of all other factors, physics dictates that the reduction of pressure surrounding a flexible fluid-filled vessel would result in expansion.</p>\n\n<p>But there is an even stronger force: <a href=\"https://www.cvphysiology.com/Cardiac%20Function/CF016\" rel=\"nofollow noreferrer\">venous return</a>, which is the flow back to the heart from peripheral circulation. (Resource linked is from the author of the cardiology physiology text used in many med schools.)</p>\n\n<ol>\n<li>Inhalation = diaphragm contracts, decreasing intrathoracic pressure</li>\n<li>This causes the R atrium to expand, reducing pressure in the R atrium</li>\n<li>This increases venous return to the R atrium by pulling from the SVC and IVC.</li>\n<li><strong>If this occurs rapidly, then much like sucking liquid rapidly through a flexible tube, the tube (vein) can collapse.</strong></li>\n</ol>\n\n<p>Also <a href=\"https://www.youtube.com/watch?v=RVYKlsoEEMU\" rel=\"nofollow noreferrer\">this video</a> is a good illustration of venous return and its impact on the IVC.</p>\n\n<p><em>I couldn't find a diagram of exactly what I wanted so I altered a graphic to illustrate.</em></p>\n\n<p><a href=\"https://i.stack.imgur.com/bHHCP.jpg\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/bHHCP.jpg\" alt=\"enter image description here\"></a></p>\n\n<p><a href=\"https://i.stack.imgur.com/Co33w.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/Co33w.png\" alt=\"enter image description here\"></a></p>\n", "score": 6 } ]

[ "blood-circulation", "cardiovascular-disease", "ultrasounds" ]

[ { "answer_id": 18428, "body": "<p><strong>1.</strong> Some individuals with pollen allergy experience mouth itching and swelling after eating certain <em>raw</em> fruits, vegetables and tree nuts. The condition is called <a href=\"https://acaai.org/allergies/types/food-allergies/types-food-allergy/oral-allergy-syndrome\" rel=\"nofollow noreferrer\"><strong>oral allergy syndrome</strong></a> or <strong>pollen-food syndrome.</strong></p>\n\n<p><strong>2. A certain food allergy as such</strong> may increase intestinal permeability <strong>(leaky gut syndrome)</strong> and allow additional allergens to enter the blood, which can result in multiple food allergies (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16880015/\" rel=\"nofollow noreferrer\">PubMed, 2006</a> ; <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5288588/\" rel=\"nofollow noreferrer\">PubMed, 2016</a>).</p>\n\n<p><strong>3.</strong> The use of <strong><a href=\"https://medicalsciences.stackexchange.com/questions/18354/is-there-solid-evidence-that-antibiotics-cause-allergies\">antibiotics</a></strong> in infancy can increase the risk of food allergies later in life.</p>\n\n<p><strong>4. <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751572/\" rel=\"nofollow noreferrer\">Orofacial granulomatosis</a></strong> (which may or may not be associated with Crohn's disease) increases the risk for food allergies. A cinnamon- and benzoate-free diet can help (<a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16775496/\" rel=\"nofollow noreferrer\">PubMed, 2006</a>).</p>\n\n<p><strong>5.</strong> Children with <strong><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696370/\" rel=\"nofollow noreferrer\">inflammatory bowel disease (Crohn's disease or ulcerative colitis)</a></strong> are at increased risk for food allergies. <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230978/\" rel=\"nofollow noreferrer\">Another study</a> has found an association between inflammatory bowel disease and food allergies.</p>\n\n<p><strong>6. <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/16292078/\" rel=\"nofollow noreferrer\">Infections</strong> or <strong>stress</strong></a> may increase intestinal permeability and thus induce food allergies in susceptible individuals.</p>\n\n<p><strong>7.</strong> Due to <strong><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4482820/\" rel=\"nofollow noreferrer\">cross-reactivity</a></strong>, certain non-food allergens can trigger food allergies: <em>Alternaria</em> (a common mold)-spinach syndrome, dust mite-shrimp syndrome, cat-pork syndrome and bird-egg syndrome.</p>\n\n<hr>\n\n<p>As a side note, <a href=\"https://www.kidswithfoodallergies.org/page/food-protein-induced-enterocolitis-syndrome-fpies.aspx\" rel=\"nofollow noreferrer\">food protein-induced enterocolitis syndrome (FPIES)</a> can develop in infants after introducing solid foods and can present with multiple food allergies, which, unlike traditional IgE-mediated allergies, do not cause itching, hives, swelling, coughing or wheezing, but \"only\" gastrointestinal symptoms, such as diarrhea.</p>\n", "score": 3 }, { "answer_id": 18429, "body": "<p>Experts believe having eczema increases the risk a child may develop food allergies and other allergic conditions later in life.\nAbout one-third of children with moderate to severe eczema have diagnosed food allergies. Likewise, about 30 to 40 percent of all people with eczema also have one or more food allergies.\nAccording to a recent study, young children with food allergies are more than twice as likely to develop asthma or rhinitis before age 5, compared to those without food allergies. The risk for respiratory allergies is higher in children who are allergic to milk, egg or peanut. This is also true for children with multiple food allergies (<a href=\"http://www.aaaai.org/\" rel=\"nofollow noreferrer\">http://www.aaaai.org/</a>).</p>\n\n<p>Chronic respiratory symptoms are not thought to be caused by food allergies. When respiratory symptoms occur during allergic reactions to foods, they occur suddenly and usually are not the only symptom. Instead, they appear alongside other symptoms affecting the skin, gastrointestinal tract and other parts of the body (<a href=\"http://www.aaaai.org/\" rel=\"nofollow noreferrer\">http://www.aaaai.org/</a>)</p>\n\n<p>People with both asthma and food allergies are at higher risk of experiencing life-threatening anaphylaxis during a food allergy reaction. Research has similarly shown that having a food allergy is linked to having worse asthma symptoms and more hospitalizations from asthma.\nIgg is the immune response to pathogens like bacteria, viruses, and fungi. It is not the type of response typical to allergens.\nIn an Allergic March the typical sequence is patients develop allergic diseases; starting first with eczema, then followed by food allergy, asthma, and allergic rhinitis <a href=\"http://www.aaaai.org/\" rel=\"nofollow noreferrer\">aka hay fever</a>.\nI believe it is worthy to both look for an underlying cause and attempt desensitization. There may be an underlying condition that is linked to the food allergies. Yet, desensitization may also work and alleviate some of the person's suffering. </p>\n", "score": 1 } ]

[ "allergy" ]

[ { "answer_id": 21204, "body": "<p>I work in a pediatric office, and we regularly administer combination vaccines to our patients. (Such as Pediarix, Pentacel, ProQuad, etc.) You can check out table 2 in <a href=\"https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/us-vaccines.pdf\" rel=\"nofollow noreferrer\">this link</a> to see all CDC approved combo vaccines in the U.S.</p>\n\n<p>On a side note, the CDC does not even consider MMR (or DTaP for that matter as well) to be a combo shot as it is hard to find a vaccine for each individual component of those vaccines. (<a href=\"https://www.cdc.gov/vaccines/parents/why-vaccinate/combination-vaccines.html\" rel=\"nofollow noreferrer\">Source</a>)</p>\n", "score": 3 } ]

[ "vaccination" ]

[ { "answer_id": 31647, "body": "<p>While there has been some research showing that exposure to a large amount of non ionizing radiation can be harmful, at this time there is no definitive research showing that this exposure is definitely harmful.</p>\n<p>Exposure to radio frequency energy is measured in SAR (specific absorption rate) In the US, <a href=\"https://transition.fcc.gov/oet/info/documents/bulletins/oet65/oet65.pdf\" rel=\"noreferrer\">the FCC requires</a>* that a transmitting facility take action to limit the exposure of the general public to 0.08W/kg. Workers who are in direct contact with transmission equipment may have exposure of up to 0.4W/kg. <a href=\"https://www.scielo.br/j/ibju/a/Rg9yjCFyL3bHTwcLy8nGMsp/?lang=en\" rel=\"noreferrer\">One of the sources linked</a> on Wikipedia showing a decrease in sperm motility and viability was looking at exposure levels of 1.46W/kg and 27.5W/kg, over 18 times the limit for general population exposure.</p>\n<p><a href=\"https://ntp.niehs.nih.gov/whatwestudy/topics/cellphones/index.html\" rel=\"noreferrer\">Another study</a> looking at cancer risk in rodents was measuring levels between 1.5W/kg and 10W/kg. Even at these levels, <a href=\"https://www.nih.gov/news-events/news-releases/high-exposure-radiofrequency-radiation-linked-tumor-activity-male-rats\" rel=\"noreferrer\">&quot;it was unclear if any of these tumor increases were related to [radio frequency exposure]&quot;</a></p>\n<p>*: Limits defined on page 75, guidelines for controlling exposure are pages 52 to 59</p>\n", "score": 5 } ]

[ "cancer", "physical-health", "bioelectromagnetics", "cellular-phone" ]

[ { "answer_id": 24613, "body": "<p>From</p>\n<p><a href=\"https://doi.org/10.1007/s11606-020-06067-8\" rel=\"nofollow noreferrer\">Masks Do More Than Protect Others During COVID-19: Reducing the Inoculum of SARS-CoV-2 to Protect the Wearer</a></p>\n<p>Authors: <strong>Monica Gandhi MD, MPH, Chris Beyrer MD, MPH &amp; Eric Goosby MD</strong><br />\nPublished: <strong>Journal of General Internal Medicine (2020)</strong></p>\n<p>(<strong>emphasis</strong> mine):</p>\n<blockquote>\n<p><strong>A report</strong> from a pediatric hemodialysis unit in Indiana, <strong>where all patients and staff were masked, demonstrated that staff rapidly developed antibodies</strong> to SARS-CoV-2 after exposure to a single symptomatic patient with COVID-19. In the setting of masking, however, <strong>none of the new infections was symptomatic</strong>. <strong>And in a recent outbreak</strong> in a seafood processing plant in Oregon <strong>where all workers were issued masks each day at work, the rate of asymptomatic infection</strong> among the 124 infected <strong>was 95%</strong>. <strong>An[other] outbreak</strong> in a Tyson chicken plant in Arkansas <strong>with masking also showed a 95% asymptomatic rate of infection</strong>.</p>\n<p>One model showed a correlation between population-level masking and number of COVID-19 cases in various countries, but an even stronger correlation with suppression of COVID-related death rates.However, it should be acknowledged that this model could not account for all confounders that led to such low death rates in the regions examined. This group showed that, if 80% of the population wears a moderately effective mask, nearly half of the projected deaths over the next two months could be prevented. Countries accustomed to masking since the 2003 SARS-CoV pandemic, including Japan, Hong Kong, Taiwan, Thailand, South Korea, and Singapore, and those who newly embraced masking early on in the COVID-19 pandemic, such as the Czech Republic, have fared well in terms of rates of severe illness and death. Indeed, even when cases have resurged in these areas with population-based masking upon re-opening (e.g., South Korea, Singapore, Hong Kong, Taiwan), the case-fatality rate has remained low,47 which is suggestive of this viral inoculum theory.</p>\n</blockquote>\n<p>One of the doctors that authored the research above also published <a href=\"https://www.inverse.com/mind-body/masks-breathing-in-less-coronavirus-means-you-get-less-sick\" rel=\"nofollow noreferrer\">this article</a> where she wrote (<strong>emphasis</strong> mine):</p>\n<blockquote>\n<p>When you breathe in a respiratory virus, it immediately begins hijacking any cells it lands near to turn them into virus production machines. The immune system tries to stop this process to halt the spread of the virus.</p>\n<p><strong>The amount of virus that you’re exposed to</strong> – called the viral inoculum, or dose – <strong>has a lot to do with how sick you get.</strong> If the exposure dose is very high, the immune response can become overwhelmed. Between the virus taking over huge numbers of cells and the immune system’s drastic efforts to contain the infection, a lot of damage is done to the body and a person can become very sick.</p>\n<p>On the other hand, if the initial dose of the virus is small, the immune system is able to contain the virus with less drastic measures. If this happens, the person experiences fewer symptoms, if any.</p>\n</blockquote>\n", "score": 1 } ]

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

[ { "answer_id": 21433, "body": "<p>Those are rough estimates coming from estimates of the <em>basic reproduction number</em> <em>R</em>₀¹, which for COVID-19 are between 2 and 3². <em>R</em>₀ is a measure of how transferable a disease is, and it measures on average how many people an infectious individual will pass the disease to. 1-1/<em>R</em>₀ is the fraction of the total population which needs to develop immunity, either through a vaccine (which currently doesn't exist for COVID-19) or because they got infected and recovered, developing immunity. </p>\n\n<p>This can be intuitively understood in the following way: if 1 infectious individual infects on average 3 other susceptible individuals (<em>R</em>₀=3), then, if 1-1/3=2/3 of the total population develop immunity, then 2 out of the 3 persons which would normally be infected won't be. This means that on average one infectious individual infects another one, before recovering. Thus the size of the disease doesn't grow, but it ends up in a so-called \"endemic state\".</p>\n\n<p>Coming back to COVID-19 and considering the two extreme values for <em>R</em>₀:</p>\n\n<pre><code>&gt; R_0 &lt;- c(2,3)\n&gt; (1-1/R_0)*100\n[1] 50.00000 66.66667\n</code></pre>\n\n<p>we can see where the estimate you were referring to, comes from.</p>\n\n<p><em>R</em>₀ is not to be confused with <em>R</em>, the <em>effective reproduction number</em>, which is the quantity we try to reduce through non-pharmacological interventions during an epidemic.</p>\n\n<hr>\n\n<h2>References</h2>\n\n<ol>\n<li>Milligan, Gregg N.; Barrett, Alan D. T. (2015). Vaccinology : an essential guide. Chichester, West Sussex: Wiley Blackwell. </li>\n<li><a href=\"https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf\" rel=\"nofollow noreferrer\">https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf</a></li>\n</ol>\n", "score": 2 }, { "answer_id": 21307, "body": "<p>Some Canadian experts said <a href=\"https://www.msn.com/en-ca/news/canada/coronavirus-could-infect-35-to-70-per-cent-of-canadians-experts-say/ar-BB10Z837?li=AAggNb9\" rel=\"nofollow noreferrer\">35% to 70%</a> will be infected:</p>\n\n<blockquote>\n <p>According to a disease-transmission model developed by University of\n Toronto researchers, the virus’ overall attack rate in Canada could\n exceed 70 per cent. That number drops sharply, by about half, “if we\n add modest control,” said epidemiologist Dr. David Fisman, one of the\n model’s creators, but it will take “aggressive social distancing and\n large scale quarantines” to reduce it further, he said.</p>\n \n <p>“That’s still a huge number of people ill, and critically ill people\n are a large fraction in this disease,” Fisman said in an email. “I’m\n not going to share more specific numbers because I think they will\n scare people to no particular end.”</p>\n</blockquote>\n\n<p>In reality no one knows. I can tell you if they contain the spread no more people will be infected. If they don't contain the spread more people will be infected. Steps like Italy took today where only essential work can occur and all business closed except transportation, grocery stores and pharmacies are a desperate attempt at containment that may be too late. That said given recent numbers it appears to have worked for China.</p>\n\n<p>The German Chancellor is wasting her time and ours spewing off meaningless numbers that will only serve to scare citizens of the nation she is supposed to lead. Something better would be her plan to make the homeless self-isolate for 14 days at home if they come into contact with someone who was positive or preemptively positive.</p>\n\n<p>Today the WHO leader said if American governments (Federal, State, County, City, etc) do not act it could be \"many, many millions\" dead in the USA. Today's US government talk to borrow 40 billion dollars to spend on the pandemic is not a plan.</p>\n", "score": 1 }, { "answer_id": 21429, "body": "<p>This is a rough estimate based on how contagious this virus is to provide a guess on when herd immunity can be reached.</p>\n\n<blockquote>\n <p>Rough estimates indicate that herd immunity to Covid-19 would be reached when approximately 60% of the population has had the disease</p>\n</blockquote>\n\n<p><a href=\"https://www.bbc.com/news/science-environment-51892402\" rel=\"nofollow noreferrer\">https://www.bbc.com/news/science-environment-51892402</a></p>\n\n<p>The percentage needed for herd immunity depends on the virus. So, for measles, it is required that about 95% of the community be immune before herd immunity is effective for your local population.</p>\n\n<p><a href=\"https://www.globalhealthnow.org/2019-12/myth-about-herd-immunity\" rel=\"nofollow noreferrer\">https://www.globalhealthnow.org/2019-12/myth-about-herd-immunity</a></p>\n", "score": 1 } ]

[ "epidemiology" ]

[ { "answer_id": 21660, "body": "<h2>TL;DR: please WEAR A MASK!</h2>\n\n<p>(unless your nearby hospitals are out of it, in which case give your masks to them and stay at home)</p>\n\n<hr>\n\n<p>The link you mentioned provides the reason that the CDC likely has in mind (though I agree it doesn't identify it clearly as the reason):</p>\n\n<blockquote>\n <p>The worldwide supply of masks is limited. It's critical that we use them appropriately. [i.e., prioritizing them for high-risk people].</p>\n</blockquote>\n\n<p>Thought the <a href=\"https://www.washingtonpost.com/health/cdc-considering-recommending-general-public-wear-face-coverings-in-public/2020/03/30/6a3e495c-7280-11ea-87da-77a8136c1a6d_story.html\" rel=\"nofollow noreferrer\">CDC is now considering recommending general public wear face coverings in public</a>.</p>\n\n<p>{1} compiled different government guidelines on the use of mask. You'll see that some of them do recommend wearing a mask whereas others such as the UK mentions that \"there is very little evidence of widespread benefit for members of the public\". Some governments such as the South Korean \ngovernment even distribute free respiratory masks (2 KF94 per person per week in South Korea).</p>\n\n<hr>\n\n<p>A great <a href=\"https://archive.org/details/linlabcovidpresentation20200316\" rel=\"nofollow noreferrer\">summary</a> on the use of fask masks from Stanford researcher <a href=\"http://med.stanford.edu/linlab.html\" rel=\"nofollow noreferrer\">Michael Lin, PhD-MD</a>:</p>\n\n<p><a href=\"https://i.stack.imgur.com/aW0aL.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/aW0aL.png\" alt=\"enter image description here\"></a></p>\n\n<p><a href=\"https://i.stack.imgur.com/YA08a.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/YA08a.png\" alt=\"enter image description here\"></a></p>\n\n<p><a href=\"https://i.stack.imgur.com/OmQO6.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/OmQO6.png\" alt=\"enter image description here\"></a></p>\n\n<p>Also:</p>\n\n<ul>\n<li><a href=\"https://slate.com/news-and-politics/2020/03/experts-question-advice-against-face-mask-use-coronavirus.amp\" rel=\"nofollow noreferrer\">Experts Increasingly Question Advice Against Widespread Use of Face Masks</a></li>\n<li><a href=\"https://www.sciencemag.org/news/2020/03/not-wearing-masks-protect-against-coronavirus-big-mistake-top-chinese-scientist-says#\" rel=\"nofollow noreferrer\">Not wearing masks to protect against coronavirus is a ‘big mistake,’ top Chinese scientist says</a> (thanks <a href=\"https://medicalsciences.stackexchange.com/users/734/scaaahu\">scaaahu</a> for pointing to this article)</li>\n<li><a href=\"https://youtu.be/gAk7aX5hksU?t=895\" rel=\"nofollow noreferrer\">https://youtu.be/gAk7aX5hksU?t=895</a>: interview with Professor Kim Woo-joo from Korea University Guro Hospital, urging the importance of wearing masks.</li>\n<li><a href=\"https://www.wired.com/story/its-time-to-face-facts-america-masks-work/\" rel=\"nofollow noreferrer\">Wierd -2020-03-30 - It's Time to Face Facts, America: Masks Work</a> (<a href=\"https://web.archive.org/web/20200331091038/https://www.wired.com/story/its-time-to-face-facts-america-masks-work/\" rel=\"nofollow noreferrer\">mirror 1</a>) (<a href=\"http://archive.is/scjrL\" rel=\"nofollow noreferrer\">mirror 2</a>) (thanks <a href=\"https://medicalsciences.stackexchange.com/users/734/scaaahu\">scaaahu</a> for pointing to this article)</li>\n<li><a href=\"https://www.maskssavelives.org/\" rel=\"nofollow noreferrer\">https://www.maskssavelives.org/</a> (<a href=\"http://archive.is/zLgvO\" rel=\"nofollow noreferrer\">mirror</a>): contains a lot of details and references on why wearing masks is useful.</li>\n<li><a href=\"https://skeptics.stackexchange.com/q/46156/7654\">Can the SARS-CoV-2 virus float in the air for up to 3 hours?</a></li>\n<li><a href=\"https://skeptics.stackexchange.com/q/47227/7654\">Is wearing facemasks the reason South Korea, Japan, Singapore and Hong Kong have more control of Covid-19</a></li>\n<li><a href=\"https://amp.scmp.com/news/hong-kong/health-environment/article/3078437/mask-or-not-mask-who-makes-u-turn-while-us\" rel=\"nofollow noreferrer\">To mask or not to mask: WHO makes U-turn while US, Singapore abandon pandemic advice and tell citizens to start wearing masks</a></li>\n<li><p><a href=\"https://www.reddit.com/r/Damnthatsinteresting/comments/fuu4lo/mask_vs_no_mask/(https://www.lavision.de/en/news/2020/4302/)\" rel=\"nofollow noreferrer\">https://www.reddit.com/r/Damnthatsinteresting/comments/fuu4lo/mask_vs_no_mask/(https://www.lavision.de/en/news/2020/4302/)</a>:</p>\n\n<p><a href=\"https://i.stack.imgur.com/RnjxK.gif\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/RnjxK.gif\" alt=\"enter image description here\"></a></p></li>\n</ul>\n\n<hr>\n\n<p>References:</p>\n\n<ul>\n<li>{1} Feng, Shuo, Chen Shen, Nan Xia, Wei Song, Mengzhen Fan, and Benjamin J. Cowling. \"Rational use of face masks in the COVID-19 pandemic.\" The Lancet Respiratory Medicine (2020). <a href=\"https://doi.org/10.1016/S2213-2600(20)30134-X\" rel=\"nofollow noreferrer\">https://doi.org/10.1016/S2213-2600(20)30134-X</a></li>\n</ul>\n", "score": 7 } ]

[ "prevention", "epidemiology", "coronavirus", "face-mask-respirator" ]

[ { "answer_id": 22931, "body": "<p>The NEJM <a href=\"https://www.nejm.org/doi/full/10.1056/NEJMe2005477?query=recirc_curatedRelated_article\" rel=\"noreferrer\">editorial</a> that accompanied that issue says:</p>\n<blockquote>\n<p>One antiviral-drug candidate is a combination of the HIV protease inhibitors lopinavir and ritonavir. Lopinavir, which acts against the viral 3CL protease, has modest antiviral activity against SARS-CoV-2.</p>\n</blockquote>\n<p>A quick search shows that SARS-CoV 3CL protease was the topic of some more <a href=\"https://www.pnas.org/content/113/46/12997\" rel=\"noreferrer\">in-depth investigations</a>, including a theoretical Thai <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7094092/\" rel=\"noreferrer\">study of how</a> of lopinavir might act on the 3CLpro of SARS:</p>\n<blockquote>\n<p>it was found that a mixture of two HIV-1 proteinase inhibitors, lopinavir and ritonavir, exhibited some signs of effectiveness against the SARS virus. To understand the fine details of the molecular interactions between these proteinase inhibitors and the SARS virus via complexation, molecular dynamics simulations were carried out for the SARS-CoV 3CLpro free enzyme (free SARS) and its complexes with lopinavir (SARS–LPV) and ritonavir (SARS–RTV). The results show that flap closing was clearly observed when the inhibitors bind to the active site of SARS-CoV 3CLpro.</p>\n<p>[From:] Nukoolkarn et al. &quot;Molecular dynamic simulations analysis of ritronavir and lopinavir as SARS-CoV 3CLpro inhibitors&quot; J Theor Biol.</p>\n</blockquote>\n<p>It's &quot;above my pay grade&quot; to comment whether that makes any sense or not as a practical approach to SARS (or Covid-19) medication, but the paper notes that lopinavir has a similar effect on the HIV protease:</p>\n<blockquote>\n<p>Similarly, this kind of flap (loop) closing was also observed when inhibitors bind in the active site of HIV-1 protease (Hornak et al., 2006a, Hornak et al., 2006b).</p>\n</blockquote>\n<p>As noted <a href=\"http://proteopedia.org/wiki/index.php/Flaps_Morph_for_HIV_Protease\" rel=\"noreferrer\">on Protopedia</a></p>\n<blockquote>\n<p>Drugs that inhibit HIV protease prevent the virus from replicating, and are crucial components of anti-HIV therapies.</p>\n<p>The proteolytic active site of HIV protease is covered by two &quot;flaps&quot;. It is believed that these flaps must open to enable substrate polyprotein to enter the active site. Drugs that inhibit HIV protease tend to &quot;lock&quot; the flaps closed.</p>\n</blockquote>\n<p>So I think they were/are hoping that 3CL plays a similarly vital role for SARS and Covid-19 virus replications, and so that drugs that close it will inhibit virus replication.</p>\n<p>There seem to be other researchers who have <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/17605471?dopt=Abstract\" rel=\"noreferrer\">considered</a> this approach for the SARS-CoVs, so perhaps it has some merit:</p>\n<blockquote>\n<p>One promising approach is to develop small molecule inhibitors of the essential major polyprotein processing protease 3Clpro. Here we report a complete description of the tetrapeptide substrate specificity of 3Clpro using fully degenerate peptide libraries consisting of all 160,000 possible naturally occurring tetrapeptides.</p>\n</blockquote>\n<p>There's even a library-compound-search paper like that (i.e. trying to find molecules that would inhibit its 3CL) for SARS-CoV-2 out <a href=\"https://doi.org/10.1016/j.jpha.2020.03.009\" rel=\"noreferrer\">already</a> (published March 26) by Chinese and Saudi researchers:</p>\n<blockquote>\n<p>The viral 3-chymotrypsin-like cysteine protease (3CLpro) enzyme controls coronavirus replication and is essential for its life cycle. 3CLpro is a proven drug discovery target in the case of severe acute respiratory syndrome coronavirus (SARS-CoV) and middle east respiratory syndrome coronavirus (MERS-CoV). Recent studies revealed that the genome sequence of SARS-CoV-2 is very similar to that of SARS-CoV. Therefore, herein, we analysed the 3CLpro sequence, constructed its 3D homology model, and screened it against a medicinal plant library containing 32,297 potential anti-viral phytochemicals/traditional Chinese medicinal compounds. Our analyses revealed that the top nine hits might serve as potential anti- SARS-CoV-2 lead molecules for further optimisation and drug development process to combat COVID-19.</p>\n</blockquote>\n<p>However, this latter paper also notes that there are some key differences between the SARS-CoV and SARS-CoV-2 3CL proteases, so compounds that work against one might not be so effective against the other:</p>\n<blockquote>\n<p>results revealed that the SARS-CoV-2 3CLpro receptor-binding pocket conformation resembles that of the SARS-CoV 3CLpro binding pocket and raises the possibility that inhibitors intended for SARS-CoV 3CLpro may also inhibit the activity of SARS-CoV-2 3CLpro.</p>\n<p>To test this hypothesis, we docked (R)-N-(4-(tert-butyl)phenyl)-N-(2-(tert-butylamino)-2-oxo-1-(pyridin-3-yl)ethyl)furan-2-carboxamide), a potential noncovalent inhibitor of SARS-CoV 3CLpro named ML188 [35], with the SARS-CoV-2 3CLpro homology model. We also docked ML188 with the SARS-CoV 3CLpro structure (PDB ID: 3M3V) as a reference, and ML188 bound strongly to the receptor binding site of SARS-CoV 3CLpro. The inhibitor targets the Cys-His catalytic dyad (Cys-145 and His-41) along with the other residues, and the docking score (S = −12.27) was relatively high. However, surprisingly, <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3569073/\" rel=\"noreferrer\">ML188</a> did not show significant binding to the catalytic dyad (Cys-145 and His-41) of SARS-CoV-2, and the docking score (S = −8.31) was considerably lower (Fig. S3).</p>\n</blockquote>\n<p>This paper also investigated (in the theoretical/computational sense) three other drugs of that kind that might work on the SARS-CoV-2 3CL: Nelfinavir, Prulifloxacin and Colistin. <a href=\"https://en.wikipedia.org/wiki/Nelfinavir\" rel=\"noreferrer\">Nelfinavir</a> is also a protease inhibitor used to treat HIV-1 and Wikipedia says it's also being investigated for COVID-19, but I haven't checked the details. Interestingly perhaps, lopinavir is not mentioned at all in this SARS-CoV-2 inhibitor screening study. I couldn't tell you exactly why, but it might be because <a href=\"https://en.wikipedia.org/wiki/Template:Antiretroviral_drug\" rel=\"noreferrer\">there are</a> at least six &quot;1st gen&quot; protease inhibitors used in HIV treatment (and some &quot;2nd gen&quot; ones) so they probably just picked one for this study as representative.</p>\n", "score": 6 } ]

[ "covid-19", "medications", "sars-cov-2", "mechanism-of-action", "antivirals" ]

[ { "answer_id": 22927, "body": "<p>I refer to the American Society of Anesthesiologists </p>\n\n<blockquote>\n <ol>\n <li>Does the anesthesia machine need to be decontaminated after use on a COVID-19 patient? We have HEPA filters in the circuit and the gas sampling line.</li>\n </ol>\n \n <p>Please refer to ASA Guidance that states, “After the case, clean and disinfect high-touch surfaces on the anesthesia machine and anesthesia work area with an EPA-approved hospital disinfectant.” The internal components of the anesthesia machine and breathing system do not need “terminal cleaning” if breathing circuit filters have been used as directed. Please also see guidance from the APSF on decontaminiation. </p>\n</blockquote>\n\n<p>For further information see the American Society of Anesthesiologists <a href=\"https://www.asahq.org/about-asa/governance-and-committees/asa-committees/committee-on-occupational-health/coronavirus/clinical-faqs\" rel=\"noreferrer\">COVID-19 FAQs</a></p>\n", "score": 13 }, { "answer_id": 22926, "body": "<p>This advice is about cleaning of anaesthetic equipment after a Covid-19 patient</p>\n<blockquote>\n<p>Short Answer: Cleaning procedures are the same for all patients if high quality viral filters are used to protect the machine. Discard disposable items – breathing circuit, reservoir bag, patient mask, gas sampling tubing, filters placed at the airway and elsewhere if supply is sufficient. Wipe all exposed surfaces. Manufacturers’ cleaning recommendations are useful for individual devices.</p>\n<p>As noted previously, a high quality viral filter will protect the internal components of the anesthesia machine from contamination. Single use items must be discarded and not used between patients. Practices of using an HMEF and reusing the breathing circuit between patients are not desirable in part because it is virtually impossible to decontaminate the external surfaces of the circuit. Some practices in Europe are reusing circuits by just changing the airway filter after use with patients at low risk for COVID 19 infection. Manufacturers typically have recommendations for cleaning solutions that are safe and effective for cleaning between patients. Usual practices for surface cleaning are acceptable.</p>\n</blockquote>\n<p><a href=\"https://www.apsf.org/faq-on-anesthesia-machine-use-protection-and-decontamination-during-the-covid-19-pandemic/#cleaning\" rel=\"noreferrer\">https://www.apsf.org/faq-on-anesthesia-machine-use-protection-and-decontamination-during-the-covid-19-pandemic/#cleaning</a></p>\n", "score": 5 } ]

[ "infection-control" ]

[ { "answer_id": 24607, "body": "<p>The initial Russian announcement was bluster. From the <a href=\"https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html\" rel=\"noreferrer\">NYT's vaccine tracker</a>:</p>\n<blockquote>\n<p>On Aug. 11, President Vladimir V. Putin announced that a Russian health care regulator had approved the vaccine, renamed Sputnik V, before Phase 3 trials had even begun. Vaccine experts decried the move as risky, and Russia later walked back the announcement, saying that the approval was a “conditional registration certificate,” which would depend on positive results from Phase 3 trials</p>\n</blockquote>\n<p>In other words, the Russian vaccine approval was basically just a statement that &quot;we're starting Phase 3 trials and will use the vaccine if those trials are successful&quot;. Several other vaccine candidates are also in Phase 3 trials, so nothing is particularly special about the Russian progress. Perhaps they will start distributing it before the phase 3 results are in, but that hasn't happened yet.</p>\n", "score": 21 }, { "answer_id": 24604, "body": "<p>Answering my own question since I believe I've found the answer.</p>\n<p>According to <a href=\"https://www.rt.com/russia/497360-russia-first-covid19-vaccine/\" rel=\"noreferrer\">this</a> source,</p>\n<blockquote>\n<p>The senior minister at the department, Mikhail Murashko, announced last week that a nationwide mass vaccination program is planned to begin in October. Murashko added that all expenses will be covered by the government.</p>\n</blockquote>\n<p>Therefore right now (September) the vaccine hasn't been deployed yet, and therefore we should not expect to see a reduction in cases or deaths.</p>\n", "score": 12 }, { "answer_id": 24601, "body": "<p>It is now in the third testing stage, which would end at the start of 2021. Announcing and readiness are quite different things.</p>\n<p>Direct quote from <a href=\"https://www.forbes.com/sites/kenrapoza/2020/08/11/putin-says-russian-covid-19-vaccine-ready-to-go-january-1-2021/#21d5088a15c7\" rel=\"nofollow noreferrer\">Forbes</a>:</p>\n<blockquote>\n<p>Vladimir Putin said on Tuesday that the country registered its vaccine and that after passing phase trials for emergency use <strong>it will be made available by January 1, 2021 for regular patients</strong> if all goes well in final tests.</p>\n</blockquote>\n", "score": 1 }, { "answer_id": 24639, "body": "<p>The answer to this question is: &quot;we don't know&quot;. This is because <strong>COVID-19 statistics reported by Russia may be highly questionable</strong>. This alone makes its interpretation hard, whether or not the vaccine is widely available by the time the data are published. Even by the time the vaccine is distributed widely, and regardless of its effect on COVID-19 statistics, the serious questions about the data will remain.</p>\n<p>Some refer to the COVID-19 statistics currently coming from the official Russian sources as <a href=\"https://www.rferl.org/a/russian-demographer-questioned-government-covid-numbers-fire/30724158.html\" rel=\"nofollow noreferrer\"><strong>&quot;almost completely handcrafted and manipulated&quot;</strong></a>, and having <a href=\"https://www.themoscowtimes.com/2020/08/11/six-months-into-the-coronavirus-outbreak-russias-statistics-still-provide-more-questions-than-answers-a71069\" rel=\"nofollow noreferrer\"><strong>&quot;nothing to do with reality at all&quot;</strong></a></p>\n<p><strong>SEE ALSO:</strong></p>\n<p><a href=\"https://stats.stackexchange.com/q/467704/\">A chart of daily cases of COVID-19 in a Russian region looks suspiciously level to me - is this so from the statistics viewpoint?</a>. The answers note that &quot;[The chart] is decidedly out of the ordinary&quot;, and that other charts from Russia show similar &quot;underdispersion&quot;.</p>\n<p><strong>REFERENCES:</strong></p>\n<blockquote>\n<p>For health demographers like Aleksei Raksha, employed by the state\nstatistics agency Rosstat, something hasn't been right for months, and\nin May, he spoke out publicly: The low death toll wasn't due to a\nsuperior state response, he said, it was due to how coronavirus\nstatistics were being counted.</p>\n<p>In other words, Russia has been misclassifying COVID-19 deaths.</p>\n<p>Two months after speaking out, Raksha received what may be official\nacknowledgment of his contribution to Russia's national discussion\nabout the government's response: He was fired from his job, he said. ...</p>\n<p>&quot;In general, the statistics on the Stopcoronavirus.ru website raise a\nlot of questions, I don't trust them, and it's obvious to any\nspecialist that they've all been drawn, forged, fitted, brushed,\ncropped, aligned and almost completely handcrafted and manipulated,&quot;\nhe said.</p>\n<p>&quot;But we have nothing else, so you need to somehow take [this data],\ndecode it, think it out, and make a guess. Unfortunately, it is very\ndifficult to draw conclusions based on it,&quot; he said. ...</p>\n<p>Rosstat itself has come under fire over the past year, with\nallegations that its otherwise reputable number collection and\nrecord-keeping on many socioeconomic indicators were being manipulated\nfor political purposes.</p>\n</blockquote>\n<p><em>Mark Krutov, Timur Olevsky. &quot;Russian Demographer Questioned Government COVID-19 Numbers. He Was Fired Earlier This Month.&quot; Radio Free Europe/Radio Liberty (RFE/RL). July 13, 2020: <a href=\"https://www.rferl.org/a/russian-demographer-questioned-government-covid-numbers-fire/30724158.html\" rel=\"nofollow noreferrer\">https://www.rferl.org/a/russian-demographer-questioned-government-covid-numbers-fire/30724158.html</a></em></p>\n<hr />\n<blockquote>\n<p>“In many regions, the statistics have nothing to do with reality at\nall,” said Tatiana Mikhailova, a statistician who has been tracking\nthe virus outbreak since the beginning and regularly raises concerns\nabout data. ...</p>\n<p>But Mikhailova told The Moscow Times that the quality is so poor, “it\nmakes no sense to draw medical, virological, or epidemiological\nconclusions from them.” ...</p>\n<p>New more detailed information on deaths being published by regional\nregistry offices — with a significant delay — is now starting to show\njust how wrong Russia’s original fatality count is.</p>\n<p>The data shows that Russia saw 26,360 excess fatalities in May and\nJune, compared with the average death tally over the previous five\nyears, while Russia’s coronavirus task force reported just 9,303\nfatalities from Covid-19 over the same period. ...</p>\n<p>“Essentially all Russian regions are doing their best to artificially\nsuppress the headline death count,” said Mikhail Tamm, a statistician\nat the Higher School of Economics (HSE). ...</p>\n<p>In a policy which runs counter to World Health Organization guidelines\n— which says all deaths related to Covid-19 should be counted as such\n“unless there is a clear alternative cause of death that cannot be\nrelated to Covid-19 disease (e.g. trauma)” — Russian authorities only\ncount deaths assigned to the first two categories [out of four total]\nas specifically resulting from the coronavirus. ...</p>\n<p>The broader interpretation of coronavirus-related deaths would have\nsent Russia’s overall mortality rate at the end of June up from the\n1.4% reported by the task force to 4.2%.</p>\n<p>Once again, in many regions, the discrepancy is significantly starker,\nand further complicates understanding the regional aspects of Russia’s\ncoronavirus spread, which was already showing major discrepancies. ...</p>\n<p>In fact, including all deaths would have more than tripled the\nheadline mortality rates in 19 of the worst-affected regions.</p>\n</blockquote>\n<p><em>Jake Cordell. &quot;Six Months Into the Coronavirus Outbreak, Russia’s Statistics Still Provide More Questions Than Answers.&quot; The Moscow Times. Updated: Aug. 13, 2020: <a href=\"https://www.themoscowtimes.com/2020/08/11/six-months-into-the-coronavirus-outbreak-russias-statistics-still-provide-more-questions-than-answers-a71069\" rel=\"nofollow noreferrer\">https://www.themoscowtimes.com/2020/08/11/six-months-into-the-coronavirus-outbreak-russias-statistics-still-provide-more-questions-than-answers-a71069</a></em></p>\n", "score": 1 }, { "answer_id": 24624, "body": "<p>The other answers have said (correctly) that the vaccine hasn't yet been distributed as it is still in Phase 3 of testing.</p>\n<p>But even if it was distributed, it takes <em><strong>time</strong></em> before the number of cases/day goes down. People that were first infected by SARS-CoV-2 three weeks ago might only have started to develop a fever one week ago, and a confirmed positive test completed today. Therefore today's &quot;cases/day&quot; includes people that were infected 3 weeks ago. To think that a vaccine announced on August 11th would have an impact on the number of cases/day at the beginning of September is a bit extreme (even if it <em><strong>was</strong></em> actually done Phase 3 testing and was deployed to people by now).</p>\n", "score": 0 } ]

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

[ { "answer_id": 24871, "body": "<p>As far as I can tell the most relevant CDC guidelines are the <a href=\"https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html\" rel=\"noreferrer\">&quot;Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance)&quot;</a></p>\n<blockquote>\n<p>Patients with mild to moderate illness who are not severely\nimmunocompromised:</p>\n<ul>\n<li>At least 10 days have passed since symptoms first appeared and</li>\n<li>At least 24 hours have passed since last fever without the use of fever-reducing medications and</li>\n<li>Symptoms (e.g., cough, shortness of breath) have improved</li>\n</ul>\n<p>Note: For patients who are not severely immunocompromised1 and who\nwere asymptomatic throughout their infection, Transmission-Based\nPrecautions may be discontinued when at least 10 days have passed\nsince the date of their first positive viral diagnostic test.</p>\n<p>Patients with severe to critical illness or who are severely\nimmunocompromised1:</p>\n<ul>\n<li>At least 10 days and up to 20 days have passed since symptoms first appeared and</li>\n<li>At least 24 hours have passed since last fever without the use of fever-reducing medications and</li>\n<li>Symptoms (e.g., cough, shortness of breath) have improved</li>\n<li>Consider consultation with infection control experts</li>\n</ul>\n</blockquote>\n<p>The document also notes</p>\n<blockquote>\n<p>A test-based strategy is no longer recommended (except as noted below) because, in the majority of cases, it results in prolonged isolation of patients who continue to shed detectable SARS-CoV-2 RNA but are no longer infectious.</p>\n</blockquote>\n<p>So it appears that a mostly time-based decision is supported by the CDC guidelines. But there are some important conditions here that are not based on the duration of the illness alone, but on the symptoms and the severeness of the illness.</p>\n<p>In the case of Donald Trump we simply don't have all the information that is necessary to apply these guidelines.</p>\n", "score": 9 }, { "answer_id": 24875, "body": "<p>Here is a nice graphic that aggregates data from CDC &amp; WHO that demonstrates the stages of Covid19 progression.</p>\n<p>Notice that the contagious/infectious period tends to begin 3 days after exposure, reaches a peak about 5 or 6 days after exposure and gradually diminishes over the period of 10/11 after initial exposure. By the 16th day after exposure the anticipated infectionness is near zero.</p>\n<p>Note, however the persons may continue to test positive well after infectiousness ends (up to three months).</p>\n<p>As it applies to Trump, we do not know when he was exposed, nor do we know when his last negative test occurred prior to his first positive test. Similarly, we do not know if he has tested negative since returning from Walter Reed (although I would be very surprised if he has had a PCR negative result yet).</p>\n<p><a href=\"https://i.stack.imgur.com/P1vmk.jpg\" rel=\"noreferrer\"><img src=\"https://i.stack.imgur.com/P1vmk.jpg\" alt=\"Link\" /></a></p>\n", "score": 6 } ]

[ "covid-19" ]

[ { "answer_id": 25402, "body": "<p><a href=\"https://elemental.medium.com/every-covid-19-vaccine-question-youll-ever-have-answered-9a0eeb334ded\" rel=\"noreferrer\">An article</a> on Medium had a Q&amp;A with various medical and public policy experts about the vaccine and its rollout. One of the questions was exactly what you asked. The answer is basically &quot;probably not but it might help against SARS and the research could lead to multi-coronavirus vaccines later.&quot; Here is the main part of the response:</p>\n<blockquote>\n<p>“We do not expect any cross-protection against other coronavirus infections since the vaccines trigger an immune response to the SARS-CoV-2 spike protein,” Belongia said. “The immune system sees this as distinct from other human coronaviruses with little or no cross-reactivity. Seasonal coronaviruses cause mild upper respiratory illness, and the focus of vaccine development has been to prevent serious illness due to Covid-19.”</p>\n</blockquote>\n<blockquote>\n<p>But we can’t completely rule out cross-strain protection against a new coronavirus that comes along later, or even SARS-CoV (which causes SARS) if it returns, said Maria Elena Bottazzi, PhD, associate dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of Texas Children’s Hospital Center for Vaccine Development.</p>\n</blockquote>\n<blockquote>\n<p>“There is evidence, for instance, that because of the genetic similarity between SARS-CoV and SARS-CoV-2, antibodies generated from SARS vaccines or SARS-2 vaccines can cross neutralize both viruses,” Bottazzi said. “This provides initial evidence for the development of multivalent vaccines or possibly universal coronavirus vaccines. This will be the new research moving forward.”</p>\n</blockquote>\n<p>Bottazzi's credentials are mentioned there. Belongia's are given elsewhere in the Q&amp;A piece:</p>\n<blockquote>\n<p>Edward Belongia, MD, director of the Center for Clinical Epidemiology &amp; Population Health at Marshfield Clinic Research Institute, Marshfield, Wisconsin</p>\n</blockquote>\n", "score": 8 }, { "answer_id": 25414, "body": "<blockquote>\n<p>Don't all coronaviruses share this same spike protein?</p>\n</blockquote>\n<p>No they don't, although the spikes do share a &quot;shaft&quot; fragment &quot;S2&quot; that is recognized by some anti-bodies across several coronavirues. This cross-reactivity <a href=\"https://www.cidrap.umn.edu/news-perspective/2020/11/prepandemic-coronavirus-antibodies-may-react-covid-19\" rel=\"nofollow noreferrer\">was</a> even in blood samples collected as far back as 2011, but it was at low levels.</p>\n<blockquote>\n<p>Two preliminary retrospective studies in the United Kingdom, sub-Sahara Africa, and the United States suggest that some people who were never infected with the virus that causes COVID-19 have cross-reactive antibodies against it—perhaps from previous exposure to similar human coronaviruses.</p>\n<p>[...]</p>\n<p>the researchers analyzed more than 300 blood samples collected from 2011 to 2018. While almost all samples had antibodies against coronaviruses that cause the common cold, 16 of 302 adults (5.3%) had antibodies that would recognize SARS-CoV-2—regardless of whether they had recently had a cold</p>\n</blockquote>\n<p>And in slightly more technical <a href=\"https://science.sciencemag.org/content/370/6522/1339\" rel=\"nofollow noreferrer\">detail</a>, which explains these findings, a sub-unit of the spike is indeed shared between SARS-CoV-2 and &quot;common cold&quot; coronavirues [hCov], but not all of the spike:</p>\n<blockquote>\n<p>Ng et al. report that in a cohort of 350 SARS-CoV-2–uninfected individuals, a small proportion had circulating immunoglobulin G (IgG) antibodies that could cross-react with the S2 subunit of the SARS-CoV-2 spike protein [...] By contrast, COVID-19 patients generated IgA, IgG, and IgM antibodies that recognized both the S1 and S2 subunits. The anti-S2 antibodies from SARS-CoV-2–uninfected patients showed specific neutralizing activity against both SARS-CoV-2 and SARS-CoV-2 S pseudotypes. A much higher percentage of SARS-CoV-2–uninfected children and adolescents were positive for these antibodies compared with adults. This pattern may be due to the fact that children and adolescents generally have higher hCoV infection rates and a more diverse antibody repertoire, which may explain the age distribution of COVID-19 susceptibility.</p>\n</blockquote>\n<p>(In case you wonder, from the paper's supplementary <a href=\"https://science.sciencemag.org/content/sci/suppl/2020/11/05/science.abe1107.DC1/abe1107-Ng-SM.pdf\" rel=\"nofollow noreferrer\">materials</a>, the <a href=\"https://en.wikipedia.org/wiki/Pseudotyping\" rel=\"nofollow noreferrer\">pseudotyping</a> involved &quot;Lentiviral particles pseudotyped with either SARS-CoV-2 S or Vesicular Stomatitis\nVirus glycoprotein (VSVg)&quot;; the latter was basically the control.)</p>\n<p>Diagrammatically, the S2 unit is the &quot;shaft&quot; (or the &quot;stalk&quot;) of the spike, not its tip (aka &quot;bulbous head&quot;); <a href=\"https://www.nature.com/articles/s41401-020-0485-4\" rel=\"nofollow noreferrer\">shown</a> below for SARS-CoV-2. And it is the tip (S1) that actually provides specificity to the receptor (ACE2 in the case of SARS-CoV-2, but that receptor is also targeted by the original SARS virus, albeit with a spike that is only ~75% similar to the one in SARS-CoV-2, at the genome level).</p>\n<p><a href=\"https://i.stack.imgur.com/IGnu3.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/IGnu3.png\" alt=\"enter image description here\" /></a></p>\n<p><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604128/#sec3title\" rel=\"nofollow noreferrer\">In general</a></p>\n<blockquote>\n<p>Among HCoVs, the S1 subunit varies in length and amino acid sequence, while the S2 subunits share relatively high sequence homology</p>\n</blockquote>\n<p>Another <a href=\"https://www.nature.com/articles/s41598-020-78506-9\" rel=\"nofollow noreferrer\">study</a> published this December even found some cross-reactivity to the S1 &quot;tip&quot; part of the spike between antibodies for HCoV-NL63 (which also targets ACE2 like SARS-CoV1 &amp; 2, although by a spike that is very substantially genetically dissimilar). Again this cross-reactivity was slight (and actually HCoV-OC43 which targets a different receptor with its S1 has somewhat higher cross-reactivity with SARS-CoV-2 on S1):</p>\n<p><a href=\"https://i.stack.imgur.com/qOd7z.png\" rel=\"nofollow noreferrer\"><img src=\"https://i.stack.imgur.com/qOd7z.png\" alt=\"enter image description here\" /></a></p>\n<p>It's even less clear how much protection one can expect &quot;in reverse&quot; i.e. to hCoV while having SARS-CoV-2 antibodies, because this basically was not studied, as far as I can tell... (understandably since the risk of severe disease from &quot;common cold&quot; HCoVs is extremely rare, although <a href=\"https://pubmed.ncbi.nlm.nih.gov/31996093/\" rel=\"nofollow noreferrer\">not totally</a> inexistent.)</p>\n", "score": 3 } ]

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

[ { "answer_id": 30644, "body": "<h3>The numbers are different because the package insert rates are based on two clinical trials while the information on Drugs.com is determined by Cerner Multum, a commercial drug database.</h3>\n<p>Adverse events frequencies reported in the drug prescribing information is typically determined by initial clinical trial data. The table included in your question indicates two studies as the source of these rates.</p>\n<p>However, the very <a href=\"https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/021817s028lbl.pdf\" rel=\"noreferrer\">prescribing information</a> you linked notes:</p>\n<blockquote>\n<p>Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed\nin practice.</p>\n</blockquote>\n<p>Turning to Drugs.com, <a href=\"https://www.drugs.com/support/editorial_policy.html\" rel=\"noreferrer\">editorial policy page</a> says:</p>\n<blockquote>\n<p>The information available on the Drugs.com website is displayed under a number of licensing agreements with various publishers. For our drug-database information, we rely on the solid reputation of our suppliers: <strong>Cerner Multum</strong>, Micromedex and American Society of Health-System Pharmacists.</p>\n</blockquote>\n<p>Indeed at the bottom of the <a href=\"https://www.drugs.com/sfx/reclast-side-effects.html#refs\" rel=\"noreferrer\">Drugs.com zoledronic acid (Reclast) page</a> we find:</p>\n<blockquote>\n<p>References relevant to chosen section (Show all references)</p>\n<ol>\n<li>Cerner Multum, Inc. &quot;UK Summary of Product Characteristics.&quot;</li>\n</ol>\n</blockquote>\n<p>If we review the <a href=\"https://www.drugs.com/mtm/\" rel=\"noreferrer\">informational page about Multum</a> on Drugs.com</p>\n<blockquote>\n<p>Multum's content is written by full-time associates who have no affiliations with drug companies, using a combination of sources. Initial References include the <strong>Product Information/Package Insert, primary literature and information from standards groups such as the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and the American Academy of Pediatrics</strong>.</p>\n<p>Physicians and pharmacists review the new information and make any necessary changes; all leaflets are reviewed by one or more practicing clinical specialists. Content is verified using secondary references that include standard authoritative medical textbooks and the Multum Expert Review Panel.</p>\n</blockquote>\n<p>Cerner itself is the second largest vendor of electronic health record technology in the United States, and so it is also possible that adverse events may be supplemented by information gained by their customers.</p>\n<p>Which source should be considered more reliable is difficult to say and probably opinion based.</p>\n", "score": 5 } ]

[ "medications", "side-effects", "regulatory-agencies" ]

[ { "answer_id": 30623, "body": "<h3>A diagnostic test should never claim 100% sensitivity or specificity.</h3>\n<p>So we are all on the same page, let's review what sensitivity and specificity actually mean. According to the US <a href=\"https://www.fda.gov/regulatory-information/search-fda-guidance-documents/statistical-guidance-reporting-results-studies-evaluating-diagnostic-tests-guidance-industry-and-fda\" rel=\"noreferrer\">Food and Drug Administration</a>, the organization which regulates medical diagnostic testing in the US:</p>\n<blockquote>\n<p>In studies of diagnostic accuracy, the <strong>sensitivity</strong> of the new test is estimated as the proportion of subjects with the target condition in whom the test is positive. Similarly, the <strong>specificity</strong> of the test is estimated as the proportion of subjects without the target condition in whom the test is negative.</p>\n</blockquote>\n<p>As <a href=\"https://www.fda.gov/regulatory-information/search-fda-guidance-documents/statistical-guidance-reporting-results-studies-evaluating-diagnostic-tests-guidance-industry-and-fda\" rel=\"noreferrer\">an FDA guidance document notes</a>:</p>\n<blockquote>\n<p>These are only <strong>estimates</strong> for sensitivity and specificity because they are based on only a subset of subjects from the intended use population; if another subset of subjects were tested (or even the same subjects tested at a different time), then the estimates of sensitivity and specificity would probably be numerically different. ... This type of uncertainty decreases as the number of subjects in the study increases.</p>\n</blockquote>\n<blockquote>\n<p>Sensitivity and specificity estimates (and other estimates of diagnostic performance) can be subject to bias. Biased estimates are systematically too high or too low. Biased sensitivity and specificity estimates will not equal the true sensitivity and specificity, on average. Often the existence, size (magnitude), and direction of the bias cannot be determined. Bias creates inaccurate estimates.</p>\n</blockquote>\n<p>One of the key issues is that of the &quot;reference standard&quot;, that is what actually defines that a tested condition is actually present or absent. The US <a href=\"https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antigen-tests-guidelines.html\" rel=\"noreferrer\">Centers for Disease Control and Prevention</a> notes:</p>\n<blockquote>\n<p>The “gold standard” for clinical diagnostic detection of SARS-CoV-2 remains laboratory-based [nucleic acid amplification tests].</p>\n</blockquote>\n<p>Thus, the definition of sensitivity and specificity for a new nucleic acid amplification test (NAAT) is circular, with the reference standard being another NAAT.</p>\n<p>As <a href=\"https://www.fda.gov/regulatory-information/search-fda-guidance-documents/statistical-guidance-reporting-results-studies-evaluating-diagnostic-tests-guidance-industry-and-fda\" rel=\"noreferrer\">FDA guidance continues</a>:</p>\n<blockquote>\n<p>Two sources of bias that originally motivated the development of this guidance include error in the reference standard and incorporation of results from the test under evaluation to establish the target condition.</p>\n</blockquote>\n<p>These sources of bias and uncertainty are why reputable testing companies don't claim 100% sensitivity or specificity. The reality is that &quot;&gt;99% sensitivity&quot; is also almost certainly overly optimistic and does not incorporate all of the possible sources of bias described in depth by the FDA.</p>\n<p>One final note is that a diagnostic test <em>can</em> have 100% sensitivity if it reports all tests positive or 100% specificity if it reports all tests negative. Obviously, such a test has no clinical utility.</p>\n", "score": 9 } ]

[ "covid-19", "test", "sars-cov-2", "test-results", "pcr" ]

[ { "answer_id": 32170, "body": "<p>You're confusing relative and absolute pressures, which is easy to do because we don't usually specify which is meant, the meaning is implied by context.</p>\n<p>At sea level, atmospheric pressure is around 760 mmHg. If you take &quot;normal&quot; arterial blood pressure to be around 120/80 mmHg and venous pressure to be closer to 5 mmHg, that would suggest an extreme outward pressure on both arteries and veins, where any cut would result in a massive rush of atmospheric gas into the vasculature. Of course that doesn't really happen. Why?</p>\n<p>When you say the venous pressure is 5 mmHg, you mean relative to the outside. Relative to outer space, the pressure of blood is more like 880/840 mmHg in arteries and maybe 765 in the veins. Whether the pressure outside is from atmosphere or atmosphere+water, the pressure described is relative to that outside compression.</p>\n<p>If you go underwater, pressure increases on the outside, but that pressure is also pushing on and compressing all the vessels in the body. There's nowhere for the fluid inside to go, so its pressure relative to outer space increases, but pressure relative to the local outside won't really be any different. Just like in atmosphere, most of the absolute pressure in the veins is not from any sort of muscle tension or compression within the venous system, only the 5 mmHg comes from that - the other 760 mmHg comes from all the weight of the atmosphere, and if you somehow opened a magic portal from the inside of your veins to outer space, yes, in that instantaneous moment blood would come out with a lot of force, and it would come out with even more force if you were deep under water.</p>\n<p>Diving pressure is important for the dissolved gases in blood, though, which are compressible unlike the liquid blood.</p>\n", "score": 12 } ]

[ "cardiology" ]

[ { "answer_id": 214, "body": "<p>RSI refers to Repetitive Stress Injury. You see the word 'repetitive' there? So, it has to come with <strong>anything</strong> that you repeatedly do. No matter wrist, ankle, elbow, knee! </p>\n\n<p>But then, if you think a bit more, the strength we have in our extremities is different from each other. Said that, by nature, legs are stronger than hands. Extending this further, toes are stronger than fingers, knee ...than elbow, and hip joint ...than shoulder. The same goes true in case of foreleg vs forearm, thighs vs biceps and so ankle vs wrist. </p>\n\n<p>I don't say that using ankles won't cause RSI), BUT as compared to wrists, your ankles are a bit stronger so they'll take <em>longer</em> time to get affected. But RSI -repetitive...so doing it again and again won't spare you at all! </p>\n", "score": 8 } ]

[ "computers", "ankle", "ergonomics", "repetitive-strain-injury" ]

[ { "answer_id": 34, "body": "<p>Purely anecdotal, but I've never seen good results from pushing tendinitis (and bursitis, and really any connective tissue inflammation). Decades of (amateur) athletics have taught me that the magic to treating tendinitis is to identify it early and stop aggravating it. </p>\n\n<p>A little bit of tendinitis is a lot easier to work through than a lot of it. </p>\n\n<p>In the <a href=\"https://fitness.stackexchange.com/questions/23662/should-i-squat-with-sore-knees/23666#23666\">\"good vs bad pain\" continuum</a>, tendinitis is very much on the \"bad\" spectrum. In large part this is why proper training spends so much time ensuring that you don't develop overuse injuries (such as tendinitis) since it is so debilitating and can easily sideline progress for weeks.</p>\n", "score": 7 } ]

[ "tendinopathy" ]

[ { "answer_id": 4717, "body": "<blockquote>\n <p><strong>Why are inflammations painful in the case of a tendinitis?</strong></p>\n \n <p>When suffering from tendinitis, does the inflammation itself cause any\n pain, and if so why?</p>\n</blockquote>\n\n<p>Based on the <a href=\"http://patient.info/health/tendonitis-and-tenosynovitis\" rel=\"nofollow\">definition of tendinitis</a> actually meaning <strong>inflammation of a tendon</strong>, what's typically associated with this condition, and the body's immune system response with it stimulating nerve cells and triggering pain, <strong>inflammation can and does cause pain</strong>. </p>\n\n<blockquote>\n <p><a href=\"http://www.mayoclinic.org/diseases-conditions/tendinitis/basics/definition/con-20020309\" rel=\"nofollow\"><strong>Definition ₍₁₎</strong></a></p>\n \n <p>Tendinitis is inflammation or irritation of a tendon — any one of the\n thick fibrous cords that attaches muscle to bone. The condition causes\n pain and tenderness just outside a joint. ₍₁₎</p>\n</blockquote>\n\n<p>When swelling occurs and the immune system responds accordingly, this process can also stimulate nerves and trigger the pain effect so based on this, that is WHY inflammation causes pain with tendinitis or any other condition for this matter with the human body.</p>\n\n<blockquote>\n <p><a href=\"http://www.webmd.com/arthritis/about-inflammation\" rel=\"nofollow\"><strong>WebMD - Inflammation ₍₂₎</strong></a></p>\n \n <p>When inflammation occurs, chemicals from the body's white blood cells\n are released into the blood or affected tissues to protect your body\n from foreign substances. This release of chemicals increases the blood\n flow to the area of injury or infection, and may result in redness and\n warmth. Some of the chemicals cause a leak of fluid into the tissues,\n resulting in swelling. This protective process may stimulate nerves\n and cause pain. ₍₂₎</p>\n</blockquote>\n\n<hr>\n\n<ul>\n<li><a href=\"http://www.mayoclinic.org/diseases-conditions/tendinitis/basics/definition/con-20020309\" rel=\"nofollow\"><strong>Mayo Clinic - Tendinitis Definition(1)</strong></a>\n\n<ul>\n<li><a href=\"http://www.mayoclinic.org/about-this-site/meet-our-medical-editors\" rel=\"nofollow\">Meet the Mayo Clinic Staff</a></li>\n</ul></li>\n<li><a href=\"http://www.webmd.com/arthritis/about-inflammation\" rel=\"nofollow\"><strong>WebMD - Inflammation (2)</strong></a>\n\n<ul>\n<li><a href=\"http://www.webmd.com/about-webmd-policies/about-who-we-are\" rel=\"nofollow\">Meet the WebMD Staff</a></li>\n</ul></li>\n</ul>\n", "score": 4 } ]

[ "tendinitis" ]

[ { "answer_id": 337, "body": "<p>The Apnea-Hypopnea Index (AHI) is a measure of severity in <a href=\"http://www.aasmnet.org/resources/factsheets/sleepapnea.pdf\">obstructive sleep apnea</a>. It is calculated as the number of times per hour that the airway partially or completely collapses, associated with a drop in oxygen levels. Partial collapse is labeled a hypopnea, whereas complete collapse is labeled an apnea. CPAP treatment uses air pressure delivered through a mask to stent open the airway. <em>If there continues to be partial or complete collapse despite CPAP, the basic idea, in theory, is that the pressure is inadequate.</em></p>\n\n<p><strong>The major caveat</strong>: \nWhere are you getting this AHI? Most likely, you’re reading it off a PAP machine. The upshot of this answer is that, as much as we all love numbers, such readings should not be trusted.</p>\n\n<p>The AHI was initially validated in the setting of overnight polysomnography, i.e. a sleep lab. There a technician watches the tracings generated from a nasal pressure transducer, chest/abdomen effort belts, and continuous pulse oximetry. There are specific criteria for scoring apneas and hypopneas. The recommended <a href=\"http://www.aasmnet.org/articles.aspx?id=4203\">criteria from the American Academy of Sleep Medicine</a> for a hypopnea are now:</p>\n\n<blockquote>\n <p>a. The peak signal excursions drop by ≥30% of pre-event baseline using nasal pressure...</p>\n \n <p>b. The duration of the ≥30% drop in signal excursion is ≥10 seconds.</p>\n \n <p>c. There is a ≥3% oxygen desaturation from pre-event baseline and/or the event is associated with an arousal.</p>\n</blockquote>\n\n<p>There has been <strong>a lot</strong> of controversy in recent years as to whether that number in the c criterion should be 3% or 4% drop in pulse oximetry. <strong>Why should we care?</strong> </p>\n\n<p>The number you’re getting off your PAP machine has no pulse oximetry to correlate with. They must therefore be using some <em>other</em> non-standard metric. How do they calculate this? This, unfortunately, is proprietary information known only to the PAP manufacturers. Occasionally there are validation studies of varying quality published, but there is no uniformity in the industry as to what algorithm is used, and there is very little transparency about where these numbers are coming from. </p>\n\n<p><strong>What, then?</strong><br>\nMonitoring of sleep apnea treatment is symptom-based. If symptoms improve, good enough, keep with it. If there is inadequate improvement or recurrence of symptoms after improvement, things should be re-evaluated. Generally this involves one or more of the following: </p>\n\n<ul>\n<li><p>assessing the interface (Is the mask leaking? That will cause inadequate pressure delivered to the airway.)</p></li>\n<li><p>home overnight pulse oximetry </p></li>\n<li><p>adjustment of the settings on an auto-titrating machine to allow for higher pressures </p></li>\n<li><p>empirically increasing the pressure on a fixed-pressure CPAP </p></li>\n<li><p>a repeat sleep study while using PAP, adjusting the pressure settings (i.e. a titration study)</p></li>\n</ul>\n\n<p><strong>Conclusion</strong>: Most likely, in the next few years these technologies will get better, and hopefully transparency and uniformity will improve. In the meantime, take the AHI number on your CPAP machine with a grain of salt.</p>\n\n<hr>\n\n<p>_{\nKryger, Roth, Dement. <em>Principles and Practice of Sleep Medicine.</em> Chapter 107: Positive Airway, Pressure Treatment for Obstructive Sleep Apnea-Hypopnea Syndrome. pp 1219-1232.\n} </p>\n\n<p>_{\nEpstein, LJE, et al. <a href=\"http://www.ncbi.nlm.nih.gov/pubmed/19960649\"><em>Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults.</em></a>. J Clin Sleep Med. 2009 Jun 15;5(3):263-76.\n} </p>\n\n<p>_{\n<em>Caveat lector</em>: In addition to the afore mentioned references, this answer contains my own impressions gleaned from training in the area.\n}</p>\n", "score": 10 }, { "answer_id": 10249, "body": "<p>As a patient, Mayo Clinic physicians have indicated to me, as a patient, that weight loss can improve your position (reduce / eliminate apnea+hypoxia events) and reduce the need and possibly eliminate the need for CPAP therapy. </p>\n", "score": 2 } ]

[ "sleep", "sleep-apnea", "pulmonology" ]

[ { "answer_id": 293, "body": "<p>There is no <em>complete</em> cure for Limited <a href=\"http://en.wikipedia.org/wiki/Scleroderma\" rel=\"nofollow\">Scleroderma</a> (LS). Luckily, there are good ways that doctors can treat the symptoms of it and help prevent any complications.^1,2,3</p>\n\n<ul>\n<li><p><strong>Topical treatments</strong> - one of the complications of LS is skin ulcers; if these become infected, there are some topical treatments to stop them from spreading</p></li>\n<li><p><strong>Antacid drugs</strong> - used to stop some of the heart problems that may come with LS, especially heartburn</p></li>\n<li><p><strong>Other drugs</strong> - doctors may prescribe other drugs to prevent lung problems and other heart problems</p></li>\n<li><p><strong>Physical Therapy</strong> - stiff joints and skin are common problems with LS; physical therapy, mostly stretching, can help to keep your body flexible, including your face</p></li>\n<li><p><strong>Occupational Therapy</strong> - helps overcome any problems that LS patients might have on a daily basis; ie: special toothbrushes and flossing devices help with any dental problems</p></li>\n<li><p><strong>Surgery</strong> - surgery might need to be done to help with some complications, such as calcium deposits under the skin, red spots caused by swollen blood vessels, and possibly amputation of fingertips if and infection causes gangrene (unlikely as infections are usually stopped before they can spread)</p></li>\n</ul>\n\n<p>_{[1] <a href=\"http://www.mayoclinic.org/diseases-conditions/crest-syndrome/basics/treatment/con-20031524\" rel=\"nofollow\">Mayo Clinic</a>}<br>\n_{[2] <a href=\"http://archderm.jamanetwork.com/article.aspx?articleid=478648\" rel=\"nofollow\">JAMA Dermatology</a>}<br>\n_{[3] <a href=\"http://www.sciencedirect.com/science/article/pii/S0190962205046074\" rel=\"nofollow\">A randomized controlled study of low-dose UVA1, medium-dose UVA1, and narrowband UVB phototherapy in the treatment of localized scleroderma </a>}</p>\n", "score": 5 } ]

[ "dermatology" ]